kid’s health news...kid’s health news EAST BAY CHILDREN’S SPECIALTY HIHLIHTS In ThIs Issue 2016 |ol.V 1 No. 3Calendar Deciphering the CBC featuring Jay Balagtas, MD PICU Case

Kid’s Health NewsEast Bay ChildrEn’s spECialty highlights

In ThIs Issue2016 | Vol. 1 No. 3

Calendar □ Deciphering the CBC featuring Jay Balagtas, MD

□ PICU Case Presentation featuring Budi Wiryawan, MD

healTh TeChPICU Simulators

PersPeCTIvePediatric Hematology/Oncology featuring Jay Balagtas, MD

referral Info

InTroduCIngAmanda Sanders, MDDaria Thompson, MDAnisha Khaitan, MD

PEDIATRIC HEMATOLOGY/ONCOLOGY

What can the new John Muir Health + Stanford Children’s Health pediatric hematology/oncology program deliver to a community like ours? – continued inside

2016 | VOL. 1 NO. 3 1

PersPeCTIve PedIaTrIC heMaTologY/onCologY

“We bring academic-level, cutting-edge specialty care for children right to their front door. The program allows a family to stay in their own community, but still have access to the best possible care, during a crisis like a cancer diagnosis,” says Sadie Hannah, MS, nurse practitioner.

SADIE HANNAH, MS, NP SPEAKS WITH A YOUNG PATIENT Of THE JOHN MUIR HEALTH + STANfORD CHILDREN’S HEALTH PEDIATRIC HEMATOLOGY/ONCOLOGY PROGRAM.

What can the new John Muir health + stanford Children’s health pediatric hematology/oncology program deliver to a community like ours?

Jay Balagtas, MD, pediatrician and pediatric Hematology-Oncology specialist, says “Before we were here, our families had to go to Oakland, UCSF, or Stanford, and that is a bigger obstacle than people realize. In the first year of therapy for our patients, the children have to be seen frequently. For some appointments, they may be hospitalized for several days. For a lot of families, this is a real hardship. We cut out the hurdles, and provide the same standard of care for blood diseases and cancers as the more established children’s hospitals. We’re able to ease the burden on these families.”

This benefit was an enormous relief for the mom of one young leukemia patient, at the hospital recently for a follow-up visit. She says, “I have three children. Before, when my daughter was in the hospital, I would stay with her for a week at a time, and never see my other kids at all. Now, it’s completely different. We live close to the hospital, and it makes everything so much easier.”

Kid’s Health News met with Dr. Balagtas and Sadie Hannah to find out more about the new pediatric Hematology/Oncology program, based at John Muir Medical Center, Walnut Creek. Dr. Balagtas a graduate of New York Medical College, completed his internship and residency at the Naval Medical Center. His fellowship was at Lucile Packard

Children’s Hospital at Stanford. At UC Davis, he was Acting Chief of pediatric hematology/oncology for three years before returning to Stanford. Sadie Hannah comes to John Muir Health via a nursing degree from Sonoma State, followed by a pediatric hematology/oncology master’s degree and her NP degree from UCSF in pediatric acute care. She was at UCSF for five years, and has been at Stanford for six.

WhaT TYPes of CanCers do You TreaT?Sadie Hannah, MS, NP: We see most pediatric cancers: leukemia, brain tumors, solid tumors, osteosarcomas, Ewing sarcoma (a malignant bone tumor), rhabdomyosarcoma (a muscle tumor) and Wilms (kidney) tumor. We also see bleeding and clotting disorders, hemoglobinopathies such as Sickle Cell anemia and thalassemia, and bone marrow failure syndromes like aplastic anemia.

Dr. Balagtas: We can see patients from all those categories, and as we build the program, we will grow to fit more needs. We are able to see urgent new patients within 24 hours, sometimes even the same day, and can do routine consults in 24–48 hours.

WhaT are Your goals for The PrograM?Dr. Balagtas: We aim to increase the services that we can bring to this community. We want to provide 90 percent of what you can get at

a large children’s hospital. Though we may not have the infrastructure for certain things such as stem cell transplant, we will be able to provide standard therapy, and possibly get access to clinical trials for some patients.

