Speaker 1: Bringing you conversations with leaders within the operating room and healthcare community, this is Scrubbing In.

Todd Schlosser: Hello and welcome to this episode of Scrubbing In, a podcast powered by SpecialtyCare. I’m Todd Schlosser and today my guest is Dr. Paul Saphier, a neurosurgeon at Atlantic Neurosurgical Specialists. In this conversation, Dr. Saphier and I discuss his desire to work in neurosurgery, how innovations in a neurosurgical space have been accelerating in the past five to 10 years, and how he and his team are working to provide options for stroke patients that currently have none. Enjoy the conversation.

Todd Schlosser: Thanks for joining us here on Scrubbing In. We are on location at Atlantic Neurosurgical Specialists and my guest today is Dr. Paul Saphier. And I like to start off the conversation, sort of similar in every episode, and that is simply to ask what is it that sort of drew you to healthcare initially?

Dr.  P. Saphier: I come from a big family of doctors. So yeah, my father’s a doctor, my uncle’s a doctor, my older brother’s a doctor, my little brother’s a doctor, my sister works in the healthcare industry, so a long lineage of physicians. So, I think it’s … if not genetic within me, certainly been in my blood for a long period of time.

Todd Schlosser:  Sure.

Dr.  P. Saphier: And I think a lot of people, whether it be healthcare, or whatever profession that people come from, it’s sort of in the family, so to speak. That’s really … My exposure is from an early age.

Todd Schlosser: Would you say that any one particular member of the family sort of acted as a mentor? Was it your father who guided you into it or was it just sort of the expectation?

Dr.  P. Saphier: Yeah, for sure my father, certainly was a driving force. I mean, certainly sitting around the dinner table, my brother-in-law, my sister’s husband, tells a very funny story about how one of the first times he came to a family dinner, he saw us discussing family topics. And he’s a little bit squeamish, so he’s kind of taken aback. But, no, I remember as a kid seeing, you know, kind of crawling into my dad’s home office at times kind of sneaking in, wanted to see him, and also having him take me around the hospital and seeing stuff like that. He’s a very different type of doctor. But it was very cool, it was neat as a kid to see that.

Todd Schlosser: Yeah, absolutely. It is one of those fields that as a kid you’re like, “I want to be a doctor or a fireman,” or one of those things, so it’s-

Dr.  P. Saphier: It has sort of an allure to it, a mystique to it.

Todd Schlosser:  Absolutely. So you made the decision to go into healthcare. What was your education journey like? So you started out, I’d imagine pre-med and then moved up.

Dr.  P. Saphier: Yeah.

Todd Schlosser: So where did that path take you?

Dr.  P. Saphier: In medicine and healthcare, there’s obviously a lot of different pathways that people can get into and subsequently funnel out and go beyond. My trajectory was relatively linear and straightforward, in the sense that I went to an undergraduate and medical school combined. So very straightaway and-

Todd Schlosser: Straight from the early-

Dr.  P. Saphier: Yeah, exactly. I knew from an early age that I wanted to go into healthcare, be a physician, and so I joined that path early on. And then while I was in medical school, I was exposed to a lot of different fields.

Todd Schlosser: Sure.

Dr.  P. Saphier: As you can imagine.

Todd Schlosser:  Yeah. So how did you hone in on neurosurgery?

Dr.  P. Saphier: Well, I always, you know, to quote what you said earlier, in my mind as a kid, sort of like an astronaut or a firefighter.

Todd Schlosser:  Sure.

Dr.  P. Saphier:  I wanted to be a surgeon and I didn’t know why I wanted to be, but it just sort of sounded very, very neat to be that way or to be that kind of a physician. And so I had that preconceived notion going into medical school and then I was exposed to what we called the neurosciences. So yeah, neurology, surgery, so on and so forth. And I didn’t really know what being a neurosurgeon was, but I really liked how, you know, the concepts of the physiology of the brain and the spine and all this different, you know, complex, really eloquent interactions. And I thought, wow, how do I be a surgeon that deals the neurosciences all in neurosurgery, and then that’s when I developed a keener understanding of it.

