Upstate Health magazine
A publication that champions the healthy lifestyle in Central New York, brought to you by Upstate Medical University, the academic medical center in Syracuse.
Health UPSTATE UPSTATE MEDICAL UNIVERSITY Fall 2013 DOCS LEARN EMPATHY FROM IMPROV BEING A PARENT WITH CANCER Physician chose surgery to dodge cancer His story: 10 CONCUSSION FACTS YOU NEED TO KNOW A SUPER-CLOSE LOOK AT SCHIZOPHRENIA WANT TO TAKE A MEDICAL MISSION TO AFRICA? A 120-MPH HOBBY Health JOIN US! Fall 2013 PUBLISHER Wanda Thompson PhD Senior Vice President for Operations EXECUTIVE EDITOR Leah Caldwell Interim Director, Marketing & University Communications EDITOR-IN-CHIEF LILLY PATRICK LACEY LEE JULI BOEHEIM MELANIE LITTLEJOHN Amber Smith, Jeff Kramer, Jim McKeever Designer Susan Keeter Photography Susan Kahn (cover, pages 2, 5, 7, 10, 17, 20) Robert Mescavage (pages 3, 4, 12,13, 16, 18) Post Standard/Syracuse.com (page 14) Medical Photography (pages 2, 8, 9, 11, 17, 22) Susan Keeter (page 21) AMINY AUDI THE WOMEN’S HEALTH NETWORK illustrations Randy Glasbergen (page 3) Susan Keeter (page 8) Lavanda Ladd (pages 9 & 21) INVITES YOU TO TAKE CHARGE OF YOUR HEALTH Sign up to receive: Visit us online at www.upstate.edu or phone us at 315-464-4836. ● Alerts to Upstate health education events ● Access Amber Smith WRITERS to support groups and seminars For corrections, suggestions and submissions, contact Amber Smith at 315-464-4822 or email@example.com ● Small group Q&A sessions with doctors and other specialty care providers ● The ﬁrst opportunity to attend special events throughout the year ADDITIONAL COPIES: 315-464-4836. ● Nurse-guided access to services and providers Upstate Health offices are located at 250 Harrison St., Syracuse, NY 13202 ● Monthly e-newsletter On the cover: David Halleran, MD, a colorectal surgeon at Upstate’s Community Campus, shops for locally grown blueberries (source of vitamin C and manganese) and carrots (source of vitamin A and potassium) at the Central New York Regional Market in Syracuse, which is open year-round. Photo by Susan Kahn. ● Call, email or sign up on line–it’s free! HAVE A HEALTH QUESTION? NEED AN APPOINTMENT? Contact our Upstate Women’s Health Network Nurse at 315-464-2756, 855-890-UWHN (8946) or WHNNurse@upstate.edu www.upstate.edu/women The story behind the ads – You’ve seen them, haven’t you? THE WOMEN’S HEALTH NETWORK ADS he ads are in magazines, on billboards, websites and more — all with the goal of encouraging women to join the network to take charge of their health. The network is a new way for women to access Upstate’s expertise — from health information, to events, to seminars led by experts, to the specialty care offered by Syracuse’s only academic medical center and its partners. T Green, the color of life, was chosen to distinguish the campaign for the network as it represents security and balance. A flower bud makes up the logo, because buds are full of promise. Five real Central New York women were selected for the first phase of the membership campaign to connect with women at different life stages: Lilly Patrick, Lacey Lee, Juli Boeheim, Melanie Littlejohn and Aminy Audi. “I’m a great believer in wellness, and I would love you to join me,” Audi says in an accompanying video on the WHN website. 2 U P S TAT E H E A LT H fall 2013 Melanie Littlejohn urges: “Do something for yourself.” A bold “call to action” encourages readers to join the network. The cost of joining – it’s free! – is mentioned. Membership offers women a streamlined way to receive information about health, events and services. The toll-free phone number is Melissa Cosser, fairly prominent, to demonstrate the MSM, RNC simplicity of a single phone number for access to services across Upstate’s health system. Many ads also feature a picture of Melissa Cosser, the friendly nurse who fields phone calls and answers questions and helps with appointments, if needed. ● w w w. u p st ate . e d u Our priorities: medical care, education, research, community I n recent months the Syracuse skyline has seen a dominant new structure rising. Hundreds of construction workers have played a role in creating the new home for the only place in Central New York that provides cancer care for people of all ages. The Upstate Cancer Center is scheduled to be ready for patients next year. Syracuse has also gained new laboratory and workspace for scientists and entrepreneurs in the opening of Upstate’s Neurosciences Research Building and the Central New York Biotech Accelerator. And the New York State Cord Blood Science Institute is under construction on the Community Campus. These projects and others represent nearly $500 million in new construction, providing modern new space for patient care, research and education, the core components of Upstate’s mission. On these pages you’ll find that mission in stories about advanced medical care for stroke, concussion and trigeminal neuralgia. You’ll find a very personal story about a prominent surgeon, incoming Onondaga County Medical Society president, Dr. David Halleran, MD whose family has a strong history of pancreatic cancer. You will also read about an innovative way doctors are learning communication skills, the advice from a mom who is parenting with cancer, and a dietitian’s explanation of the benefits of fiber. From the research realm are stories about post-traumatic stress disorder, improving immunization rates, the ill effects of party drugs, the value of social workers and understanding schizophrenia. Upstate Cancer Center construction (top); Upstate Neuroscience Research Center (above left); CNY Biotech Accelerator (above right) We share stories about a medical mission to Ghana, and passions for soccer, car racing and reading in our leisure section. As a reminder that laughter is the best medicine, don’t forget The Humorist, Jeff Kramer, who recently was a patient in the emergency department of Upstate University Hospital. We hope you enjoy your Health, brought to you by Upstate. Need a referral or more information? For appointments or referrals to the health care providers on these pages, or for questions about health topics, contact Upstate Connect at 315-464-8668 or 1-800-464-8668, day or night. Contents PATIENTS FIRST Meet four students who suffered concussions cover story page 4 Dr. Halleran shares a personal medical story page 5 Upstate surgeons repair gastric bands that slip page 8 FROM OUR EXPERTS Do you have trigeminal neuralgia? page 9 FOR OUR COMMUNITY Increasing immunization rates page 14 How social workers save hospitals money page 14 IN OUR LEISURE Humorist: Bike crash sends him to the ER page 17 Why I love soccer page 20 Advice from a mom with cancer page 10 ‘Ocean’ novel stirs anticipation page 22 Lasting effects of Molly Benefits of fiber page 11 fall 2013 page 23 U P S TAT E H E A LT H 3 PATIENTS FIRST ’NETTING’ CLOTS STOPS STROKE DAMAGE S troke treatment has come a long way in a few decades. Doctors used to use a corkscrew device or a suction tool to remove a blood clot from the brain. Now neurosurgeons at Upstate turn to the Solitaire FR Revascularization Device, the first retractable stent, and the first designed specifically for stroke therapy. The device deploys a small metal net called a stent into the artery that contains the clot, and the doctor is able to grab and remove the clot. “You can prevent permanent brain damage by removing the clot as soon as possible, re-establishing blood flow and oxygen to that area of the brain,” says Eric DeShaies, MD, director of the Upstate University Hospital Neurovascular Institute. DeShaies and his team recently began using the second generation Solitaire stent. “It has a stronger joint that connects the stent to our movements so we can get more difficult clots out.” Strokes typically are treated within the first four hours with a clot-busting drug, followed by a stent procedure. An international trial is underway to determine if a combination of the two, used earlier, would be more effective. Upstate—along with the Gates Vascular Institute in Buffalo and New York-Presbyterian University Hospital in New York City— is participating in that study. Learn more about stroke care at Upstate at www.upstate.edu/ stroke. 