2018 - November Edition
Alice Kuo, MD, PhD, MBA, FAAP   President, AAP-CA2    2018 - 2020 
Today is Election Day, and one of the most important elections in a long while with respect to children's health. Voting is the ultimate civic duty of every adult in the U.S. In the current federal climate in which lawmakers are so ideologically polarized, each one of your votes matters. Please go to the polls if you have not yet voted and take 2 or 3 friends with you!!
The AAP is also having its national and district elections. You should have received an email last week, and the election links are active until December 2. While you're thinking of it, please find your email ballot and cast your vote for National President, District Chair and District Vice Chair. Information on each candidate is available below in this month's newsletter.
The proposed changes to the public charge rule were released for public inspection on October 5 and open for public comment on October 10. This means that we have 60 days to encourage pediatricians to publicly comment to the proposed rule expressing opposition. The more personalized comments we can collectively submit, the more effective our efforts will be to delay the publication of the final rule and influence its contents. Form letters that are submitted by multiple people or with multiple signers are considered to be one comment submission, so we are encouraging members to submit individual, personalized comments. Please click here to submit a comment and here for the AAP public charge advocacy toolkit which will give you the information you need to make a comment. After one month, we have approximately 35,000 comments thus far, and our goal is to have 100,000 comments in opposition to the proposed changes by December 6. Your voice counts!
The comment period to the proposed changes to the Flores settlement ends today, November 6. The proposed changes allow DHS to expand family detention centers, increase the length of time children spend in detention, and create an alternative licensure process that undermines state child welfare laws and basic protections for children. If you have a minute today, please consider submitting a comment expressing opposition to the proposed changes here. For guidelines from the AAP Federal Affairs Office on how to make a comment, please click here
Both of these proposed regulatory changes significantly affect the fate of immigrant and refugee children seeking haven in our country. If you are interested in learning more or getting involved, please plan to attend our Town Hall on November 15 in East Los Angeles (click here for more details).
It is officially flu season! Please vaccinate your patients over 6 months of age, and especially those who are risk for complications of the flu. Also, last month the Food and Drug Administration (FDA) approved a new antiviral medication against the flu, baloxivir marboxil (trade name Xofluza). This is the first medication approved by the FDA against the flu in 20 years. It is a single dose, must be given within 48 hours of onset of symptoms and is only approved for children 12 years and over. I am not endorsing the medication, but just wanted you to be prepared in case parents start asking you about it as we get into the season.
I'm happy to report some good news - we have received sponsorship to revive our Life After Residency event for pediatric residents and recent graduates. This evening social will be at the end of January at the Sheraton Universal hotel. The preliminary agenda includes a career panel, networking and the ability to bring residents and practices looking to fill locums, part-time and full-time positions in the next year. If you would like to come to the biggest job fair for pediatric trainees in our chapter, please contact Tomas Torices here.
Please check out the rest of our newsletter for information on our Annual Symposium, Town Hall meetings and other CME opportunities, ways to get Maintenance of Certification (MOC) points with Quality Improvement (QI) projects, and statewide advocacy priorities that the AAP is working on behalf of children.

Thanks for all that you do on behalf of children in our communities!
Alice Kuo, MD, PhD, MBA, FAAP
Chapter President
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Elections End Dec 2 -  National and District
National AAP Presidential Elections  
+   District IX Chair/Vice Chair 
AAP elections started on November 2 and will continue through December 2.
The AAP National Nominating Committee has selected Sara "S ally
" H. Goza, M.D., FAAP, of   Fayetteville, Georgia, and George C. Phillips, M.D., M.B.A., FAAP, of Overland Park, Kansas, as candidates for AAP president-elect.  
In the same Ballot, California voting members may vote for the positions of District IX Chair and Vice Chair (DVC). You may read additional information about the candidates, including profiles and position statements online by accessing this AAP-CA page:
Please look for the email from the AAP in order to cast your vote during this important AAP election.

