neither the el paso medical society its members nor pbs el paso shall be responsible for the views opinions or facts expressed by the panelists on this television program please consult your doctor what is interventional radiology what is advanced cardiac imaging we know that doctors can look inside of our bodies and make diagnoses with images such as ultrasounds we know about ct scans we know about mris we're going to talk about all that this evening but using these types of imagings also doctors can now use small tools like needles and tubes to do procedures or give treatments right where you need it probably sometimes before the big stuff happens so it's really nice to be able to do this often these can be done with tiny cuts they could be small as a little pinhole and these are less invasive procedures that can be great especially for children because again today is pediatric interventional radiology say that 20 times really fast i dare you during the next hour we have experts again answering questions about pediatric interventional radiology and as you know this is a live program so think of some questions that you want to call us with us this evening the number is 881-013 and the lovely miss brenda hernandez is going to be answering the telephones we also want to thank the el paso children's hospital the department of radiology this evening for underwriting this program and as always the el paso county medical society for bringing the show to you i'm catherine berg and you're watching the el paso physician thanks again for joining us there's a mouthful of the uh the topic for tonight again pediatric interventional radiology but also combined with advanced cardiac imaging again both pediatrics and this is so interesting because of the tiny tools that you guys use to help things out with us this evening we have dr aaron ross who is advanced cardiac imaging again pediatric radiologist that is this guy and then you go over to this guy and it's dr chet morthy and he is again interventional radiologist again specializing in pediatrics so you right before the show started did this great breakdown of what you specialize in what you specialize in so i'm gonna let you do what you specialize in but talk a little bit if you could uh dr morty about the breakdown of what you do kind of all the specialists and then we're gonna talk about specific advanced cardiac imaging when we get to you yeah sure so we already talked about how most of your audience is familiar with what radiologists do they know that we use x-rays cat scans ultrasounds nuclear medicine mris to create images of the body to help other physicians make diagnoses and then take care of our kids also part of radiology and less well-known by people is that as imaging involved we discovered that you can do minor surgical procedures guided by images and that technique allows you to do things with less invasiveness minimally invasive image guided surgery and so that's how the specialty of interventional radiology developed dr ross and i are more interested in doing that for kids right and so that is the sub-specialty that we are developing in el paso children's and that's the one that i am the most interested in and that's the one i'm dedicated to see i and i'm gonna where the to me where the happiness happens on these shows is like the half an hour of us just talking uh so dr morty came to el paso in 1996 he was recruited to be here he and his wife his wife is a neonatologist over at the el paso children's but just the idea that you have been invested from the get-go and just the different things that you've seen in the time that you've been here because you're you're looking at 15 plus years that you've been here um 25 say 25 what 24 24 24 yeah hello 24 plus years so it and there was also that whole process too of before the children's hospital was put together and then it was a dream and then it was reality then it was a dream then it was reality and dr ross came along in 2012 um and wife works at utep so very very again involved in el paso and um we'll talk a little bit later but your son benefited from el paso children's too but i'd like to hold back there for a minute because i really like it when doctors are so invested in el paso even if they're not from here a lot of them are from here they go away they get trained come back now we have people that are here getting trained here staying here but let's talk about advanced cardiac imaging in the world of pediatrics for you what does that mean to the people at home so um basically it's it's a new service that we're we just started um a couple years ago in el paso and most of the big cities have it for a community of this size about a million people there's probably 10 000 children with congenital heart disease and about 140 born every year and what i do is i do mri ct or other imaging studies to investigate that determine what the anatomy is and be able to tell the surgeons the cardiologists what's going on and whether or not they need intervention and that like i said before it wasn't here so before just to get an mri of the heart just to get a ct of the heart you had to go to houston um further away in some cases and so that's in-house now and we hope that now that we're doing the imaging here we can get the surgeons we can get everyone else in to take care of that here too but at least now the people who have congenital heart disease they don't have to go all the way to houston or dallas to get the mri scan they can do it at el paso children's and we're the only place doing it from phoenix to dallas to houston to mexico city so our our region is very large there's not very many uh pediatric cardiac imagers less than 50 in the world and uh so so when you're talking about in part my ignorance on this when you're looking at pediatric imaging versus adult imaging so prior to you coming along prior to this going on adults could get this imaging done but children could not what is the big difference you know when you're looking at it like me it's like oh it's a lot smaller but what is it that is so specialized with doing pediatric cardiac so um on the cardiac side there's a lot of differences with with you know all of us older people usually our heart disease is heart attack atherosclerotic disease you know something causing blockages in the heart kids what happens is they're born with an anonymous genitals so it's a little different and so you're looking for the diseases are more complex actually and um they're more difficult to treat sometimes they're more treatable too and so if you do intervene you can you can save them but actually interestingly i think for for the community is actually right now i'm the only adult cardiac imager as well oh my goodness so so el paso children's is actually providing imaging for you know select adults as well that we wouldn't have if we weren't here so um just having those those very sub-sub-specialized you know medical practices right benefits numerous populations besides the one you're focusing on so anyway so uh yeah it's it's been good beneficial yeah yes well i just want to add one the truth is um medicine has done a great job over the last history of maybe you know 60 years of saving babies with congenital heart disease and these are advances in surgery in medicine and icu care we have a growing population of adult survivors of congenital heart disease this is a really important target group because sure you take care of the kid you fix that child in in early on but guess what to follow they have complications uh later on and this is actually where the bulk of dr ross's work comes in where a child may have been repaired but now we have to monitor the child for complications and that requires the mri right and the mri is done at children's and then information goes to wherever he needs it we have patients who are 