Ep. 8 | David Hardy, MD, Vascular Surgeon, 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 wanted to start today's episode by thanking all of our listeners for liking and subscribing to our podcast. And we would also like to encourage you to be sure to leave us a review if you can on Spotify and Apple.

- Yes. And also if you have any questions that you would like any of our guests to answer, you can submit those at sgmc.org/podcast where you can also see all of our episodes and just submit your questions.

- Alright, so today we are here with David Hardy, MD Vascular surgeon. So Dr. Hardy, the infamous question, what brings you in today? Yeah,

- So I'm here and thanks for inviting me. This is great. I'm here to talk about vascular surgery. It's what gets me up, it's what keeps me up all day and all night and I'm still pretty excited about it as a career and what we get to do here at SGMC with it. Cool.

- So how'd you start? What encouraged you to be a provider? So tell us a little bit about your journey and how you developed an interest for vascular surgery.

- I guess it's a little muddled, it goes back a long way. So I was a janitor in a doctor's office, in a family medicine doctor's office in Washington, Georgia. And a family medicine doctor. I really, I thought I was gonna drive a truck 'cause I, yeah, I was like gonna do that. I like where that sounds. And he said, look, you got something, you do well in school, you're motivated, you care about people. And he kind of took me under his wing and started, I mean, just as a janitor every day in this place. And, and I mean I'm what, 17, 18 years old at this time. So, and no one had really maybe believed in me up until that point. So this was kind of my starting point now that was, so I think those were the seeds that were planted. Yeah, I went to college and I guess in high school I took a health occupations class and I thought it was a nursing class and I said this is what I wanna do. So it kind of planted that seed. So I really started college as a nursing major and took a anatomy physiology class first semester and loved it so much. I said, I want to be a lifelong learner. Yeah. So what can I do? And then I go back to those conversations at that family medicine clinic and said, yeah, this is what I want to do. So that, that started it. And I did well in school and was able to take the tests and ultimately got into med school and worked with some key people in my life. It turned out I was a vascular surgeon who got me in a vascular research lab. I had no idea I wanted to be a vascular surgeon at that point. I didn't know what a vascular surgeon was. Probably like a lot of people watching this podcast or so. So I didn't know. And then I went through, met some of the residents, loved what they were about, loved how they felt like they can make a difference in people's lives. Like right there not something where you're gonna treat with medications and find out that difference years later or whatnot. So those kind of things appeal to me and I knew I wanted to be a surgeon. So that was it. As far as vascular surgery, I did general surgery as a residency. That was done. I did that for about six years and did some research mixed in. And my second or third year I did a carotid surgery where we clean out a carotid artery and I thought that was one of the coolest surgeries I'd ever seen. And that's what I wanted to do. I just, I think that was the point.

- Yeah, that is so cool. So vascular surgery, since you said it give us the layman's terms, what is it? Yeah, for the listening audience

- And, and it is, it's not embarrassing to say, what do you do? Because every person, all of my family members, all the friends, they said, oh, you do veins. Yes. But that is not the majority of what we do. So we like to say that we work on every blood vessel in your body except for the heart and lungs. So, or heart and brain. I don't work past into the skull that's a neurosurgeon or a brain surgeon. I don't work on the heart. That would be a cardiac surgeon. But I do every blood vessel. Otherwise, besides the heart and brain, what could you have with those blood vessels? They get bigger, they rupture, they block off. So people get shot through these blood vessels and they bleed to death or can be. And we go in and try and save that. So anything that does with the blood vessel, we take care of it. And then we also do veins, meaning we can take care of some of the cosmetic vein work in your legs like varicose veins. We can deal with them when they get, cause you swelling, achiness, we deal with arteries in the legs that sometimes leads to ulcers or sores in the feet. That's, you know, we see that when you have maybe a diabetic patient, an older patient, someone who smoked for a long time in the south, we don't eat so well. I mean I'm guilty of that for sure. But that's one of these things where after living a long life you start having these blockages. And that's what we try and save. We're trying to save limbs and we're trying to save lives by opening these vessels.

