>> hello and welcome to a brand-new edition of "in good shape," your weekly health show on dw from berlin. did you know that childhood diseases like mumps, chickenpox, and measles can affect adults and they can be quite dangerous and sometimes even deadly despite widespread vaccination -- these diseases are still a problem as many people in the western world to not see a point in getting vaccinations. they seem shortsighted. we will talk to an expert about

childhood diseases in adults and what to do about them. here is what else we have in store. every breath you take. how robert breathing techniques can energize you. howevery meal you make. how to eat right to prevent kidney failure. and every step you take. how to recognize ganglions and treat them. first, the good news. according to the world health organization, there has been a worldwide drop of 80% and measles mortality over the last 12 years thanks to vaccination. in other words, measles vaccine nations have saved 14 million lives. but there are 300 people dying every day of measles for making this disease one of the main causes of death in young children. even adults are at risk. >> she had to spend several days

in isolation ward. she contracted measles. >> i had been feeling quite unwell. for several days rundown, no appetite and too worn-out for daily activities. then i got a bad cough and a rash, so i went to hospital. it happened quite fast. >> the rash is similar to the kind that you would associate with a allergic reaction, but they do not cause itchiness. once the rash disappears, the other symptoms improve, too. basically anyone can catch it regardless of age, children and adults. older people who grew up in the postwar period in the 1950's are

immune because they have had the disease, so they are protected. those who aren't immune are in the 15 to 40 year old age group because they have not been adequately vaccinated and have not had the disease before. measles can be a very serious disease. some 10% to 20% of people who contracted develop complications, including pneumonia. apart from pneumonia, children contract middle ear infections. they are known as superinfection. bacteria which piggyback on the other very serious infections involve the central nervous system. that is the brain and the men in just -- meiningus. in young children there is a serious strain that is fatal. but if you can get the

vaccination, it is entirely avoidable. the vaccination provides long-term protection against the disease. >> vaccinations can cause on-site reactions as well as general ones, but the side effects disappear quickly. >> all it takes to ward off measles is too small of the needle to your upper arm. > >> health experts recommend that the first administration be administered between 11 and 14 months. children should have a second booster shot before the age of two. in the case of adults, anyone born after 1970 who has not been vaccinated or who has only been back in native ones should get a booster. >> the measles virus is contained in tiny droplets that can survive for two hours in the air. carriers are contagious before they developed centuries. astrid knows she might have infected others. >> when i think when i went

shopping or walking in the park there were little kids around me. i will have coughed without realizing i was contagious. i hope i did not pass it on to too many people. >> fortunately, astrid made a full recovery with no complications. >> with me in studio is a pediatrician. welcome to the show. >> i am glad to be here. >> why do so many people underestimate the danger of measles? >> i think that has to do with the decreased degree of information and of awareness that is attributable to the success of prevention programs. back to the 1970's, every child had measles in the natural course and people knew very well how to recognize it and how to care for it.

but nowadays measles have become rather rare, due to the success of vaccination. both haircare workers and the general population -- health care workers and the general population do not recognize the symptoms as the beginning of the disease and that can lead to infection spreads that we see often. >> i mean, the rash is quite characteristic but there are some a specific signs. >> the rash only develops between the third and fifth day of the disease, but before people suffer from fever and from flulike symptoms like cough and malaise but only with the rash the diagnosis of measles becomes more evident. >> if i would contract measles what should i do? >> once the diagnosis has been made, there is no definite causal option.

