Cold Steel: Canadian Journal of Surgery Podcast

This episode we had a special guest, Dan Van Hooren. Dan is the head coach for the University of Calgary Dinos basketball team and is a legend in Canadian university basketball history (see bio below). We asked Dan to tell us about what goes into creating great teams - the parallels to surgery were striking!

Links:
1. Georges Laraque book: https://www.amazon.ca/Georges-Laraque-Story-Unlikeliest-Tough/dp/0143181017
2. Wooden: A Lifetime of Observations On and Off the Court: https://www.amazon.ca/Wooden-Lifetime-Observations-Reflections-Court/dp/0809230410
3. Eleven Rings: The Soul of Success by Phil Jackson: https://www.amazon.ca/Eleven-Rings-Success-Phil-Jackson/dp/0143125346
4. The 7 Habits of Highly Effective People: https://www.franklincovey.com/the-7-habits/
5. Legacy (All Blacks) by James Kerr - https://www.chapters.indigo.ca/en-ca/books/legacy/9781472103536-item.html
6. The Inner Game of Tennis: https://www.amazon.ca/Inner-Game-Tennis-Classic-Performance/dp/0679778314
7. The Gold Standard: Building a World-Class Team by Coach K: https://www.goodreads.com/book/show/6033770-the-gold-standard

Bio (from Dinos website):

Dan Vanhooren joined the Dinos in May 2000 and is the seventh men’s basketball head coach at the University of Calgary.

Since he took over the program, Vanhooren’s Dinos have made a steady climb into elite status in U SPORTS basketball. In just four years, he took a program that had not enjoyed a winning season in nearly a decade all the way to the conference title and within two points of the national final in 2004. It was Calgary’s first Canada West championship since 1993, and their first-round victory at the Final 8 in Halifax was the Dinos’ first national quarterfinal win in 38 years. The two-point semifinal loss came at the hands of the Carleton Ravens, who went on to win the CIS title.

In 2008, he coached the Dinos to their best conference record since 1976 (18-4) and played host to the Canada West Final Four in front of a sold-out Jack Simpson Gym. Eight years later in 2016, the Dinos won their sixth Canada West Championship and went on to compete in the national finals for the first time since 1966 against the Carleton Ravens. The Dinos finished with a silver medal. It was the first of five consecutive trips to the national tournament for the Dinos, who captured three conference titles in four years (2016, 2018, 2019) and reached the program's pinnacle with the 2018 national championship - a 79-77 win over Ryerson in Halifax.

The following season, the Dinos posted the first undefeated season in program history at 20-0, winning an eighth Canada West title before falling in the national final. Vanhooren earned his second Canada West coach of the year honour in 2018-19 and became the first Dinos coach to win the Stewart W. Aberdeen Trophy as U SPORTS coach of the year the same season.

Currently, he is head coach of the Canadian national junior team.

Vanhooren moved to Calgary following a four-year stint as head coach of Medicine Hat College. In 2000 he coached the Rattlers to a bronze medal finish and was named the ACAC south coach of the year.

He played varsity basketball at the University of Alberta under the legendary Don Horwood. After three seasons with the Golden Bears, Vanhooren graduated with a Bachelor of Physical Education in 1993 and moved to graduate studies at the University of British Columbia. While attending UBC he worked for the NBA’s Vancouver Grizzlies in their inaugural season, and he received his Master’s of Human Kinetics in 1996.

Vanhooren is a certified NCCP Level III coach.

Dan and his wife Kara reside in northwest Calgary with their three children: Peyton, Wyatt, and Nash.

Dr. Marcus Burnstein is a colorectal surgeon at St. Michael's Hospital in Toronto, Ontario. In this episode, we ask him to break down his approach to patients presenting with anal pain, perianal abscess, and perianal fistula. We also hear about the famous "circle of love"!

Check out the CAGS seminar on perianal disease on April 1 at 7 pm ET! Register here: https://cags-accg.member365.ca/public/event/details/1c1d9fd96fc1866649258c9aee3cff283c4c2fe4/1

Also, check out the CAGS video library for all previously recorded CAGS webinars: https://cags-accg.member365.ca/sharingnetwork/education/videolibrary

Bio (from U of T website):

Dr. Burnstein is a graduate of the Faculty of Medicine, Dalhousie University. He trained in General Surgery at the University of Toronto and in Colon and Rectal Surgery at the University of Toronto and the Lahey Clinic Medical Centre in Burlington, Massachusetts.

