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Coming to you live from Houston, Texas, home to the world's largest medical summer.
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After this is your Health First, the most beneficial health program on radio with doctor Joe Glotti.
During the next.
Hour you'll learn about health, wellness and the provention of disease. Now here's your host, doctor Joe Bellotti. Well la marvelous Sunday Evening to everybody, Doctor Joe Galotti. As usual, we're here every Sunday between just an hour between seven and eight pm Central time. And if you're traveling over the summer, don't forget. You can catch us anywhere in the globe if you go to the iHeartRadio app type in KTRH and we will be here at seven o'clock Central time.
And my goal is, I say, every Sunday evening, we want to make you better consumers of healthcare. We want to raise your health IQ so that you really really understand how the body works, what that pain in your stomach means, and that you don't blow things off out of not wanting to be well, but just I hate to use the word ignorant, you're just ignorant of what a particular problem is. So that is our goal. We're going to raise your health. I q our website doctor
Joegalotti dot com. You can send me a message, sign up for own newsletter. All of our social media info is there now. On the program tonight in the studio to veteran of the radio program, doctor Caroline Simon and Elie Chia. They are transplant surgeons at Houston Methodist Hospital. They are colleagues, friends of mine, co workers in the marvelous liver transplant program that we have at Euston Methodist, and they're going to discuss the robotic surgery that they do,
but also in the setting of live liver donation. So when you do liver transplant, you have this idea. You get a liver from somebody that is brain dead and they donate their liver and it is recovered and planted into the recipient the person that is going to be allocated that liver. But here a healthy adult will donate half of their liver, but that has to be surgically taken out, and that is what their expertise is here.
So they'd previously been on the program, but it's about a year and a half, a little bit of an update on new technology and how the program is going and what all of you need to know, So stay tuned for that. A couple of articles in the news that caught my eye. Now this one is for those that feel marijuana is completely benign. Everybody should smoke it. Why should there be laws to limit it in any way. Well, an article came out this week that is associating a
link with heart attack and stroke. And the general consensus is that the general population feels that marijuana is safe. But new research that was just published showed that there's an associated risk with a associated higher risk which stroke and heart attack, including amongst young adults. So this was a study that looked at twenty four different research studies and it was published in the journal Heart, and it found that marijuana use was associated with a twofold increase
in the risk of death from cardiovascular disease. Now, you have to be careful in how you analyze the data. It is not a direct correlation, but the relationship is there. But it's very tough to prove that smoking marijuana caused all of these problems. Now, what they think the problem is it is a rise in blood pressure and a rise in heart rate, as well as cardiac arrhythmia, so irregular beating of the heart, the electrical system goes a little bit berserk, and that is what they think is
the culprit. Now speaking, older adults and people with underlying conditions like diabetes, high cholesterol, pre existing heart disease, they are going to be the greatest at risk. And certainly there are more older adults, a lot of baby boomers that are using marijuana, either recreationally or for some kind of medical use, and so they are definitely more at risk. Now.
In twenty twenty three, about seven percent of the US adults sixty five and old are reported using marijuana within the last month, So that's a fair amount of people that are that are using it now. The other somewhat alarming part is that younger, younger adults sort of in that thirty five to forty range are coming in with heart attack, but a lot of them don't know what the signs and symptoms of a heart attack or stroke are,
so they're sort of getting diagnosed a bit late. And so what do we do well, I would think certainly, if you're an older adult, you have to be very careful. Talk with your doctor if you are using marijuana. If you are younger and using marijuana, you probably need to get a good checkup to make sure you don't have highpertension, you don't have diabetes, there's no rhythmias with your heart.
The amount of people that have a FIB has gone up four hundred percent in the last ten years, so there's a lot of people with underlying heart disease that may not realize it. So buyer, beware, proceed with caution. All right. With that said, we're gonna take a quick break here in the wings. Doctor Simon and doctor Chia will be here gracing our airwaves. I'm doctor Joglotti. Doctor Jogolotti dot com is our website. Stay tuned, we will back.
As of this morning, they were approximately nine one hundred and twenty eight Americans waiting for a liver transplant all around the country, big cities, small cities, And that is a real challenge. And I'm very fortunate to be part of a world class liver transplant program. And in the studio today are two stars, doctor Carolyn Simon and doctor Eeli Chia. They're sort of veterans of the program and they've been begging me to come back on the program.
So doctor Simon, doctor Chia, welcome and so glad you come back and share your knowledge with everybody tonight about liver transplant and more importantly robotic surgery.
Thanks for inviting us, Thanks for having us back to you.
