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What Happens When Someone Gets Propofol; Obama Says Health Reform Won't Ration Care; Pregnant Women Infected With H1N1 Likely Have Complications; Patient Waiting for Lifesaver

Aired August 1, 2009 - 07:30   ET


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

First up: Taking inside the operating room so you can get an idea of just how the drug Propofol works.

And, your health care reform questions. Could care one day be rationed? Would you be able to get the tests you get now? I'm going to dig for answers.

Plus, medication for children. What every parent needs to know before agreeing to prescription drugs for ADHD.

You're watching HOUSE CALL.


GUPTA: Michael Jackson and the powerful drug Propofol -- or Diprivan as it's called. It's back in the news this week. This is medication that according to a source with knowledge of the investigation Michael Jackson's doctor allegedly gave the singer the night before he died.

Now, I've talked in the past about how dangerous this drug can be in improper circumstances. But I wanted to show you so I'm going to take you inside my O.R. at Grady Hospital so you can see someone actually going under with this powerful drug.


GUPTA: So we are here inside the operating room with Dr. Gershon. He's the chief of anesthesiology here. Propofol is a medication he uses all the time.

Is this it right over here?


GUPTA: It looks like milk of amnesia, they call it.

GERSHON: Milk of Amnesia. Vincent (ph), you OK?

We have to monitor his EKG. We have to monitor his end-tidal CO2. We have to make sure that he's breathing. We got to see his saturation. We have to make sure he's ventilating.

GUPTA: So these are all -- that's all typical stuff.

GERSHON: Standard of care. Yes.

GUPTA: OK. So the Propofol...

GERSHON: We're going to start infusing this.

You're going to get a little sleepy, Vincent. OK? Give me some good, deep breaths.

GUPTA: We just go and take a look at his eyes, how quickly he's...

GERSHON: Deep breaths, Vincent. Doing great. May feel a little burning, OK?

GUPTA: Ten, nine...


GUPTA: ... eight, seven, six, five, four, three, two, one.

GERSHON: There's a reason for his heart rate increasing.


GUPTA: So, what's...

GERSHON: As you see, his eyes just closed.

GUPTA: His eyes closed. And what else are you going to perform?

GERSHON: He stopped breathing. So, this is watching his end- tidal CO2. And he's not breathing anymore. And my wonderful (INAUDIBLE) is going to help him breathe.

GUPTA: We'll take a look over here. All the breathing right now is taking place with this bag and this mask. For that medication, he wouldn't be able to breathe on his own without those things.

And there you can see part of the problem. Just with that much Propofol there, he stopped breathing and he's going to need a breathing tube.



GUPTA: What's so attractive about this medication?

GERSHON: Well, (INAUDIBLE) has really been in the advent in the last 10 years or so, even more, 15 years. And it's just basically a quick-on, quick-off. That may answer why people may think that this is something they could do at home, because if it gets out of hand, it goes away quickly. The problem is it gets out of hand and there's nobody there to resuscitate you, then nobody can bring you back.

GUPTA: That was -- that was pretty quick. You just made some of the medication, you're going to...


GERSHON: Five, 10 minutes.

GUPTA: Five, 10 minutes, he's gone from being completely awake to completely asleep.

GERSHON: He's not breathing. I'm breathing for him.


GUPTA: Well, it's worth pointing out, the patient came out of the operation just fine. Also, doctors use Propofol in hospitals thousands of times a year. And it's also used in outpatient surgical centers, medical centers. And no doctor that I've talked to has heard of it being used in the home.

As you know, we are your source on health care. We're going beyond the talk in Washington. That's our job here at HOUSE CALL, even blogging to us, calling us, tweeting us questions about how your health care might be affected by all that's happening and we've been doing our homework.

Take a listen to Linda in Dallas.


LINDA, CALLER FROM DALLAS, TEXAS: My dad had prostate cancer and I suffered complications during pregnancy. Both of us benefited from procedures that technically were not classified as standard of care. Who decides what procedures are standard versus, quote-unquote, "experimental"? If the House health bill passes, will they only cover the cost of standard procedures?


