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 2015
RECOVERING FROM STROKE page 5
KAYAKING CO-WORKERS
page 22
WEIGHT LOSS SURGERY AS A FAMILY AFFAIR page 9
DISTRACTED
DRIVING ADVICE page 13
REBUILDING NEPAL IN EARTHQUAKE AFTERMATH page 18
WHEN TO WORRY ABOUT BLADDER CANCER page 15
BEST BONEBOOSTING EXERCISES page 21
WELCOME
What do these numbers say about Upstate?
Words tell stories, but so can numbers.
The eight below help illustrate the missions of Upstate University Hospital – medical care, education and research – and reveal the institution’s dedication to the Syracuse-area community through charitable donations and its environmental stewardship through composting. On the pages that follow, you’ll read stories that tell more about the caregivers, patients, teachers and scientists who live and work throughout Central New York and whose paths cross at Upstate.
1,168
babies were born at the Community campus of Upstate University Hospital in 2014. That’s the highest number of deliveries since 2007 when it was the former Community General Hospital. The increase can be attributed to the launch of the Midwifery and Gynecology Program and Upstate’s partnership with the Syracuse Community Health Center.
More than
5,807
degrees Celsius is the temperature at which stem cells are stored while awaiting transplant at the Upstate Cancer Center.
150,000 pounds of food scraps have been diverted from the trash at Upstate Medical University since an initiative to compost food scraps began in 2011.
is the number of the fruit fly gene named by scientists in the laboratory of Upstate’s Francesca Pignoni, PhD. They chose the name Lilipod, an acronym for Lipocalin-like membrane protein receptor. The scientists work on fruit flies because their genome is so similar to that of humans, and they anticipate their research will some day have an impact on cancer and other human diseases.
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mammograms were provided to women living in the Syracuse Housing Authority’s Pioneer Homes development through a program called “She Matters.” A grant from the Susan G. Komen foundation helped create the program, which relies on trained resident health advocates to educate, support and encourage breast cancer screenings among low-income women. A grant renewal means the program is expanding to Syracuse’s Toomey Abbott Towers.
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527,956
dollars were pledged to be donated to charities by Upstate employees through payroll deduction during 2015.
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94.2 percent of first-year medical students at SUNY Upstate are New York state residents, according to the Association of American Medical Colleges. Interim President Gregory Eastwood, MD, says, “The education of New York residents is directly tied to Upstate’s mission. When we commit to improving the health of our community, growing our own to be the next generation of doctors is an integral part of that process.” Upstate is competitive, receiving 4,412 applications for the 154 spots in its first-year medical class this year.
past and present chief executive officers for Upstate University Hospital gathered for a ceremony in June that dedicated and renamed the main lobby after James H. Abbott, the hospital’s first leader.
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WELCOME
Contents 5
PATIENT CARE Helping stroke patients get their lives back
page 5
Supporting each other through thick and thin
page 9
Pain relief, robotic surgery expand at Community campus New surgical options for enlarged prostates, salivary glands
page 10
page 11
Health UPSTATE
TY ERSI UNIV CAL MEDI AT E UPST
Summer 2015
RING RECOVEROKE page 5 FROM ST
ING KAYAK RKERS
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FROM OUR EXPERTS 5 sunburn remedies Staying focused on the road Better breathing – for preemies and patients on ventilators
IN OUR COMMUNITY
CO-WO
ERY LOSS SURG9 WEIGHT Y AFFAIR page AS A FAMIL
IN OUR LEISURE
page 12
Meet a mystery-writing nurse practitioner
page 20
page 13
Best bone-boosting exercises
page 21
Kayaking co-workers
page 22
What’s Up at Upstate
page 4
Upstate Answers Can older people ride roller coasters?
page 12
Lessons from Upstate When to worry about bladder cancer
page 15
Recipe Chickpea salad
page 21
page 14
On a mission to teach computer skills
page 17
Earthquake aftermath: rebuilding Nepal
page 18
page 22
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DEPARTMENTS
cover story
ING IN REBUILD NEPAL
KE EARTHQUA H AFTERMAT 18 page
TE13 D ACpage DISNGTR ADVICE DRIVI
RY TO WOR WHEN ABOUT CANCER BLADDER
NEBEST BO ING BOOST SES EXERCI 21 page
page 15
On the cover: Upstate nurses Sherod Harris (left) and Andre Poirier kayaking on Oneida Lake. Photo by Susan Kahn.
Need a referral?
Contact Upstate Connect at 315-464-8668 or 1-800-464-8668, 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 Health magazine is a community outreach service of Upstate Medical University in Syracuse, NY. 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.
Health
Summer 2015
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
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
Visit us online at www.upstate.edu or phone us at 315-464-4836.
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WHAT’S UP
WHAT’S UP AT UPSTATE
News items you might have missed TAKING OFFICE. A graduate of Upstate Medical University’s School of Medicine is the new president-elect of the American Medical Association, so he will likely pop up in the news in the year to come.
Andrew Gurman, MD, an orthopedic hand surgeon from Hollidaysburg, Pa., will assume the office of AMA president in June 2016. Gurman received his medical degree from Upstate in 1980. In a recent interview for Upstate’s weekly talk radio program, “HealthLink on Air,” Gurman spoke of ways to keeps costs and fees reasonable for patients, doctors and medical students.
Hear an interview at www.upstate.edu/ healthlinkonair by searching “Gurman.” DESTROYING ODORS. A scientist can never predict his or her contribution to society. The Microsoft Network included Max Mozell, PhD, a distinguished professor emeritus in neuroscience and physiology, along with eight other experts who offered ways to deodorize bad smells. Mozell advised what to do after gutting a fish. The network quoted him as saying to mix a powdered bleach cleanser such as Comet with water until it forms a thin paste. Scrub your hands and then rinse with the hottest water you can handle. “The Comet has an oxidizing effect, meaning it chemically neutralizes the smell, and the hot water may help vaporize the odorous fish oil molecules,” Mozell told the network.
