From Scalpel to Strategy with Dr. Wade Fischer

In episode 5 of The One Percent Doctor, Adam Lamb interviews Dr. Wade Fisher, a Cardiovascular Surgeon, as he shares his journey from aspiring orthopedic surgeon to a leading heart surgeon, and how his passion for health and wellness has shaped his approach to medicine.

Tune in to discover the dedication and expertise that define excellence in the medical field.

TIMESTAMPS

[00:02:50] Health and wellness in surgery.

[00:08:02] Athleticism and family influence.

[00:12:07] Inflammation and cardiovascular health.

[00:15:44] Cholesterol and dietary impact.

[00:20:20] Importance of muscle mass.

[00:25:28] Physical activity instilled in kids.

[00:27:09] Visceral fat versus subcutaneous fat.

[00:32:40] Measuring visceral fat.

[00:37:30] Testosterone and cardiovascular health.

[00:43:31] Health span versus lifespan.

[00:46:03] Mindset and lifestyle changes.

[00:50:02] Smoking and cardiovascular disease.

[00:54:06] Personal responsibility in healthcare.

QUOTES

• "I think the quality of your life will be better if you're able to maintain your muscles into your 70s and 80s and beyond. And also by having muscle, you're more insulin sensitive. It helps you manage glucose better and manage your sugar better." - Dr. Wade Fisher
• “There's just a different value to life by any means, but just as somebody who values being able to perform athletically well into, you know, past your kid and young adult years. It's just, it's important to have that.” - Adam Lamb
• "Visceral fat is definitely considered to be the more dangerous, but in general, the less fat you have, the better off you are, the less inflammatory you are." - Dr. Wade Fisher

SOCIAL MEDIA LINKS

Adam Lamb

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WEBSITE

One Percent Doctor: OnePercentDoctor.com

Transcript

Welcome to The One Percent Doctor podcast. What separates the good from the great, the standard from the extraordinary? It's not just skill. It's not just knowledge. It's mindset. It's execution. It's the relentless pursuit of growth. And that's exactly what we talk about here on The One Percent Doctor podcast. I'm Adam Lam. I'm your host. Welcome to the show. All right, welcome back to The One Percent Doctor podcast. I'm your host, Adam Lamb. Today, we have a good friend of mine, longtime friend and amazing doctor, Dr. Wade Fisher. He's a cardiovascular surgeon. He's been in the game for a long time. This man is a wealth of knowledge. I've been blessed to call him friend and known him for a long time. So grateful to have you on the show, Dr. Wade. Thanks for joining us and being here today. And thanks for the friendship.

Adam Lamb

Well, thanks for having me. And I'm excited to be on your show. Thank you.

Dr. Wade FIsher

So, you know, give the audience a glimpse of how long have you been doing heart surgery? I mean, that's not something you meet someone doing every day.

Adam Lamb

Oh, I've been, I finished my training in 1995. So it's, it's been about 30 years now. I've been in the game. And so like, how many thousands of hearts do you think you've, you've done surgery? I would guesstimate on average, and it's varied depending on which practice I've been in, that I've generally done around one or 200 hearts a year, give or take, but I also do thoracic lung surgery, some vascular surgery. So, you know, every year I do hundreds of procedures, but if we're just talking about, you know, the big open heart surgeries, probably 100 to 200 a year. So I would guesstimate in the range of 2,500 to 3,000 hearts would be my guesstimate.

I would say that makes you an expert. And you know, what I've loved about our relationship, having a good friendship, I've always been able to like kind of run stuff by you. And, and I appreciate that because I think you're a wealth of knowledge, but one of the things I've liked about you the most in our relationship is like, you're also like a health and wellness guy too, which I think is maybe rare for cardiovascular surgeons. Give me a little background on, you know, like how you've like, how through your career as a doctor and then just if you've approached your personal health and how you eat and you know those kind of things you share a little bit about that I think it could be encouraging.

Sure. Well, I will say that throughout, through my time growing up, I was always involved in sports and enjoyed sports and played football and hockey and did some running. And then during, once I, originally when I went into medicine, I was going to go into orthopedic surgery and do sports medicine. But when I was rotating, everybody in medical school does six weeks of general surgery, three weeks of a subspecialty that you're assigned to, and three weeks of a subspecialty that you choose. So I did my six weeks of general surgery, and I chose orthopedic surgery as my elective, and I was assigned to cardiac surgery. And everybody hated cardiac surgery because, especially back in those days, the medical students were treated very poorly. And it was long hours and not generally a pleasant experience. But I had to say that that was one of the coolest operations that I had ever seen when they opened the, the head surgeon opened the chest and arrested the heart and you saw the EKG stop and did a valve replacement or bypasses. And so that changed my trajectory in medical school from being focused more on what I thought I would do, which was sports medicine, to going into heart surgery. But I still try to stay in the game with sports. And over the years, I've been involved with doing triathlons I did an Ironman triathlon years ago. Actually, that was in 2009. I got involved with CrossFit for a few years, and of course, I got multiple repetitive use shoulder injuries from doing CrossFit.

