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Dr. Kashmer: Welcome to the Absite Smackdown podcast. And I'm here today with my cohost Jessica Rizzo. Hi Jessica, how are you today?

 

Jessica Rizzo: Hi David. I'm great. How are you?

 

Dr. Kashmer: I'm doing really well. And as you may know, from the last episode, Jessica recently said, “Hey, Dave, you're on here so much. Why don't you become the co-host?"  And so today I get to call her my co-host. I mean, technically it's true. Right Jessica?

 

Jessica Rizzo: Yeah, that's true. And you got to do the intro, which you know, is my least favorite part. So I'm super excited. I kind of passed the buck a little bit, huh?

 

Dr. Kashmer: Sure. You delegated it effectively to the new guy! Congratulations. That's what all great hosts do so well done on that today. And I'll just go on and intro the thing too. Today, we're going to talk about our 50th episode. Jessica, can you believe this is our 50th episode of the podcast?

 

Jessica Rizzo: No, I mean, that's an amazing thing, especially with it falling right at Christmas time and doing a holiday podcast. Wow. It's amazing. I'm surprised.

 

Dr. Kashmer: Yeah. Things line up. And I think as we've gone along, we've kind of generated a pretty easy way to do it and tried to keep it meaningful. And so look, this is what I was really looking forward to because today we're going to talk about which of the last 50 episodes have been our favorites. So this one is Jessica and David's favorite episodes from the first 50 episodes of the Absite Smackdown podcast. And so just with that, let's get to it!

 

Dr. Kashmer: What have you liked so far?

 

Jessica Rizzo: Okay. Well, I feel like I'm going to be kind of biased cause I've definitely liked it more as we've grown, as we've adopted and changed a little bit. and they've gotten longer and we have the YouTube channel. So almost all of my favorites fall around like the holiday.  And then I have one that is silly. It's my favorite strictly because of the slides we used:  Star Wars!  It’s the one about statistics.

 

Dr. Kashmer: Sounds like a bunch.  So let’s go through them each individually. Why don't you tell me…just tell me about one of your favorites. Give me a title, or what it’s about.  What's one of your favorite episodes we've done so far?

 

Jessica Rizzo: Okay. So my favorite episode period end of story is the Halloween episode because I got to see you in costume. I got to be in my little cow costume and we were talking about like the dark and twisted facts of Absite Smackdown, which was different than the five dumbest facts episode, but super awesome. And I especially loved it just because, you know, we talked about how the liver regrows itself and how kind of creepy that is, how the Greek mythology, you know, tied into that and then the twisted gut. And it was just so cool to me. And so that was definitely by far my favorite.

 

Dr. Kashmer: Yeah. And just as a reminder, you know, if someone's listening and they haven't heard that episode yet, a couple of things like Jess was talking about:  sort of the punishment of Prometheus's where he took fire and then was obligated by Zeus to get his liver eaten every day by some huge bird and how that actually turns out to be true (sort of) because the liver will regrow and it takes in a lot of phosphate as it does that. That was one of the darkest ABSITE facts. Cause it's just sort of strange. And then that twisted gut one that actually one to 2% of people are walking around with asymptomatic, non-rotations of their gut. Really weird, strange, but true and dark. So yeah, that was a really good episode. It was really interesting to bring all that together around the Halloween time and I got to wear my Dodge Ball uniform. Like you said, you got to wear your cow costume. So yeah, that was a fun one. What else?  What's another favorite one that you have?

 

Jessica Rizzo: Ooh. Okay. So again, I just felt like I'm, I'm picking that the holiday ones, which is such a cop out, but I also love the Thanksgiving one because, you know, I knew that we all got sleepy when we ate Turkey and I knew that there had to be a reason for it…but it wasn't until we talked it about doing the episode and you explained it to me…and I still can't say it right. Tryptophan? Correct? Yes.

 

Dr. Kashmer: Yeah. There's a lot of thought, like you said, that the amino acid tryptophan is some, at least a part of what's responsible for making us sleepy, but of course you just ate a big meal too, and that's known to make you sleepy.  That was part of that fact that made the podcast kind of interesting for me to do. And there were some other things too. Is there anything else you liked about the podcast and the facts that came up?

