Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Tetralogy of Fallot

Episode Date: May 11, 2017

Thanks to Jimmy Kimmel's heartfelt plea for healthcare on behalf of his infant son, Tetralogy of Fallot has been in the headlines. This week on Sawbones, join us for the inspiring story of how we fought back against the debilitating ailment. Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, not a sense, the escalant macaque for the mouth. Hello everybody and welcome to Salbone's

Emerald Tour of Misguided Medicine. I'm your co-host Justin McElroy. And I'm Sydney McElroy. No middle name this time said, I want to get straight into business. Let's get straight to it. Okay. Are you gonna get straight to it?

You're in the business. Well, I am the... I know. If we were a mullet as a couple, I'd be the front. You'd be the front and I'd be the back for sure. So I would be what gets us hired. You'd be what gets us fired. Exactly.

Right. Exactly. To Mundo. That's fair. So Justin, occasionally it's nice to cover a topic that a lot of people are talking about occasionally it's nice to cover a topic that a lot of people are talking about or hearing about right now a lot of people probably watched Jimmy Kimmel's talk speech monologue story that he told on either because you watch a show or because you saw it on Facebook like me because I was viral as they say. Yes. Yes. And does it kind of internet is like, is that what that web

professionals people like me and web media. We say it also has to it also has to do with an infectious disease that is a virus like that term. Oh, well, that's, yeah, that's not my best choice of words. And so sorry about that. Everyone. But if you if you haven't seen it, then Jimmy Kimmel was telling the story, the very touching moving story of the birth of his child who had a congenital heart disease, heart defect,

excuse me, congenital heart defect called tetrology of flow. And a lot of people probably aren't familiar with that. But that is what that means. I know I wasn't certainly. So I thought, and so did Shantel, one of our listeners who wrote in and suggested this topic, Shantel thought that this would be an interesting thing maybe to talk about. For some of that is so serious, it's certainly a fanciful name, isn't it? Tatology of fellow.

It seems very fanciful to me. If you break it down, what it means, it does, it's not. I mean, do you know Tertology, what it's referencing? Look in my eyes, Sydney. Look into our 11 plus years together. Do you think I know what it's referencing, Sydney? Petra's five, right? Four.

This is off to a great start. Excellent work, everyone. The the tetralogy references for the four components of it and follow is the person who called it a tetralogy. So there you go. That's the last name, Dr. follow. Got it. Are you spoiling the story from now? No. Okay.

So because the first thing I want to tell you is what it is. As as if you've watched the video, you may be aware it is a congenital heart defect. Meaning, it's something that you are born with that is malformation of the heart. It doesn't, it doesn't come together the way that it traditionally does while you're in utero. It is a complex congenital heart defect, and it occurs in about one in two thousand newborns. Do you mean complex to mean something clinical or like? Yeah, it's as opposed to there are some simple heart defects.

So some people will say, you may have heard this before, I have a hole in my heart and there's a little teeny hole in between two of the chambers that may not necessarily ever be clinically significant, may just have been found and is there and may not do anything. This one's more complex. And it is the most common of the complex heart defects, about 10% of congenital heart defects are tetrology of flow, fairly common. I have seen it. It's common enough that me and my I'm still I'm still pretty young My few years of practice. Yeah, I've seen it So it involved the four things it involves first of all is a ventricular septal defect now to describe these things just

Picture this Okay, the heart has four chambers. Yeah, right. We're aware of that. Yep. There's two bottom ones Mm-hmm the ventricles, two top ones. See, order. Nope, atria. Okay, all right. Do the best here. The, so excited.

And the basic way, the heart works. Do you know how the heart works? Do you know how, what it does? Yeah, it's like a big pump. Uh-huh. And the bad blood goes in and the good blood comes out. Okay, where does, okay,. And the bad blood goes in and the good blood comes out. Okay, what's the bad blood? Blood that is not oxygenated. Right. And it goes into the heart, which side? The right. Yeah.

Crossed it. And from the right side of the heart, it goes to the left lungs. And from the lungs, it goes back to the heart, the left side. The left side. Right. And from the lungs, it goes back to the heart. The left side. The left side. Right. And from the left side of the heart, it gets pumped out through the whole body, through the aorta, by the way. Perfect.

