The Science Pawdcast

Episode 7 Season 7: Seal Oxygen, ER Dogs and The Heart of Anesthesia with Dr. Ashley Gabrielsen

• Jason and Kris Zackowski • Season 7 • Episode 7

Share episode

Send us a text

From groundbreaking research on seal oxygen perception to heart-stopping surgical techniques, we explore medical frontiers that sound like science fiction but save lives daily with cardiothoracic anesthesiologist Dr. Ashley Gabrielsen.

• Gray seals can perceive blood oxygen levels rather than CO2, allowing them to adjust dive durations accordingly
• Therapy dogs in ERs significantly reduce pediatric anxiety – dropping scores almost twice as much as standard care alone

Then an amazing chat with Dr. G!


• During cardiac surgery, the heart can be completely stopped while a bypass machine takes over circulation
• In extreme procedures, patients can be cooled to 20°C and circulation stopped briefly – being "clinically dead" before resuscitation
• The brain lacks pain receptors, enabling awake brain surgeries where patients can play instruments during the procedure
• Modern anesthesia techniques allow joint replacements with minimal medication and same-day mobility

Dr. G's Instagram Handle @ashleesi306

https://www.instagram.com/ashleesi306/


Our links! 

Our Website!  www.bunsenbernerbmd.com

Sign up for our Weekly Newsletter!

Bunsen and Beaker on Twitter:

Bunsen and Beaker on TikTok



Support the show

For Science, Empathy, and Cuteness!
Being Kind is a Superpower.
https://twitter.com/bunsenbernerbmd

Speaker 1:

Hello science enthusiasts. I'm Jason Zukoski. And I'm Chris Zukoski, we're the pet parents of Bunsen, beaker, bernoulli and Ginger.

Speaker 2:

The science animals on social media.

Speaker 1:

If you love science.

Speaker 2:

And you love pets.

Speaker 1:

You've come to the right spot, so put on your safety glasses and hold on to your tail.

Speaker 1:

This is the Science Podcast. Hello everybody and welcome back to the Science Podcast. We hope you're happy and healthy out there. This is Episode 7 of Season 6. Nothing major to report with the dogs or the cat this week before we get into the science news and our amazing guest. I think the big development that we're just so proud of is how good Beaker is doing at Doggy Daycare. We're getting reports that she's playing happily with all of the dogs and her and Bernoulli are becoming best buddies and definitely there's been a change in how they interact with each other at home. Bernoulli still makes Beaker crazy and she tunes them up sometimes, but we do hear that they play together all day, which just you know, it's so sweet. And then we also heard that Beaker has a friend and oh my God, it's like it's like she's. You know there are kids and you have like a kid that's struggling socially and has made a friend in grade two. It's pretty sweet. Anyways, go beaker, all right.

Speaker 1:

Well, what's on the show this week? In science news, we're talking about holding our breath, but if you're a seal, and in pet science, a really heartwarming study about reducing anxiety in kids during ER visits You'll have to listen to figure out what's going on there. Our guest in Ask an Expert is Dr Ashley Gabrielson, who's going to be talking to us about anesthesiology. What a cool guest. Okay, let's get on with the show, everybody. There's no time like Science Time. This week in science news, let's talk about holding your breath. But specifically, if you're a seal, chris, how long can you hold your breath for?

Speaker 2:

Not very long at all, probably a maximum of two seconds. You may recall teaching me how to swim, and I didn't want to put my face in the water.

Speaker 1:

No no.

Speaker 2:

And then I had to do the time swim doing the back crawl because I was like I can't do it, I can't do front crawl and coordinate and breathe and not die.

Speaker 1:

Holding your breath is something you can train though. Holding your breath is something you can train though I, through competitive swimming. I could hold my breath and would do like peak physical activity for a long time.

Speaker 2:

Yes, Jason, you always surprised me and it was so cool that you were able to do full lengths under the pool. You would be like watch this, and then you would just stay under the water and go from end to end and not even come up for air.

Speaker 1:

It's a fun party trick and occasionally I've been at swimming pools with kids, either as a chaperone or when I used to teach phys ed. We would. That was a long time ago and that was the thing I'd always bet the kids. I was like, okay, if you can swim further than I can underwater, no homework for the rest of the year. And the kids would always be so overconfident and they'd be like, yeah, we can take you, your old man, and then they would go not very far and then I would wax them. It's very satisfying.

Speaker 2:

I just think of how we used to play video games like Conker's Bad Fur Day, and I couldn't get through the level where he had to swim underwater because he his oxygen would run out and he would die.

Speaker 1:

Yeah, rather graphically. Some of those old games every one of those old games, though had a swimming level and, as you said, a fire or lava level, but we're talking about holding your breath underwater, and the creature we're talking about is the gray seal, and, as new research findings show, they might have a specialized sense that helps them survive deep under the water.

Speaker 2:

So how do they do that? Why is that unusual?

Speaker 1:

When we hold our breath, if you want to try it right now, if you're listening, carbon dioxide builds up as your body goes through some of the respiration. That buildup of carbon dioxide drives you to take a breath. Now, for people who hold their breath, swimming or whatever you can push that feeling back through training. You're like, oh, I need to breathe. And you're like, no, I'm just fine. You can go quite a ways without taking a breath, but it takes practice because that feeling can be terrifying. To take a breath, but that's carbon dioxide. These gray seals may adjust their dive time side. These gray seals may adjust their dive time not based on carbon dioxide levels, but oxygen levels, and maybe they can perceive their own blood oxygen levels, which stops them from drowning.

Speaker 2:

The research findings were published on March 21st in an issue of Science. Like you were talking about, Jason, if oxygen levels drop too much in humans, a person loses consciousness, but marine mammals can't afford to lose consciousness underwater.

Speaker 1:

Yeah, especially if they're really deep, right. They'll lose consciousness and they'll just drown. If they're really deep, yeah.

