June 20, 2024 • 32 mins
Unlock the secrets to successfully navigating revisional bariatric surgery as we invite Dr. Francesca Dimou, a pioneering Bariatric and General Surgeon with a talent for robotic procedures, to illuminate the complexities of this life-altering medical journey. Transitioning into a new chapter at USF and Tampa General Hospital, Dr. Francesca Dimou outlines the essential steps she takes in the intricate dance of preoperative evaluations. As she shares her algorithm and stresses the importance of diagnostic tests, you'll discover the empathy and expertise needed to set patients up for triumph in the face of obesity's challenges.
As we wade through the murky waters of insurance coverage for bariatric surgery, Dr. Francesca Dimou and her team of patient navigators emerge as beacons of hope, guiding patients through the labyrinth of policies and procedures. It's not just about the physical transformation; the conversation turns to the emotional odyssey patients embark upon, confronting societal misunderstandings and internal battles. With Dr. Francesca Dimou's insight, we're reminded that obesity is a chronic disease demanding a cocktail of surgical intervention, medication, and lifestyle changes, all delivered with a generous dose of compassion.
Finally, we converse on the synergistic power of a multi-generational surgical team, where experience meets innovation, and colleagues become confidants. Dr. Francesca Dimou reflects on her own professional voyage, which took an unexpected detour from anti-reflux to bariatric surgery, a field ripe with the potential for impactful change. She emphasizes the mentorship that sculpted her career and offers pearls of wisdom to young surgeons: Embrace the strength of a united team, and you'll not only excel in your field but also ensure the highest standard of care for those you serve.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Core Bariatrics podcast hosted by
Bariatric Surgeon Dr MariaIliakova and TMA LaCose,
bariatric Coordinator and apatient herself.
Our goal is building andelevating our community.
Core Bariatric podcast does notoffer medical advice, diagnosis
or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Speaker 2 (00:24):
Let's get into it.
Today we are so glad to havewith us a Bariatric and General
Surgeon that works with USFUniversity of South Florida and
Tampa General Hospital.
She recently transferred fromWash U in St Louis.
She's performed over 500robotic surgeries and I was
lucky enough to meet her in oneof our committees, in our
professional organizations.
She did fellowship at CornellResidency at the University of
(00:48):
South Florida in Tampa and she'sback home now.
Please welcome Dr Francesca.
Thank you for having me.
Thanks for being here, lookforward to it.
Speaker 3 (00:56):
Yes, of course, I'm glad you're here.
Speaker 2 (00:58):
I'm excited to talk about everything.
Oh yeah, so you just moved backto Tampa.
How's it going?
Speaker 3 (01:03):
Yes, so I just moved back and started here at the
University of South Florida andTampa General in October so only
a few months and I was at WashU for four years.
2019 is when I started mypractice there and I started in
September and then March of 2020, covid happened, so navigating
that as a brand new Bariatricsurgeon.
(01:26):
So it's a little bit differenthere, because now I have a lot
of experience under my belt.
So, fresh out the gate, whenbuilding a practice and coming
out of training, you don't takerisky procedures, you kind of go
with simple things and you arereally risk averse which you
(01:46):
should be because you'rebuilding your reputation and
those sorts of things.
And then I think it was probablyafter a year, year and a half I
started doing more revisionalcases and so patients came
specifically to see me and sohere at Tampa General, it's
unique because I started doingmore revisions first than
primary Bariatric cases, becausethat was what was put in my
(02:07):
clinic and I'm not opposed to it.
It's just different and it'sunique.
But now I have a different.
It's a different health caresystem that you have to navigate
, different specialists you haveto develop relationships with,
especially for patients who dorequire revisional surgery.
I do have a specific algorithmin how I work patients up
(02:30):
because I need to set them upfor success.
It's not the primary bypass orsleeve, it's they've had
multiple surgeries or they'vehad multiple complications and I
got to get them set up to havethe best outcome possible.
So it's navigating that as well.
Speaker 2 (02:44):
So you talk about an algorithm for revisional surgery
.
Just to sort of break that downSounds like one.
You're offering a new serviceor sort of an updated service to
what was available before,which congratulations, because
that's a really, really big dealin patient access.
Two, for folks who have hadsurgery before and may need
surgery down the road if theydon't have someone like you in
the area, they're kind of hostand have to travel far to get
(03:08):
that kind of service.
So first of all,congratulations on developing
something like that.
That takes a lot of guts andskill.
But can you tell us a littlebit more about what it takes to
actually get revisional surgery?
What's that algorithm youmentioned?
Speaker 3 (03:19):
So typically what'll happen is patients will come to
me.
Either they'll have, let's say,a hiatal hernia and they had a
prior sleeve.
I've had also several patientscurrently in my clinic that are
undergoing workup.
They've had a history of a VBG,which is a you know, or they'll
say stomach stapling, and thatwas done a long time ago.
(03:40):
That was done in the 80s kindof thing.
So typically for those patientsit depends on what the problem
is.
So if they're having any sort ofacid reflux or any sort of
forego problem, I do a fullforego workup.
So that includes pH menometry,a swallow study and an EGD, and
the reason for that is thatgives me all the information.
(04:03):
As far as any issues with youknow, motility, if there is a pH
issue because sometimes ifthey're having reflux after a
bypass, why is that non-acid oracid reflux it does help.
Also, the reality is isinsurance approval, because
sometimes insurance sees it as,oh, I'm doing this other weight
loss operation, but that's notwhat I'm doing it for.
(04:23):
I'm doing it because they can'teat or they have an ulcer or
someone and so forth.
And the other thing I do,especially in the older cases,
like a VBG, I will get a CT scanBecause sometimes they don't
know and I'm kind of guessing,and that's fine.
You know, it just wasn't apopular operation and there
aren't very many around even now, and so I'll get a CT scan also
(04:44):
to have a better idea and kindof get a lay of the land,
because the majority of theseoperations that I do are robotic
.
So then I can kind of tellexactly what's going on, and
that helps me as well and I tellpatients ahead of time.
You know there's going to be alot of steps along the way, but
I need all of that informationto put all the pieces together
again to make sure that I do asafe operation for them and I
give them the right operation.
Speaker 2 (05:06):
So that's pretty interesting.
Your workup involves a lot ofimaging and kind of procedures,
like you mentioned, andsometimes that can be really
scary to people coming into theprocess.
And I'm telling you I'mactually going to call you out a
little bit you had not hadsurgery before, but part of the
typical protocol was actually ascope, an EGD, and you had said
that you've mentioned since thattime that if you actually knew
(05:29):
why you had to do the scope,that you would have gone through
that process.
So this is kind of a comboquestion to both of you what do
you think makes it possible forpatients to go through a lot of
procedures or a lot of workupwhen they don't necessarily know
why that's happening or what?
That can be intimidating.
Speaker 3 (05:46):
Tammy, you can go first, because my hands will
probably be long.
No problem.
Speaker 1 (05:50):
So really, the reason , the two main reasons that well
, three I should say that Ididn't undergo the scope was
well, for one, the provider thatI originally seen didn't really
did give me the choice, becauseI didn't have acid reflux, I
didn't have any issues, I waslike a picture perfect patient,
(06:10):
I guess.
Quote unquote.
So I also PTO was limited, andthen also my resources to having
some a driver take me there andbring me back, because if it
was my husband then he had totake a whole day off.
So, but now, so I really wasjust looking at the work aspect
because I knew I was going tohave to take a bunch of time off
of work after surgery.
(06:31):
But now, looking at it andknowing why we do it, you want
to look and see the lay of theland and make sure there aren't
other issues going on and ifthere is, you can prepare for
that for surgery.
