The story below is from our July/August 2023 issue. For more stories like it, Subscribe Today. Thank you!
Less pain, smaller scars, reduced healing times, better outcomes are all hallmarks of some of the medicine being practiced in the Roanoke Valley these days.
The physicians practicing this magical, mystical, exotic new medicine tend to downplay it by calling it “state of the art.” It is, indeed, that, but it’s so much more, especially for those on the receiving end who tend to recover faster, with less pain, shorter hospital stays and scars that can barely be detected.
The evolution of “modern medicine” from its near-barbaric state 150 years ago to high-tech, robotic, AI, big pharma, quality of life extending treatments of 2023 is, quite frankly, remarkable and fully expected. It is changing so fast, in fact, that by the time you read this, some of it will likely be dated.
Much of what is taking place is a natural progression of modern society. Video gaming with his children helps keep LewisGale surgeon Dr. Phillip Patterson sharp for the operating room, where he employs a robotic system at a console—often about eight feet away from the patient—to perform delicate knee, hip or shoulder surgery.
Courtesy of LewisGale Medical Center
Ribbon-cutting ceremony at LewisGale Alleghany for a new nuclear medicine machine.
Patterson performs various types of thoracic robotic surgery. He operates with much smaller incisions, going through muscles and ribs (and not ripping apart the chest) to remove cancers and correct heart and lung malfunctions. The robot provides a “full virtual reality 3D image. You can really see it … You can put the instruments at any angle, and you can get in there.”
Mike Abbott, senior VP of Hospital Operations at Carilion Clinic, talks of the days when a patient’s chest had to be “opened” for surgery now being replaced with procedures that go through a blood vein and leave almost no scarring at all.
Courtesy of LewisGale Medical Center
LewisGale surgeon Dr. Philip Patterson
LewisGale Hospital Alleghany’s imaging director Tom Elmore talks of new equipment that “cuts the exam table time for the patient in half for most exams, allowing patients to spend more time doing their daily activities and less time undergoing imaging testing.”
In hospital speak, the technology “combines a Single Photo Emission Computed Tomography (SPECT) with a traditional Nuclear Medicine Scan. The result is a test that shows the function of the organ system (NM) combined with the detailed anatomy of the body (CT). This aids clinicians in diagnosing certain conditions and overseeing treatment plans.”
Patterson says the “newest in my world in joint replacement is robotic assisted hip and knee replacement. There are different systems out there … and I’ve been watching them. I don’t like being first; I haven’t liked the technique of most, but one I use … combines the best elements of others.”
And this is just a tiny part of a wholesale re-imagining of medicine.
Carilion is out front in a number of these exotic areas. Specifically:
With “fenestrated-endovascular aortic repairs” surgeons are able to customize grafts for a patient’s individual branching arteries. Few systems in the country have this service. Dr. Joshua Adams does the procedure at Carilion.
Interventional gastroenterologists perform a lot of minimally invasive procedures using the gastrointestinal tract. For example, early-stage esophagus cancer can be removed through a scope with no incision. For advanced esophagus cancer, physicians can place a large stent across the tumor blockage, allowing patients to swallow and giving chemo and radiation time to work.
Courtesy of Carilion Clinic
Carilion’s new PET Scan Siemen’s Vision 600
Carilion has teamed up with DroneUp, a leading autonomous drone delivery provider headquartered in Virginia Beach, to investigate how drones could be used to improve health care delivery in the Commonwealth.
Author Debbie Seagle of Radford has had two surgeries for brain aneurysms in the past few years, the first saving her life (and resulting in six weeks’ hospitalization) and the second preventing the aneurysm from forming (overnight in the hospital). The blood vessels were leaking in the first instance, causing intense pain, she says, and she had surgery at the University of Virginia Hospital in Charlottesville, just hours ahead of checking out permanently.
Her physician, Dr. Mary Jensen, entered her body through a vein at the top of her thigh, proceeded through the heart, the back of the eye and into the brain, where she wrapped the leaking vessel with drops of titanium and stopped the bleeding. There obviously is no scar on her scalp and the skull remains intact.