what you should do is try to prevent further spread by remaining away from things like public transport or the waiting room. and you should seek medical care to be screened for potential complications. you can treat fever and make sure that your fluid intake is high enough. >> there are complications and they are quite dangerous. what kind of complications does meet have -- does measles have? >> they have potential complications like pneumonia or typhus, but also what we fear is two different types of infection of the central nervous system, a form of encephalitis that can occur acutely, both in adults and children. and a very complicated and mostly lethal form of late onset

infection of the nervous system that can have a latency period of 10 years. >> the best thing is to get a shot against measles, get yourself vaccinated. who should get the shot, even adults? >> everybody, yes. in central europe or recommend general vaccination coverage for young children. the first shot before the first birthday and another, second vaccination after the second birthday. but also adults who have not or not definitelyy been vaccinated twice and have not covered the natural course of the disease should be vaccinated if they have access to health care. >> if i am not sure if i am immune, should i get my vaccination nevertheless? >> in a situation when there is someone near you that was

diagnosed with measles, that is definitely the best thing to do because the time period is crucial. and early vaccination within three days of exposition will protect you fairly well against the disease and also lower the risk of consultations. if it's not such an accute outbreak you can have a blood draw and have your specific antibody titus checked. >> see you gp if you are in doubt. we will continue to talk about vaccines and among. childhood diseases are highly contagious. most of them are airborne so coughing can be enough to transmit the disease to the person sitting next to you on the bus. most people infected do not take precautions because they do not realize how sick they are at first, like the patient in this report. >> just listening to it is distressing that these people few people recognize whooping cough. >> we've actually seen a

significant rise in the number of whooping cough infections over the last few years. it is unclear whether that is due to a reluctance to be vaccinated. in adults the main symptom is a really brutal cough that is difficult to treat. in children it can sometime cause severe breathing difficulties. >> whooping cough is highly contagious. expressed by bacteria that enter your lungs as you breathe. the bacteria and attached themselves to your bronchial membranes and release toxins. that mobilizes the tiny hairs lining the lungs. as a result of body's natural defenses are weakened. the toxins cause the caugh. -- the cough. claudia does not know how she contracted whooping cough. her first symptom was a headache company by temperature. >> then i got the cough and i could not shake it. .it was really brutal

i was coughing up phlegm and it really hurt. i took antibiotics but they did not help. i did steam inhalation but that did not help, either. so i just had to suffer through 45, for six weeks. >> whooping cough starts with nonspecific symptoms. in some cases, a nasal or throat swab can identify bacteria. that is vital if patients are to be treated with antibiotics. antibodies in the blood can reveal when the bloo infection began. >> it's only in the first phase, that is during the first week or two that you can detect the pathogens and fight them with antibiotics. later on, when only the toxins remain, you need to employ other methods. at that point it is about treating symptoms through inhaling steam and cortisone.

>> as well as relieving the cough, treatment aims at preventing other complications. this x-ray shows what can happen if the infection is not treated successfully. this patient has contracted severe pneumonia in the upper right-hand section of their long. -- their lung. other complications include bronchitis and asthma. to avoid developing complications it is important to receive regular booster vaccines. it is not enough to have received the whooping cough vaccination as a child. >> the vaccines are effective for about 10 years. after that, you are just as susceptible to the disease as someone who has never been vaccinated. vaccination is vital because whooping cough is so contagious. between 80% and 90% of people who come in contact with the disease and contracting it.

-- end up contracting it. children in particular tend to develop life-threatening convocations. it stops some infants being able to breathe. children can only be protected of all adults get the vaccination. i need a break is a small price to pay to prevent yourself and others from catching a cough that can be deadly. >> so you should get a whooping cough booster efrin 10 years after immunization. but what if you caught the disease in childhood. are you immune for the rest of your life or do you have to boost it? >> other than measles, whooping cough does not leave lifelong immunity. even after natural disease, a booster vaccination is recommended after 10 years. >> so how often should you go and see your gp to check your immunization? your pediatrician. but for adults? >> in children we have

recommended vaccinations sometimes several times a year. in adults, interval between five and 10 years seems reasonable to see your gp to review your immunizations and make sure that your coverage is up to the actual recommendations. >> not all infectious diseases are viral. there are many diseases that are caused by bacteria. what is the role of antibiotics in treating scarlet fever or whooping cough? >> in bacterial diseases, there are good recommendations for instituting antibiotic treatment. whooping cough for example, if antibiotic treatment is instituted early it can shorten the length of sentence. mostly when whooping cough is diagnosed in the stage of a coughing, then it probably will not change the course of the

