Upstate Health summer 2016

Health UPSTATE

U P S TAT E M E D I C A L U N I V E R S I T Y

Summer 2016

RECOVERING FROM STROKE page 5

COMING SOON: PANCREAS TRANSPLANTS page 8

WHERE TO FIND TRANSGENDER MEDICAL CARE page 10

THE POXVIRUS DISCOVERED

BY UPSTATE SCIENTISTS page 12

PROTECT YOURSELF FROM A SHOOTER page 14

summer 2016 l upstate.edu

WELCOME

Contents 11

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CARING FOR PATIENTS cover story

A runner regains his footing after a stroke page 5 The rare but serious risk of a neck adjustment

page 7

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FROM OUR EXPERTS

The poxvirus discovered at Upstate

IN OUR LEISURE

page 12

How to survive an ‘active shooter’ situation

page 14

page 8

Researching hunger

page 15

Caring for the transgender population page 10

IN OUR COMMUNITY

How pancreas transplants can treat diabetes

Seeking a nonsurgical solution for hydrocephalus page 11

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When a marathon is not far enough

page 20

Memoir explores race and medicine

page 21

Taking to water

page 22

DEPARTMENTS What’s Up at Upstate

page 3

Lessons from Upstate page 16 Sleep diaries, jungle races and ankle surgery

The medical class where se habla español

page 17

Preserving Somali culture

page 18

Picking up the pieces after an earthquake

Recipe Freekeh Fruit Salad

page 19

Science Is Art Is Science back cover Studying fin regeneration

page 21

Correction Elliott Williams of Auburn was featured, along with a photograph of another man, in a story about veterans in the spring 2016 issue of Upstate Health. Here is the correct photo of Williams.

Health

Summer 2016

PUBLISHER Wanda Thompson, PhD, Senior Vice President for Operations EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications EDITOR-IN-CHIEF

Amber Smith

DESIGNER

Susan Keeter

Visit us online at www.upstate.edu or phone us at 315-464-4836.

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For corrections, suggestions and submissions, contact Amber Smith at 315-464-4822 or smithamb@upstate.edu

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.

ADDITIONAL COPIES: 315-464-4836 Upstate Health offices are located at 250 Harrison St., Syracuse, NY 13202

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.

upstate.edu l summer 2016

Checking in on the children’s hospital

WHAT’S UP AT UPSTATE

Staff at the Upstate Golisano Children’s Hospital cared for 37,525 patients in the pediatric emergency department, plus 6,429 in the pediatric “aer hours” urgent care center during 2015. Also that year, surgeons operated on 5,373 pediatric patients.

In addition to 90 attending physicians, 40 residents and fellows, and 165 nurses, the children’s hospital depends on assistance from volunteers, including:

who help to keep the washer/dryer, 2volunteers family waiting room and family sleeping rooms clean; therapy volunteers (with their four-legged 3pet friends) who help to reduce stress and anxiety by visiting with patients; Resource Center volunteers who provide 11Family resources and media rentals — and sometimes just a friendly ear — to patients’ family and friends; tutors who assist two teachers who help pediatric 18patients keep up with their schoolwork while they are hospitalized; and child life volunteers in eight specialty areas of 35pediatrics who help provide a comforting environment for patients and visitors.

Tymareah Rudolph and Daphne, a therapy dog, in a hospital playroom.

Why she donates blood four times a year Diana Pelletier of Camillus was critically injured in a car crash nine years ago. She was driving her husband, 22-month-old toddler and 3½-week-old infant when the car wrecked, flipping over three times.

Her family was fine, but Pelletier broke her neck and lost a lot of blood.

Aer four weeks in intensive care, Pelletier spent five months at Upstate University Hospital. She was in a wheelchair and unable to drive for three years. She still receives physical and occupational therapy at Upstate.

Pelletier’s lengthy recovery gave her time to ponder the importance of donating blood. Today she’s a regular donor at Upstate’s blood drives.

“I wouldn’t be here today if it weren’t for the generosity of others,” she explains. “Blood donation is the renewable resource that takes so little time and gives so much to others.”

Find a blood drive near you by visiting the American Red Cross website at redcrossblood.org and typing in your zIP code.

summer 2016 l upstate.edu

Children’s hospital volunteers make a weekly commitment for extended periods of time.

If you’re interested, call Volunteer Services at 315-464-5180.

Experts in stroke care earn ‘gold plus’ award photo by Susan Kahn

Members of the comprehensive stroke team earned an award that recognizes Upstate University Hospital’s commitment to providing patients with the most appropriate stroke treatment.

“When it comes to stroke care, Upstate exceeds national quality measures,” hospital CEO John McCabe, MD, says in reference to the American Heart Association/American Stroke Association’s Get With e Guidelines®-Stroke Gold Plus Achievement Award with Target: Stroke Honor Roll Elite Plus status.

Quality measures from the association are designed to help hospital teams follow the most up-to-date, evidencebased guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. is new honor from the American Heart Association builds on Upstate’s already stellar commitment for providing the best in stroke care, patient education and outreach.

Just last year Upstate received the Comprehensive Stroke Center certification from DNV (De Norske Veritus) Healthcare, a hospital accreditation organization with some of the most rigorous standards in healthcare.

U P S TAT E H E A LT H

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WHAT’S UP UP AT AT UPSTATE UPSTATE WHAT’S

Upstate’s basketball connection Central New York native Breanna Stewart, who led the University of Connecticut women’s basketball team to an unprecedented fourth straight national championship this spring, is the daughter of Brian Stewart, who works in radiology at Upstate, and Heather Baldwin Stewart, who works in human resources at Upstate. ey live in North Syracuse.

Stewart was the first-round dra pick for the WNBA and is heading west to play for the Seattle Storm. She also has been named to the U.S. women’s national team roster for the Olympics in Brazil this summer.

PHOTO BY DENNIS NETT, SYRACUSE.COM

Parenting classes offer online option Expectant parents can access prenatal, childbirth and family education online, as well as inperson, through Upstate Best Beginnings. e online option is a self-paced, interactive program that can be completed from a computer or mobile device. Topics covered include pregnancy, labor, birth stories, comfort techniques, medical procedures, cesarean birth and newborn and postpartum care.

Upstate Best Beginnings also offers classes for expectant parents and for new siblings. e online education tool is $85. Other classes range from $55 to $95. Learn more by calling 315-464-2756. e Advocates for Upstate Medical University offer financial assistance so expectant parents can afford the classes.

Pet health issues mirror those of humans People can feel so bombarded with messages about improving their health that they may stop listening. But those same people are liable to be more receptive about learning how to improve the health of their dogs and cats, says Cristina Pope, director of the Upstate Health Sciences Library.

She got a grant from the National Institutes of Health to pay for the Healthy Pet Project, classes she offers through a variety of community groups. Participants soon realize how closely their pets’ needs and diseases parallel their own. “e top 10 things that go wrong with us are the top 10 things that go wrong with our pets,” Pope says, explaining that skin allergies are a top concern for dogs, bladder and urinary tract diseases are a top concern for cats — and both can be concerns for humans.

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e classes teach how to handle emergencies, how to avoid hazards and how to maximize a pet’s potential for good health. Dogs, for instance, need regular exercise, something that also benefits their human caretakers.

To arrange a class, contact Pope at 315-464-7086 or follow the Healthy Pet Project on Facebook.