Sadie Hannah, MS, NP: We want to be seen as a major resource in the community for the pediatric, adolescent and young adult population.

WhaT do You WanT oTher PhYsICIans To knoW abouT The Work You do here?Sadie Hannah, MS, NP: What is most gratifying is that we have a really close connection with our patients. It’s wonderful how available we can be to the patients in a smaller center. With our team, there are no barriers to communication. We all talk about the patients constantly.

Dr. Balagtas: We also have great continuity in care. Both of us trained and worked at large hospitals, where for patients, it may not be possible to see the same doctor and nurses at each visit. Here, we provide that continuity. We know our patients; we see them every week. We know their medical history completely — for instance, which particular nausea medications work for them.

WhaT Makes You MosT Proud of The Work You are doIng here?Sadie Hannah, MS, NP: We’re providing an incredible service. We’ve been at academic centers, and seen the patient experience at

huge centers far from here. We get to tailor the patient experience to what these patients and families need. Also, it has been great to build this program from the ground up. I’m proud of the staff here, they have fallen in love with this population, in terms of nursing, ancillary care, and pharmacy, and the administration is very supportive.

Dr. Balagtas: I’m definitely proud to see everyone come together to take care of these pediatric patients, and to provide exceptional care. The commitment has been there from day one from Stanford Children’s Health and John Muir Health. It’s been clear that the hospital and administration want to work together with us so that our patients can get the best possible treatment. From the patient standpoint, feedback has been very positive. Our patients frequently tell us how nice everyone is, and how their care feels personalized.

WhaT do You look forWard To In The fuTure?Sadie Hannah, MS, NP: We want to grow to meet the needs of this community, and the surrounding population. We’re in a unique position as opposed to a larger referral center. People live in this community and we are now able to create a community of survivors locally.

WE AIM TO INCREASE THE SERVICES THAT WE CAN BRING TO THIS COMMUNITY. WE WANT TO PROVIDE

90 PERCENT Of WHAT YOU CAN GET AT A LARGE CHILDREN’S HOSPITAL.

2 KID’S HEALTH NEWS 2016 | VOL. 1 NO. 3 3

John Muir Medical Center1601 Ygnacio Valley Rd, Walnut Creek, CA 94598

Thursday, 7:30 a.m. – 8:30 a.m. Epstein 1 Conference Room †

Calendar uPCoMIng evenTs

november*3 Management of Adolescent Depression, Arman Danielyan, MD10 Perinatal M&M Case Presentation, Rosa Won, MD and Kristin Hubert, MD

december*8 Pediatric Dermatology, Renee Howard, MD

15 Pediatric M&M – PICU Case Presentation,Budi Wiryawan, MD and Rusly Harsono, MD

January †*5 ADHD/Overmedicating, Lawrence Diller, MD

*12 Chronic cough in children, Pulmonary, Manisha Newaskar, MD

PEDIATRIC HEMATOLOGY/ONCOLOGY

deciphering the CbC (complete blood count) with dr. Jay balagtasWednesday, november 9, 2016 6:00 p.m. – 8:00 p.m.Hilton Concord HotelClub Room 1, 1970 Diamond Blvd, Concord, CA 94520CME credit provided | Valet or self-parking available (pre-paid)Dinner will be served – RSVP with dinner selection: pan seared salmon or filet mignonTo rsvP, contact:Beth Lannon — [email protected] or Sandra Stone — [email protected]

Pre-Conference: Integrative Medicine for the Pediatric Primary Care PractitionerTuesday, november 15, 2016 11:00 a.m. (registration begins at 9:30 a.m.)Mauna Lani Bay Hotel, Kohala Coast, HIfor registration and more information, go to: cme.stanfordchildrens.org

Popular Pediatric Clinical Topics 2016Wednesday, november 16 – friday, november 18, 2016 8:00 a.m. – 11:30 a.m.Mauna Lani Bay Hotel, Kohala Coast, HIfor registration and more information, go to: cme.stanfordchildrens.org

* Webinars | Webinars are available via the internet starting at 7:30 a.m.

sophisticated simulators help train staff in varied scenariosLaura B. Kaufman

Simulation-based learning has come a long way since the 1960s, when people learned cardiopulmonary resuscitation (CPR) from a soft plastic mannequin called Resusci Anne.

