Episode Transcript
[00:00:00] Speaker A: Welcome to True north, your destination for better health, brought to you by North Mississippi Health Services.
Each episode, we sit down with experts from across our health system to explore the topics that matter most to you and your family.
From prevention and wellness to the latest treatments and healthcare innovations, we're here to provide trusted information that that helps you make informed decisions and live a healthier life.
[00:00:34] Speaker B: Welcome back to another episode of North Mississippi Health Services Podcast. I'm Morgan Roe, brand strategist here at North Mississippi Health Services, and I have the honor and privilege of being with our general surgeon today. Dr. Hoang, how are you today?
[00:00:47] Speaker C: I'm doing great. How are you, Morgan? I'm doing well, thank you.
[00:00:49] Speaker B: Introduce yourself. Tell us a little bit about what you do and how long you've been with our staff.
[00:00:53] Speaker C: Right. So I do general surgery within the system, and I came to Amory out of training in New Orleans at LSU. So that was back in 2000. So this is my 27th year here with the system.
[00:01:06] Speaker A: Wow.
[00:01:07] Speaker B: I'm sure you've seen a lot of surgeries in that time.
[00:01:09] Speaker C: I've seen one or two.
[00:01:11] Speaker B: One or two. Well, let's talk about one or two surgeries real quick. I know you have a lot of patients that come to you for a lot of different reasons, and it's hard to just give a cookie cutter answer. But we'll give it a try.
Patients that are preparing for surgery, if they've never had surgery before, they could be very anxious.
[00:01:27] Speaker C: Absolutely.
[00:01:27] Speaker B: How do you talk to them about that?
[00:01:29] Speaker C: That's right. Well, it's okay to be anxious, but know that the team, and there's lots of members to this team, they've been fully trained and they've trained for years to accomplish this task. So. And that patient. That patient is not a number to us. That patient is somebody's mother, somebody's daughter, brother, so on and so on. So we take that seriously. And that means a lot to us that they gave us the opportunity to help them so they can rest assured that we're going to give them our best effort. And it's okay to be nervous, but we'll take good care of them.
[00:02:05] Speaker B: What questions should they come to you with if they do have questions before surgery?
[00:02:10] Speaker C: Most of the time, patients don't necessarily ask, for example, how we might do something. Most of the time, it's okay. After my surgery, when can I get back to being a mom, to going back to work, to mowing my yard, to dragging a deer out of the woods? When can I do all those things? In other words, Getting back to life. And so we spent a good portion of our time talking about that because ultimately they're not here to come visit with us. They have a problem, they need their problem solved. And hopefully we'll do that in a manner that gets them back to what they need to be doing, because that's life and that's what they enjoy doing. So we'll try our best to get them back to that.
[00:02:50] Speaker B: Let's talk about recovery for a little bit. I know that there are some special things we do here at North Mississippi Health Services for recovery efforts. What are those and how does that play into each of our patients roles?
[00:03:02] Speaker C: Right. You know, some of that it's because it's a team effort. There are things that we can do, but some things that also the patient can participate in too, because this is a team effort. So the things that they can do beforehand would be some things like for example, let's say they're having bowel surgery, intestinal surgery. Well, a lot of what goes on into when they recover is going to be how quickly their malfunction returns. So simple things like, okay, start an exercise regimen before surgery, even if that may be just a week, go ahead and start walking because we're going to get you up soon and ambulate. And the quicker you do some of those things, the quicker you recover. Even things like, for example, something as simple as a high fiber diet to kind of get your GI tract going quicker.
So at the time of surgery and after surgery, we'll do our part. And for example, if it's intestinal surgery, colon surgery, small bowel intestine, we employ what's called eras, enhanced recovery after surgery. And these are protocols, whether it's medication, type of medication, type of pain medications, early ambulation, so on and so on. That gets that patient through surgery with as least pain as possible and also as quick of a recovery as possible so they can get in and out of the hospital and back to their life.
[00:04:23] Speaker B: Because ultimately that's what we want.
[00:04:25] Speaker C: That's what we want. That's right.
[00:04:27] Speaker B: Let's talk about surgery day.
[00:04:28] Speaker C: Sure.
[00:04:29] Speaker B: What can someone expect? Again, I know we're talking very general here because it's hard. Every patient's different.
