Announcer (00:07):
You're listening to the La Jolla Cosmetic Podcast.

Monique Ramsey (00:14):
Welcome, everyone, to The La Jolla Cosmetic Podcast. And I'm your hostess, Monique Ramsey. Today, I have a very special guest, Dr. Steve Saltz. And you all might not know, unless you've been in our OR, that he's one of our anesthesiologists.

(00:32):
So people do a lot of research to trust that their plastic surgeon is capable and competent, but plastic surgery takes a team. And one of the most important people on that team, who you may never really think about and who you don't see because you're asleep, is the person delivering your anesthesia. So I'd like to introduce you to Steve Saltz. Welcome.

Dr. Steve Saltz (00:56):
Good morning, Monique.

Monique Ramsey (00:58):
He's a board-certified anesthesiologist, and you've been now at the center for how many years?

Dr. Steve Saltz (01:04):
I started with La Jolla Cosmetic Surgery Center back in '92 or '93. And we've had several locations, but I've been there the whole time.

Monique Ramsey (01:15):
That's awesome. You've probably done thousands of cases. I don't know if you count them. Do you have a little chart where you make a tick mark of how many cases you've done, or could you approximate for the audience?

Dr. Steve Saltz (01:28):
I would imagine in a normal busy anesthesia practice, you're probably doing several thousand cases every year. And the same is probably true at La Jolla. I would imagine at 50 weeks, you could do 15, 20 cases. Maybe that would be about 1,000 cases for one year.

Monique Ramsey (01:48):
Wow.

Dr. Steve Saltz (01:49):
And since 1992. So it begins ... yeah.

Monique Ramsey (01:52):
It starts to add up.

Dr. Steve Saltz (01:54):
You accumulate a lot of experience.

Monique Ramsey (01:57):
So Dr. Saltz, tell us about your background.

Dr. Steve Saltz (02:00):
Sure. So, unique, I think is probably a good descriptor of that. I came the long route to anesthesiology. I started medical school back in 1977. And after medical school, I first trained in internal medicine, and I did a residency in that. Then I decided to specialize in pulmonary and critical care medicine, and I did a fellowship in that. But in between internal medicine and pulmonary, I worked full-time in an emergency room for a while. After finishing my training in pulmonary, I started my private practice in pulmonary and critical care medicine in the San Diego area, up in Oceanside. That was in 1985.

(02:46):
But after five years, I made the decision to switch to anesthesiology. And so I went back and did an anesthesiology residency on top of everything else, from '90 to '92. And then in 1992, I finally decided what I wanted to be when I grew up. And I started my anesthesiology practice in 1992, and I've been doing that since then. Despite that long background, it's been 30 years since I finished my training. And I've been working as an anesthesiologist since.

Monique Ramsey (03:19):
I feel like years ago, you told me a story about a patient ... not at our clinic, maybe in the ER or something. Something about you were asking, maybe it was a teenager, if he'd eaten, and he said, no. But then there was something about a pizza later. Does this ring a bell?

Dr. Steve Saltz (03:38):
That was one of my partners at an outpatient setting. Yeah, he had a ... and this is always our fear. And why we ask the day of surgery, have you had anything to eat or drink? Your stomach needs to be empty prior to surgery, prior to anesthesia. Because when we give our medicines to induce the anesthesia, all the muscles in the body might relax. And including, there's a sphincter, a muscle ring between your esophagus in your stomach that keeps food and liquids and anything down there, down there where it belongs. If that relaxes during anesthesia, then anything in the stomach can come up and go into the airway. And that's a disaster. And that's what happened.

(04:20):
He told the anesthesiologist, he told the personnel that he hadn't had anything to eat. And apparently he had snuck some pizza on the way to the ambulatory surgery center. And on induction of anesthesia, he vomited, and this pizza came up. He was fortunate in that my partner was also a previous pulmonary specialist and a superb anesthesiologist and doctor, and he was able to grab a bronchoscope and quickly put it down the young man's lungs and got out any pieces of pizza that were there, and also suction the airway vigorously. And the young man did well, but it was an unnecessary risk. Scared everybody to death.

Monique Ramsey (05:03):
So, because the pizza's preventing him from breathing at that point, right?

Dr. Steve Saltz (05:08):
Exactly. If you aspirate, it can cause just mechanical blockage of the airway. And aside from causing mechanical obstruction, just the chemical burn of any foreign object being down, getting into the airways or the lungs can cause a severe reaction and edema and pneumonia. And that can be fatal.

(05:30):
Now, we're talking about establishing an airway. So he was on his way to establish the airway, that's the thing. So you're not off the hook with the type of airway you're placing, necessarily. If someone has a full stomach, that's a completely different situation, and we approach things in a slightly different manner. And we don't do that for elective surgery. There's no need to worry about a full stomach situation.

Monique Ramsey (05:54):
So I remember, in the last couple years, that you had a patient who was young and she had an underlying condition that she didn't know about.