Dr. Burnstein began his career at Dalhousie University in 1986. He was the Program Director of the General Surgery Residency Program at Dalhousie University from 1989 – 1992. In 1992, Dr. Burnstein joined the Department of Surgery at the University of Toronto, where he has been the Program Director of the General Surgery Residency Program (1994 – 2001) and Head, Division of General Surgery, St. Michael's Hospital (1996 –2003). He was the Program Director of the University of Toronto Residency Program in Colon and Rectal Surgery from 1996 - 2011.

Dr. Burnstein is a Member of the Board of Directors of the American Board of Colon and Rectal Surgery and is an Examiner for the American Board. He has served as an Associate Editor of Diseases of the Colon and Rectum and an Associate Editor of the Canadian Journal of Surgery. He has served as the President of the Canadian Society of Colon and Rectal Surgeons and as the Chair of the Royal College of Canada Specialty Committee for Colon and Rectal Surgery.

Dr. Burnstein is an Associate Professor of Surgery at the University of Toronto, and practices at St. Michael's Hospital.

Dr. Melissa “Red” Hoffman is one of only 80 dual-boarded trauma surgeons and palliative care physicians in the US. She joined us on this episode to talk about surgical palliative care and how surgeons can potentially do this better. We also ask her about her life journey informs the work that she does today, including her outstanding writing. 

Links:

1. Dr. Melissa Red Hoffman: https://redhoffmanmd.com/
2. The Sound of Silence – When there are no Words. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2737686
3. Surgical Palliative Care podcast: https://redhoffmanmd.com/podcast/ 
4. Being Mortal by Atul Gawande: http://atulgawande.com/book/being-mortal/
5. The impact of country and culture on end-of-life care for injured patients: results from an international survey. https://pubmed.ncbi.nlm.nih.gov/21045742/

Bio (From Dr. Hoffman’s website):

When she was 19 years old, Dr. Red’s father was tragically killed in Cairo, Egypt. Her father’s violent death, and the experiences which followed, inspired her to pursue a career in both trauma surgery and hospice and palliative medicine. She now utilizes both her integrative medicine training as well as her training in palliative medicine to provide whole-person care to her surgical patients and their families.

As one of just 80 surgeons in the United States who is board-certified in hospice and palliative medicine, Dr. Red is a leader in the field of surgical palliative care.

She writes and speaks extensively on how to integrate palliative medicine into the care of all surgical and trauma patients. She has an active online presence, has a bi-monthly column in General Surgery News entitled The Surgical Pause and is the creator and host of The Surgical Palliative Care Podcast.

In her free time, Dr. Red enjoys writing, reading, taking long walks, eating gorgeous food and drinking yummy drinks, and spending time with her orange cat Sammy and her boyfriend Brandon.

It’s not uncommon for surgeons to think about taking a break at various points in their career, but for many of us, it might seem daunting to think about how to make that happen. Dr. Paul Duffy is an orthopedic surgeon, Clinical Assistant Professor and Division Chief of Orthopedia Trauma at the Foothills Medical Centre in Calgary, Alberta. He recently gave a fantastic grand rounds for the Department of Surgery in Calgary about his experience taking a 6 month sabbatical. In this episode, we asked him to share with us his thoughts on his career and “taking a break” in the form of a sabbatical.

Dr. Vahagn Nikolian (https://twitter.com/VNikolian?s=20) has been thinking about the way we can adopt virtual care far before the COVID19 pandemic. Dr. Nikolian is a surgeon at Oregon Health & Science University and specializes in abdominal wall reconstruction. In this episode, we talk to him about how he got interested in telehealth, how we can streamline telehealth consults, and where he sees telemedicine going in the future. 

1. Pilot study on eClinics: https://journals.lww.com/annalsofsurgery/Fulltext/2018/10000/Pilot_Study_to_Evaluate_the_Safety,_Feasibility,.18.aspx

2. Role of telemedicine in postoperative care: https://mhealth.amegroups.com/article/view/19310/19390

3. Touch. CMAJ. https://www.cmaj.ca/content/183/18/2141

4. Surgical plans generated from telemedicine visits are rarely changed after in-person evaluation in spine patients. https://pubmed.ncbi.nlm.nih.gov/33227550/

Bio:
Twitter: @VNikolian
Link to OHSU profile: https://www.ohsu.edu/people/vahagn-c-nikolian-md

Dr. Vahagn Nikolian is a board-certified General Surgeon with advanced training and expertise in abdominal wall reconstruction. He is a member of a talented team of surgeons at OHSU where he uses his experience and research to help advance the treatment of patients with hernias and abdominal wall defects.