Dignitaries welcome president Upstate professors formed a procession as part of the inauguration of Upstate Medical University’s new president, Danielle Laraque-Arena, MD, which took place April 15 at the Oncenter.

Civic leaders and officials from colleges throughout Central New York joined in the celebration. LaraqueArena unveiled her Presidential Symposium Series, called “Connected to the Future,” which will start in October with a seminar on genes and precision medicine.

Café Kubal, Gannon’s opens in children’s hospital Syracuse-based coffee roaster Café Kubal opened its fih Syracuse location in the Upstate Golisano Children’s Hospital, taking over the space on the 11th floor that was vacated when Tim Hortons closed in November. e restaurant will be open 24 hours a day. It will add some healthy food choices and a kid’s menu, plus it will serve Gannon’s ice cream, which is locally produced.

A portion of sales at the Café Kubal in the hospital will help e Advocates support direct service projects to improve and enhance patient care services, support medical education and enhance community health. upstate.edu l summer 2016

CARE FOR PATIENTS CARING PATIENT

Going the distance

Kyle Reger with his wife, Marla; sons Jackson and Maxwell; and their new puppy, Halo.

Good news, good vibes help runner regain footing after stroke

PHOTO BY SUSAN KAHN

Stroke survivor Kyle Reger with Shernaz Hurlong, DO, during a rehabilitation session last September.

PHOTO BY ROBERT MESCAVAGE

BY JIM HOWE

MONTHS AFTER DRAGGING HIMSELF across a hotel room floor to phone for help, Kyle Reger, 41, has diligently worked his way toward recovery from a stroke.

Further, some long-awaited good news arrived during his rehabilitation. Reger and his wife, Marla Velky-Reger, were told that their son Max, a first-grader, is now considered cancer free.

at meant weeks in a hospital bed, months of rehabilitation and — particularly hard for a lifelong athlete and runner who has finished marathons — having to depend on others for things like car rides as he struggled to regain the use of his le side.

Reger, who travels the Northeast for his sales job, was alone in a Massachusetts hotel room on Sept. 4 when he awoke with a calf cramp in the wee hours of the morning.

He had run the night before.

roughout his recovery, Reger was bolstered by the support of his family and friends, his hometown of Cazenovia and his employer, and he learned a new appreciation for the little things, like being able to pick up and use a pepper shaker.

“I remember trying to flex my toe, to prevent it from continuing, and I couldn’t flex my toe, and I just thought it was odd,” Reger said. en he noticed his le side felt asleep, and he tried to jump out of bed to shake it out but crashed onto the floor instead.

summer 2016 l upstate.edu

Continued on page 6

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CARING FOR PATIENTS

Going the distance Continued from page 5

It finally dawned on him: He was having a stroke.

He managed to drag himself to the phone and call for help.

He was admitted to Springfield’s Baystate Medical Center, with a bleed in his brain, a hemorrhagic stroke. Six days later, he was transferred to Upstate University Hospital in Syracuse, where he stayed about three weeks.

“I don’t think I could move anything when I arrived at Upstate,” he says, but in the months of outpatient rehabilitation that followed — working with parallel bars, bikes and other equipment — he has been relearning how to use his le hand, arm and leg.

From the thrill of watching his thumb move a tiny bit to walking (at first with a cane) to being able to drive a car again in February, he estimates his abilities have come back about 90 percent, enough to play the piano.

His doctors concur.

“Having a positive attitude and an active lifestyle prior to his stroke have certainly helped him progress,” says Shernaz Hurlong, DO, the physician overseeing Reger’s rehabilitation.

“He made an excellent recovery in part because of his good health and excellent attitude, but also because he received expert care at the hospitals he was taken to. is gave his brain the best possible chance to heal itself. He’s well on his way to a full recovery,” agrees Lawrence Chin, MD, Upstate’s chairman of neurosurgery. Reger’s stroke resolved itself and did not require surgery.

Friends, neighbors and former college soccer teammates held fundraisers to defray his medical costs, brought meals, drove him to appointments and cheered him on.

His company hired a retiree to help cover his job, and Reger returned to work part time in December, then full time in February. Being able to drive again was “a huge gain to my mental health” he says, both restoring his independence and ability to work and relieving some of the strain on his wife.

Kyle and Max Reger

e couple has two sons, Jackson, 3, and Max, 7, who was diagnosed with Wilms’ tumor, a kidney cancer, at 16 months and underwent chemotherapy, the removal of a kidney and radiation treatments. Max recently achieved “survivor” status, meaning he has been free of cancer for five years.

Max ran the Chilly Chili 5K, a January race in Cazenovia, then returned to walk the route alongside his father, who was determined to finish the course, and did.

Reger hopes to be able to run again by the end of summer and to do a marathon again someday. He also considers himself blessed for the support and insights his stroke revealed. ●

Physical therapist Daisy Sandbek working with Kyle Reger in Upstate University Hospital’s Rehabilitation Center last September.

PHOTO BY ROBERT MESCAVAGE

WHAT IS A STROKE? Stroke occurs when a blood vessel to the brain either bursts or is blocked, thus killing brain cells. Stroke is the fifth leading cause of death and a leading cause of disability in the U.S. All strokes and TIAs (see below) should be treated as emergencies with immediate attention.

Ischemic strokes occur when clots block the flow of blood to the brain.

They account for about 87 percent of all strokes.

The other 13 percent are hemorrhagic strokes, which occur when a blood vessel in the brain breaks, resulting in blood seepage and damage to brain cells.

A transient ischemic attack or TIA, sometimes called a “mini-stroke” is temporary, often lasting only a minute or more and usually leaving no lasting damage.

SOURCE: AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION

Hear more at healthlinkonair.org. Search “stroke.”

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upstate.edu l summer 2016

A different stroke

CARING FOR PATIENTS

Hers happened after a neck adjustment

BY AMBER SMITH

Her equilibrium remained strange when she got up the next morning. As she drove to work, Carroll’s vision began to dim. She pulled over and threw up. She called for help through her vehicle’s security system. She lost sensation on her right side, and her vision. Her face drooped, and her speech became slurred.

She did not know what was happening. “I just remember there was a lot of chaos,” she recalls. “e reality is, if I didn’t get help soon enough, I was going to die.”

Both of her vertebral arteries were affected. Carroll says doctors immediately placed a stent inside one of the arteries, as reinforcement. Aer she was stabilized, they placed a stent on the other side.

Carmella Carroll, seven years after a stroke.

PHOTO BY ROBERT MESCAVAGE

IN SEEKING RELIEF for tension headaches, Carmella Carroll sought treatment that — she later learned — increased her risk for a stroke. e Manlius woman was 33 in October 2009 when she went to a chiropractor for a neck adjustment. She wound up spending more than 20 days hospitalized and months in rehabilitation aer suffering a type of stroke called a vertebral artery dissection.

It’s a rare but serious injury, says Lawrence Chin, MD, the chairman of Upstate’s neurosurgery department. “I’ve seen it happen,” he says. e vertebral arteries thread through the vertebrae of the spine on each side of the neck. ey can be damaged through spinal manipulation, leaving small tears in the inner lining of the arteries. Blood clots can develop and travel to the brain, causing a stroke.

