The Hernia Gods Podcast E14 - Shirin Towfigh, MD FACS

Episode 14 of The Hernia Gods Podcast features Shirin Towfigh, MD FACS of The Beverly Hills Hernia Center talking about her passion for hernias of the groin and groin pain patients, growing her practice and online presence, and the under-representation of females in the hernia literature and algorithms.

Check out this link to donate to female hernia research:

http://beverlyhillsherniafoundation.org/donation

Disclaimer: The views, thoughts, and opinions expressed on this podcast belong solely to the hosts and guests, and do not serve as a representation of or necessarily reflect the official policy, position, or opinions of Orlando Health or any of our employers.

Transcript

SPEAKER_01 0:06

Welcome to the Hernia Gods Podcast. This is your mere mortal host, Luke Elms. The views, thoughts, and opinions expressed on this podcast belong solely to the hosts and guests and do not necessarily reflect the official policy, position, or opinions of Orlando Health or any of our employers. And now, without further ado, let's talk hernias. Hello, and welcome to another episode of the Hernia Gods Podcast. This is your Mere Mortal host, Luke Elms, and I am joined today by Sharon Tofi. We are so happy that you are here, and uh we are excited to get to know you a little bit better.

SPEAKER_00 0:40

Thank you, Luke. I was so excited to get your your uh invitation. I was waiting for it actually.

SPEAKER_01 0:46

Well, we were you you can't invite somebody too soon because you have to have a little bit of credibility because you know you're it you're internet famous, and so we can't just like pull pull out all the stops right away.

SPEAKER_00 0:57

Well, I've been listening to all your podcasts. I've I've caught up.

SPEAKER_01 1:00

So I really appreciate that. That's uh that means a ton.

SPEAKER_00 1:03

Yeah.

SPEAKER_01 1:03

Well, as we start all podcasts, I'm sure you know, I love to just hear uh how a little bit about who you are, where you come from, and how you got where you are.

SPEAKER_00 1:10

Thank you. Uh Sharin Tofi, I'm based out of Beverly Hills. I founded the Beverly Hills Hernia Center, kind of mid-career back in 2013, and never looked back. Uh, I do 100% hernia and hernia-related kind of surgery. I'm very excited to treat all different types of patients. Um I feel like my practice is a little bit different than the average hernia surgeon. I really enjoy the groin and pelvis. Um, I also offer, you know, hernias of all different types, abdominal, all the rare ones as well. But I like chronic pain, I like solving problems, um females, I have a lot of females. Most of my patients are actually female, which is not typical of a hernia practice. And yeah, I like everything related to hernias.

SPEAKER_01 2:05

Was that always an interest of yours? Or was that something that just kind of you ended up in serendipitously?

SPEAKER_00 2:11

I hate to admit this, but I hated hernias as a resident because I didn't understand it. I think the reality was I didn't like the exam down there, and I didn't understand the surgery very well, and it was not really considered something to aim for as a resident. I I trained in the late 90s, early thousands, 2000s. And so when I came to graduate, I said, well, hernia is gonna be like the most common thing I need to learn. So I really focused towards the last couple months to do as many hernias as possible because then you're gonna be an attending. Who are you gonna rely on then? And my first job was at the county hospital at LA, LA County Hospital, and I got bombarded with hernia complications, mesh infections, these big loss of domains. And it's a very resident-run, you know, county hospital. And so there wasn't really an attending that owned those patients. And I felt bad for them, honestly. It wasn't like I had that much of an interest, but I just felt bad for the patients because I knew there's a treatment for it. So I started treating them, and the run's like, oh, TOFI is okay with these patients. So I they started, you know, giving me more of those patients, and I started getting involved with the American Hernia Society, which I didn't even know existed until I started my first job, and you know, the rest is history.

SPEAKER_01 3:36

Yeah, it's uh I think people, you know, you're talking about you were mostly kind of growing hernias. I think people underestimate the complexity of those, and um and how uh even the simple ones can be complex if you can't pick up on some of the nuance. And I only know that because I think that I'm just now starting to pick up on some of the nuance. But similar to you, when I came out of practice or came out into practice, I I was not very confident with hernias in the groin. And um towards the end of my last year of residency, I actually went to some of the attendees that did high-volume lap tips. And I went to them and I said, I just want to watch you do them. Yeah, because I think that I I realized that there was a level of of uh you know observation that I think early in training is really helpful. And then you go through this period of like learning how to do it, yeah. And then after you learn how to do it, you have to learn how to do it well. And yeah, and so I've and then all of a sudden I went and started observing some of the attendings when I was a chief, and then I said, Oh, so that's how they make that look easy.

SPEAKER_00 4:42

Exactly.

SPEAKER_01 4:43

Yeah.

SPEAKER_00 4:44

When when I so the whipple is like considered the most like the elite of all general surgery procedures you'd ever do. Now it's mostly surgical oncologists do it or hepatobiliary surgeons do it. But when I was a resident, I did 22 Whipples. And I think I still hold the record for our residency as a number of whipples done. So I was like, this is like the most amazing operation. And so when I went to interview for my first job, which was a general surgery, like acute care surgery job, they're like, if you were to do one operation for the rest of your life, what would that be? And I was like, Oh, that's easy whipple. And they're like, Yeah, you're never gonna do whipple here. How about hernies and gallbladders?

SPEAKER_02 5:28

Yeah.

SPEAKER_00 5:29

So, you know, it's it's just not given the I mean, today's different. People actually want to go into hernial surgery nowadays, but back then it was not something to aspire to. It was mostly out of necessity that I started getting involved.

SPEAKER_01 5:46

Yeah, when they asked me when I came out of residency, and it's still one of my favorites, when they asked if they had asked me that question, yeah, mine would have been a facial nerve-sparing parodidectomy.

SPEAKER_00 5:56

Oh, yeah.

SPEAKER_01 5:56

I love I loved those cases for some reason.

SPEAKER_00 5:59

Yeah, those those made me nervous. Yeah.

SPEAKER_01 6:02

Yeah, I mean, I think it's I loved it because I wasn't the one that was the attending. There's a lot of cases I loved as a resident. When I became an attending, I was like, oh, this is terrifying.

SPEAKER_00 6:11

Yes. You know, some people think that, think of that about angular hernias. When I start, when I um when I was at a different hospital, I was like the hernia person for that hospital. And everyone around me is like, we are so afraid to do hernias now because like you're here. And so we're like before we would just fix a hernia, we wouldn't think about. Now we're like, oh shoot, uh, are we acetophy? Are we using the right suture? Like, which mesh are we supposed to use? You know, should we do this lap or open? I mean, it was like so they understood that there's a skill and a science to it now, whereas before there wasn't.

SPEAKER_01 6:51

Yeah, and the idea of it just being a hernia um is you know equally frustrating to me as saying it's just a gallbladder. Everybody that ever says that, I'm like, well, thanks. Now this case is gonna suck. But you know, it's uh but the whole just a hernia, um, it's just a hernia until you have a problem. And then it can be, as I'm sure with your specialization in your practice, those can just go forever. I had a patient just even today that's suffering from chronic groin pain, and you it's so multifactorial in this patient's case. And you know, they're at their wits' end and it's destroying their you know quality of life. And I'm trying to explain that there are certain things that I can help and other aspects of it that I actually can't, um, you know, that that she has like a lot of different if even medical issues going on, and it's just a really tough situation.

SPEAKER_00 7:45

Yeah, patients get suicidal from you know hernia, chronic pain. It's very serious.

