Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or civic needs.

Daniel Lobell: (00:25)
Hello and welcome to the Doctorpedia podcast. I’m your host Daniel Lobell and joined by me on the line. I’m honored to have Dr. Ulrike Berth. How are you?

Dr. Ulrike Berth: (00:35)
I am wonderful. How are you, Daniel?

Daniel Lobell: (00:37)
Thank God I’m doing great. I’m excited to speak to you. I love hearing the origins of the doctors who I speak to. So let’s jump right into it today. What made you decide to become a doctor? At what age was this something you wanted to do?

Dr. Ulrike Berth: (00:54)
Well, it was actually quite a personal decision. I have a twin sister that unfortunately has some medical problems. She’s doing well, knock on wood, but seeing her go through with many, many surgeries and hospitalizations, I wanted to help. I wanted to do more than just comfort her when she needed it, or hold her hand or wait for her after surgery. I just felt there had to be more I could do. And quite frankly, I always wanted to be a doctor. Maybe just not a human doctor.

Daniel Lobell: (01:37)
A veterinarian?

Dr. Ulrike Berth: (01:40)
Yeah. I wanted to be a veterinarian actually, initially. I love animals, but I have this one big phobia and you can’t tell anyone that I told you. It’s a snake phobia. So I was like, “I can’t be a veterinarian and put a sign on my door saying ‘All animals welcome except snakes.'” [Daniel laughs] So for me, that sounded weird, thinking about this. So I went away from the veterinarian thing and went over to the human.

Daniel Lobell: (02:16)
Well, it’s probably better, especially in that you can help your sister now, rather than her cat.

Dr. Ulrike Berth: (02:22)
[Daniel chuckles] Exactly. Yes, yes. So I went from animals to humans and I haven’t looked back.

Daniel Lobell: (02:31)
So, it’s funny because there was a period of my childhood where I really wanted to become a veterinarian also. And I went and I volunteered at a vet clinic and that kind of did it for me to make sure I wasn’t going to do it. [Ulrike laughs] I did it because I love animals so much, but I didn’t love seeing them open as much as closed.

Dr. Ulrike Berth: (02:51)
That was actually another thing that might sound weird, considering that I’m putting needles and things into human beings these days, it was just something that I couldn’t imagine doing because of those poor little animals.

Daniel Lobell: (03:09)
Yeah. But with humans, you don’t care. You’re like, “Ah, whatever.”

Dr. Ulrike Berth: (03:17)
[Both laugh] It’s different. It’s different. I don’t even know what to say to get myself out of this one. But I think we could do a lot of good things and humans actually understand what we’re doing and why we’re doing it. So I think it’s a little different. Animals are so helpless because they just get held down and you do what you need to do. And they have no idea what’s happening. So at least with humans, you can prepare them for what’s happening. You can talk to them, you can explain to them. So I think it’s a little different.

Daniel Lobell: (03:54)
Absolutely. I noticed you have a slight accent. I’m curious, where did you grow up?

Dr. Ulrike Berth: (04:01)
What? I don’t have an accent! [Daniel laughs].

Daniel Lobell: (04:02)
Maybe it’s just the connection. [Both laugh] So where were you born?

Dr. Ulrike Berth: (04:12)
I grew up in East Germany.

Daniel Lobell: (04:15)
In East Germany, wow.

Dr. Ulrike Berth: (04:16)
Yes. Before the wall came down. I lived there for — well, the wall came down when I was about 10 or 11 years old. I remember it like it was yesterday, but yeah, I spent the first 10, 11 years of my life as an East German. I have nothing bad to say. We had everything. It was great. And we had this peace and quietness and everyone was taken care of. And obviously I have now the other side to look at and we didn’t have any crime, we didn’t have any kids sitting in the streets after school. Everyone was accounted for, we had after-school activities. There was no smoking, there was no drinking. There was no gangs or anything. It was a quite precious childhood, I have to say.

Daniel Lobell: (05:10)
Are you telling me that there was an orderly society in Germany? [Daniel laughs]

Dr. Ulrike Berth: (05:20)
[Both laugh] Yes. Yes. I know. It seems very far fetched.

Daniel Lobell: (05:30)
So what age were you when you moved to America?

