Hello and welcome to Scrubbing In, a podcast powered by Specialty Care. I’m Todd Schlosser and today my guest is Dr. Brian Lima, the Director of Cardiac Transplantation at Northwell Health. In our conversation, Dr. Lima and I discuss what led him to a career in healthcare, specifically heart transplantation surgery and how future plans include him authoring his own book. I think you’ll find the part of the conversation about engaging a heart failure specialist early on in the heart disease process very eye opening, I know I did. But for now enjoy Scrubbing In with Dr. Brian Lima.

So I’d like to start off the podcast by asking everyone sort of what drove them into pursuing a career in medicine. So what was it sort of in your youth or young adult life that made you want to be a heart transplant surgeon?

Brian Lima:                   So wanting to be a heart transplant surgeon or a heart surgeon specifically evolved over time. But when I realized I wanted to go into medicine was at a very early age when my father had a heart attack. He was only in his early fifties and I was very young. I was like 10 years old. And so thankfully he did okay, but that scared our family a lot. So that’s when I sort of began to have this fascination with interest in wanting to learn medicine, become a doctor. So to help other people, other families not feel helpless like that, like we felt when that, when that all occurred.

Todd Schlosser:            So I’d imagine at 10, you would feel very helpless because you’re sort of in a whole new world, you’ve probably hadn’t been to hospital a lot and it’s like a whole new thing. And then it’s sort of a life and death situation. Fortunately he came through it well it sounds like, but that could be an eye opener for anybody. So at that point you decided medicine’s the life for me. But that wasn’t what got you into heart transplant surgery. That seems interesting to me.

Brian Lima:                   Yeah. So it came later, why I wanted to become a surgeon. Yeah. And it sort of evolved sort of a piecemeal, I guess. And I did a summer program at NYU in college at the medical center and I randomly just, I forget what I filled out in my little questionnaire. I was randomly connected to shadow a surgeon at NYU that summer and he’s a cancer surgeon, actually, surgical oncologist. And so I had really, I had thought of surgery, but I’d never, I just knew medicine, but I really didn’t know, I didn’t know anything. I mean I was young and so-

Todd Schlosser:            I mean that’s why they do those things so you can get an idea of what you want.

Brian Lima:                   So here I was, I was 20 years old and he let me scrub in into a procedure. I actually got to watch a surgery and I don’t know what it was about that, but it was like an epiphany. It was like this is it, this is what I want to do, this is amazing. And hook, line and sinker, I was done. And then from there it was, okay, I’m going to be a surgeon. And then it evolved into heart surgery, heart transplant. As I kind of got to learn more and see more heart surgery, for me, it was just the ultimate fascination, the ultimate rush. It’s just amazing to see a heart, you know, you have the heart stop even if you’re just doing a routine heart operation, you have the heart stopped for two hours and then you, you know, you bring it back to life to have and it’s just, it never gets old. So that’s kind of how it evolved.

Todd Schlosser:            So there’s some other things in there I want to talk about in a second. But, so you were, I think you went to Cornell for undergrad-

Brian Lima:                   Undergrad.

Todd Schlosser:            And then you went to Duke for medicine.

Brian Lima:                   Correct.

Todd Schlosser:            So you sort of focused on that, I guess surgical and on that track and at Duke I should say, right?

Brian Lima:                   Yeah. So Duke is, I think, how my career trajectory evolved, did have a lot to do with kind of what I saw, what I was exposed to at Duke. Because Duke is such a, has such a legacy for excellence in surgery, namely heart surgery too with Dr. Sabiston having been there as the chairman for such a long time. You know, the father of bypass surgery.

Todd Schlosser:            Yeah.

Brian Lima:                   So the culture of heart surgeries is very, very strong at Duke. And so I think that also played a huge role in my exposure to it early on as a medical student throughout my time.

Todd Schlosser:            Yeah. I’d say, I mean not speaking for you, but your first scrubbing in surgery was actually a cancer surgery. It wasn’t a heart surgery.

Brian Lima:                   Yeah, that’s right.

Todd Schlosser:            So you must have had maybe a mentor or just enough experiences in the heart surgery [crosstalk 00:04:34] that you were like, that is for me.

