Each year, Mayo Clinic pediatric surgeon Christopher Moir, M.D., serves as a visiting faculty member at hospitals in Africa. This work has expanded his view of how health care can be delivered and reinforced his admiration for those who practice medicine under persistently challenging circumstances.

As a kid, Christopher Moir, M.D., a pediatric surgeon at Mayo Clinic in Rochester, traveled a lot; his father was a pilot. When he got older, as a medical student in Vancouver, British Columbia, he kept traveling. Dr. Moir did short-term surgical mission work in rural Honduras and, as a resident, ran a clinic there.

"It opened up a new way of thinking about delivering health care," he says. "Stepping out of our Western system of health care into countries with a huge burden of disease, limited resources, inadequate infrastructure, and lack of knowledge and skills to address problems was revelatory. In that environment, patient contact is unvarnished — much more intense and meaningful. What you do can have a greater impact on the patient because you don't have a well-developed system supporting you. You're required to work at a higher standard."

Today, Dr. Moir's global medical efforts focus on training, primarily in Cameroon and Kenya. Four times a year, he goes to Africa for two-week stints as a visiting faculty member. He provides classroom surgical instruction and what he calls respite care.

"Transferring our knowledge to African surgeons is important and similar to training surgical residents at Mayo Clinic," he says. "The surgical residents overseas are every bit as skilled and knowledgeable as our own residents. What they lack is the opportunity to interact with different surgical staff. Adjunct faculty bring fresh ideas and new experiences and ways of doing things. They're hungry for that opportunity."

Beyond the comfort zone

"In addition to classroom teaching, residents need face-to-face practical teaching. I scrub in and operate with them, which provides support and encouragement," Dr. Moir says. "It also gives the attending staff a break, which keeps them working longer and at a higher level for improved patient care."

"I return to Mayo with a renewed appreciation of what it means to care for others in medicine."

Christopher Moir, M.D.

Staff and residents at the hospital in Cameroon communicate with Dr. Moir regularly and save difficult cases for his visits. One of those was a major esophageal gastric resection. A child had ingested lye, which completely destroyed his esophagus and created an inflammatory mass in his chest, which stuck to the heart and great vessels. Even an experienced surgeon such as Dr. Moir was intimidated.

"I knew about the case in advance, but it was worse than I anticipated," he says. "We had no critical care support and were in the chest without minimally invasive visualization. We were operating almost blindly. And yet the mass was resected cleanly, and we created a new way for the child to swallow. Despite the difficulties, he did really well. Global medical care pushes you beyond your comfort zone with less high-tech imaging, fewer support systems and higher personal stakes on the outcomes."

Dedicated to others

Dr. Moir describes his motivation to participate in global health as a combination of a desire to help and to teach. "It brings me closer to my roots as to why I became a physician," he says. "I wanted to help and serve others. Of course, that happens every day at Mayo Clinic, but I also have a strong desire to pass on what I've learned and concretely express my gratitude for the training, knowledge and experience Mayo Clinic has given me. I bring that expertise to a region and continent suffering under a huge surgical burden of disease. Helping meet those needs through education and training new staff is very satisfying to me. I return to Mayo with a renewed appreciation of what it means to care for others in medicine."

"Instead of complaining, they look outward, focusing on improving the lives of others rather than themselves. I'm not fit to tie their shoelaces."

Christopher Moir, M.D.

Dr. Moir's respect for the physicians he's met overseas has only increased with time. "The residents I work with in Africa are truly joyful individuals who are absolutely dedicated to learning and caring for their surgical patients," he says. "The future of these physicians will be in difficult places, such as Uganda and South Sudan, with low pay, long hours and machines that may not work. They demonstrate gratitude and a strong work ethic and have much tougher lives than I'll ever have. Instead of complaining, they look outward, focusing on improving the lives of others rather than themselves. I'm not fit to tie their shoelaces."

Dr. Moir strongly recommends global health endeavors to other health care professionals. "If you're unsure whether you're qualified to do it, you're qualified. It's a matter of getting up and going to work every day you're there. Anyone can do it; there's a job for you," he says. "You have to enter into it with the attitude that you're there to serve others, accept the challenges and be willing to do what you're told, not what you want. The more we can responsibly study and teach global health, the better."

Note: A version of this story previously was published in Mayo Clinic Alumni Magazine.

HELPFUL LINKS

• Explore Pediatric Surgery.
• Visit Mayo Clinic Children's Center.
• Learn about education at Mayo Clinic.
• Request an appointment.

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William Bilicic, 20, is dedicated to helping others ease their hospital stays. He shared his inspiration in a recent visit to Rochester, Minnesota.

William Bilicic knows hospital life — doctors' orders, family visits, the food, the routines. He's seen it all.

At 20 years old, he has spent more time in hospitals than his average peer. William estimates he's had about 40 surgical procedures in addition to his routine visits. But rather than try to hide that part of himself, he's made a commitment to share it.

