Board of Directors James S. Bush

Chairman Dennis Ragsdale

Vice Chairman Michael Crabtree

Secretary/Treasurer Debbie Christiansen, M.D.Dawn Ford Steven HarbLewis Harris, M.D.Jeffory Jennings, M.D.Bob Koppel A. David Martin Dugan McLaughlinChristopher Miller, M.D.Alvin Nance Steve SouthBill Terry, M.D.Laurens Tullock Danni Varlan

Medical Staff Lewis Harris, M.D.

Chief of StaffDavid Nickels, M.D.

Vice Chief of StaffLise Christensen, M.D.

Secretary

Chiefs of Services John Buchheit, M.D.

Chief of Medicine Alan Anderson, M.D.

Chief of Surgery

Administration Bob Koppel

President Laura Barnes, R.N., M.S.N., C.N.A.A.,B.C.

Vice President for Patient Care Paul Bates

Vice President for Human Resources Joe Childs, M.D.

Vice President for Medical Services Rudy McKinley

Vice President for Operations Jim Pruitt

Vice President for Finance

A quarterly publication of East Tennessee Children’s Hospital, It’s About Children is designed to inform the East Tennessee community about the hospital and the patients we serve. Children’s Hospital is a private, independent, not-for-profit pediatricmedical center that has served the East Tennessee region for almost 70 years and is certified by the state of Tennessee as a Comprehensive Regional Pediatric Center.

Ellen Liston Director of Community Relations

David Rule Director of Development

Wendy Hames Editor

Neil Crosby Cover/Contributing Photographer

“Because Children are Special…”...they deserve the best possible health care given in a positive, child/family-centered atmosphere offriendliness, cooperation, and support - regardless of race, religion, or ability to pay.”...their medical needs are closely related to theiremotional and informational needs; therefore, the total child must be considered in treating any illness or injury.”...their health care requires family involvement,special understanding, special equipment, and specially trained personnel who recognize that children are not miniature adults.”...their health care can best be provided by a facilitywith a well-trained medical and hospital staff whoseonly interests and concerns are with the total health and well-being of infants, children, and adolescents.”

Statement of Philosophy East Tennessee Children’s Hospital

www.etch.com

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August 1, 2006

Dear Children’s Hospital,

My daughter, Isabella, is a Neonatal Intensive CareUnit graduate, and we are very grateful for all thatEast Tennessee Children’s Hospital did for us. Shewas born on 1/25/05 and discharged on 4/25/05.Isabella was born at 27 weeks and weighed 1 pound,5.7 ounces and was 12 3/4 inches long. We areblessed that she had none of the major complicationsthat are associated with being an extreme preemie.

In honor of her first birthday, we requesteddonations of scrapbook materials for the NICU andwere able to donate over $700 of these items to theNICU. We can’t say enough good things about thecare she received and the staff at the NICU. Manythanks, and we hope to be able to continue in ourown small way.

Tammie and Chuck HumphreyMaynardville

Special thanks from Children's Hospital

Children's Hospital would like to extend itsappreciation to The Pool Place, Kingston Pike inKnoxville, for graciously allowing us to shoot our cover and patient story photos for the Winter 2006 It’s About Children magazine at their Christmas store.

August 7, 2006

Dear Children’s Hospital,

My name is Melissa Voorhies. My daughter, RileyVoorhies, was born May 19, 10 weeks early. We had tovisit the Neonatal Intensive Care Unit, and they weregreat. My husband was deployed in Iraq when our littlegirl was born, so they [the NICU nurses] acted like myfamily and kept my spirits up when I was down. Theydid an awesome job. Riley got to come home one nightbefore Daddy had to go back to Iraq. Now she is 11weeks old and probably weighs over 8 pounds! Thanksyou guys!

Love,The Voorhies FamilyKnoxville

“Dear Children’s”“Dear Children’s”1

On The Cover: Meggi Weeks is ready for Christmas! Read her story on pages 4-5.

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On January 1, 2007, the Children’s Hospital

Auxiliary will change its name to Children’s

Hospital Volunteers.All volunteers will automatically become

members of the organization, which raises funds to

support some of the important services throughout

the hospital such as the Clothing Closet.

Throughout the year the volunteers host various

sales and coordinate an annual holiday greeting

card sale, which is their largest fundraiser.

The group recently made some adjustments in

their by-laws, policies and procedures, including

the name change, to strengthen the organization.

HELPING CHILDREN IS ‘IN THE CARDS’ THIS HOLIDAY SEASONChildren’s Hospital Auxiliary Annual Holiday Cards Now Available

With the holidays quickly approaching, people throughout East Tennessee are starting to makegift lists and plan family get-togethers. The East Tennessee Children’s Hospital Auxiliary has aneasy way to check one important task off that holiday “to-do” list – purchase the just-released2006 Children’s Hospital Auxiliary Holiday Card, and help thearea’s children at the same time.

This is the 42nd year Children’s Hospital’s Auxiliary has soldholiday cards to benefit the hospital.

Artist and Children’s Hospital Auxiliary member Jan Churchdesigned this year’s unique holiday card especially forChildren’s Hospital. Titled “Up on the Housetop,” thisseason’s card features a snowy rooftop scene with Santa’s sleighoverflowing with nostalgic holiday toys that stirs feelings ofexcitement and anticipation for the arrival of Saint Nick. Themessage inside the card is “Sending Good Wishes Your Way.”

The Children’s Hospital Auxiliary’s holiday cards are $1per card, can be sold in any quantity including box sets of 12cards for $12, and personalization is available on bulk orders.The cards are appropriate for both business and personal use.

Proceeds from the holiday cards will be used to support avariety of the Auxiliary’s programs at Children’s Hospital, allof which help to make a child’s hospitalization morecomfortable.

For more information or to place an order, send an e-mailrequest to wharalson@etch.com or call the Volunteer ServicesDepartment at Children’s Hospital at (865) 541-8136.

The Auxiliary Board of Directors also recently

approved a $50,000 gift to Children’s Hospital from

Gift Shop proceeds. The gift is being distributed as

follows: $15,000 to the Fantasy of Trees, $15,000 to

the Children’s Miracle Network Telethon, $11,500 to

the laboratory for a Aggram Modular System, $4,185

to the library for partial funding for an annual

subscription to CINAHL, $3,000 to Community

Relations for portable signage for special events and

$1,315 for the Open Door Endowment Fund.

By Bethany Swann, student intern

Bulletin Board

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Auxiliary changes name, gives gift to hospital

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Imagine being invited to a friend’sbirthday party and not being able to eat theparty food. Or going out to a restaurant andnot being able to order off the regular menu.Or having to pack a lunch for school everyday instead of ever buying a cafeteria lunchlike your friends.

For a child with gluten intolerance (alsocalled celiac disease), this is a daily reality.Ten-year-old Megan Weeks – Meggi – hasbeen living this way for just over a year,since her October 2005 diagnosis.

Now a fourth-grader at Knoxville’s WestHills Elementary School, Meggi hadexperienced a variety of health issues sincebirth. A happy, energetic baby, she struggledwith reflux as well as frequent ear infectionsthat tended to progress to sinus infectionsand even pneumonia. By age 5 she appearedto have outgrown some of the earlyproblems but was diagnosed with asthma.

She began seeing pediatric pulmonologistEduardo Riff, M.D., at Children’s Hospitalfor management of her asthma. When it didnot improve and Meggi (now age 7) began todevelop some digestive problems, Dr. Riffsuspected a connection to her earlier reflux andsuggested they have this problem re-examined.The Weeks chose to wait a little while to see ifthe problems would improve. Later, becauseMeggi was not showing improvement, herpediatrician, Gregory Swabe, M.D., ofKnoxville Pediatric Associates, referred her toYouhanna Al-Tawil, M.D., pediatricgastroenterologist at Children’s to see if she stillhad reflux. Testing revealed stage two reflux.Dr. Al-Tawil prescribed medication and dietarychanges, which helped but did not eliminateMeggi’s digestive problems.