Dr. Ulrike Berth: (05:34)
After finishing high school, at the age of 18. And no, I did not take any extra years in high school. It was due to the school system working a little differently in Germany. I actually decided I want to see something from the world, learn English, before going to medical school, which I knew of course at that point I was going to do. So I said, “What’s the easiest and best way to do that?” I wanted to be somewhat protected and not just take a backpack and go hiking in the United States. And also I think my mom would have not liked that. So the idea came after speaking to a friend who did a year as an au pair that this could be maybe something. So I applied for becoming an au pair. And I met with a family here on the East Coast, right around where I still live now. And, yeah, that was my first encounter with the United States. And obviously something happened there that I decided to come back.

Daniel Lobell: (06:51)
Something must’ve happened. So, what is the difference between a nanny and an au pair, or is there no difference?

Dr. Ulrike Berth: (07:00)
Well, it’s pretty much the same, but an au pair is more like — so you’re kind of in a program, which means there are people that look out for you, making sure that everything is going well with your family. And if you have any issues, they try to resolve it, and you’re supposed to be part of the family. And even though you’re taking care of the children and might have some other responsibilities, it’s a more family-like setting. And you’re also actually required to do some educational component, whatever you want it to be. Just, it had to be something that actually your host family had to sponsor and had to also let you do whatever you chose to do. And I actually joined the local ambulance corps, because I knew I was going into medicine.

Dr. Ulrike Berth: (08:03)
So I wanted to see how the healthcare system works here. And I figured that might be a good way, so I went to EMT school and became an EMT, doing this au pair year here. And yeah, that’s probably the difference. When you’re a nanny you go to someone’s house, you take care of the kids, do some other chores. And at the end of the day you go home or you might even stay with them depending what the setup is. But an au pair is more like a program. And you’re, like I said, taken care of. It’s more protection. So you’re not all by your lonely self in a foreign country.

Daniel Lobell: (08:42)
Well that’s cool. I always just thought it was a fancier way of saying “nanny,” but now I get that there’s more to it. Like, “Is this your nanny? No, it’s my au pair. Oh, I’m sorry. Excuse me. I didn’t know you guys were so fancy.” [Ulrike chuckles] But that’s cool to be part of that program and becoming an EMT. Was that also something that pushed you towards working with non-furry living creatures? [Daniel chuckles]

Dr. Ulrike Berth: (09:09)
[Ulrike chuckles] At that point, I knew already I was going to be a human doctor, and my application for medical school was actually in Germany. But I just thought this might be a nice way of seeing how the healthcare system works here. And, because you’re actually riding in an ambulance, you’re picking up sick people, when you get called and you go to the local hospitals. So you get to see a little bit how things work. And I also thought it might be a nice introduction in general to healthcare in the United States.

Daniel Lobell: (09:47)
Right. Well, who wins? Who’s got a better healthcare system, us or Germany?

Dr. Ulrike Berth: (09:54)
That’s really difficult to say. I think both are excellent healthcare systems, both have excellent scientists and dedicated physicians and I think it’s the politics behind it that are a little different and it makes one of them less potentially attractive. [Ulrike chuckles] I’m going to let you figure out which one.

Daniel Lobell: (10:31)
Well I can guess which one is more orderly, I’ll tell you that. [Daniel chuckles] Where the orderlies are more orderly, I’m guessing. [Ulrike chuckles] So your specialty is anesthesiology.

Dr. Ulrike Berth: (10:45)
Yes. And you said that without breaking your tongue. That’s great.

Daniel Lobell: (10:48)
Thank you! Wow. I get extra points, I guess, for that.

Dr. Ulrike Berth: (10:52)
Absolutely.

Daniel Lobell: (10:53)
So as far as I understand, that’s the medicine of putting people to sleep, which is what I hope not to do with these podcasts. [Daniel laughs] [Both laugh] The opposite of what I’m trying to do.

Dr. Ulrike Berth: (11:05)
Well, we’ll see. I mean, it goes with the territory, right?

Daniel Lobell: (11:09)
Right. Yeah. Let’s see.

Dr. Ulrike Berth: (11:11)
I’ll take full responsibility if it happens.

Daniel Lobell: (11:14)
If it happens, it’s a credit to you and a discredit to me! But why did you say — did you not want to deal with people awake, or is there more to it that I don’t know? Tell me more. [Ulrike chuckles]

Dr. Ulrike Berth: (11:29)
[Both chuckle] Oh, man. It seems like we met in a different life before and you can read my mind. So I always wanted a specialty in medicine that combines the need for keeping up with everything you, for example, learned in medical school. I always wondered, you learn all these things over six years, that’s what medical school is in Germany. I didn’t have to take any extra years, just for the record. I was just always wondering, you learn all these things and then you’re allowed to forget it because you’re just looking at someone’s stomach all day long or someone’s brain or whatever it might be. And I wanted a specialty where I had to keep up my knowledge and, with anesthesia, you really have to be pretty up to date in any specialty that you can think of. For example, pharmacology, right?

