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Life & Times Transcript
2/26/07 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 -- A radical form of therapy is offering hope to paralyzed patients. Kevin Kroushinsky>> I mean, I could raise my hands. You know, I could scratch myself. I could do a lot of things. I could stand. I've been bearing my own weight for the first time. Val Zavala>> And then, it's the best defense against a disease that many of us have forgotten about. Would you face a needle to save a child? 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>> Welcome to this special edition of Life and Times where we focus on health. We begin with a trip to a remarkable place, a place that helps paralyzed people walk again. These are people with serious spinal cord injuries and they claim they can achieve more movement than traditional rehabilitation approaches. How do they do it? Hena Cuevas went to Carlsbad in San Diego County to see for herself. Hena Cuevas>> It looks and sounds just like any other gym. Weights, balance balls, even rowing machines, but here progress is measured one push at a time. Most of the clients can't walk through the door, though someday they hope to. Ted Dardzinski>> "It basically opens those up." Hena Cuevas>> Ted Dardzinski is the founder of Project Walk in Carlsbad. Since 1999, the nonprofit organization has been helping people with spinal cord injuries get back on their feet literally. Ted Dardzinski>> There are no guarantees, but we've been very good at providing the right stimulation and we feel that we're the best at what we're doing. Hena Cuevas>> Just don't ask him for numbers, even though researchers are looking into his program. Dardzinski says that his best evidence are the clients themselves. Kevin Kroushinsky>> "Yeah, that feels good right there." Hena Cuevas>> For two years now, forty year old Kevin Kroushinsky has been working out here. Today he's getting on a bicycle for the first time. >> "Really find that core. Don't be afraid. Chad is behind you, so don't be afraid to use your core a little bit more. There you go. Find it, find it, find it, push down." Ted Dardzinski>> His arms aren't supposed to be very good. He's supposed to be doing nothing below the level of his injury. Hena Cuevas>> Nothing below the neck? Ted Dardzinski>> Yes. When we met Kevin, he couldn't really do anything except shrug his shoulders. He's learning how to stand, he's starting to move his legs, he's starting to push with his legs. >> "Squeeze, squeeze those abs." Hena Cuevas>> Kevin was an avid surfer. In 2004 during a competition, he dove into shallow water and broke his neck. Kevin Kroushinsky>> They said just imagine Christopher Reeves and that would be pretty much my scenario. Respirator, you know, not much movement at all. Hena Cuevas>> He was paralyzed from the shoulders down. Kevin Kroushinsky>> I'd have dreams that I was cast in cement from my waist down. I'd wake up and I'd be like, "Was that a bad dream?" I'd go to try to move and I'd be like, no, that wasn't a bad dream. I'd realize that it was just my situation because I had no movement. Hena Cuevas>> Project Walk has a very different approach from other rehab centers. Traditional therapy focuses on the parts of the body that remain functional, but Project Walk makes clients use as much of their body as possible, even the muscles considered immobile. Ted Dardzinski>> If you don't treat below the level of injury, you're not going to get anything back. Hena Cuevas>> Kevin has been here since 2005. Kevin Kroushinsky>> I had no movement. I had no -- you know, I couldn't do anything at all. Hena Cuevas>> What can you do now? Kevin Kroushinsky>> Well, I could raise my hands. You know, I could scratch myself. You know, I could do a lot of things. I could stand. I've been bearing my own weight for the first time. >> "Ready? One, two, three, drive." Ted Dardzinski>> It doesn't matter that he's not pedaling like Lance Armstrong. All that matters is that he's using everything that he has in his body. >> "Break?" Kevin Kroushinsky>> "Yeah." >> "Okay." Hena Cuevas>> Dardzinski's method, as it's called, revolves around a simple premise: exercise. No part of the body is off-limits, not even the so-called dead limbs. Ted Dardzinski>> Forget about spinal cord injuries. Take an able-bodied person, put me in a Lazy Boy recliner, drug me so I can't move. Eight months later, come in and say fire. Take me off the drugs. I'm going to lose my muscle mass. I'm going to start losing bone density. I'm going to start losing nerve functions. Hena Cuevas>> Basically to have a healthy body, you need to work out and it's even more important for those with injuries to the spine. Ted Dardzinski>> Project Walk is basically trying to show that the exercise can even help the healing process. Hena Cuevas>> Dardzinski never expected to be doing this. He's a physical therapist, but had no experience with people with spinal cord injuries. Then in early 1999, his friend Mike was in a car