Maggie McKay (Host): Welcome to Conversations Like No Other, presented by Valley Health System in Paramus, New Jersey. Our podcast goes beyond broad everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. Thanks for listening. I'm your host, Maggie McKay.

Today, we have with us Dr. Eric Lazar, pediatric general surgeon and Chair of Surgery at Valley Medical Group, to discuss pediatric surgery. Thank you so much for being here today, Dr. Lazar.

Dr. Eric Lazar: Hey, thanks for having me.

Host: Let's just start with: What is a misconception you frequently hear from parents about pediatric surgeries?

Dr. Eric Lazar: Where do I start with that? One is that some parents and some pediatricians even are under the impression that some children are too young to have surgery, that they should wait until they're a certain age to have surgery. And the fact is that an operation that is needed to alleviate suffering or to prevent suffering in the future is the right time to do that operation. So, we operate on children that are one-hour-old if necessary, And we operate on newborn babies who've been home for a week or a month or all the way up through, of course, getting ready to leave college. So, you're really not too young to have surgery that you need. And in fact, some surgeries are even done in utero before a baby is born.

So, I think that the important point to get across is that just like adults, the right time to have surgery is when you need it. And you certainly don't need to have surgery that you don't need. But when you need it, it's not right to say, "Well, he is only a month old, we should wait." When the time is right, it's the time.

Host: I can't believe that one-hour-old. But like you said, also in vitro. So, it's got to be worrisome for parents to have their child operated on. So, what are parents most concerned about when it comes to surgery and how do you provide reassurance to them?

Dr. Eric Lazar: Most parents ask us not about the surgery. I think that when their child is suffering in some way, or there's something obviously wrong, like they can't eat because they're missing a piece of their intestine or rest of their GI tract, they understand that pretty innately, and don't have too much concern about the surgery per se, but most people have questions about the anesthesia. Is it safe for my child to have anesthesia? Will anesthesia be used? And so, many of the questions revolve around the question of anesthesia. And the fact is just like surgery, if we've determined that surgery is needed and necessary, then it is appropriate to go ahead with the next step, which is anesthesia. Anesthesia does have some risks in children just like it does in adults. But if the surgery is needed, and you can't do the surgery without anesthesia, then the anesthesia also becomes within the risk-benefit analysis of offering the surgery to begin with.

Host: Do kids really "bounce back" better? Or do we just say that to make adults feel better? And what is recovery truly like for a pediatric patient and their family?

Dr. Eric Lazar: Well, that is a great question. And it's one of my favorites, because I sort of do believe they do bounce back faster, but for different reasons. And the fact is that the definition of recovery is getting back to your normal routine and doing what you do normally. So for let's say a baby that's crying, eating and pooping and sleeping, they recover pretty quickly because they're not expected to climb stairs or to go to work in a day or two or lift heavy farm equipment or anything like that. So, the fact is that a baby does recover pretty quickly, because getting back to normal is pretty fast.

I think that the other thing that I've learned about children and younger children in the school age range is that I think that we teach disability. And I think that if our expectation is that we're not worried, they can do whatever they would feel like doing. If they don't want to do something, If they're afraid, that might be a sign that they're in pain or they're not sure of themselves yet. But if they are ready and they are willing, then that means their body is ready, and we can listen to them a little bit better. Adults have too many other ulterior motives, you know, to not work sometimes or to get back to work, because it's really important.

Adults don't listen to their bodies very well, but kids do. And so, if a kid feels okay to go out and throw a ball or jump on a trampoline, I think that we should allow that and we should take their lead and not. Suppress their activity by saying, "Oh, you just had surgery. Oh my gosh, you must be in pain. You must need to take it easy." That's not really true. When they're ready, they show us. And one of the best ways that we know they're back to normal is they're playing, even if we had instructions in place not to let them play. That's actually how I learned as a clinician to not be so restrictive with activities after surgery is just by watching children. They don't care what our instructions are. They start playing when they're ready. And so, that's my instructions to parents. Let your kid take the lead on this. Let them do what they would do. Don't restrict them. They're going to be safe. They're not going to hurt themselves and do something that they aren't ready to do. But when they're ready, don't hold them back.

