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
Cliff Diving, Chess, and The Unexpected Journey into Urology with Dr. Randall Dooley
What do cliff diving, The Cure, and a career in urology have in common? Join us as Dr. Randall Dooley shares how his unexpected journey into urology became a life-changing experience, all thanks to a canceled plastics rotation. This episode offers a captivating glimpse into the mind of a urologist who has mastered the art of balancing a demanding medical career with an array of exhilarating hobbies. Dr. Dooley discusses how his passion for continuous learning and the discipline required for both surgery and hobbies like playing guitar, Krav Maga, and chess fuel his daily life. Listen as he recounts the joy of teaching his young son chess, fostering a love for the game and the rapid development of a child's mind.
Moreover, Dr. Dooley sheds light on the unique camaraderie and humor that define the world of urology, sharing stories from his practice at St. Luke's Hospital. He speaks candidly about urologists' diverse roles and the importance of teamwork in handling complex cases. With gratitude, he emphasizes the ongoing growth of his practice and the comprehensive care offered to patients. So whether you're a medical enthusiast or simply curious about the passions that drive professionals beyond their careers, Dr. Dooley's multifaceted journey will inspire and entertain, proving that life's unexpected paths often lead to the most rewarding destinations.
Welcome to Doc Discussions. I'm Jason Edwards and this is the world's best medical podcast where we have discussions with physicians to discover who they are and what they do. I am honored today to be joined by Dr Randall Dooley. Dr Dooley is a urologist here at St Luke's Hospital. Randall, welcome, Glad to be here. Thanks for having me. You bet, and so you know I want to come right out of the gate. You're an interesting guy, you play guitar, you practice Krav Maga and you are a urologist Is there a common theme between these three disciplines?
Speaker 2:Well, are the sensors available? I mean, I think that if you go into any sort of surgical specialty, there's a little bit of it takes a little bit of cojones if you will, and so you're often a more baseline. Have a higher threshold of excitation, okay, often a more baseline, have a higher threshold of excitation, okay. So the combat sports jumping off cliffs in the ocean, riding motorcycles, doing all these sorts of things yeah.
Speaker 1:Playing a band yeah, we're always looking for a thrill right the thrill yeah, go around once yeah, you know, I mean when I you know, being a urologist is a it. It's a difficult specialty to get into and the surgical specialties and many other specialties are kind of a difficult go. As far as the things you have to do on a day-to-day basis Playing the guitar, practicing martial arts, being a physician, all of these things are, it's a certainly delayed gratification. I mean the first day on the guitar, you're not great.
Speaker 2:The first day at golf practice.
Speaker 1:It's not, you know, you get beat up, but they all kind of take this long-term discipline too Sure. And do you enjoy that? Do you enjoy that process?
Speaker 2:Well, it drives my wife a little nuts because I get obsessive about things that I get interested in. So I recently decided to teach myself to play chess. Okay, and so I play chess. Like I have 15 games going on simultaneously on my phone at any given time and I'm in these international tournaments. I started in November or so of 2023 teaching myself to play chess. So I will get involved in something and I will put a whole so of 2023 teaching myself to play chess. So I will get involved in something and I will put a whole bunch of time into it, to a point that other people might find a little obsessive, but I've always enjoyed. I'm fluent in Spanish. I've been teaching myself a little German. I like to do things to expand the mind and to put challenges in front of myself to that are difficult, just to see if I can do it, sort of thing.
Speaker 1:So I've I've been down the chest pathway before and um and it you know, um, I think it's good for the mind, Um, and it's also like it's also not scrolling on social media, it's also not, you know, smoking cigarettes or drinking at the bar.
Speaker 1:It's, it's, it's a um, and it's also not, you know, smoking cigarettes or drinking at the bar. It's, it's, it, it's a uh and it's a, and it's a social thing too, or it can be. You know, obviously we have the national, or the uh was the world chess museum. Here we have something, something here.