 

Jessica Rizzo: Well, I mean, I found it really interesting that, so when we were talking about carcinoma, how it's not apparent all the time and that that's one of the issues that we have, and I, I cannot say the word…polite? Pellagra? Pellagra? Yeah.

 

Dr. Kashmer: Yeah. Pellagra some people say differently and you did well. And I'll tell you also very interesting that, the particular carcinoma that you're talking about is carcinoid.  Carcinoid and carcinoid syndrome and the diversion of tryptophan and niacin diversion, along with that, and pellagra with its four D’s:  diarrhea, dermatitis, dementia, and death. I liked the Thanksgiving one. The only problem for me was it got me thinking about one of my favorite parts of Thanksgiving, which is the fake cranberry sauce. And I just thought about that for weeks because we record the podcast before we get to Thanksgiving and man, that was on my mind for days before Thanksgiving actually came up. But I really enjoyed that podcast too.

 

Jessica Rizzo: I did too. Yeah.

 

 

Jessica Rizzo: Yeah, it was great. What about you though? I mean, there has to be a favorite for you.

 

Dr. Kashmer: Well, you have shared a lot of the ones I liked. I liked the holiday ones too, but I have an unusual one. I was on the Island of St. Martin doing some work when COVID was really kind of toward the beginning of it. And they wanted a team to set up a forward hospital there and take care of COVID patients with these ventilators. And, oh, it's just, it's so much of a story. But at the beginning of one of the podcasts, I actually recorded it on a beach in St. Martin. And so as far as podcasts go, that was a super fun one just because of where I was. It's the thyroid review and, in the beginning, you can hear the waves. I think there may be a stray bird. It wasn't really that great. I think you had to edit some of that out because the stray bird is kind of in the way, but super fun to record there. And it was just beautiful. So I can't say enough about that one.  Kind of a strange reason to have it as a favorite, I guess, because it was the recording of it. Not so much the facts of the thing.

 

Jessica Rizzo: I mean, it can still be your favorite experience. And actually that is one of the more helpful series that we've done for people to actually learn from. So it, it could be a favorite for that too,

 

Dr. Kashmer: For sure. You know, we see the statistics and you guys show them to me on who's looked or listened to each podcast. And some of the ones with hundreds of viewers are the thyroid review. One for free. It's obviously all free.  Colorectal too. There's an adrenal one and the videos are posted too, for each of those, you can find that at AbsiteSmackdown.com, along with the transcript. So those seem to be the most listened to most watched, et cetera, and you'd expect that. But the other ones are not far on their heels, or are right on their heels. I should say. There's a lot of people from all over who listened to it. And I couldn't be more amazed and feel lucky because the first 50 episodes have been pretty well received. It's been great.

 

Jessica Rizzo: It's a fun time. 50. Wow. All right. I'm trying to think of what could be some of my other favorites. Oh, there's just so many in there also. Good. I have good memories of every single one of them.

 

Dr. Kashmer: Well, as you think I'll share my other favorite and this'll be my last one for the list, but my other favorite is the top five dumbest Absite facts. And you know, with questions you can say, there's no stupid question or no stupid fact. And that's, I understand that that's a great mentality.  But one of them, one of the facts always stands out in my mind. And that is “cirrhosis of the liver”.

 

When people say cirrhosis of the liver, there's really not much else that has cirrhosis. You don't say, well, this person had had a cirrhotic little toe.  You just don't do it. And then one of the other facts that was really kind of a weird fact is under the indications for resection of a hepatic metastasis from colon cancer. When do you take those out of the liver and one of the criteria for doing it, one of the indications for doing it is if you think the patient could tolerate the procedure.

 

Dr. Kashmer: Well, yeah, I mean, I don't know any procedure where you say, well, you know that this isn't a life-saving procedure. It's pretty elective. I don't think they're going to tolerate it. They're going to do really badly with it. And you know what, I'm going to do that procedure on them. It's probably just not a good idea. So that's kind of one of the review book facts that makes me think hmmmmm…

 

I really enjoyed getting those facts out. because every time I read these review books, I think to myself, that's just, that's a weird one. So there you go.

 

Jessica Rizzo: They're making it super obvious for the really, really smart people that take things literally. That's what that is.

