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December 21, 2004

Host: Michael Grant
Topics:
"Medical Breakthroughs"
Artificial Heart | Asthma | Ceramic Hip Joint Replacement
These segments first aired November 15-17, 2004.


>> Michael Grant:
Tonight on "Horizon," a new artificial heart is saving lives of patients waiting for donor hearts. One Arizona man's story. And asthma is the fastest growing chronic disease in the U.S., but new research here in Arizona could lead to better medicine and treatments. Plus, a new hip joint implant is helping osteoarthritis patients. We talk with one Arizona man and his doctor before, during and after implant surgery. Medical breakthroughs, next on "Horizon."

>> Michael Grant:
Good evening, I'm Michael Grant. Tonight we bring you a "Horizon" special, three advances in medicine that are saving lives, improving treatment and enhancing the quality of life for patients. First up, this medical breakthrough just recently received FDA approval, but in its experimental stage the Cardiowest artificial heart saved the lives of many, including among those, one valley man who now participants in triathlons. Mike Sauceda has his story, and tells us about the artificial heart that saved him. A note to viewers, this report does contain some video of the surgery.

>> Reporter Mike Sauceda:
Bill Wohl is gearing up for a bike ride. Five years ago he would not have been able to put on his shoes, much less think about riding a bike because of a massive heart attack he suffered in 1999.

>> Bill Wohl:
The doctors always kid me. They've had nicknames for me, walking death, cat on his 12th life.

>> Reporter Mike Sauceda: :
But Wohl cheated death thanks to an artificial heart that kept him alive while he waited for a human heart transplant. He was sent there after 17 valley hospital stays. He received the heart developed at the U of A and implanted by Dr. Jack Coplin at USC.

>> Bill Wohl:
The day they took me down there, it was the beginning of the football season in spring of '99, and that night while watching a football game in my room, my heart failed, my liver, my lungs, my kidneys, everything shut down. So they rolled me into surgery and they removed my heart and that's when they put in the Cardiowest total artificial heart. What they do is remove your heart and put in a prosthetic right and left ventricles and you are attached to a 400 pound blue washing machine looking thing that beats at 150 beats a minute.

>> Reporter Mike Sauceda:
After getting the heart he was in a coma for a month but came out of it and started feeling better. He started working out at the hospital gym.

>> Bill Wohl:
A little bit after that I felt better. They said would you like to go to the gym, and I went, well, I used to work out in a gym, I used to love being a gym rat. They took me down what they call cardiac rehab and after a nine-minute workout I was so worn out and exhausted that I slept for almost two days.

>> Mike Sauceda:
But getting around with the 400 pound piece of machinery that provided power for his heart was not easy.

>> Bill Wohl:
You had to be very careful. There were a few times that I flat lined because I crushed the lines. You had airlines that were plugged into your body through those two prosthetic right and left ventricles. I remember one night I rolled over on my lines sleeping and they saw I flat lined. Nurses came running in, shaking me, bill, bill, wake up. And I remember one day I really had to go to the bathroom really bad, and you wheeled this big box and my lines got caught underneath the box and one of the nurses came in and I was tiptoeing around the box, can you help me? I have to go really bad.

>> Mike Sauceda:
Wohl who ran track in college started thinking about participating in triathlons after seeing a story about transplant games. His dream became possible the day tragedy struck for a 36-year-old actor named Brady Michaels who was preparing for a stunt for a reality TV show being filmed in Benson.

>> Bill Wohl:
On February 18th, we shot a video for the transplant journal, like a 60 minutes. That was the day that my heart donor, Brady Michaels had his freak accident climbing up a ladder, supervising a stunt for the show "I dare you, the ultimate challenge" he fell and crushed his skull and suddenly when he was pronounced brain dead on February 22nd, I had my donor I was going to be his heart recipient because they found we were a perfect match for body size and blood type and I didn't realize it at the time, but I couldn't have been luckier, all of the time that I waited, all of the time that I put in, Cardiowest saved my life and kept me alive and now I had a new heart and I had the opportunity for new life.

>> Reporter Mike Sauceda:
Wohl started working out at home and by 2002 participated in his first transplant games. He participates in 1500 meter swim races and 50 kilometer bike races. He had great success in October this year in the Australian transplant games.

