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SANJAY GUPTA MD
Michael Douglas Has Throat Tumor; Bedbugs on the Move; Presidential Mystery
Aired August 21, 2010 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: Good morning. I'm Dr. Sanjay Gupta. Welcome to the program.
First up, Michael Douglas, his career has been so based on his voice. Now, he's been talking about having a tumor in his throat. I'm going to tell why this particular condition often goes undiagnosed.
And a bedbug outbreak hits the Northeast. That's what one looks like incidentally. Could they make their way to your neighborhood? That's the question a lot of people are asking. I'll tell you how bedbugs spread.
Plus, our medical mystery. What do these three presidents have in common? Well, the answer might surprise you.
Let's get started.
GUPTA: An Oscar Award-winning actor and Hollywood legend Michael Douglas has been diagnose with a tumor in his throat. A spokesman for Douglas says the 65-year-old actor is going to undergo eight weeks of radiation and chemotherapy and is expected to make a full recovery.
Now, Douglas said in a statement to "People" magazine that he's, quote, "very optimistic."
GUPTA: Head and neck cancer is estimated to kill more than 10,000 people a year. It's truly hard to diagnose. So, it got us thinking, you know, what should you look for, exactly?
And, today, we have Dr. Amy Chen -- head and neck surgeon for Emory University Hospital, to help clarify some of this.
First of all, welcome to the show.
DR. AMY CHEN, HEAD AND NECK SURGEON: Thank you.
GUPTA: You know, we don't know for sure what Michael Douglas has. They just said a tumor in his throat. So, we continue want to speculate here. But I thought this is a good opportunity to talk about something that we hardly ever get to talk about, these types of tumors.
This is what you do. Why, first of all, is it so hard to detect? When do you typically see these patients?
CHEN: Unfortunately, over 50 percent or half of the patients that we see present with advanced cancer when they come to see us. And the reasons for that are that many of the symptoms that these people get are very similar to symptoms that one would have when you have allergies, chronic cough, difficulty swallowing, allergies -- allergy-like symptoms.
GUPTA: Do they get pain at all? Or --
CHEN: They can get pain when they swallow. And all of us have had pain, some pain when we swallow --
CHEN: -- or some pain in our mouth.
GUPTA: You think it's an infection or allergies, like you said.
GUPTA: But you have a model of the tongue here and the back of the throat. What happens specifically here with these types of tumors?
CHEN: Well, this is the part of the tongue that moves when we speak. This is the back of the tongue or the base of tongue. If a tumor develops here, it can obstruct the breathing passage, which is right here.
CHEN: And then the swallowing passage.
GUPTA: Trachea and esophagus, right? Yes.
CHEN: Yes. So, you can see how if you have something here, it can cause ear pain, which the ear is out here. Or more difficulty swallowing because there's something in the way between where the mouth is and where the esophagus is.
GUPTA: So, if you're one of these patients watching, and you know, you've had some pain here. Now, you're worried because you heard Dr. Chen talk about this. Are there some particular warning signs?
CHEN: Well, the main thing is that if any of these symptoms last for more than two weeks, attention should be directed at it. Whether we take antibiotics and see if the lump in the neck or soreness in the throat goes away. If it doesn't go away, then I would advise that a specialist be called in.
GUPTA: So, really, the chronic, how long it lasts. CHEN: Yes.
GUPTA: He -- Michael Douglas, as you know, is so famous for his voice. And besides the trachea and the esophagus, the impact potentially on his voice -- what would it be and why would it be?
CHEN: Well, treatment for this type of area is a combination of surgery, chemotherapy and radiation. And those things can affect this area. This is not a very large area. And, therefore, if there's any sort of surgery or treatment in this tongue area or in the larynx or voice box area can impact someone's ability to speak.
GUPTA: So, the surgery itself potentially could be the problem.
CHEN: Surgery or chemo or radiation, any of that can do that.
GUPTA: You know, he's talked pretty openly about wanting to quit smoking. He talked about back in 2006. He's talked about on and off drinking problems in the past.
Are those risk factors and what are some of the other ones?
CHEN: Absolutely. The main risk factors are smoking or tobacco abuse. It can be oral tobacco like snuff or -- and also alcohol. The two of them together can make the risk factors even greater than either one of them individually.
