Transcript

Will: [00:00:00] Knock, knock, hi! Knock,

knock, hi!

Hello and welcome to Knock, Knock, Hi! with the Glockenfluckins. I am Dr. Glockenfluckin. What? Are you okay? I’m Dr. 

Kristin: Glockenpleggen. Okay, I’m Lady Glockenpleggen, but I am also concerned about your mental 

Will: health. I’m fine. I’m good. I’m getting punchy. Yeah, I can tell. We’re late. It’s late in the day. We’re doing a rare night recording.

Mm hmm. And so we’ve had a full day. It’s a whole 

Kristin: 7. 30 p. m. We’re ready for bed. 

Will: It is late, you guys. So late. Uh, I mean, who is productive past 7 o’clock at night? Night shift people. I say that as many people in medicine work at nights. Uh, yeah. , but not ophthalmologist. No. The last time I went [00:01:00] into the, I actually, I can’t say anything ’cause I have a call week coming up in like a week.

Mm-Hmm. Did you know that by the way? Yeah, I saw that. Yeah. Mm-Hmm. Um, and I don’t wanna jinx myself. Yep. Do you believe in jinxes? Um, are you a superstitious 

Kristin: person? No, but I also feel like, well, it can’t hurt, you know what I mean? Like it’s not going to do anything, but it doesn’t bother me either. If people want to do, it doesn’t hurt anything.

Okay. 

Will: Yeah. Yeah. That’s, that’s kind of, that’s kind of how I feel a little bit. Although maybe a little bit more, like, I’m a little bit more convinced that I will jinx myself. I feel like a lot 

Kristin: of medical professionals are. Because what 

Will: else do we have to go on? We have superstition and like, nothing else.

Nothing else. I don’t know. Really. That’s depressing. We just have to, we have to. You have no data. 

Kristin: No. No. No evidence. Just. Just pure superstition. Just superstition. No 

Will: science whatsoever. When it comes to how bad your call shift is going to be, yes. Um. What’s going on? Like the Q word. You don’t say the Q word.

We don’t. We don’t. Actually, I don’t really care so much about that. [00:02:00] People are. That’s a big one. That’s a really big one. Especially in traditionally very busy places like emergency departments. Emergency. Yeah. Well, what’s going on with 

Kristin: us? We’re about to, we’re about to go on another trip. We’ve got a lot of trips.

Yeah, the fall is very busy, conference season, 

Will: conference season. But this one is a kind of a interesting special conference. Yeah, we are going to our alma mater. That’s right. We’re going to Texas Tech University in the bustling metropolis of Lubbock, Texas. Where they are literal tumbleweeds that blow across the 

Kristin: roads.

And what are those storms? They’re haboobs? Haboobs. Yeah. The 

Will: wind, dust storms. Yes, they have dust storms. It is, um, as fun as it sounds. Yeah, it’s beautiful. 

Kristin: But we do love But we have a very, very, 

Will: very fond. But we do love Texas Tech. And part of that is because we met there. That’s right. 

Kristin: And that’s where we went to college.

College is fun. 

Will: Yeah, college is fun. It doesn’t matter where you’re at. You’re just in college. You’re not having fun 

Kristin: in college. [00:03:00] You are doing it wrong. Yeah, I don’t 

Will: know. You could be in college anywhere. Just, just have fun in college. Right. But the, the city of Lubbock is, it leaves somewhat something to be desired, but um, but it does have our favorite colleges.

Well, no, we 

Kristin: don’t, we haven’t been there in Many years, 

Will: so. I think 2018. 

Kristin: Oh, we did visit. It wasn’t 2018. When 

Will: my brother, no, it was when my brother graduated. That was I 

Kristin: was pregnant. So it was 2018. No, no, no, no. I was not 

Will: pregnant in 2018. No, not you. We’re talking about two different things. When my brother graduated.

Kristin: Yeah. Oh, you went. I did not. Yeah, I was there. Yeah, that’s why we have different memories. Nobody cares about this. There probably is. 

Will: We’re going back. But it wasn’t 2018. How old am I? What year is this? I don’t know. What? How old is my brother? He’s five years younger than me. No, this is like 20 2008. That’s when 

Kristin: we graduated, it was 2008.

I [00:04:00] know, math is hard 

Will: so hard. So anyway, the point is, it doesn’t matter. None of this matters. Nobody’s even listening anymore. I know, we’ve scared everyone away. I’m sorry everyone, please come back. Hopefully 

Kristin: Jason can do 

Will: something with all this episode, we’re giving a random listener a million dollars. Of Rob’s money.

Anyway, we’re gonna go watch the tumbleweeds this weekend. And, uh, we’re also dragging our kids. 

Kristin: Yeah, we are, because while it’s not so much a tourist destination, uh, it is for our family a part of our, our history. So they’re gonna go see where their parents met and where we went to college and had a lot of fun memories.

And the, 

Will: the college is Putting on a humanities conference and having us keynote. So we’re, it’s 

Kristin: exciting. That’s right. The honors college particularly, which is really meaningful. I don’t know. You didn’t, did you care so much? 

Will: Do you guys know that Kristen here is, was honors college student of the year?

That’s right. I was. Yeah. There’s like, there’s like a plaque and her name in a break room somewhere. 

Kristin: [00:05:00] Yeah, probably. Well, no, I don’t, I don’t think they keep a plaque. Do they? Sure they do. Maybe. I don’t know. We’ll find out. We sure will. I had a great time at the Honors College and so it is very meaningful to be able to come back and speak to all the Honors students now and uh, we met through the Honors College in fact and you were an RA in the Honors 

Will: Dorm.

I was, so yeah, I can’t really say much about you being a nerd. I know, we were both RA in the Honors College Dorm. I 

Kristin: am the bigger nerd though and I take that as a compliment. Sure, 

Will: that’s fine. You can be the bigger 

Kristin: nerd. Yeah, right? Like, you’re smart, but I don’t know if you’re 

Will: a nerd. I would Thank you.

Yeah. I think, I think, anyway, let’s get to our guests. So we got some great guests today. We are talking with a couple of orthopedic surgeons. Yes. We have Dr. Paul Zalzow and Dr. Brad Weaning. Which are 

Kristin: just great 

Will: names to say. Great names. I mean. We talk about [00:06:00] this during the, during the episode. A little fun saying their names.

Yeah. Uh, but they are, you may know them a little bit better as the hosts of Talking with Docs. They’re the creators and hosts of this wonderful YouTube channel. Uh, where they provide medical information in a fun, entertaining way. I mean, orthopedic surgeons, they’re just, they’re fun people. It was a good time.

So we had a great time talking 

Kristin: with them. And they’re Canadians on top of it. So they’re just like extra nice. Absolutely. 

Will: It was really nice. Good guys. Uh, and so I hope you like it. All right. Here is Paul and Brad.

Today’s episode is brought to you by the Nuance Dragon Ambient Experience or DAX for short. This AI powered ambient technology is helping you, physicians, be more efficient and reduce clinical documentation burdens that cause us to feel overwhelmed and burnt out. To learn more about how DAX can help reduce burnout and restore that joy of practicing medicine.

Kristen, you gotta have that joy. [00:07:00] You gotta have it. Stick around after the episode or visit Nuance. com slash Discover DAX. That’s N U A N C E dot com slash discover D A X.

All right. We are here with Dr. Wiening and Dr. Zhao Zhao. Yeah, you guys, you don’t, do you realize how big you are, uh, in Canada, at least probably elsewhere too, but we have gotten so many, uh, requests to have you guys come on the podcast. So thanks for joining 

Dr. Paul Zalzal: us. Oh, thanks for having us. Yeah. Thanks for having 

Dr. Bred Weening: us.

Awesome to be 

Dr. Paul Zalzal: here. We were really excited. A little nervous. I was a little nervous cause you guys are so. You’re so nice and smart and you have great hair. We don’t take 

Will: any of those boxes. I’m sure you’re talking about my hair, yes, absolutely. I also want to make sure our listeners know that before we started recording, we were doing some mic check things and uh, and I heard them, these two call each [00:08:00] other, or I heard call.

I heard, I heard Paul call Brad bro, like three different times. This was it within 30 seconds of meeting you guys. And I 

had 

Dr. Bred Weening: just taken off my headband and put the dumbbells down. So yeah, 

Will: that’s right. I do want to, I want to start there actually, because I, uh, there, I know there are a lot of people that, uh, you know, on social media, seeing you guys, seeing me and, and, and the podcast and everything.

And I’m sure a lot of people, the only. Like, knowledge they have of orthopedic surgeons is like what I make videos about. That’s me. And so, yeah. That’s you? 

Kristin: Yeah. I don’t, I don’t know anything about orthopedic surgeons other than your 

Will: character. So let’s, uh, let’s, uh, this is a perfect time to kind of set the record straight here.

Um, uh, and I want to start with this question, like, do you have to be like a, a strong person, like physically strong to do orthopedic surgery? Yeah. Absolutely. So, so I, 

Dr. Bred Weening: I would say [00:09:00] yes. And actually Paul has a very interesting story about residency where this was brought up. But I’d say generally speaking, yes, you do have to have a certain amount of strength.

However, one of our greatest colleagues is a female, and she’s like five foot two, and she’s a firecracker and she stands on three stools and she’s strong as anything so. Uh, where there’s a will, there’s a way as well, but, but Paul’s a great story that actually lends to it. 

Dr. Paul Zalzal: Yeah, you do have to be strong. I learned that in residency.