SPEAKER_01 7:52

Yeah, and I and if people uh you know, and one of the ways that I grew my practice before I even really started becoming higher volume in hernia uh was with pain control. And I was basically doing perioperative pain control using multimodality. But whenever you get into that space, yeah, chronic pain patients seek you out because you kind of speak their language and a little bit of the fact that it's not just something like, well, I can't fix that, see you later. You know, you're willing to like talk to them about it. But it's it's also, you know, a lot of chronic pain patients, unfortunately in today's world, have been caught up in the wash of a lot of the opioid minimization, which it has its own benefits and everything, but but sometimes there's like these bystanders that get caught up in this that you can end up having people whose pain is just neglected or under-treated. Um, because that we, you know, I watch a lot of my colleagues and and other people that kind of got really concerned about opioids. Um, and so then they started to pull away. But if if people don't realistically treat pain with something else, you can't just not treat the pain. And so these chronic patients, chronic ground pain patients, you know, I feel for a lot of them because you can tell it's just like an everyday thing, every movement, and it's just it's brutal.

SPEAKER_00 9:11

Yeah, having friends as like really good pain doctors that understand what you do is priceless if you're a hernia surgeon. Yeah, absolutely.

SPEAKER_01 9:21

Yeah, we um, you know, it's it's just uh, and and some of these folks they have bounced around so much that by the time they get to you, they're like distrustful of doctors in general because they've never had somebody actually listen to them. And so then you're kind of working on an uphill battle to really develop a relationship or a connection with them.

SPEAKER_00 9:38

So Yeah, I mean, some of the messages I always tell my fellow surgeons is please don't discount their pain. If you're not the right person to fix it, don't tell them it's in their head or you know it's uh it'll get better, or you know, there's nothing wrong with you. Send them to one of us that's actually interested to fix these because you don't know what you don't know. And what you're telling the patient is there's no more hope for you. And that's just not right because almost I would say not only almost everyone, I would say like 99% of patients that have a hernia-related problem, their pain is curable, like curable, not just like, oh, just live with it. But there's a treatment for almost everything, except the really like end stage, you know, patient, which is very, very rare. So I hope that people learn to make friends. Like, you know, I have people, even today, I got a text from one of my former fellows, you know, asking me about a patient. Every day I get phone calls from people around the world. This morning I had a a call from a friend in London who had a patient that just they just want to ask me for help. And like that's good to go and ask and get advice instead of just tell them to not only tell them there's nothing wrong with them, but don't refer them out. Like that's that I think is is a not good for patient care.

SPEAKER_01 11:09

Yeah, it's the there's a level of humbleness, and I think there's also some psychology for the surgeon as well, especially when it's your patient. You know, and it's it's tough, it's tough because I try to uh throughout periods of my life, I've not always held this specific point of view, but I've trying more recently to just assume that people mean that people in general mean the best and that they're doing the best they can. Um, I've not always been so uh been more negative in the past in my outlook on life, but the um but I think that most people just want to do the best. And it's really tough to to see somebody who's having a problem and you're like, oh, you know, dang, they like they really wanted there, they came to me with this problem and they've still got the problem. You know, did I is this is this a technical error on my fault? That was my fault. Did I miss something? You know, the number of times that I see patients, it seems like for recently I've had this run of patients who have lumbar back pain that is causing some major like they come to me and they're like, I've got this groin pain, groin pain, and and then I'm and they're like, and it, and it's here, and then it radiates down the back of my leg, and I'm like, okay, cool. Like, wait, we gotta we gotta reset expectation. Um let's see what's what here, you know.

SPEAKER_00 12:23

But hernias can cause lower back pain. Sure, you can you can fix someone's horn, they're like, Wow, my back pain's gone, or they they it radiates around to their lower back. So that you know, that we know can happen.

SPEAKER_01 12:35

Yeah, it I I try to talk to patients about pain, and and I was just a patient I was talking to today. I said, you know, I said, just because I can't see something on imaging doesn't mean you're not doesn't mean you're not having pain. You know, like this is not a the pain doesn't necessarily always have to have a physical finding associated with it and and pain, it can absolutely be occurring, uh, even though the the CT report reads, you know, negative C T of the abdomen pelvis, you know, and so it's uh it's tough because they you know they're desperate and sometimes a surgeon feels desperate to find an answer and it may be just outside the scope of what of what you do. And uh and so I did even today I said, you know, I've got some people around the country that I know treat chronic pain all the time, that you know, maybe maybe that's somebody we should get a second opinion from if it comes to that. And so we're working through the process, but I do think it's it's really it's a tough problem for the patient, and it also can be the a tough problem for the surgeon if they're you know well-intentioned to just really trying and kind of running into to no success in any of the treatments.

SPEAKER_00 13:38

If your practice is one where you don't have the time to spend an hour or more with the patient going through their chart and going looking at all the images and having your staff get all the back information and sitting down and really like going through the nitpicky of like their symptoms, there are those of us that do it. Now, I would also say a general surgeon's hernia surgery is not considered like something to really focus on. That's true for other specialties too, and I think radiology does not really appreciate the importance of hernias when they look at images. So three-fourths of CT scans are misread or not read at all for hernias, so the report alone is not adequate. MRI, ultrasound, these are all like half half of ultrasounds are incorrect for hernias. So, you know, these are things that you know, if you have a patient with the right story, right? Like a good story for hernia, and you examine them, and if they have a hernia fine, but sometimes you can't really see like a perfect hernia, maybe they're tender where they should be, but and then you go for imaging to try and maybe bring that story into fruition as a diagnosis. You really need to make sure that imaging is correctly read. So I learned to read it myself.

SPEAKER_01 14:55

Yep.

SPEAKER_00 14:56

Um, what you can do is you can partner with a radiologist that you can sit down and review imaging for, but you know, it's it's unfortunate if you know you you do the right thing and you you you think of hernia and you get the right image, but then the report comes back as falsely negative, you know?

SPEAKER_01 15:16

Yeah, I I read all my own CTs, ultrasounds, and MRIs. MRIs I'm getting better at, and they're not the best. I don't read those the best. Um, I used to have an attending that called them blurrograms, and sometimes I feel like that when I'm looking at them, but the CT scans, you know, I I have to tell my patients frequently, and I've gotten to a point actually where sometimes in patients I know that there's probably going to be some disparity. Like it's not somebody who's, you know, half their abdominal walls outside the fascia, or half their abdominal contents are outside the fascia that's gonna be obvious. I tell them, like, listen, I'll look at it myself. They're looking, radiologists are looking for hundreds of different things. I'm looking for really a few much more narrow focus, and so I can focus on the things that I know I'm looking for. One of the things I did with one of our radiologists, which was really helpful, is uh he was he was a really, really great guy. Unfortunately, he retired. It's like we this is a big loss for all of us. But I used to um review the scans before and after with him, and then I would take intures and send them to him. Oh he could see he and it was not just for hernias, it was for everything, but he could see the physical manifestation. So he actually got incredibly good at diagnosing internal hernias and closed loop obstructions because then he finally understood about the pitch points and all that stuff and knew what to look for. And so then, and so then it would be like, Well, he was like hyper aware of it, and so it'd be like three in the morning, and I'm like, Richard, come on, man. This is not easy, I got it. Like, be careful what you wish for.

SPEAKER_00 16:45

Yeah, yeah, that's true. But yeah, you know, in radiology, they don't really tell them what a hernia is. You know, sometimes they say it has to be like peritoneum going through. That's not true. Or they, you know, if if it's really huge, sometimes they don't even call those, or for the abdominal wall, they call it diastasis when we know it's an incisional hernia. Right. So yeah, you have to understand the weaknesses of of radiology sometimes and and and you advocate for a patient.

SPEAKER_01 17:14

Yeah, it you know, something that you have uh kind of in your career path. First of all, where did you do your training?

SPEAKER_00 17:20

UCLA.

SPEAKER_01 17:21

UCLA. And um, and then when you went through, you went, you said you went and kind of in a more of an acute care job at the county hospital.

