Winter 2014 Upstate Health
Health and wellness publication from Upstate Medical University, the academic medical center serving Central New York.
Health UPSTATE UPSTATE MEDICAL UNIVERSITY Winter 2014 A new wAy to pinpoint prostAte cAncer whAt you need to know D About medicAl mArijuAnA modern birth control options dAngers of prescription creAms exercising outdoors Improving abilities with dance M On the cover: Marley Aberdeen, a patient with cerebral palsy, practices her ballet moves with help from her doctor, Nienke Dosa, MD, MPH, who is associate professor of Pediatrics and medical director of the Spina Bifida Clinic at Upstate’s Center for Behavior, Development and Genetics. Photo by Susan Kahn. IF YOU EVER FACE PROSTATE CANCER...PUT UPSTATE'S SPECIALISTS ON YOUR TREATMENT TEAM! Health publisher Wanda Thompson PhD Senior Vice President for Operations executive editor Leah Caldwell Assistant Vice President, Marketing & University Communications editor-in-chief writers designer photogrAphy Susan Cole (page 4) Susan Kahn (cover, pages 7, 8, 13, 15 & 16) Robert Mescavage (pages 2 & 19) Jim McKeever (pg. 20) William Mueller (page 22) Amber Smith (page 3) Ross Taylor (pg. 5) Richard Whelsky (page 17) illustrAtions Travis Bruce (page 17) Randy Glasbergen (page 3) Dan Cameron (page 13) Amber Smith Amber Smith, Jeff Kramer, Jim McKeever Susan Keeter Winter 2014 Coach Jim Boeheim is surrounded by Upstate’s prostate cancer team: urologist Oleg Shapiro, MD, pathologist Steve Landas, MD, urologist Gennady Bratslavsky, MD, radiation oncologist Jeffrey Bogart, MD, pathologist Gustavo de la Roza, MD, radiologist Andrij Wojtowycz, MD, urologist Srinivas Vourganti, MD, and radiologist Robert Poster, MD. The basketball-prostate cancer connection in Syracuse S yracusans love our basketball team and our coach, who happens to be a prostate cancer survivor. That’s why Jim Boeheim is featured in many of the advertisements for Upstate’s prostate cancer services. Visit us online at www.upstate.edu or phone us at 315-464-4836. For corrections, suggestions and submissions, contact Amber Smith at 315-464-4822 or email@example.com AdditionAl copies: 315-464-4836. Upstate Health offices are located at 250 Harrison St., Syracuse, NY 13202 Boeheim, who was diagnosed in 2001, speaks about his experience as a way to encourage other men to be screened for prostate cancer. The American Cancer Society does not offer strict screening guidelines but urges each man to speak with his healthcare provider to determine whether and when screening is appropriate. Screening may include a blood test and/ or a rectal exam. “If you’re diagnosed, you have to figure out the right treatment for you, and then just take care of it,” Boeheim told Men’s Fitness a few years ago. The American Cancer Society projects that 17 of 100 men who are age 50 today will be diagnosed with prostate cancer sometime during their lives, and three of 100 will die of the disease. A man’s chances of developing prostate cancer increase with age. 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 – and an extensive clinical health care system that includes Upstate University Hospital’s downtown and community campuses and the Upstate Golisano Children’s Hospital. Part of the State University of New York, Upstate is Onondaga County’s largest employer. In a series of recent ads, he is surrounded by Upstate physicians, led by Gennady Bratslavsky, MD, who offer a variety of treatments for prostate cancer. They all wear serious looks and white physician coats. Four carry basketballs. They are Syracusans, after all. And the academic medical center where they work is adjacent to Syracuse University. The ads are succinct. One uses the words “outstanding technology and treatment” to summarize the amazing advances available at Upstate. (Read about the latest, on page 4 in this magazine.) Another simply says, “If you ever face prostate cancer, put Upstate’s specialists on your treatment team.” For details, visit upstate.edu/urology. G 2 U P S TAT E H E A LT H winter 2014 w w w. u p st ate . e d u Taking care of New York is what we do, every day Upstate Medical University is academic medicine at its best. We care for patients with a range of health issues from routine to complex. We train tomorrow’s healthcare providers, and we conduct research that may lead to the cures of the future. This year as we celebrate 50 years (p. 17) our hospitals welcome a dynamic electronic medical records system called Epic that wasn’t even dreamed of 50 years ago. It will organize patient care documentation and allow patients access to much of their health information. Even as Epic illustrates technical advances, we are mindful to maintain the human touch (p. 14) and our important role in the Central New York community. Three examples in this issue: • the physician who prescribes ballet to improve the lives of her patients with cerebral palsy (p. 6) • the scientist who helps us understand how smoking addictions affect babies in utero (p. 11) • the staff who volunteer on Onondaga County’s Search and Rescue Team (p. 15) A physical therapist offers encouragement, along with her therapy session. A surgeon offers hope to a patient who wants to be able to walk. A professor offers enthusiasm for science. Photographer Susan Kahn shoots photos at Jowonio School of Nienke Dosa, MD and Miracle Thompson for this issue. Contents PATIENTS FIRST Pinpointing prostate cancer page 4 page 6 page 8 cover story Prescription: Ballet A therapist who can empathize about cancer FROM OUR EXPERTS Facts about medical marijuana Modern birth control options SPECIAL REPORT: The dangers of prescription creams page 9 page 10 We hope you enjoy your Health, brought to you by Upstate. Need a referral or more information? 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. page 12 FOR OUR COMMUNITY Search and rescue volunteers Special care for moms-to-be with diabetes Upstate celebrates 50 years page 15 page 16 page 17 IN OUR LEISURE Shooting pool The student who walks everywhere Recipe: roasted delicata squash The Humorist page 19 page 20 page 22 page 23 winter 2014 U P S TAT E H E A LT H 3 PATIENTS FIRST A new way to pinpoint cancer BY AMBER SMITH Relief? Or confusion? Jeffery Barkley, 59, of Phoenix remained worried about his risk for prostate cancer after his first biopsy in 2005. “I just had a gut feeling,” he says. He has a family history, so he knew he needed to be vigilant. Blood test after blood test kept showing a high level of prostate-specific antigen. The subsequent four biopsies, like the first, showed no cancer. Barkley’s urologist sent him to a urologic oncologist at Upstate in 2013. Srinivas Vourganti, MD used the UroNav fusion biopsy system to locate the cancer that was hiding in Barkley’s prostate. “It was definitely a cancer that any urologist would treat and not want to miss,” the doctor says. Until now, prostate biopsies using ultrasound would guide surgeons to areas where cancers tend to form. If the cancer was in another part of the prostate, it would not show up in the biopsy. UroNav is designed to pinpoint areas that could be suspicious of cancer, such as a spot where the blood supply is abnormal. Barkley underwent magnetic resonance imaging. Then those images from the MRI were fused with ultrasound-guided images so that Vourganti could see precisely where within the prostate the cancer might be growing. Upstate acquired the Philips UroNav Fusion Biopsy System in October, becoming the only provider in Central New York and one of a few sites in the country to offer this breakthrough technology. The machine bears the serial number 002 signifying it is the second of its kind, after the prototype at the National Institutes of Health. Gennady Bratslavsky, MD, professor and chair of Upstate’s Department of Urology, and Vourganti assisted in the development and testing of this new technology, working closely with Invivo, a subsidiary of Philips Healthcare, while they were working at the National Institutes of Health. As soon as UroNav was available commercially, Bratslavsky wanted Y ou follow medical advice to be screened for prostate cancer, and the blood test suggests prostate cancer. When you have cells removed in a biopsy, the results show no cancer. Srinivas