STICKING TOGETHER. You weren’t seeing double if you attended medical school graduation in May.
Matthew Siegenthaler, MD, and Michael Siegenthaler, MD, are identical twins who earned their medical degrees together and who have identical career paths. Both are pursuing family medicine, starting with residency training at St. Joseph’s Hospital Health Center. The Siegenthalers were among 181 students graduating from Upstate’s College of Medicine this year. SHARING MEMORIES. When the film version of “The Sound of Music” celebrated 50 years, a pair of Central New York sisters relived their summer of 1964. Upstate nurse practitioner Heidi Cross and her sister, Kate Huddleston, worked as stand-ins for Louisa and Brigitta von Trapp during the filming in Salzburg, Austria. As 12- and 13-yearolds, their job was to stand in place of actresses Angela Cartwright and Heather Menzies while lighting and sound were adjusted on the set. Their story appeared on Syracuse.com, with Cross disclosing some mischief. “They were filming that scene by the lake, and we went out in the boat,” she told a reporter. “We forgot to take oars with us and got stuck out there. They had to shut the production down for a bit and come out to get us.” Their family moved to Syracuse in 1968. Cross staffs Upstate’s ostomy clinic and specializes in care for those undergoing colon and rectal surgery. ●
BARIATRIC SURGERY SO I CAN SEE MY CHILDREN GROW UP Upstate’s Bariatric Surgery Program is the area’s longest-established program of its type, treating thousands of patients since it opened in 2002. We offer two options for surgical weight loss — Roux-en-Y gastric bypass and gastric sleeve. We also offer revisional surgeries, when appropriate for certain patients.
LeArN MOre Or regiSTer FOr A SeMiNAr: WWW.UPSTATE.EDU/BARIATRICS Bariatric Surgery Program
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PATIENT CARE
These doctors help stroke patients get their lives back S T R O K E R E H A B I L I TAT I O N I S A T E A M E F F O RT BY AMBER SMITH
Someone suffering symptoms of a stroke is surrounded by caregivers in the emergency department. Doctors assess the person’s consciousness, eye movement, reflexes, memory and ability to speak. Nurses start intravenous lines for medications, fluids and blood samples. Radiologists examine the blood vessels in the person’s brain through imaging scans. The focus is on lifesaving — determining whether the person has had a stroke and limiting its damage. This effort involves almost all of the caregivers. All but one. Bernadette Dunn, MD, is certified in brain injury medicine, a relatively new subspecialty recognized by the American Board of Medical Specialties. From the moment a stroke patient is stabilized, it’s her job to zero in on that person’s recovery. The patient is transferred to a specialized neurological care unit on the ninth floor of Upstate University Hospital, and that’s where he or she first meets with Dunn or one of her colleagues.
continued on page 6
Brain injury specialist Bernadette Dunn, MD, greets a stroke patient as visitor James Tredo looks on. She sees many of her patients in the neurological intensive care unit at Upstate University Hospital, a key feature of what is Central New York’s first and only comprehensive stroke center. The neurological ICU offers three levels of care for stroke patients, staffed by nurses with specialized training and credentials. PhotoS BY RoBeRt MeScavage
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Spotting the clues to stroke recovery continued from page 5 Once test results show the spot in the brain that is affected by the bleed or the clot, then Dunn can provide a good idea of the stroke patient’s prognosis. She can project what types of therapy the patient will need and for how long. As she monitors their recovery, she can predict any lasting problems.
“There are a plethora of changes that you can see following brain injury,” said Claudine Ward, MD, who also specializes Claudine Ward, in brain injury medicine at Upstate. “These MD we hope go away but a lot of times are persistent.” She noted that patients with brain injuries, including stroke, may have neurobehavioral changes, mood disorders or agitation, or they may experience changes with their endocrine systems. Having a doctor who recognizes issues and knows the best treatments to recommend can positively influence a patient’s outcome, Ward said.
Tiny movements help predict outcomes
Dunn sees patients in their own hospital rooms at Upstate. Her visits concentrate on actions that may seem minor but have huge significance. One patient, three days after a stroke, can pinch her fingers together but has trouble uttering more than one word. Another, nearly a month after a stroke, locks eyes with Dunn but struggles to lift her arm or speak. Each movement, or lack thereof, is a clue to the location and severity of the patient’s stroke and his or her recovery potential. Dunn uses the information to help predict how soon patients may need to begin intensive rehabilitation, what sorts of physical therapy they need now, and every other aspect of their care. Brain injury medicine specialists lead a multidisciplinary team that may include surgeons, psychologists, nurses and a variety of therapists. They care for patients with a variety of brain injuries, not just strokes.
A patient’s ability to move and feel sensation in the toes and fingers can help predict his or her recovery from stroke; that is one of the things brain injury medicine specialist Bernadette Dunn, MD, checks as she makes rounds, above. She often consults with other members of the stroke care team, including occupational therapist Kelly Van Auken, below.
“Everybody’s brain is different, and everyone has a different reaction to that injury, depending upon the area of the brain that is injured,” Dunn explained. For a stroke patient, the injury is a clot or bleed in the brain. “We can see two people who have a similar injury, one who has significant deficits in terms of thinking processes and ability to function in daily life, and the other who had what would be considered a larger injury and fewer deficits. It really just depends on the area of the brain that is impacted.”
continued on page 7
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PATIENT CARE
continued from page 6 One woman who had a stroke on a Sunday was not able to move her left arm the next day. But by Tuesday, she lifted it up and down. And when Dunn asked her to pinch her fingers together, she did. Often after a stroke, patients may retain movements that occur closest to the center of their bodies, such as flexing a knee or elbow. Movements that occur further from the core, involving the fingers or toes, may prove more difficult. The woman’s husband of 55 years was at the side of her bed, and one of her grandsons stood at the foot. The woman tried to explain to Dunn how she had walked earlier with a therapist’s help.
