Kenda Hooker was 3 years old when doctors discovered a hole in the top chamber of her heart. Like many congenital heart defect (CHD) patients, she went on with her life assuming her heart had been ‘fixed.’ As memories faded, her medical records were lost and her parents, who knew the most about her condition, passed away. So when she ended up with health problems nearly three decades later, doctors didn’t know where to begin.

“I started feeling dizzy and fatigued. I even passed out a few times,” said Kenda. “Several doctors told me the same thing, ‘You’re a new mom, you’re probably depressed. I even had my husband go with me to tell them that there was something wrong.”

Kenda wasn’t depressed. Instead, she was having issues with arrhythmia and would need a catheter ablation to remove the faulty electrical pathway inside her heart. That was just the first of several unfortunate diagnosis’s Kenda would hear over the coming years.

Next, it was the severe heart defect found in her first daughter, Koralyn.

“Koralyn Marie was born April 9, 2012. We knew prenatally that she had hypoplastic left heart syndrome,” said Kenda. “She spent her whole life at Cook Children’s, we were never able to take her home.”

Koralyn’s cardiologist, Lisa Roten, M.D., said her little heart was severely underdeveloped. As hard as they tried, there was little the doctors and nurses at Cook Children’s could do to save her. She passed away at 4 months old.

With the arrival of Kenda’s second daughter, Karis, in October of 2015 came more unwelcomed news. Another heart defect was diagnosed, again prenatally, but this one was less severe.

“Karis has an atrial septal defect,” said Kenda. “She had another hole in her heart but it has already closed on its own.”

Dr. Roten says there’s no way to know right now if there’s a genetic reason Kenda’s daughters both experienced heart problems. After all, she also has three heart-healthy boys.

“Kenda is part of the first generation of complex CHD patients who are truly thriving,’ said Dr. Roten. “A lot of the surgeries we perform now were not an option before the 1980’s so we’re seeing a new group of patients who have undergone surgery and are able to lead pretty normal lives.”

Dr. Roten says there are so many of these patients that a new subspecialty has even been created. At Cook Children’s, The Adult Congenital Heart Disease program treats patients who have outgrown pediatric care, including women with CHD who are considering becoming pregnant.

For Karis, her future is full of hope. Dr. Roten isn’t sure she will even need surgery. Even if she does, it likely won’t be an open heart operation like the one her mother had. Instead, her heart could be mended in the cardiac catheterization lab at Cook Children’s, with just an overnight stay. But like her mother, she will need to see a cardiologist for lifelong care.

“The fact that people with CHDs are going on to have kids shows just how far we have come,” said Dr. Roten. “At the end of the day, it may not be the life you would have chosen for yourself or your child, but it’s not a bad life. People with CHDs are going on to live good quality lives. The most important thing is to keep going.”

About Cook Children's Heart Center
The cardiology team at Cook Children's has extensive experience in the diagnosis and treatment of pediatric heart care. They know the unique requirements of treating the growing hearts of children, including those with extremely rare and difficult conditions. Our areas of expertise include cardiac surgery,interventional cardiology, adult congenital cardiology, electrophysiology, cardiac testing and imaging,echocardiography, fetal echocardiography and cardiac anesthesiology.

“Epic fail.”

A couple of years ago, this was the phrase that my teenage son used as I unsuccessfully attempted to beat him in a game we were playing. At the time, I thought to myself that it was a harsh but accurate assessment of my performance. And, I was certainly motivated to practice on my own so that the next time, things would be different.

That same phrase came to mind as I read through an alarming article of interest to physicians. The article, published in Cancer Epidemiology, Biomarkers & Prevention is titled Quality of Physician Communication about Human Papillomavirus Vaccine: Findings from a National Survey.

Bottom line: Physicians (primarily pediatricians and family physicians) do poorly in providing the Human Papillomavirus (HPV) vaccine to patients.

Another source, the most recent National Immunization Survey-Teen for the year 2014, reports another alarming trend. The survey shows the number of patients who start the shots – and also complete them – lags far behind what it should be. (The HPV vaccine is given as a series of shots.)

So, it came as no surprise to me that the first article clearly showed what I have suspected for some time and which has been hinted at by previous studies. The epic failure in providing what is essentially a cancer-prevention vaccine to the recommended population of 11-12 year old boys and girls lies not at the feet of the anti-vaccine movement or hesitant parents. Rather, the failure belongs to we physicians!