4 Above: Concussion patient Alayna Slayton, 16, of Auburn with occupational therapist Kim Nemi. At right: Brian Rieger, PhD, director, Upstate’s Concussion Center. Making an impact PROMPT RECOGNITION, TREATMENT SPEEDS RECOVERY FROM CONCUSSION BY AMBER SMITH lurry vision. Dizziness. Ringing in the ears. Headaches. Trouble with balance. Concussion can produce frightening symptoms. Brian Rieger, PhD, an assistant professor of physical medicine and rehabilitation who leads Upstate’s Concussion Center, regularly speaks to school, athletic and community organizations. He is on a mission to raise awareness of concussion. B Rieger is also the parent of children who play contact sports. In his presentations, he strives to reassure. “I don’t want to alarm parents unnecessarily or deprive children of participation in sports, because that has a lot of benefits,” he says. “If a kid suffers a concussion, and it’s properly managed, we shouldn’t expect long-term consequences. A concussion is almost always a short-term event, when managed properly.” Ignoring the symptoms of a concussion can delay healing. Overlooking a concussion, then suffering another, can be disastrous, with symptoms more severe and lingering for months or years. The key is to recognize the injury when it happens. “The job of coaches, of athletes and of parents is to be suspicious,” Rieger says. That means removing an injured athlete from play until he or she is properly evaluated. And, that means encouraging athletes to be honest about their injuries. Four Central New York families agreed to share how concussion has impacted their lives: Alayna You can also hear an interview on this subject at upstate.edu/ healthlinkonair by searching “DeShaies.” “My vision was affected, and now I have to wear glasses with prisms in them. It is affecting my reading and computer work,” says Alayna Slayton, 16, of Auburn. She also suffers headaches now, and she didn’t before. U P S TAT E H E A LT H fall 2013 She was a midfield soccer player in September 2012 when she and another player collided head to head. She remembers “everything was sort of spinning, and I saw the scoreboard in six different places.” She could not stand on her own. Continued on page 12 w w w. u p st ate . e d u PATIENTS FIRST Decision point: Cancer some day or diabetes now? SURGEON HAS PANCREAS REMOVED TO BEAT THE ODDS BY AMBER SMITH r. David Halleran, MD faced a decision similar to the one made by Angelina Jolie. The actress had a double mastectomy because of her genetic predisposition to breast cancer. The doctor elected to have his pancreas removed due to a strong family history of pancreatic cancer, one of the most deadly cancers. The difference was that Halleran knew he already had advanced pre-cancer in his pancreas before it was removed. D “The reality is, you are not doing this on a lark. The other option, to do nothing, is much worse,” says Halleran, a colorectal surgeon in his 30th year of practice. Halleran, 62, had surgery eight years ago, in July 2005. His father, Dr. Leo Baker Halleran, MD, was 58 when he died in 1974; his brother, Leo Baker Halleran, Jr., was 50 when he died in 1999. Both men developed cancer in the exocrine cells of the pancreas. The Halleran patriarch had been a solo internal medicine doctor, practicing in New York City. Some of his patients told him he didn’t look well. He kept working until his skin and eyes turned yellow. The sudden jaundice sent him to the hospital, where he underwent surgery and died. David Halleran – the middle child of five – was in his second year of medical school. “I like to think he knew he was sick,” he says of his father, “although there is a lot of self denial when it comes to your own health.” Pancreatic cancer is so deadly because most people don’t find out they have it until it has spread. Symptoms can mimic those of an ulcer, stomach flu or indigestion. The position of the pancreas deep in the belly makes it difficult for tumors to be felt or seen. Even reaching the pancreas for a biopsy of its tissue can be complicated. David Halleran believed that the pancreatic cancer that killed his father and brother was somehow related to their smoking—even though he knew up to 10 percent of cases were caused by inherited DNA changes. He maintained that he was in good health. It was his younger brother who began researching. Michael Halleran, PhD – an academic of Greek and Roman classics who now is provost for the College of William & Mary — taught at the University of Washington in Seattle at the time, and one of the physician scientists there happened to be studying familial pancreatic cancer. To be involved in Dr. Teresa Brentnall’s study, a person had to have at least two close relatives who had pancreatic cancer. So Michael Halleran enrolled. Brentnall is conducting surveillance of families with hereditary pancreatic cancer, hoping it will lead to Continued on page 18 His father had jaundice but no pain, which Halleran learned was indicative of cancer in the “head” of the pancreas. Twenty-five years later, Halleran’s older brother developed upper back pain and jaundice. That’s more typical of cancer in the “tail” of the pancreas. The older brother, Leo Baker Halleran, Jr., had the tail of his pancreas removed during an operation in Boston. He died less than a year afterward, in 1999, a few weeks after the family celebrated his 50th birthday. The incidence of pancreatic cancer has been slowly increasing over the past 10 years, and survival rates remain grim. “It’s a very unforgiving cancer, as far as mortality,” Halleran says. This year more than 45,000 Americans are expected to be diagnosed with cancer of the pancreas, and more than 38,000 Americans will die from the disease, according to the American Cancer Society. David Halleran MD frequents the Central New York Regional Market year-round on Saturdays in Syracuse. fall 2013 U P S TAT E H E A LT H 5 PATIENTS FIRST Exploring how to predict BY AMBER SMITH ix students step into a big rectangular classroom at Syracuse University’s College of Visual and Performing Arts. Assistant professor Stephen Cross tells them to stroll through the open space. Then, to walk faster. Look for an empty space, and walk to it to fill it, he commands. Pick up the pace ... Walk with more intention, more purpose ... Keep your eyes on the horizon, not the ground. S . S tephen Glatt, PhD led a study to determine whether we can detect which individual Marines are likely to suffer from post traumatic stress disorder. Glatt is an associate professor in Upstate’s departments of psychiatry and behavioral sciences, and neuroscience. He took blood samples from 50 Marines prior to their deployment to war zones in Iraq or Afghanistan. Half went on to develop PTSD, and half did not. And it turns out, blood tests predicted with 70 percent to 80 percent accuracy which of the Marines would develop PTSD. Two different blood tests looked at the levels of immune genes, and at one exon from each of five genes. Glatt’s study concludes that if these blood tests can be further refined and replicated, they could suggest avenues for early intervention and prevention among individuals at high risk for trauma exposure. Listen to an interview on this subject at upstate.edu/ healthlinkonair by searching “PTSD.” 6 Acting up – Improv class, dramatic scenes teach communication skills U P S TAT E H E A LT H The exercise is just the start of a 90-minute improvisational workshop and part of a larger mission. “I tell my students that they have to become comfortable with seeing people and with people seeing them,” Cross says. In a classroom or on a stage, “they have to learn to own that space. They have to learn to be comfortable in that space, like they are comfortable in their own homes.” Usually, his students are preparing for a life on the stage or screen. But on this morning, his students are new doctors (medical residents) from neighboring Upstate Medical University, participating in a workshop called “Education Through Theater Arts.” The acting workshop is one way Upstate teaches communication skills and professionalism, two of the core competencies of medical education at the undergraduate and graduate level, says Upstate’s Stephen Knohl, MD, an associate professor of medicine and the residency program director. He approached Cross, who established the workshop in 2012. Upstate University Hospital put their communication skills to the test in a series of scenarios. Professors observe the doctors through videocameras as they interact with actors playing the role of patients. The scenarios — all based on real events — require the doctors to make an apology, deliver unpleasant news and deal with difficult patients or colleagues. Afterward, the actors provide immediate feedback on how they felt during the encounters. Then as a group, the doctors discuss the issues raised in each scenario. Both of these programs borrow from the stage, and Cross says that makes sense. “In the theater, we are challenged to feel more, see more, hear more.” The best doctors develop those traits. Sonja Gill, MD, a resident doctor in her third year, says the SU workshop “helped to humble us into realizing that we are all human and have the same insecurities and shortcomings as our patients. When we were put into uncomfortable ‘improv’ situations, that made us realize how patients may feel when placed outside of their comfort zones.” Her classmate, Colin Hardin, MD says “Being aware of where my gaze is, what my body movements are doing — This was something I didn’t really think of before.” Such seemingly small details are important for doctors to absorb, for the crux of the doctor-patient relationship is communication. ● Already underway was a program Knohl created in 2008 called “Learning to TALK (Treat All Like Kin).” Through TALK, the residents at fall 2013 w w w. u p st ate . e d u PATIENTS FIRST Syracuse University professor Stephen Cross works with first-year medical resident, Dr. Dipti Baral, MD during a class this fall at Syracuse Stage. fall 2013 U P S TAT E H E A LT H 7 PATIENTS FIRST THE UPSTATE CANCER CENTER SUPPORT GROUP FOR MEN WITH PROSTATE CANCER. UPSTATE CONNECT: 464.8668 Take the Health quiz! Y ou’ll find a fun health quiz on the “What’s Up at Upstate” blog. (Go to upstate.edu/whatsup and click on “careful reader quiz.”) All answers can be found in this issue. Read the magazine, take the quiz...and you may win a prize! 