FOCUS Vol. 36.1 Winter 2024
on Pediatrics
Fetching addition to our team
INSIDE
Happy 40th anniversary, Midlands hospital ENT practice expands pediatric procedures Lactation Center opens in Columbia
Focus on Pediatrics is published by Prisma Health Children’s Hospital. Medical editor James Stallworth, MD Editorial, design and production Marketing, Communications and Consumerism Editorial board Nichole Bryant, MD Carl Cromer, MSN, FNP-BC Ann Faulks Jennifer Hudson, MD Robin LaCroix, MD Jonathan Markowitz, MD, MSCE Kelly Melton, MSN, RNC-OB Janine Sally, MS, CCC-SLP Kerry Sease, MD, MPH R. Caughman Taylor, MD Elizabeth Tyson, MD If you would like your name added to or removed from our mailing list or have any comments, questions or suggestions, please send the appropriate information to: Marketing Services Prisma Health 255 Enterprise Blvd. Suite 200 Greenville, SC 29601 864-454-5160
The information contained in the Focus is for educational purposes only – it should not take the place of medical advice or diagnoses made by health care professionals. All facilities and grounds of Prisma Health are tobacco free. “Prisma Health” and Prisma Health symbol design are trademarks of Prisma Health.
© 2024 Prisma Health 24-0571
FROM THE MEDICAL DIRECTORS
Pediatric subspecialty challenges Census data indicates that South Carolina has gained 3.2% in population since 2020, making it fifth in the nation for percentage of population growth from 2020–22. Twenty-one percent of this growth is children under 18 years of age, which equates to just over 1 million – about the population of Delaware – needing health care! Plus, estimates show that more than 22% of children in the state have special health needs. This population growth, combined with more premature infants, increased life expectancy for many life-limiting illnesses along with new options and therapy, requires additional subspecialty care. However, the rate at which some subspecialties has grown continues to create long commutes and wait times and, in some cases, may mean receiving care from providers without subspecialty training. Overall, most subspecialties have not grown at the same rate as the population: Nationwide, for example, only 23 child abuse, 26 developmental– behavioral, 27 rheumatology and 33 nephrology fellows began training last year. A root cause of these shortages is that more training is required to be a subspecialist – and with less net career earnings in 12 of 15 analyzed subspecialties in comparison to primary care pediatricians. That means paying off medical school debt can make subspecialties less desirable. To recruit and retain subspecialists, Prisma Health works hard to garner philanthropic support, improve reimbursements that cover costs, use extender services when appropriate, and maximize efficiencies around referrals and patient care.
How can you help? Please ensure referrals are complete. Urge patients to keep or cancel appointments in a timely manner; we face no-show rates above 15% in many areas. We are actively working to enhance referral processes so that children who most urgently need subspeciality care can be triaged to earlier appointments. We are also offering educational sessions to make primary care providers better equipped to address the more complex aspects of care for conditions such as refractory constipation, disrupted sleep and ADHD. Prisma Health Children’s Hospitals are fortunate in that their geographic location and satellite sites allow subspecialty care to be brought into closer proximity to the communities we serve. Furthermore, close collaboration between our two hospitals helps subspecialists coordinate care and services. Such collaboration has brought much-needed care to more of the Palmetto State and allows subspecialists to expand the number and locations in which they deliver this care.
Robin N. LaCroix, MD, Chair, Department of Pediatrics, Prisma Health Children’s Hospital–Upstate
R. Caughman Taylor, MD Chair, Department of Pediatrics, Prisma Health Children’s Hospital—Midlands
CONTENTS
Inspire health. Serve with compassion. Be the difference.
2
Mom expresses her gratitude for NICU team.
Special milestone
4
Midlands hospital marks 40th anniversary!
Inspire Campaign underway
6
Funding will build new cancer and blood disorders unit.
2
Departments What’s new?
8
National summit, Lactation Center, PICU renovations and more
Feature story
13
Now (h)ear this: ENT practice delivers complex care
Program update
16
RESET a life-changer for patient
Collaborating for better care
20
Columbia museum exhibit, Carolinas Collaborative report
Clinical case report
22
4
Can you solve this mystery?
Medical Staff spotlight
23
Meet new members of our clinical team, Q&A with chaplains
Academic news
28
’Tis the season for grants
Quality counts
31
Improving vaccine rates in vulnerable populations
Leadership profile
33
Get to know Drs. Moroski, Shirley and Williams
Bulletin from the Bradshaw Institute
16
35
A summary of FY23 accomplishments
In the community
36
Holiday cheer
Celebrations
38
Philanthropic news
Extra treat
40
Halloween highlights
Phone directory
41
A handy guide for both Children’s Hospitals
On the cover: (l–r) Duke and Mirabel are the inaugural facility dogs at Children’s Hospital in the Midlands.
28
CONNECT TO PURPOSE
Mom shares gratitude for NICU team To the NICU 1 nurses: You saw us at our absolute worst and loved us better than you will ever know. You gave us strength, courage, hope and confidence. You somehow managed to make a scary place a joyful place. Thank you for every bottle you brought me, every pillow you found for me, every light you turned off, every word of advice you provided and every smile you gave. To the NICU 2 nurses: Thank you for teaching me how to treat my little girl like a big girl. Thank you for helping her get off the oxygen support, for teaching us how to feed her, bathe her, take her temperature, swaddle her and start the transition to home. Your constant care allowed me to go back to work so that I could save my maternity leave for when she came home. To the NPs: Thank you for your calming presence, for being our constant as we transitioned between the NICUs, for always patiently answering all my questions and helping me to process tough information. Your expertise gave me so much confidence in the unknown. You all helped me and my husband just as much as you helped Lucy. Thank you for helping us navigate the scary and uncertain road.
Lucy enjoys downtime at home, having spent more than two months in the Bryan NICU.
Baby Lucy spent nearly 10 weeks in Prisma Health’s B.K. Bryan NICU in Greenville after she was born at just 28 weeks’ gestation. Her mom, Mandi Segale, says that those two months were among the hardest days her family ever faced, but she can look back on that time with joy because of the amazing care she and her daughter received. Seven weeks after Lucy was discharged from the 80-bed unit, Mandi wrote to the Children’s Hospital NICU team on behalf of her grateful family. Here are excerpts from her letter showing how this team brought Prisma Health’s purpose to life: Inspire health. Serve with compassion. Be the difference. 2
To the therapy team: Thank you, thank you, thank you, for answering all my questions (even when I asked the same one 10 times)! I am certain that your work with her will play a large part in her developing fully and living a full life. Thank you for always encouraging me and helping me know how to push Lucy. Emily Kimble, Kari Mello, Grace Ellis – you all are amazing! To the cleaning staff: Thank you for always greeting me with a smile, for keeping Lucy’s room clean and playing a big role in keeping her infection-free. I hope you know how grateful we are for your diligence and devotion to keeping a clean environment. To the front desk staff: Thank you for always buzzing me in and for taking my calls when I wasn’t able to be there. Thanks for always greeting me with a smile – it made entering a scary place a little easier.
To Abby Rishovd: You were the first person to sit and talk with me and Eric on the scariest day of our life. Thank you for allowing us so much time to talk through all our concerns, fears and hopes. You are an incredible listener. Thank you for your genuine concern, authentic approach and caring heart. You pulled us out of some of our darkest times. To Rachel Balck: Thank you for always knowing when to show up. Thank you for the stories of hope, for the words of wisdom, and for every sweet and thoughtful surcee, book, craft and conversation. You were our constant angel from the very beginning. We wouldn’t have made it through the tough days without you. To every doctor: Thank you for being the brilliant healers that you are. Dr. Michael Stewart, your words on the night Lucy was born were exactly what I needed to hear. Thank you for telling me that I saved Lucy’s life – you took away my guilt. You also told me that the journey would be hard and that we would be overwhelmed at points, but not to worry because you and your team weren’t overwhelmed, that this was your normal. Dr. Bryan Ohning, thank you for “pulling out all the tricks” to save Lucy’s life. I know she is still here because of you. You will forever hold a special place in my heart, and thanks for always bringing a little humor to the floor! Dr. Benton Cofer, thank you for delivering tough news with such grace, tact and kindness. You shared the news of the brain bleed and PVL and did it with such tenderness. Thank you for never making me feel rushed or unimportant.
Lucy and family are all smiles at the lake.
“I tell people daily just how amazing the Greenville NICU is.” –Mandi Segale
Dr. Nicole Cothran, thank you for welcoming us into NICU 2, for always pushing our girl and for celebrating all her milestones. I know you are a huge part in why she beat some odds. Dr. Jeff Ruggieri, thank you for giving us the good news that we got to go home and for having the confidence in Lucy and us to break out of there!
Every single one of you made our journey a little bit easier. We love all of you and can’t wait to tell Lucy, as she grows, about all the heroes and angels in her life.
Editor’s note: We are happy to report that Lucy is doing well and turned 1 in February.
Brother Leo with Lucy shortly after she arrived home for good.
3
SPECIAL MILESTONE
Children’s Hospital celebrates the big 4-0 On Sept. 28, 2023, Prisma Health Children’s Hospital in Columbia celebrated a milestone as the state’s first children’s hospital. “Today we’re celebrating that legacy of 40 years of serving our community, serving children and how much we’ve grown,” said Caughman Taylor, M.D. A first-year resident when the hospital opened in 1983, Dr. Taylor now heads the Children’s Hospital. “When we were created, we only had a few pediatric subspecialties,” he said. “We did have a small NICU, and we’ve grown to be a regional perinatal center for children. We’ve grown to be a pediatric trauma center, a cancer center, a neurology center of excellence.” Dr. Taylor noted how the original leaders of Children’s Hospital visited Vanderbilt University to learn how to start a hospital and then slowly began building programs with foundation and system money.
“The spirit that’s here in the staff and in the pediatric community has made that possible, because they truly believe it’s a privilege and an honor to take care of children and provide them the very best care,” he added. Thanks to that commitment, the hospital has twice been named “Top Children’s Hospital of the Month” in the past five years by the National Solutions for Patients Safety Network, which consists of 140+ U.S. children’s hospitals. Dr. Taylor said they are now addressing socio-economic determinants of health as well, such as food security, transportation and living conditions through community programs and medical-legal partnerships: “We’re not only the leading edge of care, but we’re also sometimes the only option, so we take that responsibility very deeply.” He concluded by saying, “I have the best job in the world. I get to help take care of kids and work with such great people here who are so dedicated to taking care of children. They don’t see it as a job; they see it as a mission. They see it as something very important, and that makes every day a great day.”
Here’s a look at some of the changes that have occurred since 1983:
4
Then
Now
10 pediatric subspecialists
125+ subspecialists
12-bed NICU
69-bed NICU
40 inpatient beds
120 inpatient beds
12,000 children served
166,000 children served
Hospital within a hospital
Freestanding hospital
Columbia location only
Columbia and Sumter inpatient care
“We believe it’s an honor and privilege to take care of children, and that means the obligation to be the best we can be.” – Dr. Taylor
5
LEAD STORY
‘Inspire Courage’ campaign kicks off Funding to build new cancer and blood disorders unit
Drs. Aniket Saha and Nichole Bryant display renderings for their unit’s renovation. With them is Amy Bowers, continuum of care manager.
Prisma Health Children’s Hospital in Greenville launched a fundraising campaign in September to raise $6 million for a new pediatric cancer and blood disorders unit. The unit will combine “whole family care” with exceptional clinical expertise and provide more treatment space for children and adolescents with cancer, blood disorders and sickle cell disease.
Children’s Hospital Medical Director Robin LaCroix, MD, said, “Hogs for the Cause’s visionary $1 million gift serves as an inspiring example of how private philanthropy can transform health care and bring hope to countless families in need. This gift is a testament to the remarkable generosity and dedication of the Hogs for Cause organization and its CEO, Becker Hall.”
Hogs for the Cause, a nonprofit barbecue competition and festival based in New Orleans, and with significant ties to South Carolina, kicked off the capital campaign with a gift of $1 million.
