Within the first 6 weeks of our first daughter’s birth, we could see the very subtle “cave” in her tiny chest. Her father had undergone the very invasive Ravitch Procedure when he was 11 so this “cave” was not unknown to us. Her infant pediatrician reassured us that “that surgery was cosmetic nowadays” and encouraged us not to give it another thought. We didn’t, for 12 years.

As she aged, the “cave” in her chest deepened and I watched my once energetic and enthusiastic dancer and gymnast begin to become very self-conscience and embarrassed by her protruding ribs and abnormal looking chest. As she developed, her clothing no longer fit as it should and her once excited outlook on pool parties began to get overshadowed by finding the “just-right” bathing suit to minimize the questions, comments, and looks that were sure to come. At her 12 year check-up, I mentioned to our current pediatrician my concerns about her deepening chest and she recommended a consultation with a Thoracic Surgeon at Children’s. She reassured me that if the surgeon felt it was just a cosmetic procedure, than it would be a surgery that we did not have to do. I immediately decided for myself that it was cosmetic and my daughter was not going to have that “awful and painful surgery.”

We met with Dr. Brown in the fall of 2014. Hailey has always had severe anxiety making doctors and dentist visits difficult for her. But Dr. Brown’s soft spoken fashion caught us off guard. Her gentle bedside manner put both me and my daughter at ease. After she examined Hailey, it became evident that she felt the surgery was necessary. She thoroughly explained the Nuss Procedure and showed us how the bar that would be inserted.

As I sat there, I remember thinking of multiple excuses I could tell her why we were not having this surgery. I remember telling Dr. Brown multiple times, “we are not going to have this done unless it is medically necessary.” I look back now and appreciate her patience with me. She very easily could have told me then how medically necessary it was but she could obviously sense that I was not willing or ready to hear it at that time so instead she encouraged me to set up a Cardiac MRI so they could measure the severity of the cave and also see if there was any impact on my daughter’s heart. After doing some research and learning all about the Haller Index, I dutifully scheduled her MRI.

In late September, 2014 we met with Dr. Brown to get the MRI results. Again, fully expecting the results to confirm what I wanted them to confirm, this was just cosmetic, and we were NOT having this surgery. We listened intently as Dr. Brown explained that based on her measurements and images seen during the MRI, our daughter‘s heart was already being mildly impacted by her sternum. She explained that as Hailey grew, her heart and lungs would have less and less room and she would eventually become more symptomatic. This was something I had never considered….this “cosmetic flaw” could be much more than that….it could be negatively impacting her heart, lungs, and/or her aortic valve. The fear of that damage and its consequences began to be bigger than the fear of the actual surgery. Based on these results and the growing confidence I had in Dr. Brown, my own fear was something I was unwilling to allow to prevent me from doing what was best for my daughter’s future health, any longer. My husband and I agreed that day with Dr. Brown’s recommendation that our daughter have the Nuss Procedure to correct her Pectus Excavatum.

Over the next 9 months, we followed the plan set out before us by the Pediatric Surgery Department and scheduled her surgery in late June of 2015. Those 9 months were full of much anxiety, many prayers, sleepless nights, and even more days spent trying to put the impending surgery out of our minds. My biggest fear was the tremendous amount of pain our daughter would be in. I was terrified of the “breakthrough” pain, fearful that the epidural would not work or that she would not be a to handle the pain, terrified that I would not be able to bare to see her in such pain…..so much fear surrounding the “pain”.

Finally the day arrived and I had “prepared” all of us as best I could physically and emotionally for the day. I had run through the all the possible horrible scenarios in my head. I had prepared for the worst. On June 29th, 2015 Hailey had the Nuss Procedure performed by Dr. Rebecca Brown at Cincinnati Children’s. Through all my preparing, what I had not prepared for was the excellent communication with Dr. Brown throughout the procedure and days that followed. The expertise, professionalism, and periodic checking on her that Dr. Brown personally did every day we were in the hospital, the amazing nurses that cared so well for our baby girl and her pain, day in and day out, as well as being her “cheerleaders” our entire stay, the way they each went out of their way to make her feel “special” and encouraging her every day. I was not prepared for just how well the actual surgery and our hospital stay would go, how well the epidural and pain management team would help her through. How every staff member at Children’s, from the doctors to the daily custodial staff, would all make us feel welcome, safe, and well cared for. But, honestly, I was least prepared to learn how immensely strong and resilient my 13 year old daughter actually was. She was amazing. All the fear I had, I was putting on her and I was unable to believe that my child was going to be able to handle the pain far better than I could have ever imagined and that children really are resilient.

