Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
From Lung Biopsies to COVID-19: Insights from Dr. Bobby Shah
Are you ready to uncover the secrets behind managing respiratory health in today's challenging environment? Join us as we engage in a compelling conversation with Dr. Bobby Shah, a distinguished pulmonologist at St. Luke's. Dr. Shah provides an invaluable look into his daily practice, balancing hospital duties, patient consultations, and high-stakes procedures like lung biopsies. We delve into the dynamic nature of pulmonary medicine and the profound impact COVID-19 has had on respiratory health, highlighting the crucial role pulmonologists play in managing these increasingly common issues.
In our second segment, we explore the concept of resilience through the fascinating narratives in Michael Lewis's books, reflecting on how these stories of underdogs can inspire our approach to health and wellness. Tackling the persistent presence of COVID-19, we underscore the importance of healthy living, including pulmonary rehabilitation and cardiovascular exercises, as essential tools for building strength and mental fortitude. Finally, we address the complex topic of forgiveness, particularly towards smokers, and the necessity of self-compassion in overcoming past mistakes. This episode is jam-packed with insights that will leave you better equipped to navigate both personal and global health challenges.
Hello, this is Jason Edwards, and this is another episode of Doc Discussions. I have with me my good friend, dr Bobby Sha, who's a pulmonologist. He's a lung cancer or a lung doctor, and sometimes a lung cancer doctor. Bobby, how are you doing today? I'm doing fine, thanks, jason. And so can you tell me a little bit about your practice and kind of the typical patients that you see in the clinic? Sure, sure.
Dr. Bobby Shah:So, like you said, I'm a pulmonary physician. My background is in pulmonary and critical care medicine, so it's a little bit of pulmonary plus also some other areas too. But at St Luke's, where you and I practice, our hospital, our office is set up. Where I focus on the pulmonary, the critical care, is handled by a totally different team of doctors, even though I have the background, the education, the training to do something like that. We've got a slightly different setup here.
Dr. Bobby Shah:So pulmonary medicine for me, my practice, involves taking care of patients that have, you know, any sort of respiratory or lung complaint. Things like that could include cough or shortness of breath. You know, unfortunately, because of smoking, lung cancer, like you were saying earlier, comes up a lot. You know, lung cancer screening is something we do nowadays where patients get CAT scans once a year and so we find all kinds of abnormalities there. And when patients have things there and physicians see things there, they often refer them to us, you know, to help sort of decipher. You know what the radiologist is seeing, put it into some sort of context, then hopefully kind of, you know, figure out with the patient what the next right steps are. So that's a lot of what we see in the office here, you know, at St Luke's, and my day-to-day operations are pretty simple. You know I see patients in the hospital sometimes too.
Dr. Bobby Shah:Part of being a pulmonologist means coming over to the hospital.
Dr. Bobby Shah:If a patient gets admitted to the hospital with a respiratory complaint, and if the hospital, if a patient gets admitted to the hospital with a respiratory complaint, and if the hospital team, the hospitalists, are having any trouble figuring out what to do if any other tests or treatments are necessary, they'll often call one of us to come see them, either myself or one of my partners.
Dr. Bobby Shah:And so a lot of times I'll go over to the hospital and see patients too. And then I spend the bulk of my day in the office you know, 10 to 3, 10 to 4, seeing patients. And then sometimes the third part of our practice is doing procedures. Patients, like we talked about earlier, that have possible lung cancers will sometimes need a biopsy to figure out what's going on. And there's different ways to do that and one of the techniques for doing a biopsy involves me coming in and trying to help those patients figure out what's going on or what those abnormalities are. So I'd say three parts there's the hospital work, there's the office work, and then there's the procedures that tend to make up a large bulk of my day.
Dr. Jason Edwards:Yeah, it's kind of nice to have a few different settings where you practice medicine, so you're not doing the same thing all the time. Some people like doing the same thing all the time, but a little bit of variety is nice.