Brian Lima:                   Yes.

Todd Schlosser:            Awesome. So you graduated from Duke. Where’d you do your residency?

Brian Lima:                   So I stayed at Duke.

Todd Schlosser:            Oh, okay.

Brian Lima:                   Yeah. So I stayed at Duke for seven years to do general surgery residency. And it’s typically five years, but Duke and many other programs like to involve research and research component. So two years of research, years three and four. And so that’s where I also kind of did a deep dive in heart surgery because I did heart surgery research, cardiovascular biology.

Todd Schlosser:            Right.

Brian Lima:                   And incidentally it was was going to potentially be with Dr. Oz. This was when Dr. Oz- yeah.

Todd Schlosser:            Before TV?

Brian Lima:                   Before TV.

                                    So he obviously was a very well known pioneer in heart transplant surgery and mechanical heart pumps. And so he had a very, very prolific lab at Columbia. And actually one of the Duke surgery residents had gone there a year or two before I was considering, to spend his two years of research there.

                                    So this was, I was emailing back and forth and was actually for a minute there, close, very close to doing my lab work at Columbia.

Todd Schlosser:            But then you stayed at Duke?

Brian Lima:                   I stayed at Duke and finished out and was going to also stay there to do my heart surgery training. By then it would have been, I had already been at Duke for 11 years and they had three slots for the heart surgery fellowship. There were three of us in our finishing program. I’m like, hey-

Todd Schlosser:            Might as well.

Brian Lima:                   And I just said, well, let me just take a look around. I know, I love Duke. I bleed Duke blue.

Todd Schlosser:            Sure, yeah. [crosstalk 00:06:06] a Duke lamp.

Brian Lima:                   Absolutely. I can’t say enough about Duke, but I was like, well let me just see kind of what’s out there. And I visited the Cleveland Clinic and that’s, at the time, and still arguably the Mecca of heart surgery.

Todd Schlosser:            Yeah. I mean you talked about Duke being sort of a training ground for heart surgeons. The Cleveland Clinic is sort of that for actual like fellowship and residency.

Brian Lima:                   It’s something I would describe from a trainee’s perspective, what I likened it to is like a kid in a candy store. You go in and literally on any given day there’s 20 open-heart operations being performed by the who’s who in the world in the specific niche areas of heart surgery.

Todd Schlosser:            Sure.

Brian Lima:                   And it’s sort of being able to be exposed to that. It’s like drinking out of a fire hose. It’s literally, you know, the next closest place in the United States does maybe half that amount of surgery in a year. And so it is just a beast. And so I thought, well, you know, it’s all about reps and exposure.

Todd Schlosser:            Yeah, absolutely.

Brian Lima:                   If, you know, why not try to. So and I thought, going somewhere else, seeing a different perspective.

Todd Schlosser:            Sure.

Brian Lima:                   For those reasons, I elected to go there.

Todd Schlosser:            Yeah. So at the time, we talked about this a little bit before, Toby Cosgrove was heading the Cleveland Clinic and I’ve been fortunate enough to hear him talk and one of the things I took away was when he transitioned from being a heart surgeon to the CEO of the Cleveland Clinic, he was totally unprepared for that change. Was it a very different change when you went from Duke to the Cleveland Clinic?

Brian Lima:                   It was, I mean, there was definitely some risk to it, because at Duke I was a known commodity.

Todd Schlosser:            Sure.

Brian Lima:                   I had been there for a long, long, long time. All the heart surgeons knew me. There is no question that I would get early, frequent repetitions.

Todd Schlosser:            Right.

Brian Lima:                   They knew, okay here, why don’t you help do this case and we’ll walk you through it. I had to prove myself all over again, which is actually on the one hand you could say maybe most would be averse to that, but I actually thought that would help just push me even more.

Todd Schlosser:            Absolutely.

Brian Lima:                   And so I had to re, sort of, prove myself completely. The learning curve for heart surgery is pretty steep.

Todd Schlosser:            I’d imagine.

Brian Lima:                   Even after training for seven years in general surgery now you’re going to something that’s a moving target and the needle angles and everything are completely different and it’s literally a surgery where at all let’s say a hundred steps, you can literally kill somebody.

