IO ‘Unmasked’: An Interview With Dr. AJ Gunn

In this interview, Dr. AJ Gunn shares insights and lessons about his profession and passions. 

In this interview, Dr. AJ Gunn, SIO Publications Committee Vice Chair and Director of Interventional Oncology at the University of Alabama at Birmingham, shares insights and lessons about his profession and passions. 

IO Learning:

How did you get into the healthcare industry and at what age did you decide to pursue this profession? 

Dr. Gunn: 

That's an interesting question. I had an older brother who was in medical school when I was in high school, and I kind of remember thinking about it at that point. And then, when I got to college, I did think about other possibilities, but didn't really consider much else.  

While in medical school I was introduced to interventional radiology, where they were discussing the mercy retriever for stroke patients, and this idea of chemoembolization where you could go and shoot chemotherapy directly at tumors. At that point, I was totally hooked. 

I definitely chose interventional radiology pretty early on. I remember doing a tumor ablation under ultrasound guidance and being there with the doctor, and he was pointing to where the tumor was under ultrasound. You could see the needle going in, and then they just burned it off and just sent the patient away. And I thought, gosh, why would anybody ever want surgery? And I still  feel like that a little bit to this day.  

IO Learning:

What are the accomplishments you've achieved in this field that you are most proud of? 

Dr. Gunn: 

What it really comes down to for me, is am I a good partner to my partners, am I a good partner to my referring physicians, and am I a good partner in the care of my patients? So some of the things that I'm probably just most proud of is when  I get these side text messages from colleagues inside the hospital like, “Hey, can you take a look at this case?”, even if it's not a formal referral, or, “Hey, I'd really love to hear your thoughts about this.” Or, seeing the way that interventional radiology is done inside of our institution at UAB has expanded out to different tumor boards and working groups, and how other people  are taking our feedback and integrating that into patient care. To me, that's one of the things that's probably most satisfying more than anything else. 

And then, when I go to clinic, I see that it is full of patients that are there to see me for cancer treatments or other therapies. I don’t know about the things I am most proud of, but I think those are things that probably bring me the most joy about my job. 

IO Learning: 

So, if you could recommend one book that changed your life or altered your outlook on life, what would it be and why? 

Dr. Gunn: 

Oh, there's so many’’I would say the books that focus on managing yourself, managing other people, managing your emotions and your thoughts, and the ones that provide different strategies on ways that you can grow personally in your interactions with your family, friends, and coworkers.  It's also interesting to read different people's perspectives about how we think about problems and each other and trying to employ those strategies. . I don't do a great job, obviously, but I do always try to employ those in my day-to-day life. So it's hard to pick a specific book because my perspectives come from many different sources, and I don't want to leave anything out, but at the same time, I don't want to drill down to one specific book and everybody thinks that that's the one they have to read! 

IO Learning: 

What about the future of interventional oncology excites you the most? 

Dr. Gunn: 

There are so many different things. I think especially in HCC, new immunotherapeutic agents are really exciting, along with what we can do in interventional radiology to work in combination with our immunotherapeutic agents. Can we boost the response to immunotherapeutic agents? How does combination treatment work? , How targeted can we become with these new agents? Can we deliver the new agents either percutaneously with an injection or intra-arterially like we've done with radioembolization or chemoembolization? These are really interesting questions that people are looking at. Also, how do we expand interventional radiology  How do we continue to expand some of these minimally invasive therapies to other patients and other disease states, and then once we do that, continue to build the evidence to have those incorporated into guidelines and standardized treatment algorithms.  

IO Learning: 

Are there people in the industry who have helped you to succeed throughout your career? 

Dr. Gunn: 

Oh, there's too many to name. I have this talk that I was asked to give at the Society of Interventional Radiology last year about mentorship, and it was really awesome to put together the talk because I have this one slide. It's just pictures of people that have been a mentor and a sponsor to me. It's like 50 people. It's really awesome to go back and think about people like Dave Maddox, who was a basic biomedical scientist in my medical school who I did my first summer research with. And someone like Peter Choyke at the NIH, who kind of took me under his wing into his lab and helped me get into a good residency. Then you get into that residency and are helped by so many people inside that residency likePeter Mueller, Steve Dawson,Raul Uppot, Deb Gervais, and Ron Arellano.   Then you go into fellowship and people like Cliff Weiss, Kelvin Hong, Mark Lessne, Brian Holly, and all kinds of people who sponsor you along the way. When I think about mentorship, you realize there's no way you can really ever pay them back. I can't put them on a committee or help them with papers. They've already accomplished these things. The only way that I can really pay some of these people back is by paying it forward to people that are coming along behind us. That is such a strong part of the culture in interventional oncology, interventional radiology. To keep this idea, of reaching out to others if you have questions. There are people like Mike Soulen and Dan Brown that I didn't train with at all but who have just been incredible mentors, all because I reached out and asked for help, for no other reason than that. I really do feel like that's the culture of this community, and it's excellent to hopefully be able to contribute to that culture going forward. 

IO Learning: 

If you could meet one person throughout all of history, who would it be and why? 

Dr. Gunn: 

I would have to say probably Abraham Lincoln. I don't love the fact that my choice is from a totally different generation so I don't know how we'd converse or if our language would be so different today from back then that it would just make for boring conversation. But I just think about the things we learned about the Civil War. It was a very perilous and tenuous time, and people were trying to get him to negotiate and settle things, and he really held the country together. It would be great to talk to him about the lessons that he learned from doing that, hearing his perspective, and knowing what his thoughts were. I think that would be really interesting.  

IO Learning: 

Has studying, training, or practicing in different states throughout your career given you a better understanding of diversity, rural versus urban care, socioeconomic disparities, etc.? 

Dr. Gunn: 

A thousand percent. I did a year of IR at Mass General as a resident before I went on to fellowship at Hopkins, and I specifically remember on my first day of fellowship taking the last case of the day. My attending said, “Have you put in a cholecystostomy tube before?” And I said, “Yeah, I've done like 50. I'm totally comfortable.” He said, “All right, go for it.” So how we did cholecystostomy tubes in residency was just a straight trocar technique. We do ultrasound and we take the tube and we put it directly in there. So I was lining up to do that, and he opens the door and he says, “What are you doing?” 

“I'm putting in a cholecystostomy tube.” And he said, “You will take a needle. You will access the gallbladder. You'll inject. You'll put in a wire and then you'll dilate and then you'll put in the tube.”  And so we did and that's just how they did it. What that taught me is that people do things all sorts of different ways, and that has  really made me much less dogmatic about what's the right way to do anything.  

It's great to put tips and tricks inside your pocket and think I've seen it done these other ways when maybe the way that you really try first doesn't work out. But whenever I hear people get up and say, “Well, this is the only way to do X, Y, or Z” , I just feel like maybe you've been at one institution for way too long. So I definitely think it has given me a perspective about the diversity of practice more so than anything else in interventional radiology.