The third new risk factor that we've discovered is the human papillomavirus, HPV.
GUPTA: That's right.
CHEN: And we have been seeing that associated with more and more head and neck cancers.
GUPTA: So, if someone is a smoker or uses smokeless tobacco, now -- I mean, is there a way to screen for this or is there something that you do if they came to your office to make sure they don't have it?
CHEN: Yes. It's a simple exam. We just examine the mouth, examine the throat. We have special scopes that can look in this region in the back of the throat without any surgery. It can be done as an outpatient. Usually about 20 to 30-minute visit.
GUPTA: That's good. So, at least some screening possibilities there. Eight weeks of chemo radiation they set for him. He said he's optimistic.
Does that sound right to you? Does that sound typical?
CHEN: Well, most patients do have some chemo and radiation. The treatment length of that time is usually about six to eight weeks. There is a tough recovery afterwards. But most patients regain most of their functional status afterwards. GUPTA: All right. I had a chance to meet him not long ago. He's such a nice guy. We wish him the best of luck. Thanks so much for joining us as well.
GUPTA: Really good stuff.
GUPTA: You ever wonder if your teenager is just ignoring you? We see a lot of heads nodding out there. Well, it turns out there may be a legitimate reason. I'm going to tell you about a shocking increase in hearing loss among teens.
Now, if you haven't heard about it yet, bedbugs seem to be sprouting up everywhere in New York City. So, a big question for a lot of people the rest of the country: how far so they travel and how exactly do they do that? We'll answer that question for you next.
Stay with us.
GUPTA: And we're back with SGMD.
Every week at this time, we're going to be answering your questions. This is your appointment. No waiting, no insurance necessary.
You know, from coast to coast, people are talking about this story this week, bedbugs. Right now, they're on New York City's most wanted list quite literally. They are seed-sized insects and they invade workplaces, high-end stores, mattresses, couches, even laundry baskets.
And New York City is a travel mecca. People are constantly in and out of there and as a result, they travel all over the United States. In fact, these beds even invaded the Time Warner Center in New York. That's our home.
This whole thing got my staffers really talking. They ask this question, "Can you transport bedbugs from one place to another?"
You know, we did some investigating on this particular question. The answer is yes. Bedbugs are known to be hitchhikers.
Here's how they move though. They don't necessarily travel on people. They tend to travel on things, your purse, your backpack, your suitcase. And they literally feed themselves by sucking your blood. They can leave behind a red welt and likely a psychological mark as well.
I want to show you something else. We had a bug expert on. He just got bitten by bedbugs. To keep his specimens alive so he can study them, he allows them to bite them and then puts up a container with 1,000 of them to his arm. Take a look.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: Doing this, I am working on their behavior by learning how they do certain things. It actually helps to get rid of them in places.
(END VIDEO CLIP)
GUPTA: You probably don't want to do that so you're probably wondering how could you avoid these bedbugs. I want to give you some tips.
First of all, you know, it's about making sure your room, the place you're going to spend a lot of time, is not infested. You can take off the fitted sheets off your bed, take the headboard off as well, and just simply make sure you don't see any.
If you're traveling around, check the luggage straps before you put your bag down. That's sometimes where the bedbugs like to hang out.
Third of all, you know, you can take your laundry and -- when you take your clothes off, put it in the laundry immediately as opposed to living them in a hamper. Something I do and this is going to make me change.
And lastly, store your suitcase in an attic or a garage. The bedbugs are eventually going to die out because they have nothing to feed on.
Now, switching topics, parents, if you think your teenager is not listening to you -- well, maybe think again. This is a fascinating story. Researchers found a 30 percent jump in minor hearing loss for teens since the mid-'90s -- 77 percent spike in serious hearing problems for teens.
Typically think of hearing losses as being something associated as you get older. But here, we're talking about the consequences really of the world that we live in.
We don't know for sure if this is connected, but here's what researchers are speculating. Loud noise of any kind, including music, for prolonged periods of time is dangerous to your hearing. You already knew that.
Once your hearing starts to go, starts to lose it, you usually don't get it back -- something that people don't always realize.
And authors of the study aren't making a direct link to ear buds and iPods and things like that. Well, they say more research is needed. And this is the direction they're headed.
There are things you can do to try and protect our child. I mean, this is something that we think about quite a bit. Use noise canceling headphones, for example. Set a volume limit on your iPod. It's something we did recently.