50 years old who had their congenital heart disease fixed in childhood and now they're developing some layer complications and the decisions have to be made about whether or not a surgical intervention is necessary right and that is based partly on an mri and again that adult right now unless dr ross increases the number of adults he's doing either don't get it done or they have to go out of town right yeah and a lot of these you have to do it every year so you can imagine having to go to houston every year would be a huge burden for these families that are already undergoing massive costs and medication and other things well i love what you said before the show that the mission really is to reduce out migration which means you want to reduce and hopefully eliminate one day people having to leave town to get things done um so we we talk about congenital heart conditions you know what if you could describe some of what those heart conditions are when babies are brand new or sometimes you know this before the babies are even born describe what some of those are because i know there's there's a there's a whole gamut of them yeah or maybe what are the most maybe one of the most important the one that i image the most is called tetralogy of flow okay and it's where uh one of the arteries is kind of stenosed the one the pulmonary artery where blood goes to your lungs it's all stenosis and it's hard to get blood past it and then the nose means what closed up yeah yeah it's very tight it's hard for blood to get past anyway to overcome that they do a patch and then once you get the patch you have to get imaged every year to see if you need a new valve put in there too because your heart gets bigger and bigger as it's trying to uh as you have blood come back into the heart because there's no valve right and so it gets bigger you need to know how big it is when you need surgery again and describe on that note i don't mean to interrupt but sure this is always fascinating to me because our bodies know that something's going on and so our bodies start adapting to that so why does the heart get bigger and bigger physiologically how does the heart know what to do yeah physiologically basically what happens is is you you end up with higher and higher pressures in in the ventricle the squeezing part of the heart and there's a there's a rule called compliance where it depends on how much it's stretched and also what af what how much pressure it's pushing against and if it's too high then the heart kind of gets bigger and bigger and it just it's kind of slowly failing really and so the solution for that is just to and now they can do it via catheter put a valve in and stop that but they need to know when because you don't want to do it too early you want to save everything till the last minute in these cases because you want to intervene as little as possible so we have to do yearly imaging figure out how big the heart is um and that's that's that's probably the most common thing i look at but there's all sorts of other things like one of the worst ones is babies sometimes are born like you have the aorta and you have the pulmonary artery aorta goes to your whole body pulmonary artery goes to your lungs they can be flipped and it's right if you have them flip you've got to fix it within a month or two because the baby will die otherwise and the the flipping correction is very difficult so there's a lot of things to check so on that note things to check so you're going in you're trying to figure out and sometimes if there's no complications during pregnancy baby's born goes home seems like everything's fine what is it that parents can see and what they're looking for when it's like well something's wrong and how do you guys take it from there do you know we're just going to do several imaging things and maybe the baby's just not thriving et cetera take it from there so the message here to el paso is what we talked about earlier recruiting one physician like dr ross who has a certain talent is not enough you've got to put that position in a place where you can build a team an infrastructure and so the question you ask the answer is it starts with the obstetrician the obstetrician during the routine surveillance of a pregnancy does an ultrasound during the ultrasound he or she may detect some things wrong with the heart that results in a referral to a perinatologist who is a specialist that periodologist then consults a pediatric cardiologist to do a fetal echocardiogram that feed like a cardiogram almost always gives us a pretty good idea of where we are okay that decision is made at that point is hey this baby needs to be sent out before delivery or no it can be safely delivered at el paso children's or umc which is where we deliver our babies right right away we know that baby's coming so then you need a level four nicu the highest level of new york already the highest level of neonatologists you need the pediatric cardiologist you need a potentially pediatric interventional cardiologist you need a cardiac imager and you need the nurses and the respiratory therapists and the technologists and the equipment ready right to say okay we know what to expect when this baby is born the baby goes to the nicu the neonatologists are the first ones to resuscitate and stabilize the baby so we have a level four nicu that have trained qualified teams again right and the important thing here is it's not like this physician is uh got his office on why count this opposition has his office over on the west side no no no that's not good enough right you've got to be these physicians this team is committed to being in the same place so that if you deliver your baby at umc which by the way is the only highest maternal designation hospital in the region okay the safest place to deliver a baby that has complications then it's connected to this our hospital right gotcha the physicians that you need are on our campus they're there they know this baby's coming so it's not a question of calling at the last minute exactly if the baby stabilized and needs an intervention right away it may be from a pediatric interventional cardiologist which we have access to in town or it may be an emergent transport out of town because what we don't have in el paso yet is a pediatric heart surgery program that is the ultimate goal that will prevent out migration forward a big sigh from dr ross yeah we need to get that here but between that but yeah so between where we are now and that there are many many steps honestly so recruiting just recruiting a heart surgeon tomorrow is not going to do it right when she shows up she's not going to have the support i love how you said it when she shows up oh no she's coming okay we don't know her name yet [Laughter] so what el paso children's has accomplished is the commitment the commitment we recruit physicians who want to be part of that team that's ready to take care of that kid and do what we can here safely right now the other topic we've skipped is when the perineutologist identifies abnormalities of any kind on the ultrasound sometimes the next step is a fetal mri now this is not usually for a heart abnormality it's for abnormalities of the brain spine abdomen chest liver you name it and again we are the only ones that do fetal mri right so the perinatologist consults us and says hey i see this this and this i think right i need to clarify it and we do the fetal mri at mrh at el paso children's some conditions need to be shipped out of town exactly and that's what we're trying to prevent but i i see what you're saying that that's the ultimate goal too but most of the conditions almost all the conditions are taken care of here and that's because we have advanced surgical subspecialists we have pediatric surgeons we have pediatric urologists we have a bunch of other