William is the proud creator of a website called Spot-Aid that offers his advice and insider tips to people who need to make hospital visits. The website and William's tips are intended to make any hospital stay, for any patient, just a little easier. To those who know him best, William's website is characteristic of the young man. He is inquisitive and driven by an intense desire to help the people around him.

"He's a thoughtful, reflective, respectful young man who asks great questions. When he came up with Spot-Aid, it seemed like a natural outgrowth of who he is," says Dr. Christopher Moir, who was William's pediatric surgeon and remains a close friend and adviser. Read the rest of William's story.

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The study focused on pain control after children receive a Nuss procedure, in which small incisions are made and a stainless steel or titanium bar is placed under the sternum to reshape the chest wall. Researchers looked at the cases of 132 children who had Nuss surgery from 2010 through 2015. Of those, 114 received paravertebral catheters and continued receiving the infusions for two to five days after returning home. Eighteen were instead given an anesthetic injection called an epidural.

Use of paravertebral catheters cut the median hospital stay by roughly a day and a half from 120 hours to 80 hours, the researchers found. Opioid painkiller consumption also decreased. Opioids can have significant side effects that slow recovery after surgery, including drowsiness, lightheadedness, nausea, constipation and risk of falls.

MEDIA CONTACT: Sharon Theimer, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu.

“Our operation is minimally invasive, but it produces major changes in the chest wall. Pain was an issue for our patients, but this new technique has solved the problem. It’s better than an epidural, because it’s reliable, and kids can go home with it. For the first time, we consistently deliver on our promise to minimize pain,” says co-author Christopher Moir, M.D., a pediatric and thoracic surgeon in the Mayo Clinic Children’s Center.

Chest wall deformities are fairly common. Pectus excavatum, also called funnel chest, is the most frequent. The sunken breastbone is noticeable when a child is born and typically worsens during the adolescent growth spurt. Even mild cases can cause children to feel self-conscious. Severe cases can interfere with heart and lung function.

Physical therapy can improve posture when the deformity is mild. Surgery can correct moderate to severe cases. The most common surgery to correct pectus excavatum used to be a chest-opening procedure in which the ribcage was reshaped. More recently, the less-invasive Nuss procedure has been adopted, but it can include significant pain after surgery, and possibly more pain than the open procedure. Pain control can affect several physical outcomes after surgery, including how well a child can breathe deeply, how early a patient can walk after surgery, and the length of the hospital stay.

Epidurals have been a standard method to manage pain after pectus excavatum surgery, but they are stopped before children leave the hospital, and severe pain may persist after that. Many hospitals, including Mayo Clinic, have been using other options, such as nerve blocks, patient-controlled painkiller delivery and non-narcotic painkiller injections. There has been little consistent data on pain outcomes.

“This study puts solid data to what we see each day in the hospital and what families tell us.  Paravertebal catheters work,” Dr. Moir says.

Previous research at Mayo and other institutions has found that paravertebral blocks effectively control pain in operations, including breast cancer surgery, hernia repair and shoulder surgery.

The study’s first author is Natalie Dean, M.D., an anesthesiology resident. The senior author is Dawit Haile, M.D., an anesthesiologist. Pediatric surgeon D. Dean Potter, M.D., is a co-author.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinicor https://newsnetwork.mayoclinic.org/.

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One year ago this month, teams of Mayo Clinic physicians were making complex plans to save a little girl with a very special heart. Baby Kieran had not yet arrived in the world. While still in the womb, her parents learned their daughter's heart was developing outside of her chest. "The odds were stacked against her," says Kieran's mother, Caitlin Veitz.

Today, however, Kieran is speaking her first words and her family is making plans for her first birthday. Her heart is performing so well, she may be able to wait another year or two before the next surgery to make additional repairs. Congenital heart problems are the most common structural birth defect. They affect about 1 in 100 children. While Kieran's situation was more complicated than most, February's American Heart Month is a great time to celebrate the progress being made for patients of all ages.

Watch the original story to see the amazing teamwork that saved Kieran's life.

The post Update: Baby Kieran’s Heart appeared first on Mayo Clinic News Network.

The circumstances around her birth, however, were not as serene.

At her 20-week ultrasound, Caitlin learned her baby's heart was not where it was supposed to be and that it had developed outside of the chest wall. The condition, called ectopia cordis, is "one of the, if not the, most rare congenital heart defects,” according to Joseph Dearani, M.D., a Mayo Clinic pediatric cardiac surgeon.

“We didn’t have any idea that anything like that could happen," says Caitlin. "It was scary. The odds were stacked against her.” 

While congenital heart problems are the most common structural birth defect, affecting about 1 in 100 children, Kieran's condition is incredibly uncommon. It’s also uncommon for children to survive it — unless, the stars align perfectly. In Kieran's case, the stars, and a team of about 60 doctors and nurses did align to give her and mom the care they needed.

Kieran would need very complex, highly specialized surgery to survive. “The only chance you have of treating this successfully is having an integrated approach where you can gather experts,” says Dr. Dearani.

