Patrick's Journey: Transforming Lives Through Pediatric Neurosurgery

In a special episode of Precision: Perspectives on Children's Surgery, you will hear a powerful story about a little boy named Patrick Marvel who was diagnosed with drug-resistant epilepsy due to a perinatal stroke and how an endoscopic hemispherectomy surgery at Lurie Children's transformed his life. Patrick’s parents, Erin and Brendan Marvel, join Dr. Sandi Lam, Division Head of Neurosurgery at Lurie Children’s who performed Patrick’s surgery, to discuss how advocacy and medical expertise can turn a devastating diagnosis into a hopeful new beginning.

“We believe that the future is bright and that Patrick is going to show us what he can achieve. There are many things to coordinate and there are going to be many hurdles and challenges, but we know that the alternative would be Patrick at three years old having had three years of  seizures and and he wouldn't be where he is now and he wouldn't be walking and interacting with mom and dad the way he is now.”

Sandi K. Lam, MD, MBA 
Division Head, Neurosurgery; Yeager Professorship in Pediatric Neurosurgery
Professor of Neurological Surgery, Northwestern University Feinberg School of Medicine

Show Notes

• About three months after Patrick Marvel’s April 2022 birth, his health journey began with alarming symptoms– abnormal arm and leg movements. This eventually led to the diagnosis of infantile spasms and a perinatal stroke that had caused damage to one side of his brain.
• After trying several medications to try to stop the seizures, Patirck’s condition was classified as drug-resistant epilepsy and surgery was recommended as the best option to stop the seizures. Patrick was a candidate for endoscopic hemispherectomy surgery because his seizures were originating from only one side of his brain. During this procedure the “bad side” of the brain with the seizures is disconnected from the “good side” of the brian, which prevents seizures from spreading over to the good side from the bad side and causing irreversible damage.
• The Marvels interviewed potential surgeons from around the country and after meeting Dr. Lam and the Lurie Children’s team knew they found the right fit. Dr. Lam is an internationally recognized expert in pediatric epilepsy surgery and one of the few with expertise in endoscopic hemispherectomy surgery in children.
• Patrick was 11 months old when he underwent the procedure in March 2023, during which Dr. Lam disconnected the entire right side of his brain leaving the left side of the brain to take over almost all the function of both sides.
• That day was not only “surgery day” but Patrick’s “first haircut day.” Dr. Lam had to cut his hair to make a scar line and she saved the hair and put it in an envelope in the pocket of her scrubs. After sharing the good news that the surgery was a success, Dr. Lam gave the Marvel’s the envelope with a lock of Patrick’s hair, a precious memory they will never forget.
• Patrick and family were able to fly back home within two weeks of the procedure and he has been making strides ever since. He undergoes many hours of different therapies every week and while currently non-verbal, he has learned to sign to communicate and is walking. These are milestones that would have not been possible without the surgery, Dr. Lam says.
• Dr. Lam is passionate about family-centered care, understanding the emotional journey families face, and she is currently working with families such as the Marvel’s to research how to improve the process of getting specialized care for children with epilepsy.

Transcript

[00:00:00] Erin Spain, MS: This is Precision Perspectives on Children's Surgery from Ann & Robert H. Lurie Children's Hospital of Chicago. I'm your host, Erin Spain. On this podcast, we introduce you to surgeons at one of the country's most renowned children's hospitals to find out how they are transforming pediatric medicine. Today we are sharing a remarkable story about a young family from Colorado who found their way to Lurie Children's and neurosurgeon Dr. Sandi Lam for a rare and life-changing surgery for their baby boy. Just 10 months after Patrick Marvel was born, he underwent an Endoscopic hemispherectomy surgery at Lurie Children's for a form of drug resistant pediatric epilepsy. Patrick's parents, Erin and Brenden Marvel have navigated the journey to surgery and life after the procedure with courage and optimism. We're going to hear from them today and Dr. Lam, who is also the division head of neurosurgery here at Lurie Children's about Patrick's surgery and outcome and the importance of the partnership they've formed along the way. Welcome to the show. Erin Brendan, and Dr. Lam.

[00:01:19] Erin Marvel: Thank you for having us.

[00:01:20] Dr. Sandi Lam: Thank you for having me.

