MEDICAL NEWS COMPASSION + EXPERTISE After medical school and his internship, residency, and fellowship in craniofacial and pediatric plastic surgery, Mark Schoemann, M.D., wanted to give back to the community. So at 35, before starting his own practice, he signed on as medical director of the Operation Smile Guwahati Comprehensive Cleft Care Centre in Assam, India. He spent a year there performing difficult cleft lip and palate surgeries.
Arlo McCombs, who was born with a cleft lip and palate, is shown before surgery (top left), and after. His parents, Stephanie Knight and Seth McCombs, cuddle with Arlo at home.
CORRECTING A BIRTH DEFECT
CARILION’S FIRST PEDIATRIC PLASTIC SURGEON BRINGS NEW SKILLS TO REGION By Sarah Cox
Arlo McCombs has gone through a lot in his first year of life. Born in July 2013 with a cleft lip and palate, tiny Arlo has already had two surgeries. When he’s 7 or 8, he’ll need a bone graft.
His parents, Stephanie Knight and Seth McCombs of Callaway, learned of Arlo’s birth defect after a routine ultrasound when Stephanie was 19 weeks pregnant. “I Googled the worst-case scenario,” she says. “It was totally frightening. We then went through a battery of tests to rule out any other syndromes.” A cleft lip is a split in the upper lip and a cleft palate is a split in the roof of the mouth. Both are birth defects that occur when the mouth doesn’t close completely during pregnancy. Either may appear as an isolated birth defect but can also be associated with many genetic conditions or as a result of environmental factors. One in about 700 babies globally is born with a cleft lip or palate. SURGERY TO REPAIR THE MOUTH
After the ultrasound, Stephanie and 12 FALL 2014 | CarilionClinic.org
Seth met with specialists at Carilion Clin- just in case Arlo had to spend time there. ic’s Cleft and Craniofacial Center. They “They told us not to worry, that they were learned that a series of surgeries can crehere for us, and that we could call any ate normal function in most cleft babies, time,” Seth says. with minimal scarring. They also discovered that cleft babies may have other problems, including ear, dental, feeding, and speech difficulties. To give them the best care, the Carilion cleft center team includes an oral surgeon, otolaryngologist, and early intervention social worker, along with a plastic surgeon, speech pathologist, genetic counselor, and dentist. Everyone on the team helped StephaMARK SCHOEMANN, M.D. nie and Seth understand what to expect. Specialties: Plastic Reconstructive Before Arlo was born, they also met Surgery, Pediatric Plastic Reconstrucwith Mark Schoemann, M.D., Carilion’s tive Surgery first pediatric plastic surgeon, who heads College: Emory University the Cleft and Craniofacial Center. Dr. Internship: University of Kentucky Schoemann, who joined Carilion last year, discussed what would happen when he Residency: Duke University performed Arlo’s surgery. Fellowship: Craniofacial and PediatStephanie and Seth were then given a ric Plastic Surgery, Children’s Healthtour of the Neonatal Intensive Care Unit care of Atlanta at Carilion Clinic Children’s Hospital,
“I had spent a lot of time focusing on myself in medical school and in training,” Dr. Schoemann says. “I wanted to give something back.”
A FIRECRACKER
Red-haired Jasper Arlo McCombs was born on the Fourth of July and named after famed folk musician Arlo Guthrie. His initials (JAM) also reflect the fact that his parents met at FloydFest. Stephanie and Seth call Arlo their little firecracker. At four months, Arlo had his first surgery, when Dr. Schoemann repaired his lip and a collapsed nostril. “That went great,” says Stephanie. During his second surgery, at nine months, Dr. Schoemann repaired Arlo’s cleft palate. Prior to this, Arlo wore a NAM, or nasoalveolar molding device, which was tightened every week to facilitate joining the two sides of his mouth during surgery. The second operation was “majorly intense,” Stephanie says. “We left the hospital in 24 hours. Most patients stay two to three days.” For the following two weeks, Arlo was in pain. He had already started eating solid foods, but swallowing was difficult, and Stephanie and Seth had to teach him to drink from a cup. “I cried and wanted him to be happy again,” Stephanie says, describing Arlo as a typically smiling baby. After his second surgery, Arlo’s mouth was also slightly discolored. Stephanie and Seth called Dr. Schoemann, who reassured them that infections are rare, and that the discoloration was just bruising. Now Arlo is expected to return for a
checkup in January to assess how his ability to speak is developing. After that, he’ll be checked every six months; if he needs a speech therapist, one can be assigned for home visits. Otherwise, he is expected to need the bone graft when he is 7 or 8. Stephanie and Seth say they also appreciate being able to see all of Arlo’s specialists as needed in one trip to the cleft center. To minimize travel for parents—many of whom must drive several hours for visits—the cleft team coordinates all the care required during each appointment. The team also meets regularly to discuss cases and make recommendations to give patients the best outcomes. “It improves care,” says Dr. Schoemann. “All providers are on the same page, and there is no miscommunication.” ADVICE TO OTHERS
Looking back, Stephanie would tell other parents in their situation to do as much research as possible. “But don’t look at the worst cases, and don’t get scared by ‘Dr. Google,’” she says. Stephanie and Seth were also relieved to find that Dr. Schoemann was so accessible. “He takes his time and really cares about these kids,” Stephanie says. “He’s
The center in Assam is a partnership of Operation Smile India, the government of Assam, and India’s National Rural Health Mission. It performs about 2,500 cleft lip and palate surgeries annually. Operation Smile, in turn, is the largest volunteer-based children’s medical charity, and it has performed more than 220,000 free surgeries to correct cleft defects around the world since 1982. “India was a very interesting transition for me,” Dr. Schoemann says. In a third-world country, the number of cleft lips or palates is much higher than in the United States due to poor nutrition, he explains. Often a child will go untreated until he or she is 8 or 10, and at that point, must completely relearn how to enunciate. Dr. Schoemann plans to continue volunteering with Operation Smile, headquartered in Virginia Beach. Until then, he is bringing smiles to both adult and pediatric Carilion Clinic patients in western Virginia.
passionate about it. And he’s a genius.” Seth agrees. “We can’t imagine being any place other than Carilion,” he says. For more information, go to CarilionClinic.org/pediatric-plastic-surgery or call 800-422-8482. CarilionClinic.org | FALL 2014 13