GUPTA: All right. Linda, a good question. It gets to a lot of the important issues here. A lot of people have likely had treatment's tests, even operations that aren't classified standard of care, might not even known that they had it.

Now, there's a couple of points. First of all, there's a lot of people who are very satisfied with Medicare, which is a government program that might in fact be a good model for the public option that you're hearing so much about. Now, fewer than 10 percent of people rate that program as either fair or poor. Most people generally satisfied.

We also don't know what's going to be covered under the proposed health plan. But since the public option is supposed to be similar to Medicare, we took a look at their coverage as a guide. So, a couple of examples for you. First of all, for example, something like a pap smear, Medicare on average covers that every 24 months as opposed to private insurance once every 12 months, at least a couple of the insurance companies that we talked to. It obviously is going to change if you had some sort of abnormality and these are just sort of general averages.

Let's take a look at something like cholesterol and lipid testing. Medicare once every five years, private insurance, again, once every 12 months, according to a couple of the insurance companies that we talked to, it changes if you have abnormalities.

The important issue here as you think about this is, does it make a difference to get these tests more frequently? Is it somehow going to make a difference in terms of your care, in terms of your outcomes? That's really at the root of a lot of this.

Now, to the second part of your question: who decides? Well, again, we don't know for sure because there's a lot of people sort of involved in the crafting of the final bill here.

But there probably is going to be an independent executive branch agency. There going to be a Medicare Advisory Council that's going to recommend to the president and Congress, they're going to recommend what they think works best and how best to pay for it. And that's probably going to determine in many ways what the standard of care is.

We have another question now from CNN iReporter Jason. Take a listen.


UNIDENTIFIED MALE: Four years ago, my father was diagnosed with terminal brain cancer. And for 18 months, we fought that disease with everything that we have, because we felt like every day was precious and we felt like every day that we kept him alive, we were one day closer for a cure to that disease.

I guess my question is, under a public option or government-run health care system, would that type of care be possible? Is that something that 10 years from now we're going to have to sacrifice or come up with a tremendous amount of cash to pay for because it would be rationed under our government-run health care system?


GUPTA: All right, Jason. First of all, thanks so much for sharing such a personal story. As you know, I'm a neurosurgeon and I can tell you, I've seen a lot of cases of brain cancer and we have much further to go in our fight against the disease.

Now, the idea that you raised, rationing care, strikes at the core of what many have been talking about, trying to cut costs and get more access for people. There was a "New York Times" editorial a couple of weeks ago, it's really -- was controversial. A lot of people paid attention to this. This is Peter Singer, a bioethicist of Princeton and he writes something that we should read. It said here, "The death of a teenager is a greater tragedy than the death of an 85-year-old. And this should be reflected in our priorities."

Now, what his -- think about that for a second. He's saying that we're going to assign value of life differently in certain situations. That's what's going to be necessary to make health care reform work.

I should also point out, Jason -- we took your story specifically to the White House, to ask them how they would respond. Here's what they said, "Our heart goes out to Jason and his family -- and we know families across America are dealing with issues like this every day.

There are a number of different bills making their way through Congress right now. But we know this: The reform bill that the president signs will not lead to rationing. It will be fully paid for and bring down costs over the long term."

The White House went on to say, "The president is not going to sign a bill that doesn't guarantee coverage to all people of all ages despite any specific health conditions."

Now, you know, when you're talking about cutting costs, would the government be able to afford to pay for all kinds of treatments to the end? There's no clear answer. But the president does say he will not sign a bill that will ration care for aging Americans, allowing people to get every precious day with a loved one is how he put it.

Now, at this moment, thousands of people are waiting for news that a bone marrow match has been found. So, is this woman, if she's an exception. Why finding her match is going to be so much more difficult.

And be careful where you swim this summer. Your beach could be making you sick. We'll explain.

