Cancer Treatment Facilities

dr. mansfield:lights off. let’s go green. darryl:when he pulled the tooth, they found cancer there. dr. mansfield:he was expecting it to be simply an infected tooth. not a very rare cancer. leslie:you’re just going along living your life…suddenly, new movie! darryl:they’re going to be carving out huge chunks of my skull.

colleen murphy:every human being has a story. and we intersect with that story at some of the most traumatictimes in people’s lives. sally:it would be very sad to not be able to see my kids’ beautiful faces, watch them growup. dr. kulkarni:bami! that’s the tumor that we found. dr. udani:it can lead to blindness, and eventually it can compress her brain stem and lead to death. dr. adamson:her chance of living for six months is very low. maybe 10%. i mean, look at this heart.this is just a monster heart. your heart was

weak as a kitten.vincent: when is it ever going to end? you know, thesehard times…. announcer:these are stories of real people. these are stories of the sharp experience. darryl:we lived in, what can only be called a hippie commune. we were the original hippies, um,but we were the serious hippies. (song: keep your head up high) darryl:so leslie, my wife, i picked her up hitchhiking. that’s the short version. (laugh) so leslieand this other girl were by the side of the

road and my bus picked them up. leslie:we got on that bus, and there was darryl. darryl:my friend nicholas and i, we both looked at each other and uh, this is cool… and we’redriving along (laugh) and pretty soon the two of them are singing, in harmony. we’vegot a couple of angels here. and we married ‘em! (laugh) went looking for a place tobuy a farm. found a place in tennessee. we bought it, moved into the woods and made alife. and we ultimately ended up doing our own medical care, delivered our own babies,did our own schools, published our own books, invented stuff, we were a bunch of city slickersand we did it.

i went in to the dentist for a tooth cleaning.tooth cleaning! they did an x-ray and they saw there was a three-rooted tooth. only onewas completely in bone. there was a tooth that’s no longer there, the last tooth,that uncorked the genie. they found cancer there when they pulled the tooth out. dr. mansfield:this is a stage 4 tumor. it was deeply invading the bone. it deeply invades the skull base. darryl:well, one of the things that dr. mansfield established was, we’re no longer tryingto deal with a tooth here, we’re trying to save your life.

dr. mansfield:untreated, darryl wouldn’t survive more than several months to a year. the cancerhas grown and eaten away all of these holes in the bone. we have to remove this entiresegment in one piece. leslie:when dr. mansfield actually showed us how much they’re going to take this, and thisout, we were both like… of my skull and stuff, and he comes up withthis little gizmo that corks it all and makes it normal! even if i were to go into a declinenow, be hard to bitch. i’ve had a great life. dr. mansfield:there will be a combination of treatments.

a surgery initially, followed by radiationtherapy and chemotherapy. two thumbs up…we’ll see you inside. as a result, we’ll havea much higher success rate in curing the cancer than simply with surgery alone. dr. corey:you’re the king. we’re taking care of you. everybody in that room is there to takecare of you. you tell us what we need to do. while that’s happening, blood pressure cuff,ecogram leads, pulsoximeter on your finger. none of this will hurt. then i’m going togive you some very special medicines in your iv. whoosh…off to sleep. next thing youknow – (popping sound) – awake, finished…i will be with you every second… okay…relax,if you can. let me worry for you.

darryl:at 69, i’ve been playing goalie for things like strokes and heart attacks…and now (laugh)broadsided by this cancer…really never occurred to me. leslie:you’re just going along living your life…and suddenly, new movie. darryl:last time i’ll have this much of a smile. there’s a very nice view of the tumor. yousee a bulge here. this is a tip of the iceberg where that’s just the beginning of the tumor.prepare the saw. i will actually use a saw to make the incision through the cheekboneinto the nose, across the cheek and into the