Dr. Steve Saltz (06:03):
Right, right. We had a patient who, during the operation had a big difference in the blood pressure between her arm and her leg. And the first question would be is, Dr. Saltz, why are you putting the blood pressure cuff on the leg? Well, when you're operating on the upper part of the body and the surgeon is leaning in close and you have the blood pressure cuff on the arm, a lot of times you get these aberrant readings from the blood pressure cuff. You don't want that. So sometimes we just move the blood pressure cuff down to the leg.

(06:36):
So we did that at one point because we were getting a lot of strange readings from the arm. But when we moved it down to the leg, we were getting these low readings. And we kept moving it back and forth between the arm and the leg, probably driving the surgeon crazy. But it's like, okay, so, case is over. Patient did fine. We got everything done, but it's an issue in the back of my mind. So when we're in the recovery room now, surgery's over, the patient isn't under an anesthetic anymore. Back to baseline. Let's double check these pressures. So we check them in the arm and the leg. And there's still quite a bit of difference, that the pressure in the legs is lower than in the arms.

(07:14):
And so what you suspect is that they may have a blockage in their aorta at some point. So the pressure will measure normal above that blockage, and below the blockage it would be lower. So we had her follow up with her doctors and sure enough, she did have what's called a coarctation of the aorta, which is a narrowed part of her aorta, which is the main blood vessel that comes out of the heart, supplies the rest of the body. And she had to go and have it repaired by interventional radiology, I believe they put a stent in.

(07:49):
That saved her a lot of inconvenience and misery down the line, because left unattended, it puts a lot of strain on the heart. It's like having induced hypertension. And so it might not have been discovered for a long time, if ever.

Monique Ramsey (08:04):
Well, I think all your additional training, having that pulmonary background and having your brain thinking, what's going on here, and get to the root of maybe some other issue.

Dr. Steve Saltz (08:15):
Well, maybe. I mean, I think all experience helps.

Monique Ramsey (08:19):
Now, for all of you who might have caught the fact that Dr. Saltz's name is Dr. Saltz, Dr. Steve Saltz. Your wife works in the surgery center, Dr. Lori Saltz. So we have ...

Dr. Steve Saltz (08:33):
Yes, she does.

Monique Ramsey (08:34):
... boy Saltz and girl Saltz. And so are you guys in the same OR a lot of the time? And how do you like that?

Dr. Steve Saltz (08:42):
Yeah. We don't play favorites. We divide it all up. We have all the anesthesiologists work with all the surgeons. So whatever the odds are, a third of my time will probably be spent with Lori, my wife, which is always fun. And I've cut back on my work, I'm just working at La Jolla. I have a little more time off. But when I first started anesthesia practice and I was at the hospital and doing hearts, and a very, very busy practice, and she was very busy at the time. Working in the OR was the only time probably would see each other sometimes.

Monique Ramsey (09:16):
Yeah. Hey honey, how you been?

Dr. Steve Saltz (09:16):
Yeah. Yeah. And that's where we would touch bases and make plans. And it's fun for me to watch her because she is so meticulous and so obsessive about what she does. It's fun to watch that, as someone who's my wife. To be a plastic surgeon, you have to be a bit of a nut about the details and doing fine work. So I'm always observing that. But when it's your wife, then it's different. And Lori, she's always obsessing over the details. And it's just fun to watch her interact with her scrub techs, because they appreciate Lori and how meticulous she is. And so it's fun to watch that.

(09:55):
It's fun to watch her interact with her nurse, Ruth, because Ruth and Lori, I mean, they're like introvert and extrovert. So I call them the odd couple of plastic surgery. It's just hilarious to watch them interact together, and they do a great job between the two of them. And so it's really a lot of fun. It's never an issue. Some people, sometimes, you get a raised eyebrow. It's like, well, are you guys getting along? Did you fight? And it's never like that. First off, we get along, number one. Number two, we're doctors. Even if we were fighting ...

Monique Ramsey (10:29):
We're professionals.

Dr. Steve Saltz (10:30):
... we're professionals. It wouldn't make a difference. It's one of the first things that you're taught. Nothing else matters when you go to do your job. There is no other issues. Everything else is done. There's only the present. You don't worry about the past. You're not working in the past. You're not worried about the future. You're just, you're there. You're taking care of the patient. Nothing else matters.

(10:50):
To reassure everybody, it's never an issue. It's just all good. It's all fun. I'll tease her a little bit. I tease the patients. They say, what's it like working with your wife? And I go, oh, it's great. That way, not only does she get to tell me what to do all the time at home, but she can tell me what to do in the operating room too. So it's perfect. It's a very uniform approach.

Monique Ramsey (11:11):
Do you mind me asking how you two met?