Stay with HOUSE CALL.


GUPTA: We're back with HOUSE CALL.

You know, we're learning who's going to be the first to get the swine flu vaccine once they become available this fall. Look at the list: Pregnant women, health care emergency personnel, children and young adults are going to be high on the list according to a federal advisory committee. Also included, caregivers and parents of young children. Now, the vaccine should be available in October. Clinical trials have already begun to assess the safety.

There was a study earlier this week that found that pregnant women infected with H1N1 virus, that's the swine flu, are four times more likely to have complications and to be hospitalized. That's another reason why pregnant women will be a high priority to get this vaccine once it becomes available. Also, be careful where you swim this summer -- I love to swim. A new report by the Natural Resources Defense Council finds more than 20,000 beaches were closed or posted warnings in 2008 due to elevated bacteria levels. Now, these levels could be caused by a number of contaminants like sewage, pollution runoff.

The report cites beaches in Louisiana, Ohio, and Indiana as the most contaminated. Now, dirty water can make you really sick. It can give you skin rashes, intestinal and respiratory infections and pink eye, to name a few.

Incidentally, the report also rated good beaches. If you're interested in that, check out for the list of five- star beaches.

All right. We got some troubling news this week. We've been talking about obesity for years on this show, as you know. Now, a new report shows Americans are starting to pay the price, not just with their health but with their wallet. The price tag -- when talking about obesity overall -- is about $147 billion a year. It's a lot of money.

And I want to break down some of those numbers in terms of what it costs you and how much it costs you for various people. If you're a normal weight person, it's about an extra $3,700 per year. If you're someone who is obese, it's close to $5,000 per year in additional costs. A lot of that is because of the prescription drug costs used to treat diabetes and a lot of other obesity-related diseases, including heart disease.

There are a lot of numbers that are involved here. But here are some that really caught my eye. These calories do add up. On average, we eat about 250 calories more a day than we used to in years past. Multiply that, times 365 days, that is 91,250 calories.

But here's the number you need to pay attention to. About 26 pounds a year, 26 more pounds a year. And I'll tell you what -- it is easy to see how two-thirds of Americans are overweight or obese.

Now, in your 20s, facing cancer and waiting for a stranger to save your life? We got a story of survival -- that's straight ahead on HOUSE CALL.


GUPTA: You know, each year, thousands of people with different forms of cancer turn to the National Bone Marrow Registry for transplants. And 7 million people are listed on that registry, yet only 9 percent are Latinos. So, what does all that mean to those who are desperately waiting? Well, the odds may be stacked against them.


GUPTA (voice-over): Twenty-nine years old Denise Bertholin was diagnosed with a rare form of acute leukemia. DENISE BERTHOLIN, WAITING FOR A BONE MARROW DONOR: First, you just listen and you're sort of not really understanding the whole thing. And then it really hits you.

GUPTA: Denise was living a full life -- planning a big wedding. But with the news, came a reality check and a small ceremony at Johns Hopkins, where she was rushed into treatment.

BERTHOLIN: We have our love and our family and God. This is a different way of starting a marriage. It's a way that's going to make us stronger.

GUPTA: Now, along with thousands of others, she waits for a bone marrow transplant that could save her life.

DR. DOUGLAS SMITH, ONCOLOGIST: For patients who have leukemia, if they can't be cured with traditional chemotherapy, we look for allogeneic bone marrow transplants in order to try to give them the best chance of keeping the disease away forever.

GUPTA: Allogeneic means a transplant from another person. Bone marrow is spongy substance found inside large bones. It produces stem cells to turn into new red and white blood cells and platelets. Transplants work best when there's a family member who's a well- matched donor.

SMITH: Unfortunately, Denise's family did not have a perfect match. And so, we're now looking at the national registry.

GUPTA: But Denise's chances of finding a matching donor on the registry are complicated by her heritage. She's Latin American with European ancestry.

