Innovation is by definition full of surprises. Medical treatments once labeled “science fiction” are now common. The pace of breakthroughs finds modern medicine changing more rapidly than at any time in history. At Ventura County hospitals, technology is fueling novel treatments.
Los Angeles hospitals, including Cedars-Sinai and UCLA medical centers, have in the past been the only options for state-of-the-art medicine, but many advances are now available locally.
Technology transforms treatment
The Ventura County Medical Center unveiled its all-new North Tower, on Hillmont Avenue, in June, and its planners’ visionary efforts are evident.
New technology is good news for radiology patients who are not fans of being stuck inside claustrophobic Magnetic Resonance Imaging, or MRI, tubes. VCMC is now home to MRI techniques that decrease the time a patient has to spend inside. The new machines are twice as powerful as the older ones. More power produces images more quickly, which means less time inside. Not only can doctors find what they’re looking for in less time, they can see more detail.
“We’re bringing better resolution, higher resolution, to the process,” VCMC Medical Director Dr. Bryan Wong explains. He likens the difference between new and older MRIs to high-definition TV. “For example, on a traditional TV you can see actors’ and actresses’ faces well enough to understand the story. But once you’ve seen high-definition TV, you realize that you can see so much more. You can see up-close beads of sweat on an actor’s face. That’s like the difference between new MRI machines and older ones — higher image resolution.” This improves precision of diagnoses.
“With the higher resolution, we can see tiny images in high-def that might not be visible on conventional MRI,” Wong says. This means a doctor can see miniscule malformations, or something very small that does not look right — conditions that were not visible on older MRIs.
Technology also drives advances in camera systems. “In the operating room, we now have four or five cameras — all connected and integrated with each other. The system is called ImageStream®, and that name is very apropos,” says Wong. A surgeon might want to see a recent MRI while operating, because of something discovered during surgery, and an assistant can display that image instantaneously. “There is also a camera inside the body and images from inside the body can be displayed simultaneously,” Wong says.
The surgical team can also display an X-ray on another screen, or heart-rate data or blood-pressure numbers using a third or fourth screen. The surgeon can see four or five different streaming videos or pictures from different angles. “The surgeons have all the information needed right at their fingertips. We can see the camera that’s inside the body, with this integrated monitor system, a visual display system. It gives the ability for staff to instantaneously put up different images for the surgeon.
“There’s a multitude of things you can put up on the monitors. There’s a lot of capability there, all at your fingertips. And the resolution is excellent,” says Wong.
The building also includes what Wong calls a “central brain.” With a whiff of sci-fi that is reminiscent of Star Trek bridge controls, sensors are monitored 24 hours a day from panels inside this central brain room. Temperatures in patient rooms, in the operating room where it needs to be cool, and in refrigerators that store medications, are all kept at optimal levels by the central brain. Refrigeration is critical to medicine storage, and in the past medicines could be damaged by temperature shifts that went unnoticed by busy staff dealing with emergencies. “Staff used to have to check and adjust individual gauges inside each refrigerator,” Wong says.
Maintaining “air balance” is another job of the central brain, insuring all components of cooling, heating, freezing, ventilating or air conditioning are working. This is not merely comfortable for staff and patients, it’s critical. If a patient just out of surgery or chemotherapy, or a newborn baby, or a stroke victim, or one who can’t move due to injury or disease is too cold, too hot or too humid, the immune system and nervous system will be affected. Decontamination and contagion areas are also monitored. Water temperature and leak detection are also critical for smooth operation. The central brain alerts a staff member if any measurement strays from its safe level.
Technology also drives continuous improvements in surgery. VCMC now houses the most up-to-date version of robotic surgical tools, including robotic equipment manufactured by DaVinci Surgical System. Surgery performed with tools attached to robotic arms makes only tiny incisions into patients’ skin, much smaller than non-robotic surgeries. Such incisions are possible because of the very small robotic tools — controlled by surgeons — that perform the procedures. Miniaturized, and smaller than surgeons’ human hands, these tiny tools can achieve great dexterity.
Robotic tools can easily get into places that hands are too large for. This can mean less blood loss for the patient, and less time under anesthesia, which in turn leads to less pain, and sometimes faster healing.
Robotic equipment enables surgeons to manipulate body tissue as never before, and in particular improves suturing, or stitching up a patient following surgery. “For example, a gynecological surgery for uterine prolapse is one of the types of surgery to repair tissue that is very complex,” Wong explains. “With a robot it’s vastly simpler and easier — with matching benefits for patients.”
