The Hope Table

On the Edge of Life: Surviving a Ruptured Aortic Aneurysm

• Erin Brinker • Season 7 • Episode 14

Share episode

Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.

0:00 | 56:40

In this episode of The Hope Table, host Erin Brinkersits down with Dr. Jeffrey Hsu, vascular surgeon with Kaiser Permanente, and his patient Phil Crawford, a survivor of a ruptured aortic aneurysm—an event that is often fatal. Dr. Hsu explains vascular health in down-to-earth “plumbing” terms, breaks down what aneurysms are, who’s at risk (especially older male smokers), and why screening and early detection matter.

Phil then shares his powerful, emotional story: a sudden onset of excruciating abdominal pain, an emergency 911 call, waking up weeks later from a medically induced coma with 111 staples and a new understanding of his own mortality. He talks about quitting tobacco, facing esophageal cancer a year later, and how family, faith, and sheer determination carried him through. Erin closes by reflecting on post-traumatic growth, advances in vascular medicine, and practical steps listeners can take right now to protect their own vascular health and truly “seize the day.”

Send us comments and thoughts.

Erin Brinker:

Erin, welcome to the hope table. I'm Erin Brinker. Now one of the my most favorite things on this show is being able to talk to Kaiser doctors who are experts in everything from women's health, Men's Health, cardiac health, everything today I have the distinct pleasure to sit down with Dr Jeffrey shoe. He's the former chief of vascular surgery, still with Kaiser Permanente, and not only is he joining us, but one of his patients, Philip Crawford, he survived an aortic aneurysm, which is almost always a death sentence. Dr Hsu and Phil Crawford, welcome to the show. Thank you. Thank you. So Dr Hsu, first of all, we think of cardiac health. We think of pulmonary health. We think of, you know, the other systems in the body. But I don't know that anybody pays attention to pay pays attention to vascular health. Can you kind of tell us what that is and what that specialty entails?

Dr. Jeffrey Hsu:

Yes, yes. So vascular health has to do with the blood flow in your body, and one of the reasons why it may not be as memorable to many people is that it encompasses pretty much the entire body and doesn't have any one specific location or one specific organ. However, it is still very important, and it it most, I think, likely has a analogy to the plumbing in your house, for instance, which covers your entire house. It could be in any room, but if there's a problem, you kind of have to fix it in that location. So vascular health is still very, very important, but it is not as memorable or clear to much of the to much of the population,

Erin Brinker:

I think about all of the systems that, first of all, all of the systems depend on blood, right? That's how nutrition and oxygen makes it around to the various organs. But the liver impacts at the heart, the lungs, the muscles, certainly, you know, I mean everything, the kidneys and so you know, when you're when somebody has a vascular issue, do they often think it's something else, and they they find out through trial and error that it's vascular. How do you how do you find that leak in your pipes?

Dr. Jeffrey Hsu:

Oftentimes, it takes a few steps of investigation before finding out it is, in fact, a vascular issue. However, we do have with modern imaging, we do have the tools we need to figure out whether or not it is a vascular issue pretty quickly these days, and yes, absolutely correct everything in your body requires blood flow, and so many maladies that happen have to do with an interruption or problem with that blood flow. And once we figure out what it is, it is surgeons like myself, vascular surgeons and other vascular specialists, who will then come up with a solution or treatment plan to try and correct that problem.

Erin Brinker:

So let's talk about aneurysms, specifically, because that is Phil Crawford's issue. What is an aneurysm and where can they occur in the body.

Dr. Jeffrey Hsu:

So the word aneurysm is a general term we use in medicine. It basically has to do with an enlargement of something. It's usually a tubular structure that develops a bulge in it. If you can imagine a garden hose, for instance, with an area that has become wide, or, you know, maybe the size of a small apple or something like that, and and that would be, you know, what An aneurysm is in the vascular system. It's basically a weakening of the wall of the artery, which which then under pressure, there's blood flow through the artery. Under pressure tends to, tends to enlarge that area of the aorta or artery and cause this bulge, essentially, and so that's what an aneurysm is technically in in the vascular system.

Erin Brinker:

So that literally, could happen anywhere in your body, anywhere you have veins and arteries. It could happen

Dr. Jeffrey Hsu:

that is correct. It can happen literally anywhere.

Erin Brinker:

And so what are some of the things that that weaken a vascular wall? I would imagine diabetes and high blood pressure can't help. Are there other things? First of all, is that true? And then are there other things that can weaken the artery and vascular walls?