Dr. Bobby Shah:Oh yeah, absolutely, and that was one of the reasons why I picked pulmonary medicine. I liked the critical care aspect of it. When I was in med school, when I was in training, I liked having that option because I thought that it was a really fun part of being in the hospital as a physician. It's probably one of the places where you tend to exercise that brain muscle the most. You're in there, people are at the sickest, they're at the most vulnerable, they need your help, and it was really exciting to do for a long time. But as time went on, it got to be a little exhausting and so having the pulmonary side to fall back on was nice too, and then, like you said, even having that mixed day to day kind of breaks up the monotony a little bit.
Dr. Jason Edwards:Yeah, I really think critical care doctors are some of the most respected doctors in the hospital, just because they have to think a lot and they have to know a lot of different systems and they're dealing with very complex problems, and so you know when the patients are at their, at their sickest or their you know most infirm state.
Dr. Bobby Shah:You're the guys you know we asked to help them out and so it's challenging, it's fun, it's exciting, it's exhausting at times, but it's also extremely rewarding when you're able to help someone there too.
Dr. Jason Edwards:Yeah, very cool and so so, not only and everybody, you know the pulmonologist is kind of well connected to surgeons, oncologists, internal medicine doctors, so everybody. In a way it's kind of the hub of the wheel of the of the current medical system. Everybody knows Bobby, you know, at the hospital, which is good.
Dr. Bobby Shah:I think when you look at the hospital statistics whether it's St Luke's or other hospitals and you look at the reasons why people get admitted to the hospital, you know respiratory issues tend to be in the top three, if not oftentimes the number one reason.
Dr. Jason Edwards:Yeah.
Dr. Bobby Shah:You know and we're just coming off three years of a pandemic you know that was a large portion of what people were coming to the hospital for, whether it was their physician's office, the ER, the urgent care or, in our case, being admitted to the hospital. Pulmonary reasons were probably number one these last few years.
Dr. Jason Edwards:Yeah, you know, it became clear very quickly that the pulmonologist and the intensive care doctors seem to kind of have the brunt of the workload. You know, when it came to dealing with COVID, of course you know your internal medicine doctors on the floor and your emergency room doctors and you know, and the nurses.
Dr. Bobby Shah:And yeah, don't forget the nurses, for sure. Yes, and everybody, I mean the janitors.
Dr. Jason Edwards:you know you had to have people go in and clean those rooms, but you guys were really hit hard, I think by COVID.
Dr. Bobby Shah:It was a challenging three years. You know there was. You know times coming home exhausted. You know times that we came home feeling defeated. You know times that we came home wondering you know what was going on. You know we spent four years in med school, three years in residency, three years in fellowship. All these years in practice decades for some of my partners to all of a sudden have this disease that's not following the rules, not playing by the playbook, not doing anything. We expected Some of my senior partners likened it to when they trained during the early HIV days yeah, where all of a sudden there's this virus that's doing things that nobody really knows, even what it's called or what it is, or where it's from or what to do with it. You know, I mean we were having conversations there where they were thinking this is so similar to what we went through decades ago.
Dr. Jason Edwards:Yeah.
Dr. Bobby Shah:And to be full circle and to go through something like this again. It's really humbling.
Dr. Jason Edwards:Did you reach out to any of your colleagues at other institutions during the? Early onset to try to, because you're figuring it out on the fly. How do we treat these patients?
Dr. Bobby Shah:Oh, for sure, for sure. So when I did my training in residency, one of our chief residents went on to be the critical care director at one of the bigger hospitals with the University of Washington. The midwest were kind of landlocked and things were hitting us probably three to six months later than what it would, and maybe on the coast, whether it was the east coast or west coast, yeah, you know. So, talking to physicians that we knew in training on the west coast, talking to physicians and much more um central hubs for travel like denver, yeah you know, hearing what they were going through, getting any advice from what they were going through, was a big part of what we did here.
