Dr. Robert Cerfolio Returns! - podcast episode cover

Dr. Robert Cerfolio Returns!

Apr 29, 202550 minSeason 2Ep. 39
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Episode description

The wonderful Dr. Cerf is back again! He is one of the world’s top thoracic surgeons and his peers have voted him one of America’s Best Doctors. EnJOY this conversation between Dr. Cerf and Craig! 

See omnystudio.com/listener for privacy information.

Transcript

Speaker 1

This is me, Craig Ferguson. I'm inviting you to come and see my brand new comedy hour. Well it's actually it's about an hour and a half and I don't have an opener because these guys cost money. But what I'm saying is I'll be on stage for a while. Anyway, come and see me live on the Pants on Fire Tour in your region. Tickets are on sale now, and we'll be adding more as the tour continues throughout twenty twenty five and beyond. For a full list of dates,

go to the Craig Ferguson show dot com. See you on the road, My DearS. My name is Craig Ferguson. The name of this podcast is Joy. I talk to interest in people about what brings them happiness. Today in the podcast, one of my favorite guests of all time, of all the shows I've done. Terrific man. I'm very interesting. If you're interested in your health or general health. I think most people are, but you know, maybe you're but this guy is just I just kind of good enough

of him. His name is doctor Wells, his name, but that's his title. He's doctor Robert sirfolio John.

Speaker 2

So listen. Here's the thing, Sheriff, you.

Speaker 1

Are a record breaker today because you are the first time I've had Is this a third time you've been on.

Speaker 2

The show her time? That's a big honor for me. I'm honored.

Speaker 1

And listen and let me just say this the third time on the show. But we remember the first time we recorded, didn't record at all? How could I forget fourth time? The fourth time? That's exactly right.

Speaker 2

What's the what's the deal with your head? Say? Are you? Are you doing a lot of.

Speaker 3

Robutics therect I'm an air traffic controller and I wanted to get a drink of my water.

Speaker 2

But I don't want to get water on the thing. Hey, what's the I'm going You made me think I want to drink of water?

Speaker 1

So what's the deal with when you do the theoretic surgery?

Speaker 2

Do you do it thoracic? Thoracic like Thoracic park.

Speaker 3

Exactly instead of Jurassic it's thoracic. You're right, but I love that analogy. You're right on it, man, So let me ask you this.

Speaker 1

Do you wear your little headset when you're doing it and tell everybody they're what you're doing?

Speaker 3

So when I have visitors that are remote, I do, and it's awkward. When I scrub in, you have a headlight, magnifying glasses and this. Then when I go to the road, that should put the ports in and make the incisions. Then when you leave the patient and you walk ten or fifteen feet over and said at the da Vinci console where you're looking through the box and moving your hands, then I just have this thing on, but it's more comfortable than the one that they gave me today.

Speaker 1

Talk to me about it. What's the da Vinci console? Because I think you know, I of course know what it is, but many people will know what dvin No, you're you're.

Speaker 2

One hundred percent right. I mean people still don't get it.

Speaker 3

So when we say we do robotic surgery, what that means is first we're scrubbed in like doctors with gloves and a mass standing over the patient. We make three or four little incisions, put tiny instruments in, like through a little probe, and then the instruments go inside of that and then there's this giant contraption that comes rolls over the patient and gets attached to those arms. That's the robot. But we don't operate that from the operating

room table. We then leave the table, We take our gown off, our gloves off, we go sit in the chair and we look in this giant box and we're sitting looking in this monitor, this immersive world, and what I love about it. Actually, I was giving a lecture

last night and they say, where I'm the happiest. I said, you know, I'm I'm happiest you know in a very competitive pickleball match or a great golf match, when I'm doing well or teaching or educating or putting an impact on the world, or when I'm submerged underwater scuba diving in the robotic console. Because what it's like is you become miniaturized and they drop you inside the chest in my case, or the belly if you're a belly surgeon.

So I'm now looking in this console. My head is in this thing three D. I'm looking through this classes. I can move my hands, I can move my feet. There's six pedal for my feet, there's a couple of pedals for my hands. And as I move those instruments that we put in through those little tiny sticks, they move and they are a mimic to our hand motion,

So the surgeon's doing the operation, not the robot. But the robot allows you to shrink your hands down to these tiny little one sonometer or half an inch instruments instead of your big ugly mits in there where you're making big decisions and spreading the ribs or cutting the muscle.

Speaker 2

So it's minimally invasive. So that's how it works. You know.

Speaker 1

That's amazing to me because I don't know if you remember when you were a kid you and died of the savings. You remember a movie called Fantastic Voyage with Raquel Welch in it.

Speaker 3

I'm forget Raquel Welsh in that outfit my gosh, right, So.

Speaker 1

Raquel Welson Fantastic Voyage where there's a roulebot scientist or something like that, and they have to shrink they shrinkle sales down into a little spaceship and then they go into the guy's bloodstream and they sort it out.

Speaker 2

That's exactly what it's like.

Speaker 3

But they of course are really small and they're interest inside. Remember they the way they got out was through the lymphatic system.

Speaker 2

Remember there was the arteries in venus and they went in the lymphatic See.

Speaker 1

I think that was a that was a script there. They should have come out with the corooper. I feel like, get into the digestive tract, get your little spaceship. Look, there's been times when I felt like I've had a spaceship, my digestive tract, and you get into the intestinent note you come and on the way out, quick colonoscopy.

Speaker 2

Not to mention.

Speaker 3

And then it's very appropriate that they end up in the excrement, giving you know.

Speaker 2

How how the end of that movie had.

Speaker 3

But yeah, you're exactly the problem with that is, of course, if they get in the l any type of the GI track, they create a hole that they have to seal on their way in. So that was one of the tables. That's why they went through the ear if you remember. But what a fantastic movie.

Speaker 2

What a fantastic I didn't.