8 U P S TAT E H E A LT H Upstate surgeons Howard Simon, MD, Taewan Kim, MD and Matthew McDonald, DO perform about 500 bariatric surgeries per year, including a couple of band revisions every month. What happens if your gastric band slips after undergoing weight loss surgery? ariatric surgeons at Upstate are performing a growing number of operations to fix problems created when gastric bands slip inside patients who have previously undergone weight loss surgery. B Because Upstate University Hospital and Dr. Howard Simon, MD, chief of bariatric surgery at Upstate, have offered bariatric surgery since the 1970s, longer than any other hospital or surgeon in Syracuse, many patients who had their gastric bands implanted elsewhere seek the expertise of Upstate. Simon says Upstate surgeons no longer offer bands as an option but do offer repair. “We believe a ‘sleeve’ is better in every possible way,” he says, referring to a surgical option in which part of the stomach is removed. About 30 percent of the weight loss surgery patients at Upstate have gastric sleeves. About 70 percent have gastric bypasses, a procedure in which a pouch is fashioned from the stomach and then connected to the small intestine. Up to 25 percent of the people with adjustable gastric bands experience trouble, ranging from slippage of the band to erosion through the stomach wall, says Simon. Bands have been used in recent years to reduce the size of the stomachs of people who are drastically overweight, and they are FDA-approved for obesity treatment. fall 2013 The procedure helps people lose weight, but overeating, drinking carbonated beverages or excessive vomiting can cause the band to shift. This leads to additional operations and, sometimes, removal of the band and weight re-gain. The two most common problems are inadequate weight loss and band slippage, Simon says. If a person has had a gastric band in place for two or three years without reaching the weight loss goal, he or she may need surgery for a gastric bypass or a sleeve – procedures that permanently reduce the size of the stomach. If a person has a band that slips and obstructs the stomach, the band will have to be removed, says Simon. In those instances, weight re-gain is a serious concern. “I’ve seen patients who have had bands come out regain 100 pounds in three months.” How would someone know his or her gastric band has slipped? Some symptoms include nausea, acid reflux, difficulty eating or the ability to eat more than usual. Simon says follow-up appointments with the surgeon who originally placed the band are important, too. ● Listen to an interview on this subject at www.upstate.edu/ healthlinkonair by searching for “weight loss.” w w w. u p st at e . e d u FROM OUR EXPERTS That sharp stabbing pain may be trigeminal neuralgia HERE’S WHAT TO DO ABOUT IT harp, shooting, painful shocks that strike one side of the face — usually the lower face or jaw but sometimes the forehead or an eye — warrant an assessment by a neurologist or neurosurgeon. S Trigeminal neuralgia is nerve pain coming from the fifth cranial nerve, which is responsible for sensation in the forehead and eyes, upper cheeks and lower jaw. Neurosurgeon Dr. Lawrence Chin, MD, who leads Upstate’s neurosurgery department, describes the pain as “the most excruciating pain that you can experience.” Patients may feel the pain when they chew, shave or touch their faces, or even when wind blows across their skin. Some patients who eventually see Chin have already had teeth pulled, thinking the pain was from a toothache. The neuralgia is caused by an artery in the brain pressing against the lining of the nerve, stripping it away like the coating of an electrical wire may break down over time. Some primary care providers are adept at diagnosing trigeminal neuralgia, but it’s tricky. Blood tests don’t pick it up, and imaging studies are not conclusive. Mostly trigeminal neuralgia is diagnosed based on the story a patient tells, plus a thorough neurological exam. Equal numbers of men and women are affected, and it occurs with greater frequency as people age. 175 Upstate by the numbers dollars that paid for a year’s tuition 100 years ago in the College of Medicine. “As you get older, your brain sags like every other part of your body,” Chin explains. “That might bring the artery more in contact with the nerve.” When it is found in someone younger than 50, Chin says its origin may be from something else, perhaps multiple sclerosis. Treatment usually begins with medications, but they don’t always work, and many patients cannot tolerate the side effects of drowsiness. Chin says the gold standard treatment is an operation called microvascular decompression, in which a small hole is drilled through the skull, allowing a neurosurgeon to locate and move the offending artery. “Basically the idea is we take the pressure off the nerve,” he says, adding that the surgery is effective for 99 percent of his patients. About one-third will have a recurrence of trigeminal neuralgia 10 to 15 years later, but they are free of pain in the interim. ● Listen to an interview on this subject at www.upstate.edu/ healthlinkonair by searching for “trigeminal.” 25 89 percent of incoming students who are New Yorkers (making it likely they will practice here after graduation.) percent of Upstate Medical University students who completed their undergraduate work at another SUNY school. 9 students per teacher ratio within the College of Health Professions. fall 2013 U P S TAT E H E A LT H 9 FROM OUR EXPERTS Parenting when you have cancer reatment for rectal cancer leaves Shelleen Soltys exhausted. The Camillus mother has four children from age 10 to 22, all able and willing, but she still makes the effort to do the laundry, and help with homework and other chores around the house. T “They think as long as Mom keeps doing this, she’s going to be okay,” Soltys says. “So many people have said to me ‘you have to rest.’ I will when I need to. I’m keeping things as normal as they’ve always been, or close to it. But don’t get me wrong – I’m tired.” Soltys was in the midst of a divorce when, at age 38, she started feeling tired. Soltys felt something was wrong, but listened to friends who thought she was just reacting to stress. She developed pain in her lower spine, and had problems going to the bathroom. Finally pain in her tailbone became unbearable, and she went to Upstate University Hospital’s emergency department. Doctors discovered a mass. Soltys was diagnosed with rectal cancer. Throughout, she continues to participate in her children’s lives as much as possible. “Even when I didn’t feel well, I put the happy face on. It’s important for the people around you. It’s hard, but I have discovered that the days that I felt like I was going to die, no matter how bad it hurt, I made myself get out of bed and do something. “Psychologically, you’re so proud of yourself.” More than a year into her health crisis, Soltys is still grateful for the meals people give her family just about every other day, and for the good grades her children continue to make in school. She has a new job now, with a desk and daytime work hours, and she wishes she had stopped working after her cancer diagnosis. She managed a bar at the time. “I thought that if I wasn’t working I was giving in to the illness. That’s not true,” she says. If Soltys did it over, “I would give myself a chance to rest more.” ● She saw a specialist and got test results before telling her sister, Christine Coleates, and her children. She considered keeping them in the dark but quickly realized she wouldn’t be able to keep such a secret. This Mom’s Advice ● Listen to your instincts; seek medical care if you feel sick. “I sat them all down together,” she recalls. “I told them very matter-of-factly. I was not emotional. I said ‘this explains why I haven’t felt well.’ I think what helped was, I didn’t act emotional myself. If you’re upset or nervous or quiet, they’re going to take that on. I told them the type of cancer and that it was treatable.” ● Gather the facts before announcing your diagnosis. ● Minimize your emotional reaction to set a tone for the children. ● Push yourself to get out of bed each day. ● Make an effort to do some ‘normal’ activities, such as making dinner. ● Accept help from others; ask for help if none is offered. ● Stay busy so as not to dwell on your illness. Since then, there have been some nightmares, and some revealing stories shared at school, but she says the children cope well. They depend on their Aunt Chrissy a lot, along with other relatives and friends. Soltys underwent six weeks of radiation and chemotherapy in June and July 2012 to help shrink the mass. She had surgery on Halloween 2012 to remove what was left, and then six months of chemotherapy. She has gamma knife radiation treatments and targeted chemotherapy to get rid of the last specks of the tumor. ● ● Stop working during treatment if possible, or change jobs to accommodate time to rest. Periodically ask the kids if they have questions. Shelleen Soltys is surrounded by her children, Jack 14; Chloe, 12; Clara, 10; and Angie, 22. 10 U P S TAT E H E A LT H fall 2013 w w w. u p st ate . e d u FROM OUR EXPERTS Lessons FROM UPSTATE Party drugs can have lasting consequences 20-year-old woman was dropped off semi-conscious at Upstate University Hospital’s emergency room. She did not respond to doctors. She was not feverish. Her heart beat normally. She had wet herself and vomited. Blood tests revealed no alcohol in her system, but a dangerously low level of sodium known as hyponatremia. A In trying to piece together the woman’s previous 24 hours, a medical student scrolled through her cell phone messages. He found several references to “Molly,” a street name for the amphetamine-derived party drug also known as Ecstasy. An Upstate physician told The New York Times that “Ecstasy had been shown to cause this kind of extreme hyponatremia, especially in young women. The drug affects the brain and kidneys in ways that promote water retention, which dilutes the sodium in the body. It is a dangerous side effect. Nearly one in five who developed hyponatremia because of the drug died. Others had permanent brain damage.” The woman in Syracuse clearly had suffered a brain injury when she awakened a week later. Doctors reported her speech jumbled and slow and her vision impaired. She was in therapy for months to learn how to read and write again. This case helped lead to passage two years ago of New York State’s Good Samaritan 911 law, which protects people who seek help for someone with a drug overdose from being arrested for drug possession. answers UPSTATE “ “There are so many genetic conditions. Why does amniocentesis only test for Down Syndrome?” ” AFTER HOURS CARE – SETH TUCKER, SYRACUSE Amniocentesis is a procedure that provides a diagnosis of fetal defects. It is usually done in the early second trimester. In the 1970’s, Down Syndrome was the most common condition for which amniocentesis was performed. “Today, more than 800 diagnostic tests are available through amniocentesis— which makes this procedure not exclusive to Down Syndrome. –NURSE MIDWIFE HEATHER SHANNON, DIRECTOR OF THE UPSTATE MIDWIFERY AND GYNECOLOGY PROGRAM Have a question for Upstate Answers? Send it to firstname.lastname@example.org community campus U P S TAT E . E D U /A F T E R H O U R S fall 2013 U P S TAT E H E A LT H 11 IN THE KNOW Making an Impact from page 4 University Hospital emergency department, and then at the concussion center. Sixth nerve palsy is a condition that can affect hearing and cause facial weakness, in addition to causing abnormal eye movements. The affected nerve is the sixth cranial nerve, which supplies nerves to the muscle that pulls the eye away from the nose. When the nerve is impaired, the eye crosses inward toward the nose. To compensate, Goodman turns to see out of one eye. Slayton was out recovering for two weeks. In the first game of her return, a player kicked a ball that struck her head in the same spot. She fell face-first to the ground, suffering a second concussion – and ending her participation in contact sports. He sees an occupational therapist, optometrist and neuro-optometrist for help improving his vision. He wears corrective lenses, which have helped. He missed some school but has caught up. “He’s been cleared for gym,” Phillips says, “but they said he’s kind of done with contact sports.” “I’ve played since I was 6 years old,” she says of soccer. “I’ve played with these kids forever. But my health is more important than the sport. The main thing I miss is being part of the team.” Slayton plans to play golf in the spring. And she hopes to become a trauma nurse. Mikayla Four years ago, Mikayla Frego was tending goal for her soccer team in Norwood. “I was going to save a ball, and I dove. Next thing I knew, I woke up in the hospital. It was kind of like I was in a dream, almost.” After she was released from the hospital and back to school, she had headaches all the time and struggled to concentrate. Sometimes she passed out. But she didn’t want to tell anyone because she wanted to keep playing. Chris Chris Goodman wears glasses designed to help his eyes work together. A series of four concussions led him to develop a weakness in a nerve near his eye called sixth nerve palsy. “It’s getting a lot better,” his mother, Patricia Phillips says hopefully. Two of his concussions can be blamed on basketball: hard elbows to different parts of his head in different games. Another, he suffered when he and a friend were horsing around and he fell backward against a pole. The last one happened April 24, 2013 when a friend punted a football into Goodman’s head. The 16-year-old Syracuse boy was treated in the Upstate 12 U P S TAT E H E A LT H fall 2013 Eventually she sought care. She received physical therapy to help with vision and balance. She improved enough that she returned to her soccer team for her junior and senior year. Today Frego is a field player on an intramural soccer team at the State University of New York at Albany. “I feel great now,” she says. “Every now and then, I notice that my memory is not what it used to be. And I get headaches much more now.” She is a biology major with plans to attend medical school – which she says was influenced by her concussion experience. Frego thinks she would like to become a neurologist, or pediatrician. w w w. u p st ate . e d u James For a long time after that soccer game on Sept. 25, 2012, James DePaul looked like he was high on drugs, or sick with fever, recalls his mother, Diane DePaul of East Syracuse. She was watching from the sidelines and saw his head ricochet from side to side when a ball hit his head. His eardrum was perforated, his vision became blurry and he lost his balance. “For a 13-year-old who does karate not to be able to stand on one leg – that’s bad,” she says. DePaul drove her son to an urgent care clinic, which sent him by ambulance to Upstate University Hospital’s emergency department. Many people who suffer concussions see symptoms abate within a few weeks, but DePaul wound up needing physical therapy and occupational therapy. He attended school only for half days until after Christmas. He still managed to make the honor roll, and he played baseball in the spring. A year after the injury, his mother says “just because he looks OK doesn’t mean he is OK.” For instance, she wonders whether his migraine headaches are because of the concussion or something else, like puberty, and she figures she will have similar concerns the rest of his life. But one thing is for certain, she says: “He will never touch a soccer ball again, as far as I’m concerned.” ● Listen to an interview on this subject at www.upstate.edu/healthlinkonair by searching for “concussion.” 