interventionalists but the truth is if we don't have the fetal mri program again the perineutologist is either stuck trying to make the decision on ultrasound right or again sending the mom out of town and we have had moms go as far as philadelphia to get nothing more than a fetal mri interesting and be told yeah this can be taken care of in el paso well no we don't need to do that right right so here's a question i was going to pop over to dr ross on this so let's say right now there is someone who is seven months pregnant and we know that there needs to be some kind of intervention prior to getting you know birthing of the child um right now right now that is an out-of-town procedure always or is there some things that we can do are there some things that we can do here in el paso there's there's a lot of things we could do in el paso and uh there's uh they tend to be more medical things like surveillance medications things like that there is a new burgeoning field of fetal surgery which is really exciting the fact that you can do that well you know i don't know if you've seen those pictures where the little baby's sticking her hand through the uterus and grabs onto the finger it's really cool right um they had it where i trained in cincinnati but um we're not there yet we're we're we're just trying to get heart surgery and stuff like that and then right you know yeah in the future that would be amazing to get that but right now when we have cases that may need that typically we're sending them to houston but uh um so when when can you come in so when can dr ross come in and save the day um and i say that because and you smile because we were joking about yeah there's he's the dude um and i and i want to say like from birth like a couple of days on what is it that has been found out you're at the ready like you're talking about we know the baby's coming the team knows the baby's coming right when the baby's born dr ross comes in and does and maybe just give me a couple of examples of what you what you do in those schools well let's see let's like um something i can think of recently is there's a baby who's turning blue and breathing really hard and they do an echocardiogram they say something's wrong we're not 100 sure there's a weird artery going someplace we're not sure what it is we need to send somewhere but we don't even know where to send you because we don't know what it is so we do a ct scan we look at it we figure out the anatomy we're like okay it's a fistula like a connection that doesn't belong from one artery to the other and we can say okay so that's what you need to fix then the cardiologist here the pediatric cardiologist says okay i know who can fix that i know where to send them let's send them to san antonio houston wherever and uh so basically for us mostly what we do when we do interventional we're actually fixing people we're helping them directly but a lot of our work is infrastructure is helping other doctors know what's wrong exactly and so we're some people call us doctors doctors because we're the doctor the doctors see when they don't know what's wrong um and that's that's a lot of our business and i would say so the majority of my business is people who've already had the surgery now we just got to keep following up seeing how they're doing but um yeah there's there's a lot of babies that get born with an anomaly we don't know what's going on it's just very scary they're sick we don't know and we do all sorts of stuff the cardiologist does echo at the hospital i do ct we do lots of different things and so going back to dr morty then um because i know you were about to talk so continue your thoughts obviously yes i mean again we want to make sure that your audience keeps things separately we cardiac imaging which can lead to cardiac intervention right that step is not completely developed yet okay we do have a pediatric interventional cardiologist in town and that physician does perform significant interventions on kids we also have a surgeon who does some surgery in the nicu when it's necessary sometimes it's just a matter of closing off a blood vessel that's causing the heart to work too hard that's done in the nicu by a local surgeon recently if if a baby is born with a valve that's closed off and not letting blood come out theoretically our pediatric conventional cardiologist can go in with a tube and use a balloon to open up the valve and stabilize the baby long enough to get the baby out sometimes babies are born with the artist flipped like he talked about if the arteries are flipped but there's a hole in the heart the baby's fine but if the arteries are flipped and there's no hole in the heart which means you've got two circuits which are parallel and blood flow is not going anywhere that baby needs an emergent procedure and again the interventional cardiologist comes in goes in with a tube and he actually tears a hole in the wall between two chambers to make a hole so that blood mixes oh that just sounds really crazy right now okay so say that again so because if there's a hole in the heart it's natural because the holes are already there and so it allows what to mix right so right about the baby's not fine but there's enough oxygen to keep the baby alive and not dead not die right but if you have the artery switched and the right side of the heart is pumping blood to the lungs and it's coming back to the right and the left side of the heart is pumping blood to the body but it's coming back to the left it can't be baby can't survive and if there's no hole in the heart to make large mix the baby's in trouble within hours the nicu doctors can only do so much they need the cardiology to come in go through the vein from the leg under x-ray and ultrasound go across the wall that's connecting the two blood chambers take a balloon and tear a hole into it so next time you guys come and i'm a big proponent of this next time you guys come and tell your people bring videos oh yeah bring graphics great because it's so not nice it's a terrible word but when you're able to visualize when you say going into the groin and we're talking about people this yeah you know people people but it's again pinholes needles i mean this is just tiny tiny so yeah this is what i do and i'll give an example of that baby yes that we need that procedure on we enter through the vein that goes to goes to the baby's leg we use ultrasound that vein by the way when you put the little pressure on it collapses completely its diameter is maybe maybe three millimeters okay so you have to get a needle to go into the vein under ultrasound make sure a wire goes in and doesn't tear the lining put a tube in which can block the vein sometimes what you have to do has to have to get to the heart and that can have complications in the leg of course but you got to pick and you gotta do it quickly enough so a lot of the interventional procedures we do not just heart procedures in fact dr ross mentioned the fistula we had a baby last year born uh the baby they were the family was actually from out from near martha fort stockton not for stockton what's the four days davis yeah okay they were out from the moon anyway the baby was born with heart failure and we couldn't figure out why well after we did some imaging we found that there was a fistula an abnormal connection between the arteries and veins of the left arm and the blood was just the left arm so we're not talking about heart area we're talking oh okay but normally when blood goes to the left arm it goes through all the muscles and goes through small vessels and comes back and that comes back with very little pressure but if you have an abnormal connection with the artery vein it's coming back fast it's called and then puts a lot of load on the heart the heart fails so once we found the fistula that's what we did i we took the