"Chronic pain, mysterious, invisible, complex." "It destroys lives and causes unimaginable suffering." "But now, we're on the verge of new understandings." "Targeting the agony of cancer, watching the brain's response to pain, zapping the spinal cord with electrical current." "These are just a few of the 21st Century weapons used against this ancient enemy." "Pain specialists wage battle against chronic pain next, on "Killing Pain."" "Okay, just relax and take some slow, deep breaths." "Where are you hurting at, sir?" "Pain, we can't survive without it." "When we break a leg or cut ourselves, the pain system sounds the alarm." "When we come too close to a flame, the pain system warns us of danger." "But for some people, the alarm never shuts off." "You can't remember what life is without pain." "My bones are made of glass, and all of a sudden they are hit with a baseball bat." "Like being stabbed with a hot sword." "The pain takes over, refusing to heal, destructive, cruel sometimes, without apparent cause." "You know, I was ready to just lay in bed, in pain, for the rest of my life." "Chronic pain is not a symptom, but a disease itself." "I mean, I've had broken bones and I've had babies and none of it's like this." "This just keeps wearing on you." "It makes you old." "Until recently, chronic pain has been a mystery, to both patients and doctors." "The mystery has led to misunderstandings." "Because chronic pain is often invisible, people, including doctors, might say that pain is in your head." "The hardest part during those years was also having doctors tell me there was nothing wrong with me." "Pain is in your head, real pain." "Your brain filters your basic pain signals through feelings thoughts, even your energy level." "All these factors determine the pain's intensity." "21st Century pain specialists understand this." "They must be medical sleuths, ferreting out the sources of their patients' pain." "Every time I have a flare-up and I'm feeling the level of pain that I feel and I feel it in the exact same spot," "I say to myself "How can they not find out what is causing this pain?"" "It's right there." "This body isn't so big."" "Vincent Preto is a busy man." "Most days, he's up before dawn, rousing his family for breakfast." "No thanks to the team." "It's all coaching, I think, this year, huh?" "And then, out the door for the hour commute to his 60-hour-a-week accounting job in New York City." "...good play!" "Good play!" "After a long day's work, he rushes home to coach his son's basketball game." "Vincent is able to do all this thanks to new ideas about an ancient drug." "Vincent is one of an estimated 40 million Americans suffering from chronic pain." "To keep the pain under control, he depends on these pills." "Without them, there'd be days he couldn't get out of bed." "The drug that allows Vincent to have a life is morphine." "I don't think I'm any different than someone who has to take a blood pressure pill for high blood pressure, someone who has to take some other medication, someone who's diabetic, who needs insulin every day." "I just have a different problem." "See you later." "See you tonight, pal." "Don't get hurt..." "Vince's difficult journey to combat pain began one afternoon." "I'll see you later." "Meet you in the city for lunch, all right?" "Right." "Okay, bye." "I'll never forget that day, the day that ruined my life, so to speak, at least changed my life forever." "Come on, you can do it!" "Go, Angela!" "You can do it!" "Come on!" "Vince and his coworkers were participating in an outdoor team-building course." "Go, go!" "One of the activities was a cargo net." "Come on!" "There you go!" "I proceeded up the net." "There were three people on the other side, nobody on my side, and nobody holding the net." "So when those three jumped off the net, it became like a rubber band and I lost my balance and I fell backwards." "I felt like a pop in my back and I had pain shoot down my leg." "I guess three days later, I was up in the middle of the night, screaming, in total pain." "My back, every muscle in my back was in spasms, completely hard as a rock" "That's when Vince started the trek from doctor to doctor." "Every doctor had a different answer, every doctor had a different reason what was wrong." "But no doctor was helping me." "I had one doctor that gave me nerve blocks." "I must have had 35 of them in my back, saying "Oh, the next one's going to do it, the next one's going to do it."" "And it was just getting worse, my pain." "Vince estimates he saw 1 5 physicians." "Most scrutinized his X-rays, trying to find a problem." "They took their X-ray, they took their pictures, and if they couldn't see it on a picture, well, you know, "There's nothing wrong with you." "What can I do?"" "Vince continued to work after his accident." "Now distraught and exhausted from looking for help, his pain was worse than ever." "He was about to quit his job when his son asked..." "And he said, you know," ""Dad, when are you going to be like a regular father?"" "And that like, struck me, and I just said "You know what?" "I'm letting this pain take over my life and I'm letting it be the center of my life."" "Vince made an appointment with Doctor Russell Portenoy, chairman of the Pain Department at the Beth Israel Hospital in New York City." "In the case of Mister Preto," "I'm convinced that there's something seriously wrong in his body, causing this pain, but it's just beyond my ability to find." "Portenoy suggested that before Vincent give up, he consider narcotics, or opioid drugs, to manage the pain." "For hundreds of years, doctors have known opioids can effectively reduce the pain response in most people." "These drugs attach to specific receptors in the brain to block pain signals." "You may still feel pain, but the pain is no longer bothersome." "Vince was skeptical." "Have a good day, don't work too hard." "I'll see you tomorrow." "All right, okay." "Bye bye." "Bye bye now." "I said, first I said no." "I mean, you know," "I mean, those things, you know, those are what people take who have drug problems and stuff." "I don't want something like that." "Portenoy understood." "Despite their long history, there's a stigma against using opioids, even among fellow physicians." "When Portenoy was in training, these drugs were only prescribed for the most serious illnesses." "We were just told it's wrong, don't do it." "The drugs will make the patients into zombies." "They'll all become addicted." "You'll never get them off." "You'll just harm people if you start them down that road." "According to Portenoy, this attitude is changing among pain specialists, but the rest of the medical community is still catching up." "That hurt, up a little bit more." "How about down here?" "That's the usual." "Doctor Portenoy hopes that within the next ten to 20 years, physicians in all specialties will recognize opioid therapy as an appropriate option for some patients with chronic pain, and that the public will recognize they don't always need to fear these drugs." "People who take narcotic medications for pain function better when the therapy is appropriate." "They function better when these drugs are being taken, not worse." "So they don't take the drugs and produce harm." "They take the drugs and produce good." "And they don't escalate the dose and they don't lose control over their drug use." "Look, Ali, look Look at the bird." "Look" "Several months after first seeing Doctor Portenoy," "Vince started morphine therapy." "On good days, Vince forgets he has a pain problem." "On three." "One, two, three, dominate!" "Dominate!" "In the case of Mister Preto, I truly believe that very aggressive therapy using morphine has been a lifesaver." "...good play!" "Good!" "I don't consider it a problem anymore." "I just consider it a different way of life." "When the pain started, it was very slow in, in the way it formed, in the way it formed in my life, and in the way it formed in my body." "The best way I can describe it is that my bones are made of glass, and all of a sudden they are hit with a baseball bat and they fracture into your, into your skin, into your muscle tissue," "into your body, and it's shards of glass coming through." "You got art you're doing?" "Yeah." "Okay." "Sandra Lenagh and her husband Kevin own a firm that designs and manufactures large-scale banners." "Just as the business started to flourish, Sandra developed back pain." "Beginning as a dull ache, the pain came out of nowhere." "As the days and months passed, the pain grew worse." "Sandra's doctor prescribed exercise." "I could lift my right leg, but I couldn't lift my left, and I would lay there and cry." "I was dragging one foot, I was walking with a cane." "No mater what I tried to do, it just got worse." "Soon, I had no life." "Two and a half frustrating years after her pain began," "Sandra demanded an MRI." "A fist-sized tumor was invading her pelvic bone." "Over a decade before, Sandra had been treated for breast cancer." "Now the cancer was back" "I thought the enemy was another lump." "I did all of the things that, that I thought you were supposed to do, but no doctor ever sat me down and said pain could be the first indication of your cancer returning." "After her diagnosis," "Sandra made an appointment with Doctor Denis Clohisy, an orthopedic surgeon at the University of Minnesota Medical Center whose specialty is cancer pain." "Have you heard the latest?" "As far as treating Sandra's pain, there are really two objectives." "One is to treat the tumor and the other is to treat the loss of bone where the tumor occurred in her pelvis." "Doctor Clohisy recommended immediate action." "Following five weeks of radiation therapy Sandra's tumor and the pain disappeared." "To live those first few days without the pain I literally thought that I had died and gone to heaven." "But doctors can't treat all cancer bone pain as effectively." "Radiation can manage one tumor, like Sandra's, but often cancer seeks several sites in the skeleton, and multiple tumors require more radiation than the body can tolerate." "How can doctors stop bone destruction in these cases?" "Doctor Clohisy and his collaborate, neuroscientist Doctor Patrick Mantyh, are trying to answer this question." "Working together, the physician and the researcher have made a number of landmark discoveries about cancer pain." "They wondered why cancer pain is so agonizing and difficult to treat." "Their experiments prove that cancer pain is different, that it actually has different neurochemistry than other major types of pain." "The beauty of what we're doing is we're able to dissect out what is different about it and to identify new targets that we can actually use these new drugs to go after." "Is it the tumor that you think that's actually breaking through the bone, or is it another cell that's..." "Mantyh and Clohisy have also targeted the cells that cause bone destruction, osteoclasts." "Healthy osteoclasts are involved in day to day bone maintenance." "But cancer causes chemical changes in the bone, sending the osteoclasts into hyperdrive." "Put simply, in the presence of cancer, the bone eats away at itself." "We've been able to, to identify that the osteoclast is one of the principle cells involved in causing the pain." "In Sandra's case, radiation treatment had stopped the osteoclasts and the pain." "But the tumor left a hole where her bone used to be." "Doctor Clohisy prescribed the best drug available to rebuild the bone." "It would do its work in two to three months." "Based on their research, Mantyh and Clohisy have developed an experimental drug, a molecule, that stops the diseased osteoclasts in their tracks without radiation, and in just two to three days." "It basically stops the bone destruction, which ultimately gives rise to the pain." "The molecule is smart." "Like other 21st Century experimental drugs, it targets only the diseased cells, not the healthy ones." "The molecule comes in, it binds to the osteoclast, it does not allow it to basically break down bone." "So the bone stays intact, normal." "The tumor's still there, but the pain is not there because the osteoclast is not allowed to shift into hyperdrive." "The doctor's experimental treatment also reverses some of the ways lingering pain actually alters the nervous system." "One of the most revealing discoveries of the last decade is that chronic pain can produce physical changes in the spinal cord and brain." "Long after an injury has healed, the nerves may continue to send pain signals or make the body acutely hypersensitive to pain." "Clohisy and Mantyh's experimental treatment reverses this process." "People with these diseases, they don't die within six months anymore." "Many of them live for six years, 12 years, 20 years." "And if pain is there for that full six, ten, 20-year period, you know, that makes a major impact on their life." "Sandra still has cancer, but with the pain gone, she's reclaimed her life." "The only time I ever stopped living was during the pain years, the two and a half years of pain." "No one can be sure how long Sandra's current treatment will work" "If the current regime stops being effective, the Clohisy-Mantyh experimental drug will be available to patients like Sandra in about two to three years." "I got cancer diagnosed, and all of a sudden, now I have my life ahead of me." "Now we know what we're dealing with." "I still have cancer, but I have my life, and it's the most incredible thing." "If you have constant pain, it becomes your whole life, because you're feeling it all the time." "And no one else can see it, but you're always aware of it." "So in a way, it starts to become, over time, who you are, who you think you are." "Ken Weinstein suffers from a condition called scoliosis, curvature of the spine." "In his early teens, he developed back pain." "For years, he learned to live with the discomfort until he was 22 or 23." "I got this terrible spasm and my muscles, my back muscles, clenched around my rib cage and I couldn't breathe." "When you get pain, you can't remember what life is without pain." "And that's what this pain was, was, tripled that." "It was just completely debilitating." "Ken, a publicist in the music business, became a new father and started his own business in the same year." "I work with a lot of bands and there's always a lot going on." "The phones are always ringing." "There's the dealing with getting the business, keeping the business, doing yourjob." "He was aware that his back felt worse as the stress rose." "Ken made an appointment with Sheila McLaughlin, a licensed acupuncturist." "Acupuncture doesn't cure anything." "What it does is it sets up a state of balance in the body." "In, in, allopathic medicine, we call that homeostasis." "And it's about helping it get there." "Okay, I'm going to do a general treatment to help relax you." "Chinese medicine describes pathways of energy that run through the body similar to the way nerves or blood vessels do." "These pathways of energy are called meridians." "During acupuncture, needles are placed on meridian points to help stimulate energy flow." "Acupuncturists believe pain is an obstruction of this flow." "So if you, if you obstruct the flow, then you're going to get pain, you're going to get inflammation." "Things aren't moving through properly." "So if you can open that up and balance it, it will circulate through properly and be harmonized." "According to Ken, the treatment is soothing." "If you, when you think of a needle going in your skin, you think of a great deal of pain and this is not pain at all." "But, I mean, you feel the, the prick of the needle, but then you're immediately taken over by this sort of electronic sensation." "It's like the needles are, the meridians are talking to each other or something." "Well, one of the more important things, I think, about acupuncture, that it does, in terms of disease, it helps alleviate stress." "So the outside part of stress in their lives does not change, but what it will do is it will help change their relationship to it, how it affects them and how they feel about it." "From a Western perspective, we don't fully understand how acupuncture works." "Experiments show some acupuncture points release endorphins, which in turn help reduce pain." "The Western mind thinks of proving things and the Eastern mind more thinks of doing it and over time you see how it is, how it works." "So it's more of a narrative." "So you can never, I think, exactly break down how acupuncture works in that way and prove it in that way." "But in the 21st Century, the main concern among patients is not how it works, but whether it makes them feel better." "Acupuncture relieved Ken's pain, but only temporarily." "Sheila guessed he might be undoing the effects of the treatment by reinjuring himself in between visits." "So she sent him across the hall, to her office mate, Hope Gellerman, a certified Alexander Technique teacher." "What happens when people are in pain is there's a whole kind of cycle that happens." "The pain will trigger muscle tension." "The muscle tension then feeds back into more pain." "I think acupuncture works very well with Alexander Technique, particularly in cases where there's pain that has to do with postural misuse." "Sheila believed that Alexander training would teach Ken ways to prevent the repeated small injuries caused by the scoliosis, bad posture, and tension." "Kenny needed something to do to stop worrying about the fact that he was going to be hurting his back all the time." "Okay, so I'm going to take your head, not your neck, okay?" "Hope begins each Alexander session with gentle manipulations focusing on head and neck alignment and breathing." "Then, she moves on to exercises that complement the normal activities of each student." "Okay, phone." "You see, if your phone is farther away than that, do you see, you're going to lose your back support." "Right." "She was strengthening my back" "She was putting the Alexander Technique into my daily life, so I could sit properly at the computer, so I could walk better." "I think, you know, Hope definitely changed my life." "There's no doubt about it." "More changes were coming." "When Ken and his wife Lisa discovered they were having a baby," "Sheila and Hope helped the couple prepare for new life." "I knew I was going to have a large weight that was going to shift my center of gravity and I saw a lot of women in pain, holding their backs, walking around, and I just did not want to feel like that." "Okay, so you can kind of see what's going on with your back, when you look in the mirror." "Lisa discovered Alexander Technique not only relieved her lower back pain, but also helped her avoid neck pain, insomnia, and migraines, discomforts many pregnant women learn to expect." "And often, that their doctors tell them "Well, that's just part of pregnancy."" "Sheila also helped Lisa and Kenny deal with another pain issue." "The acupuncture was a great way to keep me calm during the pregnancy and sort of keep me focused on my new role in life." "Before delivery, Sheila taught Kenny to use meridian points to help Lisa through labor." "Kenny used the tips of his fingers to perform acupressure on the meridian points." "Without help from epidurals or any anesthetic, Lily was born." "I think, no matter what, you're going to feel the, the pain of labor." "But just knowing that you, you can try to help out, pain management," "I guess, some people call it, that you can help further it along or, you know, shorten the amount of pain during the contractions, it was incredibly helpful to know that I had a resource." "Lily Weinstein is new five months old." "Ken and Lisa's new challenge is to learn how to lift, hold, and carry Lily without hurting their backs." "They just love to be held." "So you're walking back and forth and holding her and your arms are getting tired and you're asymmetrical all the time, and so you have to learn to compensate." "Lisa would like to pass on all she has learned from Sheila and Hope to the next generation." "I think one of my main goals being a mother is to, to help her learn that she can heal herself." "Sheila and Hope represent another 21st Century approach to pain." "Pain specialists advocate the use of interventions other physicians may consider to be alternative or complementary." "If acupuncture can actually help the body to get better by itself," "I think that's an optimum way to heal, and I think that is possibly something that was, will be really important in the 21st Century, that, to help people get better by themselves, to help them participate in their own health care." "We drive out through the country and I would see the old cemeteries around there, and I would look and I'd say "Well, at least they're not hurting."" "The body's own electricity helps conduct pain across nerve endings, over to the spine, and up to the brain." "Like acupuncture, evolving medical technology exploits this system so that, rather than prescribing drugs or other therapies, some 21st Century physicians use doses of electricity to treat chronic pain." "Susie Arbagast and her husband Bob were on a camping trip when she came down with a blistering, burn-like rash." "It was like being stabbed with a hot sword." "Susie spent the rest of their trip huddled in the corner of their camper." "Susie had shingles, a disease that strikes adults when chicken pox virus, dormant sometimes for years, awakens." "The condition may go away on its own." "But in this case, the disease obstinately established itself in the nerves of Susie's spinal cord." "It was a screaming pain." "It would make you," "In fact, I did." "I would have to hold me mouth shut and go" ""Mmm, mmm, mmm."" "With Susie Arbagast, her pain was in her shoulder." "There were damaged nerves that had stimulated her nervous system and there was a specific part of the nervous system, the sympathetic nervous system, that had become aroused." "And ourjob was to turn that off." "Susie's doctors referred her to Doctor Scott Fishman," "Chief of Pain Medicine at the UC Davis Medical Center." "Does, does that feel funny when I touch it?" "No." "Or is it numb?" "It's numb." "It's numb." "Yeah." "I mean, you know, you had one of the worst cases of zoster" "I think I've ever heard of." "And there's no question that, in the time that it wasn't treated the nerves were damaged." "Oh, yeah." "Doctor Fishman started Susie's treatment with oral medication, then proceeded with a series of specialized nerve blocks to quiet the inflamed area of her upper shoulder." "Passing a very thin needle through Susie's throat, he bathed the affected part of her nervous system with a local anesthetic." "Most pain treatments come with no guarantees." "Doctor Fishman knew if the third block didn't keep the pain away, he would have to take Susie to the next step." "Then the next step would be to use this technology called the spinal cord stimulator, which fakes the nervous system out." "It uses the same electrical noise that the nervous system uses to communicate with itself." "That noise, the electricity provided by the system, jams the pain signal and keeps it from reaching the brain." "The spinal cord stimulator has two major components, a palm-sized battery and a narrow lead." "Both are surgically placed close to the spine and feed small amounts of electrical signal to the nerves in that area." "It's the same principle as rubbing your elbow after you've bumped it." "The sensation of rubbing overrides and confuses the signals of pain." "Unlike Susie Arbagast," "Connie Page suffers from nerve damage of an unknown cause." "It's been to the point where I couldn't even go out of the house to go to the grocery store or to sit in a movie." "It causes burning pain in her feet that radiates up one leg." "It's just been off the wall, and the medications that they've poured into me either haven't worked or have made me very, very sick" "Connie has decided to try the stimulator." "But before a battery is implanted long-term, stimulator candidates like Connie try the system temporarily." "Doctor Karen Pantazis, an anesthesiologist, performs the trial." "Spinal cord stimulation is hopefully at least 50 percent effective in at least 50 percent of the patients." "Yes." "You're going to feel some numbness going into your back, but it's going to be a little bit sharp..." "After she is lightly sedated, the doctors give Connie a local anesthetic." "And I'm going very, very slowly here." "There." "Okay, I'm in the epidural space." "Connie, you doing okay?" "I'm fine." "All right." "The worst part, in terms of placing the needle, is over." "Doctor Pantazis and her colleagues adjust the electrical feed and begin testing Connie's response to the first small jolts." "Okay, what, is it in your right leg?" "Oh, my right foot, my left foot, the right leg." "Connie's almost ready to go home." "She'll experiment with the temporary stimulator for a week" "If it provides relief, she'll return and have a more permanent battery, one that lasts two years, implanted." "An instruction booklet, as well." "And what I'm going to describe to you is all described also in this little booklet, so you can kind of..." "Before she leaves the hospital, she learns to control the amount of electricity she'll receive." "The buttons here on the left, the blue buttons here." "We're now starting to see pictures of the brain after minute molecular changes have occurred, and we're seeing what happens to the brain in pain and what happens to the brain when we give pain treatments." "Other significant advances in 21st Century medical technology have led to the development of a revolutionary diagnostic tool that offers new insights into chronic pain." "Functional MRI, or FMRI, allows pain specialists to watch brain activity in real time." "This is the first completely non-invasive safe way to monitor the brain of someone like Gerald Malerba." "Gerald is never without pain." "Each morning, he rolls off the couch where he sleeps because his pain is so intense he can't stand up." "was injured on the job." "Since then, he's undergone two major surgeries to repair a collapse spine." "The pain may range from dull to excruciating." "Every day, you don't know what to expect." "Might be pain level five to wake up with, and it might be pain level 20." "I'm up." "Gerald is a volunteer in a breakthrough pain imaging study using FMRI and led by Doctor Vania Apkarian." "Apkarian and his team watch the brain's reaction to pain." "Good morning, Mister Malerba." "How are you?" "Hi." "Okay." "How are you today, doctor?" "Good." "How are you feeling?" "Pretty sore." "Yeah?" "Yeah." "I think you're going to get some good readings today." "Good, good." "Doctor Apkarian has been studying pain for 20 years." "There's a whole new horizon opening up, as far as understanding pain and treating pain, and that horizon very much has to do with the revolution in brain imaging technologies." "Including fMRI." "Like MRI, fMRI uses the body's magnetic fields to create images." "But unlike MRI, FMRI can record activities like changes in blood flow to reveal how the brain is actually working." "This provides an unprecedented opportunity." "Gerald's fingers are fitted with a perceptometer, a simple device that helps him communicate his level of pain." "So show me a zero." "Show me a ten." "Great." "To gauge how their system works, the team asked Gerald to report what he's feeling during his MRI scan." "Apkarian will later analyze the blood flow changes recorded by the fMRI and compare that to Gerald's responses." "The experiment will last about an hour." "After several minutes, Gerald's legs begin to spasm." "So now they're shooting up." "That means the pain just went up and, and then it's going back down." "So Mister Malerba has these spasms." "The pain goes up and then comes, comes back down." "As the experiment continues, Gerald's pain escalates and the research team decides to call off the experiment." "Doctor Apkarian hopes the ability to observe the brain's responses may lead to an objective measurement of what has been invisible up to this time, pain." "Why does Gerald put himself through this torture?" "Why?" "So these fellows can find some possible help for somebody besides me." "I'm kind of excited about the technology." "For everything that bad happens to you and for everything negative, there's always a positive." "Something always happens that's positive." "My life has changed a lot because of pain." "It's basically affected every aspect of our life, our activity level, my work, starting a family." "Pretty much everything has revolved around it." "Before chronic pain set in, Debbie Mosarski was a flight attendant, an avid hiker, and a ballroom dancer." "Now, an ingredient that usually conjures up delicious aromas and exotic tastes offers promise for overcoming her pain." "When I first started having the flushing symptoms the doctors really couldn't explain to me why I was having them." "Debbie's quest to understand her pain began six years ago, when she began to notice a strange flushing and terrible burning in her feet." "Though they were working blindly, her doctors urged her to try a wide variety of treatments, including medications, acupuncture, and orthotics." "We finally resorted to surgery and did multiple surgeries, trying to address the, the nerve aspect of the pain." "None of the approaches worked." "We pretty much felt like we had exhausted all our resources." "Finally, by doing research on the Internet," "Debbie discovered she had an unusual disorder called erythroneuralgia." "It involves irritation of the nerves, usually in the feet, as well as swelling, redness, and other skin changes associated with some sort of inflammatory disorder." "The Web also led Debbie to Doctor Wendye Robbins." "Doctor Robbins, an anesthesiologist and a Director of Palliative Care at UC San Francisco, is investigating the pain-killing effects of high strength capsaicin." "Capsaicin is the active ingredient in chili peppers." "Debbie, who has flown in from Virginia with her husband John, is the 45th person to volunteer for the capsaicin clinical trial." "A cure