Incredibly sophisticated new mannequins are now being used effectively to improve patient care and safety through simulation-based learning.

At John Muir Health’s new PICU, two highly advanced simulators are helping staff train for both routine and crisis situations.

Budi Wiryawan, MD, PICU medical director, explains their value: “When we opened the PICU, we had one goal: to create a unit that, in time, will provide quality care with an increasing degree of complexity and acuity similar to any children’s hospital. We had the challenge of bringing a whole team - nursing staff, ancillary staff, respiratory therapists and others - to this level and sustaining it. We acquired simulation devices that are very detailed and complex, complete with heart and lung sounds that change, a range of skin tones, lips that can turn blue - even pupils that dilate - making them an excellent teaching tool.”

stanford’s resources Make the differenceDr. Wiryawan adds, “Because of our joint venture, we have Stanford’s world-pioneering simulation program for guidance,

and they have been providing ongoing training for us and the hospital staff.” Stanford has multiple laboratories, investigators and centers for immersive and simulation-based learning, including one at Lucile Packard Children’s Hospital Stanford.

“It’s very uncommon to have access to this technology in a community hospital,” says Deb Updegraff, nurse practitioner and clinical nurse specialist for the Pediatric Acute and Intensive Care units at John Muir Health. “We have a mannequin that’s approximately the size of a seven-year-old, and an infant-sized mannequin. Both can vocalize. The child can talk via a microphone. Symptoms are programmable to reflect the scenario diagnosis.”

According to Updegraff, “Our goal is ongoing skills training – cognitive, technical and behavioral – as we take care of an increasingnumber of sicker patients.”

Timing Can be everything“Simulating a pediatric Code Blue at 1:00 a.m. is different from simulating one during the day,” Dr. Wiryawan explains. “In this scenario, there would be one physician and three nurses on

duty. Therefore, we have developed code roles with an emphasis on team building and functioning. As we grow our service, we are incorporating resources outside pediatrics. Resources from the ED, the adult ICU and in-house pediatricians can help us solve manpower issues in pediatric emergencies. We’ve assigned them roles for a code – and train them. There is so much benefit to doing this when a patient is not at risk.”

He concludes that the advanced training, with Stanford’s resources, supports the PICU and clinicians in Walnut Creek and the Concord ED in their quest to fundamentally change local access to high-quality pediatric care. “We’re going beyond being a community pediatric center — creating safe, very high quality care. We’re the only community hospital with a PICU in Contra Costa County, and becoming increasingly capable of pretty much all pediatric subspecialties.”

“When I tell people what we have to offer, they say, ‘Really? You can do all that?’ We want the community to know that yes, we can do all that.”

† Starting in January 2017Thursday, 7:30a.m. – 8:30 a.m.Ball Auditorium, Lower Level

healTh TeCh PICu sIMulaTors


referral Info ChIldren’s sPeCIalTY servICes

Cardiology stafford grady, MdPhone: (925) 239-2900Fax: (925) 932-2456

106 La Casa Via, Suite 220Walnut Creek, CA 94598

Critical Carebudi Wiryawan, MdPhone: (925) 941-4580PICU Main Number:

(925) 947-5230

John Muir Medical Center1601 Ygnacio Valley RdWalnut Creek, CA 94598

dermatology Jennifer sorrell, MdPhone: (800) 995-5724Fax: (650) 721-2884

Wednesday


endocrinology suruchi bhatia, MdCristina Candido-vitto, MdPhone: (415) 600-0770Fax: (415) 600-0775

Monday, Thursday, Friday


gastroenterology sabina ali, Mdkelly haas, MdPhone: (925) 239-2900Fax: (925) 932-2456

Monday – Friday


hematology/oncologybyron smith, MdPhone: (925) 947-5272Fax: (925) 947-3337

Jay balagtas, MdJoan fisher, Mdsadie hannah, nPPhone: (925) 941-4144Fax: (925) 947-3208

Monday – Friday

John Muir Medical Center3-East, 1601 Ygnacio Valley RdWalnut Creek, CA 94598

hospitalist services (Pediatrics)lyn dos santos, MdPhone: (925) 941-4588Pediatric: (925) 876-0489Newborn: (925) 952-2903