“Today, we fulfill a dream that continues to grow greater than we could have imagined,” said Hall. “This stateof-the-art pediatric oncology and hematology unit will have a massive impact for families here and in
Children’s Hospital in the Upstate sees 50–75 new cases of children with cancer every year. 6
neighboring states. We are extremely proud to partner with Prisma Health and with the barbecue restaurants here helping support this phenomenal project.” Construction on the 7,580-square-foot unit on Greenville Memorial campus – to be named the Prisma Health Children’s Hospital–Upstate Hogs for the Cause Pediatric Hematology-Oncology Unit in honor of the lead gift – is set to begin in early 2024 and take approximately two years to complete. “I’m thrilled that we can take this next leap forward by creating a space that is literally custom-built for and by families,” said Aniket Saha, MD, the unit’s medical director. “This specially designed space will better blend family care with clinical care, helping reduce stress and offer a positive healing environment that nourishes the mind, body and soul.”
“Teaming up with our friends at Home Team BBQ to increase our impact in the community has certainly been a life-changing experience,” said Anthony DiBernardo, pitmaster and owner of Swig & Swine. Home Team BBQ’s pitmaster and owner Aaron Siegel added, “Having a restaurant here in Greenville makes this project even more personal and tangible for us. We were incredibly moved by this need and wanted to help.”
Below are renderings of the hallway and patient rooms.
The expanded unit will include: • Nine inpatient rooms • Day-stay room with two infusion chairs for children needing daylong transfusions • Special two-room suite for families in end-of-life situations • Family-suggested design elements: - In-room desks for parents - Respite space - Expanded playroom
Roots run deep Hogs for the Cause began as a pig roast in 2009 when CEO and co-founder Becker Hall returned home to New Orleans after graduating from the University of South Carolina. The roast raised money for a young boy with pediatric brain cancer. It has now grown into one of the country’s most highly acclaimed barbeque competitions and music festival. Festival funds allow the organization to help thousands of families through direct grants and funding programs at children’s hospitals across the Southeast. S.C. restaurants taking part include Home Team BBQ – with eateries in Charleston, Greenville and Columbia – and Swig & Swine in the Lowcountry. Over the last two years, the two festivals have donated more than $250,000 to Hogs for the Cause.
$4.2 million has already been raised for this new space.
If you would like to help Inspire Courage, visit www.PrismaHealthUpstateGiving.org/InspireCourage.
7
W H AT ’ S N E W ?
Conference goes to the dogs Dog handlers from across the country came to Greenville last October for the National Facility Dog Summit, a twoday event organized by Prisma Health to learn about new and creative ways to incorporate specially trained canines into goal-based health care.
at Children’s Hospital; and Cookie works at Outpatient Specialty Clinics in developmental pediatrics and Child Life on the system’s Patewood campus. Bo works with children and adults in orthotics. In October, the facility dog program expanded to the Midlands (see next page).
Attendees – including physicians, physical therapists, social workers, recreational therapists and Child Life specialists – shared innovations in their programs, how to start a program and challenges that dog handlers face.
Facility vs. pet therapy dogs
The conference was organized by Taylor Stathes, manager of Child Life and Special Programs, and Erin Shaffer, Child Life specialist and primary facility dog handler, both at Children’s Hospital–Upstate. The Canine F.E.T.C.H. Unit started in the Upstate in 2016 with two dogs. (F.E.T.C.H. stands for Friends Encouraging Therapeutic Coping and Healing). This Prisma Health program now has seven working dogs in Greenville, five of whom work with children: Becky (preop surgery and whose handler is Shaffer); Kalle (inpatient) and King (inpatient and pediatric palliative care) are based
Many people confuse facility dogs with Pet Therapy program dogs. Facility dogs are service animals trained in goal-based interventions alongside a specialty such as palliative care, developmental pediatrics or surgery. They can be present during a procedure, help demonstrate various treatments or processes, or help calm a patient before surgery. Facility dogs are sponsored by the hospital, philanthropically funded and live with a Prisma Health handler. “People always see the glamorous side of it – you get to bring your dog to work,” said Shaffer. “But people don’t understand the connection between our role and our dog’s role. The dogs are teaching tools. We think about goals when we create a patient care plan and determine how best to use the dog.” In contrast, she said: “A pet therapy dog is typically someone’s pet that goes through a short-term training process. They come in once or twice a week to do brief visits with patients to provide a little sunshine or pick-meup.” Shaffer added that pet therapy dogs are not employed by a facility but are scheduled through Volunteer Services. “We have to be mindful of how much work we give to our facility dogs,” Shaffer cautioned. “They’re taking on a lot of emotions and interactions. We can’t meet all those needs, so our Pet Therapy program is an important part of our interventions.” To learn about the formal application process involved in securing a facility dog, contact Christy Fink (Midlands) or Taylor Stathes (Upstate), managers of Child Life and Special Programs. To donate to the Canine F.E.T.C.H. Unit, please go to https://www.prismahealthupstategiving.org/fetch/.
Excited attendees entered on two and on four feet.
8
Facility dog program expands pawprint
Canines embark on new calling in Columbia Meet Duke and Mirabel, the Midlands’ newest four-legged teammates. Mirabel (l–r) is accompanied by co-handlers Becca Kelly and Ashley Fisher, while Duke is co-handled by Christy Fink and Jordan Parker. Kelly is a music therapist, and Child Life Specialist Fisher “floats” to various areas; Child Life Specialist Parker is stationed in the PICU. Fink is the manager of Child Life and Special Programs as well as the coordinator for our new Midlands’ Paws for Peds Facility Dog program. Duke is a goldendoodle born in August 2022 who loves loud squeaking objects and playing outside. Mirabel, a golden retriever born in March 2022, enjoys walks, chewing sticks and anything that crinkles. Their arrival was made possible by a $50,000 gift from the Michael J.
Mungo Foundation, but ongoing donor support will be vital in growing and sustaining the program. “We know facility dogs can provide important medical benefits,” said Stewart Mungo, chairman of the Michael J. Mungo Foundation. “We also know they can provide a child with confidence, security and general well-being, not to mention the simple joy and healing touch they bring to young patients.” During the dogs’ “Welcome Paw-ty” in December, the Mungo family surprised the Foundation and Children’s Hospital with an additional $50,000 donation.
To learn more or make a donation, click here!
Facility dogs – proven to help patients feel more comfortable, relaxed and motivated – are an integral part of the patient care plan. 9
Lactation Center opens in Columbia The Lactation Center at Prisma Health Richland Hospital, which opened last August, helps ensure a seamless transition from hospital to home for breastfeeding moms and their newborns. Note that moms do not have to deliver at Richland Hospital to take advantage of these services, most of which are covered by insurance. “We are excited to offer lactation services for our patients and our community,” said Kelly Melton, MSN, RNC-OB, executive director for Women’s & Children’s Services at the hospital. “We became aware of this need from both our providers and our caregivers. I am grateful that our lactation team and physician champions came together to make this dream a reality. Our campus has never had a dedicated space for lactation, and we couldn’t be more pleased with the new location.” Center staff include internationally board-certified lactation consultants (IBCLC). No referral is needed, but appointments are required as consults with IBCLCs last about two hours. During that time, an initial assessment is made, followed by weighing the baby, then evaluating the mother as she feeds her newborn and then weighing the child again. The center includes two lactation consult rooms and is conveniently located on the first floor (formerly the gift shop). Designated parking is also available nearby. Once inside, moms can feel at home in this warm, nurturing environment. Special breastfeeding recliners, low lighting and a handwashing station provide the perfect atmosphere to relax and embrace teaching moments.
Support for baby Multiple factors may affect a newborn’s ability to coordinate suck-swallow-breathe actions, such as: • Latch issues • Sleepiness/arousal • Inability to suck • Respiration • Oropharyngeal skills • Anatomical structures Sometimes, the cause is obvious, but oftentimes not. That’s when IBCLCs can refer the baby to occupational therapists, led by a board-certified feeding specialist, to help identify and correct many newborn feeding issues. In addition, therapists can help with these conditions: • Cranial facial anomalies (cleft lip, cleft palate, micrognathia) • Torticollis • Shoulder dystocia • Erb’s palsy • Clavicle fractures • Neonatal abstinence syndrome
To schedule an appointment To make an appointment or learn more about center services, call 803-434-5618. The center is open weekdays from 8 a.m.–4:30 p.m. Visits outside these hours can be arranged as needed.
Support for moms Many new mothers do not realize that breastfeeding is a skill that they and their baby must learn together. IBCLCs provide one-on-one sessions that offer handson assistance, expert help and individualized planning to speed this learning process. Common issues they address with breastfeeding moms include: • Complications with latch • Sore nipples • Milk supply issues • Breast engorgement • Collection and storage of breast milk • Follow up for preterm feeding difficulties
IBCLCs Rachel Rosen and Jacquelyn Garcia flank patients Lauren Apple and son Gordon. The Apples were the first to visit the Lactation Center.
“This is another initiative by our Children’s Hospital to promote breastfeeding of infants. We know that breastfeeding helps infants to get off to a good start, and we hope our new Lactation Center will assist new mothers and pediatricians in those efforts.” – Caughman Taylor, MD, chair of Pediatrics 10
Shain, committed to offering a calming experience during challenging health journeys through art, expressed her dedication to the project: “Art has a unique ability to soothe and inspire, especially in the face of adversity. I am honored to contribute to this project, knowing that my artwork can bring a sense of calm and positivity to the lives of these young patients and their families.”
The Ridgell Family presented $100,000 as part of the PICU construction campaign. (l–r) Daniel Ridgell, Holly and Don Ridgell, Kenny and Hillary Ridgell, and Robin LaCroix, MD, Pediatrics chair in the Upstate.
PICU renovations complete
Robin LaCroix, MD, medical director of the Upstate hospital, expressed her gratitude for all donors, saying, “The support of the Ridgell family, Clemson Miracle and community philanthropists was instrumental in making this exceptional facility a reality. We look forward to continuing our mission of providing high-tech care in a high-touch, family-centered environment that serves the unique health care needs of our young patients.”
Prisma Health Children’s Hospital in the Upstate has completed a $3.7 million renovation of its pediatric ICU. Funding came from anonymous donors, Clemson Miracle and local philanthropists, including a $100,000 multigenerational gift from the Ridgell family. Kenny Ridgell said, “We believe in the power of community and the importance of coming together to support our most vulnerable. Prisma Health Children’s Hospital–Upstate is an essential part of our community, and we are honored to contribute to this new PICU, ensuring that children in need receive the best care possible. We hope this gift from our family will make a difference in the lives of countless families.” Board-certified pediatric critical care doctors, pediatric resident physicians and PICU nurses staff the unit 24/7. In addition, a child life specialist helps patients and their families cope with procedures and therapeutic activities they may experience during their stay.
PICU hallway
PRISMA HEALTH GMH PICU RENOVATION April 12, 2022
PRISMA HEALTH GMH PICU RENOVATION April 12, 2022
Conceptual Rendering Nurse Station & Corridor
Conceptual Rendering Family Lounge
Family Lounge
PICU room
The PICU also features a transport team capable of swiftly bringing critically ill children within a radius of 50 miles to Greenville. This team includes paramedics, respiratory therapists, pediatric intensivists and critical care nurses who travel by helicopter or ambulance, all while delivering care throughout the journey. PRISMA HEALTH
Offering a healing environment Healing is promoted in many ways. With its emphasis on active family involvement to help a critically ill child recover, the PICU offers unlimited visiting hours for parents and encourages them to spend the night. In addition, the unit’s design was carefully constructed to provide a healing environment. Prisma Health’s facilities team, in collaboration with architect firm McMillan, Pazdan and Smith, ensured the selection of soothing colors and child-friendly materials. Plus, special artwork was donated by local artist Dorothy Shain.
