Ep. 42 | Daniel Sohinki, MD, Cardiac Electrophysiology, 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 all of our listeners for tuning in. If you haven't already, please like and subscribe so you can get the latest episodes as they release.

- And if you have any questions or topics you like us to discuss, you can submit those at sgmc.org/podcast.

- All right, well, today we're here with Daniel Sohinki, MD and Cardiac Electrophysiologist. So Dr. Sohinki, what brings you in today?

- Well, I'm here just to kind of get the word out about electrophysiology, what we do, kind of heart rhythm disorders and how people can, can figure out if they have any issues that need to be seen by a cardiologist and just kind of educate folks about, about what we do and why it's important.

- Absolutely. So tell us a little bit about your background of, of course, first. So let, let us get to know you. You're new to our community.

- Yes. So tell us new, not new necessarily, to Georgia. So I grew up in Virginia actually. And then I went through my training kind of in, I was in medical school in Iowa, and then I did my residency in Dallas, and then my cardiology in Oklahoma. So I was kind of all up and down the Midwest, but, but my parents are still in, they're in Aiken, South Carolina. So I knew I wanted to get back to the East Coast, so, so came to Augusta for the past six years and then, and then moved down here thereafter. So we're excited to be here.

- All right. Yeah. And what led you in your career? Did you always know you were gonna be a physician? And then what specifically led you to the EP world?

- I am told, I always said I wanted to be a physician, so I had heart surgery and I was four actually for, so I was gonna, I was born with a heart

- Defect. Okay.

- And according to my parents, it was basically since then I was saying I wanted to be a, a physician. And then I always kind of had that interest in cardiology. And then I was also interested in technology a lot. So I was a, I was a biomedical engineer as a, as an undergraduate. And so electrophysiology is kind of a cool intersection between Yeah. Cardiology and technology that's always evolving. So that's kind of how it, how it started for me. That's cool. So it's a little bit of a personal connection. Yeah. 'cause I thought I wanted to be a heart surgeon at one point, but, but I don't think I could live the surgeon's lifestyle. I don't think so. This is kind of more

- My speed. It's, well, that's very interesting. We like it when there's a, a backstory and a connection there. I think that's, that brings a little something extra. Yeah. So some of what you deal with is heart rhythm disorders.

- Yeah.

- So can you talk about what that is and let us know?

- Sure. So when we talk about heart rhythm problems, really there's the heart beating inappropriately fast, inappropriately slow, or irregularly erratically. That's that sort of thing. And so in general, when we talk about arrhythmias and that kind of thing, that's, that's what it means. And there's a variety of different kinds of arrhythmias, but, but in broad strokes, that's what we mean when we say heart rhythm problems is it's going too fast, going too slow, or it's just beating very irregularly and erratically.

- Okay. And what are some signs of that? Like what do patients experience Sure. That might be a symptom of

- That. Sure. Most people think it's palpitations, you know, feeling your heart skip and race and that sort of thing. But a lot of times the symptoms can be a little bit more vague. So, so the most common heart rhythm problems in adults can be, can cause things like fatigue and low energy and this kind of thing. And so a lot of the symptoms that people can have from arrhythmias may not at first point to the heart. 'cause again, it can just be very, very general things like not having enough energy or getting tired, usually this sort of thing. And so, and so I, yes, sometimes people do get the palpitations and skip beats and that sort of stuff. A lot of times it can be more subtle than that. So.

- And a palpitations, what does that typically feel like

- For

- A person? Yes,

- Sure. So people experience it differently. Some people feel the heart pounding in the chest. They'll have that sensation where their heart is beating really hard in their chest. Some people feel that it's fast. So like if they feel their pulse or they feel the chest, they'll actually feel it beating rapidly. So everybody experiences a bit differently, but it's either beating very hard or very fast, or some combination thereof is what people usually, usually describe.

- What are some common treatments that you use in your practice to correct some of these different disorders?