Dr. Jason Edwards:Yeah, and Washington got hit early.
Dr. Bobby Shah:Yeah, washington got hit early, and so to talk to my former chief resident, you know, and to hear what they were going through was extremely helpful.
Dr. Jason Edwards:Yeah and so. So what outside of medicine? You have three children, your wife's a school teacher and you're busy. You know I think you're busy at work and you're busy with the family, but it seems like you do a good job of kind of keeping it all together. Your kids are doing well.
Dr. Bobby Shah:I wouldn't say that all the time if we're doing a good job but, we're trying our best. I mean as a parent. You know, you never feel like you're always doing everything, right? Yeah, well, okay, I'm not comparing you to an ideal.
Dr. Jason Edwards:I'm comparing you to other people dealing with that kind of adversity or responsibility, and I think you're doing well with it. But I know it's a challenge, of course, and so I know you like traveling with your children. What other stuff do you do in your spare time? I know there's not a lot of it, but yeah, with a 15 year old, a 13 year old andyear-old who's almost 10,.
Dr. Bobby Shah:Free time is a hot commodity I'm guilty of. I do a little reading when I can. It's been a while. I'll be on the wagon, read for a year, knock through a few books and then I'll fall off the wagon for a year and just not read for a little bit.
Dr. Bobby Shah:One of my guilty pleasures is binging on TV, binging on movies. You know, it's one of those things where you can just turn your brain off and relax and put your feet up. And I'm not embarrassed to admit that I like some really bad TV and I like some really bad movies too. But because sometimes you just want to turn your brain off at the end of the day, yeah, I get to the gym, do a little exercise whenever I can. You know know, I think the physical release of that's important, you know. You know. I know, um, people will tell you that exercise is not supposed to be like a mental therapy kind of thing. It's not supposed to be. You know, a way to collect yourself mentally or emotionally, you know, because you're still physically exhausting yourself. But for me it is.
Dr. Bobby Shah:I agree you know, I mean I mean people that say that I just I frankly disagree. I agree, you know, I think there's something about the solitude of that, um, and so I think that's, yeah, that's what I. You know, it's take care of myself as much as I can, some fitness and spend as much time as I can with my family yeah, so um.
Dr. Jason Edwards:So, when it comes to bad films, what? What are some bad films or tv shows? That that are not critically acclaimed but you're a big fan of.
Dr. Bobby Shah:I, you know I'd say the worst possible thing that I like to watch any bad reality show with Gordon.
Dr. Jason Edwards:Ramsay.
Dr. Bobby Shah:Yeah, yeah, you know there's something to be said about watching somebody else get yelled at and beat up on that, I guess is just not. I mean, it's a guilty pleasure.
Dr. Jason Edwards:Yeah, it takes you back to your training days, right?
Dr. Bobby Shah:Yeah, it takes you back to training. It takes you back to your training days. Right, it takes you back to training. It takes you back to you know being humbled, you know, and to not be on the receiving end, I guess, is somewhat rewarding. Yeah, you know.
Dr. Jason Edwards:I mean, there's a good and bad with him. He's telling the truth. You know, as he sees it, and a lot of times you know, aside from your parents and your spouse, sometimes maybe a coach or or a mentor, not too many people are going to tell you the absolute truth.
Dr. Bobby Shah:You know it's going to be sugar-coated to some degree well, sometimes there's probably, I think there's a small part of us, and all of us deep down, that wishes we could approach situations with that level of candidness and that level of bluntness yeah but you can't talk to people that way in real life no, our egos are too sensitive yeah you can't always accomplish things in real life that way. You know, it's fine for reality TV, but not for real life.
Dr. Jason Edwards:Yeah, and earlier you had talked to me about there was a book that you liked called the Premonition by Michael Lewis. What did you like about that book? Well, first, the book kind of gives an overview.
