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 specific needs.

Daniel Lobell: (00:20)
Hello, and welcome to the Doctorpedia podcast. I’m your host, Daniel Lobell. And today it’s my great honor to be talking to Dr. Paul Saiz. How are you?

Dr. Paul Saiz: (00:31)
Good. How are you doing?

Daniel Lobell: (00:32)
I’m doing well. Thanks for doing the show.

Dr. Paul Saiz: (00:35)
Oh, my pleasure.

Daniel Lobell: (00:36)
I’m excited to talk to you. And not only because you’re the very first orthopedic spinal surgeon that has been on this program, but because I have just so many questions regarding spinal things. [Laughs] I find the spine very fascinating. Maybe it is only because of that! [Both laugh] Now that I think about it. [Chuckles] I’m so excited to talk to you today and I have a lot of questions regarding what you do, which is orthopedic spinal surgery, but let’s start at the beginning and get to know a little bit about your background. Where did you grow up?

Dr. Paul Saiz: (01:19)
Sure. I was actually born to a resident at UCLA Medical Center. So I spent my early formative years in Los Angeles, but, unbeknownst to me, my parents moved, and I didn’t find out at the last second. So I finished high school in Arizona, ended up going to college in South Bend, Indiana, University of Notre Dame. And from there, I migrated over to Baylor College of Medicine, Houston, Texas, where I went to medical school and they say if I wanted to be a cardiologist and that morphed into, I wanted to be an orthopedic surgeon. So I ended up doing my orthopedic training in Phoenix at the Phoenix Orthopedic Residency program. And from there decided I had not only wanted to be an orthopedic surgeon, but I wanted to be a tumor and spine surgeon. So believe it or not, I actually did two additional years, one in spinal reconstructive surgery, as well as another in musculoskeletal oncology in Chicago. And lo and behold, they are, you have an orthopedic spine surgeon.

Daniel Lobell: (02:17)
So you wanted to go into cardiology initially, but then you found your heart just wasn’t in it. Is that…

Dr. Paul Saiz: (02:24)
Yes, it’s kind of interesting. And again, I’m going to date myself here. When I was in medical school, going back to the early nineties, things were a little bit more old school than they are now in that, it’s almost very military where, you know, you get told to do something and you do it, and there’s not a lot of talk back. And what I noticed is that with the internal medicine rotations or the rotations where you go and you take care of people, you, you take their blood pressure and you give them medications. That, for me, at least the work was just very mundane while on the surgical side of things, there was a lot more of do do do. So, you know, here’s a classic example. My very first day of my surgery rotation, I’m a medical student, it is basically I show up at the VA and I’m on the general surgery team.

Dr. Paul Saiz: (03:20)
And this is in Houston, Texas, and the chief resident of surgery who’s, you know, at that time, looked like he was 6’6″, walks in with boots and scrubs, and we’re all these little lowly medical students looking at him. And he very abruptly said, “You know, I don’t care who you are. I don’t care where you come from. All I care about is if I give you a list of things to do, if they get done at the end of the day, it’s been a good day. If they haven’t been done, it’s been a bad day.” And he sent us off on our way. And I liked the black and white nature of that. It was just very, this is your list of things you either do em, or you don’t. And from there, it morphed into wanting a surgical calling and eventually into orthopedics, which, if you’re at all athletically inclined, that’s kind of a natural fit where you’re trying to, you know, maintain athletes and fix things and get people more active. And then again, that morphed into the spine after my residency and the ability to train under some really remarkable smart guys, and that really spurred my interest in the spine.

Daniel Lobell: (04:23)
Well, you did a really good job of fast-forwarding your life in this interview, right? To the medical part of it, which is great because I’m fascinated. And I have a lot of questions percolating, but I’m going to force myself to rewind a little bit because I feel like we didn’t really get into your story too much. I know as you mentioned that you were born to a resident, so you are of a medical family. As a kid growing up, did you always have your heart set on being a doctor or at what point in your life did that happen?

Dr. Paul Saiz: (04:58)
So, actually when I said I was born in a resident, I actually mean that literally. My dad was in Vietnam and my mom didn’t have a lot of resources. So she literally went to the medical center and a resident was the one who delivered me. So actually I don’t have anyone in the medical field. My parents have always been accountants and very business oriented. And to be honest, that’s what I wanted to do. Now, that was against what my interests were. So when I was younger, I do remember I built this glow in the dark skeleton that I used to hang on my light, and that was 8, 9, 10 years old. So that when I turned off the light, the skeleton glowed. So that might’ve been my first real, perhaps a hint that I was looking at orthopedics as a specialty, but going through high school, I really did not want, I don’t, perhaps burden is a rough word, but I didn’t necessarily want the responsibility of taking care of people. So when I went to college, I decided to kind of meet things halfway and be a, this is my initial plan was to be a, basically a pharmaceutical rep. But then I got to college and half your freshman class either wants to be an engineer or the other half wants to be a doctor. And I just said, well, why not? And that’s how things started really.

Daniel Lobell: (06:19)
So just for people out there, orthopedic, how do you define it? I have an understanding of it, but I couldn’t put it into words.

Dr. Paul Saiz: (06:28)
Basically it is the treatment, both non-operative and operative, of the musculoskeletal system. So that could be a muscle, that could be a knee joint, and the things that are in your knee joint, which includes cartilage or the little rubber stopper between the bones known as a meniscus. And that could be ligaments. Ligaments connect bone to bone. So for instance, if you know, you’re throwing a ball in softball and you hurt your elbow, perhaps you tore a ligament, or it could be a tendon, a tendon connects a muscle to bone. So a common one as we get older, as you’re out and you’re the weekend warrior and you tear your Achilles, which is the connection with your calf muscle to your heel. So it’s basically taking care of all of those. And then when you focus in specializing the spine, it’s basically everything from the back of the skull, to the pelvis, from the disks, which are basically shock absorbers, to the bones, to the nerves, to ligaments and tendons.

Daniel Lobell: (07:25)
So when you had that glow in the dark skeleton hanging up in your room, it was missing a lot of the parts that you wind up working on.

Dr. Paul Saiz: (07:32)
You know, it did, but you know, I’ve always kind of had this fascination with horror movies, with skeletons, with [laughs] the Day of the Dead. I am Hispanic and the Day of the Dead is a big part of what we do and, you know, just kind of that. Skeleton and the interest in it. But more importantly, you know, orthopedics really is keeping people moving because unfortunately, and it’s a good thing nowadays, our lifespan is much longer than it used to be, but that means that, you know, we’re having a body that’s wearing out on us, whether it’s a knee or a hip or a thumb or an elbow or a shoulder, things are wearing out on us. And really orthopedics is trying to keep us moving and doing all the things that we need to do as we hit our 80s and our 90s.