SPEAKER_00 17:30

This is before yeah, this is before there was such an acute care fellowship. So at the county, uh uh Tom Demester was our chair, so he didn't believe in laparoscopic surgery. He's like, that's a technology, not an organ. So everything was organ-based. So we had thoracic, you know, uh breast, hepatobiliary. We didn't have surgical oncology. It was like colorectal, it was organ-based. He has foregut. Um so MIS, laparoscopic, like MIS did not exist. So MIS became like the at the county side, it became the kind of um everything non-trauma. So if it wasn't a trauma patient, it went to general store, it went to MIS. We were the general surgeons. So if it was a bowel obstruction or hernia, we would try and do it laparoscopically. Um robot was not available back then. Uh and then like bariatric kind of fell under foreg. So yeah, that's why. So we technically were acute care surgeons. And the trauma people did their trauma, and we did what's called non-trauma. Um but yeah, so you we we kind of just showed up and whatever came through those county doors, you took care of it.

SPEAKER_01 18:48

Here it came. Yeah, we uh and then you ended up in you said it was 2000, what year was it, 2013 that you ended up going to?

SPEAKER_00 18:58

Went to private practice, solo, loving.

SPEAKER_01 19:01

How scary was that?

SPEAKER_00 19:02

Never, never scary.

SPEAKER_01 19:03

Never, never, you're just ready to roll.

SPEAKER_00 19:05

I couldn't wait. I'll tell you, you can't do it coming out of a county hospital. That does not prepare you for private practice at all. But my second job was at a um community hospital, Cedar Sinai Community Hospital, but very kind of academically inclined. That's why they hired me. Um, but you get exposed to a lot of private practice, uh, doctors and practices, and you kind of start dreaming about what you can do without the auspices of like a boss telling you what to do and what not to do. So yeah, I loved it.

SPEAKER_01 19:44

And so you're and so did you feel did you have like a a business mind before going into private practice? Or was that something that you did you do you feel like you've developed it? I'm assuming that you have.

SPEAKER_00 19:59

Yeah, I cultivated it for sure. I had former residents that um were very successful in private practice that helped guide me. I read a lot, read a lot, and by that time I already had like a name. So I was able to kind of bank on my reputation for people to refer to me. So I didn't need the institution's name to gain patrons. They were sending them to me because of me, not because of where I practiced. So that's when I noticed it was time not to kind of be hindered by the by the limits of an institution.

SPEAKER_01 20:39

And I'm assuming you're you know, you you recognize that um I would assume you recognize that the you're the brand. And so when you were in at Cedar Sinai or even all the way back to the the county hospital, did did you recognize that building your own like personal brand was integral to your the success of your career, or was that something that kind of came to you as you were moving into that private space?

SPEAKER_00 21:06

Uh correct. Um at the county, you're just there to take care of patients, and your academic side was there to promote the institution. So wherever you went said, you know, USC, CECUSC. Um same with Cedar Sinai. In fact, I was hired specifically to um take my academic kind of potential and help spread, you know, the name of Cedar Sinai as being associated with what I do, and and that was one of the reasons why I was hired was to kind of elevate the academic output of the hospital. Um and you don't really think of it. And then uh social media came around and I was like very anti social media. And Brian Jacob, who you interviewed, I think he was your first interviewee. Um was he your first?

SPEAKER_01 21:54

He was actually, he would have been episode six, I think.

SPEAKER_00 21:56

Actually, oh six, okay.

SPEAKER_01 21:58

Haney Haney was my first, and he He felt every bit of the rookie behavior.

SPEAKER_00 22:03

Uh so Brian called me and said, I I have a Facebook group called International Hardening Collaborate Collaboration. Um, can you sign up and be a member? And I was like, I don't have a Facebook account. And I was like so anti-social media at the time. I want to say that was 2006, maybe or 10. Yeah, 2006, I think. And then for him, right? Uh I opened up a Facebook account and then I started getting involved in like social media, understanding branding. And um, then I started posting on social media, not just using it to get on the IHC uh Facebook group, and I became more and more into it, whereas now I have Instagram, Twitter, uh, YouTube. Like I'm very involved in social media, and I understand how that helps kind of promote what I love to do, which is surgical education and kind of educating patients, educating surgeons, you know, whatever it is. But it was really Ryan that kind of under showed me social media, and then through that the branding kind of idea started to percolate.

SPEAKER_01 23:28

In looking at your social media presence, it comes across to me that it is something that you feel passionate about because there is a strain of um empathy that comes across when you're connecting with the patients on like your QA sessions on Hernie Talk and all those things that that um it seems like you're really just very, very passionate about getting the word out there and reaching some of these folks and trying to really help. And do you feel like that's something that you're passionate about? Because you feel like it helps you kind of magnify the effect of your expertise.

SPEAKER_00 24:02

Well, thank you very much for saying that. That's definitely how I hope to come across. I do feel in order to be a good doctor, especially dealing with chronic pain patients and you know, revisional hernia surgery, et cetera, that empathy is part of your strength of being a good doctor. Um you know, the the YouTube part where it's like this, right? So it's video, talking, engaging with others. Um I feel like that has really helped not just me, but our specialty. So, right around when I started the YouTube, which was right before at the pandemic 2020, we were like at the height of so much negative press about like doctors are horrible, you're killing people by putting mesh in them, mesh is evil, doctors who put mesh in are evil. And I was on Twitter mostly answering these people, and man, the backlash I was getting was was like stressful, and it was just they didn't even know who I was, these people. And I I in my own heart knew that I was doing good with my patient population, and then these people were calling me names, and like because I was the most vocal on social media about hernias, and I was I was trying to balance between understanding what they're trying to say, but also instilling some science and data to try and counteract what they're saying, so they you know, all these patients aren't truly believing that we're killing everyone. 100% of patients don't have chronic pain or bad outcomes. That's just not like we would never do an operation if everyone died, you know? Like that's not what we do. So uh when I started Hernia Talk Live, which is the the video component of I had the discussion forum forever, hernia talk.com. That's free, you know, people can talk, share, whatever. When the YouTube video came out, I started hearing very positive. Oh wow, Dr. Ramshaw was so caring. Wow, Dr. Jacob really thought, put a lot of thought into his care of patients. And I felt like that exposure of our hernia specialists and our fellow colleagues to the general population kind of softened us up a little bit. They could see that we do think we do um, we're not just like getting, quote, paid by industry to put mesh in, like all this kind of completely not factual stuff that you you read about on some of these forums. And they started saying, Oh, I saw Dr. Let's say Dr. East. Um, I'm gonna go to her now because she really came out as like very caring and understanding. So I felt that the tenor of that also in the Facebook groups and social media had dropped, that I wasn't reading as much negativity and hate against us because I was humanizing us on video. And that's I think the best part of what I what I enjoy and and what I hear as feedback about the the YouTube and why I like to promote people like you and Haney and others on my um forum to and I only put people that I trust, you know, that I I stand by. So those are people that I know that I that I share patience with, and then it's open, it's live. You can ask us whatever question you want, we'll answer it, you know?

SPEAKER_01 27:53

Right.

SPEAKER_00 27:53

So yeah, it's it's really the the empathy needs to come out so patients understand there's so much negativity against doctors in general, medicine, Western medicine, that it's really important that patients understand that it's not real, we're not evil people, we're just human beings. We make mistakes, that's that happens, but it's not like we're going out to purposely maim you. That's just ridiculous.

