The Science of Fitness Podcast
Welcome to the Science Of Fitness podcast where we aim to inspire you to live a healthier and more fulfilling life as we share evidence and anecdotes on all things health, fitness, performance, wellness and business.
Hosted by Kieran Maguire, Co-Owner and Director of Science Of Fitness with an Undergraduate degree in Exercise Science and Masters degree in High Performance, the podcast includes guests and friends of SOF from all walks of life sharing their knowledge and stories within their field of expertise.
Join us as we provide listeners with digestible and relatable educational tools and entertaining stories to inspire a healthier and more fulfilling life.
The Science of Fitness Podcast
Under the mask, lessons from Anaesthetist Dr Conrad Macrokanis
Surgery isn’t a Netflix nap. It’s a high‑stakes team effort where your anaesthetist runs the room, balances risk, and quietly steers you from fear to recovery. We sit with Dr Conrad Makrikanis to decode what really happens before the first dose, why obesity is a medical emergency, and how prehab can slash complications by half.
Conrad traces a path from rural retrievals to Brisbane theatres, revealing how prevention often lives in a bubble while most patients arrive in crisis. He breaks down GLP‑1 agonists—how they silence food noise, why they’re not a quick fix, and how to protect muscle with resistance training and protein. We go deep on NEAT, the underrated daily movement that improves endothelial health, lowers clot risk, sharpens insulin sensitivity, and speeds wound healing. If you’ve got joint pain or a surgery date, his blueprint is clear: two strength sessions, two aerobic sessions, eight hours of sleep, six to eight weeks off smoking, minimal alcohol, and a plan for post‑op care at home.
We also talk anxiety. Information lowers fear, and a simple pre‑op call with your anaesthetist can change your whole day. Learn the real risks—nausea, soreness, rare awareness—and why timing, age, urgency, and even after‑midnight cases influence outcomes. From Indigenous health contrasts to the power of community programs that drive prehab compliance, this is a candid look at what moves the needle in modern care. The future? Personalised anaesthesia guided by pharmacogenetics and CNS profiles. Until then, prepare like an athlete and recover like a pro.
If this conversation helped you feel more prepared, follow the show, share it with a friend facing surgery, and leave a review so more people can find it. Your next best outcome starts with one small step today.
Welcome to the Science of Fitness Podcast, where we aim to inspire you to live a more healthy and fulfilling life as we share evidence and anecdotes on all things relating to health, performance, business, and wellness. Welcome back, ladies and gentlemen, to the Science of Fitness Podcast. Very exciting guest, Dr. Conrad Makrikanis. How are you, mate? Good mate, thank you. Thank you for jumping on. Just uh plowed through a session. Um and uh I think you're probably Yeah, the first medically trained doctor on the interest on the podcast with us. Might have offended someone saying that, but very excited about this, mate. Um very quickly, give us a brief introduction. What do you do? Where do you do it? How long have you done it?
SPEAKER_00:Yep, so I'm an anethodist um working at predominantly Green Slopes Hospital now, so all private, um, and encompass a broad range of sp surgical specialties. So this afternoon doing three Caesars. Yesterday we were playing with orthopedics, doing joints the day before, fixing people's bowels, do a lot of eyes, stood a urology, so cover a broad spectrum. And that's the beauty of anesthesia, you really touch upon a lot of different surgical specialties. Um, a long medical history. Uh started started in science as a um a field biologist. Went through the back door, did my honours and got through medicine when I was undergrad and went Bush, got a rural scholarship, went to Bush for a couple of years and loved it, especially with a biological background. So I spent the next 15 years working in remote communities, a lot of Indigenous work, specialized in Indigenous health. We're in Broome for seven years. The nearest referral centre was um Perth at two and a half thousand kilometres. Oh wow. So you package people up, stuck them in the plane. We do a lot of um medical evacuation and and um retrieval, so it was awesome. And you're doing everything from ED with nearnates to you know old folk delivering kids, doing anaesthetics. Um, but that's a young person's game. And uh we had three kids and then we went back to Cairns, and anesthesia in Australia is a five-year training program, regardless of what we've done beforehand. Wow, so it's a slog, getting on is very difficult. Um, there's two big exams. One's a physiology and pharmacology, so we're like then in medicine, we know most about those two areas, which gives us a great advantage, you know, when we're doing our practice. And then the second exam is incorporating pathology surgeries and the outcomes of giving anesthetic, obviously, and the outcomes. And so now anesthesia incorporates the pre-hab component, so pre-op work, the interop work where you're putting people to sleep looking after them, managing, and then the post-op, which is managing pain and extreme physiology, physiology sort of events. The um exams and anesthesia are shit. So there's two exams, there are a thousand hours each of study, which is full-time work plus 20 hours a week for a year, and you do that twice. So that's the real entry point and exit point. Um, so yeah, we do a lot of work, and we're probably the most unknown, talked about specialty. So in 2016, they interviewed 3,000 Australians, 16% recognized us as specialists, another 25 recognized us as doctors, and the others just didn't know. And that's that's bad on our behalf because no one really, you know, you don't meet an ethos very long.
SPEAKER_01:Yeah.
SPEAKER_00:And there's not much publicity about it. Yeah. Um, but we're really, you know, we're running the theatre, um, looking after people while they're unconscious and and you know, at high risk. And then ideally you're optimizing them pre-op, and then you're looking after them post-op. And there's all variations in that. So yeah, super interesting, especially it's been a long journey.
SPEAKER_02:It's funny that that assumption is, you know, oh, I met my anethetist, he spoke to me for two minutes, and then that's it. It's the easiest job in the world. It must have a wonderful work-life balance. We'll talk about that.
SPEAKER_00:We will talk about that. Boom, boom.
SPEAKER_02:Um, right. Before we get into the nuts and bolts, uh, the person behind the practitioner. Um, so we've been doing with a few guests. Yeah. Um, first question. If you could improve one thing in the world, what would it be and why? As it stands today for you.
SPEAKER_00:Yeah, I think um it would be to ask and demand health specialists to talk about obesity. Um because I came from a general medicine background and into anesthesia. Uh sadly, in Australia, by 2030, so in a few years' time, 50% of our population will be obese. Uh at the moment, it's 75% are either obese or overweight. Um 75%. Either. So it's based on BMIs, right? So BMI is body mass index, it's not perfect, but it's great. And it's your weight over your height squared. And it's supposed to correlate to how much, what percentage of your body is is of adipose tissue of fat. So um I think you know, people get really caught up in the cosmetics of obesity and the you know, the negative tropes. If you're fat, you're you know hopeless and lazy and blah blah, um, which clearly is a very significant, you know, emotional people's self-esteem is low. Um, but from a medical perspective, it's a disaster. Uh, there's a list of what obesity causes. So the WHO did do a 10-year review, came out a month ago. Leading cause of global cancers is smoking at 20%. Obesity comes in at 15%.
unknown:Wow.
SPEAKER_00:So I'm sure people don't recognize that aspect. Alcohol is about 7%. Um, so the cancer causes breast, colon, ovary, uh, endometrial. Um, there's all the metabolic stuff which people are much more aware of. So the increased risk of diabetes, you die of heart attacks, strokes, kidney disease. Um, it's the leading cause of liver transplant. So non-alcoholic liver, fatty liver disease, snappy D. Yep. And then there's the joint stuff, so increased arthritis, especially pelvis and um knees. Uh, there's um there's gut disease, so increased gut, you know, reflux, gallstones, like just doesn't stop. And this keeps going. Yeah. So I I just I would be, you know, there's the the other side of that coin is the first time ever in our history um there's a drug that specifically deals with it. Now, the big question is why has obesity become such an issue? So, evolutionary-wise, it is a very it's a great strategy for our body to store energy when we need it. Historically, we've never been surrounded by so much food. You know, you get food everywhere.
SPEAKER_02:Food and comfort.
SPEAKER_00:Food and comfort, right? Everywhere.
SPEAKER_02:Not moving.
SPEAKER_00:And in the 70s, the obesity epidemic started, uh, where 75% in the 70s worked outside, and now 75% work inside.
SPEAKER_01:Wow.
SPEAKER_00:So people are just inactive. Um, and foods definitely become more dense. So the you know, the combo of of fat, sugar, and salt. And unfortunately, there's this great divide between low socio and high socio. Where in the old days, as you know from Africa, if you're wealthy, you're fat.
SPEAKER_01:Yes.
SPEAKER_00:Because you showed your wealth by eating more, and everyone else was skinny. So it's the opposite now. So the poorer you are, the fatter you are because you have access to cheap foods, which are disgusting.
