July 16, 2024 • 44 mins
Have you ever wondered how a WWII MASH surgeon's legacy could shape a modern-day cardiologist's career? Get ready to be inspired as Dr. Kelley Branch from the University of Washington Division of Cardiology shares his incredible journey into medicine, deeply influenced by his grandfather's remarkable history. Join us for engaging personal anecdotes, from his childhood in San Diego to his transformative research at UCLA with Nobel laureate Louis Ignarro, all of which shaped his passion and expertise in cardiology.
We then turn the spotlight on the revolutionary advancements in cardiac imaging technology. Discover the fascinating backstory of the CT scanner's development, thanks in part to the Beatles' success, and follow its evolution from single-slice models to the latest photon-counting CT technology. These cutting-edge innovations are providing doctors with higher resolution images at lower radiation doses, transforming how we diagnose and treat heart diseases. Hear how these advancements could potentially reduce the need for invasive procedures and improve patient care.
Finally, we delve into the critical realms of post-resuscitation care and clinical research. Learn about the groundbreaking Sudden Death CT scan and the ongoing trials focused on lipoprotein A (LP(a)), a significant marker for early cardiovascular events. Dr. Branch also shares a thrilling adventure in Beirut, blending high-stakes experiences with his signature humor. This episode is a heartfelt tribute to the profound impact of innovative cardiology and the dedicated professionals who drive it forward—don't miss it!
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
This is Coffee and Cardiology.
Speaker 2 (00:05):
In this podcast, we sit down with a faculty from the
University of WashingtonDivision of Cardiology to
discuss the very latest indiagnostics, therapeutics and,
as a special bonus, we ask whatmakes our cardiologists tick.
We have before us the greatKelly Branch, and one of the
(00:27):
things I just learned in thehallway as we're talking about
this is that Kelly's father wasactually a radio guy.
So I am proposing that perhapswe ought to at least conduct
some of this podcast with ourradio voices today.
Speaker 3 (00:46):
I think that's a great idea.
Thanks, Jim.
I appreciate this opportunityto be here, and what a wonderful
setting here today.
Speaker 2 (00:54):
Well, Kelly, I'm just so proud to have you on, it's
such an honor.
I have to say Well, tell me,Kelly, how are you doing today?
Speaker 3 (01:03):
I'm doing great.
But you know what, jim?
I'm always doing great.
So it's almost like every dayis sunshine in the Kelly Branch
world.
But that's just what I pickedup from my father and all of
those years in San Diego, wherewe learned a lot when we go from
the sea all the way to themountains.
(01:23):
That's right, because San Diegohas just about everything
except for the beauty of thePacific Northwest.
Speaker 2 (01:31):
Well, it is quite beautiful here.
I must say, I'm not even goingto try.
Speaker 1 (01:36):
That's great.
Great work guys.
Speaker 2 (01:38):
Great work Well this is going to be a fun one,
absolutely.
For those of you who don't know, the great Dr Branch also is
kind of, I would say, one of themore humorous people on our
faculty.
Everyone knows him for that andrespects him greatly for that.
He kind of really does light upthe room whenever he enters it,
(02:02):
and so we're expecting him todo.
Nonetheless, it's unfortunateyou can't see the aura that is
actually emanating becauseyou're listening.
Speaker 1 (02:09):
Is this off the cuff?
Is this dad jokes?
What is your repertoire?
Speaker 2 (02:11):
Oh my goodness, Dad jokes for sure, okay.
Speaker 3 (02:15):
Yeah, well, we're going to refrain on the dad
jokes because you know thegroaners are definitely there.
I will say that.
But yeah, well, maybe we aredefinitely there I will say that
Maybe we'll fit in a few littlebits.
Speaker 2 (02:35):
That's good.
We'll definitely appreciatethat.
But all joking aside, the goodDr Branch is also a nationally
recognized expert in computedtomography of the heart and we
are so grateful to have himactually on faculty as a leader
in the professional societiesand also as sort of a resident
expert in cardiac CT, and healso leads our clinical trials
unit and that is a veryimportant thing that we want to
(02:58):
hear some more about.
Kelly's a great imager.
He also sees patients in theGeneral Cardiology Clinic.
He's just an all-around niceguy.
I can't wait.
This is great.
Yeah, it is fabulous.
Well, kelly, you hinted alittle bit the fact you grew up
in sunny San Diego.
I did that, but tell us therest about your journey in
(03:20):
medicine.
Speaker 3 (03:27):
Yeah.
So I always knew I wanted to bea doctor ever since I was a
little kid and a lot of thiscame from my grandfather, who
actually had an interestingcourse himself Graduated from
Tulane back in the day Manystories about medical school and
things like that and actuallywas a MASH surgeon in World War
II and actually went islandhopping interestingly in the
same division as myfather-in-law both in the same
(03:49):
division, so they but he cameback and could not handle that
kind of acuity and that kind ofmortality and came back and,
even though he was afull-fledged surgeon, went back
to Pennsylvania and actuallybecame a psychiatrist.
Wow.
So which is a complete 180.
(04:09):
It's a little different 180.
But one of the most intelligentguys in the world Photographic
memory.
I remember that I was sittingin his one of his chairs just
kind of flipping through thishuge Shakespeare book that he
had trying to figure out whatthe heck was going on and he
says, oh, oh, is thatShakespeare's soliloquy?
(04:30):
Looked me straight in the eyeand did the entire soliloquy
from memory reading, from hisphotographic memory, and I said
this is an intelligent man butalso a kind soul, and so with
that he has the humility and thekindness, but actually started
psychiatry, basically west ofthe Rockies, starting at
University of Utah, started thedivision there excuse me,
(04:52):
department there, as well ashelped with starting the School
of Medicine, and so he was ahuge influence, wonderful man
and just someone I inspired tobe.
And so I knew from about theage of four and, yes, at the age
of eight my number one requestwas Grey's Anatomy for Christmas
, wow.
So at the age of nine I wentback to my grandfather and
(05:13):
quizzed him on all 200 bones ofthe body and he did rather
poorly until it came to thewrist and then I corrected him
and so some of us were a littlemore geeky than others, but it's
been a lifelong passion.
And so I went to UCLA forundergrad and there met some
(05:36):
wonderful people, worked forcardiothoracic surgeons there
and actually met Louis Ignaro,who subsequently was working
with our lab and actually wonthe Nobel Prize for figuring out
nitric oxide.
So it was fun to see those kindof interactions of some really
wonderful people and that reallystarted my career in research,
because I was helping with thecardiothoracic research and
figured this is a really greatway to do things and then went
(05:59):
off to medical school and thatwas really the sorry.
And then, in the interim Ishould say, medical school, and
that was really the sorry.
And then, in the interim Ishould say, I started working
for a private group thatactually had some money.
And so for three years after Ihad first gotten married right
out of college to my lovely andwhat I say long-suffering bride,
heidi, is that we had so I wasthe Rosie Zeus Research Scholar
(06:21):
and then from that got a bunchof papers out, figured out that
research is really where Iwanted to go, and then
matriculated to medical school,where I continued as a research
coordinator in San Diego whilebeing in Philadelphia and doing
medical school.
So yet that was just the startof the craziness in my world and
(06:42):
spending a lot of time doingmany things.
So from there went to Michigan,had a wonderful time, lots more
research, met some wonderfulpeople that I still emulate to
this day, and then came to theUniversity of Washington and the
rest, they say, is history.
As I established here and wasgoing to come as a heart failure
transplant LVAD specialist, wasgoing to be doing those
(07:03):
artificial hearts.
That's what I really wanted.
To come as a heart failuretransplant LVAD specialist, I
was going to be doing thoseartificial hearts.
That's what I really wanted todo.
Again, I think I took a lotfrom my grandfather because the
high acuity and the mortalityand the sickness of the people
just couldn't do it.
So I didn't think aboutpsychiatry.
I only a slight pivot and wentto imaging, because people tend
(07:23):
to do a little bit better whenyou image them.
And then we started to do thatIn 2004, we got this new machine
.
It was right off the GE line.
It was the first 64-slice CT.
It was the serial number 001.
And so we got that machine andone of my mentors, who was the
(07:44):
vice chair of radiology, said wehave these new CT scans.
I know you're looking aroundfor research.
I think this would be wonderfulresearch, and so we started to
do CT scans in 2004 when therewere only two training centers
in the United States, and so wejust basically kind of learned
by ourselves.
I went down to see Matt Budoffback in LA, my good friend Matt,
who helped me kind of finish upmy training, and then ever
(08:08):
since then that's been thejourney, wow.
Speaker 2 (08:12):
That is quite a journey.
Speaker 1 (08:15):
Where did the heart come into all this?
Where was your?
Why?
For why you got into cardiology?
Speaker 3 (08:20):
Oh, it's a great the I had known for a while.
There were two things I wasvery interested in.
One was the brain and then onewas the heart, and for kind of
different reasons, right, brainsare very interesting just
because they are so.
They're us, they're human,right, and you know so much of
who we are and so much ofeverything is just the brain.
(08:42):
What I found out as we weregoing through is that when the
brain gets injured, there's notmuch you could do.
And this was in the heyday wherewe're going to have all of
these wonderful new medicationsthat were going to help the
brain and none of them worked.
At the same time, I had gottenan experience with
cardiothoracic surgery andcardiology, and that was a
wonderful mix of intellectualism, of being able to do something
(09:05):
for people, of really being ableto, and then also having kind
of the ability to treat patientsand having that acuity that
makes things a little bit moreinteresting, kind of had that
whole, kind of had everything.
And so that's where I reallykind of said, well, I'm either
going to do neurology orneurosurgery, cardiothoracic
surgery or cardiology, and thosesurgeons work way too hard.
Speaker 1 (09:27):
I'm sorry, they work way too hard.
Speaker 3 (09:29):
So love them to death , but I'm not that crazy.
So cardiology was really themesh of all of those wonderful
things, and I'm still interestedin neurocardiology, don't get
me wrong but cardiology isreally where this ended up, yeah
that makes a lot of sense.
Speaker 2 (09:47):
So imaging in particular, you gave us a little
bit of a window about how youheaded into that.
What sort of changes have youseen in CT other than that we're
no longer on 64 slices, but?
But where else has CT gone?
And what continues to captivateyou about cardiac CT?
(10:07):
What?
Speaker 1 (10:08):
are we at now?
Speaker 3 (10:09):
Yeah, so we are on.
Well, we've expanded.
So there are many differenttypes.
