Caitlin Whyte (Host):  Welcome back to another intriguing episode of the In Their Words podcast, proudly brought to you by the UPMC Pinnacle Foundation and UPMC in Central PA.

Today's installment is a followup to our last episode, where Walter shared his awe-inspiring medical journey. We have the privilege of welcoming the esteemed Dr. Melton to the podcast. If you recall, Walter alluded to this remarkable cardiothoracic surgeon in our previous episode. Join us as Dr. Melton shares his insights and unravels the medical intricacies of this particular case.

Dr. Nathaniel Melton: My name's Nathaniel Melton, one of the cardiac surgeons, one of four here at UPMC in Harrisburg. I did my general surgery residency here for five years. And then, I went to Penn State in Hershey to do a cardiac surgery fellowship for two years. And then, I came back here once I was done my training to be one of the surgeons here.

So, I've been here a little over year now in my current role. I probably went through a bunch of different things when I was a kid. But I would say, honestly, I've really since eighth grade, I can trace kind of when I wanted to, or I guess my initial interest in becoming a physician. We had to do this project where we basically wrote a research paper on a profession that interested us. And I can't really tell you maybe the exact reason why I picked physician, because I don't have anybody in my family that's even in the medical field at all prior to this. So, I think I could trace it. That was the first thing I can remember that I expressed any interest in being a physician and it kind of just planted a seed and kind of grew from there.

Obviously, I think the surgeons, sometimes we get, I guess, all the glory, if you will. But I mean, I couldn't do anything without them. The team here is amazing. As I mentioned earlier, I was a general surgery resident here, and I went to Penn State for my fellowship. And the reason I came back here is to be an attending. Sometimes it's easy to get caught up in the UPMC versus Penn State versus WellSpan, you know, these different health systems around. But for me, it was more about the team I knew I'd be coming back to because, again, I was familiar with them when I was a resident here.

And that goes from the people in the office here, nurse practitioners to the nurses, the medical assistants in the office here, to everyone in the hospital, the physician assistants, nurse practitioners there, but also the nurses in the ICU and on the floor, and then the janitors look after your people, I mean, everybody. I mean, it takes everybody to make this happen.

So honestly, if you take all those people into account, I think I play a pretty small role in everything. But anyways, the main point is that there's a reason I came back to this institution after I left fellowship. Like I said, the team here and the quality of work that they did, and I wanted to be a part of it.

Host: When posed with the question of why patients should opt for UPMC in Central PA, Dr. Melton conveyed his conviction. Because choosing UPMC in Central PA is not just a healthcare decision. It's a commitment to prioritizes innovation, compassion, and the overall well being of every patient who walks through their doors.

Dr. Nathaniel Melton: I think ultimately I would tell them I picked this system, because I know firsthand the quality of the work that we do. And I'm not even taking credit for that. I mean, this program had a great reputation really due to the work of the people that have been here for years. My partner, Dr. Loran, Dr. Abrishamchian, Dr. Mumtaz, obviously built this program from the ground up and really have built it into what it is today. So, I'm not taking any credit for the quality of work. Like I said, I've only been here about a year and a half. So, I'm learning a lot from those guys. Not only that, but also, I think a lot of the nurses that have been here for a lot of years, a lot of physician assistants and nurse practitioners that I work with daily have been here for many years, many from the beginning. And I really think that speaks volume. Because in contrast, in my fellowship, a lot of the nurse practitioners and physician assistants, you know, it's kind of a revolving door, if you will. So, that's why I would say to come here just because I'm familiar with the quality of work that we do. If I had any family member that needed work done, I would tell them without hesitation to come to any one of my partners, because I know not just the quality of the work, the surgery they would get, but also the postoperative care that they would get.

Host: With Walter as a prime example of the discerning individuals who opt for UPMC and Central PA, Dr. Melton begins the process of unraveling the case. As he peels back the layers, he not only brings forth the medical nuances, but also sheds light on the unique approach and commitment to patient care that sets UPMC apart.

