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SANJAY GUPTA MD

Battlefield Breakthroughs

Aired July 9, 2011 - 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: And thanks for joining us. I'm Dr. Sanjay Gupta. Welcome to the show.

Now, last month, President Obama announced plans to start bringing down the number of U.S. troops in Afghanistan. But still, U.S. troops are going to be there for years to come. Come fall, it's going to be a full decade we've been at war.

So, this week and next, we're taking a closer look at an aspect that's easy to forget, easy to miss -- at least until your life is on the line. I'm talking about the impact this war has had on medical care, not just for wounded troops, but also right here at home.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): One pretty stark example is the care that saved the life of Congresswoman Gabby Giffords, a bullet through the head. The kind of wound you might see in combat.

Dr. Peter Rhee was running the emergency room that day but he learned his trade in Iraq, with the Navy. He says with a wound like Giffords had, a decade ago, a lot of doctors would have given up before they even started.

DR. PETER RHEE, MEDICAL DIRECTOR, UMC TUCSON: For most handgun injuries through and to the head, the chance of them going to the operating room were exceedingly low. But nowadays, now that we've gotten our experience about penetrating trauma from the recent Iraq experience, we were aggressive about getting to the operating room.

GUPTA: In Iraq and Afghanistan, we've learned to do as much as possible right away. Don't wait until you get to the hospital tent. Now, they teach that same principle here as well.

(on camera): For the congresswoman, the goal of the paramedics in a situation like this is literally to just get her into the ambulance, get her here as quickly as possible.

UNIDENTIFIED MALE: Yes. As you said earlier, scoop and run.

GUPTA (voice-over): The war has lessons for neurosurgeons, too.

(on camera): What we know is that a through and through bullet injuries causes direct damage to the brain and that's something we can't fix, but it's that secondary damage due to swelling where you're trying to minimize the risk. (voice-over): To save Gabrielle Giffords, a surgeon cut away part of her skull, relieve pressuring from swelling. It's called a hemicraniectomy.

(on camera): This is where I lift that bone right out of there.

(voice-over): The battlefield drives breakthroughs like QuikClot, pack it in a wound to stop bleeding. It works fast.

Surgery directed by remote control.

(on camera): We are here controlling this robot in Santa Barbara. We're here in Texas. Dr. Chong (ph) does this all the time.

You could be here controlling a robot in this hospital or controlling a robot really anywhere around the world, right?

UNIDENTIFIED MALE: Anywhere around the world.

GUPTA (voice-over): Meanwhile, the whole field has developed the help a generation of soldiers missing arms and legs.

Military money helped fund this robotic arm from inventor Dean Kaman.

(on camera): You did deserve that.

(voice-over): Technology can be miraculous, but sometimes it can also be as simple as a mirror.

Nick Paupore lost a leg when a missile hit his truck in Iraq.

SGT. NICK PAUPORE, AMPUTEE: I could feel the rush of the EFP going to the vehicle, of the - a change of pressure and then all of sudden, smoke.

GUPTA: In rehab, the pain was unbearable, until doctors tried a new approach.

(on camera): What we're seeing here basically is just using a $20 mirror to basically make it seem like his right limb is still there. That's all it is. And what that does basically is coordinates his visual, his actual visualizing this with what's known as his position of the right beg. Coordinating those two things together really helps.

The brain is tricked. It sees the leg, shuts of the pain signal.

(END VIDEOTAPE)

GUPTA: Now, finding a better way to treat pain has become a greater focus for military and for civilian doctors alike. There's sort of this new understanding of pain. It's not just the injury itself.

To understand pain, you have to understand the way it changes your entire nervous system. The nerves can keep sending pain signals even after the original injury is healed.

And joining me now: my friend, Barbara Starr, CNN's Pentagon correspondent. She's seen these injuries first hand. She's ridden with the wounded troops from Afghanistan back to the States, and a lot of time in military hospitals around the world and here at home.

