Old Knees

It was a cold winter Saturday morning, and I head to the gym for my usual pickup basketball. I get there late and and was not able to warm up. We had next game. First play of the game, I get an outlet pass by the sideline and make a cut towards the basket. I drop to the floor in excruciating pain…POP! My knee starts to hurt as I recount this. As I drop to the floor, I close my eyes and I can visualize my knee popping.

Going to the doctor, I was hoping for the best, maybe a severe strain. As a precaution, she ordered x-rays first to check if there were any issues with my bones. As the x-rays came back negative, I was then sent to a physical therapist to do another evaluation. He literally asked me a few questions, barely touched my knee, and then referred me to get an MRI (which I should have done in the first place). The MRI showed a torn anterior cruciate ligament (ACL) and meniscus. Onto the orthopedic surgeon. He was able to provide me some options, where I decided to take tendons from my hamstring to repair my ACL. All in all, this process took 2 months from injury to actual surgery…something is seriously messed up with our healthcare system. This is timely to what is currently going on with the Trump administration trying to repeal Obamacare. Please don’t be stupid, just watch Last Week Tonight.

The ACL is located in the center of the knee joint where it runs from the backside of the femur (thighbone) to the front of the tibia (shinbone).The ACL runs through a special notch in the femur called the intercondylar notch and attaches to a special area of the tibia called the tibial spine. I do not want to bore you with all the technical terms about the ACL, you can just look that up yourself, but the main purpose of the ACL prevents anterior (forward) movement of the tibia off of the femur, as well as hyperextension of the knee (a straightening movement that goes beyond the normal range of motion in the joint).

Screen Shot 2017-03-08 at 10.22.25 AM

There has been tremendous advancements in ACL procedures. When my dad got his ACL repaired 20+ years ago, the doctors had to cut open his entire knee and suture together the torn ends of the ACL. This has been shown to be unsuccessful, as there were a staggering amount of re-injuries. The current norm is ACL reconstruction using patellar tendon or hamstring tendon grafts. This is now done arthroscopically. Artificial grafts (LARS) can be used in certain circumstances and return to sport can be within a few months, however good quality evidence is lacking on this procedure, and many clinicians are concerned on the long term viability of the artificial graft.

So what can we expect next from ACL reconstruction? Feeling fearful of actual surgery, it would be a cool if there was something that wraps around your knee that magically repairs your injury, or just use a healing spell from Harry Potter.

Instead, something almost like magic, Dr. Martha Murray has been developing a new surgical technique that could revolutionize the management of ACL injuries. The Bridge-Enhanced ACL Repair (BEAR) surgery uses a sponge bridge to connect the two ends of a torn native ACL. A special protein infused sponge-bridge is placed in between the two torn ends of the torn ligament, and the sponge is injected with the patient’s own blood to create a clot and a healing scaffold. The surgeon draws the two ends of the torn graft into the sponge, and allows nature to take over and knit the ligament together naturally over time. If you’re finding that hard to visualize, here is the link to the video. Can I be a part of the phase 2 trial?!

Screen Shot 2017-03-08 at 10.13.08 AM

After speaking to numerous people who had their ACL reconstructed, I am feeling hopeful with my recovery. To help with my motivation during rehab, I will have 3 goals for the year after my surgery.

  1. Run a half marathon
  2. Squat 225 lbs.
  3. Have a 30 inch vertical leap.

 

Virtual Reality and Healthcare

Being in the technology industry, there are so many topics that came to my mind when trying to write my first tech blog post. Everything from artificial intelligence  to autonomous cars, there are so many interesting options. I could talk about mobile optimizations and driving conversions on mobile sites and apps, but I do enough of that everyday at Moovweb. Then it hit me…I had my first volunteer session for the Boost program at UC Berkeley this past week. I mentored and helped the 10th grade students with their business plans for their end of the year presentation. These high schoolers are placed into groups based on their interest (technology, entertainment, food / beverage, fashion, etc), where they brainstorm different ideas to build their businesses from. It was fitting that I was placed with the students that are interested in tech. My group pitched me a virtual reality headset specific for the healthcare industry. I was very impressed with what they presented; they are an incredibly smart group. This aligns perfectly with what my site is all about, marrying healthcare with cutting edge technology.

Let’s not confuse virtual reality with augmented reality. Virtual reality (VR) is an artificial, computer-generated simulation or recreation of a real life environment or situation. It immerses the user by making them feel like they are experiencing the simulated reality firsthand, primarily by stimulating their vision and hearing. Augmented reality (AR) is a technology that layers computer-generated enhancements atop an existing reality in order to make it more meaningful through the ability to interact with it (i.e. Pokemon Go). AR is developed into apps and used on mobile devices to blend digital components into the real world in such a way that they enhance one another, but can also be told apart easily.

The use of VR headsets is growing exponentially. It has evolved from starting out as a gaming and entertainment system, and along the way it has picked up various application uses. None more important than for the use in healthcare. My first thought was VR headsets can be used for doctors and medical students to to train and practice difficult procedures. With visual simulation combined with force-feedback technology, the user could experience both visual and physical feedback when practicing a surgery. Training medical professionals is expensive, and there is limited time and space for trainees to witness surgery themselves. There have been surgeons that performed procedures, and the whole operation was broadcast live through virtual reality.

