Latest / Voyage Clinics Podcast / Surgery Preparation and Recovery | Tips From Dr. Jonathan Dell

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Surgery Preparation and Recovery | Tips From Dr. Jonathan Dell · Voyage Clinics Podcast

• 0:10
  Speaker 1: Hello, welcome to the Voyage Clinics Podcast. I'm your host, Dr.
• 0:12
  Speaker 1: John Sanders, a family physician and friend of the community.
• 0:16
  Speaker 1: Voyage Clinics Podcast, our objective is just learning and growing
• 0:18
  Speaker 1: as a community. Today, I have a good friend of mine, Dr.
• 0:21
  Speaker 1: Jonathan Dell, as my guest. And Jonathan Dell is perhaps
• 0:27
  Speaker 1: the most interesting man in the room. So he was
• 0:30
  Speaker 1: born in South Africa, raised in Canada, trained in New York.
• 0:35
  Speaker 1: He's married. He's got a bunch of kids. He's a
• 0:37
  Speaker 1: mountain biker. And... Works for Utah Surgical Associates here in
• 0:43
  Speaker 1: Utah County. And is, so four years med school, four
• 0:47
  Speaker 1: years undergrad, four years med school. How many years Gensurge?
• 0:50
  Speaker 2: Five years.
• 0:50
  Speaker 1: Five years Gensurge. And then fellowship trained after that for?
• 0:53
  Speaker 2: It was just a year. A year.
• 0:55
  Speaker 1: Head and neck. Head and neck. Head and neck.
• 0:57
  Speaker 2: Head and neck endocrine.
• 0:58
  Speaker 1: Oh, head and neck endocrine.
• 0:59
  Speaker 2: So really thyroid, parathyroid is my jam.
• 1:01
  Speaker 1: Okay, that's your jam. So yeah, anything else I missed?
• 1:05
  Speaker 1: I feel like I wrapped it up beautifully.
• 1:06
  Speaker 2: Yeah, it was pretty good. Besides that I'm ridiculously handsome. Yeah, yeah.
• 1:12
  Speaker 1: I was going to add that. And Dr. Dell is
• 1:14
  Speaker 1: on call today, so thank you for taking some time out.
• 1:16
  Speaker 1: We're just a skip away from the hospital that he's
• 1:18
  Speaker 1: on call for him, so he's in the call zone.
• 1:20
  Speaker 1: It's fine. We're totally kosher with this podcast. And, well,
• 1:24
  Speaker 1: we're going to talk about some really fun stuff today.
• 1:27
  Speaker 1: It's towards the end of the year. We're getting towards October, November, December.
• 1:31
  Speaker 1: These are really busy months surgically. I know this as
• 1:34
  Speaker 1: a family doctor. A lot of people have hit their
• 1:37
  Speaker 1: deductibles or about to hit their deductible for the year.
• 1:39
  Speaker 1: They're all rushing to go in for surgeries.
• 1:41
  Speaker 2: Yeah.
• 1:42
  Speaker 1: And I understand it. It's the name of the game.
• 1:44
  Speaker 1: So y'all are super busy this time of year, generally.
• 1:47
  Speaker 1: And we wanted to talk about something really important and
• 1:50
  Speaker 1: applicable to everyone in our community, which is post-op stuff. Nice. Right?
• 1:55
  Speaker 2: Yes.
• 1:55
  Speaker 1: Okay.
• 1:56
  Speaker 2: And I know I told you post-op stuff. Okay. But
• 1:58
  Speaker 2: I was like, maybe we should start pre-op stuff, too.
• 2:00
  Speaker 1: I love that. Let's start with pre-op, post-op, op. Let's
• 2:03
  Speaker 1: go through all of it.
• 2:04
  Speaker 2: I like it.
• 2:05
  Speaker 1: Okay. Okay.
• 2:06
  Speaker 2: And the reason I thought about the pre-op stuff was
• 2:08
  Speaker 2: I was thinking about a story I could tell people.
• 2:11
  Speaker 2: Cause you know, why not tell a story?
• 2:13
  Speaker 1: Yeah.
• 2:14
  Speaker 2: Um, and the one that popped into my head was
• 2:16
  Speaker 2: I had this really cool patient. Um, he was actually
• 2:19
  Speaker 2: a really nice guy and he showed up the day
• 2:22
  Speaker 2: of surgery and you know, the nurse is asking me
• 2:26
  Speaker 2: if he ate anything and he was like, well, he
• 2:27
  Speaker 2: had a bite of pizza and And so I go
• 2:30
  Speaker 2: talk to him and I was like, you had a
• 2:32
  Speaker 2: bite of, well, he told actually the nurse that he'd
• 2:35
  Speaker 2: had some yogurt. And then when I asked him, I
• 2:38
  Speaker 2: was like, so I heard you ate some yogurt. And
• 2:39
  Speaker 2: he's like, well, I ate some yogurt and like a
• 2:41
  Speaker 2: bite of pizza. I'm like, okay, well, we're not going
• 2:43
  Speaker 2: to be able to do surgery now. Let me go
• 2:46
  Speaker 2: talk to anesthesia and see if we can do your
• 2:49
  Speaker 2: surgery in six hours. Right. Because you need to.
• 2:52
  Speaker 1: Be six hours. Yeah.
• 2:55
  Speaker 2: And let me talk to the OR and see if
• 2:56
  Speaker 2: we've got space and stuff like that. It was like
• 2:58
  Speaker 2: an eight o'clock case. So I went to talk to
• 3:01
  Speaker 2: him and we couldn't do it. And he was he
• 3:03
  Speaker 2: was devastated. And he was like, you're going to get
• 3:06
  Speaker 2: one piece of pizza come between me and surgery.
• 3:09
  Speaker 1: And.
• 3:12
  Speaker 2: I just realized like what I take for granted every day, like,
• 3:15
  Speaker 2: you know, six hours MPO for real food, you know,
• 3:19
  Speaker 2: like two hours for clear liquids and stuff like that.
• 3:21
  Speaker 2: The general public just doesn't really know. Right. Yeah. Um,
• 3:26
  Speaker 2: and actually sometimes I'll talk to patients about low fat
• 3:29
  Speaker 2: diet and they'll be like, well, what's that? You know,
• 3:33
  Speaker 2: like what, what has fat in it? Yeah. And you get,
• 3:36
  Speaker 2: you're surprised, right? Cause you know, we think about low
• 3:39
  Speaker 2: fat and stuff like that a lot.
• 3:41
  Speaker 1: So, I love that. Thanks for that story. It's super fun.
• 3:44
  Speaker 1: Tell us a little bit about your journey towards medicine
• 3:47
  Speaker 1: and towards being a surgeon. We're going to back up
• 3:50
  Speaker 1: just a little bit. Who is this mysterious Dr. Dell,
• 3:54
  Speaker 1: the rugby player?
• 3:55
  Speaker 2: Well, I actually decided to be a doctor when I
• 4:00
  Speaker 2: was watching a rugby game. Let's go. Springboks? Yeah, it
• 4:03
  Speaker 2: was the Springboks.
• 4:04
  Speaker 1: Let's go.
• 4:05
  Speaker 2: And actually, in South Africa at the time, there wasn't
• 4:08
  Speaker 2: any professional rugby. And so... They were just lay people,
• 4:13
  Speaker 2: and one of the players was a doctor. And he
• 4:18
  Speaker 2: got a laceration on his forehead, and he sewed it
• 4:22
  Speaker 2: up on the sideline with a mirror. He had someone
• 4:25
  Speaker 2: holding a mirror, and he sewed up his head. And
• 4:27
  Speaker 2: I was like, I want to be a doctor surgeon.
• 4:31
  Speaker 2: Or a doctor rugby player surgeon. I wanted to be
• 4:33
  Speaker 2: all three. I got older, bigger. Rugby wasn't in the cards, but... Um,
• 4:40
  Speaker 2: doctor still was.
• 4:42
  Speaker 1: Yeah.
• 4:42
  Speaker 2: Um, so that was when I decided to do medicine
• 4:46
  Speaker 2: and I switched back and forth, but came back to medicine.
• 4:50
  Speaker 1: Well, that's fun. That's fun. Um, so I played rugby
• 4:53
  Speaker 1: at UNLV for club team. It was super fun. And
• 4:56
  Speaker 1: that's how Dr. Dale and I have had some rugby
• 4:59
  Speaker 1: bondage going on. So that's really fun.
• 5:01
  Speaker 2: Yeah. Yeah. One of us went to the South Africa game,
• 5:04
  Speaker 2: but it's not the one that should have.
• 5:05
  Speaker 1: Yeah, it was me.
• 5:07
  Speaker 2: I should have taken the time off work and gone.
• 5:09
  Speaker 1: In Baltimore. I bugged you a little bit, but probably
• 5:12
  Speaker 1: not enough.
• 5:14
  Speaker 2: Yeah, it is 100% my fault. Dr. Sanders invited me
• 5:18
  Speaker 2: more than once. So it is just me.
• 5:21
  Speaker 1: Well, there's, there's hundreds of thousands of fans that are
• 5:23
  Speaker 1: disappointed in your, in my choice. Yeah. Okay. Let's talk
• 5:27
  Speaker 1: about pre-op stuff. So what should the average person I'm
• 5:31
  Speaker 1: scheduled for surgery? Generally, they're going to get a pre-op
• 5:34
  Speaker 1: instruction stuff from, they're going to go see somebody first.
• 5:37
  Speaker 1: They'll see me. That was a doctor, John. I think
• 5:39
  Speaker 1: I need surgery on my knee and we'll take x-rays.
