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Health UPSTATE

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

Christine’s

strength

Spring 2014

How to keep your cool

page 9

Can mustard oil help you get pregnant?

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Make a home “senior safe”

page 8

The right way to eat carbs

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Preventing amputations in patients with diabetes

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PATIENTS FIRST

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On the cover: Christine LaFave with her oncologist Sam Benjamin, MD.

Health UPSTATE

Spring 2014

Publisher Wanda Thompson PhD Senior Vice President for Operations Executive Editor Leah Caldwell Assistant Vice President, Marketing & University Communications Editor-in-Chief Writers Designer

Amber Smith

Amber Smith, Susan Keeter, Jim McKeever Cynthia Courtney

Photography Kathleen Paice Froio (page 10) Susan Kahn (cover, pages 4, 7, 14) Susan Keeter (page 2) Robert Mescavage (pages 4, 5, 17, 19) William Mueller (page 18) Debbie Rexine (page 22) Medical photography (pages 13, 15, 20) Illustrations

Randy Glasbergen (page 3) Dan Cameron (page 13) Lavanda Ladd (page 22)

Visit us online at www.upstate.edu or phone us at 315-464-4836. For corrections, suggestions and submissions, contact Amber Smith at 315-464-4822 or smithamb@upstate.edu additional copies: 315-464-4836. Upstate Health offices are located at 250 Harrison St., Syracuse, NY 13202

The award-winning 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 biomedical research enterprise, 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.

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Andrea Berg, MD, assistant professor of medicine, specializes in geriatrics.

Get a glimpse of Upstate workers on posters throughout campus

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long hallways throughout the Upstate campus are posters that showcase individual employees in their workplaces. Each uses a minimal number of words to evoke a story and make the point that the employees of Upstate Medical University in Syracuse take care of New York in multiple ways. “Trustworthy,” proclaims the one featuring Alicia Pekarsky, MD, a pediatrician who works in the Child Abuse Referral and Evaluation Program. “Looking out for abused children. Making sure they are safe.” Another describes phlebotomist Gloria Smith as “Meticulous. Providing a gentle touch to dozens of patients each day. Treating each as

if she (or he) is the only one.” Occupational therapist Jennifer Donnelly’s is about “Encouragement.” She works in Physical Medicine and Rehabilitation. “Knowing patients can improve. Helping them believe they will.” The word, “Motivation” dominates the poster with radiographer Kurtis Wilson. “Visualizing biological processes at the cellular level. Finding medical problems at earlier, treatable stages.” The posters allow visitors to glimpse some of the mission and values of Upstate Medical University. They also serve to remind employees of the important work they do day in and day out.

Commitment.

Christian Knutsen, MD, Emergency Medicine

Preparing for when disaster strikes. Directing emergency response. Taking care of New York.

Just another way that you and 9,000 coworkers are taking care of New York.

TakingCareofNewYork.com

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This issue contains information and inspiration

W

e hope Upstate Health is helping Central New Yorkers live their best lives. In this issue:

 ead about the expansion of Upstate Medical University’s R sleep center, the only one in this region with services designed to accommodate children as young as infants.

 former trauma patient shares his ordeal, and his A gratitude that Upstate University Hospital and Golisano Children’s Hospital are the first in New York to achieve national verification from the American College of Surgeons.

 ur pages contain reason to cheer: for the courageous O mother battling breast cancer, for the stroke survivor who is almost fully recovered, for the Special Olympian who loves floor hockey – and for the four runners from Upstate who won the right to compete in the Corporate Challenge in London this year.

 ou will meet Palma Shaw, MD, the vascular surgeon who Y specializes in preventing amputations in diabetics, and Ray Muldoon, the nurse practitioner who is getting a doctorate in nursing through an innovative online program at the Upstate College of Nursing.

Contents PATIENTS FIRST Surviving stroke Crash course in trauma care

p. 4 p. 5

cover story:

An image of strength

p. 6

FROM OUR EXPERTS Preventing amputation Making a home “senior safe” Chest pain advice How to keep your cool The future in knee repair Does mustard oil = baby?

p. 7 p. 8 p. 8 p. 9 p. 10 p. 11

FOR OUR COMMUNITY Lessons learned in a flood What makes heroin so dangerous Nurses achieving doctorates

p. 14 p. 15 p. 18

IN OUR LEISURE Why I love floor hockey Racing in London How to craft a children’s book Our experts share information about a dangerous drug that Apple Farro Salad is hospitalizing, and killing, people in our community; the The right way to eat carbs new national stroke prevention guidelines for people with

p. 19 p. 20 p. 22 p. 23 p. 23

a heart rhythm disturbance called atrial fibrillation; and the latest news about the impact of coital lubricants on a couple’s chances of conception. Upstate experts give advice on how to make homes safe for seniors, the best way to consume carbohydrates and what’s on the horizon for knee repairs.

 lso, one woman shares her tips for writing a children’s A book, and one man reveals his secrets for keeping calm and carrying on.