 

Dr. Kashmer: And pretty much everybody who gets to the level of being a surgical resident, you know, they're all smart people. They've done well in medical school, they got to medical school. You know, they're not, we're not talking a bunch of schleps here. So every time I see something like that written down, I think to myself, who is that one for what and why do we continue to write it in review books and kind of perpetuate it? And I've never met the person who needs that particular fact, but, hey, you never know.

 

Jessica Rizzo: Never know. So I did remember my favorite and I lied because it's not the Halloween one. It's not the Thanksgiving one. It's the don't F with the pancreas one. Now that's my favorite. That's my favorite podcast. I can't believe I didn't say that right off.

 

Dr. Kashmer: What is it about that one? Is it just the title of it?  What is it that does it for you for that one?

 

Jessica Rizzo: Well, it's not just the title, but it's kind of like that. That's such a known, known thing throughout Surgery that you don't do it and what it does to itself and how like finicky it is. And then it can make soap. And then we were talking about Fight Club and making soap out of body fat. And I don't know, it's just so cool to me. It's awesome. So that's mine.

 

Dr. Kashmer: Yeah, it's a thing. I mean, there are three rules of general surgical residency, and this is a tongue in cheek thing. That one that gets passed from attendings to residents and residents to residents, and the three rules are:  (1) eat when you can (2) sleep when you can and (3) don't F with the pancreas. Those are the three rules, which is really interesting because then I went on in my training to do transplant fellowship, and we didn't just F with the pancreas. We took it out, put a Y graft on it, put it in somebody else. But in general, that saying don't F with the pancreas is a wise saying, because the reasons you're there in general surgical cases are different.  So it's a good idea often not to mess with it so much for what you're there for. It's really interesting to me that you liked that episode for the title and yes, the saponification, when you have drains in patients with pancreatic injuries or lesions or whatever, and you shake the drain and it's soapy--it looks like it has bubbles in it. And it's soapy because of the saponification. Really interesting to me that you picked up on that. And you liked that one. That's interesting.

 

Jessica Rizzo: It is. It was so cool to learn. So now that we've kind of reviewed some of our favorites.  Obviously we already know what my definite number one is. What is your number one?

 

Dr. Kashmer: Hmmmm. Whoa. My number one?  I would have to say of all the ones we've done so far my favorite is the top five dumbest ABSITE facts. And the facts that actually didn't make the podcast were some great ones.  For example the word “etiology”. We didn't really put that into the podcast, but etiology is the study of the cause of something. So, you know, we'll be speaking about something in health care, doc to doc or someone to someone, and we'll say, “Oh, what's the etiology of this?”

 

We don't mean what's the study of the cause of this. We mean what's the cause? What's the cause of their pancreatitis? So there are all kinds of things that didn't make that podcast for top five dumbest facts, because they were only dumb enough to be like number seven or eight, we thought, and I enjoyed the episode for those too. Like I said, that episode for me was really cathartic. It kind of got out all these years of reading review book facts. That's kind of a weird one. So it got all that out there. I really enjoyed that one. I thought it was fun.

 

Jessica Rizzo: Well, I guess that's asking us to do another one! Part two:  More Dumb ABSITE Facts.  I guess we'll have to cover that.

 

Dr. Kashmer: Yeah. You know, I really want to be careful about it because they're not dumb facts. I mean, you need to learn this stuff, so we practice it, but ones where you first read it and you say “what the heck?” or ones that are just kind of left field or don't make sense. And then there are even some facts where one fact contradicts the other. It doesn't really fit with it. And you say, well, how does that work And you try to resolve it. So, yeah, I'd be happy to go back to that in the new year, but I'll tell you, I've looked ahead to what you guys have on tap for what we're going to talk about over the next several months. And they're going to be good ones. So maybe toward the end of the year, but I don't want to skip anything that's already on the docket because they look pretty good.

 

Jessica Rizzo: Right. Alright. Dr. David!  Thanks so much for being here with me again, and I hope you have a wonderful holiday season and looking forward to everything that's going to happen with the new year!

 

Dr. Kashmer: Oh, Jessica, Jessica!  Let me say it this time. Okay. First off to everyone out there:  Happy holidays! And remember…#AbsiteSmackdown!