March 26, 2025 • 15 mins
From the swimming pool to the operating room, Dr. Ryan Reidy's journey exemplifies how elite athletic discipline transforms into surgical excellence. As a former Division I swimmer at Eastern Illinois University who now serves as a cardiothoracic surgeon at St. Luke's Hospital, Dr. Reidy reveals why surgical program directors actively seek athletes for their residency programs.
The parallels between competitive athletics and surgical mastery become evident as Dr. Reidy describes his training at the renowned Texas Heart Institute within the massive Texas Medical Center complex. This medical metropolis, housing approximately 40 hospitals including world-class institutions like MD Anderson Cancer Center, provided unparalleled surgical volume and experience. "Reps really matter," Dr. Reidy emphasizes, explaining why busy surgeons typically deliver superior outcomes through both experience and validated trust from referring physicians.
Dr. Reidy offers fascinating insights into modern cardiothoracic surgical approaches, particularly his preference for minimally invasive thoracic techniques that speed recovery without compromising cancer outcomes. He shares his philosophy on esophageal cancer surgery, balancing technical considerations with patient safety through meticulous visualization. Beyond the operating room, he discusses how mountain biking and disconnecting from constant communication help maintain the mental clarity needed for surgical precision. Whether you're curious about surgical careers, interested in medical technology advancements, or simply appreciate stories of human excellence, this conversation delivers compelling perspectives from the cutting edge of cardiothoracic surgery.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Doc Discussions.
I'm Dr Jason Edwards and thisis the world's best medical
podcast where we havediscussions with physicians to
discover who they are and whatthey do.
I'm joined today by Dr RyanReedy, a cardiothoracic surgeon.
Welcome, ryan, thanks.
Speaker 2 (00:13):
Jason, thanks for having me.
Speaker 1 (00:15):
You bet.
Now, ryan, you're a hometownboy here, right?
Are you from the St Louis area,is that right?
Speaker 2 (00:20):
Yeah, that's correct.
So I was raised in St Charlesarea and then came back here
after training and been backhere for about six years now at
St Luke's.
Speaker 1 (00:31):
And from our discussions previously I've
learned that you were actually aswimmer at the collegiate level
.
Is that right?
Speaker 2 (00:37):
I was.
Yeah, I swam at the Division Ilevel in college.
Where'd you go?
Eastern Illinois.
Speaker 1 (00:42):
Eastern Illinois.
Okay, eiu, that's correct, yep.
And so um what's their mascot?
Speaker 2 (00:48):
Uh, Panthers, the Panthers home of Tony, Tony Romo
.
Speaker 1 (00:51):
Okay, uh, northern Iowa is also the Panthers home
of Kurt Warner.
I so anyway, not that thatmatters, but uh, so very cool,
and so, uh, you must've been avery accomplished high school
swimmer as well.
Speaker 2 (01:04):
Uh, yeah, correct, yeah, it's you must have been a
very accomplished high schoolswimmer as well.
Speaker 1 (01:06):
Yeah, correct, yeah, you can brag about yourself,
it's okay.
Speaker 2 (01:09):
Probably not as good of an athlete as you were as a
runner, I don't know about that.
Speaker 1 (01:12):
But no, very cool, and I think you know a lot of
cool things that you learn andyou know competing at that level
and then also just like adifferent mentality, oh, there's
no doubt about it.
Speaker 2 (01:27):
I mean, competing at that level allows you to just be
better with your timemanagement.
You clearly see that thosepeople who compete at a high
level have better dedication andability to manage difficult
schedules, difficult cases,things like that.
Speaker 1 (01:47):
Yeah, there's no doubt about it You've been
nervous before.
Speaker 2 (01:49):
You've been in stress before.
Speaker 1 (01:51):
Yeah, it's not a new thing, correct.
The chair of surgery where Idid my training said he always
loved having D1 athletes assurgical residents.
Speaker 2 (02:00):
Right.
Once you kind of get into ityou understand why you figure it
out pretty quick.
Yeah, I think when I was intraining at Texas Heart I never
heard anyone say that, but thatwas always kind of the rumor
that they wanted theypreferentially took athletes
there, yeah, and so, and so,where did you do your, your
residency, and was it a combinedresidency and fellowship, or
(02:21):
was it just a residency?
No, that's more of a new thing.
