Ep. 49 | Guilherme de Oliveira, MD, Cardiothoracic Surgery, SGMC Health

Transcript

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- Welcome to another episode of What Brings You in Today? I'm Erika Bennett, and we just wanna start off by thanking our listeners. If you haven't already, please like and subscribe so you can make sure that you're staying abreast of all of our new episodes. And then, of course, if you have any questions that you want to share with us or any topics you wanna hear about, please let us know and we'll be glad to try to line line someone up to talk about that. But today we're here with Dr. Gui Oliveira. He's a cardiothoracic surgeon. And so Dr. Gui, what brings you in today?

- Hi, good morning. Well, first, thanks for having me here. Well, I think for us to just talk about heart disease or lung disease and, and get more information for the public out there.

- Sure. Heart and vascular disease is very prevalent in our area. So very important topic, but let's start by just learning a little bit about you and your background.

- Well, I was born in Brazil, but our family is like Italian as well. Grew up there, did medical school there. Ended up going to Canada here in the US and Portugal to do some, some observerships or or rotations in surgery and heart surgery. And then I, when I finished medical school, I joined the Army as a doctor for two years in Brazil. And then decided to come here to the US. Went first to the Mayo Clinic in Rochester, did a year of research and started residency there of general surgery and then moved to UNC in Chapel Hill and then last in Utah for, for cardiothoracic fellowship. And now I'm here.

- Okay. So tell us about that decision to specialize in the heart and lung and all. What led you to that?

- Well, I think it was funny, you know, when I started medical school, I, I said that I, I'll never do surgery. Like I, I don't know, I thought that was, but then when I started rotating and seeing things and like, I guess the changes you can make, like, you know, by, by operating and then re restoring their health, I was lucky then to, to have a, a very good and famous surgeon in our, in our city that was a heart surgeon. I was able to shadow him and like work with him for a few years and, and then came to to, to Boston and, and Toronto to do heart surgery rotations. But like, I started general surgery and then I was like, well, you know, unfortunately, I think, and maybe that happens for many specialties, but I think on the either medical student training now or residency training, like the general surgery people don't go through cardiac anymore too much because it's not part of the requirements. Yeah. So I, I guess during a few years of general surgery I was like trying to find something that I liked that, but I, I, I wasn't in contact with heart surgery and for that time, but I was like, well, there's nothing I really like, you know, I liked everything, but it was nothing like really sparked me. And then we were able to, to, to get me to do heart surgery by the third or fourth year again of, of residency. And, and then I was like, yep, that's what I, I wanna do. But I think mostly like some of the, the changes that you can do either with heart transplant or, or other things is right. Like you, you can significantly improve their lives. So,

- So what is that like looking at a live heart beating heart that you are going to work on? Like what does that feel like? How do you approach that?

- Well,

- Just mentally from just a, you know, a surgical aspect, but from a human aspect too.

- Well, I'm, I'm, I'm sure like in the beginning it was probably scary, but as, as, as if anything, I remember like, you know, in the beginning of residency training and like you are, you're in the trauma bay in a big, a bad car accident or gunshot wound comes and you're like, oh boy, are, are we gonna be able to handle this? Right? But I think with, with the repetitions, with training, with everything by the end of some years there, like you were like, well, there's nothing that can come that we can't at least, you know, stabilize the patient. But I think with the heart is, is definitely fascinating. I remember the first heart transplant I, I've done and it's I guess something that know, but know many people know, but like even when we remove the, the, the sick heart, right? It still keeps beating in your hand for a little bit. Wow. So that was like, wow. Right. Like, and, and then I guess to see that like bad heart, like distended, no sick heart and then you put a new one and, and, and that was very, very impressive to me. But, but I guess on a daily basis, yeah, I mean it's, I guess every surgery is humbling and, and you need to be doing your best because even with images or tests and everything, sometimes there, there are things that you get surprised every time. But, but definitely it, it's a privilege I gather.

- All right. Well, tell us a little bit about what kind of surgeries you do, like what different things can be done on the heart.

