In this conversation Dr Wudel and I discuss how he became a Cardiothoracic surgeon. We also discuss what factors can lead to heart disease, the steps we can take to avoid it, and the approach even some world-class athletes are taking to ensure strong heart health.

Speaker 1:  Bringing you conversations with leaders within the operating room and healthcare community, this is Scrubbing In.

Todd Schlosser:  Hello and welcome to this episode of Scrubbing In, a podcast powered by specialty care. I’m Todd Chloroses entity. My guest is Dr. James Wu del, a cardiothoracic surgeon at Nebraska Heart. In this conversation, Dr. Wu del and I discuss how he became a cardiothoracic surgeon. We also discuss what factors can lead to heart disease, the steps we can take to avoid it, and the approach even some world class athletes are taking to ensure a strong heart health. Enjoy the conversation.

Todd Schlosser:  Thank you for joining us here on Scrubbing In. I’m Todd Chloroses and joining me today is Dr. James Wu del, who is a cardiothoracic surgeon here at Nebraska Heart. You said before we started that I can call you Jim, is that okay if I call you Jim?

James Wudel:  Absolutely. Absolutely.

Todd Schlosser:  Excellent. What I’d like to do, and I started all the podcasts this way, is sort of try and find out how you developed your passion for medicine and what led you into that field. What is it that happened sort of in your early life that made you want to be a doctor?

James Wudel:  Well, it was a bit of music. My parents were from a small town in South Dakota and they were in business. We obviously had known the family physician there for many years and always had great respect for him and enjoy what he was doing. My parents actually felt that I shouldn’t go into business. They thought I should try and do something else, and so that’s how it sort of started. It was also at the time when it was economically not that good in the US in the early 70s and such with some of the other things, and they thought I might consider that. I started working with the local physician a little bit and that’s really how it started.

Todd Schlosser:  Your family having taken the path of business gave you the option to not take that path and follow the same footsteps?

James Wudel:  Correct. They give me the option to not take it.

Todd Schlosser:  Yeah. When you worked with that physician, did that physician sort of mentor you into, I think you went to Emory for a medical school, right?

James Wudel:  For medical school, I went to Emory. I think it opened up some exposure to things. He just always said this is an opportunity, that if you’re interested you should explore. I think that’s how we started. I was curious and one thing led to another.

Todd Schlosser:   Yeah. It is one of those professions, even like at a very young age, like three or four, you want to be a fireman or a doctor. Right? It’s one of those two, so I like to see what it is that sort of drove you to sort of seek a mentor for that. A lot of people, it’s someone from church, or a family member, or your physician they just sort of mentor with and then sort of expose you to that world, which I think is very valuable

James Wudel:  Right. I think they can perhaps give you some exposure to that path, but I mean, it ultimately comes down to you having the curiosity, and the interest, and the want to take and continue down that path. Because it does take a while.

Todd Schlosser:  Oh, it’s a lot of work. Yeah. It’s not just that it takes a long time. It’s a lot of work all along the way. Let’s start talking about that journey, if you will. You went to Emory. What was it about Emory that got you to go specifically there?

James Wudel:  Right. Well, this is unusual. I actually started at South Dakota, a very rural based program. They were training a certain number of physicians, but they didn’t have openings for everyone for the whole four years. They’re only accredited for a certain number. So they sought volunteers to go elsewhere for their two years of clinical medicine. I knew that some people had gone to Emory from South Dakota before and had a great experience. And so I applied, and I got in, and that’s how it started at Emory.

Todd Schlosser:   Yeah. You went to Emory, you were there for obviously a few years.

James Wudel:  A couple years.

Todd Schlosser:  Yeah. Then you did your residency. I’m assuming it was your general surgery residency at Vanderbilt in Nashville.

James Wudel:  At Vanderbilt Right. That was a program that Emory liked, and I liked it when I interviewed there. That was a great, it was actually seven years there. One of the years was spent Australia doing some research, so I enjoy that. It was a nice mix of clinical experience but also some research. It was really a very good mix.