                                    Every mistake, every step along the way could lead to death.

Todd Schlosser:            It is the very definition of high risk, high reward.

Brian Lima:                   And so basically when you have one of the most famous heart surgeons in the world, hand you the scalpel or hand you the stitch and say, all right, let’s see what you got, you know, it’s exciting.

Todd Schlosser:            Yeah, sure.

Brian Lima:                   Nerve wracking. But yeah-

Todd Schlosser:            I can see that as being very intimidating though.

Brian Lima:                   Very intimidating. And you really, you kind of had to make the most of it, because that was your shot. That was like your audition and if you blew it, you kind of blew it.

Todd Schlosser:            Absolutely.

Brian Lima:                   There’s 20 other guys warming up in the batting cage.

Todd Schlosser:            Who wish they got your spot.

Brian Lima:                   Who would step right in. So that’s, it felt like being in the NFL combine or something like that. Or preseason.

Todd Schlosser:            I could definitely see that.

Brian Lima:                   It’s like, hey, you know, yeah, you kind of threw an interception that last series, why don’t you sit this one out. You know, that’s what it felt like.

Todd Schlosser:            So obviously you were a success there though, because you went through that program and then you had some various other positions, but eventually ended up here.

Brian Lima:                   Right.

Todd Schlosser:            Where you sort of are the surgical director of heart transplantation.

Brian Lima:                   Right.

Todd Schlosser:            So I mean that’s not something you get overnight. Obviously there was a lot of schooling that went into that, but how did that all come about and why did you choose Long Island to set up a surgical transplantation center?

Brian Lima:                   I’m from the northeast originally. I am born and raised in New Jersey and had for the last almost 20 plus years, been out of the northeast and got pretty comfortable. I was in Texas at Baylor. I was at the helm of the Mechanical Circulatory Support Program there. We were one of the busiest heart transplant centers in the world and I had to manage to make a bit of a name for myself in the field. I’ve been published a lot in that space. And so that’s why I was in contention for this type of position.

Todd Schlosser:            Right.

Brian Lima:                   And what struck me was, it caught me off guard. I did not have any clue that Long Island still, after all this time, didn’t have a heart transplant program. And if you look at the numbers, you know, you’re talking about, if you add Long Island, Brooklyn, Queens, Staten Island, it’s about 8 million people.

Todd Schlosser:            That’s a huge population.

Brian Lima:                   You would be hard pressed to find anything even remotely close to that in the entire country where that size of a population doesn’t have a heart transplant center to call their own.

Todd Schlosser:            Yeah.

Brian Lima:                   And you know, heart transplant is not getting your gallbladder taken out. There’s a lot that goes into figuring out who’s an appropriate candidate, back and forth visits, and then not to mention the follow-up afterwards. So this population of folks have had to endure that hardship of having to trek all the way into Manhattan, which from a mileage perspective isn’t a big deal, but from a travel perspective, anyone who’s traveled here, knows that’s a huge deal.

Todd Schlosser:            Yeah.

Brian Lima:                   It’s very costly. The tolls, the traffic. It’s very taxing for families. So I think that in and of itself has presented a huge barrier to care. So I thought it was one of those things that I like to call it the second epiphany, and the first epiphany was surgery. Yes, I like that. The second one was, wow, this is, I need to, I felt like morally compelled and I thought it’d be the opportunity of a lifetime to help start something for such a massive population of people.

Todd Schlosser:            So when opening up a surgical center, especially one so vital as heart surgery, in a population size of that magnitude, was there a sort of influx of need that came in after you guys opened your doors? Or how did that reception in the community go?

Brian Lima:                   Well it’s still a work in progress in that we’re still trying to spread the word, if you will, about the availability of these services. I think it’s decades old now. These referral patterns, this, you know, oh we kind of have to make do without having a transplant on Long Island. So I think we’re still doing our best to promote the program, increase awareness for the program.

                                    So there’s definitely a massive need and I see and hear from patients on a day to day basis that really will benefit from the availability of these services. But it’s a massive unmet need that hopefully we’ll be able to fill over time.