Vourganti, MD and Norman Starkweather, RN demonstrate the UroNav system. to make it available to Central New Yorkers. He says it is a major breakthrough in the fight against prostate cancer. “UroNav incorporates precise knowledge of the needle location within the prostate, and using a technology similar to GPS navigation it directs the biopsy needle to the heart of the suspicious lesion,” says Bratslavsky. Jeffery Barkley “Compared with the traditional biopsy technique that uses random prostate sampling, the new technology helps to avoid missing hard-to-find and often aggressive prostate cancer, and potentially helps give greater certainty as to the extent and aggressiveness of the disease, as well as allowing patients to avoid unnecessary repeat prostate biopsies,” he says. Barkley was one of the earliest patients — and is grateful for the peace of mind. “Now I have an answer,” he says of the UroNav procedure. “My next step is to meet with a radiologist and continue to discuss my options with Dr. Vourganti.” UroNav is not just about locating insidious cancers, however. Vourganti says equally important is being able to locate and differentiate which cancers need treatment. G Listen to an interview at upstate.edu/ healthlinkonair by searching “uronav.” Kid-friendly dialysis center hildren who need dialysis can get their care at a new center opening this spring within Upstate University Hospital. The pediatric dialysis center will be on the fifth floor of the downtown hospital and consist of two bays of special dialysis chairs, with room for a parent or guardian. C families will use,” says Scott Schurman, MD, a professor of pediatric nephrology at Upstate. Doctors will be able to look in on their patients who come in for treatment, and hospital services such as the Child Life program will be available. In addition, Upstate will provide a home dialysis-training program to help parents and families prepare for caring for a dialysis patient at home. Up until now, many children have received dialysis at an adult hemodialysis center on Genesee Street in Syracuse. G “The new center gives us the opportunity to create a pediatric-friendly environment, from the bays where the kids will receive treatment, to the waiting areas that their 4 U P S TAT E H E A LT H winter 2014 w w w. u p st ate . e d u PATIENTS FIRST SPOTlighting PATIENTS BY AMBER SMITH PHOTOJOURNALIST CREATES SERIES OF FILMS child without hair reaches inquisitive fingers to the strings of a guitar during a “music therapy” session. A man with kidney failure tears up when his sister — “she’s my everything,” he describes — offers her healthy kidney for transplant. A mother and father remind themselves “one day at a time,” as their preschooler battles a brain tumor. A on assignment in six countries and is co-creator of The Image Deconstructed, a nationally recognized blog that highlights an image and asks the photographer to deconstruct the creation of the image, and the psychology and emotion behind the photograph. He has won the prestigious National Photojournalist of the Year award, and was nominated for a Pulitzer for his documentary photographs in a trauma hospital in Afghanistan. For his projects at the hospital, Taylor is working in video, rather than still photography. “Film is much more difficult to do, and even harder to do well. It takes much more time and investment on both my part, but also the hospital and the patients who are willing to share their story,” he says. “I believe, though, that in the end, it’s a very powerful way to share someone’s story, and it’s worth the extra work.” These video vignettes tell the poignant stories of Upstate University Hospital patients. They were produced by Pulitzer Prize-nominated photojournalist Ross Taylor, a fellow at the Multimedia Photography and Design Department at the S.I. Newhouse School of Public Communications at Syracuse University. Working closely with Kathleen Paice Froio of Upstate’s Public and Media Relations Department, Taylor spent many days at the hospital last fall talking with patients, family and staff who allowed him to be present during many personal and emotional moments. Taylor, a photojournalist for 20 years, is known for his sensitive ability to tell deeply personal stories. He has shot Pictured: Patient Kayla Smith touches the guitar as music therapist Claire Arezina sings to her, a moment caught on film by photojournalist Ross Taylor (below). His three Upstate films include: G “Music Therapy” showcases the work of board certified music therapist Clare Arezina, who uses music as a tool to help connect with and heal patients in the Upstate Golisano Children’s Hospital. G “There are days when ‘Rocky’ theme music should be playing in the background, and it’s fantastic,” Arezina says. “It’s those very clear moments of ‘this is why my job has worth,’ and ‘this is why I do what I do.’ It’s rewarding to have a kid smile, to have a kid reach who hasn’t reached for anything, to have a kid play and interact who hasn’t been playful or interactive.” “A New Beginning” follows a brother and sister from Auburn through a living kidney donation. LaToya Alexander learned that her brother Robert Barnes was suffering kidney failure, and said “Yeah. I’ll get tested, and I’ll donate my kidney if it’s a match.” They prayed with loved ones before their surgery with transplant director, J. Keith Melancon, MD. “If you don’t have good kidney function, your life is tremendously shortened. When someone donates a kidney to you, she’s saving your life,” the surgeon explains. G “This Changes Everything” tells the sort of Aiden Erwin, 4, and his parents, Melanie Overy and Glen Erwin, as they cope with their son’s brain cancer diagnosis. They have been basically living at the hospital. “Just one day at a time. That’s what you tell yourself every day,” Overy says. “Things change very quickly, and you don’t want to get your hopes up or have your hopes too low. You just kinda want to take it as it comes.”G winter 2014 U P S TAT E H E A LT H 5 PATIENTS FIRST Prescription Children with cerebral palsy improve physical abilities through dance L ballet BY AMBER SMITH ike many preschoolers, Marley Aberdeen was enthralled with the mouse, Angelina Ballerina from the series of children’s books. So it was easy to enlist her participation in a pilot project last year exploring how ballet could help children with cerebral palsy. Her mother brought her in pink leotard and tights to Jowonio School, where teenage dancers from the Syracuse City School District volunteered to help Marley and other children enjoy the benefits of dance. It’s a program created by Nienke Dosa, MD, a developmental pediatrician at Upstate, and Lisa Neville, an occupational therapist at Jowonio. They were inspired by Citali Lopez, PhD, an exercise scientist at the Rehab Institute of Chicago who gave a presentation at Upstate last year, attended by physicians, dance instructors and physical therapists from throughout Central New York. “In ballet, dancers learn positions that are held for eight counts, then four counts, then two counts until they become fluid movement,” Dosa explains. Her patients are children with physical disabilities such as cerebral palsy and spina bifida. She says dance is a good way for them to experience movement and motor learning and to be part of a group. “Motor learning is about repetition. We don’t sit down at a piano and play music right away. We practice our scales until finger movements become second nature. Same thing with ballet. We give children with cerebral palsy the opportunity to practice postures and for postures to turn into movements. Structured movement in a social setting is beneficial for any child.” Many dance studios offer creative movement classes for youngsters before formal dance classes begin. The classes for children with cerebral palsy are a step between the two, helping the children to become comfortable with movement and helping their muscles to strengthen. Because many of the children do not stand independently, two dancing assistants are required per child. Neville and Dosa developed a workbook full of photographs to teach high school dancers who are willing to volunteer, and they formed a partnership with the Syracuse City School District. Students from Nottingham High School walk to nearby Jowonio after school one day a week to dance with the children with cerebral palsy. Cheryl Darby admits that she was unsure how ballet would benefit her niece, Miracle Thompson, 5. “I was skeptical. I was not sold that it would help her so much. But boy, what a change,” she says, explaining how Miracle can balance on one leg and hold the other up to form a P. Ballerinas call the move a passe. It’s quite an accomplishment for a little girl who struggles to walk. Marley’s mom, Stephanie Pearman, noticed improvement in her daughter, now 6. Before, when she sat on the floor, she would bend both knees backward. Now she keeps one straight. “She’s got what we call ‘dynamic’ tone. If she’s reaching for something, the tone in her arm will stiffen up. “What ballet will help her to do is calm down, and it becomes more of a fluid movement. It’s almost like she can quiet down that tone with her brain when she does ballet.” Plus, says Pearman, “it’s fun. She enjoys it.” G Listen to an interview at upstate.edu/healthlinkonair by searching “ballet.” 