Dr. Jeffrey Hsu:

Yeah, this is an active area of research, and it is not 100% clear right now, why certain areas of the artery arterial system get weaker than others, but it is, it is known that there are certain factors that cause injury to the artery wall, which then leads to weakening. So the most common example of that would be what we would call a plaque formation or atherosclerosis, and that has a lot to do with diet and smoking history as well. So this, this is a process that causes inflammation, and it does affect the integrity of the artery walls. And it turns out that some areas of the arterial tree, so to speak, are more prone to weaknesses than others. And so we oftentimes see aneurysms in certain locations. In Mr. Crawford's case, it was, is the abdominal area and and that is, that is what we know. So there's a lot of also heredity and genetics that play into this as well.

Erin Brinker:

So I have heard that there is a link between oral health and vascular health. Now, whether those whether that causes an aneurysm, I don't know, but that that people who have poor oral hygiene, they put their vascular system at risk. Is that true?

Dr. Jeffrey Hsu:

I think that may be alluding more to cardiac risk.

Erin Brinker:

Okay, okay, well, that's very helpful. So let's talk about Phil's situation, the kind of what what is the aorta? What does it do? Where is it located in the body, and what you know, what do you do when you have an aortic aneurysm?

Dr. Jeffrey Hsu:

Sure, sure. So. What is the aorta? Again, going back to the plumbing analogy, you the aorta is can be considered the main line, the main line of blood in your body. So your heart is the central pump that moves the blood and acts as a pump. But as it pumps blood, the biggest blood vessel, the main line, so to speak, is called the aorta. It sits centrally in your body, and everything else branches off from there, and the arteries then get smaller and smaller and smaller until they reach whatever organ that is intended. But the aorta is the biggest blood vessel in your body. So so that that's why it's such a serious condition, because it is the main line. And so if you have a problem with this main line, it can really be catastrophic.

Erin Brinker:

So how do you what are some risk factors or warning signs for an aneurysm, well, specifically, an aortic aneurysm. And you know, how what do you do when you start to notice these?

Dr. Jeffrey Hsu:

So here's the problem. The problem with these aneurysms is that they are oftentimes silent. In other words, you really are likely not to know that you have one. They really, in general, don't cause symptoms. They don't cause any real problem that you may notice, until perhaps something then happens. So when they do cause issues, typically it is having to do with pain. So there can be pain experienced in the lower back area. It can radiate down the legs. It can be in the abdominal area. It can radiate into the groin areas. Sometimes it will radiate up into the the chest area. However, pain is usually the first sign that there isn't aneurysm there, and if that happens, it's usually a. Sign. So this is one of the dangers of having an aortic aneurysm, is that there's no good way of knowing that you have one other than having something called a screening test.

Erin Brinker:

And what does that screening test entail? I assume it's a CT scan.

Dr. Jeffrey Hsu:

Actually, it's it's usually an ultrasound. Oh, it's usually an abdominal ultrasound, and it is done based on the recommendations from our government, national screening recommendations and the current recommendation for screening is to have men who are between the ages of 65 and 75 get who have had a history of smoking. So that's basically the the population that we're looking for is to screen in that population men from the ages of 65 to 75 with any history of smoking. Smoking history being about 100 cigarettes in the past. And it is in that population that there's a national screening recommendation and, and, and, so that is the current screening recommendation.

Erin Brinker:

So let's, let's talk specifically about Phil's case. So I'm going to switch it to Phil. Tell me about your life and what you were doing that led up to this challenge, before you were diagnosed, or did it rupture? Tell me. Tell me what happened.

Phillip Crawford:

It's there. There was no warning. I can tell you that I did smoke and I chewed skull, and one day I was sitting at the breakfast table, and I reached around to open the sliding door, and an immense pain came over my abdomen, and I knew I needed help, so I started the process at that point.

Erin Brinker:

So did you think that you were having like, a stomach issue or an intestine? Because I'm thinking about where the aorta is in the body, there's, you know, all those organs are in there at once, like my liver is a problem, or my, you know, my stomach or my intestines, or, you know, if you've got pain shooting down your legs, you could think I have sciatica, when it's none of those things, right?

Phillip Crawford:

They I didn't really have any inclination of what it possibly could be. I just knew it was a pain that I couldn't control, that it was, it was a severe pain. It took me to the floor, really. Oh, so,

Erin Brinker:

so I assume that that you somebody was with who was with you? Called 911

Phillip Crawford:

yeah, my wife was there. She's on the she's on the podcast with us. She, she started the process. I asked her for help, and she started 911 and everything after that point is a story she can tell you. I know nothing about anything that happened, from the time I got in the ambulance until I woke up two or three weeks later from a medically induced coma, oh my gosh. And the doctors asked me to show them my sutures. And I looked over my wife, I'm like, What are they talking about? And they told me to raise my gown, and I had 111 staples, I believe, in my abdomen, from like my belt line to my sternum.