My daughter’s self-esteem is no longer a worry, she finally feels “normal”. Shopping is fun now, as it should be when you are 14! There are other subtle changes that she has noticed as well…..she has more energy, exercise stamina, and knows she can accomplish anything she wants when she faces her fears and thrives! I would encourage any mother who is facing the same fear and anxiety I was just 1.5 years ago….trust this incredible team of physicians, nurses, and staff to take the best care possible of your child. Trust your child’s resilience and strength. Trust yourself, that you are making the best decision for the future health and well-being of your most important possession and responsibility in the world. It will be okay.

Melanie Christmas
Hebron, KY

Dear Dr. Becky Brown:

My daughter, Reagan, was referred to you through her pediatrician around the age of 12 to explore correcting her Pectus Excavatum. During that initial visit you recommended that she likely should have the surgery but that because of the difficult nature of the surgery you felt it really needed to be her choice to correct. As she became older she became more symptomatic as you suggested would likely be the case. As a result with some more consultation with you on a subsequent visit my daughter, with some encouragement from her parents, came to the realization that it was in her best interest to have it surgically corrected. 

You performed the surgery in December 2013 and now a little over a year from that date I think we all realize now how important in hindsight it was to make sure the patient as well as the parents were prepared.  As you let us know on multiple occasions, it is not an easy surgery or an easy short term recovery. As a parent it is so difficult to know that you are doing the right thing for your child especially as it relates to medical decisions. A lot of faith is put into the doctor and in this case you. As the parent I can’t tell you how much we appreciated your guidance and support through the entire process.  I know that my daughter echoes those same thoughts. She has been asked on a couple of occasions to speak to groups of patients preparing for the surgery and their parent at the request of your office and she willingly has accepted each time she has been asked to share her experiences. I think it is therapeutic for her because she knows exactly what those kids are thinking. I also realize how concerned the parents are because I remember it all too well. 

In the past year it has been inspiring for me to see my daughter once again compete in competitive volleyball on her high school team and water ski with no limitations. She can breathe properly for likely the first time in her life and the dull pain in her chest from her chest pushing on her right ventricle is gone. I also shed a tear when I saw her put on a dress for a homecoming dance recently that she could not have worn the year before without others noticing her Pectus. All of this according to her makes everything she went through and will continue to go through until the bar is removed worth it. 

We were very fortunate to have you and the entire team at Children’s Hospital in Cincinnati right in our own back yard.  Your initial care and concern for my daughter’s well-being was evident from the very beginning. The care from the nurses and the pain team at Children’s Hospital made the procedure bearable. People constantly ask my daughter that simple common question that they always want to know; “Was it worth it?”. The fact that after everything she went through she always quickly answers “Yes it was!” is all I as a parent need to know. Thanks for your guidance and support.

James Griffiths

From Dr. Brown

Dear Mr. Griffiths,

Thank you so much for the wonderful letter and offering to share your experience with others.  As you expressed, even with the known benefits of relieving cardiac compression, improving cardiopulmonary function, and improving the appearance of the chest wall, the decision to proceed with pectus surgery can be a difficult one, both for patients and parents. Although our Pectus Team at Cincinnati Children’s works very hard to prepare patients and their families for their surgery and minimize the pain and anxiety associated with the procedure, there is no doubt that the immediate postoperative period can still be difficult given the nature of the surgery. Being prepared and knowing what to expect can ease the recovery process, and I know that Reagan has given hope and encouragement to many other patients and families by her willingness to honestly and openly share her own experience.  I can tell you that she always earns rave reviews for her presentations at the Pectus Education Classes, hence, the frequent calls asking her to come back. She is a superstar! I am so glad to hear that she has been able to return to competitive volleyball and waterskiing without limitations and can now wear clothes that she couldn’t wear before surgery, but more importantly, I am ecstatic that she can breathe normally and no longer has the chest discomfort. It has been a pleasure and privilege caring for Reagan, and it warms my heart to know that despite everything she went through, that “it was worth it”. 

