When it comes to accessing pediatric specialty care, the more appointment options, the better- especially for busy families caring for a child with complex medical needs. Beginning May 4, families living in the Plano area have another close-to-home location for connecting with Cook Children’s Health Care System and its vast network of pediatric specialty physicians.

Conveniently located just off the Sam Rayburn Tollway between Plano, Frisco, Allen and McKinney brimming with young families, Cook Children’s new multispecialty clinic gives patients increased access to pediatric physicians specializing in neurology, endocrinology, pediatric surgery, pulmonology, gastroenterology, nephrology, urology, plastic surgery and orthopedics. Cook Children’s physician specialists from the Prosper Specialty clinics will rotate through the clinic regularly, giving parents more choice and flexibility in scheduling appointments at a location most convenient to them.

“Patients requiring specialty care often need to see their specialist multiple times, and those with complex medical conditions may see multiple specialists across several departments regularly, said Teresa Baker, Cook Children’s vice president of Primary and Specialty Services. “In addition to the convenience of closer-to-home care, the new clinic increases appointment availability so busy families have more options when scheduling visits. The new location also provides additional space to add more physicians and advanced practice practitioners to meet the needs of families in the fast-growing communities of the region.”

This will be Cook Children’s seventh multispecialty clinic in the Metroplex. Others are located in Alliance, Denton, Hurst, Mansfield, Southlake and Walsh Ranch. The Plano clinic offers 10 exam rooms, including one that will flex as a procedure room, as well as an X-ray unit. While Cook Children’s physicians will rotate through the clinic, it will have full-time, on-site clinical staff, an X-ray technician and front desk personnel.

Damian Campbell, D.O., a Cook Children’s pediatric neurologist, will see patients at the new Plano clinic on Thursdays. He’ll have the ability to offer many of the same evaluations in Plano as in his primary office at Cook Children’s Pediatric Specialties Clinic in Prosper, with the exception of electroencephalograms (EEGs) and some concussion evaluations.

"We’re aiming to be available for patient families every week right from the start of this new project,” Dr. Campbell said. “We know that life gets busy, and juggling work and school can make finding time for appointments a bit tricky. Having more availability close to home is designed to help make that easier. Our goal is for this new venture to help make sure families have more access to the high-quality care and attention that Cook Children’s is known for.”

This new addition to the health system’s network is one more example of Cook Children’s keeping its Promise to the children and families in the communities it serves, says Kevin Greene, president of Cook Children’s – Prosper.

“Our Promise is to improve the health of every child in our care and our communities,” Greene said. “By opening this new specialty clinic in Plano, we are bringing that Promise to the doorsteps of the families we serve. We are no longer asking parents and caregivers to endure long commutes for specialized care. Instead, we are meeting them where they live, work, and go to school—ensuring every child has access to high-quality pediatric care and the opportunity to grow up healthy, regardless of their zip code.”

Uzoma “Ben” Gbulie,

“I’ve been looking out for these babies since they were in the womb. I spent a lot of time studying intrauterine ultrasounds and MRI images even before they were born. They’re basically like family to me,” Dr. Gbulie said.

Giving Patients a Ray of Hope

In elementary school, Dr. Gbulie realized becoming a doctor was his calling. By the time Dr. Gbulie graduated from medical school, he knew surgery would be his path. He started out in General Surgery but during his second year of training discovered that he wanted to repair instead of remove.

“I have been privileged to train and become a board-certified General Surgeon, board-certified Plastic Surgeon as well as a Pediatric and Craniofacial Plastic Surgeon. Plastic surgery is very rewarding to me because it allows me to fix things and replace whatever was removed so it gives my patients a ray of hope. Filling that void in someone else’s life brings me great fulfillment.”

Finding the Right Facility for the Twins 

This is Dr. Gbulie’s astonishing third time managing a set of conjoined twins. He had already been involved in two prior separation surgeries – one in 2011 where the male twins were joined at the sacrum, and the other in 2016, where the female twins were joined at the hips/pelvis.

“A separation surgery is as complex as it gets. It’s rare to do even one of these cases in one’s career, and a privilege to be invited to take care of a third set of conjoined twins,” Dr. Gbulie said.