GMH PICU RENOVATION April 12, 2022
Conceptual Rendering Patient Room Headwall
Painter Dorothy Shain stands beside one of 17 original artworks she contributed to the PICU.
11
#ClearTheCrib challenge focuses on safe sleep As part of its HealthySteps program, Prisma Health Pediatrics–Powdersville completed the #ClearTheCrib challenge to highlight Safe Sleep Awareness Month. “This was our first year, so we completed the challenge with team members,” said Shannon Rogers, a HealthySteps specialist in the office. “The setup did spark many conversations with parents, though. We even had a few young students who were able to tell us what needed to happen to make our test setup a safe sleep environment!” Rogers said the challenge was to remove items from a playard to make the area a safe sleep space – in 10 seconds: “A safe sleep space would be a tight-fitted sheet and only the baby and pacifier, if needed, with no strap. So basically, everything except the sheet and baby needed to be removed.” (See photo.) Pediatrics–Powdersville is the system’s only medical office with a HealthySteps program, designed to provide child development, behavioral and parenting assistance to families, especially those in low-income communities, where they are most likely to access it – the pediatric primary care office.
This playard contains many safe sleep hazards.
The office received “Sleep Baby Safe and Snug” board books, in English and Spanish, from Charlie’s Kids, an advocacy group founded by a couple who lost their son because of unsafe sleeping practices.
Approximately 3,500 infants die annually in the U.S. from unsafe sleep practices.
New practice debuts in Greenville Prisma Health opened a new pediatrics practice Sept. 18 in the Prisma Health Verdae Boulevard complex. Prisma Health Pediatrics–Verdae offers expanded access to same-day sick care for children newborn to 18 years for Prisma Health pediatric primary care locations that have no available same-day sick appointments. The practice will also accept new primary care patients over 4 years of age. Visits are by appointment and can be accessed via MyChart, scheduled from a primary care pediatric office or by calling 864-522-6600. Primary doctors at this location are Andrew Gunter, MD; Hannah Kline, MD; and Frederick Suhrstedt III, MD, with additional providers available for evening visits.
12
Prisma Health Pediatrics–Verdae 905 Verdae Blvd., Suite 102, Greenville 29607 Hours: Monday–Friday, 9 a.m.–9 p.m.; Saturday and Sunday, noon–6 p.m.
F E AT U R E S TO RY
Caring for ENT concerns – simple to complex Prisma Health Ear, Nose and Throat at 200 Patewood Drive, Suite B400, on Greenville’s Patewood campus, now includes pediatric ENT surgeons specially trained to address a wide array of ear, nose and throat problems in children.
2. Zelda Gosnell underwent an emergency tracheostomy in the NICU because of a severely obstructed airway. Thanks to airway reconstruction (see before and after photos) performed by Edward Penn Jr., MD, and Nathan Alexander, MD, this lively 3-year-old is shown breathing easy and all smiles in her hospital bed.
The team performs a variety of procedures, including ear tube placement, tonsillectomy, cochlear implantation, neck mass excision, cleft repair, sinus surgery and airway reconstruction. Using a multidisciplinary approach, they work closely with other subspecialists from Prisma Health Children’s Hospital to provide specialized treatments based on each patient’s needs. This team is among a select number of Upstate otolaryngologists who care for the more complex ENT conditions affecting children. Here are four examples. 1. This 2-year-old had a benign skull base dermoid cyst/ tumor. He presented with a lateral orbital wall fistula associated with a soft tissue infection (see below). (A) CT reveals a lucent osseous defect with sclerotic margins and a narrow transition zone extending through the right greater wing of the sphenoid consistent with an intradiploic dermoid cyst. (B) MRI shows a dumbbell-shaped sinus tract extending from the skin surface to the right middle fossa abutting temporal lobe dura.
8.2.22
8.21.23 Before
Removal required a specialized approach through the lateral aspect of the orbit from the middle fossa dura, a procedure performed by Gustavo Rangel, MD. A
8.2.22
B
8.21.23 After
13
Conditions treated Airway • Tracheostomy (neonatal and pediatric) • Subglottic stenosis • Airway reconstruction • Laryngomalacia • Obstructive sleep apnea • Swallowing and feeding problems • Laryngeal cleft • Stridor • Nasal obstruction • Choanal atresia • Communication disorders (velopharyngeal dysfunction, articulation disorder) • Lip and tongue tie • Pyriform aperture stenosis • Tonsillar hypertrophy/obstruction in the pediatric and very young population • Lingual tonsil hypertrophy and epiglottic obstruction in persistent OSA • Nasal obstruction • Drooling Ear • Hearing loss, speech delay • Eustachian tube dysfunction • Bone conduction devices (surgical and nonsurgical) • Cochlear implantation • Tympanic membrane perforation • Cholesteatoma • Chronic mastoiditis Neck • Neck masses (benign and malignant) • Hemangioma • Vascular and lymphatic malformation • Thyroglossal and branchial cleft cysts • Cervical cleft • Tracheoesophageal fistula • Salivary gland masses • Thyroid nodules
3. Now 1.5 years old, this young girl has a history of Stickler syndrome, cleft palate and retrognathia. Born with a recessed jaw (see image) that caused her tongue to interrupt the closure of her soft palate, she underwent mandibular distraction – a service that was not previously available at Prisma Health before the arrival of Travis Reeves, MD. She did well with the advancement and now her jaw sits in a better position, allowing her to breathe and swallow with less obstruction. More recently, she has undergone cleft palate repair and is healing well.
4. Born in May 2022, Anderson Grace Caldwell is the daughter of a pediatric ICU nurse at Prisma Health. Diagnosed early in life with bilateral hearing loss, Caldwell was referred for genetic testing and an ophthalmologic evaluation; she was found to have Usher’s syndrome as the cause for her hearing loss. In January 2023, she underwent bilateral cochlear implantation by Dr. Alexander and has done wonderfully since that time. Because she is at risk for vision decline, access to sound at an early age was crucial.
Sinus/Skull base/Cleft • Nasal masses • Chronic sinus disease • Cleft lip and palate • Neonatal mandibular distraction/advancement • Cleft lip and palate • Skull base tumors, benign and malignant • CSF leaks
Since her cochlear implant, Andie Grace has been delighted by making – and, more important, hearing – music. Click the arrow to watch Andie Grace enjoying the sounds emanating from her birthday gift.
14
Meet our pediatric specialists Nathan Alexander, MD, received his medical degree from Louisiana State University in Shreveport. Dr. Alexander then completed a residency in otolaryngology–head and neck surgery at University of Alabama at Birmingham followed by a fellowship in pediatric otolaryngology at Ann and Robert H. Lurie Children’s Hospital/Northwestern University in Chicago. He has worked at what is now Prisma Health for 10 years. Special interests cover all aspects of pediatric otolaryngology including airway obstruction and obstructive sleep apnea, hearing loss and cochlear implants, pediatric sinus disease, and head and neck masses. He has received subspecialty certification in complex pediatric otolaryngology. Edward Penn Jr., MD, completed his medical training and a residency in otolaryngology, head and neck surgery at University of Kansas School of Medicine in Kansas City. Dr. Penn then completed a fellowship in pediatric otolaryngology at Ann and Robert H. Lurie Children’s Hospital/Northwestern University in Chicago. He was then on staff at Vanderbilt Children’s Hospital for five years. He has worked at Prisma Health for six years. Special interests include pediatric airway issues, swallowing disorders, and congenital head and neck and vascular malformations. He has received subspecialty certification in complex pediatric otolaryngology. Travis Reeves, MD, received his medical degree from Duke University. Dr. Reeves then completed a residency in otolaryngology–head and neck surgery at Medical University of South Carolina in Charleston followed by a fellowship in pediatric otolaryngology at University of Minnesota. Before joining Prisma Health in 2022, he was on staff at Children’s Hospital of the Kings Daughters in Norfolk, Virginia, for five years and then at Virginia Tech–Carilion Clinic in Roanoke for four years. Special interests include all aspects of general pediatric ENT (hearing loss, ear infections, snoring, enlarged tonsils), head and neck masses/tumors, and cleft/craniofacial surgery. Gustavo Rangel, MD, joined the health system in 2021. Dr. Rangel obtained his medical degree from Universidade Federal Rio de Janeiro in Brazil before completing a residency in otolaryngology-head and neck surgery at the Hospital of Federal Servants. Afterward, he pursued fellowships at Nationwide Children’s Hospital and Ohio State University Wexner Medical Center in Columbus and St. Jude Research Children’s Hospital in Memphis, Tennessee. Special interests include pediatric skull base lesions, pediatric head and neck cancer, and pediatric thyroid cancer.
Hughes
Pettit
Chamberlain
Cappelmann
Other providers: The practice has had a dedicated pediatric ENT PA-C, Kelly Hughes, since 2014, and a new NP, Ally Pettit. Dedicated pediatric audiologists are Emily Chamberlain and Sarah Cappelmann. Several other clinicians in the office treat both adults and children.
If you would like a consult or have questions, please call 864-454-4368 or fax 864-454-4348.
15
P R O G R A M U P D AT E
RESET reaping results RESET stands for Restorative Self-management Training and Functional Rehabilitation.
Editor’s note: This new program was highlighted previously. Kate Gamwell, PhD, director of Pediatric Pain Psychology and Rehabilitation at Prisma Health Children’s Hospital in the Upstate and an assistant professor in Pediatrics at the University of South Carolina School of Medicine Greenville, shares a success story from a grateful teen.
Program background One in four youth will be diagnosed with a chronic pain condition prior to adulthood, with prevalence rates on the rise (King et al., 2011). Chronic pain associated with functional disabilities in youth may result in difficulty completing activities of daily life; significant school/ work absences; inability to take part in leisure, social or extracurricular events; high health care use; and feelings of hopelessness. In those with moderate to severe pain-related disabilities, the annual economic burden exceeds $19 billion (Groenewald, Essner, Wright, Fesinmeye, Palermo, 2014). Left untreated, these youth are at increased risk of worsening mental and physical health symptoms, seeking or ending up on disability, and using opioids. Despite the prevalence of and detrimental outcomes associated with chronic pain, there is a lack of multi/ interdisciplinary pediatric pain programs in the nation. RESET fills this gap as the Southeast’s only inpatient intensive interdisciplinary pediatric pain (IIPT) rehab program. For patients who have undergone multiple outpatient treatment efforts (such as PT, OT or pain medication) for three months without significant gains, IIPT may be warranted. The program is intense, so patients are expected to have some quantifiable baseline coping strategies prior to admission at Prisma Health’s Roger C. Peace Rehabilitation Hospital. RESET’s goal is to improve independent functioning and equip patients with the skills needed to live a fulfilling life despite pain. This researchbacked approach also involves caregivers, who learn how to best support their child’s functional restoration.
16
Eligibility requirements for patients • Age 12–19 • Motivated to change their circumstances using a biopsychosocial approach • Medically, psychologically and nutritionally stable • Have no significant improvement after using outpatient multidisciplinary care for three months • Have no active or pending lawsuits • Are not seeking new workups or diagnoses • Are not seeking disability status or a service animal • Have no seizures or similar events for at least two weeks before admission • Have a mental developmental status of at least a 10-year-old • Use some coping skills for mood/stress management • Have high moderate or severe functional disability for three months Average length of stay is four weeks. Patients have therapies and related activities from 8 a.m.–4:30 p.m. as well as independent home exercises and cardio work on the rehab unit in the evening. (See sample schedule.) In IIPT programs such as RESET, patients learn pain/ neuroscience education, self-management and behavioral pain management skills, proper form and functional movements, strength and stamina, how to incorporate skills in everyday activities, and how to function independently. Successful graduates show improved school/work attendance; increased engagement in social, leisure and physical activities; and decreased health care use. What follows is one patient’s journey from struggling to looking happily ahead.
RESET is the first program of its kind in the Southeast.
