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11/01/05
Announcer>> This Life and Times health care special is made possible by a grant from QueensCare, a public charity providing health care to the low-income and uninsured residents of Los Angeles County.
Val Zavala>> Tonight on Life and Times --
Why is a disease linked to heavy drinking showing up in children?
Dr. Rula Harb>> This is a biopsy of a child who is twelve years old and, if you probably took this to show it to an adult hepatologist or an adult gastroenterologist, they may think that this is the liver of a fifty or sixty year old alcoholic, for example.
Val Zavala>> And then, brushing may be more important than you know. Why bad teeth can delay life-saving treatment.
These stories and more next on tonight's Life and Times.
Announcer>> Life and Times is made possible through the generous support of the L.K. Whittier Foundation dedicated to improving the quality of life by supporting innovative endeavors in the fields of medicine, health, science and education.
And by a generous grant from Jim and Anne Rothenberg.
Val Zavala>> Liver disease used to be the domain of alcoholics, but no longer. Doctors are noticing a second culprit that is putting thousands of Americans on the liver transplant list. So what is it? Kyung Lah met one man who found out for himself that liver disease is not always about drinking.
Kyung Lah>> Sal Godoy is a man of routine. The fifty-three year old architect enjoys a daily chat with the neighborhood kids.
Sal Godoy>> "You want to walk down to the mailbox? Let's go."
Kyung Lah>> Then a stroll around the block. But lately, those walks are shorter, tougher and broken by rest on the bench.
Sal Godoy>> I get winded and lose my breath when I get to the top and I get dizzy, and I was wondering what's going on.
Kyung Lah>> What's going on? Sal's liver is failing. Doctors diagnosed him with cirrhosis of the liver, a shocking diagnosis for Sal and his wife.
Linda Godoy>> She advised me to tell your husband to stop drinking and I asked her, I said, "What are you talking about?" She said, "Well, we just got his lab results back and he needs to stop drinking." I was livid. I was so upset, you know, because my husband's never been a drinker.
Dr. Francisco Dorozo>> "The liver is pretty nodular. The surface is nodular."
Kyung Lah>> In most cirrhosis cases, the cause is drinking. But Sal's doctor says, in his case, the cause wasn't alcohol, but fat overrunning the liver so that it doesn't filter anymore. It's an irreversible condition called Nonalcoholic Steatohepatitis, or Fatty Liver Disease. Doctors often call it NASH.
Dr. Francisco Dorozo>> It's undistinguishable on liver biopsies from alcoholic liver disease.
Kyung Lah>> So someone who never drinks could have the liver of somebody who does drink?
Dr. Francisco Dorozo>> Exactly, and the only way to distinguish it is by history.
Kyung Lah>> And the impact is the same as cirrhosis and severe liver failure. Only a liver transplant will save Sal's life.
Sal Godoy>> My son and daughter, hopefully down they line, they'll have grandkids and I hope I'll be able to run around and play with them.
Kyung Lah>> Sal controls the disease with medication from blood thinners to diuretics, but his liver continues to fail. He's cut back on work, given up Little League coaching. A die-hard USC alumna and Trojan fan, Sal wears the championship ring from last year and prays he'll see another.
Sal Godoy>> The liver, to me, is like the engine making the whole body function by feeding it, but you know, with the breakdown that I'm experiencing now, different parts of my body are starting to kind of fall apart now.
Kyung Lah>> Sal is also a diabetic. Researchers are trying to understand if diabetes speeds up Fatty Liver Disease. Dr. Francisco Dorozo is Sal's doctor and a leading researcher of NASH at UCLA. He says the strongest trigger is obesity.
Dr. Francisco Dorozo>> This is very prevalent in the population. I think it's the most common cause of abnormal liver tests in the United States.
Kyung Lah>> The National Institutes of Health says two to five percent of Americans will suffer liver failure even though they don't drink. Those numbers are expected to grow as America gets fatter. The wild card for researchers? Why some thin patients end up with too much fat in their livers.
Dr. Francisco Dorozo>> Some of them are really thin, very slim, never obese and young and already they have significant disease.
Kyung Lah>> And you don't know why?
Dr. Francisco Dorozo>> And I don't know why. That's why we are working because this is going to become a public health problem.