Todd Schlosser:            Absolutely. I didn’t think about that because it’s not like a walk-in clinic where you open your doors and be like, “Oh hey, I can go there and get my medicine for whatever.”

Brian Lima:                   Right.

Todd Schlosser:            You have to be referred to, probably by a few people to end up here.

Brian Lima:                   Yes.

Todd Schlosser:            So you actually need to change the sort of referral culture, if you will in this whole area.

Brian Lima:                   Yeah and that also brings me to a soapbox I love to get on and then it’s hard for me to get off of and it’s heart failure itself. It does not get the street cred that diseases like cancer get. It’s still very, very much case by case. It’s not standardized like cancer. Cancer, it’s very sort of cookie cutter slam dunk. You have a cancer, well then you go straight to an oncologist, no questions asked and we figure out if you need chemo, radiation, surgery, et cetera.

                                    Heart failure, it’s well let’s see how things go. And unfortunately like cancer, it could get worse over time silently.

Todd Schlosser:            Yeah.

Brian Lima:                   And so unfortunately more often than I care to admit, we see heart failure too late where patients are beyond the scope of what can be treated with medications. And that doesn’t always go to schedule. By schedule, meaning it’ll happen abruptly and someone all of a sudden is deathly ill and then we’re trying to pick up the pieces and make up for lost time. So there’s a lot of room for improvement in heart failure care in general throughout the country, because really only a small fraction of the people that really would stand to benefit from heart transplant or mechanical heart pumps are actually ever referred soon enough to reap those benefits.

Todd Schlosser:            So you guys are sort of at a traumatic event center and not so much on the prevention side, even though there is a strong case to be made that you should be involved in the prevention side. Is that typically, because I mean, if you have cancer, you have it, right. And if you have sort of precursors for heart disease, there are things you can do to mitigate that, you know, exercise, eat better. Those sorts of things. So is it that those sort of preventative things get prescribed earlier on in the process and then perhaps the patient doesn’t quite, they’re not quite as engaged in that-

Brian Lima:                   Sure.

Todd Schlosser:            Medical decision as the doctor was, right. So then they end up in a traumatic event and ended up at a place like this. Is that sort of the reason that you’re not engaged earlier on?

Brian Lima:                   Well, I think it’s because, I would say that more and more heart failure should be thought of as something like cancer. Like cancer, if you aggressively treat it upfront, even at an earlier stage, your chance of a cure is greater. Heart failure, if you wait until someone’s really, really sick, your likelihood that A, they’re going to get better, or B, they would even tolerate a surgery to get them there is less. And there’s many patients who simply get to us too late where they’re just not eligible for anything.

                                    There’s also the fact that there’s a lot that goes into being able to figure out if someone is a candidate for a transplant or a heart pump. There is a whole laundry list of check boxes we have to go through.

Todd Schlosser:            Yeah.

Brian Lima:                   I tell patients we’re going to look under the hood, A to Z and make sure everything is, are there any hidden cancers, you know, have you had your cancer screenings, things like that. Things that could preclude candidacy for a transplant. And again, you’d be surprised how many patients come to us, they finally get to us, they’re really sick and oh by the way, they’ve not had any of those things.

                                    So now here we are, 11th hour, trying to save their life. They need something now and now we’re trying to make up for lost time and get this screening, that screening, check off all those necessary boxes so that we can make the right decision. So I think if they were referred early to a heart failure specialist, we may say, okay, well you’re not sick enough at this time for, but we noticed that you haven’t had this screening, that screen, let’s get all of our ducks in a row so that if and when things were to get worse, we already know about you. You’re in our system, this is not coming as a surprise to you and your family, if you see it. That’s another thing, you know, they’re like transplant, what? What are you talking about? No one told us this. It’s like, well you, they should have.

Todd Schlosser:            Sorry about that.

Brian Lima:                   You should have been made aware that this was a potential eventuality because of your disease. One, of course, that we would like to avoid, but one that we need act on in due time before the window of opportunity closes. So that’s kind of where the things are with heart failure.

Todd Schlosser:            If you don’t mind, I’d like to ask you a question about that. So and I understand getting all your ducks in a row and preparing for the worst, even if you don’t need it. That makes complete sense to me because it is so difficult to get on the transplant list and get an actual transplant, a heart.