6 U P S TAT E H E A LT H winter 2014 w w w. u p st ate . e d u PATIENTS FIRST Upstate patient Miracle Thompson, 5, dances with Jowonio occupational therapist Lisa Neville, and is supported by Nottingham High School student and dancer, Bela Harris. The ballet program is sponsored by the Madeline Cote fund. winter 2014 U P S TAT E H E A LT H 7 PATIENTS FIRST Drawn to breast cancer patients, to help them live the best lives P psychiatrist Aliya Hafeez, MD began specializing in psychiatry services for people with cancer because she is a breast cancer survivor herself. “I feel like it’s an additional degree that I’ve gotten,” she says of her health ordeal, which began with a diagnosis in November 2009. She went through chemotherapy, radiation and surgery at Upstate’s Regional Oncology Center. “Now I get to work with all of the doctors who treated me.” Her office is at the same location many cancer patients come to see their physicians. “Psychologically, it makes a huge difference if they get to see me where they come from their care,” she says. “I really want to make them feel like my care is part of their cancer treatment.” She is kitty-corner from the hospital, at 550 Harrison St., in the Patricia J. Numann Center for Breast, Endocrine and Plastic Surgery. Hafeez joined the Upstate staff a couple years ago, after completing her psychiatry residency in 2007 at Upstate. She obtained her medical degree from Fatima Jinnah Medical College in Pakistan. She offers individual psychotherapy and medication management. In April, she begins a 12-week support group at Upstate’s Harrison Center and hopes to add a stress reduction group and other support groups after the Upstate Cancer Center opens later this year. Survival rates for cancer are improving, though the disease still has a negative association with death. Hafeez wants to step away from the gloom and doom and focus more on living the best life possible. Her personal experience with breast cancer left her feeling fortunate. She was able to take time off work, and family members took care of her throughout chemotherapy, radiation and surgery. Her sister or brother would accompany her to medical appointments. “Mom and Dad stayed home and prayed.” Cancer is something we cannot control, but Hafeez says her experience taught her that “you can control how you are going through that experience with cancer,” and she hopes to share that with her patients. G Listen to an interview at upstate.edu/healthlinkonair by searching “Hafeez.” One call connects women of all ages to services, providers, specialists, social events and educational opportunities. CONTACT US EMPOWERING WOMEN TO TAKE CHARGE OF THEIR HEALTH 8 U P S TAT E H E A LT H winter 2014 to schedule appointments, ask questions about women's health, or to ﬁnd out about our latest educational oﬀerings. 315-464-2756 Toll Free 855-890-8946 WHNnurse@upstate.edu To learn more and to sign up for our communications, log on to www.upstate.edu/women w w w. u p st at e . e d u FROM OUR EXPERTS What you need to know about medical marijuana Its side effects can include: G L G G G G G It can be used to: ots of news coverage lately has been devoted to whether New York will legalize marijuana for medical use. Stepping away from the politics, here are some facts to consider: slowed central nervous system and impaired motor coordination. increased high blood pressure and heart rate. worsening of some seizure disorders. impaired memory. lung irritant, if smoked. personality disturbances. irritability and psychosis, in high doses. addiction, if use becomes compulsive. possible learning and memory deficits in adolescent users. attention, memory and problem solving deficits in babies born to mothers who use marijuana in pregnancy. reduce muscle spasms. “It will release muscle spasms, for example, in people with multiple sclerosis who have spasticity,” says Upstate psychiatrist Gene Tinelli, MD. This may allow a person to use a walker rather than a wheelchair. provide a calming, euphoric effect. reduce intraocular pressure in people with glaucoma, although the effects are short-lived. help people forget suffering, such as in cases of posttraumatic stress disorder. reduce nausea and vomiting, especially after chemotherapy, and to a lesser extent after radiation therapy. “That’s a big thing,” Tinelli says, “because if people can eat, they can survive.” treat some seizure disorders. lessen the pain of shingles and other painful conditions. relieve suffering in patients with chronic pain who develop breakthrough pain. Many already take prescription opiates and don’t want to increase their opiate dosages. mask the pain of migraines, although scientists are still exploring exactly how. G G G G G G G G G G G G Whether marijuana use permanently reduces IQ, cognitive functioning, learning and memory has not been proven. G Patients don’t have to smoke it. “Inhaling a burning plant is not healthy, period,” says Tinelli. Herbal vaporizers allow the drug to be inhaled without ingesting toxins. The active chemicals of the cannabis plant are available as alcohol elixirs or teas, or made into a spray that can be absorbed sublingually. A variety of edible products are made using butters or oils derived from the cannabis plant. Marijuana is also available as a salve, lotion or spray for the skin. A synthetic version of THC, the chemical responsible for marijuana’s high, is available in the prescription drug, Marinol, but some patients dislike the drug’s side effects of dizziness, drowsiness, confusion, an exaggerated sense of well-being, red eyes, dry mouth, headaches and lightheadedness. But it is cannabidiol, another of the more than 60 psychoactive compounds in cannabis, that captures the attention of patients and scientists. Cannabidiol and THC balance each other, cannabidiol tempering the stoned sensation caused by THC and maximizing the pain relieving effects. It affects the body’s endocannabinoid system. Scientists are still learning about the body’s endocannabinoid system, a neural communication network which plays an important role in normal brain development and function, and which some medical authorities consider the bridge between body and mind. It is this system that marijuana overactivates and, according to the National Institute on Drug Abuse, causes distorted perceptions, impaired coordination, difficulty with thinking and problem solving and disrupted learning and memory. The first endocannabinoids were discovered in 1992. Anandamide and 2-AG are natural brain compounds that activate the same receptors as THC and cannabidiol. The function of the endocannabinoids is to maintain homeostasis, or to keep internal conditions the same, whether they’re physically located in the brain, abdominal organs, connective tissues, glands or immune cells. They play a role in appetite, memory, pain, mood and several other physiological processes. G Its potency has increased. Cannabis grown today contains higher levels of THC, short for tetrahydrocannabinol. “In the 1970s, the THC content was around 1 or 2 percent. Today it’s more like 11 or 12 percent,” Mahmoud ElSohly, PhD, director of the University of