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HOUSE CALL WITH DR. SANJAY GUPTA

Hypothermia Can Treat Cardiac Arrest; Harley-Riding Doc Helps Restaurant Workers; Two Doctors Practice Old Time Medicine to Cut Cost; Malaria Mystery Solved; High Cholesterol's Link to Alzheimer's

Aired August 8, 2009 - 07:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


DR. SANJAY GUPTA, CNN HOST: Good morning. Welcome to HOUSE CALL: The show that helps you live longer and stronger. I'm Dr. Sanjay Gupta. Thanks so much for watching.

First up, treatment for cardiac arrest, proven to improve outcomes approved by the American Heart Association and it could save your life. So, why is barely anyone in the United States using it? We got details.

And a 14-way kidney donation all in one hospital -- an amazing story of strangers saving strangers.

Plus, virus hunters believe they found the origin at one of this planet's deadliest diseases. We're going to go into the jungles as they track a pathogen.

You're watching HOUSE CALL.

(MUSIC)

GUPTA: You know, you would think that if hospitals knew a treatment for cardiac arrest was inexpensive and could make a dramatic difference in outcome, they'd all be using it. But as a new study finds out, most are not.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Zeyad Barazanji is back from the dead. Nearly five minutes without a heartbeat after a sudden cardiac arrest. But three years later, he's alive and well.

ZEYAD BARAZANJI, CARDIAC ARREST SURVIVOR: I feel stronger. I feel better.

GUPTA: Part of his treatment at New York Presbyterian Hospital was therapeutic hypothermia. I met with Barazanji's doctor, neurologist Stephan Mayer.

DR. STEPHAN MAYER, NY PRESBYTERIAN/COLUMBIA HOSPITAL: Imagine a chemical burn injury in the brain triggered by 20 minutes of not enough oxygen. Hypothermia is like throwing water on the fire. It just puts out the fire.

GUPTA: The method is simple. You run chilled saline through an I.V. and wrap the torso and limbs in pads filled with cold solutions. Think of it like the opposite of a hot water bottle.

As far back as 2002 studies in Europe showed it sharply improved the outcome from cardiac arrest. A new study says it's just as cost- effective as many standard therapies.

But here's the thing. It's never quite caught on here. A University of Chicago survey found that only 230 hospitals out of some 6,000 ob actually have this equipment.

MAYER: There's a treatment that was shown to be effective in two clinical trials in the "New England Journal of Medicine," the premier medical journal in the world. Yet, today, you could easily be taken to a hospital and not be given that treatment.

GUPTA: For Zeyad Barazanji, it meant a chance to cheat death, another chance to smell the summer air.

(END VIDEOTAPE)

GUTPA: An induced therapeutic hypothermia after cardiac arrest is recommended by the American Heart Association. But the authors of this latest study pointed out something amazing to us, that fewer than a quarter of the 300,000 people suffering from cardiac arrest actually get cooled. The reason, as far as we can tell, are complicated, departments need to coordinate care and there's no real money to be made of this therapy. And sadly, as a result of that, there are few champions for this sort of therapy.

And the good news, though, cities, like New York, are starting to direct more cardiac arrest patients to hospitals that cool them. And I've been researching a lot of stories like this going to the frontlines of emergency for my upcoming special "Another Day: Cheating Death." Watch that on October on CNN.

Now, we've got a story about groundbreaking kidney transplants that were successfully performed in Washington. Fourteen, seven donors, seven recipients, taking part in a so-called "domino transplant."

And senior medical correspondent Elizabeth Cohen is here to tell us about it.

When you read about it, it sounded actually amazing.

ELIZABETH COHEN, CNN SR. MEDICAL CORRESPONDENT: Oh, it is amazing. I mean, the coordination that it took over a period of months to make this happen.

Let me introduce you, Sanjay, to the seven recipients. They all needed a kidney, and getting a kidney from a cadaver off...

GUPTA: Right.

COHEN: ... the waiting list was going to take them about five years.

GUPTA: Wow.

COHEN: And none of these people had five years to wait.

GUPTA: Yes.

COHEN: They needed a kidney much faster than that.