Todd Schlosser:  If you don’t mind if I ask how that sort of works, because you’re there to get hands-on surgical experience. Correct?

James Wudel:  Right.

Todd Schlosser:  But you also worked at a research capacity. Is that why the residency took seven years?

James Wudel:  Right. Some of the programs, maybe even still today, it may not be mandatory, but you may do one year, two years of research. You can define that number of ways. I did one of mine in Australia where I actually was a clinical junior registrar at a large hospital performing a lot of general surgery, and so that was a different way to get different experience, different life experience, social experience. Then I came back and did a year in the cardiovascular lab at Vanderbilt.

Todd Schlosser:  Oh, okay. So not having any practice in surgery myself, clearly, do different continents have different surgical techniques? Like when you were in Australia, do they do things a little bit differently there

James Wudel:  They had a few things that were different. Some things that are different is the teaching philosophy or the structure of the residency program may perhaps be different, and I think those are some things that took a little bit of time getting used to. But you know, the philosophy or the certain techniques were very similar, the general techniques. There may be a few things that were a little nuanced to we’d say are a little bit different, but in general fairly similar. But they did have also different philosophies about surgery, about medicine that was really fantastic to hear about. A different perspective.

Todd Schlosser:   I’d imagine it’s all still, and western medicine and medicine in general is still very outcomes-focused, what’s best for the patient, we’re going to do what’s best for the patient. From Vanderbilt, your residency at Vanderbilt, you then went to the Cleveland Clinic?

James Wudel:  I went to the University of California, San Francisco.

Todd Schlosser:  Oh, did you?

James Wudel:   I did. I did.

Todd Schlosser:  There’s a gap in my research. I apologize.

James Wudel:   I followed a surgeon there basically who headed the program at UC San Francisco. I went there for two years for my formal CT surgery training. Then had the opportunity to be a chief resident at the Cleveland Clinic since it was such a large volume program.

Todd Schlosser:   They do a lot of hears at the Cleveland Clinic. Yeah.

James Wudel:  Right. And had the opportunity to work with just some fantastic surgeons, Toby Cosgrove, [inaudible 00:06:35], Lidel, and number of others. It was a great experience.

Todd Schlosser:  I’ve heard Toby Cosgrove speak a few times and I mean, he’s been in the business for a very, very long time and he’s got a lot of experience both in surgery and also leading the Cleveland Clinic. I heard him say that when he had been doing heart surgeon for 30 years and he became CEO of the Cleveland Clinic and he was totally unprepared for that, and that blew me away. Just because they’re different skill sets. But I mean, as a surgeon, I’d imagine that you’re picking up different skill sets and learning new things all the time. You can’t really rest on your laurels, which is something that you guys do here at the Nebraska Heart Institute. You guys sort of innovate as much as you can, and you guys are getting a lot of touches on patients. It’s probably not the best way to say that, but you’re in surgery a lot. You do a lot of hearts here. What is the value of a high volume experience, if that makes sense?

James Wudel:  Sure. Sure. Practically every study, whether it be general surgery, gynecological surgery, complex procedures, [inaudible] surgery that outcomes are influenced by volume. In general, higher volume centers that have more experience, do more procedures, do more cases, tend to have better outcomes. Right? That’s not just for surgery, general surgery, orthopedics across all those fields. That’s fairly reproducible over the last several decades. You can occasionally find things if there’s a one off here or there, but in general, that really holds true.

Todd Schlosser:  Yeah. The more you practice anything, really, the better you’re going to get at it.

James Wudel:    You should be.

Todd Schlosser:    So if you’re in surgery more, you’re better at surgery. That doesn’t always work out that way.