Todd Schlosser:  Sure. And then went into residency for neurosurgery?

Dr.  P. Saphier:  Yes.

Todd Schlosser: And then when you were done with that, you then did a sort of post-fellowship in interventional neuroradiology.

Dr.  P. Saphier: Right.

Todd Schlosser: So what made you decide to go in a specialization of a specialization?

Dr.  P. Saphier: So again, it’s all sort of by chance, you know, the things that you’re exposed to at certain points in your life.

Todd Schlosser:  Sure.

Dr.  P. Saphier:  I think we’re all like that. So when I was in medical school and made this decision to pursue neurosurgery or you know, kind of caught the neurosurgery bug, at that time in neurosurgery, there was a tremendous change in the way that we as a field now, and I can say we now, because I’m part of that field, approach or approached certain disease states. Things like brain aneurysms and blood vessel disorders in the brain and things like that.

Todd Schlosser:  Right.

Dr.  P. Saphier:   And we went from a very conventional surgical approach and married that with radiology and similar, what changed was, say, cardiothoracic surgery and cardiology. Back in the day, that gets a go. The only way, that as physicians we could treat certain blockages in the blood vessels in the heart, was maybe doing open surgery. And then that evolved into going to a less invasive and minimally invasive approach. And something very similar happened at that time that I was making that decision to go to neurosurgery, within the field of neurosurgery. And I thought to myself, this is just so neat the way that technology was evolving and this was in the late 90s that the technology was evolving and I said, this is clearly the path it’s going to go.

Todd Schlosser:  Sure.

Dr.  P. Saphier:  And so I kind of geeked out and really loved that technology and said, wow, this is very cool.

Todd Schlosser:  So that drove you out into LA to learn-

Dr.  P. Saphier: Correct.

Todd Schlosser:  … sort of those, I guess, more advanced techniques?

Dr.  P. Saphier: Yes.

Todd Schlosser:  And they were on the cutting edge at that point. Would you say that because you did that interventional neuroradiology, that you handled more specialized procedures than like a regular neurosurgeon? Not that what they don’t do is important, but you sort of just focused even more?

Dr.  P. Saphier:  Yes. So, focus is a great way of thinking about it. So, in medicine, like everything else, a lot of other professions out there, there’s increasing sub-specialization, right? So the more that we learned more that we do, the more the technology evolves, people become very more and more tailored as the professionals into that space. And neurosurgery is very, very similar in that there are neurosurgeons who, say, specialize in only complex disorders of doing spine surgery.

Todd Schlosser: Sure.

Dr.  P. Saphier:  And then there are pediatric neurosurgeons that do certain things, so on and so forth. And so for what I do as an endovascular and vascular neurosurgeon, there is a very sub-specialized area of focus within that field of medicine that because of what I do and how I do it, yes, a neurosurgeon who isn’t in that sub-specialization doesn’t really do what I do. Out in Los Angeles is where I learned how to really sort of develop that next layer of proficiency and it was just amazing being out there and surrounded by the talent and the exposure to the evolving technology that that enabled me to get that education and go even further with it.

Todd Schlosser:  Yeah. So, and then you came on here at Atlantic Neurosurgical Services, right? Is it … Did you move from LA to here?

Dr.  P. Saphier:  Yes.

Todd Schlosser:  And so how did you end up at this location?

Dr.  P. Saphier:  Well, I’m from New Jersey originally.

Todd Schlosser: Oh, so you were sort of coming home?

Dr.  P. Saphier:  Exactly. I’m kind of like salmon. I kind of swam back to my birthplace, I guess.

Todd Schlosser: Yes.

Dr.  P. Saphier: Yeah, I mean, I was out in Los Angeles and you know, people say that there’s no better place in the United States in Southern California, and I mean it’s certainly idyllic. So you can imagine the draw to come back here to this area.

Todd Schlosser:  Yeah, I lived in San Diego for three years and couldn’t wait to come back.

