August 12, 2025 • 28 mins
Dr. Sandeep Rao brings the borderland the latest information in healthcare, medicine and technology. He considers himself a hacker in the positive sense, using his intimate knowledge of the medical system to break down some of the barriers to accessing new medical technologies and information.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Good afternoon. It's another weekend here in the heart of
the dusty ch want when desert in West Texas. You're
listening to the Medical Ackers, however, you may be tuned
in this week, and I'm your host, doctor Sandy Row.
I'm here to bring the Boordland's latest information in healthcare,
medicine and technology on the show. I'll consider myself a
hacker in the positive sense, a hacker who used my
(00:26):
intimate knowledge of the medical system to helping breaking down
some of the bearest accessing new medical technologies into current
healthcare information. So I got Juni back here with me.
Speaker 2 (00:37):
Hey, doctor Row, It's always good to be here with you, brother.
Speaker 1 (00:40):
Great to have you here as a sounding board and
just to kind of, you know, let you know what's
going on. So this was very interesting for me. I
had a very interesting week last week. As you know,
I'm a vaster interventionalist. I deal with all things dealing
with blood vessels, and folks often ask me what's a
(01:01):
common issue that you deal with, And sometimes just to
give people an example, I always talk about embolizing or
that means cutting off the blood supply to an organ. Now,
whenever I use that example to the layman out there,
the late public euthor. Oftentimes I talk about the most
(01:21):
emergent issue that would cause that a situation in which
you have to come in, you have to get it
done within a certain window of time, and so I
oftentimes use example of splenic injury. But interestingly, because I've
sort of started gravitating to doing more outpatient procedures outside
(01:42):
the hospital, doing embolizations for you know, for knee pain,
for patients who have I don't know, foot pain, plantar fasciatis,
prostate issues, all these different areas that you can treat
with decreasing the blood supply, I don't see the need
to do splenic embolization much. However, what is splinic? So
(02:07):
the splenic that's that's a good that should you know,
take suspect the very beginning of it, right. What is this?
The spleen is the spleen is an organ that sits
in the left side of your abdomen. Okay, so if
you were to see the right side of your abdomen,
you can actually feel your liver, Okay, like kind of
under your rib cage. You can feel the liver. It's
a big organ and those of us, those folks who
(02:30):
who might have liver disease, might people who have issues
with alcohol, folks who have issues with cirrhosis, hepatitis. It
might be a little bit bigger, it might actually be
what we call hepatomegally, it might be a little bit larger.
But when it comes to the spleen, you are usually
not able to feel that organ. It's act but it
(02:51):
does sit on that left side, so it's exactly its
opposite the liver, so on the left side kind of
under that rib area. So it's not an organ that
you will frequently feel, but it's it's it's there, it's
there's doing a very valuable task. It's an organ that's
about I would say normally about thirteen centimeters long or so.
(03:12):
So it's not that it's not a huge organ, but
I would say, you know, thirteen centimeters if you were
to think about it, kind of look at look at
your hand, okay, you know, depending on you know how
big your hand is. You know, it's you know, I
would say about it's in that size. Thirteen centimeters weighs
about two hundred and fifty grams in weight. That's sort
of the normal size of a spleen. That's sitting there,
and it plays a real vital role in general when
(03:34):
it comes to your immune system your blood. You know,
it clears out a lot of red blood cells in
your bloodstream. Whenever you heat blood red blood cells emergentally
in your body, it releases them. So what we call
hemato poesis that's just a technical term meaning hemato meaning
the blood. It deals with the entire regulation of your
(03:56):
blood and clearance of a lot of debris in your bloe. Okay,
so the spleen is a very vital role. However, it
is probably considered one of the most commonly injured organs
in your body when it comes to trauma, specifically blunt trauma.
And that's exactly what I had to deal with last week.
(04:17):
So I've been practicing for a very long time. I
don't frequently see splinic injury as much now, as I said,
now that I'm working more in the hot outpatient setting,
I do go to the hospital very frequently, but unless
you're in a trauma hospital, you're not going to see
splenic injury as much. So last week I was actually
(04:37):
at another facility. I like to go out to the
Gulf Coast a little bit a goal was at in
Corpus CHRISTI at a facility there. It's a trauma hospital,
a Level one trauma center. That means that if you
have a car accident an injury, the emergency services of
the ambulances will preferentially bring you to a trauma facility
(04:59):
because they know that they have the staff capable of
dealing with that trauma. So I, after having not seen
a single splenic case, I would say for the past
I would say, I don't know, at least two years, okay.
I had three in one week left.
Speaker 3 (05:16):
Wow.
Speaker 1 (05:17):
Unfortunately for these these were all car accident victims okay,
and they ranged in age from There was one very
young patient who was in their mid twenties, twenty six
year old female, and then at the very end there
was a much older gentleman in his seventies. All happened
to be in different tops of motor vehicle crashes. Either
(05:41):
they probably got hit. Honestly, I don't really get into
the true mechanism of injury because I don't see them
that early. It's the emergency medicine doc who might see
I'm the trauma surgeon who actually sees them first. They're
the ones who call me so usually when a person
with a splenic injury comes in, they just come We
don't know they have a splenic injury. We don't know
(06:02):
that they have broken their spleen. You just come in
because it hurts. After a car accident, you might have
a bunch of bruises. There's this thing that we call
called the seat belt sign. Okay, it's a sign that
sometimes you can see wherever you're wearing your seat belt
because you've been significantly impacted. You'll see after you get
(06:23):
pulled out of that vehicle, you'll see a huge bruise
or along where the seat belt is. That's something that
we've frequently seen in splenic injuries because that's sometimes says,
you know what, this patient has had such severe been
jostled around in their vehicle so severely that now they've
developed a huge bruise along their belt area, maybe even
(06:45):
the upper abdomen aera depending on how that seat belt
is configured. But that's something we see, and very frequently
they also have abdominal pain. They may in a worst case,
their blood pressure may drop. That's where you start to
suspect maybe it's not just a few broken bones that
(07:07):
you might have had during a vehicle accident, but it
might be something that what is causing you to bleed,
and the spleen is one of the most commonly injured.
