Contact Dr. M. Victoria Marx
Fibroids1: How did you come to specialize in interventional radiology?
Dr. Marx: I wanted to find something I could do that would combine my interests and my skills – my eye-hand coordination and my good three-dimensional thinking skills and my technical skills – with a professional culture that was perhaps a little more forgiving and allowed a little bit more personal life. I’m not sure if in the end interventional radiology really allows that now, but I’ve never regretted the decision.
Fibroids1: That said, can you tell Body1 some of the things you find especially rewarding about your specialty, that have caused you to feel your decision was the right one?
Dr. Marx: Interventional radiology is a very fast changing specialty, so it’s a specialty that thrives on innovation. We tend to be the specialty that introduces new techniques, and they become increasingly accepted as they are seen to be successful, and then other specialties adopt the techniques that we pioneer. It’s very similar to plastic surgery, which has pioneered all kinds of aesthetic surgeries, and now all kinds of specialists are adopting those plastic surgery techniques.
Interventional radiologists pioneered angioplasty and now all kinds of people are doing angioplasty because they see it as being so valuable. So that’s one thing: the innovation, the constant change. I think most of the things I do now I didn’t do when I was in training, and I like that. It keeps you young. It keeps you on your toes, to always be learning new things.
The other thing I like is that I can really see very immediate results of helping people. The patients are almost uniformly surprised at how they were worried about it, they were scared about it, but going through the process of the treatment was not as bad as they expected it to be compared to, say, open surgery with an incision. So you can see you’ve done somebody some good and surprised them with how easy it was to get through.
I also like the combination of the use of imaging and technical skills. Those are two sort of separate skill sets that we get to combine. And I like working in an academic environment. I really like working with medical students and residents and fellows, because it teaches you. As you get old, it’s easy to get stale and to get used to doing one thing, but when you’re constantly training new people they’re always challenging you.
Another thing I like about what I do is that I’m very active in the National Interventional Radiology Society. It is a fairly small group of physicians, and it’s just a great group of people to work with. By knowing a lot of people around the country I have a tremendous resource. We pick each others brains a lot and it’s a really high-level group of professionals.
Fibroids1: Maybe this will be a harder question to answer, because it sounds like you really love what you do, but what do you find frustrating about your work or your specialty?
Dr. Marx: I think the biggest difficulty that interventional radiology faces – which is also a thing that I have mentioned as one of its strengths – is the very innovative nature. We do some of the pioneering work, get it started, then it becomes successful and other people take it. So in practice, interventional radiologists can feel all kinds of interdisciplinary turf battles with other specialists. So that’s a source of frustration in the field, and I think it has an effect on people.
For interventional radiologists to succeed nowadays, we have to be willing to compete with other specialties for work. You have to market yourself; you have to be willing to have clinic hours; you have to answer your phone calls; you have to, perhaps (and I think all physicians are doing this), work harder for the income that you get. The shrinking reimbursements in health care lead to physicians being more competitive with each other. So that’s a frustration. That’s probably the biggest frustration in the field. I don’t have a lot of that, personally, but I see it because I’m on the board of the Interventional Radiology Society. What I see is that one of the biggest issues facing the field is the need to retool ourselves into physicians who are willing and able and prepared to compete for livelihood.
Fibroids1: Do you find that that competition, when it goes well, leads to a higher standard in patient care, in addition to the marketing savvy and the willingness to go out and find patients in a more proactive way?
Dr. Marx: I think it certainly has the potential to do that, because as healthcare consumers become savvier they have higher expectations, and ultimately we have to meet those expectations. Is that higher level of excellence always achieved via competition? No, I don’t think so. I think there’s some dirty politics that go on out there in the world in some places.
Fibroids1: Related to that, you keep mentioning the technologies and techniques that are so constantly evolving. One thing that would be of interest to doctors and patients reading this interview is a mention of some of the latest and greatest things coming into the field currently.
