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Medical Advances On The Treasure Coast Ensure Residents Are In Good Hands No Matter The Diagnosis

The diagnosis was for stage 1 breast cancer. Shocked and understandably scared, 67-year-old Port St. Lucie resident Diane Fraser absorbed the news and weighed her options. Fraser was under the care of Dr. Craig Wengler, a breast cancer surgeon at the Robert and Carol Weissman Cancer Center in Stuart, part of Martin Medical Center. Since her cancer was small and detected early, it was suggested that she would be a good candidate for a newer treatment—one that had only recently been introduced to the hospital.

Intraoperative Radiation Therapy, or IORT, simplifies the treatment process by allowing radiation to be administered during the same procedure as the lumpectomy. The surgeon goes in, removes the tumor, and then uses a balloon-like device to insert the radiation directly into the cavity left by the tumor. It’s quick and simple as far as medical procedures are concerned. “I went in at 7 a.m. and was home by 1 p.m.,” Fraser remembers. “I had radiation for 12 minutes, they glued me up, and I went home.” She only took one pill for pain, on the first day. And within two and a half weeks, Fraser was back to her aerobics class.

Diane Fraser received Intraoperative Radiation Therapy at Martin Health System when she was diagnosed with stage 1 breast cancer.

“I went in at 7 a.m. and was home by 1 p.m. I had radiation for 12 minutes, they glued me up, and I went home.” - Diane Fraser

“It’s a highly targeted, very precise form of radiation,” Wengler explains. Because of how the patient receives the radiation, doctors are able to perform the surgery and administer treatment all in one day. It avoids the standard method of care, which requires up to seven weeks of radiation being applied to the whole breast on a daily basis. IORT is faster and less invasive because it treats more of the affected area and less of the surrounding tissue, and has fewer side effects, including those daily hospital visits required for the standard radiation therapy.

This year, Fraser was among the first to receive IORT at Martin Medical Center. Since her Jan. 14 procedure, approximately 50 women have received IORT from Dr. Wengler. It’s an important milestone for Martin Health System to be the only health care provider in the area to offer the treatment, which has been performed primarily in academic settings for the last 16 years. There are still certain states in which this procedure isn’t available at all. Remarkably, Martin Health has four surgeons who can offer this option: Dr. Wengler, Dr. Ed Wengler, Dr. James Vopal and Dr. Denise Sanderson.

Like Fraser, much of the community isn’t aware of the medical technologies available to them until they become a patient in need of treatment. But local hospitals like Martin Medical Center, Indian River Medical Center and HCA hospitals like St. Lucie Medical Center are working diligently to bring the newest advances in medicine to the Treasure Coast.  

Dr. Craig Wengler readies the balloon-like device that delivers radiation during the IORT treatment.

Seeking weight loss

Martin Health is seeing new technologies in other patient services as well, including weight loss. Dr. Richard Follwell is leading the advancements at the Center for Bariatric and Metabolic Surgery with a new FDA-approved solution called ORBERA. During this procedure, a silicon balloon, called the ORBERA Intragastric Balloon, is placed in the stomach and then filled with 600 milliliters of saline solution. The insertion is done through the esophagus without making an incision. The balloon is small enough that the patient only requires a mild sedative for it to be put in place. This means the patient can go in, receive treatment, and be on his or her way home the same day. “The actual process takes 10 minutes,” Follwell explains. “Patients are able to go [home] within an hour of the procedure.”

The ORBERA device is placed in the stomach and filled with 600 milliliters of saline solution in order to shrink the stomach during a weightloss treatment.

The balloon reduces the amount of food eaten by tricking the stomach—the device touches the stomach lining, and the nerve endings send out signals that the stomach is full. Patients who have struggled with over-eating will be able to better gauge their sense of satiety and exercise control over their eating habits. But the balloon doesn’t do all the work. Each ORBERA recipient is enrolled in a yearlong weight-loss program designed to aid and support him or her in creating new healthy habits for a sustained lifestyle change. The ORBERA balloon stays in the stomach for six months, and the weight-loss program continues for six months after the device is removed.

For Debra Wasserman, the ORBERA balloon was the key to her success. Wasserman was a triathlete, and had to halt her exercise regime after sustaining an injury to her back. The incident marked the start of an emotional spiral that she coped with by using comfort foods she wouldn’t have eaten when she was actively training. It’s a familiar pattern for anyone who has struggled with weight issues—one that can need an extra boost to break.

“It was tough in the beginning,” Wasserman recalls. “But anything like that is going to be.” She was tired for the first few weeks after having the balloon inserted, and she had to make adjustments to the position in which she slept, but she had little to no complications otherwise. 

Dr. Richard Follwell brought weightloss solution ORBERA to Martin Health. 

