(bright music) - Coming up next on this special health and medical edition of "Arizona Horizon," we'll hear about a groundbreaking larynx transplant that took place earlier this year in Arizona.

Also tonight, a unique way to treat chronic joint pain.

And can apple cider vinegar be used as a health remedy?

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

- [Announcer] "Arizona Horizon" is made possible by contributions from the Friends of Arizona PBS, members of your public television station.

- Good evening, and welcome to this special edition of "Arizona Horizon."

I'm Ted Simons.

In early 2024, Mayo Clinic Arizona performed an exceedingly rare larynx transplant.

Indeed, it's the first known successful larynx transplant involving a patient with active laryngeal cancer.

To learn more about this groundbreaking procedure, we welcome Dr. David Lott of Mayo Clinic Arizona.

Welcome to the (indistinct), congratulations on.

This was fascinating to read about.

This is a total transplant here, windpipe, voice box.

Talk about it.

I mean, what was involved here?

- Sure, yeah, if we think about a larynx transplant, it's really more than just the larynx.

So the larynx, we think of the voice box part of it, but like you mentioned, there's the trachea, the upper part of the trachea, the upper part of the esophagus, the pharynx, the thyroid gland, parathyroid glands, nerves, and vessels.

So it's really a composite graft that we're transplanting.

- Describe the patient's condition and why this was an option.

- Sure, he had a long-time battle with a low-grade cancer in the larynx called a chondrosarcoma.

And one way to treat that is to resect it slowly over time to try to prevent somebody from needing a laryngectomy.

And unfortunately, it just didn't work for him.

The benefit he had is he had already had a transplant, and so he was on immunosuppression, which made him a really, a great candidate for this.

- I was gonna ask about the immunosuppression in a second, 'cause there's a great balancing act there, and it's really interesting 'cause you can do this, but you can't do that.

But it sounded like, could he speak?

Could he swallow?

What was his life like?

- Sure, yeah, he went through a point where he could not speak at all.

Through some reconstruction, he was able to get a bit of a voice out but really not much of one where he could communicate, he could, just the basics.

He had a trach tube, so he had to breathe through a hole in his neck, because he couldn't breathe through his mouth.

He was able to swallow but only because his larynx was so bad he physically could not aspirate.

- And, again, he became a good candidate for something.

Despite this active cancer, he became a good candidate because?

- Because he was on immunosuppression already.

- All right, talk about why immunosuppression is such a thing you don't necessarily want, you either want or you don't want with cancer and transplants.

You've gotta make the twain meet, right?

- Sure, yes.

Exactly right, yeah.

Immunosuppression is wonderful for transplants, because it prevents those grafts from being rejected by the body.

However, it suppresses the immune system, so it can't fight off cancers or prevent cancers from growing.

So that's really where that balance comes from.

- And he was on immunosuppressants to treat the cancer?

- No, he was actually on immunosuppression for a kidney transplant he had previously.

- Oh my goodness gracious.

- Yes, yes.

- Okay, so that was there.

Did that grease the skids a little bit then?

- It did, yeah, it made it much safer for us to be able to do this in that setting, because he needed the larynx removed anyway, and he was already on the immunosuppression.

- And, again, that would help keep the cancer from spreading and all sorts of other things from happening.

- Well, correct, yeah, it didn't put him at additional risk from the cancer spreading, because he was already on the immunosuppression, exactly.

- And that would've been a risk if he had not been there.

- That's correct.

- So the surgery, do I get this right, 21 hours?

- 21 hours, yes, yes.

- Goodness gracious.

What was involved here?

- So the first part of it was the procurement, where we had a wonderful gift from the family who donated the larynx.

And then, so that first part of that, about three to, you know, four hours of that 21 hours is the procurement, and then coming back is the actual transplantation into the recipient.

- [Ted] And the first order was to remove the cancerous larynx, I would imagine.

- Exactly right, yep.

So the first things first, you have to make sure the patient's safe, and the cancer is removed.

- [Ted] When you're transplanting something so involved, with so many different aspects involved, I mean, it just... And, you know, it's gotta be right, or it's wrong, if you know what I'm talking about.

- Yes, correct, yes.

- [Ted] I mean, is it intricate work?

I mean, are there computer-generated models?