would be wonderful, but we're kind of looking at it as a, hopefully a long-lasting treatment." "What capsaicin does is it gets inside of the skin near where we apply it and it works on the nerve fibers that signal heat pain." "So what we do when we work with capsaicin is we selectively target bad nerve fibers that are sending signals that Debbie doesn't need anymore" "and we turn those off without affecting the other normal nerve fibers." "The capsaicin the doctors apply to Debbie's skin is 1 00 times stronger than the capsaicin available without prescription to treat arthritis and muscle aches." "It's a thousand times stronger than the hottest chili peppers we eat." "It's so powerful it's dangerous to inhale or apply without anesthetics and careful monitoring." "The capsaicin starts its work deadening the diseased nerve cells in Debbie's feet." "Right now, they burn, on the top of the feet, and the bottom, still, I, I don't feel anything yet." "They're still quite numb." "Now, you might say to me "Why would I want to make a nerve die away, if that means that she's not going to feel anything?"" "And my answer to you is those nerves weren't working right to begin with." "They weren't protecting her from getting in too hot of a bathtub or from spilling something hot on herself and not knowing it." "All they were doing is severely disrupting her lifestyle." "The actual treatment takes about an hour." "Some people require two or three applications." "But the effects of the final treatment should last about two years, about the time it takes the nerves to grow back" "I'm so excited at the prospects." "You're done!" "The thought of the flushing not happening constantly, day in and day out, it's just, oh, it'd be great." "It often feels like I'm a single combat warrior in the sense that there aren't enough people doing the work and so the, the volume of calls and letters from patients and from people who'd like to be patients is quite intense." "Additionally, there's a fair amount of resistance from other parts of the medical community about whether or not these issues are legitimate." "My advice would be to be proactive in your own treatment." "I have really found, over the years, that if you just basically go on what you're told, a lot of times things could be missed and, orjust treated and not necessarily cured or," "or investigated well enough to know what you're really dealing with." "We're very much anticipating that, that at least, that the pain will be reduced and we'll be able to maybe not focus on it so much day in and day out." "Think of the last time you had a headache or a toothache and imagine that's 24 hours a day, 365 days a year, forever, because you're not going to die from it." "What's that like?" "Despite progress, our understanding of pain is still limited." "There are times when even the best doctors cannot take away the pain." "Then, the only option is to learn to live with it." "It's Monday morning and a group has just arrived at boot camp for back pain," "the Multidisciplinary Pain Center at the University of Washington." "This is what our day is supposed to be and each of our names are here and...." "Meet the new recruits," "Bill Weingartner, Loni Strege, and Charmaine Stark" "And we start, we lay on our back and you just do what you can." "Okay?" "Okay." "Bill, who broke a vertebra in his lower back over ten years ago, has traveled from Kona, Hawaii." "Loni's upper back was hurt when an automatic garage door fell and slammed her to the ground." "Charmaine was a neonatal intensive care nurse before slipping on a wet floor in the hospital and wrenching her back" "So bring your toes in and then point your toes out." "There's a frustration that goes with not being able to deal with, you know, my own life." "So what you do is you roll..." "You get angry, because it won't ever go away." "And you can't sleep, you can't sit, you can't stand." "You stop doing the things that you used to do." "Apparently, I'm stuck with the pain." "So my hope is that I learn some kind of coping mechanisms." "The three are here to learn skills to recharge their lives." "Every day for three weeks, Monday through Saturday, they'll work out for three or four hours a day." "The rest of the schedule is devoted to the biology and psychology of pain." "Important to keep that up because if those get tight, then those tuck down onto the hips and cause the hips to be pulled downward, which causes more tension into your low back" "In some sense, this is where you send the health care system's failures." "It's tough, if you think of somebody who's had pain for three, four, five, six years, the fact that they have to come here early in the morning, spend the entire day, be active." "So it's a very difficult task for these people." "Doctor Dennis Turk, one of the national leaders of the boot camp method, is a psychologist specializing in pain." "He collaborate closely with Doctor Jim Robinson, an attending physician in the program." "I basically tell the patients, you know," ""You're, you've tried many of the things we do here." "You're experience so far is largely one of failure."" ""And it's very easy to say 'Well, nothing can work'" "But I want you to keep an open mind and be willing to take the plunge, to try new things."" "Initially, everyone takes the plunge, but with trepidation." "Excited but scared." "That's weird." "My morning here today?" "Well, it wore me out." "The group is counting on the program." "They've each been to chiropractors, orthopedists, neurologists, surgeons, all who have referred them to other doctors, none of whom could help." "To be most effective, Jim Robinson feels he and other pain specialists need to step out of the traditional role as physicians who diagnose and cure." "So it's hard for physicians." "We're trained to treat biology, and pain is, it breaks out of that mold." "It, it can be strictly biological, but it can be many other things." "Multidisciplinary centers like this one are created to deal with the other things." "When you come in here, you feel like you are in a pain oasis and you have cronies with you that are like you and, and then the people here understand more of what's going on." "A team of psychologists, nurses, occupational therapists, physical therapists, and physicians work together, focusing on Charmaine, Bill, and Loni for the next three weeks." "Day two." "It's nine a.m. and the group starts the day in stretching class." "One of the hallmarks of this program is to push through pain." "I'm tired and I'm sore because other muscles got worked yesterday that apparently haven't been working." "I'm still hopeful, and then there's a little bit of concern because, you know, you only go up from here." "You don't go back" "Because something hurts doesn't mean it's harming you." "A lot of physicians, a lot of physical therapists, are used to" ""if it hurts, don't do it."" "And the philosophy here is that we've made sure we're not going to make you worse, but you're going to be using muscles you haven't used in a long time." "So don't be surprised if it hurts." "By the time the group graduates, exercise will ease pain rather than aggravate it." "Almost everyone finishes the program, but not everyone meets his or her goals." "Since it began, Doctor Robinson and Turk have seen a wide range of outcomes." "Nancy Garvey is one of their star graduates." "Nancy, who has suffered from chronic pain since a car accident, is working out at the center today." "She's also here to cheer on the new group, to let them know if she can do it, they can, too." "We were all here for the same reason, pain." "Yeah." "Yeah." "So are you doing better?" "Do you feel like you're doing better?" "I feel like I have my life back" "For me, it was a great relief, because I was so tired of that spiral of medications and side effects and emotional upset." "Statistically, most graduates improve their abilities to get on with their lives." "What's the price?" "Programs like this one, which are covered by some insurance companies, cost ten to 1 8,000 dollars a person." "But most back surgery cost 20 to 35,000 dollars." "Good." "For people in chronic, hard to treat pain, there aren't options." "It's cruel and we'd love to have a magic wand." "I'd love to be able to go "Your pain's gone."" "But the reality is current understanding of pain, current understanding of a physiology and anatomy, we don't have a way to cure it." "But that will change in the next five to ten years." "Medicine's new focus on pain, the current research, and the development of the specialty, will bring rapid-fire improvements." "Aggressive, assured care, using traditional and complementary approaches, genetically engineered drugs without side effects, smarter technology, better training, breakthroughs." "Still, people must learn that much of the responsibility is up to them." "They have to be willing to complain to their physician." "They have to be willing to assert their right to an expert evaluation." "And my advice to patients in chronic pain is to get information about all the ideas that cover the gamut of the experience of pain and find somebody who can be your ally and your consultant, to help guide you, just like you would if you were going through a forest" "that you didn't know before." "The monster is there, but it's gotten smaller." "And although this is less spectacular than cure, if you're a person who has a problem where there is no cure, it's a whole lot better to get optimal rehabilitation than to just stay where you are." "From our first breath, we are aging." "Every new line and furrow is a testament to that fact." "But now revolutions in cosmetic surgery are offering new techniques that will not only stall the outward signs of aging, but allow a person to completely redesign their appearance." "Total body contouring." "Virtually scar free surgeries and designer faces are already here." "Were the explorer, Ponce de Leon to wage his search for the fountain of youth in the 21st Century, he would do best to begin not in the swamps, but in the surgical suites." "In the past, cosmetic surgery was thought largely to be the domain of wealthy aging women." "That's no longer the case." "Meet Helen Dunne." "At 24, she's decided to have her face and body re-contoured in an afternoon." "22-year-old, Jorg Tanis, has traveled halfway around the world to have a surgeon who he found on the Internet implant jaw, cheek and chin implants." "And then there's the world record holder for cosmetic surgeries," "Cindy Jackson, who has completely redesigned herself through 27 procedures." "Her friend Isobel Hayes, like Cindy's look so much, she had surgery to become her clone." "In the 21st Century perhaps the most revolutionary change in the field of cosmetic surgery will be how common it becomes." "Some doctors predict in the not so distant future, a trip to the aesthetic surgeon will become as routine as our yearly trip to the dentist." "In fact, last year, millions of people around the world looked in the mirror, didn't like what they saw, and decided to do something about it." "One of those people was Sherri Hanson, a 42-year-old wife and mother of two from Tennessee." "Sherri might seem like an average middle aged cosmetic surgery patient." "But her story has a twist." "By the time she was in her mid 30's," "Sherri's weight had reached several hundred pounds." "There's no surgery to cut away that much fat." "Just good old-fashioned determination." "Several years ago, dieting and exercise became a permanent part of Sherri's lifestyle." "The results were impressive." "She lost nearly 80 pounds." "After I lost all of the weight and did the exercise program, the very disciplined exercise program, there was still all this excess skin." "So despite her phenomenal weight loss," "Sherri says her body was still not what she had hoped." "This isn't fat." "It's her excess skin following the weigh reduction." "Underneath this loose skin, was Sherri's well-toned body." "The question was, how to reveal it." "She went to see Dr. Patrick Maxwell of Nashville, an internationally respected aesthetic surgeon." "Dr. Maxwell's recommendation?" "A very rare procedure called a total body lift, in which the skin is actually detached from the underlying muscle, then drawn up tight." "A bit like having a suit taken in by a tailor." "It's a buttock lift, it's a thigh lift, it's an abdominoplasty." "It's taking all that stuff that we'd all like to throw away, you know all the stuff you can grab, front and back, thighs, buttock and throwing it out the window." "The skin has great elasticity." "It can stretch and it can shrink" "Still, there are limits." "Sherri's skin had exceeded those limits." "But, with the help of Dr. Maxwell and some 21st Century surgery, there was hope." "Sherri's lift was to be done in two stages." "Her lower half was lifted in the spring of 1999." "And the outcome was nothing shot of amazing." "Tomorrow Dr. Maxwell will rebuild Sherri's top half, so it will better match her bottom half." "In the first operation I made an incision from here, all the way around and all the away, to the front side." "The very first time I ever came to see Dr. Maxwell, and I disrobed for him to look at me, it was more like, instead of a doctor looking at a patient," "I felt like it was a sculptor looking at a piece of clay." "Like many of the new surgical techniques that are revolutionizing cosmetic surgery, the total body lift relies on a thorough understanding of anatomy." "The field is moving away from the days of simply stretching the skin tighter." "Some surgeons, like Dr. Maxwell, are becoming much more skilled at putting the skin exactly where they want it." "I lifted the skin up, dissected down," "I stuck my hands down her thighs." "And then I pulled all of this up, like that, and I threw all of this away." "Bam." "Gone." "Although most of tomorrow's surgery will concentrate on Sherri's top half, the artist in Dr. Maxwell would also like to do a bit of liposuction, to further refine her thighs." "Here's the point of maximal protrusion." "So this is a topographical mark I'll take off the most here." "Then here, and feather it out." "Not so long ago, the idea that surgery could take ones body from this to this would have seemed science fiction." "But according to Dr. Maxwell, this is only the beginning." "What will happen the next five and ten years will be more minimal scar procedures." "Not visible scars that will maintain youthful appearances." "But then, the bigger advances are going to be topicals and ingestables." "People will start applying things to their skin to make their skin look more youthful." "And then, anti-aging types of ingestables." "Things we'll take like vitamins." "And that takes away some of the surgical need." "And in the future, there will be a new attitude towards aesthetic procedures." "An attitude like Sherri Hanson's." "I don't know why anyone would want to hide the fact that they had had plastic surgery." "Because it's something that you're doing for yourself to enhance yourself." "So why would you want to hide that?" "Today is the day I'm having my surgery." "No, I'm not nervous at all." "I'm too excited to be nervous." "It's going on." "I think we can save the deal." "You're next.I don't think so." "The top half of Sherri's body lift will be an assortment of procedures." "Her breasts hang nearly to her waist." "For this, Dr. Maxwell will perform a breast lift." "No tissues will be removed other than a bit of skin." "And there will be no need for implants." "Just a clever use of some geometric incisions and an artist's eye for detail." "The surgery we're doing today differs from a reduction in that, this is more of a loose breast sag operation." "And it's almost like if Sherri had large breasts and you stuck a needle in there and just let all the air out." "Which kind of is what happened." "So in an essence what we're doing is taking this pattern, scooting the nipple up, creating a shaped mound like that, and tucking all this up and filling it and making a breast." "Once her breasts are lifted," "Dr. Maxwell will turn his attention to Sherri's arms." "The skin has shrunk up down here, but up here she's left with this bat wing." "So, I'm going to surgically remove this bottom skin." "Suction won't help because it's not a matter of fat." "It's a matter of elastic recoil." "Then she'll have a blepharoplasty." "That's an eyelift." "Then, of course, the liposuction." "Okay." "I'm going to pull this up, so you can't change your mind and leave." "All righty." "See you, buddy!" "I'll give you a call upstairs when we get started." "Okay." "See you!" "And I'll likely give you a call when we're finished." "I'll see you when you're transformed." "All right." "When I'm transformed," "I'll have large American breasts, double D." "Cosmetic surgery can encompass a wide range from minor tweaks to the total body lift, which is major surgery." "And there are always risks." "One of Dr. Maxwell's concerns is the length of Sherri's anesthesia." "Although patients are routinely put under for ten or even 1 5 hours during major lifesaving surgeries, this is elective surgery." "His goal is to complete all four procedures in about five hours." "The first step will be the sculpting of Sherri's thighs." "In regular or traditional liposuction, a metal cannula is connected to a vacuum source." "And then when this is introduced into the skin, it sucks fat out, purely by vacuums." "In ultrasonic liposuction, a generator converts electrical energy into sound waves." "Yes, sound waves." "For years, sound waves have been used in other procedures." "Kidney stones are routinely blasted with ultrasonic frequencies." "Not so long ago, some cosmetic surgeons began to ask, what would such sound waves do fat?" "The ultrasonic waves quickly liquefy the fat." "Allowing a far more gentle and safer removal from the body." "The area is also infused with fluid to lift the skin off the fast layer." "So what took months and years to build up, is gone in minutes." "And with no pressure." "I'm not, you know, this is with my fingers, this isn't the rough liposuction you may have seen before." "And look what comes out." "Liquefied fat." "Vanilla milkshake." "Liposuction is the most common cosmetic surgical procedure for both men and women." "But it is not without controversy." "The greatest dangers are infections and serious bleeding." "These concerns can be lowered by first infusing the area with fluid, including a blood constrictor and anesthetic." "Possibly the most important safeguard is finding a board-certified surgeon, such as Dr. Maxwell." "As he works up Sherri's body, the breast lift is next." "The initial reshaping is done, then temporarily stapled in place as Dr. Maxwell decides the new location of the nipples." "...the bottom remover." "Hold it right there." "Stop." "And let me see, oh!" "Pick it up." "Let's see what we can find down here." "Ah!" "Look at that." "This just basting and shaping." "But look at the shape of the breasts we've created." "Do you remember what it looked like?" "It was pretty, not so good." "And despite my preoperative markings, to really shape and sculpt, you've got to do things during the operation, to look at it, see it, figure it out." "The arms are then reshaped." "And finally, the eyelids are lifted." "As each stage of her surgery is completed." "Sherri is one step closer to a whole new body." "But her doctor says it will be many weeks before she's healed enough to see the results." "And months before all the swelling subsides." "Dr. Maxwell has performed Sherri's surgery in a hospital setting." "But an increasing number of procedures are performed in doctor's offices." "While many office ORs are well staffed and equipped to handle emergencies, some are not." "And regulations do not insure those safeguards for the patient." "Let the buyer beware." "It has been eight weeks since Sherri Hanson's total body lift." "Today she's returning to Dr. Maxwell's office for a follow-up visit." "Sherri!" "Yes!" "How are you?" "Wonderful, and you?" "Good." "Good seeing you." "Good to see you." "You look great." "Thank you." "Two months?" "Two months." "Two months." "Any problems?" "Not a one." "What size, clothing are you wearing these days?" "Misses size six or a eight petite." "What did you wear before we started surgery?" "Before we started the surgery I was in a size 12, 1 4." "Gosh." "This is a good example of why we call what we do, plastic surgery." "The plastic in our name doesn't refer to silicon or plastic materials," "It's a Greek term, plastikos, that is defined as molding or shaping." "And I think this is an excellent of molding or shaping the body from one form to another." "My next surgery, I would like for you to make my legs longer." "I have a lady that was too tall last week that I shortened." "You shortened one, jeez." "I just have..." "I just have about six inches in my closet." "You just happen to have it, her." "Each year millions of people around the world have cosmetic procedures." "In the past five years alone the numbers have increased over 1 50 percent." "But beauty has a price." "Tummy tucks, thigh lifts, breast implants, liposuction and face-lifts can range from two to 5,000 dollars, each." "What's driving this willingness to open up the checkbook or hand over the credit card?" "The baby boomers are getting old, and they don't like it." "In the 21st Century, will aging as we know it, exist?" "Or will advances in cosmetic surgery make the aging face and body a thing of the past?" "If there is a national epicenter leading the trend towards this youth culture, it is no doubt in the land of sunshine and movie stars." "Southern California." "Doctors Grant Stevens and Brian Kinney...both aesthetic surgeons in the Los Angeles area, know all to well the impact of the media on their business." "This is a tough town for people who are concerned about their appearance." "Not only is this town driven by youth and the youth culture, but the pursuit of perfection here is as high as it is anywhere." "There is something that I have coined the phrase personally, and talked about the Bay Watch Body Syndrome." "Sometimes people want to look absolutely perfect in slow motion from any angle, practically naked." "Now if you take the people that we use as our role models." "They may be born one in a million beautiful." "They get hundreds of pictures taken of them." "They choose the best one." "They photo enhance it, and then the people in the line at the grocery store say," ""Oh, I've got to look like that."" "That's not reasonable." "Those people don't even look like that." "One of the first jobs of any competent cosmetic surgeon is to help the patient decide what is reasonable." "A patient who wants to have the change done immediately, who has only wanted to do it for the last few days or weeks, in other words the duration of time they're thinking about it, that wouldn't be a good reason to have a life altering," "or facial altering procedure." "And we want to know, this is something that's been bothering them for a certain period of time." "Most doctors would agree that a well-informed patient is the first goal." "And the advent of the Internet has had a powerful impact on everything from answering the basic introductory questions, to the important decisions on which surgeon to use." "The Internet has leveled the playing field." "People from all over the world can obtain information about a subject that, up until now, has been sort of difficult, sort of mysterious for some people." "Over half of Dr. Stevens' patients visit him on the web first." "Patients are welcome to the web page, and are offered various possibilities including picking a procedure that they might be interested in." "And once they've found the procedure, they may then learn about it." "And subsequently, actually view before and after pictures that would show them what they might look like if they were to have this procedure." "There are two basic kinds of aesthetic surgery, those intended to redesign a person, and those that fight the signs of aging." "Each year, more non-surgical techniques are added to the list of weapons against aging." "It's a war that might be summed up in be word, maintenance." "Walk through the door of Grant Steven's office and it's a bit like walking into the future of cosmetic enhancement." "Here surgeons, dermatologists and skin technicians work together in the battle." "Most cosmetic surgeons agree, in the future the fight against aging will begin when we are young." "The first step basic skin care procedures, to prevent the wrinkles from forming." "Which might include exfoliating skin." "That is, removing the top layer." "This dermaplane is basically a straight razor." "The latest wave in exfoliation is the chemical peel, of which there are many varieties." "The weaker chemicals may be applied by a technician, while the stronger solutions require a dermatologist." "For the slightly braver age warriors, there are even more high-tech weapons." "Perhaps the most bizarre involves injecting botulism into the frown muscles." "Botox is a medically used derivative of the botulism bacteria, which in larger doses, is poison." "Dermatologist Molly Griffin says there's been a rapid increase of interest in simple procedures such as this." "I'm about to inject this patient with Botulinum Toxin A, which is the same as Botox." "Deep scowl for me." "Good." "Okay." "The Botox begins working in the days following injection." "It can be affective for several months." "During that time as various facial expressions are made, those muscles that repeatedly furrow the brow, are motionless." "No longer subjected to constant creasing, the skin doesn't wrinkle." "...three days, and the full effect is about seven." "It's a very strong toxin, so we use a small amount of the toxin and we put it place it locally." "And you only get the effect locally in the muscles." "There is no systemic absorption of Botox." "I tend to use Botox on the lateral eyes, for the smile lines, and for the squint lines." "For the scowl lines between the eyes and horizontal forehead lines." "When you lift your eyebrows you can see the horizontal forehead lines." "It can also be used on the neck for the lines that some people get from contracting this superficial muscle right here." "There are potential complications, namely a condition called ptosis, in which the paralysis travels to unwanted areas, leaving the patient with a short-term lazy eyelid, for example." "For many, the small risks are worth the gains." "I like the fact that you can get small things done without having to have any cutting or having it obvious that you've had any kind of surgery." "So you just look like maybe you're well rested, you like you just look great for your age, that you've kept out of the sun all these years." "And really that's what it's about, taking care of yourself." "Although Botox is an active ingredient, much of the current focus regarding injectables is about finding better substances that can be used in contouring." "If you look at someone's face." "If you look at their cheeks in the mid-face, this material here, five or ten years ago, used to be up here." "It didn't used to be back here." "And there was probably just a little bit more fat." "So our emphasis is on restoring volume and re-contouring someone." "Not on pulling, not on tightness." "The most popular biological injectable is collagen, a protein that occurs in all mammals." "Cosmetic collagen is extracted from cowhide." "Because it's an animal product, all patients must first be skin tested for allergies." "Unfortunately, collagen is only temporary." "The immune system recognizes it as a foreign material and gradually digests it." "There is, however, a new injectable." "Remember that liposuction fat like Sherri Hanson's?" "Now it can be frozen and used to fill in lines and wrinkles." "But it's still only temporary." "And it should be noted that not every injectable has gained FD A approval for cosmetic use." "Even with something has simple as removing a line, there are risks." "And as we enter our 30's, the lines will inevitably deepen." "Then, one might step up the battle, with an occasional laser resurfacing." "Until recently, the only lasers used in resurfacing were so powerful, they required a trip to the OR and weeks of recovery before the skin was healed." "Incredibly, this cool touch laser affects the layer beneath the skin's surface promoting collagen." "The laser is not the only futuristic thing in this scene." "So is the gender of the patient." "Lars Isaakson is, in many way, typical of the male patient wanting cosmetic surgery." "A middle aged professional competing in the workplace with much younger men." "Male aesthetic procedures have increased over 1 00 percent in the past decade." "Experts predict the trend has barely begun." "I've personally seen a dramatic increase of the number, a number of men having cosmetic plastic surgery." "During the recession in the early 90's," "I had a number of men tell me that they were wearing their resumes on their faces." "I think appearance has always been important to a lot of men." "And I think that just like the boom in the workout phenomenon, you go to the gym partially for your health." "But also because you want to look good." "And I think, you get a haircut because you want to look good." "You pay more money to go to a certain stylist." "So I think it's a natural evolution." "I've had a number of attorneys, litigators who want to have face-lifts, so the juries take them seriously." "I've had principals and schoolteachers come in for face-lifts, because they want to be perceived as young so their students take them seriously." "If you look like an old guy, they're going to, you might have old ideas." "If you look like a young, youthful guy, you know, then you're going to, age won't necessarily be a factor." "We know that attractive people do better in their environment." "We know they good the best jobs, they get the promotions, they make the most money." "And people want to look the very best they can." "It might be tempting to blame all this concern over youthful beauty on the media." "But