Building on success
Dunn moved to the end of the bed. “Can you bend this foot up yet?” The woman did, and then arched her toe. “Oh, I liked that, too,” Dunn said. The woman had acquired a lot of motor skills in just three days, and Dunn wanted to build on her success. She would arrange to get her into intensive rehabilitative therapy as soon as possible. “We want to take you to rehab,” Dunn told the woman. The second patient she checked was a woman who had a hemorrhagic stroke a month before. The woman’s recovery was slow, as expected, given the location and severity of her stroke. The woman smiled. Warm, sparkly eyes followed Dunn, engaged more than was usual. Dunn tapped her knee, checking her reflexes. The doctor raised the woman’s leg, asking her to hold it up. She couldn’t. The leg dropped. Still, Dunn thought it may be time to transfer her to a longterm rehabilitation facility. “She’s actually very alert and bright, and that’s good.” The woman would need a shunt to help drain the fluid from her brain, a common complication after a bleeding injury in the brain, so Dunn considered whether to recommend surgery before or after the move. She also had to make sure the woman had the ability to swallow because nutrition was crucial during rehabilitation.
Brain injury medicine specialist Bernadette Dunn, MD, discusses a case with neurosurgery resident Khalid Khalid, MBBS. Dunn is also an associate professor of physical medicine and rehabilitation who trains residents and medical and other students.
Coping together
continued on page 8
GROUP AIDS PATIENTS AND FAMILIES RECOVERING FROM STROKE
When a stroke damages a person’s ability to speak or talk, it can lead to frustration, anxiety and social isolation for both the patient and his or her loved ones. That’s why Carrie Garcia, a speech language pathologist at Upstate, co-founded the Central New York Stroke Support Group with Jennifer Dougherty, a speech pathologist at St. Joseph’s Hospital Health Center. “Our mission is to educate patients, families and caregivers and provide them an avenue for socialization and self-expression of their experiences and their feelings, needs and
social networking — meeting other patients and families that are like themselves,” Garcia said. The group, open to all, meets from 5 to 7 p.m. the third Monday of each month at OASIS/HealthLink, 1 Telergy Parkway/6333 state Route 298, DeWitt, just east of Carrier Circle. Meetings include a guest speaker and group sessions for spouses and survivors. For more information, call the Upstate Neurology Department at 315-464-4243 or go to www.upstate.edu/stroke ●
Hear an interview at www.upstate.edu/healthlinkonair by searching “Garcia.”
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Nearly a dozen caregivers meet to discuss individual patients’ care and progress. This meeting is led by Shernaz Hurlong, DO, and attended by additional physicians, nurses, brain injury specialists, physical therapists, occupational therapists, speech language pathologists and a rehabilitative psychologist.
Specialized rehabilitation is key to stroke recovery continued from page 7
Another important issue during rehabilitation is bowel and bladder management, an area of rehabilitative nursing specialization. Dunn said many of the therapists and nurses work with patients in various stages of recovery from stroke, both in the neurological intensive care unit as well as the rehabilitation unit.
Team of caregivers focuses on recovery
Some stroke patients with mild deficits may go home after they are discharged from the neurological care unit. They may attend outpatient rehabilitation for physical, occupational and/or speech therapy. They may also make appointments with a rehabilitative psychologist for help adjusting. Some stroke patients are recommended for inpatient rehabilitation. Upstate University Hospital has 50 beds dedicated to rehabilitation, 30 at its downtown campus and 20 at its community campus. In selecting which stroke patients should remain hospitalized during rehabilitation, Dunn said she considers their medical complexities, the severity of their stroke and whether they can tolerate and benefit from six therapy sessions per day. It varies, but a typical course of inpatient rehabilitation is two weeks. During the last part of their hospital stay, someone recovering from a stroke is surrounded by a set of caregivers, different than those who cared for him or her in the emergency department. The nurses, therapists, dietitians and doctors who concentrate on recovery are focused on helping patients get on with their lives. ●
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Brain injury medicine specialist Bernadine Dunn, MD, discusses a patient’s progress with nurse manager Virginia Castro.
Hear an interview at www.upstate.edu/healthlinkonair by searching “brain injury.”
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PATIENT CARE
Top: Sisters Cherica and Nicole Hoistion before bariatric surgery; above: Tanya and David Hoistion before surgery.
David Hoistion, 46, weighs 185 pounds, down from 345 pounds before his surgery in April 2012. His wife, Tanya Hoistion, (second from left) had surgery in October 2012, dropping to 140 pounds from 265 pounds. His two daughters had surgery on the same day in October 2014. Nicole Hoistion, 25, (left) has dropped to 210 pounds from 325, and Cherica, 20, (right) has dropped to 170 pounds from 272 pounds. Photo BY SUSan Kahn
SUPPORTING EACH OTHER THROUGH THICK AND THIN BY AMBER SMITH
The most successful weight loss surgery patients surround themselves with people who have had the surgery, are following the new way of eating and can support the post-operative lifestyle.
often embark on weight loss surgery with a friend or family member. They arrive together at an informational session and go on to schedule their operations for the same day or several weeks apart, so they can help one another recover.
Sometimes these veteran patients are found within hospital support groups. Sometimes they are found in the same neighborhood. And in this case, the same household.
“When you have that built-in support, you’re able to keep each other kind of on track and accountable,” Hammerle said.
Weight loss surgery has been 100 percent life changing for David Hoistion, 46, the patriarch of a family in Calcium, outside of Watertown. He and eight of his relatives have had weight loss surgery, including his two daughters, his wife, his mother-, father- and sister-in-law, an aunt and uncle – plus the pastor and several friends from his church.
Losing weight and keeping it off can require a significant lifestyle change, and for many people, support is the key to success. The best weight loss surgery programs provide ongoing support – as Upstate’s does. Many patients also find support from friends or relatives.