skull base. we’re very close to deliveringthis. look how that fractures out. just beautiful. tumor’s out. so what we’re doing now istaking samples of the peripheral margins for biopsy. these tumors could have already spread,and that’s a reality that we all have to live with. that we go throughthis entire process and sometimes down the road we find that there really was somethingsmall…we just couldn’t see it. and there’s where the tumor was located. now there’sa large hole. we don’t fix that…everything he eats goes out his nose. all right, let’sget the obturator ready. so there’s the obturator fitted. a beautiful fit. all done.went great. let me give you a big hug. he’s great. he’s fine. first time you’re seeinghim after all this…

leslie:yeah…you made it! darryl:yeah. leslie:you look like you looked going in. you look…you’re still handsome! dr. mansfield:two thumbs up? two thumbs up. leslie:this is the worst. and you’re surviving it. darryl:counting – garbled dr. mansfield:okay, give that a try. it’s got to snap

in. you’ve got to feel it. there you go. darryl:counting to ten – clear dr. mansfield:thank god we build those obturators! darryl:good grief! i’d be a monster. dr. mansfield:okay, so why don’t we chat a little bit about the pathology. come on, sit over herewith your wife if you don’t mind so i can face both of you together. so one of the mostimportant parts of the surgery is to decide what type of cancer we were dealingwith, how the cancer is behaving. and today i have really difficult news about the cancer.and one of the most important questions i

need to ask you as we gothrough this is a decision whether you want to have the cameras in the background or whetheryou want to talk privately first. darryl:privately first. dr. mansfield:okay. darryl:uh, it was bad. a biopsy of the cells was much more aggressive. they’re in the primeof life, kicking butt. mine. leslie:with the operation, you feel like you’ve come through something really big and youwant it to be done. and then you realize, oh, it’s still here (small laugh).

darryl:it doesn’t change the treatment. it doesn’t require further surgery. uh…..chemo andradiation were inevitable in any case. dr. kossman:your drip is about one-third done already. what we’re going to do is clear any residualmicroscopic cancer that might be there. radiation tech:all right. ready to start? darryl:i’m not afraid of dying. the problem with my dying would be the impact on the peopleleft behind, not on me. my wife would be upset for a while, but she has a dog. (laugh) radiation tech:you doing okay?

leslie:you just want to appreciate and love what you have. and get on with it. not waste anymore time you know, being bummed. get on, live our life. darryl:i’m in good spirits. because your attitude is optional. you choose it. radiation tech:you did awesome. darryl:look at the resources being expended on this. i’m 69! radiation tech:that was your first one!

darryl:i feel obligated to do something worthwhile…this is free time from now on… dr. mansfield:so first and foremost, you’re finally finished your radiation therapy. quite a journey. sowhere we stand right now, we don’t feel at this point that further treatment is necessary. darryl:boy, do i ever like hearing that. dr. mansfield:so what i’m really sharing with you today is that you are cancer-free. we have beenable to effect an early cure for your cancer. darryl:you guys did it.

leslie:wow. didn’t expect this. darryl:thank you for getting me through all this. leslie:just a bump in the road. my kids’ beautiful faces, watch them growup. i’d be really devastated. dr. udani:so sally was recently pregnant. she had twins, and during her pregnancy, she noticed changesin her vision. sally:so i have like a field, a pretty good field of vision still, but it’s not as good asit once was, and i don’t want it to get worse. i don’t want it suddenly be likethis, like in a tunnel.

dr. kulkarni:here’s your field of vision. this is your right eye. you can see how up here there’sthis black area. you had some trouble seeing the lights. here’s your left eye. and again,up here, you had some trouble seeing the lights. sally:when i go like this, i know something’s happening up there, but i don’t, you know,see it very well. so it’s kind of like this outer ring. i rely on my eyes for everythingi do. from work to play to parenting… dr. kulkarni:she said, i was pregnant, my vision got worse peripherally…i delivered, it got better.and to a normal person that might not make any sense, but to me, it was screaming loudand clear “i have a pituitary tumor.”