Speaker 1

I didn't know that it was. Actually it was so I could do you ever? You know, I met Raquel Wells a couple of times. She was on my old late night show. Really yeah, now for you and I your generation to get to meet Raquel web So. But here it gets even better. So she knew I was very excited to meet her. So the crew at my show. They got a giant poster of you know, the poster of her wearing the fur bikini and a million.

Speaker 3

You say it was in the fur bikini and what movie was that? It was one million.

Speaker 2

Years BC, that was it. Yeah, so she's in.

Speaker 1

The fur bikini and she's she wrote on it and she said, share Craig because she she liked to speak friends. She said, share Craig. I could I remember, because I've still got the poster, Share Craig. You can visit my cave anytime I remember to wear your kill love Raquel.

Speaker 2

Oh my gosh, that would be like it was.

Speaker 1

She was.

Speaker 3

Yeah, the everybody had a poster or when I was a kid, she was unbelievable.

Speaker 2

Yeah, that was that was.

Speaker 1

Is she still alive and how well she? Sadly she passed a year or two ago. I think I don't know for sure, but I think she had trouble with Alzheimer's or dementia or something that it was. I don't really know the difference, to be honest. Well, maybe you could tell me what is the difference between Alzheimer's and dementia.

Speaker 3

Well, there's a there's a pretty pretty big difference, actually, I mean Alzheimer's. One type of dementia is a more general term of which there are specific types.

Speaker 1

Yeah, all right, so dementia is like a blanket term, like like like cancer maybe like kind of there's so many different cancers, but it's a type of cancer.

Speaker 2

It's kind of like dementia where you and I are headed. That's a general term that we could have fought.

Speaker 1

You know, I don't know why you have to say that, because it's not necessarily going to Somebody asked me what A buddy of mine asked me once. He said, when you get older, what do you want to go the plumbing or the or the upstairs, not like definitely upstairs. Yeah, oh you do, well, no thing upstairs, because then if I my upstairs goes, that somebody else's problem.

Speaker 2

If the plumbing goes, that's my problem, that's vegan.

Speaker 3

So it's interesting how we because I think of somebody else's problem. The last thing I want to do is do that to my my three boys. Remember my three boys lost their mom. The last thing do a hard thing with me. So I'm like, listen, if that happens, we go on a cruise, and I just happened to slip off that top part of the oh yeah, the little outdoor thing, and I'm gone and don't tell anybody for like the next day, and then don't worry about it, no, because that's terrible.

Speaker 1

My deal I have with my wife is is that you get me, get me into some kind of situation where I'm on a drip, like some kind of parcacet propfol drip, and just like just hit that thing every hour on there and put and put movies on.

Speaker 2

Yeah.

Speaker 3

The only the only problem with that is there's a medical record that leads to that could get her in trouble.

Speaker 2

I think the cruise is much safer for you. Yeah, yeah, I get well. Look see here's the thing now.

Speaker 1

I go for my annual physical yesterday, so it was kind of yeah, so you know what, it's two years since I had a physical.

Speaker 2

But well, you're so healthy. That's all you need. Man. Look at you. You look you look like you're forty five years old.

Speaker 3

You look great, you look you look even healthier this time than I think the last. Maybe because it's we're not together, but you look. No, I tell you what it is, my friend, I lost weight.

Speaker 2

I knew it.

Speaker 3

I could tell I bet you lost about twenty pounds, right.

Speaker 1

I don't know if it's as much as that, but it's a lot. I mean what I did was I recorded a stand up special and then I went to the edit for the stand up special.

Speaker 2

Like, who the fuck is that guy? Yeah?

Speaker 1

I was like, I was like, oh my god, I know the special is out now when people are like, oh my got eling some fat and I got I go fah, I just I just I just stopped exercising and I just kind of like wasn't paying attention to the food. And yeah, bol because it happens much quicker now, that kind of thing now that I'm older. No, So I know question like, yeah, I just like I'm back on it. I'm walking and running every day, I'm doing calistanis. I'm like trying to lay off the candy and stuff.

But it's much harder than it used to be to get in shape, you know.

Speaker 2

Because we're sixty. Yeah, because we're sixty.

Speaker 3

That's why I'm so you know, I don't even have a glass of wine at dinner anymore.

Speaker 2

Last year, I'm like, I don't need it.

Speaker 3

I sleep better without it, and I don't need the calories because I literally affects my sleep, and I can notice that I'm up a pound or two because I weigh myself twice a day because I'm crazy. But I think you're right. It's part of being sixty, you know. And so I'm totally into the health thing.

Speaker 2

You know. I'm not about exercising and all that. It's fun. I know you are right, but the show is look at you. I mean you, I mean you. You appreciate it.

Speaker 1

Fantastic shape, I mean, I appreciate that. Now, let me just say this. So I go for my annual physical and I'm talking to the dogs. It's a new doctor. Because I knew I moved back to New York. So I go, I get a new doctor.

Speaker 2

You know me.

Speaker 3

We're happy to have you back in the city where which is your home, where we love you.

Speaker 2

So thank you for coming back. Thank you.

Speaker 1

It's the greatest city in the world. And anybody that doesn't agree with me, you know, they don't need to come here. So I agree it. So I I'm talking to my doctor.

Speaker 4

Now.

Speaker 1

You know, I like a doctor, especially for a general practitioner. I had like a big city doctor with slim fingers.

Speaker 2

You know what I'm saying. I'm I'm talking to him about that.

Speaker 1

He said, you know, the first exam said that's going to go away soon, that's going to go away.

Speaker 3

You could just say you don't want to just get a digital rectal ultrasound or a p s A or an MRI of the prostate and say the last two times I said, listen, I don't want a digital record exam.

Speaker 2

I'm out, you're not doing it. You can do that. Well, I you know, I don't know about you, man, I'll miss it, of course not.

Speaker 1

I mean, no, man, I'm like, you know, it's for me. It's a bit like vinyl, you know what I mean. It's like it's not necessary anymore.

