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PrintHealth trends & technology
Advances in research and technology are improving our quality of life every day, from relieving chronic pain to restoring our youthful vitality. Here's a look at some recent medical trends in Central Ohio.
© 2011 Crestock
Monitoring heart failure
Heart failure occurs when the heart muscle becomes unable to pump oxygen-rich blood effectively to the rest of the body. According to the American Heart Association, about five million Americans are living with the condition now—and living every day with the swelling, fluid retention, confusion, fatigue and shortness of breath that come with it. The condition can worsen over time, resulting in an enlarged heart.
Researchers have developed monitoring systems that allow doctors to assess a patient’s condition remotely.
Garrie Haas, medical director of the Ohio State University Medical Center heart failure and transplant program, says hemodynamic monitoring systems help doctors with outpatient heart-failure management.
“One such system is a device that directly monitors pressure in the heart and provides a mechanism whereby patients can be instructed to provide home self-therapy for heart failure,” he says.
Like a pacemaker, the device and its antenna are implanted beneath the skin. Patients are able to take pressure readings by holding a patient advisor module over the antenna.
“The subsequent pressure reading for that patient is coupled with specific, physician-prescribed instructions concerning how they should take their medications for that day,” Haas says. Frequent adjustment of medication in direct response to a patient’s condition on a given day may keep the condition from worsening and prevent hospitalization, he says.
Patients typically are discharged the day after the procedure, and there are no known side effects, Haas says.
Saving stroke victims
For the past two decades, doctors have been using a clot-busting drug called tPA to help restore blood flow in the brain. Unfortunately, tPA only can be used within about three hours of the stroke, or it could cause dangerous bleeding. Peter J. Pema, a neurointerventional surgeon and vice president at Riverside Radiology & Interventional Associates, says many victims delay medical attention and therefore aren’t candidates for tPA.
“A lot of people don’t take the symptoms seriously,” he says. “They think they just slept on their arm a little funny and that’s why it’s numb.” Pema says because of the risk of bleeding and the time pressures involved, a lot of physicians would rather not use the drug. Currently, only about 5 percent of stroke victims receive tPA, but new advances have lengthened the safe time window from three hours to four-and-a-half, or maybe longer.
“The diagnosis is individualized to the patient,” Pema says. Specialized tests such as CT perfusion imaging map the inside of the brain, giving doctors a look at the extent of the damage.
Other new technologies look inside the body and then send messengers to do a job. Doctors now are using a tiny corkscrew-like device to snag a clot and remove it from the body. Coupled with a balloon that blocks the artery and a vacuum device that creates suction, doctors can be sure the entire clot is safely removed, restoring healthy blood flow. Another technique employs a catheter with an ultrasound tip, which may cause the clot-dissolving drug to permeate the clot more thoroughly.
The goal is to minimize damage from lack of blood flow as quickly as possible. The alternative is a potentially long road of recuperative therapy and a high chance of financial hardship and permanent disability.
Correcting pain
Pain can completely disrupt normal activities, and when that discomfort goes on for months or years, it can change a person’s life completely. Doctors now are using something called spinal cord stimulation to treat severe, chronic pain.
“SCS is a procedure that uses an electrical current to treat chronic pain,” says Dr. V. Brandon Thompson of the Cardinal Orthopaedic Institute. “A small pulse gener-ator is implanted in the back and sends electrical pulses to the spinal cord. These electrical pulses short-circuit pain signals to the brain and replace them with a tingling sensation.”
Initially, a trial stimulator is implanted under the skin. If the patient experiences significant relief, a permanent stimulator is implanted. The stimulator itself is placed under the skin of the abdomen, and the small wires (leads) are inserted under the skin and then into the spinal canal, Thompson says. The patient can control the device from home, turning it on for one to two hours a few times a day. Patients generally are back to normal activities in six to eight weeks, and the device is permanent.
Even milder pain can put a crimp in lifestyle. Tennis elbow and golfer’s elbow now can be treated with the use of platelet rich plasma, according to Dr. Raymond Wurapa of the Cardinal Orthopaedic Institute.
“PRP contains a rich concentration of growth factors and cell mediators, which are thought to stimulate the healing process,” he says.
During the procedure, a small volume of blood is drawn and processed to extract the PRP component, then is injected into the affected elbow. “Since it is the patient’s own blood produced and used immediately at the point of care, it is a very safe treatment,” Wurapa says.
The procedure is reserved for those who don’t respond to the traditional prescription of rest, therapy and anti-inflammatory agents. The treatment takes about 30 minutes, and patients heal in anywhere from a few days to several months.
For foot pain caused by plantar fasciitis, doctors have begun using extracorporeal shock wave therapy, a technique commonly used to disintegrate kidney stones. “The shockwave triggers an inflammatory healing response, which allows the body to send healing cells and increase blood flow to the site of the injury,” says Dr. Jonathan Feibel of the Cardinal Orthopaedic Institute. “So, in a way, it creates a new, acute injury in the same area to jumpstart the healing process.”
Patients may be pain-free in as little as two weeks, or it may take several months for noticeable healing to occur.
Promoting women’s health
Over the past two years, the recommended frequency of mammograms has been hotly debated. In 2009, the U.S. Preventive Services Task Force spoke out against annual mammograms for women older than 40. The task force recommended that women between 50 and 74 get mammograms every two years, and that women older than 74 not undergo the test at all. Proponents of less frequent testing say that doing the procedure every year can expose women to additional radiation. Opponents of the changes say that the benefits far outweigh the minimal exposure women may face.