Speaker 2 (07:17):
Organ so that's when it gets damaged.
Speaker 1 (07:19):
Yes, exactly. So if you were to just you know,
do go back to your rural activities and you had
some minor trauma, maybe you fell, you know, that's that's
certainly within the realm of blunt trauma. But just you know,
blunt trauma accounts for almost ninety four percent of splenic injuries.
So it's not just you know, a minor injury, but
it's blunt trauma, not the sort of penetrating trauma of saying,
(07:42):
get getting shot. It's getting having a usually a car accident,
it could be of a fall, a fall from a
very large height. Sometimes we even have patients who very commonly,
very commonly, I see this during football season, young men
who have they've been you know, they're running around the
football football field and they get speared, they get hit,
(08:05):
they get dropped, and that's an organ that can frequently
get ruptured or injured in that setting as well.
Speaker 2 (08:13):
So what happens, doctor Rolbie, they have internal bleeding exactly.
Speaker 1 (08:17):
So your spleen can develop a wide variety of lacerations.
I'm going to get into that a little bit here,
but I'm gonna take a quick break here on the
Hackers and go into this whole realm of your spleen,
why it's important, and how I deal with it in
a trauma basis.
Speaker 3 (08:38):
You're listening to the Medical Hackers with doctor Sande Brow,
Board certified vascular interventionalist bringing you insights on treatments for
common medical problems on news Radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Rowe call nine one five five hundred four three
seven zero or by emailing at medical Hackers dot com.
Speaker 1 (09:05):
So they say, when it rains, it pours, And that's
exactly what happened to me last week. So I'm doctor
rout here talking about the spleen and so I had
three patients come in within a span of four days
with splinic injuries and how I had to get involved
with it. So when a patient comes in, the trauma
(09:26):
surgeon will usually see them, assess them and decide if
you have a splinic trauma. If they've identified that the
spleen has actually ruptured has been injured, and usually we
find that out on CT scan. Okay. So one of
the first things calls that will get to be performed
during that trauma setting is you'll get a CT scan okay,
(09:48):
And so sometimes they'll call me from that standpoint, they'll say,
you know, can you read this trauma CT and then
we'll look for blood, blood and the abdomen. Sometimes we
can see this fluid accumulating and around different organs, and
sometimes it will accumulate around the spleen. If it's really
bad trauma, it'll be all over the place, all the
way extending to your palvis. Now, sometimes you don't know
(10:09):
where that blood's coming from. Is it come from the spleen,
is it come from the liver? Is it coming from
some other organ that we don't know about. And usually
in this particular pre individual's cases, we definitely saw a
splenic injury. I saw one in various different stages. Okay.
So really the first thing I do is I grade
the splinic trauma. I try to see how big a cut,
(10:33):
how big a laceration is in your spleen. So the
very last patient that came in actually had a very
small cut. It say, it's about a centimeter or so
in size in the spleen, and we did not see
any active bleeding from the spleen on ct. So that's
kind of the splenic injury you can sit on that
you would want to have. It's a grade one splinic injury.
(10:55):
It means that you've been injured in your spleen. You're
bleeding out. However, it's not that bad. On the very
end of that spectrum was the patient that I had
to take to the procedure room within a matter of hours,
and that patient had what's called a grade four or
a grade five splinic injury. And this particular patient actually
(11:16):
had what was called a shattered spleen. The spleen was
literally it looked like it had just broken into many
different pieces. Both were vehicle incidents, vehicle accidents, but very
very different treatments. So the first the last patient who
just had a small injury, I was able to say,
(11:36):
you know what, we can sit on this injury. We
can just observe them, make sure that they're doing fine,
and let this body take care of itself. Let the
spleen heal stuff. The last one, however, if you don't
take care of it, the patient's going to bleed out,
and that's exactly why the trauma surgeon called me in.
So the goal of the spleen is of dealing with
(11:57):
plant trauma is to try to preserve as much of
your spleen. Remember, the spleen plays a very important role
in the immune system. So if a trauma surgeon just
goes in and takes out every single bleeding spleen, you're
gonna have issues afterwards. So just say no. If you
take out your spleen. There's this incidence of what we
call post splenectomy sepsis or post splenectomy infection, and that
(12:19):
has a fifty percent mortality. That means if they took
out your spleen and you develop infections, and you should
know this, if you take out your spleen, you will
be more predisposed to having infections going forward for the
rest of your life. So that's why that to really
monitor you if they take out your spleen. So if
you get an infection after your spleen has been removed,
(12:40):
one in two patients will die. And that's why the
goal of splenic injury management is to make it as
much nonoperative as possible.
Speaker 2 (12:51):
Around when you say the spleen is broken, you mean,
lacerated in multiple places.
Speaker 1 (12:56):
Exactly. It just looks it's difficult for me to think about. So,
so I don't know. Do you guys remember this comedian
and way back he used to smash watermelons. Do you
remember this? I remember that the name Gallagher.
Speaker 2 (13:09):
It was Gagher Gallagher watermelon.
Speaker 1 (13:12):
Exactly. He would take a watermelon, he'd put it on
the front of page, and he would take a hammer
and he would just smash it. So think about a
shattered watermelon or a shatters plan. Imagine someone just taking
a hammer and you're in the front room and you're
just gotting splattered with all these little pieces. That's what
it looks like in your body. It looks like it
looks like it's just literally just broken from the inside.
Speaker 2 (13:35):
So how do you fix that? Doctor?
Speaker 1 (13:36):
So, so that's why you might ask why do I
as a vascular interventional to play So in some cases,
if a patient is unstable, if a patient needs to
have it removed immediately, and the patient is dropping their
their blood, they're dropping their blood pressure. We keep a
log of their hemoglobin, which is the volume of their
(13:59):
blood in their body, the content of their blood and
their body. The hem atecriate keep track of their vital signs.
