Departments

Local Health Centers Offer the Best of the Best 

The medical world is a fascinating place, with milestones and breakthroughs marking eras in history. We take a lot of it for granted having grown up in the 21st century—we’re lucky!—but some day, history will point to now as the time for technology being brought to the forefront. In the Fox Cities, our local health centers offer the best of the best when it comes to leading technology.

GyroStim

There’s a buzz and energy in the air when it comes to new technology, and it’s no different at Neuroscience Group. Appleton’s Summit Concussion clinic within Neuroscience Group in Appleton is proud to bring the first GyroStim machine to the state, it being the fiftieth installation worldwide. The FDA-designated machine is a versatile, non-invasive, and cost-effective way to treat balance and vestibular disorders, concussion, TBI, and other neurological conditions. The group’s goal is to also use it to enhance sports performance.

“We’ve given (the GyroStim) a bit of an acronym: SMART,” Nichole Siebert, GyroStim Specialist, says. “Sensory, Motor/Multi-axis Automated Rotational Therapy. It’s a computer controlled way that we can challenge the entire vestibular system in ways that we can’t do manually.”

“A concussion is a blow or jolt to the head that results in an alteration in normal brain function,” Dr. Benjamin Siebert, MD, FAAPMR, adds. “Headaches are the most common symptom… dizziness, unsteadiness, vision changes, cognitive issues, memory loss, ringing in the ears, loss of smell and taste. Those are typically what we see.”

The EyeBox test is used first to diagnose concussion amongst its patients, the first step or line in defense before heading to the GyroStim. The computer-based device shows a short movie with pictures going around the screen in order to track eye movements and determine.

“It gives us a ton of data on specific things our eyes, our pupils are doing,” Dr. Benjamin Siebert explains. “All of it generates a single score that’s specific to concussion. It’s one more tool to use.”

Next in the comprehensive approach to concussion and vestibular disorders is the impressive 
GyroStim, “a treatment option that utilizes a rotating chair, which moves in multiple directions and speeds, to stimulate the brain and body. This device is designed to provide specific types of sensory input to the brain and stimulate neuroplasticity, which is the brain’s ability to reorganize itself and form new neural connections.
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“It’s cool!” Dr. Siebert laughs. “But I see it as an arm of the treatment that we offer… it’s one piece that’s part of the bigger picture. It helps to train different aspects of your vestibular system.”

While the movement and “spinning” may seem counterintuitive for those suffering from nausea and dizziness, Dr. Siebert explains that navigating the world with such disorders can be overwhelming and overstimulating, the GyroStim provides a controlled environment to practice movement and hand-eye coordination in the form of laser targets and cognitive techniques like counting to ten or reciting the alphabet while the machine is moving.

“It’s a controlled room, there’s nothing around them and we’re moving them but we’re telling them what to do and how to hit the targets. You’re controlling your hand-eye coordination in a slow dose,” Dr. Siebert says. “This is controlled stimulation. We’re starting off super slow. Then as we pick it up, we’re training their brain to tolerate that stimulation. It’s a training tool.”

“I usually tell patients that it’s like if you have a surgery and then you have to do physical therapy,” Nichole says. “You go slow and you build your range of motion and your strength. It’s the same idea with your vestibular system.”

Cardiac CT with Fractional Flow Reserve

Although the cardiologists at the Heart and Vascular Institute of Wisconsin in Appleton have had a cardiac-dedicated CT scanner since 2006, use of a cardiac-focused CT scanner has joined other technology, such a EKGs, Echo sonograms and Nuclear Cameras (aka SPECT) as a core diagnostic tool for heart and vascular disease.

Computed tomography, more commonly known as a CT or CAT scan, is a diagnostic medical imaging test. Like traditional x-rays, it produces multiple images or pictures of the inside of the body. Coronary computed tomography angiography (CCTA) is a heart imaging test that helps determine if plaque buildup has narrowed the coronary arteries, the blood vessels that supply the heart. Plaque is made of various substances such as fat, cholesterol, and calcium that deposit along the inner lining of the arteries. Plaque, which builds up over time, can reduce or in some cases completely block blood flow. Patients undergoing a CCTA scan receive an iodine-containing contrast material as an intravenous (IV) injection to ensure the best possible images of the heart blood vessels.

The most recent technological advancement with cardiac CT is the use of Fractional Flow Reserve, otherwise known as CT FFR.

According to Heart and Vascular Institute cardiologist Dr. Robert Wilson “CT FFR is an advanced technology that provides detailed information about your heart, how blood flows through your arteries, and the extent and type of coronary plaque buildup. If your cardiac CT indicates a blockage in your arteries. FFR will provide us with further information to better understand the extent of your blockage and determine if the blockage should be treated medically or is significant enough to require an invasive procedure or surgery. This is a game changer in our ability to make a more accurate clinical diagnosis, determine a treatment plan, and potentially avoid unnecessary radiation, procedures, or surgery.”

Left Atrial Appendage Closure Device (aka Watchman)

On the left atrial side of your heart is a finger-like appendage which is a small pouch. Like your appendix, your left atrial appendage (LAA) doesn’t have a clearly understood purpose in your body but it can present some problems. As your heart contracts with each heartbeat, blood is squeezed out of the left atrium and into the left ventricle (bottom left of your heart). However, if you have atrial fibrillation (Afib), blood can’t be squeezed out of your left atrium effectively, and can therefore collect in your left atrial appendage, form a clot, and increase your chances of that clot traveling to your brain and causing a stroke.

According to Heart and Vascular Cardiologist Dr. Cherian Varghese, “Everybody has a left atrial appendage of some sort, but the size and anatomy varies. The appendage becomes problematic when blood stays longer in the atrium and blood clots can form. A person with atrial fibrillation is five to seven times more likely to have a stroke so it is very important to reduce the risk for blood clots. For many people the approach would be to take blood thinners to reduce the risk of clotting. But some patients cannot tolerate blood thinners, or have a high bleeding risk, and that’s where the Watchman device can be an effective alternative. Basically, a Watchman procedure is when we can, without open heart surgery, implant an umbrella-like closure that seals off the appendage and prevents blood from clotting there. People are discharged the same day or next day and most can stop taking blood thinners within a few weeks of having a Watchman device implanted to close off their LAA. It really is life changing.”

CardioMEMS

Although we have made progress in the treatment of many forms of heart disease, heart failure is a growing problem in the United States. Current estimates are that nearly 7 million Americans over the age of 20 have heart failure with almost a million new cases being diagnosed annually.

It is estimated that 1 in 4 people are likely to develop heart failure in their lifetime. Because of the serious nature of heart failure, it is important for your cardiologist to monitor your health more frequently than periodic office visits. That’s where a CardioMEMS device becomes an effective tool.

According to Heart and Vascular Institute cardiologist Dr. Brian Guttormsen, “My goals with heart failure are to try and prevent worsening and improve their quality of life. To do that we need accurate data regarding the patient’s status so we can adjust the plan of care and/or medications.

We also want to know when complications are starting so we can keep heart failure patients out of the ER or hospital whenever possible. A CardioMEMS device is a small paperclip-sized sensor implanted via a catheter into a pulmonary artery.

The procedure takes about an hour and the patient goes home the same day. By lying on a specialized pillow for a few minutes each morning, patients can then transmit information about their fluid retention and pulmonary artery pressure to their heart team without leaving their home. This daily source of information can make a huge difference for heart failure patients.”