Breakthrough Technologies in Medicine: hospitals offer patients better care in Alaska.

Alaska's hospitals are modern, bright and well equipped. Gone are the days when you had to travel outside the state for medical treatment Most surgeries and other procedures can now be scheduled in one of Alaska's many hospitals. Providence Alaska Medical Center is a leader in breakthrough technology.

Sherry Hill, communications and public relations manager for Providence Health System, Alaska Region, speaks of new developments in health care available at Providence: a new coronary stent, Cypher, aids in keeping arteries open-arteries that before would plug; a new simple procedure for varicose veins has been developed; a uterine alternative is available for women who have been told they need a hysterectomy (it allows tumors to shrink and go away); and interventional laser radiology methods are replacing previously required surgeries.

NEW CORONARY STENT

The Food & Drug Administration recently approved a new Cypher stent for usage, which is available now to medical centers nationwide. Providence was the first hospital in Alaska to use the new technology. Its usage will greatly improve options for patients. "Before we were not able to give people the option they needed," says Hill, "but now the technology is here."

James Scott, clinical supervisor of the cardiac catheterization lab at Providence, says, "Before Cypher (the drug-eluting stent created by Cordis, a division of Johnson & Johnson) and Galileo (a Brachytherapy device developed by Guidant Corp.), a small number of patients were sent to Outside hospitals for procedures that were not available in Alaska. Now there is even less reason for patients to leave the state to receive this kind of specialized medical care."

The use of the new drug-eluting stent helps reduce restenosis, which will keep the patient from having to come back for more treatment. Some patients with multiple-vessel coronary artery disease can be treated successfully with drug-eluting stents versus open-heart surgery. Recovery time for the stent procedure is usually one night in the hospital and the resumption of normal routines within three to seven days. Recovery from open-heart surgery involves a longer stay in the hospital and an extended healing process after the patient is discharged home.

"Five years ago we were doing open-heart surgery for coronary artery disease," says Scott. "Now we can treat them with interventional procedures in the catheterization lab."

Scott, who has 16 years experience in his field, recalls when only balloons were used, quite a rudimentary technology; now he sees so much change. "There is something new to learn every day."

Currently Cordis is the only company to have received FDA approval for its drug-eluting stent; however, other companies will be following within six months to one year. The competition will help ,educe the cost of the de vice, and increase the number of choices the physicians have.

CARDIAC DEFIBRILLATORS

Alaska's governor has signed legislation allowing cardiac defibrillators to be used in businesses. Now businesses do not have to worry about having one at public sites; they will not be held liable if it is used. The new defibrillators, compact and economical, are much more common than they used to be in health clubs and in CPR training, said Hill. They can be seen at airports, on school buses, air lines and tour buses.

Hill feels the availability of the new defibrillators will save lives. The Automated External Defibrillator unit actually talks the layperson through its proper usage.

Training in the use of an AED is now included in basic life support classes. Before its approval, training was only available for EMTs, paramedics and hospital staff. Color-coded and voice activated, this new device tells you to put patches on the patient, with a diagram showing you where to place the patches. It tells you when to keep your hands off, then checks for rhythm, delivers a shock and monitors the patient. It will tell you to stop when the patient's rhythm has returned to normal. For a layperson, this device is quite slick, says Scott. The machine does all the analysis.

LASER ABLATION OF VARICOSE VEINS

Providence Radiology had been the leader in imaging in the state for more than 30 years by providing cutting-edge technology to patients. It acquired the first ultrasound and whole body CAT scans even before most West Coast cities.

Dr. Chakri Inampudi, who specializes in interventional radiology, is the medical director of radiology for Providence Alaska Medical Center. His group is the only one in the state adapting new technologies, such as laser ablation of varicose veins.

The old procedure for varicose veins would surgically strip (actually grab and pull out) the vein while the patient was under general anesthesia. This grueling procedure also required a long recovery period of a week or two, while the new interventional radiology procedure is an outpatient procedure with minimal sedation and recovery time. Patients have minimal discomfort during the laser probe and their varicose veins, along with the associated symptoms, disappear in a week. This procedure is also beneficial from a cosmetic standpoint. Inampudi believes this technology will become the standard of care in a few years.

UTERINE FIBROID EMBOLIZATION 

From a patient's standpoint, uterine fibroid embolization, a new procedure a little over a year ago at Providence, provides an alternative to having a complete hysterectomy. The biggest plus side for a woman of childbearing age is that the fibroid can be kept from growing and the uterus mainrained. This provides a reasonable probability of the patient being able to conceive in the future. This outpatient procedure replaces extensive surgery that requires days of hospitalization. While the recovery time for surgical alternatives is approximately one month, with the new procedure the patient goes back to work after an extended weekend.