So there's a lot of things,education wise, that I learned
that I would have done it if Iknew all these things.
Speaker 3 (06:52):
Yeah, and I think the thing is is that education is
empowering to patients.
You have to explain things tothem, and so I always tell them.
I explain what if we do a,whether we do a bravo or pH,
with impedance?
I explain, you know we'relooking for a numeric value.
You tell me you have symptoms,but I need a numeric value
because what if you have thesesymptoms after surgery?
(07:12):
I can kind of compare, you knowsame with the manometry that
tells me how things are movingdown.
And I'm also very, very honestwith patients about manometry.
I tell them they're going tohate it and it's miserable,
because I did it in training, sowe learned how to not only do
the manometry but read it.
Inserting that probe is awful.
Patients don't like it, and Iremember my attending at the
(07:34):
time we told the patients notthat bad, and I was like, no,
but it is.
And I was like, but it is.
And so I tell patients, so atleast they have that in their
mind.
And then sometimes they're likeactually it wasn't as bad.
And so I think you have to.
You have to give thatinformation and give them a
reason for things, especially ifit is a long list of things or
(07:54):
a workup that they're going tohave to undergo, because in
their mind, like you said, it'swork, it's money, it's cost,
they're deductible, and so youhave to provide them with them
understanding.
It's to help tell a story, in away.
I tell patients it's kind oflike we're in a movie and
they're the main star, right,they've been in the movie the
(08:16):
whole time, they know everything, and I'm coming in like three
quarters of the way in and Ihave to like catch up and put
all the pieces together of thatmovie in order for us to get to
the end.
And so that kind of helps too,because I wasn't there for the
last 20 years or whenever theyhad their original surgery.
So I have to kind of piecethings together and do it safely
(08:36):
for them.
Speaker 1 (08:38):
So quickly, because I don't know what is that
procedure that you were justtalking about, Just in case
patients, sorry, just in casepatients are listening to this
and don't know, what it is andhave to do it.
Speaker 3 (08:51):
Yeah.
So a menometry basically iskind of I call it like a noodle.
It's a little noodle that goesinto your nose.
You are awake for the procedure.
You do have to be awake for it,and so when the tube goes down
into your nose it goes all theway into your esophagus but kind
of goes, you know, between theesophagus and the stomach.
That's kind of ideally whereyou want it.
And while you're awake withthis tube in your nose you have
(09:15):
to drink water and the probesenses the water based on
temperature of the water, and sothen that helps us see the
actual function of youresophagus, the actual muscle
movement.
So sometimes we see abnormalmenometry, let's say, for
patients who've had a sleeve,for whatever reason, they may
have abnormal movement of theiresophagus, and so that kind of
(09:37):
gives us again more numericvalues into what's actually
going on in the physiologicalcomponent of that.
Speaker 1 (09:44):
That makes sense.
Thank you for explaining thatAbsolutely.
Speaker 2 (09:48):
Yeah, I think that's a big.
That's really key, tammy, I'mglad you brought that up,
because a lot of people, evenwith a scope, they've never had
a procedure before.
A lot of folks that we operateon or are considering for
operations are well below 45 or50 when they're getting
colonoscopies and so they maybenever had a procedure really in
their life and all of a suddenyou're coming with a menu of
items that people have to do andmaybe seeing some other
(10:09):
physicians or some other folksthat they really need to get
evaluated by it can be verydaunting, yeah it can, it can be
.
Speaker 3 (10:17):
And I think that's the hard part too.
So you are mentioning, as faras you know, you know, being a
bariatric coordinator and thingslike that.
And now we have the role ofpatient navigators, because
every patient's insurance isdifferent and every policy or
whatnot is going to havedifferent requirements.
And then if you're like givingthem this laundry list, it's
either like, oh my God, like Ihave to do all this stuff yes,
(10:40):
you know.
And so sometimes it's like wait, what do I have to do again,
you know.
And so that can be overwhelming.
And what I also tell patients isyou know, especially when you
do like an info session andyou're talking to patients,
patients will say, well, I haveBlue Cross, blue Shield.
Does that cover bariatricsurgery?
And I said I don't know, itdepends on your policy.
(11:01):
And the thing is is people willcall insurance.
You'll call your insurance andyou'll just talk to a generic
person and say, do you guyscover bariatric surgery?
And that generic person isgoing to give you the generic
yeah, we do, but your policy maynot cover that.
And so that's what we have tobe very explicit with patients
because, yeah, blue Cross, blueShield offers bariatric surgery,
(11:21):
but your policy or youremployer may not provide that
benefit to you.
Speaker 1 (11:26):
And then, especially in your case of doing revisions,
you have to check to make surethey do the second surgery
because some insurances will noteven do any second bariatric
surgery.
Yeah, at the end of I could haveput myself in an office
somewhere and not seen patients.
Honestly, just talk to thembefore they come in, whatnot.
(11:48):
But I wanted myself at thecheckout so that after their
appointment I can say I know,you just got thrown a lot of
information.
Here's how to contact me.
Do you have any questions?
Because you know the secondthat they walk out that door.
That's where all the questionscome.
Speaker 3 (12:03):
Oh yeah, oh yeah.
It's a lot.
And I think, for patients as itis, when they come into clinic
to see me, they are already sonervous, they're nervous,
they're emotional, they inreality don't want to be there.
Right, like no, and that's thething is yeah.
(12:25):
And the thing is is that theyhave been.
Our patient population has beenstigmatized and ostracized and
judged all of their lives andthey're just told you need to
eat less and exercise more andthat's going to solve all the
problems.
And I tell patients I said,would you be nervous if you were
coming here for your bloodpressure?
And they're like no, and I'mlike and that's the thing is is
(12:45):
that we have to change themindset of obesity and that
obesity is a disease, it's achronic disease and it's not a
choice.
There are all these componentsand, yeah, and we are.
We have no idea, becauseeveryone thought surgery was
this cure.
And then if patients gainedweight after surgery, they were
like, well, you're a failure.
(13:06):
And now we're like, well,that's maybe not necessarily
true.
And then it's like and theneveryone thinks we'll go via
nozepik is going to be theanswer to everything, and I
don't think it's an either, or Ithink it's a complex disease
that we have to understand andwe have to stop blaming people
for it, because that's not fair,absolutely.
Speaker 2 (13:25):
Amen.
You're very much preaching, andI appreciate that, because
there's this sentiment sometimesthat people don't even come
back to get seen if they regainweight or if they happen to have
reflux or some other issueafter surgery, because they're
so afraid of the judgment orafraid that they'll be told this
is all your fault and we can'tdo anything for you, when
(13:46):
actually it's usually notanything to do with what you did
as a person.
And then, too, there's actuallya lot of options on the table
to be able to help people atthis point.
Speaker 3 (13:56):
Yeah, and I think, again, it's all about
expectations, it's all aboutknowledge, because I tell
patients one thing so I say, ifI give you a gastric bypass and
you see me a year later andyou're like, hey, doc, I've been
doing all these things, I stillcan't get those extra 10 pounds
off, and so on and so forth,that's one discussion.
(14:18):
And then we're like, ok, well,we can maybe add a medication,
or we can look at other things,or so on and so forth, and it's
not that you're a failure, it'snot that your surgery failed,
it's just your metabolic setpoint is different.
Now I tell patients that samepatient.
I say, well, if you come to mea year later and say, well, you
know, I'm eating Taco Bell, andI kind of let things go, that's
a different discussion Because,again, treatment of obesity is
(14:41):
multifactorial.