Speaker 2:That's a big deal central west end.
Speaker 1:Yeah, um and so the chess club, um and so um, and boy you can get. I use chesscom, which is how you use.
Speaker 2:I use chesscom and there's another one called chess Royale that I use. Yeah, and I play on a board too. So I do that too. Yeah, and I play against bots, I play against friends, I play against my family. Yeah, and I'm teaching my little guy, who's almost eight Awesome, and he's becoming a little obsessive.
Speaker 1:Well, I'm teaching my little guy who's almost eight, awesome, and he's becoming a little obsessive. Kids can be really good. I mean I've played some young children Like I. Actually, two or three weeks ago I played one of our friends. They had an eight-year-old child and I mean I could beat him but you had to pay attention to what you're doing, and so I think the child's mind can really develop that a lot faster than you know me and you are probably a little past our prime as far as that kind of thinking.
Speaker 2:It's interesting because I read a quote from a chess master a grandmaster and he said that being able to play chess well is the mark of a gentleman. Being a grandmaster in the chess is the mark of having wasted one's life. Yeah, there is a sweet spot here, there definitely is.
Speaker 1:Yeah, I think you know doing things like this too. There's the element of mastery. You can get into a flow state with music, sports, certainly chess, where it's just kind of a nice place to be. You know, mentally Um and and and I, I I would assume that you know surgeries, you know that you've done many times and you're proficient at. You can kind of reach a flow state too. Do you ever feel any of that?
Speaker 2:Oh, absolutely. My favorite time doing my job is when I'm in the operating room and I'm just in my zone. Yeah, plus, you get to pick the music. That's part of the reason I go to surgery you get to choose the music, which has always been. I'm a little bit dictatorial about no, no, no, we're not listening. This is why I'm in the surgery.
Speaker 1:Well, the surgeon is the captain of the ship. Yeah, and then you have a favorite band.
Speaker 2:Who's your favorite band? My favorite band of all time is the Cure, and I've seen them. I've traveled all over the world to see them play. I saw them play in a medieval fortress on an island on the Danny River.
Speaker 2:I've seen them play in Prague and Budapest and I saw them play outside Copenhagen in the Irish countryside. So lots of really interesting venues, yeah, and it leads to meeting people that are local and then that leads to different experiences than an average traveler gets, yeah. So, yeah, I've been a big world traveler seeking out the, and it all happened just on a just kind of a crazy whim of a buddy of mine who was awake at 2 o'clock in the morning, couldn't sleep, was scrolling the Internet and he found this festival in the Irish countryside and the Cure was headlining it. That's awesome. And he bought tickets on a whim and he called me up and said, hey, we have to go to this.
Speaker 1:So now— I agree with you. We have to go the OR nurses get a healthy dose of the Cure. That's right.
Speaker 2:Well, you know, it's another form of benefiting their expanding brains.
Speaker 1:It's helping them, and so what are some of the common surgeries that you do in your practice?
Speaker 2:So I would say that the most common procedures that I do are related to stone disease or BPH. Okay, and then there's a fair bit of cancer surgery as well and that sort of thing, and BPH is benign prostatic hyperplasia right, so I do a ton of BPH related surgery.
Speaker 1:And can you explain, like, how, what's like the one minute explanation of how that surgery takes place?
Speaker 2:Well, so there are actually several different procedures, and the selection of which depends on what the end goal is and also what the patient's tolerance for different side effects of treatment are, because the procedures that have the best outcomes, the most durable outcomes as far as improving voiding symptoms, also come with some risk of potential sexual side effects and that sort of thing, whereas if your real big priority is preservation of sexual function, then that may lead down a different. Got you Different? Because some are ablative or actually removing tissue, some are more manipulating tissue out of the way, or there's a procedure I do where I inject steam into the tissue that causes a delayed breakdown and reabsorption of tissue. So there's everything from the old school TURP that's been around for 100 years to lasers and steam and implants. Yeah, sometimes the old school stuff still works.