[00:04:34] Speaker C: Right. So most surgeries will involve first of all going to what's called pre admission testing. And that's where they meet the anesthesia team. They get labs, EKGs if necessary, chest X-ray and so on and so on. So that's called pre admission testing. We also check to see, okay, whether or not Their labs may need to be tweaked, their blood pressure medication and so on. And so once all those things are optimized, then they come in the day of their surgery. So when they come in, most of the time you can't eat or drink anything after midnight. That's pretty standard protocol for most procedures.
And then they come in and we get them ready, we put them in a gown.
And some patients will have certain needs. For example, some will tend to be have some nausea after surgery. And they know from maybe previous surgeries, hey, I tend to get nauseated. So we have different protocols to help with that. Post op nausea, we start an iv. Sometimes they'll get IV antibiotics prior to surgery to help reduce the chances of an infection. After surgery, their procedures obviously may vary in time. And then they go to the recovery room, they wake up, perk up, use the bathroom, hold down something, and then it's back to the house for the most part. And obviously if they're admitted after certain procedures, there's to the floor or going to the ICU after that.
[00:05:57] Speaker B: Okay, you listed a lot of steps, so there must be a pretty big care team. Can you talk to us a little bit about that?
[00:06:03] Speaker C: That's right. So on any given day, even if I'm here by myself back in surgery, I'm the only surgeon there. There's actually about 23 employees as part of the OR team. Everyone from someone who checks in the patient up front, to the pre op nurse, to the nurse that starts the iv, to the nurse that picks up the patient, to the crew members in the or, to the anesthesiologist, to the CRNAs, which are our nurse, anesthetist, and then the post op recovery room nurse and then the outpatient nurse and then somebody who wheels them outside. So when you add all that up, that's a lot of team members and they're all dedicated to getting you better and getting you back.
[00:06:46] Speaker B: That's a lot of people working together.
[00:06:48] Speaker C: That's right. And it's a well oiled machine. And, you know, if things can come up, if there's a lot of sets of eyes, then maybe we can help prevent things from, for example, falling through the cracks. You know, in, in medicine, it's all about safety. Safety is number one. And we will try to do the safest procedure in the timeliest manner possible.
And it takes a lot of people to make that happen.
[00:07:15] Speaker B: How do you ensure that?
[00:07:17] Speaker C: Well, there's everything from checklists to in surgery we have what's called a timeout. So when the patient is asleep. Let's do a timeout. Everyone and everybody directs their attention to a nurse who's doing the timeout. And there's a list of the things that we describe. And during that part, it's, I might say something like, okay, guys, this is going to be something that we may have a lot of blood loss, so let's make sure blood bank is available, let's make sure that the platelets are thawed, and so on and so on, just in case. And so that's an opportunity where everyone gets a voice and everybody's voice is important.
And so we acknowledge that. And then at the end of the case, we also do another mini timeout to assure that, hey, whatever the task was, we accomplished it, and that now this patient is ready to get to the next stage in their life.
[00:08:16] Speaker B: That's very reassuring.
What about when the surgery's over?
They're wheeled to recovery. Do we see you again? What happens?
[00:08:25] Speaker C: Right, right. So most of the time during the surgery, a surgery day, I'll be in and out of surgery, and usually I'll come by and talk to the family and say, hey, your mom did fine, or your husband did fine. And then after that, I may walk back to the recovery room and say, hey, hey, Bobby, you did fine with surgery. Okay? And then I'll see them back, or my nurse practitioner will see them back, and then I have the opportunity to help the next person.
[00:08:54] Speaker B: What are some realistic timelines for healing?
[00:08:58] Speaker C: Okay, so, of course, everything is a little different. And even with the same procedure, there's going to be different parts that heal differently. For example, we were talking about colon surgery earlier. You know, when we do colon surgery, we remove a portion of the colon and most of the time put the two ends back together. We use laparoscopic equipment, little small incisions through the abdominal wall.
But for example, the.
The. What's called the anastomosis, where the two ends of the intestine put together. If you went back in a week later, you couldn't even tell where the ends were put together.
It heals that quickly. On the other hand, the abdominal wall takes a little longer.
So we tell folks, okay, it might be three or four weeks or six to eight. It kind of depends on how large the incision was, their downtime, their recovery. And.