“They may go in and tie your stomach, but for the patient, this surgery is more mental,” Hoistion said, describing how he cried when he smelled chicken he wasn’t able to eat soon after his operation. His weight loss helped to correct his sleep apnea and high blood pressure and relieved the pressure on his knees. Nurse Casey Hammerle, the program coordinator for bariatric surgery at Upstate University Hospital, said people
Cherica Hoistion, 20, who lives in Rome, had surgery on the same day as her older sister. As she shed her excess pounds, she was no longer lactose intolerant, and she felt more confident. Today her family eats smaller portions and healthier foods and drinks water instead of soda. She said, “We’ve all kind of gotten used to eating the gastric way.” ●
For details about weight loss surgery at Upstate, visit upstate.edu/bariatrics
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PATIENT CARE
By happenstance
HOW A COFFEE SHOP DIAGNOSIS S AV E D A N E W B O R N , G U I D E D A C A R E E R
Rahul Dudhani, MD, remembers when he was new to Syracuse and had a chance — but influential — encounter in June 2012 at Café Kubal. He was a few weeks away from starting his surgical training at Upstate, and enjoying a rare day off, when he noticed a man looking intently at his cellphone in the downtown Syracuse coffee shop. The man turned out to be pediatric cardiologist Frank Smith, MD. Samaritan Medical Center in Watertown had contacted Smith for his expertise because a newborn baby was in cardiac distress, and there was no pediatric cardiologist on hand. Smith was trying to view the echocardiogram and highly detailed images of the newborn’s heart, but his new cellphone did not immediately connect to the café’s wireless network. Dudhani helped him. Moments later, the young physician received his first lesson in cardiac pathology from Smith, a member of Upstate’s faculty, and a man who would become a mentor. Examining the echocardiogram and images of the newborn’s heart, Smith diagnosed a rare and dangerous condition called total anomalous pulmonary venous return. Blood was not flowing properly within the heart’s chambers. The baby would need surgery, and soon.
“Rahul’s help was well timed,” Smith said. “This was a rare heart problem, potentially a life or death situation for the baby.” The baby was transferred to the neonatal intensive care unit Squad 1: surgery at at Crouse Hospital and daysUpstate later underwent Upstate University Hospital. David Landsberg, MD;
Christian Knutsen, MD;
Dudhani began his surgical residency at Upstate Derek R. Cooney, MD; a few months after meeting Smith. Chris Today he isMD; a fourth-year Tanski, Jeremycardiac Joslin, MD and ● resident, specializing in pediatric surgery.
New at community campus: Pain relief, robotic surgery Upstate’s suburban hospital has new robotic surgery options and pain relief services.
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Erin Wirths, DO.
place at the downtown hospital.
A team of specially trained anesthesiologists provide outpatient pain management, including injections and pain pump refills for patients with chronic pain, at the Upstate University Hospital community campus on Broad Road in the town of Onondaga. This supplements service that is offered at the Upstate Bone and Joint Center in East Syracuse.
Surgeons at the community campus are using a new da Vinci surgical system that limits the number of incisions, reduces the time a patient is in surgery and provides improved picture quality. It is being used for patients undergoing hysterectomy, hernia repair, weight loss surgery, prostate removal, pelvic prolapse surgery and a variety of operations on kidneys and bladders.
Most patients are being treated for chronic neck or low back pain, chronic arthritic pain in the shoulders or knees or nerve pain from diabetes, shingles or central nervous system disorders. Surgery to install pain pumps still takes
“This technology helps Upstate teach future generations of surgeons and offer patients more surgical options,” said David Halleran, MD, chief of surgery at the community campus. ●
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PATIENT CARE
Delicate maneuvers
NEW SURGICAL TECHNIQUES PROVIDE PATIENTS WITH OPTIONS
Laser targets excess tissue in prostate
An enlarged prostate can affect the flow of a man’s urine and create urgency and frequency issues that can impact his daily activities and sleep. Medications are often prescribed, but they may only offer temporary relief and intolerable side effects. “For many men, taking medicine for this condition isn’t something they want to do long term, and for other patients, the medications may not be effective,” said Jessica Paonessa, MD, an assistant professor of urology at Upstate who offers an alternative. “In these cases, the next step is to remove the obstructive tissue surgically.” She offers a minimally invasive surgery called holmium laser enucleation of the prostate. A high-powered laser removes the obstructive portion of an enlarged prostate in its entirety. The surgeon accesses the prostate through the urethra and uses the laser to separate the obstructive tissue from the original prostate. A device cuts the tissue into small pieces and extracts it using suction. “This allows for a thorough cleanout of the blocking tissue and offers patients many benefits,” Paonessa said. The prostate, which is left intact, retracts to its original size and allows the patient to regain the ability to urinate without difficulty. Patients remain in the hospital for approximately 24 hours and are able to return to their daily activities without restrictions in seven to 10 days. Paonessa said the results of the surgery are long-lasting, “and patients experience lifechanging results. They can travel, sleep through the night and return to their normal daily activities.” ●
Hear an interview at www.upstate.edu/healthlinkonair by searching “Paonessa.”
Salivary treatment leaves gland intact
People in need of salivary gland surgery have more options, thanks to a new ear, nose and throat surgeon on staff at Upstate. Mark Marzouk, MD, the chief of the division of head and neck oncologic surgery, is one of the few surgeons in New York who is trained in an endoscopic procedure that allows the surgeon to simultaneously detect, diagnose and treat inflammatory and obstructive disorders of the salivary ductal system without having to remove the salivary gland. “Our ability to visualize and treat the specific cause of the inflammation or obstruction allows us to save the salivary gland, leaving the patient with no external scars and at no risk of facial nerve injury,” Marzouk said. “Other benefits include less recovery time, same-day discharge, and the resumption of normal activity the next day.” The salivary glands play a role in digestion, keeping the mouth moist and supporting healthy teeth by producing saliva. Depending on the severity of their condition, patients who have surgery on the salivary glands may be able to return home the same day. ●
Hear an interview at www.upstate.edu/healthlinkonair by searching “salivary.”
