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Clinic focuses on children’s complex urinary, bowel issues

Dec. 8, 2016, 9:12 AM

Elizabeth Speck, M.D., holds patient Jeremiah Bevis while talking with the boy’s mother, Ashley Bevis, during a recent appointment at Monroe Carell Jr. Children’s Hospital at Vanderbilt’s Complex Urinary and Bowel Issues (CUBI) Clinic. (photo by John Russell)
Elizabeth Speck, M.D., holds patient Jeremiah Bevis while talking with the boy’s mother, Ashley Bevis, during a recent appointment at Monroe Carell Jr. Children’s Hospital at Vanderbilt’s Complex Urinary and Bowel Issues (CUBI) Clinic. (photo by John Russell)

Jeremiah Bevis, 4, hops around the performance stage area of Monroe Carell Jr. Children’s Hospital at Vanderbilt, burning off some energy before his clinic visit with his team of doctors. He’s an active, lovable boy who will offer a hug within a few minutes of meeting a new person.

For Jeremiah, Children’s Hospital is like a personal playground, a place where he feels comfortable enough to have fun, despite dealing with health issues. It’s a credit to his mother and his care team. Born with one kidney, an imperforate anus and a narrow urethra, Jeremiah has dealt with urinary and bowel issues since birth. He also was born with velocardiofacial syndrome (VCFS), a deletion of the 22nd chromosome, which varies from child to child but can involve kidney, heart, speech and development issues.

On this particular day, Jeremiah came to Children’s Hospital with his mother, Ashley, and his two sisters, Brionna, 8, and Karrington, 5, to go to the Complex Urinary and Bowel Issues (CUBI) Clinic. It’s a new multidisciplinary clinic — the first of its kind for Tennessee — designed to serve as a one-stop appointment for patients like Jeremiah who have complex intestinal and urinary issues.

The clinic allows patients to see multiple doctors at one time and to receive a coordinated and comprehensive care plan, instead of scheduling multiple appointments on different days. Jeremiah has had surgery to repair his imperforate anus, which involves creating a normal connection between the anal opening and the rectum. His one kidney works well, and doctors are monitoring the narrow urethra.

“Seeing all the doctors at one time definitely eases down on the confusion of having to keep up with three doctors’ appointments,” said Ashley Bevis, who travels about three hours from Milan, Tennessee, to receive Jeremiah’s care from the CUBI Clinic team. “And the doctors usually come in to the room at the same time too. Everyone is so sweet and friendly. I’ve thought about moving to be closer to Vanderbilt for his sake. He will likely always be a patient because of his long-term concerns. I don’t want him to go anywhere else.”

The CUBI Clinic team leaders include medical and surgical pediatric specialists K. Elizabeth Speck, M.D., assistant professor of Pediatric Surgery; Melissa Danko, M.D., assistant professor of Pediatric Surgery; Kirk Thame, M.D., associate professor of Pediatric Gastroenterology; and John Thomas, M.D., associate professor of Pediatric Urology. The team also includes nurses trained to care for children with intestinal and urinary problems.

In a monthly afternoon clinic, held within the Pediatric Surgery clinic on the seventh floor of the Doctors’ Office Tower, the team (Gastroenterology, Surgery and Urology) rotates through exam rooms to visit with patients. Additionally, they have a team case conference the hour before clinic starts for the day, reviewing the patient’s history, treatment plan and follow-up care. The CUBI Clinic typically meets the third Monday of every month.

“This clinic arose from the idea that Children’s Hospital is a national leader in managing pediatric complex medical and surgical problems and we want to continue to be both a regional and national leader,” said Thomas. “Our continued growth and success is due to the collegiality of our providers, an extremely well organized clinic coordinator in Samantha Absar, valuable input from the parents of our patients, and the initial and continued support of the leadership and colleagues in our respective divisions. We feel humbled and privileged to care for these wonderful patients and their families and look forward to future growth.”

On the day of his clinic visit, Jeremiah lights up as he sees his doctors, giving a hug to Speck and later, a high-five.

His mother and Speck discuss the site where his colostomy bag was removed, his dilation schedule and his bowel management in conjunction with Thame. Thomas then discusses and evaluates his ongoing urologic concerns.

The CUBI Clinic team evaluates and manages more than 20 types of complex urinary and bowel conditions, and helps patients needing long-term management of issues like chronic constipation and difficulty urinating.

Among the conditions treated are anorectal malformations, cloacal malformations, Hirschsprung disease, bladder exstrophy, inflammatory bowel disease and enterocolitis.

“We really strive to make life a little easier on the patients and their families who are dealing with complicated issues by coordinating their care both in clinic and in the operating room,” Speck said.

Since the clinic started, the patient volume has grown, with parents eager to reduce the stress on their children of multiple appointments on different days.

“Our children with complex urology and colorectal medical needs really need their treatment to be tailored to their unique diagnoses. The Complex Urinary and Bowel Issues Clinic at Children’s Hospital brings together experts in different disciplines to treat the whole child, offering an integrated, multidisciplinary approach,” said Trisha Torrado, a mother of two children with complex colorectal and urological needs. “This benefits families, because instead of making separate appointments with various departments, a family can make a single appointment and be seen by the experts who then collaborate on how to best tackle the complex and unique needs.”

The CUBI Clinic is open to all patients with complex urinary and bowel needs. For more information, visit the team at their website

To learn more about the Strategic Directions, go here.

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