How a Stroke Pioneer Is Rewriting Brain Medicine

I've been doing interventions for 35 years, you know, I'm still doing 300 procedures a year easily.

So our work is actually taking care of brain vascular problems from outside. Dr. Camilo Argomez is a neurologist medical educator and health care innovator. He helps advance stroke care and neurological medicine through pioneering clinical leadership, medical education and a lifelong commitment to improving patient outcomes. The real problem, at least for me, that hasn't been solved, is what makes us who we

each are. Think about this. Two patients died. One of them was a mathematician.

The other one was a Janet. You take their brains. They're dead. Put them on a table.

It's not a difference between those two brains. We don't know. We still don't know what the essence of what you could call the soul. It's very well known phenomenon. It's called neural network facilitation. The more you use a certain neural network, the more facilitates is used. If you think a certain way, you manifest that in a certain way, you brought that process gets facilitated over and over again. So the question is how can you do that to your

event. The living your legacy podcast for those who live to leave a legacy.

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three. Hey, welcome back everyone to another episode of Living Your Legacy Podcast. I'll be your host today. Jason Langen and we're here in the podcast studio in sunny Miami Beach Florida, right? And we have a special guest today. One of America's best doctors and this guy's top notch.

“I've heard a little bit about him, but we're going to get to know him together. What's your name?”

Way from and tell us about what kind of doctor you are. My name is Camilo Gomez. I am an interventional neurologist. I'm actually probably the most senior interventional neurologist in the United States and I work for University of Missouri in Columbia. Yeah, yeah, right. So when I think of interventional, right, I think of kind of stopping it before something happens. And sometimes reversing it when it has happened. Okay. And the term interventional really has to do with minimally invasive

procedures, where we use little catheters and balloons and stents to go from within the blood vessels, to fix a problem, either open a vessel that has been blocked or to shut down a vessel that is bleeding. Okay. And that's usually for like cardiovascular diseases and and that the original idea of interventional work started in the legs and the coronaries in the heart. We work in the brain. Yeah. So our work is actually taking care of brain vascular problems from outside,

essentially either going through the artery in the groin or in the artery in the wrist with

“catheter all the way out to the brain. Wow. That's like intense stuff. So how long do you have to”

study and how long is the pathway to get to a position like yours? They well, for the basic training program involves having finished medical school, the individual spents four years doing neurology, a supposed graduate education. And after that, they need to spend one year doing vascular neurology. Okay. And after that need to do two more years of interventional neurology. So it's a total of seven years after medical school. All right. Seven years after eight years or no, how long is medical

school again? Well in the United States, it's four years of medical school after four years of college. Yeah. Yeah. Okay. So you're talking about eight and seven. It's 15 years. Yeah. All right. So that's quite a journey. Yeah. I mean, I feel like the the field of neurology that is

“is really interesting. And there's so much coming these days. So I had a hypnotist here, right?”

And she was saying that like our pathways to the brain. And I'm going to, I'm going to mess this up. So please help me on this. Okay. But like, what are the pathways where information goes? Information usually comes through the senses. Yeah. So visual information comes through the ice. Yes. Auditorial information comes through the ears. Sensory information comes tactile. Guestatory through through the, uh, custody toy organ in the mouth. And so on. And that all feeds

But neurons are kind of like the pathways of information. And neurons are the cells in the brain

that then process that information. Yeah. So the information gets there through pathways and then different neurons or nerve cells have different functions. The simplest one of them just take that electrical information from the sensors and transmitted upward into into further centers. And then there are centers that are what we call uni model. So for example, there's parts of the brain that only deal with visual. Yeah. There are parts of the brain that only deal with auditory. And then there's

those process, those nerve cells, those neurons process the information further into integrating centers that deal with together. For example, if you think about how food tastes very different

when you can smell it, then when you cannot smell it. Yeah. Because they're related. And the

memories are related. And the commission is related. Gotcha. So where I was going was these pathways of where information travels. She was saying that the more that you use, the more that you think of something. And the more the way that, you know, like with depression almost, right? You think you're down, down, down. And these pathways get stronger, the more that in the way that you think, right? But then kind of rewiring your brain to think another way. And then almost like

manifestation, right? If you continue to think a certain way, just tell yourself every day, the pathways will get kind of more used. And then information will travel down those pathways

more in terms of like, and she kind of explained it like roads and dirt roads and then dirt trails,

you know? And she was saying that that's how you can rewire your brain by just thinking some way. And even goes with, I guess, you know, doing something repetitive over and over. Yeah, this is, it's, it's, it's very well known phenomenon is called neural network facilitation. Okay. The more you use a certain neural network, the more facilitates is used. If you're an example, well, it's 2020, six. I don't know how many people still drive sticks shift. Yeah. But those

of us who you drink, you drink, you drink, I have driven sticks shift. Well, not anymore. But if you

