(upbeat music) - Coming up next on this special medical science edition of "Arizona Horizon", we'll meet the Mayo Clinic surgeon and the patient involved in Arizona's first ever triple organ transplant.

Also tonight, a closer look at a new Alzheimer's treatment recently approved by the FDA, and we'll hear about an alarming increase in nearsightedness, especially among children.

Those stories and more next on this special edition of "Arizona Horizon".

- [Narrator] This hour of local news is made possible by contributions from the Friends of PBS, members of your PBS station.

Thank you.

(upbeat music fades) - Good evening and welcome to this special medical science edition of "Arizona Horizon".

I'm Ted Simons.

Surgeons at Mayo Clinic recently completed the first ever triple organ transplant in Arizona as 53-year-old Doyle Duke successfully received a new heart, liver, and kidney.

We spoke to Doyle from his hospital room the day before he got to go home.

We also spoke with Dr. Bashar Aqel, chair of the Mayo Transplant Department.

And by the way, at last report, we're told that Doyle is doing great.

(logo whooshing) We welcome Dr. Bashar Aqel, chair of the Mayor, Mayo, I should say, Transplant Department.

And joining us from his hospital room at Mayo Clinic, there he is, Doyle Duke and his wife, Billie.

Good to see you both in a variety of ways.

We're gonna get to you in a second.

Doctor, we're gonna start with you.

First triple organ transplant in Arizona, huh?

- Yes, yes, that's the first one.

I mean, as you know, a triple transplant, heart-liver-kidney transplant, is a very rare occurrence.

You know, since we start tracking the number of those transplants since 1988, you will be surprised that it has been done only 42 times.

Now, an average of only three times per year across the US.

And this is clearly the first heart-liver-kidney transplant in the state of Arizona, and we are proud that this surgery has been performed at Mayo Clinic in Arizona.

- Talk about Doyle.

Why was he the first?

- Well, I mean, Doyle has dealt with what we call congenital heart disease.

Despite multiple surgeries and the great team that he had home, and his heart disease did not respond.

And that has resulted in progression to what we call end-stage heart failure.

Unfortunately, and because of his heart failure, this start to affect his liver and resulted in advanced liver disease, and also, his kidneys were affected by the disease process, which resulted in chronic kidney disease.

It was very obvious for his medical team back home that heart transplant alone is not an option, and his only option is a heart, liver, and kidney transplant.

- And real quickly, before we get to Doyle, from what I understand, you can't really do a heart transplant if there is liver and kidney disease.

You almost have to do the replacement just to get the heart transplant, true?

- Absolutely true.

I mean, if there is a heart, if you have an underlying liver and kidney disease, heart transplant alone is not an option.

You're unlikely to survive the surgery, and thus the only way you can survive, by getting a simultaneous heart, liver, and kidney transplant.

And as I told you and shared with you the statistics, the number of transplant centers that are able to perform this are very few, and that's why Mr. Duke and his medical team reach out to Mayo Clinic, Arizona for help.

- Alright, Doyle, let's get to you now.

First of all, how you feeling over there?

- I feel great.

- [Ted] Feeling great.

I mean- - Thanks for having me.

- You bet you.

Thank you for joining us.

You feel great.

Is this kinda how you expected to feel?

I mean, it's just such a unique situation.

None of us can figure out how exactly you feel.

Is this what you expected?

- Well, yeah, pretty much.

I expected it was gonna be tough, hard, you know?

Yeah, I expected it to be tough.

- Yeah.

Your thoughts prior to the surgery, Doyle, again, what were you expecting?

What were you looking out for?

What were you thinking?

- "Oh my God" is what I was thinking.

"Am I trying to do this, really?"

- [Ted] Yeah.

- But we did, I was woke up, as I always do from every heart surgery, and here we go.

Let's get better.

- I was gonna say, you'd been through enough.

You knew this had to get done, right?

It's time for rubber to meet the road.

