WEBVTT 00:00:00.000 --> 00:00:07.340 Welcome to today's episode of Medically Speaking. 00:00:07.340 --> 00:00:09.860 We are certainly glad you joined us today. 00:00:09.860 --> 00:00:14.540 I have two very special guests from our general surgery department today. 00:00:14.540 --> 00:00:21.000 I have Dr. Ryan Bolt and Dr. Alex Wang, both with general surgery, both trained robotic surgeons, 00:00:21.000 --> 00:00:23.520 and I'm super excited about our conversation today. 00:00:23.520 --> 00:00:25.680 So let's just start a little bit with introductions. 00:00:25.680 --> 00:00:27.760 We'll start with Dr. Bolt. 00:00:27.840 --> 00:00:31.600 Dr. Bolt, maybe tell me a little bit about your background, where you're from, 00:00:31.600 --> 00:00:33.260 and how did you find yourself to Greenwood? 00:00:33.260 --> 00:00:35.100 Sure, no problem. Thanks for having me. 00:00:35.100 --> 00:00:38.640 Yes, I'm Ryan Bolt. I'm one of the general surgeons at Salf Regional. 00:00:38.640 --> 00:00:45.200 I did my undergraduate in Buffalo, New York, a chemistry undergrad major, 00:00:45.200 --> 00:00:50.700 then found my way down to Virginia for medical school, Michigan for residency, 00:00:50.700 --> 00:00:54.500 which is a five-year program, and then after finishing up the five years, 00:00:54.500 --> 00:00:57.640 I was looking for a job and had postdocs. 00:00:57.840 --> 00:01:02.940 So I did all those things on a job board, and the recruiters here at Salf Regional reached out 00:01:02.940 --> 00:01:07.440 and kind of went down that path, and there were several things about Salf Regional, 00:01:07.440 --> 00:01:11.440 including the presence of robotics and that sort of thing that kind of drew me here. 00:01:11.440 --> 00:01:13.740 Awesome, awesome. Thanks. Alex? 00:01:13.740 --> 00:01:16.140 Thanks for having me. I really appreciate it. 00:01:16.140 --> 00:01:21.980 Yeah, so I'm originally from Atlanta, Georgia, and I did most of my schooling in Georgia. 00:01:21.980 --> 00:01:25.600 So I did college at University of Georgia in Athens, 00:01:25.600 --> 00:01:29.240 and then I went to MCG in Augusta for medical school, 00:01:29.240 --> 00:01:33.280 and I did my residency at Morehouse School of Medicine in Atlanta. 00:01:33.280 --> 00:01:40.020 And when I finished my residency, I knew pretty early on that I spent most of my life growing up in cities. 00:01:40.020 --> 00:01:45.280 From a very young age, I grew up in Paris and lived in city life, 00:01:45.280 --> 00:01:54.620 and I knew that as much as I love the city, I want to be somewhere a little more to my pace and my liking, 00:01:54.620 --> 00:01:55.000 Yeah. 00:01:55.600 --> 00:02:01.940 and I had to look for somewhere where I'm close enough to family still but not too far away. 00:02:01.940 --> 00:02:06.240 I can't see them on a regular basis, so that's how I ended up in Greenwood. 00:02:06.240 --> 00:02:11.000 This was like perfect. It's about two hours from where the rest of my family lives in Atlanta, 00:02:11.000 --> 00:02:17.840 and the other thing I looked for that brought me here to Greenwood was exactly the robotics program, 00:02:17.840 --> 00:02:23.100 the availability, the ability for us to grow that part of our practice. 00:02:23.100 --> 00:02:24.320 Awesome, awesome. 00:02:24.320 --> 00:02:29.820 Have you guys found the community to be pretty welcoming to you and kind of hit the ground running, 00:02:29.820 --> 00:02:31.260 or has it been a little slow start? 00:02:31.260 --> 00:02:36.100 No, it's been great. It's been a very busy practice, and it's just continued to grow, 00:02:36.100 --> 00:02:39.400 and we've continued to kind of increase the utilization of the robots 00:02:39.400 --> 00:02:44.560 and try and get more and more types of patients and types of cases on the robot. 00:02:44.560 --> 00:02:47.880 Exactly what I expected, you know. 00:02:47.880 --> 00:02:53.040 In medical school, I specifically did all my surgery rotations in smaller towns. 