Hi, I'm Darrin Godin and this is Talking Hope. My guest today is Dr. Jason Salsamendi. Dr. Salsamendi is the lead interventional radiologist for City of Hope Orange County Lennar Foundation Cancer Center. Dr. Salsamendi, it's such a pleasure to have you on the podcast today, thanks for being here.
Dr. Jason Salsamendi: Oh, thank you so much, Darrin, for having me join your podcast today.
Darrin Godin: So Dr. Salsamendi, I'd love to chat today as we discuss interventional radiology, I'd love to know what sort of difference it makes for patients and really how it impacts patients who have cancer. So, can you start by first telling us really what is interventional radiology and what are its benefits for patients?
Dr. Jason Salsamendi: Great. I'm glad you asked because that's one of the most common questions that we encounter. What is this IR field, interventional radiology? Because we're not quite a radiologist and we're not quite a surgeon and we're kind of a mixture of multiple different specialties, but the true essence is that we're image-guided interventionalists and clinicians.
We provide almost surgical-like procedures without stitches or incisions, and we're able to do that by means of using really precise imaging. So we're trained in radiology, but we have additional training to apply what we know in radiology to the actual interventions from opening up vessels, to closing vessels that are bleeding, to tackling tumors, and many different things in between. It's the same common thread of image guidance using radiologic tools to be able to accurately perform those particular procedures.
Darrin Godin: So, are you talking about X-rays and MRI, or what type of imaging?
Dr. Jason Salsamendi: Yeah, it could be any of the diagnostic imaging we traditionally think of, but commonly it's going to be something called fluoroscopy, which is a type of X-ray that over the years has basically improved to the point that we call it the Angio Suite. We think of that with cardiology, vascular surgery, and interventional radiology where we have real-time imaging guidance of our catheters and guide wires and other tools that we use, but with this type of particular X-ray. Then we have CT and ultrasound and MRI. Not as much with MRI with real-time imaging, but that's also a tool, but the workhorse is really CT and ultrasound outside of the X-ray.
Darrin Godin: How does this benefit the patient?
Dr. Jason Salsamendi: Well, it has tremendous benefits. One of them is just taking procedures that have been traditionally considered difficult for patients, and here at this cancer center, one of those may be bone marrow biopsy. They may not really be looking forward to bone marrow biopsy from the traditional approach that maybe they've had in the past where it's performed using landmarks.
By the textbook guidance, we can convert that to an interventional radiology procedure where we basically take a CT scan of the bone marrow space, and just like GPS, we can know where we're entering at the skin to where we're entering into the bone marrow space, and we can be able to anesthetize, numb that whole area really, really well. Then with some little sedation, enter the bone marrow space almost completely at ease with the patient, as opposed to other experiences that may not be so comfortable. So, that's one way we use that imaging.
Darrin Godin: Great.
Dr. Jason Salsamendi: As an example. The other kind of avenues are basically offering procedures that had not been available before. Certain types of treatment of tumors may be in a liver or kidney that previously may have required open surgery or some modification of that now can be performed with just basically needle guidance. No stitches, no incision, and just advancing one or two or multiple needles to be able to bracket these tumors and then apply heat or a cold to be able to destroy the tumor cells.
That can be done as an outpatient, which is great for the whole recovery process. As you can imagine, there could be other things going on with these patients where just having less of a recovery process from these procedures really makes a big difference.
Darrin Godin: Wow. So saving them time, certainly saving them ... you're not just on an exploratory thing you're doing, I mean, you definitely can see what you're doing and you can get in, get out. I mean, it's a very interesting field. I mean, that sounds like it requires a lot of different types of skills as well. So, what kind of drove your passion for this field?
Dr. Jason Salsamendi: Yeah, this field actually when I basically was exposed to it, because it was more like being exposed and really seeking it out at the time, it wasn't something that was on most people's radar back in the early 2000s. You would maybe in your medical school rotation come across a clinical scenario where a patient goes to IR and then you get that exposure, and that's kind of what happened with me.
But in my particular case, it was neural IR where they came in with stroke and they needed emergent intervention, and I just saw the team kind of click all together, and it was just like magic watching a patient that was in a really stressful period of their life in the ER go upstairs, and within about 45 minutes the problem was addressed and they were recovering neurologic function right there.