In some dimension, if you don't mind, Wade, is not everybody is going to be watching this on video, so they don't get a chance to see you. How old are you? I'm 64. Yeah, it's, it's still kicking butt and taking names, which I, which I love. And when, you know, you're iron, so, you know, when you talk about doing an iron man in 2009, you know, you, you weren't a spring chicken.

No, no, I was, uh, I was in my, my forties at the time and between, uh, having a a busy cardiac surgery practice and trying to train for an Ironman. It was like having three jobs. And I think that was the closest my wife ever came to leaving me.

Yeah, at least she could not run yet. But that's glad that she glad that she didn't. And then like, yeah, you you met your wife and you have two sons, right? You boys. There are ports, right?

Yes, my older son, after high school, played two years of junior hockey and was recruited to a D3 school, Misericordia University, where he plays D3 hockey. And he also walked on to the tennis team years ago. He had played tennis since he was very small and he beat everybody on the team. So now he's the number one single men's player for his college tennis team as well. Almost like by accident.

I love the walk-on stories. And then your other son, he plays hockey too?

Yes, he's a senior in high school and he's at a boarding school in New Hampshire where he just finished his season playing for the New Hampshire Mountain Kings AAA team. and he's trying out for a number of junior hockey teams. He was up in Canada for a couple junior tryouts in the CCHL, and so he's excited about where he might end up to continue his hockey career and hopefully do, as his brother did, get a commit for college hockey. That's awesome.

And, you know, I think, you know, as a, I'm a dad to my son plays competitive soccer and, you know, it's a lot of commitment to, you know, work. the way that we work and not, you know, I know that you and I both just work a lot, obviously in way different sectors, but, you know, being a heart surgeon, kids, and I'm assuming they're in travel, hockey, which is a full-time job in itself, doing all those. But, you know, one of the most important things I think that often gets overlooked is like how we lead by example as dads, right? So like you being into athletics probably helped set the bar, you know, in your house of, you know, staying healthy and fit, right?

Absolutely. As a matter of fact, both my boys are very, very athletic. And my older one, when I was doing the Ironman triathlon training, he wanted to do a triathlon. So we signed him up. They have the Iron Kids triathlon program. He ended up as a six-year-old. He won his age group in nationals. That's awesome.

That's cool. I didn't know. I learned something new about you every time. I love that. I think it's just something that's often overlooked. As healthcare professionals, I love, especially you, the guy that works on people's hearts that are likely ignoring their health. It can be a genetic issue, but a lot of cases, it's people that are ignoring their health. I think for me, if I have to get heart surgery, I want it from the guy who also values somebody who's athletic and lives that life because there's a certain lifestyle that you know, the difference of being able to exercise pretty rigorously regularly versus somebody who just sits on the couch and eats junk. There's just a different value to life by any means, but just as somebody who values being able to perform athletically well into, you know, past your kid and young adult years. It's just, it's important to have that. And so that's one of the things I love about you. Tell me, tell me a little bit like, you know, in the heart surgery space, what are some of the biggest things you see that, you know, just people have to avoid for better health? Like what, what are some of the things you would say in that area?

Well, you know, the, the, Population as a whole, and we've talked about this, has become a third of us are morbidly obese, half of us are obese, and even now with children, there's a huge obesity problem. And this sets the groundwork for being a metabolic dumpster fire as you grow older. And once you have that milieu set, it's extremely difficult to break out of it. And so it's not necessarily one thing, but it's everything that we talk about. It's your diet. And when I say diet, it's all this stuff that we know you should do, but we often don't do. not eating sugar, not eating fried food, not eating fast food, eating whole foods, fruits, vegetables, all of those issues. And I tell patients, whatever diet they choose, that the most important aspect of a diet is not to eat more than More calories more energy than you're going to expand because it doesn't matter if you're whether you're overeating mcdonald's or your. overeating some high-end steaks. It's still overeating. And so it's the whole avoiding that cycle where you eat poorly, you don't exercise, and you develop that inflammatory obesity, obesity-generating lifestyle that is always going to end in disaster.