SPEAKER_01 28:23

Yeah, I um man, I could I I could inject what you just said into my veins, but you know, I think that uh it's funny because I had some conversations pre-dating predating this podcast. So my whole thing with podcasting, I think I've probably talked about this on this podcast before, but I was going through a lot uh trying to find a a way to get some of my own personal struggles out. And I started a podcast that I've not released. It's called I called it This Two Show Podcast. Really funny story why I call it that. I can I'll share that with you if you want to hear it. But um so I uh I started that and I started just talking into a mic. And as you know, it's a very when you're podcasting, when you first start, it is awkward. Like it is not a it is not a it's not a natural thing. Um and so I started doing these podcasts and and it it quickly turned into kind of like a mental health focus because that's a really big thing for me. Um and it turned into physician wellness. And as I went into physician wellness, I started thinking, like, you know, I, you know, you're talking about how patients respond to you. Even other administrators in the hospital system don't some a lot of them are well-meaning, but they don't understand. Yeah, and we don't understand what it is to be them, they don't understand what it is to be us. And I'm right now in my career kind of in this weird middle ground where I'm kinda like building everything as the department chairman and things like that, which puts you kind of in this weird position. We're living in both worlds. And I realized very quickly that a lot of times people are saying a lot of the same stuff. Uh patients and surgeons saying the same thing, administrators and surgeons are saying the same thing, they just speak different languages.

SPEAKER_02 30:06

Yeah.

SPEAKER_01 30:06

But at the end of the day, if you translate it, they're everybody's kind of on the same page and they all think they're on a different page. And um, and so I I one of the points I brought up to our administration uh was to get approval to release that podcast, which I have yet to do, and then eventually it kind of turned into this podcast, but uh was to say I think we really need to do a better job of humanizing surgeons and humanizing leaders.

SPEAKER_02 30:28

Absolutely.

SPEAKER_01 30:29

And because one of the things that I feel that we get into a situation in medicine that can be really, really dehumanizing and really difficult for the surgeon, there are a whole host of things that can be dehumanizing and problematic for the patient themselves because I think we're all living in a in a pretty fundamentally broken system in a lot of ways, and the surgeons or the physicians feel it just as much as the patients, unfortunately. But uh, one of the things that that for me that I felt really tough about is that in medicine uh from my perspective, uh the expectation of us is perfectional. And so if I ever uh I didn't ever feel the victories of what we do. I felt like I either met expectation or failed because it was always it, and so I had a hard time. I can listen to a hundred patients come back to me and say, Hey, you saved my life, or you know, I was at my wit's end with this hernia painter, hey, I'm back skiing or doing whatever it is that I love or playing with my kids. I can hear that, and they're like, Thank you so much. And to me, when I internalize that, I say, right, that's what I'm supposed to do. Right. And then, but then the one person that goes, parking was too far away, and the doctor seemed like he was in a rush. And I'm like, I was in a rush. I sat there for 25 minutes, listen, like intentionally slowing down. Like I had plenty of stuff I needed to get to, but I really wanted to make sure that I had that connection. And um, and those that one I remember. I forget the hundred. I remember that I remember the other one. So whenever you're in those situations where uh you're getting like hammered online for not caring, it just it it's so brutally so deep.

SPEAKER_00 32:18

But yeah, I mean we all have negative reviews, you know. You try and uh I encourage everyone to make sure that they're very aware of what's online and and make sure that they address the whatever's negative. Like if truly there's issues with your front desk, like try and fix it, right? Um yeah, a lot of those reviews are about parking and and uh you know how nice a person was who picked up the phone and stuff, which is important, but you know, some of the these things you you don't have control over it. Um but yeah, it's you know, it's it's very stressful to be a surgeon. I think the older I get, I feel a little bit more daintier about it. Like I don't like to hear bad stuff. I want because I feel like I'm giving up so much of my time and energy to make every single patient feel special and get the best care. That when something goes wrong, right? Or they're unhappy, or there's anything negative spoken about it, like it hurts more. I don't know. I feel like we go through we have so much stress, and then you come home and and you know, people have family and lives and everything that they have to deal with in on top of like their surgical life. Yeah, surgery is a stressful job.

SPEAKER_01 33:36

It is, and it's it is it can be really tough. You know, my own personal experience with getting that kind of like hate thrown back at me is one of the things that happened is I was doing my multimodal pain control and it went really well. And it coincided with like a big uh push, a national research questionnaire that they that the organization sent out. So I ended up uh doing uh some national media interviews. And what I found out was that um when you start taking clips of what you're saying, if you're taken out of context, you can say stuff that is perfectly well-intentioned, well thought out, and can be very, very misled. Either people can be very misled by what they think you're saying. And so I was out there trying to promote, like, hey, we just need to do a better job of pain control. Like some of these people have pain that we're not addressing, and look at all these other options. We can use we can use all of them together and they can get even better pain control. And I had uh people that were like sending me like hate bail over 20. Dr.

SPEAKER_00 34:39

Elm says we're not doing a good job of pain control.

SPEAKER_01 34:42

Well, oh man, the one of them was um it was uh Doctor Finds uh finds cure or finds alternative to dangerous opioids or dangerous narcotics. And I'm like, oh boy, yeah, here we go. And so I started getting stuff, and people are like sending me like uh uh you know wishing ill upon my family and stuff and the DMs of my Twitter. I like had to delete everything, and it wasn't until I so I ended up like getting basically fading off social media for over two years, and um it was glorious, by the way. It was I I wasn't like doom scrolling, I wasn't like you know angry every time I got off off the off my phone, but um, and then this kind of came around and I ended up having to get back on it. So now I've I've downloaded an app where I have a certain amount of time every day I can be on it, or it makes me do push-up squats or a plank to get to earn minutes to be back on it. And what I found is that my will to be on social media is um not as high as my will to be lazy. So I'm just not on social media anymore because they're like I was like, you want me to do five squats to be on here for five minutes? I don't think so.

SPEAKER_00 35:48

I'll just uh just it is, yeah. Tell me more.

SPEAKER_01 35:53

Yeah, I can't remember. Let me see here. I may have to start that app if they're lit if they're listening. I'm I'm always available for sponsorships.

SPEAKER_00 36:00

You know what's my mom keeps telling me I have to stretch out my legs more.

SPEAKER_01 36:04

Yeah, yeah. Um, it's called push scroll.

SPEAKER_00 36:07

So push scroll, okay.

SPEAKER_01 36:08

Yeah, and it makes sense. It actually films you, or it doesn't film you, but it you have to turn your camera on and do them in front of the camera, and it uses AI to track if you're actually doing it, so you can't just lie.

SPEAKER_00 36:19

Yeah, so there's a somewhere there's some poor app developer that's like looking at videos and be like change like how aggressive you want it to control your your social media time.

SPEAKER_01 36:31

Yeah, and you you can do you can like set different things and and it it'll let you override, but then when you try to override it without doing it, um it makes you take it makes you take this like really long, slow, deep breath and let it out. Then it goes, are you sure you still want to go on there? Oh wow, like, oh no, okay, fine.

SPEAKER_00 36:49

But AI is taking us over.

SPEAKER_01 36:52

Yeah, it is.

SPEAKER_00 36:52

Tell us what to do, and we've we need to like feel obliged to do it.

SPEAKER_01 36:56

Yeah, I know. Didn't we make a few Terminator movies about this? And nobody seems to remember. But no, I think um it's it's a really interesting thing, and I and you know, I I applaud you for being willing to go out there and put yourself out there because um, you know, hernia surgery, like you said, um, I spend a lot of time talking about mesh uh because of the recruitment for lawsuits, at least for locally and I'm sure nationally. And um and sometimes you know you have to tell them listen, yeah, it does have risks. Here are the risks, here are the benefits. And I understand that if you don't want it, then you know, but the one thing that I do I think a lot of people want is they want like a minimally invasive, you know, tap approach, and then they're like, I want it, you know, mesh free and this and that and all that.

SPEAKER_00 37:41

I want the shoal dice for my ventral on your repair.

SPEAKER_01 37:44

Yeah, you're like, uh, well, and so um there's a it's so there's like one of those is a lot of things that you end up talking about, and one of the main things that the internet really kind of skews in my patient population, I still do a lot of gallbladders, and um there everybody thinks that you know every single patient that has their gallbladder removed has explosive diarrhea 24-7. Yeah, and uh, and I'm like, you know, actually the number is like 10 to 15 percent. If it happens, it's very detrimental and stuff. But I mean, happy people don't post.