She was in the intensive care unit for five days and had a difficult time regaining her health, although her vision was restored. For the first two weeks, Carroll couldn’t swallow, and for months aer she could only eat so foods. She walked with a cane when she le the hospital, and her home had to be modified with ramps and stairs that helped her reach her bed.

Carroll worked with occupational and physical therapists and audiologists during her rehabilitation. “Each time things would get a little bit easier, I would start to see this ray of hope.”

Seven years later, she is grateful for her health. She has a new husband, a third child, plus two stepchildren. She still has trouble eating some foods. When she is tired, her speech slurs. Her temperature regulation is sometimes off.

But her headaches are under control, with medication. ● Carroll’s sons visit her in the hospital, shortly after her 2009 stroke.

“In those situations you can’t say that the chiropractic adjustment wasn’t a significant contributing factor — although maybe not the only factor. Some patients do have other predisposing factors,” Chin says. “And, many people who get dissections don’t have chiropractic adjustments.”

Carroll remembers the last time she le her chiropractor’s office, feeling groggy and almost intoxicated. Once home, she lay down to calm her dizziness. She was vaguely aware of carving pumpkins with her husband and their children, who were 2 and 4 at the time.

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CARING FOR PATIENTS

Pancreas transplant

Could this help someone with severe diabetes?

UPSTATE DOCTORS PLAN TO offer a new transplant option for some patients with diabetes mellitus, the most common cause of kidney failure.

“Rather than waiting until the kidney fails, you may want to be proactive and go for a pancreas transplant, specifically if you have brittle, or labile, diabetes,” says Rainer Gruessner, MD, Upstate’s transplant chief and professor of surgery. He and his team expect to offer these transplant surgeries in the coming weeks — separately or combined with kidney transplants.

In the future, Gruessner’s team may also offer transplants of just the clusters of cells that produce insulin, called pancreatic islets.

Ruth Weinstock, MD, PhD, Upstate’s division chief of endocrinology, diabetes and metabolism, says, “the treatments for diabetes are getting better and better, but they are still are imperfect.”

Type 1 diabetes, in which the body’s immune system destroys insulin-producing cells, requires multiple insulin injections daily or insulin pump therapy along with frequent monitoring of blood sugar. Many people with long-standing type 1 diabetes, despite vigilance in glucose monitoring and administering their insulin, can no longer

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feel symptoms of low blood sugar, called hypoglycemia unawareness. ey can have unpredictable and lifethreatening episodes of low blood sugar, called severe hypoglycemia, and wide fluctuations in blood sugar levels.

Progress has been made in the development of insulin pump therapy and continuous glucose monitoring, components needed for the eventual development of an “artificial pancreas.” ey are a great step forward, says Weinstock, but they are not a cure.

Only a properly functioning pancreas or pancreatic islets would be a real cure.

Gruessner says a pancreas transplant can improve the lives of some patients with diabetes, and also halt or reverse complications such as diabetic changes in the eyes and kidneys. ose who may be considered for pancreas transplants have particularly hard-to-control type 1 diabetes, known as “brittle diabetes.” ey experience frequent and extreme swings in blood sugar, which increase their risk of heart attack, stroke, kidney failure, blindness, circulatory disorders and death.

Some people with diabetes who develop irreversible kidney damage may need a kidney transplant. ey may be candidates for a pancreas transplant at the same time.

upstate.edu l summer 2016

CARING FOR PATIENTS

ILLUSTRATION BY DAN CAMERON

THE ISLET OPTION Transplants of the pancreatic islets, the clusters of cells that produce insulin, show promise in treating people with severe diabetes and those with chronic pancreatitis and intractable pain.

Research published in April in the journal Diabetes Care shows that islet transplantation “offers a potentially lifesaving treatment that in the majority of cases eliminates severe hypoglycemic events while conferring excellent control of blood sugar,” says Anthony Fauci, MD. He is the director of the National Institute of Allergy and Infectious Diseases.

In the United States, islet transplants are currently available only through clinical trials. Research is underway to encapsulate the islets so they will not be recognized by the recipient’s body as foreign. The hope is that in the future, islets will be able to be implanted without the patient having to take anti-rejection drugs, which suppress the immune system.

For pancreas transplants, the donor organ comes from a person who has died. e pancreas is added to the recipient’s body, and the recipient retains his or her original pancreas, which continues to produce digestive enzymes. e new pancreas immediately begins producing insulin.

No surgery is without risk, but Gruessner says the risk of dying from a pancreas transplant is 2 to 3 percent, compared with an annual risk of dying that can be higher for some patients. “Of course we are selective about who should have a pancreas transplant, but the results in terms of patient survival are excellent.”

He says 85 percent of transplanted pancreases function as they are supposed to. Patients no longer have to check their blood sugar levels multiple times a day or inject themselves with insulin. ey are able to eat what they like. But, they must take anti-rejection medication.

“It’s lifesaving,” Gruessner says of the surgery, “but it’s also life enhancing.” ●

An experienced kidney, liver, pancreas and intestinal transplant surgeon, Rainer Gruessner, MD, (left) joined Upstate last fall as division chief of transplant services. He recruited Mark Laftavi, MD, to be surgical director and Oleh Pankewycz, MD, as medical director of Upstate University Hospital's pancreas transplant program.

Laftavi and Pankewycz previously directed the transplant program at the Erie County Medical Center, the teaching hospital for the University of Buffalo Jacobs School of Medicine.

PHOTOS BY ROBERT MESCAVAGE AND DEBORAH REXINE

PANCREAS CARE A SPECIALTY AT UPSTATE Upstate is one of 37 National Pancreas Foundation designated Centers for the Care and Treatment of Pancreas Diseases, and the only one in New York outside of New York City.

The designation, earned in March, means Upstate has all the services, health care professionals and programs necessary to provide multidisciplinary treatment for patients with diseases of the pancreas, including pancreatitis, diabetes and pancreatic cancer. Designated centers also play a role in advancing research and leading the way for heightened awareness of pancreatitis and related conditions.

“It’s a seal of approval for how we care for patients with pancreatitis,” says Nuri Ozden, MD, an interventional gastroenterologist at Upstate and the medical director of the foundation’s New York state chapter.

In addition, Upstate provides the Liver, Gallbladder and Pancreas Center. Established in 1994, the center provides comprehensive evaluation of patients with both malignant and nonmalignant diseases involving these organs.

Hear more at healthlinkonair.org. Search “pancreas.” summer 2016 l upstate.edu

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CARING FOR PATIENTS COMMON STEPS IN TRANSITION Gender transition is a different experience for everyone.

Some common steps in a medical transition are: 1. Live in the new gender role for a year.

2. Seek therapy from mental health professionals who can provide letters of support, which a health care provider may require for surgery later on.

3. Take appropriate hormones for another year.

4. Schedule surgery, which would be done in stages. Some transgender men may desire chest reconstruction. Some transgender women may seek a tracheal shave, facial feminization surgery or other feminization procedures.

5.Undergo genital reconstruction.

Gender reassignment operations sometimes require repairs A SURGEON SKILLED in reconstructive urology for men and women has developed a specialization in caring for transgender patients at Upstate.

Dmitriy Nikolavsky, MD, does not perform initial gender reassignment surgeries. Rather, he handles occasional complications that may occur in the months aerward, as well as follow-up medical care for years to come.

“Patients aer such complex operations, even without complications, will need lifelong urologic care,” he says.