Now, right, really, the vendorshave gone two different ways,
one of which is to use what'scalled a wide detector, so one
rotation, one heart is what wecall it.
So you get everything withinless than a second.
(10:29):
That's it, you're done.
One of the other vendors usestwo CT scanners that are
basically mounted at 90 degreesto one another Also a very quick
way to do that in wonderfulimages.
So people have gone a coupledifferent ways.
The newest kit on the block,which is something that we are
looking into and we'll begetting a prototype here, and
(10:49):
then hopefully, we'll be gettinganother vendor down at
Harborview there's somethingcalled a photon counting CT.
Now Godfrey Hounsfield, when hewas first creating the CT
scanner.
And, by the way, quick aside.
So what is the relationshipbetween the Beatles and a CT
scanner?
Do you know?
Is this a dad joke?
Speaker 1 (11:11):
No, no, it's a good question.
Speaker 3 (11:12):
It's a good question.
No, this is honest to goodness,honest to goodness.
Do you know the?
I do not know the answer.
Okay, this is one of thosewonderful connections.
So Godfrey Hounsfield ofHounsfield Units right, was an
engineer at EMI which was alsosupporting the Beatles.
Now the Beatles had been doingso well for EMI and Godfrey
(11:32):
Hounsfield, his engineering crew, had kind of been put a little
bit on the wayside.
So he had some time and withthis time he said I've been kind
of brewing this a little bit,this idea of this CT scanner.
And so while he was at EMI,which is basically supported by
all of the Beatles, he was ableto create the CT scan and
(11:53):
actually develop that whilegetting paid by EMI.
Wow, so the Beatles wereindirectly supporting the
development of the CT scan.
Wow.
So there you go.
So there's your trivia fortoday.
Speaker 2 (12:06):
So really, when people are in that scanner, we
should be playing the Beatles.
Speaker 3 (12:10):
I think that would be completely appropriate, even
though it's so short.
I mean, yeah, exactly.
Speaker 1 (12:14):
So, but then didn't hit the US until 2004?
.
Speaker 3 (12:18):
The 64 slice.
This it got it.
We did have the.
We did have the early slice,the one slice, the four slice,
the 8-16.
We had this kind of era.
The 64 slice was really thefirst era where we were able to
create cardiac CT.
We were able to get the imagesgood enough and still enough
that we were able to read themin a robust way.
The older slices, the olderscanners sometimes those took
(12:41):
minutes.
They weren't gated to thecardiac cycles.
There was a lot of motion so itwas hard to tell.
64 slice was really that firstera.
Now we've gone through a coupleof iterations with different
kinds of scanners, and reallywhat we're at now is this thing
called the photon-counting CT.
Godfrey Hounsfield wanted todevelop the idea that, as
(13:03):
photons are being kind of pushedthrough the body, there's very
complex interactions that arehappening at the molecular level
.
If you're able to measure those,those kinds of interactions,
rather than having just a photonthat hits a detector yes, no,
there are some subtleties to thekind of energy as it hits the
detector and from that you canget much better resolution and
(13:25):
you can figure out things thatare metal, calcium and bone and
other soft tissues, and sothat's the new revolution.
Right now there's only onevendor that has it, but other
vendors are in development, andso I think that's going to be
the new revolution, in that weare going to be seeing much more
(13:45):
than we're able to see today.
We're going to be able to takeout a lot of the artifacts which
CT is really prone to, and withall of the other technologies
that have been developed overtime, we do this with a low
radiation dose very, veryquickly.
Oftentimes these are less thana second, or sometimes maybe
within two to three seconds.
And again, these are 3D datasets.
You can go back forever and goback and reconstruct these and
(14:08):
take a look as you like.
So that's the new revolution.
Speaker 2 (14:14):
So how do you think that's going to play out in
clinical cardiology right now?
I think most of our listenersare probably very aware of the
coronary calcium scores andcardiac CT for coronary artery
disease detection andcharacterization.
What else are we doing or whatis on the horizon for CT in the
clinical realm?
Speaker 3 (14:32):
Yeah.
So I see two different waysthat this is going to go for
cardiac CT.
Number one, because of the waythat the new scanners are
working and kind of the benefitof the new scanners, especially
with photon counting CT, theidea of taking someone to a
diagnostic, invasive coronaryangiography where you do it from
the hand, you know the arm orthe groin, where you're just
(14:54):
going to look, a lot of that'sgoing to go away because we
don't have to worry about thethings that are in the way now
the stents, the calcium, thingslike that.
The motion artifacts are goingto be reduced.
All of those things are goingto be working in our favor.
So we may not.
So when we're doing anangiogram, we're doing the
invasive coronary angiogram,we're actually going there to
try to fix something, so we'rereally going to be reducing that
(15:18):
angiogram.
That really didn't have much ofa purpose other than to rule
out disease.
It also allows us, becausewe're able to see the plaques
better.
We can start to treat thepatients accordingly, and that's
what I've been doing is to say,yes, I see the stenosis, you
have symptoms, I don't need toget any additional studies.
I know that this is probably,you know, a blockage that's
significant.
(15:38):
Here are your medications thatare going to allow you to go off
and do the things you want todo.
You don't necessarily need astent.
It's equivalent as far asputting in a stent versus not
for many, many people.
And so now we can start to justuse CT scans and then move
forward, and that is the onlymodality that you need.
The final thing that I think isgoing to be revolutionary and a
(16:00):
lot of us are working withinthis field now is to actually do
something called plaquecharacterization, and that is
not just looking inside thevessel, which shows the blockage
, but looking outside the vessel.
And outside the vessel is wherea lot of the machinery for
atherosclerosis and the layingdown of atherosclerosis.
What I tell people is, I saidit's like an asphalt machine.
It keeps laying down layerafter layer after layer, right,
(16:23):
and a lot of those get stablewhen they're down at the bottom
and that first layer can becomecalcified and that's that
calcium score that you see, it'sthe endpoint of atherosclerosis
.
That's mature.
It's not going to go anywhere,it's not going to affect
anything, it just sits there.
You can't get rid of it either,at least not very easily, but
it's the hot top layer.
That's the thing you can getrid of with medication.
(16:44):
But we're able to start seeingthat top layer and start seeing
those hot zones right, we callthem the low attenuation plaques
and we're starting to see thetotal plaque volume and the
non-calcified plaque volume.
All of these measurements now ina very robust way, and we think
the revolution is that whenpatients come to see us ask how
am I doing, I can say you knowwhat.
(17:06):
I could get a CT scan.
I can see where youratherosclerosis burden is.
Are we better, worse?
Do we have more calcium, whichis sometimes good because it's
maturing, but do we have a lotmore atherosclerosis?
If we do, I need to be moreaggressive and so we are able to
do this in a more robust wayrather than just relying on
(17:28):
serologic, you know, like blooddraws and those kinds of and
then the risk factorsmodification.
So those work okay, but if Ireally want to know what's going
on inside your vessels, I'mgoing to be able to see, you
know, and this just strikes me.
Speaker 2 (17:42):
The overall role that CT is playing is one of nuance
and sophistication.
This is the new thing.
It sounds like what you'resaying.
Yeah, because in the past welooked at calcium Well, it's a
marker for disease.
We looked at even stenosis Well, that is another marker for
badness and bad things arehappening.
But now we're drilling down andI have a surprising number of
(18:04):
patients you know well we need astatin.
Well, I really don't want totake a statin.
And they ask very probing andinsightful questions and with
our current way of riskstratification I can't really
answer them.
But it sounds like in thefuture CT is holding some
promise for that, absolutely,absolutely.
Speaker 3 (18:22):
Yeah, it's really going to give you an insight
that we've never seen before,and it's not only for the
coronaries, it can be for othervessels too.
Actually, those other vesselsare much easier, they don't move
as much and they're much larger, so you can get kind of an idea
about what's going on withinnot only a coronary, but you can
actually get a whole-bodyatherosclerosis burden if you
want to go down that track.
What we just don't know is weknow that these are associations
(18:47):
.
We know that certainmedications can regress
atherosclerosis versus if you'renot on the medication.
We know that it progressesatherosclerosis.
Things like testosteroneactually increases
atherosclerosis versus if you'renot on the medication.
We know that it progressesatherosclerosis.
Things like testosteroneactually increases
atherosclerosis rather thanregressing atherosclerosis.
So there are things that areactually detrimental to
atherosclerosis, and so the idearight now for one of the groups
(19:07):
that I'm working with is thatwe are going to FDA to say,
rather than doing these largestudies on every single compound
that could possibly come out,because these studies are $300,
$400, $700 million, you justcan't do that for every compound
you're interested in.
What if I said that for $3million, I would be able to tell
(19:32):
you in 18 months whether or notthis reduces atherosclerosis,
and I'd be able to tell you in18 months whether or not this
reduces atherosclerosis.
And I'd be able to do it with400 patients, not 27,000, right.
So now we see this newrevolution of being able to do
these smaller programs,interesting compounds that may
actually affect atherosclerosisin a way, but people just don't
(19:56):
have hundreds of millions ofdollars to do the study.
But if it looks promising thenwe can move forward to a more
robust way of looking for, youknow, kind of the usual
endpoints, the major adversecardiovascular events, which
unfortunately takes thousands,sometimes tens of thousands of
people in years to figure out.
But I'm going to be able tofigure out whether or not this
is a good idea in 18 months.
Speaker 1 (20:18):
And that's because of the nuance of the technology we
have now versus got it.
Speaker 3 (20:21):
Yeah, because that atherosclerosis we can actually
measure it in a quantitative wayand compare when we begin and
when we stop, and we canrandomize people to either
placebo or the medication andthen know whether or not it's
good or, in the case oftestosterone, detrimental.
Speaker 2 (20:39):
And it sounds like it's going to be much more
nuanced than just more calciumor even more atherosclerosis.
It's going to be?
What type of atherosclerosis?
We're talking about, yeah, andactually calcium is going to be
good yeah more calcium better.
Speaker 3 (20:54):
A little bit of calcium is good.
Too much is bad.
Too much is bad.
There's always this middleground.
Speaker 2 (20:59):
Well, this is a great segue actually into your work
with the Clinical Trials Unit.
Could you tell us a little bitabout what that is, what you do,
how that fits into the Divisionof Cardiology?
Speaker 3 (21:10):
Sure.
So the Clinical Trials Unitreally has two facets to it, one
of which is that we serve as aresource for these large trials
that I just talked about, thesevery, very expensive trials.