research shows that although beauty may be skin deep, our attraction to it is deeper still." "It's written into our basic genetic code." "Beauty has been with us since the beginning of humanity." "It's not the case that the media are perpetuating some beauty myth on us all, because every culture, the current cultures and historical cultures... have all been beauty cultures." "The media use attractive people to sell products." "Dr. Victor Johnston is a biopsychologist, who's studying the connections between our instinctual attractions and human beauty." "As it turns out, some things are universal." "If we took pictures of..." "Caucasian faces, and we took them to China where they have never seen a Caucasian, and we ask them to rate them for beauty, what we'd find is that their beauty ratings are exactly the same as the beauty ratings that Caucasians give this set of faces." "So it's not something that's coming from culture." "It is something that's coming from our biology." "In other words, across culture's beauty, is beauty." "The most attractive faces in any race share certain basic proportions and attributes." "And those features are sending an age-old message." "We find someone attractive because beauty is telling us something biologically important." "An attractive female face has a much narrower shorter lowerjaw, indicating a low level of testosterone exposure at puberty." "It has less dominant eye ridges." "Again, this indicates a low level of testosterone." "And then you'll find very full lips in an attractive female face." "And this is due to estrogens in the bloodstream." "So this combination of high estrogens and low androgens are actually telling us something." "They're telling saying this person is fertile." "And, of course, ancestors who could detect fertility in females have simply reproduced more." "Unfortunately for those of you who falling in love with this beauty, she doesn't exist." "She's a cyber face." "A composite." "Her features were voted on by 1 0,000 web surfers from over 56 different countries." "But those genetic cues for attractiveness are not only found in females." "Here's an average male face." "Now you can see the effects of testosterone." "That lowerjaw getting much wider and longer." "The eyebrows getting very bushy." "Now these are testosterone effects." "At the other end here, we see estrogen effects." "The lips beginning to swell up." "The lowerjaw getting narrower." "And these are the characteristics we find in an attractive female." "I'm not surprised at all at the increase in cosmetic surgery, because people have always tried to manipulate beauty with cosmetics." "And I think now we just have the technology to do more of that." "Given all of these deep-seeded connections of appearance to fertility and youth, perhaps it shouldn't be surprising that one of the fastest growing segments of cosmetic enhancement are young women and now even young men in their 20's." "Born into an era of rampant technological advances, they easily embrace the latest innovations as a natural part of modern life." "24-year-old Helen Dunne is one of those Generation X ers who has no reluctance to make a tweak here and there to improve what nature's already generously bestowed." "Today I'm going to have my breasts enlarged." "I'm going to have my nose done, and some liposuction." "I'm really comfortable with technology." "That part I'm not worried about." "And then there's risk with everything you do." "What's life if you don't take risks?" "I felt like I deserved this operation." "I work hard everyday." "I have three children." "I'm in school fulltime." "I run a household." "I don't have a housekeeper." "I control, I manage their social lives," "I manage my significant others' social life, and I manage my social life, what little social life I have." "So, I just felt like this is something that I deserve." "If she wanted bigger breasts, to her, the next step seemed obvious." "If I'm going to get it done, I need to go where, you know, everybody goes, you know, where they do the best job." "So I was like, "Why not go to L.A.?"" "Everybody has, you know, new breasts in L.A." "Helen found Dr. Stevens via the Internet." "And he will perform her breast augmentation, nose job and liposuction." "Everybody's nervous." "This is Los Angeles, and people are always striving for perfect bodies." "Admittedly many people would love to have this as their final result." "But Helen wants to make it even better, and have me smooth this out and get rid of this little bulge right here." "One recent innovation in breast enlargement is teardrop shaped implant." "This is a smooth walled, round, saline implant." "And this is a textured saline with an anatomic design." "You can see this round and equal in all dimensions, whereas this is thinner at the top and a higher projection at the base." "So that it would stay on the patient's body like so, in a more anatomic fashion." "Helen, I'd like to talk to you about your nose now." "And just what you'd like me to do for it." "I understand there's somebody you'd like to like after today's surgery." "I like Halle Berry's nose." "Halle Berry, huh?" "She has a nice nose." "She does..." "Yes." "...doesn't she?" "What about her nose do you like?" "I like the way it's shaped and it still has an ethnic shape to it." "When you look in the mirror, and you see your tip comes out a little bit." "It's a little boxy." "Her nose is more in here." "Right?" "But otherwise it looks very similar to your nose." "So we won't be doing too much up here." "You have a beautiful tip here." "Helen's biggest concern, though not a large one, is not what you look like, she's nervous about the anesthesia." "Naturally so." "It's one of the major risks of surgery." "But Dr. Stevens' anesthesiologist employs a futuristic little gadget that may help calm her nerves." "This is the BIS Monitor." "And it's a bispectral analysis of the EEG, which is the, your brainwaves." "The numerical readout corresponds with consciousness." "An alert person registers in the 90's." "Under 65 and the brain is completely unconscious." "There are two advantages to this." "First, after hearing horror stories of patient's who could remember surgery under anesthesia, many patients appreciate the assurance the BIS Monitor gives them that they will indeed be completely knocked out." "Second, as the surgery is nearing an end, the anesthesia can safely being lightened without the danger of the patient waking too early." "The overall result is a lighter, more finely controlled anesthetic." "You just relax." "Take some nice slow deep breaths." "Think about your favorite place to be." "Not here" "Not here." "Maybe Tahiti or a nice warm sunny beach someplace, that's where I'll send you for a little while." "In minutes, the BIS monitor confirms that the operation can begin." "Here's the indentation I showed you earlier." "We want to stay out of there." "Dr. Claytor, what's her BIS monitor?" "Okay, why don't we prep her nose now." "Helen's nose job, known as a rhinoplasty, will entail removing cartilage at the tip." "The tip of the nose is somewhat like an Oreo cookie in that there's the skin on the outside, and skin on the inside, and the middle is cartilage." "We remove a portion of this cartilage and thereby narrow the tip of the nose." "And breaking the nose to thin the bridge." "A splint is placed on the nose to help the cartilage memorize its new position." "This may look like it's going to hurt after surgery, but Dr. Steven's has assured Helen that she probably won't even notice it, compared to the pain of the breast implants." "Is that all right?" "There are a wide variety of breast implants and methods of placing them." "The incision may be under the arm, under the fold of the breast or even tunneled up through the navel." "Dr. Stevens is placing Helen's through an incision just below her nipple." "This is a 390 cc." "We will be doing a submuscular breast augmentation, which means simply that they breast implant is below the muscle." "By placing the implant beneath the muscle, we won't feel the implant as much, because the muscle will buffer the ability to feel the implant." "And probably most importantly, mammograms will be easier to read." "The safety concerns over breast implants have a rich history." "Silicon implants were originally marketed before regulations required proof of safety." "Following mounting health concerns and lawsuits against the manufacturers, they were removed from the market and are currently under study." "One futuristic dream is that tissue engineering might some day allow a breast to be enlarged with one's own tissue and do away with implants all together." "This is a tissue adhesive, or tissue glue." "This is a new product, which we apply to the skin edges, eliminating the need for sutures." "It also eliminates the need for suture removal." "So we have just closed the incision without any stitches, thanks to this tissue glue." "In little more time than it might take to go to a movie," "Helen's body is reshaped." "It has been less than two months since Helen's surgery, although she's still not completely healed." "She already knows what she thinks of the results." "Very happy with my breasts." "They're just, they're great." "I look, my clothes look great." "I have no pain." "They move." "They feel really natural." "They actually feel like a part of me now." "The first two weeks they actually feel like alien." "They don't feel like they belong to you." "But probably about the third week you start feeling like, "Okay."" "And you don't have so much pain." "But I do have to say, that first week I was like," ""Maybe I shouldn't have done this."" "There's hardly any scarring." "It's right on the edge so it kind of blends in to where my skin changes colors." "The favorite part of my nose is that the, the," "I had like extreme boxiness at the very tip, and that's gone." "So I'm just waiting for some of the swelling to go down." "I know I'm still healing." "I'm still going through recovery, so I just have to be patient." "That's about the only thing." "The increasing willingness to surgically alter and enhance ourselves is not merely a result of our faith in technology." "In fact, the greatest shift is philosophical." "The idea that changing ones appearance through surgery is a valid pursuit." "And the leading philosopher in the field is Dr. Ivo Pitanguy, from Brazil." "Dr. Pitanguy is known around the world." "In Brazil he's something of a celebrity." "Having performed over 42,000 surgeries, he's arguably the world's foremost authority on cosmetic surgery." "Everything you do as a doctor even, is applied art." "Our goal is to make someone happier and more in balance with themselves." "And whenever someone comes here that I'm going to see now with a defect, and this and that, we try to comprehend them and to see inside, our knowledge, how much peace the result we can bring to them." "The result will be someone happier." "So we are a field of medicine, like many others." "But that we do need to have sometimes, like a psychologist with a knife in his hand, to always never forget whom is in front of you." "The popular Brazilian attitude toward cosmetic enhancement is very positive." "Here it is less likely for a man or woman to hide that they've had surgery." "In fact, it's rapidly becoming a symbol of status." "This, along with Dr. Pitanguy's renowned clinic, has made Brazil a worldwide destination for cosmetic surgery." "Although cosmetic surgeons can be found around the world, today many patients don't let geography limit them." "There we go." "Take 22-year-old Jorg Tanis" "He lives in the Netherlands and has researched cosmetic surgeons in Europe," "Brazil and America." "Jorg seems bright, creative, and when it comes to cosmetic surgery, fearless." "He's decided to surgically change his face." "But nothing so routine as a simple nose job, although he's having one of those." "Jorg wants to have chin, jaw and cheek implants." "So Jorg has traveled halfway around the world to Dr. Brian Kinney." "I think that people who are so strongly against plastic surgery are perhaps a bit too narrow-minded." "There are a lot of people around who will just say," ""Well, it shouldn't matter the way you look" "It's your personality that counts."" "But if it's important for the person himself, well, then it is important enough to have something done." "In a situation where a patient comes in to talk to me about making a change, one of the things you have to so is suspend judgement." "And make sure that you don't overlay your value system on them." "Although as a surgeon you ultimately have ht decision whether not you do or do not operate." "Well, I told my friends and, well, they said the same as everybody else says, that I'm good looking and I don't need it." "And, but still they're quite supportive." "I mean, they, they do believe that I'm a little bit crazy to have all of this done." "I'm quite open about it." "I think this works best for me." "Imagine choosing to undergo a surgery in which your appearance would be radically altered." "In a matter of hours, the face you would come to know over a lifetime, would be gone." "Whether one considers this crazy or courageous, the trends suggest that in the 21st Century, it may be common." "Dr. Kinney will be placing all the implants through tiny incisions inside the mouth, leaving no visible scars." "These come in various shapes." "This happens to be the shape that's called the square jaw shape, because that's what he's looking for." "Now, if you see, this material's a little bit like maybe a Styrofoam cup." "It's brittle, but it's not completely brittle." "It has just a light amount of flex to it." "So we can actually cut this, much like you would cut a piece of Styrofoam." "There he is, nice and square." "And he's right down in the midline, and this is where the implant sits." "Interestingly enough, when we discussed this at some length, what he wanted was the Brad Pitt type look to his jaw." "Jorg knew he couldn't be made to look like Brad Pitt." "But he did have very specific ideas of how his ideal face should appear." "It would be weeks before the swelling would subside enough to reveal his new look" "It's been about one month since Jorg returned home from the states." "Although his recovery has gone well and the swelling has nearly gone," "Jorg's pursuit of his ideal look is not over." "I came home to the Netherlands and the operation had been really tough for me, both physically, and I suppose mentally." "And I went home and the swelling went down and it's really hard for me to see that." "Because I was feeling bad..." "because the operation." "And because of the fact that I had to get used to my new face." "And then, well, I feel, I feel quite ugly right now." "I like my face before the operation much better." "It's really tough." "And, of course, I'm planning to go to have another operation, because I want to look the way I want to look good, of course." "Since I'm here in the Netherlands and Dr. Kinney's in L.A., of course," "I'm writing him a letter to, for my follow up, to let him know how I feel." "And we talked before the operation, of course, about what I wanted to have done, and now we're talking about how I wanted to get fixed again." "Sometimes I feel like, "Whoa, this is growing out of proportion." "This is going too far."" "But on the other hand, it's, it's, I've got this really strong longing to reshape myself in one way." "And it's a really strong feeling and desire." "And it's really hard to ignore, so I just give into it." "When I'm finished I don't think I'll look regular." "I don't want to look regular." "So, I'm not doing this for society." "A few decades down the road, Jorg's precise ideal just might be easier to translate into reality." "The use of computer modeling is a frontier of cosmetic surgery that's just beginning to be explored." "I'll have you look right into the camera here." "Chin down just a little bit." "Turn this way just a little bit." "Okay." "Meet Diane Ruiz, a grandmother, working woman and soon to be patient of Dr. Patrick Maxwell." "I'm that generation that's kind of on the leading edge." "We've seen a lot of changes in our generation." "And I think this is just another change, that plastic surgery is not just for the affluent, or not for the beautiful people of the world." "It's for grandmother's like me, who are in a professional realm and yet, we want, we want to present an entire package I guess." "Diane has decided to have Dr. Maxwell lift her face, her eyes, do a little laser work and put in upper lip and chin implants." "But first, through some high-tech photo retouching, she'll test spin her face on the computer." "Mark is going to show us on the computer what we plan to do surgically, and let's just take a look" "From the before, to the after," "I think this is a fairly...realistic expectation of what can be achieved." "Getting rid of the jowls." "A little more strength to the chin, and a very slightly fuller upper lip." "I just marked Diane in the pre-op area and they'll roll her right down here in just a few minutes, around the, the corner and into the operating rooms that are right here." "Much of the latest technology in face-lifts...has been geared toward more minimal scarring." "We used to do the browlifts with a big cut all the way around and pull the forehead down." "It looked like a Halloween mask" "And if you ever saw a video of an open browlift, you wouldn't have one." "Times have changed." "Today, Dr. Maxwell is using an endoscope to do Diane's brow section." "Allowing him a direct view of critical nerves by inserting a miniaturized camera through tiny incisions hidden in her hairline." "And watching his movements on a television screen." "But if you're considering an entire facelift procedure, brace yourself." "Not all of the facelift is less invasive." "Today, the most thorough lifts are done below the muscle level." "So the skin isn't stretched into a new location, it's detached, then replaced." "Incredibly, all the scars are hidden neatly within the ear and hairline." "Diane's top lip will be plumped with a rather startling, though safe material." "Cadaver skin." "This is preserved...human dermis." "And, hold this up please, you can ask, "Well, why don't I use her own." "I've got plenty of it." That's a good question." "At the moment, I'm just seeing a little better results with this material rather than the patient's own material." "After a small chin implant, and some laser work around the eyes," "Diane's surgery is over." "All that's left of her transformation is the healing." "If this looks like it will hurt, it will." "But it is also very effective." "This photograph was taken just two months after surgery." "As we've seen, cosmetic enhancement may mean many things to different people." "Still, every procedure, whether it's large or small, rearranges this to a degree." "If the average cosmetic surgery is akin to doing a bit of remodeling." "Then 44-year-old Cindy Jackson from London, knocked down the walls." "I've dermabrasion on my forehead, laser treatment on my forehead." "Upper and lower blepharoplasty, which is an eyelift." "Eye debagging." "And my lower eyes were done a second time." "I had two nose jobs." "I've had my upper lip cut and rolled upwards." "It's called an upper cheiloplasty, because the space between my nose and lip was too large." "I've had a soft form implant in my lower lip." "Restolane injections in my lower lip." "Semi permanent makeup all over my face." "Dermabrasion over most of the rest of my face, aside from the forehead." "Gel and liposuction." "Cheek implants." "Three face-lifts." "I had my chin and jaw sawed apart so the chin could be moved back" "I had breast implants put in, but I've had them removed." "I've had ultrasonic liposuction on my love handles and inner thighs." "And regular liposuction from my waist to my knees." "If you're getting the idea that Cindy's a walking tribute to an entire branch of medicine, you're right." "To date, she's had 27 cosmetic surgeries and counting, enough to put her in the Guinness Book of World Records." "She's become a celebrity of sorts in London, making public appearances as the human Barbie doll, her chosen model of beauty." "And as a result of her media attention, she's grown her unusual experience into a web business." "Consulting with fellow patients." "Income that might come in handy, since she's had hundreds of thousands of dollars worth of surgery." "I spent my life doing exactly what I was told couldn't be done." "For example, when I first started having cosmetic surgery," "I was told, the three basic rules of cosmetic surgery." "One is that you can't take more than ten years off a face." "Two, you can't make a plain person attractive, and three, you can't change bone structure." "I've done all three." "As if Cindy's story wasn't unusual enough, meet her friend, Isobel Hayes." "Isobel originally contacted me through my organization." "And eventually, I think about a year and a half after we first met, she decided to have the nose job redone." "Because she'd had a nose job." "It wasn't very good." "I'd had my nose done and I'd had it done badly, and I was unhappy about it." "And I thought, "Well, she's got the nose I want."" "So I got in touch with her and that's where I all started, really." "And then when she finished that she decided she wanted my lips, she wanted my, everything." "When Isobel first started looking like me, people started taking notice and she was in the papers as my clone." "And eventually more people, as a result of seeing that, wanted to be like me." "And then we got more and more clones." "And there are a few dotted all over the place." "But Isobel being the first is my chief clone." "And she likes it that way." "She doesn't want to be just another one of the clones." "Cindy's goal was simple, to redesign herself in the proportions of classic beauty, like Barbie." "While there are few who dare to undertake such an extreme project, the results are undeniably amazing." "Is Cindy Jackson the future of cosmetic surgery?" "Could we some day be able to choose our appearance as easily as we might have a suit tailored?" "Will coming of age include choosing ones face?" "And what will we look like as we age in the 21st Century?" "Will new pills and surgeries become a real life fountain of youth?" "And if so, what pitfalls lie ahead as these revolutions reshape us?" "Seemingly every individual falls somewhere along a continuum." "There are those who would never have cosmetic enhancement." "Others might consider a tuck here and there." "And the boldest will follow in the footsteps of Jorg and Cindy." "Who knows exactly what's ahead in the distant future?" "Will designer people someday become routine?" "One thing seems certain, in the 21st Century, who we appear to be, will be our choice." "Imagine looking inside the human body and learning its most intimate secrets, seeing problems as they occur and without having to slice through the skin." "Images help navigate the tangled blood vessels of a patient's brain before ever lifting a scalpel." "A virtual flight through the human colon locates a suspicious growth without the need for cold probing steel." "And a special camera is detecting radioactive signals tracking down a tumor before it grows into life threatening cancer." "Each of these imaging technologies are opening the door for new cures and better treatments." "It's all part of medicine in the 21st Century." "And it's next on the Image Within." "The healing power of medicine beings with understanding what's gone wrong inside the body." "As we cross the threshold of the 21st Century, high-tech tools for peering deep inside the human body are revolutionizing the way doctors see and treat illness." "Three-dimensional images of this man's arteries allow them to stay one step ahead of a deadly disease." "Our surgeons hands, aided by the lens of a microscope and the precision of computer images, deliver this man from debilitating pain." "And a surgery guided by X-ray images reveals the cause of this woman's mysterious illness." "This is the liver here." "This is the aorta, which is the main..." "Doctors are looking deeper into the body and seeing more than ever before." "For the first time, we can imagine how well the body is working on a molecular level, making it possible to detect diseases earlier and treat them sooner." "Seeing, opens the gateway to understanding." "And with understanding, doctors are finding new ways to heal." "Like astronomers probing the frontiers of space, pioneers in medical imaging are always seeking new ways to explore the human body." "For more than 1 00 years, we have been searching for different ways to look inside the body." "It started when German scientist, Wilhelm Roentgen accidentally discovered he could expose the bones in his wife's hand using a luminescent screen and a glass tube charged with electricity." "Thus was born the X-ray, and a whole new way of diagnosing medical disorders." "That search continues." "Now there's a multitude of ways to visually penetrate the body." "The list of medical imaging devices is long." "And the technologies, varied." "From ultrasound, MRI, and C AT scans, to PET scanning and Magnetic Resonant Spectroscopy." "Still, no technology will ever replace a doctor's need to thoroughly understand human anatomy." "Historically, the best way to learn human anatomy has been to cut and dice up the human body." "That is until the National Library of Medicine commissioned a group of scientists to literally take a human body apart and put it back to together on a computer." "Creating an exact, three-D, digital atlas of a human being." "People with the visible human project have done just that." "With first a man, and then a woman." "And they did it without the tissue damage that accompanies surgery, or the distortion that comes from cutting into flesh." "Two cadavers frozen solid were donated to science to serve as models for this ultimate 21st Century anatomy lesson." "First, the frozen cadavers were sawed into three big sections." "Then, much like sanding down a fine piece of wood, each layer was literally shaved away, from head to toe, slice by slice, millimeter by millimeter." "After each layer was ground away, high-resolution C AT scans, magnetic resonance images, and photographs were taken of what was left." "These images were then matched together with hair-splitting precision, to build an exact detailed replica of the human body on a computer." "Vic Spitzer is one of the visionaries in charge of the project." "He foresees a day when scientists will be able to imitate all the systems that make human life possible." "We're trying to simulate life, if you will." "And for us, that starts out as simulating the anatomy of the human body." "And then we add to that, the physiology of the human body." "And since this is about medicine, we could eventually add the pathology of humans." "As you're twisting it here, it twists that into the..." "So far, Spitzer and his team of researchers at the Center for Human Simulation in Denver, have identified every detail of the visible man's anatomy." "A remarkable feat, but only a baby step in a titanic endeavor." "Building a blueprint of the human body in the virtual world, is a lot like creating a flight simulator to train airplane pilots." "This doctor is using the visible human to perfect a new procedure using endoscopic ultrasound to examine a patient's trachea." "Inexperienced doctors get to train on a computer before ever laying hands on a live patient." "The advantage to patients in the future, when we really start training with simulation, is that every patient, even the doctor's first patient, gets an experienced clinician." "More experienced than they get, than they get today." "I would like to think that translates into a, into better care." "So for example, a surgeon operating on his or her first real patient, will have already performed that particular procedure in the virtual world." "The problem is that no two people are alike." "And a couple of visible humans can not represent humanity." "We certainly want to simulate everyone in the world, but that, that comes from knowledge and transforming this one man." "He's a 39-year-old, 200 pound man," "I don't think it will be that far away, when we can realistically transform him into a 39-year-old, 1 80 pound man, 1 60 pound man." "With a click of a mouse, Vic Spitzer eventually wants to be able to transform this virtual man into any man, of any race, old or young, big or small." "The goal is to have enough control that we can dial in the person we want." "The clear precision of magnetic resonance imaging allowed scientists to gather enough detailed information to build a virtual human in three-D." "The same MRI technology made it possible for doctors to actually look inside Matthew Kelly's weakened aorta, possibly saving his life." "Come here!" "Matthew was born with cerebral palsy but he never let his disability keep him down." "Growing up, he worked hard, first to be able to walk, then to build up his body." "Although today it's a challenge to lift even 12 pounds, there was a time Matthew was bench pressing 1 70 pounds." "That was something I was really big into in high school." "And I managed to get hurt." "Subsequently my pediatrician had sent me to a specialist to see if, he thought I had injured something." "The surgeon did not find the hernia he suspected." "But during a physical exam he did detect a heart murmur." "An MRI revealed that Matthew had a ticking time bomb in his chest." "When they did the MRI, they were able to tell, due to that technology, that the wall of the aorta was thinner in the portion where they noted the aneurysm, which, of course, pretty much led them to diagnose the Marfan Syndrome." "Marfan syndrome is a rare genetic disorder that effects connective tissue like the aorta, the main blood vessel leading from the heart." "Matthew's weakened aorta had swollen up like a balloon." "The ballooned blood vessel is called an aortic aneurysm." "A sudden increase in blood pressure could cause his aorta to burst, and possibly