Even as the health care system becomes more competitive as the cost of treating patients soars, medical communities are pulling together and pooling knowledge, research and technological resources for the overall well being of patients. Doctors no longer simply treat a liver disease, for example; they see it as a systemic malady that can have dynamic repercussions on other organs and even the mental health of a person and their families. Support groups have been established to help patients and their families through almost every disease that affects the human condition, and once-competing medical and research centers are consolidating their efforts to more effectively take care of what ails us.
Mapping of the human genome holds great promise in revealing medical mysteries that have been locked away in our DNA and genes since the beginning of time and continue to be passed through generations by the simple acts of conception and birth. Such progress will not be made overnight, but researchers are sharing information with doctors and each other to make each new discovery more relevant and to cover the ground between laboratory analysis and treatment of patients more quickly.
Medical centers are responding to the needs of patients already ravaged and confused by the onset of diseases by coordinating comprehensive centers for dealing with cancer, women's diseases, cardiovascular maladies and more in one place, cutting down on frustration to the consumer and in the long run delivering better and more systemic treatments for consumers. Health fairs that purvey a wealth of information on myriad subjects from cancer to spiritual well-being are drawing increasing numbers of consumers who want to take charge of their health without having to make scores of appointments with specialists.
On a more individual basis, firms are introducing technology that improves the detection and eradication of such diseases as cancer and brain problems. The New Orleans Regional PET Center, for example, offers an advanced method for detecting cancer at early stages, which vastly improves the chances for recovery. PET, an acronym for positron emission tomography, which can detect and track the progression of various kinds of cancer more specifically than conventional computed tomography (CT) and magnetic resonance imaging (MRI) scans alone. The process involves injecting into a patient's vein a compound of fluorodeoxyglucose (FDG) -- glucose enriched with radioactive fluorine molecules -- and watching where the FDG accumulates. Because cancer cells have a higher metabolic rate than normal cells, they absorb the FDG more quickly and show up on images of body scans as colorful blobs.
"It can be used for just about every type of cancer there is," says PET Center manager Ellen Thomas. "We can see tissue that's cancerous down to 5 millimeters. The best chance they have for (effectively treating) cancer is in the first stage." The diagnostic tool also can show physicians if and where the cancer cells have spread and how much. Currently, the technology is used in conjunction with CT and MRI because while PET reveals the level of involvement at a cell level, the other modalities show the structure of the organs. "In the case of cancer," Thomas says, "a person could have a mass that shows up on CT or MRI. Instead of doing a biopsy, PET could be done. In the case of someone with breast cancer ... PET could be used to look for involved lymph nodes and to monitor the effects of treatment. That (monitoring) tells the oncologist whether they have the right drug before the patient goes through the whole regimen of chemotherapy. It's a great tool."
Another advantage of PET scanning is that once a patient is injected with the radioactive glucose, technicians can scan the entire body from head-to-toe for one price, whereas CTs and MRIs generally are used for specific areas, such as the breast or lungs, and additional scans must be ordered if doctors suspect cancer in other parts of the body. "I've seen cases where a person has two or three types of cancers and they're primaries" that show up on a full-body PET scan, Thomas says.
The effectiveness of PET for detecting cancer and tracking whether treatment is working has been demonstrated by Medicare approval of the technology for lung, colorectal, melanoma, lymphoma, head and neck, esophageal and breast cancers. Medicare approval generally means commercial insurance companies also will cover the costs. In addition, some commercial carriers pay for PET scanning for ovarian, pancreatic, musculoskeletal and metastatic thyroid cancers. Presently the cost of PET is higher than that of CTs and MRIs, but the price could come down as use of the technology becomes more commonplace. "It's a great tool, used in the right way," says Thomas, "I would love to see it become part of a physical screening. It's one more tool that physicians have to help patients."
Another dramatic innovation for people with serious medical problems is the use of a gamma knife to treat brain tumors. Again, New Orleans is leading the way in this technology in this region with the opening of the New Orleans Gamma Knife Center, which is associated with the PET center.
The technology allows incision-free surgery using meticulously targeted radiation to treat brain tumors without damaging tissue around the disease site. The procedure obviously is much less traumatic that conventional surgery and comes with fewer side effects such as infection and damage to healthy tissue.
"The gamma knife is ideal for tumors in the brain," says Judy Weber, a registered nurse and coordinator of the New Orleans Gamma Knife Center. "It's also good for benign tumors of the brain. Some of the benign tumors can grow for years and years (without becoming cancerous), but over time will begin to impinge on the brain. The pressure will start to cause problems. For patients with malignant tumors, of course, something needs to be done immediately."
Outside the gamma knife, the only option is open surgery, Weber says, which is traumatic to the body, requires time in intensive care, followed by a period in the hospital after intensive care. Depending on where the tumor is located in the brain, some of the patients also must undergo rehabilitation after open surgery, "because sometimes you have to go through good tissue to get to the bad," she says.
The gamma knife employs more than 200 focused beams of radiation with precision at the tumor, essentially killing the cells and disabling their ability to reproduce. Over time, the tumor should begin to shrink and will be absorbed by the body or turned into scar tissue.