00:02:53.040 --> 00:02:55.520 I was in Columbus, Georgia. 00:02:55.520 --> 00:03:01.400 I guess you shouldn't say those are small towns, but kind of what we were considered outside rotations, 00:03:01.400 --> 00:03:08.080 and so I was in Columbus and Albany and all these other places, and I just loved the small-town feel. 00:03:08.080 --> 00:03:12.880 I think people are extremely welcoming, and it's been a great transition. I couldn't be happier. 00:03:12.880 --> 00:03:17.000 Awesome. Alex, maybe I'll start with you. 00:03:17.000 --> 00:03:22.040 Let's dive into robotic surgery just a little bit, maybe just give an overview to our audience. 00:03:22.040 --> 00:03:28.360 What is robotic surgery? What makes it special, and why is it important that we have that service here? 00:03:28.360 --> 00:03:32.520 Yeah, I think it's interesting when you look at the evolution of surgery, 00:03:32.520 --> 00:03:35.720 because for a long time, everything was open surgery, 00:03:35.720 --> 00:03:44.520 and with the advent of laparoscopic surgery, it started off in the field of GYN in the late 1980s. 00:03:44.520 --> 00:03:50.200 In 1987, we did our first colostectomy. That was actually done over in Atlanta. 00:03:50.200 --> 00:03:50.760 And so, 00:03:52.040 --> 00:03:58.120 that idea of, "Can we do the same surgery with smaller incisions?" was the whole goal, 00:03:58.120 --> 00:04:04.360 because as people who had large incisions for, say, a gallbladder surgery, they know it's much 00:04:04.360 --> 00:04:09.320 more painful. You stay in the hospital for a longer time, and so the evolution to minimally 00:04:09.320 --> 00:04:14.520 invasive surgery starts with laparoscopic surgery, and kind of now we're at a new frontier where 00:04:14.520 --> 00:04:20.360 robotic surgery over the past 10 years has really taken a hold in a lot of training and a lot of hospitals, 00:04:21.320 --> 00:04:26.120 and robotic surgery itself is specifically different than laparoscopic surgery, because 00:04:26.120 --> 00:04:35.160 the technology itself allows surgeons extremely minute control of the surgical field with 00:04:35.160 --> 00:04:43.880 great magnification and high visualization. And to us, it offers us more abilities to 00:04:43.880 --> 00:04:48.840 offer a surgery for a patient with better outcomes, is really the goal here. 00:04:48.840 --> 00:04:51.160 Okay. Just one thing. 00:04:51.160 --> 00:04:56.120 One thing that came to mind. Can you describe the difference between traditional laparoscopic 00:04:56.120 --> 00:05:01.800 surgery versus using a robot for surgery, and maybe some of the benefits and differences 00:05:01.800 --> 00:05:03.000 between the two? 00:05:03.000 --> 00:05:11.400 Yeah. So, one big advantage with the robotic platform is the wristed instruments that we have 00:05:11.400 --> 00:05:20.440 control of, and it basically mimics having wrists inside a patient's abdomen. And the advantage to 00:05:20.440 --> 00:05:25.880 that is that when we're talking about colon surgery and talking about connection of bowels, 00:05:25.880 --> 00:05:32.280 like Dr. Bolt mentioned, traditional laparoscopic surgery, it slightly limits you when you have to 00:05:32.280 --> 00:05:36.440 talk about suturing bowel together laparoscopically, just because you're 00:05:36.440 --> 00:05:41.960 limited on the wristed portion of that. And the robotic platform offers us the ability to do 00:05:41.960 --> 00:05:49.400 the entire surgery within the abdomen. And to me, that makes a big difference because in the end, 00:05:50.280 --> 00:05:56.120 when you have to take out the portion of the colon that you've cut out, that makes a difference 00:05:56.120 --> 00:06:02.600 in terms of outcomes. The colorectal field has done extensive research on this and found that 00:06:02.600 --> 00:06:09.720 depending on laparoscopic surgery extraction sites versus robotic surgery selected extraction sites, 00:06:09.720 --> 00:06:14.840 people can come back with higher risk of incisional hernias in the