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Game-Changing Medical Technology (MRgFUS) In Danger Of Underfunding

I’ll admit it – when I was a kid, I admired Dr. Bones (McCoy) of Star Trek. He was a no-nonsense kind of guy who was very clear about his areas of expertise (“Damn it, Jim, I’m a doctor, not a spaceship engineer.”) But best of all, Dr. McCoy had special healing gadgets that he could wave over people for diagnostic and therapeutic purposes. Those “tricorders” fascinated me – and I always wished I could have one myself.

And now my dream could actually come true: advances in focused ultrasound technology (FUS) make non-invasive surgical procedures possible. I attended the very first international symposium about this new technology, and learned some very exciting things.

First of all, Dr. Ferenc Jolesz gave a riveting key note address about the history of focused ultrasound technology, and why modern advances have made this treatment modality feasible.  Scientists have been fantasizing about heating tissues with sound  waves since 1942 when the first ultrasound experiment was conducted on a liver tumor. Unfortunately back then, imaging studies (beyond X-rays) had not yet been developed – so it was virtually impossible to “see” one’s target.

However, now that magnetic resonance imaging (MRI) machines are capable of displaying our innards in exquisite detail (and can also calculate the temperature of tissues to within 1 degree Celsius) we can see exactly what we’re heating and we know when we’ve achieved the desired temperature. In addition, advances in probe technology have made it possible to target exact tumor boundaries, thus curing rather than “debulking” various cancers.

I asked Dr. Jolesz to explain why heating was such a powerful treatment option for cancer and other tumors and he replied,

If you boil an egg, you’re never going to get a chicken out of it.

In other words, focusing sound waves on an internal target can heat the desired area to such a degree that the cells and tissues are permanently destroyed. There is no need for surgical intervention. The patient simply receives the treatment via focused ultrasound beams through their skin – and best of all, it’s essentially painless.

MR guided focused ultrasound is truly a “Star Trek” level medical breakthrough. The first questions in my mind were: will insurance companies pay for such therapy? Can people actually have access to this technology? The answer to both, as you might expect, is “no.”

Let me explain.

First of all, because MRgFUS is relatively new, it has only managed to win one FDA-approved use so far: the treatment of uterine fibroids. Insurance companies generally do not pay for experimental or non-FDA approved treatments, so even though research has demonstrated its effectiveness in treating brain tumors, breast cancer, and blood clots in the brain (stroke), those are not covered. Now, in all fairness to the insurance companies, I can understand why they’d want to fund FDA-approved treatments only. If they paid for every test or procedure touted as the next “scientific breakthrough” (without sufficient evidence to support the claim) healthcare costs would skyrocket, making health insurance unaffordable for anyone.

However, in these difficult economic times, it will be up to patients (“consumers”) to put pressure on insurance companies to cover MRgFUS procedures. It will take time, and there will be resistance (there is always resistance to paying for new things) but in the end, I believe that non-invasive surgery will save far more than it will cost. We need to overcome this initial opposition in order to take medical science to the next level. To learn more about MRgFUS, please check out the Focused Ultrasound Surgery Foundation website.

In my next post I’ll interview Dr. Elizabeth Stewart, professor of Obstetrics and Gynecology at the Mayo Clinic, to discuss her experience with MRgFUS in treating uterine fibroids.

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4 Responses to “Game-Changing Medical Technology (MRgFUS) In Danger Of Underfunding”

  1. bongi says:

    welcome home dr val!!!!

  2. Gary L says:

    Congratulations, Dr. Val on the new blog!!
    As I said, “Fluffy and Soft”

  3. Doc. I’d like my picture up next to Grant Hill. I have next Wednesday at 2pm free if you need another interview.

    Happy :)

  4. Kim says:

    I always wanted to be Nurse Chapel, probably because she wasthisclose to snagging Spock and I had a crush on him. : )

    The site looks GREAT and so does this new approach to non-invasive treatment.

    Glad to see you “open for business”! : D

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


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