Speaker 2

But you know, but you kind of like today, I tell you a quick story.

Speaker 3

So when you're a medical student, you have to pair off with another medical a male student. Of course, the men got the there was female medical students. They had to do it to the man obviously, and you know and advice.

Speaker 2

Oh yeah, yeah, it's the day. Yeah, exactly right.

Speaker 3

So to make a long story short, when I went into the room with the other guy said, I said, listen, I'm just going to skip it. If you agreed to skipping it, I'll skip mine if you skip yours.

Speaker 2

He said, yes, so we did. So I never had one.

Speaker 3

So about five years ago I had to get this executive physical and I go see a doctor here in New York where I work, and he goes, you need a digital rector. I said, listen, bro, I've never had one. He says, well, then you rover du And I said, no, you can do an MRI I and you can do a PSA of the blood and I'll take it. And he said, and you need a digital rectal exam as well. He was so insistent. And then he said, you know you're not listening. You're being a typical doctor who's a

bad patient. I said, okay, fine, so I've had one in my lifetime and that will be the last one.

Speaker 2

Yeah, well, I don't know. I mean, look as things that.

Speaker 1

Can happen to you and the doctor's office, a digital regal exam, it's kind of like a night in the eighties.

Speaker 2

As smart as I'm concerned. It was like, it's no big deal, but the but the I've never heard it express that way, Craig, but I love it. I may I may use that line and my lecture.

Speaker 1

I mean, we all live differently in well, I live differently in those. But let me ask you this, then, if you're doing an MRI of uh, the procepct of the prostate isn't the MR isn't that radiation?

Speaker 2

Isn't that MRIs have no radiation.

Speaker 3

That's the advantage to MRIs no radio and and the CAT scan that has some radiation. Like like I'm I've flown to the Bahamas the last couple of weekends. I got probably more radiation on that flight three and a half hour flight there and back. Then I do get in a CAT scan without contrast or a chest X ray. So yes, there's chest X rays and there, and there's cat scans, and there's cat scans with contrast, and there's a PET scan has a lot more radiation, but the

amount of radiation is negligible. And when patients ask those questions, we say, we're doing this to either you have cancer and we're following you or surveying you, or we're working you up for cancer. That's a much higher risk to your life than the minuscule amount of radiation that you're getting on the scan. Yeah, so don't worry about it.

Speaker 1

Hello, this is Greig Ferguson, and I want to let you know I have a brand new stand up company special out now on YouTube. It's called I'm So Happy, and I would be so happy if you checked it out.

Speaker 2

So what's the special?

Speaker 1

Just go to my YouTube channel at the Greig Verguson Show and is this right there? Just click it and play it and it's free. I can't look. I'm not going to come round your husband and show you how to do it. If you can't do it, then you can't have it. But if you can figure it out, it's yours. So let me ask you this. Then, because they got a new doctor, so I got to run on list. You're my second opinion guy right.

Speaker 2

You know you might go to.

Speaker 3

Guy right, and my price is right for the second.

Speaker 1

I was going to say, I wish I hadn't said that, because you're telling me what I'm worth, so it's appropriate, so it's not really a second opinion. But you said to me, look, we're going to look at your cholesterol and as a whole new blood panel. He said, but you're you're in your early sixties, so I want to do a calcium calcium scoring study.

Speaker 3

And I was going to suggest that you get one, you should get one of your heart to look at calcium in your the epicardium, the outside of your heart, to make sure you don't have coronary artery disease. As opposed to getting a CAF where they stuck a catherine you're growing at your wrists and they put a cather up and then they inject contrast and they look at your ye really would.

Speaker 4

No, I'd prefer not to have That's like, that's not a big deal. But that's a little bit invasive. It's a little nick in your artery. But you're right, you don't want it. And the calcium scoring stuff hopefully.

Speaker 2

Yours was zero. I don't know. Yeah, I haven't had it yet. Oh yeah, I had mine six months ago. It was zero, which was good.

Speaker 1

But yeah, you know, what when does it get to be a problem if you have what do they do if they find calcium on the outside of your heart?

Speaker 2

What are you are their drugs? Yeah, typical doctor, you know, we always give an answer.

Speaker 3

It depends. I mean, it depends on your family history. If you're overweight, if you have hypertension, all these other if you're symptomatic, do you get chest pain, if you do, then you're going to get a cath.

Speaker 2

I mean, you're going to buy a cath if that happens.

Speaker 3

If you're asymptomatic and don't have any risk factors and it's fifty, you're probably okay.

Speaker 2

But if the.

Speaker 3

Score is a thousand or two thousand or something, then you're going to get a cardiac cath, which is what I just described a minute ago.

Speaker 4

What is a cardiac cat Yeah, they used to put it in the groin and put a ca up. Now we do them in the wrist, and we put a little tidy cather up the artery and it goes retrograde, opposite of how the blood flow goes right down to your A order and right off the very proximal part of the order. Two little orifice, two little openings that carry your right and left coronary artery, assuming you don't have congenital heart disease, and a lot of people do

and don't know it. But let's say you're normal, and they put a little catheter in that and they shoot contrast, and then it shows all of the arteries. The left sided artery that has a couple of big ranches ones called the lad ones, calls the up to marginal et cetera in these other branches. And then on the right side you have a right coronary artery that usually supplies your sinus, the sinus node, which runs the rhythm of

your heart. So they look at the left and the right arteries of the heart and make sure that there aren't blockages that are seventy percent or greater. If they're seventy percent or greater, then you might need either a stent, which they can do right through this little incision, or if you have two or three arteries that are blocked, then you need a bypass.

Speaker 3

Operation, which is what you know. I'm a cardiothoracic surgeon. I do the thoracic part. My partners do the cardiac part. But that's what we do in this department every day.

Speaker 2

Man.

Speaker 1

That sounds like like, now, I wasn't really bold about it, but now I'm.

Speaker 2

Kind of scared about it a little bit.