Daniel Lobell: (08:20)
Tell me if this is just crazy sci-fi thinking, but are we going to get to a point where our bones will be replaced with like titanium, as a grown adult when they’re not really growing anymore so that they can last, you know, into 200 years or something,

Dr. Paul Saiz: (08:38)
The answer, well, we already have bones that are made of metal. But for the purpose of extending our lifespan, the answer is no. We may get there, but in all reality, I think it’s more mental aspect of things that tends to go out on us as we age, moreso than necessarily body parts. Now everyone’s a bit different, but what I mean by that is, you know, our mental faculties really aren’t necessarily what they used to be as we get older. So the segue to your question is, we can already do that now. So one of the other things that I did training in is musculoskeletal oncology, which is a fancy way of saying, taking care of tumors that originate either from bone, muscle, ligament, or tendon. And in some tumors, especially, let’s say your femur, which is your big thigh bone, in some tumors, you literally have to remove the femur, it’s called a femorectomy. Well, you need to put something in its place. And we can already put in a metal femur and attach things. So that’s there are unfortunately functionally, you know, yes, you have a metal femur, but can you go out and run and do the things you were doing before? Unfortunately, functionality is not there. So –

Daniel Lobell: (09:59)
I also imagine it’s gotta be scary anytime you walk past a refrigerator, you could get stuck.

Dr. Paul Saiz: (10:05)
[Laughs] You know, these, these are significant, well, think about going through the alarm or the airport alarm, things like that. So I think the question is, will we be able to rebuild certain musculoskeletal parts? I think, yes, but I’m not necessarily sure that extending our lifespan out that much will be as important or based on those things so much as other things.

Daniel Lobell: (10:32)
So ultimately you are saying maybe yes, it is possible to build a body that keeps lasting, but you’re going to just have basically dementia patients walking around with metal bones.

Dr. Paul Saiz: (10:42)
To a certain extent, yes. Because that’s more important in reality. Being there. You know, you see a lot of very lucid 95, you know, people in their 90s, and then you see a lot of people out there in their 60s who, for the most part, have a functional body, but are not there. So, yeah, I really do think the mental faculties are gonna trump the musculoskeletal.

Daniel Lobell: (11:05)
So we’ll need somebody like Elon Musk to build like an external hard drive for the brain.

Dr. Paul Saiz: (11:11)
[Laughs] He can do a lot of things. I can tell you that guy is –

Daniel Lobell: (11:14)
That in combination with somebody like you replacing the bones. Do you walk around on Halloween? Just noticing the skeletons that are completely anatomically incorrect?

Dr. Paul Saiz (11:27)
I do actually. [Chuckles] And you know, my kids probably are somewhat desensitized because my home has a lot of day of the dead things. And I have a lot of old pictures. If you go back to the Renaissance, a lot of, you know, what medicine was born was a lot of people dissecting and doing a lot of things. So I have a lot of old Renaissance pictures so our house is filled with them, so my kids are perhaps morbidly inclined, but, you know, the sight of a skeleton doesn’t necessarily phase them.

Daniel Lobell: (11:56)
Right. They’re the only ones going through the haunted house being like, yeah, yeah, yeah, it’s just my living room. [Chuckles] So I want to go back a little bit to, you mentioned that you worked in the VA hospital and you set that really cool scene, which almost felt like it was out of a movie with the surgeon walking in, and “I don’t care who you are, just get things done.” What’s it like working in a VA hospital? Because I’ve been to VA hospitals and they’re pretty interesting places.

Dr. Paul Saiz: (12:27)
That is a really good way to say that. So when I was there that it was in Houston, Texas, and it was a brand new VA. So, you know, we had shiny walls, but it’s still the same. Still the same people working there. I think the VA is a really good area for people to learn and people who are people, medical students, residents, because you have a lot of different pathology there. You have pathology from, at least in when I was there from World War II, that to Korean War to Vietnam. And nowadays you likely have some from the Afghanistan, but it’s a really good place to see a wide array of pathology, meaning mental pathology, musculoskeletal pathology. And for me, it was a great learning experience. Now, as with anything associated with the government, there are inefficiencies. And I just think that’s just a by-product of size.

Dr. Paul Saiz: (13:27)
But, talking to vets, talking to a World War II veteran, talking to somebody who was in Guadalcanal, hearing their stories. And I almost lament that I didn’t take more time to just talk to some of these vets, just to get a feel for what they had been through. It’s amazing. It really is amazing. So I’m a big fan of the VA and I hope the VAs are an integral part of training programs. Cause I think as a learning doctor, as a doctor who’s early on, you pick up a lot of things from the VA.

Daniel Lobell: (14:05)
Yeah. Absolutely. Problems that you won’t face with the normal public for sure. For instance, I’m just thinking, what’s it called, strap? Scrap? Scrapnel? Strapnel? What is it when a bomb goes off and people get little pieces in it?

Dr. Paul Saiz: (14:21)
Oh, shrapnel.

Daniel Lobell: (14:24)
Shrapnel. Did you work on anybody who had shrapnel in their system, in their bones? Did that kind of situation present itself?

Dr. Paul Saiz: (14:34)
Actually, yes. And this was, so shrapnel. I mean, a lot of bombs are actually designed to be like that, where basically it just goes off and you get all of these metal parts being thrown out in different directions, and they’re coming out with such force that they can injure you. We had a gentleman I remember, and I believe he was Korean War if I remember correctly, where it had a piece of shrapnel basically embed itself into his tibia, which is your leg bone from your knee down to your ankle. And they had elected at that time not to do anything about it. And oftentimes they did that. So they allowed the wound to close over, but he would come in about once every six months with a draining sinus, or basically a skin defect where, you know, purulence, pus, was flowing out from the bone.

Dr. Paul Saiz: (15:21)
And we would, you know, periodically go in there and debride it. The metal was long gone by then, but, you know, he still had repeated infections, and we’d have to go in there and basically his, you know, semi-annual drain out and he’d be treated in antibiotics, he’d get off the antibiotics and the infection would come back. And those were actual realities for a lot of these patients who were thrown into the wartime environment. I think the biggest thing I take away was how positive he was. He was generally a happy guy and he’s happy with his life. And I always thought it was like, “Wow, he can keep a good attitude. And yet he’s coming back every so often for us to take him back and basically debride some of the purulence coming from the bone in that area.”

