Better medicine through engineering

For me, the last eight months have been very interesting when it comes to medical treatment. I have had my left hand rebuilt to eliminate chronic pain, I had my heart inspected to make sure it was working properly, and this week I had the retina in my right eye re-attached using some very clever engineering.

For once, this essay will not be about the politics of medicine and the disaster of Obamacare, which is still ongoing. Instead, I will outline how freedom and human creativity has now made possible a whole range of modern medical techniques that are either improving the quality of life for patients or literally saving their lives.

The heart was pretty straight forward. If your heart doctor suspects you might have a blockage, they now have a range of techniques for inspecting its interior, including the insides of the arteries that lead to it. And they can do it as a simple outpatient treatment. They make a small incision in a major artery, insert a camera/tools attached to the end of a long fiber optic tube, and use this to travel to the heart where they can inspect everything in great detail. If they find something they need to fix, they can do it then, using the tools at the end of the tube. And even if they don’t need to do anything, when they are done they can give you a very accurate appraisal of the state of your cardio-vascular system, allowing you to take whatever actions are necessary to keep it in tip-top shape.

Most amazing of all, this kind of medical examination has become an entirely routine procedure in the past few decades. Heart doctors do it on almost a daily basis, like clockwork.

I went through this in June, and the result was that I was able to have a great time hiking in the Grand Canyon in July.

The wrist treatment was equally amazing. For the past seven years I had had increasing chronic pain in my left wrist. By last year, it had gotten so bad that I was having trouble doing ordinary tasks. Worse, my ability to compete in bullseye pistol competitions had declined so much that I literally couldn’t do it.

By April 2013 I finally decided to do something. Fortunately, one of the top doctors in this field, Joel Thompson, happens to live in Tucson. He immediately made a diagnosis, explaining that of the many bones in the hand two were now in contact and rubbing against each other. It was this contact that was causing my pain.

Thompson explained that the solution was a procedure called suspension plasty., developed in the early 1980s by surgeon James S. Thompson (no relation). In this procedure, the surgeon literally removes one of the small bones that is in contact with the others and then rewires the ligaments to the remaining bones so that the thumb and hand can continue to function as before.

I had this operation in May, and have been astonished at the result. The pain is entirely gone, and I have only lost a tiny amount of inconsequential range in my left thumb. Who wudda thunk it?

Finally, there was my eye problem this week. When you reach the hallowed age of sixty-plus, the eye begins to change. The viscous gel that fills the eyeball and keeps the retina in place shrinks and then separates from the retina. When this happens you will suddenly see a lot of floaters as well as light flashes, which should immediately be a warning to see an eye doctor at once. If the retina tears when this happens, fluid can leak through the tear and push the retina out, causing it to detach and thus resulting in blindness in that eye.

For me, the vicious gel separated from the retina in both eyes in February and August of 2013 respectively, and both times I immediately saw my eye specialist. Fortunately there were no tears and I got a clean bill of health. After a few weeks the floaters disappeared and I was back to normal.

On Saturday, however, I suddenly noticed a new bunch of floaters as well as what looked like a small black blob blocking my vision on the left edge of my right eye. I shrugged, and said, “Why does this always happen on the weekend?” In February the first floaters had appeared on Friday night, and when I called the doctor he said it was acceptable to come in on Monday. Then, however, I had not noticed any blockages in my vision.

I decided there was no point calling over the weekend, as they would probably not do anything until Monday anyway. By Sunday afternoon, however, the blockage had grown. It was like a giant black disk that was slowly moving from the left to the right, increasingly blocking my view of the world. By 6 pm on Sunday I decided I better call the doctor anyway. When I described these symptoms to my doctor, Leonard Joffe, he said to meet him in his office within an hour, on Sunday night, so that he could figure out what to do. (As it turns out, he was attending a basketball game with friends and family at the time, and left that event to meet me.) He explained later that he knew immediately from my symptoms that I had a detached retina, but he needed to make a close examination to figure out the best course of treatment.

This is what he did. On Monday morning he used cryotherapy to freeze seal the tear that had occurred in the retina. This would prevent any more fluid from leaking in behind it. He then injected into the eyeball a special gas. This gas, lighter than the fluid in the eye, would rise to the top to form a bubble that would press against the retina. My job would be to keep my head in the right position so that the gas bubble would always press against the part of the retina that had detached.