Dr. Bobby Shah:Yeah, it talks a lot about COVID. It talks about a lot of what happened during the pandemic. And I know it's kind of nerdy to read about books, about what you do every day. But you know, it was interesting because I think, looking back on the three years, you know like the one thing I always tell my kids, I tell myself, I tell everybody is that you should always be able to look back on something and say you learned something.
Dr. Jason Edwards:Yeah, you know.
Dr. Bobby Shah:Maybe you learned that you were doing things right, maybe understanding of what you were doing. You know forever how much time you're looking back on. So so for me I want to hope that we learn something from the past three years as we move forward, you know. And so reading Pandemic was exciting because it talked a lot about you know disease. It talked a lot about pandemic preparation. It really opened my mind up and my eyes to why we did some of the things that we did, because I knew they were probably the right things to do. From what I'm seeing on TV and from what I'm reading, but to understand the historical background for those things really put things in a different context and kind of gave me a different perspective.
Dr. Jason Edwards:Yeah, it's, it's. I mean, I think we got to be fair when we look back at the pandemic and say we haven't had a big pandemic like this in about 100 years and like everything for sure, will not go perfectly, just because it's, you know, it's such a rare event and and so and we, and I think, if we look back, we can say we did some things right and it was certainly suboptimal in many areas too, I, I think everybody's, you know, most people's effort was in the right place.
Dr. Jason Edwards:Sure, and their hearts were in the right place. Yeah, but it's just not going to go. Perfect Nothing does no it doesn't.
Dr. Bobby Shah:But I think again, at the end of the day, if we can look back on it and say we learned something, I think that's a win.
Dr. Jason Edwards:I agree, I agree and I I remember a tweet that came out like two or three years ago and Elon Musk said you know, I hope this prepares us for the big one, you know, saying, if there's another pandemic in the future, we've learned some things and we know how to kind of deal with it more appropriately. Yeah, absolutely.
Dr. Jason Edwards:Absolutely. And so, yeah, Michael Lewis is interesting. Yeah, Michael Lewis is interesting, His books. There's a little bit of a common theme as he goes through his books in that he kind of will challenge power structures. Sure, like Moneyball, yeah, like Moneyball, Liar's Poker, and this book, the Premonition which he kind of does that to the federal government to some extent.
Dr. Bobby Shah:Yeah, that's a whole. Other part of the book is what is that power structure, like you said, of the federal government? You know there's almost this semi-underdog story you know in all of Michael Lewis's books. You know and to hear about. You know these people, you know within a small part of the government trying to rally the big part of the government to kind of see what they're seeing.
Dr. Jason Edwards:Yeah, it's. It seems like he likes people who are disruptors, um, uh, people, and it's like an inversion.
Dr. Bobby Shah:It's a better way to describe it than underdog.
Dr. Jason Edwards:Yeah, Uh, it's. It's like a person that's lower down on the food chain, you know not, not the head honcho, who kind of sees what's going on.
Dr. Bobby Shah:And they see things from a different perspective because they're low on the food chain.
Dr. Jason Edwards:Yeah, and then and then, um, yeah, there are more boots on the ground, right, yeah, instead of the generals, and they see kind of a clear picture of what's going on. And then a lot of these books and some of them have been turned into movies focus on how do you get the message out, how do you sway the generals to kind of move things in this direction or that and this is not a new problem, no, this has probably been around since the Romans or before. But he always does a good job of kind of finding the right characters and the essence of the characters.
Dr. Bobby Shah:Absolutely.
Dr. Jason Edwards:Yeah, it's been kind of a wild few years, but here we are, we're on the backside of it and we're moving forward in COVID. Is it all but dead, or what's going on there right now currently?