SPEAKER_02:Yeah. So the the economics I'm finding probably the most interesting thing. I mean, now it's one of the leading causes of death in Samoa. Yeah. Um, unlike, you know, not a developed nation by any means, yet, exactly as you're saying, they have now this access to this mass-produced, highly processed cheap food.
SPEAKER_00:So Samoa's interesting. I worked there a couple of years ago. Um, big biggest people in my life I've ever seen.
SPEAKER_02:And they're and innately genetically. Yeah, exactly.
SPEAKER_00:So there's there's a there's a Samoan fat gene now. So 40% of Samoans have this gene. Yeah. So when they jumped on the boat and paddled as Lapita people, if you had the fat gene, you stored more energy and you could make the journey. So it was an advantage.
SPEAKER_02:So that's the theoretical model as to why it's it's a thrifty theory. Stayed, stayed.
unknown:Wow.
SPEAKER_00:And so now that's just working in they're good at good at footy as well. Yeah, exactly. They're big and fast and strong, you know.
SPEAKER_02:Is it a fat gene or is it a synthesis gene in its own right?
SPEAKER_00:It's that that specifically is fat gene. So they've so shown that 40% of you know, morbidly obese Samoans have this gene. Okay. Stores fat. Yeah, right. That's interesting. Very effectively.
SPEAKER_02:Yeah, which is, as you said, for tens of thousands of years, our entire evolution made a ton of sense until the last, what, 30?
SPEAKER_00:Yeah, 20 in this case. Since the 70s, yeah, Samoans later. But you know, you you think so in this it's been 50 years this evolutionary sort of epidemic of obesity. Our genes have not changed, right? It's not a genetic problem. So people have tried to blame epigenetics, but it's not a genetic thing. It's just we we now live in a lipogenic society, so a fat-gaining society.
SPEAKER_02:Yeah.
SPEAKER_00:So it's actually difficult to exercise. Like you guys are in a bubble here. There's not much obesity here, right? No, everyone's motivated, you know, tend to be quite young, 30s and 40s, maybe 20s. Um, and they're bad here, they managing their health.
SPEAKER_02:They identify psychologically with exercise in the gym and you know, he's the he's the fit guy in the office.
SPEAKER_00:Yeah, but but now it's that's unusual. Like we, you know, when you even compare working in a public hospital to private hospital, um, public hospital, wow, if you go and work in Logan, you know, the the uh average BMI is 3035 average, and then it goes up from there. Like it's just insane. It's become so such a common thing that people's you know, yeah. So the average weight of a of a male in the 70s was 70 kilo. You know that 70 show? Everyone's skinny, right? Yeah, now it's 92 is the average weight. So in 50 years we've put on 20 kilos as a society. Jesus. It's just awesome. But the so the other side of the corn, there's GLP agonists, which you've heard of Azembic, Wagovi, um, Wonjaro. I I mean, I'm the greatest advocate of the drug. Um, I see obesity as a chronic disease now. It's not a cosmetic problem. Okay. Um, the surgeries for obesity, gastric sleeves, gastric bypass are a disaster. Gastric sleeve, you can eat through your sleeve in about three years. So you'll lose 20, 30, 40 kilos and put it back on. And then once you have a gastric bypass where they detour the plumbing of your stomach to dump food straight in your intestine, you get all these complications.
SPEAKER_01:Yeah.
SPEAKER_00:So, you know, for massive, for people who are, you know, super morbidly obese, they definitely help. But these these new injections, and there's 20 uh GLP agonists. So GLP stands for glucone, glucon-like peptides. Yeah, it's a natural occurring hormone, right, in your body. It's glucon-like because it that's the peptide that sits there and it's cut up into different versions, and you get 20 versions of it. Okay. So when you inject it, you get a thousand times of your natural occurring dose. Interesting. And it suppresses your appetite, it you the food noise goes, um, your more s the satiety increases. So you only eat a certain amount of food and all of a sudden you feel that you're full. You're full and you stay full. You stay full and your gut slows down. So that's the side effects. The reason we give a shit about anesthesia is because you're increased risk of aspirating, where your food contents go into your lung. So we became experts about the drug very quickly. You had to do, yeah. Because of the risk of aspirations.
SPEAKER_02:Okay, so then the layman listening to this that goes, oh, but what about the gut health? Or they they they've listened to some 15-second Instagram clip of some someone breaking that this could be a risk to their stomach.
SPEAKER_00:And the you know, it's early days, been around 10 years. Um, all I would say is that the risks associated with being obese far outweighs uh some of these other aspects that we talk about. That are potential risks. So I think it will upset the microbiome, and the microbiome is a big deal. That's I'm sure you've talked about microbiome before, which is your the colony of bacteria that lives in your gut but also on your skin everywhere. Uh, we haven't worked out what the microbiome does medically yet. It's clearly probably a responsibility for these early cancers we're getting. Um, but let's get people's weight down first and then we'll talk about it. That'd be my perspective.
SPEAKER_02:Yeah. And you know, when people do bang on, oh, gut health is going to be at risk with it. Well, it's probably already at risk being obese, being overweight, you know, and and and and the consumption of certain foods that got you there have probably I won't say wrecked your gut health. It's hard to actually definitively say that, but it's probably had an influence on it.
SPEAKER_00:For sure. And you look, I'm not I'm I'm not trying to minimize the impact of an individual who's carrying extra weight. Like it's you know, you see staff at hospitals, a lot of the doctors are on now, and a lot of nursing staff are on it, GLPs. Yeah, and you know, and I am intrigued by their journey, like I love it as a you know, just a human sort of experience. And you go and talk to some of these staff, and they're like, a doctor hasn't, I've worked here for 20 years, and a surgeon's never spoken to me. And for the last year, people are so you know, I appear in the room for the first time. Wow, I'm a person, you're like, holy shit. So the impacts are massive. You know, carrying weight in this society is is difficult for sure. But these drugs are expensive. There's 20 more in the market. There's a new one coming out next year, um, retertitide. Uh, it's 30% weight loss. There's a new tablet coming out, so rather than injectable. Uh so it's probably a I if you see blood pre increased blood pressure causes stroke and heart failure and heart attack, you take an antihypertensive for your life. Diabetes is where insulin can't um efficiently store sugar. Sugar goes up, you're associated with blindness, heart attack, whatever. You take any diabetics the rest of your life, this will be a rest of your life tablet or injection.
SPEAKER_02:You reckon? Yeah, for sure. Interesting. Um Do we know if people are getting on it, coming off it, they're gaining that weight back?
SPEAKER_00:They definitely gain the weight back. Okay. Yeah. About two, about three-quarters of the weight's gained back. So if you're on the drug, it's not a miracle drug in that I just take and I'm done. Um, lean body weight is lost as same as adipose tissue. So lean body weight's bone and muscle. And you know, and this place knows that muscle is now become the biggest organ in our body, regulates all sorts of shit, not just like emotion, but um, you know, sugar control, lipid control, mood or you know, a whole bunch of things. So if you're on a GLP agonist, you have to start resistance training twice a week and you just go slow because it's a long game. So you do a little bit and you build more. I highly recommend seeing you know, you guys X-Fizz. Since you guys got a provider number, there's more X Fizz on the block than I've ever seen in my life. Yeah. Um, and you have to increase your protein intake to preserve your muscle mass.
SPEAKER_02:Which is hard when you don't feel like eating.
SPEAKER_00:That's right. But so you're you know, you must go to a nutritionalist, yeah, be the recommendation, and you should see X Fizz. And look, this is all cost, but you've got to value, you know, what's the cost of your life and what's the cost of a good life.
SPEAKER_01:Yeah.
SPEAKER_00:Uh, and you get all that by looking after yourself.
SPEAKER_02:Yeah, absolutely. Okay, well that's a small thing we could improve. That's right. Um, one major life lesson you've learned or experienced in the last 12 months, it's good or bad.
SPEAKER_00:Um thing that's been annoying me lately is uh this idea of a work-life balance. It shits me a big time. Um, you know, Ericsson showed uh you need 10,000 hours to be good at something. And you it's very in in these years where you're having kids and buying, try and buy a home and and doing your job, you just gotta work hard. Like there's no if you want to be good at something. And so what I've gained, you know, so how do you deal with the work-life balance? It's very difficult, right? Like now my life is balanced per se, if if because I'm you know I'm 57, I've done the hard years, the kids are now left school, and um I'm no longer on call, 30 years on call, so I can spend time doing this sort of stuff. Um, but from your work here, this idea of you know the hot cold baths where you put yourself in extremis, and the Winhoff breathing where you put yourself extremis. This idea of going hard where you have to go hard, be efficient, and when you're off, go off going hard. Okay, you know, wind down, find mechanisms to wind down well and be aware, don't don't leave things to chance, program it in, do it properly.