>> Bill Wohl:
In 2004, I just got back last month from Australia where I was with team USA, and I had a pretty good haul. My thing going in there, I wanted to see if I could emulate Michael Phelps in some small way. I wound up with four gold metals, some bronze and silver metals. One of the races I set an Australia record in the time trial and beat the Australian current ranking world champion who had won in France.

>> Reporter Mike Sauceda:
His athletic success is owed not only to Brady Michaels but also to the Cardiowest heart, which evolved from the Jarvic 7. The university technology was turned over to a private company and the heart received FDA approval in October.

>> Dr. Jack Copeland:
The FDA approved a total artificial heart. This is a different kind of device. It's not a partial support to the heart. It doesn't support just one side of the heart. This supports all of the heart and it replaces the heart. So in order to put it in, you have to remove the patient's own heart. This is a big and important step, but after all, that's what we're doing with heart transplantation as well. So this is a landmark ruling by the FDA that allows commercialization of a total artificial heart, never happened before anywhere.

>> Mike Sauceda:
Dr. Marvin Slepian explains how the heart is put into the patient.

>> Dr. Mark Slepian:
This device is basically aimed at bridging patients, the transplantation. So therefore the type of surgery involved in implanting this device is very similar to the actual transplant-type surgery that a patient would be involved in receiving a transplant. As such, the chest is opened, the heart is removed leaving small cuffs of the two upper chambers of the heart called the atria, very similar to a transplant procedure. This heart is then attached to the atrial cuffs and actually the bottom pumping of the chambers snap in then a small drive line is exited out through the chest wall.

>> Richard Smith:
The goal is to simulate how the regular heart works. And so what happens is blood fills two chambers, which are two actual ventricles just like the normal ventricles. And then there is air that's blown in to push it out, and so where your normal heart would squeeze, these actually have a diaphragm that pushes up to accomplish the same thing.

>> You've got it Bill.

>> Reporter Mike Sauceda:
For Bill Wohl the heart is a miracle. He was able to ride in the races and he is working to help pass on that miracle through the Bill Wohl foundation awareness center.

>> Bill Wohl:
I'm blessed to be healthy, much less to be to compete again as an elite athlete. Because I'm thankful, I want to help as many people behind me and as many people that are involved in the transplant community.

>> Michael Grant:
If you would like to visit Wohl's web site to learn more about organ donation, it is at WWW.donatorawareness.org.

>>> Michael Grant:
Next up Arizona has a higher percentage of asthmatics than most other states. The reasons, air pollution allergens and other triggers. The disease is a major cause of emergency room visits for all ages and school absences for students. But now an Arizona researcher's medical breakthrough is giving asthma sufferers hope. He has identified a component of a white blood cells necessary for asthma to be triggered. Paul Atkinson has the story.

>> Reporter Paul Atkinson:
Jamie Lee has asthma. So does his wife and one of his four children. He has wheezing a bit today but like a lot of asthmatics, he's still able to work.

>> Jaime Lee:
Since I was a kid, the asthma has continually gotten worse and worse and worse to the point where now I'm a steroid dependent asthmatic. Every day I'm taking steroids to keep my asthma under control. And for the most part that works and it's okay, but during different parts of the season, the year, when the seasonal allergies get a little above the medication, I start getting wheezy. I have to increase the dosage of the medications that I take.

>> Reporter Paul Atkinson:
Asthma causes a person's airways between their trachea and lungs to inflame. Here's how a normal bronchial tube looks. Here's one with asthma induced inflammation. It makes normal breathing harder and cases more mucus, and swelling. This doctor treats patients in Glendale.

>> Thomas Van Osdol:
The most common triggers for asthma in the early age group in the young kids tends to be more viruses and colds, certainly smoke exposure is a significant factor. As children get older, pollens, molds, animals, cats, dogs, those tend to be more factors in that they are allergies and cause an allergic reaction.

>> Reporter Paul Atkinson:
The National Institutes of Health estimates there are 20 million Americans who have asthma, more than 12 million have had an asthma attack in the last year. Asthma is responsible for half a million visits to the hospital annually. While only 5,000 people are estimated to die each year from asthma, the cost on the economy is great, at an estimated $12.7 billion in 1998.