When I went through, it wasmore classic to do general
surgery first and then do acardiothoracic fellowship after
that.
So I was in Pittsburgh atUniversity of Pittsburgh Mercy
Hospital and then I went to theTexas Heart Institute, which is
associated with Baylor inHouston, after that.
Speaker 1 (02:42):
And that's where the world famousfamous Dr DeBakey
was.
Speaker 2 (02:45):
Yeah, so that was yeah actually.
So the program is mergedbetween Texas Heart, which is at
St Luke's Hospital in Houston,and Baylor, which used to be at
the Methodist Hospital, andCooley's Hospital was at the
Texas Heart Institute andDeBakey was Methodist, yeah.
Speaker 1 (03:06):
And that's all part of the Texas Medical Center,
which is like 40 hospitals orsomething crazy.
Speaker 2 (03:11):
Oh, yeah, yeah, it's huge.
Speaker 1 (03:12):
It's huge.
Speaker 2 (03:13):
I mean it's probably bigger than like downtown St
Louis.
In total size it's huge.
Speaker 1 (03:19):
Yeah, and I would imagine that's one of the best
places to train forcardiothoracic surgery.
I'm sure there's other goodplaces.
Speaker 2 (03:25):
Sure, there's a lot of great places out there, but
it's definitely one of them.
Yeah, because just our trainingprogram was combined with Texas
Children's World's LargestChildren's Hospital.
They either do the most or thesecond most like congenital
heart surgery.
Md Anderson's, where we do ourthoracic, world's biggest cancer
Institute yeah, um, the mostheart surgery, and one area in
(03:49):
in the United States has done itwithin the uh medical center,
texas medical center.
Um, so you know a singleinstitution.
I think Cleveland clinic doesmore, but as total you know the
whole medical center.
I mean it's the most heartsurgery done in the country.
Speaker 1 (04:03):
So yeah, it's huge yeah.
Speaker 2 (04:05):
So tons of opportunity.
Speaker 1 (04:07):
I'm a big believer, whether it's a uh, you're
practicing a football play or uh, or swimming or doing surgery,
that reps really matter.
Speaker 2 (04:15):
And so if you're busy , yeah, there's no practice you
have to be busy, otherwise, um,you can't be legitimate.
Yeah.
Speaker 1 (04:26):
And and so, and actually, Jeremy, when he on
Jeremy Leidenfrost, when he wason, he was saying that you do
more lung surgeries than heartsurgeries, but you're still a
high volume heart surgeon.
You know, consider a highvolume heart surgeon, oh yeah,
yeah, Just because you do somany cases here.
Yeah, my heart surgeon.
Speaker 2 (04:41):
Yeah, yeah.
I mean, if you look at my totalvolume, I'm our busiest surgeon
within our group by a long shot, but it, like my total cardiac
volume would be, you know,probably in the 90th percentile,
and then my thoracic volume,something like that in the 90th
percentile.
Usually people just do one ofthe two.
Speaker 1 (05:01):
Yeah, and so if you're a patient, I think you
want to go to a doctor who'sbusy, because it means two
things it means they've done ita lot, but it also means that
other doctors have referred alot of patients to that person,
which is always a good sign.
Same with tattoo artists.
You don't want your tattooartist to be like the first day.
You know.
You want like somebody withexperience.
Speaker 2 (05:23):
I like being compared to a tattoo artist.
But yeah, there's no doubtabout it.
Um, you can definitely um seethat if, if someone's very high
volume, like you just said thatsomeone trusts them either prior
patients or or their physicianstypically for us, you're not
going to have people referringto you If you have not provided
(05:44):
good quality product referringto you, if you have not provided
good quality product in return.
So you lose those referrals.
Speaker 1 (05:50):
And that's a function of the surgeon and also the
surrounding staff, the OR nurses, the post-operative care, it's
a whole team.
Speaker 2 (05:56):
There's no doubt about it.
Speaker 1 (05:57):
Yeah, yeah, and so do you still swim.
I'm going to go back to theswimming.
Do you still swim some?
Speaker 2 (06:02):
Not very frequent, but I started.
Yeah, so I started moremountain biking recently.
Yeah, yeah, I used to be reallyinto like cycling, but I've
gotten away from all thesethings, but I started getting
back into it again, yeah.
