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Seth Ammerman, MD, Founder of the Teen Health Van, Retires

Seth Ammerman, MD, clinical associate professor of pediatrics (adolescent medicine), has retired after 28 years of service to Lucile Packard Children’s Hospital Stanford.

Ammerman’s celebrated accomplishments include founding one of the nation’s first adolescent-focused mobile health clinics in 1996. The hospital’s Teen Health Van provides free, comprehensive primary health care services to uninsured and homeless youth ages 10 to 25 at 10 sites in Santa Clara, San Mateo, and San Francisco counties.

Under Ammerman’s leadership, the Teen Van provided over 15,000 visits to more than 4,500 patients. Its multidisciplinary staff—made up of a physician, nurse practitioner, social worker, and registered dietitian—provides care for those who rely exclusively on the Teen Van as their link to a network of health care services. All services are provided free of charge, including acute illness and injury care, physical exams, family planning services, pregnancy testing, HIV and STD counseling and testing, blood tests, immunizations, mental health services, substance use counseling, and nutrition and fitness counseling.

The Teen Van is nationally recognized as a successful strategy to provide adolescents with high-quality health care.

“My career has been guided by the approach that we all need to take care of each other if we are to ultimately succeed, and to provide our young people with the care and support they need and deserve,” says Ammerman.

Bone Marrow Transplants without Chemotherapy or Radiation

An antibody-based treatment can gently and effectively eliminate diseased blood-forming stem cells in the bone marrow to prepare for the transplantation of healthy stem cells, according to a study in mice by researchers at Stanford University School of Medicine.

The researchers believe the treatment could circumvent the need to use harsh, potentially life-threatening chemotherapy or radiation to prepare people for transplant, vastly expanding the number of people who could benefit from the procedure.

“There are many blood and immune disorders that could be cured by a transplant of healthy cells,” says Judith Shizuru, MD, PhD, senior author of the study and professor of medicine and of pediatrics. “But the pre-treatments necessary to get the healthy cells to transplant effectively are so toxic that we can’t offer this option to many patients. A treatment that specifically targets only blood-forming stem cells would allow us to potentially cure people with diseases as varied as sickle cell disease, thalassemia, autoimmune disorders, and other blood disorders.”

Causes and a Potential Cure Discovered for ‘Chemo Brain’

More than half of cancer survivors suffer from cognitive impairment from chemo-therapy that lingers for months or years after the cancer is gone.

In a study explaining the cellular mechanisms behind this condition, Stanford scientists demonstrated that a widely used chemotherapy drug, methotrexate, causes a complex set of problems in three major cell types within the brain’s white matter.

The study also identified a potential remedy. A drug now in clinical trials for other indications reversed symptoms of “chemo brain,” as the condition is known, in a mouse model.

“Cognitive dysfunction after cancer therapy is a real and recognized syndrome,” says Michelle Monje, MD, PhD, associate professor of neurology and neurological sciences and the study’s senior author. “In addition to existing symptomatic therapies—which many patients don’t know about—we are now homing in on potential interventions to promote normalization of the disorders induced by cancer drugs. There’s real hope that we can intervene, induce regeneration, and prevent damage in the brain.”

Chemo brain is especially severe in childhood cancer patients, Monje adds, and children have the most to gain from better remedies.

FDA Appeal Saves Patient From Heart Failure

Lizneidy Serratos became the youngest and smallest person in the country to receive the type of heart pump now keeping her alive. The 12-year-old was saved by her doctors and nurses at Packard Children’s, who petitioned the U.S. Food and Drug Administration (FDA) for permission to use a medical device that was not yet approved for children. They got a compassionate-use exemption in roughly 24 hours.

“When Lizneidy came to us, she was very, very sick,” says pediatric cardiothoracic surgeon Katsuhide Maeda, MD, who performed her surgery. Lizneidy had dilated cardiomyopathy, a leading cause of heart transplants in children.

Lizneidy needed a surgically implanted pump that would help her failing heart move blood through her body. The Packard Children’s cardiology team wanted to give Lizneidy a pump called the HeartMate 3, which is small enough to implant in the chest. To implant it, Maeda needed to create a hole in Lizneidy’s left ventricle and suture a washer-like device called a sewing ring onto the heart to anchor the pump. But the sewing ring that was approved by the FDA was too big for Lizneidy. At the time, a smaller ring was approved only in Europe.

The problem with the larger sewing ring was that Maeda would have had to sew across one of Lizneidy’s most important coronary arteries. In rare cases, heart pumps allow children’s hearts to regain enough function to avoid a transplant. Closing the artery would have permanently severed the blood supply to part of her heart muscle, cutting off this possibility.

People in several locations across the country—including FDA staff—worked to secure a compassionate-use exemption. Approval was complete, and Lizneidy received the small sewing ring in the nick of time.