“It is not surprising that urologists who are not familiar with specificities of transgender anatomy may not be comfortable offering even routine urologic care.”

His first patient was a Central New Yorker who traveled out of state for gender reassignment surgery. ree months later, the person was still unable to urinate properly.

Nikolavsky, in collaboration with the original surgeon, made surgical repairs, and the patient recovered.

Some of the most common complications aer gender reassignment surgery include strictures caused by scar tissue, abscesses that harbor pus and the formation of abnormal passageways called fistulas. Nikolavsky says it’s not uncommon for a patient to have more than one complication concurrently.

To stay current with his techniques, Nikolavsky connects with other reconstructive urologists who offer repairs, and he stays in touch with reconstructive plastic surgeons who perform gender reassignment surgeries. Multiple approaches can be used for male-to-female and female-to-

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male surgeries, and the initial approach can dictate the type of repair for which Nikolavsky must be prepared.

He says this specialty is something he did not envision when he graduated from Wayne State University School of Medicine in 2004 in Michigan. Even today, the number of gender reassignment surgeries remains low, but it’s growing. In addition to providing surgical expertise, Nikolavsky says he has diligently helped select properly trained nurses and office staff who want to create a trans-friendly office environment.

In January, Upstate hosted a Transgender Health Panel, designed as an introduction to the challenges transgender patients face in the health care system.

Also, parent Terri Cook spoke on campus about the “long and difficult process” of her child transitioning from female to male, the subject of a book called “Allies and Angels: A Memoir of Our Family’s Transition.”

“I watched my son grow from a depressed, strugglingwith-anxiety, bullied, withdrawn, isolating individual into a young man who is now rising in his life,” she describes in an interview with Nikolavsky on Upstate’s weekly podcast and talk radio show, “HealthLink on Air.” Cook goes on to discuss the surgery and its results. “He is a successful college student,” she says. “He has held a fulltime job. He is in a happy, healthy relationship. I don’t know what more any parent could want for their child.” ● Hear more at healthlinkonair.org. Search “Nikolavsky.”

upstate.edu l summer 2016

Grateful parents

CARING FOR PATIENTS

They support surgeon’s mission to remedy hydrocephalus without surgery

BY JIM HOWE

THE URGE TO HELP a 6-year-old Vernon girl and others with a painful disorder has inspired her parents and her surgeon.

Tom and Kim Clough’s daughter, Elyse, has a condition in which fluid builds up to dangerous levels in the brain.

Elyse was 4 months old when her parents noticed her eyes rolling downward, a symptom of hydrocephalus. At Upstate Golisano Children’s Hospital they learned the only current solution was brain surgery.

Satish Krishnamurthy, MD

Neurosurgeon Satish Krishnamurthy, MD, implanted a tube called a shunt to drain the fluid into her belly.

Patients with shunts can develop infections and blockages, must be monitored and oen need corrective surgery.

Elyse needed emergency surgery about a month aer her first shunt, Tom Clough says. She got her sixth shunt in February. Hospital visits terrify her. e Cloughs’ frustrations led them to become advocates for an alternative treatment for hydrocephalus. “ere’s a 40 percent chance that a kid with a shunt will be a productive member of society. And that is unacceptable,” Clough says.

Elyse Clough

Krishnamurthy’s research is examining the theory of the brain as a plastic bag that needs to be tapped. What if the brain were more of a tea bag, he says, and medication, not surgery, could drain excess fluid? It would be a chemical, rather than physical, problem and solution, he says.

Central New York families of people with hydrocephalus created a support organization in 2010 called REaCH. That stands for Research, Educate and Cure Hydrocephalus. Elyse Clough’s father, Tom Clough, is president. (Learn more at reachorg.org)

e Cloughs are grateful to Krishnamurthy and support his research as well as a bill introduced last year in the House of Representatives to expand and promote hydrocephalus research. ●

PHOTO BY SUSAN KAHN

SEEKING A BETTER WAY TO TREAT HYDROCEPHALUS

The group has donated $10,000 toward the hydrocephalus research of Upstate neurosurgeon Satish Krishnamurthy, MD. He wants to find a medication that can cure hydrocephalus without the need for surgery.

To contribute to the Hydrocephalus Research Fund, contact the Upstate Foundation at 315-464-4416.

Hear more at healthlinkonair.org. Search “Krishnamurthy.” summer 2016 l upstate.edu

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FROM OUR EXPERTS

discovering a

Image preprinted from Nelli S. Lakis, Yu Li, Jerrold L. Abraham, Chris Upton, Donald C. Blair, Scott Smith, Hui Zhao, and Inger K. Damon, “Novel Poxvirus Infection in an Immune Suppressed Patient,” Clinical Infectious Diseases, 2015, 60: 1543-1548.

By permission of Oxford University Press.

POX virus

How a man from Upstate New York, and a feral cat, helped scientists identify a new poxvirus

BY AMBER SMITH

EVERY DOCTOR HAS THAT PATIENT he or she can’t forget.

Jerrold Abraham, MD, and Donald Blair, MD, took care of a man with a mysterious infection 15 years ago, but only recently was their diagnostic quandary solved, thanks to advanced DNA testing that wasn’t available back then.

“I remember setting the sample aside and saying too bad we can’t figure this out yet,” recalls Abraham, a professor of pathology and family medicine at Upstate.

Years later, a scientist from the Centers for Disease Control and Prevention got back in touch with him. Now, when virologists study the hundreds of known poxviruses, the one called “NY_v014” is noted to have been identified at Upstate Medical University in Syracuse.

Abraham, Blair and a pathology resident, Nelli Lakis, MD, who is now doing a neuropathology fellowship at Brown Alpert Medical School, wrote about the case in the August 2015 issue of the journal Clinical Infectious Diseases.

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It started with a lesion It was 2001 when the 45-year-old man first noticed a blisterlike lesion under his right arm. For three weeks he watched a rash spread on the right side of his chest, becoming progressively rougher, more tender and reddened. When he went to his rural community hospital, the man was admitted, so he could receive intravenous antibiotics. e rash got worse. e doctors tried another medication that also had no effect.

Aer five days, they transferred the man to specialists at Upstate. By now the rash area was a wound about 6 inches wide, and other lesions were developing. e man felt ill, was in pain and soon developed a fever.

Doctors struggled to determine what was causing the infection. To help spur healing, surgeons removed dead tissue from the wound and sent the man for hyperbaric oxygen therapy. Nothing helped. continued on page 13

upstate.edu l summer 2016

FROM OUR EXPERTS

Donald Blair, MD, and Jerrold Abraham, MD, in their Upstate lab with the microscope they used to isolate the NY_v014 poxvirus.

PHOTO BY DEBORAH REXINE

ABOUT POX VIRUSES Despite its name, chickenpox (caused by varicella-zoster virus) is not from the family of poxviruses. Chickenpox is a herpes virus. One of the better-known poxviruses is smallpox (or variola virus). Of course, smallpox is essentially eliminated, but some of the findings in this patient’s tissues resemble those reported many years ago with smallpox.

Poxvirus continued from page 12

Blair, a professor of medicine with decades of experience in infectious disease, had never seen anything like it.

“No matter what we did, it got worse.”

Tissue samples from the wound revealed that it wasn’t caused by bacteria. at’s why the antibiotics had not helped. It wasn’t caused by a fungus, either. e man’s infection turned out to be viral.