10 facts about concussion ● A concussion is a mild traumatic brain injury caused by a blow or a jolt to the head. ● No objective medical test diagnoses concussion. “It has to be diagnosed by taking a good history and looking at the way the person’s functioning is affected,” says Brian Rieger, PhD, director of the Upstate Concussion Center. ● The new state safety laws regarding concussion apply to scholastic sports – not youth sports organized outside of school. CLIP & SAVE IN THE KNOW ● Recognizing a concussion is crucial, so that the player can be removed from the game until he or she is medically cleared to return. ● Research shows that people who suffer repeated concussions take longer to heal and have more severe symptoms. The effects of repeated jolts to the head (concussion or not) are also thought to have long-term consequences. ● Headache is the most common symptom, but not all concussions are marked by headache. Symptoms vary from person to person. ● Concussion may or may not be accompanied by a loss of consciousness. ● Damage from a concussion is almost always short-term, when managed properly. However, some symptoms may linger for months. ● Until recently, the only data on concussion rates was from professional, collegiate and high school teams. Now researchers say the rates are comparable in youth sports. ● Upstate’s Concussion Center (315-464-8986) provides comprehensive evaluation and treatment services for people struggling with the lingering effects of concussion. fall 2013 U P S TAT E H E A LT H 13 FOR OUR COMMUNITY Pediatricians who specialize in infectious diseases at Upstate Golisano Children’s Hospital administered shots last year at the Christmas Bureau. Distributing the gift of good health ffering flu vaccinations when people came to the Salvation Army holiday gift program last year in Syracuse improved vaccination rates so much that authorities plan to make it an annual event. Upstate pediatricians and medical students decided to target families that registered for the gift program as a way to reach a population with low vaccination rates. Families with incomes below 150 percent of the federal poverty level qualify for the gift program. O Some parents decline vaccinations for cultural or religious reasons, or philosophical differences. But a lack of access (no transportation, or no ability to take off work for medical appointments) and a lack of education are the main reasons poor families skip childhood vaccinations, says Joseph Domachowske, MD, a professor of pediatrics specializing in infectious disease. Researchers wondered if they could increase vaccination rates by educating the families and making vaccines available at the gift program. They provided education along with the pneumococcal vaccine for children age 6 and younger, and the flu vaccine for children of all ages and their family members. “We met each family individually, and asked questions regarding their understanding of routine pediatric vaccines,” recalls Manika Suryadevara, MD, an assistant professor of pediatrics also specializing in infectious diseases. Then, researchers checked each child’s vaccination status. Of 1,531 children, just 416 were current with all of their childhood vaccinations. That’s 28 percent. The results? Among children who attended the gift program, 45 percent were current with all of their childhood vaccinations. “We found that providing vaccine access for the families at a place where they’re already accessing other services was effective in increasing vaccination rates in this community,” Domachowske says. “It won’t solve the whole problem, but it’s one of those steps toward a solution.” Their research paper appears in the August 2013 edition of the journal, Pediatrics. ● Listen to an interview on this subject at upstate.edu/healthlinkonair by searching for “public health.” Social workers cut costs by reducing hospital readmissions aculty and student researchers from Upstate and Binghamton University have found a way to reduce readmission rates, for which hospitals are financially penalized. They turn to social workers to help people who have recently been discharged remain healthy in their own homes. F About 100 patients were part of a two-year study that looked at social worker intervention. Half of the participants received home visits in which a social work intern checked to see how they were faring. Did they have appropriate food for their diet? Was their oxygen being delivered properly? Was their sidewalk cleared of snow? Were they having side effects from their prescription medication? “It’s not a very time intensive intervention,” says Laura Bronstein, interim dean and professor of SUNY 14 U P S TAT E H E A LT H fall 2013 Binghamton’s Department of Social Work. “Most of these home visits were between half an hour and 45 minutes, with maybe two follow-up phone calls.” She says this approach was effective in reducing readmissions by more than half. Shawn Berkowitz, MD, director of geriatrics at United Health Services and a clinical professor at Upstate, says the savings can be substantial: “A social worker can create savings equal to his own salary and benefits just by preventing seven readmissions a year – and the patient’s quality of life is improved significantly in the process.” ● Listen to an interview on this subject at www.upstate.edu/healthlinkonair by searching for “social workers.” w w w. u p st ate . e d u FOR OUR COMMUNITY Into Africa on a medical mission urse Lauri Rupracht would see Africa on television as a child and tell herself, ‘some day I’m going to go and help.’ That day came when her children were grown. Now Rupracht, 51, is organizing her third trip in as many years to the rural villages of Ghana. She says it is a safe and peaceful country with a high poverty level. “The country has so much potential,” she says. N Last spring she spent her vacation leading a group of 13 nurses from the Syracuse area to Ghana. They sweated from the time they got off the plane, traveled for hours in a bus along dirt roads and slept beneath mosquito nets. One of the nurses, Kimberly Vuocolo, recalls the working conditions throughout the villages they visited: “Sometimes we had electricity, and sometimes we didn’t. Sometimes we had water, and sometimes we didn’t.” Vuocolo, 28, an oncology nurse, says in addition to providing health care to 1,470 people, the group delivered school supplies and sneakers to orphanages and schools. They also managed some tourist side trips. Rupracht is organizing another trip next spring. The Americans Serving Abroad Project (ASAP) will return to Ghana in March 2014 to provide medical care in rural villages. “It’s probably the hardest work anybody’s ever going to do, under the circumstances in the heat,” Rupracht says. “But you get so much out of it. You come back with a whole new perspective. You come back a changed person.” The volunteers provide first aid, blood pressure and diabetes screening to patients who would otherwise have to walk hours for care. Patients with problems that require follow-up are directed to a hospital. The ASAP group partners with the nonprofit ElGhana, which helps arrange the clinics, lodging and transportation between villages. WANT TO HELP? L auri Rupracht is hoping to include a physician, nurse practitioner, dentist or dental assistant, optometrist, nurses and medical students or residents on her next trip in March 2014. She estimates each volunteer will need about $2,500 for the trip and a variety of vaccinations before traveling. Learn more by emailing Rupracht at email@example.com Perhaps the most difficult part of the trip is realizing that, as Rupracht describes, “you can’t do everything.” A girl of 8 or 9, for instance, had never seen a doctor and was malnourished. Checking her pulse and looking in her mouth for obvious tooth decay was not going to solve that. “You can only do so much.” ● Listen to an interview on this subject at upstate.edu/healthlinkonair by searching for “Ghana.” fall 2013 U P S TAT E H E A LT H 15 FOR OUR COMMUNITY ew York Mayor Michael Bloomberg proposed a ban on sugary drinks in containers larger than 16 ounces. It was a strategy to fight the epidemic of overweight and obesity that affects 58 percent of residents, increasing their risk for heart disease, cancer and diabetes. N THE UPSTATE Ethicist The New York City Board of Health enacted the ban because the National Institute of Medicine and most public health bodies in the country now recognize that sugar-sweetened beverages are a main dietary contributor to recent dramatic increases in the incidence of obesity in America, according to Syracuse University law professor Peter Bell and Upstate bioethicist Amy Campbell, who spoke at an ethics symposium at Upstate this summer. Two courts have ruled the city overstepped its legal bounds, but public health experts believe those court judgments are misguided. They say a cap on the size of sugar-sweetened beverages sold in fast food establishments was simply another modest restriction on individual liberties, a necessary step in protecting the public from the health threat of obesity. Restrictions on individual choice have been recognized for 150 years, first with quarantines during smallpox and cholera epidemics and including mandatory school vaccinations against other virulent diseases. Public health laws may not be popular, but they can effect change. It was New York City that pioneered laws requiring restaurants to include calorie counts on menus. Although researchers found that did not have a big impact on people’s food choices, it did spur some eateries to begin offering a bigger variety of low calorie options. ● GEM CARE A calm, easy-access setting especially for seniors. BENEFITS INCLUDE: • High level of geriatric knowledge. • Dedicated space, dedicated trained staﬀ. • Coordination with your own doctor — with the goal to return you home safely. • Immediate hospital care for those who