These advances are coming so rapidly that almost every specialty is struggling to keep up. "It's the pace of biotechnology," says Dr. Gerald Grubbs, a neurointerventional radiologist in Naples. The fast pace is fueled, he adds, by the never-ending quest by doctors and nurses to find "a better mousetrap" so they can save lives.

We talked to medical professionals along the Gulfshore about some of the astonishing advances that are changing medical care-and the lives of patients-right here in Southwest Florida. Most are outpatient procedures that are faster to perform, less invasive and, most important, more medically effective. Here's how some local doctors are using these near-miraculous treatments and techniques.

Super Scans

In the '80s, there was the ct scan; in the '90s, the MRI. Both are diagnostic imaging techniques that have allowed physicians to view our anatomy on the inside to look for problems. The latest advance in imaging is positron emission tomography, or PET, a technique that, instead of simply taking pictures of our anatomy, actually measures how the cells in our bodies function.

"It's the greatest modality to hit imaging since the MRI," says Dr. Robert McDonald, a Fort Myers nuclear medicine specialist at Radiology Regional Center, which installed one of the first PET scanners in the region about two years ago. PET is actually older than the MRI, but wasn't used much outside of research settings until it was approved for reimbursement by Medicare in the late '90s.

In the majority of cases, PET is used to diagnose tumors; and it can help do away with unnecessary biopsies, surgeries and other scans, says McDonald. Basically, tumors have a higher metabolic rate than other tissues in the body, which makes them use glucose, a source of the body's energy, at a greater rate. When a doctor suspects a problem-for example, perhaps she sees a nodule in the lungs on a CT scan-she can follow up with a PET scan instead of ordering an invasive biopsy. The patient receives an IV solution of a very small amount of radioactive material (no more radiation than a normal CT scan, says McDonald), which is attached to a glucose-like compound. Once injected, the material painlessly travels through the body for about an hour. If there is a cancer, it will be taken up in larger amounts by the hungry cells of the growing tumor. The patient is then taken to a scanner, where traces of the radioactive material will light up on the image, showing if the nodule is indeed cancer.

PET scans are also useful in following up on cancer therapies. A breast cancer patient who has undergone chemotherapy might have a PET scan so the doctor can see if the tumor is shrinking and decide whether to continue with the chemotherapy or try another treatment. PET is also being used to evaluate epilepsy and cardiac conditions, and might help diagnose Alzheimer's and Parkinson's disease. "It's an incredible technology," McDonald says. "My prediction is that PET will become as popular as MRI and CT, and all major medical and imaging centers will have one, if not multiple, PET scanners."

Fantastic Voyage

It's not often that doctors get to travel to unexplored regions, but Dr. Raymond Phillips, a Naples gastroenterologist, did just that when he swallowed the M2A, a camera the size of a large vitamin pill.

That's right. A camera pill. Recently approved by the FDA and Medicare, the M2A, an acronym for mouth-to-anus, is a tiny, picture-taking capsule that painlessly travels through the gastrointestinal tract, taking 50,000 pictures during its eight-hour journey before it's naturally eliminated.

"It's pretty astonishing," says Phillips. "There's something gee-whiz about it. We're able to see a portion of the GI tract we've never been able to see before. The images are very, very good."

The M2A reaches a part of the body that has been particularly hard to reach-the narrow 10 to 18 feet of the small bowel. Colon-oscopies, which pass a long tube with a light into the rectum, and endoscopies, which pass the tube through the mouth, can't reach most of the small intestine. Doctors have often relied on barium X-rays to diagnose unexplained belly pain or bleeding. The patient drinks a barium solution, which, under X-ray, highlights obvious abnormalities, but has been unsatisfactory for its lack of clear detail.

The M2A, swallowed with a glass of water, includes a light source and transmitter that radios images of its journey to a receptor strapped around a patient's abdomen. Doctors can detect small tumors and diagnose Crohn's and celiac disease-even bleeding from use of over-the-counter non-steroidals like Advil and aspirin. "We're able to identify bleeding sites we suspected but could not prove," says Phillips.

Even more exciting, he says, is where the M2A may travel during the next decade. "Right now, the M2A is just a diagnostic test. But wouldn't it be nice to have something therapeutic?" he asks. Eventually, the M2A might be able to cauterize bleeding with mini-lasers, he says, and doctors would be able to maneuver it from outside the body.