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FROM OUR EXPERTS
UPSTATE ANSWERS
Can older people ride roller coasters? Question
Roller coasters and other wild rides provided so much enjoyment in my youth, but as I’ve gotten older, riding these rides leaves me feeling ill, with nausea, dizziness and/or headaches that last for hours afterward. What’s going on?
Answer
“You have described not uncommon symptoms related to the vestibular system contained in the inner ear,” says physical therapist Dale Avers, DPT, PhD, left, who directs Upstate’s post-professional program for physical therapists who want to obtain their doctorates. “As we get older, the vestibular system gets less efficient, meaning it doesn’t respond as easily to motion of the head or to movement around us. Normally the inner ear responds to movement automatically, so we aren’t aware that it is working until the movement is too much for our vestibular system to handle. “When that happens, such as riding a roller coaster or even riding in a car or airplane, we experience motion sickness, which are symptoms you describe. “The good news is that you can train the vestibular system to be less sensitive, although the training isn’t fun. Basically you have to provoke the symptoms so that the vestibular system becomes more tolerant.
Battling sunburns with cream and ketchup “Or, you can just avoid those roller coaster rides.”●
Obviously it’s best to avoid getting a sunburn in the first place, said Ramsay Farah, MD. But if your skin ends up reddened after a day in the sun, here’s what Upstate’s division chief of dermatology advises: 1. Gauge the severity of the burn. If you have blisters, he said to make a trip to your health care provider, “just to make sure it’s examined and that no possibility of scarring arises.” 2. Take an aspirin. Its anti-inflammatory effects can help during the initial stage of a sunburn, if you take it promptly. 3. Apply cool compresses on the affected area. 4. Use a low-strength (1 percent) hydrocortisone cream, available over-the-counter, to help decrease inflammation but not affect wound healing. “You want to be careful not to put very strong steroids on the burn,” he said. 5. Head to your kitchen for a bottle of ketchup. Yes, you read that right. Farah explained that “Ketchup has a lot of lycopenes and other anti-inflammatory factors, and it’s cold because it comes from the refrigerator. So if you put that on right away, along with taking aspirin, you will decrease the inflammatory response.”
None of these measures will reverse the damage, but they should help the burn heal better and feel better. ●
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FROM OUR EXPERTS
How to stay focused on the road
‘LET’S NOT MEET BY ACCIDENT’ PROGRAM BATTLES DISTRACTED DRIVING
ADVICE FOR TEENS: l Turn off your cellphone while driving,
or at least put it on safe mode. If you must use your phone, pull off the road and park safely first. l Refuse to ride in a car with a driver who is
under the influence of alcohol or drugs. Create a backup plan with your parents or other caregivers, so you can count on a safe ride home. l Limit your vehicle to one passenger if possible
and reduce conversation and movement while on the road. l If you are a passenger, do not encourage speeding or
other negative behavior. l Find your preferred radio station or playlist before you
start the car and stick with it until you reach your destination. Keep music at a low level – and no dancing while driving. l Review maps and directions before you leave for an
unfamiliar destination. If you need to consult a global positioning device, pull over first.
Cell phones, alcohol or drug use, passenger conversation and the car radio are the most common distractions for teen drivers, said Kim Nasby, the Upstate Trauma Center’s injury prevention coordinator and an instructor in the Let’s Not Meet by Accident program. She said motor vehicle accidents remain the leading cause of death for drivers age 15 to 19. Health care providers at Upstate want to help teens drive safely. Here is their advice:
ADVICE FOR PARENTS OF TEENS: l Lead by example. Don’t text and drive. Wear seat belts. Follow traffic laws. l Explain the dangers of driving under the influence
and make sure your teen knows the use of alcohol or drugs is non-negotiable. l Consider a “no passengers” policy for new
teen drivers. l Look into smartphone applications
that monitor a teen’s texting and phone calls while they are driving. Let’s Not Meet by Accident is a free interactive injury prevention program designed by the Upstate Trauma Center. It’s offered once a month for up to 150 students from schools throughout Central New York. Learn more by calling 315-464-4779. ●
l Keep sunglasses in your car to minimize
the outside distraction of the sun. Reduce the glare from reflective surfaces such as glass and polished metal by purchasing sunglasses labeled “UV 40.”
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FROM OUR EXPERTS
UPSTATE DISCOVERIES
Protecting preemies and patients on ventilators RESEARCH POINTS TOWARD TREATMENT CHANGES Critically ill patients who require ventilators are at risk for developing acute respiratory distress syndrome, a condition with a mortality rate higher than that of breast cancer in the United States. Four out of 10 of those patients who develop acute respiratory distress syndrome will not survive. Those who do may cope with lung problems forever. Scientists from Upstate are leading efforts to prevent the syndrome from developing. Their research could prompt a change in the way patients all over the world are treated while they are on breathing machines, or ventilators. Most patients who develop an acute lung injury do so within 48 hours of being connected to a ventilator and this can progress to acute respiratory distress syndrome. The current treatment is to reduce the volume of air delivered to the patient, which improves his or her survival rate but by less than 10 percent. An Upstate laboratory run by Gary Nieman, in collaboration with Nader Habashi, MD, from the R. Adams Cowley Shock Trauma Center in Baltimore, proposes a new strategy to prevent the development of acute respiratory distress syndrome. It is a type of ventilation, called airway pressure release ventilation, which lengthens the patient’s inhalation phase to open collapsed lungs and shortens the patient’s exhalation phase to keeps the air sacs from collapsing. The trick is, caregivers must know what to look for, so they can intervene ahead of the syndrome’s development.