So, what happened was that they went out and found living donors. And so -- for example, Larry found Elizabeth, husband and wife, Elizabeth needed an organ. It didn't work. They weren't a match.

Terry asked her sister Jacqueline who said yes. It didn't work. Not a match.

Shawn and Dominic, cousins, didn't work. Not a match.

So, what they ended up doing is sort of crisscrossing if you can imagine what happen here. For example, Elizabeth needed a kidney. Larry said, "Great, I'll donate to you," but they weren't a match. But what happened was that Jordan was a match for Elizabeth. So, he donated to her. That freed up Larry's kidney, because Larry was going to give it to his wife.

GUPTA: Right. Right.

COHEN: So, he said, "Well, heck, I'll give it to Dachia (ph). Never met her, but it allowed sort of this domino effect to happen and so on and so on. And then, everybody managed to get the kidney that they needed.

GUPTA: And so much of this is dependent on the kindness literally of strangers. Because Larry still gave his kidney although he didn't really need to anymore. His wife had received a kidney.

COHEN: Right.

GUPTA: You know, we've done a lot of reporting about ethnic differences and how much harder it is if you come from certain ethnic backgrounds. Did that play a role here? How easy was it to find all these matches?

COHEN: It certainly did. You will notice that all the recipients except for one are African-American.

GUPTA: Yes.

COHEN: And that is not just by coincidence. What happens is that African-Americans are more likely to need a kidney but there are fewer donors that match them. Plus, African-Americans have a sort of strong immune response. You could say they're more likely to attack a kidney once it's implanted. And so, that's a problem as well.

So, those two factors combined, it's very tough. And that's why they had to do all this whole sort of rigmarole in order to get them the kidneys that they needed.

GUPTA: Higher chance of diabetes and other diseases...

COHEN: Yes.

GUPTA: ... which could lead to kidney failure.

COHEN: That's right.

GUPTA: So, I'm always amazed that, you know, they're taking it from a healthy person, the kidney from a healthy person that has its own sets of risks as well.

Well, thanks for bringing us the story. Amazing stuff. And we're glad we could hear about it.

Be sure to check out Elizabeth's "Empowered Patient" column as well this week. She has tips to help make sure your next hospital stay is a safe one. We all want that. Visit CNN.com/empowered patient.

Now, he's not your typical doctor and he is coming up with a not- so-typical solution, if you will, to a major health care problem. That's ahead.

And a breakthrough discovery in a war against a disease that kills more than a million people every year. Virus hunters are tracking a killer.

But first, which prescription medication did Americans spend the most on last year? Your guess: cholesterol-lowering drugs, statins, narcotic painkillers or antidepressants. We got the answer in 60 seconds.

(COMMERCIAL BREAK)

GUPTA: So, did you get the answer right? Which prescription medication did Americans spend the most on last year? Well, the answer: antidepressants. In fact, sales in 2008 hit almost $300 million. That one surprised me a little bit as well.

And a new study out this week finds more and more people are taking the medication. Get this -- between 1996 and 2005, the percentage of people taking antidepressant drugs nearly doubled from 5 percent to 10 percent. That means 27 million Americans now take antidepressants regularly.

What could be more troubling -- while medication use was going up, using therapy along with antidepressants, that was going down. The study authors say this could be due to the cost of mental health services overall.

Also, plastic surgery for migraines. A new study out this week finds removing muscle tissues or nerves in a migraine trigger area may reduce headache pain and frequency. Now, surgeons would randomly selected migraine sufferers who'd received Botox to get a facelift combined with removing the tissue and nerves. Eighty-four percent of those who had the surgery reported at least a 50 percent reduction in pain.

Experts say this is not a treatment for the majority of the migraine population since this only look at those whose pain responded to Botox in the first place.

HOUSE CALL is back in 60 seconds.

(COMMERCIAL BREAK)

GUPTA: We are back with HOUSE CALL.

And as you know, this is your destination for all things health care. While Congress battles over what to do about health care, outside of Washington, doctors are trying to find solutions on their own. Photojournalist Deborah Brunswick caught up with Dr. David Ores in New York City, he's not your typical M.D., all of it starting with a Harley.