Speaker 2:

If they're really deep, and so the study aimed to identify what adaptation allows the gray seal to regulate their oxygen levels so effectively. Evolution obviously strongly favors adaptations that prevent seals from drowning.

Speaker 1:

Now here's the experiment. It's a fun one. I love seals. They kind of look like water dogs. They look like they're having fun. They kind of look like water dogs they look like they're having fun. They kind of look like Beaker if Beaker didn't have fur and had fins like the dogs of the ocean.

Speaker 1:

They had six juvenile gray seals from a wild population. They were studied in a controlled experiment. Each seal swam in a 60 meter long pool, traveling back and forth. That would be fun to watch. There was an underwater feeding station and a breathing chamber with controlled gas contraptions, and they had four different air compositions. There was ambient air, which is what we're breathing right now, which was roughly 21% oxygen. There was high oxygen air, that's double the normal oxygen concentration. Low oxygen air, which is half, and high CO2 air, that's double the normal oxygen concentration. Low oxygen air, which is half, and high CO2 air, which is normal oxygen, but 200 times the CO2 level, and if you were to breathe that as a human, you would immediately feel bad, breathing that much CO2. And 510 dives were recorded across the seals.

Speaker 2:

And what they found is that the dive duration of a seal was directly linked to oxygen availability. So if there was more oxygen, the seals dove for longer. Less oxygen, it's obvious shorter diving time, but interestingly, carbon dioxide levels had no effect on dive duration. Interestingly, carbon dioxide levels had no effect on dive duration, so the seals were able to independently adjust their behavior, which suggested that they were aware of their blood oxygen levels.

Speaker 1:

And that kind of makes sense, because if you're a marine mammal, you probably know that. What I was talking about earlier, chris, where you can blunt your response to CO2 rising. You can feel that gross feeling that you get when you hold your breath, and if you train enough, you can push that to the side. Obviously, marine mammals probably have evolved an extremely good response to blunt that, because that would just naturally build up in them as they dive. That same sensory system used by us and other mammals to track how much CO2 they have may in fact detect oxygen levels instead, and maybe that's how their brains process the blood oxygen content.

Speaker 2:

You know how they are different. Whereas in humans we detect the CO2, and their key difference might be in how their brains process oxygen as opposed to CO2, the levels of oxygen in a seal.

Speaker 1:

Awesome, right, the low O2 levels in a seal may bring on those same feelings as high CO2 levels in us, which is really cool. And, of course, other marine mammals may have the same physiology and that's what they want to study in further studies.

Speaker 2:

Because it could have potential medical applications and it's a unique physiological adaptation.

Speaker 1:

The more we know about our natural environment. I think that's cool. It answers a question and who knows where that question may go. But I think we can all agree that the need to breathe is probably the most important need that you have. It doesn't matter how much money you have. I told my kids that today I was like what's the most important thing? And some kid was like money and I was like you can have $5 million but you have to hold your breath for 20 minutes. And the kids that's impossible. I'm like, see, it doesn't matter how much you want the money, you got to breathe, just breathe, all right, that's science news for this week. This week in pet science we're going to the ER and talking about therapy dogs.

Speaker 1:

Now, of our two sons, duncan and Adam. Duncan is quite a bit older. He doesn't live at home and he hasn't for a while. Adam was really healthy. I don't think Adam ever went to the ER. He's been super lucky to not have any injury or any real bad illness, but Duncan's been a couple times when he was a little guy. He was very little. This is back when we were a young couple. Adam wasn't born, obviously, at my parents' house. He was pushing a baby carriage and he tripped and he broke his arm in half and, yes, we had to go to the ER because of that.

Speaker 2:

He was two. Yeah, he was just a little guy just a little guy and his arm because he was a toddler his bones were a little bit bendy, so it wasn't really broken in half. It definitely had a nice curve to it, though yeah, what did they call it?

Speaker 1:

A green stick break or something like that.

Speaker 2:

Something like that, but it still was ridiculous that had happened.

Speaker 1:

Yeah, and I guess, luckily with a broken arm, once you get it stabilized, I didn't think. I didn't think Duncan was in too much pain, honestly, but he was in a ton of pain until we figured out what it was and then, once we got his arm stabilized, he was OK. I'm not super thrilled with life being a two yearyear-old, but it was a lot better, even going to the ER. Young kids there must be a lot of anxiety there. I think I was more anxious than you and Duncan. I think I almost passed out. Anyways, this comes from Riley's Children's Hospital in Indianapolis and they took the data from early 2023 to 2024 and it was just published in JAMA in March.

Speaker 2:

And what they found is that kids who spent more time with a therapy dog reported significantly greater reductions in anxiety compared to those who did not, and also parents perceived a more noticeable decrease in their child's anxiety when therapy dogs were involved. And this tracks with the research that we have been talking about and having dogs in the classroom and the positive impact that they have on people, specifically children.

Speaker 1:

Yeah, of course this is not the ER, but the day before Christmas I brought Bernoulli and Beaker into my school and I have that time in the first semester I had these grade nine students or young students. They're good kids first off, but they're grade nines, they have a lot of energy and it's the day before Christmas is. It was amazing what those dogs did. Just having them in that classroom it just sucked. They took on all of that nervous energy that the kids had. The kids were just completely different and again, I'm not saying that my kids that I teach were bad. They just had a different type of energy around the dogs.

Speaker 2:

They just had a different type of energy around the dogs, so that's key. I guess we could talk about managing pediatric anxiety in the actual ER. So the American Academy of Pediatrics highlights the importance of managing anxiety and pain in children who are receiving medical care, in children who are receiving medical care, and the emergency departments often employ child life specialists to help young patients cope, through play therapy and age-appropriate explanations, with what is going on with their condition.