Yeah. I knew that was up in the mix. So, a ventricular septal defect means that there is a hole in between the two ventricles. So the two ventricles are supposed to be separate. They have a septum between them, separation, a wall between them. And in this, the first defect is there's a hole there. So does that mean that the old blood can mix the new blood? Yes. Okay. Then the second part is hypertrophy of the right ventricle. That means is that the right ventricle gets big and thick.

And it's not really supposed to be. The left ventricle is thicker normally because it's got a pump blood to the whole body, right? Well, the right side just has to pump blood into the lungs, so it's not as hard. So in this case, the right ventricle is very big and thick. Okay. Because it's been working really hard to try to pump blood through the next defect, which is pulmonary stenosis.

So the pulmonary artery that comes out of the right side of the heart, just like the aorta does the left side, the pulmonary artery is tight. It's too tight in this condition. So here's this ventricle trying to pump blood through it and this is really tight. So the ventricle gets all big and beefy trying to pump blood through it.

That makes sense. And then the last part is what we call an overriding aorta, And this is really tight, so the ventricle gets all big and beefy trying to pump blood through it. That makes sense. And then the last part is what we call an overriding aorta, meaning that the aorta now is actually getting blood from both ventricles. It's just supposed to get it from the left, but instead it's like crossing over and getting blood from the right side too. And all this is really hard, I know this is hard when you're trying to visualize it. If you look at a picture of the heart, and this is really easy, you can Google a picture

of tetralogy of flow, and that can kind of help describe it. But if you imagine that what happened to the embryo, what happened developmentally that caused this, is that the division between the pulmonary artery and the, and the, a, order just didn't happen in the right place. So it moved too far over making this tiny little pulmonary branch, making this big large aorta, this hole between the septums, and the result is that just like you said, you're not getting enough oxygenated blood and you're getting blood that isn't properly oxygenated, pumped out through the body body and there's blood being shunted from the right side of the heart to the left side of the

heart. So instead of going through the lungs, just being shunted over back and pumped back out into the body. We remember by the way, we learned a pneumonic for this in med school to remember the four different parts of chitrology flow and it was I hop. I just thought I'd share that. I was remember it that way. So like I said, this causes a right to left shut all this unoxygenated blood. I hop it stands for the interventricular septal defect hypertrophy of the right ventricle overriding aorta and then pulmonary stenosis. And it's just that easy. And it's just that easy. And now you at home can remember that entire sequence thanks to the acronym IHOP. But I remember it. Perfect. So,

so all this blood that is not oxygen in rich is being sent through the aorta because it can't get through that pulmonic valve. And as a result, you're not getting enough oxygen to your body and you become cyanotic. So you don't have enough oxygen. Your hypoxic, you know, you're not getting enough oxygen to your body and you become synodic, so you don't have enough oxygen. You're hypoxic, you know, you don't have enough oxygen. Okay. As a result, what will this look like? Well, babies can have a bluish tint, especially around their mouths. They can actually look kind of blue, because they're not, they're deprived of oxygen. Right. Which is one of the things Jimmy Kim will mention. You may hear a murmur. A heart murmur is just the sound of blood moving through a valve, by the way.

Okay. You're not. Yeah, we're not supposed to hear the blood as it moves through the valve. We just kind of hear the valves opening and closing. If you can hear the blood move through the valve, it's called a murmur. I was thought it was a hole in the heart. No. Okay, that job, sorry. You could have a hole in your heart, that's not a murmur. I was thought it was a hole in the heart. No. Okay.

That job. Sorry. You could have a hole in your heart. That's not what it is. These babies might have difficulty doing things like breastfeeding, for instance, because they tire out really easily while they're doing it. So they might turn blue or even pass out. They can have these things that call tet spells where they do exactly that.

They might cry or even when they're having a bowel movement, they might turn blue and pass out. TET. TET, tetrology, TET, spells. TET, it's a sad guy. I can also call something called clubbing. It's not just seen in this particular disorder, anything that results in hypoxia, so a lot of lung diseases, a lack of oxygen, can result in clubbing, which is this bulbous enlargement of the fingertips.