I was in like early residency, I think like first year, and I was trying to like reduce a femur fracture and you know, you have to pull pretty hard and manipulate pretty hard. And my staff guy, great staff guy, really, you know, nice guy, super guy. He looks at me at one point and goes, Paul, do you work out?

And I’m like, yeah. Yeah. And he’s like, no, like with weights, I was like, I do, they’re lightweights, but I do, but apparently not strong enough. But having said that, our, our, our colleague, Heather, she’s, she’s, you know, she, when I’m operating and they sit over here, uh, grab a mallet and it weighs like 200 pounds.

Like who uses this mallet? And they’re like, Heather, like, uh, I can’t lift [00:10:00] Heather’s mallet. What, 

Will: what are you talking, mallet, 200 pounds? What are you talking about? We use mallets. 

Dr. Bred Weening: See. It’s like a two to five pound mallet, but yes, it feels like 200 to Paul. It doesn’t work out much with weights. 

Kristin: I thought, I took that literally.

I was like, oh my 

Dr. Bred Weening: goodness. So, 

Kristin: so it’s, it’s the strength. You’re pulverizing the bones. 

Will: The strength comes in, so, because you’re lifting like heavy appendages and you’re having to move bones around and so it’s. It’s not the like the the hammering and the and the malleting that says is that the word verb form of mallet?

I don’t know. To mallet something. Is that is that difficult? Is that where the strength comes in? 

Dr. Paul Zalzal: Moving the limb is a lot. You’re doing a knee replacement. You’re lifting, bending, lifting that limb. 50 times, you know what I mean? So yeah, I think there’s just, I mean, it’s a certain amount of strength, I think.

Brad’s stronger than me. What do you think, Brad? 

Dr. Bred Weening: I would agree with that and particularly for fracture care. So you have to, if a bone’s [00:11:00] crooked, then you got to pull kind of the ends back together and the muscles are trying to keep that deformed force. So yeah, there is a certain amount of strength required for 

Kristin: sure.

Yeah, I gathered that bones don’t really want to move 

Will: much. We are very end of the spectrum, uh, ophthalmology and orthopedic surgery. And I move my fingers like, you know, just a little micro microsurgery, um, my muscles throughout residency atrophy quite a bit. And that’s, that’s actually, uh, an advantage for me.

We know it’s the opposite. We don’t want people who are very physically strong. We want incredibly weak surgeons. That’s what we want in ophthalmology. 

Kristin: Well, I can vouch for you there. 

Will: Wow, that is tough. There you go. 

Dr. Paul Zalzal: I love ophthalmologists. I mean, you guys, we get a bad rap as orthopods. If you look at like, you know, ophthalmologists, they chose Tom Selleck to represent ophthalmologists in Friends, right?

In the show Friends. 

Will: Oh, that’s 

Kristin: right. He was an 

Will: ophthalmologist. 

Dr. Paul Zalzal: Yeah. We got, we got tag in [00:12:00] ER. You know what I mean? Nobody’s rooting for Tagg. I don’t even know if that guy acts anymore, right? Nobody’s rooting for Tagg. Won’t care if he gets to go to the rocks. 

Will: We get a bad rap. Well, uh, so let’s go into that a little bit.

How do you feel about your, the public’s perception of orthopedic surgeons? And how much have I contributed to that? 

Dr. Bred Weening: So I’d say a fair bit on the latter. You certainly are partially responsible for the propagation of stereotypes, but that’s okay. Um, and I think at the end of the day, We know that it’s not true.

We believe that, I mean, once you get into medical school, everyone has a certain level of intelligence. I tell my kids this all the time, you know, you didn’t have to be the smartest person to get into medical school, but you probably had to work as hard or harder than a lot of people and kind of outlast them.

So you’re not splitting the atom. You’re not the applied math person or applied physics person, but no, yeah, we’re, we’re okay with being strong. 

Dr. Paul Zalzal: No, I love your character. I mean that character is awesome and and within orthopedic surgery. You’ve got different, you know subspecialties, right? And so I think [00:13:00] you’re the character you create is is a very good sports Orthopod like the sports medicine type orthopod.

Oh, they really okay. They really are That character. And we’re, we’re interviewing right now, so we’re hiring in our hospital and, and you know, and we’re looking for a sports me, a sports orthopod, and they’re the ones who played like, you know, like nearly professional level sport, like a varsity sport of some kind.

And they’re just real athletes, you know, and then they gravitate towards sort of sports medicine and sports orthopedic surgeons. Yeah, we have, I’m not that guy. 

Dr. Bred Weening: We have a 60-year-old colleague who actually participated in the Iron Man in Kona, like at 60. Like he’s unbelievable. 

Will: Oh my god. Yeah. Well, I, I think what another thing people don’t realize is, is yes, everybody’s smart in med school, uh, but people who go into orthopedic surgery, like you guys.

Are, like, incredibly smart and, and you have to because it’s so competitive to go into ortho and I think, I think secretly, you’re never going to admit this, I think you use it to your [00:14:00] advantage. I think you secretly like having a little bit of low expectation in terms of your non bone related knowledge.

Hey, I’m there with ophthalmology, same thing, okay? Under promise 

Kristin: over deliver works every time. You can’t 

Will: fool me, you guys, I know, I know. You know, and I think 

Dr. Bred Weening: you’ve done it because one of your, one of your videos actually shows that really well, where the guy’s like, listen, uh, heart failure and diabetes and all the rest of it, you know, and then someone’s like, listen, I’ll just take care of it.

And you’re like, thank you so much. You’re so smart. We really appreciate that. I got to get back to the O. R., you know? Yeah, 

Will: we do. We do 

Kristin: do that a lot. I think your ortho character is pretty smart, though. Like, at first he was just like a dumb puppy, but as it’s evolved, I mean, he’s one of my favorite.

Characters, because he’s smart, but he’s also super lovable and kind and there’s not a lot of those in your universe. 

Will: Yeah. And that’s, that’s an honest representation of a lot of the orthopedic surgeons that I’ve met. 

Dr. Paul Zalzal: Yeah. It’s true. I [00:15:00] think you’re bang on with them. We love it. I get that sent to me like five times a week, you know, our colleagues, we love it.

Will: So, so tell me, uh, so you guys met, uh, during residency, you got, you went to the same residency program. 

Dr. Bred Weening: Yeah, so it’s an interesting story. So I was in my last year of medical school, um, and had gone through almost all of my medical school training and I, when I first got there, I thought I was gonna be a family doctor.

You know, like all of us, you get to medicine, you don’t really know what you want to do. And then after about 20 seconds in family medicine, I was like, this is probably not for me. Um, and then banged through a bunch of different other specialties and landed on general surgery. And then I was at that very end and I did two weeks of mandatory orthopedics.

And Paul was my senior resident, and thankfully we had a really lazy junior resident who didn’t want to do anything. So, Paul, he would always call this guy and say, Hey, do you want to go reduce this fraction? And the guy would be like, No, not really. So, Paul grabbed me and then we’d go and straighten this kid’s broken arm and have a bunch of laughs.

And then before he knew it, he, uh I mean, so I kind of give them the credit and the [00:16:00] blame for my career choice. 

Dr. Paul Zalzal: Listen, I have to, I have to confess something to Brad here. I’ve never told him this and I’m, it’s okay with you, I’m going to do it on this podcast. Oh my. So we used to It’s a safe space. It’s okay.

I have not. This is the first time you’re going to hear this one. It’s a theory. And it We did reduce a lot of fraction. I remember, you know, I said, Brad, my, my, you know, my resident doesn’t want to come. You want to come along? Sure. And Brad was awesome. Most keenest medical student, right? And we’d been there, but back then we, we sedated the children with nitrous oxide, which is laughing gas.

Okay. And we did it in a small room and the seal for the laughing gas mask wasn’t very good. So, it leaked out into the room, so I’m, if it’s fixed law, I think it’s fixed law of diffusion, I’m pretty sure we were all getting a little bit of laughing gas while we were doing that, which explains why that rotation was so fun, Brad, and then thereafter the rotations were just not that fun anymore.

You know, you make a good point. It’s brilliant. I’m sorry that [00:17:00] you based your whole career on that experience, even though you were under the influence. Most likely of a pretty high level of nitrous oxide laughing gas. Well, 

Dr. Bred Weening: you know what it all worked out 

Will: So so you were you were on the path to general surgery.

I was 

Dr. Bred Weening: honestly I knew all the people at the institution where I did medical school and sent you had a spot Yeah, for sure. I was very close to just taking out gallbladders and colons 

Will: Were they disappointed in 

Dr. Bred Weening: you for switching courses? To be honest, the program director, once he saw where I had applied, he was a little bit disappointed, I think, because I had done so many electives.

You know, you invest a lot of time, obviously, in the specialty you’re interested in. So, I guess, like, flatteringly, I kind of want him to be a little bit disappointed. But I think he understood. At the end of the day, you work so hard. You just want everyone to get to do what they want to do. 

Will: Unfortunately, you had Paul there to drug you.

He tricked me. He really like influenced you. He tricked me. In that way. Paul, what was it? What got you into orthopedic 

Dr. Paul Zalzal: surgery? Um, I, I, well, I studied engineering before medicine, [00:18:00] mechanical engineering, and then biomedical engineering. I always knew I wanted to go into medicine. My older sister was studying medicine.

I was intrigued by it. You know, I really loved the interface of, like, uh, machine and humans, you know what I mean? I don’t know if you guys remember that show, Six Million Dollar Man? Poor astronaut crashes. You’re a little younger 

Will: than us, Paul. I’ve, I’ve heard those stories. 