On the frontier of medicine, robotic arms have been constantly improved over their 30-year history. During the 1980s, National Air and Space Administration (NASA) researchers experimented with “telesurgery” — where the surgeon and the patient were not in the same place. The Department of Defense decreased wartime mortalities by building on NASA’s research. A system was devised whereby a wounded soldier could be operated on remotely, by a faraway “telesurgeon” directing a robotic arm that was placed near the soldier. The goal was to prevent wounded soldiers from bleeding too much before they reached a hospital, and to protect surgeons from being wounded because they were too close to battle.
According to the National Institutes of Health’s Cancer Institute, almost 80 percent of prostate removal surgeries in the U.S. are now being done with robotic equipment. Other conditions seeing a rise in successful robotic surgeries include lung diseases, upper- and middle-back (thoracic) conditions, hysterectomies for women, and bariatric surgeries to treat obesity.
St. John’s Pleasant Valley Hospital on Antonio Avenue in Camarillo, and St. John’s Regional Medical Center on Rose Avenue in Oxnard, two Dignity Health facilities, received Partner for Change Awards for 2017 from Practice Greenhealth, a national environmental health organization. The accolades were earned for their accomplishments in conserving water, reducing medical waste, increasing recycling and reducing toxic pollution. While the average hospital produces more than 33 pounds of trash per patient per day, St. John’s has reduced that by more than half, to 15 pounds.
“Our health is impacted by the health of our environment, and the decisions we make as an industry can either harm or benefit the well-being of families in our community,” Sister Suzanne Soppe, chair of the Ecology Committee at St. John’s Hospitals, wrote in an email.
Such undertakings are not easy. To achieve environmental health, identifying the problem is half the battle. For more than 100 years, traditional blood-pressure measuring cuffs have been used in hospitals, and they contain mercury. The tongue-twisting technical name for these cuffs is “sphygmomanometers.” Doctors have historically relied upon them to accurately diagnose high blood pressure. Mercury-based blood-pressure measurements have been a life-saving tool that contributed to decreasing heart disease for millions of people. Yet mercury is a poison and can be fatal if inhaled or harmful if absorbed through the skin. Small spills can be safely cleaned up with proper techniques. Beads of mercury, however, can settle into cracks or cling to fabric or wood. They can also be tracked on shoe soles.
Mercury can harm the kidneys and lungs, as well as the nervous, digestive, respiratory and immune systems. In the past, when mercury spills happened from thermometers or sphygmomanometers, precise cleaning procedures were used to avoid toxic exposure. Still, hospital workers were at some risk.
Incineration of mercury waste spewed toxic air pollution. As health care improved and populations grew, larger hospitals were built to serve more people. Small old clinics could be sources of brief mercury pollution releases spewed into the air from their incinerators, but as hospitals grew in size, the amount of toxic mercury pollution could grow to dangerous levels.
For a century, mercury had seemed indispensable. Easing it out has not been easy, as many health care workers only gradually came to trust that new, mercury-free devices are reliable. When concerns first emerged in the 2000s, noted vascular biologist Dr. George Varughese was moved to pen a uniquely titled article: “How do we say goodbye to mercury sphygmomanometers?”
That question is now answered. “For over 15 years, Dignity Health, and the two St. John’s Hospitals have sought alternatives for products that contain hazardous chemicals, such as mercury,” says Soppe. “Through our efforts to routinely inventory purchasing practices and by enforcing regulatory policies, we have virtually eliminated mercury from our hospitals.”
Putting patients first
Kaiser Permanente’s new Market Street medical office building in Ventura is set to open in December 2017. The building’s futuristic architecture pushes the boundaries of health care. A unique messaging system will allow KP members waiting for appointments to walk inside and outside the lush facility grounds and meditation gardens without fear of missing their appointments. For waiting members who prefer privacy, there will be private zones. For those who prefer to be more social, or have family with them, there will be clustered seating. These new designs recognize that not everyone in a medical waiting room is feeling well, or in a good mood. A welcome concept, where “personalized, patient-centered care” has been a buzzword but not often a reality.
“Visitors can expect an experience that looks and feels different from any medical visit they’ve had in the past,” according to Ed Essa, Kaiser Permanente public affairs director. “The facility will feature an open, modern interior with a variety of seating options to fit the need of the patient and interaction style.”