dr. udani:so we did an mri scan and it showed a tumor arising from the base of the skull which wasunfortunately a brain tumor. dr. kulkarni:so here’s the right and left eye. we traced the optic nerves going back towards the brain.bam! that’s the pituitary tumor that we found. sally:for a single mother with twins, it was pretty alarming to have to deal with that with 9-day-oldbabies. dr. udani:most likely, this is a benign tumor. which means it’s not going to spread to otherparts of her brain. it’s not cancerous.

that being said, nothing in the brain is trulybenign because if it continues to grow and we don’t treat it, it can lead to blindness,and eventually it can compress her brain stem and lead to death. sally:well, it’s important that i hold on to those memories…i just love gazing into their eyes…whatif the pictures go black? that’s terrifying. dr. udani:so the surgery is done through the nostril and that takes us straight back to the baseof your skull. if we had to do this surgery in the old days, we’d have to make an incisionin the skull starting at the top of the head, coming down to her ear, pull her scalp forward,remove this bone and then work underneath

the brain to get to the tumor. now, fortunately,we’re able to do the same surgery, but through her nose, and still be able to remove theentirety of the tumor. sally:i’m taking a deep breath and hoping it all works out. it’ll be scary kind of lookingat them for the last time before surgery, for sure. dr. udani:this is our neuro operating room. this is our microscope which we use. this will giveus a direct view to the skull base. these sensors pick up a signal and it tells us exactlywhere in the brain we’re located, and it will show me on the screen exactly where weare.

admitting nurse:what are your babies’ names? sally:sophie and lexie. nurse:see, i’m distracting you. sally:yes, i know. nurse:flowers and puppy dogs! sally:i have plenty of those too. nurse:you do? sally:i have four dogs. nurse:four dogs?

sally:yes. dr. kulkarni:for sally, like most of the population, losing vision is one of the main fears they couldpossibly have. dr. udani:this is all for the image guidance. once he registers her face, it’ll link it to thescan that we have which will show us exactly where we are in the patient’s brain. looksgood, rory. so this is all bone at the base of the skullthat we remove to get access to the tumor. so now we’re just opening the lining ofthe brain. so this is all tumor right here, all this yellowish tissue. we’re just pickingaway at it, removing it piece by piece. here’s

some tumor on there, jackie. here’s somemore. so we did get a preliminary report on the pathology. it looks like a pituitary adenoma,a benign type of tumor. it’s not cancerous, so that’s very good news. and the fact thatwe were able to remove everything that we saw means that hopefully she’s cured atthis point. dr. kulkarni:you did awesome! sally:is it any better? dr. kulkarni:100% better. sally:yay! dr. kulkarni:let me show it to you because it’s pretty

impressive. here is your right eye from lasttime. and here it is today. sally:wow. so that’s dramatic. dr. kulkarni:it’s all cleared up there. here is your left eye. dr. kulkarni:you’re cured. good job! sally:thank you. dr. kulkarni:that’s awesome. being able to look at the visual field before she knew the results isthe best part for me, because i know her vision is perfect now and i get to go in and giveher the good news.

sally:peek-a-boo! felicia:a lot of people describe my voice as having a sadness in it (felicia sings). the painthat i’m going through is in my music, for sure. mike:her knees are screwed up. it’s been forever. she was born that way. felicia:oh, my right leg is killing me. i got to stretch it a little bit. i just have suffered prettymuch and made my way pretty much the way i was put together. i can’t get up this, ithurts too bad. it’s excruciating, to the

ground painful. takes the breath out of youpainful. dr. sechriest:i’m going to do something a little unusual, don’t be alarmed. okay? i’m actually goingto put my ear on your knee. i know, it’s crazy, right? but i’m going to listen. itsounds like snap, crackle, pop in there. felicia:some percussion going on? dr. sechriest:oh, yeah. felicia:first thing he said when he walked in the door was, where have you been, felicia? (laugh)what do you mean? he said you should have come see me twenty years ago!

