Health UPSTATE
UPSTATE MEDICAL UNIVERSITY
Summer 2018
WHAT TO DO IF YOU WITNESS A STROKE page 5 HOW TO SAVE SOMEONE FROM OVERDOSE page 15 SHE AWOKE PARALYZED page 13 BRAIN RESEARCHERS PUT THEIR HEADS TOGETHER page 18 YOGA FOR ALL page 22
WHY SOME SURGEONS PRACTICE ‘DAMAGE CONTROL’ page 10
New pharmacy open for business
WELCOME
NO NEED TO STOP at the pharmacy aer you’re discharged from your stay at Upstate University Hospital. A new outpatient pharmacy near the lobby offers a “meds to beds” service that delivers take-home prescriptions to patients at the bedside before they go home. e Upstate Pharmacy also dispenses prescription drugs to the general public. It’s located just inside the hospital’s main entrance on Adams Street in Syracuse. Hours are 9 a.m. to 7 p.m. Monday to Friday and 9 a.m. to 2 p.m. Saturday and Sunday.
Most major health insurance plans are accepted. For patients who need financial support to meet copays, the pharmacy has an advocacy foundation and other programs that can help. A drug disposal box is located outside the pharmacy entrance for the safe collection of unwanted or expired medications. is is designed to eliminate potential consumption of a discontinued medication, reduce drugs entering the waste stream and avoid the potential abuse of controlled substances, including opioid painkillers. Patients can opt for the “meds to beds” program upon admission to the hospital, explains pharmacist Luke Probst, Upstate’s executive director of pharmacy. “Ensuring that patients have their prescription medicines before they are discharged helps improve medication adherence and can reduce hospital readmissions,” he says. e pharmacy receives any take-home prescription orders as soon as the physician or nurse practitioner enters them into the patient’s electronic medical record.
Cutting the ribbon to officially open the new SUNY Upstate Outpatient Pharmacy are, from left, Upstate University Hospital Interim CEO Robert Corona, DO, MBA; Pharmacy Technician Stephanie McDevitt, CPhT; Pharmacist Emily Adamy, PharmD; Pharmacy Director Luke Probst, PharmD; Pharmacist David Geloso, PharmD; Upstate Medical University President and Health System CEO Danielle Laraque-Arena, MD, FAAP; Associate Director of Pharmacy Enterprise Eric Balotin, RPh; and Chief Financial Officer Stuart Wright, CPA, MBA. PHOTO BY DEBBIE REXINE
e pharmacy team works with the patient’s health care team to obtain insurance pre-authorizations, if necessary. And, pharmacists add a layer of patient safety by reviewing all of the patient’s medications for any dangerous interactions. Under “meds to beds,” patients will receive medication counseling by a pharmacist who is familiar with their hospital stay. ● To transfer prescriptions to the Upstate Pharmacy, call 315-464-DRUG (3784.)
89.9 & 90.3 FM
6 a.m. & 9 p.m. SUNDAYS ON WRVO
2
U P S TAT E H E A LT H
Listen anytime on www.healthlinkonair.org or find us on iTunes
upstate.edu l summer2018
WELCOME
Contents 5
6
PATIENT CARE
12
IN OUR LEISURE Yoga for all
page 22
Music and medicine
page 23
page 2
What to do if you witness a stroke
What is the role of interventional radiology? page 16
page 5
Putting their heads together
page 6
Why calling 911 is important
page 8
A surgeon’s ‘damage control’ strategy
page 10
At high risk for breast cancer
page 12
She awoke paralyzed
page 13
DEPARTMENTS page 18
IN OUR COMMUNITY Giving back to his home country: Afghanistan
Health How-to page 15 Save someone from overdose Science Is Art Is Science How cancer invades
page 14
back cover
page 20
Health UPSTATE
UPSTATE MEDICAL
A small box that saves lives
21
FROM OUR EXPERTS
Check out the new pharmacy
Remarkable stroke recovery
18
On the cover: Peter Corigliano underwent surgeries by Moustafa Hassan, MD, after an industrial accident., page 10. PHOTO BY SUSAN KAHN
UNIVERSITY
Summer
2018
WHAT TO WITNESS DO IF YOU A STRO KE page 5 HOW TO SAVE SOM FROM OVER EONE DOSE page 15 SHE AWO KE PARA LYZED page 13 BRAIN RESE THEIR HEADARCHERS S TOGE PUT THER page 18 YOGA FOR ALL page 22
WHY SOM SURGEO E PRACTI NS CE ‘DAMAG CONTR E OL’ page 10
Health UPSTATE
Summer 2018
EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications EDITOR-IN-CHIEF
Amber Smith
WRITERS
Jim McKeever Jim Howe Susan Keeter Amber Smith
DESIGNER
Susan Keeter
Visit us online at www.upstate.edu or phone us at 315-464-4836. For corrections, suggestions and submissions, contact Amber Smith at 315-464-4822 or smithamb@upstate.edu ADDITIONAL COPIES: 315-464-4836 Upstate Health offices are located at 250 Harrison St., Syracuse, NY 13202
Upstate Health magazine is a community outreach service of Upstate Medical University in Syracuse, N.Y. Upstate is an academic medical center with four colleges (Medicine, Nursing, Health Professions and Graduate Studies); a robust research enterprise and an extensive clinical health care system that includes Upstate University Hospital’s Downtown and Community campuses, the Upstate Cancer Center and the Upstate Golisano Children’s Hospital. Part of the State University of New York, Upstate is Onondaga County’s largest employer.
Need a referral? Contact Upstate Connect at 315-464-8668 or 800-464-8668, day or night, for appointments or referrals to the health care providers on these pages or anywhere at Upstate or for questions on any health topic.
summer 2018 l upstate.edu
U P S TAT E H E A LT H
3
PATIENT CARE
4 organ donors improve lives of 12 people BY AMBER SMITH
ONE BUSY WEEKEND in April saw the Upstate transplant team caring for four patients who made the decision to donate their organs upon death. In all, 12 people received lifesaving organ transplants thanks to the four donors.
in New York state. “e transplant business is unpredictable,” said Mark Laavi, MD, professor of surgery and the interim chief of transplant services. “Sometimes you have a couple donors in one day, and sometimes you have none. So, we are always prepared.”
Each of the donors — including two men and More than 7,000 people two women — were able died waiting for an organ The transplant surgery team, from left: Mark Laftavi, MD, Tamer Malik, MBBCH, to donate both their le transplant in 2016, according Zeki Acun, MD, Rauf Shahbazov, MD, and physician assistant Sharon Denise. and right kidneys to eight to the United Network for PHOTO BY ROBERT MESCAVAGE different people. Two of the Organ Sharing. Laavi is kidneys were transplanted at proud to help improve lives through transplant. Upstate, where surgeons perform more than 100 kidney “ere’s nothing more rewarding than saving a mother, transplants per year. Two hearts, two livers and the six a father or a child, who regain their lives,” he said. ● other kidneys were transplanted to patients elsewhere
HIGH MARKS
Upstate honored for stroke treatment
UPSTATE UNIVERSITY HOSPITAL’S CARE FOR STROKES and heart failure has again earned high marks from three national organizations. e award — Get With e Guidelines® — Stroke Gold Plus Achievement Award with Target: Stroke Honor Roll Elite Plus — recognizes the hospital’s commitment to providing the most appropriate stroke treatment according to nationally recognized guidelines. Upstate received the same honor last year. e designation is awarded by American Heart Association in conjunction with the American Stroke Association and the American College of Cardiology. Upstate became the only specially designated Comprehensive Stroke Center in the region, in 2015, when it met a rigorous review of its stroke treatment protocols by DNV Healthcare, a hospital accreditation organization. ●
4
U P S TAT E H E A LT H
upstate.edu l summer 2018
STROKE EXPERTISE
PATIENT CARE
Off-duty nurse spots stroke in progress, springs into action at restaurant BY JIM HOWE
wanted to go home.” Bradford says the stroke’s effects got noticeably worse before the ambulance arrived.