Erin Brinker:

So I am guessing your wife is Shelly. Heaton, Shelly. Are you able to take yourself off mute and and I can welcome you to the show. Thank you so I can barely hear you once you lean into whatever microphone you are using. Tell me what it was like to experience this as a as a loved one and a bystander. I unfortunately can't hear Shelly.

Phillip Crawford:

Okay, she might be trying to fix it. She's, that's, that's all

Erin Brinker:

right, that's right. We had not prepared for her to be here, but I'm happy that she is. If we can get this worked out in the meantime, I'm going to, I'm going to ask Dr Hsu, so when you when, when Phil came into the hospital, I'm sure you were paged from to the emergency room. What happened?

Dr. Jeffrey Hsu:

So when, when Mr. Crawford came into the emergency room, the emergency room. Room, physicians quickly diagnosed him through getting a CAT scan with something called a ruptured aortic aneurysm. So that is usually how it's diagnosed. CAT scans are oftentimes used to investigate causes of abdominal pain, and in this case, it showed very clearly that there was a rupture of a large aortic aneurysm. And so they they called us, me, I was on call that day, and and we took care of the problem.

Erin Brinker:

So I have to think that time. I mean, you have no time. Everything has to be really quickly, because someone could bleed out in minutes. That is correct.

Dr. Jeffrey Hsu:

Wow, is one of the most. This is a situation where every minute counts. And in my specialty, it's known as the one thing where you just drop everything you whatever it is you're doing, you just have to drop it, and you have to go take care of it. It's that immediate. So basically, it, it. It was in that situation where Mr. Crawford was losing blood actively, as we were, as we were figuring out, you know what, what to do with him. And so we very quickly prepared the operating room and basically got him in for the operation that he needed. I believe it was very quick when we got him up there.

Erin Brinker:

Well, that's outstanding. I mean, if, if Shelly hadn't reacted so quickly and gotten 911, there, and then gotten you all, gotten filled to the hospital in time, and then you hadn't reacted so quickly, then he would not be here.

Dr. Jeffrey Hsu:

That's absolutely correct. That is really correct, that that is the most important step, is to get to the hospital fast. We know that when these things happen, about 50% of people don't make it to the hospital. And when they do make it to the hospital, and let's say they have treatment, only 50% of those people survive the operation. Wow. So it's a very dire event. The fact that we were able to see Mr. Crawford in the hospital was just a huge advantage for us, because we were able to treat the problem right away.

Erin Brinker:

And I want to as an aside very quickly. This is why people donating blood is so important, because I assume that he that you threw up some O positive blood or negative. I'm not sure which one's the universal. I think it's O positive that you threw that blood up right away so that he could, that you could keep things going while you, while you sewed him back up. Is that true?

Dr. Jeffrey Hsu:

You know, actually we, we actually have, we actually have certain strategies when it comes to giving blood, and sometimes we do have to give it right away, but other times we can hold off until it's a little bit more advantageous to give it. So it's not necessarily the first thing that we do, but you know, they're, they're a, what we call a, you know, resuscitate strategy that we use in this situation, and sometimes it does involve giving blood. Other times, no

Erin Brinker:

okay, but it should be on hand either way,

Dr. Jeffrey Hsu:

that is true.

Erin Brinker:

So let's go to where you wake up, Phil, let's go to where you wake up and you are. You've been in a medically induced coma. You've got your wife standing next to you. What was the realization of what had happened to you? What was that like?

Phillip Crawford:

It was shock. Everybody telling me, You know what had happened to me, I just, I'm thankful that Dr Hsu and all those people were available. It was super shocking. I mean, it still grabs me now. I mean, I'm my eyes are watering up right now. Just talked about it. It was amazing, scary. I was scared to death. Time, yeah,

Erin Brinker:

so I imagine there's some PTSD for you, like, you know, that's something that you know, because there's the mental side of things, right? Your body went through an incredible shock, and you may have been asleep, but your body wasn't. And so it remembers, and I imagine it is, it has changed your outlook in life. It's changed your certainly, the feeling of your own mortality, what you're thinking about is important in your life. Kind of talk about some of those things.