• 5:42
  Speaker 1: We'll look at that. We'll send them to the referral to,
• 5:44
  Speaker 1: to see like the orthopedic surgeon or the gen surgeon
• 5:46
  Speaker 1: or whomever. And then they'll say, yeah, I agree. I
• 5:50
  Speaker 1: think this is surgery material. And then sometimes they'll come
• 5:54
  Speaker 1: back to me for like clearance for health care, cardiac clearance,
• 5:58
  Speaker 1: they call it, just to make sure they're safe during
• 6:00
  Speaker 1: surgery because there's some strain on your body during surgery.
• 6:02
  Speaker 1: You want to make sure you survive from a cardiopulmonary standpoint. Um,
• 6:06
  Speaker 1: if they're generally healthy people, then y'all just clear them. Um,
• 6:09
  Speaker 1: but sometimes if they're questionably, then they'll push back to
• 6:12
  Speaker 1: me and then I'll do some testing and make sure
• 6:13
  Speaker 1: everything's kosher. And then we send them back to y'all
• 6:15
  Speaker 1: and then, and then take that, take it from there.
• 6:18
  Speaker 2: Yeah. So you're right. We send you a pre-op package
• 6:23
  Speaker 2: as someone who's had surgery. I also know that a
• 6:26
  Speaker 2: lot of people don't read that preoperative package. Um, I didn't, um,
• 6:33
  Speaker 2: I know my wife hasn't for her pre-op stuff until
• 6:36
  Speaker 2: it was like too late. She was scheduled for a
• 6:39
  Speaker 2: colonoscopy and didn't read the prep until it like had
• 6:43
  Speaker 2: to happen that second. So it was in time, I guess,
• 6:46
  Speaker 2: but it was like, you know, a little bit late.
• 6:50
  Speaker 2: So there is that part of it. But, you know,
• 6:54
  Speaker 2: the big things with preoperative care, just making sure. You
• 6:58
  Speaker 2: do go see your doctor. Your surgeon and your doctor
• 7:01
  Speaker 2: know your whole medical history. Not that anyone watching a
• 7:07
  Speaker 2: podcast is going to, but if you do drugs, if
• 7:10
  Speaker 2: you've got some embarrassing thing in your history, don't worry.
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  Speaker 2: Doctors aren't going to judge you. We want to hear
• 7:15
  Speaker 2: about that kind of stuff because it can make a
• 7:19
  Speaker 2: huge difference.
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  Speaker 1: It can seriously affect the safety of your procedure.
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  Speaker 2: Absolutely.
• 7:23
  Speaker 1: Yeah, big deal. And just be truthful. We're not like
• 7:26
  Speaker 1: police and we're not doing any of that. We just
• 7:28
  Speaker 1: love people, want them to live.
• 7:30
  Speaker 2: Exactly.
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  Speaker 1: Yeah.
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  Speaker 2: And I'm sure we've all had stories of patients who
• 7:35
  Speaker 2: didn't tell us about drug use and it would have
• 7:38
  Speaker 2: really been helpful if they had.
• 7:40
  Speaker 1: I feel like there's something under the surface here. Should
• 7:42
  Speaker 1: we dive into that?
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  Speaker 2: I mean, I did have a patient, but it's fine.
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  Speaker 1: Okay, that's another time.
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  Speaker 2: That's a doctor's lounge story.
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  Speaker 1: Yeah, exactly. Got it.
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  Speaker 2: So make sure your doctor knows and make sure you
• 7:53
  Speaker 2: know what to expect from the surgery. Your doctor is
• 7:56
  Speaker 2: going to kind of tell you what to expect, and
• 7:59
  Speaker 2: those kinds of things. The big thing that's universal to
• 8:02
  Speaker 2: all surgeries are if you're going under anesthesia, you're going
• 8:06
  Speaker 2: to need to be NPO. Sometimes they say after midnight,
• 8:10
  Speaker 2: but it's at least six hours if it's real food
• 8:13
  Speaker 2: or even coffee with cream. Clear liquids, it's more like
• 8:19
  Speaker 2: two hours.
• 8:20
  Speaker 1: Can we talk about what NPO stands for? People probably
• 8:23
  Speaker 1: don't know that.
• 8:24
  Speaker 2: Yeah, that's a great idea.
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  Speaker 1: Not a per oral, nine per, I don't know, some
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  Speaker 1: Latin phrase.
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  Speaker 2: Yeah, so don't eat or drink anything. And the eating
• 8:36
  Speaker 2: food and drinking food with milk in it or anything
• 8:40
  Speaker 2: like that would be, don't do that for six hours.
• 8:44
  Speaker 1: What if we have medicines I need to take in
• 8:46
  Speaker 1: the morning, et cetera?
• 8:47
  Speaker 2: That's a great question. Yes, medicine with a sip of
• 8:49
  Speaker 2: water is fine.
• 8:51
  Speaker 1: Yep, blood pressure stuff and whatnots. Yes. Cool.
• 8:54
  Speaker 2: And if you have a ton of medicine or if
• 8:55
  Speaker 2: you have certain medicines, definitely talk to your doctor about
• 8:59
  Speaker 2: which ones you should take. If you're on blood thinners, aspirin, Plavix, Coumadin, Eliquis,
• 9:08
  Speaker 2: super common. Definitely talk to your doctor about when you
• 9:12
  Speaker 2: should stop those and if you should stop them. Sometimes
• 9:16
  Speaker 2: we have people who are really high risk, so we
• 9:17
  Speaker 2: have to bridge them. So definitely. if you're on any
• 9:21
  Speaker 2: blood thinners, talk to your doctor for sure.
• 9:23
  Speaker 1: For sure. Um, we're doing surgery. We're doing some cutting generally.
• 9:26
  Speaker 1: I mean, there's, there's going to be some bleeding. So
• 9:28
  Speaker 1: if you're on a blood thinner, double check with like
• 9:31
  Speaker 1: what the protocol might be. Sometimes it's okay to continue
• 9:33
  Speaker 1: if it's just kind of a, yeah.
• 9:35
  Speaker 2: Yeah.
• 9:35
  Speaker 1: Yeah.
• 9:37
  Speaker 2: And it also depends on the doctor.
• 9:38
  Speaker 1: Totally. I've noticed that. But the orthopod over here said
• 9:42
  Speaker 1: there's something totally different.
• 9:44
  Speaker 2: Yeah.
• 9:44
  Speaker 1: Yeah. So, um, let's talk about like, um, it, decolonization stuff?
• 9:50
  Speaker 1: I mean, the ortho guys are doing this quite a
• 9:51
  Speaker 1: bit before surgeries. They're pretty rigid about that. Do you
• 9:54
  Speaker 1: guys do anything like that? What I mean by that,
• 9:56
  Speaker 1: just for our listeners, is we all have colonization issues.
• 10:00
  Speaker 1: of multiple things, normal gut flora, normal skin flora, normal
• 10:03
  Speaker 1: everything flora. And sometimes, especially if there's a risk of
• 10:08
  Speaker 1: resistant strains of certain bacteria that we can grow on
• 10:11
  Speaker 1: our skins and things, some surgeons are like, hey, we
• 10:14
  Speaker 1: need that all gone. And decolonizing might mean a scrub.
• 10:18
  Speaker 1: like a decolonizing soap or some kind, and then also
• 10:21
  Speaker 1: treating the nasal passageways with, like, mupiracin for 10 days
• 10:25
  Speaker 1: prior to surgery, an antibacterial ointment, that kind of thing.
• 10:29
  Speaker 1: Do you guys do that routinely?
• 10:31
  Speaker 2: We don't do that routinely. Sometimes we'll give the skin— the
• 10:35
  Speaker 2: skin wash is actually much more routine, like an antibacterial—
• 10:42
  Speaker 2: skin wash. We have you shower the night before. Hibiclens
• 10:46
  Speaker 2: type thing. Hibiclens, exactly.
• 10:48
  Speaker 1: Yeah, very good.
• 10:49
  Speaker 2: So I guess antibacterial soap, but like supersized.
• 10:53
  Speaker 1: Yeah, it is. The big pink bottle. Yeah. You can
• 10:56
  Speaker 1: get it over the counter, actually.
• 10:57
  Speaker 2: Oh, you can?
• 10:58
  Speaker 1: Yeah, I always thought it was a prescription too, but
• 11:00
  Speaker 1: I saw it in the pharmacy. I'm like, wait.
• 11:02
  Speaker 2: This whole time.
• 11:04
  Speaker 1: I don't recommend decolonizing routinely. That is super unhealthy. And
• 11:08
  Speaker 1: in fact, I had a, I think it was a
• 11:10
  Speaker 1: I don't remember if it was a podcast I was
• 11:11
  Speaker 1: listening to or what, but there was a colorectal surgeon
• 11:14
  Speaker 1: talking about those man wipes and the disinfecting butt wipes
• 11:19
  Speaker 1: and how that's super not healthy for the flora around
• 11:22
  Speaker 1: your rectum. There's actually normal bacteria that needs to live
• 11:25
  Speaker 1: there that's not healthy to disinfect all the time. Yeah.
• 11:28
  Speaker 2: I mean, the bacteria on your skin actually is part
• 11:31
  Speaker 2: of the protective barrier, right? And the same in the gut, right?
• 11:36
  Speaker 2: Like those normal bacteria are good and healthy. Um, so
• 11:41
  Speaker 2: you don't want to do that. Actually, I had a
• 11:42
  Speaker 2: biology professor in college who didn't even like antibacterial soap.
• 11:47
  Speaker 2: He was like, you should just use normal soap.
• 11:49
  Speaker 1: 100%. In fact, 100%. Yes. We're seeing a lot more
• 11:53
  Speaker 1: resistant strains. Cause if you kill all the happy strains,
• 11:55
  Speaker 1: all the healthy strains, the symbiotic strains, then you're going
• 11:58
  Speaker 1: to get strains that are maybe a little more noxious,
• 12:01
  Speaker 1: fussy infection causing.
• 12:04
  Speaker 2: Yeah.
