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 [Music] good evening at pediatric surgeons they diagnose they treat and they manage children's surgical needs which are very very different from an adult's surgical needs it's a specialty that includes care of patients from the nicu up to 18 years of age so think about 18 year old they look like adults but there's a lot of special care that each one of them has and christina who's joining us this evening said let's not forget about the parents there's a lot of help that the parents need with this as well as you know this is a live program so think of some questions you want to call and ask us about this evening that telephone number is eight eight one zero zero one three we are talking about high risk newborn clinics and pediatric surgeries this evening and we are underwritten by tenet the hospitals of providence we also want to thank texas tech the paula foster school of medicine for providing these students to man our phones this evening and today i have to throw out a huge congratulations to madeleine morris because as of i think a week or so ago she is now a second year in medical school she is done with her first year so congratulations madeline and thank you so much for helping us out with the phone so madeline will be answering the phones and sending your questions our way we also want to say a huge thank you to the el paso county medical society who has been bringing the show to you for almost 26 years good evening i'm catherine berg and you're watching the el paso physician [Music] thanks again for joining us we're talking about pediatric surgeries there's a lot of different things that can go wrong and little ones we're going to talk very specifically about very very young ones even some newborns that are born a little bit too early and then really extending all the way through until the age of 18. that's the entire genre that pediatric surgeries deal with so we have with us this evening dr john lawrence who is the section chief of pediatric surgery at the texas tech university health sciences center um he's also done some work with doctors without borders and then we also have christina zapata who is a nurse who is the supervisor of the providence children's specialty clinic and so both of you thank you so much for being here this evening um we think of little ones and you know when when a baby is born a couple of months early um it's a big deal a couple of weeks early it's still a big deal but a couple of months early and and this is where we're going to talk a little bit tonight and i know that we look at a span of well just add a couple more months onto that and things are good and better but there are also things that follow these children going forward so we're going to talk a little bit about that and then surgeries in general with everything that has to do with pediatrics so dr lawrence i'd love for you to start and just give us a brief background of who you are why you came to el paso what do you like about here what you have studied and why is it that you like surgeries on little tiny little people all right thank you for the introduction first of all and for having a chance to be here tonight um to you know address your question or questions uh linked together there as they were um you know talking first about you know my background in pediatric surgery my career has been primarily in academic settings much as it is here so working in teaching hospitals and the the practice itself um you know it has a appeal to me really from my first exposure to it as a surgery resident and it was some of the issues that or facets of it that you've already highlighted it's a diversity in conditions the variation in the age range and size of the patients and i would say maybe in a way that's different than the adult populations that obviously whose care is very important but they need to be connected to families and the interaction you know may be primarily to the patient or maybe primarily with the the parents or extended family or it may be an interaction of all of those elements right um as to what brought me to el paso i think i would i could you know very honestly say that the the real attraction was a um endowed chair that exists at texas tech what's called the meyer mounsey endow chair which is a pretty unique nationally and a position that is geared towards providing opportunities for a pediatric surgeon to do not only pediatric surgery in a more standard clinical setting here in the u.s but also to work internationally and so it's uh you know was was set up in recognition of the work that don meyer who was for people who've been in the community for many years may have had contact with but a pediatric surgeon who devoted a good portion of his practice to working internationally in africa and doing a lot of charitable care and then a family who he cared for here um in el paso that were very grateful for the care they received and set up this endowed position that i'm occupying so it's you know an honor and a privilege to be here and assuming it and as to what do i like about el paso i would say the cuisine is great it is and yes hard to hard to top the kind of uh i must say i'm a big fan of the proximity to open space near a major metropolitan area so as somebody who loves to get out on the trails and the thousand steps trail in that area it's pretty you know pretty unique we have lovely mountains here and absolutely more and more getting more bike trails and and involved so i appreciate being here and it's i agree it's a place i never want to leave yeah yes absolutely christina i should ask you are you from here did you also relocate to el paso or no relocation i am from here yay i love that so what do you like about el paso actually we do have to answer that question now that we've asked dr lawrence that but i also would like for you to explain to the folks at home what you do all day every day and how your position with pediatric surgery helps everyone that's involved well this is home i'm very family oriented we have a huge family tons of kids so we spend all day every day with family and outside it integrates into my job because i love the connection i make with the families number one is family and the child and taking care of the the whole family as a whole rather than just the patient right and i like when you said that when i was writing down some of these questions here and i said well do we stop at 18 when is pediatrics and i know in our head it's 18 but i know some 18 year olds that look like 25 year olds um so we were kind of joking about that but i really like that you said that it's not just the child because you're you're looking also at siblings too