IF AN UPSTATE NURSE had not decided to take a photo aer dining out with a friend, another restaurant patron’s stroke could have turned out much worse.
e woman had a massive stroke. Bradford visited her in the intensive care unit the next day and befriended the woman’s daughters. ey stay in touch. e woman has recovered but has lingering speech and movement problems.
Cassandra “Sandi” Bradford, a diabetes nurse educator, was dining with a high school friend at the Bonefish Grill in Fayetteville Towne Center. Aer their meal, they stepped outside to take a photo together near the restaurant sign.
Although she now works for the Joslin Diabetes Center at Upstate’s downtown campus, Bradford previously worked with patients recovering from strokes. She has seen how tough the condition and its aermath can be.
Bradford had le her purse in the waiting area. When she returned for it, she noticed an elderly woman with a walker who seemed lost. e woman, who was 90, said she was about to leave with a relative aer their dinner. Bradford and the woman then le at the same time, Bradford through a revolving door, and the woman though a regular-style door beside it.
“I don’t think I did anything different than I would want someone to do for me,” Bradford says. Cassandra “Sandi” Bradford
“Now, you’ve got to picture that I’m in the glassed-in revolving door, and I notice her arm drop off of the walker, and then I notice she couldn’t li her foot to walk through the door, and I’m looking at her, and I’m saying, ‘She didn’t look like that a second ago,’ so I go back. “And I hear the person holding the door say, ‘Come on,’ and I looked at her face, and I said, ‘Something’s wrong with her.’ And her relative said, ‘You look like you’ve had a stroke.’ I saw her face, and I turned her around, and I said, ‘Let’s get her back in and have her seated.’” Bradford let it be known she was a nurse. She asked a hostess to call 911. en she got the woman seated and tried to get some medical information from her while keeping her calm. “She could still talk, but her speech was slurred. e right side of her faced drooped, and her eye was closing on her right side,” Bradford recalls. She checked the woman’s pulse and borrowed a light from someone’s cellphone to check her pupils, while waiting for the ambulance. e woman was initially upset at her relative, Bradford said. “She didn’t realize she was having a stroke and just
summer 2018 l upstate.edu
PHOTO BY JIM HOWE
“It really, really touched my heart that I was able to help someone.” ●
Act FAST if you suspect a stroke
Face
Ask the person to smile. Does one side of the face droop?
Arms
Ask the person to raise both arms. Does one arm drift downward?
Speech
?bof Ask the person to fry repeat a simple phrase, fleu? like “The sky is blue.” Is the person’s speech slurred or strange?
Time
If you see any of these signs, even if they go away, call 911 immediately.
SOURCES: AMERICAN STROKE ASSOCIATION, NATIONAL STROKE ASSOCIATION
U P S TAT E H E A LT H
5
PATIENT CARE
STROKE EXPERTISE
Remarkable recovery
His stroke care included fast-moving, coordinated efforts by his wife, ambulance crew and specialists at Upstate BY JIM HOWE
DAVE CARTNER HAS A REMARKABLE STORY TO SHARE.
The patient e 50-year-old Marcellus resident had finished breakfast on Feb. 13 and was about to leave for his job as a meat supervisor for a local food chain. “As I was walking out to the kitchen to say goodbye to my wife, my le foot felt heavy as I was walking the three or four steps to the chair. en I kind of slid into the chair, and as my wife was talking to me, she could notice my face was drooping a bit, and as I was trying to speak with her, my speech was very muffled. en my whole le side — my arm down to my feet — was gone. I couldn’t feel it any longer, so she could tell something was wrong,” he said.
Dave and Shirley Cartner PHOTO BY ROBERT MESCAVAGE
Jeff Elwood and Stephen Knapp of Marcellus Ambulance PHOTO BY SUSAN KAHN
Cartner’s wife, Shirley, realized he was likely having a stroke and called 911, overruling his request to “just get me in the car” and drive him to the hospital. “She’s the brains behind the whole thing. I can’t praise her enough,” her husband said of her insistence on an ambulance.
The ambulance team A Marcellus Ambulance crew quickly arrived, did a preliminary evaluation and got him ready for transport, recalled Stephen Knapp, the ambulance service’s executive director, who took part in the call. “It was quite obvious he had had a stroke,” he said. Crew members took Cartner’s vital signs, ran an electrocardiogram to check for a possible heart attack and relayed their information ahead to Upstate University Hospital, so the stroke team would be ready to receive the patient without delay. “e ambulance crew asked us what hospital we wanted to go to, and we picked Upstate, knowing it was the place to go for stroke, because of the specialists there,” Cartner said. e emergency medical technicians explained to Cartner that a team of professionals trained in stroke care would be waiting to meet him at Upstate. ere he would get an imaging scan of his brain to see where the problem was, and things would move quickly, since the clock is ticking when treating a stroke. e paramedics were able to relay Cartner’s medical information to the hospital while en route, including the crucial detail that he had been taking a blood thinner for atrial fibrillation, a heart condition.
continued on page 7
6
U P S TAT E H E A LT H
upstate.edu l summer 2018
STROKE EXPERTISE Remarkable recovery
PATIENT CARE
continued from page 6
The resident physician “It was pretty clear he was having a stroke, even before he opened his mouth, because one side was completely limp, his face was drooping, but his speech was intact, so he was able to answer questions,” recalled Claribel Wee, MD, the neurology resident who examined him. Since the le side of the brain controls speech, his ability to talk signaled that the problem was likely on the right side. e stroke turned out to be from a clot, not a bleed, which seems odd, since Cartner had been taking a blood thinner. Blood thinners, however, are not a guarantee against clots, Wee said. Another type of blood thinner is oen given in stroke cases, the “clot-buster” medicine tPA, but since an additional blood thinner could have caused heavy bleeding in his case, the doctors decided to try a different approach. “We found the large vessel occluded (blocked) exactly where we thought,” Wee said. She summoned specialists Grahame Gould, MD, and Hesham Masoud, MD, who agreed on what to do next.
The specialists Gould would perform a thrombectomy, or clot removal, through a process called interventional radiology. is means that, guided by an X-ray screen, he runs a slim tube up through an artery in the patient’s groin to an artery in his brain to ensnare the clot with a retrievable stent, then pull it out. “Patients can make wonderful recoveries in a short time, even if they do not recover as fast as Dave did,” Gould said of the procedure. Masoud oversaw Cartner’s care but stresses that resident physicians like Wee play a major role in initially evaluating
the patient, determining where the stroke is and what to do about it. “Kudos to the residents. ey work very hard, and you can directly link outcomes to the speed of their diagnosis,” Masoud said. He said the results could have been “devastating” if Cartner had not gotten to a stroke center quickly. He could easily have lost the use of his le arm or leg and had impaired vision and other problems. Without removing the clot, the right half of his brain would have been lost. “To go from that to be able to walk home — that’s pretty incredible. But it’s kind of a typical story these days. You see a lot of these Lazarus effects,” Masoud said. e Lazarus effect, referring to a man in the Bible who was brought back from the dead, is the sudden, seemingly miraculous recovery a patient can experience in a case like this.