Dr. Nikolian was raised in Southern California, where he attended medical school and graduated with honors from the University of Southern California. He completed his surgical residency at the University of Michigan. He completed his complex abdominal wall reconstruction fellowship at Columbia University Medical Center in New York City. His research and commentaries have been published in several prominent journals such as the Journal of the American Medical Association and Annals of Surgery. His research at OHSU involves utilizing technology to improve patient care. Specifically, he directs his efforts towards improving access to digital health and improving outcomes in hernia surgery using minimally invasive and robotic surgical technology. To date, he has over 60 peer-reviewed publications and book chapters focused on general surgery, resident education, and digital health. He has received numerous national awards as well as funding from the National Institutes of Health and other surgical societies.

Dr. Nikolian aims to work with patients, their families, and primary care doctors to develop patient-centered treatment plans. He looks forward to collaborating with other specialists to give patients the most options and the best possible outcomes.

It is astonishing how a pea-sized gland in one’s neck could be so troublesome. Dr. Jesse Pasternak is an endocrine surgeon at Toronto General Hospital. In this episode, we delve into the workup of hyperparathyroidism, Dr. Pasternak’s approach to parathyroid surgery, and his thoughts on the introduction of new surgical techniques. 

Links:
1. Charles Martell (first successful parathyroidectomy): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135504/

2. Differences in long-term quality of life between hemithyroidectomy and total thyroidectomy in patients treated for low-risk differentiated thyroid carcinoma. https://pubmed.ncbi.nlm.nih.gov/31623853/

3. David Urbach on language around thyroid nodules: https://soundcloud.com/cjs-podcast/e17-david-urbach-on-checklists-wait-times-in-the-time-of-covid-and-medical-devices/reposts

4. The Role of Disease Label in Patient Perceptions and Treatment Decisions in the Setting of Low-Risk Malignant Neoplasms. https://pubmed.ncbi.nlm.nih.gov/30896738/

Bio (https://surgery.utoronto.ca/faculty/jesse-pasternak):

Dr Jesse Pasternak is an endocrine surgeon specializing in the surgical management of thyroid, parathyroid and adrenal tumors.  After obtaining his undergraduate degree at McGill University, he completed his medical school and residency at McMaster University in Hamilton.  He then moved to San Francisco, California where he trained as an Orlo Clark Fellow in Endocrine Surgery and Oncology at UCSF. Dr Pasternak also completed a master’s degree (MPH) at Harvard University with a focus in epidemiology.  As a surgeon at the University Health Network, his clinical focus is minimally invasive endocrine surgery. As a researcher, he studies clinical endocrine surgery and health outcomes.

What do you do if you are a "struggling" trainee or trying to help a struggling trainee? We were lucky enough to have Dr. Ahmer Karimuddin join us on this episode to try to answer those questions. He might even change your mind on the way you think about the word "struggling". Dr. Karimuddin is a colorectal surgeon at St. Paul’s Hospital in Vancouver, British Columbia. Along with Dr. Tracy Scott, Dr. Karimuddin is the co-program director for the UBC general surgery program.  We talk to him about how to approach the struggling trainee, as well as some of the innovative strategies the UBC program is utilizing to more objectively select residents.

Links:

1. Equity, Diversity, and Inclusion in Academic American Surgery Faculty: An Elusive Dream. https://pubmed.ncbi.nlm.nih.gov/33011449/

2. "Hamlet was wrong." Revisionist History podcast by Malcolm Gladwell. http://revisionisthistory.com/episodes/49-hamlet-was-wrong

3. "Talking to Strangers" by Malcolm Gladwell. https://www.amazon.com/Talking-Strangers-Should-about-People/dp/0316478520

4. Surgical training in the midst of a pandemic: a distributed general surgery residency program’s response to COVID-19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458681/

In this episode, we interview Shane DiNapoli, a chartered accountant based in Calgary, Alberta. We talk to him about some of the common mistakes he sees physicians make with their finances, physician corporations, and the advice that he has for physicians starting out in their practice. 

Links:

1. https://shanedinapoli.com/

Have you ever stared at the garbage bags in the operating room and thought – that’s a lot of trash! Dr. Andrea MacNeill (https://twitter.com/Ecosurgeon?s=20) took that thought and decided to do something about it. Dr. MacNeill is a surgical oncologist at Vancouver General Hospital and is on a mission to improve planetary health, inside and outside the operating room. We ask her in this episode to walk us through how the operating room impacts the environment, what we can do to lessen that impact, and how that effort might help cut costs and improve patient care.

