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SANJAY GUPTA MD
The Cost of Care; "It was a Lot of Pain, Torture"; Tough Disease Vs. Tough Woman
Aired March 30, 2013 - 16:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: Hey there, and thanks for watching.
You're going to meet this former soldier whose name is D'Angelo Vaughn. He's got five daughters. He was having a hard time back from Iraq until he found this unique program. He calls it a kind of life coach. We'll explain.
And fighting cancer -- the fun way.
This woman, the one in the helmet there in the middle, she's unforgettable. We'll introduce you.
And there's a lot more.
Let's get started.
First up, when desperate parents meet the high cost of medical care, autism is a case in point. Studies after studies says that early intervention is crucial, and that with immediate intense therapy, children will improve and sometimes dramatically. The problem is that gold standard treatment can easily run tens of thousands of dollars a year. And about a third of U.S. states do not require insurance companies to pay. So, of course, they don't.
Georgia is one of those states. So, this winter, a group led by three mothers decided to fight for more help.
GUPTA (voice-over): They are fighting for a bill called Ava's Law.
This is Ava. And this is her mom, Anna. They are at the state capitol in Atlanta.
UNIDENTIFIED FEMALE: I met a mom whose daughter was diagnosed two months ago.
GUPTA: It's late February, day 23 of the 40-day lawmaking session.
UNIDENTIFIED FEMALE: If it could be voted on --
GUPTA: This is Megan Drati (ph). She recently adopted a 10- year-old boy with severe autism. And Melissa Solares, her son Arturo was diagnosed with autism a little over a year ago, on his 4th birthday.
MELISSA SOLARES, SON HAS AUTISM: I think we started noticing differences in him as early as 9 months old.
GUPTA: By age 4, he wasn't even potty trained and he was barely able to speak.
MELISSA SOLARES: He wouldn't walk by himself. I either had to carry him or put him in a stroller. He wouldn't eat by himself. I had to feed him. And if I didn't feed him, he just wouldn't eat.
His main method of communication was screaming and pointing. He never would play with me. I remember Arturo would come home and try to play with him and he was like, I can't get him to play with me. I said, you have to try harder.
GUPTA: The official diagnosis was terrifying.
MELISSA SOLARES: You have this baby and you have all of these hopes and dreams attached to him. You want him to have this fulfilling life. And then, in one moment, all of that gets robbed from you.
GUPTA: That was the nightmare.
UNIDENTIFIED CHILD: My camera got broke (ph).
GUPTA: But today, a year later, Arturo speaks in full sentences and he goes to a regular preschool.
MELISSA SOLARES: In my mind there is no way he would be in this position without the therapy that we did for him.
Are you ready to sound it out?
UNIDENTIFIED CHILD: Hmm-hmm.
MELISSA SOLARES: OK. You look at my finger.
GUPTA: The key, Melissa says, is intense therapy, behavioral therapy.
UNIDENTIFIED CHILD: Hat.
MELISSA SOLARES: OK. So, do it fast.
UNIDENTIFIED CHILD: Hat.
MELISSA SOLARES: What word is it?
You get two tokens for that. That is awesome. GUPTA: She does hours of this each day. She's also training a new therapist. There are two weekly visits from a more experienced behavior coach. And a monthly visit from the program director.
ARTURO SOLARES, ON HAS AUTISM: She makes $150 an hour.
MELISSA SOLARES: Plus mileage.
ARTURO SOLARES: Plus mileage, because she comes from Charlotte.
GUPTA: There are few specialists nearby. So, those experts had to drive nearly 200 miles each way from Charlotte. It adds up. Last year, Solares and her husband spent $115,000. All of it out of pocket.
MELISSA SOLARES: Do you want the helicopter or the iPad?
GUPTA: Solares knows that she and her husband were fortunate.
MELISSA SOLARES: I think it's very unfair to say, you know, that is medical issue, this is medical treatment and because you are not wealthy, your kid can't have a chance at life.
GUPTA: Melissa, Megg, and Anna. They are pushing a law to require private insurers to pay for evidence-based treatments.
MEGG ANDRADE, SON HAS AUTISM: She said our best chance is to find another bill that can be amended.
GUPTA: Self-funded plans would be exempt, although some large companies like Home Depot do choose to cover autism. The sticking point is cost. Even a group setting like this specialized classroom at the Emory Autism Center can be prohibitive.
UNIDENTIFIED MALE: Our most expensive classroom is $26,000 a year. Most treatment, the intensity they receive here costs between $40,000 and $80,000 a year.
GUPTA: Those kinds of numbers are a big concern for the insurance industry, which says other customers will end up paying the price.