- Sure. So there's a variety. From a medical perspective, there's medicines and then there's procedures that we do as electrophysiologists. So for, for abnormally fast heart rhythms, there's a variety of medicines that we can use to try to slow the heart rate down and suppress the arrhythmias and that sort of thing. And again, for rapid arrhythmias, when those don't work or if people don't wanna be on a medicine for a long time, we do what are called ablation procedures, which are basically specialized kinds of heart catheter procedures where we put IVs in the leg and snake some equipment up into the heart and try to find where the arrhythmias are kind of firing off from. And get rid of the abnormal tissue there, either by burning it or freezing it. There's a variety of ways that we do it. But, and then for abnormally slow heart rhythms, the treatment by and large is pacemakers. So implanted pacemaker devices that are basically aimed at artificially raising the heart rate. If, if somebody's heart rate is too slow and they can't do it on their own, basically

- Electrical currents in the heart. Is the heart the only organ that has an electrical current?

- It's not, but it's probably the only one that generates its own electrical signal. So if you, so when a person has a heart transplant, for example, it's not like the transplant surgeon connects the nerves back up to the heart or something like this. If you give a heart a blood supply, it will generate its own electrical signal. So it's kind of cool in that way. Yeah. And it can for, you know, as, as you might imagine, that's kind of a complicated process. And so it's easy for it to, to get,

- Yeah.

- To become problematic in some way. But yes, in general, the heart actually generates its own electrical signal. And, you know, when we record EKGs and that sort of thing, that's what we're seeing is the signal that the, the heart's generating for itself.

- Okay. So diagnostically, is that what's used most often in your practice or EKGs?

- Yeah, so the first step is really an ekg. So somebody has symptoms that are suggestive of an arrhythmia. Really the first step is to record the heart rhythm during those symptoms to see is it truly a heart rhythm problem. And the most common way we do it is the EKG. There's all kinds of, of consumer that can do it. Now, you know, apple watches can record the heart rhythm. There's the Cardi, there's all sorts, all sorts of devices on the market now that can do it as well. But really that is the first step is if somebody has palpitations or they're getting fatigued or something like that, the first step is to try to record the heart rhythm during those symptoms to try to correlate the abnormal rhythm with the symptoms that people are having.

- Is it common that people have arrhythmias or irregular heartbeats?

- So it is common to have irregular heartbeats and it's, so we actually consider that more or less normal. So the most common, the most common arrhythmia that we see are what we call PVCs, these little skip beats that people have. And everybody has them. So one of the more common tests that we order for people are these wearable heart monitors. And so if everybody in this building wore a heart monitor, everybody would have a PVC, a skip beat here and there. It's very normal to have those. If you have a lot of them, that can be a problem. But, but that's probably the most common thing that we see in adults anyways, is these little skip beats. And again, most of the time they're totally normal. Some people feel them, some people don't. It's kind of hard to predict who will. But for the most part those are, those are the most common ones that we see.

- What's the difference in the heart monitor and the EKG?

- So the heart monitor is just a longer term monitor. Okay. So the, the EKG is just kind of a ten second recording that you have in the office, something like this. The wearable heart monitors are these patches that you can stick on the chest and they can stay on for up to a month, actually. And so they're kind of a, so if somebody has symptoms, they say I'm having palpitations, but it only happens once every couple weeks. Then a ten second EKG is not likely to capture. Yeah. So you really do need to wear one of these monitors to try to, to try to figure out what's going on.

- My husband had to wear one of those and he was not happy about, they're real

- Cumbersome. I think the, the adhesive, the, the,

- Well it was the chest hair situation. I think you were supposed to shape that before you put that on. Well, he did. And then when he took it off, he had all

- These patches. I know, I was super impressed. I actually also wore a heart, heart monitor not that long ago. And just how much they've evolved and how simple, like how minimal they are and how you can, that little phone that like, you know Sure. Then you just go ship it back and stuff. It's pretty interesting. I

- Wore as a child and it was, and they probably still have these, but you had a little battery pack you had

- To wear. Yeah, I remember that. I remember seeing those. Yeah.