- Yeah. So we all have veins, right? I mean they're all, we all have veins all throughout our body. It's something that you really do not think of unless maybe you have a varicose vein or a spiral vein and you see it. So what does the, what does the impact of your overall health, if you have blockages? Yes. Or you know, some other

- And disease and a vein is, is usually a little more simple than arterial disease or artery. The arteries are one that carries flow to all of our limbs and all of our organs. So if those are blocked, the organ or the limb that that's supplied by that artery can die or become ischemic, meaning it doesn't have good blood flow. And that's what we try and fix. So what's the impact? So if you, for example, if you have leg arteries that are blocked or not getting good blood flow down, you could end up losing a leg. What are the symptoms of that? It actually, most of the time doesn't start off with just a dead leg. That's not how most people show up. Most people notice for years, months or years that they've been walking and they used to walk a mile, but then they walk half a mile because their legs cramp, their calves cramp their butt or their thigh cramps. And when they sit down that gets better. But then when they walk again they start cramping. That is called claudication. And that is some of the early signs of having blood vessel disease. If we can kinda get to you at the beginning, sometimes we can make some lifestyle changes to where we don't have to operate. So that's another part about vascular that I like. I'm not just gonna fix a hernia or a gallbladder and never see you again. As soon as I see you, I'm gonna create a relationship with you like a primary care physician and we're gonna see you the rest of your life. Because vascular disease, once it starts, doesn't go away. It only stays the same, gets better with therapy and visits or, or it gets worse. And that's why we have to follow someone the rest of their life. But yeah, so after you find that, so that was a little aside, but after you find that your legs may be cramping when you walk, that could be an underlying, like a little more serious disease underlying. Sometimes that gets worse to where it hurts at rest. You can be sitting here and it hurts. Or when you lay down at night your legs hurt. That's a little more serious disease where it's worse and we need to move forward. Or if you get a wound on your foot that doesn't heal due to a lack of blood flow. Those are serious. When that happens, your risk of losing your leg, we're talking about an amputation, goes up tremendously, probably about 20% chance per year.

- Yeah. And our area particularly having a high prevalence of diabetes. Yes. Peripheral artery disease. Yeah, absolutely. I mean what's your best advice for the listening audience in regards to when they need to seek specialty care and how important it is to get care before you end up on the table? Having to have a limb removed or before it gets so bad that they it can't be.

- Yeah, I, I think I'll back up and say our community has a, it's a great community of primary care physicians and I think that's where you start. Okay. You start with your primary care physician for diet management, weight loss, stop smoking, exercise and exercise is, you don't have to join a gym 30 minutes of walking a day. We have trials to show that can improve you if you can kind of make some of these lifestyle changes. So I think having a good relationship with your primary care, but if you have some of these symptoms, then we get involved. I went that way and I lost my train of thought about what your question was there, but

- I lost my train of thought too. I, it was, but I mean, I'm glad you mentioned the primary care 'cause we do try to Absolutely. You know, there's absolutely, we also have 70% of our area does not have a primary care provider.

- Absolutely. And I think that's where I'm seeing a lot of people in the late stage diseases because they, they haven't really maybe been to their primary care doctor in a long time until the disease has gotten so much worse.

- And that's what it was. That was my question is, you know, like what are the interventions you can do early on versus like waiting, we always talk about like cancer screenings and stuff for things like that. The earlier you

