Amazing Breakthroughs

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.