And I'm glad you brought that up because I think a lot of people, they think, okay, you're obese or you're fat or you're overweight. But one thing you mentioned there is people forget the amount of inflammation that starts piling up inside of their body. due to a lot of poor health decisions. And ultimately, inflammation is really, would you say, what leads to a lot of these cardiovascular events?

Yeah, I think our understanding of how heart attacks happen, of how strokes and atherosclerotic disease and plaque formation in vessels, our concept, I think, is starting to evolve. It started out, well, you know, the plaques are made of cholesterol. So if you have a, you know, high LDL, if you have high cholesterol levels, then that's what's gonna cause it. But it's not just the cholesterol level. It's also high blood pressure sets the stage for endothelial injury, which allows the plaque to form, ultimately might cause the plaque to rupture. And underlying all of this that we're just now, I think, really starting to get more of a handle on, I think people who aren't in mainstream medicine have understood this concept before. mainstream medicine has, and that is inflammation and markers like CRP are indicators that there are problems that may be brewing even before you have an elevated cholesterol or an elevated triglyceride.

Yeah, that's one of the things, you know, me being in the health and wellness space for so long, like CRP, which is C-reactive protein. And there's a couple different markers to look at, right? You have like your quantitative and then you have the cardiovascular, which is what, which I think is one that's. really important to look at is like where you're at. And there's some people we see with that have the inflammation, cardiovascular inflammation that like a smoker would have. And, you know, we want to try to figure out the root cause of what could actually be causing that higher, you know, they don't smoke and maybe they're not even overweight and trying to figure out what some of that stuff could be going on in their body. Curious if you ever see any rare situations as it comes, comes with like, you know, uh, and you probably don't see these people, you see them after an incident typically, right? Versus what their cardiologist or maybe primary care sees from that standpoint. The inflammation, yeah, it seems to be, and like you said, the people outside of mainstream medicine have been following this stuff for a long time, but we're starting to really see that change of how that inflammation like you said, and blood pressure, that pressure inside of your system that can lead to a rupture of something that causes a significant event.

Yeah, I mean, there are definitely some genetic predispositions and even some genetic syndromes that you can't escape if you happen to have one. If you have familial hypercholesterolemia, then you're going to be battling your cholesterol, and that's not somebody who I would encouraged not to take statin. That's somebody whose wife is going to depend on being on statins and other medications like that. And it's interesting from a from the diet standpoint. There's a, he is a general surgeon at the Cleveland Clinic, a guy by the name of Caldwell Esselstyn. I don't know if you might've heard of him. He's written a few dietary books, but he's a big proponent of being a vegan. And he said everybody eats too much protein. And that was part cholesterol, saturated fat, all of that were the issue. And he actually has one of the only small studies. He had patients at the Cleveland Clinic who were not candidates for surgery and were not candidates for angioplasty and stenting who had critical blockages in their coronary arteries. and he put them on his vegan diet. And he actually showed, it was a relatively small cohort, maybe a dozen patients. He actually showed angiographic evidence of disease resolving in the coronaries. So that he would put, he had their angiograms pre-diet, put them on the diet, and then Andrew Graham's post-diet, and actually showed resolution of plaque and blockages. So that clearly there's something to that, but that's only a piece of the story. Now having said all that, I'm a big meat eater. I eat steak, it's probably my most common dinner. Yeah, I think that that you know that is the cholesterol issue is is a piece of the of the problem, but it's also the the the sugar issue where. It's not just having cholesterol, it's when the cholesterol gets glycosylated, meaning that it gets coated in sugar that adds to the inflammation and the endothelial injury that leads to plaque. So I think that there have been many people who have identified a piece of the puzzle and have shown how that piece fits into that if you do this, then you can, you know, if you're a vegan and you can lower your cholesterol, then you can actually potentially show a resolution of disease. But that's not the whole story. And it doesn't necessarily, to my mind, mean that that's the answer. And clearly it's not because there are plenty of vegans who are dumpster fires metabolically as well.

Well, and I think there's like this, you know, it's why like treating all of it, you know, I think there's a difference too, between someone who has, you know, a triple cheeseburger every other day and French fries and sits on the couch versus someone who has, you know, a 10 ounce steak and a potato three times a week and goes to the gym four times a week, you know, and that, that's so like, there's a difference I think in how the body uses that stuff, but also the quality of, of the intake of those calories of carbs and protein, you know, sometimes we categorize carbs, you know, all proteins not created the same and all carbohydrates are not great same based on how they convert in the body. And so that can be something that people that are unknowledgeable. can easily categorize something that's not fully true. And then, you know, there's a lifestyle aspect of it. And so, you know, I think someone like you, like you said, you eat steak pretty regularly, as do I, but you also, you know, how often do you exercise? What's your, at 64 years old, what is your, you know, workout regimen like?