future. And so, I think 00:06:14.840 --> 00:06:19.560 that is one advantage is that if we're able to do everything inside the abdomen, we're not limited 00:06:19.560 --> 00:06:25.320 in terms of where we want to take out the resected colon, and it offers patients 00:06:25.320 --> 00:06:32.360 less risk of future complications from that standpoint. There was another study that was 00:06:32.360 --> 00:06:38.280 done very recently in 2022. They looked at conversion rates to open. And so, when we talk 00:06:38.280 --> 00:06:44.680 about a potential risk of minimally invasive surgery is that there's always a small chance you end up with an open incision. 00:06:44.680 --> 00:06:47.000 And that study 00:06:47.000 --> 00:06:53.640 showed pretty convincingly that for left-sided colons, there's a pretty much 00:06:53.640 --> 00:07:02.600 third less risk of open surgery. So, it was about 6% with laparoscopic surgery and 00:07:02.600 --> 00:07:08.280 about 2% with robotic surgery. And I think that's a big difference. And again, it just shows 00:07:08.280 --> 00:07:14.520 the advantages of having the robotic platform in terms of the visualization, the manipulation of 00:07:14.520 --> 00:07:21.400 the instruments, and finer dissection, especially for patients who have more difficult anatomy, 00:07:21.400 --> 00:07:26.200 more inflammation, things like that, where normally you would have to resort to open. 00:07:26.200 --> 00:07:30.040 The robotic platform allows us to continue minimally invasive. 00:07:30.040 --> 00:07:35.400 Yeah, I would say it even provides an advantage in more obese patients as well 00:07:35.400 --> 00:07:39.400 to enable completion of the surgery without having to convert to open. 00:07:39.400 --> 00:07:44.360 And I would definitely echo what Dr. Wang was saying with the wristed motions. I think that's kind of the 00:07:44.360 --> 00:07:51.960 game changer with the robotic platform is the fine, delicate ability for dissection and for 00:07:51.960 --> 00:07:56.760 suturing is just, it's not even really a comparison as compared to laparoscopic surgery. 00:07:56.760 --> 00:07:59.640 Awesome. Thank you. 00:07:59.640 --> 00:08:07.320 Good. So, certainly better outcomes is certainly one of the important results that we hope to see. 00:08:07.320 --> 00:08:13.160 Brian, maybe talk to me about recovery time for things like a robotic surgery versus an open 00:08:13.160 --> 00:08:14.200 surgery for something like... Sure. 00:08:14.200 --> 00:08:18.920 ...a colectomy, which is colon removal for cancer or whatever reason may need to be done, 00:08:18.920 --> 00:08:22.920 versus the, again, robotic versus traditional open. 00:08:22.920 --> 00:08:29.000 Yeah. I mean, the comparison between the two is pretty stark. I think a minimally invasive robotic 00:08:29.000 --> 00:08:36.120 surgery is going to have a post-operative stay of two days sometimes. That same type of surgery 00:08:36.120 --> 00:08:44.040 performed open can last five days for various factors. By doing it with the small incisions in a small, 00:08:44.040 --> 00:08:48.440 smaller extraction site to remove the specimen, you're able to minimize pain, get people up 00:08:48.440 --> 00:08:53.800 ambulating earlier, and you can essentially advance their diet faster, have quicker return 00:08:53.800 --> 00:08:58.280 of bowel function, and meet all the milestones to discharge in a much quicker way than if it's 00:08:58.280 --> 00:09:02.200 done open. And just to add to that, 00:09:02.200 --> 00:09:07.240 the other thing we don't think about is, a lot of times we look at the immediate effects like, "Oh, 00:09:07.240 --> 00:09:11.960 you're in the hospital for a shorter time. You have less pain." But you also got to think long-term 00:09:11.960 --> 00:09:12.120 that with a bigger incision, you're going to have less pain. But you also got to think long-term that 00:09:12.120 --> 00:09:12.920 with a bigger incision, you're going to have less pain. But you also got to think