Daniel Lobell: (16:08)
And it didn’t make sense to go back in there and remove it, rather than continue to do that?

Dr. Paul Saiz: (16:15)
So there was some talk about that time of going in and actually removing the portion of the infected bone. But the problem is at that time, and again, we’re going back, shoot. I was still a medical student, so you’re still talking early nineties. We didn’t really have the technology to fill in the defect. Now, normally what we’ve done in the past is basically you take a cadaver piece that’s similar and you kind of fit it into that defect. The problem is, cadaver bone doesn’t have any live cells. It’s basically a calcium scaffold. There’s just this big calcium structure. And it’s very susceptible to infection and it’s also very susceptible to break down. So we never really had a good option of how to place something in there that can weight bear, that won’t get infected and will last his lifetime. So in the end we just elected to go in there every so often and clean out. We wouldn’t take all the bone, but take out the infected part.

Daniel Lobell: (17:19)
And nowadays, has the field changed enough that you would have that option available to you?

Dr. Paul Saiz: (17:26)
Yes. Things have changed quite a bit. So number one, the ability to go in and remove what’s infected, replace it with something that’s structurally more tolerant, whether it’s a metal, you know, it could be some form of a porous titanium, or it could be some form of porous tantalum, which is another material that is used. But more importantly, also the ability to get a blood supply. Because blood supply is extremely important because if you think about it, if I give you antibiotics, so let’s say you have an infection somewhere. You’re really relying on the bloodstream to deliver those antibiotics to that area. Where infections really enjoy, really where they thrive are in environments that don’t have a very good blood supply. So when you have a piece of bone that has had chronic infection, it has a very, very poor blood supply.

Dr. Paul Saiz: (18:19)
So nowadays what you can do is you can swing a flat, which is a fancy way of saying, perhaps loosening up your calf muscle and then swinging it over and putting it on that area. Because if you think about the front of your tibia, you don’t have a lot of stuff there, you have skin, but if you hit yourself hard on the front of your tibia, it hurts. Cause there’s not a lot of muscle there. So if you can swing that muscle over, which by the way also has a really good blood supply, your chances of treating that infection go up significantly. We have a lot more options nowadays to better treat these types of infections.

Daniel Lobell: (18:55)
And what about growing bones in the lab? Is that something that’s happening yet?

Dr. Paul Saiz: (19:01)
So, the answer is it’s been tried. Has it reached the point where it’s actually viable? The answer is no. Now the problem is growing bones is, what if you think about what makes a bone grow? If you’re young, basically the way we grow is, you set up a scaffold that’s made of cartilage first, and then bone cells come in and lay calcium on top of that cartilage scaffold. And you build on what’s already there. And basically you grow. Nowadays, what happens is, let’s say you fracture your bone, the bone cells fill that space with a young bone material, or some people might see that sometimes as callus. And then that basically matures to bone. So you need a bone cell to go in and start doing what it does, which is grow bone. So to take a bone cell out of the system, put it down into some form of a scaffold, let’s say, and have it turn on and start to grow a bone.

Dr. Paul Saiz: (20:01)
Number one, it’s difficult. Number two, what kind of bone are you growing? Does it just have general directions to make bone, or does it have directions to make a hard bone, like your thigh bone or is there directions to make a softer bone? Because if you think of spine bones, the inside of your spine bone is actually much softer than the outside. So there’s a lot of little fine points that have not been figured out, but do I think we’ll eventually get there? The answer is yes. Will it be within the next 20, 30 years? Maybe. But at this point now we really don’t have any viable way to grow bone outside of the person and then implant it.

Daniel Lobell: (20:47)
You’re reminding me of something horrifying I read in a book this past week about somebody who said their ex-wife felt that their son was not tall enough and would bring him in to have his legs broken and sort of stretch so the bone would grow taller so he could be taller. First of all, is that legal? And second of all, is, am I doing justice to, is this a thing?

Dr. Paul Saiz: (21:14)
Yes, actually it is. Well, so let’s put it in this context. So let’s say somebody has an injury. Let’s say they have a tibia. Again, that’s the bone between your knee to your ankle that’s fractured. And this is a young person who’s growing. So you handle what we term a limb length discrepancy, meaning one leg is longer than the other. So what we can do is you can go in and break it and then you put up this kind of fancy, well, it almost looks like, I’m trying to think of the horror character name who has all the needles sticking out of him.

Daniel Lobell: (21:52)
Now I don’t remember either.

Dr. Paul Saiz: (21:55)
But it looks like that. So what you do is you put wires into the top portion of the bone, the bottom portion of the bone, and you put gradual stretching tension onto the bone, kind of forcing it to grow in a lengthened position. It’s called a limb lengthening procedure and it was first founded by actually a Russian, a gentleman by the name of Ilizarov, it’s called the Ilizarov procedure, but yes, there are ways to help a bone grow, but that’s typically used in the scenario where you have a trauma or you had something that happened causing one leg to be shorter than the other. Now, to do it just because you want your kid to be longer, or I should say shorter. Longer, taller. I have not heard it being used like that, but could it potentially? The answer is, yeah.

Daniel Lobell: (22:43)
So it’s kind of a horrific thing to do cosmetically.

Dr. Paul Saiz: (22:47)
Yes.

Daniel Lobell: (22:49)
Yeah. So that brings me to my other question. When you said you do spinal reconstructive surgery, I assume that that’s not a cosmetic thing, though I’ve heard of reconstructive surgeries being used to describe cosmetic things, but what is a spinal reconstructive surgery?

Dr. Paul Saiz: (23:07)
So typically as we age, or even somebody who’s younger, let’s say has scoliosis and you have what we term a deformity or spine that isn’t quite curved in the right area. So first and foremost, a spine is not a straight piece of anatomy. If you look at someone from the front, yes, your spine should appear straight. But if you look at him from the side, they actually have three curves. We have a curve in our neck. We have a curve in our mid back and we have a curve in our low back, low back being lumbar, mid back being the thoracic, neck being the cervical. When the spine, or when someone has scoliosis, what that means is the spine is actually rotated. So that the curve, which is in your side view, is now seen in the front, the back view and typically surgery done for that is to rotate the spine back to the way it should be.