- Yeah.

By the time we got here, I knew it's either new or package me up and ship me out.

- [Ted] Yeah.

Yeah.

Well, you're about to get shipped out here tomorrow.

Congratulations on that.

Billie, I gotta ask you now, how do you feel about it?

This must have been really rough on you.

- Yes, and I'm just so thankful for the organ donor.

And I can't thank them enough, their family enough for what they did for my husband.

He's still here with me.

- He is indeed.

And real quickly, Doctor, it was the same organ donor for all three organs?

- Absolutely, yes.

It's from the same organ donor.

- [Ted] Wow.

That's unusual in and of itself, is it not?

- It is unusual that you get three organs from the same donor and direct them to a single recipient.

But that's the only way we can do it when you are really pursuing multi-organ transplants.

- Doyle, when you first heard about the possibility now of a transplant, just even the possibility, what were your thoughts?

- Oh, I was ecstatic.

Very happy.

You know, I love life, and I wanna be here, and I wanna help people.

And I think I've learned a lot through this adventure, and I'm willing to help out people all over, make 'em understand to donate, donate, donate.

- I was gonna say, is that what you've learned most about this, is how important donation is?

- Oh, right.

You know, eight people to every one person.

That's amazing.

- Yeah.

Yeah.

- All you gotta do is check a little red box, get that heart on there, you know?

- Billie, I asked Doyle about what he expected beforehand, and did he expect... What were you expecting beforehand?

Did you realize... All these months, has it been what you expected, or has it been a real unique journey?

- It's been a real unique journey.

It's a slower process than what I thought it was gonna be.

I thought that he would be well a lot sooner, stuff like that.

He did have a couple of setbacks, but it's been amazing.

- I was gonna say- - We would do it all again.

- It feels...

I've heard people say that it's like a miracle recovery just in and of itself.

First of all, Billie, does it feel like a miracle recovery to you?

- Yes.

- I'll bet it does.

- It is (audio distorts).

- What do you think- - He is a true miracle.

- [Ted] Go ahead, I'm sorry.

Go ahead.

Billie, go ahead.

- I just said he was a true miracle.

- [Ted] Yeah, he was.

What do you think about that, Doyle?

- I like that.

(everyone laughing) - [Ted] I'll bet you do.

Now- - It's a miracle.

- Have you got your life all planned out here once you get... You're from Oklahoma, correct?

- Yes.

- Yes.

- [Ted] You got your life planned out?

How are things gonna change for you?

- Well, as much as I can live, I'm gonna live.

I owe it to my recipient, or to my donor, and I'm gonna live, live, live, live as hard as I can, and enjoy life, enjoy my grandkids, and enjoy my kids, and just carry on.

- Yeah.

Yeah.

Doctor, back to you.

This surgery, how long did it take?

How many people involved?

- Well, the story of that triple transplant, and as you know, very few centers are able to perform this, I mean, for Mr. Duke, once we became aware of the case, we have him come here for an intensive evaluation.

Medical and surgical expertise were involved to do a very comprehensive evaluation to determine whether we can do it all together.

After an extensive discussion, our team internally came with a plan that really, internally, we called it the playbook.

And the playbook was simply outlining the complexity of the surgery that we will be performing, the sequence of the surgeries and how we will perform them, and then involving all the teams that will make sure that this is a success.

You will be surprised at every single minute during a 14-hour surgery.

There were at least 10 to 15 people in the operative room in order to make sure that this is the successful outcome that we are dealing with.

- Wow, that is absolutely... And Doyle, that must be just music to your ears.

We gotta go now.

We gotta let you go, 'cause you got a life to live here.

Thank you so much for joining us.

- All right.

- You betcha.

And Billie, congratulations to you as well.

You both look happy and healthy.

And best to both of you.

Thank you so much.

- Thank you for having us.

- See you, Doc.

- You bet.

And Doctor, thank you as well.