Speaker 1:Yeah, and just for kind of a backup just a bit. Of course you know this, but the urethra is a tube that comes from the bladder and then, you know, for the man out through the penis but it goes through the prostate and if the prostate's larger it can kind of crimp the urethra a little bit and make it difficult to urinate.
Speaker 2:So there's a static component and there's a dynamic component. So the static component is basically characterized by the fact that there's just tissue there that's just obstructive, so it's just mechanically causing obstruction, and the other component is the fact that the tissue is densely enriched with smooth muscle that maintains a tone. Got you and that and that's involuntary. So, additionally, it's supposed to be part of your continence mechanism and your ejaculatory mechanism. But what happens when it overgrows is you become sort of hyper-con and obstructed. Yeah, and so you know, we have meds to treat the dynamic component, we have meds to treat the static component, got you. So the procedures? I mean, you're sort of, if you're removing tissue, you're sort of eliminating both.
Speaker 2:One of the things that's been unfortunate with the advent of some of the medications is that, well, there have come to light some fairly serious long-term consequences, side effects of the medications. We have discovered a link between Tamsulosin or Flomax, which is commonly used to treat the dynamic components of alpha blocker, with increased risk of dementia. There seems to be a link. And then with finasteride, there seems to be an increased risk of depression in the elderly. Okay, so in addition, there's a litany of other potential side effects, but they also don't really prevent deterioration of bladder function over time, and what really does do that is procedures, and so the pendulum is swung a little bit towards earlier intervention versus waiting until they fail, medical therapy and this sort of thing which has been yeah.
Speaker 1:And then you have organ dysfunction Right yeah, how about that? And so you know what other? And then you do prostatectomies, where you remove prostates in patients who have prostate cancer.
Speaker 2:Well, I don't personally do that much anymore because I've done hundreds of prostatectomies, but they're all open Okay. But actually I've been able to successfully recruit a partner and we're hoping to get another one as well. And the partner that I have recruited, who's going to be starting first week of September, he's robotically trained, so he'll do robotic.
Speaker 1:Okay, yes, and I've met this physician and he seems like a great guy, yeah, coming straight out of Wash U. Yeah, and he's Venezuelan. I believe he is.
Speaker 2:He's Venezuelan, yeah, so it's interesting because I speak Spanish fluently and he's from Venezuela, I train at Grav Maga and he's Israeli His parents live in Israel, so we sort of have these weird commonalities.
Speaker 1:So this is a weird thing. So he was telling me that he was Israeli, from Venezuela. Yes, and I know one person exactly who's Jewish and from Venezuela. I don't know her personally, but her name is Steffi Cohen and she's a world champion power lifter. And so I just said, hey, do you know Steffi Cohen? Yeah, I know her. He said she was at my wedding and so I thought how crazy is that? But he seems like a great guy and I also have another mutual friend with him, um, who's urologist? But I've only heard good things, and so I think he was.
Speaker 2:he was on the um Venezuelan national water polo team, really so he traveled around the world competing. How about?
Speaker 1:that Crazy, I think. The urology department's in the running for the most interesting department I try to be and then you have Dr Naughton and Dr Scully as partners as well. Yes, correct, yeah. Was there anything that inspired you initially to go into urology?
Speaker 2:Actually, when I was in college I had a good buddy and we're still close friends and his uncle is a now retired urologist, okay, and we used to go to his house because he had this sweet pad in san diego, where I'm from, and he always had this really great music collection and he always had top shelf liquor that he would serve us and he was growing up steaks and everything and um, he would hang out with us and listen to music and everything and he's this really interesting, great guy. But I but I always was asking my buddy like what's wrong? Why did he go into urology? Like what's wrong with him? And he anyway, but I always really liked the guy.