Dr. Paul Saiz: (23:59)
So that your curves are, you know, in the side view, as opposed to the front view. Now, as we age, the cushions between the bones, which are known as discs and really function as shock absorbers, begin to wear out on us. And the reason they wear out is they have the same problem I alluded to earlier, is they have a very poor blood supply and any tissue that has a poor blood supply has a very poor regenerative capacity. In English, it doesn’t heal itself very well. So for instance, if I somehow cut my thigh and muscle has a very good blood supply, that initial injury is going to heal itself pretty quickly. However, if you injure something like knee cartilage or the rubber stopper between known as the meniscus or a disc, it can’t heal itself. So what happens is it begins to break down and what we sometimes don’t realize is that the disc will sometimes break down on one side more than another.

Dr. Paul Saiz: (24:59)
So, you know, kind of a simple way to think of it is the reason we rotate our tires is so that you prevent uneven wear on the tread. Well, you can’t rotate your disc. So if one disc decides to wear out more on the right side, it causes the bone on top to now tip towards the right side. Well, if that happens over an extended period of time, you’re walking around like the leaning tower of Pisa, which the body doesn’t like. So what the body does is it curves itself back to keep the head centered over the pelvis. And we get what we term a degenerative curve.

Daniel Lobell: (25:29)
Is that a hunchback in lay terms? Is that –

Dr. Paul Saiz: (25:33)
No, a hunchback’s a little different. A hunchback is where, when you look at someone from the side where they are hunched over, what I’m talking about is when you look at them from the front, they have a curve. We can actually touch on that a little bit. It’s a little different, but yeah, it has similar principles in the reconstructive. So really what reconstructive surgery is, is going in there and number one, unpinching any nerves that are pinched, number two, stopping any moving parts that hurt from moving, in layman’s terms a fusion, but more importantly also restoring the curvature, the appropriate posture to the spine. So that biomechanically, they have a more functional spine because the more crooked you are, the more biomechanically out of balance you are. And the more at risk you are of having back pain.

Daniel Lobell: (26:25)
So if the hunchback of Notre Dame had come into your office, could you send him out walking with a good posture?

Dr. Paul Saiz: (26:35)
[Laughs] He had some other issues going on there, but the answer is yes. There are surgeries that you can go in. And typically you do that in the side of things, on the pediatric side of things where you can go in and correct some of the congenital abnormalities that are out there. And again, congenital meaning that you are born with, perhaps instead of having two vertebra or two spine bones are fused together, which causes a deformity. So typically those types of things are taken care of early on by our pediatric surgeons.

Daniel Lobell: (27:07)
I remember being checked for scoliosis as a kid all the time. That was like the biggest fear, is that you might have scoliosis, you know, in terms of, from the nurse’s office. I don’t know anyone who had it. I don’t remember anyone having scoliosis. I just remembered, it was like every year you got checked for it. Is it common?

Dr. Paul Saiz: (27:27)
Actually, yes. And I think the reason it probably has such a negative connotation to it was that, you know, kids who had scoliosis had to wear those ugly braces. So the answer is scoliosis, which is multifactorial in origin, but we do think there’s a significant genetic component, it’s just as common as it was back in the day. It’s just that, you know, we have better treatment options for it. The braces aren’t as big and bulky. And we don’t allow these curves to get as big anymore before we intervene. And the surgeries are much more effective than they used to be.

Daniel Lobell: (28:07)
Right.

Dr. Paul Saiz: (28:07)
So yeah, things have come a long way when it comes to scoliosis. But whenever I remember being in school, I always thought of scoliosis as the person having to wear that big ugly brace.

Daniel Lobell: (28:18)
Yeah. I’m glad I never had to do that, but I certainly was checked enough times. By the way, I’m just looking at your resume here. And I’m seeing that you actually trained at the University of Notre Dame, which is a different one I imagine than the one in France, but still funny to imagine that you could have had the hunchback of Notre Dame at your school.

Dr. Paul Saiz: (28:42)
Yeah. Actually, on Halloweens we had quite a few of them running around.

Daniel Lobell: (28:47)
[Chuckles] I bet. So to sum up, spinal reconstructive surgery is basically a correcting of the curvature of the spine.

Dr. Paul Saiz: (28:58)
Yes. On top of taking care of what is painful. So normally, and again, I deal with predominantly adult degenerative issues, meaning that adult issues, adult curvature, not, you know, kids being born with congenital abnormalities. So yes. And when you have a reconstructive frame frame point, you are unpinching nerves, you are stabilizing the spine where they’re unstable and you are correcting the deformity and you’re paying extra attention to trying to biomechanically situate the spine in such a way as to minimize back pain.

Daniel Lobell: (29:38)
Okay. Got it. What about musculoskeletal oncology? What is that and how does it differ?

Dr. Paul Saiz: (29:46)
So musculoskeletal oncology was a separate fellowship where we number one, learned about tumors that were based on the skeletal system, muscles, ligaments, or tendons. And those are actually fairly uncommon. Cause if you think about the majority of tumors, really, they come from your lungs, let’s say, or your prostate or your bone marrow or your liver, or things like that. So it’s an uncommon type of tumor, but a tumor nonetheless. So really the treatment was number one, how to diagnose it, number two, how to treat it. And you also learn chemotherapy protocols with that. Now, the musculoskeletal oncology is really focused more on the surgical aspect of things and how to, you know, get rid of the tumor. And a lot of these tumors are dependent on what we term margins, meaning that when I do a surgery to cut out the tumor, do I get it all out or do I leave some of it there? And that’s a big deal because if you leave some of it there with some of these tumors, then it’s going to come back.

Daniel Lobell: (30:49)
Why would you do that then? Why would you leave some of it there?

Dr. Paul Saiz: (30:53)
Because let’s say you’re next to a nerve, a very important nerve. Or let’s say, you’re next to a big blood vessel that’s very important. Or, if you think you have it all, but if there’s microscopic advancement going into another area. So there’s a lot of little factors that go into trying to get what we term a clean margin, meaning that the area you cut out, let’s say a tumor, and the area around that cutout is clean of tumor. And some of these areas can be quite difficult. So let’s say you think of your pelvis, you know, the skeleton, the connection points for the legs, let’s say you have a big tumor there. Well, it’s really hard to go in and get a clean margin in that area. Number one, and number two, functionally, what have you done to the patient? Because one of the rules of musculoskeletal oncology is you have to cut it out, but then you have to reconstruct it with something to give the patient the ability to do normal things. So there are some instances where you will unfortunately leave a margin that has tumor in it. And then of course, you’re dealing with the ramifications of that.