Speaker 1 (06:16):
And your wife's a physician and you have two kids,
so you've got plenty of freetime.
Speaker 2 (06:20):
So it makes it easy, it makes it super easy.
Speaker 1 (06:23):
But I think swimming and biking can be very
therapeutic.
Speaker 2 (06:35):
Obviously it's good cardiovascular exercise, but
it's really good for the mindtoo, I think.
Oh yeah, it's a great thing tojust get away and give yourself
a break and spend an hour outdoing whatever.
It is some kind of activity, soyou can relax from your day at
work, from the stress at home.
Speaker 1 (06:45):
Any type of break you get from that kind of stuff is
good and every time I've I've uh, felt fatigued and worked out,
it's actually been a positivething, like even though you're
tired, you go work out and ityeah, it's weird, but I think
that's.
Speaker 2 (06:59):
I think you're correct on that.
Speaker 1 (07:00):
Yeah, um the um I, I broke my leg.
Uh, actually I had a stressfracture in my leg several times
in my training, so not a cleancompound fracture, but I had to
swim and you know I swam as akid but the one thing I remember
is it was you know, you don'thear a lot and so it's very
(07:21):
isolating, which is kind of good.
I mean, it kind of leaves youwith your own thoughts, maybe a
little bit more than running orbiking.
Speaker 2 (07:29):
Right, and, as you know, as a physician, just like
getting away from your cellphone is a great thing sometimes
, yeah, like if people can reachyou.
You're being called all thetime, so just doing something
where you get away from thephone is nice.
Speaker 1 (07:39):
Yeah, as somebody's texting you right now, right
Right Two of them already, justwhile sitting here.
Speaker 2 (07:45):
Yeah, yeah, so it's it is good, I mean, if you can
get away from the cell phone andtake a break, it's nice.
Speaker 1 (07:50):
Yeah, it's good to be needed, it's good to be useful,
it's good to be helpful, but atthe same time you have to have
your sanity, some boundariesRight, and it's not a good long
term plan to be alwaysaccessible all the time, no
doubt.
But in general, to be helpful,you got to be there for people,
correct, um and so uh, and yourwife's a physician, she's an
(08:10):
anesthesiologist, is that?
Speaker 2 (08:11):
right, she's an anesthesiologist.
She's at Wash U.
She's does cardiac anesthesia.
Speaker 1 (08:16):
And did you guys meet in medical school?
Speaker 2 (08:18):
Medical school Yep.
Speaker 1 (08:35):
And so, and she's kind of, uh, she's kept you in
line these years, right,straight and narrow, right,
right, of course, and so, um, novery cool Um, and so, um, no
very cool um, and so are thereum.
I know, in medicine in generalthere's a lot of changes.
Are there any um newtechnologies or new surgeries or
new techniques that are beingused?
Um in the field ofcardiothoracic surgery?
Speaker 2 (08:45):
there are, but but right now there's not a lot.
That's like total.
You know where I would considerlike revolutionizing this
especially.
I mean there are certain thingslike minimally invasive surgery
, that's picking up roboticcardiac surgery that you know
some people have interest in.
But at least with roboticcardiac surgery it's tough to
(09:10):
build those practices, yeah, andthe outcomes have not been
great.
So it's hard to adapt when yousee that the outcomes haven't
been great across the board.
Speaker 1 (09:22):
What about thoracic?
Do you do minimally invasivethoracic surgeries?
Everything I do is minimallyinvasive.
Is that right?
Speaker 2 (09:27):
I mean, unless it's just something that's too big,
too large of a tumor that youcan't take out through like a
small incision, but otherwiseeverything I do is uh
thoracoscopic, or you know, andsmall port surgery.
Speaker 1 (09:40):
When did that change over from like the open
surgeries to, oh, that's beenmore than 20 years, 25, god,
even more than that.
Speaker 2 (09:48):
Um, you know, like in the 90s or so, when yeah was
pretty popular, people werestarting to do like
thoracoscopic lung resectionsand stuff.
And if you say, though, likepopular, like when it was like
or when it became predominantActually pretty recent, I mean
(10:09):
until just recently, a goodportion of all the lung
resections in the country werestill done by general surgeons.
So general surgeons weren'tgoing to be doing these
minimally invasive, they'regoing to be doing them open.
Speaker 1 (10:21):
It's just too technical.
