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HOUSE CALL WITH DR. SANJAY GUPTA

Amazing Surgery: New Face of a Patient Who Underwent a Face Transplant; Possible New Birth Control Method for Men; Being Prepared For Severe Weather; Post-Traumatic Stress Disorder From Natural Disasters; More Information on Swine Flu

Aired May 9, 2009 - 07:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


DR. SANJAY GUPTA, CNN HOST: Good morning. Welcome to HOUSE CALL, the show that helps you live longer and stronger. Thank so much for watching. I'm Dr. Sanjay Gupta.

A surgery that once considered unimaginable. Now, doctors revealed a new face of a patient who underwent a face transplant. It's amazing stuff -- just moments away.

And a possible new birth control method, this one is for men.

Plus, severe weather can bring severe distress for those living through storm after storm after storm. We've got some tips to help keep you prepared.

(MUSIC)

GUPTA: We start, though, with a woman undergoing an extremely complicated operation.

Connie Culp endured a near-fatal gunshot wound that almost destroyed her face. But today, she has a new look, thanks to an unprecedented transplant at the Cleveland Clinic.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): A shotgun blast five years ago blew this woman's face to pieces, a 46-year-old mother of two. In a moment, her identity gone.

This was the end result. Connie Culp no longer had a nose, could not eat solids or drink from a cup. She had a hard time breathing. She lived in virtual seclusion.

DR. FRANK PAPAY, CLEVELAND CLINIC: Little children would shy away from her and actually be scared of her.

GUPTA: Then after years of waiting, Culp was matched with a donor, a face donor. Even as a doctor, I'd never seen anything quite like it -- the most extensive facial transplant ever. Before, after. It took 2 hours, eight surgeons. Eighty percent of Culp's face, her palate, upper lip, nose, eyelids -- replaced with that of a donor.

CONNIE CULP, FACE TRANSPLANT RECIPIENT: I got me my nose.

(LAUGHTER)

GUPTA: And here's how she got it. First, graft skin from the face of a donor who had just died -- doctors careful to preserve arteries, veins, nerves. The next hours are critical. Using powerful microscope, doctors married the veins and arteries from donor to recipient, and then grafted the donor's skin onto Culp's face. The only indication it worked, the veins and arteries began to course with blood.

PAPAY: We have to wait and see if it clots or make sure that it continues to flush. For that initial five minutes, you know you've done your job.

GUPTA: Face transplantation is new territory, conferring tremendous risk, especially for a procedure, that unlike liver or heart transplantation, is not life-saving. Add to that, face transplant patients require high doses of immune system-suppressing drugs for life, so that the body doesn't reject the new face.

I interviewed Dr. Maria Siemionow, who led Culp's operation before the transplant.

(on camera): You're talking about a long operation with a foreign tissue that's going to require a lifetime of anti-rejection medications and may not take and the person could actually -- their life could be threatened. How do you reconcile those two things?

DR. MARIA SIEMIONOW, CLEVELAND CLINIC: Those people are not just coming with such a commitment because they want to be beautiful. They want to be normal. And they want to be just come back to society as anybody else. And I think they have a right to decide about that.

CULP: You never know what might happen to you. You might get in a car wreck and think of me one day. So, don't judge people who don't look the same as you do. You never know one day it might be all taken away.

(END VIDEOTAPE)

GUPTA: I'll tell you what? Connie does have an amazing attitude. Now, she is still quite swollen, when we look at those images, even months after procedure. That swelling is going to continue to go down and her facial nerves are going to continue to regenerate. But this whole thing is a slow process. Those nerves, for example, only grow about an inch a month.

And I want to show you this image again of her. This is a caricature, but this is what she might look like two years from now, after a lot of that swelling starts to go down, after those muscles start to renovate and she gets all that contour back in her face. Remarkable -- again, the first transplant like this done in this country, the most extensive one done around the world.

There's also news this week about birth control for men. Researchers have been testing this for decades. But now, we may be one step closer to an effective form of birth control. Well, the scientists looking at testosterone injections specifically and how it might inhibit sperm production.