Dr. Ulrike Berth: (12:44)
We work with a lot of drugs and we also work with a lot of patients that come with a lot of medical problems that are on a bunch of different medications. So we have to account for all that and how they interact with the anesthesia and vice versa, or what we do with the anesthesia to these patients taking certain medications and / or side effects that can happen due to medications that a particular patient is on. And I found that quite challenging and intriguing, that you have to keep up with all these kinds of things. And it’s not just pharmacology, it’s medicine. I have patients, basically from 0 to 110 and they all have their own different medical problems, physiology, anatomy that I need to account for, and that I need to be aware of and need to adjust my anesthetic for. And the list is ongoing. The same as I need to anticipate what a surgeon is doing so that I can react to them in case I have to.

Dr. Ulrike Berth: (13:59)
So I need to have a pretty good idea what the surgeon is doing and when in a particular surgery. Because there is quite a hand-in-hand in the operating room at all times. So I found that part very intriguing. And then the other card was — quite frankly, I also wanted, I always say “to get my hands a little dirty.” I want to do procedures too, but I knew I never wanted to be a surgeon. So, as an anesthesiologist, you do quite a bit of procedures and I like that part as well. And I think this third component answer to your question is yeah, I did not want to be in an office all day long, not necessarily because I didn’t want to talk to patients all day long, I just couldn’t see myself spending all day in an office setting. And those three things combined, I think worked really well for me in terms of picking the field of anesthesiology.

Daniel Lobell: (15:13)
How much risk is there involved as a patient in being put under anesthesia? Because I remember even when my dog, going back to our little veterinary talk, when my dog had to get a surgery, they said a local anesthesia would be much less risk to the dog. Is it the same for humans? Are we trying to move away from it? What’s the story?

Dr. Ulrike Berth: (15:39)
So, again, since I didn’t want to become a veterinarian, I can’t really talk in regards to animals. However, I think the fear that we hear a lot from patients about, “Oh, will I not wake up after anesthesia? Or am I going to die from anesthesia?” I think that fear is for some reason deeply rooted in patients. Why, I’m honestly not quite sure. Because anesthesia has quite a good safety record. Yes, there were many, many, many months ago, centuries ago, anesthesia was not very safe simply because the monitoring systems were not in place. And now over the years, over the decades, I mean, just since I graduated in the past 10 years from residency, so much has changed. And I can honestly say anesthesia is very safe.

Dr. Ulrike Berth: (17:01)
We have so many monitoring systems that monitor every little part of the patient. And I always say, when patients ask me that question, that I literally have to be blind and deaf and quite frankly not paying attention for anything bad to happen to a patient. I think also a big misconception, amongst patients is the fact that we’re actually in the operating room the entire time of this patient surgery. We’re not leaving the patient site at any time. There is always an anesthesia care provider in the room at all times to monitor and make sure everything is the way it’s supposed to. And again, monitoring systems have become quite detailed and it’s really difficult to do something bad to a patient with anesthesia these days. Because the medicine also has become very, very safe, very low side effect profiles for a bunch of the anesthesia medications that we’re using to anesthetize patients. And I think patients can trust when they go into the operating room that anesthesia is very safe today.

Daniel Lobell: (18:47)
Was it that early anesthesiologists basically just used a club and knocked people out that way?

Dr. Ulrike Berth: (18:55)
[Ulrike laughs] Yeah, I don’t think that was part of it, but I think there was a lot — and to a certain extent still is –there is a lot of stuff we don’t understand about the human mind and brain and how certain things work. And back then, even 30, 40 years ago, it was not, I will probably say, not even half of what we know now we knew back then. And there were only a few anesthetics available and most of them, you know, had a lot of side effects. So, yeah, minus the club, I think [Daniel chuckles] things have developed quite significantly, in a way that the club, or I say the bite block, in worst case scenarios, is not needed anymore.

Daniel Lobell: (19:53)
So if you’re out on a date with somebody and it’s not going well, do you just walk around and anesthetize them and leave?

Dr. Ulrike Berth: (20:03)
Oh, absolutely. [Daniel laughs] Absolutely. All the time. Happens all the time. [Daniel laughs] They actually send me thank you cards afterwards, because they’re saying that it was the best sleep they had in a long time.