No, I have a gym in the garage and I try and do something every day. Now, sometimes the something may just be walking up and down the flights of stairs in the hospital for that day if I'm on call and I'm in the OR most of the time. But I try and get in around three to five strength training sessions a week. And I try and do some kind of aerobic exercise, whether it be walking, jump roping. Actually, when I walk the dog now, sometimes I'll throw on a weight vest to burn a few more calories. And I think a part, we talked about what can people do besides their diet. I think two other key issues are creating and maintaining muscle mass. And I think that's very important from a frailty standpoint as you age. I think the quality of your life will be better if you're able to maintain your muscle into your 70s and 80s and beyond. And also by having muscle, you're more insulin sensitive. It helps you manage glucose better and manage your sugar better. So that I think it's also a key piece in having a good metabolic milieu.

Well, I know you think of it, you know, that a lot of times people hear muscle and they think you have to look like a bodybuilder. And you're not saying that by any means. It's just a matter of, you know, number one, muscle helps you be stronger and do the things even daily, whether it's going up and down stairs or moving something around in the garage or getting in and out of your car. But the other part is that muscle can create a layer of protection to the bone, right? So there could be less likely for breakage if you do have a slip and fall type thing. And then even like you mentioned in the metabolic piece, I think a lot of people don't know that the more muscle mass you have, the better your body is at processing sugar and makes you less insulin resistant. And it just makes more sense. And you can only get muscle by strength training, typically, you know, or some sort of something along those lines. But it just seems to be often overlooked, especially when you think of, you know, even you as a kid, I'm sure if you looked at your PT or, you know, or phys ed classes as a kid versus what the kids do today, it was probably a bit more strenuous of activity. when you were in school versus kids in school today? What do you think about that?

I think that's very true. I think this has been a cultural problem that has just gotten worse as the video games have morphed into the iPhones and beyond. and social media and all those I think are important issues that are part of, I mean, there are certainly positive aspects of that for our culture, but some of the negative aspects are the kids who now don't go outside and play ball, but are sitting inside playing electronic games, electronic ball rather than, than being physically outside doing things.

And you know, both of them, I get my daughter does competitive cheerleading and my son is competitive soccer and they both train about, I'd say two hours, six days a week, right? And so that I would say it's pretty good for a young person. And so, you know, for us, I don't really care when they're on their phone or my son, he likes to play video games with his headset and his buddies are all playing. It's like a social thing that they do. But I know that they're also, doing the physical things versus only living on the electronics. Because a lot of docs I coach or dads I work with, they're like, oh, my kids are They're always on their phone. We always are. I'm on my phone all the time too. But also if you're having that healthy balance of physical activity. And here's the thing is that it's hard to get someone to start exercising regularly in their 30s after a bad doctor report versus just keeping that, whether it's go for a walk with your kids or lead by example. My kids have been going to the gym with me since they're three months old. They just, you know, they're familiar with athleticism. My wife and I both live that. And so I think that it's a culture that starts at home. But if your home you grew up in that isn't it, you know, it's time to add that habit to your schedule because it can save your life.

Yeah, it's definitely more difficult if you don't start young. And when the kids do start young, I think we've touched on this before, when they play competitive sports and they want to get to the next level, then lo and behold, their coaches are telling them that they need to get sleep and they need to eat right. And they start to learn and pick up those better habits on their own. without our having to mandate it. And I think that is probably one of the best benefits of kids playing competitive sports.

Yeah, I think a lot of times, my father-in-law, he's from France, and so he's not a sports guy. America, we're obviously just a bigger sports country. And so he never understood the value in like, wow, they spend so much time doing it, but we're instilling the value of physical activity into our kids with the hope of you know my wife's in her 40s i'm in my 40s and we both go to the you know we both exercise pretty much daily and and so do our kids and we want that for them and we want that for their kids and you know just it creates a healthier environment and you know and some education around food what's good what's like my kids know that bowl of lucky charms that they want is full of garbage and they shouldn't be eating it but they might have that snack every now and then but they also know like hey i need to eat some chicken i need to eat some steak i need to eat some rice and it it just really it starts at home and event you know if we all do a little bit of a better job learning that for our own family, implementing it, right? That we have less people that actually need to come see you with a surprise visit of a heart incident, right?