That's pretty, I mean, you would notice right away. That's a really old sign, by the way. It's maybe the oldest sign in medicine. Wow, really? They used to be called Hippocratic Fingers, because Apocrates talked about them, too. They're not just in tetrology, a phylobe, but that is one thing you can see them in. So like I said, the whole thing has to do with early on in development, the separation

between the order and the pulmonary vessel do not form in the right place. Like I said, the whole thing has to do with early on in development, the separation between the order and the pulmonary vessel do not form in the right place. All of this leads to, like I said, the enlarged right ventricle that isn't pumping or that's trying to pump through this tight vessel. And it can be related to certain genetic mutations. There are certain syndromes. Did George syndrome is one? Down syndrome can be related to this.

If mom gets rebella while she's pregnant, this can cause totology. What's a totology of full of causes or would they be an offshoot of those? They would be a... Yeah, exactly. So if you have somebody who has Down syndrome or your George syndrome or mom had congenital rebella, advanced maternal maternal age or drug or alcohol abuse any of these things. You have a higher likelihood of tetralogy of flow and then sometimes you just see it.

Yes, happens. Yeah. Now, as complex as all of this sounds because it does, we have known about tetralogy of flow for over 300 years. We figured this out a long time ago. In 1673, the Danish autonomous or natomist, Steno wrote the first description of trilogy of flow. It was obviously based on an autopsy and he noted all of the abnormal findings

and he basically said, I wouldn't even attempt to tell you why this happened. What? Listen. Listen, you're gonna hear a lot of people around my time period, try to feed you a load of bull crap that they know what's happening and I'm here to tell you listen history ends of the future you're not gonna look back and laugh at me not it's now. I'm just telling you I don't know

Flat out. I got no clue what's going on here But he did he did say this the baby was noted to have what is called a hair lip, what was colloquially called a hair lip, like a cleft, a cleft lip, a cleft lip, but the baby was noted to have what they were calling a hair lip, and the mom had said, I think this is probably because I was really craving rabbits too while I was pregnant, I ate a lot of it, and to know it's like, now that sounds dead on. Yeah. Definitely, that's why that happened.

And this is why I'm not guessing about what is actually causing it. And this idea, just on a side note, and I think we may have mentioned this briefly before, but this particular idea that things that mom did, saw and counter thought about emotions that the pregnant person had during the pregnancy would have these kinds of effects on the baby. This was widespread. Even some of the way ahead of their time, luminaries of heart defects and then other congenital issues

of, you know, congenital heart defects and then other congenital issues, kind of had this concept that- It's extremely pervasive idea even in modern age, right? You have, you hear about women being told they shouldn't go see scary movies, like why they're pregnant because they, you know, could have effect on the baby. Exactly.

For finding things, I should say. Yeah, and well, and that's exactly what they used to, they used to tell women is that, you know, if you're distressed in any way, if you're putting any on do emotional or physical stress, it's like hearing about something upsetting, reading a very thrilling book, you shouldn't read anything too exciting or thrilling. Don't see a scary movie, don't even think sad thoughts, pregnant people were advised to basically like stay positive, stay away from anything intense, just be really cheerful all the time.

Rest. No problem. Rest a lot, and if you, except for housework, which is always great exercise for pregnancy, so pregnant people were advised to do lots of housework. Yeah. That's very convenient. Yeah. Yeah. That's the work that's best for you we found. Yeah, just doing the dishes and sweeping the floor. In 1777, Dr. Sandefurt wrote a case report of what he called a blue boy who had what he described as sinking spells. Upon autopsy, he was found to have these similar findings that we've already talked about, the tisrology findings. And shortly after

that, there was a Dr. Hunter who wrote of a case of a boy who lived to the age of 13 with the same defect. He had the same sorts of spells, these what they would call sinking spells, basically just passing out, which is becoming hypoxic and passing out, especially with exertion, so doing something stressful or demanding. But he also seemed to have some growth issues as well. And he even, Dr. Hunter even theorized that maybe the lack of pulmonary blood flow, this tight, pulmonic valve, maybe this has something to do with it, and why you don't have proper growth and stuff, it was way ahead of its time. The idea that this has anything to do with anything.