If surgery, it's potentiallymedications, it's diet, it's all
of those things, and so it'sall about perspective.
In that sense, yeah, absolutely.
Speaker 2 (14:53):
So I'm curious.
Actually, we've talked a lotabout what you do now and some
of the cool and complex thingsthat you break down.
How did you get into this field?
What brought you to it?
Speaker 3 (15:01):
Bariatrics in general .
It was funny Because when Iwent to fellowship I thought I
was predominantly going to doanti-reflex surgery Because that
was a lot of my training.
But then when I went intofellowship and I purposely chose
a fellowship that gave me avariety, Because I didn't want
to kind of pinch it home myself,so I did something where I did
complex abdominal wall, I didforegut and then I did
(15:22):
bariatrics, and then I thought Iwould never do robotics, I
thought I would just do leprosy.
Speaker 2 (15:28):
You ended up in Florida.
How could you avoid it?
I know.
Speaker 3 (15:31):
And then I did it and I loved it and I loved the
operations but also I loved thepatient population.
I loved taking care of thosepeople.
I loved seeing how much theychanged afterwards.
And it wasn't about a number ona scale, it was about life
goals.
And I really realized that inmy first job, where it was like
(15:56):
a patient would say somethinglike I was able to take my son
and I could go on the rollercoaster Because it wasn't a
weight restriction or one womanwas like I've never been on a
plane and I finally got to go ona plane and I wasn't
embarrassed Because we alwaysdrove everywhere.
Speaker 1 (16:11):
You just did two things.
Yeah, I used to go on rollercoasters Wins, we go every year
to Adventureland here in Iowaand a year before my surgery I
got onto a roller coaster and itcouldn't shut.
So that was heartbreaking,Because my oldest son was like
mom, why did you get off?
And I haven't been on a planesince middle school and here I
(16:35):
am going on planes now.
Speaker 2 (16:36):
So it was just a few things that you never seen, and
it was very either.
Speaker 1 (16:42):
My anxiety was a little through the roof just
because it's a new thing, butweight had nothing to do with it
.
Me not fitting in an airplaneseat had nothing to do with it.
So, yeah, yeah.
Speaker 3 (16:55):
It was more of like getting through.
It was more like TSA security.
Speaker 2 (17:00):
Literally Not using a shoe or that power Exactly.
Speaker 3 (17:05):
It's like getting all your stuff out on time.
That's a whole separate stress.
But yeah, I mean that's kind ofhow it should be for what we do
.
And then the revisional workwas something that it was, I
would say I fell into it.
But also there is so little onon against I don't want to say I
(17:27):
didn't have a choice.
I would say that those patientsstarted coming into my clinic
because my other two partnersalso did very similar operations
and, being at WashU, we werethe only huge medical center
that would even take care ofthese patients, and so we were
(17:47):
at Catchman's area, not only forMissouri, but for Illinois,
sometimes Kentucky, tennessee,arkansas, so we saw people from
everywhere that hadcomplications, and so I had to
take on these patients.
But also, at the same time,being a young surgeon, I was
fortunate enough where I had twocolleagues that were awesome.
They're my good friends,they're my mentors and they
(18:09):
helped me through that too,because I could do it.
But it's always nice whenyou're a young surgeon to have
that backup.
And so they helped me andtaught me so much, because I saw
things that I had never seenbefore and patients with
complications from surgery thatI had never managed before, but
with my colleagues I was able totake care of those people and
(18:32):
really have that kind of aspectof changing their life as well.
Speaker 2 (18:36):
So that's a really interesting thing that you
mentioned.
You basically not only wereable to use the skills that you
had, but because you had goodmentors where you worked, you
were actually able to do evenmore complex things and grow
into a role where you could takecare of whoever came in the
door.
You actually were able tofigure out a way, even if it was
complex.
It sounds like.
Speaker 3 (18:57):
Oh yeah, my one senior partner, Chris Egan, has
been doing bariatric surgery for30 years, has done over 4,000
bypasses and I'd call himSometimes.
I'd call him because I'd be oncall.
I'd be on Christmas.
I'd be like, hey, Fritrisco,what's up?
Speaker 2 (19:12):
And he was just like and I'd talk to him.
Speaker 3 (19:15):
And I'd say, hey, like what do you think?
Or I've never seen this.
And he's like, oh yeah.
Speaker 2 (19:19):
I've seen that I'm like, of course he's so
experienced yeah, he's soexperienced.
Speaker 3 (19:24):
And Shayna Eckhaus was my other partner.
She's, I think, three yearsolder than me.
She came from Duke and is nowback at Duke, but she taught me
so much too.
But then it was awesome becauseit was nice to have also two
female surgeons that were soclose and she didn't do a lot of
robotics.
So then she would call me inwhen she did robotic cases and I
(19:45):
kind of helped her withrobotics and then she would come
in because I would be like hey,can you take a look at this?
And she's like, yeah, sure, andso we were just very it was a
very great collaborative teamthat we had.
That I was very appreciativefor, and I think that's probably
the most important thing when Itell junior trainees, like,
going into their first job, yougot to have the right people,
(20:07):
because that makes such a hugedifference to who you will
become as a surgeon a thousandpercent.
And they really, really helpedme.
I cannot thank them enough formy first job and I talked to
Shayna still all the time.
Speaker 2 (20:19):
Wonderful person.
Speaker 3 (20:20):
Yes, that makes a lot of sense.
Speaker 2 (20:22):
Yeah, can you talk a little bit more about?
Yeah, so we definitely do havesome listeners who are in the
medical field, and I think that,for I really want to emphasize
something that you said, whichis when you're looking for a job
, especially your first job, itdoes matter who's around you and
the people there.
Can you tell me a little bitmore about how?
Did you know you were cominginto an environment where you
(20:42):
would be supported, where therewould be that kind of
relationship, or was that onethat you actually participated
in making yourself?
Speaker 3 (20:49):
I got the sense and I felt that at the time with
WashU and the MIS section.
It was a little bit unique atthe time that I came in because
a lot of people were youngsurgeons and I thought you know
you have the senior surgeons aswell that were more experienced.
But the reality is is there isa different feel when you have
(21:11):
colleagues sort of around yourage range.
You know, because I loved Egan,I could call him anytime but it
was nicer because Shayna wascloser to my age.
Speaker 2 (21:21):
Right, you know what I mean.
Speaker 3 (21:23):
It was just easier to call her and even if I had a
hernia, that I was on call, Iwould call my other colleagues
who were also younger, and so Ifelt more and I think that's the
thing is that when you havethat group and you get that
sense too and even my group here, they are younger and I know
them Like I knew them throughthe conference trail and those
(21:44):
sorts of things, but they callme and they are like, hey, can
you come take a look at this?
I do the same thing.
So you really want that teameffort where you're not on an
island and you can get thatsense when you interview.
Speaker 2 (21:55):
Yeah, that makes a lot of sense.
And then from the patientstandpoint, I think what's
really interesting about that isit's safer for patients too,
because there's more than oneset of eyes and the combined
experience in the room sometimesmeans more than the experience
of just the person.
Speaker 1 (22:10):
That's the surgeon.
Speaker 2 (22:13):
So you're speaking, I think, to something that's a
huge quality and safety issuefor the people we take care of
too.
Speaker 3 (22:19):
Exactly, and I think us as surgeons, as an individual
person.
We don't know everything, wehaven't seen everything, but
that's why it's all about that,what I don't know about that I
wish I wish you know what I mean, right?
No, I don't.
Speaker 1 (22:36):
Say that You're willing to say I don't know it
all and I'm not afraid to callsomeone and be like I've never
seen.