For the next two years, Meggi usually saw anurse practitioner in Dr. Al-Tawil’s office.According to her mother, Alisa Weeks, “I didn’tthink my child was seriously ill. At Dr. Al-Tawil’s office, we often saw children who werevery seriously ill.” The family felt Meggi’sproblems with reflux were minor and couldeasily be treated without seeing Dr. Al-Tawil,enabling him to devote more time to hisseriously ill patients.

But one time they were scheduled insteadwith Dr. Al-Tawil, and he was concerned thatMeggi continued to have so many problems.He ordered a battery of new tests – six vials of

blood were drawn in the Children’s HospitalLaboratory, according to Meggi – to check forceliac disease, diabetes and a host of otherpotential problems.

Because of these tests, Meggi was diagnosedwith gluten intolerance and was immediatelystarted on a gluten-free diet. The family workedwith (and continues to work with) Mary SueWalker, Ph.D., R.D., L.D.N., a clinicalnutrition specialist in Dr. Al-Tawil’s office, tolearn about and practice the gluten-free diet.

Within two weeks of her dietary changes,her stomach aches and other digestive problemshad improved, her migraine headaches haddecreased in frequency and severity, and she feltsubstantially better overall. Only her asthmacontinued to be a problem.

Gluten is a protein that is found in wheat,rye, barley and possibly oats (until recently, oatswere a definite no-no for the gluten-intolerant,but recent studies suggest it may be OK,although the Weeks family keeps oats on theirbanned list for now). Gluten is found in manyunexpected places – not just food but alsocosmetics such as lipstick and school suppliessuch as Play-Doh. “At first, it seems like glutenis found in everything, but there are manythings that it is not in. I often say it is in almosteverything, but there isn’t anything we cannot

have,” Mrs. Weeks said.The keys to living gluten-free are avid label

reading and becoming familiar with productsand brands. Once you learn what is safe, youcan cook anything, Mrs. Weeks said. BecauseMeggi was diagnosed in October, the holidayswere fast approaching, and that required somesignificant adjustments. “Thanksgiving isactually easy,” Mrs. Weeks said. “It’s just thebread and stuffing that need adjusted, and lastyear we had crustless pies. Christmas is harderbecause of all the parties and social events –they are wonderful to attend, but we mustprepare our own food for each occasion. It’salready a busy time, and this makes us evenbusier.” (The Weeks have shared some gluten-free holiday recipes on the next page.)

When Meggi was first diagnosed, the Weekshousehold went completely gluten-free. Thatmeant that everyone – mom Alisa, dad Bill andbig sister Ali (age 14) – only ate what was safefor Meggi. After about three months, theyrelaxed the household rules a bit. One day Billwas preparing to go grocery shopping and askedif anyone wanted anything in particular. Meggisaid, “Get Ali some Pop-Tarts.” They were allsurprised that Meggi would be comfortablehaving something in the house she couldn’t eat,but Meggi said she was ready. Ali returns the

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MeggiMeggi

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favor by being sensitive to Meggi – “Aliwon’t eat something Meggi can’t have infront of her without asking Meggi if it’sOK,” Mrs. Weeks said.

Gluten intolerance is a geneticdisorder, and Mrs. Weeks believes she isthe parent who carries the affected gene.She has not been tested because shefollows the gluten-free diet so strictlythat the test result would not be accurate.But she’s confident she’s the carrier for avery simple reason – she had for manyyears experienced digestive problems ofher own with a different diagnosis, butthe problems ended and she ceased torequire medication when she beganfollowing the gluten-free diet. LikeMeggi, Mrs. Weeks follows the diet at all times, and all family meals are gluten-free. Mr. Weeks and Ali opt not tofollow the diet outside of the home.

Purchasing gluten-free products isboth difficult and costly, although in justthe past year it has become easier becausenew federal laws about food labelingrequire the eight major allergens to belisted on labels of products that containthose allergens. Because wheat, one ofthe eight allergens, is also off-limits tothose with gluten intolerance, this newlabeling system has proven very helpfulto families such as the Weeks.

Many foods must be cooked fromscratch; gluten-free convenience foods(such as baking mixes and frozen items)currently are available only in a limitedsupply, although such products areincreasing in number. Many gluten-freeitems cost more than their gluten-containing counterparts. The Weeksshop at such specialty stores asEarthFare, where a store employee tookthem on a tour to show them how tofind the special shelf labels identifyinggluten-free products; Go Nutrition,which also uses a special labeling system;and Nature’s Pantry, which stocks allgluten-free items together in one aisle.Food City in Bearden and Kroger inKnox Plaza are two major grocery storesthat have begun to carry a number ofgluten-free items, but they do not yetoffer a labeling system to make it easy toidentify the safe products.

Restaurants pose an entirely differentchallenge because there are no labels toread and the responsibility is placed insomeone else’s hands. The restaurantchains Outback Steakhouse, Carrabba’sItalian Grill, Bonefish Grill and P.F.Chang’s China Bistro all offer gluten-free menus and knowledgeable staff, sothese are where the Weeks typically eatout. Of course they are not inexpensive,nor are they fast. Some other chains –both fast food and casual dining – offergluten-free menus on their websites, butemployees in the individual restaurantstypically are not well-trained in gluten-safe food preparation, so the risk of crosscontamination is a problem.

After going so long on a gluten-freediet, Meggi can tell when she has eatensomething that does contain gluten —she is much attuned to the symptoms.She also clearly remembers how poorlyshe felt just a year ago, so she is carefuland conscientious to stick to her diet.

The Weeks are thankful for a greatdeal of support from their extendedfamily (all family functions are nowgluten-free), several friends and theCeliac Support Group, sponsored by Dr.Al-Tawil’s office (visit www.celi-act.comfor more information).

Meggi remembers some friends whocame to see her shortly after herdiagnosis. They brought her a bag ofnon-food gifts with a note that said,“There’s more fun things to life thanfood!” It’s a sentiment Meggi believes in.

They are also thankful for Dr. Al-Tawil and Dr. Riff and their office staffmembers; their pediatrician, GregorySwabe, M.D., of Knoxville PediatricAssociates; and Children’s Hospital.

“It is an amazing place of positive,caring, patient people,” Mrs. Weeks said.“Children’s Hospital has been wonderful.Everyone is extremely kind to all of uswhen we go there.”

What is gluten intolerance?Gluten intolerance (also called celiac

disease) is a digestive disorder that damagesthe small intestine and interferes withabsorption of nutrients from foods containinga protein called gluten.

What are the symptoms of gluten intolerance?

Symptoms vary from person to person —one person might have diarrhea andabdominal pain, while another person may be irritable or depressed. In fact, irritability is one of the most common symptoms inchildren. Symptoms can include:

• Gas • Recurring abdominal • Delayed growth bloating and pain• Chronic diarrhea • Pale, foul-smelling,• Osteoporosis or fatty stool• Fatigue • Unexplained anemia• Bone or joint pain • Weight loss or gain• Muscle cramps • Behavioral changes • Seizures • Recurrent miscarriage• Missed menstrual periods

(often because of excessive weight loss)• Infertility• Failure to thrive in infants• Tingling numbness in legs (from nerve damage)• Pale sores inside the mouth,

called aphthous ulcers• Tooth discoloration or loss of enamel• Itchy skin rash called dermatitis herpetiformis.

Source: The National Digestive DiseasesInformation Clearinghouse, a service of the NationalInstitute of Diabetes and Digestive and KidneyDiseases (NIDDK). The NIDDK is part of theNational Institutes of Health under the U.S.Department of Health and Human Services.

Old-Fashioned Pumpkin Pie2 eggs One 16-ounce can pumpkin3/4 cup sugar 1/2 teaspoon salt2 teaspoons pumpkin pie spice1 1/2 cups cream or nondairy substitute 1 cereal crust (recipe follows)

In a large mixing bowl, beat the eggs slightly. Add pumpkin, sugar, salt andspice. Stir together. Add the cream and mix thoroughly. Pour into the unbakedcrust. Bake in preheated 425° oven for 14 minutes. Reduce temperature to350° and bake another 45 minutes or until knife inserted in the center of thepie comes out clean. Cool.

