Provider Q&A

All Articles in the Category ‘Provider Q&A’

Diagnosing and Treating Thyroid Cancer: A Q&A With Drs. Scott Manning and John Dahl, with Case Study

Headshot of Scott Manning

Scott Manning

Headshot of John Dahl

John Dahl

Is thyroid cancer on the rise?

Scott Manning, MD, program director, Otolarnygology Education, and John Dahl, MD, PhD, MBA, pediatric otolaryngologist, Seattle Children’s: Yes, the reported incidence of thyroid nodules across all age groups is increasing in the United States, with thyroid cancer now the fastest-growing cancer diagnosis for adult women. We believe environmental factors are contributing to this rise. For children, a thyroid nodule has an even higher chance of being malignant than for adults; in some centers, as many as 20% of pediatric thyroid nodules turn out to be cancer, versus 5 % in adults. That said, it’s important to keep in mind that the majority of thyroid nodules in children and adults turn out to be benign. About 350 pediatric thyroid cancers are reported each year in the United States.

What is the best way to diagnose a thyroid nodule?

Ultrasound is the best way to initially evaluate a nodule and will determine whether a particular nodule additionally needs a fine needle aspiration (FNA) biopsy in order to make the definitive diagnosis. Ultrasound does not require anesthesia/sedation or radiation and is cost-effective. It can also be used to evaluate for the presence of cervical metastases in children with thyroid cancer.

At Seattle Children’s, we are able to do FNA biopsies in clinic with our kids awake under local anesthetic, which makes the process that much safer and easier on the family and child. About 85% of our FNA biopsies are done this way, which is unique in the United States; most FNA biopsies elsewhere are done under general anesthesia.

It’s important to have a patient’s ultrasound read by a pediatric radiologist rather than an adult radiologist, because of their specialized knowledge and training in working with children and imaging.

For a variety of treatment-related reasons, we don’t recommend diagnosing a nodule by starting with a CT with contrast. Read full post »

All in A Day’s Work: A Q&A with Dr. Kathleen Kieran

Kathleen Kieran

Kathleen Kieran

Kathleen Kieran, MD is a pediatric urologist serving patients in both Seattle and Tri-Cities.

You’re from Boston originally. What brought you to Seattle Children’s?

Dr. Kathleen Kieran, pediatric urologist, Seattle Children’s: I’ve been slowly working my way across the country from the East Coast. I grew up in the suburbs of Boston, and went to college, graduate school, and medical school there. I attended the University of Michigan for my urology residency, and then the University of Tennessee for pediatric urology fellowship. I worked in Iowa for 5 years before I came to Seattle.

The greatest impetus for my move to the West Coast was that my husband (who grew up in Puyallup and is an adult urologist in Tri-Cities) loves living in the Pacific Northwest and will absolutely not entertain the idea of living anywhere else. So I called Dr. Paul Merguerian [Seattle Children’s division chief of urology], and luckily they were about to post a position. Read full post »

Kawasaki Disease: A Q&A With Dr. Michael Portman

Michael Portman

Michael Portman

How has our understanding of Kawasaki disease etiology changed?

Dr. Michael Portman, director, Pediatric Cardiovascular Research, Seattle Children’s: Kawasaki disease (KD) is considered a systemic autoinflammatory disease and vasculitis that shows specific predilection for the coronary arteries, resulting in dilation or aneurysm formation. Many KD experts believe that the autoinflammatory response is triggered by environmental factors in genetically susceptible children. Over the past decade numerous genetic loci and polymorphisms have been identified as influencing KD susceptibility and treatment response. For instance, studies performed at Seattle Children’s Research Institute have highlighted the importance of polymorphisms for genes encoding Fcγ receptors, which regulate immune cell responses. The specific environmental factors have not been clearly identified but may be related to a common antigen carried by certain bacteria or viruses. Read full post »

Spinal Muscular Atrophy: A Q&A with Dr. Fawn Leigh

Dr. Fawn Leigh

Fawn Leigh

Spinal muscular atrophy (SMA) is the leading genetic cause of death for infants. Seattle Children’s neurologist Fawn Leigh talks about the fast-changing landscape of research and treatment that is bringing new hope to patients and their families.