Thus, I spent almost all of Monday and Tuesday lying on my side so that the bubble would rise to the right spot inside my eye. By Tuesday morning Joffe looked at the eye and declared the retina had completely reattached, “the best possible outcome he could expect after only one day.” I had also noticed that the blockage had faded, leaving behind a cloudy vision which I think is steadily clearing.

I have still had to keep my head positioned all day Tuesday, but today and later this week the amount of time I need to do it is less each day.

This amazing technique, called pnematic retinopexy, where a simple bubble acts to press the retina into place, replaces other surgical techniques, such as scleral buckling, that while successful were far more invasive and complicated. Had it not worked, I could always have had the option for the scleral buckle surgery, but I am glad that was not necessary. The technique itself was developed originally in the early 1900s, but did not become acceptable until the late 1980s, after several California eye surgeons teamed up to do their own improvised clinical trial. As one of those doctors described,

Dr. Hilton decided that the only way this new procedure would be accepted in the retinal community would be with a prospective, randomized, controlled clinical trial. He invited seven groups of fellowship-trained retina surgeons from across the country who had experience with pneumatic retinopexy and scleral buckling to participate in the trial. He outlined how pneumatic retinopexy would be performed, but told the participants to perform whatever scleral buckling operation they normally used. This trial could not be done today. We did not have IRB approval (I don’t think there was an IRB at that time); we used a gas that was not approved for intraocular use (the cost of the gas and lecture bottle was $14); and we funded the project internally, paying for the biostatistician who provided randomization envelopes. We did not charge the patient for the pneumatic operation. It was a very exciting time. Then, one day Dr. Hilton called me. He was a bishop in the Mormon Church and told me he had been called for a mission to Tahiti. He asked if I would take over the trial and, in a moment of weakness and complete ignorance what that meant, I said yes. [emphasis mine]

These doctors had spotted a treatment that could benefit patients by its simplicity and moved to prove it could work, quickly and freely. No one was supervising them. They, as experts in their field, had the freedom to function as experts and do it. The result was a gain in knowledge and experience that can hardly be measured.

As the doctor noted above, “this trial could not be done today.” Too many rules, regulations, and supervisory agencies looking over everyone’s shoulders. Very sad and unfortunate.

Nonetheless, we must note the amazing innovations that all these procedures illustrate. Technology, science, engineering, and human creativity all melded together to produce some clever techniques for helping the body to heal itself.

These facts should be remembered the next time someone announces ponderously that something can’t be done. History tells us bluntly that they are wrong.

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13 comments

  • Dwight Decker

    Well said about the progress of medical science. I’ve been in good enough health over the years that if I had been born a hundred years or more earlier and all else being equal, I probably would have reached my present age (62), but I’d be effectively blind due to cataracts. More recently, I could have the cataractous lenses removed, but I’d have to wear contact lenses as well as glasses, as was the case of a neighbor kid I knew who had cataract surgery when he was about twelve. Within the last twenty years or so, replacing the lenses with artificial ones has become the common procedure. The amazing thing is with the artificial lenses, I’m seeing better than I have been since I was about nine, and after a lifetime spent behind thick glasses, I now only need glasses to read.
    Before the advent of artificial lens implants, people who had their cataracted lenses removed could see further into the ultraviolet (because the natural lenses block UV). I remember reading about such people being recruited into the British shore patrol during World War II because there was a fear the Germans in occupied France might be signaling their agents in Britain across the English Channel using normally invisible UV lights, but I don’t recall if any instances of it were ever discovered. I also recall reading in an astronomy magazine an article by someone who’d had his lenses removed but not replaced, and he saw the sky rather differently than before. Naked eye astronomy in ultraviolet. My artificial lenses perform the same filtering or blocking function as natural lenses, so I don’t need sunglasses in normal daylight, and I didn’t develop any super-powers. The main effect on astronomy for me was that as my cataracts got worse, my night-vision went to heck as less faint light got through, and towards the last I couldn’t see the stars *at all.*

  • please wear glasses that block the harmful rays because a high proportion of people who have had cataract surgery go on to develop macular degeneration.