We're looking at something right now.

It's kind of what's involved here.

I mean, how do you prepare for something like this?

- Well, first you have to have a wonderful team of physicians.

We had a team of six surgeons, the transplant department at Mayo Clinic in Arizona, just nurses, a wonderful faculty and staff.

And then you had to have the right patient to make sure that everything was squared away, and you knew that their recovery was gonna be outstanding.

- [Ted] And how's he doing?

- [David] He's doing much better than I ever could have dreamed.

- Really?

- Yes, absolutely.

- Really?

So he's doing- - Yes.

- I gotta ask, I mean, you're talking voice box here.

Does he sound like the donor, or does he sound like himself?

- That's a great question.

And it isn't what you think it would be.

So even though you are donating your voice box, actually the way the voice is produced is the vocal folds.

They just vibrate.

They're kind of like a guitar string.

And the sound of the guitar comes from the body of the guitar.

So in our body, the vocal folds vibrate, and that sound comes from our throat, our sinuses, our head.

And that's actually what produces our sound, yep.

- Interesting, interesting.

So that's the hollow body guitar right there.

- That's the hollow body guitar.

Exactly right.

- So he sounds pretty much like he did and will?

- Correct, yeah, so you know, he says it's his voice.

It's about, I would, you know, say about 60% of his voice.

It has a lot to improve, but he can communicate, and he can talk to his mom.

He can talk to his grandchild.

He can communicate.

- Is it different or difficult for him to hear his own voice, like in his head?

You know, when we speak, we hear ourselves.

Is he hearing something else up there?

- The way he describes it, again, is it's his voice, but it's not him yet.

- Yes.

- To get to that point, and I can understand that.

- [Ted] This was a clinical trial, correct?

- It is.

Correct.

- Okay, so what does the success of the surgery, what does it suggest for future surgeries?

- Well, one is we know that it's safe.

So we wanna make sure that when we do this, that we really are going to be able to restore the quality of life for people.

And because we were able to do this safely and, so far, with somebody with cancer, it gives us a little bit of encouragement to say, okay, let's take that next step, safely, and see if we can do this for more patients in this area, and then with future science, if we can do it with more aggressive cancer.

- So very encouraging then on your point.

- Absolutely.

- And the last point I wanna make is the heart...

He wanted this mostly so he could read bedtime stories to his granddaughter.

- Yes, yes, right.

- And he can do that now, can't he?

- [David] He can do that now, yes.

I've seen him do it.

- Dr. David Lott, Mayo Clinic Arizona, congratulations, a great story.

- Thank you.

Thank you very much.

(gentle music) (singers vocalizing) (gentle music continues) (singers vocalizing) (dramatic music) (dramatic music continues) (dramatic music continues) - There's a new way to treat chronic joint pain, and it involves going after the nerves that are sending pain signals to the brain.

It's called joint denervation, and Dr. Josh Hustedt, an orthopedic surgeon at Banner Health, told us more about the procedure.

Good to see you.

Thanks for joining us.

- Thanks for having me.

- This is really interesting.

Okay, joint denervation, give me a definition.

So joint denervation is going after the nerves that go to the joint instead of, for instance, replacing the joint.

So we go after the nerves, and we address those nerves to interrupt the signal between the brain and the joint to treat the pain that you're feeling.

So it affects the nerves only and not the joints.

- Exactly.

- They don't even touch the joints?

- All the work is done outside the joint.

So we do so through very small incisions.

We isolate the nerves that are going to the joint themselves.

We actually cut those nerves.

We transfer them to surrounding muscle.

What was once a sensory nerve grows into the muscle, becomes a motor nerve, and you actually have a cortical response change in your brain that makes it so you don't feel it anymore.

- Holy smokes.

Okay, so let's say it's your knee.

And the nerves around, just very, very tight circle, I would imagine, around the knee?

- There's four main nerves that serve the knee, for instance.

And we go after all four of those when we do a denervation procedure.

- All right, when you do that, though, you said you move the nerves to the muscle, surrounding muscles and that... Make that more clear.

Because it seems to me that pain is a really good way for your body to say, "You got a problem down there.

Knock it off."

But now you're not getting that signal anymore.

- Yeah, so pain can be a good signal.

It could also be a bad signal.