baby to the cath lab the neonatal just kept the baby alive i went through the little artery in the baby's belly button okay small tube goes in under x-ray you put it up to the artery you get into the artery you put a smaller tube to that artery you make a map right right and then you block off the fistula and you can block off the fistula using little metal coils and luckily you know once i blocked off the fistula unfortunately the little finger turned blue and we were like uh but babies are amazing they can recover they can make blood that baby is awesome today that baby's growing so that's the that's the follow-up question so growing because we were talking about now that this is a fix yeah the fix the fish tail was fixed the strain on the heart resolved now we still needed a lot of icu care because the heart took a lot of damage right but the neonatologists were able to stabilize the baby the heart slowly sort of overcame its initial damage i mean she won't be a concert pianist right but that baby is healthy and growing and has come back for follow-up and is doing awesome so that's the kind of intervention that is very fulfilling to me right right blocking off abnormal blood vessels pediatric intervention radiology deals now both of us do when you talk about interventional radiology there's the hospital stuff sick patients in the hospital need a lot of very basic intervention they call us to put lines in the veins when they can't do it when a patient in the intensive care needs dialysis and we need to put a temporary dialysis catheter sometimes we'll do that if a child comes in with a ruptured appendix right and has a big abscess the surgeon won't take him to the operating room because that's gonna be a big operation so one of us will take him to the operating room so let's go there for a minute because these are the things that i wanted to talk about here because this is pediatric again interventional international radio yeah radiology but interventional again the definition of that is trying to fix things before they get really really bad minimally invasive minimally invasive image guided surgical surgical procedures that's that's the i guess the caption i guess so let's talk about this appendix so let's say so appendicitis is massively common enough which is crazy i've heard that over and over again what is it about el paso i mean there have been times when i you know coming to work monday and i talked to the pediatric surgeon who's been on call for the weekend and he's told me i did eight appendectomies this weekend is it our diet is it our i mean appendix as you know is this blind-ending little thing that just hangs off our cone right well unfortunately it can get blocked and it gets blocked usually with a piece of poop that turns into a rock that's sorry that's the best way i can put it you know what this is what the show's about a piece of poop that turns into a rock because everybody can picture this so and again when you're looking at an appendix you can live without an appendix yes very easily yes so that is my that's my question that there probably isn't an answer for why in el paso you were talking about constipation we're talking about maybe our diets um which is again great for everything so we have and this is more in children than adults i don't hear appendicitis in adults like rarely no no it's not sometimes it's common it's common but i feel like it's like a pediatric thing i mean i would say the incidence of appendicitis in children is way higher than adults but most of our adult surgeons do appendectomy right yeah it's a routine surgery for that right right so again we've got that piece of poop that turns into a rock the appendix gets blocked it's full of bugs now we want to diagnose appendicitis right then and there right but that's early appendicitis what are the symptoms since we're on that subject number one loss of appetite nausea fever pain that starts in the belly button but then it started slowly starts going towards the right side right lower side okay that's the textbook now if you're younger it's hard if it's a 18 month old because how can they tell you good luck yeah right so we want to diagnose a fantasize then okay that's an easy fix for the surgeon go in with a little scope make a hole that big take the appendix out baby goes on the next day unfortunately we don't always make the diagnosis of appendicitis early in kids the younger they are the more often they present with a ruptured or perforated appendicitis so you can imagine a parent can't really or at least i'm thinking a parent wouldn't really know what to look for and again if you're not thinking appendicitis at all what might the baby be presenting with that a parent can see number one belly pain yeah okay so just maybe you know if you're looking at a baby bowled over and and rolled up or doesn't want to eat doesn't want to eat okay fever okay that's an infection of course it's an infection right right and and tenderness tenderness in the tummy you know now again it's easy to say all this stuff but it's hard it's hard sometimes because babies a lot of times will just have a stomach bug exactly but but go see the pediatrician because they're very actually very good at checking it out and then that's when we come in and they'll say okay well i'm not sure i'm worried about appendicitis but i'm not sure then also you come to el paso children's you get an ultrasound we know for sure whether or not right it's appendicitis and sometimes it's bad news sometimes it is appendicitis but frequently it's not we can reassure you and then you'll have to worry about it now what he said i want to emphasize uh we've already shown and there was a study done by one of our pediatric surgeons that first of all we use cat scans a lot less than our than other adult hospitals cat scans are a lot of radiation unfortunately adult hospitals where you are less likely to have a pediatric subspecialist to diagnose appendicitis they're not as good with ultrasound they're not used to it your child is much more likely to get a cat scan to diagnose it right if you come to children's i will tell you that 90 plus percent of our time we diagnose not only appendicitis but a normal appendix with ultrasound and we hardly ever use cat scans interesting so that's number one that's important okay if we make the diagnosis i'm gonna i'm gonna interrupt here just because when i have a question as well no problem when you're looking at a cat scan and ultrasound first let's do this describe what the differences are throw an mri in there because a lot of times this happens with the question so what's an mri what's a cat scan what's an ultrasound sound magnetic uh x-ray so i'll let the engineer here all right dr ross go dr ross yeah ultrasound uses sound waves and it's like you see with the new unborn babies you know that gray scale picture it's kind of hard for people who haven't been trained to understand what it looks like but it's fast no radiation and cheap relatively compared to the other modalities now ct is basically an x-ray but in a circle and so you spin the x-ray all the way around the patient and then you use a computer to calculate what all of that looks like and so it's a 30-second scan and you see everything in 3d like the belly if you're looking for appendicitis okay mri is a totally different thing now you're using radio waves right you're going to this big long tube you're in there for an hour and it's very annoying everybody loves it and it's very noisy and it takes forever but it's amazing for what it does because it lets you see soft tissues really well so it's like someone's having seizures you can see little bits of the brain that are wrong or in actually in pregnant women who may have appendicitis you could look at the appendix without messing with the baby you know without getting