lead to his death." "Matthew's mother, Pinky, said she found it hard to believe he had another problem to deal with on top of his cerebral palsy." "It was kind of devastating to us." "Because we thought he had done, you know, had conquered so much, and then here he was, he had a new hurdle to jump over." "Every six months, Matthew comes to Johns Hopkins, the world's leading center for the study of Marfan Syndrome, for an MRI and a check up." "MRI, magnetic resonance imaging, uses radio waves and a magnet, many times stronger than Earth's gravity to capture clear, detailed images from any angle in the body." "Powerful computer technology allows doctors to combine MRI images into a three-dimensional portrait of Matthew's blood vessels." "Because his Marfan syndrome is chronic, Matthew is in constant danger of developing a life threatening problem somewhere in his blood vessels." "I would have to say on those days my blood pressure's probably the highest, it's been for the month." "Matthew is nervous, never knowing what his doctors might find during these visits." "Still he can find solace in the fact the latest MRI technology is helping them anticipate any complications with his Marfan Syndrome." "The exquisite clarity of three-D, high-resolution MRI allows doctors to examine Matthew's entire aorta inside and out." "We've checked the images as we've gone along..." "As his doctors follow him into the 21st Century, they hope that these precise, detailed images will prevent the kind of near death experience Matthew endured ten years ago." "Not long after he was diagnosed with Marfan's, Matthew suffered a nasty fall on the ice." "He was taken to Johns Hopkins." "But before doctors could find the cause of his pain, the main artery leading from Matthew's heart started to rupture, nearly killing him." "Matthew was rushed to emergency surgery." "They repaired Matthew's shredded aorta and put in a new heart valve." "He has since had two more major surgeries to repair the rest of his aorta." "Matthew won't be lifting serious weights again anytime soon." "Still he says he's lucky, especially considering where he's been." "Lucky an MRI revealed his condition in the first place." "Lucky too, he happened to be in the right place when his aorta began to rupture." "Dr. Thomas Traill is Matthew's cardiologist." "We don't have, nobody has, many patients at his age with Marfan syndrome who've been through what he's already been through." "We had him talk to the medical interns." "A generation ago hardly anyone knew what Marfan Syndrome was, much less, how to repair a shredding aorta." "Recent advances in surgery saved Matthew's life." "In the future, faster, more precise MRI will help keep him alive by staying one step ahead of his disease." "What MRI does is move you from muddling through, to making the surveillance and the surgical treatment routine." "And only when these things are routine, do you get really good at them." "Unlike the heart, the aorta is difficult to visualize because it's hidden." "MRI takes beautiful pictures of this major blood vessel." "And because it's completely non-invasive, scans can be repeated over and over with no risk to the patient." "Let me tell you, from a patient's point of view, anything that allows them to find out what they need to find out without poking nine million holes in you or, putting anything else in you, is a godsend." "Go ahead and take a deep breath in." "Literally in a breath hold, we get three-dimensional images of his entire aorta and the branch vessels off the aorta, all the way down to his abdomen." "Dr. David Bluemke says three-D imaging makes it much easier to detect signs of weakness in Matthew's blood vessels." "As a radiologist, David Bluemke was trained to look at the human in slices." "Reading an MRI or C AT scan can be compared to taking a slice out of a loaf of bread." "But unlike bread, the human body does not come in slices." "It works as a three-dimensional hole." "In radiology we're trying to generate images that represent reality and reality is what the extent of disease process is." "And the body is in three dimensions." "It's not a two-dimensional world." "And we need to present that as accurately as possible." "Five years ago, a three-D representation such as this would have taken up to a week to build and interpret." "Today, it takes only ten minutes." "That means Matthew doesn't have to wait, worrying what the MRI might reveal." "I've had all the big surprises I need for this lifetime." "I think we'll just call the rest of them off right now." "While MRI is able to capture the fine detail of blood vessels leading to and from the heart, it can not yet follow the real time motion of the heart itself." "Bluemke and his colleagues want to change that." "They're working towards the day when just 30 minutes in an MRI scanner will be able to evaluate the entire cardiovascular system from head to toe." "Just look all the way towards your right side." "Good." "If we diagnose disease earlier and more accurately, we'll be able to avoid a lot of pain and suffering in the first place." "Advances in medical imaging are making even necessary procedures like screening for colon cancer, pain free." "The American Cancer Society estimates more than 56,000 people will die of colorectal cancer in the year 2000." "Yet there's a lot of evidence to suggest early screening can save lives, even prevent colon cancer." "Traditionally, screening for this disease has involved cold probing steel and a camera." "At Wake Forest University Medical School, Dr. David Vining has found a non-invasive way to look inside a patient's bowel, applying the same computer animation used to make Hollywood movies." "This is a three-D model of the colon." "And we can literally fly inside to look for abnormalities." "Vining has combined information from a CT scan with a futuristic computer animation program to develop a way to travel through a patient's colon in virtual reality." "As we travel through this bowel, what we're looking for are lumps and bumps on the colon surface." "Looking for polyps and masses." "This new technology means doctors can now detect early signs of colon cancer without sticking anything inside the body." "The alternative to using a C AT scanner and computers to look inside the bowel, would be this guy." "An actual endoscope, which is inserted inside one of the patient's orifices and then we look through a camera inside to see inside the body." "A non-invasive, pain free alternative to an endoscope could encourage more people to be screened for colon cancer." "With early screening and the clear relief of three-D imaging, doctors can save lives by detecting and removing harmless polyps before they grow into deadly cancers." "At the Mayo Clinic, the latest high-speed spiral C AT scan technology is being used to screen for a number of often-deadly diseases." "CT or C AT scan stands for computed axial tomography." "During a C AT scan, a special X-ray machine rotates around the body imaging detail cross sectional slices, which are then stored in a computer." "In many cases, patients are given a contrast dye that shows up as a bright white in healthy tissue." "In just ten seconds, this new high-tech CT scanner generates detailed high-resolution pictures." "Less time in the scanner speeds up procedures." "But more important, it means patients are exposed to a lot less radiation." "And a CT scan is cheaper than an MRI." "Just sit a minute and make sure you're not..." "Dr. Stephen Swenson the chief of radiology at the Mayo Clinic, wants to use this high-res, low risk CT technology to stop the biggest killers in America from being so deadly." "We received a very generous grant from the National Cancer Institute of 1.6 million dollars." "And that grant is specifically to look at screening for lung cancer, trying to find it when it's that big." "When it's very likely to be cured." "So far, the results are promising." "And not just for people with lung cancer." "Swenson figured while they were imaging the chest and upper abdomen, they might as well look for other abnormalities as well." "So what began as a lung cancer study, has evolved into a screening exam for other big killers like heart disease." "Breathe." "Just as Star Trek's Enterprise tricorder can scan the entire body with the wave of a hand," "Swenson believes we can look forward to the day when a single machine will provide all the diagnostic information your doctor needs." "In one scan." "As easy as having your blood pressure taken." "It's not too outrageous to expect that sometime within our lifetimes, that we will see a screening exam, maybe with MRI, maybe with CT, that starts at the stem and goes to the stern, that we can use" "as a mass screening for many of the diseases that cause death in America." "All right." "Breakthrough advances in 21st Century imaging not only mean diseases can be detected earlier and more accurately, they also mean surgery can be done with more precision and less trauma to the patient." "As medicine relies upon images instead of exploratory surgery to find out what is making someone sick, radiologists are taking on a whole new role." "Interventional radiologists are not only diagnosing what's wrong, they're also fixing it." "So we just gently unscrew the needle." "These 21st Century surgeons can perform lifesaving operations with incisions as small as a pencil point." "People who, five years ago, needed major surgery, can now be treated as outpatients." "That means faster recovery with fewer complications." "For Alice Grey it could also mean rescuing her kidney." "Alice Grey arrived at the Mayo Clinic weak, sick and scared." "She's been admitted with a persistent fever and chills." "And no one can figure out the cause." "So her doctor has sent her down to radiology for a C AT scan." "The radiologist on duty is Jeffrey Quam." "This patient was scheduled because she has a known infection in her hip." "And they were worried that that infection from her hip might have caused an abscess in her abdomen somewhere." "Using the Mayo Clinic's newest high speed CT scanner," "Quam is going to search Alice's entire midsection for signs of infection." "Okay, hi." "I'm Dr. Quam, Jeff Quam." "Are you feeling okay?" "After giving Alice a contrast dye to illuminate all her healthy tissue, the radiology team starts the scan." "As the CT reaches Alice's lower abdomen," "Dr. Quam stumbles upon something completely unexpected." "A dark spot in her right kidney." "Instead of it being white, which is from that dye that we gave in her vein, look at the one on the right now is very dark" "And that means none of the dye is getting there, and, in fact, it's as dark as the gall bladder, which means the density is just like water." "Just like water means there's a good chance Alice has a nasty kidney abscess." "And tissue turned liquid by an abscess is dead tissue." "Alice has a history of endocarditis." "A bacterial infection of her heart valve." "It's possible her heart condition is related to her kidney infection." "This patient's bacteria that were on her heart valve may have been pushed into the blood stream, out into one of the kidneys, and actually nestled into one of the kidneys and caused a little kidney abscess." "So this is a perfect example of something that nobody was really expecting." "Something that we can likely treat by putting a small catheter in there and getting some of that infection out of there." "A decade ago an infection like this would have been treated with general anesthesia and major surgery." "Today, an interventional radiologist like Jeffrey Quam, can biopsy the kidney and drain the infection right here, right now, all on the CT scanner." "Alice is relieved to learn they may have found the source of her misery." "Okay, all right." "We'll be back in just a little bit." "But Dr. Quam says he's still not completely confident he's doing the right thing." "Just not something we do very often." "Is that something that is a reasonable idea and is a fairly safe thing to do for this patient?" "So he makes one more call to a kidney surgeon." "We'll go ahead and do that." "Thanks for your help." "Bye." "With the blessing of the urologist, Quam starts planning the procedure." "Using CT scans to plot a course, he goes through the small of Alice's back so he can avoid puncturing the bowel and small intestine." "...So why don't we mark her at, I-304." "On the right." "On her right flank" "Unlike slicing open the kidney, passing a needle is non-invasive and safe." "Still, the kidney is rich with blood vessels, so bleeding is always a danger." "But at the moment, Alice says she's worried about something else." "She says she's afraid she might have some kind of cancer." "Dr. Quam tries to reassure her." "In fact, if this turns out to be an infection, what we're going to do today will make a big difference in making you feel better because we're going to take that infection fluid and pull it out of there." "Your most important job during this whole thing is to let us know how you're feeling, okay?" "No general anesthesia is required, so Alice can stay awake." "That means Dr. Quam can talk to Alice during the entire procedure." "The first thing we're going to do here is go ahead and numb up the skin." "It's time to begin." "A little poke with the needle." "The procedure itself should take no more than 20 minutes." "We'll go nice and slowly so it shouldn't hurt you too much, okay?" "Local anesthesia numbs the area where the needle is to be inserted." "Dr. Quam sticks the needle in part way." "Then takes a picture to make sure it's in the right place." "He will use CT generated X-ray images to guide him each step of the way, as he aims the needle towards Alice's kidney." "After inserting the needle, the X-ray tells him he needs to adjust his angle to reach the kidney." "I'm going to pull the needle back a little bit." "And aim it forward a little bit." "Apart from the discomfort of lying on her belly, Alice is feeling no pain." "...now hold your breath right there." "After several minutes, Quam finds the long angled path into the kidney." "All right that needle tip is right where we want it to be." "The next step is to see if we can get any fluid out of there." "But pulling back on the syringe, he can't seem to extract any fluid." "Well, it's, it, it looks like it's solid and not liquefied." "So what we're going to do is send the tissue for culture." "We're going to go ahead and put a small needle inside of this needle." "Using a long needle, he extracts several pieces of semi-liquefied kidney tissue." "These tissue samples will determine whether Alice has an infection." "And if so, what kind of antibiotic will work best to treat it." "I'm going to have you take a breath in for me again, Ms. Grey." "Blow it all the way out." "Another breath in and just hold your breath there for a second." "Might feel a little tug here." "The needle's out and you're all finished." "Oh thank God." "You did a great job." "Don't move too much though, okay?" "Just let me get on my elbows." "There you go." "Duck soup." "Didn't bother me." "Prick, sure." "But, good Lord, how many pricks have I had in my life?" "Lucky for Alice her hip did not cause the fever." "Lucky too, they caught her infection early enough to treat it with antibiotics." "Yeah, as time goes on, what is now solid kidney tissue that's infected with some bacteria, those bacteria will start to eat up the kidney tissue and turn it into just liquid." "Liquid tissue means dead tissue, which means a loss of kidney function." "Given another week, Dr. Quam believes" "Alice would have needed a catheter to drain liquid from an abscess." "Instead, there's a good chance antibiotic therapy will restore her kidney to full function." "And I'm glad I didn't have to have a tube and all that good stuff." "So, isn't this wonderful?" "This is my happy day." "As future surgeries become more image-guided, surgeons will need a better road map to navigate the body." "The technological challenge for medicine in the 21st Century, is to be able to simulate each patient's condition in the virtual world, so doctors can provide better treatments in the real one." "Dr. Elizabeth Bullitt is doing just that." "She made her mark as the first female neurosurgeon at the University of North Carolina Medical Center at Chapel Hill." "Now Elizabeth Bullitt is attempting to make brain surgery safer with computer guided images." "To do so, she's teamed up with Stephen Aylward a young computer whiz in the radiology department." "What Stephen has done is to write a program that allows you to define, exactly where individual blood vessels are within magnetic resonance angiogram, or MRA data." "MRA, or magnetic resonance angiograms, are images that illuminate the arteries as bright dots." "Using these MRAs, their program creates a three-dimensional roadmap of each patient's spaghetti plate of blood vessels." "This is what it looks like to follow a carotid artery in the brain." "Scrolling through a series of flat, two-dimensional MRA slices on the computer." "With a simple point and click, this is the same artery rendered in three-D." "This easy to use roadmap lets the user track individual blood vessels through the brain and inspect them from all angles." "And you can see how this looks from any angle of view, really like a mass of spaghetti." "But if you start to color individual arteries or groups of arteries in a different color, you can see better what the relationships really are." "Working with Dr. Bullitt, Stephen Aylward has developed a kind of Nintendo game for untangling the brain's intricate web of blood vessels." "Sometimes blood vessels supply pathological lesions, and then you need to interrupt the blood supply to those lesions." "But blood vessels also supply normal brain." "And if you interrupt a blood vessel that supplies normal brain, your patient may have a stroke." "Mine crosses and comes back" "Yeah, it goes over." "It makes this big..." "For the first time ever, Dr. Bullitt is going to use her imaging program to plan a surgical procedure." "Her patient, Garry Stephenson, has opted for brain surgery, hoping it will relieve the nerve jolting facial pain he's endured for nearly two years." "If someone puts a, takes a frayed lamp cord and kind of rubs it against your face and plugs it in, kind of thing, and it's just this, current that runs from here to there." "Garry suffers from trigeminal neuralgia." "A condition caused when the nerve that controls feeling in the face is somehow injured." "For Garry, eating, drinking, and even brushing his teeth, have at times, been just too painful." "First go round, I had lost about 65 pounds." "Last summer Garry lay in a hospital bed while doctors filled his bloodstream with pain medication." "But nothing seemed to work" "The pain grew so extreme at one point, Garry wondered whether he could go on." "You have to imagine someone who's, who's goal oriented, driven, 1 8 hours a day, to accomplish things, to move forward." "And I'm sitting, for basically two and three months, doing nothing." "Because I don't, because I feel, I feel bad." "I'm in pain." "You are going to need..." "Still, not knowing the cause of his pain," "Garry sought out different specialists, including a dentist who suggested he talk to Dr. Bullitt." "Having treated several cases of trigeminal neuralgia," "Dr. Bullitt understood Garry's anguish." "I've had men come in with beards because they can't shave." "I've had people who are housebound because they're afraid to go outside because the wind will hit them." "As for the cause of this debilitating disease." "I think we aren't sure absolutely." "The theory at the moment is that an artery in the back of the head presses on the root of this fifth nerve, just as it enters the brain stem." "And causes an injury to that nerve, so that different small parts of the nerve talk inappropriately to each other." "This artery is big enough and way over on the left that it's even pushing down on the brain stem there a little bit." "Bullitt believes that artery, called the basilar artery, is rubbing against the fifth cranial nerve, sending electrical shock waves through Garry's face." "These are the two carotids and these..." "Although she's performed this procedure many times," "Dr. Bullitt has never before had the benefit of planning a brain surgery in three-D." "And she can do it all on a home PC or laptop." "What this program will let you do is, at home or in the office, look at the subset of vessels that you're interested in, from any angle of view, let you figure out what your approach is going to be," "what the relationship is of the place your interested in to the other vessels, and really plan very quickly in three-dimensions, what you want to do." "To make herjob easier, she color-codes the different arteries running through the brain." "In this case, blue for basilar, and gold for carotids." "...carotids." "And these, this blue circulation in the back are the vessels we're interested in." "And it's this big curving vessel that is the difficulty, I think" "Seeing those complex connections in full relief can prevent strokes during surgery by taking much of the guesswork out of surgical planning." "Three-D images can also provide valuable guidance during difficult procedures." "This is the first time Bullitt is going to test her new program in the operating room." "Haven't lost one yet." "As Bullitt scrubs for surgery, she knows this could be a dangerous procedure, because of the large size of the blood vessel pressing on Garry's fifth cranial nerve." "Bullitt's first job will be to find the offending artery." "To do this, she'll be guided with another powerful imaging tool, a microscope strong enough to clearly reveal minute nerve fibers." "Without these magnified images, this type of brain surgery would not be possible." "We have a tiny opening." "We've gone in this deep, and that would be a very deep, dark hole." "And there are a lot of blood vessels down there." "It doesn't take long to find the large basilar artery." "And just as expected, the fifth cranial nerve is splayed across it." "With each heartbeat, the artery pulses up against the nerve." "Lordy, he's in a network" "This is the..." "Bullitt also discovers something she did not expect." "The nerve is tangled up in a cluster of arteries and veins." "So the nerve is actually sandwiched between the basilar artery here, and this vein, here." "And there's yet another loop of a vessel here, coming from the side." "Even with the help of three-D computer images," "Dr. Bullitt could not have predicted the artery was entangled in a big vein." "That's because the MRA images she used to create her three-D map of Garry's brain, revealed arteries, but no veins." "Bullitt successfully maneuvers through an obstacle course of blood vessels and nerves." "Once she reaches the artery, she uses a tiny piece of sponge to separate the nerve from the blood vessels wrapped around it." "Out of all that Medusa's nest of stuff, I think we've got it now." "The surgery appears to be a success, thanks to Dr. Bullitt's keen eye and steady hands." "I love the imaging." "And I've worked with the imaging." "And the imaging is helpful, but it doesn't replace being there, and, to me, seeing it and touching it with my own eyes and hands." "Bullitt hopes her program will help surgeons avoid many of the hazards associated with delicate brain surgery." "What this kind of program means for both the patient and for the surgeon, is that the surgeon is going to be able to have a much better perception of each patient's individual anatomy in three-dimensions, a much better..." "As technology advances, medical imaging will increasingly guide surgeons through a variety of complex procedures." "And as Bullitt and Aylward move their innovation out of the laboratory and into the operating room, they hope their software program will also be used to map blood vessels in other parts of the body, like the kidneys and lungs." "Major brain surgery did not hold Garry Stephenson down for long." "Less than three weeks after surgery, he returned to work part time." "And less than a month, he was back to a full 55-hour workweek, doing what he loves, managing a one-of-a-kind landscaping operation for roses." "I, I feel great." "I'm doing, I'm doing better than I expected." "Garry is pain free for the first time in almost two years." "I can go back to the way I was for the first 39 years of my life as far as being pain free." "It's kind of like getting a new, you know, starting life all over again, I guess." "Breakthroughs in computer imaging are making surgery more precise, by providing a clear roadmap to the body's internal landscape." "In the 21st Century, we will go beyond anatomical roadmaps and see cells as they grow." "Exposing growing cancer cells before they become dangerous tumors, can mean the difference between life and death." "A difference, 43-year-old Barbara Wells knows only too well." "Just lie back here." "In 1999, Barbara found herself facing two life-threatening cancers." "Less than a year ago she was diagnosed with colon cancer." "She went through a successful surgery to remove her colon." "But during the procedure, her surgeon discovered the cancer had spread to her liver." "Hi Ms. Wells." "Hi, Dr. Loggi." "How are you doing?" "When Barbara first came to see Dr. Loggi, a surgeon oncologist at Wake Forest University Baptist Medical Center, she thought perhaps her cancer was too aggressive to make her a good candidate for surgery." "Well, I had CT scans done in Greenwood, South Carolina, and they showed that there was a tumors on my liver." "They were thinking it was three." "She had come with a scan that suggested that she might have a metastatic lesion in the liver." "In fact, possibly several lesions." "But we also had another scan that had suggested that, that all of these might be benign." "In search of a definitive answer, Dr. Loggi ordered a PET scan, positron emission tomography, an imaging technique capable of seeing cancer cells as they grow." "To Barbara's surprise and relief, the PET scan revealed one cancer tumor instead of three." "To hear of three tumors, I mean, you're devastated." "I mean, one tumor's bad enough, but when you're thinking you've got three and end up, you've only got one, that's a relief, you know." "You're just praise and thank God for it." "Not only did the PET scan clearly identify Barbara's malignant tumor, it also provided Dr. Loggi with another critical piece of information." "And also importantly there was no disease outside of the liver, because surgery for people that have disease in the liver and also outside of the liver, is ultimately not going to be very beneficial." "The reason PET was able to identify Barbara's cancer so clearly, is that unlike other common imaging techniques, a PET scan provides vital information about how cancer tissue is growing, not just how it looks." "Basically PET is a very high technology way of taking pictures of biological functions as they're going on within the body." "Dr. Lee Adler was one of the first to apply PET technology to cancers other than brain tumors." "PET imaging, he says, is the best way to screen the entire body for cancer." "Most of the other techniques that are used to look for cancer in the body, are a study of the body's anatomy." "PET imaging on the other hand, can reveal chemical changes in the tissue itself." "Adler says this functional imaging technology can detect abnormal changes in tissue long before those changes become large enough to cause a visible mass or enlarged organ." "Right now PET is the, the only practical way that one can study living biochemistry within the body." "That ability to study chemical changes in the body makes PET a powerful tool for detecting cancer earlier and more accurately than ever before." "Giving people a much better chance of survival." "To detect chemical changes in growing cancer tissue," "PET imaging uses a radioactive sugar manufactured right here at the PET center." "Because cancer cells are growing so rapidly, they need a lot more energy than do healthy cells." "They get that energy from sugar." "There's no side effects from this material." "In this case, from the radioactive sugar injected in patients before they're scanned." "After getting her injection, Barbara moves through the scanner." "As her body uses the sugar, a radioactive signal is emitted." "A gamma camera captures those signals, which show up as hotspots on a three-D computerized PET image." "This is how cancer cells in Barbara's tumor show up on her PET scan." "Like cancer cells, the heart muscle also uses a lot of sugar and shows up as a bright spot on a PET scan." "Although PET is uncovering cancer earlier and more accurately than ever before, it is not yet widely available to the public." "And like a lot of people, Barbara had never heard of the technology." "I didn't know what to expect, what it was going to be." "When she found out what the PET scan revealed," "Barbara says she was overwhelmed." "A wonderful procedure." "And if my telling that it located and pinpointed the exact area that" "Dr. Loggi needed to go in and remove the tumor, then I'm more than happy to tell the world it's a good thing." "Dr. Loggi says PET has also revealed tumors other imaging techniques have missed." "But overall I would say, especially for certain types of cancer," "I think that the PET scan is, is, is superior." "You just relax the best you can." "In the 21st Century, Loggi says, PET imaging will not only allow us to expose cancer when it's small and more treatable, it also promises to help in cancer treatment itself." "Right now a treatment measurement such as radiation therapy must be almost completed before doctors can gauge whether or not it's done any good." "With PET, Dr. Loggi says, it's possible to determine whether a particular therapy is killing off cancer cells almost from the beginning." "Because it's a functional scan we can, we can use it in different ways, both for diagnosis to follow up with treatment and to help guide treatments." "And I see your incision is all healing up very nicely here." "Because Barbara's