“remember how you learn, yeah, when you first start driving sticks shift, you have to think about the”

clutch and the changes and the shift and so on. Once you become proficient, during a think about it, you're driving your sticks shift card through the traffic thinking about what you're going to do that day. And you keep shifting. Why? Because you have facilitated the network to perform a certain task, or the concert pianist. Why do they practice eight hours a day? Because they facilitated that neural network. The same is true for thinking. Yeah. If you think a certain way, you manifest that

in a certain way, you, you brought that process gets facilitated over and over again. So the question is how can you do that to your advantage? Gotcha. Gotcha. So what's interesting in your field right now? Well, I'm biased. It's a biased answer because I love interventional neurology. I think that the new devices, the new techniques we have, the robotics, the ability to use artificial intelligence to assess different images and things like that that go beyond what

they human eye can actually see. Yeah. To integrate all of that and the ultimate thing that interests me is to help the patients. Yeah. Because are you working at the forefront of technology and robotics

“and AI right now? I think I am. Yeah. Again, biased opinion, but I think I am. I'm very interested”

in artificial technology. I recently became certified as an AI consultant and I'm looking into getting a masters in AI. But robotics is in reality. We, we are in the process of trying to develop the ability to operate on a human being at a distance. Yeah. So we could be able to do some of the procedures that we do in somebody who's 100 miles away in another hospital by simply having a console with a joystick like a video game where we manipulate the devices out there. Yeah. I've

seen videos of that of how the robots and like kind of like these wires, they they peel the skin off an apple. Like it's it's like so fine, right? And yes, once again they're doing that remotely. Yeah. And so what they're trying to eventually in your line of work that would be putting catheters into these blood vessels. Absolutely. Yeah. In fact, that that technology does

“exist already. It's being polished. I think I will see it in my lifetime. The being applied”

whether I will apply it myself or not. I don't know yet, but but it will be applicable without it out. All right. And what kind of things is AI seeing that humans can't see? Well, in your line of work.

to diagnose. We use imaging to monitor. We should we use imaging to treat patients. As it

“turns out, for example, if you look at a CT scan or any diagnostic study, there are certain”

amount of it comes in black and white and shades of gray. There's only so many details, so many pixels that the human brain can discriminate between one and the next one next to it. Artificial intelligence, on the other hand, can have a computer look at that same picture and discriminate more. So for example, it should be it is possible. And actually those systems do exist and we use them on a daily basis where they can detect the volume of tissue that has been affected by a stroke

when the patient presents. And that sometimes is one of the determining factors for us to do an

intervention or not because we know, for example, that be you on a certain threshold, the volume of tissue, if injured completely, we cause disability. Yeah. Well, smaller volumes of tissue when they're affected, we'll not cause disability. So the benefit versus risk of intervention needs to change between one or the other situation. Are you saying that with the CAT scans and whatever graphs and charts that you guys get, like you are getting an area and the AI is seeing a

volume. Yes. And it calculates the amount of volume in CCs and cubic centimeters and it compares it to other forms of volume. And it allows it to detect, for example, if the tissue is already injured, be unrepaired. Yeah. There is no point in taking somebody to the catheterization laboratory to do an intervention when the tissue is already permanently injured. Yes. We're not solving any problem and we're actually creating more. So the benefit and risk ratio is upside down. Yeah.