• 12:04
  Speaker 1: Big deal. Big deal. Streps, staph. Those are very common
• 12:07
  Speaker 1: skin floras. There's a whole bunch that live in your
• 12:10
  Speaker 1: nasal cavity that are strep staphylococcus plus a whole bunch
• 12:13
  Speaker 1: of other things. And they're all normal. I think they're super,
• 12:17
  Speaker 1: super normal. And it's super healthy to embrace that. Like
• 12:21
  Speaker 1: embrace the fact that bacteria is good and they're your friend.
• 12:25
  Speaker 1: And it's like, I don't know, like putting your hands
• 12:27
  Speaker 1: in a nest of bees. If you're all scared about
• 12:30
  Speaker 1: it and you're all fussing around, they're going to bite you,
• 12:31
  Speaker 1: all of them. But this is totally not science, but
• 12:34
  Speaker 1: like if we could embrace the Zen of like dirtiness,
• 12:39
  Speaker 1: that it's okay to have like quote unquote germs, bacteria, candida,
• 12:45
  Speaker 1: like all of these things are normally on your skin
• 12:47
  Speaker 1: and your mouth and your, like they're everywhere. And sometimes,
• 12:50
  Speaker 1: especially social media in the age of misinformation, we hear
• 12:54
  Speaker 1: all these things and then we get freaked out and
• 12:56
  Speaker 1: then we're like nervous about it. And then we're washing
• 12:58
  Speaker 1: our hands too much or we're, you know, doing all
• 13:00
  Speaker 1: these wipey things that probably don't need to happen. Yeah. Yeah.
• 13:03
  Speaker 2: I've seen moms like disinfecting every single thing and you're like,
• 13:09
  Speaker 2: you know.
• 13:09
  Speaker 1: Yeah. COVID was counterproductive for that too.
• 13:11
  Speaker 2: For sure.
• 13:12
  Speaker 1: Let me sanitize everything all the time.
• 13:14
  Speaker 2: Yeah.
• 13:14
  Speaker 1: Nope. We need dirty. We need dirty. Our bodies are
• 13:17
  Speaker 1: beautifully built to handle germs beautifully.
• 13:20
  Speaker 2: Yeah. Yeah. I tell patients that, well, not that exact thing,
• 13:23
  Speaker 2: but all the time that like God or the universe
• 13:27
  Speaker 2: or Darwin, whoever you believe like created us did a
• 13:30
  Speaker 2: really good job. Yeah. Right. And we are much more
• 13:34
  Speaker 2: resilient and able to heal than, um, than we think.
• 13:38
  Speaker 2: And actually healing is like our body's ability to heal
• 13:42
  Speaker 2: is the only reason surgery works.
• 13:45
  Speaker 1: Right.
• 13:45
  Speaker 2: Like we put the tissues next to each other, but
• 13:47
  Speaker 2: your body's what actually like seals them back together.
• 13:51
  Speaker 1: Totally.
• 13:52
  Speaker 2: And I've seen patients who were like really malnutrition, malnourished, um,
• 13:57
  Speaker 2: who didn't heal from surgery and like, A year later,
• 14:02
  Speaker 2: the wound broke down. And I was like, I've never
• 14:05
  Speaker 2: seen that before. But it was just because her body
• 14:08
  Speaker 2: wasn't healthy. And the surgery doesn't work, right? Like our
• 14:10
  Speaker 2: sewing stuff back together only works so much. Like a
• 14:13
  Speaker 2: lot of the healing is actually done by our body.
• 14:16
  Speaker 1: Gosh, there's probably no studies on this, but like high cortisol,
• 14:19
  Speaker 1: high stress states, you know, prior to surgery. It's hard
• 14:23
  Speaker 1: to tell people like, hey, just chill. It's just surgery.
• 14:25
  Speaker 1: You're just getting your knee replaced. Because there is a
• 14:28
  Speaker 1: certain amount of anxiety that comes with that. But if
• 14:30
  Speaker 1: you can put your head around it emotionally preparing for it,
• 14:34
  Speaker 1: probably outcomes are much better. I mean, anytime we go
• 14:37
  Speaker 1: into a stressful event with less stress on our systems,
• 14:42
  Speaker 1: our immune system functions better, our healing is better, everything
• 14:45
  Speaker 1: is better. I mean, pre-op, you probably don't say, chill out,
• 14:49
  Speaker 1: do some yoga and stretch and do that kind of thing.
• 14:51
  Speaker 1: But maybe we should.
• 14:53
  Speaker 2: Yeah, I've never thought about it, but we probably should.
• 14:55
  Speaker 1: Let's do a study.
• 14:56
  Speaker 2: I definitely... Agree. I don't know of any studies about
• 15:00
  Speaker 2: surgery or that kind of stuff, but we do have
• 15:02
  Speaker 2: an ICU study where patients who had family with them,
• 15:06
  Speaker 2: like healed way quicker. They like did better in the
• 15:10
  Speaker 2: ICU just because they had family with them. And I
• 15:13
  Speaker 2: think it's because of that, right? They're just more comfortable.
• 15:17
  Speaker 2: They feel loved. They're able to be less stressed.
• 15:20
  Speaker 1: Okay. So I want to hear more about that. Tell
• 15:22
  Speaker 1: me about that ICU study with family present and kind
• 15:24
  Speaker 1: of the It probably calmed them down and they probably
• 15:27
  Speaker 1: had less cortisol and better immune function and better healing. Yeah.
• 15:30
  Speaker 2: It was a long time ago that I read it.
• 15:32
  Speaker 2: But when I read it, I was like, are you kidding?
• 15:34
  Speaker 2: Like family actually matters, right? Like going and seeing your
• 15:37
  Speaker 2: family member in the hospital after they just had surgery
• 15:41
  Speaker 2: is probably a good idea. Wow.
• 15:43
  Speaker 1: That's cool. That's cool that they did a study on
• 15:45
  Speaker 1: that too. Yeah. Yeah.
• 15:47
  Speaker 2: Well done. I'll have to find it and send it
• 15:48
  Speaker 2: to you.
• 15:48
  Speaker 1: Sounds like family medicine study of some kind, some soft touch. Yeah.
• 15:52
  Speaker 2: They're the real doctors.
• 15:53
  Speaker 1: Being all holistic over here. Yeah.
• 15:56
  Speaker 2: They're definitely the real doctors. We just cut stuff out
• 16:00
  Speaker 2: when it needs to come out.
• 16:03
  Speaker 1: So pre-op care, we talked about that. Anything else for
• 16:06
  Speaker 1: pre-op that we should be thinking about? NPO, nothing per oral,
• 16:09
  Speaker 1: six hours.
• 16:11
  Speaker 2: Just making sure you have somewhere like sort of along
• 16:14
  Speaker 2: the cortisol thing, like just somewhere where you can heal. Right.
• 16:17
  Speaker 2: So if you're getting a knee surgery and you've got
• 16:20
  Speaker 2: to fly to stairs, you know, like maybe find some
• 16:24
  Speaker 2: way to sleep on your your first floor or something
• 16:27
  Speaker 2: like that. Try to prepare somewhere where you can be because,
• 16:30
  Speaker 2: you know, it's hard. And I think sometimes like we
• 16:33
  Speaker 2: talk about trying to chill out, I think sometimes embracing
• 16:36
  Speaker 2: the scariness of it. Right. Like just just yeah, this
• 16:40
  Speaker 2: is scary.
• 16:41
  Speaker 1: Right.
• 16:42
  Speaker 2: Just face it and be like, OK, I'm feeling scared.
• 16:45
  Speaker 2: I'm going to get surgery and then feel that scared
• 16:48
  Speaker 2: and then move on.
• 16:49
  Speaker 1: Let it be Halloween scared.
• 16:50
  Speaker 2: Yeah.
• 16:51
  Speaker 1: Yeah.
• 16:51
  Speaker 2: Because, you know, it's totally normal to be scared. Like
• 16:54
  Speaker 2: everyone's scared. I was scared before I had surgery and
• 16:58
  Speaker 2: I do surgery every single day. Right. We talk to
• 17:02
  Speaker 2: patients and we're like. Oh, yeah, don't worry about the
• 17:05
  Speaker 2: hospital because I know it's scary for you, but it's
• 17:08
  Speaker 2: not scary for us because we do it every single day.
• 17:10
  Speaker 2: But when it was actually me, I was like, oh,
• 17:13
  Speaker 2: never mind. It is scary for me.
• 17:14
  Speaker 1: You know, I think Doc should... undergo any treatments that
• 17:18
  Speaker 1: they do just for and medicines too because we give
• 17:21
  Speaker 1: medicines to some people like what I gave that to
• 17:24
  Speaker 1: somebody I took it and it was like crazy but
• 17:26
  Speaker 1: like the same thing with surgeries like oh I did
• 17:28
  Speaker 1: my first colonoscopy and I was like oh I've been
• 17:31
  Speaker 1: telling folks they need these for years and that's what
• 17:32
  Speaker 1: that's all about okay now I can talk to them
• 17:34
  Speaker 1: about it.
• 17:36
  Speaker 2: Well, I agree with you. Hopefully some of it could
• 17:38
  Speaker 2: be virtual with the whole new AI stuff, because otherwise,
• 17:43
  Speaker 2: during my surgical training, I would be left with nothing
• 17:46
  Speaker 2: left on the inside. No spleen, no colon, big chunks
• 17:51
  Speaker 2: of small bowel missing. I'd have all kinds of ostomies
• 17:55
  Speaker 2: and stuff like that. I wouldn't have a thyroid, parathyroid,
• 17:58
  Speaker 2: since that's what I specialized in.
• 18:00
  Speaker 1: Well, maybe just have them cut it and put it back.
• 18:03
  Speaker 2: Exactly.
• 18:04
  Speaker 1: Yeah. Well, that's very fun. That's cool. Pre-op stuff. Operation, obviously,
• 18:09
  Speaker 1: there's probably not a whole lot to do there. I mean,
• 18:11
  Speaker 1: you're going to have the surgeon, you're going to have
• 18:14
  Speaker 1: an anesthesiologist talking to you about getting ready for it.