long-term that with a 00:09:12.920 --> 00:09:13.880 bigger incision, you're going to have less pain. But you also got to think long-term that with a bigger incision, 00:09:13.880 --> 00:09:18.600 what we see a lot are hernias, incisional hernias, down the line, whether it's five, 00:09:18.600 --> 00:09:24.680 10 years and things like that. And so the smaller incisions you have, the further away they are from 00:09:24.680 --> 00:09:29.560 the middle or your belly button, which is the natural weak point for hernias, the less likely 00:09:29.560 --> 00:09:35.160 you're going to have people come back down the line with a hernia, which could be associated 00:09:35.160 --> 00:09:38.760 with so many other complications itself. Any other benefits? Just one thing that 00:09:38.760 --> 00:09:43.720 comes to mind. You all know I'm an ER doctor, and one thing that we would see a lot are someone with 00:09:43.720 --> 00:09:49.560 a hernia years after surgery with adhesions, and they get bowel obstructions. Do you see less 00:09:49.560 --> 00:09:54.280 incidence of those type complications with a robotic approach versus traditional approach? 00:09:54.280 --> 00:09:59.480 Yeah, I would say definitely. Yeah, I mean, a big midline incision to perform an open surgery 00:09:59.480 --> 00:10:04.360 more commonly is going to have significant abdominal adhesions, which, as some people 00:10:04.360 --> 00:10:08.600 may know, your small bowel is mobile and can get caught in those adhesions. And then if it just 00:10:08.600 --> 00:10:13.160 twists off in the wrong way, it can cause an obstruction, which may need repeat surgery to 00:10:13.160 --> 00:10:13.560 alleviate. 00:10:13.560 --> 00:10:18.520 And if it can't be managed conservatively. Yeah, so I think of adhesions like scar 00:10:18.520 --> 00:10:24.280 tissue basically from surgery. So less scar tissue, less likely to have a complication 00:10:24.280 --> 00:10:30.840 like that. That's good. When you compare the equipment that we have at Self Regional, 00:10:30.840 --> 00:10:37.720 so far as the robotic platforms that we have here versus just compare us to the most advanced 00:10:37.720 --> 00:10:43.400 hospital in the world, is our technology comparable or are there some opportunities that we have 00:10:43.400 --> 00:10:46.920 or maybe we could do a little bit different? I know we've certainly invested a lot in 00:10:46.920 --> 00:10:50.920 trying to make sure we have great technology. I'm just curious from your perspective, 00:10:50.920 --> 00:10:54.120 what you think. I mean, I would say, you know, we just, 00:10:54.120 --> 00:11:00.920 I mean, the hospital just purchased three brand new state of the art DaVinci Five robots. That's 00:11:00.920 --> 00:11:06.440 the newest and best technology that, you know, Intuitive Surgical offers. And there's many 00:11:06.440 --> 00:11:12.680 advantageous aspects of that platform. And, you know, that's the that's the same type of robot 00:11:12.680 --> 00:11:19.720 that any hospital has. That's the best, the newest and best toy, so to speak. So we're all really 00:11:19.720 --> 00:11:24.120 excited about that, having that access to that platform and the availability. Good. 00:11:24.120 --> 00:11:28.520 Yeah, I think, you know, I came from a training program that was very busy in Atlanta. 00:11:28.520 --> 00:11:36.040 And my entire training, we were between two programs, Morehouse and Emory, 00:11:36.040 --> 00:11:41.960 sharing one robotic platform at the main tertiary hospital in Atlanta. And it just goes to show that 00:11:42.680 --> 00:11:48.760 how committed Self has been to advancement in technology and providing, you know, the best care 00:11:48.760 --> 00:11:54.120 for patients, you know, that our hospital system didn't get a second robot until I left, you know, 00:11:54.120 --> 00:11:59.080 and so when I came here already having two robots, and now investing in a third one, let alone the 00:11:59.080 --> 00:12:04.360 newest robot really shows the commitment that Self is putting towards technology and patients. 