ALF Resolutions
Annual Leadership Forum - Resolution Submission Process
Deadline for District Sponsorship: November 15  
Marsha Spitzer, MD
AAPCA3 Chapter President
District IX CFMC representative
As an AAP member, you have the opportunity to advocate for and influence national AAP policy and priorities through the resolution process.  Any member or trainee can write a resolution on a topic of interest on which they'd like the AAP to act.  Some examples of "Top 10" resolutions in recent years addressed gun safety, immigrant health, safe dental anesthesia, and immunization strategies.   
The process for submitting a resolution starts with an idea... Read more

In Memoriam   
Touraj Shafai, MD, Ph.D, FAAP
Dr. Touraj Shafai, 81, of Riverside, California, husband, father, and grandfather, passed away October 24, 2018, following a short but difficult battle with amyotrophic lateral sclerosis (ALS).
His passion for life, contributions to the community, and expertise in medicine were an inspiration to all who knew him.  With a firm belief that every child should be afforded the highest quality of health care, Dr. Shafai never turned away a patient, providing support to numerous organizations in Riverside for at-risk children and assisting governmental agencies and nonprofit organizations including First 5. Dr. Shafai was a pioneer in expanding medical care in Riverside, helping to nurture and teach new doctors in the area and even assisting with the establishment of UCR Medical School. As part of the clinical faculty of UCR Medical School, he opened his medical practice to numerous students, hoping that once their schooling was completed they too would practice medicine in the Riverside area. As an advocate for breastfeeding, Dr. Shafai served as chair on the American Academy of Pediatrics Committee on Breastfeeding, and was a loyal member of AAP-CA2. He will be greatly missed.  Read the full obituary, here
In The Community  
October 9, 2018 in Santa Barbara -  Town Hall / Dinner 
AAP-CA2 Area Representative in Santa Barbara Brian Santacrose, MD, FAAP hosted a Town Hall at Wine Cask in Downtown Santa Barbara on October 9. Nedim Cakan, MD spoke on Central Precocious Puberty (CCP) Early Recognition and Management. Dr. Cakan is Medical Director of the Department of Endocrinology at Valley Children's Health Care. 
A few Pearls from Dr. Cakan's lecture
Precocious puberty is defined as the onset of developmental signs and maturation earlier that would be expected based on population norms.
  • In girls, secondary sexual development before the age of 8 years.
  • In boys, secondary sexual development before the age of 9 years
Signs of precocious puberty in girls < 8 years old: Breast development, vaginal discharge, pubarche. For boys < 9 years old: Enlargement of the testicles, facial hair, voice deepening, increased growth velocity, pubarche. 
  • Bone age is a marker of physiological maturity and skeletal maturation. Epiphyseal maturity and radiographs of that left hand and wrist are compared with published standard. Projected predicted adult height can't be calculated from chronologic age, height, and bone age.

CPP treatment rationale: 1) Rapidly advancing bone age, 2) Loss in predicted adult height, 3) Psychosocial situation.

Dr. Cakan recommended the following resources: pubertytoosoon.com  |  pedsendo.org  hgfound.orgmagicfoundation.org 