Speaker 1:

Yeah, if they have something way more serious than a slightly broken arm, like Duncan did, this becomes something that's really hard to communicate to a kid if you're not trained. I can't imagine having to tell a kid about their bleeding or maybe they have to be on a feeding tube or something like that. So it's just heartbreaking, and there's obviously people trained in the hospitals for that, and managing child anxiety leads to better outcomes child anxiety leads to better outcomes.

Speaker 2:

80 children ages 5 through 17 participated in the trial and all of the patients received support from the child life specialist that I spoke up before Now. Half of the children so 40 children spent about 10 minutes with a therapy dog and its handler. Now, children with dog allergies or fear of dogs were excluded from the study.

Speaker 1:

Which is important, right? Not every kid grows up seeing a dog as a friendly thing, and I was. I am allergic to cats, so if somebody's hey, you're at the ER and here's a cat, I'd be like, are you serious? I'm already super sick, I'm at the ER, and then you're throwing a cat at me.

Speaker 2:

It's going to make me even worse Now. It's important to note that the Riley Children's Hospital already had an established therapy dog program in place and they vetted their therapy dogs and they were fully vaccinated. They undergo an annual veterinary checkup and they are actually certified as therapy animals.

Speaker 1:

So this is not throwing Bernoulli, his guberness, into the ER, or even as good as Beaker is, because Beaker is our good girl. She's our steady girl in tough situations. This is their train to be there. They've gone through all of that and they had all of those participants you mentioned, the 40 do an anxiety measurement method. They needed a baseline, so they took them. Researchers used the FACES scale, which visually represents the stress from zero to 10. Of course, the people, the kids in the study, were probably old enough to talk about their anxiety, but this is something they could also use with kids that were unable to like have a conversation about how anxious they were if they were little, and the results were nothing short of amazing.

Speaker 2:

So the average self-reported score was 5.4 across all participants. What they found was that anxiety reduced after 45 minutes. So patients with standard care with a child life specialist only demonstrated a 1.5 drop on average, but the patients who also had a therapy dog visit dropped 2.7 points on average. So that's how they split it up. They had the 80 participants, 40 got the dog and 40 just had the standard care, and this trend was consistent with parents' assessments of their child's anxiety. So parents self-reported how anxious their children were feeling.

Speaker 1:

Yeah, that's pretty amazing. If you're about a five, you're anxious, like five is not no anxiety, and you drop 2.7. That's a huge dropping down almost to about a two and a half, which is just a little bit scared or something like I don't know what low anxiety would be. Obviously, the ER is not a place you want to be, but it's not 10 severe anxiety. So these findings really suggest that therapy dog visits are super effective for reducing stress and anxiety in young patients. And really we've talked about this before, Chris. The only thing holding everything back from having therapy dogs everywhere is it's expensive and these dogs don't grow on trees. Not every dog can be a good therapy dog and you also need a handler to bring the dog into the hospital and it's either through volunteerism or you have to pay them and it's expensive. It's expensive to train the dog, it's expensive to get the dog there, but perhaps the cost benefit is better for the patient than not having them at all.

Speaker 2:

So they could explore using therapy dogs as a valuable complement to existing child life specialist programs that are already in place to support pediatric patients and their families.

Speaker 1:

Yeah, exactly. Maybe you don't have them every day, but they come in and among the most anxious of the young people, the therapy dog makes a visit there. That just warms my heart. I bet you most of those therapy dogs are golden retrievers or labs. It would be interesting to find out. They're just so affable.

Speaker 2:

My anxiety and stress levels are reduced just talking about it.

Speaker 1:

You got to be home with the dogs today. How's your anxiety right now?

Speaker 2:

Jason, I had a beautiful day with the dogs.

Speaker 1:

I told you my best days, not that I don't love everybody, and not that I don't love my job or the students or my colleagues, but nothing makes me happier than doing nothing with dogs.

Speaker 2:

I know. So I had parent teacher interviews for the last two nights, and then we get a day in lieu for the after hours that we spent at the school. And then today it was relaxing. I hung out with all the dogs and Ginger and you can't ask for a better day.

Speaker 1:

Do you think you had a 2.7 drop in your average anxiety on the FACES scale?

Speaker 2:

I think I did.

Speaker 1:

All right, that's Pet Science for this week. Hello everybody, here's some ways you can keep the Science Podcast free. Number one in our show notes sign up to be a member of our Paw Pack Plus community. It's an amazing community of folks who love pets and folks who love science. We have tons of bonus Bunsen and Beaker content there and we have live streams every Sunday with our community. It's tons of fun. Also, think about checking out our merch store. We've got the Bunsen stuffy, the Beaker stuffy and now the ginger stuffy. That's right, ginger the science cat has a little replica. It's right, ginger the science cat has a little replica. It's adorable. It's so soft, with the giant fluffy tail, safety glasses and a lab coat. And number three, if you're listening to the podcast on any place that rates podcasts, give us a great rating and tell your family and friends to listen to. Okay, on with the show. Back to the interviews. Back to the interviews.

Speaker 1:

Time for Ask an Expert on the Science Podcast, and I am thrilled to have Dr Ashley Gabrielson with us today. Doc, how are you doing? I'm good. How are you? I'm so good? Where are you calling into the show from? Where are you in the world?

Speaker 3:

I am in Southern Oregon.

Speaker 1:

Oh, Oregon is so beautiful. I love Oregon.

Speaker 3:

It is really gorgeous here. I'm blessed to be here, for sure.

Speaker 1:

I've been down through Idaho, oregon, montana, that whole area south of us in Alberta, really pretty area of the United States. Yeah, have you lived in Oregon most of your life or have you moved around?

Speaker 3:

No, moved around, mainly actually due to training. I was born and raised in Indiana and then I've been all over the country with training. I did my medical school in Illinois and residency in Massachusetts and then fellowship in Ohio and then out to Oregon for a job.