Yeah, I definitely agree with that. And I would also, going back to our recommendations for what can people do to try and avoid developing atherosclerotic disease and avoiding the inflammatory condition is by maintaining part of maintaining and increasing muscle mass, is usually goes hand in hand with losing fat. And one of the things that every patient, almost without exception that I operate on, is that they have a significant amount of visceral fat, even when they're not necessarily overweight by normal population standards.

Explain a little bit about what visceral fat is versus maybe, what's the word? I can't think of the word for the other kind of fat we talked, but explain a little bit visceral facts.

I think there's subcutaneous fat and fat. Yeah. And the generally what I've read in a lot of the health and wellness literature is People say that the subcutaneous fat isn't as problematic as the visceral fat, and technically that's probably true, but I don't think you're going to have a lot of subcutaneous fat unless you also have significant amount of visceral fat. I think they go hand in hand, and visceral fat is fat around your organs. so it's fat around pressure and it's just you're basically putting a tighter area on a lot of your organs by that fat expand well yeah it definitely does uh it does put stress on on your organs but more importantly it it creates hormonally the inflammatory condition that we've been talking about. And the visceral fat in particular, and depending on your genetic predisposition, some people develop more visceral fat than subcutaneous fat, but I wouldn't Visceral fat is definitely considered to be the more dangerous, but I think in general, the less fat you have, the better off you are, the less inflammatory you are. Now, I don't think that it's, you know, there are extremes for both ends. I don't think it's necessarily healthy to go down to single-digit body fat like many of the bodybuilders do and go to great diet and and drug extremes in order to achieve that. On the other hand, I think that once you get over about 25% body fat, then you're starting on the road to having that inflammatory milieu. And the visceral fat is a significant part of that.

You know, you bring a good point. Like for me, I think last time I checked my body fat, I was at like 14%, which I wasn't pleased with. Ideally, I'd like to be around 10. But even to that point, 10 is a very hard level to. sustain without pretty considerable restriction, you know, for a man, for a woman that I would consider that to be unhealthy. You know, those bodybuilders, when I used to bodybuild, I got myself down under 4%, you know, which was, and it hurt to walk because I had no fat even on the, I had like baby fat that was gone. And so like, to your point, yeah, you don't, you don't have to be this shredded fitness model. It's just a matter of gauging that, that, you know, subcutaneous fat and, as a sign of what's that visceral fat? Is there a good test that someone could do to check what their visceral fat is necessarily?

Well, you can get a DEXA scan, something along those lines. Some of the scales that they sell now do They give some kind of electromagnetic assessment when you stand on them, but they're extremely, extremely inaccurate. I think the most exact one is either an MRI where they can actually calculate the exact amount of fat you have. Or they also used to do it with displacement with water. I'm blanking on the name of that. But there are a number of different ways of doing it. There's actually, I came across something called Spren. It's an app for your phone. I think it's S-P-R-E-N. I'm pretty sure it's a free app, and I think it gives a fairly accurate assessment of body fat. I don't know exactly how it works, but when you use it, you put the phone down on the floor and angle it up a certain way. and it has you step away and you just wear like a bathing suit. It takes a picture of you frontal and side, and then it goes through a number of calculations based on the picture of what your body fat is. It claims to be as accurate as a DEXA scan. I don't know if that's true or not, but

I'll look into that. For me, to your point, not all of those things are accurate. When I do it, I use the same one. When I go to the gym with my wife, they have an in-body, and I use the same one. But you know what? There's so many variations of how hydrated are you versus not hydrated. There's some of those things that can vary to that. But I think for people that are concerned, it would be good to take a look at that. And like you said, if you have the subcutaneous fat, you probably have the visceral fat, but there's a lot of guys I think that just don't live even, you know, like sleep apnea. There's a lot of sleep apnea people that don't, I think they develop that visceral fat more from the sleep apnea at a faster rate. I don't know if you've seen that as well.

Well, actually, sleep apnea is a major problem in a number of ways. It's actually increases your likelihood of developing heart failure. And it has to do with these episodes of hypoxia that occur while you're sleeping. And a very simple way just- Talk a little bit about what hypoxia is. One thing I wanted to mention, an easy way to measure for visceral fat is by your waist circumference. And if you're a man, I think they say if your waist circumference is over 36 or 38, then you likely have a dangerous amount of visceral fat. For a woman, I think it may be 34 or 36. But that's a simple measurement that everybody can do to get an idea of, you know, in a very rough way where they are on the scale. Now, hypoxia in relationship to sleep apnea is when people who have sleep apnea literally stop breathing while they're sleeping. And it happens for a number of reasons. which I'll let one of my pulmonology colleagues elaborate on, but part of it has to do with a collapse of the airway while you're sleeping, and that's associated with obesity. But what happens when you stop breathing then you're hypoxic, and hypoxic means that your body's not getting enough oxygen. So if you're not breathing, then you're not exchanging oxygen and CO2 in the lungs, and then you're losing your cells of your body, then start becoming starved for oxygen. And if it is prolonged, then it can lead to brain injury, heart attack, all of that. But with sleep apnea, you don't stop breathing for that long a period of time. But the intermittent episodes of periods of inadequate oxygen, we are leading to heart failure and other end organ damage.

