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The Hoeflinger Podcast
Welcome to the The Hoeflinger Podcast, where Dr. Brian Hoeflinger and Kevin Hoeflinger delve into riveting discussions about life as a neurosurgeon, the world of medicine, healthy living, fitness, and anything else that piques their curiosity. Dr. Brian Hoeflinger, MD, brings his extensive 24 years of experience as a full-time neurosurgeon to educate and inform. Get ready for engaging conversations that will broaden your understanding of the medical realm and beyond!
The Hoeflinger Podcast
#9: Listener Q&A: Your Questions Answered
In this episode, Dr. Hoeflinger and Kevin Hoeflinger answer their viewers and listeners' questions. They discuss the typical day for a neurosurgeon, the tools of a neurosurgeon, various conditions, Kevin's recent Ironman finish, and much more!
Please ask any questions you want them to answer on their social medias for them to answer in a future Q&A.
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They were doing. We're trying something different. We're doing a live podcast and we're just going to go through like all the posts. You know, we put some posts out about questions you might have and topics you wanted to cover, so we thought we can do this, do a little more in depth. We'll put this out video and podcast out after, but just we wanted to do this someone a regular thing of answering people's questions, viewers questions, and just doing the Q&A.
Speaker 2:Yeah, so if you have specific questions to spy on them, we'll try to answer them as we go along.
Speaker 1:Yeah, so, and I've got a bunch of these pulled up, but we'll also answer some of your guys's questions live. So if we don't see them right away in the chat, sorry about that. Feel free to put questions in there. But there was, we had a post of last week and there's a lot of people put questions in there, so we're going to start with some of those. So I think one thing to start would be and I think people get this with one of this a lot is just like a typical day in your life is in their own surgery. And well, a lot of people think of like doing the surgeries, like what time do you get up at? Like what's your routine look like? Do you want to just walk through?
Speaker 2:that yeah so. So just pick a day, like last week. I had a day where I had three surgeries and basically I don't know. Surgery starts at 7.30. They take the patient back to operating room at 7.30. But I was trying to be there a half an hour early. I didn't have any patients in the hospital. So if I would have had patients to hospital I'd get there even earlier, but I probably get.
Speaker 2:I get up, usually around 5.30, I think, and then maybe sometimes, if I don't have to be there till 7, I might get up at 6 o'clock. And I get up and I go. Obviously I'm going to take a shower, take a shower, brush my teeth, things like that, get ready, get dressed. Then I go downstairs and I typically I make a lunch, so I pack my lunch and put some snacks and things like that and I get that ready. The dogs need water and the watering thing. I'll put some water in there. And then I, what else do I do? I usually I make some coffee, obviously coffee to go, and then I sit down. I just sit down for five or 10 minutes a year, like 10 or 15 minutes, just relax and I just kind of close my eyes and just sit there, and not necessarily meditating, maybe in a way, but I just like to clear my mind. It just calm, you know, just settles the day, and then, and then I go.
Speaker 1:So what time? I know sometimes you're sitting down in the dark at like 5.30 or 6. What time do you usually leave at? Do you think at 6?
Speaker 2:No, I mean it depends. So it just depends. I mean like if I, if I only have to go to surgery and I have patients in the hospital, I may only leave at you know 6.30, quarter or 7. If, if I've got patients at different hospitals and I'm on call and I got to see consults, I may leave at you know 5 o'clock or 5.30 in the morning to get that done before surgery. So it really depends where I have patients, at what hospitals. You know how early my surgery starts and my office starts and things like that. So like it's just a general idea, but it's early.
Speaker 1:Yeah, so usually start like your first surgery starts on like seven or right.
Speaker 2:So then so my first surgery usually starts at 7.30. Oh, 7.30.
Speaker 2:So then you base it off that like getting there at 7.30 if you have other stuff to do before that, yeah, and then I use to kind of break it down in my head Like if, if it's 7.30 start time, I usually make incision on the patient, like 8 o'clock. And then my first say one of my days in the last couple of weeks I had a big fusion surgery, so that was like a 3.5 hour surgery. So I started 8, finished around 11.30. And then it takes an hour to wake up the patient, for them to clean the room and then get the next patient and use this a little bit more than an hour. So maybe I start the next case around one o'clock.
Speaker 2:Next case was a neck fusion from the front. It takes about an hour and 15 minutes, hour and a half to do that surgery. So what does that put you at? What do you say? I'm 31 o'clock, so that puts me about 2.30. And then they have to wake the patient up, turn the room over, maybe start that case around four. And then the last surgery was a person with a pinch spinal cord. So I did surgery from the back of the neck to unpin the spinal cord. That was like an hour and 15 minute surgery. And then, when I'm done with that, I got one patient up on the floor to go see a consult. I had that I went and did and then I go home and I think I'm home around 6.30 or something.
Speaker 1:You know, it just varies a lot by day. It always varies.
Speaker 2:It's just your day it depends if you're on call and how many consults you have when you get out of surgery and how many patients you have and anybody having any problems. You have to go see them again.
Speaker 1:So yeah, so this is a good one going off of surgery. So equipment and products needed to complete a case like letter, like obviously it varies by surgery. What is some of your most common tools you use.
Speaker 2:Yeah, so they have, so they have kids that it's in the hospital.
Speaker 2:So if I'm going to do a lower back surgery see, just like a lower back surgery without fusion they'll have like three or four trays of standard instruments that I use and they're they're for me. So it's Dr Heffler and your trays. So I have specific things in there. I like in a different surgeon may have something else, but those trays are made up and then they open those trays and then there's all kind of different things you use. I mean I can name them it won't make sense to you, but like a penfield for instrument or a handheld retractor or bipolar instrument or metsymbolum scissor, so all the things. There are 11, 11 blade.