Phillip Crawford:

I'm kind of a rock head. But the as far as the mortality, it's just at any given moment, you know, tomorrow is not a guarantee. That kind of thing, as far as me living my life, thinking about my aneurysm, I I try not to. It brings up, you know, it tugs on our heartstrings. My wife can't hardly talk about it. You know it was, it was very bad. I mean, you know, to have Dr shoe come in and tell your wife to come in and say goodbye. Oh, you know that happened more than once. As far as I know, that's what I'm told. I I wish she could tell this story, because her and Dr HSU have had more conversations than Dr Shu and I not that Dr Hsu and I haven't had many of those. Sure they're, you know, their relationship was, you know, two or three weeks.

Erin Brinker:

So how is it? Has it changed your personality. Has it changed your priorities? How do you including about how you relate to your own health? You know? How has it changed you?

Phillip Crawford:

Well, I quit smoking and chewing while I was in my coma. He fixed that too, it doesn't it. There's more to my story than the aneurysm. A year later, a year later, I was diagnosed with esophageal cancer, so I've been dealing with that for it's a little over a year right now, so

Erin Brinker:

it I'm so sorry to hear that.

Phillip Crawford:

It's all right. I'm fine. The cancer is has been removed from my body and all that. And, you know, it's just trying to learn how to eat with my new throat. So, you know, I wish she could talk. She knows everything. I guess it changed my life that I value. You know family, and every day, you know my family, and every day, I mean, they were there with me, every day, every minute, nobody ever left me there. Wow. I was never alone. I had family friends. There was somebody sitting with me the whole time.

Erin Brinker:

Wow, that's awe inspiring, because not everybody has that. That is amazing.

Phillip Crawford:

My family's pretty good.

Erin Brinker:

So how old were you when you started consuming tobacco products, whether it was smoking

Phillip Crawford:

or chewing? Well, it was in the fifth grade, but it wasn't like steady at that point. That was just the beginning. I'd say I'd probably been I was smoking from the time I was 14, off and on. I quit once for three and a half years and once for a year and a half, but I always restarted to this. There is not a urge to smoke anymore, where there was always, whenever I quit, before there was, you know, I wanted a cigarette, and nowadays it never enters my mind. Chewing never enters my mind. It was, you know, I think that's the only way you can quit chewing. Chewing is very bad.

Erin Brinker:

Oh, see, I had no idea. I've only known a handful of people who chewed, but I know they loved it when they did.

Phillip Crawford:

Oh yeah, it was, it was very difficult. I could never quit that. I tried and I was unable to, but Dr HSU was able to fix it.

Erin Brinker:

Thank you. Dr Hsu, a miracle worker in many ways. He is so dr Hsu, talk about, you know, some of the other patients that you've had that have kind of gone through the same thing. Are they pretty much all smokers or consumers of tobacco products?

Dr. Jeffrey Hsu:

I would say, in my experience, most of them, however, there, there are a handful of patients I've seen over the years where they have. Smoked, and it is from another, you know, issue probably having to do with some genetic factor. So, you know, we do know that these aneurysms do occur in certain populations more than others. So for instance, it does affect men more than women, about three, three or four times more in men than than women, and it that some of the other risk factors that haven't mentioned yet are also those folks with a condition called COPD, which is chronic obstructive pulmonary disease. You may have heard people smokers get this often as well, but it has to do with a breakdown of the lung tissue causing it to be very difficult to breathe. It's similar to the aneurysm problem, because it has to do with the elasticity of the tissues. And so there is a relationship between that condition and aortic aneurysmal disease. So it's, it's, it also affects certain ethnic groups more than others. It is, is more common in the white Caucasian population than others, and it, as mentioned, affects men, you know, over the age of 55 that is, that is really the, the the population who is most at risk from having aneurysmal disease.

Erin Brinker:

So are we seeing the numbers? Because the number of people who smoke has gone down. I mean, for a lot of efforts, you know, the way that, especially in California, how much cigarettes and tobacco products are taxed, how much, you know, there's the all the peer pressure not to smoke. Although I'm seeing smoking more in in movies and on television shows, I'll see the cool person walking around with a cigarette more than I used to. How are we? Are we? Are you seeing more fewer people who smoke, and therefore fewer people coming in with this condition?

Dr. Jeffrey Hsu:

Yeah, I, I can't. I actually can't say that. I've seen more or or less. I mean, pretty much all my patients are smokers, you know, just, I think, by self selection, just, you know, having vascular issues. So I haven't been able to notice whether or not there's some more general trend, you know, towards more smoking or not. Yeah, but it is definitely something that is I definitely counsel all my patients on it, whatever problem, whatever vascular issue they may have. One of the first things I tell them is to stop smoking.

Erin Brinker:

And Kaiser has resources for that right to help people stop smoking.