[00:01:21] Erin Spain, MS: Erin and Brendan. Tell me about your family. I understand you were first time parents when Patrick was born in 2022. Tell me what was going on during these early months and the diagnosis you eventually received.

[00:01:34] Erin Marvel: Patrick was born at 39 and a half weeks. A long delivery, but a healthy delivery. As far as we knew, everything went great and we stayed at the hospital for about three days after he was born, as you normally do, and went home. About three days after that, you go to that pediatrician appointment to meet them and have them check in with the baby. And at that appointment, Patrick actually was 96 degrees. His body temperature was really cold, and we had no idea, the doctors were like, did you give him a bath? Bath and not wrap him really warm. And we were like, no. Like he has been cozied up in a blanket since the day we left the hospital. so we actually got readmitted to the mom and baby floor that day. They did a bunch of blood work, which ruled out any type of infection, which was a relief. Then they put 'em under a heat lamp for about 12 hours and we got to go home the next morning with what again, we thought was a perfectly healthy baby. And in hindsight, now we know that a low body temperature a lot of times can mean neurological things. That was just missed by. Everyone. So we came home, continued life as normal.

[00:02:37] Erin Spain, MS: Life was going on as normal at home. First time parents with a new baby, but around three months of age, you noticed something was happening with Patrick and his arm and leg movements. Tell me about that.

[00:02:50] Erin Marvel: I noticed it one night, I was giving him a bottle to go to bed and he was half asleep and he did the startle reflex. And I was like, that was weird. It's dead silent. We're in your nursery. It's just me and you. You're half asleep. There was nothing to startle you whatsoever. I didn't even move. And then 10 seconds later he did it again. And then 10 seconds later he did it again. And he did it about six times over the span of maybe a minute. still drinking his bottle, nothing other than that. Nothing changed other than he kept doing the startle reflex. And I literally just was like, well, that was weird, that was on a Monday and I vividly remember then Wednesday it happened again and it was just in the middle of the day and I was like, that is weird. So I started Googling, which I would advise new moms to never do. But also I feel like we got where we got, because I did get on Google and it led me down a dark hole and I was watching these YouTube videos of babies doing exactly what Patrick was doing. And the words infantile spasms kept coming up. I immediately called our pediatrician. I had gotten multiple videos of him doing it. So when we got to the pediatrician, I showed them the videos they said, you know what, we will forward your videos to a neurologist just about 20 minutes from our house. And they will reach out if they have concerns. And that put me at ease. I was like, okay, someone else in the neuro world is looking at it. So we come home and no more than two hours later my phone starts ringing and my heart sank. 'cause I knew exactly where this was going. And it was a neurologist who said, I watched the videos and I'll never forget his words. He said, time is of the essence. you need to get here. Like now the ER knows you're coming. So we threw him in the car with the clothes on our back and rushed down we were up on the neuro floor where they did an overnight EEG. And that next morning the neurologist came in and said, Patrick has something called infantile spasms. I knew it, I just knew it. They said the infantile spasms are only coming from the right side of his brain.The left side of his brain actually looks perfect. So that tells us that there's something going on that right side of his brain and we would like to do an MRI to see what's going on. So he went in for an MRI and when he came out of the MRI, they came to tell us that Patrick had had a stroke at some point. And we don't know when they could tell that it wasn't a fresh wound. They could tell it had happened a while ago. It really could have happened any time after my 20 week anatomy scan. So yes, he got diagnosed with infantile spasms and a perinatal stroke, and we got to see a picture of his MRI. And the perinatal stroke was rather big. It's a pretty big black circle on the right hemisphere of his brain.

[00:05:25] Erin Spain, MS: Erin, thank you so much for sharing that story. And Brendan your wife, she had this diagnosis before the doctors even did talk to me about that and what role did you play in, you know, being a support during this very anxious time?

[00:05:40] Brendan Marvel: Yeah, it was, it was actually impressive. It's just the mom's intuition that you have to trust in your gut. And, you know, I think that it's second nature for moms and it's one of those things where you can't have both parents start jumping in and jumping off the deep end.I feel like Erin, being the mom, being Patrick, being our first, and us being brand new to being parents, somebody had to just say we're where we need to be. You know, our doctors are going to give us the answers. The answers there's nothing we can do in the meantime so we have to kind of wait and see.