- Can Yeah, absolutely. So, so yeah. Can prevent it. Perfect. Yes. That's actually, so yeah, if you can get in with your primary care, there are things, if you get in when you're just cramping and aching in the legs. We used to maybe 20 years ago, people just operated on that 'cause they wanted people to feel better. What we kind of understand now, some of those people don't need an operation, they just need to, it, it really can't, I emphasize how important it's to stop smoking. These studies we have, which are randomized trials suggest if you can stop smoking, if you can exercise 30 minutes a day in a specific way that we talk about. But if you get exercise 30 minutes a day, five days a week, at least most of those people will not go on to that rest pain or that wound on their feet. They may actually improve and double triple their walking distance without pain and can kind of go forward and, and like I, I like to say I put food on the table by operating, but I don't want to operate on you if I don't have to. I'd rather you do it all with no surgery if that, if we can do that. So I think getting, noticing those symptoms, getting into your primary care or having an appointment with us early, and this is specifically talking about legs at this point, that I think that's the best way to manage it. The other important part with peripheral arterial disease or PAD for short, and you could think about it, most people know coronary artery disease or CAD. There's a common saying in our world, if you have the pad, you have the cad. So if you have PAD, there's a really high chance you have coronary artery disease or CAD. So it is a marker. In fact, if you, if you feel healthy, do great, you're 50 years old walking around and somehow you have peripheral arterial disease and we find it, you can even be asymptomatic with it. You're about a 15 to 20% chance of having a heart attack within the next five years. Wow. Without any symptoms. And that's kind of what our data shows. So it is a good marker to, hey, you might not have this now, but this is something we need to get you in with your primary care and make sure that you don't have any of those other symptoms that could lead to heart disease or whatnot. Because,

- And is there anything that causes that particularly, or is it, is it genetic? Is it lifestyle?

- Yeah, that's,

- That's a great have question. You just have weak veins. Can you just be born?

- You can, you can actually have have, you can have a genetic disease, you can have diseases that can, that affect your connective tissue. Like EERs, Dan, Los Lois, Dietz, Marfan syndrome. Some of those are some of the more common ones and they affect your vessels. But that's more of, they stretch out their disease. But you can also have cholesterol disease in the family. You can have genetic issues with that. Smoking, I keep going back to it. We have a paper, I believe Dr. Goody up at Dartmouth did this a while ago. But when you're looking at these diabetes and smoking are the two worst things you can do. And we have a lot of patients that do both of those. They can't really help their diabetes, they can help control it. Once they have it, they can help control it and, and that will improve your outcomes long term. But the smoking is the single most thing you can do to stop smoking. We talked

- About that with Dr. Disser. He encourages his patients to

- Stop smoking. Often say if people didn't smoke, I don't think I'd have a job.

- Yeah,

- Wow. I think we would miss, we would probably lose a lot of the disease that we have if we could get rid of that.

- What does the smoking do to your veins? Exactly.

- So, and I say I just had a, like a tangent but smoking and vaping. So some people go to vaping. Yeah, I was

- Gonna ask about that too. We'll go

- That but but what does it do? There's a lot of things it does, but one of the biggest things, the nicotine in the cigarettes as far as I understand it can break down the elastic membrane in your vessels and elastic membranes like a rubber band. It breaks it down and, and creates hardening of the vessels and it can actually cause deposits of it. It just, it worsening. So, so we know at in lay terms, like hardening of your arteries. That's what people say. So that's what happens. Like that vessel loses its compliance or elasticity like a rubber band and it just hardens over time. And when you have our blood vessels hopefully that are young and they, every time your heartbeats, they bounce and move with your heartbeat and they help continue pushing blood. But if that becomes a lead pipe, that blood does not flow better. It didn't flow well down your leg. And that hardening just continues to narrow in the, in the lumen in the pipe. And it's, I mean it's, it's very similar to, so I'm just a human plumber. So when people have clogged pipes, if you've ever been under your sink and have the P trap and you take it out, all that gunks in there, that's what your blood vessels look like with smoking and

- Disease. But they're much smaller. So how do you even, I mean how did you even learn how to open up a vein and like tell us about one, how you learned about it, what you do, and then how it's advanced over what do, what have you seen in advancements? Absolutely. So to vascular surgeries,

- That's a big question. So how did, so remind me about the advancements. Okay. Alright. But the, but starting out, how did I learn it? It is just years. I mean it was a hundred hour a weeks in residency in general surgery, just learning how to operate using instruments, taking care of patients. And then with gen, with vascular surgery, it was two years straight of just doing cases in vascular. And these are small vessels, like we open them up, some of them are the size of our fingers, the aortas, the size of our a water hose, like a garden hose. And then you have some below your, your legs or below your knees that are smaller than a mouse cord. So they're pretty tiny. So I