And there's a Web site out there as well. It's called "Listen to Your Buds." It can teach your child when it is time to turn the volume down.
Again, the consequence of the world that we live in sometimes can be this.
Coming up, you're go to hear what my colleague, CNN medical correspondent Elizabeth Cohen did with her own daughter when she was lying in the ICU. And she thought that nurses and the medical staff simply had it wrong.
And later in the show, before you scramble, poach or fry up those eggs. There's a recall. It may affect you. We'll tell you about it. That's ahead.
GUPTA: And we are back with SGMD.
Today, we got a little something different for you, a little surprise. You're going to see my colleague and friend Elizabeth Cohen in a new light, in a way that maybe you haven't seen her before. She's here to talk about her new book, "Empowered Patient."
And this is something that I've read it. I love the book. I think -- you know, it's really interesting because you've been talking about "Empowered Patient" for some time on television and now you decided to write the book. A lot of people know you in this light.
How did this whole thing start with the "Empowered Patient"?
ELIZABETH COHEN, CNN SR. MEDICAL CORRESPONDENT: You know, it started with several experiences I had with my family -- one of them with my daughter, Shir, my third daughter. And she was born and she had seizures. And they needed to do spinal taps. I know, you've done millions of them.
COHEN: And they did a couple and they said, all right, there's no infection. We're going to stop and the doctor said to myself and my husband, "We're going to stop now."
And then I went to visit her the next morning and they had just done another spinal tap and they were about to do another one. And I said, I gave them that face, I said, "What's going on here? The doctor said this would stop last night." And the nurse said, "No, we never got that order. And we are going to do another one because the first one she was so dehydrated it didn't work."
And I said, "Well, I'm going to sit here and not let that happen." And she said, "No, this is the one hour every 12 hours, one hour you can't visit. You've got to go." And she told me to leave. And to make a long story short, I got a nurse to intervene and to call them and say, "Hey, don't do that." But I was so upset and just crying and crying and crying that at first I couldn't get anyone to help me. And it took a long time for me to get someone to put a stop to the spinal taps.
GUPTA: Was a -- was a mistake occurring? I mean, was it a miscommunication? What happened there?
COHEN: Something happened and she received a spinal tap she shouldn't have had. And I felt very powerless to stop it. And that's why when I came back to work, I said, there's something here.
COHEN: And I kept hearing other stories like that. And I said, I need to teach people and myself how to deal with sort of this big medical system which usually works in our favor, but doesn't always.
GUPTA: I want to ask you about those things. But as far as you know specifically, why do you -- why do you think more people aren't empowered patients? I mean, your health is, you know, presumably the most important thing you have, but it seems like people are just willing to relinquish that, just lose control.
COHEN: Right. Like when you buy a car, you don't relinquish control to a used car dealer, right?
COHEN: I'm not going to compare you and other physicians to a used car dealer, you're not. But I think that what happens is when you're sick, you want to believe in the people who are helping you. You know, you really want to believe that they're going to do the best thing -- and most of the time they do. But sometimes they don't.
And so, for example, in my daughter's case, what I should have done is I should have said, hey, you need my consent or my husband's consent to do a spinal tap. I'm not giving it to you. And as a matter of fact, I'm writing on a statement saying you don't have my consent and I should have done that or I should have gotten on the phone to the hospital ombudsman, hospitals have ombudsman who are there for that purpose, to help patients.
And it's a great question. Why didn't I do that? Well, you know, I just had a baby.
COHEN: I was, you know, hormonally challenged. I was upset seeing this baby at the intensive care unit sedated and getting spinal taps.
COHEN: And you're not thinking as clearly as you do when you're at your desk or at your computer. I mean, it's a different situation.
GUPTA: Sure. Well, one other piece of advice that you put in the book is being a bad patient. And a lot of people may not know what that means. What is the message there?
COHEN: Right. I tell people to be bad patients. And I think sometimes people take that the wrong way. So, I'm going to get to explain.
What I mean is that sometimes I think that people feel like they have to -- that they want their doctor to like them. They put a high premium on that. Everyone wants to be liked. We all want to be liked.
But this is a situation where maybe it's OK not to be liked. So, for example, in the book, I write about my mom who -- when she wasn't feeling well, her doctor basically patted her on her head and said go home and relax. And she really should have challenged him more.