Medical professionals learning a neurological procedure.

Medical professionals learning a neurological procedure.

There are other areas within healthcare that can benefit from VR. VR can be used to treat neurological disorders. VR simulators have been used to treat patients with conditions such as post-traumatic stress disorder (PTSD), patients with severe pain, phobias, and cognitive disorders. Clinicians expose their patients gradually to stimuli that trigger their traumatic stress responses, allowing them to help the patients recover.

For preventative medicine, VR can be used to help educate users on the effects of poor life choices, including smoking, overeating and eating unhealthy foods, and drug usage. Studies found that virtual reality to be much more effective than educational pamphlets or videos at getting the message across and prompting behavior change. The brain experiences and processes a virtual-reality scenario in the same way it does a real experience. Virtual reality researchers have shown that letting people experience the future today makes them more likely to change present-day behaviors.

VR is still in its early stages. This is just scratching the surface with the possibilities in the medical field. Cost and public buy in is necessary for it to gain traction. But smart, adaptive virtual simulations that learn as a patient interacts with it will revolutionize decentralized patient-focused care and fundamentally change the way healthcare is delivered. I envision doctors using virtual reality headsets to perform live procedures from anywhere. This would not be virtual reality anymore, but instead using the headsets to help perform operations from remote locations. They would virtually control robots that can operate in their place. This has the possibility to bringing specialist from all over the world to help treat people in different locations.

Doctors will be able to perform procedures and control robots as if they were playing a video game.

Doctors will be able to perform procedures and control robots as if they were playing a video game.

Advancements in Stents

Welcome! After a year of saying I would create my own website, I have finally done it! I wanted to start my own personal site because I wanted to talk about what interests me the most: life-altering and cutting edge advancements in the biomedical field (don’t worry, these will not read as scientific papers), as well as innovative and disruptive products in technology.  My inspiration to start my blog came from my wonderful and supportive girlfriend, Alessa. Go follow her blog at What Are You Going To Have

For my first post, I’m going back in time and talk about stents, medical devices I researched for my senior project / thesis at Cal Poly. Stents are small, expandable tubes that treat narrowed arteries in the body. In people with coronary heart disease caused by the buildup of plaque, stents can help with the following: open narrowed arteries, reduce chest pain, and help treat heart attacks.

screen-shot-2017-01-05-at-10-15-27-pm

Stent being deployed into the coronary artery, expanding the balloon and stent, and pushing the plaque against the artery wall. This opens the artery for blood flow.

My stent research was on coronary stent implementation for diabetic patients. In my experiments, I simulated a diabetic patient’s heart using blood vessel mimics (BVMs). To make this as humanistic as possible, I used fluids that contained endothelial cells with similar viscosity to blood, a pump with comparable pressure to the heart, and placed it in an incubator the same temperature as a human body. As this was done back in 2011-12, biodegradable / bioabsorbable stents were not yet available. So we resorted to the old- fashioned bare metal stents.  

Since diabetic patients have a higher risk of restonsis (re-narrowing of the artery), I focused a lot of my research on drug-eluting stents. Depending on the type of drug that coats the stent, these stents help prevent clots for forming and help with prevention of plaque buildup on the stent itself. It has been a few years since I performed this initial research, and looking at new advancements in stents, there have been some ground-breaking discoveries. 

Biodegradable stents, once they degrade, leave behind only the healed artery or vessel. Because the stent is no longer there, the risk of thrombosis is unlikely (one of the previous concerns around bare metal stents). This would have been way cooler to study, and with the accepted use of biodegradable stents, why even bother with the classic bare metal stent? However, as with everything, biodegradable stents have their limitations. Polymeric biodegradable stents lack strength, which can result in early recoil post implantation. Metal biodegradable stents have the risk of corrosion and increased toxicity. 

Where am I going with this…? Stents are very interesting and have saved countless of lives, but what if there was a way to prevent clotting, without thrombosis? I am interested in both bio and technology, and thought it would be cool if I came up with an innovative idea to help monitor blood flow after stents are implanted. With the explosion of Internet of Things (IoT), the world is becoming more connected. My initial thought was to attach sensor to the stents in order to view the blood flow on a mobile device. The phone would send an alert when there has been some build-up, thus catching the build-up early enough without having to go to the hospital to run tests. Instead, the patient could let his/her doctor know and take appropriate measure – ultimately this could help with  preventing restonsis. Mainly, I thought it would be really cool to watch one’s blood flow on their mobile device. 

screen-shot-2017-01-05-at-10-05-46-pm

Sensors attached intravenously that transmits information on blood flow, heartbeat, and blood flow volume.

But with the introduction of biodegradable stents to the market, this idea seems to be less valuable. So maybe, rather than adding sensor to the stents, perhaps we could think about adding sensors throughout the patient body to monitor blood flow. This could potentially be used as an early detection mechanism to prevent blood clots, coronary artery disease, or heart attacks.  

Enjoy! This is my first blog post ever…go easy on me.