Enjoy your Health, brought to you by Upstate.

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.

Spring 2014

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PATIENTS FIRST

Stroke survivor –

A patient after 52 years of public service by amber smith He did not immediately think “stroke.” As his symptoms emerged on that July morning last summer, 69-year-old Onondaga County Undersheriff Warren Darby began to realize he needed to hurry to the hospital. Not just any hospital. A designated stroke center: Upstate University Hospital. Word spread quickly about Darby’s medical crisis. Friends feared the worst. Darby says, “The Lord had other ideas,” as he recalls that day and the months that followed into his recovery. As blood leaked from a tiny vessel in Darby’s brain, he was at the mercy of a system of medical care that he actually helped create — a system in which the state Department of Health designates certain hospitals as stroke centers, to improve quick access to definitive care for anyone suffering what appears to be a stroke. Now Darby was dependent on that system. continued on page 12

Sleep Center expands to suburbs With sleep disorders on the rise, Upstate has opened a new 12-room sleep center that includes four dedicated pediatric beds/cribs at Medical Center West in Camillus. “This new facility offers patients a comfortable, hotel-like environment,” says co-medical director Dragos Manta, MD. The Upstate Sleep Center operates seven days and nights per week, offering a variety of studies that look for disorders of sleep and breathing. The

obesity epidemic contributes to a rise in sleep apnea, and today’s fast-paced, always-wired culture also contributes to sleep deprivation. Most sleep disorders can be treated — if recognized and properly diagnosed. That’s especially important for infants and children, says co-medical director Zafer Soultan, MD. “Diagnosing a child’s sleep disorder at a young age can not only help them as they develop, it gives them the gift of a restful night’s sleep for a lifetime.”

Getting a good night’s rest may begin with a sleep study.

Listen to an interview at upstate.edu/healthlinkonair by searching “sleep.”

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PATIENTS FIRST

Crash course

Ed learned the value of a trauma center by amber smith

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he scar stretches from his neck to his belly button, a vivid reminder of that day in January 2013 when Ed Wasilewski skated just about as close to death as one can – and still survive. Wasilewski, 31, of Erieville had been riding his longboard along Route 20 between Cazenovia and Morrisville. It was the end of a spring-like day in the middle of winter. Dusk was turning to dark along the rural stretch of asphalt. Then, a truck turned onto the road. “He turned right in front of me, and I ran right into him,” says Wasilewski, who does not remember the crash, or anything else that entire month. “I’ve been told that the frame of the truck was bent.” The collision left Wasilewski with eight broken ribs, a broken pelvis and a broken shoulder blade. His spleen ruptured. One lung was punctured. And – mercifully not until he arrived at Upstate University Hospital – he

save the date

began bleeding from a tear in his aorta, the primary artery that keeps blood circulating through the body. Wasilewski’s situation illustrates how Central New York depends on Upstate’s trauma center, which recently earned national verification from the American College of Surgeons for its adult and pediatric trauma services. Trauma specialists are on duty around the clock to care for people who are severely hurt, some of whom, like Wasilewski, arrive by helicopter. Each of Wasilewski’s injuries required urgent repair. He remained in a coma for almost three weeks, during which time he underwent 18 surgeries. He was out of work for a year, recovering. “I think somebody was looking out for me,” he says. “I think somebody knew that my Mom wouldn’t be around for very long, and my Dad wouldn’t be able to handle both of us being gone.” His mother succumbed to cancer in the months after Wasilewski’s crash.

Ed Wasilewski with his longboard.

Now he’s back to work as a welder who also does heating and air conditioning duct work. He is also back on the longboard. He says it’s what keeps him sane. Friends gave him a vibrant green sweatshirt so he will be more visible. The crash left him safety-oriented and cautious of cars and grateful for a nationally verified trauma center.

Upstate Cancer Center opening

please join us to celebrate the opening of the Upstate Cancer Center friday, july 18, 10 a.m. ribbon cutting ceremony

open to the public, with tours

saturday, july 19, 9 a.m. to 1 p.m. open house

open to the public, with tours

Spring 2014

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PATIENTS FIRST

UPSTAT

by the numbers

An image of strength

Biology professor battles breast cancer

5,006

by amber smith

medical journal articles were scoured by Expertscape.com to select Upstate’s physician scientist Michael C. Iannuzzi, MD as one of the world’s leading experts in sarcoidosis, an immune system disorder.

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hristine LaFave became a breast cancer warrior on Jan. 28, 2013. That’s when she discovered that the lump she felt in her breast was cancerous. After an ultrasound, biopsy and complete body scan, LaFave was left with the diagnosis of stage IV metastatic breast cancer. The cancer has spread to her breastbone, liver and lungs. “Mine’s a terminal disease. I’m going to die of this,” LaFave knows. “But I’m going to live my life, and I’m going to be happy.”