Speaker 3

No, No, don't be because it's just a screening study, and chances are high, and you've lost weight, you're exercising, you have no pain with exercise, so chances are and you have no family.

Speaker 2

History of heart disease in your family. Do you nobody lives.

Speaker 1

Long enough in my family a heart attack to bus drinking, right, they die of alcohol or food related cancer.

Speaker 3

Fork of fork and hand related disease. I call it fork in hand, the hand, the fort.

Speaker 1

But that's interesting because I was talking about, you know, because my dad, I know, you know I told you to my dad, self guilt cancer. Yeah, and I was getting things I operate on, right, So I was talking to my doctor about it and I said, is you know, what do you think? And and he's because what happened was I remember I told you this. I was getting you know, pretty intense uh indigestion like heartburn and stuff.

Speaker 2

Yeah.

Speaker 1

I had it screened and they found selfais, no barrets, but some kind of a selfhagitis and some kind of information. And I went on those uh prevaced things, you know, the omnioprazole or something like.

Speaker 3

That, empprasol, mipersol. Yeah, it's great.

Speaker 2

I went on it.

Speaker 1

I went on it for a for about I think it was seven or eight months.

Speaker 2

I was on it, and.

Speaker 1

Then I got second screening and it all going away, but I still got reflux.

Speaker 2

So what I started to do is like that's when I really changed.

Speaker 1

I dropped the weight and stuff like that, and I think it's the weight, man, I think.

Speaker 3

It's one hundred percent the weight. And I'm sure he told you that. So the ammprasol just produces the acid production. Uh And but if you lose weight, you'll have much less reflex for sure.

Speaker 2

So that's great.

Speaker 1

That's amazing to me because I I mean, I put on wait, but I wasn't like nobody was going to who's that?

Speaker 2

Five? Guy said me, But you don't need to have that much Apparently, you know you can.

Speaker 3

There's just you could just gain ten or fifteen pounds and all of a sudden start to reflux. And as we get older, you know, you're more likely to reflux.

And here's the important thing for your listeners. And I'm sure they're not listening for medical advice, but if they are, thirty or forty percent of people who reflux are asymptomatic, meaning you know, they think they have sleep apne or they don't sleep well, or they have stenosis of their windpipe, and it's because they're refluxing and they don't know it. So it's one of the things that we look for when people have these other symptomatologies. They get recurrent pneumonias

and we don't know why. Well, at night day lie flat food comes up. It goes down the wrong pipe into the lung, usually on the right lower low because of the structure of the anatomy of the bronchus, and they get right lower lobe pneumonia's and as they've been refluxing and asperating at night when they sleep, or a lot of people sleep, apnea is related to reflux and they don't know it. You know, they wake up because there's a little bit of acid in the back of their mouth.

Speaker 1

That's so weird to me because I kind of like for something as I mean, I'm very kind of sensitive too because my father and his story. But you know the fact that people can be experiencing that and not even know because they think it's something else. I mean, it's like you know that thing. I'm sure you know this. Hippocrates who said I heard of it. Yeah, Let food be thy medicine is what he said. That was one of his things. Let food be thy medicine. And i'd

historical wisdom. You have all this wisdom of some history. You're a history buff. I have a history buff I do like I do like the ancient Greeks. I have to say, I'm interested in them. But I'll tell you what they didn't have. He didn't have antibiotics.

Speaker 3

No, they didn't have that. And they didn't have morphine. Yeah yeah yeah.

Speaker 1

Do you know what though, I heard this thing about ancient Egyptians, like you know how they used to wear the black high makeup right, yes, yeah, it's because of the sand right right, right right, and what like football players. But also what they had in ancient Egypt is that they had severe dental pain because sand gets everywhere and they and the bread, and the bread would grind other things.

So that's what opened up the trade route the opium root from China to ancient Egypt, because opium was the new wonder drug that was coming in from oh in Afghanistan was now Afghanistan.

Speaker 2

But I guess I do something else.

Speaker 1

Then he's a minor and all that stuff, and that's these trades out of them, because the Egyptians would buy as much opium as they could get.

Speaker 2

Of course because of the dental pain. So what I'm saying is well, and of course they didn't take care of their teeth.

Speaker 3

They didn't really understand, you know, the importance of it or have the skill.

Speaker 2

It probably had a lack of floid.

Speaker 3

We don't want to talk about fluoride with all the political controversy of florid right now, But they didn't have that when they were younger, which was clearly needed, et cetera. Yeah, and you know, dental infections led to a lot of heart disease in those days.

Speaker 2

And you know, I was a heart lung surgeon. We have it.

Speaker 3

There's a thing called endocarditis, which is infection on your heart valve, often from infections in your teeth.

Speaker 2

Bad.

Speaker 1

That's where that's why I heard that the plaque in your archeries, it's just the same.

Speaker 2

Plaque is like plaque on your teeth, right, it's the same ship Well.

Speaker 3

That's a little little different, but it's it's a little bit different, but I think it does similar damage.

Speaker 2

Let's put it that way.

Speaker 1

I mean, it's funny that because when I grew I mean famously, I think it's bare no, But the UK was bad. Scotland particular when I was a kid, was bad for dental care is bad, terrible, terrible, and they have this huge, you know problem with uh heart and lung problems the US, and I think that was smoking.

Speaker 3

It's got better, yeah, and the dental care has gotten much better for sure.

Speaker 2

Yeah. But the was it?

Speaker 1

I could I don't think it was Apocrates who said this, but I have heard this phrase. Death enters the body through the mouth of the anus.

Speaker 2

Uh. That's that's how it gets in. Who the hell said that? I don't know, but I I maybe maybe I see it. Maybe the mouth I can see, but the anus.

Speaker 1

Well, but the rise in cool on concerts with the young people, I mean.

Speaker 2

That doesn't come from the anus.

Speaker 3

That comes from and the colon comes from epithelial changes inside the lining of the colon, coming from the ass going up.