Mississippi’s Marijuana Project, told Men’s Health magazine. Listen to an interview at upstate.edu/ healthlinkonair by searching “marijuana.” winter 2014 U P S TAT E H E A LT H 9 FROM OUR EXPERTS Upstate by the numbers Birth control options for young women kAren teelin, md Q A And with 311 64 pleats in the executive chef ’s toque (hat). Each pleat represents mastery of each of the positions in a brigade kitchen. specific locations mapped so far in the greater Syracuse area for Upstate University Hospital’s new waysliding service. For turnby-turn directions to where you’re going, look for the new kiosk in the main lobby. Q why are the rates of sexual activity among American teens the same as in other developed countries, but our rates of teen pregnancy and abortion are higher? “That’s partially because of the use of highly effective contraception in other countries. “There is a 2011 Centers for Disease Control and Prevention study showing 50 percent of teens by 12th grade have had sex, and if you go up to age 20, it’s about 70 percent. There is a decreasing age of menarche (age at a woman’s first period) and an increasing age of first marriage, so there is a longer period of fertility when women need birth control. “Eighty to 82 percent of teen pregnancies in America are unplanned. It’s a huge public health problem and a very stubborn public health problem and a difficult one to address. Part of the answer, really, is education and contraception.” A There is one with no hormones that stays in for 10 years. The progesterone IUDs release a small amount of progesterone locally. The Mirena will last five years, and the Skyla, which is smaller and has less progesterone, will last three years. They’re both highly effective. “Back in the ’70s and early ’80s there was an IUD (the Dalkon Shield) that had been associated with an increased risk of pelvic infections, however those studies were fraught with methodological errors. In the more current studies, there is actually a decreased risk of pelvic infections with some of these IUDs. “There are noncontraceptive benefits, too. The Mirena, for instance, can reduce menstrual bleeding and menstrual pain, and many women don’t get periods on it. That is one of the reasons they’re so popular.” per year for Health156 Link on Air, the weekly talk interviews conducted Q A what is the most effective contraceptive? Q A Are other methods still used? “We have a lot of young women who choose the pill, and it can work, but you need to take it every day. “The patch is like a birth control pill, except instead of taking it every day, you have a sticker, a little bit bigger than a Bandaid, that you change every week. Some people really like the patch because you don’t have to think about it every day — but you have to remember it each week. “The shot is commonly referred to as Depo, (short for Depo-Provera). That is a shot that you would get every 12 weeks. That is also progesterone-only, like the implant, but there might be more side effects. “The ring is like the birth control pill, with the same medicines of estrogen and progesterone, but it is inserted into the vagina, and it stays for three weeks, and it releases a small amount of the hormones. Some people really like that. The teens can put it in themselves. It’s a small ring. It’s flexible. You just sort of bend it and put it in.” G radio program produced by Upstate. (Tune in at 9 p.m. Sundays on WRVO Public Media, or visit the archives at upstate.edu/healthlinkonair) “The LARCs — long-acting reversible contraceptives — are as effective as sterilization, but they are reversible. That would include the implant and two types of intrauterine devices. “The current implant is one little rod, a couple centimeters long. It goes into the arm. It’s called Nexplanon, and it releases a small amount of progesterone. It lasts for three years. The procedure to implant it is very simple. It takes about 5 minutes. It hurts as much as getting a shot would, or even less than that. Once it’s in there you can completely forget about it for three years. “The IUD is a small T-shaped device a couple centimeters long that is inserted by a doctor into the uterus. It can be put in teenagers, young women or women who have had children. It stays in the uterus. 70 years Myrtle Bush has been a nurse. At 90, she remains a per diem nurse in the department of health education. Listen to an interview at upstate.edu/healthlinkonair by searching “birth control.” Karen Teelin, MD tells her patients the ABCs of sexuality. A is for abstinence, B is for be faithful, and C is for condom. She is quick to point out that condoms have a 10- to 20-percent failure rate and that sexually active teens need to use two forms of birth control. 10 U P S TAT E H E A LT H winter 2014 w w w. u p st ate . e d u FROM OUR EXPERTS UPSTATE “ ANSWERS “When somebody in my family dies, we have an open casket at the calling hours. If I sign up to be an organ donor, can I still have an open casket when my time comes?” –TIM JONES OF SYRACUSE Many people have the same concerns, so thank you for the opportunity to reassure that someone who has donated his or her organs can still have an open casket. Donation does not disfigure the body or change the way it looks in a casket. Every donor is treated with great care and dignity during the donation process, including careful reconstruction of one’s body. Surgery lines will be fully covered by most clothing chosen for the viewing. For skin donation, skin is taken from the back and the legs and is not visible with clothing. For bone donation, a stand-in plastic bone is used to allow the shape of the arms and legs to remain the same. For eye donations, plastic caps are placed over the eye to maintain the shape of the closed eyelid. Organ donation, as a rule, does not delay funeral plans. –NURSE ELLEN HAVENS, CERTIFIED CLINICAL TRANSPLANT COORDINATOR, UPSTATE TRANSPLANT CLINIC. ” Urge to smoke begins in utero Scientists at Upstate recently showed that nicotine, the most addictive of more than 4,000 chemicals in tobacco, modifies part of the brain responsible for smell and changes the neural sensitivity of the olfactory cells in the noses of the babies in utero. This is what leads them to develop a preference for the sweet, warm and spicy odor of nicotine, according to Nicole Mantella, a graduate student in the lab of professor Steven Youngentob, PhD. Youngentob’s lab in the Department of Psychiatry and Behavioral Sciences explores what drives kids to have that first cigarette, or that first drink. He has done similar work showing how alcohol exposure in the womb can create a craving in adolescence. He is alarmed that with all we know about the dangers of smoking, 25 percent of smoking women who become pregnant continue to smoke during pregnancy. Not only does this put babies at risk for stillbirth or prematurity, but they are also more likely to have behavioral problems such as hyperactivity and impulsivity and defects in learning, memory and attention – and to become smokers, themselves. G B abies born to mothers who smoke during pregnancy are four times more likely to begin smoking in adolescence. Listen to an interview at upstate.edu/healthlinkonair by searching “Youngentob.” winter 2014 U P S TAT E H E A LT H 11 FROM OUR EXPERTS Lessons from upstAte Drugs you rub into your skin can be dangerous, too W hen a previously healthy 18-month-old child developed a diaper rash, the toddler’s mother reached for some pain-relieving cream. What she grabbed was a prescription her husband used for neck pain. She rubbed a small amount onto her son’s rash and put him down for a nap. Within 20 minutes, the child was gasping for breath and unresponsive. An ambulance rushed him to Upstate University Hospital’s pediatric emergency department, where he continued to deteriorate. His heart rate and blood pressure dropped. Doctors inserted a tube in his windpipe to help him breathe. This case was shared in the November issue of the journal, Pediatric Emergency Care. The authors, all health care providers from Upstate, expressed concern that as compound preparations gain popularity, people mistakenly assume they are safer than pills. “This perception and the fact that these are not dispensed in child-proof