Pediatric Center for Airway, Voice and Swallowing Disorders

Podcast Transcript

Dr. Scott Steele: Butts & Guts, a Cleveland Clinic podcast, exploring your digestive and surgical health from end-to-end.

Hi again everyone, and welcome to another episode of Butts and Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. And today I am very pleased to have three experts with us talking about Pediatric Center for Airway, Voice and Swallowing Disorders. First Annie Banas, who is a certified nurse practitioner in the Center for Pediatric Pulmonary Medicine at Cleveland Clinic Children's. Annie?

Anne Banas, MSN, SPRN-CNP: Hi. Nice to meet you.

Dr. Scott Steele: Glad to have you here. And Diane Cowles, who is a registered nurse specialty care coordinator at Cleveland Clinic Children's.

Diane Cowles, RN: Hi, nice to be here.

Dr. Scott Steele: Absolutely glad to have you here. And finally, Christine Arnica, who is a pediatric social worker at Cleveland Clinic Children's.

Christine Arnica, MSSA, LISW: Hi. Thank you for having us.

Dr. Scott Steele: Well, thank you so much for being with us here today. And today again, we're going to talk about the Pediatric Center for Airway, Voice and Swallowing Disorders. But before we get there, I'd like for each of you to briefly tell us a little bit about yourself, where you're from, where'd you train, and how did it come to the point that you're here at the Cleveland Clinic? Annie, we'll start with you.

Anne Banas, MSN, SPRN-CNP: So again, I'm Annie Banas. I am a certified pediatric nurse practitioner. I've attended John Carroll University. I was a biology pre-med major, and I decided that I once had a guidance counselor ask me what I really wanted to do and I said I really wanted to work with people and help them. And she said, there's two avenues you can go. You can go more a nursing route and treat the patient or more of a medical route and treat the disease process. And that really spoke to me.

So, I did, after I graduated from John Carroll, decided to pursue my Masters in nursing. So then I went to Case Western Reserve. I spent the first four years of my career as a pediatric ICU nurse at Rainbow Babies and Children. And then after I finished my Masters, I joined the Cleveland Clinic and the Pediatric ENT program where I was there for 10+ years where we actually conceived of this idea with Dr. Paul Krakovitz and Dr. John Carl. And since then it's grown exponentially.

About six years ago, I was afforded the opportunity to focus primarily on this program and develop the program into more of a nationally recognized program. And now I'm in the Peds Pulmonary Institute.

Dr. Scott Steele: Great. Glad to have you here. Diane?

Diane Cowles, RN: So healthcare was a second career for me. So, I've been with the Cleveland Clinic since 2009, became an RN in 2012. I've always been in pediatrics, worked both inpatient and outpatient. Started working with PCAVS as the ambulatory RN with Peds ENT in 2016, and then took this care coordinator role in 2020, and I'm now here in Peds Pulmonary.

Dr. Scott Steele: Fantastic. Glad to have you here. And then finally, Christine?

Christine Arnica, MSSA, LISW: I am a licensed independent social worker. I have both my Bachelor's and Master's degrees in social work, and I have been at the clinic since 2017. Prior to that experience, I did work as a social worker for a children's services agency, and I love working with this patient population.

Dr. Scott Steele: Well, I am so glad that the three of you have a chance to join us here today. And Annie, we're going to start a little bit with you for a couple of questions. So, as I said today, we're going to talk a little bit about the Pediatric Center for Airway, Voice and Swallowing Disorders, also known as the Pediatric Aerodigestive Clinic here at the Cleveland Clinic. So, can you start off by sharing a little bit more about what this clinic is to our listeners?

Anne Banas, MSN, SPRN-CNP: Sure. So PCAVS, which again stands for Pediatric Center for Airway, Voice and Swallow, again started about 12 years ago where we focused mainly on children that had primary needs and ENT pulmonary and GI airway, digestive disorders. It's a multidisciplinary clinic where we focus as a team because I always think multiple heads and brains are better than one, and we can focus on their needs as a complete package instead of just identifying one need. And then we can take our group recommendations as either procedural, so surgical options that we have or following them for the longevity of this disorder.

