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Mind Pump: Raw Fitness Truth
2727: The Surgeon Who Rebuilt a Man's Face After a Grizzly Attack! Dr. Benson Pulikkottil
01:36:56
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- [00:00]
Dr. Benson Pulikotl
AI agents are everywhere, automating tasks and making decisions at machine speed. But agents make mistakes.
- [00:09]
Sal Destefano
Just one rogue agent can do big.
- [00:11]
Dr. Benson Pulikotl
Damage before you even notice. Rubrik Agent Cloud is the only platform that helps you monitor agents, set guardrails, and rewind mistakes so you can unleash agents, not risk. Accelerate your AI transformation@rubrik.com that's R U B R-I K.com if you want to pump your body and expand your mind, there's only one place to go. Mind Pump. Mind Pump. With your hosts, Sal Destefano, Adam Schaefer, and Justin Andrews, you just found the.
- [00:44]
Sal Destefano
Most downloaded fitness, health and entertainment podcast. This is Mind Pump. Today's episode, Advanced plastic surgery with Dr. Benson Pollicotl. By the way, this is the guy that that literally put somebody's face back on. True story. Grizzly bear attack took someone's face off. This is the doctor that put it back on. He tells that story and more. This is a riveting episode. By the way, this episode's brought to you by Element. This is the electrolyte powder everybody's talking about. It's high enough in sodium to make a difference. No sugar, no artificial sweeteners. Tastes amazing. Go check them out. Go to drinklement.com mindpump with a purchase, you'll get a sample pack of their most popular drink, mix flavors. Also, Black Friday for us right now, every Maps program, every bundle of programs, every everything on our site, 60% off across the board. You got to go to maps, fitnessproducts.com, get them all if you want. But you got to use the code Black Friday. By the way, every purchase enters you into a contest. Two people are going to get a vacation from us at the Park City house that we own. It's amazing. Fifteen people are going to get personal training for a few months. Once again, 60% off everything. Maps fitnessproducts.com, but you have to use the code blackfriars Friday.
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Dr. Benson Pulikotl
All right, real quick.
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Justin Andrews
If you love us like we love you, why not show it by rocking.
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Sal Destefano
One of our shirts, hats, mugs, or.
- [02:04]
Justin Andrews
Training gear over@mypumpstore.com I'm talking right now. Hit pause. Head on over to my pumpstore.com. that's it. Enjoy the rest of the show.
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Sal Destefano
Dr. Pulikotl, welcome to the show.
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Dr. Benson Pulikotl
Thank you so much.
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Sal Destefano
Did I say that right?
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Dr. Benson Pulikotl
You said it perfectly. Said it like my mom. Yeah, man.
- [02:20]
Sal Destefano
We met you at the Peptide Congress. This was in Vegas. I spoke there and we were all attending. And Ran into you and you told us a little bit about what you did and how you listen to the show and you kind of, I mean, fascinating some of the stories you were telling us.
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Dr. Benson Pulikotl
Yeah.
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Justin Andrews
You showed us, showed us a bunch of crazy pictures.
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Dr. Benson Pulikotl
I remember that much. That was definitely.
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Sal Destefano
Yeah, yeah. So for our audience, what do you do? Tell us a little about your background before we kind of.
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Dr. Benson Pulikotl
Sure. First of all, thank you so much. I'm not, I'm geeking out because you guys, I've listened to you for like 10 years, taking advice from you on finance, fitness, family, being a father of two young boys too. And I really appreciate the entrepreneurial spirit and each of your personalities. I feel like I'm in my college dorm right now with my bros.
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Sal Destefano
Awesome.
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Dr. Benson Pulikotl
That's what I feel like.
- [03:10]
Justin Andrews
That's great.
- [03:12]
Dr. Benson Pulikotl
So my name is Benson Pulikotl, South Indian, grew up in New York, New York City. I'm the medical director of a double verified burn and reconstructive unit. And what I do is there's not many surgeons that kind of do what we do. There's a handful in the country. We do burn surgery, we do hardcore reconstruction. We're double boarded in plastic surgery, hand surgery, nerve surgery, microsurgery. Also, I have an aesthetic practice with my wife, Lily Danieli, who is the reason why I'm anything. I'm seriously. And my two partners, Ryan Enders and Wojtek Przylecki, we created our own side aesthetic practice. And so one of the things I love about plastic surgery, it's the ability to change things immediately. And you guys have that same ability. You just don't see it. You sit in this room and you don't see the direct effect until somebody writes a comment or tells you. But you change lives in a similar way. I know people that listen to you that were suicidal and aren't anymore. They've found fitness. And this my. In my world, I fix a tendon, a hand move, so I get that awesome cause and effect. And so I take care of a full gamut of really, really traumatized sick patients. And I have an awesome hospital, Swedish Hospital in Englewood, Colorado, that from the administrative level to the, from the CEO to the maintenance worker, they all care about patients, they care about our program and they care about me. And I care about them. And we are able to take care of some of the hardest, sickest things in the country and in the world.
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Justin Andrews
How does a kid in New York growing up decide I'm going to go into plastic surgery like that? I mean, did you watch a movie or something like that. I mean, that's like a different type of profession to land on.
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Dr. Benson Pulikotl
You know, the. I really feel like success is a lot of luck and just jumping into some opportunity. And my dad always told me, if the window of opportunity is open even a crack, you jump through it. And I've always taken that approach. I think a pivotal point in my life was when I was in fifth grade. There was a science fair, and I wanted to do something on the heart. So my dad took me to a butcher shop. We got a goat heart, and I took red food dye. And they had left for the day. And I was like, I want to make this thing pump. And so there's no YouTube, there's no Internet. I'm going to be 47 this year. Oh, wow. Yeah. So I think that at that time, you had Funkin Wag Nos. We didn't have Britannica, dude.
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Sal Destefano
I had those.
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Dr. Benson Pulikotl
Yeah. Funkin Waggles. We had, like, multiple editions of the same one, too.
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Sal Destefano
Funkin Wagnolds was like the.
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Justin Andrews
I actually didn't know that.
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Sal Destefano
It was like the multiple meal of. Of encyclopedias.
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Dr. Benson Pulikotl
Oh, yeah.
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Justin Andrews
Oh, really?
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Sal Destefano
They were the least.
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Justin Andrews
The less I was gonna say. We had Britannia. I didn't know that you get them.
- [06:20]
Dr. Benson Pulikotl
For free if you. At the. When you go shopping. So, like, you'd buy some milk and you want Funking Waggles. We had, like, the same number 12, dude. You know, it's so funny.
- [06:30]
Sal Destefano
We had a whole set, dude.
- [06:31]
Dr. Benson Pulikotl
Oh, yeah.
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Sal Destefano
We didn't see the whole thing.
- [06:32]
Dr. Benson Pulikotl
Yeah, it's. And so I'd looked this stuff up, and what I ended up doing was I ended up taking a fish pump, fishing from an aquarium. Turning, like, a setting on it to make it intermittent. And I sewed it to the heart. And my mom came in and she started crying, and I was like. Because I took her sewing stuff, and I was like, I'm sorry. She's like, no, this is amazing. She's looking at this hemline. How do you know to sew? And I played football when I was a little kid, and I'd have to sew on jerseys and fix things. And so that was, like, the first. And I won first place in that science fair.
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Justin Andrews
Wow. And so that moment for a kid.
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Dr. Benson Pulikotl
Right, it was unbelievable. I mean, to watch red food dye fill up this heart. And it wasn't perfect, but it looked really cool for a fifth grader. And I think a pivotal moment in my life was when my mom's friend told us about this school in New York City called Regis High School. And this is a really special high school. In this high school, if you. You take a test, it's for all. It's Catholic boys. And if you do well on the test, you get an interview. It's thousands of people apply for this. And if you get past the first 250, you get an interview, and then it's 125 out of that, and that's your class. And this high school is so cool because it's right next to Central Park. Art class was in the Metropolitan Museum of Art. The gym was in Central Park. I mean, it's unbelievable. And it was the first time I was around. I grew up with a lot of Latin, Black, Jamaican, Trinidadian, Indian people. And it was the first time I was really around Americans and like, Polish and Italian and Russian and. And New York City at that time in the mid-90s, was this just bastion of music, art, culture, food. Everything was just so cool. And in this high school, I learned all about myself, and I learned about music, learned about sports, fitness. But it's such a rigorous high school and getting in, and I didn't crush high school. I just did a little bit above average, and that was hard to do. And this whole community of dudes, we still keep in contact. Yesterday I texted them that I'm going to be on this show, and they're all like, dude, you're going to be great. And so we still keep in contact with each other. But my junior year, I wasn't sure what I wanted to do. And I always liked medicine. We didn't grow up with money. My parents, you know, my dad was an accountant, my mom was a nurse, but no doctors. I have an older sister and a younger sister who. They're doctors now. But my guidance counselor, John Vigan, he said, hey, Benson, if, you know, one cool thing to do is apply at a high school for some of these medical programs. And I didn't know what that was. And what that is is essentially, if you apply and you get in, you get a seat to medical school. You don't have to take the mcat. You just have to do your four years of college, four years of med school, which is huge to get in. It was extremely competitive. Several thousand people applied, and myself with seven other people got in. And we're. We're still friends because it's like a. It's like a unit. And I went to Siena College, played football over there. I had a great college experience learning about sports, learning about fitness, learning about studying and really intermingling all these three so I could be successful. A really cool part about the program is this particular program, the CNA Albany Medical College program is really big on volunteering. And so they pay for you to go away two times. And I went both times. Well, three times. Two times to the Dominican Republic in children's. Essentially like a nutrition center where there's really malnourished kids. And we were taking care of them, we were feeding them, we were changing them. It was cool. And the second time, the third time I went. I went back to where we're from in India, and I learned a lot about my culture there. And in medical school. Medical school's weird. It's like a strange place because you think you know what you want to do. I wanted to be a medicine doc. I wanted to be a nephrologist. And so my first medical rotation. So in your third year, you do a bunch of clerkships. It's where you essentially get a taste of each specialty. And so the medical doc who. My first rotation. And I'll say his name because he was so pivotal in my life. Alan Rauch. He's a hematologist. And he had me buy this huge book. Remember, we have like, no money and these two books are like a thousand bucks. I bought these books, I read as much as I could. They're called Harrison's. And he. He, at the end of the week, wanted me to present to him. And so he picked a topic.
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Justin Andrews
A thousand. A thousand page book.
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Dr. Benson Pulikotl
And you know, he would tell me the topic. Oh, okay. There's different topics. Choose your own advent type stuff, you know. But he would pick a topic. Like the first topic was sarcoidosis. And I picked the topic and I did my talk and I presented to the entire office. And he was like, listen, that sucked. And I was like, that's awesome. And I was like, what do you mean? And he's like, dude, you got to get more into it. You got to get. You're just doing bullet points. And I was like, okay. The next week was somewhat. Was like a. Some kind of nephropathy. And he's like, it's not better, man. Like, if you're going to do nephrology, you really need to get deeper into this and understand it more. And I'm like, okay. And every week I got a little bit better. I thought at some point he's like, showing me pity. But at the end of it, he was like, are you sure you want to be a nephrologist? And I'm like, Getting pissed now because.
- [12:53]
Justin Andrews
Yeah, yeah, I'm doing all the work.