Dr. Paul Zalzal: Yes. So this guy, he’s an astronaut.

He crashes. He loses, like, both his legs, an arm, and an eye, so some ophthalmology in there. I’m sold. I’m sold. So they rebuild him. The engineers and the surgeons rebuild him with, like, legs, and an arm, and a bionic eye, and he can, like, see farther, and, like, see stronger, and he can run faster. He’s like an arthropod.

Will: Yeah. There you go. He would have been a perfect order pot. As 

Dr. Paul Zalzal: a kid, my son, and I just loved the cyborg, the interface of machine and man. So now, you know, we place knees and hips so people aren’t really strung or faster, but at least they can like get out of bed and walk to the dining room now. But [00:19:00] yeah, that was kind of so that’s what I love so engineering medicine joined together becomes orthopedic surgery in my mind Yeah, now 

Will: how have how has the the culture of orthopedic surgery you feel like changed throughout your career because you’re I don’t know How many years you’re into your your orthopedic surgery career?

but in terms of like the the attendings that you had Paul like going through training Uh, compared to maybe the way you guys are now or, or, you know, how, how has that culture changed over time or has it 

Dr. Paul Zalzal: changed? Oh, it’s changed. Yeah. We had some characters. Uh, uh, we had some characters. I think Brad, your stories, your story sort of, your, sure, opens it up nice.

Dr. Bred Weening: So both of us have been in practice, uh, me just under 20 years, Paul just over and residency is so stressful regardless of whether you’re ophthalmology, dermatology, whatever. And especially early on when you’re like a first year resident or an intern. And you’re on your first rotation. I remember my very first rotation was in orthopedics, it was at a level one trauma center.

And I remember one of my very [00:20:00] first calls, um, it was middle of the night, guy got shot with a, got a gunshot wound to his forearm, had a lacerated vessel and a broken bone. So vascular surgery said to us in very typical Um, your kind of fashion said, listen, we don’t want to fix it and then you guys mess it when you fix the bone.

So why don’t you fix it quickly first and then we’ll deal with the vessel so you don’t get in the way. So me and my staff went and did fix this bone. And he was notorious, like some people said that he was like a black ops Green Beret from the UK. He had like size nine and a half hands, like the biggest hands you’ve ever seen.

There were legends of feats of strength that he had done throughout his career where he lifted stuff that was not possible to lift. Anyway, he was terrifying. And so we’re, we’re fixing this for him. And when you fix a broken bone, you drill a hole, you measure the length of the hole, and then you put in an appropriate size screw.

But because of the gunshot wound, the bone was very convoluted. So it was in a whole bunch of different pieces. So he would drill, and then I would measure, and then tell him the size, and we put the screw in. So he drilled, and I’m trying to measure with this depth gauge, but because the bone is so broken, I couldn’t hook it.

And I said, I [00:21:00] won’t say his name. I’m like, I can’t, I can’t get it. Cause it’s so accommodated and without looking up from the table, and this is classic shame based learning, you know, the anesthetist, the nurses are there. He says, that’s because you’re doing it so badly. And I was like, wow. Right. So, so I’m crushed.

Right. I’m like, what do you say to that? Sorry, so he grabs the death gauge out of my hand. He tries it and he can’t get it And I was so happy that he couldn’t get it. Did you have to bite 

Kristin: your tongue so hard to not say it? I 100 percent get right through it. That’s because you’re doing it so 

Dr. Bred Weening: badly. Yeah, he can’t say anything.

I can’t say it because I’m PGY1, right? So I, so I looked down. Well, you know, 

Kristin: but like that would be the first thing that popped into 

Dr. Bred Weening: my mind. You want to say it. And he’s like, oh, yeah, I guess you’re right. It’s so common or whatever and then And then we moved on from the case and, and this is a guy that actually liked me.

Um, so after the case, he’s like, Oh yeah, you know, that was a tough case or whatever. And, and it goes on interesting about this guy is he says, listen, I’m, I’m flying my plane to one of the clinics. Um, that’s remote from [00:22:00] here tomorrow at 9am. If you, if your call’s not too bad, if you want to come. I think he was saying if you’re, if you’re too busy, then don’t come.

I was like, no, definitely. I’m in. So after my call, I’ve been up all night, 8 in the morning, shift’s over, and then I drive out to the airport. So we get to this plane, it’s like this two seater plane that it turns out he has built. I’m like, okay, so we’re like shoulder to shoulder and he’s like a crazy, massive man.

He says, oh, can you open up the glove box? So I open up the glove box. He says, can you hand me those? And it’s like instructions on how to start the plane. He’s like, number one, and I’m like, what? And he’s like, number two, I’m like, shouldn’t you know how to do this? So anyway, so we get the plane started and we fly up, it’s like a one hour flight.

So we get up to about 10, 000 feet or whatever, and he says, can you hand me the newspaper? And I’m like, okay, so I give him the newspaper, and he goes, okay, there you go, there’s two steering wheels. He goes, okay, you can’t do any damage up here, just keep this line flat. So like, he literally taught me how to fly a plane.

And then, later on, other residents tell me, say, Hey, did you know Dr. So and so has crashed his plane twice and, you know, had, like, near death experiences in his plane? I’m like, no, [00:23:00] that would have been good information to know before I took the flight all the way up north with him. Anyway, um, so yes, I’d say the culture has changed a lot and that’s, but it does drive you.

I’m sure your staff are the same. It drives you to work so hard. You just, you just want to please. You just want them to be proud of you, you just want to know the answer, you want to be a good surgeon and a good student and a good doctor. So at the end of the day, I think it’s a fine balance, but some of it is a little bit necessary, I 

Will: think.

Yeah, I mean, you definitely want to, I mean, no matter what specialty you’re in, obviously you want to like succeed and you want to, you know, become insanely proficient in your job and be the best that you could possibly be. Uh, and surgery just feels like Uh, there’s so many life and death decisions like in the moment, you know, and, and that’s so fine.

Right. And you’re stressful. The stress is high. I would say, uh, and, but then, you know, surgery over the years has that reputation of, of being difficult. I remember in, yeah, I [00:24:00] didn’t graduate residency or a med school that I graduated in 20, 20, 20, 13. And, like, even then, 

Kristin: what, 

Will: what, I’m not, I’m not saying they’re old.

Is that what you’re gonna guess? We know, I’m saying I feel old. We know we’re old. Yeah, don’t worry. They’re young. We’re like the same age, right? You guys, you don’t have to answer. No, listen, 

Dr. Paul Zalzal: even though it’s a podcast, I went through three different webcams before I realized, no, this is what I look like.

I’m serious, I’m not lying. Three webcams and it’s a podcast. 

Will: But even like, you know, a decade, like 10 years ago, like I still, I had moments in the operating room where I, I felt shamed. Yes. And, and it’s, it’s still something that, it’s like hard to get that out of surgery, it feels like. I mean, 

Kristin: yeah. Is it not still there?

Will: I’m sure it, I don’t know. Yeah. I, I mean, do you guys work with trainees? Yeah. At 

Dr. Paul Zalzal: all? Yeah, we do. It’s still there. I mean, it’s, it’s changed a lot. Like back, like, you know, [00:25:00] when we were going through it, you know. The term mental health didn’t really exist in, in our world, right? There were, you didn’t worry about your mental health back then.

And, and, and there weren’t many rules around. Like, you could be on call, you’d work all day, be on call, be up all night, and then you’d work the whole next day. And, uh, you know, at the end of that day, you could go home. And it was, you know, frowned upon if you tried to go home before that, because the idea was, well, there’s so much to learn.

If you go home, you’re not going to learn it. But you’d be like, you know, I’d, I’d be, You know, uh, working all day up all night on call for some, some traumas or something. Then I was on a neurosurg rotation and then the next morning we’re doing a neck dissection in the OR and then the surgeon hands me the knife and he’s like, okay, why don’t you get us down there?

And I’m like, I can think of a few reasons why , you shouldn’t hand us down there. But that’s changed. They came in with rules where at first it was, okay, you have to go home at noon the next day. And then even then, like, you know, if you’re an orthopedic surgery resident. You’re not going to follow that rule.

You’re going to break that rule and stay all day. And then, and then it moved to, you can go home at 8am the next day. And, and, [00:26:00] you know, they, they, you would just break that rule. But now, nowadays it’s a lot better. It’s a lot safer. It’s a lot healthier. And I still think you learn everything you need to learn.

So while that culture, you know, there were some good things about it, but I think the bad things about it outweighed it. And it’s, and it’s gotten a lot, it’s gotten a lot better now. I was having a discussion with some other staff guys at a nearby teaching center. And they’re like, yeah, like, You know, if, if we know someone’s, you know, post call, we make, we make them go home and just say, you have to go home.

Yeah, that’s good. That’s right. And that’s the way 

Kristin: you really learn when you’ve been up for 36 hours or whatever? Like what we know about the psychology of learning, that’s not conducive to it. 

Will: I know that the, the, what you, what we shouldn’t do is make people be on call and then post call drive to an airport and learn how to drive a plane, uh, a two seater plane 

Kristin: from 

Will: somebody who’s probably also sleep deprived and may or may not be a giant, like an actual giant person.

Yes. So I’m glad you [00:27:00] survived that. Yeah, as was I. By the way. Uh, I’m curious, how long are your average surgeries? 