This.
That says a lot about yourcharacter for sure, because
there are some people that willbe like, oh yeah, I've seen it
all, I can do anything, and thenhave issues because they just
yeah.
Speaker 3 (22:55):
So good for you for not having yeah.
I love a good team approach andalso not only that, I enjoy it.
I enjoy going my partners, evenif they don't call me, I go see
and I'm like, oh yeah, Like Isee what they're operating.
They come see me Like hey,what's going on?
And I think you should havethat team approach, Because what
we do is hard and we take careof complex patients and you want
(23:16):
to do the right thing for theperson, and so if there is
someone else that knows about it, then you should be able to go
to that person.
Speaker 2 (23:26):
Yeah, that's a great approach and I do think that
there is.
Luckily we're trained that way.
We don't always end up insituations where we work in the
real world that has that kind ofcross coverage, but definitely
it is beneficial for everyoneinvolved most times.
Yeah, that's great, that'sgreat.
So are you enjoying Tampaoverall, being back and kind of
(23:46):
being back home, being back inyour environment?
I know the insurance isprobably a little different, but
overall it is.
Speaker 3 (23:55):
It's crazy how Tampa has changed, and so I left in
2018.
So left pre-COVID, obviously,and the population here has
exploded, so the number ofpeople that have moved to Tampa
(24:16):
has exponentially increasedpost-COVID.
And so what's interesting is youhave a hospital system that was
used to a certain number ofpeople in the city, and that
hospital hasn't grown toaccommodate all the people, and
so now Tampa general is workingfeverishly to build a new
(24:38):
surgical pavilion to help expandthose things, and so I'm
learning how to.
That's a whole separate thingthat I'm learning how to
navigate, because I came from asystem that was a huge system
but didn't have anywhere nearthe population of people here,
and it's interesting too,because you have so many other
(24:59):
facilities in the area, you haveso many other hospital systems
in the area, and then you alsohave the component of patients
don't always live here full time, so some come from the
Northeast, there's snowbirds,and that always makes me nervous
because I'm like I don't wantto do this big surgery.
And then you go back up toJersey, and so I'm learning how
(25:24):
to navigate those things too,because it's a different
landscape here than I was usedto, and I think that's also just
because of how Tampa haschanged.
There are some places that Idon't even recognize.
Channelside used to be dirt andnow it's like Michelin Star
restaurants and all this otherstuff and I'm like what happened
(25:45):
?
So it's just crazy how it'sgrown, which is good for the
city.
Speaker 2 (25:50):
That actually brings up a good point, though, because
I think a lot of places don'tnecessarily get the get
bariatric care or foregut care,good reflex care.
There's never really enough togo around, and even in a place
like Tampa, where I think peoplehave the belief, probably, that
it's like oh, there's so muchof it, it's totally easy to get
that no big deal.
Even in a big population it'sactually not that easy.
Speaker 3 (26:14):
Yeah, just because there's so many people I think I
read somewhere that 5,000people are moving here every
quarter or something.
Crazy, just the number ofpeople.
And because also, what we seeis people will live in Florida,
because now again, how COVID haschanged things is everyone
works remotely, so people's jobswill be in New York, but they
(26:35):
will reside in Tampa, and soit's just kind of crazy now that
everyone works from home andeverything's digital and
technology and stuff.
Speaker 2 (26:46):
In dealing with people who do travel, since that
seems to be the specific kindof snow bird or digital nomad
situation in Florida.
Do you have patients thatapplies to, and how do you
counsel them differently or workthem up differently than you
would anyone else?
Speaker 3 (27:01):
I would still do the same work up.
I did actually have a patientrecently and I did a big
revision on her and I waitedpurposely because she was like
I'm going to be up in theNortheast for the holidays and
so on and so forth for like twoor three months at a time and I
was like I'm not doing yoursurgery until you're here for at
least six months.
(27:21):
She was like, okay, you know soand so forth, and I think when
patients realize and especiallyfor a revisional patient when I
tell them the magnitude of theoperation that we're doing and
those sorts of things, I thinkthey really get a better idea.
You know it's not.
I tell them I'm like this isn't?
You know, we're not removing amole or something like this is a
big operation, although I'mdoing it robotically, and
(27:41):
there's four small incisions.
It's a lot of work on theinside and so I want to make
sure that you are okay, becauseI also I know this is going to
be shocking as a surgeon, I'm acontrol freak and so if it's my
patient, I want to be able totake care of them and I want to
be able to be there for them ifsomething happens.
Speaker 1 (28:02):
Yeah.
Speaker 2 (28:04):
That makes a lot of sense, yeah, and I think that
sentiment is really importantfor everyone to hear too, that
these, even though they are safesurgeries, they're people, are
really worked up really fromhead to toe and they're done in
minimally invasive ways, withcuts that look really small on
the outside.
These are big changes thatpeople are going through, so I'm
really glad that you mentionedthat as a specific consideration
(28:27):
for your practice.
Speaker 3 (28:29):
Yeah, and I think for those undergoing bariatric
surgery, because they'll saythings like well, is it like my
getting my gallbladder out?
And I said same incisions.
I said, but when you have agallbladder, you kind of go back
to your normal life, right, youjust kind of hear feel a little
sore, or whatever I said thebiggest thing is is like what I
tell you is I'm going to do thissurgery on you in a couple of
(28:50):
hours and then you're going towake up and now I'm going to
tell you to change everythingthat you've ever done for
however many years you've beenon this earth, and I expect you
to do it today.
You know, and that's hard youknow, like take small sips and
make sure you do this and makesure you do that, and so I think
, and when I tell patients, it'smore of the mental aspect of
things, it's interesting.
(29:11):
Yeah, and sometimes patientsare like what you know, they get
offended.
I'm like, no, I'm like it's thepsychological change, it is
your relationship with food thatchanges.
It is how you, you know, arewith family and friends.
It's everything.
Speaker 1 (29:27):
And so we can give us all situations and if you even
want to indulge in something,you can't, and that is mentally.
Speaker 3 (29:34):
Yeah, the mental part is definitely huge and yeah
it's hard, it is hard and so andI think that's the thing that
unfortunately some people don'tunderstand outside of patients,
like even other physicians, youknow they'll be like, oh yeah,
just give it.
You know, just do a bypass, andI'm like that's not how that
goes, and so it takes a lot oftime and I think, if anything,
(30:00):
sometimes the psychologicalevaluation before surgery is
probably the most important part.
Speaker 1 (30:06):
Yeah, yeah.
Speaker 2 (30:08):
Very much so.
Yeah, that's key, and I think alot of people are afraid of
that because they think they'llstop them from having surgery or
stop them from having arevision, but oftentimes it's
the opposite it actually is.
It's a way to enable someone todo well and to identify things.
So I'm really glad that you'rebringing that up, because that
is a source of concern for a lotof people considering this.
Speaker 3 (30:30):
And I think it's just you know, and again, patients
are fearful, they're going to bejudged, they're going to be
like analyzed or whatever, andit's more about understanding
and having insight.
Like Tammy mentioned, yourrelationship with food, how you
use coping when food and justthose sorts of things, because
(30:51):
that will be differentpost-surgery and what that looks
for what that looks like isgoing to be individual, you know
, or different for everyindividual.
Speaker 2 (31:00):
Yeah, definitely.
Well, this has been a very wideranging conversation.
Speaker 1 (31:05):
Yeah, yeah, I know right.
Speaker 2 (31:08):
So from St Louis to Tampa.
I'm sure Tampa is thrilled tohave you back, because it sounds
like you're making waves.