cancer had not spread to other parts of her body, her tumor was removed surgically instead of with radiation." "What Barbara and her husband Carroll want to know now is whether surgery got all the cancer." "I told her that there are no surprises on the pathology." "We did confirm that a tumor that had started in the colon had spread to the liver." "The PET scan had suggested that there was only that one tumor, and that's basically all we found." "Dr. Loggi says the surgery was a success, and Barbara's prognosis is promising." "There's probably better than a one third chance of her being cured and, better than a 50 percent chance of being alive at five years." "Well, we're going to go home and we feel like we have a new beginning, a new relationship." "So it's everything that we asked for, it really is." "And even more." "20th Century medical imaging has made tremendous strides in answering the questions, what does the human body look like on the inside?" "And what does disease look like?" "In the 21st Century, medical imaging will move beyond anatomy to answer the questions, how does the body work?" "And, how do diseases grow?" "Those questions will be answered by looking deeper inside the body than ever before, as we study disease on a cellular, even molecular level." "There will be a need to move to the next level of imaging, what we call molecular imaging." "Mechanisms that will allow us to verify the success of gene therapy work, for example." "Adler says PET imaging can be used in genetic therapy because of its ability to visualize cells as they grow." "That ability, he says, puts PET in the forefront of 21st Century medicine itself, as new technologies, such as gene therapy are developed to fight deadly diseases like cancer." "In the future, someone like Barbara might receive genetic therapy before cancer cells ever start to grow." "Until then, PET imaging can make the difference between hope and despair." "For Barbara and millions of cancer sufferers like her." "We hear, cancer, and we think, death." "And that's it." "And sometimes we cave in and give up, you know?" "But we're fighting it." "We're going to continue to fight it." "And we're going to stay on top of it." "With the power of computers, 21st Century imaging is saving lives, monitoring illness, unveiling the mystery of pain." "The precision of MRI reassures Matthew Kelly's family that he'll continue to keep his Marfan Syndrome under control." "Each time he has an MRI, you're anxious to see how the results are." "And each time they're fine, the next time's not quite as hard to, you're not as quite as anxious." "For Garry Stephenson, images revealing the source of his nerve jolting pain have help delivered him from intense suffering." "So what we will plan to do..." "I want to think that this is giving me another chance." "And with that next chance in life, I'll do better than I did the first 39 years." "Breakthroughs in medical imaging are uncovering secrets within the inner limits of the human body." "Secrets that will lead to revolutionary new ways of healing in the 21st Century." "Livers revitalized from a bag like this full of human cells." "Ears grown from living cartilage." "Thumbs, sculpted from coral." "Needed parts and vital organs, from the lab and into bodies." "Sound too good to be true, or more like science fiction?" "It's closer to reality than you might think, and it's next on 21st Century Medicine's Regenerating Life." "What if you were so severely burned that you couldn't recognize your own face in the mirror, but a skin patch made of discarded human cells could painlessly restore it to normal?" "Suppose you were a promising young athlete and the cartilage in your knee was damaged beyond repair, but with the help of a serum-based growth solution it was possible to grow new cartilage?" "Imagine breaking a bone that refused to heal and facing a life of pain and disability, but then being offered an experimental putty filled with protein to help you heal." "Or what if you needed a new liver, but instead of a major transplant doctors simply repaired your old one?" "All of this is becoming possible, thanks to an entirely new field of medicine called tissue engineering." "The ultimate goal is to repair any and all organs by regrowing healthy cells in a lab and then reinjecting them back into the body." "We are already growing blood vessels, cartilage and bone." "And now have off-the-shelf skin." "The cells in one tiny piece of this skin can produce enough healthy skin to cover five football fields." "Not only amazing, but true." "And for burn patients like Catherine O'Leary, it's nothing short of a modern-day miracle." "It was Saturday, July 18th, 1998 and former operating room nurse Catherine O'Leary and her husband Cyril were doing what they loved most, sailing." "The plan this particular weekend was to sail across the harbor from their picturesque home of Fairhaven, Massachusetts, drop anchor and spend the night across the bay near Cape Cod." "The next morning, just like she did every day on the boat," "Catherine got up early to make the coffee." "I got up. I went to the galley." "I got the coffeepot out, the coffee." "But when she turned on the stove and lit the match, in an instant the peaceful weekend quickly ended." "Then, as I lit, went to light the stove, that was when the fire just consumed me." "The alcohol stove had somehow misfired, exploding in her face and instantly engulfing Catherine and the boat's galley in uncontrollable flames." "I heard my wife screaming." "And that alerted me. I woke up and turned and saw her all aflame." "She was, her hair, her face, her clothing, all on fire." "The first thing I screamed was, "Help!" "I'm burning." "Cyril." "Wake up!" "You got to help me!" "I'm going to die!"" "She was engulfed in flame." "And I just, I didn't think at all." "I just reacted." "I was just going to put the flame out." "And I did that as quickly as it could be done." "Cyril put out the fire with a blanket, burning his arms and legs from the intense heat in the process." "Fortunately, within minutes after the explosion, a Coast Guard cutter arrived." "Catherine and Cyril were airlifted to the nearest burn trauma center," "Brigham and Women's Hospital in Boston, ironically, the same hospital where she had worked as a nurse" "29 years ago." "I could feel myself being moved through doors." "She had third degree burns on her arms and second degree burns on her face." "Third degree burns completely destroy both layers of skin and cause severe scarring." "While second-degree burns also leave terrible scars, not all the skin cells are killed." "Those few remaining cells were Catherine's only hope of getting back the face she had come to recognize as her own, the face Cyril had fallen in love with." "We photographed them immediately and then photographed their progress on a... lt would be up to Dr. Robert Demling, Director of the Burn Trauma Center at Brigham and Women's Hospital to save Catherine's face." "He said he knew it would not be easy." "This is Catherine on admission." "And this whitish area on the lower part of her face involving her nose and her neck is deep burn." "And this char on her forehead is also deep burn." "It's dead surface skin." "She has a tube in her mouth because she's on a ventilator at this point in time." "The ventilator was needed to keep Catherine from suffocating." "Her burns were so bad and her swelling so severe that her air passage was in danger of being squeezed shut from the swollen tissue." "Doctor Demling quickly stabilized Catherine." "And then he turned his attention to her scarring." "Once you get a burn, your face, particularly on a facial burn, your features are very distorted, especially from the swelling and the color change." "So it would be hard to even recognize your own relatives." "Cyril's burns were fairly minor." "But he was still in pain." "He couldn't lose the image of seeing his wife's face on fire, and he couldn't help thinking about what she might look like once she recovered." "I thought she'd be a, I thought she'd be a mess afterwards, and..." "Demling knew there was only one way to keep Catherine's face from being scarred beyond recognition, and it was the skin patch being developed here at Advanced Tissue Sciences." "Researchers at the La Joya, California company have come up with a way to create human skin, skin that would cover Catherine's burned face and give her back her beauty." "But before skin can be grown, it has to have a seed, a tiny bit of natural material that can tell the new artificial skin how to grow." "This 21st Century skin comes from an ancient religious and medical practice." "It comes from the discarded foreskins of circumcised baby boys." "So we take these surgical discards, enzymatically treat the tissue to remove the cells, and then start our cell banks." "And it's really remarkable, because these are young, healthy cells that have a tremendous potential to grow." "And from one starting material, we can actually get 250,000 square feet of final product." "That's five football fields of new skin from one tiny foreskin." "As thin as a paper towel, biodegradable skin is the first FDA approved tissue regenerated product." "Doctor Demling thought it could save Catherine's face." "Not only would the skin eliminate scaring, but it would eliminate something else that has always been part of burn treatment, pain." "...which is very different than traditional care, which requires painful wound care dressings two, three times a day for several days." "So painful, that morphine has to be given to the patients." "Until now, doctors have used the skins from animals or cadavers to cover severe burns." "But patients' immune systems react violently to both." "However, the skin flap eliminates the possibility of rejection because of the way it is made." "The cells themselves are surrounded by a natural secreted matrix." "So they basically are coated by collagen and other naturally secreted proteins which are not different from one person to another." "So what the immune system sees are not the cells, but the matrix that surrounds them, sees that as self, and doesn't reject them." "And then on day eight we can see most..." "The laboratory-grown skin would remain on Catherine's face while her own skin grew underneath." "ln only a week, the patch is peeled off, almost like a Band-Aid." "The results are immediately apparent." "...heal." "You can see the smooth, new skin on her face now." "This miracle skin did save Catherine's face." "But her arms were too severely burned for the skin patch." "Tissue regeneration saved my psychic." "I'm so scared on my arms." "But my face is fine." "And that's because within a couple of hours from... I was in Brigham and Women's." "And a few hours after that, I had the treatment." "Doctors say Catherine's face is remarkably radiant and completely unscarred." "If they had treated her the conventional way without the regenerating effects of the skin patch, that would not be the case." "She really has no scar today." "And I would have predicted more scar on her face if we would have used the standard treatment." "Thanks to 21st Century medicine's ability to regenerate life," "Catherine's radiant smile is shining again." "It's my whole world, my whole being, my whole ability to go out and face the world and go back to work as quickly as I did, be able to function as quickly as I did to be able to sit her on the boat," "it's all because of the technology." "Early success with growing skin for burn patients like Catherine O'Leary has led scientists to explore the possibility of growing even thicker tissues in the laboratory, tissues as thick as human cartilage." "The pain from torn, damaged and dead cartilage is a curse to a young athlete like Morgan Montgomery." "Morgan suffers osteochronditis, a wearing down of his cartilage." "But after four knee operations, only temporary relief was in sight." "He began riding a bike to help his cartilage and liked it so much, he began cycling competitively." "But his knee was still a problem, and not getting better." "He pedaled on despite the pain." "Then he learned about a procedure that could replace his cartilage, a procedure that could get him back on track and put him in the race for a spot on the US Olympic Team." "Oh, this feels great." "That, my one problem, feels just like a normal knee." "Last year, Morgan underwent a Carticel cartilage replacement procedure." "Healthy cartilage cells from his good knee were grown and multiplied in a lab, and then reinserted into his damaged knee." "If I hadn't had this Carticel procedure, I wouldn't be doing this right now." "There's no way." "Number 125, Morgan Montgomery." "Number 1 14..." "Today, Morgan's racing in the EDS Cup, a national race in his home state of Minnesota." "If he wins, he'll be another step closer to making the Olympic Team." "They're off!" "120 laps, 30 kilometers." "We count number one, two and three points race." "Meanwhile in North Carolina," "Kevin Ketchie is about to have the same procedure Morgan had." "Ever since the 28 year-old tore the cartilage in his left knee playing basketball, he can only sit on the sidelines and watch." "Sometimes, that hurts almost as much as his knee." "I can pretty much keep my mind off of it if I stay away from here, you know?" "Just don't think about it too much." "But you can tell when I came in here, it was kind of hard for me to just kind of sit around." "I still want to be out there, so..." "But Kevin hasn't taken a shot since the night his knee gave out." "I finished playing that game actually." "Did pretty well." "Went home and the next morning I knew that I had really done something to it at that point." "Kevin faces a daily reminder of that night every morning when he goes to work." "I have a hard time at work just because of the fact that working at old Courthouse, doesn't have an elevator." "And my office is on the third floor, which, I really don't have a hard time getting up the stairs to the office." "Coming downstairs takes a little longer just because of the way the knee moves." "It could be a prediction of what lies ahead, a lifetime of pain." "Doctors told Kevin that sooner or later he would have to have the knee replaced with a mechanical one." "More than 200,000 knee replacements are performed every year." "And they work great, except for one catch." "Kevin's mother is a nurse." "And she told him that if he got a new knee at 28, he would need another one at 43." "That was enough for Kevin." "If my mother wasn't a nurse, I probably would have went ahead and had the procedure done here in town with the first physician l went to." "But she thought it was better through all of her experience to go ahead and get a second opinion." "So Kevin headed down the road from his home in Greensboro to Duke University in Durham, North Carolina." "He sought the advice or orthopedic surgeon Doctor Larry Higgins." "Instead of a knee replacement, Doctor Higgins told Kevin that he could have a Carticel cartilage implant." "This procedure isn't for everyone." "It's clear." "It has very limited indications." "This is not a treatment for arthritis." "This is a treatment for someone who has loss of cartilage in a focal area on the femur bone and has an intact, that the remainder of the knee ligaments and the remainder of the cartilage ligaments are intact." "The first step was to remove healthy cartilage cells from Kevin's right knee, the one he hadn't injured." "The cells were shipped to Genzyme Tissue Repair in Cambridge, Massachusetts and injected with growth nutrients, a sort of fertilizer for human cells." "To repair Kevin's knee," "Doctor Higgins will need 12 million healthy cartilage cells." "Along with the basketball." "Just a month later, the new cells for Kevin's knees are ready." "So Kevin and his mom return to Duke, where Kevin sees them bringing in his restored cartilage." "I think I saw them bring the cells in, in the box a while ago." "Saw a guy coming in with a box that had Carticel written on the side of it." "And my mom, of course, was like, "There's your stuff."" "At this time, doctors can't use the minimally invasive arthroscopic approach to replace cartilage." "So once Kevin is in the operating room," "Doctor Higgins wraps his leg in an elastic bandage." "And that will allow us to minimize our blood loss and allow us to implant the cartilage in a bloodless field, which is the ideal growing conditions for the new cartilage we're going to implant." "Doctor Higgins can now open up Kevin's knee and look directly at the joint." "And this here is normal cartilage." "This nice, white, shiny cartilage here is all normal cartilage." "And that's what we like to see when we look in the knee of someone who's Kevin's age." "This here is a big cartilage defect." "And that is what's causing the discomfort that he's having and his inability to participate in sports." "The cartilage cells taken from Kevin's right knee are ready to be injected into his left." "And these are Kevin's cells, all suspended in the fluid there." "And we're going to take these and then I'm going to slowly inject Kevin's cells into the little patch that we made for him." "All Doctor Higgins has to do now is close up Kevin's knee." "And this is the final stitch we're going to put in." "And that is the patch with the cells in it." "And we'll let that sit for a few more minutes." "And that's the end." "And because the local anesthetic was used," "Kevin hears the results of his surgery while still on the operating table." "Okay?" "Kevin, everything went great." "lmplantation went perfect." "So, good news." "That's good news for Kevin and for thousands of people who injure the cartilage in their knees every year." "He'll be on crutches for about ten weeks, then start rehab." "By a year, he'll be released to full activities, playing one-on-one basketball, being able to compete at whatever level he wants to compete at." "And that's really the purpose for doing this procedure." "So how's the knee feeling?" "Oh, it feels great." "If Kevin had any doubts about the operation, all he has to do is look at cyclist Morgan Montgomery." "Thanks to 21st Century medicine's ability to regrow cartilage," "Morgan is not only back in the race, he's winning." "Very close. I would say, Montgomery!" "Nice race." "Morgan Montgomery is once again pointing towards the Olympics, something that wouldn't be possible without the Carticel implant." "From growing healthy cartilage and restoring dreams, doctors move to an even greater challenge growing actual body parts." "We've seen how cartilage can be harvested from a healthy knee, grown in a laboratory and used to heal an injured one." "But can doctors take that one step farther?" "Can 21st Century medicine actually regenerate the human skeleton?" "Can we grow bones?" "Sarah Whiteley takes pictures of bones for a living." "She's a radiographer." "But a simple fall while walking through the park near her home in Wakefield, England turned her into a patient with a bone fracture that wouldn't heal." "She landed on her back and left shoulder, and felt something crack." "It was her collarbone." "And it was a silly accident, really." "Nothing exciting." "I was walking through the park." "It was raining." "I slipped on wet leaves. I had my arms full of shopping." "I didn't have the sense to drop what I was carrying." "So I landed on the back of my shoulder and broke my collarbone." "Because of where the bone fractured, it wouldn't heal." "So doctors installed a plate to help it along." "But after a few weeks, the plate worked itself out of position." "A second surgery failed." "A third surgery used a bone graft taken from Sarah's hip to keep the plate in place." "Once again, the plate worked itself out of place in a matter of weeks." "A silly accident had become a far more serious problem." "Sarah was in so much pain that she couldn't even make a cup of tea." "It was a big problem." "Even down to every-day things like making a cup of tea, housework, even going out to work." "By lunchtime I was in an awful lot of pain." "Right down the back of my shoulder blade, across my collarbone, up into my neck." "I couldn't move my arm to do anything." "So it was becoming a major problem, something that had to be dealt with." "Can I see the other side as well?" "Let me see this." "The surgeon who performed Sarah's third operation," "Doctor Simon Lambert, soon learned that her collarbone wouldn't heal using conventional methods." "It was like trying to glue a leg onto a table, then resting the table on the leg that was just set." "The bond simply didn't have time to take." "And down the back of your hands." "So Doctor Lambert decided that Sarah's shoulder needed two things." "The first was a new type of plate with a hook to hold the broken bone segments together more securely." "The second was an experimental putty." "We were running out of options at that point." "If I wanted to go back to work and carry on leading a normal life, we had to find something that was going to work and work quickly." "The putty was a synthetic material called osteogenic protein one, or OP-1 ." "Tests had shown that it helps broken bones grow together." "And Doctor Lambert said it was Sarah's last chance." "If bone can heal, OP-1 will make it heal." "The putty is used then to fill and modeled to look like the host bone." "And we then hope that it then induces bone formation from the host." "That's the important thing." "It doesn't actually produce bone in the putty." "It induces bone formation in the host bone, which then should meet across the putty." "OP-1 works as a sort of bridge between two broken bones." "Within the putty is a morphogenetic protein, the same protein that stimulates broken bones to regrow." "OP-1 is still considered experimental, but has been used on approximately 500 patients." "OP-1 could eliminate the need for bone grafts." "Right now, bone grafts are taken from other parts of the body, which can be very painful." "Grafts are also taken from cadavers." "But this procedure heightens the risk of rejection." "OP-1 could also help Sarah." "What happened in this particular instance, and we've used OP-1 specifically in this case, because at the end of her collarbone in that position there, there was a fracture which had failed to unite." "And after standard treatment of plates, screws and her own bone graft, it had still failed to unite." "And rather than take her own bone again, which would have had OP-1 in it, her own OP-1 , we decided to use exogenous OP-1" "and give her a slightly more stable construct and use the OP-1 to induce local bone formation." "But Sarah wasn't so sure." "The first few weeks after her collarbone was joined with OP-1 were no better than the weeks after the three previous operations." "It wasn't the miracle cure I was expecting." "Progress was very, very slow." "And there were times when I thought I had made a big mistake." "Today, Sarah is having her shoulder examined." "Sarah has said her shoulder has felt better lately, and her doctors are beginning to see results." "Sarah spends her life looking at X-rays." "And when she sees hers, she is convinced." "The OP-1 is working." "So I think you are achieving the status quo, finally." "Yeah?" "Yeah" "Five months." "I'm so pleased." "Even Doctor Lambert was surprised by how much the OP-1 had helped Sarah's bone heal." "Sarah has, in fact, formed what appears radiologically to be normal bone in the gap where there was previously no bone and failure to unite a fracture." "So, so far, there has been union." "The OP-1 even induced bone growth in the old holes where the screws for the plates were inserted." "Without OP-1 and its power to join bones," "Sarah may never have been able to raise her arm above her head, and she certainly would have faced a lifetime of chronic pain." "After four operations, she is finally on her way to full recovery." "Take care." "Have a nice Christmas." "And you, too." "And as I say, a good New Year." "OP-1 is the first material that can graft bones together." "It is also being used to fuse spines and to secure jawbones." "Doctor Lambert believes that 21st Century medicine could eliminate the need for bone grafts." "And broken bones won't necessarily mean weeks or months in a cast." "At the moment, we have simply a bone induction agent." "What would be good is to have a bone conduction agent, bone grows across it or through a matrix, in a way that actually reproduces woven bone very quickly." "And that's where l think we're going to see the big advance in the 21st Century." "And OP-1 is at the beginning of that." "One person he won't have to convince is Sarah Whiteley." "Hopefully from this point forward, I mean, we have very good bone growth at the moment." "It's progressing a lot better than it did to begin with." "The fracture is stable." "It's healing nicely." "It'll probably take another three months for it to heal completely." "And once that's healed, they'll take the metal plate out so there won't be any problem with my shoulders or..." "Regrowing bones wasn't the first thing on Doctor Joseph Vacanti's mind when he decided to get into tissue engineering." "The field didn't even exist." "Eventually he would grow bones and much more." "But in his younger years as a pediatric transplant surgeon at Childrens Hospital in Boston, all he knew was the children he saw were dying." "And he wanted to do something about it." "When I completed my training and the problem of organ shortage became my problem, then I decided, well, maybe the main thing to do is just make organs, and then we wouldn't have to rely on a supply that would never meet the need." "And so with those beginnings in the 1980's with my good friend" "Professor Langer, we began down a road to try to understand what the problems might be and then go on to try to actually design and build a whole organ." "A pretty lofty goal." "But his colleague, Bob Langer, an mit chemical engineer, was no ordinary professor." "And his specialty was building dissolvable plastic structures that harmlessly go away after giving new cells a place to grow, or as they are called in the world of tissue engineering, biodegradable polymer scaffolds." "Soon, they were on to something." "But what actually propelled them forward didn't come from a lab." "It came from the sea." "It was 1986, and Doctor Vacanti, or "Jay" as his friends call him, was on vacation in Cape Cod." "He had never stopped pondering about how to build a liver." "As he sat on the jetty watching his family play, he saw some seaweed." "A major breakthrough in tissue engineering was about to happen." "I could see seaweed waving through the water." "As the water moved, so did the seaweed." "And so, it struck me that the seaweed was answering that question." "Doctor Vacanti's question was how to keep alive and grow the cells of tissue like cartilage, or eventually livers." "The answer was the porous shape of the seaweed." "lts shape allowed nutrients to reach a large number of cells both deep within and on the surface." "The branches of seaweed were the key." "The fundamental repeating unit in nature for all living systems that are multicellular are branching systems." "Like seaweed." "Doctor Vacanti immediately phoned Professor Langer, and they began working on a dissolvable structure that would look and act like the seaweed, branching out and supporting life." "Before long, they were seeding their dissolvable plastic scaffolds with living cells." "This did exactly as the seaweed in the water did and it allowed the fluids to percolate through it and keep much larger, thicker masses of cells alive while they formed new tissue and laid down their own matrix." "When they put these cell factories into bodies, blood vessels would grow into them, providing even more support." "And eventually the plastic or polymer scaffolds would harmlessly go away." "Soon, Doctor Vacanti's brother, Doctor Charles Vacanti, an anesthesiologist, joined the team." "Earlier in his career Charles says he witnessed a patient die from a tumor on his windpipe, and knows it could be a different story today." "If this patient walked into our institution today, we have the science and the ability to resect that particular segment of windpipe and that tumor and then to replace it with a tissue-engineered windpipe." "By the early 1990's, the Vacantis and Professor Langer were growing cartilage." "It was significant research." "But at the time, few people were paying attention." "So they decided to grow something needing cartilage that no one had been able to create, an ear." "So we decided to, we talked to a plastic surgeon, a Doctor Upton at the Beth Israel Hospital, and he said that the gold standard for a plastic surgeon was to try to recreate the shape of a human ear." "He said with all the technology that plastic surgeons had access to today, they still were not able to do that." "So we said, "Let's sit down and generate cartilage in the shape of a human ear."" "Charles and Doctor Upton needed help creating the mold that would dissolve harmlessly." "When we'd start, we'd have the peptide solution and we'd have water, okay?" "So they solicited the help of Doctor Linda Griffith, an mit chemical engineer, who had come to Boston to work in the lab with Charles' brother Joseph and Professor Langer." "And Charles had done this really fabulous work showing that you could combine cartilage cells with a polymer and get a piece of tissue to form, but lacked the ability to make that polymer in a specific shape." "So they called me because they knew that I knew something about polymer processing." "ln 1992, they presented their ear to the world, on the back of this mouse." "They had taken another step towards realizing a dream of growing needed parts and organs." "But the Vacantis work didn't stop here." "ln 1998, Charles helped a 36 year-old machinist named Raul Mercia avoid living with a lifelong deformity by regrowing a thumb." "And he was a laborer and working with industrial machine had chopped off the end of this thumb." "Once again, the inspiration for an innovative solution would come from the depths of the sea." "We've actually used three