- So, well, I guess in general then, as a cardiothoracic surgeon, like what we do is, I guess basically anything inside your chest or thoracic cavity and in the thoracic wall. So a, a cardiothoracic surgeon could do anything from like heart surgery, lung surgery or esophagus and of course rib fractures or, or or stuff like that. In terms of the heart, I think, well, the most frequent probably we do is coronary artery bypass graft, right? Like if you have a, a blockage that either gave you a heart attack or, or if luckily you, you found out before you had a heart attack and, and we can bypasses tho those lesions or if any of the valves of the heart are not working well, we can replace them or repair them if your heart doesn't beat in a regular way that, you know, there's types of ablation, like kind of trying to reset the, the normal heart rhythm. And of course then there's I guess more, more advanced things like devices that you can put on the heart to help beat because it doesn't work well or, or eventually up to heart transplant. Right. Yeah, I guess those are

- How, so I know obviously sergeants have to go through a lot of school and you go through a lot of training years and years and years. How did you see things advance even during your training? Did you see a lot of advancements take place at that point? Or how do you feel? Oh, like technology plays. I,

- I, well definitely I think I started medical school like in 2007, 2008, like, and this August is gonna be 12 years that I, we finished. So definitely like at least I guess to say in heart surgery, right? Like, or then we can talk about lung surgery as well. But you know, back in the day things were very, let's say maximally invasive, right? Yeah.

- Like - Big incisions to get the vein from the legs to do the bypasses was like a, you open the whole leg, right? And it was something very morbid, like right. There's a high risk of infection of issues with the wound healing. And, and, and nowadays we get the veins with, you know, a little small cut in a camera and, and like instruments that you, you basically just do incision very small, right? Like a couple inches instead of the whole egg. And even I guess in the heart, all the devices, right? Like when heart surgery I guess began, like they could only do one procedure because they didn't have how to stop the heart or, or give

- Or

- Give blood and everything for the rest of the body, right? Like, and so, yeah. And, and it's, I guess surprising to think that nothing like that came before the 1950s, right? So it was like 1950s to sixties that like, they developed the heart lung machine and, and all that stuff. So I think definitely we came a long way and, and now more and more like it's robotic instruments getting involved or minimally invasive like smaller cuts to prevent, you know, to facilitate healing and everything. And then I guess that's the same for lung surgery, right? Like back in the day it was also a big cut on between ribs, like, and nowadays we can do it with, with timing seasons in the robot and camera and all. And, and I guess that helps a lot for the patients and, and everything.

- Yeah, absolutely. Let's talk a little bit about lungs and lung surgery. When would someone, what would, you know, spur someone to have to have a lung surgery?

- Yeah, so I guess we, you know, we can probably separate in in benign things that like in, in malignant like cancer, right? But like, I think benign things, things that we see often is like people that have, for some reason they, they have like maybe bubbles or we call blebs on the lungs and changes in pressure or have heavy cough or something that those kind of can burst or, you know, and then they have air inside the chest, right? Like we call pneumothorax and it's usually more common in very like young and tin tall males, but like can happen I guess with anybody. And, and that air leaks and pushes against your lungs so the lung cannot expand, right? So those are one of the things that we do often, sometimes just a tube fixes it, but sometimes you have to do surgery or infections on the lung, like after a pneumonia. And if sometimes we see unfortunately people that try to toughen up and like, or didn't see care for weeks after a pneumonia, and then they come with a lot of fluid around the lungs that that's infected as well. So we need to drain that and, and clean everything. Lung cancer of course, right? Like, and yeah, I think those are the, the main things on a daily basis like

- Yeah.

- That we see. But of course there's some different things, right? People that smoked or have bad lungs their whole life and the lung is so dilated and big that you, you have to remove part of part of it to kind of help the, the breeding because they're, they're super,

- And that's fascinating to me that you can remove parts of like the lungs. Yeah. And then still your body can function

- Without,

- Yeah.

