Ep. 18 | Luke Seibolt, MD, Interventional Cardiology, SGMC Health

Transcript

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- Welcome to another

- episode of What Brings You in Today.

- I'm Erika Bennett.

- And I'm Taylor Fisher.

- And we just wanna thank everyone for tuning in. And if you are an avid listener, please like and subscribe and leave us a review.

- And if you have any questions or topics you would like to submit, you can do so on our website at sgcm.org/podcast.

- All right, today we are here with Luke Seibolt, MD, an interventional cardiologist at SGMC Health. So Dr. Seibolt, what brings you in today.

- Hey, good morning guys. You know, today I wanna talk a little about cardiovascular health and an SGMC cardiovascular program.

- Perfect. Just to get us started, tell us a little bit about your history and, you know, how you became a cardiologist and how you ended up here.

- Yeah, absolutely. So, born and raised in Phoenix, Arizona, and that's where I did most of my training and loved it out there, but had an opportunity to come to Valdosta with a med school friend, and that was my first introduction to, to South Georgia and fell in love with it. And then the opportunity came for, for work down here and brought my family and we fell in love with it. And so here we are. My love for cardiology began. My father actually had quite a bit of cardiovascular disease issues, and so his cardiologist became a, a mentor to me. And I always knew I wanted to do medicine. And so, you know, in medical school you think you're gonna be anything from a orthopedic surgeon to a, you know, plastic surgeon, to a dermatologist. And then, you know, after further conversation, my dad's cardiologist always says that the cardiologist is a crown jewel medicine. Everything runs through the heart. And I said, there's no way I'm not gonna do internal medicine. I'm not gonna go through all that. But I did, and I'm so glad I did. It's been an amazing journey for me and, and really rewarding. So I really owe this all to my dad and, and Dr. Byrne, who's my kind of mentor back in Phoenix that I still keep in touch with.

- I love that you said that, you know the heart. What'd you say? The crown jewel?

- Crown jewel of medicine.

- The crown jewel of medicine. Yeah. Okay. So yes, with that said, how important is your heart health to your overall health and wellbeing?

- It's, it's, it's hard to think of another organ that's more important to your body. I mean, really, we, we joke with the nephrologist, there's dialysis for a reason, right? There's no dialysis for the heart. Yeah. And

- So - Really all the, you know, all the organ systems, everything runs through cardiac output, cardiac function, and it's really, really important to take care of your heart, you know, from early on to keep cardiovascular health in mind throughout, you know, really all, all all medical checkups and, and visits and things like that. And, and be seen early if there is an issue to try to try to prevent any further downstream effects.

- What are the current exercise recommendations just for, to keep your heart healthy?

- Yeah, so that's, you know, that's a great

- Question. I mean, that probably varies from

- Different Yeah, it does. It does. From particularly recommend tell commend, you know, 150 minutes a week is, is kind of the current a CC recommendation. You know, that's pretty attainable. I think, you know, when you spread that across seven days. And what I tell my patients is, is that, you know, a lot of people are like, oh my gosh, I have to go to the gym, I have to get a gym membership. I need to go buy some new tennis shoes. I, you know, that's not it at all. Just, just walk the block, you know,

- Just make it so overwhelming that then they never do it. Yeah,

- Exactly. You know, it's like, oh my gosh, I need to go work out for 150 minutes. No, I mean, take little bites, right? So, you know, we tell patients, walk the block, you know, once that becomes comfortable, do it twice. Once that becomes comfortable, do it three times, you know, find a friend. It's, it's all about keeping yourself accountable. And really, and least personally for me, it becomes, it just becomes repetition. It becomes second nature, it becomes habit, right? So you do it once. It, it's tough. It's tough to get up early. It's tough to stay up late. It's tough to go out when it's a little bit warm. You do it twice, it's enjoyable after three or four times. It just becomes something that is part of your daily activity. And that's what I hope to, to really try to, you know, kind of reinforce on my patients. I mean, I, I, I try to keep myself accountable to that same thing, you know? And so that's, that's very important to my family and I to stay active and, and it's a part of our daily life. And so that 150 minutes can go quickly or it can be very difficult. Yeah. But I think the, the more you chip away at it versus try to take a big bite at it, I think you can be successful.

- Yeah. From my personal experience, that first time going back or getting back is always the hardest. It's always the one that your mind will like, talk you out of that you can come up with the most excuses. As soon as you get that first one in, you're like, oh, this really wasn't that bad. No, I can do it again. It's always, so anyways, I'm motivating. Hopefully you today, if you've been on the fence, just get out there, walk, do something good for your heart.