because if someone who's very ill there is a way to uh bring care home with all of that as well so one of my my first questions is and dr lawrence i'm gonna i'm gonna bring this to you um and i'm just gonna go from very very beginning stages up to the age of 18. so we have a pregnant mom and pregnant mom is maybe four or five months pregnant how does a person know and i know that there's sonograms they go through her checkups etc how does one know when there is an issue in a pregnancy and and just kind of maybe take us through a case study or two in your mind that you can think of and what some of those issues could be pre-birth yeah well and i think i might even um you know take a step back before you know getting into the sort of the more specific details of that and just um you know highlight that you know i think that the expectation of almost any set of parents is that their child is going to be normal and so we can't as we are bringing in as i think is entirely appropriate sort of the emotional social aspects of health care you know as a subset of of the patients that we deal with you know parents of a newborn who has been identified as having an anomaly have you know more stress i think than almost any of us can imagine and i think it's important that we we highlight that because anyone who's been a parent knows how difficult it is with a child who's otherwise normal and um so that to kind of add on to that uh you know and a condition that one may have not have understanding about and or what are the ramifications of that is you know really a significant burden to be bearing so the the identification process though you know typically does as you highlight it begin with a screening ultrasound that's done and i'll be honest with you and say i don't know what the standard of care is not being an obstetrician for when that might be done obviously there are circumstances where in the course of a pregnancy women may not be able to access prenatal care so it's sometimes exactly they're born with conditions where they're you know caught unawares if i may say and um and then related to that it also you know ultrasounds are also somewhat imperfect and so it happens on occasion that a child is born with an anomaly and it hadn't been appreciated ahead of time so all those things can can factor in but if we you know talked about one in particular and i'm just going to choose a diagnosis of what's called gastroschisis which is a type of abdominal wall defect where the intestines are actually outside of the abdominal cavity for most of the pregnancy so that immediately after birth the child then needs to have a procedure performed to return the intestines back into the abdominal cavity if at all possible and that's something that most likely if there's sonograms you can tell so there would be a pediatric surgeon at the ready so to speak at the birth of the child that'd be correct exactly and so i would say um you know perhaps not physically in the delivery room but you know being made aware that the child was going to be born and so you know in proximity and ready prepared to take that child you know to the operating room more often than not to um then perform a procedure to get the intestines back into a contained space so so yes this is the the sort of thing that if it's picked up ahead of time then often what's done is a prenatal consultation is arranged for the family and that would could include meeting you know someone like myself or my colleagues in pediatric surgery it oftentimes can include meeting with a member of the neonatology team or the team that would be working in the knee natal intensive care unit to care for the child afterwards so you know to try to provide you know i think a more broader encompassing um approach to you know what it is that would be happening after their child was born and what the stayer and the environment was you know might be like right and you know that can include and again it varies from institution but that could also include you know having a chance to tour the nicu before the actual delivery has happened so that the parents you know can actually conceptualize you know what it is that uh you know that may need to be done or where the environment is where procedures might be performed or care given and christina i'm going to kind of jump in here because i think this is where you might come in with the staff because i the years of doing this program it's amazing to me the teamwork that has to occur not amazing to me it's just it's nice to see the teamwork that has to occur when anything goes down so let's take this case as an example that the mother knows that there's going to be surgery pretty soon after the birth of the child and that they're going to have to be in the neonatal unit for a while or the nicu unit for a while you and the staff talk us through how that would be so talking the mother you know taking them on tour and i know at the times of covet it's a little bit different than it was in the past you know for a while they think we're trying to get back to a little bit normal now you know things are a little bit changed if you want to throw a little bit of that into i completely respect that but the communication in general with the families so what happens is the patient once admitted into nicu i don't know currently if they're allowing families there is a program where they would include um siblings and grandparents into the care of the child currently i'm not too sure who they're letting in because we're just going from day to day no i completely understand that maybe talk about what you would talk to the parents about or to the mother maybe we can just look at now what we're talking to the mother about before um it's an explanation of kind of what's gonna happen how long possibly the patient might be in nicu um what the procedure might look like what their role in the nicu would be because baby would stay and they obviously go home um concerns about which i think is a hard thing to explain absolutely absolutely i mean it's very hard to say my brand new baby is gonna stay and i go home it's very hard to comprehend um what breastfeeding might look like can you still breastfeed um i think overall the care of the child and then um for them it's a realization of what the next couple of months might look like exactly yeah exactly yeah so let's look at um there are so many different and i know right before the program dr lawrence we were talking about a lot of different types of surgeries that pediatric surgeons perform so we were kind of talking a little bit about prebor pre-birth and now um let's take a a case that you might think of off the top of your head that you've treated before