One thing I heard with sleep apnea is also that, you know, when you stop breathing, your body almost has that like fight or flight response of like fear, like, you know, if I ran into your bedroom while you're sleeping and jumped on you, and that it can release sugar into the system because you have this quick fight or flight state, but because you're laying in bed sleeping that that sugar then can start going back and resting around the organs and then it eventually can start becoming more of a visceral fat issue.

Yeah, well, I think that that you do have probably get increased levels of cortisol, which will lead to increase release of blood sugar from, you know, you're having the sensation that that you're choking, whether you're aware of it or not, and the body responds. But I think that the more important or the more dangerous issue is the periods of lack of oxygen. But I mean, neither are good. Right, right.

And, you know, one thing I want to talk about with you, too, that we talked about strength training in heart and, you know, recently in the news, they took the black box warning off of testosterone. And so for people that aren't aware of that black box warning means it's kind of a high risk thing because studies for a long time that I think were done inaccurately, were saying that testosterone can increase the tendency for cardiovascular disease or heart problems. And what they realized over more recent studies is that it can actually be more cardiovascular protective. And I, you know, obviously use it as a cardiovascular surgeon, you know, love to hear what's your feedback, you know, what are you seeing in that?

I think that low testosterone is a risk factor for cardiovascular events. And so I think that if patients have low testosterone levels that, and again, when we do blood work, we're looking at population norms. And so what might be within a normal range of testosterone is not necessarily what is an ideal level of testosterone for a patient or for anybody. Yeah, because the range is so big too, specifically on total testosterone. Exactly. No, but I think that low testosterone is a risk factor for cardiovascular events. And I think that could be an indication for TRT.

And, you know, what we see too, you know, being in that TRT space for so long is that usually guys that lower testosterone, they get more optimal, right? Not abusive bodybuilder stuff. We're gonna talk about those guys, but just optimal testosterone levels. Well, most of those guys tend to exercise a little bit more. And they also, when you're building muscle, like we talked about too, so that muscle, instead of that degenerative process of losing muscle or the catabolic process, is they begin to be in more of an anabolic state of building muscle, getting stronger as they age. And I think their body just has a bit more endurance to do some of the things at a later age than it would without the testosterone. That's what we see in a lot of patients too.

Yeah, I definitely agree with that. And it's interesting that years ago when AIDS was a newly diagnosed disease, and many of the patients who had the HIV virus and had the full-blown AIDS, one of their major issues was muscle wasting. And so some of these patients were starting to be treated with anabolic steroids or testosterone. And I often think that in some of my patients who need to have heart surgery or recovering from heart surgery would benefit from some of that.

it just to be just to be healthier and stronger. And you know, one of the things I know you've mentioned in the past too, is you know, when when you before you're going to do heart surgery on somebody, you're you're kind of walking them through almost like you said, like a frailty test or something like just to see Yeah, talk about that.

In particular, when we're evaluating patients for heart transplant, but also for other big operations. And we do six-minute walk tests to assess their ability to ambulate and how far can they go on a six-minute walk test. And we do grip strength tests. as an assessment of frailty. And if a patient is too frail to pass some of these tests, it's been shown that they have a significantly higher morbidity and mortality, meaning they're at much higher risk for post-op complications or death before, during or after surgery. And so, you know, that that is also an important consideration. As a matter of fact, a patient I saw today is a 68 year old gentleman who is morbidly obese. who came into the hospital with shortness of breath. He is diabetic. They did some lab tests and they found that he was in heart failure and he was having a heart attack and they did a heart cath on him and he had severe triple vessel disease. And he also, had newly diagnosed renal failure. He was still making urine, but his kidney function was not normal. And his risk of death from surgery is in the range of about 10 to 20%. If you look at all comers that we do open heart surgery on, the average person's risk of death is just under 2%. So here's a guy who, from my standpoint, where I'm sitting, 68 isn't that old. And I think that right now he's too high risk to do open heart surgery on, even though he's got good, his vessels are good targets. If I could get to that heart without having to give him anesthesia and put him on the heart-lung machine, then he would benefit from it. But because he can't ambulate well because he's so overweight and because he's you know, got renal insufficiency and has all these comorbidities, he's actually better off having angioplasty and stenting by the cardiologist rather than my doing open-heart surgery because I don't think he's in good enough shape to be able to recover from surgery. And my discussion with him was, look, get the angioplasty and stenting. We know that for diabetic patients with multivessel disease, it's not as good a fix as open-heart surgery. But if you do it and you change your lifestyle, and we know that coronary artery disease is a progressive disease, then maybe in 10 years when you need an intervention again, you'll be in better shape to be able to tolerate surgery at that point.