Now, the study is out of Beijing, China. It looked at about 1,000 Chinese men between the ages of 20 and 45, and found it was 99 percent effective. It's also reversible. Within four to six months after stopping the shots, a man's sperm count should return to normal.

An interesting note about this: The injections may not be as effective in Caucasian men. They couldn't figure out why that was. Other studies have found hormonal male contraceptive seemed to work differently in different Caucasian versus Chinese men.

Safety studies do need to be done, in case you're curios. Doctors may be concerned about the increase of testosterone, what that can mean for a man's risk of potentially getting prostate cancer. I'm going to keep tabs on this. We'll certainly keep you posted.

Now, will the swine flu return even stronger in the fall? It seems to be the question everyone is asking. We have the latest.

And we are at the peak of storm season. And weather destruction like this can cause some real anxiety -- how to prepare yourself.

But first, determining if your toddler is at risk for autism. Wouldn't you like to know? It could be linked to brain size.

Stay with HOUSE CALL. We're back in 60 seconds.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL.

Taking a look now at this week's medical headlines.

The Food and Drug Administration has finally approved the cancer- fighting drug, Avastin, for use in treating brain cancer. Now, the drug has already been approved for lung, colon and breast cancer, but was being used off label for brain cancer as well. In clinical trials, about 25 percent of patients with glioblastoma, that's one of the worst types of brain tumors, did respond to Avastin. Now, traditionally, this type of tumor kills half of its victims within a year, and on average, Avastin held off progression of the disease for about four months.

There's also a new study out there looking at the size of a toddler's brain. See, it may help experts pinpoint if and when a child will develop autism. Using MRI brain scans, researchers sort of focus on a specific area of the brain called the amygdala. They found that on average, it was 13 percent larger in young children with autism. It's this almond-shaped area near the front of the brain. Now, they compare that to a group of children without autism to find these findings here.

Now, this part of the brain helps us process faces, emotions. Researchers believe that children with autism have a normal size of amygdala at birth but at some point, in the latter part of the first year of life, it begins to grow and then stops by age two. Autism experts say the findings are critical in developing new ways to treat and diagnose autism earlier.

Six kids from a public school in Chicago had a once in a lifetime opportunity this week. They got to hang out with the White House chef, and have 40,000 kids across the country and Congress eat a meal that they themselves created. The culinary students won a cooking competition sponsored by the Healthy Schools Campaign. The nonprofit group is lobbying to get more funding for school lunches.

(BEGIN VIDEO CLIP)

ROCHELLE DAVIS, EXEC. DIRECTOR, HEALTHY SCHOOLS CAMPAIGN: I just think it's a really important time now, with food prices increasing, with the concern about childhood obesity, with the president's commitment to ending hunger to finally properly fund school food programs.

(END VIDEO CLIP)

GUPTA: And that's exactly where these kids come in. They cooked up foods like all Carrotquedilla, chicken stuffed peppers, salsa salad, all of them costing just a little bit more than a dollar a person. So, you get some healthy food for a good price. They also had to adhere to pretty high nutritional standards.

President Obama's budget calls for $1 billion to improve childhood nutrition programs. But the question is this: Will Congress approve such an increase in these economic times? A question to ponder.

HOUSE CALL is back in 60 seconds with tips on being prepared when severe weather strikes.

(COMMERCIAL BREAK)

GUPTA: We're looking at some pretty dramatic video of a strong storm that destroyed a facility, sort of this air bubble that was built so the Dallas Cowboys could work out indoors even in bad weather. About a dozen people were hurt. One of them was paralyzed; he had a fracture of the spine.

Meteorologist Chad Myers is here to explain just what happened.

It seemed to come out of nowhere for them.

CHAD MYERS, CNN METEOROLOGIST: A very small event, there was a severe thunderstorm warning which means storms were in the area. But this very small, less than two-mile wide event was caused by a microburst.

Now, we have a thunderstorm. It goes up miles and miles to the sky. Some of these storms will have hail coming down. And if the hail is coming down here, you can actually cool off the atmosphere like opening up a freezer the air wants to go down. The air goes down even faster if the ground wasn't here that wouldn't be a problem.