SPEAKER_00 38:13

I have patients that are so into like social media and reading, and they're like, I don't God gave me this organ, I don't want to remove any organs, and like literally they have cancer, and they're refusing to have the cancer surgery because they don't want their organ removed, like it's somehow going to affect their their longevity. It's just you know, it's you can help some and you can help others, but I think the empathy and not making them sound like they're stupid or or crazy in any way, and just understand that you know, a lot of what they're really explaining is that they're scared. Oh, they can share that they're that there's there's fright and try to understand, like patients come to me like I don't want mesh. So my question isn't like, oh, I can't do it without mesh. My question is, well, why is that, right? Oh, I heard that it's got more chronic pain. Like, well, actually, let me explain to you that's actually not true. So then we go through it. So my my office jokes because there are people that travel from all around to see me because I do offer non-mesh repair, right? Should Ice, um, Marcy, whatever, McVay, whatever they need, even robot, there's some patients that I'll offer it. However, there are certain patients that should not get a huge scroll hernia that's been chronically incarcerated. I'm not gonna offer you tissue repair for that, you know. Um, but that patient will come to me and travel multiple states at hardship because they heard that I do not mesh repair. So they come into the room with that idea and they come out of the room, and I schedule them for a laparoscopic or robotic repair. Because you just need to address what they're scared of and then give them the data objectively, and you need to have a reputation that you're honest, right? Yes. I'm very honest in what I say. I I I'm I try and be as clean as possible. I'm not in the pocket of any industry, you know. I don't take, you know, I don't do speaking and dinners and stuff for industry. I've always kind of kept that very like very distant for myself because I do feel like I need to have that sense of like um uh safety and honesty with the patient, right? Yeah, because they look up everything, you know, they will they will look everything up and and read about where you went to school and and what these reviews said, and in this forum, so and so said they saw you for a consultation, you said X, Y, and Z. So be honest with them, give them the data, and listen, if there's a patient that would do almost as well, I'm not gonna say perfect, almost as well with a tissue versus a mash repair, and they understand the risks and benefits of each, and they'd still choose the tissue repair, I'll offer it. I won't do one if I'm I think I'm doing harm. But you know, at the end of the day, it is this kind of like mutual decision making and this idea that um like I'm the god and I tell you what happens, like that's kind of out the door. We don't really do that anymore as doctors.

SPEAKER_01 41:22

Yeah, there's it it is a very interesting balance. Um, there are cases, there are some, they're pretty rare, actually, that you kind of have to be like, no, I'm not gonna, I don't recommend you ignore this cancer, you know, like it's stuff. But um, but yeah, I think as I've gotten further in my career, I've become more resilient against criticism from my peers because I think as surgeons, many times we are so critical of each other, and we're like, and there's a my my friend has a he's a trauma surgeon and he has a quote. He's like, nobody can F another doc, nobody can F a doctor like another doctor. And um, and and you know, and I'm a firm believer that there's no better surgeon than the surgeon sitting in a morbidity and mortality conference with all of the information and the full storyline with someone else's case, right? So then they're like, Well, you know, I would have seen that. Yes. Yeah, yeah. So um, but I think that uh as I become more resilient to to those situations, there are times that that I am willing to discuss with the patient less than maybe not my first choice for their treatment, if it means something to them. So the idea, you know, being uh, hey, this patient has a breast mass that realistically just needs for in some of my patients, their you know, they just need a six-month follow-up ultrasound. And they're like, listen, I'm losing sleep every single night. Yeah, like peace of mind means something. Yeah, it really, really means something. We, you know, I think there's a there's the physical treatment of problems that we do as surgeons, but many times the psychological benefit that we do people do good for people is much better uh than any of that. You know, like I had a patient today who had literally a seven millimeter umbilical hernia that was seen on a CT scan. The radiologist did catch it, of course. And comes in and I'm like, listen, you know, this is really, really small. You're a small person, you didn't even know you had it. It's a completely it's an old finding. Yes, I can feel it. There's nothing in it, it's very, it's very small. I think I said, you know, really, I offered him. I said, Listen, you can watch this. And the guy's like, I just want it fixed. Like, I'm scared to do anything. Okay, fine. I'm totally fine doing that.

SPEAKER_02 43:35

Yes.

SPEAKER_01 43:35

There's there are other people that are like, you know, I'm not touching this until it's like I'm half dead. Like, well, as long as you understand what we're getting into, I'm not here to tell you you're right or wrong. I'm here to tell you to let you make a choice. How do you handle it when patients you're in a situation where you may be in a problem where there isn't necessarily one right answer? There's like two. Not great options. And patients are yeah, I have patients that like demand that I make the decision for them. Well, how do you do you ever have that? And if so, how do you handle that?

SPEAKER_00 44:09

I mean, I'm okay making the decision for them. You know, I'm okay doing that. Um, after understanding like what's important to them, right? Like, what do you want to get out of this? Oh, I want to be able to go back to my hiking. Okay, laparoscopic repair is better than a tissue repair for that, right? Um, oh, I can't imagine having anything in me. You know, that's just gonna destroy me. Uh, I'd rather have a recurrence and then get the mesh in. You know, some but in some situations, I'm talking mostly groin. That's you know, um not ideal, but that's their decision. And and if it's considered like a low risk for recurrence, I'm okay offering a tissue-based repair. Um but yeah, I mean there there are there are patients where um I I think and I think a lot of what I'm saying comes with age and time. Uh I'm okay being the person that makes that decision for them. If they can at least give me a little bit of idea of what what their wishes are in terms of quality of life, in terms of um their tolerance of scars, even, you know, where their scar will be, or how long the recovery will be, like what's important to them.

SPEAKER_02 45:26

Yeah.

SPEAKER_00 45:27

Um, but I would say going back to your discussion about peer, you know, your peers and and so on, uh, I don't care anymore. You know, it's early on. I I knew that that the way I approached hernia surgery was different than others. My patient population is different. I'm a female surgeon. It's it's just different. Um and there's a there's a lot of people in our in our world, in our society, they're a little bit more loud, they're a bit more boisterous, and some of them like talk very directly. And I've just learned like I'm just not them, you know? Yeah, and there are patients that I see that I refer to them, there are patients they see that refer to me, or the patient chooses to like see multiple surgeries and and pick one of us. And you know, it's it's I'm totally okay with it. In fact, I encourage, I encourage that kind of back and forth. Um yeah.

SPEAKER_01 46:30

I've I have never once in my life tried to talk somebody out of a second opinion. I'll tell you that. That's like I encourage it.

SPEAKER_00 46:36

If you listen to me on Pernat Live, one of the things I always say is get a second opinion. It's a surgery, it's not just a hernia. Every person who's had a problem has regretted just quote, trusting their first surgeon and not questioning it. You should I've myself had had have had surgery. I know exactly which surgeon I need to go to. I still would go to a second opinion to double check that I'm not missing anything, the questions that I should have asked are all being answered. And I encourage anyone who gets any surgery, no matter how small, to get a second opinion. It's very helpful.

SPEAKER_01 47:12

Yeah. Yeah, I've uh yeah, I go even even beyond the surgical decision making. Yeah, I go directly because I feel that the relationship between the patient and the surgeon is so critical as far as that trust and if you're clicking. There have been patients that are like legit, we're in agreement about what needs to be done, but you can tell that we're just not like we're just not on the same wavelength personally. Like we just like the the communication is just kind of like awkward and different, they don't seem comfortable. I'm not really comfortable. Like, and so I was like, would you if if you would like to feel like to talk to somebody else, definitely no no problem for me. I'm happy to get yourself somebody because I think that you know there is nothing, it is gonna be a terrifying experience. My wife had uh two major surgeries this month, kind of unexpectedly, and we we're both in medicine, we know what's going on, but it's scary, it's still scary. And and you know, so we if it's scary for us, think what it is for people that don't know all the safeguards in place. Um, and and so those those types of things I take very seriously. One of the things you you brought up uh was you have a little bit of a different patient population. You focus um a lot on on uh female patients just by that's your patient population, and so you're you're kind of focused heavily on those. My wife, who is has gone deeper and deeper into menopause specialty, she has uh you know really enlightened me to the the dramatic differences between some of the data out there and how it doesn't necessarily always accurately represent women. And how do we have to do that?