radiation and stuff like that so each modality has its own use the great thing about el paso children's and children's hospitals in general is we focus on ultrasound we focus on mri we avoid ct we try to get the lowest amount of radiation possible and that's what dr morty was saying is that and that's why when i was worried if my kid had appendicitis i went to children's because i could look at it with ultrasound so so on that note we talked a little bit before the show and your your young one when he was seven yeah i had an issue and you said you were cool to talk about it so talk about what issue your your son had and what what happened at el paso children's so yeah it's i i i don't like related but i love telling about it because it's it's important for people to understand that we don't just talk about yeah exactly it's a relatable thing if it's something that happens you and this is and we talked about this before our show too and i keep saying that but when you guys become people is when you're on this table you know a lot of times doctors are doctors and people kind of glaze over when you talk because he's the doctor did you what did he say i don't know did you remember what he said i don't know but here you guys are people and so when they know that you had a son that had an issue and you took him somewhere it's like oh he's a dad too that's right he's a dad so right now you're a dad you happen to be a doctor but you're a dad so yeah so i'd been here about a year and i woke up and started working and at home and my son woke up and my wife started screaming uh that he couldn't talk couldn't walk he was throwing up acting real weird scared the crud out of me and he's seven he's seven and uh so i ran into the room saw him and uh he was acting just really really weird and then i kind of started recognizing that he was probably having a seizure and but he had no history of seizures nothing like that this is a very scary event we called 9-1-1 i called dr morty and we got him in an ambulance and brought him to the a west side hospital and then got him transferred to children's and um it turned out he had meningitis oh and it was extremely scary we were in the hospital for a month but you're in the hospital for a month yeah but i really credit um obviously the doctors like dr morty he actually helped diagnose what the ultimate problem was um but i really credit uh all the physicians working there with saving my child and that is the beauty of having a children's hospital is there somewhere where people know what it is that kids get wrong they know how to deal with kids when they have a heart iv when something's wrong and so um so we didn't have to go out of town and before i came here i was working in amarillo and if i'd been in amarillo i absolutely would have had to leave town we would have been on a plane to dallas and who knows what would have happened in the plane and uh so i'm a huge believer in el paso children's i'm all in on the hospital um and i'm really grateful that the community not only came together to make the hospital not just a place for me to work but a place for my family to be safe exactly and so i i i think i think it's important that people understand that that i i don't just work at children's i bring my family to children's and i trust it and so it's uh it's it's it's just a beautiful resource to have in el paso and uh i uh every day we see miracles that really wouldn't happen if we didn't have the hospital and it's it's what dr morty's saying is you need you need a coalescence of medical specialists like a big group where we can all talk and i can't tell you how many times i've heard something get solved in the doctor lunch room or you know something like that and on college we call it the tumor board right where everybody gets together and they talk about that um and i'm glad that your son's doing well today he's a healthy family everything came out okay he got the antibiotics and everything he's perfect now so on that note antibiotics that makes me think that's a bacteria uh meningitis because there's also viral meningitis but i'd like to to bring that same story dr morty to you what what is it that you were looking for how did you find out what well i mean i want let's let's i want to make sure everybody understands first of all uh the picu the pediatric intensive care doctor our children's hospital committed a long time ago to making sure that there is a pediatric intensive care doctor 24 7 in the hospital absolutely key right other doctors that were involved in taking care of his son the neurologist the pediatric neurologist we had a pediatric infectious disease specialist my expertise in that case was my experience with pediatric neuroradiology it was an infection it was an infection that came from a particular place but then more importantly after the initial infection was treated and he didn't respond the way we expected something else was going on and it really was the mri in this case that showed us hey another thing that's going on is maybe his immune system is reacting to the to the infection in a certain way right and causing a second problem now that is a very unusual complication okay and to recognize that you just need to be doing pediatric radiology yeah all the time and that's that's wrong if he hadn't been focused on peds the picu doctor hadn't been focused on pediatrics this could have been missed so easily so easily and it and and and sometimes we see people come from other cities little towns and stuff where everyone does the best they can and they they get generally good care some things get caught at the large city pediatric hospital and it's it's it's just because that's what we do it's the volume it's the amount of people you have coming in again the mission is to reduce out migration so that when people are here you all see everything that you can see and if we're able to fix it here we're able to fix it here i i love that story um and when we're i've got some questions here from the audience so what i'm gonna do because time is going fast you guys are fast so uh brenda thank you very much we have a question here from the audience son had open heart surgery so let me first do the disclaimer all that we have is what we have from the questions here so brenda writes it down we don't have extra information um so do the best that you can with the information i give you son had open heart surgery at age nine to close a hole in the top part of his heart how have materials change from before to now when doing the same surgical procedures so it doesn't say how many years ago he was nine uh but maybe we can talk a little bit about that and dr ross would i be sending that your way yeah that question okay great so uh materials have changed a lot since uh over the last couple decades um since i did med school um basically we've developed better and better plastics that uh the body recognizes and doesn't reject and then recently we've even developed ways to insert into the plastic certain medications like medications that keep arteries from closing up or keep clots from forming and so uh so as the plastic is built in whatever factory it's being built in there's medication put in there so it constantly emits this medication inside the body wow that's cool okay and uh and it's it's it's one of the most interesting fields going forward is uh meta biological devices and we live in an amazing country right now because america is the leader in developing uh medical devices and and i we want to make sure el paso has access to all of that i'm going to guess based on the description that this baby had what's called an atrial septal defect and what that means is look at you fancy pants no yes say that slowly atrial septal defect okay the two smaller chambers of the heart have a separation of a wall and some babies are born with a hole