Serve cold with whipped cream or whipped nondairy topping if desired.Makes 6 to 8 servings.

Source: Bette Hagman cookbook, The Gluten-Free Gourmet, Living WellWithout Wheat

Cornflake Crust 2 cups Gluten Free Cornflake, crushed (4 rounded cups before crushing it) 1 teaspoon cornstarch 1/2 cup melted butter1/3 cup sugar 1 teaspoon vanilla

Put all the ingredients together in a food processor, and mix until all flakesare crushed. Pat on two 9” pie plates, sprayed with Pam, and bake 8 to 10 min.at 350°F. Makes 2 crusts.

Old-Fashioned Sugar Cookies1 1/2 cups sugar 1 1/2 cups potato starch flour1 cup Butter Flavor Crisco 2/3 cup cornstarch4 egg yolks 2/3 cup tapioca flour1 teaspoon dried orange peel or vanilla 2 teaspoons baking powder1 teaspoon salt

In a large mixing bowl, blend the sugar and shortening. Add egg yolks andflavoring. Mix flours, baking powder and salt together and add to the firstmixture. This will seem crumbly, but work the dough with your hands untilyou can form balls.

Roll out dough on wax paper to about 1/8-inch thick. Cut into desiredshapes and transfer to greased cookie sheets. Bake in pre-heated 375° oven for8 to 10 minutes. When cool, frost if desired. Makes 6 dozen 2-inch cookies.

Note: Don’t be afraid to handle this dough. It does not toughen with handling.

Source: Bette Hagman cookbook, The Gluten-Free Gourmet, Living WellWithout Wheat

Rice Bread Stuffing1 large onion, minced 1 cup diced celery6 T (3/4 stick) butter or margarine 1 to 1 1/2 tsp poultry seasoning2 T minced parsley 6 to 8 cups gluten-free bread,1 to 1 1/2 cups chicken broth crumbled **Salt to taste

Sauté the onion and celery in butter until clear; add the poultry seasoningand parsley. Pour this mixture over the bread in a large mixing bowl. Stir untilblended, then add the broth, a little at a time, until the dressing is as moist asyou prefer. Add salt to taste. Makes enough to stuff a 10-12 pound turkey.

Seasoned Bread: If you are baking your gluten-free bread near the holidayseason, try putting the 1 to 1 1/2 teaspoons poultry seasoning directly into thedough for at least one loaf before you bake it. Try adding some dried mincedparsley, also. This seasoned bread will make excellent stuffing.

**The Weeks family uses Bob’s Mill gluten-free bread mix for this recipe, makingthe bread in a bread machine and adding the seasonings to the bread mix.

Source: Bette Hagman cookbook, The Gluten-Free Gourmet, Living WellWithout Wheat

Gluten-Free Recipes

1960s tree lighting at Miller’s DepartmentStore on Henley Street each December. Thenightly tree lighting began in 2004 at theevent’s 20th anniversary in honor of theKnoxville tradition. Local television and radio

personalities will join a hospitalpatient to light the tree eachevening.

Fantasy visitors will also havethe opportunity to win abeautifully decorated seven-foottree or one of five $500 gift cardsdonated by Target Stores ofKnoxville. The raffle tree will besurrounded by a variety ofelectronics, children’s toys andgames, holiday goodies and muchmore, valued at $5,000. Raffletickets are only $5 each and will beavailable at the Fantasy of Treesbeginning Wednesday, November22, at 9 a.m. They will be soldthrough 4 p.m. on Sunday,November 26. Winners will bedrawn immediately after ticketselling ends on Sunday afternoon.

Since 1985, Children’s Hospitalhas received overwhelmingcommunity support for its annualFantasy of Trees fund-raiser. Againthis year, hundreds of businessesand individuals have participatedin the Sponsor Program, which isinvaluable to the success of eachyear’s show.

Special events at the Fantasy ofTrees include:

Gala Preview PartyTuesday, November 21,

7-11 p.m.

Dance the night away at the season’s first andmost festive party! Enjoy cocktails, an eveningbuffet, a private preview and sale of designertrees and holiday accessories, and shopping inthe Holiday Marketplace. Festive attire isrequested at this black-tie-optional event.Tickets are $150 per person and must bepurchased in advance. Call the VolunteerServices and Resources Department at (865)541-8385 to purchase tickets. The gala is

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In 2006, it’s time for “O Christmas Treats”at the Knoxville Convention Center fromNovember 22 to 26 for the 22nd annualFantasy of Trees. The convention center’sexhibit halls will be filled with sweet holidaytreats in a magicalwinter wonderland,featuring more than300 designer-decorated items,entertainment,holiday shops andactivities for children.

Fantasy of Treesvisitors can strollthrough anenchanting winterforest of holiday trees,as well as enjoylooking at holidayaccessories, roomscenes, fireplacemantles, swags, doordesigns, tablecenterpieces, topiariesand “Adopt-A-Trees,”created and donatedby local students.Guests can alsomarvel at an array ofdelicious creations inthe GingerbreadVillage, crafted with avariety of ediblebuilding materials byarea bakers, chefs andchildren.

Each dayentertainers fromthroughout EastTennessee willperform at theFantasy Theater. Singers, dancers and otherentertainers will help visitors celebrate theseason by sharing their talents each day. Whileenjoying the trees, decorations, activities andentertainment, visitors also can shop at theHoliday Marketplace, where they will findholiday items ranging from children’s gifts andtoys to clothing and accessories to holidaydecorations.

A family-oriented event, the Fantasy of

Trees offers activities and fun for children of allages, including favorites such as the beautiful30-horse carousel and visits with Santa. Thisyear several new activities are featured,including Christmas Plates (children can

decorate a small holiday plate); Coaster Art(kids can color, paint and create holidaypictures on tiles for decorating their house);and Gingerbread Chef Wands (children candecorate their own magical gingerbread chefwand). New holiday boutiques have beenadded for adults, making it easy to shop foreveryone on your Christmas list.

Each evening the Fantasy of Trees will lighta Christmas tree commemorating the nostalgic

22nd Annual FFaannttaassyy ooff TTrreeeessto kick off holiday season November 22-26

sponsored by the Cazana Family andCommercial and Investment PropertiesCompany.

Babes in Toyland ParadeWednesday, November 22, 7 p.m.

Don’t miss the first and only indoor holidayparade of the season as children from area childcare centers show off their colorful costumeswhile parading to the sounds of a marchingband. The parade’s grand finale features SantaClaus and indoor “fireworks” provided by PyroShows, Inc. The parade is broadcast live onWVLT-TV Volunteer News at 7 p.m. and issponsored by Dollywood.

Santa’s Senior StrollFriday, November 24, 9-10 a.m.

Seniors and walkers of all ages can enjoy aone-mile walk through the splendor and sparkleof this year’s Fantasy of Trees. Tables will be setup at the end of the walk with information onhealth topics of interest to seniors. Best of all,seniors 55 and over get a half-price admissionof $4 to enjoy all of the Fantasy of Trees whenthey arrive during Santa’s Senior Stroll. (Thisdiscount cannot be combined with any otherdiscounts.) Santa’s Senior Stroll is sponsored byBaptist Senior Health Centers and KnoxvilleCoca-Cola.

Kris Kringle’s Kiddie PartyFriday, November 24, 10:30-11:15 a.m.

and 11:30 a.m.-12:15 p.m.

Join us for a free party just for preschoolersat the Fantasy Theater, expanded to includetwo fun sessions this year. Your little ones willenjoy children’s activities and entertainmentfrom Music-N-Motion, have photos madewith Shoney Bear, enjoy snacks and receive aholiday gift. The party is sponsored byKnoxville Pediatric Associates.

The funds raised at the Fantasy of Trees thisyear will purchase a variety of equipment for anew surgery suite at Children’s Hospital. Overthe past 21 years, the Fantasy of Trees hasraised nearly $4 million for the hospital.