Speaker 1:So why don't you just like, maybe pick like to like and just describe what they like, what you would use them for?
Speaker 2:Like describe what I mean. The instruments are hard to describe.
Speaker 1:I mean no like what you would use, like what's the case for. Like the buy.
Speaker 2:Yeah, so like a buy. A bipolar instruments is a general instrument, doesn't? It comes from most surgery. So you know if you get into bleeding you have to cauterize a blood vessel. A bipolar instrument has little tips that occur and goes between and when you touch those tips on the structure it burns the structure in between. So it cauterizes. So a bipolar instrument I use to cauterize things A penfield for instrument is like a little spatula. It's very small, it's like a miniature spoon. But when I need to gently move the nerve over or dissect tissue from a nerve I use that instrument. You know I have a hand.
Speaker 1:What's that one tool like when you have to like, take part of the spine bone out or the bone out?
Speaker 2:that like bone crunching to. Yeah, so it's different. There's a Lexel Ron's UR. A Lexel Ron's UR is a bone, that instrument that bites the bone away big chunks of bone. So that's an instrument. Drills you know we use a drill a lot, so sometimes I drill bone away. It gets really hard. Some people's bone is very thick and hard and it actually hurts your hands to try to bite this bone away with instruments. So often I'll use a drill to thin that bone down and then I can use the other instrument to bite the thinner bone off. So there's a lot of different instruments that we use and you have to tailor it to what you're doing where you are in the body. Obviously, stuff that you use on brain surgery, on the actual brain, is different than things that we use in spine surgery.
Speaker 1:Someone wanted to know do you have, do you use any Olympus medical products?
Speaker 2:I do not use Olympus now.
Speaker 1:And then is foot drop common when having a fusion or an L4, L5 fusion.
Speaker 2:It's not common. I mean, you know, obviously the nerves that we're working around control the strength to the foot and you know if someone has an injury to a nerve they can end up with a foot drop. Or if someone has a diabetic neuropathy, that's a condition that can cause a foot drop. There's a nerve on the outside of the knee that controls lifting the foot up a vagate injury. People have foot drops. So it's not usual during that surgery to have a foot drop. Most of the time people have foot drop before they have the surgery done. Then you do the surgery to try to help with the foot drop.
Speaker 1:So when getting the laminatec, what would be a reason it would affect that side joint or is there a specific reason? They're not really.
Speaker 2:Yeah, I think these are all my opinions. Honestly, I don't know. The SI joint is a different structure from where we do a laminatec me over the back of the spine. So I don't know of a correlation necessarily between the two structures that I know of. So I don't know as if a laminatec me would cause a problem with your SI joint that I know of. But that's just my opinion, I don't know. Maybe someone else knows something, I don't know.
Speaker 1:What about so, if there's a blood clot in the brain, what would be the process of removing it?
Speaker 2:Right. So you have a blood. So say you're in a car accident and they hit their head, and they hit, maybe crack their skull or something along that line a blood clot can form over the brain, and so that can become an emergency because people die when those blood clots get big enough. So what you do at surgery say it's on the right side of the brain, you have to shave. You know, you position the patient on the operating table with their head like this, and then you have to shave most of the hair off of that side of the scalp. You make an incision in the scalp and reflect the scalp back.
Speaker 2:So you're looking at the bone. If your muscle is there too, you have to reflect part of the muscle too. Once you're looking at the bone itself over the skull. And you have to make sure, obviously, that the bone you're taking gonna take off is over where the blood clot is. So that just comes with experience. And then we have a little drill called a codmin perforator and it's a drill that will drill holes through the skull. And so I drill a perimeter of several holes when I want to take the bone off, and then we have an instrument. It's almost like a like a buzz saw and it's, it's a it has a foot plate that fits under the bone but above the brain and it just you.
Speaker 2:It's a you know power and you pull it between the, you connect the holes and Then that completes what's called the craniotomy and you lift that piece of bone right off. It's one piece of bone that comes off and we save that bone. And then you're looking at the covering of the brain. If the blood clots on the outside of the covering of the brain, you'll take the blood out right away. That's called an epidural hematoma.
Speaker 2:If the blood is under the covering of the brain, you have to cut open the covering of the brain and reflect that back, and then the blood will be sitting there over the brain. And then usually you gently irrigate and have a couple Instruments to take that blood off the top of the brain. And so that's how you take a blood cut off the top of the brain and then if there's active bleeding you have to stop it. Sometimes when you take the blood cut off but there's bleeding from the brain, so that's where you use those bipolar instruments to stop the bleeding. Once that's all done, if the brain isn't too swollen, then you can close the covering of the brain, put the bone back on with little plates and screws and Then so the muscle and the scalp back together. If the brain is swelling so bad that you can't get the bone back on so often, will leave the bone off and let the brain swell over the soon weeks. So the patient will survive.
Speaker 1:Do you eat breakfast before surgery?
Speaker 2:Yeah, most of the time I don't. I'm just not hungry that early in the morning so I usually eat when I get done with my first surgery. So sometimes it's 11 30 noon when I eat. Sometimes it's a shorter surgery, I'll eat around 9, 30 or 10.
Speaker 1:I've done that my whole career Is there any aspect of surgery that grosses you out?
Speaker 2:No, not, not anymore, but sometimes like a bad infection somewhere in the brain or the spine. I mean that they can really, when the pus comes out it can be pretty gross looking, but it doesn't Not much affects you as far as grossness anymore.
