Pediatric Colorectal & Pelvic Surgery Comprehensive Care Center

Podcast Transcript

Dr. Scott Steele: Butts & Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end. Hi again, everyone, and welcome to another episode of Butts and Guts. I'm your host, Scott Steele, Colorectal Surgeon, and President of Main Campus here at the Cleveland Clinic in beautiful Cleveland, Ohio.

And today, I'm very pleased to have two guests. First, Dr. Lynn Woo, Associate Professor and Center Director for Pediatric Urology at Glickman Urological Institute, and Dr. Anthony DeRoss, Pediatric Surgeon as a part of our Children's Institute, both here at the Cleveland Clinic. Lynn, Tony, thanks so much for joining us on Butts & Guts.

Dr. Anthony DeRoss: Thanks so much.

Dr. Lynn Woo: Thank you so much for having us.

Dr. Scott Steele: Fantastic. So Lynn, we'll start with you first. So tell us a little bit about where you're from, where'd you train, and how did it come to the point that you're here at the Cleveland Clinic?

Dr. Lynn Woo: Perfect. Thank you, Dr. Steele. So I am a Pediatric Urologist, and I have the pleasure of saying I trained at the Cleveland Clinic. I did six years of urology residency and then went down to Vanderbilt where I completed a two-year fellowship. And I did not see that I would come back to Cleveland, but as fate has it, I returned. I was at Rainbow Babies for the last decade and recently have rejoined my alma mater to be a Pediatric Urologist here at the Clinic. So I'm really thrilled to be working with old friends and teachers and excited to promote the new things that we're offering.

Dr. Scott Steele: And Tony, I know you've been on before, and so tell us a little bit about yourself for the listeners who haven't listened to the back episodes.

Dr. Anthony DeRoss: Thanks so much. It's nice to be back. I've been at the Cleveland Clinic for going on 11 years now, and I've been a part of the section of Pediatric Surgery since then, and I'm very excited to be a part of this new center that we've put together.

Dr. Scott Steele: Today, we're going to talk a little bit about pediatric and pelvic surgery here at the Cleveland Clinic. To start, Lynn, can you share a little more about the new Pediatric Colorectal and Pelvic Center?

Dr. Lynn Woo: Yeah, thank you. We're very excited. This is a multidisciplinary clinic where several providers from different specialties get together and help patients with colorectal and pelvic disorders. It can be very complicated, and all of them need to go to many different doctors, seek a lot of different treatment. So the goal of this is to sort of bring us all together, which we think improves things for patients, the providers, makes things hopefully easier for families in trying to streamline the care for their child; understanding that these can be very overwhelming situations for anyone.

Dr. Scott Steele: So Tony, can you kind of expand on that a little bit more? So what type of treatments are available at the Care Center?

Dr. Anthony DeRoss: So, we care for patients with complex urologic, gastrointestinal, and colorectal problems. And those can include patients with anorectal malformations, patients with Hirschsprung's disease, patients with complications of neurogenic bowel and bladder. And we see those patients together. We've actually been seeing these patients separately and collaborating in a less structured basis previously.

What this center does is allows the different subspecialties, representatives from pediatric colorectal surgery, pediatric neurology, and pediatric gastroenterology to get together and in real-time see the patient, examine the patient, speak with the parents, develop a plan for that patient to really optimize their care. And that care can include additional diagnostic tests, additional procedures or surgeries that they may or may not have had previously, and different treatment regimens; whether that's a referral to occupational therapy for pelvic floor therapy if patients are having difficulty with perhaps chronic constipation or if it's a referral for different bowel management from a medical standpoint that we will develop within our center with advice and expertise from pediatric gastroenterology and surgery together. So it's all those different things and it's whatever the patient needs if they have these chronic, complex pediatric colorectal or urologic conditions.

Dr. Scott Steele: Well, that sounds very exciting. So Lynn, when would a parent reach out to this Pediatric Colorectal and Pelvic Surgery Center? Is it only when their child needs surgery? I just heard Tony say that sometimes you've got some issues like constipation that may need surgery in certain very specific instances, but when would they reach out?

Dr. Lynn Woo: Yeah, that's a great question. I think it's definitely, we don't want to limit to, "Does my child need surgery?" I think that having it in the title might be misleading, but I do think one of the things our patients will have in common is they do have a more complex underlying issue that potentially involves major abnormalities in rectum and/or bladder.

And so, I would say if you have a child with a condition that you know is affecting both their bowel and bladder function, then this may be a clinic to start with. And we generally begin by reviewing all of the medical data that's available to us and work to get those outside records. If your child was born with a condition that affects their pelvic, rectal, or genital region, whether or not you've been seen elsewhere, we are happy to review all of that data. And if you're looking for someone who's been managed elsewhere but you'd like additional evaluation or want to find care closer to home, then I think that this is something we are able to provide.