Wasserman lost 30 pounds with the help of the balloon. She even feels like she could have lost more had she been stricter with her nutritional habits. “It was hard to switch your brain, you have to be really, really diligent,” she says. But she credits Follwell and his team for keeping an eye on her and providing support throughout the entire process. And now that the balloon is out, she still doesn’t want to eat large quantities. “I think that’s just what some people need—that really good kick in the butt,” she laughs.

Dr. Brett Faulknier leads The Heart Center at IRMC. 

Targeting tumors

Martin Health isn’t the only health care organization in the area with exciting news. Indian River Medical Center in Vero Beach has introduced a few developments of its own this year. First, there is the TrueBeam radiotherapy system, which treats cancer by targeting tumors in any part of the body. It can pinpoint the tumors to within millimeters, and uses a combination of imaging, beam delivery and motion management to administer treatment. This system is part of what’s now available at the new Scully-Welsh Cancer Center, which opened in January. The $48 million facility offers radiation therapy, including TrueBeam, chemotherapy and a wealth of educational resources and support services.

In matters of the heart

Even more recently, IRMC saw the launch of its electrophysiology lab. Electrophysiology, or EP, treats heart rhythm disorders. Operated in conjunction to The Heart Center and led by Dr. Brett Faulknier, the EP lab features new advancements in both the diagnostic and treatment phases of caring for irregular heartbeats, called arrhythmias. 

The MediGuide System is an example of one of these advancements. This technology uses tiny sensors contained in catheters and other delivery tools to allow physicians to navigate the heart. Through this system, the heart can be seen in real time on a pre-recorded, incredibly fast series of X-ray images, or fluoroscopy. It’s similar to a GPS in how it maps information. The benefit is that patients have less exposure to radiation, and IRMC is the first health care organization in the state of Florida to use this new technology.

The MediGuide System also aids in conducting EP studies. An EP study looks for the source of arrhythmia by testing the heart’s electrical activity. “Electrophysiologists are cardiologists with additional training for heart rhythm disorders,” Faulknier says, referring to the specific specialists who conduct these studies.

Faulknier himself will perform a procedure known as a cardiac ablation. “An ablation is performed in two different ways,” Faulknier explains, “radiofrequency ablation and cryoablation.” Radiofrequency ablation uses heat, while cryoablation uses freezing to address heart rhythm irregularities. It’s an advanced procedure that involves inserting a thin, flexible tube into a vein in the groin area and threading it up to the heart. It then works to correct any arrhythmias by damaging the tissue that is causing the problem. It’s a brand new treatment for the community, and one of many commitments IRMC has made in bringing the latest technologies and improvements to the area.

While some of these treatments are exclusive to a specific hospital, there are others that are being developed in multiple locations, such as the TAVR program. TAVR is the acronym for transcatheter aortic valve replacement, a procedure tailored toward those who would benefit from open-heart surgery, but aren’t a good candidate for such an invasive operation. Both Martin Health and IRMC will offer this option.

Wally is a robot with a television screen for a face, a computer for a body and wheels for feet. 

Robotics for speedy diagnoses

When a patient experiences a stroke, time is precious, and decisions should be made quickly. Traditionally, in the event a stroke is the possible diagnosis, the physician would be required to contact a neurologist who would then need to drive into the hospital to orchestrate a plan of action. However, Jim Kruger, assistant vice president of nursing and the director of emergency services at St. Lucie Medical Center, notes that with the hospital’s device, Wally, a neurologist is reachable on-demand.  

Wally is a robot with a television screen for a face, a computer for a body and wheels for feet. Rebecca Armstrong, nurse manager in the emergency department at St. Lucie Medical Center, says the device got its name from the movie “WALL-E” because it looks similar to Pixar’s 2008 cartoon robot. When it’s placed at the foot of a hospital bed, the nurse is able to contact a 24/7 on-call neurologist who can assess the patient from a remote location by appearing on the TV screen. 

“The camera can actually focus in on the pupils and see if they are dilated or if one is larger than the other, which indicates a neurological problem,” Kruger says. 

Kruger can remember a time last year when the device was used on a patient in his 30s who was found unresponsive in a construction site. Through the use of Wally, the patient received a prescription for tPA, a medicine often used for stroke victims, and within three days he was released to his family.

In addition to on-call neurologists, St. Lucie Medical Center also has access to psychologists with its ARC robot, which is used in situations where a patient might be experiencing more mental symptoms. 

“We had a young person (14), he was acting out [by] running in traffic, and he was having a real breakdown. He was brought into the police and we were trying to contact parents, so we put the robot in and he was really interested in the technology,” Kruger says. 

Once Kruger and his team found the patient’s parents they were able to transfer him to a proper hospital based on the diagnosis given by the psychologist.  

With robots, balloons and radiotherapies aside, perhaps the most extraordinary advancement in medicine is the talent, prestigious affiliations and awards that have found their way into our stretch of coastline. “The big appeal is that people can now stay in the community to get high-level, quality work,” Faulknier says. And that is a goal to which all members of the medical community are fully committed to upholding.