Ep. 45 | Rehan Dawood, DO, & Tony D'Abarno, DO, Orthopedic Surgery

Transcript

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- Welcome to another episode of What Brings You in Today?

- I'm Erika Bennett.

- And I'm Kara Hope Rockwell.

- And we just wanna start off first by thanking our listeners for tuning in. If you haven't already, please like and subscribe so you can stay abreast of all the new episodes that we release. And if

- There's any topics you're interested in hearing more about or any particular guests you'd like to see on, you can let us know at sgmc.org/podcast. Alright, so today

- We are here with orthopedic surgeons, Rehan Dawood and Tony D-Abarno. And so Docs, what brings you in today?

- Well we're here to kind of introduce ourselves to everybody and talk about what our area focuses in orthopedics and what we bring to SGMC.

- Alright, so orthopedics pretty much can touch any individual no matter the age or you know, demographics. But let's start by just getting a little history of each of you. So if you wanna start and then we'll move on and just kind of tell us your school, your education, and how you got landed here today.

- Sounds good. So, I'm originally from Pittsburgh. I grew up there. My mom was an O-B-G-Y-N grandfather was a neurosurgeon. So that's kind of where I got introduced to medicine and surgery. I knew I kind of wanted to do orthopedics from the get go. Once I got into medical school, I did medical school in Chicago at Chicago College of Osteopathic Medicine and then continued residency there for orthopedics at Midwestern University and Olympia Fields on the south side of Chicago. Went all over the city, rotated with all the big programs, rush, USC, UFC, Northwestern, and then focused on adult reconstruction last year at Geisinger in Scranton, pa. Okay. So that's my background. Adult reconstruction is total hip knee replacement.

- You hope you don't have to have any of that but that's good to know. We have a specialist for that. Tell us a little bit about your background.

- So I grew up in Virginia. I was born and raised. I went to Virginia Tech for undergrad. I actually have nobody in my family that's in medicine, so I was the first but, and I, I didn't even myself think I would go into medicine. I went to Virginia Tech in engineering and I realized I didn't want to sit behind a desk crunching numbers. I worked as an emergency room technician while I was in college, help play for school. And that kind of sparked my interest in medicine and I started to volunteer clinical hours and I realized that helping people was the passion that I think I, I needed to like help give me purpose. So from that time I went to medical school in the same campus at Edward via College of Osteopathic Medicine. I also commissioned into the US Navy and I actually did my orthopedic training at Naval Medical Center, Portsmouth and Virginia Beach for orthopedic surgery residency following my residency training. I served in Japan for two years and then I served consecutively in Italy for two years. And then I went to do my fellowship in Washington DC with Inova. Was very fortunate to train with a couple professional sports teams including the Washington Nationals DC, United, Washington spirit as well as the United Football League. I worked with the DC Defenders who won the UFL championship this past year, which was pretty exciting but kind of backtracking into orthopedics. Orthopedics for me, I love sports and helping athletes, even individuals and their active lifestyles was very important to me just 'cause I like to see people get getting back to what they love to do.

- And so how did y'all come, y'all both joined SGMC Health around the same time and together. Did you know each other prior to coming here? No. Okay. I kind of assumed y'all had like known each other over coming at the same time. So how do y'all like each other?

- Actually Tony is one of the reasons why I'm here 'cause he had actually signed on before me and he called me on the phone, we talked and one of my big pulls to come here was making sure that I had partners that I appreciated and had good values and a good mission to helping people. Which when I had first spoken to him, impressions last a lifetime. He had given me that comfortability of knowing that my partner was gonna be a good partner to help me out as well as take care of PA patients. And I think we kind of share that same sort of mentality and dedication towards taking care of people.

- Yeah, I love that. Absolutely. It's important and I mean because you're gonna spend a lot of time together and I know from the doctors that we have spoken with, I mean, being a physician is a lifestyle choice, right? You spend so much time in ORs on call in the hospital in the clinics, it does take a large part of your life. So it's important to have, you know, good people around you. But tell us a little bit, I know y'all all both have families too here, so you wanna tell us a little bit about that?

- My wife and I have two kids, two boys, a 5-year-old and then the second is about to be a year old this November. So they keep us busy getting into sports and school and everything. So it's been, it's been great and they love it here. I've met a lot of friends so.

- Very good. What about you?