Daniel Lobell: (20:21)
[Daniel laughs] So you mentioned a few minutes ago that since you finished medical school, even in the past 10 years, there have been incredible strides in the medical industry. What are some notable ones that have really changed things for you?

Dr. Ulrike Berth: (20:37)
Well specifically for my profession as an anesthesiologist, our monitoring systems have gotten much, much better. I mean, 30, 40 years ago, there were no such things as pulse oximeters or they were not a gold standard, meaning not every anesthesiologist and every practice used it simply because they didn’t have access to it, or they had maybe one for the whole facility. The same goes with the monitoring of patient breaths, for example, under sedation, these were not considered monitors that you really needed. And now they’re a gold standard and they are actually required. So for example, we do a lot of sedation procedures, for example, for colonoscopy or endoscopies. And these procedures are very safe to do because we have the monitors to safely sedate someone and still make sure that their breathing is fine.

Dr. Ulrike Berth: (21:51)
Their blood pressure is fine, and their oxygen saturation. So I think that along with the invention of propofol, which is quite a famous anesthetic, unfortunately for the wrong reasons, because propofol is actually an extremely safe medication that we use day in and day out. And it’s probably considered one of the safest medications there is. And with the invention of that, we had another anesthetic where we can actually, for example, give patients general anesthesia without using anesthesia gases that sometimes in people have bad side effects too. So yeah, I think the overall monitoring has made a huge impact in the field of anesthesia. And there’s this new monitoring that’s now also out for like 10 years or so, to monitor how deeply your patient is sleeping. So that changed tremendously how we practice anesthesia because it gives us the opportunity to try to titrate our anesthesia in a way that we don’t have to give too much to the patient, which then translates into less grogginess and side effects for the patient when they wake up. But also at the same time, we can assure that the patient is still nicely asleep during surgery. So I think that’s another fundamental change for the practice of anesthesiologists.

Daniel Lobell: (23:50)
Yeah. The one that you mentioned, I believe it began with a P? Prop, propa, propafane?

Dr. Ulrike Berth: (23:58)
Propofol?

Daniel Lobell:(23:58)
Propofol? You said it was sort of famous for the wrong reason. Is that the one that Michael Jackson died from? Is that why it’s famous?

Dr. Ulrike Berth: (24:05)
Yup. That’s exactly why. But he obviously — I don’t know any circumstances, I’m not privileged to that information, but he did not die because of propofol itself. Because propofol is a very safe medication. The setting, I have to obviously speculate, was probably not the right one.

Daniel Lobell: (24:33)
Why was he being anesthetized to go to sleep on a nightly basis anyway? Is that even healthy and recommended under any circumstances?

Dr. Ulrike Berth: (24:42)
The categorial answer is no, and I think you’ll be hard pressed to find an anesthesiologist who would cater to something like that.

Daniel Lobell: (24:55)
So he basically found a rogue doctor and he got what he, what you get what you get when you find somebody who’s totally unprofessional.

Dr. Ulrike Berth: (25:02)
Again, it’s very hard for me to speculate on these things, but something definitely didn’t add up.

Daniel Lobell: (25:14)
Right. Because I was wondering as you were saying that, and actually when you were saying, I made the joke about you putting a bad date under, and you said they’ll thank you for having the best sleep. My first thought was, maybe we should all be sleeping like that! But then I thought, no, that’s, that’s probably not right. But I guess that’s the thinking that Michael Jackson had, he must’ve loved being put under because he was getting such great sleep. I wonder if there’s something we could be doing to be getting better sleep. Is there something in your research that you’ve found that people should be doing to improve their sleep without anesthesia?

Dr. Ulrike Berth: (25:56)
I was just going to say, anesthesia is definitely not the answer for a good night’s sleep. I think a balanced lifestyle with exercise and making sure that all kinds of distractions that one likes to have in the bedroom are outside, left outside the doors, meaning any kind of TV or phones, any kind of unnatural lighting that can interfere with sleep. And —

Daniel Lobell: (26:33)
My wife, should I put her outside of the room?

Dr. Ulrike Berth: (26:36)
Well, if she snores, [Daniel laughs], I would definitely consider that because it will give you a better night’s sleep. However, it might also give you a divorce. [Daniel laughs] So I’m not sure if I can recommend that.

Daniel Lobell: (26:51)
Tougher days, easier nights. [Both laugh] So I know there are four different types of anesthesia. What are the differences between them, when are they used and what are their different effectivenesses?

Dr. Ulrike Berth: (27:05)
Four different kinds of anesthesia? Which four kinds are you talking about?