- Thank you so much.

(patriotic music) - Leqembi is the first Alzheimer's antibody treatment to receive full FDA approval.

It's not a cure for Alzheimer's, but it has been shown to slow the disease's progression.

We learned more about this drug during a recent conversation with Dr. Alireza Atri, director of the Banner Sun Health Research Institute.

(logo whooshing) Dr. Alireza Atri, he's director of the Banner Sun Health Research Institute.

Doctor, good to have you here.

Thanks for joining us.

- Great to be here with you.

- Let's talk about Leqembi, or I know you'd like to use the full medical term, but what are we talking about here?

- Lecanemab is a monoclonal antibody, which also, in times of COVID, we learned about, and it's a first-of-its-kind treatment in many ways, as you mentioned, it's got full approval, because it removes and lowers the plaques in the brain that are contributing and causing Alzheimer's.

These are amyloid plaques that develop over 20, 25 years before individuals show symptoms.

And for the first time, we can actually show, with these class of medications, that we can lower the plaques and actually, in many individuals, after a year and a half, we can actually bring them down to normal levels of plaques in the brain.

And with that, when you look at groups, we can slow down, on average, about 25 to 35% the clinical progression, the decline that we see.

So over in a year and a half, that's worth about six months of benefit.

- I was gonna say, again, not a cure- - [Dr. Atri] Not a cure.

- But does slow the progression, which means you have more time, and obviously more time in Alzheimer's is a blessing.

- It is, particularly because the appropriate time for this medication is when individuals have symptoms at the earlier stages, what we call mild cognitive impairments or the mild dementia stages.

And at those stages, individuals can really function quite well.

And having more time at those stages can be very meaningful for patients and families.

- Now, how is this administered?

- Well, so the good news is that we have these clinical benefits.

The burdens and costs that come along with it is it's an infusion drug.

So you'd have to go in, put an IV in every two weeks, get an infusion.

The cost of the drug can be high, and Medicare and other insurance companies will have to pay for some of that.

There may be some costs that are associated.

And the other parts of that are there are reactions or side effects that some individuals may have.

So with that, we need to do things called surveillance MRIs, so look at MRIs in scheduled ways, because you can have some inflammation or even some bleeding that can occur in the brain.

- I was gonna say, I saw brain swelling and bleeding, but how likely are those risk factors?

- It really depends on the patients that's been chosen properly.

So some patients may not actually qualify because they're not in the right clinical stages or because already their MRIs show that they've had some bleeding or a lot of damage to their blood vessels.

And there's also some genetic risk involved with that.

So some individuals that have a certain kind of gene called APOE4, it's a cholesterol transport protein that actually increases our risk for Alzheimer's to begin with, but those individuals are more at risk.

So when you look at everybody in these clinical trials for lecanemab, it's about 12% that get some of the swelling kind.

But that risk really, really depends on how much blood vessel changes you've had and whether you have this E4.

And mostly they're not symptomatic, so we catch them in clinical trials where we just see them on the MRIs, and then we adjust the medications, or we may pause them.

But very rarely, they can actually cause big swelling or actually big hemorrhages.

- I was gonna say, obviously you wanna get started early on this.

The earlier, the better.

Asymptomatic, some symptoms?

When is too much symptoms, we just can't go there right now?

- Right.

So because Alzheimer's has a clinical symptomatic stage that, for any individual, could be anywhere from five to 10 to 15, even 20 years, it also has a more silent phase, a presymptomatic or preclinical phase that could be 20, 25 years.

Plaques develop, they can cause inflammation, then the tangles develop, and then there's usually shrinkage of the brain.

So in the stages where individuals don't have any symptoms at all, they're not really clinically diagnosed, that's not something that is clinically available.

But research shows that probably that's a very, very hopeful stage.

So we have trials, clinical trials for individuals to come in to see if they actually have plaques in their brain, and then be randomized to getting drugs like lecanemab or other drugs in the class.