- Yeah. So it was, it used to be very cumbersome and it's still a little bit cumbersome, but not quite so

- Much, especially if you don't have chest hair.

- Yeah. - Easier, I think it'd be way easier as a female. But what led him to wearing one was his fam, there was a family history of AFib Sure. Which his dad had before he passed away. So there was some testing done to kind of rule out whether or not we needed to be concerned about my husband. And so he wore the monitor for several weeks, I think, and nothing, you know, irregular came up.

- Sure.

- Which is fine. That's good.

- Yeah. - But I, I think AFib is pretty common, right?

- Yeah. As far as, you know, sustained heart rhythm problems, AFib at least in adults is the most common arrhythmia that we see. And it's, it's becoming more and more frequent as people, as you know, people get older and, and, and develop, you know, other health conditions,

- But there's a lot of different treatments for it. Correct.

- Yeah. And that's evolving quite a bit. So the treatments for AFib are similar to kind of what we talked about. There's medicines that can be used. The ablation procedure for AFib has evolved quite a bit and we've really only known how to do it since probably 1998 was when they sort of first kind of figured it out. And back then the ablation was like a 10 hour procedure with these big kind of, oh my gosh, morbid procedures. And it's evolved now to the point where people can do it in under an hour. And so it's become a very, it's in, in relative terms, it's a lot easier to do. And so it's a lot more widely available to people. And so it's, that's that's, it's exciting to see that, 'cause it's evolving, it's even, even now it's evolving quite a bit.

- What do you see that tr, is heart rhythm issues? Is that more genetic or is it something that is triggered by some kinda lifestyle

- Sure.

- Choice or what are you seeing that

- Now? Probably a combination of those. I mean, there's not really an AFib gene for example, but people's genetic makeup probably makes them more or less susceptible to AFib. But we tend to think for AFib specifically, that for most people it's a disease of, of accumulating risk factors. So we tend to think of things like high blood pressure and diabetes and having coronary blockages, all of that sort of thing. Increasing your risk of, of an arrhythmia in the future. The other one that I think is common and maybe underdiagnosed as problems with sleep and breathing issues during sleep with sleep apnea,

- They, so sleep apnea, they also made him do a sleep test. Yeah. So he had a fun time with all that.

- Yes, those are, although there are home versions of

- It. Yeah. Those are getting better too. But

- Yeah. But the sleep lab I, and at Smith Norview, the sleep lab is awesome. Yeah. And so if, if anybody ever needs a sleep test, as cumbersome as they are, it's not a bad place to have one done. Yeah. They've got a nice little setup there where it looks kind of like a bedroom. And so it's a lot, again, a lot less, a lot, a lot better than it used to be I

- Guess.

- But yes, there is a very co a very strong association between sleep disordered breathing and AFib and that sort of thing. And so a lot of times if we're concerned about that, that's one thing that we'll test pretty frequently is, is for sleep apnea.

- It's so interesting how sleep can impact so many areas of your health.

- Yeah.

- And it's probably something that nobody really thinks about, but every single person does.

- Yes. I think they're probably an underutilized specialty or are the sleep physicians, because yes, there's a lot of of things that poor sleep can impact. You know, heart rhythm issues are certainly one of them. So

- Definitely I think we've probably mentioned sleep and you know, maybe 80% of our podcast at some,

- It impacts everything. We are, I'm on the neurosciences committee where we're like looking at evolving our program here and one of the things that they're looking at is an alternative to CPAP that Sure. That, you know, the neurostimulator type situation.

- So we have a, there's a device that, I don't know how long it's approved, it's called the inspired

- Device. Yeah, that's it. Yeah.

- Which the, the guts of it almost look like a

- Pacemaker, right? Yeah. It's kind of

- Put under the skin and then basically what it does is it kind of stimulates the nerves in your neck to sort of open your airway when you're sleeping. And so, and so I think we have a there, I don't wanna speak outta turn. I think there's a physician that they're looking to hire or have higher that, that does that procedure. And so it's usually the ear, nose and throat physicians that put them in. But, but yeah. And folks that, that have sleep apnea who have trouble wearing those masks or get claustrophobic or whatever it is, it's not a bad option because it works pretty well and, and can alleviate some of these arrhythmia issues.

