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
What Makes a Great Cardiothoracic Surgeon? Reps Matter.
From the swimming pool to the operating room, Dr. Ryan Reidy's journey exemplifies how elite athletic discipline transforms into surgical excellence. As a former Division I swimmer at Eastern Illinois University who now serves as a cardiothoracic surgeon at St. Luke's Hospital, Dr. Reidy reveals why surgical program directors actively seek athletes for their residency programs.
The parallels between competitive athletics and surgical mastery become evident as Dr. Reidy describes his training at the renowned Texas Heart Institute within the massive Texas Medical Center complex. This medical metropolis, housing approximately 40 hospitals including world-class institutions like MD Anderson Cancer Center, provided unparalleled surgical volume and experience. "Reps really matter," Dr. Reidy emphasizes, explaining why busy surgeons typically deliver superior outcomes through both experience and validated trust from referring physicians.
Dr. Reidy offers fascinating insights into modern cardiothoracic surgical approaches, particularly his preference for minimally invasive thoracic techniques that speed recovery without compromising cancer outcomes. He shares his philosophy on esophageal cancer surgery, balancing technical considerations with patient safety through meticulous visualization. Beyond the operating room, he discusses how mountain biking and disconnecting from constant communication help maintain the mental clarity needed for surgical precision. Whether you're curious about surgical careers, interested in medical technology advancements, or simply appreciate stories of human excellence, this conversation delivers compelling perspectives from the cutting edge of cardiothoracic surgery.
Welcome to Doc Discussions. I'm Dr 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'm joined today by Dr Ryan Reedy, a cardiothoracic surgeon. Welcome, ryan, thanks.
Speaker 2:Jason, thanks for having me.
Speaker 1:You bet. Now, ryan, you're a hometown boy here, right? Are you from the St Louis area, is that right?
Speaker 2:Yeah, that's correct. So I was raised in St Charles area and then came back here after training and been back here for about six years now at St Luke's.
Speaker 1:And from our discussions previously I've learned that you were actually a swimmer at the collegiate level. Is that right?
Speaker 2:I was. Yeah, I swam at the Division I level in college. Where'd you go? Eastern Illinois.
Speaker 1:Eastern Illinois. Okay, eiu, that's correct, yep. And so um what's their mascot?
Speaker 2:Uh, Panthers, the Panthers home of Tony, Tony Romo.
Speaker 1:Okay, uh, northern Iowa is also the Panthers home of Kurt Warner. I so anyway, not that that matters, but uh, so very cool, and so, uh, you must've been a very accomplished high school swimmer as well.
Speaker 2:Uh, yeah, correct, yeah, it's you must have been a very accomplished high school swimmer as well.
Speaker 1:Yeah, correct, yeah, you can brag about yourself, it's okay.
Speaker 2:Probably not as good of an athlete as you were as a runner, I don't know about that.
Speaker 1:But no, very cool, and I think you know a lot of cool things that you learn and you know competing at that level and then also just like a different mentality, oh, there's no doubt about it.
Speaker 2:I mean, competing at that level allows you to just be better with your time management. You clearly see that those people who compete at a high level have better dedication and ability to manage difficult schedules, difficult cases, things like that.
Speaker 1:Yeah, there's no doubt about it You've been nervous before.
Speaker 2:You've been in stress before.
Speaker 1:Yeah, it's not a new thing, correct. The chair of surgery where I did my training said he always loved having D1 athletes as surgical residents.
Speaker 2:Right. Once you kind of get into it you understand why you figure it out pretty quick. Yeah, I think when I was in training at Texas Heart I never heard anyone say that, but that was always kind of the rumor that they wanted they preferentially took athletes there, yeah, and so, and so, where did you do your, your residency, and was it a combined residency and fellowship, or was it just a residency?
Speaker 2:No, that's more of a new thing. When I went through, it was more classic to do general surgery first and then do a cardiothoracic fellowship after that. So I was in Pittsburgh at University of Pittsburgh Mercy Hospital and then I went to the Texas Heart Institute, which is associated with Baylor in Houston, after that.
Speaker 1:And that's where the world famousfamous Dr DeBakey was.
Speaker 2:Yeah, so that was yeah actually. So the program is merged between Texas Heart, which is at St Luke's Hospital in Houston, and Baylor, which used to be at the Methodist Hospital, and Cooley's Hospital was at the Texas Heart Institute and DeBakey was Methodist, yeah.
Speaker 1:And that's all part of the Texas Medical Center, which is like 40 hospitals or something crazy.
Speaker 2:Oh, yeah, yeah, it's huge.
Speaker 1:It's huge.
Speaker 2:I mean it's probably bigger than like downtown St Louis. In total size it's huge.
Speaker 1:Yeah, and I would imagine that's one of the best places to train for cardiothoracic surgery. I'm sure there's other good places.
Speaker 2:Sure, there's a lot of great places out there, but it's definitely one of them. Yeah, because just our training program was combined with Texas Children's World's Largest Children's Hospital. They either do the most or the second most like congenital heart surgery. Md Anderson's, where we do our thoracic, world's biggest cancer Institute yeah, um, the most heart surgery, and one area in in the United States has done it within the uh medical center, texas medical center. Um, so you know a single institution. I think Cleveland clinic does more, but as total you know the whole medical center. I mean it's the most heart surgery done in the country.