>> Bill J. Pfeifer:
When a child does have an asthma attack, and they have to stay home from school, well, the first thing is more than likely if they had that asthma attack, they are going to the emergency room and that's an increased burden not only to the emergency room and the hospital alone, but also to our healthcare system. That's added cost that again didn't have to happen. Now you've got a parent who has now stayed home and they have a lost day of work. Possibly a lost day of wages, but then you have the employer that is impacted. It's a trickle down effect.

>> Reporter Paul Atkinson:
For those with asthma, medication plays a major role in preventing attacks.

>> Katie O'Neill:
There is two types of asthma medicine. The first is what we call asthma controllers. They control the inflammation and swelling and they prevent asthma symptoms from developing. Those are daily medicine and generally it's thought that if you have symptoms more than twice a week, you should probably be on a daily preventative medicine for asthma. The other group, the other class of medicine are called the relievers. Those are quick reliever medicine, Albuterol is an example. It opens up the airways, relaxes the muscles around the airways so individuals with asthma can breathe better fairly quickly.

>> Reporter Paul Atkinson:
Medicine has made the world of difference in Jamie's life.

>> Jaime Lee:
So now where I would be a fairly sick child, sick adolescent, I'm a fairly healthy adult. I might wheeze a little bit and I have my problems, but by staying on my medication and following my doctor's advice, I live a fairly normal life. That's a dramatic improvement in 20, 30 years.

>> Reporter Paul Atkinson:
Jamie is hoping for more dramatic improvements. You see, he's not just an asthma sufferer, he is a leading asthma researcher at the Mayo clinic in Scottsdale. He switched his area of research while at Cal Tech.

>> Jaime Lee:
My asthma got so bad, I got so sick. I ended up in the hospital. From my hospital bed I said I've got to stop working on what I'm working and I'm going to work on asthma because I'm going to die before I go anywhere.

>> Reporter Paul Atkinson:
In September, "Science Magazine" published the latest research. It took place in this lab using genetically engineered mice. The mice are exposed to the same things that trigger asthma attacks in humans.

>> We can measure how they are breathing. Here we have it graphed. You can see like mouse two, you can see his breathing patterns from the machine, and what we'll do is graph it and we can calculate exactly what mice are reacting to what, and we kind of try to figure out why they are.

>> Jaime Lee:
We engineered a mouse through various genetic tricks to essentially oblate, to kill off all of the cells we're studying in the animal. The mouse has all of the white blood cells that a human has, with one exception. It's missing the cell we're studying. When we made that mouse allergic, when we gave it asthma and asked did it get sick, did it have the symptoms associated with asthma, the answer was no. They all disappeared. Everything from just the inability to breathe, as well as the mucus that would normally start accumulating in the lung. All of that simply disappeared. And the only reason or the only difference between that mouse and a normal mouse is the presence or absence of the cells we're studying.

>> Paul Atkinson:
Now that the cells have been identified as something essential for asthma to attack, Dr. Jamie Le says the key is finding out exactly what role it plays in triggering the chronic disease.

>> Jaime Lee:
It's a long road from where I'm at. I'm not at the bedside. I'm really at that fundamental point of trying to figure out at a real fundamental level what's going on, but I've been surprised in the past of just how much of an impact this kind of research has on patient care. And in this case, because we're identifying a clear causative agent, it's not going to be too far from potential therapies that are directed against that causative agent.

>> Michael Grant:
Asthma experts say it is research like this that is helping doctors better understand the disease and control the symptoms of asthma.

>>> Michael Grant:
Our third medical breakthrough, more than 20 million adult Americans have osteoarthritis. It is the most common form of the disease and a leading cause of disability in the United States. But a new type of hip implant is helping one Arizona arthritis patient get back on his feet. Producer Merry Lucero brings us the story. And after the story, the patient, the surgeon and another medical expert on arthritis joined me in the studio. A note again to viewers, this report has video of surgery taking place.

>> Dr. Brett Smith:
He's young. He's active, healthy. He's got over 20 years left.

>> Reporter Merry Lucero:
The surgery you are about to see took only 90 minutes, but the results mean near normal activity for the rest of this patient's life thanks to advances in medical technology. Jim Bonnell necessarily discovered his arthritis as age 45.

>> Jim Bonnell:
I've been a runner all my life. I've run long distance and different things. So what happened is I ran a 10K and thought I had pulled a muscle. I went into the doctor's office and they had said that I had no cartilage in my hip, and that from that standpoint, it was -- it then was allowing arthritis to grow in there because of no cartilage.

