← 🎙️ Interesting Humans Podcast
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- [00:01]
Jeff Hopeck
All right, folks, welcome back to another episode of Interesting Humans podcast. My name is Jeff Hopeck. I'll be your host today. And I've got an incredible guest here, a remarkable human being by the name of Dr. Armando Sardi. Doc, thank you for being here.
- [00:16]
Dr. Armando Sardi
Thank you for the invitation.
- [00:18]
Jeff Hopeck
And folks, back on episode 39, a friend of mine I interviewed, it was titled the mother of all Surgeries. His name is Gary Young, and if you remember his story, he had under undergone a procedure that was 14 hours long. And one of the highlights from it is that he was put onto what he called is like a rotisserie and rotated around after being filled with scalding hot chemo. And the doctor who performed this surgery is sitting here today. We're going to hear from him. So, Doc, I just, I can't. It's remarkable what you've, what you've uncovered with this Hypex surgery. Truly, truly remarkable. And I want you to start off by telling the listeners what is it and what is it about?
- [01:04]
Dr. Armando Sardi
Yes, the patients with advanced cancers in the abdominal cavity. These are patients with colon cancer, pancreatic cancer, small bowel, appendix, gynecological cancers, ovary, and so on. Frequently when they get out of their organ, they metastasize or they spread inside the abdominal cavity. So it's like a room that everything gets stick around. So this is a stage four cancers, really. Systemic therapies have very little place on this. It helps in some cases, but unless you remove it, people are not going to do well normally. And Even today, after 35 years that these treatments have been available, patients are told that nothing can be done, that the only option is chemotherapy. What this surgery includes is really two components. One is surgery with the idea to remove all visible cancer. If you imagine it's a lot of cancer everywhere in every organ, you frequently will remove organs or clean organs, depending on what's happening and what type of tumor it is. And then after you get to that point, clearly there are going to be cancer cells floating around that you don't even see. So heat comes there. Heat kills cancer cells and enhances the effect of chemotherapy agents, some of them. So we actually put some catheters and then we bathe the abdominal cavity inside with this heated chemotherapy for 90 minutes and the patient is shaking and move around, not rotate, but move around the operating room table in all directions patients to make sure that the heated chemotherapy reaches all these surfaces where cancer cells may be harvested.
- [02:53]
Jeff Hopeck
Okay, now it's safe to say that every day a certain amount of people probably in the thousands, maybe even higher, are being told from a doctor somewhere to go home and die. Is that correct? Is that the way it works?
- [03:09]
Dr. Armando Sardi
Oh, correct, yes. And there are many patients. You know, I even recommended doctor Assisted suicide in other countries that. That is available, like Canada. And so it's sad now, again, this is not an operation for everybody, but it's something that is very important that physicians and patients know about it. That is a potential option for many patients.
- [03:31]
Jeff Hopeck
Yeah. Okay, so I want to talk a little bit about Gary's story. So Gary was told by two surgeons that, just like you said, doc, he was told to go home and. And get his affairs in order, I guess, is the way they say it, and that he had a year, a year to live. And then something happened, and I don't know exactly what it was, but he got connected to you. How did he find you? That was 11, 12 years ago.
- [04:01]
Dr. Armando Sardi
This is something that is very interesting because thanks to Dr. Google and Dr. Facebook, his wife. His wife Amy, actually look into it. And, you know, he was kind of given up already, and his wife found doctors and then came and interviewed with us and other people and decided to come here. You know, actually, we have become very good friends. He's even a member of our foundation, and he's been very active in helping to spread the word that this procedure is available for a lot of people. But he did go to a major university institution and was told that nothing could be done. And actually, that happens very frequently. Yes.
- [04:45]
Jeff Hopeck
Yeah. So he gets to you. They get connected. They go up. They come up to Baltimore, because we're in Atlanta. They come up to Baltimore, they meet with you or. How did that work? A couple hours together.
- [04:58]
Dr. Armando Sardi
Yeah. Patron comes, we examine them. They will sit down as much time, for as much time as is necessary to discuss the treatment. They know that this is a big operation. Not everybody is going sail through. In fact, he had a tough time for a while after that. But the idea is that if we support people through that acute episode, people do well and, you know, you talk to them, you explain what it is. Frequently there are patients here who usually are, as. I've been doing this for over 35 years now, 32 years. You know, we have patients here that we follow that can connect with other patients that tell them how. How things happen for them and their experience, which is very helpful. So we made. We met, and he said, I want to do it here. He went to other places that. I don't recall where they were. And, you know, something like, about the place here that he wanted to come here, and I am glad he did. It's been an honor to know him as you know him. He's an extraordinary person. You know, I think I benefit more from him than he did from me, but it's been a very, very interesting relationship.
- [06:10]
Jeff Hopeck
Yeah. So here's. So here's a guy who was told by two great surgeons to go home and die, and we're now post 11 years. This procedure has given him an additional 10 years. And I saw him at the golf tournament, and you saw him at the golf tournament. And it looks like he's going to have a lot more. A lot more time.
- [06:33]
Dr. Armando Sardi
Right.
- [06:33]
Jeff Hopeck
At the end of the day, those are the numbers that we have to work with.
- [06:37]
Dr. Armando Sardi
Yeah. And that's, that's why we do that. I mean, we had over 600 people alive, you know, that are doing very well that I've been doing through the years. My. Some of my partners do it as well. And, you know, seeing people like him enjoying life, running their business, having fun with their family, I mean, it's an honor to see that. Yeah.
- [06:57]
Jeff Hopeck
So, okay, let's go all the way back because you've been a surgeon for a long time, not just doing this hypic, but you were practicing before. So I want to talk about what were you practicing before? And then what happened where you said, I'm going to start. I want to start doing this procedure. I have no idea how it works in the, in the medical community if you have to start a trial. But sort of walk me through before what happened to get you excited or interested in hipec. Right? Let's talk about that.
- [07:29]
Dr. Armando Sardi
Yes. I'm from Colombia, South America. I did my medical school in Colombia. Actually, you have to make the decision whether you go to a career right after high school. It's not like you go to college and think about it. I love physics and calculus and I want to do a computer engineer, systems engineer. And in those days, as you may recall, you're probably too young to remember that it was a whole computer where the size of a room, we have punch cars. And now to understand that these phones that we work with all day are more powerful. Those big computer. For some reason that I cannot explain why two months before I graduated, say, wow, I'm going to be a doctor. And I took my exam. I don't know why I made that decision. You know, and it was the best decision I have been in my life. You know, everything went. You know, I am. I believe in God, and I really feel that I'M an instrument of God in many ways. And that, you know, it must have been because I never, I mean, in my life, I was never, I mean, I never thought in my life as a doctor growing up. And again, it had been spectacular. Then I came to the States to do a training in general surgery, which is another five years, seven years first and five years of general surgery. And then I went to Ohio State to do two years of surgical oncology, which I was very fortunate because I always have been aggressive in my up, you know, and very upcoming in life. But I had the opportunity to train with two great surgeons there that were very aggressive with recurrent colon cancer, stage four cancers, when people were sent home to die. And I, you know, learned, wow, people are alive many years later when the book says the opposite. And that is not so. Then the year, you know, then I finished my training, I went to the Austrian clinic in New Orleans. They were doing those big operations. And then I end up back in Baltimore where I trained. And then I met Dr. Sugarbaker, you know, who started this operation about three or four years before me. And the Japanese started two years before. So this treatment had been around for 35 to 36 years now. And then I said, wow, what he's doing makes sense. Which is giving heated chemotherapy after we remove all the tumor, however highly controversial at some point. We were about six people in the world in the early 1990s doing this and has grown now exponentially because of the talks and the publications. But I am always open to new ideas and especially if you're helping patients. It's something that I love to do and I always had the opportunity to have the opportunity to train with excellent surgeons who gave me obviously the mentoring necessary to. To do it.
- [10:40]
Jeff Hopeck
Yeah, sure. What kind of strides have been made since the first procedure that you've done 30 plus years ago, up until now.