Kyung Lah>> So far, organ donation remains the only magic bullet once patients hit liver failure, and there's yet another problem: more obese people mean more obese donors and more unusable livers.
Donna Gracon>> They found out that at least a quarter of the livers where the families had agreed to be organ donors were unusable because there was too much fat.
Kyung Lah>> So not only do you have people who are suffering from Fatty Liver Disease, the livers that are potentially being donated have too much fat in them to be used?
Donna Gracon>> Exactly.
Kyung Lah>> While the exact cause of Fatty Liver Disease is not known, what is known and noted by researchers here at Children's Hospital is that its victims are getting younger and younger.
Dr. Rula Harb>> Unfortunately, this is something that we're starting to see a lot more frequently.
Kyung Lah>> Why?
Dr. Rula Harb>> Well, I think the lifestyle and the degree of obesity that's been increasing has a lot to do with this.
Kyung Lah>> A pediatric gastroenterologist, Dr. Rula Harb, says Fatty Liver Disease is no longer an adult disease. But in children, there are no symptoms.
Dr. Rula Harb>> This is a biopsy of a child who is twelve years old with NASH and, if you probably took this to show it to an adult hepatologist or an adult gastroenterologist, they may think that this is a liver of a fifty or sixty year old alcoholic, for example, and this is the kind of thing that you see now in children.
Kyung Lah>> The solution may be in preventing obesity. Caught early enough in childhood, research suggests the damage to the liver might be reversed with exercise.
Dr. Rula Harb>> Diet and exercise make a huge difference and I think people under-estimate that.
[Film Clip]
Dr. Rula Harb>> Something as simple as going out and playing, riding your bikes, talking a walk around the block, walking to the post office (laughter), will help. Every little bit helps.
Kyung Lah>> Sal now sits on the organ transplant list waiting for a usable liver that his family knows may never come.
Linda Godoy>> More recently, Sal and I have had a lot of heart to heart talks. We've sat down and talked about what-if, you know. What would happen if we don't get that phone call? If that liver isn't available? We've had to face what it would be like to have to deal with death and he's shared with me a lot of things that he would like as part of his service, just a lot of thoughts, you know, that he's had. So I've been keeping a journal and I've been putting pictures aside to be prepared and it's just a fact of life. You know, we need to be ready.
Kyung Lah>> Sal and six million non-drinkers live with liver failure due to fatty livers knowing, even if they lose weight, there is no treatment. Are you optimistic?
Sal Godoy>> Am I an optimist? I am very optimistic. I've always lived the model that things will happen when you're not a hundred percent and you never say the word "can't" because can't is not in the vocabulary. We all hit bumps on the road, but I'll straighten out the road and make things work and I plan on doing the same thing with this liver disease.
Kyung Lah>> I'm Kyung Lah for Life and Times.
Announcer>> Kcet.org is the place to look for the very latest on Life and Times. You'll find previews of upcoming stories, transcripts and audio of past episodes and links to some of our most interesting features. Just go to kcet.org and click on "Life and Times".
Val Zavala>> They're only baby teeth, so you don't have to take care of them, right? Well, that's a fallacy too many mothers believe in and that's why so many young children have mouths full of cavities. But you may not realize that poor dental health can also delay vital medical treatment. Hena Cuevas has the story of one little girl who had no time to lose.
Hena Cuevas>> When three year old Lexie was diagnosed with cancer two years ago, it became a race against time.
Laura Yanez>> She had a tumor and it was cancer and it went to her lungs.
Hena Cuevas>> Doctors told Laura Yanez that her daughter's cancer had already spread so much that Lexie had to begin radiation and chemotherapy as soon as possible. So she was sent to see oncologist, Paula Groncy. Dr. Groncy told Lexie's mother something she never expected to hear. Before treatment could begin, the little girl first needed to see, of all things, a dentist.
Laura Yanez>> We were really surprised because we didn't it would interfere with her getting chemo or anything because her teeth needed to be fixed.
Hena Cuevas>> The problem? The intense treatments for cancer were going to weaken Lexie's immune system.
Dr. Paula Groncy>> When she gets very low blood counts, she can get infected simply from germs from her own body such as the mouth. For that reason, we wanted to make sure that her teeth and her mouth were in good clinical condition.