We serve as a site for thesetrials, which allows our
patients access to a lot ofthese new potentially beneficial
(21:30):
medications.
Now, the important part of whatI just said is the potentially
beneficial medications.
We don't know.
As Einstein said, if we knewwhat we were doing, we wouldn't
call it research right, and sowe do this.
But if you think about it andthis is what I tell patients a
lot if you think about all themedications that you're taking
that we know are beneficial,it's because somebody, just like
(21:51):
the people that are alreadyenrolled in the CTU, stood up
and said I'm going to be in thisresearch study and I'm going to
help you find information.
It may not help me, but it'sgoing to help people down the
line.
And so, really, all of thesepeople that are in the CTU and
we appreciate them so much forvolunteering for research
(22:11):
they're really standing on theshoulders of all of the millions
of people that had volunteeredfor clinical research previously
, the millions of people thathad volunteered for clinical
research previously, but theclinical research.
So we do site, what we callsite trials.
Right, so we will be one siteof, say, 600 sites within the
world that are asking a veryimportant question, and they
come in different flavorsSometimes they're smaller trials
(22:31):
, sometimes they're biggertrials, sometimes they're trials
that we own or we do, andsometimes they're larger trials.
And really all of this is totry to drill down and again kind
of move the needle forward, sowe're always on the cutting edge
and looking at what's new.
There's another side to this,called the Clinical Trial
Service Unit, which my mentor,now colleague, jeff Probstfeld,
(22:54):
had started 30 years ago, andthis helps with fostering these
large, large clinical trials.
Okay, and so we generally runthe United States for one of our
groups in Canada called PHRI,and so these trials are anywhere
between 10,000 to 50,000 people, and so we kind of help run the
(23:15):
United States, work on thesteering committees and then
have a little bit of a differenteffect in that we are helping
to foster other sites, not justour site but other sites and
many of the sites in the UnitedStates, and this has really
helped to kind of push thingsforward and a lot of these
things have ended up in veryinfluential places like New
England Journal and Lancet andJAMA, and this kind of work
(23:38):
actually really propels thingsforward.
The site is very, veryimportant, but sometimes the 50
sites or 60 sites that weoversee are equally important.
So we kind of serve twodifferent roles.
But that kind ofcross-fertilization has really
allowed us to really become arobust place, because we know
what the sponsors want from us,because we're a sponsor right,
because we know what people want, and so we become very, very
(24:00):
good sites.
Speaker 1 (24:02):
And when you say we University of Washington at
large for that service unit.
Speaker 3 (24:06):
This is University of Washington, correct?
Speaker 1 (24:07):
And then we have our clinical trials unit within
cardiology.
Correct, got it, yep.
Talk a little bit about thatteam that you have.
Yeah, I got to meet thembriefly.
Speaker 3 (24:15):
So, okay, we're good.
Well, they're a wonderful team.
So we have 18 people right nowthat are underneath the CTU all
very dedicated people and at alldifferent levels of experience,
and so we love to bring peoplein and train them, to show them
how to do this kind of work, andthen they either go on to
bigger and better things or staywith us for long periods of
(24:38):
time.
But these really are highlydedicated people to again
getting answers, gettingimportant answers to important
questions, and making sure thatpatients, once they become in a
trial we call them participants,because that's really what they
are.
They're not patients anymore,they are participating, actively
participating in this.
We make sure participants arewell treated.
(25:00):
So what I tell people is thatparticipants that are here, they
get to fly first class.
Speaker 1 (25:05):
If they have a problem they come to me right.
Speaker 3 (25:08):
So if they're my patients, then we say you have
this problem, I got a guy.
I'm going to give the guy acall.
You got a problem, that's, youknow, with your gastroenterology
tract or something like that.
I got a guy.
So it kind of allows people, ifthey're going to be this
generous, then I'm going to haveto reciprocate by kind of
greasing the skids a little bitand making sure that they are
(25:28):
very well taken care of from amedical standpoint and otherwise
.
Point is and otherwise.
So we really kind of fosterthat within the clinical trials
unit have wonderful people andyou know couldn't say enough
about Jennifer Schaefer whoreally runs it.
Laura Curtin is one of oursenior coordinators.
Those are really the.
You know, laura's kind of theheart of the CTU and Jennifer
kind of keeps us all in line andit's good to have both of those
(25:51):
people.
They're really kind of headingit up and of course, all the
other wonderful people within it.
Speaker 1 (25:55):
This may be a little self-serving of a question, but
how do you find and engage andget participants?
Speaker 3 (26:04):
Yeah, so there are a lot of different ways that we
find it.
Sometimes we'll screen throughthis massive amount of data that
we have.
That's called an electronicmedical record right, that's a
common way of finding it.
Sometimes we'll find people inthe clinic that will be referred
by our colleagues, or sometimeswe screen for them.
So we're actively looking forthem.
Once in a while we'll actuallyhave, you know, tv or radio that
(26:26):
will go out and we'll say, hey,we're doing this wonderful
trial about this particularproblem, if you do give us a
call, and so we sometimes findpeople.
So there are many differentways that we do it.
We have placards and thingslike that and little posters and
things.
So there are many differentways that we identify these
people.
But it's amazing how manypeople are so altruistic that
(26:47):
they actually search us out, andespecially if there's something
really interesting.
One of the things that I've beenworking on a lot is lipoprotein
A or LP, little a.
It's kind of what we call it.
Sticky ldl is a way of thinkingabout her sticky bad
cholesterol, and it's just adriver for very early
cardiovascular events, forsomeone that has recurrent
cardiovascular events, somethingthat everyone should be
(27:07):
screened for once in their life,at least once in their life.
But we see we now have a lot ofpeople that are now coming to
us because we're doing this workand saying I have elevated
lipoprotein a, what can I doright?
And so, along those lines, wehave one trial that's actually
looking for major adversecardiovascular events.
That's the large trial.
(27:28):
Okay, that's an 8 000 patienttrial.
And then, along the lines ofthat plaque characterization
that I talked about, we have amuch smaller trial, 700-patient
trial that's actually looking atplaque characterization in
people that have not had eventsyet, that have not had a heart
attack, stroke or acardiovascular event.
So they're early.
And so now we have two prongsfor people that have already had
(27:48):
events and people that have nothad events, so that we actually
get that full gamut ofexperience for this particular
thing.
But it's amazing how manypeople come find you.
Speaker 2 (27:56):
Well, that's great.
So some of our listeners mayactually be wanting to refer
patients to you.
How do they do that?
Speaker 3 (28:03):
Yeah, so on the UW website you can look for
clinical research, and there area couple of different ways that
in the Division of Cardiologythere's line items that are
there as well.
Couple different ways that inthe division of cardiology
there's line items that arethere as well.
Within what's called the ITHS,which is our large clinical
group, there's also a listingfor clinical research.
(28:25):
If you're interested, go to oneof those websites and then
there will be a link there thatyou can click.
It actually emails us or emailsITHS and they'll get to us if
you're interested in what'sgoing on.
If not, then just say hey, youknow these are my problems.
I'm interested in getting toclinical research and we'll be
happy to chat with you and seeif something fits and if it
(28:46):
doesn't, we also know what'skind of going on around town as
well, and sometimes there's abetter fit somewhere else.
We're more than happy to referto those places as well.
Speaker 2 (28:56):
Oh, that's just fantastic.
Speaker 3 (28:56):
Well, I want to pivot a little bit and talk about
patients who are probably notgoing to be intentionally
referred to you, and that isyour work in resuscitation,
that's true, that's true, that'syet another hat, but it was
born out of kind of my and Iguess it's a passion for being
(29:18):
able to do more with very, verylittle right and really trying
to be as efficient as possible.
I love efficiency.
I really don't like to, youknow, kind of lollygag around.
That's kind of not my modusoperandi, even though I am from
San Diego, so I'm supposed to bevery chill.
I can use dude in a sentence,don't get me wrong.
Speaker 2 (29:38):
I have no doubt, but there's a little burning fire
underneath all of this.
Speaker 3 (29:43):
So part of that was to try to figure out, because
when I was at Harborview andthis was actually as a trainee
when I was a fellow I noticedthat all of these people would
come in after a sudden deathevent and the real question was
what do we do with these people?
How do we work these patientsup?
What was the initial problemthat they had that had their
sudden death event?
Because that's going to informwhat we're supposed to be doing.
(30:04):
Was this because of blockagesin their arteries?
Was it because the heart wasn'tworking?
Was it because of a blood clotthat went to the lungs or some
other problem?
Well, what also ended uphappening is that they would
have resuscitation, which in andof itself, is kind of a
traumatic event.
There's a lot that happens withCPR and being in a breathing
machine and being cooled and youknow all of the things that go
(30:25):
on with trying to optimize.
You know, bring people back andthen optimize them.
Speaker 2 (30:30):
So you're seeing, it's not like daytime soap opera
resuscitation, it is not.
It is not Good to know.
Speaker 3 (30:37):
It's been a very, very long time since I've
actually pulled any paddles andkind of rubbed them together and
put them on anybody's chest,okay, so Hollywood needs to
catch up a little bit.
But suffice to say that thequestion was how can we work
this up in a robust way to tryto figure out what the
(30:59):
resuscitation problems that theyhad, what caused the sudden
death event, and how are wesupposed to treat these patients
differently?
And so we came up with thisthing called the Sudden Death CT
or SDCT, and basically it's thepan-man or pan-woman scan.
It's basically from head allthe way to the pelvis and
evaluating all of thosestructures that could actually
(31:20):
cause sudden death or could beaffected by the resuscitation or
falls or anything else.
And so from this development wefound out that actually the
yield was very, very good withthis.
So we were able to instead ofhaving 25% of people we had no
idea why they died, had no ideawhy they died.
(31:40):
Now we're up to 92%.
Now we know 92% of people.
We had no idea why they died,had no idea why they died.
Now we're up to 92%.
Now we know 92% of people.
We know why they died.
Okay, so there's a huge increasein.
Now we know what the problemwas, okay, and then we looked at
all the complications and thecomplications that are not just
there right from theresuscitation because they had a
little pneumonia or whatever,but also things that need action
(32:01):
right, and about 30% of peoplewe were finding things that
needed some kind of action right.
Something needed to get changed, and this was sometimes
resuscitation problems.
This was sometimes there was awhopping pneumonia that we
didn't know that they had thingslike that.
So now, 30% of the time, we'reactually changing what we're
doing based on the CT scan, andthis is a CT scan that is done
(32:23):
within two hours of the patientarriving.