Dr. Jeffrey Hsu:

Absolutely, absolutely. We have educational resources treatments. We have a variety of resources at Kaiser that patients may contact their primary care doctors and and, you know, enter into certain programs and things like that.

Erin Brinker:

So, so Philip, are you doing any if the answer is, no, that's perfectly fine. Are you doing any outreach to youth to tell them about the dangers of smoking? Is it something that you'd ever thought about doing? You know, I are you screaming it from the rooftops? What this actually is, like,

Phillip Crawford:

I have not done anything like that. Like I said, my the last two years of my life have been very stressful, I imagine. But, you know, there's I, I live my life. I'm good,

Erin Brinker:

that's awesome, and you're still here, which is

Phillip Crawford:

the best part about it, you know. And I think I'm reasonably healthy, I'm 50 pounds lighter, but yes,

Erin Brinker:

did anybody tell you that if there's an easier way to lose weight? Oh, my God, I wish

Dr. Jeffrey Hsu:

I made the comment on sure issue here. You know it's not uncommon for people who go through this ordeal to have PTSD or to have some psychological issues following it, it is pretty a well known, documented problem, and I think it really is like, as you mentioned before, it's a shock to your system, it's a shock to your mind, it's also and it's obviously a shock to your body, but it's one of the most unimaginable things that I think a person can. Undergo in their lives. If you can imagine, you're just sort of living your life one minute and the next minute, you're being told by people that you have never met before that you don't know in a place that you probably haven't been in, that this may be the end, and, you know, it's, it's a sudden thing, it all happens within minutes. I don't think that's a kind of a normal experience, no, and that, yeah, that definitely would have a psychological impact. So it's something that we surgeons do know about. And you know, we, we, we have seen it in our patients over the years, and in Mr. Crawford's case, you know, I just wish him the best, and just having, you know, to fulfill his his dreams, you know, having gotten over this now and that, that he can go on and have a wonderful life.

Erin Brinker:

Yeah, they came into that.

Phillip Crawford:

They it's pretty much normal, with the exception of my eating nowadays. But I mean, as far as what I'm able to do and how I'm able to live I'm I travel. I went on a world cruise after the surgery, I think I left in January. He operated on me in October, and I was on a world cruise in January. So Wow. Well, it's my wife trying to seize the day. You know, every day she's like, you know, we're gonna live life while we're living but the post traumatic that all happened that day, whenever they asked to see my sutures, and that was the worst day

Erin Brinker:

it would have to be. I mean, I think my worst day, yeah, I mean, it was, it was it would have to be, because this come to this realization that all of these things had had, you know, this, you that you've been through this hell, and then then you realize, oh, I have pain, and I'm in a hospital, and people have been here, and I almost died, and all of those things that, as it starts to sink in, that that has to be traumatic,

Phillip Crawford:

they, you know, the whole dying part I didn't learn about until I came out of the coma. I, like I said, I pretty much know nothing of other than arriving to the hospital and waiting for the doctors to see me and then waking up one day, you know, three weeks later, I think it was 20 days, to be exact, I don't know, wow, wow. I don't dwell on it. Try not to talk about it.

Erin Brinker:

Sure, sure. And you can't, right? Because nobody wants to live that way. But it is, you know, you've been through, you've been through a lot, and clearly you wanted to to be successful in coming through it, or you wouldn't be here. I mean, clearly you fought for your life, even if you was subconsciously, you fought for your life. And so all of you were fighting together, right?

Phillip Crawford:

It right the fight. I mean, it's that's what I see in people who, who don't lead the life that I live, is like they give up, and I just never gave up. I still haven't given

Erin Brinker:

up. You have a lot to fight for.

Phillip Crawford:

There's a lot of people who need me, I guess so.

Erin Brinker:

What are your goals for the next 10 years? What do you want out of life now?

Phillip Crawford:

I want to be a scratch golfer. Are you still golf? I golf twice a week. I hit balls twice a week. I I want to be the best father that I can be to my children and my grandchildren, and that's what I want. I think that sounds fantastic. Sometimes, you know, I get a little down and grumpy, but

Erin Brinker:

that's because you're human. Yeah,

Phillip Crawford:

I think I even got doc grumpy with Dr shoe one day. Sorry. Dr shoe,

Dr. Jeffrey Hsu:

no, it was all part of the it was all it was all good. Mr. Crawford, it was not an issue. All right,

