The Cutting Edge

Ann Marie Helm had been overweight all her life. At age 4, she was classified as morbidly obese. In her early 20s, joint pain made it hard to walk. By the time she was 30, with her diabetes and weight spiraling out of control, her doctor said she’d likely be dead before reaching 40. But after laparoscopic gastric bypass surgery, the once 330-pound Waukesha resident has lost 160 pounds (and counting). She’s also resolved many of the lifelong health issues that plagued her. Within days of the surgery, her glucose levels returned to normal, and today she no longer suffers…

Ann Marie Helm had been overweight all her life. At age 4, she was classified as morbidly obese. In her early 20s, joint pain made it hard to walk. By the time she was 30, with her diabetes and weight spiraling out of control, her doctor said she’d likely be dead before reaching 40.

But after laparoscopic gastric bypass surgery, the once 330-pound Waukesha resident has lost 160 pounds (and counting). She’s also resolved many of the lifelong health issues that plagued her. Within days of the surgery, her glucose levels returned to normal, and today she no longer suffers from type 2 diabetes.

“I feel like a brand new person,” says Helm, who now has indeed reached 40 and is a mother of two young children.

She’s not alone. One study showed gastric bypass surgery resolved type 2 diabetes in more than 84 percent of people with morbid obesity, along with the majority of cases of hypertension, sleep apnea and high cholesterol levels.

This is major news, given that last year in the United States, $174 billion was spent to treat diabetes, the country’s fifth-deadliest disease. Secondary problems with diabetes include eye, kidney and nerve damage, along with an increased risk of heart and blood vessel damage.

In Wisconsin, the rate of people diagnosed with diabetes increased more than 60 percent between 1995 and 2005, according the Centers for Disease Control and Prevention. The National Institutes of Health reports about 85 percent of people diagnosed with type 2 diabetes are overweight.

So bariatric surgery, once seen as a cosmetic procedure, is now viewed as a way to reverse the negative health effects of obesity. And many other patients around Milwaukee are receiving treatment for old problems using new techniques. From magnetically guided heart catheters that cure an irregular heartbeat to inexpensive video game therapy for stroke survivors, area doctors are on the cutting edge of the latest trends in health care. Here’s a peek into a few of these exciting new technological advances.

Bariatric basics
Helm is just one of many patients seeking bariatric surgery to remedy serious health issues stemming from obesity, says Dr. Manfred C. Chiang, a surgeon with Brookfield Surgical Associates, an affiliate of the Bariatric Institute of Wisconsin. But just why and how does it work?

Gastric bypass essentially makes the stomach smaller, so less food can be eaten and fewer calories absorbed. Chiang says the reason the surgery resolves diabetes in such a large percentage of patients, and so quickly, is two-fold. With type 2 diabetes, cells are resistant to insulin, a hormone that helps the body process blood sugar. Reducing the amount of carbohydrates a patient eats can immediately help regulate blood sugar. Then after surgery, carbohydrate absorption becomes limited.

Though the surgery has been performed for decades, the techniques used in the operating room have become more advanced. Chiang, who has performed more than 400 surgeries, says 99 percent of the procedures from his office are done laparoscopically, which is less invasive and just as effective as the traditional surgery using a 10-inch incision in the abdomen. Benefits include less scarring and a quicker recovery.

Drastic weight loss is often not just a question of simple will power. Chiang says studies have found that most people can’t sustain significant weight loss through dieting. Helm estimates she lost 1,500 pounds throughout her life by dieting and almost always regained the weight, plus a few more pounds.

“I’d try to eat salads and do the right thing,” Helm says. “I’d yo-yo. I’d lose 20 pounds and I’d gain 40 pounds.”

These days, she’s physically incapable of eating large meals, requiring her to eat six small meals a day. She closely monitors her carbohydrates and eats mostly proteins.