materials from the sea." "The first is the seaweed for structure." "Second, coincidentally, the hydrogels that we use when we make a minimally invasive such as an injectable tissue is derived chemically from seaweed." "And third, when we made the thumb implant for Mister Mercia, the base of the scaffolding was coral, which was derived from the sea and then injected with this seaweed derivative referred to as alginic acid containing his own bone cells." "Specially treated coral was used because it's very porous and would provide a nice template for bone growth." "It's chemically very close to the matrix of bone." "So the chemical content of coral is very similar to the chemical content of bone, minus the living cells." "Over time, this coral would break down naturally." "Full regeneration takes 16 weeks." "Week one makes sure there is no rejection." "At week ten, immature bone growth can already be seen." "During week 12 to 14, there's new, mature bone growth." "And finally by week 16, ligaments and tendons are reattached, giving Raul Mercia almost normal use of his thumb." "He can lift very heavy objects and it's fixed in this position." "But it works exceedingly well." "Fortunately, he can now give the procedure a thumb's up." "He was very happy." "Joseph Vacanti will tell you, there are many approaches for regenerating organs." "If you visit Doctor Lola Reid's lab at the University of North Carolina," "Chapel Hill, you'll find yet another possibility for the future of regenerating livers." "You'll know the setup." "Would you please get out one of the bags of the human cells?" "The Vacantis are not the only ones trying to eliminate the need for liver transplants." "Doctor Lola Reid hopes to eliminate the need for most liver transplants in a different way, with non-invasive liver cell therapy." "She believes she can do this by growing livers right in her lab." "I want you to realize that there are special cells within the organ called stem cells, which are cells that are like seeds that can, in fact, flourish and grow and form the whole organ." "Reid is a scientist at the University of North Carolina, Chapel Hill." "She and her associates are the first to figure out how to purify these stem cells in bulk and use them to regenerate a liver." "With help from researchers at Albert Einstein College of Medicine in New York, they have shown that these cells can form liver tissue." "These cells would also be available whenever they are needed, something that could end up helping millions of people with liver damage, including a young girl named Maria Luisa Lujan in New Mexico." "I want to meet N Sync." "The only sign that Maria is sick is the slight yellowing of her eyes and face." "They are reminders of her rare liver disease." "Doctors first thought Maria had neonatal jaundice, which is common in newborns." "It usually repairs itself after the baby is placed under ultraviolet lights." "But Maria never improved." "She was later diagnosed with Crigler-Najjar Syndrome." "Her liver doesn't properly excrete wastes or bilirubin." "Maria is one of only 150 people in the world with the disease." "Because of it, this 13 year-old girl was not expected to see her 25th birthday." "Maria says she never worries about her illness." "But the same cannot be said of her father." "Unless we find a cure, we don't know how long we'll have her." "But there's a lot of other parents, at least 150 that I know of, that have children that do the same thing we do, care for their children and take the best care of them they can." "That includes turning on Maria's UV lights every night, a much larger version of the bill lights that doctors first put Maria under when she was a baby." "The heat from the lamps helps her sweat out the bilirubin her liver cannot eliminate." "Without the lights, Maria could have brain damage and might eventually die." "Maria has never known life any other way." "But her father says having a daughter who has to spend every night under these giant lights can take its toll on a family." "It's a devastating disease in more ways than one, you know?" "It really takes it toll on the body and the person and the people in the family." "Like I say, you just can't get up and go on vacation, can't go camping for two, three days." "We haven't had a vacation since she was three years old." "We just can't do it." "Before Maria becomes an adult, she will need a liver transplant." "That will make her one of nearly 14,000 Americans waiting for a new liver." "But there will be only 4500 livers available." "Odds that trouble Maria's father." "She's my little girl." "She's the only one." "She's my only daughter." "And I guess it's just the fatherly instinct to want to do more for your daughter." "Lujan searched the internet and found Doctor Ira Fox at the University of Nebraska." "Fox was one of a handful of surgeons using adult liver cells harvested from cadavers to regenerate the livers of patients like Maria's." "But the new method still had the same, old problem, not enough livers and too many people who needed them." "Finally, after two years of waiting," "Maria's liver was infused with seven point five billion healthy liver cells." "The treatment worked." "And Maria can now go as long as two nights in a row without sleeping under the lamps." "At least she had rosy cheeks, you know?" "And she looked really, really good." "Her liver bilirubin level is the lowest they had ever been in her life." "So we knew that it was, there was some hope and there was something working." "But Maria had to wait two years for her cell infusion, something that patients in the future may not have to do." "Doctor Reid hopes to overcome the liver shortage by taking the cells of one liver and giving them to perhaps hundreds of patients." "That means that we would be able to stockpile the cells in a tissue bank and be able to ship them at any time." "So she wouldn't have to wait in the future, if we make use of the progenitor cell therapy." "Only the young cells, the progenitor cells, can regenerate." "And therefore they hold the key to turning a damaged liver into a normal one." "Doctor Reid shoots the progenitor cells with a laser beam, which colors them and makes them easy to identify." "And then there's a computer associated with it that can be told to take all the cells of a given color, let's say a yellow and orange ones, and put them into a particular test tube." "And they will vibrate the solution to go to that test tube." "Finally, the cells are frozen with liquid nitrogen." "Because we will be able to store these cells frozen, it means that we can have lots of different types of donors with marker studies done on them." "And therefore we can match precisely a set of cells that would go into a given patient." "The regenerated liver would have another advantage over the current treatment." "Despite her progress, Maria still needs to take immunosuppressant drugs three times a day." "Doctor Reid says this, too, will be eliminated in the 21st Century." "So that means that that patient would basically be able to have a normal liver, normal function, within a couple of weeks." "Let me just cast it in." "The cell infusion has helped." "But Maria has not been cured." "The cells from the adult liver will not live forever." "But because the process is so new, no one knows exactly how long they will last." "If Maria's health is threatened by rising bilirubin levels," "Dr. Reid's cell therapy is her greatest hope." "It means Maria wouldn't have to wait for a donor." "She wouldn't need immunosuppressant drugs, and her family would never have to worry about her bilirubin levels again." "It's going to revolutionize all of transplant surgery." "It, indeed, what it's going to happen is that many of the transplant surgery that's done today will not be done in the future." "We've a lot of homework." "Doctor Reid predicts that the liver will be the first organ recreated in the lab to reach patients." "But that will be only the beginning." "The liver is going to be the first organ that is going to be done for cell therapy." "But we think that all of the organs are going to be treated in this way in the future." "More than 40,000 people a year suffer second degree burns." "But to see Catherine O'Leary's face, you'd never know she is one of them." "Morgan Montgomery continues to train for the Olympics, and rarely thinks about his knee or the lab-grown cartilage inside it." "And Kevin Ketchie can look forward to an active life free from pain." "But even the 21st Century procedures they underwent may soon be outdated." "So instead of having to go through a biopsy, and then having his own cells expanded and then additional surgeries to go and have his knee opened up and the cells themselves injected into the defect, we would have a readily available cartilage" "that is physiological human cartilage, acts like, feels like cartilage, to be able to insert into his knee in one minimally invasive procedure." "Every day that Sarah Whiteley moves her left arm without pain, she is reminded of the wonders of 21st Century medicine." "But the Vacanti's are working on projects that even in the 21st Century seem too spectacular to believe." "Joseph Vacanti hopes to grow an artery inside a human heart, and then an entire heart." "Charles, his brother, is convinced that nothing is out of reach." "I believe that if we harvest the appropriate cells and put them back into this tissue, into the correct environment with some type of architecture, that we will be able to generate new brain or spinal tissue." "Skin and bones, cartilage and organs, even hearts, brains and spinal cords, all created in the laboratory." "Testament to 21st Century medicine's ability to regenerate life." "The New Testament of the Bible promises a day when the blind will see, when the lame will walk, when the mute will speak" "Once, that promise was a matter of faith." "But today it is also a matter of medical science." "What were once considered miracles, will soon be known as 21st Century medicine." "They're all part of bionic breakthroughs." "20 years ago, the Bionic Man was merely science fiction." "But thanks to 21st Century medicine's use of high tech materials, high-speed computers, and high concept cures, he is now simply science." "And he will cost a lot less than six million dollars." "Today, a college basketball player competes with a prosthetic leg." "A track star runs the 1 00-meter dash faster with an artificial foot, than when he had two healthy ones." "A man who hasn't seen a thing for 1 7 years, may see his wife's face for the first time." "And a little girl uses her motorized hand every bit as well as the hand she was born with." "We'll be able to get you back in just a minute." "The first day of school is just a week away and Ashley Perry is doing what a million other kids do, going to the doctor for a checkup." "Ashley is in perfect health, but she's having a problem." "Good afternoon." "Hi, Mike." "Her arm is wearing out." "Ashley was born without a left hand." "When she was in the womb, the umbilical cord wrapped around her forearm and kept the limb from growing." "Until the moment she born, Mike and Lisa Perry had no idea there was anything wrong with their baby girl." "Is your hand working Ashley?" "When I pulled Ashley out, I immediately noticed something was wrong." "And you could also see it in the medical staff." "Only a few days later the Perrys' got news, that in some ways was even worse." "Their doctor told them that when their little girl as old enough, maybe 12, she could be fitted with the best prosthesis available." "A hook" "There's no way I'm putting that on my child." "I mean, I don't care, you know, what I have to do, how much I have to pay, you're going to get something that will fit her and that she will be normal." "So the Perrys took Ashley to Duke University in Durham, North Carolina and prosthetist, Mike Schuch." "Duke was known for its advances in myoelectric arms." "A myoelectric arm uses the muscles in the forearm to send minute electrical signals to a motorized hand." "What the Perrys didn't know, was Duke had joined forces with Mike Tompkins, founder of Animated Prosthetics in nearby Greensboro." "Tompkins is a pioneer in myoelectrics that use high tech computers and high port motors." "When Ashley was just six months old, she was outfitted with a prosthetic arm." "For a long time, she didn't even realize her two arms were different." "And then one time she did ask, was it going to grow?" "Okay, I want to sing." "A year later, Ashley was fitted with her first myoelectric arm." "A computer inside the arm deciphered the movements in Ashley's forearm." "This let her move her hand with an almost natural precision." "She first started really using it, and you could see she would use it without really thinking about it just actually reaching and picking up a toy." "That really felt good." "Only today, everyone is feeling a little frustrated because Ashley's hand won't do what she tells it to." "Can you open and close for me?" "Squeeze me." "Yeah, just no grip at all." "Ashley wears out hands because she uses them so much." "An adult with a prosthetic hand typically uses it about 1 500 times a day." "Ashley opens and closes her hand twice that much." "Once every 20 seconds." "Even the doctors were surprised by how much Ashley uses her hand." "But the real surprise, is that until Tompkins started designing prosthetics, doctors and technicians had no idea how many times people used their hands at all." "When I got into this field I used to ask people the same thing, what is normal?" "And the answers I used to get were 700 is normal." "A thousand was normal." "And I didn't know." "So Tompkins built his..." "21st Century myoelectric arm with two computers." "One controls the movements of the hand, and the other computer, the outboard computer, tells doctors and technicians how the hand is being used." "The second computer gives us the ability to look inside the arm while the patient's wearing it without any restrictions, and view everything that's happening." "Thanks to the precision of the computer, the latest generation of myoelectrics has all the strength of a human hand." "And it is sensitive enough to pick up something fragile without so much as a crack" "And, it lets Ashley do just about anything any six-year-old can." "She can swing on a swing." "She can dress her Barbie." "She can even thread a needle." "Here we go." "Ashley is so good with her hand because the hand is set up specifically for her." "Technicians can set the hand's computer to match Ashley's strength." "And if Ashley has a problem with her arm, they can tell if she or the arm is causing it." "That's a big change from the way prosthesis used to work" "The system is fine tuned both for her open and closing to allow her variable speed and grip that exactly matches what she's able to do." "In the old days, they would have had one setting, and if she didn't adapt to that, then she wouldn't be very good with the product." "And then we turn that around and say," ""No, don't make the patient adapt to us, we'll adapt to them."" "It's field trip day for the first graders at Perry Harrison Elementary." "Ashley and her class are taking a trip to the county fair." "So we're going to stand double in line, two by two." "It's a day for petting animals and riding rides and learning about what grows from the ground." "Ashley's teacher, Kari Whiteley, knew she would have a student with an artificial limb in her class, but on her very first day she found out exactly what that meant." "I was real nervous the first day of school." "She was out at recess and her arm fell off." "So Ashley calmly walked in from the playground, and just like she does every morning, put her arm back on." "As sophisticated as the inner workings are, a prosthetic arm still has a tough time keeping up with a six-year-old on a swing set." "There are still limitations." "Ashley can only move her thumb and forefinger." "Researchers at Rutgers University are working on a hand that moves the thumb and all four fingers." "But it will be well into the 21st Century before that becomes available." "Not because they can't build a hand with five fingers that can move, but because they can't build a hand that knows when to move." "In order for us to take the hand to the next level and give it more capabilities, more finger movement, we need to get more information from the patient." "To get a hand that does this requires a lot more technology than we have available today." "Ashley's hand is not silent." "But that's no accident." "The sound tells her it's working." "And that masked the other problem with prosthetic hands." "Unless the patient can see them or hear them working, there's really no way to tell if they are." "Schuch says there's no way to tell how hard a hand is squeezing something." "The only type of feedback that these people have is visual." "So when they pick something up, they don't know whether they're squeezing it and distorting it, or if they've got a strong enough grip to hold it." "And I use the example of getting eggs out of the refrigerator while you're talking to somebody in your kitchen." "How do you know whether you're going to crush that egg or not?" "While prosthetists would love to make a hand with sensory feedback, that won't be easy." "Again, because the myoelectric link between patient and prosthetic simply isn't strong enough." "Tompkins says that the next generation of prosthetic hands may actually have to connect inside the wearer's natural arm." "Researchers at Stanford University are trying to do just that, surgically place electrodes directly on the nerves." "That way the wearer can send better signals to the hand, and the hand can send signals to the patient." "That's just one of the improvements that Ashley... and others can look forward to." "There'll be new battery technology that will be smaller and lighter." "New materials and plastic composites will be used in the hand design, so it will be more functional and weigh less." "Lighter hands with fingers and joints that move." "Sensors that can tell hot from cold." "They may be a few years away." "But as Ashley matures, so will prosthetic technology." "So what does the little girl who doctors said would have to wear a hook want to be when she grows up?" "Right now, she wants to be an artist." "She wants to work, with her hands." "What she's got now is fantastic, but when she's a teenager it's going to be even more advanced." "She's going to have a really good future in front of her." "In the 21st Century, medicine will use the computer to come up with even more bionic breakthroughs." "For one man the computer could hold the gift of vision itself." "The first time Harry Woehrle visited an ophthalmologist was 37 years ago." "He still remembers what the doctor told him, word for word." "Mr. Woehrle, you have retinitis pigmentosa." "And you'll, you know, you're probably going to go blind, which I was 35 years old at that time, which was kind of a stunner." "And he was right." "The 200,000 Americans like Harry Woehrle who have retinitis pigmentosa, or RP, are totally blind." "Most can't make out even a hint of light." "The disease deadens the eye's rods and cones." "That means light coming into the eye is cut off before it gets to the optic nerve, and therefore never reaches the brain." "There is no treatment." "There is no cure." "And until now there was little chance that would change." "Okay, I'm going to dim my lights." "Doctors at Johns Hopkins University's Wilmer Eye Institute, are trying to restore hope for patients with RP." "They are working on an idea that even just a few years ago was little more than science fiction." "Doctors will try to let Harry Woehrle see again by replacing his damaged eyes with a computer chip." "The two big revolutions that have occurred in the past 50 years, are microelectronics and medical knowledge." "The only thing that hasn't quite happened yet, is the integration of both." "That integration is called the Multiple Unit Artificial Retina Chip Set, or MARC System." "The project is spearheaded by doctors, Mark Humayun and Eugene de Juan." "Here's how doctors think it will work" "A tiny camera is placed on a pair of glasses." "This sends an image to a decoder, which transmits a wireless signal to a computer chip, actually implanted in the eye." "The chip then sends a pattern of light, shadow and color to a tiny piece of plastic called an electrode array." "So what this electrode array will do is jumpstart these remaining cells, retinal cells." "And then this information will be transmitted via the nerve to the brain." "And the idea is that the patient will then begin... to see some sort of useful vision from this." "A 21st Century melding of microelectronics and medical knowledge." "But there is a reason the two have not joined forces before." "They don't get along." "You know, biological fluids are toxic and damaging to microelectronics." "Microelectronics' heat dissipation, corrosion from the metal electrodes, is damaging to the biological tissue." "In other words, chips are bad for eyes, and eyes are bad for chips." "And this can't be just any chip." "This chip needs to be small enough to fit into a human eye." "It can't give off enough heat to damage the eye, and it has to be hardy enough to handle all the bumps and bruises a person can encounter." "Who could come up with such a chip?" "Everybody said, you know, if anybody can do the engineering of this chip and device, it's Wen-Tai Liu." "Wen-Tai Liu is a computer scientist at North Carolina State University." "For the last 12 years, he and his staff have worked closely with Humayun and De Juan on developing a computer chip that will take the place of a human retina." "But when they first came to him with the idea, he couldn't believe it either." "I thought it a big challenge." "And a little bit kind of science fiction." "The eyesight, it seems, is a gift that the God or creator give to the human and how I was going to fool around with that." "To recreate God's handiwork, Liu and his team have spent the last dozen years developing a chip that meets all the requirements." "Liu and Ph.D. candidate, Chris DeMarco, started small, building a chip with a just a three by three grid of electrodes." "Meaning a person's field of vision would be divided into nine segments." "After a dozen years, the North Carolina State computer scientists have worked up to a ten by ten pattern, or 1 00 segments." "So clearly a ten by ten chip won't add up to 20/ 20 vision." "Ten by ten sized image, you could probably tell that someone is in front of you, but maybe not enough to tell who this person is." "A patient with this chip might see an image which is similar to what you would see sometimes on television news as a criminal is escorted and his identity's hidden by fuzzifying his face." "While everyone agrees that more electrodes are needed, no one has any real idea how many it will take before fuzzy, becomes clear." "Because for all the medical science and computer wizardry that has gone into the development of the chip, there is still one unknown." "Still one wildcard that doctors hope will help them in their quest to make the blind see." "These electrodes are wired to probably the most complicated and most able computer of all time, the human brain." "That's why, for the last two years," "Harry Woehrle has come to the Wilmer Eye Institute, to gauge the project's long term effects." "Right now, he is little more than a lab rat." "In return, he will be one of the first people in the world to receive the MARC chip." "Hey, Mr. Woehrle." "He'll do whatever the doctors ask because of the woman sitting in the corner." "Harry married Carol about a year and a half ago." "He has never seen her." "See, I need a chip so that I can see her." "Well, I tell you, you won't be disappointed." "The chip probably, you know, in the early stages wouldn't do justice to her, so." "Oh, I see." "They're both waiting for the day when Harry leaves the operating room, puts on his glasses, looks through the camera and can look up at her face for the first time." "I am going to get myself all gussied up." "I'm going to look as good as I can look that day, that's for sure." "About the closest Harry has come to seeing was the day" "Dr. Humayun placed a probe into his eye." "The probe was a sort of a temporary chip that told doctors that light was indeed reaching Harry's optic nerve." "I saw light." "I saw shapes." "They say, "Now, tell us when you see something."" "And I say, "Now!" "Now!" "Now!"" "It was the first thing Harry Woehrle had seen in 1 7 years." "The fact that Harry and others have seen light and shapes, may not seem like much." "But it assured the doctors that the MARC System can actually work" "It was thought that RP damaged the entire retina." "But Humayun and de Juan have discovered that that is not the case." "It turns out about 80 percent of those nerves are working." "And the only nerves that are gone are the photoreceptors." "So, Humayun and de Juan were right." "The computer chip can bypass the dead receptors and stimulate the cells behind the rods and cones." "What the probe test proved, was that thanks to the computer chip," "Harry, and others with RP, will see again." "One of the best moments of my life was when the first patient who was completely blind was able to see again." "See only a dot of light, but yet see again." "And that moment was truly, makes up for all those long nights and all the times where I thought that this project was not possible." "The retinal chip system could be ready as early as 2001." "And it could signal the beginning of a partnership between microelectronics and medical science." "And, if successful, it will provide hope for curing other diseases that are currently untreatable." "But will the future arrive in time for Harry?" "After 1 7 years of darkness, will he see again?" "Am I going to see again?" "You better believe it!" "I don't know how much I'll see, but I'm going to see something." "One of the things that makes us human, is our ability to communicate." "But imagine if you lost that ability." "Imagine never being able to tell someone what you were thinking or feeling." "And then imagine a bionic breakthrough that gave you that power." "Lori Campbell was valedictorian of her high school class." "Now she's a junior in college." "When she graduates she wants to work for a newspaper or a magazine." "That's not the future many people had predicted for Lori." "I had had people tell me, "You know, well, you'll just have to put her, this child in a home somewhere, because she'll never be able to even get around on her own."" "Lori was deprived of oxygen during birth." "She has lived with cerebral palsy ever since." "She grew up here, amid the oil fields and the cow pastures of Slocum, a not very wide spot on an East Texas farmhold." "She couldn't speak, she couldn't walk" "She couldn't even feed herself." "But everyone knew there was something special about Lori." "But you could just tell, you could look at Lori and you knew." "You could see the light in her eyes, that there was something there that, gosh, she just wanted to tell you so bad." "Unfortunately, Lori could produce sounds that only her mother could understand." "That's why she ended up at the Callier Center for Communication Disorders in Dallas." "And with speech pathologist, Delva Culp." "As a very young child she had very limited motor abilities." "You could see in her eyes and in anything you said to her, she understood complicated humor, complicated explanations." "You could see her brilliance behind her body." "To let that brilliance shine through, Culp had to devise a 21st Century augmentative communications system." "A system that would use machines to produce what Lori could not." "Culp's first step was to get Lori proficient with a picture board." "Slowly, Lori began to form sentences by pointing to pictures." "Lori spent the next five years working with more sophisticated boards." "Until Culp decided she was finally ready to use the most sophisticated communication tool of all" "I never dreamed from that point that she would go to a computer." "You know, it's like, we're out here, we're not in Dallas and we don't see a lot of technology." "But seeing, was believing." "And as Lori became more adept at typing, people could finally find out what she was thinking." "And it was just amazing that she could type in a whole sentence and it would read it back" "And when she had that first voice, and she could say, I don't like that." "You know, "I don't want to eat that", or "I don't want to go with you", or "I'm not ready to go to sleep" it was just like, there really is a person there." "Lori would type letters into the keyboard and with the press of a button, the computer would convert her words to sounds." "But there was a problem with the first voice synthesizers." "They had only one voice quality, robot." "The voice sounded so computerized and so male, that Lori didn't want to use it." "But as the technology improved, so did her outlook" "It was as if a whole new world had been opened up to me." "I really didn't know how much the laptop was going to expand my communication abilities to the outside world." "I was able to talk to my Mom and my teachers like never before." "As she got her voice and she could express herself, I think people saw a whole different side of Lori." "And then as she progressed through high school, and people realized that she really was a very intelligent young lady." "So intelligent that she was the top student at Slocum High School" "That Fall she enrolled at Stephen F. Austin State University in Nacogdoches." "Lori is a junior now, majoring in English." "She is as much on her own as any of the other students away from home for the first time." "And because she's so far from Dallas, she almost never gets to see the person who's helped her get here." "This is a long drive, it's a good four hour drive." "And so I didn't see her for months, couple times, years at a time." "But on those rare occasions when Delva and Lori do meet, the years and the distance are erased." "Hey, how are you