Dr. Bred Weening: So we do a lot of HIPAA knee replacements, so nowadays, to be honest with you, they’re a lot faster and pretty efficient, so I’d say somewhere in the 60 to 90 

Dr. Paul Zalzal: minute range. But Brad and I do, we operate together on some, like if you have a complicated case or a revision or something like that, we’ll do it together and those, you know, we can push three, four hours for some of those.

Um, you know, uh, there are some complicated ones that go longer, but are, are sort of bread and butter ones are, yeah. 

Will: That’s what, that’s what pushed me away from other tech. Cause I loved being in the operating room, like surgery, but. It was those, uh, four, five hour, six hour cases that just killed me. I was like, I just didn’t want to sit down.

Dr. Paul Zalzal: That was, that was neurosurgery. Do you remember the neurosurgery rotations? We’d be in there. I remember, like, we’d start a case, and then, like, the nursing shift would change. And you’d have a bunch of new nurses. And then, then the nurse would come back and I’d be like, Oh, are you on break? She’s like, no, that [00:28:00] was yesterday’s shift.

This is my next day’s shift. And we’re like, we’re still, we’re still trying to get this brain tumor. You know what I mean? Those neurosurgeons, I mean, thank God I’m not a neurosurgeon, but they have some long, tedious cases. There’s no other 

Will: option. How do that? So you guys, you guys work in the same, you’re in a hospital, like a big teaching hospital, right?

So you’re around the other surgical subspecialties. Is there, is there like a secret hierarchy? Is there, is there like a, like rivalries? Are there, do you butt heads with other, I mean, you can, they’re not going to hear this. Sure. Maybe they will. So I’ll let you in on a little secret. Pretend they’re not going 

Dr. Bred Weening: to hear this.

Orthopedics is obviously the king of the castle, obviously, obviously ophthalmology is second, and 

Will: all the rest are tied for third. Even though we don’t like to be in the hospital at all, but 

Dr. Bred Weening: yeah, we’re still second. Everybody else is tied for third. So what I’d say is, not really, to be honest with you, I think.

The hierarchy really happens at night when the urgency of the cases changes, [00:29:00] so orthopedics, the broken bones are not super urgent, so we get pushed around a lot by, you know, a perforated bowel or, um, an urgent, like if you had, say, a retinal detachment or something like that that has to be fixed right away, a lot of our stuff can wait.

A little 

Will: bit. I appreciate that. But even that can wait. 

Dr. Bred Weening: Okay. That’s good to know. I’m coming at our ophthalmologists that say I can’t. 

Dr. Paul Zalzal: We’re actually in a community hospital that’s affiliated with the teaching center. So it’s kind of like the best of both worlds. There’s a community setting and we’re affiliated with the academic center down, down the street.

So we do get teachers, but yeah, it’s the evenings where the, where the battle comes in. Right. Where you’re trying to get your case done off the board. You know, on the board, those are those added cases and then, you know, like Brad said, you know, General Sergio come in, try and bump you and then, and we share an anesthetist with like OBGYN, so there’s like an urgency section, so you’re all battling for the anesthetist.

So you can get in the O. R. I gotta, I gotta do it. 

Will: I can do a video about this, about, uh, surgeons, you know, trying to bump each other and [00:30:00] take each other’s O. R. Honestly, 

Dr. Bred Weening: it’s very real and it’s a great topic and especially with O. B. Like someone says, like say the O. B. kind of says, Hey, Brad, Paul, you know, we have this lady who’s been trying for labor for a long time.

We need you to do this. What do you say? No, the baby’s gonna have to wait. I want to fix my broken ankle. You can’t. It’s always baby waiting every time, every single time. 

Dr. Paul Zalzal: And it brings out the worst in everybody when you’re battling at night. You’re tired, it’s night, and everyone just gets mean and like, pulls punches and sneaks around.

I looked at your patient, they’re fine. They’re walking. That appendix doesn’t have to come out. Oh my god. I gave him some antibiotics. It’s like, it just brings out the worst, right? I don’t like who I am after 

Will: hours. This is why I love outpatient surgery. 

Kristin: Yeah, you don’t have to deal with any of 

Will: that. But you guys do a lot of outpatient surgery.

I mean, that’s, that’s, that’s 

Kristin: orthopedic surgery. Well, like, even hips and knees these days are probably Are 

Dr. Bred Weening: they outpatient? I would imagine. Yeah. Same day or next day at most centers nowadays. Yeah, you’re right. Big 

Dr. Paul Zalzal: change. Our chief just came up to me today and said, it’s like, I feel like, [00:31:00] so we do outpatient, you know, hip and knee replacement, and I had, you know, my nurse says like, hey, your next case, you got her going home today, but I don’t know if she’s going to be able to go home today.

I’m like, okay, well, you know, we’ll see, whatever you think. And then, you know, I’m in between cases and then are my chief. Chief of Surgery comes to me and says, Hey, what can we do to get you doing more outpatient hip and knee replacement? I’m like, I don’t know. I’m trying, right? And there is a push to do that, whether it’s right or wrong, but we do, like, for my list today, two of my, uh, three joints went home today.

So yeah, we are getting them home same day, right? 

Will: I want, I wanna talk about, um, talking with docs. So what, what was the origin of the, because this is, this is great. I’ve, I’ve watched, I, I never thought I’d learn about hemorrhoids from orthopedic surgeons. , uh, but I’m already, I’ve, I’ve gotta improve my diet.

Not that I have hor, I don’t have hemorrhoids in anybody, everybody. There’s no shame in that though, even. No shame. So if you do have hemorrhoids. You 

Kristin: [00:32:00] ophthalmology, 

Will: that’s right. But uh, uh, it’s great. Over 500, 000 subscribers on YouTube. It’s just, it’s fantastic. So what was the, the origin of this? I’ll let you take that 

Dr. Paul Zalzal: one.

Oh, okay. Well, you know. We kind of made the videos for our patients, right, because we say the same thing over and over and we found people would forget and, you know, they would call the office and say, let’s just make them for our own patients. And we looked at them and, you know, some of the clinical studies show that, hey, people forget 60 to 80 percent of what the doctor tells them.

And we’ll don’t try, don’t try using this statistic in any other way other than medicine. I tried it. with my partner. I was like late at work one day and she’s like, why are you late? I said, I told you how to meet and you didn’t tell me. I said, I did. She said, no, you didn’t. I said, look, people forget 60 to 80 percent of what the doctor tells them.

It’s not your fault. That didn’t go over well because apparently husbands forget nearly 100 percent of what their wives tell them because I was supposed to pick the kids up from school that day. [00:33:00] Well, don’t use that statistic at home, but we were finding that people were forgetting like 60 to 80 percent of everything you tell them.

So we made these videos for our patients and then, you know, we’re looking at it and I’m like, Brad, did you give our video to like a thousand people? And he’s like, no. I’m like, neither did I. And then, you know, next week, oh, did you give it to 2000 people? No. And then we saw that there was an appetite for this sort of information, like information.

You know, like we’re not sponsored by anybody, we’re just giving like medical information. We try and give both sides even if we don’t agree with it. And then we kind of like expanded it to other sub specialties and stuff we don’t know we get an expert. You know what I mean? We have some like really cool and funny colleagues, um, you know, that we bring on and you know like Nicole Callan who talked about hemorrhoids, she’s amazing.

And Mike Heffernan, our cardiologist, we got him on. And so we kind of landed in a place where we’re like, you know what? We want to give like just medical information that’s not sponsored, not getting paid, we’re not asking you to buy something, we’re not asking you to come and see us, we can’t. In Canada we’re like [00:34:00] overworked, in fact we don’t want you to come and see us, go somewhere else and we’ll take this information with you.

But we want two things. We want one, and it’s an or. We want one to learn something or know, you know, if you know something you didn’t know before you watch the video. And two, have a little laugh. Have a, have a chuckle. You know what I mean? Have a laugh. Learn something. That’s, that’s all we want. And, you know, that’s sort of how we’ve sort of stuck to that.

And that’s how it’s evolved out. 

Will: What year was it? When did you start doing these? 

Dr. Bred Weening: So we started in May of 2016 and then Honestly the real change like I think it took us almost six years to get a hundred thousand subscribers And then yeah now we’re almost at six hundred thousand the pandemic really changed that right people were stuck at home Couldn’t get access to a physician.

We’re bored. We’re watching YouTube and And a lot of them found us. Same thing with me. Yeah, right? Absolutely. Yeah, just all of a sudden it was like, boom. Everyone was on social media, right? Although your pandemic experience was slightly different than the average person. Yeah, 

Kristin: he had to go all, be all dramatic, uh, die for a [00:35:00] while, just to get some attention.

Yeah, it’s gross. Yeah, 

Will: exactly. That’s quite a story. And then, but, Paul, sounds like the, the, uh, the notoriety of having a successful YouTube channel went to your head and you went and tried to write yourself a sitcom, it sounds like. Like, just like tone it down a little bit, Paul. Like, there’s limits to your talent, okay?

No, 

Dr. Paul Zalzal: I’m just kidding. Move over, Tina Fey. It’s Tony Fey here now. So yeah, that was during the pandemic, right? Because, which was a weird thing, right? Like, we’re 

Will: sure We all had our projects. Yeah, we all had projects. Brad, what did you, before we hear about Paul’s, uh, Shirley’s successful sitcom, Paul, Brad, what did you, uh, what was your So I’d say probably 

Dr. Bred Weening: the two things that flourished for me is I became like a plant based eater.