Speaker 1:I Don't know for this one, because kind of I don't really is anything but for, like, migraines and headaches. Do you have any thoughts on that? Of what the cause? Is there anything like that?
Speaker 2:I mean, I don't treat migraine headaches. That's what a neurologist would do. So often. If someone has a migraine, what I think is a migraine headache is their problem and that's something that is structural that I can help with. I would refer them to neurologists for that. So I don't deal much with migraine headaches. There's so many different reasons for migraine headaches and it's not doesn't have to be from a brain tumor or some other problem like that.
Speaker 1:So so Intercranial pressure.
Speaker 2:So intercranial pressure is just the pressure inside your skull. You can measure that. You know, if someone comes in with a bad head injury and they're in a coma and Say they don't have a blood clot, I mean they don't have something that needs surgery, but you're worried about increased pressure on the brain. We drill a little hole through the skull and put a little Fibro optic monitor wire into the brain and that will monitor the pressure and we can see how high the pressure is. So Intercranial pressure is pressure inside of the skull that puts pressure on the brain.
Speaker 2:To generate disc disease, like what it is and it's yeah, so degenerative disease it's more of a Well, it's something you can see on an MRI. So it's more of a radiologic finding. But it is degeneration of this. So it's not a disease, it's a condition. So as we get older our disc will start to degenerate, so they lose their water content and they start showing up as dark on an MRI. So when you see a dark disc On your MRI of your back or your spine, that's what we call degenerative disc, degenerate disc themselves. Sometimes it causes pain, sometimes it doesn't. So not everybody who has a degenerative disc We'll have chronic back pain. But you know, if you have one level of degenerative disc and the disc is collapsed, often that can be the reason for your back pain. You can treat that with conservative measures. Or sometimes people need surgery to have their spine fuse at that level. But the gender of this disease is not a disease. It's a condition of the spine where the, where the disc is aging and it's losing its water content.
Speaker 1:Um, a lot of people ask about, like trigeminal neuralgia. I don't know if you want to touch on that just a little bit.
Speaker 2:So targene or neuralgia, it's a long-standing, it's been in the history books for a long time but it's one of the most painful conditions, as described by people, that you can ever have and it's it's lancinating, shooting pain into the face. It can be the trigeminal nerve comes out of the, the brain and it goes into your face. There's three sections to it. There's Um, v1, v2 and v3, and it covers the forehead, the, the cheek and the jaw area, and so those nerves can Send horrible pain, just incapacitating pain, into the face and it comes in waves, it's spasmodic. Some people have committed suicide because the pain is that bad. So it's a condition of the trigeminal nerve, which is one of the cranial nerves in your brain, the.
Speaker 2:The treatment for it varies. I mean, the first line treatment for trigeminal neuralgia is um medication, so you can. There's different medications that you can use to treat it. Sometimes people have to be on two or three different medications to try to stop the attacks of pain. If medications don't work or cease to work, then there are other procedures you can have done. There is a procedure where you can Uh, put a needle and then a balloon over the nerve itself and inflate the balloon and compress the nerve and that can help For months or years with the pain for most people.
Speaker 2:Um, there's a procedure where they do a RF rhizotomy, where they actually burn, burn the nerve. That can help. Those tend to be more temporary procedures. They don't last forever. They have to be repeated in most people. And then there's a bigger surgery called a micro vascular decompression, where it's a regular craniotomy, where you have to take the Bone off the skull, dissect down in the brain to where the nerve comes out of the brain stem. Um, and often what people find there's a blood vessel, usually over the nerve that's stimulating the nerve and causing the trigeminal neuralgia pain, and so there's a little piece of gauze at least when I was doing these procedures there's a little piece of gauze that we would put between the artery and the nerve, um or the blood vessel in the nerve, and that usually would cure people Long term of their pain.
Speaker 2:So there's different ways to treat the pain from conservative the more aggressive ways. Um, most people can be treated to some extent. There are people who, unfortunately, their pain is not well controlled, but it's, it's a horrible pain. That that's well documented literature. It's been around for a long time and, um you know, it gets so bad that a lot of people have committed suicide because of that type of pain. So the people who have trigeminal neuralgia know what I'm talking about and, how often have you?
Speaker 1:it's a pretty rare disease, right? Yeah, it's not, it's not that common.
Speaker 2:But you know, for people who treat it I don't treat trigeminal neuralgia anymore, but when I did, people get referred to you. So it can seem common to you because all those people get referred To you, but but it's, it's a pretty rare from like a primary, or they from it could be a primary doctor that refers him.
Speaker 2:It could be somebody in the. You know a neurologist that saw a person for a trial neurologist and refers him to a surgeon. It could be, um, it could be any doctor. And you saw orthopedic doctor and he realized that you had trigeminal neuralgia. Dentist often dentist will be um. People go to the dentist because they're having pain in their gums and their teeth and they think of the dental problem and the dentist will um diagnose Okay um, do you think people with physical jobs Uh, have have more back injuries With neurological involvement in other occupations, or have you seen there?
Speaker 1:Or what do you do I?
Speaker 2:mean certainly a lot of people that see me will Will say I was doing this for a long time or this type of work or had this happen at work and now I have back pain. So I I don't know. I don't know the literature. Honestly, to be honest, if there's a direct correlation, I mean obviously if it's a traumatic incident at work that you get a blunt trauma in your back, that certainly can be the cause. But you know, is is a job where you're stocking things or repetitively lifting. Is that something that causes Chronic back pain? I mean, some people it is, but some people do that their whole life and they don't have a lot of back pain. So I don't think there's a good answer to that.