SPEAKER_00 48:58

Yeah, we can have rate changes on hormonal on uh bagular estrogen, yeah, absolutely.

SPEAKER_01 49:04

So, and and then some of the historic studies that we still use for treatment as like the dogma and where we kind of move our rest of our treatment strategies from sure may have very narrow scopes of the diversity of the patient population that was studied. So when it comes to hernias surgery in general, what do we get wrong about hernial surgery in women?

SPEAKER_00 49:27

Well, the same way medicine kind of treats women as like what we call bikini medicine, it's either a breast issue or it's like a gynecologic issue. And all the other things, colorectal, heart, even hernias, are mostly like male-dominated studies, male and so on. Um, I think we treat women's hernias the same. So we think that women present the same way, which they don't. We just published our paper that shows the very different symptoms that women present with versus men for the same quote ingual hernia. Um this kind of overstudy of femoral hernias saying that, like the European Hernia Society guidelines say because women have a higher risk of chronic pain after ingual hernia repair, and a large proportion of those, I think 30, 40 percent, are because of missed femoral hernias. Therefore, all women should get laparoscopic hernia repairs. Well, what does that imply? That means all women should get a mesh-based repair. That is not good for women. Women do not need mesh-based repairs, they tend to have smaller inguin canal, smaller hernias. Marcy has been shown to be perfectly good for these really small hernias. Some women do better with the tissue-based repair. There's more nerves in the pelvis, there's more concentration of nerves in the pelvis, that's been shown in anatomy. So mesh causes inflammation, women have more autoimmune disorders, mesh is not a good idea in those women. So tissue repair should be more common in women than men. But if you follow the Hernia Society guidelines by the European Hernia Society, laparoscopic mesh, laparoscopic repair should be the gold standard for women to reduce the risk of femoral hernia, misferral hernias, but that implies every woman should get mesh. So it's this poor understanding of how they present. Women are going to have more pain during their menses. That doesn't mean they have endometriosis, that could be a hernia. Women are going to have pain with intercourse. That's not a gynecologic issue, that could be a hernia. Women are more likely to have public floor spasm, and the downstream effects of that, besides pain with intercourse, urinary frequency. Don't send a urologist and get them worked up for interstitial society. They probably have a hernia. So there are all these things that men don't necessarily present with that women do, and women don't have this big hernia most of the time. It's usually small or more difficult to diagnose, and it's more subtle. And because you can't necessarily see a good hernia in a lot of these women, you label them with chronic pelvic pain and you send them to pain management or the gynecologist that treats them for chronic pelvic pain, voltiny, and all this other stuff. So by treating these women and then getting a good relationship with my gynecologists and urologists, and then my pain doctors and my and my my radiologists, I've gotten to learn how different women are. And it's just not cool when my I look at my patient population and they're misdiagnosed, delayed in diagnosis, and much more likely to have opioids diagnosed before they ever see me. That doesn't happen with women. Same thing is with heart disease, right? They're more likely to be given pain medication and sent away and told they're just, you know, anxious when their chest pain is not exactly the way men present. So I'm hoping that we will have watchful waiting trial for women. We don't have one yet. University of Michigan is, I think, either got their NIH grant or applied for their NIH grant to study it. I hope to be involved in that, to actually give enroll patients in that because we need to understand whether watchful waiting is appropriate for women. Currently it's not. Why? Because we may be missing femoral hernias and people die from misheral femoral hernias. Um, we don't understand what happens with pregnancy. If you have a ventral hernia or umbilical hernia in a woman, if she's not done with her pregnancies, probably shouldn't repair those yet, right? That's not a discussion we have with men. It's really a discussion that we should have with women as to how symptomatic they are and where they are at the pregnancy. You know, gynecologists want to fix a belly button hernia during their c-section. Don't do that. They want the hernia fixed during the c-section. Don't do that. You know, wait until they're done three months after their last three months after after they deliver or three months after they're done breastfeeding, whichever one's later. That's when your abdominal wall is different. So hormonally, it's different. Scars are different, right? Women like to be midrift-bearing, you know. The scars may be more important for women than men, and diastasis may be more important for women than men. There's so many little intricacies that you should think of when treating women that doesn't really fall into your algorithm when treating men, that I hope one day we will be a bit clearer about all to me. It's natural now. Like I don't think twice about it.

unknown 54:49

Yeah.

SPEAKER_00 54:49

And so when I just rattle it off, it's like crazy. But, you know, I think the average surgeon doesn't appreciate that yet. And hopefully, as we publish more and write more book chapters on it, then maybe eventually it'll get into medical school and people will kind of learn about this. Because it's not just a surgeon issue, it's the family doctor, the internal medicine doctor understanding that this chronic pain is not a gynecologic problem. And the gynecologist understanding it's not a gynecologic problem.

SPEAKER_01 55:18

Sure. Yeah, no, I think um, I think that you know, even those of us that that take care of hernias, I think that even us that are well well intentioned, um, there are because there aren't the studies, and because you know, we don't probably because they're just not being referred to us, because they're being mislabeled, we don't see as many familial hernias and females as are out there. And so that experience and that like seeing the reps over and over and over again, it just doesn't happen. And so, you know, I feel like I should like bust out a notebook and have you say that. I'm gonna go back and listen to this later and take some notes. But um, no, I think we've got you know, we have a um Winnie Palmer hospital here is an enormous they uh 14,000 deliveries a year, I think it is. And so, you know, we see a ton of of those. And just talking with people, you know, the number of women that are sitting out there with rectus diastasis, where they, you know, these are otherwise like fairly fit ladies who have a hard time sitting up out of bed. Yeah, and it's just completely ignored because it's just you know, that's well, I had the babies, and this is kind of the what I was left with. And you know, you see them and you're like, you know, we can do something about that if it's really if your core is that unstable and you're having that much problems, you know. They half the time they come to me for for like chronic abdominal pain, they're going, oh, is it their gallbladder? And I'm like, No, it's because they've got this massive colon full of stool because they can't generate any abdominal pressure to have a bowel movement.

SPEAKER_00 56:48

Yeah, compensation due to diastasis for sure.

SPEAKER_01 56:53

And then uh, and then you know, you only do a few of those, you only do a few of those cases before you realize that you really need to make sure they're not constipated prior to the surgery, immediately prior, because then the recovery is really difficult because they're like they're always pain. But and then the the inner the connection between um pelvic floor dysfunction and diastasis and and all and how all of that kind of molds itself together.

