By the time David Rosenthal, PA-C, MHP, DFAAPA, is called in to see patients, their abdomens are often distended so dramatically that they look like they swallowed a basketball.
The culprit is a condition called malignant ascites, which causes recurrent, painful build-up of fluid inside the abdominal cavity. It may develop in patients with cancer who are approaching end of life. Eating, sleeping, moving and getting dressed all become debilitating tasks.
Historically, these patients had to make frequent trips to the hospital to have the fluid drained—an especially grueling task for someone suffering from cancer or another disease. But for the past decade, Rosenthal, chief PA in Interventional Radiology, has been part of a team of physician assistants championing a minimally invasive procedure that allows patients and caregivers to drain the fluid at home as needed.
“It’s a tremendous improvement in their quality of life and independence,” said Rosenthal, whose team recently surpassed performing 500 of these procedures. It is the highest number performed at a single hospital in New England, and possibly the country, he says.
In the past, tunneled catheters used in the procedure were prone to malfunctioning and causing infections. Today’s devices have dramatically reduced such risks, Rosenthal said. In addition, the BWH team says their technique for insertion and use of imaging have been carefully honed to ensure patient safety. Fewer than 1 percent of BWH patients who underwent the procedure have experienced a serious infection that required hospitalization or removal of the catheter, Rosenthal said. The technique was recently published in the Handbook of Interventional Radiology Procedures.
“We’ve really found over the years that these procedures have a lot more benefit than risk,” he said.
Physician assistant Yaralia Kelleher, PA-C, who trained under Rosenthal in Interventional Radiology, says their team’s combined experience and knowledge have significantly improved patients’ quality of life.
“We have been carrying out these procedures proficiently and efficiently, resulting in high-quality care for these patients,” Kelleher said.
Moreover, safety doesn’t start and end in the procedure room.
“Choosing the correct candidate for the procedure is a major consideration,” Kelleher said. “If someone is too sick to undergo it, we might recommend they don’t. Being able to identify those patients is a result of the expertise we’ve gained from doing these procedures.”
For those who are able to safely have the tunneled catheter inserted, the immediate relief it provides has been personally and professionally rewarding to see, said Courtney Atkinson, PA-C, a physician assistant who joined the Interventional Radiology team last year.
“It feels like we make a big different for patients and their families in a really critical time,” Atkinson said.