If we know you have arthritis, If you're a 20-year-old person, and you have a meniscus tear, and you're a professional athlete, it's really important to know that you have an injury that you might be able to heal.

If you're 85 years old, and you have pain every single day, and you know you have chronic arthritis, it's not so helpful anymore.

And so what we've done is we've targeted those sensory nerves to take away the pain.

The benefit of this procedure, though, is that it leaves the posterior capsule intact, which is mostly the proprioceptive fibers.

So you don't lose the ability to feel your knee in space or your ability to use your knee.

You just really tamp down that pain signal that you're getting.

- You say you don't lose that.

Do you lose anything that you, where you wake up, and you go, "I don't feel the pain anymore, but I also don't feel X, Y, and Z?"

- No, most people maybe get a little bit of skin sensation loss in the area of the anterior portion of the knee.

But most people wake up the day after surgery, and they say, "That deep-seated knee pain that was keeping me back and holding me back is completely gone, and I'm able to now do the things that I wanted to do, and my knee is functioning really well."

- And the knee will... Whatever the joint, we're concentrating on knee, but it could be any other joint.

It will function as normally as...

If you're 85 years old, it's not gonna function the same way as if you're 35, but it will go back to that, huh?

- Absolutely, and you know, we do this in other areas of the body.

We've done studies in the hand and the wrist.

But the knee population is just such a huge need in our world today that we've really focused some of our most recent studies in the knee.

- How long a surgery is this?

- It's only about 45 minutes.

- Really?

- We'll use a camera to get inside the, underneath the skin.

We make a little three-centimeter incision on either side of the knee.

You come in, outpatient surgery.

You get it done.

You go home the same day.

And you're better within a couple of weeks.

- So it is outpatient then?

- Yes.

- Holy, all right.

Who's a good candidate for something like this?

And not just the knee, I mean any joint.

- Yeah, so a particularly in the knee, a really... We have a lot of people that are not candidates for arthroplasty, for a knee replacement.

So a knee replacement, it's a great procedure, but some people don't qualify, if they're too old, they're too overweight, they're too sick, or they get a knee replacement, and they still have pain.

A lot of people are falling through the cracks in our system today, because they don't fall in that catchall basin of get a knee replacement.

Those are the people that we're really targeting this procedure for, because they don't really have another answer.

- Yeah.

How long has this procedure been going on?

- It's about five years that I've been doing it here in Arizona.

There's a long history of joint denervation, but we've taken that history and modernized it with new tools to make it, for instance, through those small incisions.

And we have about five-year outcomes from my patients here.

- That's what I was gonna ask you about.

I mean, how long do you know?

And over five years from your patients, anything change?

What are you seeing?

- Yeah, so we've had really great outcomes.

I didn't wanna tell people about a procedure I didn't believe in.

- Yes.

- So we did 25 patients, and we followed them for two years.

And we just published that study in "Plastic and Reconstructive Surgery," which is one of our top journals in orthopedics, which we were really proud of.

But more importantly, it just shows that there's a really great option for people that might fall through those cracks, and that this may be a way that they could reduce their joint pain and really increase their quality of life.

- Can you do, I mean, can you do this in more than one spot on the...

I mean, how many times can you do this without the brain saying, "Wait a minute.

I don't know what's going on here."

- Our bodies are amazing, and it's fascinating that we can do it in multiple spots.

Our brain has a specific spot for every area of the body, and there's an area of the brain that's targeted just to the knee, that's targeted just to the hand, just to the wrist.

And these little teeny tiny nerves, one to two millimeters, we can take and transfer and change that response.

- This kind of surgery is done for other things as well, right, not just...

I mean, joint pain, obviously, what we're talking about, but sure the nerves don't do the damage.

Other parts of the body, other procedures, true?

- Yeah, so we do a lot of nerve work across the body, both for numbness, for instance, for strength and motor function.

We'll do nerve transfers.

But this, we've really focused in on the peripheral joints, which are mostly in the hand and the wrist and the knee.

- Okay, and again, I just wanna be clear about this, because you know, the idea of, let's say you're a runner, and you've hurt your knee, and your knee has got arthritis, and you think, if you run, you get this done, all of a sudden, "Hey, I'm great.

I'm gonna go run five miles."