SPEAKER_00 57:19

Yeah, my you know, family, and you know, you can treat uh you can treat uh ventral hernia, even an incisional hernia, with a tummy tuck. You know, you don't have to put mesh in everyone. Putting mesh is hazards, risks, and benefits. And um, you know, the you know, we had this discussion a long time ago, and I said, you know, you really when you do these TARS or ETAPs, you really should close the posterior fascia. And they're like, no, you don't need to. And I'm like, uh, or you shouldn't. I said, literally every patient that I do, I close it. Now that it'll be rare, and I I tend not to have 20 centimeter patients, I'll grant you that. But you know, the 10, 12, 15 centimeter hernia is do your dissection so you can close the posterior fascia. Like, you don't need to do that. And I'm saying, what you're not understanding is that's your transversal fascia. The transversal fascia is the inner girdle. If you don't restore your inner girdle, you're gonna get a boxy belly. It's going to be like a box, like a square. And if you're operating on patients that are somewhat you know overweight or obese, you may not appreciate that. But a lot of my patients are not obese. And if I don't close that posterior fascia, they're gonna be very unhappy with this kind of boxy look to their belly. And now all of a sudden, they're like, oh yeah, we should we should consider doing it. But because I'm more of a capelvic person, not an abdominal wall person, you know, no one listened to me until now that they're seeing this more often, they're seeing the change in contour and how important that posterior fascia is that people are starting to do it. You know, it's it's you just learn over time. And um at my LA County job, I was very young when I started compared to everyone else there. I joined a very old, like everyone was over 70 among the faculty. I think we had one guy who was in his 60s, and then I started there and I was I was like 29. Um so I was like their grandchild basically. But the beauty of it was I was surrounded by really experienced surgeons. They taught me stuff that they learned in the 50s, 40s and 50s, right? Yeah that we don't know anything about, and we've lost like the history of hernias and the history of surgeries, we've lost it. Yeah, but they taught it to me, and I learned and they gifted me books from during their time, and I learned so much from them. And I see our younger generation of hernia surgeons, which is so awesome, that we have so many really gifted, talented surgeons joining our hern society, but some of them are cocky, like I used to be cocky when I was younger, and they think they know what they're talking about. And I'm like, no, no, no. What you're saying we did 40 years ago, 50 years ago, 30 years ago. Let me tell you, that's not how to do it. And they think they're like being so innovative. Um, and you know, we don't want to repeat history. And what I like about the IHC and many of our herny society societies is we are in general a very kind family of international doctors. That's why I go to the European Hernanie Society meeting every year because I I love hanging out with people of different countries and learning how they do things. Um and we do we're pretty nice to each other, you know. We refer to each other a lot, we share a lot of patience. I offer what's called an online consultation. I know most people can't travel to Beverly Hills to see me. Um, but maybe they I could help them in some ways. So I do offer like an opportunity just to review their their story and guide them, and I'll say, you know, and then go to Florida, Dr. Takla is there, you know. And like, oh, I didn't know that, you know, once one city over, let's say.

unknown 1:01:32

Right.

SPEAKER_00 1:01:32

And that way you kind of share the love, right? And kind of allow patients to get good care within their community, and you know, what comes around, goes around. I strongly believe in that. So um that's the beauty of hernia family, I call it. I really like my group of people.

SPEAKER_01 1:01:54

Yeah, you it's um it it I don't I've not been deep into other sub-specialties, you know, groups of people. I know some that I probably I can just intuitively guess some I wouldn't want to be a part of, but her hernia has been a very, a very uh beautiful surprise. And everybody that I've had the opportunity to talk with, um, you know, I've been really lucky to have the opportunity to talk with some some very well-known folks such as yourself. And everybody's so I think the thing is crazy how everybody is so humble about everything, yet not much to be humble about. There's there's no reason for them to be humble. They have all the reason in the world to be extremely arrogant and cocky because of how good they are at what they do and everything, but but yet they're still so every single one of them is helpful.

SPEAKER_00 1:02:45

If you call any one of those people that you may even think are cocky or whatever, every single one is kind, helpful, will go out of their way to guide you and and make you a better surgeon.

SPEAKER_01 1:02:57

Yeah, no, they're not they're not cocky at all. And you're and I'm just sitting there going, like, you do you realize who you are, right? You could be cocky, and nobody would blame you for it. Like, like everybody, everybody knows who you are. It's amazing, you know. And and then they're just so down to earth and and uh so willing to talk about it.

SPEAKER_00 1:03:14

I I'm in this is Hollywood, right? So it's not like being a hernier surgeon is like you're being like someone in the street's gonna notice you. You know, that's that doesn't happen. Well, it happens when we're around my office, I'll tell you that.

SPEAKER_01 1:03:30

But I'm sure the EHS people know, you know what I'm saying? It's it's all relative.

SPEAKER_02 1:03:34

Yeah, exactly.

SPEAKER_01 1:03:35

No, it's it has been a really it's been a really good uh a good thing. You know, we've had I've had the absolute pleasure to talk to uh quite a few female surgeons, a lot of of which are in uh Europe. And they all have their own their own stories, and um, you know, obviously the surgeons in the United States and and other countries have theirs theirs as well. But you know, I think that there are definitely some hurdles that uh females in the surgical community have to um overcome, unfortunately, in a lot of cases. Um and how how have you felt about your journey? And do you feel like um the the current situation, are we moving in the right direction when it comes to embracing females in surgery?

SPEAKER_00 1:04:21

100%. 100% moving the right direction. Uh my first European, I mean my first American Harmony Society meeting was in 2002. Um I opened up the door, I think it was in Orlando, I opened up the door to the to this space, and it was like a sea of white hair or bald-haired men, bald-headed men. And I was like, oh my god, because I, you know, as a resident, I was pretty prolific and I'd gone to a lot of different society meetings, present my research. That was not my understanding. And I was like, oh my, am I the only female? I think there was one other female, not even joking, to the point where remember, I just graduated, I didn't do fellowship, I went straight from job, from residency to job. And I gave my talk, he came down, and Chuck Philippi, who past president of the American Hearning Society, he was editor in chief of the uh Hernan Journal at the time. I had no clue. Um comes up to me and says, That was really great. Would you like to be one of our editors in the uh the Hernia Journal? I was like, me? But yes, we've never had a female before. And I said, Hell yeah. Now I I had no business being any part of any journal. I was like four months out of residency. Um but it just showed how wonderful and kind it was for Philippi to do that. And then I got a position on the board, so that helped. And now we're at a point where Where the next several presents are female. We have the Hernia's Hernia Surgeons Alliance, which is like a female-oriented alliance of young, or like younger generation of surgeons that are all female that are hoping to promote more research and education and interest in female-based, um female-based stuff. I would say about eight or eight, eight, six or six or seven years ago, I started a grant at the African American Hernia Society. It's $2,000, right? My own money that I gave, and I said, this has to go to any research, well, the top research that specifically looks at female factors in hernias, right? No more of this like male-only research. And I thought if I throw money at it, then someone will want to write a research project or an abstract to the society meeting. And I think the one who won the first one, it was the only abstract. So there was like no competition. Now there's actually competition. Multiple abstracts are submitted that look at female factors and hernias. And you know, it's like a somewhat competitive you know award to win at the American Hernia Society. So you each of us is doing our part to promote it, and hopefully that'll infiltrate into the general public too.

SPEAKER_01 1:07:32

Is that is that is it still the the $2,000 grant?

SPEAKER_00 1:07:36

$2,000. Is there a way to $2,000? Is it a high quality abstract that specifically addresses female factors?

SPEAKER_01 1:07:44

Well, that's that's one thing, but how do how do people that want to get in on that action help support the grant?

SPEAKER_00 1:07:51

I mean, I'll take donations. I do have a foundation, it comes from my foundation. So I do have the Beverly Hills Hernia Foundation. It's a 501c3. Um, if you ever need to put some money away as a tax donation, feel free to donate. It's on my website, Beverly Hills Hernia Foundation.org. And 100% of the money goes towards supporting research and education in hernias, including the grant that goes to the American Hernia Society Foundation.

SPEAKER_01 1:08:21

So if they make a donation to that, can they earmark it for that grant? Uh a little bit. Let's get it, let's get it going.

SPEAKER_00 1:08:28

Bring it up. Yeah, let's do it. We can actually, you know what? Why not? One day we'll have an actual research grant of let's say $10,000, $20,000. Um, specifically meaning it, that kind of research. Absolutely. We should.

SPEAKER_01 1:08:41

It's a big deal here in the Elms household with my wife's with my wife's interest. It would go a long way towards getting me out of a lot of trouble that I get in frequently.

