Kentucky Children's Hospital

LEXINGTON, Ky. (May 7, 2013) - The following column appeared in the Lexington Herald-Leader on Sunday, May 5.

By Dr. Patrick O'Donnell

There are two types of bone cancers. Primary bone cancers (sarcomas) are the rarest type of human cancer and probably affect fewer than 100 Kentuckians per year. Metastatic cancer which spreads to the bone is much more common, and often originates in the prostate, breast, thyroid, kidney or lung.

Bones have a complex network of cellular types, so primary bone cancer can develop in cells designed to make bone itself (osteosarcoma), cartilage (chondrosarcoma), fibrous tissue (spindle cell sarcoma of bone), or the marrow elements (multiple myeloma). There are also other types of tumors which occur in bone which we haven’t fully characterized, such as Ewing’s sarcoma of bone.

How does bone cancer develop?

Any bone in the body can develop a cancer, but bones that grow the fastest (like the knee and the shoulder) have a higher risk for cancer. Additionally, specific types of bone cancer are common in certain areas. For example, Ewing’s sarcoma of bone tends to occur in the flat bones of the pelvis, shoulder girdle, and spine, while osteosarcoma and chondrosarcoma typically occur in the limbs.

There are some genetic syndromes that predispose patients to develop certain types of bone cancer, but most cases are sporadic. There is no association between bone cancer and lifestyle or environmental factors. Most cases of bone cancer are just genetic bad luck.

How is bone cancer treated?

The two types of bone cancer are treated differently. For primary bone cancers that haven’t metastasized, we have an opportunity to cure the patient with appropriate care.

Treatment for primary bone cancers typically involve a combination of chemotherapy and surgery. These are the rarest and most aggressive types of human cancer, and surgery to remove them is carefully planned.

Think of the cancer like the fruit of an orange — these cancers are so aggressive, they have to be removed with a “rind” of normal tissue completely surrounding the tumor so that the cancer doesn’t see the light of day during surgical excision.

These surgeries are difficult due to the complex anatomy of the skeletal system — the location of the cancer can mean that you are only millimeters away from major blood vessels or nerves that serve other areas of the body.

Twenty years ago, bone cancer was treated with amputation more than 90 percent of the time.

Today, with advanced surgical techniques, limb-salvage surgery is the treatment of choice. After removing a section of bone from the body, we have developed internal prosthetic devices which can restore function for children, young adults and adults who have been afflicted with bone cancer. These truly “robotic” internal prostheses can restore leg length, gait, and can even grow with a growing child.

When a cancer spreads to the bone from another organ, however, the ability to “cure” that cancer decreases drastically. As such, treatment of metastatic cancer to bone typically involves improving the quality of life by decreasing pain and improving patient function.

Dr. Patrick O’Donnell is an orthopaedic oncologist for UK HealthCare.

LEXINGTON, Ky. (April 23, 2013) - The following column appeared in the Lexington Herald-Leader on Sunday, April 21.

By Dr. Jamie Pittenger

April is National Child Abuse Prevention Month, and unfortunately, Kentucky is one of the worst states for child abuse and child deaths due to non-accidental trauma.

Each year in Kentucky, there are more than 14,000 substantiated reports of abuse and neglect. The result is that Kentucky averages 30 to 40 child deaths each year involving abuse and neglect, with another 30 to 60 near fatalities annually. Child abuse does not discriminate based on race, religion, or socioeconomic status.

The aftermath of physical abuse usually requires ongoing treatment and therapy, and often results in irreversible brain damage and limits on cognitive development, causing lifelong learning and socialization challenges.

The financial resources to treat the physical and psychological needs of victims of child abuse are often derived from state-funded programs generated and maintained from taxpayers’ dollars; not to mention the staggering monetary drain it takes to prosecute, incarcerate, and rehabilitate perpetrators of child abuse.

Child abuse hurts everyone. So, how can parents, teachers, relatives, friends and other caregivers help to prevent child abuse?

• Know how to spot the signs of abuse. Young children are not able to report abuse, and older children may be too afraid to do so. Bruising is an important warning sign for child abuse for infants and children. For a non-mobile infant, bruising of ANY KIND is not normal. For a child of any age, bruising to the ears, neck, torso, buttocks or genitals should raise concerns. If you see bruising, seek immediate medical attention for the infant or child.

• Be aware of steps to staying in control to prevent abuse. It is normal to feel frustrated when a baby or young child cries, but crying is the way they communicate. If you are feeling frustrated or angry, take a break. It’s OK to leave the baby in a crib or other safe place while you take a moment to regroup.