Proposing this, right now this seems really obvious, but proposing this at the time was kind of brilliant. He also advised that, while again, he didn't know what caused it or what to do about it at all, definitely don't do any of the popular cares of the day, like bleeding or purging or blistering or giving caustic agents, agents or anything like that. So that was good.

That's good. He's on point. Good job, Dr. Hunter. In general, in many of these cases, the patients didn't live very long lives. If they made it out of infanthood, we have a lot of these, you know, like children and and teenagers. That was about as long as anybody was expected to survive with this defect. They were weak and sickly throughout their lives. They were not able to go to school or have job or get married or have kids or any of those kinds of things. What kind of advances did we start to make? This story gets little happier. In the 1850s, the stethoscope was still new and exciting. And Dr. Peacock used it to correlate various murmurs

with different defects that caused them, including being able to recognize a murmur that was associated with tetralogy of flow. And I've met people who had them then all have like cool moves that they did with them, like really getting showy with their stethoscope. Swing it around. Oh, no problem. I can listen to your heart with my spru hearing. Like rap it around and I can swing it around like a hula-hula. Yeah exactly. Very cool.

Very hip look. I do that now. Is that good? Yeah that's excellent. That's a great way to inspire confidence in your patience. They're giving lots of friends. In the 1880s, we finally see the Dr. Folo of renown, Dr. Folo, who publishes his article where he has actually encountered numerous cases now of the tetrology. He writes up all these different studies and what happened to them and their clinical findings and upon autopsy and all this stuff. He's the first one who dubs it the tetrology, who actually says like if you find these four things, they go together, this is indicative of this disorder.

We know what this is, it's called the tetrology and everybody was like, of follow, I guess. And of follow and he's like, well, I'm not crazy about it. But so this is my, just want to check my legacy. Okay, great. Are you kidding me? No way.

He was like, yes. You all have co-well. You took the words right out of the mouth. Well, I mean, I don't mean to brag. If you insist. I guess I do. I guess the kind of is my tetrology. Why not flow's tetology?

It's usually the structure that you say, right? But it sounds good, to trilogy of flow. And it had a good flow to it for sure. It's abbreviated well. I have TOF all through my document. It's abbreviated well as TOF. To trilogy of flow.

In 1936, Monde Abbott, who was a famous Canadian physician, and which is really cool to talk about. Your 1936 Monde Abbott, who was female, was a famous Canadian physician, and which is really cool to talk about. Your 1936 mod abit who was female was a famous Canadian physician expert on congenital heart disease, who published the atlas of congenital cardiac disease, which was the bible of congenital cardiac disease, recognized in its time as one of the finest works

anybody put together. She actually, um, ended up pursuing her course of study and pathology and and studying congenital heart disease and going down this road because she was denied the other internships, the other paths and medicine she wanted to take. Because of her gender. Uh, but well, I guess that that time though sexism worked out great for everybody. I guess this one goes to sexism right? I guess it worked out pretty good that time. Maybe some of us are just we're just gonna succeed no matter how hard you the man try to hold us down. She put so in it we're drawing clinical descriptions EKG findings chest x-ray findings,

the heart looks boot like on a chest x-ray if you have tetralogy full of. Oh, God. And pathology and all this together, for tetralogy full of, and this is really important because you think about, we're still not at a time where we can do

what we would do now, which is an echo, the echo cardiogram, which is like an ultrasound of the heart, which can show us all this stuff. We weren't doing all that yet. So anyway, you could diagnose it. It was a pretty, pretty good idea. Well, we diagnosed it, but I don't want to fix it, Sid. Well, I'm gonna, we're gonna, I'm not gonna do anything. Other smart people who can do surgery are gonna do something about it. But first, why don't we head to the billing department? Let's go. The medicines, the medicines that ask you let my God for the mouth. You were going to be a conduit for history as it fixed the technology.

Right. I'm going to tell you about the, this is the good part. So the first, the first, the beginning of this story actually starts with a successful surgery to fix something else, a different congenital heart defect called a patent ductus arteriosus that happened in 1938. Now, I really, I wish that, you know, I love podcasting, but this is an episode where if this were a visual medium, it would be helpful. So there is a something called the ductus arteriosus that you have when you are a fetus.