disease but it will stop the contagiousness of the patient and no further spread can occur. in early fever antibiotics are foreign to treat the disease. >> if yo ucau can treat the disease, you should get vaccines but many of my patients are scared of the side effects. like our viewer from argentina. she is afraid of the side effects of vaccination. do you have any advice? >> my advice would be that she should review together with her general practitioner the existing evidence and the recommendations. there are worldwide expert and nationwide committees that b alance the complications and the risk of problems that the natural disease can bring about against the very low incidence

of serious complications of the vaccinations, which are, their prevalence is way below one in 100,000 vaccinations, if we are not talking about a little bit of swelling, redness at the site of injection, but relevant complications are not really something to be worried about. >> those are more local side effects. what about if a child hasn't tolerated a vaccine well the first time? should i continue with the immunization? >> we need to differentiate very well. there are certain rare but complicated problems after vaccination that can be a reason to change the immunization rate or use a different product or stop the vaccination because the risk of subsequent immun ization, but that has to be weighed. >> if in doubt, after gp.

thank you so much for being with us today. >> you are most welcome. >> if you can, see your doctor soon to get yourself vaccinated. do not forget to send in any questions you would like us to ask our experts in our studio. interview. >> in an upcoming show will be talking about relaxation techniques. some people find it tough workout the most relaxing thing in the world, while others prefer more gentle techniques. if you have got a question about relaxation, write to us at ingoodshape at dw.de. the key word is relaxation and the closing date is july 8. you will find our mailing address on our website. >> take a deep breath and relax. where do you feel your breath? expanding your chest or do you feel it down in your tummy? focusing on breathing can be very relaxing. many meditation techniques use

the awareness of breathing to relax and concentrate on the here and now. in and out and enjoy our report on breathing. >> astrid always begins her class with a diaphragm exercise. it involves the -- reading technique. it it helps a lot of air to circulate and relaxes the diaphragm which is important for good breathing. >> people whose diaphragms are constricted use different muscles for support. they start breathing like this. and as yo ucan imagine you can even see it quite clearly in my facial expression. there are under a strain. but what you need is to open up and relax. you need to use your diaphragm as your main respiratory muscle. >> every day we take 30,000

breast. -- 30,000 breath. learning to breathe properly is about perceiving the air moving through your body. this group is learning to breathe consciously and deeply. >> when people only breathe shallowly in the upper part of her lungs they end up getting short of breath. that leads to a lack of energy. breathing with her abdomen gives us energy and strength. >> nursery teachers ingrid experiences breathlessness. she is learning how to use techniques to generate the energy she needs for her job. >> i notice in my everyday life i often do not breathe deeply enough. that i tend to breathe in the lower part of my long. leaving the upper part out.

that has been quite challenging for me. but i notice it has been improving with time. >> breathing is so deeply connected with a person. it belongs as much to us as our life story does. everyone has a different breathing style. breathing cannot be categorized as either right or wrong. but if you sense construction, there are many techniques you can employ to free yourself up again. >> breathing deeply allows more air to enter the lungs. it's then distributed by the blood, allowing our entire body to get a good supply of oxygen. >> if you ever heard of a lump that may form at any joint. doctors call it a ganglion cyst.

suffers used to try to crush it with a big book. >> bible bumps are soft lumps that appear directly under the skin. they appear the wrist joint on the back of the hand. the swellings appear on top of a joint or tendon and can feel for more spongy. the medical term for them is ganglion cysts. ganglion cysts are soft to begin with. they contain a clear fluid and become firmer overtime. eventually they harden and appear as a round or oval lump. bumps can vary in size. ganglion cysts the form near n erve can cause pain. that can lead to loss of

mobility. their cause is still unknown. excessive strain and infection are thought to play a role. but an individual's predisposition is considered the most important factor. treatment of ganglion cysts used to be brutal. doctors and patients themselves smashed them open with limited success. to remove the lump for good, you need an operation. related conditions include heel spurs and finance. both of these involve bone protrusions -- heel spurs and bone spurs. >> they are shaped like two big beans and are located on either side of her abdomen. normally you do not notice him working but if they fail, you have a real problem as you cannot eliminate toxins from your body and you will be slowly poisoned if you do not get it treated. so make sure you take good care of your kidneys. here's how.