SUSAN PISANO, AMERICA'S HEALTH INSURANCE PLANS (AHIP): The cost of the mandated benefit has driven coverage to a point where a lot of employers can no longer afford to purchase it.
GUPTA: But the group Autism Speaks, they helped draft Ava's Law, says that in states with similar laws, autism treatment pushed up premiums less than $4 a year.
JUDITH URSITTI, AUTISM SPEAKS: The states that have this for a while, like Texas, and South Carolina, Indiana, no one is losing their health insurance. The sky has not fallen. There's just no indication of that at all.
MELISSA SOLARES: He will not need as much services this year as he did last year. He won't need as much the year after. We are already decreasing what he needs.
GUPTA: And that's part of the point says John Albers, who sponsored Ava's Law in the Georgia State Senate. Pay now and you save money later.
JOHN ALBERS (R), GEORGIA STATE SENATE: First and foremost, it's about children and families which should be number one. For those of us like myself who are conservative, this is a huge cost savings. We know what it costs when a child needs to be taken care of with special needs throughout their lives.
GUPTA: Early March, day 28. The insurance side seems to be winning.
UNIDENTIFIED FEMALE: The chairmen are not taking my calls.
GUPTA: Suddenly --
UNIDENTIFIED FEMALE: We have a small chance here.
GUPTA: -- word came the Senate Insurance Committee would hold a hearing.
UNIDENTIFIED MALE: Today, we are going to hear Senate Bill 191 in a hearing only.
UNIDENTIFIED MALE: Thank you, Mr. Chairman, members of the committee. And to put a face with the name of this law, I would like to introduce Ava to you.
UNIDENTIFIED FEMALE: South Carolina (INAUDIBLE) early your doctors, in the past five years, we have really worked hard and all these (INAUDIBLE).
UNIDENTIFIED MALE: Economically this is the way to go.
UNIDENTIFIED FEMALE: That part can be the narrative for every family dealing with autism in the state of Georgia, if you allow it.
UNIDENTIFIED FEMALE: And the cost of treatment he needs is the salary I gave up.
UNIDENTIFIED FEMALE: I think it went great. I think we accomplished just what we wanted to. That was to put the information out there for them to see that there is nothing else to study.
UNIDENTIFIED MALE: That was impressive, 32 states, (INAUDIBLE) just coming on board.
UNIDENTIFIED MALE: Just wanted to give them space, let them take it all in. Of course I will hit him probably tomorrow.
GUPTA: Their optimism didn't last. The bill was with sent to another committee. It was stuck.
MELISSA SOLARES: We're not going to give up hope. We're not going to stop fighting until the very last day.
GUPTA: The last day, day 40, and Drati (ph) and Bollard (ph) back at the capitol.
UNIDENTIFIED FEMALE: We are not giving up. If nothing happens today, we are going to keep going through the mandate commission. You know, we said we're holding out.
GUPTA: On and on -- into the night. Ava's Law didn't even come up for a vote.
MELISSA SOLARES: He's been in a year and we have liquidated our entire emergency fund. Basically all of our savings is gone. It's gone. And we've gone into debt for it. We can't afford to live in Georgia for much longer.
GUPTA: Now, I'll tell you, a number of private companies including Home Depot and Capital One Bank, they decided to, on their own, pay for autism treatment for their families and employees. Some government programs like Tricare do as well and a massive federal employees health benefit program, they do as well.
Now, a lot of this is new. So, people are still getting a handle on the true cost as well as trying to determine which treatments are going to be the most effective.
Coming up, an Iraq veteran with five daughters. He was almost ruined by a brain injury. But he beat it. That's next.
GUPTA: Well, this number is shocking. Traumatic brain injury has affected nearly 20 percent of the veterans of the Iraq and Afghanistan wars. The usual cause is explosions. And mostly, injuries are mild, but for many, the damage is permanent.
Army combat engineer, Sergeant D'Angelo Vaughan, he was injured in an IED explosion in Iraq in 2005. He suffered a severe brain injury and it's been a long road back.
D'ANGELO VAUGHN, MILITARY VETERAN: I had a feeling that I would be injured when I went to Iraq that second time.
GUPTA (voice-over): Army combat engineer, Sergeant D'Angelo Vaughn, was injured in an IED explosion in Iraq in 2005.
D. VAUGHN: We were riding to a mission to blow up some IEDs. My driver, he ran over an IED and I lost one of my eyes. And the left side of my skull was fractured. And they had to take out a piece of my brain because it got infected. GUPTA (on camera): This is the part they had to take out because of the injury and to take some pressure off your brain?