- So, and, and that's a discussion we have every day in clinic. When we see patients like that, you know, we, we test their lung function and we, and we get some, there's some cutoffs that like, okay, if your lung function is below this, we shouldn't be doing surgery because you're gonna need oxygen for the rest of your life. But it's actually interesting that the lung is, the right lung is divided in three main parts we call lobes the the left one in two. But inside those lobes you have small, what we call segments. So sometimes it feels like, oh, you're removing half of my lung, but like actually that upper part of the lung is just three segments and in the big picture is like three out of 19 segments. So I, it is not that we're taking

- Yeah,

- It's a big volume, but like, it's not like necessarily that we're gonna impair your breeding if, if your previous function was normal, right?

- Yeah. I guess I just think about it as being like too big lungs, like, and if you're taking a section, it's like, I, I never thought about it being

- Yeah.

- Different sections within the greater lung, I guess, which is pretty cool that you're able to do that. As far as prevention goes, I know it's different for, well, very similar I guess for cardiac and lung disease, but what are the best tips that our listeners can take to not have to ever see you?

- Yeah. Well that's, that's what I always, you know, when we meet people or patients or stuff like, I hope you don't need me,

- Right? Yeah.

- But I think unfortunately there's people that just are born, right? Like it's genetics, not that we can point a specific gene, right? But like it's genetics, right? Like we, unfortunately we see very young people that are active or athletes and they have heart disease, right? But overall we know that smoking is pretty bad, right? For

- And is vaping equally as bad? Like how,

- So the studies, I'm not entirely sure the last exactly what they say, but the studies show that basically vaping is the same as your smoking like 10 or more cigarettes, right? So like, and I think the problem with vaping is of course maybe they don't have as much nicotine as a cigar or, or something, but I don't know if it's that controlled, right? So like you can be getting a vape from, and you don't know each other

- Quality control of the

- Actual vape in them. Like, so, so I think the problem is that maybe they're putting something other substance that we don't know that might be causing more harm as well. Right.

- Okay.

- And, and that's a problem now with younger people. Like there's a lot of like teenagers or, you know, young adults like vaping and, and a good amount either because it, it looks cool, it's like socially, you know, they think that they have to do that or, or

- Well, and to your point, it was positioned as having like less nicotine in it and things like that. So, but not really consi if you're not considering the full picture of which most young adults are not.

- And we see then a lot of like very bad lung disease in younger people, you know, if eventually they get a CT scan or something and, and taught to be caused by vaping. But back to that question, so like, I think of course having the, a healthy diet, you know, be moderate with fried things, fatty food and exercise daily, you know, I think we know that if you exercise 30 minutes a day, if three to five times a week you already improve significantly your, your heart health. And so I, I guess it's kind of what everybody kind of knows, but it's very hard to apply, right?

- It's easy to tell people what to do, harder to do it yourself.

- Yeah.

- Let's talk about the collaboration between the different departments, the different areas. 'cause heart and vascular, that's kind of a big field. So talk about maybe how you work with some of the different areas within like cardiology and electrophysiology and even pulmonology maybe like how do all those compliment each other? And then what's the importance of being able to have those different specialties to kind of connect the care? Yeah,

- Definitely. I think is, it's very important to have all, all those, those specialties together. You know, a lot of things that we talk about nowadays, we talk about the approach as a heart team, right? Like it's not just the surgeon or just the cardiologist, right? Like, so for instance, the tavr, right? The valve that we can replace through the groin, right? Like that, a lot of people seek for that because, well, you don't have to open my chest to go home the next day, right? But that is something that not even, I think the heart team is good approach to, I give my opinion as a surgeon, what's the best for the patient. The cardiologist give their opinion as, you know, in their view and their training, but also per the laws and and regulations, both me and a cardiologist needs to be there during the procedure, right? Like, so here, Dr. Sibo and I do them and, and I, and I think it's very important, right? Because he sometimes see patients and I, and I see patients and we have like, well yes, we could do through the groin, but is that the best for the patient, right? Like in term terms of nowadays we talk a lot about long time lifelong management of, of heart disease, right? Like, because some valves last sometime, right? Like the others can last longer. So like what, what's the best for the patient, right? So like, I think it's very important to have that connection. And then the same happens with, you know, they do a, a heart calf find the blockages and they, you know, if, if meet some criteria they're like, they call us because, hey, this patient should have surgery instead of stents, right? Or you mentioned a electrophysiologist is the same thing. Unfortunately there's surgeries that we do or, or even before that, that because of the disease, the patients have heart block and need a pacemaker, right? Like, so we we're always kind of in, in connection with them as well. And then to recovery for, from everything, right? Like then you need a good team of physical therapists, rehab, right? Like, and all that to like set up all the patients to, to get the most success after.