- I love walking outside, but in the heat it's a little harder. It's a little harder in South Georgia. Do it's,

- It is, but you know, the, the, the early mornings and the, you know, the, the evenings are, are really

- Nice. The evenings, me and my husband enjoy an evening walk around Freedom Park in the evenings. I like to run. He can't keep up with me, but that's okay.

- Yeah. Yeah.

- So back to heart health, you do something a little bit different. We've had Dr. Dison who talked a lot about heart health too. So if you want more information on that, you can go to his episode. But tell us about the TAVR program and the structural heart program. 'cause that is something that's relatively new to our area, but important for people to know that we offer it here as far as treatment of our heart issues.

- Absolutely. So TAVR stands stands for transcatheter aortic valve replacement. And so transcatheter means that the procedure's done via catheter-based procedures, which is relatively non-invasive, the procedure's done through the groin. So it's just like a heart catheterization if anybody's had one of those. And then valve replacement, obviously you're replacing the aortic valve and, and kind of just the, the background of that is you're not necessarily cutting out the old valve and putting a new valve in. You're just kind of pushing the old valve out of the outta the way. And so TAVR is, is is an amazing procedure and amazing technology. We've been doing it here for just over two years. We've done just under, I think about 78 TAVR procedures here at SGMC. And we should be well over a hundred within our next year, which is awesome. I think that was one of our goals is to get to a hundred by three years and, and we're definitely gonna get there. It was originally invented about 20 years ago. So as far as like medical technology, it's, it's, it's relatively new still. And initially this procedure was, was invented for folks that, that weren't candidates for open heart surgery. You know, previously if you had aortic valve stenosis or tightening the aortic valve, which is what this, this therapy treats your options, were open heart surgery or your options were medical therapy. And so obviously as you age, you get into the seventies and eighties, not everybody's a surgical candidate. And so a lot of people were left with medical therapy for the aortic valve stenosis. And unfortunately, the downstream effects of, of, of tightening of the aortic valve leads to heart failure, chest pain. It's not a, it's not a, it's not a fun way to kind of end, you know, live out your last days. And so 20 years ago, an incredibly brilliant physician made this technology, used it for someone who was not a surgical candidate. So they really either were gonna pass in the hospital or have this technology. And so he was successful, the first procedure was successful and that really kind of set off the really kind of domino effect of, of tavr. And so currently there we're on about our third or fourth valve technology as far as that goes. So technology obviously is, is, is driven by innovation and desire. And so everything is, you're trying to make it small, you're trying to make it more sleek, you're trying to make it quicker. And so with that, the valve has become more safe. So initially it required very large access sites, the complication rates were high, and now we've been able to kind of take those complications and, and really minimize them to where it's something we discuss. But it's, it's, it's, it's, the expectation is that the procedure goes well without complication versus, listen, this may not go well, but let's give it a shot. Right? I expect it to go well. And so the, the history of it is that it started with you can't have surgery, so let's try this. And it was successful. And so they went, well, well what if you're high risk for surgery? Let's compare those two TAVR performed. Well then they went to people that were intermediate risk or moderate risk. TAVR did well then they recently looked at low risk patients. So really now what we look at is anybody, you have to pick an age and we say about 65, that's kind of national age. If you're over 65 with severe or valve stenosis, it really is patient preference as far as open heart surgery versus tavr. Now there's obviously some things that will lean us one way or another, but it's an incredible technology and, and the fact that we involve patient decision as well as physician discussion, I think is the best way to do this.

- Yeah. So it's not, it's not just you go to the doctor and you decide, Hey, I'm gonna have this, like y'all do a lot of tests. Oh yeah. Pre-work up

- Yeah.

- And kind of help you make that decision. Yeah. Of which one is best for you.