accident. He was paralyzed and asked Dardzinski for help. Ted Dardzinski>> I picked up his leg. He had a spasm and I actually dropped his leg because it moved and it thought he was paralyzed. Because of my ignorance, I thought it was good. He told me it was bad. He took medication to get rid of these things. Hena Cuevas>> But Dardzinski saw the spasms as a positive sign that somehow the brain was still making a connection. Ted Dardzinski>> So by applying the right pressure, I created a muscle contraction. That spasm got stronger and I applied more pressure and more pressure and, eventually, he could push through me. Hena Cuevas>> Three years later, his friend Mike was walking again and word got around. Ted Dardzinski>> And then people just starting showing up with the wheelchairs and, as people starting showing up with the wheelchairs, I started kicking out my old body clients. Hena Cuevas>> That was seven years ago. Project Walk is now working with three hundred clients like Dan. He came here three years ago after suffering a neck injury. Ted Dardzinski>> Basically, right about here, so his arms were compromised. He's supposed to be paralyzed from the neck down with limited use of his arms and limited use of his hands. He was basically told that's it, but I guess he didn't believe it. Hena Cuevas>> Here, every piece of equipment is modified to promote circulation and allow for movement. Ted Dardzinski>> Basically, this and this comes up, so it duplicates the natural walking motion. They have a harness that they're suspended in, so it's partial weight-bearing. They get to move their legs. They're in front of a mirror. Their goal is to concentrate and try to move their legs on their own. Hena Cuevas>> Because even if you don't have any movement, blood is still circulating. So by doing this movement, you're still -- Ted Dardzinski>> -- you're still increasing it. >> "So push, push, push, push. Nice. Keep your leg straight." Hena Cuevas>> How long does it take to see improvement? Sometimes as little as six or seven months. John Pou is a thirty-seven year old police officer from North Carolina. John Pou>> Seven months ago, like if I just lean over, I would fall over and then I couldn't get back up. Now I can pretty much come down pretty far and be able to sit back up. Hena Cuevas>> His was also a water injury. He dove into an ocean wave, broke his neck and was paralyzed. John Pou>> Once you get discharged, you're kind of at your house and the reality really sets in and I started thinking that I just can't live like this the rest of my life without trying to recover or get better. Hena Cuevas>> So he and his wife moved to southern California to give Project Walk a try. But getting this kind of therapy and being able to work with these adapted machines isn't cheap. It's about a hundred dollars an hour and a lot of the clients aren't even from southern California, so you have to add transportation and relocation expenses. That's why Project Walk has developed a training program so that clients can continue their physical therapy when they go back home. But miracles have a price. Project Walk isn't covered by insurance, so every client must pay their way. Kroushinsky is fortunate. He's sponsored by a family friend. Kevin Kroushinsky>> I just dream of the day that I can walk into their house and meet with them and just say, "Here we go. Thank you" and give them big hugs, you know. I see it, you know. It comes closer and closer each month. Hena Cuevas>> But will everyone here be able to walk again? Ted Dardzinski>> We basically say, you know, we don't know. It's going to take a long time. It's a life-long recovery process and what we're learning is that the clients that don't give up are the ones that are succeeding. >> "Good job, good job, good job." Hena Cuevas>> I'm Hena Cuevas 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, plus transcripts and audio of past episodes and links to some of our most interesting features. Just go to kcet.org, scroll down the page and click on "Life and Times". Val Zavala>> Here's a statistic that will probably surprise you. More women die of heart disease than all cancers combined. That's right. Heart disease is the number one killer of women in America, one in three compared to one in eight for breast cancer. And what's more troubling is that too few doctors know how to diagnose heart disease in women. No one knows that better than Charlotte Bornstein of Los Angeles. Charlotte Bornstein is a classic case of how easily heart disease in women can be missed. Charlotte Bornstein>> I'd been told for years by my former cardiologist that there was no damage to the heart. My cholesterol levels were all normal. My HDLs were great, my LDLs, triglycerides low. My internist had said, "You have very little chance of having a heart attack." Yet, I had one. Val Zavala>> In 1998, Charlotte was undergoing an operation for an unrelated condition in one of her intestines. The procedure didn't go as planned. Charlotte Bornstein>> And when I woke