[00:06:16] Erin Spain, MS: It did take some time after you received this diagnosis, before you were in touch with Dr. Lam. I wanna bring Dr. Lam in right now. Tell us more about infantile spasms. This is a serious type of epilepsy that Patrick was diagnosed with.

[00:06:31] Dr. Sandi Lam: Erin did the right thing to advocate for Patrick. Advocating for your child when you think something is wrong, and getting to medical attention and getting to care, right for getting diagnosed with the infantile spasms and understanding that this is a rare form of epilepsy that can be very serious, the infantile spasms usually are associated with some underlying issue with the brain either a brain injury or other metabolic or genetic disorders. It's a manifestation that something is wrong inside and having these ongoing seizures can be detrimental to the brain. So getting the diagnosis and being under treatment to try to get these seizures under control is really important. With the diagnostics, there are characteristic patterns that we see on the EEG, such as hips, arrhythmia, being in the children's hospital and getting treatment quickly, was the right thing to do.

[00:07:32] Erin Spain, MS: And then that realization that only one hemisphere of the brain seemed to be affected. Dr. Lam, can you talk to me about that diagnosis and how it led them to you because of a surgery that you perform here at Lurie Children's?

[00:07:46] Dr. Sandi Lam: When seizures come from one side of the brain. And we can see with the EEG where the seizures are coming from, when everything lines up we call it concordance. When all the data points to one part of the brain being the origin of the seizures. We think about all of the tools that we have in our toolbox for treating epilepsy, and that includes medicine all the way to surgery. So we have different tools, but we think about what the best tool would be. So when it is localized, we can identify it, then surgery becomes a very good tool for. Patrick, one entire hemisphere was the good hemisphere, that no seizures were coming from there, and that all of the seizures were coming from the bad hemisphere. So in that framework, that makes Patrick A. Good candidate for Hemispherectomy or Hemi Otomy surgery, which means disconnecting the bad side from the good side. So then we allow the good side of the brain to really live and develop to its full potential without having seizures spread over to the good side from the bad side.

[00:08:52] Erin Spain, MS: So Erin and Brendan, you knew that surgery could be a possibility soon after diagnosis, but you didn't go straight to surgery. There were some steps in between before you met Dr. Lam. Tell me about that.

[00:09:03] Erin Marvel: The first line of defense typically is steroids. Patrick was on steroids and the hope is that the steroids will stop the seizures permanently. So it was a four week period that he was on these steroids. The hope was that after one month of steroids, the seizures would be gone. Patrick was on prednisone. a very high dose of a very strong steroid. He definitely had roid rage. It was a very hard four weeks and he got really swollen and really big, but the seizures did stop within probably five hours of his first dose. It was almost instant that they stopped. We were like, we're willing to do whatever it so we did this bout and pretty much the day he was fully weaned off, they came back. And so the next line of defense is a medication called Vigabatrin. So he was on Vigabatrin and it's meant to be a short-term medication, I believe like 12 months-ish max is what they told us we could be on. So we started that in September and everything was going really well. He was on it. We had probably two EEGs a month checking in, and then finally in November. Eight weeks into the medication, our neurologist said it is working, but the way his brainwaves look, we're just not optimistic that this is going to be a permanent solution for Patrick. And she said, the next big conversation we need to have is surgery. And it sounds crazy, but in that moment I felt a sense of relief. These medications have these side effects. And it's really daunting to think about doing that forever. Bouncing from medication to medication in hopes is it gonna work, is it not gonna work? What are the side effects? And surgery to me seemed like a really hopeful, permanent one and done, a massive one and done, but regardless of one and done. So, that was the process of getting two, the thought of surgery. We started looking into the top hospitals and neurosurgeons for Patrick, and we ended up traveling a bit and had some overnight EEGs throughout the country where everyone recommended the surgery. Everyone that we visited and saw did overnights, and that was definitely the consensus. So we felt very confident in the decision that. This was the route we were going. It was just a matter of where we felt the most comfortable. Dr. Lam was our last one that we met. And Brendan's uncle actually is in the medical sales world and just asked around his peers and coworkers if they knew of this surgery, if they knew any surgeons that are well known in this surgery. And that's what led us to Dr. Lam.

[00:11:37] Erin Spain, MS: And Dr. Lam just tell us again why Patrick was such a good candidate for this surgery.