When the twins’ mom Amanda Arciniega was only three months pregnant, she reached out to Dr. Gbulie after her mother-in-law’s best friend mentioned she knew a surgeon who had experience with conjoined twins. Amanda and her husband, James Finley, met with him at his office. 

“We had a long talk about where and how it would be best to deliver the babies and eventually separate them," Dr. Gbulie said. "They wanted the assurance that if they stayed in the area, we had a facility where they could be separated. Being a member of the Surgery department at Cook Children’s Medical Center, I was very glad to assure them that Cook Children’s definitely has that capability.”

Expect the best and prepare for the worst 

Dr. Gbulie said it is humbling when you take care of small babies who can’t make decisions for themselves. In the world of pediatrics, it’s really a doctor, parent and patient relationship. 

“As the days became closer to the actual separation, the mother became more emotional," Dr. Gbulie said. "The family has trusted not only me, nor the entire team but also Cook Children’s Medical Center to take care of their precious babies.” 

By reviewing the surgical anatomy, imaging and operative plan enough times that it became second nature, Dr. Gbulie felt that they had reduced the chances of unanticipated surprises. He also planned the original incisions since the way they open affects the way they close. The main challenge for his part would be the complexity of the closure.

The closure could be a complex repair or possibly require a graft or tissue substitute.

“That portion would be a game-time decision depending on what we find and how the babies are doing,” Dr. Gbulie said.

Once the separation is done and closure completed, the twins will be handed over to the Neonatal ICU team. 

“Of everything I have learned from other separations, one of the most important lessons is the importance of the perioperative care," Dr. Gbulie said. "The preparation of the twins by the neonatal unit, making sure they were gaining weight, their electrolytes were normal, their respirations optimal and so forth – all of those allow them to tolerate a very long operation, followed by the hugely important post-operative care. It really does take a village.”

Dr. Gbulie’s motto for surgeries such as this one is to expect the best and plan for the worst. 

“And with God, it will go great.”

Indescribable Joy

On January 23, the day of separation, Dr. Gbulie remained focused. 

“Knowing it is my responsibility to take care of another human being, especially when it is a child, is a huge motivator and keeps me focused no matter how long the surgery takes,” Dr. Gbulie said.

He made the original incisions to be sure the skin flaps were protected for good closure. 

“Once we got into the nitty gritty parts of separating the liver and bowel, I took a step back,” Dr. Gbulie said.

For the next 2.5 hours, Dr. Gbulie took on the role of assisting the pediatric surgeons as the separation of the organs proceeded. Time seemed to stand still as he watched all the hours of meticulous planning by the team fall into place.

Following separation, the pediatric surgery team worked on the diaphragmatic and abdominal fascial repair using mesh. Then it was time for Dr. Gbulie to close JamieLynn which he performed using skin advancement flaps. When it was all done, he stated: “To be able to give this (gift of separation) to the family is an indescribable joy.”

Cautious optimism

Dr. Gbulie said high fives won’t really come until weeks from now. The separation is a major step but is the first part before the recovery truly starts. He will breathe a sigh of relief when the twins go from surviving to thriving.

“The skin is the largest organ in the body and protects our interactions with the environment," Dr. Gbulie said. "It’s really important to get them well healed and a stable wound because without that, more problems could arise such as post-operative infections.”

He feels fortunate for not only the twins’ medical team but Cook Children’s as a whole. 

“There are not many medical centers in the world that have done this procedure," Dr. Gbulie said. "I think this proves that we have a hospital system that literally has every subspecialty and the technology required to pull off something this complex. That’s an amazing achievement and I’m very grateful for that.”

When asked about his work, he stated “I love every bit of what I do, and if given the choice I would always choose to be a plastic surgeon. My training and experience have given me the opportunity to help another set of conjoined twins and I consider that a blessing.”

Background

Dr. Gbulie is a member of the Plastic Surgery Department at Cook Children’s Medical Center. Besides his elective practice, he also provides on-call coverage for facial and hand trauma and has handled many complicated cases including severe dog bite injuries to the face and scalp which require literally putting the child's face back together.

“It's amazing how fulfilling it is to make the child whole and see them smile again, especially when we're able to achieve this with minimal scarring and deformity,” Dr. Gbulie said.

“The Essential Glue”

“My wife Ndidi is an attorney, the love of my life and the essential glue that holds our family together. We're blessed with three wonderful kids – Amaka (14), Sam (11) and Obi (9). During my free time, I love watching soccer and I’m quite sure I’m the biggest Manchester United fan!”