Dr. Nathaniel Melton: Yeah, I met him as an outpatient in the office here, immediately was very easy to talk to, really enjoyed meeting him. And I remember his main complaints, really people that come in with we call coronary artery disease, so just blockage in the arteries that supply blood to your heart muscle. He had numerous bad blockages that were not really amendable to stenting. And his main symptom, I remember, was a significant shortness of breath. So, we sat down. And when I sit down with patients, you know, I try my best to not only explain to them what the surgery is, but why we're recommending what we're recommending, because, you know, I understand that this is something myself, my team do every day. However, for patients and families, I mean, this is a huge deal. Not that it's not a huge deal to my team, what I mean is, you know, it's a huge deal to them, because they're not familiar with any of this stuff. I tried to take time to explain to them why, not just the surgery, but why we're recommending surgery and not just giving them medicine or, stents, which obviously are much easier to recover from. You know, we're trying to do what's, best for them not just short-term, but also long-term.

So anyways, I remember just sitting down with him and explained to him the reason why we recommending bypass surgery and going through the benefits of the surgery, but also the risks of it as well. And remember the surgery, I did double bypass on him. Surgery went very well. And the postop period, I remember he had a couple issues at postop. One, he had a stroke, which we think was secondary to atrial fibrillation, which is the most common abnormal heart rhythm in the world, most common complication we see after heart surgery. About a third of patients will go into this atrial fibrillation rhythm. And the big deal with it it increases your risk of stroke. And so, I remember he had some visual field defects following a stroke. What I do remember about that, though, is his attitude. You know, a lot of patients would be very discouraged and frustrated, and rightfully so. But I remember specifically about him. You know, I'd still come in and see him and he would have a smile on his face and have a great attitude about just pushing forward and I really remember that distinctively about Mr. Roth.

Stroke in general is always one thing. We're very cognizant of as cardiac surgeons. You know, not just from we know it's a complication of surgery. In general, I would say the risk of stroke, the average patient, it's going to be less than 5% with a bypass surgery for sure. But however, as I mentioned, when you develop these other things like atrial fibrillation that can increase your risk of having a stroke. Certainly, strokes come in many different forms you know, I think the most common thing where people think of stroke is to not be able to speak correctly or not be able to move one side of the body compared to the other, stuff like that. But definitely, depending on where the part of the brain that's affected, definitely vision changes and defects in your peripheral vision can be affected by a stroke.

You know, being newer in my career, I'm not doing, I would say, as complex surgery as my partners, just due to the fact that I'm newer in my career. And so, I think my partners have been great helping me learn. But also, patients that are a little bit more complex. You know, of course, I always talk to them before the surgeries, "Hey, this is what I'm thinking about this particular patient. What do you think?" And bouncing ideas off of them. So, yeah, certainly, we do a lot of complex operations at this hospital. I would say for me specifically, just kind of slowly building up to getting into the more complex surgeries where we're doing multiple things, you know, like this was a bypass, but he had a couple things that made this surgery a little bit harder than others. But in terms of the complex surgeries where I'm doing bypasses and valves at the same time, that's what I would consider really complex. I'm just starting to kind of get into that as my career really gets rolling here.

Host: With a wealth of experience as a cardiothoracic surgeon, Dr. Melton is well read when it comes to the cutting edge innovations and groundbreaking procedures that have positioned UPMC as a leader in the field.

Dr. Nathaniel Melton: So, I can speak to, I think, a few things specifically at this institution. One of the things is our structural heart program, I would say, is very advanced. And that is a testament to Dr. Hemal Gada who's an interventional cardiologist here. He's really built a very busy-- it's called a TAVR, which stands for transcatheter aortic valve replacement, basically a way of replacing someone's aortic valve through poke holes in your groin. And we're a very busy program with excellent outcomes. And not just with the aortic valves, but also there's more and more technology coming out to fix another one of the heart valves on the left side called the mitral valve. And not only are we a very busy program with very good outcomes, but Dr. Gada and also Dr. Mumtaz, who's the Surgical Director

of the Structural Heart Program, we're involved in a lot of these cutting edge clinical trials with these newer devices that are coming down the pipeline. So, it seems like we have quicker access to some of these newer technologies than other places.