in the past that we didn't know that there was going to be an issue until the baby is now born what might some of those be and how would you handle that and maybe look at some of the most common and that way some people might recognize some of those yeah of con conditions that we might not be aware of so i you know i could give an example um you know a condition called diaphragmatic hernias where there's a the the diaphragm or the breathing muscle on one side of the chest um you know doesn't uh close properly in the way that it should so it actually starts as kind of a peripheral rim of muscle that that in growth to kind of make a congruent layer should occur and if that doesn't happen that can then lead to the herniation or the the movement of abdominal contents up into the chest cavity and so with that circumstance again many times we're going to be aware of it antinatally and and be prepared to deal with it because those infants can be you know quite ill at times but conversely you'll also see the circumstance where some cases aren't identified or picked up until you know the time of birth or and and the child presenting then with some element of respiratory distress or difficulty in the first few days of life or it it may be that they even go a few weeks or a few months into life before it's picked up just kind of incidentally on a chest x-ray that may be obtained because they had a cough or for some other um reason and so um it's a you know an example of of a condition that really can present anywhere along the way from we know ahead of time and in in the way that it's very odd this is a case the ones that we do know about ahead of time often have the worst outcomes right and whereas the ones that present later because they tend to be more minor uh and or the child has adapted uh better to them um that that they don't wind up having as um as that's severe because you would think would almost be the opposite if you knew ahead of time that that's something you can fix but that's a good point too and christine i'd like for you to hop in on this too but our bodies are amazing i mean you there's a baby is born and sometimes they can have issues with the heart and i know that we're talking about cardiac pediatric surgeon it's a whole different thing but i don't know how often you have seen issues where a child has had some kind of abnormality but nobody knew for weeks on end and so i'm going to ask you and i know this is a hard question but what might be some symptoms or just some things that parents can look out for if my babies you know feel like they're out of breath or this and that and the other what is it that parents can look at for if they think everything is fine going home in the first place it might not even be that they're not reaching milestones it could be they look a little different and to say different i mean it's very difficult for a parent to understand that but they have differences that mom and dad don't have a different chin per se um it could be something simple as that that way they've caught before it could be that they're not reaching their milestones some babies are a lot faster some babies a lot slower but it could be something very minor that they're not reaching it could be once they're starting to babble they're not babbling correctly they're doing repetitive movements um it could be something very nice this is where it would be very important to have those uh those checkups where first you think man and i remember with my two little ones who are 24 and 18 it's like really i have to go to the doctor again yeah it seems like you know first week and then two weeks and and those are some of the things tonight and i remember breathing i remember you know how are they breathing color jaundice for example would be you know and i know that's very minor that's not surgical i respect it um but just maybe gastro issues i know that you were talking about gastro issues right before we started the program um maybe bowel movements if those are you know i remember the first bowel move of my child i'm sorry i'm going to be gross but i thought she was pooping tar you know i'm like what is that and i remember telephoning the hospital going is this normal so on that note uh let's talk about just gastro issues just the the the track in the first several days or first several weeks that again that baby's brand new you know a brand new set of parents maybe don't have other parents around what is it that they could be looking for yeah well you've already you know touched on a couple um that i think are you know probably worth reiterating or or you know going back over um specifically so one that comes to mind is is spitting up or vomiting which again all babies do and it's a very common part of um you know the i think i would just say sort of normal life with a newborn um and that uh you know it's the the white badge of courage is a parent that you have on your shoulder remember those days you know after you burp them but um then you know that can can um trend though into becoming you know more pathologic to the point where um you know smaller children in this first couple weeks of life have more persistent vomiting and there's a condition called pyloric stenosis or thickening of the end of the stomach muscle okay that that often presents in a very gradual fashion typically you know around for a term baby at around two weeks of age but it can be a little bit earlier it can be a little bit later and just becomes progressively more of an issue and you know easy to overlook um and in you know scenarios where you know grandparents will say oh yes you did the same thing don't worry it's going to get better or you know are you feeding him or her too fast or too much at a time or whatever it may be but questioning about that you know new role of a parent that can come into it and these are cases that you know sometimes are picked up within a few days of their onset with a kind of a collaborative effort between the parents and the pediatrician or primary care doctor family doctor but other times they go weeks before they're picked up and then how is that diagnosed so if they come in is there a what kind of tests are done to diagnose that well so i'm you're you're talking to a somewhat more senior pediatric surgeon so i'm going to say the best way to do that is with a physical exam and a history as we've talked about so you can actually feel this thickened muscle on exam what's um relied on today far more commonly just because it's easy and accessible in the community are ultrasound right exams okay so that that's the far and away good old-school ultrasound yeah able to see all kinds of stuff yes exactly um but um so that would be an