A small wand instantly detects straggling cancer cells during surgery. A person with a chronic disease, living far from a hospital, sends his avatar to the doctor’s office. The general public becomes trained in providing first aid for those with mental health problems.
Pioneering Milwaukeeans are working on making these – and other – breakthroughs a reality. For their enterprising work, they are prepared to be hated (for creating a co-sleeping device for babies), ignored (for improving the city’s public health) or loved (for keeping older heart patients alive with a new treatment).
What will be their legacy? Only time will tell. But this much is already known: The men and women in these 10 stories reflect the spirit of the likes of Jonas Salk (who developed the polio vaccine in 1952) and Florence Nightingale (who founded the world’s first secular nursing school in 1860). They are smart, driven, ambitious. And in the world of health care, they are breaking new ground.
1. The little wand that could
On a Thursday afternoon in November, a pea-sized lymph node from a mastectomy patient is brought into the crowded office of Dr. Gerald Smith, laboratory medical director at Aurora Sinai Medical Center. While the patient remains in the operating room, Smith freezes, slices, stains and microscopically examines the tissue for cancer. His conclusion will help determine if more of the woman’s breast tissue or lymph nodes are removed. The process takes about 20 minutes.
Smith’s possible replacement for this procedure rests atop a table near his microscope – the FastPath Residual Cancer Probe. It’s a cancer-detection device that inventor and physicist Bill Gregory, the chief science officer of NovaScan LLC, compares to a metal detector. Sized and shaped like an electric toothbrush, the device is held by a surgeon to a patient’s surgical cavity during a mastectomy. By detecting the electrical characteristics of individual cells, the cancer probe alerts doctors to remaining cancer cells. If successful, the 20-minute wait time plummets to nearly zero. “It instantaneously detects cancer,” Gregory says.
The probe has kept pace with pathologists so far. In 187 tests, it recognized cancer cells 100 percent of the time. If it aces the next testing phases – two in the United States and one tentatively planned in Europe – the future of breast cancer surgery could include not only faster surgeries but also fewer second and third surgeries to remove residual cancerous cells. Between 20 and 40 percent of breast cancer patients undergo second operations, and 6 percent have third operations to remove straggling cells, says Gregory, who is also the retired dean of the University of Wisconsin-Milwaukee’s College of Engineering and Applied Science. If the cells stay in place, they may not be life-threatening, he explains. But studies show as much as 90 percent of cancer deaths are caused when these cells set up shop elsewhere in the body.
The patented device has cost $3 million to develop, says Gregory, and it’s supported in part by Aurora Health Care. He hopes it will be on the U.S. market by 2018.
2. The end of open-heart surgery
At 92 years old, Ed Miller of Oconomowoc would not normally have been an open-heart surgery candidate because of his age. He suffered from severe aortic stenosis – one of his heart’s four valves was dangerously narrowed – and doctors said he could expect to live another year or so with debilitating shortness of breath and fatigue.
But on June 18, 2012, Miller took a chance and entered a clinical trial, becoming the 13th patient to undergo a nonsurgical valve replacement at Aurora St. Luke’s Medical Center. “For me,” Miller says, “13 is a lucky number.”
Replacing a diseased aortic valve is tricky business, as it’s anatomically hard to reach. Open-heart surgery has traditionally been the only option but one inaccessible for patients who aren’t strong enough to withstand it, like Miller. So without opening his chest cavity, surgeons routed a replacement valve through an artery in his leg and into his heart, where it was deployed. Miller was home two weeks later. “I have the pleasure of enjoying grandchildren and great-grandchildren,” says Miller, who lives alone in a house overlooking Okauchee Lake.
For patients with severe aortic stenosis, the emerging treatment of transcatheter aortic valve implantation (TAVI) offers not only swift recovery but also prolonged life. “This is a game-changer for older patients,” says Dr. Tanvir Bajwa, an interventional cardiologist and co-principal investigator for the clinical trial at Aurora St. Luke’s. “We didn’t have solutions before.” Most people, he explains, die less than three years after the diagnosis.
About 100,000 cases of severe aortic stenosis are annually diagnosed in elderly Americans, and one-third are too frail for open-heart surgery. The hallmark of the condition is a narrowing valve between the heart and aorta that allows blood to leak backward. Its symptoms – fatigue, dizziness, chest pain, shortness of breath, heart palpitations and fainting – become progressively debilitating. Bajwa says by age 65, 15 percent of the population has some degree of aortic stenosis, and about 5 percent of that group requires treatment. TAVI marks a “new era for these patients,” Bajwa says.
|Hear more about Medical Breakthroughs on WUWM’s “Lake Effect” Feb. 6 at 10 a.m.
TAVI also may offer a solution for younger patients who are ineligible for open-heart surgery because of other health conditions. At age 62, Diane Mann of Racine became the youngest patient in the Aurora St. Luke’s clinical trial. Prior to surgery, Mann had marked the progressive narrowing of her aortic valve after annual physician visits. “Each year, it opened less and less,” she says. Constantly short of breath, she found walking through the grocery store too difficult. “I had no ambition to go anywhere. Not even to a movie.” Lupus and other medical conditions precluded her from open-heart surgery, and her valve shrunk to about three-tenths of its healthy size. Death, when it eventually came, would be quick, she reasoned. “I would have gone to bed and not woken up.”
On her 41st wedding anniversary in 2011, she was sitting outside with her husband, John, at 6 p.m. when she received the phone call: She could enter the clinical trial and undergo surgery in three days. “I considered not doing it,” she says. “I was really scared. But I couldn’t leave John with a burden alone. We lost our only daughter to a drunk driver six years ago, six weeks before her own wedding. Maybe I won’t leave behind any grandkids. But maybe someone will learn something from my experience. This could be my legacy.”