- That is really interesting. I have not

- Heard of that.

- Yeah. Yeah. Yeah.

- Well it's just the evolution in the healthcare arena. I mean, you talked about it with the ep

- Yeah.

- Procedures and how those can go from a 10 hour procedure to one is fascinating.

- Yeah. - What other like advancements are you seeing or in your area, what kind of

- Sure.

- Trends are.

- So the DE device, you know, the devices that we use for pacemakers and that sort of thing have evolved quite a bit. You know, it used to be, and this is 50 years ago, the, the batteries were huge and you actually had to put 'em in the belly. And they've evolved to the point where these, there are these little, you know, multi coin sized things that just go under the skin in your chest. And now just in the last few years, we have pacemakers that are completely wireless. So the pacemaker looks like a little 22 caliber bullet. It's put in through the groin. And then if you looked at somebody, you'd never know they had a pacemaker. 'cause there's no incision, there's no wires. And so the, the evolution of, of the technology that's used in pacemakers, in defibrillators has been pretty, pretty amazing. And also helpful for patients too because it's, you know, it's not as big of a deal

- Right. All

- These things put in. So that's been the other kind of cool thing to see is the, the device technology

- Evolve. Yeah. Yeah. Yeah. What about imaging? Have you seen a lot of changes in that?

- Yeah, so we, we, in EP we use a lot of imaging just to kind of help us plan our procedures. You know, one of the nice things about about SGMC is that I think they're trying to kind of ramp up a cardiac imaging program. So getting cardiac MRI here as a, as a modality is very helpful in CAT scans of the heart and that sort of thing. And in EPU we use them because when we're, we're doing these ablation procedures, we make a little three dimensional map of the heart. And so what you can do is do an image of the heart beforehand, like a CAT scan or an MRI, and then import that image into the system. So you have basically a three dimensional

- Picture - Of the person's heart as you're working on it. So it's, it's just, it's amazing the way the technology's evolved. That's wild. In the last several years.

- Does lifestyle play a role in any of this? I know you said some of it could be genetic and some of it could be,

- Yeah.

- A little bit of lifestyle. Sure. So is there anything that people can, can do to if they either have an arrhythmia or are worried about a family history to alleviate

- That? Of course. Yeah. So for AFib specifically, there's a lot of lifestyle sort of things that can impact that. We know that being active in general, you know, aerobic exercise tends to reduce the risk of AFib over a long term basis. And so just being active, I think in general, I think helps reduce the risk of having arrhythmias. Alcohol consumption is kind of a, a debated one. We used to tell people that, you know, a glass of wine or two a day was probably good for the art, this kind of thing. I think it's probably safe to say that there's not really a safe amount of alcohol for folks to drink, especially from an arrhythmia perspective. And certainly with AFib, alcohol is a very common trigger for AFib. And so people will often, they'll literally say, I have a glass of wine, then a half hour later I have an episode. Yeah. And so in those situations, certainly we tell people, you know, as, as to minimize as much as you can, but you know, staying active, controlling your weight is another big one. When you reduce your weight by about 10%, that's basically as effective as an, as an ablation at reducing your risk of AFib. Wow. So, so being active and controlling your weight can really have a, a strong impact on your risk of arrhythmias in the future. Now some arrhythmias, you truly are born with the predisposition too. And so, so there's not as much impact as, as far as losing weight and that sort of thing, but people do find that reliable triggers, so caffeine can be a trigger for some people. Even spicy foods can be trigger. Not everybody, we don't, we don't blanket tell people not to drink caffeine, but caffeine. But if you find that, if you find that I have a glass, you know, a cup of coffee and then half hour later my heart's racing, then we would maybe send, you know, to

- Or several Celsius.