This spectacular holiday event would not bepossible without the more than 148,000volunteer hours that make the Fantasy of Treesa reality year after year. Children’s Hospitalwould like to thank everyone who has helpedmake this event a success, ensuring Children’sHospital can continue to provide the best inpediatric health care to all of East Tennessee’schildren.

For more information about the 2006Fantasy of Trees, visit our Web site atwww.etch.com/fantasy.cfm.

2006 Fantasy of Trees co-chairs Stephanie Jeffreys and Linda Redmond and assistant co-chair Sarah Beth Carlon (l-r).

2006

Fantasy of TreesMajor Event

Sponsors

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Show TimesWednesday, November 22

9 a.m. to 9 p.m.

Thursday, November 23Thanksgiving Day

3 to 9 p.m.

Friday, November 249 a.m. to 9 p.m.

Saturday, November 259 a.m. to 9 p.m.

Sunday, November 26Noon to 6 p.m.

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Scott Brice, M.D.Age – 35Family – Wife, Sarah Brice; children Luke(7), Anna (4) and Janie (1)Name of Pediatric Practice – KnoxvillePediatric Associates, Clinch Avenue officePersonal Interests – running, biking and allsports

Academic Background/Prior Experience B.S. – Wofford College, Spartanburg,S.C., 1993M.D. – University of South Carolina,Columbia, S.C., 1998Internship – University of Tennessee,Knoxville, 1998-99Residency – UT-Knoxville, 1999-2001Other – Practiced pediatrics from 2001-06 in Greenwood, S.C.

Why Pediatrics? I enjoy watching childrenand adolescents grow physically anddevelopmentally. Pediatrics gives me anopportunity to work with patients and theirfamilies.

Greatest Influence – My father. He hasalways been a source of encouragement forme. He has a great passion for his work andmaintains a positive attitude. His integrityis without question. Those are all qualitiesof his that I have tried to emulate.

Philosophy – Each child is a special andunique gift and, as such, should be treatedwith care and respect.

Proudest Moment as a Pediatrician – I don’thave any particular moment that stands out.I’m proud to have the opportunity each dayto do something I enjoy.

Rob Schaerer, M.D.,F.A.A.P.Age – 30Family – Wife, Nikki; son Calvin (2) anda baby on the wayName of Pediatric Practice – LoudonPediatric Clinic, LoudonPersonal Interests – songwriting and musicperformance, golf, cooking and the BigOrange

Academic Background/Prior ExperienceB.S. – University of Tennessee,Knoxville, 1997M.D. – University of Tennessee,Memphis, 2001Residency – University of South Florida,Tampa and St. Petersburg, 2001-04Other – Board certification from theAmerican Board of Pediatrics, 2004

Why Pediatrics? Every day allows me theopportunity to care for and encourage ournext generation. Their innocence, energyand honesty are refreshing, amidst a busyworld and hurried days.

Greatest Influence – An unsuspectingpatient at St. Jude Children’s ResearchHospital, whose gleaming eyes showed memy future during a tour prior to medicalschool.

Philosophy – Always let our patients andtheir families know how much we care,maintain a fun and friendly officeenvironment, and never stop learning.

Proudest Moment as a Pediatrician – Being asked by close friends to care fortheir children.

Pediatrician Profiles

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There is no such thing as a “typical” day in a hospital.Day in and day out, patients enter our doors for care, buteach child is unique, and each experience is different.However, within each day at Children’s Hospital, thereare some common threads. One common thread is thetraining and experience of the hospital’s staff — nomatter what situation arises, our staff is skilled andprepared to meet the challenge. For the next several issuesof It’s About Children, we will profile some of our staffand highlight all our clinical areas. We hope it will giveyou a glimpse into life at Children’s Hospital.

SURGICAL SERVICESChildren’s Hospital meets a wide range of

pediatric surgical needs, from common outpatientprocedures such as tonsillectomies to morecomplicated procedures, such as reconstructivesurgery and neurosurgery. Children’s Hospital’sSurgical Services includes Outpatient and InpatientSurgery (both located on the hospital’s FourthFloor), and Anesthesia, Post-Anesthesia Care Unit(also known as the PACU, “wake up” room orrecovery room) and the Operating Rooms (all locatedon the hospital’s Sixth Floor).

These departments work together to make sureeach child’s surgery and recovery is as quick andpainless as possible. The physicians, nurses and othersurgical staff are trained in pediatric care.

Depending on the individual department’sfunction, staff in the Surgical Services departmentsinclude R.N.s, L.P.N.s, patient care assistants(PCAs), transporters, unit secretaries, surgicaltechnologists, sterile processing assistants, nurseanesthestists (C.R.N.A.s) and anesthesia technicians.

Liza GravesGraduating with a degree in Physical Education

and playing basketball at the University of Tennesseemay have been an unlikely starting point for PediatricNurse Liza Graves. Graves wasn’t sure what careershe wanted to have when she graduated, but sheknew it wasn’t teaching or coaching. But shortly aftergraduation Graves found her home at Children’sHospital; a friend suggested she consider a job atChildren’s, and 25 years later, she’s still here.

Graves first worked as an emergency tech whilegoing back to school to earn a Bachelor of Science inNursing from UT. After receiving her BSN, shemoved into Surgery, where she plans to stay until sheretires. As an operating room nurse, Graves primarilyworks with neurosurgery and plastic services but is

able to assist with all types of surgeries and is on-call at times.

One of Graves’ favorite memories is of a patientin the Hematology/Oncology Clinic, whichformerly was part of the Emergency Department.“All of the children really touch your heart, but onein particular, Brad, will always have a special placein mine,” Graves said. “He considered himself a‘country boy,’ and the rest of the patients were ‘cityslickers,’ as he called them.”

Traonna Smith

Traonna Smith chose to work as a patient careassistant/transporter at Children’s Hospital for manyreasons, but most importantly because she lovesworking with children. “I entered into this fieldbecause I’m a people person, and I enjoy helpingpeople,” Smith said.

Smith is a certified PCA/transporter in thePACU who is constantly improving her knowledgeand skills through various training. She participatesin in-services, CPR training and NetLearning(online employee continuing education programs).It’s Smiths’ primary task to assist the PACU nurseswith patients during the recovery period, and thentransport the patients back to their rooms whenthey are awake enough to leave the PACU. It isimportant to Smith to do her best to comfort andcare for “the little ones,” as she likes to call heryoung patients.

Tracey JacksonWhen Tracey Jackson began thinking about what

career she wanted to pursue, she knew she wanted aprofession that would keep her interest andcontinuously challenge her. Nursing was a perfectfit. Jackson graduated from nursing school ten yearsago with an Associate of Science Degree inNursing. While continuing to complete her degree,Jackson worked as a medical assistant. Critical carewas Jackson’s first interest and she began working asan ICU nurse at St. Mary’s Medical Center. “I lovedit, but I couldn’t get a schedule that was suitable forhome,” Jackson said.

The desire for a more flexible schedule ledJackson to apply for a position at Children’sHospital. Although pediatric nursing was not anarea Jackson ever expected to be in, she was hired in2000 and now it is her “home.” Jackson enjoys beingable to have fun while working hard in an

environment of “teamwork” to provide the best carepossible for Children’s Hospital’s patients andfamilies. “I work with a wonderful group of people,including management… I can’t imagine doinganything else,” Jackson said.

One of Jackson’s favorite memories is of the firstcritically ill child she cared for. Jackson worked withthis patient through a long and stressful recoveryand became very attached to him and his supportivefamily. “It was rewarding for me to see him go frombeing so critical to recovering without complicationsat all,” Jackson said.

Jackson now works as a Shift Leader on 4EastInpatient Surgery. She maintains and increases herskills and knowledge through Net Learning andannual competency skill days.

Amber Wilson

Amber Wilson, a unit secretary for OutpatientSurgery, chose a career in pediatric health carebecause of her love for children. Wilson wanted totake part in providing health care for children andhelping in every way that she could. “Every childwho comes in is as special as the next. They all needlots of love and special care,” Wilson said.