00:12:04.360 --> 00:12:11.080 Awesome. Thank you for that perspective. Okay, well, let's transition a little bit and think 00:12:11.080 --> 00:12:12.360 about colon cancer. Okay, well, let's transition a little bit and think about colon cancer. 00:12:12.360 --> 00:12:12.840 Okay, well, let's transition a little bit and think about colon cancer. 00:12:12.840 --> 00:12:16.600 Just for a few minutes. And, you know, that's a pretty common problem. 00:12:16.600 --> 00:12:23.240 What might you want any of our listeners to know about colon cancer, the importance of screening, 00:12:23.240 --> 00:12:29.480 maybe first steps after initial diagnosis, and when does a surgeon get involved versus just your 00:12:29.480 --> 00:12:35.480 gastroenterologist? So I think as a general baseline, I'll just start with saying that 00:12:35.480 --> 00:12:41.560 anyone above the age of 45 has new recommendation. Now, they recently changed it from 50 to 45 since 00:12:41.560 --> 00:12:47.720 the incidence of colon cancer has gone up so much in the recent years, should at least have had a 00:12:47.720 --> 00:12:53.320 colonoscopy. I know there are alternatives that your primary care physician or GI doctor may 00:12:53.320 --> 00:12:58.040 recommend, you know, there's fecal blood tests you can do, there's fit tests you can do, you know, 00:12:58.040 --> 00:13:03.240 there's the yearly tests you can do, but they're not truly alternatives to a formal colonoscopy. 00:13:03.240 --> 00:13:07.080 And if any of those tests are positive, anyway, you still need a colonoscopy. So 00:13:07.080 --> 00:13:11.400 I think that should be everyone's baseline. If you're above the age of 45, highly, 00:13:11.400 --> 00:13:16.200 consider at least a colonoscopy and then follow the recommended schedule by your GI team. 00:13:16.200 --> 00:13:24.680 Good. So if someone is diagnosed with colon cancer, when does a surgeon need to get involved 00:13:24.680 --> 00:13:29.240 in, like, how's that decision made? Yeah, it kind of just depends on what's 00:13:29.240 --> 00:13:34.760 found. I mean, when a biopsy comes back, proven cancer, then we typically have to 00:13:34.760 --> 00:13:40.280 obtain kind of staging CT scans where we take a scan of the chest, abdomen, pelvis, we obtain some 00:13:40.280 --> 00:13:41.240 blood work. 00:13:41.240 --> 00:13:46.360 Specific tumor markers. And then based on those results, we kind of determine what the next best 00:13:46.360 --> 00:13:53.240 step in your care is going to be. Most of the time, if there's no evidence of distant disease 00:13:53.240 --> 00:13:59.800 or spread of disease outside of where the tumor is, we can perform a resection, remove that segment 00:13:59.800 --> 00:14:05.080 of the colon and then make a new connection. And many times that can be curative and they 00:14:05.080 --> 00:14:11.080 can proceed with surveillance in the future. Awesome. And a multidisciplinary team with 00:14:11.080 --> 00:14:15.000 the oncologists and radiation oncology and all the folks looking at care. 00:14:15.000 --> 00:14:19.720 Yeah, I was going to mention that. I don't think there's ever a wrong time for a surgeon to really 00:14:19.720 --> 00:14:25.720 get involved because even if it is found at a later time that, you know, unfortunately if the 00:14:25.720 --> 00:14:31.000 cancer had spread, you know, somewhere else and may need chemotherapy, we're still involved in 00:14:31.000 --> 00:14:35.160 that process. We can help with that, you know, putting a port for them to administer the 00:14:35.160 --> 00:14:39.800 chemotherapy and things like that. So our involvement through any process, I think, 00:14:39.800 --> 00:14:40.920 hopefully could only be beneficial. 00:14:40.920 --> 00:14:43.960 I think it's beneficial for the multidisciplinary process of all this, you know? 00:14:43.960 --> 00:14:44.360 Yeah. 00:14:44.360 --> 00:14:48.280 Yeah. And sometimes, you know, it's just good to have, you know, if we're able 00:14:48.280 --> 00:14:52.840 to catch something early, we get the work started early, you know, before they see the oncologist. 