This event was generously sponsored by AbbVie. We thank Bruce Yuen and his team for their support. 
October 10, 2018 in Woodland Hills -  Town Hall / Dinner 
AAP-CA2 Member-At-Large Ken Saul, MD, FAAP hosted a Town Hall at Maggiano's, in Woodland Hills on October 10. Laurene Mascola, MD provided an update on vaccines.
A few Pearls from Dr. Mascola's lecture
  • If you are a dermatologist or orthopedist, please encourage your patients to get the HPV vaccines. These are the two subspecialties most visited by adolescents.
  • 3 things to know before giving a vaccine: 1) Is there a considerable disease burden, 2) Is it a good vaccine (efficacious), and 3) What is the side effect profile. The HPV vaccine meets all of these requirements: HPV has a tremendous disease burden with HPV related cancers, and the side profile is minimal.
  • 8 out of 10 individuals have the HPV virus. 14 million new individuals are infected each year. 80% of infections clear on their own, 20% persist.
  • Make a strong recommendation for the vaccine listing it in the middle of the three: "Today you're due for Tdap, HPV and meningococcal vaccines.
  • There have been a total of 200 million worldwide doses. To date, there is no significant data to suggest that this vaccine causes harm in any statistical way.
Q. If an adolescent who had not received the HPV vaccine has already been exposed to HPV, should they get vaccinated? 
A. Yes. Infected individuals are not exposed to all types during initial contact. The vaccine can still be useful as a preventive measure against other types.  
This event was generously sponsored by Merck.  
October 11, 2018 in Los Angeles - Press Conference  
On October 11, 2018, Mayor Eric Garcetti, County Supervisor Hilda Solis and immigrant, child and healthcare advocates spoke out against the proposed public charge rule change that would render visa and permanent resident applicants ineligible if they were to use essential public benefits like health care, housing assistance, food aid, and major tax credits created to strengthen middle-income families and children. 
Immediately after Mayor Garcetti's opening remarks, Sural Shah, MD, FAAP, Chair of the AAP-CA2 Immigrant Health Committee, delivered a powerful message emphasizing the primary needs of children. Among her statement were the following points: 
"Nationwide, nearly 1 in 4 children lives with an immigrant parent and nearly 90% of these children are U.S. citizens. Research suggests that when parents forgo public benefits because of immigration status, their children are less likely to be enrolled in programs for which they qualify- reinforcing a culture of fear for our most vulnerable families.
By restricting immigrants who use public benefits from obtaining green cards or visas, the administration is asking immigrant families to make an impossible choice between keeping their families healthy and risking their ability to remain in the country. " Sural Shah, MD, FAAP 
Children need your support. To submit a public comment, please click on the following link:    
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October 20, 2018 in Long Beach - Wellness Party
Dr. Leila Yoonessi celebrated the grand opening of her clinic by holding a Wellness Party in Long Beach on October 20, offering food, fun, music, and health education with the support from the Department of Health and community partners.
You may view two videos of her event on her Blog, at https://www.mypediatricclinic.com/blog  
October 25, 2018 in Hesperia -  Dinner/Lecture - Town Hall
Pediatricians in the High Desert met on October 25 at Bangkok Cuisine in Hesperia for a Town Hall hosted by AAP-CA2 Vice President and San Bernardino High Desert Area Representative Damodara Rajasekhar, MD, FAAP.
Dr. Rajasekhar provided an overview of Proposition 56 funds (Tobacco tax, passed in 2016) that resulted in significant increased physician payments (for office visits and well-child care) by bringing Medi-Cal payments to 85% of Medicare rate for office visit codes and 100% of Medicare rate for Preventive care codes for providing care for children. These Medi-Cal rates increase started in July 2018, although the initial minor change started in July 2017 for office visit codes.  