- [10:50]
Dr. Armando Sardi
I mean, the big thing is probably the technology development other than understanding more the disease and which will be help and who we cannot help. I mean, we used to have to tie things, you know, cut things tight, you know, and taking a long longer. Now we have these instruments that not only speeds the, you know, how you do it, but you can put bowel together easier than you could do it by hand, faster. So in an operation that in an average today, after many, many of these surgeries have done over, you know, 1500 of these surgeries we have, you know, takes eight to 10 hours. And sometimes some of these operations took 15, 16 hours, you know, and that's all you just Go until you finish. So all these new devices had help us to be more effective and faster acting in doing the operation. The also the understanding of the heated chemotherapy, you know, who should do it or should not do it, quality of life. Because it's not about a procedure, it's about a patient with cancer. It's not a cancer. Right. So you always have to focus. Everybody's different, everybody behaves different, and the response to therapy is very different. Even the attitude of patients towards what is going with them is very different. Some people are very proactive and it's not a, you know, they just want to do whatever is necessary to get them to the next step. While other patients are complaining about why them, why not someone else? And those people usually don't do very well. It's a very interesting learning experience. But that's been the major changes. Still, we are now cooperating with more groups around the world who do that. Actually, in two days, I'll be in Colombia, my country, giving a talk to the national surgical oncology organization to talk more about the technique and so younger physicians can be more proactive and learning how to do it better.
- [12:54]
Jeff Hopeck
Right. Wow. So when people come and see you, do you notice there's a particular tipping point when you're meeting with them and as soon as they hear one particular thing, they say, okay, now I'm in, or they say, okay, now I'm out.
- [13:15]
Dr. Armando Sardi
Yes. I mean, most of the patients to get to us are coming like the life last resort and coming to us because they are looking for someone who know, understand their cancers, understand this treatment. They already in some information out there that patients at least get some communication. So they are looking for the last straw. I said, and so usually they come with a family member, which we always encourage, because some people you can hear, you know, you can talk to them for an hour after you, you know, an hour a week later, you tell them, hey, we talk about it. Hey, you never talk to me about it. So, you know, it's always good to have a family member accompany them. And I always tell them, you know, this is the operation. You have to be clear about it. It's a big surgery. It takes 10 to 12 days in the hospital and takes two months to full recovery. Now we as a center are available 24 7, which is very helpful because these patients need to do that to the point that when people come out of town, I ask them to stay in town for an extra week just to make sure that we take care of any potential problems that can happen in the Initial, post operative period. Because sometimes they go to their hometowns and the doctors there had never been, had not even heard about this. And they don't know how to deal with the patient. And they look at the operative note of, you know, 10 hours of surgery and all these procedures in one surgery, they think, oh, you're going to die, forget about it. You know. So we have very developed a program of support because that is extremely important.
- [14:57]
Jeff Hopeck
Okay, so that's interesting. What, what are you finding when, like when people come to you and they say I'm in Doc, I, I'm, I'm doing this. What do you find in like for next exact steps? What do you see them doing? Do you see them going home, taking some time before the procedure? Or is it, I mean, can you do this tomorrow? Since I'm already committed, yes.
- [15:27]
Dr. Armando Sardi
I mean most of these procedures are not emergency. So even people can wait several weeks if necessary. In fact, because of the scheduling and insurance approval, you need at least three or four weeks just to get that through. For example, Medicare after 35 years only this year have a code about the surgery. Just to give you an idea, many insurance do not approve it. Some patients, especially out of state, pay out of pocket. You know, coming from Canada, they are, they are paid, paid a full surgery because they don't, otherwise they're not going to do well. And so it's, you know. But some patients sometimes want to talk to other physicians. And I said, I think it's very important because the doctor that you is going to take care of you has to be your friend in the sense that you need to believe in that doctor and be committed, understanding what they want to do because otherwise you will not do well. And I said, I encourage them if they have two or three other consultations to do that so they can get the right information. So but we, let's say they say yes, we are in and looking at everything. Look like you are ready to go. We all schedule two or three or four weeks later, give it a time, because it's a whole day surgery. We start at 7:30 in the morning and we finish when we finish. And there is always a lot of tumor, a lot of cancer. So it's very easy to give up. You open up and say, oh, what I'm doing here? So you need to start slowly, meticulous, to start doing without creating problems. Because we can always do harm if we don't do what, we don't know exactly what we're doing or we don't do it right. You cannot Start cutting things without know that you can fix those, you know, things that you can't. Right. So you have to be very meticulous and make sure that you are in the right doing the right thing. And you work and sometimes take three or four hours to know whether you're going to be able to do it. And then before you know, you say, wow, this is amazing. It happened, you know, and now we use frequently laparoscopy. Laparoscopy is a way that we can look through a little incision, you know, tiny little 5 millimeter. We look inside with the camera, try to figure out where they have a good opportunity to remove all the tuber, you know. Now it doesn't apply to everybody. And if patient had multiple surgeries before, like frequently happens, that is going to be very difficult to do. But we use that more and more to help patients to have this surgery without going through a big cut and say, oh, now you have a big cab, but we cannot help you. And then delays any other further therapy that may be necessary.
- [18:17]
Jeff Hopeck
Yeah. What does the misdiagnosis part of this look like? I know Gary's story. What do you see? Typically all the same thing or is it a range?
- [18:29]
Dr. Armando Sardi
It's a range. I mean, depending on where you go. Some people actually have, for example, the appendectomy and sent to us right away or. Or they see disease right. All over the place. And doctors who are already seeing our results or the results of other centers send it to us right away. Because you understand the limitations. Because for those gastrointestinal cancers, chemotherapy has very little benefit without surgery. So they understand that now all these patients get surgeries and chemotherapies and they are sent to us when nothing has worked for a long time. Now you are dealing with debilitated patients, patients with a lot of problems, some of which we won't be able to help because they are so debilitated and so many problems have occurred already and toxicity from the therapy that they are not able to. So it's a wide range and depends on how they get to the right place at the right time. Now, these are all advanced cancers, stage four cancers which know usually again, goodbye my friend. But many patients can be benefit by getting to the right place to do it. And if you do get there at the right time as a first option for treatment and it's possible to do it, that is the best option.
- [19:51]
Jeff Hopeck
Okay, that makes sense. What you mentioned the word appendectomy. Just. Just clarify what. What is that? That's the removal of the Appendix, the appendix.
- [20:00]
Dr. Armando Sardi
Actually, appendix cancer is a very rare cancer. But this procedure, that procedure applies a lot to these cancers which even though they are rare, there are many out there and they have been in increased incidence in the last several years. I don't know if it's because of recognition or not, but the appendix is attached to the colon, but behaves very different to the colon Cancer doesn't respond to chemotherapy very well. And it presents with a perforation that is called the jelly belly or is like a mucin, a jelly that is spread to the abdominal cavity without people recognizing until it's too advanced. Sometimes they present with appendicitis. So they go to general surgery, they cut the appendix and they find the cancer. And then at that time is the best time to refer because there are different kinds, but some of them present with advanced disease, like Gary did. And I told, oh, my friend, nothing I can help you with. And that is not correct.
- [21:04]
Jeff Hopeck
Yeah.
- [21:05]
Dr. Armando Sardi
So appendix cancer is rare, but it's actually the standard of care procedure for these cancers. And it is for mesothelioma, but also it has a lot of impact now in ovarian cancer, fallopian tube cancers, gastric cancer. And today I saw a follow up on a patient with pancreatic cancer, which is extremely rare. And she's two and a half years out after, you know, she had failed all these systemic therapies before. And she's excited and the husband, you know, is a pilot and they are going to Italy to travel now. And with a disease that even on earlier stages is usually fulminant and. But, you know, this happens and, you know, seeing that is very joyful.
- [21:51]
Jeff Hopeck
Yeah. Wow. All right, pick us. Pick a story. Walk me through the whole thing, start to finish. Maybe it would be like a case that you can never forget or one of your favorites. Tell me the. Tell me the whole story.