- And so one of the, the cool things that, that brings to us is something called a heart team. And so a heart team is a cardiologist, a surgeon, primary care physician, referring cardiologist, anybody else in that person's medical team. We typically try to get together and make sure everybody's on the same page if there's a reason to, to lean one way or another. Typically we know that upfront. But what's fun is when we have conversations, no, this guy should have tavr, no, this lady should have surgery. No. And then we go back and forth, okay, let's, let's do this. Right. And so going back to that patient saying, we've had extensive discussion. We've looked at all your data, we've looked at all your studies, we think you'll do best with this. You know, it really gives the patient a lot of confidence knowing that it's not just me saying, yes, you should have this right. Or the surgeon saying you should do that. You know, kind of incorporating all that together. And I think it strengthens our cardiovascular team as well. 'cause we're in constant communication. We're seeing these patients together. And as you mentioned, the workup for it is quite exhaustive, which I love. 'cause you know, the diagnosis is made with an ultrasound of the heart or an echocardiogram. Once severe artery, valve stenosis has been identified, then we look at a heart catheterization. So we're looking for any sort of major obstructive coronary disease, which say you find a big, a big lesion that needs to be fixed, you know, well that that patient may need open heart surgery anyways. So you're gonna fix the valve while you're fixing the coronaries. Right. Or if the coronary is okay, or there's some minor, minor disease, we can go either way. And so you're getting a heart catheterization. We look at lung function tests, we look at carotid artery ultrasounds, and one of the best things I think we have is something called a CT CT scan where we look at the heart and we get a three dimensional, three dimensional representation of the heart where we can actually see the valve, what's the size, what's the distribution of calcium, what's the calcium in the aorta, our access point sizes. We really feel like, and I tell patients about 80% of the procedure is done before they even get on the table. When they're on the table for that procedure. I know, hey, there might be some calcium here, or this might be a little bit small and we might need to do something here. Or Hey, listen, the, the, the, the deployment angle of the heart is a little bit off, so something's gonna, it might look a little bit different than our normal, but that's expected, which is nice.

- Even the valve is like the size is like ordered for the size of the patient.

- Correct. Right. Correct. So there's, there's specific valves. We look at perimeter, we look at area of the valve. And so we know, we know, we know exactly how big this valve is. We know what their anatomy is. Our C department has, our CT department here has done an amazing job getting on board with US industry. We work with Medtronic and I think we have some of the best reps in the region helping us. And, and in that representation, that 3D representation, you know, we get this, it's like a 10 page printout of, of just 3D representation of everything of the heart, the valve, the arteries. And so it's, the, the data we collect on it is, is quite expansive. But that allows us, I think, to be safe

- And be confident. We kind of had the same conversation with Dr. Mackey. I'm saying so many trends from speaking to all of the different specialists. But her, she said the same thing about the brain. You know, that we have the ability to map out the brain before she ever goes in.

- Yeah. - You're saying that about the heart, which that's so, because if patients don't know that, I mean, patients don't understand all the technology that's in the background that have been invested in from the organization to allow y'all to be really good. Right. At

- Your job, actually had the pleasure of speaking with one of Dr. Sal's TAVR patients, and he was 89, I believe.

- Yep. - And he had the procedure and it was successful. I spoke to him and his wife and they were just like over the moon, just like glowing over, you know, the difference between before and after. Yeah. And I remember asking you in that email when I sent you this story, like 89, gosh, like that seems it's a little old to be having surgery. But I now I understand that that was the point of tavr, right? And

- That in, in aortic valve stenosis, it's not something that happens overnight. It's not a heart attack, it's not a car. Accident's not an event in time that began and that's when the symptoms started. It's, so usually people start to develop calcium on that valve, 50 60. And over time, calcium starts to build up. As that calcium builds up, that valve becomes tighter and tighter and symptoms progressively kind of begin versus all of a sudden, so what we see a lot of time is people, you know, south Georgia farmers or whatnot, you know, they used to be out there 12 hours a day, you know, or sun up to sundown, not ever needing a rest, feeling like a million bucks. And all of a sudden, you know, they'll, they'll call it quits at, at at five because they're a little tired and then it's four and then it's noon, and then it's like, I don't feel like going out today. And, and you ask 'em symptoms, well, I don't have any symptoms. I'm just tired. Right. Well, an 89-year-old, yeah, you deserve to be tired, you deserve to rest. But

- That's what I said. They probably attribute it to getting

- Older. Could when it could. Yeah. That's what's nice thing, thing about the valve is that, and why I really love that procedure is 'cause you don't, a lot of people, they come back for their follow up and they're like, I didn't realize that it was my valve causing me, causing me to be tired. Not me being 89.

- I'm tired all the time. I might need a v checkup.

- But, but it is so rewarding to see these people kind of gain back years of activity that they previously just kind of chalked up to, to aging. And so it's crazy

- How your heart plays such a role. I recently, my grandmother came in and was a patient of Dr. Disser and she had some fluid around her heart and he's taken great care of her. But she was like, yeah, I'm just, I'm tired, I'm sluggish. She was having trouble breathing, which she attributed to her asthma. She's 81. She attributed to just being older and now post, you know, being treated by him. She's like, oh, I feel so much better. I'm like, well, you can breathe now.