Speaker 2:But when I went to med school I said the last thing I would ever do is urology. Okay, but I was on general surgery as a third-year med student and we had a mandatory specialty rotation and I was scheduled to do plastics, which appealed to me because of the artistic sort of aspect, and so I was scheduled to do plastics and the week before the scheduled rotation I got a page because we had pagers back then from the secretary of the department who told me that the professor who was going to be overseeing. My rotation was actually going to be on vocation for two of the four weeks so they had to cancel the rotation. So I was scrambling for a specialty. So I talked to the chief resident I was on trauma surgery at the time and he said you should do urology. I said urology, why would I want to do that? He said, first of all, you need a rotation and they'll take you. Second of all, coming off of general surgery and rotating on urology, you will find it's like night and day.
Speaker 2:Those guys are so much happier, they enjoy their job so much more. They do these big cancer cases and then they do all these minimally invasive cases and they can tailor the practice to however they want to practice. They just don't seem to be all cases and they can tailor the practice to however they want to practice. They, um, they just they don't seem to be all stressed out all the time. They have very busy daytime schedule. In the evenings they don't go in as much as a general surgeon's orthopods or other surgeons do. So it's a really great work, work, life balance. And so, worst case scenario, you learn about an organ system that most other physicians don't know much about.
Speaker 1:Yeah. And so I rotated on it, the rest is history right, that's where it came from.
Speaker 2:It really was night and day. I mean, you went in there and you're joking around and telling dirty jokes.
Speaker 1:Yeah, I actually had to do a year of general surgery and I did a month of urology and I actually found it enjoyable. I mean it's a nice niche where there's not a lot.
Speaker 2:I mean, I'm sure in some areas people are encroaching on it, but it was like you know, like we got called from the Gynocs and they would have us, you know put in urethral stents and things like that, because you have a cervical cancer, that's, you know, pinching off the kidneys, and it's kind of surprising kind of how many areas of the hospital that the urologists were involved with. Oh right, we're always getting called in by other surgeons to help them, help them all.
Speaker 1:Yeah, yes, yeah yeah. Somebody accidentally nicks the ureter and then, all of a sudden, you're involved.
Speaker 2:Or sometimes they just have a patient on the table. They can't get a catheter in. Yeah, I mean, or it's involved. Or sometimes they just have a patient on the table. They can't get a Catherine. Yeah, I mean, or it's right or the inadvertent bladder injuries, the funny thing.
Speaker 1:So that was like my job when I was like the, the radonc intern who was doing a month in urology, and they would be like we can't get a Catherine, and you know, buck, who was my chief, would say, jason, get a Kude and put some gel down there and just shove it in. And I was like I'm going to the ICU and there's like this is not at this hospital, but I would go to the ICU. There's like a nurse who's put in like 1,000 catheters and I've put in three and I'm tasked with getting the job done. But in surgery you do have this kind of gung ho mindset of like you know, come hell or high water, I'm going to get the job done. And so I think I got them all in, but um, but it. But it was an enjoyable month and you know they were all really funny guys and I I don't know what it is, but most urologists are are fun guys to talk to and they have a good sense of humor and there's kind of a good atmosphere there.
Speaker 2:You sort of have to do the job. It's a requirement. It comes with the territory, but it's funny. What they say about surgeons is that they're usually right but never in doubt. That's how you have to be, randall. No one wants a wishy-washy surgeon, right?
Speaker 1:Yeah, that's right. That's right. Yeah, you need to be decisive right in the operating room. There's not much room for kind of futzing around. Yeah Well, randall, I appreciate you joining us here on the podcast. I'm glad to work with you here and I'm happy that you and your team are here at St Luke's taking care of our mutual patients.
Speaker 2:We're glad to be here and we just keep expanding, so can they get a full complement of us? Yeah, very good, Because Tom will retire one of these days and we need to keep it going.
Speaker 1:Yeah, all right. Well, thanks so much.
Speaker 2:Well, thanks for having me.