Dr. Steve Saltz (11:13):
I was in Chicago at the time. I had finished internal medicine. I was going to do my pulmonary fellowship, but I wanted a break in between to just take a break from training. So I worked ER full-time and I was able to do a lot of different activities. So in the meantime, Lori came to Chicago to interview for her plastic surgery residency. And we met through a mutual friend. Someone who was a friend who I was living with at the time, was also in the plastic surgery program. And he knew Lori from, I think they met in the general surgery program. So she came up. He invited her up. Said, come up and take a look at this program. And so he introduced us and that's how we met.

(11:58):
So I showed her around the Oak Park area, because that's where we were. This is where the grocery store is, this is where the dry cleaner ... And then we just, we enjoyed each other's company. You know how that goes, and you start hanging out. And then we started dating. And one thing led to another, and then we got married. And it made for an interesting part of our wacky history, because Lori actually had to finish up some training in Chicago while I was starting my practice out in San Diego. Our schedules were off. So I was out in San Diego for a year while she was still finishing training back in Chicago. So that made for a stressful, interesting year. So I was flying back and forth while she finished up her training. But everybody survived and we made it. But it's a good test.

Monique Ramsey (12:47):
Now, anesthesiologists sometimes maybe have a reputation for being sedate ... ba-dum-bum.

Dr. Steve Saltz (12:54):
That's a good thing. You want to sedate anesthesiologist. Some people might object to the word sedate, it has some connotations to it. But I have no problem with it. Medicine in general, but certainly anesthesiology, teaches you humbleness. You have to bring an attitude of humbleness to the job, to what you're doing. We're taking people and rendering them unconscious and unable to breathe. If you don't approach that with great respect and humbleness, you're not doing your job properly.

Monique Ramsey (13:31):
Tell us about what you do in your free time.

Dr. Steve Saltz (13:34):
So that's one of the reasons why I took a break between internal medicine and pulmonary. I ran the Chicago marathon. I went skydiving. I took a race car driving course up in Canada. I did ski mountaineering course in Wyoming. I did cross country ski marathons, downhill skiing. So currently ... I don't do a lot of that stuff now. My hobbies, I love to road bike. That's my number one thing.

Monique Ramsey (14:03):
Thrill seeker and adventurer.

Dr. Steve Saltz (14:05):
Yeah, a gentleman adventurer. I mean, what I do, in the pantheon of adventure is pretty low key, but I like to pretend. My enthusiasm and my persistence far outweighs my ability. So I enjoy [crosstalk 00:14:20]. Yeah, absolutely. I love to road cycle, I love to cross country ski. It's a toss up, but I live in San Diego, so obviously I do more road cycling. I love to cross country ski because when I was back in Chicago, I did a lot of it and I loved to downhill ski.

(14:35):
My wife, Lori, likes to hike. We used to do more of it, we got to get back to it. And now that I have a little more time, I look forward to doing that a little bit more. She likes to hike and bird watch, and so I like to go out hiking with her. A little more sedate of a sport, but I'm fortunate, very fortunate ... to anybody who might be listening. Let me do a quick segue and point out one of the secrets to life is having a group of friends that you do this kind of stuff with.

(15:02):
I've been very fortunate to have a group of guys, mostly doctors out here on the west coast. And we meet every Saturday to go biking and we just have an absolute blast. We're so fortunate to be able to be cycling in San Diego in this beautiful environment and getting exercise. And I encourage all young people to seek that out. Seek out people with similar interests and develop a group who you can age with and continue to do the things that you enjoy. That's one of the secrets to aging well. Not that I'm aging, of course.

Monique Ramsey (15:35):
You're not aging.

Dr. Steve Saltz (15:36):
But I'm getting older.

Monique Ramsey (15:36):
How did that happen? Well, this has been so informative. And I just love the fact that we've just wound our way, like a road cycling event, up and down hills and looked into interesting parts that people might not have thought about. I've known you the whole time I've been at La Jolla Cosmetic. And that was ... I came in 1991. So it's been an honor to have worked with your wife and with you for all these years, and see your kids grow up. And it's so fun. And have you take care of me over the years. And so it's really a pleasure, and I thank you for coming on the podcast.

Dr. Steve Saltz (16:17):
Oh, it was my pleasure.

Monique Ramsey (16:18):
Yeah. This was really fun. For anybody who is listening, if you're a subscriber to the podcast, take a picture, show us, and we'll give you $25 off of $50 or more. You can spend that ... I think, Dr. Saltz, you'd probably spend it on sunscreen. Because you're out in the sun riding your bike, right?

Dr. Steve Saltz (16:34):
Yeah, exactly. Exactly.

Monique Ramsey (16:36):
And please write a review of the podcast if you like it. And we would love to hear from you. So thanks for joining us, and we'll see you next time.

Announcer (16:51):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment, or mention the promo code, podcast, to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the XIMED building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram @ljcsc. The La Jolla Cosmetic Podcast is a production of The Axis. theaxis.io.