Hena Cuevas>> At Miller Children's Hospital in Long Beach where Lexie is being treated, every child diagnosed with cancer is referred to an in-house pediatric dentist. Lexie was assigned to Dr. Afsaneh Matin.
Dr. Afsaneh Matin>> "How big can you open? Let me see all the way."
Hena Cuevas>> Her baby teeth were in such bad shape they needed extensive dental work.
Dr. Afsaneh Matin>> Other than two of her teeth which have like fillings on them, everything else is covered with metal caps, and it was because her teeth were so badly decayed that we were not able to fix them by putting things in the teeth, but rather we had to cover them.
Hena Cuevas>> This type of dental work takes time and, in the worst cases, can sometimes postpone the cancer treatment when every day counts.
Dr. Afsaneh Matin>> It can become a potential delay and, on occasion, we have had situations where even chemotherapy had to be delayed at least by days if not weeks so we could get the oral condition under control.
Hena Cuevas>> For Dr. Groncy, this additional step taking care of bad teeth makes her job much more difficult.
Dr. Paula Groncy>> So we do put off dental treatment if it is extensive such as extractions. A different case is for radiation therapy and that has to be postponed until dental treatment has been completed.
Dr. Afsaneh Matin>> It's all interconnected and any minor issue in the mouth can become complicated, can cause pain and discomfort, and can lead to more serious infections and systemic problems.
Dr. Robin Su>> "He's getting a lot of grownup permanent teeth."
Hena Cuevas>> According to the California Dental Association, sponsor of this free dental clinic, tooth decay is the single most common disease in children.
Dr. Robin Su>> "You drink a lot of soda pop, honey?"
>> "No."
Dr. Robin Su>> "Okay."
Hena Cuevas>> Robin Su is one of the volunteer dentists.
Dr. Robin Su>> I've noticed that about fifty percent of the children today actually require dental work and immediate dental work because they have cavities. "You need to take care of it as soon as possible or else she could get what is called a baby root canal."
Hena Cuevas>> What Dr. Su has seen today is close to what a recent study of California children found. Nearly half of those entering kindergarten already have cavities.
Dr. Robin Su>> "How often are you brushing your teeth now?"
>> "Not that often."
Dr. Robin Su>> "Okay, try, sweetheart, in the morning and at night."
Hena Cuevas>> And the primary cause for these high numbers is the same as it's always been: eating too many sweets.
Dr. Afsaneh Matin>> Anything that can be broken down into sugar in the mouth is potentially a source or contributing factor in causing dental decay and, if you combine that with poor oral hygiene, then you have the recipe for major dental issues.
Hena Cuevas>> And it's not just eating sweets and drinking sodas. There may be another contributing factor and that is drinking bottled water. Why? Well, according to the American Dental Association, the water in this bottle contains very low levels of a key ingredient in the fight against cavities in young children and that is fluoride, which is found in abundant quantities in tap water. To get a decent dose of fluoride, dentists recommend drinking both bottled and tap water. But it's more than just what you eat and drink. Parents also need to get children in the habit of brushing their teeth. How early should they begin?
Dr. Afsaneh Matin>> As soon as the first tooth comes in. They don't have to floss and brush and get, you know, super stressed about it, but as soon as teeth come in, they're at risk of developing infections.
Hena Cuevas>> Lexie's mother says she's tried to get her daughter into a routine, but is hasn't been easy.
Laura Yanez>> It's hard to make her brush her teeth because she doesn't want to, and she drinks a lot of soda.
Hena Cuevas>> However, to continue with her cancer treatment, they have to cut the soda to make sure she doesn't get additional cavities, so Lexie was given a new toothbrush and instructions on how to brush.
Dr. Afsaneh Matin>> "So make sure you go around every tooth, little circles, and clean every single tooth because even though they're covered now, the food can still stick to them and cause gum problems and still decay because she has some teeth that are not covered fully."
Hena Cuevas>> Lexie's mother knows that getting Lexie to brush regularly will be a struggle. So if she doesn't like to brush her teeth, how are you going to get her to brush her teeth?
Laura Yanez>> Bribe her (laughter). Tell her we'll give her something if she does it, you know.