- Yeah. Well in my defense, I didn't realize that Celsius was a energy drink when I first started. I fell victim to their marketing because I thought it was a healthy drink.

- Sure. I think they're very good sometimes at kind of hiding how much

- Yeah.

- Sometimes

- A lot of beverages are actually, 'cause I do look now. Yeah. And the caffeine is not listed like in the normal nutritional facts. It's like kind of hidden

- In the, the

- Other. Yeah. Oh

- Yeah. Yeah. But again, we don't blanket tell people not to drink caffeine, but if you find that if it triggers, yeah, it triggers it, then we'll tell people to kind of be, you know, be judicious for, I would say.

- Yeah, that makes

- Sense. Yeah.

- And for the weight, I know losing weight, you know, is probably helpful for a lot of reasons, but what exactly is the correlation between that and the arrhythmia?

- Yeah, so it's a good question. I think in general, a lot of the things that that people do that will make them gain weight are inflammatory in the body. So there's a lot of data on, on high sugar and high carbohydrate foods being kind of pro-inflammatory that impacts the heart. Also, that inflammation that can cause the heart to go out a rhythm. You can actually have fat that gets deposited into the wall of the heart that can, for complicated reasons, predispose, predispose people to arrhythmias. And so I think it's probably that just the, the, the chemical composition of the, of the tissue in the heart changes and you get these inflammatory chemicals in your body. And that I think can trigger arrhythmias in a lot of people. And some of it we just don't know. I mean there's certainly a strong correlation there, but that's in general, I think the way we think it works.

- Gotcha. Tell us a little bit about the heart program here at SGMC. We have a lot of kind of different specialists within the harfield and what role do they kind of, generically speaking for just our listeners who may not have ever had any heart issues or anything, but you know, we have general cardiologists, interventional ep of course surgeons. So tell us a little bit about the, how you all work together as a team.

- Of course. Sure. So as you said, general clinical cardiologists who, who don't really do invasive procedures necessarily. The c people in the clinic who may have either a concern about a, a, a heart problem or they have a diagnosed heart problem. And so they'll see them and then if they feel that they need some sort of procedure, you know, a heart catheter procedure or a pacemaker or something, they'll send them on to us to evaluate that further. And then amongst, so amongst the physicians and cardiologist that do procedures, there's the interventional cardiologists and they're the ones that do stents and angioplasties and heart valve procedures, that sort of thing. And then there's electrophysiology and we do the ablation procedures and the pacemakers and defibrillators and that kind of thing. But most of the time the flow is the patient will see their general cardiologist and they'll either suspect either an issue with a blockage or an issue with a heart rhythm problem and they'll send them to, to one of us to kind of evaluate that further basically.

- Gotcha.

- And then the heart surgeons, you know, people think of heart surgery as bypass surgery, but they do a, a lot more than that. And in fact we as electrophysiologists will often collaborate with them quite closely because for AFib for example, there's a procedure that can be done where the surgeon will do some ablation on the outside of the heart and then we'll go and do some ablation on the inside of the heart. So we actually work together with them very closely.

- Is that the convergent

- Procedure? That's the convergent procedure, yes. And then the other procedure that we're trying to, to get going here is when patients have pacemakers and defibrillators, they can become problematic in some ways. They can break, they can get infected, this kind of thing. And so when that happens, the whole system needs to be removed. And when it's been in there for several years, it develops a lot of scar tissue and that sort of stuff around. So it's not just as simple as pulling it out, you have to use these special tools and we, we do that procedure in conjunction with the surgeons also. And so we actually work together very closely with the surgeons to kind of do our work. And then the interventional cardiologists, of course, who are dealing with heart blockages and valve problems, there's always a discussion, is it better to be fixing this with bypass surgery and and surgical heart valve replacements or can we do it with stents and catheter based heart valve replacements? So it really is, when it comes to the procedures that we do kind of a team effort, kind of a collaborative effort between us and the, and the cardiac

- Surgeons, the heart is complicated.

- It is complicated, yes.