>> when he go shopping, he has for the fruit investable file. he tends to avoid eating meat and salty foods. it was not always that way. he used to eat a lot of meat. a healthy diet was not a priority. but when a checkup revealed impaired kidney function, his doctor advised him to change his diet. >> the combination of high blood pressure and impaired kidney function is not a good way to avoid dialysis in the long-term. changing my diet allowed me to keep my blood pressure within a normal range and sometimes even below. that is good for my kidneys. so diet is hugely important. >> if he had not changed his diet he would require dialysis. he is a regular at this university hospital.

making these life cell changes probably saved his kidneys. he had no idea his kidneys were no longer functioning properly. >> the scary thing is that in many cases kidney diseases do not cause any pain. kidney stones are really painful and so is -- but many diseases that lead to kidney failure do not cause any discomfort. you might notice fluid retention in your legs and your blood pressure might be high but that is it. >> experts believe that millions of people around the world to not realize that their kidneys are not functioning properly. >> i've realized that there are some diseases that do not give you warning signs but later massively impact on your quality of life. so i can really only advise people to go for checkups and make sure they get properly examined every now and then, particularly as they get older. >> you can also monitor it

yourself. >> blood-pressure meters are readily available. and if your blood pressure is more than 140 over 90, then you should get it checked at the doctors office. ask them to take the urine sample and check that your kidneys are functioning properly. >> he's grown accustomed to his dude i. he -- his new diet. he is happy to have appointed dialysis and he has managed to shut vertical -- to shed 30 kilograms. >> that is all for today. friend is on facebook. we will be back again next weekend. until then, let's all try to stay "in good shape." captioned by the national captioning institute --www.ncicap.org--

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>> mcfarland: one of the most critical activities in the human body takes place deep within our skeletal framework in the bone marrow. it is here that life-sustaining blood cells are made. so if disease should strike the bone marrow, interrupting its work, things can become serious very quickly. such is the case with the bone marrow disease called myelofibrosis. >> there are a number of chronic diseases of the bone marrow that are similar to each other, and myelofibrosis is one of them, the most aggressive and the deadliest of them. >> mcfarland: "myelo" is greek for "marrow," and "fibrosis" describes the process of scarring. so myelofibrosis is the scarring of the bone marrow. >> the scarring in the bone marrow is not healthy and can lead to a failure of the bone marrow to function. >> and so the bone marrow didn't produce enough blood

cells, so the doctor said what will happen is that your spleen will take over. >> mcfarland: and as the spleen works to make blood cells, more trouble begins. >> so they get this huge distension of the abdomen with the enlarged spleen, but then they are losing weight all over the body. >> mcfarland: this time on healthy body, healthy mind, we'll delve into this rare and potentially deadly bone marrow disease called myelofibrosis, learn about its symptoms, and see how researchers and physicians are working hard to make life much more rewarding for these patients. [upbeat instrumental music] ♪ >> male announcer: major funding for healthy body, healthy mind is provided by novartis oncology. novartis oncology strives to become the world's premier

oncology business by consistently discovering, developing, and making novel therapies that may improve and extend the lives of people living with cancer. and by incyte corporation. incyte's vision is to become a leading biopharmaceutical company focused on improving the lives of patients with serious unmet medical needs. additional funding provided by: abbott. ironwood pharmaceuticals. janssen pharmaceuticals inc. >> mcfarland: myelofibrosis is thought of as a type of chronic leukemia where bone marrow is slowly replaced with scar tissue, or fibrous tissue. this scarring process gradually

