Meet our Docs: Dr. Lee Warren is an inventor, author, podcaster and neurosurgeon
By Kristy Bleizeffer Feb 23, 2016
W. Lee Warren Jr., M.D., is a surgeon who wears many caps. He’s a neurosurgeon, sure, but it’s not all he is.
He is a veteran and a retired major of the U.S. Air Force, deployed twice in support of Operation Iraqi Freedom. He is the author of three books. The latest, “No Place to Hide: A Brain Surgeon’s Long Journey Home from the Iraq War,” is an Amazon best seller.
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He is a podcaster and a blogger for his website, wleewarrenmd.com, and writes a weekly newsletter to subscribers on his mailing list. “I talk about neuroscience a lot, and I use it as an avenue to understand the way we think and how our attitudes and thoughts are well under our control,” he said. “People do not understand this sometimes. You do not have to be trapped in the way that you felt about your life in the past. You can make a choice to be happy. By doing so, you can improve your brain chemistry and improve your life.”
He’s also an inventor. He holds two U.S. patents for minimally invasive surgical equipment and has brought numerous medical devices to the market through Warren Innovation, Inc., a medical technology incubator he co-founded with his wife, Lisa Warren.
He sat down with The Pulse for a two-part interview about his career, his inventions and what brought him to the wide open West. (Read Part One here.)
Let’s start by talking about some cases that have stuck with you through your career.
I think the most unusual case I have ever been involved in, outside of Iraq, is I had the notoriety of having the longest operation ever done in the history of Wilford Hall Medical Center in San Antonio. A staff sergeant who was on active duty went deaf and was found to have an 8-centimeter tumor on his brainstem – about the size of an orange. Another neurosurgeon and I did a staged operation on him that took 57 hours. We removed the entire tumor, and the man was able to stay on active duty.
You were away for 57 hours, or you two switched on and off?
We operated for about 12 hours, and then he operated for 4 to 5 hours, and then we put the patient in the ICU and let him physiologically rest for 24 hours. Then we brought him back and did the rest of the surgery. It was threatening his life and causing hydrocephalus with brain stem compression.
Deafness was his first symptom, but he would have died from this if we had not taken it out. The way those tumors work is you pretty much have to take the whole thing out, or it will come back. So, it was massive and lengthy.
He was able to finally come back and was able to retire as a chief master sergeant. It was kind of a unique thing. The case presented itself, it needed to be done, and we decided that together we could do it. That was the biggest case I have had. It was not like separating Siamese twins at the head, but it was an amazing case.
Tell me how you became interested in medical inventions?
I think the thing that has been the most surprising to me in my career is my transition into complex spine operations. When I was trained in Pittsburgh, I was groomed to be the brain tumor specialist. I then went to San Antonio, and I was kind of the skull base and aneurysm guy for the Air Force. They brought people from all over the world for me to fix neuromas and aneurysms. I was not that interested in spinal surgery.
Then a neurosurgeon in Memphis, Kevin Foley, invented something called a METRx tube, a system for performing spinal surgeries in a much less invasive way. I read an article about it and trained for it the year it came out. I came back to San Antonio and taught the other three neurosurgeons how to do minimally invasive spine surgery through these round ports. METRx turned spine surgery from a big, invasive and kind of devastating procedure to a complex but microsurgical procedure. We were able to take the same kind of delicate finesse microsurgical techniques we use in brain surgeries and apply them to the spine using these access ports.
It made a huge difference in outcomes for people. Take a simple operation like a lumbar laminectomy or ruptured disk microdiscectomy, for example, and you turn that from a 3-inch skin incision to a 14-millimeter skin incision. You then do the same operation without cutting any muscle or disrupting any bone or ligament structures away from the spine. Patients return to work faster. They do not lose any blood. We never have to give blood transfusions for spine surgeries any more. It changed everything.
When I went to private practice, about 85 percent of my work was on the spine. That minimally invasive paradigm really kind of changed everything from the way that I practiced and the way that I looked at neurosurgery.
For the past 10 years, I have been working hard to develop technologies that are less and less invasive. For example, with the Warren Minimally Invasive Spinal Access System, I had the idea to make the ports square instead of round to allow surgeons to take their instruments in the corners and still be able to see their target. That allowed me to open the dura and take out spinal cord tumors and do minimally invasive brain surgeries, and all kinds of things now through really tiny incisions.