Speaker 1:

Okay, so you've seen lots of places getting your training to be a doctor. That's a lot of work, so my hat's off to you.

Speaker 3:

Oh, thank you.

Speaker 1:

Not a short path, that's for sure.

Speaker 3:

No. People frequently ask me oh, how long have you, how long did you have to be in school for this? And when I stop and think about it and total it up, it was 26 years. It's a long path.

Speaker 1:

Oh my goodness, that's a little longer than the six I took to be a science teacher, so just a titch. But as we get into it, generally, people's life isn't in the palms of my hands. As I'm doing my job, I just have to get the kids to stay awake to listen to some chemistry.

Speaker 3:

So you still have lives in your hand, it's just in a different form.

Speaker 1:

In a different form. That's right. So when you were young, were you the kid that wanted to be a doctor when they were older, or was this something that happened to you later in life?

Speaker 3:

I was a little kid with a Fisher-Price doctor bag I was, with the little blood pressure cuff and the faith thermometer and all that. I went through a brief stint where I think we had just eaten at the pizza hut and it was back in the day when they had windows where you could stand there and watch them make the pizzas. So I went through a brief stint where I told my parents I wanted to be a pizza maker.

Speaker 1:

It does look fun. They're still pretty disappointed, but that's okay. Have you thrown dough before Doc? Is that something you've done?

Speaker 3:

Oh, no, not at all. Oh, you've got to try it.

Speaker 1:

That's why you wanted it. You missed your calling as a pizza thrower. The dough, people chuck it in the air. That's a lot of fun.

Speaker 3:

I think the dogs would love that. I think they'd love me to give that a try.

Speaker 1:

but yeah, I've dropped a few when I've done it before. Yes, and right now, currently, you specialize in anesthesia.

Speaker 3:

Is that correct? Yes, that's correct.

Speaker 1:

Okay, and specifically during heart surgery.

Speaker 3:

Yeah, yes, so my actual title is I'm a cardiothoracic anesthesiologist.

Speaker 1:

Wow, can you? Okay, like I have in my head a general path to be a general practitioner doctor, right, somebody that's in a clinic. Something's wrong with you. You go see a thing. They talk to you, they make you cough, I don't know, maybe that's just me. They write you a prescription, maybe, and then you're on your merry way. What did you have to do? That kind of specific medical training?

Speaker 3:

After medical school actually I should backtrack In your third and fourth year of medical school. Here in the US you do rotations. They're usually anywhere from a month to two months long, and you go through a lot of different specialties, the core specialties, general practitioner surgery, obstetrics, pediatrics, psychiatry all those different fields just to get a well-rounded education, but also to see what you like. And I was fortunate enough that my surgical subspecialty rotation just happened to be anesthesia and I fell in love with it.

Speaker 3:

So after medical school, I did four years of anesthesia residency, which is just training in anesthesia for all different types of surgery, and one of the types of surgeries that you do is cardiac anesthesia, and it was a very similar sort of thing. My first day in what we called the heart room, I fell in love. It was an instant yeah, this is my calling, this is where I belong. So after anesthesia residency, I did a one-year fellowship in cardiac anesthesia at Ohio State University and that is a year where you only do anesthesia for heart and lung surgery. So it's a whole focus on that and that was the most intense year of my life, to be sure. But yeah, after that then I was let loose upon the world.

Speaker 1:

Go do your anesthesia.

Speaker 3:

Exactly, exactly.

Speaker 1:

Okay, I am fascinated by surgery. I am a little squeamish so I don't know if I could be in the room. I like watching videos of it or like the computer simulations. I think our audience would just be in awe if you could walk us through like what happens during a typical heart surgery. And where do you come in with your role with anesthesia?

Speaker 3:

yeah, let me just preface that tv is really inaccurate. Youtube videos actually. Yeah, youtube videos are probably actually more accurate than tv, gotcha yeah, I meant like the, the computer animations of like procedures.

Speaker 1:

I think they showed a med school. I'm like sometimes I go down a rabbit hole and I just watch a million of them.

Speaker 3:

But anyways, so essentially what happens on the day of surgery, a patient will come in and before they even come into the hospital they have had an extensive workup. So they've had lots of blood tests, x-rays, ekgs which is an electrocardiogram that measures the electrical rhythms that go through the heart, that tell the heart exactly what part needs to beat and when, and imaging of their heart, so ultrasounds, cts I'm sorry CAT scans and sometimes even MRI. So they've had all this done before they get to me. So we know exactly what the problem that we need to fix is. And when they come in, we do the usual say hi, they get changed into a gown and I start putting in my special types of IVs. What I do I will give. Typically I'll give the patient some sedation, because nobody likes being stuck with needles. It's not fun and when you're about to have heart surgery your nerves are already just through the roof Can't imagine.

Speaker 3:

Yeah, so I give them some sedation so that they're comfortable. They don't really care what's happening, and I put the first thing I'll do is I'll put in what's called an arterial line. What's happening, and I put the first thing I'll do is I'll put in what's called an arterial line. It's very similar to an IV, typically goes on the inside of the wrist into the radial artery, and what this does is it measures the blood pressure with every heartbeat, instead of a blood pressure cough you may have had at your GP's office.

Speaker 1:

Yeah, the OOPA thing.

Speaker 3:

Yep, this is. Every single time the heart beats I get a special waveform that tells me exactly what the blood pressure is, and this gives me more real-time data so that I can respond quicker. Once that's in, then I will put a large IV in the side of the patient's neck, into the internal jugular vein.

Speaker 1:

Whoa really. I just thought it was on the arm.

Speaker 3:

They do have one in the arm, but for heart surgery specifically, we do have a bigger one in the neck. Wow, this one is. I don't know the exact internal diameter it's less than a centimeter, but over half a centimeter big. And what this does is if I need to give the patient something very quickly, so if they need lots of IV fluids or lots of blood products, or if they need strong blood pressure medications, I can do all that through this big IV in the neck and it's a direct path to the heart.