                                    And that process can take a long, long time. And some patients don’t make it to their surgery, to their transplant day because they were engaged in the process too late for them to I guess make it that far. Is that, that’s still a problem, right? I mean-

Brian Lima:                   It is. And also though the silver lining, I guess you could say is that there’s mechanical substitutes, very, very good mechanical substitutes for the heart. You know, it’s my favorite organ, but at the end of the day it is just a pump, I hate to say. It’s a glorified pump. So very amenable to sort of an artificial sort of substitute that have come a long, long way. So we do have something literally on the shelf that we can offer somebody, if they’re too sick to wait for a transplant, if for whatever reason they’re not a candidate for a transplant.

Todd Schlosser:            Are those longterm solutions?

Brian Lima:                   They can be. The latest pumps have their ability that rivals, outcomes that rival transplant.

Todd Schlosser:            Oh wow.

Brian Lima:                   So I think it’s definitely something that, again, has not really gotten out there to the masses, to the referring providers and we’re working on that.

Todd Schlosser:            Sure.

Brian Lima:                   There is a lot that we could do to save somebody, even if it doesn’t mean necessarily a transplant for whatever reason.

Todd Schlosser:            Interesting. Those mechanical, I guess, devices must work exactly like the heart or maybe like more like a profusion device where they just keep it pumping. Like does it actually beat?

Brian Lima:                   So the mainstay is a left ventricular assist device, an LVAD, which is basically a pump attached to the heart. So you’re not actually removing the heart and replacing it. You’re attaching this pump that, by virtue of the two places you attach it, take over the work of that ventricle, that main pumping chamber of the heart. So they just basically say, you know what, we’re going to take over the work and we redirect the blood flow through this pump as opposed to through the heart.

Todd Schlosser:            Okay.

Brian Lima:                   And it’s a pretty simple, I mean it’s an open heart surgery but-

Todd Schlosser:            You say it’s pretty simple for you, but there’s no way I could do it.

Brian Lima:                   It’s, you know, it’s a relatively straightforward heart operation and when done at the right time, it can go very, very well. So, but it’s really the timing. Not doing it too late and someone too sick.

Todd Schlosser:            Yeah. Much like everything in life is sort of down to timing. So about that. So when you’re in there doing the surgery and as you said, it’s a very critical moment in that patient’s life and it’s a very high risk, high reward and obviously you’re sort of the head of the team that’s there. But there are a lot of people in the room helping with that. You have your anesthesiologist, you have your perfusionist, you have you, you have probably other people scrubbing in to make sure things go, like surgical assist, that kind of stuff. How important is that teamwork there?

Brian Lima:                   Heart surgery is the ultimate team sport and it’s critical that you obviously control the conduct of the surgery, but you’re also sort of orchestrating the movement and function of these other participants who all play a key role. In heart transplant, also, I have my colleague, Dr. Husain, Syed Husain, who’s the lead procuring surgeon also. So who your surgeon that you work with that’s actually looking at that donor heart, for example, while I’m working on the recipient, is huge. So those are your eyes out several hundreds of miles away. So that level of trust has to be second to none. It’s a dance, it’s a delicate dance and in heart transplant especially, it has to be orchestrated down to the minute because time is of the essence. The heart can only be out of the body for a certain period of time before it can sustain some damage. So that all has to be very, very, very tightly sort of organized.

Todd Schlosser:            Okay. So I’d like to transition a little bit to you recently earned, well I should say in the late stages of writing a book and-

Brian Lima:                   The book is done, it’s just in final editing and hopefully should be in print in the next couple of months.

Todd Schlosser:            So the title of the book being Hard to Beat and how did you, not so much the title, but we’ll talk about that, but how did you decide that it was time to write a book and you were the person to write it?

Brian Lima:                   It was really nothing I ever planned on, quite honestly. And nothing like this has ever happened in my life before, but I literally, I would say five years ago, six years ago, woke up in the middle of the night with this flurry of ideas. Midnight fever, you know, just got on my phone and started writing a bunch of notes down. It’s just something I felt compelled to do.