(BEGIN VIDEOTAPE)

DR. DAVID ORES, STARTED HEALTH CARE CO-OP: I like motorcycles because it's like a rollercoaster that goes anywhere.

Most doctors don't have motorcycles or tattoos or do not-for- profit work. And that's kind of sad, because it's really fun.

My name is Dr. David Ores and I've been practicing medicine since 1987.

Here today to talk for a couple of minutes about the restaurant health care cooperative -- which is health care for all of guys.

I started the health care cooperative six, eight months ago. It's a little local community health system that provides not for profit health care for people who work in restaurants. Restaurants, the owners or management, contribute a small amount of money every month into a common fund. And then that fund is used to treat the workers and staff with any kind of medical issue or problem they have.

Hey, Dr. Dave.

BILLY GILROY, RESTAURANT OWNER: We want to take care of our people, but financially, we're only capable of doing so much.

This is so affordable. It's like such a win-win that we really are excited about it because you feel like you're being part of something that could really change things.

CHRIS MACPHERSON, RESTAURANT WORKER: Not your cliche doctor, I suppose. But obviously, he cares a lot about his patients.

ORES: Is that painful doing that?

MACPHERSON: The hospitality industry is a big industry, a big part of New York City. So, it's great that somebody sort of looking out for their backs. ORES: The last 10 to 15 years, I've seen lots of people from these places who have no help, they have nowhere to go, they no one to turn to. Somebody needs to help them and probably lots of other people, too. But you've got to start somewhere.

I think the idea of not-for-profit is what I'm getting out there. The fact this is restaurant workers is one thing, but this not-for- profit notion could work in any industry.

I think it is special and I think it is great. But it disheartens me that it is those things. It really should not be special. It should not be great. It should be the way things work.

(END VIDEOTAPE)

GUPTA: Dr. Ores there, putting a dent in a big problem. In fact, a 2005 survey found 73 percent of New York restaurant workers have no health insurance.

Now, just up the road in Rhode Island, two doctors are experimenting with the solution of their own, they're making house calls and they're spending more time with patients. All of that may sound like boutique medicine to you, but these doctors are doing this to save money. We'll tell you how.

Photojournalist Bob Crowley has the story.

(BEGIN VIDEOTAPE)

DR. ANDREA ARENA, PRIMARY CARE PHYSICIAN: Barrington Family Medicine, Dr. Arena.

My partner Lisa and I opened a small practice -- I think it's been a year and a half ago now. When you walk in the door, you're going to see a big arrangement of flowers where you normally would see a secretary sitting. There's no staff.

DR. LISA DENNY, PRIMARY CARE PHYSICIAN: We don't have a secretary. We don't have a nurse. We don't have an office manager.

ARENA: You're going to probably not see other patients because we don't double-book. We put the bill there because we got tired of hearing people say, "Are you there?"

Hi, Jennifer.

It's called ideal medical practice.

How have you been?

Having fewer patients in your practice allows you to spend more time with them. And the idea is to just lower your overhead so that you can see fewer patients, spend more time with patients, really focus on quality care.

DENNY: Barrington Family Medicine. This is a practice that's been completely redesigned.

What can we help you with?

We use computers a lot to do what usually a staff does. So we can click a button and our prescriptions get sent off to the pharmacy and we can push a button and our referrals get faxed over.

Do you have your insurance card?

And our computer automatically e-mails patients before their visits so we don't have to call each one to remind them about their appointment.

And we wanted to be the kind of doctors that we are trained to be. We both really value the relationship with our patients.

ARENA: We're doing a home visit for a newborn who needs a weight check. He's two weeks old. We learn a lot by going to people's homes. Yes, this is it.

Hi.

UNIDENTIFIED FEMALE: Hi.

ARENA: How are you doing?

UNIDENTIFIED FEMALE: Good.

ARENA: Not many people do house calls.

Hi, big guy.

It's great for the patients. Lovely for a mom with three toddlers.

UNIDENTIFIED FEMALE: It's hard to get out the door with a newborn so it's nice to have them come to you.

ARENA: See you guys!

UNIDENTIFIED FEMALE: Bye.

ARENA: Bye-bye.

DENNY: This is what the medical assistant usually does.