doing?" "Hey you!" "All right." "Let's go inside." "Their meetings are a chance for Culp to check on one of her patients." "But they are also a chance for two friends to catch up." "You're 21 now." "You get to vote." "How do you feel about the presidential candidates?" "And Lori has already made up her mind." "Bush all the way." "Bush all the way!" "All right." "Good Texas girl." "Lori is well known around campus." "Not just because she's the only student who communicates through a computer and a set of speakers, but because of her outgoing personality and edgy sense of humor." "If brains were gunpowder you wouldn't have enough to blow your nose." "Lori knows that without her computer and the humanity it provides, she might be back in Slocum." "She might be housebound." "She might even be institutionalized." "I won't be able to be here..." "at college, that is for sure." "I won't be outgoing and happy." "My world would be in more frustrations than I could imagine at this moment." "My system is like a part of me and my world would be turned upside down if I end it." "But with it, Lori motors through her world like any other college student." "She is at college." "She's independent." "She manages her own business." "She manages her own course work" "But basically, she is an independent young woman." "And that's what we all strive for, for our kids." "That's what we all want to be ourselves as we're growing up, and this does allow her the ability to do that." "Lori does need help getting ready in the morning." "She needs help eating." "She needs other students to take notes for her in class." "But when it comes to college, she is in a class by herself." "Lori has become a good writer." "A precise writer, because she's had to be." "After all, she has only one tool with which to communicate." "Her words." "She is a real overachiever." "Linda White teaches Lori's literature class." "She gave her class a series of assignments early in the semester." "But Lori couldn't bring herself to do just what was required." "Most students were doing two pages, Lori's would be five pages." "And she even asked me once, "Am I doing too much?"" "And I said, "Yes, yes, you can do a little bit less."" "One day Lori hopes to write her autobiography." "Her story is the story of augmentative communication itself." "As we begin the 21st Century, two advances could help Lori even more." "One system would let Lori simply look at letters on a computer screen, instead of forcing her to type on a keyboard." "But such a system would have to be mobile and impervious to changes in light." "Neither advancement has taken place." "The other is a voice decoder that could translate Lori's speech." "But for that to work, Lori would have to mispronounce her words the same way every time." "She can't do that." "Lori, on the other hand, dreams of a day when technology can bypass her body all together, and get right to her brilliance." "I would love to see a system to be developed that had the capability of reading minds and showing what I was thinking on the screen." "It would make life so much easier and communication less of a struggle." "Thanks to her 21st Century medicine, Lori Campbell is inspiring people and changing their minds, one keystroke at a time." "People have the tendency to think just because I have cerebral palsy and a wheelchair and do not have perfect speech," "I don't have thoughts rolling through my head all the time." "21st Century medicine is using the computer to replace the hands and eyes, even speech." "The computer is also being used to give something else, mobility." "While computerized knees will be common in the 21st Century, only a half dozen Americans are walking around on one now." "The C Leg represents the future of computer driven servo powered prosthetic knees." "The, C, stands for computer." "Here's how it works." "50 times a second, a microprocessor measures the angle of the knee, how fast it's moving, whether it's slowing down or speeding up." "And it measures the forces in the mechanical ankle below." "The computer then opens and closes valves, that let fluid into the knee to make it more rigid or more flexible." "All this technology lets the wearer go down stairs and keeps him from falling if he stumbles." "But today, prosthetist, Todd Anderson, and John Angelico, are trying to take the C Leg one step farther." "Walter's the first person at this amputation level to be fitted with a C Leg." "So we're all here to learn." "Unlike every other C Leg user, Walter Kreiseder isn't just missing half his leg." "He's missing all of his right leg and half his pelvis." "A near fatal tumor forced doctors to remove them ten years ago." "Walter didn't plan on making medical history." "But he runs a company with 1 700 employees and his old prosthesis simply went on strike." "My knee was failing, and it was failing very quickly." "So Walter had no choice but to become the first hemipelvectomy to use a C Leg." "Or at least try to be." "There is one problem." "The C Leg is not designed for so severe an amputee." "We really have to try to figure out what that hemipelvectomy gate is actually doing, so we can apply it the software of the knee." "While the knee's computer calculates the force Walter puts on it," "Anderson and Angelico read what's going on through an outboard computer." "They can then program the C Leg's computer right on the spot." "Because we're actually programming the knee to fit you." "We're not trying to get you to fit the knee." "We're programming the knee to fit..." "your style." "The first few steps are difficult." "eah, it feels like I'm being pushed." "More stiffness?" "No, no, looser." "Okay, practice with that a little bit." "Okay." "As the hours pass, the adjustments proceed." "And under the watchful eyes of Anderson and Angelico," "Walter Kreiseder is learning to walk again." "It's working very smooth, working very accurate." "I have to get used to it." "And as I'm working with it, which has only been perhaps an hour, hour and a half," "I'm starting to get used to it already." "The knee also lets him apply pressure when he sits down without fear of falling." "Something Walter hasn't felt since he had two legs." "It will take Walter a while to be completely comfortable with his C Leg, but Anderson is thrilled." "In just one afternoon, and after a few dozen adjustments, it's obvious that even severe amputees will be able to use the power of the computer." "In prosthetic terms, it's huge, it's huge." "Like all hemipelvectomy patients, Walter can't walk without help." "But there is a chance that with the C Leg he'll be able to throw down his canes." "A lot of that will be up to Walter himself and how much confidence he develops in the prosthesis." "Our goal is to help him walk with more confidence." "And help him focus on the journey, rather than on how he's moving through the journey." "Good looking guy, huh?" "The computer isn't the only tool that 21st Century medicine is using to develop bionic breakthroughs." "Strides are also being made in space age materials and advanced designs that one day could make prosthetics as good as the original equipment." "...number 12, Mike Edwards!" "Mike Edwards is not one of the best college basketball players in America." "In fact, these were the only two points he scored all last season." "What's amazing is that he's a college basketball player at all." "Mike is the first player in the history of college athletics to play a high profile sport like basketball at a high profile place like Notre Dame, with a prosthesis." "But amputees like Mike have a saying," ""It's not the leg attached to the person it's the person attached to leg."" "I live my life everyday knowing that this is what I have." "So, and you adjust." "If I would have had to do it all over again, would I have two legs?" "No, no, uh-huh." "Having one leg is what makes Mike Edwards who he is?" "Mike was born with only one bone below the knee in his right leg, instead of two." "Because there was no fibula, the larger tibia had nothing to grow against and began to curve." "Mike wore a brace until he was 13." "But then he made the decision." "He would have doctors amputate the lower half of his right leg." "He made the decision." "He knew that whatever came of it, he was going to have to live with it." "But he had to do that himself." "As Mike was ready to start his senior year in high school, his father," "Lieutenant Colonel Michael Edwards, was appointed head of Notre Dame's ROTC department." "Mike figured, new town, new chance." "So he went out for basketball at South Bend's Adam's High." "Of course, coach Pat King was interested in a six, three senior transferring from Kansas, despite the catch." "They said, "Oh, by the way," and they kind of whispered, they said" ""He's got an artificial leg."" "Only Mike didn't tell anybody he had an artificial leg." "He told people he had a knee injury." "Mike hid his handicap so he could be just one more kid trying to make the team." "Well, I always knew that I wanted to play." "And I didn't know if I'd be accepted as everyone." "Or I'd be treated differently." "Mike was accepted." "He made the squad." "And he helped South Bend Adams win Indiana's sectional championship." "That's the team after winning the title." "And yes, that's Mike's leg being raised in victory." "Now Mike is competing on a much larger scale." "Playing for the Fighting Irish has made him something of a celebrity on campus and around the country." "But Mike's spot on the team is anything but guaranteed." "He's a walk-on." "And at Notre Dame, walk-ons have to try out every year." "Mike hopes he will be able to do more once he gets a prosthetic leg designed just for basketball." "Right now, he wears the same leg on the court and in class." "And it isn't perfect for either." "His foot is angled for basketball so he can move more quickly." "But that forces him to walk on his toes all the time." "The new leg will give him even more bounce for basketball, and his everyday leg can be aligned so he can walk normally." "What does Mike want out of his basketball leg?" "Everything." "I hope it gives me increased mobility." "I hope there's some spring in it." "I hope it's lightweight." "He wants it to hold up better." "I break legs every other day." "And he wants a leg that doesn't hurt when he runs." "Comfortable, definitely more comfortable." "Before he can get a new leg..." "Michael Edwards." "...doctors at Chicago's Shriner's Children's Hospital, have to examine his old one." "And what they see is troubling." "The young man's leg is showing its age." "You feel like you're not getting all the way down into it?" "No, and even when I do get all the way down it, it's very painful to the bottom of it, because..." "The reason is simple." "Prosthetic legs aren't designed to take on the Indiana Hoosiers." "The stress, coupled with Mike's do it yourself maintenance... has sent the leg out of alignment." "Yeah, when you walk, your knee, as you step down, it, you get a little bit of a bow there." "Go once more." "The examination proves that Mike needs a leg just for basketball." "It will be designed by prosthetist, John Angelico." "And the Edwards can't wait to see it." "I don't know exactly what John's..." "got in mind, but based on what he's done in the past," "I can only imagine it's going to be a real piece of work" "What Angelico has in mind is a prosthetic that mimics the human foot almost perfectly." "Its simple, effective design will give Mike more of what he needs from his leg, spring." "You turn it upside down, all of a sudden it looks like a diving board." "Someone runs up here, pushes down and it springs down, and then they're able to jump off it." "It's the exact same thing with the foot." "They come down and it springs off to the next step." "While the foot will provide spring, the leg needs to provide stability." "And it will have to withstand the pressure of a 200-pound basketball player coming down on it after a dunk" "So Angelico will have the factory build the leg around a vertical shock pylon, an aluminum alloy shock absorber." "A device called a leaf spring will absorb even more energy." "So when you jump up and you come down, there's not going to be as much trauma on your limb." "Right now, every time you come down, your whole limb feels it." "And some of it is going to be dispersed on this leaf spring on the side." "Of course, shock pylons and leaf springs come with a price." "They will make the new leg heavier than the one Mike already has." "He hoped it would be lighter." "And for a kid who told people his artificial leg was just a knee injury, there's another problem." "Before you even put a cover on, we've increased this to about almost an inch wider." "You're going to get more comfort, and better function." "And in return you're going to give up the cosmetic appearance of this." "You're going to need to make the decision." "Do they go with the new foot, or stay with the type of leg Mike is already wearing?" "Both father and son realize the new leg will take some getting used to." "He's obviously going to have to make some adjustments, with the way he runs and the way he exercises and the way he plays basketball." "But remembering how basketball has damaged his leg," "Mike has only one choice." "If I need a piston, then I'm going to get a piston." "And if it weighs more than it does, then I'm still going to play." "So, that's just the sum of things that you have to deal with." "As sophisticated as the foot is, it will return only about 95 percent of the energy that Mike sends to it." "The human foot, on the other hand, returns three times that much." "So what improvements are ahead in the 21st Century?" "The next basketball player with a prosthesis, may have it actually implanted into his leg." "The pylon may be connected right to the bones." "And it could be covered with his own skin." "Angelico says there will be a day when computer driven motors and servos can make an artificial leg as responsive as a human one." "But all the 21st Century medicine in the world won't mean a thing unless the patient has Mike Edwards' determination." "My father and I were sitting down on the couch one day, and I was like, "Man, what if I had been born with two legs?"" "And he said, "You know what, Mike, this is what you have to do." "You have to think like this." "You always need to put your best foot forward."" "He said, "Since you only have one foot, what do you have to lose?"" "Mike Edwards!" "Mike Edwards' problem was congenital." "He was born essentially with one leg." "But what happens when a traumatic ccident takes the leg of an athlete?" "Is the memory of two healthy legs so overpowering that it can never be forgotten?" "Can he ever stop asking what might have been?" "Seven years ago Brian Frasure was sprinting toward his future." "He was at North Carolina State University in Raleigh on an academic scholarship." "He was going to run track in the spring." "Med. school was in his future." "But he had one vice, what they called train hopping." "We would hear the trains coming through, we'd run out to the tracks, we'd sprint along side the train and then grab on to one of the ladders off of one of the freights." "And it was just kind of this adrenaline thrill ride competition." "None of us ever thought that we would get hurt." "But the night that I was injured the train was moving very fast." "It was dark And just as I went to grab on to one of these ladders," "I slipped, my feet came up under the train and two sets of wheels ran over me." "The damage was so bad, particularly to the left foot, that there was no way they could save it." "So it resulted in amputation." "And you can imagine what it was like for an 19 year old athlete to lose his leg." "In my mind, having my foot taken away...was the worst possible thing that could happen." "I felt like I would just rather be dead than to have to deal with something like this." "That's how negative I was at the time." "But then Brian saw this." "A track meet featuring amputees." "And I saw that they ran well, they ran fast." "They didn't limp." "And that's when I decided to start training again." "Now Brian trains three hours a day, six days a week, just a few hundred yards from the very spot where he lost his leg." "In October, Brian became the fastest amputee who has ever lived, when he broke the record for the 1 00 meter dash during a meet in Australia." "He can actually run faster now than when he had two legs." "But he doesn't want to just set records." "No." "Brian Frasure wants to make history." "The big hype in amputee sports now is who can be the first amputee to run a hundred meters in under 1 1 seconds." "Because then we're getting into times that are actually world class speed for one leg or two legs." "And I'm only 1 00th of a second away from that." "Brian runs so smoothly, that as you watch him train, you'd never guess he is any different than the other people on the track" "But then his workout gets serious." "Well this is really what I call an all terrain leg." "Because I can do just about anything in it." "But then for something like sprinting, we need to get a little bit more specific." "Specifically this is the Sprint Flex Three." "The latest generation of sprinting leg." "It's composed of laminated carbon fibers." "The same material that makes up Indy race cars." "The fibers are stronger and lighter than steel." "The foot forces Brian to run on his toe, because it doesn't have a heel to fall back on." "It even has track spikes built right in." "But people look at it and think, "Oh, how do you run on that?"" "And then I run on it, and they're like," ""Oh, okay, that's how you run on that."" "Since he has only needed a prosthesis for the last seven years, all Brian has ever run on is carbon fiber." "His competitors, however, tell him about running on legs made of steel." "Of running on wooden feet." "They say it was like trying to sprint in a ski boot." "Nothing like this." "As medicine develops even more advanced prosthesis, made out of even more sophisticated materials, it is not impossible that an artificial leg might actually become an advantage." "Especially for a double amputee who wouldn't have to worry about balancing his artificial leg with his natural one." "Brian is a prosthetist himself and he knows his field is not there yet." "But he also admits that if he were able bodied, he might not want to run against 21st Century medicine." "I've thought about that and to me I think I would get in there... and say, "hey, you can't run, because that prosthesis is making you faster."" "Because there are no rules to deal with that, that would be a very interesting scenario." "Before the accident, Brian could run the 1 00, in about 1 1.3 seconds." "But now he's right on the cusp of breaking 1 1 flat." "That's right." "Brian is faster with one leg, than with two." "Something that even he finds hard to believe." "If somebody would have told me seven years ago when I had my foot amputated that" "I would be running faster now than I was at that period of my life," "I would have told them they were crazy." "I think that just goes to show you what pure determination and faith and good technology, when you put all those things together, miracles can happen." "Thanks to the miracles of 21st Century medicine, the people we've met can touch, see, speak, walk, jump and run." "Since this television show began," "Ashley Perry has opened and closed her hand 1 80 times." "Harry and Carol Woehrle wake up every morning one day closer to the day he might see her." "Lori Campbell's computer was down for several days after we visited with her." "Days that reminded her how precious her bionic breakthrough is." "While his custom made leg helped, there was no spot on the team for Mike Edwards this year." "He says, "Don't worry." "He'll make it next year."" "And Brian Frasure is gearing up for the next track season." "A season when he promises the 1 1 second barrier will fall." "Have we reached the day when the blind will see, the lame will walk, and the mute will speak?" "Not as the Bible foretold it." "But 21st Century medicine has made believers out of at least six people." "Miniaturized TV cameras voyaging deep into the body revealing sources of pain." "Surgery requiring no stitches." "Robot arms, powerful as video game warriors, repairing dying hearts." "Infrared wands targeting a cancerous mass of fast-growing tumors." "lnnovations today only beginning to reveal the promise of tomorrow." "Next on Operating ln The Future." "Even in the hands of the best doctors, the body takes a beating during traditional surgery." "But as we turn the corner into the new century, surgeons are revolutionizing the ways they operate." "They're making smaller incisions, using computers and cameras to illuminate anatomy's secrets, and practicing surgery via remote stations from across the room or across the world." "This prescription mixes raw high tech, healthy measures of knowledge and vision and a large dose of compassion." "Because medicine always comes back to helping a person." "A person with a problem." "A person like Cliff Boag." "It's always there. 95 percent of the time, it's there." "Cliff is a 40-year-old father of three." "For the last five years, he's lived with a stabbing, stubborn pain in his groin." "Mysterious from the beginning, the pain overshadows Cliff's life." "We have three children, you know, we have a life ahead of us." "We can't let this, you can't live on pain medication." "The pain, caused by simple activities like walking, lifting a child, or sitting too long, is most severe on the lower left side, just below the belt." "Desperate for help, Cliff saw an assortment of specialists." "Most had no answers." "One suggested exploratory surgery for a hernia." "But even after doctors opened him up, found a hernia, and fixed it, the pain didn't leave." "Finally, Cliff was referred to Doctor James Rosser, otherwise known as Butch, or "The Big Boss."" "A doctor with a new idea." "He put me at ease, you know, more than any other doctor I've ever met." "But he said "Don't worry, you know, this thing can run but it can't hide." "We'll get in there and set this thing off and figure it out."" "I heard that he was a wizard." "You know, his hands don't look like they would do the job." "They're just too big." "People look at me, they wonder, you know, how this guy, especially a big old guy like me with ham hocks for hands, how does this guy do those delicate things?" "How does he do it?" "Butch Rosser is totally at home inside the human body and knows its anatomy inside and out." "He has another advantage." "He's applied his love for radio controlled airplanes to his surgical technique." "Flying these airplanes calls for extraordinary two-handed hand-eye coordination, a skill needed by a surgeon with one foot in the future." "Butch's vision of the future was inspired by another love, science fiction." "It all started with the television shows of his childhood." "The two shows that inspired me the most were Star Trek and The Jetsons." "And I think, just like a lot of people that were touched in interesting ways by that show, we want to accelerate the future." "Hermes?" "Talk to me, goose." "Butch doesn't have a Star Trek tricorder yet, or a C-3PO, but he does have a trusty sidekick named Hermes." "Hermes is a voice-activated, computer-driven surgical assistant." "Awry." "Hermes, insufflator." "Doctor Rosser takes Hermes for a test flight before Cliff's surgery." "Hermes helps control the CO2 doctors will use to inflate or insufflate Cliff's belly, creating room for the camera and instruments." "Hermes helps with the camera shots, zooming in for close ups, adjusting light, and rolling tape for the surgical staff." "So I bring in the probe, and..." "Though trained in traditional surgery," "Butch was an early proponent of laparoscopic techniques, operating through small tubes while using a tiny camera for viewing inside the body." "So we're going to use our miniaturized instruments to be able to go in while he's awake and let him help me find out what's going on." "It's like Jerry Maguire." "Help me help you." "Oh, I can't wait. I can't wait for him to be able to come home and say "You know what?" "I don't feel this pain." "You know, I feel normal again."" "While Kelly looks forward to Cliff's recovery," "Butch and the team prepare for surgery, and Cliff waits." "I'm nervous." "Talked to the anesthesiologist and I got the lowdown." "And it's not going to be fun for me." "That's because it's going to hurt." "It's all part of pain mapping, a new approach developed by Doctor Rosser and his copilot for the day, Doctor Lloyd Saberski, a neurosurgeon." "Saberski had the idea of tracking down pain by viewing nerves inside the patient's body while he or she is awake." "The doctors will be making incisions smaller than Cliff's thumbnails, sticking long instruments into his belly, and directly touching the nerve." "Their mission is to fire up the pain and identify the nerve causing it." "Cliff's mission is to tell them when they've hit the nerve." "Then, they'll put him under and freeze the nerve and quiet it." "Cliff should remain pain-free for several months." "This is a different technique." "So we can take the patient on a fantastic voyage and through their abdomen and they can help us." "And we're going to try to look at those nerves." "Before making the first incision," "Butch numbs the area with local anesthesia." "But remember, Cliff is fully conscious, just slightly sedated to make him more comfortable and calm." "Okay, let's have a little knife." "Do you feel this, my friend, at all?" "I don't feel anything." "Oh, you don't feel anything." "Okay." "Now, the one thing, traditional laparoscopy involves a scope that's about a half-inch." "This is two millimeters." "So you only need a little bitty cut here." "Just a little one." "That's it." "That's it." "Now, let's see our scope." "Because this scope, and I need to check it, look how small this scope is, and it's very fragile." "It's time to engage Hermes." "Hermes, Awry. lnsufflator." "Hermes starts to work, inflating Cliff's stomach." "Down." "Down." "Hermes, light source." "Activate." "Activated." "Okay, we're on the fantastic voyage." "We're going through the tunnel now." "All right, we're open and free." "All right, this is looking good." "Brighter." "Hermes." "Light source." "Light source." "Brighter." "Brighter." "Brighter." "Brighter." "Okay, hang in there." "I have to find a safe place to land." "Are you with me, Mister Boag?" "Okay, look at there." "That is the inguinal region." "That is our target." "We got a great view." "Okay, here we go." "Here, we're going to go." "Tell me when you feel that pain." "The doctors couldn't do this without Cliff." "No, down." "None of that's hurting you?" "Well, it hurts, but I'm..." "But is it the pain?" "That's what I need. ls it the pain?" "Am I reproducing your pain?" "They work against the clock." "...not near it." "Several minutes later, with Cliff's help, the surgeons believes they've found the source of Cliff's pain..." "How are things right now, Phil?" "It's a sharp pain." "Yeah?" "You're having a sharp pain?" "Yes, right there." "...all while manipulating tiny tools they can't see without the help of a television monitor." "Let's go ahead and put him to sleep, okay?" "Once Cliff is under, the doctors are ready for the next step in the process, the temporary freezing of the genital branch of the femoral nerve." "Rosser works gingerly." "Surgeons call this area of the body "the triangle of doom."" "One wrong move can lead to impotence or paralysis of Cliff's legs." "Using another probe, Doctor Saberski will freeze the troublesome nerve with liquid carbon dioxide." "The frozen nerve will revive in a few months." "But if pain returns," "Doctor Rosser, hoping for a permanent solution, will clip the nerve." "Now, look at that." "That's that nerve." "The pointer is right on the nerve." "Right on the nerve." "That's our target." "I'm convinced that's the genital branch." "All right, zoom in, please." "Okay, engage." "Put him in the center, please." "And see this ice ball forming?" "We're going to freeze that nerve." "Now he's withdrawing the probe." "She's following him out." "The lower probe is out." "All right." "No bleeding." "All right, big guy. lt's time to go home." "Even Hermes has something to say." "Hermes, controls." "Compliment." "You are such a great surgeon." "You are such a great OR staff." "All right, bravo!" "We're out of here." "Smaller is the key to the future." "Hey, you did great, big guy." "You were great!" "Okay?" "I don't remember." "You don't remember, that's great." "Let's see how he's doing." "How you doing, big guy?" "Thank you. I feel good." "You were, can l give you a little hug?" "You know, he..." "We heard you were a hugger." "He was great, though." "He's only been out like 45 minutes." "You can't even see the incisions." "And no stitches." "Real teeny tiny, no stitches?" "Yeah, because this is a modern day miracle." "Cliff is on his way home." "Pain mapping, the procedure doctors Rosser and Saberski use to uncover the source of Cliff Boag's pain, is only possible because of advances in minimally invasive techniques and tools." "But even though minimally invasive surgery is becoming more mainstream, not every doctor finds the new tools easy to use." "I think the guys and women that grew up with the Nintendo games are much better at this than guys my age." "When Joseph Hahn became a surgeon in the 70's, it was a different era." "He was trained to make big incisions, incisions that not only allowed him to see what he was fixing, but to get his hands on it, too." "And so, if you were having a liver operation, for example, or a colon operation, you would have in incision that literally would start from your breastbone and go all the way down to your pelvic bone." "But Hahn wondered if such large incisions were always necessary." "Seeing the trauma people went through, the complications that occur, the sort of massive incisions that were going on, it seemed to make just a lot of sense to me to try and minimize trauma." "He wasn't