Hena Cuevas>> But in the middle of our interview, holding her new toothbrush, Lexie interrupted us.
Lexie>> "I want to brush my teeth."
Laura Yanez>> "You want to brush your teeth?"
Lexie>> "Yeah."
Hena Cuevas>> Following her mother's instructions, Lexie began to clean.
Laura Yanez>> "Now look at yourself in the mirror. Up and down, yeah."
Hena Cuevas>> Dr. Matin says parents need to take a more active role in their kids' oral health.
Dr. Afsaneh Matin>> Good oral habits and hygiene starts early and we'll do our share to take care of them, but we expect parents to do their share of preventing it because we can help treat, but we can't really prevent. It's up to the parents.
Hena Cuevas>> For now, Lexie will continue to get radiation and chemotherapy to help fight her cancer, although Dr. Groncy says her chances for a full recovery are small.
Dr. Paula Groncy>> Lexie had a very highly malignant type of cancer and, unfortunately, very soon after she completed her initial therapy, the cancer came back.
Hena Cuevas>> Right now, though, Lexie is focusing on discovering just how much fun brushing her teeth can be.
Laura Yanez>> "You going to brush your tongue?"
Lexie>> "It tickles."
Laura Yanez>> "Okay."
Hena Cuevas>> I'm Hena Cuevas for Life and Times.
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Val Zavala>> Only smokers get lung cancer, right? Wrong. A good number of lung cancer cases hit people who have never taken a puff in their lives and yet they're lumped in with smokers and often held responsible for their disease. Kyung Lah met two women who say this just isn't fair.
Kyung Lah>> Look hard at Nancy Michener. She exercises, eats right, has never touched a cigarette. She also has terminal Stage Four lung cancer.
Nancy Michener>> Like most people, I believed you needed to be a smoker to get lung cancer, so I just never thought I was at risk. I was forty-four years old and I had never smoked in my life. I was very active. I always bicycled and played single tennis, hiked and walked regularly. Perfect health. And they found a spot on my right lung that wasn't normal, so they repeated the test x-ray to make sure it would show up again and it did.
Kyung Lah>> What showed up was the earliest stage of lung cancer.
Nancy Michener>> Well, I was shocked, shocked beyond belief.
Kyung Lah>> Doctors operated and removed a third of Nancy's right lung. They thought she was cured. Three years later, though, the dark spots on her x-ray showed the cancer came back.
Nancy Michener>> And at that point, they found the cancer was in my ribs. In fact, it had almost completely disintegrated one rib. As a recurrence, I was now diagnosed as Stage Four, which is the final stage of cancer. I was confronted with much less hope in terms of long-term survival.
Kyung Lah>> Chemotherapy and radiation bought Nancy another year. Then this last January --
Nancy Michener>> The cancer had come back yet again, this time in both lungs and likely one other rib. This was even harder to deal with than the other two times. I think every time it comes back, emotionally it's more difficult. From my perspective, if I could get lung cancer, anyone can get lung cancer.
Kyung Lah>> Lung cancer kills more Americans than breast, colon and prostate cancer combined. Now granted, most cases of lung cancer are caused by smoking, but one in five new lung cancer cases strikes people who have never smoked. Dr. Robert Figlin is with UCLA's Johnson Cancer Center.
Dr. Robert Figlin>> We're talking about a disease where the common person thinks that it's smoking or smoking-related. But in reality, that's not -- that's too simple. Not only is it not smoking-related, but there is an increased incidence of men and women, specifically women, who are developing non-smoking related cancers. These non-smoking related cancers are not in households with parents or siblings or jobs where smoking is commonplace in the workplace, but these people are still developing lung cancer.
Kyung Lah>> The reasons why a never-smoker gets cancer, researchers say they simply don't know. Is it an environmental factor like air quality? Or is it genetic? At the same time, while they search for that answer, they face an uphill battle with funding. For every dollar spent on lung cancer research, fifteen is spent on breast cancer and ten on prostate. Why is lung cancer such a hard sell?
Dr. Robert Figlin>> Since the stigma of lung cancer has always been ascribed to the smoker and society has taken a view which some people fight with or disagree with that it's self-caused. You've decided to smoke and, therefore, one of the risks of smoking is developing lung cancer. Society has taken the position that, for whatever reason, this disease is really less funded, especially the resource that translates to people, than other less common diseases like breast cancer and prostate cancer where we've made great strides, but it's really not helped the lung cancer patient at all.
