Learn about six of the latest trends in health care and the leading Valley doctors who perform them
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A new route for cardiac treatment
There’s a new twist on cardiac catheterization, a common medical procedure that’s used to help unplug clogged arteries.
Ordinarily, a tiny tube, or catheter, is placed into the body through an artery in the groin, then snaked up to the arteries surrounding the heart. This is known as the transfemoral approach. After the catheter is in place, physicians can perform an angioplasty. During this procedure, a tiny balloon-like device is inserted to open the blocked artery further; sometimes a stent (a tiny mesh tube) is placed in the artery to help keep blood flowing smoothly.
Nirav D. Shah, M.D., a cardiologist at St. Luke’s Cornwall Hospital in Newburgh, is one of the first physicians in the Valley to perform transradial catheterization — a technique that bypasses the groin and instead uses an artery in the wrist as the entry point for the catheter. First performed in 1989, the technique became popular first in Europe and Canada, and is now catching on across the U.S.
“The artery running down through the wrist — the radial artery — is smaller than the artery in the groin,” explains Shah. Thus, taking the wrist route reduces risk of bleeding during the procedure. “Transradial catheterization, however, does requires a greater learning curve for the physician” to master the technique, he says. “But it has fewer complications than going in through the groin. And it’s much more comfortable for the patient.”
Recovery is quicker, too. With standard catheterization, the patient must lie totally still throughout the procedure, then remain in a virtually prone position for several hours during post-op monitoring.
“By comparison, going in through the wrist, the patient can sit up right after the procedure. They can even walk right out of the treatment room; most go home within about two hours,” Shah says.
Transradial catheterization has proven effective for both sexes, even though women tend to have slightly smaller arteries, he says. And if a patient has multiple blockages, or clogging in the arteries recurs, it’s no problem to repeat the process. “We could even go back in for treatment the next day, using the same wrist artery,” he says.
Shah, who performs as many as 500 angioplasties a year, says transradial catheterization is indeed a breakthrough in the field of coronary care. “I’d say that 90 percent of the procedures I do are now done through the wrist,” he says.
Nirav D. Shah, M.D.
Goodbye to bladder woes
That “gotta go” feeling is no laughing matter, especially if you suffer from overactive bladder — a medical condition in which the need for frequent urination can interfere with daily life and play havoc with nighttime rest.
Treatments can range from medication to behavior modification — and now a new technique, called percutaneous tibial nerve stimulation (PTNS), can help control this common and uncomfortable bladder problem.
With PTNS, a tiny needle is used to stimulate a nerve, which helps regulate bladder function. Remarkably, the needle isn’t inserted anywhere near the bladder. “The procedure is actually done on the leg, where we stimulate the tibial nerve, just above the ankle,” says Jose Sotolongo, M.D. who is affiliated with Hudson Valley Urology in Poughkeepsie. “By stimulating the nerve, a reflex occurs in the spinal cord; the nerve originates in an area of the spinal cord that’s not far from where the nerves to the bladder also originate,” he explains. “The stimulation seems to somehow reset the electrical activity of the nerves going to the bladder.”
The procedure, done in a physician’s office, takes about 30 minutes. It’s performed once a week, usually for about six weeks or more, depending on the case. The patient sits in a comfortable position with the leg slightly raised. A tiny needle is inserted near the ankle. A gentle electrical pulse is then sent through the needle, which travels through the tibial nerve, into the region where the spinal/bladder nerve areas lie. “There’s no pain; you just feel the tiny needle prick,” says Sotolongo. “The patient can just bring a book and relax through the procedure.”
Sotolongo says the method works somewhat like acupuncture. “It certainly makes you think of acupuncture — it’s a similar approach, of stimulating one part of the body to affect another.”
PTNS can help many, but not all, cases of overactive bladder, he adds. “The only patients, in general, who aren’t candidates for the technique would be if their overactive bladder isn’t linked to a nerve problem. It might be someone whose urination is affected because they’re receiving radiation therapy in that area. Or a man may have urination issues because of an enlarged prostate.”
Sotolongo says medical studies have shown that PTNS, which is FDA-approved and is used to treat both sexes, is extremely effective. “It appears that up to 96 percent of my patients seem to respond to it, with good results still showing after about 52 weeks; it could be repeated as needed,” he says.
“The expectation is that it could take the place of medication for many patients dealing with overactive bladder. It will certainly open the door to treatment for many people.”
Jose Sotolongo, M.D.
Hudson Valley Urology, 845-339-4900