WEEK 2
MON
TUES
WED
7:15
wake up, get dressed, breakfast
wake up, get dressed, breakfast
wake up, get dressed, breakfast
7:30
THURS (parent(s) join)
wake up, get dressed, breakfast
FRI
SAT
7:15
wake up, get dressed, breakfast
7:45 8:00
SUN
*MD/nurse rounding throughout
8:15
PT
PT
PT
PT w/fam
PT
8:30
8:15-8:45
8:15-8:45
8:15-8:45
8:15-8:45
8:15-8:45
8:45
7:30
wake up, get dressed, breakfast
wake up, get dressed, breakfast
Home exercise program Home exercise program
9:15
OT
OT
OT- *yoga*
OT w/fam
OT
9:30
8:45-9:45
8:45-9:45
8:45-9:45
8:45-9:45
8:45-9:45
break
break
9:45
break
break
break
10:00
PAIN PSYCH
PAIN PSYCH
PAIN PSYCH
10:15
10:00am-~11:15am
10:00am-10:55am
10:00am-11:30am
PAIN PSYCH w/fam
Skill practice
cardio on unit
cardio on unit
break independent school
break independent school
10:15
11:00 11:15
Review skills/goals for 11:30 community pass 11:45
school/scholastics
school/scholastics
school/scholastics
school/scholastics
12:00
lunch
lunch
lunch
lunch
lunch
lunch
lunch
12:15
12-12:35
12-12:40
12-12:40
12-12:40
12-12:40
12-12:40
12-12:40
Review skills/goals for community pass
11:45
12:00 12:15 12:30
12:30 12:45
music therapy
1:00
12:45-1:15pm
skill practice
12:40-1:20
Spritual Care
*Parent yoga 1-2*
12:45-1:15
school/scholastics
1:15
12:45
School catch up/ free time
1:00
free time/community pass
free time/community pass
1:30 1:45
OT
OT
OT
OT w/fam
OT
2:00
1:30-2:00
1:30-2:00
1:30-2:00
1:30-2:00
1:30-2:00
2:15
PT
PT
PT
PT w/fam
PT
2:30
2:00-3:00
2:00-3:00
2:00-3:00
2:00-3:00
2:45 3:00
Speech
Speech
Speech
Speech
Speech
3:15
3:00-3:30
3:00-3:30
3:00-3:30
3:00-3:30
3:00-3:30
1:15 1:30 1:45
skill practice
skill practice
2:00 2:15 2:30
free time/community pass
free time/community pass
skill practice
skill practice
2:45 3:00 3:15 3:30
3:30
Massage Therapy
4:00
5:00
9:45
10:30
school/scholastics
11:15
4:45
9:15
10:45
11:00
4:30
8:30 8:45
10:00
10:45
4:15
8:15
9:30
10:00am-11:15am ish
10:30
3:45
8:00
9:00
9:00
11:30
7:45
3:30-4:00pm
rec therapy
skill practice
3:30-4:30
rec therapy 3:30-4:30
pleasant activity w/ volunteer
3:45 4:00 4:15
home exercise program home exercise program home exercise program home exercise program home exercise program home exercise program home exercise program 4:30 in room in room in room in room in room in room in room 4:45 dinner
dinner
dinner
dinner
dinner
dinner
dinner
5:00
5:15
5:15
5:30
5:30
5:45
5:45
6:00 6:15
independent cardio
independent cardio
independent cardio
independent cardio
independent cardio
independent cardio
independent cardio
free time
free time
free time
free time
free time
free time
free time
6:15 6:30
6:30 6:45
6:00
6:45
7:00
7:00
7:15
7:15 7:30
7:30 8:00
wind down
wind down
wind down
wind down
wind down
wind down
wind down
9:00 9:30 10:00
8:00 8:30
8:30
relaxation/meditation
relaxation/meditation
relaxation/meditation
relaxation/meditation
relaxation/meditation
relaxation/meditation
relaxation/meditation
lights out
lights out
lights out
lights out
lights out
lights out
lights out
9:00 9:30 10:00
Caregiver schedule overview during admission: -attend at least 2 caregiver yoga sessions -3 parent pain psychology sessions -2 half-day observations w/ PT, OT and Pain Psych
*virtual options available for some appointments based on request
17
Patient spotlight: Etta Smith Before RESET, Etta could not attend more than one inperson course at school, napped several hours a day, had no social life, was unable to do more than a few minutes of low-intensity exercise and had high health care use. She had no future goals because she did not think it realistic. While in RESET, Etta went from being unable to walk more than a block without significant pain interference and fatigue to running on the treadmill daily, establishing a sleep schedule, meeting hydration goals, increasing strength and stamina, and “knowing how to control pain and how to live my life without it controlling me.” During her five-week stay, Etta raised $15,000 for the Ronald McDonald House by having people donate for every lap she walked/ran for her independent cardio, which she performed daily. She also learned pain and neuroscience education, self-management, and pain behavior skills.
Etta on prom night. Before RESET, Etta said she had no social life.
Etta recalls the initial shock during her evaluation when learning that RESET does not escalate medical treatment or introduce new medications, but uses a biopsychosocial functional rehab approach. After having been through the program, she said, “I now know that using acute pain strategies for chronic pain only makes it worse. And I learned that medicine can play a role if necessary, but it doesn’t have to be the primary or only thing that can help you. Exercise and belly breathing, other progressive muscle relaxation, self-management, and mental and behavioral pain management can help, too – they can even be more helpful than medication.” According to Dr. Gamwell, it is not uncommon for pediatric chronic pain patients to be high achievers and experience clinical anxiety or other comorbid mental health conditions. RESET teaches patients about the relationship between thoughts, feelings, actions, body response and impact of stress on one’s health.
Before RESET, Etta said she would have been challenged to walk across the football field for Homecoming.
Etta shared that she re-learned that lesson the hard way after returning to school: “I was working really hard in physics, but it was causing me not to take care of myself like I should, and I wasn’t doing things I enjoyed. I made the decision to drop it because I now know and can see that my mental, physical and emotional well-being is more important than a class. RESET taught me the importance of doing things you enjoy and for your health.”
Etta’s advice for future RESET patients? “If you’re nervous, it’s OK. Just try your best, trust the process and do what Dr. Gamwell says – it will change your life.” 18
When asked what she was most proud of after RESET, Etta said, “Running on the treadmill a lot, which I never thought I could or would do, and being way more involved in school activities. I went to all the home football games and was on Homecoming Court.” She added, “Before when I would fill out the questions about walking the length of a football field [referencing the Functional Disability Inventory], I would put ‘impossible,’ but now it is so easy. I was so proud to walk across that field during the Homecoming ceremony.”
As for more recent activities, Etta has traveled to Africa where she hiked up a mountain, completed a neonatal ICU internship, attended multiple college tours, is baking often, spending more time with friends, and prioritizing her physical and mental well-being using the skills she learned from RESET.
For more information about this program or to refer a patient, call Dr. Gamwell at 864-522-4880.
“RESET changed my life – now I’m an actual teenager and can do things I enjoy!” – Etta Smith
Etta high above the African coast and Cape Town. 19
C O L L A B O R AT I N G F O R B E T T E R C A R E
A special place for kids with chronic health conditions To mark National Childhood Cancer and Sickle Cell Disease Awareness Month in September, Columbia’s EdVenture Children’s Museum unveiled Celebration Circle. In three distinct ways, this space honors Prisma Health Children’s Hospital patients who face chronic health conditions, their families and the health care professionals who care for these children in the Midlands. Bell-ringing nook A private bell-ringing ceremony is open to all pediatric patients who face chronic health conditions, regardless of where they are in their treatment journey.
were so thrilled for this opportunity to partner with EdVenture to create a space that is inclusive and welcoming for all children who face this journey — no matter where they are in treatment.”
“It is incredibly hard to watch a family witness other kids ringing the bell to signify the end of treatment, knowing that their child might never have that opportunity,” said Stuart Cramer, DO, medical director of the Gamecocks Curing Kids Cancer Clinic for Cancer and Blood Disorders at Prisma Health’s Children’s Hospital. “That is why we
During a patient’s bell-ringing ceremony, a retractable bell is lowered to the height of the child. For children who cannot physically ring the bell, EdVenture’s exhibits team created a button that can sound the bell remotely. As an added feature, color-changing lights allow this space to be representative of all childhood illnesses.
For those who cannot physically ring the bell, a button can be pushed to sound it remotely.
Color-changing LED lights outside of the bell-ringing nook allow this space to represent all childhood illnesses. The retractable bell can be lowered to the patient’s height for the ringing ceremony.
20
Memory wall In addition, patients and their families can sign a memory wall that commemorates their journey. “A topic like childhood cancer or having sickle cell disease is surrounded by grief and sadness,” said Andy Marquart, EdVenture’s CEO, “but there are other aspects of the journey that deserve celebration. As you’ll hear in our videos from the health care workers at Prisma Health Children’s Hospital, each day small treatment milestones and medical research discoveries are all cause for celebration for these kids and their families. And that is why we created Celebration Circle.”
Health careers kiosk The museum has also created a kiosk that visitors can scroll through to explore pediatric health care careers. “We hope it humanizes the health care career choice for kids by exposing them to video stories of everyday people who work in that field at Prisma Health, right here in our own community,” said Lloyd McDonald, facilities director at EdVenture. EdVenture hopes the public’s increased awareness and understanding of childhood cancer, sickle cell disease and other pediatric illnesses will help promote kindness, inclusion and acceptance of others. “This effort is a very important part of raising awareness of the need for research, which will result in more effective and less toxic treatments, and will save the lives of children with cancer,” said Gráinne Owen, co-founder and president of Curing Kids Cancer, which funded the Gamecocks Curing Kids Cancer Clinic. “Having lost my own son to cancer at age 9, my hope is that more communities will come together to support these efforts to provide better treatments,” she said. “You never think this ugly disease can affect your children – until it does. Community support like this is essential if our children are to be able to go on to live long, healthy and happy lives.”
EdVenture’s mission includes accessibility and workforce exploration, both of which are highlighted in this exhibit.
Carolinas Collaborative report for 2022–23 The Carolinas Collaborative (CC) is a network of advocacy leaders from all eight pediatric academic institutions across North and South Carolina. CC is grounded in the belief that promoting the well-being of all children requires integrating effective clinic, community and population health strategies. For the past decade, CC has been focusing on community health and advocacy in Pediatric Residency training. A partnership with Reach Out and Read (ROR) is ramping up to explore the intersection of early literacy and social-emotional development. Meanwhile, a three-year grant from The Duke Endowment is concluding on food insecurity and early childhood development. As a result, this past academic year saw: • 53 publications produced and 49 abstracts or posters presented • 164 medical students, residents and fellows involved in QI or advocacy projects involving food insecurity • 406 residents exposed to food insecurity curricular enhancements via Grand Rounds, conferences, required modules, etc. • 68 trainees involved in QI or advocacy projects involving ROR or early relational health • 382 residents exposed to ROR or early relational health curricular enhancements via Grand Rounds, conferences, required modules, etc. Every CC institution has a member deeply embedded in this work in the community. Prisma Health is proud that Blakely Amati, MD, FAAP (pictured), is the South Carolina lead for this project. In fact, of the 25 active members, seven are part of Prisma Health.
Prisma Health members Midlands April Hobbs, MD Jeff Holloway, MD Katie Stephenson, MD Upstate Blakely Amati, MD Meredith Eicken, MD, MPH Easter Pennington, MD Kerry Sease, MD, MPH Jackie Young (coordinator)
Photos provided by EdVenture Children’s Museum 21
CLINICAL CASE REPORT
What’s the diagnosis? A 2-year-old male with a past medical history of a premature birth at 28 weeks was noted by his mother to be crying, staring into space and diaphoretic two hours after putting him to bed. On arrival to the ED, the patient was found to be hypothermic, intermittently bradycardic, with altered mental status. A point of care glucose was 35. A workup was started, labs drawn, and dextrose given intravenously with improvement of signs and symptoms. The physical exam was otherwise unremarkable. There were no focal neurologic signs. He is following his growth curve. On further history, the patient attends day care, eats a normal diet and takes no medications. His neonatal screens were normal except for sickle cell trait. There are no other constitutional symptoms and no history of trauma. The mother denies prescription medications being taken in the home. The family history, social history and ROS are otherwise noncontributory. A comprehensive metabolic panel confirmed hypoglycemia and demonstrated metabolic acidosis with increased anion gap. Complete blood count was unremarkable, and a urinalysis revealed a pH of 5.5 and was negative for ketones or other abnormalities. Insulin level and C-peptide were elevated. “Critical sample” evaluation for metabolic/endocrine abnormalities is pending.