Now if only patients could get over the idea of swallowing a camera. "It's a tasteful beige color," reassures Phillips, "and it's pretty slippery. For patients who have problems swallowing pills, we have them practice with M&Ms first."

Triple-A Treatment

When we think of leading causes of death among seniors, few of us would list the abdominal aortic aneurysm (AAA). But, in fact, AAA is one of the top 10 causes of death in the United States, says Dr. Hiranya Rajasinghe, an endovascular surgeon in Naples.

Basically, AAA is a weakening of the walls of the aorta-the main blood vessel coming from the heart-in the abdomen, caused by hardening of the arteries, smoking, high blood pressure or infection. Most people with this condition are older than 55. As the vessel weakens, it bulges. If it stretches too much, it bursts; and the patient can bleed to death. The likelihood of surviving this type of ruptured aneurysm is only 10 percent. There are no symptoms and most people only find out about it incidentally if they're undergoing other medical tests.

For the last 30 years, the only treatment for this condition was major abdominal surgery, in which an incision was made from sternum to groin, and the surgeon removed the weakened area and then sewed the aorta back to the healthy tissue above and below. The procedure, while tried and true, was extremely invasive, requiring a six-to-eight-week recovery period, which tended to exclude frail, older patients with lung and heart problems as candidates.

Rajasinghe was the first in the area to perform endovascular stent graft repair. In this procedure, the surgeon makes two small incisions in the groin and threads a catheter up to the aorta. Then he removes the aneurysm and relines the blood vessel with a stent-a small mesh tube covered in fabric that strengthens the vessel. Since the aneurysm is removed, the vessel is no longer under pressure, and it shrinks. The procedure requires only one night in the hospital, and patients are back to normal in a week.

"This is a very successful model for the old-age patient," says Rajasinghe, who predicts it will become the standard of care for AAA patients. Perhaps more important, he stresses, is educating patients and doctors about AAA to aid in its prevention and detection. A healthier, non-smoking lifestyle with a good diet and exercise can help prevent AAA. If people have risk factors, they should make sure their family practitioners check for the condition. If AAA is detected, they should be screened once or twice a year to monitor size and growth. "We must be more vigilant," Rajasinghe says. "This is lethal."

Backs to the Future

About 10 million people have some degree of osteoporosis-thinning bones-in the United States. About 700,000 of those people will suffer from a compression fracture in the backbone. The fracture is extremely painful as bone grates against bone. "Any movement-getting out of bed, just getting up from a chair-is painful," says Dr. Michael Carron, an interventional radiologist with practices in Fort Myers and Naples. In the past, doctors most often offered pain medicine and back braces for the pain. Rarely was invasive and risky back surgery a preferred option.

Then about five years ago, U.S. doctors began performing vertebroplasty. This is a noninvasive, outpatient procedure in which doctors make two small incisions on either side of the spinal cord and insert a needle the size of a cocktail straw through the incision to the collapsed vertebrae. Then they inject a surgical bone cement into the bone to stabilize it, preventing it from rubbing against any other bone. Patients are sedated and given a local anesthetic for the procedure, and are usually on the table for about 15 minutes. Afterward, they are observed for about two to four hours before being sent home.

The relief can be almost instant, says Carron, who began performing the procedure soon after it was approved. "About 20 to 25 percent experience immediate relief," he says. Most of the remaining patients express relief in hours or days.

"It's phenomenal," Carron says. "It's the most gratifying procedure, because you get immediate feedback from patients."

Targeting Tumors

For decades, doctors have used radiation therapy to kill cancer cells. While often successful, radiation can cause lingering or painful side effects because it passes through normal organs and tissues in order to reach the cancer site. A common side effect is fatigue. Other side effects are specific to the cancer being treated. Patients with throat cancer may develop a dry mouth due to salivary gland damage. Breast cancer patients might develop burning of the skin or breast thickening from radiation.

Dr. Debra Freeman, a radiation oncologist at Raymond L. Lutgert Cancer Center in Naples, says an improved technology called intensity modulated radiation therapy, or IMRT, is reducing some of these side effects and may increase the cure rate of various cancers. Instead of radiation being delivered from a single "field" or beam, IMRT treatment targets the tumor more precisely by treating with multiple tiny beams. The radiation can also be "modulated" or adjusted so that the tumor receives a higher dose than surrounding tissue. Previously, doctors were limited by the damaging effects of radiation to healthy tissue; now, by increasing the radiation to the tumor, they may cure more patients.