alone." "Today, scopes, the basic tool of minimally invasive surgery, are used routinely everywhere in the body." "The reproductive system, the abdomen, the joints, the chest, even the ducts inside the breasts." "Though they have different names, each is about the same." "Hollow rods called canulas are inserted into small incisions." "The rods provide pathways for both miniature television cameras used by surgeons to look inside and for instruments used to make repairs." "Eyes on, not hands on." "Here at the Cleveland Clinic," "Hahn is a major advocate for new, improved surgical techniques." "The surgeons who work under him are on the leading edge of the learning curve as they develop new procedures." "They're even using scopes to remove major organs of the body." "Doctor lnderbir Gill, a colleague of Doctor Hahn's, is a kidney specialist and an expert on minimally invasive technique." "...how things were in there." "Well, you put the laparoscope in there and all of a sudden, those little things that, you know, were just swept out of the way, now are real entities." "Doctors perform between nine and 10,000 kidney transplants a year, using live donors for about 4,000 of them." "Traditional harvesting requires a large incision and is very invasive for the donor." "Doctor Gill is perfecting a significantly less invasive method for harvesting kidneys." "Using this innovative approach, Doctor Gill locates the kidney with a laparoscope." "Next, he separates the kidney from the body." "He makes the final incision, the one he'll use to remove the kidney, as small as possible in this case, it still has to be large enough to fit his hand." "This little incision is truly within the bikini area, and we are not going to be cutting any muscle whatsoever." "This creates the potential for the healthy donor to have a quick and easy recovery." "Today, this technique is offered at four or five centers in the United States, including the Cleveland Clinic." "Tomorrow, as doctors receive the appropriate training, the procedure should become widely available." "The reason we are doing this is laparoscopy affords us unmatched visualization." "It's hard for people to understand this, that you can obviously see better with your two eyes than with a little laparoscope." "I think the converse is true." "The magnification and the visualization that the laparoscope gives us in unparalleled." "ln the future, what is now minimal will become miniature." "A forerunner of this new generation of even smaller devices is an instrument being tested by a breast surgeon, and another member of Doctor Hahn's team, Doctor Jill Dietz." "This is the camera that goes to the ductoscope." "21st Century breakthroughs won't be limited to operating rooms or biomedical laboratories." "The scope Dietz is using was born in Hollywood." "A group of movie producers created a miniature camera to look inside very small places." "With the help of Doctor Dietz, they're developing an even smaller model called the ductoscope, to diagnose breast disease, particularly breast cancer." "It's a 1 .2-millimeter scope, smaller than, say, uncooked spaghetti noodles." "Until now, no one has ever been able to see inside the breast this clearly." "While still experimental, this procedure recently received FDA approval, and Doctor Dietz is the first surgeon anywhere to use it." "Going to get your vital signs and..." "Julie Willett, a nurse at the Cleveland Clinic, agreed to be part of the scope's trial." "I thought it would help benefit patients down the road and help fight cancer." "And another reason, because I thought it would be a less invasive kind of a procedure for me." "There'd be less cutting involved, because they have this little scope with a little camera at the end of it, and she could go in and clearly see the mass and take it out." "So I saw it as a winning type situation for me." "ln 1996, one out of every nine women got breast cancer." "And the risk keeps on increasing." "The scope creates the potential to spot cancer early enough to save lives." "We've entered the milk duct." "And you can see the light that comes from the end of the camera shining through the skin, deep within the breast." "A light that illuminates the minute camera, allowing Dietz clear vision, a window into the interior of the breast." "Women that are at high risk for breast cancer, currently there is no good screening method that'll catch breast cancer when it's extremely early." "It's not a cure for cancer, but it certainly is going to help diagnose cancer, and also help fight cancer in the early stages." "ln my situation, mine was non-cancerous, but she was able to take the mass out, whereas if it had been left in there, who knows what could have happened down the road." "Dietz hopes the scope will add to the arsenal of effective screening tools doctors use to fight against breast cancer." "She's inspired by the rapid advances of the 21st Century." "Again, it's just taking us to giving people the best treatment they have with a less amount of surgery, a less amount of complications, a less amount, you know, less pain, less recovery time." "So it's an exciting time right now." "Using smaller scopes and operating in tighter spaces inside the body requires steady hands, hands as steady as a robot's." "Again, the sort of concept of the OR of the future is there would be some robotic devices." "And we're also looking at doing this for heart bypass surgery, where you'd sew the coronary arteries to the heart arteries using the robotic arm." "The operating room of the future, where robotic arms are used to repair damaged hearts, is becoming a reality." "This futuristic OR is manned by a 34-year-old, soccer-playing surgeon," "Volkmar Falk, and his visionary mentor, professor Friedrich Mohr." "They live in Leipzig, Germany, where soccer, not heart surgery, is the usual focus." "And they work at this ultramodern medical center, the Leipzig Herzzentrum, dedicated exclusively to taking care of the heart." "This state-of-the-art operating suite is where many of their ground-breaking minimally invasive heart surgeries take place." "Surgeons around the world repair almost a million diseased hearts a year." "Until now, open heart surgery usually required cracking open the sternum and prying open the chest." "But in Leipzig, doctors are able to operate through three small incisions, each about the size of a dime." "The whole heart center is very high tech." "Nevertheless, we felt our limits, especially in endoscopic surgery." "We felt that there is a limitation, we can't do very precise coronary work endoscopically, and so we thought, about two years ago, how can we overcome that?" "Professor Mohr made medical history last year, by overcoming those limits and performing the world's first totally videoscopic mitral valve repair." "He used this American-made robot-like system." "Actually, it's not a robot, though it looks like it was made for the bridge of the Starship Enterprise." "It's really a tele-manipulation system." "As the surgeon sits at a console, he guides robot-like arms attached to tiny, computer-enhanced mechanical wrists." "The wrists reach deep inside the patient." "There's one small catch." "The console and the surgeon are not in the operating room." "Psychology, it's something completely new, because you're no longer at the table, and so as a surgeon, you used to be sterile and to be able for immediate action." "Now, you're at the remote location, so you're six meters away from patient, and that changes a lot, in terms of your attitude." "The procedure is still being perfected, but it's a risk patients like Dieter Schaller are willing to take." "The former race car driver knows that his surgeon, Volkmar Falk, has logged more surgeries using this system than anyone in the world." "He also understands how traumatic traditional open heart surgery can be." "So he says that he thought about it quite a bit and then he came to the decision that a smaller hole in the body, basically, would mean that the healing process goes faster, and that made up his final decision to choose the less traumatic approach." "Mister Schaller realizes the minimally invasive surgery has additional risks." "Doctors must stop his heart and place him on a heart-lung machine for hours." "All he has to say is that he hopes tomorrow is a great day, for both him and the team and that his health is well after surgery." "His surgery will take approximately four hours, more than double the time of a traditional approach." "It will require some of the most sophisticated operating tools ever created, tools still classified as experimental." "We're going to see a bypass procedure today, a total endoscopic bypass procedure." "And we will take down the left internal mammary artery, and that's the artery that runs along the sternum, and that will be used as a graft." "And we will graft the left interior descending artery, which is the main coronary artery, to the left heart." "Mister Schaller is a candidate for this surgery because he has only one blocked artery." "For now, if more vessels needed repair, his doctors couldn't use this system." "Though Volkmar operates from another room, there is still a full surgical team in the OR, including another skillful surgeon." "But unlike open chest heart surgery, only Volkmar can hold and move the instruments inside Mister Schaller's body." "Dependent on the robotic arms, he's still one hand short." "A lot of steps you usually wouldn't think about in surgery require that an assistant hold something." "It's like a mountain climber." "You need three points of fixation, usually, to not fall down." "And the same is true in surgery." "If you hold soft tissue with three fixation points, then you can do an easy stitch." "Here, we have only two hands, so I basically have one hand to hold something, one hand to do the stitch." "And you will see later that this is more difficult, so you have to find ways to circumvent this problem." "The surgeon inside the OR, Doctor Anno Diegeler, makes the incisions, or ports, and inserts the canulas, or hollow tubes, to hold the specialized instruments, including a tiny 3-D camera." "Volkmar's view through the goggles is magnified ten times." "Unlike two-dimensional endoscopes, it provides dazzling high resolution three-dimensional pictures." "It's a cross between working in virtual reality and operating under a microscope." "You can see that the artery is covered by fat tissue and also by muscle bundles that go across, which makes takedown a little difficult because you can't see it really and you have to first dig it out." "When you sit at the console, you're almost totally immersed." "I mean, you're inside that cavity, basically." "You don't have the feeling that there is any distance between you and what you're seeing." "It's actually right there." "Inside the console, his hands guide the instrument handles." "As he works, his motions are translated to the robotic arms and tiny instruments inside Mr. Schaller's body." "Precision is critical in such a potentially dangerous operation." "Making the slightest slip is not an option." "So even if Volkmar has an extra cup of coffee, the system makes adjustments." "As you can see, the system is not shaking." "Even if I would be shaky, the system wouldn't transmit those fast motions." "And actually, that's a very helpful tool, because if you watch conventional endoscopy, you have a one-to-one transmission of all motions, including tremor." "And if you have a long shaft on the instrument, this will even amplify the tremor." "Volkmar can also move the camera with handles." "Pressing a foot pedal, he engages the camera while the instrument tips stay in place." "Like a race car driver, he must coordinate hand and foot movements to maneuver a demanding course." "Okay." "So I can look around, and basically, it's driven like the wheel of a car, which is very intuitive, by the way." "Much more convenient than voice control." "Don't be fooled by this magnified view." "Volkmar must control his surgical tools in a very small space." "He needs all the help the system can provide." "The robot-like arms are incredibly responsive and precise and function as mechanical extensions of Volkmar's own arms." "Attached to the mechanical arms are long, pencil-thin instruments." "And this part here couples to the electronic part, which is the motors, basically." "And the different motors actually drive those wheels." "And then, there's a lot of cabling inside the shaft." "And then, at the end, there's this articulating wrist, and this is called the endo-wrist." "And by moving those wheels, I can move the tip." "So it's a combination of very sophisticated electronics, but also it's a masterpiece of mechanics." "After freeing the artery for the graft, he must open the protective covering around the heart and look for the blocked artery." "If the doctors can't find the blocked artery, they must remove the robot-like arms and open Mister Schaller's chest." "Now I make a clip here, just to mark the area." "So this is the target vessel here." "And you can see, this is the right ventricle." "It beats differently from the left." "And here's the clip, here's the target vessel, and this is the graft." "And it should be enough, lengthwise." "So our next step would be to decide whether we try to do the procedure closed chest now." "Anno will put the patient on pump by dissecting the groin, and then put in a catheter that then can arrest the heart." "Anno." "Here I am." "Closed chest." "Okay." "With the target artery clearly in sight, the two surgeons decide to continue endoscopically." "But before they connect the open artery and bypass Mister Schaller's clogged one, they have to stop the heart." "They hope one day this won't be necessary." "One big aim of modern cardiac surgery is to get rid of the pump in as many cases as possible, which we know has some detrimental effects on the human body." "Which is a generalized inflammatory response." "Also, it affects the clotting system and a number of different things." "Also, there's a small risk of stroke associated with the use of the pump." "But right now, the endoscopic approach forces us to apply cardiopulmonary bypass in order to be able to really work endoscopically on the heart." "We have not found yet a way to do that efficiently, endoscopically beating heart procedures." "But this is really experimental stage, and it will require a couple more months, maybe years, to really develop an endoscopic beating heart procedure." "Dieter Schaller's heart is not beating." "With the heart stilled," "Volkmar sews the healthy artery in place." "He works under the watchful eyes of his mentor." "Professor Mohr understands the great potential the system offers for advancing surgical education." "One day soon, he hopes to link two consoles side by side." "One for the master and one for the student." "So if you have a trainee who starts his first case, he is sitting on the master and is doing the case, but his super master is sitting aside to him." "So if he does something wrong, he just takes over digitally and the guy sees the right step and feels the right step as his own hands, because it's transferred to the instruments." "His goal is to improve the learning curve while providing the patient with the best possible care." "I think it's an okay graft." "So I think we have the right treatment, hopefully." "The grafted artery is tested." "Fortunately, the blood flows smoothly through it and into the heart." "The surgery is a success." "But it has taken five hours, because the surgeons are inventing a new way to operate." "You have to redefine the operation completely, because there's multiple steps you don't even think about usually." "There are just motions you make that are beyond your conscience, which now become a real problem again." "And then there's no textbook written on this surgery yet, so you have to figure out all the problems yourself." "The doctors expect Mister Schaller to do very well." "They were able to complete the operation without splitting open his chest." "And thanks to the small incisions, they expect him to heal quickly." "Each time Volkmar and Professor Mohr operate using the system, they are one step closer towards realizing their goal, making this novel heart surgery the standard." "Stepping through the doors of time, we've seen how surgeons searching for pain view nerves inside the body." "We've discovered how 21st Century surgical technology is bringing hope to doctors working to defeat cancer, and how heart surgeons are saving lives without making gaping incisions." "What groundbreaking methods will doctors use when they operate on the final frontier, our vital master control center, the brain?" "Daddy." "Mama." "John Duncan hopes surgeons can save his life." "Their 21st Century tools aren't small scopes." "They are an infrared wand and a chemotherapy wafer." "31 is right down this hall." "When you get inside the room, you'll hand this to the person at the desk, okay?" "The 34-year-old father of two suffers from a particularly vicious form of brain cancer." "This is a tumor that started someplace else and went..." "Today, doctors will open John Duncan's skull for the second time." "The first surgery diagnosed the cancer." "Now, despite weeks of intensive radiation therapy, the tumor has grown." "It has already affected the strength of his right arm and leg." "This is really a terrible type of tumor to have." "Gene Barnett is John Duncan's surgeon." "If we don't get this under control, this tumor will progressively disable him and eventually take his life, probably in the order of months to a year or two." "I went after my radiation thinking they was, after my checkup and everything, thinking they was going to tell me everything was okay," "and it's like he hit me in the face with a ton of bricks when he told me that." "That just, you almost lose hope, you know?" "It's just mental, really mental." "While there's no possibility today's operation will cure the cancer," "John and his doctors need to buy time." "They hope the malignant tumor can be reigned in until new advances can be made." "I think a lot of cancer patients lose it, you know, mentally." "They can't, I mean, because it's stressful." "A lot of people can't handle it mentally, you know, and that's hard to take." "You know, you be thinking, it's almost like when somebody gives you cancer, they give you a death sentence, you know?" "You're wondering how long." "You know, how long l have, you know." "You just don't know." "If this area..." "John's counting on new computerized equipment to give him back his life." "This equipment, the Stereotactic Navigational System, will create a detailed road map for doctors when they enter his brain." "This device over here contains four infrared light-emitting diodes, which produce, to us, invisible beams of light that are then detected by a tracking camera." "It can determine to within a fraction of a millimeter where any of these LEDs are in space." "Markers pasted on Mister Duncan's smooth scalp are signposts for infrared light." "While doctors operate, the markers give the navigational system the precise location of John's head in space." "Scissors." "The 3-D MRls on the computer monitor help answer questions." "How does the outside, his skull, relate to what's inside, his brain?" "How deep should the scalpels go?" "Where does cancerous tissue end and healthy tissue begin?" "Doctor Barnett and his team open John's brain with a previously-created flap." "Our plan then is to go in and, as much as possible, remove this orange and red area that we're seeing on the display, which represents the most aggressive form of the tumor, and then close him back up and then hopefully he'll be no worse" "for having undergone this." "Doctor Barnett has reached the surgical site." "...supposed to look like." "This is decidedly abnormal." "Yeah, that's the tumor that we're looking at." "Doctor's remove the core of Mister Duncan's tumor." "Over and over, they check their position with the navigational system's wand." "...that what I am seeing really is the edge of the tumor." "And so far, that is indeed the case." "And so far, I'm pretty pleased with what I see." "After the life-threatening malignant tissue is removed, doctors prepare for the next step." "They attempt to stop the growth of more cancerous tissue by implanting biodegradable chemotherapy wafers." "Doctor Barnett precisely arranges the wafers where the cancer cells are beginning to invade the rest of the brain." "I think we may only be able to get five of these in here." "The hope is that the wafers, releasing their chemotherapy, will slowly eat away diseased tissue while sparing healthy tissue." "The wafers and the cellulose mesh that hold them in place will dissolve within the next several months, leaving behind a full dose of toxins in the tumor bed." "Now, doctors put Mister Duncan's skull back together, using a biological glue not unlike household epoxy." "Two agents applied together create a seal that will secure the bone in place." "Surgery's all done." "You're just waking up." "Doctor Barnett won't know if the surgery is successful until John wakes up." "If too much brain tissue was removed," "John could be paralyzed on his right side." "He waits anxiously in the recovery room." "Wiggle your toe, John." "Good, good." "Wiggle your right foot, John." "Can you wiggle your right foot, John?" "Wiggle both feet." "Wiggle both real good." "Can you try squeezing your right hand for me?" "All right." "Push away." "All right, good." "And once again, John, wiggle your feet for me." "Real big, both sides." "Right side, too." "There you go." "Excellent." "Okay, good." "Before surgery, the tumor made it difficult for John to move his right hand." "Even if the surgery is successful, he won't regain its use immediately." "But he is able to move his right foot right now, which I think is very good." "Clearly, it's weaker than the left." "Doctor Barnett will continue to follow John Duncan's progress." "He hopes to find that the cancer has retreated, or at least that the core of the tumor has not grown back." "John, how you doing?" "Okay." "Can you wiggle your feet for me?" "Oh, great." "Look at those toes go." "Excellent." "All right, try and push me away here, with your arm." "Good, good." "Not bad." "Not bad." "Excellent." "Relax here for a second, if you can." "ln 1999, we still don't know how to cure this type of tumor." "We have treatments that we're hoping that, in the next few years, will translate into some effective treatment for these tumors and to help bridge these people using today's techniques to tomorrow's techniques." "I want you to know that we're all done." "He's doing fine." "John will have to wait about six weeks before he knows if his surgery has worked." "Doctor Barnett hopes the new navigational system and the road map it created have preserved John's speech and motion." "He and John keep their fingers crossed that the surgery and chemotherapy will hold the tumor back." "If the surgery and chemotherapy don't work," "John and Doctor Barnett have other options." "One of them, the gamma knife, sounds like science fiction." "But it's been around since the 60's." "...around for quite a while." "There are new technologies that are under development that will probably one day supersede what we're able to do with the gamma knife, but for now, it remains a very accurate way of providing the ultimate in non-invasive neurosurgery." "Many people think of the gamma knife as being an X-ray laser." "Actually, it operates more like a magnifying glass for X-rays, in the sense that you have 201 beams of gamma rays that are precisely channeled so that they all converge at a single point." "And what this allows us to do is to truly, in a non-invasive fashion, destroy tissue deep inside the head." "Doctors and technicians can set the machine to pinpoint abnormalities and spare healthy tissue." "But there is still a slight risk, depending on the site of the tumor, that significant brain damage may result." "A newer tool, the CyberKnife, the next generation of radiosurgery machines, also destroys the growth of unhealthy tissue with X-rays." "The CyberKnife isn't a Jedi weapon out of Star Wars." "It's based on something out of GM." "This is an industrial robot that's used for putting cars together, welding doors on your Saturn, if you will." "This is one of only six in the world." "A small X-ray generating device is attached to the robot." "It can precisely point beams of X-rays through selected targets in the patient's head." "However, this device only works for certain patients with certain conditions." "For those people, it can be used rather than traditional surgery and allow them the benefits of an operation, without going under the knife." "As we make our way into the 21st Century, doctors predict they'll soon understand cancer better and defeat the disease more frequently outside rather than inside the operating room." "The knowledge and technology are almost there." "Today we're going to go out and see Steve Gallagher, because he has a history of those intermittent wound infections." "Remember when doctors made house calls?" "Well, they're starting to again." "Nurse Lynda Gardner and Doctor Michiuori Murayama are about to bring Doctor Butch Rosser, their boss, face to face with his patient, Steve Gallagher." "Hi, Lynda." "Hey, Steve." "How you doing?" "Oh, not too bad today." "Yourself?" "Good." "But Steve will never leave his home, and Doctor Rosser will never leave his office." "This house call's in cyberspace." "The two cameras and the computer that Lynda and Michi are carrying bridge distance and dissolve borders." "With Rosser at the lead, the two are part of a revolution that could dramatically change home health care." "With the electronic medium, we can have that ease of interaction successfully accomplished, so that we get more information about the patient and therefore, we can serve them better." "Electronic house calls provide important links between patients and their doctors." "The technique works especially well for specialists like Rosser, who are in high demand, and for patients who can't get to doctors' offices." "The calls are especially useful for those like Steve Gallagher, patients with postoperative problems that won't go away." "Okay, under your tongue." "It's taken Steve four years to recuperate after mysterious symptoms almost took his life." "We'll keep that one." "Butch Rosser saved him." "Doctor Rosser took it upon himself, he was going to do exploratory surgery and find out what was going on." "Because if not, they were going to lose me within 24 hours." "And you say you've been running around 250?" "Rosser found a football-sized cyst growing on Steve's pancreas, slowly strangling his large intestines." "The doctor removed the cyst and damaged bowels, then rebuilt Steve's intestinal track in a series of five other complicated and debilitating operations." "During the time since his first surgery," "Steve was too weak or too ill to get out of his bed for critical post-surgical checkups." "Every couple of months, he ends up having this little abscess, that was gathering in this little area right here." "To provide Steve with the constant post-surgical care he needed," "Doctor Rosser began making electronic house calls." "...give us a good picture of the wound itself." "And we should be able to transmit this to Doctor Rosser." "It's as if this world-class surgeon were here in the room." "Hi, Mister Gallagher." "How you doing?" "The pictures and audio are a little fuzzy, because this part of the technology is still developing." "But they provide the personal link Rosser believes is so essential." "That is perfect, Steve." "You look marvelous." "Over." "You look marvelous, too, darling." "Over." "Can you see me all right?" "Over." "Your reception is fine, doctor." "Over." "After greeting his patient," "Butch reviews the high resolution pictures sent by Lynda and Michi." "That wound looks better than it has ever looked before." "What do you think about that?" "Oh, absolutely, doctor." "I like to get things answered." "I think anybody who has been through any major surgery doesn't want to get something second hand and go home guessing "Well, I still don't know much more and I still have to wait for my doctor to come back."" "Okay, we're all set." "I think people like to see the, quote unquote, "Big Boss"" "because my number one goal, I'm going to take care of you like you're family." "Even though they're separated by miles," "Steve feels the intensity of Butch's concern and attention." "I bought four more years on this planet than I should have had." "It's the constant care." "What else might the future bring?" "What might it bring to Cliff Boag, the young father suffering from mysterious intense pain in his groin." "I knew right away, you know, as soon as, basically when I went home, I could feel a big difference." "The nerve Doctors Saberski and Rosser froze temporarily is no longer causing problems." "A few weeks after surgery," "Cliff is looking forward to taking his family to the beach, a 400-mile trip, and then water skiing when he gets there." "Up to a few weeks ago, these activities would have been impossible." "And what about the future of John Duncan, the other young father, waging a life and death war against brain cancer?" "I feel stronger than I did." "After Doctor Barnett removed the core of the tumor and planted chemotherapy wafers in his brain," "John has had few side effects." "Now, his right hand, weakened by the advance of the tumor before surgery, has regained some of his strength." "Several weeks after surgery, he feels healthy and optimistic." "I think I'm living with it and I'm beating it." "ln several more weeks, his surgeon, Doctor Barnett, will take an mri and determine if the cancer is growing or retreating." "All the surgeons we've met, and many of their colleagues around the world, people engaged in life and death battles every day, have the hope, the vision, and the courage to go beyond what others think is possible." "Their breakthroughs and compassionate care will carry us into the next century."