Darrin Godin: Wow.
Dr. Jason Salsamendi: So for me, that was my eye-opener, and then I just saw various different examples of that throughout my schooling and training.
Darrin Godin: Could you tell us another story perhaps of a patient with cancer that has really been impacted in a positive way by IR?
Dr. Jason Salsamendi: Oh yeah, for sure. There are so many different scenarios, where a lot of my interventional oncology practice in the past was in a transplant center. So, we would have patients that are awaiting a liver transplant with a liver tumor. It's a very anxious period of time, it could be a number of months to a number of years before they can get to qualify for their organ transplant, and during that period of time, they may have a couple of tumors that are slowly growing.
So in those roles, we had patients that we are able to treat those liver tumors, keep them stable or shrink them down or completely eradicate them and keep them on the transplant list. Then sometimes it's so successful they have to debate, do I even want a transplant now, because the tumor is gone? Then you have this new unanticipated dilemma at times. So, you seek one thing and sometimes you get another unanticipated reward.
Darrin Godin: Wow, that's probably a good decision to have to make to know that the IR treatment has been so successful. Tell us, what role does IR play in the integrated approach to cancer care here at City of Hope?
Dr. Jason Salsamendi: Oh, I mean, not have any particular bias here, but I feel like it's very central to the integrated approach. The reason I say that is that we can't really treat something we can't see, so we're usually using radiology to be able to track our results. Of course, there are other things that we track like tumor markers and things of that nature to be fair, but a lot of it is image-based doing PET CTs, and MRIs.
With interventional radiology, we can provide some of the reads for those scans along with their diagnostic colleagues in radiology. We can also help answer questions, like if there's an area that looks suspicious that unfortunately a tumor may be growing back, or maybe there's a different site, is it really the same problem that was there a year ago or we have some other new issue coming? Then in interventional radiology, we can target that, do maybe a percutaneous biopsy, like an outpatient procedure, sample that, and be able to send it, figure out what we're dealing with.
Then it just escalates from there, because we can then send samples for multiple molecular targets and helps our oncology colleagues be able to maybe change their medical management, their chemotherapy or immunotherapy or what have you, and we can also work along our surgeons. Our surgeons may have a patient that unfortunately may have issues where they can't go under anesthesia completely, and that patient may benefit from having a procedure where we can just sedate them only and be able to maybe treat a kidney tumor or treat a liver tumor in a less invasive way, for instance.
Then a lot of what we do kind of just goes in the background, because we just do so much of it. One of them is most of our patients really get a lot of benefits from having a vascular port, so they can be able to get blood draws and get their CT studies and most importantly get their therapies through it. We place those on a very frequent basis here and a whole bunch of other procedures that we get involved in.
When you talk about integration, one of them that's really important is making sure that throughout this whole process that the patient is as comfortable as possible. In interventional radiology, we can target various nerves and [inaudible 00:10:12] and be able to anesthetize and be able to help them if there's any discomfort in a certain area. We could also help drain fluid and be able to manage distension of the belly or difficulty breathing with various different means by working alongside our pulmonology colleagues. So, we definitely are in the mix with all the various specialists to try to see how we can fit in and help our patients.
Darrin Godin: Wow, that's incredible. It sounds like you have so many tools at your disposal to help patients in so many ways, that's very cool. What types of cancer-related needs or side effects is IR used for?
Dr. Jason Salsamendi: Cancer-related needs or side effects, I would kind of like to break that down into multiple pieces, because it's a quite wide canvas there. But going back to that integrated approach and working with our colleagues, we have the curative box where we're able to, for instance, a real clear cut would be a two-centimeter renal mass. We can freeze that, offer a curative treatment, or we could have a patient that, for instance, has a rapid progression of liver tumors, and if for whatever reason the systemic therapies aren't working, we can go into the liver arteries and provide a certain radiation therapy called Y90 to be able to work on those tumors in a very selective way where we're treating the liver and not having the side effects throughout the system by giving some of the systemic therapies.