But I think all of us just want to trust a doctor and be good, you know, and do what you're supposed to do, do what you're told to do. And so, I talk in the book about being a bad patient.
COHEN: You might annoy your doctor. It might annoy your doctor to say, hey, I don't think that's a good explanation. You know, I'm sick. It's not just because I'm not relaxed.
GUPTA: And there's no question. I mean, an individual knows their body best, knows their family's medical situation best.
GUPTA: There is a fine line, I imagine, between being that bad patient and really benefiting as much as you can from the doctor. How do you -- how do you tell people to navigate that line?
COHEN: But you don't want to annoy your doctor, you don't want to annoy anyone -- your plumber, your electrician -- again, not comparing. But these are people who are providing you a service and you, of course, want them on your side and on your team.
On the other hand, you want to question them when you think something isn't right. Here's a situation I know you probably dealt with a million times. People come to your office with a stack of Internet printouts, right? And they hand them and say, Dr. Gupta --
COHEN: -- here, look at this.
COHEN: We have 10 minutes, here's 300 pages, take a look, right? What do you do with that situation? GUPTA: Well, there's so much information out there. But, I think, you know, there's a distinction between information and knowledge, you know, because you have to try and cut through some of that for the patient and much in the same way that each patient is different from their perspective -- each patient is going to be different from the doctor's perspective as well. So, the Internet stuff may not apply to that particular patient.
But I think, you know, this is a different world. We have to make sure that we're taking into account a lot of that.
You got a documentary coming up as well where you go through the amazing stories that I read about. And that's September 25th, I believe, right?
COHEN: That's right. Eight o'clock, and then again at 11:00, for the folks on the west coast.
GUPTA: That's right.
COHEN: And what's great about this documentary is that we made a decision, Sanjay, to write about positive stories. So, these are people who took matters into their own hands and became their own empowered patients and their own advocates and really kind of solved their own problems.
GUPTA: That's great stuff.
COHEN: And they're just -- I take my hat off to all of them.
GUPTA: The ultimate empowered patients.
COHEN: That's right.
GUPTA: And the ultimate "Empowered Patient." Thank you so much. We really appreciate it.
GUPTA: Thank you very much.
And you know what, it can be nerve-racking the first time someone performs brain surgery. I can remember that myself. But nowadays, the learning starts in an entirely different place. It's cutting-edge stuff. It's brand new. We're going to show you how. That's next.
Stay with SGMD.
GUPTA: Welcome back.
You know, many years ago when I was training to be a neurosurgeon, there was this mantra, it was "see an operation, do an operation, and then teach an operation." But, now, there's a whole new way of teaching brain surgery to residents. It's pretty clever. I'm taking you inside brain surgery boot camp 2010.
GUPTA (voice-over): That sound you hear is a drill being used on a skull. But none of this is real. It's not a real skull. In fact, this is not a real brain. This isn't even a real operating room.
It's all simulation. Welcome to brain surgery 2010, boot camp.
DR. DAN BARROW, CHAIR OF NEUROSURGERY, EMORY UNIV.: Traditionally, you know, people coming into residency programs whether it's neurosurgery or any other specialty, kind of learn by fire almost. You just kind of -- you got to show up and you start doing things.
GUPTA: Dr. Dan Barrow is chairman here. And for the first time ever, he's trying to teach this first year neurosurgery resident how to operate under a microscope on a red pepper.
These types of programs are popping up all over the country.
UNIDENTIFIED MALE: Learning those skills here on models is certainly much safer than learning it for the first time on a patient.
GUPTA: The mantra in surgery has always been: "see an operation, do an operation, teach an operation."
UNIDENTIFIED MALE: And that's why they call it a --
GUPTA: Well, with that style of teaching is disappearing. This boot camp is proof.
BARROW: So, these stations in here are designed to take these young neurosurgery residents and teach them some of the very basic skills they're going to be using really literally in the next few weeks and then throughout their career.
UNIDENTIFIED MALE: Oops. (INAUDIBLE), right?
GUPTA: Trial and error. And that's the point. Better to have a disaster here -- rather than here.
Now, we're in a real operating room. That's a real brain. And I'm showing my residents how to clip a real aneurysm.