Todd Schlosser:            Sure.

Brian Lima:                   Why me? I guess I asked the question, why not? I think we all have our own stories that I think are worth sharing. And my story is more of a, you know, I really was a long shot as far as if you consider where I came from, I’m a first generation Cuban-American. My parents came over from Cuba and my dad was a factory worker. We didn’t speak English at home. I had a lot of, I guess, a socioeconomic chips stacked against me in many ways.

                                    Is it the most difficult or strenuous story of adversity ever? Of course not, but it’s my story and I felt like the message that I could convey out there is that if you put your, you know, set your mind to it, if you’re willing to put in the work, sky’s the limit. It’s not an easy road. There’s definitely some dark days along the way. But I think it’s more of a story of hey, you know, if I could do it, you could do it.

Todd Schlosser:            Sure.

Brian Lima:                   If you, and I tell the residents, if you could tie your shoelaces, theoretically you have what it takes to become a heart surgeon.

Todd Schlosser:            That’s good to know.

Brian Lima:                   It’s about reps, like everything else, the 10,000 hour rule, all that stuff. It’s being able to get back up after getting knocked down, handling disappointment, moving forward, just, and sticking to it, is really what it’s all about. And I think that’s what this book is about. And I also close at the end of the book with sort of a note on heart health that, like everything else in the book, nothing is passive. You have to be an active participant in your self-improvement and being the best you can be. The same applies to your health. It’s not autopilot.

                                    You know, there’s a lot of things you could do for your health, but it’s not going to do it on its own. No one’s going to exercise for you. No one’s going to eat right for you. You have to do these things.

Todd Schlosser:            Right.

Brian Lima:                   You have to take ownership over your health. And the same rule applies with your life. You can be as successful as you want to be. It’s about taking ownership and doing what it takes.

Todd Schlosser:            Yeah. So the book covers all of that. Things like how to get back up when you’ve been knocked down. And do you share like certain experiences in your life?

Brian Lima:                   Yes.

Todd Schlosser:            Where you did that?

Brian Lima:                   And just from my own, for the sake of simplicity, because I’ve never written an actual book before. I’ve written a lot of other like smaller journal articles. This was a whole new-

Todd Schlosser:            You’ve written things that have been published in the medical space for sure.

Brian Lima:                   So to make it simple for me, I went chronological and so I cover the various themes over the course of 12 chapters in sort of chronological order and you know, some of the early lessons like first and foremost you got to believe in yourself. You got to put in the work, all these different things. And then how I kind of use personal vignettes to sort of illustrate these various points along the way.

Todd Schlosser:            Right.

Brian Lima:                   But I go through the whole gamut. The good, the bad, the ugly, you know, how there is a price to pay for really going after something with every, you know, I make examples of elite athletes, Olympic athletes, people that have to put so much time and effort into that-

Todd Schlosser:            Sure.

Brian Lima:                   You know, your calling, you know that it’s tough to be well rounded or it’s tough to have life balance when you’re engaged in things that are so, requires so much effort. And so it’s not all, rainbows and unicorns and stuff. There is some negative to it. And it’s just knowing that, and that’s often in and of itself a deterrent for some, or a limit to how far people are willing to go.

Todd Schlosser:            I definitely think that’s true. I think I’ve talked to a lot of people in your space, in surgery or people who are a perfusionist or anesthesiologist. And some of the perfusionists said, I looked at medical school and doing the surgery route and I realized that I didn’t want to be in school for the next 15 years and perfusion is a great path and I felt more comfortable doing that. So there is a lot of people who that deters them from going on.

Brian Lima:                   Right. It’s a, not that … I think it’s a book for everybody. It’s definitely what I hope I can manage to convey or get across is that it’s not a book about a heart surgeon. And this is only a book for people medically inclined or surgically inclined, this is a book for anybody. It’s really a book about you could do anything you set your mind to.

Todd Schlosser:            It seem like it’s about perseverance.