- Yeah, yeah. Exactly. And I mean, that's the same thing that we're dealing with with aortic valve stenosis is you just, you are, you're putting so much pressure and volume on the main pumping chamber of the heart. And I describe to patients as, as, as you have a, a hose, a garden hose. And as you, as you put your thumb on top of that hose, it increases the amount of velocity that comes out, but also increases the pressure on the backside of that hose analogy. And that's basically what analogy that valve is doing analogy. And good analogy, you put a valve in, you take your finger off that hose, now all of a sudden that water's flowing freely and that pressure drops on the val on the backside of the hose. So I i I think it's, it helps people understand is as you try to just kind of discuss things with them, you know, and, and I'm not the most technical as far as cars or, or building or things like that, but I try to relate to the patients in some way that helps them understand why we need to do this. You know? 'cause one of the hardest things to do is, is some folks really don't have symptoms. You know, they, they say they don't have symptoms. Yeah. And so trying to, not convince, but trying to educate somebody for why they need to undergo a procedure when they feel quote unquote well is sometimes difficult to do. Yeah. But when you, when you kind of,

- Because it's their normal,

- Right? And so, you know, why do I want to undergo these procedures? Why do I want the CT scan? Why do I want all this if, if I feel fine? It's like, well, you know, and, and I'm able to show them the echo. I'm able to show them the valve. Listen, this is what your valve looked like when you were, were were born or, or you know, in adolescent, and this is what the valve looks like. Now look at that pressure and volume that that heart's having, you know, under undergoing every time it, it squeezes. And so sometimes that helps folks understand why we need to do this. So, and the other thing that's nice about TAVR is the expectation is they come in, we do this on Monday, and the expectation is they go home Tuesday. So these folks are home next day.

- Well also the other trend that's relating for throughout all of our talks is just going more minimal invasive, you know, going to do the least of, like you said, things are getting smaller. Yeah. Things are getting just easier to recover from. Yeah. So I think that's really,

- Yeah. And that, that kind of good for

- Health in general.

- You know, Dr. Randy Brown helped really champion this program and get it going to start with, and, and him and Kelly did a ton of, of leg work initially, and he was very hesitant to start the program here because his previous experience, as we talked about, we're on the third or fourth generation of this valve. His experience was maybe in the second or third generation where the access sites were massive and complication rates were through the roof. And he's like, I don't think we should subject to that type of risks to our patients here locally. You know, thankfully we, we, we took a chance and we've seen how well that technology has done. And really our vascular complication rates are, are very minimal now versus, you know, almost a coin flip back when he was doing it making and training. Now here, you know, the, again, the expectation is these folks are getting up and walking, you know, as soon as they wake up from anesthesia and, and, and get going. So.

- Well, our, our world is changing like so fast, like technology. I mean, you think of everything you can do just even on your phone now versus 10 years ago.

- Yeah. - I mean, imagine where we'll be 10 years from now.

- That's what's exciting about cardiology. I

- Keep myself up to date and

- Yeah, no, it's, that's great. I mean, there's always, it's funny, I feel like I'm getting an email from the American College of Cardiology or, or a big interventional, you know, is almost daily of, of this is new or this is, this is, this is better or, and it, and it is, it's, it's interesting. Cardiology is very trial heavy, meaning that they're always looking for research, always looking for trials. Well, if we, if we tweak this or we look at that and it starts this whole new kind of workup. And so, you know, you need to take all those trials with a grain of salt and kind of look into some of the nitty gritty details of it. But once guidelines come out and it tells us, Hey, listen, this is how we need to be treating patients. It's, it's easy to follow those and understand the technology and, and kind of the research behind it so it is ever changing, which is fun, right? I mean, we're not one of these all of medicine change as you described. Right. But, but cardiology has always been on the forefront of trying to push that envelope smaller, faster, you know, i

- I improving hemodynamics to try to help these patients feel better. Well they say if you're not moving forward, you are moving behind because others are moving forward around you.

- Exactly. Exactly.

- So that's really cool. I know we just recently became a level one emergency cardiac care center.

- Yeah.

- So that's good news.