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Dr. Benson Pulikotl
I'm doing the work. This is what I want to do. And he's like, I don't think you're going to do well at that. I said, okay. Have you thought about surgery? I'm like, man, the surgeons at that time are like these mean guys just walking around yelling at med students. It's like, I'm not into that. Not into it at all. And so then my surgery rotation came, and on my surgery rotation, another. Like, I remember these experiences because they were so monumental for me. There's a rotation called vascular surgery. This is where you operate on the vessels. And the med students don't rotate on this. If you get this for two weeks, they pretty much take off because they're so busy. The surgeons don't even keep track of having a med student. But I was like, you know what? I'm never gonna do surgery. I'm gonna take this seriously. So I went in, and so young Indian doc, cool dude. He's playing Red Hot Chili Peppers. I still remember in the or. In the or is the Californication album. And he's playing, you know, and he's like, hey, man. And I'm like, hey, my hat's, like, on backwards because I didn't know how to put on a surgical hat. It was the first case with him. And he's like, hey, have you. What do you want to do? It's like, nephrology. And he's like, okay, cool, man. You know, this is a. We're doing a fem pop, which is where you take a bypass graft and you bypass the femoral artery to the popliteal artery. He's like, have you ever sewn before? And I'm like, yeah, in fifth grade when I did a science project and.
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Justin Andrews
I sewed a fish pump. That counts.
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Dr. Benson Pulikotl
And so he's talking to me about, like, surgery, and he's like, do you want to throw some stitches? I said, sure. And so he had part of the anathan. He's putting his hand on me and guiding my hand, and I'm doing this. And he'd let go for a second, and I'm just sewing. He's like, dude, have you sewn before? And I was like, just, you know, not nothing crazy. He's like, you know, you're pretty good at this. And that was, like, sparked it for me. And I was like, huh, Interesting. And my rotations for the rest of that year were in transplant surgery, so I was doing hardcore transplant just Cases as a student, like, really liking. Then I applied for general surgery, and I got into a program called UMDNJ in New Jersey. This is in Newark, New Jersey. I don't know if you know Newark, but it's tough town. Tough. And in the last rotation in medical school, I rotated with the plastic surgeon, and I'd already matched into general surgery. And this guy was doing cool things. He was, like, fixing huge holes in patients after cancer and, like, putting fingers back on. And I had never seen anything like this, but I had already matched in general surgery. So I was a little sad because I'm like, man, kind of want to do plastics, But I didn't have the super uber, uber numbers that my wife had to get in right out of med school. And so I day one of general surgery, I'll never forget, I went to Mark Ranick, who's the head of plastic surgery, and I was like, hey, I want to be a plastic surgeon. And he's like, dude, chill. You're like an intern on day one and July 4th. Like, you know, like, do general surgery because there was a big stigma. And talking about plastic surgery because everyone thinks plastic surgery is breast augmentation fillers and all that stuff.
- [16:17]
Sal Destefano
That's right.
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Dr. Benson Pulikotl
Yeah. And so I would slowly. I befriended a lot of the plastic surgery residents, and I'm in the er, like, getting these appendectomies set up and doing bowel work and all this stuff. And these guys roll in white coats, says, plastic surgery, glasses, hair slicked back. I'm like, oh, man, I want to be one of those guys. And I didn't know anything about plastic surgery really, but I liked the concept of what these little experiences. And what's funny is a lot of doctors pick their pathway that way. It could be a doc, like, you buy somebody a coffee, and all of a sudden they like you. And you have a lot of influence on people, just like in your field. And so then I started thinking about how to get into plastic surgery. And one of the ways is having a really strong CV and doing research. And so my second year of residency, there's an opportunity to do research, and most people stay because there was no option to leave Rutgers to do research outside. And I had a spot with the chairman guy from Boston, Dr. Deitch. And somebody told me, they're like, dude, you're doing surjonc research to get plastics. It makes no sense. You need to do plastics research. But there were no opportunities at UMD and J, which is now Rutgers. So I talked to Dr. Deitsch and I was like, hey, listen, I have an opportunity in Pittsburgh. And I got this opportunity because I emailed every program director in the country. This is like hundreds of people. And only two people responded. Cleveland Clinic. And the director at Pittsburgh said, hey, we have an. An unpaid research spot for you if you want, for two years. It'll help bolster your cv, whatever. It's in face and hand transplantation. So I went back to my chair. I was very scared because he's like, intimidating Boston, very famous surgeon. He's like, okay, you can do it, no problem. And he shook my hand and I broke my contract. That was the first time anyone has broken a contract because if something happens to him and I want to come back after my research years, there's no spot. So again, another pivotal period was in Pittsburgh doing face and hand transplant work. We were transplanting limbs from mice, like dark mice to light mice, rats. Taking, you know, facial structure from one rat to the other rat and doing all these immunologic medications to help prevent rejection. And the peak of this was in my second year. The transplant team had the first double arm human transplant. And my responsibility was we're peons in the lab. But what's cool was, and it's sad because these are always. It's one of the reasons why I moved away from transplant because it's amazing to get a transplant. But the person who donated was usually some traumatic event. And this was a 17 year old kid or something like that that had an accident, I believe, or a younger person. And we harvested the arms and these are the surgeons, the attendings at the time. My role was to take vertebral bodies, which are the spine, bring them to the bone marrow center, process them, get the cells out of them, bring them back to inject into the.
- [19:47]
Sal Destefano
This is part of the immune.
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Dr. Benson Pulikotl
Yeah, to help them from rejecting. So I got into this and this is what got me into plastic surgery. The reconstructive aspect of it, like working on hands, working on tendons, doing this microsurgery. These sutures that you use for these rats are fourth or fifth the size of a human hair under a microscope. And I'm like, holy crazy crap, I can do this with my hands. And so that point, I went back to general surgeon, Rutgers, and I had a really good resume. And, you know, God was on my side. And I was able to get into the number one program at the time for plastic surgery, UT Southwestern in Dallas. Now this is. This is like the Navy SEALs of plastic surgery. And when I went in I was definitely shell shocked because they expect you from day one to not just have the knowledge base, but be technically superb. And so what I did was I just, I remember I just heard a podcast about you guys talking about Goggins, for example, and how some of that may not be beneficial, but that's the mentality I took. I was going to be the biggest, best at what I do and learn it so well. So I, for three years at UT Southwestern, I'd go home, I cut up gummy worms, I would practice tendon work with gummy worms. I made a little microscope out of a bounty, quicker upper innard thing with two lenses. I was practicing, I was learning because technically I was good. It's just the knowledge we didn't have because you're competing with people that like my wife Lily had started plastic surgery much earlier. And by the time you're the general surgery and the plastic surgery teams meet, there's a knowledge gap. And so I really focused on getting knowledge and working hard and was ultimately really successful there to the point where a few months ago they asked me to come back after the 10 year alumni event. And it was just full circle. They were so proud and I was so proud to be part of that place. But when I finished there, I realized that that's not enough. Like you have to have some additional specialization and to get privileges in hospitals to take call, to have a financial edge, to have a competitive edge and get patients and not be irrelevant. I did a hand fellowship and that's an additional year of training in Pittsburgh. And so after four years of college, four years of medical school and 11 years of training, I finally took my first job at 37. And the best part about this is the last year when I was in Pittsburgh was one of the coolest years. Lily and I were married, but we were living separately. She was doing a hand fellowship in Dallas and I was doing it in Pittsburgh. I lived in a 110 square foot apartment above a garage.
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Justin Andrews
It's a bathroom, bro.
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Dr. Benson Pulikotl
It was this big. It was this big. But some of the most just simple times that you look back on and it was, it was great. And right after that we got this job in Denver as burn surgeons. At the time there was a different director. They gave me the position after a year and it's just been, it's just been full on.
- [23:16]
Justin Andrews
When, when did you meet Lily? Where was she at?
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Dr. Benson Pulikotl
Yeah, so this is, this is a great story. So in, when I was in the lab in Pittsburgh, Lily wanted to be a family practice doctor. And she had a similar interest in plastic surgery. So she told her parents, Persian family, very, very controversial. She told them, I want to take an extra year off of med school and do just a year of rotating and plastic surgery. And she did that. And so she rotated in Pittsburgh when I was a lab resident. And I'm focused on, like, transplanting rat legs. And I look, and she's presenting. I'm like, oh, pretty cute girl. And that's all I thought about it. And she makes fun of me because I asked her out to, like, some horror movie on, like, a taco night, and she said no, but whatever. And then what happened was she needed to get back to Hopkins. She went to Hopkins undergrad, and on her last day, she asked for a ride.
- [24:19]
Sal Destefano
And.
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Dr. Benson Pulikotl
And I was happy to do it, but also, like, it was stressful because I had zero money, and I'm like, thinking, man, I gotta pay for lunch here. And she actually bought me lunch because I didn't get paid in the. In the lab at all, but randomly. What happened after she left? She. She. She matched in plastic surgery at Rutgers.
- [24:44]
Sal Destefano
And.
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Dr. Benson Pulikotl
And we just started talking every night for, like, just like, how, like, all of you guys know. Like, you talk for hours, and you're talking about just random things. And did you reach out to her.
- [24:54]
Justin Andrews
Or she reached out to you? Like, what was the first she.
- [24:57]
Dr. Benson Pulikotl
What really happened was she matched in plastic surgery. She was happy but not ecstatic.
- [25:04]
Justin Andrews
What does that mean? She matched. She matched in plastic surgery.
- [25:06]
Dr. Benson Pulikotl
Perfect. Yeah. I feel like I'm.
- [25:08]
Justin Andrews
No, yeah.
- [25:09]
Sal Destefano
I got to explain.
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Justin Andrews
That's why I'm here. Don't you?
- [25:10]
Dr. Benson Pulikotl
No. Thank you. Thank you. So this is why I say things are so random in medicine.
- [25:15]
Justin Andrews
Yeah.
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Dr. Benson Pulikotl
So when you finish any of these things, like, let's say you finish medical school, there's a day called match day.
- [25:21]
Justin Andrews
Okay.
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Dr. Benson Pulikotl
Where you put a list of the places you want to go for residency. And on March, I think it's 17th, everybody in the country opens an envelope, and this is where you go.
- [25:31]
Justin Andrews
Just so randomly random.
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Dr. Benson Pulikotl
Oh, wow. Well, I mean, you can. You can try to. Like, they have. They like you, and that you hope.
- [25:37]
Sal Destefano
That they pick your envelope and you pick them. You matched.
- [25:40]
Dr. Benson Pulikotl
Yeah, essentially. Oh, wow. And so that goes through every phase. So whether it's when I got into UT Southwestern, that was my number one. That's why I was so amped to get in. And then Pittsburgh for hand. And so Lily had a list of places she wanted to go for plastic surgery, and she was very happy to match, but wasn't ecstatic. My buddy and I in the lab, Paula Fruz, who's a very famous Miami cosmetic surgeon. I remember when she called me and she's, like, not super excited. And I'm standing outside the lab. I'm like, hey, Lily, that's amazing that you got in. And I'm watching Paul. Paul's, like, trying to put a line, a central line in a pig. And the pig is crapping on his leg. And he's like. And I'm like, lily, you know what? Like, any of us would just want this spot. Like, you should just be really happy. And he was kind of mean. But I'm sitting there, I'm like, in this lab, just toiling, just wanting this opportunity. And so she really took that to heart and crushed residency. And I went back as a general surgery resident, and she went back as a plastics resident. And she was pivotal in me getting into UT Southwestern, because the day of the UT Southwestern interview, I was late because I was driving from another interview, and I'd already kind of not wanted to go there because I heard it's so intense, and it's just, you know, it's a beat down. I wanted a more gentlemanly approach. And as I was listening to them talk about plastic surgery, I was like, this really resonates with me, the discipline. It's very organized. You get a full throttle experience. And I call Lily. I'm like, lily, this place is awesome. She's like, yeah, I know, dummy. Like, this is where you should go. And I'm like, I don't have an interview with the chairman, Dr. Roerich. And so she was like, well, you need to go meet him. I'm like, well, the interview's over. She's like, knock on the door. Where they're deliberating about the candidates and tell them you want to be at that place. I'm like, dude, like, I'm going to be interrupt. Knock on the door. So I knocked on the door, he came out, and I'm like, Dr. Rourke, I want to be at this place. Just like a robot. And it all worked out. It really all worked out.