Daniel Lobell: (32:07)
Are there devices like 3D printers that can make very specific fillers for where you’ve removed tumor area?

Dr. Paul Saiz: (32:17)
Yes. And actually, you’re seeing a lot of push and a lot of advancement in that area. There’s now 3D printers that can print out, for instance, when you fuse people, sometimes you’ll use spacers or cages in another term for that, that you will put in between the bones. You now have 3D printers that can be very specific to that. You have 3D printers that can print out a femur made of metal for you, or you have 3D printers that can do half that pelvis that you’ve resected, that can go ahead and print out that material. So you can reconstruct the area that you just excised. And again, part of musculoskeletal oncology is not only getting the tumor out, but also reconstructing the defect that you caused.

Daniel Lobell: (33:05)
Yeah, it reminds me of this little gadget I have for getting wine out of a bottle without taking the cork out, it’s called a Coravin. And as much wine comes out, it puts the oxygen that reoxygenates the bottle. So I think that’s what it’s doing anyway. But it fills it with gas so that the wine remaining in the bottle stays good. So it seems like, I don’t know, that comes to mind as the visual, but just like for every little bit coming in, you have to replace it right as you do it.

Dr. Paul Saiz: (33:41)
You do, and part of the problem too, is you got to reattach certain things. So let’s say you remove a piece of bone, all the attachments to that, which are ligaments, again, bone to bone, or tendons, which is muscle to bone. You have to reattach that and to get a viable attachment, meaning that it not only attaches, but it stays attached and can withstand your day-to-day activity. Sometimes it isn’t as easy as it sounds. So, you know, musculoskeletal oncology is really an interesting field and it is some big, big surgeries. And ultimately the purpose of the surgery is to save someone’s life. But your other goal is to give them functionality so they can do the things that we take for granted.

Daniel Lobell: (34:24)
How do you attach those ligaments back? I mean, I’m guessing you’re not using thumbtacks. What, what is the –

Dr. Paul Saiz: (34:33)
So normally what you do is you want to have some type of surface that the tendon or the ligament can attach to biologically. So we’ve done things such as cadaver bone, which I had mentioned earlier. The problem with cadaver bone again, is that it is not viable bone. It is not bone that has live cells in it. And what you hope is that some of your cells can take over that calcium scaffold, that calcium empty building and make a home of it. The problem is, on bigger defects or bigger pieces of cadaver bone, the ability to incorporate all of that cadaver bone into actual live bone is actually minimal. So metal has actually been a material of choice as of late. And oftentimes you can get a biologic connection between tissue and metal, which can last long term.

Dr. Paul Saiz: (35:28)
So yes, basically from suturing the actual tendon or the ligament the metal, to some form of a, in smaller defects, a cadaver bone that your body can incorporate into your own live bone. Those are all the techniques that you use. And you hope for the best, but it’s not uncommon in these situations where things don’t necessarily heal right away or our cadaver bone breaks or infection. Cause in a lot of these bigger procedures, I’m putting in an inanimate object and you’re asking the body to basically incorporate it, but bugs or bacteria love inanimate objects because there’s no blood supply. And again, blood supply is what brings the cells that fight off infection. So those are a lot of things you have to take into account when you’re doing some of these bigger procedures,

Daniel Lobell: (36:23)
Is there any advantage to getting a cadaver bone from someone who just died?

Dr. Paul Saiz: (36:29)
So the answer is no, not really, because you have to realize that person has their own immune system, they have their own different cells. And if you put in that material into someone else, your body, let’s say it was me and I received fresh cadaver bone from someone else, my body would recognize it as being foreign and basically attack it. So when I talk of cadaver bone, it’s basically being cleaned of all cells. So that way, when the body sees it, it sees it as neutral, not necessarily as belonging to somebody else.

Daniel Lobell: (37:01)
Can it have cells from the person it’s being implanted into incorporated into it before the surgery? Can you infuse cells from the person into it?

Dr. Paul Saiz: (37:12)
So do you take a piece of cadaver bone and then you take cells from the person that it’s going to go into and put it in there? The answer is I have not heard of that being done. The question is though, again, you have to remember that cells need some form of a blood supply. They need some form of nutrition and you just put a cell on to basically a calcium substrate that does not have any of the other things that we take for granted, such as blood, nutrients and those cells would die. So as of yet, no.

Daniel Lobell: (37:40)
So all we’d need to do essentially is create some kind of artificial way to create blood supply to the cadaver bone, to infuse the cells from the person who it’s going to be implanted into with, so that it absorbs into it. And then you and I become billionaires. [Chuckles] So what are we waiting for, doctor?

Dr. Paul Saiz: (38:03)
[Laughs] You know, there’s a lot of study going out there and ways to try to speed up this process of incorporating bone, speeding up the healing process. But as of now, unfortunately, it’s not a viable option, but hopefully, and things have changed quite a bit, if you think about just technology and you think about lifespan, you know, a hundred years ago, how long were we living? Was it 50s, 60s? And now legitimately we’re 70s, 80s, perhaps the next 20, 30, years we’ll be up into the late 80s, 90s, and maybe one day we’ll be three figures and that’ll be considered normal.

Daniel Lobell: (38:42)
Yeah. Well, we’re definitely gonna need pensions again then. [Both laugh] When researching, you saw that you deal in diseases of thoratic or thoracic spine, is that correctly pronounced? And what is it?

Dr. Paul Saiz: (39:05)
Thoracic spine. So that is your mid portion. So that is the part that has the ribs to it. So again, the spine has three parts to it. The cervical thoracic, and then lumbar, and then our tailbone, which is known as the sacrum. But the vast majority of pathology or degenerative change or arthritic change, or, for lack of a better way of describing it, the “getting old changes,” occur in the parts that move the most. And that is your neck, cervical, and your lumbar, low back. The thoracic, interestingly, it doesn’t wear out as much because it doesn’t move as much because of the ribcage. But yeah, dealing with thoracic issues is a big part of what I do,

Daniel Lobell: (39:42)
Which is the more difficult part to work on, out of lumber, cervical and thoracic?

Dr. Paul Saiz: (39:50)
You know, that’s interesting. It really depends on the pathology. So for instance, a lot of people don’t realize is that our spinal cord, which comes off your brain, actually ends right where your thoracic spine meets your lumbar spine. We refer to that as our thoracolumbar junction. So all we have is individual nerves and your low back, which means that I can move an individual nerve out of the way to do whatever it is I need to do. And there’s really no risk of paralysis. So the vast majority of lumbar low back surgery is done from the back. But once you hit the cervical and thoracic spine, you actually have a spinal cord there. And for the most part, spinal cord does not like to be manipulated. So the majority of the surgeries you do are aimed at avoiding the spinal cord. So for instance, the cervical spine or the neck, a good portion, I would say the vast majority of surgeries are actually done from the front.