No pun intended, but you'rereally offering a service that's
not only extremely high quality, especially with the revisional
work that you're doing, butreally compassionate, and just
everything that you do shinesthrough as focused on taking
care of people.
(31:29):
And I'm very proud to know you.
You served as a mentor to mealso in the brief time that
we've known each other.
I really appreciate it.
So thank you for being such aguiding light in this space.
Really appreciate it, thank youguys.
Speaker 1 (31:42):
Thank you guys for having me.
Yeah, absolutely Thanks forbeing here.
So, for those that arelistening, don't forget to like
us on Instagram.
Send us a message if you wantus to discuss anything, but
otherwise we will see you allnext time.
Thank you for being here.
Bye.
Speaker 3 (31:57):
Bye.
Guys, Bye.
Welcome to Core Bariatrics podcast hosted by
Bariatric Surgeon Dr MariaIliakova and TMA LaCose,
bariatric Coordinator and apatient herself.
Our goal is building andelevating our community.
Core Bariatric podcast does notoffer medical advice, diagnosis
or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Speaker 2 (00:24):
Let's get into it.
Today we are so glad to havewith us a Bariatric and General
Surgeon that works with USFUniversity of South Florida and
Tampa General Hospital.
She recently transferred fromWash U in St Louis.
She's performed over 500robotic surgeries and I was
lucky enough to meet her in oneof our committees, in our
professional organizations.
She did fellowship at CornellResidency at the University of
(00:48):
South Florida in Tampa and she'sback home now.
Please welcome Dr Francesca.
Thank you for having me.
Thanks for being here, lookforward to it.
Speaker 3 (00:56):
Yes, of course, I'm glad you're here.
Speaker 2 (00:58):
I'm excited to talk about everything.
Oh yeah, so you just moved backto Tampa.
How's it going?
Speaker 3 (01:03):
Yes, so I just moved back and started here at the
University of South Florida andTampa General in October so only
a few months and I was at WashU for four years.
2019 is when I started mypractice there and I started in
September and then March of 2020, covid happened, so navigating
that as a brand new Bariatricsurgeon.
(01:26):
So it's a little bit differenthere, because now I have a lot
of experience under my belt.
So, fresh out the gate, whenbuilding a practice and coming
out of training, you don't takerisky procedures, you kind of go
with simple things and you arereally risk averse which you
(01:46):
should be because you'rebuilding your reputation and
those sorts of things.
And then I think it was probablyafter a year, year and a half I
started doing more revisionalcases and so patients came
specifically to see me and sohere at Tampa General, it's
unique because I started doingmore revisions first than
primary Bariatric cases, becausethat was what was put in my
(02:07):
clinic and I'm not opposed to it.
It's just different and it'sunique.
But now I have a different.
It's a different health caresystem that you have to navigate
, different specialists you haveto develop relationships with,
especially for patients who dorequire revisional surgery.
I do have a specific algorithmin how I work patients up
(02:30):
because I need to set them upfor success.
It's not the primary bypass orsleeve, it's they've had
multiple surgeries or they'vehad multiple complications and I
got to get them set up to havethe best outcome possible.
So it's navigating that as well.
Speaker 2 (02:44):
So you talk about an algorithm for revisional surgery
.
Just to sort of break that downSounds like one.
You're offering a new serviceor sort of an updated service to
what was available before,which congratulations, because
that's a really, really big dealin patient access.
Two, for folks who have hadsurgery before and may need
surgery down the road if theydon't have someone like you in
the area, they're kind of hostand have to travel far to get
(03:08):
that kind of service.
So first of all,congratulations on developing
something like that.
That takes a lot of guts andskill.
But can you tell us a littlebit more about what it takes to
actually get revisional surgery?
What's that algorithm youmentioned?
Speaker 3 (03:19):
So typically what'll happen is patients will come to
me.
Either they'll have, let's say,a hiatal hernia and they had a
prior sleeve.
I've had also several patientscurrently in my clinic that are
undergoing workup.
They've had a history of a VBG,which is a you know, or they'll
say stomach stapling, and thatwas done a long time ago.
(03:40):
That was done in the 80s kindof thing.
So typically for those patientsit depends on what the problem
is.
So if they're having any sort ofacid reflux or any sort of
forego problem, I do a fullforego workup.
So that includes pH menometry,a swallow study and an EGD, and
the reason for that is thatgives me all the information.
(04:03):
As far as any issues with youknow, motility, if there is a pH
issue because sometimes ifthey're having reflux after a
bypass, why is that non-acid oracid reflux it does help.
Also, the reality is isinsurance approval, because
sometimes insurance sees it as,oh, I'm doing this other weight
loss operation, but that's notwhat I'm doing it for.
(04:23):
I'm doing it because they can'teat or they have an ulcer or
someone and so forth.
And the other thing I do,especially in the older cases,
like a VBG, I will get a CT scanBecause sometimes they don't
know and I'm kind of guessing,and that's fine.
You know, it just wasn't apopular operation and there
aren't very many around even now, and so I'll get a CT scan also
(04:44):
to have a better idea and kindof get a lay of the land,
because the majority of theseoperations that I do are robotic
.
So then I can kind of tellexactly what's going on, and
that helps me as well and I tellpatients ahead of time.
You know there's going to be alot of steps along the way, but
I need all of that informationto put all the pieces together
again to make sure that I do asafe operation for them and I
give them the right operation.
Speaker 2 (05:06):
So that's pretty interesting.
Your workup involves a lot ofimaging and kind of procedures,
like you mentioned, andsometimes that can be really
scary to people coming into theprocess.
And I'm telling you I'mactually going to call you out a
little bit you had not hadsurgery before, but part of the
typical protocol was actually ascope, an EGD, and you had said
that you've mentioned since thattime that if you actually knew
(05:29):
why you had to do the scope,that you would have gone through
that process.
So this is kind of a comboquestion to both of you what do
you think makes it possible forpatients to go through a lot of
procedures or a lot of workupwhen they don't necessarily know
why that's happening or what?
That can be intimidating.
Speaker 3 (05:46):
Tammy, you can go first, because my hands will
probably be long.
No problem.
Speaker 1 (05:50):
So really, the reason , the two main reasons that well
, three I should say that Ididn't undergo the scope was
well, for one, the provider thatI originally seen didn't really
did give me the choice, becauseI didn't have acid reflux, I
didn't have any issues, I waslike a picture perfect patient,
(06:10):
I guess.
Quote unquote.
So I also PTO was limited, andthen also my resources to having
some a driver take me there andbring me back, because if it
was my husband then he had totake a whole day off.
So, but now, so I really wasjust looking at the work aspect
because I knew I was going tohave to take a bunch of time off
of work after surgery.
(06:31):
But now, looking at it andknowing why we do it, you want
to look and see the lay of theland and make sure there aren't
other issues going on and ifthere is, you can prepare for
that for surgery.
So there's a lot of things,education wise, that I learned
that I would have done it if Iknew all these things.
Speaker 3 (06:52):
Yeah, and I think the thing is is that education is
empowering to patients.
You have to explain things tothem, and so I always tell them.
I explain what if we do a,whether we do a bravo or pH,
with impedance?
I explain, you know we'relooking for a numeric value.
You tell me you have symptoms,but I need a numeric value
because what if you have thesesymptoms after surgery?
(07:12):
I can kind of compare, you knowsame with the manometry that
tells me how things are movingdown.
And I'm also very, very honestwith patients about manometry.
I tell them they're going tohate it and it's miserable,
because I did it in training, sowe learned how to not only do
the manometry but read it.