KP will prioritize achieving “net zero” building certification to guarantee that it generates as much energy as it consumes. The facility will feature solar, covered parking; a green roof and water reclamation. KP will be working toward LEED Gold green building certification for energy, lighting, water and material use efficiencies.
“We will promote wellness through interactive videos, self-guided electronic resources and community activities,” Essa adds. The goal is “a personalized care experience that embraces technology while placing patient needs first.”
State of the Heart
New science infuses heart disease treatment at Community Memorial Health System and other area facilities. “We are in the process of developing our minimally invasive aortic valve replacement procedure,” Dr. Omid Fatemi of Cardiology Associates Medical Group (CAMG), in Oxnard and Ventura, wrote in an email. “As people age, their aortic valves can become tight, or stenosed, which impedes blood flow from the heart to the vital organs.
“Until recently, to fix the problem a person would have to undergo open-heart surgery,” noted Fatemi, a radial-artery heart catheterization specialist. “As technology has progressed, many people can have their aortic valves replaced through a catheter from the femoral artery in the leg. We look forward to bringing this technology to Ventura in the upcoming months.”
Novel treatments for angina or heart attack differ from older treatments because they come with fewer vascular complications and less bleeding. ASD (atrial septal defect) is a congenital “hole” in the heart that can cause breathing problems or heart failure. In the past, ASD had to be treated with open-heart surgery. Not now. “Usually the person goes home the next day,” Dr. Fatemi says. That’s significant news for heart patients.
PFO (patent foramen ovale) is a more common defect that can increase the chance of stroke. “We have been closing those with minimally invasive catheter procedures,” says Fatemi. “Additionally, we treat advanced heart rhythm disorders with the newest catheter ablation techniques, and the most up-to-date pacemakers and defibrillators.”
New methods from the frontiers of science include treatments for blood clots in the lung, as well as for atrial fibrillation. “In terms of electrophysiology and heart rhythm, we have the newest ablation techniques for supraventricular tachycardias, atrial flutter and atrial fibrillation,” Fatemi says.
“We will begin inserting leadless pacemakers that are inserted through a catheter from a vein in the leg into the heart, without any need to cut the chest and leave a scar on the chest wall,” says Fatemi. In the past, conventional pacemakers required the use of wires, known as “leads.” The leads had to be threaded through blood vessels to connect to the heart. These leads could cause complications such as vein injury or infections. Therefore, leadless pacemakers are a welcome advance for patients.
Community Memorial Health System is steeped in more innovation at its new facility currently under construction. This includes the CardioMEMS™ HF System wherein a pressure-sensing device is implanted within the pulmonary artery. From there it can wirelessly send information to a doctor, who can adjust medication as needed, before a patient ever feels symptoms. Call the doctor, without even trying.
Other innovations not far removed from Star Trek’s sick bay include the new Impella CP® heart pump to treat severe heart failure, and the WATCHMAN implant, which prevents blood clots from escaping from a patient’s heart. If a clot travels to another part of the body, it can cause a stroke. Thus the WATCHMAN reduces the chance of stroke.
“One of the things we are most excited about is that our Imaging Department in the new hospital will become a West Coast Show Site for GE (General Electric),” Michael G. Ellingson, vice president of marketing and development at Community Memorial Health System wrote in an email. CMH will be a facility where GE representatives can demonstrate their most cutting-edge imaging technology to benefit patients.
In addition, a “hybrid operating room” will combine a cardiac catheterization lab, called a cath lab, with the sterile environment of a surgical suite. This gives staff the flexibility to adapt quickly when a change of plans is needed. If unexpected complications arise, all procedures can be completed in one “hybrid” room, without putting a patient’s safety at risk by having to be moved to a different specialized area.
CMH’s blood-clot fighting EkoSonic™ Endovascular System uses ultrasonic waves in combination with clot-dissolving drugs to target an entire clot. The Interventional Stroke Program will combine neurology, neurosurgery and radiology to develop treatment to reverse paralysis and to treat aneurysm. To monitor prostate cancer patients, the fusion of MRI with ultrasound allows urologists to perform biopsies that are mapped, targeted and tracked, rather than traditional, less precise biopsies.
Whatever arises next from medical research, local practitioners envision bringing it home. At the confluence of diverse scientific discoveries are local hospitals. Second to none.