The pump made an enormous difference. Lizneidy’s breathing tube was removed the next day, and she soon began eating again. “Having her just talking and laughing and asking for things was great,” says her mom, Maricela Alvarado-Lazarit. “When she started being able to get up, it felt like she’s going back to normal.”

Brain Response to Mom’s Voice Differs in Kids with Autism

For most children, the sound of their mother’s voice triggers brain activity patterns distinct from those triggered by an unfamiliar voice. But the unique brain response to mom’s voice is greatly diminished in children with autism, according to a study from Stanford University School of Medicine.

The diminished response was seen on brain scans in face-processing regions and learning memory centers within the brain, as well as the areas that process rewards and prioritize different stimuli as important.

“Kids with autism often tune out the voices around them, and we haven’t known why,” says the study’s lead author, Dan Abrams, PhD, clinical assistant professor of psychiatry and behavioral sciences. “It’s still an open question how this contributes to their overall difficulties with social interaction.”

The study also found that the degree of social communication impairment in individual children with autism was correlated with the degree of abnormality in their brain responses to their mother’s voice.

Promising Treatment for Pediatric Tumors

When the FDA announced in 2017 that it was approving an immunotherapy treatment for children with certain relapsed blood cancers, doctors and patients were excited. The treatment engineers the patient’s own immune cells to make biological chimeras, called CAR-T cells, to recognize and attack cancer.

Now, with findings reported in Clinical Cancer Research, Stanford scientists have made a big step closer to using CAR-T cells for solid tumors—including tumors of the brain, nerve cells, bones, and muscle—in children who need better treatments.

In studies using mice, “the tumor just goes away,” says Robbie Majzner, MD, the lead author of the new study and an instructor in pediatrics at Stanford. “It’s very consistent. It happened in all the mice, and that’s exciting.” The next research step is human clinical trials.

Lax State Gun Laws Linked to More Youth Gun Deaths

A Stanford study found that compared with U.S. states with the strictest gun control legislation, gun deaths among children and teenagers are twice as common in states with the most lax gun laws.

In addition, states with laws that restrict children’s access to guns have lower rates of firearm-related suicides among youth, even after controlling for other factors, the study found.

Senior author Stephanie Chao, MD, assistant professor of surgery, hopes the work will inform state legislators. “If you put more regulations on firearms, it does make a difference,” she says. “It does end up saving children’s lives.”

Positive Mindset Helps with Treatment’s Side Effects

Researchers at Stanford University wanted to find out whether a simple mindset shift could help patients tolerate an uncomfortable treatment. They learned that when physicians make the effort to reframe potentially unpleasant symptoms in a positive light, it helped patients stay calm and persevere.

The researchers studied this approach with a group of families who signed their children up for a study testing oral immunotherapy and its ability to build tolerance to their food allergy triggers. The procedure is safe if done with medical supervision, but many people experience unpleasant—and very occasionally life-threatening—allergic symptoms. As a result, participation can cause considerable stress.

In the study, the research team split the children into two groups. Half of the children and their parents received standard information about handling mild side effects, such as how to treat them with antihistamine medications. The other group also got the standard information but was encouraged to view mild side effects as signs that the treatment was working. At the end of the trial, patients and families in the positive-mindset group reported significantly less worry during the treatment process.

Alia Crum, PhD, principal investigator at Stanford’s Mind & Body Lab, thinks the food allergy study provides a model for studying how mindsets could help people cope with other medical procedures. “Once we understand mindsets that are more useful, hopefully we can inform clinical practice so they’re using the more useful mindsets,” she says.

Nurse Gifts Guitar Signed by Ed Sheeran to Patient Awaiting Transplant

When nurse Colin James, RN, won a guitar inscribed by musician Ed Sheeran in the Mix 106 Toy Drive drawing, he immediately knew he wanted to give the guitar to Lucile Packard Children’s Hospital Stanford’s biggest Ed Sheeran fan, Kayano Lizardo-Bristow. Kayano, a 15-year-old from Yuba City, California, was undergoing dialysis while awaiting a kidney transplant.

Packard Children’s music therapist, Rebekah Martin, MT-BC, told James about Kayano’s passion for music and how it helps him cope with being in the hospital. “I knew I had to give this guitar to him. He is going through a difficult time in his life, and my hope is that it brings him a little joy,” says James.

“I was sitting in dialysis with Mom, Dad, and Rebekah, playing the [Ed Sheeran] song ‘Thinking Out Loud,’” says Kayano. “Rebekah said, ‘I think we need a new guitar for this part.’ Then a few people walked in; Colin was carrying a guitar case. I was in shock. I was about to have a heart attack! I had a very emotional reaction. Everyone was tearing up. I played a song on the new guitar; I finished while I was crying.”

The guitar is inscribed with the words “Play, don’t display! Ed Sheeran.”

“He has wanted his own guitar for a long time, but we couldn’t afford it,” says Kayano’s mom, April Bristow. “This is a great boost of inspiration and energy that we could both use right now!”

This article originally appeared in the Spring 2019 issue of Packard Children’s News.