dr. sechriest:she has the knees of someone twice her age. felicia:those are not my knees. are they? dr. sechriest:oh, yeah. the bones are essentially touching on the inside. and this is really advancedarthritis. this is way more than you deserve. but it’s what you’ve got. the best solutionwe have to offer is a full knee replacement. and we’re going to use some state of theart technology to try to get you a prosthesis that will actually bond and grow into yourbone. felicia:that’s pretty fascinating. dr. sechriest:it will literally become a part of her body.

and once it becomes part of her body, it can’tfail. once you get a metallic lattice adjacent to bone, the blood from the bone adheres toit and you have a piece of metal that is bonded biologically to the bone. felicia:thank you guys. appreciate it. i can’t carry my own amp which is really annoying, becausei want to be like that tough girl that plays in a band that carries around her own stuff… emily:people always joke around that she’s never written a happy song, and so (laugh) a lotof her stuff is sad and in minor key, and things like that. she’s actually in twobands, so sometimes we do a double set, and

that’s a good three hours on stage. felicia:i look at pictures of me as a kid, and my knees look, they look strange. like they’reindented. i try to tough through it, because that’s kind of like the culture of my family. irene:now that this has come up, maybe i wasn’t as sympathetic as i should have been, youknow. i mean i was raised in scotland…you just pick up lassie, you don’t complain.and it’s just part of life. dr. sechriest:you’re my only mission today. i’m going to do a great job. i’m going to sign yourleg. i think this case presents enormous technical

challenges. this procedure has to be donetechnically perfectly. and so there really is no room for error. there is no room forerror. everything matters. knife please. when felicia was a little girl, her kneecaps dislocatedhundreds of times. oh boy, this is just incredible. what’s fascinating is that a very largepiece of bone that shouldn’t be here is sitting right in her joint. this is very pathologic.we’re going to carefully excise this. wow. so this was just something that was a littlebonus. that’s crazy. so far there’s not a good thing to say about felicia’s knee.(under breath) just like that. excellent, excellent, excellent. so the whole major distalweightbearing surface of her knee is completely diseased. everything here is just gone. absolutelyjust devastating. this is the tibial cut.

and this is the platform of the prosthesis.okay. this is the moment when the implants are going in. all right guys, stay with me.i’m happy where i am. now this is going into felicia’s bone. and there it is. it’sabsolutely wonderful. i am thrilled. and this is a big moment. tracking is really good.i think we’ve achieved perfection. i’m actually pleasantly surprised how awful herknee was. okay? (laugh) because it means we were doing the right thing. instead of cartilageon cartilage, you have highly polished chrome attached to titanium alloy. mike:she’s got a hot rod. dr. sechriest:that’s what she’s got.

physical therapist:you’re walking. first walk. congratulations! dr. sechriest:felicia has a life that matters. and she doesn’t need to be on the sidelines. and that’skind of where she is right now. we need to get her back in the game. vanessa:you need a workout today. it’s great to watch someone progress, and that’s why allthe physical therapists here, we love our job. we love watching that process…of peoplechanging and growing. and bringing them back the things they want to do. felicia:i just started practicing again with both

my bands. vanessa:oh, really! felicia:yeah. vanessa:do you have a performance coming up? she’s getting back to what she loves. i can’twait to see her next show. felicia:having my new knee has like taken the pressure off the left side, because i have a solidfoundation on my right knee. (music plays) i’m so much happier. i mean i do things…andi’m like, wow…i just, i’ll get excited, i put a little jog in my step, reborn, youknow, with a brand-new knee. (applause)

thank you. nurse:wiggle your purple toes. say, there’s no place like home. (laugh) robert:i was going to get a shirt made. says my mom is the strongest woman i know. you know, so…istill have to get it made. maria:my heart is only working 23% and it will only get worse. vincent:she couldn’t even walk from our house to two houses away. that was it. she was finished.i had to get a car to come pick us up and