example you mentioned jaundice there's a condition called biliary atresia which is in a you know very unusual surgical subset that is can account for jaundice so again um for jaundice babies pediatricians primary care doctors family doctors are going to be following that looking for improvement and also potentially then trying to see exactly what the the components are of what's called bilirubin the compound in the body that causes jaundice i remember putting my baby in the sunshine yeah you know and that was one thing that that you know everybody's worried about but then again once you kind of go through you you figure that out yeah um but it it can um that but the in that particular condition this biliary atresia the the bilirubin level typically continues to go up rather than you know kind of dropping back down which is what's more normal uh in the vast majority of cases and in turn it can then lead to a need for a surgery ideally that would be performed at about two months of life too so what causes that to go up versus going down like it like it should um and then what does the surgery physiologically do to help bring that level down yeah so the the the um so the surgery itself which is called a kasai procedure it's named after the japanese pediatric surgeon who um invented it um is in essence the a means of correcting the problem which is sort of a progressive sclerosis or narrowing of the main bile duct combined with an element of intrinsic disease or dysfunction inside the liver itself so it's kind of a two-pronged entity i guess i would say but the surgery that's done is to surgically replace the bile duct using part of the small intestine so you relieve where the you know the narrowed scarred obstructed element is and allow the bile to then flow through a rather convoluted hookup of the intestines that probably isn't entirely pertinent to go into tonight so that would be you know another example of something that comes up and since you talked about bowel movements and your own experience with uh with with tarpoo yeah our poop is famous in our house yes exactly which uh yeah you know the the um once you get it on you know it's next impossible to get off too it's really sticky i threw my pants away yeah yeah i did anyway um the um you know the medical term for that is meconium and there's you know some neon needle um individuals wear badges that say meconium happens and we'll kind of leave it leave it at that but um this condition um that's called hershbung's disease is an entity where um children aren't having normal passage of bowel movement so we would say you know that in the first 24 hours of life you know the vast majority of infants are going to have passed that first stool that meconium stool on their own by the time you get to 48 hours of life you know it's it's only going to be a very small a couple of percent of of normal individuals that haven't passed a bowel movement by that point in time so so children who present with late passage of a bowel movement or in that neonatal period have what seems to be really excessive constipation um that this entity her sprung disease can be present and it's important to be aware of because they can also get this condition called enterocolitis or in distension and inflammation of the uh of the intestines get they can be rapidly lethal right so we and the healthcare team feel very neat that this need to be very vigilant on children and infants before they leave the hospital who might be potentially at high risk of having that of trying to be as certain as we can be oh and christine i'm going to throw this your way and i'm not sure how this works but i know when a baby's born pediatrician comes in does the though sure everything's fine how um specific is that and or and i know this is such a general question and i feel bad that i'm just like throwing general questions your way that's okay but to do a check in the hospital because usually mom and baby are there a day if everything's gone just fine um how does that what what is the pediatrician looking for so with a new baby really the pediatrician is looking at a full head to toe assessment say um they hear bowel sounds they hear clear lungs their eyes are okay the fontanelles are okay their hips are okay um their pulses feel good but the nurse is the one who's there for the 24 first 24 hours the nurse to also make sure that the baby has voids and stools in the first 24 hours that the baby's feeding well that the baby's not vomiting that the baby does have the bowel sounds the clear lung sounds so although the doctor does come in once it is also the nurse's job to monitor that baby every sewed up and all that other good stuff what is happening when baby gets whisks away you know again i i think a lot of things that you're talking about right now yes the doctor comes and you're absolutely right i mean praise and adoration to all the nurses in the world because front line i mean it's just happening all the time absolutely um and there's waiting obviously they get weighted looking at color what what what is happening during that time before they bring the baby back so they're checking um baby's temperature breathing respirations color um again the bell sounds again though yes again yeah and that makes sense though because that has to start working that has to start working they give it a little bit of time they check their glucose they do a number of things to just be sure that baby came out okay baby's not in distress right of course if baby doesn't pink up they have to put baby on oxygen so that's always a very big concern does baby need any nicu right so it's it's a number of things that are really of concern right as soon as baby's born okay and so dr lawrence i'd like to maybe get older now and i mean that figuratively um so we i think we've covered a lot of baby and just a little while we'll be able to go back to uh to some other things that maybe we have missed but what are some of the common surgeries that you perform on let's say children under five and then maybe children five to ten just to kind of i have hernia written down here um umbilical hernias or the possibility of one yes i feel like that's something that i hear not often but i hear about yes with little ones yes yeah so um umbilical hernias is probably one of the more common conditions for children that get referred to us in that i'm just going to sort of say three months to three or four year age range okay and so they are a part of the normal process of development or i might say a mild variation of the the normal development process where at the strong layer of the abdominal wall the the area where the umbilical cord had attached has not um kind of fully cinched