containers and are often mailed to the patients without pharmacist counseling can lead to increased inadvertent exposures in the pediatric population,” wrote authors, Ross Sullivan, MD, Michael Holland, MD and Jeanna Marraffa, a doctor of pharmacy at the Upstate Poison Center. Matt Rzewski, MD was also a co-author; today he is completing a fellowship in neonatal intensive care in Massachusetts. The skin’s epidermal layer absorbs substances such as pain-relieving cream through diffusion, the speed of which varies depending on the chemical makeup and amount of the substance as well as the condition of the skin. continued on page 13 12 U P S TAT E H E A LT H winter 2014 w w w. u p st ate . e d u FROM OUR EXPERTS EPIDERMIS DERMIS SUBCUTANEOUS TISSUE Skin is a barrier that exists to keep body water in and microorganisms and noxious chemicals out. The skin consists of three main layers: the epidermis, the dermis and the subcutaneous tissues. The epidermis actually has multiple layers, the most superficial of which is the stratum corneum, which provides almost all the skin’s protective properties. The stratum corneum is made up of keratin, which consists of dead skin cell remnants and fibrous proteins that overlap in layers. Transnormal absorption occurs via a passive diffusion through the epithelial cell layer, in a concentration-dependent process. The magnitude and speed of diffusion depends on the integrity and also physical properties of the applied drug. Drugs with low molecular weight with a high water and lipid solubility show the greatest penetration. Source: “Compounded Ointment Results in Severe Toxicity in a Pediatric Patient,” Pediatric Emergency Care, November 2013 Drugs you rub – continued from page 12 The toddler in this case was at particular risk because of his size and his rash. Any open wound on the skin can greatly increase absorption of anything applied to the skin. “The smaller the child is, the larger the surface area, relative to body weight ratio. As a human grows in volume, so does the surface area, but at a much slower rate,” the authors write. Adults have a small skin surface area-to-weight ratio, compared to infants, who have a large surface area in proportion to size and weight. “Because absorption depends on the amount of surface area exposed to a topical drug, a child will absorb a higher dose per kilogram than an adult.” The prescription in this case was a compound of several potent drugs known to cause central nervous system depression. Even a small amount was highly toxic to the little boy, who improved over the next 12 hours in intensive care and eventually recovered. G tAkeAwAy G Topical compounded preparations are increasingly prescribed for chronic pain. These drugs are potent. Many patients receive these customized prescriptions through the mail. Childproof packaging is not standard. Children are especially at risk for significant toxicity if they are exposed. Listen to an interview at upstate.edu/ healthlinkonair by searching “poison proof.” Poison Center toxicologists Michael Holland, MD, Ross Sullivan, MD, and Jeanna Marraffa, PharmD G G G G winter 2014 U P S TAT E H E A LT H 13 FOR OUR COMMUNITY Adding electronics to patient care E Ethicist the upstAte ighty to 90 percent of communication between humans is nonverbal — which means that healthcare providers could overlook important patient information if the provider's focus is on the Electronic Medical Record computer screen. Body position, eye engagement, gestures and facial expression can provide important information when diagnosing patients, says Joyce Sacripant, DIP, director of the Doctor of Nursing Practice program at Upstate’s College of Nursing. She recently spoke on campus about Emys, urging providers to be mindful of the impact technology has on their provider-patient relationships and on daily personal communication. What are the ethical implications this technology has on the patientprovider relationship and our personal lives? Research shows that Emys can improve quality and safety. Scarpinato reports that studies are mixed about patient satisfaction. Some studies found that patients feel more involved in their own health care when the provider is using an EMR; however, others found that broken eye contact and a lack of face-to-face interaction (while the provider enters information into the EMR) decrease patient satisfaction.G Thinking pink — and green hen Community General Hospital became part of Upstate in July 2011, Volunteer Services Director Kristin Bruce was left wondering what to do with 300 pink volunteer smocks, many embellished with the old hospital logo. W The smocks were in great condition, so it made sense to try to recycle them. Volunteers Dick and Barb Bratt suggested that some of the smocks be donated to Robinson Presbyterian Church USA. There, a missionary group was collecting clothing items for people in need living in Uganda. Months later, an email arrived from Ngamije M. Faishal of Kasese, Uganda with thanks for the smocks, which were put to use in the distribution of goods to men, women and children. Closer to home, more than 70 of the smocks were donated to the Syracuse City School District, for students to wear during art classes. And 50 smocks that were not customized with the hospital logo were donated to the team of volunteers serving the Centers at St. Camillus in Syracuse. “To see these Community General Hospital volunteer smocks being used halfway around the globe is amazing,” says Bruce. “What’s more, the volunteers themselves truly appreciate the legacy of their uniforms and are humbled to see their repurposed use today.” Today, the volunteers wear navy vests with an Upstate logo. G L ? A 14 ? Winter is more than a season eslie and Linda Berry were expecting their first child in February 1982. The blissful mom-to-be was reading a book – she can’t recall which one – with a character named Winter. She liked the name. Her baby would be born in winter, after all. @ ? Winter Berry was born on Valentine’s Day and raised in the wintery climate of New Hampshire. “I liked having a different name that no one else shared. Growing up, I had four or five Kaitlyns in my grade.” In her third year of medical school, Berry and the man who would become her husband moved to Watertown and experienced lake effect snow. “We sort of fell in love with Northern New York,” she says. It was like New England but a slower pace and more affordable. ?@ She played violin and until 10th grade wanted to be a music teacher because she loved kids. She was good at science and by age 16 decided to become a pediatrician instead. ? A Today Winter Berry, DO lives closer to Syracuse. She is an instructor of pediatrics at Upstate. The young patients who notice her first name on her name badge invariably ask if ‘Winter’ is her real name. G ? ? U P S TAT E H E A LT H winter2014 w w w. u p st ate . e d u FOR OUR COMMUNITY Renae Rokicki and Ann Salvagni in the woods. Helping others, helping themselves RESCUE VOLUNTEERS EXPAND THEIR SKILLS, COMFORT LEVELS BY AMBER SMITH ealth administrator Renae Rokicki has not one iota of outdoors in her blood. She does not hunt or hike or camp. But she does believe in coincidences, which is how she ended up a member of a team that is summoned to search for and rescue hunters, hikers, campers and others who go missing in the wilderness of Central New York. H “When hunting season starts, that’s a very busy time for us,” says Salvagni. Rokicki says one type of rescue that is becoming more common is “an elderly person with dementia who has wandered.” The team is trained to support a program called Project Lifesaver through the Onondaga County Sheriff’s Department, which provides arm bands with tracking devices to people who are known to wander. When the team is activated, members arrive with the food, water and equipment necessary to sustain themselves for as long as possible, knowing they may be needed for hours or days. Salvagni says her volunteer role is part of growing, as a person and as a professional. “It has helped me to learn new skills that I would have never learned before. It sort of pushes your comfort zone — and you get to meet people who have a similar interest as you whom you wouldn’t otherwise meet,” she says. “You