Links:
1. Paper in Lancet Planetary Health: https://pubmed.ncbi.nlm.nih.gov/29851650/

2.Life cycle environmental emissions and health
damages from the Canadian healthcare system: An economic-environmental-epidemiological analysis. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002623

3. Transforming The Medical Device Industry: Road Map To A Circular Economy. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.01118

Bio (from BCHLC website: https://cchl-ccls.ca/site/bchlc_plenary_MacNeill)

Dr. Andrea MacNeill is a surgical oncologist at Vancouver General Hospital and BC Cancer, and a clinical associate professor at the University of British Columbia where she specializes in sarcoma and peritoneal malignancies.  She holds a Master’s Degree in Environmental Change and Management and has published a number of studies investigating the environmental impacts of healthcare activities.  She is the international working group lead for sustainable healthcare for CODA, a global health community mobilizing around climate and health issues, and is co-leading a Canadian initiative for a commitment to net zero healthcare emissions.  She is working with Vancouver Coastal Health on a transformational planetary health strategy to mitigate the healthcare climate footprint while creating health and social value.  She is committed to designing health systems for optimal planetary health and educating health professionals to be agents of change.

Dr. Michael D’Angelica (https://twitter.com/MichaelDAngeli2?s=20)is a surgical oncologist and hepatobiliary surgeon at Memorial Sloan Kettering Cancer Centre. He is world-renowned for both his research and clinical expertise in the treatment of colorectal liver metastases. We got to pick his brain on his approach to colorectal liver mets, as well as some of his broader advice for prospective fellows and his experience living in New York City though the COVID19 pandemic.

Transcript: http://canjsurg.ca/podcast-episode-e61-masterclass-with-michael-dangelica-on-colorectal-liver-metastases/ 

Links:

1. Hepatic resection for colorectal metastases – review by Tim Frankel and Dr. D’Angelica. https://pubmed.ncbi.nlm.nih.gov/24318723/
2. Safety and feasibility of initiating a hepatic artery infusion pump chemotherapy program for unresectable colorectal liver metastases: A multicenter, retrospective cohort study. https://pubmed.ncbi.nlm.nih.gov/33095919/
3. The re-birth of hepatic arterial infusion for colorectal liver metastases by Dr. Nancy Kemeny. https://jgo.amegroups.com/article/view/1042/html
4. Assessing resectability of colorectal liver metastases: How do different subspecialties interpret the same data? https://pubmed.ncbi.nlm.nih.gov/30067183/
5. Treatment sequencing for simultaneous colorectal liver metastases. Review by Dr. D’Angelica. https://pubmed.ncbi.nlm.nih.gov/30816577/

Bio (from AHPBA website):
Dr. D’Angelica is an Assistant Attending in the Department of Surgery, Hepatopancreatobiliary Service at Memorial SloanKettering Cancer Center. He is a Board-certified surgical oncologist with expertise in treating cancer of the liver, bile ducts, gall bladder, and pancreas. He works with a team that has developed and uses many surgical and non-surgical techniques that have shown remarkable success in treating these cancers. Sloan-Kettering’s multi-disciplinary methods of treatment — including novel combinations of surgery, ablation, embolization as well as systemic and regional chemotherapy — offer patients with cancers in these organs a good chance of long-term survival and cure.

Dr. D’Angelica earned his M.D. at the Tufts University School of Medicine in 1993, followed by a residency at the University of Connecticut Integrated General Surgery through 2000. He did a Research Fellowship at Memorial Sloan-Kettering Cancer Center from 1995-97, serving as Chief Administrative Fellow in 1996-97. Dr. D’Angelica did his Clinical Fellowship at Sloan-Kettering form 2000 to 2002.

Dr. D’Angelica belongs to several professional societies in addition to AHPBA, including the American College of Surgeons, Society of Surgical Oncology, the Society for Surgery of the Alimentary Tract, and the Uconn Surgical Society. He serves as a reviewer for several professional journals, including Surgery, Journal of the American College of Surgeons, Cancer, Pancreatology, and the Annals of Surgical Oncology.

Dr. D’Angelica has a strong clinical interest in combining surgery, systemic chemotherapy, and hepatic arterial infusional chemotherapy (chemotherapy delivered directly to the liver through an implanted device) to treat tumors that have spread extensively throughout the liver. Dr. D’Angelica has published extensively on the treatment of metastatic colorectal cancer and proven that cure is possible with liver resection. He has been very involved in research on the treatments of gallbladder, pancreas, and bile duct cancer. Members of his research group are studying tissues from surgical specimens to identify genetic changes in tumors with the goal of improving treatment outcomes and enable us to develop new treatments.