Dr. Scott Steele: So Tony, being a parent myself, what are some signs that a parent can look out for when it comes to GI conditions? When is it past the run-of-the-mill stomach ache?

Dr. Anthony DeRoss: So that can be a tough question to answer. Kids have abdominal pain frequently and usually, fortunately it's usually gastroenteritis or constipation or something that is really self-limited. But if mild symptoms persist, then it's probably worth a trip at least to the pediatrician. Certainly, if children are having persistent or recurrent episodic abdominal pain, if the pain is really increasing in severity or symptoms are increasing, or if it's accompanied by symptoms like fever, dehydration, weight loss, blood in vomit or stool, then probably those patients should seek a more timely evaluation in an urgent care center or emergency department. Now the PCPC Clinic that we're doing is not really for acute issues, but it's in helping patients manage the chronic conditions that we spoke about earlier.

Dr. Scott Steele: So Lynn, turning the same kind of question back to you, from a neurological perspective, what are some common symptoms that may indicate maybe a more serious condition in a child that they should reach out to the PCPC?

Dr. Lynn Woo: Great. I will echo Tony DeRoss. There are a lot of urologic symptoms that many children will exhibit that aren't indicative of something serious. However, things that might raise the suspicion of a provider or a pediatrician seeing your child that would cause them to refer or suggest this clinic would be a child who really isn't able to have good control of both the bowel and bladder beyond the age at which you typically expect potty training, so ages five, six. Kids that are having recurrent serious urinary tract infections that are making them ill or require hospitalization. Children that are unable to empty their bladder in a typical fashion. All of those could be warning signs that there is potentially something more serious going on here. And one of the common themes here is that the nerves that go to both the bowel and the bladder are very closely related. So many children that suffer from either a gastrointestinal issue or a bladder issue may have problems with the other.

Dr. Scott Steele: So, truth or myth, truth or myth, Tony, colorectal and pelvic surgery on a child is pretty much the same as it is on an adult.

Dr. Anthony DeRoss: I would say myth, Scott. There are so many differences between kids and adults. First, size, age, weight can influence the diagnostic testing that we do for different conditions. It can influence the operative approaches, and also the time for recovery. In addition, especially with respect to surgery, pediatric anesthesiologists who we work with very closely address specific aspects of care for kids that make it safe, where that may not be the same approach that you would use in an adult patient.

Dr. Scott Steele: So, Lynn, in situations where a child needs either colorectal or other pelvic surgery, what's the best way that a parent can advocate for their child?

Dr. Lynn Woo: The best way is to speak up, and we're all going to be on the same team. And that's one of the things that we emphasize to families when we first meet them. We introduce ourselves, we talk about the understanding we have of their child's current medical conditions. And then, we very specifically ask the family to tell us what goals do they have or what do they hope to achieve with our visits. And I think that's very helpful.

But if they feel that there's uncertainty or doubt with what's being presented or they're worried or scared, letting us know is the first step. And to echo Tony, our team is uniquely poised to care for the youngest patients. And not only do the children differ anatomically and medically, just the emotions and the potential trauma of talking about examining, operating on some of the most sensitive body parts can make it very difficult for children. And I think we're exquisitely sensitive to that. And I think we're all... I heard you say you're a parent, Tony's a parent, as am I. And so, I think we're all very empathetic, just trying to put ourselves in the place of that parent who has likely been working through a lot of difficult testing and information and evaluation with their child.

Dr. Anthony DeRoss: Scott, I'll just add in there real quick if I could. Lynn, I totally agree with all of what you said. There may be some listeners who find themselves outside of the Cleveland area. We're proud that this is, we think, the first center of its kind in Northern Ohio. But if patients are listening to this broadcast from afar, they might wonder if there's a similar center where they can get care closer to home if they don't want to make the trip to Cleveland. Certainly they're welcome to, but if they need to see someone closer, they can ask their pediatrician for a referral. They may have some resources. Certainly the internet, social media can help find a center to address their needs. But again, we always want to encourage patients to find information, but really exercise caution when using the internet, making sure that they're getting their information from a verified source, like a trusted website from a healthcare system, the CDC, or the local Department of Health. And then, really friends and family can be valuable sources to help parents advocate for their patients and find centers where they can seek care as well.

Dr. Scott Steele: So, Lynn, we'll start with you, two questions for each of you. The two questions are, number one, are there any advancements on the horizon as it comes to the pediatric colorectal and pelvic surgery? And then, what do you find the benefits of working in a multidisciplinary team are?

Dr. Lynn Woo: So, I will say some of the advancements we are very excited about is just the increased usage of minimally invasive features, surgical. So again, I'm not saying that everyone is going to require surgery; however, if it's needed, our team really is going to try to do this in a way that can promote the least negative impact on the child. And in many cases, trying to make that surgery a more minimally invasive approach is great.