If it looks like they are extremely unstable and they
are not able to survive without blood pressure medications to
keep their pressure up what we call pressers, then the
trauma surgeon usually has to just wheel them back immediately
(14:20):
and take out that spleen. Go in and just make
a cut, take it out. But if we can save it,
they will oftentimes call me and say, can you save
as much of this fleen as possible? So the question
is how do I save a spleen. That's where the
process of embolization comes in. So I go in through
a blood vessel, usually the ephemeral artery, which is a
(14:41):
blood vessel when you're going I can also go in
through the wrist if needed. I go in and I
put a little tiny wire, a tiny spaghetti type device
called a catheter into the blood vessels of your spleen.
I identify those using X ray and I snake this
little wire in cathe into the blood vessels of your spleen.
(15:02):
Once I identify the blood flow to your spleen, I
can usually see blood just spilling out into your belly.
That's where I then put a series of met things
into the blood vessel, usually what we call coils. I
can also use these things called gelfoam, which is a
sort of a foamy mixture. But basically, I'm blocking the
(15:23):
blood supply to the spleen. And so by blocking the
blood supply, I'm essentially doing what a surgeon would do
from the outside, but I'm doing it internally without a
huge cut, because I'm going through a little IV. You know,
when the surgeon goes in, what do they do. They
go in, they make a cut and they ligate, or
they tie off the blood vessels to the spleen and
they just remove the spleen. They clean it out, clean
(15:46):
out the blood, take it out. But when I go in,
I am ligating internally. I'm cutting off those little blood
supply from the inside and trying to save as much
of your spleen as possible. So if it's just a
small and you're involving a small portion of spleen, maybe
I can save the bottom half of your spleen. And
that's very important because the goal is, as I said,
(16:07):
try to save as much of your spleen.
Speaker 2 (16:10):
So, doctor Rewald, are there different highways of vessels that
go to multiple parts of your spleen.
Speaker 1 (16:16):
So that's very interesting that you asked that, because so
one of the splinic embolizations that I do was very typical.
There's one vessel that comes off right directly off your
aorta through your It's called a splenic trunk, and it
goes to the spleen at a very quick case. It
took me fifteen minutes. Wow, okay. But the next case
that I did, it was a very complex case. The
(16:38):
main highway to the spleen was actually completely blocked off.
The patient had underlying something you're familiar with, perfer arterial disease.
They completely blocked off the celiac trunk. So I had
to take a diversion. So imagine you're driving down the
highway and I tend is closed. How are you going
to get to the other side of town. You might
have to start going down take the exit. I'm just
(16:59):
trying to think off the top of my head. Maybe
go down Montana.
Speaker 2 (17:01):
The border highway.
Speaker 1 (17:02):
It was the border highway, right, and so this is
what this patient had. This patient had a weird path,
so I should actually I very rarely take pictures during cases,
but during this particular case. I had to take pictures
and I had to even send it to some other
colleagues to say, look at this weird path I took
to get in this plane. But it was very tortuous.
(17:23):
I had to go through a vessel feeding your intestines,
and then took another back channel going into a vessel
feeding your duodenum, which is just a small bowel, then
circled back through your liver, then into this particular pation,
and then I went to this plane. So it was
it was a very amazing image act that's right, the
scenic route, which took a much longer time. It took
(17:45):
me about an hour and a half to do that case,
but the outcome was still the same. I was still
able to block off the blood supply to this plane
and the patient had a great outcome. So really the
question is why why do we go to all this
effort to preserve the spleen. And after this quick break,
(18:05):
I'm going to kind of get into why we want
to preserve the spleen, why it's so important, and what
happens if you don't preserve your spleen. What if your
doc actually can't save your spleen like I do, And
to have to take it out.
Speaker 3 (18:18):
You're listening to the Medical Hackers with doctor Sandy Brow,
Board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four to
three seven zero or by emailing raw at medical hackers
(18:41):
dot com.
Speaker 1 (18:45):
Background the Hackers, and we're talking about splenic injury that
has injuries to the spleen, the organ that sits in
the left side of your belly, and why I try
to save it as a vaster interventionalist. So really the
question is what is the role of the spleen. So,
as I said, if filter's blood okay, for bacteria, for viruses,
so it serves a very important role in.
Speaker 2 (19:06):
That have to arouse that both white and red blood cells.
Speaker 1 (19:09):
Exactly and red blood cells. So not only does it
do that, but it also produces this clean produces white
blood cells okay, so that those are what knows as lymphocytes,
and those are helped to fight infection. So whenever you
have an infection your body, your white cells go up,
and we can see that on your lab values. It
also very importantly it's towards platelets. Okay, so those of
(19:32):
us are familiar with blood and blood clotting, your platelets
play a very very important role. It helps with that
entire process of clotting. Now, also all the RBC's, the
red blood cells that are floating throughout your body. Over
time they get you know, it's like any other tissue,
there's a recycling process, right, you have to remove old
(19:54):
damaged RBCs. Then you've got to recycle it from iron
and produce new blood cells. The spleen is all very
very key to that. It does all that stuff. So,
and there's also a reserve of RBC's red blood cells
in your spleen. So if you had a cut, like
a huge I don't know, let's say it's a traumatic accident,
not even to your spleen, maybe to your legs, and
(20:15):
you're losing blood. Now, your spleen is important in releasing
this reserve of RBCs in that So it's important in
blood cell regulation and in the immune system. It helps
regulate the overall volume of blood in your body. So
why do we save the spleen? As I said, what
happens if you remove the spleen, right if you were
(20:37):
one of these patients who had a splenic trauma. So thankfully,
in all three of these cases that I mentioned, these
three patients, we were able to save the spleen. We
were able to do nonoperative management. The trauma surgeon did
not have to go in and cut it and take
it out. But let's just say a surgeon had to
do that, had to take it out. So the incidence
(20:58):
of what we call trombosis that means clotting off a
blood vessel, ranges almost up to a third of patients.