Dr. Paul Saiz: (40:44)
So you make an incision on the neck, you move your food tube and your breathing tube to the side, and you access the spine from the front, that type of surgery. Actually, most people recover quickly because you really haven’t injured a lot of muscle like you have in your low back. The thoracic spine, for instance, if you need to address something such as potential infection, or maybe a disc herniation, or maybe even a tumor, you typically have to find a way to get around the spinal cord to be able to remove whatever’s causing the problem. That typically is a little bit more complicated surgery, but again, it really depends on what you’re taking care of. It really depends on how healthy the patient is. And actually, a lot of it depends on, something we don’t talk a lot about is the patient’s girth. I mean, the bigger you, the more tissue it requires you to go through to get to where you need to go through. And the more things you have to push out of the way to get there, obviously the increased pain issues and the increased difficulty at the surgery.

Daniel Lobell: (41:51)
So being in good shape is a hugely advantageous when it comes to surgery. In other words.

Dr. Paul Saiz: (41:59)
It is as far as, well, let’s define good shape. So let’s say I have to remove a disc herniation on an athlete and I take care of New Mexico State University. I’m a spine physician. So I have a football player come in and he has a disc herniation causing some leg issues and I have to take care of it. So that means I typically have a very sick and robust muscle layer in the back for me to get through, to be able to go where I need to go. Okay. Versus let’s say I have a real skinny elderly female, who, you know, the distance from her skin to the spine, let’s say is three centimeters, while that football player is a good ten. So, you know, being in shape is important. I think it’s good for other things, your lungs and your heart, but it can sometimes make your surgery a little bit harder just because people have more muscle.

Daniel Lobell: (42:55)
I didn’t even think of it in terms of muscle. I was thinking strictly in terms of fat. I wonder if actually going through muscle is more difficult than going through fat.

Dr. Paul Saiz: (43:04)
It is, because there’s more bolt to it. And you know, again, it’s how much of one versus the other. So in that athlete, you know, he doesn’t typically have any fat, so it’s just strictly all muscle, versus let’s say somebody who, you know, let’s say has a BMI over 40 or 50, then typically you may be going through three to four inches of fat prior to even getting to the muscle layer. And that can affect number one, the difficulty of the surgery, but number two, the size of the incision. So, you know, sometimes I get people ask me how big is the incision? I said, well, it depends. It really depends on the depth of the area. If I have to go six inches versus let’s say three inches versus let’s say nine inches, then the extensive incision is gonna really depend on that. The deeper I have to go the bigger the incision.

Daniel Lobell: (43:58)
Can you just cut the fat out of the way? Whereas muscle, people need their muscles. People don’t need fat, right?

Dr. Paul Saiz: (44:05)
You can. But then you have this area that, you know, when things are all healed, you may see evidence of a defect in that area because they have fat and all the other areas other than where you’re at. Thing is about fat is that it liquefies quite a bit. In other words, like for instance, if you throw a suture through fat, it won’t hold because the suture is going to cut right through the fat and the fat liquefies. So it’s just kind of this necessary space occupying thing you have to deal with where you just push it to the side, you get down to where you need to go. And then when you close, you close a wound, you close and you throw sutures and things that will hold the suture. So for instance, muscle doesn’t hold suture very well either, but the white portion on top of muscle or the fascia as we term it, or you might think of that thick, tough stuff on a steak that you’re eating through, that actually holds the suture. So when you close a wound, you’re actually looking for that covering over the muscle as your layer to be able to close the wound. And then when it comes to fat, you try to reapproximate the fat and just hope that scar tissue heals, and then you close the skin and there you go.

Daniel Lobell: (45:15)
Is liquefied fat easier for the body to burn off than solid fat?

Dr. Paul Saiz: (45:23)
Well, if your body’s metabolizing fat, then that’s a good thing, because that means that your body is now turned towards keto based metabolism versus carb-based. But the answer is the liquefaction or the liquefied fat material either come out of the wound and sometimes be mistaken for pus. Cause it is yellowy in color, or the body will just reabsorb that liquid.

Daniel Lobell: (45:48)
I wonder if putting sutures through fat would help people as a weight loss mechanism. [Both laugh] What is the biggest advance that’s happened recently in your field and what are you most excited about?

Dr. Paul Saiz: (46:03)
Well, I’m going to answer that with where I think we’re still lagging, is the ability to regenerate tissue that is degenerative, i.e. the discs. Because really when the spine begins to age and you see this as soon as late teens, early twenties, where the discs themselves, again, they have a poor blood supply, begin to wear out. That’s really the initial step that leads someone towards having a degenerative spine. And we have really no good way to turn on those disc cells and make them think they’re young again, and have viable disc tissue. As far as what the biggest advancements and things that I’m most excited about is, I do think the use of computers and the use of intraoperative navigation. So –

Daniel Lobell: (46:54)
Is that like robotics?

Dr. Paul Saiz: (46:56)
I’m sorry. Similar to robotics but you know, robotics to me is a robot putting in a screw for you, but how do you know where to put that screw or what trajectory to do? So case in point, yesterday, I did a seven hour case where unfortunately someone had had multiple spine surgeries and they broke down at the top of the thoracic spine. And they also had a pinched spinal cord in the cervical spine at multiple levels. So we did a front back surgery and I had to put a screw into cervical 2. Now the cervical 2 bone, which is the second vertebra down from the skull, in her case was very unique. In other words, she had rotation and in that area was two big blood vessels known as the vertebral artery. One on the left and one on the right. And if that gets injured, that’s a bad thing. So normally the way I was trained to do it is, you identify your landmarks and you just kind of give it your best guess and put the screw in. More likely than not, you’re going to put it where it needs to be.

Dr. Paul Saiz: (47:53)
But if there’s any anatomic variation, you may sometimes injure those vessels. So what I did yesterday was I used an ORM, which basically it’s an interoperative CAT scan that will take a picture. And then I will have an instrument that I put next to the body and I can look at a screen and it tells me where I am in the body. And if I’m thinking about putting in a screw, it will tell me what size screw I can get in, the length, and the trajectory. Meaning that, you know, if I’m a little bit too medialized, maybe I’m headed towards the spinal cord, or maybe if I’m too lateralized, maybe I’m headed towards that blood vessel. So the ability to be a lot more comfortable in putting a screw in, more importantly, improves patient safety. Number two, you can get a biomechanically bigger, stronger screw in, I think has really helped us be more put in a construct or screws in that’s much more durable. And more importantly, that the safety aspect of things has really helped decrease the risks associated with some of these bigger surgeries.