- Yeah, absolutely. Big congratulations to to all the, the folks that work hard for that. And, and I think it really, you know, it's funny, they, they came in for those interviews and they, they just said, yeah, you guys are good. It wasn't like, change this or do that. I mean, it was, it was kind of like a why haven't we been already? Right. You know,

- I mean I sat in this, the post survey thing. They were just like so complimentary at the team.

- Yeah. The, the, the, you know, the critic, the critiques they had were just very minimal. I mean, really just like, yeah, okay. Like that's not a problem. You know, just, just things, it, it was nothing big, nothing fundamental, nothing that we had to change in our culture, our culture's there. It's just, it's just really kind of, you know, being able to provide that care and, and, and receive that recognition, which is great. I mean that's, that's a lot of people involved in that from EMS to the er, to the ICU teams to, to outpatient care. So

- Tell us just a little bit about the importance of calling 9 1 1 if you do feel like you are having a heart issue and how they can kind of in the field do certain things. Of course.

- Yeah. So I mean the, the, the adage is time is muscle, right? And so in, in cardiology we have, especially interventional cardiology, we have checkpoints. You know, it's, it's, we have this door to balloon time. We have a, a door in door out time as far as if intervention is not possible. And those are times that, that are our guidelines and times that we follow. And so the longer you wait to, to seek that care, the the longer it is to, to receive the benefit. And so, you know, our, our EMS services have, have done an amazing job working with both local and kind of regional fire departments, EMS, things like that, to, to make sure that that care is driven and, and done quickly. And so what's nice now is EMS can, can activate a STEM alert in the field, you know, and so a lot of times we'll get a call saying, Hey, STEMI coming in from x you know, name wherever. And they'll be here in 30 minutes. And, and we're literally standing in the ER waiting for them to roll in. They get their armband and their next stop is, is a cath lab. So versus coming in with private vehicle, getting registered, getting an eek G then recognizing that they're having a heart attack and you've lost who knows how much time at that point. Right. You know, so especially, you know, back to school, the roads are getting a little bit heavy now. And so I know right. You know, sometimes lights and sirens can be helpful getting somewhere fast. So that true, if, if you have symptoms concerning, you know, it's always, it's always better to say, Hey listen, this isn't something that we have to worry about as opposed to, I wish I would've. And so, and, and folks are doing, you know, with the way that technology has gone and we go back to technology and our stents are better, we can, we can ultrasound the arteries while we're in there to look at sizing, look at calcium distribution. We have a therapy called Shockwave, which is a lithotripsy therapy within the coronaries, breaking up the calcium so that our stents are better deployed. The time needed for anti-platelet therapy is becoming less and less. And so it's, it's, it's, it's, it's really important to recognize that upfront to even allow us to use that technology.

- Yeah. What are the most common, just quickly sign symptoms that someone might need to see? A cardiologist? I mean, I know your primary care will probably work up some of that.

- Of course,

- Of course. What are the concerning

- Signs? Yeah.

- Yeah. I mean I think, You know, it's funny, it's, it's, it's across the board and, and we know that not everybody follows that, that that picture of the, of the kind of older balding gentleman bent over grabbing his chest. Right? Not, that's not everybody. There's a, a lady I take care of who, who has been very vocal about her symptoms. She had some neck pain and she actually went to the gastroenterologist first thinking she was having some sort of reflux. They looked at her and said, this is cardiac and and center to the hospital. Yeah. And so females seem to have a little bit more kind of generalized symptoms as opposed to specific chest discomfort. You know, we talked about fatigue, chest pain, obviously if you know, all of a sudden some sort of activity that you previously tolerated, well now you're getting short of breath. Things like that definitely should, should raise some flags to, to seek, seek help.

- And what are the most common sort of like conditions we're seeing, we know where we live.

- Yeah, - Yeah. So what kind of conditions do you see that need to be treated?