Which of your inventions makes you most proud?
I am really looking forward to seeing where the last half of my career goes from here. There are now surgeons all over the world that are embracing that noninvasive is better for spine. Since that is now kind of a common thing, we are seeing companies getting interested in this and the possibilities are endless. We can now do big spinal fusion surgeries through little bitty incisions. People used to say, “I will never have back surgery because I will never be the same again.” That was really because the surgery did so much damage to the muscles and bones, and the ability to stand upright was compromised. Now, we do not lose anything. I think the thing that I am most proud of in the spinal work that I have done is when I see an MRI on a patient six months to a year later and the radiologist does not notice that the patient has had surgery.
Do you have a background in engineering, or is this is a case that you saw a problem in your field and the solution just came to you?
My wife, Lisa, is an interior designer and she and I started an innovation company. We like to talk about problems. She will notice a problem of some product that does not work like it should, and I will do the same thing with surgical products. We try to figure out why they do not work and how they can work better. The whole square port thing came about of me complaining about how hard it was to do certain things through a round port. She wanted to know why it was round? That led us together kind of expanding that notion of making it square. It sounds so simple, but it was a whole universe of how you do this operation and asking what the possibilities are.
I have seen surgeons who cannot think their way out of a problem, because they were trained to do this when that happens. They never ask, “Why do you do it this way?” I was really blessed to train in Pittsburgh where we had university professors and two private practice groups with 15 surgeons from all over the world who taught us. One neurosurgeon would teach us to always do a microdiscectomy one way, and the next guy would say you should always do it another way. So, I was taught five different “always do it this way” approaches. What I learned is there is never one way to skin a cat, so to speak. That led into me trying to understand how instruments are designed and what the designer was thinking. When it does not work perfectly for me, then I want to develop some other instrument to make it work. That has been my whole path of my career, just trying to solve problems. When you give me a set of tools, and they do not fix the problem, I am going to make a new set of tools.
What brings you to Wyoming Medical Center?
Lisa and I were in Alabama because our family was there, but it was never our intention to be in Alabama forever. Our last child started college this year, so we are empty nesters now. When we go away, we go west because we like to hike and climb. That is one reason.
But the real driving factor was, as a solo-practice doctor in a market where I am the only neurosurgeon, I have pretty much been on call for 10 years now. Because Lisa ran our office, the neurosurgery practice has been our whole life for the past 10 years. It was exhausting. With the changes in health care in the past five years, it has become pretty clear that it is harder and harder to run a private practice.
Sometime in early August, I got a flier in the mail, which I normally toss in the garbage. This one said “Rocky Mountains.” I just kind of tossed it on the bed and Lisa said, “Why don’t you call these guys?” She said that maybe it was time to think about doing something else. The flier turned out to be from Casper, Wyoming.
The more we talked about it, the more it started to make sense on a work-life balance kind of scale. Then, on an economic scale, it started making sense too. On Sept. 1, late at night, we got off the airplane and we were driving, and it was one of those blood moons. We thought it was a beautiful place. We got up the next morning, saw the mountains, and came to meet everybody.
What do you think about the medical services here at Wyoming Medical Center?
That was the biggest surprise to me. I thought this was going to be a little place in the middle of nowhere. Casper has an amazing medical center with a really cutting-edge staff. Wyoming Medical Center has better equipment, better support and better peer relationships than I had in Alabama. The neurology, radiology and other specialists here are remarkable to me. I think I can actually elevate what I am able to do professionally here. I see that this is not a lateral move, but actually a move up professionally. We are super excited about what I can do here.
Dr. Warren is a board-certified neurosurgeon and a retired major of the U.S. Air Force. After serving the country for 14 years, including a deployment as a combat surgeon in Iraq, he retired as chairman of neurosurgery at Wilford Hall Medical Center in San Antonio. He is founder of the Air Force’s Comprehensive Epilepsy Management Center and the Center for Minimally Invasive Neurosurgery. He also served as Director of Cerebrovascular, Skull Base, and Neurotrauma Surgery. In his spare time, he writes and podcasts about the influence of neuroscience on mental wellness and personal development at his website www.wleewarrenmd.com.