Danielle Lee: Good evening, Jacksonville and happy Saturday. I’m Danielle Lee and welcome to the conversation with Dr. Ali Casrayen. As always, you too can join the conversation. Give us a call, 340-1045. How are you doing today, Dr. Ali?
Dr. Ali: I am good, happy Saturday to you.
Danielle Lee: Happy Saturday. It’s beautiful outside after a week of rain.
Dr. Ali: It is beautiful outside. The skies have opened up to a beautiful Florida day, although it’s a little bit hot.
Danielle Lee: It is hot. I’m not going to lie, it’s pretty hot.
Dr. Ali: This is an interesting for our guest today, so Dr. Scott Lynn is, he was actually my first surgical mentor when I was third year med student, he was the person to lead me through my figuring out how to become a surgeon of sorts. Actually, wrote my first paper and abstract and everything with him. I remember I was in a VA and your Bob Feaser, Dr. Bob Feaser was a wonderful vascular surgeon now, was a duet for years. Him and I and you were in your VA office and him and I were babbling statistics and you’re typing up the abstract and we sent it off and we presented a national and then it got published and we did the second paper, so that was on breast cancer, sentinel lymph node dissections.
Dr. Scott Lynn: Listen, it’s a pleasure to be here and I’m glad to have functioned in that role in your career and you certainly have turned out great, and your mother and family are proud of you as I am, and look forward to being on your show.
Dr. Ali: Thank you, so this has been a while in the making, Dr. Lynn is relatively new to Jacksonville, but not to Florida. He’s the Chair of Surgery at UF Health here in Jacksonville. He’s a surgical oncologist. Today, we are going to talk about melanoma. It’s the most dangerous of the skin cancers, so we’re going to talk about skin cancer in general. A big key for that, which should be fairly obvious is prevention, so we’ll talk about that, but before we start, I wanted to bring up a really interesting study that was published in the New England Journal of Medicine recently that showed more than 10% of the world’s population is obese. That’s a BMI of greater than 30, which means this is a ratio of height to weight, is very high, that’s morbid obesity. 25 to 29 is considered just being overweight.
About a third of the world’s population is overweight. The challenge with that in terms of putting our mind around this, everyone kind of assumes and now expects the United States to be very high up in those statistics, but this looked at all populations across the world in developed nations, underdeveloped nations, rich nations, poor nations, and they found that the obesity trends are increasing, especially in children, younger than 13 and approaching their teen years. One thing that they found was interesting. A potential culprit seemed to be what they called high-energy foods. You see, it’s the processed foods. The fast foods, the junk foods and things of that nature, which are heavily marketed, seem very attractive to eat, they’re delicious but they don’t have a significant nutritional value in terms of the positive and they’re inexpensive.
All over the world, you’re seeing fast food chains and I don’t want to sabotage any potential sponsors of WOKB, so I won’t name any by name, but they have arches and kings and things of that nature around them, but it’s basically fast food. It brought me to mind, actually we were in Egypt for my mom’s breast cancer conference and a big breast cancer run where they lit the pyramids pink and so we’re all standing around, I remember being at the Sphinx and kind of looking to my right and literally within 50 feet, there’s I think a Kentucky Fried Chicken, a Taco Bell, and things of that nature, and I was just so disappointed that that’s so close to that.
As a surgical oncologist looking at the impacts of that, not necessarily in terms of cancer, although obesity, fat, poor diet, are really associated with not only getting cancer, but poor survivorship, but heart attacks, strokes, increased diabetes, heart disease. All these things are such poor indicators and one thing that some editorial comments on the study was that if now children are in these brackets of obesity and being in such overweight states, we’re now going to have to think about studying obesity for periods of 40 to 50 years through the adolescents so the 20s to the 30s and the health implications of that, especially from the cardiovascular side and the diabetes side are profound because those are the bigger killers. Cardiovascular disease is still the biggest killer of people in the world and in the United States, if you have chest pain and you’re having a heart attack, you survive that because our medicine is so good and the time from getting into the hospital to getting the intervention you need to survive is so great. Same with strokes. If you’re in a developed nation that doesn’t have that kind of technology or the money to provide those things to everyone, you can see that the potential implication on loss of life is profound.