- Didn't realize they were that large

- In my head. They were much smaller. They have, yeah, so there's some that are mouse cords and there's some that are microscopic that you have to kinda have a microscope to work on. But every time we work on, we have these loops magnifying glasses where we operate using those. So yeah. And there and and how is it advanced vascular surgery? I don't know. It used to be, at least when I was just coming up in med school and and residency people said, ah, it's just fem pop chop chop. So a fem pop is when you have leg disease you do a femoral to popliteal bypass and those are the names of vessels and then it goes down and you cut the leg off. And that was one of these colloquial sayings where people said, oh, m pop, chop chop. That's all we ever thought of as vascular surgeons. And I don't know, I, I give the credit to a guy named Dr. Frank V out in New York that took vascular and I think he just took it in the public's eye to another level and even told us like, if you don't get on board with this, we're gonna be dinosaurs kind of. So he started the having vascular surgeons do the endovascular and that's minimally invasive vascular surgery. So where we used to just cut, we cut bellies, open arms, open legs open, and we're just getting the blood vessels out and doing bypasses. Just like if you had a blocked pipe or blocked plumbing pipe. If you can't get it open with the Roto-Rooter device, then you just put two ends and put a brand new pipe in. And that's what we did. And then someone along the way, you know, interventional radiology does it, different specialties do the endovascular where we can do a lot of our work with just putting wires in. Just like a heart cath. You stick the needle in the groin or the arm and you go into the blood vessel and you put a stent and that's what we can do. I can go from your wrist and go all the way to your foot and open that vessel up if we need to. Most of the time I go from one groin up and over to the other side. If we need to fix your aorta, which is the main blood vessel off your heart, we usually go from the groins. We can go from your neck, we can go from, yeah, so, so if we can get a wire through, typically we can put a stent or a balloon in it. So how are advances from that? Dr. Perotti was a, actually his son is a good friend of mine and, and he, and in South America I think he trained, he did some stuff at Cleveland Clinic and he says, when I was there I was thinking about this, but in South America with another friend of his was an interventional radiologist. They came up with the idea, when you have an aortic aneurysm, if it ruptures you're pretty much dead. A 90 plus percent chance you're not gonna make it. Even if you, if it ruptured and you were sitting in the hospital. But a lot of these people we were not saving because they were too sick. When they get older, they have it, their heart's not as good, their lungs aren't as good. So they were having a hard time and this was back in the early nineties where we have to open the belly and just do big open surgery and that's a big surgery. So he had the idea if we can put stents in, why not just put huge stents in the aorta? And no one had really done that. So in his garage or whatever, he took fabric and he sewed it to stents and then collapsed it inside of a plastic tube. And, and the first one was done in 1991 where he just said, well I got nothing for this guy. It's been written about. So you could read the paper if, if it was interesting to you but, but he really didn't have a better option. And he put the stint in and the guy ended up living for a while afterwards. And that was the beginning of this endovascular revolution. So that's gone from very cumbersome long cases to, I'm doing one as soon as we finish this I have another, I have an endovascular aortic aneurysm repair. These devices have the technology's blown up so much to where they have holes cut in them specifically for that patient. So we can put stents out certain vessels, some of the bigger centers, and this is more research and this is what I was fortunate enough to be involved in in my prior institutions in these big institutes. But some people are going all the way almost to the heart and doing this, putting stents and holes through that graft material to stent open the blood vessels to the brain, to the arms while putting those in. So what we used to do is people had their chest cracked open to do that. Yeah. Now you're just doing it through wires and you're groin to kinda do that. So it's, it's amazing how far it's come and the technology that's gone into that for these blood vessels in our legs that are blocked. This calcium is so difficult. The med students we have with us and even some of the new students like surgical tech students or nursing students, when we take it out of the body it feels like gravel, like hard rocks that you picked up outta your driveway. And that's how hard, that's why we call it hardening of the arteries. So you can't imagine sometimes when you feel, how do those stents open that up? Sometimes they don't because it's so rock hard, you can't get the stents to open it. So we have devices called atherectomy devices that will break those open. We have devices, if you've ever heard anyone getting a kidney stone ablated with a lithotripsy or one of those kind of vibrating or ultrasonic machines, we have those inside the blood vessels that'll break that calcium. So it'll make it compliant. We put stents in, we have lasers that we can use inside the vessel. And so, and then, you know, kind of the newest thing we've had and then last several years are drug coded stents, which cardiologists have had for a while that they put in the heart. So now we're getting all that for our lower limb stents. So the technology just continuously advances.