Speaker 1:I mean there's probably a lot of compounding variables, like if you're lifting properly, if you're strength training your back how much you're lifting, you know how frequently.
Speaker 2:I mean there's just so many things. And then there's genetics. I mean there's gotta be a big genetic component to back pain. So some people maybe they have a genetic pre Disposition of back pain and then they have a hard job and it's back breaking. They're probably a setup for back pain, you know so.
Speaker 1:And also just as your body gets older, like no matter what you can't, you can't beat father time.
Speaker 2:Well, because then the arthritis sets into your spine and your joints and the disc start to degenerate. That you know. That's why we get aches and pains in our joints, in our body as we get older, just because of those reasons.
Speaker 1:So Uh, do you have a? Do you think there's a part of surgery that's the most interesting to you, or what's the most interesting surgery you've been involved in?
Speaker 2:I don't know, I wish. I mean I think the most interesting procedures are things that are more rare. I saw more of these things in residency where you were something that doesn't come along very often, or certain procedures like there was a procedure of residency where we take half the brain out, I think for Rasmussen's encephalitis and tumors deep in the brain, where you rarely see that anatomy. Only you know in rare occasion when you're deep in someone's brain.
Speaker 2:So but I think I think you know, brain procedures are more interesting. Brain tumors and things like that are probably more interesting than spine. But it's pretty neat to see the spinal cord in the individual nerves which I see every day to.
Speaker 1:Do you ever get nervous or anxious before after surgery?
Speaker 2:No, I mean, I don't get nervous per se. I just always am cognizant that when I do surgery on somebody, I want them to come out exactly the same or better, and so I want to make sure, when I do surgery on somebody, that I'm very careful. And so that's what I think about most of all is, as I'm doing surgery, I'm thinking of the steps, thinking ahead, making sure you know that I'm doing what the patient needs to have done, but not anymore. I always want I was worried I want to make sure that people you know come out of surgery the same, with no deficits, and hopefully their pain is better. So that's why I think about more of us not actually nervous. It's about trying to protect the patient, I guess, which I guess could make you apprehensive.
Speaker 1:Have you ever done surgery on someone with brain parasites?
Speaker 2:With brain parasites. I don't know if we did and I don't think I have.
Speaker 1:What causes your spine to fuse? Naturally.
Speaker 2:Yeah, I don't think. There are certain conditions I guess that people can have, like ankylism, spondylitis. That is a condition that can cause that, but it would have to be a certain, probably genetic, condition that causes premature fusion. Now, if somebody has a spine infection, like, say, you get an infection like what's called an osteomyelitis or a dyskitis, infection of the disc or bone, when that's cured and treated with antibiotics, I mean that causes the bone to grow and fuse. So there are certain conditions, like infections, that can cause fusing of the spine prematurely. And then sometimes people just have congenital or genetic conditions where their spine fuses and have a condition that predisposes them to it.
Speaker 1:When do you start leading surgeries in residency?
Speaker 2:When you start leading so in my residency like it. So even when I was a first year nurse or resident, we would be in surgery assisting right with the surgeon. But I would say when you start leading surgeries is more later years, like your fifth or sixth year, especially when you're a chief resident. You're the primary surgeon. Your attending is there but you do the majority of the case. Probably. You know that's probably the most surgeries you'll do in a year. I think is during chief residency because we're operating every day in complex, big cases, but that's when you're the lead surgeon as a resident would be chief resident.
Speaker 1:Any live questions? Yeah, some of these are live questions, like last couple of them. How cool is it growing up with a neurosurgeon father? Pretty cool. When I was much younger I didn't really understand what he did, but as I got older it's cool to understand what's cool about. I mean, there's a lot of things.
Speaker 1:Well, it's cool to see what people perceive neurosurgeons do versus what's actually done. I think some people just think a lot of times they don't realize that they think that you're just a brain surgeon and you only operate on the brain. Even a lot of people I meet now and there's just a lot of things like you put people talk about like in books, in pop culture, like about what maybe see those fighter pilots, brain surgeons you know what I'm saying. So they talk about people who can focus and do stuff like that. So that's cool. But it's also way different If you don't like there's not a ton of neurosurgeons. So if you don't haven't met someone who is one of these things rather people they just think you're like a robot versus until they know a person, they might think you're like someone who wouldn't know you.
Speaker 1:if they just heard about you Before we started making videos, might just think you're a lot more serious or a lot more. You know what I'm saying Intimidating. A lot of people are intimidated by you, I think, before they meet you, just because they know that you're a neurosurgeon. Then, once they meet you, they know you're just like a regular guy.
Speaker 2:Well, I think there's so few. There's like 3,500, 4,000 nurses in the country, but in Toledo I mean neurosurgeons in Toledo, I think there's like there's probably 10 or 12. I don't know. There's not many for a big city, yeah.
Speaker 1:No, I think most people just don't meet someone. I mean obviously, you know, like that's what's funny when you go to like the conferences, there's all these neurosurgeons in one place, but most of those people. So you are much more likely as a doctor to see neurosurgeons and other surgeons, but for the majority of people they never meet somebody, let's see yeah, so what else?
Speaker 1:what do you think are the most common things like when you've met people in your life over the last since you've been at practicing neurosurgeons in the last 24 years? When you meet someone and you say you're a neurosurgeon, what do you think like?
