Amazing Breakthroughs

By staff May 1, 2003

Where are the most exciting advances in medicine today? Take your pick. According to Sarasota neurosurgeon Dr. Peter Mayer, "I don't think you'll find one area of medicine that isn't seeing rapid change." Even in Sarasota, where no university teaching hospital is spurring the development and use of the latest techniques, Sarasota physicians participate in clinical trials, lobby local hospitals to purchase the latest technology and undergo extensive training in the latest techniques.

Many of the advances are the result of ever-improving technology, which is creating more precise tools for diagnosis and treatment. Such technology often enables physicians to replace invasive surgery with outpatient procedures that are faster to perform, easier to endure and, most important, more successful.

Engineers are designing smaller and smaller instruments for minimally invasive surgery. Computers can reconstruct the insides of our bodies on TV screens so surgeons can perform complicated surgeries through tiny incisions. Cancer radiation therapy is becoming so accurate that it can nuke a tumor while leaving healthy tissue virtually unharmed.

But not all breakthroughs are high-tech. Sometimes common sense, a simple shift in procedure and the commitment to improve care provide that extra edge for the patient. Case in point: Sarasota Memorial Hospital began to give each patient in the emergency room an aspirin as soon as it was determined the patient might be having a heart attack. The hospital also assembled an emergency team of cardiologists who committed to being on call seven days a week, 24 hours a day, and then brought the average length of time from doorway to operating room down from 120 minutes to under an hour. The result: More lives are being saved.

We asked area hospitals and physicians to give us the names of local doctors who are using some of the most exciting advances in medicine. From that extensive list, we chose five physicians who are on the leading edge of new technologies. Here's a look at how medical innovations are changing the way Sarasota doctors work-and improving the lives of their patients.

Dr. James J. Fox-coated stents

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Dr. James Fox, a bear-sized man with bushy hair and the curious distinction-for a doctor, at least-of being a former amateur boxer and an attorney, dislikes frequent flyers. No, not the sort who collect free airfare, but the kind he sees as medical director of interventional cardiology at Sarasota Memorial Hospital.

In cardiology, frequent flyers are patients who return after an angioplasty because their arteries have become blocked again-a process called restenosis. In the initial angioplasty, a small balloon is threaded through an artery in the groin up to the blocked artery in the heart. The artery is then cleared of the sticky plaque clinging to its walls and a stent-a stainless steel mesh tube smaller than a spring in a ballpoint pen-is often installed to keep the artery open after the procedures. More than 1.5 million angioplasties were performed last year; many are outpatient procedures, requiring only intravenous sedation and a local anesthetic. They have been extremely successful in restoring blood flow to the heart.

The problem, however, is that within six months, up to 30 percent of all angioplasty patients develop scar tissue around the stent, and the artery is blocked once more. Hence the frequent flyer label, as patients return for radiation therapy to clear away scar tissue, or worse yet, for bypass surgery, a major open-heart procedure, requiring four to seven nights in the hospital and up to eight weeks to recuperate.

Different methods are being used to prevent the build-up of scar tissue, but Fox is most excited about a new type of stent he and other Sarasota interventional cardiologists are using. These stents, which are in clinical trial through Sarasota Memorial's Clinical Research Center, are called drug-eluting stents or "coated" stents, and they're painted with a chemotherapy drug. Essentially, the coated stent emits a medicine that penetrates the coronary artery wall and prevents scar tissue from growing. The hope is that coated stents will prevent most by-pass surgeries.

"It has the potential to dramatically change the way a huge population of patients is treated," Fox says. "The hope is that people are never going to come back."

Dr. Thomas Sweeney II, endoscopic spinal fusion

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Sometimes, smaller is better-at least when it comes to incisions.

More than one million Americans undergo spinal surgery every year for chronic back pain. Until about a year ago, about 350,000 of those patients had a procedure called spinal fusion, in which the surgeon made a four-to-10-inch incision along the back and inserted rods along the vertebrae to stabilize the spine and, it was hoped, end the pain. Recovery time was eight to 12 weeks, and often, the procedure was painful and created additional problems.