Daniel Lobell: (49:01)
That’s really fascinating. And I wonder how many times in the past surgeons have put the wrong size screw in, or didn’t know they could put one in and how much this is changing?

Dr. Paul Saiz: (49:15)
It’s a lot because normally what I used to do is, obviously you don’t want to put too long of a screw in, so it comes out, so you typically would go either small on the screw or short on the screw for fear of, you know, putting it in where you don’t want it to go. And you’re relying on x-ray, which is really poor form in its imaging with [?]. Here I can get a bigger screw, longer screw. And again, that improves the biomechanical feasibility of that construct. Construct meaning all of the screws taken in combination. So yeah, I can tell you for, for at least, for, as far as the pucker factor, the stress associated with putting in these screws, it really has decreased the amount of anal sphincter tone required to be able to do the surgery.

Daniel Lobell: (50:00)
And less trips to Home Depot, I imagine.

Dr. Paul Saiz: (50:02)
[Chuckling] Well, no, you’re just going for different things.

Daniel Lobell: (50:09)
If you have a specific thing you need, you know, you don’t have to keep going.

Dr. Paul Saiz: (50:13)
I need a bigger screw and a longer screw, but I tell you the technology and the ability to image and get lifetime feedback on that imaging, I think has really helped, help really change the game.

Daniel Lobell: (50:25)
So is there some kind of video on the surgery like, that you can, let’s say you’re taking ligaments or tendons off of a piece of bone and you want to know exactly where they go back on, do you have some kind of dash cam footage that you can refer back to and be like, okay, this goes here, this goes there. Or is it all basically off of memory or training?

Dr. Paul Saiz: (50:49)
It’s going to be off of memory and training, and that’s more on the musculoskeletal oncology side of things. Which again, I have, even though I’m trained in it, I now focus 100% on the spine. I do not do anything as far as the femurs and the tibias anymore. But I do know that the use of 3D printing has really helped in getting more patient specific implants. Meaning, let’s say somebody needs a femorectomy, and you’re gonna take out the femur. Well, the new one you put in needs to match the other one. And back in the day, you’d kind of eyeball it and guess, and you would have the company build it. Or if you were going with a cadaver, you would hope you’d find a cadaver that was similar in stature to the other legs so you can see some of those variables. But nowadays with the help of 3D printing, you can be anatomic in these new implants. So I really do think the 3D printing has really helped the musculoskeletal oncology side of things.

Daniel Lobell: (51:50)
Between that and knowing exactly what size screw to put in. I imagine that’s transformative.

Dr. Paul Saiz: (51:56)
It is, and it just kind of calls in it. Well, it just shows you how in the past, as these technologies were developing, how much you were really relying on what available information you have and your experience. How big a screw, how long it should be, and where should my starting point be to get the screw in.

Daniel Lobell: (52:18)
Pretty, pretty interesting stuff. Let’s shift gears for a minute and talk about the technology space of medicine. I know we’re doing this interview on behalf of Doctorpedia, which is a wonderful website where people can go and get all kinds of great information and find you as well. What role are you playing in Doctorpedia? And what role do you think Doctorpedia should be playing in terms of the online health space?

Dr. Paul Saiz: (52:47)
I found Doctorpedia to be extremely fascinating because one of the issues I encounter daily when I see patients is really educating the patient as to what’s going on. Unfortunately in the spine arena, there’s a lot of misinformation out there as to what causes pain, what treatments are and what treatments are going to give you. Meaning that there is no medication out there that is going to grow back a new disc. Hanging upside down is not going to make your disc younger again. The traction units that are out there is not going to revitalize your disc. The various herbal remedies out there are not going to counteract the arthritic changes you have in your spine. So just really educating the patient, going, “Hey, the spine is a series of moving parts, it ages like you do. Having back pain is normal.”

Dr. Paul Saiz: (53:44)
Really what we’re trying to do is help you deal with your back pain, through exercise, through proper back posture, so that you can learn to live with it, and hopefully avoid any of the surgeries we’ve alluded to. Because of all the misinformation out there from, you know, those late night commercials, infomercials that you see out there, sometimes having to reeducate the patient as to what’s going on. So I look at Doctorpedia as a way to inform patients as to what’s going on, educate them as the natural history of how the spine is and how it degenerates, and hopefully give them more tools to assess what their options are. Not everybody needs a surgery, not everybody needs an injection. What do you need and what do these treatments, for instance, injections, what are they aimed at? What are they trying to do?

Dr. Paul Saiz: (54:38)
So for me, the ability to help focus the information to what I think is relevant is extremely important. And I found one of the key points of Doctorpedia that most attracted me. It attracted me so much that I’ve become a founding medical partner. And I’m also one of the founding medical partners for the Spine channel. And I’m just excited. I’m excited to be able to put something out there that the general public can access, that is valid information, and can educate and give people options. And again, you don’t necessarily need to see a spine surgeon if you have back pain. But if you do, you at least understand why you’re seeing the spine surgeon and why certain surgeries can help this, but perhaps they can’t help that. And realize that spine surgery is not a cure. I spend a lot of time with the patient saying, “Hey, my goal is to unpinch this nerve to help your left leg pain per se, but you’re still at risk of having some back pain.” And that way the patient knows what to expect, what the pluses and minuses of surgery are, and then they can make the decision that’s best for them.

Daniel Lobell: (55:47)
Yeah, that’s a very valuable tool for people. And by the way, now that you have your own channel, this might be your way to debut as a horror film maker. [Paul laughs] Sending different kinds of chills down people’s spines. You have your own channel, you can do anything!

Dr. Paul Saiz: (56:05)
[Daniel laughs] You know, maybe on Halloween we’ll have some of the animations and we can be doing a surgery on a wolfman or a vampire or some sort.

Daniel Lobell: (56:14)
Yeah, you gotta do a Day of the Dead special on that channel, for sure, with all the skeletons. What is the biggest compliment that a patient can give you?