- [22:05]
Dr. Armando Sardi
Oh, there are many. I mean, one of the. Probably one of the best things that I could remember is that, you know, children coming to me and say, hugging me and say thank you for saving my father or mother. I would not have been born. And actually the person who managed our foundation now is a young man that at 27, had cancer. We did his surgery. He's now six years out and he already had a two year old girl. But probably one thing that I remember about cancer, that that lady didn't have hype. It's many years ago, but I did a major surgery for recurring rectal cancer. You know, removing bone. I mean, it was five years later, she got A obstruction. And it was the day before I went to Europe on vacation with my family. And I ended up operating on Friday night. And it was a difficult operation. She was very unstable. But the chief resident at that time said, oh, let her go. We cannot help. He said, no. I said, she's going to be fine. Don't worry. Let's work on it. And, you know, everything went good. She was very light because of the, of the, you know, she was very unstable. Blood pressure was not good. And she went to the ICU and recovered very quickly that night. And in my way to the airport the following morning, I stopped by and the first thing that she said to me, say, Dr. Sarthik, what are you doing here? You need to rest, go home and do vacation. I'm going to be fine. He actually left the hospital seven days later. But I was concerned. I mean, say, wow, it's amazing. She's worried more about my health than her health, health at this time. And she, you know, and that's what I found. People care for you. You know, I have my, my boats of, you know, hard stains and all that. Actually, I have five stents on my heart already. But, you know, life goes on and people are more worried about how I'm doing that. That's them sometimes, and they really care for you. Is that it? So there are, you know, some very interesting stories along that way. And, you know, again, patients who. I was playing golf the other day, she had this advanced cancer with multiple nodes. And she said to me, you know, 10 years ago when I came to see you, 12 years ago when I came to see you, I spoke with a patient that was 10 years out from the surgeon and say, wow, I never gonna make it. And here I am 12 years later playing golf with you. What an ear. So you see, so I mean, when you hear that, and you know, I'm 71 years old and I feel like I'm, you know, 40, you know, just joking, but, but it really, it's, you know, seeing people doing that and it's very difficult to retire because it's really an honor and a pleasure to be able to do that. And, you know, that's.
- [25:09]
Jeff Hopeck
That'S so awesome. Do you see this? Do you see the future of Hypec being spread across the world and in, in, in physicians in other countries and continents learning this? Or do you see all these cases continuing to come to, to America for just a future growth of it?
- [25:30]
Dr. Armando Sardi
I mean, it's actually already happening around the world. Latin America, Asia, Europe, you know, and even In Canada they do it, although they are not very aggressive. And there is no misconception about who should go and not to go. This idea that if you have too much cancer and there is a way to measure that called peritoneal cancer index or PCI and they said, oh, if I bought 12 or 20, you should never do that. That is not true. Because the only chance that this patient have that if you remove all the cancer, even though if you have more cancer it may be more difficult, take longer and the result may not be as good as less cancer, you still save a lot of people that otherwise will not be safe. Like Gary, for example. Like Gary, you know, he had a very high number that today people say, oh, we wouldn't operate on him. So it depends on where you go to, to the point that now in our foundation we recommend that everybody gets at least two expert opinions because I may say, oh, I cannot help you. But there's another one that can actually help for a variety of reasons. So it's very important that you actually get that information, understand what it is. If you are telling no, why is now because they're, you know, but again, we cannot help everybody. And again, these are operations that can hurt people if you're not careful. Like any treatment.
- [26:55]
Jeff Hopeck
Sure, sure. Is there an organization out there that's, that's speaking that kind of language to the, to the patient saying hey, I know you're going to XYZ Hospital, but make sure you're get, make sure you get two or three. Did you say looks or professional opinions. Is, is anybody telling them that? Because I, I could see it where they go to the hospital and the doc says one thing and most people are going to say okay, you're the doctor, you know better.
- [27:26]
Dr. Armando Sardi
Yes. And actually many people do that. However, there are a lot of patient led organizations that have been going on for a long time for appendix cancer, PNP, pulse, ACPMP, there's a FaceTime group which you know, talk a lot about with the patients. So but again, everybody's working as a silo, you know, it's kind of independent. So one thing that I'm trying to do, which people tell me I'm crazy, but I think is the, in my opinion is the only way it's going to happen. Working together and creating this web of information. So my foundation, the abdominal cancersalliance.org what we do is we're trying to connect all these organizations so without people losing their identity, we can communicate. Because ovarian cancer groups talk different to the gastrointestinal cancer groups, colon cancer groups. Just imagine the power of the people connecting, like we're doing now, to spread the word of something that can save a lot of people. We are treating today the minority of the people, and I will say probably less than 1% of the people that are potential candidates for this operation. Now that's an estimate, but based on my practice, because I see a lot of people that were told nothing could be done and there are many over there that what we're trying to do with the foundation is connecting those organizations. So we all start creating this web of information that makes it more easy identifiable or found by patients who get into with this diagnosis. And you know, that's. People tell me I'm crazy, but I'm determined to do that because if not, I mean, I've been doing this for 32 years. I started in 1994 and we still see the same problem today that we saw that long ago last week. I did the chemotherapy for free because insurance on someone who is well insured refused to do it for a patient with sarcoma of the uterus. When we know that even though they are not prospective trial because the people who are treated with chemotherapy alone, they all die. But we have many patients now follow for over 15 years. And we even did a study with other groups around the world showing the benefit of that. But insurance refused to pay. So I had a decision, Okay, I refuse the surgery and don't get paid and don't get do more surgery or I do the surgery and. And don't get paid. So I, as a physician, I refuse to believe that just because someone cannot pay and I'm going to help them. I mean, fortunately, I have created my philosophy that medicine, yes, is a business too, probably, but I never really went like a business part of it. And you have to try to help people. And sometimes it's possible, sometimes it's not. However, hospitals cannot absorb, you know, many patients without payments because then you break the system. Right. So it's a complex area. But fortunately we were able to help that lady. She did extremely well, went home within seven days. And it's a young patient which hopefully will see her for many, many years to come here.
- [30:56]
Jeff Hopeck
Wow. And that wasn't hypic, that was, that.
- [30:59]
Dr. Armando Sardi
Was a hypec was a high peg for a sarcoma of the uterus, which is a very aggressive cancer which once you spread out of the uterus, people don't do very well. And you know, we have people alive playing with us golf too, because there Are a lot of golfers. You know, golf I think is a, is a social thing that I started doing when I was in the 50s. So as you can imagine, I'm not a very good golfer. I enjoy it out there. But many patients communicate and you know, we do this event on September that people join together. You know, it's best ball. So everybody had fun for a good cause.
- [31:34]
Jeff Hopeck
Oh, that's wonderful. So what's a list of cancers then that this works for and then also then that it doesn't work for that you would say no to somebody.
- [31:45]
Dr. Armando Sardi
I mean the number of groups are pretty much gastrointestinal gynecological cancers. Now more specific was appendix and standard occur mesothelioma is the tender of care. So for Colonial Works, although there is some controversies, but the big surgery to remove all the tumor is the way to go at least even if the chemotherapy is not added. But there is studies showing the benefit of it. We have small bowel cancers, we have some gastric cancer, we have gallbladder cancers, we have some appendix pancreatic cancers and then the gynecological cancer. There is a 10 year follow up study that showed that if you do the surgery with cancer, the HIPEC or the heated chemotherapy people and then systemic chemotherapy people are going to do better that if you don't do that. And there is a prospective trial, you know, large study groups comparing both groups showing the benefit of that. But you know, or you know, to even today, most women with gynecological cancers, they'll get to this treatment even though now we have a very good study showing the benefit of it. The other thing that we have found actually unfortunately is because all these cancers as you imagine the abdominal cavity is like a room, everything is kind of exposed to and even there is fluid that circulates around. It's a normal circulation. So once all these cancers breaks out, it's going to see it everywhere. And one of the common places is the ovaries because it's dependent and it's the only organ that doesn't have coverage from mesothelium, which is the petone, you know, doesn't cover because the ovule has to be released and go to the tubes and get pregnant, you know, when, when that happens. So and the ovaries have a lot of blood supply so they can become very large as coming from cancers of the ovary. But also even if there is a cancer from the appendix or the colon or the pancreas that went there, they can grow even bigger than the tumor. Where they came from, and they're mistreated many times as ovarian cancers. And then they get big operations, removing only part of the tumor, leaving a lot of tumor behind, making more difficult the next operation or. Or sometimes even impossible. So that's something that we're trying to educate other groups to say. Listen, if you see this, don't jump into the conclusion that it's necessarily an ovarian cancer just because it's a big ovarian mass. Do a laparoscopy, take a biopsy, see what's going on, and then refer the patient with the appropriate diagnosis to the right center who is going to do the best for that patient.
- [34:33]
Jeff Hopeck
Is this exception accepted fully by the insurance companies and other, I'll call them, peers and colleagues out in the medical community, or is there pushback from anybody?
- [34:46]
Dr. Armando Sardi
Yes, as a pushback is changing. But, you know, many gynecological oncologists, even in major center, don't believe in this, even though there are data already showing that laparoscopy, of course, is approved. Because now we try to do minimally invasive surgery, which is sometimes overuse, to treat cancers that you can't do that way because it's just too much like these cancers. But the idea is make the appropriate diagnosis and then make sure that the patient gets to the place where they're going to be treated the best way they can.
- [35:22]
Jeff Hopeck
Yeah.