[00:11:43] Dr. Sandi Lam: Well, Patrick had already failed medical therapy, right? He had already tried medicines and was responding and then really showed us that just wasn't enough. He's continuing to have seizures even with medical treatment, we see on his brain MRI, there is a clear problem and a clear lesion with the perinatal stroke along with ongoing seizures from that side of the brain that is already injured, All that means. We're not doing well enough for Patrick, right? It's not enough. We can't let Patrick continue to have seizures, so we know that he's a good candidate for surgery because we can do something about it, right? We know that we have surgery that works well when you have a hemispheric problem and a lesion or an abnormality that is localized to that one side of the brain where the seizures are coming from. So hemispherectomy surgery is clearly the right thing to do in this situation,and the earlier the better because Patrick's brain is developing. The good side of the brain is being held back because the bad side of the brain is continuing to have seizures, and we know that we can help him. When we can have the seizures be under control, that's when the good side of the brain can thrive. When we see these situations, it's really great to be able to say that we know that this is a problem, that we can help with surgery. We have a team that is experienced to do this, and we would be honored to be able to take care of your child. as Erin said this is a fit, because. You are trusting your child to us, and that is a really big decision. Nobody can tell you what is the right thing to do or what's the wrong thing to do. You need to understand that this is the decision that you're making for your child and for your family, and this is a decision that you're gonna live with. I have so much respect for you, Erin and Brendan, for everything that you went through and everything that you did to advocate for Patrick and your conviction in knowing that you are doing the right thing for your child and your family.

[00:13:56] Erin Marvel: A big thing with Dr. Lam is it just felt right. With her, it was just, there was never any question. And as you just heard the way she was talking about us and Patrick, like, we are real people to you, Dr. Lam. And that's just, it's just not always the case. Not only that, but you're so experienced in this surgery, which is very comforting. Patrick wasn't just another practice round you do this often. And not only that, and you're, I just feel like you're dedicating your life to improving neurosurgery. As a whole not just about Patrick for all kids. I'll never forget, during one of our very first meetings with Dr. Lam she looked right at us and was like, it's not about the surgery at all. It's about Patrick's life? That's exactly why we're here. You know, it is about Patrick's life.

[00:14:44] Erin Spain, MS: So, Dr. Lam, just take us through the surgery. What happens during the surgery, and what was the outcome for Patrick?

[00:14:50] Dr. Sandi Lam: The goal of the hemispherectomy surgery is to disconnect the bad hemisphere from the good hemisphere. inside the brain, there are known connections where we have to make those disconnections. I have to make four very specific cuts. The way that I do this surgery is from a vertical approach with an endoscope. So a camera that I can put into the brain to help me see in detail the areas of the brain that I need to work on. where I'm doing the disconnections, so I'm not actually removing things. I'm disconnecting something so that the seizures can't cross. So you don't actually have to take out all of the brain tissue. You just need to disconnect it so that the seizure will not be able to propagate through. So in doing the surgery in this way where I make the disconnections in the areas that I know I need to make the disconnections and not by removing. Portions of the brain, we are able to minimize blood loss and inflammationAnd minimize other types of trauma. So, also with the vertical approach from the top of the head, we're able to use a natural corridor in the brain where I am between the right and left sides of the brain. So I don't actually have to cut through any brain in order to get into the ventricle. so the middle part of the brain where the fluid space is, and I'm able to actually make all of the cuts and disconnections from inside the ventricle. So as much as possible, we're using natural corridors. And being minimally invasive, while being maximally effective. And also we're able to do the surgery with minimal blood loss. Even Patrick at 10 months old with the surgery that we did, he did not need to go to the ICU and he was able to recover in our neurosurgery ward.

[00:16:44] Erin Marvel: One of my favorite things to tell people is on March 10th, 2023, Patrick had his hemispherectomy, but he also had his first haircut. And Dr. Lam had to cut his hair to make his scar line, and she saved the hair and put it in an envelope and it was in her scrubs for the whole surgery. And when she came out to give us the good news, the first thing she did was gave us Patrick's first haircut. So if that doesn't convince you to go to Lurie Children's, I don't know what will. 

[00:17:12] Erin Spain, MS: Dr. Lam, you are passionate about making families feel comfortable and informed, and you care about the parents' needs, along with the needs of the child. Tell me about this family centered approach to care, and why does this matter so much to you?