Yeah. It's not only that, but you end up wasting a lot of resources that you may use in another patient who actually may need it more. Yeah. Plus you have, you know, the human factor of humans getting tired at the end of the day and trying to read charts, right? AI doesn't get tired and they're also comparing thousands or as many charts as gone into the system all at once and they can say, hey, here's a pattern, right? Where this is usually, well, maybe these patterns,

“the human eye can't see. Also, right? Yes. That is true. And I think that there's something to be said”

about the fact that the patient who gets to be the fifth case of an interventionist over a day

doesn't get the same doctor that he got. The first one did. Yeah. So you know, fatigue is a real problem

that must be acknowledged. On the other hand, we got to be careful about replacing that with AI because AI has other problems like AI hallucinates. AI creates things that are nowhere. So as we teach AI to our learners, medical students, residents, and so on, the AI has the capability but we still have the responsibility. Yeah. So it is going to be up to us to look at the information AI generates and decide, is it applicable? Is it real? Is it correct? Is it what we need at the

present time? So AI is a tool? Well, we call AI the present time is a tool that is as good or as bad as the individual using it. Of course, if that individual is tired, then you're just displacing the fatigue from one point to another. Yeah. Now, it is conceivable that you could use the AI to create alarm systems for that. That would be important. But we don't want to give the impression

“that AI will solve the fatigue problem. All right. So how many surgeries have you performed?”

I guess in your career? I've been doing interventions for 35 years and roughly 4,500 a year. Wow, you do the math. Oh, my lord. I mean, a lot. Yeah. It's a lot. I mean, we do. I even now that, you know, I'm still doing 300 procedures so you're easily. Wow. Okay. And so what kind of people are getting it and like people that you say like kind of have suffered with strokes or their they show signs of suffering, they're going to suffer a stroke? We have two populations that we

serve. One that are urgent intervention. So the people who come, let's say with an acute stroke, where a blood vessel in the brain, a large artery in the brain, has been closed suddenly. And part of the brain is start from blood flow and our job is to open that blood vessel.

So it doesn't bleed again and kills the patient on the second round. So those patients,

“our job is to intervene in such a way to with a time critical interval to prevent a real catastrophe”

from occurring. Then there are the patients who are elective that are found to have a problem that needs fixing before it causes symptoms or before it causes stroke or before it causes the bleeding. Like an aneurysm that is found, 3% of the entire population of the planet is sitting at home with an aneurysm that don't even know it. Oh, wow. Okay. I was curious. Do you think about it? It's really scary. Yeah. And aneurysm is like a blood bleed or a brain bleed or something, right? Well,

and it produces a hemorrhage. But an aneurysm is imagine a blister on the wall of a vessel.

Okay. Blister begins to grow the same way you take a water balloon and you put more water in it. Yeah. And you keep putting water in the water balloon until it's so big that it explodes.

“Gotcha. And that's what an aneurysm is. So our job is to actually go in there and fill the”

aneurysm with or prevent blood flow into the aneurysm by filling it with platinum coils or closing the neck of the aneurysm. So there's no flow in it. So not only it doesn't rupture because there's no flow in it. But it's something it shrinks or disappears. Wow. That sounds so much. That's interesting. Yeah. So I detect an accent, right? You are originally from Cuba. I was born in Cuba. All right. So tell us a story of how you ended up here in Missouri.

Well, I grew up in Cuba. Actually, I was born in Cuba. And of course, in 1959 with the advent of Castro and the communists regime over there, my parents were forced to emigrate from Cuba and the early 1960s. So we moved, we spent time in Mexico in Bogotá, Colombia and South America. Then I spent most of my formative years in Caracas, Venezuela. Okay. And then I went to medical school in the Dominican Republic. Wow. And from there, I moved to this country, worked in New York for a while

in New York and in Columbia University Medical Center. And then went to St. Louis University in St. Louis, Missouri for my neurology training. From there, I led their stroke program. And then I got recruited at the University of Alabama Birmingham where I led their stroke program. Then I was in private practice for 13 years in Birmingham, Alabama. And then I was recruited to go to Leola University in Chicago. And after that, I was recruited to come to University of Missouri in Colombia, which is where I

had them. Wow. That is the doctoral nomad. Something like that. Instead of a digital nomad, you're like a doctoral nomad. It's about, right? Yeah. Well, that's a lot of schools. And why

why in New York? I was always intrigued by the brain. I am the type of person that always finds

the most difficult things as the most intriguing things for me to tackle. And the brain is it has been for many years and continues to be to some degree of black box, where, you know, least when I started at school in 1977. And, you know, we didn't know a quarter of what we know now. Yeah. And, you know, we still don't know as much as we should know. But neurology seemed like the way to go.