Speaker 2:pre make misconceptions or I don't know, I don't know what people think, because they're only saying to me you know, I don't. People just say hi, you know, I don't know, I don't know what they're thinking. They don't really go like wow, or anything. Most people like like I'll be somewhere and someone will ask me, like we'll be talking, and they'll say what do you do? And I'll say I'm a surgeon. They'll go what type? And I'll say I'm neurosurgeon, and then that kind of ends the conversation like people don't run, they don't ask me any questions about it, like we move on. I don't know if they're intimidated or they don't want to look stupid and ask questions. So so have you noticed that and people don't really ask me much about? Yeah, no, even my friends like I. They don't really ask me like what goes on in the operating room. I don't know people that are squeamish about asking me what I do because I don't know I'm. They're either not interested or scared to ask.
Speaker 1:Well, that's just weird because, like so many people are interested, I think. But it's just they think they're not going to understand anything. Maybe I think that's why some people like the videos, because when you break stuff down, someone who really understands the topic can break stuff down so anyone can understand it, just like someone like Stephen Hawking or Albert Einstein, like those people could break down super complex physics and and making the way a typical person can understand. So I think a lot of people, like you said, live with different things. People don't want to ask or they just don't even know what to ask and even know about some stuff. What about Chiari malformation?
Speaker 2:So Chiari malformation is one of those things that I think is over diagnosed. It's there's a part of your brain in the back called the cerebellum and there's a the bottom of our skull is called the frame and magnet. It's like a circle area where the the brain meets the spinal cord and so there's this tissue, the cerebellum tissue. If it drops below that level of the frame and magnet, below the level of the skull, then that is called the Chiari malformation. I think you know you can have two or three millimeters below that level is okay, but if you're past that level radiologically they call it Chiari malformation. So true, chiari malformation can cause headaches. It can cause, you know, headaches back here. It can cause weakness of your hands, drooling, trouble walking, and that's because it's pressing on the brainstem in the upper spinal cord.
Speaker 2:But most carries that I see are just, you know, they're three or four millimeters below what's called the frame and magnet like I described, and so they get sent for surgical consultation and most carry malformations. In my experience, my experience, don't need surgery. Most of the time headaches I do not think are due to carry malformation. But I've had a few people you know, obviously, who've had very large carry malformations. I had a one gal who was dropping things with her hands and their balance was off and she couldn't walk and she was weak in her arms and legs, and so I did surgery for her carry malformation to open up that space and she got back to normal strength and activity. But those are the exceptions. There's so many people that get sent to us for just mild carry malformations that really I don't think they need surgery, and so carry malformations is a condition. It's diagnosed by looking at an MRI and looking how far that tissue was dipped down.
Speaker 2:So, if anybody has that, you know, you might get referred to a neurosurgeon to have it evaluated and you just have to talk to the neurosurgeon, see what kind of symptoms you are having and then you can determine from there if if you need to have surgery or not or would benefit from it. So that's an individual conversation you have to have with your individual neurosurgeon.
Speaker 1:Why do orthopedic surgeons operate on spines as well as neurosurgeons?
Speaker 2:Yeah, so so. So it's called ortho spine surgeons versus neurosurgeons and so typically in orthopedic residency I mean they do a full five year orthopedic residency which deals with all the joints of the body, including some spine, I think. But then typically they'll do a one to two year fellowship after residency to specialize in spine, to learn spine surgery in detail, as opposed to neurosurgery. In our residencies we do spine all all six to seven years of our residency. So it's just a different way of training and again, I don't think one's better than the other. There's great ortho spine surgeons and there's great, you know, neurosurgeons operate on the spine. So it really it's individual to the surgeon more than I think if you're ortho spineer, um nurse, or did they both train?
Speaker 1:Were you nervous the first time you did surgery on a live person?
Speaker 2:Yeah, I don't even remember when that was, but I'm sure I, I'm sure I was.
Speaker 1:But also you'd have to specify the first time you were did surgery on a live person you would be a residency. So you have to check. I'd be on your right. He's asking about you but or a resident.
Speaker 2:I think the biggest thing when you first are operating on your own and no one's in the operating room with you, so you know you do all these years of residency where someone's always there to bail you out if you get into trouble, and then you get into into out of residency and you're in the operating room by yourself. Operating a live person is daunting because you're responsible and no matter what happens in that room if I get into the bleeding I can't stop or a nerve gets injured or something. I mean I'm, I'm, I'm the guy that has to take care of it. There's nobody else to bail me out. So it's, um, it's, it's what. It's a learning experience to me. It's it's where you really grow up fast.
Speaker 2:When you get out of residency and you get into practice by yourself. You have to stay calm. You can't let things jar you. If something happens to operating, you just got to slow down and just work your way through it. You can't give up because you don't have that option to give up. You know you can't leave the operating room. This is a real person who has to, um, wake up at some point. So, yeah, it's, it can be. It was nerve wracking in the beginning, but as you go through the years I'm 25 years into it I mean most things I can handle now and it doesn't phase me, but when I first started out, there's always that learning curve, like anything in life, you know yeah.
Speaker 1:Well, don't you think that's why the training is so rigorous? So long yeah.
Speaker 2:Cause they they try to get you used to this stuff before you can get out there, but it's still different. It's like it's like somebody can, having ever been there where somebody can tell you how to do something, or you can watch somebody do something a million times. When you are actually doing it, it's like you forget everything. It's like what do I? You know?
Speaker 1:it's all new to you.
Speaker 2:when you're actually doing it, you can watch somebody and it looks easy and you watch them and you watch them. But when that person leaves, and then they say okay, now you do it.
Speaker 1:It's like all of a sudden you forget.
Speaker 2:What do I do?