Solving part of the mystery Using an electron microscope, Abraham could tell that the virus was a poxvirus, but it was unlike any of the hundreds of known poxviruses. Cidofovir, the medicine used to treat poxviruses, can cause severe or fatal kidney problems.

Since this man had received a kidney transplant two years before, Blair couldn’t risk giving him the medicine.

“We just kept holding off, and holding off, and it was tough. at wound kept getting bigger and bigger,” Blair recalls. Doctors kept removing the dead tissue, and they kept the man as comfortable as possible. Finally, his body’s immune system kicked in and fought the virus.

Abraham, Blair and other doctors remained stumped: How had the man had become infected with a poxvirus no one had seen before?

He had not traveled outside of the country. He hadn’t even le Upstate New York. He lived a somewhat isolated, rural life. He had no contact with animals, other than a feral cat. e man recalled treating an abscess on the cat’s back.

Since the cat came out of nowhere and had since disappeared, no one knows for sure that the man

summer 2016 l upstate.edu

contracted the poxvirus from direct contact with the cat’s abscess. But it’s Abraham’s and Blair’s best guess.

Recovery, and the rest of the story e man, who asked not be identified, was hospitalized for two months.

Six weeks aer he went home, he returned for a skin gra procedure, which helped repair the wound site. Ten years aer that, he remained free of complications. Earlier this year, he told Blair that his health remains good.

Like all organ transplant patients, the man’s immune system is suppressed, making him more susceptible to the transmission of a poxvirus or any virus.

He recovered from the infection, but Abraham and Blair were still curious to learn more about his particular poxvirus.

Aer isolating the virus at Upstate, they sent a viral culture to the CDC. Scientists there could only say that it was not one of the known poxviruses. Since then, advances in molecular biology and DNA sequencing improved, and new technology became available. Abraham got the call last year from CDC virologist Inger Damon, MD, the director of the division of high-consequence pathogens and pathology. e poxvirus that had infected the man back in 2001 was unique and previously unidentified. No cases have been reported since. e closest cousin to the NY_v014 poxvirus is one that was identified in a mosquito collected in 1972 in Central Africa. ●

U P S TAT E H E A LT H

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FROM OUR EXPERTS Upstate’s trauma team trained with Syracuse emergency responders during a school shooting drill held at a vacant Syracuse school building in 2015.

PHOTOS BY ROBERT MESCAVAGE

RUN, HIDE, FIGHT WHAT TO DO IF YOU ARE CAUGHT IN AN ‘ACTIVE SHOOTER’ SITUATION

BY AMBER SMITH

NEWS COVERAGE of mass shootings shows that such unpredictable violence can happen anywhere. How can you be prepared? Knowing what to expect and having a plan can help improve your odds of survival, says Chief Paul Waltz Jr. of the New York State University Police.

He points out that all of the various law enforcement agencies receive training from the U.S. Department of Homeland Security so that each knows what to expect from the other. eir overall strategy at the scene of an active shooting is called “immediate action rapid deployment.” It focuses on “neutralizing the threat” and “stopping the body count.” at means when officers arrive at an active shooting scene, their priority is not to tend to the wounded but to get the shooter.

Should you find yourself in an active shooter situation, Waltz says, events are likely to move quickly — and you are not likely to be able to talk your way out.

Your best course of action is to:

1. Run.

2. Hide.

If you can, run. Have an escape route in mind and keep your hands raised, so officers don’t see you as a threat.

If running is not an option, get yourself out of view.

If you are caught in an open area, seek cover and concealment. What’s the difference?

Cover is something that offers protection. It may not hide you entirely, but it can save you from being hit. A tree may be protective. So may a street curb if you lie flat.

Concealment can hide you but may not be able to protect you. Bushes can conceal you but wouldn’t be able to protect you from a spray of bullets.

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U P S TAT E H E A LT H

Block entry to your hiding area, perhaps by moving furniture in front of a door.

Turn out lights and close doors and window blinds.

Silence your phone. Dial 911 to give your location or leave the line open if you cannot speak.

Look for alternate exits in case the shooter finds your hiding spot.

Continued on next page

upstate.edu l summer 2016

Eat to live? Live to eat?

FROM OUR EXPERTS

Researchers explore how emotion and appetite are linked

BY JIM MCKEEVER

EARLY ON IN HUMAN evolution, our brains acted like thermostats to control our food intake. When we were hungry, brain circuitry drove us to consume food. When we were full, different brain circuitry prompted us to stop eating.

Our brains — specifically, the almond-sized hypothalamus attached to the pituitary gland — still regulate feeding behavior. But today we also eat out of habit and for pleasure, explains Patrick Sweeney, a fourth-year neurosciences student working on his doctorate in the laboratory of Yunlei Yang, MD, PhD. Sweeney’s research focuses on the link between emotion and appetite. He has explored how activating certain nerve cells can induce anxiety, and he has tracked how that affects feeding behavior.

In a paper published in the scientific journal Nature Communications in December, he and Yang explained how regions of the brain that are known to be involved in emotion and stress are also involved in feeding behavior.

Yang’s lab uses advanced techniques such as chemical genetics, electrophysiology and optogenetics, a technique that targets specific neurons in the brain with light. e light is converted to electrical signals that allow scientists to “turn on” or “turn off ” specific neurons to determine how the neurons control behavior. e researchers demonstrated how food intake can be reduced through selective activation of certain neurons or nerve cells in the brain. ink of the brain as an electrical circuit, with regions that are involved in emotions sending connections to regions that are involved in feeding.

RUN, HIDE, FIGHT

The hypothalamus is the primary brain region responsible for regulating feeding behavior. It is located above and attached to the pituitary gland, through which it links the body’s nervous and endocrine systems. The main job of the hypothalamus is homeostasis, keeping the body in a constant, stable condition.

Sweeney and Yang spent a year identifying and characterizing those neural circuits that travel between key regions of the brain.

“It turns out that these connections have a major influence in controlling feeding behavior,” Sweeney says. at knowledge may help shed light on how stress may cause a person to overeat or contribute to the development of anorexia, an eating disorder characterized by an obsessive refusal to eat. ●

continued from page 14

3. Fight.

Fighting should be your last resort.

Act with aggression to incapacitate the shooter any way you can. Team up for this if you are with a group of people. row things and improvise weapons. Take the shooter to the ground if you can.

When law enforcement officers arrive, stay calm and do not make any sudden movements. Listen and follow their instructions. Waltz advises keeping your hands up with fingers raised so that officers see you are not a threat. And be prepared to provide details about the shooter, his weapons and any victims. ● Learn more about active shooter response at upstate.edu/universitypolice

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Why Frank Middleton doesn’t eat bacon

FROM OUR EXPERTS

Short answer: Cancer prevention THE BACK STORY: Today Frank Middleton is an associate professor with appointments in three departments and extensive research related to neurological and psychiatric diseases. A few decades ago, Frank Middleton was a doctoral student at Upstate Medical University.

He attended a lecture by John Lucas, PhD, about the “Bacon Mismatch Repair Pathway.”

Lucas now works at an international biomedical research institute in Philadelphia. In the 1990s, when Middleton was working on his doctorate, Lucas was an Upstate biochemist focused on the field of glycobiology. For his lecture, Lucas presented slides demonstrating how cells use the repair pathway for DNA alterations that are introduced by high levels of nitrates in bacon.