Erin Brinker:

so, Dr shoe, let's talk about some other vascular issues that people should be looking out for. And you brought, brought up, you know, the the COPD, but people also get, you know, they get plaque buildup in their arteries, which you also talked about, I know somebody in my family had to have, they had pretty much 90. Percent occlusion in their carotid artery, and their vascular surgeon went out, went in and took a piece of it out, where the where the plaque was, and so the other two pieces together, which is absolutely miraculous that happened in Houston. And you know, could kind of talk about other things that a vascular surgeon does, and where the industry is going, or where that specialty is going,

Dr. Jeffrey Hsu:

sure, sure, vascular surgery is a specialty that has basically been here since the people started first doing surgery, but it really came into its own specialty, so to speak, in I would say, the late 70s, early 80s, and started being recognized, as you know, its own specialty. There have been so many advances in vascular surgery with technologies over the years. The major one happening in the late 80s, early 90s, where we started instead of doing a lot of open surgeries, we started doing things called endovascular procedures that had to do with getting inside of the arteries instead of having to open them up and getting inside and place things like stents and balloons. And so that was a huge revolution that that occurred and changed the entire specialty. The specialty continues to grow. I estimate there's probably around 3500 to 4500 vascular surgeons in the United States. And there is, I think, a shortage, and there's a need for more vascular surgeons in many areas of our country, so that when things like this happen with Mr. Crawford, that there can be a vascular surgeon available to perform these type of procedures. But I see, I I see the specialty as a growing specialty, and one that is also affected greatly by technological advances.

Erin Brinker:

So when you were in medical school, did vascular surgery always interest you? Or did you just kind of fall into it and realize, Oh, I really want to do this. How did you make that decision?

Dr. Jeffrey Hsu:

Yes, that's a there's a story there. The the specialty of vascular surgery is pretty specialized, so oftentimes it's not even introduced at the medical school level. Oh, there could be situations where a medical student could get through an entire medical school education and have never even heard about or experienced working with vascular surgeons. That is because we are a sub specialty of a, you know, another broader specialty, specialty of surgery. So the way I the way, the way it happened for me was that I had a general interest in surgery, and so I started my career going into a sort of a, what we call a general surgery training program. And while you're in that program, you get exposed to many different sub specialties of surgery. And in my case, what happened was I, I found vascular surgery to be very natural, very interesting. I had good mentors. I was, I was very much that that has a lot to do with it when you have mentors that guide you into a direction. That is essentially what happened to me. So I kind of found, you know, that during my training years and went off in that direction.

Erin Brinker:

So I, I picture vascular surgeons working with technology. So you're not in there with your hands repairing that. You're using machines, or, you know, technology, to do the repairs on those on the veins and the arteries. Is that correct? And what, what is actually the nuts and bolts. How does it look?

Dr. Jeffrey Hsu:

Yeah, I'm sorry, Erin, I because there was an incoming call. I missed the front part of that.

Erin Brinker:

So I picture that you that when you're doing vascular surgery, that you're actually operating a machine that's doing the surgery for you. And I don't know what they call those machines, but you know it. Instead of you stitching up the the artery or the vein you're having, you're working through a machine that's stitching up the artery or the vein or there, you know, you talked about, you know, not being invasive, like trying to find a way into the arteries and veins. What does the actual nuts and bolts look like?

Dr. Jeffrey Hsu:

Yeah, so I think you are describing what we call robotic surgery, which is not made majoring roads into vascular surgery just yet, although it may be something that we do more of in the future, what we do as vascular surgeons are we use things like X ray machines to help guide instruments and things through the body, but we are still the ones actually manipulating the instruments. So, so we haven't really, you know, made a lot of use of robots, but that's just now. I mean, I do think that's going to change in the future, but the but the typical scenario now would be the vascular surgeon would be present and doing the ethical surgeries in the operating room, some some operations that we do require X ray machines and and we don't have to make large incisions. And these are procedures where we're putting stents in, we're putting things on the inside of the arteries, and we're having, we're basically not having to open the body to expose these vessels. Mr. Crawford's case, it was not possible.

Erin Brinker:

The body opened itself, unfortunately, on the inside, unfortunately,

Phillip Crawford:

yeah, that was all done by hand, the way, I understand it for nine and a half hours.

Dr. Jeffrey Hsu:

That's right. In Mr. Crawford's case, we did it the old fashioned way possible. We basically had to get get in there. We had to open everything up and move everything over in order to get through to the area.

Erin Brinker:

So if you were talking to somebody who is interested in becoming a surgeon, and telling them about your specialty, what part of it that is the part that you love the most? Dr Hsu.