And I learned something recently as far as being patient. And we had a spot in our driveway that had cracked concrete and had the concrete guy come out and, of course, pour the concrete. And, you know, they tell you, you don't walk on it for a couple of days. You can't drive on it for a week. And so concrete. I didn't know this, but, but it takes, it takes about a week to cure to 70% and it takes a month to cure to 100%. What I'm getting at is right after surgery, you know, it may take just a couple of weeks to get you to 70, 80%, but it may be a year before you get to that 100%. Now that doesn't mean we tell you sit on the couch for a year. We just tell you, hey, don't drive
[00:10:34] Speaker B: a big truck on the concrete.
[00:10:35] Speaker C: That's right. Don't drive a big truck on the concrete.
[00:10:37] Speaker A: That's right.
[00:10:38] Speaker C: So we all have to learn how to be patient.
[00:10:41] Speaker B: That's certainly true in a lot of aspects. What are the biggest mistakes that patients could make?
[00:10:47] Speaker C: Yeah, probably the trying to do too much too early. You know, by nature we're all impatient, right? I mean, we eat our meals in three minutes when it should be 20 and so on and so on. So. And all of us feel the push to get back to work, to get back to taking care of the kids, to mowing the yard, all those things. But if you listen to your surgeon, they are probably telling you a week or two or three weeks for a reason because they've seen the outcomes of when you try to do a little too much too early.
[00:11:23] Speaker B: Sure, sure. What are some warning signs that patients can look out for?
[00:11:28] Speaker C: Some of the things that we tell patients as far as most surgeries generally are things like, for example, bleeding issues or hey, if suddenly you're running a fever.
And when I say fever, we don't mean 100.2.
Sometimes that could be just inflammation from surgery, but if it's 102, we need to know about that.
And most patients will recognize something's not right. Yes, I'm supposed to have pain after surgery, but if it's unbearable pain, then that might be something else.
[00:12:03] Speaker B: How is pain managed?
[00:12:04] Speaker C: Yeah, well, the good thing about that is now with all the different modalities that we use, some of it is we inject long acting pain medications into the actual wounds itself.
We recognize that opioids are wonderful, but they can also be a problem. And so we try to minimize the opioid usage. And so we use non opioids, whether it's Toradol or non steroidals or Tylenol. And most people, when they realize, okay, it's going to hurt some, but if I'm okay with that, then maybe I can Minimize how much opioids I use.
[00:12:46] Speaker B: Let's talk about minimally invasive. We throw that word around a lot. What does that mean?
[00:12:51] Speaker C: Okay, so for example, let's say we did someone's bowel resection, colon surgery in the good old days. And when I say the good old days, I mean probably 1980s, early 90s, we made, we made huge incisions in order to get exposure, because in surgery, you want to be able to see what you need to see, but also do it safely. So it wasn't unusual for us to make eight 10, 12 inch incisions to get to where we need to get to.
Now, with advances in cameras and laparoscopy and robotics, these incisions are now half an inch, an inch, or maybe a couple of inches wherever the specimen is taken out.
But that allows patients quicker recovery, less pain, maybe less bleeding, less risk of infection. So there's a lot of benefit to minimally invasive surgery.
[00:13:50] Speaker B: What are some examples of those surgeries?
[00:13:53] Speaker A: Right.
[00:13:53] Speaker C: So a lot of those are abdominal cases within my realm as far as a general surgeon. So it could be a colon resection, it could be hernia surgery, it could be reflux surgery surgery, it could be bowel resection.
In the realm of the cardiothoracic folks, they also use cameras and scopes and they can do lung resections.
I'm sorry, thoracoscopically, and also use the robot for those applications as well.
[00:14:20] Speaker B: And just a little bit more about how these techniques are so beneficial, if you will, when it comes to recovery time.
[00:14:28] Speaker C: Right. And so it's interesting how, for example, in laparoscopy, a trocar, which is a, like a small tube, is inserted through the abdominal wall, and then the instruments go through that tube. So in a robotic case, the tube is fixed, the instrument moves around, and so there's not so much pressure on the abdominal wall. In a laparoscopic procedure, there may be a little more movement, and if there's a little more movement, maybe there may be a little bit more pain.