These increased Medi-Cal payments, he said, "will not only bring in financial stability to physician offices, but will also provide increased access to care for our patients in California".  
Dr. Rajasekhar stated "Pediatricians will no longer be the lowest paid physicians in California".
The work for our California Medical Association (CMA) now is to get these Medi-Cal revised rates permanent. Dr. Rajasekhar urged attendees to join the CMA and the local County medical societies to support organized medicine. 
The focus for the evening was on physician wellness and meditation.  
AAP-CA2 past president Paula Whiteman, MD, FAAP, FACEP spoke on "Physician Burnout, and Mindfulness". Dr. Whiteman provided compelling data that highlights the desperate need for peer support and techniques to alleviate the stress related with the medical profession.  
  • Doctors who work in small, independent primary care practices (13.5%) with fewer than five physicians, nurse practitioners or physician assistants experience less burnout. Only 13.5% in this group report burnout, as opposed to 45-54% of doctors in larger groups reporting burnout. You may read about this study, here.
  • Burnout is manifested by disengagement, blunted emotions and depression or hoplessness. Burnout may lead to depression, substance abuse, broken relationships and suicide. About 400 physicians die by suicide each year.
  • The tools for wellness include resilience ("strategic stopping" to recharge), compassion, mindfulness and meditation.
  • By definition, Mindfulness means paying attention in a particular way, on purpose, in the present moment non-judgmentally.
  • Dr. Whiteman shared a quote from Theodore Roosevelt (26th US President): "Nobody cares how much you KNOW, until they know how much you CARE".
Dr. Whiteman practices and lectures on Mindfulness. Be sure to register for her session at 6:45 AM on March 2, 2019 at the 30th Advances in Pediatrics Symposium. 
Nirmala Murthy, M.D, FAAP provided an overview on "Meditation" and provided the following pearls:   
  • It is recommended to take a couple of moments a day to meditate. With time, the mind learns to meditate at a deeper state.
  • Meditation is an art of doing nothing, letting go of all efforts. Basically, an effortless practice so as to conserve all energy.  
  • When the mind becomes free of agitation, it becomes calm and serene - then meditation automatically happens.
  • Meditation provides rest deeper than deep sleep, by relaxing the subconscious mind where energy is stored. This is resting while being alert, as opposed to sleep where one rests while not being alert.
  • EEG studies have been done on Buddhist monks revealing that during meditation, "loving kindness and compassion" is activated in the prefrontal cortex, predominantly consisting of gamma waves.
  • Through meditation, stimulation of the parasympathetic system leads to relaxation.
The evening ended with Dr. Murthy leading the group on a 15 minutes guided meditation.   
Dr. Murthy offers a free class as an introduction to The Happiness Program, with powerful breathing techniques and practical wisdom that can change your life. To register for this free event taking place on December 6 in Apple Valley, follow This Link.    
Dr Murthy offers a variety of courses. She may be reached at nirmala.murthy@artofliving.org 
October 28, 2018 Los Angeles -  Immigrant Health Committee
Members of the Immigrant Health (IH) Committee met in Silver Lake to brainstorm and develop several resolutions to be presented at the 2019 Annual Leadership Forum (ALF). In attendance were IH Committee Chair Sural Shah, MD, FAAP; Nneka Edwards-Jackson, MD, FAAP; Mayuri Ganupuru, MD, Lisa Gantz, MD, FAAP, Paula Whiteman, MD, FACEP, FAAP, and Chapter 2 executive director Tom├ís Torices, MD. 

