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10/11/06
Announcer>> This Life and Times health care special is made possible by a grant from QueensCare, a public charity providing health care to the low-income and uninsured residents of Los Angeles County.
Val Zavala>> Tonight on Life and Times --
The prognosis may be grim, but he won't take it lying down. A reporter's pledge to shed light on ALS.
Leo Greene>> With all the devices they have nowadays for communication and working on the computer, I can still function. So it doesn't mean you have to stop living.
Val Zavala>> And then, they're called Country Docs, but the calls they make are on the city's meanest streets.
These stories and more next on tonight's Life and Times.
Announcer>> Life and Times is made possible through the generous support of the L.K. Whittier Foundation dedicated to improving the quality of life by supporting innovative endeavors in the fields of medicine, health, science and education.
And by a generous grant from Jim and Anne Rothenberg.
Val Zavala>> Welcome to this Life and Times health care special where we begin with a look at a relatively rare but devastating disease, Lou Gehrig's Disease. The famous first baseman died back in 1941 and still there's no cure. Yet many people with the disease are using their final years to change that. I met one such man, a reporter, who decided that his final assignment would be the story of his own journey.
It's a typical day at the Daily Bulletin, a small paper in Ontario. But Leo Greene, one of their reporters, is anything but typical. Leo is sixty years old. He knows he'll probably never see seventy.
Leo Greene>> The first symptom I noticed was actually my voice. At certain times of the day, I'd begin to slur my words. About the same time, I was getting muscle twitches in my hand and shortly thereafter or about the same time, I started developing a limp.
Val Zavala>> Doctors checked for signs of a stroke. Nothing. Blood flow? Fine.
Leo Greene>> And then when the weakness spread to my right arm, I got concerned. I was out nailing a fence post and I could barely lift the hammer. I knew something was wrong and that's when I went back to the neurologist and he began to order a whole battery of tests.
Val Zavala>> Two MRIs, a lumbar puncture, yet more blood tests. And with each illness that was eliminated, the list of remaining suspects became shorter. Then last August, he went for the final test, an electromyography. By that time, Leo had researched his symptoms on the internet.
Leo Greene>> I knew what was coming. Plus my primary care doctor a few days before patted me on the shoulder and he said, "Find a support group."
Val Zavala>> Leo Greene has ALS, amyotrophic lateral sclerosis, or Lou Gehrig's Disease. The nerve cells in his brain and spinal cord, the ones that control his muscles, are dying. Over the next few years, he will lose the ability to walk, to eat and eventually to breath. There is no cure.
Leo Greene>> Well, they titled it "Leo's Story".
Val Zavala>> In August when he got the diagnosis, he decided to go public.
Jeff Keating>> It very much fits Leo's personality, which is that he's extraordinarily forthright.
Val Zavala>> Jeff Keating is Leo's boss, the Daily Bulletin's Managing Editor.
Jeff Keating>> The thing about ALS is that it's a process of elimination. You're trying to find out what it's not. And the longer it went on, the way he describes it, the worse the news got for him. When he realized that he had this disease with a certainty, he told me that there was about a day of feeling sorry for himself and then his next thought was, "What can I do?"
Val Zavala>> Now Leo writes a monthly column, answers readers' mail and has videotaped important moments for the paper's website like the day he got the news from his doctor.
[Film Clip]
Leo Greene>> Even though I expected the diagnosis, when he gave it to me, it still hit me hard. I took it, I think, like most people would take it, as a death sentence.
Jeff Keating>> It was a real shock and there is a degree of that because what do you say? I mean, we all have this reflex to want to make it better and you don't make this better.
Leo Greene>> I take three of the COQ10 which would be twelve hundred milligrams.
Val Zavala>> At his home in Pomona, Leo takes a cluster of supplements.
Leo Greene>> Two of the B-12, one of the other ones, one or two protein.
Val Zavala>> But there's just one FDA-approved drug for ALS: Rilutek. It extends life for only about three months and costs about nine hundred dollars a month. Fortunately, Leo is insured and fortunately he has Judy.
Leo Greene>> We were sweethearts in eighth grade. In fact, when we got together, Judy went into one of her chests and, at the bottom of this chest, found a snapshot of the two of us from eighth grade taken at the Los Angeles County Fair.
Val Zavala>> They lost touch for decades, then met again about four years ago.