Wilson chose Children’s because she knew itwould be a wonderful place to work; prior to hercurrent position, she worked as a pharmacytechnician in the Children’s Hospital pharmacy.

“The people who work at the hospital are angels.I believe you have to be an angel to take care of sickkids,” Wilson said.

By Amandalynn Thomas and Bethany Swann, student internsLiza Graves with Jay Lucas, M.D.

Amber Wilson

Tracey Jackson

Traonna Smith

lifeA day in the of Children’s Hospital

Children’s News...

10

In August, leaders from Holston ValleyMedical Center in Kingsport announced areinvigoration of children’s services within theHolston Valley Regional Children’s Hospital andCenter.

The centerpiece of the sweeping initiative is agroundbreaking alliance with Children’s Hospital,the pediatric referral hospital for the region andthe only state-designated ComprehensiveRegional Pediatric Center in East Tennessee.

Because of this new alliance, 17 board-certifiedpediatric specialists will establish an office andbegin seeing patients at Holston Valley.

“Every year, 2,500 children from our region arereferred to Children’s Hospital for expert carethat, until now, has been unavailable in NortheastTennessee and Southwest Virginia,” said Dr.Richard Salluzzo, Wellmont Health System’spresident and chief executive officer. “Now,instead of asking children and their parents todrive two hours or more for care, we’re bringingthe pediatric specialists to these children. Workingwith the outstanding pediatricians, neonatologistsand pediatric specialists already on the HolstonValley staff, these physicians will delivercomprehensive pediatric care that is unmatched inour region.”

Specialists in pediatric endocrinology, pediatricgastroenterology, pediatric hematology/oncology,pediatric neurology, pediatric pulmonology andpediatric surgery will make regularly scheduledvisits to see patients at Holston Valley. Thespecialists’ office will be located within thehospital, and appointments will be available byreferral from a pediatrician or family-practicephysician.

“At Children’s Hospital, we are committed tomaking sure every child gets the medical attentionnecessary when faced with illness or injury,” saidBob Koppel, president and CEO of Children’s

Hospital. “For many years, Children’s Hospitalhas seen children who have been referred to usfrom Upper East Tennessee. This alliance withHolston Valley will allow us to assist even morechildren as we bring our talented and dedicatedpediatric subspecialists to Upper East Tennesseeand allow us to see children where they live andhelp them with unique medical needs. We areexcited about the opportunities that this bringsto help the children in this area live happier,healthier lives.”

Dr. Stephen Combs, a board-certifiedpediatrician and president of the Holston Valleymedical staff, said “Through the new

relationships we’ve announced, Holston Valleyis affirming its commitment to the children ofour region. As a pediatrician, I can think of nobetter investment for any hospital than aninvestment in the health of our children.

“I know I speak for all the physicians ofHolston Valley and East Tennessee Children’sHospital when I say I’d move mountains tomake life better for just one child,” Dr. Combsadded. “How wonderful it is, then, that thealliances we’ve formed and the programs we’vedeveloped will ease the pain and restore thesmiles of countless children in our community.”

Children’s Hospital forms alliance with Holston Valley

Children’s Hospital and Children’s HospitalHome Health Care were awarded a renewal oftheir three-year accreditation following asuccessful survey by the Joint Commission forthe Accreditation of Healthcare Organizations( JCAHO) during the week of August 21.

The JCAHO surveyed Children’s Hospital(including the Children’s Hospital RehabilitationCenter in West Knoxville) as well as Children’sHospital Home Health Care in Farragut over afour-day period.

The JCAHO is a private, not-for-profitorganization that seeks to improve the qualityof health care through the accreditation ofhealth care organizations. It began hospitalinspections in 1918, and today, the JointCommission surveys hospitals, health carenetworks, long-term care pharmacies,laboratories and organizations specializing inlong-term care, ambulatory care, behavioralhealth and home care.

In its preliminary report, the JointCommission survey team recommended athree-year accreditation — the longest periodoffered by the JCAHO — for the hospital andHome Health Care.

The surveyors were extremelycomplimentary of our organization, staff andthe care we provide to our patients and families.

The Children’s Hospital Laboratory had aseparate, successful survey in August.

2006 Joint Commission survey a success

Dr. Stephen Combs (left), President of the Holston Valley Medical Center medical staff, and Children’sHospital President Bob Koppel (right) at the Holston Valley press conference with Tony and CariCrawford and their children, Jake and Gracie. Both Crawford children were born prematurely atHolston Valley and have frequently sought pediatric specialty care at Children’s Hospital.

11

The quest for qualityChildren’s Hospital has a history of providing a

high quality of health care to our patients. Butexceptional quality requires exceptional effort. AtChildren’s, the quality of care is a prioritythroughout our medical center.

For that reason, Children’s Hospital places agreat deal of emphasis on instilling a “culture ofquality” in physicians and employees. According toLaura Barnes, M.S.N., C.N.A.A.,B.C., VicePresident for Patient Care Services, with employees,it begins with the hiring process. “We hire the rightpeople with the right skills and goals,” she said.Then it continues with the new employeeorientation process, with all areas of the hospitalworking continually to mentor the new employeeswith the goal of improving patient care.

Although the employees providing leadershipand support in quality improvement at Children’sHospital are Quality Management DepartmentDirector Alzena Abernathy and her staff, all hospitalstaff members play a role in quality improvement.

Quality issues can be identified by anyone – aphysician, a nurse, a tech, a housekeeper, anyonewho observes something that could be done betteror more safely. They report their suggestion, and if it is approved for action, a team is selected toimplement the plan. The suggestions mostfrequently pertain to quality and safety for ourpatients, but enhancing safety for our staff is also a priority.

At Children’s Hospital, quality improvementgoes beyond casual observation of something thatcan be improved. Children’s Hospital constantly ismonitoring quality in a number of ways, looking fortrends, new services, equipment or processesavailable elsewhere. Departments develop their ownquality improvement (QI) plans annually to helpthem continuously search for areas to improve.

One key element of the quality initiative atChildren’s Hospital was the establishment earlierthis year of the CSI team. CSI – not the networkTV series – stands for Children’s Safety Initiative.The CSI team members, representing all hospitaldepartments, meet monthly to review safety andquality issues and report to their peers. They provideeducation opportunities, poster presentations andother activities to help hospital staff remain up-to-date on policies, standards and expectations.

The Joint Commission for the Accreditation of Healthcare Organizations, which surveyedChildren’s Hospital in August, encourages hospitalsto have ongoing readiness by doing surveys on anunannounced basis (the hospital knows only the yearin which the survey will take place, but not the dayor even the month). Barnes said the goal of theJCAHO’s new unannounced surveys is, “Instead ofpreparing for the next survey, you are preparing forthe next patient.” When the JCAHO surveyedChildren’s Hospital in August of this year (see page10 for information on the survey), one question thesurveyors frequently asked employees was, “Whathave you done to improve care over the last year?”

The Medical Staff members of Children’sHospital also are very integral to the QI program.

They are involved in QI processes, in examining howwe deliver care to make sure it is of the highestquality, and serving on various Medical Staffcommittees that monitor the quality of care renderedto our patients. The committees have a variety offunctions (including Trauma, Infection Control,Pharmacy/Therapeutics, Acute Care, Department ofMedicine and Department of Surgery) and they allinclude QI. They all report monthly to the MedicalStaff QI Conference, currently chaired by JohnLittle, M.D., pediatric otolaryngologist.

Dr. Little said the community might be unawareof the degree to which Children’s Hospital works toenhance quality. “We watch for national alerts andtrends from other hospitals, especially children’shospitals, and we act on them to prevent problemshere,” he said. “We also encourage and solicit inputfrom hospital staff and the Medical Staff to identifyproblems or potential problems.

“We try to be proactive, not reactive,” he added.“We work to prevent things from occurring orrecurring when possible. It’s better to learn fromother hospitals’ problems or mistakes, rather thanresponding only when they occur at our institution.That’s why when we receive national alerts, we takepreventive measures” to avoid similar problems at ourmedical center.

