Maggie McKay (Host): Most people don't expect to hear from their doctor that they need a colectomy or a splenectomy. But if you are diagnosed with something you've never heard of, it can be unnerving, and it's always good to know how to find out more. So joining us today is Dr. John Tyson, a board-certified general surgeon at Beebe HealthCare, to tell us about some of those procedures and what to expect.

Host: Welcome to Beebe Healthcare Podcast. I'm your host, Maggie MacKay. Thank you so much for being here today, Dr. Tyson. It's an honor to be able to talk with you for a few minutes.

John Tyson, MD: I appreciate it. This is a great experience.

Host: Would you please introduce yourself?

John Tyson, MD: Yeah, I'm John Tyson. I go by Jack with my friends, so Jack is great. I'm a general surgeon here at Beebe. I've been here over a year, and I'm very, very thankful and happy to be here.

Host: And where did you study?

John Tyson, MD: I did my undergraduate up in Baltimore at Johns Hopkins. And I just have to put a plug for the Orioles right now, they're in first place, so that's good. I did my med school at Penn State in Hershey, Pennsylvania, which was just a beautiful town to live in. And I was fortunate to get a Navy scholarship, they paid my way through medical school. So, I did my residency in Navy Hospital San Diego, which was another beautiful place to be. I spent a couple years in Sasebo, Japan on an amphibious vessel, the St. Louis. And then, after residency, I spent a year on an aircraft carrier, the Ranger. Then, I spent four years at Lejeune. So, a variety of places.

Host: My goodness, I don't even know how you keep it all straight. That's so exciting. It must never have gotten boring.

John Tyson, MD: No, no. I've been very, very thankful. I've had a great life. I've had a great career. I'm not just starting out as a general surgeon, which has its pluses. I have a lot of experience, but I've had great career. I really have enjoyed everything I've done.

Host: Dr. Tyson, what types of surgeries do you perform?

John Tyson, MD: I'm a classically trained general surgeon, which means we're trained in a tremendous amount of things, vascular surgery and thoracic surgery, all sorts of things. But at this point in my career, I do mostly abdominal, complicated laparoscopic surgery, trauma surgery. I do all sorts of lumps and bumps and things like that in the office. But I do love complicated laparoscopic surgery. And I do a lot of laparoscopic colectomies for both benign and malignant disease.

Host: And what is a colectomy?

John Tyson, MD: So, a colectomy is taking out a part, usually it's a part of the colon. The colon is about five-feet long and you have a right side, you have a left side, you have a transverse. So, there's different parts to it. And generally, you take out a segment for, again, a disease, frequently cancer. You don't take out the whole colon for cancer. You'll take out a segment with the lymph nodes. Traditionally, that's been done in an open manner with a big incision. And it's a good operation. But since really the '90s, I've been doing them laparoscopically. I have a lot of experience with it. It's just a smaller incision, faster recovery, less pain, less scarring. So, it is preferential, at this point, to do these laparoscopically.

Host: And do you have any specific success stories that stand out in your mind?

John Tyson, MD: I have a bunch of success stories. The biggest thing in cancer care is getting things early. So, that's screening, whether that's with colonoscopy, which is preferential, or Cologuard if you can't do that. But when we get an early cancer resection, it's a life-saving thing. You've given people 30 or 40 years of life. It makes you very happy. It's very delightful.

Host: Right. I bet it just changes people's lives unbelievably. Any one case you can think of?

John Tyson, MD: I can't off the top of my head, honestly. I mean, there's just--

Host: Too many.

John Tyson, MD: There's been so many cases, yeah.

Host: And Dr. Tyson, could you talk more about laparoscopic colectomy? I know you touched on it a little bit, but does anybody do it the traditional way or is pretty much everybody doing it this way?

John Tyson, MD: I don't know what the numbers are nationwide now on an open versus laparoscopic. I know there are still people who are not trained laparoscopically and do that in an open manner. But I think it's pretty clear at this point that laparoscopic is the preferred modality in terms of recovery and all that.

Generally, I always tell my colleagues, there's different port sizes that we use and I use a lot of five-millimeter ports, which are half a centimeter, which honestly I've never had a patient complain about pain or anything with those. You just don't notice them. They're so small. And so, most of my ports are five-millimeters. And so, those are pain-free. There's almost always a small incision you have to make to get the colon out and, you know, I'll tell the patient, "This isn't completely pain-free. It's not completely scar-free. It's just so much better than it was in the past."

Host: I imagine with laparoscopic surgery, Dr. Tyson, that you can pinpoint areas much better than the traditional. Is that accurate?

John Tyson, MD: There are some areas that are much easier to get exposure in laparoscopically. The pelvis is a difficult place to operate, especially in men. Men have a narrower pelvis than women, and they can be big, like me, and big people are harder to operate on, and the pelvis in a man can be very difficult to open. Whereas laparoscopically, you see everything much, much better than you do open. So, the pelvis is certainly an area you see better. And another area that I do a lot of surgery on is upper abdominal. I've done a number of what are called Nissen fundaplications and parasophageal hernias, which are up by the diaphragm, up by the esophagus. It's a very hard place to get to open. And it's not that difficult laparoscopically, much, much easier to get good exposure. So, narrow and small areas are much more amenable to laparoscopic surgery than open surgery.

Host: And what are the signs and symptoms of colon disease?