SPEAKER_00 1:08:51

Yeah, let's do it. Let's do it. That's that's like the legacy I want to leave behind because eventually I have to retire, is that hopefully I've been able to kind of shift the understanding of of and improve the care given to women in her needs.

SPEAKER_01 1:09:07

All right. So we're going for what are we going for? 10,000?

SPEAKER_00 1:09:10

Sure.

SPEAKER_01 1:09:11

We're at 2,000 now.

SPEAKER_00 1:09:13

I think it's 10, 20, and 30. There may be a 30,000 grant that's currently there. Yeah, we can start 10,000. Sure.

SPEAKER_01 1:09:19

I got I got a thousand towards that right now.

unknown 1:09:22

Okay.

SPEAKER_01 1:09:22

So we'll go, we'll go a thousand there and then then the listeners, let's do it. Let's get it up to 10.

SPEAKER_00 1:09:27

How's that?

SPEAKER_01 1:09:28

Sounds good. Well, I mean, you've kind of already matched double that. You're making me look bad now.

SPEAKER_00 1:09:32

On top of that.

SPEAKER_01 1:09:33

On top of that, excellent. Excellent. Yeah, now we're it's a um we've had some already. Let's do it.

SPEAKER_00 1:09:40

See how easy that was?

SPEAKER_01 1:09:41

That was. We're almost there. So let's see. We gotta get somebody, we gotta get somebody that we know has just made of money. Let's see. Uh if we knew somebody maybe that practiced on Fifth Avenue in New York, that might be somebody that that might we.

SPEAKER_00 1:09:55

Right around Central Park for College. Right around there.

SPEAKER_01 1:09:59

I think that would be something. I could probably do something with that.

SPEAKER_00 1:10:02

I'd have to have a pride about that.

SPEAKER_01 1:10:04

Yeah, well, maybe he'll know somebody. Well, uh, you know, it's been it's been an absolute uh pleasure talking to you. I've been looking forward to this this discussion uh for a while. And um, and you know, flattered that you that you would take the time and and come on come on the podcast as we kind of come towards the end of an episode every time we do the the hernia hot take, which uh I shamelessly stole from Hot Ones, I'll tell that right now. I love the I love that that uh that YouTube uh channel. But um the the hernia hot take. So uh if you have your your opportunity here for your opinion on hernia surgery. My opinion on hernia surgery unpopular or popular or otherwise.

SPEAKER_00 1:10:50

My opinion is that we will eventually have a scoring system that will make it even simpler to understand who has a hernia and what kind of treatment they should get. Because even diagnosing is hard, even for like ER docs and the same way we have like the Alvarado score for appendicitis and all that. My prediction is we'll have a scoring system. You fill in all your symptoms, right? AI is going to help with that. It tells you which surgery, whether you have a hernia, and that's the cause of your groin pain, let's say, and not your hip or your back or whatever. And then based on the information you you feed it, it'll tell you what are your best options and the success rates for each of those.

SPEAKER_01 1:11:38

That's fantastic. Sounds you know what it sounds like? It sounds like a good way to get a $10,000 research grant once we hit up our friends in New York. So no, that's great. Again, thank you so much for uh for coming on. It's been it's been a pleasure. You know, obviously we to we could uh take a lot from from your uh presence online and how you connect with your patients and um and the and the uh passion you have for for treating um all patients, including those that are that are painfully up underrepresented in the treatment algorithm. So it's been a very much a pleasure talking to you, and hopefully we can have a conversation again in the future.

SPEAKER_00 1:12:21

Thank you so much, and you have to promise to be the guest on my podcast.

SPEAKER_01 1:12:26

Anytime you let me know.

SPEAKER_00 1:12:30

I really enjoy listening to your other podcast. The humanity and caring that you have and the stories that you extract from people is is fantastic. So, congratulations on your podcast.

SPEAKER_01 1:12:41

Well, do you want to hear one quick parting story about why I named my other podcast, uh, this two show podcast?

SPEAKER_02 1:12:48

Yes.

SPEAKER_01 1:12:48

My wife and I um I got my first job offer, and um, and so they uh uh we went out to celebrate. And I'd had a couple of corona readas, I don't know if they have those in Beverly Hills, but out here in Florida, that's a corona turned upside down and a margarita. As we were celebrating. And um, and so we uh we go do the where's it there? And I'm thinking, you know, I'm always in my head living in the future in the past. And um I said, you know, this too shall pass. That motto, it really means, you know, not just get through the bad times, but really cherish the good times, because even those are gonna pass. And I'm you know pontificating a margarita and a half deep, you know. And my and I was like, you know what, I'm gonna get that as a tattoo. My wife has tattoos all over her her torso. And um, and she's just like, you're always seeing that's like, I'm gonna do it. And she's like, No, you're not. And I was like, No, I will. And she goes, No, I think you're a and then she's a gynecologist, so she says a word that's for her, but I won't repeat it here. But it was a it was a derogatory, she meant it in a derogatory way towards me. And um, and I said, uh, I said, fine, I will. And she goes, good. She picks up the phone and calls her tattoo artist. She goes, he has he has availability right now. And I'm like, uh-oh. And so an hour and a half later, I'm in a tattoo chair and I'm getting this too, shall pass, tattooed on my chest. And so I have it set up right here. And um, I'm sitting there and I'm getting myself hyped up to get this done, and she's just like, it looks dumb there. And I'm like, well, what do you mean? She's like, it looks dumb, it needs to be moved. I go, we'll just move it and make it look good. And so she moves it, she takes it from here and she moves it here. And so I get the tattoo done. And I'm on my way home and I send my buddy a picture. He's a urologist. I send him a picture and I said, you know, um it said, why? Uh I said, check this out and everything. And he goes, bro, go home, put on scrubs, take a picture and send it to me. I'm like, okay. So I go home, I put on a scrub top, scrub top serve v-neck, and I take the picture and I send it to him.

SPEAKER_00 1:14:55

And oh no, A S S.

SPEAKER_01 1:14:57

It turns out that when you wear scrubs, all the shows pass. And so I go to work the next day and I was the administrative chief, and uh, and I'm like, you know what? Uh so I wear an undershirt, and uh, I'm a husky dude, so I was like sweating in this car. Yeah, so I go in and we have a resident meeting, and I'm running the meeting, and I put take off my undershirt before in the locker room and just put on regular scrubs of like if they don't say anything, I'll be fine. So I go, okay, everybody, calm down, calm down. Okay, and then I go, okay, so and boom, hand goes up.

SPEAKER_00 1:15:38

Oh my god.

SPEAKER_01 1:15:40

Yeah, and he goes, Hey, why is your chest say ass? I was like, So that's that's my uh that's my story of how the other podcast got its name.

SPEAKER_00 1:15:52

Oh, that's good. Yeah, oh wow, that's a great story.

SPEAKER_01 1:15:59

I wish I didn't have so many of those embarrassing great stories.

SPEAKER_00 1:16:04

Now, does your wife feel guilty about how she positioned it?

SPEAKER_01 1:16:08

Not at all. No, she thinks this is she really she takes every opportunity to make me look like an ass. So I love her.

SPEAKER_00 1:16:15

I need to meet her.

SPEAKER_01 1:16:16

Yeah, she's she's a very she's a very powerful person. So and our daughter's taken right after her, so it's good. But patients love it though. It's very humanizing for the patient. So yeah, like they they comment, I don't wear it on a shirt anymore. I'm like, uh, see if that's gonna make you not choose me as a search, then they probably need a second opinion. So, but uh, but anyway, so that's that's the way where that came from. So, well, I appreciate you again coming on. Thank you so very much, and uh can't wait to have a future discussion.

SPEAKER_00 1:16:44

Yeah, looking forward to seeing you again.

SPEAKER_01 1:16:47

All right, thanks. Well, this wraps up another episode of the Hernady Gods Podcast. This is your Mirror Mortal host, Luke signing off. Thank you.