Dr. Armando Sardi: A Surgeon Changing the Future of Cancer

In this episode of the Interesting Humans Podcast, Dr. Armando Sardi discusses the innovative HIPEC surgery, which combines surgical tumor removal with heated chemotherapy to treat advanced abdominal cancers. He shares inspiring patient stories, including that of Gary, who was given a terminal diagnosis but found hope through this procedure. Dr. Sardi reflects on his medical journey, the advancements in surgical techniques, and the importance of patient perspectives in decision-making. He emphasizes the need for second opinions in cancer treatment and the challenges faced with insurance acceptance. The episode provides a comprehensive look at the complexities of cancer treatment and the hope that innovative procedures like HIPEC can offer. In this conversation, Dr. Armando Sardi discusses the critical importance of early cancer detection, the emotional challenges faced by medical professionals, and the need for community awareness and connection. He shares personal stories of resilience, the future of cancer treatment, and his daily health routines as a surgeon. Dr. Sardi emphasizes the significance of passion in medicine and encourages listeners to find their own ways to contribute to the fight against cancer.

Takeaways

HIPEC surgery combines tumor removal with heated chemotherapy.
Many patients are told there is nothing that can be done.
Dr. Sardi's journey into HIPEC began after years of traditional surgery.
Advancements in technology have improved surgical outcomes.
Patient attitudes significantly affect treatment success.
Preparation for HIPEC surgery is crucial for recovery.
Misdiagnosis can lead to missed treatment opportunities.
Appendectomy plays a critical role in cancer treatment.
Memorable patient stories highlight the impact of HIPEC.
The future of HIPEC is expanding globally, but challenges remain.  Early detection of cancer can prevent severe outcomes.
Awareness and community connection are vital in healthcare.
Emotional resilience is crucial for medical professionals.
Life must continue despite personal tragedies.
The future of cancer treatment includes genetic testing.
Personal health routines are essential for longevity in medicine.
Passion is necessary for success in surgical procedures.
Everyone has a talent that can contribute to society.
Finding purpose can help in overcoming life's challenges.
Engagement in community efforts can lead to significant change.

Transcript

SPEAKER_01: 0:00

All right, folks, welcome back to another episode of Interesting Humans Podcast. My name is Jeff Hopeck. I'll be your host today. And I've got an incredible guest here, a remarkable human being by the name of Dr. Armando Sardi. Doc, thank you for being here.

SPEAKER_00: 0:15

Thank you for the invitation.

SPEAKER_01: 0:18

And folks, back on episode 39, a friend of mine I interviewed, it was titled The Mother of All Surgeries. His name is Gary Young. And if you remember his story, He had undergone a procedure that was 14 hours long. And one of the highlights from it is that he was put onto what he called is like a rotisserie and rotated around after being filled with scalding hot chemo. And the doctor who performed this surgery is sitting here today. We're going to hear from him. So, Doc, it's remarkable what you've uncovered with this hypic surgery. Truly, truly remarkable. And I want you to start off by telling the listeners, what is it and what is it about?

SPEAKER_00: 1:03

Yes, the patients with advanced cancers in the abdominal cavity, these are patients with colon cancer, pancreatic cancer, small bowel, appendix, gynecological cancers, ovary, and so on. Frequently, when they get out of their organ, they metastasize or they spread inside the abdominal cavity. So it's like a room that, you know, everything gets stick around. So this is a stage four cancers. Really systemic therapies have very little place on this. It helps in some cases, but unless you remove it, people are not going to do well. Normally, and even today after 35 years that this treatment has been available, patients are told that nothing can be done, that the only option is chemotherapy. So what this surgery includes is really two components. One is surgery with the idea to remove all visible cancer. And if you imagine there's a lot of cancer everywhere in every organ, you frequently will remove organs or clean organs, depending on what's happening and what type of tumor it is. And then after you get to that point, clearly there are going to be cancer cells floating around that you don't even see. So heat... comes there, heat kills cancer cells and enhances the effect of chemotherapy agents, some of them. So we actually put some catheters and then we base the abdominal cavity inside with this heated chemotherapy for 90 minutes. And the patient is shaking and moving around, not rotate, move around, you know, the operating room table in all directions to make sure that the heated chemotherapy reaches all the surfaces where cancer cells may be harvested.

SPEAKER_01: 2:53

Okay, now, it's safe to say that every day, a certain amount of people probably in the thousands, maybe even higher, are being told from a from a doctor somewhere to go home and die. Is that correct? Is that the way it works?

SPEAKER_00: 3:09

Oh, correct. Yes. And there are many patients, you know, there are even recommended doctor assisted suicide in other countries that that is available, like Canada. And so it's sad. Now, again, this is not an operation for everybody. That is something that is very important that physicians and patients know about it. That is a potential option for many patients.

SPEAKER_01: 3:31

Yeah. Okay. So I want to talk a little bit about Gary's story. So Gary was told by two surgeons. that just like you said doc he was told to go home and get his affairs in order i guess is the way they say it and that he had a year it's a year to live and and then something happened and i i don't know exactly what it was but he got connected to you how did he how did he find you that was 11 12

SPEAKER_00: 3:59

years ago this is something that is very interesting because thanks to google and also facebook His wife, Amy, actually looked into it and he was kind of given up already. And his wife found doctors and then came and interviewed with us and other people and decided to come here. Actually, we have become very good friends. He's even a member of our foundation. And he's been very active in helping to spread the word that this procedure is available for a lot of people. But he did go to a major university institution and was told that nothing could be done. And actually, that happens very frequently, yes.

SPEAKER_01: 4:45

Yeah. So he gets to you. They get connected. They go up. They come up to Baltimore because we're in Atlanta. They come up to Baltimore. They meet with you or how did that work? A couple hours together?

SPEAKER_00: 4:57

Yeah. Patients come. We examine them. They will sit down for as much time as is necessary to discuss the treatment. They know that this is a big operation. Not everybody is going to sail through. In fact, he had a tough time for a while after that. But the idea is that if we support people through that acute episode, people do well. And, you know, you talk to them, you explain what it is. Frequently, there are patients here who usually are, as I've been doing this for over 35 years now, 32 years. You know, we have patients here that we follow that can connect with other patients and tell them how things happen for them and their experience, which is very helpful. So we met and he said, I want to do it here. He went to all the places that I don't recall where they were and something like about the place here that he wanted to come here. And I am glad he did. It's been an honor to know him. As you know him, he's an extraordinary person. I think I benefit more from him than he did from me. But it's been a very, very interesting relationship.

SPEAKER_01: 6:09

Yeah. So here's a guy who was told by two great surgeons to go home and die. And we're now post 11 years. This procedure has given him an additional 10 years. And I saw him at the golf tournament and you saw him at the golf tournament. And it looks like he's going to have a lot more time, right? At the end of the day, those are the numbers that we have to work with.

SPEAKER_00: 6:37

Yeah, and that's why we do that. I mean, we had over 600 people alive, you know, that are doing very well that I've been doing through the years. Some of my partners do it as well. And, you know, seeing people like him enjoying life, running their business, having fun with their family. I mean, it's an honor to see that.

SPEAKER_01: 6:56

Yeah. So, okay, let's go all the way back because you've been a surgeon for a long time, not just doing this hypic, but you were practicing before. So I want to talk about... What were you practicing before? And then what happened where you said, I wanna start doing this procedure. I have no idea how it works in the medical community if you have to start a trial, but sort of walk me through before, what happened to get you excited or interested in HIPEC, right? Let's talk about that.

