Ep. 549 Liquid Embolics: Practical Applications and Techniques with Dr. Gary Siskin

Nuestro primer episodio de Backtable en español está aquí. Las doctoras Gloria Salazar y Gina Landinez discuten COVID, las demandas médicas y endovasculres de nuestra población Iberoamericana y como convertir un ”no” en un “si". Our first episode of BackTable en Español is here! With a growing demand for outreach in the Latin American community, Drs. Gloria Salazar, MD, FSIR and Gina Landinez MD talk about COVID, growing medical needs of our Spanish speaking community, and how to find opportunity when turning a “no” to a “yes”. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Cdf5S1 --- SHOW NOTES En este episodio de BackTable, la radióloga intervencionista Dra. Gina Landinez entrevista a la Dra. Gloria Salazar, la jefa de división de radiología vascular e intervencionista de UNC Chapel Hill , sobre las desigualdades de salud en las comunidades minoritarias, su camino médico, y sus consejos para los aprendices médicos latinos. Nacida por padres chilenos, la Dra. Salazar creció en Brasil. Desde su niñez, tuvo aspiraciones de ser doctora en los Estados Unidos y por eso, tuvo la motivación para aprender inglés a una temprana edad. Como alumna médica de la Universidad Federal de Sāo Paulo, tuvo excelentes mentores quienes fomentaron una curiosidad de pesquisa en ella. Fue ahí que nació su deseo de participar en el desarrollo del campo de la medicina. La Dra. Salazar explica cómo su perspectiva sobre la salud cambió a través de sus experiencias como fellow y attending en el Hospital de Massachusetts General, donde el treinta por ciento de los pacientes eran latinos. Durante la pandemia, ella se dio cuenta que los pacientes latinos con COVID-19 enfrentaban retos únicos, como la barrera lingüística y dificultades económicas que impactan su recuperación. Ella recalca la relación entre las comunidades inmigrantes y el acceso a salud básica y describe como esta pandemia funciona como un despertar y llamada de conciencia tanto como para ella como para todos sus compañeros médicos, al enfatizar las divisiones existentes en nuestro sistema de salud. Sin embargo, cree que la competencia cultural y la colaboración internacional entre radiólogos puede mejorar las vidas de pacientes estadounidenses y latinos. Finalmente, refleja en los factores más importantes en su éxito hoy en día. Reconoce que la persistencia inculcada por sus padres desde joven le proveía la fuerza de superar los retos profesionales y personales. Adicionalmente, destaca la importancia de los buenos mentores quienes pudieron iniciar sus intereses médicos y clarificar sus caminos. Finalmente, explica el fenómeno del “síndrome impostor” y anima a los médicos en formación a creer en sí mismos.

27 Aug 202138min

We talk with Dr. Robert Ryu about Imposter Syndrome. What is it, why is it so common in medicine, and how do we effectively deal with it? --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/MWOHi5 --- SHOW NOTES In this episode, Dr. Robert Ryu and our host Dr. Michael Barraza discuss the prevalence and implications of imposter syndrome. They open up about personal experiences with imposter syndrome and share strategies for overcoming feelings of inadequacy. Dr. Ryu distinguishes between self-examination (critically assessing the situation and figuring out if you have the resources to succeed) and imposter-like feelings (constantly questioning yourself and unwillingness to acknowledge your achievements), noting that there is a whole spectrum of thoughts and feelings in between the two terms. As a new department chair, Dr. Ryu acknowledges that he had experienced some insecurities with adjusting to the role. After learning about imposter syndrome, he has become interested in how it affects the medical community. He also emphasizes the important role of medical schools and residency programs in raising awareness of this topic to prevent burnout. The doctors wrap up the episode by discussing their personal strategies for managing self doubt. For Dr. Barraza, extensive preparation brings confidence. For Dr. Ryu, reaching out to others for support and keeping a larger goal in mind has proven to be beneficial. --- RESOURCES The Imposter Phenomenon in High Achieving Women: Dynamics and Therapeutic Intervention: https://psycnet.apa.org/doiLanding?doi=10.1037%2Fh0086006 How to Deal with Imposter Syndrome (TIME article): https://time.com/5312483/how-to-deal-with-impostor-syndrome/