disrupts the body's normal production of blood cells and platelets. depending on the severity of the scarring, there are consequences such as anemia, weakness, extreme fatigue, and an enlarged spleen or liver. and though as of today there's no cure, recent success has been made in the treatment of myelofibrosis. >> myelofibrosis is a complicated term for a simple thing, which means scarring of the bone marrow. >> mcfarland: dr. hagop kantarjian is chairman of the leukemia department at m.d. anderson cancer center in houston. >> so we have to think of myelofibrosis the same way as we think of scarring in the skin. when there's an injury to the skin, there's a scarring process that heals it. in the bone marrow, there's an injury to the bone marrow, which leads to the irritation and scarring. >> mcfarland: for many of us, myelofibrosis is not

a familiar term. that may be because it's such a rare disease. >> it is like a leukemia, a chronic type of leukemia. >> mcfarland: dr. john mascarenhas is assistant professor in the department of medicine at mount sinai school of medicine in new york. >> since it's not a very common disease and has not gotten a lot of attention or publicity, it remains very vague in people's eyes. >> mcfarland: in fact, myelofibrosis affects far fewer people than most any other blood disorder. for instance, the national cancer institute estimates that the number of lymphoma patients is a little over 22 out of every 100,000 americans. in contrast, only about 1 to 2 people in 100,000 are discovered to have myelofibrosis. but even though the numbers are small, the problem is a big one for those who are diagnosed. and primarily, it's a disease of the elderly.

>> the median age of diagnosis of myelofibrosis is approximately 65 years of age. so it is typically a disease that affects older people, but we have patients that can be as young as 20 or 30. so it can affect people at any age but has a--has a higher rate as you get older. >> mcfarland: there are two types of myelofibrosis: primary and secondary. secondary myelofibrosis can come about as a result of some other disease that damages the bone marrow. it may also occur through a person's exposure to certain industrial toxins or an overexposure to radiation. the likely culprit behind primary myelofibrosis is a mutation that happens in one of several genes, but the gene that seems to be most affected is the janus kinase 2 gene, simply known as jak2. >> we know that there are many multiple mutations in different genes in the cells in the bone marrow, malignant cells.

>> mcfarland: dr. srdan verstovsek is a professor in the department of leukemia at m.d. anderson cancer center in houston and chief of the section for myeloproliferative diseases. >> we started with the discovery of a genetic mutation in a gene called j-a-k 2, or jak2. this mutation is present in about half of the patients. >> mcfarland: jak2 is the gene that gives instructions for making a protein that promotes the growth and division of cells. >> the cells in the bone marrow that support the growth of these malignant bone marrow cells react to the presence of the growth by secreting some proteins--we call them cytokines--that result in the production of fibers. >> mcfarland: and the fibers, or scar tissue, continue to grow. when that happens, the bone marrow's work of creating new blood cells begins to slow. soon the lack of cells takes a toll. >> these patients develop very

low blood cell count. and anemia, for example, is one of the major problems that these patients develop. >> it was with the red platelet count and then my spleen had started to enlarge. and i was bloated all the time, didn't have any energy, and just--just felt really bad. >> mcfarland: betty mitchell lives in woodward, oklahoma. betty makes the trip here to m.d. anderson for her myelofibrosis treatments. she is 79 years old. >> the symptoms i had was, my stomach started getting real bloated, and i thought, "oh, gee, what's wrong?" you know, and then i didn't have any energy, and i just didn't want to do anything. >> mcfarland: the bloated stomach betty is talking about is caused by an enlarged spleen. before we're born, blood cells are created in the spleen and liver, so when the bone marrow fails to create enough cells for the body to function properly, first the spleen will take over that process.

unfortunately, trying to keep up with the demand causes the spleen to grow. the liver can follow in this same pattern. >> so the spleen and the liver get enlarged. they are trying to produce blood cells again, but it's not an effective way. it cannot keep up with the demand in the body for the blood count. >> mcfarland: dr. rami komrokji is clinical director of the malignant hematologic department at h. lee moffitt cancer center in tampa, florida. >> 85% of the patients will have enlargement of the spleen. so this is a picture of a patient, and what is marked is actually the spleen enlargement. so they get this huge distension of the abdomen with the enlarged spleen, but then they are losing weight all over the body. [playing a bright piano tune] ♪ >> well, i was a high school band director for 34 years, most of those years being here in gainesville, georgia. >> mcfarland: ronald evans is

