Dr. Curtis A. Given II and Dr. Christian Ramsey, co-directors for Neurointerventional Services at Central Baptist Hospital:Cerebral [brain] aneurysms are outpouchings or blister-like areas that develop at a weakness in the wall of a blood vessel supplying the brain. While they may exist harmlessly for years, aneurysms may rupture [burst] and produce a life-threatening brain bleed. Aneurysms have been treated for many decades with traditional brain surgery [‘clipping’], and more recently with less invasive endovascular techniques [‘coiling’]. Yet some aneurysms remained “untreatable” or at a “high risk” for treatment because of their location, size or shape.
Newly developed endovascular devices, called flow-diverters, offer a treatment option for many of these aneurysms previously deemed high risk or untreatable. The Pipeline Embolic Device [PED] is a recently U.S. Food & Drug Administration approved flow-diverter for the treatment of brain aneurysms. The PED is a flexible, mesh-like tube [similar to a stent] that is placed within the diseased [weakened] portion of the blood vessel that harbors the aneurysm. The PED then diverts flow away from the aneurysm, allowing the aneurysm to occlude, while preserving blood flow to the brain.
The PED is delivered via an endovascular approach, threaded into the blood vessels of the brain via a catheter inserted into the blood vessels of the leg. The endovascular approach is similar to that utilized during heart catheterization procedures.”
Dr. Michael Jones, an interventional cardiologist with lexington cardiology at central baptist hospital:
Coronary artery disease, the leading cause of death in the United States, is a process characterized by buildup of fatty materials in the small arteries that supply blood to the heart. The treatment of this condition requires the use of medications in all patients and the use of coronary stenting or coronary bypass procedures, as well, in many. Historically, medical decisions as to the type of treatment required have relied heavily on coronary angiography, a procedure involving the direct injection of X-ray dye into the coronary arteries. Limitations of this technique center around the difficulty in making decisions about the significance of coronary narrowings in an “intermediate” [40 percent-70 percent] range — narrowings that are seen in almost 50 percent of patients undergoing diagnostic cardiac catheterization.
Fractional flow reserve (FFR) study has recently been introduced and validated to address this limitation of routine coronary angiography. In this technique, a small [0.014 inch] sensor-tipped guidewire is passed across questionable narrowings during administration of medication designed to increase coronary flow. The pressure ‘drop’ across coronary lesions is then measured. By analyzing trans-lesion pressure gradients, FFR use allows the cardiologist to separate coronary lesions into those that may be safely treated with medication alone versus those that require revascularization with bypass surgery or stents. The procedure thus allows the physician to safely defer all intervention in some, to carry out coronary stenting in some who would have been treated with coronary bypass surgery in the past, and to carry out complete revascularization with fewer stents in all. Most recently, FFR-guided stent placement in stable coronary artery patients has been shown to be not only safe, but also superior, in terms of patient outcomes, to medical treatment alone.”
In allowing cardiologists to both improve patient outcomes and to reduce costs without safety concerns, FFR is a transformational technology that improves not only individual patient outcomes but also the cost effectiveness of coronary care delivery.
Dr. John Kitchens, ophthalmologist:
The last decade has brought about a sea change in the way that we look into the eye. The retina, or the light sensitive tissue that lines the eye, is no exception. Our ability to “see” the retina has fundamentally changed the way we do everything in our field. Gone are the days of long examinations with bright lights.
One of the sentinel advancements in imaging is that of Optical Coherence Tomography (OCT). It is hard to believe that this diagnostic test was only invented 10 years ago at MIT by a team of brilliant physicians and engineers. It is currently the most utilized diagnostic test in all of medicine. OCT provides a digital “cross section” of the retina. It reveals its intricate anatomy precisely and in great detail. We use OCT to help make the diagnosis of various retinal conditions as well as to determine the patient’s response to treatment [surgical or medical].
Another major advancement in imaging involves a test that was discovered over 50 years ago — retinal angiography. This test involves the injection of fluorescein [a dye] into the vein in a patient’s arm. Images are then captured as the “dye” circulates through the retinal blood vessels. This allows us to assess conditions that affect the blood vessels in the eye such as macular degeneration and diabetes. A recent modification of this procedure called ultrawide field imaging has allowed us to assess the entire retina with a single photograph. This is of critical importance in assessing patients who have peripheral vascular abnormalities such as diabetic retinopathy or uveitis [inflammation of the eye]. With this system we can diagnose problems earlier and prevent vision loss.
Dr. W. Jeffrey Foxx, Family Practice Associates of Lexington:
One of the most transformative technologies that I use in my practice is the scale. It is useful in multiple disease processes by measuring and tracking your weight. Obesity is epidemic, and managing the problem with the use of the scale is helpful to the doctor and the patient. The patient is able to see progress and set goals, or see gain and change lifestyles. Gaining weight makes diabetes worse, and it makes blood pressure higher. Sometimes weight gain can be rapid, indicating fluid retention and an exacerbation of congestive heart failure. Being overweight makes the joints work harder and leads to arthritis. Sometimes transformative technologies are simple, like the scale. Sometimes they are fancy computer-driven machines or genetic manipulation. However transformative everyday technology is, we all need to step on the scale.
Dr. Joseph Bark, dermatologist:
There can be no doubt that the Internet is by far the most influential technology in dermatology. There are dozens of reasons for this, but in my specialty, we have a closed chat group of over 2,000 dermatologists across the world who communicate, read and respond to each others’ thoughts and questions about our specialty. That similar interest group is called RXDerm and is owned by a renowned Californian who masterminded a way we could all consult with one another about our most difficult cases. Those of us who are members (and surprisingly, there are very few Kentucky dermatologists who participate) post questions and photos (kept completely confidential) and exchange thoughts on diagnosis and treatment of the most difficult skin medicine questions. This helps us find and pursue the most novel and advanced treatments for rashes, tumors and other skin maladies.
But this is not a one-way street. We find the Internet useful for our very computer-aware patients, too, who regularly have researched and reviewed the most recent diagnostic methods and newest treatments, and who actually come to us aware and prepared to ask the best questions of their doctor/dermatologists. No doctor should take offense at this approach. We realize that in this era of rapid medical advancement, using the resources of the Internet can only enhance patient knowledge, and an aware, prepared patient can efficiently cooperate in getting well as soon as possible. In short, the more you know about your condition, the quicker you can get well.
Nicole G. Freels, DPM, President Lexington Podiatry
I would have to say that there are several transformative technologies that have impacted my practice. For example, the electronic medical records continues to modernize the health care industry. While it is an expensive undertaking, it has definitely made a positive impact on speed and efficiency in my office, especially with many intangible processes.
However, the most recent transformative technology has been the use of ultrasound technology in my office, Lexington Podiatry. This technology allows us to visually find and identify problems that were previously just estimations or educated guesses. A practical example would be the use of the ultrasound-guided injections for heel pain specific injuries (i.e., plantar fasciitis). The ultrasound now allows us to visually identify the area of injection, increasing the likelihood of success. This technology has had an extremely positive impact for both the physicians that use them and the patients that receive treatments.