  • Kent Sogge

    Great to have medical advancement. Unfortunately the ability for all to have access to benefit from advancement has sorely been missing. Frankly missing for access to basic healthcare. The Affordable Care Act is leading us in the right direction. Its not perfect but nothing is so time will improve. In my case I now have affordable care and appreciate the efforts of the President working against the party of no and no solutions to get as far as we are.

    • Please define ‘affordable care’. This is a phrase thrown around without meaning. It sounds good, but what, exactly, does it mean? I find that all of my health care is ‘affordable’. I pay for basic care in cash (and realize a significant discount over insured care). For more expensive care (historically traumatic injury), I make arrangements to pay over time. I still get the cash discount, and I’ve always paid my bills.

      I’m not rich, or even well-to-do. My income is squarely in the middle-class range. Yet when government money is taken out of the equation, I can readily afford basic health care. The Big Lie pushed by government is that the individual needs help to take care of themselves. It’s not true.

    • Dannawally

      If the GOP is the party of “No”, I want to change my vote for the party of “Hell No!”. So far the GOP has accepted the ridiculous premise that the Healthcare system in America is broken and only government can fix it. I’m afraid we are going to see what a broken healthcare system actually looks like if/when the full-blown Obamacare fiasco is implemented.

      • Micha Elyi

        Every party in a democratic republic tends to move toward the positions embraced by a majority of voters. The problem is not with our politicians, it is in ourselves. At least you’ve purged the desire for your neighbor’s goods from yourself. Alas, you and the rest of the remnant have 100 million more US voters to persuade to do the same.

    • wodun

      My policy was cancelled. My ACA approved policy has a 222% higher deductible and has crappy coverage, doesn’t even cover prescriptions (Obama fanatics keep telling me prescriptions are covered). Then after going through all the due diligence in selecting a new policy, January 1st was notified my doctor was no longer in the network. Now, I get to shop for insurance again or find a new doctor.

      A friend had her MS preferred MS medicine taken away and there are countless stories of people who are facing higher costs and potential costs (deductibles).

      It is nice that you now have insurance but apparently you don’t know how much better the older policies were and you don’t have the experience to compare the before/after.

      Obamacare doesn’t make health insurance or healthcare more affordable. Even if you get a subsidy, that plan is more expensive than it was under the old system and as a group we all pay more.

      The level of access has not changed. People could always see a doctor if they could afford it and that is the same now. And after a doctor has been visited, the cost of treatment is getting more expensive under the ACA. Even people who get subsidies for out of pocket expenses are expected to absorb them for a year until they can get reimbursed on their tax return.

      Sure, you don’t have to pay a $20 co-pay to see your doctor for a yearly exam but in exchange for that the minimum deductible is now the out of pocket cap. For individuals that is $6350. For me, that $20 savings comes at the expense of an additional $4350 in medical expenses if I get seriously sick. And know what? My old plan let me see the doctor up to 6 times a year for any reason, not just preventative care, with no co-pay. Know what else? That “free” doctor visit isn’t free at all. The cost is converted into premium and deductible increases.

      Obamacare sucks which is why Obama gave waivers to all of his cronies and campaign donors and delayed the employer mandate for a year (contrary to the law).

      Are you going to report this comment to flag@whitehouse.com so they can sick the IRS and DOJ on me?

      • Micha Elyi

        “A friend had her MS preferred MS medicine taken away…”–wodun

        The National MS Society has been a big fan of Obamacare all along. Like the AARP, the NMSS was a player in the lobbying coalition that urged its passage.

    • William Jefferson

      Are you a fool or a knave?
      Obamacare will be the deathknell for innovation.

      Oh, I am so sorry. Surely, everyone will do their best for the collective even if it means exposure to liability and no return on investment. Stardust, unicorn shit and rainbows in your freaking world.

      And the “affordable care” will be minimal, desultory government standard workmanship.

      • As much as I agree with you about the failings of Obamacare, I don’t think you do our argument any good by insulting Mr. Sogge. There is no need to call him names.

        We need to convince people, not offend them. Please keep this in mind in the future if you wish to comment here.

  • Democrats are destroying the rationale for biomedical and pharmacological research.
    Nobody and no company will work for no profit.

  • LA Grant

    Stories of medical progress leading to better medicine. As opposed to medical progressivism, which will have the same effect on medicine as it has had on education.

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