• Use extreme care when deciding who can watch your child. If you don’t have total and complete trust in the person, then don’t trust him or her with your child.

• Know how to report child abuse. Federal and state laws require that you report any suspected child abuse, and you have several options to do so.

•  In situations involving children in immediate danger, call 911 or the local emergency number. In Kentucky, if you need an immediate response to your report, call the Kentucky Child Protection Hotline toll free 24/7 at 877-KYSAFE1 (877-597-2331). Anonymous calls are accepted. To report non-emergency situations that do not require an immediate response, you can use the web-based reporting system at https: //prd.chfs.ky.gov/ReportAbuse from 7 a.m.-3:30 p.m. Monday-Friday, except for state holidays. Anonymous reports are accepted.

• Finally, know where to find good sources for more information about resources and child abuse prevention. In Kentucky, contact Prevent Child Abuse Kentucky at 859- 225-8879, toll free at 1-800-244-5373, or PCAKY.org.

The Childhelp National Child Abuse Hotline, staffed with professional counselors, is available 24/7 at 1-800-422-4453 or Childhelp.org.

Dr. Jaime Pittenger is an assistant professor of pediatrics at the University of Kentucky and a physician at Kentucky Children’s Hospital.

LEXINGTON, Ky. (March 26, 2013) - March 3, 2013, is a day Heather and Dustin Stephens will never forget. Ever.

Their 6-week-old son, Kasen, had been sick. He had a cough that just would not stop. The worse his cough became, the more trouble Kasen had breathing. He had not spiked a fever, but they knew something was wrong.

So they decided to take Kasen to Baptist Regional Hospital in Corbin, where he was diagnosed with pneumonia. Kasen's breathing worsened, and doctors decided Kasen needed to be transported to the Kentucky Children's Hospital (KCH) for care. Heather and Dustin would follow the transport to Lexington.

As the KCH pediatric/neonatal transport team loaded Kasen into their specialized pediatric ambulance, they told Heather and Dustin that if anything happened while they were traveling - if Kasen's situation worsened - the driver would pull the ambulance over to the side of the road. If that happened, Heather and Dustin were to stay in their car and wait for information from someone in the ambulance.

About 15 minutes into their trip to Lexington, Heather and Dustin saw the ambulance pull over. Heather says at that point, everything became a fog.

Dustin jumped out and ran to the ambulance. Heather followed him. When they got to the ambulance, they witnessed the team performing CPR on their tiny baby.

The next moment was unfathomable for Heather.

"Kelly (Turner, of the transport team) said 'you're going to get in this ambulance, and you're going to kiss your baby'." Heather said. "I thought that would be the last time I kissed him, but it wasn't."

What followed was the longest drive of Heather's life, she said. Members of the transport team called Heather regularly throughout the rest of the trip to let her know that Kasen was doing well.

***

The Kentucky Kids Crew - the Kentucky Children's Hospital's pediatric/neonatal transport team - provides inter-facility (hospital-to-hospital) critical care transportation for both neonatal and pediatric patients. They are the only transport team in the region exclusively dedicated to transporting newborns and children.

The team is dedicated to pediatric and neonatal transport 24 hours a day, seven days a week, and 365 days per year. The team averages 700 transports a year in a service area that includes Kentucky, West Virginia, Ohio and Tennessee.

Kasen was one of the dozens of pediatric patients transported by the Kentucky Kids Crew this month. The Kentucky Kids Crew's Facebook page is filled with comments from appreciative parents,

For Heather, this experience was life changing. If not for the Kentucky Kids Crew, Heather says, she is certain Kasen's outcome would have been different.

"If it hadn't been them - a team that is specialized in what they do - I think we would have attended Kasen's funeral instead of bringing him home," Heather said.

The Kentucky Kids Crew is led by neonatologists and pediatric intensivists and includes:

• Critical care nurses trained in advanced procedures such as intubation, chest tubes and umbilical line placement

• Emergency medical technicians (EMT) who drive the ambulances used for ground transport

• Air Methods of Kentucky, which provides pilots and helicopters used for air transport

• A dedicated transport team on duty 24 hours a day, ready to be mobilized immediately when a referring facility calls

The transport team utilizes state-of-the-art ambulances, helicopters and other equipment specially designed to meet the needs of our young patients.

The team vehicles are equipped as mobile intensive care units that enable the team to provide neonatal and pediatric critical care. They are a close-knit team that encourage and support each other in their roles and exemplify the mutual respect that encompasses Kentucky Children’s Hospital. 

In January, the Kentucky Kids Crew transported 88 patients - the most in a single month since December of 2006.