Ewing, who plays Dylan on the hit comedy Modern Family, opened up about how he obsessed over his looks in a recent op-ed piece in the Huffington Post. He says that he has faced eating disorders, depression and body dysmorphic disorder, a condition he describes as a “mental illness in which a person obsesses over the way he or she looks.”

Reid said that he would take pictures of himself, analyzing his looks, before deciding he needed plastic surgery. He said he felt ugly and that his looks were unacceptable.

Reid describes in great detail the horrible pain he went through during his initial surgery, cheek implants and yet felt the need to do it again. He says that no one gave him a mental evaluation, except to ask if he suffered from depression (he did), to learn of his history of eating disorders.

Joy Crabtree, PsyD., a psychologist at Cook Children’s, says that the insecurity and body dysmorphia often develops during adolescence, and they become more unhappy as they get older. In some situations, the discontent may develop in childhood, and start with a specific dislike for a certain part of their body or over focus on a perceived flaw.

“I like how the article makes the point that therapy is a great place to start before jumping into big cosmetic surgery decisions,” Crabtree said. “I think standard protocol requires some level of psychological screening for most bariatric surgeries as well.”

Crabtree says people sometimes don't think of boys dealing with these body image issue, but she treats boys struggling with eating disorders and their own looks.

One in 10 of those diagnosed with eating disorders are male. Moreover, nearly a third of adolescent boys participate in unhealthy weight control techniques, like skipping meals, smoking cigarettes, vomiting or taking laxatives (National Association of Anorexia Nervosa and Associated Disorders). The American Psychological Association says males are less likely to seek treatment for an eating disorder due to the perception that it is a disease that only affects women, but the shameful secret isn’t just a girl thing.

Issues with eating and problematic concern over weight usually begin during adolescence or young adulthood. According to Joy Crabtree, PsyD., a psychologist at Cook Children’s, “This is typically a higher time of stress in general, and also a time when bodies are changing quickly or rapidly; this creates more discomfort with their self-image. Additionally, sometimes males are involved in sports where there is a focus on either gaining or losing weight, which can contribute to eating challenges as well.” Crabtree notes that eating disorders tend to occur among those who have perfectionist tendencies. “Increased stress can be a contributor, as well as unreasonable goals or ideals for meeting or maintaining a certain weight in order to participate in certain sports,” she observes.

To tackle the issue, Crabtree says schools should make their staff aware that males can suffer from eating disorders in addition to female students. Coaches and athletic personnel should be careful not to set unrealistic standards for their athletes and reach out to students and their parents if they see unhealthy patterns developing. In the meantime, though, the responsibility to identify problematic concern over weight or an unhealthy relationship with food lies with a boy’s parents.

Parents need to remember that eating disorders can be even more problematic in young men due to their reluctance to come forward. Watch for boys who develop a focus on eating only “healthy” food, counting calories, step on the scale a little too frequently or exercise excessively. Crabtree recommends “ensuring your family has a healthy focus on body image in general without a frequent or specific focus on weight, food intake, calorie counting etc. Try to stress balance in food intake and activity or exercise for overall health.” In addition, get input from your primary care physician regarding whether your child is in the average weight/height range or needs to focus more on eating a more balanced diet.

For boys diagnosed with an eating disorder, the treatment approach would not necessarily be different than it would for a girl. Crabtree stresses, however, that “the clinician must be aware and sensitive to the fact that they may be more avoidant or resistant to treatment in general, as well as less inclined to be open or honest about the issue as it is not as frequently seen as a male issue or concern.” Parents can help their teenaged boys to gain perspective on what is typical or average and what is extreme and unhealthy. Just as with young girls, it is important to stress that the celebrities they see on television or in the media are not typically “average” bodies. Parents can’t change societal pressures, but they can foster healthy behaviors and a realistic outlook on body image within their own households.

About the author

Natalie Raymond is an associate marketing specialist at Cook Children’s. She graduated from Texas Christian University with a Master of Science in journalism and certificate in business in 2014, and has a background in strategic communication and health care communication. Natalie enjoys doing her part to help our patient families stay healthy and spends her spare time with her eight furry friends (also known as pets).