Yeah. Yeah. So gave up all animals, and I’d say the other thing is like I’ve grown a lot of my own food. I have a very large garden that grows, 

Will: you name it. She’s just making everyone else feel bad. All right, Paul, let’s I don’t know, I feel like 

Kristin: we could play a game of like, diagnosing people’s like, mental struggles by what their pandemic project was.

Will: That’s too, [00:36:00] too productive, too good at like, making 

Dr. Bred Weening: his life better. I also started to enjoy country music, does that count for anything? Oh, oh dear. Now we’re coming back down. 

Will: You guys are from Texas, there you go. That’s a little bit better. Uh, we have, Paul, I want to hear about the sick. I want to, let’s hear, let’s 

Dr. Paul Zalzal: hear your story.

Okay. So, so the odd thing was, was it’s during the pandemic, your doctor. So everyone thinks, Oh my God, you guys are gonna be so busy during the pandemic. Aren’t you? Right? You’re a surgeon. It’s like, yeah. Yeah. What can I do? You know, you phone the hospital, you know, it’s a pandemic. What can I do? Okay. We need you to stay home, but people are dying.

I’m a doctor. Yeah. Stay home. Should I call and check in? No, no, no. Don’t call us. We’ll call you, okay? What about all my vital important surgeries? They’re all going to be on hold. How long? Indefinitely. It really sort of takes you down a notch, right? If I’m so, I’m a doctor, I should be helping in this pandemic.

And the best thing I can do is stay home. So I gotta do something. Um, so, I took this online course, uh, uh, through Stage [00:37:00] 32, it’s based in California and it’s how to write a sitcom. And it’s a six week course, and by the end of it, you’ve written a sitcom, right? I’m like, this is great. I got, cause, you know, the stuff we do in the OR, we have such a laugh.

There’s so much funny stuff in the OR and the hospital. We have a really good time, so I think I’m going to make a sitcom out of this, right? So, I have my first Zoom meeting with everybody, and like, there’s real writers in this course. I’m like, I am in over my head. These are real writers, right? I don’t know how to write it.

The only thing I write is like a prescription, and I can’t even read it, right? I don’t even write words anymore. Yeah, it’s all electronic. I don’t even write that anymore. I write nothing. It’s like, okay, that’s fine. You know, I’m in over my head, but that’s not a first time for me. So, um, you know, the, the first thing is your premise, you know, what’s your premise?

My premise is, you know, I want to write a, you know, community OR, like the OR in the community. Uh, and it’s going to be about, um, trying to, you know, deliver world class care on like a shoestring budget. That’s my premise for the, and my, my feedback is amazing, right? Like, uh, I was like, [00:38:00] this is great. There’s more, need more of these.

The email is like. All this glorious feedback and I’m just getting so inflated, right? I’m already writing my like, my SNL monologue, right? What am I going to wear on SNL? This is going to be huge. So then the next week is okay, what’s your setting? Well, it’s a community OR. Great. That’s amazing. We need community OR.

Next one is develop your characters. Okay, so the characters are like me. Brad, you know, people we know, administrators, nurses, I just, they’re all in front of me. I don’t have to make anything up. I just write up these characters. Feedback’s amazing. The characters are great. They’re really, you know, I like the way you develop these characters and I’m like, oh, they’re real people.

Like, you know, instead of Paul, it’s Pete, you know, instead of Brad, it’s Bill. I didn’t even change the names much. And then the next one is, okay, you got to write act one. All right, so I write act one, and I’m waiting to get the feedback. I’m so excited, right? Because I’m waiting to get the Emmy on this one.

And so the feedback is like, short. The email is extremely short. It’s one line. What? [00:39:00] Your characters are not very 

Dr. Bred Weening: likable. This 

Will: is 

Dr. Paul Zalzal: us, it’s me, it’s Brad, and I’m like, they’re not, what are you talking about? And so that, it was kind of, the next day at work, I was like holding the door open for people. They were like 20 yards away.

And I’m holding the door, I’m like, I’m not, I’m not going that way. I’m like, it doesn’t matter. You change your mind. I got the door. I’m going for coffee. Here’s a hundred bucks. Get coffee for everybody. Because it was a real mirror, like, I was writing stuff, the jokes we make, the stuff we do, and, and it’s not likable, you know, and I thought, you know, like as a doctor, one thing you got to kind of be is likable, right?

As orthopods, sure, I get it. So it was a real mirror for me to see that, hey, you know, what kind of stuff we joke around with, what kind of stuff we laugh about. It’s not likable. So, you know, I rewrote it, tried to make it more likable and, you know, got the project done. Um, but yeah, it was, it was, it was a neat learning experience.

Which, 

Will: which streaming service. Can we find this on ? 

Dr. Bred Weening: [00:40:00] Is this Well, 

Dr. Paul Zalzal: are you Hulu or it’s coming, coming to one near you. Seus . 

Will: Well, we’ll take a look. We’ll, uh, we’ll look out for that one. Let’s take a quick break. We’ll be right back.

Hey, Kristen, what do you know about hearts? Well, I know they need to beat. That’s true. And you’re really good at making them do that. Yeah, I did that one. You helped me with mine. I did. I was, I still appreciate that, by the way. You know what would help you learn even more about hearts? The ECHO Core 500 digital stethoscope with three lead ECG.

This thing is awesome. How do I look? You look so fancy. Doesn’t that look nice? Yeah. It’s like, anybody who listens to hearts in your job could benefit from one of these. That’s right. It’s got 40 times noise amplification, noise cancellation, three audio filter modes. And a full color display. 

Kristin: Yeah. So you can listen and see the ECGs.

Will: It’s amazing. It’s really cool. I mean, what stethoscope allows you to do that? I know we live in the future. It’s incredible. It’s also the best [00:41:00] sounding digital stethoscope that you’re going to find out there. Trust me on that. We have a special offer for our us listeners. Visit echohealth. com slash KKH and use code knock.

50 to experience echoes core 500 digital stethoscope technology. That’s EKO health slash KKH and use knock 50 to get a 75 day risk free trial and a free case and free shipping with this exclusive offer.

All right. We are back with Paul Zalzow and Brad weaning. I love, I just love saying your name, Paul. I get this like puts you in a good mood. 

Kristin: Yeah, it’s, it’s, it’s like you can’t be grouchy when you’re saying Zalzow. 

Will: That’s great. Yeah. Um, I’m sure you probably get a lot of pronunciation, uh, you know, different things from 

Dr. Paul Zalzal: patients.

It’s amazing. It’s just, it’s three letters repeated itself, but people manage to mess it up. 

Will: Yeah. Just like Glockenflecken. It’s such an easy thing. Spelled just like it sounds. Come on. Come [00:42:00] on. Like how hard could it be? Um, all right. So we’re gonna, we’re going to, uh, play a little game here. Uh, I actually didn’t like name this.

Let’s just, uh, we’ll, let’s call it, uh, things we’ve forgotten. Okay. It’s a terrible name. Anyway, I don’t know. Somebody, somebody tell me what this should have been named after we’re done with it, but, uh, all right. So what we’re going to do is because a part of what you do with talking with docs is so much education, right?

That’s, that’s a big part of it, but you also have fun. So I want to try to educate our audience here. Um, what we’re going to do is Kristen, I’ve written down some, some ophthalmology related things. Maybe it’s anatomy or a diagnosis or something, and she’s going to give you guys one of those things. And on the spot, you have no, I didn’t give you any preparation time here.

No, you did not. You have to just tell me as much as you can about that thing. Okay. And then when it’s your turn, you’re going to do the same thing to me. Hey Paul, we’re picking hard ones. You can pick [00:43:00] whatever you want, alright? Whatever bone related thing that you want. Uh, and uh, we’ll just see. We’ll see who knows the most about our two very, very different specialties.

Uh, I think that’s why this is going to be fun. Because, they’re like, totally could not be any different. There are no bones in the eye, guys. And there’s no eye in the bones. There’s no, uh, there’s You can’t use the bones to see. It doesn’t work that way. All right. So, uh, who should go? I guess we’ll go first.

So, yeah, 

Kristin: you go ahead. Okay. Um, cataract. 

Dr. Paul Zalzal: Ooh, clouding of the lens. 

Dr. Bred Weening: Yeah. Clouding, a clouding of the lens where reduced vision over time. That’s a process that can be treated with a lens replacement. Um, nowadays it’s become a very, very efficient process that literally heals the blind. Probably the number one procedure to improve quality of life.

Dr. Paul Zalzal: Most commonly in the elderly and actually can be as UV light is implicated in it, as well as some other [00:44:00] medications. That’s pretty 

Kristin: good. That is pretty good. And I I And they stroked your ego while they were at it. Oh, they, oh, they 

Will: sure did. That’s, that was great. . I mean, you could have, I mean, ’cause knee and hip replacements, you know, those thing, this quality of life there, number two, and.

Dr. Bred Weening: And like some, oh, there’s some real measure. Apparently we are number two and three. You are number one at Healing the Blind. Yeah. 

Will: That’s a, oh, that’s like a real’s. A real thing’s like a thing. There’s real data 

Dr. Paul Zalzal: behind this measure somehow measurement improvement. Total hit 

Will: number two. Yeah. I feel like I should’ve known that.

I 

Kristin: think you should . 

Will: Alright. Hey, I, I’m impressed. That’s good. Yeah. And, uh. That’s okay. You said you said a high bar there. Okay. Yeah, they’re talking about 

Kristin: implications and treatments 

Will: and all sorts of things. All right. All right. Give me a I would have just been fine with you saying clouding of the lens, but whatever.

All right. 