- [27:56]
Sal Destefano
That's great. Tell us about the pictures you showed us.
- [27:59]
Dr. Benson Pulikotl
Oh, yeah, yeah, yeah.
- [28:01]
Sal Destefano
So, hey. Because it was pretty remarkable.
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Dr. Benson Pulikotl
Did you see them all or.
- [28:06]
Sal Destefano
I know, Justin.
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Dr. Benson Pulikotl
It was the.
- [28:07]
Justin Andrews
Yeah, it was the bear attack.
- [28:08]
Dr. Benson Pulikotl
Yeah.
- [28:10]
Sal Destefano
So tell us about this, because you. I mean, first off, some of the most challenging, and correct me if I'm wrong, areas of the body to operate on or the hands, that's. That's very, very difficult. And Then trying to reconstruct a face. Because as humans we can tell when something's a little off on a face.
- [28:30]
Dr. Benson Pulikotl
100.
- [28:31]
Sal Destefano
You have to be precise. Unlike doing surgeries inside the body where if it's working, it's working. It's working. When it comes to. When it comes to the face, if something's a little off like. And people really, their self esteem really gets attached to that. Very different. So you talk about the bear attack dude. And what you had to do with that. Sure.
- [28:51]
Dr. Benson Pulikotl
That was one of our first cases. We had a friend who was a trauma surgeon on call and he called me up and he said, hey man. Cause there's a specific element of call called replant. Replant means when a part is off your body, you put it back on, you replant it back on. And we were on replant call for hands. He's like, hey, I got an interesting replant for you guys. I'm like, what is it? It's a guy whose nose and upper lip got ripped off by a grizzly. Are you guys interested in it? And I'm like hell yeah. And my wife is like, yeah, let's do it. But there's also a facial plastics call that's supposed. And this will come into play later because they were upset that we got the call. Kind of. They should have had it, but whatever. So we go in and there's this guy. The story is he's. And his name is out there. So he, his name is Lee Brook. He's given up all of the privacy things because he's a speaker. He's done all that stuff. And Lee, I remember looking at him in the er. He had no face. His. All I saw were two eyes. His teeth were exposed. No mid face. Just blood everywhere.
- [30:01]
Sal Destefano
Yeah. What do you have to work with? It's not like the lip and nose are just. I mean do you have pieces of that or do you have to come up with your own?
- [30:07]
Dr. Benson Pulikotl
So there was a bucket and in the bucket was his nose and his upper lip. And the story is he had hunted two elk in Wyoming and killed one quartered it brought it back, came several hours later to get the other one and looked and it was like three in the morning, saw that it had moved. And then he jumped off of an embankment onto a mother bear with cubs. Jumped onto the bear, onto the bear. And so he didn't know that he.
- [30:36]
Sal Destefano
Was.
- [30:38]
Justin Andrews
Three in the morning.
- [30:39]
Dr. Benson Pulikotl
That's where three or four in the morning. And he got totally attacked. And he, he, he was and we could talk about the, the, the differences in his personality. Mine and we're really good friends now, but he was telling us at the time, you know, after the fact, that he was stabbing the bear in the face and the bear, you know, bent the knife and he was shooting the bear and there was no gut. And we're just like, whatever, dude, like, sure. They went back years later and found the knife, found the gun, found all this stuff. So he was telling us the truth and we've become really good friends. So he jumps on this bear, gets attacked. He and his brother, I think brother in law are there, and he wakes up and he's looking at his mid face. That's what this portion is called, your mid face on the floor, picks it up, puts it in his pocket, comes down the mountain with his brother. They get flown to the local ER and then they get flown to us. And so I'm looking at this piece in a bucket with Lily, and I was going to chuck it, get rid of it and start afresh. And she's like, hey, listen, like, let's look at it under the microscope and see if there's any blood vessels. And so we clean it off and there's the angular artery, which is the. It's an artery that goes on both sides right here that we see. And doing hand surgery, this is why it's a beautiful thing to have a lot of training and a lot of different. Just the way you guys do different exercises, you can translate it to different elements in your life. Hand surgery. Having that hand surgery fellowship was really important because on people who have arthritis of the base of the thumb, you make an incision here, get rid of the arthritic bone and fix the tendons and do things. But as you access it, there's a blood vessel there, the radial artery and the, the vein associated with it. So what if we took this piece and connected it there temporarily to start working on the face?
- [32:34]
Sal Destefano
So, so you took. Hold on a second. So by the way, the hand. Are the hands particularly vascular? Is. Oh, yeah. Okay. So this is perfect. So what you did is you took the part of the face and attached it to the artery here in the hand to keep it alive right here. To keep it going.
- [32:49]
Dr. Benson Pulikotl
To keep it going until we could stabilize his. Because we're working with trauma at this time.
- [32:54]
Sal Destefano
Because that was my question is how do you keep that tissue. Yeah. From going necrotic or bad?
- [32:59]
Justin Andrews
Is it good to put it like. So for instance, if this happens and you have access to ice, is that like the move or is it just how you transport?
- [33:07]
Dr. Benson Pulikotl
That's a great question. So we give lectures on to EMS all the time. Because in Colorado, you get stuff sent from Texas. I mean, I get stuff sent from Cali. Get some New York. And these. You have to specifically tell them that. Let's say a finger is amputated. The way to transport that is not in direct ice. You have to put it in, like, some kind of gauze in a Ziploc, In a Ziploc bag over a slurry. Because the ice crystallizes, like, the cellular components of the.
- [33:36]
Sal Destefano
Destroys it.
- [33:37]
Dr. Benson Pulikotl
And so you won't know until you connect it. And you're like, why isn't blood flowing? Because it's essentially frozen. So this facial segment, not only was it. I don't. I think it was put in ice, but it was like 12 hours later. So we had such low hope that this would work. And so we're.
- [33:57]
Sal Destefano
And what are you looking for when you attach it to the art of the hand? Is it going to work? Is the blood going to go, like.
- [34:02]
Justin Andrews
Color back to it or something?
- [34:03]
Dr. Benson Pulikotl
Yeah, yeah. It's like a gray piece of tissue. And I'm sitting there. Lily's. We're doing it together. I'm Put the artery together, and having a good vein was really hard. We finally got the vein together, and there's these two clamps, one on the artery, one on the vein. We removed the vein clamp. And then when I removed the artery clamp.
- [34:19]
Sal Destefano
Let's see what happens.
- [34:20]
Dr. Benson Pulikotl
It turned pink. And Lily and I looked at each other, and we knew that moment our life changed. And the reason why I say that was this is a case that had never happened before. And we were so young at that time and so fresh. And we. We took a break at that point, and we sat on his stretcher outside the room, and we actually both started, like, kind of crying. We were like, holy crap, Lily, this worked. And now we have to figure out the rest of his face. Wow. And so the trauma back up for a second.
- [34:49]
Sal Destefano
How would you even reconstruct a face without tissue like that? Where would you get it from?
- [34:54]
Dr. Benson Pulikotl
Yeah, so that. That's the reason why. So Lily's also a craniofacial. Lily did plastic surgery, craniofacial surgery, hand surgery, pediatric surgery. So she had all these ideas, and she was thinking very rapidly. She's like, listen, if we do this from scratch, this person's gonna look like crap and need a face transplant. And so we have this segment, which is so hard to Make. It's so hard to make a nose. Why don't we try to use it? That was her logic behind it. But if it's gone, let's say you don't have that segment. You take tissue. Like, you can take your rectus with the blood supply, the artery and the vein, and you can kind of stuff that. This is not an aesthetic thing at this point. This is gonna be to save their life or temporize them for an eventual face transplant at one of these transplant centers. But we had the piece, and so we really wanted to try to figure out how to make it work. And so when it lit up, that's what they say. When this tissue gets blood flow, it lit up. And we went back, and we were like, hey, we gotta figure out the face now. So Lily did a bunch of bony work, put plates on. We washed out the face together, and we put dressings on, and we just let that chill. That night, the flap, the nasal segment, became purple. And so what that means is when you have arterial blood going in, that's oxygenated venous blood, the vein takes it away. That's deoxygenated. So the vein had some issue. So we went back in, we tried to fix the vein, but it was still. There was a purplish hue to the tissue. And if you leave it like that, the tissue clots off and becomes necrotic, like you said. So this is where we go old school and we have to use medicinal leeches. And so what, leaches because of the.
- [36:41]
Sal Destefano
Anticoagulant effects of the.
- [36:43]
Dr. Benson Pulikotl
Yes.
- [36:43]
Justin Andrews
Suck it, huh?
- [36:44]
Sal Destefano
Well, no, they have compounds that breaks clots.
- [36:47]
Dr. Benson Pulikotl
Yeah, it's a compound that breaks clots. But also the mechanical act of removing that deoxygenated blood allows in time. It takes about 12 days is what the studies say, for new veins to take this. So we were leeching him. Nurses were, like, putting a leech on him every couple hours, taking it off for, like, 12 days.
- [37:09]
Justin Andrews
Wow, that's crazy.
- [37:10]
Dr. Benson Pulikotl
In the ICU, do you just have.
- [37:12]
Justin Andrews
Leeches laying around there?
- [37:13]
Dr. Benson Pulikotl
There's a number called 1-800-LEECHES.
- [37:15]
Justin Andrews
Shut up.
- [37:16]
Dr. Benson Pulikotl
Seriously, look it up. Look it up. I swear it's a real thing. You call 100 leeches, pharmacy comes, and they send you a bunch of sterile leeches. Okay?
- [37:25]
Justin Andrews
So I'm trying to envision this tagline, we suck hard. Okay? This guy is. Is. I'm. I'm sure laying in a bed, and his nose is attached to his hand the whole time.
- [37:36]
Dr. Benson Pulikotl
Is that what this time?
- [37:37]
Justin Andrews
That's wild.
- [37:38]
Dr. Benson Pulikotl
But now We're.
- [37:38]
Justin Andrews
That was a thing.
- [37:39]
Dr. Benson Pulikotl
No, that. And we should look at the pictures. I'll keep them clean for you at some point. Just because there's. We're so proud of this because it's. It's just.
- [37:47]
Justin Andrews
Hadn't been done right.
- [37:48]
Dr. Benson Pulikotl
It had been done, but it's like. It's a husband and wife team just trying to figure this. It's just such a. It's a storybook for us. And then his face was like a big gap here. And so we got him through that first surgery, and now we're trying to figure out what to use to close this gap, to just get him stable, to heal. And one of the techniques is, it's called free flap. A free flap is a piece of tissue that has an artery and a vein. So you take it off, it almost looks like. Like an island with two tails. Artery and vein. And the whole body has these all around them. Like your body is perfused and has blood flow in these different territories. And you just have to know where they are. And one of them is by the leg here. And so when people have cancer of the jaw or, you know, mandibular issues, one of the treatments for it is the ENT surgeon will take the mandible out and you need a new mandible. So we take the fibula out from here to here. A segment that doesn't really affect your ankle or knee too much. We take the bone out with the overlying skin, artery and vein. We cut it according to 3D constructs to match this segment, and we plug it into the carotid vessels.
