Transcription:
Top Medical Advancements of 2015

Melanie Cole (Host):  The science of medicine is always improving and evolving and Abbott Northwestern Hospital is often leading the way. My guest today is Dr. Ben Bache-Wiig.  He is President of Abbott Northwestern in Minneapolis and he’s here to talk with us about some of the medical advancements that we saw in 2015. Welcome to the show, Dr. Bache-Wiig. Tell us first about immunotherapy cancer treatments and where has this gone? It’s such an exciting field.

Dr. Ben Bache-Wiig (Guest):  It is Melanie. What immunotherapy is for cancer is a treatment that activates the patient’s immune system to fight off the cancer. It’s used primarily now in patients who have failed standard treatments and still have evidence of cancer. The drugs are given and they activate the patient’s immune system and we’ve seen some tremendous responses in patients with lung cancer, kidney cancer and melanoma that would have been very difficult to treat in the past.

Melanie:  How does it compare to traditional cancer chemotherapy or radiation treatments?

Dr. Bache-Wiig:  One of the things is that it doesn’t have some of the side effects that are traditionally involved in those treatments. There can be other side effects but, in general, it’s well tolerated by patients. It can be used in patients who haven’t responded as well to those more standard treatments. We’ve seen some quite lasting responses in cancers that are often very challenging to treat.

Melanie:  Will this be more of a first line treatment in the way of maybe cancer vaccines and other immunotherapy treatments?

Dr. Bache-Wiig:  In general, with the way cancer research works, we tend to start with new treatments to be sure they are safe in patients who have failed other treatments because we have good treatments and we don’t want to use the experimental ones before we know that they work as well as they should.  As therapies prove their benefit though, they tend to move up the line. I think with some of these immunotherapy treatments, we’re already seeing them move into more of a first line role in some clinical situations.

Melanie:  Now, we’re going to move on to lung cancer screening. We’ve heard a lot about this in the media, Dr. Bache-Wiig. Tell us a little bit about lung cancer screening, the guidelines and what patients are referred for in the screening.  

Dr. Bache-Wiig:  This is primarily done for patients who are at higher risk for lung cancer. That primarily is patients with a smoking history or an exposure to chemicals that may increase the risk of lung cancer. In the past, we’ve used chest x-rays as the main screening tool. The challenge with chest x-ray is that often the tumors are of such a size when we find them that they are beyond the place where surgery can be curative. Using a CT scan specially modified to minimize the radiation dose, we can find cancers at a much earlier stage where they are much more amenable to treatment.  

Melanie:  What’s involved in this screening? If it’s got a lower dose of radiation and it’s pretty easy to do, why isn’t everyone who has ever smoked allowed to get the screening?  

Dr. Bache-Wiig:  I think one of the challenges has been to prove that we actually make an impact on outcomes in patients with screening tests. Abbott was one of the study sites that really demonstrated the value of this technique and that led Medicare to go ahead and approve its use in patients who are at higher risk for lung cancer.  So, smokers now can get this screening and have it be covered. What’s involved is a CT scan that is done on a periodic basis and if there’s anything found, then those findings are followed up with additional testing.

Melanie:  Which smokers are allowed to get this screening – or recommended to get it?

Dr. Bache-Wiig:  In general, there is a dose relationship between smoking and the risk of cancer. This would generally be patients who had smoked somewhere on average of 10 cigarettes a day or had a more than what we would call a ten-pack a year smoking exposure over their lifetime.

Melanie:  Tell us about the new treatment of mechanical thrombectomy for stroke patients. What is this and how does it work?

Dr. Bache-Wiig:  With strokes, in the past we really had very limited treatments other than rehabilitation and monitoring.  Over the last few years, it has really exploded with the number of new treatments. First, clot dissolving drugs that are given early on in the course of a stroke can open an artery that has been blocked. Now, we’ve added additional treatments for patients who may not respond to the clot busting drugs or have a more major artery plugged where we can go in with a catheter and, using suction, remove a clot and restore circulation to that brain tissue before it suffers permanent damage. 