Speaker 2

That's starting off. Well, you say that it could be rising damp. Do you know what I mean?

Speaker 1

It could it be like but let's let's talk a little bit about that, because what is the uh do you have any kind of opinion or take on this or is it even true that there is a huge rise in gastro intestinal cancers and young people colon concer in particular.

Speaker 3

I think, yeah, so we've got to be a little bit careful about incidents and discovery. So you know what I mean by that is, now we're doing a lot more colonoscopies on people we would never do before. We're doing more cat scans, and we're discovering things and asymptomatic

patients and much more asymptomatic patents are getting screened. And we're also much better identifying a genetic group of patients who are predisposed to this because of either they have an autosomal dominant or some sort of genetic disorder or a family history that puts them at risk.

Speaker 2

And so we're finding more of it.

Speaker 3

So does that mean that there is a greater incidence in the population or we're just better at discovering it now.

Speaker 2

So I think it's probably multifactorial.

Speaker 1

All right, So better call them, may have better call them? B right, Yeah, incorrect is there? I mean, you know everybody talks particularly cancols. You talk about Alli detection, AARI detection, early detection.

Speaker 3

I mean, and it makes a huge difference, enormous difference. That's really night and day. I mean, look at lung cancer. Twenty years ago. You see, everybody was stage three disease and twenty or thirty percent were alive. In five years now, ninety percent of the people I see are stage one disease and I operate and take the lung cancer out. In ninety five percent are alive at five years. The practice is completely shifted in my lifetime.

Speaker 1

The friend of mine actually just had a cancer and he went through I don't know exactly which one it was because he's kind of like didn't really want to talk about it, but he had an operation to remove the tumor and then went on a course of chemotherapy. Yep, Now what's that if you remove the trumor, what's the deal with the chemo therapy.

Speaker 3

Yeah, so it depends and it would be nice to know the specific cancer. So I'll just talk about lung cancer. So the majority of our lung cancer patients don't get temo because we see them in stage one. But if there's stage two or three, they get chemo first, which we call neo adjivate neo before so they do neo adjivant chemo, then we do surgery, and then they often

get chemo afterwards. But to make a long, very long complicated answer very short, if the tumor is over a certain size, it's a predictor that could be microscopic cells in the blood even if we don't see it, even if the pet scan and cats get says, hey, livers clean, brains clean, everything looks great. We sometimes give chemo or if it's in a lymph node. So if it goes to one of the lymph nodes that we as surgeons

remove routinely and make sure the patient's out there. If they're getting lung cancer surgery, they go to a real surgeon who takes out noes. We take out twenty thirty sometimes forty lymphntes. If the lymphnotes just have one lymph note has cancered out of forty, that's an indication to get chemo because it means there could be circulating tumor cells in the blood and chemo just goes in the blood and circulates in the ideas to kill it, but of course it kills your normal selves too.

Speaker 2

That's why you lose your hair. No, does that still happen?

Speaker 1

Because he was talking about they got some kind of cold yeah.

Speaker 2

Hat thing or something they do. There's cold hat.

Speaker 3

It was just supposed to supposed to help the follicles resist that cellular death from the keymo one and it does work. So yeah, but in general people still lose their hair and their hair thins. It depends even if they're wearing the cold cap all the time.

Speaker 2

Yeah, I don't know.

Speaker 1

I mean I think I might just wear the cold cap even if I'm not getting keyboards, just in case.

Speaker 2

You know what I'm saying.

Speaker 3

Well, I mean, I think in your case, it'd be a nice story to explain to people why the hell you're doing it.

Speaker 2

And then you got the beautiful locks and you.

Speaker 3

Got that nice You know, I've always wanted the little I've had so many patients come to me and like, you're the doctor. I flew ind to see you. I said, I got a lot of gray hair. You gotta look. But they want surgeons with gray hair. So I'm freaking jealous of that.

Speaker 2

That one. You gotta have the gray hair. That's what I want.

Speaker 1

I want my doctor to Luke like the first George.

Speaker 2

Yeah, like me. Yeah, yeah, but I don't want to. I don't want it to be like me, though, Yeah, I don't want to. I get it. But you see, the thing is, though I've noticed this about doctors.

Speaker 1

When you're we were a kid, I had ever saw a doctor whatever, Keny. You know, see, a doctor would break a leg or something. I don't care, I mean exactly, but now you know, I you know, when you get to forty, I guess that's when it starts kinna, you know, bom and and all that, and yeah, you're right right.

Speaker 2

Well what are the barn and the man? Let's just go reach one the burt and what what did that reflect?

Speaker 1

That that's the pro staggs on not because that's what I thought it was. And this is the colonoscopy, That's what.

Speaker 2

I thought it was.

Speaker 3

Yeah, I wanted to make sure the audience knew exactly the screening modalities that you were articulating the so A jointly.

Speaker 1

But but the thing is, I mean I was very relieved that when I saw the size of the camera for the colon because I was used to working a CBS at the time.

Speaker 2

The cameras were prey, but I thought, I don't need you know, now, you swallow a capsule with a camera in it? Shut up? Is that true? No?

Speaker 1

One?

Speaker 2

And then when you you know, when.

Speaker 3

The capsule comes out, it can it can give images all the way through and then you just defecate it out so they can get images with capsule or cameras.

Speaker 1

It really is fantastic voyage. Then it really is a fantastic vo. So you say that, and then what you you do it poop and you send the poop the snappy snaps and.

Speaker 2

They the images get sent. But yeah, I guess that's the other way to do You could just filter.

Speaker 3

Your stool and then just send it into that. I guess the camera studio down CBS. We don't quite do it that way, but that's another way to do it. Does it transmit it from yes, your boy?

Speaker 2

Yes, Yes, that's unbelievable, dude, that's insane.

Speaker 3

Yeah, that's not it. I don't think that's even new. No, I think that's been around and good. I'm gonna say a decade. I might be wrong if any of your listeners want to tell the truth.