- [39:10]
Sal Destefano
Does it? Does it. So they then have a piece missing from there. The tibia does the job.
- [39:15]
Dr. Benson Pulikotl
Tibia does the job. You lose. They say there's 15% sure. Is what you lose. But honestly, with our patients, I don't really see that.
- [39:23]
Sal Destefano
Yeah.
- [39:24]
Dr. Benson Pulikotl
And so that is in the. Again, plastic surgery. It's awesome because you don't have to get so stuck in the text. The Funk and Wagnalls, you get to. If you know anatomy and you can logically think and you're creative.
- [39:40]
Sal Destefano
I was just going to say you get really creative.
- [39:41]
Dr. Benson Pulikotl
You get creative. And so we didn't. The rest of his body had bite marks and cuts. So all we had was this segment, which wasn't ideal. He didn't need bone. We just needed the skin. So we took the skin with the blood vessel. We also took the bone and put it in the fridge just in case some of the bony work didn't heal down. The future and we put a big plug over his face so he did not look human for a while. And he had this patch here of skin, two eyes and a lower lip. And we let him stabilize. The trauma team saved his life at Swedish and it's a level one trauma center. And those guys were amazing. And now he's outpatient. And now we can start taking off the. The save your life hat and put on the reconstructive. Kind of artistic.
- [40:31]
Justin Andrews
Wow. So that's just like a patch to bridge.
- [40:33]
Dr. Benson Pulikotl
To bridge.
- [40:34]
Sal Destefano
You have to wait till he's like, okay.
- [40:36]
Dr. Benson Pulikotl
Yeah, he had hand fractures. He had all this stuff that needed to be taken care of.
- [40:40]
Justin Andrews
How long does that take before you can then. So how long does he look like that?
- [40:44]
Dr. Benson Pulikotl
So we had him, but that thing was on his arm for like two years.
- [40:47]
Justin Andrews
Oh, shit. Yeah, his nose is attached to his hand for two years.
- [40:51]
Dr. Benson Pulikotl
Two years.
- [40:52]
Justin Andrews
Get the fuck out of here. 100%. So he's walking around like, what? I mean, with a. Or is he in the hospital the whole time?
- [40:58]
Dr. Benson Pulikotl
No, he's really funny, man. He like. He'll be at restaurants in Pennsylvania. I got to blow my nose.
- [41:05]
Sal Destefano
What?
- [41:06]
Justin Andrews
That's crazy.
- [41:07]
Dr. Benson Pulikotl
He's the funniest guy, man. He's a guy. You may want to have interview one day. So then, now we went to a major conference in microsurgery, the American Society of Reconstructive Microsurgery. And we found two of the thought leaders, these gray haired guys that do a lot of this stuff. And we were waiting in line to talk to them because everyone wants their, like, autograph or something. We just had, I drew on a napkin our case that I wanted to present. Like, this is where we're at. This is what we're thinking. And so both of them were like, huh? And we're like, well, what do you think? Like, you guys did a good job. We have no idea what to do. And so we're like, oh, thanks. And so interestingly, I didn't mention this. He had a cleft lip and a cleft nose. So part of that lip and part of the nose had a little mark in it. And over the two years, that half got necrotic and died. So we were left with this half nose. And we were like, what are we going to do with this? This doesn't look like a nose anymore. And so first things first, he needed an upper lip. And so this is a cool. This is also a cool picture. Lily found one paper that talked about putting a tissue expander, which is a balloon that expands the Scalp. And over a period of three months, you get. Looks like an extra skull up here, a big bubble of tissue. And so stretches it. It stretches it. You put a little fluid every couple weeks, and you put it.
- [42:41]
Sal Destefano
What's that for? Is that to use the tissue or is that for a different procedure for the tissue?
- [42:45]
Dr. Benson Pulikotl
Because what. There's two blood vessels here, the superficial temporal artery, one here, one here. So she essentially planned out a headband flap, like a headband, drew it out, put the expander underneath, and then we cut it like this and just brought it as an upper lip. Hair was even growing down. And then in the. You know, plastic surgery is cool because you essentially do small moves. We do a big move, and then you whittle it away. And so we removed the two segments, and now he had this big handlebar mustache, which was his scalp. And he loved it. He loved it.
- [43:22]
Sal Destefano
Wow.
- [43:23]
Justin Andrews
It's like growing straight down.
- [43:24]
Dr. Benson Pulikotl
I'm going to show you all you got to see. It's just. It's amazing because he sends us a picture and we were like. At this point, we were like, kind of hoping he didn't want to use the. The forearm because it's so hard. We're like, maybe you want to do a prosthetic and. Because a prosthetic, you know, they're awesome looking, but it's a prosthetic. Yeah, it's like the Groucho Marx thing you were talking about. But he. He ultimately wanted to use that tissue, so now we had to really think this through. So using the T so it's on his arm, and we used the existing radial tissue, the arm tissue, and kind of created that other half with it and took the blood vessels, the radial artery and the vein with it out, plugged it on his nose, and sewed it to his neck vessels. When we did that and put it the right way down, it turned blue. And so we moved things around in the neck, and whatever we did, it would not stay the right color. So the only way it would stay the right color is we had to put it upside down. And so for three weeks, he had his nose upside down. And there's a really cool video of us taking him to the OR and me releasing it and turning it right side down because it had enough time to mature the blood vessels.
- [44:43]
Sal Destefano
And so how did you figure that out? Are you just moving it around? Oh, there it is.
- [44:46]
Dr. Benson Pulikotl
That's it. You put a Doppler. There's a little machine called a Doppler machine that lets you listen to the blood flow and when you turned it, it would go away. And I'm like, we're gonna do this for a while. Yeah. And so how's his breathing and everything? Like, how he's got a trachealis.
- [45:01]
Justin Andrews
Yeah, trachealis.
- [45:02]
Dr. Benson Pulikotl
He's got a trach. And so he finishes that course, he's in the icu, and he puts a picture of himself on Facebook. So thankful. He's like, my docs, they did this. This happened. But it looked like a big ball on his nose. And I'm looking at it. I'm like, Lillian and I are like, this is not a good nose. And so we started thinking, what if we make this the internal part of your nose? And so we went with that plan now. And we used rib cartilage, took a piece of rib to give him what's called the dorsum ear cartilage to give him the shape of the nostrils. And now he needed a cover because you're looking at innards now, because we again, whittled this down to the inner portion, and we needed something to cover it. So again, we used that expander, put it under his forehead. We drew out a nose like this shape, and over a period of a month, we released it, flipped it down, kept it connected so there's blood flow going like this. And then at three weeks, we released it. And so.
- [46:11]
Justin Andrews
So wild to do that.
- [46:14]
Dr. Benson Pulikotl
It's.
- [46:14]
Sal Destefano
It's.
- [46:15]
Dr. Benson Pulikotl
It's. It's amazing. It's amazing that this works, that it.
- [46:20]
Justin Andrews
Works, that you can stay alive the whole process. That, like, that's. That's wild. That, I mean, you can troubleshoot your whole way through, all from beginning to the end. How long did this. This whole process take for this guy?
- [46:31]
Dr. Benson Pulikotl
Probably like two and a half, three years. And even now, like, there's still little things we. We tweak, like, every now and then, he has a little thickness in his nose, so he has a. This. So one of the most beautiful experiences was we were in. He had his nose. He's sitting there in the icu, and this was essentially, we thought, gonna be functional for breathing, but he'd lost his sense of smell. And we thought. And it was really for aesthetics, because these patients, they're not trying to be on the COVID of gq, man. What they're trying to do is just get milk, get gas, and not be stared at. Burn patients, trauma patients. That's all they want to do, is live a normal life. And so his wife was cutting an orange, and he was like, oh, I smell an orange. And everyone freaked out. Because his olfactory sense, his, his smell was intact.
- [47:22]
Sal Destefano
That's remarkable.
- [47:23]
Dr. Benson Pulikotl
It was unbelievable. And we didn't do anything for that. That just meant that the beer didn't attack him.
- [47:28]
Sal Destefano
How do you, how do you work? So burn has to be the other incredibly challenging thing, because how do you get skin that was severely burned to, I don't know, grow back or look like it wasn't severely burned? What does that look like? Is that still very difficult? Almost impossible? Like, how do you do that?
- [47:47]
Dr. Benson Pulikotl
Yeah, I mean, the cool thing about our burn unit, it's, I think, and I'm a super confident guy about this, we are the best in the world. And the reason why I say that is we're double board certified plastic reconstructive surgeons. Four of us, we love each other, we love taking care of patients and we love complexity and really getting people back. We love when we get pictures of these patients doing the stuff that they used to do. So when you come in with the big burn, it's not necessarily the burn that kills you. It's the inflammatory cascade afterwards that gets you so kidney shutting down, infection, lung issues. So back in the day, the way they treated big burns was if you had a big burn, like 30, 40, 50, they just did wound care and everybody was dying. There was a fire, I think in the 40s or 50s in Florida, where multiple people got burned. I mean, I think maybe 100 or more. And the surgeons at that time thought about, what if we just excise the source of this inflammat, the source where the inflammation starts. So they'd cut away the burned skin and put dressings on. They noticed.
- [49:01]
Sal Destefano
And let it heal from there.
- [49:02]
Dr. Benson Pulikotl
Well, do that first and see what happens. The patients were living at that point. It'll never heal on its own unless it's a really small burn that the skin around it can close. But if you have a big burn, you need skin from your body on it in some fashion. So fast forward to what we do now. So now if a patient comes in, 20, 30, 40, 50% burn, we stabilize them, the resuscitation, we give them fluids, we watch their hearts. And our ICU doctors are just badass. They just come in and they save people that you think would die in transport. So now it's our part and usually the second day we go in and we essentially just take a scalpel or an instrument and remove that burn until you get to healthy bleeding tissue. Now it's about temporizing them. So we in our unit use donated human skin. And I put That a recent post on my Instagram was holding a sheet of human skin, skin that was like this big, that gets donated. It's a gift. It's a real blessing to have this stuff. And we essentially put this on to temporize them. The body will do everything except accept it. So it'll start growing, it'll start healing, but it can't accept it because there's an immunologic barrier there. And so now, depending on the size of their burn, let's say they're like 30% burn. You have 70% of their body which is not burned that you can use to help transplant, transplant from that side onto your burn. So some cool things we do. Anytime a burn over 30% comes, we take two specimens from the groin, about that big. We send it off to a company. The company takes that skin and they make a really thin epithelial layer. Very thin epithelial layers. So they're essentially making skin. But it's not full thick. It's not like.
- [51:02]
Sal Destefano
Are they. Are they taking the stem cell, the cells and having.
- [51:05]
Dr. Benson Pulikotl
No, they take the epithelial.
- [51:06]
Justin Andrews
They're thinning it, like, right?
- [51:07]
Dr. Benson Pulikotl
Nope, they take it and put it in culture under hood and they just grow sheets of it in petri dishes. Oh, wow.
- [51:12]
Sal Destefano
And.
- [51:12]
Dr. Benson Pulikotl
But it's like very, very, very thin.
- [51:15]
Sal Destefano
Right.
