This is “Healthy Conversations,” a podcast presented by Adventist Health.

Prakash Chandran (Host): Your brain, spine and nervous system are all intricately involved in almost everything you do in your life. Having an experienced team of Neurosurgeons that can provide state-of-the-art care using advanced and minimally invasive techniques is a big reason why Adventist Health has been a leader in brain and spine care. We're going to talk about it today with Dr. Phillip Kissell, the Director of the Neuro Spine Institute at Advocate Health and Clinical Professor at the UCSF Department of Neurological Surgery.  

My name is Prakash Chandran. So, first of all, Dr. Kissel, it's great to have you here today. Let's start just with the basics here. What exactly is neurosurgery and how does it differ from neurology?

Phillip Kissel, MD (Guest): That's a great question. Neurology is more a specialty where the doctor thinks about what problems are occurring in the nervous system and hopes to prescribe usually medication or therapy to take care of the problem, whereas neurosurgery has to do with actively operating on the central nervous system and the spinal column. So, the difference is basically we intervene as Neurosurgeons, in a way that allows us to deal with acute problems and things that are causing significant compression of the nervous system or dysfunction within the nervous system, whereas neurology, they use a lot of medications, a lot of different techniques, and they're not as interventional.

Host: Okay. And just to clarify, when you say acute problems, maybe list some of the most common things that you see.

Dr. Kissel: Well, the most common things that Neurosurgeons deal with, have to do usually with the spine, meaning the neck or cervical spine, the mid or thoracic spine, and the lower spine, which is very commonly involved with degenerative problems. In other words, people, as they age, get arthritic problems in their spine, and oftentimes they pinch nerves, can't do their day-to-day activities and require a Neurosurgeon to do an operation to fix that problem in the spine.

But we don't just limit ourselves to the spine. A good portion of our operative intervention has to do with the brain. And that involves things like brain tumors, hemorrhages in the brain, infection, things that involve the central nervous system that are threatening the way the function is occurring.

Host: Okay, understood. And one of the things I wanted to ask you about is, when we hear about Neurosurgeons or brain surgeons, it feels like they do the most complex type of surgery. Right? So, I imagine there's a lot of time, energy and education that's involved in becoming one. So, maybe talk a little bit about your journey and why you decided to become one in the first place.

Dr. Kissel: Yeah, it's a long discourse. So, I'll try and keep it down to earth as I can. After you get done with high school, to sum it up, to get to a point where I could actually sit for my Neurosurgical Boards took 19 years. So, almost two decades to get from high school, to being a Board Certified Neurosurgeon.

And some people don't realize it, but to do neurosurgery, you really do have to be an expert in your field before you even start the process of operating on someone. So, it's a lifetime commitment. There's no question. And it's a lifetime of learning. Once you're actually practicing on a day-to-day basis, I'm constantly getting exposed to different problems, which I may have experienced in the past, but they are a little different and I learn from each case. So, it's a challenge and I recognized that early on, and I also recognized I wanted to work in the operating room. It'd be a surgeon. So, the two came together in the title Neurosurgery.

And that's the direction I chose early on in my medical career and subsequently have gone on to train at UC Davis for actual Neurosurgical training. And then I started practice here in San Luis Obispo in 1989 and have been here ever since enjoying the whole environment and what my practice is able to offer to the people of our community.

Host: Yeah, I wanted to expand on that a little bit. So, you live in San Luis Obispo. You've been there for over 30 years. Why have you chosen to practice at Tenet Health Central Coast?

Dr. Kissel: Well, neurosurgery takes more than a village. In other words, there's a population base of at least a hundred thousand to support one neurosurgeon. So, many neurosurgeons are based in the bigger cities. But I recognized that this community already had established neurosurgery. Neurosurgeons have practiced there for many decades related to initially, the trauma that occurs on our highways.

San Luis Obispo is a crossroads between highway 101 and highway 1. And those car accidents in the early days had very severe injuries that required neurosurgical help. And it was too far from the other cities. So, a neurosurgeon learned that he could be here and to help people that were acutely in need of his services. So, we have a longstanding established neurosurgical hierarchy here. And when I started practice, I was probably in the third or fourth, maybe even fourth generation of neurosurgeons to practice here.

Host: Yeah. You know, I've heard that Sierra Vista has always been a leader in brain and spine care. And I'm curious as to why you think that is. I guess more specifically what sets the neurosurgical care program apart from other hospitals in the area?

Dr. Kissel: Well, neurosurgery is very resource intensive. In other words, you need personnel that are highly trained in the operating room and the ICU, throughout the hospital itself, emergency room to facilitate the safe care of neurosurgical patients. And that takes generations to establish within an institution. So, each hospital evolves in its own pathway. Sierra Vista has evolved through the surgical pathway. Again, because of, as I explained earlier, the trauma has attracted all of these cases to Sierra Vista. And then as time has gone on, the neurosurgeons actually bring in new equipment, new ideas, new procedures, and we're able to keep the hospital at the level of its ability to help patients that need neurosurgical operations and then again, very resource intensive. So, it doesn't make a lot of sense to have multiple neurosurgical units around smaller community like ours.