"Research shows that transporting these fragile patients requires an experienced team and access to specialized vehicles and equipment,” said Dr. Scottie Day, medical director of the Kentucky Children's Hospital pediatric/neonatal transport team. "As a parent, you can rest assure that when we arrive at outside facilities, we bring the cutting-edge intensive care capabilities of KCH.” 

The team is also involved in other endeavors beyond the transport and stabilization of neonatal and pediatric patients. In January of 2012, the Kentucky Children's Hospital joined six other children's hospitals to form the first-ever national consortium to benchmark and set guidelines for quality and safety on critical care transports.

***

On March 14, after 12 days in the Kentucky Children's Hospital, Kasen went home.

As Kasen continues to get stronger and grow, Heather remains thankful for the people who were there to care for Kasen during such a difficult time.

"They saved his life," Heather said. "They were God-sent for sure."

The Kentucky Children's Hospital pediatric/neonatal transport team members are: Debbie Rice, Tina McCoy, Kimberly Samuelson, Kelly Turner, Kate Fletcher, Yoshiko Ishmael, Caty Curlis, Alissa Richey, Jennifer Moore, Carrie Shepperson, Terry Nalle, Erin Willis, Lynne Kain and Shelly Marino. EMTs and Paramedics from the UK Emergency Communications Office drive the ambulances and assist the nurses when necessary in patient care.

LEXINGTON, Ky. (March 18, 2013) - Dr. Scottie Day, director of the Kentucky Children's Hospital Transport and Outreach Program and assistant professor of pediatric critical care in the UK College of  Medicine, has been appointed to a national Expert Work Group charged with developing pediatric quality metrics for the Pediatric Intensive Care Unit (PICU).

This Expert Work Group has been charged with developing and/or enhancing measures for the Pediatric Intensive Care Unit (PICU) that will be proposed for national endorsement by the AHRQ-CMS Children’s Health Insurance Program Reauthorization Act (CHIPRA) Pediatric Measurement Center of Excellence (PMCoE). 

"Honestly, it is such a privilege to be selected to work on this project not just as a representative of Kentucky Children's Hospital, but as an advocate for the children of the commonwealth - the place where I grew up and now call home," Day said.

This pediatric-focused project is a broad collaborative effort comprised of the Medical College of Wisconsin, the American Board of Medical Specialties, the American Board of Pediatrics, Northwestern University, Thomson Reuters Healthcare Inc., and the American Academy of Pediatrics. The Pediatric Critical Care Unit is one of three targeted areas for this second year of the multi-year project.  The actual PICU effort is being led by the Medical College of Wisconsin on behalf of PMCoE, and the American Academy of Pediatrics is providing key administrative support.

The long-term goal for this project is to advance and improve children’s healthcare quality measures that make a difference by both informing policy decisions and actual clinical performance in the inpatient and ambulatory settings using proven methodologies to achieve this broad goal.  This proposal has numerous aims.

The PMCoE PICU Expert Work Group will focus primarily on the following:

• Review of existing measures and supporting data including evidence, gaps, and data for impact
• Refine existing measures
• Measure development and enhancement
• Measure testing and re-evaluation in preparation for national endorsement

The approach used will follow the AMA-Physicians Consortium for Performance Improvement Roadmap for developing quality measures in collaboration with the key project personnel from the eight major national organizations identified above including the AAP.

The PMCoE PICU Expert Work Group will convene for an initial face-to-face meeting on April 8 at AAP headquarters in Elk Grove Village, Ill. The Expert Work Group consists of 21 individuals representing multiple disciplines, including critical care medicine physicians, nurses, family representatives and program leaders. The extensive selection process included efforts to represent diversity and broad-based constituency with considerations for individuals’ experience, quality training, unit and institution size, volume, type, acuity, locations specific to region as well as factors such as metropolitan, suburban, or rural in nature.      

LEXINGTON, Ky. (March 8, 2013) – Kentucky Children’s Hospital is taking part in Chili’s Pepper Partner Program for the entire month of March. When customers bring in a Chili’s Pepper Partner Program coupon for Kentucky Children’s Hospital, 10 percent of the purchase, excluding taxes, will benefit the hospital.

Coupons can be obtained on the web at www.givetokch.org and on the Kentucky Children’s Hospital facebook page. Coupons can be downloaded for printing or displayed on a smart phone at time of purchase. Coupons can also be ordered by phone at (859) 257-1106.

Participating Chili’s include two Lexington locations, 2851 Richmond Road and 108 Market Place Drive. One Frankfort location is also participating, 345 Leonardwood Drive.

The two Lexington Chili's Restaurants accept the UK Plus Account for students who wish to participate.

MEDIA CONTACT: Kristi Lopez at (859) 323-6363