SPEAKER_00: 7:29

Yes, I'm from Columbia, South America. I did my medical school in Columbia. Actually, you have to make the decision whether you go to a career right after high school. It's not like you go to college and think about it. I love physics and calculus, and I want to do a computer engineer, you know, systems engineer. And in those days, as you may recall, you're probably too young to remember that, it was a whole computer where the size of a room, we have punch cards, And now to understand that these phones that we work with all day are more powerful than those big computers, for some reason that I cannot explain why, two months before I graduated, I said, wow, I'm going to be a doctor. And I took my exam. I don't know why I made that decision. it was the best decision i have been in my life you know everything when you know i i am i am i believe in god and and i really feel that i'm an instrumental god in many ways and that um you know it's it must have been because i never i mean in my life i was never i mean i never thought in my life as a doctor growing up and again it had been spectacular i then i came to the states to do a um a training in general surgery, which is another five years, seven years first and five years of general surgery. And then I went to Ohio State to do two years of surgical oncology, which I was very fortunate because I always have been aggressive and very upcoming in life. But I had the opportunity to train with two great surgeons there that were very aggressive with recurrent colon cancer, stage four cancers when people were sent home to die. And I learned, wow, people are alive many years later when the book says the opposite. And then I finished my training. I went to the oxygen clinic in New Orleans. They were doing those big operations. And then I end up back in Baltimore where I trained. And then I met Dr. Sugarbaker, who started this operation about three or four years before me. And the Japanese started two years before. So this treatment had been around for 35 to 36 years now. And then I said, wow, what he's doing makes sense, which is giving he the chemotherapy after we remove all the tumor. However, highly controversial. At some point, we were about six people in the world in the early 1990s doing this and has grown now exponentially because of the talks and the publications. But I mean, I am always open to new ideas. And especially if you're helping patients, it's something that... that I love to do. And I always had the opportunity to train with excellent surgeons who gave me obviously the mentoring necessary to do it.

SPEAKER_01: 10:40

Yeah, sure. What kind of strides have been made since the first procedure that you've done 30 plus years ago up until now?

SPEAKER_00: 10:50

I mean, the big thing is probably the technology development. other than understanding more the disease and who should be helped and who we cannot help. I mean, we used to have to tie things, you know, cut things tight, you know, and taking a long longer. Now we have this instrument that not only speeds the, you know, how you do it, but you can put balls together easier that you could do it by hand, faster. So in an operation that in an average today, after many, many of these surgeries have done over, you know, 1500 of these surgeries, we have, you know, takes eight to 10 hours. And sometimes or some of these operations took 15, 16 hours, you know, and that's all you just go until you finish. So all these new devices had helped us to be more effective and faster acting in doing the operation. Also the understanding of the heated chemotherapy, you know, who should do it or should not do it, quality of life, because it's not about a procedure. It's about a patient with cancer. It's not a cancer, right? So you always have to focus. Everybody's different. Everybody behaves different. And the response to therapy is very different. Even the attitude of patients towards what is going with them is very different. Some people are very proactive and they just want to do whatever is necessary to get them to the next step, while other patients are complaining about why them, why not someone else. And those people usually don't do very well. And so it's a very interesting learning experience. And that's been the major changes. Still, we are now cooperating with more groups around the world who do that. Actually, in two days, I'll be in Colombia, my country, giving a talk to the National Surgical Oncology Organization to talk more about the technique and so younger physicians can be more proactive and learn how to do it better.

SPEAKER_01: 12:53

Right. Wow. So when people come and see you, Do you notice there's a particular tipping point when you're meeting with them? And as soon as they hear one particular thing, they say, okay, now I'm in. Or they say, okay, now I'm out.

SPEAKER_00: 13:15

Yes, I mean, most of the patients who get to us are coming like the last resort. And coming to us because... They are looking for someone who know, understand their cancers, understand this treatment. They already, you know, some information out there that patients at least get some communication. So they are looking for the last straw, like I said. And so usually they come with a family member, which we always encourage because, you know, some people, You can hear, you know, you can talk to them for an hour after, you know, an hour, a week later, you tell them, hey, we talk about it. You never talk to me about it. So, you know, it's always good to have a family member accompany them. And I always tell them, you know, this is the operation. You have to be clear about it. It's a big surgery. It takes 10 to 12 days in the hospital and takes two months to full recovery. Now we as a center are available 24 seven, which is very helpful because these patients need to do that. To the point that when people come out of town, I ask them to stay in town for an extra week, just to make sure that we take care of any potential problems that can happen in the initial postoperative period, because sometimes they go to their hometowns and the doctors there had not even heard about this. and they don't know how to deal with the patient and they look at the operative note of 10 hours of surgery and all these procedures in one surgery, they're saying, oh, you're gonna die, forget about it. So we have very developed a program of support because that is extremely important.

SPEAKER_01: 14:57

Okay, so that's interesting. What are you finding when people come to you and they say, I'm in doc, I'm doing this. What do you find in like for next exact steps? What do you see them doing? Do you see them going home, taking some time before the procedure or is it, I'm in, can you do this tomorrow since I'm already committed?

SPEAKER_00: 15:27

Yes, I mean, most of these procedures are not emergency. So even people can wait several weeks if necessary. In fact, because of the... the scheduling and insurance approval, you need at least three or four weeks just to get that through. For example, Medicare, after 35 years, only this year have a code about the surgery, just to give you an idea. Many insurance do not approve it. Some patients, especially out of the state, pay out of packet. Coming from Canada, they are paid full surgery. because otherwise they're not going to do well. And so it's, you know, but some patients sometimes want to talk to other physicians. And I said, I think it's very important because the doctor that is going to take care of you has to be your friend in the sense that you need to believe in that doctor and be committed, understanding what they want to do, because otherwise you will not do well. And I said, I encourage them if they have two or three other consultations to do that so they can get the right information. So, but we, they said, they say, yes, we are in and looking at everything, look like you are ready to go. We'll schedule two or three or four weeks later, you know, give it a time because it's a whole day surgery. We start at 7.30 in the morning and we finish when we finish. And there's always a lot of tumor, a lot of cancer. So it's very easy to give up. You open up, you say, uh-oh. what I'm doing here. So you need to start slowly meticulous to start doing without creating problems because we can always do harm if we don't know exactly what we're doing or we don't do it right. You cannot start cutting things without knowing that you can fix those things that you cut, right? So you have to be very meticulous and make sure that you are doing the right thing. And you work and sometimes take three or four hours to know whether you're going to be able to do it. And then before you know it, you say, wow, this is amazing, it happened. And now we use frequently laparoscopy. Laparoscopy is a way that we can look through a little incision you know, tiny little five millimeter. We look inside with the camera, try to figure out where they have a good opportunity to remove all the tumor. You know, now it doesn't apply to everybody. And if patient have multiple surgeries before, like frequently happens, that is going to be very difficult to do. But we use that more and more to help patients to have the surgery without going through a big cut and say, now you have a big cut, but we cannot help you. And then delays any other further therapy that may be necessary.

SPEAKER_01: 18:18

Yeah. What does the misdiagnosis part of this look like? Terrible. I know Gary's story. What do you see typically? Is it all the same thing or is it a range?

SPEAKER_00: 18:29

It's a range. I mean, you know, depending on where you go, some people actually... have, for example, the appendectomy and sent to us right away, or they see disease all over the place, and doctors who are already seeing our results or the results of other centers send it to us right away because they understand the limitations. Because for those gastrointestinal cancers, chemotherapy has very little benefit without surgery. So they understand that. Now, all these patients get surgeries and chemotherapies and they are sent to us when nothing has worked for a long time. Now you are dealing with debilitated patients, patients with a lot of problems, some of which we won't be able to help because they are so debilitated and so many problems have occurred already and toxicity from the therapy that they are not able to. So, you know, it's a wide range and depends on how they get to therapy. to the right place at the right time. Now, these are all advanced cancers, you know, stage four cancers, which, you know, usually again, goodbye, my friend, but any patients can be benefit by getting to the right place to do it. And if you do get there at the right time as a first option for treatment and it's possible to do it, that is the best option.

SPEAKER_01: 19:50

Okay, that makes sense. You mentioned the word appendectomy. Just clarify, what is that? That's the removal of

SPEAKER_00: 19:59

the appendix? The appendix, actually, appendix cancer is a very rare cancer. But this procedure, that procedure applies a lot to these cancers, which, even though they are rare, there are many out there and they have been in increased incidence in the last several years. I don't know if it's because of recognition or not, but the appendix is attached to the colon, but behaves very different to the colon cancer. It doesn't respond to chemotherapy very well. And it presents with a perforation that is called the jelly belly, or it's like a mucin, a jelly that is pressed to the abdominal cavity without people recognizing until it's too advanced. Sometimes it presents with a lack of appendicitis. So they go to general surgery, they cut the appendix and they find the cancer. And then at that time is the best time to refer because there are different kinds. But some of them present with advanced disease, like Gary did, and I told all my friends, nothing I can help you with. And that is not correct. So appendix cancer is rare, but it's actually the standard of care procedure for these cancers, and it is for mesothelioma. but also it has a lot of impact now in ovarian cancer, fallopian tube cancers, gastric cancer. And today I saw a follow up on a patient with pancreatic cancer, which is extremely rare. And she's two and a half years out after she had failed all these systemic therapies before. And she's excited and the husband is a pilot and they are going to Italy to travel now and with a disease that, even our earliest stages is usually fulminant. And, but you know, this happens and, you know, seeing that is very joyful. Yeah.