Warmest Regards,

Becky

The Stricker Family, Indiana

We wanted to send along our deepest appreciation and gratitude, yet our words seem shallow compared to how we truly feel. Yet, we had to attempt to pen a proper note of thanks that may begin to present our feelings!

We were troubled to learn about Sam's PE that was compressing and displacing his heart with decreased pulmonary function thrown in for an extra dose of concern. As many rattled parents would do, we dug in deeply and did our homework. When the pediatric cardiologist told Sam that having a pectus corrective procedure would change his life, it was clear the only decisions to be made were who would perform the procedure and where. The more we read about PE, Nuss and Ravitch, the more we knew we weren't going to be satisfied by blindly accepting a referral to a surgeon because he is the "main" doctor in town to handle this condition. The doctors and facilities in Louisville were an option, as were those in Indianapolis.  As we researched more names and places, Cincinnati Children's Hospital Medical Center continued to pop-up in our search results - as did your name, Dr. Garcia!

Your obvious level of expertise combined with your ability to relate to Sam, and make him smile, made us know we made the right decision almost immediately. This was reinforced as we repeatedly witnessed how Sam responded to your mere presence with a silly voice, " ... well, hello ... " Even at his lowest moment, while trying to recover from an intolerance to the oxycodone, we could hear his pleasure (or relief?) in knowing you were there. Maybe it's a connection between a patient and his surgeon. Maybe it's a connection between two people who appear to sincerely care about each other, although barely more than strangers. We don't know, but for whatever it is, we are grateful that our son had that experience! It touched our hearts when you were as happy as we were that Sam had turned the corner after getting "transition day" behind him.

It is remarkable to us that absolutely every human being we encountered during Sam's six day visit was polite, kind, and compassionate. We don't know what business model or philosophy for patient relations/customer service you have integrated within your organization, but you have effectively created a culture of caring and kindness. That culture infusing with the expertise of top notch medical professionals creates a potent outcome !

Our son's condition nor his surgery were as serious of a situation as many brave kids and families at Cincinnati Children's face every single day. However, the people we met made us believe that they took Sam's reason for being there seriously. In addition, everyone treated this young adult with dignity and spoke to him in a way that made him feel he had a role in his own care.

So here we are, back to how a mere "thank you" seems so weak, yet so important to say! Please share our satisfaction with your nurses, residents, nurse practitioners, the pain management team and the nurses of A4 North. Our only suggestions would be to work out an allergy patch test that is more easily dealt with for out-of-towners. And if possible, to get a few longer beds (and sheets!) for kids like our gentle giant, Sam! Sure, removing the footboard worked, but feet hanging off the end of the bed probably shouldn't be the goal.

Be assured you have advocates in the Kentuckiana area. If there is .ever a family in the Louisville/Southern Indiana area who would like to talk to us about our experience, we would be willing to meet with them to discuss it; help them with their planning, help them with setting their expectations appropriately. Signing your child up for surgery can be a daunting experience. Now that we're on the other side of it, our perspective is clearer.

Sincerely,

- The Stricker Family, Indiana


From Dr. Victor Garcia:

I am at once humbled, grateful, and appreciative.   Without the team Sam’s hospital care would not have been the exemplar experience it was.

All the way from Samantha, my administrative assistant, Susan Exner and Toni Hill in our Ped Surg scheduling section, Christina Bates and Jenni Russell, our exclusive and outstanding ped surg pectus nurses, the other nurses in ped surgery, Vicki, Cathy, and Allison on the ped surgery phones, Sarah-Ross and Dede from the OR Team, Vidya, Vanessa, and Roxanne in the Pain Team and her team of exceptional doctors led by Senthil, and of course the outstanding nurses on A4N working with the incredible resources available in Child Life, Music Therapy, Occupational and Physical Therapy. And I’m sure I’ve missed a few others. But all committed to making what obviously is a very anxiety producing experience as uneventful as possible.