- Yeah, so the big ones, I mean the three big ones, hypertension, hyperlipidemia, high cholesterol, diabetes, those are, those are the three big ones. Unfortunately we see tobacco abuse way more often than, than I'd like to admit. But, you know, the biggest thing is as far as all of those go is that, is that some of those we can control. Some of those we can't control right now. There's people that genetically have high cholesterol. You could be a marathon runner and eat nothing but vegetables and your cholesterol can still be through the roof. And so it's really hard to have that conversation with someone who says, well, I'm so active. I I go to CrossFit every day. I, I eat my own meals. I don't eat out. Why do I need to be on a statin? It's like, well, you know, your your, your genetics kind of predispose you to that. And so recognizing that 'cause, 'cause unfortunately those are the, those are the cases that, that really bother me is that we could have, we could have gotten to that patient earlier. We could have tried to prevent some of these cardiovascular issues. 'cause they do, they do live such a healthy lifestyle otherwise, but, but your genetics are what they are. You can't out eat or outwork, which you were kind of born with. And so identifying those, you know, hypertension or high blood pressure taking your medications is number one. Right. And so that's the biggest thing is make sure you take your medication. Sodium is a huge thing for us. So salt causes your blood pressure to go up. And I haven't been out to eat in Valdosta that didn't have a meal that wasn't just loaded with sodium. Right. It's kind of everywhere. So locally, that's, that's definitely something, you know, and diabetes as well and, and tobacco use. Like I just, I I I don't, it's hard, it's hard to quit. I get it. But, but man, it's, I tell people, I mean I could, I can give you a handful of medicines and all that tobacco's doing is, is playing tug of war with you every single day. So.

- Well, and I think all of what you just said validates your need to have a primary care physician. A hundred percent need to go every year to check because otherwise how do you know if you have high blood pressure or if it's changed or if you do have diabetes, if you're monitoring that well and living the right way. So it all starts with that primary care. And I think about 70% when we did a survey, about 70% of our area did not have a primary care physician.

- Yeah. Yeah. That's unfortunate. But, but I believe that,

- Yeah. Right. That's huge. I do think we're making a lot of great strides in our area with bringing in more internal medicine, family medicine doctors and then with our affiliation with Mercer and the internal medicine residency program. I think that's gonna hopefully change a lot of that. Of course, of

- Course.

- If you don't have a primary care provider, you know, again, this can be your little encouragement to go ahead and schedule that appointment. Absolutely. Make that happen.

- Absolutely. I think, you know, the medical education program is gonna be huge for that. I mean, any physician that's ever, you know, is where they are as a physician has, has been through medical education, right? Yeah. And so it's, it's fundamental in your learning for primary care and, and, and taking care of, of outpatients. So that's hopefully, we'll, you know, and, and as these folks come in, hopefully we're can recruit them to stay here locally as well.

- For sure. 'cause you like it hearing about Austin,

- Right? I do, yeah. I mean, I, I gotta be honest, I I I didn't know, you know, I knew I liked it. Yeah. But would my wife like it? Would my kids enjoy it? And, and we've, we've set up some roots that, that are, that are growing deep, so we really enjoy it. Good.

- And the heat's not too bad if you're from Phoenix

- Humidity. No, the humidity is different though. Humidity. Yeah. Obviously. But I'll tell you, you know, jump in a pool and, and there you're just fine. So it's,

- You - Just gotta be close to water. Yeah. Yeah.

- That's right. That's

- Right. Well, I have one more question, which is something that I try to ask every guest 'cause I know y'all spend so much time here Yeah. That you probably have to eat here a lot. So what is your favorite meal that we serve either in the cafeteria or the spice?

- Ooh, that's a good question. You know, my wife will probably laugh, but I, I'm, I'm a kind of a, I'm not a picky eater, but at the same time, I don't really expand my culinary, you know, things too much. So I, I'm, I'm a, I'm a pretty simple, just kind of a sub or a, you know, something like that, or, or a Turkey wrap I think are pretty good. So they do a good job making that down there. I'm, I'm one that kind of just, I grab something and keep working. I, you know, I kind of get made fun of by some of my colleagues.

- Sometimes you just make on purpose, you're just trying to, you

- Know, yeah, I'm trying keep your body sustained. I'm trying, I'm trying to stay fueled so I can go home, you know, and so I try to, I i, I always try to work through launch. That way I can try to get home a little bit earlier. So. Yeah.

- Well, I like that that question was the hardest one for you to answer. That gives me a lot of confidence in your cardiology skills.

- Yeah, yeah. Absolutely. Absolutely.

- So, well, we just wanna thank you for coming on. Of course. And especially for sharing all that information about the TAVR program. I know most people are like, what is tavr? And we refer to it like it's, you know, something very, everybody should know what it is. But we're glad that you've helped develop that. Yeah. And bring that to our area. So if you wanna learn more about the TAVR program or heart cardiology, any of that, let us know. We'll link Dr. Seibolt's office information below. So, yeah, so thank you for coming in and

- Thank everybody for listening. So if you like this episode and you wanna hear more, please subscribe. So you can get those episodes downloaded and leave us a review. And you can also submit your questions at sgmc.org/podcast. Thank you for listening.