There are just some moments that defy all odds, even in medicine. In this episode, Dr. Oz explores some of the most incredible medical miracles and remarkable recoveries that will inspire us all.
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She was crying when I told her what the problem was. And I told her he had a horrible injury to his neck and that was affecting his breathing and we needed to operate and he may never walk again. There was a good chance, a better chance that he wouldn't than he would And she cried and she said, I need to speak to my baby. And then he tells her he loves her. He doesn't want her to worry because she's going to get better, and tell the girls that he loves them. Hey, everyone, I'm Dr Oz and this is the Doctor Oz podcast. When Kevin Everet, who was a tight end for the Buffalo Bills, was cruising down the field to make a wonderful tackle on Dominic Kickson, and when the two of them collided, these two real strong guys collided. Uh, Kevin's head snapped forward and he fell to the ground, sort of like a puppet that's been dropped. You know, Marinette, that those strings have been cut from And we saw at the time, UH physician run out there together with the rest of the medical team. You couldn't really tell what the TV cameras rolling specifically what was going on, but you could tell there was a lot of banks. The players had crowded around Kevin Everett and they were they were off to the side, We're praying. And we went back and revisited that event, and we revisited because Kevin Everett, uh, the football player who had been injured, has made a remarkable recovery. And so I've got the honor today of I spent a few minutes with Andy Cappuccino, who is the orthopedic surgeon that took care of Kevin, who was someone I got to spend a little time with in Buffalo and thanks you joining us than you. So I was telling Oprah what what you were like, and I said, well, you know, the reality is we sort of bonded on the football field. And she said how so, I said, well, the Buffalo Bill's football stadium, of course, is in the snow path, so it had a couple of inches of snow on anyway. But in addition, they had played a hockey game on it a few weeks earlier and covered it with ice. So that's Cappuccitto, who's very fairly athletic type of I went out there with shovels and shoveled a little square in the astro turf, so we can actually figure out where Kevin had fallen to the turf. And I said, he wasn't he wasn't unwilling to roll up his sleeves. And that's exactly what you do when you're taking care of Kevin. You can go through with the audience, Uh, what happened that day and what it was like for you, and some of the big decisions you had to make sure. It was certainly a very frightening situation to see a professional football player face down on the field and make a diagnosis of a cervical spinal cord and neck injury that had him paralyzed. He was on the field, he couldn't breathe, and we have a drill with the Buffalo Bills and medical staff that we use whenever someone is injured in such a manner. Our drill worked like clockwork. In conjunction with the other medical doctors and the trainers on the team, we were able to rapidly stabilize Kevin's neck on the field, meaning by using manual traction, hold it in line and secure it while he's still in his uniform on a special spine related backboard, get him on an ambulance and within thirteen or fourteen minutes have him well on his way to the hospital and speaking with Kevin himself, who was having difficulty breathing because of his high level neck injury, we made the decision to institute some fairly controversial therapies as well as standard cares for a neck injury. Among those things, we decided to use high dose steroids, which steroid methyl predness alone by name, is a medicine that helps to shrink inflammation and protect the nerves of the spinal cord. It works for other parts of the body, too, but in this instance it was utilized to help protect his spinal cord injury. The other thing we it was we knew that if we could lower his body temperature, he was all heated up, he was all sweaty, he was playing in a football game at the NFL level. There's somebody of literature them that helps us to believe that if we lower the temperature and kind of cool him down and use his body like a big ice bag to surround the spinal cord, we might limit some of the inflammation and possibly protect some of the spinal cord tissue that may have a better chance of healing and restoring function, because when we picked him up off the field, he had no feeling and no movement below his chin. Andy and the show we talked a little bit about UH, the personal risk you took. For example, that you called your wife to make sure that you know if you if you lost the mortgage in the house and to tuition for the kids school, she'd still love you. And she very endearingly told you to file your conscious to do what's right, which is our hippocratic oath. And I really want I will applaud you again for UH, for keeping that UH first and foremost in your mind. But but I must say, if I if I sprayed my ankle, I put ice on it. Right. We recommend that to our patients all the time. Why would the idea of putting ice on an injured spine be that controversial? I mean, we do it for the heart, we do it for the brain. Sometimes it's something that is conventionally used in medicine and in