- My wife, her name's Kathleen. She is actually a cardiology nurse practitioner. She works with Dr. Hinky and Dr. Hannah. Okay. Electrophysiology. So actually another reason why I came down here is 'cause we got to both work at the same hospital. So I get to see her at lunchtime, which is amazing.

- That's nice.

- And then we just recently welcomed our first born son earlier this year. His name is Elias. Oh. And he is now four months old.

- Congratulations.

- Thank you.

- I love that. Well I'm a boy mom. I have two boys and they're 14 and 10 so it, it is the best but it is, they're wild. So it'll be fun but at least y'all can take care of them when they get hurt on the monkey bars or whatever might be. All right. So now that we've kind of gotten to know y'all, let's talk a little bit about orthopedics in general.

- Yeah. - What type of patients do you normally see? What kind of items do you treat? When should someone seek out an orthopedic specialist?

- For me, my area of focus is hip and knee replacement. So I tend to see patients on the older end of the spectrum for the most part. But we both see everybody treat general orthopedics. My area of focus is really anybody that has kind of advanced arthritis in the hip and knee that they've tried everything for anti-inflammatories, weight loss, injections, and it's affecting the quality of their, their life to the point that they just want a definitive solution and hip or knee replacement. Is that definitive solution,

- Is that common among adult older adults? Like is that something that you're kind of seeing frequently as people age that people in or that were living longer and that they're needing that or what is, or is it kind of rare?

- No, it's, it's very common. It's multifactorial. So age related genetic component, weight is a big factor. Activity level, all of those things kind of combine. And as far as arthritis requiring hip and knee replacement, it's only on the rise. There's, you know, studies that show that the demand for hip and knee replacements is only gonna go up as we go into the future. So

- What does that look like as far as the procedure and then the recovery time? I know we've probably advanced from over the years to be a little bit easier for patients, but what, what kind of experience would a patient have if they have to have something like that?

- Hip and knee replacements are a little bit different. So I'll start with the hip. Hip in general, try to do all the surgeries on an outpatient basis as long as the patient's safe to do the do so based on their medical history. And as far as you know, weight bearing, the patient's able to get up, walk with therapy, go home the same day, you know the, the recovery itself has different components. So you have your incision which takes two to four weeks to heal. And then as far as motion and weight bearing hips tend to have a quicker recovery curve so you're able to get up, weight bear, move around, getting back your motion isn't so much of a challenge on the knee replacement side, all of those same things apply but getting motion back takes a little bit longer time. So most of your recovery happens in the first eight to, or sorry, two to three months where you get 80 to 90% of your motion back. But you can get your motion back for up to a year and a half on the knee side. And the reason is you have collateral ligaments that support your, that we preserve during the time of surgery but those can scar down and get stiff. So knee, knee replacements need to really work on motion and it, that just takes time and, and work with therapy. My focus is on kinematic alignment which kind of preserves the soft tissue envelope around the knee. And the goal is to help with a quicker recovery, preserve your, your normal anatomy and and help you with that recovery process.

- I have PTSD from knee procedures because my husband tore his ACL and meniscus or something on playing softball was out for like six months after that. And that the knee thing situation is, that's a major component to your, I mean you can't walk or do anything

- So. And what kind of things do you see as far as like from a sports medicine perspective, what kind of common injuries or things do you see?

- Well ACL tears are probably the bread and butter of the sports world but we tend to focus on a lot of ligamentous and cartilage type injuries. So our breatho scope is, you know, shoulders, knees, elbows and also hip and ankles. But primarily, you know, some of the big pathologies we see are rotator cuff injuries, ACL meniscus injuries. We kind of, Tony and I kind of give the gamut of patient range from zero to a hundred 'cause I take care of a lot of the sort of younger athletic type injuries. But I do also do shoulder replacement so I kind of go zero to a hundred for the shoulders. But a lot of athletic type injuries, tendonitis, you know, joint, joint issues. I think one of the important things that we try to educate our patients on is that surgery is not necessarily the first answer for a lot of the, you know, things that we see. Certainly we do have quite a number of patients we can get to recovery without having to ever make a skin incision.

- I was gonna talk about that too, like how can somebody tell the difference between what is maybe a minor orthopedic and what maybe needs emergency attention in the er?

- Yeah, so emergencies you know, tend to be things that are very painful. Swelling if you can't walk, if you can't move a joint, those are things that definitely need to be seen pretty immediately. Things that you know, sort of linger on for a few weeks to a few months. Those are definitely things that probably need to be seen but doesn't necessarily need to be seen in an emergency room. I will say that a lot of people tend to push things off and that sometimes isn't always the best answer 'cause we can take care of things earlier rather than later and treat them and get people on the road to recovery faster.