SPEAKER_02:In what context of okay, I'm programming in some off time.
SPEAKER_00:Yeah, off time, yeah. Programming off time. You know, Brooks talks about those four values of being happy, you know, faith-based, whether it be a philosophy or not, your family, your friends, and a job that's you know, that's provides a purpose to yourself and you're servicing others. So to do those things, you just gotta program it in, dude. You just gotta do it well, go hard when you can, switch off when you can.
SPEAKER_02:I think it's an important thing for young people to understand is programming the off because it's you know, we have a lot of young people around us as clients and and and and our teens young. It's very hard to go home and turn off when you turn onto any one of the myriad of devices available to distract us, but they often pull you not necessarily into your work, but into something that probably relates to your work. Yeah. Um, you know, I can go on my phone any one time, someone's training, someone's writing programs, someone's giving health advice, someone's, and my head's gonna be in there going, I agree, I don't agree. And it sort of feels from a like a cognitive load perspective, I'm still on. And and then to close it and to open the freaking book and read this thing recreationally just for the sake of it and enjoy it, it's invaluable, you know. And even just sitting still, we've spoken about a lot, just literally just sitting and just like being still, going for a walk or going for a surf. Um, the conscious, deliberate programming of it is I think what we now need to be. And again, it's an area as a species I think we've stumbled in, stumbled into unintentionally.
SPEAKER_00:Yeah, I agree.
SPEAKER_02:Yeah, for a lot of time we would walk to and from work, you know. I I was thinking those reflecting, you could probably talk about this a bit more. We used to get paid by a check and walk to the bank and have to cash that thing in, what, every fortnight, every day? That doesn't happen anymore. All those little incidental moments of maybe activity or maybe just boredom and downtime are gone and it's exhausting. So now we need to, just like we need to consciously not choose to eat that food that the ingrained evolution is in us, to be really conscious and clear.
SPEAKER_00:And then the device, the devices really muddy all the waters, you know. So I'm trying to like I put the phone in the kitchen at night now, I've got a bedside clock, like it's great. Yeah, you know, try and do those things. I think that you if you can isolate the device, I think you're halfway there to a quieter mind.
SPEAKER_02:And and consciously observe your behaviors with it. Yeah, because we're ingrained not to have to do that, but suddenly we're here. Yeah. Um, interesting. Right, yeah, let's let's dive into it. So, you know, first and foremost, I would really want to dive into the evolution of medicine and healthcare. Um, in this nature of we've evolved into these circumstances, and it's not I don't believe there's any one evil group of people with a staff in the ground going, ha ha, look at the rest of them, we're gonna make fun of fun of them. I feel like there's quite often a narrative sold, particularly on the internet, that they want you big pharma, this, that, the other, and it makes people kind of neurotic about all this sort of stuff. Yeah, yeah, yeah. Um, but are we moving to more of a preventative model as opposed to you know being reactive, or is it just a nice idea to think that I live in a bubble?
SPEAKER_00:Yeah, yeah, totally. You're in a bubble. Um, like the P2s of this world, it's a big expensive bubble. Uh the general health that I see, no one's doing it. Like, you know, even if you look at the there's about 300 billion spell on spent on health per year in Australia. Something like two to three percent on preventative health. Wow. It is not there. Okay. And uh the idea, uh the idea that we're you know doing health checks and we're you know, this whole longevity sort of scene. It I you know, to me, even amongst my colleagues who are you know well versed in health, good great medical literacy, there's only a handful doing it. And amongst patients, if I find one who's doing it, I celebrate and chat to them for 10 minutes before the operation sort of thing. So yeah, it's a bubble. It really is a bubble, sadly. Um people are just you know in crisis mode most of the time. They seek health care when they're in trouble, you know, help in terms of health, illness wise. There is the occasional person that's you know, like even um the it's funny the guidelines that the Australians release about what we should eat, how we should sleep, and how much exercise. If you look at the data, 15% of people follow it. 15%.
SPEAKER_02:Jesus.
SPEAKER_00:You know, it's just craziness. So I think um yeah, this preventative health idea, it's as individual, I'd promote anyone to go and get regular health checks, you know, GP wise, but things are getting expensive. Yeah, it's difficult. It is. Yeah, but the you know, the I think the basic things still stand, right? Sleep well, eat well, exercise, be happy.
SPEAKER_02:Well, that's what I was gonna say. What's in your opinion, um low barriers of entry?
SPEAKER_00:Um the pr uh the preventative so the general practice is the cornerstone of our health system. And unfortunately, you know, they had a f poor bastards. I mean, I was I was a GP for years, um, not desktop GP, but 2010 they did a freeze on Medicare until 2022. So for 12 years they got the same payment. And then from that time, the out-of-pocket expense went from 20 bucks to now average 50 bucks to go and see someone. So it's all just become, you know, it's just become muddied and more difficult. But if you go to a decent GP who's a good communicator, they'll tell you what you need to do in terms of screening for various, you know. In Australia, you start as a kid, you've got your infections and trauma, and then teenagers is drug and mental health, and then there's a pause for a while, and then it's chronic disease and then cancer. That's the normal progression of our life.
unknown:Yeah.
SPEAKER_00:Where chronic disease takes up 80% of the health budget, like it's the big deal. Um so if you can stop that in the 30s, 40, age 40 is when shit starts happening. You know, the early cancers pop up, people have sudden death, and that's when chronic disease starts. Yep. So if you can get in and be proactive about, you know, looking what your cholesterol is, having checking your blood pressure, doing these basic things, yeah. And don't see going on medicine as being uh a negative. The agents we use these days, most of them have gone through pretty rigorous testing, you know, um randomized controlled trials. You've got to watch out for drug company sponsored stuff, there's definitely some bias there, but now there's a lot of those you know, systematic reviews that pile all the evidence together and come out with some reasonable sort of ideas. And that's where we're a well-trained medical society. Um, and if you go and get some decent advice, you know, you can if you go on a lipid lowering agent, you you will lower your chance of having a stroke and heart attack. So I don't see it as being, you know, I hate when people say, Oh, I'm in this drug, I hate it, you know, sort of thing. Um, because you'll live longer and better.
SPEAKER_02:Totally.
SPEAKER_00:And if you chuck some, you know, throw some exercise in, you know, a couple of resistance training sessions a week and maybe a couple of aerobic sessions a week, you know, you're on top of the game with anyone else. So that's the I think that's the low, low threshold in is that plastic, you know, sleep well, try to eat well and do some exercise, like literally.
SPEAKER_02:And so, in your experience of a range of diverse communities, indigenous health, you've worked in Samoa, for example, developing countries, private centres. Um how has that sort of shaped your view on good health care?
SPEAKER_00:I th yeah, it's the same thing. I I I will so the indigenous stuff is super interesting. It is um overall, indigenous health is improving because black fellows are going into the cities rather than staying in the bush. Okay, the communities are disasters, absolute disasters. If you can this is a great one, if you compare Q Suburban Melbourne, which is the healthiest postcode in Australia to Alice Springs, which is the worst health code in Australia, there's a difference of 30 years of life expectancy.
unknown:Wow.
SPEAKER_00:So there's a whole generation lost by being an indigenous person living in Alice Springs.
SPEAKER_02:And the lifestyle effects on this.
SPEAKER_00:Take that having your grandparents help you look after the kids. All of it. So they, you know, that that classic trajectory I talked about where you have infection trauma and mental health and whatever. I I nearly started PhD in Indigenous health, thank God I didn't. But um there the mums aren't well nourished to start with. Um, you know, some grog and alcohol stuff goes on. This is by no means across, there are now a whole bunch of medical, you know, there's doctor, indigenous doctors, lawyers. So there's now a much more diverse range of the indigenous individual in Australia, so you can't generalize it at all. But in this compressed lifestyle, you get this overlap of um there's a burden of disease early on, uh so infection, a lot more infections, a lot more trauma. They start getting chronic disease at age 15, and they're getting cancers in their 30s. It is insane. So we, you know, working there was in you know, it was great in terms of Ukraine's medical experience, but it's so tragic. Like it's so tragic. Do we understand why? Yeah, it's it's a lot of it like colonization definitely had a big impact. Um, in that just you know, in Queensland, 1890, the state government auctioned communities to the churches, created 13 communities like you know, like um Yarabar and Cherberg and um uh Dumingji, those places, and auctioned them to the churches to take control of these this what they thought was going to be a dying race. And so uh they split men and women, they wouldn't allow um language being practiced, traditional practices were abolished, and you know, kids stolen, and and that I mean it's very it's a very real, real event. It's not just something the government sort of goes on about. We moved to WA to broom, they didn't have that same system. So up there, the the pastoralists had big bodies of land, would let a clan of 50 or 150 people live on their land, practice culturally, um, have four or five languages, be able to, you know, there's this idea that they're not a wandering race, they're not nomads, they're very distinct cultural groups. Uh, there's four to five hundred languages in Australia, languages as separate as European languages.