get to be part of something that’s bigger than yourself. Isn’t that awesome?” G Three years ago before bed one night, she caught a story on the television news about training for the region’s Wilderness Search and Rescue program. The next morning, a friend who lives out of state was effusive in a Facebook status update about her work with a search team that resulted in locating a missing child. Rokicki decided to look into joining. Ann Salvagni is a registered nurse who enjoys hiking and the outdoors. A paramedic friend suggested the search and rescue program needed people with her skills. So she looked into joining. Rokicki and Salvagni are Upstate colleagues who volunteer together on the region’s Wilderness Search and Rescue team. That means they underwent training and certification and continue training with the team at least twice a month in all kinds of weather. They purchase their own uniforms and gear and gasoline. And they are basically willing to respond to outdoor emergencies throughout the region, at any hour. They receive no compensation, and people who are rescued receive no bill. The search and rescue program relies on donations and volunteers. wAnt to leArn more? Members of the Onondaga County Wilderness Search and Rescue team (www.wsar.org) work closely with the Oswego County Pioneer Search and Rescue team (www.oswegosar.org) The teams seek volunteers who are in good health, at least 18 years of age and able to pass a moderate physical fitness test. winter 2014 U P S TAT E H E A LT H 15 FOR OUR COMMUNITY Obstetrician Unzila Nayeri, MD of Upstate’s Regional Perinatal Center (center) talks with patients at a recent Centering Pregnancy class. Centering on diabetes in pregnancy Centering Pregnancy is a program offered in a variety of medical practices throughout the country, bringing together women with similar due dates for group visits. The Regional Perinatal Center at Upstate used grant money from the March of Dimes to launch Centering Pregnancy specifically for pregnant women with diabetes. “This is a time for us to help women with diabetes meet the challenges of pregnancy and possibly make some big changes in their lives,” certified nurse midwife Kathleen Dermady says. This includes mothers living with diabetes and those diagnosed during pregnancy. Diabetes increases the risk in pregnancy, requiring frequent medical visits and close monitoring. Pregnancy hormones decrease the body’s sensitivity to insulin, the hormone that helps the body process glucose, so that even women who have experience living with diabetes can become frustrated in pregnancy. The moms-to-be who choose to participate attend 10 twohour Centering sessions before their babies are born. Blood work, sonograms and other tests are scheduled before or after each session. “Moms tell us they learn so much more than they would in an office visit,” Dermady says. The support they feel from other women is important, too. P regnant women, some with their partners, gather in a circle with their obstetrician, midwife, a nurse and nutritionist. A chime sounds. The Centering Pregnancy group begins. The sessions include bursts of laugher, some education and warm cups of tea. Unzila Nayeri, MD talks about the A1C blood test. Because glucose leaves its mark on the red blood cells, this test reveals the average glucose in the last three months. She reminds the women, still in the early months of pregnancy, of the importance of stability. Dermady explains it this way: A car that drives down a bug-infested highway may arrive at its destination — but the imprint of all those bugs will remain on its windshield. Women with diabetes are at high risk of having difficult labors and deliveries, partly because they are liable to have large babies. This may mean they require a Cesarean section or other interventions. “If we do a good job taking care of sugar levels, we can really reduce these risks,” Nayeri says. Registered dietitian Julie Mellen speaks about proper portion sizes and weight gain, saying that the desirable pregnancy weight gain is based on a woman’s prepregnancy weight. “What if you are gaining 1 to 2 pounds per week?” she asks before answering: “Your baby is getting too big, too fast.” Centering leaves time for questions, too, an efficient way of addressing common issues, Dermady says. “Many of the questions they have are questions that all the moms have.” Learn more about Centering Pregnancy by contacting the Regional Perinatal Center Program Coordinator Karen Davis 315-464-5702. G 16 U P S TAT E H E A LT H winter 2014 w w w. u p st ate . e d u FOR OUR COMMUNITY Both hospital campuses celebrate 50 years in 2014 C Summer 1960. The Post Standard read: “Mrs. Josephine Reidy turns the first shovelful of dirt at the groundbreaking ceremony for the Community Hospital of Greater Syracuse at Broad Road.” From the Onondaga Historical Association. ommunity Hospital’s grand opening was June 30, 1963. University Hospital’s was May 24, 1965. So why is Upstate University Hospital celebrating 50 years THIS year? Because even though Community’s grand opening was in 1963, it wasn’t until Sept. 5, 1964 that it merged with Syracuse General Hospital to become Community-General Hospital. And although University’s grand opening was in 1965, the doors actually opened to patients in late summer 1964. Later, University became known as Upstate University Hospital. The two hospitals became one in July 2011 when Upstate acquired Community-General Hospital. G How can you join in the celebration? 1) Share your memories, scrapbooks, photos and more with the anniversary committee. (Contact Susan Keeter at firstname.lastname@example.org or 315-464-4834.) 2) Subscribe to the What’s Up at Upstate blog at www.upstate.edu/whatsup and read a post about the anniversary every Thursday this year. 3) When you are at Upstate University Hospital, downtown campus (750 East Adams St., Syracuse), stop by the second floor cafeteria for a 64-cent coffee any Thursday this year. A variety of other deals will also be featured as “Throwback Thursday” specials. Summer 1961. New York Governor Nelson Rockefeller and Upstate President Carlyle Jacobsen review the architect’s model of Upstate University Hospital, downtown campus. From Upstate’s Health Sciences Library. Doc puts toxicology in a box A n assistant professor of emergency medicine is using comic illustration to teach clinical toxicology. “Toxicology in a Box” is a deck of 154 full-color flashcards designed to teach how to recognize and treat drug overdoses and poisonings. Brian Kloss, DO is co-author. The backs of the cards provide signs and symptoms and a description of how patients are likely to appear, along with treatments and advice. The collection, with a price of $49, is meant to help doctors and other medical professionals study on the go, quiz themselves or brush up before exams. Kloss appeared on the AMC Television program,“Comic Book Men,” in the fall to talk about the concept of medical education through comic illustration. He hopes to create a second flash card set on infectious diseases. G This mouse illustrates symptoms of arsenic poisoning (fish scalelike skin, garlic breath, “glove and stocking” neuropathy and more). winter 2014 U P S TAT E H E A LT H 17 Opportunities. Come to our prospective student open house: Saturday, March 29 Brought to you in part by the 90% of our students who come from New York. Upstate Medical University. 9,000 New Yorkers taking care of New York. Upstate isnâ€™t just the stateâ€™s oldest public medical school. We also enroll more students from New York than any other medical school in the state. Our four colleges include Medicine, Nursing, Health Professions and Graduate Studies. www.upstate.edu/students IN OUR LEISURE Like many billiards enthusiasts, Christopher Sanders has no pool table in his home, preferring instead to frequent a pool hall. His favorite is Premium Billiards, 228 Chapel Dr., Syracuse, which sponsors him. During the day he is an EEG technician at Upstate University Hospital. 1. Fond childhood memories. 