Dr. Bred Weening: Paul, you’re me. 

Kristin: Well, they’re they’re ortho. They’re overachievers. 

Will: That’s right. It’s really a secret. All right, give me a guess. What do you got? I got one 

Dr. Paul Zalzal: that I got one that kind of bridges the two of us. Osteogenesis imperfecta. 

Dr. Bred Weening: Oh, it does, it [00:45:00] does bridge nicely though, that’s a good one, Paul.

Kristin: Can I, can I take a stab at what it is? 

Will: You go ahead, yeah. And then I’ll, I’ll try to clean it up. 

Kristin: Okay. Osteogenesis, so that would be like, like new bone being created. Yes. Okay. 

Will: Or bone. Genesis of 

Kristin: bone. Generating. Okay. Yeah. And then like imperfect, obviously something has gone wrong in the process of bone generation.

Pretty good. 

Will: Yes. That’s excellent. So it’s, uh, If I recall, it’s a, it’s a, a, um, defect in a type of collagen formation, I think. Um, and then as far as the eye, uh, one, a sign of osteogenesis imperfecta is you get, uh, a blue color to the sclera. Yeah. Because you have thinning of the sclera. Uh, and the reason it looks blue is because on the other side of the sclera, which is the white part of the eye, uh, you have what’s called the choroid.

And the choroid is, um, it has a kind of [00:46:00] a bluish tinge to it. And so you can, I think that’s, I think that’s why you see it. I think that’s why it looks blue. It’s I, I, I have honestly never seen osteogenesis imperfecta in an eye clinic. 

Dr. Paul Zalzal: Perfect. That was exactly what I was looking for. It’s one thing that bridges ortho and ophthalmology, kind of the only thing I could think of, but the blue sclera is one, is a sign of one type of the.

What’s the 

Will: underlying defect? What’s the, what is it? Like what, what causes, 

Dr. Paul Zalzal: you pretty well described it. There’s four types. And, uh, and the under, the underlying, you know, manifestation of it is just fragile bones. Bones that break and break and break 

Dr. Bred Weening: and break. Unfortunately, even as a kid, so a lot of these kids come in with multiple fractures at a very young age and, and even for the parents can be difficult because they can be accused of, of abuse because young, young children are breaking bones with no trauma and they come in, they’ve had seven or eight fractures by the age of three.

So until it’s diagnosed, it’s actually a very, very difficult situation. Yeah. That would be 

Will: rough. Yeah. I imagine that’s not a very common thing. You probably don’t see this [00:47:00] very often. Alright, what do we got, Kristen? Alright, 

Kristin: an eyeball one. Macular degeneration. 

Dr. Bred Weening: Eugh. Okay, so. Let’s hear it, Brad. So macular degeneration, there’s two types.

There is wet and dry, um, as they progress, they both can lead to blindness and it may be the number one, is it one of the number one causes potentially of the number one cause of blindness. The number one cause of age related blindness? No. 

Will: Well, it depends on, uh, The population, I guess, maybe. Which country you’re talking about.

A worldwide cataract. Oh, yeah, worldwide cataract. Okay. But, but, uh, macular degeneration. Maybe irreversible blindness. Yeah, that makes more sense. I think glaucoma’s two and macular degeneration would be three. Okay. And 

Dr. Bred Weening: a podium, anyway. So it’s up there. Top three. It’s 

Will: a podium. I don’t expect you to know the epidemiology of, of, of ophthalmologic conditions.

They’re really taking this far. Well, 

Kristin: you know. This is a game, not a test. You know that, right? 

Will: Yeah. Uh, do you know, do you know how, uh, what are the two types? Do you remember that? Wet and dry. [00:48:00] Wet and dry. He said that. Oh, he did say that. Do you know how to treat the wet form? What 

Dr. Bred Weening: do we do dermatology where you just, anything dry you make wet and anything wet you make dry?

Will: I thought that was all 

Dr. Bred Weening: of 

Kristin: derm. 

Dr. Bred Weening: Don’t tell Dr. Pimple 

Will: Popper we said that. You do, you do want to dry the wet, but you do not want to wet the dry. That’s for sure. I 

Dr. Bred Weening: am not familiar with the treatment for the 

Will: dry. Yeah, so. That’s great. That’s actually really good. Um, there’s a wet form and a dry form. The wet form is whenever you have, uh, bleeding in the, in the back of the eye, in the, in the macula, which is the, the part of the retina that’s most important for vision.

That’s where your best acuity vision occurs. And so if you have, A wet form of macular degeneration. You get blood vessels that grow into there and cause swelling. You treat it with injections. Lasers the old way to do it. That’s what we did like when we were 30 years ago when we were 

Dr. Bred Weening: residents and med students.

[00:49:00] That’s 

Kristin: probably maybe what you learned. Yeah. 

Will: And it was a pretty much a terrible treatment. It’s like it didn’t work very well. Um, and people generally just went blind, but now we have these intravitreal injections, Okay. Which sounds But just like Kristen looks, right? It sounds horrible, but it’s, but it’s actually a really easy, common procedure.

And, um, it’s totally revolutionized what macular degeneration. So it’s yeah, the dry form we don’t have as many options for, but that’s. That’s more of a long term 

Dr. Bred Weening: Do you think someone after hearing this is going to maybe look into making the dry form wet, or no? 

Will: No, no, please. But good job, you guys. That was great.

Macular degeneration. Alright, alright. 

Dr. Bred Weening: Okay, so the one that I’m going to go with is Compartment syndrome. 

Will: This is actually one that, uh, I can relate to in ophthalmology. Yeah. I’ll tell you why. Okay. Go ahead. What do you have? Any idea? A compartment syndrome? This is gonna be a hard one with no medical background whatsoever.

Kristin: I, um 

Dr. Bred Weening: It’s [00:50:00] not intuitive. 

Kristin: You have a compartment syndrome. You have a real hard time putting things back where they belong. 

Will: That’s it. You got it. Yeah, it’s pretty good. So compartment syndrome, um, would be if you have I guess there’s natural, um, uh, delineation and, and with the natural compartments that are separated by tissue planes or something like that.

And if you have an increase in pressure within that compartment, that within that tissue plane or something, then, um, you can cause like, uh, fascia, fascia planes, something, something fascia related. There’s a fascia in there. You got it. Uh, and if the pressure in that compartment, yeah. Uh, gets too, too high, then it can cause, uh, damage to the muscle, it can cause, uh, you can lose blood flow to that compartment, and so things 

Kristin: start Kind of a reverse Titanic situation.

Will: Things [00:51:00] start to die off, and, and it just, you have, uh, damage, permanent damage to the muscle. That was perfect. 

Dr. Paul Zalzal: Bang 

Will: on. 

Kristin: Wait, where are the compartments located? You didn’t make that clear. Are they in the muscle? They’re in the bone? I think you have them in the legs and the arms, right? No, no, I’m talking, like, what kind?

Bone? Muscle? 

Will: These are, you know, I don’t know. Yeah, so 

Dr. Bred Weening: there’s compartments throughout our body, but the most common place you’d have compartment syndrome is in the arms or the legs. And so there’s multiple different compartments in, say, your lower leg. So if you break your tibia, the bleeding can increase the pressure inside of one of the specific compartments or the amount of swelling associated with the trauma.

And then you’re exactly right. So as that swelling increases, it compromises the blood flow, damages the nerves, and ultimately can cause the muscle to die. So if you don’t release those pressures in a very time sensitive fashion, like four to six hours, this is when we get to bump other cases on the board.

You don’t want to do this case where you’re like, yes, you have to go to the OR. You actually make an incision, releasing essentially a tight compartment so that it can expand and save muscle. You can lose your leg for sure, or even die as the muscle dies, [00:52:00] and it can lead to myoglobinuria and then kidney failure.

Will: I have a very vivid memory in med school of seeing an orthopedic surgeon stick a striker something. 

Dr. Paul Zalzal: A pressure measurement. 

Will: A pressure measurement tool into a compartment to see if it was high pressure. Do you guys still do that? 

Dr. Paul Zalzal: That’s exactly the one. The striker manometer, yeah, to measure the pressure.

Okay. 

Will: Alright. That also sounds 

Dr. Bred Weening: horrifying. It is. It’s a very bad diagnosis. You don’t want any part of 

Will: it. Well, same thing with, in ophthalmology, we have orbital compartment syndrome. So if we have a retro bulbar hemorrhage, so a bleed behind the eye, it’ll push the eye forward, but you can only push it forward so much and the eye just kind of gets trapped by the eyelids and you have to make a decision.

How come it doesn’t just pop out? Because the eyelids will keep it from 

Kristin: But if the pressure’s high enough, can it overcome the eyelids? Mmm, 

Will: usually not, because it happens very There’s no, generally, no popping. That’s another whole Your eye [00:53:00] can kind of pop out, but, uh, that’s a whole other conversation. I 

Dr. Bred Weening: think Chihuahua’s not asking about 

Kristin: that.

He dropped something. We had, I mean, oh, this is really getting off on a tangent here, but we had my brother growing up had a pet rat. And, um, I don’t know why, because boys are weird. But My mom was vacuuming one day and the rat did not like that, totally panicked, and it was trying to get out of the cage and it just kept like, hitting its head against things and it’s eye came out because it just kept giving itself.

Will: I thought your mom was going to vacuum up the rat. That was shockingly 

Dr. Bred Weening: graphic. 