- How do you help alleviate fears and anxiety? And that can come like with your patients of undergoing a surgery.

- Yeah, I think it's, you know, heart surgery is tough on that point, right? Because it's not like kind of simple thing, right? Like in, I, so my, my mom was a nurse and then my, and my dad was a doctor as well. So like, I grew up like seeing how I guess they care for patients and with that saying of like, you should take care of your patients. Like you wanted your parents to be treated, right? Like, so I think you just, I just try to, I guess, of course you try to explain everything and sometimes it's too much, right? It's too much information. Yeah. But like at least I encounter, I think the first time I've seen that was at the Mayo Clinic and I, since then I adapted and like I have my drawings, you know, of the bypasses, what we, where's your blockage, where you can, what we're gonna do or this, this is your valve, what we're gonna do, and that's a picture of your lung and this is where your cancer is or stuff. And I think going through them with that and, and the, the visual picture as all like helps them understand much better what

- Yeah.

- What they're going through and like, and I guess just them being there for any questions, any issues, but in, in a close communication with family and everything. Yeah.

- What's the most rewarding part of your job?

- Well, I think just being able to help people, right? Like they, it, it's good like seeing people in clinic, you know, after a month or, or even earlier but like after surgery and they're like, wow, like I never had this much energy in my life. You know? Yeah. You, you just assume that like, oh, you're getting old and things are are normal, right? Like to, to slow down, but like sometimes it's valve not working or your heart not, you know, with the, the blockages on the coronaries and, and after you operate on them and they're like, do well and, and you know, improve their quality of life and all that. I think that's, that's very rewarding.

- And so kind of piggybacking off of that with, you know, someone being tired all the time and I guess the importance of having a primary care provider and like actually tracking your, all your levels and all your just getting that primary care ha because ultimately do you get referred, I mean, it has to pretty much start there unless you're coming in the ER Yeah. With like an emergency

- Yeah.

- Situation

- Would be either the primary care or cardiologist or a lung doctor, right? But I think that's like, it is extremely important, right? Like, and even after surgery, like it's important to keep following with them to blood pressure, to control all the things. But, but yeah, I think having a primary care, having, you know, continuous care and of course there's different diseases that have screening that happens at different ages, right? Like if you are a smoker or you know, and you're like 55 or something, you should be getting,

- Did a low dose CT

- Scan, annual CT scan, right? Like, and that was definitely proven to be not worth it only on cost, but like in, you know, saving years of life or quality life,

- Right? Yes. Absolutely. That early detection is the best. Okay. Well, is there any misconceptions about heart or any common questions that you get asked that we could clear up while we're on the