SPEAKER_01: 21:51

Wow. All right. Pick a, pick a story, walk me through the whole thing, start to finish. Maybe it would be like a case that you can never forget or one of your favorites. Tell me, tell me the whole story.

SPEAKER_00: 22:05

Oh, there are many. I mean, one of the, probably one of the best things that I could remember is that, you know, children coming to me and say, hugging me and say, thank you for saving my father or mother. I would not have been born. And actually the person who managed our foundation now is a young man that at 27 had cancer. We did a surgery. He's now six years out and he already had a two year old girl. So, but probably one thing that I remember about cancer that The young lady didn't have high pecs many years ago, but I did a major surgery for recurring rectal cancer, removing bone. It was five years later, she got an obstruction, and it was the day before I went to Europe on vacation with my family. And I ended up operating on Friday night, and it was a difficult operation. She was very unstable, but the chief resident at that time said, oh, let her go. We cannot help you. So no, I said, she's going to be fine. Don't worry. Let's work on it. And, you know, everything went good. She was very light because of the, you know, she was very unstable. Blood pressure was not good. And she went to the ICU and recovered very quickly that night. And on my way to the airport the following morning, I stopped by. And the first thing that she said to me, she said, Dr. Sardi, what are you doing here? You need to rest. Go home and do vacation. I'm going to be fine. She actually left the hospital seven days later. But I was more concerned. I mean, I said, wow, it's amazing. She's worried more about my health than her health health. at this time and she you know and that's what i find people care for you you know i have my my boats of you know hard hard stance and all that actually i have five states on my heart already but you know life goes on and people are more worried about how i'm doing that that's them sometimes and they really care for you as is that it so so there are um you know some very interesting stories along that way and you know again um Patients who, you know, I was playing golf the other day, she had this advanced cancer with multiple nodes and she said to me, you know, 10 years ago when I came to see you, 12 years ago when I came to see you, I spoke with a patient that was 10 years out from the surgery and said, wow, I'm never going to make it. And here I am 12 years later playing golf with you. What an error. So you see, So, I mean, when you hear that and, you know, I'm 71 years old and I feel like I'm, you know, 40, you know, joking, but it really, it's, you know, seeing people doing that and it's very difficult to retire because it's really an honor and a pleasure to be able to do that. And, you know, that's... That's so

SPEAKER_01: 25:10

awesome. Do you see this, do you see the future of Hypec being spread across the world and physicians in other countries and continents learning this? Or do you see all these cases continuing to come to America for just the future growth of

SPEAKER_00: 25:29

it? I mean, it's actually already happening around the world. Latin America, Asia, Europe, you know, and even in Canada, they do it, although they are not very aggressive and there is a misconception about who should go and not to go. There's an idea that if you have too much cancer and there's a way to measure that called peritoneal cancer index or PCI. And they said, oh, if about 12 or 20, you should never do that. That is not true because the only chance that this space should have is that if you remove all the cancer, even though if you have more cancer, it may be more difficult, take longer, and the result may not be as good as less cancer, you still save a lot of people that otherwise would not be safe. Like Gary, for example.

SPEAKER_01: 26:13

He

SPEAKER_00: 26:14

had a very high number that today people say, oh, we need an operator. So it depends on where you go to, to the point that now in our foundation, we recommend that everybody get at least two expert opinions. Because I may say, oh, I cannot help you, but there's another one that can actually help. for a variety of reasons. So it's very important that, you know, you actually get that information, understand what it is. If you are tell no, why is no? Because there are, you know, but again, we cannot help everybody. And again, these are operations that can hurt people if you are not careful, like any treatment.

SPEAKER_01: 26:55

Sure. Sure. Is there an organization out there that's, that's speaking that kind of language to the patient saying, hey, I know you're going to XYZ hospital, but make sure you get two or three, did you say looks or professional opinions? Is anybody telling them that? Because I could see it where they go to the hospital and the doc says one thing and most people are going to say, okay, you're the doctor, you know better.

SPEAKER_00: 27:26

Yes, and actually many people do that. However, there are a lot of patient-led organizations that have been going on for a long time for appendix cancer, PMP Pulse, ACPMP. There's a FaceTime group, which, you know, talk a lot about with the patients. So, but again, everybody's working as a silo, silo. It's kind of independent. So one thing that I'm trying to do, which people tell me I'm crazy, but I think in my opinion is the only way it's going to happen, working together and creating this web of information. So my foundation, the abdominalcancersalliance.org, what we do is we're trying to connect all these organizations. So without people losing their identity, You know, we can communicate because, you know, ovarian cancer groups talk different to the gastrointestinal cancer groups, colon cancer groups. And, you know, and imagine, just imagine the power of the people connecting, you know, like we're doing now to spread the word of something that can save a lot of people. We are treating today the minority of the people, and I will say probably less than 1% of the people that are potential candidates for this operation. Now, that's an estimate, but based on my practice, because I see a lot of people, you know, that were told nothing could be done, and there are many over there that... So, what we are trying to do with the foundation is connecting those organizations. So, we all start creating this web of information that makes it, you know, more easy, identifiable, found by patients who get into with this diagnosis. and you know that's people tell me i'm crazy but i'm determined to do that because if not i mean i've been doing this for 32 years i started in 1994 and we still see the same problem today that we saw that long ago last week i did the chemotherapy for free because insurance on someone with well insurance refused to do it for a patient with sarcoma of the uterus when we know that even though there are not prospective trials because the people who are treated with chemotherapy alone, they all die, but we have many patients now follow for over 15 years, and we even did a study with other groups around the world, so in the benefit of that, but insurance refused to pay. So I had a decision, okay, I refuse the surgery, and don't get paid or, and don't get, you know, and, and, you know, do more surgery that, or I do the surgery and, and don't get paid. So I, as a physician, I, I refuse to believe that just because someone cannot pay and I'm going to help them. I mean, fortunately I, you know, I have created, you know, my philosophy that, you know, medicine, yes, it's a business too, probably, but I never really went like a business part of it. And you have to try to help people, and sometimes it's possible, sometimes it's not. However, hospitals cannot absorb many patients without payments because then you break the system, right? So it's a complex area, but fortunately, we were able to help that lady. She did extremely well, went home within seven days. And it's a young patient, which hopefully we'll see her for many, many years to come.

SPEAKER_01: 30:55

Wow. And that wasn't hypic. That was

SPEAKER_00: 30:58

a hypic for a sarcoma of the uterus, which is a very aggressive cancer, which once you spread out of the uterus, people don't do very well. And, you know, we have people alive playing with us golf, too, because there are a lot of golfers. You know, golf, I think, is a social thing that I started doing when I was in the 50s. So as you can imagine, I'm not a very good golfer. I enjoy it out there. But many patients communicate. And, you know, we do this event on September that people join together. You know, it's baseball. So everybody has fun for a good cause now.

SPEAKER_01: 31:33

Oh, that's wonderful. So what's a list of cancers then that this works for and then also then that it doesn't work for that you would say no to somebody?