“So what's the, what's the, what's the big question now that neurologists are trying to answer?”

Consciousness. Where does the consciousness come from? No, we, we have a relatively good idea about consciousness. I think that the real problem, at least for me, that hasn't been solved, is what makes us who we each are. Yeah. Think about this. Two patients die. One of them was a mathematician. The other one was a janitor. You take their brains, they're dead, they put them on a table. There's no difference between those two brains.

Yeah. They're very little. I mean, I'm sure you can look and you find some differences in neural networks and so on. But one makes the mathematician, he or she, what makes the janitor, he or she? We don't know. We still don't know what the essence of what you could call the soul is. Yeah. Yeah. What makes us unique? Yeah. I had messed that up with Consciousness and, and soul. Yeah. But yeah. But don't you think that that's really where the money is. Yeah. One makes us who we are.

Yeah. And that's, that's very, it's very intriguing to me. Yeah. You don't know if it's a male,

are there, I guess, schools trying to tackle that question? A lot of, I'm a lot of money being pumped into that. I'm sure, I'm sure people, I don't know the details, but I'm sure there are people who are tackling that. But for example, you mentioned the male or female. I mean,

the bottom line is that there are differences between the male and the female brain. You're not

readily apparent by looking at them in a, on a table, when you put the two brains on a table, but how the, how the system grows, yes, there are differences between those two. And,

“but still, the question is, how come, how come, you know, something happens in a certain way?”

Well, and what about your field? What are you most excited about in, in your fields? The pace at which is evolving. Yeah. Yeah. Yeah. You were talking about AI and I'm sure, at the vice, even in, in my field of arts and everything AI is, is just the pace. It's just, it's almost like they say this, this thing of AI anxiety, right? Because it's coming so fast, a new tool now and the next tool now. And then it's like version five, version six. And it's like,

oh, my God, it's like shiny objects. Yeah, any objects. Yeah. And well, so like, they have, what's great in, in the creative field? Like, they had a, you know, with AI video, right? Generators.

They had Will Smith, like the first video, Will Smith trying to eat spaghetti, right? And it was

all, it, it was all messed up, right? He had extra fingers. It didn't look, he was putting this spaghetti to his eye or something like that. It's like really, really bad. And then, but they kept that, and they kept on doing it with the different versions, right? And now it's like Hollywood Will Smith, not only is he eating spaghetti, right? But there's like a whole story line of why he's eating spaghetti. And it's a perfect movie on it now, you know? But I'm sure in your field is, is it just

moving so fast? And this is all but in like five years, right? You know? But even more fundamentally, in our fields, just devices, the device creation, the engineering behind the devices that we have. I mean, what we do today in interventional neurology would have been thought of being witchcraft when I was a resident years ago, because it's like, we, you know, we had an idea what we wanted to do, but we didn't have the tools. The tools have followed them, but they continue to advance

at a pace that is absolutely amazing. Yeah. Yeah, it's, it's all, it's all really just crazy.

“So, how can people find you? You have a website, do you do any kind of podcast?”

Sorry. That's very interesting question. Of course, from the medical point of view, I'm working the University of Missouri in Colombia, so people can go on the University of website and they're going to find me. You got, you got papers published. Oh my God, yes, I have papers and all sorts of things. No. A couple of years ago, I started my own consulting and publishing company and it's called C.K. Strategic Solutions Group that has his own website and that'll take you into

our multiple areas, the consulting, the publishing, the books, the online courses that we give. You can even, there's a form, if you want a consultation, there's a form there. The one thing I'm about to do that I haven't deployed yet is a podcast. Okay, so we have a blog, the blog goes in social media, what we don't have is the podcast yet is because I'm doing a lot anyway. I know, but it's nice to just sometimes have a seat and just

talk out ideas with another person. Absolutely. Yeah, absolutely. Well, it's been great to sit here

“and talk to you for the past, you know, 20 minutes or so and yeah, I mean honestly, I can sit here”

and just just listen. Right, just take a class with you. I just feel like get my mind blown of what's going on. Well, I appreciate you opportunity. Yeah, but and thank you guys again for for joining us, but yeah, he just finished filming and the interviewer was like, oh wow, you know, just so much to talk about with him. So I'm excited for your episode to air. And thanks for joining us again and we'll see you next time, guys. Cheers!

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