Dr. Jeffrey Hsu:

I, for me, personally, vascular surgery is is elegant, and there's a beauty to it that I think you need to I think you it takes a while to appreciate, but it's it's it has to do with how delicate the surgery is and and the fine work that needs to be done to be able to put things back together in their right place. So I think that's what drew me to the specialty, was the technical challenge, and also the fact that it was a way of it was a way that I thought I could use my skills to help people, and that, you know, there could be some benefit, all right, from this craft, so to speak, you know, to allow people to have better lives and better quality of life as well. At the same time, it was a, it was a, it was like a manual craft or interesting craft that I had to also work on and perfect as well, so that that's really the that the the the attraction of the specialty for me. But you know, at the end of the day, it really, you know, whatever specialty anybody chooses. You know, in medicine, at the end of the day. I believe strongly that the rewards come from how our patients do and and that in cases like this, where, you know, we were able to be successful with, you know, Mr. Crawford, I mean this, this is, this is the reason why we this is the reason why I went into it.

Erin Brinker:

I'm so glad you did. So glad, you know, and I think about, you know, had Mr. Crawford, had Philip lived in, you know, rural anywhere, even out at our rural deserts, and this had happened, he may not because of the access to a vascular surgeon, he may not have been here. And so being able to attract more people into the field is critically important.

Dr. Jeffrey Hsu:

It is, and that is a ongoing issue with our healthcare system, is being able to provide the access. Us into some of the harder to reach areas, you know, of our country, and that is a that is a huge challenge. Yeah, right,

Phillip Crawford:

right now I'm in northern Minnesota, and I I'm glad it didn't happen here?

Erin Brinker:

Yeah. First of all, How cold is it up there right now?

Phillip Crawford:

Oh, right now. It's not bad. I think it's like, it's probably 20 degrees, but, oh yeah, that's not bad. No, the cold thing is over New York and all those people right now. But now the the health care available up here is minimal at best. I mean, the the place I'm at right now, if I had a problem, I'm in trouble there. There's not even a stoplight in the town I'm in. Oh, wow, right, so

Erin Brinker:

you're being airlifted to to Minneapolis. Well, I'm sure the Mayo Clinic probably has a vascular surgeon, but it doesn't sound like that's anywhere near you.

Phillip Crawford:

I'm seeking out Dr shoe. That's what I'm doing.

Erin Brinker:

Well, that's fantastic. So, so as we you know, kind of close up, you know, what are, what are, where can people get resources for vascular health education, learn more about their vascular health and and give people the power to be proactive about taking care of themselves. And this is a question for Dr shoe, yeah. Sorry, no, it's okay.

Dr. Jeffrey Hsu:

Yeah, education is definitely, I think, much needed for this condition and vascular conditions in general. I would, I would recommend, for anyone interested, they can go to our society website. It is vascular.org just basically, you know, that's it. It's very simple, vascular.org which is the home website for our main society. It's called the Society for Vascular surgery, and there are a number of wonderful educational information there that you can find in various conditions, and also help find a vascular surgeon in your area. So that would be kind of the great place to start. And you know, there's also a lot of material that can be found on online, but I would be careful with that. I would go to this website as a kind of a starting point.

Erin Brinker:

Dr Google's probably not the best source of information,

Dr. Jeffrey Hsu:

is it? I think that you would get a mix of everything in there.

Erin Brinker:

Dr Google's probably better than Dr Tiktok, though. I'm just saying.

Phillip Crawford:

I can tell you that I never use

Erin Brinker:

that. Oh, that's good.

Phillip Crawford:

I never go to Google for what happens to me.

Erin Brinker:

That's good. And you're still here as a testament to that being a good decision. So I, I'm, I'm in awe of your story, and I would love to you know both have both you, Philip and Shelly, on the show to talk about the hope side of it. This is, you know, this, this. The show is called the hope table, and what we're trying to do is give people a reason to just to feel hopeful and to engage with positive stories. And we weren't able to get Shelly on the air today, but I suspect she's got a lot to say that people could really relate to. It's really hard to watch. It's hard to go through it. It's also hard to watch it happen to somebody who's the most important person in your life. And I'm interested in hearing She sounds like a strong, amazing woman, and I'm interested in hearing her story as well, and hopefully we can get that scheduled. Dr, Hsu, you. I'm in awe of your skills, and I'm so grateful for you joining us today and that you were able to say and really in like you said, basically 75% of the people do not make it through and so Philip, you are a miracle, and it's been a treat to have you all on the show today. Thank you.

Phillip Crawford:

Thank you. Thank you, Dr shoe for everything.

Dr. Jeffrey Hsu:

Thank you, Mr. Crocker for fighting us.