Speaker 1:

Okay, that makes sense actually because that's like straight to the heart. Okay, that makes sense actually, because that's like straight to the heart. Okay, I got it.

Speaker 3:

Yeah, and it's a quicker acting thing than a peripheral IV which has to go through all the veins, get back to the heart and then do its thing. This just goes right to where I need it to be and with certain types of heart surgery I put in what is called a pulmonary artery catheter. So this actually goes through that IV in the neck and rests inside certain chambers of the heart and the pulmonary artery, which is the artery that comes off of the right side of the heart that goes out to the lungs. So this artery takes deoxygenated blood out to the lungs where it gets oxygen and then comes back. But this catheter can measure different types of pressure in the chambers and in that artery. So I have an idea how certain parts of the heart are working and if I need to do anything to help them work. So that's all that's before surgery.

Speaker 3:

Yeah, once all that's done, then the patient goes back to the operating room and I give them a selection of medications depending on how old they are, what type of procedure we are doing, what their pathology is, so what's wrong with their heart and how it's affecting the rest of their body. But either way, everybody ends up going to sleep. Once they're asleep, I put a breathing tube in and this is how I breathe for the patient during surgery and once surgery is over actually after heart surgery patients typically stay asleep and then we'll go to an IC or coronary care unit to have some time to rest before they wake up and start breathing on their own again.

Speaker 1:

So I did Google your job description before and I was I apologize, doc, I was ignorant. I just thought you were the put to sleep of the person doctor. But there's way, way, way more than that and I apologize that. I even thought that before our talk.

Speaker 3:

Oh no, don't, no worries at all. That's actually a really common misconception.

Speaker 1:

Yeah, this is so good. Thank you so much.

Speaker 3:

Oh, yeah. So once the patient's asleep and they're intubated, I put an ultrasound probe so it's called a transesophageal echocardiogram a fancy name for an ultrasound probe that goes into the esophagus, which is the. When you eat, that's where and swallow, that's where your food goes. And this ultrasound probe takes pictures of the heart both inside and outside, while the surgeon is working and before and after they're working, so that I can make sure that everything looks okay before surgery is done. So let's say the surgeon is replacing one of the heart valves. Once they put in the new valve, I need to make sure that it's in the right position, that it's functioning well, that the valve is opening and closing like it should and they haven't left any pieces of plastic behind that sort of thing. Yeah, so that essentially is my role in the beginning, and then the surgeon and their team will do what they need to do.

Speaker 3:

Sometimes, if we are doing what's called a coronary artery bypass graft or we call call it a CABG, that's a common heart surgery that we do and that's where you take veins from the leg and sew them onto the aorta and onto the heart to provide new blood flow, to take the place of the arteries that have been blocked for whatever reason. Typically it's cholesterol plaque, that sort of thing. So the surgeon will do that, they'll get their veins ready and then they will open the chest and that can be a bit gruesome. It involves a saw and a big rib retractor that almost looks like a I'm blanking on the term but something you would crack crab legs with.

Speaker 1:

Basically, oh my goodness, like a nutcracker almost.

Speaker 3:

Yeah, yeah.

Speaker 3:

And then the surgeon will put in what's called the aortic cannula, so that's a really big IV that they stick directly into the aorta, and then they will put another big IV into the right atrium of the heart.

Speaker 3:

And what these cannula do essentially? The aortic cannula will give blood to the body and the venous cannula will take blood from the body. And what it does is it takes blood from the body to a special machine called the cardiopulmonary bypass machine, and this machine will provide oxygen to the blood and filter out any waste products. It will maintain the pH of the blood, keep the blood in a state that it would normally be in a healthy body, and then it spins it all around and uses centrifugal force to pump that blood through the aortic cannula out to the body. So essentially what this gets to is that the body can survive without the heart for a certain amount of time. So we use special medicines then to stop the heart. Wow, that's so wild, isn't it just science fiction sounding stuff? It really is. So we use special medicines to stop the heart so that the surgeon has a stationary field to work on.

Speaker 1:

Yeah, it's not quivering. And going like crazy, right, exactly. And going like crazy, right, exactly.

Speaker 3:

And because this machine also provides oxygen to the blood, I can turn off the ventilator so that the patient is also not breathing. They're not breathing. Their heart's not beating.

Speaker 1:

Was that insane. The first time you saw that in real life, like there.

Speaker 3:

It was, and the fact that the people doing it it didn't think anything of it.

Speaker 1:

it's oh yeah, another day at the office yeah, we do this multiple times a day.

Speaker 3:

This is it's just what we do. Yeah, the first time I saw it, I was just flabbergasted. I thought it was the coolest thing ever that is bananas.

Speaker 1:

Yes and sorry, I don't mean to derail, I'm just. I'm sitting here like a stunned banana listening to you talk about this.

Speaker 3:

And the amazing part is, when the surgeon's all done, we can essentially reverse all this stuff and the medicine that stopped the heart. We can give other medicines to counteract that and I can start breathing for the patient again and we've switched back from that bypass machine to the patient's own heart.

Speaker 1:

Once it starts going again, the machine goes off.

Speaker 3:

Yes, and it's. Unfortunately, it's not always as simple as that. Sometimes patients need a lot of help in terms of medications and this is where I come back into play is starting medications that help increase the function of the heart, whether it's the heart rate or the pumping function, what we call the ejection fraction of the heart, and I have medications that can affect all different aspects of the heart how it functions, the pressures in certain chambers, the pressures in the body, the pressures in the pulmonary artery just lots of different operate or lots of different cocktails that I can use to make sure that patient is ready to transition to life on their own.

Speaker 1:

Essentially, that is, that's bananas, and, and you're obviously there for the whole surgery, right like you, don't take off to go have a coffee.