The outcome Aer the thrombectomy, “Dr. Gould came in and checked on me. I was so glad, and he was really surprised I stood up and shook his hand,” Cartner said. “I feel great now,” Cartner said several months aer the stroke. His only lingering problem appears to be a dull feeling in his le arm that he is working to resolve. Wee called Cartner’s recovery “pretty remarkable,” considering how fast and fully he recovered. He was discharged Feb. 14, one day aer he was admitted to the hospital. Cartner is thrilled with the outcome of his stroke and praised the EMTs, doctors and nurses who took care of him. His only regret was for his wife. “I felt bad I ruined her Valentine’s Day,” he said.
●
Members of Upstate’s stroke team who had a role in caring for patient Dave Cartner include: seated from left, Claribel Wee, MD, neurology resident physician; Cartner; and Hesham Masoud, MD, stroke neurologist. Standing from left, nurse Lauren Kaul, emergency department; Grahame Gould, MD, neurosurgeon; Jessica Guido, X-ray technologist; nurse Michelle Vallelunga, stroke program data coordinator; Shirley Cartner, the patient’s wife; Shantel Henry, X-ray technologist; nurse Patricia Veinot, stroke data coordinator; nurse Josh Onyan, stroke program manager; and Theodore Albright, MD, emergency medicine resident physician. PHOTOS BY ROBERT MESCAVAGE
summer 2018 l upstate.edu
U P S TAT E H E A LT H
7
PATIENT CARE
STROKE EXPERTISE
Clot-busting medicine saved her from stroke
Retired physician assistant knew something wasn’t right She was able to let the ambulance crew into her home, but when she tried to tell them where to take her, “I couldn’t say the whole thing, just ‘Up … Ups …,’” she recalled. ey understood that she meant Upstate University Hospital. She was relieved on arrival to see not only her sister but a team of stroke specialists awaiting her. She was familiar with Upstate’s comprehensive stroke treatment program, aer spending nearly 10 years as a physician assistant in geriatrics at Upstate before retiring in 2013. She got the clot-dissolving drug, tissue plasminogen activator (tPA) quickly, once the stroke team determined that bleeding was not a problem. Five or six hours later, in the neurological intensive care unit, Rosecrants began to feel better. Speech language pathologist Carrie Garcia, left, works with stroke survivor Eileen Rosecrants. PHOTO BY SUSAN KAHN
BY JIM HOWE
EILEEN ROSECRANTS BECAME ALARMED during a phone call. “I couldn’t speak clearly,” she recalls of that evening last fall. It wasn’t that her speech was slurred. She couldn’t figure out what to say, so she abruptly hung up, thinking, “I’m not right.” Someone else then phoned her, and Rosecrants couldn’t handle that call, either, so she hung up again. en, the 73-year-old Baldwinsville resident phoned her sister in Syracuse, thinking she would understand something was wrong and call for help. Her sister figured out there was a problem and alerted 911. Rosecrants didn’t call 911 herself because she worried that her inability to speak would delay help — but now she knows it’s best to call 911 directly.
A day and a half later, she could repeat words and follow simple directions, such as liing her arm. She was able to go home. “I was so much better. I had the words back. I could make sentences. I could be socially appropriate. But there was, and is, a deficit,” she said.
She had weekly outpatient therapy to help restore speech and executive function — that is, the way people take in, think about and act on information. Carrie Garcia, a speech language pathologist at Upstate, helped her to regain skills including finding the right words, organizing her thoughts and following a set of directions. “People can relearn these things and gain them back,” Garcia says, “not always to the exact same level as before the stroke, but sometimes a modified or adapted level.” Meanwhile, Rosecrants has been living independently in her home, exercising at the YMCA three times a week, driving a car and shopping. She is grateful for Garcia’s help, especially for her suggestion to use a white board each month to write down all her activities and plans, continued on page 9
8
U P S TAT E H E A LT H
upstate.edu l summer 2018
STROKE EXPERTISE Clot-busting
PATIENT CARE
continued from page 8
which Rosecrants says greatly helps to organize her thoughts. “For somebody who made my living putting pieces together, it’s hard,” she said, referring to her years of treating patients. Upstate neurologist Antonio Culebras, MD, who treated Rosecrants aer the stroke, said, “She did the right thing by coming to the hospital as soon as she knew it was the beginning of a stroke.
Antonio Culebras, MD
“e key is to give tPA as soon as possible. Every minute, literally, counts,” he said. e drug has saved many people from ending up in a nursing home, he said. Upstate experts also have other methods for removing clots and restoring blood flow. Culebras says the techniques allow for recovery that was unimaginable 50 years ago. Although each case is unique, the neurologist noted that recovery can take a year or more. As for what to do when someone is suspected of having a stroke, Rosecrants knows to tell people: “Call 911 as fast as you know there is something wrong.”●
CALL 911 EVEN IF YOU CANNOT SPEAK
IF SOMEONE CANNOT SPEAK because of a stroke or other problem, he or she should still call 911. e 911 operator will try to keep the caller on the line and figure out what is going on, to rule out mistaken or crank calls. If a medical emergency is suspected, he or she will dispatch an ambulance, according to the Onondaga County Emergency Communications Department/ 911 Center. e 911 operator can usually figure out the caller’s location. If you think you are having a stroke, don’t drive yourself (which is dangerous) and don’t have someone drive you (which wastes time), advises Upstate neurologist Antonio Culebras, MD. Call 911 for an ambulance. e crew will be able to begin your care, monitor you and communicate with doctors at Upstate University Hospital, so the specialists from the stroke team are ready for your arrival.
summer 2018 l upstate.edu
Eileen Rosecrants, a few months after a stroke. PHOTO BY SUSAN KAHN
U P S TAT E H E A LT H
9
Damage control
PATIENT CARE
Surgeons rely on Navy strategy in operating on severely injured trauma patients BY JIM HOWE
PETER CORIGLIANO IS A LIVING EXAMPLE of what “damage control surgery” can accomplish. e Rome resident, now 62, was injured in a horrific industrial accident in 2012. He was working at Rome Strip Steel when a giant electromagnet slammed into him. e trauma shredded his abdominal muscles, broke his pelvis, ruptured his iliac artery, severed his colon and urethra, ruptured his prostate and cracked some ribs. Aer he arrived by ambulance at Upstate, surgeons worked to stop the bleeding and control the immediate emergency, but they did not do definitive repairs right away. Among other injuries, the accident caused hernias — where Corigliano’s organs protruded through the hole in his abdominal muscles. He had skin le, but no longer the underlying, supportive wall of muscle.
Instead of subjecting him to hours in the operating room that day, the surgical team controlled his injuries and sent him to the intensive care unit with a special dressing, like a plastic wrap, covering his wounds. His time in the ICU allowed his body to stabilize before undergoing the added stress of major surgery — which happened fewer than two weeks later. While this surgical strategy has become standard practice in academic medical centers today, it was not so as recently as the late 1990s, said the doctor overseeing Corigliano’s treatment, Moustafa Hassan, MD. He is Upstate’s chief of acute care surgery and Hernia Program. “Many years ago, surgeons were very concerned about initial injuries and wanted to repair them right away, even if it was very complex,” Hassan said. is meant a patient who might still be bleeding or otherwise unstable faced continued on page 11
Moustafa Hassan, MD, talks with his patient Peter Corigliano, who has made a profound recovery after being severely injured in an industrial accident. PHOTO BY SUSAN KAHN
10
U P S TAT E H E A LT H
upstate.edu l summer 2018
PATIENT CARE
Damage
continued from page 10
several hours in the operating room, putting heavy demands on the body. “Over the years, we found that doing that and keeping them unstable made them worse, with a worse outcome,” Hassan said. So, for severe cases — such as gunshot wounds, serious car accidents or nonviolent problems like a piece of intestine becoming strangulated as it pokes through a muscle wall — surgeons began opting for damage control.