Amazing reporting you've been doing. I know you're fascinated by this topic as well.

Let me -- let me just start with pain because I -- this is a vexing problem, you know, for military and civilian doctors alike. You've talked to the doctors at Walter Reed.

What are they telling you ability pain? What are some of their approaches?

BARBARA STARR, CNN PENTAGON CORRESPONDENT: Well, you know, Sanjay, what they're looking at is just what you described, a new way to address pain -- pain management. Whether you suffer a traumatic wound from war or you're suffering from pain from some disease or something you're dealing with just as a regular civilian, looking at it not just as a symptom but as a disease, if you will, of the nervous system.

GUPTA: Right.

STARR: How do you interrupt that pain signal that goes to your brain? You get injured, you have a problem. That pain signal goes to your brain. How do you very quickly interrupt it so it doesn't become a neurological pattern?

They are looking at things like regional anesthetics nerve blocks. If you have an injury to your arm, doing some sort of nerve block right away so that pain signal doesn't get started and go to your brain. They're having a lot of success in this. And they think what they're learning in dealing with so many wounded troops, may help everyone else as well.

GUPTA: Yes, stopping that cascade from -- you know, we always tell that to patients as well, give pain medication early, don't brave it you because you can stop that cascade. You know, Barbara, one of the things you and I were talking is that some of our greatest lessons, I think, in medicine has come from the battlefields, throughout history. And you've seen some of that as well.

STARR: You know, people don't realize it. It's a fascinating topic. It goes all of the way back to George Washington and the Revolutionary War when there was the first real use of smallpox vaccines or inoculations.

GUPTA: Yes.

STARR: You know, think about that. All of the way into the Civil War when they started doing amputations and really understanding we have large numbers of wounded, how to do triage, how to prioritize, just like they do in emergency rooms today. If you've got cases coming in, who do you deal with first?

Wars have actually proven to be great arenas for learning medical lessons.

GUPTA: Yes, it's amazing to think about that history because triage is just the way we do things now, but to think it has a genesis perhaps in the Civil War is fascinating.

What about Vietnam?

BARBARA STARR: That has been the case I think that most people could probably relate to.

As you know, in Vietnam, it was the first use of helicopters landing right on the battlefield under fire to take wounded troops out of there and get them to medical care -- the so-called "golden hour" began to emerge, what you reported on, getting somebody off the battlefield, getting them to care within an hour.

And, of course, now, we sort of take it for granted. You know, if you get injured, if you're in a traffic accident on the highway, hopefully not, if you're in an accident in a building or a factory --

GUPTA: Right.

STARR: -- a helicopter from your local emergency room may come land very quickly and take you away. That's the lesson of Vietnam.

GUPTA: From the battlefields. And interesting because you still see it, you know, in daily life at big hospitals. But also even on the battlefields, they've started taking medical commodities, you know, these forward tents and moving them forward for that same reason.

There's been a lot of lessons more recently from Iraq and Afghanistan. And you've been talking to people about that. What have you learned?

STARR: You know, what doctors are telling us, and it's sad to think but it's a basic fact, tens of thousands have been wounded in this war. So, you have this giant population that they are learning from.

And what they're basically learning they will tell you, I think, is dynamic innovative, fast-moving medical care. Try new things. Try and see what you can accomplish with new techniques, new procedures, because they can't stick to just the old way of doing business. These kids are coming back with traumatic injuries that are very, very tough. They got to find a way to deal with them.

And you find doctors and nurses out there trying new things -- things that may be in your emergency room not too far from them.

GUPTA: Yes. I'm not quite sure how to say this, but I think on the battlefield, you are forced to innovate in ways that, you know, in civilian medicine, you're not. You can't -- you don't do it so much because it becomes so wrought here in hospitals.

This is really fascinating stuff. Let's keep talking about it. We're going to talk about healing the brain. That's coming up next.

There's a new approach. It's pretty striking. You're going to want to hear this.

We're also going to be back with more battlefield breakthroughs right after this.