in that wall right back in the day a surgeon would have to put the baby to sleep open up the chest open up the heart stop the heart and sew the hole up right close back start the heart again and that was open heart surgery for asd closure that is very very rarely done now yeah so we talked about the pediatric interventional cardiologist that is now done through a tube that goes through your vein from your groin so explain the procedure to where a second grader can understand that again next time you guys next time you're bringing graphics next now i'm not the one that does this but there is a guy in town that does it all right but he does it with another cardiologist who first of all puts a probe an ultrasound probe down the baby's esophagus right behind the harp so they can see the two chambers and the hole in between then the interventional cardiologist goes through the vein from the leg goes in with the tube right goes across the hole where these two chambers are make some measurements because there's another big vessel that's coming out this way they need to make sure they don't clamp off based on the measurements and based on the anatomy he he or she can deploy a device through the tube and that device can look like a little clamshell yeah a little plug so it's a little clamshell or plug where he goes across opens up one part of the clamshell pulls back opens up the other part of the clamshell which are connected like a little sandwich the hole is closed you pull out the tube from the groin the plug stays in the plug stays in and the hole is just life well that's the child's life okay baby goes home okay so my follow-up question there is baby's this big yep when baby gets this big baby becomes six two yeah and so dr ross let's go to you because and you were talking about this earlier too you fix things you monitor every year you look at something else somewhere along the way this little tiny clam shell unless it's a la you know elastic or whatever and this is where you come in where again you look every year but how often and when along this baby's life will that need to be looked at again so yeah i mean it kind of depends even with even with with the plugs we're talking about they will do follow-up imaging and occasionally usually with ultrasound usually it's a cardiologist but if they have any question like maybe there's a leak around it or or like there's some symptoms like they're getting tired early or something they'll check it out then and then uh if they can decide what to do at that point um but like in the case of this child like even though maybe this happened a while ago and they got older devices or whatever still they're gonna benefit from the newer diagnostic techniques now and if something does have to be done in the future they're going to benefit from the newer materials too so the parents just know and this child knows and i'm thinking a couple of days a couple of months whatever old so as the parents age as a child ages how's the question i'm trying to think of here um sports you were talking about a person won't be able to be a concert pianist maybe she will just she will maybe she will um what and there's different options of what we what we can go to right now but what is it that will keep children from thriving physically like what congenital issues are they born with but yes we're able to fix them but still not fixed enough because biology and yeah so this god intervening all that stuff what are some of the cardiac some of them are going to be things he does okay but this particular one that we just that we're guessing right from your audience member right it's actually a one-stop fix yeah for the most part that hole doesn't get bigger so that little clam shell stays there as the heart grows yep and the hole is closed forever almost never does anything have to be done and the fact that it was done when he was nine is sounds about right it doesn't get the baby into trouble early on okay so it can cause some pressure problems later on and they fixed it around the age of nine that sounds about right for back then i don't know how long ago that was right and right now it's not something that would be done as soon as the baby was born at all because sometimes these little holes close by themselves so you give them a shot but if it's a true atrial septal defect today it will be closed by an interventional procedure by the interventional cardiologist so when you say sometimes we wait for the hole to close on its own what is happening again physiologically around that heart what what problems is that hole causing right now right now before you guys are do we wait several weeks do you wait several months to see if that hole starts closing what are you looking out for this gets complicated and probably a question that you should direct your next pediatric cardiology guest okay but broadly speaking the asd won't get get into trouble but there are two larger chambers at the bottom of the heart which are big muscles if they have a hole in between we're talking about the major pumping chambers of the heart you want each chamber to only pump blood this one to the lung this one to the body but if there's a hole in between they're both pumping blood to both and that is too much work and the muscle will fail not right away a lot of them close by six months depending on how big they are depending on how much flow is going across so the cardiologist can follow this with the ultrasound the echo but at some point if it doesn't close it's open heart surgery or nowadays it's through the tube and they can put a closure device across that hole depending on the anatomy of it of course and uh avoid surgery avoid openstack so for those six months what is the baby going through what is mom and dad looking for baby sleeping this and that and the other yeah you go to that age all you care about is is the child feeding and gaining weight gotcha so the big signs for congenital heart disease when the child is young let's face it you can't do too many tests you can't see if they can run in stairs so the best signs for the cardio and the patrician can do this is the baby gaining weight he's able to feed a lot of babies with congenital heart disease that don't need surgery right away guess what they get tired just feeding so then the gi doctor gets involved they put a tube in the babies sometimes have tubes in their stomachs for months just so we can give them nutrition to grow because they get tired trying to feed and then you fatten them up get them to a certain size based on a certain weight that's when the cardiologist and the surgeon can do the surgery right okay so yeah this is a complex field no it is and that's why we could we could do 15 hours on this i have another question here from the audience dr ross i'm going to pass this on to you because we were talking about the different types of imaging this isn't necessarily pediatric but the question is can you take an mri or can somebody take an mri when you have titanium hardware and so we were talking about different tests and what they do uh question is which scan methods can be used with titanium hardware so that's the question so yeah that's a great question we come up against this all the time uh so uh titanium use most titanium hardware you can put into the mri but it um um it ruins the image because you're sending radio waves and receiving radio waves as you can imagine this big long antenna is sucking them up and it makes the image look real cruddy it's hard to it's hard to see anything so then you could try ct ct is also hard because the x-rays have a hard time going through the metal so you get these streaks coming off of it um if you have hardware there's kind of a that's when it's really important to involve your radiologist and have the doctor invol talk to the radiologist because you got to