Host: Right. That makes a lot of sense. You touched on anesthesia a little bit. What's the biggest misconception about pediatric anesthesia?

Dr. Eric Lazar: I think that many patients these days, and many parents, have read a lot in the press about is anesthesia safe for children, and what about narcotics and narcotic addiction? And people actually arrive at the hospital prepared to tell us what they're allowing the anesthesiologist to do or not do.

But I think that the truth about anesthesia is that the pediatric anesthesiologists that we have on staff and that practice at the Valley Hospital are extremely good at giving your child exactly what they need to make them comfortable and to not feel pain and to allow us to do the surgery, but not overdoing it. And not making it so that you have to worry about drugs and drug addiction.

And having been exposed to fentanyl, fentanyl outside the hospital has a terrible reputation on the street, but it's not supposed to have been a street drug. In the hospital, fentanyl is a perfectly good medication that we need to put children to sleep and keep them asleep while we're operating. So, I know it's hard to do this in this day and age, to put the genie back in the bottle to get people less aggressive about sharing their opinions, but I think this is one of those areas where we should turn over our trust to the anesthesiologists. They're really good. They're dedicated. They take their job very seriously. They take your child's safety very seriously as we do in addition. And so, let them do their job because they're really good at making the child feel comfortable and safe.

Host: Is a pediatric surgery ever just a minor surgery?

Dr. Eric Lazar: I know that phrase sometimes occurs, but I think of nothing as minor when it involves your child. I watched my own first daughter, who's now a doctor herself. And in her 30s, I almost passed out when she got her first shots, because it was so dramatic for me. And what that taught me was there is nothing that's small.

 And if you think about it, none of us likes to go to the dentist to have tooth work done, even though it's relatively speaking small. I think that anxiety and fear are not proportional always to what the event is that's happening. And that's important to appreciate that it may not be a big deal at the end of the day, this particular surgery or that particular surgery. But the anxiety and the fear that can accompany it can be just as big even if it were a heart transplant.

So, I think it's really important to appreciate that there is no small surgery in the head of people and family members who are undergoing surgery. I try to never minimize it. I like to minimize it in order for people to understand that it's safe and that it's necessary and there's going to be a good outcome. But I also hate to minimize it because I don't want to step on someone's fears or anxieties that are impossible to assuage unless you acknowledge them, and acknowledging them is listening to them.

Host: Is operating on smaller patients more challenging than larger patients?

Dr. Eric Lazar: I think that millimeters matter in a small child. We wear sometimes special glasses that help magnify things. We are very slow and deliberate in our movements. But in some ways, children are a little easier to operate on than adults. Many adults, especially in our country, have packed on a few pounds since childhood and getting in and out of some patients to do the job that you need to do can be very much affected by size.

And so, in some ways, children are easier. Children have in some ways fewer complications because their body systems aren't as prone to some of the complications you see in adults. So, for example, everyone is concerned about deep venous thrombosis and pulmonary embolus in adults. Not such a big deal in most kids, for example. And so we don't have to put most of our patients on blood thinners, for example. Most of our patients have healthy hearts, so we're not worried about a heart attack or something occurring in the surgery or immediately post-op. So, in some ways, children are easier. But of course, it's all in the training. It's what you've trained to do. It's all about being prepared and planning in advance. I can't emphasize that enough. There's a lot of planning that goes into an operation that takes place well before the operating room. And in that regard with children, we're very careful and very meticulous.

Host: What's a more notable difference between pediatric surgery versus adult surgery?