practice. Why wouldn't it have already been studied in the spine. Well, I think that I think the real problem is that the concept is not new. It's fairly older. But it was the way that we attacked it in the past when studies were done amendment, we cooled the spinal cord directly, we slid special catheters in, and of course it took a long time to get the injured patient to a place where an epidural cathether cape that lays right on the cord could be utilized. And then there's the thought that and and the results weren't that good, I think, either from direct thermal injury to the cord or the fact that if you cool the chord selectively directly, you actually cause a vasal constriction. We caused the blood supplied to close down in that area by using too much cool and that's not really we want. So if we cool the whole body, we don't get any selective vasal constriction or stopping of blood supply to the cord, because it's part of the spinal cord injury. A moment is not just direct blunt injury to the cord and not just direct swelling, but it's also ischemia, which means the blood supply gets cut off because of the pinching. So by utilizing the whole body and cooling the whole body, it's a trick, so the body doesn't know where to turn off or turn on blood supply. It's cool everywhere, so the blood supply selectively remains open. So we're shrinking the inflammation while feeding the cord a good blood supply. And the thought nowadays by using a systemic not just directly cooling the cord with a with a special catheter that lays on the spinal cord, but using a special catheter that goes into the main body's circulation and cools the blood internally, is that we can keep the blood supply going, we can lower the inflammation and spare as much spinal cord tissue as possible. Yeah, I'm I was really impressed by that because I think that a lot of Americans believe that when you break your neck quote unquote, you know you're actually transsecting, You're you're cutting the cord in half. Before I became a physician, that's what That's what I thought, because you remember, you used a beautiful analogy that is of a celery stock with the strings remaining intact um. And that's really I mean describe that well. I think I stole the idea for many actually, but at least it was his his imagery that I transferred into a celery stock because you couldn't find the better alternative. We actually went not to get glow sticks andy, which is your original concept, and we couldn't find glow sticks that broke the way they're supposed to break. So we use the celery stock because I think if you think it's always talking, you twist it so that fractures will notice that you do get the disconnection of of the stock a little bit, but there are little strains that hold the top and the bottom of the stock together. And metaphorically, when you injured the spinal calm, that's what we're dealing with. Right, You've got a couple of cells that are alive. You don't know how many yet, but there are probably a couple um that if you can just keep the the live, just recruit a few extra cells to work, then you go from a guy who can't breathe to someone who can breathe because now the level of paralysis is beneath the frantic nerves which which power our diaphragms, or it's maybe a little bit lower, So you're actually able to move your legs a little bit more than you could have and That's what's so studying about about Kevin when you know he walks and he's an imposing figure as a pro football player, and he walks out onto the stage and you know he's he's got some issues that are he's dealing was still, but they're trivial compared to what you would have expected and what would in the press conference that you gave after the um after the surgery, what was the number you quoted for the press, Well, about ten percent chance that he would ever walk again. And statistically in the spinal cord injury group that end. Like doctors, we try to classify everything. We have a classification system, and the classification of his spinal commentary, which was the second worst as worse as it can be, the only thing that would be worse, as you mentioned, it would be a final chord transaction, and there would have been nothing we could do for him at that point or at this point in time, with this final cord injury, there were only about ten at the most chance that he was going to be a walker again. Yeah, and he walked out there is you know, bubbly and making his mother and his girlfriend prouty. It was pretty impressive. Now just to walk through the time course a little bit, so you know, an hour actually, I think it was about thirteen minutes into the uh injury. There was an ambulance there. Twenty minutes after that getting into the AMLST. You were at the hospitals. So in thirty five minutes or so after the injury, he's already at a at a pretty good medical center. You also made the big decision. I should tell the audience of going to a different hospital than perhaps the one that you would have gone through that was closest, because they had technology that you needed, in particular an m R I scanner that you knew was manned all the time. And I bring us up to the honest because these are not subtle insights. These are hugely important because once you get to the hospital and find out the text not there for two more hours, you're really in trouble. And and not only that, but they moment. The