- Yeah, I was gonna mention that too when you were talking about the hip and the knee or ask that question, how many people like just get the pain and like wait, wait wait, wait, wait, wait, wait. And then do you see it like at an advanced stage because they prolong trying to get any kind of help

- As far as far as arthritis goes? You know, waiting too long generally doesn't change the surgery or what we're gonna do. I think there's very specific cases where maybe it makes the surgery more challenging but the goals of surgery stay the same. So really from my standpoint, those surgeries are elective and we do it to treat the patient. So we're, we're trying to give you back the quality of life, remove the source of the pain. But you know, if you get relief and can do your day-to-day activities with conservative things like injections, physical therapy, anti-inflammatory medication, that's reasonable too. So I wouldn't say people are doing anything wrong by waiting, you know, longer. It's really do you have the support at home to recover from surgery? Is your quality of life affected so much that you, you would rather just get a definitive solution. Those are the times where we talk about surgery.

- And then speaking of the er, when should you come to, I mean you kind of said it but I know in our area a lot of people tend to naturally go to the er but give us a tip. So you had an injury but you might not need the er, you could probably just hold off and go to the orthopedic the next day type situation. What would be your guidelines of hey you need to seek emergency help versus just wait until the morning and go to the orthopedic specialist?

- I think if you can't bear weight to one of your legs would definitely be a reason they go to the emergency room and if you can't fully range one of your joints, let's say your elbow or your wrist, you can't move it completely. Those would probably be big indicators that you probably should get it seen and at least get some sort of imaging, typically a radiograph or x-ray of that joint to make sure that there isn't an injury or a fracture.

- And what are the most common things you're seeing in our ER from patients common or frequent?

- We see quite a bit of hip fractures in the elderly population

- And that's what I was thinking like false prevention and things like that. If we were to give any advice to our listeners as far as how they can prevent having an orthopedic injury, what would you suggest?

- You know, that's actually quite a bit of patient education. We do for a lot of our patients speak speaking on hip fractures, that's a specific type of fracture called a fragility fracture that we see in elderly females and males. But that also encompasses wrist fractures and spine fractures as well. We do our best to get patients initiated on sort of an all-encompassing care to include vitamin D and calcium supplementation. We work closely with our internal medicine and primary care doctors on making sure that patients are treated appropriately so they don't have those injuries in the future. But for our listeners out there making sure you know that they're on the right calcium and vitamin D supplementation, making sure that they have the appropriate labs done so they can prevent those types of injuries. 'cause they can be kind of devastating injuries especially to our elderly folks and their families when that does happen. And if we can sort of prevent that from happening, I think it can go a long way. We love doing surgery but if we can prevent, you know, having to do surgery, I think that's actually probably the better outcome.

- Absolutely. For sure. So this one's kind of off the wall, but what is the most craziest thing you've seen in your experience? Like as far as an injury or that you had to like work on?

- I had a pretty extensive trauma and adult reconstruction experience both in fellowship and when I was in Chicago. So you know, high speed polytrauma from motor vehicle accidents. Motorcycle accidents are always really bad. Mainly 'cause the soft tissue gets injured so much. The fractures are usually actually the most straightforward part of those injuries. So soft tissue management involvement of plastics and getting antibiotics if there's open injuries. The big thing from adult reconstruction we did, we had a very unique experience whenever I was in Chicago we worked with Henry Finn who is the inventor of one of the original hinge knee replacements. He was a oncology trained orthopedist by by training. So he was doing a lot of bone tumor work and so he developed that knee replacement and then transitioned to adult reconstruction. And he was doing everything from big pelvic discontinuities with almost no bone loss with it large cup cage constructs, which is just a big metal cage that screws into the ileum whatever bones left and then you cement a cup in to the cage, you know, up to total femur replacements where the entire femur is replaced, which is something you try to avoid unless it's absolutely necessary. So seeing the full spectrum of big open orthopedic procedures. Yeah,

- Yeah, I, my trauma training when I was in residency we did training down in Tampa and in the Virginia Beach area. But probably the more notable injuries that I saw were sort of military combat related type injuries. Kind of different mechanisms of, you know, damage that, you know, a little bit different than highway motorcycle car accidents. So they were a little bit challenging to treat when we were overseas. A lot of the care that we provided was more, we call 'em the spectrum of damage control orthopedics where our primary goal is to stabilize the patient and then get 'em to back to really back to the United States for sort of definitive treatment management. A lot of our sort of wounded warriors were definitively sent back to Walter Reed up in Bethesda, Maryland, which they have a incredible sort of rehabilitation center for those folks. But those were probably, I'm, I'm not gonna go into the details of them, but probably some of the tougher yeah. Injuries to treat that I've seen over the last several years.