need it. UPSTATE.EDU/GEMCARE 4900 Broad Road, Syracuse (the former Community General Hospital) 800.464.8668 16 U P S TAT E H E A LT H fall 2013 community campus w w w. u p st ate . e d u THE HUMORIST Ribs, shirt, ego suffer the brunt of bicycle ‘Emergency’ BY JEFF KRAMER veryone hears horror stories of long waits in ERs, but as an experienced patron of these facilities I’ve learned how to avoid lines: Go by ambulance. E So it was on a recent Friday when I ended up in the region’s only Level 1 Trauma Center after being hit by a car while riding my bicycle. T ypically, about a quarter of the people who are seen in Upstate University Hospital’s Emergency Department are admitted to the hospital. After getting hit, I sprang to my feet and walked a block to the DeWitt Fire Station from the crash scene to get checked out. I felt OK, but my left side hurt. I told a firefighter I’d been struck by a car. Then I got pale and woozy. I heard someone describe me as “diaphoretic”* — which immediately reminded me of the old television show “Emergency” and in particular Dr. Kelly Brackett who was always throwing around that word to impress the ladies. Then I thought about Nurse Dixie McCall and how, as a kid, I never thought of her as “hot” per se, but in retrospect her Awesomeness Quotient was quite high and I would now be extremely interested. Of the 144 people who came to the Emergency Department because of a bicycle injury in the first eight months of this year, 43 were admitted. The rest, including Jeff Kramer, were treated and released. And then my wife, Leigh, arrived at the fire station. She sounded worried but no more worried than usual as my emergent interludes go. Soon after, I was wheeled to a recovery area for observation. Dr. Mike Costanza, MD, a friend and vascular surgeon at Upstate, came by to check on me. He kept making me laugh, which made my ribs hurt. So much for “First, do no harm.” Then Dr. Jones arrived to make sure I could walk and to tell me the x-rays showed nothing broken or otherwise amiss. I could barely see her because by then I was strapped to a backboard, and someone had clamped a plastic mask on my face, apparently to stop me from talking. An ambulance arrived, and off I went to Upstate where I became the charge of Dr. Samantha Jones, MD and her team of Concerned Helper People. I don’t remember a lot, but I do remember the team searching with ultrasound for something called Morison’s pouch** and me being relieved when they finally found it even though I had no idea what it is. A nurse gave me some bad news: My favorite neon green UnderArmour shirt would have to be cut off. That was tough to take. I felt cold, and I kept hearing the words “hematoma” and “abrasion” in reference to my injuries. Yet even in my compromised state I was impressed by the thoroughness with which the team probed my personage. I was asked about a small bandage on my shoulder. I told them it was from a cortisone shot I’d had earlier that day. What can I tell you? I have issues. Samantha Jones, MD, Emergency Medicine resident, College of Medicine, class of 2011 My wife had even better news: My bike wasn’t seriously injured either. And so what could have been a tragic day ended well, thanks to good fortune, some experienced firefighters and a crackerjack team of emergency room professionals living up to the proud tradition of Dr. Brackett and Nurse McCall. The lesson for Central New Yorkers is clear: If you’re shopping for a Level 1 regional trauma center, you can’t beat Upstate. I know I’ll be back. ● * Diaphoretic means sweating profusely. **Morison’s pouch is the space separating the liver from the right kidney, which may fill with fluid as a result of injury. Veteran journalist Jeff Kramer also writes for the Syracuse weekly, The New Times, which is published every Wednesday. Gradually the room became more relaxed. Dr. Jones asked if I’d like something for the pain. That sounded like an excellent idea. Then I heard the one word that makes being on the losing end of a car-bicycle accident almost worth it: morphine. Five minutes later I understood: The Upstate Regional Trauma Center is the most wonderfulest place on earth. fall 2013 U P S TAT E H E A LT H 17 PATIENTS FIRST Cancer some day, continued from page 5 creation of a simple way to screen for the disease. “A blood test is probably several more years off,” she says. “Its creation has been tricky because when chronic inflammation or another disease affects the pancreas, blood that is tested for cancer can give a false positive. Doctors would not want to give a patient such a dire prognosis and subject him or her to more extensive testing if the person did not have cancer. This is why it has been such a struggle.” As for a genetic test, Brentnall says research is underway to determine which genes may predispose a person to pancreatic cancer. She and other scientists are looking at proteins in the blood, which perhaps could be used as a biomarker the way ProstateSpecific Antigen is used to detect prostate cancer. Progress is slow because of a lack of research money. “Pancreatic cancer is highly lethal. It is increasing in the population. Yet, there’s very little funding to study this disease,” Brentnall says. “The researchers in the field have been heroic in trying to get this work done. It has been a real uphill struggle.” The Halleran family has made its contribution to science. Michael Halleran underwent an endoscopic ultrasound so Brentnall could get a good image of his pancreas. What was revealed was troubling. Additional images were taken using an endoscope containing a camera that was threaded into the duodenum, the part of his intestines that sat against the pancreas. A contrast dye was introduced, to help show abnormalities in the ducts, where cancer forms. Brentnall again did not like what she saw. To make the diagnosis of pancreatic pre-cancer, a piece of tissue has to be examined under a microscope. So, Michael Halleran underwent a laparoscopic biopsy, in which the tail of the pancreas was removed for further study by pathologists. The laboratory reported severe pre-cancer throughout all of the tissue. He was developing pancreatic cancer. The pancreas has two main functions. It provides enzymes to the intestines so that food can be digested, and it controls blood sugar levels. This means that people who have complete removal of the pancreas would have to take pancreatic enzyme pills with their food and would be diabetic, requiring insulin to control blood sugar. Michael Halleran understood this, and given his family history, he decided to have the rest of his pancreas removed before the pre-cancer could become cancer. The surgery took place in 2003 and made an impression on David Halleran in Central New York: His 18 U P S TAT E H E A LT H fall 2013 David Halleran MD is the president-elect of the Onondaga Medical Society. brother had been healthy and in no pain. Yet, his pancreas was found to be in a severe pre-cancerous state. Halleran made an appointment for a computerized tomography scan in Syracuse. He looked at the technician’s screen. He saw a bump on his pancreas. “This is not good,” the surgeon fretted to himself. The bump turned out to be a benign abnormality, but the experience got Halleran’s attention. He decided to travel to Seattle for an evaluation similar to what his brother had done. Halleran’s surveillance imaging exams were abnormal, like his brother’s, so he too underwent a laparoscopic removal of the pancreatic tail. His operation did not go as smoothly. Halleran wound up hospitalized for 13 days. He returned to Syracuse wearing drains from the surgical site. He was out of work for three months, recovering. When the pathology report arrived, he barely paid attention. Meanwhile, he watched his brother thrive. Michael Halleran took a new job, moved his family across country, and stayed active. Of course without a w w w. u p st ate . e d u PATIENTS FIRST pancreas, he was enzyme deficient and diabetic. But, life was going well. “I feel like I dodged a bullet,” he says. “The cancer has been, basically, prevented.” More than a year after the biopsy, Halleran set about making a big decision he would not be able to reverse. He dug out the pathology report, which said his pancreas had “varying levels of dysplasia with some high grade dysplasia,” the scientific word for pre-cancer. He worried whether he was already too late. He was back to taking care of his colorectal patients two months after his surgery. Since his brother was no longer living in Seattle, Halleran sought the surgeon who had operated on his older brother, in Boston. Halleran refers to July 12, 2005 as his “pancreas independence day.” His surgery lasted 10 hours. One of Brentnall’s colleagues was there to collect part of his pancreas, to transport back to Seattle for further study. Halleran was hospitalized for a week before