Dr. Terry Grogg of Southwestern OB/GYN recommends that his patients get annual mammograms. “I’ve seen more breast cancers, but they are being detected so early that the prognosis is much better,” he says. “It’s not unusual to have patients who are 10 to 15 years out from breast cancer who are doing fine.”
Others say frequency helps catch problems early, and so does increased quality of the images. Digital and 3D mammography are revolutionizing the procedure with very high-resolution images.
Another controversy has cropped up over the issue of vaginal mesh, a sling-like material used to re-suspend internal organs. Grogg says complaints crop up over materials and techniques that were done a decade ago, but now are causing problems. He says the newer generation of mesh is thinner, more pliable and anchored in ways that won’t damage surrounding tissues.
After decades of heavy lifting, chronic straining, smoking, childbirth and other stressors, women may begin to notice low back pain, pelvic pressure and, in the late stages, internal tissues protruding from the vagina. It used to be that surgeons would repair the herniated tissues by sewing them back in place. “But stitches dissolve, and then you had to rely on scar tissue,” Grogg says. The results didn’t always last. “It was not uncommon for women to have the procedure three or four times.”
The polypropylene mesh is permanent because it doesn’t dissolve. The procedure, while not suitable for everyone, can help women who would eventually experience interference with bowel and bladder function, and even activities of daily living.
Hearing devices
Advances in hearing technology have erased the stigma of the old-fashioned hearing aid. No longer bulky or difficult to use, they now blend into any lifestyle with ease.
“We now have hearing devices that can be worn 24 hours a day, seven days a week for up to four months,” says Dr. Mary Lou Luebbe-Gearhart of Luebbe Hearing Services. “They are invisible, because we place them about four millimeters from the patient’s eardrum.”
The most basic of hearing aids contain a microphone, a receiver and an amplifier. But newer models use digital technology and also include a tiny computer.
The newest generation of devices does not need to be removed every day and the batteries are long-lasting. They can be worn while showering, swimming, exercising and sleeping.
“You can wake up and actually hear the alarm clock or the person next to you,” Luebbe-Gearhart says. “They take away the daily hassles. You just set them and forget them.”
Part of a hearing assessment includes an inventory of a person’s lifestyle. Hearing aid technology can be matched to anyone, from those who live a sedate life and need just the basics to those who have demanding schedules.
Good form
Health is our most precious commodity, but it doesn’t hurt to look good, too. When it comes to those areas that store fat in spite of our best exercise efforts, technology comes to the rescue.
Dr. Mary Beth Luca of Dermatology and Cosmetic Surgery of Dublin recommends CoolSculpting by Zeltiq.
“CoolSculpting is a new noninvasive way to reduce fat, especially from those stubborn, exercise-resistant areas such as the abdomen and love handles,” she says.
The procedure, which uses a patented, precision cooling technology, is performed on areas where the patient wants to eliminate fat cells.
The medical term is cryolipolysis, but what it means for the patient is that fat cells are literally frozen out of existence. There are measurable results right away, but patients will notice increased reduction over the first three months as the remains of the cells naturally are broken down within the body.
“On average, you’ll see a 20 percent reduction of fat in the treated area after one visit,” Luca says. The procedure is entirely noninvasive and so requires no anesthesia. It is most effective in those individuals who are within 10 to 15 pounds of their ideal body weight, she says.
“The entire procedure is an easy, one-hour treatment with virtually no down time,” she says. Some patients may experience minor bruising or tingling, but side effects are temporary.
Another fat removal technique is a new form of liposuction called Vaser Lipo.
“It uses the assistance of ultrasonic waves to break up the unwanted fat cells for removal,” says Dr. Timothy Treece of Columbus Aesthetic & Plastic Surgery. “It allows extra precision in shaping body areas, including hard-to-treat areas, often with less downtime.”
“SmartLipo is also a newer form of liposuction,” says Dr. Susan Vasko, also of Columbus Aesthetic & Plastic Surgery. “It uses laser technology to target and melt fat cells for removal. SmartLipo is also great for smaller areas of fat such as below the chin.”
Both procedures can be done in the office with only a local anesthetic. The most common side effects are bruising, tenderness and swelling for both procedures. Patients generally return to normal activities within a day or two.
For those looking to add fullness rather than remove it, Sculptra injectable filler is an option. The process, usually done in three treatments over three months, helps to replace the collagen lost to aging.
“Facial aging begins in your 20s, when your collagen production decreases, resulting in shallow to deep facial folds and wrinkles,” says Columbus Aesthetic & Plastic Surgery’s Dr. Robert Heck. “Sculptra actually works to correct these folds by stimulating your own collagen production at the injection site.”
Dr. John Wakelin, also of Columbus Aesthetic & Plastic Surgery, says Sculptra is different from previous fillers.
“It gradually and subtly corrects these facial wrinkles and can last two years, compared to six months to one year for other fillers,” he says. “It is great for increased facial volume for the entire face.”
Sculptra may be combined with procedures such as Botox injections to create a “liquid face-lift,” Wakelin says. Patients may experience redness, bruising or swelling, but they generally are able to return to normal activities within a day.
Kristin Campbell is a freelance writer.
