From CyberKnife to virtual bed rails, the future is now with patient treatment and care.
June Cunningham recently encountered a futuristic cure for a disorder that had haunted her for more than 10 years.
Trigeminal neuralgia usually is caused by a blood vessel compressing the largest of the nerves that emerges from the brain stem. The trigeminal nerve controls facial sensations, so when it short circuits, it causes extreme pain that Cunningham describes as feeling as if she had been electrocuted.
“It hurt so much that it would make me walk the floor at night and not even remember it; I’d just remember the pain,” Cunningham says. “I would go in the kitchen and wring my tea towel in my hands. By morning, I was surprised that the towel didn’t tear.”
Once, the pain struck while she was grocery shopping. “Tears were rolling down my face,” she says. “I found a vacant aisle, held onto my cart and just waited.”
CyberKnife was the answer for Cunningham. CyberKnife was introduced at St. John Medical Center in October 2005, and that’s where Cunningham had the successful procedure last July. A second facility, Oklahoma CyberKnife, 6802 S. Olympia Ave., opened in 2008. Oklahoma CyberKnife is a partnership with Hillcrest Medical Center. In just one 45-minute CyberKnife treatment, Cunningham’s pain was gone.
CyberKnife uses a computer-controlled robotic arm to aim highly concentrated beams of radiation that destroy cancer cells and benign tumors with pinpoint accuracy. Just as in Cunningham’s case, CyberKnife also can be effective in some conditions that don’t involve cancer, such as abnormal tangles of blood vessels called vascular malformations.
Formerly, many of these conditions in the brain, spine and lung would have been impossible to treat.
In about an hour, the outpatient treatment is finished and the patient can return to work.
“It is my belief that we are offering the best and most advanced treatment available anywhere in the world for tumors and certain benign functional conditions such as trigeminal neuralgia,” says Dr. Diane Heaton, medical director of Oklahoma Cyberknife. But that’s just one of several — almost sci-fi — treatments available to Tulsans.
For example, for many years physicians have treated tumors with stereotactic radiotherapy, a non-surgical procedure that uses highly focused X-rays to treat certain types of tumors. The equipment used a 3-D grid to orient with the patient’s body. The patient would be held in position while the dose of radiation was delivered.
With more than 40 years of research, new machines are making the treatments much easier and more precise, says Dr. Charles Stewart, a radiation oncologist at Saint Francis Hospital. A machine called Trilogy came to Saint Francis in June 2006.
A CT scan pinpoints the tumor each day, allowing doctors to precisely position the patient before treatment. Trilogy targets tumors precisely, delivers a higher dose of radiation and requires fewer treatment sessions than former radiation treatments.
The Trilogy system is built around a machine called a linear accelerator, which rotates 360 degrees around the patient to deliver treatments from many angles.
Stewart describes Trilogy like this: If you’re watering a rose bush, and it needs an exact increment of watering, say five minutes, you can go about it two ways. You can aim the water at the bush, in the same spot, for five minutes, creating a puddle and damaging the grass in front of the bush. Or you can walk around the bush, still watering the same spot as before, but minimizing the puddle.
Trilogy’s precision allows doctors to aim radiation at the same spot on a tumor, but they can hit it from different angles. This results in less damage to other organs, provides greater accuracy and, subsequently, less treatments. Trilogy typically is used to treat head and neck, liver, lung, pancreatic and prostate cancer. It is especially beneficial because it can treat cancers that lie very close to critical structures, such as the eyes or spinal cord, Stewart says.
Because it can be focused in increments smaller than a millimeter, it can treat smaller tumors earlier, while they’re most treatable.
Trilogy also reduces the amount of time treatments take and could reduce the number of treatment sessions, Stewart says.
Oldie but goodie
Although it has been in use for more than 35 years, there has been no equal to a machine called ECMO, which stands for extracorporeal membrane oxygenation.
It is a system for taking a child’s blood outside the body, passing it through a membrane of oxygen and returning it to circulation.
The machine acts as an artificial set of lungs and heart to support a baby or child while he or she recovers from a viral infection, heart failure after operations or a congenital diaphragmatic hernia. (The last is a condition in which babies are born with their abdominal organs protruding into the chest, which cuts off lung function.)
Only 151 ECMO centers exist in the world, with 110 of them in the United States. One of those is at Saint Francis Children’s Hospital, which has five ECMO machines, says Dr. Michael Gomez, medical director for neonatal intensive care.
At Saint Francis, only children with a nearly 100 percent chance of dying are put on ECMO. “By that point, ECMO is the only option,” Gomez says. “It’s an urgent conversation we have with parents.” Fortunately, Saint Francis ranks in the top 25 percent for positive outcomes. Children go on ECMO facing certain death and have an 80 percent chance of survival because of the machinery. Saint Francis’ oldest ECMO survivor is now in college. Another plans to become a nurse. Two boys, ages 3 and 4, each were born with diaphragmatic hernias and doctors were pessimistic that they’d survive. They each spent more than two weeks on ECMO. Today, they frequently stop by the hospital to say “hi,” Gomez says. “They’ve grown up and are walking,” he says. “Both of them are delightful children, and their parents are thrilled that they were given a second chance.”
A virtual visit
A video technology that allows both a nurse to monitor multiple patients’ rooms and family members to make a virtual visit recently debuted at SouthCrest Hospital. “I would find comfort in it if a member of my family were in the hospital and I couldn’t get there,” says Kris Schueren, who is responsible for implementing the technology, called CareView, at SouthCrest. “And as a nurse, it’s nice to know that there’s another set of eyes to make sure your patient is safe.”
The system has a variety of uses. Through PatientView, friends and family can connect to a Web site and enter a code to see and talk to a patient in the hospital.
Similarly, the BabyView option allows a mother to see her baby in the special care nursery while she is recovering in her room.
Additionally, if a patient calls for a nurse, the person monitoring the screen at the nurse’s station can quickly locate which room the nurse is in and summon him or her to the patient’s room without searching the hallways.
Virtual Side Rails is a fall-prevention program that allows a nurse to make a drawing around a patient’s bed on a computer screen the same way football commentators diagram plays on the TV screen. If the patient tries to get up, an alarm sounds at the nurse’s station.
“We’re always looking for options to improve patient safety,” Schueren says. “This is an opportunity to prevent any type of injury.”
A special siren
A futuristic siren is helping EMSA make safer runs. EMSA is the first ambulance service in the nation that is outfitting its entire fleet with a siren that drivers don’t just hear, but also feel. It’s a solution to a problem that EMSA paramedics face on nearly every response: Many drivers don’t yield because they don’t hear the siren. They’re listening to the radio, talking on the phone and are enclosed in nearly soundproof vehicle cabins.
The Howler sirens emit low-frequency tones that sound different from the traditional siren and also cause objects within 200 feet to reverberate.
It’s important for patient safety, says Afton Bennett, EMSA emergency medical technician. “When motorists fail to yield quickly, it takes longer for ambulances to get where they’re going,” Bennett says.
The Howler costs less than $400 — much less than the vehicle damage, pain and suffering after a collision.