Inserting that probe is awful.
Patients don't like it, and Iremember my attending at the
(07:34):
time we told the patients notthat bad, and I was like, no,
but it is.
And I was like, but it is.
And so I tell patients, so atleast they have that in their
mind.
And then sometimes they're likeactually it wasn't as bad.
And so I think you have to.
You have to give thatinformation and give them a
reason for things, especially ifit is a long list of things or
(07:54):
a workup that they're going tohave to undergo, because in
their mind, like you said, it'swork, it's money, it's cost,
they're deductible, and so youhave to provide them with them
understanding.
It's to help tell a story, in away.
I tell patients it's kind oflike we're in a movie and
they're the main star, right,they've been in the movie the
(08:16):
whole time, they know everything, and I'm coming in like three
quarters of the way in and Ihave to like catch up and put
all the pieces together of thatmovie in order for us to get to
the end.
And so that kind of helps too,because I wasn't there for the
last 20 years or whenever theyhad their original surgery.
So I have to kind of piecethings together and do it safely
(08:36):
for them.
Speaker 1 (08:38):
So quickly, because I don't know what is that
procedure that you were justtalking about, Just in case
patients, sorry, just in casepatients are listening to this
and don't know, what it is andhave to do it.
Speaker 3 (08:51):
Yeah.
So a menometry basically iskind of I call it like a noodle.
It's a little noodle that goesinto your nose.
You are awake for the procedure.
You do have to be awake for it,and so when the tube goes down
into your nose it goes all theway into your esophagus but kind
of goes, you know, between theesophagus and the stomach.
That's kind of ideally whereyou want it.
And while you're awake withthis tube in your nose you have
(09:15):
to drink water and the probesenses the water based on
temperature of the water, and sothen that helps us see the
actual function of youresophagus, the actual muscle
movement.
So sometimes we see abnormalmenometry, let's say, for
patients who've had a sleeve,for whatever reason, they may
have abnormal movement of theiresophagus, and so that kind of
(09:37):
gives us again more numericvalues into what's actually
going on in the physiologicalcomponent of that.
Speaker 1 (09:44):
That makes sense.
Thank you for explaining thatAbsolutely.
Speaker 2 (09:48):
Yeah, I think that's a big.
That's really key, tammy, I'mglad you brought that up,
because a lot of people, evenwith a scope, they've never had
a procedure before.
A lot of folks that we operateon or are considering for
operations are well below 45 or50 when they're getting
colonoscopies and so they maybenever had a procedure really in
their life and all of a suddenyou're coming with a menu of
items that people have to do andmaybe seeing some other
(10:09):
physicians or some other folksthat they really need to get
evaluated by it can be verydaunting, yeah it can, it can be
.
Speaker 3 (10:17):
And I think that's the hard part too.
So you are mentioning, as faras you know, you know, being a
bariatric coordinator and thingslike that.
And now we have the role ofpatient navigators, because
every patient's insurance isdifferent and every policy or
whatnot is going to havedifferent requirements.
And then if you're like givingthem this laundry list, it's
either like, oh my God, like Ihave to do all this stuff yes,
(10:40):
you know.
And so sometimes it's like wait, what do I have to do again,
you know.
And so that can be overwhelming.
And what I also tell patients isyou know, especially when you
do like an info session andyou're talking to patients,
patients will say, well, I haveBlue Cross, blue Shield.
Does that cover bariatricsurgery?
And I said I don't know, itdepends on your policy.
(11:01):
And the thing is is people willcall insurance.
You'll call your insurance andyou'll just talk to a generic
person and say, do you guyscover bariatric surgery?
And that generic person isgoing to give you the generic
yeah, we do, but your policy maynot cover that.
And so that's what we have tobe very explicit with patients
because, yeah, blue Cross, blueShield offers bariatric surgery,
(11:21):
but your policy or youremployer may not provide that
benefit to you.
Speaker 1 (11:26):
And then, especially in your case of doing revisions,
you have to check to make surethey do the second surgery
because some insurances will noteven do any second bariatric
surgery.
Yeah, at the end of I could haveput myself in an office
somewhere and not seen patients.
Honestly, just talk to thembefore they come in, whatnot.
(11:48):
But I wanted myself at thecheckout so that after their
appointment I can say I know,you just got thrown a lot of
information.
Here's how to contact me.
Do you have any questions?
Because you know the secondthat they walk out that door.
That's where all the questionscome.
Speaker 3 (12:03):
Oh yeah, oh yeah.
It's a lot.
And I think, for patients as itis, when they come into clinic
to see me, they are already sonervous, they're nervous,
they're emotional, they inreality don't want to be there.
Right, like no, and that's thething is yeah.
(12:25):
And the thing is is that theyhave been.
Our patient population has beenstigmatized and ostracized and
judged all of their lives andthey're just told you need to
eat less and exercise more andthat's going to solve all the
problems.
And I tell patients I said,would you be nervous if you were
coming here for your bloodpressure?
And they're like no, and I'mlike and that's the thing is is
(12:45):
that we have to change themindset of obesity and that
obesity is a disease, it's achronic disease and it's not a
choice.
There are all these componentsand, yeah, and we are.
We have no idea, becauseeveryone thought surgery was
this cure.
And then if patients gainedweight after surgery, they were
like, well, you're a failure.
(13:06):
And now we're like, well,that's maybe not necessarily
true.
And then it's like and theneveryone thinks we'll go via
nozepik is going to be theanswer to everything, and I
don't think it's an either, or Ithink it's a complex disease
that we have to understand andwe have to stop blaming people
for it, because that's not fair,absolutely.
Speaker 2 (13:25):
Amen.
You're very much preaching, andI appreciate that, because
there's this sentiment sometimesthat people don't even come
back to get seen if they regainweight or if they happen to have
reflux or some other issueafter surgery, because they're
so afraid of the judgment orafraid that they'll be told this
is all your fault and we can'tdo anything for you, when
(13:46):
actually it's usually notanything to do with what you did
as a person.
And then, too, there's actuallya lot of options on the table
to be able to help people atthis point.
Speaker 3 (13:56):
Yeah, and I think, again, it's all about
expectations, it's all aboutknowledge, because I tell
patients one thing so I say, ifI give you a gastric bypass and
you see me a year later andyou're like, hey, doc, I've been
doing all these things, I stillcan't get those extra 10 pounds
off, and so on and so forth,that's one discussion.
(14:18):
And then we're like, ok, well,we can maybe add a medication,
or we can look at other things,or so on and so forth, and it's
not that you're a failure, it'snot that your surgery failed,
it's just your metabolic setpoint is different.
Now I tell patients that samepatient.
I say, well, if you come to mea year later and say, well, you
know, I'm eating Taco Bell, andI kind of let things go, that's
a different discussion Because,again, treatment of obesity is
(14:41):
multifactorial.
If surgery, it's potentiallymedications, it's diet, it's all
of those things, and so it'sall about perspective.
In that sense, yeah, absolutely.
Speaker 2 (14:53):
So I'm curious.
Actually, we've talked a lotabout what you do now and some
of the cool and complex thingsthat you break down.
How did you get into this field?
What brought you to it?
Speaker 3 (15:01):
Bariatrics in general .
It was funny Because when Iwent to fellowship I thought I
was predominantly going to doanti-reflex surgery Because that
was a lot of my training.
But then when I went intofellowship and I purposely chose
a fellowship that gave me avariety, Because I didn't want
to kind of pinch it home myself,so I did something where I did
complex abdominal wall, I didforegut and then I did
(15:22):
bariatrics, and then I thought Iwould never do robotics, I
thought I would just do leprosy.