Leo Greene>> We met for coffee and, the next day, I went looking for her with flowers.
Val Zavala>> There was something unusual about that meeting?
Leo Greene: Yeah.
Val Zavala>> It felt different?
Leo Greene>> Yeah.
Val Zavala>> And you were both available?
Leo Greene>> Yeah (laughter).
Val Zavala>> Judy is now Leo's fiancé. Life expectancy for people with ALS is not long. Half of those diagnosed die within three years.
Leo Greene>> What you have to get to is learning how to live with the disease and not worry about tomorrow, the outcome. If you think about I'm going to be paralyzed, I'm going to die, you can't function.
Val Zavala>> Leo has become very active in the local chapter of the ALS Association. The ALS Association is headquartered in Calabasas. Gary Leo is its CEO. It's the largest source of private funding for ALS research and its goal is to find a cure.
Gary Leo>> We have about thirty thousand patients. It's what we call an orphan disease. Unfortunately, it doesn't have the potential for large pharmaceuticals to see great returns from the investment to develop drugs, so they don't have the kind of research that's going on with diseases such as cancer or heart disease or others such as that, or Alzheimer's, which affects so many more people.
Val Zavala>> The ALS Association invests millions in a search for an early detection test, a drug cocktail to slow down the disease, and gene therapy.
Gary Leo>> In about ten percent of the cases, it's genetically diagnosed, the SOD1 gene in about ten percent of the cases. So we're studying that through ALS mice that have been engineered and we're looking at is there a way we can shut off the gene so that those who have it basically, like a light switch, boom and shut if off and they no longer develop the disease because of the nature that they shut off the gene. So gene silencing is one area.
Val Zavala>> The Association also provides free services, equipment and emotional support, but some patients still fall prey to false promises.
Gary Leo>> The other day, we received a call from a patient who said that he was going to the Dominican Republic for fetal stem cell transplants. It was not only disturbing, but it was just so sad because he was paying twenty-five thousand dollars and he was going alone.
I said, "Where did you learn about this?" Well, this company is a local company and promised him. I said, "Well, who told you this would work?" He said, "Well, they gave me a number. I called this person and he said, 'I used to be able to not walk and now I feel like a lion.' Now I want to feel like a lion."
Val Zavala>> The man who claimed to have gotten better didn't even have ALS.
Gary Leo>> But in a disease like ALS, there's the issue of people feeling like time is running out and they have no choice.
Val Zavala>> ALS's most famous spokesperson was, of course, Yankee first baseman, Lou Gehrig, who died in 1941 at age thirty-eight. Physicist, Stephen Hawking, also has Lou Gehrig's Disease. He's survived for more than forty years, a miracle by ALS standards. Leo has Judy, four sons and a grandson who help keep his spirits up. Others are not as lucky.
Leo Greene>> I just got an email from someone whose best friend was diagnosed and, a week later, he shot himself.
Val Zavala>> And Leo has another advantage. He's been through a twelve-step program.
Leo Greene>> They all teach the same principles. Acceptance, living one day at a time, gratitude. My father had oral cancer and he suffered with that for ten years in horrible pain. I watched that and I think, compared to what he went through, this is a cakewalk.
Val Zavala>> The disease doesn't affect his mind, so Leo will continue to tell his story in the Daily Bulletin for as long as he can lift a video camera and type. How long will that be?
Jeff Keating>> If I have anything to say about it, absolutely as long as he wants, and I hope for a long, long time.
Leo Greene>> With all the devices they have nowadays for communication and working on the computer, I can still function. So it doesn't mean you have to stop living.
Val Zavala>> If you'd like more information about ALS or the activities of the ALS Association, you can go to their website at alsa.org.
Announcer>> Kcet.org is the place to look for the very latest on Life and Times. You'll find previews of upcoming stories, plus transcripts and audio of past episodes and links to some of our most interesting features. Just go to kcet.org, scroll down the page and click on "Life and Times".
Val Zavala>> He was diagnosed with prostate cancer and he could have opted for surgery and radiation. Instead, he chose what they call "watchful waiting". Is this the best choice? Sam Louie takes a look at the debate among doctors over the best way to treat this second most frequent form of cancer among men.
Sam Louie>> Eric Kaldor is seventy-seven and spends many of his mornings working out at the gym. Whether it's lifting weights or stretching, these good habits have been in place for most of his lifetime. But now it's even more critical for Eric to stay healthy because Eric has prostate cancer.