Speaker 1:So yeah, it's huge yeah.
Speaker 2:So tons of opportunity.
Speaker 1:I'm a big believer, whether it's a uh, you're practicing a football play or uh, or swimming or doing surgery, that reps really matter.
Speaker 2:And so if you're busy, yeah, there's no practice you have to be busy, otherwise, um, you can't be legitimate. Yeah.
Speaker 1:And and so, and actually, Jeremy, when he on Jeremy Leidenfrost, when he was on, he was saying that you do more lung surgeries than heart surgeries, but you're still a high volume heart surgeon. You know, consider a high volume heart surgeon, oh yeah, yeah, Just because you do so many cases here. Yeah, my heart surgeon.
Speaker 2:Yeah, yeah. I mean, if you look at my total volume, I'm our busiest surgeon within our group by a long shot, but it, like my total cardiac volume would be, you know, probably in the 90th percentile, and then my thoracic volume, something like that in the 90th percentile. Usually people just do one of the two.
Speaker 1:Yeah, and so if you're a patient, I think you want to go to a doctor who's busy, because it means two things it means they've done it a lot, but it also means that other doctors have referred a lot of patients to that person, which is always a good sign. Same with tattoo artists. You don't want your tattoo artist to be like the first day. You know. You want like somebody with experience.
Speaker 2:I like being compared to a tattoo artist. But yeah, there's no doubt about it. Um, you can definitely um see that if, if someone's very high volume, like you just said that someone trusts them either prior patients or or their physicians typically for us, you're not going to have people referring to you If you have not provided good quality product referring to you, if you have not provided good quality product in return. So you lose those referrals.
Speaker 1:And that's a function of the surgeon and also the surrounding staff, the OR nurses, the post-operative care, it's a whole team.
Speaker 2:There's no doubt about it.
Speaker 1:Yeah, yeah, and so do you still swim. I'm going to go back to the swimming. Do you still swim some?
Speaker 2:Not very frequent, but I started. Yeah, so I started more mountain biking recently. Yeah, yeah, I used to be really into like cycling, but I've gotten away from all these things, but I started getting back into it again, yeah.
Speaker 1:And your wife's a physician and you have two kids, so you've got plenty of free time.
Speaker 2:So it makes it easy, it makes it super easy.
Speaker 1:But I think swimming and biking can be very therapeutic.
Speaker 2:Obviously it's good cardiovascular exercise, but it's really good for the mind too, I think. Oh yeah, it's a great thing to just get away and give yourself a break and spend an hour out doing whatever. It is some kind of activity, so you can relax from your day at work, from the stress at home.
Speaker 1:Any type of break you get from that kind of stuff is good and every time I've I've uh, felt fatigued and worked out, it's actually been a positive thing, like even though you're tired, you go work out and it yeah, it's weird, but I think that's.
Speaker 2:I think you're correct on that.
Speaker 1:Yeah, um the um I, I broke my leg. Uh, actually I had a stress fracture in my leg several times in my training, so not a clean compound fracture, but I had to swim and you know I swam as a kid but the one thing I remember is it was you know, you don't hear a lot and so it's very isolating, which is kind of good. I mean, it kind of leaves you with your own thoughts, maybe a little bit more than running or biking.
Speaker 2:Right, and, as you know, as a physician, just like getting away from your cell phone is a great thing sometimes, yeah, like if people can reach you. You're being called all the time, so just doing something where you get away from the phone is nice.
Speaker 1:Yeah, as somebody's texting you right now, right Right Two of them already, just while sitting here.
Speaker 2:Yeah, yeah, so it's it is good, I mean, if you can get away from the cell phone and take a break, it's nice.
Speaker 1:Yeah, it's good to be needed, it's good to be useful, it's good to be helpful, but at the same time you have to have your sanity, some boundaries Right, and it's not a good long term plan to be always accessible all the time, no doubt. But in general, to be helpful, you got to be there for people, correct, um and so uh, and your wife's a physician, she's an anesthesiologist, is that?
Speaker 2:right, she's an anesthesiologist. She's at Wash U. She's does cardiac anesthesia.
Speaker 1:And did you guys meet in medical school?
Speaker 2:Medical school Yep.
Speaker 1:And so, and she's kind of, uh, she's kept you in line these years, right, straight and narrow, right, right, of course, and so, um, no very cool Um, and so, um, no very cool um, and so are there um. I know, in medicine in general there's a lot of changes. Are there any um new technologies or new surgeries or new techniques that are being used? Um in the field of cardiothoracic surgery?
Speaker 2:there are, but but right now there's not a lot. That's like total. You know where I would consider like revolutionizing this especially. I mean there are certain things like minimally invasive surgery, that's picking up robotic cardiac surgery that you know some people have interest in. But at least with robotic cardiac surgery it's tough to build those practices, yeah, and the outcomes have not been great. So it's hard to adapt when you see that the outcomes haven't been great across the board.