Absolutely so happy. So if there are people listening that didn't catch you the first time about eighteen months ago, so really quick introduction about yourselves and your training, your background and what you do here in Houston.
My name is Caroline Simon, so.
Everybody knows that is Caroline. Doctaccia will be number two here.
Yeah, I've been in Houston now for just over two and a half years. I was trained in kind of a mixture. My med school was done in Ireland and my residency and fellowship was done in the Northeast between Rhode Island and Boston. I specialize in hepatobilliary and pancratic surgery, how to do it open as well as robotically like you were saying, and then I also do living down a liver transplants. The recipient part.
Right right Doctachia number two. This is a get your left and right speakers set here.
Hi, I'm a Yilicia. I'm the director of the Robotic living don A liver transplant program at Houston Methodists.
I follow.
A similar path to doctor Simon. I graduated from an Irish medical school and then I did most of my training in Brown and Leahy Clinic in Massachusetts. And my passion is living down a surgery where I look after healthy patients who want to donate part of the liver to help someone on the waiting list.
Right exactly. Now, we've talked about robotic surgery, and there are people sitting there saying, robotic surgery totally automated. What some something that Elon Musk is going to make is going to come and do the surgery. So don't why don't you both explain what exactly robotic surgery is.
I'll take that it's basically computerized surgery allows us to perform really fine movements, really complex surgery through very very tiny incisions, you know, smaller than your finger. It is a common misconception, you know, even my mom would say that, oh, you set the robot and it just goes off in the room and right exactly, but there's no self parking, there's no self driving assist modes. Here, this is just you know, augmented to make so basically you control the robot.
You control everything it does, and that's what makes it so cool.
Yeah, what do you think?
Yeah, it's kind of like a remote operated vehicle, except the surgeon is no longer at the bitside, but is like sitting in a console with the hand controls and foot pedals that will enable us to use different kinds of energy devices to help us with to stop bleeding or to cut through the liver, right, and there's usually a separate surgeon or a system at the bedside to help us changing instruments and any kind of like sectioning assistance that we may need.
Right.
So, the sense is you're in the room, you're doing the surgery, the surgeon is doing the surgery. The robot really is just a super cool tool that you are using at you know, ten feet away.
Absolutely, you know, it also makes you.
A slightly different surgeon.
And what I mean by that is automatically, you have two right hands and two left hands, right, and so think of all the things that you could do with an extra couple of hands. Right. It also makes you automatically and be dexterous and so you could, you know, throw the same amount of sutures and cut and dissect the same way right handed or left handed and looks exactly the same.
You know, you look at different and physicians and any specialty and you'd almost look at them in different eras as far as they're training. So you graduated medical school in the late nineteen seventies, and you did your training through the eighties, and here you are. What is how is the retrofitting of surgeons to pick this up? Where? And you know, we're not naming names to say this guy shouldn't be doing it or she's a disaster, but
where do you think this is? Is this truly a new generation of surgeons and physicians that are getting involved in this versus the retrofitting? You know, should we really have high hopes for that?
I think it goes both ways, because the current generation of junior surgeons who have graduated from official training, they are trying to pick up the robot because they're at a I guess a time in their careers where they can still pick up new technology pretty easily.
So I'm one of those so.
Called retrofitted surgeons because I had no exposure to robotic surgery during training, and that takes a lot of self motivation and learning, sure to kind of figure out how the device works, how the equipment will help you do the surgery and kind of operate in a very different way. One of the fallbacks of the robot is that as opposed to open surgery, you don't have any teachtile feedback. You can't feel the liver, you can't feel the tissues
as you're sewing it. And that's something that someone who's learning that technology will have to figure out and takes, you know, methods like simulation training, training on cadever models, biotissue models to try and figure that out.
Sure, yeah, and I would think most people don't think about that that you're actually not touching and feeling and so much of that is important when you're doing you're doing surgery. So as a retrofit in the fifteen years, how tell everybody how far the technology has come from you know, version one point oh robot that you vers first sat with, versus what you're going to be dealing with tomorrow morning.
I think the first robot was mainly used by our urology colleagues and they've really pushed the development of better robots. When we first started the robotic surgery and the liver and pancreas, it was like the third generation robot, and
there was still some disadvantages to the technology. But with the current fourth generation and the most recently released fifth generation robot, they've kind of overcome a lot of those difficulties and added some safety features that I think helps with a surgery like liberal panker surgery, where you know, there is a sense that you need to have better control to help with bleeding and any kind of those like fine futuring that we will need for operations in.
Yeah, Caroline, what would you say is the new cool feature that you've had for the past few years compared to five ten years ago that maybe just didn't exist.