D. VAUGHN: Yes, sir.
GUPTA (voice-over): Unlike the physical wounds of war, traumatic brain injuries, they are often invisible to the eye. It's not uncommon for vets like Vaughn to suffer in silence.
(on camera): What was recovery like? You have these operations. You're seven months in the hospital.
D. VAUGHN: Lots of pain, torture, it seemed like. Light will cause me to have migraines. I was having seizures.
GUPTA: That whole chapter is hard on you --
D. VAUGHN: Yes.
GUPTA: -- and your wife.
D. VAUGHN: It caused me and my first wife to get a divorce. Luckily, I have tremendous parents.
GUPTA (voice-over): Now, D'Angelo's happily remarried.
UNIDENTIFIED FEMALE: Can you wash that pan out?
GUPTA: But communication was still a major challenge for him and his wife Kenyatta and his five girls.
KENYATTA VAUGHN, VAUGHN'S WIFE: I could tell something would be bothering him sometimes. He wouldn't know how to express himself.
D. VAUGHN: I just didn't feel like I could offer anything to society.
UNIDENTIFIED MALE: Keep your head nice and strong -- strong through the core.
GUPTA: Just last year, D'Angelo found the SHARE Clinic. It's a comprehensive rehab program in Atlanta, focusing on helping vets recovery from trauma dick brain injury.
DR. ANDREW DENNISON, SHEPHERD CENTER/SHARE MILITARY INITIATIVE: A lot of people will headaches. They'll have trouble with concentration and attention, insight and judgment and planning. You will also see difficulty with emotion control.
GUPTA (on camera): How do you describe this program?
DENNISON: The one stop shop for everything -- treating all of the different symptoms in a cohesive way.
GUPTA (voice-over): For Vaughn, regaining independence a key living in the SHARE-provided housing. D. VAUGHN: That's independence right there.
GUPTA: He also surprised himself by discovering a new hobby.
(on camera): What does this do for you physically and mentally?
D. VAUGHN: It gives you patience.
GUPTA: What are you looking for?
DENNISON: I'm looking how we're paying attention to the left side in particular.
GUPTA (voice-over): Vaughn has completed the inpatient program, it took him 81 days. Now he's living at home with his family. He meets with his life coach weekly.
JACKIE BRETTENSTEIN, SHARE LIFE COACH: And go ahead and instead of 5:00 to 6:00, put the correct time. So, put 3:00.
So, it could be appointments, it could be a daily routine, it could be things they want to accomplish -- volunteer time, how they're structuring time.
D. VAUGHN: I'm going rock climbing in Utah.
GUPTA (on camera): Do you have goals now for the future?
D. VAUGHN: To become a personal trainer, to be the best father that I can be to my five children. And to be the best husband I can be to my wife.
GUPTA: How would you rate your quality of life?
D. VAUGHN: Scale out of 1 to 10, 10.
GUPTA: That's fantastic. Would you go back to Iraq?
D. VAUGHN: If my country needed me, I would go back.
GUPTA: Just remarkable. And I can tell you, I heard the exact same words from Jesus Vidana, you met him last week. He was the marine I operated on in Iraq I went back and saw a few weeks ago. Just like D'Angelo, he said, I would go back.
I also love this next story. This woman I'm about to introduce you to her. She's the one in the helmet there. And she's got this wild sense of humor, zero sense of quitting. She'll make you completely re-imagine what it's like to be in fight for your life.
GUPTA: In today's "Human Factor", a tough disease versus even a tougher woman. You don't want to be on this woman's bad side -- whether it's in court, she's a lawyer -- or on the court, she loves to play basketball.
And when Gloria Borges took on the fight of her life, she decided to have a little fun along the way.
GLORIA BORGES, COLON CANCER PATIENT: September 19th, 2010, I received news that no healthy 28-year-old expects to hear. But I didn't cry, panic or feel sorry for myself.
GUPTA (voice-over): Gloria Borges is a fierce opponent -- calculated, competitive, unrelenting.
BORGES: I joined the gym in the beginning of 2010, but I lost about 30 pounds of fat, put on 10 pounds of muscle. And so, I thought my body was going through changes in general. And so, the G.I. issues were tied to those changes.
GUPTA: As the year progressed, Gloria's symptoms got worse. But she toughed it out until one day she got fouled in a basketball game.
BORGES: She put both hands on my gut area and didn't slap me hard. It was just trying to throw me off balance. And the pain was excruciating. And I remember hobbling over to the free throw line and realizing, there is something very serious here.