come up with the best solution you can and there's no ideal solution ultrasound as long as you're not trying to go through the metal you can do right right but ct and mr are definitely affected by metal of any kind now you want to make sure i don't know if the audience member is asking can you go into an mri unit with titanium hardware somewhere else let's say we're trying to image the brain but they might have a titanium valve right now okay we have a resource in the hospital and most patients who have let's say a heart valve most of the time the parents will carry around a card telling you exactly what kind of valve it is and we can look it up every one of our mri technologies knows how to look up oh this valve is it safe and compatible mri now that means it's safe for them to go in now we're not going to image the heart right because we can't like he said the titanium but we can image the brain right and it wouldn't affect it wouldn't affect the imaging of the brain okay yeah so if they're asking whether or not they can even go into mri that you have to check you got to get the literature on your device and then that'll tell you if it's safe and then sometimes it'll tell you how strong of a magnet you can go into okay all right um we are not like closing down the show but we're like at 13 minutes and you guys have a lot going on so what i'd like to do is stop questions from the audience for a few minutes and talk about what either we haven't covered yet that you really do want to cover or if there's something that we did talk a little bit about that you want to expand on but i think there's so much that we haven't covered yeah uh dr morty you get to go first and again feel free to talk with each other on top of each other etc because so this is also the place where the magic happens yeah so we've talked we've talked a little bit about what he and i both do for sick patients in the hospital i want to talk a little bit about what i want to do for the el paso community on an outpatient basis what are we making available at el paso children's that really prevents kids from going out of town okay pediatric interventional radiology is a clinical specialty we want to have a clinic that clinic is going to be a subspecialty clinic that involves a pediatrician a pediatric dermatologist a plastic surgeon a pediatric craniofacial surgeon and me here we go this is our multidisciplinary team why these people most pediatricians encounter benign tumors that are made up of abnormal blood vessels there's different kinds right most pediatricians are comfortable treating them initially with medication if they get more complicated that's when we come in right dermatologists sometimes and we have two pediatric dermatologists in town by the way we're very lucky to have them they sometimes encounter a child that has a weird skin lesion that skin lesion turns out to be another collection of abnormal blood vessels or a blood vessel tumor these are the kind of abnormalities that i'm interested in treating almost every children's hospital has what's called a vascular intervention clinic okay a multi-special team that says hey these tumors are called hemangiomas there's a whole bunch of different kinds and then there are these things called malformations collections of abnormal blood vessels like the one we talked about in the arm the fistula that caused the heart failure these kids almost always can be managed with either medication or some sort of conservative therapy we have a bunch of nice biologic therapies that we use our hematologists who also treat cancer are also very good with these medications some of these very aggressive blood vessel tumors actually respond to medication but when they don't that's where i come in right now we're talking about doing an interventional procedure going through the groin or the arm doing an angiogram an angiogram is just a map of the blood vessels that map tells us what do the blood vessels look like how fast is the flow is it shunting is it going to abnormal places can and then the decision can we block off the blood vessels safely okay that is what i really care about and number two anywhere else in the body where there's an abnormal blood vessel just uh three weeks ago we had a young child 11 years old present with high blood pressure 11 years old 11 years old high blood pressure was caused because the artery going to his left kidney was narrowed when the arteries narrowed the kidney thinks the blood pressure is too low it pumps out a hormone that raises the blood pressure beautiful right we go into the groin right go into the artery make a map take a balloon open up the artery does it work it works i saw him two weeks later he's off of one of his blood pressure medications now this one happens to have some more problems we need to fix but that's the kind of procedure that we need the team to build around okay i just had the pediatric dermatologist send me another case that we're going to schedule for a combined what i do embolization right and then a plastic surgeon comes in and takes care of the other part so let's talk about this balloon for a second the balloon goes in there blows up the vessel a little bit does the balloon stay inflated do you just go in there does the vessel then say again physiological it's my favorite one does the vessel say okay well now that you've blown me up a little bit now that i know i'm supposed to be this stretched out will the vessel then for the most part stay that size beautiful or is there a stent that goes in there perfect question okay so you basically covered it it depends on the disease process that caused it and we know which disease processes in kids cause these things i think i know what disease this process this kid has i think he has a genetic disease we still have to prove that it turns out for depending on the cause whether or not it stays open when i balloon it depends there's a certain rate i already checked him a two weeks later with an ultrasound it looks like it's open i'm going to do what's called a ct angiogram next to see whether it's restate open enough if it looks good great i'm going to leave them alone and follow them up and take them off with the blood thinners i have them on if it doesn't look good i'm going to go back and put a stent in oh okay so it's a sec it's a thing that we don't like to do in kids because once you put a stent in it's in it's in and i can't take it out and he's 11 so he's going to grow a little bit right so i'm going to try to avoid doing that so the reason i asked that night you hit it too is a stent because then your body wants to you know grow around the stent it you know puts its little tentacles in there and the roots grow and um so when we're talking about kids and i'd like to talk about cardiology stuff too sure um with stents that have to be put in when you're young they're not able to be taken out but then you can go later and then re-put in another stent either close by or where that scent is if that is not because again i'm thinking 11 let's say he's four though let's say he's really small and 11 is already kind of old but now that stent is like okay i'm a little small yeah so the end these are these are the these are the most important questions we are asking in our fields now the holy grail of stenting is biodegradable stents oh nice and they have them right we don't have them in this country yet but they have they are putting them in coronary arteries the arteries to the heart in some places as part of clinical trials okay these are made up of sugar polymers of various kinds and he's the chemical engineer he'll explain to you but bottom line is this is what i'm waiting for in kids because in kids for example i think a couple years ago we had a child who had a gunshot wound to his shoulder an abnormal connection formed between two vessels the