I think they've made the camera a little bit more functional. You know, it's smaller, it white balance is better, right. You tend not to think about it, but you know, in a cavity, especially if it's say, you know, a certain type of pink or a certain type of red, white balancing is actually pretty important, and so that's actually gotten better. The other thing that we're able to do is we're able to inject a substance called ICG or
indosyanine green. We can change the light models and have immunofluorescence kind of guide us for different parts of the surgery. It can show you blood vessels, it can show you where to cut on the liver, it can show you where the bio ducts are. And then also the instruments that we have that's gotten better too. You know, there's
more joint it's more functional. Like doctor Chio was saying, the ceiling or the grip the yeah, the grip that the heating elements or the cattery elements that that's gotten better too.
Yeah, you know. I would I would say that the average average person listening tonight, which I like to think they tend to be very health motivated or health conscious, really they have no idea what this looks like in there. I remember, I don't know if you were visiting I think you were visiting Houston, and you're standing there at the podium and you flip up this video and I think everybody, the chairman of Surgery was there gaping with
mouth open, thinking this is really unbelievable. I went to him afterwards, this is doctor Gaber at the time, and I said this is unreal, and he said it is, it is. It really is coming a long way. So we have these topics tonight to talk about really for the average citizen to really understand what is available to them. Last word before we take a break, Doctor.
Chiah Joe, I just want to say that I know the videos look pretty cool and the technique is really nice and clean, but the reason why we move into robotics is because it's actually better for a patient. Yes, right, because the incisions are smaller and the recovery faster.
Yeah. Yeah, I you know, robotics has trickled down to everything and I've in some knee issues that I've been having talking to the surgeon saying, oh, yes, we could fix that robotically, and like robotically, it's we're talking about a small area. No, we're going to fix it robotically. So it's fascinating. All right, Well, we have doctor Chia and doctor Simon for the whole hour here, so don't miss anything. Doctor Joeglotti dot com is our website. You
can actually message me if you have any questions. Stay tuned. We will be right back. Welcome back, everybody, playing a little Billy Joel while we're filling some time here tonight, but don't forget every Sunday night between seven and eight pm, we are here Raising your Health IQ, bringing you the best experts in health and wellness. And I'm so pleased to have doctor Carolyn Simon and Ylie Chia surgeons at Houston Methodist Hospital, part of the liver transplant program that
we have there. And we are talking about both robotic surgery, but living donation, live living donation, liver transplant. I get that to live liver. When I on my Siri and I say live liver, it goes liver liver or live live and doesn't quite work all the time. But we are talking about taking a healthy life liver or part of a liver from a healthy donor and putting it into a person that is in dire need of needing a liver transplant. So, doctor Simon, what is the general
concept of live liver donation? What do the people tonight need to know?
The basic fact that your liver can regenerate and so if you are willing and able to donate, you know a portion of your liver you can help save someone else's life.
Right, And I actually I've got the numbers here national data. So back when I broke into transplant nineteen eighty nine, there were two live liver donations done transplants, probably in kids, and then nineteen ninety was fourteen, and then twenty two into the thirties. But last year six hundred and four, six hundred and four live donor transplants. So again, it's technology, it's knowledge, it's no how from people like you, so expand on that.
You know.
I mentioned there are almost ten thousand people waiting for liver transplants, and despite the best of care, the technology that we offer them before transplant, we're still losing nationwide, somewhere between twelve to fifteen percent of patients waiting for a liver. They've been approved good candidates, their heart, their lungs, their kidneys, their insurance, everything is good. But yet they get too sick and they die, which is always horribly
sad for everybody. But this live donor program is really a stop gap to cut that down.
Yeah, So Joe.
Structured so that there is prioritization of the sickest patients, patients who are about to die, and they will get offered deceased donor organs from people who did and are willing to donate their organs. The problem is there are not enough of those organs to go around to those over nine thousand people. When you have a living donor come forward, that living donor is giving a directed gift to someone on the recipient list, and the living donor is not going to care where they are on the
waiting list. So what the living donor does is that they take the patient out of the queue, out of the waiting list, and donate part of their liver to them. They will get a liver transplant, and it also frees up a DC's donor organ for someone else on the waiting list who can only access DC's donor organs. So technically a living donor can save two lives right.
Now, there is the sense that it has to be a relative. It is my brother, it is my sister, it is my wife, it is my husband. What's your experience been with who are these candidates that you're operating on.
Well, usually the donor has some sort of emotional connection to the recipient, even though there are people who are altruistic in a sense that they have no relationship to the recipient. They just want to donate an organ to them. But most of our living donor. Donors for liver are emotionally connected to the recipients, but they don't have to be relatives. In fact, fifty percent of our living donors are friends or family of friends and friends of family, right, so sort.