Anywhere from five percent to thirty seven percent of pations
can start developing significant blood clots through their body, especially
once the spleen has been taken out, because now your
body's platelets is disregulated. I also mentioned the most important
(21:22):
thing is actually the fact that fifty percent of patients
who've had their spleen removed will have or are potentially
susceptible to dying from an infection. That's why if you
do get your spleen removed, one of the most important
things that we have to have to do before discharging
you is we administer vaccinations within two weeks of you
(21:45):
being discharged from the hospital, and we have to do
that just to lower your overall risk of having an infection,
having a risk of sepsis. So they're going to go
after very the common organisms, streptococcus, hemophilus, influenza, be all
these things that you could be potentially to be susceptible
to that your spleen is such an important role in
(22:06):
we have to now vaccinate you and make sure you're
up to date because if not, you're gonna be more
prone to having infections. And as I said, if you
get an infection after your spleen has been removed, one
in two review will die.
Speaker 2 (22:18):
So doctor Rold, the vaccination process is that one time
gig or is that even gone.
Speaker 1 (22:23):
So unfortunately, it's gonna be something that you're gonna have
to now be much more vigilant about getting it through
the course of your life. So we will definitely give
you one immediately because you're gonna be most susceptible to
it within the first you know, year of your injury.
But over time it's quite possible your spleen could regenerate,
(22:43):
and so that's kind of where it's very becomes very important.
So some people might wonder if your spleen is taken out,
does that mean your entire spleen is gone? So some
people actually have what we call accessory spleens or splendules.
That means that you might have another little portion of
the spleen that's floating in your body. It's not all
the time, but I do see it, So you might
(23:04):
have your main organ. Or maybe the surgeon went in
and did not completely take out the whole spleen. Maybe
if it's remember going back to this thing of the
smashed watermelon, maybe there's a little piece that they left behind.
Maybe it's still functional and that can start regaining function
and it could almost essentially take over as a true spleen.
Speaker 2 (23:24):
And will that grow again?
Speaker 1 (23:26):
It can? It can, It can start growing and becoming
bigger insize, So there's always a possibility to that. Now,
when I try to save the spleen, when I block
off the blood vessels to the spleen, imagine you have
a spleen as I said, maybe the size of your hand,
maybe only the top part, maybe your fingers that areas
is a part of your spleen that's broken off that
(23:47):
I have to shut down the blood flow. So now
all you have is a spleen that's the size of
your palm. Okay, So now that part of the spleen
can still overtake function, and over time it can you know,
grow as much as possible and hopefully take over your
splinic function. So that's the real goal that we're trying
to do when it comes to saving your spleen. So
(24:10):
really the goal whenever we do this is to save
at least try to save at least fifty percent of
your splenic mass. So that's what I'm trying to do
by doing as selective a blockage, selective a embolization of
the blood vessels to the spleen. Really, because we want
to maintain any part of spleen is good to maintain
(24:32):
it for the immune function.
Speaker 2 (24:34):
So, doctor Row, with the evolution of AI in medicine,
do you think that we'll be able to someday clone
this spleene, grow it man made labs.
Speaker 1 (24:45):
That's a very interesting question, something I've never had to
deal with, something I've never even thought about. You need
to start, certainly, I mean in terms of where of
where we're going, especially in terms of I've definitely seen
you know, we're able to create. Now we're getting especially
for blood. Right when we have a traumatic injury, if
(25:05):
you don't have enough blood supply, there are people who
are able to actually even create you know, this sort
of almost this man made sort of volumemizer that we
can add to the blood. So we're definitely going in
a direction where you know, twenty years ago, I.
Speaker 2 (25:20):
Just read about that a month ago. Yeah, yeah, yeah,
that's wow.
Speaker 1 (25:23):
And so the thing is, you know, we're definitely headed.
You know, if you have this conversation twenty years ago,
I'd have been like, no, that's that's that's star trek.
That's something you know, in the very very future that
may not happen, but I would not be surprised if
in my lifetime we are able to clone organs, create organs,
because you know, there are definitely organ shortages. But going
(25:45):
back to this, I've never seen anybody transplant a spleen
or anything like that, but that's certainly something that I
think it could be very very interesting going down going
down that road, especially if you could create a organ
that does not have that cannot be rejected by your body.
Because remember, whenever you have an organ that's being put
(26:08):
in your body, the main risk is being rejected, especially
we talked about liver transplants or kidney transplants. Your body
could reject that organ. But imagine you create an organ
that is less prone to rejection. That's certainly something that
quite frankly, you know, I think it'd be very very
interesting going forward. But really I think in terms of
where we have headed as a field of trauma, in
(26:32):
the old days, I would say, you know, twenty thirty
forty years ago, it was very very common to see
patients have their spleen removed. You know, if I were
to tell you the story of what I started with
this week, I saw three patients who came in various ages,
all having various degrees of splenic injury, and we were
able to save all their spleens. If I were to
(26:54):
tell you that story thirty years ago, you probably would
not have believed it. But because of the fact that
we now have number one good imaging, we're able to
see the exact damage that is going on to your
spleen in terms of how much were I to see
on a CT scan. If we're able to see you
and we can say fifty percent of it's damage, or
twenty percent is damage, or ten percent on top of
(27:16):
the fact that we now have access to technologies that
I'm able to provide, which is embolization, that I can
go in through a blood vessel, I can go in
and deal with the injury on a non operative basis.
All these things make it very very much the future.
Speaker 2 (27:34):
Right.
Speaker 1 (27:35):
We're basically we're living on that future that thirty years
ago people have been like, Wow, you saved three patients
from needing a big surgery, and so really, you know, honestly,
that's kind of what everything that I do is, right,
I'm trying to save patients from surgery. Whether it comes
down to patients who have knee pain and they've been
told they need to get a new replacement, they're trying
to avoid a new replacement and they're trying to get
(27:56):
those procedures, or patients who've had to prostate issues prostate
enlargement that is trying to that avoid that sort of surgery.
In general. As a VASCAR inventionalist, I'm doing everything minimally invasive.
So unfortunate our time this Saturday is up. If you
are interested in any more information on any of the
mentioned minimally invasive treatments, you can always call to get
(28:17):
more information at nine five hundred forty three seventy that's
five zero zero four three seven zero. You can also
reach me by email at raw that's my last name,
r AO at medical haackers dot com. I hope these
healthcare hacks have helped you navigate our complex medical system.