DR. JEFFREY CHELL, CEO, NATIONAL MARROW DONOR PROGRAM: Your background, your heritage is absolutely critical in finding a match.

GUPTA: Yet, only 9 percent of people on the bone marrow registry are Latinos and over 1,000 are in need of a transplant.

CHELL: The number one reason people don't join the registry is because they don't know about it. Number two, there is some fear.

GUPTA: Joining the registry involves taking a simple swab of the inside of your cheek to determine your tissue type. And even the process of extracting bone marrow from a donor usually from the hip has become less painful. And stem cells can often be found in a donor's blood instead of harvesting bone marrow.

Doctors hope this will encourage more people, including Latinos, to join the registry -- which will definitely give Denise a fighting chance.

BERTHOLIN: What goes around comes around. And I think that has -- that has been sort of the moral we've been living by. We'll find our match. I have hope.


GUPTA: I'll tell you what, you know, Denise has now gone through three rounds of chemotherapy and is still waiting for a bone marrow transplant. We certainly wish her luck from everyone here at HOUSE CALL.

Be sure to tune in this fall as CNN's Soledad O'Brien explains how Latinos are reshaping schools, churches and neighborhoods, forcing a nation of immigrants to rediscover what it means to be an American. CNN special report "Latino in America" in October 21st and 22nd.

Now, running can cause painful shin splints. I've had those. They hurt. What can you do to stop the pain and how do you come back stronger than ever? That's my goal.

And, should your child go on drugs for ADHD? Are we overmedicating? The questions you should be asking your doctor -- that's next on HOUSE CALL.


GUPTA: We are back with HOUSE CALL.

How do you know whether your child should go on prescription drugs to treat ADD and ADHD?

Well, CNN senior medical correspondent, Elizabeth Cohen, has a look at what you should know before medicating your child.


ELIZABETH COHEN, CNN SR. MEDICAL CORRESPONDENT: We all like to get something for nothing, but "Consumer Reports" has an article out this month that questions whether you want to get free medications for your child with ADHD. The article explains that when your doctor hands you a free sample of any medication, chances are it's for a very expensive drug. While it might be free for the one month or so that he's given you supplies for, later, you're going to have to pay for that drug.

And there are lots of generic drugs out there for ADHD and there are many generic drugs out there that are less expensive and many doctors say are just as good as the brand name drugs for ADHD.

Now, whether or not your child should go on ADHD drugs to begin with is a question that many parents have.

So, here's the advice child psychiatrists give. First of all, talk to your child's teacher and ask them about how your child is behaving at school. Then take your child to the doctor and ask your doctor these questions. First of all, ask the doctor, "What can I expect an ADHD drug to do for my child?" Some parents think the drugs are going to do more than they actually can do.

Secondly, ask if there are alternatives to drugs. We've talked to families who say that they gave their child counseling, they thought them some study skills and that that works instead of drugs, or sometimes, in addition to drugs.

Also, ask your doctor, "What are the downsides to this drug?" ADHD drugs can have side effects including psychiatric side effects such as aggressive behavior and can also lessen your child's appetite.

Now, for more information about choosing treatments for your child to ADHD drug, take a look at my "Empowered Patient" column. It's at


GUPTA: Thanks, Elizabeth. Maybe next time, we can get you to talk about adult ADHD as well -- a big topic.

You know, our own Larry King is going to tell us how heart disease changed his life for the better.

And E-cigarettes, a tool for stopping smoking, actually a dangerous habit. We'll answer that question in "Ask the Doctor."

Stay with HOUSE CALL.


GUPTA: We're back with HOUSE CALL.

You know, our very own Larry King almost lost his life to heart disease 20 years ago. Since then he's become a big advocate for healthy eating, exercising, and especially when it comes to the obesity epidemic in this nation's children.


LARRY KING, CNN HOST: When you go into certain schools and see vending machines that are selling products that make kids fat, which is the introduction to heart disease, you can control it. Heart disease is a preventable killer, just start early enough this childhood. The answer is to educate. If you can educate schools and teachers and parents to -- at one of those meals, skip the French fries and put down string beans. Kids are going to adapt to that and learn from it.


