Moises Yoselevitz M.D has served as chief of vascular radiology at the Alton Ochsner Medical Foundation in New Orleans since 1991. Prior to that he was chief of interventional radiology at the Veterans Administration Medical Center in West Haven, Connecticut and an assistant professor of interventional radiology in the department of diagnostic imaging at the Yale University School of Medicine.
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Fibroids1 : Much of your work has been in interventional and vascular radiology. Can you first define those fields for readers and then discuss how you became interested in them?
Dr. Yoselevitz: Interventional radiology is the field whereby you use minimally invasive techniques and imaging to do what formerly was done with major surgery. In the past, patients with vascular diseases, for instance, have had to undergo major surgery to repair vessels. Now we can fix the problem by placing an angioplasty ballon or a stent, a sort of metallic scaffolding that keeps the vessel open.
With minimally invasive techniques, patients frequently don’t have to undergo general anesthesia or assume the other risks associated with surgery like infection, major bleeding, and various other complications. Also, instead of the weeks and even months it takes patients to recover from major surgery, recuperation times associated with minimally invasive techniques can be as brief as one to two days.
The majority of people that do interventional radiology treat a gamut of diseases including peripheral vascular disease. In addition interventional radiologists will take care of other problems including those in the liver and kidneys, cancer and gynecological problems like uterine fibroids that might be treated with uterine artery embolization. Interventional radiologist can intervene in almost any organ in the body with minimally-invasive techniques.
I was born and raised in Mexico, and I trained as an obstetrician. After I started practicing, I found I really liked the imaging part of obstetrics and gynecology - like ultrasound. So I decided to go into the field of radiology, and that’s where I discovered interventional radiology. Combining the image modalities with my surgical skills was the perfect mix for me, and I currently use both techniques to diagnose and treat patients.
Fibroids1: What types of medical problems is your field equipped to manage, and what is the long-term outcome for patients in terms of quality of life?
Dr. Yoselevitz: Uterine artery embolization is a particularly successful type of intervention for patients that come in with symptoms associated with excessive bleeding or pain and pressure. It used to be that good portion of patients with uterine problems such as fibroids were offered hysterectomies as a treatment. Those patients had to undergo major surgery and sacrifice four to six weeks of their life for recovery. Now when you do a uterine artery embolization, the majority of those patients return to normal activities within a week to 10 days. In addition the outcomes and the relief from symptoms is comparable to surgical intervention. So, interventional radiology relieves those symptoms as successfully as surgery without the extended recovery time.
The question of fertility, it is still being investigated. We do know for a fact, however, that patients that undergo uterine artery embolization can get pregnant and carry successful pregnancies to term. The Society of Interventional Radiology is putting together the statistics in order to give the public better information on fertility issues. But almost everyone that has done uterine artery embolizations has success stories of patients that were able to get pregnant in the aftermath of the procedure.
Fibroids1: What questions do patients most often ask you and what are your answers?
Dr. Yoselevitz: Although it’s not surprising, what I’m finding more and more is that patients are very educated. By the time they come to see me they’ve done a lot of research - have gone to different Web sites on the Internet and have very specific questions.
Besides questions related to their symptoms, they want to know about my professional experience - my training and skills, as well as the number of embolizations that I have you performed. They also want to know whether I will be able to give them good outcomes in relation to their symptoms.
I think education is really incredible. That’s the most important thing - a patient knowing what her choices are and then making informed decisions on her own health. For the longest time some of these treatments were almost imposed by physicians. I think it’s great to see that patients are becoming empowered and making their own decisions on their care.
I’m an interventional radiologist and graduated from Yale University in 1987. Over the past three to four years, I’ve developed an interest in uterine artery embolizations to treat fibroids. Since that time, I’ve probably performed close to 400 of those procedures.
I also am a participant in the fibroid registry created by the Society of Interventional Radiology and am very involved in patient education throughout the state of Louisiana, including public seminars geared toward informing people about their choices.
Fibroids1: What advances have you seen on the cutting edge during your career of 18 years? And are there any particular areas of research that show further promise at this juncture?
Dr. Yoselevitz: Interventional radiology has made considerable strides. By combining the new imaging modalities that have been coming out with technical advances in the catheters and type of medical instruments that we can use, we can do things that were not even dreamed of in years back.
Also, on the subject of the cutting edge, in probably the next few years, we will most likely see a number of minimally invasive techniques emerge to fight cancer. Even at the present time, there are image-guided techniques that help us either ablate or kill tumors. Radiofrequency ablation, cryoablation, and some techniques in which we apply medications or use very local radiation to kill tumors are already available, so it’s a field with a lot of promise.
Fibroids1: How can people manage their lives and habits so that they minimize the chances of ending up as one of the many patients you and your colleagues in interventional and vascular radiology treat?
Dr. Yoselevitz: I think that that’s a great point. People should empower themselves by taking the initiative of improving their health. There are so many clear relationships between our behavior and the diseases we get. So we should do our best to avoid those behaviors that we know for a fact are going to lead us to problems.
By not smoking and with exercise and good eating habits we can help ourselves. Since I am also human, I know myself that this isn’t always easy. But the more we can work toward cooperating with our bodies, the better off we will be, particularly as we get older.
Fibroids1: Finally, you seem extraordinarily cordial and without the pretension or patronization that has been associated with the medical profession in the past. Are you part of a larger trend?
Dr. Yoselevitz: I don’t know if there has been any particular change in the profession, I’ m just a person that loves to engage my patients. I try to be more than just the aloof physician that is there to treat and then forget about patients. That’s just part of my nature. I’ve always been very open and very friendly in general. So that’s the way I practice medicine and I truly enjoy it that way.
As far as larger trends in medical school, I hope they are there. I don’t know, though, whether there’s any education in that regard. One of my sons is graduating from medical school, and I do see some of these more personal attitudes in him. Whether he learned from me or the medical school, I don’t know. I hope that it’s coming from the school, though. Anything we can do to humanize the medical profession and leave pretension behind will be to both the medical profession’s and larger society’s credit.
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