SPEAKER_00: 31:45

I mean, the number of groups are pretty much gastrointestinal and gynecological cancers. Now, more specific was appendix cancer. as a standard of care. Mesothelioma is the standard of care. For colonic works, although there's some controversies, but the big surgery to remove all the tumor is a way to go, at least even the chemotherapy is not added, but there is studies showing the benefit of it. We have small bowel cancers. We have some gastric cancer. We have gallbladder cancers. We have some appendicitis. pancreatic cancers, and then the gynecological cancer. There is a 10-year follow-up study that showed that if you do the surgery with the HIPEC or the heated chemotherapy, people, and then systemic chemotherapy, people are going to do better that if you don't do that. And there is a prospective trial, you know, large study groups comparing both groups showing the benefit of that. That, you know, or, you know, even today, most women with gynecological cancers don't get to this treatment, even though now we have a very good study showing the benefit of it. The other thing that we have found actually, unfortunately, is because all these cancers, you know, as you imagine the abdominal cavity is like a room, everything is kind of exposed to, and even there is fluid that circulates around, it's a normal circulation. So once all these cancers, you know, breaks out, you're just going to see it everywhere. And one of the common places is the ovaries because it's dependent and is the only organ that doesn't have coverage from mesothelium, which is the peytonium, you know, doesn't cover because the ovule has to be released and go to the tubes and get pregnant, you know, when that happens. So, and the ovaries have a lot of blood supply. So they can become very large as coming from, cancers of the ovary, but also even if there is a cancer from the appendix or the colon or the pancreas, that when there, they can grow even bigger than the tumor where they came from. And they are mistreated many times as ovarian cancers, and then they get big operations, removing only part of the tumor, leaving a lot of tumor behind, making more difficult the next operation or sometimes even impossible. So that's something that we're trying to educate other groups to say, listen, if you see this, don't jump into the conclusion that it's necessarily an ovarian cancer just because it's a big ovarian mass. Do a laparoscopy, take a biopsy, see what's going on, and then refer the patient with the appropriate diagnosis to the right center who's going to do the best for that patient.

SPEAKER_01: 34:33

Is this accepted fully by the insurance companies and other i'll call them peers and colleagues out in the medical community or is there pushback from anybody

SPEAKER_00: 34:46

uh yes that's a pushback it's changing but you know many gynecologists many gynecological oncologists even in major centers don't believe in this even though their data already showing that laparoscopy of course is approved because now we try to do minimally invasive surgery which is sometimes overused to treat cancers that You can't do that way because it's just too much, like these cancers. But the idea is, you know, make the appropriate diagnosis, you know, and then make sure that the patient gets to the place where it's going to be treated the best way they can.

SPEAKER_01: 35:22

Yeah.

SPEAKER_00: 35:24

And that is true for any treatment of anything, you know. You know, you have a brain tumor, you wanna go to the place we do that, make it a proper diagnosis, don't start doing therapies that are gonna complicate and create more problems for the next definite treatment.

SPEAKER_01: 35:40

Yeah, yeah, that makes sense. I wanna take a walk inside the operating room now. I wanna try to get there mentally. So it's my day of hypic procedure. I come, I check in. I'm brought in like any other procedure, I'm guessing. When I come in the OR, do I see 20 people? You mentioned a lot of teams go into this. What does that all look like on the day?

SPEAKER_00: 36:06

Actually, it has been a change over the years. And many years ago, we used to bring the patient the same day, had the bowel preparation at home. People coming from out of town, it was difficult. They had a lot of problems. So we admit now every day before. I had to fight with insurance company to approve that because, you know, people need a lot of calm. This is a big operation. It's like running a marathon. You need to be prepared for that. Not only for the several weeks before that, not only mentally, but physically, but also understanding everything that is going to happen. So we bring it in the day before, not only to prep the bowel, but they see physical therapy. They understand that we're going to get them out of bed the first day, whether they like it or not. You know, they see respiratory therapy to understand that they need to breathe in the appropriate way. And we showed them the, you know, the machines that they need to blow into to get them, you know, make sure that the lungs don't have problems. We get someone to mark a colostomy. You know, some patients may need a bag or a stool for the rest of their life or temporary. So they get marked for potential sites, because as you imagine, if you have a colostomy, which is a bag for the colon or the small bowel comes through, the stool comes into a bag, it has to be placed in a very good place. Otherwise, for quality of life, it's an issue of leakage of stool around it. So they get marked in the best potential site if we have to do that, which is the minority of patients. But all those things are things that affect the quality of life. Now, this is after we have spoken to them in the office, gave a lot of information. We encouraged them to talk to other patients that had the same diagnosis and hopefully similar age. So they're already mentally prepared to what to expect. But that way, you know, the next morning they are taken to the operating room. You know, anesthesia met them the night before as well. So they go to the operating room the next day already with their mind kind of at peace. Now, of course, there's a lot of things. They get some sedation, so they hopefully forget most of that. But at the operating room, we have the anesthesiologist. We have a scrub nurse that works with us. We have a circulator nurse. And then we have one or two PAs with me or one of my partners that we work together. And the surgery starts, and again, we finish when we finish. And then the patient after that, usually we try to get the tubes out. They are going to end up with a lot of tubes, the drain fluid, because we give a lot of fluid to protect the kidneys. Kidney failure could be a problem if you don't hydrate them very well, and so they get swollen. But within two or three days, that goes away. They have tears in the chest. They have tears in the abdomen. They have a falling catheter. They have a nose tube. They go to recovery room, and then after that, they go to the intensive care unit. They stay there usually one night, and the next day, like the lady that I did yesterday, is up on the floor today. already out of bed talking and, you know, obviously a little sore, but we give pain medication as well as some local anesthesia for the last about three days to improve the pain management, which is also, as you imagine, this is a cat that goes from your chest bone all the way down to the pubis, you know, so it's the whole abdomen. And so it's a painful operation. But, you know, and then patients start, you know, we get them out of bed next day and get them moving, breathing. And we see them every day. They see us every day with not only ourselves, but also the PAs and nurses, which in my center here, they love what they do. I mean, the nurses are just amazing. You know, they really, you know, I mean, I really, I'm honored to work with a team like that. They just, They just love what they do. I do the easy part. They do the tough part, I can tell you. The recovery of these patients is tough. But that's it. We actually tell the patient families, go home. If they are in a hotel, go home. We'll call you every two hours. The nurses will call them in the OR every two hours so they know that things are moving along. When we are doing the heated chemotherapy, which is after we remove all the tumor, Then that's when I go out and eat something, the patient gets close, just the skin, and we check them, you know, and the operating room moves in all directions to assure that the chemotherapy kind of lies, you know, touches all the surfaces. And then after that, we open up and we connect everything that has been disconnected. And then we close back up and then patients go to the recovery room. But then when I finish, I call the family or if they are here, I speak with them. If they want to come and talk to me directly, they do. Most of the time we tell them, listen, patron is going to be asleep for another three or four hours. Just rest because you're going to be arrested for the next few weeks to help them. And they usually do that. And we establish a very good contact with them. And after 10 or 12 days when they leave the hospital, we give them a 24 seven number to connect with us if any problem happens. And so that way we are sure that patients are gonna do well.

SPEAKER_01: 41:33

Sure. What is it like, like, are you taking organs out of the body? Are you physically like putting them on a table? I

SPEAKER_00: 41:42

mean, we take, there are organs that cannot be safe. You know, if you have to remove the right colon because it's involved, you remove the right colon. Sometimes a lot of the small bowel, frequently the rectum, ovaries, uterus, spleen, gallbladder, and then clean all the surfaces. You cannot, you know, just can't really peel that layer of tumor. And then that's it. So that takes a long time, as long as it takes. Of course, you are looking about quality of life. You need certain amount of a small bowel to have a good quality of life. You know, you can live without colon, but you need at least two meters, you know, of a small bowel to at least absorb food and not be dependent on IV food. But again, many times we can save a lot by doing, you know, cutting pieces and putting together several of those. Now, we don't put anything together until after the heat of chemotherapy with everything is well and so on, but that way we make sure that all the surfaces get washed with the chemotherapy. If you connect it before you do that, you may entrap cancer cells that will grow in the areas that you join together and create recurrences that hopefully shouldn't happen. So there's a lot of technical aspects, and again, we can do a lot of things, but it's all about quality of life. If I do an operation and the patient cannot eat well, they are miserable for the rest of their life, then And this is true for any treatment. We cannot cure everybody. And we tried, and we would like to do it. It doesn't matter whether it's surgery, chemotherapy, or radiation. At some point, we have to say no more. And actually, it's interesting now that you ask me, what are the interesting cases that you can remember? Several years ago, a very wealthy man that was a board member of a hospital and had colon cancer, had gone everywhere because he had the means to do that. I got every chemotherapy available and he came to me because he knew I was a very aggressive surgeon. And I said to him, you know, I would love to help you, but I cannot. You reached the point of no return. I know you're going to die from this cancer, but I cannot tell you when. I can tell you that you have limited life. And you make a decision. You need to make the decision of how spend that rest of your life. Because, you know, so far you have been spending a lot of money. You have been taking your family all over the world, you know, probably wasting time that, you know, it didn't help. So make a decision. So, you know, say, oh, Dr. Sardi, thank you very much. They left. I got a letter from his wife three months later saying, Dr. Sardi, thank you for telling that to my husband and I. After that, we took our boat, you know, they had, you know, means to do that. And we went into the Caribbean, you know, and I can tell you that he died at sea, at sea. And the last three months had been the calming and more relaxing times of the last five years of his life. So, you know, it's saying that at some point, really, we can hurt people, you know, it doesn't matter what it is, we can do things. And you can always find doctors to do something. And sometimes, actually, we're not trained to be very direct sometimes to tell patients, hey, I cannot help you. Or if I can operate, but my chance of helping you is minimal. And I had that conversation with a patient today. Or actually, I'm going to hurt you because, again, you have limited quality of life. I can operate, take some tumor out, but you're just going to lose time, not gain time.

