GERD is caused when the sphincter muscle at the bottom of the esophagus opens when it's not supposed to, allowing food and acid from the stomach back into your throat. Typically, people pop a Tums or Rolaids to control the ensuing heartburn, try to lose weight or modify their diets, avoiding alcohol, caffeine, peppermint and chocolate. When this doesn't help, doctors prescribe proton-pump inhibitors, powerful drugs that help "inhibit" the formation of acid. The last resort has been an invasive hospital surgery that wraps the top of the stomach around the esophagus to tighten the misbehaving sphincter. "But the majority of patients did not get off their medicines," says Corbett about this surgery, adding that many patients developed difficulties in swallowing if the wrap was too tight or had no benefit if the wrap came apart. "We've kind of been waiting for an answer," he says.

Then, in April 2000, the FDA approved the Stretta procedure. Corbett has been a leader in this area in performing the procedure and teaching it to other physicians. This minimally invasive technique uses radio frequency waves-the same kind used in TV remote controls-to knock out the nerves that cause the sphincter muscle to relax inappropriately and to remold the lower esophagus to create a one-way barrier to reflux. (Radio frequency has been used for years by cardiologists to block abnormal nerve transmissions to the heart and by plastic surgeons to remold collagen.) It's a 45-minute, outpatient procedure, performed with endoscopic guidance, usually under conscious sedation. Normally, patients go back to work the next day; 90 percent discontinue their medicines within a couple of months and 70 to 75 percent are able to get off all reflux medicines.

"What intrigues me most about the Stretta is that it's working in a way that improves the physiology of the sphincter and makes it work better. It actually addresses the pathology of the disease. It's a procedure where you can help so many people," Corbett says.

Dr. Graciela Garton

IMRT-Safer and more accurate radiation therapy

452 words

Dr. Graciela Garton landed in Sarasota eight years ago from the Mayo Clinic in Minnesota, wooed by sunshine and a colleague who wanted her to open a branch of 21st Century Oncology, a company that develops and operates 42 radiation therapy centers around the country.

Garton is a radiation oncologist, the physician patients see after they've been diagnosed with a tumor and need some form of radiation to kill the cancer cells. Radiation therapy has been used for decades, but it has often caused painful and annoying side effects as it passed through normal organs in order to reach the cancer site. Sometimes the effect is overwhelming fatigue. At other times, the radiation has destroyed healthy tissue. Patients with throat cancer might have salivary glands destroyed or, worse yet, a part of the spinal cord. Breast cancer patients might develop "hot spots," painful burns where the radiation had passed through the skin. Prostate cancer patients might develop problems with urination or diarrhea as the radiation passed through parts of the bladder and rectum.

Garton and her associates at 21st Century were some of the first in the area to bring in a revolutionary form of radiation therapy called IMRT, or intensity modulated radiation therapy. (Only Dr. Michael Dattoli of the Dattoli Cancer Center, a prostate cancer treatment center in Sarasota, is also currently using it in this area.) Approved by Medicare only 1 1/2 years ago, IMRT has the ability to vary the amount of radiation the body receives according to the type of tissue it's passing through. The radiation beams can also be precisely shaped to avoid healthy tissues and organs on their way to the tumor site. For example, if the patient has a head or neck cancer, the radiation beams reduce their power while they pass through the skin and may entirely avoid the spinal cord, the majority of salivary glands and other normal tissues.

Used to treat prostate, breast, brain and deep-seated cancers like pancreatic cancer, IMRT is a breakthrough fueled by computer advances. IMRT's sophisticated computer system is able to fuse images from MRIs and CT scans to pinpoint the exact location of the tumor. Huge computer monitors display rotating 3-D images and diagrams of intersecting lines that look like aerial maps of military targets. Once the "map" is completed, multiple beams of radiation can be precisely targeted to "nuke" the tumor. The learning curve is steep, but these IMRT images eliminate much of the guesswork and reduce the side effects so patients can live normal lives while under treatment.