Speaker 3:

Correct, correct. I'm there watching what's happening, working with the perfusionist, which is the person who runs the cardiopulmonary bypass machine. I'm there working with them to make sure that labs and blood sugar and all the things that we need to keep the patient healthy and in as tip-top shape as we can get them to come off the bypass machine, as we can.

Speaker 1:

So I feel like in every medical show I've seen they gloss over your job. Do you ever watch a medical show and you're like, hey, that's what I do in the show somewhere?

Speaker 3:

Not really. I stopped watching medical shows in medical school.

Speaker 1:

Oh, okay, I'm so sorry. It's like bad science fiction and I'm talking to a cosmologist and they're like everything in those shows are wrong. I don't like to watch them.

Speaker 3:

And yeah, typically if they show an anesthesiologist, they're playing Sudoku or, like you said, they're in the lounge drinking coffee while the patient's in surgery, and it's one of those where you just get so frustrated it's ah, that's not how it works, I promise.

Speaker 1:

They definitely show the surgeons as like the only things that are involved in anything in surgery. At least some of the shows I've seen.

Speaker 3:

Yes, exactly.

Speaker 1:

Very much a team effort.

Speaker 3:

Oh for sure. And it's also not just me or the surgeon, it's the nursing crew and the surgical technologists, and there are lots of people involved. So I definitely don't want to diminish anyone else's role.

Speaker 1:

No, that's what. It's just so impressive that, like we have the technology and the personnel to do something as insane as stop someone's heart and have a machine. Basically, we do that what the heart and lungs do. It's operated on and then magic drugs are given to them to make them alive again. Like it's just so. Bananas, Like wow.

Speaker 3:

It is, and that's not even the craziest stuff we do.

Speaker 1:

That's not the craziest stuff you do.

Speaker 3:

Oh my God, I know.

Speaker 3:

So some of my favorite types of heart surgeries that we do involve when we have to work on the aorta so that's the main artery that goes from the heart to the body and all sorts of bad stuff can happen to the aorta.

Speaker 3:

Unfortunately, it's a multi-layered tube, essentially, and if one of those layers what we call dissects, essentially, and if one of those layers what we call dissects, so if one of those layers breaks, obviously that can lead to bad stuff and your body not getting the blood it needs. So if a patient has an aortic dissection, there are times when we have to do what we call deep hypothermic circulatory arrest, and that involves the same thing I was mentioning before with the cardiopulmonary bypass machine, but we actually cool these patients down, typically to about 20 to 22 degrees Celsius, we pack their heads and their hearts in ice and then for a brief while typically under 30 minutes, depending on what exactly is wrong we actually turn off the bypass machine. There is a period of time where there's no blood flowing. The patient is clinically dead for a little bit while we fix things up and then we warm them back up, we start the bypass machine again and bring them back to life.

Speaker 1:

Is the cold just to stop metabolic things?

Speaker 3:

It is Okay.

Speaker 1:

Yeah, yeah, yeah.

Speaker 3:

Being hypothermic decreases the amount of oxygen that the tissues need. So that's one way we can protect the brain and can protect the body from that brief time where there's no new oxygen.

Speaker 1:

So freaky that is, so wild it is. I don't even know what to ask you now, doc. This is not my. I've got questions to ask you. I'm like what? The? This is bananas. Okay, so, aside from heart stuff, and thank you for talking about this type of surgery, oh yeah, Happy to. This is wild. Is there some of the? Are there other procedures that you're in on, or is it specifically just heart stuff?

Speaker 3:

So with my type of job and there are jobs at other facilities across the country where people will only do heart stuff or only do other types of surgeries but I do everything. So I am in on C-sections or when babies are born surgically, I do labor, epidurals. So helping laboring patients with their pain, general surgery, trauma surgery, joint replacements I do it all and honestly, it's all fascinating and rewarding in such different ways. That's cool. I remember my first C-section that I did after I had graduated.

Speaker 3:

During a C-section, typically the mother is awake and I'm standing up at the head with the mother and their support person and the obstetrician is very vocal letting us know what's going on again because there's certain medicines that need to be timed certain ways. But that very first one, when the obstetrician said it honestly I don't remember if it was a male or female baby, but they held it up and said here you go, and I just started crying right along with the parents. It was just such a beautiful moment and it's really amazing that I get to share that with people I don't know and it can be one of the most profound moments of their life.

Speaker 1:

Yeah, it's a new little person.

Speaker 3:

Yeah, it's just beautiful.

Speaker 1:

That's so sweet, were the. Did you get any looks from the parents? They're like why is she crying? She's the doctor.

Speaker 3:

No, the parents were too absorbed in the baby. Oh, they didn't see, yeah, the obstetrician was giving me a little bit of a look and I was just like this is beautiful, yeah, so that's another really amazing part of my job that I enjoy Some of the things that we can now do with modern technology and modern medicine. It blows me away, even when it's something I see on a regular basis.

Speaker 1:

You're the expert and you're like this is pretty weird what we do, this is pretty amazing. That's crazy.

Speaker 3:

It is when we replace knee or hip joints. Oh that's wild, isn't it? Yeah, and we typically do what's called spinal anesthesia, so that's where we inject medicine into the fluid around the spinal cord and it numbs the patient from the waist down for a few hours, and then we typically we give them some sedation during surgery because no one wants to hear that. But to think that we can cut out someone's joint only using two to three cc's of medicine just blows my mind.

Speaker 1:

I was my dad's support person for his hip stuff. He has got both of his hips done and we watched a video about what's going to happen and I was like holy hell, like that's banana it's pretty gruesome, not gonna lie the drill comes in and like drills into the socket to put a new thing in there, and I was like, oh my god, my dad's, maybe we shouldn't, maybe they shouldn't show that video, maybe we don't need to know this.