CANCER CARE. CLOSE TO HOME.
“It was found that temporary repair is associated with better outcomes and survival,” Hassan said. Aer preliminary surgery — which might include a colostomy, stapling or other measures and can be reversed later — the patient is carefully monitored in the ICU. A definitive operation then takes place usually within one to three weeks, depending on the patient, he said. THE TRAUMA SURGERY STRATEGY known as damage control has a long history in the Navy. Damage control keeps a troubled ship afloat and stable until lasting repairs can be made. Damage control is practiced in many types of surgery, from the hernia repairs and other abdominal work done by specialists like Hassan to repairs of the heart, bones and blood vessels. Corigliano’s case is unusual in that he lost his abdominal wall and would have to come back for additional surgery, including getting pig tissue to replace his abdominal wall. “I’m doing OK, but my life has changed drastically,” says Corigliano, who is on disability and faces limitations like no heavy liing, constant nerve pain in his legs, difficulty sitting for extended periods and having to mostly give up the outdoor pastimes of hunting, fishing and motorcycle riding he used to enjoy. He credits his wife, Carlene, with helping him get through the years of surgeries, rehabilitation and recovery. “I couldn’t have done it without her,” he says as he recounts the accident and its aermath. His wife in turn praises the medical care he received. “If it wasn’t for Dr. Hassan and his group and all the specialists he ended up seeing, he wouldn’t be here, so for that we’re very, very grateful,” she said. “He’s had to learn to live differently than he did before, and sometimes that’s harder than the physical component — not being able to do those things he used to enjoy.”
Medical oncologist Muhammad Naqvi, MD, sees patients in the Oneida and Syracuse offices.
If you’re facing a diagnosis of cancer, turn to the experts at the Upstate Cancer Center. Our physicians provide comprehensive cancer care for patients at our main site in downtown Syracuse and at our centers in Oneida and Oswego. Explore your treatment options, close to home. Our highly personalized care includes the advanced knowledge and technology found at the region’s only academic medical center. The power of teamwork brings together board-certified physicians and oncologycertified nurses to consider all options to create your treatment plan. As part of a research university specializing in cancer, Upstate also offers access to clinical trials.
SYRACUSE: 315-464-HOPE (4673) ONEIDA OSWEGO Medical Oncology: 315-361-1041 Radiation Oncology: 315-606-5045
Medical Oncology: 315-342-6215 Radiation Oncology: 315-207-9066
Still, she says, “His recovery has been remarkable, considering what he went through, because of the staff and the quality of care that he received.” ● upstate.edu/cancer
Expertise Compassion Hope l
summer 2018 l upstate.edu
l
U P S TAT E H E A LT H
11
PATIENT CARE
At higher risk for breast cancer
She’s vigilant about self-exams and doctor visits
BY SUSAN KEETER
DAKOATA WILCOX WAS 27 when she felt a lump in her breast during a self-exam. “I was young,” she remembers. “I didn’t think breast cancer could happen to me.” Still, she made an appointment with breast surgeon Mary Ellen Greco, MD, who took a family history. Wilcox’s mother had been diagnosed with breast cancer at age 30 and died from a stroke at age 40. Wilcox’s maternal aunt developed breast cancer in her early 40s and her maternal grandmother was diagnosed at age 64. Such a family history puts Wilcox at a higher risk for breast cancer. To analyze Wilcox’s lump, Greco ordered a diagnostic mammogram and sonogram. Imaging was normal, but clinical findings warranted a fine needle aspiration, which Greco performed at her office. It was benign. She had Wilcox undergo genetic testing, a simple blood sample taken in her office at the Upstate Community campus. Wilcox was found to have a variation of the Rad51D gene. is variant is oen benign, but since genetic profiles on Wilcox’s relatives are unavailable, it is possible that the familial genetic cancer link may be there.
A year aer Wilcox found the first lump, she found another. She underwent a second diagnostic mammogram, sonogram, and fine-needle biopsy. e second lump was also benign. Because of her family history of breast cancer and her personal history of lumps in her breasts, Wilcox sees Greco every six months for breast exams, and she does self-exams in the shower weekly. Wilcox is vigilant — and cancer free. Her message to other young women: “Don’t think cancer can’t happen to you,” she says. “Do breast self-exams. Some lumps are normal, but they need to be checked out.” ● The flowers on Dakoata Wilcox’s forearm are a memorial to her mother, who was diagnosed with breast cancer at age 30 and died of a stroke at age 40.
Grateful for answers
PHOTO BY SUSAN KAHN
Symptoms result in highly unusual diagnosis “ONE MORNING, I woke up and had difficulty walking and was seeing multiple images.” is begins Marianne Ford’s intriguing story of diagnosis and treatment … of breast cancer. Ford became increasingly anxious about her symptoms and confused — as were the optometrists and other specialists she consulted who were unable to diagnose the source of her symptoms. It wasn’t until she was referred to Luis Mejico, MD, a neuro-ophthalmology specialist at Upstate, that — literally — the fog began to clear. “Once Marianne became my patient, she had a series of tests that confirmed the likelihood of a paraneoplastic syndrome affecting her brain,” explained Mejico. “Paraneoplastic syndromes are rare disorders triggered by an altered immune system response to cancer. Further evaluation confirmed breast cancer, even though she had no other symptoms.” Ford is grateful that she was referred to Mejico and credits him with saving her life. Aer Mejico’s diagnosis, Ford’s
12
U P S TAT E H E A LT H
consultation with a surgeon at Upstate’s breast care center resulted in a radical mastectomy. “When I woke up aer my surgery, the first thing I saw was my husband — and just one of him,” recalled Ford. “I was pleased to make progress so quickly.” Ford’s unusual story is an example of the “we will figure out the cause of your symptoms” approach of the Luis Mejico, MD neurologists at Upstate, which can lead to lifesaving treatments of complicated disorders.
Are you grateful? A gi of gratitude is a meaningful way to express appreciation to special caregivers and help patients during their time of great need. To donate to Friends of Neurology, contact Upstate Foundation at 315-464-4416. ●
upstate.edu l summer 2018
‘Living a miracle’
PATIENT CARE
Recovering from rare disorder that causes nerve damage, paralysis BY SUSAN KEETER
MARCH 16 WAS A TYPICAL DAY for Barbara King, 79. She cooked meals and did housekeeping for the brothers at Christian Brothers Academy. She took her huskies, Cody and Daisy, on a two-mile walk. at Friday evening, King felt a little off and asked her granddaughter, Amy Windhausen, to spend the night. King awoke the next morning paralyzed from the waist down. King’s daughter, Rebecca Mazuryk, called an ambulance, which took King to an area hospital. Pain — which ran from King’s toes to her waist — made sitting in a wheelchair unbearable, so she lay on the floor of the emergency department. King was admitted to the hospital, told she had a virus and released. Shortly aer she returned home, the weakness and pain spread to King’s arms. Her daughter again called an ambulance. is time, King insisted she go to Upstate University Hospital’s Community campus. She underwent more blood tests and X-rays. A team of health care providers including Marc Iqbal, MD, Anupa Mandava, MBBS, and eodore Koh, MD, worked together in search of the cause of her symptoms. “e pain was so bad I prayed to die,” remembers King. e painkiller morphine helped.