And that's what is really, I think, the hope for the future, this prevention and also probably combination drugs.

- And you can see that now.

You can see plaque in the brain now, can't you?

- Yes, we can measure it in multiple ways.

One of them is through PET scans where we actually can see where the plaques are.

We can do it with spinal fluid, getting a lumbar puncture.

And the blood tests are also coming.

- Yeah.

- The blood tests are gonna become more accurate and available in the coming years.

So those will all be available.

And I encourage people to take charge of their health if they are at risk or if they have symptoms.

- You mentioned the price.

I'm seeing 26.5, $26,500 a year.

- A year.

Correct.

- Does FDA approval, Medicare, how does that factor into all this?

- Right.

So Medicare has said that there's an appropriate way that it has to be used.

It has to go through a registry, so the clinicians actually have to register patients in that way.

Other insurance companies are making determinations.

Medicare's also determining whether to and how to pay for the PET scans.

Lumbar punctures are paid for.

And that is the sticker price, so I really don't know what's gonna be charged.

But some individuals may have copays.

So that's something that, again, has to be determined.

- And that obviously along with having to go there twice a month, once every couple of weeks, for rural patients, that can be tough.

- Yes.

So access can be an issue.

What I can say is that we're gonna learn how to do this better in the coming years.

This is just...

This is such a new paradigm for us.

It's an important step and stepping stone for our field.

But we're gonna have to learn over the next years, and probably even a decade, with these things called biomarkers, how we measure the processes of Alzheimer's disease in the brain, not just the plaques, but also tangles and inflammation, how to use these drugs better.

So we're kind of like some cancers were 20, 30 years ago, or multiple sclerosis was maybe 20 years ago.

So we can maybe, hopefully...

I think it's a really rational basis for hope to take the 25 or 30% slowing of decline and make it maybe 50 or 60 or 80%, and make it more safer in the coming years.

But it's gonna be a learning curve, and practicing clinicians, it's a completely new paradigm.

- Yeah.

- So we have to do this in a very rigorous and a very methodical way.

- Yeah.

Optimism is a new paradigm when you're talking about Alzheimer's.

Any kind of optimism.

- Absolutely.

Absolutely.

And I really do think that this is the end of the beginning, but we need combination drugs and we need to know how to do it for any given patient in the right way.

- Doctor, thank you so much for joining us.

Good information.

- Thank you very much for having me.

Appreciate it.

- Remember, first impressions.

(upbeat music) - This is just the beginning.

To a change in fortunes.

(glasses clink) (dramatic music) - I'm awake.

I feel like I've opened my eyes.

The world is changing.

- I think we should take it to the next level.

♪ Are you ready for it ♪ Are you ready for it - I thought that was rather jolly.

- So much fun.

(horse whinnies) - We make a good team.

- [Tom] But what will you tell the child when they ask where their dad is?

- There's a war.

I'll tell them you're dead.

♪ Are you ready for it - If we can find him, we'll get him.

- I'm here to make sure justice gets done.

♪ Oh, whoa, oh, oh - I really love you, more than anything.

(upbeat music) (bell dings) (bell rings) (bell dings) - It's really loud.

♪ Oh, whoa, oh, oh, oh ♪ Oh, whoa, oh, oh - Shall we?

(upbeat music continues) - Fortune favors the bold.

♪ Are you ready for it - It feels more like the start of something than the end.

♪ Are you ready for it (upbeat music fades) - It's estimated that 50% of the world's population will be diagnosed with myopia or nearsightedness by 2050, with increases especially high among children.

So why are so many people being diagnosed with nearsightedness, and what can be done to address the issue?

We ask those questions to optometrist, Dr. Stephen Cohen.

(logo whooshing) Good to have you back.

Good to see you again.

- Thanks, Ted.

Good to see you.

- Shortsightedness on the rise.

What's going on here?

- Well, we have not had a change in our evolutionary change, but we've had a lifestyle change.