up, there was this man I'd never seen. He was the cardiologist called in and he said, "Hi." He was very nice. He said, "Guess what? You had a heart attack." Val Zavala>> On the operating table? Charlotte Bornstein>> On the operating table. Val Zavala>> Her doctors gave her the usual heart test, an angiogram looking for clogged arteries, but her arteries were fine. No blockage at all. Her doctor put her on aspirin and blood pressure medicine. Charlotte Bornstein>> But then I noticed this pressure when I would start to work out, when I was walking the dogs. Again, that stabbing pain just right below my left breastbone. Val Zavala>> For eight years, Charlotte lived with the troubling symptoms and the mystery. Then in 2006, it happened again, this time while she was driving. Charlotte Bornstein>> I was on Olympic Boulevard stuck in traffic and I couldn't move. I knew I was having a heart attack. It felt as if someone put their hand right through my chest and squeezed my heart as tightly as they could. It was like a vise. I didn't have a pain running down my arm, but I knew I was having a heart attack. [Film Clip] Val Zavala>> A few miles at Cedars-Sinai's Women's Health Center, Dr. Noel Bairey Merz, a cardiologist, had been studying heart disease in women. Dr. Merz is head of a comprehensive study called WISE. It looked at nearly one thousand women over five years, women who had had chest pain and other symptoms of heart disease. The study was revelatory. Dr. Noel Bairey Merz>> About a third of them will have open arteries and yet they have clear evidence of, you know, what we call myocardial ischemia. They have insufficient blood flow to their heart and that is the reason they're having all these symptoms. Val Zavala>> But no apparent plugged up? Dr. Noel Bairey Merz>> No apparent plugged up. Val Zavala>> But if a third of them, like Charlotte, had no blocked arteries, what was the cause of the heart problems? Research revealed the condition called microvascular dysfunction affecting not the big arteries, but the smaller vessels in a woman's heart. Dr. Noel Bairey Merz>> This condition turns out to be primarily a condition of women, though until you study women, you really wouldn't know. So we did that and we have been able to document that it is associated with an adverse prognosis. Two and a half percent of these women per year will have a heart attack, a stroke, develop heart failure, or die. Val Zavala>> In microvascular disease, the tiny vessels don't get clogged like men's large arteries do. Instead, they constrict when they should dilate. Dr. Noel Bairey Merz>> For example, if you and I were to walk up a flight of stairs, if we have normal microvascular function, those small arteries dilate and allow our hearts to do that extra work of needing to walk up the stairs and deliver that additional blood flow and oxygen to the heart muscle. Ladies with microvascular disease -- and there are a few men that have that have this -- they constrict, so they get angina which is that chest pain coming from the heart. They have abnormal stress tests. Val Zavala>> It's a condition that Charlotte's previous doctor missed. Finally after two heart attacks and eight years of chest pain and shortness of breath, she was referred to Dr. Merz. Charlotte Bornstein>> She knew immediately when I went in. The first day I went in, she knew immediately. She said, "I think you have small vessel disease. I think you fit right in." Dr. Noel Bairey Merz>> When I say I think I know what you have, I know how to diagnose it if you have what I think you have and there is treatment. Sometimes just incredible relief. Charlotte Bornstein>> I think the world of her. She's remarkable. Val Zavala>> But if traditional heart tests can't spot microvascular disease, how do you detect it? Dr. Noel Bairey Merz>> Well, we can do cardiac MRIs now and we can actually see the blood flow to the heart. Val Zavala>> A few blocks away at Cedars-Sinai's Imaging Center, MRIs, Magnetic Resonance Imaging, detect everything from injured knees to brain damage. It can also detect microvascular heart disease with eighty percent accuracy. Dr. Louise Thompson>> We're looking at a circle of ventricle muscle. That's the pumping chamber muscle. Val Zavala>> Dr. Louise Thompson is a colleague of Dr. Merz. She explained that the tiny vessels aren't visible, but that the MRI can tell if the muscles alongside the vessels are getting enough blood. Dr. Louise Thompson>> We don't have an imaging test that can actually show you these vessels. What we look at instead is how does the perfusion pattern to the muscle perform during stress conditions. The muscle wants more oxygen. It wants more blood flow. It's not receiving that oxygen and you get chest pain or discomfort or tightness in response. Dr. Noel Bairey Merz>> Why do these arteries do this? Good question. About twenty percent of it appears to be attributable to traditional risk factors, high cholesterol, cigarette smoking, high blood pressure, diabetes. That we know. What