Speaker 2

But it's not that new. I had annoyed. Well, how come I'm still getting the thing going up now?

Speaker 3

Because it's not as good because think about it, it doesn't really look in all the you know, when you put a doctor in the camera, we first of all, we clean your colon out so we can see there's not all that fecal material and fluid.

Speaker 2

And this doesn't really do this too.

Speaker 3

We move the camera on and get really a much better look at each one and really inspect it much more carefully. But we can't get to the small bowl, right, it's hard to put a scope. A scope can go down in your mouth. Then you have like thirty feet of loops of val You can't get through all that

with a scope. The colon you can look at. You can put a scope from the anus and go up the you know, the rectum, the sigmoid colon, the acending the transverse and the descending or excuse mean the descending transverse and a sending and get right to what's called the ilio secal valve, and even look at some of the ilium, which is the end of the small vowel. But you can't look at all the doum ju junum

and ilium they're way too long. So this little camera can look for that in people are having bleeding to see if there's little lesions in the small bowel because you can't scope.

Speaker 2

The entire small bow. So it has other indications.

Speaker 1

So what would you say that if anyone said to you, like someone between ages of fifty and seventy, said, if I can only have one test, one screening, what would be get this.

Speaker 2

If you don't get any of the nails, get this.

Speaker 3

It's an easy for me. It's a very easy answer. It would be a full body CT scan or full body MRI. And I like the CT, but people are moving more towards the MRI. There's no radiation and stuff. But a CT scan of your chest, abdomen and pelvis gives us so much information. We're not looking at your thighs, your knees, your ankles, and you could include the brain, but if you're cognitively with it, like I guess you and I would just pass the mark that were cognitively with it.

Speaker 2

They were just at the border line.

Speaker 3

But you know, then there's you don't get much benefit of Skeff doing a brain scan, but a brain a CT scan of neck, chest, abdomen, pelvis does. Even now it's not blood work. The blood work is also needs to be augmented. But you said one test. I don't know if you give me both, but I would pick the CT over the blood work.

Speaker 1

So does that I mean like that calcium thing I'm getting, you know, that skin I'm getting in my heart, that kind of routine thing, would that be included in that?

Speaker 2

No, that's a very specific thing to look at coronary ardor disease. But let me tell you something interesting.

Speaker 3

So I had clinic on Tuesday, and I told you I had three people come from other countries. Two of the three had their lung nodule found in a calcium scoring screening study. They're asymptomatic, they never smoked. These are very wealthy people getting there their executive calcium scoring study. And you would just look at parts the lung. You look like the right middle lobe and part of the left upper lobe, and one had a nodule in the middle and one had a lodge on the upper lobe.

Speaker 2

And they both turned out to be lung cancer.

Speaker 3

So that screening study for the heart saved their life and got their lung cancer reseected.

Speaker 2

We did their operation yesterday and they both went home today. Wow, not fat. So it was a thoracic operation then right, it was.

Speaker 3

Yeah, I took out part of their lung. They went to see their heart doctor to make sure their heart was good. But that study which images the heart blows the heart up, also looks at a small part of the lung and happen to find lung nodules in that small the just in the right middle lobe and then the left upperlobe, which is when they look at the heart.

Speaker 2

The heart sits there.

Speaker 3

And they both got their cancers discovered serendipitously on their calcium screening study of their heart.

Speaker 2

That's crazy.

Speaker 1

That's that, you know what though, I mean, knowing all the stuff you have, you know you know, and I know you you know, we've talked quite a bit over the past couple of years. Would I think I wouldn't sleep a wink at I think every time I feel like sing.

Speaker 2

I sleep like a rock.

Speaker 3

Hey, because I hate that smart to worry b because I got a pretty clean conscious.

Speaker 2

And see, you know, I think if you just work out and eat well.

Speaker 3

And I got to tell you, our society has it wrong, having these big late dinners like you go to Spain or you go to these other countries. They eat at nine or ten. You shouldn't need after four or five o'clock. I mean, really, even three or four. You should have a pretty big breakfast, kind of skip lunch that have something big at three or four, and then make sure you're going to bed at like ten o'clock, say, on an empty stomach, so your body is sleeping and not

digesting food. But if you do those things, if everybody gets aches and pains. I mean, I worked out on Sunday, I played an two hour pickleball match and I worked out for two hours.

Speaker 2

That was sores hell Sunday night and Monday. But that's not cancer related.

Speaker 3

So I mean, I think everyone has aches and pains when they wake up, especially when we get to our age at sixty two six.

Speaker 1

Dude, man, I mean it's so funny that. I mean, first of all, pick a ball. I mean, that's the new thing.

Speaker 2

Singles pickleball is great.

Speaker 3

I played a young twenty nine year old young buck and I finally beat them. The guy's great, but I took it to him finally, but I was.

Speaker 2

I was sore. Two hours of singles pickleball is brutal. What is pigg I don't pick a ball. It's pick a ball like it's like tennis but with a tighty little bat or something.

Speaker 3

Yeah, well it's not a bat exactly, but it's like, think of ping pong and make it bigger, and think of tennis and make it smaller. So it's like standing on a really big ping pong table, but you're in singles you're running around. I mean my heart rate was a median of one hundred and fifty two for like, uh, I think this. In the middle hour of that match, my median heart rate was one fifty to On other

ends I was about one ten. So it's brutal workout and a lot of people so caution the people listening because a lot of older people play doubles. They tear their achilles, they tell are calf muscles, they get little tears in their their legs. Have you have to stretch and work out, even if you're gonna play doubles pickleball, because you're bending and turning and hitting and running alone.

Speaker 2

No, it's not for me, man, I don't. I don't do that.

Speaker 1

I think it. I work alone, so I do cattle standings on my own. It's run and I walk or or lift some weights. So when you run, how far do you run?

Speaker 2

Greg you know it? It kind of varies.