Yeah, it's amazing. It's sad, you know, that it takes somebody that, but you know, there's, there's these, call it 68 years of choices, you know, and potentially lack of discipline. And, you know, sometimes it's knowledge, but, you know, I think maybe we could do a better job at teaching people even, even through school, but, but it's sad that someone gets themselves to that point where your body is, is It's quitting on you, right? Like there's just so much in that could just it's not the case. And that's what I love about you being like you are the heart surgeon and you exercise regularly. You eat the way you eat in it. You're an example of that. for so many versus, you know, not being that example, it's just, it's sad, right? So for me, I've always wanted to be in top health. And I think that's probably something that you value as well, obviously. And so, you know, do you find it hard sometimes, like almost frustrating when you meet some of these people that like almost seem too far gone? Like do you deal with some of that sometimes or?

Well, you know, we are, Medications and our technologies have gotten so good that even though these patients are so ill, we can still keep them alive for a long time. And then we get into the discussion of health span versus lifespan. One of the things I'll tell patients, and I wish I could remember where I saw this to reference it, but everybody has pain in life. And it can either be the pain of going to the gym and not eating desserts or the pain of illness later in life.

Yeah, and at the end of the day, it's like going to the gym. I don't hate going to the gym. I like going to the gym. I'm sure you like to go out in your garage and get a little workout in when you can. And it's just a perspective shift, right? And so changing the perspective, I even think with alcohol, I used to drink alcohol regularly. eight and a half years ago, I quit drinking alcohol. And a lot of people are like, how do you do that? How do you stop? I just, I just stopped. And so I changed my perspective on how I felt about consuming alcohol. So I just stopped. But you know, it was a mindset. It's a mindset. Same with the gym is, everything sucks in the beginning, that's hard and change. But through time, you can learn to love those things. And they can also produce a lot of fruit in your life if you're willing to kind of go through that period of discovery.

You're absolutely right. It is it is a mindset. And it's you know, you can do that. You can eat better because you can look at dessert and say, is this going to help me achieve my goals? Is this going to help me live longer? Or is it just going to be, you know, a minute of of pleasure on my whips or a decade of fat on my hips.

It's great. And I like a little ice cream sometimes, but again, there's a balance in all of these kinds of things versus having, even being in the hormone space for so long, those guys, we'll talk about testosterone, for example. I'm like, listen, man, if you're if you're exercising regularly and you have a healthy sex life and like you or you have like a, you know, like a lust for life and you want to get out there and do things and explore, you know, and you have low testosterone, increasing that than optimal testosterone is going to help you. But you're going to you're going to enjoy all those things more. Now, if you eat fast food every day for lunch and you drink six beers sitting on your couch every night and you don't do any physical activity like little testosterone is probably not going to help you feel much better without some, you know, psychological motivational change of how you spend your time and what you want to do with this body that you're, you know, we only get one of them, right? And it's harder to turn that ship around it. Someone who's maybe 68 versus 38, you can make some changes that can really impact the future. It's harder to in later years. How often do you see people that even after a surgery or something like that, that just don't change? Does it happen often or is something like an open heart surgery really change somebody?

You know, I've seen it go both ways and everybody is different. Some patients, you know, they, you know, find, I'd say they find religion, you know, they have the epiphany and they say, you know, I'm done, you know, I'm gonna change my lifestyle. And, you know, one of the ways I present it to them is I say, if you're gonna get the most benefit from this surgery, then you need to stop smoking, you need to start eating better, you need to do all the things that you know you need to do, or we could potentially be doing this again in a few more years rather than never or in a decade. And coronary artery disease, there's no cure. When we do bypass surgery, when we give medications, it's all palliation. It's slowing the progression of disease. So if you can understand that concept, and that's why I present it to them, is if you want to get the most benefit from this operation, then you need to make these changes. And again, some of them do, but some of them, you know, they feel better and then they go back to smoking or, you know, not working out or eating poorly.