23 Aug 202135min

We talk with Dr. Leah Houston, founder of HPEC, about the healthcare applications of Blockchain Technology and Self-Sovereign Identity (SSI), including the importance of giving physicians control over their own professional digital identity. Thank you to Dr. Tim Yates for co-hosting! --- SHOW NOTES In this episode, our co-hosts Dr. Tim Yates and Dr. Aaron Fritts invite Dr. Leah Houston, founder and CEO of Humanitarian Physicians Empowerment Community (HPEC), to discuss blockchain technology and how she is applying it to healthcare. Dr. Houston describes how she was initially introduced to blockchain through investing; however, she learned more about the technology and felt compelled to seek ways to use the technology to decentralize healthcare and allow physicians to regain autonomy as well as patient trust. She describes her vision of creating self-sovereign identities (SSI) for physicians that would allow them to carry digital assets like credentials, medical documentation, and payments. From the patient’s perspective, SSI could help them easily access their medical records. HPEC is a physician-owned and physician-led company that aims to help them regain control over their practice of medicine. Dr. Houston describes the process of crowdfunding through other physicians and friends/family that has allowed her team to develop and test their product, a mobile application. She encourages any interested physician to get involved in development and/or pilot testing through the HPEC website. --- RESOURCES Humanitarian Physicians Empowerment Community (HPEC): https://www.hpec.io/ World Wide Web Consortium: https://www.w3.org/

20 Aug 202146min

We talk with Dr. Blake Parsons about his approach to Radial vs. Femoral access for Prostate Artery Embolization for BPH, including patient selection, device considerations, and practice pearls. --- SHOW NOTES In this episode, Dr. Blake Parsons and our host Dr. Chris Beck discuss access sites for prostate artery embolization, along with advice for visualizing pelvic anatomy, procedural tips, and post-operative care. We start by comparing radial and femoral access. Dr. Parsons prefers femoral access because it is faster, although both approaches share the same amount of bleeding risk. Radial access may offer more pushability and may be more appropriate for patients with tortuous iliac arteries. Additionally, we discuss the closure methods for each approach-- TR Band for radial access, and Angio-Seal for femoral access. Since pelvic anatomy varies from patient to patient, it can be challenging and time-consuming to identify the prostate artery. Dr. Parsons recommends using the obturator and pudendal arteries as landmarks. He also emphasizes that resources like lectures, meetings, papers, and courses can help IRs gain exposure and confidence in the pelvic anatomy. Finally, we talk about managing patient expectations about post-operative pain and dysuria relief. Dr. Parsons prescribes antibiotics, Medrol Dosepak, and Pyridium. The timeline for improvement in benign prostatic hyperplasia is different in each patient, but improvement can be tracked with the IPSS score at follow up appointments. --- RESOURCES STREAM Meeting: https://www.thestreammeeting.com/

16 Aug 202148min

We talk with Dr. Sahil Mehta, founder of MedSchoolCoach, about how a side gig as an MCAT and med school tutor scaled up into a successful business. We also talk about the importance of passion projects of all types and sizes in preventing burnout, and avoiding "analysis paralysis" when it comes to starting a new business. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/4HTCj4 --- SHOW NOTES In this episode, physician entrepreneurs Dr. Sahil Mehta and Dr. Aaron Fritts discuss how they started their passion projects and share business operations advice for budding entrepreneurs. Dr. Mehta starts the show by telling the origin story of MedSchoolCoach, an online educational platform created to help students achieve their goals of entering medicine. MedSchoolCoach offers academic and career resources for high school, college, and medical students. While Dr. Mehta was a medical student when he originally had the idea for the company, the majority of business development occurred in his IR fellowship year. The doctors talk about how passion projects can protect against burnout and actually relieve academic and financial stress from working in clinical practice. They also emphasize how they can apply business concepts to enhance their clinical practices. For example, marketing MedSchoolCoach to consumers taught Dr. Mehta how to better market IR procedures directly to patients. Scaling up a business can present obstacles, so Dr. Mehta outlines strategies for hiring the right people, conducting market research, and making effective use of social media. He highlights the fact that motivated and talented employees can always learn specific industry knowledge. To anyone who is debating whether or not to pursue a passion project, Dr. Mehta advises them to avoid over-analysis and jump into the idea because it will always be a learning experience. --- RESOURCES MedSchoolCoach: https://www.medschoolcoach.com/ Entrepreneurship in Medicine Panel: https://www.prospectivedoctor.com/entrepreneurship-in-medicine/