They're sedated, they have allof the things of the
post-resuscitation care, but itreally guides what we're doing
as far as resuscitation goes,and so I think it's a new
paradigm for how people aregoing to be evaluated as they
move into the post-arrestsetting.
Speaker 2 (32:43):
Yeah well, that certainly makes a lot of sense.
You know there had been someresearch and even people setting
up a cath lab in the emergencydepartment so you could cath all
of these patients with all thepotential complications that are
happening.
If they have bleedingcomplications, it can arise from
that and create other problems.
It sounds like this kind ofgets more to the issue and
(33:03):
potentially avoids all that.
Speaker 3 (33:05):
Yeah, it really does.
The big thing was is that whatpeople were finding out?
Is that by bringing people inand taking them directly to that
invasive coronary angiography,if they did that, for all comers
there was no difference.
It made no difference forwhether or not they did or
didn't do it early.
So the idea is we don't need todo it in everybody.
But one of the things is theway that we created this sudden
(33:27):
death CT is we actually get acardiac CT so we're able to see
the actual vessels.
So since we can see thecoronary arteries, we can make
decisions whether or not thatpatient needs to go to the
invasive angiolab sooner ratherthan later.
If the coronaries are fine,well, we've ruled out coronary
disease.
Let's go look for some otherissues.
Speaker 2 (33:47):
Yeah, powerful, and we can't wait till this gets
disseminated more widely Indeed.
Speaker 1 (33:52):
Was there any direct change that happened if you do
something every time now whensomeone comes in, Like you said,
30% of patients that you lookedat there was something.
Speaker 3 (34:08):
Yeah, so well, right now, at most of the people that
come in with sudden deathactually go to Harborview.
Okay, that's because that'swhere the center of excellence
is for those kinds of patients.
So they're now doing suddendeath CT routinely on all of
those patients that come in.
So we have all of those data.
So what we're finding out isthat there were sometimes
bleeding complications that goalong with this.
We're finding pneumonias thatare being treated earlier.
(34:29):
We're finding sometimes thatthere are.
Sometimes the lung can bepierced from all of this or the
lung can have a problem,something called a pneumothorax.
So that gets treated very, veryearly and very rapidly.
Sometimes you can't see that ona chest radiograph.
You need it on a CT scan.
We've seen people that have hadbrain bleeds and that's the
(34:51):
reason why.
But you have no idea becausethey can't give you a history,
right?
You don't know what's going on.
And so now you know youshouldn't be giving them
medications which wouldotherwise thin their blood,
because you think, well, maybeit's cardiac source.
We want to thin their blood,open up their arteries and the
blood clot in the arteries.
No, no, no, no.
(35:12):
Don't do the opposite.
Definitely don't give thosemedications and now it's time to
go talk with our neurosurgeonsto see if there are things that
we can do for that patient.
So it's that kind of inferenceand change in management that I
think is really important.
Speaker 1 (35:23):
So wait for the CT is the big change, absolutely.
Speaker 3 (35:25):
Now, the other thing that's interesting is that I was
just reviewing a paper todaythat was saying this, and I
agree the negative impact of anormal scan cannot be overstated
, right?
Okay, it's the FOMO, the fearof missing something, right?
The fear of missing out, right,the fear of missing something.
(35:47):
So if I miss something, right,I'm going to feel really, really
bad about that.
But my tools are limited.
So what the sudden death CTshowed is that, for the
proportion of people that had nofindings whatsoever, there's
nothing that you need to do forthose patients other than your
usual sudden death care, right,so you don't need to take them
(36:08):
to the cath lab and do theinvasive angio.
You don't need to be doing anyof these more aggressive things.
That was a normal scan.
Now look for other things, andunfortunately, what we're seeing
is that many of these peoplehave had overdoses, and so we're
making a diagnosis of nothingon the CT scan, even prior to
their talk screens coming back,and so it gives the emergency
(36:30):
room physicians, as well aswhoever's taking care of those
people, a lot of reassurance.
They don't need to be doinganything more aggressively,
right, and so you're not goingto get into trouble by doing
things you shouldn't, and thenby refraining and doing the
things only you should.
Speaker 2 (36:45):
Yeah, that makes a lot of sense.
Well, your work takes you allover the world.
You're probably one of the morebetter traveled people on our
faculty.
And I know, you've got someinteresting stories about some
places that you have been.
Speaker 3 (37:00):
Oh boy, okay, I'll have to think about this and
make sure that it's rated forthe radio here.
Speaker 1 (37:08):
Okay, we're back from that.
Yeah, we'll be all.
Right, had to cut that last one, yeah right, Exactly Anyway
hold on for that one.
I've got to think about thisfor a second.
I've got to think about thisfor a second.
Anyway, hold on for that one.
Speaker 3 (37:20):
I've got to think about this for a second, I've
got to think about this for asecond.
What are some?
Speaker 2 (37:26):
good.
Well, I know you had a ratherinteresting taxi ride in the
Middle East, oh.
Speaker 3 (37:31):
Lebanon.
Okay, all right, I'll do theLebanon story Okay.
Speaker 1 (37:36):
And is this all CT related, usually with your
travel.
Speaker 3 (37:40):
This is usually big trials.
It's usually big trials and CT.
Yeah, big trials and CT.
So I'll give you my mostinteresting trip, and that was
that I was asked to go to theMiddle East, and specifically
the first stop was Lebanon,flying into Dubai and then
flying to Lebanon to give anumber of talks to the
physicians there and to talkabout one of the compounds that
(38:03):
we had been working on thatactually decreased mortality, so
a very important medication.
When we got there it was verylate at night, and so I hopped
into this white Toyota Corollaand we were driving along and
the guy said we're going to getyou there safely, everyone's
(38:24):
having a good time.
And I said I don't know reallywhere you're going with this.
But as we were driving along, Isuddenly found that the entire
five lane highway both ways wasblocked by burning tires and a
bunch of young people out theredirecting people off the
off-ramp.
We had found out that theLebanese government that day had
imposed a large tax, which wasactually on all of their phones,
(38:48):
and so in retaliation they didthis.
So we did a little Mr Toad'sWild Ride, including going
backwards up a freeway, which Ihad never done before.
He did get me to the hotel ontime.
Now after that, lots of peoplequote-unquote celebrating or
protesting this tax, and so wenever were able to really leave
(39:09):
the hotel very much and weweren't able to give any of the
talks.
I was unfortunately not able tomeet everyone there and, by the
way, this was about a half amile away from where the
explosion had subsequentlyoccurred, right on the water.
So I was told well, it's timefor us to go.
We have found transportation.
(39:29):
We can't get us all the way tothe airport.
I said, wonderful, that wouldbe okay, just get us as close as
you can, we'll be fine.
So again piled into a whiteCamry, this time just not to be
done by the Chikorola, and soseven of us, wedged into a Camry
, were driven again all over upand down, past burning tires and
(39:51):
dumpsters, and thensubsequently stopped and said
this is as far as we can go,thinking full well in my full
suit that I was wearing at thetime, that we were just going to
kind of, you know, wheel it inor something like that.
He said, no, we have foundtransport.
So I was loaded on to a scooterwith a very nice young man
(40:11):
named Muhammad, who was reallywonderful and was very
interested in cardiology.
So we had a wonderfulconversation, dodging various
burning things as we rodethrough the streets and freeways
of Lebanon trying to get to theairport.
At one point there was one wallof fire that was literally four
lanes across.
They had stacked tires 10 high,and so this was a conflagration
(40:36):
.
Mohammed looked at this andfound out that there was about a
four-foot opening on theleft-hand side and gunned it.
They said so I've never been ina blast furnace except for them
.
And so we blasted through thefurnace and there we were at the
airport.
And so, again, mylong-suffering wife.
I chose not to speak with herabout this until I came home,
(41:00):
but the best part is I havevideo of all of this.
Speaker 1 (41:03):
I was about to say I have video.
Do you have a GoPro on yourhead?
It was the.
That would be great.
Speaker 3 (41:08):
Because it's interesting on the radio.
It is better when you visualizeit.
Speaker 1 (41:12):
I might have to tease that for why you listen.
I'll have the clip embedded.
Speaker 2 (41:18):
We can put the AVI on me, no one will miss this
interview.
Speaker 3 (41:21):
We can be on the me on the back of a.
There's actually video of me onthe back of the scooter with
Mohammed having a wonderfulconversation about cardiology in
the Middle East.
Speaker 1 (41:30):
They would make that better as a sidecar, but that's
how it is.
Speaker 3 (41:33):
That's great, this worked pretty well.
Speaker 2 (41:37):
Well, this has been wonderful and extremely
entertaining.
Speaker 1 (41:41):
Yeah, absolutely I would actually say I need at
least one dad joke, though.
Speaker 2 (41:46):
Alright, we do need to we need to end with a dad
joke in the radio voice.
Dad joke in the radio voice.
Speaker 3 (41:54):
This is a little bit of a can I do my highbrow?
Speaker 1 (41:57):
we are extremely highbrow.
We need to go for another fiveminutes with as many dad jokes
as you got.
Alright, alright, just areextremely highbrow.
We need to go for another fiveminutes with as many dad jokes
as you got.
Okay, all right, all right, allright Okay.
Speaker 3 (42:04):
There's a little highbrow, highbrow, okay.
Okay.
So a priest, a pastor and arabbit walked into a bar.
The bartender walks up to therabbit and says hey, why are you
here?
He said spelling error.
Speaker 1 (42:24):
Solid, you here, he said.
Speaker 3 (42:24):
Spelling error.
Speaker 2 (42:25):
Thank you very much.
It was a little highbrow it wasa little highbrow.
Speaker 1 (42:32):
It really tested reading comprehension, that's a
groaner, only the best for thispodcast.
Speaker 2 (42:41):
Exactly right.
Well, this truly has beenamazing, and we so appreciate
you joining us today and givingus not only insights into CT and
clinical research, but alsoamong the most groaning dad
jokes, that there possibly canbe.
Speaker 3 (42:58):
That was pretty good.
Speaker 2 (43:00):
No, but really this has been amazing.
I really appreciate you.
I appreciate all you do for thedivision and the role that you
have taken on, and really one ofthe things I just want to
highlight, too, is your view ofthe research participants.
That really is amazing.
I just think that's sowonderful and I think when
people refer patients toresearch studies here, when
(43:23):
patients sign up, they know thatthey're gonna get treated well.