00:14:52.840 --> 00:14:56.600 And if the oncologist sees them early, they start to work early. So really just benefits 00:14:56.600 --> 00:15:01.240 all around for the patients to get either the tests or the imaging or whatever they need sooner. 00:15:01.240 --> 00:15:06.600 Yeah. Yeah. Good call out there. So just one other thing, 00:15:06.600 --> 00:15:10.760 maybe the audience might be curious. So just in general, general surgery, certainly take care 00:15:10.760 --> 00:15:14.680 of things like colon cancers and things like that, but what are some other common conditions 00:15:14.680 --> 00:15:21.720 that you treat as a general surgeon? Lots of, I mean, all types of gallbladder 00:15:21.720 --> 00:15:25.800 problems from acute cholecystitis where you're in severe pain in the emergency department or 00:15:25.800 --> 00:15:30.440 where you're just having intermittent flare-ups after you eat certain foods like fatty foods, 00:15:30.440 --> 00:15:40.600 fried foods, appendicitis, all sorts of soft tissue lesions, melanoma, for example, cancers, 00:15:40.600 --> 00:15:47.480 elsewhere. What else do you think? Yeah. And our other big one is other hernias. 00:15:47.480 --> 00:15:52.920 We mentioned earlier, definitely, you know, we do a lot of belly button hernias, ventral hernias, 00:15:52.920 --> 00:15:57.880 which is any hernia along your abdominal wall falls in that category. We do a lot of inguinal 00:15:57.880 --> 00:16:02.840 hernias, inguinal scrotal hernias. They're kind of their separate category because these are kind 00:16:02.840 --> 00:16:08.680 of more advanced hernias that have kind of grown into someone's scrotum to say inguinal scrotal. 00:16:10.440 --> 00:16:17.240 Diverticulitis is another big pathology that we see quite a bit of in terms of whether 00:16:17.240 --> 00:16:20.920 it's just uncomplicated diverticulitis where it's an infection of the colon, 00:16:20.920 --> 00:16:26.280 infection of the outpouching is called diverticulosis, or it can have complications 00:16:26.280 --> 00:16:33.880 such as abscess, perforation, fistula between other organs like the bladder, the vagina. Stricture is 00:16:33.880 --> 00:16:39.000 another complication, narrowing of the colon, and some of these things require surgery as well. 00:16:40.280 --> 00:16:45.880 Yeah, so it's a pretty broad specialty in my view. One of the things you haven't mentioned, 00:16:45.880 --> 00:16:50.680 but is, you know, we're a level three trauma center and you guys end up seeing a lot of trauma 00:16:50.680 --> 00:16:55.160 patients as well when you're on call for the emergency department. And I know we certainly 00:16:55.160 --> 00:16:58.360 are glad you guys are here to help with those situations, whether it be a car accident with 00:16:58.360 --> 00:17:04.280 someone with an internal organ injury or, you know, heaven forbid, a stabbing or whatever, 00:17:04.280 --> 00:17:10.120 some other penetrating injury. Maybe talk about that a little bit in our trauma center 00:17:10.120 --> 00:17:12.760 and kind of your involvement. 00:17:12.760 --> 00:17:20.360 Yeah, you know, like you said, we cover any, when we're on call and any activations that are more 00:17:20.360 --> 00:17:26.040 emergent, typically like level one activations, these are typically patients that are more sick 00:17:26.040 --> 00:17:34.680 or meet certain criteria to be labeled as a level one. You know, we respond and we're available. We 00:17:34.680 --> 00:17:39.960 are immediately involved in all the care for those patients and we're there, you know, pretty much if 00:17:39.960 --> 00:17:45.720 if there's a blunt injury to an organ or bowel or liver or any anything kind of like emergent, 00:17:45.720 --> 00:17:49.800 we're there and available to be able to take care of that for folks as well. 00:17:49.800 --> 00:17:55.320 Yeah, yeah. And you guys both trained in places where like big trauma services and 00:17:55.320 --> 00:17:59.800 very familiar with caring for some critically ill trauma patients as well, which is 00:17:59.800 --> 00:18:02.200 awesome for our community to have you guys here. 00:18:02.200 --> 00:18:06.840 Yeah, yeah, yeah. We did in our training, at least, you know, we both came from heavy trauma 00:18:06.840 --> 00:18:09.800 center training. I would train at a level one, 00:18:09.800 --> 00:18:12.840 one center in Grady in Atlanta, which was, was very busy. 00:18:12.840 --> 00:18:17.320 Ours was a level two with quite a high volume of even penetrating and, 00:18:17.320 --> 00:18:19.240 and motor vehicle accidents, that sort of thing. 00:18:19.240 --> 00:18:24.680 So how do patients get to you? Do, can you self-refer? Can you call the surgery office? 00:18:24.680 --> 00:18:29.800 Say, I think I've got a hernia or someone told me my gallbladder may be bothering me, 00:18:29.800 --> 00:18:32.440 or do you have to go through your primary care doctor first? Or 00:18:32.440 --> 00:18:34.440 how does someone make an appointment with one of you guys? 00:18:34.440 --> 00:18:39.640 To my understanding, I believe, I mean, we see people who self-refer and from referrals with, 00:18:39.640 --> 00:18:43.640 uh, primary care physicians, you know, I've, I've seen people who, you know, 00:18:43.640 --> 00:18:48.360 an older gentleman who said, you know, I noticed a bulge in my groin and, uh, you know, I wanted to 00:18:48.360 --> 00:18:52.840 have it checked out. Um, so I've seen people that way, but a lot of times it comes from primary care 00:18:52.840 --> 00:18:57.800 referrals. It comes from emergency visit referrals. Uh, and that sort of thing is primarily how we see 00:18:57.800 --> 00:18:58.680 people. 00:18:58.680 --> 00:19:04.120 Yeah. Yeah. I think we're pretty open to any scenario, but I agree the bulk of our referrals 00:19:04.120 --> 00:19:08.680 to get to us typically comes from a primary care, primary care physician, because you at least 00:19:08.680 --> 00:19:09.480 typically want. 00:19:09.480 --> 00:19:13.960 Some provider to confirm that, yeah, there's probably something wrong here or there's an 00:19:13.960 --> 00:19:19.080 hernia. There's some sort of pathology that we can see. Uh, not that there's anything wrong that if 00:19:19.080 --> 00:19:23.960 someone wants to self-refer and, and come in and see us, you know, I think that we are, uh, well 00:19:23.960 --> 00:19:27.720 staffed enough to accommodate that. And we're more happy to see anyone who thinks they may have 00:19:27.720 --> 00:19:32.440 something wrong. That's specifically surgery related. We're always happy and open to, you know, 00:19:32.440 --> 00:19:37.560 uh, confirm that with them or do more workup if need be for them to, to, to get them through that. 00:19:37.560 --> 00:19:39.320 Yeah. Great. Great. 00:19:39.320 --> 00:19:43.960 If you could think of one or two things that you would like for the community to know, 00:19:43.960 --> 00:19:49.320 whether it be about, about your practice or about, uh, preventative care or really anything 00:19:49.320 --> 00:19:53.240 you can think of, what would you like to share with, uh, our service areas community? 00:19:53.240 --> 00:19:58.360 Well, I mean, one thing that comes to mind, I mean, uh, we just passed, I believe colorectal 00:19:58.360 --> 00:20:04.360 cancer awareness month. I think a lot of people, they dread and they put off the colonoscopy. And 00:20:04.360 --> 00:20:08.520 really, I think it's something that just has to be undertaken as you know, the rite of passage. Once 00:20:08.520 --> 00:20:09.160 you pass forward. 00:20:09.160 --> 00:20:17.480 I think, you know, as, uh, Dr. Wang mentioned, the, the incident seems to be on the rise for 00:20:17.480 --> 00:20:22.760 whatever reason. And I think the last thing that we want some want to see for anybody is 00:20:22.760 --> 00:20:28.120 to have something that could have been removed endoscopically with a camera grow and become 00:20:28.120 --> 00:20:32.760 something that's much worse and potentially, you know, could be the end of the line, sort of speak. 