- Wow. I know Dr. Curly who's our interventional physiatrist, he has mentioned kind of the same situation. I think he served at Walter Reed too.

- Yep.

- But explain a little bit of how those different support specialties do. If someone were to come to you, what do you do to try to prevent surgery if you don't think surgery is necessary? So do you refer and work with those other specialists to tell us how that works?

- Yeah, absolutely. I think cer like a huge percentage of our patients. I would say upwards of 70 to 80% of our patients don't necessarily need a surgery. They just need sort of a conservative management approach that kind of tackles on how to fix, you know, their issue. And that can include a combination of other specialties as well. But making sure there's an activity modification to this types of activities that are causing them pain. Anti-inflammatories certainly there's what we call, there's diagnostic injections we do that also provide a therapeutic benefit as well as physical therapy is probably paramount in treating a lot of these, you know, soft tissue like ligament tendonitis types, injuries. We do work with, you know, interventional physiatry, Dr. Curly as well as pain management. Certainly there's several specialties that kind of tie in and kind of collaborate with us and making sure that we can treat our patients appropriately. But like I said there, there's certainly a number of orthopedic injuries and ailments that I think we can get treated. Surgery usually I like to say tends to be the last resort 'cause once we get to the surgery route we really can't go back from that route.

- Yeah, yeah absolutely. We had Dr. Hogan on the, his family medicine and he said that he's been seeing a lot of injuries from pickleball is for sports injuries.

- Are there any particular sports that you see more injuries in?

- Yeah, absolutely. I, in the sports world there are very sports specific injuries. I'll say, you know, lacrosse and soccer tend to be our highest knee ligamentous injuries like ACL tears that we see. Football can be a lot of different things 'cause it's a very high velocity, high contact sports. So you can see anything from fractures to ligamentous injuries to shoulder dislocations. As our population becomes more active into an older age, especially with amazing knee and hip replacements that lets you play golf and pickleball. We certainly do see a lot more injuries in the elderly population, but there are very, very sports specific type injuries that we see throwing athletes that do baseball or you know, even javelin throwing for that matter. I see a lot of shoulder type injuries with that. Volleyball players have very specific type of shoulder injuries. So, and that, and we do try to actually treat and tailor our care to the specific activities that our patients do. 'cause we want to get, especially in the sports where we want to get our patients back to sort of a high level of athletic activity.

- Yeah. And our area specifically soccer and volleyball has sort of taken off over the last couple of years. It wasn't very popular prior to that but that's been something that's been growing in our youth and so I expect that to kind of,

- We'll see that more of those around our area. Do you have any specific injury prevention tips for athletes?

- Absolutely. So one of the big things I think for athletes, and you'll see this like especially on the more professional scale, is the amount of preparatory training and warmup and stretching and sort of prehab that they do before they play sports. A lot of athletes need to make sure that they're probably, you know, warmed up, trained, stretched before they go out and do very high athletic activities. Injury prevention is, is is key. I think a lot of our athletes could prevent their injuries if they also pay attention to things that are bothering them. An athlete that's going out playing 80% is not going to recover well if they let that go on to an injury. So making sure that our young athletes, even as young as five years old playing football to our teenagers if they have any injuries that are bothering them, is to not let a linger on. It's to properly rehab, let 'em heal and then get them back a hundred percent on the field or the court.

- Do y'all see a lot of that? I, I don't, I'm not gonna say this right, but it's something like Oscar or some kind of Oscar something knee thing with like 12-year-old, 13-year-old. Do you know what I'm talking about?

- Oscar sweaters?