2. Leagues. Why I love shooting pool 5. Fills the calendar. I play Mondays and Wednesday nights. I take off Tuesdays and Thursdays, maybe Fridays. League is on Sunday, and on Saturday I go in to play with friends who aren’t in the league. We had a table when I was growing up probably 40 years ago. I hit the balls around there and just kept playing. The 9-ball league is broken into skill levels from 1 to 9, with 9 being the highest. I’m a 9. The 8-ball league is different; the highest is a 7, and the lowest is a 2. I’m a 7. Anybody can play in this league. It’s not just for the best. Every person on the team is just as important. We want the beginners. In 9-ball, it’s a maximum of 23, and you have five players that play. If I’m a 9, the other four players have to total no more than 14 all together. Everything is computerized, as far as your skill level. When you get a new player, they automatically, for the first few weeks, come in as a 4. It’s just fun. We have great people of all ages. We’ve got people in their 70s, to their early 20s. 6. Opportunity for improvement. Here in Central New York, we have a really big pro tournament twice a year at Turning Stone Resort and Casino. There will be 126 players, and 100 of them are professional. They bring in tables from California, 16 tables that are brand new. These are world-class players that come and play. That is really good to go and watch. You can learn to improve your game by watching. 7.Vegas, baby! 3. Mentoring. I am a captain on my 8-ball and 9-ball teams. I help the lower-skilled players. I try to make it fun for them, not to get too intimidating. I’ll go in and have practice sessions with them. I’ll show them the basics of how to stand. I show them how to stroke the ball three times, every time. If you don’t start out on the right foot in pool, you can pick up a few bad habits, like keeping your arm in and keeping your dominant eye over the stick. The league I’m playing in is a world-class league. What they do is take the best 8-ball team, the best 9-ball team, the best doubles and have tournaments. Then the national and international tournament is in Las Vegas. Usually they have 10,000 people out there playing. In the master’s division — that’s the best of the best — there were 272 teams, and we placed 16th. There was only three of us on the team. We played teams from Japan, Canada and the United States. 8. Chance to give back. 4. Premium Billiards. It’s not a bar. It’s a nice place near Camillus (228 Chapel Drive, Syracuse) with all new tables and felt. They sponsor me. You bring your own sticks. You usually have one to break with and one to shoot with. Your breaking stick is usually a stiff shaft, and it’s a lot heavier so you can break the balls harder. The other one, some of them have very flexible shafts to where you can get a deflection on the balls better. My wife’s mother passed away at the age of 39. She had a massive heart attack. I’ve been a team captain for the American Heart Association’s Heart Walk for 10 years. My master’s team this time, we are donating $2 for every point we score — plus we have a backer who will double that — to the heart association. The most you can score is 21 points per match. There are 14 teams. We’ll play each team probably twice. We play two games every three weeks. It starts Nov. 24 and goes to the first week of May. G winter 2014 U P S TAT E H E A LT H 19 IN OUR LEISURE HOW TWO FEET TAKE ONE WOMAN JUST ABOUT EVERYWHERE SHE NEEDS TO GO Passion FOR WALKING W hen she has an errand to run or a place to be, graduate student Parisa Afshari, MD decides whether she can get there on foot. She walks four miles from home to campus, where she conducts research on schizophrenia as she works toward a doctorate in neuroscience. Once at a conference in San Diego, she went for a seven-hour walk, seeing more than 20 miles of sights. Walking is her exercise, but it also brings Afshari happiness. “I’m very happy when I’m walking,” she says. “I can daydream, but I also concentrate and make decisions about studying and my research, and think about what’s going on in the lab.” Afshari fell in love with walking and hiking while in Iran, where she earned her medical degree and worked in emergency medicine and sports medicine until 2008. She lived and worked in a mountainous region of Iran, and her colleagues invited her to join them for an overnight hike. She enjoyed it so much that her next hike was up 18,603 feet to the country’s highest peak, Damavanad in northern Iran. Now living in Syracuse, Afshari owns a car but only uses it when she cannot walk. Her ideal walking weather is temperatures from the 40s to the 70s, with mist or a light drizzle, or sunshine without heat. Typically she averages 4 to 4 1/2 miles per hour, depending on terrain and traffic lights. She dresses with comfort in mind and Asics sneakers on her feet. She carries a phone for emergencies and an iPod, “but the most important item is my CamelBak hydration pack, which has been with me literally every day for the past three and a half years, and still goes strong.” Afshari usually tunes her iPod to a podcast about a topic in psychology or social science. Sometimes she listens to comedy. Sometimes she disconnects digitally and hears just feet hitting the pavement. G three FAVORITE PLACES TO WALK G LaFayette Road, which is almost 18 miles both ways and very scenic. sections of the Erie Canal towpath. G Various G The long trail around Green Lakes State Park. MASTER OF PUBLIC HEALTH JOINTLY OFFERED BY UPSTATE MEDICAL UNIVERSITY & SYRACUSE UNIVERSITY w w w.upstate.edu/cnymph 20 U P S TAT E H E A LT H winter 2014 w w w. u p st ate . e d u MORTALITY Christopher Hitchens travels from ‘Welltown’ to ‘Tumortown’ BY JOEL POTASH, MD IN OUR LEISURE Jason Meany teaches scuba diving and brokers dive trips through his company, Deep Stop Scuba. calorie BURN hristopher Hitchens was a famous author, journalist, and lecturer who loved to debate religion with representatives of various religions. He was an atheist and perhaps best know for his book, “God is Not Great: How Religion Poisons Everything.” C T In 2010, on the day of a book signing event for his new memoir, “Hitch 22,” he experienced chest pain and went to a hospital emergency room, where an x-ray showed lung cancer, later found to be metastatic from cancer of the esophagus. “Mortality” tells his story until his death in 2011, from “Welltown” to “Tumortown.” Hitchens chose aggressive treatments in hopes of prolonging his life, and if not, then of adding to medical knowledge of cancer treatment that might help others. His treatment side effects included loss of his voice, hair loss, fatigue, inability to swallow food, and nerve weakness that caused the loss of function of his writing arm. Writing and speaking were the two most important things to him. Yet, he endured. As he was an avowed atheist, some of the public saw this as fitting punishment. Others set up prayer days, hoping for the efficacy of prayer in his healing. Hitchens disavowed both. Hitchens is splendid in talking of the etiquette of dealing with a dying person. His comments about treating physicians remind me of the play, “Wit.” Some physicians remain uncertain about what and how much to tell patients about their diseases and treatments. A physician who cares for dying patients recently wrote in the New York Times that when he asked his oncologist how long he had to live, the oncologist refused to answer — and the physician with cancer defended the oncologist's choice. I’m not sure I agree, but there is no one approach to all patients with a terminal disease. So, is it helpful (or depressing) to read books about dying? I have a shelf full of such books, both fiction and nonfiction. Neither doctors nor patients seem to have the time or energy to go in depth into patient experiences of disease and treatments, so I find these books expand my understanding of what patients (and doctors) go through in dealing with the dying process. They may also educate future patients about the medical system so they can deal with it more satisfactorily. Medical students and residents should be required to read some of these books. But will they prepare me for the time when I may be dying? I hope so — but all bets are off when that time comes. G he exact number of calories you burn is affected by your age, gender, body size and composition and level of physical fitness. Here’s an estimate of how many calories someone