- But I mean it is interesting that there's so many different things. I mean there's so many different things that can be wrong. So I feel grateful to know that we have all of y'all available here. They've

- Developed really an amazing

- Team here. That's probably helpful to have because you can just go down the, the hall, you know, so to speak and, and say, can you consult and you know, what would be the best way to do this? And maybe you all tackle it from a different angle.

- Yeah. It's a very collaborative approach and I think, and we, everybody gets together and, and kind of gets along really well and so they can be very nice conversations and, and it's ultimately best for the patients kinda having all these

- Specialties to, they don't go to a different city or a different specialist. Right. You can just say, I'll refer you to, you know

- Yeah.

- The person who's literally across the hall and Right.

- And there is something to be said for that. I mean, if you're gonna have a complex procedure, it's nice to be able to, to see the people at that site as opposed to going three hours away to have a procedure and then you come back and then you have to have this issue of the person that did the procedure is not immediately available if there's an issue or something

- Like

- This. And so it's nice to have a lot of that specialization here so people can stay here and kind of get all their care

- Yeah.

- In the same setting.

- And the efficiencies too of all being on the same system. Yeah. From imaging to, you know, consultations and patient record keeping and things like that. Yes. It just seems like it makes it much more convenient from the patients' aspect. Yes. More streamlined, I guess.

- Yes, I totally agree.

- Do you have any patients that you've treated, you know, any stories that stick out to you of patient successes?

- Yeah, it's always the younger patients that, you know, 'cause it's for whatever reason, you know, when, when there's kids involved, it always just kind of pulls at your heart a little bit more. So there's a lot of times where kids, you know, I've, I've done ablation procedures on several kids, you know, children who have had, who were born with an arrhythmia syndrome of some kind. And obviously that's very scary because when kids are passing out, when they're playing basketball, you know. Yeah. There's obviously in the, in the media in the past there's been all these, these, you know, stories of kids, you know, having sudden death during, you know, during soccer games and this kind of stuff. And so the stakes always kind of seem a little bit higher. But, but, but most of the times when people have, most of the times when kids have those issues, they are, they can be cured with these ablation procedures. There's not a lot we can cure in cardiology. And so being able to, to do the procedures and say your problem is fixed, you can go about your life is kind of the, it, it's, it's very nice to be able to do that.

- Yeah.

- Yeah.

- Definitely. How many people have, what is the prevalence of heart issues in our area? Comparative to the other?

- I don't know. There's the rest

- Of the

- US I would say it's high. I don't know if I could give you a percentage

- Far as the

- Number of people that have, that have heart problems in general. But it is certainly, you know, we always, we live in kind of the stroke belt I guess they call it, of, of, of, of cardiovascular disease. And so it seems like it's probably higher than at least some places elsewhere in the country. But there's a lot of things that will impact that. But certainly, you know, the, the classic things that people think about as far as what you're eating and, you know, the prevalence of smoking and that kind of thing. And some of that is cultural and region dependent, that kind of thing. But they're certainly very prevalent, you know. Yeah. Cardiovascular disease in, in general very prevalent here in the, in the southeast of the United States. Yeah. So, so that's what I'm sure we'll talk about. You know, if you have symptoms that are concerning to you, it's, it's better not to ignore them.

- Yeah. Let's just go right into that. Let's go right into what,

- Yeah,

- If you feel like you're, you know, having these symptoms or something doesn't feel right, what should a patient do?

- Yeah. So certainly let your primary physician know at the very least. 'cause if, you know, they can at least come, you know, get, take a history from you, examine you and then, and then, you know, get you referred on to whoever you need to see. But, but I think a lot of people, either they, they don't want to admit that there's something wrong with them or they just kind of wanna put it off. And so it's easy to kind of say, you know, you have a little twinge your chest pain, you say, yeah, it was probably, you know, nothing or whatever it is. But, so I would say the, the number one advice I would give is don't, is you know, don't ignore your body. You know, if your body's telling you something's wrong, then then you should go get it evaluated. And, and as we've kind of talked about, the symptoms from heart disease can be a little bit subtle and so, you know, fatigue and tiredness, there's a thousand things that'll cause people

- To get

- Fatigued and tired. Doesn't mean you shouldn't go get evaluated though. Right. And so I would just say, you know, pay attention to your body and if it's telling you that something's something's up, then you know, you certainly need to go get evaluated. And the pipeline is usually you'll see your primary physician, they'll kind of do their evaluation. If they think that you need to see a cardiologist, they'll send you on to us basically.