Speaker 1:I don't know what's the next step it's the different levels of learning. Yeah, so watching someone doing it, doing it yourself and then teaching someone else to do it, you progress with the levels and you chose deeper understanding. So this person asked do you think neurosurgery is significantly different than 10 years ago? They just asked that live.
Speaker 2:Yeah, I don't. I mean, I don't think it is. This is just my opinion. Other people have other opinions, but I think I think the basics of neurosurgery has remained the same since I was a resident.
Speaker 2:Many of the procedures that I do that we did in residency. I'm doing the exact same way I do in private practice. Yeah, there's been advances in navigation, like for brain tumors and doing biopsies. We used to have a very complex, archaic system that we would use, which was very accurate, but it was a big, complex system. You know, now we just have a wand that we put over the brain and tells you exactly where we are. So I think it's facilitated accuracy, but it's facilitated getting a procedure done more efficiently.
Speaker 2:But has it in the end made everything all better? I mean, I don't know. I think things are basically done the same, but there's robotics now and a lot of different advances in gene therapy. But I think the basic for me, the basic way of doing surgery, is the same as when I train. You just have different devices that can assist you at different levels. I guess, did you ever have to break scrub to use the bathroom? Surprisingly, my whole life I've never once broke scrub to use the bathroom, unless if we're in one of those 12-hour cases. Obviously you have to take turns. You're in there with another surgeon so you can leave to use the bathroom.
Speaker 1:So individually, but individually I've never left the operating room.
Speaker 2:I can say that with complete truth.
Speaker 1:Never left the operating room with the bathroom, when you guys are both operating not just the bathroom but like switching, like one of you is so thirsty or just like because that's kind of like long term. If you're doing really long, just like doing a triathlon or something, you can't take it. No food right, I don't know.
Speaker 2:For me, my body changes when I'm in surgery. Because you're focused, I think my body's trained not to need to go pee or anything during surgery because I don't know why, Like I can be out during on a Saturday, drink a bunch of water and I got to go to the bathroom multiple times, but when I go to surgery I just don't. I mean my body's been trained not to make more.
Speaker 1:So you don't really get thirsty or hungry, I don't, I mean, I don't Well not. So you're just yeah.
Speaker 2:And then that hunger comes. When I'm done it seems like and if you're in there for a really long case, obviously it's not good to go without drinking. So you know, we would stop periodically and drink. Or sometimes, sometimes the nurses I can't ever say like I've been in surgery where it's late in the afternoon I haven't eaten. I'll ask the nurses to bring me some orange juice and crackers, and what they do is they, you know, I'll step off to the side and they pull my mask up and give me a straw and I'll drink the orange juice and then put the mask back over. Or sometimes I'll break scrub just for a second to do to drink that or take something and then scrub right back in, but never leave the operating room. Yeah.
Speaker 1:How is your back with so much leaning and bending over from trained surgeries?
Speaker 2:Yeah, it's not, it's. I've noticed a little bit of change through the years. I mean, as I've gotten older I had a little bit more pain in my back and especially my neck. You know, I'm always looking down. I'm surprised I don't sit like this all the time. But it's not bad. I mean I'm surprised. It's not worse. You know, sometimes my hands get achy from using them through all these years, but not as bad. I mean I thought. I thought I'd probably be more sore as the years went on, but I'm not.
Speaker 1:What about, on the topic of being an operating room, if you stand on a standing pad, right that standing mat?
Speaker 2:Yeah, so sometimes I have a standing mat. I don't even use a standing mat for comfort, it's more for height. It raises me up a little bit to get in focus. But sometimes I don't use a standing mat.
Speaker 1:So do your feet like what kind of shoes? You just wear your normal shoes.
Speaker 2:Yeah, I just wear loafers. I mean, a lot of people have specialized shoes. I've always just worn regular like loafers shoes.
Speaker 1:You're like again. You're probably just so focused with your legs. Do you ever feel like your legs really tired after like a long standing?
Speaker 2:Yeah, I mean, I think so sometimes. Yeah, it varies. Some days you feel good and the other days you don't feel as good, like everybody else.
Speaker 1:Well, no for me, like I can, if I'm walking a bunch around, like I'd rather walk for hours standing in one place for a long time.
Speaker 2:your legs? Yeah Well, you definitely move around. You just kind of slide to side and stretch my back. You know if you're in a weird position.
Speaker 1:Yeah, so I'm just going to end with a couple lights, or just lighter ones. Everyone's obviously just asked about all this and well, if you guys are just listening or seeing this video, this live podcast later on we're going to try to start doing these, you know, maybe every couple of weeks, but have this be a regular segment where we do your live questions. You can ask about anything. We look through for anyone live. You can put your comments in and also we post from time to time, like we post regularly on social media and we post specifically about video topics and other things. You comment those. We look through all those all the time. We try to curate some good comments.
Speaker 2:But real quick, I want to ask something. So you can see, we both have these Ironman shirts on. So we were just in Ironman Chat Nougat last weekend. Kevin did a Chat Nougat Ironman. I just got the shirt I finished in Ironman 2017, so I can wear it, it's capable? Tell us a little bit about it. What was it like? I haven't asked you much about it.
Speaker 1:Yeah, so it was a hot day you know it was very hot, so started at 7.30. And what time did you get up? I got up at five.
Speaker 2:Oh, okay.
Speaker 1:Yeah, because you went to the start line, dropped my stuff off.
Speaker 2:And it was dark, right?