If you've been tuned into us this whole time, bless
your heart and your health. I'm doctor San deep Brow,
(28:39):
and you've been listening to the medical Hackers
Good afternoon. It's another weekend here in the heart of
the dusty ch want when desert in West Texas. You're
listening to the Medical Ackers, however, you may be tuned
in this week, and I'm your host, doctor Sandy Row.
I'm here to bring the Boordland's latest information in healthcare,
medicine and technology on the show. I'll consider myself a
hacker in the positive sense, a hacker who used my
(00:26):
intimate knowledge of the medical system to helping breaking down
some of the bearest accessing new medical technologies into current
healthcare information. So I got Juni back here with me.
Speaker 2 (00:37):
Hey, doctor Row, It's always good to be here with you, brother.
Speaker 1 (00:40):
Great to have you here as a sounding board and
just to kind of, you know, let you know what's
going on. So this was very interesting for me. I
had a very interesting week last week. As you know,
I'm a vaster interventionalist. I deal with all things dealing
with blood vessels, and folks often ask me what's a
(01:01):
common issue that you deal with, And sometimes just to
give people an example, I always talk about embolizing or
that means cutting off the blood supply to an organ. Now,
whenever I use that example to the layman out there,
the late public euthor. Oftentimes I talk about the most
(01:21):
emergent issue that would cause that a situation in which
you have to come in, you have to get it
done within a certain window of time, and so I
oftentimes use example of splenic injury. But interestingly, because I've
sort of started gravitating to doing more outpatient procedures outside
(01:42):
the hospital, doing embolizations for you know, for knee pain,
for patients who have I don't know, foot pain, plantar fasciatis,
prostate issues, all these different areas that you can treat
with decreasing the blood supply, I don't see the need
to do splenic embolization much. However, what is splinic? So
(02:07):
the splenic that's that's a good that should you know,
take suspect the very beginning of it, right. What is this?
The spleen is the spleen is an organ that sits
in the left side of your abdomen. Okay, so if
you were to see the right side of your abdomen,
you can actually feel your liver, Okay, like kind of
under your rib cage. You can feel the liver. It's
a big organ and those of us, those folks who
(02:30):
who might have liver disease, might people who have issues
with alcohol, folks who have issues with cirrhosis, hepatitis. It
might be a little bit bigger, it might actually be
what we call hepatomegally, it might be a little bit larger.
But when it comes to the spleen, you are usually
not able to feel that organ. It's act but it
(02:51):
does sit on that left side, so it's exactly its
opposite the liver, so on the left side kind of
under that rib area. So it's not an organ that
you will frequently feel, but it's it's it's there, it's
there's doing a very valuable task. It's an organ that's
about I would say normally about thirteen centimeters long or so.
(03:12):
So it's not that it's not a huge organ, but
I would say, you know, thirteen centimeters if you were
to think about it, kind of look at look at
your hand, okay, you know, depending on you know how
big your hand is. You know, it's you know, I
would say about it's in that size. Thirteen centimeters weighs
about two hundred and fifty grams in weight. That's sort
of the normal size of a spleen. That's sitting there,
and it plays a real vital role in general when
(03:34):
it comes to your immune system your blood. You know,
it clears out a lot of red blood cells in
your bloodstream. Whenever you heat blood red blood cells emergentally
in your body, it releases them. So what we call
hemato poesis that's just a technical term meaning hemato meaning
the blood. It deals with the entire regulation of your
(03:56):
blood and clearance of a lot of debris in your bloe. Okay,
so the spleen is a very vital role. However, it
is probably considered one of the most commonly injured organs
in your body when it comes to trauma, specifically blunt trauma.
And that's exactly what I had to deal with last week.
(04:17):
So I've been practicing for a very long time. I
don't frequently see splinic injury as much now, as I said,
now that I'm working more in the hot outpatient setting,
I do go to the hospital very frequently, but unless
you're in a trauma hospital, you're not going to see
splenic injury as much. So last week I was actually
(04:37):
at another facility. I like to go out to the
Gulf Coast a little bit a goal was at in
Corpus CHRISTI at a facility there. It's a trauma hospital,
a Level one trauma center. That means that if you
have a car accident an injury, the emergency services of
the ambulances will preferentially bring you to a trauma facility
(04:59):
because they know that they have the staff capable of
dealing with that trauma. So I, after having not seen
a single splenic case, I would say for the past
I would say, I don't know, at least two years, okay.
I had three in one week left.
Speaker 3 (05:16):
Wow.
Speaker 1 (05:17):
Unfortunately for these these were all car accident victims okay,
and they ranged in age from There was one very
young patient who was in their mid twenties, twenty six
year old female, and then at the very end there
was a much older gentleman in his seventies. All happened
to be in different tops of motor vehicle crashes. Either
(05:41):
they probably got hit. Honestly, I don't really get into
the true mechanism of injury because I don't see them
that early. It's the emergency medicine doc who might see
I'm the trauma surgeon who actually sees them first. They're
the ones who call me so usually when a person
with a splenic injury comes in, they just come We
don't know they have a splenic injury. We don't know
(06:02):
that they have broken their spleen. You just come in
because it hurts. After a car accident, you might have
a bunch of bruises. There's this thing that we call
called the seat belt sign. Okay, it's a sign that
sometimes you can see wherever you're wearing your seat belt
because you've been significantly impacted. You'll see after you get
(06:23):
pulled out of that vehicle, you'll see a huge bruise
or along where the seat belt is. That's something that
we've frequently seen in splenic injuries because that's sometimes says,
you know what, this patient has had such severe been
jostled around in their vehicle so severely that now they've
developed a huge bruise along their belt area, maybe even
(06:45):
the upper abdomen aera depending on how that seat belt
is configured. But that's something we see, and very frequently
they also have abdominal pain. They may in a worst case,
their blood pressure may drop. That's where you start to
suspect maybe it's not just a few broken bones that
(07:07):
you might have had during a vehicle accident, but it
might be something that what is causing you to bleed,
and the spleen is one of the most commonly injured.
Speaker 2 (07:17):
Organ so that's when it gets damaged.