- Which is why it's important. Yeah. It's very important to have a primary care physician. Yes. Hundred percent. And that's

- Something we always try to, we

- Talk about in almost every episode.

- Yeah. 'cause I mean a lot of people feel healthy, they may not feel like they need. So it's just important to go ahead and get that relationship established and get that baseline kind of measurement so that you're already established when you start having something that you wanna discuss more in detail and it can kind of expedite that.

- Yeah. As referral, if you have a family history of, of issues and that sort of thing. It's very important. But yes, I mean it's, it's such a hard job being a primary physician because you have to juggle all these things and, and it's, they do just amazing work. And so

- If, if,

- You know, it's, I think even, you know, like in the, the 20 to 30 crowd where they're like, you know, people feel invincible and they're like, nothing's wrong with me. I think it's easy just to kind of let you know your healthcare visits sort of go by the wayside, but it's, it's still important just at least a every year.

- Yeah. So - Your physician just make sure your labs are okay and there's no issues going on or anything. 'cause, 'cause like we said, you know, the, the issues can be kind of subtle and slow growing.

- Yeah.

- So it's, it's important to have, have regular follow up.

- Alright. You heard it here first. Go ahead and get your primary care provider. We have a lots of them here in our area, so we'll be happy to help you get connected with one.

- Yes, definitely. We have any, you know, any variety to choose from you pick? Yeah, they

- Took me around I guess when I first got here to kind of shake hand and there was, gosh, I was surprised at how many a variety of folks that we have here. So there's a great network, there's a lot of folks, there's, there's plenty of people.

- It's definitely evolved quickly over the past couple of years. So that's good. I think partly with our residency program and launching that internal medicine residency here and then just recruiting more and more specialists and it's kind of like when you get good, they recruit their friends and family to come and that's awesome because then we just get more specialties and access. So that's very important for our area since, like you said, we have a kind of a, a regional, a region where it, the stroke belt, we'll just say, we'll just call that it's the stroke belt. So just need to be aware.

- That's been the other nice thing to see is the residency programs because I think, you know, when, when there's an academic program involved, it just kind of keeps people sort of more up to

- Speed on their toes and on their toes a little

- Bit. So it's, it's been cool to

- See that keep advancing. Yeah. Yeah. I'm interested to see like, just even how that program continues to advance. I know we have lunch in welcoming family medicine Yeah. This next summer and that, you know, will help with OB GYN kind of women's health services and then also the pediatric services. But you know what's in it. One day we could have a cardiac program here, say you never, you never know, so you gotta think big.

- Yes.

- Well, I just have one more question and I know you haven't been here a long time, but we always ask our guests what their favorite meal to eat here at the hospital is. The hospitals,

- When I go to All Spice, they have like a, like a grilled chicken deluxe or something like that. It's got this like pesto ale. Gosh, it's, it's very good. And it's grilled chicken. It's not fried so it's not tea, you know, so, man. Yeah, I, I really like it. It's

- Okay. I don't think we've had that one yet. We've had really,

- What if you, I'm curious what people say.

- I mean a lot of people say fried chicken

- As a cardiologist. I can't

- Really say that. Yeah. Or chicken. We've had chicken sandwiches but I don't think anyone has mentioned that specific one,

- So Yeah. That's good man. I

- Commend it's way. Give it a try. Yeah. Alright, well thank you so much. Of course. Here. Course. Thank you guys for having me. Yeah. And thank you to all of our listeners for tuning in. If you have any topics you'd like to hear us discuss on future episodes, you can submit those at sgmc.org/podcast.