The hospital also actively “benchmarks” itself,which is something of a report card where wecompare ourselves to other hospitals, particularly toother children’s hospitals. In neonatal care, Children’sHospital uses the Vermont Oxford scale, whichexamines a wide variety of neonatal indicators atvarious NICUs. We’re also part of BENCH, whichstands for Benchmarking Effort for Children’sHospitals. This is a group of about 30 children’shospitals across the country that benchmark againsteach other and learn best practices from each other.

Locally, Children’s participates in Knoxville AreaHealthcare 21 initiatives, where area hospitals sharepractices and work together to develop best practices.One example of an initiative from Healthcare 21 wasthe development of protocols for ventilator care todecrease ventilator-associated pneumonia. Inaddition, this group advanced the development ofRapid Response Teams (RRTs) to identify andaddress changes in patient status before the patientsreach a critical state. All area hospitals haveimplemented the teams. (See sidebar for moreinformation on the Rapid Response Team atChildren’s Hospital). Both of these Healthcare 21projects have been recognized by the state forimproving patient safety.

The hospital’s Board of Directors is ultimatelyresponsible to ensure that the QI process is thoroughand complete. The Quality Management Committeeof the Board meets quarterly to hear reports aboutthe processes and results of QI and makerecommendations for improvement. The board alsoprovides for resources and support necessary for theimplementation of plans, helps to evaluate plans’effectiveness and identifies 8-10 QI prioritiesannually for the hospital.

Rapid responseteams providebetter care forpatients

Rapid response teams (RRTs)represent one way Children’s Hospital isworking to provide the best care possiblefor each patient. In the past if a patient’scondition reached a critical state, a staffmember alerted a “code team” to race tothe bedside and care for the patient (a“code” is a life-threatening event for apatient). Since December 2005, rapidresponse teams have been available atChildren’s Hospital to interveneBEFORE a patient requires emergency care.

If a staff member is concerned andthinks a patient may be developing aproblem, or if that staff member needsassistance in evaluating a patient, therapid response team is called to assessthe patient and begin basic interventionsto slow or even prevent deterioration inthe patient’s condition. The rapidresponse team then notifies the patient’sphysician, reports its assessment of thepatient’s condition and receivesadditional orders from the physician.

At Children’s Hospital rapid responseteams are composed of a nurse from thePediatric Intensive Care Unit and aRespiratory Care professional. Eachteam member brings extensive expertisein pediatric critical care to the bedsidewith the goal of preventing emergencies.The teams are available 24 hours a day,seven days a week not only for responsebut also to provide education andsupport to other hospital staff. Theavailability of the teams is reassuring tonursing staff members, who know that ifthey feel the need for additional helpwith a patient, it is readily available.

Hospitals around the country, such asChildren’s, that have implemented RRTshave seen a decrease in their rates oflife-threatening events (“codes”).

by Meghan Alcorn, student intern

Safe SitterDates: December 9, January 6 and 20

Time: 9 a.m. to 3 p.m.

Safe Sitter is a national organization that teaches young adolescents safe andnurturing babysitting techniques and the rescue skills needed to respondappropriately to medical emergencies. Instructors are certified through SafeSitter nationally. Participants must be ages 11-14. This course is $18 per person.

CPRDates: December 4 and January 15

Time: 6:30-9 p.m.

This class will teach caregivers cardiopulmonary resuscitation and chokingmaneuvers. This class also gives general home safety advice and tips. This courseis $18 per person.

Class size is limited, so preregistration is required. All classes are offered inthe Koppel Plaza at Children’s Hospital, unless otherwise noted. For moreinformation or to register for any of these classes or to receive our free HealthyKids parenting newsletter, call (865) 541-8262.

Additional classes are being scheduled for 2007. Announcements aboutupcoming classes can be seen on WBIR-TV 10 and heard on area radiostations. Or visit our Web site at www.etch.com and click on “Healthy KidsEducation and News.”

Children’s Hospital’s Healthy Kids Campaign, sponsored by WBIR-TVChannel 10 and Chick-Fil-A, is a community education initiative of thehospital’s Community Relations Department to help parents keep their childrenhealthy.

12

Estate Planning...knowing when NOT to do-it-yourself

IncludeChildren’s Hospitalin your estate plans.Join the ABC Club.For more information,call (865) 541-8441.

Please send the free brochure titled “Personal Information Record.”

Name______________________________ Address__________________________________________

City___________________________ State_______ Zip_____________ Phone#(______)___________r Please call me at the phone number below for a free confidential consultation concerning planned giving.

r Please send me more information about deferred giving.

r I have already included Children’s Hospital in my estate plan in the following way:

__________________________________________________________________________

r Please send me information about the ABC Club.

Children’s Hospital Development Office • (865) 541-8441

Americans are a self-sufficient group. We takepride in our homes, with many people doing repairsor enhancements themselves. Home improvementstores sell the needed materials and offer classes andself-help books on topics ranging from building adeck to landscaping your yard.

But there is also a time you should not “do-it-yourself ” – when you are preparing your will. That isthe time you need the advice and counsel of yourlawyer. No preprinted form, “Will Kit” or computersoftware can take into account all of your individualneeds; only your lawyer can do that. Here is a brieflist of some things you can accomplish with your will:• Name the person(s) you trust enough to carry out

all your instructions after you are gone – yourExecutor, sometimes called your PersonalRepresentative.

• Specify whether your Executor is required to posta bond and file reports with the probate court.

• Document your wishes about a guardian to takecustody of your minor children.

• Instruct the guardian(s) how to use your moneyfor their benefit:

° Should they sell everything and put theproceeds in a trust to provide living andeducational expenses?

° You can give a specific asset – home, securities,land.

° After all other bequests, you can leave some orall of the remainder to a charity.

° You can name someone special to be honoredor memorialized by your gift.

Perhaps this list gives you an appreciation for thetask and helps you understand why the cookie cutterapproach of a “Will Kit” cannot meet all your needs.This is why your lawyer is so important to theprocess. Your lawyer can prepare a document thatprecisely accomplishes each of your wishes.Remember the amount you spend on legal fees issmall compared to the comforting security of asound plan and the great peace of mind you willhave when your will is complete.

We have a complimentary Personal InformationRecord booklet that will help you gather theinformation your lawyer needs to begin working on your will. Please use the form below and thebusiness reply envelope in this issue to request yourcopy. Or you can call Teresa Goddard, SeniorDevelopment Officer, or David Rule, Director of Development, at (865) 541-8244.

° What type of expenses do you wish to cover andwhat would you prefer not to spend money on?

° Are there certain items of sentimental value youwould like the guardian to keep and give to yourchildren when they reach a certain age?

° If there is money left after raising and educatingyour children, should it be turned over to themwhen they reach a certain age? If so, what age?And how should it be divided?

° Do you have special needs children who willrequire support into adulthood or perhaps forthe remainder of their lives?

• Specify how you would like to dispose ofeverything you have accumulated over yourlifetime:

° Your home and any other real property

° Your personal property – clothing, furnishings,china, family memorabilia, artwork, vehicles,firearms, quilts, etc.

° Your cash and investments• Name the people you wish to benefit and specify

what each person is to receive.• Name the charities you wish to support and

specify the amount going to each.

° You can list a certain dollar amount.

Upcoming Community Education ClassesUpcoming Community Education Classes

CCAALLEENNDDAARR OOFF EEVVEENNTTSS

13

JAMMIN’ IN YOUR JAMMIESJammin’ in Your Jammies is an annual event

designed to “cure those winter blues” and giveyoung families a weekend of affordable fun.The event will take place January 26-28 at theHoliday Inn Select, Cedar Bluff, and all theproceeds from the event will benefit Children’sHospital. A family of four can enjoy anovernight stay beginning with registration at 5 p.m. on Friday and concluding with ascrumptious Saturday morning brunch, ORthey can register at 5p.m. on Saturday andconclude their weekend with a Sunday morning brunch.