Also I would say even the surgical techniques again, I'm not quite doing these a little bit more advanced surgical techniques in terms of valve replacements, but my partners Dr. Mumtaz and Dr. Loran do a lot of valve work through a n incision in the right chest instead of going through the front. So, there's no need to open up the breastbone or sternum with these surgeries. And then also, my other partner, Dr. Abrishamchian is also starting to do that. So, I'm kind of be the lone guy out for a little while in terms of that. But once I get more experienced, I'll be doing that as well. But one of my partners, Dr. Loran does advanced bypass surgery work with the robot which I think it is great. Again for patients who need bypass surgery, there are candidates for this robotic-assisted bypass surgery, which again saves you. You don't need an incision through the front through the sternum or breastbone. Again, we make an incision for that surgery actually through the left side. So again, there's multiple things that I think we can offer at this institution that they really can't offer at other places.

 We're involved in a lot of clinical trials when it comes to what I was mentioning earlier, those TAVR procedures and these minimally invasive valve operations. Again, we started a clinical trial dealing with atrial fibrillation surgery and decreasing stroke after open Heart surgery, we're getting ready to start a clinical trial on that. So yeah, we are definitely involved in some of these clinical trials that are coming out.

Host: When asked what it signifies when a thankful patient, much like Walter, expresses their gratitude, Dr. Melton provides a unique perspective.

Dr. Nathaniel Melton: Yeah, I mean, that's why I do this, right? It never gets old frankly. You know, I'm in this to help patients like him get through a very scary, anxious time in their lives and get them through that, and then on to enjoying their life, their different hobbies, you know, their pets, their families, all that stuff. So, it's hard to put into words. I get that question a lot from friends and family. You know, that's got to feel amazing, they tell me, you know, and it really does. But it really is hard to express how that feels. Now, every patient doesn't have a good outcome, which obviously you'd hate to go through that. But fortunately, most patients do well like Mr. Roth. And simply, that's why I do this to see patients like him do well and get through this difficult time in their life and get to enjoy it on the other side.

So, anytime I get a letter from a patient or they tell me, "Thank you. Thank you," I tell my team about it. "Hey, guys, just so you know, this patient just wanted to express their gratitude to you." And so, it definitely is a huge morale booster. Obviously, healthcare, especially as you're going through the COVID, you know, with the pandemic, that was really, I know, hard on a lot of the healthcare workers. But as we're on the other side of that, it's a big morale booster for them to hear that. Because, you know, I'm sure you know that most of us, especially, like I said, the nurses, the physician assistants, they hear usually the bad stuff compared to the good stuff. So, for them, I can tell you, like, when they hear, a good thing a patient said about them specifically or just the team in general, it really is, it means everything to them and is a huge morale booster.

Host: As we draw the curtains on this captivating episode of the In Their Words podcast, we extend our deepest gratitude to Dr. Melton for sharing his invaluable insights and unraveling the compelling medical narrative surrounding Walter Roth. Through Dr. Melton's expertise, we've gained a profound understanding of UPMC and Central Pennsylvania's commitment to excellence in cardiothoracic care and the transformative advancements shaping the field.

We also want to express our appreciation to Walter, whose decision to choose UPMC in Central PA for his care has woven a thread of trust and confidence throughout this episode. His story exemplifies the genuine impact that exceptional healthcare can have on individuals and communities.

As we navigate the intricate world of medicine and in their words, we remain inspired by the dedication, innovation, and compassion that define UPMC and Central PA. We invite you to stay tuned for future episodes where we continue to explore the stories, experiences, and expertise that shape the landscape of healthcare.