Dr. Tamir Friedman enjoys the immediate reward of performing a procedure that lets patients walk home the same day or dramatically reduces recovery time, using minimally invasive procedures.
But it took 14 years of higher education to become an interventional radiologist who had the training to help those patients. Following medical school, he worked as a radiology resident at Yale-New Haven Hospital, and as an assistant professor at Weill Cornell Medical College in New York City.
Dr. Friedman – who joined Charlotte Hungerford Hospital in the fall of 2017 and is also part of Advanced Medical Imaging in Torrington – is looking forward to bringing the kind of cutting-edge medicine to Torrington that is offered in Hartford, New Haven and major cities nationwide. With the help of a fluoroscopy machine and six years of specialized training following medical school, he uses image-guided techniques to treat some kinds of cancer, alleviate the pain and symptoms of uterine fibroids, and fix vascular diseases such as varicose veins and blocked arteries.
“There’s no better gratification than interventional radiology, which allows me the privilege to tremendously help patients, day in and day out,” says Dr. Friedman. “You do these minimally invasive procedures, which are quick by most standards, and patients really see instant results – especially in pelvic pain, veins and also in treating cancer.” While in medical school, Dr. Friedman considered surgery, cardiothoracic surgery or trauma surgery. Then he learned about interventional radiology.
“Interventional radiology encompassed all the exciting facets of all of these specialties into one subspecialty,” he says. Interventional radiology (IR) uses radiological image guidance, such as X-ray fluoroscopy, ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) to target therapy in each individual patient. Most IR treatments provide minimally invasive alternatives to traditional and laparoscopic surgery.
Dr. Friedman and his colleagues usually go through an artery or a vein and, with the help of guided imagery, direct a catheter anywhere in the body by using the patient’s veins and arteries as “highways.” They can work on the targeted organ system, be it cancer in the liver or non-cancer growths in the uterus, called uterine fibroids. Through a small catheter, Dr. Friedman is able to precisely target his therapies without collateral damage to surrounding organs or structures. He does all of this through a tiny incision measuring less than one-eighth of an inch.
Born in Israel, Dr. Friedman moved to South Africa at six years of age. He later moved to the United States, and grew up in Cheshire. He was always fascinated by science and medicine, and knew he wanted to become a doctor from a young age. His grandmother, a nurse, is the only other family member in the medical field, but he sought out mentors and did research at Yale-New Haven Hospital with doctors during the summers while earning his bachelor’s degree. Interventional radiology has been around for about 60 years, but technological advances are driving rapid growth.
With the press of a pedal, Dr. Friedman says, he can see where he is guiding the tubes and wires inside the patient’s body in real time. This method can be used to treat women with debilitating symptoms due to uterine fibroids such as severe cramping and bleeding, whereas traditional surgical therapies include removing one of many fibroids or removing the entire uterus. Although controversial, fertility may be spared with Dr. Friedman’s procedure, called uterine fibroid embolization – and recovery times are cut in half. Essentially, the procedure blocks blood flow to the fibroids, causing them to shrink.
The bulk of his work involves the vascular system, which relates to veins and arteries. Arteries take the blood from the heart to the extremities and organs, and veins bring the blood back to the heart. There are two vein diseases that interventional radiologists can treat – superficial vein disease, which causes varicose veins that can result in leg pain, cramps and fatigue, and deep vein disease, such as when a clot or deep vein thrombus (DVT) occurs. DVTs and can be life-threatening and may also result in significant leg swelling.
Dr. Friedman can treat the underlying cause of superficial vein disease and relieve patients’ symptoms in a couple of ways. The first is angioplasty, in which a balloon is inserted into a blood vessel that has become clogged or narrowed. A stent can be inserted and left inside the body to hold the blood vessel open. This approach reestablished blood flow, reopening blood vessels in the legs that were previously closed, and lessening leg swelling that can cause pain, he says.
Another approach is to close off the troublesome superficial blood vessels. In varicose veins, the veins are damaged. Normal veins are like an elevator, and, when there’s a problem, instead of stopping on every floor as it should, it’s as if the elevator is not coming to a full stop, so blood is escaping and pooling in the legs and feet. This is called venous congestion and it can afflict people who are on their feet for a long time or who have had several children. In a case like this, Dr. Friedman inserts a wire with a laser attached and burns the inside of the vein that’s causing the trouble, closing that vein and forcing the blood to reroute itself to other veins.
This is painless and takes about a half hour, he says. “They have to come back for touch-ups here and there, but the underlying cause of the disease is treated,” he says. “They leave with a couple of bandages that come off the next day.” He also uses the same technology and other specialized techniques to heal patients with leg ulcers caused by severe forms of vein diseases. Patients who told Dr. Friedman they often came home from work and had to keep their legs elevated are now able to move more, walk more and live a fuller life, he says.
SAVING LIVES IR
has not only evolved to treat blood vessel disease that affects the arteries and veins, but to provide treatment and pain relief to those with lung, liver, kidney and bone cancers. If someone with liver cancer has failed traditional therapies, interventional radiologists can insert a catheter to the tumor and place small plastic particles bathed in a chemotherapeutic agent right onto the tumor. The particles slowly disperse the chemotherapy drug into the tumor, allowing for less of the drug to circulate through the body and therefore decreasing side effects of the chemotherapy.
These procedures can generally be performed quickly on outpatient basis, he says. His “workhorse,” the fluoroscopy machine, provides extremely clear images, yet it only emits low levels of radiation. When patients are being treated, the machine provides technology that helps the doctor determine which blood vessels are feeding individual tumors within the liver on individual organs. The machine is also capable of showing the organ and targeted cancer in 3-D, so that treatment planning and delivery is precise.
If a patient meets the criteria, Dr. Friedman can also insert a needle and freeze or burn a small cancer in the kidney, adrenal glands, lungs or liver. “In the liver, we’re as effective in killing small tumors as an open surgical procedure when the tumor is small enough to burn with microwave treatment,” he says. Contrary to the image of a radiologist who sits in a dark room analyzing film, Dr. Friedman’s face lights up as he talks about his work.
“I have the good fortune of using the latest technology and the most innovative procedures and getting to see improved patient outcomes – in real time,” he says. “This is the best job. I always tell my wife: ‘I made the right decision.’” Dr. Friedman’s goal is to collaborate with primary care physicians, podiatrists, wound care specialists, obstetricians and others to offer patients the most current minimally invasive therapies available, right in Torrington. Since so many of the procedures are relatively new, he says, even some doctors are unfamiliar with all the treatment interventional radiology offers. “I do think this specialty is groundbreaking,” he says. “Its capabilities are endless.”
Theresa Sullivan Barger, of Canton, writes about health, science, the environment, and education.
Photographer Seshu Badrinath of Avon specializes in intimate, natural portraits of families and children; seshuphotography.com