Melanie:  That’s fascinating. Is this available at Allina Health?

Dr. Bache-Wiig:  It is. At Abbott Northwestern, we have been doing it. One of the absolute keys to being eligible for this kind of treatment is that if someone has stroke symptoms that they get medical attention as quickly as possible. There is a window of time, usually somewhere in the range of three to six hours in which if we apply these treatments, we can see improved recovery. If we are out beyond that, they just don’t have the same benefits. We really encourage people to call 9-1-1 at the first onset of any stroke related symptoms so that they have the maximum opportunity for being treated.   

Melanie:  It’s true that time is brain when it comes to stoke. That’s a fascinating type of procedure. Now, onto heart flow analysis, what are some of the new techniques for identifying blood flow in the arteries of the heart? People worry about this, Dr. Bache-Wiig as far as their risk of heart attack or impending heart disease. Tell us about heart flow analysis.

Dr. Bache-Wiig:  What heart flow analysis does is take the information from another CT scan procedure – CT coronary angiogram which basically saves the patient from the risk of having to have a catheter placed in the heart and, instead, can measure using data from the CT scan how the blood is flowing through the coronary arteries and decide whether a patient needs more invasive testing or can be safely treated with medication to prevent progression of the blockage.  

Melanie:  Is this hoping to find various heart diseases earlier? Is it available at Allina Health?   

Dr. Bache-Wiig:  It is. Actually, one of our physicians at the Minneapolis Heart Institute, Dr. John Lesser, was instrumental in developing this technology and we were one of the first places in the world where this technique was available. It does help us to both find heart disease early but also help us make decisions and get patients back functioning without putting them through unnecessarily risky procedures.  

Melanie:  Sometimes, heart valves go bad in the heart. Mitral heart valve replacement. Tell us a little about what is involved in a valve replacement.

Dr. Bache-Wiig:  As you say, as the heart ages or is affected by other processes, there can be problems with the heart valve. They can either become narrowed or they can start to leak and when that happens, it can cause significant problems with shortness of breath, heart failure and other serious medical issues. We’ve had heart valve replacement – Minnesota has always been a leader in heart valve treatment. In this last year, we were the first in the world to use a minimally invasive technique to replacement the mitral valve which is the valve between the top and bottom chamber on the left side of the heart. Instead of having a major open sternotomy and open heart surgery in the traditional way, this is done through a small incision in the chest and then, a catheter that puts the valve in place. It’s a big advance and what it does, I think, is make this treatment available to patients who might have been too ill to undergo open surgery and they end up with a much faster recovery and get back to functioning more quickly.

Melanie:  Dr. Bache-Wiig, tell us about the exoskeleton for spinal cord injuries and the Courage Kenny Rehab providing this new treatment. It is an absolutely amazing treatment. Tell us about it.

Dr. Bache-Wiig:  It really is. This is a treatment that really borrows from the world of robotics and has created these devices which a patient puts on supporting their lower back and legs and then, using the controls coupled with their own nervous system are able to get back to ambulating or being able to walk. It’s been really life changing for our patients with spinal cord injuries who are often confined to wheel chairs to be able to actually get up and move again and get the benefits from ambulation and being upright.

Melanie:  Now tell us, in just the last few minutes, what are some of the new medical studies and advancements that you see coming to us in 2016?

Dr. Bache-Wiig:  We’re really fortunate here at Abbott Northwestern to have a culture of innovation that’s an ongoing thing that has been supported by our Abbott Northwestern Foundation. I see a lot of progress being made in the areas of heart disease and cancer and in neurology as well as rehabilitation. I see those things coming together. Some of them are new devices and drugs. Some of them are approaches to making care more coordinated and helping patients flow better through the system. It’s all targeted to getting people back on a path to better health.  

Melanie:  Thank you so much for being with us. What great information, Dr. Ben Bache-Wiig, President of Abbott Northwestern in Minneapolis. You’re listening to the WELLcast with Allina Health and for more information, you can go to AllinaHealth.org. That’s AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.

[END OF RECORDING]