“It stuck with me,” Middleton recalls. “It is an established fact that there is a significantly greater risk of DNA modification in cells exposed to high nitrates.”

LESSONS FROM UPSTATE

He shares an article from the journal Nucleic Acids Research, that explains how carcinogenic compounds form and may prompt mutations that lead to cancer: “e smoking process of meats is thought to introduce heterocyclic amine byproducts in the food, and the curing process involves nitrate salts that cause nitroso-compounds, which are thought to act as potential mutagens,” says the article from 2006.

Middleton says the molecular mechanisms are all completely worked out now.

“It’s a fact that it happens, and that our cells can respond to these mutations and repair them. But, over one’s lifetime, certain cells that are continually exposed to these types of mutagens will become less efficient at repair, and — voila — you can have a cancer cell.” ●

Jungle races, ankle surgery and sleep diaries

Keeping athletes safe in the tropics

Easing back into activity

Studying how best to track sleep

Mandatory rest stops for athletes competing in distance running events in hot climates — such as the Jungle Marathon in Para, Brazil — can improve the safety of the athletes and help them acclimate to the tropical environment.

How active can someone be aer ankle replacement surgery? ough the surgery is becoming more common, consensus guidelines about recovery activity levels have not been available — until now.

Wrist-worn devices are at least as accurate as paper diaries kept by people tracking their sleep habits, according to a study published in December in the journal Sleep Disorders.

Upstate orthopedic surgeon Scott Van Valkenburg, MD, was involved in research published in December in the European medical journal Foot and Ankle Surgery.

Karen Klingman, PhD, an associate professor in Upstate’s College of Nursing, is one of the researchers who studied 35 sleep-tracking adults over a two-week period. e research project was assembled because paper diaries can be lost, illegible or unreliable “and are considered out of date according to the newer technology- savvy generations,” the researchers wrote.

For a study published in January in the journal Prehospital Disaster Medicine, Jeremy Joslin, MD, and colleagues from Upstate’s department of emergency medicine reviewed six years of records for the Jungle Marathon.

Before mandatory rest stops were instituted, more than half of the runners who dropped out of the race did so because of a heat illness.

With mandatory rest stops in place during the first two days of the sevenday staged ultramarathon, just 15 percent of those who did not finish blamed heat-related factors.

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U P S TAT E H E A LT H

His group surveyed orthopedic surgeons about 50 sports and activities and found that in general “surgeons were comfortable with aerobic or low impact sports and activities” aer ankle replacement surgery. High-impact activities and sports requiring cutting and jumping were discouraged.

Surgeons were most restrictive with three types of patients: those who were young, those who were overweight or obese, and those with poor bone quality.

upstate.edu l summer 2016

se habla español

In this Upstate classroom,

IN OUR COMMUNITY

BY JIM HOWE

SI NADIE ENTIENDE MI LENGUA EN EL HOSPITAL, ¿CÓMO VAN A ENTENDER MIS PROBLEMAS MÉDICOS?

they need it most, I tell my students. e moment they greet the patients, culturally, they have already made the contact, and the patient thinks, ‘He cares for me.’”

If you had trouble understanding that first sentence, you can probably sympathize with a Spanish speaker who might say it. It means, “If no one understands my language in the hospital, how are they going to understand my medical problems?”

In the advanced class, the students work with cases taken from real life, play various roles and ask relevant questions, keeping an eye on their grammar all the while.

Bridging that language gap is the goal of María-Lourdes Fallace, who has been teaching medical Spanish to future doctors and others at Upstate for more than a decade. e elective classes range from basic to advanced and include students who never studied Spanish as well as native Spanish speakers who never learned medical terms.

As they learn the proper names for body parts, symptoms and diseases, the students also enlarge their conversational ability and their grasp of the cultural norms and attitudes they are likely to encounter among native Spanish speakers. Fallace, a native of Ecuador who has lived in Syracuse for several decades, enhances her teaching with insights into Latin American cultures.

For example, in a recent advanced class, students spoke in Spanish about diversity in the Hispanic world, including how different countries, regions and ethnic groups regard skin color.

First-year medical students Ryan Nightingale of Chatham and Daniel Farrell of Syracuse are taking the class to sharpen their Spanish. Both have spent time in Latin America and plan to do dengue virus research in Ecuador this summer.

Fellow first-year student Dulce Barrios from Miami is a native of Cuba who grew up speaking Spanish. She says the class reinforces the importance of explaining things to patients and the need to show respect.

A recent class, for example, featured a visitor who played the role of a 54-year-old man with chest pain and other problems. e students, acting as various specialists, had to diagnose his problem, explain to him what they were doing and act professionally in the face of his distrust, lack of cooperation, and, for added realism, his hysterical wife (played with glee by Fallace). e students learned that this patient likes to eat hamburguesas con queso (cheeseburgers) and cebolla frita (fried onions), that he has a 95 percent obstrucción (blockage) in an artery and that his mother had an ataque al corazón (heart attack) before she was 50. ey convinced him not to leave the hospital until they could perform more exámenes (tests), advised him to start eating food that was más saludable (healthier) and suggested that his diet was not totally the fault of his esposa (wife). ● THE 6 MOST POPULAR LANGUAGES AT UPSTATE Spanish is just one of more than 100 languages that might be spoken by Upstate patients every year. The other most frequently used languages include Arabic, Nepali, Somali, Karen (from Southeast Asia) and sign language, according to Upstate’s patient education and interpreter services department.

Below: María-Lourdes Fallace, center, talks with a students during the Medical Spanish course. Students, from left to right: Ryan Nightingale, Dulce Barrios, Daniel Farrell, and Laura Szczesniak.

PHOTO BY WILLIAM MUELLER

e classes also teach the importance of observation, notes Laura Szczesniak of Utica, another first-year student, who adds that patients appreciate being greeted and spoken to in their own language.

Fallace began learning medical terms from her grandfather, a retired physician, when she was a child. She also works as a bilingual medical interpreter and was honored in 2015 by the state Assembly for leadership and advocacy among the region’s Hispanic residents.

“I find both teaching the medical Spanish to the students as well as the interpreting so incredibly rewarding,” she says. “You are helping people where

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Somali culture

IN OUR COMMUNITY

Preserving a way of life for refugees in Syracuse

BY JIM MCKEEVER

SOMALI WOMEN AND CHILDREN who have relocated to Syracuse get together to socialize and do embroidery, crocheting and beading at a community center called RISE, several blocks from Upstate. Medical students from Upstate are part of the gatherings every other week or so.

“We’re building cultural competency and mindfulness.

We’re not just learning it. We’re practicing it in a way that’s mutual,” says Diane Kim, a second-year medical student who plans to be involved in some aspect of public health.

“One of our group’s key tenets is that both refugees and students have something to bring and share. ere are benefits for all involved.” e students form relationships with the refugees and immigrants, whose participation helps preserve their culture.

In her first year at Upstate, Kim met the executive director of a Syracuse organization that provides services to the Somalis. Soon aer, she created the Somali Upstate Folk Partnership and invited others from the Class of 2018 to get involved. e partnership received a $1,000 grant from Upstate’s Center for Civic Engagement. at money pays for art supplies. e benefits are clear to Haji Adan, executive director of RISE, which stands for Refugee and Immigrant Self Empowerment. “e women feel pride because their culture is seen and acknowledged,” says Adan, who came to the United States from Somalia nine years ago. He says the women are thrilled with the recent donation of two sewing machines.