But if you run five miles, are you hurting the joint without feeling that pain?

- Yeah, not any different than you normally would.

So let's say you don't do this procedure.

- Yes.

- What are your options?

You live in pain.

You don't get to do your activities.

Or you get a cortisone injection, which also takes away the pain.

So what we do as orthopedic surgeons is try to make you be able to live the life you wanna live again.

And there shouldn't be a lot of change in that, because we still keep that posterior capsule.

But even if it was, you still could be a candidate for another procedure.

This doesn't mean you can't get a joint replacement if you need it in the future.

- Interesting.

- And it doesn't mean that you got a joint replacement, and you can't have this procedure.

So it's a tool in our toolbox to try to help people get better.

- That's interesting, artificial knee, you can still not have the same nerves hitting the artificial knee.

- Yeah, so if you look at a total knee replacement population, even in the best of hands, best surgeon in the world has about a 20% of the population that's not happy with their outcome, and they still have pain.

It's a massive number of people in the United States.

We do about 1 million joint replacements now, supposed to go up to 4 million.

We have 20% of those people that still have pain, and we don't have a procedure for them.

And that was really our target population when we came up with this, and we started studying it.

It's like, how do we address that population and try to provide them with the best outcome they can have?

- Yeah, get an answer for joint pain one way or the other.

Dr. Josh Hustedt, again, Banner Health, congratulations on this surgery.

Sounds fantastic, must be very rewarding.

Thank you so much.

- You're welcome.

(soft music) (moves to upbeat music) (moves to gentle music) (gentle music continues) (traffic buzzing) (lively music) (lighthearted music) - Nearly 5 million people a year travel to Arizona from all over the world for a chance to peer into the sublime expanse of the Grand Canyon.

It's hard to imagine that any of them notice the giant Navajo sandstone slab jutting from the earth just outside the park's eastern entrance at milepost 268 on highway 64.

A plaque was once affixed to this stone.

It honored the victims of one of the gravest air tragedies in American history.

(propeller whirring) On the morning of June 30th, 1956, TWA Flight 2 and United Airlines Flight 718 left Los Angeles within minutes of each other.

One was en route to Kansas City, the other for Chicago.

They would collide over the Grand Canyon.

(uneasy music) Both airlines and the government would recover, identify, and return home as many of the victims as the rugged wilderness would yield.

67 of the TWA victims, 63 unidentified, are buried in the Citizens Cemetery in Flagstaff.

Services were performed by Roman Catholic, Protestant, Jewish, and Mormon clergyman.

29 unidentified victims from the United flight were interred below a memorial in the Grand Canyon Cemetery on the South Rim.

(plane whooshing) Public outcry from the accident resulted in the creation of the Federal Aviation Agency and a modernization of the country's air traffic control system.

Nobody knows what happened to the plaque that once paid tribute to the victims of Flight 2 and 718, but their deaths are honored by the safe arrival of the many tourists that fly to the Grand Canyon each and every day.

(soft music) For thousands of years, apple cider vinegar has been used as a home remedy for everything from healing wounds to soothing stomachaches.

But do these home remedies really work?

And what does science have to say about all this?

Carol Johnston is from ASU's College of Health Solutions.

She joined us recently to share some of her research on apple cider vinegar.

It feels like this is a hot topic all of a sudden, but it's been going on for generations.

What's going on here?

- I think the science is catching up.

The folklore has been around, as you said, for thousands of years, but the research was never applied.

The scientific method was never applied.

And now it's being applied, and we can see clear evidence of benefit.

- Apple cider, is it the apple?

Is it the cider?

Is it the vinegar?

What's the key player here?

- So vinegar is a fermented food from whatever the vegetable source or the fruit source is.

And so it's fermented.

And it's the only dietary source of acetic acid.

And so that's what makes it so special is that it's the only food we consume that has acetic acid in it.

- So the fermentation is the big deal here?

- Mm-hmm, mm-hmm.

- So it could be...

The apple and the cider could be interchangeable with other things?

- Well, the benefits that we're seeing from vinegar seem to relate mainly to the acetic acid.

And so any vinegar, any vinegar, red wine, you know, from grapes, or pomegranate vinegar from pomegranates.

- Yes, yes, interesting.

- It all has the acetic acid.