Speaker 1 (07:19):
Yes, exactly. So if you were to just you know,
do go back to your rural activities and you had
some minor trauma, maybe you fell, you know, that's that's
certainly within the realm of blunt trauma. But just you know,
blunt trauma accounts for almost ninety four percent of splenic injuries.
So it's not just you know, a minor injury, but
it's blunt trauma, not the sort of penetrating trauma of saying,
(07:42):
get getting shot. It's getting having a usually a car accident,
it could be of a fall, a fall from a
very large height. Sometimes we even have patients who very commonly,
very commonly, I see this during football season, young men
who have they've been you know, they're running around the
football football field and they get speared, they get hit,
(08:05):
they get dropped, and that's an organ that can frequently
get ruptured or injured in that setting as well.
Speaker 2 (08:13):
So what happens, doctor Rolbie, they have internal bleeding exactly.
Speaker 1 (08:17):
So your spleen can develop a wide variety of lacerations.
I'm going to get into that a little bit here,
but I'm gonna take a quick break here on the
Hackers and go into this whole realm of your spleen,
why it's important, and how I deal with it in
a trauma basis.
Speaker 3 (08:38):
You're listening to the Medical Hackers with doctor Sande Brow,
Board certified vascular interventionalist bringing you insights on treatments for
common medical problems on news Radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Rowe call nine one five five hundred four three
seven zero or by emailing at medical Hackers dot com.
Speaker 1 (09:05):
So they say, when it rains, it pours, And that's
exactly what happened to me last week. So I'm doctor
rout here talking about the spleen and so I had
three patients come in within a span of four days
with splinic injuries and how I had to get involved
with it. So when a patient comes in, the trauma
(09:26):
surgeon will usually see them, assess them and decide if
you have a splinic trauma. If they've identified that the
spleen has actually ruptured has been injured, and usually we
find that out on CT scan. Okay. So one of
the first things calls that will get to be performed
during that trauma setting is you'll get a CT scan okay,
(09:48):
And so sometimes they'll call me from that standpoint, they'll say,
you know, can you read this trauma CT and then
we'll look for blood, blood and the abdomen. Sometimes we
can see this fluid accumulating and around different organs, and
sometimes it will accumulate around the spleen. If it's really
bad trauma, it'll be all over the place, all the
way extending to your palvis. Now, sometimes you don't know
(10:09):
where that blood's coming from. Is it come from the spleen,
is it come from the liver? Is it coming from
some other organ that we don't know about. And usually
in this particular pre individual's cases, we definitely saw a
splenic injury. I saw one in various different stages. Okay.
So really the first thing I do is I grade
the splinic trauma. I try to see how big a cut,
(10:33):
how big a laceration is in your spleen. So the
very last patient that came in actually had a very
small cut. It say, it's about a centimeter or so
in size in the spleen, and we did not see
any active bleeding from the spleen on ct. So that's
kind of the splenic injury you can sit on that
you would want to have. It's a grade one splinic injury.
(10:55):
It means that you've been injured in your spleen. You're
bleeding out. However, it's not that bad. On the very
end of that spectrum was the patient that I had
to take to the procedure room within a matter of hours,
and that patient had what's called a grade four or
a grade five splinic injury. And this particular patient actually
(11:16):
had what was called a shattered spleen. The spleen was
literally it looked like it had just broken into many
different pieces. Both were vehicle incidents, vehicle accidents, but very
very different treatments. So the first the last patient who
just had a small injury, I was able to say,
(11:36):
you know what, we can sit on this injury. We
can just observe them, make sure that they're doing fine,
and let this body take care of itself. Let the
spleen heal stuff. The last one, however, if you don't
take care of it, the patient's going to bleed out,
and that's exactly why the trauma surgeon called me in.
So the goal of the spleen is of dealing with
(11:57):
plant trauma is to try to preserve as much of
your spleen. Remember, the spleen plays a very important role
in the immune system. So if a trauma surgeon just
goes in and takes out every single bleeding spleen, you're
gonna have issues afterwards. So just say no. If you
take out your spleen. There's this incidence of what we
call post splenectomy sepsis or post splenectomy infection, and that
(12:19):
has a fifty percent mortality. That means if they took
out your spleen and you develop infections, and you should
know this, if you take out your spleen, you will
be more predisposed to having infections going forward for the
rest of your life. So that's why that to really
monitor you if they take out your spleen. So if
you get an infection after your spleen has been removed,
(12:40):
one in two patients will die. And that's why the
goal of splenic injury management is to make it as
much nonoperative as possible.
Speaker 2 (12:51):
Around when you say the spleen is broken, you mean,
lacerated in multiple places.
Speaker 1 (12:56):
Exactly. It just looks it's difficult for me to think about. So,
so I don't know. Do you guys remember this comedian
and way back he used to smash watermelons. Do you
remember this? I remember that the name Gallagher.
Speaker 2 (13:09):
It was Gagher Gallagher watermelon.
Speaker 1 (13:12):
Exactly. He would take a watermelon, he'd put it on
the front of page, and he would take a hammer
and he would just smash it. So think about a
shattered watermelon or a shatters plan. Imagine someone just taking
a hammer and you're in the front room and you're
just gotting splattered with all these little pieces. That's what
it looks like in your body. It looks like it
looks like it's just literally just broken from the inside.
Speaker 2 (13:35):
So how do you fix that? Doctor?
Speaker 1 (13:36):
So, so that's why you might ask why do I
as a vascular interventional to play So in some cases,
if a patient is unstable, if a patient needs to
have it removed immediately, and the patient is dropping their
their blood, they're dropping their blood pressure. We keep a
log of their hemoglobin, which is the volume of their
(13:59):
blood in their body, the content of their blood and
their body. The hem atecriate keep track of their vital signs.