Speaker 2 (10:23):
Yeah, because they're used to operating in the belly
and that's shifting and nowpeople are doing more like VATs
and robotic lung resections.
Speaker 1 (10:33):
VATs is video-assisted.
Speaker 2 (10:34):
Video-assisted.
Yeah, very similar to likelaparoscopic on the belly or
arthroscopic on the knee and thechest is just thoracoscopic.
So it's more common now thatalmost all providers are going
to offer some minimally invasiveoption.
We do, you know, close to like100% minimally invasive
(10:54):
Obviously, the huge tumors, youcan't do that way, but we're
trying to do almost everythingminimally invasive quicker
recovery, less pain, things likethat.
Speaker 1 (11:03):
And so there's just some small incisions on the side
.
Yeah, yep.
Speaker 2 (11:08):
And it doesn't sacrifice anything for like
cancer outcomes, it's still ayeah, yeah, yep.
And it doesn't sacrificeanything for like cancer
outcomes, it's still a greatoperation, yeah.
Speaker 1 (11:14):
Yeah, and you and I share plenty of patients with
lung cancer.
And then you also treatpatients who have esophageal
cancer, sometimes in conjunctionwith a general surgeon, because
the lower part of the esophagusis in the abdomen but the upper
part of it is in the thorax,that's correct.
Speaker 2 (11:30):
Yep, yeah, we typically do all those combined
with the general surgeon here.
Speaker 1 (11:34):
And there are two main types of esophageal
surgeries.
As far as like where theanastomosis is, is it like
transthoracic?
Yeah, that's correct.
You're laughing at me nowExplain to me why it's funny.
Speaker 2 (11:51):
It's not funny, uh, but no, there's uh, it just uh.
There's several approaches ofhow you can do an esophagectomy,
because it traverses, like theneck, the chest, the belly, um.
So there's approaches where youcan make a decision on the
belly and the chest, uh, thebelly and the neck, the belly,
chest and neck, um.
So there's just different waysto do it and it really all comes
down to preference.
(12:11):
I mean, there are someadvantages to each technique,
based on, like where tumor isand stuff like that.
But really, at the end of theday, it's just what your
preference is, what you'recomfortable with.
So what's your preference andwhy?
So?
I typically just go through thebelly and also the chest to
incisions, and the reason why isbecause it's a complex
(12:35):
operation.
I think you get great exposure.
That way you get better lymphnode harvest, which is important
in staging cancer.
It's blind if you don't go intothe chest right it's blind and
so like, yeah, you're taking outthe esophagus blindly if you
just go through the belly, so ifyou injure something, that
could be catastrophic.
So it is good to be able to seewhat you're actually operating
(12:57):
on.
Speaker 1 (12:58):
And then one issue can be the anastomosis, which is
the medical term for where theyconnect the two portions of the
esophagus once they resect thetumor, and that matters too
right where the anastomosis isyeah, so, yeah.
Speaker 2 (13:11):
So if you just go through the belly, like you just
said, then it's up in the neck,meaning it has to go a longer,
longer way, and the blood supplyis further away now at that
point, so they just don't healas well if they're up there and
it but and the advantage of thatis, if they have an anastomotic
leak, it doesn't go into thelung.
That's correct.
Yeah, it doesn't leak onto thelung and the chest.
Speaker 1 (13:32):
But fortunately, especially with a good surgeon
like you, you don't see a lot ofanastomotic leaks?
Speaker 2 (13:36):
Yeah, knock on wood.
So far we haven't had a lot ofproblems.
Speaker 1 (13:45):
But yeah, of course, anytime you do high anything
enough, like you know, errorswill occur.
Speaker 2 (13:50):
But if your error rate is low, then that's the
that's good to have good, youknow, low complication rate, but
at the same time, like, if youdo have a complication, if you
can take care of it, almostalways the patient's going to be
okay.
Yeah, that's the importantthing.
Speaker 1 (14:03):
So, if you, so, if you have an error rate of one or
2%.
That's's good, but it's reallygood if you've treated, you know
, a couple thousand patients andyou've dealt with that one or
two percent scenario.
You know more than once Correct, yeah, totally, and that's why
kind of volume is just soimportant.
Absolutely, patients, yep,aside from swimming, what other
(14:25):
things do you do for your health?