Daniel Lobell: (27:10)
Well, that’s what I — I did a little bit of research and I found that there were four. Let me see.

Dr. Ulrike Berth: (27:14)
Okay. So you’re saying general anesthesia, you’re saying monitored anesthesia care with and without sedation, and you were —

Daniel Lobell: (27:24)
Local anesthesia? Yeah, I found there’s local anesthesia, regional anesthesia. This one, I’m sure I’ll pronounce poorly — neuraxial anesthesia and general anesthesia.

Dr. Ulrike Berth: (27:37)
Ah… Okay. All right. Yeah, so there are a bunch of different types of anesthesia. General anesthesia basically means that you’re completely asleep and that you’re not aware of what’s going on and you’re probably very likely to have some kind of airway management along with that, to protect your breathing while you’re under general anesthesia. The neuraxial anesthesia is, for example, a epidural, what the ladies get when they have babies, or spinal, that just goes in a different compartment in the spine, and these can be used, like I just said, for moms to be, when to have their babies, whether it’s natural or through C-section, but epidurals and spinals also are used in other settings. In the hospital, taking care of patients, for example, someone that gets knee replacement can safely have a spinal anesthetic if there are no contraindications and just needs a little extra sedation and will be up and about much quicker. So there are benefits to doing neuraxial anesthesia, because it usually translates to patients being up and about quicker and having less side effects from potential general anesthesia.

Daniel Lobell: (29:15)
What are some of the side effects, I’m sorry to interrupt you, that you would have from a general anesthesia?

Dr. Ulrike Berth: (29:20)
So general anesthesia, a lot of patients that just complain of a little sleepiness and grogginess after general anesthesia. Depending how sensitive they are to the medication, they might also complain of nausea and in severe cases, vomiting after general anesthesia. Other than that, general anesthesia is tolerated really well.

Daniel Lobell: (29:47)
Okay. And what about from the epidurals? Are there long-term side effects from them?

Dr. Ulrike Berth: (29:54)
No. Epidurals are very safe to place if — the procedure of placing an epidural catheter is performed by an anesthesia care provider that learned how to do these. These are extremely safe and have a very low profile of complications. To make sure that we don’t harm a patient by placing epidurals, our main concern is always potential bleeding when there’s a needle involved. And bleeding and needles usually don’t go well together. Especially when we talk about placing a needle like this into someone’s back. So you will hear anesthesiologists always ask to make sure that there’s no bleeding disorders, any underlying issues in that regard. And we usually check the correlation factors before we place any such epidural or spinal to make sure that this one potential greatest side effect doesn’t happen. And in terms of other side effects, we see sometimes hemodynamic changes, which are due to the medication that we’re giving.

Daniel Lobell: (31:20)
I’m going to interrupt you. I’m not sure what that means, that word. You said hema dynamit? Hemo dynamic?

Dr. Ulrike Berth: (31:25)
Hemodynamic means the — sometimes the blood pressure goes a little low. And because we’re monitoring all patients very carefully, we see these things happen. And also we are aware when these things happen. So we watch for these hemodynamic changes very closely and we can treat them right away, obviously. So I think these are probably the most common side effects of placing epidural spinal.

Daniel Lobell: (31:59)
So local anesthesia, I think I get what that is, and regional, I suppose that makes sense too. Why do we need neuraxial anesthesia? Wouldn’t that fall under a regional anesthesia? Because the region being the spine, or…

Dr. Ulrike Berth: (32:16)
Good thinking, but regional and neuraxial anesthesia are actually two different things. So regional anesthesia actually means that, I mean, in a broader picture, you could probably put all of them into one bucket, but we like to separate them. Because with regional anesthesia we’re actually trying to numb up a very specific nerve or nerve bundle. So what that means is, for example, let’s say you break your arm and you need to have shoulder surgery, or you have a ruptured, I think easier to understand for people, is a ruptured tendon in their shoulder, biceps tendon, for example. And that needs to be repaired, we can actually numb that shoulder with regional anesthesia in a way that the patient will have no pain after surgery and will go home without having any kind of pain. And that will speed up the recovery for that particular patient.

Dr. Ulrike Berth: (33:35)
And also it will reduce the amount of other medications, for example, opioids, right? Opioids is a big discussion. So by numbing up certain body parts that we can with these regional techniques, we actually reduce the amount of general anesthetics we have to give, sometimes even none, we can do these once the arm or the knee or whatever else is operated on, is numbed up. Some patients just need a little sedation on top of that, so that translates into less grogginess because no general anesthesia is needed. It also translates into not needing to give all a bunch of other medications, and especially for post-op care, when they go home and their arm is still nice and numb. They don’t need any pain pills, which, we all know, can cause all kinds of other problems.

