Are You Missing Out on the Most Up-To-Date Procedures?

Don’t miss out on the latest state-of-the-art medical procedures.

by Meryl Davids Landau
Photograph: Illustrated by Bryan Christie

Whether it’s a new treatment technique or a different way of performing your regular checkups, modern medicine is always coming up with advances and breakthroughs. But that doesn’t mean you’ll hear about them from your doctor. Some physicians are slow to embrace change, perhaps because they are waiting for more evidence that the latest way is better than the old way, or because they’re unwilling to invest in learning the new technique or buying the new equipment, or simply because they feel that innovation isn’t warranted in certain situations. But if a breakthrough is going to be bypassed, you should know it—and decide whether you want to seek the new procedure elsewhere. Here, several top-of-the-line techniques to ask about before you book a procedure.

Minimally Invasive Breast Biopsy: Determines whether a lump is cancerous

Some 25 years ago, after my gynecologist found a lump in my breast, he shipped me off to the OR, dug out the
whole tumor and biopsied it. The wound bled for days and I still sport a two-inch scar, but the tumor was benign and I am not complaining. At that time, open surgical biopsy was standard practice, but technological advances of the last two decades should have rendered that procedure nearly obsolete. Working on an outpatient basis, doctors can now use ultrasound, MRIs or stereotactic navigation to guide a thin needle into the skin to remove tissue samples for biopsy, which allows for a definitive diagnosis and enables the patient to recover almost immediately. Indeed, a 2009 conference of top cancer doctors agreed that these minimally invasive needle biopsies represent the “best practice” for diagnosis in almost all cases.

Yet a recent study found that a stunning 40 percent of biopsies by breast and general surgeons at one top-ranked institution are still done via the more invasive technique. This means some women are needlessly undergoing a major surgical procedure, says Beth DuPree, MD, medical director of the breast health program at Holy Redeemer Health System in Meadowbrook, Pennsylvania.

If your doctor recommends an open biopsy after a lesion is found, ask why. “There are a few valid reasons to get an open surgical biopsy, such as when the tumor is close to the chest wall,” explains Judy Kneece, RN, author of The Breast Cancer Treatment Handbook. (DuPree notes that her open biopsy rate is about two percent.) “But if your doctor says, ‘That’s how I always do it,’ or she doesn’t give a good justification, absolutely get a second opinion,” Kneece says. Most comprehensive breast centers are equipped to perform minimally invasive biopsies.

High-Definition Colonoscopy:  Checks the health of your large intestine

Watch an HD TV set and you actually see the pores and pimples of the actors. So it only makes sense that using high-definition colonoscopy equipment—which includes an HD video chip attached to the tip of the endo­scope plus a higher-resolution HD monitor to see the results—gives physicians a much better view of your colon. When researchers at the Mayo Clinic in Jacksonville, Florida, reviewed more than 2,400 colonoscopies that had been performed there, they discovered that the enhanced equipment detected 20 percent more precancerous polyps than did the traditional apparatus. The difference was most pronounced when the growths were small (less than 10 millimeters, or smaller than a half inch). While it hasn’t been proven that spotting and removing these small growths saves lives, most experts believe it’s prudent to have them excised.

Even though it’s not clear how many medical centers use the HD procedure, it is undoubtedly becoming more prevalent. Ask in advance if the physi­cian performing your colonoscopy has this option available.

Laser Throat Polyp Surgery: Removes benign, precancerous and cancerous polyps

Midlife women suffer throat polyps at double the rate men the same age do, thanks to our more delicate (and thinning) vocal cords and higher occurrence of acid reflux disease. Typically, benign, precancerous and small cancerous polyps are removed in a surgical procedure that requires general anesthesia and sometimes an overnight hospital stay. But there’s an alternative: unsedated office-based laryngeal laser surgery (UOLS).

During this procedure, the doctor sprays a topical anesthetic on the vocal cords, places a small flexible scope down the patient’s nose, then activates a pulsed-dye laser to treat the polyp or other growth to be removed. “The laser destroys only the abnormal tissue, which is why the complication rate is very low,” says Jamie A. Koufman, MD, director of the Voice Institute of New York. Patients can go back to work, pain-free, the same day. “Our study of over 400 procedures found the results are superior to surgery that requires anesthesia, and patients overwhelmingly prefer it,” Koufman says.

The problem: Insurance companies haven’t yet created a UOLS code, so it’s a battle for doctors to be reimbursed (though they will get paid eventually). As a consequence, many stay away.

If your doctor recommends surgery to remove throat polyps, get a second opinion from an otolaryngologist who does UOLS. You’ll have to call around, but Koufman says these specialists practice in most major cities.

Endometrial Ablation: Stops excessive vaginal bleeding

Women in their forties and early fifties are increasingly prone to menorrhagia, a condition in which the uterine lining grows, causing heavy and painful bleeding. When hormone treatments don’t relieve the problem, women may undergo a hysterectomy, the surgical removal of the uterus (and sometimes the ovaries, too). Fortunately, there’s a much less drastic way to stanch the blood flow: endometrial ablation, a procedure that heats up and destroys much of the uterine lining.

