Arizona Horizon Banner

May 15, 2014

Host: Ted Simons

Deep Brain Stimulation

  |   Video
  • For the first time in its history, the Barrow Neurological Institute at Phoenix Children’s Hospital performed an advanced form of brain surgery called deep brain stimulation on several children with dystonia. That’s a disease that produces chronic, involuntary contortions of the trunk and limbs. The procedure involves placing electrodes deep in the brain and then connecting them with a pacemaker-like device placed in the abdomen. The surgery has allowed children to walk again and perform everyday functions. Neurosurgeon Dr. Ratan Bhardwaj will discuss the procedure.
  • Dr. Ratan Bhardwaj - Neurosurgeon, Barrow Neurological Institute at Phoenix Children’s Hospital
Category: Medical/Health   |   Keywords: medical, health, deep, brain, stimulation, procedure, children, surgery,

View Transcript
Ted Simons: The neurological institute at Phoenix children's hospital recently performed an advanced type of brain surgery called “deep brain stimulation” on several children with dystonia; it marked the first time the procedure has been used successfully to treat children in Arizona. The surgery has allowed the children to walk again and perform everyday functions. Neurosurgeon Dr. Ratan Bhardwaj joins us now to discuss the procedure. It’s good to have you here. This is amazing – deep brain stimulation. What are we talking about?

Dr. Ratan Bhardwaj: It's a pleasure to be here. This is a pretty amazing technology that I’ve seen. It’s very humbling from a medical point of view. Technically what we’re doing is we're seeing children who are suffering from really bad movement disorders. What we're doing while they sleeping in the operative setting is we place electrodes, very precisely in the right location deep in their brain. Then we tunnel these leads into a battery Pack in the chest or the abdomen. Two weeks later we turn it on and amazing things seem to be happening.

Ted Simons: That's amazing. You go up into the brain. The wires go where? Just straight down the spine?

Dr. Ratan Bhardwaj: No. The spine is lower. We try to avoid that. There's an important part of the brain called the basal ganglia that’s very important for how we move things. For instance for me to pick up the glass like this I have to use a lot of different muscles in my hand,different tension in my tendons to be able to pick it up. So that part of the brain is the basal ganglia, and that’s precisely where we put it. It's specifically in a certain part of the --.

Ted Simons: Oh ok so that makes it clearer then. How precise if I have a problem doing what you said, lifting things, how precise can you be? Is it still -- I don't want to say guesswork. Are you approximating or can you fine tune this?

Dr. Ratan Bhardwaj: We have to be as precise as we possibly can. Millimeter or better. We're doing this while the patients are all sleeping. Children, it's very tough do while they are awake. It's all placement and location. I have an excellent operative team. I work with a lot of people, whether it's a frame that goes on the head or the highest technology of brain imaging to make volumetric models of the brain trajectory to safely avoid the blood vessels. We put so much care and thought into this and so far, so good.

Ted Simons: So far you have gotten children -- dystonia means, what, you can't control movement?

Dr. Ratan Bhardwaj: That's a great way to put it. These are very debilitated children. So the crazy thing is it's almost like somebody who could see and went blind. There normal until five or six, running around in the park playing in kindergarten, then they start getting worse. They get worse and worse and medications don't help. So these children who out of our first two or three were wheelchair bound children who used to be running and playing, now basically can maybe sometimes lift their head and watch TV. They can't eat, they can't type, they can't text, they can't run, they can't play. Their life has changed dramatically as well as the family's life. Medicine doesn't help. DBS is the only treatment for these children.

Ted Simons: And the treatment you say is successful what constitutes success?

Dr. Ratan Bhardwaj: It's a great question. I have a love for the brain. It's the most complicated thing in the universe. So when I started I wanted to treat children with brain problems. When I started a DBS program at Phoenix children's hospital, I didn’t know, I said wouldn't it be great if these children could walk again. That to me was an amazing possibility. And once we did our first child, a lovely young girl, that was the million dollar question. Sure, she could open her hand, sure she could finally put her shirt on by herself, sure she could wash her hair, but she's looking at me saying I can't walk. That was at one month. Then at about three months she started walking and with a lot of physical therapy she's actually walking now.

Ted Simons: I believe we have video of a patient who is literally moving, doing things that, again, this was -- things were debilitating, deteriorating pretty fast in these kids.

Dr. Ratan Bhardwaj: But you asked me what success -- absolutely agree. What totally blew me away with this patient and is so humbling is that she told me in my clinic, doctor, you have made me more human. From a medical point of view I could never imagine a patient would tell me that. That means you have a 13-year-old girl who can't write, speak, who can’t type, text, she can’t communicate with the rest of the world. Now she's writing journals, now she’s texting people, making Facebook friends. She's got her life back. This is so immensely more important than walking even, which is absolutely unfathomable.