a lifelong musician and makes his home in gainesville, georgia, a little over an hour's drive north of atlanta. ronald is 72. ronald's myelofibrosis came about as a result of having another disorder associated with the jak2 gene called polycythemia vera. >> and for years, i produced too many blood cells, too many red blood cells. in about 1992, the--the bone marrow started hardening, or scarred, as my doctor said. and so the bone marrow then didn't produce enough blood cells. and for the next eight years or so, the spleen took over and helped me produce my red blood cells. and in 1998, we had to have the spleen removed because it had grown so large. and so the liver did take over. and for about eight or ten

years, the liver began to grow. >> mcfarland: for the most part, it takes t myelofibrosis, and there is an assortment of measurements that can be used to do that from a physical exam to imaging studies of the bone, spleen, and liver and to blood tests and finally to the most precise diagnostic procedure, an examination of the bone marrow. >> i'm just going to listen to your heart. >> okay. >> mcfarland: diagnosing myelofibrosis typically comes about through a series of steps. >> there is no one single test that will diagnosis myelofibrosis. it's a criteria of about five or six factors that needs to be combined together for myelofibrosis to be diagnosed. >> mcfarland: the road to a diagnosis may start with a thorough physical exam where the spleen and abdomen are checked. lymph nodes are also examined. then blood samples are taken to look for abnormally low red blood cell counts.

the blood test used is called a complete blood count, or cbc. here at h. lee moffitt cancer center, hematology supervisor jeanine jaehme reviews the cbc process using automated analyzer systems. >> as we go down the line, there's a slide preparation analyzer. this is our slide-maker stainer. and the blood is again sampled by this analyzer, placed on the glass side, and then it's actually stained. and the end result is a slide that has been stained and prepared and is ready to be analyzed on the microscope or one of our other analyzers. >> we look at the blood counts of the--the blood--what we call the blood smear, which is examining the blood cells under the microscope. those are red blood cells. and some of those red blood cells look like teardrop-shape, and that's a characteristic of this disease because of the scarring in the bone marrow.

>> i think, you know, the most common procedure and the most valuable procedure in the workup of a patient with myelofibrosis is a bone marrow biopsy and aspiration. >> mcfarland: bone marrow has both fluid and solid components. in a bone marrow aspiration, doctors use a needle to withdraw a sample of fluid. in a bone marrow biopsy, a larger needle is used to take a sample of the solid part of the marrow. together, they can show if the marrow is healthy and making the normal amounts of blood cells needed by the body. >> i started noticing approximately the last 10, maybe 15 years that i didn't seem to be as strong as i used to, 'cause i've always been skinny, but i've lost about 40 to 60 pounds. that's a lot of weight to lose. >> mcfarland: gilbert sherman is a 76-year-old retired pastor and lives in new york city with his wife, cecelia. although he has experienced symptoms of fatigue and weight loss over the years,

gilbert didn't seek medical help right away--not until the late 1980s, in fact. >> but what did cause me to see a doctor, frankly, was my blood, because a red cross bank confidentially told me they couldn't use my blood. i said, "what?" they said, "there's an anomaly." well, i hadn't heard that before. >> when i saw the blood cells on the differential report, is what it's called--and i knew that those immature cells are leukemic cells. that's how i remember you... >> mcfarland: gilbert's wife, cecelia, graduated college in 1956 as a medical technologist. she continued in that profession until her retirement 15 years ago. >> i mean, i was never a doctor, but i just knew that that was bad. so he went to the doctor. >> mcfarland: even though the diagnosis led gilbert and cecelia to a good medical team,

it wasn't long before they knew something more had to be done if gilbert was going to survive. >> [breathing deeply] >> when i first met him, he was very debilitated. he lost a considerable amount of weight. he was--you know, he was probably 50 pounds off his baseline when i first met him. >> actually, i'm feeling a bit better than i did the last time i saw you. >> okay. and that's why he was referred to me for consideration for experimental therapy. >> mcfarland: after ronald evans of georgia was advised to have his enlarged spleen removed, his liver then took over the work of creating blood cells. >> i had thought, "well, you know, if the liver grows, how is it going to--how will we solve that problem?" so i really thought it was probably a death sentence at that point. >> mcfarland: for most patients, myelofibrosis is an incurable disease.