Eric Kaldor>> Once you give up, you might as well -- I mean, that's it. Just measure yourself for a coffin. You've got to fight this every day.
Sam Louie>> Prostate cancer is the second most common form of cancer among men after lung cancer, but only a small percentage die from it. The prostate is a gland which is about the size of a walnut located below the bladder in men. It promotes proper sexual function and bladder control.
Dr. Mark Scholz>> More than half of men have prostate cancer in their prostate by the time they die, but we don't diagnose it in every man because it usually remains quiet and doesn't cause symptoms.
Sam Louie>> Eric was diagnosed with a low-grade form of the disease eight years ago. It ran in his family. Both Eric's father and brother died of prostate cancer despite aggressive therapies. One had surgery, the other had radiation therapy.
Eric Kaldor>> Cancer is the scariest word in the English language, I think.
Sam Louie>> Eric had to decide. Should he also get surgery or radiation and possibly suffer permanent side effects, or take a totally different approach? His original doctor recommended surgery, but he did not want to become impotent or incontinent, so Eric did something bold. He went against his doctor's advice and opted to do neither surgery or radiation.
Eric Kaldor>> And I was told by my primary physician that I was committing suicide by doing that.
Dr. Mark Scholz>> "So you're situation is so stable. I mean, we figure you're in the most favorable category of all."
Sam Louie>> Eric also switched doctors. He started seeing Dr. Mark Scholz, a prostate cancer oncologist. Dr. Scholz recommended a less invasive procedure known as testosterone deprivation, basically blocking the production of the hormone. But this had noticeable side effects.
Eric Kaldor>> Well, it robs you of your manhood. It robs you of your sexuality. It was almost pleasant for the first three months. I told Dr. Scholz that I wasn't looking at every woman on the street, you know, which we all do. I was like, oh, what a relief in not having this problem, you know. But after three months, I said, wait a minute, things are really changing here.
Sam Louie>> For Eric, the one year of hormone therapy worked. His cancer shrank back dramatically. And even more good news, his libido returned.
Dr. Mark Scholz>> He's definitely made the right choice. His sexual function is intact. He doesn't have any problems with urinary or bowel problems.
Sam Louie>> Since then, he's been carefully monitoring his prostate level while diligently watching his diet and exercise.
Eric Kaldor>> For me, I felt absolutely that it was the way to go.
Sam Louie>> But is watchful waiting the best way to go? When should someone get surgery or radiation therapy? The medical community remains divided on the issue. Some believe that too many patients are given only one choice: surgery.
Dr. Mark Scholz>> The patients themselves think that they need surgery and they are very pro surgery, that they want to get it out of their bodies. They think they've got an immediate life-threatening problem.
Dr. Stuart Holden>> "This is the bladder here and this indentation is the prostate."
Sam Louie>> Dr. Stuart Holden is the Director of Urology at Cedar Sinai Medical Center. He acknowledges the medical profession is split on which treatment method is best for the two hundred thirty-four thousand Americans diagnosed with prostate cancer each year.
Dr. Stuart Holden>> Should they have surgery? Should they have radiation? Should they have other forms of therapy? There's a lot of controversy about every aspect of prostate cancer.
Sam Louie>> Dr. Holden also recognizes that some urologists have a professional bias in recommending surgery.
Dr. Stuart Holden>> If you're a hammer, everything looks like a nail so that people in a given specialty will tend to recommend the treatment that encompasses their own specialty.
Sam Louie>> Dr. Holden does not take this hard-line approach, but he does defend surgery, saying it's arguably the best chance of survival for some patients.
Dr. Stuart Holden>> It's hard to prove, but it's logical to assume that any cancer which is localized to the place where it starts, if that place is removed, there should be a virtually one hundred percent cure of cancer.
Sam Louie>> But with the potential for a cure comes the potential for severe consequences: incontinence and impotence. And it's not just surgery. Other invasive procedures like radiation therapy can cause irreversible side effects as well. Just ask Harry Pinchot of Oxnard, California.
Harry Pinchot>> I'm impotent. There's no hiding that. I have many rectal problems or intestinal problems.
Sam Louie>> Harry is sixty-six years old and went through radiation therapy more than a decade ago on the advice of his former doctor. Harry has a more aggressive form of prostate cancer, which also claimed the lives of his grandfather, father and four of his uncles.