That's not true everywhere, butI think because of what you
have done and the way that youlook at things, that actually is
is as a reason to come here,not just because you get access
to the cutting edge, not justbecause you get to participate
in this, but because becauseyou're going to actually be
treated well and you mightactually hear a bad dad joke too
(43:45):
.
Speaker 3 (43:45):
Yeah, great.
Well, thank you so much forhaving me.
I do really appreciate it, andI'll do this in my regular voice
rather than my big boy voice.
But it's been wonderful havingthis conversation and kind of
reliving some memories I haven'thad for a little while as well.
So, thanks so much.
Some memories I haven't had fora little while as well.
Speaker 2 (44:01):
So thanks so much.
Fantastic, and thank you verymuch.
See you next time.
This is Coffee and Cardiology.
Speaker 2 (00:05):
In this podcast, we sit down with a faculty from the
University of WashingtonDivision of Cardiology to
discuss the very latest indiagnostics, therapeutics and,
as a special bonus, we ask whatmakes our cardiologists tick.
We have before us the greatKelly Branch, and one of the
(00:27):
things I just learned in thehallway as we're talking about
this is that Kelly's father wasactually a radio guy.
So I am proposing that perhapswe ought to at least conduct
some of this podcast with ourradio voices today.
Speaker 3 (00:46):
I think that's a great idea.
Thanks, Jim.
I appreciate this opportunityto be here, and what a wonderful
setting here today.
Speaker 2 (00:54):
Well, Kelly, I'm just so proud to have you on, it's
such an honor.
I have to say Well, tell me,Kelly, how are you doing today?
Speaker 3 (01:03):
I'm doing great.
But you know what, jim?
I'm always doing great.
So it's almost like every dayis sunshine in the Kelly Branch
world.
But that's just what I pickedup from my father and all of
those years in San Diego, wherewe learned a lot when we go from
the sea all the way to themountains.
(01:23):
That's right, because San Diegohas just about everything
except for the beauty of thePacific Northwest.
Speaker 2 (01:31):
Well, it is quite beautiful here.
I must say, I'm not even goingto try.
Speaker 1 (01:36):
That's great.
Great work guys.
Speaker 2 (01:38):
Great work Well this is going to be a fun one,
absolutely.
For those of you who don't know, the great Dr Branch also is
kind of, I would say, one of themore humorous people on our
faculty.
Everyone knows him for that andrespects him greatly for that.
He kind of really does light upthe room whenever he enters it,
(02:02):
and so we're expecting him todo.
Nonetheless, it's unfortunateyou can't see the aura that is
actually emanating becauseyou're listening.
Speaker 1 (02:09):
Is this off the cuff?
Is this dad jokes?
What is your repertoire?
Speaker 2 (02:11):
Oh my goodness, Dad jokes for sure, okay.
Speaker 3 (02:15):
Yeah, well, we're going to refrain on the dad
jokes because you know thegroaners are definitely there.
I will say that.
But yeah, well, maybe we aredefinitely there I will say that
Maybe we'll fit in a few littlebits.
Speaker 2 (02:35):
That's good.
We'll definitely appreciatethat.
But all joking aside, the goodDr Branch is also a nationally
recognized expert in computedtomography of the heart and we
are so grateful to have himactually on faculty as a leader
in the professional societiesand also as sort of a resident
expert in cardiac CT, and healso leads our clinical trials
unit and that is a veryimportant thing that we want to
(02:58):
hear some more about.
Kelly's a great imager.
He also sees patients in theGeneral Cardiology Clinic.
He's just an all-around niceguy.
I can't wait.
This is great.
Yeah, it is fabulous.
Well, kelly, you hinted alittle bit the fact you grew up
in sunny San Diego.
I did that, but tell us therest about your journey in
(03:20):
medicine.
Speaker 3 (03:27):
Yeah.
So I always knew I wanted to bea doctor ever since I was a
little kid and a lot of thiscame from my grandfather, who
actually had an interestingcourse himself Graduated from
Tulane back in the day Manystories about medical school and
things like that and actuallywas a MASH surgeon in World War
II and actually went islandhopping interestingly in the
same division as myfather-in-law both in the same
(03:49):
division, so they but he cameback and could not handle that
kind of acuity and that kind ofmortality and came back and,
even though he was afull-fledged surgeon, went back
to Pennsylvania and actuallybecame a psychiatrist.
Wow.
So which is a complete 180.
(04:09):
It's a little different 180.
But one of the most intelligentguys in the world Photographic
memory.
I remember that I was sittingin his one of his chairs just
kind of flipping through thishuge Shakespeare book that he
had trying to figure out whatthe heck was going on and he
says, oh, oh, is thatShakespeare's soliloquy?
(04:30):
Looked me straight in the eyeand did the entire soliloquy
from memory reading, from hisphotographic memory, and I said
this is an intelligent man butalso a kind soul, and so with
that he has the humility and thekindness, but actually started
psychiatry, basically west ofthe Rockies, starting at
University of Utah, started thedivision there excuse me,
(04:52):
department there, as well ashelped with starting the School
of Medicine, and so he was ahuge influence, wonderful man
and just someone I inspired tobe.
And so I knew from about theage of four and, yes, at the age
of eight my number one requestwas Grey's Anatomy for Christmas
, wow.
So at the age of nine I wentback to my grandfather and
(05:13):
quizzed him on all 200 bones ofthe body and he did rather
poorly until it came to thewrist and then I corrected him
and so some of us were a littlemore geeky than others, but it's
been a lifelong passion.
And so I went to UCLA forundergrad and there met some
(05:36):
wonderful people, worked forcardiothoracic surgeons there
and actually met Louis Ignaro,who subsequently was working
with our lab and actually wonthe Nobel Prize for figuring out
nitric oxide.
So it was fun to see those kindof interactions of some really
wonderful people and that reallystarted my career in research,
because I was helping with thecardiothoracic research and
figured this is a really greatway to do things and then went
(05:59):
off to medical school and thatwas really the sorry.
And then, in the interim Ishould say, medical school, and
that was really the sorry.
And then, in the interim Ishould say, I started working
for a private group thatactually had some money.
And so for three years after Ihad first gotten married right
out of college to my lovely andwhat I say long-suffering bride,
heidi, is that we had so I wasthe Rosie Zeus Research Scholar
(06:21):
and then from that got a bunchof papers out, figured out that
research is really where Iwanted to go, and then
matriculated to medical school,where I continued as a research
coordinator in San Diego whilebeing in Philadelphia and doing
medical school.
So yet that was just the startof the craziness in my world and
(06:42):
spending a lot of time doingmany things.
So from there went to Michigan,had a wonderful time, lots more
research, met some wonderfulpeople that I still emulate to
this day, and then came to theUniversity of Washington and the
rest, they say, is history.
As I established here and wasgoing to come as a heart failure
transplant LVAD specialist, wasgoing to be doing those
(07:03):
artificial hearts.
That's what I really wanted.
To come as a heart failuretransplant LVAD specialist, I
was going to be doing thoseartificial hearts.
That's what I really wanted todo.
Again, I think I took a lotfrom my grandfather because the
high acuity and the mortalityand the sickness of the people
just couldn't do it.
So I didn't think aboutpsychiatry.
I only a slight pivot and wentto imaging, because people tend
(07:23):
to do a little bit better whenyou image them.
And then we started to do thatIn 2004, we got this new machine
.
It was right off the GE line.
It was the first 64-slice CT.
It was the serial number 001.
And so we got that machine andone of my mentors, who was the
(07:44):
vice chair of radiology, said wehave these new CT scans.
I know you're looking aroundfor research.
I think this would be wonderfulresearch, and so we started to
do CT scans in 2004 when therewere only two training centers
in the United States, and so wejust basically kind of learned
by ourselves.
I went down to see Matt Budoffback in LA, my good friend Matt,
who helped me kind of finish upmy training, and then ever
(08:08):
since then that's been thejourney, wow.
Speaker 2 (08:12):
That is quite a journey.
Speaker 1 (08:15):
Where did the heart come into all this?
Where was your?
Why?
For why you got into cardiology?
Speaker 3 (08:20):
Oh, it's a great the I had known for a while.
There were two things I wasvery interested in.
One was the brain and then onewas the heart, and for kind of
different reasons, right, brainsare very interesting just
because they are so.
They're us, they're human,right, and you know so much of
who we are and so much ofeverything is just the brain.
(08:42):
What I found out as we weregoing through is that when the
brain gets injured, there's notmuch you could do.
And this was in the heyday wherewe're going to have all of
these wonderful new medicationsthat were going to help the
brain and none of them worked.
At the same time, I had gottenan experience with
cardiothoracic surgery andcardiology, and that was a
wonderful mix of intellectualism, of being able to do something
(09:05):
for people, of really being ableto, and then also having kind
of the ability to treat patientsand having that acuity that
makes things a little bit moreinteresting, kind of had that
whole, kind of had everything.
And so that's where I reallykind of said, well, I'm either
going to do neurology orneurosurgery, cardiothoracic
surgery or cardiology, and thosesurgeons work way too hard.
Speaker 1 (09:27):
I'm sorry, they work way too hard.
Speaker 3 (09:29):
So love them to death , but I'm not that crazy.
So cardiology was really themesh of all of those wonderful
things, and I'm still interestedin neurocardiology, don't get
me wrong but cardiology isreally where this ended up, yeah
that makes a lot of sense.
Speaker 2 (09:47):
So imaging in particular, you gave us a little
bit of a window about how youheaded into that.
What sort of changes have youseen in CT other than that we're
no longer on 64 slices, but?
But where else has CT gone?
And what continues to captivateyou about cardiac CT?
(10:07):
What?
Speaker 1 (10:08):
are we at now?
Speaker 3 (10:09):
Yeah, so we are on.
Well, we've expanded.
So there are many differenttypes.
Now, right, really, the vendorshave gone two different ways,
one of which is to use what'scalled a wide detector, so one
rotation, one heart is what wecall it.
So you get everything withinless than a second.
(10:29):
That's it, you're done.
One of the other vendors usestwo CT scanners that are
basically mounted at 90 degreesto one another Also a very quick
way to do that in wonderfulimages.
So people have gone a coupledifferent ways.
The newest kit on the block,which is something that we are
looking into and we'll begetting a prototype here, and
(10:49):
then hopefully, we'll be gettinganother vendor down at
Harborview there's somethingcalled a photon counting CT.
Now Godfrey Hounsfield, when hewas first creating the CT
scanner.
And, by the way, quick aside.