The article describes findings from an online survey sent to 2368 pediatricians and family physicians in 2014. The 776 respondents self-reported their own performance on strength of four criteria: Endorsement (how strongly they recommend the vaccine); timeliness (whether they recommend it at 11-12 years of age, which is the most beneficial age); consistency (recommending it routinely vs using a risk-based approach); and urgency (whether they recommend the patient receive the vaccination that day). More than a quarter stated they did not strongly endorse the HPV vaccine, and a similar number reported that they did not recommend it be given at 11-12 years of age. Amazingly, 59 percent said they used a risk-based approach versus a routine approach to recommending the HPV vaccine, and only half of the respondents recommended giving the vaccine then and there, while the doctor discussed the HPV vaccine with the patient and parent. And these results represent a best-case scenario because respondents would be unlikely to paint an unflattering picture of their own performance.

Clearly, we have a major problem with physicians struggling with their own discomfort in talking about the HPV vaccine and who erroneously believe parents do not value it. Physicians who can’t communicate the importance of this cancer-preventing vaccine in turn fail to recommend it, which is so important to protect our patients. We are at risk of being the generation of pediatricians and family physicians who collectively failed to protect our patients from a preventable cause of cancer. Only we physicians can fix what it wrong with us: Only we can reverse this epic failure!

1. What do you need to know as a parent?

The flu may start like the common cold with symptoms of cough, congestion and runny nose, but may also be associated with prolonged fever, muscle and body aches and fatigue. It is spread from person to person when an infected person, coughs, sneezes or talks and droplets are released into the air. It can also be spread less often from touching surfaces where drops are present. The flu virus is contagious from up to 1 day beforethe person presents with symptoms and up to 5-7 days after the symptoms resolve.

2. How can you protect yourself?

The best way to protect yourself is by getting the flu vaccine as soon as it becomes available. Other means to protect yourself are effective hand washing and wiping down surfaces with anti-bacterial/viral cleansers.

There are multiple flu vaccines available but the two common types are the inactivated virus which comes in the injectable from and the live virus which is the nasal form. The determination of which vaccine is right for you will be made by your healthcare professional.  Most important to remember, you CANNOT get the flu from either vaccine. Minor side effects may include congestion and runny nose for 2-3 days.

3. Why get the flu vaccine?

Even healthy persons who have never had the flu in the past can get the flu and experience serious complications. Older people, young children, pregnant women and people with medical conditions like asthma, diabetes, heart disease, or kidney disease are at especially high risk from the flu, but kids, teens and adults who are active and healthy also can get the flu and become very ill from it. In the United States each year, more than 200,000 people are hospitalized from seasonal flu-related complications. Last year from September 30 to February 9th, 64 children died from flu-related complications.

4. Who should get the flu vaccine?

Everyone over the age of 6 months.

Higher risk populations include those between the ages of 6 months to 5 years, children with asthma or other chronic disease,  pregnant women, people with immune problems, and adults  more than 65 years old.

Children under the age of 8 MAY require 2 doses of the vaccine 4 weeks apart from each other depending on their previous immunization status.

5. How is this year’s flu vaccine different than last year’s?

Last year, the flu vaccine contained two common Type A strains called H1N1 and H3N2, and one strain of Type B. This year, a new quadrivalent form of the vaccine is available which includes the two Type A strains and 2 Type B strains.

Manufacturers anticipate producing between 135 million and 139 million doses of flu vaccine this year, but only about 30 million doses will offer the four-strain protection. All of the nasal live virus formulations will be the quadrivalent and a portion of the injectable form will be quadrivalent. The CDC and the AAP does not recommend one over the other, as long as you get vaccinated.

6. What happens if you get the flu?

See your health care professional as soon as possible because if it is treated with anti-viral medications in the first 48 hours, the duration as well as the severity of the illness can be decreased. The CDC does not recommend treatment of healthy individuals with anti-viral drugs, but certain high risk populations will benefit from treatment.

Lizy Varughese, M.D., joined Cook Childrens Physician Network in Lewisville in 2013. She is married to Dr. Shane Varughese and has two children, Noah and Sarah. Dr. Varughese enjoys photography, cooking, and church activities. Her passion in life is taking care of children and educating families on preventative care and battling childhood obesity.