Of like your phone, friends and family get a discount.
So the most important thing is that they have to be volunteers for this procedure.
They need to understand the risk.
They will get educated during the work up for limit donation and they get a very terough process of evaluation where you make sure that they are fit for major surgery. Number one and number two, their liver is fit to be donated, as it has to be split appropriately into two, with a pot that can be transplanted into recipient and the remnant that stays in the donor will regenerate as well.
Right you know, Caroline, As I said this before, a lot of people don't know that much about the liver, but they know one thing it regenerates. And I would think that with what you are both doing, this is the ultimate case of regeneration. You're taking half the liver out and within weeks the liver is back to.
Normal, absolutely, right, you know, you get two thirds of the growth happening within the first two months, and then kind of that exponential growth tailors off a little bit. You know, within six months to a year, you're back to full size.
Yeah, how would you you've been at live donor programs up at the Late Heat Clinic. How would you say the program here at Methodist is different, sim s Oller upgrades. Where would you say you're at with that?
We started living on a lover transplant in Lahay Clinic because the allocation system of Massachusetts made it very difficult for our program to get a disease donor organs. So living on a liver transplant made up about twenty percent
of total transplants the Massachusetts VERSU in Houston. You know, we have a much larger, more established disease donor program at Houston Netodis, but our waiting liss is four hundred plus patients and there's still a signment number of patients on the waitings who would benefit from living on a liver transplant, which was why the leadership of our transplant program wanted to bring us here to start living on a lover transplants to help those people who have no
access to the diseased donor augans.
Yeah, and many many patients which the allocation the sickest patients, like you said, they are near death. Those are the ones we're transplanting. But a lot of our patients in this scoring system, they're in they're in purgatory, they are sick, they're in and out of the hospital. They're there, they can't work, they can't take care of their family. But yet they look at us and they say, get me a liver, get my husband deliver this really is that that vehicle to make all of that happen.
Absolutely, you know, friends, family members, if they can, you know, put the word out that you know, my loved one needs a liver. Like you said, you know, you don't have to be related, right, you know, you just have to be a willing, healthy volunteer, get tested and you know that that's about it.
Yeah. Yeah, what I want to do on the final saman the final segments coming up, we're gonna have to come and do the radio station and take it, take
it another hour. I really want to get into this screening process, and a lot of it is online to start off with, as a as a weeding system to get people and just really sort of end the evening with everybody having a good sense of how this works and why it's important not only to take care of your liver, but understand how these programs and processes work. All right, final segment coming up, This is Your Health First. I'm doctor Joe Glotti here with doctor Chia and doctor
Simon on Your Health First. We'll break back final segment of this week's Your Health First, every Sunday between seven and eight pm. I'm doctor Joe Galotti. Doctor Joeglotti dot Com is our website. Go there to learn more about the program, send me a message. All of our social media is there, and we are blessed to have doctor Carolyn Simon and doctor ye Lee Chia from Houston Methodist here in the studio with us. I think they're having a good time.
Oh yes, absolutely, yeah, this.
Is the place on Sunday night. So in the short time that we have left, the evaluation of potential donors. How is that done, doctor Chia?
So they start by filling in a health questionnaire online and the team will look at the questionnaire and if we deem that they're suitable for further evaluation, they will do a set of screening labs, just basic stuff, and then if we find that those are appropriate, we will
bring them in for full evaluation. That's usually to a three day process where they see all the members of the team and each one will kind of evaluate specific parts, you know, including the surgical aspect of the donation, and if they're suitable surgically, someone like you doctor Galati, will evaluate them medically and make sure they are medically stable
for donation. They also see a psychiatrist, a social worker, the pharmacists, the dietitians, so everyone on the team will contribute a report that we will discuss at our multi discipline reading meeting, and then we'll decide as a committee better than doble for liber donations.
Right now, in your current experience, the number of people that come forward that are weeded out, what what's your conversion rate in a sense, it's.
Probably around fifty.
So the fifty percent that are disqualified, doctor Simon, what what are the concerns that you have or the group has.
With them, Probably that they are not medically fit to donate, you know. It usually most of the time actually boils down to either of them being very much overweight or having some version of metabolic syndrome.
Right, so they're diabetic and and you know this is where we talk so much about that here, these are the circumstances where you may be sitting at home saying, oh, you know, who cares if I'm overweight twenty pounds or I've got to touch a diabetes. But that day may come where you get the call to say, say, hey, somebody you know may need to be a donor, and you get washed down. So it's a wake up call that we still need to take care.