GUPTA: Gloria finally checked herself into the hospital -- bloated and vomiting ferociously. An emergency operation uncovered a large tumor in her colon.
BORGES: My mom told me initially it is stage 4 and it is aggressive. And I said, well, I'm an aggressive girl. So, what do we do?
GUPTA: Doctors told Gloria she had one to two painful years left at best. She was undaunted.
Here she is at chemotherapy round one, sporting a Rocky t-shirt. Then came round two. Round three.
At round 45.
She had beaten the odds, she decided to have a little fun.
GUPTA: Today, Gloria is checking into USC's cancer center for round 46.
UNIDENTIFIED MALE: Cancer is tough. And I'm tougher.
BORGES: You like that?
UNIDENTIFIED MALE: That is a good one.
GUPTA: With her husband Will and her parents by her side. Together with Dr. Luntz (ph), they launched a foundation to find a cure for colon cancer within the next decade.
BORGES: I said, all right. If you had all the money in the world, could you cure it? Do you and your team of doctors know what to do? And he said yes.
GUPTA: Their goal, $250 million.
BORGES: My answer to cancer was no. This is not going to happen.
GUPTA: I'll tell you, 100 percent of donations to the WunderGlo Foundation go directly to research. Want to learn more, you want to donate to the cause -- log on to thewunderproject.org.
Up next, do you want to eat smarter, have more energy, even lose some weight? We're going to get a crash course in food schooling with the Fit Nation triathlon team.
We'll be right back.
GUPTA: So we are here with Ilana Katz, a registered sports dietician.
Thanks for joining us.
This is a very important part of training for triathlon, as you know. So, I want to go through a couple of food diaries and specifically with Ray and Annette. Talk about the value and importance of smaller meals throughout the day.
ILANA KATZ, SPORTS DIETICIAN: What we found with Annette and Ray's food diaries is you guys are waiting a long time before you eat. What more meals more often does is prevent us from going between grazing and starving. And remember, it's the grazing/starving, grazing/starving, like cows eat which forces us to store fat.
GUPTA: The prevailing wisdom is, I'm just going to eat less and lose weight, that's going to help lose weight.
KATZ: Right. And that doesn't work, eating less to lose weight because if the body is starving it holds on, even if you are eating good foods. So, eating less more often is much better. I call it ELMO's law. Eat less more often -- ELMO.
GUPTA: Well, you know, I can relate to some of what you do. I didn't learn how to cook when I was younger. But you eat out a lot. Talk about the reasons why that's the case for you.
But you saw Will's food diary. What first jumped out of you?
KATZ: Foods coming from restaurants food, a lot of fast food. And it tells me, lack of planning.
GUPTA: And again, from a sports dietician's standpoint if you have time on the weekend to cook for the week what should he focus on.
KATZ: Separate food into containers. Make your own lean cuisine. Personally, I make a big pot of quinoa and then I just eat it during the week by just adding things to it like pumpkin seeds and almonds. I make a big pot of chili and I freeze most of it. Lean turkey with lots of veggies, even throw a baked potato in the microwave and have it with Greek yogurt, like salad cream on top.
GUPTA: I think that's a good segue to maybe we should all go navigate the supermarket now and figure out where we should spending our time and our money.
KATZ: How many of you have tried kale before? For breakfast you can put it in your smoothies. For lunch you can make a salad out of it. For dinner, you can saute or bake it.
So, this is our seafood section. One thing to keep in mind is if you see something with bones and skin on it, if you go to the grocery store, they will take the skin off and take the bones out for you. Don't be afraid or intimated to ask about that.
The leaner the meat is, the less white stuff you're going to see. So, you can tell the higher fat meats are going to be like ribs and your briskets. Whereas your tenderloins, your loinsyou're your ground round are the leaner cuts.
GUPTA: There's another thing I take away from all that, these guys are now part of a team. "Chasing Life" isn't just about diet or exercise. It's proven people who stay socially active tend to live longer and be healthier. Having friends outside of work provides a sense of purpose, that keeps your brainer sharp, can lower your stress.
There is no magic number. Many people are fine with just one friend. Now, realize, it isn't as easy as when we were kids but do make the effort. Say you are fascinated with wine, for example, or the stock market or exercise -- chances are there is a social group nearby that you can look to join, a common interest, common activity. That's a great way to make friends.
And spring is here. So, RSVP yes to your school reunion, reconnecting with an old friend is great. And it could help you live a longer, and healthier life.
That's going to wrap things up for SGMD. Let us know what you think, CNN.com/Sanjay. And also, follow me on Twitter @DrSanjayGupta.
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