- [35:24]
Dr. Armando Sardi
And that is true for any treatment of anything. You have a brain tumor, you want to go to the place who do that, make it appropriate diagnosis. Don't start doing therapies that are going to complicate and create more problems for the next definite treatment.
- [35:39]
Jeff Hopeck
Yeah, yeah, that makes sense. I want to. I want to take a walk inside the operating room now. I want to try to. I want to try to get there mentally. So it's my day of HIPIC procedure. I come, I check in, I'm brought in. Like any other procedure, I'm guessing when I come in the. Or do I see 20 people? You mentioned a lot of teams go into this. What does that all look like on the day?
- [36:07]
Dr. Armando Sardi
Actually, it has been a change over the years. And many years ago, we used to bring the patient the same day. Had the bowel preparation at home, people coming from out of town. It was difficult. They had a lot of problems. So we admit now every day before, I had to fight with insurance company to approve that because you, you know, people need a lot of calm. This is a big operation. It's like running a marathon. You need to be prepared for that not only for the several weeks before that, not only mentally, but physically, but also understanding everything that is going to happen. So we bring it in the day before, not only to prep the bowel, but they see physical therapy so they understand that we are going to get them out of bed the first day, whether they like it or not. You know, they see respiratory therapy to understand that they need to breathe in appropriate way. And we show them the, you know, the mature machines that need to blow into to get them, you know, make sure that the lungs don't have problems. We get someone to mark a colostomy. You know, some patients may need a bag for stool for the rest of their life or temporary, so they get marked for potential sites. Because as you imagine, if you have a colostomy, which is a bag where the colon or the small bowel comes through, the stool comes into a bag, it has to be placed in a very good place. Otherwise, for quality of life is an issue of leakage of stool around. So they get marked in the best potential site if we have to do that, which is the minority of patients. But all those things are things that affect the quality of life. Now, this is after we have spoken to them in the office, gave a lot of information. We encourage them to talk to other patients that had the same diagnosis and hopefully similar age. They're already mentally prepared to what to expect, but that way, the next morning they are taken to the operating room anesthesia meet them the night before as well. So they go to the operating room the next day already with their mind kind of at peace. Now, of course, there's a lot of things. They get some sedation, so they hopefully forget most of that. But at the operating room, we have the anesthesiologist, we have a scrub nurse that work with us, we have a circulating nurse, and then we have one or two PAs with me or one of my partners that we work together and the surgery starts and again we finish when we finish and then the patient after that. Usually we try to get the tubes out. They are going to end up with a lot of tubes to drain fluid, because we give a lot of fluid to protect the kidneys. Kidney failure could be a problem. If you don't hydrate them very well, they get swallowed. But within two or three days that goes away. They have tubes in the chest, they have tubes in the abdomen. They have a Foley catheter, they have a nose tube. They go to recovery room and then after that they go to the intensive care unit. They stay there usually one night and next day, like the lady that I did yesterday is up in the floor today, already out of bed talking and you know, obviously a little sore. But we get pain medication as well as some local anesthesia for the last. About. Last about 3 days to improve the pain management, which is also, as you imagine, this is a cat that goes from your chest bone all the way down to the pubis, you know, so it's the whole abdomen. And so it's a painful operation, but, you know, and then patients start, you know, we get them out of bed next day and get them moving, breathing, and we see them every day, every. They see us every day with not only ourselves, but also the PAs and nurses, which at my center here, they love what they do. I mean, the nurses are just amazing. You know, they really, you know, I mean, I really, I'm honored to work with this team like that. They just, they just love what they do. I do the easy part, they do the tough part. I can tell you the recovery of these patients, staff, but that's it. We actually tell the patient families, go home. If they are in a hotel, go home. We'll call you every two hours. The nurses will call them in the OR every two hours so they know that things are moving along. When we are doing the heated chemotherapy, which is after we remove all the tumor, then that's when I go out and eat something. The patient gets close, just the skin, and we check them and the operating room moves in all directions to assure that the chemotherapy kind of lies, touches all the surfaces. And then after that we open up and we connect everything that has been disconnected and then we close back up. And then patients go to the recovery room. But then when I finish, I call the family or if they are here, I speak with them. If they want to come and talk to me directly. They do. Most of the time we, we tell them, listen, patient is going to be sleep for another three or four hours, just, you know, rest, because you're going to be rested for the next few weeks to help them. And they usually do that. And. But we establish a very good contact with them. And after, you know, 10 or 12 days, when they leave the hospital, we give them a 24, 7 number to contact with us if any problem happens. And so that way we are sure that patients are going to do well.
- [41:33]
Jeff Hopeck
Sure. What is it like, are you taking organs out of the body? Are you physically putting them on a table?
- [41:42]
Dr. Armando Sardi
I mean, we take. There are organs that cannot be safe if you have to remove the right colon, because it's involved. You remove the right colon, sometimes a lot of the small bowel, frequently direct on over his uterus, spleen, gallbladder, and then clean all the surfaces. You cannot, you know, just can really peel that, that layer of tumor then, and then, then that's it. So that takes as long time, as long as it takes. Of course you are looking about quality of life. You need certain amount of a small bowel to have a good quality of life. You know, you can live without colon, but you need at least 2 meters, you know, of mobile to at least absorb food and not be dependent on IV food. But again, many times we can save a lot by doing, you know, cutting pieces and putting together several of those. Now we don't put anything together until after the heated chemotherapy with everything is swell and so on, but that way we make sure that all the surfaces get washed with the chemotherapy. If you connect it before you do that, you may entrap cancer cells that will grow in the, in the areas that you join together and create recurrences that hopefully shouldn't happen. So there's a lot of technical aspects, but. And you know, again, we can do a lot of things, but it's about quality of life. You know, if I, if I do an operation and the patient cannot, you know, eat well, they are miserable for the rest of their life. Then you know, and you know, this is true for any treatment. You know, we cannot cure everybody, you know, and you know, we tried and we would like to do doesn't matter whether surgery, chemotherapy or radiation. At some point we have to say no more. And actually, it's interesting now that you asked me, what are the interesting cases that you can remember?
- [43:39]
Jeff Hopeck
Yes.
- [43:39]
Dr. Armando Sardi
Several years ago, a very wealthy man that was a board member of a hospital and had colon cancer had gone everywhere because he had the means to do that. I got every chemotherapy available and he came to me because he knew I was very aggressive surgeon. And I said to him, I would love to help you, but I cannot. You reach the point of no return. I know you're going to die from this cancer, but I cannot tell you when. I can tell you that you have limited life and you make a decision, you need to make the decision or how spend that rest of your life because, you know, so far you have been spending a lot of money. You have been taking your family all over the world, you know, probably wasting time that, you know, didn't help so make a decision. So, you know, say, oh, Dr. Tardy, thank you very much. They left. I got a Letter from his wife three months later saying, Dr. Sardis, thank you for telling that to my husband and I. After that, we took our boat, you know, they had, you know, means to do that, and we went into the Caribbean, you know, And I can tell you that he died at sea. At sea. And the last three months have been the common and more relaxing times of the last five years of his life. So, you know, it's saying that at some point, really, we can hurt people. You know, it doesn't matter what it is. We can do things. And you. You can always find doctors to do something, you know, and sometimes, actually, we are not trained to be very direct, sometimes to tell patients, hey, I cannot help you. Or if what I, you know, I can operate by. My chance of helping you is minimal. And I had that conversation with a patient today, or actually going to hurt you because, again, you have limited quality of life. I can operate, take some tumor out, but you're just going to lose time, not gain time, and that's important so patients can make the appropriate decisions. Again, we are treating patients. We're not treating a cancer. Right. You have a patient that has a cancer, and then we say, okay, based on everything. And also, we need as doctors to recognize that, you know, I don't know everything. I'm not the guy to do everything in cancer, and I should be able. When I don't do something good, you know, I used to do a lot because we trained in the time that we did everything, you know, from vascular surgery, head and neck, long. And I can do a lot of those procedures, even today, but I'm not the best person to do it. So I need to recognize that. And when someone needs something that I cannot do well, I should be able to say, listen, I can do the operation, but my partner or the patient, the other hospital can do it better.
- [46:31]
Jeff Hopeck
Right.
- [46:32]
Dr. Armando Sardi
You know, go ahead and do it.
- [46:34]
Jeff Hopeck
Sure. So when you have a patient opened up, when you have somebody opened up, it said, there's just so many moving parts. You have all these different organs and all whatever it looks like inside the body. But it's. It's certainly complex. Have you ever done a case where you had a call somebody else in that was not even at the hospital, some kind of specialist? I don't even know who it could be.