If it looks like they are extremely unstable and they
are not able to survive without blood pressure medications to
keep their pressure up what we call pressers, then the
trauma surgeon usually has to just wheel them back immediately
(14:20):
and take out that spleen. Go in and just make
a cut, take it out. But if we can save it,
they will oftentimes call me and say, can you save
as much of this fleen as possible? So the question
is how do I save a spleen. That's where the
process of embolization comes in. So I go in through
a blood vessel, usually the ephemeral artery, which is a
(14:41):
blood vessel when you're going I can also go in
through the wrist if needed. I go in and I
put a little tiny wire, a tiny spaghetti type device
called a catheter into the blood vessels of your spleen.
I identify those using X ray and I snake this
little wire in cathe into the blood vessels of your spleen.
(15:02):
Once I identify the blood flow to your spleen, I
can usually see blood just spilling out into your belly.
That's where I then put a series of met things
into the blood vessel, usually what we call coils. I
can also use these things called gelfoam, which is a
sort of a foamy mixture. But basically, I'm blocking the
(15:23):
blood supply to the spleen. And so by blocking the
blood supply, I'm essentially doing what a surgeon would do
from the outside, but I'm doing it internally without a
huge cut, because I'm going through a little IV. You know,
when the surgeon goes in, what do they do. They
go in, they make a cut and they ligate, or
they tie off the blood vessels to the spleen and
they just remove the spleen. They clean it out, clean
(15:46):
out the blood, take it out. But when I go in,
I am ligating internally. I'm cutting off those little blood
supply from the inside and trying to save as much
of your spleen as possible. So if it's just a
small and you're involving a small portion of spleen, maybe
I can save the bottom half of your spleen. And
that's very important because the goal is, as I said,
(16:07):
try to save as much of your spleen.
Speaker 2 (16:10):
So, doctor Rewald, are there different highways of vessels that
go to multiple parts of your spleen.
Speaker 1 (16:16):
So that's very interesting that you asked that, because so
one of the splinic embolizations that I do was very typical.
There's one vessel that comes off right directly off your
aorta through your It's called a splenic trunk, and it
goes to the spleen at a very quick case. It
took me fifteen minutes. Wow, okay. But the next case
that I did, it was a very complex case. The
(16:38):
main highway to the spleen was actually completely blocked off.
The patient had underlying something you're familiar with, perfer arterial disease.
They completely blocked off the celiac trunk. So I had
to take a diversion. So imagine you're driving down the
highway and I tend is closed. How are you going
to get to the other side of town. You might
have to start going down take the exit. I'm just
(16:59):
trying to think off the top of my head. Maybe
go down Montana.
Speaker 2 (17:01):
The border highway.
Speaker 1 (17:02):
It was the border highway, right, and so this is
what this patient had. This patient had a weird path,
so I should actually I very rarely take pictures during cases,
but during this particular case. I had to take pictures
and I had to even send it to some other
colleagues to say, look at this weird path I took
to get in this plane. But it was very tortuous.
(17:23):
I had to go through a vessel feeding your intestines,
and then took another back channel going into a vessel
feeding your duodenum, which is just a small bowel, then
circled back through your liver, then into this particular pation,
and then I went to this plane. So it was
it was a very amazing image act that's right, the
scenic route, which took a much longer time. It took
(17:45):
me about an hour and a half to do that case,
but the outcome was still the same. I was still
able to block off the blood supply to this plane
and the patient had a great outcome. So really the
question is why why do we go to all this
effort to preserve the spleen. And after this quick break,
(18:05):
I'm going to kind of get into why we want
to preserve the spleen, why it's so important, and what
happens if you don't preserve your spleen. What if your
doc actually can't save your spleen like I do, And
to have to take it out.
Speaker 3 (18:18):
You're listening to the Medical Hackers with doctor Sandy Brow,
Board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four to
three seven zero or by emailing raw at medical hackers
(18:41):
dot com.
Speaker 1 (18:45):
Background the Hackers, and we're talking about splenic injury that
has injuries to the spleen, the organ that sits in
the left side of your belly, and why I try
to save it as a vaster interventionalist. So really the
question is what is the role of the spleen. So,
as I said, if filter's blood okay, for bacteria, for viruses,
so it serves a very important role in.
Speaker 2 (19:06):
That have to arouse that both white and red blood cells.
Speaker 1 (19:09):
Exactly and red blood cells. So not only does it
do that, but it also produces this clean produces white
blood cells okay, so that those are what knows as lymphocytes,
and those are helped to fight infection. So whenever you
have an infection your body, your white cells go up,
and we can see that on your lab values. It
also very importantly it's towards platelets. Okay, so those of
(19:32):
us are familiar with blood and blood clotting, your platelets
play a very very important role. It helps with that
entire process of clotting. Now, also all the RBC's, the
red blood cells that are floating throughout your body. Over
time they get you know, it's like any other tissue,
there's a recycling process, right, you have to remove old
(19:54):
damaged RBCs. Then you've got to recycle it from iron
and produce new blood cells. The spleen is all very
very key to that. It does all that stuff. So,
and there's also a reserve of RBC's red blood cells
in your spleen. So if you had a cut, like
a huge I don't know, let's say it's a traumatic accident,
not even to your spleen, maybe to your legs, and
(20:15):
you're losing blood. Now, your spleen is important in releasing
this reserve of RBCs in that So it's important in
blood cell regulation and in the immune system. It helps
regulate the overall volume of blood in your body. So
why do we save the spleen? As I said, what
happens if you remove the spleen, right if you were
(20:37):
one of these patients who had a splenic trauma. So thankfully,
in all three of these cases that I mentioned, these
three patients, we were able to save the spleen. We
were able to do nonoperative management. The trauma surgeon did
not have to go in and cut it and take
it out. But let's just say a surgeon had to
do that, had to take it out. So the incidence
(20:58):
of what we call trombosis that means clotting off a
blood vessel, ranges almost up to a third of patients.
