Surfing the Winds of Change

An excerpt from University of North Dakota School of Medicine & Health Sciences 1/3/2010

By Gary Niemeier

A Technophile's Dream Job
Even as Edward Fogarty, MD mentions kite sailing as a way of integrating physics into an extreme sport, he never strays far from his view of radiology as the ultimate playground for a tech-obsessed doctor. Without question, he says, the computer has been the biggest agent of change. It has allowed for CT (computed tomography) scanners that can image the entire heart, taking a rapid series of photographic "slices” in just one beat. (He proudly notes that MedCenter One has the only 320-slice scanner in North Dakota.)

But mention that most vital of organs, the brain, and Fogarty really gets excited. Stroke victims, for instance, have always been vulnerable to the time delays typical with MRI (magnetic resonance imaging) scans, which take up to 45 minutes. "The ability to have CT data,” he says, "in all of three minutes, tracking the blood flow through the brain—this enables the neurologist or ER doc to say with confidence, ‘this person is having a stroke right now,' and they administer a powerful, yet risky drug that can eliminate the blockage in the affected cerebral artery. It's pretty amazing to see that!”

 

Fogarty also points to an important shift in radiology from its traditional role of "defining structure to find pathology,” to an evolving new frontier where function itself is being revealed. Breast specific gamma imaging and PET (positron emission tomography) imaging provide a functional roadmap where active cancer cells are targeted (labeled). These functional tests make cancers easier to diagnose and allow the care team to track responses to therapy with greater precision. Fogarty states the obvious benefit: "Cancer drugs are not a walk in the park. This information means we don't have to over treat patients.”

"The ability to have CT data in all of three minutes... enables the neurologist or ER doc to say with confidence, ‘this person is having a stroke right now."

From "the Bends” to Brain Healing
Fogarty's open-mindedness has led to an out-of-the-box opportunity in defining how hyperbaric oxygen therapy (HBOT) is helping brain-injured patients. He's teamed with Dr. Paul Harch of Louisiana State University, an unsung hero of medicine, using HBOT to improve the neurological function of many brain-damaged patients. Dr. Harch's understanding evolved out of the treatment of brain-injured divers.

With the ongoing warfare in Iraq and Afghanistan, blast injury to the brain has become an epidemic, and Fogarty is clearly passionate about extending the benefits of HBOT to these "silent injuries,” often suffered by soldiers from roadside bombs. He notes, "The patriotism and graciousness in North Dakota is such that we have a greater percentage of our citizens at risk. We are not doing enough to define, by imaging, the real pathology. It's how I'd like to give back to the community.”

Fogarty and Harch have published a case report on the method of healing the brain by HBOT and tracking this with functional neuroimaging. He credits two North Dakota natives, Steve Reimers and Linda Butts, for introducing him to Harch. "He's a real pioneer, and I just happened to be a lucky guy, the squirrel that came across this cache of medical chestnuts.”

As if he weren't busy enough, Fogarty is also working with Jon Allen, MD '84, the director of UND's Clinical Education and Simulation Center, to make classic radiology cases available to students by computer.

What drives this windsurfing doctor to achieve so much? "It's a calling. I'm in the right place at the right time, and every day there's something new. I've never had a boring day.”

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