itself down is maybe the best way i could describe it okay and so they are are are prevalent it's they are almost never a surgical emergency um but they certainly create i think a lot of concern for parents or families because when children are agitated or crying they will often bulge out and the logical association of kind of cause and effect my child is crying and unhappy and this hernias bird bulging out or present i wonder if the two are related right so um so a lot of concerned expressed but we typically a good percentage of these that we see in our clinics will resolve spontaneously and so um you know that's kind of the best surgery of all in the hands of a pediatric surgeon is you don't have to do anything right exactly exactly but a subset that then don't wind up closing spontaneously and although there's variations in given cases usually you know we wait until the child is in the you know the four to five year range before suggesting that um surgery would be done not that there aren't exceptions okay um another kind of hernia and um would be the you know inguinal hernias or groin hernias oh yes so um again even though it i think commonly those are thought of as you know something that adults get from straining or heavy lifting or you know being overly active um in children again it's it's just a variation of normal development processes so a canal that exists between the main abdominal cavity and the genital region that nature should close down soon after birth that persists in staying open and so those unlike the umbilical hernias that that rarely create any urgent or emergent problems with the inguinal or the groin hernias there's a pretty high prevalence or potential for uh intestine to get trapped in those and okay and take a um you know sort of a more benign elective condition and turn it into an emergent one so so when we uh so this could be going on and the parents don't know and the child is too young to say anything exactly until it gets to a point where it's so uncomfortable i guess for the child that they're well so the the more typical sequence is that it presents as a bulge down in the the groin region and parents come in because they've noticed it you know often at a diaper change in that in that age group and so um that's you know probably the most common way that they present versus is being something dramatic uh you know with something actually stuck in it or what we call incarcerated in the hernia sac yes but that's a very common procedure that we do preventatively to try to avoid the more emergent circumstance so it's not something when we see it where we say well we need to drop everything that we're doing exactly get this taken care of but rather so the digestive system is still working at this point just not working at the optimal level so the digestive system shouldn't be affected by it unless the bowel has dropped in there and gotten caught and then it can create a blockage of the intestines okay makes sense uh christina i'm gonna ask you a question and don't laugh at me because it may not even be a thing anymore but i'm an old lady and back in my day my baby brother needed tubes in his ears and i felt like so many people needed tubes in his ears and when my little one was young she had chronic strep throat you know ear infections et cetera et cetera and i remember that's a surgery um so i'm just throwing that your way to give you a turn to talk um and asking how common that is in any way absolutely very common is it really well then i don't feel so bad we used to have we had surgeries every tuesday thursdays i believe sometimes fridays that they would come in get their ear tubes okay and explain what that is and what what's happening so the tubes and the ears are just the the normal tubes are not slanted the right way just explain how that could be from chronic ear infections it could be from a lot of sinus infections it um overall they find that the patient just continues to have some sort of infection or they um correct me if i'm wrong born um breached and they have uh water in their ears oh my goodness didn't even think about that yeah yeah i was just going to add it yeah i think that um you know as we're you know talking here on the show tonight overall this is a you know i think a great example of the value of preventative care so surgeons we're sort of action oriented and you know we want to do things and but you know so much of what's important in healthcare are preventative measures and really the value of ear tubes is you know releasing fluid and or to prevent recurrent infections so that you know hearing will develop normally so that is one of the you know the major values of of putting tubes in into the ears and um and as i say i think that it's uh you know yes the child's children are very unpleasant anyone who's ever had a child who's had an ear infection knows the misery associated with screaming yes yes with that absolutely but it's that much more the long-term perspective i think that the you know the value of those procedures provide yeah um i want to i'm just looking at some of these notes here then we already talked a little bit about uh pioneer uh disease or did we that was when we were talking about the intestines correct we haven't touched on that so okay so let's do talk about that because i know we're starting to time's going fast it's amazing yeah so so pilonidal disease is a condition um that affects the region in over the tailbone or by the gluteal cleft um so um you know without trying to be you know too particular or uh as to exactly where that is but i'm sure the audience can well understand and um the you know the the pathology or the basis of it somewhat poorly understood but it certainly seems to be implicated by kind of turning in of the skin that may have occurred there developmentally and or irritation of hairs that are in that region and of course elsewhere in the body as well right but as a major factor that that me sort of for lack of a better phrase kind of stir things up so it can lead to sinus formations or sort of little open tracks that drain fluid it can lead to you know much more significant infections um and it's tends to be it's something that we i would say really see in adolescence you know in the pediatric practice so it's not something a four or a five-year-old is going to be um and that's something that is developed of no fault of if that's just something that's hereditary exactly well it's a hereditary and or i would just say you know a formation to to some degree um more you know i might even use the word phrase a random event to the population that gets it we don't really understand precisely you know why they uh you know why they do how are