James Wudel:   And your team is better at it. Because we depend a lot, when you talked about the CEO concept, I mean in the world of heart surgery, it’s really is -based on a team. Yes, I may be perhaps the focus for most of that, but I depend incredibly on anesthesia, the nursing staff, the perfusion staff, and then the people upstairs and the people preop. So you know, we all work together, and I think that the teamwork provides a lot to the outcomes.

Todd Schlosser:  Let’s, if you don’t mind if I asked you a question about the teamwork in that, as I’ll say the head of the team, as the surgeon, you’re kind of the one who is calling the shots in the room. Do you have any say over building that team that’s around you to support you or do you sort of get assigned a team and then you sort of are in charge of mentoring them into what you need as a surgeon? Because that can change based upon personality type or what you need and expect as a surgeon.

James Wudel:    We all have to, in general play, by the rules in the sandbox. Right?

Todd Schlosser:   Yeah.

James Wudel:  No one’s immune to anything that’s outside the parameters of decorum and working together. We have folks in the surgery division that get some experience with the newer people coming in and they make it, how will these people fit in, what can we do to optimize how they do in the operating room, how they coordinate their activities in the system so it optimizes how they do. And so, I depend on some of the nursing staff and the profusion staff to make those decisions, who’s going to come in initially, and getting involved, and work and get trained, and then we become more intimately associated with them in the operating room. I frankly don’t have input initially, but over a period of time, how that person does, then certainly I have involvement.

Todd Schlosser: Yeah. I imagine that because the Nebraska Heart Institute is heart focused, you do a lot of heart surgeries and that’s really …

James Wudel:  Right. And so the nurses, all that they do on a daily basis is cardiac surgery, vascular surgery, things in the cath lab that are cardiovascular based, some thoracic things. All the anesthesiologists, all they do is cardiovascular thoracic procedures, and they’re all board certified in that specialty, so it’s really a focused approach.

Todd Schlosser:  Yeah. I would imagine that focus makes the Nebraska Heart Institute a sort of a sought after resource or sought after hospital to go to if you’re having any sort of heart issue, whether it be sort of a chronic heart issue that you’re dealing with over the course of your life or whether it’s you have a heart attack, you need to go somewhere immediately.

James Wudel:   I think one of the benefits is just the experience that’s been developed. The hospital was built in 2003, and it was built by the physicians, and it was a purely cardiac vascular thoracic center, for not just surgery, but also cardiology, electrophysiology, and it was really focused on those kinds of patients. And so, the whole system has been developed to take care of those kind of people. That also allows you the opportunity over the years, if you do develop some experience and some good outcomes, that other opportunities arise with research projects and new therapies that these other companies and other specialists are interested in bringing or showing to you.

Todd Schlosser:  Yeah. In your capacity here at the Heart Institute, have you helped pioneer or work to innovate some techniques in that space, in that cardiothoracic space?

James Wudel:   Even going back to the early 2000s, three, four, five, there were surgical procedures that we had the opportunity to be involved in that were national trials the acorn trial, the collapses mitral valve repair trial, and then ultimately the transcatheter valve trials partner two, partner three, and the mitral valve trial for Colab. I think the opportunity arose because we were involved heavily clinically and had a lot of experience. Yeah.

Todd Schlosser:   Yeah. I want to shift gears a little bit. You’re located in Lincoln, Nebraska, which is a pretty rural area. What is it about Lincoln that drew you to want to work in this community?

James Wudel:   Lincoln is 10 about 300,000. the whole state has maybe 1.8 million. The philosophy of the system many years ago was there was going to be a lot of outreach, that the physicians were going to go to where the patients were. We weren’t going to just sit back and open the door and let the patients drive three hours to get to get care, especially with some of the changes with probably the weather.

James Wudel:  The cardiologists do a lot of outreach. I mean, going into western Nebraska, northern Nebraska, going down to Kansas, and Iowa to some extent. We go out, see patients and then they come back for their procedures, if they need them. And their follows typically all done remotely. We can do that without them coming back. The reason I came here many years ago was based on two things. really the town, this was a nice college town at the university had the state capitol, but also, we did a lot of heart surgery. We did a lot of heart surgery. That was one of the things that the people at Cleveland always said, go somewhere where you’re going to be very, very busy. That’s what you’re trained to do.

