Do you remember the classic high school physics project where you were tasked with designing a contraption that would protect an uncooked egg from a high fall? At first, this task may have seemed daunting and maybe even impossible, but with a little inspiration, persistence and learning from several scrambled eggs, you likely achieved success. As I am learning in my third year of medical school, this process of problem solving and innovation is how progress is being made at the frontier of medicine.
The surgeon delicately dissected the hypoglossal nerve, carefully separating the intertwined branches of the nerve under magnifying surgical loupes based on each branch’s effect on tongue movement, as confirmed with intraoperative nerve stimulation monitoring. In awe, I watched the surgery proceed and couldn’t help being inspired by the skill and knowledge of the surgeon, a recognized world expert on this operation. I was also inspired by the elegance of the device that was being implanted during the surgery and how drastically this operation could improve the patient’s quality of life.
The device being implanted was newly approved by the FDA in 2014 and is called Inspire Therapy. Named not because of its awe-inspiring effect on medical students, but because the device detects and responds to each inspiration event during sleep in patients suffering from obstructive sleep apnea (OSA). OSA is a debilitating disease that is rising in prevalence, currently affecting 20 to 30 percent of all males and 10 to 15 percent of all females in North America. Due to the collapse of their upper airway and a resulting inability to breathe, patients with severe OSA awaken throughout the night, often upwards of 30 times per hour, gasping for breath. If you have ever been on call, you know the debilitating effect sleep deprivation can have on your ability to function. Now, imagine never being able to get a good night’s sleep. Patients with severe OSA suffer greatly, experiencing an overall two to three times increased risk of all-cause mortality. These patients are at greatly increased risk for cardiovascular problems, metabolic syndrome, type II diabetes mellitus, psychiatric disorders, sexual dysfunction and perioperative complications. The effects of OSA also extend beyond physical health, impairing the patients’ work, relationships and ability to drive. Prior to Inspire Therapy, treatment was limited to a few surgical options only useful for a minority of patients and continuous positive airway pressure (CPAP) therapy — a treatment plagued by noncompliance and disdained by many patients for numerous reasons, with the most common reason being discomfort.
Inspire Therapy is a novel solution for many OSA patients who cannot tolerate CPAP, allowing them to achieve full nights of sleep. It is an innovative remote-controlled device that consists of three parts: a small generator, a sensing lead that detects negative intrathoracic pressure and a hypoglossal stimulation lead designed to activate muscles that protrude the tongue forward. The ultimate effect is an open airway during inspiration, allowing the patient to remain asleep all night long without periods of apnea or hypoxia. Among other impressive outcomes, patients report dreaming during sleep for the first time in decades. Now isn’t that inspiring?
Dr. Boon, the surgeon who I had observed implant the Inspire Therapy device, has performed the operation over 100 times, making him one of the most experienced surgeons in the world with the technology. Dr. Boon has been integral in devising the optimal implementation of this device. His advice to students on incorporating novel technology to improve patient care is to be humble, to realize what you do not know and to seek to fill the gaps in your knowledge.
Inspire Therapy is just one example of novel medical therapies revolutionizing medicine and improving patient care. Other examples abound in the news, such as the novel Chimeric Antigen Receptor (CAR) T-cell Therapy approved recently for blood cancers. This groundbreaking therapy is unique, involving genetically engineering patients’ own T-cells to attack cancer cells. This therapy is providing another option for patients with otherwise limited treatment possibilities.
Further, examples of innovation are ubiquitous in the health care setting, and new examples are continually being implemented. One physician, Dr. Pitou Devgon, is a role model for identifying problematic health care and creating solutions. This innovative physician is founder and president of Velano Vascular. As medical professionals in training, we know from firsthand experience that the most common invasive, inefficient and unpleasant procedures performed in hospitals today are good old blood draws. To date, Velano Vascular is at the forefront worldwide in reducing pain, risk and inefficiencies of vascular access through the development of innovative technology, such as needleless blood draw devices, currently being introduced in various United States hospitals. Hailed by the Wall Street Journal and others for delivering compassionate care, Velano Vascular is truly a leader in modern medicine, challenging historically accepted standards in traditional health care.
Dr. Devgon first came by the idea of needleless blood draw devices while working with a patient as a medical student. Later Dr. Devgon sketched out rudimentary devices on a napkin at a local coffee shop. In a recent speech, Dr. Devgon advised students of medicine to be mindful of problems they encounter while in training, to record them in a journal and to use these ideas as inspiration for novel innovations.
As many of us began to learn early in our education, as future leaders in medicine we can address the seemingly impossible challenges we will face by being persistent, staying humble, observing problems, seeking innovative solutions and learning from our mistakes — ultimately leading to better care for our patients, just as our role models are doing today.