What do you want providers to know about SMA?

Dr. Fawn Leigh, neurologist, Seattle Children’s: Being aware of SMA and spotting it early is very important in getting babies into treatment. It can be seen as early as during the newborn checkup. The most common feature of infants with SMA is hypotonia (low muscle tone). We typically see babies with neck flexor weakness, where they can’t lift their head on their own, and significant head lag when pulling up. There’s an absence of reflexes too. But the main thing is hypotonia; that’s the red flag providers should watch out for. Read full post »

Climate Change Effects on Skin: A Q&A With Dr. Mark Boos

Dr. Mark Boos

Mark Boos

How are children affected by climate change?

Dr. Mark Boos, pediatric dermatologist, Seattle Children’s: We are all affected by the changes in our natural environment that have been precipitated by the climate emergency our world is experiencing secondary to elevated atmospheric carbon dioxide levels. But while natural disasters such as wildfires, hurricanes and other forms of extreme weather can cause lasting physical, mental and emotional harm to all people, specific populations are more adversely affected. This includes children, the elderly and individuals with disabilities. Currently, it is estimated that 88% of the existing global burden of disease secondary to climate change affects children less than 5 years old.

Children are uniquely vulnerable to changes in the environment, specifically to extreme changes such as heat waves and air pollution that are worsened by climate change. Children have an immature physiology and metabolism that prevent them from optimally regulating their temperature. Additionally, children have a greater challenge in clearing inhaled or ingested pollutants, while simultaneously having an increased exposure to these agents (per unit body weight) in air, food and water. Furthermore, their distinctive behavior patterns (i.e., spending more time outdoors) and dependence on adult caregivers place children at much higher risk of climate-related health burdens than adults. Specifically, children may suffer from impaired lung development, asthma exacerbations, worsening allergies and malnourishment as a result of climate change. Post-traumatic stress, physical injury, disruptions in education and loss of a stable home environment are additional ways that children can be negatively affected by natural disasters.

Read full post »

The Latest in Pediatric Cranial Base Surgery: A Q&A With Dr. Randall Bly

headshot of Dr. Randall Bly

Randall Bly

What are cranial base diagnoses?

Dr. Randall Bly, principal investigator, Seattle Children’s: These are diagnoses of tumors or other lesions in the middle of the head. The cranial base is also sometimes called the skull base. Diagnoses can include nasal dermoids, orbital tumors, cholesterol granulomas, craniopharyngiomas, schwannomas, paranasal sinus tumors, pituitary adenomas, inverted papillomas, neurofibromas, angiofibromas, glomus tumors, esthesioneuroblastomas and cerebrospinal fluid (CSF) leaks.

Read full post »

IBD Treatment: A Q&A With Dr. Namita Singh

Photo of Namita Singh

Namita Singh

What causes inflammatory bowel disease (IBD)? How has our understanding of it changed over time?

Dr.  Namita Singh, physician, Seattle Children’s: IBD is a multifactorial chronic disease. It is due to the overly active immune response to gastrointestinal (GI) enteric bacteria in genetically susceptible individuals, triggered by environmental factors. More than 200 genetic loci have been identified as playing a role in IBD, with some (i.e., NOD2) being associated with more progressive disease. Using our understanding of the inflammatory pathways affected in IBD, newer medications have been developed targeting these various pathways. The enteric bacteria, or GI microbiome, is known to be very different in IBD — with less diversity — than in healthy non-IBD patients. There has been an increase in IBD incidence worldwide over the past decade, suggesting a large impact in environmental factors rather than genomic shifts. For example, immigrants from countries with a lower prevalence of IBD assume a much higher risk when they immigrate to the United States, and their children even more so. The fastest-growing population is the pediatric Crohn’s disease population, and we are seeing IBD in very young patients as well.

Read full post »

Caring for Transgender Youth

A Q&A With Dr. Juanita Hodax

Dr. Juanita Hodax

Juanita Hodax

Who needs to make the referral, and what happens once the referral is placed?

