Journey to a rare diagnosis: Colten’s story

Christine Schweer knew early on that her son, Colten, faced some health complications.

Christine, a pediatric intensive care nurse living in the Midwest with her husband, Todd, and then 3-year-old daughter, Chloe, recalls feeling different during her pregnancy with Colten. Once Colten was born, little things started popping up, she says.

Over the next few months, Colten developed several symptoms: cold hands and feet, a sleepy demeanor, strange breathing and chronic, involuntary eye movements – a condition called nystagmus.

At this point, Colten had already gone through several emergency department visits, including an admission to the hospital for respiratory syncytial virus (RSV) and eventually unexplained heart failure. But after genetic testing and screening for cystic fibrosis, cancer and blood clots all came back negative, Colten and his parents and doctors were left confused.

Searching for an answer

Colten was 6 months old when two new symptoms arose. An occupational therapist thought Colten’s vision and hearing were waning, and an ophthalmologist confirmed the therapist’s suspicion.

Then, around 9 months old, Colten’s weight mysteriously began to skyrocket.

Meanwhile, the Schweers decided to relocate to California to be near family. Christine, who now works in the PICU at CHOC Children’s at Mission Hospital, transferred all of Colten’s records to CHOC. She began to schedule visits to a team of CHOC providers, including pediatrician Dr. Lauren Dwinell and pediatric cardiologist Dr. Anthony Chang.

Armed with her signature beach bag full of Colten’s records, Christine continued the search for a diagnosis with Colten’s new care team, led by Dr. Chang.

“We hit it off right away,” Christine says of Dr. Chang. “He admired me for my dedication and advocacy for Colten, and I respected him for his thoroughness, for trusting my parental instincts and for his commitment to innovative treatment. We developed a good rapport and a lot of trust. He would listen to me and recommend next steps for us both; then we would meet and compare results.”

But the Schweers and Dr. Chang were still puzzled by Colten’s symptoms, and Colten was now 2 years old.

“Nothing was adding up,” Christine says. Colten’s heart function would worsen if off his medication, and his weight continued to climb. “He was eating healthy and walking, swimming and exercising a lot, but his weight was not budging.”

A few years passed while they continued to search for an answer.

An answer at last

Dr. Chang suggested they revisit genetic testing, despite Colten having received genetic testing a few years prior.

“We trusted Dr. Chang’s instinct,” Christine says. “He pointed out that tests can change even in a short time, and he wanted to be sure we covered our bases.”

He sent them to Dr. Neda Zadeh, a CHOC pediatric geneticist and Associate Director of the Molecular Diagnostic Laboratory.

A thorough walkthrough of Colten’s history and several questions later, Dr. Zadeh had an idea. Recalling a case she encountered during her fellowship at Stanford University, she brought up a rare condition called Alström Syndrome and suggested they test for it.

While they waited, Christine got to work researching Alström Syndrome symptoms and immediately knew they had figured it out.

“Alström checked all the boxes: heart failure, flat and wide feet, nystagmus, obesity and delayed developmental milestones – it completely fit,” Christine says.

Six months later, a genetic sequencing test paid for by the foundation Alström Syndrome International confirmed what Christine and Dr. Zadeh suspected – Colten had Alström Syndrome. He was the 972nd person in the world to receive the rare diagnosis. By this point, he was 8 years old.

The Schweers were immediately welcomed into the Alström family, Christine says. They got involved with the foundation that covered Colten’s genetic testing, and families around the country and globe reached out to them. Colten even met one of his current best friends, a boy with Alström from Canada.

Despite the relief of a diagnosis after years of searching, Alström came with some difficulties. The diagnosis meant that Colten’s vision was weak and that his hearing would decline, too. The disease also affects his lungs, kidneys, liver and weight.

“It of course felt horrible at first to me and my husband to learn that Colten has a rare disease, but it was also a relief to know that we had an answer now; there wouldn’t be so many surprises anymore,” Christine recalls.

The Schweers continued to work with Colten’s specialists, finally certain they knew the cause of his symptoms.

Collaboration is key

Christine reflects on the years of searching for answers and, despite the difficult moments, feels thankful for their collaborative care team at CHOC.