Getting the diagnosis On March 23, physician assistant Alisa Albanese identified Guillain-Barre syndrome — a rare condition in which the body’s immune system attacks the peripheral nervous system — as the source of King’s debilitating symptoms. Her diagnosis was confirmed by Matthew Glidden, MD, who had King transferred to the care of neurologists at Upstate’s downtown hospital. ere, she received intravenous immunoglobulin treatments designed to reset her immune system, so it would stop doing damage. Fortunately, King was diagnosed and treated before nerve damage spread to her chest, which would have required that she be placed on a ventilator to breathe. King remembers little of the time between diagnosis and her transfer back to the Community campus on April 6 for physical medicine and rehabilitation. She could barely move. To get in and out of bed, she had to be hoisted by a mechanical li with support from several staff members. King was unable to move her hands. She used a catheter. Gradually, with daily physical and occupational therapy, King regained her abilities. She developed her motor skills by learning to stack conical cups, later by planting flowers summer 2018 l upstate.edu
Barbara King, left, works with occupational therapist Kelly Ryan. PHOTO BY SUSAN KAHN
and chopping vegetables. King strengthened her legs, first by touching her feet to the floor while supported by a swing, eventually by walking on a treadmill, gripping handrails and being supported by a physical therapist. By the end of April, King was able to get in and out of bed, in and out of a chair, and walk with a walker. “It was nice watching her do more and more,” remarked nurse Sarah Hirsch, a clinical leader of the rehabilitation unit. Nearly two months aer she woke up paralyzed, King returned to her one-story home in East Syracuse. erapists from e Centers at St. Camillus provide physical and occupation therapy three times a week, and her daughter and granddaughter rotate staying with her so she has round-the-clock attention. King continues to do exercises and is able to walk with a cane. King realizes that it may take a year or two to fully recover from the damage done by the Guillain-Barre disorder, but she is grateful for the progress she has made. “I’ve lived a miracle,” King says tearfully. “I wouldn’t be able to walk if it weren’t for the people in this hospital. ey worked their hearts out for me.” ● ABOUT GUILLAIN-BARRE SYNDROME
Guillain-Barre syndrome is a rare, difficult-to-diagnose disorder that causes the immune system to attack the peripheral nervous system. ese nerves connect the brain and spinal cord with the rest of the body. Damage to the nerves makes it hard to transmit signals, so muscles have trouble responding to the brain. e first symptom is usually weakness or tingling in the legs. is can spread to the upper body, becoming life-threatening. In severe cases such as King’s, the person becomes almost paralyzed. Most recover, but recovery can take a few weeks to a few years. e cause of the syndrome is unknown. SOURCE: NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE
U P S TAT E H E A LT H
13
PATIENT CARE
Marcela and Robert Crain with their daughter, Isabella, 8, in the chapel at Upstate University Hospital on Feb. 14, when he was discharged.
Christopher Tanski, MD, with the ECMO machine. PHOTO BY WILLIAM MUELLER
PHOTO BY ELIZABETH DORAN/SYRACUSE MEDIA GROUP
A SMALL BOX THAT SAVES LIVES Fayetteville man recovers from infection thanks to ECMO machine
BY AMBER SMITH
ROBERT CRAIN, 47, awoke on Jan. 8 from a medically induced coma. Slowly he pulled together memories from three months before. e Fayetteville podiatrist had a nagging cough in early October. When he began feeling short of breath, his wife, Marcela, suggested they go to the emergency department. Crain collapsed before they could leave their home. An ambulance brought him to Upstate University Hospital. His temperature was 104 degrees Fahrenheit. He dried in and out of consciousness. Crain had developed bacterial pneumonia, explains Christopher Tanski, MD, who directs Upstate’s extracorporeal membrane oxygenation program. at technology, known ECMO, kept Crain alive for 61 days. ECMO does for lung function what dialysis does for kidney failure, explains lung surgeon Jason Wallen, MD, the chief of thoracic surgery at Upstate. Wallen also helped care for Crain during his stay. e ECMO machine, a bit larger than a shoebox, handles oxygen delivery to the patient’s body, allowing his or her lungs to rest and heal. Cardiovascular surgeons since the 1970s have relied on similar “heart-lung machines” during surgeries that last an hour or two. Today, the use of ECMO has been extended to several days for some patients with
14
U P S TAT E H E A LT H
various lung injury. “It’s used to provide support for either the heart or the lungs, or both if they’re not functioning properly,” explains Tanski. Crain underwent a dozen procedures to remove fluid from his lungs. Because his kidneys failed, he also underwent dialysis regularly. During his coma, his muscles basically shut down, including those involved with chewing and swallowing. Intensive speech, physical and occupational therapy are helping him rehabilitate. e Crains shared their story with Syracuse.com. While Robert Crain doesn’t remember his time in a coma, Marcela told the news organization, “It was awful. My brain heard them say he wasn’t doing well and wasn’t improving, but my heart wouldn’t accept it. I went to the chapel every day at the hospital and prayed, and my daughter and I prayed every night.” Crain was hospitalized during Halloween, anksgiving and Christmas. He awakened a week aer New Year’s, and he was well enough to go home on Valentine’s Day. “I had a huge support system, with my family and friends, and I never gave up,” Crain says. “I always told myself I would recover.” ●
upstate.edu l summer 2018
FROM OUR EXPERTS
HOW TO SAVE SOMEONE FROM AN BY AMBER SMITH
In preparation
opioid overdose
Purchase naloxone (trade name, Narcan), available without a prescription in New York pharmacies. Keep it with you, but do not store it in extreme temperatures (such as a car glove box), which can damage the medication. Naloxone can be lifesaving for someone who has overdosed on opioids. It is a very safe medication, and if given incorrectly to a person who is having another medical problem, like a heart attack or stroke, it will not harm them, says clinical toxicologist Willie Eggleston of the Upstate New York Poison Center. He says you can find naloxone at more than 2,000 pharmacies in New York state and that the New York State Naloxone Co-Payment Assistance Program (N-CAP) will cover up to $40 of the cost. e drug can be administered in a variety of ways. During the New York State Fair, researchers from the Poison Center and Department of Emergency Medicine conducted a study to see which method was quickest and easiest for regular people. A single-step nasal spray (available as Narcan nasal spray) won out over an intramuscular injection and a nasal atomizer. e nasal spray is a device that delivers medication into the nostril, where it is rapidly absorbed through nasal membranes, regardless of whether the person is breathing. The poison center will provide naloxone training to groups. Call 315-464-8906 for details.
How naloxone works “It’s an antidote that goes to the sites in your body where opioid drugs work, and it kicks those opioid drugs out, so that you can reverse the effects,” Eggleston explains. “at helps people who have overdosed to start breathing again and to start to wake up. You still want to call 911 and get that patient to a health care facility, so they can get the treatment that they need.” Naloxone does not always successfully revive a person, but administering the medication offers the best chance of saving a life. Eggleston recalls a Central New Yorker who called 911 aer discovering what appeared to be a dead body in a wooded area. Police arrived, found a faint pulse on the person, administered naloxone — and the person recovered.