It was a TEAM effort and we looked after Sam as he was my son and cared for and interacted with you and Don as if you were family. You are!

Regarding your suggestions, I would like to let you know we shared these in a team meeting and are currently investigating bundling our services to simplify the processes, such as Allergy testing, for our out of town families. In addition, our Clinical Director is looking into having longer beds, as well as an extended recovery chair similar to a recliner, available to our patients during their hospital stay.  Thank you so much for offering your suggestions to us.  We are consistently striving to be better today than we were yesterday.  Having recommendations and feedback from our patients and families allows us to achieve this goal and make the difference.

So thanks again for the acknowledgement and being advocates for what we are able to do at Cincinnati Children’s Hospital Medical Center. We do what we do and how we do it because we care. We strive to be the best at getting better. To be sure, there is ineffable  joy and satisfaction in the journey.

Until next time -----

Appreciatively,

Victor and the Team

Growing up with the “hole” in my chest, I was always self-conscious shirtless and expected that it was something I would always have - that was until my early teenage years when my pectus deformity started to cause health problems, constraining my lungs and preventing their ability to fully expand. Facing this plight, there was no question who my family and I wanted to do this procedure – Cincinnati Children’s own, Dr. Rebeccah Brown.

We hold great faith in Dr Brown’s skills as she had done amazing work and proved herself to me personally just a few years prior when I was diagnosed with cancer. The care she provided at that scary time in my family’s life left us with no question when choosing her and her team for my pectus surgery. From the get go, she explained everything I would go through, how they perform the surgery, and the care and precautions I would need to keep in mind while living with the “bars” they were putting in my chest.  It was then that Dr Brown told me that I was going to need two pectus bars due to the extent of my pectus defect – she definitely made me feel special for being the first of her patients needing two and explained that in the end it would show much more promising results! I went into surgery expecting to come out with a brand new chest, but waking from surgery the results were better than I could have ever imagined. My chest looked great and I couldn’t have been happier, thankful that the “hole” was gone and my chest looked “normal” for the first time in my life!

The four years following flew by and before I knew it, we were scheduling my pre-op check-up where I asked Dr. Brown the one question that I had come up with in those five years – could I see the bars after she took them out? She told me she would do her best to make that request a reality. Coming out of the anesthesia, I was elated and astonished by what on the bedside table waiting for me, the two bars from my chest! Dr. Brown came in to check on me and explained in even more detail how the initial surgery goes and I was even more blown away than I had been. Yet again, Dr. Brown proved just how amazing of a surgeon she was to my family and I.

The surgical team at Cincinnati Children’s was spectacular but Dr. Brown went above and beyond in every aspect of my care. She has proven herself to us time and time again and I have always thought of her as an excellent doctor - a true miracle worker in her skills, but above all, she has shown us what a genuine and wonderful person she is, whose perfect personality is only matched by the results she achieves in her work. I cannot thank her enough for all she has done for me and without a doubt, she always comes to the forefront when I share my story with someone. Dr. Brown truly is a surgeon I would encourage everyone with a pectus deformity to seek out for his or her surgery. She truly is, without a doubt, the absolute best!

-Devin Klaserner

 

From Dr. Rebeccah Brown:

Devin, 

Thanks so much for the wonderful letter. You are too kind and quite the eloquent writer. I have thought of you often over the years - you were very special to me. I always admired your strength and bright, cheerful attitude even in the face of adversity that always brought a big smile to my face.  Although the primary reason to repair pectus excavatum is to alleviate the pressure on the heart and improve cardiac and pulmonary function, it also improves one’s self-image and bolsters confidence, and I saw that firsthand with you.  I will never forget how excited you were to go on a cruise after your repair and for the first time be able to take off your shirt to go swimming and not be embarrassed.  What a great feeling!  And to be able to take a deep breath – even better!

It was a delight and true privilege caring for you and your wonderful family. I am so glad that you chose our Chest Wall Center and that we were able to exceed your expectations for care.  Please update me on what's been going on in your life. I am genuinely interested and am sure you are succeeding in everything you do.  So good to hear from you.

Becky