- Yes. My son had that when he was playing football and we had to, and it was hard, like especially in a world where sports is so such a priority amongst our area, that to be like, okay the son has to sit out, he cannot go play 'cause he has this and the importance of making sure. So you might need to convince the dads for the dads that still want their kids to go play. What's the importance where you just said said, that's

- Actually a really great point to bring up. So we have seen across the country, not just in this area, but a higher number of young adolescents playing sports and year round sports. When we were growing up, typically we played in school, but now there's travel leagues Yeah. And private leagues where kids are playing all throughout the year. And we're seeing a lot more injuries in the teenage athletic population, specifically in throwers. Like baseball players, majority of elbow injuries are actually treated in under 18 years old for UCL injuries than there are over 18 in the country right now. Wow. And the reason is, and we've we've worked on pitch counts and things like that. Yeah. But even with other sports like volleyball and soccer and the year round sports and lack of cross training into different activities, we do see a lot more of those athletic type injuries. So for parents out there making sure that they're, you know, student, I mean, sorry, their athletes, you know, are sort of cross training a little bit more and not focusing in on specific sports at young ages can help prevent those injuries. Certainly that may not always be the case.

- Right.

- For our child pros out out there

- Future N-F-L-N-B right. Stars,

- There's a lot of parents, big a lot parents, kids, the, you know, five to 10, there's, there's a lot of future professional athletes.

- There is, it is so competitive and especially now with the travel leagues and what you, you know, you hit it spot on as far as

- What Yeah, I can

- What's out there.

- I highly, highly recommend making sure that, you know, kids are cross training and doing different sports and different activities. They can still maintain that same healthy competitive drive.

- Right. - Without overloading their joints and ligaments.

- Very, yeah. What sports will your children play

- To be determined?

- Is there anything you would not want?

- That's a great question that you asked because my child's sports has a nursery and it's completely sports theme.

- Oh, okay. So

- His mobile has a football, a soccer

- Ball, a baseball. So you're already like thinking about, you're like, okay, you're gonna cross train, we're gonna do all

- These. But he, he has a baseball would be my, my number one sport for, for myself if we can, if Hess to play,

- If he likes playing.

- My 5-year-old just likes to run continuously. So anything that involves running, he played flag football, he can throw a baseball really well. You know, he may even get in into golf. It just depends. Yeah. He likes it all My wife's from Brazil so, you know, to keep that, that cultural background. Yeah, he probably gotta play some soccer too. Yeah.

- I That's fun. That's fun. You're, you're get ready. It's exciting. It's such a good mine played football, baseball, cross country wrestling. They really kind of did the gamut of all the stuff and it's so, it's just so fun to watch 'em get out there and do their little things. So it's impressive.

- So are there any like, new advancements in orthopedic surgery that you can tell us about?

- I think from a total joint replacement, you know, something that is slowly being incorporated to the total joints community at large is kinematic alignment, which is an area of focus for me on the knee replacement side. So traditionally mechanical alignment where you try to line up the hip knee ankle axis neutral with a a 90 degree tibia cut to the, to the floor is, or parallel to the floor is kind of the standard approach. Kinematic alignment's a little bit different where you just resurface the, the femur, the top part of the knee and then you balance the soft tissue envelope off of that resurface femur. The goal is basically to give you your, your natural soft tissue envelope and, and speed up recovery. That that strategy was developed by Dr. Howe. And so my mentor and fellowship kind of has been pioneering a lot of the technology behind that. So I try to continue that. We, we have Matta's next AR system, which is an augmented reality system that he, he's helped develop and it basically gives us a direct ligament read whenever we're doing your, your knee replacement to actually make a precise cut on your tibia to restore that soft tissue envelope.

- That's pretty cool.

- So it's, it's very similar to robotics without the robot, but you use the, the sensors and navigation to actually place the cutting guide for your cut.

- Yeah, we're seeing that a lot in all of our specialties. Just how advanced we can get and the images you can get now is like phenomenal. So I imagine you're seeing that in your specialty as well and that just makes it better for y'all to do your job and better for the patient 'cause you can makes it Correct. Sorry. Yeah,

- We've, we've had extensive evolution of sort of our orthopedic treatment over the last 10, 20 years. Medicine is constantly evolving. So orthopedics is, is absolutely in line with that and we constantly do conferences and kind of stay up to date on our education to make sure we're giving patients the most UpToDate treatments. I was very fortunate when I was training up in Washington DC I trained under Dr. Robin West who was the first female NFL and MLB team physician.

- Oh nice to brag

- For her. But she did quite a bit of cartilage restoration, which is something that, you know, we can offer patients to help them maintain the longevity of their joints so they don't have to see Dr. DeVargas as soon. Yeah. In our practice we utilize a lot of new products and implants that we can do through minimally invasive surgeries, through small incisions in the shoulders and knees. We incorporate newer types of collagen sort of patches for rotator cuffs. One of the new things I've, I've been using is something called an O osteo implant, which is not a metal implant, it's actually a fiber mineral type of implant that is very strong almost to the same strength as titanium. And we can put that in patients and it actually turns to bone over the course of one to two years.