It's a connection, it's a vessel that connects the aorta and the pulmonic vessel, and it is supposed to exist in the developing fetus, and then it goes away because we don't need it anymore in our adult life. The reason is because it's in the fetus, it's shunting blood back to the aorta and away from the pulmonary vessel because it doesn't need to pump blood through those fluid-filled, you know, amniotic fluid-filled lungs. But then after we're born, we need blood to be pumped through our no longer fluid-filled lungs. So this closes off itself. That's part of the process. It closes off, just becomes a ligament, a remnant that's left there.

Now this doesn't always happen. Sometimes things go wrong. And so sometimes this little connection between these two vessels is left open. It causes a machine like murmur. What's that name? Sounds like machinery. Oh. Or grinding machine oil like murmur.

If you hear it. Anyway, so surgeons were trying to figure out how can we close this thing? We need to know how to close this thing because it shouldn't still be open at about a week after birth, you know, at the latest it closes. It shouldn't be open after that. We need to figure out how to close it. So in 1938, they figured out how to just ligate it and close it. And this was a big success because we hadn't been doing surgeries on hearts, especially baby hearts. So this was, you know, a huge deal. So because they fixed that, this inspired somebody. So this is Dr. Helen Tossig, who was working in the cardiology clinic at Johns

Hopkins, who was a brilliant, maybe the most known pediatric cardiologist in history, definitely one of the most known. So she began to wonder about a lot of the children she was seen in her clinic with congenital heart defects, and whether there would be some surgery that might help them as well. Because it seemed like the only approach to this, it's got to be a surgical solution. It has to be a surgery here, right? She also, by the way, had worked there for some time because she was denied a spot in the medical internship she wanted, because they would only allow one woman on the house staff at any given time. And she was beaten out for the spot by two points by another woman. So anyway, she devoted her life to this cardiology clinic and to these children and there was a wonderful thing that she did because she started to ask the question, if we can close

a ductus, that little connecting vessel in the heart, we can close it. Could we not build one? Like a like, okay, could we not construct a duct? We can close a duct. Could we not construct a duct? Constructed duct is more fun to say. Certainly we should be able to. She actually went to Dr. Gross who was the doctor who had done this procedure in 1938. The surgeon who had done it. She went to him and said, it's just an unfortunate name for a doctor. Dr. Gross. Dr. Grazes Ruff. That's a rough one. She went to him and said, just an unfortunate name for a doctor. Dr. Gross. Dr. Gross is rough. That's a rough one. She went to Dr. Gross. And he was a surgeon.

Yeah. Oh, man. Oh, Dr. great. My heart goes out to you. One for it. That's a tough but she went to Dr. Gross who had just done this successful procedure and said, Hey, you got to work really clean. That's the thing. If you will come in to operate a table and they're like, oh man, there's guys everywhere, they're gonna be like, good, not just a name, but I get it.

I've heard it my entire life, okay, I'm a messy guy. It has nothing to do with my name. I'm just saying you gotta work really clean. That's true. I'm done talking about Dr. Dr. Griss. You're down with his name. Yeah. Well, I'll be looking in your nose today. My name is Dr. Buggers. I'll be talking about Dr. Dr. Gris. You're done with his name. Yeah. Well, I'll be looking in your nose today.

My name is Dr. Buggers. I'll be your ENT. You're not going to be done because she went to Dr. Gros and said, hey, you figured out how to do this. And it's amazing. Do you think you could do the opposite? Do you think you could build a duct? And he said, yeah, definitely.

Like for sure, no problem. I could. I'm not going to. not really feeling that right now. Everybody's super excited about how I close that other duct. So that's kind of where the heat is. I'm not feeling, I'm not picking up what you're putting down. Right. There's a heat behind making ducts.

So, so he said no. So she went back to Johns Hopkins and she bided her time because she knew that another surgeon, Dr. Alfred Blaylock, along with his assistant Vivian Thomas, were coming to work there and she thought, this is a guy that I'm gonna talk into the surgery because I know the surgery means, I know this is gonna mean something.