important point here, I mean one of the important points is this is these are very difficult decision for a doctor. I mean he actually probably thought, well, this is the best thing for the patient, and the risk is I'm going to lose my mortgage and I'm going to be penniless. That's that's a pretty it's a it's a real fear for a lot of physicians. And he did what was right. I mean, what what he did is is the model. And I think one of the reasons you probably bonded with him so much is he did the model of what every physician should do. But in today's litigious climate, it's a little risking. I got a lot more questions to go, but first let's take a quick break before I get to the other bigger issue on to bring up as a surgery. Uh. And it's that we're not used to having folks criticize us for doing our best. Uh. And I don't know, frankly think that there's a lot of big criticism of you that I think is defensible. But there are people came out and said you could have done things differently, which is true in any kind of politicized environment. How did you deal with that? Sure? Well, first of all, you know, it makes you uncomfortable when you think you've done your best and you're seeing a good job or a good result evolving, yet still your colleagues are criticizing you. You take it personally. Um, But at the end of the day for me personally, when I lay my head on the pillow and I think about my personal conversations with Kevin Everett, and I said, Kevin, are you happy with the job that I've done for you? And Kevin continually, obviously from the great work that he was doing on his own, told me that he was happy. I felt good, you know. I mean, there was a lot of banter in the literature. The New York Times article basically slaughtered me um. Some of the popular press lauded me, but it wasn't my position at the time to answer back. I was protecting my patient's chart because you know, there are laws that help us to protect them, so I kind of kept it quiet. I internalized a lot of that, but you know, my wife again, she's a good guiding force. And every night when I put my head on the pillow, my conscience was clear that I did the best job I could do. And as positions, that's all that people can ask of us. To stay current in your field, try to make good decisions, make decisions that are based on the best interest of your patient, and you're never gonna go wrong. Do we get things right a hundred percent of the time. Any doctor that tells you that he has no complications. Where he's right a hundred percent of the time is not an honest position. And the only thing that can make us dangerous in our field is if we're not honest with ourselves and with our patients. So I feel pretty good about the job that I've done. Absolutely, you know, surgery is controlled arrogance, and I don't see it in a disdainful way. When we go to the operating room, we've got to be able to make very difficult decisions and not look back all the time, and it takes a certain amount of UH confidence. It's been more than confidence to be able to do that, and sometimes doesn't help you in real life situations. So I think you took a very healthy perspective on this UH in the last few miss let It may go to the other point you brought up when I was visiting in Buffalo. I actually was not aware of this, but your point it out that when someone has a fracture of the vertebral the spine and the or the vertebral body, and in Kevin's place, he shoved the third vertebrate onto the onto the fourth one. So you use a shingle analogy and sort of taught me that these things, when these things slipped, and I think they're called perch facets, is that the right term. One was was a dislocated and locked facet on the left side, and the other was a perch facet on the right side. And so when when that happens, then you've got a dilemma because you've got to reconconnect that. But you've got fractured bones are which aren't going to protect the spine or cord anymore. So you pointed out that before you put the patient to sleep and they lose muscle tone, which is what holds uh, this spinal cord intact. It doesn't allow the muscles to relax, which would then allow everything to collapse in the bones and crushed the cord. Worst you actually fixed the spine while he was awake. How do you do that? We do that by actually using a special halo system. You've seen pictures of guys with something drilled into their all bolted into their head like a halo, and we use this method. Well, he's awake with a local anesthesia because he can still feel his head. We drill some bolts into the head and under X ray control with a little bit of muscle relaxation. We gently longitudinely, we stretch his neck back into position and it's called a closed reduction. There's no opening of the skin. We realign the bones of the spine and sometimes it takes weight up to forty or fifty pounds to pull the neck out to length to overcome the muscle spasm that's there and realign the neck. And we did that while he was awake. And the reason that you do that while he's awake is because you don't want to overdistract it and either tear the remaining spinal cord tissue or essentially tear the head right off the shoulders. It's a careful process that would be very anticlimatic to the care of the patient. Uh. Finally, there's a big emotional element. Obviously, you're going to the operating room. You've got to speak