Daniel Lobell: (34:41)
Sure, addiction, and all kinds of side effects as well, right?

Dr. Ulrike Berth: (34:44)
Yes, exactly. So by doing all that, we’re reducing a bunch of potential issues that come with general anesthesia. And don’t get me wrong, general anesthesia is great. It is safe and it is necessary in a lot of circumstances, but nowadays, with the regional capabilities we have, we can add so much more, which is amazing.

Daniel Lobell: (35:17)
Well that’s a good lead into my next question, because we kind of talked a little bit about where it’s come since you started. But where do you see it going? Are there any exciting innovations on the horizon that you’re like, “Ooh, I can’t wait for that. That looks really promising.”

Dr. Ulrike Berth: (35:33)
I mean, there is a lot of innovation out there. I think one of the biggest innovations – I alluded to that in the beginning, when you asked me why I want to become an anesthesiologist, I said, “Oh, I like to stick needles into people and do procedures and things.” So some of those procedures, for example, placing central lines or arterial lines where you monitor the blood pressure based on putting a little plastic cannula right into an artery to monitor blood pressure beat by beat and not like a regular blood pressure cuff that, you know, cycles only so often, we have the capability of creating all these currently invasive measurements to become noninvasive measurements, because all different — new technologies we can actually measure blood pressure almost the same way as we would if we put this little cannula into an artery without doing that, just by putting a little clip or sticker on someone’s finger or, we also have, especially in big surgeries have to make sure there’s not too much bleeding and check the patient’s hemoglobin levels very frequently.

Dr. Ulrike Berth: (37:07)
So instead of poking someone every half an hour and seeing what that number reads at a given time, we have now monitors that are starting to come in that show us actually just by a sticker on a finger what the hemoglobin actually is and what direction it goes. And these kinds of things I think are going to be developed even more so in a way that they become even more accurate than they are right now. And I think that’s something really exciting that we don’t have to do all this invasive probing and probing, which is nice for patients.

Daniel Lobell: (37:58)
Sounds good for the patient bad for you, because you mentioned you —

Dr. Ulrike Berth: (38:02)
[Ulrike chuckles] I’ll get over it.

Daniel Lobell: (38:02)
Love sticking needles in. Did all your dolls look like voodoo dolls when you were a kid? [Both chuckle] What is it — I was just thinking, and when you said that you like sticking needles into people, why do you think that is? I’m just curious. Not to play psychologist, but —

Dr. Ulrike Berth: (38:28)
[Both laugh] I was just going to say, the mood changed here. [Daniel laughs] No, no, no, it’s, it’s not so much the sticking needles into people. I just wanted to do procedures and these procedures that you do as an anesthesiologist, there are some invasive things. And depending on what fields of anesthesia you’re trained in, I mean, you put in chest tubes, you do cricothyrotomies. You do —

Daniel Lobell: (39:00)
Wait, what is that?

Dr. Ulrike Berth: (39:03)
So this is basically when someone needs a, basically an artificial access to their airway. And they can’t —

Daniel Lobell: (39:18)
Is that pretty common now with COVID? With people being on ventilators?

Dr. Ulrike Berth: (39:22)
Yes and no. There are certain standards for patients that are intubated for a certain amount of time. If you have an endotracheal tube, a breathing tube, what patients get when they get intubated, it does add to the work of breathing they have to do. And by taking that part away and making that access directly on their neck, you’re taking away some extra work for them, you’re making it easier for the patients to breathe. So, depending on the circumstances, it is indicated to move over to a trach at a certain point. But especially with COVID, things are a little different and there are other factors that need to be considered. But yes, in general, once you’re intubated for a while, there is the recommendation to move over to a trach and it can be temporary, doesn’t mean it has to be forever. But while a patient is on the ventilator to ease their work of breathing, and also the side effects that come with just having a breathing tube in your mouth, in the back of your throat, because that can also cause pressure ulcers and all kinds of other problems. And it’s also much easier to clean these trachs and the hygiene surrounding everything.