- [46:56]
Dr. Armando Sardi
No, I mean, fortunately. I mean, to do this operation, you need to have. Everybody is needed one way or the other. We have all these specialities. However, sometimes we have very complex cases. So much disease that my partner, which have been together for 20 years. He's very good. Dr. Badin Gutchen. So we work together in this complex case from the beginning, not only because you can move a lot faster than when you are working with a pa, but you actually have a better chance to be successful. And, you know, in these surgeries, if you save two hours of surgery, it's a lot of time, not only for the patient, but also for you.
- [47:36]
Jeff Hopeck
Sure. Yeah. Makes sense.
- [47:38]
Dr. Armando Sardi
We made sure. I mean, we have at this institution all the people necessary to do that. If you have to call someone to another town, then you shouldn't be doing that operation.
- [47:49]
Jeff Hopeck
Okay. Do you. Would you have maybe to call somebody who's in you. Your actual hospital in the four walls, but they're not in the operating room.
- [47:59]
Dr. Armando Sardi
Oh, yeah. Sometimes we call urology, you know, when we find that, you know, there are areas involving the bladder or, or the ureter or vascular that we have to resect the vessels to connect, because you need to. So we resect the vessels and they come and repair it. Yeah. So they are available. And sometimes we suspect that ahead of time, they already prepared to be available if necessary. Or sometimes we do big operations that we need plastic surgery to replace areas of the pelvis or with organs and so on, you know, with a tissue, you know, so they are already, you know, notified about that.
- [48:34]
Jeff Hopeck
Sure.
- [48:35]
Dr. Armando Sardi
So we work together. So we. It's a lot of planning, you know, again, you know, but again, you shouldn't be doing these operations if you don't have these services available. And also after surgery, you know, you need to have a good ICU where people are there all the time. You know, you need to have, you know, the whole team. We have medical oncologists that I can call them. Hey, I'm going to give this chemotherapy. Do you think this is the appropriate one based on this history? Actually, our medical oncologists are side by side with us. And then we, you know, so we. When patients come from out of town, they can see them right away without having to be wait two months to see another physician.
- [49:14]
Jeff Hopeck
Yeah, sure.
- [49:15]
Dr. Armando Sardi
Or vice versa, sometimes they are seeing a patient. Hey, Armando, what do you think? And send them over here. So we are side by side here? Yeah, yeah.
- [49:25]
Jeff Hopeck
When you. When you have an organ, pick anyone. But when you say, like you're scrubbing an organ, are you. Are you literally, when you're scrubbing an organization, watching the cancer come off of it, like instantly.
- [49:41]
Dr. Armando Sardi
Yeah. Yes. There are different type of tumors. You know, this appendix cancer, for example, they are. Or some ovarian cancers. They are like, like jelly. You literally can wash it out. I mean, you can get with a rug and just clean it up. And if you cannot do it, you cauterize it. Very careful. Sometimes you cauterize into the bowel, and you've repaired the bowel. If they are more penetrating, but they are too many, you do many of those, or you resect the bowel and connect. No. So, yes, it's a combination of factors that you use to destroy the tumor. Either remove it or destroy it. You know, that's the point. Yeah.
- [50:17]
Jeff Hopeck
Yeah, that makes sense. Okay, so then it's safe to say, you know, all that we talked about today, that if. If you've been told that you have some kind of cancer in. In and around your stomach, get a second opinion.
- [50:35]
Dr. Armando Sardi
Correct. If you have, you know, the stomach is an organ itself, but the stomach is also defined like the abdominal cavity. Everything that. Everything is in an abdomen. You know, the. You know, in the abdomen, we have many organs. If you have a tumor that had spread or is big, you know, you should make sure that you. You shouldn't get to this to start with as a first treatment choice. Instead of having a small surgery, then you get more therapy and then have to come back to a second surgery when one surgery would happen enough.
- [51:07]
Jeff Hopeck
Right. Okay.
- [51:08]
Dr. Armando Sardi
You know, most cancers, you know, I mean, like colon cancer, you know, you can find early cancer. That's why we recommend colonoscopy. If you get a colonoscopy and you find a polyp and you take it out, then you know you are not going to have cancer. And believe it or not, even in the United States Today, only about 40% of adults that should have a colonoscopy are having. Colonoscopy has increased a little bit, but many people don't want to have it. Oh, but I feel great. I say, but when you feel bad, it's too late. Now you have to come to me to do a colostomy, give you chemotherapy, give you these big operations when all that can be avoided. I mean, appendix cancer is difficult to diagnose it. We don't have a way to diagnose ovarian. Unfortunately, ovarian cancers are diagnosed 80% of the times at stage three or four cancers. But there are a lot of cancers that can be found early that if you do the proper things, will work.
- [52:12]
Jeff Hopeck
Colonoscopy being one of those.
- [52:13]
Dr. Armando Sardi
Colonoscopy. Oh, yes, very important. Yeah, Correct.
- [52:16]
Jeff Hopeck
Yeah, yeah, very important. Okay. The future. So looking out, you're 34 years into it. You have all these people that You've helped. It's incredible. It's remarkable. What's your hope going forward? What do you want?
- [52:34]
Dr. Armando Sardi
I think the first, you know, continue to train more people to do this, you know, but most important, to increase awareness. My dream really at this today, you asked me that question is to connect people. And when you call and tell me, hey, I would like to do a podcast. Oh, yeah, that's great. You know, someone has worked with Netflix and I want to do a story about that, and I say, wow, that would be great. You know, we have a patient from firefighters from 911 that he did in 2002 and three that are still alive, enjoying life. And, you know, you know, so stories that are, you know that they went to big centers in New York and told in 2002, you won't be able to be helped. They came here and they're still alive. Actually, last year, we do a walk every year to raise funds for our research. He spoke about it, and he's a funny guy. And, you know, he was just. But seeing these patients doing it is amazing. So the idea is that my dream will be that we can connect enough people and enough organizations, you know, and the media to spread a word. That is a treatment that, while it's not for everybody, can help a lot of patients. And by doing that, we are going to save mothers, parents, brothers, sisters, and it will be a better world for a lot of people.
- [53:58]
Jeff Hopeck
Yeah, that's neat. All right. I want to ask you a couple questions about you as a doctor. We put a lot of light, and I love it on. On the HIPIC procedure and all the benefits of it. You as a person, Doc, doing this procedure, you have so many great outcomes, and there's got to be cases just like anything else where the outcome is not so great. How. Just how do you handle this emotionally as a person, as a human being, what do you tend to do?
- [54:31]
Dr. Armando Sardi
I mean, I'm a type A personality. You know, at some point we got younger, we think we can do anything. I can do a lot of things, but I recognize my limitations. I know that I can help a lot of people, and I like to help. And, you know, I do everything possible not to harm people as much as we can, but, you know, sometimes complications occurred, and, you know, that's tough, especially when leads to a bad outcome. Fortunately, you know, it's not often, but that is very, you know, it. Not only it demands a lot of moral support, but, you know, you are dealing with a life of a person and family that I get compromised and so on. But you need to recognize that we cannot help everybody and make that decision as you can now. For me, it's more difficult not to be able to help that help Sometimes. You know, sometimes when I call my wife early and say, oh, I'm going home and it's early, she know that nothing good happened. And she says to people, oh, I know when something happened because it's not the same person. But yes, it's, you know, I deal with that as a whole. But you know, it's part. But you need to recognize that first we have to be honest with the patient that we are going to, we're doing our best and not every time is going to be perfect. We try to be as perfect as possible, but as you know, perfection is not possible really, but we can get close to it and that, you know, the output of that is good. And actually the patients who are believers and they believe that you are doing the best, those patients are going to do better because they have all that energy into it. But as a physician, especially to do this procedure, you need to be passionate about it. This is not a procedure. You cannot just, oh, I'm going to do high pac just because I train in this or do. Even people who are trained as a surgical oncologist, most of them are not trained to do this procedure or even have the mentality or the patient to do that. You need to have passion to say, okay, I'm going to put whatever time is necessary to do that. And I tell my patients, listen, I, you know, you're going to have all my energy, you know, as long as necessary that day. But I need your energy, your mind and your body to help me, you know, don't make me work too hard, please. But you know, it's part of the, of the game. But you know, I've been through, I mean, I lost a son when I was 25 years old. He drowned in a pool that I built for him. I was a 25 year old medical student. I had to extubate him in surgery, you know, and I was. When my wife came to say, Armando Mauricio's drowned, he was pregnant of the oldest one. Now that's 48 years ago now. The, you know, say, oh yeah. And I was in my last day of rotation in pediatrics. So I went to the emergency room with all my friends and I saw him, he was dead. He was intubated. I said, guys, he said, he's dead. I took the tube out, wrap him up and took it with me home and, and that was it. And I took three days off of work and I told my, my wife, you know, we have, you know, this is happen to anybody and I have to continue. We have a new child coming, whether it's a boy or a girl, she needs to come to a wonderful home and we need to move forward. I took three days off from work and I felt that my friends, which were working very hard for me, couldn't keep working for me just because my son died. Although I know they would love to do so. But life have to continue. I mean, we're all going to fall at one point, but life has to continue. And I love every minute of life. I mean, I wake up, up in the morning and I mean I ready to go. I mean, I excited about whether it's Monday, Tuesday, Wednesday, Saturday, Friday. And I don't want to go to bed because I think I need to do more, you know. However, as soon as sit down, I go to bed, I fall asleep, you know, and ask, asking my mother, she used to Armando, you were the same when you were two years old. You never wanted to go to bed. You Woke up at 5 o' clock in the morning and you just went on all day long bothering people.