Harry Pinchot>> Obviously, the fear of cancer goes through your mind. I've seen what cancer can do to family members and that becomes the driving force just to try to avoid that death.
Sam Louie>> But Harry says the radiation treatment had no positive impact. Looking back, he regrets going through with it especially since it's affected his love life.
Harry Pinchot>> I know there was an impact there, but clearly, it makes you feel like you're less of a man.
Sam Louie>> Harry currently is being treated with chemotherapy which his doctor says does not pose the same risks of side effects as the more aggressive forms of localized treatment. Back at Cedar Sinai, Dr. Stuart Holden believes that, in the near future, the diagnosis and treatment of prostate cancer will become much more accurate.
Dr. Stuart Holden>> We hope to find the pattern of response to any particular stage of the disease and to be able to predict whether or not you're going to respond to one thing or another and give you the thing that you're going to respond to rather than do trial and error, which is what we do today.
Sam Louie>> But until that day arrives, the general consensus is for men to be more proactive in choosing a treatment. As for Eric Kaldor, his prognosis is good. His low-grade cancer is under control due to a healthy lifestyle and, while surgery works for others, he's thankful he didn't go through with it.
Eric Kaldor>> I think it's saving my life and it's also saving me from therapy and I have my prostate, all very important things to me.
Sam Louie>> I'm Sam Louie for Life and Times.
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Life and Times
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Val Zavala>> Doctors making house calls are a thing of the past, so we were especially surprised to learn about a group of health care professionals who still go to their patients and we were especially impressed when we realized that the patients were on Skid Row. Hena Cuevas went along on these very unusual rounds.
Hena Cuevas>> It's six a.m. on a Thursday morning at this clinic in downtown Los Angeles.
[Film Clip]
Hena Cuevas>> A doctor, a nurse, a social worker and a health coordinator are getting ready to make their rounds.
[Film Clip]
Hena Cuevas>> Except this team won't be walking the halls of a hospital. Instead, they'll be making house calls of sorts to patients with no homes living in the worst part of downtown, the gritty area known as Skid Row. They're the Country Docs, members of a six month old pilot program. Three times a week, they bring medical treatment to the homeless. It's not a glamorous assignment.
Dr. Bryan Sauter>> "Morning. How are you today?"
Hena Cuevas>> By seven, they're combing the sidewalks looking for patients, or clients, as they call them.
Dr. Bryan Sauter>> "Los Angeles Mission Clinic. Does anyone need any medical services today?"
Hena Cuevas>> Heading the team of four is Dr. Bryan Sauter.
Dr. Bryan Sauter>> We see a lot of individuals who are suffering from street problems, as we call them, the bronchitis, the sexually transmitted diseases, the things that they're not getting any care for and which can progress in more serious diseases.
Hena Cuevas>> Such is the case of the first man they encounter.
Dr. Bryan Sauter>> "What's going on?"
Samuel>> "I'm in a lot of pain."
Dr. Bryan Sauter>> "A lot of pain? Can you kind of tell me a little bit of what's happening?"
Samuel>> "My leg."
Dr. Bryan Sauter>> "Your leg?"
Samuel>> "No, it's not my leg. It's my chest."
Dr. Bryan Sauter>> "Your chest?"
Hena Cuevas>> His name is Samuel and, like many of the clients they treat, he doesn't give them much information.
Dr. Bryan Sauter>> Well, what we see with a lot of clients who are actually living on the street is they don't even know what their problems are, so we have to begin from the very, very start and just kind of create a foundation around that patient. "How long have you been out here on the streets for?"
Samuel>> "Long time."
Dr. Bryan Sauter>> "Long time?"
Hena Cuevas>> He tells them he smokes crack. Drug addiction and mental illness are rampant and are the biggest problems they have to deal with. Howard Kahn is with L.A. Cares, the group that funds Country Docs. He says bringing health care to the homeless is the first step in helping them get off the streets.
Howard Kahn>> It's real hard to get a job if you're not healthy. If you're suffering from a mental illness that's not treated, getting off the street is really difficult.
Dr. Bryan Sauter>> "Does your chest hurt when I push on it?"
Samuel>> "Yes."
Dr. Bryan Sauter>> "It hurts all over?"
Samuel>> "Yeah."