Speaker 3:

The orthopedic surgeons really do essentially use sterile power tools. They have drills and saws and hammers and chisels and all the things you'd find in your garage.

Speaker 1:

It's wild, wow. And that's true Cause my dad again, I was my dad's support person and they knocked him out with that Right and then his the feeling started to come back and he was up on his leg that day. I think that's part of it, right, they want to get you up as long as the patient is healthy enough, which most of them are if they're having a joint replaced.

Speaker 3:

They go home that day and they're up and walking that day.

Speaker 1:

Yeah. Yeah, he was in some pain, but it wasn't. After seeing that video, I was expecting him to be in excruciating pain for weeks. It wasn't fun, but it wasn't as bad as we thought, yeah.

Speaker 3:

And one of the other aspects of my job is we do what are called nerve blocks, and that's similar to what I was describing with the spinal anesthesia, except we inject medicine around peripheral nerves. About a little less than two months ago I had my ankle. I broke my ankle and I had it fixed and I had a nerve block before surgery and similar sort of thing. It was just a little bit of numbing medicine, so like the lidocaine that you get at a dentist office, but longer acting. I had two shots of that in specific parts of my leg and I didn't have pain for almost two days after surgery and it's that similar sort of thing. Wow, look at what we can do with so little.

Speaker 1:

That's yeah, doesn't take much to knock out a human hey, is that what we're saying? Doesn't take much to knock out a human hey, is that what?

Speaker 3:

we're saying Exactly.

Speaker 1:

You can. So like Dexter Morgan's was correct. If you've seen that show, is that true, correct? Yes, oh my God, really, oh geez, okay. So one of my students dressed up as Dexter Morgan for Halloween oh nice. It was when my Chem 20 students she had. I got it right away because she had like his. I don't know if you've seen Dexter, but she had a syringe in his gloves and I was like are you Dexter? She's like yes, and she had little blood slides that she was carrying around. I was like that is amazing and also borderline inappropriate for high school.

Speaker 3:

But she's going places.

Speaker 1:

That sounds amazing yeah, she's a pretty good student. Before we wrap up this section, doc, a tough question maybe for you, but one I'm. I have goosebumps and I started shivering when you were talking to me. Like do you have nerves of steel? Do all of the people that do this just have nerves of steel? Do you ever get scared or worried, or do you just go into work mode or focus mode? I'm sure some things go bad or are unexpected.

Speaker 3:

Do you know what I'm getting at without being yeah, okay, I'd like to think we all do have a little bit of nerves of steel, and I think there is a certain level of hardness that has to come with this field and anyone in medicine who does procedurally based things, because you don't ever want to hurt anybody, but we sometimes have to do things that are painful. You learn fairly early on to distance yourself in a certain way, so it's not necessarily that Mr So-and-so is having surgery. It's oh, this is a 62-year-old man and it helps you to focus on the physiology as opposed to the humanity of it, if that makes sense.

Speaker 1:

Yeah, because I can imagine if you focused on the humanity you would burn out. I don't know how you would. Yeah, like my job is as a teacher. I'm so focused on the humanity of these kids and if I started to treat them like a number, I think that's where I would lose the skill as being a teacher.

Speaker 3:

But it might be different for you and your profession maybe, I don't know a little too close to home for me and I haven't been able to distance myself. It was a few years ago where I had a patient who was the same age as me and she had the same first name and it was a really awful emergency life or death case and it was really hard for me to set my emotions aside and just focus.

Speaker 1:

I can't imagine. I can't imagine.

Speaker 3:

She ended up doing fine and survived her injury and went home. But it was got me in the gut there for a little bit.

Speaker 1:

Yeah, just like the work that you, the healthcare professionals, do. I've said this before, but just thank you so much as a lay person, like saving lives and doing that day in and day out. Just thank you for the work that you do.

Speaker 3:

I don't know what to say, except you're welcome and honestly I think your job as a teacher is much more challenging than what I do, for sure, and there is no way I could do what you do.

Speaker 1:

Oh, I think I would fail the first day at yours, so they'd kick me out. I don't have the same level of training though, so I don't know who knows I do. A funny, fun fact, doc, you might. I've told this before on the show I cannot stop myself from passing out when I get a needle. I'm not scared of them, I could care less if I get them but as soon as I get an IV or needle I faint like a vasovagal syncope or something like that. Yeah, so I tell my students that and they think it's hilarious. But if I have to give blood or if I have to go in for a minor procedure, I just warn everybody. I'm like, hey, just let you know, I'm going to pass out when you give me the needle, and the nurses are always like, hey, just let you know, I'm going to pass out when you give me the needle, and the nurses are always like, oh, you'll be fine, you look great, and I'm like nope.

Speaker 3:

And then I pass out. That is one thing you learn that patients do know their bodies best. So it is very important, when people tell you that, to listen, because that's exactly what's going to happen.

Speaker 1:

Doc, thank you for sharing a little bit about your fascinating job, oh yeah, my pleasure. We love to hear from our guests about their pets and I was wondering if you could share a little bit about them or a special pet story from your life okay.

Speaker 3:

Yeah, my husband and I, we have three dogs soon. We have grizz, who's 10 years old and. Tuna, who is six, and Yogi, who is four, and Yogi is a black lab. He is my husband's service dog, and we also have a two-year-old cat named Scully. I'm not sure if you were an X-Files fan, but her formal name is Agent Scully I am a huge, you have no idea.

Speaker 1:

That is why I became a scientist. I had a crush on Dr Dana Scully in high school and I thought Mulder was an idiot and I wanted to be a scientist. And I met Gillian Anderson at a Comic-Con. Oh, wow. I know, anyway, sorry. Yes, I absolutely know who Scully is.