- So for things like that, if it's not emer, are most of your cases emergent cases or do you have a lot or you know, what's the mix between emergent and then those that truly are seeing you in the clinic and being evaluated prior to something? I

- Think I still, I think I still have a good like non-emergent practice where I can see you in clinic and put you on there. The problem is a lot of the patients see in clinic have wounds in their feet. Now that's not emergent where I need to take you immediately. Right. But we need to get that done in the next few days to a week or so because if that tissue keeps dying, you're gonna end up losing that leg if we can't save it. So, you know, time is tissue. So I think a lot of our cases are urgent or they just need to get in. But we do, I, I do see a lot of patients in clinic that we put on for, I mean I'm booked out for three or four weeks right now at least. And then I will have emergencies. I'm gonna call all weekend. The case I'm doing right now, the aneurysm is some person who has pain so it's not gonna wait. We have to fix it. Yeah. So that was more urgent. Emergent needs to go. Yeah. Soon as we can get 'em, get them on the table. Something we didn't talk about, we do a lot of dialysis work and that's something if someone ends up having kidney failure needs dialysis, a lot of times they need a catheter, one of those plastic tubes that hang out of the chest or neck or even the groins to get your blood cleaned on dialysis. Those aren't great. I mean they do their job but you don't want those tubes hanging out in, 'cause the tube, the tip of it sits right in right above the heart and when it sits in those veins, those veins can get scarred down and shut down over time. So ideally you want to get those out as soon as possible. So that's what we do as vascular surgeons. We come in and find veins in your arms or legs and we hook those into arteries to create circuits so you can dialyze. Wow. So that's it. Or we take pieces of Gore-Tex tubing if your veins are too small to do that. 'cause a lot of people's are, we just take these Gore-Tex or plastic tubing to put in the upper extremities so that people can dialyze.

- So I mean obviously you are the expert in this film. I feel like I've learned so much, much. I know I feel like it's way over my head, but it's, I'm glad that you know, what you're doing is is my thing. But so primary care, I mean you gotta start somewhere with the, I mean you gotta know your body, know what's going on with it. And then if you're having symptoms, signs of vascular issues, then they can be referred to you and then you can absolutely consult and kind of check that out.

- Yeah. And like you were asking earlier, yeah the symptoms, leg pain, leg weakness, different changes like the, the don't ignore those things. Those, the earlier we can look at 'em, the better people that have belly pain or we all have aches and pains in our back over time, but something different belly back pain, the, you know, you don't know you have an aneurysm until someone looks for it. So that's one of those things.

- And tell me what an aneurysm is again.

- So an aneurysm, your aorta is the main tube about like a garden hose running right down and all the blood vessels come off that feeds everything in your body. But over time that that vessel can grow. And it'd be like if you've ever seen a tire weaken and have a bulge off the side of a tire, that's what your arteries do sometimes. Okay. And they thin out and if it ruptures, that's all your blood flow is just out coming. Okay. And you would not survive that most of the time. Right. Sometimes our body, even if it ruptures our body will seal it off long enough to get them and those are the ones that survive long enough to get to surgery.

- And so you can catch those just by like if someone's symptomatic and you can find those through ultrasound or Yeah,

- If you look, if you look at the history, that was such a high risk of death with that. And over time, and I forget exactly when it was, but the Medicare save act, S-A-A-A-V-E, whatever it stands for, but it, it basically allows every person who 65 or going into Medicare to get a screening. And it was so important because we find a lot of them to treat and if we could treat them we can decrease the mortality. And that's what we found. As soon as they put that in the death from that went went

- Down. Wow. It's about like stroke. I mean I was always told the story that back in the day they used to, they called it a stroke because they didn't know what it was and they thought that God was striking you down. Oh yeah. I think And so they called it a stroke. Yeah. And you know, it's just interesting how we evolve and can.