Dr. Bryan Sauter>> "So it sounds like it may be a cardiac problem. What we'll do is we'll get him over to the clinic and start doing the basic workup on him, EKGs and some other cardiac testing and, then if we need to, we'll work in conjunction with the county and hope we get him connected back into services if we need to, all right? How's your stomach been feeling?"
Hena Cuevas>> The doctors patrol the five-block area of Skid Row where there's an estimated nine thousand homeless. After they make the initial contact on the street, they encourage them to come here to Volunteers of America, a drop-off center. It's a place where the homeless can come, get referrals and take a shower. Once here, they can give them the additional health care that they need.
But convincing the transient population to come inside to see a doctor is a challenge, so a lot of treatments are performed right here on the streets of Skid Row. This man not only has a bloody forehead, but also an infected finger.
Dr. Bryan Sauter>> He's got a blister that we're getting some of the fluid out of the blister. They are very painful. I've been quite a bit down here in the street because a lot of people on their feet, we see them mostly.
Hena Cuevas>> Next, the group encounters a man who's been in a wheelchair for more than three years.
Richard White>> "Sign your name right there for me. That's just giving the doctor permission to treat you and give you medicine."
Hena Cuevas>> Richard White is the team's health coordinator.
Richard White>> I really believe we're making a big impact. The more I come down here, the more I'm encouraged to keep coming back.
Hena Cuevas>> And he's coming back in more ways than one. More than fifteen years ago, Richard used to be one of them.
Richard White>> I was out here two to four years and my drug addiction was real heavy and deep.
Hena Cuevas>> White eventually got help from the Los Angeles Mission, the group that runs Country Docs. He's now their HIV screener and he hopes his example will help others leave Skid Row.
Richard White>> Yeah, and it really burns my heart to see people still down here in their addictions. They were out here when I was out here and I really hope that what I'm doing will be a testimony to them and an encouragement to them to come out of it.
Hena Cuevas>> Rounding out the team are a nurse and a social worker who offer guidance on finding jobs and housing. So is Country Docs making a difference? It's too early to tell and there aren't any figures on what kind of an impact they're having, but Sauder says he can see the change.
Dr. Bryan Sauder>> When we make that connection out in the street and they see the care that we're bringing out here to them, they see that somebody does really care and it makes a difference. "Patty's going to go ahead and wrap that for you right now, okay?"
>> "Thank you."
Dr. Bryan Sauder>> "You're very, very welcome."
Hena Cuevas>> Sometimes clients ask the Country Docs for more than health care.
Sandy>> "Can you pray for me?"
Dr. Bryan Sauder>> "Sure. We can do it here. Why don't we start off with that? Sounds like you're having a rough time today. Father, God, we lift Sandy up to you right now, Lord, praying that whatever is bothering her and troubling her right now, you'll just take that load upon yourself, Lord, and just give her a sense . . ."
Hena Cuevas>> Country Docs is a three-year pilot program and, if it's successful, L.A. Cares hopes to continue with it.
Howard Kahn>> If this works, I think expansion is the right idea. The shame of it is that all these folks should have health care coverage anyway, but so many of them don't down here.
Dr. Bryan Sauter>> "Yeah, you're very congested up there. What color is the phlegm that you're bringing up, your sputum?"
>> "Green."
Dr. Bryan Sauter>> "Green. Okay. And three weeks, you're not getting any better. And no stomach problems? Nothing like that?" Ultimately, people have to make a choice and we'll do everything that we can to help them. So when it comes to saving the world or making a difference in everyone's life, it's a reality that we can't do that. But if we make a difference in one person's life, we've done our job. "God bless. You be good, okay? Take care."
Sandy>> "Bye."
Dr. Bryan Sauter>> "Bye, Sandy. Take care."
Hena Cuevas>> I'm Hena Cuevas for Life and Times.
Val Zavala>> Thanks for joining us for this Life and Times health care special. If you'd like to see past health care stories, you can go to our website at kcet.org and click on "Life and Times".
I'm Val Zavala. For everyone at Life and Times, thanks for watching. We'll see you next time.
Announcer>> This Life and Times health care special is made possible by a grant from QueensCare, a public charity providing health care to the low-income and uninsured residents of Los Angeles County.
By the L.K. Whittier Foundation dedicated to improving the quality of life by supporting innovative endeavors in the fields of medicine, health, science and education.
And by a generous grant from Jim and Anne Rothenberg.
Sponsored in part by:
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