9 Aug 202147min

Interventional Radiologists Dr. Jeffrey Chick and Dr. Ravi Srinivasa tell us all about the latest and greatest in Spyglass Interventions, including how and where they're being used for lithotripsy, as well as upcoming training opportunities for those interested. --- SHOW NOTES In this episode, Dr. Ravi Srinivasa, Dr. Jeff Chick, and our host Dr. Michael Barraza discuss the SpyGlass Direct Visualization System and its benefits for endoscopic procedures. The doctors begin with a short introduction to previous single-use endoscopes, noting challenges like limited flexibility and incompatibility with existing hospital infrastructure. The SpyGlass overcomes these obstacles by providing on demand irrigation, four-way flexion, recording capabilities, and its own compatible ancillary devices. Dr. Srinivasa describes his use of the Spyglass in targeted biopsies and lithotripsies. Dr. Chick emphasizes that any IR can easily access and use this device, whether they are in a private, academic, solo, or hybrid practice. The minimal setup and ideal dimensions of the SpyGlass make it adaptable to many parts of the body. Finally, the doctors discuss upcoming educational content from Boston Scientific that will help IRs learn how to use the device and adapt it to their practices. --- RESOURCES Spyglass Direct Visualization System: https://www.bostonscientific.com/en-US/products/single-use-scopes/spyglass-ds-direct-visualization-system.html

2 Aug 202128min

We talk with STREAM meeting founders Dr. Ari Isaacson and Dr. Sandeep Bagla about its origin story, as well as what they have planned at STREAM 2021 for docs who want to learn Prostate Artery Embolization, Musculoskeletal Embolizations, and new techniques for Pain Therapy. --- SHOW NOTES In this episode, Dr. Ari Isaacson, Dr. Sandeep Bagla, and our host Dr. Michael Barraza discuss the evolution of the STREAM conference and new developments for the September 2021 meeting. Starting from 2017, the STREAM conference has attracted minimally invasive specialists seeking practical education and training. While the conference originally revolved around prostate artery embolization, it has since expanded to include topics such as genicular artery embolization, peripheral artery disease, and musculoskeletal interventions. Drs. Isaacson and Bagla highlight the wide variety of speakers, which include urologists, orthopedic surgeons, and medical malpractice lawyers. They both emphasize that this dynamic conference responds to the audience’s interests and has an overall laid-back atmosphere. This year will also be the first one to feature a case competition for students and residents. Click the link below to register for the conference and apply the BackTable promotional code! --- RESOURCES STREAM Meeting: https://www.thestreammeeting.com/ For attendings, use the code “BACKTABLE” for 50% off registration fee. For residents/fellows/students, use the code “BACKTABLETRAINEE” for 100% off registration fee.

30 Juli 202140min

Dr. Sabeen Dhand talks with Dr. Blaise Baxter and Dr. Satoshi Tateshima about direct aspiration vs. co-aspiration technique when treating ischemic stroke. In this first episode of a multi-part series covering treatment of ischemic stroke they discuss radial vs. femoral approach, anatomic considerations, and tips and tricks with both techniques. --- SHOW NOTES In this episode, neurointerventional specialists Drs. Blaise Baxter, Satoshi Tateshima, and Sabeen Dhand discuss anatomical considerations and procedural techniques in direct aspiration and co-aspiration for ischemic stroke treatment. The episode starts with a discussion about radial versus femoral approaches. While femoral access remains the most common method, device innovations are making brachial and radial access more available. Dr. Baxter and Dr. Tateshima describe the use of co-aspiration in their frontline techniques. However, Dr. Tateshima notes that he prefers to use direct aspiration in posterior circulation, since the vessel size may be unknown. Dr. Baxter also emphasizes that with co-aspiration, it is important to size-match the catheter with the vessel. The choice of direct aspiration vs. co-aspiration depends largely on the location of the clot. The doctors walk through different considerations for M1, M2, and M3 strokes. Additionally, they talk about studies that compare the aspiration techniques and outcome factors such as improvements in TICI and mRS scores. Finally, they speak about the rewarding nature of stroke interventions and exciting new developments in the field. --- RESOURCES ASTER Randomized Clinical Trial: https://pubmed.ncbi.nlm.nih.gov/28763550/ SAVE vs. ADAPT for Acute Stroke: https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-019-1291-9

26 Juli 202145min