A. Carnitine deficiency B. Beckwith-Wiedemann Syndrome (BW) C. Growth hormone deficiency D. Ingestion E. Adrenal insufficiency
Article authors
Jonathan Markowitz, MD, FAAP, NASPGHAN-F
22
What’s your diagnosis?
James Stallworth MD, FAAP
Have you figured out the diagnosis? See Page 34 for the answer.
M E D I C A L S TA F F S P O T L I G H T
Meet our new providers Welcome to these new members of our clinical team in the Midlands and Upstate. The physicians are or will be in the process of being approved for faculty appointments at the University of South Carolina Columbia or Greenville – an academic health center – depending on their location.
MIDLANDS Developmental-Behavioral Pediatrics Page Moore, PhD, is a licensed school psychologist with clinical interests including neurodevelopmental (such as ADHD), intellectual and learning disabilities. Dr. Moore completed her undergraduate major in psychology from University of Virginia in Charlottesville, her master’s degree in criminal justice from Virginia Commonwealth University in Richmond and her doctorate in school psychology from University of South Carolina. She can be reached at 803-434-6598.
Inpatient Pediatrics Jeanette Epstein, MD, completed her medical degree at State University of New York at Buffalo, followed by a residency in pediatrics at Jacobs School of Medicine at the University of Buffalo. Dr. Epstein is working as a pediatric hospitalist at Children’s Hospital–Midlands. She can be reached at 803-434-6155. Michael Lever, MD, completed his medical degree at University of South Carolina School of Medicine Columbia, followed by a residency in pediatrics at Atrium Health Levine Children’s Hospital in Charlotte, North Carolina, and a fellowship in pediatric hospital medicine at Cleveland Clinic Children’s in Cleveland, Ohio. Dr. Lever is working as a pediatric hospitalist at Children’s Hospital–Midlands. He can be reached at 803-434-6155. Jeanette Norris, MD, earned her medical degree from Mercer University School of Medicine in Macon, Georgia. Pediatric residency training then took place at Emory University School of Medicine in Atlanta, Medical College of Georgia in Augusta and Florida Department of Health in Palm Beach County. Dr. Norris is working with the pediatric hospitalist group at Tuomey Hospital in Sumter. She can be reached at 803-774-9225/9226.
Pediatric Endocrinology Alison Lunsford, MD, completed her medical degree at University of Oklahoma College of Medicine in Oklahoma City, followed by a pediatric residency at Prisma Health Richland Hospital in Columbia and a fellowship in pediatric endocrinology at University of Alabama in Birmingham. Dr. Lunsford has a special interest in diabetes. She can be reached at 803-434-7990.
Pediatric Nephrology Allison Wade, PA-C, received her medical training from Medical University of South Carolina in Charleston. Wade is board certified by the National Commission on Certification of Physician Assistants. She can be reached at 803-434-3572.
Pediatric Pulmonology Hannah Hopfensperger, PA-C, received her medical training from University of South Carolina School of Medicine Columbia. Hopfensperger is board certified by the National Commission on Certification of Physician Assistants. She can be reached at 803-434-2505.
UPSTATE Adolescent Medicine Joseph Laterza, MD, is an adolescent and young adult medicine specialist who received his medical degree from Ross University School of Medicine and completed a family medicine residency at Prisma Health in Greer, where he was chief resident. Dr. Laterza is board certified by the American Board of Family Medicine. Special medical interests include equitable access to care, reproductive/ sexual health and the LGBTQIA+ population. He can be reached at 864-522-4888. 23
General Pediatrics Alexandra Springhetti, MD, received her medical degree from St. George’s University School of Medicine in the West Indies and then completed a pediatric residency at Memorial Health in Savannah, Georgia. Dr. Springhetti is working at Center for Pediatric Medicine–West. She can be reached at 864-522-5220. Sharon Wretzel, MD, received her medical degree from Royal College of Surgeons in Ireland. Dr. Wretzel then completed an internal medicinepediatrics residency at the University of Massachusetts Chan Medical School–Baystate. Board certified in internal medicine and in pediatrics, she is working at Center for Pediatric Medicine. She can be reached at 864-522-5220. Osman Yousufzai, MD, MPH, completed his medical degree at Medical College of Georgia in Augusta, followed by a residency in pediatrics at Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas. Dr. Yousufzai is working at Center for Pediatric Medicine. He can be reached at 864-522-5220.
Inpatient Pediatrics Hannah Galloway, MD, completed her medical degree at Mercer University School of Medicine in Macon, Georgia, and her pediatric residency at Prisma Health Children’s Hospital in Greenville, South Carolina. Dr. Galloway is working as a pediatric hospitalist at Oconee Memorial Hospital. She can be reached at 864-482-3300. Leah Somerville, DO, completed her medical degree at Edward Via College of Osteopathic Medicine in Blacksburg, Virginia, and her pediatric residency at Children’s Hospital in Greenville, South Carolina. Dr. Somerville, a Newborn Nursery hospitalist at Patewood Hospital, can be reached at 864-797-1301.
24
Neonatology Jackie Razzaghy, MD, graduated from the Medical University of South Carolina College of Medicine in Charleston. Dr. Razzaghy then completed a pediatric residency at Greenville Memorial Hospital, followed by a neonatal-perinatal fellowship at University of Alabama at Birmingham. A member of Pediatrix Medical Group, she can be reached at 864-455-7165.
Pediatric Emergency Medicine Bradley Beamon, MD, earned his medical degree from East Carolina University Brody School of Medicine in Greenville, North Carolina. Dr. Beamon went on to complete a pediatric residency at Vidant Health via East Carolina University, followed by a fellowship in pediatric emergency medicine at University of Mississippi Medical Center in Jackson. He can be reached at 864-455-6015. Kathleen Jackson, MD, earned her medical degree from American University of Antigua College of Medicine. Dr. Jackson went on to complete a pediatric residency at Vidant Health via East Carolina University in Greenville, North Carolina, and then a fellowship in pediatric emergency medicine at Medical University of South Carolina in Charleston. She can be reached at 864-455-6015.
Pediatric Endocrinology Faith Lindsay Mart, MD, earned her medical degree from East Tennessee State University–Quillen College of Medicine in Johnson City. Dr. Mart completed her pediatric residency at The University of Tennessee Health Science Center in Chattanooga, followed by a pediatric endocrinology fellowship at Cincinnati Children’s Hospital Medical Center in Ohio. She has a special interest in Turner syndrome. Dr. Mart can be reached at 864-454-5100.
Pediatric Neurosurgery Lacey Carter, MD, is a fellowshiptrained pediatric neurosurgeon specializing in hydrocephalus, spina bifida, craniosynostosis, Chiari malformations, pediatric neurotrauma, and other congenital abnormalities of the brain and spinal cord. Dr. Carter serves as the division chief. She obtained her medical degree at Brody School of Medicine at East Carolina University in Greenville, North Carolina, where she was elected into the Alpha Omega Alpha (AOA) Honors Medical Society. She then completed her neurosurgery residency at the University of Oklahoma Health Sciences Center in Oklahoma City before finishing her training at Duke University in Durham, North Carolina, with a pediatric neurosurgery fellowship. She can be reached at 864-797-7440.
Pediatric Pulmonology Erin Kallam, DO, earned her medical degree from Campbell University School of Osteopathic Medicine in Lillington, North Carolina. Dr. Kallam then completed a pediatric residency and pediatric pulmonology fellowship at Children’s Healthcare of Atlanta/ Emory University in Atlanta, Georgia. She can be reached at 864-454-5530.
Plastic Surgery David Lobb, MD, is a board-certified, fellowship-trained pediatric and adult plastic surgeon. His pediatric clinical expertise includes cleft lip and palate repair, craniosynostosis surgery, reconstruction for benign and malignant disease, microtia repair and otoplasty, and general pediatric plastic surgery.
UPSTATE COMMUNITY PEDIATRIC CLINICIANS
Crosby
Early
Gunter
Li
Price
Suhrstedt
Kline
Emily Crosby, MD, has joined Prisma Health Pediatrics– Easley. She can be reached at 864-855-0001. Jessica Early, MD, has joined Prisma Health Pediatrics– Greer. She can be reached at 864-797-9100. Andrew Gunter, MD, has joined Prisma Health Pediatrics– Verdae. He can be reached at 864-522-6600. Hannah Kline, MD, has joined Prisma Health Pediatrics– Verdae. She can be reached at 864-522-6600. Susan Li, MD, has joined Prisma Health Pediatrics & Internal Medicine–Wade Hampton. She can be reached at 864-522-5000. Ally Price, DO, has joined Prisma Health Pediatrics– Powdersville. She can be reached at 864-220-1110. Frederick Suhrstedt III, MD, has joined Prisma Health Pediatrics–Verdae. He can be reached at 864-522-6600.
Dr. Lobb completed his fellowship in craniofacial and pediatric plastic surgery at Cincinnati Children’s Hospital Medical Center in Ohio after a six-year integrated plastic surgery residency at the University of Virginia Health System in Charlottesville. Born in South Africa, he immigrated to the United Kingdom with his family as a teenager where he completed university studies and medical school. He can be reached at 864-522-6630.
25
Q&A with our chaplains Chaplain Anthony Hughes, MDiv, BCC Current position Chaplain, Children’s Hospital in the Midlands (15 years) Educational background • Bachelor of Theology, Liberty University • Master of Divinity, Southeastern Theological Seminary • Board certified, Association of Professional Chaplains What did you do previously? I am endorsed by the Southern Baptist Convention, and my ordination occurred at Rustburg Baptist Church in Virginia. I was a pastor for 14 years in South Carolina. Through a series of various circumstances, I left the church and pursued a chaplaincy role. The church life was great, but I have found the chaplaincy to be even more rewarding. How did you end up in Columbia? I started out as a student chaplain CPE (Clinical Pastoral Education) with Richland Hospital, now part of Prisma Health. During my residency, a staff chaplain job came available. I applied and was selected for that position at the hospital. Upon residency graduation, I moved into my role as a staff chaplain in the adult hospital. After about two years, I was asked to transfer to Children’s Hospital. I have since taken on more of the lead chaplain position, which includes overseeing the clinical work of our students. What are your goals in this position? My focus has always been to support patients and families at Children’s Hospital. Some days, I listen to them telling me about their dogs and cats at home; other days, I am listening to doctors giving a grim report. No matter what the case, I want to be a supportive, helpful presence. Being part of the team in a patient’s life is very important to me. Many times, I have been able to support families in a spiritual way that has helped them make very hard decisions. We have laughed together and have also cried together. My new responsibilities in the lead chaplain role brings with it the joy of seeing resident students learn and grow in their quest of becoming a chaplain. What do you find especially fulfilling in your work? I have led our department in participating in Halloween activities and in the Christmas parade each year. These events are more important than people realize because they help children and their families celebrate “normal” holidays even though they are in the hospital, a very “abnormal” place. 26
“Elf” Anthony Hughes prepares to deliver holiday cheer.
I consider it a blessing to know that I had a part in the life of a family who was struggling through a very difficult medical diagnosis and that I made a difference in their lives during that crucial period. That I could reflect back to them their spiritual theory at a time when they felt they had lost it is an honor and privilege from my perspective. What are your pastimes? I love anything involving lakes and beaches. In fact, I have a small houseboat I stay on nearly every weekend. What would others be surprised to learn about you? I have surfed my entire life. My brother and I travel every February to other countries just to surf.