“If it weren’t for Dr. Chang suggesting more genetic testing, if he hadn’t advised we see Dr. Zadeh and if it weren’t for the Alström case Dr. Zadeh remembered from years before, we probably wouldn’t have figured it out,” she says.

Christine thanks Dr. Chang for always keeping innovation in mind.

“It would be easy to think inside the box and rely on past test results,” Christine says, “but Dr. Chang always stayed up-to-date with tests and looked at things creatively. It’s a multidisciplinary team approach at CHOC.”

Most importantly, Christine admires the way Colten’s care team relates with him.

“Doctors at CHOC are very personal with Colten,” she says. “They get on his level and take time to get to know him and what he’s been up to. Colten trusts them and wants to make them happy, so it’s always a positive experience for him to see them.”

The approach has resulted in a fruitful partnership between Colten, his parents and his providers.

“We’re all such a good team now. We feel confident we’re doing everything we can possibly be doing for Colten.”

Learning about rare disease at Peds2040

The experience getting Colten’s diagnosis sparked in Christine a connection to the rare disease community. She heard about a rare disease panel planned for the Pediatrics 2040 Conference, an annual conference on innovation in pediatrics spearheaded by Dr. Chang, who had since been appointed CHOC’s Chief Innovation Officer and head of CHOC’s Sharon Disney Lund Medical Intelligence and Innovation Institute (MI3). Christine expressed interest in attending right away, so MI3 sponsored her to attend. The experience was invaluable.

“It was a great learning opportunity,” Christine says. “I had lunch with a speaker whose son had a rare cancer, spoke with other families and shared Colten’s story with providers, interns and residents.”

She also learned about CHOC’s partnership with Rady Children’s Hospital to offer microarray testing – a more thorough chromosomal test that can detect rare genetic conditions in kids like Colten during infancy.

Thinking back to Colten’s journey to a diagnosis, Christine felt grateful they had MI3 and Dr. Chang on their side. Peds2040 highlights the importance of medical innovation to those with rare diseases.

Colten visits with Dr. Anthony Chang at the Pediatrics 2040 Conference.

One of the most memorable moments of the conference for Christine was Colten arriving toward the end of the day, when he was able to catch up with Dr. Chang.

Colten today

Today, Colten is a loving, strong-willed, intelligent 13-year-old with a deep love of cars and an amazing memory. These days, he and his family are grateful to be able to go several months between specialist appointments.

Even so, Christine notes, he faces some difficulties.

He is short for his age, so they’re seeing endocrinologist Dr. Himala Kashmiri to monitor his hormone levels. Additionally, like his vision, Colten’s hearing has waned and will continue to weaken during his teenage years. But, Christine reports, he has learned braille and thriving at it. And, because Alström can affect multiple organs, they continue to watch his heart, liver and kidney function with the help of medication and several specialists.

Colten continues to see Drs. Dwinell and Chang, along with nephrologist Dr. Shoba Narayan, pulmonologist Dr. Chana Chin, gastroenterologist Ellen Schoenfield, NP, registered dietitian Vanessa Chrisman, audiologist Dr. Kristi Panek and a pediatric ophthalmologist.

Nevertheless, the Schweers ensure Colten is empowered to do what he wants.

“We’ve never held him back from doing something,” Christine says. “If he wants to do something, we’re going to make it happen.”

Colten joined a Challenger baseball team for kids with special needs, now one of his favorite activities.

And, despite vision loss, his love of cars is as strong as ever.

“Before, he could instantly tell you what a car was when he saw it” Christine says. “Now, he can identify them by sound.”

Some of Colten’s favorite memories so far include joining his baseball team, going horseback riding and ziplining, and he has plenty more adventures planned.

“Despite his challenges, he’s very determined and has a don’t-baby-me, I-can-do-this attitude that impresses me – and makes me a nervous wreck,” Christine adds.

“When Colten was little, his doctors said he might not be able to talk. Now we joke that we have to beg him for five minutes of quiet. He doesn’t stop talking when he’s around his loved ones.”