Dr.  P. Saphier:  Yeah, I mean it’s certainly nothing … I mean, it’s a gorgeous place to live.

Todd Schlosser:   It is.

Dr.  P. Saphier:  But my family was back here and you know, I’m an east coast kind of guy, so came back here and joined the practice that I’m in. And as soon as I met the other partners that I have, I just realized this is a great group of people and it is a practice that enabled me to really flourish in the area of neurosurgery that I wanted to do.

Todd Schlosser:  When we talked a little bit before this interview, we talked about the speed of innovation and the space of neurosurgery. And I had mentioned that, you know, like cardiac surgery is … it’s sort of been around a long time and you know, brain surgery, neurosurgery has been around for a long time, too, but it sort of was in its infancy until, like the 60s and 70s and then kind of computerized technology, CAT scans, those kinds of things, allowed us to take a look inside without going inside, right? So those kinds of innovations have been coming out and, sort of since then, it seems like innovation, and you probably can speak to this more than me, has been happening more rapidly.

Dr.  P. Saphier:  Sure.

Todd Schlosser:  So, what are some of the innovations that you’ve been on the front lines of in the neurosurgical space?

Dr.  P. Saphier: You’re right, I mean, innovations have certainly at certain points, discrete points in the history of everything, you can see certain milestones that are accomplished. And I would say, you know, one thing that I would add to that is that certainly beyond just healthcare technologies, exponentially improving, right?

Todd Schlosser:  Yeah.

Dr.  P. Saphier:  So, over the years, if you look at telephone technology, right, and how that evolved from the beginning of just telephone conventional lines to then cell phones and now, how rapidly even cell phone technology is. And the same thing happens in medicine and in neurosurgery, very much so. Me, specifically doing what I do, there’s this drive to accomplishing complex neurosurgical procedures in the brain in an increasingly minimally invasive approach, to decrease the amount of potential injury that we can do for somebody and improve the amount of rehabilitation and to improve what that person could enjoy, right?

Todd Schlosser:  Sure.

Dr.  P. Saphier:  So, for instance, a brain aneurysm treatment. You know, that’s something that is a clear interest of mine and there’s been, like I said, in my training back in the early 90s or, I should say, mid to early 90s you know, we had this huge transition from open conventional surgery for brain aneurysms to trying to take care of them kind of like the cardiologists do, with small little tubes and wires going into the arteries and either the wrist or the leg and going up to the blood vessel and fixing it that way. And even that has evolved. Our understanding of the technology has increasingly evolved. And I certainly participated in trials and research for that as well. And even now, you know, some of the trials that we’re running specifically here at my institutes that I’m at, are looking to change the way the face of how we treat certain clinical disease states. And it’s just really truly miraculous.

Todd Schlosser:  So one of the ones that we talked about briefly before the interview was a provocative spinal angiogram? Am I saying that correctly?

Dr.  P. Saphier:  Yeah.

Todd Schlosser:  Awesome, so walk me through what that procedure was like and what made it special?

Dr.  P. Saphier:  Right. It’s provocative in the sense, not like a provocative question that stimulates conversation.

Todd Schlosser:   Sure.

Dr.  P. Saphier:  But it’s provocative in the sense that you know, we are looking … So, spinal angiograms when we perform those, we’re looking at the blood vessels going to the spinal cord.

Todd Schlosser:  Right.

Dr.  P. Saphier:  And we do that for many different reasons, a couple of different reasons, for sure. And sometimes we’re looking at blood vessel disorders in the spine that may cause bleeding or spinal cord impairment. Sometimes we’re looking at spinal tumors that are, you know, tumors that are growing into the spine sometimes. And before we do surgery for them, we want to get a better understanding of the blood supply or maybe even try to cut out the blood supply to the tumor, so that way there’s not so much bleeding at the time of surgery. And so when we do that, before we start manipulating those blood vessels, the provocative element is we will instill a little bit of medication that flows through those blood vessels that will temporarily suppress the function of the spinal cord if it’s being supplied by that blood vessel.