"These patients, unlike the patients who have open surgery, generally walk in the center at 6:30 in the morning and walk out in the early afternoon ... and the next day go back to their normal activities," Weber says. "For the patients that gamma knife is indicated for, I truthfully don't believe they give up anything versus having an open procedure. It's not like taking a shortcut or doing something that's second best. The gamma knife is considered the gold standard for radial surgery of the brain. I wish we could adopt this to treat every part of the body ... but at this point, there's no way to deliver it to other parts of the body."
National Imaging Affiliates in Metairie now offers a faster and less invasive method for colorectal cancer screening -- the so-called virtual colonoscopy, or CT colon scan -- using CT scan imaging and diagnostic software technology that can detect even presymptomatic colon cancer. Statistics show that about one in 17 Americans will develop colorectal cancer, but only about 25 percent of Americans receive adequate screening. This new technology, officials say, is less invasive than barium enemas and sigmoidoscopy and is absent the stigmas of discomfort and embarrassment associated with optical colonoscopies that require a long fiber-optic scope to be inserted into the large bowel. With a virtual colonoscopy, technicians expand the colon slightly using carbon dioxide gas, then insert a small rubber tube, about as big around as a drinking straw, just 1 1/2 inches into the rectum. Using the new technology, doctors and radiologists can visually detect pre-cancerous polyps as well as cancer that already has taken hold by examining three-dimensional images on a computer screen and even peering behind folds in the colon where polyps often are hidden.
Not all the technological advances deal with dire illnesses; some focus instead on quality of life issues and staving off health complications. MedGem, offered through HealthSouth on the West Bank, for instance, is a small device that allows medical personnel to make nutritional and weight management assessments quickly and easily to determine how many calories a person can eat daily without gaining weight.
"It does an accurate measurement of your resting metabolic rate," says HealthSouth's Karen Johnson. "It's the only device out there that gives a personal measurement. It tests your oxygen and resting metabolic rate, then we track it through a computer program ... to track how many calories your organs need to function. It's very specific." The idea is to give patients tools to lose weight without suffering adverse health consequences.
The testing itself is performed at HealthSouth, but consumers have access to "balance log" software that can be installed in a Palm Pilot and can be used at restaurants or at home. That log will calculate how many calories are consumed at a meal and how many are left for the rest of the day. After a patient loses 10 pounds or so they are advised to return to HealthSouth to be retested because metabolism rates change as weight is decreased.
"MedGem is non-invasive and painless," Johnson says. "It takes between 10 and 20 minutes. When you first go in, you relax and sit for a few minutes, put a mouthpiece in and breathe normally for about 20 minutes, and the test is over. The measurement is on (an LCD screen) on the machine."
For some aspects of health, it's not the new but time-tested knowledge that fuels innovations. For Catherine Wilbert, teaching people what generations ago was common practice is helping her fitness and nutritional supplements customers become healthier and more fit. Wilbert, who owns NutriSport and gives talks on fitness and nutrition, tries to help customers to a healthier lifestyle through educating them about what they should be eating and making sure that the supplements they do take have the nutritive value they expect. Because nutritional supplements are not regulated by the federal Food and Drug Administration, the quality of ingredients they contain can vary greatly. Her goal, however, is for customers to become fit without needing such supplements and to battle health deficiencies without the need for myriad prescription drugs.
"Most of my clientele are people with health issues who don't want to be on all these medicines," says Wilbert. "The bottom line is that 90 percent of illness can be dealt with through nutrition, through building your body's own immune system. If I can work with people with their diet, we can get rid of a lot of their problems. For things like high blood pressure and high cholesterol, with dietary changes and lifestyle changes, you often can eliminate the need for medication."
For people who need to maintain their drug regimens, herbs often can help alleviate or counter side effects of the medications, she says. There are even natural remedies to ameliorate the symptoms of menopause, she says, doing away with the need for controversial hormone replacement therapies.
"Nutrition should be the first place to start," she says. "That's not a new concept. Hippocrates said 'Let your food be your medicine and your medicine be your food.' With science and technology, we've just forgotten about it."
Dr. Harrison Cho, a physician and second-generation acupuncturist with a practice in Metairie, has drawn from ancient practices to relieve his patients of pain.
"Ninety-nine percent of the acupuncture that I do is for pain," he says. "For people who can't take anti-inflammatory drugs because of stomach problems or kidney failure or liver failure, they are limited in what they can do for pain management."
He touts the centuries-old practice of placing needles at strategic points on the body as an alternative to potentially harmful medications and arduous surgery. "I firmly believe in it as a modality," he says. "This should be the first choice before going for medication and surgery. Complications are low ... and the cost is much lower."
Cho has used acupuncture in a range of situations, from back pain caused by herniated disks, muscle spasms and even nausea brought on by pregnancy. In the past, medical doctors shied away from acupuncture as unproved and taboo, but in the past two decades the American Medical Association has published literature attesting to its medical validity.
"The concept of acupuncture originated 2,000 to 3,000 years ago," Cho says. "They didn't know anything about the anatomy, and they thought that by putting the needles in you could get rid of the devils. It was like a voodoo-type thing. In the 1980s, people tried to adapt a small needle with an electric stimulator ... to boost cell metabolism; it was a more scientific approach. You can stimulate a nerve ending and relieve tissue distress.
"Over the years, research has gotten better and methods are getting better. The public should know about the alternatives of managing pain ... with less medication and less surgery."
As patients learn more about alternatives available, doctors also become more aware and increasingly open to all the options. When it comes to health and managing disease, this is a good time to be alive.