Daniel Lobell: (41:12)
Got it. Well, I kind of took you off on a tangent from what you were saying by asking you to define that, but going back to my question, I was asking you what it is you liked about these surgeries and I think you started going into it. I think I’m trying to retrace our conversation. I think that’s —

Dr. Ulrike Berth: (41:34)
Yeah, I just enjoy also doing things with my hands, and doing these invasive procedures. And like I said, in the beginning, when you asked me what attracted me, or why anesthesia, that’s one of the parts of anesthesia because you are doing procedures which is a nice aspect of the field. Because you’re helping people with that. So you can actually make patients better by putting central lines in, because you can monitor them better and you can give them different therapies that you can’t, for example, do with a regular IV. So it’s all in the good for the patient at the end. But I don’t mind doing these things there. You know, some people there don’t like to do stuff like that, I don’t mind. And actually, I’m glad I have the skill to do these things. Yeah.

Daniel Lobell: (42:50)
And I’m glad you have it too, for the sake of the patients that you help.

Dr. Ulrike Berth: (42:53)
Yeah, absolutely.

Daniel Lobell: (42:55)
What’s the biggest compliment the patient can give you?

Dr. Ulrike Berth: (43:00)
I think the best compliment that a patient can ever give you is just to like, look you in the eye and really say thank you because they realize what you did for them or their family member. And I actually have, I think a very touching encounter that happened now many years ago. I was actually on the way to work and I stopped at a local coffee shop to get coffee before my shift. And I walked in, ordered my coffee and this gentleman came up to me without even saying anything, gave me this huge hug. And I was like, “Oh my God, what is happening?” [Daniel laughs] And then he looked at me and he said, “Thank you so much. You saved my wife’s life. You were fantastic.” And I just had to think for a second. And then I remembered what happened. And I think that was the best compliment I’ve ever gotten. This man, just walking up to me without even saying anything and giving me this bear hug. And that was, yeah, just getting goosebumps talking about it.

Daniel Lobell: (44:26)
It’s good he didn’t hug the wrong person, you know? [Both chuckle] “You saved my wife’s life. What are you talking about? I’m a railway worker. [Ulrike laughs] Oh. Well, don’t report this.” [Both laugh]

Dr. Ulrike Berth: (44:41)
Yeah, no, he was pretty sure, which I was completely impressed by.

Daniel Lobell: (44:47)
Yeah. Yeah. Are there any apps you engage with to check your own health?

Dr. Ulrike Berth: (44:52)
Well, yes. I mean, Peleton has an app, right. And I have the bike.

Daniel Lobell: (44:58)
Oh, cool. I’m getting one. I’m excited.

Dr. Ulrike Berth: (45:01)
Oh my God. You’re going to love it. You’re going to absolutely love it.

Daniel Lobell: (45:04)
We could Peloton together, I think. Right? We can become Peloton buddies.

Dr. Ulrike Berth: (45:07)
Yes. Absolutely. Absolutely. Yes. It has saved me, getting through the whole past year, with COVID, quite frankly. But I use Headspace. Headspace is an app where you can just follow meditations or use it to fall asleep. And I actually, even as an anesthesiologist, believe it or not, have a little trouble falling asleep at night and I’ve been using this app for, I don’t know, six plus months now. I put it on every night before I go to bed. I prefer the little waterfalls. So you can have like these specific little going-to-sleep sounds and it’s set up for 45 minutes. I don’t think I ever made it to the end. And so —

Daniel Lobell: (46:14)
That’s kind of ironic that you yourself have a hard time sleeping. You need to just basically start injecting yourself before you go to sleep. [Both laugh]

Dr. Ulrike Berth: (46:27)
Yeah. I don’t think that’s a good idea.

Daniel Lobell: (46:29)
No, don’t do that. Don’t do that.

Dr. Ulrike Berth: (46:30)
I won’t, I promise. Headspace is much easier to use.

Daniel Lobell: (46:37)
Yeah, it sounds healthier too.

Dr. Ulrike Berth: (46:40)
Absolutely. Yes.

Daniel Lobell: (46:41)
So congratulations. I been told that you’ve newly been appointed the CMO of Doctorpedia’s Anesthesiology channel. What unique viewpoints do you have that you hope to contribute through the channel?

Dr. Ulrike Berth: (46:55)
Well, thank you. It’s an honor joining Doctorpedia as CMO of the Anesthesia channel. I just hope my part can be to educate patients about what anesthesia is, what it means, and especially to share with patients that they don’t have to be afraid about anesthesia and also share with them all the little things that we do behind closed doors, that a lot of patients are not aware of. And I think that’s another part of where this scariness is coming from. Because a lot of people, rightfully so, don’t understand what we actually do, what we do behind closed doors. And most of the time, you meet us for about five minutes before you’re having surgery.