Dr.  P. Saphier:  So that way if, say for instance, I inject that medication and we monitor that patient with complex instruments that allow us to tell how much the patient’s able to feel and move with the patient being under anesthesia, if I see that there’s any possible change in that function, then maybe it’s not so safe to manipulate that blood vessel. Whereas, if I instill that medication, and I see that the function going through the rest of the body remains absolutely perfect, then maybe it is safe to compromise it, but sort of manipulate it.

Todd Schlosser:  Right. So you can go in there and operate on the tumor or whatever is causing that?

Dr.  P. Saphier:  Correct. Operate on the tumor, change the … Again, if it’s a blood vessel issue, if I need to, what we call embolize or shut down the blood vessels, and I can do that with safety.

Todd Schlosser:   You talked a bit before about aneurysms. I’d imagine you deal with strokes as well because that’s also-

Dr.  P. Saphier:  Yes.

Todd Schlosser:  … dealing with blood on the brain. What are some innovative techniques that are being used now as opposed to maybe 20 years ago?

Dr.  P. Saphier:  Well, a lot of what we’re doing today, we weren’t even doing five years ago, first of all.

Todd Schlosser:  Oh wow, so it’s that fast.

Dr.  P. Saphier: Yeah, it is, and again, there’s these discrete portions in time where you’ll see … You mentioned CAT scan, back in like the late 70s, early 80s CAT scans came about and that revolutionized things.

Todd Schlosser: Yeah.

Dr.  P. Saphier: And then maybe there was a lull of time that MRIs came out and then so on and so forth. Then it becomes a little bit more compressed the more recent we go, because the technology just evolves so fast. But yeah, so strokes and aneurysms and things like that, that I treat, stroke technology, for instance, back in 2005 was when we first started the safety and efficacy trials for some of the, what we call, stroke interventional technology that we don’t even use anymore, but really served as a springboard to get us into that field. And that has absolutely revolutionized the way that we treat patients with ischemic stroke, when they’re having blockage of blood vessels.

Todd Schlosser:  Right.

Dr.  P. Saphier: That disease state is something very similar to, say, like a heart attack and I mentioned that because everybody seems to know what a heart attack is or the signs and symptoms and some of the technology. They may not have had it or they may not know of anyone, specifically, that has had, say, a cardiac catheterization, but that name sounds somewhat familiar. People recognize that and we have adopted that technology and apply it to the blood vessels in the brain when people are having acute strokes and things like that.

Todd Schlosser:  So you can literally go into the brain and find the blockage and administer medicine to break it up or even can sort of scrape it out or whatever the terminology is.

Dr.  P. Saphier:  Absolutely, yeah. You know, scraping it out sounds a little bit …

Todd Schlosser:  Yeah, it’s probably not that aggressive.

Dr.  P. Saphier:  But yeah, something to [inaudible 00:14:09], correct. If there’s a blockage in a blood vessel that’s supplying a portion of the brain and that brain is being starved of oxygen and is not working well and may soon die if we don’t do something, yeah, we get in there and we can try to open up that blood vessel one way or the other. Medicines or, you know, some people say Roto-Rooter. Again, that sounds a little rudimentary, but yeah, you go in with your smaller type-

Todd Schlosser:  It’s very tiny.

Dr.  P. Saphier:  Exactly, and try to pull that that blockage out. Conceptually, it’s relatively straightforward.

Todd Schlosser:  Yeah.

Dr.  P. Saphier:   But you know, in medicine the onus is on us in the field of medicine to both innovate but also validate, so to speak, right?

Todd Schlosser:  Sure.

Dr.  P. Saphier:  In the sense that we come up with technology or procedures, but then we have to say if they really truly work. And sometimes it’s really hard to come up with that. So with acute ischemic stroke, for instance, it took us from 2005 when the first safety and efficacy trials came about, to show that this technology was safe to use.

Todd Schlosser:   Yeah.