- Raw, unpasteurized apple cider, I'm seeing that that works best.

Well, what do you think about that?

- I'm seeing benefits from even distilled white vinegar.

- Wow.

- And that's not to say that these other ingredients that are present in the vinegar aren't helpful, but when I'm looking at centers on the acetic acid.

- Well, let's talk about what you're looking at.

I mean, things like helping to lower blood sugar, have you found that this actually works?

- Yes.

- Yes?

- So my research now, I've been doing this work for almost 20 years.

And my early research was definitely focused on diabetes and lowering blood sugar.

And there are quite a few reports over the past 20 years, outside of mine, mine and others, who are showing the same benefit.

- So did you drink the... How do you apply it?

- So the acetic acid is a really interesting molecule.

So I'm sure you've heard of the gut microbiome.

- Sure.

- And you consume probiotics and prebiotics to feed the microbe.

Well, acetic acid is a prebiotic.

The reason you wanna feed your microbiome is to produce these chemicals that are known as postbiotics.

And the main chemical produced by your gut microbiome is acetic acid.

- So you're basically helping the gut along here.

- Yes, yes, and we know all the benefits from the gut microbiome.

And so the acetic acid, it will benefit quite a few different metabolic pathways.

- So, and I also hear that it slows digestion, which might help with stomach discomfort.

Is that true?

- Well, there are reports out there showing slowing of gastric emptying, though there's also reports showing that the acetic acid can inhibit the enzymes that digest your starch.

And so that's where the glucose comes from.

That's where the blood sugar comes from, is from the breakdown of the starch that you're consuming.

- Yes.

- And we know that acetic acid can stop that digestion 20 to 40%.

- Wow.

- And so what that means is the amount of glucose entering your bloodstream after you eat a big pasta dinner is gonna be reduced.

And so that helps the diabetic or the pre-diabetic manage their blood glucose.

- Is it reduced if you have the apple cider vinegar before the meal or after the meal?

- You know, we actually did some research this.

Five hours earlier than the meal does not help, and post meal does not help.

You need to get the acetic acid into the small intestine before the starch.

- Wow.

Isn't that interesting?

- It is.

It's very interesting.

- Helps to lose weight, are you buying that?

- Okay, so that's another metabolic pathway.

So remember, acetic acid enters metabolism in a lot of different places, and we see benefits with glucose uptake in the bloodstream, which is good.

But we also see fat oxidation, which is burning of fat.

- One last one here, and this is the one I...

I'm not so sure about this one.

- Okay.

- You apply it topically, and it can get rid of everything from acne to eczema.

And topically, too?

- Well, all right, so again, the science hasn't caught up with everything.

And so I'm not saying that it's not gonna be scientifically proven, but it's an acid.

And so it's gonna be very harsh to apply to an open wound.

- Okay, all right.

- Because it is an acid.

- Yes.

- And so it could, it could kill the organisms, like prevent infection, but it's gonna damage tissue, too.

- What are the side effects, taking too much, I mean, what's going on here?

- So what we recommend is people dilute a tablespoon or two in a glass of water and drink it at the start of the meal.

And so first of all, you're diluting it.

You're not chugging it, which we don't recommend, 'cause it's a strong acid.

So you wanna dilute it and consume it as you're consuming food.

So the food will help that matrix sort of dilute it out a bit and help you, you know, consume it without too much of the irritation from the acid.

- And there's not like a pill you can take or anything like that?

- There are pills on the market.

- There are?

Oh, there are.

- But they don't contain an active level of the acetic acid.

And so you would have to consume 40 pills at a sitting to get the amount.

- Holy smoke.

No, we're not- - I know, to get the amount you would in a tablespoon of vinegar.

- You got about 10 seconds left here.

Is there anything else that has this acidic acid?

'Cause that seems to be the key.

Is it just apple cider vinegar?

- It's any vinegar, it doesn't matter which vinegar it is, and most fermented foods like sauerkraut, mustard.

Mustard is a great example.

Because if you put mustard on your sandwich, it will have the same effect as vinegar.

- All right, we're gonna stop right there, 'cause I can buy that one.

Great information, thank you so much for joining, this os- - Oh, you bet.

- really interesting stuff.

- Thank you for having me.

It's been a pleasure.

- You bet.

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.

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