In addition to the regular sessions with Upstate students, RISE offers language instruction, computer training, job coaching, citizenship guidance and formal case management services.

“Our goal is to be a one-stop shop for all refugees,” Adan says.

Kim has been exposed to many cultures, having traveled the world. She has been to India, Kenya, Tanzania, Indonesia, the Dominican Republic, Haiti and South Korea, where her parents were born.

Medical student Diane Kim doing beadwork and fabric arts projects with Somali women at the RISE community center.

PHOTO BY JIM MCKEEVER

One reason Kim chose Upstate for medical school was the university’s emphasis on community engagement, particularly with refugees. Syracuse has a long history as a refugee resettlement area, taking in hundreds each year from a variety of countries.

“I wanted to serve refugees in a way that involved relationship building,” Kim says. “Art is a good platform for that, with a lot of benefits. It brings people out of isolation and brings them together.”

At RISE, Kim says, language barriers aren’t necessarily an issue. A defining moment for the Somali Upstate Folk Partnership came in the group’s first session last fall.

Kim set up an activity called “Circle Dash,” in which people stand in a circle and have to communicate nonverbally that they want to switch places with someone.

When two people make that connection and start to switch, a person assigned to the middle of the circle tries to get to one of the open spots first.

Soon, the interactions were laced with laughter.

●

89.9 & 90.3FM

Now airing on Sundays on WRVO AT 6 AM & 9 PM Listen anytime: HEALTHLINKONAIR.ORG or ITUNES (search by topic)

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upstate.edu l summer 2016

Thousands need care

IN OUR COMMUNITY

Machala

Scientist responds in earthquake aftermath

Ecuador

South America

BY AMBER SMITH

WHEN A 7.8 MAGNITUDE earthquake hit Ecuador on April 16, Anna Stewart Ibarra, PhD, transformed herself from scientist into leader of a relief team.

Stewart Ibarra is an infectious disease expert from Upstate working in Ecuador to help develop a device that would attract and kill mosquitos that spread dengue fever and the zika virus, among other diseases. e earthquake killed more than 600 people and le Ecuador in a state of emergency. Stewart Ibarra lives and works in Machala, in the southern coastal region, about 400 miles south of where the earthquake hit. She and her team felt the earthquake and the strong aershocks every day for the following week. “ere are thousands of people without homes, sleeping outdoors, who need primary medical care, including many vulnerable infants and elderly,” she says via email.

Stewart Ibarra seeks donations of money to purchase medical supplies to be used by her team of volunteers in the coastal community of Bahia de Caraquez.

Upstate has a long-standing relationship with Ecuador through the Center for Global Health and Translational Science. Stewart Ibarra, an internationally recognized expert in the ecology of infectious diseases, has worked in Ecuador for the last nine years. Her research includes studies on the environmental and sociopolitical drivers of the transmission of dengue fever in coastal Ecuador, where dengue is hyper-endemic. She is rolling out new projects focused on zika, an emerging epidemic in the region.

from the earthquake. She suggests doctors, nurses and other health professionals consider joining the relief effort by contacting Tina Lupone, an instructor in research administration at Upstate, at 315-464-9493 or luponec@upstate.edu.

Stewart Ibarra says Ecuador has a shortage of health care professionals and will face a long-term public health crisis

To learn more about the dengue research project, find “Dengue REDDeS” on Facebook.

Above left: Anna Stewart Ibarra, PhD, in the midst of earthquake damage.

Above: Children in Ecuador.

PHOTOS PROVIDED BY ANNA STEWART IBARRA, PHD.

YOU CAN HELP Visit www.foundationforupstate.org/Ecuador to make a donation to the Upstate Ecuador Earthquake Relief effort. Anna Stewart Ibarra, PhD, is in Ecuador and will direct where the money is spent.

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19

She just goes

IN OUR LEISURE

BY AMBER SMITH

Ultramarathons have her running 100 miles at a stretch MONDAYS AND FRIDAYS ARE REST days for Kristen Hyer, except during soball season, when she has games.

Tuesdays, Wednesdays and ursdays are her short runs, when she logs from 4 to 15 miles each day.

Saturdays she runs 30 miles; Sundays, 20.

Hyer, 32, of North Syracuse is an athletic trainer who works in orthopedic surgery at Upstate. She runs so much because she’s training for ultramarathons — races of various distances beyond the 26.2 miles of a marathon.

“I prefer the longer-distance races because they are slower, and there are not as many people. Marathons tend to be real crowded,” Hyer says.

She grew up in the Southern tier and was a recreational runner since eighth grade.

In college she played intramural soccer. She ran a couple of half marathons. Her first marathon was the Marine Corps Marathon in 2006 in Washington, D.C., followed by the Lake Placid Marathon in 2010.

In 2011, she tackled her first ultra, the Fingerlakes Fiies, a trail race in Hector that lets participants run 50 miles or 50 kilometers, about 31 miles. She finished the 50K in just over six hours. ree years later, she completed the 50-mile race in just over 9½ hours.

Her longest distance has been 100 miles, which she first completed in 2014 in 22 hours, 13 seconds in the YellowstoneTeton Endurance Runs in Montana and Idaho. She ran another 100 miles in January, this time in fewer than 21 hours, at the winter Beast of Burden race in Lockport.

Sometimes Hyer listens to music while she runs. Sometimes she chats with other runners. Sometimes friends accompany her as pacers.

“What’s nice about ultramarathons is, unless you are an elite runner, you stop and walk when you get tired,” she says.

Races typically stock plentiful aid stations with distance runner favorites — peanut butter sandwiches, salt potatoes, macaroni and cheese, pickles. Runners will stop to refuel. Some even take time for a nap. It makes for a fun, supportive atmosphere.

Hyer isn’t sure where her stamina comes from. “I think I just have the ability to zone out,” she says. “I just go.” e runners she has met at ultramarathons are of all shapes and sizes, and most are not focused on speed. Instead, the main goal is simply to finish.

Hyer’s reward is chocolate milk. Aer races, she says, “I like to drink my chocolate milk, eat a little something and take a nap.” ●

GEM CARE EMERGENCY & URGENT CARE FOR SENIORS AGE 65+ 800.464.8668 l upstate.edu/GEM 4900 Broad Road l Syracuse

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upstate.edu l summer 2016

IN OUR LEISURE

Memoir focuses on race and medicine

BY SUSAN KEETER

IN “BLACK MAN IN a White Coat,” Damon Tweedy, MD, uses memoir to grapple with the evidence that, in his words, “being black is bad for your health,” shorthand for the fact that many diseases are more prevalent, and more lethal, among people of African descent. That reality struck home when the author — then a physically fit, 23-year-old medical student — was diagnosed with high blood pressure and kidney disease. In the book, Tweedy uses this and other experiences to dissect societal issues of class and race and to show how people of color are disproportionately derailed by diseases and circumstances.

Tweedy writes about events of racial bias that are painfully familiar: the medical school professor who mistakes him for a maintenance man; the staff who assume a clinic patient is unemployed; and a hospital patient who complains, “I don’t want no N-word doctor.”