Kyung Lah>> Inside the Johnson Cancer Center, researchers are racing to find the cause and treatment of lung cancer and hopes to make a dent in the death rate which has not improved in thirty years. Dr. Steven Dubinett heads the Cancer Center. So far this year alone, he has spent six months fighting for money.
Dr. Steven Dubinett>> Funding is a constant concern and we happen to be at a very hopeful and golden opportunity in terms of cancer research, particularly in lung cancer. To take advantage of the new opportunities in molecular biology and our understanding of cancer cells requires funding.
Dr. Robert Figlin>> Without question, if you put the adequate resources behind a disease, putting initially that the level of the country that says this is a priority for us to not only stop people from smoking, but to treat the hundreds of thousands of people that develop smoking-related lung cancer every year, there's no question that, with adequate resources, we can approach a cure over the next several decades.
Kyung Lah>> With all the funding that goes to anti-tobacco ads in California, advocates wonder if they've been too effective.
[Film Clip]
Kyung Lah>> Leading people to believe only smokers get lung cancer.
[Film Clip]
Dr. Michael Keane>> Non-smokers have been somewhat ignored because the focus has been on smoking to the degree that smoking brings on lung cancer. That's been the constant.
Kyung Lah>> Because that's been the bigger problem?
Dr. Michael Keane>> Yes, exactly.
Kyung Lah>> So do you believe that these groups should start focusing a little bit more on --
Dr. Michael Keane>> -- I think absolutely. I think people need to start focusing now. I think there has been a huge impact on smoking, but people need to start focusing now on all we can do to help the ex-smokers and non-smokers.
Kyung Lah>> Researchers also point out that millions of dollars collected from tobacco taxes go to research other well-funded cancers, cancers that are not connected in any way to smoking. They say it's not fair.
Dr. Robert Figlin>> This state would have a heart attack if we took stem cell dollars and devoted it to non-stem cell research. I would argue, do not take away tobacco dollars and devote it to anything other than tobacco-related problems.
Kyung Lah>> Kim Norris is a lung cancer advocate, one of the few pounding on doors in Sacramento and Washington. Norris' husband was diagnosed with lung cancer. When he died, she decided to fight.
Kim Norris>> No, I don't think it's fair at all and that's probably what really motivates me. It's a basic sense of fairness. We've done an incredible job with breast cancer. We have over an eighty-eight percent, five year survival rate, for breast cancer. Incredible. Prostate cancer has a ninety-nine percent survival rate. Look what we've done with AIDS. We've proven that, if we put our talent, our resources, our knowledge, behind a problem, we can do it.
Kyung Lah>> Nancy was lucky in that she was diagnosed early. Now she is taking an experimental drug called Iressa. It's a chemotherapy pill that helps some female patients and it's kept Nancy's cancer in check for the last eight months.
Nancy Michener>> That's what continues to give me hope. If I can keep on this Iressa therapy long enough, that they're going to find an even better drug that will cure or even better control the cancer.
Kyung Lah>> While she waits for that day, Nancy wishes she had something less tangible: sympathy.
Nancy Michener>> I compare it to breast cancer. There's a lot of sympathy. There's a lot of support. There's a lot of fundraisers. You won't find that for lung cancer at all. It's just the opposite.
Kyung Lah>> Nancy hopes her story will shed a different light, one that makes you see her just as a victim of cancer and that she deserves all the help she can get as she fights for her life. I'm Kyung Lah for Life and Times.
Val Zavala>> If you'd like more information on liver disease, lung cancer or dental health, you can go to the KCET website. Click on Life and Times and look for our special health page. And that's our program. I'm Val Zavala. Thanks for joining us for this Life and Times health care special. We'll see you next time.
Announcer>> This Life and Times health care special is made possible by a grant from QueensCare, a public charity providing health care to the low-income and uninsured residents of Los Angeles County.
By the L.K. Whittier Foundation dedicated to improving the quality of life by supporting innovative endeavors in the fields of medicine, health, science and education.
And by a generous grant from Jim and Anne Rothenberg.
Sponsored in part by:
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