• 18:17
  Speaker 1: The anesthesiologist is going to smile at you and count
• 18:20
  Speaker 1: to 10 and you're going to hear three and then
• 18:22
  Speaker 1: you're going to be gone. Generally, almost all surgeries outside
• 18:28
  Speaker 1: of the office in the OR are... completely under anesthesia, right?
• 18:32
  Speaker 1: Or are we doing twilight anesthesia on some cases?
• 18:34
  Speaker 2: We do do twilight anesthesia on some stuff.
• 18:37
  Speaker 1: Um, that means you're semi-conscious. Yes.
• 18:39
  Speaker 2: Um, and I've actually done parathyroid surgery with a patient awake, semi-conscious. Yeah.
• 18:46
  Speaker 1: Okay.
• 18:47
  Speaker 2: Um, and they were pretty conscious, uh, cause they were pretty,
• 18:50
  Speaker 2: they were pretty sick and they really didn't want anesthesia.
• 18:52
  Speaker 2: So we just gave them a little something to make
• 18:53
  Speaker 2: them comfortable. Um, but most of our surgery is with, um,
• 19:00
  Speaker 2: general anesthesia. Um, and if you are getting general anesthesia,
• 19:05
  Speaker 2: if you're getting colonoscopy and you're even getting sedation like that,
• 19:08
  Speaker 2: you definitely need someone to drive you home. So that's
• 19:12
  Speaker 2: something else to plan for, right? Someone to drive you
• 19:15
  Speaker 2: home and then someone to stay with you for 24 hours.
• 19:18
  Speaker 2: Cause most surgeries, they want someone to stay with you
• 19:20
  Speaker 2: for that first 24 hours. Cause that's when the biggest
• 19:23
  Speaker 2: risk of complications is.
• 19:25
  Speaker 1: Yep. Yep. Let's talk about that post-op time. Um, OK,
• 19:29
  Speaker 1: we just had surgery. We're getting wheeled out and we're
• 19:32
  Speaker 1: kind of punchy. We're coming to. And, you know, you're
• 19:35
  Speaker 1: making crude comments to the nurses because you're still just
• 19:38
  Speaker 1: a little out of it. And they're smiling, laughing. And
• 19:41
  Speaker 1: your spouse is there and she's pissed because you made
• 19:44
  Speaker 1: crude comments to the nurses. And and then you're going
• 19:47
  Speaker 1: to what's called what pack you like post-op. kind of
• 19:50
  Speaker 1: step down unit do you want to start there and
• 19:53
  Speaker 1: or just.
• 19:54
  Speaker 2: Sure you know some people remember the post-operative care unit
• 19:58
  Speaker 2: some people don't true right um you actually wake up
• 20:02
  Speaker 2: in quite a bit of pain after surgery like it
• 20:05
  Speaker 2: it hurts quite a bit more than you think but
• 20:08
  Speaker 2: the nurse is are totally on top of it. They
• 20:10
  Speaker 2: take care of the pay and they give you medicine.
• 20:13
  Speaker 2: There's usually, at least most of the facilities I've worked,
• 20:17
  Speaker 2: there's an anesthesiologist that's kind of planted there, slash they
• 20:22
  Speaker 2: run and do other things, but they're there to help
• 20:25
  Speaker 2: the nurses make sure that you're doing great.
• 20:28
  Speaker 1: I have a lot of patients that get hesitant about pain.
• 20:30
  Speaker 1: They're like, ooh, I'm going to get addicted to this medicine. And, man,
• 20:35
  Speaker 1: you just got your whatever operated on, like literally cut
• 20:39
  Speaker 1: and stuff. And so one of my biggest things is
• 20:41
  Speaker 1: just tell people when you're in pain, don't try to
• 20:43
  Speaker 1: muscle through it because pain stacks on top of pain.
• 20:45
  Speaker 1: And then once it gets really, really big, then it's
• 20:47
  Speaker 1: really hard to control. But if you can kind of
• 20:50
  Speaker 1: keep on top of it, it's better. Stay on top
• 20:53
  Speaker 1: of it. Tell the nurses, hey, I'm like 7 out
• 20:55
  Speaker 1: of 10. I don't want to get 10 out of 10.
• 20:57
  Speaker 1: I want to get there. And just let them know
• 20:59
  Speaker 1: and they're on top of it. Yeah.
• 21:01
  Speaker 2: And there's medicines that we can use. And actually, one
• 21:04
  Speaker 2: of my favorite medicines in the PACU that we use,
• 21:07
  Speaker 2: we can only use it once while you're in the PACU.
• 21:10
  Speaker 2: But it's not an addictive medicine, right? It helps with inflammation.
• 21:16
  Speaker 2: It helps with pain. So we've got... Yeah. It's great.
• 21:19
  Speaker 2: It's the NFL before the game. Yeah. I think some
• 21:27
  Speaker 2: people even put them in the IV bags that they'll
• 21:29
  Speaker 2: come to like your office and like give you the
• 21:32
  Speaker 2: anti-hangover cure or whatever.
• 21:33
  Speaker 1: A little Toradol in that. Yeah.
• 21:35
  Speaker 2: So it really is a good medicine. And we do
• 21:38
  Speaker 2: have a lot of other medicines that we can. I
• 21:40
  Speaker 2: agree with you. Don't let the pain get out of control.
• 21:42
  Speaker 2: And your risk for... Addiction to pain medicines is really
• 21:46
  Speaker 2: sort of like, do you need it and how long
• 21:49
  Speaker 2: you've been on it?
• 21:50
  Speaker 1: Right.
• 21:50
  Speaker 2: So if you've been on it for three days and
• 21:53
  Speaker 2: you've really needed it because you just had surgery, the
• 21:55
  Speaker 2: chance of you being addicted after that is super low. Yeah.
• 21:59
  Speaker 1: Right.
• 22:01
  Speaker 2: Whereas if you go home and you're still taking the
• 22:03
  Speaker 2: pain medicine a week later and you really don't need
• 22:07
  Speaker 2: it anymore, you just kind of like the way it feels.
• 22:09
  Speaker 1: Yes.
• 22:10
  Speaker 2: Then you're getting into the really dangerous time.
• 22:13
  Speaker 1: Yeah, I like that you differentiated that. I have more
• 22:16
  Speaker 1: people I'm having to really twist their arm to get
• 22:19
  Speaker 1: them to take their medicine. Even for physical therapy, I
• 22:24
  Speaker 1: weaned off of it day two post-op, and I'm like,
• 22:27
  Speaker 1: it's okay. But then do you need it afterwards for
• 22:32
  Speaker 1: some PT to get your joints moving again or whatever?
• 22:35
  Speaker 1: That's okay, too. So I have to reassure them a
• 22:37
  Speaker 1: lot and let them know, I'm not going to keep
• 22:40
  Speaker 1: prescribing that to you. Don't worry. And you can't get it.
• 22:42
  Speaker 1: I mean, you can, but it's harder to get it
• 22:44
  Speaker 1: at other pathways. And so I try to protect people
• 22:47
  Speaker 1: from addiction. There was a time when there were a
• 22:49
  Speaker 1: lot of candy folks out there prescribing these kinds of
• 22:52
  Speaker 1: things for folks that didn't need it. And they were
• 22:54
  Speaker 1: kind of proliferating that kind of thing. And, you know,
• 22:56
  Speaker 1: we had that opioid epidemic thing and we've reigned back
• 22:59
  Speaker 1: on that, but maybe a little too much. I mean,
• 23:01
  Speaker 1: maybe scared people a little bit too much. So they're
• 23:03
  Speaker 1: reigning in a little too hard and So some balance
• 23:05
  Speaker 1: between that makes sense.
• 23:07
  Speaker 2: Yeah. I think there should be a healthy fear of
• 23:09
  Speaker 2: pain meds.
• 23:09
  Speaker 1: Yep.
• 23:10
  Speaker 2: But honestly, with pain meds, the biggest thing that, like,
• 23:14
  Speaker 2: negative outcome from it that I see is constipation.
• 23:18
  Speaker 1: Totally.
• 23:19
  Speaker 2: Let's talk about that. Bowel.
• 23:21
  Speaker 1: Yeah. Post-op bowel.
• 23:22
  Speaker 2: If you're on any, like, opioid, any strong pain medicine
• 23:28
  Speaker 2: after surgery, or even if you're not on one, you
• 23:31
  Speaker 2: should make sure you're pooping.
• 23:32
  Speaker 1: Right?
• 23:33
  Speaker 2: Right. Um, because I have admitted, I probably admit one
• 23:37
  Speaker 2: or two patients a year for constipation after surgery. Um,
• 23:41
  Speaker 2: often it's because they had a, either a surgery that
• 23:45
  Speaker 2: was painful to poop, right. Or it was the pain
• 23:49
  Speaker 2: medicine more for me, like head and neck, right. More
• 23:51
  Speaker 2: commonly the pain medicine. Um, but yeah, you know, like
• 23:55
  Speaker 2: if you get a hemorrhoid surgery or something like that,
• 23:57
  Speaker 2: then you can also get really constipated cause it hurts
• 24:00
  Speaker 2: to poop. Yep. But, Having bowel movements is very normal
• 24:05
  Speaker 2: and very important because if you get constipated, it actually,
• 24:10
  Speaker 2: like the first few that I saw becoming a surgeon,
• 24:15
  Speaker 2: I was like, there's no way that there's having that
• 24:18
  Speaker 2: much pain from constipation. And then you're like, oh, yeah,
• 24:22
  Speaker 2: that was all it was, right? They have a good
• 24:24
  Speaker 2: bowel movement. They feel great. They're like, I'm ready to go, doc.
• 24:26
  Speaker 2: See ya. And you're like, really? That's all it was?