Speaker 3:

That's awesome. I've been trying to talk my husband into a friend for Scully and so far I've told him we can name it Mulder, and that's how I'm gaining traction, yep, and in terms of a good pet story. So when we first moved out to Oregon, we are about one and a half to two hours from Crater Lake National Park, which is, if you ever have a chance, you should absolutely go there. It's breathtakingly gorgeous. It's an old volcano that exploded I think it was about 7,500 years ago and the crater from the volcano is now a lake. It's a crater lake and it's actually the deepest lake in the US and all of the water is just this absolutely beautiful glacial blue because it's all snow melt, because the elevation is very high, and so it's just this pristine, amazingly beautiful lake. And I don't recall the exact elevation, but this park has snow almost year I think there's maybe a month in the summer where the snow finally all melts and they get something crazy like 50 feet of snow a year.

Speaker 3:

I was at work and my husband, toby, took Grizz which at the time he he was our only dog took him up to Crater Lake to play in the snow, and Toby called me and was like, hey, I can't find my car keys. I know I had them in my pocket, but they're gone now so it's towards the end of the day and shoot, okay, I'll get off work, I'll find your spare keys and then drive for two hours and hopefully it's not dark and freezing and you guys will be okay. And so him and Grizz roamed around a little bit and Toby said he kept telling Grizz, hey, buddy, where are the keys, where are the keys? And Grizz actually was able to find the keys. No, he led him around and to this certain spot that he kept going to, and Toby dug a little bit and there were his car keys.

Speaker 3:

What a good dog, I know, and I don't think newfoundlands are particularly known for scent work or anything like that.

Speaker 1:

I think I just say he's a smart boy oh, my goodness, I love the story and can I just tell you I'm so jealous. You have newfoundlands. I've been trying to convince, I've tried to convince my wife to get one. We have Bernoulli. So I, bernoulli is just a joy. But I actually made a powerpoint presentation for her about why we would need a Newfoundland but she said no, it's their drool. The drool was a deal breaker understandable.

Speaker 3:

There there's a lot of drool at my house. I have read, or at least seen in in, like breeder websites and things, that there there is such a thing as a quote-unquote dry mouth, new feet, but I I don't know that. I don't know how much of a thing that really is how big are your new fees?

Speaker 1:

are they huge?

Speaker 3:

yes, so grizz is 150 pounds. Nah, yeah, yeah, and tuna is about 160, 165 oh my god, I love that so much they're the best, they're my heart and my joy and my love god, I just love those dogs so much.

Speaker 1:

What a cool story, though, doc. Thanks for sharing. Oh yeah, very cool. As we come to the end of our chat, one of the things we challenge all of our guests is to leave us with a super fact. It's something that you know, that when you tell people, it blows their mind. Now I'm saying this and I feel like I'm an idiot because this entire talk my mind has been blown out of my face. I was wondering if you have one for us as we wrap up.

Speaker 3:

I do and you might want to hold on to your mind and your face. It's, of course, medical related, so the human brain actually does not have pain receptors, and what this means is that brain surgery can be done awake sometimes.

Speaker 1:

You feel nothing.

Speaker 3:

When they go through the skull, there are pain receptors in the skin and the skull, but yeah, when they're actually working on the brain itself, you feel nothing.

Speaker 1:

Oh my God, that's so weird.

Speaker 3:

There's a famous photo and I don't recall the exact location or when or where it's from, but there's a famous photo of a violinist having awake brain surgery with their violin in hand, and that's one of the ways the surgeon can tell what part of the brain is what, and what the patient needs is how the patient interacts during surgery. So this patient is playing the violin while they're operating on their brain During brain surgery playing a video game.

Speaker 1:

What am I good at besides teaching? I don't know, not playing the violin. That is a cool super fact.

Speaker 3:

Yeah, it still baffles me. I just can't believe we can do that.

Speaker 1:

That's wild, Ashley. Are you on social media anywhere that people could follow? Is that something somebody could do to connect with you?

Speaker 3:

Yeah, I am on Instagram. Yeah, what's your handle to connect with you? Yeah, I am on. Instagram yeah what's your handle it is? This is a little embarrassing. I was very into Game of Thrones. It is ashleesee306. Ashleesee yes, it was a play on my first name and Khaleesi 306.

Speaker 1:

Okay, so we'll, I'll make sure there's, we'll try to find, we'll find you and then we'll put that in the show notes for people to follow.

Speaker 3:

Okay, and then there's lots of pictures of my dogs. It's mainly just my dogs.

Speaker 1:

We'll make sure that your handle is in the. Yeah, we'll make sure your handles in the show notes. This has been a treat and a delight to have you on the show. Speedy recovery with your ankle injury.

Speaker 3:

Oh, thank you. Yeah, this is has been amazing. I love sharing my passion with people, and especially other people who are just as crazy about their dogs as I am.

Speaker 1:

That's it for this week's show. Thanks for coming back to listen to the science podcast. That's it for this week's show. Thanks for coming back week after week to listen to the Science Podcast. That's it for this week's show. Thanks for coming back week after week to listen to us and special shout out to our top tiers on the Paw Pack. They support us, as do many others. But a perk of being in the top tier is you get your name shouted out and if you want to have that perk too, check out in our show notes and sign up on the Paw Pack. All right, Chris, take it away.

Speaker 2:

Amelia Fetig Rhi, oda Carol Hainel, jennifer Challen, linnea Janik Karen Chronister, vicky Otero, christy Walker, sarah Bram, wendy, diane Mason and Luke Helen Chin, elizabeth Bourgeois, marianne McNally, catherine Jordan, shelley Smith, laura Steffensen, tracy Leinbach, anne Uchida, heather Burback, kelly Tracy Halbert, ben Rather, debbie Anderson, sandy Brimer, mary Rader, bianca Hyde, andrew Lin, brenda Clark, brianne Hawes, peggy McKeel, holly Burge, kathy Zerker, susan Wagner and Liz Button.

Speaker 1:

For science, empathy and cuteness.