SPEAKER_01:Yeah.
SPEAKER_00:And we saw in Broome, the middle class in Broome was indigenous. Like it was such a relief to see that you know it's not all the same across Australia.
SPEAKER_02:That's very interesting.
SPEAKER_00:Very interesting. And so very difficult to generalize, but um the combination of being a black minority in a white dominant society, um, the colonial effects are massive, you know, translocation, dispossession of land and place, huge. Uh, and it's and just when your parents, like the biggest predictor of how an indigenous person is going to the outcomes is where their parents worked, and so there's this um gross chronicity of generational unemployment, and you and you can see that in the white society as well. You know, a poor white person is suffering big time, their education standards are lower, and it's just choices of shit, and their life options are limited. Yeah, and that's just magnified indigenous stuff. Yeah, wow.
SPEAKER_02:It's it's something that I found very interesting moving here, you know, whenever years ago it was, about 17 years ago, culturally, is having lived in Africa where and you've been and you've seen it, it's so culturally rich. And it's beautiful, the tribal nature of that place is actually frightening but beautiful in its own right. But there's you know, six or seven major different African black cultures in South Africa alone. Yeah, and you know, you move here and there's indigenous, and that's it, and you sort of go, Well, you don't learn anything else, you don't learn the language, you don't celebrate the culture, you don't understand that there's four or five hundred languages. I mean, that's the first time you know, and that's my ignorance. I haven't opened the book or read or listened or looked. Um, but yeah, I mean it's it's it's fascinating. Then there's that that state-to-state contrast as well.
SPEAKER_00:And you know, New Guinea's the same, 400 languages there, separate ones, they're the same sort of peoples. 60,000 years been pretty much um established now. People compare the Indigenous Australians to Maoris, New Zealand Kiwi Maoris, completely different. One language group, they're only there five, six hundred years ago, um, culturally you know, similar. I'm not right, I'm not related to Maoris. My studies aren't in Maoris, but you can't make that comparison, yeah. You know, and they did a treaty with the the Brits, you know, 1800s, 1850s, very different scenario.
SPEAKER_01:Yeah.
SPEAKER_00:So the reason I think one of the reasons that the black fellas here can't get their shit together is because there's so many different cultural groups. There's no one voice, almost yeah, there's no one language.
SPEAKER_02:So it makes it very and then all the colonial, yeah. Layers upon layers upon layers. Yeah, exactly. Yeah, it's very interesting. Um, I didn't know what the original question was. Yes. No, it's just that sort of understanding of diversity and uh how it has shaped your opinion of good health care. And I think we've already touched on it. You know, I sit here in this wonderful, unique 99.9 percentile of health, and I formed my opinions on oh, we need to look at you know, bone density a little bit more for women and that sort of thing. And I'm a little bit worried about your muscle mass or your DEXA scan. And and yet here we are, you know, looking at it in Australia in Indigenous societies and even just lower socioeconomic societies in general. Um, it's it's quite interesting, and you know, for me, my head goes to how can we dive in and solve those problems?
SPEAKER_00:Yeah, and it's not a one I I thought education uh would be the you know, growing up you know, as a lefty, I thought education would solve everything, um, but clearly not. Um it has to be a combination, you know. Work work is um work is a real thing that drives a lot of self-confidence and um motivation. And so yeah, it's multi-lad. Things are definitely improving though. I think you know, you if you listen to everyone's made to feel guilty about their existence in this country, yeah. It's obviously a balance, but um things are improving for sure.
SPEAKER_02:Yeah, and I think for the individual, you know, for me is is is it is exciting. I like to sort of look at these things with the degree of excitement in terms of someone listening to this might find a lot of purpose, and I'm gonna go and attempt to solve that problem or contribute to it. Um it's it's yeah, it's really funny just don't get a health perspective.
SPEAKER_00:Yeah, don't go and think you know the answers, that's for sure. We we still do we still go out to Long Range a couple of times a year to do eyes, uh cataracts mainly, and we do um indigenous eye lists here on a Saturday like three or four times a year. And there's a service that they go that a bus goes around and picks up a whole bunch of folks from gold from the Goldie out to Sherberg, all the way up to Gympie actually, and brings them to one place, then takes them home at night. Wow. And we uh we use a system now in a steak's called the ASA, which is the American Surgical Association. So if you're one, you're fit and healthy, you're doing great. If you're or if you're six, you're ready to give your organs up for transplant. So as the number goes up, your health status deteriorates. So typically people would be twos, maybe threes. If I'm doing cataracts, which are 50 plus years old. In in urban in white, white Australian Brisbane central dwellers. And uh in like just we did a list two weeks ago, um, you know, 30 eyes, uh the uh three or fours they were in terms of just your average blood, you know, people missing limbs, missing organs, just shit life. You know, just one guy just came out of ICU a few days prior, uh rang him up saying, He's okay for your eye thing, yes. You get in there and he said, My resting SATS, which is the p the peg you put on your finger, is 88. I've got 20% of my lung function. Um, and if you give me oxygen, I'll die because my my respiratory system is so crap that I rely on oxygen levels, not CO2 levels, which we are. It's like, you know, you wouldn't get an operation anywhere in the world here, dude. Let's do it, let's get your eyes going. Let's go. Because we know that giving people their vision, you know, is the cheapest and most effective operation you can have. Interesting. So he came back for his second one, he's smiling, still abusive, still swearing at everyone. Yeah, you can see he was pretty happy.
SPEAKER_02:Uh yeah, it's pretty cool. I mean, it's so interesting. Um, let's stay on that sort of rating scale, and I guess the preparedness. Um, you mentioned anesthetics deeply involved in the pre-operative optimization.
SPEAKER_00:Yeah.
SPEAKER_02:Um, do you think specialists within medicine will increasingly become part of that preventative ecosystem in that sort of sense as we understand the more we mitigate for risk, the better the outcomes are going to be?