[00:14:57] Speaker B: Sure.
[00:14:57] Speaker C: So if there's a fixed point and the instrument just moves inside it, then typically it hurts less. And so. And that's just one example.
[00:15:05] Speaker B: Example. Sure. That makes sense. How do you determine as a patient?
You know, I have an issue. I need to call my doctor and get seen. But as the surgeon, how do you determine when surgery is necessary?
[00:15:21] Speaker C: Right.
So, yes, even though I am a surgeon, and that's what we specialize in, oftentimes less surgery is better surgery. So if there's a way we can avoid an operation altogether, whether it's medical management, whether it's lifestyle changes, those are always ideal. First, when you've exhausted those things, for example, let's talk about reflux, okay? And I do a lot of reflux surgery, but ideally, okay, if you can lose a little bit of weight, if you can watch what you eat or when you eat, or how much you eat, or when you go to bed, don't eat at 9 o' clock and go to bed at 9:30 because you're going to suffer.
On the other hand, things like raising the head of the bed up and so on and so on.
And then if those lifestyle measures don't work, then you go to medical management.
So that could be anti acids, it could be acid control or acid suppression type therapy. And if those things don't work, then you come see us. And then we can do things, for example, that fix the valve that controls the acid.
So we'll exhaust everything that we can. But there's a time and a place for that and oftentimes we'll explain to the patient. You'll know when enough is enough.
Now there are certain times when surgery is mandatory. For example, if there's a colon mass or a colon cancer, then there is no choice, you have to operate. But there's many things that can be managed without an operation.
[00:16:50] Speaker B: That's wonderful. What advice would you give someone who's preparing for surgery and who's nervous?
[00:16:58] Speaker C: I think the thought of surgery is nerve wracking. I think for most people, once they get to know the team, the office staff, how they're welcome when they sit down with their surgeon and then he or she goes through what happens in the recovery period. And I think that gives patients a lot of peace about that. And you know, enlist your support groups, whether it's your family, your church members, they're there for you and they'll help you get through it. We're just a small part of it, we're grateful to be a part of it, but we are just a small part of their overall healing.
[00:17:37] Speaker B: What is your true north?
[00:17:41] Speaker C: I think about the fact that patients don't come to see me, just to hang out with me.
They're there, there's a reason and they have a problem and hopefully we can get them through this. And most of the time, most of these surgeries will be a one time thing, gallbladder trouble, for example. But sometimes it may be something that's going to be something on the back of their minds forever. For example, breast cancer. So we walk the journey with them, we realize they're not there to hang out with me. They have a problem.
Let's help them through this and maybe it'll just be a speed bump in their life as far as the recovery and getting over it and then moving on with life. But we're on this journey together, so let's help each other get through this and hopefully there'll be brighter days ahead.
[00:18:33] Speaker B: Talk to me a little bit about your pre surgery ritual, if you will.
[00:18:39] Speaker C: Okay, so oftentimes we have what's called scrub sync time, and while the patient is being put to sleep, and usually it's just next door to where we're standing and we're standing at the scrub sink and we start scrubbing our hands.
And even though we're preparing for surgery, there's going to be outside influences and pressures during the day. There's the office trying to call, when are we going to schedule Mrs. Jones case? The pharmacy is saying, hey, that prescription was not filled out correctly. And there's the emergency room wanting us to see a consult, and so on and so on.
Well, we have to set that aside.
We compartmentalize and we give our undivided attention to that patient. So that scrub sync time, that three minutes, is where we let things go to the side so that we can truly concentrate on our task at hand. We review the case in our head, in our mind. We think about what instruments may be necessary, what pitfalls we may encounter, what team members are necessary, all those things so that we give that patient the best surgery possible, bar none anywhere.
[00:19:59] Speaker B: Well, thank you, Dr. Wong, for your time today, your expertise and your passion for what you do. We really appreciate it.
[00:20:05] Speaker C: Well, thank you. Glad to be here.
[00:20:06] Speaker B: Thank you. If you have any questions or you want to learn more, go to www.nmhs.
have a great day.
[00:20:14] Speaker A: Thanks for listening to True north, your destination for better health. For more information and resources related to today's episode, visit the links in our show notes. Until next time, stay healthy, stay informed, and remember, you are our true north.