Our clinic actually is unique to some of the other bigger national aerodigestive programs, where we ended up becoming their medical home where a lot of services just see them for a surgical need and then they disperse to the disciplines individually. Where we keep them as long as we feel that we're still servicing their needs.

Dr. Scott Steele: You mentioned the word team, so whom does make up that team?

Anne Banas, MSN, SPRN-CNP: So, the primary medical providers are pediatric ENT, pediatric GI, and pediatric pulmonary. We also have social work, a dietician, speech and language pathologist, and a pediatric physiatrist.

Dr. Scott Steele: So, who can be treated at this pediatric aerodigestive clinic?

Anne Banas, MSN, SPRN-CNP: So, anyone who has a primary swallowing airway need that has services for ENT, pulmonary and GI. We, as a team, decipher those referrals. We usually will see any referral at least once and make sure that this is the right home for them.

Dr. Scott Steele: Okay. So, I'm a parent or a legal guardian listening to this. When should I seek care at this pediatric aerodigestive clinic for their child?

Anne Banas, MSN, SPRN-CNP: So, I think if your child has an ENT pulmonary or GI need and primary airway swallowing issue, I think you should call us, and we would be happy to talk to you, gather more information and decide if we are the right place for your child.

Dr. Scott Steele: Fantastic. Diane, we're going to now turn it over to you. So, what could be expected during someone's first appointment?

Diane Cowles, RN: I think one of the things that's really unique is that once we've had contact with the parent, we start with a virtual visit with Annie where she collects a lot of medical history, finds out what the family's goals are for their child so that when they do come and get seen in-person, the providers already have an idea of what's going on with them.

When they come in person, we see patients at our main campus in our outpatient pediatric building. Families get roomed into an exam room and providers will come in and out to them, so they're not having to be shuffled around the building. Everything is focused on them, and they'll see each of those specialties individually.

Dr. Scott Steele: So, I don't need to tell the three of you, but a diagnosis can be life-changing at any age. So, what can be expected of a pediatric patient's care at this pediatric aerodigestive clinic?

Diane Cowles, RN: Like Annie alluded to, it's very team-focused and the providers are all very invested in these patients. Included in that team is also the families, and we very much keep it individualized where not every patient and family have the same end goal. And so, their care is really customized to them, and everyone is on the same page.

Dr. Scott Steele: So, the pediatric population is extremely unique for a lot of reasons, but one of which how the quick changes that can happen over a relatively short time period. So how does that care evolve as those pediatric patients go into adolescence?

Diane Cowles, RN: It's hard to say because there is no one answer. All of our children are so unique that it's different for everyone. We certainly will start having conversations and often with Christine about guardianship that parents have to worry about as their children get older. We'll talk to them and help them with a transition into adult services when that time is ready, and really try and make it as smooth as possible.

Dr. Scott Steele: So, let's transition now to Christine. So, can you describe your role? You mentioned obviously a case management social worker. How does that fit within this aerodigestive clinic?

Christine Arnica, MSSA, LISW: Yes, as a social worker, I provide non-medical support to both patients and their families. Our aerodigestive clinic knows that in order to fully optimize a patient's medical care, we also have to take a look at the psychological and social barriers that impact both patients and their families. And that's where I come in as the social worker.

Dr. Scott Steele: This truly is a journey. So how do you first connect with the patient and their family and how does that help evolve over this entire process?

Christine Arnica, MSSA, LISW: Ideally, I connect with the patient and family from the very beginning. I meet with everyone who comes through our clinic whether there is an identified social work need or not, and I really get to know the family. One of the main pieces of support I provide is clinical and emotional, while the patient and family navigate through their healthcare journey. I also assist them with finding both government and local community resources to meet their specific needs. My goal really is to walk through the journey with the family, and I'm always available to assist as the needs arise.

