How biportal endoscopic spine surgery is changing the present and future of outpatient spine care

When every second matters: Emergency care across a growing system

Chris Fox, MD, professor and chair of the Department of Emergency Medicine at UCI Health, joins Physician Huddle to discuss the evolution and growth of emergency medicine at UCI Health and the department’s expanding leadership across Orange County. Fox reflects on his long connection to the city of Irvine and UCI Health, from undergraduate and residency at UC Irvine to his faculty career in emergency medicine. He discusses how point-of-care ultrasound became a defining part of his academic work, including the development of an ultrasound fellowship and a longitudinal ultrasound curriculum for medical students. The conversation explores the UCI Health growth from one emergency department to a broader acute-care network, including emergency departments in Orange, Irvine, Los Alamitos, Fountain Valley, and Placentia. Fox discusses how his team is working to deliver consistent, high-quality care across different sites while respecting the needs and strengths of each community. Fox also shares how technology is changing emergency medicine, including the value of a shared electronic health record, ambient documentation and evidence-based clinical decision support. He explains how these tools can help physicians understand patients more quickly, document more efficiently, and preserve the human connection at the bedside. The episode also covers leadership during system growth, emergency department staffing, patient experience, Irvine’s new emergency department, the challenge of boarding, and the opportunity to move from a hospital-based model to a more integrated health system. Topics discussed:  * UCI Health emergency medicine is expanding from a single academic emergency department into a broader health system acute-care network. * Patient experience in emergency medicine starts with accurate care, timely access and the ability to build trust quickly with someone in a vulnerable moment. * Technology can improve care when it supports physicians rather than distracts from the patient encounter. * Ambient documentation may help clinicians stay more present with patients while reducing documentation burden. * Integration across UCI Health emergency departments, urgent care and community hospitals will be essential to improving access and patient flow. * Boarding remains one of the most serious challenges in emergency medicine because it limits access for new patients who need care. * Fox’s leadership style centers on transparency, culture-building, staffing support and recognizing that each site needs a model that fits its community. Connect with UCI Health physicians online at clinicalconnection.ucihealth.org [https://clinicalconnection.ucihealth.org], on LinkedIn @UCI Health Physicians [https://www.linkedin.com/company/uci-health-physicians/], on Instagram @ucihealthphysicians [https://www.instagram.com/ucihealthphysicians/], or at @uciphysicians [https://x.com/uciphysicians] on X. Refer a patient at referralportal.ucihealth.org [https://referralportal.ucihealth.org/] and learn more about ongoing clinical trials at ucihealth.org/clinical-trials [https://www.ucihealth.org/clinical-trials].

KRAS-targeted therapy and the future of pancreatic cancer treatment

Jennifer Valerin, MD, PhD, a UCI Health medical oncologist and pancreatic cancer specialist, joins Physician Huddle to discuss breakthrough treatments in the landscape of pancreatic cancer care. Valerin shares how a family member's pancreatic cancer diagnosis more than 20 years ago shaped her decision to pursue medicine and focus her career on bringing new therapies to patients with pancreatic cancer. She also discusses her MD-PhD training path, her work in hereditary pancreatic cancer, and how clinical questions from patient care can inform research from bench to bedside and back. The conversation explores why pancreatic cancer is often diagnosed late, including nonspecific symptoms such as weight loss and back pain, the role of imaging and endoscopic ultrasound-guided biopsy, and why the disease has historically been so difficult to treat. Valerin also explains the significance of KRAS in pancreatic cancer and how emerging KRAS-targeted therapies — including daraxonrasib — may represent a major step forward for patients who previously had limited options. She discusses the importance of clinical trials, side effect management, multidisciplinary care and UCI Health leadership as a pancreatic cancer referral center in Southern California. The episode closes with a discussion of cautious optimism on how oncologists can balance realism with hope and how treatment goals can be individualized around patient milestones. Topics discussed:  * Valerin’s career in pancreatic cancer was shaped by a deeply personal experience caring for her aunt through diagnosis and treatment.  * Pancreatic cancer can be difficult to detect because symptoms are often nonspecific, including unexplained weight loss and back pain.  * Tissue diagnosis remains essential, but ctDNA and mutation profiling can help inform molecular understanding and treatment planning.  * KRAS has long been a major driver in pancreatic cancer and was historically considered difficult to target.  * Emerging KRAS-directed therapies are creating new possibilities for patients with pancreatic cancer, particularly through clinical trials.  * Side effect management is central to helping patients remain on therapy, including close collaboration with dermatology for rash associated with KRAS inhibitors.  * The UCI Health pancreatic cancer program is positioned around multidisciplinary care, clinical trials, nutrition, psycho-oncology, surgery, interventional radiology, and close collaboration with community oncologists. Connect with UCI Health physicians online at clinicalconnection.ucihealth.org [https://clinicalconnection.ucihealth.org], on LinkedIn @UCI Health Physicians [https://www.linkedin.com/company/uci-health-physicians/], on Instagram @ucihealthphysicians [https://www.instagram.com/ucihealthphysicians/], or at @uciphysicians [https://x.com/uciphysicians] on X. Refer a patient at referralportal.ucihealth.org [https://referralportal.ucihealth.org/] and learn more about ongoing clinical trials at ucihealth.org/clinical-trials [https://www.ucihealth.org/clinical-trials].