Then from some of those more advanced procedures, there's a whole host of more simple procedures we do in ultrasound. When a patient's getting worked up and they're getting a PET CT from head to toe, they may find out they have a nodule in their thyroid that looks a little off and we can sample that and make sure that it's just a benign nodule, or they may find that they have a little thing light up on one of their vertebral bodies or a little compression fracture, we can go in there and biopsy that and find out what's going on with CT guidance.
We can also use that X-ray we talked about, and if it's a fracture, we can stabilize it and put cement in the fracture plane, and a balloon even to get a little bit extra height if it's a compressed fracture. So, one of the challenges is it's hard to be able to just label with just one soundbite what interventional radiology does because we quite often find ourselves in a diverse set of procedures. I hope that kind of touched on your question, but...
Darrin Godin: It does, it does. I'm wondering, some of those procedures you're talking about, are those all done in the same ... you're doing say a PET CT and then you do those procedures during that same period? Or is that something that after they've had the CT, the patient has to come back again for another appointment with you? Or is this all done in real time as they're going through some of the imaging?
Dr. Jason Salsamendi: I think that one of the greatest aims is to be able to scan somebody, provide the biopsy, and do everything that's needed all in one setting. With that said though, it may cut out that multidisciplinary integrated approach, because perhaps that biopsy isn't necessary. After talking to the oncologist, it may not be so relevant. So being super expeditious definitely can have its great advantages, we all agree on that, but occasionally it may have some downsides, 'cause it will cut out some of the teamwork, which is what this institution's so well-known for.
We want to be able to make sure that we're doing the biopsy the right way, we're getting the right type of sample because it's not simply just removing tissue, it's also removing the area of the tumor that's suspicious and it's putting in the right solution to get the right type of pathology exam done, et cetera, et cetera. So with that said, usually they get their PET CT and their scans first. We reassess, talk to their referring oncologist or surgeon, and then proceed from there.
Darrin Godin: Gotcha, okay. So, let me ask you this question. We ask all of our guests on the podcast, you work at City of Hope, we use the word hope a lot. What does hope mean to you, Dr. Salsamendi?
Dr. Jason Salsamendi: Well, I think that hope and faith kind of go together. So with hope, you can have faith, and having faith really gets you through the storm. I think that in the vast majority of cases that we have patients here, the storm hits like a lightning strike and they just were never expecting to have this pop-up. They had all the things going on in their life and then this just came out of nowhere, so it leads to a lot of uncertainty for most people and anxiety and trying to make the right decision.
So having an environment that allows for hope to flourish and having faith, and yeah, I think it's an extremely positive environment. That's one of the greatest assets here is that patients really start to develop the strong faith that they're seeing all our teams support them in various ways, and that gets them through that initial storm onto a road to recovery.
Darrin Godin: Mm-hmm. I like that combination of hope and faith, right? I mean...
Dr. Jason Salsamendi: Yeah.
Darrin Godin: You can have hope, but when you can also have faith that there's a better tomorrow and there's an answer, there's something that can be done to help you, that's really reassuring.
So before we go, I guess I'd love to know a little bit more about you and your family. You're living here in Orange County, I suppose, and tell us about what you do outside of being a doctor.
Dr. Jason Salsamendi: Oh, great question. Well, I have two kids in middle school and in high school, and my wife and I moved here from the East Coast about four years ago almost. What I do basically afterward is I just cherish all the moments of the family, whatever that may be. Whether going to catch a movie or just a road trip or what have you, just cherish every moment with them. Then other times just make sure that they're doing their homework right.
Darrin Godin: A junior high high school student, I'm sure that's tough.
Dr. Jason Salsamendi: And that they go to bed on time and they do all the things they need to do, yeah.
Darrin Godin: Well, there you go.
Dr. Jason Salsamendi: Yeah.
Darrin Godin: Well, Dr. Salsamendi, thank you so much for bringing your heart and your hands to City of Hope, lending your skills to our patients, and really developing that hope and that faith in others. We appreciate you and we appreciate you for being on the podcast today as well.
Dr. Jason Salsamendi: Right, okay.
Darrin Godin: Thanks so much for being here. I'm Darrin Godin. This is Talking Hope, and we look forward to seeing you on our next episode. Have a great day.
Dr. Jason Salsamendi: Thank you.