Signs of overdose • Person is drowsy or unconscious and will not awaken. • Breathing is slow, gurgling or stopped. • Pupils are small or pinpoint. • Lips and fingers are bluish or gray. summer 2018 l upstate.edu
What are opioids?
chemical structure of naloxone
• Prescription painkillers including morphine, OxyContin, Vicodin and others that are designed to provide shortterm pain relief. • e illegal drug heroin. • Synthetic opioids such as fentanyl, which is 50 times as potent as heroin, and carfentanil — used in veterinary medicine to sedate elephants — which is up to 5,000 times as potent. “It takes a much smaller dose to have lethal effects,” Eggleston says.
What to do If you come upon someone that you believe has overdosed, 1. First, make sure it’s safe to approach that person. Try to awaken him or her. 2. If they do not respond, call 911. e person may have a different medical emergency. Even if he or she overdosed, the naloxone you administer may not be enough to revive him or her. Or, there could be complications. Better to have emergency medical services on the way. 3. Administer the naloxone. Place the tip of the nasal spray into one nostril. Press the plunger on the opposite end. Effects may not kick in for five minutes. 4. If the person is not breathing, do rescue breathing. Tilt the head back, li the chin, and pinch the nose. Give two breaths into the mouth and continue with one breath every five seconds. e person’s chest should rise and fall. Continue rescue breathing until the person wakes up or help arrives. 5. e person may be disoriented as they awaken. Do your best to keep him or her calm. Place the person on their side, in case they get sick. Stay with them until help arrives.
Protections Good Samaritan laws protect people who act in good faith to render aid. New York state law protects the person who overdoses, and the people who try to revive him or her, from charges or prosecution for possession of small quantities of drugs or alcohol, or for sharing drugs, with some exceptions. e law does not protect against charges or prosecution for possession of felony quantities of drugs, for intent to sell drugs, for violation of probation or parole or for open warrants. ● U P S TAT E H E A LT H
15
FROM OUR EXPERTS
Close-up of Mitchell Karmel, MD, performing a nephrostomy tube check, a procedure to evaluate whether a kidney remains obstructed and to evaluate the position of the tube. PHOTO BY SUSAN KAHN
HE LOVES
SOLVING PROBLEMS BY AMBER SMITH
IN A TYPICAL DAY, Mitchell Karmel, MD, may take a biopsy of a liver tumor in one patient, install a port, so another patient can receive chemotherapy, and drain an abscess from deep within the abdomen of another. He may treat a woman’s uterine fibroids using particle embolization, an alternative to hysterectomy, and then treat a liver tumor with radiation particles before caring for a baby who needs long-term intravenous access. Karmel is an interventional radiologist. He chose the specialty, he says, “because I liked that it was very goal-directed and problem-solving.” Many patients arrive in the interventional radiology department because other doctors need assistance in making a diagnosis or because they need intravenous access installed in the form of a port or a PICC line. at’s medical parlance for peripherally inserted central catheter, a way to provide long-term venous access, for patients who require repeated intravenous medications or blood draws. Aer medical school, Karmel completed a yearlong
16
U P S TAT E H E A LT H
internship and four years of residency training at Cornell University Cooperating Hospitals, plus an additional year of fellowship training at Harvard Medical School. Today, as an associate professor of radiology at Upstate, he is director of vascular and interventional radiology. He and his colleagues staff Upstate University Hospital around the clock. ey provide minimally invasive, image-guided diagnosis and treatment of a broad range of diseases and conditions, for a broad range of patients. Most of the procedures they offer are alternatives to open surgeries, with generally less risk, quicker recovery time and lower cost than open surgeries. Interventional radiologists are sometimes summoned for emergencies. It was an interventional radiologist who stopped the bleeding and stabilized U.S. Rep. Steve Scalise, R-La., so that a surgeon could repair the damage the congressman suffered in June 2017 when he was shot in the hip during practice for a charity baseball game near Washington, D.C. continued on page 17
upstate.edu l summer 2018
FROM OUR EXPERTS
WHAT IS AN INTERVENTIONAL RADIOLOGIST?
Interventional radiologists diagnose and treat a variety of benign and cancerous conditions of the thorax, abdomen, pelvis and extremities. In caring for patients, they use imaging to guide minimally invasive techniques that help open blood vessels, stop bleeding, obtain tissue for biopsy, and other varied procedures. Karmel places a nephrostomy tube in a patient with blocked drainage of the kidney while a fourth-year medical student observes. PHOTO BY SUSAN KAHN
SOLVING PROBLEMS
continued from page 16
Venous access One of the most common procedures interventional radiologists perform is the insertion of a PICC line when other services have failed, or in pediatric patients. On a recent weekday, Karmel walks into a hospital room to talk with a mother who cradles her baby girl. e 10-month-old was not growing properly. He explains how he would install a line in the big vein of her neck that would help with her therapy. A short time later, the interventional radiology team assembles in an operating room, the baby looking like a small doll on a vast operating-room table. She wears a tiny blood pressure cuff, and a tiny mask covers her nose and mouth. Nurses roll a baby blanket, position it beneath her neck and turn her head to the le. It would be Karmel’s job to insert a central catheter into the baby’s jugular vein, a big vessel on either side of the neck that carries blood from the head and face to the lungs. Not all interventional radiologists are comfortable inserting a PICC line on a child, especially one this little. e secret, Karmel discloses, is to use ultrasound guidance to find and puncture the vein, a technique interventional radiologists are comfortable with. Using his le hand, Karmel presses a probe along the baby’s neck. Images of her vessels appear on a television screen on the opposite side of the table. Karmel’s right hand wields a tiny needle, destined for the jugular. Not only are baby vessels small, they are rubbery and difficult to puncture. Aer Karmel makes his insertion, it’s time for an X-ray. “Has everyone got lead on?” he asks the room. Nurses, technicians and the anesthesiologist check to make sure they’re wearing protective gear. A machine shaped in a giant C is rolled near the bed and arcs around the patient. e X-ray it produces confirms that Karmel has placed the line correctly. His most challenging case in 35 years was a 26-week-old premature infant who needed long-term vascular access — just like this 10-month-old, but even smaller.
summer 2018 l upstate.edu
Karmel reviews a CT scan of a chest to evaluate whether fluid around the lung needs to be drained. PHOTO BY RICHARD WHELSKY
Performing image-guided biopsy Biopsies are another typical procedure done by interventional radiology. at’s where ultrasound, computerized tomography or fluoroscopy provide image guidance while the physician places small needles into areas of abnormality. Tissue samples or cells can be removed for analysis, oen to help diagnose cancer or rule it out. His white hair now keeps most patients from asking Karmel, “So, how many of these biopsies have you done?” But one patient asked him recently. Karmel had to stop and think. He has done so many that he has lost count: more than 4,000, probably closer to 5,000. ● Board-certified interventional radiologists at Upstate University Hospital see patients at both the downtown and Community campuses and can be reached at 315-464-5189.
U P S TAT E H E A LT H
17
FROM OUR EXPERTS
Putting heads together
Brain researchers collaborate to understand and battle dementia, addiction, schizophrenia and more BY AMBER SMITH
WHAT DO DRUG ADDICTION, neurodevelopmental disorders and dementia have in common? All three disorders have origins in the brain, with causes and potential treatment methods that tend to overlap. For instance, they are all caused, at least in part, by a damaged prefrontal cortex, the brain structure that controls our cognition, emotion and memory, and altered neural connections and communications between this and other regions of the brain. Neuroscientists at Upstate, led by professor Wei-dong Yao, PhD, study the brain and have a variety of collaborative research projects that deal with addiction, psychiatric diseases and dementia. What they learn about dopamine — a neurotransmitter linked to reward and addiction, and synaptic plasticity — helps in the understanding of schizophrenia and other neuropsychiatric diseases. And, learning about the synaptic loss that leads to frontotemporal dementia may actually reveal new ways of treating this devastating early-onset neurodegenerative disease. Yao is a professor of psychiatry and behavioral sciences, and neuroscience and physiology who came to Upstate in 2014 aer 10 years on the faculty at Harvard Medical School.