SPEAKER_00:Yeah, it's in terms of surgery, right? Specifically, publicly the anetherists run all the pre-op stuff. Um, and it depends, it's it's a it's a stupid system. So a surge a patient comes to a surgeon, they book a surgery based on your category. So category one surgery has to be done within a month, and then it goes backward from there, two, three. So if you talk to people in public and in public, you know, for a knee replacement, say, they might be waiting for a year or so before they get caught in public. So you'd think that as an anetherist, I would see them and then have a year to work them up. But the system is not that organized. They get a date for their surgery a year later, you know, a month coming up to it and say, okay, go and see Conrad now in pre-op, you know, three weeks before your operation. Because we can't let them go earlier because they may not get an operative date or things might change, or so it'd be a waste of resources. That's the perspective, right? So that means you've only got a short period of time to optimize somebody. And so when they come to our clinic, um, and that's anyone having an operation, uh, we try and we identify what disease, ongoing disease, what burden of health they've got, and try and optimize it. You know, is their asthma well managed? Do they still have chest pain? And then we'll send them off for tests and then we give them a tick when they're ready for surgery. So the prehab stuff is pretty unique, like in terms of you need a motivated person with some assets to get places to be able to do some physio for a couple of times a week. And we've shown that, especially in the older population who are weaker, that if you pre-optimise them for up to six weeks, they'll halve their complication rates by 50%. Wow. So I think to our audience here, the message is you know, you the chance of having operation is pretty high, right, at some stage. And surprise, surprise, you need to be in good form all the time. Yeah. So the time you because you okay, I think this is a nice topic. Um, if you look at and your, I think Hannah was Hannah was talking about nutrition the other day in metabolism. So if you look at your metabolic needs, 56% is basal metabolic rate, which is the amount of energy your body needs to stay alive, just at rest. Right. At rest. And everyone's blown away by that because you think that if you go and do an exercise for an hour, you know, you'll be consuming most of your calories, which is bullshit, right? So 60% is better basal metabolic rate, 5% is your energy required in eating. So the more whole foods you have, the more energy you expend, which is recommended. And then if you go for a run or do a session, you might spend 10-15%. So the rest of it's this thing called NEAT, non-exercise activity thermogenesis. Now, when I used to talk to patients, and I'm a pain in the ass talking to patients about their exercise. I've had complaints about me to surgeons saying, I came to have my knee done, and this guy's just talking about how much I'm going out walking and what I'm gonna do, what exercise I'm doing. Neat um, there's non-exercise stuff, is the steps you walk, you know, the 7,000 steps. That's neat. In the garden, that's neat. Walking the dog, that's neat, right? So is it important? Yes, it is important because it reduces your your metabolic risks, your cardiac, your vascular risks, which I elaborated on, and your immune health. So it actually reduces your risk in an operation. If you're 30% neat, you reduce your risk of clot, right? So because you're lying flat in a bed for a period of time and someone's operating on you, your inflammatory markers go up, your blood stays still, you increase the risk of DBT, then go to your lungs and PE. Um, your you reduce your risk of wound breakdown, so improve wound healing. Wow. This is just neat. Yeah, this organic stuff, right? Just removing, you improve your immune system and your insulin resistance goes down. So you're, you know, so you're overall better. So that's this neat stuff. So doing that stuff is actually important. You know, stopping the bus stop, the one stop before you get to work, walking up two flights of stairs, you know, I thought it was all bullshit, but it actually has a function. Totally. And especially and it's been shown now, illustrated in surgery to reduce risk. Um, and then if you actually focus on a cardiovascular system by doing the aerobic and strengthening, um, you reduce your major complications and you reduce your length of stay in hospital. So, you know, I've been fit, I'm active lots and have been all my life. Thank goodness, just a good habit. Enjoy it. Um, a colleague of mine who's five years older, we had I had a um aortic valve replaced a couple years ago, lucky, you know, streamed through, no complications. He got atrial fibrillation, he had a stroke, he's had wound infections. He's not an overweight, he's an active guy, but he's not super fit. Um, he's quit anesthesia because of it.
SPEAKER_01:Jesus.
SPEAKER_00:Yeah. Just you know, and uh, you know, I I I think a lot of it is just you know, there's so many elements, there's luck involved. But statistically, if you do this stuff, your risks are lower. And your luck increases. Your luck increases, that's right. So, you know, can we pre-optimize people beforehand? Yes, we can. But the overall story is, you know, if you stay fit all the time, it just happens that if you have surgery, you'll do well.
SPEAKER_02:Yeah, I mean, that's it checks out, makes sense. And that's what I was gonna say when you know, back to developing countries, you know, lower socioeconomic people. There is access to get off the bus, stop earlier, as simple as that is. It does go such a long way. I mean, I know for myself, I'm one of the lucky ones. I've got such an active job. Yeah, I'll average 15,000 steps a day. Yeah, and my big days, if I do a run or something, you know, beforehand, it'll blow out to 22, 25,000. Active, active, active. I need to, I don't actually get enough fuel in. Yeah, yeah, that's right. It's a rare problem. I was just so lucky. But you know, I think if you know the average person sitting there, sitting listening to this, sitting watching something, sitting at work, not moving. And it's all well and good to come and do a hit class with us. I bang on about the mechanical effects of not being moving, not active, you know, not having a neat type exposure. Yeah.
SPEAKER_00:Um, but it has it has effects on the way people move and generate force here. Yeah, I mean, you know, there's a whole there's secondary and tertiary gain, you know, all this stuff. But like for the sitting, for example, 70% sit at a desk. And so the recommendation for neat is that every 20 minutes you get up for two, two minutes and go for a walk, and that's enough to offset your sitting for 20 minutes. Yeah, wow. Like it's crazy. Yeah, it's actually crazy. It's not complicated. It's not it's not complicated, but you know, you get tied up and you sit there for hours and you know, you know, meanwhile, your clot risk increases and your vascular health decreases, like it's amazing.
SPEAKER_02:Yeah, yeah.
SPEAKER_00:It's crazy.
SPEAKER_02:And and I think, you know, that's the other thing, and an extent of this on sleep is that you can um you can kind of offset it. You do a 15, 30 minute walk into work, you you take that extra little moment, you might you'll be able to afford to sit for that little bit longer in terms of actually on that equation. It doesn't need to be on 20 minutes. Yeah, exactly. If it's not that, then you're done. It's it's manageable um and you can bookend sedentary periods really well. And I think that's the biggest thing for me. The funniest thing I find is people's energy levels, particularly when they come in here, particularly in the afternoon, yeah, they are flat. Flat, yeah, yeah, yeah. But by the time they finish, they've got more energy at 6 p.m. after a long day of work. Yeah. And they're like, yep, I feel good. They're happier, their mood's better. There's obviously you know plenty of neuropsychological and biochemical processes that drive that. Yeah, totally.
SPEAKER_00:Yeah. Movement motion gets things going. Well, you know, we're we're made to run, it's no question about that. Yeah.
SPEAKER_02:Made to move. Yeah. Um, let's dive in and speak to the 1% or the 3%. Because they're probably listening to you. Yeah, that's right, yeah. Um, with longevity being the motive, how do we navigate major medical procedures better? We've just spoken about generalized exercise, fitness, and wellness. I've got this knee, yeah, seen bolts for physios. At some point, I'm going to get. Surgery, the surgeon said, hang in tight.
SPEAKER_01:Yeah.
SPEAKER_02:You've got bone on bone, this, that, and the other. When the pain becomes unbearable, correct. Let me know. Yeah. What can someone do in that that one year runway?
SPEAKER_00:Yeah. So, you know, knees, if we knees specifically, but it's can be elaborated to all, you know, the other joints and other things. You know, knees are all about quads, and you need to strengthen your quads as much as you possibly can. So the the general terminology, the general sort of approach would be, you know, see a physio or exphys beforehand, before if someone says you need an operation at some stage, you engage with someone who has knowledge in that area. You say, Rodeo, you know, do with me what you will. You know, especially shoulder surgery, you know, getting your supraspinatus going before a soldier surgery has massive impacts post op. So you're doing the prehab stuff, so your post post-op process is much more refined. If you're training your muscles to move beforehand, they will move better post-op for sure. Um, you want to optimize your weight, ideally. Um, so we talked about obesity before. Obesity or extra weight in surgery is a pain in the ass for us. Like we see it medically. I can be very black and white about it because you know, we had a 190 kilo guy the other day having a bowel surgery. Normally it takes, you know, 15, 20 minutes to get someone into surgery, get ready, put them to sleep, have the operation. You know, so it's a two and a two, two and a half hour process, the whole thing for bowel surgery. Five hours this took, took us an hour and a half to get ready. Um, all the extra bits of the bed we had to put on, all their risks are increased, DVT, respiratory risk, aspiration, like it's just everything. So you don't want to be, you don't want to be in a catabolism, you don't want to break up your body in surgery and post op. So you don't want to be in an attempt to lose weight being prepped for surgery. Exactly. So you don't want to be nutritionally poor, but you want to try and lose adiposity. And so the way to do that is nutritional. Let's go and see a dietitian. Um and in that combo with physio and dietitian, you know, you'll be all over it. And you really want to, for those things we said before about the neat and the uh strengthening and your cardiovascular fitness, you want to do that combo of two sessions of strengthening a week and two sessions of aerobic a week. Plus, you know, if you you need to sleep well, because that's where all your all your um healing processes are, your rejuvenation. Uh, and you know, you need the eight hours so you can the you know the first part of your sleep is for healing, and the second part of the sleep is for your cognitive organization. Um, I'd stop alcohol, to be honest. Um, alcohol uh screws you the sleep big time, as if anyone wears a whoop will know that. But also it's a it's a fairly impressive immune suppressant for the bone marrow, even a couple a night. So, you know, the remember the adage that it was a hockey stick where two two glasses of red wine was good for you?
SPEAKER_01:Yeah.