- [51:16]
Dr. Benson Pulikotl
The thing that kills these patients is infection. One of your best barriers for infection is skin. And so what we do is. And that takes about three weeks. So now we're doing. We have the donated skin and you have this cooking in the background. We start planning on optimizing nutrition, which is huge. This is what we talk about, creatine, those kind of things, vitamins, all that stuff really helps.
- [51:38]
Sal Destefano
Are you giving them amino acids, protein? What are the things that help grow?
- [51:41]
Dr. Benson Pulikotl
Oh, yeah. I mean, like they're on tube feeds that are optimized for protein. Their protein losses are just unbelievable when you don't have skin.
- [51:49]
Sal Destefano
Yeah, I said that because the original, the original studies on. When you look up the old studies on essential amino acids, branch chain amino acids, they were all done on burn victims. It was all burn victims is where we got the data that it helps with, you know, some of the stuff.
- [52:01]
Dr. Benson Pulikotl
And when you think about in medicine, a lot of the advances happen in really violent and dark times. Wars.
- [52:09]
Sal Destefano
Yeah.
- [52:09]
Dr. Benson Pulikotl
Big tragedies, things like that.
- [52:11]
Sal Destefano
Huge need.
- [52:12]
Dr. Benson Pulikotl
Yeah. And so, so now you have this patient, he's got. He or she has donated skin on. You bring him back, you change out the donated skin and you find the areas where they have Normal skin. And you take what's called a dermatome, which is essentially looks like a tool that extremely thin slices of skin. So you put it on the normal areas and you harvest skin off of them. You put it through a machine called a mesher, which takes that skin and puts holes in it so you can stretch it out. And then you start covering them. Right. At the same time you're covering them, you get that company to send you the thin sheets and you can sometimes put that on top to help fill in those gaps. Sometimes. So if you don't have a lot of donor sets, let's say you're 80% burned, you only have 20% of your skin available. You take the skin, you mesh it. Now there's different patterns. There's one to one which is like small holes. There's eight to one, which are huge holes. So you have. It looks like a sheet with just lines now to help allow for those skin cells to close. That's when the company helps a lot with that thin skin in between because it acts like a bridge.
- [53:32]
Sal Destefano
How does the. Because we met you, I met you at the peptide conference.
- [53:35]
Dr. Benson Pulikotl
Sure, yeah.
- [53:36]
Sal Destefano
So I'm assuming now you're looking at using peptides to accelerate or help this process. Things like GHKCU.
- [53:43]
Dr. Benson Pulikotl
Yeah, yeah, no, PPC157, GHKCU. All of these things are awesome. But medicine is slow. If you noticed at that peptide conference, the people meeting moving the needle aren't the docs necessarily. It's people like you guys talking about it. It's the people who are actually using it. And what I feel is just modern day medicine. There's so much red tape to get that stuff through for me to even change a dressing kind of in a different way. Algorithm takes a lot of effort. So peptides aren't incorporated yet, but there is no doubt that that'll be the future of this stuff for healing. I mean, I used bpc. I had it band syndrome for like two months. I did it for two and a half weeks, went away completely. So I mean, I'm not here to like give medical advice about peptides, but just anecdotally for me, they have helped me and I just see the way medicine is going.
- [54:50]
Justin Andrews
So can you not. So right now you can't use it with patients.
- [54:52]
Dr. Benson Pulikotl
You can't.
- [54:53]
Sal Destefano
Oh, wow. Unless it was what, private? If. Because if it was like someone, I'll pay out of pocket, do whatever I was to say.
- [54:59]
Justin Andrews
Are you even allowed to do that? Like, hey, I can't recommend this to you, but I've heard or seen you.
- [55:04]
Dr. Benson Pulikotl
You can. And there's like non uninformed people that can, that have been doing that. I mean in my esthetic practice I talk to patients about the benefits of peptides after a facelift, after you know, aesthetic surgery because they can go do their research and essentially if they want buy it on their own. And I can only tell, I mean tell them the risks that it's. There's no long term studies on this but there's no doubt that there is benefit in these peptides. It's just with medicine you need to go through the randomized control trials. You need to ensure that they're not harming patients.
- [55:46]
Justin Andrews
Going to take a decade before it's possible.
- [55:48]
Dr. Benson Pulikotl
It's possible.
- [55:49]
Sal Destefano
But how, how hard is it to, to reattach parts of the hand? Because it's such a. Yeah. I mean there's, there's, there's constant movement. Yeah. So much articulation and so much touch and so much we do with our hands. And I mean if you look at the anatomy of a hand it's like good luck.
- [56:08]
Justin Andrews
I would actually would have thought because isn't it there's more nerve endings in the feet than there are the hands. I would think the feet would be as hard or harder. So that make a difference.
- [56:16]
Dr. Benson Pulikotl
We don't. There are from, from you know, just hearing that, you know, I think there's more nerve endings just because we're making more contact. But I'm actually not sure if that's the case. But I think that the foot. There's a lot more give if you lose toes.
- [56:32]
Sal Destefano
That's right.
- [56:33]
Dr. Benson Pulikotl
You're not gonna. Sure you're not. We do things right.
- [56:36]
Justin Andrews
So it's not as big of a deal if my foot doesn't look as good. It doesn't move quite as much.
- [56:40]
Sal Destefano
Plus you're not playing a piano with your and you're not picking up a four foot.
- [56:43]
Dr. Benson Pulikotl
And so when it comes to hands now essentially the hand is skin. And this is a different type of skin than the rest of your body. The soles and this is called glabrous skin. There's more nerve endings, there's different architecture to it. And so it's skin underneath it. There's actually a lot of muscles, small intrinsic hand muscles. There's nerve, there's bone, there's tendon, there's. On this side, same thing. Skin, tendon, bone, ligaments, all of these things. When you and I do a lot of wide awake surgery. So if somebody comes in with the tendon cut. I'll numb their entire hand and do.
- [57:21]
Sal Destefano
It while they're awake.
- [57:22]
Dr. Benson Pulikotl
Do it while they're awake so I can get the tendon to the right excursion.
- [57:26]
Sal Destefano
So you can ask them to do something?
- [57:28]
Dr. Benson Pulikotl
I ask them to open up and if it's a little low, I'll tighten it up.
- [57:31]
Sal Destefano
I see.
- [57:32]
Dr. Benson Pulikotl
And so when you're watching this, this dance of extensor tendon with flexor tendon and just motion, it's hard not to be amazed. It just is because it's like you said, it's so complex. And when these structures get cut, it's very, very hard to make them perfect. But recently I had a patient. She's 20 something. She was, you know, having a hard time and she tried to kill herself. She took a box cutter and went right at her wrist longitudinally, so deep. She cut the bone. And what's interesting is I got the call in the middle of the night. I went over all the tendons, all the arteries, all the, all the nerves, and I put them back together, spent all this time, and it looked really cool, really good repairs. Went home, went to sleep. She came back in on a Wednesday. And I take care of a lot of these patients. Some of them don't even show up for follow up because they're in their mind state. First thing she says is, I'm really sorry. You don't have to be sorry. And she said, no, no. I heard when you are called that your kids were crying. And it's the first time like I've ever heard a patient say something like that. And I was like, listen, this person's different. And so to answer your question, the surgery part is challenging, but the stuff after is where it counts.
- [59:07]
Sal Destefano
Sure.
- [59:07]
Dr. Benson Pulikotl
So I knew this girl was different than the rest. So she was coming to therapy all the time. And it's really important because your body is not as smart as you think. When you fix a bone, the bone heals, but it scars everything else above it. So you have to differentially move things. You guys know this when you train people, like, body parts and muscles slide over each other. And if you don't, if you're not.
- [59:31]
Sal Destefano
Aware of that, it's not exactly like a puzzle.
- [59:34]
Dr. Benson Pulikotl
It's not. And so the hand therapist is crucial in making sure the tendons move just enough so scar doesn't happen on the bones and additional surgeries and function isn't limited.
- [59:47]
Sal Destefano
How do you attach tendon? Is tendon to tendon or tendon to muscle?
- [59:50]
Dr. Benson Pulikotl
Harder to attach tendon to muscle because tendon to tendon. When you look at a tendon, this is also amazing. Look, you don't really see blood vessels with your eyes, but there are microscopic blood vessels there. And so you take a suture. So imagine a tendon end, tendon end like this. You put a suture in like this. You wrap it around and you have it come out this way and you do the same format.
- [60:10]
Sal Destefano
Oh, I see.
- [60:10]
Dr. Benson Pulikotl
And then when you tighten it, it connects this way. And if you've seen a tendon, there's some substance to them. Whereas like muscle is just.
- [60:20]
Sal Destefano
I was just gonna say how do you attach a tendon to a muscle?
- [60:24]
Dr. Benson Pulikotl
So there are some techniques in the muscle. You can take a baseball stitch and sometimes if I have a loose piece of muscle, like a lawn mower injuries, the muscle is cut, you do a baseball stitch, attach to the stitch. Attached to the stitch. Exactly.
- [60:39]
Sal Destefano
Does it heal back just as strong?
- [60:42]
Dr. Benson Pulikotl
It can.
- [60:43]
Sal Destefano
Okay.
- [60:43]
Dr. Benson Pulikotl
Yeah. And there's, there's, there's techniques you can do. You have some extraneous tendons in your body. Like this tendon right here is called the palmaris. You can take that out and use it and use it for grafting. And I do that all the time.
- [60:57]
Sal Destefano
Why is it sometimes I see people will get a torn bicep and they just leave it torn and they don't pull the bicep back down and reattach it. Is it because it's like, eh, waste of time or.
- [61:06]
Dr. Benson Pulikotl
There's a couple of reasons. One is you have another muscle, the brachialis, that can do that function. Sometimes people are.
- [61:11]
Sal Destefano
So it's more aesthetic than anything.
- [61:13]
Dr. Benson Pulikotl
Well, one of the reasons it may not be possible the tendon may be the tendinous portion may not be enough to implant back into the bone, but a lot of times people who have that will get that fixed. It's easier than like a peck, for example.
- [61:31]
Sal Destefano
I was just going to say the.
- [61:32]
Dr. Benson Pulikotl
Big peck is really challenging to fix.
- [61:35]
Sal Destefano
It typically tears up. You're in the armpit and that's pretty difficult.
- [61:38]
Dr. Benson Pulikotl
Yeah, because it's all muscle at that point.
- [61:40]
Sal Destefano
Wow. Wow, that's interesting. That's fascinating. So, yeah, to me the hands are so fascinating because what I was told or not taught, because it's not something I learned necessarily, but what I would hear, the surgeons that I trained, and I never trained a hand surgeon, but I did train general surgeon. Sure. Vascular surgeon. A lot of anesthesiologists, they would talk about how like the hands were just like, yeah, that's, that's tough. That's really, really tough because of just all the moving parts and how intricate the hands are and how much feel there is. And so that's got to be one of the more difficult areas to hand is very challenging.
- [62:12]
Dr. Benson Pulikotl
And really the. When we're on call for hand, if the arteries cut, you have like four to six hours before they start losing tissue and get necrotic, things like that. If the nerve is cut, you have like 12 to 18 months after you repair to see if it'll come back. So the nerve is actually one of the most like if there's an injury there, resilient. No, no, it's. It's actually if you cut like the median nerve or one of the major nerves, that's what really dictates your function.
- [62:45]
Sal Destefano
Yeah, there's no nerves, no juice moving to the muscle.
- [62:47]
Dr. Benson Pulikotl
And so sensation, motion, like you said, and where you cut it makes difference. If you cut a nerve up here, the chance of you getting sensation and feeling in your arm and your hand is much less than if you cut it here.