Dr. Bobby Shah:It's definitely still around. I think it's going to be something we're going to be dealing with for a long time. It's something that's going to come and go. It's going to ebb and flow, wax and wane, whatever you want to call it. It's going to ebb and flow, wax and wane, whatever you want to call it. You know it's going to be there in the background, you know, and whether or not it's going to ever be as severe as it once was, you know. Only time will tell. You know 2009,. You know swine flu. You know similar situation. Influenza has been around for a long time. Nobody knew when the next epidemic or pandemic was going to come around in 2009, swine flu hit. So we don't know. And so it's just a matter of being smart, being prepared and understanding. You know. You know what it means to be sick.
Dr. Jason Edwards:Is the current severity of the coronavirus? Is it similar to like prior coronaviruses? It seems like the severity of the illness.
Dr. Bobby Shah:Yeah, I mean I'd say, in general, we're not seeing people come in quite as sick as they once were, you know, but we still do have the occasional person that comes in really sick, and so I think it's you know, I think it's hard to know for sure what to expect. You know, right now, you know, despite numbers kind of coming up and going down periodically, we're still sort of on a heightened sense of awareness. You know, it's probably the best way to describe it.
Dr. Jason Edwards:Yeah, you know, one thing that really came to my mind during the pandemic you know you talked about working out and the health of health care workers kind of came to a forefront because a lot of our colleagues and co-workers, you know, got sick and we know that the healthier you were on average, the healthier you were, the better you endured the COVID virus infection, and so you know it came to light To me I thought I need to get in better shape, I need to eat a little bit better, exercise a little bit more, and of course we all think that, but it really kind of came to a head.
Dr. Bobby Shah:Yeah, I mean healthy living is a big part of anything you know. I mean, I tell my patients in the office all the time with COPD that the first letter of COPD is C it's chronic. That means it's not going anywhere. Whether you like it or not, you have a chronic condition. And healthy living is sometimes more powerful than any inhaler, any pill at the bottom of a pill bottle, any shot in a vaccine. Healthy living is a big part of being able to handle a chronic condition and, in the case of COVID, handle an acute condition and so simple things like exercise, nutrition, diet, weight loss. You know, it's like having extra money in the bank for when that big bill hits, that car accident comes along, having a little reserve you know to fall back on, having a little security blanket. It's nice financially and it's also nice physically. It's nice mentally, it's nice emotionally.
Dr. Jason Edwards:Yeah.
Dr. Bobby Shah:To have that physical, you know sort of, you know security blanket of health and wellness and well-being. Yeah, that's a good way to put it, and so having that could get you through something like that.
Dr. Jason Edwards:And we have a pulmonary rehab department and I walk by there every morning and every evening when I go to my car.
Dr. Bobby Shah:Yeah.
Dr. Jason Edwards:And I think that's been very helpful. It's huge.
Dr. Bobby Shah:It's huge. Pulmonary rehab, pulmonary rehabilitation, you know, is a big part of helping patients with chronic lung disease. You know, get healthy, get well, stay well, stay healthy and build up some of that reserve and so they it looks like they're doing mostly cardiovascular exercises, and slowly yeah, to some extent you know, the main focus of pulmonary rehab is to work on those sort of large muscle groups legs, back, hips, the kind of things that you can physically train yeah the things that you can physically improve so that the rest of your body isn't working as hard.
Dr. Bobby Shah:Yeah, you know, having a stronger foundation, you know, for your body can take some of the pressure off the heart, the lungs and everything else.
Dr. Jason Edwards:Yeah, and then their strength and stamina improves and their quality of life goes up because they're able to go to the baseball game and there's scientific proof of that too, and I'm sure there's mental and emotional benefits too.
Dr. Bobby Shah:Oh yeah, Some of the patients that go there and they come back and they say that a lot of it's just being able to see other people, you know, interact with other people. The accountability someplace to go, someplace to be, you know, for some people it's knowing they're not alone dealing with what they're dealing with.
Dr. Jason Edwards:Yeah. You know so much of it can be mental too. I've got to give a quick shout out to nurse Sherry down there. I always love seeing her and she's always very optimistic and hopeful. And so, anyway, shout out to nurse Sherry. She's great and she helps.