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BY AMBER SMITH
“Timing of an intervention may be as critical as the intervention itself,” Nieman wrote with colleagues in the Journal of Trauma and Acute Care Surgery. Research from his lab has shown that early intervention with airway pressure release ventilation blocks the development of acute respiratory distress syndrome and prevents swelling and inflammation in the lungs. Now Nieman and Habashi — with assistance from research scientist Josh Satalin and surgery residents Michaela Kollisch-Singule, MD, and Sumeet Jain, MD — are exploring whether this same strategy can save the lives of premature babies. Human gestation lasts 40 weeks. Babies born before 37 weeks are likely to have organs that are not fully developed. The lungs are of particular concern because the body does not produce the surfactant they need in order to keep the lungs inflated until about week 28. The chance of survival is low for babies born before then. The theory is that airway pressure release ventilation used on babies born as early as 25 weeks gestation could provide their bodies enough time to start producing the surfactant that will keep their lungs open and functioning for the rest of their lives. Nieman can’t help the enthusiasm he feels for the research. “We are currently in the position to change how medicine is practiced within the next few years.” ●
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FROM OUR EXPERTS
Who knows your wishes?
APPOINT A PROXY TO SPEAK FOR YOU IN CASE YOU CAN’T SPEAK FOR YOURSELF By appointing a health care proxy, or agent, you can make sure someone you trust carries out your wishes when you cannot make your own decisions, and you can help avoid conflict and confusion among loved ones at a stressful time. A proxy will speak for you if you are unable to speak for yourself — even temporarily — while receiving medical treatment. Tom Curran, MD, and Robert Olick, JD, PhD, members of the ethics consultation service at Upstate University Hospital, recently spoke about the benefits of designating a health care proxy. They said the hospital promotes New York’s health care proxy form as the preferred type of advance directive. You can download the form at www.upstate.edu/bioethics. (Click on “ethics consultation” and then “health care proxy forms.”)
way, it is a good idea to discuss your wishes with your proxy and your doctor, then give a copy to each of them as well as to the hospital where you will receive care — and you can carry a wallet-size card with you. Your proxy and your health care providers are required to follow your wishes. Your wishes may be based on your moral and religious beliefs, your view of quality of life, concern for your family or other factors that matter to you. You can appoint a backup proxy, and you can cancel the proxy’s authority at any time. A person maintains the right to make his or her own health care decisions as long as he or she is able. Decision-making power only passes to the proxy when a doctor determines you are unable to make health care decisions yourself. You must be 18 or older to be a proxy or to complete a health care proxy form. ●
Instructions can be as general or specific as you like. Either
Scans reveal symptom-free bladder cancer
LESSONS FROM UPSTATE
WHEN YOU AND YOUR DOCTOR SHOULD BE CONCERNED A medical scan of your abdomen or pelvis may reveal more than what your doctor was looking for. Some specific features of your bladder could indicate cancer, even if you have no pain, bleeding or other symptoms. A follow-up is warranted, say a pair of Upstate urologists who published their work in the journal Urology this year. Timothy Byler, MD, and Imad Nsouli, MD, created a database of 2,400 patients who underwent cystoscopy, a procedure that examines the inside of the bladder. “This data suggests that patients with bladder wall thickening reported should undergo cystoscopy to exclude cancer. If your patient’s CT report comes back with bladder wall thickening, get a urologic consult,” Byler said. From their data, they discovered:
A. Shows the normal bladder appearance. Among radiographic bladder wall abnormalities are B. diffuse bladder wall thickening, C. focal bladder wall thickening and D. bladder mass.
lA
mass in the bladder has a 50-percent chance of being cancerous.
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bladder wall that was uniformly thicker than usual had a 20-percent chance of being cancerous.
lA
bladder with a localized area of thickness on the inside wall is not likely to be cancerous.
The urologists admitted they were surprised that nearly 15 percent of the patients included in their database were
found to have bladder cancer. Half had a more aggressive, deadlier type of cancer. Undergoing cystoscopy to explore the abnormalities that turned up incidentally could have saved these patients’ lives. The lesson is: Carefully read imaging reports and seek answers for any abnormalities. ●
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DAKOTA A AND HER PEDIAT TRIC ONCOLOGIST, GLORIA KENNEDY, MD
If your child facess a diagnosis of cancer, turn to the t experts at Upstate fo or personaliz onalized care and treatment options. We offe er ac a cess to clinical research studies, exceptional technology and suppor pport services at the Upstate Golisano Children's ' Hospital and outpatient treatme ent at the Upstate Cancer Center. Our multidisciplinary teams of oncology-certifi fied nurses and board-certified ph hysicians are here for you.
FOR INFORMA AT TION CALL 855.964.HOPE OR VISIT UPSTA AT TE.EDU U/CANCER
CARING FO OR PA AT TIENTS. SEAR RCHING FOR CURES S. SAV VING LIVES.