SPEAKER_00:So I knew cardiologists back in the 90s who would deliberately drink wine because they thought from the data that it was good for them. They didn't like it and they did it. And now uh the Brits have shown 30-year prospective study every cigarette you knock off 20 minutes of your life, right? How's this? Every drink's 10 minutes of your life. Wow. So drink is alcohol's poison. Like it's there's no question about it, it's very direct. So there's no benefits alcohol long term. Clearly, you get benefits socially and stuff here. But um, I would stop drinking. Um, smoking, vaping, pot, you know, smoking a joint should stop. And you need at least six weeks for your lungs to recover from so if you go in at four weeks, we would we would cancel surgery like 10-15 years ago. If someone was a 20-pack smoker, say 20 a day, um, and that we saw them for their operation at a month, we'd actually cancel the surgery in the day because that increases their risk of bronchial secretions. So you need a good six weeks to eight weeks for your lungs to heal after smoking, and your lungs will heal, and then you'll actually have good lungs from from then on. Like if you've done damage, you'll do damage, but you know what I mean? You'll actually repair it to a degree. Um, so yeah, so the fags, grog, um, sleep, nutrition, and exercise, if you do those, you're you know, you're swimming.
SPEAKER_02:Yeah, and you're dealing with the big problems as well. Yeah, that's right.
SPEAKER_00:Yeah, yeah.
SPEAKER_02:Um, in terms of patients that navigate surgery exceptionally well, and from those who don't, and I guess more in the psychological context of you deal with people there and then, as you said, three three weeks out and you're going, oh you know, mentally you obviously can't help people in their confidence.
SPEAKER_00:It's a big part of it, actually. It's a big part of it. Meeting an anetherist beforehand is very beneficial, like that exchange you have by both calming, um reassuring, having medical literacy around your operation is super key for your brain, for your emotions. So if you're able to definitely ask questions to people who know, you know, jump on AI, whatever you have to do to get information around your surgery. And if you're um, I'd recommend in private, if the anethus doesn't make contact with you, I'll I'll ring people if it's a major surgery these days, but I won't ring everyone. It's just it's just too much work involved. Um ring the the anethus was typically be associated with a practice, an anesthetic practice. Ring the practice, ask them for him or her to ring you. Uh, and that's if I speak to people on the phone the day before, a couple of days before, and then meet them on the day of, it's like we've been friends for weeks. It's very, it's a unusual experience, actually, um, but very reassuring. Patients love it. Anxiety levels are now driving the community, like it's the highest anxiety we've ever had historically. People don't know the causes. Uh, and it's a common problem pre-operatively. People are coming in shitting themselves, pale, sweaty, the whole lot.
SPEAKER_02:Which is gonna have biochemical effects on it.
SPEAKER_00:Biochemical effort, you require more anesthesia, for example. Wow. And if you're anxious beforehand, you come out not fresh, like you definitely suffer post-op as well. Yeah, right. Super interesting. Uh, and so what do you you know, what how do you manage anxiety? There's all the stuff you guys do with your breathing, and you know, so embedding some of those techniques pre-op is key. Um, the information literacy, definitely having more information, reduce the anxiety. But you can actually request some something like Valium. Yeah, and I do that for sure. Um I will do that to anyone who asks for it. If you're shitting yourself and it's really overwhelming, overwhelming, just ring again, you know, ring up the anesthetic office and say, can he give us a call and we can get some volume? So you arrive, check in, have some Valium. I know if you've had Valium before, it's a lovely drug. Uh it's uh so it's a benzodiazepine. Um it works on GABA receptors in your brain, and that's the hyperpolarizing negative. So you just super chill, it's lovely, and you just the people are smiling, and you know, and it makes the anesthetic actually smoother, ironically. Interesting, yeah.
SPEAKER_02:Um, in terms of the understanding of the risk profile of minor surgery versus major surgery for individuals, how often are you sort of communicating that? I guess what's the big misconception?
SPEAKER_00:Yeah, so people, I think it's a really good question. People think so, anesthesia, I'll just talk about that for a second. Um so the anesthetic day is 16th of October 1846. That's when the first anesthetic was given formally in the Etherdom in Massachusetts, in Boston, Massachusetts. It was a big deal. Um so prior to that, people, you know, there was, I mean, there's been anesthetic versions for forever, the Greeks, you know, a common combination of opium and alcohol, um, mandrake, like in Harry Potter, which is anticholinergics, um, THC pot was used. So a whole bunch of things. But in terms what's what's anesthesia? Anesthesia means an is the removal of, like anorexia, removal appetite, um, anemia, removal of blood cells. Aesthesia is sensation. So aesthetics, right? So anesthesia is the removal of sensation. And when you break it down, it's a combination of reduced awareness or abolishment of awareness. Um, it's hypno, we call it hypnosis, which is a drug-induced reversible state of deep sleep, and analgesia, which is a removal of pain. So that's what anesthesia is, plus or minus paralysis. Um, so uh 1846, a demonstration was a guy gave ether, um, William Morton, to a uh guy having a vascular tumor cut out of their neck in the ether dome, which is like a theater. That's what I call it theater because everyone used to watch.
SPEAKER_01:Yeah.
SPEAKER_00:Uh and for the first time ever, it was demonstrated that you could actually so ether, um, diethy ether, uh, which is a horrible agent, but it has all those three components as amnesia, analgesia, and hypnosis, as all three, right? Uh, and so the patient got the neck cut up, sutured up, the gases removed, he woke up and said, What's happening? And the you know, the classic thing is this is no humbug gentleman. That was the statement made. But the the drugs, so nitroxide, ether, and chloroform had been around for some time, like 20 years beforehand, but the Christians wanted people to suffer. Like it was a classic, you know, you will suffer if you have anything. And so it it changed. Um, so people were having drug parties with nitrous specifically and ether, where they go to upper society, suck on this shit, and then be unconscious. And that's how it worked out because one guy broke his leg but didn't feel it. And they were like, Oh, actually, this shit could be eus anesthetic.
SPEAKER_02:Wow.
SPEAKER_00:Uh, so it evolved from so all our agents have evolved from there. Australia, first anesthesic was given in Hobart, uh, in sorry, in Loncest in a year later, so it spread very quickly once it was released. Yeah, the Yang the the Brits did chloroform, which is a different agent we don't use anymore, but modern anesthesia now is an evolution from the ether days. Uh and you think uh the Civil War, American Civil War just came after that and the American-Mexican War. So for the first time ever, you know, the soldiers were getting anesthetics for their amputations and whatever. So it really started surgery off. So now the problem is now that anesthesia is so safe, right? The medicines are good, the monitoring is good, that now I'm doing 91-year-olds. I did two 91-year-olds the other day because we can do that now. So operations become more complex. So, in terms of risk, um, I think people either are clueless as to what risk means in anesthesia, it's not a risk-free procedure. There's the anesthesia and the surgery, they're both inflammatory components. And so we say there's common things like bruising, sore throat, nausea and vomiting, pain. Um that's related to anesthesia. Well, and and both, but yeah, we sort of anesthesia. And you know, you will feel dizzy and you'll feel fatigued. And they're there. So we say they're all common things. They're what to expect. And then the uncommon things, aspiration, where your gastric content goes in your lung. So the uncommon things are life-threatening, anaphylaxis, a reaction to a drug that causes swelling, histamine release, and things. Um, a cardiovascular event, uh, respiratory event where you your lungs just collapse. Um, death, death on anesthesia is about the same as dying from jumping out of a plane with a parachute. With parachute. That's right. So it's about one in 400,000. So the other thing people are scared shitless of and rightly is so is awareness. So awareness is where there's implicit and explicit awareness. Explicit is where you're paralyzed because of the anesthetic. For some reason, the anesthetic has worn off for whatever reason. Um, and you remember everything that's going on, and that can really you know screw with your brain. People get PTSD, it's horrible. So that's something we focus on for everybody. So we've got a brain monitor to avoid that. Happens in about one in 20,000 cases. Okay. There's high-risk cases, you know, there's a whole bunch of things. But for the average guy that we're talking to here, that risk is lower, much lower than that. And then there's this stuff called um implicit where you don't remember anything, but you're sort of a bit screwed up for some reason. And if you actually go and see a cognitive habile therapist, you can come down and say, was the time of the anesthetic. And that's that's more common, actually. I actually have I had this similar experience, and it can be pretty weird. But overall, I think that's we we talk about common stuff, which is um to be expected, pain, nausea, involving, whatever, and then the uncommon stuff, which is rare. And it's you know, it's based on how healthy the people are, um, what sort of surgery you're having, high risk surgery.
SPEAKER_02:And that's what I was gonna say is yeah, is it you know, minor surgery? I'm getting my wisdom teeth down versus you know major surgery. Exactly. Is it an anesthetic risk profile a little bit different?
SPEAKER_00:Very, very different, yeah, very different. Yeah. So the it's very unusual to have a major complication in minor surgery. But what we'll do is if you're having your teeth taken, for example, WYSI is done, um, you know, there'll be bleeding. So the risk of aspiration is high and respiratory stuff is high, higher.