about that eighty percent? What's going on? Val Zavala>> That question has yet to be answered. Dr. Merz says it may be genetic or possibly linked to artery-squeezing drugs like migraine medication, certain ADD drugs or diet pills, but it will take more research to know for sure. In the meantime, Charlotte is being treated with medications which she'll probably have to take for the rest of her life, but her chest pain and shortness of breath are much reduced and, after eight years of wondering, she now has some peace of mind. Charlotte Bornstein>> And I feel great. I'm so happy to know that I have heart disease (laughter). Val Zavala>> (Laughter) It is a relief. Charlotte Bornstein>> It is a relief. Val Zavala>> But knowledge of women's heart disease even among doctors is surprisingly limited. Only one out of five physicians knows that women are at greater risk for heart disease than men. That's because, for decades, heart disease research was focused on men and why is that? Dr. Noel Bairey Merz>> The people making those decisions -- and this goes back to the 1950s and the beginning of the National Institutes of Health. They identified early on that men were more likely to suffer from what was called premature heart disease. So prior to retirement age, more men in their fifties would have heart disease than women. There's typically a five to ten year lag. And the academic said so what studies, the most prevalent group, that has the most unfortunate death, meaning a wage earner, the dad leaves the wife and children, you know, unexpectedly and suddenly. Val Zavala>> Dr. Merz is helping tip the research scales toward women and Charlotte has some advice of her own for women experiencing suspicious symptoms. Charlotte Bornstein>> You have to trust your own instincts. So often, as women, we don't. We find a doctor who went to Harvard or he went to Stanford, you know, so he's got to be good. But you have to find someone who can think out of the box a little bit. Dr. Noel Bairey Merz>> Women now are very good with their mammography. They're very good with pelvics and paps. That is what we need to do with heart disease. Val Zavala>> Next stop, heart. Dr. Noel Bairey Merz>> Exactly. Next stop, heart. Own your heart. Get it checked. Val Zavala>> If you'd like to know your risk for heart attack, you can go to the website for the Cedars-Sinai Medical Center Women's Health Center at cedars-sinai.edu/cardiacrisk. Announcer>> To send a comment or a question to our program, you can reach us by mail at this address: Life and Times 4401 Sunset Blvd. Los Angeles, California 90027 You can also call our viewer comment line (323) 953-5555) or contact us the fast way by e-mail at kcet.org. Val Zavala>> We think of it as a childhood disease from another era: whooping cough, or pertussis. And yet whooping cough is making a comeback in grownups and teenagers and, as Toni Guinyard tells us, that has triggered a vaccination campaign for the good of individuals and the public. Toni Guinyard>> Immunizations. They're required for babies and even most school-aged kids. But once children hit adolescence and adolescents become adults, getting vaccinated to prevent illness often gets left off the to-do list. Doctors warn that it shouldn't. >> "You're a professional. That was great. Didn't even hurt. Thank you very much." Dr. Joel Ward>> Certain vaccines don't last forever. Toni Guinyard>> The vaccine for whooping cough does not. Dr. Joel Ward is the founding director of the UCLA Center for Vaccine Research. Supported by the National Institutes of Health, the Center and its General Clinical Research Center is involved in the testing of new vaccines, one of the many clinical trials focused on pertussis. Dr. Joel Ward>> Pertussis is another name for whooping cough. It's a disease well-known to mothers, children, particularly grandparents, because it was a leading cause of childhood death in much of our history, as late as the mid-1900s. Toni Guinyard>> And a growing number of teens and adults who have not been vaccinated for whooping cough since childhood are contracting the highly-contagious respiratory infection and passing it on to children. Dr. Joel Ward>> Pertussis is a bacteria. It's a unique organism. It invades the respiratory tract and down into the lungs, so it begins with symptoms not unlike those of a common cold. Susan Partridge>> You know, a lot of people, when you ask them, "Have you had a cough that didn't improve or didn't go away, or someone in your family that didn't go away?", a lot of people were quick to say yes and they could identify with that. Toni Guinyard>> But they don't know whether it's pertussis or not? Susan Partridge>> No, because we haven't been testing for pertussis in adults. Toni Guinyard>> Dr. Jonathan Fielding, Director of the Los Angeles County Department of Health Services. Dr. Jonathan Fielding>> It's transmitted by droplets. That's when, if you cough or if you sneeze or even talking when spittle will come out a little bit, those are the ways that