>> Reporter Merry Lucero:
Bonnell put up with the pain until finally in 2001 he decided to have the joint replaced. The prosthetic implant in his right hip has a metal head on the femur which fits into an implanted socket that is lined with plastic.

>> Dr. Brett Smith:
This is the shell which is the metal portion and the plastic liner and then this is the chrome femoral head. That is the old bearing surface that he has in the right side. The reasoning behind the design for the ceramic implants is that the plastic sheds microscopic beads and those lead to the failure of the implant. Your body senses the beads as being foreign and sends cells out to kill it but it can't, so then it sends cells out to degrade it. Those enzymes try to eat the plastic away, the microscopic beads and it can't, so it sends out more enzymes and eats the bones away instead of the plastic.

>> Merry Lucero:
The prosthetic is doing well so far, but his osteoarthritis has worn down his left hip.

>> Jim Bonnell:
Now the second one is equally as bad and I try to play golf and it's been very painful, and so in walking, walking up steps, lifting heavy loads, it's been painful. So now is a good time to do it.

>> Reporter Merry Lucero:
Dr. Brett Smith recommended Bonnell get the newest hip replacement approved, ceramic on ceramic.

>> Dr. Brett Smith:
This is the ceramic liner and the femoral head where the two articulate. That's the bearing surface that we think is much improved over the previous design of the plastic and metal which hopefully in him will last his lifetime now given his activity level and age.

>> Reporter Merry Lucero:
Some preoperative support from his family while the DOC read December for surgery. He is wheeled into the OR. Aiding the surgery, a camera mounted in the overhead light. The procedure begins.

>> Dr. Brett Smith:
This is for leg length. I put a pin in the pelvis which doesn't change. That checks for offsets and leg length. Because we want to make sure he's got the same length when we leave here. So when he's laying his side, this is his position on the table. The first thing we do is dislocate the hip and pop it out of socket and then cut the femoral head off. This is the head cut out. You can see from x-ray he has bone on bone. This shiny hard part is like a pool ball. That's where the cartilage has worn away. This where it's more dull is the remaining cartilage. You can see where it's rough where the cartilage is starting to wear away as well. This is osteoarthritis. So this is the cup being inserted. This is the bony ingrowth side. The ceramic liner goes inside that. This is the ceramic liner that goes inside of this shell and has a taper fit that will articulate with the femoral side that we'll get to shortly. This stem is anatomic. It's curved in that plane. At that matches the patients femur wonderfully and goes down in the center of the femur. It's press fit down the center of femur and that's the femoral side. The old mark is here. It's a mark where his leg length was before and now I'm exactly reproduced his leg length because he was equal preoperatively. The second check is for dislocation. Keep going, keep going, keep going. So this is a 32 millimeter ceramic head. Okay, rotate. I let it slide on my finger. That's it.

>> Dr. Brett Smith:
Can you call out to the waiting area and tell the wife that we're closing up and I'll be out when he is in recovery, please.

>> Reporter Merry Lucero:
The surgery is over.

>> Dr. Brett Smith:
Hello. How are you? He's doing fine. He's in recovery. He's awake. Breathing on his own. The tube is out. He did great. The brand new hip is in. It took an hour or so.

>> Marilyn Bonnell:
He's awake?

>> Dr. Brett Smith:
Yeah, he's already doing this and wants to walk. There are no complications during the surgery. Your foot, I asked you to pull it up. It's doing well.

>> Jim Bonnell:
I can move all of that stuff.

>> Dr. Brett Smith:
No worries.

>> Reporter Merry Lucero:
The new implant will most likely last Bonnell the rest of his life and will allow him to return to his active lifestyle.

>> Michael Grant:
Here now in our studio the patient you just saw watching it for the first time, Jim Bonnell and his surgeon Brett Smith and Dr. Powell Howard, the former chair of the arthritis foundation board of directors. Jim, that was the first time you had seen that?

>> Jim Bonnell:
Yes, that was quite interesting.

>> Michael Grant:
Give me your -- you were asking a question of the doctor as we were watching it. You mean that happened and stuff like that?

>> Jim Bonnell:
I had been asked prior if I ever wanted to see a video of how these have been done before. I said I'm not sure I want to see that. Now that I've seen it I'm glad I didn't see the video first.