The second other thing is that we're partnering very closely with non-surgical partners like the gastroenterology team, nutrition, and PT, Physical Therapy and Occupational Therapy, which I think is more holistic. And we are working to provide exercises, pelvic floor training, biofeedback to try to manage things not necessarily in a surgical way.

And then, the benefit of the multidisciplinary team is this is a group of providers who are experts in their own field, but then get a chance to come together to discuss things again in real time. It allows us to speak about our specific concerns and also understand how our disorder can be affected by a different specialty. And so, I've found this incredibly helpful. It's great to work with other experts. It's truly an honor, and knowing that we're all on the same page at the end of the day for that child in recommending the course of treatment.

Dr. Scott Steele: Tony?

Dr. Anthony DeRoss: Yeah, I'll echo everything Lynn said. The minimally invasive approaches are always improving. We have new technology that we just equipped all of our pediatric operating rooms with just in the last several months. So we're really on the cutting edge in terms of what we can offer to our patients in terms of the actual physical technology. We use enhanced recovery pathways to help limit the time that patients have to stay in the hospital after surgery, and it helps to decrease the use of opioids as much as possible for patients as they recover from any surgical procedures.

And there's always research that's studying the causes of potential preventions and treatments for childhood colorectal and pelvic conditions. For example, Hirschsprung's disease is one of the conditions that we see in some of our patients. And we realize that even when surgeries are done perfectly in these patients, that sometimes they still have difficulty with constipation and bowel management. And so, we help patients with those conditions, but there's ongoing research to look for holes in our understanding about what causes those disorders so that we can treat our patients better all the time.

Dr. Lynn Woo: If I could just add one more bit, I'd say that the goal of this clinic is not to replace providers that children have been seeing and that the families know and trust; it's to provide an additional resource for these families. Since many of these issues are chronic, we would offer regular visits kind of to put all of the children's clinical care together and assess that on a regular basis. But parents don't have to feel that they're somehow having to make a choice between a previous surgeon or a previous provider who they know and trust.

Dr. Scott Steele: Fantastic. And so, now it's time for our quick hitters, a chance to get to know our guests just a little bit better. And we'll go each of these four questions to each of you. And we'll start Lynn, then Tony. So first of all, salt or sweet?

Dr. Lynn Woo: Salt.

Dr. Anthony DeRoss: Salt.

Dr. Scott Steele: What was your first car?

Dr. Lynn Woo: Toyota Cressida. I don't even think they make them anymore.

Dr. Anthony DeRoss: I had a Chevette.

Dr. Scott Steele: Fantastic. Tell me about your next bucket list trip that you want to go on.

Dr. Lynn Woo: Bucket list trip. I was trying to get to China this last year and it just fell through. It was a difficulty with visa, so I think it's still on my bucket list.

Dr. Anthony DeRoss: I'm a huge Beatles fan, so I really need to get to the UK and do a Beatles tour, and also a little bit of travel in Scotland to see the Highlands and maybe find an interesting distillery.

Dr. Scott Steele: Fantastic. And finally, when you were back in high school, what did you think you were going to be when you grew up?

Dr. Lynn Woo: Oh, wow. What did I think? I think I wanted to be an artist. I thought that would be the coolest thing. I would like to draw pictures for a living.

Dr. Anthony DeRoss: I wanted to be a doctor. I didn't know that I'd be a surgeon. But I did this veterinary science class when I was in seventh grade, and we got to operate on rats and take out certain organs and then suture them together and then watch them as they recovered. And I thought it was the most amazing thing. So I guess I always had an interest in surgery but didn't know that I'd end up certainly as a pediatric surgeon.

Dr. Scott Steele: That's fantastic. And so, to both of you, we'll start with you, Tony so Lynn can have the last word. What is the final take-home message for our listeners about the Pediatric Colorectal and Pelvic Center?

Dr. Anthony DeRoss: So, I think one of the benefits to patients is really it's one-stop shopping. As Lynn said, you're still going to be able to, and we encourage you to follow with your providers that you've had in the past, but it's one-stop shopping where you can get an evaluation from all different specialties: pediatric surgery, urology, gastroenterology, and come up with a recommendation for a comprehensive plan. There's real-time discussion between providers about the optimal management for patients with complex conditions that we spoke of and standardized treatment protocols from which patients can benefit

Dr. Scott Steele: Lynn?

Dr. Lynn Woo: I totally agree, 100%. And again, this is really the only center of its kind up here in Northeast Ohio. And so, we're very excited to be able to provide this to the families and patients of Cleveland and surrounding areas.

Dr. Scott Steele: Well, that's fantastic. And so, to schedule an appointment at the Cleveland Clinic Pediatric Colorectal and Pelvic Center, please call 216.445.7878. That's 216.445.7878. And please use option two, that's option two. Dr. Woo, Dr. DeDross, thanks so much for joining us on Butts & Guts.

Dr. Lynn Woo: Thank you so much.

Dr. Anthony DeRoss: Thanks, Dr. Steele. It was great.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts & Guts.