John Muir Medical Center3A-P, 1601 Ygnacio Valley RdWalnut Creek, CA 94598

Infectious disease James McCarty, Mdsruti nadimpalli, MdReferral: (800) 995-5724Fax: (650) 721-2884

Thursday


neonatologykristin hubert, Mdnick Mickas, MdPhone: (925) 947-5350

John Muir Medical CenterNICU, 1601 Ygnacio Valley RdWalnut Creek, CA 94598

nephrologyelizabeth Talley, MdPhone: (650) 721-5807Fax: (650) 721-6685

Thursdays


neurology Candida brown, MdJonathan hecht, MdPhone: (925) 691-9688Fax: (925) 691-9820

Monday – Friday

400 Taylor Blvd, Suite 306Pleasant Hill, CA 94523

neurosurgery gerald grant, Md david s. hong, MdCamly slawson, nPPhone: (925) 239-2705Fax: (650) 736-4344

Monday & Thursday


orthopedics & sports Medicine Charles Chan, Mdscott hoffinger, MdJames Policy, Mdstephanie Pun, MdReferral: (650) 497-8263Fax: (925) 322-8492Physician Contact:

(510) 549-8480

Monday, Tuesday, Thursday, Friday


Christine boyd, MdCharles Chan, Mdscott hoffinger, MdReferral: (844) 416-7846Fax: (650) 497-8891

Monday – Friday

5000 Pleasanton AvePleasanton, CA 94566

otolaryngology Christi arnerich, Mdfrederick rosen, MdReferral: (925) 239-2900Fax: (925) 932-2456

Monday, Tuesday, Thursday, Friday


Pulmonology nancy lewis, MdPhone: (925) 239-2900Fax: (925) 932-2456

Tuesday – Thursday

diana Chen, Mdedward fong, Mdkaren hardy, MdManisha newaskar, Mderic Zee, MdPhone: (844) 724-4140Fax: (510) 457-4236

Monday, Friday


radiologyJohn Muir Medical CenterPhone: (925) 952-2701

1601 Ygnacio Valley RdWalnut Creek, CA 94598

rheumatology Imelda balboni, Mddana gerstbacher, MdReferral: (650) 723-3877Fax: (650) 736-4344

Wednesday


surgeryThomas hui, MdChristopher newton, MdWolfgang stehr, MdWendy su, MdPhone: (925) 239-2900Fax: (925) 932-2456

Monday afternoons


urology William kennedy, MdCathy Costaglio, nPsarah oppenheim, nPReferral: (800) 995-5724Fax: (650) 721-2884Physician Contact:

(650) 732-9779

Tuesday


Jeremy lieb, MdPhone: (925) 609-7220Fax: (925) 689-3298

2222 East St, Suite 250Concord, CA 94520


1400 Treat Blvd, Walnut Creek, CA 94597

First Class MailPresorted

U. s. Postage Paid

Palo alto, CaPerMit No. 1

abouT our ParTnershIP

Through our partnership, patients can now see Stanford Children’s Health specialists locally in the East Bay. When hospital-based care is needed, patients can be treated at John Muir Medical Center in Walnut Creek. It all adds up to: your patients can receive excellent quality specialty pediatric care, close to home.

johnmuirhealth.stanfordchildrens.org johnmuirhealth.com/ChildrensSpecialty

InTroduCIng

anIsha khaITan, Md

Specialty: Hospitalist Education: The Johns Hopkins University School of Medicine, Baltimore, MDResidency: The Children’s Hospital of Philadelphia, Philadelphia, PA

aManda sanders, Md

Specialty: Hospitalist Education: UCSF School of Medicine, San Francisco, CAResidency: UCSF - Department of Pediatrics, San Francisco, CA

darIa ThoMPson, Md

Specialty: Hospitalist Education: Tufts University School of Medicine, Boston, MAResidency: UCSF - Department of Pediatrics, San Francisco, CA

Documents

kid’s health news...kid’s health news EAST BAY CHILDREN’S SPECIALTY HIHLIHTS In ThIs Issue 2016 |ol.V 1 No. 3Calendar Deciphering the CBC featuring Jay Balagtas, MD PICU Case