Ted Simons: I imagine when you see something like this, see this little girl moving -- just to look in her face, this must be so fulfilling.

Dr. Ratan Bhardwaj: Magical smiles. I had a little boy who was basically wheelchair bound, rolling around in bed, losing weight and dying. Within three months he is playing tennis, although his mother says he doesn’t play tennis very well. Tough mother.

Ted Simons: How does this differ from treatment and therapy for Parkinson's?

Dr. Ratan Bhardwaj: Great question. DBS has maybe been in over 100,000 patients primarily with Parkinson's. We can help these patients. I’m on the other side of the spectrum. I'm looking at children. So amazingly, children's brains are growing and changing as opposed to an adult's brain. How we're able to modulate the circuitry that governs their movement, their thinking, governs their mind, that's amazing. These are things we're trying to understand better. We're seeing dramatic improvements that I had no idea we would see when we started.

Ted Simons: But there was some concern, maybe caution -- you are dealing with developing brains. Developing bodies.

Dr. Ratan Bhardwaj: In that caution and concern hasn't left at all. To take the responsibility to operate on a child's brain we take that with immense responsibility. I'm a very conservative surgeon, however, sometimes the most conservative thing is to do surgery. It's horrible watching them whittle away and not do well. We had one child yesterday and he suffered from a problem where unless his parents were holding his hands he was striking himself and hitting himself very hard. We have turned the system on a couple days ago, and the parents were amazed that for the first time in years they didn't have to hold his hands. I pray and hope this keeps going in this direction, but we just, you know, it's amazing what the limits are.

Ted Simons: Last question here. You pray and hope it goes in this direction. These children will have to wear this and have this apparatus in them for the rest of their lives.

Dr. Ratan Bhardwaj: It's become a part of them of the most surgery we take things out. Here we're putting something in. It's a very small Pack. Children love superheroes, so do doctors. I tell them it's a little bit like ironman. They are not going to fly but if they can walk I'll certainly take that.

Ted Simons: Well you are doing fantastic work. This is very encouraging information. It’s good to have you here. Thanks for joining us.

Dr. Ratan Bhardwaj: Thank you.

San Diego Fires

  |   Video
  • Wildfires near San Diego are wreaking havoc. Arizona Bureau of Land Management spokesman Jim Payne will discuss the fires and Arizona’s efforts to help.
  • Jim Payne - Spokesman, Arizona Bureau of Land Management
Category: Environment   |   Keywords: environment, wildfires, san diego, fires, arizona, efforts, help,

View Transcript
Ted Simons: The Arizona resources are ready to be used to fight San Diego area wildfires which have burned thousands of acres and forest. What we're hearing now is over 120,000 evacuations. Joining us now is Jim Payne with the Arizona Brewer of land management. It’s good to have you here. I want to get to how much resources have been used over there, but as far as San Diego, this is awfully early for this kind of thing.

Jim Payne: It is. Their normal fire season comes later. August and September, when they have the Santa Ana winds which can run into October. Pretty much 100% of the state is in drought. They only had like a fraction of their snowpack. In San Diego County they had some rain but what that helped the grasses grow and the brush fields they have there. You have to think about San Diego County. People build in the valleys, at the small hilltops. We have brush fields that go up the sides of those hills. So, that whole area in this kind of condition with wind, that's the primary problem.

Ted Simons: So it’s offshore breezes that really kickoff the Santa Ana’s. Compare the drought now over in California to what we’re experiencing in Arizona.

Jim Payne: We have severe drought here that's been going on for a number of years. The good news here is we have had some variable weather. Here with we were in the 90’s, 80's. And we’re going back it looks like, into the 80’s next week. Once we hit the continuous over 100 degrees,100 degrees we'll start seeing more causes of fires here. That's one of the things we're pre-pearing for. How do we keep down the human caused side of it.

Ted Simons: As far as resources are concerned how much of what is designed for Arizona being used right now in San Diego?

Jim Payne: None of our resources have been sent over there except for one national air tanker, a DC 10, that was stationed at William’s Gateway was sent over there to assist them with dropping retardant on the fires. All of our resources as far as engine, hotshot crews, municipal fire departments, everybody is staying home to make sure we’re prepared here in Arizona.

Ted Simons: Nothing compromised now, but if that thing gets much more out of hand you have to figure more resources be needed.

Jim Payne: In California they have Cal fire, their forestry department. All of the municipal fire departments well-versed in wild land fire. They’ve got a lot of resources. They haven't needed our help at this point.

Ted Simons: We're looking at some of the -- wildfire. That's the tragedy. This is a tragedy all around. As far as Arizona firefighters are concerned, are they trained? Are they ready to go?