(COMMERCIAL BREAK)

GUPTA: Traumatic brain injury, it's often referred to as a signature injury of the war that we're in right now. More than 200,000 Americans are hurt. It can be mild, it can be severe. It's same sort of injury as a concussion on the football field or in a car crash.

Mending the brain is a tremendous challenge, but there are promising treatments out there.

And CNN Pentagon correspondent Barbara Starr went to Ft. Campbell in Kentucky for a first-hand look.

(BEGIN VIDEOTAPE)

STARR (voice-over): This is an intense simulation. It's hot, loud, and stressful.

Staff Sergeant Aaron Potter and other troops are voluntarily putting themselves through this grueling episode of fake blood and plastic wounded models for one reason -- after weeks of behavioral therapy, all of these soldiers are trying to show they can't get back to their daily work, combat.

These are only paint ball guns, but these troops all brain injured in the war, are determined to succeed. This is just one example of how the war may be affecting your medical care.

(on camera): Doctors here at Ft. Campbell have developed a new approach to treating the type of war zone brain injuries that these troops are trying to recover from. It's a treatment you may find some day at your local hospital.

(voice-over): In 2009, Potter was knocked unconscious when hit by three IEDs at once in Iraq. He tells us during the first round of therapy he broke down under the stress.

Now, as he drives a convoy simulator, he is determined to make it.

STAFF SGT. AARON POTTER, TRAUMATIC BRAIN INJURY PATIENT: I really struggle with multi-tasking and getting things done, multiple things done at one time -- whereas before I never really had a problem with that.

And then now, you know, I don't have any -- I mean, there's slight problems, but I'm a lot better off than I was.

STARR: Therapy treatment can be both simple and complex. Identify the parts of the brain that have suffered trauma, the dark areas here. Identify what tasks the patient is having trouble with that relate to that part of the brain and then go to work, exercising the brain, regenerating and re-energizing specific brain functions.

A. POTTER: That's a good one.

STARR: When he came home to his wife and two sons from Iraq, Potter's brain injury left him unable to concentrate, focus on tasks, or even deal with the basic chores his wife Tiffany asked him to do around the house.

TIFFANY POTER, SGT. POTTER'S WIFE: Within a week or two you started to pick up on how either he didn't understand what I was saying to him. Simple things that he normally did, they just -- he couldn't do them. Either he couldn't do them or just didn't understand how to do them.

STARR: Tiffany urged him to get help at the nearby military clinic. Neither of them realized at the time it was a brain injury.

(on camera): The first time you met Staff Sergeant Aaron Potter, what did you see what was going on with the staff sergeant?

DR. DAVID TWILLIE, DIRECTOR, FT. CAMPBELL TBI CLINIC: Some of the things that he was having to deal were making it difficult for him to do his job well. And so, it was really a time for us to come together and say, hey, look, we can actually help, we can make a difference here.

UNIDENTIFIED FEMALE: Step into the machine and face the screen. We'll get you all hooked up.

STARR (voice-over): How do you exercise the injured parts of your brain? Here, there are exercises for balance, puzzles for concentration, and video games to teaches relaxation.

It's a treatment that can help for those suffering any type of brain injury, a sports injury, a car accident, or a gunshot.

Dr. Bret Logan says he'd like to see this comprehensive approach migrate throughout civilian care -- not just at major metropolitan trauma centers, he also thinks there would be other implications for treating brain disorders.

(on camera): Can you re-train a brain that may be suffering from Alzheimer's or Parkinson's?

DR. BRET LOGAN, EXEC. DIR., FT. CAMPBELL WARRIOR RESILIENCY & RECOVERY CENTER: We believe you can, Barbara. And you do that by exercising the part of the brain which is responsible for that function.

STARR: Now, you're not saying you can cure these diseases, to be clear?

LOGAN: Not at all. Not at all. What we're saying is we can slow, maybe even periods of rest, the process of decline in that area of the brain.