SPEAKER_01:Yeah.
SPEAKER_00:So that's stuff we tailor while while we're giving the anesthetic, you know, we'll put packs down the throat and we do all that stuff and we make sure that doesn't happen. But it's more likely than that if you're going to have a urology where someone's sticking a scope, you know, up into your bladder, for example. Like those things are like so it's very surgical surgery specific. It's the um wellness of the patient and the and therefore the age. And also it's elective versus emergency, and even emergency the data is if you're having your NOF done, your neck of femur fracture fixed after midnight, your chance of death is pretty high. Really? Yeah, you know, there's no resources, everyone's exhausted. Yeah, you know what I mean? That's shit, you know. Um and we've all been there, like we've all we've all done that stuff.
SPEAKER_02:Yeah, yeah. I think that's an important thing, you know. If you could have people, I guess, conceptually understand most of us are users. We will go in and have surgery and then walk out from the medical perspective. What do you sort of wish people maybe understood or appreciated? Say post-midnight, it's much harder to do this, these process procedures because it's dependent on multiple people. Yeah, totally. Yeah. Is it you know, is there something that yeah, you sort of think, geez, if society could could could conceptually understand what's going on here? Does something come to mind?
SPEAKER_00:I think it's just this literacy idea, you know, just being more informed. If you're if you're uncertain, ring people talk to I mean, it'll ever, you know, most people have got medical friends or can access them. Um, you know, chat GP's good. I think if the more informed you are, the better you are in terms of your approach. Yeah. And recognise there are risks involved there, even though they're low. Uh, so don't, you know, don't get pissed the night before and come in for your surgery, which happens and book some time off for after the surgery because you're not going to just bounce back straight away. Yeah, that's so take it seriously. Um, but the chances that you'll get through with a good result is quite high, but not all surgery is perfect, and most of the time, orthopedic-wise, for example, you come out what you never go back to what you originally were.
SPEAKER_02:Yeah, that's a big thing for people to understand. Huge. Particularly the latest stage surgeries I'm finding with the you know, the the knee replacements, the you know, the the ACLs for people north of 60 and meniscus issues and shoulders. And there's if you can do something to prevent it, yeah, do it. And if you're gonna have to have it, do everything you can to mitigate the effect on the whole wash-up from a movement perspective.
SPEAKER_00:Yeah, it's it's you you're not like the you're not like you were before the injury occurred, but you're better than you were after the injury occurred, you know. Yeah, so it's worth having done pain and mobility, yeah.
SPEAKER_02:Mobility day to day, yeah. Mentally, I think it's the biggest thing. Yeah, exactly. You can keep going. Musculoskeletal pain, particularly, just wrecks people. Um, Peter Atier, we've spoken about a lot, had um this sort of idea that he floated a maybe a year or two ago, um, where he talked about do we age in this gradual sequential process or does it happen in one big hit, like a major surgery? Yeah. You know, we can all probably think of a grandparent or an uncle or auntie that had that surgery that never were quite the same and never quite got back to full strength. What's your opinion on that?
SPEAKER_00:Oh, the the data's pretty clear that um you don't deteriorate slowly once there's a major event. So even if you live to 100, your year before your 100 is shit. You know what I mean? Like it's unusual for someone to just die in their sleep, they are well and they died. Typically, it's an event. Like if you uh yeah, if you are uh older than 75 and you have a necophema fracture, you break your hip, your chance of dying in the next 12 months is 50%.
unknown:Yeah.
SPEAKER_00:Like it's out, you know what I mean? Everything you've seen them. People get frail, they fall more, they don't eat as much, they don't sleep well, and they're just they're in pain, right? And their reserve, their physiological reserve is limited. And so once that once that limit has been reached, they're done. It's it's yeah, it's super interesting. Yeah, I you know, you I think you go along, you get hit, you drop a level. It's very difficult to return to the same function you were unless your function before him was quite good, and you're very, you know, it takes a year to recover a lot of this stuff, and you have to be quite vigilant to work for a year to get back to where you were. Yeah, most people, like you're saying, are after function, and then you know you have another insult and you drop down another 10%. Yeah, and when you get to the 50%, you're pretty shit, and yeah, you know, you're in an L, you know. So you interact quickly. So the last couple of years of life is where a lot of our health budget's spent. Interesting.
SPEAKER_02:Yeah, I was gonna ask, you know, to mitigate that one having a higher starting point. So when the hit happens, you fall not quite as far, and uh you've got a long way to go before it really starts to compromise your life.
SPEAKER_00:Which is a tears philosophy, right? That's what it is all about. Maintain so project what you want to do at 70. It's very difficult, isn't it? Like humans are the only species that can plan and advance. But to say, I want to lift my grandkids at 70 and be strong and whatever, it's like, yeah, it's a nice idea. But um, you know, most people just try to get through day-to-day. Yeah, but again, you know, it's just these habits, you know, these good habits you're forming early on. Um and just sort of got to stick to it. Like you, you know, you we talk about a lot, it's just showing up, showing up. Totally, right?
SPEAKER_02:And it's it's it's there's so many layers to it. I mean, yeah, it's a psychological thing, I think, you know, primarily in do you identify a certain way? Which is probably if I could change anything, you know, in in in that context, it'd be people's perception of no matter where you are socioeconomically, it's okay to go for a run. And the amount of guys I know, my age, you go, no, no, I'm not into that, mate. I'm not into that shit. Yeah, yeah, I'm not into shit. And they sort of it's like, well, mate, do it in a baggy shirt and nothing sexy about it, but just move yourself and ease.
SPEAKER_00:I harass the elderly, like I'm an I'm annoying, you know. They'll say, I was lawn bowling last year, but I've stopped. And you ask them why, and they're like, It's because I'm old. I'm like, no, it's not because you're old. What actually, and you try and break down the actual, you know, the barriers to why they're doing it. You know, someone doesn't give them a lift anymore. You know, that's a classic thing. Totally. But we know that um if you can convince a friend to join you in doing something, there's no question that is a powerful tool. Doing it by yourself.
SPEAKER_02:I'd do it, mate. I mean, I've said it on this podcast. I did get a group of boys on a Sunday morning to lift weights and do a very hard conditioning session, another group of mates to come and run on Saturday morning, Monday nights primal, and I have to do it because people pay me to be there to do it. Like I just love it. And but I have to hack my way into my adherence.
SPEAKER_00:Yeah, exactly. Yeah, that's right. So, you know, you have the ability to do it. There's a classic study in the UK where they looked at elderly people for hip surgery and hip and knee surgery, major hip and knee surgery, and they um paid money for prehab, so three sessions a week at a gym. Uh, and they looked at the outcome. There was the compliance was five percent, right? Six weeks before. So they said, okay, and this woman is she's delve in, she's fantastic. So she bought a bus. So you know them in America they've got in UK, they've got their um uh like counties that provide. They bought a bus, they bought a gym, they worked out where people lived. On the days they go around, pick up 20 people, 15 people it was, took them to the gym. Once they formed these collectives, and they all did it. Complication rate dropped by 50%, compliance went up to 75%. Jesus. You know, it's just a beautiful thing. Like you've got to do things in numbers, unfortunately.
SPEAKER_02:Totally. I mean, that's we're we're yeah we're a species of connection, yeah. And using movement and and in its own right, you know, I've seen it multiple times. You want to, you know, connect people really well, is kind of two rules in a sporting sense. Yeah, either make the team do something really bloody hard together, like long and hard, and everybody wants to quit, but they drag each other through, yeah, yeah. Or you know, go out and get on the piss.
SPEAKER_00:Yeah, that's right. Exactly.
SPEAKER_02:It's just such a funny thing, and I like to use the idea of um of the the hard stuff more so, I think we get. Better from performance training sport team outcome. Use that first and then celebrate if you want to have the social connection, but uh not good for from a performance metric training too much.
SPEAKER_00:Yeah, it's interesting. Yeah, you've got to form those committees. Like I'd not been, so I started here a couple of years ago. I'd not been to a gym ever before. Yeah. In our in our generation, the gyms just weren't or you know things where you went to hang out with the bros, but it wasn't really for um you know strength and fitness.
SPEAKER_02:And an everyday thing that you do, you're either a big muscle dude or did some aerobic stuff, yeah. Exactly. Nothing.
SPEAKER_00:Yeah, exactly. Yeah, exactly right. Uh and coming here, I was like, I was a bit reluctant and a bit dubious, but you know, the the friendships and stuff you form, it's uh I must admit it's very effective. There you go.