00:20:32.760 --> 00:20:39.000 So I would just say, um, get your colonoscopy and I would also recommend, you know, proceeding 00:20:39.000 --> 00:20:42.840 with a colonoscopy as opposed to these other tests that are available. I think, you know, the 00:20:42.840 --> 00:20:49.560 colonoscopy is the gold standard for a reason, and it allows them to see small growths or polyps and 00:20:49.560 --> 00:20:55.880 remove them entirely that sometimes these blood tests or stool sample kits aren't going to detect. 00:20:55.880 --> 00:21:03.080 Yeah. Yeah. I wholeheartedly agree. I think that when it comes to colon cancer for on that topic 00:21:03.080 --> 00:21:07.880 is if you have any doubts, anything abnormal, any, any pain, anything that just seems off, 00:21:07.880 --> 00:21:08.840 it's just always safe. 00:21:08.840 --> 00:21:12.600 Or just to get it checked out. Cause you never know. Dr. Bolton and I have seen 00:21:12.600 --> 00:21:17.880 all sorts of varying symptoms, sometimes almost non-existent symptoms, just a mild change and say 00:21:17.880 --> 00:21:23.720 their bowel movements and they ended up having some sort of colon mass or it just can vary so 00:21:23.720 --> 00:21:28.760 much. Um, but to the, to a side point to that, since you're mentioning what else we want the 00:21:28.760 --> 00:21:33.160 community to know, you know, and I'm glad you asked the question about, uh, what else we offer, 00:21:33.160 --> 00:21:38.680 you know, it's funny. I, I took care of a patient today who, um, drove all the way to Anderson 00:21:38.680 --> 00:21:43.160 for hemorrhoid surgery. And, you know, it came to my mind that maybe, I don't know if, 00:21:43.160 --> 00:21:48.280 if some people just don't know that we offer these types of surgeries here locally, you know, uh, uh, 00:21:48.280 --> 00:21:52.680 anal rectal disease, hemorrhoids, anything, you know, we are general surgeons. So, 00:21:52.680 --> 00:21:57.640 you know, maybe getting the message to them that, Hey, sometimes you don't have to drive all the way 00:21:57.640 --> 00:22:02.440 out there and maybe check locally. We're happy if you want to just call the office and just ask, 00:22:02.440 --> 00:22:08.040 ask the front desk that all of them are great. You know, we, uh, they're all great folks that work at 00:22:08.040 --> 00:22:12.920 the front and, um, they're, they'd be happy to answer any questions on, Oh, does Dr. Bolt do this 00:22:12.920 --> 00:22:18.680 surgery? Dr. Thomas do this or Dr. Wang, any of us could, could they relay the message to us and, 00:22:18.680 --> 00:22:23.080 and saves them maybe a trip, uh, you know, elsewhere if they don't want to drive an hour 00:22:23.080 --> 00:22:27.800 for that, you know? Yeah, absolutely. You know, just some other things that come to mind that 00:22:27.800 --> 00:22:31.800 might be kind of common. Some people may get like acid reflux surgery. That was, 00:22:31.800 --> 00:22:34.520 maybe we hadn't talked about that much yet, but I know that's something that's 00:22:34.520 --> 00:22:37.880 certainly within the purview of what you guys do and y'all do a great job of it. 00:22:37.880 --> 00:22:41.640 Yeah. Um, so I would definitely encourage the community to reach out, 00:22:41.640 --> 00:22:45.640 um, you know, either talk to your primary care doctor or just give the office a call 00:22:45.640 --> 00:22:49.640 and say, Hey, is this something that we take care of here? So yeah, totally a hundred percent agree. 00:22:49.640 --> 00:22:55.240 All right. Well, gosh, guys, thank you all so much for joining me today and to everyone in the 00:22:55.240 --> 00:22:59.400 audience. Uh, thank you for joining for today's episode of medically speaking and we'll see you 00:22:59.400 --> 00:23:05.400 next time.