heading back home to Jamesville. As he settled into his new life of continual insulin and enzyme injections, he was full of gratitude. His pancreas contained no cancer cells. “This is pretty good,” he thought. “I can work. I can snowshoe. I can ski. I can kayak. I can do all the things I like to do.” He is concerned about two sisters, one of whom is beginning to explore her risks. And he’s concerned about his four grown children. Will a blood or genetic test be created in time to help them? “In all honesty, I feel lucky. It took my father and my older brother dying to bring this to light for us.” Eight years out, he still wonders: If his pancreas had not been removed, would he be battling cancer? How long did he have before the cancer cells formed? It could have been a year later. Or two. There is no telling. He is glad he had the operation when he did. “I think later, it would have been too late.” ● ABOUT THE PANCREAS S cientific advances in recent years mean that crucial functions of the pancreas can take place even if the gland is removed to treat a variety of malignant or benign diseases of the pancreas. Without a pancreas, a person must receive injections of insulin and digestive enzyme replacements. Insulin replacement can be accomplished through a pump, but food and activity level have to be carefully tracked to ensure the correct dosages. Removing the pancreas is an involved surgical process. The gland is deep in the abdomen, between the stomach and the spine. Its thickest part, its head, is nestled against the small intestine, and its tail is close to the spleen, with two major blood vessels passing by. The pancreas and bile duct both attach to the small intestine, near where it attaches to the stomach, so the first step is to detach the stomach. Then the gland is removed, along with the section of small intestine called the duodenum. And then the stomach and bile duct have to be reconnected to the small intestine. Removing part of the pancreas is an option for people with pancreatic cancer if the cancer has not spread outside the gland. Most cancers of the pancreas arise in the exocrine cells, or those in the outer part of the gland, which are responsible for making digestive enzymes. Actor Patrick Swayze was 57 when he died from this type of cancer in 2009. More rare is cancer that arises from the neuroendocrine cells in the pancreas. Some of these arise from the inner cells called the islets of Langerhans that make hormones to secrete into the blood. The hormones, insulin and glucagon, help the body maintain a proper level of sugar in the blood. Others arise from similar cells but don’t secrete a hormone. This type of pancreatic cancer, which grows more slowly, is what killed Apple co-founder Steve Jobs in 2011 at the age of 56. fall 2013 Pancreas (behind stomach) U P S TAT E H E A LT H 19 IN OUR LEISURE 5 reasons I love soccer BY JIRI BEM, MD 1 Soccer colored my childhood. “When you grow up with soccer (known outside of the United States as futbol), you get to understand the game better, and you appreciate the finesse of it much better than if you don’t play the sport in your childhood. “I grew up in the Czech Republic, so I didn’t grow up with baseball, so I don’t have that much appreciation for the finesse of baseball. I don’t have an appreciation for American football at all. Yet, it’s clearly a very demanding game, and clearly there has to be some finesse in it, but I don’t see it. I don’t see the chemistry in the teams. That’s why it’s not interesting to me.” 2 Soccer inspires camaraderie. “I’m on a team. We play every Sunday in a league at Sport Center 481 (in East Syracuse) for age 35 and older. It usually starts in early October, late September and goes into April. I’ve been playing in that the last five or six years. “And, every Thursday evening, I play with the residents and the attending physicians at Barry Park. Dr. (Gennady) Bratslavsky, MD, the chairman of urology, is an excellent soccer player. He’s got really good feet.” “I consider myself a striker, (a forward who is expected to score goals.) But as I age I’m getting slower and slower, so I will probably pull myself to the defensive line, mainly.” Jiri Bem, MD, 49, (front right, in a white t-shirt decorated by his son, Matthew) is an associate professor of surgery specializing in colorectal oncology and colon and rectal surgery. Bem is pictured with, from left: Iker Unzalu, MD, first-year surgical intern; Mark Ilko, MD, second-year surgery resident; and Jeff Stein, MD, fourth-year surgery resident. 3 Soccer fits into an athletic life. “I run. I swim. I lift weights. I ski downhill and cross country. I bike a lot, probably every other day or so. “In the remote past, I used to be a very good tennis player. I almost turned professional when I was 16. The coach of (Czechoslovakian Wimbledon tennis star) Hana Mandilkova came up to my parents and said ‘I’m going to make him superstar, if you move to Prague and he devotes all his time to tennis and forgets about school and everything else.’ And my parents were against it. That was the breaking point of my tennis career. I did want (to go) but I was a good boy and listened to my parents.” Does he have regrets? “Looking back, I think I had exceptional discipline. As a parent, watching the kids around, it’s very rare to see somebody who is committed. If you read about Bjorn Borg, one of the best players of all time, his story was very similar. But he, in contrast to myself, said ‘Screw you parents. I will still do it. I am going to move at age 14 or 15 by myself, and I’m going to just bet on this one card.’ Maybe that’s what you need, and what I didn’t have, to reach the pinnacle of sports. Maybe, in retrospect, I see myself as more talented than I was — but, I was a champion of the Czech Republic when I was 12 and 13, so I did have something in my hands to substantiate the claim. 20 U P S TAT E H E A LT H fall 2013 “I kept playing tennis for fun, but less and less and less. I wasn’t used to losing, and I started losing with less training.” 4 Soccer from the sidelines is also enjoyable. “It’s fun to watch Brazil and Spain and Germany. I usually become a fan of the team that plays the nicest soccer. I do like the US and, of course, I was born in the Czech Republic, so I do follow their results.” Does he play more or watch more soccer? “It’s probably 50/50. I do watch mostly my kids, because that’s much more fun than anything else.” He has 16- and 10-year-old boys, both of whom have the speed and agility necessary to play midfield. 5 Soccer led me to my wife. “I met her playing soccer (in the Czech Republic.) She was on the opposing team.” They both attended medical school at Charles University in Pilsen and completed residencies and fellowships at the State University of New York at Buffalo and at Upstate. Sylva Bem, MD is an assistant professor of pathology at Upstate. ● w w w. u p st ate . e d u IN OUR LEISURE Jason Meany teaches scuba diving and brokers dive trips through his company, Deep Stop Scuba. A drive for racing BY AMBER SMITH ary Kittell was looking for a hobby 25 years ago. “I needed something to do,” he explains, “and I had always liked cars and going fast.” So, he volunteered at Watkins Glen International speedway, “and I came to the conclusion that the people having the most fun were the drivers.” G So, he became a driver. He chose a class of car made from Volkswagen parts, known as Formula Vee, and got started with a car he bought from a man getting out of racing. He learned to race, honed his repair skills, and looked to his wife, Elisabeth, to be his crew chief. They celebrated their 45th anniversary this summer. Kittel is a physical plant administrator at Upstate. For many years the couple spent their weekends driving to racing events year-round, towing the car and replacement parts in a covered trailer. Now they attend a handful of major racing events each year. “The thing about racing is, you can think about it at night or before the season starts, but once you’re at the track, it gets pretty consuming. Once you’re in the car and the motor starts and the green flag flies, time disappears,” Kittell says. “Your entire world is the cockpit of the car, and it’s that way until the race is over. There is absolutely no room for any extraneous thoughts, whatsoever.” His car will go more than 120 miles per hour. Like all drivers, Kittell wears a helmet, insulated balaclava and fire suit. He is buckled in with a six-point harness. His arms have restraints to be protective in a rollover. His neck has a special brace that connects his helmet to the seat to protect his neck and head. The car is like a steel cage, complete with fire suppression. Despite all of the precautions, he has been injured. He suffered whiplash in one rollover, a broken collarbone in another, and he slammed into a concrete wall at New Hampshire International