The Rev. Patrick Jinks, MDiv, BCC, HEC-C Current position Spiritual Care Coordinator, Children’s Hospital in the Upstate (10 years) Educational background • Bachelor of Science Management, Georgia Institute of Technology • Master of Divinity, Princeton Theological Seminary • Ordained minister, Presbyterian Church (USA) Why health care? As I neared the end of my time at Georgia Tech, I was imagining working for a high-performance company – perhaps even becoming a CEO. I had also, however, engaged in various forms of caring for others. Those opportunities, along with some important mentors, pulled at my consciousness enough to consider pursing ministry.
My time working with youth, camp and conference ministries, along with college students, led me to explore seminary. It was during required chaplaincy work as part of my training that led to me Children’s Hospital. What brought you here? I came to Greenville Memorial campus as a chaplain resident, part of the CPE program that trains students in health care chaplaincy. I loved Greenville, plus my spouse is a Furman University alum. Upon graduation, I was fortunate enough to stay working with the health system as a chaplain for adult patients at our North Greenville campus for three years, before having the opportunity to return to the main campus as part of the new Pediatric Palliative Care (Supportive Care) program. That opportunity was all thanks to Neil Cochran, longtime chaplain for Children’s Hospital. I learned so much from him about caring for the WHOLE Children’s Hospital community, the spirit of children and how to be a chaplain for both. In fact, he directed leadership toward me upon his retirement. What are your days like? I often round with medical teams as they develop a plan of care for admitted children. This allows me to better understand the medical concerns as I step into the room to help care for the spiritual and emotional strengths that intertwine with the medical worries.
when we reach the end of medical options and parents must accompany their child in their final moments before death. Also, I have had the honor of supporting families in groups such as STAR (Someone to Always Remember) for pediatric oncology bereavement as families look for ways to carry on their child’s legacy. What are your pastimes? I am married to my wife of 15 years, Kate. We have four children, ranging in age from 11 years to 1 year. When I have spare time, I enjoy playing board games, digging in the garden and aspiring to be a mediocre disc golf player. What else would you like to add? I am board-certified with the Association of Professional Chaplains. A long-time member of the Pediatric Chaplains Network, I recently became dean of the Pediatric Chaplains Institute, the network’s education and training arm. I am also a certified health care ethics consultant (HEC-C) through the American Society for Bioethics and Humanities and co-chair of our Upstate’s Ethics Committee.
A day can turn in a moment – being called to support a family of a trauma or medical emergency. Those times are bracketed by others where we sing, dance and act silly with a patient who has been admitted for months. I am privileged to offer words of blessing for newborns and to pray with kids before surgery. I play dolls, learn video games and color – all to help children identify the strengths of their own innate spirituality and support them in exploring their thoughts, fears, and worries amid a hard day. It’s been a joy to meet so many beautiful kids (and their incredible parents). Some are never seen again in the hospital; others return often. My hope is that I was important in the life of a child, even if only for a moment, that extends care far beyond the walls of our hospitals and clinics. What is most fulfilling? Most challenging? I have the honor and privilege of holding in tension the sacredness of our care for children – that life and death may be right next to each other. I celebrate that children are so incredibly resilient and heal so well. But we also hold the sacredness of being invited into those moments
All in a day’s work Chaplain Jinks took on an unusual “duties as assigned” role this summer when a distraught father ran into the hospital yelling for help. Jinks ran from his office to see what the matter was: a limp, lifeless 4-year-old. He took her in his arms and sprinted toward the Children’s Emergency Center. Once there, Jinks began CPR, which he had never performed in an emergency. A few days later, he celebrated the child’s recovery with a tea party in the pediatric ICU.
27
ACADEMIC NEWS
Grants and awards Hyundai Hope on Wheels Young Investigator Award Johnny Stivers, owner of Stivers Hyundai, and Michael DePaul, General Manager, Southern Region at Hyundai Motor America, congratulate Dr. Hoppmann.
Dr. Hoppmann receives prestigious grants St. Baldrick’s Scholar Anna Hoppmann, MD, MPH, pediatric oncologist at Prisma Health Children’s Hospital in the Midlands and clinical assistant professor at University of South Carolina (USC) School of Medicine Columbia, has received a St. Baldrick’s Foundation research grant. The three-year, $330,000 Scholar Grant will expand Dr. Hoppmann’s work on health disparities among patients with pediatric cancer and how they affect mortality. It is Children’s Hospital’s first St. Baldrick’s award. After graduating from USC, she completed her residency and fellowship at the University of Alabama–Birmingham. While there, she began investigating challenges that her oncology patients faced. Her research showed that children with cancer coming from areas with persistent child poverty were 30% more likely to die compared to those from other areas. Risk of death was 80% higher for children who also lived far from the treating hospital.
28
“The duration and intensity of treatment for childhood cancer are difficult to endure, particularly for families coming from underserved areas and those traveling long distances to get care,” she said. “As pediatric cancer treatments continue to improve, it is vital that we examine social factors that contribute to disparate outcomes so that gains in our field can be shared equitably.” She plans to use the findings from her research to pilot interventions for children with cancer across South Carolina to lessen disparities driven by social determinants of health. HHOW Young Investigator Dr. Hoppmann also was named a 2023 Hyundai Hope on Wheels (HHOW) Young Investigator for pediatric oncology. This award provides funding for early career principal investigators whose research projects are likely to have a significant impact on improving the understanding of childhood cancer.
The award is a $250,000 two-year grant, which will help Dr. Hoppmann continue investigating the challenges her oncology patients face and to expand her research questions to a national scale. The HHOW Young Investigator award is her second prestigious multi-award grant for work on health disparities and the first HHOW grant for Prisma Health.
(Left) Maria Broyles and daughter Francheska left their handprint on the Hyundai Hope on Wheels vehicle. (Right) Kids of all ages lent a hand – or foot, in this case. Handprints represent children who are fighting childhood cancer, have survived childhood cancer or whose memories live on.
MAiN Program receives added funding The S.C. Opioid Recovery Fund Board, tasked with distributing funds from opioid settlement litigation, has awarded a $945,035 grant to Prisma Health’s Managing Abstinence in Newborns (MAiN) Program, in partnership with Clemson University and AnMed Health, for expanding treatment services related to neonatal abstinence syndrome (NAS) in Anderson County. The program, again in partnership with Clemson University, already received $250,000 in funding from the board for Pickens County.
Every 24 minutes, a baby in the U.S. is born experiencing opioid withdrawal.
Settlement funds target three areas: • Expand comprehensive evidence-based and recovery support for babies with NAS • Expand services for better continuum of care for opioid-affected families with newborns • Expand long-term treatment and services for medical monitoring of babies with NAS and their families “We look forward to helping families in South Carolina with their recovery efforts, helping providers meet the needs of their patients and helping communities with their opioid abatement strategies,” said Jennifer Hudson, MD, medical director of MAiN and Newborn Services at Prisma Health Greenville Memorial Hospital. The program hopes to apply for funding for other counties as monies become available. To learn more about MAiN, opioid-related training and resources, go to mainbabies.org.
MAiN’s online training provides free CEU/CME credit for health care staff who complete it, including two hours of opioid-related education required for S.C. medical licensure. 29
Kudos to Dr. Dingle Jodi Dingle, MD, received the Distinguished Young Alumni Award from the University of South Carolina School of Medicine Columbia in October. This annual award goes to someone who graduated within the last 10 years (Dr. Dingle graduated in 2013) and has already exhibited excellence and significant career contributions in his or her field. After completing her fellowship in pediatric rheumatology, Dr. Dingle returned to Columbia in 2020 to establish the Division of Pediatric Rheumatology – a specialty for which there had never been a full-time provider in the Midlands. This new division has greatly expanded access to care for patients with rheumatologic conditions. In addition, she actively participates in teaching and mentorship within the pediatrics residency program and with the medical school.
Dean’s Leadership Award Kathryn (Katie) Stephenson, MD, received the School of Medicine Dean’s Leadership Award in October at the University of South Carolina School of Medicine Columbia annual banquet. Recipients are selected by a committee overseen by the dean’s leadership team. Dr. Stephenson accepted a faculty position with the school’s Department of Pediatrics in 1996. She has held many positions since then, including 20+ years as the associate residency director and as the division director for both General and Hospital Pediatrics and for Child Abuse Pediatrics. Current roles include being vice chair for Medical Staff Affairs and the associate medical director for Children’s Hospital in the Midlands. She has an interest in social determinants of health, which she addresses as the medical director for CHAMPS, a medicolegal partnership including the USC schools of medicine and law. Dr. Stephenson was also an original member of the Carolinas Collaborative, a network of advocacy leaders from both Carolinas who believes the well-being of children requires targeted integration of clinic, community and population health strategies.
Congratulations, Dr. Jones! W. Kent Jones, MD, FAAP, received the Career Achievement Award at the annual SC AAP meeting in August. This prestigious honor is given to a South Carolina pediatrician or child health care provider whose career has spanned at least 25 years AND who has made significant contributions to advancing children’s health in at least two of these areas: 1) clinical practice or academic medicine; 2) child advocacy; 3) leadership in organized medicine at the local, state or regional/national level. In 2022, Dr. Jones won the Chapter President’s Award, which is given for outstanding service to the chapter and for contributions made to the medical profession at the state level. Dr. Jones works at Prisma Health’s Ferlauto Center for Complex Pediatric Care in Greenville.
30
QUALITY COUNTS
Increasing pneumococcal vaccination rates at least one dose of PCV20 before age 6 should continue to receive one dose of PCV20 (at least eight weeks after most recent PCV13 or five years after most recent PPSV23) or two doses of PPSV23 given five years apart. Methodology: Both groups implemented incremental changes after initial data revealed care gaps, starting with review of patient inclusion criteria and stocking of PPSV23 vaccines.
Prisma Health’s Pediatric Nephrology and Hypertension and its Pediatric Rheumatology divisions in the Upstate are working on QI projects to increase pneumococcal vaccination rates in vulnerable patient populations. Background: Streptococcus pneumoniae, the leading cause of bacterial pneumonia in children, can also lead to common illnesses (acute otitis media, sinusitis) and invasive disease (bacteremia and meningitis). Vaccination is recommended for all infants, with additional doses recommended for high-risk children, including those who are immunocompromised or who have chronic kidney disease (CKD). Before recent approval of the pneumococcal conjugate vaccine (PCV) Prevnar20 (PCV20) for children, the CDC recommended a dose of pneumococcal polysaccharide vaccine (PPSV), Pneumovax23 (PPSV23), be given at least eight weeks after the initial PCV series was complete (including at least one dose of PCV13), with a second PPSV23 due five years later. This fall, recommendations changed to include use of PCV20 for the initial vaccination series in infancy. High-risk children who receive at least one dose of PCV20 before 6 years of age no longer need additional vaccination. Those who do not receive
Pediatric Nephrology also began a monthly previsit planning report. In the first cycle, staff updated the CKD stage III–V and renal transplant patient list with immunization status and upcoming nonimmunized patients’ next clinic visit. Nursing staff coordinated with satellite clinics for vaccine delivery. Subsequent cycles focused on improving accuracy of the CKD patient list in Epic and starting an electronic medical record (EMR) checklist to track immunization status, in addition to a manual entry list. Pediatric Rheumatology began with a focus on patients with systemic lupus erythematosus (SLE) and expanded to patients on TNF-alpha inhibitors. Action plans during cycles included incorporating dates of pneumococcal vaccination into note templates and stocking PCV13, allowing administration of recommended doses at clinic visits. Results: Pediatric Nephrology increased combined vaccination rates in children with CKD stage III–IV and renal transplants from 77% to 89%. Pediatric Rheumatology increased vaccination rates in children with SLE from 22.9% to 62.8% and those on TNF-alpha inhibitors from 12.3% to 31.4%. Across all cohorts, a small number of patients were not eligible due to age, use of chronic IVIG or current highly active disease. Across cycles, results were also affected by immunized patients graduating to adult practices while adding new nonimmunized patients. Continued on next page. 31
Challenges: • Unable to offer vaccinations due to late cancellation/no show or virtual visits • Overall vaccine acceptance rates affected by perceptions about COVID-19 vaccine Lessons learned: • A visual reminder in the EMR (such as checklist or note template) improves clinician memory to discuss vaccines with families, as does a yearly review of progress. • Discussion of a vaccine is more likely to lead to immunization if the dose is offered at the visit, avoiding an additional step for families. • Families who perceive their child as more ill (SLE, renal transplant) may be more open to vaccines.