In the evening, families may participate in many activities, including games, a pajamacontest, dancing to music, and swimming in theindoor pool. The Jammin’ event wraps up thefollowing morning with brunch. The cost is$125 for a family of four, and additional guestsin a family are $25 each. This price includesone hotel room for one night, dinner, snacks,breakfast and all of the entertainment andgames. Star 102.1 radio will provide music forthe event. Call (865) 541-8608 for moreinformation or to register.

DANCE MARATHONUniversity of Tennessee students will dance

the night away at the 2007 Dance MarathonFebruary 23-24 at the Tennessee RecreationalCenter for Students (TRECS). DanceMarathon is completely run by students and is the largest philanthropy on the UT campus.Each year Dance Marathon raises around$100,000 for the Hematology/Oncology Clinicat Children’s Hospital.

Students will enjoy live music from localbands and learn a Dance Marathon dance to

perform at the end of the 14-hour celebration.Dance Marathon also features a children’scarnival for Children’s Hospital Hematology/Oncology patients. Before the event each year,prospective dancers raise funds for DanceMarathon. For more information, call (865) 541-8745 or visit www.utkdm.com.

STAR 102.1 RADIOTHONThe sixth annual Star 102.1 Radiothon

will take place March 1 and 2 at West TownMall. Marc, Kim and Frank from Star 102.1’smorning show will host the live event from 6 a.m. to 6 p.m. each day and encouragelisteners and those who stop by to make apersonal pledge to help Children’s Hospital.

Another way to help is to place a bidduring the Radiothon silent auction, whichwill feature a variety of items from local andnational companies and retailers. All fundsdonated will benefit Children’s HospitalHome Health Care and fund the CarePagesservice on the Children’s Hospital Web site.Call (865) 541-8457 for more information.

“CUTEST LITTLE BABY FACE”CONTEST

The 17th annual “Cutest Little Baby Face”contest will kick off March 10 at Belz FactoryOutlet World in Pigeon Forge. The contest isopen to children ages 6 and younger, withGary Woods Photography in Sevierville takingphotos of participating children. Contestantsmay pre-register by completing a registrationform at the outlet mall or by calling theChildren’s Hospital Development Departmentat (865) 541-8745.

The entry fee for pre-registration is $5,and registration at the event is $7. The fee

includes a 5x7 portraitof the participatingchild taken by GaryWoods Photography.Pictures will be takenon March 10 and 11.Voting will take place atBelz on March 23 and24; $1 donation toChildren’s Hospital willcount as 100 votes. Thechild with the mostvotes wins and will beannounced on March24 during the “BabyFace Parade.”

B97.5 CHARITY BREAKFASTJoin B97.5 for a delicious breakfast,

entertainment and silent and live auctionsbenefiting Children’s Hospital. Local andnational celebrities will provide entertainmentfor the event. The spring date and location areto be announced. Tickets are $10 at the doorfor adults and children ages 13 and over; $5 forchildren ages 8-12; and free for children ages 7and under.

By Amandalynn Thomas, student intern

U P C O M I N G E V E N T S T O B E N E F I T C H I L D R E N ’ S

Mark your calendars now for several upcoming events to entertain families and benefit Children's Hospital. Thanks to the generous people of East Tennessee who host and participate in these events, Children's Hospital

can continue to provide the best pediatric health care to the children of this region.

CCAALLEENNDDAARR OOFF EEVVEENNTTSS

It’s time to buy a Children’sHospital license plate!

The Children’s Hospital specialty license plate is indanger of being abolished by the state due to lownumbers of plate holders.

The minimum number to maintain a specialty plateformerly was 500 license plates, but the state increasedthe minimum in 2005 to 1,000. Currently, only 800Children’s Hospital plates are registered.

Children’s Hospital must reach and maintain at least1,000 active registrations (plates) by July 1, 2007, or ourplate will be abolished. If this happens, the hospital willhave to wait three years before it can pursue anotherspecialty plate through a lengthy process.

If you have purchased one of the plates, we hope you’llrenew the plate when it comes due. This is an easy wayto help Children’s Hospital on an ongoing basis.

If you have been thinking about purchasing thehospital plate, there has never been a better time! Theplate is available continuously through each CountyClerk’s office, and the cost of the plate is $35 in additionto each county’s renewal fee. Fifty percent of the revenuegenerated from the specialty plates directly benefitsChildren’s Hospital.

If you have any questions about the specialtyChildren’s Hospital license plate, contact your localCounty Clerk’s office or the Development Departmentat (865) 541-8467.

14

Has childhood obesity become more common inrecent years? If anyone took a minute to lookaround at our day-to-day lives, most wouldanswer “ Yes” to that question, and that responsewould certainly be correct. The extent of thisgrowing issue and its dangerous healthconsequences may be less obvious and a hardertopic for us to understand.

Statistics from the Centers for DiseaseControl and Prevention are alarming. In the1960s and 1970s, four to five percent ofchildren and teens in this country wereoverweight or obese. In the 1999-2002 survey,that rate had risen to 16 percent. When thenumber of children who are “at risk” for obesity(those who are borderline overweight) isincluded, the rate rises to a staggering 30percent. In addition, the obesity epidemic isreaching younger and younger children; currentinformation indicates that 10 percent ofchildren ages 2-5 are now overweight.

Dr. David Nickels, pediatric endocrinologistat Children’s Hospital, shares surprisingstatistics and results about the increasing rate ofchildhood obesity and its relationship to Type 1and Type 2 diabetes.

QQ :: The increasing rate of obesity in childrenand teens is alarming. What are themedical concerns for these children andteens?

AA :: The real worry is the danger to health thatcomes along with this early obesity. Type 2diabetes, high blood pressure, sleep apneaand stress on the heart leading to earlyheart failure or heart attack are all muchmore common in children, teens andyoung adults who develop obesity inchildhood years. My biggest concern now

CChhii llddhhoooodd OObbeessiittyyis that because of this new severity in theobesity epidemic, we are seeing more Type 2 diabetes onset in children andadolescents before they reach youngadulthood.

QQ :: There is much more information availableabout Type 1 diabetes, but what aboutType 2? What are the symptoms andconsequences of Type 2 diabetes?

AA :: Formerly, Type 2 diabetes was known as“adult onset diabetes,” and that hasdefinitely changed in recent years. Type 2diabetes is a serious chronic healthproblem that results in many life-threatening complications, such as kidneyfailure, blindness and early onset of heartattack and stroke, and will shorten the livesof many children. It has been suggested inrecent years that at the current rate ofincrease in obesity, this generation ofchildren will be the first in history to haveshorter overall life expectancy than theirparents.

QQ :: What is the difference between Type 1and Type 2 diabetes? What are the maincauses of each?

AA :: With Type 1 diabetes, which is not relatedto weight, the pancreas loses the ability toproduce insulin because of an attack by theimmune system against the pancreas cellsthat make insulin. The insulin-producingcells are eventually all lost, and withoutinsulin, the rest of the body cannot take upglucose from the bloodstream andmetabolize it. Therefore, blood glucoselevels rise higher and higher.

People with Type 2 diabetes develophigh blood sugars for a different reason,primarily because the body becomes less

responsive to the insulin that is beingproduced. The pancreas still can produceinsulin, but because of obesity over time,the body tends to become resistant to thenormal effects of the insulin. As thisworsens, blood glucose eventually rises. Inchildren and young adults, the pancreasinitially tries to compensate for thisresistance to insulin and tries to produceextra insulin to keep blood sugar levelsdown. It may be able to do this for a whilebut eventually this becomes hard on thepancreas and stresses the pancreas cells,which then start to fail. As insulin levelsthen become lower in the face of insulinresistance, blood sugars rise, and diabetesdevelops.

Although there are some geneticinfluences on who develops insulinresistance and at what age, the singlebiggest risk factor is obesity. Because somany young people become overweight atearlier and earlier ages, we are seeing thisprocess of developing Type 2 diabetesoccur in these adolescents, sometimes evenas young as nine or 10-years-old.