to the family to tell us about that conversation. Yes, that was what we call the pre upholding area, which you know, but that's a small waiting area where the patients, the player will meet the anesthesiologists, the o R, circulating nurses. All the preparations for the operating room are made and in that area. Since things moved quickly for Kevin Everett, we needed to get a formal written consent. It's the hospitals will not allow you to bring a patient to the operating room until there's a consent written and signed. And in that light, because of the nature of Kevin's injury, um I asked him who his next of kin was, and he said, I need to speak to my mom, and we with my cell phone, we called his mother down in Texas, who was actually just returning home from a sports bar. She'd had a big family meeting, gathering of friends because it was the first game of the season and this was a breakout year for Kevin. He had a great camp. He was supposed to have the the year, the year of his career, and uh. They were all gathered and they saw him go down the field and I called his mom, and by this point Kevin was resolute. We had discussed what needed to be done, what the chances were, what therapies we were using, and what their controversies were. And Kevin and I had a very frank conversation that I told him that on my part, I would do everything in my power regardless of of you know, what my colleagues would say to help make him better. And his job was to work as hard as he could and be strong to get better. And he promised me if I did my job, he'd do his. But he needed to speak to his mom. And it was a very strange conversation because he was overly concerned about her. And the first thing he said on the phone wasn't Mom hurt or Mom, I'm frightened. He said, Mom, I don't want you to be scared. I want you to take care of the girls. He's got three younger sisters. It was a very for me, almost overpowering conversation because she was ying when I told her. I first engaged her on the phone and I told her what the problem was, and I told her he had a horrible injury to his neck and that was affecting his breathing and we needed to operate and he may never walk again. There was a good chance, a better chance that he wouldn't than he would and and she she cried and she said, I need to speak to my baby. And then he tells her that he loves her, he doesn't want her to worry because he's going to get better, and he tell the girls that he loves them. And it was a very interesting conversation because of the kind of resolve that he had at the time. And then we went on to do all the formalities having a nurse listened to the conversation and signing the consent. But it was interesting, powerful conversation that we had on that cell phone, and it caps you know that one. I salute you and again applaud you for all the wonderful work he did with Kevin Everett, but also the way you made the profession proud. I think you've got all your your your your key ethical issues lined up perfectly, which is I suspect one of the reasons that you're shure popular with your family. Okay, And he brought all of us, uh, well, not all of you brought what five of the kids to the show? I brought actually four of our five were there. One was in Europe studying in Florence for the year, and one had exams at Ohio State and couldn't get away. Well. I enjoyed meeting them, and I enjoyed seeing their love for you. It's well deserved. There's lots more. Will we come back. We got another miracles a different kind of miracle to talk about, UM, and I've asked Dr Robert Johnson joining us today. Dr Johnson is as a hematologist oncologist, and UH he has to deal with the reality that I face all the time as well, and that is UH, the the remarkable ability we have now a modern medicine to perform life saving transplantation, but the inability for us to find donors, which therefore causes us to fail in our quest. And we did a little bit on transplantation UH by featuring Jason Ray. And Jason had been the mascot for the North Carolina basketball team. He was killed in a terrible car accident when the team was on the road, and his family, who were understandably reluctant to donate the organs in this time a tragedy, had been told by their son that he wanted all of his organs donated everything, and so they abided by his wishes because they did not want to disappoint him even after his death. And so Jason Ray's organs were used UH to change the lives of seventy other human beings and several of the lives that he saved by donating his heart and his kidneys and his pancreas his liver were featured on ESPN show. Lisa's Salter was the reporter on that. On that program that has been very popular because it does a wonderful job of chronicling this young man's passion for life and how he passed life on um in his death. And we had them on the show with Kevin Everett again just talk about medical miracles. And I thought we'd have Dr Johnson speaking a little time with us talking about another individual who's actually today still looking for a donator, still looking for help. Dr Johs Than thanks for joining us. Well, thank you very much. It's uh the pleasure and a privilege to speak with you today. Ammit, Bob, tell me a little bit about Nicole Nelson. What's her problem? Uh? What how is the field advanced? And what's the need you have from our audience, because I'm hoping that some of the