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IN OUR COMMUNITY
Soldiers, families, neighbors
TACKLING HEALTH NEEDS AT FORT DRUM
Two years after earning his masters degree in public health, Ian Grant said he never would have imagined he’d be managing an annual budget of $1.5 million in state grants for population health. That’s exactly what he’s doing as population health program manager for the Fort Drum Regional Health Planning Organization in Northern New York. “My role is identifying health needs and leveraging resources to address those needs through partnerships,” Grant said recently during a grand rounds presentation at Upstate. “Our coalition includes insurers, schools, chambers of commerce and numerous community-based organizations.” The organization’s three-county service area includes the U.S. Army base at Fort Drum, family members of the soldiers and the surrounding communities, which are mostly rural. Compared with urban populations, residents of rural areas tend to be older, poorer, sicker and more likely to be uninsured, Grant said. New York state health statistics indicate North Country residents have higher rates
of adult and child obesity, binge drinking, diabetes, smoking and suicide. Grant works with nine hospitals, three public health agencies and several community organizations to protect and improve the health of more than 250,000 residents. His group relies on a web-based health information system at www.ncnyHealthCompass.org to inform and engage community members and monitor health improvements. He said the public health training he received through the CNYMPH program – which makes use of experts at Upstate and at Syracuse University – informs his work every day. “I get to use my CNYMPH training in research, data analysis, administration, health planning and program evaluation to help create a healthier community.” ●
Ian Grant
On a Mission
TECH EXPERT OFFERS COMPUTER TRAINING
A senior programmer at Upstate spends some of his free time helping to close the digital divide. That’s the division between those with computer and Internet access and skill sets, and those without. Joe Huber volunteers at the Rescue Mission in Syracuse, where he teaches computer skills to clients of the Rescue Mission and serves on its Information Technology steering committee. His Digital Bridge Class is offered to Rescue Mission clients who are seeking employment or general computer skills. They learn Microsoft Windows and Office, including Word, and they learn how to search the Internet and use email. In addition, they learn about identity security and how to be safe in cyberspace. At the successful completion of the course, students are awarded personal computers that have been donated by supporters of the mission. “It’s been a real eye-opener. It’s been one of the most interesting things I’ve ever done,” Huber said. The class had to be adapted. Some of the students needed beginner-type training which focused on the keyboard, punctuation and literacy, before they could move on to computer skills. The first group recently graduated, and Huber said he looks forward to future classes. He enjoys teaching, and he enjoys learning about the people whom he helps. ●
Joe Huber (background, standing) works with (from front to back) Robert Chapman, Jorge Varona and Patrick Carroll at the computer lab at the Rescue Mission on Gifford Street in Syracuse. Photo BY RoBeRt MeScavage
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IN OUR COMMUNITY
Upstate students benefit from nationally recognized professors, excellent job placement and SUnY tuition. Degree programs: Medicine, nursing, PhD, Public health, cardiovascular Perfusion, Medical Imaging, Medical technology, Medical Biotechnology, Physician assistant, Physical therapy, Radiation therapy and Respiratory therapy.
Education • Healthcare • Research
www.upstate.edu/students
Earthquake aftermath: Rebuilding Nepal
After dispensing medical care and supplies in the aftermath of the April 25 earthquake in his native Nepal, Upstate hospitalist Dinesh Subedi, MD, is focusing on rebuilding. The disaster killed more than 9,000 people and left nearly 3 million homeless. Subedi traveled with locally donated supplies and joined Nepali doctors from the United States to treat 25 or 30 people in each of several villages. They mostly hiked amid flattened buildings and landslides to get to patients requiring care.
Photographs Subedi shared show some of his experiences. In photo A, a family assesses the damage to their home in Sindhupalchowk, a district hit hard by the earthquake.
Photo B shows a young girl who received treatment for a broken leg at Civil Service Hospital, where most of the orthopedic supplies were donated. Photo C is of the first house to be rebuilt by a nonprofit campaign called Mission Rebuild RoBeRt MeScavage
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IN OUR COMMUNITY
B
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Nepal, in the village of SipaPokhare. Subedi's group supports the mission, which intends to rebuild 800 houses. Already, 75 like this one are near completion. He and his colleagues concluded that "people's health will only be better once they have a good place to live. So until we can fix that, we can't make them healthy," said Subedi, an assistant professor of medicine. In photo D, Subedi helps survivors in Majhigaun, a village in northwestern Nepal. The doctor said he hopes to return to Nepal to help with the rebuilding effort. ●
Hear an interview at www.upstate.edu/healthlinkonair by searching “Nepal.”
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IN OUR LEISURE
He’s booked
NURSE PRACTITIONER BUSIES HIMSELF WRITING MYSTERIES
When Tony Cerminaro started writing his mystery series, the nurse practitioner planned to draw on his medical background in the hematology/oncology department at Upstate University Hospital. He crafted the fictional doctor Hank Milson as a main character in his first book, “The Ten Knife Murders.” Hank returns for a new mystery in Cerminaro’s latest novel, “Bonding Over Bullets.” This second book continues Cerminaro’s “Andersson and Stefani” series, in which each novel presents fictional investigators Nicklaus Andersson and Roxanne Stefani with a stand-alone mystery. Similar to “Law and Order,” Cerminaro said, the investigators’ plotlines develop across books in the series. In “Bonding Over Bullets,” for example, the romantic relationship between Roxanne and Hank develops in the context of a murder case involving a dangerous aphrodisiac drug. “It’s got a very intense plot,” Cerminaro said. “It’s kind of like reading a movie.” Although Cerminaro lives in Liverpool, he set his series in North Carolina so that Hank can take advantage of research opportunities at the prominent universities there. But Central New York references still crop up, he said. Hank attended Syracuse University, for example, and played lacrosse for the Orange. “I reference all the great seasons they’ve had,” Cerminaro said of the lacrosse team.
Tony Cerminaro
“Bonding Over Bullets” was released in October 2014 and is currently available online. He recommends it for an adult audience. The third book in the series, “The Manuscript Mysteries,” is anticipated this summer.
Peek at a doctor’s early days READING RECOMMENDATION
BY JOHN LOFRESE
Terrence Holt, MD, PhD’s book, “Internal Medicine: A Doctor’s Stories,” follows its author under the pseudonym Harper through his residency training in a series of nine vignettes that capture the gravity, intensity and absurdity of medical education’s most formative years. Neither sterile case review nor dramatic storytelling, each chapter seamlessly falls somewhere in between, demonstrating both the author’s talent and the reality of daily life as a resident. Sharing the experience of a resident’s nerve-wracking first night on call, the guilty pleasure of an exciting diagnosis and misguided feelings of detached expertise, readers are brought to Holt's conclusion that the study of medicine is never truly over. For busy medical professionals, this collection of short stories is the perfect way to relax and reflect.
Lofrese is a medical student at Upstate Medical University.
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IN OUR LEISURE
HEAD TO A FARMERS’ MARKET
Mediterranean chickpea salad Here’s a light meal that you can change with the addition of seasonal greens, such as spinach, kale, arugula or frisee. This recipe yields four 2-cup portions.
