Provider Q&A

All Articles in the Category ‘Provider Q&A’

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 »

How to Best Care for Transgender Youth

A Q&A with Dr. David Inwards-Breland

Transgender youth have unique medical needs. Finding appropriate care for these patients, and their families, can be challenging.

Seattle Children’s offers the only multidisciplinary clinic in our region for youth who are transgender or gender-nonconforming. Because demand for these services is high, patients are not always able to get scheduled at the Gender Clinic as quickly as they might like.

Dr. David Inwards-Breland, medical director of the Gender Clinic, offers the following advice to providers caring for transgender or gender-nonconforming patients who may be waiting to see a specialist at Children’s. Read full post »

Supporting Children With Autism Who Will Not Eat

A Q&A With Dr. Danielle Dolezal

Image of Danielle Dolezal

Danielle Dolezal

There are few challenges that generate as much concern and frustration for parents as feeding issues. Unfortunately, for children with autism spectrum disorders (ASD), these problems are quite common. Clinical research suggests 46% to 89% of all children with ASD struggle with feeding problems.

While patients may benefit from a referral to the Pediatric Feeding Program at Seattle Children’s Autism Center, qualified specialists are not always immediately available. In the meantime, Dr. Danielle Dolezal, clinical supervisor of the Pediatric Feeding Program, offers the following advice to primary care providers who want to help waiting families. Read full post »

Tips for Treating Constipation and Incontinence

A Q&A With Dr. Lusine Ambartsumyan

Image of Lusine Ambartsumyan

Lusine Ambartsumyan

Constipation is a common condition among children and adolescents that can often be easily resolved. But when it goes untreated, constipation can lead to much more serious issues such as fecal incontinence.

Dr. Lusine Ambartsumyan is just one of Seattle Children’s gastroenterology specialists partnering with primary care physicians to offer patients the best treatment available. She has offered the following advice to providers treating constipation and incontinence in children and adolescents. Read full post »

Seattle Children’s Launches New Celiac Disease Program

A Q&A With Dr. Dale Lee

Image of Dale Lee

Dale Lee

Seattle Children’s recently launched a new Celiac Disease Program within its Gastroenterology Division. This program gives patients access to physicians and registered dietitians specially trained and experienced in working with pediatric patients with celiac disease.

Dr. Dale Lee, director of the Celiac Disease Program, addresses questions related to celiac disease, the new program and services it offers. Read full post »

Glue Embolization a Game-Changer in Treating Venous Malformations in Extremities

A Q&A With Drs. Giri Shivaram, Antoinette Lindberg and Eric Monroe

Image Giri Shivaram.

Giri Shivaram

In 2013, members of the Vascular Anomalies team at Seattle Children’s developed a method to use a medical version of super glue to treat venous malformations in the head and neck area. This glue embolization process has been highly successful in removing malformations altogether.

After seeing how well the process worked, interventional radiologists Drs. Giri Shivaram and Eric Monroe and orthopedic surgeon Dr. Antoinette Lindberg decided to try using it to treat malformations in extremities. Read full post »