Is or swimming and biking it?
Speaker 2 (14:30):
That's it right now.
Speaker 1 (14:31):
Yeah.
Speaker 2 (14:31):
Yeah, as far as like activity, that's it right now.
Yeah.
Speaker 1 (14:40):
I've recently adopted stretching, just taking like 10
minutes before I go to bed, andI felt like that's especially
the muscles around the pelvis.
I feel like that's made me feelyounger, but I don't know.
If I pull some muscle off mybone, then you'll know why.
Well, ryan, it's always goodtalking to you and thank you for
coming on the podcast to shareyour time with us To the
listeners.
Please tune in next week forour next episode of Doc
(15:02):
Discussions.
Thanks so much.
Welcome to Doc Discussions.
I'm Dr Jason Edwards and thisis the world's best medical
podcast where we havediscussions with physicians to
discover who they are and whatthey do.
I'm joined today by Dr RyanReedy, a cardiothoracic surgeon.
Welcome, ryan, thanks.
Speaker 2 (00:13):
Jason, thanks for having me.
Speaker 1 (00:15):
You bet.
Now, ryan, you're a hometownboy here, right?
Are you from the St Louis area,is that right?
Speaker 2 (00:20):
Yeah, that's correct.
So I was raised in St Charlesarea and then came back here
after training and been backhere for about six years now at
St Luke's.
Speaker 1 (00:31):
And from our discussions previously I've
learned that you were actually aswimmer at the collegiate level
.
Is that right?
Speaker 2 (00:37):
I was.
Yeah, I swam at the Division Ilevel in college.
Where'd you go?
Eastern Illinois.
Speaker 1 (00:42):
Eastern Illinois.
Okay, eiu, that's correct, yep.
And so um what's their mascot?
Speaker 2 (00:48):
Uh, Panthers, the Panthers home of Tony, Tony Romo
.
Speaker 1 (00:51):
Okay, uh, northern Iowa is also the Panthers home
of Kurt Warner.
I so anyway, not that thatmatters, but uh, so very cool,
and so, uh, you must've been avery accomplished high school
swimmer as well.
Speaker 2 (01:04):
Uh, yeah, correct, yeah, it's you must have been a
very accomplished high schoolswimmer as well.
Speaker 1 (01:06):
Yeah, correct, yeah, you can brag about yourself,
it's okay.
Speaker 2 (01:09):
Probably not as good of an athlete as you were as a
runner, I don't know about that.
Speaker 1 (01:12):
But no, very cool, and I think you know a lot of
cool things that you learn andyou know competing at that level
and then also just like adifferent mentality, oh, there's
no doubt about it.
Speaker 2 (01:27):
I mean, competing at that level allows you to just be
better with your timemanagement.
You clearly see that thosepeople who compete at a high
level have better dedication andability to manage difficult
schedules, difficult cases,things like that.
Speaker 1 (01:47):
Yeah, there's no doubt about it You've been
nervous before.
Speaker 2 (01:49):
You've been in stress before.
Speaker 1 (01:51):
Yeah, it's not a new thing, correct.
The chair of surgery where Idid my training said he always
loved having D1 athletes assurgical residents.
Speaker 2 (02:00):
Right.
Once you kind of get into ityou understand why you figure it
out pretty quick.
Yeah, I think when I was intraining at Texas Heart I never
heard anyone say that, but thatwas always kind of the rumor
that they wanted theypreferentially took athletes
there, yeah, and so, and so,where did you do your, your
residency, and was it a combinedresidency and fellowship, or
(02:21):
was it just a residency?
No, that's more of a new thing.
When I went through, it wasmore classic to do general
surgery first and then do acardiothoracic fellowship after
that.
So I was in Pittsburgh atUniversity of Pittsburgh Mercy
Hospital and then I went to theTexas Heart Institute, which is
associated with Baylor inHouston, after that.
Speaker 1 (02:42):
And that's where the world famousfamous Dr DeBakey
was.
Speaker 2 (02:45):
Yeah, so that was yeah actually.
So the program is mergedbetween Texas Heart, which is at
St Luke's Hospital in Houston,and Baylor, which used to be at
the Methodist Hospital, andCooley's Hospital was at the
Texas Heart Institute andDeBakey was Methodist, yeah.