Dr. Paul Saiz: (56:22)
What you told me to expect is exactly what happened. And what I mean by that is, you know, when you operate on somebody, obviously you want them to get better. But as I alluded to before, certain surgeries address perhaps this pain source and not that pain source, but doing a good job of informing the patient what to expect, and then having that occur to me, that’s a compliment. That means that the time spent in educating them and again, that the surgical aspect of things gave them everything that I wanted and what they wanted. I think things that, you know, make me take pause and go, maybe I need to do better jobs at communication is when they say, “Well, I didn’t expect this. I didn’t expect that.” So just the affirmation that, yeah, doc, exactly what you told me is what happened.

Daniel Lobell: (57:13)
I love that answer. And by the way, how many people still call you doc? I feel like [laughs] that’s such an old school thing, but do people still do it?

Dr. Paul Saiz: (57:21)
They do. And it’s interesting. It tends to be more of the younger generation. So as you know, I take care of New Mexico University, Mexico State University sports. So the trainers and even the athletes all just tend to call you doc.

Daniel Lobell: (57:38)
Bugs Bunny.

Dr. Paul Saiz: (57:38)
[Laughs] By the way, just as an aside from that, I learned all my classical music from Looney Tunes. So if you ever watched Looney Tunes, there was always some classical music song on there. And I think kids are just missing out nowadays because they have absolutely no sense of classical music.

Daniel Lobell: (57:55)
Yeah. Well, I mean, as long as Looney Tunes doesn’t get canceled, hopefully people will [chuckles] be able to still discover Mozart or [chuckles] hopefully they’ll hang in there. I think they just canceled the skunk though. He’s out.

Dr. Paul Saiz: (58:11)
Oh, you know what? Yeah. I think about, oh, Pepe Le Pew. Pepe. Yeah. Yeah. So, no, he was a bit inappropriate. I look back on him. I was like, whoa! [chuckles]

Daniel Lobell: (58:26)
Inappropriate maybe by our standards, but by cartoon skunk standards, who are we to judge, you know?

Dr. Paul Saiz: (58:32)
[Both chuckling] And I think he truly loved that cat as well. [both chuckling]

Daniel Lobell: (58:40)
Look, it was a different time.

Dr. Paul Saiz: (58:43)
It was a different time.

Daniel Lobell: (58:44)
Cartoon skunks were free to be who they were, they didn’t have to worry about it. [Paul laughs]

Dr. Paul Saiz: (58:51)
[Both chuckling] There were just a lot of things that when you look at it and go, “I’m not sure you can get away with that.” Who’s the other one? Speedy Gonzales. And his friend, Slowpoke Rodriguez. [chuckles]

Daniel Lobell: (59:08)
I wonder if he’ll hang in there.

Dr. Paul Saiz: (59:12)
[Both chuckling] But you know, I look back on those and again, they were, at the time, and I still think, I mean, they were cartoons, you watched them, but you picked up some classical music and there was so much adult humor in those. So, you know, sometimes at night, if nothing’s going on, I’ll just put on the cartoon channel and, you know, there’s so much adult humor that I had no idea what’s going on in these cartoons, going on. And so it’s just like, I have a better appreciation for what was available to me when I was growing up.

Daniel Lobell: (59:40)
I’ll have to revisit them. By the way, the first words of Spanish I learned were from Speedy Gonzales. “Andale, andale! Arriba, arriba! Epa, epa!”

Dr. Paul Saiz: (59:51)
[Both chuckling] Yes, that’s classic Speedy, and Slowpoke is somewhere half passed out in the town somewhere and he has to be awakened. [Daniel laughs]

Daniel Lobell: (01:00:02)
It’s been a real pleasure speaking with you today, Dr. Saiz. I’m going to ask you the same question that I round up all these interviews with, which is: what do you personally do to stay healthy?

Dr. Paul Saiz: (01:00:13)
So I actually work out three to four times a week. I’ve gone away from more of the classic Olympic style lifting and more towards core based. Core, which is your abdominals and your low back extensors, are key to a happy spine. So I make sure I do my core at least three to four times a week, divided into uppers and lowers. And, and FYI, I actually have disc problems. My L5-S1 disc is actually 90% collapsed. So if I do surgery a lot, let’s say I had multiple days of surgery. I typically have to take some amount of ibuprofen cause my back will act up. But as long as I do my core exercises, for the most part, my back allows me to do the things I need to do. But yeah, I work out and it’s a big part of what I do. And it’s also a big way to help relieve stress. So when I tell my patients, they need to be on a workout program and incorporate core, I’m preaching what I’m telling them.

Daniel Lobell: (01:01:12)
By the way, we’re going to get you a new disc as soon as we figure out our plan to send blood supply with the cells of the person to the cadaver bone and disc – can you take a disc from a cadaver?

Dr. Paul Saiz: (01:01:26)
No, because again, remember the disc itself, it’s just… When you look at it, material-wise, it is along the lines of crab meat, perhaps a little bit more tough than crab meat is. So it’s kind of this… In a young person, it’s spongy and has more of a mucinous center, but as we age, the disc dehydrates, so it becomes more just this kind of tough material. So no. To be able to take that from somebody, again, it would have cells from that person, number one, it would not have a blood supply. So if you were to put it into somebody –

Daniel Lobell: (01:02:00)
But then with our invention that we’re going to make billions on, that’ll be fine. [both chuckling]

Dr. Paul Saiz: (01:02:06)
If we could somehow turn on the cells that are in the disc and make them think that they’re young again, so they would go on more of a building of new tissue versus breakdown of new tissue. I think that that’s probably the avenue that will bring or give the quickest results in it. I do know a lot of people are working on that. I think that’s what’s probably going to end up happening.

Daniel Lobell: (01:02:34)
I think the only way to turn them on is if we get that cartoon skunk involved, because he’s a master of romance,

Dr. Paul Saiz: (01:02:40)
[Both laughing] You know what, that French accent, how can you say no to that?

Daniel Lobell: (01:02:47)
Look, what if we just put a crab cake in there in the meantime, would that do the trick?

Dr. Paul Saiz: (01:02:51)
You know, I wish, but then it’s going to depend on the crab. Is it a crab from the East coast?

Daniel Lobell: (01:02:58)
From Baltimore, a Baltimore crab, those are the [Paul chuckles] premium, from what I understand as a non crab eater. Doctor, thank you so much for your time. And I learned a lot. Truly fascinating, and I’m really looking forward to checking out your channel on Doctorpedia. Thank you.

Dr. Paul Saiz: (01:03:16)
I appreciate it. This was a pleasure.

Daniel Lobell: (01:03:19)
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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