Dr. Marx: In women’s health care, one of the techniques that certainly is well-known and has proliferated over the last seven or eight years is uterine fibroid embolization. Trans-catheter embolization, where we thread a little catheter into a blood vessel and via a variety of means plug that vessel up, is something that’s been around in the interventional radiology world for a long time, and it’s something that has traditionally been used to stop internal bleeding in trauma patients or internal bleeding in people with types of cancer or ulcer disease. It’s also been used to treat cancers in the liver among other places; it’s been used to treat abnormal blood vessel formations in the brain. But to use it to treat a benign condition in the uterus is a fairly radical notion. So the application of trans-catheter embolization to manage systems related to uterine fibroids is the most dramatic things in women’s health care.
Other things that people are applying trans-catheter embolization to include venous insufficiency: varicose veins, problems with veins in the legs. There are certain interventional radiology techniques that have made the diagnosis of breast cancer much less invasive than it used to be. Interventional radiology sort of began the concept of percutaneous angioplasty and stent placement for vascular disease – peripheral vascular disease like sclerosis that’s having an effect on the arteries in the legs, arms, or kidneys rather than the arteries or the heart.
Fibroids1: How about in the next five to ten years? Are there any technologies on the horizon that you have special cause to be excited about?
Dr. Marx: The thing that excites me most right now is that there’s a pretty strong direction in the interventional radiology world to look at ways to treat lower extremity venous disease. Lower extremity venous disease can range from just a host of annoying cosmetic problems to serious debilitation. There’s a lot of people with it, there have not been a lot of doctors interested in treating it historically, because they haven’t had many treatment options. I think as we apply that culture of interventional radiology to some of the problems with venous disease in the leg, that we’ll be able to find some treatments that are very effective. There are valves in veins that keep the blood pumping back up to the heart against gravity, that prevent backflow. So one of the biggest problems that people have struggled for years with is how to treat backflow in patients whose valves don’t work.
There are also all these image-guided techniques to ablate, or kill, tumors: radio-frequency ablation or cryoablation where you use image-guidance techniques to put a needle in a tumor and either freeze it until it’s dead or heat it until it’s dead. I think those show a lot of promise in managing cancers.
Fibroids1: You’ve been speaking about disorders of many different parts of the body, but you’ve had a special experience with uterine fibroid embolization. In your practice, do you treat primarily uterus-related disorders using your training, or do you treat things across the spectrum?
Dr. Marx: I am a general interventional radiologist, and I have an interest in uterine fibroid embolization. I have done most of them, or a higher percentage within my office here at USC than my partners, and a lot of why people know about me is that I actually had the procedure done, and offered to tell my story on a national television show. So I have the perspective on uterine fibroid embolization from the physician’s point of view and the patient’s point of view.
Fibroids1: That must have been an amazing experience. Do you feel that being both a fibroid patient and a doctor who treats fibroids in women changed your approach to patient care, or to your field at large?
Dr. Marx: Well, first of all, when I had the procedure done it was 2001 and I probably started thinking about it in 2000. It was about a five-year-old procedure at that time, and I think the most important thing about my having undergone the procedure is that I came at it from a relatively sophisticated level of knowledge about what the reports had been and what the clinical series had shown. Despite the fact that the procedure was relatively new, I had a high degree of confidence that it would work. And that’s important because just as, if you went to an ophthalmologist to ask about contacts and the ophthalmologist is wearing glasses, you think "Hmm…" So if you go into someone for surgery, and that person is a candidate and hasn’t had the procedure, then maybe they have a reason for not doing it. At the time, I was also a very good candidate for it.
Fibroids1: And it sounds like the experience that you had really affirmed your faith in the procedure.