As her former life revolved around food, her new life is strangely absent of it. But Helm says she doesn’t mind at all. She jokes that Chiang must have given her brain surgery as well as a gastric bypass because she no longer craves sweets, her weakness in the past.

It’s enough that her son is able to sit on her lap, a lap her stomach covered five years ago.

“Life is so good. It’s so rewarding,” Helm says. “This is a second chance for me to live.”

Fixing a broken heart
When Dr. Peter Chapman first saw a remote control heart surgery using magnetic navigation, he knew this new procedure had the potential to revolutionize care.

In a control room with a joystick, a physician uses a catheter to enter a patient’s heart and fix its broken beat. The patient lies on a table while two magnets, which look a little like jet engines, navigate the catheter through the body. Dozens of studies suggest that this technique is effective in restoring a normal heartbeat.

The Niobe Magnetic Navigation System, which came into use on March 25 at the Wisconsin Heart Hospital of Wheaton Franciscan Healthcare, is the only remote magnetic navigation technology in Wisconsin. It’s used to treat heart arrhythmia, a condition that causes an irregular or abnormal heartbeat. This can result in anything from fatigue to stroke if left untreated. There are many types of arrhythmia and about a dozen can be treated with ablation, or destroying the problem area of the heart.

“We believe that this is the safest system in the world and it’s the most precise,” says Chapman, who has been performing heart ablations for nearly 20 years. “This represents a peek into the future in how we’re going to do ablation.”

He calls this new device “revolutionary” in treating complex atrial fibrillations, the most common irregular heart rhythm in the U.S.

Atrial fibrillation affects about 2.6 million people in the U.S. and is difficult to treat with medication. Chapman says atrial fibrillation, which is the country’s leading cause of stroke, will begin to affect an even greater portion of the population as people keep living longer and baby boomers start getting older.

The system allows Chapman to use a catheter, which has the flexibility of a wet spaghetti noodle, to enter the vessels of the heart to find the problem area. The soft catheter, which is guided by its magnetic tip, cannot puncture the heart as stiffer catheters of the past could do.

For the last several years, Chapman has been performing ablations for atrial fibrillation. But these procedures are complex and time-consuming. Using the magnetic system, the procedures are shorter and more accurate. The procedure has a success rate of nearly 75 percent in atrial fibrillation and a 90 percent success rate with less complex arrhythmias. It also results in a shorter hospital stay and faster recovery.

“This is a miracle,” Chapman says.

Domo arigato, Mr. Roboto
While magnets are guiding doctors through the heart in one part of the Wisconsin Heart Hospital, Dr. Husam Balkhy is performing bypass surgery on a beating heart in another. And he’s using a robot to do it.

Balkhy is one of the only doctors in the country, and the only one in Wisconsin, using this technique with a da Vinci Surgical System. Instead of breaking open the breastbone to get the best possible access to the heart, he creates fingertip-sized incisions for surgical tools and a camera that provides him a 3-D view of the heart and can magnify the area up to 10 times. Many patients who have received this surgery are able to return to normal activities in just a few weeks, he says.

Using a robot to perform surgery is taking off at other hospitals as well. For the past year, Dr. Pedro Banda of Columbia St. Mary’s Health System has been using the very same system to perform prostatectomies using high-definition technology.

About one man in every six will be diagnosed with prostate cancer during his lifetime, according to the American Cancer Society. While surgery can successfully treat most men, they risk the loss of sexual function and continence.

The new robotic techniques being used by Banda allow him to move his surgical tools and the camera in any direction, including a circle, giving him precision that wasn’t available a few years ago. And as with the heart, instead of one massive cut, Banda can use five or six 1-inch incisions to reach the prostate, a difficult area for surgeons to access by hand.

“Because you can see better, it translates into less blood loss in the surgery and less pain because of the size of incisions,” Banda says. “The hospital stay appears to be shorter.”

These precise movements have proven accurate in restoring a man’s full function regarding both continence and potency. One study suggests that a year after undergoing robotic surgery with this system, as opposed to experiencing open surgery, a greater percentage of men regain full sexual function.