however, for some patients, there is reason to be extremely hopeful due to a recently approved treatment option. coming up, we'll look at how a successful clinical trial has led to a new and promising treatment to slow the progression of this disease and meet a 58-year-old patient whose myelofibrosis is likely not caused by the jak2 mutated gene. the only treatment that has the potential to cure myelofibrosis is a stem cell transplant also known as a bone marrow transplant, but because the median age of diagnosis is 65, the side effects of a bone marrow transplant often make the procedure too great a risk. to see this program again or to watch any other program in the healthy body, healthy mind series, please visit our website at:

>> we are looking hard these days to find a cause for the disease. we thought we had it by the discovery of the jak2 mutation. we now know that's only one of the many mutations and contributor to the disease's presence and existence. >> mcfarland: and although researchers say there are many other mutations to explore, the discovery of the jak2 mutation has led to some successful outcomes in terms of treatment options and fairly quickly. the problem of the jak2 mutation was addressed by the discovery of a jak2 inhibitor. >> yes, it is rather rewarding to talk about this, because the time from the discovery of our first mutation, jak2 mutation, to the time of our first jak inhibitor being tested in the clinic was only two years with remarkable response. >> mcfarland: the timing couldn't have been better for ronald evans. his doctor in gainesville,

georgia, was able to secure him an appointment at m.d. anderson in houston as a likely candidate for the jak2 inhibitor treatment study. >> the idea of the medication was to shrink the spleen, and since i had no spleen, i was an interesting subject. my liver had grown quite large, and what happened was, within the next two weeks, the liver had come down a bit. and every two weeks for a while, the liver had begun to come down to normal size. >> mcfarland: for gilbert sherman in new york, mount sinai's school of medicine also took part in the clinical study using a jak2 inhibitor. >> dr. mascarenhas told us that when they first saw gil and did the first bone marrow biopsy that they were going to give him 90 days to live.

>> he's receiving a single agent, which has shown promise in treating patients with advanced forms of myelofibrosis. and he's a testament to the fact that 30 months later, he's still here and has a-- you know, a relatively good quality of life. unfortunately, he still does require transfusional support due to his disease and in part due to the side effect of the therapy which he's receiving. >> mcfarland: transfusional support refers to blood transfusions that myelofibrosis patients typically need. the purpose is to address problems with anemia caused by low red blood cell levels. transfusions, sometimes referred to as infusions, are also part of ronald evans' ongoing treatment. >> it affects me when the red cells get a little bit low and the lethargy sets in. but once i've had an infusion, which comes now about every

six weeks or so, i get another lease on life and go with it. my last infusion was two weeks ago... so i'm feeling really good now. [laughs] >> before i got my diagnosis, i was weaker. my appetite was less. my spleen had gotten large to where i couldn't eat as much food. >> mcfarland: john owen is 58 and lives in st. petersburg, florida. john was diagnosed two years ago and is a little more on the younger side compared to most myelofibrosis patients. his diagnosis came quickly. >> the very day that we did the blood work at the oncology hematology center, they decided to also do a bone marrow biopsy that day, which was no problem. i said, "fine." so we just did that right then,

and a week later, they asked me to come in for another meeting and an interview. and it was at that meeting, within a couple weeks of me making up my mind that i wanted to see what was going on with me, that the doctor told me that i had myelofibrosis. >> mcfarland: unlike nearly 50% of myelofibrosis patients, the jak2 gene mutation was not evident in any of john's diagnostic tests. he was referred to dr. komrokji at the h. lee moffitt cancer center in tampa. >> dr. komrokji had become familiar with a study in which pegylated interferon was being used with some good results. some of the literature is so positive on it that the minute i heard about it, i asked dr. komrokji if it was okay with him, i'd like to participate. >> patients have to be active.