Dr. Marx: Oh yes. I’ve done very well. I had horrible bleeding fibroids, very heavy bleeding before the procedure and it all went away, and I had a very short recovery time, no complications. But I did know what to expect. I don’t remember the procedure, I didn’t have much pain afterwards, and I was up and around in a few days. My guess is that, based on my experience with the patients I’ve treated since I’ve had it done, that my recovery period was shorter than normal, and I think some of it had to do with just knowing what to expect. I wasn’t going to a strange, intimidating place. I was going to my home to get the procedure done, my work home. And I knew what to expect about the pain from what I had read, I didn’t have fear of an unknown sensation. I had such a low level of anxiety that my recovery time was shorter. Most people feel pretty much fine in two weeks. And I think I can speak with a high degree of confidence when I’m talking to patients and letting them know about the procedure. I don’t usually say before the procedure that I had it done. Some people come knowing, because they saw a report or saw the interview on the internet or something, but I try not to volunteer the information until after the procedure is chosen and done because I think it’s not really fair to the patient.
Fibroids1: Are you afraid it will slant their decision-making too heavily because you had it done?
Dr. Marx: Right, and I have no desire to appear coercive. Of course, if somebody asks me I tell the truth, but I don’t want to influence them too much. For some people, it’s not the right decision, and I want to make sure they’re making the right decision. I don’t want to just sell it.
Fibroids1: Have you found that your experience with fibroid embolization has influenced your thinking about other, similar interventional radiology procedures?
Dr. Marx: Sure. If I had vascular disease, I wouldn’t hesitate to get an angiogram and have it treated percutaneously, or if I had high blood pressure and turned out to have a narrowed renal artery, I wouldn’t hesitate to look at that as my first treatment option. If I had GI bleeding, I would want it to be embolized if possible. I think the most important thing it’s taught me, though, is how important spending a little time with somebody and talking is, and how little time physicians have to just sit down and talk with patients and explain things to them. My as clinical referral practice is relatively small, compared to, say, a full-time gynecologist, who tends to spend full days in the office, I don’t spend a lot of time in the office, so when I do I have time to sit and talk with them. I think it’s clearly a stress on the medical system that physicians don’t have the time to do that.
Fibroids1: How would you recommend that our readers who are patients find a good interventional radiologist?
Dr. Marx: I think they’d want the interventional radiologist to have documented qualifications in the field, such as being board certified, either having a certificate of additional qualification as a sign of dedication in the field or having done a fellowship. Somebody who is a member of national radiology societies. That is a sign that you’re committed to continuing medical education and to giving back to your profession and learning from your profession.
The other thing to do is to call hospitals. It’s hard to look in the phonebook and find one, but if you get your care in an area that’s served by one or more large hospitals -- I’d say they kind of congregate there because the infrastructure is needed for the equipment – you can call and ask to speak to an interventional radiologist, and they can answer simple questions over the phone or arrange to see you and discuss more specific questions.
Fibroids1: Is there anything else you think it’s especially important to discuss when it comes to speaking about your field?
Dr. Marx: Any time you’re in a position of needing some sort of procedure where a doctor has to go inside your body, either to make a diagnosis or treat something, you should always ask, "How do you do this through the smallest hole?" And a lot of the answers to that question involve interventional radiology procedures. If you can do it safely through a small hole, recovery and the experience overall will be better and quicker than with something that’s done through a big hole.
Fibroids1: So you’d argue that perhaps fear about newer technologies should be allocated to the back burner when compared with the leap to a shorter recovery time that may be associated with undergoing a procedure with which patients are less familiar?
Dr. Marx: Yes, exactly. And I also think that people should ask questions and learn about their diseases. I love it when people come to me with a fair amount of knowledge about the underlying disease, because it makes it so much easier to have a conversation with them. People should seek out less invasive treatments. I think, specifically, that uterine artery embolization for fibroids is an underutilized treatment right now. Way more women are getting hysterectomies than need to, and women seeking out the treatment is the only way that it will be used increasingly because there is a level of competition for income related to the procedures that we do, and that demand leads to availability.
Contact Dr. M. Victoria Marx