Jim Payne: They are ready to go and trained. Since January folks have been preparing. What we do is preparedness Between the BLM, forest service, national park service, state of Arizona Forestry Division and municipal fire departments are partners in making sure that they’re prepared for fire season. Most municipal fire departments have a wild land vision. Have engines and firefighters that work closely with the federal agencies.

Ted Simons: Is that new?

Jim Payne: No. That's been going on for quite a while but every year that cohesiveness, coordination gets much better.

Ted Simons: You talk about interagency programs we're talking federal, state and local. Talk about how difficult it is to get everyone in line and ready to go.

Jim Payne: Well, that's once again training, making sure our firefighters are trained. Every march we have Arizona wildfire academy in Prescott. Those -- this year we had over 800 students. The majority obviously from Arizona. We actually had some from Australia. What we do in Arizona, in my mind we're well advanced. We have fire-wise communities. Where ommunities do their own thinning around structures like what they’ve done in Flagstaff, Prescott and other communities. Then as far as the campaign now called one less spark, one less wildfire, it's basically all the agencies together with one voice and one goal. That's to prevent human-caused fires which come to about % of the fires in Arizona.

Ted Simons: And I was looking, as far as fires this year what have we seen and how much of what we have seen human caused?

Jim Payne: Right now out of 415 fires, 103 were human caused. Only 12% were lightning caused from earlier in the year. San Carlos reservation right now has two large fires going. Southern New Mexico near Silver City has another fire going there. These fires start throughout the spring and really for the intensity May and June is our worst, but this year it could extend into July and August, depending on how substantial the monsoon is cause with this variable weather, we're ready for large fires unfortunately, also ready to respond.

Ted Simons: I heard a couple of different folks on the program saying that the fire season looks about average from a distance. Other folks say, oh, no, it looks much, much worse than that.

Jim Payne: Statewide it's probably about average. But if you look at the southeast part of the state up-to-into central Arizona probably higher than normal. But that could change. If we don’t have this variable weather, if it stays hot, and we get ignitions, any source and winds, it could be off to the races.

Ted Simons: Now that you mention variable weather, though, when you have the cooling trends and heating trends usually the cooling trends are associated with winds. Winds not good.

Jim Payne: Winds cure out the vegetation more, makes them dry out more, but it does have a modifying effect with lower temperatures. It's the continuous high temperatures. We get into the single digits, any kind of ignition. And the thing that surprised a lot of people. People think, well, human caused fires are always from a campfire. Somebody didn't put their campfire out properly. Obviously those do happen, but it's the vehicle fires. If you look at a picture or map of the state of Arizona and you follow all the highways, the beeline highway, the highways that go to Wickenburg and places like that, between the BLM, forest service, park service, there's a clear line, all aong the highways, a bunch of fires. Dragging chains. Folks have a flat tire. They park their car on the side of the road, leave a rim. They park their car with catalytic converter on dry grass. Falling material off the back of the vehicle. Fires started on private land. Near Sedona a few years ago we had Somebody was welding on a fence, outside a steel post fence. Ignited a fire.

Ted Simons: That’s where that information program comes into play.

Jim Payne: The one less spark, one less fire is a campaign to really bring attention to an adult education and say, hey, think about what you're doing. Use your head. Any spark can start a fire. You get wind behind it, and it goes.

Ted Simons: We have seconds left here. Are the Feds, state, all firefighters looking at a new normal when it comes to Arizona fire seasons because of what seems to be a new normal?

Jim Payne: We have had a new normal for a while based on our drought and the conditions out there. With changing weather, especially you talk about the winds coming in, then our high temperatures, especially average temperatures start rising, it's going to be a problem in the future. We have an average of about 2,400 fires a year in Arizona. Of those, 56% are human caused. The rest are pretty much lightning. The message is, folks, let’s all help each other out make sure that you aren't the one who starts that fire.

Ted Simons: All right, Jim, good to see you.

Jim Payne: Thank you, Ted.

Sustainability: Sustainability Book

  |   Video
  • Northern Arizona University Regents’ Professor Zachary Smith has written a new book about sustainability. In his book “Sustainability: If It’s Everything, Is It Nothing?,” Smith argues that sustainability has lost its meaning because it is so broad and overused. He suggests a “neo-sustainability” to help refine and clarify the concept. Smith will discuss his book.
  • Zachary Smith - Regents’ Professor, Northern Arizona University
Category: Sustainability   |   Keywords: sustainability, book, concept, refine, author,

View Transcript
Ted Simons: Tonight's focus on sustainability in Arizona looks at the word sustainability. In the new book, sustainability, if it's everything it's nothing, NAU professor Zachary Smith argues that the term sustainability is so broad and overused that it's lost its meaning. Professor Smith is here now to discuss his concerns. Good to have you here.

Zachary Smith: Thank you, Ted.