Todd Schlosser:   Like we were talking about, the more you can do it, the better we’re going to get it.

James Wudel:   That’s really what they focused on.

Todd Schlosser:  You’ve been doing heart surgery for a number of years, let’s just say that. Is the need for at decreasing, is it increasing? Is it staying the same?

James Wudel:   Well, that’s a very good question. I would have thought that certain things would be decreasing. I would have fought that over time that blockage of the arteries, cholesterol problems, atherosclerosis, all those things would be decreasing, but unfortunately it’s gone just the other direction, quite honestly. There’s been a huge increase in obesity throughout the US. Big increase in diabetes. Most of it by far, driven environmentally. It’s basically driven by lifestyle.

Todd Schlosser:   Yeah. When you say things like lifestyle, you mean everything from are you getting enough exercise, or do you even have an exercise program that you even know about? What do you eat? What do you put in your body? Those kinds of things is what I assume you are getting at.

James Wudel:   That that’s what I’m getting at, and it’s become actually a bigger problem. We’re seeing a lot more even in younger folks with earlier onset heart attacks. There’s been an uptick in the younger population having heart attacks, and diabetes, and obesity, and we do really need to get our hands around that and do a better job of actually preventing things.

Todd Schlosser:   Yeah. How do you go about preventing things? Like if I’m 37 and I’m concerned about having a heart attack because I have a genetic tie to that or a marker to that, what are some things that I can do at a relatively young age to mitigate that potential outcome?

James Wudel:   As you said, a family history may put you at risk, but certainly not smoking, exercise program, and there’s a number of ways to define exercise, that could be things that are as simple as walking your dog or walking with your family, or getting out and do his various things like that, being outside, working in the yard, lawn care, that kind of stuff. It all could potentially be considered some form of exercise.

James Wudel:   The biggest thing probably is what we take in nutritionally. I think we’ve not been a great job of that as physicians over the last 50 years, and so we really need to get focused on that, because many of these things can be dramatically influenced by diet.

Todd Schlosser:  Yeah. By you’re input.

James Wudel:  Right, Right. I mean, the World Health Organization just said that if you can get your blood pressure down, if you can decrease your salt intake, and if you can decrease your trans fat intake, you’ll impact cardiovascular death dramatically. The easiest way to do that is really nutritionally, and we need to do a better job.

Todd Schlosser:   Yeah. Is there a silver bullet for a better nutritional health?

James Wudel:   Well, probably not so much unless there was some kind of diet, but I think that some sort of approach to to how you live your life and your lifestyle, and in general a plant-based focused diet is by far a nice umbrella to live under. And if you could focus in that direction, lots of vegetables, fruit. Avoiding certainly certain kinds of meats, fish, those things, cheese. A plant-based focused foundation, so to speak, will help immensely. Will help immensely.

Todd Schlosser:  Yeah. Because that’ll bring things like cholesterol down. All that ties into heart disease.

James Wudel:   Absolutely. And your total body health. Right?

Todd Schlosser:   What would you say to someone who is a competitive athlete and it’s just ingrained in them that they have to eat meat?

James Wudel:   I think traditionally you would say, well that person has to eat a lot of meat, a lot of chicken, a lot of those kinds of things, a lot of fish to get their protein. But there’s actually a new movie coming out produced by Arnold Schwarzenegger and James Cameron.

Todd Schlosser:    I’ve heard of both of them.

James Wudel:   Both game changers that completely debunks that whole myth of world class athletes depending on meat for protein. The one champion last five years, Tennessee Titans had 14 players.

Todd Schlosser:   14 players?