Article authors from the Upstate Sudha Garimella, MD Medical Director, Pediatric Nephrology and Hypertension
Sarah Payne-Poff, MD Medical Director, Pediatric Rheumatology
Midlands quality celebrated in FY23 In FY23, Prisma Health Children’s Hospital in the Midlands recorded a 67% drop in central line-associated bloodstream infections, 74% reduction in hospital-acquired infections, and logged significant decreases in harms from falls, pressure injuries and venous thromboembolic events. As a member of Solutions for Patient Safety (SPS), a national children’s hospital quality collaborative, the facility benefits from the group’s “all teach, all learn” platform by working with more than 145 children’s hospitals to implement best practices that prevent hospital-acquired conditions and provide foundations for patient safety. In addition to working with SPS, the hospital initiated projects to lower sepsis, optimize the stroke algorithm and reduce clinical variation in managing diabetes.
32
LEADERSHIP PROFILE
Meet three of our leaders Annie Moroski, MD A native of Easley, South Carolina, Dr. Moroski graduated from nearby Clemson University, then went on to receive her medical degree from Medical University of South Carolina in Charleston. Her residency in academic pediatrics was completed at University of California/Irvine followed by a fellowship in pediatric critical care at Children’s Hospital of Orange County in southern California. Happy to return to the Upstate, she now serves as comedical director for the AnMed Pediatric Hospitalist Program in Anderson, a partnership with Prisma Health whereby pediatricians employed by our system provide inpatient pediatric care. Her road to pediatric medicine was not a direct path, however. Although she majored in political science as an undergraduate, the more she learned about politics the less she wanted to be directly involved in it. She worked at United Way of Pickens County raising money for local nonprofits before deciding that the best way to contribute to the betterment of her local community and larger society was through a medical career. Her current focus is to provide families in the Anderson area with the highest quality of inpatient pediatric care, from well newborns or the Level II nursery to the pediatric floor. For many families, traveling to Greenville for pediatric care requires resources they do not have, so the AnMed partnership delivers a valuable service – “taking care of our most precious resource, the next generation,” as Dr. Moroski said. Dr. Moroski remains active legislatively by communicating and advocating with local representatives about issues relating to children and women’s access to health care. In her free time, she loves to read, enjoy the outdoors, attend sporting events at Clemson, and spend time with husband Nate and their three children.
Liz Shirley, MD Born in Denver, Colorado, Dr. Shirley migrated to the Lowcountry during middle school where she remained and graduated from the College of Charleston before attending medical school at the University of South Carolina in Columbia. Growing up, she enjoyed shadowing her father, an anesthesiologist, as often as possible. She long planned to pursue a career in veterinary medicine before ultimately following her true passion of pediatrics. Following medical school graduation in 2012, she completed her pediatric residency at Greenville Health System (now part of Prisma Health), where she fell in love with the inpatient environment and caring for acutely ill patients. She has worked as a pediatric hospitalist at the joint program with AnMed Health since finishing her residency in 2015 and recently assumed the role of comedical director for that program. What she particularly enjoys about the community hospital setting is caring for more medically complex neonates in the busy Level II nursery and providing care close to home for pediatric patients. She is excited to continue working with Children’s Hospital to deliver high-quality care and expand pediatric services for the Anderson community. Dr. Shirley is dual board-certified in pediatrics and pediatric hospital medicine. Clinical interests include allergic diseases and asthma. She and her husband have a busy home life with their two daughters and her two “bonus” kids along with a variety of pets. In her free time, she likes trying new recipes, exercising and reading.
33
The diagnosis (continued from Page 22) Answer: D. Ingestion In the intact host, regulators and counter-regulators work in concert to maintain glucose homeostasis. Thus, in the face of hypoglycemia, insulin levels should be low, and cortisol and growth hormone levels elevated. In this case, insulin level and C-peptide would be expected to be low but were elevated. Results of the critical sample ultimately revealed a normal carnitine level and appropriately elevated cortisol and growth hormone levels, making a primary metabolic/ endocrinologic disease unlikely. A C-peptide level differentiates endogenous versus exogenous insulin, in this case indicating the elevated insulin level was of endogenous origin. The lack of ketones in the urine supports either a hyperinsulinemic state or a fatty acid metabolic abnormality where fat cannot be mobilized to restore serum glucoses to normal. Carnitine disorders, the most common being MCAD, are not associated with hyperinsulinemia and are usually identified on neonatal screening, which was normal in this patient. Growth hormone deficiency and adrenal insufficiency cause ketotic hypoglycemia, which should have been picked up on a urine study. Although BW has endogenous hyperinsulinemia, the patient has no stigmata of BW such as macroglossia, macrosomia, omphalocoele or hemi-hypertrophy. Therefore, option “D” is the most likely explanation for symptoms in this patient. On further investigation, the patient attended an in-home day care where a family member received medication for Type 2 diabetes mellitus (DM). A sulfonylurea panel confirmed the presence of a glipizide in the patient’s blood. This medication’s mechanism of action is to increase endogenous insulin levels, which regulate hyperglycemia seen in DM. However, if ingested in someone without DM, this drug can cause hypoglycemia, as was seen in this child.
References • Vergano S. “IEM, becoming ready for rare.” Pediatr Rev. Jul 2022; 43(7): 371–83. • Long D and Y Akhtar. “Hyperinsulinism.” Pediatr Rev. Apr 2019; 40(4): 207–10.
34
Teresa Williams, MD, MPH Born in Huntsville, Alabama, Dr. Williams knew from an early age she was meant to care for children. She attended the University of Alabama at Birmingham where she majored in biology and stayed there to complete medical school and earn her master’s in public health. In 2012, she moved to Greenville to pursue a residency in internal medicine-pediatrics. She served as chief resident for that program and then completed a subsequent year as junior faculty, serving as pediatric chief resident from 2016–17. Dr. Williams and her spouse fell in love with the Upstate and the med-peds community of Greenville. She was glad to remain with Prisma Health as both a med-peds hospitalist at Greer Memorial Hospital and pediatric hospitalist through a joint venture with AnMed Health. In these roles, she was privileged to use the breadth of her med-peds training – attending newborn deliveries and caring for Level I and II nursery babies, pediatric inpatients, and adults on the floor and in the ICU. In 2021, she became the director of Pediatric and Newborn Services at Greer and hopes to continue expanding pediatric services there. She is triple board certified in internal medicine, pediatrics and pediatric hospital medicine. Dr. Williams enjoys working in the community hospital setting where compassionate care can be provided to children close to home. She is passionate about resident and medical student education and works closely with Family Medicine Residency programs at Greer and AnMed hospitals, serving as pediatric rotation coordinator at the latter. In her free time, Dr. Williams can be found with her husband and two daughters exploring the beauty of the Upstate, chasing waterfalls and camping.
BULLETIN FROM THE BRADSHAW INSTITUTE
Bradshaw Institute update The Bradshaw Institute for Community Child Health & Advocacy, part of Prisma Health Children’s Hospital–Upstate, works to create healthy and safe communities, increase access to care for those experiencing vulnerabilities, provide evidence-based strategies to improve health literacy, and ultimately become a best practice leader. Made possible by a legacy gift in 2016, the institute’s funding comes from various sources: grants, philanthropy and operational dollars. Here are 12 highlights of the team’s activities or statistics in the Upstate for FY22 (October 2022–September 2023): • Pediatric Support Services throughout our ambulatory pediatric practices made 1,481 referrals to mental and behavioral health services; 335 referrals were made to food and housing programs. • 667 total visits occurred at our School-based Health Centers during the 2022–23 school year. • 312 vaccinations were given to Greenville County students through these School-based Health Centers. • Health educators provided personalized pediatric injury prevention education to 2,008 families at Greenville Memorial, Oconee Memorial and Patewood hospitals before their baby’s discharge from Newborn Services at our Children’s Hospital. Also before discharge, 142 free car seats were distributed and staff performed 230 car seat inspections. • The team maintained 33 permanent Child Passenger Safety Inspection Stations in the community, including the on-site station at Greenville Memorial Hospital; 255 car seats were distributed in the community. • 187,000 diapers were distributed via our Diaper Bank to 1,055 families in need; an additional 57,525 diapers were supplied to 13 internal and external partners. • 1854 students took part in the Wheels to Wellness Bicycle Skills Clinic; participants were provided and fitted with helmets with funding by Molina Cares. • 98 cribs were given to families through Cribs for Kids. • 40 of our medical residents were trained in community health and advocacy. • 308 faculty, staff and administrators from Greenville County Schools took part in Conscious Discipline trainings.
• Buddy’s Health & Safety House was renovated to incorporate interactive exhibits that help children and families prevent common unintentional injuries in the home while also encouraging healthy habits. • The institute took the lead in creating the system’s first-ever pediatric action plan in response to the 2022 Community Health Needs Assessment.
New medical director Congratulations to Blakely Amati, MD, the Bradshaw Institute’s new medical director. Dr. Amati fills the position formerly held by Kerry Sease, MD, MPH, whose primary job is now executive director of the Institute for the Advancement of Community Health (IACH) at Furman University, one of Prisma Health’s three primary academic partners.
CIGNA grant The Cigna Group Foundation now funds projects under the Healthier Kids For Our Future Grant for existing mental health programming to address loneliness, anxiety, depression and suicide prevention. These funds were awarded to the Bradshaw Institute to expand Conscious Discipline training to integrate academics with healthy social-emotional skills while building a school-to-home connection with teachers and parents via leading by example.
Shot in the arm For vaccine clinic efforts at its School-based Health Centers, the Bradshaw Institute was recognized by the S.C. Immunization Coalition with the 2023 S.C. Immunization Champion Innovation Award.
To learn more, go to PrismaHealth.org/BradshawInstitute. 30
35
IN THE COMMUNITY
Bubble release A bubble release was held Sept. 1 in memory of mothers and infants who have passed away related to maternal and infant mortality. The event took place in front of Prisma Health Richland Hospital to mark Infant and Maternal Mortality Awareness Month. Prisma Health Midlands Healthy Start hosted the bubble release, along with a free Community Day and a symposium later in the month. The symposium featured a variety of panelists and included a viewing of Aftershock, a documentary on maternal deaths.
NICU nurses take part in the bubble release.
Midlands grants aimed at firearms Richland Hospital Trauma Administration has received two grant awards for firearm safety and gun violence prevention: • $2 million over three years to plan and implement a hospital-based violence intervention program to serve high-risk teens and young adults in underserved, high-crime areas of Columbia treated at Richland Hospital’s trauma center for a violence-related injury (gunshot wound, stabbing or assault). This grant was awarded from the U.S. Department of Justice, Office of Justice Program’s Community Violence Intervention and Prevention Initiative. • $31,528 per year for three years to provide firearm safety screenings, counseling and at-home security mechanisms (gun locks and lock boxes) during family medicine and internal medicine appointments at the five counties where Prisma Health practices are located in the Midlands: Richland, Lexington, Fairfield, Lee and Sumter. This grant comes from the South Carolina Department of Health and Environmental Control.
Upstate Diaper Bank dates for 2024: March 23, May 18, July 20, Sept. 21, Nov. 16
36
Greetings from Riverbanks Zoo Prisma Health was proud to sponsor Santa’s Landing at Riverbanks Zoo and Gardens, where team member volunteers helped children and families create notes of encouragement for Midlands patients hospitalized during the holiday season. Thousands of people visited Santa’s Landing to spread holiday cheer to our inpatients.