John Tyson, MD: That's a great question. So, some of the classic things we worry about is blood in the stool, that almost makes us anxious; a change in stool patterns. A lot of people have very regular bowel movements. They, you know, go in the morning or go in the afternoon, at some point in the day, classically in the morning, once a day. If that changes, that's always something that makes us anxious and we feel like we need to do more to look into that. Thinning of the stools makes us anxious. The patient will say the stools aren't as thick as they used to be, they're thinner. So, those are all things that heighten your concern as a physician, that you have to look into it.

Host: I have to tell you, on a personal note, both my parents had colon cancer. So, I had to start getting colonoscopies years ago. I think I've had like six. Talk about early detection and how crucial that is.

John Tyson, MD: Yeah. And I'll just put a plug in for genetics. You cannot get away from your own genetics. You should know your family history. It's very important for whatever it is, heart disease, colon cancer. I always tell my patients the most important decision you make in life is picking your parents. That's very important. But early detection, I can't tell you how important I think that is. Classically, we said age 50 for normal risk patients. We've moved that back to 45 because there's been an increase in colon cancer at age 40 to 45, pretty dramatic increase, 30-40%. So, we are doing colonoscopy earlier than we used to.

For me, if I see a patient with any symptoms in their 30s, 40s, I will, I recommend a colonoscopy. All of our cancers, I feel like we do very well when we detect things early and we do not do well late stage. You asked me about cases earlier. I have had some heartbreaking cases of people coming in in their early 50s, they're healthy, they have good heart, good lungs, and they have metastatic colon cancer, and they're gone in a few years. And if they'd had a colonoscopy, they would have had another 30 or 40 years. It's heartbreaking. We do what we can do, but we do best when we find things early.

Host: Right. So, what would you tell the patients who say, "Oh, I've heard about the prep for colonoscopies. I don't want to do it." I mean, to me, the worst thing is drinking the stuff. That's it.

John Tyson, MD: Yeah. No, you're absolutely right. The preps have come and gone in my career. I mean, I'm 64. I've been doing this a long time. In my first colonoscopy, I got some pill prep and the pills were big. They were sort of horse pills and I took them and I had to drink a bunch of like Gatorade and things. And it was great, but that pill went off the market pretty rapidly. So, there has been a lot of turnover in that. The ones where you have to drink a lot, it is tough. You know, I've had my colonoscopies and it's not great. But as a clinician, as a physician who has seen people with late stage disease who are dying, they're dying, I got to tell you, prep's nothing, nothing compared to leaving the earth 30 years before you really have to.

Host: Absolutely. Talking about those pills, I did that one year. It was 26 pills, Dr. Tyson, 26. I'm like, "Oh, we're not doing this next time." That was crazy.

John Tyson, MD: That was a lot of pills.

Host: Yeah. And they're big, like you said, horse pills. What do you like most about the team at Beebe Healthcare?

John Tyson, MD: Wow. The team, you know, I grew up coming here. I've been going to Rehoboth with my whole life. I've never known anything else. We spent all our summers there. We were blessed. Our family has a house there that a great-great grandmother bought in the '20s, and it's still the classic cottage. It is like glamping or camping, it is very rustic, but it's there and we spent all our summers there. And so, I knew about Beebe my whole life. And being a physician, I followed Beebe and have been, you fascinated by its growth by adding new facilities, by adding new specialties. And the thing that was really surprising to me was the excellence of the staff here. I've been in the Navy, which was a lot of young people. And they were very motivated, great people, but they were young. They didn't have a lot of experience, you know, and we did the best we could and we did a nice job, but still it's nice to have experience. And there are some physicians here, a lot of them that have had incredible experience that have been at big time, big name places. Now, they're here with a lot of experience. And the nursing staff likewise is really excellent. So, the care is great. That's my big thing, is I used to tell the med students and residents, I taught the secret to caring for patients is caring for patients, right? So, you can't fake that. There's just excellent care delivered here. It's very gratifying.

Host: Yeah. I've heard that the whole support staff, the doctors, the nurses, everybody is top notch at Beebe. Dr. Tyson, what are you most excited about when it comes to the future at Beebe Healthcare?

John Tyson, MD: I'm very impressed with the focus on Sussex. They know what they're about. They're about the care of this area. I love the fact that they're independent. I've been in a lot of different healthcare systems. The Navy was like socialized medicine with its pluses and minuses. I was in private practice, and that had pluses and minuses. And I love the size, I love the dedication to the area and to the patient population. I feel like Beebe in a lot of ways is what I call the tip of the spear. That's what we call the people that are really bearing the burden in the military. We have a tremendous elderly population here. A lot of people come to retire. It's a great area to retire to. And it's a challenge. It's a challenge to deliver that care at the same time you're growing. I think that's the really big challenge. And for me, I came here, I've been in a lot of different positions in my career, you know, heads of departments, all that stuff. I came here because I love to operate and I love to take care of patients. That's my heart. That's my love. And I feel like they're allowing me to do that.

Host: What a pleasure it's been finding out more about you and what you do at Beebe Healthcare. Thank you so much for your time, Dr. Tyson, and sharing your expertise.

John Tyson, MD: No, I appreciate the time. Thank you so much.

Host: Again, that's Dr. John Tyson. And if you'd like to find out more, please visit beebehealthcare.org. That's B-E-E-B-E healthcare.org. If you found this podcast helpful, please share it on your social channels and check out our entire library for topics of interest to you. I'm Maggie McKay. Thank you for listening. This is the Beebe Healthcare Podcast.