So what is the relationshipbetween the Beatles and a CT
scanner?
Do you know?
Is this a dad joke?
Speaker 1 (11:11):
No, no, it's a good question.
Speaker 3 (11:12):
It's a good question.
No, this is honest to goodness,honest to goodness.
Do you know the?
I do not know the answer.
Okay, this is one of thosewonderful connections.
So Godfrey Hounsfield ofHounsfield Units right, was an
engineer at EMI which was alsosupporting the Beatles.
Now the Beatles had been doingso well for EMI and Godfrey
(11:32):
Hounsfield, his engineering crew, had kind of been put a little
bit on the wayside.
So he had some time and withthis time he said I've been kind
of brewing this a little bit,this idea of this CT scanner.
And so while he was at EMI,which is basically supported by
all of the Beatles, he was ableto create the CT scan and
(11:53):
actually develop that whilegetting paid by EMI.
Wow, so the Beatles wereindirectly supporting the
development of the CT scan.
Wow.
So there you go.
So there's your trivia fortoday.
Speaker 2 (12:06):
So really, when people are in that scanner, we
should be playing the Beatles.
Speaker 3 (12:10):
I think that would be completely appropriate, even
though it's so short.
I mean, yeah, exactly.
Speaker 1 (12:14):
So, but then didn't hit the US until 2004?
.
Speaker 3 (12:18):
The 64 slice.
This it got it.
We did have the.
We did have the early slice,the one slice, the four slice,
the 8-16.
We had this kind of era.
The 64 slice was really thefirst era where we were able to
create cardiac CT.
We were able to get the imagesgood enough and still enough
that we were able to read themin a robust way.
The older slices, the olderscanners sometimes those took
(12:41):
minutes.
They weren't gated to thecardiac cycles.
There was a lot of motion so itwas hard to tell.
64 slice was really that firstera.
Now we've gone through a coupleof iterations with different
kinds of scanners, and reallywhat we're at now is this thing
called the photon-counting CT.
Godfrey Hounsfield wanted todevelop the idea that, as
(13:03):
photons are being kind of pushedthrough the body, there's very
complex interactions that arehappening at the molecular level
.
If you're able to measure those,those kinds of interactions,
rather than having just a photonthat hits a detector yes, no,
there are some subtleties to thekind of energy as it hits the
detector and from that you canget much better resolution and
(13:25):
you can figure out things thatare metal, calcium and bone and
other soft tissues, and sothat's the new revolution.
Right now there's only onevendor that has it, but other
vendors are in development, andso I think that's going to be
the new revolution, in that weare going to be seeing much more
(13:45):
than we're able to see today.
We're going to be able to takeout a lot of the artifacts which
CT is really prone to, and withall of the other technologies
that have been developed overtime, we do this with a low
radiation dose very, veryquickly.
Oftentimes these are less thana second, or sometimes maybe
within two to three seconds.
And again, these are 3D datasets.
You can go back forever and goback and reconstruct these and
(14:08):
take a look as you like.
So that's the new revolution.
Speaker 2 (14:14):
So how do you think that's going to play out in
clinical cardiology right now?
I think most of our listenersare probably very aware of the
coronary calcium scores andcardiac CT for coronary artery
disease detection andcharacterization.
What else are we doing or whatis on the horizon for CT in the
clinical realm?
Speaker 3 (14:32):
Yeah.
So I see two different waysthat this is going to go for
cardiac CT.
Number one, because of the waythat the new scanners are
working and kind of the benefitof the new scanners, especially
with photon counting CT, theidea of taking someone to a
diagnostic, invasive coronaryangiography where you do it from
the hand, you know the arm orthe groin, where you're just
(14:54):
going to look, a lot of that'sgoing to go away because we
don't have to worry about thethings that are in the way now
the stents, the calcium, thingslike that.
The motion artifacts are goingto be reduced.
All of those things are goingto be working in our favor.
So we may not.
So when we're doing anangiogram, we're doing the
invasive coronary angiogram,we're actually going there to
try to fix something, so we'rereally going to be reducing that
(15:18):
angiogram.
That really didn't have much ofa purpose other than to rule
out disease.
It also allows us, becausewe're able to see the plaques
better.
We can start to treat thepatients accordingly, and that's
what I've been doing is to say,yes, I see the stenosis, you
have symptoms, I don't need toget any additional studies.
I know that this is probably,you know, a blockage that's
significant.
(15:38):
Here are your medications thatare going to allow you to go off
and do the things you want todo.
You don't necessarily need astent.
It's equivalent as far asputting in a stent versus not
for many, many people.
And so now we can start to justuse CT scans and then move
forward, and that is the onlymodality that you need.
The final thing that I think isgoing to be revolutionary and a
(16:00):
lot of us are working withinthis field now is to actually do
something called plaquecharacterization, and that is
not just looking inside thevessel, which shows the blockage
, but looking outside the vessel.
And outside the vessel is wherea lot of the machinery for
atherosclerosis and the layingdown of atherosclerosis.
What I tell people is, I saidit's like an asphalt machine.
It keeps laying down layerafter layer after layer, right,
(16:23):
and a lot of those get stablewhen they're down at the bottom
and that first layer can becomecalcified and that's that
calcium score that you see, it'sthe endpoint of atherosclerosis
.
That's mature.
It's not going to go anywhere,it's not going to affect
anything, it just sits there.
You can't get rid of it either,at least not very easily, but
it's the hot top layer.
That's the thing you can getrid of with medication.
(16:44):
But we're able to start seeingthat top layer and start seeing
those hot zones right, we callthem the low attenuation plaques
and we're starting to see thetotal plaque volume and the
non-calcified plaque volume.
All of these measurements now ina very robust way, and we think
the revolution is that whenpatients come to see us ask how
am I doing, I can say you knowwhat.
(17:06):
I could get a CT scan.
I can see where youratherosclerosis burden is.
Are we better, worse?
Do we have more calcium, whichis sometimes good because it's
maturing, but do we have a lotmore atherosclerosis?
If we do, I need to be moreaggressive and so we are able to
do this in a more robust wayrather than just relying on
(17:28):
serologic, you know, like blooddraws and those kinds of and
then the risk factorsmodification.
So those work okay, but if Ireally want to know what's going
on inside your vessels, I'mgoing to be able to see, you
know, and this just strikes me.
Speaker 2 (17:42):
The overall role that CT is playing is one of nuance
and sophistication.
This is the new thing.
It sounds like what you'resaying.
Yeah, because in the past welooked at calcium Well, it's a
marker for disease.
We looked at even stenosis Well, that is another marker for
badness and bad things arehappening.
But now we're drilling down andI have a surprising number of
(18:04):
patients you know well we need astatin.
Well, I really don't want totake a statin.
And they ask very probing andinsightful questions and with
our current way of riskstratification I can't really
answer them.
But it sounds like in thefuture CT is holding some
promise for that, absolutely,absolutely.
Speaker 3 (18:22):
Yeah, it's really going to give you an insight
that we've never seen before,and it's not only for the
coronaries, it can be for othervessels too.
Actually, those other vesselsare much easier, they don't move
as much and they're much larger, so you can get kind of an idea
about what's going on withinnot only a coronary, but you can
actually get a whole-bodyatherosclerosis burden if you
want to go down that track.
What we just don't know is weknow that these are associations
(18:47):
.
We know that certainmedications can regress
atherosclerosis versus if you'renot on the medication.
We know that it progressesatherosclerosis.
Things like testosteroneactually increases
atherosclerosis versus if you'renot on the medication.
We know that it progressesatherosclerosis.
Things like testosteroneactually increases
atherosclerosis rather thanregressing atherosclerosis.
So there are things that areactually detrimental to
atherosclerosis, and so the idearight now for one of the groups
(19:07):
that I'm working with is thatwe are going to FDA to say,
rather than doing these largestudies on every single compound
that could possibly come out,because these studies are $300,
$400, $700 million, you justcan't do that for every compound
you're interested in.
What if I said that for $3million, I would be able to tell
(19:32):
you in 18 months whether or notthis reduces atherosclerosis,
and I'd be able to tell you in18 months whether or not this
reduces atherosclerosis.
And I'd be able to do it with400 patients, not 27,000, right.
So now we see this newrevolution of being able to do
these smaller programs,interesting compounds that may
actually affect atherosclerosisin a way, but people just don't
(19:56):
have hundreds of millions ofdollars to do the study.
But if it looks promising thenwe can move forward to a more
robust way of looking for, youknow, kind of the usual
endpoints, the major adversecardiovascular events, which
unfortunately takes thousands,sometimes tens of thousands of
people in years to figure out.
But I'm going to be able tofigure out whether or not this
is a good idea in 18 months.
Speaker 1 (20:18):
And that's because of the nuance of the technology we
have now versus got it.
Speaker 3 (20:21):
Yeah, because that atherosclerosis we can actually
measure it in a quantitative wayand compare when we begin and
when we stop, and we canrandomize people to either
placebo or the medication andthen know whether or not it's
good or, in the case oftestosterone, detrimental.
Speaker 2 (20:39):
And it sounds like it's going to be much more
nuanced than just more calciumor even more atherosclerosis.
It's going to be?
What type of atherosclerosis?
We're talking about, yeah, andactually calcium is going to be
good yeah more calcium better.
Speaker 3 (20:54):
A little bit of calcium is good.
Too much is bad.
Too much is bad.
There's always this middleground.
Speaker 2 (20:59):
Well, this is a great segue actually into your work
with the Clinical Trials Unit.
Could you tell us a little bitabout what that is, what you do,
how that fits into the Divisionof Cardiology?
Speaker 3 (21:10):
Sure.
So the Clinical Trials Unitreally has two facets to it, one
of which is that we serve as aresource for these large trials
that I just talked about, thesevery, very expensive trials.
We serve as a site for thesetrials, which allows our
patients access to a lot ofthese new potentially beneficial
(21:30):
medications.
Now, the important part of whatI just said is the potentially
beneficial medications.
We don't know.
As Einstein said, if we knewwhat we were doing, we wouldn't
call it research right, and sowe do this.
But if you think about it andthis is what I tell patients a
lot if you think about all themedications that you're taking
that we know are beneficial,it's because somebody, just like
(21:51):
the people that are alreadyenrolled in the CTU, stood up
and said I'm going to be in thisresearch study and I'm going to
help you find information.
It may not help me, but it'sgoing to help people down the
line.