Of ourselves absolutely, and it's actually not forever, right, I mean, you know yourself, you know, like dieting, exercising, you know, you can actually change your liver from being a little bit overweight or a little bit fatty back to being a normal liver and then being able to donate.
Absolutely. So with the process that somebody is approved this donor, they make the cut who's going to do the the donation surgery? Who's going to remove that liver?
So I'm the donor surgeon, okay, And I always try to offer them a robotic approach, and about two thirds of our living donors actually undergo a robotic living door surgery.
Right at the moment, Yeah.
Now you had said robotic surgery in general is better for the patient. So compared to conventional liver surgery versus the robotic approach, what's the major take home there?
Well, we are talking about small incisions the size of a pen, with the larger incision used to extract the graph being in the lower abdomen instead of a large incision in the upper abdomen that may or may not split their muscles.
So it's not just.
A cosmetic issue. It's also a patient comfort issue in terms of pain control after the operation, and we find that the pain control is so much better to manage with robotic surgery. And then even when they go home, our robotic donors tend to go back to work faster.
Right, And again, all of this technology, we are certainly focused on the recipient and the donor, but these people talk to their community and say, I as horrible of a thing that we had to go through because a loved one was sick. This was a great experience and hopefully that can promote other people to think, maybe with my loved one or they know somebody elsewhere that's waiting for liver. Think about that live donor situation. How is
the implanting that the actual transplant any different. When you have part of a liver that you're putting in to where there was a whole.
Liver, the whole liver still needs to be disconnected from whatever is holding it in place. It comes out, the new liver sits very nicely in its old spot. Everything gets sewn in like with like, and then the clamps get removed and you know, the blood kind of circulates.
Through it turns pink and everybody's happy.
Everyone's happy, yeah.
And anything special the recipient, the person getting the transplant after they've had a live donor transplant in the weeks months afterwards, any different than the full liver.
No, not really.
I mean, like I focus a lot on nutrition and so you know, we do have them do a high calorie, high protein diet just to enhance the graph regeneration.
Okay, okay, with all your experience combined, do you ever see does this kind of a surgery a liver transplant ever? Would it ever be suited for a robotic approach or a less of an open surgery than what you know we've been doing for forty years.
Actually, a very small number of centers in the world have started implanting livers robotically. I think the problem is oddly enough space because there's only so much you can inflate the abdomen, and to remove a whole liver and put a whole new liver in, it's difficult. But the best results are from a living new liver transplant program
in Saudi Arabia. But you put in a partial graph through the same incision, you're making the donu a lower down on the appomen So that seems pretty feasible, but I'm not sure it is for.
Everybody on the waiting list.
I think we have to be super selective, and it's too early in our experience to figure out who will benefit most from me right.
And and we're transplanting sicker patients, and I think that has to even as a non surgeon that has that has to calculate in there in the last few minutes here, doctor Chia and Simon organ donation at the end of the d at the end of the day, all of this technology is awesome. I truly hope that the advances continue, but we still need traditional individuals to be organ donors. For both of you, what what do you say to everybody tonight to be an organ donor. Think about it.
I think it's very rewarding for a living donor to save someone else's life and to be honest, for someone a recipient who needs a liver transform because of liver cancer, you can actually save someone's life and cure cancer at the same time. So I think that's a very rewarding prospect for living donors, and of course because they're emotionally connected with the recipient. Yeah, the reward is like enhanced.
Right Dutch Simon speechless, speechless. Yeah, you know, people in the community, even live donor or regular cadaver donor, there is this sense that it's not for me. It's not for me, but it really is for everybody to think about. And the lives you've all impacted is you know, if they could see that the impact, it's really tremendous.
Absolutely, everyone can be a living donor. You know, everyone should think about being a living owner this, you know, like you mentioned nine thousand plus people on the wait list.
Yeah, yeah, I guess the final question and we got a minute here real quick, each one of you, what's your health hack? How do you guys keep healthy? Because I think it's important for the public to hear how some high end surgeons here take care of themselves.
For me is really easy. I just see my PCP every year.
That's it.
That's it.
Okay, I watch what I eat, and you know, try and exercise a little bit more than you know what I should.
All right, there you go. All right, well, thank you, thank you both for coming in, and I think you you've bought a follow up visit in here for on the radio. All right, well, I'm doctor Joe Glatti. Every Sunday, have a great Fourth of July, which is this coming Friday. I'm going to be out of town. You'll probably get a best of Maybe we'll play this episode over again, but have us say fourth of July. I'm doctor Joe Giltti. Don't forget doctor Joeglotti dot com. We'll see you next week.