James Wudel:    14 players that were completely plant-based. Yeah. I think that that whole concept is getting debunked and you’ve really now got some people, one being Arnold, who would have thought that he would get on that train, so to speak. I think it’d be another way to try and make people or help people understand how they can shift things. Because we’re not looking for world class athletes. Right? But we want them to live a healthy life. And if world class athletes can do that and do well and win with that kind of plant-based focus, then certainly we can.

Todd Schlosser:   Yeah. I’ll never be a work world-class athlete, but I’d love to have a world-class heart, and if that’s the way to do it, I don’t mind doing it that way.

James Wudel:   You’re right.

Todd Schlosser:   Especially with things, and we talked about this briefly earlier, but the Impossible Burger that is like a plant-based burger but tastes like a regular burger. I’m not a huge burger fan, but I could see that helping people transition to more of a plant-based approach. I do think as, and maybe it’s not most Americans, but a lot of the people at least the way I was raised, like we had meat with every meal, more or less. I mean, every dinner, I should say. It wasn’t like breakfast, lunch, and dinner. But that just seems like a lot.

James Wudel:   You had bacon for breakfast.

Todd Schlosser:  Yeah, sometimes. Yeah. Yeah, absolutely.

James Wudel:  Sure. Sure you did. Sure you did.

Todd Schlosser:    Or sausage. Yeah.

James Wudel:    Absolutely.

Todd Schlosser:   Now that I’m thinking about it may have been breakfast, lunch, and dinner. Yeah. I mean, so I think most Americans, and again, I don’t have the numbers to back that up, but I think that’s sort of what’s ingrained into us, so shifting that perspective may be difficult.

James Wudel:   Yeah. I mean, you talk about let’s say you’re at risk, maybe you had it in your genes. Well, there’s a saying from Caldwell Esselstyn at the Cleveland Clinic that genes may load the gun, but diet pulls the trigger. Okay? That’s very true.

Todd Schlosser:    Maybe you can speak to this a little bit, because I do have genetic markers for heart disease in my family history, but I’ve always heard that the number of people who have heart issues because of environmental reasons, because of what they’re putting in their body and they’re not exercising and things like that, is way higher than the people who do exercise and eat right and also have genetic markers and have heart problems. Does that logic hold true?

James Wudel:   I think that that, again, the vast majority of people, their cardiovascular problems are environmentally induced. Right? Your genes may put you at risk, but what you take in and how you live your life really puts it over the edge.

Todd Schlosser:    Yeah. Excellent. I’d like to close with this sort of question, because much like in your young life, you had a mentor that kind of showed you the way into the medical community, if you will. If you were talking to someone who, let’s say is looking at what residency or maybe specialization they should focus on, why would you tell them, “Hey, you should do cardio or cardiothoracic surgery?”

James Wudel:   Well, it’s a great question to finish up with. Cardiothoracic surgery, for many years, has dealt with patients problems where they’re acutely ill. Right? And we are typically asked to come help somebody who’s acutely ill. Then we take care of that problem, and we hopefully get them better, and they live a good life and an enjoyable life. And so traditionally, it’s based on a certain patient population that really needs the services of a certain kind of physician. I think that for those kind of doctors who enjoy that, it’s an excellent area to get into. But just as important is how frequently it changes. Technologies that were unheard of 15 years ago are now common. I have no doubt that things I do today won’t be done in 20 years. They will be done differently, or they’ll be done much easier, or in a different way, and so I think if someone has that kind of interest and a huge curiosity to things that change in the cardiovascular area, it’s a wonderful field to go into.

Todd Schlosser:   Excellent. Well, Dr. Wu del, Thank you so much for doing Scrubbing In with us. We appreciate it. I’ll let you get back to your, I’m sure, bust day.

James Wudel:    Very enjoyable. Thank you very much.

Todd Schlosser:   Thank you very much.

James Wudel:  Yeah, absolutely.

Todd Schlosser:   Thanks for listening to Scrubbing In. Please take a second to give us a rating on your podcast app and subscribe so you won’t miss out on what we have coming up. See you next time.