Dr. Juanita Hodax, physician, Seattle Children’s: A patient can be referred to the Gender Clinic by one of their providers, or they can self-refer. Once a referral is placed, they will receive a call to first schedule an intake call with a social worker who is the Gender Clinic care coordinator. During the intake call, we get a brief history and discuss goals of the appointment and provide resources (for mental health providers, local community resources, etc.) that may be helpful to the patient and family even before they have their appointment. After the intake call is done, an appointment with a medical provider is made.

What ages do you see?

Dr. Hodax: We see pediatric patients up to age 21 years old. As patients approach age 21, we work with them to find an adult provider who can take over the management of their transgender care. Many times, this is a primary care provider who has some experience in transgender care.

Does a patient need parent permission to get services from the Gender Clinic, and if not, at what point does the parent need to be involved?

Dr. Hodax: While some treatments require parental consent for patients under the age of 18 years, some treatments are available to patients without formal parental consent. Gender-affirming hormones (estradiol or testosterone) do require parental consent from all parents who have medical decision-making power, because these treatments have the potential for irreversible long-term effects. Puberty blockers (Lupron injections or histrelin implant) are a reversible treatment but do require parental consent, as patients are typically at a younger age when this treatment is being considered.

Complete parental consent is not required for medications used to suppress menstrual cycles in transgender boys or for some testosterone blockers in transgender girls. Parental permission is also not required to schedule an appointment in the Gender Clinic. However, our providers and our social work team try very hard to work with parents to help them understand why treatment is important and necessary for their child. Read full post »

Addressing a Family’s Sleep Issues

A Q&A With Drs. Maida Chen and Michelle Garrison

Sleep is one of the most common concerns divulged to family providers. While parents most often ask for advice related to young children, Seattle Children’s sleep experts Drs. Maida Chen and Michelle Garrison suggest providers treat the entire family when addressing sleep issues.

Read on to learn more.

Thank you to Dr. Wendy Sue Swanson, Chief of Digital Innovation for Children’s and author of the Seattle Mama Doc blog, for submitting these questions.

How does parents’ sleep impact the rest of their family?

Dr. Michelle Garrison, principal investigator, Seattle Children’s Research Institute: Sleep problems between family members are often

interconnected, so providers should look beyond the sleep habits of a specific child and consider what’s going on in a family unit.

When sleep isn’t going well, it can create what I call a “feedback loop of despair.” When children aren’t sleeping well, it can affect parent sleep as well – and then the next day, the child’s behavior can be worse and parents may have less capacity for parenting the way they want to, because they are both tired. And in turn, those effects on behavior and parenting can make bedtime even harder the next time, and you have a feedback loop. Read full post »

Identifying Fatty Liver Disease

A Q&A With Dr. Niviann Blondet

Nonalcoholic fatty liver disease (NAFLD) – the accumulation of fat in the liver – is the most common liver disorder in the United States, affecting approximately 10% of children. Although incidence is increasing, this condition is uniquely difficult to diagnose.

To address this issue, Seattle Children’s has opened a new Fatty Liver Clinic to treat patients with a multidisciplinary approach.

“We estimate about 10 million children have fatty liver disease, but there’s a large population that goes undiagnosed,” said Dr. Niviann Blondet, a gastroenterologist at Children’s. “It’s not until they develop cirrhosis that they seek medical attention.”

Dr. Blondet offers the following information to providers in hopes that patients might be diagnosed sooner and treated more effectively.

What are the risk factors of NAFLD?

Obesity is the most significant risk factor. There is a direct correlation between NAFLD and body mass index (BMI). However, the disease can occur in children within a normal weight range.

The prevalence of NAFLD increases throughout childhood, possibly because BMI increases with age in children.

Studies have also shown an association with insulin resistance. NAFLD increases the risk of developing type 2 diabetes and may worsen glycemic control in children with diabetes and contribute to the development and progression of chronic diabetic complications.

Gender can also be a contributing factor. NAFLD is approximately 40% more common in boys than girls. Read full post »