Advice for other families

Christine looks back at the difficult road to a diagnosis and is now grateful for the community that Alström has brought her family.

“Let yourself grieve after a difficult diagnosis,” she says, “but also try to recognize you’re part of a new family. You’re not alone in this. Know that there are other parents out there who know what this feels like, so don’t try to take it on all by yourself. Despite how it can feel at first, every day is not going to be a bad day.”

Learn more about Medical Intelligence and Innovation at CHOC

CHOC nurse scientist to discuss collaborative innovation at national conference

A CHOC Children’s nurse scientist will discuss the health system’s culture of collaborative innovation this month at a prestigious Cleveland Clinic conference, marking the first time outside organizations have been invited to present.

Jennifer Hayakawa, DNP, CNS, CCRN, CNRN, will participate in a panel discussion titled “Teamwork makes the dream work” at the seventh annual Nursing Innovation Summit on Oct. 23.

Jennifer Hayakawa, CHOC Nurse Scientist

In her presentation, “Defending Childhood Through Collaborative Innovation,” Jennifer will discuss the role of a nurse scientist; CHOC’s infrastructure to support nurse innovation; and CHOC nurses’ collaboration with multidisciplinary teams while in pursuit of innovation.

Multidisciplinary collaboration at work

To illustrate the multidisciplinary collaboration at CHOC, Jennifer will also highlight a nurse-led innovation to study pediatric outcomes on a medical device that has been primarily used in adults. CHOC is among the first institutions worldwide to study the use of automated pupillometry in pediatrics. Pupillometers provide reliable and objective data to assist with early detection of subtle neurological changes. ​

“Quantitative pupillometry has been integrated into standard of care and clinical decision-making in adult intensive care units across the nation,” Jennifer says. “While there are multiple studies that validate the use of pupillary metrics to improve clinical outcomes in adult populations, there are very few published studies describing its use in children. Several children’s hospitals are using it, but we’re the first to develop a robust database. Through that, we’ve learned more about what works for our population and we have identified a few challenges unique to pediatrics.”

The idea to begin collecting this data came from the pediatric intensive care unit nurses at CHOC – and has led to a valued partnership with the device manufacturer. Through that relationship, a CHOC multidisciplinary research team will soon begin evaluating the use of pupillary metrics in the assessment and management of concussion, Jennifer says.

“This will help our industry partner to improve their product and will allow us to learn more about application of this new technology in diverse clinical populations,” she says. “We collaborated with the CHOC Research Institute and Innovation Lab to connect with lawyers to get advice about intellectual property and data use agreement contracts. That’s the focus of the conference and panel – working together to innovate healthcare – navigating all of those moving parts.”

During the panel, Jennifer will share the stage with a physician and a patent attorney, and she’s thrilled for the opportunity.

“Working collaboratively to innovate care is something I’m really passionate about,” she says.

The path to a research career

Jennifer’s path toward becoming a nurse scientist at CHOC began about 18 years ago, when she joined the organization as a unit secretary while in nursing school. Upon graduation, Jennifer began work at the bedside in the pediatric intensive care unit.

Through the years, she transitioned to an educator role and later to a clinical nurse specialist role.  About two years ago, Jennifer became CHOC’s nurse scientist.

“I never thought I’d move away from the bedside,” she says. “But my career path and professional growth has led to different opportunities.”

Jennifer credits participating in CHOC’s nursing research fellowship program with propelling her toward a career in research.

“I always knew research was an important part of my role as a clinical nurse specialist, but research always seemed daunting” she says. “Coming out of that program changed my perspective and gave me the confidence to pursue my doctorate degree.”

Research isn’t done in a silo

In her role today, Jennifer is charged with nurturing a culture of inquiry at CHOC. Critical to that is building infrastructure, while also mentoring and guiding nurses through the research process.

Jennifer incorporates her experience as an intimated nascent researcher when working today with nurses considering an investigation or embarking upon a new project.

“I tell them they don’t have to do it alone,” she says. “Research and innovation isn’t done in a silo; it’s done through a lot of multidisciplinary collaboration.”