Speaker 1 (03:06):
And that's all part of the Texas Medical Center,
which is like 40 hospitals orsomething crazy.
Speaker 2 (03:11):
Oh, yeah, yeah, it's huge.
Speaker 1 (03:12):
It's huge.
Speaker 2 (03:13):
I mean it's probably bigger than like downtown St
Louis.
In total size it's huge.
Speaker 1 (03:19):
Yeah, and I would imagine that's one of the best
places to train forcardiothoracic surgery.
I'm sure there's other goodplaces.
Speaker 2 (03:25):
Sure, there's a lot of great places out there, but
it's definitely one of them.
Yeah, because just our trainingprogram was combined with Texas
Children's World's LargestChildren's Hospital.
They either do the most or thesecond most like congenital
heart surgery.
Md Anderson's, where we do ourthoracic, world's biggest cancer
Institute yeah, um, the mostheart surgery, and one area in
(03:49):
in the United States has done itwithin the uh medical center,
texas medical center.
Um, so you know a singleinstitution.
I think Cleveland clinic doesmore, but as total you know the
whole medical center.
I mean it's the most heartsurgery done in the country.
Speaker 1 (04:03):
So yeah, it's huge yeah.
Speaker 2 (04:05):
So tons of opportunity.
Speaker 1 (04:07):
I'm a big believer, whether it's a uh, you're
practicing a football play or uh, or swimming or doing surgery,
that reps really matter.
Speaker 2 (04:15):
And so if you're busy , yeah, there's no practice you
have to be busy, otherwise, um,you can't be legitimate.
Yeah.
Speaker 1 (04:26):
And and so, and actually, Jeremy, when he on
Jeremy Leidenfrost, when he wason, he was saying that you do
more lung surgeries than heartsurgeries, but you're still a
high volume heart surgeon.
You know, consider a highvolume heart surgeon, oh yeah,
yeah, Just because you do somany cases here.
Yeah, my heart surgeon.
Speaker 2 (04:41):
Yeah, yeah.
I mean, if you look at my totalvolume, I'm our busiest surgeon
within our group by a long shot, but it, like my total cardiac
volume would be, you know,probably in the 90th percentile,
and then my thoracic volume,something like that in the 90th
percentile.
Usually people just do one ofthe two.
Speaker 1 (05:01):
Yeah, and so if you're a patient, I think you
want to go to a doctor who'sbusy, because it means two
things it means they've done ita lot, but it also means that
other doctors have referred alot of patients to that person,
which is always a good sign.
Same with tattoo artists.
You don't want your tattooartist to be like the first day.
You know.
You want like somebody withexperience.
Speaker 2 (05:23):
I like being compared to a tattoo artist.
But yeah, there's no doubtabout it.
Um, you can definitely um seethat if, if someone's very high
volume, like you just said thatsomeone trusts them either prior
patients or or their physicianstypically for us, you're not
going to have people referringto you If you have not provided
(05:44):
good quality product referringto you, if you have not provided
good quality product in return.
So you lose those referrals.
Speaker 1 (05:50):
And that's a function of the surgeon and also the
surrounding staff, the OR nurses, the post-operative care, it's
a whole team.
Speaker 2 (05:56):
There's no doubt about it.
Speaker 1 (05:57):
Yeah, yeah, and so do you still swim.
I'm going to go back to theswimming.
Do you still swim some?
Speaker 2 (06:02):
Not very frequent, but I started.
Yeah, so I started moremountain biking recently.
Yeah, yeah, I used to be reallyinto like cycling, but I've
gotten away from all thesethings, but I started getting
back into it again, yeah.
Speaker 1 (06:16):
And your wife's a physician and you have two kids,
so you've got plenty of freetime.
Speaker 2 (06:20):
So it makes it easy, it makes it super easy.
Speaker 1 (06:23):
But I think swimming and biking can be very
therapeutic.
Speaker 2 (06:35):
Obviously it's good cardiovascular exercise, but
it's really good for the mindtoo, I think.
Oh yeah, it's a great thing tojust get away and give yourself
a break and spend an hour outdoing whatever.
It is some kind of activity, soyou can relax from your day at
work, from the stress at home.
Speaker 1 (06:45):
Any type of break you get from that kind of stuff is
good and every time I've I've uh, felt fatigued and worked out,
it's actually been a positivething, like even though you're
tired, you go work out and ityeah, it's weird, but I think
that's.