Dr.  P. Saphier:  It took us until about 2015 to say not only is it safe and effective to use, but really should be the standard of care if patients meet criteria.

Todd Schlosser:  Right.

Dr.  P. Saphier:  So that’s an entire decade of labor of love that a lot of physicians like myself were really pushing and being champions for. So there’s a lot that goes into medicine that maybe a lot of people who aren’t in the area of healthcare are not aware of.

Todd Schlosser: So I’d imagine that between the 2005 and 2015, a lot of trials were taking place.

Dr.  P. Saphier:  Yes.

Todd Schlosser:   I know that you guys do trials here.

Dr.  P. Saphier:  Yes.

Todd Schlosser:  Were you doing some of those trials here or?

Dr.  P. Saphier:  Absolutely, absolutely.

Todd Schlosser:  Okay, so what other trials do you guys do here?

Dr.  P. Saphier:  So a couple of trials that we’re in right now … I mean, we do a lot of trials, certainly in my organization.

Todd Schlosser:   Yeah.

Dr.  P. Saphier:  We have trials for spine disorders, we have trials for brain tumors, we have trials for like we talked about, strokes, both ischemic strokes, meaning blockages in blood vessels, as well as hemorrhagic strokes.

Todd Schlosser:  Yeah.

Dr.  P. Saphier:   A couple of trials that I’m very passionate about and participating in have to do with what we refer to as hemorrhagic stroke or bleeding in the brain.

Todd Schlosser:  Yeah.

Dr.  P. Saphier:  The specific trials that we’re looking at, are the most common causes of hemorrhagic stroke and hemorrhagic stroke, by the way, is so disabling and lethal for patients.

Todd Schlosser:  Yeah.

Dr.  P. Saphier:  And we, as neurosurgeons, have not been effective in the past, not only 10 years … I would say past 30, 40 years in the era of modern neurosurgery, we have not been able to effectively move the needle when it comes to treatment for patients with hemorrhagic stroke or bleeding in the brain. And again, you might think intuitively someone has bleeding in the brain and they’re having problems from that, well maybe you should do surgery to remove that blood. Again, intuitively, it may make sense, but if the trials don’t prove that those patients do any better that receive surgery, maybe versus the patients that don’t receive surgery, then the question becomes, “Well, should we do it?” It’s not enough to just think that it’ll do better. You actually have to put pen to paper and prove that it’s going to work. And so we haven’t been able to do that with the conventional surgeries that we’ve used.

Todd Schlosser:  Because of these strokes that are bleeding on the brain, I’d imagine it builds up pressure and the brain, of course, swells to compensate to sort of protect itself, and that is what leads to … It could lead to sort of destruction of the brain entirely.

Dr.  P. Saphier:  Absolutely.

Todd Schlosser:  And end in very negative outcomes. So, what sort of techniques can be done if you’re at the point of a stroke where it’s bleeding and you know, we’ve got to go in there and fix it. By we, I mean you.

Dr.  P. Saphier: Right, right. Unless you want to come with me.

Todd Schlosser:  I mean, I’d scrub in, but I wouldn’t know how to-

Dr.  P. Saphier:  You want to shadow someday, yeah.

Todd Schlosser: Yeah, for sure.

Dr.  P. Saphier:  Well, yeah, so just to take a step back for a moment, right now, because the conventional surgical trials never proved that operating on someone with this type of brain bleeding was beneficial, we have adopted the stance that the standard of care is best medical management. And that sounds all fine and good until you realize that for this kind of disorder specifically, best medical management results in 30 days, just shy of about 50% of people are going to die.

Todd Schlosser:   Yeah.

Dr.  P. Saphier:  And of those people that are survivors, two-thirds of them approximately don’t go back to a level of independence.

Todd Schlosser:   Right.

Dr.  P. Saphier:  So you’re talking about the … For me, as a surgeon to say to someone, the best that I can do for your loved one right now, they have a 50/50 chance of living in the next 30 days, and if they do survive, they’re probably not going to be independent, you would look at me and say, “That’s the best you can do?”