Oh, it's interesting. You mentioned smoking just now. It's the first time we talked about smoking, but you know, in my head, sometimes I forget people still smoke. And I used to smoke. I mean, when I was in my 20s, I worked in bars and drank and nightclubs and smoked cigarettes. It's so stupid. But I wonder, you know, two questions for you. One, you know, is that the number one, like, if there's a number one, I know you mentioned obesity, but like, and then I think you, you know, if you match the obesity with smoking, curious how much of the smokers you see. And then secondly, I feel like people in Europe, like everybody smokes, and I don't know if they have the same cardiovascular issues in Europe, as we do here in this country, do you know?

Yeah, all the Western societies have the same issues. And the smoking is huge. The smoking is a rapid accelerator of coronary artery disease.

You're getting a ton of inflammation, right, from the, I mean, you're inhaling carbon monoxide in your blood.

Yeah, and if you have a genetic predisposition for heart disease, then it's going to increase that likelihood even more. And the nicotine, it causes constriction of the vessels, so it adds to the high blood pressure, it It does so many bad things that it's really a shame that anybody still smokes on a regular basis. And if it doesn't give you a heart disease, then you could get throat cancer, lung cancer. It's a progenitor of almost every cancer there is as well, but in particular, throat and lung cancer.

I think there's been a lot more research done lately too in the amount of carcinogens that we can consume, not just from smoking, but just environmentally, there's a lot of carcinogens we consume, whether it's in lotions or detergents or foods that we consume. And then you add an obvious carcinogen on top of it, like smoking, and it's just bad news. Yeah, it blows me away, especially if I see someone who's morbidly obese, they're smoking their cigarette, their face is just crazy red, and then anytime they're gonna have an event, you can probably tell by looking at them, I'm sure, in some extreme cases.

Actually, if you look, there's some early heart transplant data that showed that post-heart transplant, that the patient went back to smoking, they were dead within six months to a year, 100%. Wow.

That's, I mean, that's, that's a, that's a game changer. You know, you would think if you told that to that person, they're done, you know, like there's a hundred percent within six to 12 months, you're dead. Like that's, that's pretty, pretty intense.

That's why it's an absolute contraindication to being listed for heart transplant.

Yeah, I guess it has to be. So I mean, that's that's that's wild. Well, listen, I loved having you on the podcast. I appreciate the friendship and your wealth of knowledge, your willingness always to help out. We're so grateful. you know, just to have you here for me personally as a friend. And so thank you, you know, thanks for being a 1% doctor. I think there's so many people who just be inspired by you. I am personally, because I think, you know, your cardiovascular surgeon, which is, you know, that in itself is extreme, you know, awesome family guy. kids in sports, you're still doing athletic stuff, like just like living by such example. And that's why when I think of like a 1% top 1% doctor, I think of you. And so I'm grateful that you came on the show and shared your wisdom and had the conversation. Any last words for anybody listening that you can think of words of wisdom or advice or anything like that, Dr. Wade?

Well, first off, I would tell you that, Adam, thank you for having me. And I've enjoyed all our conversations and look forward to more in the future. As far as advice for people, I would say you have to, especially in medicine and in our health care system, Nobody is going to look out for you as much as you are. You have to take responsibility, both for navigating the system and looking up, you know, what medications your doctor tells you to take, you know, asking questions if, you know, whether you should have one procedure or another, and all these things are, you need to take personal responsibility for.

That's great advice, you know, and I think you're right. There's too often we just want to put all the advice in the doctor. And here's, you know, there's a lot of doctors, especially aging population that may have multiple issues, like to remember all the different doctors they see, to remember all this, you know, just add some questions. But I think to your point earlier in your life, if you take responsibility for your health proactively, you get to avoid. I don't think anyone's like, man, can't wait to have my open heart surgery. And I know you're not a, well, it's good for business guy. You're doing a great service to the folks that need it. But at the end of the day, it would be a wonderful world if no one ever needed that, with a few exceptions, because people just changed the way they lived and took control and valued their health and life a bit more.

Hopefully, we'll be able to get There.

I believe so. So thank you for being here. Thank you everybody for tuning in. Please like and share and subscribe to this podcast, The 1% Doctor, and we'll see you next time. Thanks so much for tuning in to this episode of The One Percent Doctor. Please be sure to subscribe to the show where you're able to consume more podcasts, get more value, and learn more about doctors potentially just like you. Please tell a friend, review the show, and we'll see you in the next episode.