Then came endoscopic spinal fusion, a brand-new, minimally invasive procedure that allows physicians to perform the same complicated work of rebuilding the spine by working from a one-inch incision along both sides of the back. There's minimal trauma to the body. Patients go home the next day, often in much less pain, and are back to normal-except for lifting heavy objects-in three to four weeks.

"When I heard about this procedure 18 months ago I said, 'No way,'" says Dr. Thomas Sweeney II, a fast-talking, energetic and upbeat Sarasota spine specialist who's likely to say "awesome" when asked how he's doing and then add, "but that's just baseline." But once he investigated the procedure, he started to try it. To date, Sweeney has performed more endoscopic spinal fusions than any other doctor in Florida and is nationally known as an expert in the procedure.

Sweeney says this is one of the most exciting developments to come along in his field. "What arthroscopic surgery has done for knee surgery, endoscopic back surgery will do for back surgery. It allows us to pass through the body without doing damage. Formerly, we had to strip attachments and move muscles aside," he says. "That could cause a problem by fixing another."

Sweeney says he's still astounded at some of his patients' responses, and the new procedure satisfies every orthopedic surgeon's deepest desire-to rebuild the body so it works.

"Even yesterday, I went to the hospital to see a woman who I'd performed surgery on the day before. She was already dressed, cheery-eyed and ready to go home. She told me she was waiting before she took any pain medication. Even though I know this is supposed to happen, it's just amazing to me. I couldn't be happier."

Dr. Lee Mitchel-pill camera

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Maybe you remember the classic 1966 sci-fi film Fantastic Voyage, where Raquel Welch and Stephen Boyd are miniaturized and injected into the body of a Russian spy, then travel throughout his body fighting off white blood cells and antibodies. The visual effects of what the body might look like from the inside won the film an Oscar and inspired awe in audiences back then.

That's not too far from how Dr. Lee Mitchel, a Sarasota gastroenterologist, feels about the recently FDA-approved M2A camera, a tiny picture-taking pill that travels through the gastro-intestinal tract, taking 50,000 pictures during its eight-hour journey before it's naturally eliminated.

"It's just remarkable," says Mitchel. "It's a non-invasive way to find out what's going on in your small bowel. It's painless. You need no anesthesia. In fact, I did it myself."

Mitchel says the M2A-a not-very-poetic acronym, meaning mouth-to-anus-is a tiny $450 camera with a light source and a transmitter that radios images to a receptor strapped around a patient's belly. The pictures are extremely clear and can diagnose a particularly hard-to-reach part of the body-the 10 to 18 feet of the small bowel.

Colonoscopies, 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. A longer endoscope, called an enteroscope, requires more skill from the doctor and anesthesia for the patient. The M2A, swallowed with a glass of water, painlessly travels to this part of the body and provides an annotated log of its journey. The only obstacle patients need to overcome is the idea that they're swallowing a camera. In Sarasota, Dr. Mitchel was the first physician to use the new technology, available at Doctor's Hospital, and he's been teaching it to other doctors. He's been able to diagnose everything from tumors to Crohn's and celiac disease. "This is the first time we can view the entire small bowel in a painless fashion," he says. "You know the expression, 'where no man's gone before?' That's what it feels like. It opens our eyes to a new horizon."

Mitchel says the next generation of capsule technology is looking at making the pill a tiny robot that can be guided to take tissue samples and perhaps provide treatments like removing polyps or cauterizing tissue.

"It sounds like Buck Rogers, doesn't it?" he says.

Dr. Scott Corbett-radio frequency to control heartburn

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Commercials may use humor to sell heartburn medications, but heartburn is not a laughing matter to the 40 million Americans who suffer from it.

Sarasota gastroenterologist Dr. Scott Corbett says heartburn, which is really a symptom of GERD (gastroesophagcal reflux disease), not only causes severe pain, but can lead to chronic conditions such as asthma and cancer. "It's the primary cause of adult-onset asthma," he says. "And it can cause a pre-cancerous change in the esophagus [known as Barrett's esophagus] in 13 percent of patients with reflux."

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

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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.

"IMRT is more successful and diminishes side effects," says Garton. "It is really an amazing technique."

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