Ted Simons: This is interesting because when we started to do our sustainability segment, one of the questions we tried to figure out was what does it mean? What does it mean?

Zachary Smith: Well, that's a good question. The fact of the matter is that if you asked 10 different people you get 10 different answers. A good example of that is if you go on the ASU School of sustainability web page, the front page says what is sustainability then quotes a bunch of people and they all have different perceptions of it. I want to talk a little bit about what we wanted sustainability to mean and what it has turned into.

Ted Simons: Well go ahead what. Did we want it to mean?

Zachary Smith: We wanted it to mean managing resources in a way that would take care of current generations and current needs and protect future generations and their needs in whatever way that they deem fit. What's happened is that it's turned into sustainable development and sustainable growth and most people who study this stuff think sustainable growth is an oxymoron. Sustainable development is pretty close. You can have sustainable development if the development doesn't involve the continual use of resources or using up your resource base beyond what's there for future generations.

Ted Simons: Could it be continuing to use those resources but not at such a fast pace?

Zachary Smith: Imagine this you have $1,000. You've got to do some activity. You're spending $100 a day. Now, you're going to decide that you're going to be sustainable. Through sustainability you're spending $50 a day. Well, you're still going to run through that $1,000. Unless you're spending zero and in the book we talk about we as Dr. Heather Farley, a professor at Georgia coastal college, college of coastal Georgia, we talk about rethinking sustainability. The fact that we have to have a type of sustainability that involves bringing back natural resources to where they were when we started whatever the process was. We're not doing that. We examined government institutions, academic institutions and the private sector across the board to find out who is doing what in the area of sustainability. Nobody is doing anything that's really remotely sustainable including academic institutions and government.

Ted Simons: But I go back to the question then. Sustainability development, sustainable growth. Is it possible, if it's not possible, does sustainability mean the best -- you write about how some folks say any change is good. Is any change good?

Zachary Smith: Well, you could look at it that way, I guess. Using $50 a day as opposed to $100 is better. It means that it will be the end of the earth and the end of the human race a little bit prolonged. That's better, but we really are talking about the ability to support ourselves and live the lifestyles we have become accustomed to and most people know that, and we have used this term sustainability to fool ourselves into thinking that we're going to get there sooner by being sustainable. But we're not doing that. Most of what is called sustainable now or eco-friendly is another one. Everybody is sustainable, eco-friendly, but when you look carefully at what government, academic institutions and the private sector, corporate sector in particular does that is eco-friendly and sustainable you discover it's not at all. That's dangerous. Dangerous because it leads society into this -- the general public into this complacency. I'm buying sustainable stuff. I'm recycling. I'm doing everything right. But in fact we're not being sustainable.

Ted Simons: So you want a new definition. You want a new term. Neo-sustainability. What does that mean?

Zachary Smith: That's correct. It means a number of things. One thing is we have to think of traditionally there have been three pillars of sustainability. Ecology, economy and society. We have to address all three of those things in order to be sustainable. What's happened in the way sustainability has been addressed now is there's been an emphasis on economy. We have come to interpret sustainability if we look at one of those pillars, environment is good, economy is important, society is good, but they are all equal. That's how sustainability has been dealt with. We can't think that way. You can't have economy or society unless you have a good environment. So everything has to come from that basis. So neo-sustainability means that we're going to think about the economy because we want a good, healthy economy. We're going to think about environmental justice and society because we want that as well, but it has to be in the context of what's good for the ecology and what’s goof for the environment. This sounds like tree hugger stuff to some people that are listening to this right now but the fact of the matter is that if we don't have fresh air, we can't have good drinking water or other things that we want to have.

Ted Simons: Sounds like you're focusing on improvement as opposed to maintenance. Is that in the ballpark there?

Zachary Smith: You put your finger on the most important aspect of neo-sustainability. It should not -- If we continue sustainability as it's currently defined it will ultimately lead to the destruction of natural resources. Neo-sustainability has to do what we're doing now but it also has to be leading us to a future where we're contributing back to our resource base.

Ted Simons: You mentioned tree huggers. Critics will be saying this is -- whatever. But it has to be realistic. It has to be something that society wants and society can grasp. Is this realistic? Can society as we know it, can society figure this out and accept something like this?

Zachary Smith: That’s a good question. This legislature is not going to do anything like that. I think that people are smart and people are willing to do what needs to be done if given good information in the right form. Everything that I have talk about and everything in this book is solid science. It's well researched and the fact of the matter is if it were better known I believe people would do the right thing but they don't because they are not getting good information. They’re turning on the TV, they’re thinking that this is eco-friendly, this is sustainable, when it's not.

Ted Simons: If it's everything, it's nothing. Very interesting stuff. Good to have you here.

Zachary Smith: Thank you.