you able to correct that well so it's there's a variety of means sometimes you know relatively simple procedures where you can actually sort of core out the areas that are diseased or involved i'm just trying to think of you know you know a common um you know device that's around but it that it would be a good analogy to it but uh you know almost like soil samples are taking you kind of core out that particular area that's involved sometimes it requires you know drainage acutely when it's infected and then a more extensive reconstruction later on there's a variety of procedures that can be done and in in really severe cases it it can even involve the need for plastic surgeons to be providing flap coverage so it can be in the more severe circumstances it uh yeah it certainly is something i think that shouldn't be underestimated into how um significant it can be but you know by the same token sometimes it's you know we're fortunate in the when it presents it's in a more sense uh say in the very beginning of presentation so to speak what is it that for example the teenager let's say it's someone who's 10 11 and mom and dad aren't you know he's showering alone he's doing everything alone what are they looking for are there you know other than phys physical symptoms you can see are there other issues that they're having immediately is there pain is there abscessing is there yes so it can be you know i think i would say a variety of those things but i think a you know a good point that you brought up and um you know the age range you know again is probably going to be post-pubertal in general we're not going to see they want their privacy and so my body is my body and not your body is part of the way again that that uh you know that is the expectation or the norm and that age group so um you know they often are probably um you know late to present to us just for what you're highlighting and that you know a teenager is going to be embarrassed to say mom or dad can you look at this i don't know what's going on it sort of gets you know swept under the carpet as it were but it could be pain in that area it could be drainage of purulent or or material or pus you know those are probably the you know the most common ways you know spreading redness or significant infection as time goes by right right so that's definitely something you want to try to catch before it gets to that point we uh i have down here too and this is interesting to me so vascular and lymphatic malformations um in my head i'm just thinking that is such a freeway inside of our bodies you know the spaghetti bowl times the spaghetti bolt on the spaghetti bowl so some of those malformations what could they be and then how um are they able to be surgically fixed because that seems like a handful right there so you you've asked a question that i could easily spend you know the whole next hour trying to to answer in truth so it's a a again there's a wide spectrum of conditions i think that um you know one of the more um you know common things that um that that uh you know families are familiar with our little you know sort of um what are our hemangiomas are sometimes referred to as cherry hemangio's little bulges that have a red appearance and often newborns and infants will have those or they're you know either not appreciated at birth or very subtle and then there's growth factors that the body elaborates that causes those to become more prominent and so they may then sort of blossom or bloom in size and conversely by two years of age in in some cases those growth factors have then you know diminished to a level where the that growth will then involute on its own and so depending on where it is okay many times it's better to not do anything surgically but it there's um you know a whole category of classifications and um you know in this mixture of of blood vessels and lymphatics they can present externally they can be inside the body and manifest in a whole variety of different ways so it's hard to provide a succinct answer to you but i would say one of the things that's really evolved and i think that's been exciting in this field is the the combined approach to those using services that include sometimes medications will help but uh also you know agents that interventional radiologists may be able to provide and inject into them through very select and specific pathways and so surgery has become i would sort of say the you know the the default option after all else has failed or there's something more um significant that needs to be addressed but many times you know the the need for the surgeon is actually to be involved as part of a bigger care team that are looking after these kinds of abnormalities or anomalies so we did a program not too long ago on pediatric interventional radiology and it was fascinating to me and i feel like there is a lot of cross-training or that there you know that that's just naturally happening um with that in mind when we're looking at old school surgery and when i say old school like 50 years ago you're cracking chests open this and that and the other and with interventional radiology we're talking a lot about the sonograms but in general do you as a surgeon use any interventional radiology or is that something that's kind of done and if something isn't working well then they go pass things on to the pediatric surgeon and that may be something that's still kind of in a world of of mixing and melding together i'm not sure yeah i think the best way to answer the question would be to say it's it um you know to some degree it's a combination of all the points that you made so there are cases that are clearly best served by the interventional radiologists there's cases where clearly you know us working collaboratively collaboratively with them makes the most sense and then there are cases where it's pretty clear that probably the surgeon should be the one involved addressing the problem and each case is unique and different you know the you know the variety of conditions that we have overlap with is you know very extensive one of the more common ones being after patients have had a appendicitis and a perforator on that no christina i was thinking to myself appendicitis i hear that all the time and i don't know if i hear it more often in pediatrics or is it just more you know excitable because it's someone who's a child but um i would love to ask you because again front line you know there's surgery but then after line if someone has appendicitis what are they feeling what are the symptoms and how do you know it's that versus just a really bad stomach ache or etc etc it's hard that is very hard yeah um sometimes a patient might be throwing up they have