(on camera): You got to (INAUDIBLE) as well.
(voice-over): But nowadays the learning --
UNIDENTIFIED MALE: Right here, the bone is clean. There is no tissue there.
GUPTA: The training of your hands, to developing of judgment -- UNIDENTIFIED MALE: Down and hook it back up and back up again.
GUPTA: -- starts in a place that looks like this.
BARROW: The whole goal is to make sure that the next generation of neurosurgeons provide better care than we did, and that's how we advance our specialty, is through research, it's through teaching the next generation, and make them better than we were.
GUPTA: And in case you're curious, neurosurgery training is about seven years long. And as you can see there, maybe operating under a microscope on a red pepper is not a bad way to start.
Good luck, guys.
Up next, if you're cooking up eggs this morning, you got to want to hear this story. Hundreds of people sickened by salmonella in eggs.
Plus, what do these presidents have in common? I'll tell you, it's our medical mystery. That's next.
GUPTA: We're back with SGMD.
If you're cooking up some eggs this morning, you should be checking the brand of your eggs. An Iowa company has recalled more than 380 million eggs because of possible link to salmonella.
Here's how it works a little bit. The CDC normally gets reports, about 50 people a week about salmonella poisoning. But recently, those increase to about 200 people a week. And they start tracing this back and found that, in fact, it was eggs.
What we know now is that eggs in at least 17 states have been recalled. Take a look at the map there.
We also want to give you some of the brands as well. These are some of the brands that they're talking about. We got a complete list as well on CNNHealth.com. But you can take a look there.
Keep in mind, if you do have eggs from any of these brands, you need to get rid of them. But as a general, always, you want to make sure that you're cooking your eggs thoroughly. No raw eggs, that's way to avoid some of these problems.
Now, turning to our medical mystery. What do these presidents have in common? You may have guessed it by now.
This summer, President Obama turned 49. And although he's one of the youngest U.S. presidents, a lot of people say, look, he's starting to show his age. Is that unusual? Not really. Just take a look at the history and you're going to find that he's in pretty good company and see what they all have in common.
GUPTA (voice-over): Bill Clinton did it, and so did George W. Bush. Ronald Reagan kind of did it, and it looks like President Obama is doing it, as well.
What do all these men have in common besides holding the highest office in the United States? All quickly turned gray during their presidency. Why? One word: stress.
DR. HOWARD BROOKS, DERMATOLOGIST: And when people have stressful situations, what happens is a condition called telogen effluvium and all that means is you hair is shedding more rapidly than it should.
GUPTA: As the stress triggers this chemical reaction, hair falls out quicker. Every time a follicle loses a hair and hair grows back, it uses up a pigment. So, when each new hair follicle is replaced, pigment is used. Once the pigment runs out, gray hair appears.
BILL CLINTON, FMR. U.S. PRESIDENT: He's seven years younger than I am and has no gray hair. So I resent it.
GUPTA: When Bill Clinton entered office at the age 46, he already had salt and pepper hair, but he came out of his term with a head of white.
George W. Bush, a handsome Texan, tan, youthful. And after eight years as president, his locks were gray. His face chiseled with wrinkles.
GEORGE W. BUSH, FMR. U.S. PRESIDENT: When I get home tonight and look in the mirror, I'm not going to regret what I see.
BUSH: Except maybe some gray hair.
GUPTA: And less than two years in office, President Obama is already seeing his jet black hair speckled with white. With the economy, the fight over health care reform, the Gulf oil spill and two wars overseas, he frequently jokes about his early aging.
BARACK OBAMA, PRESIDENT OF THE UNITED STATES: I have a lot more gray hair than I did last year.
BROOKS: There's so much stress, I'm sure, that his hair is starting to shed more readily than it should -- probably three to five times as fast as it should.
CROWD: Happy birthday to you.
GUPTA: And even though Obama is still a young man, doctors say his graying of the temples is just a sign of things to come. BROOKS: Usually once you're gray, you're stuck with the gray.
GUPTA: I don't know if it makes any of the presidents feel any better, but I'm just 40 years old and I'm already starting to get the gray hair as well. A lot of stress out there.
Well, if you missed any part of today's show, be sure to check out my podcast, CNN.com/podcasting. Also, set your DVR, 7:30 a.m. Eastern.
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.