SPEAKER_02: 45:39

And

SPEAKER_00: 45:40

that's important. So patients then can make the appropriate decisions. Again, we are treating patients. We're not treating a cancer, right? You have a patient that has a cancer and then we say, okay, based on everything. And also we need as doctors to recognize that, you know, I don't know everything. I'm not the guy to do everything in cancer. And I should be able when I don't do something good. You know, I used to do a lot because we train in the time that, We did everything, you know, from vascular surgery, head and neck, lung. And I can do a lot of those procedures even today, but I'm not the best person to do it. So I need to recognize that. And when someone needs something that I cannot do well, I should be able to say, listen, I can do the operation, but my partner or the patient, the other hospital can do it better.

SPEAKER_01: 46:30

Right.

SPEAKER_00: 46:32

Go ahead and do it.

SPEAKER_01: 46:33

Sure. So when you have somebody opened up, there's just so many moving parts. You have all these different organs and all whatever it looks like inside the body, but it's certainly complex. Have you ever done a case where you had to call somebody else in that was not even at the hospital, some kind of specialist? I don't even know who it could be.

SPEAKER_00: 46:56

No, I mean, fortunately, I mean, to do this operation, you need to have everybody is needed. one way or the other. You know, we have all these specialties. However, you know, sometimes we have very complex cases, so much to see that my partner, which have been together for 20 years, you know, he's very good, Dr. Badin Gushin. So we work together in this complex case for the beginning, not only because you can move a lot faster than when you are working with a PA, but you actually have a better chance to be successful. And, you know, in this surgery, if you save two hours of surgery, It's a lot of time, not only for the patient, but also for you.

SPEAKER_01: 47:36

Sure. Yeah, it makes sense.

SPEAKER_00: 47:38

We have at this institution all the people necessary to do that. If you have to call someone from another town, then you shouldn't be doing that operation.

SPEAKER_01: 47:49

Okay. Would you have maybe to call somebody who's in your actual hospital in the four walls, but they're not in the operating room? Oh,

SPEAKER_00: 47:58

yeah. And sometimes we call it urology, you know, when we find that, you know, there are areas involving the bladder or the ureter vascular that we have to resect the vessels to connect because you need to. So we resect the vessels and they come and repair it. So they are available. And sometimes we suspect that ahead of time, they're already prepared to be available if necessary. Or sometimes we do big operations that we need plastic surgery to replace areas of the or with organs and so on, with the tissue. So they are already notified about that. So we work together. So it's a lot of planning. But again, you shouldn't be doing these operations if you don't have the services available. And also after surgery, you need to have a good ICU where people are there all the time. You need to have the whole team. We have medical oncologists that I can call and say, I'm going to give this chemotherapy. Do you think this is the appropriate one based on this history? Actually, our medical oncologists are side-by-side with us. And then we, you know, so when patients come from out of town, they can see them right away without having to wait two months to see another physician.

SPEAKER_01: 49:13

Yeah, sure.

SPEAKER_00: 49:15

Or vice versa. Sometimes they are seeing a patient, hey, Armando, what do you think? And, oh, send them over here. So we are side-by-side here.

UNKNOWN: 49:23

Yeah.

SPEAKER_01: 49:23

Yeah. When you have an organ, pick any one, but when you say, like, you're scrubbing an organ, are you literally, when you're scrubbing an organ, watching the cancer come off of it, like, instantly?

SPEAKER_00: 49:40

Yeah, there are different type of tumors. You know, this appendix cancer, for example, or some ovarian cancers, they are like jelly. You literally can't wash it out. I mean, you can get with a rug and just clean it up. And if you cannot do it, you cauterize it very careful. Sometimes you cauterize into the bowel and you've repaired the bowel. If they are more penetrating, but they are too many, you do many of those or you resect the bowel and connect, no? So yes, it's a combination of factors that you use to destroy the tumor, either remove it or destroy it. You know, that is the point.

SPEAKER_01: 50:16

Yeah, that makes sense. Okay, so then it's safe to say in all that we talked about today, that if you've been told that you have some kind of cancer in and around your stomach, get a second opinion.

SPEAKER_00: 50:35

Correct. The stomach is an organ itself, but the stomach is also defined like the abdominal cavity. Everything is in an abdomen. In the abdomen, we have many organs. If you have a tumor that had spread or is big, you know, you should make sure that you shouldn't get to this to start with. That's a first treatment choice. Instead of having a small surgery, then you get more therapy and then have to come back to a second surgery when one surgery would have been enough.

SPEAKER_01: 51:06

Right. Okay.

SPEAKER_00: 51:08

You know, most cancers, you know, I mean, like colon cancer, you know, you can find early cancer. That's why we recommend colonoscopy. If you get a colonoscopy and you find a polyp and you take it out, then you are not going to have cancer. And believe it or not, even in the United States today, only about 40% of adults that should have a colonoscopy are having colonoscopy. It has increased a little bit, but many people don't want to have it. Oh, but I feel great, I say, but when you feel bad, it's too late. Now you have to come to me to do a colostomy, give you chemotherapy, give you these big operations. when all that can be avoided. I mean, appendix cancer is difficult to diagnose it. We don't have a way to diagnose ovarian. Unfortunately, ovarian cancers are diagnosed 80% of the times at stage three or four cancers. But there are a lot of cancers that can be found early that if you do the proper things will work.

SPEAKER_01: 52:12

colonoscopy being one

SPEAKER_00: 52:13

of them. Oh, colonoscopy. Oh, yes. Very important. Yeah, correct.

SPEAKER_01: 52:16

Yeah. Very important. Okay. The future. So looking out, you're 34 years into it. You have all these people that you've helped. It's incredible. It's remarkable. What's your hope going forward? What do you want?

SPEAKER_00: 52:34

I think the first, you know, continue to train more people to do this, you know, but most important to increase awareness. My dream really at least today, you asked me that question, is to connect people. And when you call and tell me, hey, I would like to do a podcast, oh, yeah, that's great. You know, someone has, you know, worked with Netflix, and I want to do a story about that. And I say, wow, that would be great. You know, we have a patient from firefighters from 9-11 that he did in 2002 and 2003 that are still alive, enjoying life. You know, so stories that are, you know, that they went to big centers in New York until 2002, you won't be able to be helped. They came here and They're still alive. Actually, last year, we do a walk every year to raise funds for our research. He spoke about it, and he's a funny guy. But seeing these patients doing it is amazing. So the idea is that my dream will be that we can connect enough people and enough organizations and the media to spread a word that it's a treatment that, while it's not for everybody, can help a lot of patients. And by doing that, we are going to save mothers, parents, brothers, sisters, and it will be a better world for a lot of people.

SPEAKER_01: 53:58

Yeah, that's neat. All right, I want to ask you a couple of questions about you as a doctor. We put a lot of light, and I love it, on the HYPIC procedure and all the benefits of it. You as a person, doc, Doing this procedure, you have so many great outcomes and there's got to be cases just like anything else where the outcome is not so great. Just how do you handle this emotionally as a person, as a human being? What do you tend to do?