stomach pain um sometimes it's just very general and they'll say my stomach hurts the parent might think that they have us a bug and they'll say okay we'll just write it out they have diarrhea they're throwing up a stomach bug the pain continues um sometimes they bring them in and they'll the doctor might agree it's a stomach bug and send them on their way because they don't have the symptoms to diagnose them um usually it's the right sided pain right lower right sided pain but they might not present that way okay um especially with little ones it can happen under five and those are usually really bad but since they can't vocalize it's really hard that's the hard thing is a little one can't tell you yes exactly what they're feeling sometimes coming in through the er they'll automatically do an ultrasound and again that's how it's diagnosed usually that's a big question sometimes it goes to a ct correct um but it's not always diagnosed right away okay and to define appendicitis it's the inflammation it's the infection what is what is happening with the appendis uh appendix you know because people say you don't want it to burst that's the big thing so it's an infection it's what is it that happens to get to that point yeah so the underlying cause that well the appendix backtracking because you know many people in the audience i'm sure you're familiar with it yeah yeah but um it's like a finger that that protrudes off the beginning of the large intestine or the right side on the right side of the colon and um it's you know its function presumably is that it's very much involved in kind of lymphatic um immunogenic processing i guess i would say of of the the gi tract but um yeah we again uh to to not uh digress too much onto that what can then happen is this um one of sort of two things that we think of as being the pathophysiology either the lymphatic tissue in the wall swells um and near where it joins the large intestine or some object or or something in the way of a more solid piece of fecal matter forms or it can even be you know parasites uh that can sometimes uh you know be causative or even tumors not very often in children but something is sitting by the opening that obstructs it something that's foreign exactly okay yeah and then what happens is the the bacteria that are in the appendix are multiplying and mucus is being secreted into the lumen or the center part of the appendix and there's no place for it to go so that then causes the appendix to start to swell where if enough time goes by it then bursts or or ruptures right goodness gracious um we're kind of at that point now where we have about 13 12 minutes left in the show so what i usually try to do at this point is stop all of these questions and kind of focus on what you all would like to talk about before we wrap up and so would you like to go first christina you're welcome to throw that over to dr lawrence if you'd like i will throw it over there i figured you would not and that makes sense to me um because i know that i i'm interested in this doctors beyond borders um or without borders i know that you've been working with this for a while too and i i i'm not super familiar with it although i've heard a lot about it and i i think it's a fantastic program but you've been working with this for quite some time and would like for you to just talk a little bit about that you bet and i'm gonna you know take the opportunity to digress for just one minute before we get into that um and um just say you know first of all i'll be you know very upfront and honest i've never watched your show before and so well for shane being new to town i don't know why that's the show i have to give credit to the el paso county medical society i mean they're really the ones that have been doing this for many many years and then pbs el paso i'm just a girl that asked the questions yes so um but i learned a lot yeah but but in that regard i think it's fabulous without you know knowing what the format typically is that but that we're highlighting the the nursing profession here um in this discussion this evening because yeah yeah because you know christina kind of i think i would say was talking like about the newborn assessment but the the the the fact of the matter is the the hard work done in the trenches in health care is done by nursing personnel and and you know nurses like christina nursing assistants aides and a whole variety of people that you know work on that umbrella and you know we shouldn't be leaving out respiratory therapists and pharmacists and people who provide the stocking and the cleaning which obviously you know has become critical here in the time of covet so this is very much a team venture and i think it's fantastic to highlight but to give credit to you know non-physicians in healthcare because they are really what keeps the engine running so to speak absolutely so i good for you well i the lead and you know that why did that come to mind because you know doctors without borders which i'll talk about now is an organization that's um existed this is actually the 50-year anniversary it's fun of its funding and it's really an organization that focuses on responding to crises and and what does that include uh that's you know natural disasters um you know outbreaks of infectious diseases so ebola being one that there's been a lot of response to um but it also includes you know what i would say might be considered more chronic problems so things like malnutrition um you know lack of vaccinations um the you know the need for attention to specific neglected diseases so uh you know and or underserved or under um conditions that haven't received enough enough attention things like hiv being another example exactly and then um you know the surgical arm which is you know what i know about uh includes uh oftentimes responding and providing surgery in conflict zones or uh areas where there's you know it may not be a formal warfare but you know instability that leads to lots of traumatic injuries but you know includes you know also pediatric care and their programs obstetrical care uh it so it's really these areas that don't have a lot of access to medical care exactly so it's designed to um to to serve you know underserved populations and if i can again add and you know editorialize a little bit as somebody who feels strongly that health care shouldn't be a privilege but should be a right for all of us you know their focus is on the the segment of the population you know globally who often have no care so as we're um you know talking about um you know some of the various nuances of conditions that we treat here you know i think it's important to recall that there's five billion people