So she told him all of her observations on conditional heart defects and what she'd seen and what she thinks that this might work. So this was her theory on constructing a duct. She noticed that the worst symptoms started about a week after birth. When that thing I told you about that Dr. Sartiriosus typically had closed. So what she was thinking was that that was allowing some of the blood to go back. Here all this blood is being shunted to the body and not making it through the lungs.

This open little tunnel was like a back channel. It was allowing blood to go back through the lungs. Yeah, I understand. So if it stayed open, maybe we could keep allowing blood to go back through the lungs. And less of that. You get more oxygen in the blood

and you get more oxygenated people. Right, good. I mean, you can stop at the oxygen in the blood. Right. That's the goal. Which is good. This wouldn't fix the problem, but kind of palliate the problem somewhat. So make things better. Thank you.

Yeah. So she, she, you know, pulled all this together and presented him with all this information. And he she, you know, pulled all this together and presented him with all this information. And he said, you know what? This sounds reasonable. I'm going to have to test out your theory for a while. So he attempted it a lot on some animal models. We won't go into detail there. Thank you. Yeah. And, and after two years, he decided, you know what? If you think I think I can do this surgery, if you think this surgery can work, let's go for it.

So in 1944, they started doing the procedure to connect the subclaving and artery, which arises from the aorta to the pulmonary artery. So not exactly replicating the natural ductus arteriosus, but inspired by a similar concept. So they started doing these procedures and they worked. So imagine with me, if you will, the moment. It's 1947 and these two doctors, Dr. Blalock and Dr. Towsig,

are giving a lecture in the big, the big giant hall, the British Medical Association in London. And they're talking about the procedure and they're showing diagrams and they're going through the intricacies of the surgery and how like with each procedure they altered it just a little to make it a little better and why the results got better with each one and all this stuff. They're telling the story and then at the climax of the story, a spotlight appears on this gorgeous little two and a half year old, curly hair, pink cheeks, looks healthy as can be. And they said, and here is a surgery we did last week.

And here stands this healthy baby girl that you know would never have been it would never have been this healthy to just be here with us today. And a week ago we did this surgery on her. Since the drama is so important when you're presenting this stuff, you're gonna be people hyped up. That's that's very good. I don't usually let they fly her in from like the on put on wires and just like fly her in some shoots or sparklers like that. She actually in from like the put her on wires and just like fly her in some sheets of sparklers, I was like that. She actually in one of the articles I read was described as terubic. Terubic.

Terubic. Terubic. So the kids did oxygenate better. They had less, you know, less problems with turning blue and passing out and all that. And they could play. And this sounds like a dumb thing to say. But these families had kids who could go play again. Who could run around outside, who could play games, who weren't stuck on the couch all day.

And the medical community just was on fire. So that's before TV. So it really was sad back. You think about it. So by the 1950s, you can understand why you're getting teary-eyed because like, and what did they watch? Because that's what I'm playing. And not sit on the couch and not watch any TV. Some of these kids were like 11 years old and for the first time in their life, they're able to run around and play. 11 years of not watching TV. I mean, can you think about it? So by the 1950s, different procedures were tried and there actually were some open heart procedures done.

You know, it took us a while to get to the point, obviously anesthesia was a big part of this too, to get to the point where we could open people up and fix problems, you know, for longer periods of time, more advanced problems. And they eventually figured out how to repair the defects, closing the hole and opening up the pulmonary vessel and reducing the size of that right ventricle and all that kind of stuff. And throughout the 70s procedures, we came better. And of course, as I already alluded to,

once we had the echocardiogram where we could alter sound and look at the heart ahead of time, we didn't have to guess about what we were getting into. We could, you know, non-invasively know exactly what the structure of the heart was, which was obviously a big, a big advantage. And we can do that in utero, right? Yeah. We can see that in utero. While you're while a patient is still pregnant, we can look in at the developing fetus and look for heart defect. Sure. So, now we do surgery.