- [58:49]
Jeff Hopeck
Wow.
- [58:50]
Dr. Armando Sardi
So my, the group here at the office, they make fun of me because I always telling, come on guys, go, go, go, go, go, go, go. We have pleasure to go, people to see. You know, like someone said I was hearing the other day what the. The movie from where Walt Disney, you know, just keep swimming. Right? And that's true in anything on life. Just keep swimming, you know, you just, you fell down, you go up and then. Yeah, you know. But life, I mean, I've been very lucky, you know, like I mentioned to you, I have five stains on my heart. But I have been at the right time, at the right place. And I was supposed to be in a plane crash in American Airlines in 2005, going to Cali, Colombia. In those days you can make a reservation and pay a week before that. And one of the nurses said, oh, Armando, I can get some commission if I pay your tickets. Okay, go ahead. But don't mess that up because you know I will lose Christmas. I want to see my family. And it was for December 20th and he forgot. So we lost the connection, we lost the reservation. When we called, the reservation was there, but my wife decided that we are not going to fly that day because it was the anniversary. So we didn't get in. We actually left from. I left with the kids from a different. From Washington. She Left from Baltimore the day before on the 19th for no reason. Completely awkward. I was even opposed to it. But they convinced me because I didn't want them to lose one day with school. And, you know, I'm in Colombia and the prank crashes. Four survivors, many friends died there and I was supposed to be there. I said, wow. So I really believe that we are here to do our job. And, you know, I was going to move to the south and because I love, I don't like cold weather. I don't like to, you know, and I say I'm finished in the north. And even though Baltimore is the south, state is too far north for me, weather wise. And here I am. So, I mean, it's the best place I could be, I think, with what I'm doing and trying to help people. And so I think that, you know, there is someone out there, you know, God has a plan for us. But, you know, life has to continue. You know, it doesn't matter how we were hit, you know, life has to continue because what if you stay down, you are going to suffer. And, you know, that's kind of my philosophy of life. And I enjoy helping people and seeing people doing well and it's fun.
- [61:31]
Jeff Hopeck
Yeah, it's wonderful. The, the night before, the very first. Just a couple more questions. The night before your very first Hypec procedure.
- [61:43]
Dr. Armando Sardi
What.
- [61:43]
Jeff Hopeck
What was going through your mind? Had to be nervous, I would think.
- [61:47]
Dr. Armando Sardi
No, I mean the, I mean the HIPEC component is just a part of the, of the, of a big procedure that I already was doing. So it's not like it was, you know, so, you know, Dr. Sugar Beckett, who did it before me, he gave me some with all machines because in those days, in those days there was no equipment designed for this. So we have to kind of change the cardiac machines to allow to raise the temperature to 43 degrees. You know, it's a high heat, you know, 108 fahrenheit, you know, that's what you run into the belly. And so he gave me that and I went to Radio Shack, you know, remember Radio Shack is, you know, that's already out of the market. So I bought two pumps and some temperature probes and created a device that will work with the pumps. It's very simple system. And that's how I started my first hipec. And actually it was for ovarian cancer. And she lived 20 plus years. She died from something else, you know, but we started. Now there are expensive machines that the heated chemotherapy component is not a problem. That's the Easy part because it doesn't require any true expertise. You are just putting heated chemotherapy through a pump into the peritoneal cavity after you remove all the cancer. The difficult part and the most important part is to remove all the tumor. And that's what it is.
- [63:18]
Jeff Hopeck
Do. Are we going to see a day, do you think where this is behind us and we don't have to, we don't have to worry about it anymore, I guess cancer in general.
- [63:29]
Dr. Armando Sardi
We are finding more and more treatments. However, surgery remains the hallmark of resection or treatment for most of the solid tumors which are pretty much everything but the lymphomas and leukemias. Now we have therapies to help with advanced cancer. What we are seeing more now is that now we can see patients who come to us because they have increased risk for cancer. One thing that we are encouraged now families is to do genetics because we can identify cancers before they are big or prevent them by removing an organization that is a high probability of developing a cancer or developing a more rigid follow up. For families of patients with colon cancer, breast cancers, ovarian cancers, in which we can recognize cancers before they're advanced so they don't have to come to me. That's probably one of the major things identifying now genetics that can get us to those cases earlier.
- [64:40]
Jeff Hopeck
Would that be covered by insurance?
- [64:43]
Dr. Armando Sardi
Oh, yes. Now it's recommended. Yes, it's kind of a standard. Yeah. And I think it's going to get even to the point that probably you just do a blood test and hey, you are high increased risk for this. This is your chance. For example, just thyroid cancer. There is a very rare cancer, the medullary thyroid cancer that there is a gene that if you have it 100% or the people are going to have cancer. So thyroidectomies are done in kids when are 4 years old to prevent that from happening in childhood. Now they are fortunately rare cancers. But you know, there are other cancer. I mean ovarian cancer you can determine find family, colon cancer, family groups that are a higher risk. So you need to, you know, breast cancers, you can do MRIs more closely, follow these people closely. So that way you, if something develops, you can develop finding them early, finding them early. The only cancer though that can be prevented is colon cancer. If you do a colonoscopy because you find a polyp, you cut it. And the chance of that cancer, that polyp becoming cancer is gone. Because the polyp is gone. There's no other treatment or another procedure that can prevent cancer by doing it. So we have procedure to make diagnosis, but colon cancer not only can find a polyp, but remove it before it's cancerous. The transition from a polyp, benign polyp to cancer could be as long as 10 or 12 years. That's why colonoscopies are recommended every 10 years, unless you have a family history of colon cancer.
- [66:24]
Jeff Hopeck
So, okay, what's the age then? If you have no family history, what.
- [66:28]
Dr. Armando Sardi
Age right now is 45 to start with? If you have family history, should be 10 years younger than the father or the mother that had it or relative. So if your mother had breast cancer or colon cancer at age 45, at age 30, 35, you should be having one.
- [66:48]
Jeff Hopeck
Oh, wow. Okay. So are those over the. I'm not calling over the counter. They're not over the counter, but they're not an actual colonoscopy.
- [66:56]
Dr. Armando Sardi
It's like a color guard that should be applied, in my opinion, only to people who are opposed, completely opposed to colonoscopy, to people who have medical conditions to be put to sleep that, you know, really should not be used for. For anybody else. Everybody, in my opinion, should have the first colonoscopy, at least to know everything is clear. Now, the other advantage of colonoscopy is that you find a polyp, you take it out right away in one procedure. If you got a color guard. If you have a polyp, you may not detect the polyp. So the tumor continues to grow. And if they find something suspicious, you still need a colonoscopy to go after it. So, you know, I mean, yes, there are risks associated with the colonoscopy. However, I. You know, in my opinion, I already have three colonoscopies, and I'll have one more in a couple of years. You know, I'm not taking that chance because I see people coming at 80 years of age telling me, oh, doctor, but I was great. I never had a colonoscopy. But now they're having, you know, bugs and chemotherapy, and they are dying from the disease that could have been prevented with a relatively simple procedure.
- [68:15]
Jeff Hopeck
Yeah. Is it normal to find polyps?
- [68:18]
Dr. Armando Sardi
It's frequently seen, but, you know, it depends. Most people don't have anything or have very small polyps that are not significant because, you know, the polyp. There are different kind of polyps. Most are not malignant or premalignant. Some can become malignant, so those. Yeah.