But like dumping a pail of water on the ground, that air has to go somewhere. It went out. And this practice facility literally got in the way. There are a lot of these out there. I mean, really, you have the Georgia Dome. You have a lot of gymnasiums. It could happen again, Sanjay.

GUPTA: You know, it's interesting, Chad. I'm so happy you're here because you give us a little bit of a sense of control. But a lot of people, it's so unpredictable. How do you get some sense of control in this sort of bad weather?

MYERS: Yes. You know, that's the thing. And I talk to school kids all the time about this. This is the most important thing. A couple of things, I think you really need to have a plan in your house.

First of all, understand what watch means and understand what warning means. Which one is worse? How about 50 percent that you can't even tell me? It's the warning, that means it's happening. We're warning you that it's happening.

Understand your surroundings. If you have a house and there's a tree on the west side, don't plan your escape on the west side of the house. Go somewhere else.

And then have a plan. Make sure everybody knows to go downstairs or go to a closet. Make sure that closet is clean. No bowling balls above your head because that doesn't help if you have a tornado in your house.

GUPTA: Warning is worse.

MYERS: Warning.

GUPTA: Got it, Chad. Good advice as always. Thanks so much.

MYERS: OK. You're welcome.

(BEGIN VIDEO CLIP)

CHRISTY TURNER, COLLAPSE VICTIM: I just screamed, "Help us, help us, we're all trapped. Help us. There's people trapped."

I think, you know, I'm here talking with you and I'm alive to talk to you, but there's a coach that's in the hospital that's never going to walk again. I got out so good and we all did. Nobody died. We're so lucky.

(END VIDEO CLIP)

GUPTA: Well, some strong feelings. Your life is threatened, you feel like you have no control over what is happening to you. Those emotions can, of course, cause anxiety, even post-traumatic stress disorder or PTSD.

Here to help understand this better is Dr. Kenneth Thompson. He's a psychiatrist at the U.S. Substance Abuse and Mental Health Services Administration. And he specifically treats patients with PTSD caused by natural disasters.

Welcome to HOUSE CALL.

DR. KENNETH THOMPSON, PSYCHIATRIST: Hello, Sanjay.

GUPTA: Thanks for joining us. You know, I got to be honest, this is something I really haven't thought of much. You know, this sort of PTSD associated with natural disasters. What are some of the symptoms a person might experience, specifically if they're having trouble coping?

THOMPSON: Well, you know, the acute stress response, I think what you heard the woman just describe, of feeling anxious or overly aroused and feeling afraid or avoidance, you know, wanting to stay away from things that are likely to hurt you. So, if there was another storm, the likelihood that people would be very anxious, and at some point, re-experiencing a sense that, you know, that the whole thing is going to repeat itself.

This kind of -- this kind of stuff happens to people who are exposed to all kinds of different kinds of trauma. And, you know, natural disasters that are highly violent and very disruptive can certainly fit into that category.

GUPTA: Weather is unpredictable as Chad Myers was just talking about. He had some specific tips so people can try and take control. How -- if I wanted to help or someone wanted to help, how can I help a person experiencing such emotions?

THOMPSON: Well, I think that the stuff that Chad was describing in terms of getting a plan and having some sense of efficacy, a capacity to deal with the problem, you know, with the weather if it comes along, business of, you know, Dorothy and her family heading for the tornado shelter -- knowing that you're supposed to do that is really, really critical and especially for kids who need to have that sometimes pointed out to them.

What you want to do is you want to establish a sense of safety. Help people understand that they are, at the present time, safe. You want to do that in a way that is calming. You want to point out that there are thing that they can do to protect themselves and help them understand that, particularly with kids, that you're going to do things to help protect them.

And then you want to, you know, instill a sense of hope. You know, people have lived through these terrible kinds of disasters over and over again. And then, I think, if you're living in a place where a lot of these things happen, it's probably a good idea to, you know, be working with your community to think about how you're going to improve your response and lessen the danger, and when something bad has happened, you know, how you're going to work together to fix the things that have been destroyed and to move on to try to put your lives together.