Uterine fibroids are very common. Approximately 30 percent of women age 35 and older have fibroids of a significant size. Symptomatic patients were traditionally treated with hormonal therapy or surgery.

PET-CT SCANNER

Inampudi speaks of the state of the art diagnostic imaging technology, PET-CT scanner (Positron Emission Tomography and a CAT scanner combined in one machine) at Providence Imaging Center. This scanner acquires images in a single setting superimposing PET images over CAT scan images. This sophisticated unit is the first of its kind in the world, featuring a high-speed CAT scanner with one of the most advanced PET scanner in a mobile system. This diagnostic tool will be used mostly for imaging cancer patients. Most of the country uses PET scans that show areas of abnormality.

RADIO FREQUENCY ABLATION

Providence is the only hospital in the state to offer radio frequency ablation, a cancer treatment that uses the tip of a needle to burn and destroy a tumor without surgery. This new form of cancer treatment is usually combined with chemotherapy. The needle can be accurately placed in the tumor under the guidance of a CAT scan. This is also an outpatient procedure done with minimal sedation and recovery time. This procedure is typically performed in liver tumors.

Alaska Regional: A Hospital of Firsts BY BARBARA MORGAN

Alaska Regional Hospital strives to bring new technology and procedures to provide the highest quality of health care to Alaskans. "It is no longer necessary to leave your support system of family and friends, which we feel is an important part of the patients' healing process," says Marketing Director Kjerstin Lastufka. "Alaskans should feel lucky with the health care we have."

NEW DEVELOPMENTS

Alaska Regional was the first in Alaska to offer catheter ablation to patients suffering from a trial fibrillation. Catheter ablation is less intrusive and extremely effective at restoring normality to a patient's heartbeat.

Alaska Regional was among the first in the nation to offer targeted cryoablation of the prostate. Cryosurgery, a cancer treatment technique approved by Medicare, uses extreme cold to destroy cancer cells. Unlike chemotherapy and radiation, it can be repeated.

Alaska Regional was the only hospital in the state to offer endoscopic ultrasound, or endosonography, an outpatient procedure combining high-energy sound waves with endoscopic technique to produce the most detailed ultrasound images of digestive tract structures.

Cardiovascular Surgeon Dr. Pedro Valdes has introduced a new option for Alaska Regional's heart surgery patients, Beating heart surgery, or off-pump surgery, allows the heart to continue beating throughout the procedure, keeping the blood flowing naturally. Beating heart surgery has been associated with shorter hospital stays, less need for blood transfusions and fewer complications,

The only nonmilitary hospital in the country with a landing strip. Alaska Regional's air ambulance can taxi right up to the emergency room.

Another perk: Alaska Regional Hospital offers free valet parking for its patients.

PET Scanners and Laser Eye Surgery BY BARBARA MORGAN

PET SCANNER

Alaska Open Imaging Center's CEO/President Jeff Kinion speaks of the center's latest diagnostic technology: the positron emission tomography (PET) scanner.

Until recently, PET was only available to Alaskans by going to the Lower 48. Since June 2003, this modality is available to everyone throughout the entire state.

"PET is the gold standard for discovery, staging and following most types of cancer," says Kinion. "It not only provides technology for Alaska, but it saves money for the state and for patients since they don't have to travel to Seattle for this service now."

PET offers the earliest cancer imaging detection available. It has become the gold standard for heart disease detection. It is also the earliest diagnostic tool for Alzheimer's disease.

PETNET and Phillips Medical Systems combined with Alaska Open Imaging Center to make PET economical. Before this team effort, it would have been prohibitive. Another advantage: the PET scanner uses a small radioactive dose.

Alaska's Sen. Ted Stevens has been the premier champion for the PET scanner nationwide, bringing it from the research laboratory to the clinical environment.

REFRACTORY SURGERY

Laser Vision Alaska, the only refractive surgery center in the state with WaveScan WaveFront-driven technology, now performs CustomVue Lasik.

Newly approved by the Food and Drug Administration, WaveFront-guided Lasik dramatically reduces night-vision problems, the need for second surgeries, and has fewer side effects. The measuring process is 25 times more accurate than similar procedures.

Eric W. Coulter, a board-certified Alaska ophthalmologist, has performed in excess of 5,500 laser vision correction procedures, treating nearsighted and astigmatic individuals. Coulter's patients enjoy an enhancement rate of 2 percent to 3 percent, far less than the national average of approximately 10 percent.

Coulter does not see any advantage for patients to travel anywhere Outside for corrective surgery when Alaska has the latest technology available. "The reality is we have the equivalent to top-notch providers in the Lower 48. We have what is available at UCLA (University of California, Los Angeles) and Stanford Research Center. Many places do not have the latest technology. Everything that is available in the Lower 48 is here."