Speaker 1:What about thoracic? Do you do minimally invasive thoracic surgeries? Everything I do is minimally invasive. Is that right?
Speaker 2:I mean, unless it's just something that's too big, too large of a tumor that you can't take out through like a small incision, but otherwise everything I do is uh thoracoscopic, or you know, and small port surgery.
Speaker 1:When did that change over from like the open surgeries to, oh, that's been more than 20 years, 25, god, even more than that.
Speaker 2:Um, you know, like in the 90s or so, when yeah was pretty popular, people were starting to do like thoracoscopic lung resections and stuff. And if you say, though, like popular, like when it was like or when it became predominant Actually pretty recent, I mean until just recently, a good portion of all the lung resections in the country were still done by general surgeons. So general surgeons weren't going to be doing these minimally invasive, they're going to be doing them open.
Speaker 1:It's just too technical.
Speaker 2:Yeah, because they're used to operating in the belly and that's shifting and now people are doing more like VATs and robotic lung resections.
Speaker 1:VATs is video-assisted.
Speaker 2:Video-assisted. Yeah, very similar to like laparoscopic on the belly or arthroscopic on the knee and the chest is just thoracoscopic. So it's more common now that almost all providers are going to offer some minimally invasive option. We do, you know, close to like 100% minimally invasive Obviously, the huge tumors, you can't do that way, but we're trying to do almost everything minimally invasive quicker recovery, less pain, things like that.
Speaker 1:And so there's just some small incisions on the side. Yeah, yep.
Speaker 2:And it doesn't sacrifice anything for like cancer outcomes, it's still a yeah, yeah, yep. And it doesn't sacrifice anything for like cancer outcomes, it's still a great operation, yeah.
Speaker 1:Yeah, and you and I share plenty of patients with lung cancer. And then you also treat patients who have esophageal cancer, sometimes in conjunction with a general surgeon, because the lower part of the esophagus is in the abdomen but the upper part of it is in the thorax, that's correct.
Speaker 2:Yep, yeah, we typically do all those combined with the general surgeon here.
Speaker 1:And there are two main types of esophageal surgeries. As far as like where the anastomosis is, is it like transthoracic? Yeah, that's correct. You're laughing at me now Explain to me why it's funny.
Speaker 2:It's not funny, uh, but no, there's uh, it just uh. There's several approaches of how you can do an esophagectomy, because it traverses, like the neck, the chest, the belly, um. So there's approaches where you can make a decision on the belly and the chest, uh, the belly and the neck, the belly, chest and neck, um. So there's just different ways to do it and it really all comes down to preference. I mean, there are some advantages to each technique, based on, like where tumor is and stuff like that. But really, at the end of the day, it's just what your preference is, what you're comfortable with. So what's your preference and why? So? I typically just go through the belly and also the chest to incisions, and the reason why is because it's a complex operation. I think you get great exposure. That way you get better lymph node harvest, which is important in staging cancer.
Speaker 2:It's blind if you don't go into the chest right it's blind and so like, yeah, you're taking out the esophagus blindly if you just go through the belly, so if you injure something, that could be catastrophic. So it is good to be able to see what you're actually operating on.
Speaker 1:And then one issue can be the anastomosis, which is the medical term for where they connect the two portions of the esophagus once they resect the tumor, and that matters too right where the anastomosis is yeah, so, yeah.
Speaker 2:So if you just go through the belly, like you just said, then it's up in the neck, meaning it has to go a longer, longer way, and the blood supply is further away now at that point, so they just don't heal as well if they're up there and it but and the advantage of that is, if they have an anastomotic leak, it doesn't go into the lung. That's correct. Yeah, it doesn't leak onto the lung and the chest.
Speaker 1:But fortunately, especially with a good surgeon like you, you don't see a lot of anastomotic leaks?
Speaker 2:Yeah, knock on wood. So far we haven't had a lot of problems.
Speaker 1:But yeah, of course, anytime you do high anything enough, like you know, errors will occur.
Speaker 2:But if your error rate is low, then that's the that's good to have good, you know, low complication rate, but at the same time, like, if you do have a complication, if you can take care of it, almost always the patient's going to be okay. Yeah, that's the important thing.
Speaker 1:So, if you, so, if you have an error rate of one or 2%. That's's good, but it's really good if you've treated, you know, a couple thousand patients and you've dealt with that one or two percent scenario. You know more than once Correct, yeah, totally, and that's why kind of volume is just so important. Absolutely, patients, yep, aside from swimming, what other things do you do for your health? Is or swimming and biking it?
Speaker 2:That's it right now.
Speaker 1:Yeah.
Speaker 2:Yeah, as far as like activity, that's it right now. Yeah.
Speaker 1:I've recently adopted stretching, just taking like 10 minutes before I go to bed, and I felt like that's especially the muscles around the pelvis. I feel like that's made me feel younger, but I don't know. If I pull some muscle off my bone, then you'll know why. Well, ryan, it's always good talking to you and thank you for coming on the podcast to share your time with us To the listeners. Please tune in next week for our next episode of Doc Discussions. Thanks so much.