Speedway. “That knocked me out for a while,” he says. Kittell recovers each time and returns to the racetrack to continue with his hobby. “It’s good because it’s competitive, and it’s cars. I like working on them, I like driving fast, and it’s technical. For me, it seems to be an ideal fit.” ● calorieBURN he exact number of calories you burn is affected by your age, gender, body size and composition and level of physical fitness. Here’s an estimate of how many calories someone weighing 176 pounds would burn if he or she did the activity for an hour. T Ironing: 156 calories Karate: 936 calories Basketball practice: 660 calories fall 2013 Scrubbing floors: 522 calories U P S TAT E H E A LT H 21 IN OUR LEISURE Tide turns to traumatic childhood in powerfully real ‘Ocean’ novel BY ANN BOTASH, MD ithin a few pages of the first chapter of “The Ocean at the End of the Lane,” by Neil Gaiman, the tension between reality and myth creates a chilling sense of anticipation. As a physician who treats abused children, I immediately recognized and felt the unmistakable raw dread that accompanies the witnessing of a recovered traumatic memory. Published reviews did not prepare me for the entry into Gaiman’s world of childhood monsters or the beauty of his description of human nature and resilience. The story begins with a man returning to his hometown to attend a funeral. We can only guess that the dead person was important to the man, as he must do a reading at the funeral. Yet, his name and relationship to the deceased remain unknown as the more vivid story from his past resurfaces. W The man’s memory is recalled from the point of view of himself as a 7-year-old boy. We learn of the boy’s poverty, natural imagination, ability to withdraw from life into the books he reads, and his experiences of being bullied. The story is full of mythical creatures, people who can see and hear him from afar and from inside of his head. Monsters are everywhere in the story, as are the larger-thanlife saviors. In my professional work, I have learned that the memory of a child who suffers significant childhood trauma is often colored by the brain’s attempts to make the story whole. The child’s brain, one that is imaginative and creative, will fill in the gaps. Knowing this, the stream of key points of trauma can be strung together by the listener. The memory becomes unleashed while the man sits at the edge of a pond at the farm at the end of the lane, a pond that was deemed an ocean by his childhood friend. The neighbors: a girl, her mother, and her grandmother, were supportive of the boy during some traumatic and stressful times. He first meets them after he finds the body of his family’s boarder, just after the man committed suicide. The car, the man’s face, the hose leading from the exhaust to the window are exquisitely described. Similarly, a new boarder, who becomes his nanny, is also described in detail. It seems those are meant to be the “real” parts to the memory. 22 U P S TAT E H E A LT H fall 2013 The memory storyline is thick with metaphors. For example, the narcissus flower represents a predominant image woven together with images of boundaries. The neighbors pick the flowers, the father gives them to the nanny, and the boy relates the story of how Narcissus dies staring at his reflection and turns into a flower. He pauses to think, “I had imagined that a narcissus must be the most beautiful flower in the world. I was disappointed when I learned that it was just a less impressive daffodil.” This foreshadows his ability to see through at least one of his monsters. The nanny, with the somewhat villainous name of “Ursula,” is a monster narcissist. The boy identifies her (described as a pain in his heart) as evil, but the family succumbs to her deception. With each of his attempts to point out her true nature to his parents his situation worsens, and the relationship with his parents deteriorates. Although the story has characteristics of a fable, the description of the course of toxic relationships and its effects on other relationships is powerfully realistic. The narcissist’s “need” for him, as a portal to her other world, is a symbol for how boundaries are crossed by narcissists. As a child abuse pediatrician, I noticed the authenticity of the boy’s conflicted feelings of love toward his father despite his father’s abusive behavior and anger. If you read the book, think carefully about the description of the boy’s dream, the shilling the boy finds in his throat, the choking, and the fact that his grandfather was in his dream. I read this book in a half day, and then I read it again. Unlike the man, whose memory was eventually “snipped out” by the neighbor grandmother only to be recovered later, this story will stay with me for a long time. ● Professor Ann S. Botash, MD is a pediatric specialist in the care and treatment of abused children. She is also associate dean for education at Upstate. She won a Bruce Dearing Writing Award this year for her short story, “Whistling Willie’s Love Song.” w w w. u p st ate . e d u IN OUR LEISURE HEALTHY eats Lemon Semolina Pound Cake with Macerated Strawberries WHY DO WE NEED FIBER? 1. Fiber aids in digestion. “And the better your digestive system is, the better nutrient absorption you have,” says Upstate registered dietitian Terry Podolak. E ven healthy eaters sometimes break for sweet treats. Here’s a fresh alternative to store-bought strawberry shortcake. Ingredients For the strawberries: 1 quart fresh strawberries, sliced 2 tablespoons fresh spearmint, thinly sliced ½ cup sugar ½ cup water 1 teaspoon lemon juice For the whipped cream: 1 cup fat-free yogurt, plain 1 cup light whipping cream 2 tablespoons confectionary sugar Preparation For the strawberries: Combine water, sugar and lemon juice in a medium sauce pot and bring to a boil. Allow syrup to cool to room temperature. Place strawberries and mint in a mixing bowl and mix to combine. Pour syrup over the fruit. Refrigerate for at least 2 hours. For the whipped cream: Whip cream until thick and add sugar, being careful not to over mix. Fold in yogurt. Refrigerate until ready to use. Nutritional information, per serving 250 calories 15 grams total fat 2. Fiber can help you feel full, which can help reduce overeating and help improve weight loss. Strive for 25 to 35 grams per day. For the cake: 1 cup all purpose flour 1 cup fat-free yogurt, plain 1 cup granulated sugar 1 cup melted butter 2 tablespoons baking powder 2 large eggs 1 tablespoon lemon juice 1 teaspoon grated lemon peel ¼ teaspoon vanilla extract 3. Soluble fiber (found in fruits, vegetables, beans, oats, barley and bran) helps remove the dangerous LDL cholesterol from the bloodstream, reducing the risk for cardiovascular disease. For the cake: Preheat oven to 350 degrees. Mix flour, sugar, and baking powder in a large bowl. Add butter and yogurt to dry ingredients and mix. Add eggs, lemon juice, zest and vanilla. Beat mixture for 2 minutes until there are no lumps. Pour mixture into a lightly greased 9”x 5” bread pan. Bake on the middle rack in the oven for 45 minutes. Remove from pan and cool completely. Slice pound cake into 10 portions of 5 ounces each. Top each with 1 ½ ounces of cream and 3 ounces of the strawberry mixture. 273 milligrams sodium 21 grams sugar 4. Soluble fiber also helps delay gastric emptying, helping with blood sugar control and diabetes. 5. Insoluble fiber (such as leafy green vegetables) provides roughage. “Think of it like a scouring pad going through your intestines. It helps move foods through,” Podolak says. Registered dietitian Terry Podolak appears regularly on Upstate’s weekly talk radio program, HealthLink on Air, from 9 to 10 p.m. Sunday evenings on WRVO Public Media. Learn more at upstate.edu/ healthlinkonair RECIPE FROM MORRISON HEALTHCARE, FOOD SERVICE PROVIDER FOR UPSTATE MEDICAL UNIVERSITY. fall 2013 U P S TAT E H E A LT H 23 Non Profit Org. US Postage PAID 750 East Adams Street l Syracuse, NY 13210 Permit No 110 Syracuse, NY S C I E N C E I S A RT I S S C I E N C E I S A RT 1 S S C I E N C E I S A RT I S S C I E N C E I S A RT I S S C I E N C E I S A RT I S S C I E N C E W endy Kates, PhD, and colleagues from the department of Psychiatry and Behavioral Sciences are studying schizophrenia. This image is derived from a type of magnetic resonance imaging known as diffusion tensor imaging. It depicts bundles of nerve fibers in the brain. These nerve fibers, called axons, transmit information in the form of electrical impulses to different neurons in the brain. In this image, they are color-coded to represent the direction of the nerve fibers. For example, fibers coded in green extend from the front to the back of the brain, and fibers coded in red extend from left to right. The image was prepared by Ioana-Lavinia Coman, PhD. 13.390 1113 34.150M ELsk Wendy Kates, PhD Ioana-Lavinia Coman, PhD