Speaker 2 (06:59):
I think you're correct on that.
Speaker 1 (07:00):
Yeah, um the um I, I broke my leg.
Uh, actually I had a stressfracture in my leg several times
in my training, so not a cleancompound fracture, but I had to
swim and you know I swam as akid but the one thing I remember
is it was you know, you don'thear a lot and so it's very
(07:21):
isolating, which is kind of good.
I mean, it kind of leaves youwith your own thoughts, maybe a
little bit more than running orbiking.
Speaker 2 (07:29):
Right, and, as you know, as a physician, just like
getting away from your cellphone is a great thing sometimes
, yeah, like if people can reachyou.
You're being called all thetime, so just doing something
where you get away from thephone is nice.
Speaker 1 (07:39):
Yeah, as somebody's texting you right now, right
Right Two of them already, justwhile sitting here.
Speaker 2 (07:45):
Yeah, yeah, so it's it is good, I mean, if you can
get away from the cell phone andtake a break, it's nice.
Speaker 1 (07:50):
Yeah, it's good to be needed, it's good to be useful,
it's good to be helpful, but atthe same time you have to have
your sanity, some boundariesRight, and it's not a good long
term plan to be alwaysaccessible all the time, no
doubt.
But in general, to be helpful,you got to be there for people,
correct, um and so uh, and yourwife's a physician, she's an
(08:10):
anesthesiologist, is that?
Speaker 2 (08:11):
right, she's an anesthesiologist.
She's at Wash U.
She's does cardiac anesthesia.
Speaker 1 (08:16):
And did you guys meet in medical school?
Speaker 2 (08:18):
Medical school Yep.
Speaker 1 (08:35):
And so, and she's kind of, uh, she's kept you in
line these years, right,straight and narrow, right,
right, of course, and so, um, novery cool Um, and so, um, no
very cool um, and so are thereum.
I know, in medicine in generalthere's a lot of changes.
Are there any um newtechnologies or new surgeries or
new techniques that are beingused?
Um in the field ofcardiothoracic surgery?
Speaker 2 (08:45):
there are, but but right now there's not a lot.
That's like total.
You know where I would considerlike revolutionizing this
especially.
I mean there are certain thingslike minimally invasive surgery
, that's picking up roboticcardiac surgery that you know
some people have interest in.
But at least with roboticcardiac surgery it's tough to
(09:10):
build those practices, yeah, andthe outcomes have not been
great.
So it's hard to adapt when yousee that the outcomes haven't
been great across the board.
Speaker 1 (09:22):
What about thoracic?
Do you do minimally invasivethoracic surgeries?
Everything I do is minimallyinvasive.
Is that right?
Speaker 2 (09:27):
I mean, unless it's just something that's too big,
too large of a tumor that youcan't take out through like a
small incision, but otherwiseeverything I do is uh
thoracoscopic, or you know, andsmall port surgery.
Speaker 1 (09:40):
When did that change over from like the open
surgeries to, oh, that's beenmore than 20 years, 25, god,
even more than that.
Speaker 2 (09:48):
Um, you know, like in the 90s or so, when yeah was
pretty popular, people werestarting to do like
thoracoscopic lung resectionsand stuff.
And if you say, though, likepopular, like when it was like
or when it became predominantActually pretty recent, I mean
(10:09):
until just recently, a goodportion of all the lung
resections in the country werestill done by general surgeons.
So general surgeons weren'tgoing to be doing these
minimally invasive, they'regoing to be doing them open.
Speaker 1 (10:21):
It's just too technical.
Speaker 2 (10:23):
Yeah, because they're used to operating in the belly
and that's shifting and nowpeople are doing more like VATs
and robotic lung resections.
Speaker 1 (10:33):
VATs is video-assisted.
Speaker 2 (10:34):
Video-assisted.
Yeah, very similar to likelaparoscopic on the belly or
arthroscopic on the knee and thechest is just thoracoscopic.
So it's more common now thatalmost all providers are going
to offer some minimally invasiveoption.
We do, you know, close to like100% minimally invasive
(10:54):
Obviously, the huge tumors, youcan't do that way, but we're
trying to do almost everythingminimally invasive quicker
recovery, less pain, things likethat.