We don't typically do that shunt that I described. The Blaylock Tossig Shunt, Tossig Blaylock Shunt. I forget which direction it's in. Anyway, the shunt that's named for them, we don't typically do that. You can still do procedures like that. Shunts sometimes are still done if in certain patients where the defect is so severe that you kind of have to do it stepwise, you need to do something immediately to help get oxygen into the blood and stabilize the patient and then down

the road you'll do the complete fixing of it, the complete corrective surgery. But most people now end up sooner or later getting the complete corrective surgery. Usually within the first year of life, there are patients as most as recently as the 90s who got it later than that, but usually within the first year of life. And it like I said, it could be one surgery, it could be a series of surgeries, depending on exactly what type of, you know, the defect isn't exactly uniform in every single person. Yeah, different. Untreated tetralogy of below used to have a 35% mortality rate

in the first year of life and 50% mortality rate in the first three years of life. And as I already mentioned, most people were not living out of their teens, the, in the majority of people. Now early mortality is less than 5%. People can live long, healthy lives. They do need monitoring and sometimes other complications down the road can occur, but a

lot of patients have the surgery, have everything corrected and never have problems from it. As an example, Sean White, the snowboarder had a cardiology flow repaired. America's favorite only snowboarder. It's really fascinating. I read the paper by Helen Tossig, where she was kind of describing, like, one of many. I mean, obviously, they wrote about this a lot, you know, if you develop this procedure, you're going to write about a lot. But in one of her kind of going back and thinking about the whole, her whole course of everything, how she started there and working at the cardiology clinic and figuring out the surgery and everything. And she was talking about that they went back to see like how many of their patients down the road, how long did they live, did they

have other problems, but also did they get a job, did they get to finish school, did they get married, did they have kids and talking about the 300 and some children that resulted from all these lives that were able to be lived as a result. And it was, I mean, it's amazing to read about because they just kind of said, hey, I think this will work and try to doubt and it was, I mean, it's amazing to read about because they just kind of said, hey, I think this will work and try to doubt and it did. She also mentioned specifically towards the end of the paper, she says, to the best of my knowledge, no patient was ever refused because he did, because he could not pay further. The hospital established the policy that no, quote unquote, psionotic patient.

So somebody comes in blue, no psionotic patient who arrived at the doors of the hospital established the policy that no, quote unquote, scionotic patient. So somebody comes in blue, no scionotic patient who arrived at the doors of the hospital seeking help should leave without seeing me. So you were never turned away and it didn't matter if you could pay. And she also said this study indicates that a handicap in childhood does not preclude success in adult life on the contrary.

A handicap may act as a stimulus to do one's best, which I thought was really, really inspiring way to look at it. Well, I'm glad that we got, that was harrowing. I would describe that as harrowing. That was harrowing. I would say it was harrowing. It was very daunting and a little upsetting at the beginning. And then things got better towards the end.

And that's great storytelling and history apparently. So we're like works in that fashion. I wasn't me. I was thinking of these brilliant physicians who came up with it. And especially it's nice to hear a story like this said in the time period where so many female physicians play a role. Yeah, absolutely. Big a a big role. And, you know, the amazing thing is, this isn't something that has to devastate families anymore. It doesn't have to, because we can fix it. And I don't understand a world that would deny anybody this life saving procedure, no matter what the cost ever.

Folks, thank you so much for listening to our show. We hope you have enjoyed it. If you did, please leave us a rating or review on iTunes or just tweet about the show. Say, hey, listen to the show. You know, that thing you heard about on Jimmy Fallon, Jimmy, not Jimmy Fallon, Jimmy Kimmel. Yeah. Why do we have two Jimmy? Jimmy Kimmel, here's more information about it. It's got a fascinating history.

And say the name of our show, Solbos, and then my name, and then Sydney's name after. You can just leave mine off, Justin's the real star. Shhhh. Thank you to Tax parents for letting us use their song Medicines as the intro now to our program. Thank you to the maximum fun that we're having us as part of their extended podcasting family. And folks, that is going to do it for us.

Actually, no wait, you know what? We have a PO box where people send us stuff sometimes PO box 54. I need so much for junior 25706. And I wanted to say thank you so much to Christina for the lovely book that is currently sitting on our coffee table. Oh, it's a great book. Cecil sent us a scarf that they made and Cecil needed us some snakes like our logo. They're adorable and Charlie love the scarf. And that is going to do it for us folks. So until next week, my name is Justin McRoy. I'm Sydney McRoy.

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