STARR: Logan says there's no reason this type of therapy would work only for soldiers. It could help drug addicts and alcoholics recovery brain function. When it comes to changing the brain and behavior, he says, counseling just isn't enough.

UNIDENTIFIED MALE: Sit with us for a little while. Join the circle.

A. POTTER: Circle of trust here?

STARR: At the end of it all, Aaron sits down for his evaluation. Initial laughter turns serious.

For Aaron, all the hard work now comes down to the finish line. His therapy team tells him he's done well. If he still wants to -- he's likely to serve again.

(END VIDEOTAPE)

GUPTA: And joining me again is Barbara Starr.

Again, just really interesting stuff -- this idea of taking medicine and applying it to civilian medicine from the battlefield. You are looking at training for the brain here. I mean, you look at that and you ask yourself, what evidence do you have that it works?

STARR: Well, the doctors are telling us at Ft. Campbell that their best evidence right now is their track record, that the major percentage of the troops that go through this program are able to demonstrate enough progress to return to duty, to return to combat.

Can it work in the civilian world? It remains to be seen.

It's the kind of thing that is already happening at major trauma centers. I think we have seen some of this in the massive rehabilitation that Congresswoman Giffords got, for example.

GUPTA: Right.

STARR: But what they are talking about is trying to expand this. So, it's not just to the major trauma center, it's just not with the military -- put it in emergency rooms and care situations across the country.

GUPTA: And what about other neurological problems?

STARR: Well, that's what they're trying to look at. If you have Alzheimer's, for example, can you identify what part of the brain and can you develop an exercise program for your brain that will help you?

It's not going to cure it, nobody is saying that. GUPTA: Right.

STARR: But can it keep that part of your brain going?

And the other thing they're looking at which perhaps has some resonance are people who suffer from drug use or alcoholism. It enters their brains. Their brains become less than they were due to this abuse. So, you know, just psychological counseling and that type of rehab won't be enough. You've got to work on those parts of the brains with brain injuries.

GUPTA: Very specifically.

Fascinating stuff. We're going to have much more with Barbara as well.

Next week, we're going to talk about a program for regular doctors out there, nurses as well, here in the States, that gets them ready to go into the war zone.

Barbara, thanks a lot.

STARR: Sure.

GUPTA: I really appreciate it.

Up next, we're going to talk to a Harvard professor who went to war.

(BEGIN VIDEO CLIP)

KIT PARKER, HARVARD UNIV. SCHOOL ENGINEERING & APPLIED SCIENCE: What happens when the brain gets hit by a blast wave and it slams up against the inside of the skull?

(END VIDEO CLIP)

GUPTA: He came back as a man on a mission to revolutionize our understanding of what exactly happens when a blast damages the brain.

Stay with us.

(COMMERCIAL BREAK)

GUPTA: You know, you run across a lot of interesting people in my line of work. But not many like Kit Parker. He's a bioengineer.

And back in 2001, he was working to develop these drugs for heart disease. He just landed his dream job. He was a professor at Harvard.

But he was also an Army officer and there was something else he had to do first.

(BEGIN VIDEOTAPE) GUPTA (voice-over): Kit Parker always wanted to be a bioengineering professor at Harvard. He thought he was going to develop the next great heart medicine.

But in 2002, when he was offered his dream job, there was a catch. He was in the Army Reserves and he signed up with a unit that he knew was headed to battle.

So, Army Major Kit Parker told Harvard --

KIT PARKER, HARVARD UNIV. SCHOOL ENGINEERING & APPLIED SCIENCE: Hey, hold the job. I got to go fight. I took off for a year to go fight in Afghanistan.

GUPTA: He spent much of 2002 and 2003 near Kandahar, hunting for Taliban. He came back to Harvard. But in 2009, with the National Guard unit, he went back to Afghanistan.

PARKER: And so, I spent a lot of time with route clearance units looking for IEDs and we got hit several times and vehicles in front of me blown up. My vehicle never got hit. I was very lucky -- very, very lucky. And when you run up there and pull open the door of that MRAP and see your injured buddies, you'll never forget that sight.