QQ :: As a physician, why do you think obesityis on the rise?

AA :: The reasons are clear – children and teensare eating more unhealthy foods moreoften and getting less physical activity.Hours spent in front of the TV, videogames and computer screens add up andtake their toll. Children who watch themost TV have the highest obesity rates.Surveys also tell us that only five percentof school children have daily physicaleducation. Most who have any P.E. inschool only have it once or twice a week.Children also play outside less and rarelywalk to school.

QQ :: What other factors contribute to the Type 2 diabetes onset problem?

AA :: Nutritional issues are a major factor in theincrease in Type 2 diabetes in children.Over-consumption of highly processed,high calorie foods and high sugar drinkswhile watching TV or doing homeworkcan result in children consuming morecalories than they need. Fast food intake,and restaurant food intake in general, is atan all-time high, and this almost alwaysresults in higher calorie intake on averagethan if children ate meals prepared athome. Intake of soft drinks and otherhigh sugar drinks is up and milk intake isdown significantly over the last 30 years.

The problems are not just in the homesetting. Schools often rely on vendingmachine sales of soft drinks and highcalorie snack foods, candy and chips forincome, and they often resist efforts toremove these machines from schools.Finally, constant daily exposure toadvertising for unhealthy foods, drinks,and fast food marketing aimed directly atchildren with prizes, games and cartooncharacters is increasing.

QQ :: What can parents, teachers, health careproviders and the community do to help?

AA :: The problems are not going to be fixedovernight. However, small steps made byall of us on a daily basis can have a verypowerful effect. Here are several ideas toget families started in making changes:

Limit television and other “screen”time with your children, starting at a veryyoung age. An hour or two a day isplenty. No matter what children end updoing when the TV or video game isturned off, it almost always involvesburning more calories than watching TVor playing video games.

15

Increase outdoor playtime by 30-45minutes per day, every day. Take familywalks more often. Parents andgrandparents must take the time toactively play with their children, and theymust resist the use of the TV or videogames as a “babysitter” for an unlimitedtime each day.

Improve your family’s eating habitswith a few simple changes. Work onreducing high sugar drinks and highly-processed, high-calorie snack food in yourhousehold, such as snack cakes, candiesand chips. Eat out less often, especiallyfast foods, and prepare meals with more“unprocessed” foods such as fruits,vegetables, whole grains and low-fat dairy.Avoid higher calorie frozen conveniencefoods at home.

Start early. Children who learn from anearly age how to live healthier will bemore likely to avoid obesity. We all knowthat changing habits later in life is muchharder. Prevention of obesity in childrenwill be more effective than trying to getchildren who are already obese to loseweight, and prevention efforts must startat birth.

Finally, talk as often as you can withcommunity leaders and school officialsabout the importance of making changesthat will encourage healthier living.Incorporating brief exercise breaks in theclassroom, removing vending machineswith unhealthy foods and drinks, andlimiting advertisement of unhealthy foodsand drinks aimed at children could beimportant changes that will help allchildren live healthier lives.

Health care providers can begin educatingparents about these healthy lifestyle goalsbeginning even during well baby exams ininfancy. Previous efforts by the AmericanAcademy of Pediatrics to push safety andinjury prevention education by pediatricianshave been effective, and similar campaignscan work for obesity prevention. This needsto be a priority for all pediatricians andfamily practitioners.

Obesity rates in children, teens andsubsequently adults can be lowered, and ourchildren’s prospects for healthier lives can beincreased. We owe them our best efforts inthese areas.

We all have busy schedules and lots ofdemands on our lives, which can make theseefforts hard to achieve. But when we think ofthe potential consequences to our childrenand grandchildren, it is hard to think ofanything that could be more important.

Compiled by Janya Marshall,public relations specialist

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The Pediatric Endocrinology Department atChildren’s Hospital, under the direction of Dr. DavidNickels, has received certification and authorizationfrom the Type 1 Diabetes TrialNet coordinating centerat George Washington University to begin enrollmentin the Natural History Study.

The Natural History Study is part of an internationalnetwork of clinical trials under Type 1 DiabetesTrialNet. Launched in March 2004, TrialNet is acollaborative network of 18 international clinical centersalong with affiliated diabetes researchers in many otherlocations. The program is dedicated to testing newapproaches to understanding, treating and preventingType 1 diabetes. This study will screen relatives ofpeople with Type 1 diabetes for autoantibodiesassociated with the development of the disease.

“We know that children, siblings and other first-degree relatives of people with Type 1 diabetes haveincreased risk of getting the disease,” Dr. Nickels said.“The risk of getting Type 1 diabetes is about 1 in 300for the general public; however, this risk increases toabout 1 in 20 for first-degree relatives.”

To be eligible for a no-cost screening test in theNatural History Study, volunteers must meet one of the following criteria:

• between one and 45 years of age and have a first-degree relative (child, parent or sibling) who has Type 1 diabetes.

• between one and 20 years of age and have asecond-degree relative (cousin, aunt/uncle,niece/nephew or grandparent) who has Type 2 diabetes.

Children’s Hospital’s Pediatric Endocrinology Officeis currently enrolling patients and first-degree familymembers for the Natural History Study. Phase 1includes an initial blood test. After the sample resultsare returned, participants will either be sent to Phase 2for further testing or will be told they do not carry theautoantibodies associated with Type 1 diabetes and will be released from the study.

Also, TrialNet has now begun enrolling subjects age 12 years and older with newly diagnosed Type 1diabetes in treatment studies looking at two differentmedication regimens. These regimens may help stop orslow the autoimmune attack on the pancreas andpreserve some of the residual insulin production that isoften still present temporarily at the time of diabetesdiagnosis. Patients interested in participating in thesetreatment/intervention studies can be initially screenedfor eligibility at Children’s Hospital, and if qualified,would travel to the University of Florida for enrollment.

For more information or to participate in the studies,call the Children’s Hospital Pediatric EndocrinologyOffice at (865) 971-7400 or visit the TrialNet Web siteat www.DiabetesTrialNet.org.

By Janya Marshall, public relations specialist

David Nickels, M.D.

Children’s Hospital2018 Clinch Ave. • P.O. Box 15010Knoxville, Tennessee 37901-5010

We always try to stay current with friends of the hospital.If for any reason you should receive a duplicate issue,please notify the hospital at (865) 541-8257.

NON-PROFITORGANIZATIONU.S. POSTAGE

PA I DPERMIT 433

KNOXVILLE, TN

The 25th annual Children’s Miracle Network Telethon to benefitChildren’s Hospital is quickly approaching. This year’s telethon hasbeen moved to Sunday, January 28, and will be broadcast live from 3:30 p.m. to midnight on WBIR-TV.

This year’s telethon again offers viewers the convenience ofdonating to Children’s Hospital online during the broadcast. Thosewatching the broadcast on WBIR-TV can log on to www.etch.comand click on “Make A Donation” on the left side of the home pageto make their contribution.

Last year’s 24th annual CMN broadcast raised more than $1.8 million for Children’s Hospital. This total represents thetremendous generosity of the people of East Tennessee and theirongoing commitment to Children’s Hospital.

The success of this year’s Children’s Miracle Network telethon iscrucial in helping Children’s Hospital grow. Funds raised during thetelethon will be used to purchase new and sophisticated medicalequipment for various hospital departments. Support from the communitythroughout the telethon helps ensure that each child who comes to Children’sHospital, now and in the future, is able to receive the care he or she needs.

Children’s Hospital is a charter member of the Children’s MiracleNetwork. In 1983, the hospital participated in the first telethon that raised$95,487 in East Tennessee, all of which remained at Children’s Hospital forthe direct benefit of its patients. Since its inception, the telethon has raisedmore than $23 million for our pediatric medical center. For moreinformation about the Children’s Miracle Network broadcast, or if you wouldlike to volunteer at the telethon, call (865) 541-8441 or visit www.etch.com.

By Amandalynn Thomas, student intern

t e l e t h o n d a t e h a s c h a n g e dChildren’s Miracle Network Telethon is January 28