take us back home. dr. adamson:her chances of living for six months is very low, maybe 10%. she has a prognosis that isworse than pancreatic cancer. maria:we’ve been married 39 years. we met in high school. vincent:tenth grade. as soon as i showed up she was the first one i saw. i know it’s probablylike a fairy tale but that’s how it happened. god gave me a gift. and that was her. so,sorry…i’m always getting emotional. kristi:maria is the, you know, she’s the strong

one in the family. i think she’s the center,the epicenter of their entire family, and i think that’s true for a lot of women.you know, they hold the families together. dr. mehta:when the heart fails, and the left ventricle can’t pump blood forward anymore, a leftventricular assist device can be implanted in order to take over for the heart. suzanne:so this replaces the function of her left ventricle. the drive line comes across here,and goes to the external to get power into and out of it. dr. mehta:we are entering the new area of mechanical

circulatory support with this new heartmateiii device. dr. adamson:now we don’t know today whether this will actually perform like we hope it will. andtherefore the need for a clinical trial. turn your corners up. we are the first center inthe west to implant this device. look at this heart. i mean, this is just amonster heart. drain the left atrium. i’m going to do a pa double doppler. she’s apioneer. the lessons that we will learn will be crucial for the next generation of heart-failurepatients. boy, this looks nasty in here. nasty clot. in this country, 500,000 people diea year and many of them, if they had more flow, they could live normal lives. hold yourlungs for a moment.

we will make a small hole in the very tipof her left ventricle. and then we will sew this ring right onto the tip of the heart.keep the stitches coming. if we just sew this to that to the heart with a running stitch…allright. give us the pump. and put this pump right like that with this on the other side.we’ll snap this pump to her ventricle to lock it there so the blood will come in here,go through the pump, out there and then into the aorta. we have to let this heart recover. dr. mehta:once the pump is implanted, we can look at the cardiac ultrasound to determine how thepump is actually working. whether the speeds are too high, too low, or in the right area.

dr. adamson:turn your rpms down to 4000. at this point in time, the heart pump is in place. uh, it’staken over her circulation beautifully. the heart’s getting better by the minute. or nurse:hi vincent, i’m in the or with maria right nowand everything is going smoothly. the pump has been started, okay? vincent:okay, thank you. or nurse:okay, you’re welcome. maria’s daughter:good. mom’s a trooper. she’s going to

hang in there…right? robert:that’s what she said. maria’s daughter:she’s going to get through it. kristi:maria…surgery’s all over. you’re doing great, okay? dr. adamson:your heart was weak as a kitten. the new pump is in and working beautifully. you have moreblood flow now than you’ve had in a long time. kristi:we gave her a lifeline. we offer hope. it’s

an amazing blessing to be in this position.i’m going to take a listen to your new machine in here, okay? suzanne:maria’s a battery-operated woman at this dr. mehta:if i can help them overcome their heart failure so that they can get back to life that isthe most fulfilling thing in the world. if you so much as sneeze and don’t like theway it sounds, you give us a call. you’re ours and we’re yours, whether you like itor not. don’t do anything crazy this weekend…i’m going to give you a hug. kristi:she’s like an astronaut. she’s going where

a lot of people have not gone. maria:we’re almost out. vincent:yeah. maria:time to go. nurse:take care, maria. vincent:we have time. we have time now. i’m glad for that. maria:there’s no place like home. colleen:our patients put their lives, literally, in

our hands. we can’t afford not to give everythingwe have to every single patient, every single time. here, let me give you some of my strength,some of my hope. that one hand on an arm. that arm around a shoulder. people get betterwhen they’re the center of everything you do. mike:feel like you have a bionic knee now? felicia:i do have a bionic knee. mike:how do you feel about going a little bit faster? felicia:yeah, let’s go. mike:oh, you want to race? cocky there, with your

little knee! leslie:you were brave, very brave. darryl:i couldn’t see past the next day. now i can. dr. adamson:this disease took maria away from her husband and children. and this pump has reunited them.the preciousness of every moment is priceless.