And so, really, all of thesepeople that are in the CTU and
we appreciate them so much forvolunteering for research
(22:11):
they're really standing on theshoulders of all of the millions
of people that had volunteeredfor clinical research previously
, the millions of people thathad volunteered for clinical
research previously, but theclinical research.
So we do site, what we callsite trials.
Right, so we will be one siteof, say, 600 sites within the
world that are asking a veryimportant question, and they
come in different flavorsSometimes they're smaller trials
(22:31):
, sometimes they're biggertrials, sometimes they're trials
that we own or we do, andsometimes they're larger trials.
And really all of this is totry to drill down and again kind
of move the needle forward, sowe're always on the cutting edge
and looking at what's new.
There's another side to this,called the Clinical Trial
Service Unit, which my mentor,now colleague, jeff Probstfeld,
(22:54):
had started 30 years ago, andthis helps with fostering these
large, large clinical trials.
Okay, and so we generally runthe United States for one of our
groups in Canada called PHRI,and so these trials are anywhere
between 10,000 to 50,000 people, and so we kind of help run the
(23:15):
United States, work on thesteering committees and then
have a little bit of a differenteffect in that we are helping
to foster other sites, not justour site but other sites and
many of the sites in the UnitedStates, and this has really
helped to kind of push thingsforward and a lot of these
things have ended up in veryinfluential places like New
England Journal and Lancet andJAMA, and this kind of work
(23:38):
actually really propels thingsforward.
The site is very, veryimportant, but sometimes the 50
sites or 60 sites that weoversee are equally important.
So we kind of serve twodifferent roles.
But that kind ofcross-fertilization has really
allowed us to really become arobust place, because we know
what the sponsors want from us,because we're a sponsor right,
because we know what people want, and so we become very, very
(24:00):
good sites.
Speaker 1 (24:02):
And when you say we University of Washington at
large for that service unit.
Speaker 3 (24:06):
This is University of Washington, correct?
Speaker 1 (24:07):
And then we have our clinical trials unit within
cardiology.
Correct, got it, yep.
Talk a little bit about thatteam that you have.
Yeah, I got to meet thembriefly.
Speaker 3 (24:15):
So, okay, we're good.
Well, they're a wonderful team.
So we have 18 people right nowthat are underneath the CTU all
very dedicated people and at alldifferent levels of experience,
and so we love to bring peoplein and train them, to show them
how to do this kind of work, andthen they either go on to
bigger and better things or staywith us for long periods of
(24:38):
time.
But these really are highlydedicated people to again
getting answers, gettingimportant answers to important
questions, and making sure thatpatients, once they become in a
trial we call them participants,because that's really what they
are.
They're not patients anymore,they are participating, actively
participating in this.
We make sure participants arewell treated.
(25:00):
So what I tell people is thatparticipants that are here, they
get to fly first class.
Speaker 1 (25:05):
If they have a problem they come to me right.
Speaker 3 (25:08):
So if they're my patients, then we say you have
this problem, I got a guy.
I'm going to give the guy acall.
You got a problem, that's, youknow, with your gastroenterology
tract or something like that.
I got a guy.
So it kind of allows people, ifthey're going to be this
generous, then I'm going to haveto reciprocate by kind of
greasing the skids a little bitand making sure that they are
(25:28):
very well taken care of from amedical standpoint and otherwise
.
Point is and otherwise.
So we really kind of fosterthat within the clinical trials
unit have wonderful people andyou know couldn't say enough
about Jennifer Schaefer whoreally runs it.
Laura Curtin is one of oursenior coordinators.
Those are really the.
You know, laura's kind of theheart of the CTU and Jennifer
kind of keeps us all in line andit's good to have both of those
(25:51):
people.
They're really kind of headingit up and of course, all the
other wonderful people within it.
Speaker 1 (25:55):
This may be a little self-serving of a question, but
how do you find and engage andget participants?
Speaker 3 (26:04):
Yeah, so there are a lot of different ways that we
find it.
Sometimes we'll screen throughthis massive amount of data that
we have.
That's called an electronicmedical record right, that's a
common way of finding it.
Sometimes we'll find people inthe clinic that will be referred
by our colleagues, or sometimeswe screen for them.
So we're actively looking forthem.
Once in a while we'll actuallyhave, you know, tv or radio that
(26:26):
will go out and we'll say, hey,we're doing this wonderful
trial about this particularproblem, if you do give us a
call, and so we sometimes findpeople.
So there are many differentways that we do it.
We have placards and thingslike that and little posters and
things.
So there are many differentways that we identify these
people.
But it's amazing how manypeople are so altruistic that
(26:47):
they actually search us out, andespecially if there's something
really interesting.
One of the things that I've beenworking on a lot is lipoprotein
A or LP, little a.
It's kind of what we call it.
Sticky ldl is a way of thinkingabout her sticky bad
cholesterol, and it's just adriver for very early
cardiovascular events, forsomeone that has recurrent
cardiovascular events, somethingthat everyone should be
(27:07):
screened for once in their life,at least once in their life.
But we see we now have a lot ofpeople that are now coming to
us because we're doing this workand saying I have elevated
lipoprotein a, what can I doright?
And so, along those lines, wehave one trial that's actually
looking for major adversecardiovascular events.
That's the large trial.
(27:28):
Okay, that's an 8 000 patienttrial.
And then, along the lines ofthat plaque characterization
that I talked about, we have amuch smaller trial, 700-patient
trial that's actually looking atplaque characterization in
people that have not had eventsyet, that have not had a heart
attack, stroke or acardiovascular event.
So they're early.
And so now we have two prongsfor people that have already had
(27:48):
events and people that have nothad events, so that we actually
get that full gamut ofexperience for this particular
thing.
But it's amazing how manypeople come find you.
Speaker 2 (27:56):
Well, that's great.
So some of our listeners mayactually be wanting to refer
patients to you.
How do they do that?
Speaker 3 (28:03):
Yeah, so on the UW website you can look for
clinical research, and there area couple of different ways that
in the Division of Cardiologythere's line items that are
there as well.
Couple different ways that inthe division of cardiology
there's line items that arethere as well.
Within what's called the ITHS,which is our large clinical
group, there's also a listingfor clinical research.
(28:25):
If you're interested, go to oneof those websites and then
there will be a link there thatyou can click.
It actually emails us or emailsITHS and they'll get to us if
you're interested in what'sgoing on.
If not, then just say hey, youknow these are my problems.
I'm interested in getting toclinical research and we'll be
happy to chat with you and seeif something fits and if it
(28:46):
doesn't, we also know what'skind of going on around town as
well, and sometimes there's abetter fit somewhere else.
We're more than happy to referto those places as well.
Speaker 2 (28:56):
Oh, that's just fantastic.
Speaker 3 (28:56):
Well, I want to pivot a little bit and talk about
patients who are probably notgoing to be intentionally
referred to you, and that isyour work in resuscitation,
that's true, that's true, that'syet another hat, but it was
born out of kind of my and Iguess it's a passion for being
(29:18):
able to do more with very, verylittle right and really trying
to be as efficient as possible.
I love efficiency.
I really don't like to, youknow, kind of lollygag around.
That's kind of not my modusoperandi, even though I am from
San Diego, so I'm supposed to bevery chill.
I can use dude in a sentence,don't get me wrong.
Speaker 2 (29:38):
I have no doubt, but there's a little burning fire
underneath all of this.
Speaker 3 (29:43):
So part of that was to try to figure out, because
when I was at Harborview andthis was actually as a trainee
when I was a fellow I noticedthat all of these people would
come in after a sudden deathevent and the real question was
what do we do with these people?
How do we work these patientsup?
What was the initial problemthat they had that had their
sudden death event?
Because that's going to informwhat we're supposed to be doing.
(30:04):
Was this because of blockagesin their arteries?
Was it because the heart wasn'tworking?
Was it because of a blood clotthat went to the lungs or some
other problem?
Well, what also ended uphappening is that they would
have resuscitation, which in andof itself, is kind of a
traumatic event.
There's a lot that happens withCPR and being in a breathing
machine and being cooled and youknow all of the things that go
(30:25):
on with trying to optimize.
You know, bring people back andthen optimize them.
Speaker 2 (30:30):
So you're seeing, it's not like daytime soap opera
resuscitation, it is not.
It is not Good to know.
Speaker 3 (30:37):
It's been a very, very long time since I've
actually pulled any paddles andkind of rubbed them together and
put them on anybody's chest,okay, so Hollywood needs to
catch up a little bit.
But suffice to say that thequestion was how can we work
this up in a robust way to tryto figure out what the
(30:59):
resuscitation problems that theyhad, what caused the sudden
death event, and how are wesupposed to treat these patients
differently?
And so we came up with thisthing called the Sudden Death CT
or SDCT, and basically it's thepan-man or pan-woman scan.
It's basically from head allthe way to the pelvis and
evaluating all of thosestructures that could actually
(31:20):
cause sudden death or could beaffected by the resuscitation or
falls or anything else.
And so from this development wefound out that actually the
yield was very, very good withthis.
So we were able to instead ofhaving 25% of people we had no
idea why they died, had no ideawhy they died.
(31:40):
Now we're up to 92%.
Now we know 92% of people.
We had no idea why they died,had no idea why they died.
Now we're up to 92%.
Now we know 92% of people.
We know why they died.
Okay, so there's a huge increasein.
Now we know what the problemwas, okay, and then we looked at
all the complications and thecomplications that are not just
there right from theresuscitation because they had a
little pneumonia or whatever,but also things that need action
(32:01):
right, and about 30% of peoplewe were finding things that
needed some kind of action right.
Something needed to get changed, and this was sometimes
resuscitation problems.
This was sometimes there was awhopping pneumonia that we
didn't know that they had thingslike that.
So now, 30% of the time, we'reactually changing what we're
doing based on the CT scan, andthis is a CT scan that is done
(32:23):
within two hours of the patientarriving.
They're sedated, they have allof the things of the
post-resuscitation care, but itreally guides what we're doing
as far as resuscitation goes,and so I think it's a new
paradigm for how people aregoing to be evaluated as they
move into the post-arrestsetting.
Speaker 2 (32:43):
Yeah well, that certainly makes a lot of sense.
You know there had been someresearch and even people setting
up a cath lab in the emergencydepartment so you could cath all
of these patients with all thepotential complications that are
happening.
If they have bleedingcomplications, it can arise from
that and create other problems.
It sounds like this kind ofgets more to the issue and
(33:03):
potentially avoids all that.
Speaker 3 (33:05):
Yeah, it really does.