Making spirits bright Prisma Health’s two Children’s Hospitals lit up the night and kindled holiday joy in young patients and their families during the annual Good Night Lights familyfriendly drive-thru events in December. The heartfelt act of shining flashlights toward patients’ windows conveyed well wishes, good thoughts and holiday cheer. Positive distractions not only reduce stress but also contribute to a quicker recovery and improved well-being.
37
C E L E B R AT I O N S
Both of our Prisma Health Children’s Hospitals have many reasons to celebrate! Prisma Health Midlands Foundation
Healing Hearts Camp debuts Healing Hearts Camp took place Oct. 13–15 at Camp Cole in Eastover. This camp is for children who have experienced the loss of a loved one and for the caregivers supporting them through their grief. Camp was made possible through the Bend Don’t Break Foundation (see related blurb). Twenty-five children and their caregivers participated in a variety of therapeutic activities, including releasing lanterns and creating family murals and time capsules to help express their feelings and process their grief. Camp was also designed to help families create new memories while honoring their loved one. Families embraced the opportunity to engage in emotionally heavy work throughout the weekend. They expressed that having a space and time dedicated to processing grief, being together and building peer-to-peer relationships proved to be the recipe for beginning the healing process. The camp was staffed by Child Life team members from Prisma Health Children’s Hospital in the Midlands and dedicated volunteers. Camp was the culmination of the monthly Healing Hearts Grief Program sessions that families attended. The program is open to bereaved children ages 5–18 years and their caregivers at no cost to the family. For more information, email Christy Fink at Christine.Fink@prismahealth.org.
Healing Hearts Camp receives $25,000 Jennifer Helmly established the Bend Don’t Break Foundation to continue the legacy of her late husband, Michael. She said, “I knew that I wanted the Bend Don’t Break Foundation to benefit those in our community who were grieving, especially families with younger children. Healing Hearts was an answer to prayer. It aligns with our mission and is a perfect fit.”
38
NEW! Prisma Health–Upstate Foundation
Sickle cell donation BMW Manufacturing has made a generous $10,000 contribution to Prisma Health’s Comprehensive Sickle Cell Disease Program, the only program of its kind in the state. This type of community support enables the program to assist families with services that are not covered by insurance but that are just as important to their well-being.
Stepping up Check this out! As you can see above, our new name is Prisma Health– Upstate Foundation. We have a new suite number as well; 401, but remain at 300 E. McBee Ave. Prisma Health–Upstate Foundation 300 E. McBee Ave., Suite 401 Greenville, SC 29601 Our phone number and digital address stay the same: 864-797-7746 • PrismaHealthUpstateGiving.org
Clemson Miracle and University of South Carolina Dance Marathons recently competed in Rivalry Week. This annual competition between the two programs occurs the week before their football game. Throughout the week, students take part in recruitment challenges, fundraising pushes, proceeds nights, blood donations and social media engagement. This year, Clemson Miracle won the challenge. Save the date for the main events: Feb. 10. Visit clemsonmiracle.org for more information. Feb. 24 for University of South Carolina. Visit uscdm.org for more information.
Fetch your calendar here The Upstate’s 2024 Canine F.E.T.C.H. Unit calendar has nearly sold out. To purchase a copy and support this grrreat pack of facility dogs, text GOFETCH to 41444.
Children’s Miracle Network Hospitals campaigns Check out these partner campaigns that will benefit both of our Children’s Hospitals: • Costco: May • Dairy Queen: June–July • Walmart and Sam’s Club: June–July • Year-round Round Up at the Register: Panda Express, DQ, Love’s Travel Stops, Speedway, Ace Hardware
39
FOCUS EXTRA
Halloween celebration boosts spirits Children’s Hospital in the Midlands and Upstate each hosted Reverse Trick-or-Treat events to allow hospitalized children and their families to celebrate Halloween. Team members dressed in costumes to hand out candy and boost spirits, while children dressed as their favorite characters and enjoyed the festivities from their hospital rooms. “There’s a buzz of excitement throughout the hospital – it’s palpable when you walk through the front doors,” said Christy Fink, manager of Child Life and Special Programs at Children’s Hospital in the Midlands. “It’s just the morale boost needed to get us through respiratory and flu season when we typically see an increase in pediatric patients.” In the NICUs, felt overlays served as costumes. Parents there were grateful for this special treat. “Being in the NICU isn’t something anybody expects to happen,” one mom said. “At first, it feels incredibly overwhelming, but once the emergency dust settles, it hits that EVERY thing that every other mom gets to experience, you don’t, good and bad. Being able to participate in small things we once took for granted – such as Halloween – makes the time in the NICU feel less overwhelming and scary, and more like home.”
Children’s Hospitals directory Admission to Children’s Hospital (Midlands): 1-800-757-4625 Children’s Hospital (Midlands) general information: 1-803-296-KIDS (5437) Caughman Taylor, MD, Senior Medical Director ..... 803-434-7950 Allergy and Immunology ............................................... 803-434-3560 Anesthesiology ................................................................ 803-434-6151 Cardiology ........................................................................ 803-434-7940 Child Abuse and Neglect .............................................. 803-434-3950 Child Developmental and Behavioral Health ........... 803-434-6598 Cochlear Implant Program ........................................... 803-744-2700 Couplet Care (Richland)................................................. 803-434-7400 Critical Care/PICU .......................................................... 803-434-4603 Day Hospital/Sedation .................................................. 803-434-7954 Dentistry ............................................................................ 803-434-6567 Dermatology .................................................................... 803-434-7995 Emergency Department (Pediatrics) .......................... 803-434-6683 Emergency Medicine ..................................................... 803-434-7088 Endocrinology.................................................................. 803-434-7990 Family Beginnings (Baptist) .......................................... 803-296-5148 Family Beginnings (Baptist Parkridge)......................... 803-907-3500 Gastroenterology ............................................................ 803-434-8450 General & Hospital Pediatrics ...................................... 803-434-7945 Genetics ............................................................................ 803-935-5390 Gynecology ...................................................................... 803-434-4480 Hematology/Oncology ................................................. 803-434-3533 Inpatient Pediatrics (Tuomey) .......................... 803-774-9225/9226 Neonatology/NICU (Baptist)......................................... 803-296-5709 Neonatology/NICU (Richland) ..................................... 803-434-7151 Neonatology/NICU Level II (Tuomey) ........................ 803-774-9006 Nephrology ...................................................................... 803-434-3572 Neurology ......................................................................... 803-434-7961 Neurosurgery ................................................................... 803-434-2700 Newborn Nursery (Tuomey) ......................................... 803-774-9006 Ophthalmology ............................................................... 803-434-2020 Orthopedics ..................................................................... 803-296-9200 Pharmacy .......................................................................... 803-434-3040 Psychiatry .......................................................................... 803-434-4300 Pulmonology ................................................................... 803-434-2505 Radiology .......................................................................... 803-434-2168 Rehabilitation Medicine ................................................. 803-434-1824 Research ........................................................................... 803-434-3109 Rheumatology ................................................................. 803-434-7995 SCCAMRS ......................................................................... 803-434-3822 Special Care Center ...................................................... 803-434-1299 Special Care Nursery (Baptist Parkridge) ................... 803-907-3400 Sports Medicine/Concussion ...................................... 803-434-7995 Surgery .............................................................................. 803-434-4555 Travel Clinic ...................................................................... 803-434-2233 Urology ............................................................................. 803-434-4555
Admission to Children’s Hospital (Upstate): 864-455-0000 Neonatal Transport: 864-505-1481 Children’s Hospital (Upstate) doctor/program: 1-800-4RBUDDY Robin LaCroix, MD, Medical Director ......................... 864-455-3512 Adolescent Medicine ..................................................... 864-522-4888 Allergy, Immunology and Asthma ............................... 864-675-5000 Ambulatory Pediatrics .................................................... 864-522-5220 Anesthesiology ................................................................ 864-522-3700 Bradshaw Institute for Community Child Health & Advocacy ................................................................. 864-454-1016 Cardiology ........................................................................ 864-454-5120 Child Abuse Pediatrics ................................................... 864-331-0560 Child Psychiatry & Psychotherapy .............................. 864-454-5612 Critical Care/PICU .......................................................... 864-455-7146 Developmental Pediatrics ............................................. 864-454-5115 Emergency Medicine ..................................................... 864-455-6015 Endocrinology ................................................................. 864-454-5100 Ferlauto Center for Complex Pediatric Care ............ 864-522-5280 Gastroenterology ............................................................ 864-454-5125 Genetics ............................................................................ 864-250-7944 Gynecology ...................................................................... 864-455-1600 Hematology/Oncology ................................................. 864-455-8898 Infectious Disease ........................................................... 864-454-5130 Infusion (Oconee) ........................................................... 864-482-3300 Inpatient Newborn Care (Greer) .................................. 864-797-8700 Inpatient Newborn Care (Patewood) ......................... 864-797-1301 Inpatient Pediatrics (Anderson) ......................... 864-512-4923/8292 Inpatient Pediatrics (Greenville) ................................... 864-455-1765 Inpatient Pediatrics (Oconee) ...................................... 864-482-3300 International Adoption Clinic ....................................... 864-454-5130 Minor Care (Greenville): Children’s Hospital After-hours Care ......................................................... 864-271-3681 Neonatal ICU ................................................................... 864-455-7165 Neonatal Intermediate ................................................... 864-455-6410 Nephrology & Hypertension ........................................ 864-454-5105 Neurology ......................................................................... 864-454-5110 Neurosurgery ................................................................... 864-797-7440 Newborn Services ........................................................... 864-455-6265 Ophthalmology ............................................................... 864-522-3900 Orthopedics ..................................................................... 864-797-7060 Otolaryngology ............................................................... 864-454-4368 Pain Medicine .................................................................. 864-522-4880 Plastic Surgery & Aesthetics ......................................... 864-454-4570 Psychology ....................................................................... 864-454-5115 Pulmonology ................................................................... 864-454-5530 Radiology ............................................................. 864-522-XRAY (9729) Rheumatology ................................................................. 864-454-5004 Sleep Medicine ................................................................ 864-454-5660 Supportive Care Team ................................................... 864-546-8955 Surgery .............................................................................. 864-797-7400 Travel Clinic ...................................................................... 864-455-9033 Urgent Care (Anderson) ................................................ 864-512-6544 Urology ............................................................................. 864-454-5135 41
Rollin’ Tigers add varsity team Prisma Health established the first youth wheelchair basketball team in South Carolina in 2017: Roger C. Peace Rehabilitation Hospital’s Rollin’ Tigers. In 2023, that Upstate team won the Prep Division (up to age 13) of the National Wheelchair Basketball Association! The Rollin’ Tigers are excited to announce that they have added a Varsity Division for anyone age 13–18 with a permanent lower limb disability! Varsity rules include: • Transitioning to a 10-foothigh goal • Adding a 30-second shot clock • Extending game length • Using a full-court press
Varsity team with coach and Prisma Health Child Life Specialist Lindsey Metz, MA, strategize before the group’s first game, which took place in North Carolina, in October.
Here’s how you can help support these teams, which rely heavily on philanthropic funding: • Spread the word – we are looking for new players to join our two teams. • Learn more – find us on Facebook or email Danielle.fitzmorris@prismahealth.org. • Help with team expenses, which are covered by generous donors and parents of participants. Costs for tournaments, hotels and specialized sports wheelchairs continue to rise, and we never want finances to be the reason why an athlete cannot take part.
To make a donation, text “RollinTigers” to 41444. For Children’s Hospital giving opportunities, contact: Prisma Health Midlands Foundation at 803-434-7275 or PrismaHealthMidlandsFoundation.org Prisma Health–Upstate Foundation at 864-797-7732 or PrismaHealthUpstateGiving.org
Coming soon: Oconee Memorial Hospital opens a Level II NICU!