• 24:29
  Speaker 1: Yeah. So post-op constipation prophylaxis or prevention. We generally, I always,
• 24:36
  Speaker 1: if I prescribe an opiate for anybody for whatever they're
• 24:39
  Speaker 1: having or have had, I always say, you're going to
• 24:42
  Speaker 1: take Colace with this. And then if you start getting
• 24:45
  Speaker 1: backed up or slowed down, Miralax on top of that.
• 24:47
  Speaker 1: And that's what I do. Do you have any other
• 24:49
  Speaker 1: protocols for those?
• 24:52
  Speaker 2: I mean, the Colace is a great idea.
• 24:54
  Speaker 1: Just keep it loose. Keep it smooth and groovy. Oatmeal.
• 24:58
  Speaker 1: I don't need a form stool from you. Yeah.
• 25:01
  Speaker 2: I tell people soft serve ice cream.
• 25:03
  Speaker 1: Oh, that's nice.
• 25:04
  Speaker 2: Because it's a little form, but not too much form.
• 25:08
  Speaker 2: So that's mine.
• 25:10
  Speaker 1: I tell them bear scat. I'm going for bear scat.
• 25:12
  Speaker 2: Oatmeal, it's fine.
• 25:14
  Speaker 1: Pile of berries and some twigs and stuff in there. Great.
• 25:17
  Speaker 2: Well, and it depends on the surgery that you had,
• 25:19
  Speaker 2: but sometimes the looser.
• 25:21
  Speaker 1: Yeah. As long as it's not 47 a day, I
• 25:24
  Speaker 1: can handle like three oatmeal consistency, four. Great. That will
• 25:28
  Speaker 1: not hurt you. Will not hurt you. And only help you.
• 25:31
  Speaker 1: Keep it smooth and groovy. Smooth and groovy. Smooth and groovy.
• 25:33
  Speaker 2: I like it.
• 25:34
  Speaker 1: I always say that.
• 25:37
  Speaker 2: Hopefully I didn't ruin soft serve ice cream for anyone.
• 25:39
  Speaker 1: No, no. I think last week I drained an abscess
• 25:42
  Speaker 1: on the guy's rectum and there was like, I don't know,
• 25:45
  Speaker 1: 30 cc's of soft serve that came out of that abscess.
• 25:47
  Speaker 1: A big bunch of pussy goodness. And yeah, I think
• 25:50
  Speaker 1: I ruined soft serve for my medical student for sure. Yeah.
• 25:56
  Speaker 2: If you like Dr. Phil Popper, then that kind of
• 25:59
  Speaker 2: stuff is.
• 26:01
  Speaker 1: Yeah, that's your jam.
• 26:01
  Speaker 2: It's pretty satisfying.
• 26:02
  Speaker 1: That's your jam for sure. Okay. So post, let's talk
• 26:05
  Speaker 1: about bowel surgery because there's some people who are having
• 26:07
  Speaker 1: bowel stuff. Post-op ileus prevention. I remember in residency, I
• 26:11
  Speaker 1: read a study. Chewing gum helps prevent post-op ileus. And
• 26:15
  Speaker 1: so you might consider... Sometimes even the anesthesia they give
• 26:18
  Speaker 1: you can slow the bowel and slow what's called peristalsis,
• 26:21
  Speaker 1: the movement of stool through the alimentary canal from top
• 26:25
  Speaker 1: to bottom. And just stimulating the chewing sensation and saliva
• 26:29
  Speaker 1: swallowing and stuff with gum chewing kind of stimulates peristalsis
• 26:33
  Speaker 1: and gets the bowel back online. Do you guys do
• 26:36
  Speaker 1: that or do you recommend anything to kind of help things? Yeah.
• 26:39
  Speaker 2: If a patient asks what they can do, I definitely
• 26:40
  Speaker 2: recommend some gum or hard candy. That helps. And it
• 26:44
  Speaker 2: also actually... I'd probably bring gum and hard candy if
• 26:47
  Speaker 2: you go to the hospital.
• 26:48
  Speaker 1: They have gross stuff there?
• 26:51
  Speaker 2: Well, it's just nice to keep your mouth feeling not
• 26:56
  Speaker 2: so dry, especially if you're NPO. Your mouth gets all
• 27:00
  Speaker 2: cottony and doesn't feel very good. I would bring your
• 27:04
  Speaker 2: own toothpaste and maybe toothbrush because the toothpaste and the
• 27:08
  Speaker 2: toothbrushes at the hospital aren't amazing.
• 27:11
  Speaker 1: No, they're not amazing.
• 27:12
  Speaker 2: But we will give you a toothbrush and toothpaste. the
• 27:15
  Speaker 2: other thing, so I recommend all my patients post up,
• 27:18
  Speaker 2: brush their teeth. And as soon as I allow them
• 27:22
  Speaker 2: to take a shower, so not using the 21st, 24 hours, um,
• 27:26
  Speaker 2: I use glue. So, um, after that first 24 hours,
• 27:29
  Speaker 2: they're kind of out of the anesthesia cause I don't
• 27:31
  Speaker 2: want them to fall in the shower or anything like that.
• 27:33
  Speaker 2: Cause you know, they can get lightheaded if they get, um,
• 27:38
  Speaker 2: have a, like a vagal response, right? They, it gets warm,
• 27:40
  Speaker 2: they get comfortable. Um, They've just had surgery. So I
• 27:44
  Speaker 2: don't want anything like that. But I usually have them
• 27:46
  Speaker 2: shower because you'd be amazed at how much doing normal
• 27:49
  Speaker 2: things makes you feel better. Right. Like showering, brushing your teeth.
• 27:55
  Speaker 2: My biggest one is walking. Right. Like I recommend everybody walk.
• 28:01
  Speaker 2: And I want you to if you have surgery with me,
• 28:04
  Speaker 2: I want you to push yourself a little bit.
• 28:06
  Speaker 1: Right.
• 28:06
  Speaker 2: I even want you to take a nap. Right. Like
• 28:08
  Speaker 2: I want you to go for a walk and go
• 28:10
  Speaker 2: for enough sort of little walks that you're tired and
• 28:13
  Speaker 2: you want to take a nap. Yeah. Right. Cause you
• 28:14
  Speaker 2: want your body to heal. So you do want to rest.
• 28:17
  Speaker 2: But I really think that movement is life. I think
• 28:20
  Speaker 2: is a good way of saying it. Like, unless you're moving,
• 28:24
  Speaker 2: you're really, you're just not going to heal as well.
• 28:28
  Speaker 1: Everything comes back online. Everything from movement, like your bowels
• 28:32
  Speaker 1: are better. Like everything is better just from moving. Even
• 28:35
  Speaker 1: like post, so I did OB for 10 years and,
• 28:37
  Speaker 1: and after like a C-section, we, we would, you know,
• 28:41
  Speaker 1: put an order on the chart, you know, out of
• 28:43
  Speaker 1: bed three times a day, you know, and so folks
• 28:45
  Speaker 1: are not just lying in bed, but they're getting up
• 28:47
  Speaker 1: and they're moving around and, you know, their, their bowels
• 28:49
  Speaker 1: come back online and their, everything kind of comes back online,
• 28:52
  Speaker 1: super healthy for them. Yeah.
• 28:54
  Speaker 2: And to go back to your pain thing, right? Like
• 28:56
  Speaker 2: if you need to take pain medicine to go for
• 28:59
  Speaker 2: a walk, I want you to take pain medicine for sure.
• 29:02
  Speaker 1: Totally.
• 29:03
  Speaker 2: Um, And I also want you to kind of embrace
• 29:07
  Speaker 2: that you just had surgery. Like if it's a big
• 29:09
  Speaker 2: bowel case and we just made like a huge cut,
• 29:13
  Speaker 2: like I want you to kind of like, it's going
• 29:17
  Speaker 2: to suck. Right.
• 29:18
  Speaker 1: But, um, embrace the suck. Yeah. You got to walk. Yeah.
• 29:23
  Speaker 2: Right. Like I had open heart surgery and getting up
• 29:25
  Speaker 2: and walking was awful, but I did it because I
• 29:30
  Speaker 2: knew how important it was. Whoa. We had one nurse
• 29:32
  Speaker 2: in New York, and I loved her because she would
• 29:35
  Speaker 2: get her patients up and walk. She was just an old.
• 29:38
  Speaker 1: like people would nurse ratchet.
• 29:41
  Speaker 2: Yeah. But she wasn't right. Cause she like made you better.
• 29:44
  Speaker 1: Yep.
• 29:45
  Speaker 2: So, you know, she'd tell you, she didn't care that
• 29:47
  Speaker 2: you didn't want to get up and walk. You were
• 29:49
  Speaker 2: getting it. You were going to get up anyway. And
• 29:51
  Speaker 2: her patients would go leave the hospital like a day
• 29:54
  Speaker 2: or two earlier than any of the nurses that didn't
• 29:57
  Speaker 2: make their patients walk.
• 29:58
  Speaker 1: If you're not complaining about a nurse a little bit,
• 30:00
  Speaker 1: they're probably not a great nurse. So just be ready
• 30:04
  Speaker 1: to be like nurse ratcheted, you know, out of bed.
• 30:07
  Speaker 1: We got to ratchet you out of there and get
• 30:09
  Speaker 1: you up and moving. And they're doing their job. Don't
• 30:10
  Speaker 1: hate the nurses. They love you. They're trying to help you.
• 30:13
  Speaker 1: And it is hard and there's hard stuff. I like
• 30:16
  Speaker 1: what you're saying. You said a couple of times, face it,
• 30:19
  Speaker 1: you know, look at it and deal with it. And
• 30:21
  Speaker 1: just like go right at it. Look at the surgery
• 30:24
  Speaker 1: and say, wow, that's a big scar. Those are a
• 30:26
  Speaker 1: lot of staples in my chest. And don't look away
• 30:30
  Speaker 1: from it. It's just a season of your life. It's
• 30:32
  Speaker 1: a portion there. One of my favorite animals is the
• 30:35
  Speaker 1: bison or buffalo. And they're like one of the only
• 30:40
  Speaker 1: animals that face the storm. A big blizzard will be
• 30:42
  Speaker 1: coming and they'll just face right at it. And they're
• 30:45
  Speaker 1: not looking away from it. They're not running from it.