Dr. Bobby Shah:It's a great team. It's a great team, I don't know. I mean, it's a big part of what we do here at St Luke's to help people with chronic. Tell them.
Dr. Jason Edwards:Wow, that's a tough question. So one piece of advice, I mean I'm going to focus it on respiratory, I guess things that might matter to me or help me.
Dr. Bobby Shah:I mean, I think we talked a lot about exercise and so I think that's good for like everybody in general. But I think what I'd probably tell people more than anything is that if you're you know, if you're a, you know, you know if you're a smoker, or if you're a former smoker, quit smoking. Yeah, yeah, smoking. I mean, you know, I think that would be it. Anybody you know to work with them to quit smoking. If you're a smoker, do everything you can to quit smoking.
Dr. Bobby Shah:You know, I think that's one small part of what we do on a day-to-day basis, but it has really far-reaching implications you know for, whether it's lung health, cardiovascular health, your mental health, how it affects your family, probably your social dynamic and emotional health at home. I think quitting smoking would be the number one thing and if you're thinking about starting, don't you know?
Dr. Jason Edwards:Yeah, and so. Is there a method or a technique quitting smoking that you found to be more beneficial than others?
Dr. Bobby Shah:Yeah, that's a good question. You know, quitting smoking is a tough, tough, tough tough thing. You know, and and I mean there's the, there's the data, there's the science part of it and the research would show that pharma, pharmacologic therapy like shantix is going to be your most successful, you know, when it comes to quitting smoking. But I think for every individual it really has to be catered. But the one thing I'd say that's consistent whether you take something like Shantix or whether you use like a nicotine patch.
Dr. Bobby Shah:For some people, I know vaping still has a lot of controversial, you know issues around it, but for some people it can be a way to quit smoking. But no matter what you end up picking, I think the number one thing that works the best for all people is preparation. You know, measure twice, cut once, have a plan, have a plan, pick a date. Don't do it when it's something stressful Like. Don't plan on quitting smoking when you're going to go do your taxes. Yeah, it's not going to go well, you know. Don't do it at the holidays, when you're stressing about affording Christmas gifts for the year. Do it when there's a time that's nothing stressful. Make sure you tell everybody around you that you're going to be angry, you're going to be cranky. You're not going to be the kind of person you were for that. You think of Social gatherings. You might not be the life of the party when you're there, but I think the one thing I'd say to help people quit smoking is preparation and planning.
Dr. Jason Edwards:Yeah, can I add to a couple of things that I found beneficial? If you're a family member of somebody who smokes, it's better to show them a little bit of grace. I think being hard on people for smoking, whether you're a doctor or a spouse, is not real helpful. No, no, it's not. I think you want to show somebody some grace and realize it's really difficult to stop using tobacco products.
Dr. Bobby Shah:And so and then, and I think most, I think most people know that smoking is bad.
Dr. Jason Edwards:Yeah, yeah, it's not a logical issue, it's a psychological issue.
Dr. Bobby Shah:I don't think that there's anyone that comes in and says what I'm doing is okay. Yeah, I don't think that happens when it comes to smoking. Yeah, but it's very difficult you may have some people that have reconciled that they're at a certain point in their life and they're not going to see themselves get better. Yeah, but they still know what they're doing is wrong.
Dr. Jason Edwards:Yeah, and the other thing too is I think it's important for people, not just with smoking but with a lot of things in life, to forgive yourself. Like we've all had past transgressions, We've all screwed up in the past, all screwed up in the past, and and if you're, if you're kind of torturing yourself and not with self-resentment, um, I think it's hard to make future progress, and so a huge part of it, a huge part of life, is forgiving yourself and just moving forward the best you can, Um, but uh well, Bobby, it's been really nice talking to you.
Dr. Bobby Shah:I appreciate it.
Dr. Jason Edwards:Thank you so much I always appreciate you and and um respect you as a physician.
Dr. Bobby Shah:Um so thanks for.