“We’re clearly making progress in prostate cancer,” Banda says. “There’s a decrease in mortality and we’re improving the quality of people’s lives.”

Virtual therapy
Who knew that one day a doctor might tell a patient to play his or her video games? Research by Dr. Michelle Johnson of the Medical College of Wisconsin reveals how using video game therapy for stroke patients has the potential to improve arm movement. TheraDrive, the robotic system that comes equipped with steering wheels and custom games, would be a low-cost and fun way for patients to engage in therapy inside their homes.

“We have to realize the potential of these systems to extend therapy beyond the clinics,” Johnson says. “We can leverage the work of therapists to more patients.” She specializes in the design, development and therapeutic use of robotic assistants. Her research focuses on neurorehabilitation, especially on developing techniques to restore function to the upper arm for stroke survivors. Her work with robotic therapy is currently in its research phase.

So how can video games help patients?

When a person has a stroke, the amount of damage can differ significantly. But when a person stops being able to lift an arm or grab hold of a cup, it’s because a link to the brain is broken.

Research suggests that the signals can be rerouted through repetition and intense therapy, Johnson says. Doctors can’t predict which patients will benefit and which won’t. But if a person can perform a task many, many times, the function might return. “Some things are totally gone and will remain gone,” she says. “We start out with the premise that everybody can do a little.”

While it’s impossible for every stroke survivor to have a therapist physically pick up the arm and move it a thousand times each day, a low-cost home system that’s both fun and relevant to the injury could supplement therapy sessions. “Using repetitive motion, engaging the mind and problem solving,” Johnson says, “those things may drive the whole plasticity of the brain.” n

 Christine Gardner is a freelance writer based in Normal, Ill.

 Health Tips
A roundup of the latest health wisdom

Over 60? Time for a shingles shot. Shingles is a painful skin condition caused by a recurrence of the chickenpox virus. It’s typically seen in older adults or those with compromised immune systems and can cause chronic pain and permanent eye damage. Those who previously received the varicella vaccine for chickenpox needn’t worry. But the Centers for Disease Control and Prevention recommends that everyone else age 60 or older be given the herpes zoster vaccine Zostavax, even those who have had shingles previously. The vaccine has been found to cut the occurrence of shingles by 64 percent for older adults.

Are mercury fillings really safe? After years of denying that mercury dental fillings cause harm, the Food and Drug Administration now says they may cause health problems. Pregnant women, children and fetuses are among those most likely to be affected by mercury’s potentially toxic effects on the nervous system. The FDA does not recommend removing existing mercury fillings, but people with compromised immune systems should discuss other options with their dentist if a filling is required.

Think your kid is vaccinated? Think again. A new study shows teens could use a meningitis booster, even if they received the vaccine as young children. Children ages 11 to 13 in the study were less likely to show protective levels of the original vaccination than those who were older, notes the study by University of Oxford researchers published in BMJ Online.

More reasons to stay in shape. Improving your overall fitness level can control metabolic syndrome and may reduce your risk of death from liver, colon, esophageal and possibly pancreatic cancer, notes a study presented at an American College of Sports Medicine meeting. Metabolic syndrome was defined as having at least three of the following factors: low HDL cholesterol, high blood pressure, diabetes or high blood sugar, abdominal obesity, or a high triglyceride level.

Wiped out by chemo? Try this drug. Chemotherapy sure can wear you out: About 80 percent of patients experience fatigue, which can be debilitating. Modafinil (Provigil), which treats narcolepsy, sleep apnea and similar disorders, was shown in a recent study to help those severely fatigued by cancer treatments. Modafinil is a stimulant that doesn’t interfere with regular sleep or cause addiction. It can cause serious side effects if misused, but it’s currently the only reliable medication to help severely fatigued patients, according to the study reported at an American Society of Clinical Oncology meeting.

– Scott R. Weinberger