- [63:01]
Sal Destefano
I love asking doctors, especially surgeon, this question. What are some of the characteristics that you notice in patients who seem to do the best? Are there personality traits or characteristics? Okay.
- [63:13]
Justin Andrews
Or what about like healthy bodies? Like when you're working on somebody who's fit and strong and healthy, somebody that's, that's not. I bet that makes a difference.
- [63:21]
Dr. Benson Pulikotl
100 and I talk about this a lot with my colleagues. Like I'm sure you noticed and I noticed a lot of doctors aren't the healthiest. And it's not that they don't want to be healthy. There's something in the culture of medical school, of training where you give everything. You sacrifice your health, you sacrifice everything.
- [63:43]
Sal Destefano
Your health, your diet, everything.
- [63:44]
Dr. Benson Pulikotl
At some point you'll get to it. I've never been that way. I've always, always really felt that it's a sport. And for me to perform in the operating room, I have to be mobile, I have to be strong, I have to be able to. And so I train every morning at 4:50 train today. And so I think that when I have a patient, I try to convey the importance of that. Part of it is, hey, listen, you're going to get through this and you're going to crush therapy, you're going to get your function back, you're going to be able to hold your kids, you're going to be able to work. Here's what I need from you. I need you to think positively. Like I'm a scientist when it comes down to it. But I'm also very holistic. Like, my family is. Generations of Ayurvedic medicine, things like that. Positivity, what you think manifests itself. Like, there's so many times where I'm like, you know what? This is going to be okay. And it's okay.
- [64:37]
Sal Destefano
Have you seen the correlation between depression and. And autoimmune disease? And they've actually been able to see that the depression leads to more autoimmune disease? Not necessarily.
- [64:47]
Dr. Benson Pulikotl
Interesting.
- [64:47]
Sal Destefano
Yeah. And I'm wondering if the immune system responds because of this. Like, you focus on how much you hate yourself so much. I wonder if the immune system starts to react.
- [64:55]
Dr. Benson Pulikotl
There's some truth to that. So when we do these big cases, like piece of tissue here put on somebody's neck. We're actually doing a huge one on Friday, covering somebody's brain with their latissimus muscle. Me and Lily are gonna do that. What we do is the scientific portion is the surgery, which goes really well, then all the other stuff. No chocolate, because there's. After surgery, there's a risk of chocolate causing vasoconstriction, which is the blood vessels shut down and close up. Coffee, there's some risk of coffee causing that. We put them in a room with a window so that they can have a circadian rhythm. We make sure that their family isn't, like, stressing them out. We don't want epinephrine in the there to shut down those blood vessels. Sometimes I'll give them a book and I'll say, hey, I'll find out what they like to do.
- [65:42]
Sal Destefano
Do you guys use PDE5 inhibitors for blood flow during surgeries?
- [65:46]
Dr. Benson Pulikotl
Like which one?
- [65:46]
Sal Destefano
Like Viagra Cialis. Would those help, or is that so.
- [65:49]
Dr. Benson Pulikotl
So we do some medications like. Like lidocaine, for example, and papaverin. These are. These are medications that take out what's called vasospasm. When you touch a blood vessel, they. There's a nervous system on every blood vessel. That's how we, you know, you do a cold plunge or a sauna. That's how you dilate and constrict. This can be harmful when you're doing these surgeries because it can all of a sudden constrict, and then your whole flap is. The piece of tissue's clotted off. So putting these medications gives you a temporary window where you can sew it and allow for blood flow back and forth. And. Yeah, I mean, there's a very holistic approach to this, too, besides the scientific part. Patients who come in that are Positive. I've seen somebody that has a horrendous injury with a positive attitude do really well versus somebody who doesn't have such a bad injury but has a negative attitude and doesn't feel like they're going to succeed, do poorly. And it's with work, too. Like, there's a study with hand. If you're out of work for something like three weeks, the chance of you going back to work is like single digits.
- [66:59]
Sal Destefano
Do you have any favorite partners that you work with? Like, you know, do you need to work? Do you work closely with other practitioners, like, you know, other doctors that aren't doing what you do, but you're like, hey, you go to this guy? Because I work very well with them and we work together well.
- [67:14]
Dr. Benson Pulikotl
We. Part of plastic surgery, which is really cool, is a lot of the work we do is somewhat unpredictable. And like, we'll be on call and the orthopedic surgeon's like, hey, man, can you come to room four? And you come in, hey, we took out the tumor and there's a lot of tibia exposed. Can we figure out a plan?
- [67:32]
Sal Destefano
Oh, right.
- [67:33]
Dr. Benson Pulikotl
And so.
- [67:33]
Sal Destefano
So they call you in.
- [67:34]
Dr. Benson Pulikotl
They call us in the. So neurosurgeons, when they do spinal surgery and they put a bunch of hardware in, instead of just closing up, they'll call us in to use the muscles to cover the hardware. So if any infection gets in, it doesn't cause a hardware infection. So routinely we'll get called, hey, we're unable to close over the scalp. Are you guys available to. Just one of you guys. And there's always an on call, one of us. Right now, it's Lily. Can you come by to room eight and just see what needs to be done? And so we'll. We'll figure something out.
- [68:06]
Justin Andrews
Is there a typical time frame? Because I remember when I just out of high school, we. We went for our senior trip to Hawaii, my friends and I. It was the beginning of the week, week, and my buddy gets drunk and gets in a fight, and this dude split his lip all the way from the bottom of his nose, flayed it wide open, and we had to rush him to the hospital. And they actually had to wake up a plastic surgeon and fly him in or something like that to come do the work, like in the middle of the night. Is there certain body parts or certain types of injuries that you've got a small window that you've got to attack it if you're going to save it or be able to recover, reconstruct it? Like Is there. Are it different or is it kind of universal, like ever? You got a certain window. Pretty much anything if you want me to be able to save that. That limb or part or.
- [68:52]
Dr. Benson Pulikotl
Yeah, so. So with nerves that are motor. So there's sensory nerves. Yeah, you touch something, you feel it, and then there's motor. Motor nerves. When they're cut, you really want to get to them within a couple of days, like soon. Because once they're cut, the end point. So your nerve is like this. There's an endpoint that accepts the signals. The endpoint's like, I'm not getting signals.
- [69:14]
Sal Destefano
It shuts off.
- [69:15]
Dr. Benson Pulikotl
It shuts off and it starts turning into scar over time. So you don't want that to happen, like in your hand and stuff like that. So that's. If somebody tells you, hey, this guy came in with a samurai cut to his wrist. He has no function of his hand. We're taking that to the. OR that night. We're going to fix the nerve, the artery. Artery is another thing. If blood flow is not there, we're going to fix that right away. But like a lip flow, for example, that's often done emergently. At least we do it because if you wait too long, the swelling is so hard to really approximate. And get the, the.
- [69:45]
Justin Andrews
Get it to line up.
- [69:46]
Dr. Benson Pulikotl
Just get it to line up just right.
- [69:47]
Justin Andrews
Okay. That's why they were so we'll often.
- [69:49]
Dr. Benson Pulikotl
Do that, like at the time. But that can, that can wait. That's something that, you know, you can.
- [69:53]
Justin Andrews
Wait like as far as health and survival, but for aesthetic reasons, that's why they did it. So.
- [69:58]
Dr. Benson Pulikotl
Because.
- [69:59]
Justin Andrews
Yeah, I remember the next day, his was like this.
- [70:01]
Dr. Benson Pulikotl
Yeah. I mean, I'd never seen really hard. And at that point, you to have to go back and try to align. It's. It's just logistically, it's easier and it's better for the patient. Nobody wants to always.
- [70:12]
Justin Andrews
I didn't think it was like a life or death thing, but it's like, man, it was very urgent. They flew someone in.
- [70:16]
Sal Destefano
It was a big deal. Any interesting new technologies on what you're doing? Because I, you know, you. I see articles and I'm sure it's years out, but they're like, you could grow, you know, from your own stem cells and nose or your own this or your own that. Like, is that all kind of on the horizon?
- [70:30]
Dr. Benson Pulikotl
A lot of it's on the horizon. One of the cool things we do is when we take skin, you know, there's the creation of skin where in that you know, a company that, like, I talked to you about sends it back in three weeks. But you can also take skin and scrape off some of the cells like the epithelium, and put it into a solution that we do at the bedside, not in the operating room, but, like, we're kind of making it with saline and things like that. And for facial burns, for example, patients we. A common burn that we get is the older person who has. Is on oxygen but decides to smoke a cigarette.
- [71:11]
Sal Destefano
Oh, lights it on fire, and they.
- [71:13]
Dr. Benson Pulikotl
Have a facial burn. Happens every week.
- [71:16]
Justin Andrews
Oh, my God.
- [71:17]
Dr. Benson Pulikotl
And so that skin is. It's very superficial often. And so that'll come off. And when you spray this solution, it can help regenerate to the point where there's new data coming out that for people like me who have melanin, it can restore melanin into some of these burns. Because that's one of the things that if I had a burn, I'd lose my melanin with some of the skin grafts and things like that. But, yeah, I mean, aside from that, there's cool things happening in surgery, like the robot. I'm sure you've heard of that. They're using robotic surgery for head and neck for different. They're trying to incorporate into different aspects of plastic surgery. I mean, AI is. Is pretty cool.
- [72:08]
Justin Andrews
You know, I know. How would you use. Because obviously the. The skill of the. The hand for you to do so many things, I think, and then the real time pivots. Human is so important. But I got to imagine there's got to be ways that you could, you know, plug something into AI and like, if we do this, what are the potential outcomes if we do this? And then, like, do you use it like that already or will you, like.
- [72:29]
Dr. Benson Pulikotl
What do you say? Not yet. I mean, for surgeons to say that AI won't replace them is, I think, ego. And the reason why I say that is because for a product to do well, you probably need it to be good, like, 80% of the time. Now, when you have surgery with me, I'm going to treat you like a family member. I'm going to give you every, like, drop of my brain and sweat and hands to make sure that the outcome you have is the best. Now, is that necessary for you to be functional? I don't know. Now, this is where I may come in and say, hey, you know what? He does. That extra 20% is not necessary for me to be functional. Health insurance pays this. And so that's what I'm a little worried about. But at the end of the day, there are nuanced things that we do that I just don't know how based on this, I'm reacting this way. I don't know if that's something that I can pick up maybe.
- [73:27]
Sal Destefano
I mean, interesting. Do you. Because I know you're in medicine. You do. You have to be so specialized. You have to know it's so deep. And sometimes there isn't like that cross communication when it comes to, like, the face. Do you work. Do you ever work with neurologists with, like, when people have things like trigeminal neuralgia or pain? And then do you guys work together and kind of learn from each other? Like, what does that look like with you guys at that level? Do you guys all sit down and go, all right, let's. Let's talk about these things we do.
- [73:58]
Dr. Benson Pulikotl
I mean, we have. Not with the neurologist, but, like, part of the burn team is. Every Wednesday, we have a multidisciplinary team round.
- [74:09]
Sal Destefano
Okay, cool.
- [74:10]
Dr. Benson Pulikotl
So on that rounds, we talk about every patient, sometimes 50 patients. And the people there are case managers, social worker, trauma icu, dietitian, pharmacy.
- [74:23]
Justin Andrews
Oh, wow.