SPEAKER_00: 54:30

I'm a type A personality. At some point, we got younger, we think we can do anything. I can do a lot of things, but I recognize my limitations. I know that I can help a lot of people and I like to help. And, you know, I do everything possible not to harm people as much as we can. But, you know, sometimes complications occurred and, you know, that's tough, especially when this to a bad outcome. Fortunately, you know, it's not often, but that is very, you know, it not only demands a lot of moral support, but, you know, you are dealing with a life of a person and family that get compromised and so on. But you need to recognize that we cannot help everybody and make that decision as you can. Now, for me, it's more difficult not to be able to help that help sometimes. Sometimes when I call my wife early and say, oh, I'm going home and it's early, she knows that nothing good happened. And she says to people, oh, I know when something happened because it's not the same person. But yes, I deal with that as a whole, but... But it's part by you need to recognize that first we have to be honest with the patient, that we are doing our best and not every time is going to be perfect. We try to be as perfect as possible, but as you know, perfection is not possible really, but we can get close to it. And that the output of that is good, and actually the patients who are believers and They believe that you are doing the best. Those patients aren't going to do better because they have all that energy into it. But as a physician, especially to do these procedures, you need to be passionate about it. This is not a procedure. You cannot just, oh, I'm going to do high PEC just because I train in this or that. Even people who are trained as a surgical oncologist, most of them are not trained to do this procedure or even have the mentality of the patient to do that. You need to have passion to say, okay, I'm going to put whatever time is necessary to do that. And I tell my patients, listen, you're going to have all my energy. As long as it's necessary that day, but I need your energy, your mind and your body to help me. Don't make me work too hard, please. But it's part of the game. But I've been through, I mean, I lost a son when I was 25 years old. He drowned in a pool. that I built for him. I was a 25-year-old medical student. I had to extubate him in surgery, you know, and I was, when my wife came to say, Armando, Mauricio's drowned. He was pregnant of the oldest one now. That's 48 years ago now. The, you know, and I was in my last day of rotation in pediatrics. So I went to the emergency room with all my friends and I saw him. He was dead. He was intubated. I said, guys, He said, he's dead. I took the tube out, wrapped him up, and took him with me home. And that was it. And I took three days off of work. And I told my wife, you know, we have, you know, this has happened to anybody. And I have to continue. We have a new child coming, whether it's a boy or a girl. She needs to come to a wonderful home. And we need to move forward. I took three days off. from work and I felt that my friends, which were working very hard for me, couldn't keep working for me just because my son died, although I know they would love to do so. But life has to continue. We're all going to fall at one point, but life has to continue. I love every minute of life. I wake up in the morning and I'm ready to go. I mean, I was excited about whether it's Monday, Tuesday, Wednesday, Saturday, Friday. And I don't want to go to bed because I think I need to do more, you know. However, as soon as I sit down, I go to bed, I fall asleep, you know. And asking my mother, she used to say, Armando, you were the same when you were two years old. You never wanted to go to bed. You woke up at 5 o'clock in the morning, and you just went on all day long bothering people.

SPEAKER_02: 58:49

Wow.

SPEAKER_00: 58:50

So the group here at the office, they make fun of me because I always tell them, come on, guys, go, go, go, go, go, go, go. We have pleasure to go, people to see. Like someone said, I was here the other day with the– the movie from walt disney you know just keep swimming right and that's true in anything on life just keep swimming you know you just you fell down you go up and then yeah yeah you know but life i mean i've been very lucky you know like i mentioned to you i have five stands on my heart But I had been at the right time, at the right place. And I was supposed to be in a plane crash in American Airlines in 2005, going to Cali, Colombia. In those days, you can make a reservation and pay a week before that. And one of the nurses said, oh, Armando, I can get some commission if I pay your ticket. I said, okay, go ahead, but don't mess it up because, you know, I will lose the guys, you know, Christmas. I'm going to see my family. And it was for December 20th, and Steve forgot, so we lost the connection. We lost the reservation. When we called, the reservation was there, but my wife decided that we are not going to fly that day because it was the anniversary. So we didn't get in. We actually left from, I left with the kids from a different, from Washington. She left from Baltimore the day before on the 19th for no reason. completely awkward. I was even opposed to it. They confused me because I didn't want them to lose one day with school. And, you know, I'm in Colombia and they prank crutches four survivors. Many friends died there and I was supposed to be there. I said, wow. So, I really believe that we are here to do our job. And, you know, I was going to move to the south and because I love I don't like cold weather. I don't like to, you know, and I say I'm Finnish in the north. And even though Baltimore is the south state, it's too far north for me weather wise. And here I am. So, I mean, it's the best place I could be. I think what I'm doing, I'm trying to help people. And so I think that, you know, there is someone out there, you know, God has a plan for us. But, you know, life has to continue. You know, it doesn't matter how we were hit. You know, life has to continue because if you stay down, you are going to suffer. And, you know, that's kind of my philosophy of life. And I enjoy helping people and seeing people doing well. And it's fun, you know.

SPEAKER_01: 1:01:30

Yeah, it's wonderful. The night before the very first, just a couple more questions, the night before your very first HYPEC procedure, what was going through your mind? You had to be nervous, I would think.

SPEAKER_00: 1:01:47

No, I mean, the HYPEC component is just a part of the, of a big procedure that I already was doing. So it's not like it was, you know, Dr. Sugarbecker who did it before me, he gave me some, we sold machines because in those days there was no equipment designed for this. We have to change the cardiac machines to allow to raise the temperature to 43 degrees. It's a high heat, 108 Fahrenheit. That's why you run into the belly. And so he gave me that and I went to Rayochak. You know, remember Rayochak is, you know, that's already out of the market. So I bought two pumps and some temperature probes and created a device that will work with the pumps. It's a very simple system. And that's how I started my first HIPEC. And actually it was for ovarian cancer and she lived 20 plus years. She died from something else, you know. But we started now, there are expensive machines that, you know, the heated chemotherapy component is not a problem. That's the easy part, because it doesn't require any true expertise. You are just putting heated chemotherapy through a pump into the peritoneal cavity after you remove all the cancer. The difficult part and the most important part is to remove all the tumor, and that's what it is.

SPEAKER_01: 1:03:18

Are we going to see a day, do you think, where this is behind us and we don't have to worry about it anymore? I guess cancer in general.

SPEAKER_00: 1:03:27

I mean, we are finding more and more treatments. However, surgery remains the hallmark of resection or treatment for most of the solid tumors, which are pretty much everything but the lymphomas and leukemias. Now we have therapies to help with advanced cancer. What we are seeing more now is that now we can kind of see patients who come to us because they have increased risk for cancer. So one thing that we are encouraging our families is to do genetics because we can identify cancers before they are big or prevent them by removing an organ that is a high probability of developing a cancer or developing a more rigid follow-up for families of patients with colon cancer, breast cancers, ovarian cancers, in which we can recognize cancers before they're advanced so they don't have to come to me. So that's probably one of the major things, identifying now genetics that can get us to those cases earlier.

SPEAKER_01: 1:04:40

Would that be covered by insurance?

SPEAKER_00: 1:04:42

Oh, yes. Now it's recommended. Yes, it's kind of a standard, yeah. And I think it's going to get even to the point that probably you just do a blood test and, hey, you are at increased risk for this. This is your chance. For example, just thyroid cancer, there is a very rare cancer, the medullary thyroid cancer. There is a gene that if you have it, 100% of the people are going to have cancer. So, thyroidectomies are done in kids when they're four years old to prevent that from happening in childhood. Now, there are fortunately rare cancers, but, you know, there are other cancers. I mean, ovarian cancer, you can determine, find family, colon cancer family groups that are, you know, a higher risk. So, you need to, you know, breast cancer, you can do MRIs more closely, follow these people closely. So, that way, If something develops, you can develop finding them early. The only cancer though that can be prevented is colon cancer. If you do a colonoscopy because you find a polyp, you cut it, and the chance of that polyp becoming cancer is gone because the polyp is gone. There's no other treatment or other procedure that can prevent cancer by doing it. So we have procedures to make diagnosis, But colon cancer not only can find a polyp, but remove it before it's cancerous, you know. The transition from a polyp, benign polyp, to cancer could be as long as 10 or 12 years. That's why colonoscopies are recommended every 10 years, unless you have a family history of colon

SPEAKER_01: 1:06:22

cancer. So, okay, what's the age then if you have no family history? What age?

SPEAKER_00: 1:06:28

Right now it's 45 to start with. If you have family history, it should be 10 years younger than the father or the mother that had it or relative. So if your mother had breast cancer or colon cancer at age 45, at age 30, 35, you should be having one.