GUPTA: I'll tell you what -- I've had privilege of talking to Mr. King about this very issue quite a bit. He was also one of the moderators for our "Fit Nation" event last weekend.

And our panelists, they came up with some very interesting takes on solutions.


DR. MELINA JAMPOLIS, CNNHEALTH.COM CONTRIBUTOR: We've got to lead by example in moving. I think eating more at home is a critical part of the equation and really setting an example. I think we have to provide people with healthier choices, teach the kids how to make it fun.

JIM KAUFFMAN, NAT'L. DIR. OF HEALTH AND WELL-BEING, YMCA: The simple rule is, whole grains and the closer to the producer, the better. The less manufacturing of it, the healthier it's going to be. So, if we can make healthy, nutritious food readily available, people will eat it. We know that that is the case.

JAMPOLIS: Well, I think they're looking -- I think it's really interesting to look at New York as a model for that, because they recently changed -- legislation requiring large change to actually put -- it's shocking when you go to New York and you go to the bakery and to get a cup of coffee and you actually see how many calories is in that chocolate croissant that you maybe had rationalized in your mind.

The problem -- I think it has the potential to help some people, but I think the people that need it the most will not pay attention to that information.

DEVIN ALEXANDER, HOST, "HEALTHY DECADENCE": It's interesting what healthy is, and I'm sure everyone even among us can debate what healthy is, and that's why I'm so about doing what is right for you.


GUPTA: You know, our "Fit Nation" tour is a chance for us to get off the television screens and talk to you at home directly -- and more importantly, to hear from you as well. We're going to make stops at marathons in your neighborhood. Three more stops to go: Minneapolis, Chicago, and D.C. Come out. Come out and see us.

Now, there's a new warning out from the FDA on electronic cigarettes. We're going to have that for you in "Ask the Doctor."

Stay with HOUSE CALL.


GUPTA: We are back with HOUSE CALL.

Time for my favorite segment, "Ask the Doctor." Margaret from Virginia asks this, "Are electronic cigarettes really a healthier form of smoking?"

Well, thanks, Margaret. A very timely question as well. The smoke that you're talking about is really vapor. It's composed of nicotine, flavoring and other chemicals. The cigarette supposedly doesn't contain the tar and chemical additives that are found in tobacco. Now, the nicotine favor releases with the help of a computer chip, which the makers say is a perfect way to quit smoking.

But here's the thing: The FDA and public health experts disagree with that. They recently put out a warning finding that E-cigarettes contain carcinogens and a toxic chemical that's used in antifreeze as well. That doesn't sound very good.

If you'd like information, you can go to the FDA Web site. You can also call 1-800-FDA-1088.

I also got a tweet from our four months to fitness training on Twitter. Emily Esposito asks this, "Any advice on how to get rid of shin splints."

Great question, Emily. Common problem as well for anyone who hasn't had them. I have.

Shin splints are an inflammation of the muscles, tendons, and even a bone tissue of the tibia -- a large bone -- that's a large bone on your lower leg. The basic treatment is no different than any other soft tissue injury: patient and RICE. And you may have heard of RICE. It stands for rest, ice, compression and elevate your legs.

You're going to need to rest or at least refrain from doing the exercise that brought on the pain for several weeks. People don't like to hear that, but that's the best advice. In the interim, you can crosstrain. Also, remember to train slowly when coming back because they come up again.

A couple of tips for preventing shin splints in the first place. Try not to run on hard surfaces or uneven areas. Also, invest in a good pair of running shoes. And always give yourself time for a good warm up, conditioning and improve your flexibility goes a long way.

If you want to get motivate -- a lot of people do -- join the four months to fitness conversation. Go to my blog, or on Twitter, search for hashtag 1023.

Well, 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:

Remember, this is the place for answers to all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta.

More news on CNN starts right now.