The big thing was is that whatpeople were finding out?
Is that by bringing people inand taking them directly to that
invasive coronary angiography,if they did that, for all comers
there was no difference.
It made no difference forwhether or not they did or
didn't do it early.
So the idea is we don't need todo it in everybody.
But one of the things is theway that we created this sudden
(33:27):
death CT is we actually get acardiac CT so we're able to see
the actual vessels.
So since we can see thecoronary arteries, we can make
decisions whether or not thatpatient needs to go to the
invasive angiolab sooner ratherthan later.
If the coronaries are fine,well, we've ruled out coronary
disease.
Let's go look for some otherissues.
Speaker 2 (33:47):
Yeah, powerful, and we can't wait till this gets
disseminated more widely Indeed.
Speaker 1 (33:52):
Was there any direct change that happened if you do
something every time now whensomeone comes in, Like you said,
30% of patients that you lookedat there was something.
Speaker 3 (34:08):
Yeah, so well, right now, at most of the people that
come in with sudden deathactually go to Harborview.
Okay, that's because that'swhere the center of excellence
is for those kinds of patients.
So they're now doing suddendeath CT routinely on all of
those patients that come in.
So we have all of those data.
So what we're finding out isthat there were sometimes
bleeding complications that goalong with this.
We're finding pneumonias thatare being treated earlier.
(34:29):
We're finding sometimes thatthere are.
Sometimes the lung can bepierced from all of this or the
lung can have a problem,something called a pneumothorax.
So that gets treated very, veryearly and very rapidly.
Sometimes you can't see that ona chest radiograph.
You need it on a CT scan.
We've seen people that have hadbrain bleeds and that's the
(34:51):
reason why.
But you have no idea becausethey can't give you a history,
right?
You don't know what's going on.
And so now you know youshouldn't be giving them
medications which wouldotherwise thin their blood,
because you think, well, maybeit's cardiac source.
We want to thin their blood,open up their arteries and the
blood clot in the arteries.
No, no, no, no.
(35:12):
Don't do the opposite.
Definitely don't give thosemedications and now it's time to
go talk with our neurosurgeonsto see if there are things that
we can do for that patient.
So it's that kind of inferenceand change in management that I
think is really important.
Speaker 1 (35:23):
So wait for the CT is the big change, absolutely.
Speaker 3 (35:25):
Now, the other thing that's interesting is that I was
just reviewing a paper todaythat was saying this, and I
agree the negative impact of anormal scan cannot be overstated
, right?
Okay, it's the FOMO, the fearof missing something, right?
The fear of missing out, right,the fear of missing something.
(35:47):
So if I miss something, right,I'm going to feel really, really
bad about that.
But my tools are limited.
So what the sudden death CTshowed is that, for the
proportion of people that had nofindings whatsoever, there's
nothing that you need to do forthose patients other than your
usual sudden death care, right,so you don't need to take them
(36:08):
to the cath lab and do theinvasive angio.
You don't need to be doing anyof these more aggressive things.
That was a normal scan.
Now look for other things, andunfortunately, what we're seeing
is that many of these peoplehave had overdoses, and so we're
making a diagnosis of nothingon the CT scan, even prior to
their talk screens coming back,and so it gives the emergency
(36:30):
room physicians, as well aswhoever's taking care of those
people, a lot of reassurance.
They don't need to be doinganything more aggressively,
right, and so you're not goingto get into trouble by doing
things you shouldn't, and thenby refraining and doing the
things only you should.
Speaker 2 (36:45):
Yeah, that makes a lot of sense.
Well, your work takes you allover the world.
You're probably one of the morebetter traveled people on our
faculty.
And I know, you've got someinteresting stories about some
places that you have been.
Speaker 3 (37:00):
Oh boy, okay, I'll have to think about this and
make sure that it's rated forthe radio here.
Speaker 1 (37:08):
Okay, we're back from that.
Yeah, we'll be all.
Right, had to cut that last one, yeah right, Exactly Anyway
hold on for that one.
I've got to think about thisfor a second.
I've got to think about thisfor a second.
Anyway, hold on for that one.
Speaker 3 (37:20):
I've got to think about this for a second, I've
got to think about this for asecond.
What are some?
Speaker 2 (37:26):
good.
Well, I know you had a ratherinteresting taxi ride in the
Middle East, oh.
Speaker 3 (37:31):
Lebanon.
Okay, all right, I'll do theLebanon story Okay.
Speaker 1 (37:36):
And is this all CT related, usually with your
travel.
Speaker 3 (37:40):
This is usually big trials.
It's usually big trials and CT.
Yeah, big trials and CT.
So I'll give you my mostinteresting trip, and that was
that I was asked to go to theMiddle East, and specifically
the first stop was Lebanon,flying into Dubai and then
flying to Lebanon to give anumber of talks to the
physicians there and to talkabout one of the compounds that
(38:03):
we had been working on thatactually decreased mortality, so
a very important medication.
When we got there it was verylate at night, and so I hopped
into this white Toyota Corollaand we were driving along and
the guy said we're going to getyou there safely, everyone's
(38:24):
having a good time.
And I said I don't know reallywhere you're going with this.
But as we were driving along, Isuddenly found that the entire
five lane highway both ways wasblocked by burning tires and a
bunch of young people out theredirecting people off the
off-ramp.
We had found out that theLebanese government that day had
imposed a large tax, which wasactually on all of their phones,
(38:48):
and so in retaliation they didthis.
So we did a little Mr Toad'sWild Ride, including going
backwards up a freeway, which Ihad never done before.
He did get me to the hotel ontime.
Now after that, lots of peoplequote-unquote celebrating or
protesting this tax, and so wenever were able to really leave
(39:09):
the hotel very much and weweren't able to give any of the
talks.
I was unfortunately not able tomeet everyone there and, by the
way, this was about a half amile away from where the
explosion had subsequentlyoccurred, right on the water.
So I was told well, it's timefor us to go.
We have found transportation.
(39:29):
We can't get us all the way tothe airport.
I said, wonderful, that wouldbe okay, just get us as close as
you can, we'll be fine.
So again piled into a whiteCamry, this time just not to be
done by the Chikorola, and soseven of us, wedged into a Camry
, were driven again all over upand down, past burning tires and
(39:51):
dumpsters, and thensubsequently stopped and said
this is as far as we can go,thinking full well in my full
suit that I was wearing at thetime, that we were just going to
kind of, you know, wheel it inor something like that.
He said, no, we have foundtransport.
So I was loaded on to a scooterwith a very nice young man
(40:11):
named Muhammad, who was reallywonderful and was very
interested in cardiology.
So we had a wonderfulconversation, dodging various
burning things as we rodethrough the streets and freeways
of Lebanon trying to get to theairport.
At one point there was one wallof fire that was literally four
lanes across.
They had stacked tires 10 high,and so this was a conflagration
(40:36):
.
Mohammed looked at this andfound out that there was about a
four-foot opening on theleft-hand side and gunned it.
They said so I've never been ina blast furnace except for them
.
And so we blasted through thefurnace and there we were at the
airport.
And so, again, mylong-suffering wife.
I chose not to speak with herabout this until I came home,
(41:00):
but the best part is I havevideo of all of this.
Speaker 1 (41:03):
I was about to say I have video.
Do you have a GoPro on yourhead?
It was the.
That would be great.
Speaker 3 (41:08):
Because it's interesting on the radio.
It is better when you visualizeit.
Speaker 1 (41:12):
I might have to tease that for why you listen.
I'll have the clip embedded.
Speaker 2 (41:18):
We can put the AVI on me, no one will miss this
interview.
Speaker 3 (41:21):
We can be on the me on the back of a.
There's actually video of me onthe back of the scooter with
Mohammed having a wonderfulconversation about cardiology in
the Middle East.
Speaker 1 (41:30):
They would make that better as a sidecar, but that's
how it is.
Speaker 3 (41:33):
That's great, this worked pretty well.
Speaker 2 (41:37):
Well, this has been wonderful and extremely
entertaining.
Speaker 1 (41:41):
Yeah, absolutely I would actually say I need at
least one dad joke, though.
Speaker 2 (41:46):
Alright, we do need to we need to end with a dad
joke in the radio voice.
Dad joke in the radio voice.
Speaker 3 (41:54):
This is a little bit of a can I do my highbrow?
Speaker 1 (41:57):
we are extremely highbrow.
We need to go for another fiveminutes with as many dad jokes
as you got.
Alright, alright, just areextremely highbrow.
We need to go for another fiveminutes with as many dad jokes
as you got.
Okay, all right, all right, allright Okay.
Speaker 3 (42:04):
There's a little highbrow, highbrow, okay.
Okay.
So a priest, a pastor and arabbit walked into a bar.
The bartender walks up to therabbit and says hey, why are you
here?
He said spelling error.
Speaker 1 (42:24):
Solid, you here, he said.
Speaker 3 (42:24):
Spelling error.
Speaker 2 (42:25):
Thank you very much.
It was a little highbrow it wasa little highbrow.
Speaker 1 (42:32):
It really tested reading comprehension, that's a
groaner, only the best for thispodcast.
Speaker 2 (42:41):
Exactly right.
Well, this truly has beenamazing, and we so appreciate
you joining us today and givingus not only insights into CT and
clinical research, but alsoamong the most groaning dad
jokes, that there possibly canbe.
Speaker 3 (42:58):
That was pretty good.
Speaker 2 (43:00):
No, but really this has been amazing.
I really appreciate you.
I appreciate all you do for thedivision and the role that you
have taken on, and really one ofthe things I just want to
highlight, too, is your view ofthe research participants.
That really is amazing.
I just think that's sowonderful and I think when
people refer patients toresearch studies here, when
(43:23):
patients sign up, they know thatthey're gonna get treated well.
That's not true everywhere, butI think because of what you
have done and the way that youlook at things, that actually is
is as a reason to come here,not just because you get access
to the cutting edge, not justbecause you get to participate
in this, but because becauseyou're going to actually be
treated well and you mightactually hear a bad dad joke too
(43:45):
.
Speaker 3 (43:45):
Yeah, great.
Well, thank you so much forhaving me.
I do really appreciate it, andI'll do this in my regular voice
rather than my big boy voice.
But it's been wonderful havingthis conversation and kind of
reliving some memories I haven'thad for a little while as well.
So, thanks so much.
Some memories I haven't had fora little while as well.
Speaker 2 (44:01):
So thanks so much.
Fantastic, and thank you verymuch.
See you next time.
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