Dr. Ulrike Berth: (48:00)
So it’s quite a scary undertaking for a patient to trust this person that’s just walking into the room and says, “Hi, I’m your anesthesiologist, come with me.” And they don’t even know what hit them, right? So, I hope by joining Doctorpedia and being part of the Anesthesia channel, I can hopefully demystify anesthesia a little bit for patients, and share with them why we do things the way we do them, why we ask patients to do certain things before surgery. Because I think by explaining why certain things are done the way they’re done, it’s easier for patients to understand, which then also translates, for example, in the case of when you have to not eat or drink anything, you’re being told by probably five different people before surgery, you should not eat or drink.

Daniel Lobell: (49:07)
I know why they say that, it’s just to make you miserable.

Dr. Ulrike Berth: (49:11)
Absolutely. [Daniel laughs] That’s the goal. Yes, absolutely. Absolutely.

Daniel Lobell: (49:18)
Well, what’s the real reason?

Dr. Ulrike Berth: (49:18)
So the true reason behind it is, when you have anesthesia in surgery and you have something in your stomach, when you’re all nicely relaxed undergoing anesthesia — especially in the beginning, what we call induction of anesthesia — when you’re nice and relaxed, your stomach, that is also a muscle, relaxes too. And whatever’s in there will go the way of least resistance, which is up. And up does not unfortunately necessarily come out of your mouth. It will go into your lungs. And that’s what we’re really worried about. That’s called aspiration pneumonia, and that can be a life threatening complication, and we don’t want anyone to have that problem. And that’s why we’re so strict with not eating and drinking before surgery. But a lot of people just get told “You can’t drink anything” but they don’t know the explanation why.

Daniel Lobell: (50:25)
Yeah, and maybe they’ll cheat on it then, maybe they wouldn’t if they knew better.

Dr. Ulrike Berth: (50:30)
Well, exactly. Because they don’t know better. And they just think it’s just — I wouldn’t say to cause them misery, but they just don’t understand. And by demystifying these and other questions that patients have, “Why should you take this medication on the day of surgery, but you can take this one on the day of surgery.” So there’s a bunch of different things. And I think by creating that knowledge for patients, patients have a better power to be involved in their own healthcare and take better care of themselves. And also by having the answers, they can also ask appropriate questions, which I think is super important.

Daniel Lobell: (51:19)
Yeah, absolutely. Arming yourself with knowledge I think is always the best way to go. And especially when it comes to your own medical treatment. Yeah. Well, I usually round off the interview by asking the doctors what they do to stay healthy, but we already heard that from you, which is the Peloton and the app Headspace, which I actually have on my phone. I haven’t used it, but maybe I will now. Yeah, we’ll both be on, on the Peloton and on the Headspace together. [Ulrike laughs] But yeah, I’m with Kaiser Permanente here in California and they actually give you that app for free.

Dr. Ulrike Berth: (51:58)
Oh, that’s awesome.

Daniel Lobell: (51:59)
So that’s pretty cool. I downloaded it and I have it for free and now maybe I’ll actually use it because you’ve inspired me.

Dr. Ulrike Berth: (52:09)
Just give it a try, just give it a try. Some things are not for everyone, but if you don’t try, you won’t know.

Daniel Lobell: (52:16)
Well, in light of the fact that we’ve already covered that, how about I ask you to give some general health advice to the listeners today?

Dr. Ulrike Berth: (52:27)
General health advice? Oh boy. Hmm… I think every person is different. Everyone has a little bias and, who am I to say what’s good and what’s not? I think moderation is really important. And don’t overdo the exercise, but also don’t overdo the glass of wine at night. And I think, if you keep a nice balance, and most importantly, you seek out help if you need it, I think is the most important health advice I can give you.

Daniel Lobell: (53:21)
And if I may add to that, stay away from snakes!

Dr. Ulrike Berth: (53:27)
[Ulrike chuckles] Yes. Definitely stay away from snakes. That is definitely not good for your health.

Daniel Lobell: (53:32)
Hey, they’ll put you under in a different way.

Dr. Ulrike Berth: (53:35)
Yeah. I mean, it’s not good in so many ways.

Daniel Lobell: (53:39)
Yeah. Yeah. [Daniel laughs] [Ulrike chuckles] If there’s one takeaway, don’t get anesthesia from venom. Thank you so much, Dr. Berth. It’s been a pleasure talking to you.

Dr. Ulrike Berth: (53:54)
Well, thank you for having me Daniel. I really appreciate it. Thank you so much.

Daniel Lobell: (53:59)
Thank you.

Daniel Lobell: (54:02)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.

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