>> Michael Grant:
How are you feeling?

>> Jim Bonnell:
I feel great. I feel excellent.

>> Michael Grant:
You had had surgery done on the other hip, what, a couple of years ago?

>> Jim Bonnell:
Right, 2-1/2 years ago.

>> Michael Grant:
It was the more traditional composition method?

>> Jim Bonnell:
Right, exactly.

>> Michael Grant:
How has that --

>> Jim Bonnell:
It's worked out fine for me so far. You don't even know it's different than your original hip. It feels the same. Feels fine. I've got all of the flexibility pretty much that I had before, so I'm looking forward to this one to get me back to playing.

>> Michael Grant:
Brett, maybe that's good because we have a rare situation here, I assume where you've got one modality in one hip and a modality in the other. Why don't you compare and contrast those so we understand better the differences on what's going on.

>> Dr. Brett Miller:
Sure, the right side is the metal on plastic hip that was designed many years ago and traditionally has been put in for the past, late 60s, actually. The newer ceramic hip on the left side has been in manufacture and use for a year and a half and has a better wear surface between the two implants which hopefully now will last Jim's lifetime. The old implant is 95% at 15 years and we're hoping that this implant he has now will last 30, 40, 50 years and never need surgery again.

>> Michael Grant:
In fact, that was one of the reasons why, as I understand it, a hip -- you normally tried to delay a hip replacement for as long as possible because it did have such a limited life duration.

>> Dr. Brett Miller:
Correct. Yeah, the youngest patient, my partner Dr. Hedley put in was a 13-year-old, and you know, I think probably 20 years ago that was unheard of. Now with the new implants and new designs, we're hoping that that will last their lifetime.

>> Jim Bonnell:
If I could give any advice to anybody going through this, at least do some exercises prior, get yourself ready for it.

>> Dr. Powell Howard:
And I'll add one more thing, weight reduction, many people with osteoarthritis. He's not -- not everybody who is overweight gets osteoarthritis and not everybody who is thin will avoid it, but many people are overweight and get osteoarthritis. One of the key things is to lose the weight. That's a lot better than a lot of medicine that people take.

>> Michael Grant:
There are other forms of arthritis?

>> Dr. Paul Howard:
There are many different types and rheumatoid arthritis and psoriatic arthritis are inflammatory diseases that are more systemic diseases as opposed to an isolated joint or two. These are conditions where the body's immune system attacks the joint and literally goes on to destroy it. But we have miracles today in terms of treatments that are not just good, they sometimes can stop the progression of disease. We're even seeing studies today that show that there is x-ray -- it stops the damage on the x-rays and even they are starting to get better.

>> Michael Grant:
Have we covered all of the prevention common techniques, the exercise, the other things, weight reduction?

>> Dr. Paul Howard: It depends on the type of arthritis, but there are some diets that can help in terms of reducing inflammation, lower fats. These cardiac diets, low fat diets, more fish, more fish oils. They help reduce inflammation. These are diseases that can't be controlled by one thing or one thing alone. It's not just medicine, it's not just diet, it's really a mixture of things.

>> Michael Grant:
Now what are his restrictions, short term and long-term?

>> Dr. Brett Smith:
I'm surprised he's here tonight.

>> Michael Grant:
This wasn't authorized?

>> Dr. Brett Smith:
No, this wasn't authorized. He sat in a pretty good sized chair. His precautions are hip precautions for three months. He can't flex for 09 degrees. Nothing links those two components together so he can dislocate or pop out of socket if he bends too far at the hip joint. Secondly, I put a bony ingrowth prosthetic in his femur. The bone has to grow into that. I don't allow him to put weight for six weeks. If he does put weight on it, that can be fibrous tissue as opposed to Bonny tissue and that leads to failure of the implant. So number one, no weight bearing and he has to abide by the hip flexion rules.

>> Michael Grant:
Well, Jim Bonell we wish you the best of luck. Brett Smith, thank you for joining us. Paul Howard, our thanks to you as well.

>> Dr. Paul Howard:
Can I put a plug in? The Arthritis Foundation, people can find it at arthritis.org, on the web site. It's a great website for people with all types of information on it.

>> Michael Grant:
Thank you very much for joining us for this special edition of "Horizon." I'm Michael Grant. Have a great one. Good night.

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