Ingredients
6 ounces “spring mix” lettuce
1 1/2 cups cucumbers, sliced like half moons
1/4 cup fresh red onions, julienne sliced
4 ounces Romaine lettuce, chopped
2 cups fresh diced tomatoes
6 tablespoons Greek feta vinaigrette
1/4 cup fresh parsley, chopped
1 1/2 cups canned garbanzo beans, rinsed and drained
1/4 cup fresh mint, chopped
Preparation
Nutritional information, per 2-cup serving
2 ounces feta cheese, crumbled
242 calories 10 grams protein 26 grams carbohydrates 12 grams total fat 14 milligrams cholesterol 804 milligrams sodium
Mix lettuces and herbs together. Place all vegetables, except onions, in a bowl and toss gently with the dressing. Garnish with feta cheese and red onions.
Bone-boosting exercises RECIPE FROM MORRISON HEALTHCARE, FOOD SERVICE PROVIDER FOR UPSTATE MEDICAL UNIVERSITY.
Exercise is important for bone health, to increase bone thickness and strength during the growing years, and to help prevent osteoporosis during adulthood. What activities provide the most bone-boosting benefit? SOURCE: KAREN KEMMIS, AN INSTRUCTOR OF PHYSICAL MEDICINE AND REHABILITATION AT UPSTATE WHO HAS A DOCTORATE IN PHYSICAL THERAPY
HOW
EFFECTIVE ARE EXERCISES FOR BONE HEALTH?
VERY:
jUMpINg RopE
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RUNNINg
hIKINg
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CLIMbINg sTAIRs
hIgh-IMpACT AERobICs
MODERATELY:
ELLIpTICAL MAChINE
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bRIsK WALKINg
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sTAIR MAChINEs
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DANCINg
LEAST: sWIMMINg
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RIDINg A bIKE
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pEDALINg A sTATIoNARY bIKE
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LoW-IMpACT AERobICs
WATER AERobICs
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YogA
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IN OUR LEISURE
Unwinding on the water Upstate nurses Sherod Harris, foreground, and Andre Poirier kayaking in Muskrat Bay on Oneida Lake.
Photo BY SUSan Kahn
CO-WORKERS TAKE TO KAYAKS EVERY CHANCE THEY GET BY JIM HOWE
Far from the demands and stress of hospital work, two Upstate nurses find peace and quiet on Adirondack waters. When they both worked in the Cardiopulmonary Intensive Care Unit several years ago, Sherod Harris discovered he and Andre Poirier shared a love of camping and the outdoors. Harris introduced Poirier to kayaking, which led to the pair taking an annual kayak trip, usually to the Adirondacks, for about the last 10 years. They also kayak locally, mountain bike and hike. Poirier, 45, who now works in the cardiac catheterization lab, said he likes “the quiet, the solitude, getting back in touch with nature” that kayakers experience. “I love it — it’s almost spiritual,” agreed Harris, 52, who now works on an elite team of critical-care nurses who respond to medical emergencies within the hospital.
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Why kayak in the Adirondacks? Why do Upstate nurses Andre Poirier and Sherod Harris like to kayak in New York’s Adirondack Mountains? “You could spend a lifetime exploring the Adirondacks and never see the same thing twice,” said Poirier. Favorite spot Lows Lake, south of Cranberry Lake, to name one. “There’s no one around. It’s only accessible by boat,” Poirier said. Other favorite spots The Raquette River and Blue Mountain Lake. Outside the Adirondacks, the pair has enjoyed Algonquin Provincial Park in Canada and the Allegheny Reservoir in Pennsylvania. Take the plunge Someone who wants to give the sport a try could buy a life vest, paddle and a cheap beginner’s kayak with a flatter bottom for a few hundred dollars, Harris says. Once you decide you like the sport, you can upgrade.
While a canoe gives the feel of an open boat, “I personally like being in a kayak and putting my hand out in the water, and you’re one with the water,” Poirier said. “I like not knowing what’s around the next bend.”
No tipping
“Their trip stories lightened the mood around the workplace,” recalled one of their former managers, nurse Lorrie Langdon. “They reminded people you could have fun outside of the workplace, and it contributes to making the workplace a better place to be,” said Langdon, who is now coordinator of the heart failure program. ●
Some people fear they will tip over in a kayak. “It takes an effort to tip over in a touring kayak,” Poirier says, because you sit low in the water, and the craft is long enough — 16 to 18 feet — to stabilize it. Further, he and Harris favor calmer waters, not whitewater or areas with lots of motorboats. It’s the shorter, narrower kayaks, such as professionals use, that are less stable.
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GEM CARE
EMERGENCY & URGENT CARE FOR SENIORS AGE 65+
Upstate’s geM care offers a calm, easy-access setting especially for seniors. Located at the community campus (4900 Broad Rd., Syracuse), geM care’s benefits include a high level of geriatric knowledge; dedicated space with dedicated trained staff; coordination with your own doctor, with the goal of returning you home safely; and immediate hospital care for those who need it.
TO LeArN MOre ABOUT geM CAre, CALL UPSTATe CONNeCT AT 800.464.8668 Or ViSiT WWW.UPSTATE.EDU/GEMCARE
located at the former Community General Hospital
FO R M O R E I N FO R M AT I O N O R TO M A K E A R E F E R R A L C A L L
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NC
CURE FOR BLINDNESS
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Growing retinal cells in frogs may teach us how to do the same in humans, which could restore sight to those whose vision has been impaired.
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To make the pluripotent cells turn into retinal cells, scientists Andrea Viczian, PhD, and Michael Zuber, PhD, discovered the cocktail of proteins that are normally found in the developing tadpole eye at the time when the eye is first forming. Viczian and graduate student Kim Wong, PhD, built on that work with the discovery of a new signaling pathway that directs retina formation.
IS SC I
This image is a close-up section of a tadpole eye with the retinal rod photoreceptor cells marked in red. The tadpole received retinal progenitor cells (which would develop into eye cells) that were derived from pluripotent frog cells, marked in green. Like human stem cells, pluripotent frog cells have the ability to develop into any type of cell in the body. The blue dye marks the cell nuclei.
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750 east Adams Street l Syracuse, NY 13210