• 30:48
  Speaker 1: They just sit there in it and they look right
• 30:50
  Speaker 1: at it. And from an emotional standpoint, that's super healthy
• 30:54
  Speaker 1: to embrace the season of the difficult season. And let
• 30:57
  Speaker 1: it pass through you and over you. And then let
• 31:00
  Speaker 1: it be gone too. Let it die. Cause that season
• 31:02
  Speaker 1: is just this big.
• 31:04
  Speaker 2: When I love that, a bison thing, right? Cause if
• 31:06
  Speaker 2: you're pushing into this, the suck for lack of a
• 31:10
  Speaker 2: better term, it'll end quicker.
• 31:12
  Speaker 1: Boom. Right?
• 31:13
  Speaker 2: Like if you're walking and you're doing those things, like
• 31:16
  Speaker 2: it hurts, it's not really comfortable, but it'll, It'll be
• 31:20
  Speaker 2: over faster and you'll get better quicker.
• 31:21
  Speaker 1: Yeah. If you're afraid, you're looking away, you're running away
• 31:24
  Speaker 1: from it. You're just in it and you're staying in
• 31:26
  Speaker 1: it because you're not going through it.
• 31:28
  Speaker 2: Yeah. Totally.
• 31:31
  Speaker 1: We should have been psychiatrists, bro.
• 31:32
  Speaker 2: I would have been a terrible psychiatrist.
• 31:36
  Speaker 1: No, I'm actually.
• 31:37
  Speaker 2: I mean, I like my patients, but listening to them
• 31:40
  Speaker 2: for 45 minutes would be. Would be very hard for me.
• 31:42
  Speaker 1: You're being a stereotypical surgeon. Knock it off.
• 31:46
  Speaker 2: I mean, 30 minutes, I'm fine. But like 45, that's
• 31:49
  Speaker 2: pushing it. Just kidding.
• 31:52
  Speaker 1: Post-op, what else can we do? So we talked about moving.
• 31:55
  Speaker 1: We talked about chewing gum, getting your bowels, making sure
• 31:57
  Speaker 1: preventing constipation like at all cost.
• 32:01
  Speaker 2: Some of the things to expect after surgery that don't
• 32:06
  Speaker 2: sort of make it better, but they do because you
• 32:08
  Speaker 2: know what you're expecting, right? So like if you have
• 32:11
  Speaker 2: an incision and you see a little drop of blood
• 32:14
  Speaker 2: or a little bit of blood, that's fine. Put a
• 32:17
  Speaker 2: Band-Aid over it. Even if it's laparoscopic surgery, there's three
• 32:21
  Speaker 2: little cuts. If it's a thyroid surgery, you got to
• 32:23
  Speaker 2: put a little bigger Band-Aid on it. If it's your
• 32:27
  Speaker 2: knee surgery and it's just a little bit of bleeding–
• 32:29
  Speaker 2: That's totally normal. You can just put a dressing on it. Um,
• 32:33
  Speaker 2: there's a little bit of clear fluid also normal.
• 32:37
  Speaker 1: Um, generally after any surgery, you're going to have a
• 32:40
  Speaker 1: list of post-op instructions and wound care instructions and things
• 32:43
  Speaker 1: like that. Um, If you're also going to be out
• 32:47
  Speaker 1: of it when those things are handed to you and
• 32:49
  Speaker 1: your family members and your family members sometimes are good
• 32:51
  Speaker 1: and not less good at listening to those things. So
• 32:54
  Speaker 1: if there's any question, you can always reach out to
• 32:56
  Speaker 1: the surgeon. They have call lines. They have nurse lines.
• 32:59
  Speaker 1: They have all these lines to give you access to. Hey,
• 33:03
  Speaker 1: I don't know what to do with this. Or, hey,
• 33:05
  Speaker 1: I got some like. a little bit of like pinkish
• 33:07
  Speaker 1: stuff oozing from this thing.
• 33:09
  Speaker 2: Am I dying?
• 33:10
  Speaker 1: Like it's fine. Like kind of look through, but to
• 33:13
  Speaker 1: your point, yeah. Some oozing after surgery, super duper normal. Yeah.
• 33:17
  Speaker 2: And I think that's the reason I bring it up
• 33:19
  Speaker 2: is that was the one thing call that our nurses
• 33:22
  Speaker 2: get probably the most is like, Hey, what about this?
• 33:26
  Speaker 1: Yeah. It's pretty wet. What should I do?
• 33:28
  Speaker 2: Exactly. Itching is super normal. Pain is normal after surgery.
• 33:35
  Speaker 1: Right.
• 33:35
  Speaker 2: Like you just had surgery. It's going to hurt. I
• 33:37
  Speaker 2: tell my patients, at least the ones that I think
• 33:40
  Speaker 2: will think it's funny, that we're going to get in
• 33:43
  Speaker 2: a knife fight and I'm going to win. I'm just kidding.
• 33:48
  Speaker 2: I read that somewhere and I thought it was funny.
• 33:49
  Speaker 1: That's pretty funny. Yeah.
• 33:50
  Speaker 2: He's like, because I'm the only one with a knife
• 33:52
  Speaker 2: and you're going to be asleep. Right. But it's like
• 33:56
  Speaker 2: we do use a scalpel. So we cut your skin
• 33:59
  Speaker 2: like there's no surgery that doesn't hurt a lot or
• 34:02
  Speaker 2: not that doesn't hurt at all.
• 34:03
  Speaker 1: Right.
• 34:03
  Speaker 2: Some surgeries hurt a lot, like shoulders, shoulders, knees, like
• 34:08
  Speaker 2: a lot of ortho stuff hurts a lot. You know,
• 34:12
  Speaker 2: a big X lap, which is just where we make
• 34:15
  Speaker 2: a huge incision belly to the top of your belly
• 34:18
  Speaker 2: to the bottom of your belly to the bottom of
• 34:21
  Speaker 2: your chest. Like those hurt a lot and moving hurts.
• 34:25
  Speaker 2: Then there's things like thyroid surgery that really doesn't hurt
• 34:28
  Speaker 2: all that much. Tonsils, if you're a kid. Not too
• 34:34
  Speaker 2: bad if you're an adult. Hurts like crazy. But pain
• 34:39
  Speaker 2: that's getting better, totally normal. Pain that all of a
• 34:44
  Speaker 2: sudden starts getting worse, that's not normal. Yep. And that's
• 34:48
  Speaker 2: something you should definitely call your doctor about. Things that
• 34:52
  Speaker 2: you should go to the ER for are going to
• 34:54
  Speaker 2: be like shortness of breath, chest pain, because like you said,
• 34:59
  Speaker 2: it puts strain on your heart and your lungs and
• 35:03
  Speaker 2: You can have something like a heart attack or pulmonary
• 35:06
  Speaker 2: embolism afterwards, which is just a blood clot in your lung. So,
• 35:11
  Speaker 2: you know, those are things.
• 35:13
  Speaker 1: Unilateral leg swelling.
• 35:14
  Speaker 2: Yes.
• 35:14
  Speaker 1: One side swollen.
• 35:15
  Speaker 2: Yeah.
• 35:16
  Speaker 1: Yeah. I like that.
• 35:18
  Speaker 2: Those are things you should definitely go to the ER.
• 35:20
  Speaker 1: Big fevers, things like that. Post-op fevers.
• 35:23
  Speaker 2: Fevers.
• 35:24
  Speaker 1: Yeah.
• 35:24
  Speaker 2: And a fever, you know, if you're otherwise feeling fine,
• 35:28
  Speaker 2: you might even just be able to call your doctor's office.
• 35:31
  Speaker 2: But it's not something you should ignore.
• 35:33
  Speaker 1: Yeah.
• 35:33
  Speaker 2: Right? So, fevers. If you start feeling worse, then you
• 35:40
  Speaker 2: should definitely give your dog a call.
• 35:41
  Speaker 1: Even profound pain. Yes. Like, you know, profound, profound, profound.
• 35:45
  Speaker 1: Holy cow. Like, ooh, this is bad.
• 35:47
  Speaker 2: Whoa.
• 35:47
  Speaker 1: And then, boom, it's like... So, complications can happen and
• 35:50
  Speaker 1: things like that. And so, talk to somebody.
• 35:53
  Speaker 2: Yeah. And, you know... Just because we say pain's normal
• 35:56
  Speaker 2: doesn't mean if you feel like the pain's enough that
• 35:58
  Speaker 2: you need to go to the ER, you don't need
• 35:59
  Speaker 2: to go to the ER. You should still go to
• 36:01
  Speaker 2: the ER if it's that.
• 36:02
  Speaker 1: Kind of pain. This is a perfect time for a
• 36:03
  Speaker 1: disclaimer that this podcast is not intended to be medical advice,
• 36:07
  Speaker 1: but just for educational purposes only. So we are not
• 36:09
  Speaker 1: giving you medical advice right now.
• 36:12
  Speaker 2: It might sound like it.
• 36:13
  Speaker 1: It just sounds like it. But this is just us
• 36:16
  Speaker 1: talking and trying to help folks post-operatively have better outcomes,
• 36:20
  Speaker 1: have an easier, smoother time, communicating with their doctor's office,
• 36:23
  Speaker 1: and when should I reach out and all the things. So, yeah. So,
• 36:26
  Speaker 1: there you go. Disclaimer.
• 36:27
  Speaker 2: I like the disclaimer. Dropped. And also, there's things that
• 36:30
  Speaker 2: we could forget because we are having a conversation, right? Totally.