- Air? I think, I feel like a lot of people are very scared, right? Like when you talk about open heart surgery, like it's very like still like a very like, oh my god, like what's gonna happen with me? Right? Like, is that, and when we talk and we explain everything and like not only the risks, but like what to expect after the surgery, right? Like, I think it's safe to say that for, for the heart surgeries that we do here, the expectation is that you'll be in the hospital for five, seven days, right? Like, it's not like, and that sometimes alleviates people and some people leave with three days, right? Like if they're meeting all the criteria. But another thing is like about I guess the, the stigma about like the breeding tube, right? Like and how long the breeding tube will stay in and how, how things are gonna be. But, but you know, normally like in, we operate yesterday, but like normally like, it's like this, we operate in the morning, you know, at in the early evening the patient has the breath tube out this morning they're sitting eating breakfast and hopefully walking soon, right? So, but I think there's a lot of like the fear of like, what's, you know, oh, you're gonna open my heart and all. And yeah, I think it, it's a big, a big thing, but I think is it became super safe, right? Like in, of course during the heart surgery we have to stop the heart to we can work on it and there's the machine that keeps giving blood and oxygen for the rest of the body and, but everything is very safe, right? Like I guess of course there's different people, right? Like different pro medical problems, but like, but in average, right? Like if, if most of the patients we calculate the chance of dying from a heart surgery is probably below one to 2%, right? So it's, it's not, I mean it was never gonna be zero unfortunately. Right? But like, it's not like probably back in the day it was like

- Right,

- 20 30% or

- Yeah. Or more likely to get something afterwards, like you mentioned the infections and stuff

- From having, yeah, I think nowadays we, we got to do a lot of learn and do a lot of things of, you know, preventing infection that seem significantly decrease the risks and, and everything. And, but I think it's just, of course it's, it's complex, it's heart surgery, but like, and, and sometimes takes a toll on the patient, but like overall it's, it's, it became very safe and very, and, and some people, you know, they're back at work depending what they do in a month or, or whenever they feel like. Yeah.

- All right. Well we also just, you know, recently, a few years ago started our graduate medical education program and we have our partnership with Mercer University School of Medicine, and so we're having more medical students here. What would you say to someone considering a career in the medical field?

- Well,

- Or what advice would you have for 'em? Yeah, because we do have a lot of those,

- I think listen to our podcast, I, I think it's worth it. I think we, we see sometimes a, a big shift in, and I guess not only in the US but like I can tell from Brazil or other places that, you know, ended up meeting people is like, there's a shift or, or, or a thought about like, oh, I want to do medical school because of, I don't know, salary or, or prestige or something. But I think you should do it if you really like it because it's not easy, right? Like right as anything you do, right. Like the, you know, you

- Gotta really be connected to it Yeah. To wanna keep going that

- And, and unfortunately we see sometimes people that like started the whole process and halfway like, oh, this is not for me. Right? Like, and

- Yeah.

- But I think, I think it's very rewarding if you like to treat people and, and, and, you know, see the outcomes of that and, and everything is very rewarding. I think maybe in the holiday days some specialties could potentially, I guess be tricky in the future, right? Like now we start hearing about AI and, and Elon Musk is saying that you won't need a surgeon in, in three years and you're

- Also, we're also not gonna need money apparently, is what I saw lately.

- And Elon Musk says that we're not, robots will be doing surgery better than any human, right. Like in this amount of years. But, so I, of course there are probably specialties that are more susceptible, I guess to like, you know, some, some form of ai Yeah. Analyzing images or, or stuff that, you know, can provide a quick answer. But I think still it's a, it's a, it's a great specialty, you know, like I, like I said, I think my, my dad is 83. He was a, a orthopedic surgeon and of course medicine changed a lot from when he went to school or start working and, and now, but like, I think you're, if you care for people and you, you want to do, you know, good. Like, it's always gonna be a great option.

- Very good. Well, the last question I have, I know you haven't been here too awfully long, but you've probably had many meals here, so what is your favorite thing to eat here at SGMC? Hope,

- Well now I should say something healthy for the heart, right? But, but unfortunately

- Can't wait.

- The, the, the, the burgers and the, the chicken sandwich there are, are surprisingly very good.

- Yeah, - I, I was like, wow, this is actually really good. So, so if my surgery is run late and I cannot get the real lunch, I ended up going through, through burger or chicken sandwich. But

- Yeah, that's a good go-to. All right, well listen, it was great to sit down. Yeah, thank you and talk to you today. I thank you for sharing all this important information and of course we'll link information to this episode so that if you would like to know more or get in contact with his office, we will put that there. And we just wanna thank you for tuning in and hope everybody has a great day.