Host: Yeah, that completely makes sense. So, you know, one of the things that is new, is this partnership with the University of California, San Francisco that Sierra Vista has made. So, maybe you can speak to this a little bit.

Dr. Kissel: Yeah. Well, this has been something that administration and myself have been working on quite diligently for the past two years. It's no small feat to bring these two institutions together. In other words, the department of Neurological Surgery at UCSF is one of the top three programs in the entire country. And I felt it was important to connect with them so that when we have situations, cases, people that have problems that are above our level of being able to care for them. We would have access to their facility, their physicians, their technology. And so, the initiation of this process occurred a few years ago when I spoke directly with the Chairman, Dr. Berger, and he, and I agreed that this would be a fruitful relationship for the patients of this community. And subsequently both Tenet and the UC University of California System have come to agreements and the affiliation is now in completion, and we have ability to transfer patients without resistance into their institution.

And so what that really means is let's say someone comes to our emergency room, has a very bad problem that we, we the neurosurgeons here assess and say, you know what, this is something that needs the university help. And at that point we can make one phone call and get that patient transferred to UCSF under the care of the surgeons there. And when they're well enough, they come back home and we complete the care cycle. So, it's just to opened up a very expedient way to take care of difficult neurosurgical problems and help our people in the community.

Host: Yeah, that completely makes sense. And, you know, in thinking about it, it seems like any neurosurgical program is measured by the experience and the different types of cases that it's exposed to and it works on, and you mentioned earlier why San Louis Obispo is unique and why it is well-known for brain and spine surgery. And it really seems like this partnership with UCSF just broadens that exposure to the different types of cases. And now together, you can collaborate on working in getting patients better, faster, and also moving patients back and forth between UCSF and San Louis Obispo. Is that correct?

Dr. Kissel: That's actually perfect. That's exactly what this is designed to do. It also allows the UCSF faculty to interact directly with our faculty. So, if we're in the operating room, let's say, in the middle of a difficult brain tumor, and we have a situation we need to a little input, we'll call it help, with I can directly link our microscope in the operating room to the professor's computer.

So, he can look at it and say, you know, Phil, you might want to do this. You might want to do that. So, it's like having a professor over your shoulder on these difficult cases and we can therefore, you know, take care of problems that, you know, maybe we couldn't in the not too recent past.

Host: That is incredible. Just as we, or I guess before we close here, and because we have a little time, you mentioned your journey to become a neurosurgeon and the fact that it took basically two decades since the time you graduated high school. Was that clear or apparent to you when you went into medical school? Was it always neurosurgeon or bust?

Dr. Kissel: Good question. So, my father was a general surgeon and I had the fortune when I was in medical school to help out in the operating room as a scrub technician in my training during my freshmen and sophomore year of medical school. So, I decided right then that the operating room was the facility I wanted to be and where I wanted to put my energies.

Secondarily, I did graduate work in the Neurosciences after college at UCSD. And at that point I decided that intellectually, I was stimulated by thinking about the nervous system. So, those two came together in what's called Neurosurgery. Had I spent a lot of time researching it, I may have known, had some different thoughts, but as life moves on, you know, you launch off and you start and then you find it fascinating.

And again, I am stimulated every day to pick up a book or get online and try and research what's going on with my patients situation, because every case is a little bit different and it takes a lot of experience to appreciate that. So, I'm at a phase now where I really feel like I'm harvesting a lot of years of hard work and I'm enjoying it.

Host: And the community is only better for it. So, just before we close, last question, is there anything else that you'd like to leave our audience with regarding Neurosurgical care at Sierra Vista or this amazing partnership with UCSF?

Dr. Kissel: Well, I think you mentioned neurology at the onset of this talk and you know, we are bolstering our neurology at Sierra Vista, because that is an integral part of doing neurosurgery. So, we have this program that allows us to harvest or take blood clots that have occurred in an acute stroke patient. We are the only center that does that in the Central Coast. We also have the ability to call in our neurologist s on a moment to moment basis to help us with understanding how to handle a certain difficult case, or seizures. Some of these things they're expert at. So, I really like what's happening. Secondarily, surrounding this relationship with UCSF. It's allowed us to grow in the fields that are offshoot or subspecialty of what we do in neurosurgery.

Host: Well, Dr. Kissel, I really appreciate your time today for sharing with us about the neurosurgical care and also about this amazing new partnership with UCSF. That's Director of the Neuro Spine Institute, Dr. Philip Kissel and Clinical Professor at the UCSF Department of Neurological Surgery.

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