As the role nurses play in CHOC’s culture of inquiry continues to deepen, the results are evident: In fiscal year 2019, CHOC nurses presented 31 posters and 24 podium presentations at local and national conference and published five articles in peer-reviewed journals.

“Research is integral to the care we provide at CHOC Children’s,” Jennifer says. “For families, it represents hope – hope for improved quality of life, hope for a cure, or hope to help other children and their families. It is an honor and a privilege to be a part of a team of talented people providing this innovative care.

Learn more about nurse research and evidence-based practice at CHOC Children’s.

CHOC Children’s CHIO Recognized for Leadership in Health Information Technology

Dr. William Feaster, CHOC Children’s chief health information officer, has been recognized nationally for his leadership in utilizing health information technology to increase positive outcomes for patients.

Dr. William Feaster, chief health information officer at CHOC

Already recognized as an international leader in population health technology and analytics, Dr. Feaster was one of five physicians to receive a Physician All-Star award from Cerner, a leading worldwide provider of health information technology solutions, services, devices and hardware, at its recent annual conference.

“This award further validates the important work underway at CHOC Children’s to use data to save children’s lives,” Dr. Feaster says. “Advancing technology will continue to dramatically enhance how we practice medicine, and I am proud to stand with CHOC on the forefront of a dramatic shift that will ultimately lead to more children having happier and healthier childhoods.”

As CHOC’s chief health information officer, Dr. Feaster leads the implementation and adoption of technologies that support clinical care and data analysis across the healthcare community. His work promotes the application of data science tools on healthcare data for predictive analytics, data mining, and related technologies to support new informatics initiatives.

Dr. Feaster’s work supports CHOC’s population health efforts; innovation and performance excellence initiatives; and clinical and translational research informatics.

At CHOC since 2012, Dr. Feaster has been involved in advancing information technology throughout nearly 40 years of clinical practice in pediatric critical care and anesthesia. He has held several medical administrative positions in hospitals, health systems and universities, and is board-certified in pediatrics, anesthesia and clinical informatics.

The annual Cerner Health Conference, held mid-October in Kansas City, Mo., drew nearly 14,000 healthcare industry leaders, practitioners and employees to discuss the latest innovations for health information technology.

CHOC Children’s at Forefront of Leveraging Data to Enhance Quality of Care

Earlier this year, clinicians, hospital administrators, and other leaders in the medical field gathered for the American Hospital Association (AHA) Health Forum Critical Conversations in health care event in Texas, which focused on leveraging health care data to improve care.

Dr. William W. Feaster, chief health information officer at CHOC Children’s, presented on the ways CHOC is applying intelligence to data and building it into the care process to better understand quality of care and patient satisfaction scores.

Dr. William Feaster, chief health information officer at CHOC

CHOC uses Cerner’s HealtheIntentSM platform to bring in data from different sources, such as EHRs, pharmacies and payers. The system normalizes the data and builds “smart registries” for certain high-cost pediatric conditions. Dr. Feaster explained that these registries go beyond tracking patient status and outcomes for a defined population. Built on top of multiple EHRs and other sources, they extract data and then feed key patient information to clinicians at the point of care, creating a living tool, rather than a more static reporting mechanism. Adherence to clinical guidelines at CHOC has improved progressively with the advent of these smart registries.

CHOC is also using analytics to improve asthma care quality and outcomes. Additionally, CHOC is applying machine learning tools to predict readmissions and to provide this information to case managers to better manage the patient discharge process. For outpatients, CHOC is also exploring how these data science tools can help predict and prevent appointment no-shows.

To learn more about CHOC’s case study, click here for a copy of Cerner’s Transforming Health Care Delivery ebook.

Submit an Idea through the Innovation Lab

Did you know CHOC Children’s has partnered with the Innovation Lab as part of the Innovation Institute to help CHOC caregivers commercialize healthcare product ideas?

Click here for “Turning Your Idea Into a Marketed Medical Device,” by American Association for Physician Leadership.

To learn more contact Suzy Engwall, national director of the Innovation Lab, at 714-234-6349 or at suzy.engwall@ii4change.com.

To learn more about innovation at CHOC, click here.