- [74:23]
Dr. Benson Pulikotl
And it's. It's long. We go and everybody says something. Oh, wow. And then we. We get really great care that way. And that's why burn units are really important, because not just the surgeon doing some skin grafts, it's multidisciplinary approach. But, you know, example of that is, you know, we work with neurology in the sense that some. There's a cool surgery that we do for headaches where neurology, there's, for example, occipital pain. They're injecting Botox, they're injecting steroids, and there's no relief. And so we get them, as kind of a last resort, put some lidocaine into that area. And if their pain is resolved, we know maybe there's an option for surgery here. And so we'll make an incision down the middle of the scalp. We'll raise the tissue up, and there's three nerves here, the occipital nerves and the third occipital nerve. And will the greater and lesser occipital nerve and the third. They're like, kind of like this three on each side. And all we do is we find them and we free the compressing tissue over them. Sometimes it could be from a trauma whiplash. Sometimes it could be a blood vessel that's pulsating on it.
- [75:38]
Justin Andrews
That's got to be life Changing for somebody who suffers from, like, chronic head headaches all the time.
- [75:43]
Dr. Benson Pulikotl
I had a patient once that I did this procedure on. She had the procedure. I'm operating another room, and the nurse is like, hey, you need to go talk to that patient. I'm like, oh, no, what's going on? I go back and I'm like, hey, what's going on? And she's like, this is the first time I have zero pain. I don't know if you know, but I was so suicidal. So, I mean, that. That gives you a lot of. A lot of just satisfaction. And. And it's a challenging surgery, but it's not like putting a face back together and this thing that you kind of think you're on the next case. It's made such a difference. Just releasing tissue on a compressed nerve.
- [76:25]
Sal Destefano
Do you get more. It sounds like you do. I think I already know the answer. But do you get. The harder the case, is it the more exciting for you? Are you like, okay, this is, like, the challenge. This is gonna be interesting.
- [76:36]
Dr. Benson Pulikotl
I think that. Yeah, I think that really is. As much as we get older, you know, my family's my number one priority. And when we didn't have kids, that's all I wanted, was the hardest case. Be the biggest badass. Tell everybody, like, this is what we do. Because we were trying to build a name for ourselves. And I'm still that way. I still want challenging cases. But what you start noticing is what is a big case to you is a big case for anyone undergoing surgery, whether it's a carpal tunnel.
- [77:15]
Sal Destefano
Sure. For them, it's always.
- [77:16]
Dr. Benson Pulikotl
Yeah, they're not sleeping. Right. That. You know, it's a.
- [77:19]
Justin Andrews
Like, the headache person, like, the head. She was suicidal. You saved her life.
- [77:23]
Dr. Benson Pulikotl
Like, I think takes 12 minutes to do a trigger finger. And people come back and, like, now I can, like, move my hand. Now I can hunt. Now I can fly fish. Now I can do all these things, you know? Well, it's cool.
- [77:35]
Sal Destefano
Yeah. That's great. How do you guys balance family? Because you're both surgeons.
- [77:38]
Dr. Benson Pulikotl
Yeah.
- [77:38]
Sal Destefano
And you got kids. What does that look like?
- [77:41]
Dr. Benson Pulikotl
It's hard, man. It's. It's. It's. I don't think there is balance, like, in life, as much as I want to say I. You know, everyone wants to get balance. I think there's points in your life where you're focused on certain things and points in your life where you're not. And I. Like I said I had this. I don't want to say it's unhealthy. This just drive to be the best resident, Be the best, technically, figure out all about surgery. Until my first son was born. I saw him and it's just like, I was like, things got to change now. And I remember the moment I'm holding him and I'm like, I gotta make sure, like, you're okay doing what you do.
- [78:25]
Sal Destefano
Would you encourage your sons to go into the same field or. Because sometimes people will do something. It's very challenging. They're like, I love it, but I don't want my kids to do it because it's just a lot.
- [78:35]
Dr. Benson Pulikotl
So I used to say I don't want them to do it because the pathway was so hard. It's not just the years of schooling. You lose friends. You know, your parents are like, hey, we're having this event. Can you can't come or. You know, I remember Thanksgiving where I had the day off, and I'm at Thanksgiving and I'm a resident, and the resident who was there was sick, and the attending's like, dude, you need to come in. So you just go in. And there's a lot of sacrifice to that. So unless you truly love it. And I'm going to gauge that with my kids. Unless they, like, really love it. I think it's. I think it's a. There's other ways to. To be successful in life, and you really have to. I feel very fortunate because I'm friends with a lot of doctors, and I love what I do. I love it. I love it to the 10th, exponential, whatever. A lot of my friends, they don't love it. They're burnt out, they're trying to get out. They're looking for side hustles. They're doing all this stuff at its core, surgery and plastic reconstructive surgery and aesthetics. I love it. Now, do I like notes and do I like the healthcare system and do I. No. But the. The job itself, it's amazing to go meet patients, talk to them, hear the changes you can make, and ultimately, like, share that with your. Your loved one. Like my wife, we talk about this stuff.
- [80:00]
Sal Destefano
I'm like, what's a date?
- [80:01]
Dr. Benson Pulikotl
Like, look, now, it's not as much like, back in the day, before the kids, we'd. We all.
- [80:06]
Justin Andrews
You talked about roles.
- [80:07]
Dr. Benson Pulikotl
Yeah, I mean, the OR used. When we got to our hospital, the OR was upset because they'd hear us fighting. And we're not fighting. We're, like, arguing about family. Like, Lily, we should go to the facial artist. She's like, dumbass, go to the thyroid art. It's bigger and better. And the OR's like, oh, my God, they're fighting. We're just. We're just, like, talking, you know, communicate.
- [80:26]
Justin Andrews
On another level than that.
- [80:27]
Dr. Benson Pulikotl
And we're, like, looking at each other like this over the microscope, like, you know, and they're getting. They're getting uncomfortable.
- [80:33]
Sal Destefano
Are you guys ever, like, in the middle of the or, you're doing something, you look up, you're like, I love you, honey.
- [80:37]
Dr. Benson Pulikotl
Absolutely. You know, great stitch. The crazy story about Lillian. I mean, she's beautiful. She's a double board certified surgeon. She's an amazing mom. So when she was pregnant, she worked until like, nine and a half. Like, nine months, right? She calls me, I'm in a flap, I'm doing. It's big procedure. She's covering somebody's brain. And she calls me and she's like, hey. I'm like, what's up, Lily? She's like, my water broke mid surgery. Mid surgery.
- [81:12]
Justin Andrews
Shut your face.
- [81:13]
Sal Destefano
She was doing surgery still.
- [81:14]
Dr. Benson Pulikotl
And so I'm like, I didn't even know what that meant because we're. He's five weeks early.
- [81:19]
Justin Andrews
Oh, he's early. That's why.
- [81:20]
Sal Destefano
Okay.
- [81:21]
Dr. Benson Pulikotl
And so I'm like, oh, my God. What. What do I like? I'm, you know, going from being a married guy with no kids to that moment, I know this is happening. I'm like, lily, I'm in the middle of a case. She's like, don't worry, I'm going to drive myself. I'm like, no, no, you got. You got to find somebody. She's like, no, I'm going to drive. So she drove herself gangster and has a C section. The next morning, kid is fine, and we have to take our hand boards. We were supposed to have, like, this later, but the timing of the kid made it so that she had just gotten the C section. And two days later, she's taking her hand boards and she's on pain meds. She's on all this stuff. And I'm. We're in the prometric test center. I don't know if you guys have ever been to a test center like that, but there's a computer here and a computer here. And I look and I get up during the break. She's asleep. I kick her chair, like, get up, like. And she comes up to me, you know, I left 10 blank. I'm like, holy crap. You know, because I felt decent about it, that I passed it. And I was like, man, hope she doesn't like not past it because this is not fair.
- [82:32]
Sal Destefano
She'd do better than you.
- [82:33]
Dr. Benson Pulikotl
10 points out. 10 points out.
- [82:38]
Justin Andrews
You'll hold that over you forever.
- [82:39]
Sal Destefano
Yeah, that's great. Any hobbies outside of, outside of work and family?
- [82:44]
Dr. Benson Pulikotl
Man fitness has been huge, huge for me. I remember fourth grade, I was like kind of chubby and I had a cousin Basil. This kid, just a beast, just an athlete from the get go. He August 15th, 4th grade, 6:30. He taught me my first sit up. I remember the time because I looked at the clock when I was doing it. I couldn't even do it. He was pulling me up and so I just started really getting into. At that time it's like muscle fitness and you know, you're watching Predator and Rambo, all of these, these idols that don't look like the people now. But that's who I wanted to be. And in the Indian community it wasn't like normal to play sports. Like none of. No, I didn't know anyone. Baseball, ran track. I played football. I worked out. He worked out with me. And I remember doing push ups and doing push ups and finally like my cephalic vein came and I was like.
- [83:37]
Sal Destefano
You got a vein?
- [83:37]
Dr. Benson Pulikotl
I got a vein. Yeah. And so it was huge for me. I mean all throughout high school we open, we opened the first real gym in our high school. I mean and you know, give him a shout out. Shawn Leonardo and Harold Riggs. These, these were high school, but they are high school buddies of mine that we'd come, I mean in high school at 5:30 in the morning to just work out. And then college playing football, that was awesome. And training is a, a huge part of my life.
- [84:07]
Sal Destefano
How much of an advantage? Again, I trained a lot. At one point I trained a lot of surgeons and they would tell me how they would make them better at their job.
- [84:14]
Dr. Benson Pulikotl
100%.
- [84:15]
Sal Destefano
Yeah. How much of an advantage is it?
- [84:17]
Dr. Benson Pulikotl
It's, it's night and day.
- [84:18]
Sal Destefano
Yeah, we'll talk about that. Why? Why? Because yeah too. Especially if you're a surgeon. Especially if you're new. You're, you're, you know, you're. The schedule can be crazy.
- [84:28]
Dr. Benson Pulikotl
Yeah.
- [84:28]
Sal Destefano
And so the thought is I'm going to take time out to go work out. I'm so fried. Or I don't know, like talk about the advantage of being fit for what you do.
- [84:38]
Dr. Benson Pulikotl
I mean I used to do the evening workout and then I realized I was missing out on kid time. So we make our life at that time now. We don't need this nanny. We had a nanny Come at five in the morning so I could get to the gym downstairs. We built a gym. 4:50 in the morning. I'm doing. I sit in the. We have an infrared sauna. I'd sit in there, just kind of loosen up, then do like a pretty powerful push pull workout. And I would always try to sprint at the end. And part of it is when you go to the operating room, you're contorting your body in a lot of different ways. And it's not unusual for surgeons to pull their back doing something stupid and be out or they hurt their neck. And so for me, part of it is that. But it's a mental edge too, because I, I also do cold plunge and sauna. I've done that for 27 years. Cold plunging and that really, when you do that in the morning, the rest of the day is easy for me.
- [85:41]
Sal Destefano
Yeah. You know, start out with something that sucks.
- [85:43]
Dr. Benson Pulikotl
Something bad, Something. Yeah, embrace the suck. Right. Like, so if you do that, for sure. If you do that, the rest of the days is. It gives you a mental legend. Surgery lets you think clearer. I typically don't eat breakfast because I found that if I eat a big breakfast, I'm a little bit shaky.
- [86:00]
Sal Destefano
Sure.
- [86:01]
Dr. Benson Pulikotl
Yeah. And so I like to be super stable. Don't eat breakfast at around 11 or 12 or 10. I'll take a huge protein bolus and then I'll keep that going for the day.
- [86:13]
Sal Destefano
What's the longest you've been in the OR where you're working on somebody?