Erin Brinker:

We just heard from a surgeon and a survivor, two people who have seen the literal edge of life. And if you're like me, listening to a story about an aortic dissection can leave you feeling a bit well, fragile. It reminds us that we're essentially held together by these incredible pulsating highways of blood. But I want to spend these last few minutes looking at the light at the end of the tunnel. You know, in the medical world, they often talk about survival rates, but in the human world, we talk about survival stories. And this one was a good one. There's a concept called Post Traumatic Growth, the idea that after a life altering medical event, something shifts. It's not just about getting back to normal, it's about finding a new normal that is actually deeper and richer than before. I've seen survivors who, after a vascular scare, finally quit the job they hated, or finally said I love you to a sibling they hadn't spoken to in years, or another family member, there's something incredibly hopeful about the fact that our hearts, physically and metaphorically, have this capacity to heal and expand after they've been under immense pressure. And let's talk about the hope sitting in the operating room if you had an aortic event 30 years ago, the outlook was, well, frankly, terrifying, and we kind of talked about that a little bit today. It meant Massive Open surgeries and months of recovery. Now, this was because the dissection had happened, and it was a big one. And as Dr Xu talked about, this was a good old fashioned surgery, but with modern techniques. But it's still far, far, far better than it was 30 years ago. We're living in a golden age of vascular medicine. We are now in the era of endovascular repair. So he talked about tiny incisions. Think about that surgeons can now go through a tiny Nick in the skin, sometimes just in the fold of the leg, and thread a life saving stent all the way up to the heart. It's like high tech plumbing performed with the precision of a jewel jeweler. And one of the things I asked, you know, I talked about with Dr Hsu, is that I have a family member who had carotid artery surgery where there was an occlusion, there was plaque buildup in the carotid artery, and the surgeon just went in there and clipped the part that had the plaque buildup, took it out and sewed the pieces together so that, you Know, the no longer had that occlusion, which just sent all so much more blood into the brain, and it was just much, much better. But the recovery there was still it was interesting, because he kind of changed as a person. When something that major happens, it kind of changed in a very good way. It changed as a person. We're seeing the rise of AI driven diagnostics. AI is everywhere, right? So there are now programs that can scan a routine CT, scan and flag a tiny bulge in an artery before the patient even feels a symptom. And as Dr HSU said, the symptoms often don't show up until they're at a critical stage. We are moving from a world where we where we react to emergencies, to a world where we intercept them. That means more birthdays, more graduations and more quiet Sunday mornings for people who a decade ago, might not have made it, and that is a miracle of human ingenuity. And as we close out today, I want to leave you with a thought, vascular health is often called a silent journey. We don't feel our cholesterol, we don't always feel our blood pressure, but that silence is an invitation to listen. And I would add kidney disease. I would add because we don't necessarily feel that. Don't feel we may have some general malaise, like we do with when our blood sugar is consistently high, but the damage it does to your body over time, we're starting we understand that better, not that we're starting to. We do understand that better than we ever have before. We talked about smoking with this in this conversation with both Philip and Dr Shu and use of any tobacco products, including what they call dip, which is the chewing tobacco, and it slowly but surely wears away at our vascular health. Taking care of your vascular health is not just about not dying. It's about living well. It's about having the stand up stamina to walk your dog, the breath to sing along to the radio and the years to see your grandkids grow up. If today's show moved you, well, don't let it end there. Call your parents. Call your parents, even if it just showed just moved you a little bit. Call your parents. Tell them that you love them. Ask them about the family medical history. Go for that 20 minute walk to see. Evening, take your dog out. I mean, people are walking cats now, so maybe take your cat out, not because you have to, because your body is this incredible, complex machine that deserves to be moved. And I'm going to add something in there too, if you have a job that you hate for whatever reason and you think you can't stay there much longer, make a plan for your exit. Maybe it's finding another job, maybe it's starting a business, maybe it's retiring. Maybe, you know, it could be a lot of things, but if you're in a place, maybe it's not your job, maybe it's place where you go to church, maybe it's a volunteer where you're just miserable. First figure out why you're miserable, and if you think that you need to go for your mental health, make the leap. You owe it to yourself. Do that thing. Make the Leap. Life is thin, meaning the vascular the walls of your vascular system, but it's also remarkably tough. So thank you to our guests today for reminding us that even when the main pipe breaks, there's a way back to the light. I'm Erin Brinker, and this has been the hope table. Stay healthy, stay hopeful. Let me say, like I did last week, I love you. I'm glad you're here. You're important to me, and I'll talk to you next time you.

Head Shot

Erin Brinker

Host
Head Shot

Dr. Jeffrey Hsu

Guest