SPEAKER_01: 1:06:47

Oh, wow. Okay. So are those over the... I'm not calling over the counter. They're not over the counter, but they're not an actual colonoscopy. It's like a... Yeah,

SPEAKER_00: 1:06:57

the Cologuard. Cologuard. That should be applied, in my opinion, only to people who are completely opposed to colonoscopy, to people who have medical conditions to be put to sleep. That really should not be used for anybody else. Everybody, in my opinion, should have the first colonoscopy at least to know everything is clear. Now, the other advantage of colonoscopy is that if you find a polyp, you take it out right away in one procedure. If you got a color guard, if you have a polyp, you may not detect the polyp, so the tumor continues to grow. And if they find something suspicious, you still need a colonoscopy to go after it. So, you know, I mean, yes, there are risks associated with the colonoscopy. However, I... In my opinion, I already have three colonoscopies and I'll have one more in a couple of years. I'm not taking that chance because I see people coming at 80 years of age telling me, oh, doctor, but I was great. I never had a colonoscopy yet. But now they're having bags and chemotherapy and they are dying from the disease that could have been prevented with a relatively simple procedure.

SPEAKER_01: 1:08:14

Yeah. Is it normal to find polyps?

SPEAKER_00: 1:08:18

It's frequently seen, but, you know, it depends. Most people don't have anything or have very small polyps that are not significant. Because, you know, the polyp, there are different kind of polyps. Most are not malignant or premalignant. Some can become malignant. Okay.

SPEAKER_01: 1:08:36

I want to spend some time on your personal routine. What are some things that are... that are absolute must-dos on a daily basis for your routine and then want to get into the opposite of that? What are some absolute stay-aways as a cancer oncologist, surgeon?

SPEAKER_00: 1:08:59

I think I believe first for us to do what we do, you need to be in good health. It may not look very good to you, but I am pretty good and feel I can. But every day I wake up at 5.30 in the morning. I exercise every day. If for some reason I do a combination, one day I do weights, especially not the day of surgery because then your hands tend to tremble a little bit if you are doing weights. Those days I do bike or abdominals. I have the Peloton that actually have been very helpful and abdominals. I alternate that. On weekends, I either walk or run a little bit. I play golf on the weekends. I play tennis. So I'm very active. I mean, and I always love to be outdoor if I can. But every day, even if I only have 10 minutes because I overslept, I do some kind of exercise, from stretching to biking to, you know, lifting a few weights, you know, abdominal, you know, whatever. I think that is very important because, as you imagine, if you're going to stand for 12 hours, you need to feel good about it. Otherwise, your back, everything is going to hurt. So my health is very important. I try to eat well. I eat breakfast every day, you know, because I don't know if I'm going to have a lunch, even though they provide some sandwiches for me. But when you start this case, you want to finish as soon as you can. So unless I start feeling that I'm slowing because I'm getting dehydrated, I just keep going until I finish. Yesterday, I went on for seven hours before I broke. It was at the time of the heat chemotherapy. When is it the time that I don't need to be there? The patient is being checked by the PAs and the operating room table moving. And there is the perfusionist and the other doctors there. But at that time, I'm eating something and getting a little rest. But yeah, that's kind of the night I go home with my wife and sit around and talk and sometimes read a little bit. I'm avid of stock picking. I love that. It's like my pastime. I learned many years ago and I'm friends with people that do well for that. I taught my grandkids and my daughters. People have learned to save for the future and how to at the same time. By doing that, you can help other people because you create some wealth. All that is part of my routine. You really are ready to go off when I wake up. Try to sleep at least seven hours, which usually I can do that. Sometimes that's not possible, but I think it's important. And my food, I am very picky about eating. I don't eat because I'm not the person who sit down and eat a four-hour meal unless it's party. You know, I eat because I have to eat and I kind of watch what I eat. But I am, you know, life has to be joy too. So I drink very little, if any. You know, occasionally I'll take a little beer, but I don't need beer to have fun or I don't need alcohol to have fun. So I love dancing. You know, in Colombia, if you are 12 years old and you don't know how to dance, forget about girls.

UNKNOWN: 1:12:23

So...

SPEAKER_00: 1:12:23

You know, the salsa and the, but you know, everything is there. And Gary can tell you that when he was there, we took him to some discotheque. So he saw what he was.

SPEAKER_01: 1:12:34

I'll have to ask him. What are, okay. What are a few other absolute stay aways? Do you have any type of foods?

SPEAKER_00: 1:12:42

No, I mean, I don't smoke. You know, I never did. My father did. And, you know, and that's what I, so I do not smoke. I never liked that. I don't, I never did or do drugs. which sometimes I see junkies, you know, all kinds of drugs, which is incredible. But, you know, so I think that's very, very important. I eat pretty much everything. However, I don't eat spicy food. I don't eat curry. I cannot, you know, spicy food, I mean, I can't. But I eat a lot of fish and chicken, meat when I have to. You know, I'm not opposed to any specific food, but I try to be... organic and the things that should be organic. And, you know, I now stay away from the sub drinks that I love, you know, so, you know, but I don't drink Cokes or, you know, unless I really, one day, you know, you'll have to take a Coke, you know, especially if you're in Atlanta, right?

SPEAKER_01: 1:13:40

Yeah. Right. Is it, is it more, it sounds like you like them and you would have them if there was a health benefit or something, but is it because of, is it, you stay away because of the fear of what it could be doing for your insides?

SPEAKER_00: 1:13:54

Yeah. I mean, it's too much sugar, you know what I mean? And in my, my, my, you know, I never growing up, even though my mother was very healthy eating, I, you know, we ate all the junk that we could find, you know, and that's normal for, for most people. So now I'm more, more information and, and, um, but, uh, you know, I try to be as healthy because, you know, without health, Not only I cannot do all the things that I do, but all of us are going to be unhealthy or have a disease that is going to get us. The idea is to have it for a short period of time. So if you give it your best chance, you're going to hopefully suffer for a little bit and you're gone. You know, my mother died this year at 93 years of age. She loved life from the day she wake up. She ate very healthy. Never really exercised, but she walked a lot on her own. And her attitude helped people all the time. And she was sick for two hours before she died. And she was up in the mountains with my brothers enjoying life. And nothing was ever a problem. And we are seven kids, six boys and one girl.

UNKNOWN: 1:15:06

Oh.

SPEAKER_01: 1:15:07

How was she sick for two hours?

SPEAKER_00: 1:15:09

I mean, she just had chest pain and she died. Oh. She had an aneurysm and she died from probably from a ruptured aneurysm, but we don't know for sure now. But she was 93. I mean, the day before she was in a party, you know. At 93 and in December, she was with us in Disney World doing all the things that the kids were doing. Take it easy. But she enjoyed that, so.

SPEAKER_01: 1:15:37

All right. I'm going to make up a crazy scenario. It's just completely made up. You wake up tomorrow and all cancer, for whatever reason, has been solved. You no longer have any need to do what you're doing. How do you spend your days going forward?

SPEAKER_00: 1:15:53

Oh, I actually go out and find ways to help people in whatever I can, even from the medical point of view that I can have all the talents that I help. But even a volunteer, we all have a talent. It doesn't matter who we are. We have a talent, and that's what we're trying to do with the foundation. What is your talent that you do best, that you have a certain amount of time that you can help us with it, like being today here talking about this? Or you have a connection. You may not have funds or money to donate. You don't know how to do it, or you don't want to do it, or you have all the interests. Do you know someone who may be interested in doing so? because of that. Or maybe you know a family member is going through this that you can help. So that's what it is. So yeah, there's multiple ways that I can help. I actually love magic. I'm a magician. Not a good one, but I do magic.

SPEAKER_02: 1:16:47

You're

SPEAKER_00: 1:16:47

a magician? You go to YouTube, you can see one of my presentations during the... During the pandemic, I did three years in the road, a show, you know, for the Heat It to Beat It, because we got together. So I did a magic show. It was amateur, amateur, but I enjoyed. And I learned everybody. I take a class of magic every week. every Wednesday night. And it's a lot of practice. So you need to really, but I enjoy it. The grandkids enjoy it. And actually I had a fun yesterday when one of my granddaughters called me, hey, granddaddy, abuelito, you know, in Spanish, abuelito, I have a new trick for you. I learned how to do it. So she's going to show it to me in a couple of weeks when I'm going to be with him.

SPEAKER_02: 1:17:37

But

SPEAKER_00: 1:17:38

it's fun, you know, it's, you know.

SPEAKER_02: 1:17:41

Yeah.

UNKNOWN: 1:17:41

Yeah.