• 36:33
  Speaker 1: Totally.
• 36:34
  Speaker 2: Okay.
• 36:34
  Speaker 1: Wound care. So, it's been seven days since my surgery.
• 36:39
  Speaker 1: I've got a bunch of staples or I got some
• 36:41
  Speaker 1: sutures and stuff like that.
• 36:42
  Speaker 2: Yeah.
• 36:45
  Speaker 1: Okay, let's, let's go back to pre seven days in
• 36:48
  Speaker 1: that first seven days before my followup. When should I
• 36:52
  Speaker 1: be concerned that I might be getting an infection? What should,
• 36:54
  Speaker 1: what would that look like? And cause infections are not,
• 36:57
  Speaker 1: you know, completely gone. Sometimes it does happen. Anytime I
• 37:01
  Speaker 1: cut the skin, it can happen. Um, they're pretty, they're
• 37:04
  Speaker 1: not as common. I mean, we use all sterile stuff.
• 37:06
  Speaker 1: We clean the crap out of everything. We do all
• 37:08
  Speaker 1: the things, take all these precautions, wear masks, all the things. And, uh,
• 37:11
  Speaker 1: still it happens sometimes. So, Maybe if you could break
• 37:13
  Speaker 1: down like post-op infection, when does it occur? Is it
• 37:17
  Speaker 1: within two hours after infection or is it like a
• 37:20
  Speaker 1: few days or weeks or when does that look? And
• 37:22
  Speaker 1: what does that generally look like as far as the
• 37:24
  Speaker 1: wound or how I feel?
• 37:25
  Speaker 2: There are bacteria that can give you an infection within
• 37:28
  Speaker 2: like a day, right? Those are super rare. So normally
• 37:33
  Speaker 2: if your incision is a little red after the surgery
• 37:37
  Speaker 2: is normal. We get allergic reactions to the tape. We
• 37:43
  Speaker 2: get irritation and actually some little redness around the staples
• 37:47
  Speaker 2: or sutures. That's just sort of normal stuff. So usually
• 37:52
  Speaker 2: infection is like three days-ish. You're going to be looking
• 37:56
  Speaker 2: at maybe I have an infection. Sort of depends on
• 37:59
  Speaker 2: the surgery what the infection is going to look like.
• 38:04
  Speaker 2: If it's like a laparoscopic surgery, then the risk of
• 38:07
  Speaker 2: skin damage. infections is a little bit lower and it's
• 38:12
  Speaker 2: usually deeper infections, right? So if you had your appendix out,
• 38:15
  Speaker 2: they're going to be looking for a deeper infection and
• 38:18
  Speaker 2: that's going to be more like pain in that area
• 38:22
  Speaker 2: and fevers and chills, right? If it's a skin infection,
• 38:27
  Speaker 2: they're nice because they're easier to find, right? It's all
• 38:30
  Speaker 2: of a sudden turns nice and red, usually gets pretty
• 38:34
  Speaker 2: tender to the touch. You can have fevers and chills,
• 38:38
  Speaker 2: but for skin infections, you don't have to.
• 38:41
  Speaker 1: Sometimes those, um, fevers and chills are only at nighttime. Um,
• 38:45
  Speaker 1: sometimes they're all days kind of. So either one of
• 38:47
  Speaker 1: those equations is a kind of a thing. If you're
• 38:50
  Speaker 1: like super cold, chills, shaking, having to put on multiple blankets,
• 38:54
  Speaker 1: you might have a fever. You checking on that?
• 38:57
  Speaker 2: Yeah.
• 38:58
  Speaker 1: Yeah. Okay, cool. Um, wound care after we've got the
• 39:00
  Speaker 1: staples out, it looks good. We've got some stair strips
• 39:03
  Speaker 1: on there and it's healing up. Um, is there, are
• 39:06
  Speaker 1: there any other precautions post-op like in that, in that
• 39:09
  Speaker 1: wound healing or scarring space that you would recommend? Cause
• 39:12
  Speaker 1: I hear a lot of people talk about scarring and,
• 39:14
  Speaker 1: and what we can do there.
• 39:16
  Speaker 2: Well, so especially the neck, right? People are really worried
• 39:20
  Speaker 2: about it. So we definitely talk about, um, scar prevention, right?
• 39:25
  Speaker 2: The biggest thing for scar prevention is going to be
• 39:27
  Speaker 2: keeping it out of the sun, right? If you can't
• 39:29
  Speaker 2: keep it out of the sun, sunscreen, cover it. So
• 39:36
  Speaker 2: keeping it out of the sun is the most important thing.
• 39:37
  Speaker 1: The ultraviolet radiation just causes more profound scarring, right? Yeah.
• 39:42
  Speaker 2: And it also can darken them, make them just sort
• 39:45
  Speaker 2: of more obvious. Scars also, massage helps them. So it
• 39:50
  Speaker 2: can break down the scar tissue. It can make them softer.
• 39:54
  Speaker 2: So in the neck, we like to get all our
• 39:57
  Speaker 2: patients to do massage because there's a lot of stuff
• 40:00
  Speaker 2: in your neck that if it gets scarred to is
• 40:04
  Speaker 2: going to be irritating, right? Like swallowing and stuff like that.
• 40:07
  Speaker 2: So massage definitely helps with that. But for any scar,
• 40:11
  Speaker 2: massage will help. You do want to wait, you know,
• 40:15
  Speaker 2: like two weeks before you start massaging a scar and
• 40:20
  Speaker 2: putting creams and all this weird stuff. And I check
• 40:23
  Speaker 2: with your surgeon before you do any of that stuff.
• 40:27
  Speaker 2: But as far as other than keeping it out of
• 40:30
  Speaker 2: the sun and massage, there's not a lot we can do.
• 40:34
  Speaker 2: Silicone has been proven to help. So silicone gel or sheets,
• 40:39
  Speaker 2: those have evidence that they help. And it seems to
• 40:45
  Speaker 2: be that they do help, but how much, you know,
• 40:53
  Speaker 2: I would sort of balance it, right? I wouldn't go
• 40:56
  Speaker 2: to the dermatologist, buy a $ 90 cream that you're going
• 40:59
  Speaker 2: to need every other month for the silicone because I
• 41:01
  Speaker 2: don't think it helps that much. But if you're very
• 41:04
  Speaker 2: worried about a scar, then maybe it's worth it to you.
• 41:08
  Speaker 2: The other thing that, oh.
• 41:09
  Speaker 1: I'm just, I'm really glad you mentioned the massaging or
• 41:12
  Speaker 1: frictioning a scar. I think we often don't talk about that.
• 41:16
  Speaker 1: And I don't know why. I learned about it a
• 41:18
  Speaker 1: long time ago, like in residency. And I tell folks
• 41:21
  Speaker 1: like your scarring goes through like a proliferative phase where
• 41:24
  Speaker 1: it's like growing. And then it goes through remodeling phase.
• 41:28
  Speaker 1: And that remodeling phase can be months and months and months.
• 41:30
  Speaker 1: And so it will continue to remodel functionally, like the
• 41:34
  Speaker 1: fibroblasts are laying down in a very disorganized way. And
• 41:37
  Speaker 1: the more that you can massage them, they become more
• 41:39
  Speaker 1: functional and they're more in line with what your body needs.
• 41:43
  Speaker 1: So the more that you can kind of agitate it
• 41:45
  Speaker 1: and move it around. Do you talk like perpendicular to
• 41:49
  Speaker 1: the wound edge or do you care or how do
• 41:51
  Speaker 1: you do that?
• 41:51
  Speaker 2: So I tell them to massage it in– for the
• 41:55
  Speaker 2: head and neck in three directions.
• 41:57
  Speaker 1: Yeah, because you probably have multiple.
• 41:59
  Speaker 2: Yeah. So you're going up and down, side to side,
• 42:02
  Speaker 2: and then twisting. And so– Cause you've got layers, right?
• 42:07
  Speaker 1: So you're getting to all those layers.
• 42:08
  Speaker 2: And you're just trying to break it all up. So basically, um,
• 42:12
  Speaker 2: I mean, if I was to do it, I just
• 42:13
  Speaker 2: sort of, you know, like all over, right. Just kind
• 42:16
  Speaker 2: of move it in every direction that you can away
• 42:19
  Speaker 2: from the neck toward it. But, you know, and scars
• 42:23
  Speaker 2: get pretty sensitive when they're healing. Um, so it might
• 42:29
  Speaker 2: not be super comfortable, but the more you, we embrace
• 42:33
  Speaker 2: the suck that we talked about earlier, um, it does
• 42:36
  Speaker 2: actually sort of become less sensitive too.
• 42:38
  Speaker 1: Yeah.
• 42:38
  Speaker 2: So at first it'll be kind of sensitive to move
• 42:40
  Speaker 2: it around and then.
• 42:42
  Speaker 1: And after two weeks, there's, there's essentially not a strong
• 42:46
  Speaker 1: risk for opening the wound back up after two weeks,
• 42:49
  Speaker 1: you're probably safe and talk to your surgeon. They might
• 42:51
  Speaker 1: say three weeks or whatever, but also talk to them
• 42:54
  Speaker 1: about direction oil because different surgeons have different thoughts and
• 42:57
  Speaker 1: different body parts and whatnot. But yeah, I like that.
• 43:00
  Speaker 1: That's good.
• 43:01
  Speaker 2: And I mean, Anything we tell you, you've got to
• 43:05
  Speaker 2: do sort of in moderation too, right? Yeah. When I
• 43:07
  Speaker 2: tell you to walk, I don't mean go climb Timpanogos, right?
• 43:12
  Speaker 2: We want you to sort of do those things. You know,
• 43:16
  Speaker 2: I'm talking more about making sure you go up and
• 43:18
  Speaker 2: get your own water and go get your own drink
• 43:20
  Speaker 2: and the same with the scars, right? You just want
• 43:22
  Speaker 2: to use some good judgment too, right?