GUPTA: This time, back home, he began to explore the science of brain injury.

PARKER: What happens when the brain gets hit by a blast wave and slams up against the inside of the skull?

GUPTA: With colleagues at Northeastern University, Parker built new tools to study how a blast affects the brain. It could be years before this leads to new treatments, but Parker hopes eventually will have a broad impact.

PARKER: Concussions that your favorite football player suffers or the head injury you get when you're in a car accident and your head snaps forward or shaken baby syndrome, these are all examples of non- penetrating head injuries that can cause a traumatic brain injury.

GUPTA: Today, his Harvard lab is humming with young graduate students. More than half a dozen are veterans.

PARKER: We're very focused on this because these are our buddies, these are our guys. You know, this could have been us. It might still be us.

So, it brings a certain level of urgency to what we're trying to do.

(END VIDEOTAPE)

GUPTA: I'll tell you, it's just a creative way of looking at some pretty tough problems. We're going to have much more next week as well on some of these battlefield breakthroughs. For now, though, we're switching gears. Less than a month away from our New York City triathlon -- I'm a little nervous. In fact, that's me finishing the race last year, with the rest of the 6-pack. Next, you're going to meet somebody who's racing with me this year.

Now, in order to finish, she tells us she has to overcome one of her biggest fears.

(COMMERCIAL BREAK)

GUPTA: So, it's one of favorite parts of the show. You know, when my producers and I launched this year's triathlon challenge, we were looking for something specific, for people who wanted to transform their lives, not just physically but also mentally.

Kas Seerla has put herself to the test on this very issue. Before our challenge, Kas, for example, had never really been swimming and none of it outside a swimming pool.

Then we took her and the rest of the 6-pack to Hawaii and Kas went to the ocean for the first time. We're going to talk to her about that.

She's joining us now from her home outside Chicago.

Kas, good to see you there, via satellite.

Let me get right to it here. The first time you did that open water swim in Hawaii, you were pretty nervous, you said. The coaches were saying, you, you know, swam further than they thought you would be able to.

What was it like? What was that experience like, stepping into the open water for the first time?

KAS SEERLA, FIT NATION TRIATLETE: Well, the first time, you know, they took us to open water and when I saw the ocean, I really immediately freaked out because I've never been in the ocean before, swimming in the ocean. And I freaked out and I wasn't sure if I could swim (ph) in water or get past the waves.

And then Tim DeBoom who was there to coach us, said, "Come on, you know, I'll take you."

GUPTA: And a lot of people have these exact same problems which is what I think I told you there in Hawaii. You were making a goal to sort of focus on your open water swims mentally as much as physically. How is that going for you?

SEERLA: It's been going well. After I came back from Hawaii, I've been doing some open water swim clinics and you know, they have been teaching me, you know, all the things that I need to know to swim in open water. How to sight, you know, how to swim in a straight line when I cannot see the bottom.

And so those are techniques that, you know, I'm practicing. I'm still learning. So, you know, it's coming along much better now than I was when I was in Hawaii.

GUPTA: How would you say you're different overall? This has been several months since you signed on to this, since we first met. How are you different as a person as a result of this?

SEERLA: I think I'm much more confident when I cannot see the bottom. I'm much more confident doing distances in open water.

So I think just being comfortable in open water is probably the biggest change that I've experienced.

GUPTA: Well, you look great, by the way. This is about fitness, more than anything else, but you look fantastic. And I can't wait to cross that finish line with you -- coming up pretty soon.

SEERLA: OK. Thank you.

GUPTA: Thanks, Kas.

And if you want to follow along with me, Kas, or any of the other members of the 6-pack, you can check out our CNN.com/Sanjay Web site for more on the Fit Nation Challenge.

Thanks for being with us, everybody.

I'm Dr. Sanjay Gupta. More news on CNN starts right now.