How pain medicine is evolving for physicians and patients

Shalini Shah, MD, professor and vice chair of the Department of Anesthesiology and Perioperative Care and director of pain services at UCI Health, joins Physician Huddle to discuss the growth and evolution of pain medicine. Shah reflects on her path from anesthesiology training at Cornell to adult and pediatric pain fellowships at Harvard-affiliated hospitals, and how she was recruited to UCI Health to help establish a pediatric pain program. She describes how UCI Health developed one of the country’s largest pediatric pain programs by volume, with care designed to improve access for children and adolescents who should not have to wait for care. The conversation explores how UCI Health has expanded pain services across Orange County, including the growth of multiple pain clinics and a multidisciplinary model that brings together physicians from anesthesiology, physical medicine and rehabilitation, neurology, psychiatry, and other specialties under a coordinated structure. Shah discusses the state of opioid prescribing, including how the pendulum has shifted from overprescribing to fear of prescribing. She emphasizes that opioids are neither “the hero” nor “the villain,” but one component of a personalized treatment plan when used appropriately. The episode also covers interventional pain therapies, longevity and function, lifestyle approaches to pain management, advocacy through organized medicine, and Shah’s reflections on physician leadership, work-life integration, and building teams that support people through different seasons of life. Topics discussed:  * UCI Health has developed a high-volume pediatric pain program focused on timely access, multidisciplinary care and community relationships. * Shah emphasizes that pain care should not be siloed; the UCI Health model brings multiple pain-trained specialties under one coordinated structure. * Shah’s leadership philosophy centers on building strong teams, understanding what people need to succeed and recognizing that team members operate at different capacities during different life stages. * Medical education around pain and opioid prescribing has historically been limited, contributing to broader challenges in clinical practice. * Shah helped advance a University of California-wide curriculum to improve medical student education in pain care and opioid prescribing. * Opioids should be viewed as part of a personalized treatment plan — not as either the central solution or something to categorically avoid.  * Interventional pain medicine is evolving rapidly, with new therapies, modalities and devices expanding treatment options. * Pain management increasingly intersects with longevity, mobility, function and quality of life. * Physician advocacy matters because healthcare policy is often shaped by people who have not directly cared for patients. Connect with UCI Health physicians online at clinicalconnection.ucihealth.org [https://clinicalconnection.ucihealth.org], on LinkedIn @UCI Health Physicians [https://www.linkedin.com/company/uci-health-physicians/], on Instagram @ucihealthphysicians [https://www.instagram.com/ucihealthphysicians/], or at @uciphysicians [https://x.com/uciphysicians] on X. Refer a patient at referralportal.ucihealth.org [https://referralportal.ucihealth.org/] and learn more about ongoing clinical trials at ucihealth.org/clinical-trials [https://www.ucihealth.org/clinical-trials].