Dr. Eric Lazar: I think that it's probably most important to realize that when you're operating on a child, you're operating on a whole family. There are parents, there are grandparents, there are siblings. I often think about the impact of my operation on a patient, on their sibling, right? They see their four-year-old sister having surgery, that's got to be scary for them too. So, I know that happens in adults as well, that when you operate on a mother, their grown children are concerned and their family members are concerned. But it does reach a special height when it comes to operating on a child with the number of other people that you're really taking care of at the same time.

And it's important to acknowledge that and remember that I often tell parents that I am their child's doctor, not their doctor, not grandma and grandpa's doctor. But the reality is I am doing surgery on a lot of people at once. Because everyone has to know, everyone wants an explanation, everyone wants to understand at their own level. And that requires some patience.

I think also that, in children, children are very resilient. They are very quick to heal, we talked about that. But children can sometimes be slow to trust. And so, you have to earn their trust. And I think the most serious tool that we use is not the scalpel, but it's just patience. Taking the time to make sure the child understands, if they can have the capacity to understand what's going on, to make sure they understand. If they don't have that capacity, that's okay too, then the effort has to go into earning their trust and making them feel safe.

Host: That's a very good point. Dr. Lazar, what's the most common pediatric surgery that you perform?

Dr. Eric Lazar: There's two answers to that. There's the emergency setting, and that by far would be appendicitis. I can't believe there are any appendixes left in Bergen County. It seems like every time that we Have to look at our OR schedule, there's somebody having their appendix removed. And that would be the most common emergency.

So, parents are at home with their child and the kid came home from school not feeling well, didn't eat dinner. And usually around about nine o'clock or so, they've localized the pain to their lower abdomen and there's a trip to the ER. And we do that several times a week, if not several times a day in some cases.

The most common operation, I think, on most other children that's more elective is a hernia. Children that have wholes in the lining of their abdomen at the level of the belly button and at the groins. And that's where hernias occur. And hernias are fixed because if something gets stuck in that hole, and can't be pushed back in, that becomes a serious emergency. And so, we fix them when we find them. And when your pediatrician sees a bulge here or there, and refers you to us, that's the reason that we want to fix it electively rather than having to deal with it as an emergency.

Host: What would you say to anxious parents trying to make the best decision for their child?

Dr. Eric Lazar: You know, I sort of alluded to this before. And I know that it's hard to do, but I do think that if they understood the degree of training and care and love that we have, just to trust us a little more. We are not recommending surgery for any other reason than it's the best for your child. And a lot of people say to me, "What would you do for your child?" And that's such an unfair question, not because I would recommend something different for your child than mine, but because my comfort level with surgery is so different than the average parents. I know that I wouldn't be recommending surgery or performing surgery without it being necessary, and that the outcome is going to be good. And we're going to accomplish our goal and we're going to make your child better or keep them from having a problem where one could develop.

And so, I feel very reassured about the process, but most parents can't share that reassurance, because they don't have that background and experience. And so, sometimes I really just want to say, trust us. We care for your child as much as we do for our own. We are careful. We want this to work out well, and we're going to make it happen. And again, we're generally only recommending surgeries that need to be done. There's very little in the way of truly elective surgery in children; where, by elective, I mean not only just not emergent, but truly you could live with it or without it, it's not a big deal. If it's really that ambiguous, then I don't recommend surgery. I only recommend surgery when I know that it's going to make a difference for that person's immediate or near future.

Host: Well, Dr. Lazar, what a pleasure it's been talking to you and learning some very useful information that's not only reassuring, but encouraging. And I just love that your daughter is also a doctor, following in your footsteps. That's so cool. Thank you so much for sharing your expertise and giving us all this useful information.

Dr. Eric Lazar: It is great being here. Thanks so much for listening.

Host: Of course. Again, that's Dr. Eric Lazar. For more information about pediatric surgery at Valley, please visit valleyhealth.com/pediatricsurgery. Thanks for listening to Conversations Like No Other, presented by Valley Health System in Paramus, New Jersey. For more information on today's topic or to be connected with today's guest, please call 201-689-3727 or email valleypodcast@valleyhealth.com.