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Cooperating for care—CADD
Emily McCormack Specialists come together at the Center for Aero-Digestive Disorders
Tim and Tamara McCormack describe the first year and a half of their daughter Emily's life as complete chaos. She suffered from chronic pneumonia, sometimes aspirating quietly and other times coughing so much that she would vomit. At 19 months old and weighing only 14 pounds, she was officially classified as "failing to thrive."
One day during an especially bad coughing spell, Emily's parents brought her to their pediatrician's office. Noticing how gray and lethargic she was, the pediatrician sent the McCormacks straight to Children's Hospital Boston's Emergency Department.
At Children's, Emily was diagnosed with aspiration but the cause wasn't clear. So she underwent multiple tests, including those for cystic fibrosis and celiac disease—all to no avail. They could only tell that liquids from meals were filling her lungs, so Emily was fitted with a feeding tube and later a Mickey button, which fed liquids directly to her stomach. During a routine visit to Radiology for imaging tests, the McCormacks learned about otolaryngologist Reza Rahbar, DMD, MD, who was in the initial stages of setting up the hospital's Center for Aero-Digestive Disorders (CADD).
Dr. Rahbar suspected that Emily had a laryngeal cleft, which is a hole in the larynx that leaks liquids into the lungs. It's a rare disorder that's hard to detect since the symptoms are often attributed to other causes, so patients often undergo many unnecessary tests and see several specialists before the problem is detected. Dr. Rahbar performed a laryngoscopy under anesthesia, and confirmed that she had laryngeal cleft.
Patients like Emily led Dr. Rahbar to organize a group of specialists from the Otolaryngology, Respiratory Diseases, Gastroenterology, General Surgery, Cardiology, Cardiac Surgery and Radiology departments, in collaboration with the speech and swallowing disorders and feeding teams, to start CADD. The center treats children with complex problems involving the airway and pulmonary and upper digestive tract—especially those suffering from chronic pneumonia, swallowing disorders, reflux, cough and pulmonary issues, croup and airway stenosis. Their goals were to integrate subspecialty care and foster the development of top medical and surgical treatments while advancing minimally invasive procedures.
Conditions treated include:
- Asthma
- Aspiration
- Croup
- Stridor
- Gastroesophageal reflux
- Laryngomalacia
- Tracheomalacia
- Airway stenosis
- Swallowing disorders
- Recurrent pneumonia
- Congenital malformations of upper aerodigestive tract
CADD offers state-of-the-art
diagnostic testing such as:
- Airway fluoroscopy
- Modified barium swallow
- Esophageal impedance
- Esophageal function test
- 3D CT airway scan
- Advanced airway and digestive endoscopy
- Pulmonary function testing
Patients who are referred to the center are seen at a single visit by specialists representing each department, which is a major feat of scheduling but a huge convenience for patients. Gastroenterology specialist Rachel Rosen, MD, says, "One of the great things about CADD is that my patients can see all the other specialists the same day they see me. It doesn't take months to get all of the appointments set up, which is great." CADD offers all of the routine tests for medical conditions that frequently require multi- specialty evaluations, such as airway fluoroscopy, modified barium swallow and state-of-the-art diagnostic testing.
After all the specialists see a patient, they meet to discuss the diagnosis, treatment plan and the possibility of future consultations, tests or procedures. Once a month, the specialists come together for the Aero-Digestive Conference, which brings in representatives from Cardiac Surgery, General Surgery and Radiology to discuss particularly complicated cases.
"At these conferences, we coordinate surgical and diagnostic procedures for complicated cases to streamline care and ensure close communication among the specialties," says Dr. Rahbar. Dr. Rosen adds, "Many of the kids we see do go into the OR, and we're able to schedule their procedures right after we see them since all of the specialists have already discussed their case."
Dr. Rahbar repaired Emily's laryngeal cleft endoscopically in December 2005. Today, she can drink liquids, and her swallow study shows no evidence of aspiration. All signs indicate that her laryngeal cleft is closed and her lungs are liquid-free.
"CADD is a welcome change," says Tim. "It makes our lives a lot easier, and it's nice to know they're all working together to ensure Emily's care is complete."
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