weighing 172 pounds would burn in an hour of the activity: other books About deAth And dying: “Without,” poems by Donald Hall “Wit,” a play by Margaret Edson “Messages from My Father,” a memoir by Calvin Trillin “Death Be Not Proud,” by John J. Gunther “How We Die, Reflections of Life’s Final Chapter,” by Sherwin B. Nuland “The Last Lecture,” by Randy Pausch “A Death in the Family,” by James Agee Ice hockey 627 Figure skating 705 Downhill ski racing 627 Cross Country skiing 705 Joel Potash, MD is emeritus faculty in Upstate’s Center for Bioethics and Humanities. winter 2014 U P S TAT E H E A LT H 21 IN OUR LEISURE HEALTHY I G eats why breAkfAst mAtters f you’re trying to lose weight, make sure you eat breakfast. Upstate registered dietitian Terry Podolak explains why: You need to “break” the “fast” by refueling after a good night’s sleep, ideally with a meal containing protein, fiber and fat. This will help keep you satisfied for four or more hours. Studies show that people who skip breakfast are likely to become overhungry, and then overeat as the day goes on. Your metabolism can be altered when you go for longer periods without food. More body fat accumulates when you eat fewer large meals than when you eat smaller more frequent meals. G G Roasted Delicata Squash with Mushrooms and Thyme G You may not be hungry when you first wake up, but that is OK. Work at being mindful of when hunger kicks in — likely by mid-morning —and have healthy foods at the ready. Some ideas: whole grain toast with peanut butter, yogurt topped with nuts or fruit, quick breads with nuts, seeds or berries, or eggs paired with some fruit. G D elicata squash stars in this wintry dish, which is equally happy in a supporting role next to meat or stealing the show as a vegetarian centerpiece. This gourd is called delicata because its skin is delicate enough to eat without peeling. Ingredients 1 pound fresh delicata squash 10 ounces crimini mushrooms 3 tablespoons olive oil 2 teaspoons minced garlic cloves 1 tablespoon minced thyme ½ teaspoon kosher salt ¼ teaspoon ground black pepper This is excerpted from “Healthy Eats” on Upstate’s weekly radio program, “HealthLink on Air,” heard at 9 p.m. Sundays on WRVO Public Media. Preparation Nutritional information, per serving 93 calories 1.7 grams protein 7.5 grams carbohydrates Preheat oven to 350 degrees F. Wash delicata squash. Cut squash in half lengthwise, scoop out seeds and discard. Slice ½ inch thick and place in a bowl. Remove stems from mushrooms and place caps in a bowl. Divide into each bowl olive oil, garlic, salt and pepper. Place the squash on the pan and the mushrooms on another pan. Roast in the oven until tender, about 10 to 15 minutes. When cooked through, combine vegetables and toss with fresh thyme leaves. 7 grams total fat 200 milligrams sodium 1 gram saturated fat 2 grams fiber 0 milligrams cholesterol RECIPE FROM MORRISON HEALTHCARE, FOOD SERVICE PROVIDER FOR UPSTATE MEDICAL UNIVERSITY. 22 U P S TAT E H E A LT H winter 2014 w w w. u p st ate . e d u THE HUMORIST Spilling the secrets of cold weather exercise BY JEFF KRAMER erely thinking this thought, let alone saying it in a magazine, surely dooms me to a crushing bout of flu, bronchitis or some other nasty seasonal ailment, but here goes: I don’t get sick as often or as severely as I once did since I started exercising regularly outdoors in any kind of weather that does not contain the phrase “polar vortex.” M It wasn’t always that way. For years I was primarily a gym guy, and even now I have not abandoned my local “YMCA.” But I’ve relegated indoor workouts to Plan B status because my overall health and mood seem better when I do my huffing and puffing outdoors. Is there science behind it? One study showed that compared with exercising indoors, exercising in natural environments was associated with greater feelings of revitalization, increased energy and positive engagement, together with decreases in tension, confusion, anger and depression. Participants also reported greater enjoyment and satisfaction with outdoor activity and stated that they were more likely to repeat the activity at a later date. There’s also evidence that larger cyclists — like me — enjoy greater benefit in the field versus the gym because they work harder due to increased wind drag. On a personal note, I like to think of myself as a giant health parachute overriding my bicycle’s efficient design, which could explain why I’m never invited on team rides. More evidence of the mental aspects of exercising outdoors: Research published in the online journal PLoS One found that participants who immersed themselves in a natural setting for four days showed a 50 percent improvement in focus and problem-solving skills. What’s missing so far is hard data that outdoor exercise improves physical health more than indoor exercise, but all the evidence I need is getting coughed on by a tubercular ectomorph in a LiveStrong T-shirt on the treadmill next to mine. Also, let’s consider Teddy Roosevelt. A scrawny, sickly child who worked out for years on an outdoor gym installed by his father at the family’s brownstone, and turned himself into, well, Teddy Roosevelt. How many more studies do we need? Up until a few years ago I saw an internist at least once a winter. I might not be the first person to get hit by whatever bug was going around, but that was all part of the conspiracy. The viral agents were honing their technique on smaller, weaker people in preparation for taking me down. By the time they got to me I didn’t stand a chance. A Monday cough would turn into bronchitis by Friday. Pneumonia came calling, too. Bllccch. No more. In a desperate bid to torch mega-calories — not with the intent of getting sick less often — I took up cycling with a zeal bordering on obsessive. The habit continued through the summer and into a mild fall. A virtually snowless winter followed, allowing me to bundle up and keep riding. When the snow finally did come I was ready with a chunky-treaded “Fat Bike.” I haven’t been at this long enough to claim victory over anything, but one minor cold and a sore throat in three years is remarkable by my standards and a trend line I’d like to continue. To that end I just purchased studded bike tires —who knew? — that even work on black ice. That brings me to a major side benefit of any kind of outdoor winter activity: The gear. It’s totally awesome. Had the Donner Party had access to wicking base layers, compression neoprene shirts, Windstopper shells and rechargeable halogens that can light up a subdivision, not only would all the members of the pioneering party have made it to California, they would have pushed north to Alaska for the heck of it, singing drinking songs as they went. See, the secret we cold-weather exercisers share is that thanks to the gear we’re not really that cold. A bigger risk than frostbite is getting bitten by a big credit card bill, the result of over-rewarding yourself for your hardy, intrepid nature. But don’t sweat it. It’s better than spending the money on antibiotics. G winter 2014 U P S TAT E H E A LT H 23 Non Profit Org. US Postage PAID 750 East Adams Street l Syracuse, NY 13210 Permit No 110 Syracuse, NY T 1S SCIE R A NC S I E P IS IS SCIE T NC AR articles that we breathe leave fingerprints, of a sort, says Jerrold Abraham, MD, medical director of environmental and occupational pathology at Upstate. “Your lung retains some evidence of what you’ve inhaled over your life.” His lab has created an extensive particle database and uses electron microscopy to identify, characterize and quantify particulate materials in tissue samples. This image shows a magnetic iron oxide-bearing pulverized fuel ash particle, a waste product from a coal burning power plant. The finest of these particles can escape into the atmosphere. They form spheres as they cool, and depending on how quickly they cool, elements within the particles may crystallize. In this image, iron oxide dendrites create the star shapes and probably form a dendritic lattice structure within the sphere. E A RT IS SC I EN IS C Photo by Andrew Hunt, PhD, who currently is a faculty member at the University of Texas at Arlington. 13.450 0214 38.1M ELsk E IS A RT S C I E N C E Jerrold Abraham, MD