ARENA: I mean, in the traditional primary care doctor's office, you need to see patients quickly, every 10 minutes in a traditional setting. I think that's where you have the doctor holding on to the door handle saying, everything else OK, right? Nothing else is a problem because you don't have time to address it if you get a positive answer.

DENNY: It's like it was I imagine 60 years ago. It's not a stressful work environment. It's kind of fun. (END VIDEOTAPE)

GUPTA: We are going beyond the headlines on health care, taking you across the country, trying to examine what works, what doesn't. Check out CNN.com/healthcare for more firsthand stories

Now, a potentially dangerous chemical, it could be in your baby bottle, soda cans, maybe even your plastic wrap. And now, the state of Massachusetts health officials are advising mothers to avoid using or storing infant formula in plastic baby bottles that contain Bisphenol A or BPA. That's a chemical that could possibly hurt the development of infants.

Now, we sat down and asked the new FDA commissioner, Dr. Margaret Hamburg, what her plans specifically are regarding BPA.

(BEGIN VIDEO CLIP)

DR. MARGARET HAMBURG, FOOD AND DRUG ADMIN. COMMISSIONER: It is important to recognize that BPA is in many different products and that the risk/benefit ratio may be different in certain products and that there may be some areas where even without a recommendation from the FDA, informed consumers may want to reduce any potential risk, such as in baby bottles.

(END VIDEO CLIP)

GUPTA: I should point out that Dr. Hamburg tells CNN that she expects the FDA will be making recommendations to the public and the policymakers in a matter of weeks, and moving pretty fast. She says late summer or early fall. We'll be giving you the latest on BPA. And look for my special hour-long investigation in December as well on all sorts of chemicals that are found in the environment and how it impacts your health.

Also, some news out this week about elevated cholesterol in your 40s and how it could raise your chances for Alzheimer's disease.

We've got the details in uncovering the origins of malaria. How it might save human lives.

You're watching HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: Possible major breakthrough now in a medical who done it? A team of researchers say it has tracked down the origins of one of the most deadly killers on the planet, it's malaria. And while malaria isn't a problem in the developed world, a find like this, how animals transmit to humans could help us with these discoveries about outbreaks of all sorts, like the H1N1 for example, the swine flu virus.

Now, I'll tell you, it was incredible to watch firsthand how these hunters track down this killer.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Deep in the jungles of Africa, Nathan Wolfe is on the hunt. Wolfe is a pathogen hunter, looking to unlock the mystery of one of nature's greatest killers, the source of malaria.

He's been at it for more than a decade, working with people who hunt these forests to take blood samples of the animals they kill -- animals that could provide the answer. Through those blood samples, they then work with research animals, Wolfe says he and his team have solved the riddle.

(on camera): There's a particular chimpanzee in here, Max. What has Max taught us about viruses?

NATHAN WOLFE, PATHOGEN HUNTER: What we've found in Max and a couple of other chimpanzees and on the Ivory Coast is actually malaria parasites will give us really the answer to an old riddle, namely, what is the origin of malaria? Where did it come from? And the answer is actually...

GUPTA: Max.

WOLFE: ... we discovered it came from chimpanzees, yes, just like Max.

GUPTA: So, malaria comes from chimpanzees. We can say that for sure now.

WOLFE: That's right.

GUPTA: You're a virus hunter, a pathogen hunter. How hard was it to hunt malaria?

WOLFE: We've been chasing this for some time some time. So, it was pretty exciting for us to nail it.

GUPTA (voice-over): They nailed it by first identifying strains of malaria found in chimpanzees and comparing them to strains killing humans globally. It turns out, genetically, they're nearly identical -- except the chimpanzee strain is older. All of that suggests that chimpanzees pass malaria to humans.

(on camera): There's this interface, if you will, between animals and humans so important because they can actually exchange viruses, they can exchange pathogens, things you may have heard of like HIV, Ebola, Marburg, even parasites like malaria. The question is: Exactly how does that swapping take place? And I think more importantly for researchers: What can they do about it?

(voice-over): Knowing the origins of a disease, even the close relatives to it, could be a huge step towards stopping it.