GUPTA: If it gets to the level of PTSD, something that you are talking about -- I mean, is there specific treatments? THOMPSON: There are specific treatments. You know, just so we're clear, the acute stress responses that I was describing, some of those symptoms are very common. It's sort of normal emotions in an abnormal situation.

The problem with what we called PTSD is that those normal responses to an abnormal situation don't go away over time. You know, if you have this kind of stuff and you're constantly re-experiencing it or you're living in fear -- I had a patient once who had to be glued to the television because she's scared to death another storm was going to come by.

And, you know, if you're getting to be dysfunctional, then clearly, we're looking, you know, we're recommending people seek out further help. There are medications that deal specifically and help with PTSD, as well as a variety of psychotherapeutic interventions that can help people kind of get a handle on this surge of emotion and anxiety and distress that they feel.

GUPTA: Well, it's good advice. And let me just add as well, because I'm a pet lover, to make sure to take care of your pets as well. Don't forget them. They can be very sort of distraught by these storms as well.

Dr. Kenneth Thompson, thanks so much for joining us.

THOMPSON: Thank you.

GUPTA: The latest on the swine flu. Will a vaccine be available by this fall? We've been covering this all week, as you know. Stay here for the latest.

Plus, a workout that's easy on your wallet, and I'll tell you what? It works.

HOUSE CALL is back in 60 seconds.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP, "THE LATE SHOW WITH DAVID LETTERMAN")

DAVID LETTERMAN, TALK SHOW HOST: And we're out of the flu season more or less. But in terms of an actual fall/winter flu season in this country, how many deaths might we get from any other strain of flu?

GUPTA: Tens of thousands.

LETTERMAN: Tens of thousands.

GUPTA: Thirty to forty thousand.

LETTERMAN: So, why was all of this -- is it just people wanting to sell those things?

(LAUGHTER) LETTERMAN: I mean, I don't -- I don't remember, even when we had monkeypox -- remember the monkeypox?

GUPTA: Yes.

LETTERMAN: And nobody was rooting harder for the monkeypox than me really.

(LAUGHTER)

LETTERMAN: But I don't remember kind of the alarmist view from the administration and from doctors and television and media and so forth.

(END VIDEO CLIP)

GUPTA: You probably never knew how hard David Letterman had been rooting for those monkeys. We had a good time on "David Letterman Show" this week. I did go on to tell David that the concern by health officials was because this is a new virus and we didn't have a built up immunity to it.

However, it's worth pointing out: the H1N1 virus does seem to be sensitive to antivirals like Tamiflu.

And on that note, scientist are digging deeper into the structure of the swine flu and learning that it seems to lack some of the traits that make viruses particularly deadly. So, have we seen the worst of it or will swine flu come back in the fall?

Well, this week's Empowered Patient, your swine flu questions asked and then answered. Here is CNN medical correspondent Elizabeth Cohen.

ELIZABETH COHEN, CNN SR. MEDICAL CORRESPONDENT: Sanjay, there are lots of questions about the future of the H1N1 virus. Let's just jump in with a question that I've heard many times.

Is the outbreak in the U.S. winding down? Public health officials certainly expect that it will in the coming weeks. First of all, that's what's happening in Mexico, and we're sort of behind them in this outbreak. Also, the number of flu cases tends to go down as the weather gets warmer.

Now, of course, that begs the question, will this virus come back? It's not known. It's expected that it could come back. It's not known whether it would come back with a vengeance or perhaps with a whimper.

And that leads us to our second question. If it comes back, when would it return? It would be expected that if the H1N1 swine flu virus comes back, that it would be in the fall. That's when flu viruses tend to return.

And here's the third question, will there be a vaccine? This is a big question mark. The Centers for Disease Control and the National Institutes of Health are certainly trying to get a vaccine ready in the next four to six months.

Now, if it is ready in time for flu season, then the question is: Who would get the shots? Would everyone be encouraged to get it? Would there be enough shots to go around for everyone? Would everyone want it?

It may be that the shot is only offered to people who are at high risk for complications for the flu such as the elderly and people with chronic conditions. Sanjay, to read more questions about the future of the H1N1 virus, you can go to CNN.com/EmpoweredPatient -- Sanjay?