Brian Lima:                   Yeah, perseverance, resilience. I do, you know, I’m a kid who grew up in the 80s so I do trash a little bit the social media and Insta-famous and instant gratification. A lot of things that I think now have impacted in a negative way some of these tried and true things, delayed gratification and stuff like that. Complacency has really come into it. People just want something now. So I touch on a lot of that stuff too. I think it’s pretty funny actually. Well I try to be humorous when I can. We’ll see. I don’t know.

Todd Schlosser:            So I’d like to ask one final question, and that would simply be if I came in and you told me that I needed a heart transplant or some sort of heart surgery, it would freak me out, for lack of a better term. So what is some information that you can give the listener or the viewer here that would make them more optimistic about that whole process?

Brian Lima:                   Sure. I mean, you wouldn’t be human if you were not scared. That’s a totally natural emotion or reaction to have. And I think the important thing is heart surgery is safe. We do it all the time. Our outcomes are fantastic. Even in things as major, as a heart transplant or a mechanical heart pump. A lot of it has to do with timing and not waiting until it’s too late. And I tell patients this all the time and that’s kind of where I tried to allay their fears. I say, you know, us sitting here having this conversation with you, conscious, not on a ventilator in an ICU, is a good thing. That means we kind of are in control of the situation. We can sort of do this in a controlled fashion. It’s not chaotic, it’s not in the middle of the night when you’re really sick and unstable.

                                    So by doing it in this controlled way, we’re taking a surgery that like all surgeries, there’s a probably single digit percentage risk of some complication.

Todd Schlosser:            I didn’t realize it was that low.

Brian Lima:                   It definitely is when it’s controlled, elective or not emergency. Whenever it becomes an emergency, that’s when you take something that has some risk, a small risk and you make it much more risky.

Todd Schlosser:            Right.

Brian Lima:                   So I think that in and of itself is something that I try to emphasize to patients. Say, look, yes, it’s okay to be afraid. I’m going to walk you through it. But the good thing is we’re going to do the right thing. It’s going to be all right. We’ll go step by step. We’re not going to make this an emergency. We’re not going to let it become an emergency. We’re going to do this in a controlled way and have a great outcome.

Todd Schlosser:            If they’re talking to someone and they’re not being referred to a heart failure specialist, like you guys are here, how do they reach out and get a consultation or a conversation with a heart failure specialist as a patient?

Brian Lima:                   Sure. I think the rest of medicine really hasn’t caught up yet to this, but I think there will come a time when anybody with heart failure, no matter how not so severe or how mild, should be referred to a heart failure specialist. Just like anybody with any degree of cancer, no matter how preliminary it is always sees a cancer doctor, no exceptions. And I think if someone has a diagnosis or have been told they have heart failure, they should definitely seek out a referral to a heart failure specialist.

Todd Schlosser:            So you can just ask for that?

Brian Lima:                   You should. And most physicians readily oblige that, you know, it happens all the time in various different things. Second opinions, everyone’s entitled to a second opinion too. I just think it’s the … you can’t go wrong. The worst that can happen is, Hey, Mr. Smith, you know, you’re, we appreciate … the good news is you’re not really, your heart failure isn’t severe enough to warrant anything, but we did notice X or Y or we think we can maybe optimize this medication, that medication-

Todd Schlosser:            Or let’s start that checklist.

Brian Lima:                   Right. yeah.

Todd Schlosser:            Just in case.

Brian Lima:                   There’s a whole science to, that’s how you manage the medications. The newer medications that are out there for heart failure. It’s not straightforward. And the specialty of heart failure, heart failure cardiology is relatively new. It’s not been around for a long time. So it’s an evolving field. So I think it’s never too early, but it can definitely be too late. So I think it’s better to err on the side of caution.

Todd Schlosser:            Absolutely.

Brian Lima:                   Much rather see somebody too early, but at least now we know about them, they know about us, they know about what some of the eventualities are with this kind of disease. So it doesn’t come by surprise. And it may, just knowing your options is all, knowledge is power and so, and this is no exception.

Todd Schlosser:            Excellent. Well, Dr. Lima, thank you so much for taking the time to talk with us. We appreciate you joining us on Scrubbing In.

Brian Lima:                   Thank you. Thank you for having me.

Todd Schlosser:            Absolutely.

Brian Lima:                   All right.

Todd Schlosser:            That’s great.