In that case, Tweedy explores his own bias when he meets the foul-mouthed patient, Chester, and his daughter and grandson, both of whom wear Confederate flag T-shirts.

Driven to prove his medical skill and avoid racial politics, Tweedy works to stay focused on caring for Chester. The doctor-patient relationship thaws when Tweedy uncovers their mutual love of the Atlanta Braves. And, Tweedy adjusts his view of Chester when he learns that the man had devoted his life to caring for his ill wife.

After multiple medical complications, Chester dies, and Tweedy must inform the family. Chester’s once mistrustful daughter tells him tearfully, “Thank you for all you did for

Author Damon Tweedy, MD, signs a copy of Black Man in a White Coat for medical student Adekorewale Odulate-Williams.

PHOTO BY DEBORAH REXINE

my daddy,” and the grandson says, “Thank you, Sir. My granddaddy liked you.”

Bonds formed. Stereotypes overcome. Lessons learned.

Tweedy’s book covers his four years of medical school, the years of internship and residency training in psychiatry, and his early years of clinical practice. It also explores affirmative action, the intersection of economics and ethnicity, and the need for a person of color to navigate multiple worlds, which Tweedy describes as “double consciousness.”

In February, Tweedy spoke to medical students, faculty and alumni at Upstate Medical University. “These are incredibly complex issues,” he told a packed auditorium. “Be humble.

Treat everyone as an equal.”

Tweedy’s highly readable, thought-provoking book hit stores — and the New York Times’ best-seller list— last fall.

He is an assistant professor of psychiatry at Duke University and a staff physician at the Durham VA Medical Center. ●

Freekeh Fruit Salad With Pecans and Cinnamon Vinaigrette

is whole-grain and vegetable salad easily layers into a jar, for a single 2-cup serving.

You can mix and match with grains, vegetables and dressings that you have on hand.

And remember, grating ginger releases more juice and adds more flavor than chopping with a knife.

Ingredients for salad ½ cup freekeh, cooked ¼ cup red quinoa, cooked ½ cup fresh blueberries ¼ cup fresh pineapple, diced ½ cup canned mandarin orange sections, drained 1 tablespoon pecan halves, chopped and toasted 2 tablespoons cinnamon cider vinaigrette dressing (see recipe)

Preparation

Ingredients for dressing Nutritional information

½ cup apple cider vinegar 1 teaspoon ground cinnamon ½ teaspoon ground nutmeg ½ teaspoon kosher salt 2 tablespoons fresh ginger root, grated ½ cup olive-canola blend oil ½ cup orange juice 1 tablespoon dark brown sugar

per 2-cup serving: 400 calories 8 grams protein 63 grams carbohydrates 15 grams total fat 0 milligrams cholesterol 104 milligrams sodium 10 grams fiber

Cook freekeh and red quinoa according to package directions, but overcook slightly, so they are tender when cold. Whisk together salad dressing ingredients and set aside. For each salad in a jar, arrange ingredients in the following order: freekeh, quinoa, blueberries, pineapple, oranges and pecans.

WHAT IS FREEKEH? Freekeh was created by accident nearly 2,000 years ago when a Middle Eastern village was attacked and its crop of young green wheat was set ablaze.

Many folks may sulk over such misfortune, but the crafty villagers rubbed off the chaff, cooked it up and Eureka!

Freekeh was created.

RECIPE FROM MORRISON HEALTHCARE, THE FOOD SERVICE PROVIDER FOR UPSTATE MEDICAL UNIVERSITY

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21

Fun and exercise

IN OUR LEISURE

Balancing

KEVIN O’KEEFE WAS INTRIGUED when he saw a man and a woman standing on boards on Skaneateles Lake. Soon aerward he read about a paddleboard shop that gave lessons.

“My wife and I had a lesson and fell in love with it from there,” O’Keefe said. e two Upstate University Hospital nurses, both in their mid-40s, became stand-up paddleboarders, something that has given them a lot of fun and exercise around the Finger Lakes and beyond. eir 11 foot, 6 inch paddleboards resemble suroards propelled by long paddles.

“A lot of people say they’d like to try it. And many people say it seems like you’d have to have a lot of balance to do that. But it’s deceivingly easy,” said O’Keefe, who works in hematology/oncology at the downtown campus.

“It was a lot easier than it looked,” his wife, Martha, agreed.

She works part time in the pre- and post-anesthesia care unit at the downtown campus.

Momentum helps keep you balanced, O’Keefe explained.

BY JIM HOWE

“It’s kind of like a bicycle — you don’t just sit on a bicycle with your feet off the ground and not move. You’re paddling, so using the paddle will increase your balance.”

While the O’Keefes took up paddleboarding mostly as a leisure activity they could do together, “it serves the purpose of a good workout if you want it to,” said O’Keefe, who has also competed in races. eir hobby now includes their children, Cathleen, 9, who can paddle by herself, and James, 5, who just goes along for the ride. Everyone wears life jackets, and the kids enjoy jumping into the water and climbing back onto the boards. ey go out for about an hour every couple of weeks in the summertime, usually on Skaneateles Lake, which is an easy drive from their Camillus home.

Martha O’Keefe gives this advice to people who ask her about paddleboarding: “Definitely try it, but rent a paddleboard a few times before they think about buying one. It’s easier than it looks, and it’s a lot of fun. We’ve met a lot of nice people through paddleboarding.”

INTERESTED IN PADDLEBOARDING? Paddleboards come in different sizes (9 to 12 feet) and styles and range from less than $400 to more than $2,000. Try renting a few types to see which suits you.

You’ll also need a paddle, a leash (so the board can’t float away), a life jacket and, unless you live by the water, a vehicle that can transport the board.

You’ll only need a wet suit if you plan to go out when it’s cold.

Once you’ve got your board, it could get “a bit dinged up, but more or less it’ll last forever,” Kevin O’Keefe said.

PHOTO BY ROBERT MESCAVAGE

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upstate.edu l summer 2016

IN OUR LEISURE

A AND HER DAKOTA TRIC ONCOLOGIST, PEDIATRIC GLORIA KENNEDY, MD

or personalized care and treatment If your child faces a diagnosis of cancer, turn to the experts at Upstate for er access to clinical research studies, exceptional technology and support services at the Upstate options. We offer Golisano Children's Hospital and outpatient treatment at the Upstate Cancer Center. Our multidisciplinary teams of oncology-certified nurses and board-certified physicians are here for you.

TE.EDU/CANCER ATE.EDU/CANCER INFORMATION CALL 855.964.HOPE OR VISIT UPSTA FOR INFORMATION

VING LIVES. TIENTS. SEARCHING FOR CURES. SAVING PATIENTS CARING FOR PA

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23

750 East Adams Street l Syracuse, NY 13210

SCIENCE IS ART IS SCIENCE IS ART 1S SCIENCE These are the cellular components of a zebrafish pectoral fin. Green indicates the endoskeleton; red staining shows the epithelial cells; blue marks the nucleus of each cell.

Unlike humans, zebrafish can fully regrow limbs (fins) that have been damaged or lost.

Understanding how fin development and regeneration happens in the zebrafish may guide regenerative approaches in humans.

PhD student Agnik Dasgupta captured the image using a spinning disk confocal microscope in the laboratory of Jeffrey Amack, PhD, in Upstate’s department of cell and developmental biology.

Dasgupta 16.153 0616 39.1M Kenyonsk

Amack