Speaker 1:Yeah, it's dark, but yeah very dark when you get there, but it's crazy Like there's so many volunteers out there, police officers just, and so many people. You get your bike ready and your run bag. You have drop bags for the transition and I took a bus over to the swim start and that lasts like half an hour to an hour, like when you're just waiting, just waiting around. Yeah, because we had to take the last bus at like 6.30 to 7.
Speaker 2:Is it kind of nerve-wracking sitting there a little bit, yeah, I just try Like, just like with the days before it.
Speaker 1:But I just don't think about it Because once it starts I know you'll just keep going. So I mean I felt that peace with it. And then at a certain point I got my white suit on and, yeah, once that line's going, you see it's a jump start into the river off the dock. So it was in the Tennessee.
Speaker 2:River. They swam.
Speaker 1:Well, yeah, and there, so three people go off the time. They do a rolling start, so every five seconds three people jump in and so it just beeps and you picking the line moves forward, so slowly moves forward. I was about five minutes after officially started and they do a rolling start for 30 to 40 minutes. But once I was in that water since I had the Western, I felt nice because it was not that cold and if you have to swim with that one and it's quick, we're going downstream. I knew it was going to be a quicker swim because they talked about your width of current.
Speaker 2:But I realized just for a quick, there's 1600 people that were in this, I mean 800 and some men and 400 and some. So this is 1200 or 13. But a lot of people these are all the people are getting in this river.
Speaker 1:It's better than when you did it. You didn't do a rolling start of. You got people kicking you and grabbing your legs sometimes, but it was a lot more spaced out and it was the river and you don't have to go. You don't have to specifically go on the left or right side of the buoy. You should have to go down, since, it was point to point, most swims are a loop, so I think that it was definitely much better in terms of not getting kicked in all that, because you usually have to fight for your life. People are all knowing everyone's just focused on their own swim, like if you're not a pretty strong swimmer. It's very daunting for people and was it hard to stay straightly.
Speaker 2:You have to lift your head. I'm not.
Speaker 1:Yeah, I have to site. Pretty often I have more. I always end up dominant, going towards my left side If I just without like a line to look at. So I have to look up and I'm like, oh, whatever, I wasted energy going over here. But yeah, the swim was fast and that was about 53 minutes.
Speaker 2:So then when you got out, so what happens? When you get out, you have this wetsuit on, you got to run to this next area where your bike is, but what happens? Like yeah, so we're coming down.
Speaker 1:You're coming down the river and you had to go to the left. What? The current is actually kind of strong when you have to swim to the left, so doing that was funny. Then you had the pull. They helped you out of the water but you had just like a ladder. You it wasn't just getting out of the water because it's like a pier, so you had the lift out of the water and you run up a little bit and if you're wearing a wetsuit, there's wetsuit peelers, so you lay down and they just rip your wet wetsuit off and give it back to you really quick, because If you ever want a wetsuit, it's really. If you haven't, I mean, it gets really stuck to you and people are trying to. It is a race. Some people take their time, though there's a lot of people trying to at least keep moving forward as quickly as they can. But yeah, so did that. The change I dried off changed into my biking gear.
Speaker 2:Which was quick. He did, though like an eight or nine minutes. That's called the transition zone. You change from this swim to the bike Takes a certain amount of time and they count that as part of the race. So his like eight or nine minute transition, yeah.
Speaker 1:So I think, totally, I like that. One was like eight minutes. Another one in my bike to run was like seven. But like when that's not. That's not great by any standards, but that's, that's fine. I mean that's. I would say that's. I'm fine with that, because I don't practice that and Also the transitions are longer there compared to like a small triathlon like Savania, where it's easy to just get to your bike. You don't have to run through a massive area.
Speaker 2:So then, what was the 112 mile by? We actually was 116 mile by, yeah.
Speaker 1:Then took off the 160 mile bike. First 50 miles were going great. It was still cool. It was only like 830 when I started the bike. So I started the like about an hour in and the bike was going the first 50 miles and I was drinking. I had using their Gatorade and water mix. I, you know, I was eating the food. I had some peanut butter and jellies. I started eating some of that stuff slowly but I was averaging like 20 miles per hour I think the first 50 miles and the hills didn't hurt and my legs were so much more fresh. And Then it started to get like by mile, like 45 to 50. I really started to feel that Start going down to like 19 miles per hour and so in like 18, because some of those hit the hills just start gaining on you and then doing the second loop, all that stuff. I was like why I already did this the first time. It felt so much harder the second, second time.
Speaker 2:But so tell them what was the fastest you got going on your bike. So you have speedometers on the bike. So how fast were you going downhill on some of these hills?
Speaker 1:Yeah, so you'd be going. I got up to like 36, 37 miles per hour on a long downhill. But that's super fun. I'm not even pedaling, I'm just sitting like the arrow position, so sitting forward, trying to be aerodynamic going up the hill. So you might be going like a mile per hour and it's, it's so it I tell you. By the end you can tell some people are feeling a little defeated.
Speaker 2:Oh, I saw people. We were waiting for him to come up from his bike. If we're watching these people come up and I mean they're just you know, you can tell they're. They're not running anymore, they're walking up to the changing era. And, yeah, people were tired.
Speaker 1:Yes, but yeah. So it's starting to be really high up to like 85 or 90 degrees and sunny, and I was drinking so much water and Gatoran Eating it's a good you seven hour bike.
Speaker 1:No, I know, but I started I could start feeling that second half of that bike, the exert, my exertion level exactly. You know I'm working harder and I've been going longer and I could start feeling myself feel a little bit less like I started getting, you know, the heat. I could start feeling that in affecting my stomach but the bike overall and everything there was good and you know I was at eight hours through the swim and Transition one, the bike and transition to.