More than 30 years ago, scientists used a close relative of human smallpox found in cows to create a vaccine for humans. Whether the same will happen with Wolfe's discovery is still unknown. He and his colleagues believe it is a major breakthrough and only the beginning. WOLFE: We know very little about the diversity of microorganisms even within our own bodies, let alone within other animals. And really, that's one of the things we're just beginning to do, is to sort of begin to describe this iceberg. We know a lot of it is underwater. I think it's part of the excitement scientifically for those of us who are out there trying to discover these things.

(END VIDEOTAPE)

GUPTA: Now, one reason this study is getting so much attention, the high stakes. Malaria kills more than a million people every year and many of them are children.

And borderline cholesterol and a new link to Alzheimer's disease, we're going to tell you if you might be at risk.

Stay with HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSE CALL.

Some news out this week that caught my eye -- elevated cholesterol levels in your 40s could increase a person's risk for Alzheimer's. In fact, a new study finds having high cholesterol in your 40s raises your risk for Alzheimer's by 66 percent. But your cholesterol numbers don't even have to be that high, just even borderline cholesterol -- those levels have a 25 percent greater risk of getting Alzheimer's as well.

Borderline cholesterol, in case you're curious, is between 200 and 239. Anything above that is considered high. To do all the math, more than 106 million Americans have borderline numbers.

And keep in mind, cholesterol problems can strike many healthy people as well. So, as we say so often on this show, you need to know your numbers.

Now, good news is, there are steps you can take today to lower those numbers and experts we've talked to say your best option is sort of a three-pronged approach. Now, we wanted to be specific with you here on HOUSE CALL. So, let me give you a little bit of an idea of what we're talking about.

When we talk about -- and we talk about your numbers overall, we are talking about diet, and it's summertime and it's a good time to sort of start a Mediterranean diet -- which means lots of olive oil, nuts, whole grain, fresh fruits and vegetables. It's summertime, you can start a diet like this today. In fact, at morning time, put some nuts on your cereal, that's something that could possibly help.

Also, when we talk about exercise, how much is too much, how much is enough. You hear different numbers on this as well. Thirty minutes every day, that's the minimum amount that you need. You need to schedule that in. You need to make it a priority. Now, if you're in weight loss mode -- which so many of us are -- you need to sort of amp that up to about 60 minutes a day and that's going to help with your numbers as well.

And, finally, stress busting. And we don't talk about this enough probably on HOUSE CALL, but this idea that you can bust stress in some ways, there's also things you can do: meditation, yoga, prayer, breathing exercises.

I spend about 10 minutes a day doing meditation because I think it makes a huge difference for me. It might be helping my cholesterol but it certainly helps my peace of mind.

Now, all of these things in addition to helping stave off heart disease and possibly Alzheimer's will help you live a longer and stronger life. Good news there.

Up next: The benefits of a good heart rate monitor. Do all runners out there need one? "Ask the Doctor," my favorite segment, that's after the break.

(COMMERCIAL BREAK)

GUPTA: It's time for our segment "Ask the Doctor."

Let's jump right in. Here's a question from the "Four Months to Fitness" blogs. Terry asks this, "I'd love some advice on choosing a heart rate monitor." Well, it turns out, Terry, our folks at CNN.com recently gave some great advice on this, advice that I paid attention to as well. There's a lot of monitors out there. New monitors are equipped with GPS, speed calculating shoe sensors and data analysis tracking every detail and your performance over time.

They say the new Garmin Forerunner 310XT is the optimal choice, but it is very expensive. It's almost $350. It does work anywhere in the world, you can get your heart rate, you can measure movement, elevation, distance and speed.

Now, if you're looking for something more affordable, like a lot of people, Nike offers a slim watch size Nike Plus Sport Band, about $59. Displays your distance, pace and calories burned. It holds about 30 hours worth of workout data.

Check out more options as well at CNN.com/technology.

Now if you do want to get motivated and join the "Four Months to Fitness" conversation, go to my blog, CNNHealth.com or on Twitter at SanjayGuptaCNN, and search for the hash mark pound sign 1023, that's my birthday.

Unfortunately, that's all the time we have for today. If you missed any part of today's show, be sure to check out my podcast at CNN.com/podcasting.

And remember, this is the place for the answers to all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. More news on CNN starts right now.

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