[00:17:28] Dr. Sandi Lam: It's something that we've learned over time, when becoming a doctor, there's so much that goes into the schooling and trying to get into the next steps, and then trying to become a neurosurgeon and learning how to do neurosurgery, and then trying to get a position in the neurosurgery community. The medical field is very much about scholastic and academic achievement and then about refining skills. And then I realized that's actually the wrong focus, when we think that we can do surgeries really well, that's not good enough. That's something that I'm still growing in and really excited by is how you actually find meaning in healthcare and in neurosurgery to say, "we understand that we're not good enough. We understand that we have to do better", and the journey that every family goes through to be able to get a diagnosis for their child. Care at the right time is really difficult. No matter what the diagnosis is. And what Erin and Brendan went through with Patrick is a really big deal. So now my research is actually focused on the journey to finding subspecialty care, the journey to pediatric neurosurgery and the journey to epilepsy surgery because we know that we have very good treatments and we know that we have surgeries that can help people, but it's actually very difficult to be able to access that treatment. Sometimes you get to it very quickly if it's a trauma, if you're in a car accident, right? And actually you can get to it quickly if you have a new diagnosis of a brain tumor and people recognize you need brain surgery. But in the case of epilepsy, it's hard to connect the dots sometimes. Time matters, right? Time is of the essence and babies are developing and we can't let these seizures go on. It should almost be like a tumor that when people hear tumor, people know, cut it out. But when you talk about seizures sometimes we think, well, we can try medicines. Well, we can try another medicine. Let's just see what happens. I'm really passionate about it. Being part of the solution together with families and our healthcare system to say, how do we align the knowledge? How do we align the way our systems work? How do we align our availability? How do we align our experience to all be focused around what patients and families need rather than coming to the healthcare system in the way that it's designed right now? And a lot of what I'm doing now with the Patient-Centered Outcomes Research Institute is working in a patient centered way to understand outcomes that matter to families. How we can work together with families to answer questions that matter to families and how we can actually do healthcare better. So I'm learning so much through this process. We're nowhere near done because it's working with families like Erin and Brendan that inform us where we're doing well and actually where we can do better. Recently we're embarking on a qualitative study where we're interviewing families on how they got to hemispherectomy hearing that journey from multiple families. It's incredible how similar those journeys are, no matter where parents are in the country. And the themes that emerged were: The decision to come to surgery is difficult. It is very individual, but it's difficult to understand and come to the conclusion that your child needs surgery. Some families actually found a lot of hope in that decision saying, it's something that we can do. That is really the silver lining. It's always an emotional journey. So how can we anticipate that and, and help? And the other thing is that families wished it were easier to get education and get information upfront. That's the power of connecting families with each other and having peer support networks, patient advocacy groups to be able to understand you're not alone. Hearing that you're not alone and that it's gonna be okay in their treatments, from other families is very different than hearing that from me as a surgeon. So we've learned a lot about what can we do to connect people together earlier and throughout the entire process. And the last thing that we learned is actually the geography education level of the parents. many things that are baked into our social and economic circumstances really influence your access to surgery and your ability to get timely care. How do we understand those barriers and how can we help every family be able to help their child and get the best care for their child? Erin and Brenda you live this and we need to listen and we need to understand how we can do better so that we can do our best for everybody and have the best outcomes like Patrick is having now.

[00:22:39] Erin Spain, MS: Erin, tell us how Patrick's doing today. Soon he will be a three-year-old and he's hit many milestones. I hear.

[00:22:46] Erin Marvel: he is walking, he is thriving in so many ways. But there are still challenges every single day. We spend probably between eight to 10 hours a week at therapy, whether it be physical therapy, occupational therapy, speech therapy, vision therapy. We also see someone called a developmental interventionist that comes in our house and just gives strategies. There's a lot going on every single day, and Patrick definitely has developmental delays with the stroke and with the hemispherectomy surgery comes pretty immense left sided weakness. We are lucky in that Patrick's lower half isn't super impacted, so his leg is pretty high functioning. He does have a brace on his ankle. but for the most part it's his left upper body and it's really tight. His arm is bent really tight, close to his body majority of the time, and a lot of our occupational therapy is working on that and teaching his brain how to use the left side of his body. And now that he's comprehending a bit more, we can say, Patrick, you gotta use Lefty. And he tries and it's still very hard. There's no grasping anything small quite yet. As Dr. Lam had told us, the lefty will forever be a helper hand, you know, so if he's taking a sip lefties there, it's not holding onto the cup. It's just a prop. Patrick is still what I would consider nonverbal. He doesn't have any solid words. We have a speech device that he doesn't quite understand how to use yet. And he uses like 10 or so signs to communicate with us. And that's a bit of a challenge, because when really you only are using your right hand, all of the typical signs that people in society would know are not signs that he does or can do because he's not using his left hand. So we know his signs. But if a stranger were to come in they would have a hard time figuring out what he's doing or saying at any given point. speech therapy, now that we feel like we've gotten over this hump of Patrick walking, the hope is that speech therapy can really ramp up and that his brain is ready to take that on next..

