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Vascular lab offers non-invasive testing (4/30/97)

The University of Texas Health Science Center at San Antonio's new vascular laboratory is especially beneficial for the South Texas population with its high incidence of diabetes. The new laboratory is well positioned to offer vascular diagnostic and clinical services to diabetic patients and all those with vascular disease.

Vascular surgery deals with diseases of the arteries and veins.

Non-invasive testing means no needles, no risk and no pain. The patient may drink and eat normally prior to testing; fasting is seldom required. This results in patient acceptance -- not only are these tests more comfortable and less expensive for the patient than tests formerly given, but people are able to drive themselves home after their completion.

The vascular lab conducts cerebral vascular studies; extremity arterial work; lower extremity studies; abdominal vascular studies, and evaluates trauma cases. Using a duplex scanner, both a sonographic image and Doppler-obtained information are provided with one machine. Patients simply lie or sit on an examining table as a technician moves a wand over their skin.

Mellick T. Sykes, MD, associate professor, is medical director of the Health Science Center's vascular surgery division and Joan Godsey, registered vascular technologist, is the technical director.

"I had worked with Joan when she was the technical director of a laboratory originated by pioneers in the vascular field, local physicians Drs. David J. Mozersky, Edward A.Wolf, Ronald Blumoff, and Gerardo Ortega," Dr. Sykes said. "We were fortunate to learn from the best. Their contributions to the field of vascular surgery have been invaluable.

"In addition, we are fortunate to work with Julio C. Palmaz, MD, professor, and Carlos E. Encarnacion, MD, associate professor in radiology at the Health Science Center. Both physicians are widely recognized leaders in the field of angiography. Dr. Palmaz developed the Palmaz stent, now marketed by Johnson & Johnson and in use throughout the world.

"Mrs. Godsey has extensive, varied experience in nursing as well as vascular testing. We are both interested in solving problems connected with vascular surgery, using non-invasive technology, and this lab has given us that opportunity."

"This is the '90s," said Dr. Sykes, "and traumatic wounds such as gunshot wounds, stab wounds and automobile accidents are frequent. It's necessary to be able to evaluate the vessels, the abdomen, the kidneys and liver, and also blood clots - areas which have clinical importance because of the current environment.

"Initially good non-invasive testing wasn't available in this field or if it was, the expense made it prohibitive," he continued.

Joan Godsey has been interested in vascular medicine since 1976. "When I entered the field, there weren't that many vascular laboratories in the country. This discipline had only recently been developed - it came about in the early seventies. At that time we were doing physiological testing, using Doppler pressure measurements for evaluation."

The Doppler probe, which provides spectral analysis audibly and in color, was named after its inventor, Johann Christian Doppler, an Austrian scientist. Wave frequency such as sound varies with change in distance between the source and the receiver. The Doppler probe measures blood velocity under the skin. This non-invasive diagnostic instrument can be used for a variety of procedures - to determine the blood flow velocity in different locations in the heart; to find the patient's systolic blood pressure; to listen to a fetal heart rate; or to measure the uterine artery blood flow velocity during pregnancy. Wave frequency, such as sound, varies with direction and speed, allowing accurate measurement of blood flow velocity and any changes that have occurred, since changes indicate the presence of vascular disease.

"Back before World War II," Dr. Sykes explained, "vascular disease could be proven beyond doubt only during autopsy. It has always been common but nothing much could be done. We lacked the proper tools to make an accurate diagnosis.

"During the '40s and '50s," he continued, "angiography - dye injected into an artery and then X-rayed - began to be used. This test was wonderful; it ushered in the golden age of vascular surgery.

"Throughout the '60s, '70s, even into the '80s, angiography was still the mainstay for certain definitive diagnoses of vascular surgery," Dr. Sykes said. "There were problems, however - it was expensive and there were risks involved. The patient had to lie perfectly still and if a vessel occluded (closed or collapsed), there was a risk of a stroke, or ischemia.

"In the early '70s," the physician continued, "cardiothoracic surgery and vascular surgery became two separate disciplines. Each required a two-year fellowship after five years of general surgery. Prior to that time, chest surgeons treated both the thoracic area and vascular problems.

"Once vascular surgery became a separate discipline, vascular laboratories were established throughout the country," Dr. Sykes said.

Joan Godsey worked in the first vascular lab in San Antonio. "It was a multi-location practice," Joan said. "We did not have the imaging equipment in those initial stages that we have now.

"Significant technological advances were made in the late '70s and early '80s with the development of the color duplex scanner, which provides both a sonographic image and Doppler- obtained information."

Both Dr. Sykes and Mrs. Godsey said that technicians who work in a vascular lab not only have to be knowledgeable enough to make an accurate judgment when they look at the screen during the imaging process, they also must be familiar with the patient's symptoms as well as audio variations to be able to judge each sound accurately.

Kristy Cox, a registered vascular technologist who works in the lab, added, "We must determine not only whether the sound is normal, but also if it is normal for that particular patient."

"That's why having the right people for this job is so important. Their expertise is everything," Joan said.

In addition to Joan Godsey and Kristy Cox, Kevin Franklin, vascular technologist, and Amy Pace, secretary, round out the team.

"We are very fortunate to have such experienced technologists," Joan added. "Their job is very subjective and the accuracy of the tests performed, both from the visual imaging and the audio testing standpoint, is dependent upon their judgment."

Mrs. Graciela Elizondo, San Antonio, who recently had some work done at the lab, sums up remarks made by numerous patients who have visited the vascular laboratory during the past year. "In the whole time I've been coming here," Mrs. Elizondo said, "I've never been treated as nicely anyplace in the system as I have been in this laboratory."

Last year in an annual physician satisfaction survey, the vascular lab rated highest among the support services. Both Mrs. Godsey and Dr. Sykes are pleased because at the time the lab was fairly new.

"We are currently in the process of expanding." Mrs. Godsey explained. "We are going from one to three rooms."

Dr. Sykes is now working on a database to improve reporting efficiency and research collaboration opportunities.

Meanwhile, the Health Science Center's vascular lab employees continue to pamper their patients and provide quality service.

Contact: Jan Elkins (210) 567-2570