- [68:35]
Jeff Hopeck
Mm. Okay. I want to spend some time on your personal routine. What are some things that are. That are absolute must do's on a. On. On a daily basis? For, for your routine and, and then want to get into the opposite of that. What are some absolute stay aways as a, as an on call, as a cancer oncologist, you know, surgeon.
- [68:59]
Dr. Armando Sardi
I think, I believe first for us to do what we do, you need to be in good health. No, it may not look very good to you, but I am pretty good and feel I can. But every day I wake up at, you know, 5:30 in the morning. I exercise every day. If for some reason I do a combination one day I do weights, especially not the day of surgery because then your hands tend to tremble a little bit if you are doing weight. Those days I do bike or abdominals. I have the peloton that actually have been very helpful and abdominals and so I alternate that on weekends I either walk or run a little bit. I play golf on the weekends I play tennis. So I'm very active. I mean and I always love to be outdoor if I can. But every day, even if I only have 10 minutes because I overslept, I do some kind of exercise from stretching to biking to you know, lifting a few weights, you know, abdominal, you know, whatever. I think that is very important because as you imagine if you're going to stand for 12 hours, you need to feel good about it. Otherwise you back everything is going to hurt. So my health is very important. I try to eat well. I eat breakfast every day, you know, because I don't know if I'm going to have a lunch even though they provide some sandwiches for me. But when you start this case, you want to finish when? As soon as you can. So unless I start feeling that I'm slowing because I get in dehydrator, I just keep going until I finish. Yesterday I went on for seven hours before I broke. It was at the time of the heated chemotherapy when he said the time that I don't need to be there. The patient is being checked in by the PAs and the operating room table moving and there is the perfusionist and the other doctors there. But at that time I eat in something and getting, you know, a little, little rest. But yeah, that's kind of the night I go home with my wife and you know, sit around and talk and sometimes read a little bit. I love, I'm an avid of stock picking. I love that it's like my pastime. I learned many years ago and found friends with people that do well for that. And I taught my grandkids and my daughters and you know, so people have learned to save and for the future and how to at the same time, by doing that you can help other people because you create some wealth. And so all that is part of my routine. But you really. I am ready to go. When I wake up, try to sleep at least seven hours, which usually I can do that. Sometimes that's not possible, but I think it's important. And my food, I am very picky about eating. I don't eat because I'm not the person who sit down and eat a four hour meal unless it's party. I eat because I have to eat and I kind of watch what I eat. But I am, you know, life has to be enjoyed too. So I drink very little, if any, you know, I, I, you know, occasionally I'll take a little beer, but I'm not the. I don't need beer to have fun or I don't need alcohol to have fun. So I love dancing. You know, in Colombia, if you are 12 years old and you don't know how to dance, forget about girls, you.
- [72:22]
Jeff Hopeck
Know.
- [72:24]
Dr. Armando Sardi
You know, the salsa and. But you know, everything is. And Gary can tell you that when he was there we took him to some discotheque so he saw what he was.
- [72:34]
Jeff Hopeck
I'll have to ask him what are. Okay, what are a few other absolute stay aways. Do you have any type of foods?
- [72:43]
Dr. Armando Sardi
No. I mean, I don't smoke, you know, I never did. My father did and you know, and that's what I. So I do not smoke. I never like that. I don't never did or do drugs, which sometimes I see young kids, you know, all kinds of drugs, which is incredible. But you know, so I think that's very, very important. I eat up pretty much everything. However, I don't eat spicy food.
- [73:06]
Jeff Hopeck
Okay.
- [73:06]
Dr. Armando Sardi
I don't eat curry. I cannot, you know, eat spicy food. I mean, I can't. But I eat a lot of fish, chicken, meat when I have to, you know, you know, but I'm not opposed to any specific food. But I try to be organic and the things that should be organic and you know, I now stay away from the soap drinks that I love, you know, so, you know. But I don't drink Cokes or you know, unless I really. One day, you know, you have to take a Coke, you know.
- [73:38]
Jeff Hopeck
Right.
- [73:38]
Dr. Armando Sardi
Especially if you're in Atlanta. Right?
- [73:41]
Jeff Hopeck
Yeah. Right. Is it, is it more. It sounds like you like them and you would have them if there was a health benefit or something. But is it because of them? Is it. You stay away because of the fear of what it could be doing for your insides.
- [73:54]
Dr. Armando Sardi
Yeah. I mean, it's too much sugar, you know, I mean, and you know, I never growing up, even though my mother was very healthy eating, I, you know, we ate all the junk that we could find, you know, and that's normal probably for most people. So now I'm more, more information and, and, but you know, I try to be as healthy because you know, without health, not only I cannot do all these things that I do, but you know, you want to every. All of us are going to be hell, are going to be unhealthy or had a disease that is going to get us right. The idea is to have it for a short period of time, you know, so if you keep your best chance, you are going to hopefully suffer for a little bit and you're gone, you know. My mother died this year at 93 years of age. Still love life from the day she wake up. She ate very healthy, never really exercised, but she walked a lot on her own and her attitude helped people all the time. And she was sick for two hours before she died. And she was up in the mountains with my brothers enjoying life and nothing was ever a problem. And we are seven kids, six boys and one girl.
- [75:07]
Jeff Hopeck
How is she sick for two hours?
- [75:09]
Dr. Armando Sardi
I mean she just had chest pain and she died. She had an aneurysm and she died probably from eruption aneurysm. But we don't know for sure now. But she was 93. I mean the day before she was having. She was in a party, you know, 93. And in December she was with us in Disney World doing all the things that the kids were doing. Say man, take it easy. But she enjoyed that. So.
- [75:38]
Jeff Hopeck
All right, I'm going to make up a crazy scenario. It's just completely made up. You wake up tomorrow and all cancer for whatever reason has been solved. You have no longer have any need to do what you're doing. How do you spend your days going forward?
- [75:54]
Dr. Armando Sardi
Oh, I actually go out and find ways to help people in whatever I can. Even from the medical point of view that I can have all the talents that I help. But even volunteer, we all have a talent on that. We, you know, doesn't matter who we are. We have a talent and you know, that's what we're trying to do with the foundation. How do we. What is your talent that you do best, that you have certain amount of time that you can help us with it, like being today here talking about this or you have a connection. You know, you may not have funds or money to donate. You don't know how to do it or you don't want to do it or you have all the interest. Do you know someone who may be interested in doing so because of that or maybe, you know, a family member is going through this that you can help, you know, so that's what it is. So yeah, there's multiple ways that I can help. I actually love magic. I'm a magician. Not a good one, but I do magic. You're a magician, you go to YouTube. You can see one of my, you know, my presentations during the, during the, during the pandemic. I did three years in the road, a show, you know, for the heated to beat it because we got together. So I did a magic show. It was. I'm a terror. I'm a terror. But I enjoy it and I learned everybody. I take a class on magic every week in every Wednesday night and it's a lot of practice. All you need to really. But I enjoy the grandkids enjoy it. And actually I had a fun yesterday with one of my granddaughters called me hey granddaddy Abuelito, you know, in Spanish, Awelito. I have a, I have a new trick for you. I learned how to do it. So she's going to show it to me in a couple of weeks when I'm going to be with him. But it's fun, you know, it's, you know.
- [77:41]
Jeff Hopeck
Yeah.
- [77:42]
Dr. Armando Sardi
And you know, one of the things that we did actually two years ago was called a magic show. You know, a lot, a lot of the patients that, you know, we have helped have a lot of talent. I didn't know to the extent until I did that. And actually we had musicians, I mean real musicians, I mean violinists, opera singers, jugglers. I mean professionals. So we did a talent show and so Everybody had a 20 minute, 20 second presentation of their story with the cancer and then they perform live at the Loyola University. I mean it was the most nice thing that I saw. People were laughing and crying at the same time. And we actually, we are planning to do a new one hopefully in D.C. you know, with even more people from different doctors and to try to raise awareness and to let people know that people live their lives after the surgery because there is a misconception that after this big operation everybody's going to have miserable life. And that's not true. Some people have tough and problems. Some people are going to die, you know, eventually. And yes, I mean, you saw Gary, you know, playing golf better than me because I throw a lot of, a lot of balls in the water all the time, so. But, you know, that's kind of the idea. So I. I love life, you know, if. If you have something to teach me that I'd love to learn. I like to read. I like history a lot. I read about history. I read about, you know, the history of the world, the rest of the United States, the Bible, you know, which, you know, the Old Testament. It's a nightmare. I never thought it was such a terrible time, you know, compared to now, we are in the best time now ever. You know, I was reading the Old Testament, say, oh, my God, you know, this is trouble here. Right? Right.