IMRT can't be used in all cases, cautions Freeman, and patients can still experience side effects. "But it's an improvement over what we did previously," she says. "It's pretty cool technology."

More Miracles

Last year, the FDA approved another alternative for the just-turned-40 set who find that reading the newspaper requires a longer arm. Dr. James Croley of Naples says the latest procedure, called conductive keratoplasty (CK), corrects mild-to-moderate farsightedness-and, when performed only on one eye-can restore reading vision, too. (The treated eye will be the reading eye and the other eye will be used for distance.) Many doctors are finding it's a less risky procedure than the older LASIK surgery, which involves cutting a flap in the cornea before reshaping the cornea with a laser. CK uses radiofrequency waves, delivered through a fine probe in a pattern around the cornea, to reshape the cornea. "I did it myself a couple of months ago," says Croley. "I don't wear glasses or contacts." Does CK mean you'll never have to wear reading glasses? Unfortunately not. Our eyes continue to change as we get older. But, take heart. "You can have it repeated," says Croley.

Every day in Collier County, three to four people suffer strokes, says neurointerventional radiologist Dr. Gerald Grubbs. Until tPA was introduced in 1996, they had few options besides supportive care. The powerful drug dissolves obstructions in blood vessels, minimizing damage to brain cells. For best results, however, patients must be treated within 90 minutes of the stroke and not later than within three hours. Grubbs says a new, more effective form of delivering tPA called intra-arterial revascularization (IAR) gives doctors and patients six to 24 hours in which to be treated, depending on the type of stroke. Now, when doctors detect a brain clot through scans in the emergency room, they can pinpoint its exact location and place a catheter within the clot to administer the "clot-busting" drug right at the source.

Only two percent of all stroke patients ever receive tPA, however, because most ignore the signs of stroke for too long. "It's critical to get to an emergency room right away if you suspect you are having a stroke," says Grubbs.

Sometimes people with perfectly normal cholesterol levels suffer heart attacks and strokes. Doctors used to wonder how they could identify these people and others at risk. Now they have another indicator. Called C-reactive protein (CRP), it detects inflammation within the body-when the plaque in our vessels becomes inflamed, it can erupt, causing a clot-and can help predict not just which patients, but when patients are about to have a stroke or heart attack. Dr. James Talano, director of cardiology of Cleveland Clinic Florida in Naples, says doctors can tell patients the likelihood of having an event within the next 30 days to 10 years based on CRP results and can prescribe various drugs to reduce the risk. Right now, because of cost, CRP is only used on patients who have already suffered a stroke, heart attack or other vascular event or have other red flags that make them look like candidates. But CRP, he says, is potentially useful for all of us.

By now, everyone has heard of Botox. Plastic surgeons inject it into the muscles of the face to get rid of frown lines. But urologists think Botox may also work to treat the overactive bladder, a spastic muscle condition where patients are urinating more than eight times a day and more than twice at night with an urgency that they can't control. Because Botox temporarily paralyzes or weakens muscles, it shows great promise, says urinary incontinence specialist Dr. Jonathan Jay of Naples, who is involved in a research protocol to study its effectiveness.

About 17 million Americans are affected by this condition-think of those drugstore aisles stocked with adult diapers. It's caused by aging, neurological conditions or for no reason doctors can discern. In the past, most people have assumed it is a natural part of aging and have decided to live with it or have been too embarrassed to discuss it with their doctors.

Drugs used to treat incontinence can cause dry mouth and constipation. Botox, injected directly into some of the muscles of the bladder, causes muscles to relax without either of these annoying side effects, Jay says. The improvement in the condition lasts anywhere from four to nine months. Urologists are also beginning to use it for urinary retention.

Psoriasis, a condition that causes thick, red scaly patches on the skin, affects seven million people in this country. About 80 percent have psoriasis on 10 percent or more of their body. Besides itchiness, the biggest complaint doctors hear is that it's embarrassing, says Dr. Charles Camisa, the senior staff dermatologist for the Cleveland Clinic Florida. Steroid creams and sunlamps were once the treatments of choice. But recently researchers have dissected ultraviolet light into its individual wavelengths, and they have discovered that one particular wavelength of the spectrum can successfully treat many cases without the risk of sunburn. Camisa also says new drugs, "designer molecules," that actually tamper with a specific part of the immune system and block the inflammation, are also proving to be more successful and less risky. They're expensive right now, he says, but for patients who may have despaired of improving their condition, "It's like a holiday."