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Upcoming AAP-CA2 Events
November 7, 2018 in San Luis Obispo
Last Chance to Register
Pediatric Town Hall: 
Strengthening Our Developmental Screening & Referral Practices
Copeland Health Education Pavilion
French Hospital Medical Center
1911 Johnson Ave, San Luis Obispo
Presentations and a provider fair will focus on early identification, support, and referrals for children with developmental concerns. Pediatricians, family medicine physicians, and other pediatric providers are encouraged to attend.
5:30 PM Dinner & Resource Fair     6:00 PM Lecture
First 5 San Luis Obispo County is proud to be co-hosting the Town Hall in partnership with AAP-CA Chapter 2, the County of San Luis Obispo Health Agency Public Health Department, and Dignity Health/French Hospital Medical Center.   We are grateful for the generous support of two additional event sponsors - CenCal Health, and the San Luis Obispo Medical Education and Research Foundation. 
Click to View the FLYER 
Click to REGISTER  
November 15, 2018 in Los Angeles
Addressing the Health Needs of Immigrant Children
Half-Day Conference 
Please join the AAP-CA2 Immigrant Health Initiative group and the Los  Angeles County Office of  Immigrant Affairs for an afternoon of discussion, collaboration, and networking on the topic of immigrant children separated from their families, their needs and ways to help them. Also in attendance will be representatives from various law firms (L.A. Justice Fund) sub-contracted by LA County to represent these children. Please join us!
Addressing the Health Needs of Immigrant Children  
SPEAKERS:  County of Los Angeles Supervisor Hilda L. Solis, First District; Office of Immigrant Affairs Executive Director Rigo Reyes; Daniel Sharp, Esq. (Legal Director, CARECEN); Lindsay Toczylowski, Esq. Executive Director of the Immigrant Defenders Law Center; AAP-CA2  President
Alice Kuo, MD, PhD, MBA, FAAP; Immigrant Health Committee Chair Sural Shah, MD, FAAP; Bobby Verdugo, Mental Health Specialist - UCLA, and Roya Ijadi-Maghsoodi, MD, president of the Southern California Society of Child and Adolescent Psychiatry. 
DATE: November 15, 2018
TIME: 12 - 4 PM
December 6, 2018 in Victorville -  Dinner/Lecture - Town Hall
Please join AAP-CA2 Vice President Damodara Rajasekhar, MD, FAAP for September' s AAP High Desert Area Townhall meeting.
CME will be provided for this lecture 
Damodara Rajasekhar, MD, FAAP AAP-CA2 Vice-President, and Area Representative in San Bernardino County/High Desert
"New Advances in Eczema"
Stuart A. Cohen MD
AAP District IX Chair 
DATE:  Thursday,December 6, 2018 @ 6.30pm 
LOCATION: Thai Dawn Bistro                        
14317 Bear Valley Road , Victorville, CA 92392
Please RSVP to drajasekharmd@gmail.com  
Save The Date -  2019
Attention Residents!  January 29, 2019
AAP-CA2 Announces: 
"Life After Residency"   
Hospitals, Clinics, Practices 
  • If you are finishing your pediatric residency soon...  
  •  If you are in need of a new pediatrician...
  • If you are looking for potential employers...
  •  If you are looking for Full-Time, Part-Time, or Locum Tenens...
  • If you want to have a fantastic time while learning about your options...  
  •  If you want to meet the graduating class from seven pediatric programs... 
... Then This Event is for You!
6 - 7 PM Social & Network with Potential Employers - Hors d'oeuvres - Bar
7 - 8 PM Panel Presentations: (Career Paths, Your first year of practice, and more)
8 - 9 PM Q&A
Residents from all pediatric residency programs in Chapter 2 are encouraged to attend. Sponsored by Abbott Nutrition
Date: January 29, 2019 from 6 to 9 PM
Location: Sheraton Universal Hotel - Poolside Terrace
March 2, 2019
Saturday, March 2, 2019 at the Sheraton Universal Hotel
"Children in Immigrant Families: How to Be an Advocate."
    Julie M. Linton, MD, FAAP 
          • Clinical Associate Professor at the University of South Carolina School of Medicine Greenville and the Medical Director of the Perinatal Awareness for Successful Outcomes (PASOs)program in Greenville County. 
          • Co-Chair of the AAP Immigrant Health Special Interest Group
Co-Author, AAP Policy Statement:  " Detention of Immigrant Children"
"Pediatric Emergencies"
    Solomon Behar, MD
          • Pediatric emergency physician at Long Beach Memorial/Miller Children's Hospital and Children's Hospital Los Angeles
          • Senior medical editor and host of the Pediatric CME program Pediatrics Reviews and Perspectives (Peds RAP)
          • Volunteer faculty at UCI School of Medicine in the Department of Pediatrics
"Adolescent Depression and Anxiety"
 "Adolescent Marijuana Use/Vaping" 
  Dianne Tanaka, MD
Christine Thang, MD 
Call for Abstracts for AAP-CA2 Advances in Pediatrics Symposium
March 2, 2019 at the Universal Sheraton in Los Angeles, CA