they will be offered different treatment options. they have some time to weigh on what they want to do. >> mcfarland: use of pegylated interferon, or interferon "a", has been show to hinder the progression of early-stage myelofibrosis. the side effects of this treatment can be difficult. >> the first two or three days after the shot can be very hard. but, you know, it did make my spleen shrink, and sometimes it would actually boost my energy, make me more ambitious. well, i think i can just say it this way, that i'm optimistic. something could happen that would change that, you know. but either way, i've had a great year. i've been able to do things i probably wouldn't have been able to do. and i just take it one day at a time. that's all you really can do. >> mcfarland: and doctors say for some patients, the recent jak2 inhibitor treatment option

has begun to create a possible new outlook for myelofibrosis patients. >> hopefully now that we have therapies that are effective in more advanced cases, we may study them in the earlier phases and see whether we would be able to prevent those patients from getting worse over much longer period of time, and that would be an alternative way of prolonging life of the patients. >> well, my spleen had gone way down. each visit it had come down more. so i feel like that's good. and i feel like that it's-- it has helped me, and i'm sure that it's gonna help some other people too. >> yes, the prog-- definitely better. and--though i keep in my mind that there is no cure for myelofibrosis. his bone marrow will never go back and be normal blood-producing bone marrow.

i know that. but i also know that it's working, so right now, i try to say thank god we've gotten two years now, and he's still up and about. >> the advice i would give to a newly diagnosed patient is, get in touch with a myelofibrosis expert so as to plan and design the treatments and have a very optimistic outlook, because we are developing and discovering new things very quickly. [somber trombone music] ♪ >> i've been able to work through it... ♪ to play through it. it hasn't bothered my family life hardly at all. and so--so in that regard,

i feel really good about it. >> mcfarland: family and friends are crucial in helping myelofibrosis patients navigate the emotional needs that come with this disease. and patients spending time with other myelofibrosis patients can be an enlightening and rewarding experience as well. a medical team can help guide families through all of these very important areas. that's it for this edition of healthy body, healthy mind. i'm dr. scott mcfarland. see you next time. if you'd like to see this program again or watch any of our other healthy body, healthy mind programs, please visit our website at: to answer any specific questions you may have, be sure to contact your health care provider. to comment on today's program, please call: or email:

or visit our website at: >> announcer: major funding for healthy body, healthy mind is provided by novartis oncology. novartis oncology strives to become the world's premier oncology business by consistently discovering, developing, and making novel therapies that may improve and extend the lives of people living with cancer. and by incyte corporation. incyte's vision is to become a leading biopharmaceutical company focused on improving the lives of patients with serious unmet medical needs. additional funding provided by: abbott. ironwood pharmaceuticals.

janssen pharmaceuticals inc. n8

many of this region's hill towns date back to etruscan times, well before ancient rome. others date to the fall of rome. when rome fell, europe was engulfed in chaos. people naturally grabbed for the high ground to escape the marauding barbarians that characterized those dark ages. over time, these towns were fortified and eventually functioned as independent city-states. in their glory days, they proudly charted their own course, generally free from the dictates of popes or emperors. then, the bubonic plague swept through tuscany in 1348. that, combined with the increasing dominance by the regional bully, florence, turned many bustling cities into docile backwaters. ironically, the bad news of the 14th century mothballed these towns, leaving them with a unique charm and a tourism-based affluence today. siena maintains much of its medieval character.

its sprawling main square and towering city hall recall the days when it rivaled even florence. assisi -- with its walls, gates, and castle -- was home to st. francis. its massive basilica remains a favorite destination for countless pilgrims today. volterra was an etruscan capital centuries before christ. within its wall, the town's rustic center offers an evocative tuscan charm. and san marino -- all 24 square miles of it -- is unique in that it's still an independent country. while novel today, tiny two-bit dukedoms like this were once the norm. medieval italy -- like most of europe before the rise of modern nation states -- was a collection of independent, little san marino-style city states -- many of them no more than fortified towns on hills.