GUPTA: All right, Elizabeth, thanks.

And flaxseed is great for lowering bad cholesterol. But what kind should you be using? We're going to answer that question in "Ask the Doctor."

And do you want to start working out? It doesn't have to cost a bundle. We've got the keys to what we're calling frugal fitness.

Stay with HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: It is time for my favorite segment of the show: "Ask the Doctor."

Let's jump right in. Tina from New York e-mailed us this. She writes, "I recently started adding two tablespoons of organic ground flaxseeds to my yogurt every morning. Am I wasting my time with the pre-ground stuff?"

Tina, not at all. You've actually got it right. It's something we've looked into. In fact, most nutrition experts will recommend ground flaxseed over whole seeds.

Now, a whole flaxseed is hard to digest. You know, you're not necessarily getting all the full health benefits. And the recommended daily intake is one tablespoon of the ground flaxseed a day. So, I really believe you're in a right track.

Now, quickly, we got a follow-up to a story that I covered a couple of weeks ago now. How a urine test may be able to tell if a smoker is at risk for lung cancer. This comes from Twitter and Snarky Sharky asked this. "Can you still take this test if you quit smoking? I quit about 3 1/2 years ago."

Well, I'll tell you what, Snarky Sharky, this story struck a cord with so many smokers, because a lot of them would like to quit smoking, but, you know, it's a hard habit to break, as we've talked about often on HOUSE CALL. First of all, great job for being smoke- free for over three years.

Now, as far as this particular test goes, unfortunately, it would only test current smokers, because it works by measuring a specific carcinogen from smoke and the level of nicotine in your urine. You're not going to find these levels in former smokers, only active ones.

But I can tell you that after you quit smoking, your body immediately starts to heal itself. In just two weeks, your lung function starts to increase. A year later, your risk of heart disease is cut in half. By the five-year mark, your risk of stroke is the same as a nonsmoker. And after 10 years of being smoke-free, your risk of dying from lung cancer is half as much as an active smoker.

So, congratulations again. You see why it's so good to quit.

Now, speaking of cutting things -- trying to cut your budget without adding to your waist line. We'll show you workouts anyone can afford.

Stay with HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL.

You know, in these tough economic times, you don't have to join an expensive gym or even pay a trainer to get fit. You don't even need equipment. You just need your own body weight.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): If it's a fit body you're after, don't worry, money matters don't have to derail your plan.

JENNIFER COHEN, AUTHOR, "NO GYM REQUIRED": I really don't believe that the every day average person needs to rely on a personal trainer to kind of motivate them and get them in shape. I think the reality is, most people can't afford it.

GUPTA: Jennifer Cohen, a fitness trainer by trade, says, you don't even need her or even a gym membership. You just need a few basics to get started.

COHEN: Using your own body weight is a great way to tone your body.

GUPTA: And if you have just a little bit of money to spare, she says, invest in some exercise tools.

COHEN: A few hand weights, a couple of resistant bands, a medicine ball, and a platform. And you can get the same workout if not better doing it at home or in your office.

GUPTA: So, if you want to get started today, just remember, start small.

COHEN: A squat using a ball on a wall, to doing a push up and then doing a tricep dip, and doing that circuit three or four times. You don't have to work out for 30 minutes at a time or 45 minutes at a time, you can do increments of 10 minutes in the morning, 10 minutes in night. GUPTA: Try to integrate some cardio-drills like running in place, make sure to stretch. And talk to your doctor before starting any workout. Last but not certainly not least, get your nutrition in check as well.

COHEN: And you can work out all day and all night, and if you're not eating properly, it makes no difference anyway.

(END VIDEOTAPE)

GUPTA: Unfortunately, that's all the time we have for today. If you missed any part of today's show, be sure to check out my podcast, CNN.com/podcasting. And remember, this is the place for the place for the answers to all of your medical questions.

Also, join us at CNN.com/health and on Twitter. We got a lot of followers there already, Sanjay Gupta CNN.

Thanks for watching. I'm Dr. Sanjay Gupta.

More news on CNN starts right now.

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