listeners today will resonate to the story and may be able to help you out. Well, I appreciate that. I just want to add one thing before we get started, and that is my specialty as internal medicine rather than hematology, and internal medicine deals with all the medical illnesses. So um, we don't come across the plastic anemia as much as the hematologist. But Nicole Nelson is a physician assistant that works with me in our hospital in Conquered New Hampshire, and she became ill blast ball and was diagnosed by her physician following a bone marrow biopsy with the diagnosis of a play actic anemia. Now, this illness consists of a failure of the bone marrow to produce three main cell types that keep us alive. And one is red cells that carry oxygen all of our organs, and secondly is the white cells that help us to fine infection, and thirdly platelets which help us to cloud our blood. Her bone male marrow is failing to produce all of those cellular elements and that is a fatal illness. Now Nicole is thirty five years old, she's a new mother, she has a fourteen month old daughter, new house, haptly married five years and to have this diagnosis, I mean clearly her whole life is just pulled right out from underneath her. And your listeners can just imagine themselves in that situation if that happened to them, or now tell me, tell me what the problem is, if you will, from why don't we have more donors and what's the problem for her and getting a typing? Her humatologist has run her tissue types to look for a match for her to have a bone marrow transplant to save her life, and they have not been able to find a match. And the main reason is because because of her ethnic background, she's part Native American Indian. Unfortunately, nationally there's a there's a serious deficiency of that group and all minorities on the National Donor Registry, so that anyone who has that ethnic background, if they go to try and find a match, at a great disadvantage because there aren't enough people with a similar background to be available as a donor. So right now I think there's about or almost seven million donors available on the national registry and she didn't match anyone. But now how do we get more people registered? Seven million is is? This is Mike Royson. By the way, seven million is just under three percent of the total in the in the country. It seems to me there really isn't any hazard is there with bone marrow transplantation for the donor? Not at all? Not at all, And so why why can't we get two million people in this pool. That's what we need, and we need the minorities to come forward to. And the problem is, first of all, there's no not really awareness of the problem by the country. This is not something that we all think about. We think in terms of blood donations and things like that, but none of us really think in terms of well, I could be screened for a marrow donation and it's so easy because all you really need is a swab of your cheek to be tested. You don't have to have blood drawn. It's just a simple swab of your cheek. Now, is there any Is there any? And I know there's no hazard if you will, but there's no pain. It's pretty easy to do. Um, Is there any limitation? Are their diseases that preclude you from from giving marrow? Well, there are a list of illnesses that would preclude you. You need to be between the ages of eighteen and sixty sort of age is concerned. You can't have a diagnosis of cancer or diabetes, or certain blood disorders or bleeding disorders. And you know your listeners could obtain a lot of information on one how to become a marrow donor by going to a website that the National Registry has that Marrow m a r r ow dot org. Signing onto that website and it explains everything you can click on joint, enter your your zip code and a distance and determine where the nearest bone Marrow drive is. Can you give that that website again, it's Marrow Donation dot com or dot org. Actually it's just Marrow dot org and it's spelled m a r r ow dot o r g, So it's Marrow m a r r ow dot org. And that is the website for the National Registry and they have a lot of information there for everyone as far as how to become a donor, information about becoming a donor, registering and if if people um don't feel that they're able to become a donor because of age or or illnesses, there's other opportunities to help the foundation by donations, volunteering, or even organizing drives themselves. Now, now I signed something on my driver's license that lets my organs be taken, but that's different than this. So this is a separate registry. Is that correct? It is separate amment. I have the same thing on my license, but until this really came about. I've given blood in the past, but I had never been screened as a volunteer marrow donor until now. Um So I've now gone through the process and it's so easy to do. And the important thing is that when you do this, you volunteer to help anyone out there who needs that bone marrow to save their life. And there may be only one person out there that can do it, and that may be in the coals case. So that, for example, if if someone out there needs my tissue type and bone marrow, I'm here for them and I'll donate it. And everyone on that registry feels exactly the same way, Bob. If you look at at the percentage of success from using this registry, it's somewhere between sixty and from what I can