Courtesy of LewisGale Medical Center
LewisGale’s Dr. James Taylor: “We now go through the groin, and don’t put the patient all way to sleep.”
Two years ago, a potential aneurysm was detected, and quick robotic surgery took care of the problem. Jensen “showed me what she did on a 3D computer, and I was like, ‘Wow!’” says Seagle. She was so impressed that she dedicated a chapter in her recent memoir, “Coffee Cups and Wine Glasses,” to the surgeries.
LewisGale vascular surgeon Dr. James Taylor speaks of a “trans aortic valve procedure where the valve is not opening properly; we now go through the groin, and don’t put the patient all way to sleep. We put the valve in the same way you would have a stint put in. The procedure takes an hour and a half, and the patient goes home the next day.”
Taylor explains an esophagectomy thusly: There is one robot, two consoles, two physicians working together. “With the robot we get right in there and move the picture to almost any angle. Dr. Dominique Dempah goes in first. The philosophy is to get the cancer out in earlier stages, and he does the abdominal part … We form a tube out of the stomach which mobilizes it and gets it ready … We take the esophagus out, then create one without cancer … The beauty is the whole thing is done with a robot … Ten years ago we would have had two large incisions, and recovery would have been brutal … Now there is a much smaller incision, and recovery is remarkable … Patients go home in two days instead of a really long hospital stay.”
Abbott says that because of the Transcatheter Aortic Valve Replacement (TAVR) procedure, the chest no longer has to be opened. “We can replace the heart valve through a vein and the patient can go home the next day.”
That can mean that a 90-year-old can have the TAVR heart surgery, where the more invasive form would have killed her. Tiny stints can be placed in one of the “branches” of the heart, says Dr. Michael Nussbaum, senior VP and chairman of the Department of Surgery at Carilion, for more specific results.
Learning some of these up-to-the-minute procedures—and the machinery attached to them—is a challenge, even for veteran surgeons. Actually, maybe especially for veteran surgeons, says Nussbaum. Often teaching, he says, “is easier for a younger generation” of surgeons. “The simulators are like a video game,” which the younger docs are likely to be more familiar with.
Dr. Jonathon Sweet, chairman of the Department of Medicine at Carilion Clinic and the VTC School of Medicine, points out that “we aren’t just replacing the aortic [valves], we plug holes in the heart and block the source of strokes.”
Courtesy of Carilion Clinic
Carilion’s Dr. Michael Nussbaum: “We’re doing cutting-edge procedures, not commonly done elsewhere and certainly not done at the volume that we do them.”
These new surgeries and other procedures require intensive training, says Nussbaum. “Medical students are years and years away” from using the procedures. A structured cardiology fellowship like ours can require seven years of instruction and practice. Still, “Medical students get exposure [at Carilion] because many of them are involved in research. [That exposure] helps them decide what direction they will take” with their careers.
Abbott points out that by its very nature, medicine “requires lifelong learning, some of it very formal.”
“In certain areas [of medicine] we are seeing a sea change … but not every field has seen those sea changes,” says Sweet. He points to medications for cholesterol and diabetes that have made substantial differences in diabetes, cholesterol, heart attacks and other conditions. With heart attacks, “surgeries are down dramatically,” he says.
Innovation, Sweet emphasizes, is a byproduct of “curiosity. I don’t know why that would taper off. We will continue the migration from treatment of diseases to prevention of those diseases. I think that open heart surgery can become a historical procedure. AI [Artificial Intelligence] will allow us to be even more precise with 3D printing of devices and organs.”
Carilion is stacking the deck by hiring or training some of these sophisticated surgeons and is building a large new 400,000-square-foot wing that will accommodate the cardiovascular institute (among other things). It already has a medical school and research institute, which “brought me here,” says Nussbaum.
Because of “all of this,” says Sweet, “we absolutely see the personalization of medicine.” And the magic will keep on coming.
The story above is from our July/August 2023 issue. For more stories like it, Subscribe Today. Thank you!