Ep. 327 Building a Pain Interventions Service Line with Dr. Stephen Hunt

Ep. 327 Building a Pain Interventions Service Line with Dr. Stephen Hunt

In this episode, host Dr. Michael Barraza interviews Dr. Stephen Hunt about building a pain practice, including his nerve ablation technique, how to obtain referrals, and why it is one of the most rewarding procedures that he does. --- SHOW NOTES We begin by discussing what caused Dr. Hunt to start building a pain service. He was treating many patients with lung cancer, and he saw so many patients toward the end of their life. What they wanted was to reduce their suffering due to pain. He saw what was being offered for them, which was opioids, but this caused them to be disconnected from their families at such an important time in their life. He knew he could offer nerve blocks and ablation, so he began educating himself. As he learned about different blocks, he adapted them to create his own technique. Pretty soon, word got out that he was doing this, and he started getting referrals from oncologists. Soon after this, thoracic surgeons and breast surgeons began referring to him for post-thoracotomy and post-mastectomy pain. Next, radiation oncologists referred their patients with radiation necrosis of the ribs, and orthopedic surgeons referred patients to him for pain from musculoskeletal metastases. For his technique, he often starts with a test block using bupivacaine and triamcinolone, which prolongs the effect of the bupivacaine and provides relief for around two weeks. For the ablation, he does the block in the same way, waits 15 minutes, and then injects ethanol to ablate the nerve. Some tips he has learned for celiac ablation are to ablate the retrocrural splanchnic nerves, because they feed into the celiac, and you will get a better result. Other areas he commonly ablates are intercostal nerves. For these, to avoid devastating paralysis from damage to the spinal cord, he always orients his needle lateral and stays at least two inches away from the spine. He advises those new in pain interventions to remember your anatomy. In radiology, we learn it all, and if you remember these nerves, you will be able to help a lot of people with their pain and decrease their suffering, making an enormous impact on someone’s quality of life. --- RESOURCES PIGI Lab: https://www.med.upenn.edu/pigilab/ Twitter: @PigiLab @md_rogue

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Ep. 49 Collaboration in the Hybrid OR with Dr. Racadio and Dr. von Allmen

Ep. 49 Collaboration in the Hybrid OR with Dr. Racadio and Dr. von Allmen

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/Ucy8jI Director of IR Innovation Dr. John Racadio and Pediatric Surgeon-in-Chief Dr. Daniel von Allmen of Cincinnati Children’s Hospital discuss their experiences in the Hybrid OR, how they built it, and how cross-specialty collaboration with pulmonary, urology, and orthopedic surgeons has greatly improved patient care.

30 Syys 201929min

Ep. 48 IR and ENT Treatment of Epistaxis with Dr. Ashley Agan and Dr. Sabeen Dhand

Ep. 48 IR and ENT Treatment of Epistaxis with Dr. Ashley Agan and Dr. Sabeen Dhand

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/xQPc7h In this episode, Dr. Ashley Agan and Dr. Sabeen Dhand join Dr. Gopi Shah to discuss IR and ENT treatment of epistaxis. We cover the differences in how epistaxis presents for ENT and IR as well as how epistaxis presents in children and older patients. Dr. Agan tells us about the types of nosebleeds that are common and the general treatment algorithm she follows. We discuss nasal packing and decongestant sprays for treatment and how to know when to take the patient to the OR. Dr. Agan talks about isolating the bleeding spot, how to use a foley for posterior nosebleeds, and SPA litigation. We discuss why ENT might consult IR for an embolization. Dr. Dhand tells us about the contraindications for embolization and the procedure for treating the epistaxis. We review the materials that should be used and why it is important to look out for artery connections and pseudoaneurysms. We discuss the pearls and pitfalls of ENT and IR treatment of epistaxis and how to avoid the risk of stroke.

30 Elo 201933min

Ep. 47 BRTO vs. PARTO and other Techniques with Dr. Luke Wilkins

Ep. 47 BRTO vs. PARTO and other Techniques with Dr. Luke Wilkins

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/ZvpYnL Special Guest Dr. Luke Wilkins of University of Virginia VIR discusses BRTO and PARTO techniques for treatment of gastric variceal bleeding.

18 Elo 201941min

Ep. 46 Collaboration not Competition between IR and IC with Dr. Achal Sahai and Dr. Chris Beck

Ep. 46 Collaboration not Competition between IR and IC with Dr. Achal Sahai and Dr. Chris Beck

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/bobcIg Interventional Cardiologist (IC) Dr. Achal Sahai and Interventional Radiologist (IR) Dr. Christopher Beck discuss ways these two specialties collaborate on complex cases, share endovascular techniques, and avoid the "turf war" trap.

31 Heinä 201945min

Ep. 45 Coping with Complications with Dr. Maureen Kohi and Dr. Sandeep Bagla

Ep. 45 Coping with Complications with Dr. Maureen Kohi and Dr. Sandeep Bagla

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/uVVOw3 Dr. Maureen Kohi from UCSF Medical Center and Dr. Sandeep Bagla from Vascular Institute of Virginia discuss the challenges of dealing with procedural complications, and the importance of talking with colleagues and mentors in effective coping.

1 Heinä 201959min

Ep. 44 TIPS Procedure Techniques: East to West Coast with Dr. Peder Horner and Dr. Peter Bream

Ep. 44 TIPS Procedure Techniques: East to West Coast with Dr. Peder Horner and Dr. Peter Bream

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/2WK9kp East Coast "McBreamy" and "Western Peder" discuss their Colapinto vs. Uchida needle preference, advantages of the ICE catheter, and other great pearls and pitfalls for the TIPS Procedure. Special thanks to our sponsor RADPAD® Radiation Protection. Protect yourself and your patients during those lengthy TIPS cases.

16 Kesä 20191h

Ep. 43 Managing Urosepsis with Dr. Caire and Dr. Bennett

Ep. 43 Managing Urosepsis with Dr. Caire and Dr. Bennett

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/rn9T7J Urologist Dr. Arthur Caire and IR Dr. Shelby Bennett return to the BackTable Podcast to discuss their approaches to urosepsis, stent vs. nephrostomy for a variety of presentations, and the middle-of-the-night patient.

2 Kesä 201934min

Ep. 42 Physician Contract Negotiation with Dr. Mary Costantino and Courtney Angeli

Ep. 42 Physician Contract Negotiation with Dr. Mary Costantino and Courtney Angeli

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/igMUV3 Dr. Mary Costantino and her contract lawyer Courtney Angeli discuss the essentials of physician contract negotiation: finding the right lawyer, partnerships, non-competes, and critical pitfalls to avoid.

12 Touko 20191h

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