Dr. Scott Steele: So, what do you find most rewarding as a pediatric social worker?

Christine Arnica, MSSA, LISW: I truly value the strong relationships that I establish with these families, and I love seeing the impact that my support has on a patient's quality of life.

Dr. Scott Steele: So, we're going to break here and take time for some quick hitters where we get to know each of you just a little bit better and we'll go around the room. We'll go Annie, Diane, and Christine for the listeners at home who got to pair up the voices with the names. So, first of all, what is your favorite meal?

Anne Banas, MSN, SPRN-CNP:I'll have to go with tacos.

Diane Cowles, RN: Oh, a good Thai curry.

Christine Arnica, MSSA, LISW: Chicken enchiladas with the rice.

Dr. Scott Steele: There you go. So, what is your favorite sport either to watch or to play?

Anne Banas, MSN, SPRN-CNP: Probably the ones my kids are playing right now, so hockey, volleyball and soccer.

Diane Cowles, RN: Yeah, I am a soccer mom.

Christine Arnica, MSSA, LISW: I love to watch baseball. Go Guards.

Dr. Scott Steele: There we go. And so, what's your favorite vacation destination that you've been on?

Anne Banas, MSN, SPRN-CNP: Probably our family trip we take every summer to Bald Head Island in North Carolina.

Diane Cowles, RN: Yeah, any kind of good chill beach vacation.

Christine Arnica, MSSA, LISW: I love visiting national parks. Acadia in Maine has been my favorite so far.

Dr. Scott Steele: And finally, what is your favorite holiday?

Anne Banas, MSN, SPRN-CNP: Oh, Christmas.

Diane Cowles, RN: Definitely, Christmas.

Christine Arnica, MSSA, LISW: Christmas.

Dr. Scott Steele: We'll leave it at that. So, Annie, are there any advancements on the horizon when it comes to treatment or diagnosis of an airway, voice swallowing disorder? And then second, what is a final take-home message for you that you'd like to share with our listeners regarding Pediatric Aerodigestive Clinic?

Anne Banas, MSN, SPRN-CNP: I think especially with this group that we have here today, the biggest innovation that we have to offer is our ability to coordinate care for these medically complex children. In terms of diagnosis and surgical procedures, I think we're always working in that direction. But I think what makes our program so special and unique is our ability to coordinate their care and be there for these families through the long haul instead of just offering one procedure or service.

I think that would be my take-home message, is that we recognize the medical complexity of the children and what it does to the family unit. And that we want to be there for the long haul and help be, for lack of a better word, the quarterback of their care and help them navigate this medically complex system.

Dr. Scott Steele: Diane, to you, so what is your final take-home message that you could share with our listeners?

Diane Cowles, RN: I agree with Annie that this program is very team-oriented, but also including the family in that and recognizing that there is no one path that's the best for every patient. Everything has to be individualized as much as possible, and we want to help them figure that out and navigate that.

Dr. Scott Steele: Christine?

Christine Arnica, MSSA, LISW: In my experience working with these families, I've learned that a lot of the time it can feel isolating to have a child with complex medical needs. And I really want families to know that there is a medical community out there that is able to support them, not only the providers at our clinic, but additional families who have gone through similar journeys. There's different resources like adaptive sports or dance that we can connect them to.

Dr. Scott Steele: That's fantastic. And so to learn more about the Pediatric Center for Airway, Voice and Swallowing Disorders at the Cleveland Clinic, please visit clevelandclinic.org/pcavs. That's clevelandclinic.org/pcavs. You can also call us at 216.445.7572. That's 216.445.7572. Ladies, thanks so much for joining us here on Butts & Guts.

Anne Banas, MSN, SPRN-CNP: Thank you.

Diane Cowles, RN: Thank you.

Christine Arnica, MSSA, LISW: Thanks for having us.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts & Guts.