Addiction For more than a decade, Yao has been working on how cocaine impairs the brain by hijacking the dopamine reward circuits. ese are the brain’s cortical and limbic structures where dopamine is made and detected that are associated with our ability to feel pleasure. “Some people are more vulnerable or susceptible to drugs,” he says, explaining that certain mutations on certain genes influence a person’s vulnerability. But that only tells part of the story. Yao’s neuroscience research lab at Upstate is working to tell more. Using a powerful microscope that allows them to view the junctions between neurons, called synapses, and sophisticated electrophysical recording equipment, Yao’s research team explores how neurons communicate in addicted brains — and whether that affects how susceptible a person will be to addiction. Ultimately, he would like to come up with a way to treat addiction by repairing the synapses and neural circuits in the brains of cocaine addicts. Wei-dong Yao, PhD PHOTO BY DEBBIE REXINE
18
U P S TAT E H E A LT H
upstate.edu l summer 2018
FROM OUR EXPERTS
Above and at left: Nerve cells. The center image of spines or synapses (circled in white) indicates sites where communication between neurons take place. FROM THE LAB OF WEI-DONG YAO, PHD
Neurodevelopmental disorders Abnormal levels of dopamine have been linked to schizophrenia and other psychiatric disorders. In Yao’s lab, researchers have provided evidence on how excessive dopamine impairs synaptic plasticity in the prefrontal cortex, which represents a significant step forward in our understanding and potential treatment of schizophrenia and attention deficit hyperactivity disorder, or ADHD. ey have also studied the medication clozapine to learn how it may improve cognitive deficits associated with schizophrenia. In collaboration with colleagues at Mount Sinai School of Medicine, Yao is also studying a group of genetic switches on our DNA, known as epigenetic modifiers, that control synapse and brain development and are linked to schizophrenia, autism and depression.
Dementia Yao is looking for a way to help people with a type of dementia that affects the frontal and temporal lobes of the brain. Synapses change over time. is ability is called plasticity. ey can become stronger or weaker or disappear, which impacts neural communication, cognitive function and behavior. Neuroscientists have learned that symptoms of cognitive impairment and dementia arise with synaptic loss. Keeping neurons active and maintaining existing synaptic connections can help alleviate symptoms, Yao says, adding that exercise, including mental exercise such as meditation, can help preserve brain plasticity and prevent the loss of synapses. Exactly how that is achieved is currently unknown. Yao’s team is working on strengthening and stabilizing synapses by tweaking some proteins within the neurons. Eventually, Yao believes, scientists will find a more physiological way to keep neurons healthy and synapses stable. He also hopes to find a way to delay or prevent the death of neurons, through controlling the brain’s natural electric activity, a project he’s working on with a colleague at the University of Massachusetts Medical School. ● summer 2018 l upstate.edu
NEUROSCIENCE TERMS TO KNOW
Neurons are nerve cells that, once born, can live for many years and oen for a person’s lifetime. Debate exists over whether the brain has the ability to continue making neurons aer a person is born. Some neuroscientists believe neurogenesis takes place into adulthood in the hippocampus, a region of the temporal lobe near the center of the brain, but research published this spring in the journal Nature questions that. Neurons are not like other cells in the body, which are constantly being replaced as they die. A molecular signaling pathway is a coordinated series of biochemical reactions within a cell that control specific cellular functions, such as cell division or cell death. Synapses are the “wiring” of the brain, the junctions between neurons where communication takes place. Each neuron starts out with many thousands of synapses. As a person learns, he or she builds more synapses. So yes, there is science behind games that are promoted for brain health. Plasticity refers to the brain’s ability to change, physically but also functionally and chemically throughout a person’s life. If the synapses weaken as a person ages, communication among the neurons diminishes. Dopamine is a neurotransmitter that facilitates communication among neurons. It is also known as the pleasure molecule of our brain. Frontotemporal dementia is the second most common form of dementia aer Alzheimer’s disease and results from the progressive degeneration of the frontal and temporal lobes of the brain. Chemical compounds used to regulate the activity of genes are called epigenetic modifiers. In some instances, modifications remain as cells divide and can be inherited through the generations. Scientists are studying what effect the modifications have on gene function, protein production and human health, according to the Genetics Home Reference from the National Institutes of Health. U P S TAT E H E A LT H
19
IN OUR COMMUNITY
Scientist walks a political tightrope
He deals with Taliban to help his native land rebuild BY JIM HOWE
AN UPSTATE FACULTY MEMBER who lost his mother as a baby and grew up in a refugee camp hopes he can help his war-scarred homeland, Afghanistan. To do this, he has secured the permission of the local tribal and religious leaders and the local Taliban insurgents to create a school for both girls and boys, a clinic and a midwife training program to help war widows support themselves. Immunologist Mobin Karimi, MD, PhD, said he was shocked that the Taliban would allow girls to attend school but noted they likely agreed because the local tribes are involved, while governmental authorities are not. Karimi knows something about the power of Afghan tribes, as the grandson of a tribal leader in the poor, rural area where he was born, in Ghazni province, about 75 miles from the Afghan capital. To ensure that his project would not be viewed as a tool of any government, he has accepted no governmental aid and wants only private donations to the charity he and some friends created in 2017. Called Education for the Afghan Children, it is registered as a tax-exempt nonprofit organization with the Internal Revenue Service and can be reached at https://educationforafghanchildren.org/.
20
U P S TAT E H E A LT H
He plans to build a modest complex that will include classrooms, a clinic and a mosque. ere will be coed classes through sixth grade, then separate classes for boys and girls through high school, eventually serving as many as 500 children. e clinic would provide limited medical services and maybe some vaccinations. A doctor could see patients and help train war widows to become midwives, which would give them an income and also address problems of maternal health. If the midwives can read and write, they could be trained as nurse practitioners and donate work to the clinic. To help the project become self-sustaining, it would also ask for 2.5 percent (a common charitable donation in Islamic countries) of local farmers’ harvest to provide free lunches for the children, which could be prepared by one cook. e local residents are poor, so they can’t be expected to give money, but maybe they can donate labor and crops, Karimi says. “I always wanted to do something, establish a school, a midwife training center, something that could move the country forward,” he says, noting that the country lacks
upstate.edu l summer 2018
IN OUR COMMUNITY
The school building, still under construction. PHOTOS COURTESY MOBIN KARIMI, MD, PHD
schools and clinics because nothing was built during decades of wars. Since Afghan government corruption siphons off much of the money for any project, Karimi says, he prefers to keep this operation private, with money going directly to the people involved. In the past year, he and some friends have sent about $4,000 to build the school, but they need an estimated $70,000 for the full project. eir first aim is to get the school building completed and operational by winter, since the children are sitting on the ground to take classes now. Karimi is hoping for some grant money as well as individual donations. He is trying to manage this on a shoestring budget while steering clear of any government involvement, keeping the tribes and community involved and not provoking the Taliban. “We’d rather be poor and secure,” he says. “You could achieve your goal in a quicker way, but eventually you will get into trouble.” ●
PHOTO BY WILLIAM MUELLER
FROM AFGHANISTAN TO SYRACUSE
Name: Mobin Karimi, MD, PhD. Position: Associate professor of microbiology and immunology at Upstate. Runs an academic research lab that studies cancers and bone marrow transplants. Born: 1979, in a poor, rural village in south-central Afghanistan. His father was a university professor. His mother died of severe bleeding two days aer he was born, and his twin sister died at birth. He lost 35 members of his family, including his father and three brothers, to war. Childhood: His family fled wartime violence to a refugee camp in the Afghanistan-Pakistan border region when he was 6. He learned English by working for an Englishlanguage publication at the camp and by age 14 was a translator and guide for the Red Crescent, the Islamic version of the Red Cross, in Afghanistan. Career: He studied medicine in his home country and came to the U.S. in 1999 with the help of a California doctor he met who headed the International Red Crescent in that country. Karimi became licensed to practice medicine in the U.S. and also earned a PhD from the University of Massachusetts. Upstate colleagues’ comments: Timothy Endy, MD, professor and chair of microbiology and immunology, praises Karimi for “coming out of a war-torn country and working his way up as a lab tech to graduate school and now a faculty member with a research program.”