Kristin: Seriously, 

Will: my goodness. I had some interesting 

Dr. Bred Weening: animal experiences in my childhood. Did she vacuum up the eye after it came out? That maybe would 

Kristin: be nice. No, it was still attached. It was just kind of like dangling. 

Will: Um, you know, the rat made a full recovery and we won’t accept any follow up questions on that.

Let’s go to the next one. 

Dr. Paul Zalzal: PETA’s on the phone. PETA. 

Dr. Bred Weening: Um, let’s, let’s 

Kristin: do Okay, no, I got, I got, [00:54:00] I know what I want to do. Okay. Okay, are you ready? Yeah, we’re ready. We are ready. 

Dr. Bred Weening: The 

Will: eye. Okay, I put that on there Just in just in case they were having trouble with the first two. Okay, I think we 

Kristin: could start. I think now we can have a comprehensive answer everything we know about the eye.

Settle in everyone, get your 

Will: popcorn. It’s the thing that really, it’s a thing that sees their 

Dr. Paul Zalzal: ability. The eye is the thing that sees the bones. 

Will: That’s right. , I want you to, I want you to, uh, I want you to do one of the other ones. Okay. 

Kristin: Um, don’t tell me what to do. . 

Dr. Bred Weening: Come on, . I feel a glaucoma question coming.

I’m an independent 

Kristin: woman. Okay. Okay. Ready? All 

Dr. Bred Weening: strabismus. Ooh, ooh. Okay. So it kind of relates to orthopedics a little bit ’cause it. It relates to the abnormal pull or lack of pull of muscles making the eye go to the side. If I remember correctly, it’s the lateral rectus, LR6 I remember, is that cranial nerve 6?

Wow. Look at that. [00:55:00] That’s kind of cranial nerves. They’re a lot 

Kristin: smarter than you. 

Will: Did I blow your mind right there? Look at that. That’s pretty, that’s pretty nice. Yeah. 

Dr. Bred Weening: LR6. Yeah. I remember that from 

Will: med school. That’s good. That’s good. Yeah, the, the abducens nerve. Nice. Abducens nerve. Um, uh, ophthalmology, we get Because of abducts?

It, it, uh, does, yes, yes, it abducts the eye, but you can get strabismus in any direction. So it can be up and down and left to right and even a, a torsional 

Kristin: strabismus. Does it tend to just happen in one eye or can you get it in both very 

Will: commonly? Yeah, you can have it, I mean, it can affect you because you have muscles on either eye, 

Kristin: so.

Right, but like, if you get it in one, do you tend to also get it in the other? No, I 

Will: mean, there’s lots of, a million reasons you can get strabismus, but um. With 

Dr. Bred Weening: Christmas coming, it reminds me of that scene from A Christmas Vacation, where Randy Quaid’s talking about his daughter, and it’s like, it’s kicked by a mule, her eyes go cross eyed, falls in a well, they go back, you know?

One of my all time favorite movies. Is that 

Kristin: how it works? That’s what you do in the OR? Yeah. 

Will: How does, how does that relate to [00:56:00] ortho? The muscle. 

Dr. Paul Zalzal: Oh, just the muscles. Yeah. Imbalancing muscles. 

Will: Oh, okay. Alright. That’s 

Dr. Bred Weening: what happens. A bit of a stretch. It’s not blue sclera, but it’s a stretch. 

Will: Yeah, yeah, right.

Alright, you guys. One more. Let’s hear it. What do you 

Dr. Paul Zalzal: got? What do you got? Ooh. Um, okay. I’m going to pick one that, let’s see here. Um, Condromalacia patella. Look how I like saying it. Condromalacia patella. Something 

Will: about the knee. Because patella, yeah. You know, what do you think condro? I have no idea what that is.

That’s cartilage. Malaysia. A 

Dr. Paul Zalzal: small country. No. 

Will: Wait, sorry. Condromalacia. I don’t know what malaysia means. Is 

Kristin: that bone related? Yeah, 

Will: it’s like atrophy. 

Kristin: So I think cartilage in your knee atrophies, 

Will: that’s pretty close, I mean but it’s patella So it’s got to be more something more like [00:57:00] with the patella tendon, the patella, just the 

Dr. Paul Zalzal: underside of the patella, the cartilage underneath the patella is Soft not well, okay, chondromalacia patella.

It’s also called anterior knee pain. It’s also called patellofemoral syndrome and it’s It’s like 7 out of 10 knee pain complaints to the primary care physician is that. Front of the 

Dr. Bred Weening: knee, knee pain, like kneeling, squatting, stairs, that kind of stuff. 

Will: What do you 

Dr. Paul Zalzal: do for it? The mainstay of treatment is physiotherapy to balance the muscles around the patella to get it to track better and hopefully 

Dr. Bred Weening: hurt less.

Kristin: Ortho was all about bones and it is, but also they’re talking a lot about muscles. I had never put that together. I know, but like, I just don’t think of muscles when I think of ortho, I think of bone. So yeah. Very interesting. A lot of 

Will: people think 

Dr. Paul Zalzal: orthopedics. I thought it was just feet. 

Will: Oh yeah. Oh really?

You get that a lot? Yeah. Do they know that you guys don’t really care about feet at all? Yeah. We tell them. 

Dr. Paul Zalzal: Except 

Dr. Bred Weening: our colleague Danny, who’s like a foot [00:58:00] and ankle surgeon, but we mostly. 

Will: So no kidding. Like we, we legit skipped the foot. Yeah, it in like anatomy of med school anatomy like we were doing going through the whole body and then we just, at the ankle we learned the ankle bones and they’re like, yeah.

And then 

Dr. Bred Weening: there’s a foot, there’s foot cares about bunions. Move 

Dr. Paul Zalzal: on. the first world 

Will: problem. . Alright, well that was, that was good. That was good you guys. I’m impressed. Yeah. You got, I got one more, um, oh, uh, overlap that I like to, to talk about with orthopedic surgery. So one of the very few ortho ophthalmology things, um.

is if we have a long bone fracture, uh, you get, um, a fat emboli. Yeah. Yeah. That can go to the R. That’s right. Yeah, and you can you can lose quite a bit of your vision. It’s like a stroke, essentially. An eye stroke. Yeah, fat embolized syndrome. Yeah 

Dr. Paul Zalzal: That’s a good overlap. Yeah, see you got so much in common.

Blue sclera. It’s so 

Will: much in common. We’re the same. [00:59:00] We’re basically the same specialty. Actually, 

Dr. Bred Weening: I’m gonna call my secretary. I’m booking a couple of cataracts for tomorrow. Go for it. Who are you gonna be? Get 

Kristin: in there. Get your mallet and just get in there. 

Will: Um, all right, well, let’s take, uh, let’s take one more break and we’ll, we’ll come back and wrap up with Paul and Brad.

All right. We are back with Brad Weaning and Paul Zalzow. Uh, and, uh, and so what are you planning on doing with talking with Doug? How long can you keep this up? Are you gonna, are you gonna, are you going to keep practicing? Cause, cause clearly it’s taken off here and you got Paul writing sitcoms left and right, and.

Like, where is it? Where are you going with it? What are your plans? So, 

Dr. Bred Weening: I’d say we definitely want to keep doing it. Um, the feedback, like you said, has been really great. We feel like it’s providing a necessary service. We’re, we’re surprised at the, the need that it’s hit. And honestly, there are limitless topics.

Even within ophthalmology, we could probably do a hundred different [01:00:00] topics. We’d love to have you on as a guest somehow. Yeah, clearly you can. We just proved that. Yeah. Absolutely. Right. But, but then I think. Something bigger? Who knows? Maybe, uh, maybe a show. Paul, do you have any thoughts on that, on 

Dr. Paul Zalzal: a show?

Yeah, well, yeah, we want to keep going and, you know, more medical experts. But we have talked about, like, taking it, like, making a show, you know, where basically you’re educating, but, and entertaining at the same time, you know what I mean? There’s a lot of shows out there where, where they’re, you know, strictly You know, just strictly information, not a lot of entertainment or fun, and, and we want to, you know, that would be sort of a dream for me anyways, if we could just take it to the next level, make like, you know, a half hour or one hour show on every topic, you know, we’re gonna cover MI.

The viewers are going to watch the show, they’re going to laugh a bit, and they’re going to know, you know, as much about heart attacks as a, you know, third year medical student, you know what I mean? But have a good time learning about it. You know, and as you know, laughter, you know, is the best medicine, we say.

No, 

Dr. Bred Weening: Paul. It’s a good way [01:01:00] to teach people. I think penicillin is probably the best medicine. Yeah, 

Dr. Paul Zalzal: penicillin is a good medicine. Historically, yeah. You know we say laughter is the second best medicine? Yeah, 

Dr. Bred Weening: yeah. What about vaccines, Paul? 

Dr. Paul Zalzal: Vaccines are good too. A lot of 

Will: things, but 

Dr. Paul Zalzal: you know, laughter’s the third best medicine.

Laughter’s top ten. We’ll say laughter’s top 

Will: ten. 

Dr. Bred Weening: What about Viagra? 

Dr. Paul Zalzal: My actors a good match. That’s very, very, very high. Very high. How does it even know what body part to act on? Fine. Laughter’s not even medicine, right? It’s fun. It’s important part of 

Will: medicine. Yeah, until you die laughing. It’s not so good.

Dr. Paul Zalzal: As surgeons, I say we’ll have you in stitches either way. 

Will: Well, uh, everybody should check it out. Uh, it’s, uh, uh, just talking with docs. It’s good. I’m impressed by, uh, do you, how much research are you doing? Like putting these topics together? Like, do you have to do a lot of reading? Probably the further you get from, at school, you’re like researching it on your own.