only way i could close it off is to put a stent in the artery that goes to his arm the stent that's covered by the way it's called a covered stent okay well i didn't want to do that but i had to right now that artery is not going to grow to serve the need of his arm growing exactly so we got a problem i would have loved to put in a biodegradable stent put it in there open up the artery shout out the connection and guess what it dissolves in success right now that is beautiful yeah but we're not there yet okay some countries are though and we're gonna get there um so dr ross again that's like a wide open question what would you like to speak about that we haven't talked about yet well you know i i was thinking you know one thing that people don't get a chance to talk to radiologists that often and so they probably just don't even understand what it is we do and it's true we've been talking a lot about pediatrics and that is our special that's our love but i just kind of like to describe for your audience what what a radiologist is and why they why they should care so uh when i went to medical school i looked at all the different specialties and and i was trying to decide what what what i would like to do and i found radiology and i found radiologists who were deciding what was wrong with people as they were coming into the hospital and so a lot of patients they never meet us never know us they may see a report with our name on the bottom some do see us and meet us in procedures we do but uh um we're part of the the the hospital that helps decide what's wrong and we've been trained specifically to deal with imaging so we train not just in physiology anatomy pathology all those things we do all that we learn all that but we also learn physics right exactly technical stuff yeah exactly um biophysics all those things that let us decide what's the best imaging for the patient and then once we get the imaging what are the things that are real disease and what are just things we call artifacts right what are things that just look wrong but aren't really wrong with the patient and so um um this could be like the chronic but benign emotions right i mean something that your body is what it is but it's benign it's not going to hurt you which is who you are there's anatomic variants that just how you look on the inside a little different than other people but it's not pathology but i i think i think it basically if you get an x-ray and it's looked at by let's say it's just a for pneumonia or something maybe only the the family practice doctor looks at it that's different than an x-ray you get at the hospital where like okay we're trying to decide if there's congenital heart disease right right and um and so we're we're specifically trained we're trained for for many many years um uh it's it's a long specialty to do this and uh so i was really excited when i when i met dr morath when i came here to interview and he was doing these cases and all that i'm like okay this is great i want to come here and do this but um uh yeah so anyway just people might be asking like who are these guys who are i've never heard of radiologists i love the story when we were talking about i mean you were here before and you guys interviewed and it just but to me it's the teams and i'd like to take just a minute because you and i know you touched base on it when we started on air but before that you were really talking about this sub specialty which becomes a sub-sub-specialty and sometimes a sub-sub-sub-specialty um and i don't want to go too crazy about it i know we're about to wrap up but i would love for the audience to understand like you said there's so much going on you've got all the medical stuff but then you really got to keep up with technology and every six months there's something new going on like you were talking about this biodegradable stent right i mean maybe we have this exact same show next year and you're like hey guess what we got guess what i got to do a week ago you know um i'd love for you to kind of talk about the sub sub subs really quick sure so a radiologist in general dr ross has already explained our commitment to el paso is that when your child god forbid needs to come to our hospital and needs any kind of radiology radiology testing we want to make sure that there is number one a pediatric neuroradiologist a specialist who's not only a radiologist but a specialist in imaging of the brain and spine in head and neck that is a separate sub-sub specialty and that helps the neurologist and the neurosurgeon we want to make sure that there's a pediatric advanced cardiac imager got one we want to make sure that there's a pediatric interventional radiologist got one that's getting a little older we want to build a team of radiologists that not only do the general stuff but do the advanced imaging stuff that prevents kids from having to go out of town right and that way the neurosurgeon and the neurologist can work with the pediatric neuroradiologist the cardiologists and the cardiac surgeons and the interventionists work with the cardiac imager the vascular surgeons the dermatologists the pediatric surgeons work with the interventionalists and really what ends up happening is you have the highest level of expertise available in one place right and we're talking and we're talking to each other right and we're because we're forming a team we're committed to working together to elevate the level of care that's that's what being teams is about and i i like what uh dr ross said earlier and it's it's always amazing to me because when i for example you two you bounce off each other beautifully and you can tell there's camaraderie here um and you said sometimes you know some of the the specific cases are you guys just talking over the lunch table going yeah i'm having an issue with this and i love i remember years ago years and years ago we were talking about the tumor board because i thought what's the tumor board i just thought that was the most odd thing um but from then on out on a try to with every one of these shows even if you have the exact same titles there are all the teams that come in and it could be you know nurse owned so that saw something 12 years ago and i remember this and that's how a problem is solved so kudos to you guys um we're wrapping up i have no time for another question but i do want to say for all of you that caught this either at the last moment or didn't have um enough time to write things down you can watch the show back two different ways actually three different ways we stream live on youtube so you can go to youtube and look up the el paso position have to work the the el paso position um and then you can find this episode and other episodes as well you can also do it with pbselpaso.org pbslpaso.org and just look at local programs find the el paso position or you can also do it with the el paso county medical society um just go with their acronym epcms.com the medicalsocieties.com however and then you can look up this program and sometimes it's it just goes too fast and brenda i want to say thank you again for all the questions this is a live program on thursday evenings but i know it gets aired back several times throughout the month and then throughout months too so again if you need to find this again feel free to look we've been talking with dr aaron ross and also dr chet morthy both of them from the el paso children's hospital again underwriting the show for this evening and every single month several times a month the el paso county medical society comes to the board they bring me the questions they bring me the doctors and all i do is do a little bit of research and get to play and have fun with you guys and learn all kinds of things thank you so much for watching i'm catherine berg and this is the el paso physician [Music] [Music] you