Speaker 1

I usually like nowadays because I don't want to screw my knees up because I run on a treadmill. And if I'm on a treadmill, I'll run anywhere between five and ten.

Speaker 2

Miles on a treadmill, So that must take you an hour. How long is that north of that?

Speaker 1

Sometime like I'm five miles yeah and under an hour, but ten miles yeah, maybe like.

Speaker 3

A bit longer than than But that's unbelievable. Able to do that with your So you know, I had both my knees replaced. I think you and I've talked about that before, because uh, I played three sports in high school, played college baseball, but really from coaching my kids basketball teams.

Speaker 2

But so I know I run sprints, I don't run long distances.

Speaker 3

So I give you amazing credit that you're able to run five or ten miles even on a treadmill.

Speaker 2

That's and your knees aren't too sore afterwards. No, they're not bad.

Speaker 1

But the thing is when you were doing all when you were doing all that, playing all those sports at the same ages, because we're the same age coming up, I was standing at a bar for fifteen years.

Speaker 2

So my knees are fine. It's delivers, deliver, it's fucked. That's so funny.

Speaker 3

Yeah, Actually, your liver, your liver is probably almost back to normal now, I'll bet you.

Speaker 2

Yeah, it should be. I I haven't had a drink in over thirty three years.

Speaker 5

So believable. I mean, let's drink to that. I mean that, no kidding, I mean at your mental tech though. I mean so like I stopped drinking when I was twenty nine years old.

Speaker 2

Incredible, And when.

Speaker 3

Twenty nine year olds are told, how many twenty nine year olds have the mental fortitude.

Speaker 2

To do that? Seriously? Not my thing, man. I think what it was is that it was I was in a fork in the road.

Speaker 1

It was either jails, institutions, and death or still drinking.

Speaker 2

And it was a decision for a minute, Yeah, it was close call.

Speaker 3

Well it's a little close call for every but there are so many twenty nine year olds that lack the self awareness, or even thirty five or forty year olds that don't see it. And even you know, a lot of people are very functional at work, but as soon as they come home, they have one or two or three drinks and that is just not not a healthy way to go.

Speaker 2

Man.

Speaker 1

Well it's kind of an interesting I find myself in the horns of a dilemma a little bit about it, because you know, I have two kids, and you know, you worry that you're passing on non genetically to those guys, and right, and what.

Speaker 2

I wonder, you know, I look, I'm not a doctor, as we both know, but I I wonder.

Speaker 1

If alcoholism is as clear cut as a genetics.

Speaker 2

I think it's. I think it's a genetic predisposition. I think you right, and we have data that that's correct.

Speaker 3

But you know, without the environment, if I took that person who has one hundred percent chance of being an alcoholic and I put him on an island his whole life with no alcohol, it's not going to happen, right, So it's a mixture between the two.

Speaker 2

Now.

Speaker 3

It's funny you talk about the kids, because I have three boys, and of course you know I told him that if you ever smoke, you're gonna die one puff if you ever drink alcohol.

Speaker 2

So my middle son, God bless my middle son, Alec. I love him.

Speaker 3

He doesn't even have a sip ever of alcohol never, he's so anti against it.

Speaker 2

It's really interesting. How old are a is?

Speaker 1

Your oldest, Greg, My oldest is twenty, just coming up in twenty four. But what I said to my kids was, look, you don't have to be an eye alcoholic for alcohol to fuck up your life. You know exactly right, You can drink you know, five beers and get in a car and think you're you're good to drive, and there you are.

Speaker 2

That's it fucking done. You're right.

Speaker 3

And even worse, Craig is if they don't get hurt, they hurt some little care so they hurt someone else and they are screwed up forever with that guilt, you know, not to mention what they did to the kid in the family.

Speaker 1

Right, And what's kind of I find myself kind of struggling with this because I'm not a tanferance advocate. I'm not saying like nobody should drink. I believe that, but well I kind of But for me, obviously, it's the question.

Speaker 3

I know.

Speaker 1

I mean, my oldest boy, he can just like he'll have a cocktail Easter or Christmas or something and go, yeah.

Speaker 2

Yeah, it's interesting, isn't it.

Speaker 3

So you know, my older son, my older son, Robbie will have, you know, glass of red wine, which is why what I always would do at dinner maybe once a week, twice a week. I've stopped doing that the last few years and it's fine. And my youngest son, Matthew is you know, they're kind of more normal in that they'll drink a little bit with their friends, and I think that's perfectly normal and healthy and fine. But as you said, there always is a moderation. But my

middle son is just completely out on alec. Which is really interesting how they they get some of this from Austin their culture, but of course they see it with their friends and when they see young women getting drunk, it really turns them off.

Speaker 2

It's funny. They just think gets a really bad look listening to them.

Speaker 1

I remember once seeing I was in France in a fancy hotel and there was an American lady in the bar and she was a little she was a little drunk. She was I mean, it wasn't bad, but she was clearly she was a little strawpy. She was leaving the bar and I just happened to glance at the way the waiter was looking at her. Yeah, and yeah, the otter does go fas I know, because the culture there is no you know, to be to be drunk is it's bad. It's a bad look. Yeah, And I don't

think it was because she was a woman. I think it was because she was drunk, you know, because a woman drum just any drum.

Speaker 2

It's like, you know, I've been.

Speaker 3

To a few social and I gotta be careful how I tell this story to keep everybody anonymous. But a few social events where there's wonderful families, you know, moms and dads and kids, they're fifteen, sixteen, twelve, twenty, and then they watch an adult get just completely inebriated. It is just an embarrassing thing for that individual and their family. And then you wonder, how are how's a twelve year

old processing this? The fourteen to fifty year old know exactly what's happening, and probably twelve, but the seven and eight year old what are they processing? And and how what do they do with that information as they get older? I think it's impactful. Yeah, definitely.

Speaker 2

I mean I saw that.