- [79:34]
Jeff Hopeck
Wow. This. Is there anything, Anything on the planet that grosses you out?
- [79:41]
Dr. Armando Sardi
What do you mean? What do you mean? What do you. Oh, yeah, give me.
- [79:45]
Jeff Hopeck
Yeah.
- [79:47]
Dr. Armando Sardi
I'm a diver, so I. But I don't swim on top of the water because I have seen shark attacks in South Carolina and had to take someone out of the water. I had that. I swam with sharks myself, but, you know, side by side. I don't like to swim on top, but I sail and do all kinds of water sports. But not swimming on the sea. No, I like to see my surroundings. You know, I don't like heights. I mean, I don't jump from airplane. No, forget about it. Die from height. No, I die from, you know, two or three meters. No more than that.
- [80:23]
Jeff Hopeck
Yeah, but you're not like, I doubt this is even. That this would even exist anywhere in the world. Like, you're not a. Although you can administer and you see blood all day and you can give needles. Like, you're not afraid to go to a doctor and get a shot in your arm or something like that, are you?
- [80:41]
Dr. Armando Sardi
No, actually, when I was young, I was six years old, I had a bad rheumatic fever, which affected my heart. And they used to draw blood with these big things that they were reusable, very painful. And I was there, actually, the nurses coming in and my mother said and say, hey, look at this kid. He's not even crying. I don't. You know, and now because of my age, I have to at least have blood drawn twice a month. And as I don't, you know, however, one of my daughter, my brothers, got into a car accident when I was a medical student, and he came, he needed the spleen removed, and he just say, armando, don't let me die. But I wasn't the doctor or anything. I was just watching. So as soon as they put him to sleep and they cut his abdomen, I almost passed out. He said, oh, man, this is Serious, you know, so. So, you know, we are humans, you know, so we go through the same things that, you know, you know, like, people think, you know, some people, you know, I thought that when I was going to be a doctor, I was never going to get sick. Oh, I was wrong. Because we get sick, we go through the same thing that people go through, you know.
- [81:49]
Jeff Hopeck
Right. I've learned to not make assumptions. I ran into a kid. I would always assume that if. If somebody said to me, hey, I go to University of Georgia. I would just assume that because they attended that fan that school, that they were a fan. But I ran into a kid who attended Alabama, University of Alabama, and I just made that assumption. She's like, actually, I don't like the academics. I like University of Georgia. That's just since that day five years ago. I just don't like to assume. So that's why I wanted to ask that question to you about.
- [82:26]
Dr. Armando Sardi
And I think that the, you know, everybody does hopefully what they like. I really believe that if you do what you like, you're going to succeed. I tell my students, you know, when you. They ask me, hey, what, what. How do you select to be a surgeon? Say, don't worry, your personality will take you there. You know, if to be a surgeon, you have to, you know, make a decision now and live with it. If you are the person who has to think and consult and come back, you cannot be a surgeon. You'll be the most miserable person that you can. And through my training, I have physicians, you know, attending that, you know, at surgery, they were a different person. You could see that they were not comfortable there. For me in the operating room, I feel like I'm in my house, you know, I know how to get to every corner. I know what I'm doing. I know how to, you know, what is the next step, you know, try to avoid problems. We have very little complications. And I think it's because of that, you know, I won't get into a place that I don't know how to deal with. It's like, you know, you don't go to a cave. You don't know what you're going to find unless you're really prepared for it. Right. So the same thing anyhow. So. But yeah, so, you know, people should do. And I tell them, your personality will take you there. But one thing is very important. Always do the best you can. Because if you are going to, don't go because they are paying you or they are not paying for. If you do your best job when you are getting paid or not, payment will come later in whatever way it will be. If you do your best job always can do more than what you are paid for. And then you'll be surprised of how much it takes you in the future. And kids today I have a patient actually that it is procedure, the high peg. She's from Indiana and she's a recruiter. And it's funny because you told me, you know, Dr. Sardi, people don't want to work. He said, what do you mean? Yeah. Having problem getting people to work? Tell me about it. Well, people want to work. These young kids, they want to work three days a week, run home and get paid as a CEO, you know, And I say, okay, it's a different world, you know, here you are, you know, working extra time, doing this the other, you know, but really everybody's different. And what moves you is very different to what moves me. And what we are trying to do with organization is what moves you, that we can really work together to make a difference, you know, in the future. But. But you're going to do what you like to do. Know what I want you to do, right. And I say that's a tricky part. Find what people move people in, how they want to help or can help and then hopefully join forces to make a change, you know.
- [85:17]
Jeff Hopeck
Yeah, excellent. Well, I, I hope I get to see you continually at Gary's tournament every year and, and other golf tournaments if there are or other fun social events. I just hope to not have to come to Baltimore to see you on a professional basis.
- [85:35]
Dr. Armando Sardi
Yeah, we do have our golf event here will be September 19th here in Baltimore.
- [85:40]
Jeff Hopeck
Oh, there's another one.
- [85:41]
Dr. Armando Sardi
It will be for partners on September 16th. It's actually a very nice golf course. September 14th is the walk for the our research. We do what's called something called heated to beat it. You know, patients come from all over the world and they do a walk to raise funds for our research. We're very active group in research here. And then the next day on a Monday, September 15th, we have a golf event. So people do all the weekend and I see them on Friday and on Saturday night we have a dinner. So everybody mingles together. So it's a kind of a weekend celebration and people connecting and you're kind of seeing the future and it's always nice to see people, you know, that again, we're told nothing could be done. Enjoying life from all parts of the world and all, you know, women, young people, old people, men, you know, families together. All that Is very rewarding. Yeah.
- [86:39]
Jeff Hopeck
Yeah, I'll bet. So I'll. I want to end on this part is just, just tell me how can, how can somebody learn? I mean they can google you, but do you have any other resources out there? You mentioned, is it a non profit that you have the Abdominal Cancer Alliance?
- [86:55]
Dr. Armando Sardi
Yeah.
- [86:56]
Jeff Hopeck
Give me a rundown through all the. Everything you're involved with and how people can connect and support you.
- [87:01]
Dr. Armando Sardi
Yes, there are different. I mean, one is direct. You know, look, if you go to, if you want to do a donation, for example, or want to play on the event, you go to the Abdominal Cancer alliance or the abdominal cancers. Abdominal cancers.org Abdominal cancers, you know, with that org and they will do a lot of information about. You see patient stories. There are way to donate. It tells you about the events coming up and ways of how to get involved. You know, if you are part of a social media and you want to advertise more about this, if you want to have a patient story, you know, we have many patients from really any part of life or almost any state. We have people from over 12 countries and you know, 48 states at least coming to us from different parts of world with different backgrounds that are having fun. And so there are multiple ways. So the idea is that how you as a person, I say you, everyone there that is going to listen to the podcast is what is your interest, how much time do you have, what is your talent and how much time do you have to give it to help discuss, you know, and it could be as simple as, hey, I know someone who really would love to help with this or I just want to talk to a patient about this because I'm a patient with this problem. You know, many patients don't want to get involved more than just talking to other patients. So when they have a problem, they can communicate with them and tell them, share with them how they went through all this without, you know, giving up.
- [88:48]
Jeff Hopeck
Yeah.
- [88:48]
Dr. Armando Sardi
So really the question is how would you like to be part of changing the world? That's it. And you know, one. One step at a time.
- [89:01]
Jeff Hopeck
Yeah, one step at a time. Well, I'm grateful to, to know you first off, to be able to do this interview and to help raise awareness and. And help you accomplish some of your objectives. So I'd love to have you on again in the future. No doubt about it, today was incredible. Thank you for sharing all the, all that you did. And I'll link over to everything, all the properties that you said. Social and abdominal cancers, the alliance, the website and stuff like that, so.
- [89:32]
Dr. Armando Sardi
Okay.
- [89:33]
Jeff Hopeck
Thank you.
- [89:34]
Dr. Armando Sardi
No, no, no, thanks. Thank you, Jeff. I mean, really have been a pleasure to have met you as well. And really, I think things happen for a reason. I'm always convinced about it. And working together is what is going to make the difference.
- [89:48]
Jeff Hopeck
I believe it. Thanks a lot, Doc. Appreciate it. Stay on for a couple of seconds after I'm going to hit stop.