Speaker 1 (11:03):
And so there's just some small incisions on the side
.
Yeah, yep.
Speaker 2 (11:08):
And it doesn't sacrifice anything for like
cancer outcomes, it's still ayeah, yeah, yep.
And it doesn't sacrificeanything for like cancer
outcomes, it's still a greatoperation, yeah.
Speaker 1 (11:14):
Yeah, and you and I share plenty of patients with
lung cancer.
And then you also treatpatients who have esophageal
cancer, sometimes in conjunctionwith a general surgeon, because
the lower part of the esophagusis in the abdomen but the upper
part of it is in the thorax,that's correct.
Speaker 2 (11:30):
Yep, yeah, we typically do all those combined
with the general surgeon here.
Speaker 1 (11:34):
And there are two main types of esophageal
surgeries.
As far as like where theanastomosis is, is it like
transthoracic?
Yeah, that's correct.
You're laughing at me nowExplain to me why it's funny.
Speaker 2 (11:51):
It's not funny, uh, but no, there's uh, it just uh.
There's several approaches ofhow you can do an esophagectomy,
because it traverses, like theneck, the chest, the belly, um.
So there's approaches where youcan make a decision on the
belly and the chest, uh, thebelly and the neck, the belly,
chest and neck, um.
So there's just different waysto do it and it really all comes
down to preference.
(12:11):
I mean, there are someadvantages to each technique,
based on, like where tumor isand stuff like that.
But really, at the end of theday, it's just what your
preference is, what you'recomfortable with.
So what's your preference andwhy?
So?
I typically just go through thebelly and also the chest to
incisions, and the reason why isbecause it's a complex
(12:35):
operation.
I think you get great exposure.
That way you get better lymphnode harvest, which is important
in staging cancer.
It's blind if you don't go intothe chest right it's blind and
so like, yeah, you're taking outthe esophagus blindly if you
just go through the belly, so ifyou injure something, that
could be catastrophic.
So it is good to be able to seewhat you're actually operating
(12:57):
on.
Speaker 1 (12:58):
And then one issue can be the anastomosis, which is
the medical term for where theyconnect the two portions of the
esophagus once they resect thetumor, and that matters too
right where the anastomosis isyeah, so, yeah.
Speaker 2 (13:11):
So if you just go through the belly, like you just
said, then it's up in the neck,meaning it has to go a longer,
longer way, and the blood supplyis further away now at that
point, so they just don't healas well if they're up there and
it but and the advantage of thatis, if they have an anastomotic
leak, it doesn't go into thelung.
That's correct.
Yeah, it doesn't leak onto thelung and the chest.
Speaker 1 (13:32):
But fortunately, especially with a good surgeon
like you, you don't see a lot ofanastomotic leaks?
Speaker 2 (13:36):
Yeah, knock on wood.
So far we haven't had a lot ofproblems.
Speaker 1 (13:45):
But yeah, of course, anytime you do high anything
enough, like you know, errorswill occur.
Speaker 2 (13:50):
But if your error rate is low, then that's the
that's good to have good, youknow, low complication rate, but
at the same time, like, if youdo have a complication, if you
can take care of it, almostalways the patient's going to be
okay.
Yeah, that's the importantthing.
Speaker 1 (14:03):
So, if you, so, if you have an error rate of one or
2%.
That's's good, but it's reallygood if you've treated, you know
, a couple thousand patients andyou've dealt with that one or
two percent scenario.
You know more than once Correct, yeah, totally, and that's why
kind of volume is just soimportant.
Absolutely, patients, yep,aside from swimming, what other
(14:25):
things do you do for your health?
Is or swimming and biking it?
Speaker 2 (14:30):
That's it right now.
Speaker 1 (14:31):
Yeah.
Speaker 2 (14:31):
Yeah, as far as like activity, that's it right now.
Yeah.
Speaker 1 (14:40):
I've recently adopted stretching, just taking like 10
minutes before I go to bed, andI felt like that's especially
the muscles around the pelvis.
I feel like that's made me feelyounger, but I don't know.
If I pull some muscle off mybone, then you'll know why.
Well, ryan, it's always goodtalking to you and thank you for
coming on the podcast to shareyour time with us To the
listeners.
Please tune in next week forour next episode of Doc
(15:02):
Discussions.
Thanks so much.
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