Anywhere from five percent to thirty seven percent of pations
can start developing significant blood clots through their body, especially
once the spleen has been taken out, because now your
body's platelets is disregulated. I also mentioned the most important
(21:22):
thing is actually the fact that fifty percent of patients
who've had their spleen removed will have or are potentially
susceptible to dying from an infection. That's why if you
do get your spleen removed, one of the most important
things that we have to have to do before discharging
you is we administer vaccinations within two weeks of you
(21:45):
being discharged from the hospital, and we have to do
that just to lower your overall risk of having an infection,
having a risk of sepsis. So they're going to go
after very the common organisms, streptococcus, hemophilus, influenza, be all
these things that you could be potentially to be susceptible
to that your spleen is such an important role in
(22:06):
we have to now vaccinate you and make sure you're
up to date because if not, you're gonna be more
prone to having infections. And as I said, if you
get an infection after your spleen has been removed, one
in two review will die.
Speaker 2 (22:18):
So doctor Rold, the vaccination process is that one time
gig or is that even gone.
Speaker 1 (22:23):
So unfortunately, it's gonna be something that you're gonna have
to now be much more vigilant about getting it through
the course of your life. So we will definitely give
you one immediately because you're gonna be most susceptible to
it within the first you know, year of your injury.
But over time it's quite possible your spleen could regenerate,
(22:43):
and so that's kind of where it's very becomes very important.
So some people might wonder if your spleen is taken out,
does that mean your entire spleen is gone? So some
people actually have what we call accessory spleens or splendules.
That means that you might have another little portion of
the spleen that's floating in your body. It's not all
the time, but I do see it, So you might
(23:04):
have your main organ. Or maybe the surgeon went in
and did not completely take out the whole spleen. Maybe
if it's remember going back to this thing of the
smashed watermelon, maybe there's a little piece that they left behind.
Maybe it's still functional and that can start regaining function
and it could almost essentially take over as a true spleen.
Speaker 2 (23:24):
And will that grow again?
Speaker 1 (23:26):
It can? It can, It can start growing and becoming
bigger insize, So there's always a possibility to that. Now,
when I try to save the spleen, when I block
off the blood vessels to the spleen, imagine you have
a spleen as I said, maybe the size of your hand,
maybe only the top part, maybe your fingers that areas
is a part of your spleen that's broken off that
(23:47):
I have to shut down the blood flow. So now
all you have is a spleen that's the size of
your palm. Okay, So now that part of the spleen
can still overtake function, and over time it can you know,
grow as much as possible and hopefully take over your
splinic function. So that's the real goal that we're trying
to do when it comes to saving your spleen. So
(24:10):
really the goal whenever we do this is to save
at least try to save at least fifty percent of
your splenic mass. So that's what I'm trying to do
by doing as selective a blockage, selective a embolization of
the blood vessels to the spleen. Really, because we want
to maintain any part of spleen is good to maintain
(24:32):
it for the immune function.
Speaker 2 (24:34):
So, doctor Row, with the evolution of AI in medicine,
do you think that we'll be able to someday clone
this spleene, grow it man made labs.
Speaker 1 (24:45):
That's a very interesting question, something I've never had to
deal with, something I've never even thought about. You need
to start, certainly, I mean in terms of where of
where we're going, especially in terms of I've definitely seen
you know, we're able to create. Now we're getting especially
for blood. Right when we have a traumatic injury, if
(25:05):
you don't have enough blood supply, there are people who
are able to actually even create you know, this sort
of almost this man made sort of volumemizer that we
can add to the blood. So we're definitely going in
a direction where you know, twenty years ago, I.
Speaker 2 (25:20):
Just read about that a month ago. Yeah, yeah, yeah,
that's wow.
Speaker 1 (25:23):
And so the thing is, you know, we're definitely headed.
You know, if you have this conversation twenty years ago,
I'd have been like, no, that's that's that's star trek.
That's something you know, in the very very future that
may not happen, but I would not be surprised if
in my lifetime we are able to clone organs, create organs,
because you know, there are definitely organ shortages. But going
(25:45):
back to this, I've never seen anybody transplant a spleen
or anything like that, but that's certainly something that I
think it could be very very interesting going down going
down that road, especially if you could create a organ
that does not have that cannot be rejected by your body.
Because remember, whenever you have an organ that's being put
(26:08):
in your body, the main risk is being rejected, especially
we talked about liver transplants or kidney transplants. Your body
could reject that organ. But imagine you create an organ
that is less prone to rejection. That's certainly something that
quite frankly, you know, I think it'd be very very
interesting going forward. But really I think in terms of
where we have headed as a field of trauma, in
(26:32):
the old days, I would say, you know, twenty thirty
forty years ago, it was very very common to see
patients have their spleen removed. You know, if I were
to tell you the story of what I started with
this week, I saw three patients who came in various ages,
all having various degrees of splenic injury, and we were
able to save all their spleens. If I were to
(26:54):
tell you that story thirty years ago, you probably would
not have believed it. But because of the fact that
we now have number one good imaging, we're able to
see the exact damage that is going on to your
spleen in terms of how much were I to see
on a CT scan. If we're able to see you
and we can say fifty percent of it's damage, or
twenty percent is damage, or ten percent on top of
(27:16):
the fact that we now have access to technologies that
I'm able to provide, which is embolization, that I can
go in through a blood vessel, I can go in
and deal with the injury on a non operative basis.
All these things make it very very much the future.
Speaker 2 (27:34):
Right.
Speaker 1 (27:35):
We're basically we're living on that future that thirty years
ago people have been like, Wow, you saved three patients
from needing a big surgery, and so really, you know, honestly,
that's kind of what everything that I do is, right,
I'm trying to save patients from surgery. Whether it comes
down to patients who have knee pain and they've been
told they need to get a new replacement, they're trying
to avoid a new replacement and they're trying to get
(27:56):
those procedures, or patients who've had to prostate issues prostate
enlargement that is trying to that avoid that sort of surgery.
In general. As a VASCAR inventionalist, I'm doing everything minimally invasive.
So unfortunate our time this Saturday is up. If you
are interested in any more information on any of the
mentioned minimally invasive treatments, you can always call to get
(28:17):
more information at nine five hundred forty three seventy that's
five zero zero four three seven zero. You can also
reach me by email at raw that's my last name,
r AO at medical haackers dot com. I hope these
healthcare hacks have helped you navigate our complex medical system.
If you've been tuned into us this whole time, bless
your heart and your health. I'm doctor San deep Brow,
(28:39):
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