Abstract Submission Deadline: January 4, 2019 at 11:59PM PST

General Information:
  • The AAP California Chapter 2 will accept abstracts on scholarly projects by pediatric and medicine-pediatric residents from CHLA, Harbor-UCLA, Kaiser LA, Loma Linda, UCLA, and USC.
  • New this year, students from medical schools in the Southern California counties of Kern, Los Angeles, Riverside, San Bernardino, San Luis Obispo, Santa Barbara and Ventura are also invited to submit their abstracts!
  • Abstracts can be on original research, quality improvement, clinical cases, or any other scholarly project conducted during residency training.
  • Abstracts will be accepted for poster or oral presentation.
Other Events  -  2019
January 12, 2019 in Los Angeles

CHLA Sports Medicine Conference
The Children's Orthopaedic Center at Children's Hospital Los Angeles is proud to present the 2019 Sports Medicine Conference.

Scheduled presenters for the event are Dr. Tracy Zaslow, Dr. Ryan Kelln, Dr. Rachel Goldstein, Dr. Bianca Edison, and Dr. Curtis VandenBerg. 
With our versatile list of topics we aim to provide a well round day of education and fun.  Special workshop presented by Positive Coaching Alliance (PCA).

UCLA QI Project - Free CME/MOC 
6-Month Primary Care Practice Quality Improvement Offering for Medical Providers
Receive Free CME & MOC Credit and Help Transform Oral Health for 
LA County Children

Over half of California's children experience tooth decay by kindergarten. You can help reduce that number and improve oral health for Medi-Cal children. More LA Smiles (a UCLA Dental Transformation Initiative funded by the California Department of Health Care Services) is offering a   6-Month Primary Care Practice Quality Improvement for Medical Providers to integrate oral health services into well-child visits for children ages 0-6. R eceive 30-50 CME and 20-25 MOC credits with six months of support from a dedicated Quality Improvement Specialist. 

Immigrant Health Initiative   -  IHI  
Advocating for Immigrant Children: Join the AAP-CA2 Immigrant Health Initiative!
Join the AAP-CA2 chapter Immigrant Health Initiative (IHI)! The IHI will be a dynamic local network for advocacy, education and mentorship for chapter members caring for our diverse immigrant children. We will also partner with the national AAP Immigrant Health Special Interest Group to engage in national advocacy campaigns and share resources for promoting immigrant health.
Click here to join the IHI!
AAP-CA  Statewide Advocacy
LA-HPAC: Sac Capitol office
Have you visited the AAP-CA website lately?
Advocacy efforts on behalf of the four California Chapters is conducted from the office of AAP-CA CEO, Kris Calvin.

Advocacy Priorities
Universal ACCESS to quality, comprehensive pediatric care in a medical home, including access to vaccines and behavioral and mental health treatment for every child in California, including vulnerable populations such as children with special health care needs, foster children, children of immigrant families, LGBTQ youth and the list goes on.

Please visit AAP-CA.org/Advocacy to learn more about the current Advocacy Priorities and the list of High Priority Bills.
AAP-CA2 Video: We Are The AAP-CA Chapter 2 -  2017

CDC Updates & LAHAN Alerts
Join the CDC Listserv
The Centers for Disease Control and Prevention (CDC) is happy to offer a free email subscription service, which allows CDC.gov users to receive alerts by e-mail when new information is available. With a subscription profile, you get the updated information on the items of interest to you automatically without having to return to the Web site and check for changes. Click to Subscribe 

Join the LAHAN Listserv  
To receive communications from the Health Alert Network, Sign-up here.
It takes less than two minutes to sign up.  
Visit the LAHAN website.

Submitting Articles for Publication in Our Newsletter


Have you written original clinical work you would like to share?

Do you have any news that you would like to publish in our newsletter?

AAP-CA2 invites you to submit your ideas, accomplishments, news, pictures...

For article submission guidelines, please click here.


Advertise in Our Newsletter

AAP-CA2 invites you to advertise in our newsletter
AAP-CA2 publishes its electronic newsletter, Peds@CA2, which is emailed to its 1,700+ members on the first weekend every month. Chapter members and non-profit organizations receive a 50% discount. Please follow the link below for more information.

For advertisement rates and guidelines, please   click here.
If you are interested in advertising, please  email the Chapter.
Please Donate
AAP-CA2 is a 501(c)(3) non-profit organization. Please consider a tax-deductible charitable donation to one of our many programs
  • The Medicine-Biological Sciences Scholarship Program, which awards scholarships to exceptional high school students each year.
  • The Committee on Service, Education, and Mentoring, which awards scholarships to pediatric residents for outstanding research projects. 
  • The S. Michael Marcy Memorial Lecture, which helps sponsor a portion of our annual Advances in Pediatrics Conference in his honor.

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Please visit our website at  http://aapca2.org/