tell, so most people who need a bone marrow transp will find a match. I am intrigued and Dr Rosen brought this up as well, that we have so few people registers and this is so easy to do. In theory, I woshould probably be up at the high nineties. Do you know in other countries if these programs have been able to get levels of success that high. I don't think so. I don't think so. I think I think the number of donors are registered are much higher in the United States. But the problem with our registry is it's so underrepresented by minorities. And uh, that's that's the main problem. We need to have them turn out to be screens so that we can help everyone of the same ethnic background, because your tissue type is inherited, and I mean you're most likely to find a match of somebody with the same race or ethnicity. So unless you have enough donors out there who have been screened, your chances to find somebody with a particular background like her Native American background is slim unless you can get more people with that background to be tested. I may ask with other solid organs, we don't have to be quite such perfectionists in our matches. Right for the heart, I just match. The major blood type is A A U B. Are you you know A B O? And I'm done. I don't have to go into more detail. Why is it so important for bone marrow recipients to have a perfect match from a donor. The problem is one of rejection unless there is an excellent match, and if if there's any difference from your own tissue type, the chances of rejection are much higher. Now you have the patient who's being treated has to go through a process of chemotherapy and medications to knock out their immune systems so they don't reject the transplant. But that's why it has to be so specific, because unless it is almost identical, you will reject it. So they go through some mythstre if you could, because I think it'll be helpful for the audience. And by the way, on oprah dot com, we have a map of the country tree and you can click on your state and you can get a organ donation form. It's it's not just for bone marrow, but it allows you to have a document that you can give to your loved ones because sometimes if in death, you obviously can save major organs, but the bone marrow itself can be used often as well. And and and they're hugely beneficial for uh, for folks who are in crisis. So myth number one in bone marrow donation is painful, right, You gotta you gotta, you know, take a piece of the hip bone to do it. Is that what it's about. No, No, that's that's that's true. And and they don't take a piece of bone, and it's not painful. They give you an anesthetic so that you don't feel anything. So that is a myth. There is no pain involved. Myth number two. All marrow donations involve surgery. It's a significant procedure. It is a lengthy healing process. Um it's a surgical procedure, but it is one that's done under an anesthetic, so there's no pain. It's not a major operation, so it's it's simple to do, it's simple to donate. And what's the recovery process, But like the recovery processes is very quick and there may be some fatigues and mild discomfort, but those symptoms usually pass within a few days, all right. The third big myth that I always hear is that the donation of your marror will weaken you. That you know, it's difficult for you to regenerate, which you've donated, uh to someone who's suffering an easy bone marrow transplant, And that's not the case, memos, because you know, really you replace everything they take out within four to six weeks, so that usually back to your usual routine in a few days, so that's not a problem. So let's go back to Nicole for one second if I could, Bob, you know you're charged with taking care of for her. Obviously you've had uh the honor working with there since she was a physician assistant in your hospital. How long could she wait before she gets an appropriate donor, donor what's what's her time horizon? Well, the problem is that with her illness, she's being kept alive by blood transfusions and plate with transfusions, the more transfusions, the more times you receive those things, the higher your likelihood is of rejecting a transplant in the future. So they try to minimize those things. So it really gives her a limited amount of time and she's really up against it right now. I mean, she's she's running out of time, and that's really the urgency of her story. That's why, uh, we're hoping that people will understand that it is so easy to be screened with just the swab of the cheek, and that when they hear her story and her plea, that they're gonna want to help and they're gonna want to check on the merrow dot org and find out how they can become a bone marrow donor and I just want to emphasize that for minorities, the screening for bonemerow transplantation is absolutely free. Dr Robert Johnson, thank you so much for joining us today. You're an internist New Hampshire. You actually graduated Jefferson Medical College, when my father taught for many years, and it's it's been a great honor to have you on. Thank you so much for sharing Nicole Nelson's story with us UM and please wish this wonderful physicians assistant the best of luck. And I'm hoping folks out there I'll hear her her story and respond with the same passion that Dr Roys and I felt when we when we first heard about her. I wish you the best. Thank you very much