globally that don't have access to safe and effective and affordable surgical care as an example so um you know we you know the organization i think very much is um you know a big part of their um uh you know of their goal or reason for existence is to be able to try to you know in a small way correct that imbalance and direct resources to those populations that otherwise may not um have the ability to have surgeries i know that there are uh more apt to have clinics and people who aren't trained necessarily in surgical because and that again is such a specialty so in doctors without borders are what are what are the main trained trained physicians are they internists are they again surgeons i feel like that would be a relatively rare uh deployment so to speak for for doctors without borders just in general what kind of doctors specialties is that so the the most valuable physicians are people with um you know broad training so generalist is what i would say so who does that include or incorporate these days so you know i think i would say family physicians are well suited because they can do pediatrics and adult care and obstetrics and you know some basic trauma care emergency room physicians is another subset because they have this same skill set and deal with acute problems well but um but you know internists obstetric obstetricians and gynecologists pediatricians are you know are also valuable and then there are some specialized projects they have that really um you know focus on you know you know what might be very surprisingly discreet subsets i've been you know spent a fair amount of time in recent years working in a project in liberia that is partly involved with pediatric surgery but the other main component of it is actually dealing with patients with mental health disorders and epilepsy and because medications you know often aren't available for these patients they are shunned from society and not able to function in a meaningful way and so it's you know the need for somebody who can has specialty in seizure treatments or for psychiatrists and other people with mental health backgrounds is an another very important element of what's provided yes yes um when you came to el paso and i and i know that we were kind of talking about this earlier um you'd been in several different countries and are there different specifics in different countries that that you have noticed uh and you were talking about war conflicts and then there's also countries that are not in any kind of a war conflict but just simply do not have access to care because of their their rule um how do doctors know where to go and i know that there's a system and i know you served on the board for a little while but that that's always curious to me is like how did how do we know how does the world know and how does the doctor network of doctors without borders know where to go and what's needed yeah um and once again uh you know i i think i might phrase that as an extremely pertinent and almost provocative question in global health these days so i think um versus i'll just say you know 30 or 40 years ago where the the mindset was very much um you know we know best as the the you know outsiders interlopers for what what it is that you need um you know now the i think the orientation is much more a collaborative system whenever possible where the the the given country is acknowledged as being the expert on what the health care needs and environment and pros and cons are in terms of what they can provide or can't provide and so that that integration with what what is already existing um you know has become an extremely important topic in i'm just going to sort of say inhumanitable humanitarian or charitable care overall not just within doctors without borders so it's but you know it's it's hard to hard to um kind of answer that you know each circumstance is very different and every land every country yes and and if you have an armamentarium where you say do we select tb care or infant mortality or hiv or years ago would be polio yeah yeah almost eradicated yes i think i would just you know follow up on that very quickly though with um you know having an orientation towards public health preventative services are really what's where the most important things are so immunizations and as we're talking about the vaccine right now right you know how vital that is for preventing various diseases clean water and sanitation fundamental element of well-being overall secure sources of food being another part of that so it's it's basics that make a big difference okay and you said the fundamentals too that we take for granted all day every day so um i appreciate you doing that i appreciate all your colleagues that do that um christina i have to say huge adoration and praise for you being here and again take that back to all the nurses and really to everyone that's on the team and and i really appreciate you saying that it's not just the medical doctors you know it really is everyone down from you know the guy that's looking for clorox wipes you know to clean everything up so it's been that kind of of a year and a year and a half um i know that uh we as the el paso county medical society pbs el paso again we are really encouraging people to get vaccinated uh for many reasons and i know that there are you know we're not telling you what to do but it is definitely strongly encouraged on this end to help out with the variants that are going on right now and again you are better protected and for sure not necessarily of getting it because i know that there are news stories too but to prevent severe disease and hospitalization so it's a big deal um if you want to watch this program again or any of the programs that you have seen here on pbs el paso with the el paso county medical society and the el paso physician you can go to two different places for that you can go to www.pbselpaso.org or you can go to the el paso county medical society website and that is www.epcms just think of the acronym of el pasocountymedicalsociety.com and madeleine morris again thank you for being here this evening she is in her second year of medical school congratulations that is brand new but the first year is always that that hard year um so we appreciate you being here so we've been talking about surgical pediatric procedures and again it's been a delight to have both you here thank you for choosing el paso thank you for staying in el paso that's a big deal and we want to thank everybody out there again the el paso county medical society who's been doing this forever tenant health care and hospitals of providence i'm catherine berg and you've been watching the el paso physician [Music] [Music] you