In the past, we were hunters and farmers who would wake up in the morning, and we'd go out to get food, to farm.

And now we spend all our time engaged in activities that are within two or three feet.

We've become computerists.

So as a result of all that time being spent up close, our eyes are basically saying to us, "Well, if I'm spending all my time looking here, why don't I just set my eyes to be clear here?"

At the expense of our distance vision.

- Interesting.

- So, as you said, it's estimated, 2050, this is considered actually becoming an epidemic.

50% of the world's population, 57% of Americans are expected to be.

And the problem is it starts when you're young.

And now with children spending so much time on devices, they're the unintended consequences that we're starting to see.

And that's gonna go forward.

- And I was gonna ask about that, because the numbers are on the rise for everyone everywhere, but kids especially, and young kids, too.

Is it's simply a matter of too much computer watching, too much education?

Please don't tell me that's the case.

(Dr. Cohen laughs) - No, it's great that we have these options available, but as is true with all things, there are consequences, there's a price tag to it.

So with children, they're spending so much time engaged in that.

It used to be you would send your child to the room now, to the bedroom if they misbehave.

Now you tell them to get out of their bedroom and get away from the devices.

We're not designed to do this.

If we were, we'd have one eyeball in the middle of our forehead.

We're not designed to spend all this time engaged here, and that's what life has become for children.

So it's the change in lifestyle that has been responsible, and at least now we can finally do something about it.

- Well, and again, in looking into this, I found that outdoor light, just being outdoors makes sense because rarely are you outdoors doing this with your computer, although some people are, but being outdoors makes a difference.

Why?

- Well, what's been found is that outdoor activities, particularly for young children, is a critical way to prevent the onset of nearsightedness.

So studies have been done that have been peer-reviewed that says two and a half hours a day or more spent outdoors decreases the chance of a child becoming nearsighted.

Now, we can't do anything about genetics.

If you have two nearsighted parents, good chance the child's gonna be nearsighted.

But at least there are mitigating factors that we can look at.

So two and a half hours a day more outdoors decrease the chance of becoming nearsighted.

And then there's also how much time we spend on devices that can make a difference.

- Because when you're outdoors, you tend to, what, look off in the distance?

You're not looking at this, whatever this magic zone is here.

You're looking off.

Is there something to do with the light outdoors?

I mean, if you sit outdoors and you do this with your phone, does it make any difference?

- Yeah, the key is to be engaged in outdoor activities, not merely to take your iPhone or iPad outdoors and look at that.

It's about the engagement and looking at things far away.

And there's nothing... You could be in a large room.

It's not the same as being outdoors.

And it's been found that if you spend the time outdoors engaged in outdoor activities, that your eyes are focused far away and it's less likely to create this environment that leads to a change.

- Is there a difference between indoor light and outdoor light, though?

I mean, does it make a difference?

- It's interesting to bring that up, because there is a difference.

But one of the factors that we're dealing with now is the fact that indoors now are exposed to high levels of blue light as well.

And blue light is right next to ultraviolet on the spectrum, so high-energy wavelength.

And what's been found in the same way that UV can increase, the short term would be sunburn, long term is skin damage, with blue light, short term is eye strain, fatigue, headaches, interfering sleep cycles.

And long term, they found it may even contribute to macular degeneration.

And now we're exposed to high levels of blue light indoors between fluorescent lighting and all the devices we use emit higher levels of blue.

- Well, and all these kids, I've read something that, in Singapore, 80% of the kids there either have or will have myopia.

They'll need glasses, they'll need correction.

Later in life, are they gonna be dealing more often with macular degeneration and these sorts of things?

- It's a great question because it finally...

I've been in practice for 37 years, and in years past, a child would come in, their eyes might change, and we update their glasses or contact lenses.

And it was frustrating because we couldn't do anything to prevent these changes.