- Absolutely. And it's a good segue. We also do strokes. People don't think about that. Well maybe they do but, but if you have a stroke, the majority of them will be from a blocked carotid artery and those are the vessels we go in and can clean it out or put a stent in.

- And y'all do a, there was another procedure that you did probably a few years ago. Yeah, well

- We do 'em all the time. Yeah.

- I mean you first we

- Talked about here

- In t Yeah.

- So yeah, as soon as we came here I brought it here and it had never been here before. So that's, you know, it's putting in a stent but it, you still have to make a cut at the base of the neck and put in a stent. It decreases your risk of stroke. But it, it makes it equivalent to open surgery. They all have their, their niche niches. And if you are going to do, I dunno if you're gonna have a carotid procedure, you know, I'd recommend, I guess I'm biased 'cause I'm a vascular surgeon, but I can put in a stent from the groin. I could put in a stent from here or I can do open surgery. There are some specialists that all they can do, if they're not surgeons, all they can do are stents. So that might be the right answer for you. But sometimes you need, sometimes you need that specialist who can do all and we do 'em equally. So we hopefully give you all the information you need to choose what procedure you want. So yeah, we offer all that.

- Very cool. Well what motivates you? And you kind of mentioned it, but you know, you go throughout your daily routine. Teyl and I talked about it earlier, we just do marketing. Like, I mean I'm just

- Sitting here like I feel like I'm taking a science class. I was never a science person, but this is very interesting. Maybe if I had a surgeon teaching my science class, I would've been more interested.

- Yeah. Show some pictures or something. Yeah. But yeah, what motivates me, it's cliche. Why do we do this? Because we love helping people. Absolutely. If you didn't care about people and didn't like to do that and, and sometimes I think it's dumb to even say that 'cause it's cliche, but if you did not really love serving other people, you couldn't do this job. It, it stinks because it is a hundred hour weeks. I'm away from my family. I don't ever make it to my kids' soccer games, the whatever, like you're here taking care of your, your work family and your patients. And if, if it wasn't because you had a heart of service, I don't think you could do it. I would just find something else to do if that was it. So, I mean, yeah, I love watching people get better and, and I, I really like vascular in the sense of we put a stint in and they wake up and their legs better. Sometimes they're not and sometimes it's worse, but you're not gonna be a hundred percent. Nothing's a hundred percent. But we save way more than we lose. And you have to have the good with the bad. But that's what keeps you going is having, having that.

- Okay. That was your tear jerker moment. Dr. Hardy, we thank you so much. We're so glad to have you here at SGMC Health and to have you in our community. As I mentioned earlier, your passion is evident and so we're glad that if we were to have something, we know you're here for us. But Taylor has one last question.

- One last question. Do you eat here very often? I imagine you do. 'cause you're here, he

- Just all the

- Time hours.

- Yeah, absolutely. You eat,

- You eat here.

- So I always like to ask people what their favorite meal is that is in either the cafeteria or in the spice.

- The favorite meal. Really? Oh yeah. That's a tough one. Yeah. 'cause it's a could, it could totally throw people off. It's like really that guy eats that. I, we haven't had it in forever but I, easy, easy for me. Like they chicken pot pie that they make is some of the best and it's in the, it was in our lounge sometimes that I haven't seen it in like a year, but that would be like my go-to

- So now we know comfort food. If we need something from Dr. Hardy we can just go chicken pot pie.

- It's simple comfort food. Yeah. Good.

- It sounds comfort food. Yep, that's right. All right, well Dr. Hardy, thank you for sharing your knowledge. If anybody has any questions that they want answered or just more information they wanna learn more about it, Taylor, I'm sure she'll work her digital magic and put some links in there to contact information. And if you, you know, just any questions or anything we're, we want this to be engaging as it can. So Yeah. So I can review us and share us with your friends.

- Yes. Thank you for

- Listening. Yeah, thanks for having me.