Todd Schlosser:  Yeah.

Dr.  P. Saphier:  So for me to say, “Well, that’s where we should just remain,” it doesn’t make sense.

Todd Schlosser:  Right.

Dr.  P. Saphier:  So the new approach that we’re trying out is to approach these hemorrhages, the bleeding in the brain, in a very minimally invasive approach, using very sophisticated, essentially GPS systems to help navigate real-time, where I’m introducing these very small tubes or what we call catheters, to get into the deep part of the brain and then through those small tubes, use very tiny little video cameras to get in there and then physically remove the hemorrhage, itself. And if we think about it, that makes sense. You know, the general surgeons, for instance, nowadays, every … Not everything, obviously, but they certainly have … There’s a huge thrust in doing general surgery, operating in the belly laparoscopically, and a lot of people have heard that, you know. And even still, they went even further with minimally invasive. So now, as neurosurgeons were saying, “Oh, well maybe we should do that, too.” And it makes sense. It’s less invasive. It’s less destructive. And pardon the pun, but it’s way more surgical than doing open ballistic neurosurgery.

Todd Schlosser:  Yeah. Or exploratory surgery, that they used to do, before that was even an option.

Dr.  P. Saphier: Well sure, yeah, for sure. Now we’re certainly not doing a lot of that because of the evolved technology, where we can look inside the brain without having to physically look inside the brain.

Todd Schlosser:  Right, absolutely. Well, I personally have a very strong connection to what you just talked about, because that’s how I lost my dad two years ago. So I didn’t know any of that stuff about, you know, bleeding on the brain or it swelling or any of that stuff until that happened and we had that conversation with the doctor.

Dr.  P. Saphier:  That’s awful, I’m sorry.

Todd Schlosser: No, I mean, I am not alone in this, you know?

Dr.  P. Saphier:  Yeah.

Todd Schlosser:  But yeah, so I really appreciate the work that you’re doing, specifically, because it’s like you’re providing an option for people who, there really isn’t an option for, or you’re looking to find options.

Dr.  P. Saphier:  We’re looking to see.

Todd Schlosser:  Yeah, that’s huge.

Dr.  P. Saphier:  Yes. Does this concept, does this technology have legs to it that it can actually, you know, make something of it and change the course for a lot of patients like your father.

Todd Schlosser:  Yeah. So, I mean, like when you said, you know, I don’t want the patients looking at me and saying, “That’s the best you can do?” Like, that is … My brother, sister and I legit had that conversation and we were at a great hospital in Nashville and you know, the best that were looking at it and were working on it, and it was just … there was nothing they could do and that blew my mind. Pardon the pun.

Dr.  P. Saphier:  Yeah.

Todd Schlosser:  But yeah. So, I’d like to close with this question because I feel like we have a lot of listeners who are interested in, you know, the pathway you took to get to where you are. So, if you were talking to someone who is in, let’s just say, medical school and they’re looking to focus on a certain field, what would you tell them about neurosurgery and why they should consider neurosurgery?

Dr.  P. Saphier:  If you’re the kind of person that likes to be challenged, in terms of helping to drive the course and come up with technology and some of the elements that we’ve touched upon previously, if you really like the challenge of complex surgery and being able to take some of the sickest patients that are out there, who may not have any good options and potentially dramatically alter the direction of their course, their overall course of their medical stay in their life, and get patients who otherwise, to put it bluntly, would otherwise die or be severely disabled?

Todd Schlosser:  Yeah.

Dr.  P. Saphier:  And be able to allow them to survive and thrive and bring them home? Then neurosurgery is for you.

Todd Schlosser:  Dr. Paul Saphier, thank you so much for being on the podcast. We really appreciate it.

Dr.  P. Saphier:  Thank you. Todd Schlosser: Thanks. Thanks for listening to Scrubbing In. Please take a second to give us a rating on your podcast app and subscribe, so you won’t miss out on what we have coming up. See you next time.