SPEAKER_00: 1:17:42

And one of the things that we did actually two years ago was called a magic show. A lot of the patients that we have helped have a lot of talent. I didn't know to the extent until I did that. And actually, we had musicians, I mean, real musicians, I mean, violinists, opera singers, jugglers, I mean, professionals. So we did a talent show. And so everybody had a 20-minute... a 20-second presentation of their story with the cancer, and then they performed live at the Loyola University. I mean, it was the most nice thing that I saw people were laughing and crying at the same time. And we are actually, we are planning to do a new one, hopefully in D.C., you know, with even more people from different doctors and to try to raise awareness and to let people know that people live their lives after the surgery, because there is a misconception that after this big operation, everybody's going to have miserable life. And that's not true. Some people have tough problems. Some people are going to die eventually. And yes, I mean, you saw Gary playing golf better than me. because I throw a lot of balls in the water all the time. But that's kind of the idea. So I love life. If you have something to teach me, I'd love to learn. I like to read. I like history a lot. I read about history. I read about the history of the world, the history of the United States, the Bible, which the Old Testament is a nightmare. I never thought it was such a terrible time. Compared to now, we are in the best time now ever. Reading the Old Testament, you say, oh my God, this is trouble here. Right?

SPEAKER_01: 1:19:32

Right. Wow. Is there anything on the planet that grosses you out?

SPEAKER_00: 1:19:41

What do you mean? I'm a diver, but I don't swim on top of the water because I have seen shark attacks in South Carolina and had to take someone out of the water. I swam with sharks myself, but side by side. I don't like to swim on top, but I sail and do all kinds of water sports, but not swimming on the sea, no. I like to see my surroundings, you know. I don't like heights. I mean, I don't jump from a plane. No, forget about it. Dive from height? No. I dive from, you know, two or three meters. No more than that.

SPEAKER_01: 1:20:23

Yeah. But you're not like... I doubt this is even... that this would even exist anywhere in the world. Like, you're not a... although you can administer and you see blood all day and you can give needles, you're not afraid to go to a doctor and get a shot in your arm or something like that, are you?

SPEAKER_00: 1:20:40

No, actually, when I was young, I was six years old, I had a bad rheumatic fever that affected my heart. And they used to draw blood with these big things that were reusable, very painful. And I was there, actually, the nurses coming in, and my mother said, and said, hey, look at this kid, he's not even crying. I don't, you know, and now, because of my age, I had to at least have blood drawn twice a month, and so I don't, you know. However, one of my brothers got into a car accident when I was a medical student, and he came, he needed the spleen removed, and he just said, Armando, don't let me die, but I wasn't the doctor or anything, I was just watching. So as soon as they put him to sleep and they cut his abdomen, I almost pass out. He said, oh, man, this is serious, you know. So, you know, we are humans, you know, so we go through the same things that, you know. Right. Like people think, you know, I thought that when I was going to be a doctor, I was never going to get sick. Oh, I was wrong. We get sick, we go through the same thing that people go through, you know.

SPEAKER_01: 1:21:48

Right. I've learned to not make assumptions. Since that day five years ago, I just don't like to assume. So that's why I wanted to ask that question to you. And

SPEAKER_00: 1:22:26

I think that everybody does hopefully what they like. I really believe that if you do what you like, you're going to succeed. I tell my students, when they ask me, hey, how do you select to be a surgeon? I say, don't worry, your personality will take you there. To be a surgeon, you don't have to make a decision now. And live with it. If you are the person who has to think and consult and come back, you cannot be a surgeon. You'll be the most miserable person that you can. And through my training, I have physicians, you know, attendings that, you know, at surgery, they were a different person. You could see that they were not comfortable there. For me, in the operating room, I feel like I'm in my house. I know how to get to every corner. I know what I'm doing. I know what is the next step and try to avoid problems. We have very little complications, and I think it's because of that. I won't get into a place that I don't know how to deal with. It's like you don't go to a cave. You don't know what you're going to find unless you're really prepared for it, right? So the same thing, you know, it's... So, you know, people should do, and I tell them, your personality will take you there, but one thing is very important. Always do the best you can because don't, you know, if you are going to, don't go because they are paying you or they are not paying for. If you do your best job, whether you are getting paid or not, payment will come later in whatever way it will be. If you do your best job, always can do more than what you are paid for. And then you'll be surprised of how much it takes you in the future. And kids today, I have a patron, actually, that is procedurally high-paid. She's from Indiana, and she's a recruiter. And it's funny because she told me, you know, Dr. Sardi, people don't want to work. I said, what do you mean? Yeah, having problem getting people to work. Tell me about it. Well, people want to work. These young kids, they want to work three days a week, run home, and get paid as a CEO. And I say, okay. No, no, it's a different world. Here you are working extra time doing this, the other. But really everybody's different and what moves you is very different to what moves me. And what we are trying to do with our organization is what moves you that we can really work together to make a difference in the future. But you're gonna do what you like to do, not what I want you to do, right? And that's the tricky part, find what people, move people in how they wanna help or can help, and then hopefully join forces to make a change.

SPEAKER_01: 1:25:19

Excellent. Well, I hope I get to see you continually at Gary's tournament every year and other golf tournaments, if there are, or other fun social events. I just hope to not have to come to Baltimore to see you on a professional basis.

SPEAKER_00: 1:25:34

Our golf event here will be September 19 here in Baltimore. Oh, there's

SPEAKER_02: 1:25:40

another one?

SPEAKER_00: 1:25:41

It will be for partner years on September 16th. It's actually a very nice golf course. September 14 is the walk for our research. We do what's called something called hit it to beat it. Patrons come from all over the world and they do a walk to raise funds for our research. We're a very active group in research here. And then the next day on a Monday, September 15, we have a golf event. So people do all of the weekend and I see them on Friday. And on Saturday night, we have a dinner, so everybody mingles together. So it's a kind of a weekend celebration and people connecting and you're kind of seeing the future. And it's always nice to see people, you know, that, again, we're told nothing could be done, enjoying life from all parts of the world and all, you know, women, young people, old people, men, you know, families together. All that is very rewarding.

UNKNOWN: 1:26:38

Yeah.

SPEAKER_01: 1:26:39

Yeah, I'll bet. So I want to end on this part is just tell me, how can somebody learn? I mean, they can Google you, but do you have any other resources out there? You mentioned, is it a nonprofit that you have, the Abdominal Cancer

SPEAKER_00: 1:26:54

Alliance?

SPEAKER_01: 1:26:55

Give me a rundown through everything you're involved with and how people can connect and support you.

SPEAKER_00: 1:27:01

Yes, there are different. I mean, one is direct. If you want to do a donation, for example, or want to play on the event, you go to the Abdominal Cancer Alliance or the abdominalcancers.org. abdominal cancers, you know, with that ORG. And they will do a lot of information about, you see patient stories, their way to donate. It tells you about the events coming up and ways of how to get involved. You know, if you are part of a social media and you want to advertise more about this, if you want to have a patient story, you know, we have many patients from really any part of life or almost any state. We have people from over 12 countries and you know 48 states at least coming to us from different parts of world with different backgrounds um that are you know having fun you know and uh and and so so there are multiple ways so the idea is that how you as a person i say you everyone there that is going to listen to the podcast is what is your interest how much time do you have what is your talent And how much time do you have to give it to help this cause? And it could be as simple as, hey, I know someone who really would love to help with this. Or I just want to talk to a patient about this because I'm a patient with this problem. Many patients don't want to get involved more than just talking to other patients. So when they have a problem, they can communicate with them and tell them, share with them how they went through all this without... given up. Really, the question is how would you like to be part of changing the world? That's it. One step at a time.

SPEAKER_01: 1:29:01

Yeah, one step at a time. Well, I'm grateful to know you, first off, to be able to do this interview and to help raise awareness and help you accomplish some of your objectives. So I'd love to have you on again in the future, no doubt about it. incredible thank you um for sharing all the all that you did and i'll link over to everything all the properties that you said social and abdominal cancers the alliance the website and stuff like that so okay thank you

SPEAKER_00: 1:29:33

no no no thank you thank you jeff i mean really have been a pleasure to have met you as well and really i think you know things happen for a reason i'm always convinced about it and uh and working together is what is going to make the difference

SPEAKER_01: 1:29:47

I believe it. Thanks a lot, Doc. Appreciate it. Stay on for a couple seconds after. I'm going to hit stop.