Cause I do that too. 

Dr. Bred Weening: Yeah. And that was nice about doing the ortho stuff at the beginning. All of our videos were just essentially [01:02:00] talking about what you did as a job. And that’s. How we prep our guests. We’re like, you don’t have to study, just tell us what you do every day. But yes, once you start doing stuff outside, that’s where all the work is, to be honest.

The filming takes, like we didn’t run 9 percent first takes. We don’t have a script. We just kind of go and, and see what happens. But yeah, it does take a lot of work, like learning about ophthalmology, like. There’s a lot of stuff to 

Will: know. Yeah. Clearly you’ve done your homework. That’s right. Well, thank you guys for joining us.

It’s really been a pleasure and, um, it’s always good talking with orthopedic surgeons. Yeah. 

Kristin: I feel like after this, like, there, I do see your character in, in Paul and Brad here. Like you can just spend a good time with 

Dr. Paul Zalzal: ortho. Yeah. You did a good job with that character. We love him. We love him. And thank 

Dr. Bred Weening: you so much for having us.

It was awesome to meet you guys. We have a lot of respect for you, love what you guys are doing. 

Dr. Paul Zalzal: Yeah, I appreciate it. Thanks for what you do. We do love it. We do get a kick out of it ourselves. We appreciate it. And thanks for having us. This was a lot of fun. Thank you guys. Good talking to you.[01:03:00] 

Will: Alright, let’s take a look at some of our favorite medical stories. We have one story, a really nice one. This is good. Okay. Yeah. This is for you. It’s for me? Yeah. Yeah. We have a fan, a story from Alex. Okay. Alex says, uh, writing in to say a little thanks. I just listened to your podcast episode with Dr.

Lindsey Fitzharris and Adrienne Teal. At the end of the episode, I had a little. Today I learned a moment where Kristen made a remark that media is the plural form of medium. That’s right I remember that. Yeah, well, Alex didn’t know that. I’m sure a lot of people didn’t know that. Yeah, I never He said I never put that together in my 30 years of life.

Thank you, Kristen. The more you know 

Kristin: Happy 

Will: to help. What a wonderful thing that you did for Alex. Thank you for the email, Alex Uh, and, uh, send us your, uh, comments or stories or anything. Knock, knock, hi, at human content. com. We want to hear from you guys. Uh, thank you for joining us. Um, what a fun episode.

That was 

Kristin: [01:04:00] super fun. I feel like they lived up to, to my expectation. Ortho’s my favorite character. It was the, so they really, they lived 

Will: up to it. And they were the, uh, that was the first, they were the first orthopedic surgeon guests we’ve had on our podcast. So, uh, I can’t believe it took us this long to get to Ortho.

It’s it’s I don’t know 

Kristin: why 

Will: no reason in particular you like every ortho is would be a fun guest Yeah, I feel like it so many ortho. Have we had a urologist? I know they’re gonna be fun, too We have to look we have to think about that. Yeah, 

Kristin: I don’t know I’m trying to feel like we did but then I’m like I feel bad if I 

Will: forgot You know off the top of your head 

Kristin: Yeah, 

Will: but uh ortho urology what are the other really fun Emergency is fun.

We’ve had some emergencies. I mean, they’re all fun in their own way. But some of them just have the most They’ve got like an energy. Yeah, and very interesting personalities. Yeah. And really good stories. [01:05:00] Right. Um, so that was great. And again, that’s just Talking with Docs. Definitely check out their YouTube channel.

Great stuff there. What did you think of the game? 

Kristin: You know, I had my doubts at the beginning, but it turned out to be really fun. I think they saved it for you. 

Will: Oh, come on. I think it was fantastic. No, it’s really good. Yeah. I got to learn a thing or two about bones. That’s right. I don’t get to learn about 

Kristin: bones very often.

See, even when med students grow up, they still, like, they still seemed like just big grown up med students, right? Like, they wanted to get it right. They were worried about how much they could remember. 

Will: Well, we, you know, we try to do a game for every episode and it takes a lot of like and mental energy to come up with games.

Yeah. So if you guys have ideas for games, let us know. Lots of ways to hit us up. By the way, email us, knock-knock high@humancontent.com. You can visit us on our social media platforms, which are all of them, and you can hang out with us in our Human Content Podcast family on Instagram and TikTok at Human Content Pods.

Thanks to all the wonderful. [01:06:00] Feedback you guys are giving us, so we’d love those. Uh, getting good feedback on Knock Knock. I, as well, I’m struggling. It’s a little 

Dr. Bred Weening: late. It’s the end of the 

Kristin: day. Yeah, we don’t normally record at this time, so 

Will: we’re I spent all day, uh, in clinic. Mmm. I saw a lot of patients today, so I’m a little tired.

That’s okay. I’m not too tired for our listeners. Uh, if you subscribe and comment on your favorite podcasting app and on YouTube, we can give you a shout out. Like today, we have a comment from Uh, Stephanie Smith 0 on YouTube, who said, I love that you were doing a podcast about ophthalmology with Knock Knock Eye.

Thank you! People like the eyeballs. Yeah! 

Kristin: I have been surprised at the amount of interest people have in eyeballs, but they really, 

Will: really do. You’re surprised people are interested in the thing that I’ve devoted my career to? Well, 

Kristin: it’s just that eyeballs are icky, right? Like, a lot of people have an eyeball You know [01:07:00] this, that’s why very few students go into ophthalmology is because a lot of people can’t take the eye, but they are fascinated 

Will: by it.

Ophthalmology is fun, everyone. Okay, I don’t know what she’s talking about. 

Kristin: I didn’t say it wasn’t fun, I just said like, there’s that barrier of people don’t like the idea of touching eyeballs. They are 

Will: a little slimy at times. I’ll give you that. Uh, full video episodes of this podcast are up every week on my YouTube channel at DGlockenflecken.

Patreon, lots of fun perks, bonus episodes, where we react to medical shows and movies. You can hang out with other members of the Knock Knock High community. We’re, we’re growing. People are moving to us. They’re moving within our city limits. Oh, wow. 

Kristin: Yeah. We’ve got city limits. Do we have 

Will: all the amenities?

We do. We’ve got a movie theater. Uh, we’ve got a community center. We got several restaurants, and some of them are good. Interactive Q& A livestream events, early ad free [01:08:00] episode access, and much more. Patreon. com slash Glockenflecken, or go to Glockenflecken. com. Speaking of Patreon community perks, new members shout out to Dr.

Funky, William S., Ryan Dimitar, Mary D., and Aviga. Those were fun ones. Those are fun ones. Uh, and shout out to, as always, to the Jonathans. We have Patrick, Lucia C., Sharon S., Omar Edward K, Steven G, Jonathan F, Marion W, Mr. Granddaddy, Kaitlyn C, Brianna L, Dr. J, Ross, Boxchaber W, Leah Deed, K L, Rachel L, Anne P, Keith G, JJ H, Abby H, Derek N, Jonathan A, Mark, Mary H, Susannah F, Mohamed K, Aviga, and Pink 

Dr. Bred Weening: Macho!

Will: Patreon roulette, random shout out to someone on the emergency medicine tier, we have Justin! Thank you, Justin, for being a patron. Happy to have you. And thank you all for listening. We’re your hosts, Will and Kristen Flannery, Special thanks to our guests today, Dr. [01:09:00] Paul Zalzow and Dr. Brad Wiening. Our Executive Producers are Will Flannery, Kristen Flannery, Aron Korney, Rob Goldman, and Shahnti Brooke.

Our Editor in Engineer, Jason Portizo, as music is by Omer Ben Zvi. To learn, and now this is the part for all of our patrons, because we know that they like to listen to the very end of this. They told us. They do. They told us that they’re waiting for this. To learn about our Knock Knock Hyatt Program Disclaimer and Ethics Policies, Submission Verification, Lengthening Terms, and HIPAA Release Terms, you can go to glockenspoken.

com or reach out to us at knockknockhyatthuman content. com. With any questions, concerns, or any fun jokes you have, puns, or blunts, or games, or games, or games. Good to talk to you. Knock, knock, hi, it’s a human 

Kristin: content production. Goodbye. Hey, 

Will: Kristen,

you ready for the holidays? 

Kristin: I am. I’m excited, but I’m also a little nervous because it’s a really busy time of year. 

Will: We don’t [01:10:00] have time to do anything. I know. And it’s really hard for physicians around 

Kristin: the holidays. Yeah, everybody trying to sneak in before January. Everybody, 

Will: everybody wants an appointment.

And so you’re just, you’re pressed for time. You have to multitask and just try to get it, fit it all in. That’s right. You know, with work and with home life and everything. But you know what helps? What’s that? 

Kristin: DAX. Oh, yeah. Saves 

Will: you some time. The Nuance Dragon Ambient Experience, or DAX for short. It’s great.

It sits in the room with you and helps you with the documentation burden. So it’s like one less thing you have to think about. 

Kristin: Yeah. And it helps you connect with your patients better, which is always really important, especially around 

Will: the holidays. Absolutely. We need to turn attention back to the patient physician relationship.

And you should ask for it. Ask your company for DAX. Like who wouldn’t want a little DAX? Like a little Jonathan, just hanging out with you around the holidays. It’s fantastic. To learn more about the Nuance Dragon Ambient Experience or DAX, visit nuance. com slash discover DAX. That’s N U A N C E dot com slash [01:11:00] discover D A X.