Speaker 2 (15:28):
You ended up in Florida.
How could you avoid it?
I know.
Speaker 3 (15:31):
And then I did it and I loved it and I loved the
operations but also I loved thepatient population.
I loved taking care of thosepeople.
I loved seeing how much theychanged afterwards.
And it wasn't about a number ona scale, it was about life
goals.
And I really realized that inmy first job, where it was like
(15:56):
a patient would say somethinglike I was able to take my son
and I could go on the rollercoaster Because it wasn't a
weight restriction or one womanwas like I've never been on a
plane and I finally got to go ona plane and I wasn't
embarrassed Because we alwaysdrove everywhere.
Speaker 1 (16:11):
You just did two things.
Yeah, I used to go on rollercoasters Wins, we go every year
to Adventureland here in Iowaand a year before my surgery I
got onto a roller coaster and itcouldn't shut.
So that was heartbreaking,Because my oldest son was like
mom, why did you get off?
And I haven't been on a planesince middle school and here I
(16:35):
am going on planes now.
Speaker 2 (16:36):
So it was just a few things that you never seen, and
it was very either.
Speaker 1 (16:42):
My anxiety was a little through the roof just
because it's a new thing, butweight had nothing to do with it
.
Me not fitting in an airplaneseat had nothing to do with it.
So, yeah, yeah.
Speaker 3 (16:55):
It was more of like getting through.
It was more like TSA security.
Speaker 2 (17:00):
Literally Not using a shoe or that power Exactly.
Speaker 3 (17:05):
It's like getting all your stuff out on time.
That's a whole separate stress.
But yeah, I mean that's kind ofhow it should be for what we do
.
And then the revisional workwas something that it was, I
would say I fell into it.
But also there is so little onon against I don't want to say I
(17:27):
didn't have a choice.
I would say that those patientsstarted coming into my clinic
because my other two partnersalso did very similar operations
and, being at WashU, we werethe only huge medical center
that would even take care ofthese patients, and so we were
(17:47):
at Catchman's area, not only forMissouri, but for Illinois,
sometimes Kentucky, tennessee,arkansas, so we saw people from
everywhere that hadcomplications, and so I had to
take on these patients.
But also, at the same time,being a young surgeon, I was
fortunate enough where I had twocolleagues that were awesome.
They're my good friends,they're my mentors and they
(18:09):
helped me through that too,because I could do it.
But it's always nice whenyou're a young surgeon to have
that backup.
And so they helped me andtaught me so much, because I saw
things that I had never seenbefore and patients with
complications from surgery thatI had never managed before, but
with my colleagues I was able totake care of those people and
(18:32):
really have that kind of aspectof changing their life as well.
Speaker 2 (18:36):
So that's a really interesting thing that you
mentioned.
You basically not only wereable to use the skills that you
had, but because you had goodmentors where you worked, you
were actually able to do evenmore complex things and grow
into a role where you could takecare of whoever came in the
door.
You actually were able tofigure out a way, even if it was
complex.
It sounds like.
Speaker 3 (18:57):
Oh yeah, my one senior partner, Chris Egan, has
been doing bariatric surgery for30 years, has done over 4,000
bypasses and I'd call himSometimes.
I'd call him because I'd be oncall.
I'd be on Christmas.
I'd be like, hey, Fritrisco,what's up?
Speaker 2 (19:12):
And he was just like and I'd talk to him.
Speaker 3 (19:15):
And I'd say, hey, like what do you think?
Or I've never seen this.
And he's like, oh yeah.
Speaker 2 (19:19):
I've seen that I'm like, of course he's so
experienced yeah, he's soexperienced.
Speaker 3 (19:24):
And Shayna Eckhaus was my other partner.
She's, I think, three yearsolder than me.
She came from Duke and is nowback at Duke, but she taught me
so much too.
But then it was awesome becauseit was nice to have also two
female surgeons that were soclose and she didn't do a lot of
robotics.
So then she would call me inwhen she did robotic cases and I
(19:45):
kind of helped her withrobotics and then she would come
in because I would be like hey,can you take a look at this?
And she's like, yeah, sure, andso we were just very it was a
very great collaborative teamthat we had.
That I was very appreciativefor, and I think that's probably
the most important thing when Itell junior trainees, like,
going into their first job, yougot to have the right people,
(20:07):
because that makes such a hugedifference to who you will
become as a surgeon a thousandpercent.
And they really, really helpedme.
I cannot thank them enough formy first job and I talked to
Shayna still all the time.
Speaker 2 (20:19):
Wonderful person.
Speaker 3 (20:20):
Yes, that makes a lot of sense.
Speaker 2 (20:22):
Yeah, can you talk a little bit more about?
Yeah, so we definitely do havesome listeners who are in the
medical field, and I think that,for I really want to emphasize
something that you said, whichis when you're looking for a job
, especially your first job, itdoes matter who's around you and
the people there.
Can you tell me a little bitmore about how?
Did you know you were cominginto an environment where you
(20:42):
would be supported, where therewould be that kind of
relationship, or was that onethat you actually participated
in making yourself?
Speaker 3 (20:49):
I got the sense and I felt that at the time with
WashU and the MIS section.
It was a little bit unique atthe time that I came in because
a lot of people were youngsurgeons and I thought you know
you have the senior surgeons aswell that were more experienced.
But the reality is is there isa different feel when you have
(21:11):
colleagues sort of around yourage range.
You know, because I loved Egan,I could call him anytime but it
was nicer because Shayna wascloser to my age.
Speaker 2 (21:21):
Right, you know what I mean.
Speaker 3 (21:23):
It was just easier to call her and even if I had a
hernia, that I was on call, Iwould call my other colleagues
who were also younger, and so Ifelt more and I think that's the
thing is that when you havethat group and you get that
sense too and even my group here, they are younger and I know
them Like I knew them throughthe conference trail and those
(21:44):
sorts of things, but they callme and they are like, hey, can
you come take a look at this?
I do the same thing.
So you really want that teameffort where you're not on an
island and you can get thatsense when you interview.
Speaker 2 (21:55):
Yeah, that makes a lot of sense.
And then from the patientstandpoint, I think what's
really interesting about that isit's safer for patients too,
because there's more than oneset of eyes and the combined
experience in the room sometimesmeans more than the experience
of just the person.
Speaker 1 (22:10):
That's the surgeon.
Speaker 2 (22:13):
So you're speaking, I think, to something that's a
huge quality and safety issuefor the people we take care of
too.
Speaker 3 (22:19):
Exactly, and I think us as surgeons, as an individual
person.
We don't know everything, wehaven't seen everything, but
that's why it's all about that,what I don't know about that I
wish I wish you know what I mean, right?
No, I don't.
Speaker 1 (22:36):
Say that You're willing to say I don't know it
all and I'm not afraid to callsomeone and be like I've never
seen.
This.
That says a lot about yourcharacter for sure, because
there are some people that willbe like, oh yeah, I've seen it
all, I can do anything, and thenhave issues because they just
yeah.
Speaker 3 (22:55):
So good for you for not having yeah.
I love a good team approach andalso not only that, I enjoy it.
I enjoy going my partners, evenif they don't call me, I go see
and I'm like, oh yeah, Like Isee what they're operating.
They come see me Like hey,what's going on?
And I think you should havethat team approach, Because what
we do is hard and we take careof complex patients and you want
(23:16):
to do the right thing for theperson, and so if there is
someone else that knows about it, then you should be able to go
to that person.
Speaker 2 (23:26):
Yeah, that's a great approach and I do think that
there is.