• 43:26
  Speaker 1: Totally.
• 43:26
  Speaker 2: Yeah. You're not trying to break down all the scar tissue.
• 43:31
  Speaker 2: You're just trying to loosen it up and move it
• 43:32
  Speaker 2: around and You know, I think for the scarring, frequency
• 43:37
  Speaker 2: is probably more important than intensity. So don't make up
• 43:41
  Speaker 2: for not doing it frequently by going crazy with the intensity.
• 43:46
  Speaker 1: I like it. I like it. Post-op emotional stuff, you know,
• 43:52
  Speaker 1: people go from, you know, high activity level to like
• 43:54
  Speaker 1: lesser activity level for a time. And that can be
• 43:56
  Speaker 1: really taxing on somebody emotionally emotionally. Again, another reason to
• 44:00
  Speaker 1: get up and walk and move. I really like the
• 44:03
  Speaker 1: embrace the suck buffalo thing, you know, where we're facing
• 44:06
  Speaker 1: the storm. And I think that's really helpful just emotionally
• 44:09
  Speaker 1: to prepare yourself for kind of a hard thing. And
• 44:14
  Speaker 1: the human mind and heart and body is so resilient.
• 44:17
  Speaker 1: I'm impressed constantly and in awe constantly at our ability
• 44:23
  Speaker 1: to endure heavy, hard things and then also to heal.
• 44:28
  Speaker 1: And it's beautiful. And get back. It's fine.
• 44:30
  Speaker 2: Well, and just like the ICU, right? Like, get a
• 44:33
  Speaker 2: good support group. If it's not family, then make it friends.
• 44:36
  Speaker 2: Make sure you have a good support group. And if
• 44:40
  Speaker 2: you don't, you should probably work on getting one because
• 44:42
  Speaker 2: you'll need them. One, at some point, not just for surgery,
• 44:46
  Speaker 2: but just for real life, right?
• 44:47
  Speaker 1: For sure, for sure.
• 44:48
  Speaker 2: And if you need to talk to a professional, because
• 44:51
  Speaker 2: this can be hard, right? Like if you have a
• 44:53
  Speaker 2: big surgery, you're in the ICU for a week, there's
• 44:56
  Speaker 2: PTSD that's involved with that, right? And if you have
• 45:00
  Speaker 2: like real post-traumatic stress disorder, you should probably talk to
• 45:04
  Speaker 2: somebody that is much smarter about that than your surgeon.
• 45:08
  Speaker 1: Yeah.
• 45:08
  Speaker 2: Right.
• 45:09
  Speaker 1: Mike, talk to me about it.
• 45:10
  Speaker 2: Yeah.
• 45:12
  Speaker 1: Cause we'll get you to the right people and we'll
• 45:14
  Speaker 1: help you with that too. No, for sure. I see
• 45:17
  Speaker 1: a lot of people PTSD after ICU, like ICU is
• 45:20
  Speaker 1: like intensive care unit. It's you're about to die. Like
• 45:24
  Speaker 1: your chances of death is pretty damn high. And we
• 45:27
  Speaker 1: put you there to save your life. And it's intense.
• 45:30
  Speaker 1: Like everybody is, that's why it's called the intensive care unit.
• 45:32
  Speaker 1: Cause you're in very intensive care. Cause you're really sick.
• 45:36
  Speaker 1: And so, yeah, for all those really heavy, heavy things,
• 45:39
  Speaker 1: Scary things, even surgery, like PTSD after all that stuff.
• 45:43
  Speaker 1: Talk to someone, have a support group. I love it. Yeah,
• 45:46
  Speaker 1: that's great. Dr. Dell, anything else on today's podcast? This
• 45:49
  Speaker 1: was super fun.
• 45:51
  Speaker 2: Well, I'm glad you had fun. I did.
• 45:54
  Speaker 1: No.
• 45:55
  Speaker 2: Oh, with scars. The other thing that has been proven
• 45:57
  Speaker 2: to help is red light therapy.
• 45:59
  Speaker 1: Oh, yeah.
• 46:00
  Speaker 2: I got asked by that. by one of my patients
• 46:02
  Speaker 2: that's a little bit, um, crunchy, I guess you'd say.
• 46:05
  Speaker 1: I'm crunchy. Let's go crunch away.
• 46:07
  Speaker 2: And she asked, so I looked it up and I
• 46:08
  Speaker 2: was like, wow, there's actually some data on it.
• 46:10
  Speaker 1: Yeah.
• 46:11
  Speaker 2: So there, it does seem like red light therapy helps. Um,
• 46:15
  Speaker 2: and honestly, I tell people to use whatever they want to,
• 46:18
  Speaker 2: but those are just the things that have been proven.
• 46:21
  Speaker 1: Yeah.
• 46:21
  Speaker 2: Right. And we do have the rules, but you know, um, No.
• 46:27
  Speaker 2: And I, I mean, I would just say to find a,
• 46:31
  Speaker 2: if you're going to have surgery, find a surgeon that
• 46:33
  Speaker 2: you're really comfortable with because you're trusting them with your life. Right.
• 46:38
  Speaker 2: And literally, but also figuratively, right? Like, but also literally.
• 46:44
  Speaker 2: So like you get to be picky.
• 46:46
  Speaker 1: Yeah.
• 46:47
  Speaker 2: And if you don't feel super comfortable with your surgeon, then,
• 46:51
  Speaker 2: you know, I tell patients it's not going to hurt
• 46:53
  Speaker 2: my feelings. It does a little bit, but it doesn't matter.
• 46:56
  Speaker 1: Yeah. Right?
• 46:57
  Speaker 2: Like, you need to be really comfortable with your surgeon
• 46:59
  Speaker 2: and really like them. And if you're not, find another one.
• 47:02
  Speaker 2: Because if you don't trust them, you're not going to
• 47:05
  Speaker 2: do what they say. And if you don't do what
• 47:06
  Speaker 2: they say, you're not going to get as better as
• 47:09
  Speaker 2: quick as you could.
• 47:10
  Speaker 1: That's right. In closing, Dr. Dell. Tell us how can
• 47:14
  Speaker 1: people get ahold of you? What kind of surgeries do
• 47:17
  Speaker 1: you perform that they might ask their doc to kind
• 47:20
  Speaker 1: of send to you? And what, what, where's your company?
• 47:23
  Speaker 1: How do they get ahold of you?
• 47:24
  Speaker 2: Oh, well, I probably should have prepared and had a number, but, um,
• 47:29
  Speaker 2: so I work for, I don't even know the official
• 47:33
  Speaker 2: name of our company, but pediatrics is our parent company. And, uh,
• 47:41
  Speaker 2: so we're in, Orem, Utah.
• 47:43
  Speaker 1: Yeah.
• 47:45
  Speaker 2: I do thyroid, parathyroid surgery is my love. It's what
• 47:49
  Speaker 2: I did my fellowship on. I also do regular general surgery.
• 47:54
  Speaker 2: So that was my initial training.
• 47:56
  Speaker 1: That's gallbladders.
• 47:58
  Speaker 2: So yeah, gallbladders, hernias, appendixes, stuff like that. I do
• 48:03
  Speaker 2: love doing surgery.
• 48:05
  Speaker 1: You've got a great team. Great team of people.
• 48:06
  Speaker 2: Yeah. We've got great people. Like our medical assistants, I
• 48:10
  Speaker 2: think they're amazing. Yeah.
• 48:12
  Speaker 1: In my stuff, you're still under the Utah Surgical Associates.
• 48:16
  Speaker 1: Has that changed? You got bought out by a different company?
• 48:18
  Speaker 2: No, so we don't work for Utah Surgical Associates. It's
• 48:22
  Speaker 2: our name is something like Surgeons of the Mountain West,
• 48:25
  Speaker 2: General Surgery of the Mountain West or something like that.
• 48:28
  Speaker 2: But it's from pediatrics. Okay, cool. But I guess if
• 48:32
  Speaker 2: you look up my name.
• 48:34
  Speaker 1: Yeah, Dr. Dell.
• 48:34
  Speaker 2: It's totally on the internet.
• 48:35
  Speaker 1: Dr. Dell. Yeah, we send referrals to you guys all
• 48:38
  Speaker 1: the time. Yeah. Got a great group. Really, really great.
• 48:40
  Speaker 1: Lee Trotter has been here. He's legendary.
• 48:42
  Speaker 2: Oh, yeah.
• 48:43
  Speaker 1: He came on a couple times.
• 48:44
  Speaker 2: Yeah, you had him here with his magical hair.
• 48:46
  Speaker 1: Oh, yeah. It's incredible. Yeah.
• 48:48
  Speaker 2: You should have seen the one when it was long.
• 48:50
  Speaker 1: Oh, really?
• 48:50
  Speaker 2: It looked even cooler almost. He looked like a surfer.
• 48:52
  Speaker 1: He's a cool guy.
• 48:53
  Speaker 2: Yeah, he's a cool guy.
• 48:54
  Speaker 1: He looks 50s, but he's really like 90s. It's insane.
• 49:01
  Speaker 2: Well, luckily his hands are still like he's 50. No,
• 49:05
  Speaker 2: I definitely think of him more as a 50-year-old.
• 49:07
  Speaker 1: Me too. Yeah, he's in good shape. Well, thank you.
• 49:10
  Speaker 1: And thanks for tuning in. And thanks for your tips
• 49:11
  Speaker 1: and tricks and pearls for pre-op, post-op, and operative care.
• 49:14
  Speaker 1: And I hope our listeners learn some cool stuff as,
• 49:17
  Speaker 1: as again, our mission is just to help the community
• 49:20
  Speaker 1: learn and grow and introduce other clinicians and people to
• 49:23
  Speaker 1: our community. So yeah. Thanks.
• 49:25
  Speaker 2: Thanks man.
• 49:25
  Speaker 1: Cool.