Speaker 2:So I did 116 miles and seven hours and so then he had the marathon left, so 26 miles to go.
Speaker 1:Yeah, so that's. And I was sitting there and I was wondering how I couldn't wait to get off the bike because your back starts to hurt A ton and I had stopped a couple times to go to the bathroom and stretch my back for a couple minutes. But yeah, by that time and I knew I never. Where we live, it's very flat, so the elevation game was like 5500 feet total. So my legs were definitely a lot more I could feel my quads were a lot more sore. So I see now the run was gonna be especially doing uphills on the run and I could tell like my stomach had by the time I transitioned.
Speaker 1:I ran like the first mile or two I could start feeling like I was slightly heat exhausted in my I did not want to eat food or drink stuff. I was forcing myself to, but I had to start slowing down. The run is where I really had to test my mental. But it was the hardest thing I've done so far in my life, life race wise, in terms of all the other stuff. I remember I did a 50 mile run like 10, 10 and a half hours. I felt like pretty good the entire time and consistent my body, like I could push myself harder, but I knew that wasn't sustainable for 26 miles and I didn't want to like injure myself or risk not finishing the race by like Pushing too hard. And then, which was a smart thing to do, yeah cuz, cuz.
Speaker 1:I felt like you know, I start feeling like I was gonna puke and everything else. And if you puke then that's 10 times worse. You're dehydrated and worse. But yeah, you have to just adjust your. You always have time, goals and stuff, but you have to just adjust yourself and enjoy the fact that you get to be out there. Something I always think about there's you don't have any headphones or anything, so something I always think about is just just having the gratitude that you're able to move. A lot of people would Would love to be able to move, and freely so, and that's the only reason you do a race. You want to test yourself, you want to see you start getting that like once things aren't going as well like that, like the bike. Yeah, my back hurt and stuff, but those first eight hours were fine. You've been the first nine hours. It's just when I know I still have to go four or five hours or so, 20 plus miles I start.
Speaker 1:You really have to start breaking it down, just one mile at a time, one step at a time, focusing on that and you have to get the negative. I think it's true for anything in your life. You have to get the negative thoughts out of your head. It's so quickly to start being like why the heck am I out here, like what were you thinking? What are you doing? I mean this person's passing me, this is going on, or you start thinking about that and you have to quickly and it keeps coming back, but it's a constant back. I think that's just daily life too. It's a good. It gets you into a deeper place like that. But you have to think like you have to think positively, like I can go. If you can go one more step, I can go ten more steps. And, yeah, just a really positive self-talk is massive when you're out there for 12 to 15 hours and it's just you and your thoughts.
Speaker 1:I, you know, I sing, sing some songs in my head. Sometimes when people are. People come by their supporters, encouraging you, so always thanking all the supporters and volunteers, other people. There's the shared camaraderie and misery and these events. When I'm other people, I remember like seeing some of the hills together. We're like, oh yes, another hill. I, a lot of you know walking just be like pace, walking up the hills. I tell you it's easy, it's very easy to walk or run a pace of. You know I can run as quick as like a six minute plus mile, just a couple miles, but by that time you know I'm I'm having it started out 11 minute miles, 12 minute miles, some uphill miles. You know it's like a 15, 16, 17, 18 minute mile and it's still for other people. They're like oh, it seems like you're going so slow, but it's hard, it's your, your body is very Soar but yeah, just getting finished.
Speaker 1:Yeah, encouraging other people and then getting encouragement, you kind of just find a way to keep going. But I thought it was a great experience because then at a certain point I always think, once you're done, you're done, you just have to suffer that day. And once you're done, you've done that, now it, the next day will come, no matter what. And then, well, somebody asked you here.
Speaker 2:I said, kevin, did your legs hurt after triathlon? How many days of rest did you need after?
Speaker 1:Yeah, so my the night of my legs Definitely were very sore and my body, like once I was done my body was very hot. So when I took a shower I was at, my body was like shit, definitely like Need to readjust. But after I slept that night I felt I felt way better, even the next day, like I could walk pretty fine. But really after after two days I felt my legs felt much. They were still heavy but they felt I could walk normally. And then about three days after I went for like a 30 minute Like just nice and easy run. And and then now it's some like six days after and my body feels. Obviously there's still slight soreness, but overall it feels pretty good. Because it's two, you're really sore, but you know I had build up a lot of training it's, so my body is somewhat used to it.
Speaker 2:It's weird too, because you start in the dark and then you finish in the dark. You know that day is just a long day and you have to put out.
Speaker 1:I think it's nice and time you have to completely put out. You can't think about what anyone's doing on normal Sunday, like I watch football and stuff. You can't think about that. Like you don't think about that Because then it's way worse. Or you can't think about trying. You have to just have your whole day focused on that, like that's your only objective that day, because you're not gonna be doing anything after I, like I knew it would be late Anyway, so I knew we were gonna get dinner, anything, I was gonna eat whatever I could.
Speaker 1:Well, we have done, yeah, but like right after I, still I did not feel like eating at all. I didn't want it. Like my stomach there was multiple times I had to stop, like my stomach was just I had to stop my bad abdominal cramps. But, yeah, it's great experience that the first one, and it just shows you you can do hard things and just the importance of training even more. And I think, yeah, just biggest thing is getting one under your belt and it's I think it's fun to try different things. But, all right, guys, yeah, well, I know, in the app of them.
Speaker 2:Thanks for watching, and that's our Saturday episode for today, and then we'll see you next Saturday. Yep, have a good one, bye, bye.