Dr. Scott Lynn: Yeah, we’re clearly, I mean you’re right. I can’t agree more. I think we’re trying to focus more on population health at UF and a lot of opportunity there. Obesity is an enormous health problem, and even though I’m a cancer surgeon, definitely [inaudible 00:05:11] it affects from a cancer standpoint across the cancer care continuum. All the way from primary prevention to detection, to diagnosis, to treatment, that will affect everything. I think as we were chatting off the air, about 75% of all cancers are preventable. The main cancers, certainly the main topic today, skin cancer, also preventable but obesity contributes to a whole host of cancers, breast cancer, colon cancer, contributes to lung cancer, so the diet can be carcinogenic as well.
Dr. Ali: Yeah, studies have come out, bacon is on the carcinogenic list, red meats are possibly carcinogenic, so look at your diet and be mindful of one, how difficult that may be, but taking proactive stance to a healthier diet is profound. Although exercise and being active very, very important, the authors and the researcher who commenting on this paper did not think that that had as much of a contribution on this global epidemic because in a lot of parts of the world, people aren’t quite as sedentary as we are here in the US.
Dr. Scott Lynn: Well, I know there’s a group of investigators in Gainesville UF that are looking at exercise and what are the genetic elements that get turned on to help improve what exercise does related to prevention of all kinds of things. Fascinating study.
Dr. Ali: That’d be interesting to look at the genetics of what keeps people exercising and those that quit after a while.
Dr. Scott Lynn: Right, definitely.
Dr. Ali: That would be the key study right there.
Dr. Scott Lynn: True.
Dr. Ali: Let me ask you this, so I’m always interested to know how did you end up deciding to become a physician and go to medical school? Then how did you decide surgery and through that, how did you decide to be a surgical oncologist?
Dr. Scott Lynn: Well, I had a medical family. My father was an academic surgeon. I was actually born at the Mayo Clinic in Rochester. My father did some of his training there, had been in England and then we came over to the US, did his training there, did a GI physiology fellowship there, then moved to Canada. Lived in Canada until I was a sophomore in college. My dada was actually and academic surgeon at two different places. Was the Chair of Surgery at University of Manitoba and McMaster where I got my undergraduate degree. I jokingly say that I had a major in basketball and a minor in biology because I’m six foot eight, and then when I was a sophomore, my family left to come to Virginia to this country where my dad was the Chair of Surgery at Eastern Virginia Norfolk for 16 years.
The smartest thing I did there was when I was a medical student, went over to the ODU, Old Dominion Library and met the love of my life. Saw her in the library, checked out a book for her. Looked into her eyes with an ophthalmoscope and she liked something. Thirty-three years later, actually how many days ago, about four or five days ago, was our anniversary.
Dr. Ali: Yeah, congratulations.
Dr. Scott Lynn: Thank you very much. Then the honeymoon was actually driving down to start internship in Texas. I did my general surgery at UT San Antonio. The best man was in tow, Ralph [inaudible 00:08:23], who was actually the democratic nominee to run for governor of Virginia, and he did his residency in pediatrics at Brook Army. I was at the civilian hospital. Spent five years there, had one child, our oldest, Joanna, across the street. My wife worked at Methodist Hospital at that time. Then we left five years later to do a three-year cancer surgery fellowship in Richmond. Had another child there, Jason, who’s actually in media. He’s working for Major League Soccer in Manhattan with the love of his life. He just got engaged about three weeks ago.
Dr. Ali: Oh, May and June have been spectacular.
Dr. Scott Lynn: Yeah, May and June have been big months for me, there’s no doubt about it. Then I was lucky enough to get a phone call, I did a case when I was a chief resident in San Antonio with Ted Copeland who’s an icon in surgery, was the Chair of Surgery at UF for 20 years. I was there for the last 10 years of his 10-year as chair, and I did a case with him when I was in San Antonio. It was back when you had visiting professors that actually scrubbed in and did cases with you, and I was sitting in the fellow’s room in Richmond and Ted called and said, “Scott, do you know who this is?” I said, “Dr. Copeland, is that you?” He said, “Yes.” He said, “We have a job in Gainesville,” and I think the reason he hired me was I was tall, left-handed, wore glasses like he did and I’d done that case with him. Thank God he did hire me.
I spent 14 years at UF in Gainesville, which was just a pleasure to be there. I was the Clerkship Director, that’s how I really got to know…