“Over the last decade our options for how to treat the lining have multiplied—and now include a heated balloon, radio frequency waves and microwaves, among others. All reduce or eliminate the lining and thereby curtail the bleeding,” says Charles Cash, MD, chair of ob-gyn at Oakwood Hospital and Medical Center in Dearborn, Michigan. The procedure, which can usually be performed in the doctor’s office, is short (patients are in and out in a couple of hours), painless and has a quick recovery period; you’ll probably be back to work in a couple of days.

“Older doctors in particular don’t offer patients this option because they’re used to performing hysterectomies
to deal with bleeding problems,” Cash says. Some also worry that a woman will end up needing a hysterectomy later on, but a recent Kaiser Permanente study found that’s much less true for women 40 and older than their younger counterparts.

If your doctor recommends a hysterectomy for your bleeding, consult with a gynecologist who performs ablations to discuss whether that treatment might be right for you.

Hip Resurfacing: Treats hip joints damaged by arthritis

For women in their forties and fifties with severe arthritis in the hip, a total hip replacement isn’t always the best option, since new joints last only 15 to 20 years and you’ll probably live a lot longer. As a result, some doctors
are choosing a procedure known as hip resurfacing, in which the head of the femur bone is saved and capped (with a metal and plastic piece) rather than removed and replaced. Consider this procedure especially seriously if
you are a woman age 40 to 55 who is active and has large bones that aren’t thinning, says Michael Mont, MD, director of the center for joint preservation and reconstruction at Sinai Hospital of Baltimore. “Resurfacing is ideal for this woman because, in my experience, it gives her a better range of motion while leaving open the option for a replacement later on,” says Mont, who has done the procedure on hundreds of women in that age group. Bone thickness matters because one of the downsides of resurfacing is that women have a higher rate of subsequent hip fracture—two percent compared with a man’s one percent. “That seems to have more to do with size than gender; bigger women likely have a smaller risk,” Mont says.

If arthritis makes it hard to walk or function, seek out an orthopedic surgeon experienced with resurfacing. Look for someone who specializes in the procedure, Mont advises, rather than someone who does the odd case between replacements, because minor errors can lead to joint failure, especially in small-sized women.

Laser Dentistry: Drills small cavities and performs other dental work

Lasers for dentistry have been around for decades, but most dentists still don’t own them because of their high cost and the fact that they can’t be used for many common dental appli­cations. Still, where they are appropriate, they can significantly reduce a patient’s trauma. If you have a small cavity—more common after 40, due to
a decline in your bacteria-battering saliva—the laser lets you skip the annoying Novocain and high-pitched drill. The new equipment can also painlessly remove flat growths in the mouth (such as lichen planus) that are more common in women over 40 than under. And, if you plan to get veneers, lasers can zap away the prominent flap of tissue inside the upper lip (known as a frenulum) that can sometimes get in the way. “Remove it the typical way, with a steel blade, and there’s a lot of bleeding, pain and scarring, and the need for stitches. There’s none of that with the laser,” says periodontist Robert Pick, DDS, associate professor of surgery at Northwestern University Medical School and author of Lasers in Dentistry.

Still, the American Dental Association notes that lasers aren’t a panacea; they say old-fashioned methods are best for root canals, and that lasers haven’t proven their worth for treating all cavities. Pick admits some overzealous dentists “claim a laser can do many things that it really doesn’t.”

If you need specialized dental work or are in the market for a new dentist, consider looking for someone who uses this pain-free method for appropriate applications. The Academy of Laser Dentistry lists members by location at laserdentistry.org.

Old-Fashioned Back Pain Remedies: Soothe low back pain

In this case, it isn’t that you need to know more about possible high-tech remedies; what you need to know is
that they may not help much. If you have chronic low back pain, new treatments like steroid injections in the joints near the vertebrae and artificial disc replacement sound impressive, and their use is soaring. But experts say that carefully designed studies have not shown many of these invasive and expensive methods to be effective at curing the pain; the best interventions are actually the low-tech fixes you can do at home.

“We all want a magic bullet. But the evidence shows that for most low back pain, it really isn’t out there,” says Richard A. Deyo, MD, a professor of evidence-based family medicine at Oregon Health and Science University, in Portland.

In fact, guidelines from the American Pain Society say there’s little to no proven benefit for most advanced invasive interventions doctors frequently offer for back pain. You’ll have greater success if you treat your
mild to moderate pain very simply: Take drugstore analgesics, apply heat to the sore area, and don’t overexert yourself until the discomfort goes away. Stay mobile; weakening the muscles through disuse makes your back situation worse.

For chronic pain, exercise “is one of the few interventions shown by research to really make a difference,” Deyo says, so ask your doctor for a good routine. Do note that in rare cases back pain can indicate more serious trouble; see your doctor if you have symptoms like fever or a weakness in the leg, or if your discomfort doesn’t improve after several weeks.

Sidebar: Why You Want Your Doctor to Look 12 Years Old
For any medical procedure, the patient-doctor relationship is extremely important. So consider this: If you’re in the market for a new doctor, you might want an individual who’s recently completed medical school. For one thing, more newly minted physicians tend to be up on the latest research. A recent study, for example, found that they are more likely than their more experienced counterparts to follow the latest National Kidney Foundation guidelines when deciding who is a candidate for transplantation. Robin DiMatteo, PhD, professor of psychology at the University of California, Riverside, says younger may be key for male physicians; her research suggests they communicate especially well with older women.

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First Published Fri, 2010-02-26 14:30

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