- [86:17]
Dr. Benson Pulikotl
43 hours.
- [86:18]
Justin Andrews
43 hours straight.
- [86:20]
Dr. Benson Pulikotl
43 hours.
- [86:20]
Sal Destefano
Hold on a second. So. So this, this is stuff that always blows me away. And the first time I understood this, I was training a general surgeon who had done a Whipple procedure. And she was in the hospital. She was in the OR for hours and hours and hours. And my question is always like, what if you got to go to the bathroom? Like, what do you do?
- [86:34]
Dr. Benson Pulikotl
You take breaks?
- [86:35]
Sal Destefano
Yeah. Okay. So. So that's what I say. How many. What do you, how do you do that? Do you go take a Nap? Because it's 43 hours.
- [86:41]
Dr. Benson Pulikotl
No, never. So this was a, a very unusual case that will never happen.
- [86:45]
Sal Destefano
How many Red Bulls are you drinking? Like, what are you doing here?
- [86:47]
Dr. Benson Pulikotl
Yeah, I don't. Because you don't want to. You don't want to shake. Oh, that's right. And so the, this was a case that I was the chief resident and there was an attending there, and it was a mandibular reconstruction. Same like this leg was being used and very detailed Attending. It took a long time to get this leg out and put it on one side of the neck. The vessels didn't work. Then tried a different vessel, didn't work. And then now you're like doing the other leg. And finally it worked. And it took, I'm not kidding you, it took 43 hours. And so in between, I took like, I don't know, five or six breaks. Not long. Ate something, came back. And then there's residents that are coming in between.
- [87:29]
Sal Destefano
You're not sleeping?
- [87:30]
Dr. Benson Pulikotl
No, no.
- [87:31]
Sal Destefano
That's crazy.
- [87:34]
Dr. Benson Pulikotl
There's also like a long time ago. That's like 20.
- [87:36]
Sal Destefano
Well, hold on.
- [87:37]
Justin Andrews
So I'm.
- [87:37]
Dr. Benson Pulikotl
Now I'm like.
- [87:39]
Sal Destefano
So I'm going to ask you.
- [87:39]
Dr. Benson Pulikotl
Controversial carpal tunnel, falling sleep.
- [87:41]
Sal Destefano
This might be a little controversial, but I know that now when you're a, A resident, when you're do. You're in, you're, you're out there, you're trying.
- [87:48]
Dr. Benson Pulikotl
Sure.
- [87:49]
Sal Destefano
They now have limitations on how long they'll let you.
- [87:52]
Dr. Benson Pulikotl
Yeah.
- [87:52]
Sal Destefano
Work and stuff. I've heard arguments on both side. One side says, yeah, yeah, we got to put limitations because there's only so much they can learn and there's a lot of mistakes. The other side says you got to go and go through the crap because sometimes you'll be in the OR for hours and hours and hours. Where do you stand on it? Do you think that they've made it too easy?
- [88:09]
Dr. Benson Pulikotl
So I went through the, the older pathway where my first year there wasn't any restrictions at all.
- [88:19]
Sal Destefano
Yeah.
- [88:20]
Dr. Benson Pulikotl
And my residency was a little bit slow to keep the restrictions in the beginning. Now it's very regular. Now, here's what I have to say about it. There is literature that shows when you are tired, you are essentially drunk.
- [88:37]
Sal Destefano
Right?
- [88:37]
Dr. Benson Pulikotl
Yeah. And you can't be that way. But at the same time, not everything happens between 9 and 5 o'. Clock. A lot of stuff happens in the middle of the night at this time, at that time. And so I think we have to find a happy medium because there's an extreme where you're in the hospital 43 hours, which is not. I don't think that's right. But then people are being pulled out of a case that they're in because they're over hours. So what I tend to find is a lot of these newer surgeons that have problems are finding people like myself and sending patients to us because we've had that experience and we have that. It's almost like a discipline.
- [89:22]
Sal Destefano
Here's my. I, I have an opinion. I would love your Your thoughts on this? Yeah, I think that there are people that are not like the average person that can operate better than the average person under a lot of sleep restriction or stress. And I feel like you kind of want that process to whittle down to the people that can do that. And maybe that's what it serves. Maybe that's. That's kind of what it serves. Because there's gonna be situations where, hey, I know when you went through residency, we had all these regulations and rules, but out here, you're gonna be. There gonna be times when you're sleep deprived.
- [90:00]
Dr. Benson Pulikotl
Yeah.
- [90:00]
Sal Destefano
And you got to be able to perform. And we don't want the people who can't perform when they're under that stress.
- [90:05]
Dr. Benson Pulikotl
It's hard to know yourself like that. I'm one of those people, like, I feel like I've. My entire life, I've really. When I like something, I love it and I focus on it. And in the operating room, when you're there, it's. You're in flow state. You are. All that matters is you're gonna get this patient that right outcome. Get them off the table. They're gonna be alive, they're gonna be safe. And you don't remember. You don't, like, sit there. And an hour pass. Yeah, you're not clockwatching. No. You're getting it done. And afterwards, that's when you're, like, sitting at the computer trying to finish the note and. And you're out.
- [90:42]
Sal Destefano
You're dead.
- [90:43]
Dr. Benson Pulikotl
And so I think that there is truth to that. I think that you have to know the kind of surgeon you are. Are you the surgeon that wants to do five or six small cases and be done? Or do you want to be the person that is the end of the line, that if it doesn't work, this person gets an amputation? And that's kind of the mentality I am. And so to hone that and do that, it's not just being in the or, it's some of the jobs I've worked in. I used to do an inventory job that I would work 24 hours straight. I used to, you know, like, study for hours on end. All of those. Those. Those things builds muscle. Yes. This. This discipline muscle. And some of my. And this is something that I. I really believe. Believe about surgeons. You can't be a sloppy person and be expected to be this neat, awesome surgeon. You can't be a bad person who cheats on certain things and then be a great surgeon because your natural tendency is to fall back into that when stress happens. So if you're a cheater and you have a corner to cut in surgery, human nature is to cut that corner. So I really feel like when you talk about training, when you talk about family, you talk about finances, they're all interrelated. You have to really think about them in the same way. So I think that type of surgeon, it's a little taboo to promote that this day.
- [92:15]
Sal Destefano
I knew it was controversial, but that's.
- [92:17]
Dr. Benson Pulikotl
Who I want as my surgeon. I want the guy or girl that has seen it all by being in the hospital, by working hard, by reading, by understanding the, the pathology. They have the experience and they can adjust.
- [92:33]
Sal Destefano
Is this where the reputation. You actually said it earlier. The surgeons were kind of like these jerks that walked around. Is that where that reputation comes from? Because they're like so focused and so if you don't understand that, they can seem like they're just.
- [92:44]
Dr. Benson Pulikotl
I mean, it was brutal residency for, for. I mean, I had it tough, but even further back, it was, it was harder. Like they call it residency because you lived there.
- [92:53]
Sal Destefano
Oh, yeah.
- [92:54]
Dr. Benson Pulikotl
And so these, these people were. There was no attending suit. And this, none of this is right. There was no attending supervision for some of these people. They were operating on people to doing, you know, trying to figure things out on their own. They're having family strife. They're. And so this gets manifested in being mean to a medical student.
- [93:14]
Sal Destefano
I trained, I trained a woman who was a general surgeon, but she was. So this was 15 years ago. She was already in her early to mid-60s. And so. And the other surgeons would talk about her because they're like, you don't know. They're like, when she went through, back when she did, it was much harder. And it was harder for a woman to go and do what she did.
- [93:34]
Dr. Benson Pulikotl
Oh, yeah.
- [93:35]
Sal Destefano
And that's why she's such a badass. And so they would. Do we just talk about this woman like she was. And she was, she was incredible.
- [93:40]
Dr. Benson Pulikotl
I mean, I see that with Lily. Like, you know, it's a very male dominated sport even now. And in her training, she was in one of the roughest places in Newark, New Jersey, and she's this amazing surgeon, but she always dressed up, she never like looked sloppy, she always was positive. And if she ever acted assertive, you know, they said that she was being a bee, you know, like, you gotta be though. Yeah. And you have to, you have to control your own destiny. You have to make sure that who's going to advocate for you more than yourself? So she really was a proponent for herself and that's why she got, she was successful. But that's, you know, swimming upstream. And so I think it's harder.
- [94:30]
Justin Andrews
Have you seen that translate into her being a mother? I bet she's a badass mom.
- [94:34]
Dr. Benson Pulikotl
She's an amazing mom. She. And we have two boys and they're crazy boys. They're like 4 and 7 and they, they do things that, you know, I, I fly fish. I've been doing 15 years. Lily got me into that. She was doing it for 30 years. But my, I never grew up doing that stuff. And my seven year old, he catches trout on three flies. He skis blacks. I never skied until two years ago. And so she's really big on giving them these experiences. If it's up to me, they'll, like, you know, they'll hang out with me, I'll do the stuff, but I won't be thinking about, okay, let's, let's go on a Disney cruise or let's, you know, go to Costa Rica and visit the OSA Peninsula with the boys. That'll be nice for them to see birds of prey, you know, like, things like that. And so she's a badass mom. I mean, I've heard about your wives and they're the similar DNA amongst them with, with high functioning school husbands.
- [95:29]
Sal Destefano
That's great. Well, I appreciate you making the time to come over here, man. I know you're real busy. Yeah, it was really awesome meeting you at the congress.
- [95:36]
Dr. Benson Pulikotl
Yeah, absolutely.
- [95:36]
Sal Destefano
Yeah. This is interesting, fascinating conversation. So. Yeah, man, appreciate you coming on, my friend.
- [95:41]
Dr. Benson Pulikotl
Absolutely, man. I'm really honored. And let me know if you guys ever have. You guys can get my cell number if you guys have.
- [95:50]
Justin Andrews
I hope we never have to call you. No, but if you do, you're the man, I'm sure.
- [95:54]
Dr. Benson Pulikotl
No, but the cool thing is like, who you see on the billboards is not necessarily, necessarily always the best person for things. And so doctors are connected with who they would go to. So take down my cell number if you guys have. I have a lot of friends and family out in Cali and so awesome you have issues or if you're worried about something, let me know.
- [96:15]
Sal Destefano
Thank you.
- [96:16]
Justin Andrews
Appreciate you.
- [96:16]
Sal Destefano
Appreciate it.
- [96:17]
Justin Andrews
Thank you, man.
- [96:17]
Dr. Benson Pulikotl
Thank you, man. Thank you guys.
- [96:18]
Adam Schaefer
Thank you for listening to Mind Pump.
- [96:20]
Dr. Benson Pulikotl
If your goal is to build and.
- [96:22]
Adam Schaefer
Shape your body dramatically improve your health and energy and maximize your overall performance, check out our discounted RGB super bundle@mindpumpmedia.com the RGB Super Bundle includes maps, anabolic maps, performance and maps Aesthetic Nine months of phased expert exercise programming designed by Sal, Adam and Justin to systematically transform the way your body looks, feels and performs. With detailed workout blueprints and over 200 videos. The RGB Super Bundle is like having Sal, Adam and Justin as your own personal trainers, but at a fraction of the price. The RGB Super Bundle has a full 30 day money back guarantee and you can get it now. Plus other valuable free resources@mindpumpmedia.com if you enjoy this show, please share the love by leaving us a five star rating and review on itunes and by introducing Mind Pump to your friends and family. We thank you for your support and until next time, this is Mind Pump.