Rethinking menopause care for midlife women

Rebecca Sauer, MD, associate professor of obstetrics and gynecology at UCI Health, joins Physician Huddle to discuss the evolving field of menopause and midlife care. Sauer reflects on her path from medical school at UC Irvine to her current focus on perimenopause, menopause, and women’s health. She explains that menopause care historically has received limited attention in medical training, despite the wide range of symptoms and health concerns that can arise during this stage of life. The conversation covers common symptoms of perimenopause and menopause, including hot flashes, night sweats, sleep disturbances, mood changes, urogenital symptoms, and cognitive concerns. Sauer also discusses emerging associations with joint issues, tinnitus, cardiovascular changes, and broader health implications. She outlines how clinicians can approach evaluation, including when to consider thyroid, rheumatologic, autoimmune, nutritional or mood-related conditions before attributing symptoms to perimenopause. The discussion also explores hormone therapy, nonhormonal options, osteoporosis prevention, resistance training, and the importance of setting realistic expectations for treatment. Sauer also illustrates UCI Health leadership in developing a comprehensive menopause program, built around certified menopause providers, multidisciplinary collaboration and evidence-based guidance for women navigating midlife health. Topics discussed:  * Sauer emphasizes that listening, validation, and individualized care can significantly improve quality of life. * Nonhormonal therapies may be appropriate for patients who are not candidates for hormone therapy or have targeted symptoms.  * Menopause and perimenopause have historically been underrepresented in medical education, even within OB-GYN training.  * Common symptoms include hot flashes, night sweats, sleep disturbances, mood changes, urinary symptoms and vaginal dryness.  * Midlife care may also involve cognitive symptoms, joint concerns, cardiovascular risk, bone health, mood disorders and metabolic changes.  * Perimenopausal symptoms are often a diagnosis of exclusion; clinicians should evaluate for thyroid disease, autoimmune conditions, nutritional deficiencies and other possible causes when indicated.  * Hormone therapy remains a standard-of-care option for vasomotor symptoms and may help prevent osteoporosis in appropriate patients.  * UCI Health progress toward a comprehensive, evidence-based menopause care model across OB-GYN, primary care, and other key subspecialties.  Connect with UCI Health physicians online at clinicalconnection.ucihealth.org [https://clinicalconnection.ucihealth.org], on LinkedIn @UCI Health Physicians [https://www.linkedin.com/company/uci-health-physicians/], on Instagram @ucihealthphysicians [https://www.instagram.com/ucihealthphysicians/], or at @uciphysicians [https://x.com/uciphysicians] on X. Refer a patient at referralportal.ucihealth.org [https://referralportal.ucihealth.org/] and learn more about ongoing clinical trials at ucihealth.org/clinical-trials [https://www.ucihealth.org/clinical-trials].

How biportal endoscopic spine surgery is changing the present and future of outpatient spine care

Don Park, MD, professor of orthopedic surgery and director of minimally invasive spine surgery at UCI Health, joins Physician Huddle to discuss the evolution of endoscopic spine surgery and the development of the UCI Health outpatient spine surgery program at the UCI Health — Irvine medical campus. Park explains how endoscopic techniques allow surgeons to treat common spine conditions through millimeter-sized incisions, using high-resolution cameras and specialized instruments. He describes how these approaches may support faster recovery, reduced pain, and a transition of appropriate spine procedures from the inpatient setting to an ambulatory surgery center. The conversation also explores why the adoption of minimally invasive and endoscopic spine surgery has been gradual in the United States, the importance of hands-on training and mentorship, and how the UCI Health multidisciplinary spine program brings together orthopedic surgery and neurosurgery in a collaborative environment. Park also discusses his use of an augmented reality headset during endoscopic lumbar fusion, the role of emerging technologies in the operating room, and the future potential of AI as an adjunct to surgical decision-making, visualization, and safety. Topics discussed: * Endoscopic spine surgery uses small incisions and high-resolution visualization to treat selected spine conditions, including lumbar disc herniations and lumbar stenosis. * UCI Health is developing an endoscopic and outpatient spine surgery program that aligns with the Irvine medical campus and its ambulatory surgery capabilities.  * Not every patient is a candidate for endoscopic surgery; Park emphasizes matching the right patient, pathology, and surgical approach.  * Training is central to broader adoption because many surgeons did not learn endoscopic spine techniques during residency or fellowship.  * Park views new technology through a patient-safety lens: It must make surgery better, more efficient or safer.  * Augmented reality technologies may offer enhanced visualization and improved ergonomics during selected endoscopic spine procedures. * AI’s future role in spine surgery may be as an adjunct that supports surgeons, rather than a replacement for clinical judgment. Connect with UCI Health physicians online at clinicalconnection.ucihealth.org [https://clinicalconnection.ucihealth.org], on LinkedIn @UCI Health Physicians [https://www.linkedin.com/company/uci-health-physicians/], on Instagram @ucihealthphysicians [https://www.instagram.com/ucihealthphysicians/], or at @uciphysicians [https://x.com/uciphysicians] on X. Refer a patient at referralportal.ucihealth.org [https://referralportal.ucihealth.org/] and learn more about ongoing clinical trials at ucihealth.org/clinical-trials [https://www.ucihealth.org/clinical-trials].