Speaker 1

I saw I saw drunkenness and adults when I was little. My mother never drank at all, but my father drank a bit. And you know, when the adults around me in Scotland drank, and when you see them, you know, kind of lose it. But it was kind of scary. But also I equated it with that must be what a good time is, you know, I mean.

Speaker 3

Exactly, it is part of Hey, we're let's go out and have fun. You know, you can have fun without alcohols. It's not The two are not inextricably intertwined. They may be related. And I love when my friends drink and have a good time and get a little tipsy. It's okay, but they're not driving anywhere. They're taking a golf car to their house.

Speaker 2

Yeah it's okay, you know.

Speaker 1

So now young people, though, I mean, there's a real rise. And this is something because I moved back to New York City, so I noticed this a lot. Is the amount of wheat the people are taking.

Speaker 3

I mean, I mean you walk as soon as you walk out of your building, you just smell it, right, what wafts of it?

Speaker 1

Yeah, I mean it's like it used to be just you know, pizza, urine and rat was the smell in New York.

Speaker 2

Now it's pizza. You're in rat and weed weed first we weed over the pizza.

Speaker 1

But what I think is kind of weird about it is that, you know, my people, the alcoholics, they still have to walk around with their hiding their their right, their alcohol in the bag. But you can smoke adobe Like the air from the smoke from the alcohol is no getting up mindo's.

Speaker 2

But they're exactly right. I feel like I feel like it's discrimination against alcoholics.

Speaker 3

You know, I haven't spun it that way in my mind, but now that you mentioned, I'm on board with that. I'm happy to join you know, your your society with that.

Speaker 2

Let's go. But but I will tell you this.

Speaker 3

You know, I operated a lot of athletes and a lot of famous people. So I've done several professional athletes. I won't tell you the sport, but you could maybe, but you could guess. But the lungs of people who smoke marijuana, and these are these are world class athletes smoking at two three there were times a day, a day for twelve to ten to fifteen years. The damage it does in their upper lobes is unbelievable, worse than cigarettes because before it wasn't regulated.

Speaker 2

You don't know what the hell was in it.

Speaker 3

You don't know about the filters, and how they're able to function at the level they are as professional athletes is shocking to me. So I have seen an enormous amount of damage from marijuana and now vaping. Of course, some young kids who vape almost get this allergic reaction. You know, once a year we have a young child

seventeen eighteen year old die because they were vaping. They have some allergic reaction when they get a pulmonary interstitial numinitis and some sort of allergic reaction in the whole long it's terrible. And then telling families going out and telling, you know, a thirty a forty year old mom and dad, and this is their life that their fifteen or sixteen year old has passed away and is now dead from vaping or smoking marijuana. It's it's terrible. So you know,

we see the terrible end of it. So I'm so anti marijuana. It's uh, I can't explain it.

Speaker 2

Well.

Speaker 1

The thing is as well with marijuana for me is that you know, because I get it. You know, I smoked marijuana. I mean I did all the drugs and the the uh marijuana, strangely enough, was the one. I had the worst time with marijuana in what way you wanted way. It made me psychotic. I mean it brought a panic in me. I mean I guess maybe speed or acid could could compare with it, but I didn't do a ton of speed and acid.

Speaker 2

Uh yeah. But whenever people would casually I would, I would smoke it.

Speaker 1

When I was about seventeen eighteen, I would smoke marijuana and it kind of made that what it did to everyone else. And then one day it changed and whenever I even I smell weed. Now I'm sixty two years old, I haven't had a drug thirty three years. I still smell it and it makes me a little nervous.

Speaker 2

I'm like, interesting, I'm.

Speaker 3

Gonna say, for the record, your because your birthday is in May, mine's May twenty fourth, and yours is May twenty seven six.

Speaker 2

No, mine is seventeen, which means than you. Yeah, no, no, no, are you? Is that what that means?

Speaker 5

No?

Speaker 2

Older than I say, I'm pretty sure I think you're older. Well, I was gonna let your run with that story.

Speaker 3

Yeah, so we both turned sixty three, are both born in nineteen sixty two, right, So I'm gonna say, for the record, you're really sixty three, just to clean the accuracy up there, because Tom is gonna Tom's gonna have.

Speaker 2

To edit that, and because it's just an actor, you know, the truth truth checker, fact checker in this story. That's interesting. You don't love to when you smell the marijuana, you don't like it. No, I don't care for it. At all. It makes me sick.

Speaker 3

Sick to mine coming out of a beautiful apartment building, jacket and ties five through in the morning, coming to the hospital, go around and I smell it on my way to work.

Speaker 2

It's just I'm like, what the hell is going on here? Man? It's all some people smell of it. People have been smoking it, think. I mean, first of all, I know, it's like cats. They can't fucking smell it, you know.

Speaker 3

I love, yeah, I love when the patients come in and they reek of it and then I'm not smoking. I'm like, Okay, you're not smoking, then I guess you're You're golden. Your golden retriever wants to live up six doobies this morning because you.

Speaker 2

Rereak of marijuana.

Speaker 3

It's all over your clothes and you oh, that's that's my partner, you know, Okay, all right.

Speaker 2

Yeah, I don't know anyway.

Speaker 1

Look, a couple of old farts like us railing against the rest of the world. It's it's just a good time, sir. If I'm always happy to do it. Listen, thank you for making time for us today. I'm always happy to talk to you.

Speaker 2

More poweries to you.

Speaker 1

You are you are the guy and if I if this calcium thing sews up anything, I'll get in touch.

Speaker 3

Yeah, just when you're actually just shoot me an email of what the score is. I'm just I'm going to say it's a zero. I think you're a zero guy, And so that's the report we want. And really a number, you know, one hundred or last or it kind of depends, or two hundred or less. We're okay, but let's let's hope and pay for a zero.

Speaker 2

You deserve a zero. I would like a zero. All right, take a ether of it. Ahbody, God bless you. Thanks, good bye,

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