Learn how that integrated team came together, with some help from Mayo Clinic’s 3D anatomic modeling lab, to create a success story you can wrap your arms around in the Mayo Clinic News Network video below.

HELPFUL LINKS

• Learn more about congenital heart disease.
• Explore the Mayo Clinic Children's Center.
• Learn more about cardiac surgery at Mayo Clinic.
• Request an appointment.

The post Putting Kieran’s Heart Back Where it Belongs appeared first on Mayo Clinic News Network.

Congenital heart problems are the most common structural birth defect. They affect about 1 in 100 children. However, the condition a little North Dakota girl came into the world with is incredibly uncommon. She was born with her heart outside of her chest. Sadly, it’s also uncommon for most children to survive it — unless, the stars align perfectly. In this case, they did and those stars were wearing hospital-blue surgical gowns. For the Mayo Clinic News Network, Dennis Douda has the story of baby Kieran's special heart.

Journalists: Broadcast quality videos of the package are available in the downloads, with narration and with natural sound only. The script explaining Kieran's diagnosis and treatment is also available.

The post Baby Kieran’s Special Heart appeared first on Mayo Clinic News Network.

Here's the podcast:  Mayo Clinic Radio PODCAST May 30 2015

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Human organ transplantation has come a long way since the first heart transplant in 1967. But despite advances, there are still more than 100,000 people in the U.S. waiting for a donor organ. We'll get an update on the state of organ transplantation from the director of the William J. von Liebig Center for Transplantation and Clinical Regeneration at Mayo Clinic, Dr. Brooks Edwards. We'll also hear from transplant surgeon Dr. Charles Rosen, who led teams that performed five liver transplants in one 24-hour period. Also on the program, springtime allergies are at their peak, and allergy specialist Dr. Rohit Divekar has tips for reducing symptoms. And pediatric surgeon Dr. Christopher Moir explains how to prevent pediatric falls among young children.

Myth or Matter-of-Fact: The first organ to be transplanted in a human was a kidney, not a heart.

Mayo Clinic Radio is available on iHeart Radio.

Click here to listen to the program on Saturday, May 30, at 9:05 a.m., and follow #MayoClinicRadio.

To find and listen to archived shows, click here.

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic. The show is taped for rebroadcast by some affiliates.

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Myth or Matter-of-Fact: The first organ to be transplanted in a human was a kidney, not a heart.

Miss the program?  Here's the podcast: Mayo Clinic Radio PODCAST May 30 2015

Follow #MayoClinicRadio and tweet your questions.

Mayo Clinic Radio is available on iHeartRadio.

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

To find and listen to archived shows, click here.

The post Mayo Clinic Radio: Transplant Update/Springtime Allergies/Preventing Children’s Falls appeared first on Mayo Clinic News Network.

There are approximately 8,000 children treated in emergency rooms for falls every day, according to the Centers for Disease Control and Prevention. At Mayo Clinic’s Level 1 Pediatric Trauma Center, 35 percent of the children cared for in 2014 were the result of a fall.

Falls can happen anywhere but some of the most common mechanisms for kids’ falls are from playground equipment, off changing tables, off infant seats placed on high surfaces, from baby walkers, out of shopping carts and out of windows. When children fall out of windows, the injuries that result are more serious than other types of falls.

MEDIA CONTACT: Kelley Luckstein, Mayo Clinic Public Affairs, 507-284-5005, email: newsbureau@mayo.edu

“Kids play. They are active, imaginative and creative and they fall all the time. That’s what they do,” says Dr. Moir. “But parents need to know how essential it is to never lose sight of their child while they are young and defenseless.”

Dr. Moir offers advice on how to protect children from general falls:

• Parental supervision is essential at all times.
• Always strap infants into bouncy seats, infant car seats and carriers.
• Keep bouncy seats and car seats on the floor not on countertops, tables or laundry appliances.
• Keep one hand on babies when they are on the changing table or couch.
• Place baby gates at the top and bottom of stairs.
• Do not allow children to stand up in shopping carts.
• Make sure playground equipment is age appropriate and supervise children at play.

This is a high-risk time for children to fall from windows. “It happens every day. Actually 14 times on average every day a child will be seriously injured from falling out of a window,” says Dr. Moir.

Here are some important reminders as the weather gets nice and windows are opened to let in fresh air in:

• Screens are intended to keep insects out, not children in. Do not rely on them as a protective barrier.
• Keep windows closed on upper floors. If you do open them, open them from top down.
• Only open windows that children can’t reach.
• Keep all furniture and anything else children can climb away from windows.
• Set and enforce rules that children do not play near windows or patio doors.
• Commercial window guards are available to help prevent falls.

If a child sustains an injury from a fall, contact a health care provider. If it is serious or life-threatening, seek immediate medical attention. If there are no obvious injuries, Dr. Moir suggests that parents watch the child, and if the child is not acting like himself after a fall, seek medical treatment immediately.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to medical research and education, and providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic and https://newsnetwork.mayoclinic.org/.

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