And now there are four or five different techniques we have, that have been studied and proven, that will slow down that progression anywhere from 25 to 50%.

So we do have ways to make a difference, but it absolutely is imperative that we do it with young children, because what's been found is, if the amount of nearsightedness succeeds a certain level, we see an increase in macular degeneration, cataracts, glaucoma, retinal detachment.

And these are all things that we can do something, that if we can prevent that from happening, we're actually helping long-term health of the eyes as well.

- You're mentioning that there are things that you can do.

Give us a couple of examples.

- Okay, a couple of quick things is that there are certain types of progressive lenses, progressive bifocal, which people think of as the no-line bifocal.

Those have been found that, because of the way they're designed, they decrease the desire of the eye to stretch, which is what causes the nearsightedness.

- Interesting.

- There are certain contact lenses that will reshape the eyes that have been found to slow it down.

And there's even an eye drop that we usually use to dilate the pupils that, in a lower dose given to children at bedtime, doesn't interfere with their focusing, but has been found to slow down that progression by as much as 50%.

- So you can literally reshape the eyeball with some of these techniques.

- Yes, yes.

And I do it commonly.

It's a lens...

Almost like a retainer would be in orthodontia- - Yeah.

- To keep things together.

It's a contact lens that's put on at bedtime.

The child wears it overnight, and they wake up, take 'em off, they can see all day.

But in the long term, it's also been found to slow down this progression.

- What about the idea, and we talked about this earlier, so I know the answer, but I'm gonna ask you anyway, the idea, like the 20-20 rule, where you're doing this for 20 minutes, what, you look away for 20 seconds?

You can... What, what, what?

- Yeah, there are visual hygiene things that we can do.

Checking where our monitor is.

The monitor should be angled a little bit away.

It should be about 10, 15 degrees below our line of sight.

And there's a mantra that we use.

We think of 20-20 vision, which most people are familiar with that, and the mantra's called 20-20-20.

Every 20 minutes on a computer, take a 20-second break and look at something 20 feet away.

So if you have the chance to look out a window, do so.

If not, close your eyes for 20 seconds and envision you're looking off to the horizon.

- So closing your eyes can work in that as well.

- [Dr. Cohen] Absolutely.

- Yeah, this is fascinating stuff.

(sighs) We talk a lot about kids.

Last question here.

Adults, I mean, are we seeing much more of this in adults?

Are adults seeing their vision get worse at a faster rate than they have in the past?

- Yeah, and I can give you the quintessential example.

I'm an identical twin.

My brother is a superior court judge.

But his eyes, when he... Three years of law school, and his first two years of practice, his prescription went up dramatically.

And maybe it says something about how little I studied, I don't know, (Ted laughs) but he is far more nearsighted than I am.

And it had to do with the amount of near work that he did both in law school and then afterwards.

So yes, it can impact adults where their eyes will change, and plus all the other issues that can go on, including, and we don't have to get into the whole thing now, that we see an increase in dry eyes, which is a progressive condition that can really affect vision and quality of life.

And that increases because, when we're on devices, we don't blink as much, and it's the blinking that recoats our eyes with new tears.

- Wow.

Interesting.

TV too?

Same kind of thing with TV?

- TV we tend not to.

Driving long distance, TV, and particularly device use, our blink rate decreases.

But one other thing I wanna say about the two-and-a-half-hour thing- - Yeah.

- For parents, two and a half hours a day or more on a device increases the progression of nearsightedness.

So when moms and dads, grandparents are saying, "Get off your iPad," or something, they're right.

- Yes, physician, heal thyself as far as- - Absolutely.

- Or parent, heal thyself, huh?

- Parent.

- Yeah.

Doctor, great conversation.

Good to have you here.

- Thanks, Ted.

- [Ted] You bet.

(logo whooshing) And that is it for now.

I'm Ted Simons.

Thank you so much for joining us on this special edition of "Arizona Horizon".

You have a great evening.

(upbeat music)