[00:24:47] Erin Spain, MS: Dr. Lam, is this a typical recovery that you would expect to see in someone like Patrick?

[00:24:54] Dr. Sandi Lam: Yes, when we say the goal is to stop the seizures, that's it. The most important goal when the brain is having seizures all the time. It can't develop, right? Patrick was not able to have the neurocognitive development that he could have if he didn't have seizures ongoing in his brain. So now we're allowing for time and development and therapies to really help him achieve his potential. We don't know what that potential will be for each child, but we know that the alternative of having continued seizures in the brain for a baby is going to be worse. In terms of what the brain can do. So we know that the neurocognitive outcomes will be much worse for somebody who is living with seizures. We also know that each year living with seizures exposes somebody to a higher risk of death, right? So there is sudden unexplained death in epilepsy, and that is something that is a recurring risk with every year lived with seizures. seizures are bad for the brain, they're bad for the brain development. There are other comorbidities and other medical issues that go along with seizures, there are many reasons why we focus on stopping the seizures, but we know that Patrick's brain had damage upfront, right? That he had a perinatal stroke. So he had a stroke in his brain around the time of birth. The damage to the brain can't be repaired, but the manifestation of that damage was the seizures. And that's something that is even worse, right? If there's ongoing seizures. So we need to stop the seizures, but we know that it is a marathon not a sprint, it is a journey and a very long road. But we do know that now that Patrick doesn't have ongoing seizures, only he will be able to show us what he can do and what he can achieve over time. The needs for physical medicine and rehabilitation and ongoing therapies are intensive. So, that is something that we learned from families as well, from interviewing families and understanding that journey. Leading up to hemispherectomy surgery, we also learned a lot about life after Hemispherectomy. We learned that it is actually a longer road after the decision for surgery because there is a lot of care coordination. Time and effort and investment in that's ongoing. So we're learning that we can do a lot better in helping with the journey after Hemispherectomy as well. That is after what seems like the big scary part of the surgery. But we know that there are many needs after that, and that is part of connecting families with other families and the power of knowledge mom and dad will continue to advocate for Patrick to get all of the therapies, all of the services that he needs. As we head into school age, there are many things that mom and dad can advocate for Patrick in the school system as well. We believe that the future is bright. And that Patrick is gonna show us what he can achieve. There are many things to coordinate and many hurdles and challenges, but we know that the alternative would be Patrick at three years old having had three years of seizures and he wouldn't be where he is now and he wouldn't be walking and interacting with mom and dad the way he is now.

[00:28:37] Brendan Marvel: Erin and I, we actually started a foundation in Patrick's name, and we wanted to be able to help out families who are going through this and who aren't able to travel, to go seek third opinions at Lurie [Children's] 'cause we were fortunate enough to be able to do that. And some families aren't that could potentially have an impact on the care that they receive.

[00:29:07] Erin Marvel: Yeah. We just don't take it for granted that we were able to travel and take the time off, dip our toes in the water multiple places and all of those things. So it's called the Patrick Marvel Charitable Foundation. We hope to gift that of mind to someone else knowing they got to choose where they wanted to do this. Where I forever indebted to you and your team and it's hard to put into words how much you meant and mean to us. And we still talk about you and your team just every day, every day. Everybody that knows Patrick also knows Dr. Lam by name. Yeah. You're a celebrity. are around our neighborhood and we can't wait for you to see him in may. Yeah. We'll be there in May, and he'll walk right into your office.

[00:29:51] Dr. Sandi Lam: Can't wait. I am. I'm just so grateful to be a part of your lives.

[00:29:56] Erin Spain, MS: For more information, including how to make a referral or an appointment, visit luriechildrens.org.