Luckily we're trained that way.
We don't always end up insituations where we work in the
real world that has that kind ofcross coverage, but definitely
it is beneficial for everyoneinvolved most times.
Yeah, that's great, that'sgreat.
So are you enjoying Tampaoverall, being back and kind of
(23:46):
being back home, being back inyour environment?
I know the insurance isprobably a little different, but
overall it is.
Speaker 3 (23:55):
It's crazy how Tampa has changed, and so I left in
2018.
So left pre-COVID, obviously,and the population here has
exploded, so the number ofpeople that have moved to Tampa
(24:16):
has exponentially increasedpost-COVID.
And so what's interesting is youhave a hospital system that was
used to a certain number ofpeople in the city, and that
hospital hasn't grown toaccommodate all the people, and
so now Tampa general is workingfeverishly to build a new
(24:38):
surgical pavilion to help expandthose things, and so I'm
learning how to.
That's a whole separate thingthat I'm learning how to
navigate, because I came from asystem that was a huge system
but didn't have anywhere nearthe population of people here,
and it's interesting too,because you have so many other
(24:59):
facilities in the area, you haveso many other hospital systems
in the area, and then you alsohave the component of patients
don't always live here full time, so some come from the
Northeast, there's snowbirds,and that always makes me nervous
because I'm like I don't wantto do this big surgery.
And then you go back up toJersey, and so I'm learning how
(25:24):
to navigate those things too,because it's a different
landscape here than I was usedto, and I think that's also just
because of how Tampa haschanged.
There are some places that Idon't even recognize.
Channelside used to be dirt andnow it's like Michelin Star
restaurants and all this otherstuff and I'm like what happened
(25:45):
?
So it's just crazy how it'sgrown, which is good for the
city.
Speaker 2 (25:50):
That actually brings up a good point, though, because
I think a lot of places don'tnecessarily get the get
bariatric care or foregut care,good reflex care.
There's never really enough togo around, and even in a place
like Tampa, where I think peoplehave the belief, probably, that
it's like oh, there's so muchof it, it's totally easy to get
that no big deal.
Even in a big population it'sactually not that easy.
Speaker 3 (26:14):
Yeah, just because there's so many people I think I
read somewhere that 5,000people are moving here every
quarter or something.
Crazy, just the number ofpeople.
And because also, what we seeis people will live in Florida,
because now again, how COVID haschanged things is everyone
works remotely, so people's jobswill be in New York, but they
(26:35):
will reside in Tampa, and soit's just kind of crazy now that
everyone works from home andeverything's digital and
technology and stuff.
Speaker 2 (26:46):
In dealing with people who do travel, since that
seems to be the specific kindof snow bird or digital nomad
situation in Florida.
Do you have patients thatapplies to, and how do you
counsel them differently or workthem up differently than you
would anyone else?
Speaker 3 (27:01):
I would still do the same work up.
I did actually have a patientrecently and I did a big
revision on her and I waitedpurposely because she was like
I'm going to be up in theNortheast for the holidays and
so on and so forth for like twoor three months at a time and I
was like I'm not doing yoursurgery until you're here for at
least six months.
(27:21):
She was like, okay, you know soand so forth, and I think when
patients realize and especiallyfor a revisional patient when I
tell them the magnitude of theoperation that we're doing and
those sorts of things, I thinkthey really get a better idea.
You know it's not.
I tell them I'm like this isn't?
You know, we're not removing amole or something like this is a
big operation, although I'mdoing it robotically, and
(27:41):
there's four small incisions.
It's a lot of work on theinside and so I want to make
sure that you are okay, becauseI also I know this is going to
be shocking as a surgeon, I'm acontrol freak and so if it's my
patient, I want to be able totake care of them and I want to
be able to be there for them ifsomething happens.
Speaker 1 (28:02):
Yeah.
Speaker 2 (28:04):
That makes a lot of sense, yeah, and I think that
sentiment is really importantfor everyone to hear too, that
these, even though they are safesurgeries, they're people, are
really worked up really fromhead to toe and they're done in
minimally invasive ways, withcuts that look really small on
the outside.
These are big changes thatpeople are going through, so I'm
really glad that you mentionedthat as a specific consideration
(28:27):
for your practice.
Speaker 3 (28:29):
Yeah, and I think for those undergoing bariatric
surgery, because they'll saythings like well, is it like my
getting my gallbladder out?
And I said same incisions.
I said, but when you have agallbladder, you kind of go back
to your normal life, right, youjust kind of hear feel a little
sore, or whatever I said thebiggest thing is is like what I
tell you is I'm going to do thissurgery on you in a couple of
(28:50):
hours and then you're going towake up and now I'm going to
tell you to change everythingthat you've ever done for
however many years you've beenon this earth, and I expect you
to do it today.
You know, and that's hard youknow, like take small sips and
make sure you do this and makesure you do that, and so I think
, and when I tell patients, it'smore of the mental aspect of
things, it's interesting.
(29:11):
Yeah, and sometimes patientsare like what you know, they get
offended.
I'm like, no, I'm like it's thepsychological change, it is
your relationship with food thatchanges.
It is how you, you know, arewith family and friends.
It's everything.
Speaker 1 (29:27):
And so we can give us all situations and if you even
want to indulge in something,you can't, and that is mentally.
Speaker 3 (29:34):
Yeah, the mental part is definitely huge and yeah
it's hard, it is hard and so andI think that's the thing that
unfortunately some people don'tunderstand outside of patients,
like even other physicians, youknow they'll be like, oh yeah,
just give it.
You know, just do a bypass, andI'm like that's not how that
goes, and so it takes a lot oftime and I think, if anything,
(30:00):
sometimes the psychologicalevaluation before surgery is
probably the most important part.
Speaker 1 (30:06):
Yeah, yeah.
Speaker 2 (30:08):
Very much so.
Yeah, that's key, and I think alot of people are afraid of
that because they think they'llstop them from having surgery or
stop them from having arevision, but oftentimes it's
the opposite it actually is.
It's a way to enable someone todo well and to identify things.
So I'm really glad that you'rebringing that up, because that
is a source of concern for a lotof people considering this.
Speaker 3 (30:30):
And I think it's just you know, and again, patients
are fearful, they're going to bejudged, they're going to be
like analyzed or whatever, andit's more about understanding
and having insight.
Like Tammy mentioned, yourrelationship with food, how you
use coping when food and justthose sorts of things, because
(30:51):
that will be differentpost-surgery and what that looks
for what that looks like isgoing to be individual, you know
, or different for everyindividual.
Speaker 2 (31:00):
Yeah, definitely.
Well, this has been a very wideranging conversation.
Speaker 1 (31:05):
Yeah, yeah, I know right.
Speaker 2 (31:08):
So from St Louis to Tampa.
I'm sure Tampa is thrilled tohave you back, because it sounds
like you're making waves.
No pun intended, but you'rereally offering a service that's
not only extremely high quality, especially with the revisional
work that you're doing, butreally compassionate, and just
everything that you do shinesthrough as focused on taking
care of people.
(31:29):
And I'm very proud to know you.
You served as a mentor to mealso in the brief time that
we've known each other.
I really appreciate it.
So thank you for being such aguiding light in this space.
Really appreciate it, thank youguys.
Speaker 1 (31:42):
Thank you guys for having me.
Yeah, absolutely Thanks forbeing here.
So, for those that arelistening, don't forget to like
us on Instagram.
Send us a message if you wantus to discuss anything, but
otherwise we will see you allnext time.
Thank you for being here.
Bye.
Speaker 3 (31:57):
Bye.
Guys, Bye.
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