it can be transmitted and it's a highly communicable disease. Toni Guinyard>> Take a walk down any street in any neighborhood in southern California and, chances are, you'll come across someone who will tell you -- Nicole Barnard Chaffin>> That my head feels like it's going to explode. Toni Guinyard>> -- they have a cold. Nicole Barnard Chaffin>> And, thankfully, it's moved from my chest to just a head cold, but initially it was a really bad cough which is what the children had. They just came from the doctor today with runny noses for the second time in two weeks. Toni Guinyard>> And, yes, they do have colds and nothing worse. But unlike Nicole Barnard Chaffin, rather than go to the doctor, others who think they have a cold only seek medical help when their cough does not go away. They could have whooping cough. Dr. Jonathan Fielding>> There is a characteristic cough where you have paroxysms of coughing and the whooping sound is when they expire after they let out all their air and they go whoop. Dr. Joel Ward>> It's a terrible, frightening cough that occurs in young infants who have very small airways. So when they get this infection of the airways, it gets constricted like a pipe that gets plugged and, when the air comes out, it makes this terrible sound. [Film Clip] Dr. Joel Ward>> Adults have a much bigger airway pipe. When they get infected, their cough is usually not as bad, but occasionally it's seen in adults also. [Film Clip] Toni Guinyard>> In Los Angeles County, the number of confirmed pertussis cases in 2005 reached an alarming level, tripling from the previous five years. Dr. Jonathan Fielding>> We saw the peak of the cycle, we think, in 2005 where there were a total of four hundred forty cases. I want to be very clear. This is very under-diagnosed, so there may be a lot more people and maybe a lot more older people that have it that are less likely to be diagnosed. Toni Guinyard>> And that's why teens and adults are being urged to get a Tdap vaccine. Dr. Joel Ward>> It has a diphtheria booster, tetanus booster and a pertussis booster. Toni Guinyard>> Especially if they're going to be around babies, children or pregnant women. Dr. Joel Ward>> The adolescent and adult vaccine has a lower dose of the pertussis component than does the pediatric formulation. Dr. Jonathan Fielding>> We talk about childhood immunizations. We need to talk more about immunizations even past the childhood period. But it has to be integrated as part of regular care when you go to see your doctor. It's one of the problems that adolescents don't go to see their doctor very often. When they go, you know, they need to make sure that you should get this or you should get that. Toni Guinyard>> The vaccine was the subject of a two and a half year long nationwide study involving people between the ages of fifteen and sixty-five. The UCLA Center for Vaccine Research served as the coordinating study site for the trial. There are more than twenty-seven hundred volunteers and all of the specimens from all of those volunteers were processed right here. Susan Partridge>> I think there was an under-estimate of the amount of pertussis that's circulated in the community among adolescents and adults and how that can be passed back and forth with children. Adults have not been receiving vaccines against pertussis because it was thought to be a childhood illness. Toni Guinyard>> The adult pertussis trial found the acellular pertussis vaccine to be more than ninety percent effective in adults. Now the challenge is getting adults to make the vaccine a part of their regular immunization routine. Dr. Jonathan Fielding>> I mean, we want the public who's educated and ask for it. "Isn't it time for me?" or "What about this?" That's also very good. So we need an educated public and we need systems within medical care that make sure that these opportunities aren't missed. Dr. Joel Ward>> Why shouldn't our society be thinking and focusing about prevention? Health care costs are enormous. Time lost, discomfort, sometimes morbidity and sometimes even death. Why not prevent it if there's a safe, effective vaccine that can be given once every ten years? Toni Guinyard>> So ask about the pertussis vaccine even if you have fears about those dreaded needles. Dr. Joel Ward>> You want to be scared? See the patients with the disease. Ask a patient who's had whooping cough whether they would take the vaccine. Ask somebody who has had influenza and been ill for a month or two or been hospitalized -- and many of our elderly adults die -- what they think about how scary a needle is. Toni Guinyard>> I'm Toni Guinyard for Life and Times. Val Zavala>> You can see these stories and previous health reports on our website along with related links. Just go to kcet.org, click on Life and Times, and then the Health tab. And that's our program. I'm Val Zavala. For everyone at Life and Times, thanks for watching. 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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