Classes are held outdoors for now because the school building is not yet ready. Organizers are hoping the classrooms will be ready before winter sets in.
summer 2018 l upstate.edu
Gary Winslow, PhD, professor of microbiology and immunology, notes Karimi is “genuinely interested in helping people, in many ways, with his clinical research and, of course, with his activities in Afghanistan.”
U P S TAT E H E A LT H
21
Yoga for all
IN OUR LEISURE
Physical therapist adapts exercise for those with developmental disabilities FROM ITS ORIGINS in India more than 3,000 years ago, yoga in America today has a reputation for improving flexibility, balance and muscle strength. Rebecca Alexander, who graduated from Upstate with her doctor of physical therapy degree this spring, extols the versatility of yoga, which can be done sitting in a chair or wheelchair. She hopes to work with patients who have neurological impairments. “Yoga can provide significant benefit,” she promises. “Yoga is about intention and the breath. It doesn’t matter if you can’t get your arms all the way over your head. e intention doesn’t get lost.” Alexander has been involved with “Unified Yoga,” a program that grew out of a mainstream yoga program at the Southwest Community Center in Syracuse.
Mainstream yoga, adapted for people with a range of developmental disabilities, such as autism, Down syndrome and cerebral palsy, was an effort by Upstate pediatrician Nienke Dosa, MD, for people between the ages of 16 and 40. Yoga classes were held outdoors in good weather, with students unfurling colorful yoga mats on the grass at ornden Park and Burnet Park, and then following Alexander through a series of poses. Alexander teamed up with Joy PapazidesHanlon, a teacher at the community center, to create a 28-page booklet for the Inclusive Fitness Initiative, a three-year pilot program paid for by the New York State Developmental Disabilities Planning Council. ●
Download the booklet, for free, at www.inclusiverec.org under the “resources” and “useful articles” tabs.
As the longest established bariatric program in Central New York, Upstate has a proven track record of successful patient outcomes. If you are considering bariatric (weight loss) surgery, come learn more from our experts about how it can improve your overall health.
TO REGISTER FOR A FREE UPCOMING INFO SESSION, VISIT WWW.UPSTATE.EDU/BARIATRICS OR CALL (315) 492-5036. Information sessions are held at Upstate University Hospital’s Community Campus, 4900 Broad Road, Syracuse. (Formerly Community General Hospital)
FREE PARKING IS AVAILABLE IN THE HOSPITAL PARKING GARAGE.
22
U P S TAT E H E A LT H
upstate.edu l summer 2018
IN OUR LEISURE
Career considerations: How do you choose between music and medicine?
Find a way to do both Kaitlyn DeHority
PHOTO COURTESY OF ITHACA COLLEGE/PHOTO BY DURST BRENEISER
BY JIM MCKEEVER
FUTURE UPSTATE MEDICAL STUDENT Kaitlyn DeHority started classes at Ithaca College as a music major. She decided to add chemistry in her second semester. Four years later, she graduated with a dual degree in music and chemistry.
“I’m busier,” she says of the music in her life, “but more balanced.”
“I sat down and planned every semester of courses, so I could do both, and I checked in with my advisers and associate deans each semester to make sure I was on track,” DeHority recalls. “I put a ton of effort into it.”
“Medicine is moving toward a team-based approach,” she describes. “It’s impossible for one person to know everything, so you rely on your colleagues. It’s the same with an ensemble. You bring your highest level, but you rely on your colleagues.” ●
Accomplished in both fields — she was an Ithaca College Presidential Scholar and the principal trumpet player in the college’s Chamber and Symphony orchestras — DeHority had to make a decision which to pursue aer graduation. How did she decide? “A lot of people have a ‘light bulb’ moment. Not me,” she says. “It was a series of little things along the way.” Her passion for music became obvious in elementary school. DeHority performed throughout middle school and high school in the Fayetteville-Manlius school district, earning honors at county, state and national levels. Her involvement continued throughout her time at Ithaca College. In high school, she attended a 10-day National Youth Leadership forum on medicine in Boston. en in college, she spent a summer doing electrochemistry research. And she shadowed Upstate experts in anesthesiology, oncology and pathology. All of those experiences made a lasting impression. When she arrived at Upstate in 2016, DeHority was used to rehearsing 15 hours a week, practicing another hour or two each day and performing regularly. She missed it. So, she joined the Syracuse University Brass Ensemble, where she performs almost weekly, along with Upstate’s James Greenwald, MD, a professor of family medicine who also plays trombone. summer 2018 l upstate.edu
DeHority’s two passions complement each other. Dedication, preparation and practice are required, whether it’s with a patient or for a performance.
STUDY MUSIC AND MEDICINE
AN INITIATIVE called the Upstate Guaranteed Entrance Program for Select Majors aims to enroll about 10 highcaliber students each year to medical school who come from a diverse range of undergraduate programs. Students will be accepted into Upstate’s College of Medicine directly from high school, with the understanding that they will complete a bachelor’s degree at SUNY Purchase College or another of SUNY campus before starting medical school. ey are able to pick from a range of pre-med degrees, including a bachelor of fine arts, bachelor of arts, bachelor of music or bachelor of science. Students will have to maintain a 3.5 grade point average in college and would not have to take the Medical College Admission Test. Interested high schoolers must apply to the SUNY campus and interview at Upstate for consideration. To qualify they must have an average of at least 90, extracurricular activities having to do with health care, and an SAT score of at least 1360 or an ACT score of at least 29.●
U P S TAT E H E A LT H
23
750 East Adams Street l Syracuse, NY 13210
SCIENCE IS ART IS SCIENCE IS ART 1S SCIENCE CELL AND DEVELOPMENTAL BIOLOGISTS including Anushree Gulvady are studying how cancer invades and metastasizes at the cellular level. Gulvady is a doctoral student working in the laboratory of Upstate’s Christopher Turner, PhD. She works with Hic-5, a molecular scaffold that coordinates multiple interactions among proteins. Plasma membrane protrusions called invadopodia are seen reaching out from the redyellow puncta. Gulvady’s project explores the mechanisms by which the invadopodia fuse together to form rosettes, the circular areas of red and yellow. e rosettes secrete an enzyme that helps degrade the extracellular matrix, which allows the cancer to spread.
Gulvady
Turner
Understanding this process may help scientists develop ways to intervene.
Xu IMAGE COURTESY OF ANUSHREE GULVADY AND THE LAB OF CHRISTOPHER TURNER, PHD
18.119 0718 44.2M ELsk