- Wow. - Which is a pretty cool product we've been using and studying over the last couple of years. So certainly there's definitely been some amazing advancements. Similar to the robotic technology for our total shoulder implants. We use computerized systems to sort of model our cts of the shoulders and we can create custom sort of implant designs specific to the patient and the companies work with us to make sure that we give the patient sort of like a custom tailored implant to, you know, meet their shoulders in need. So it's really cool come

- A long way.

- We love, we love learning about all the new things we can use to help patients kind of get better and, you know, heal faster.

- So how does it feel now? I mean I know you both had to go through extensive training and years of education, so now you're getting to dig in and kind of start your own practice. How does that feel for y'all personally, just to be in this part of your journey of your career?

- It's definitely rewarding to kind of go through the process and build up the skillset and then be able to actually help people with it. I think that's the, the best part of what what we do is you can actually see somebody recover who's got an injury and maybe they have to lay in bed until you do their surgery and then they get up and they're able to walk again and get back to normal life. So that's definitely the best part about it is when you can see you have a direct impact on somebody's life for the better.

- Yeah. It is quite a bit of training.

- Yeah, I know like most people can't do that. Like that's know

- You think about it, you're, so we do four years of undergrad, four years of medical school for orthopedic surgery. We do five years of residency training. I had a little bit of a different practice 'cause I also served four years in between my residency and then doing my fellowship and then I came straight down here. But it is exciting to, you know, have your own patients. One of the things I loved about the military and one of the things I love about being down here in Georgia is that we sort of get to be community doctors and serve the community and, you know, patients and their families and relatives. We kind of get to help everybody down here, which is, which is really exciting and sort of seeing the improvement in patients' lives and we get to have that direct impact on it is, is is actually really, really rewarding.

- Well, we're glad to have you here. So we look forward to seeing you grow and maybe we'll sit down five years from now and see how it's going then. But we're glad you chose SGMC Health and we look forward to letting you serve our health, you serving our patients in our community because it's a need that we have.

- I say we have a little bit of it all. We got the military population, big sports town, you know,

- It's perfect.

- Exactly.

- Yeah. It's kinda like the heart where, you know, we're in the southern belt too, so for cardiology we have, you know, the prime population. Yep. So we have that for heart and board though.

- Are there any misconceptions about orthopedic surgery that you would like to debunk?

- Absolutely. So people think we just want to do surgery, which is, we do love doing surgery and I, we enjoy the challenge and the technical skill that comes with it, but we don't necessarily use surgery as the first answer. Like we had mentioned earlier, we can get patients healthy without having to do any big surgeries on them. So I think that's probably one of the bigger misconceptions. Also that we only focus on bones. We do care about things outside of the bones too. We care about the whole patient treating the soft tissues and treating the patient as a whole.

- Yeah, I agree with that. That last point. I think even whenever you're talking about joint replacements or trauma where you're fixing fracture, a lot of the actual outcome is driven by the soft tissue. So we do take that into consideration whenever we're doing our surgeries.

- Yeah. And we, we definitely want to promote a healthy, active lifestyle from anyone. Whether you're a 5-year-old or you're a 50-year-old or you're an 85-year-old and you just wanna hold your grandkids. I think maintaining a healthy, active lifestyle is important for your joint health and your overall wellbeing. 'cause the, you can't be healthy without moving.

- Right. Yeah, absolutely. Well, one final question. We ask all of our guests this at the end of the podcast, but what is your favorite meal to eat here? SGMC Health in the cafeteria or in the allspice?

- I think honestly, I just like grabbing a cookie from the surgeon's lounge. No one has

- Said that, but I like that answer.

- Just to keep my blood sugar out, especially if I'm

- Busy. Yeah. My guilty comfort food is a grilled cheeseburger with grilled onions, grilled

- Cheeseburger. Yep. Yep. Cheeseburger. Very popular.

- I don't think Dr. Siebel and Cardiology would've like to hear.

- We won't tell him we can

- Keep him in business too. Right. So, all right. Well we thank y'all so much for being with us today so that we can share this important information with our viewers and we will link information to your office below this podcast episode. So if anybody wants to get an appointment with you, they can.

- Great. Thanks for, appreciate us. Yeah, thanks so much for having us.

- All right. We'll see you next time.