SPEAKER_02:It's this method in the madness. Yeah, that's right. Um if we stay on anesthetics a little bit longer, we've we've spoken about a term anesthetic fitness. Um, and I guess we're probably going to be reiterating some points here. But you know, if you were to give that an actual definition, what does it mean in a practical sense, particularly when someone's preparing for surgery or anesthesia?
SPEAKER_00:Yeah, so um it is quantified. Uh so there's metabolic equivalence, which is you know, one metz lying staying still, and then um like running a race is eight to ten mets type thing, which is calculated in mils per kilo per minute, like a VO2 max stuff. Uh so you need a minimum of uh somewhere about 12 mils per kilo, so not much for a major surgery to survive it. Wow. Right? So you're you know, the average guy's 30 mils per kilo. Um, you know, the guys who do Tour de France are 80 mils per kilo, something like that. It's crazy. So the the met, uh you need to be at least four met to get through an operation, to get through an operation, right? Not not to be optimized. Uh so that so four mets is equivalent to walking up a couple of flights of stairs or um pushing a lawnmower around. So it's low yield stuff. So these days you don't have to be that fit to get through to get through, survive an operation. But to do well, you want to be as fit as you possibly can.
SPEAKER_02:Yeah, yeah, really well prepared for it. Um if you were, you know, someone's got four to twelve weeks previous surgery, you're probably gonna say this depends, but uh would you rather them lift weights and do some strength stuff or really hammer some aerobic metabolic fitness?
SPEAKER_00:I I think the cardiovascular stuff's where it's at. Um that that has been shown to it's interesting, you know, the the weight, the strengthening hasn't really been it's a new thing. But relatively it really is a new thing, relatively speaking. And to to translate that into to risk, I don't think has been done, like not that I've seen. I go to these peroperative meetings every year. People haven't talked about it yet, but they've talked a lot about getting a card cardio respiratory is where it's out, um, you know, pumping oxygen around your body and so your heart doesn't stop. And and then when you're breathing, you're exchanging oxygen for carbon dioxide, and yeah, you know, those basic stuff. Um so yeah, aerobically, so just two sessions a week, the more the better, for sure. And I think this idea of neat, which is also relatively new, just being active, walking, dropping off, you know, immune uh vascular health, which is a new thing, so endothelial health, so you get better nitric oxide release, hence the reduction in DBTs.
SPEAKER_02:And then there's vasodilation. Yeah, exactly. Yeah, and then oxygen, any other blood chemistry transformation.
SPEAKER_00:Utilisation, yeah, and just the and the idea of wound healing, reduce your wound healing. So this I think, yeah, aerobic plus active. If you can throw in some strengthening stuff, it's good. I think the strengthening stuff is good because you less likely to go into a catabolic state, which is this idea of insulin resistance. Insulin resistance is a term thrown around a lot. It's the best way to describe it is if if I inject you some sugar and I watch what your insulin does, ideally your sugar will peak, your insulin peak, your insulin drops off because it's packaged the sugar into your cells, into your body. Insulin resistance where the the insulin plateaus, because it's just not able to do its job effectively. And then that's sort of what type 2 diabetes is.
SPEAKER_01:Yep.
SPEAKER_00:So it's assuming you've got enough insulin, then it should be working well. So the more catabolic you are, so if you uh got more muscle, you'll definitely have better insulin resistance in the perioperative period. Yeah, for sure.
SPEAKER_02:We spoke about on um the episode with Hannah, but people post-surgery, particularly, you know, um your sort of musculoskeletal type issues, yeah. They need to eat more. Yeah, they need to be able to make uses of those exact processes from a recovery perspective. Same rules apply for you know, sort of more organ-based type things.
SPEAKER_00:Yeah, so so same, yes, same stuff. Yeah, you need to be then most people do not utilise a dietitian pre-op to get any of this advice, it's all just comes off. And we give advice which is hopeless, you know, like we don't know realistically. Yeah, um, and we step especially don't optimize to people, you know. It's like, you know, whatever. Yeah, like in terms of the carbon, I mean it's all mixed up, isn't it, these days, but um, you know, have a balanced meal, whatever that that is in your idea of a balanced meal. But we definitely don't promote keto or carnivore or you know, it's just pretty standard stuff.
SPEAKER_02:By the sounds of things, the the masses don't need anything extreme, they just need the basics done well.
SPEAKER_00:Yeah, stay away from processed foods, eat as much whole food as you can. Yeah, stop eating when you're full. Yeah, basic stuff.
SPEAKER_02:Yeah, move a little bit more, move more, sleep well. It's um it's probably a nice, nice note just to kind of bring it home on. I think it's um, you know, as as we sort of spoke about, the whole reason for doing this is is I guess give people a bit more access and an insight into you know the medical end. Um as you said, most people don't even know what anaesthetics is or what an aether just does for them and their health. At some point, everyone's gonna have a major surgery. Yeah, um, it's really important to understand that. And then it's having these considerations to bookend these major um, I guess, moments in people's life, um, which is you know, it's it's incredibly valuable. Um, but yeah, I guess to to knock it on the head, to bring it home, you know, if we were to sort of pick a start uh adjuring and immediate post-recovery, and then in terms of the long term for people, um, you know, to to I guess provide advice as an anetogist, what would you really say to them? You know, they're in that phase of um the mental health, you know, teenage type years, and they're going into this preventative mechanism first and foremost. Is it exercise, is it food, is it both? What is it, what does it sort of come to mind?
SPEAKER_00:Um yeah, I think I tell people to prepare for surgery like you're preparing for a race, like it's literally a race. You want to be as fit and as good as you possibly can be. And so I think the combination of being physiologically strong and mentally prepared by getting as much advice you can around the surgery. And that includes what do you do beforehand, what's the surgery entail, and what is the process afterwards. A lot of people are sort of dummified by what they have to do afterwards, they just haven't thought about it, they haven't told work, you know, they haven't got someone at home to care for them, yeah, they haven't considered they're gonna be, you know, have a disability for a short period of time, all those things. So you just got you know, there's heaps of information around, like go to good sources, um, and you know, clearly ask the surgeon, they've got heaps of advice these days. But ring the the anesthetic, you know, involve the anetherist, ring the they're gonna hate me for it, but ring the um officers and ask them to have a chat. And I think having a chat with people individually, I can't clearly can't speak for everyone, but makes a difference. So be physiologically prepared and have information around the area so you feel mentally prepared as well. And then post, as you said, have things in place where you can take be taken care of for for a period of time. And you know, don't exclude that a complication is not for you. You know, like you look at drivers, you ask them, are they better than average? And most people say they're better than average drivers. You know, we're clearly most of us are average drivers, and it's the same thing that people just don't think they're gonna get any complications. So have that in the back of your mind in terms of if I was to get a complication, what impact is gonna have on me post-op. And it's a key thing, I think.
SPEAKER_02:Beauty. Well, mate, that's um I think that's invaluable. You know, it's uh we've spoken about it, closing that loop for general public and and the health conscious as well. Um, and then even those that aren't at the end of the day, this is gonna be a part of their life and we need to have an understanding of it. Um, so I appreciate your time and open a book. And um, mate, I think there's gonna be plenty more questions and things we want to want to ask. Um, one fun one, I'm gonna give you if you were to think of one question in terms of like a uh a PhD style, we need to research this that you know you won't have capacity for. I don't want to give away your great thoughts or ideas. There's probably a listener out there that's into research, be it medical, be it exercise, or be it a combination of both. What's one question you'd love answered from an anesthetic perspective, so that it could, you know, help improve?
SPEAKER_00:Um I well, with with AI around the corner, um, this there's this idea of customized anesthesia. So doing the genetics to work out because you can now do pharmacogenetics, so how your genes respond to the drugs you're getting. And there's CNS genetics to see how you respond to anesthetic agents. So it'd be wild to have a drop of blood, come out with a pharmacogenetic and a neural profile to tell the anetherist or the machine or whoever's gonna do it what to give you perfectly. That'd be amazing. So someone's gonna go and find out that's right.
SPEAKER_02:Good luck. All right, I love it. Conrad, thanks very much for your time. Cheers, man, that's great. Thanks, good. Thanks for tuning in to the Science of Fitness podcast. Be sure to check us out across all forms of social media and subscribe to this channel if you want to stay up to date to the latest episodes and any other anecdotes with which we might share across these video platforms. If you ever find yourself locally in Brisbane, be sure to drop into one of our facilities or down on the Gold Coast in Burley. You can also check us out at scienceoffitness.com.au and see all things relating to what we offer in programming and performance, whether it's online or in person.