1,414

Upstate employees pledged $585,649 to support community agencies in Central New York in 2014.

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She is a biology professor at Colgate University. Students established a college fund for her 6-year-old daughter, Grace, with $8,000 they raised in a “LaField Day for LaFave” fundraiser that had professors taking turns in a dunk tank. She took leave last spring for chemotherapy and completed radiation therapy at the beginning of fall, when she returned to the classroom.

medical students graduating this year will remain in Syracuse for their residency training, including 12 at Upstate and five at St. Joseph’s Hospital Health Center.

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private infusion areas will be available in the Upstate Cancer Center when it opens this summer.

Now LaFave, 46, sees Sam Benjamin, MD, and undergoes maintenance chemotherapy once a month. She will do that the rest of her life. It leaves her achy for four or five days after infusion. Her favorite course to teach is the upper level elective, Human Physiology. Her knowledge of the human body, at first, felt like a benefit as she dealt with her own medical appointments. She was determined to scour the medical journals until she discovered how to beat the disease. Then she reached a saturation point and decided to focus on what she needed to do, day by day, to persevere. “My doctors are amazing,” she says. “I love them so much. They respect me. They talk to me on almost a peer level. I know I don’t have any control of this disease, but it helps me feel like I have a bit of a handle.” continued on page 7

Christine LaFave and her daughter, Grace.

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dollars collected for Actors’ Equity AIDS charities at Syracuse Stage this season were donated to the pediatric AIDS program at Upstate Golisano Children’s Hospital.

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“Mine’s a terminal disease. I’m going to die of this, but I’m going to live my life, and I’m going to be happy.” continued from page 6 LaFave says survival rates for metastatic cancer are grim, maybe just 2 ½ years. She says there is a 78 percent chance that she won’t be here in five years, when her daughter turns 11. She remains focused: “One day at a time. Living my life. Loving my life. Doing the things that are important to me. “This is the hand that I have been dealt, and I am doing everything I can to be as strong as I can.”

Breast cancer warrior Christine LaFave was happy to participate in Upstate-hosted fashion show in April with her daughter, Grace. Her creative outlet is fashion, and she writes a blog where she shares various outfits. “I like opening up my closet and putting things together. I do some thrifting and consignment clothes buying, as well as wearing items that are my Mom’s from 50 years ago.”

Surgeon specializes in treating diabetics People who have diabetes are at increased risk of lower leg amputation. The disease may diminish blood flow and sensation in their feet, and it may impair vision, so any wound is not readily apparent. Then because their immune system is compromised, their bodies struggle to fight any infection.

Tools at her disposal: improving blood flow through minimally invasive surgery, or through delicate open surgery in which veins are rerouted. If a wound has been festering for a month or more, she may have to surgically remove the wound or use an enzyme-based medication to stimulate healing.

More advanced options include hyperbaric oxygen and cell therapy. “If they don’t have good blood supply to their foot, you can give all of Hopefully it never comes to that. Shaw urges people with diabetes to the antibiotics that you want, but the antibiotics go in the blood, and make regular visits to a podiatrist. She says monitoring foot health is as the blood can’t get to the foot. So therefore you have an untreated important as tracking sugar levels, blood pressure and kidney function. infection, and the patient can quickly lose the limb,” says Palma Shaw, MD, a vascular surgeon at Upstate University Hospital who specializes in limb salvage. Listen to an interview at upstate.edu/healthlinkonair by searching “Palma Shaw.”

Spring 2014

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FROM OUR EXPERT S

Caregiver Advice How to make a home senior safe Some practical advice from Upstate’s Marjorie Libling, a social worker specializing in geriatrics, for making your senior loved one’s home safe: in the

in the

in the

Use a nonslip rubber mat for the tub, and also for the floor outside of the tub. Avoid loose towels or rugs on the floor, to reduce the chance of slipping.

Disconnect the stove if your loved one lives alone and is developing memory problems.

Consider guard rails that can help your loved one get in and out of bed.

bathroom:

Install grab bars in the bathing area, and invest in a proper shower stool that has rubber feet and a nonskid surface. Use a doorknob that cannot be locked, or one that can be unlocked from either side, in case your loved one suddenly needs assistance. Label the faucets “hot” and “cold,” and check the water temperature to make sure it is not hotter than 120o F. Encourage your loved one to bring a phone or a medical alert system into the bathroom in case he/she needs help. Get a weekly pill box or mechanical medication dispenser so your loved one does not have to open multiple pill bottles each day.

kitchen: Use coffee makers or electric kettles that shut off automatically, and label “on” and “off ” clearly on any appliances. Sheath knives in a drawer or store them safely in a block. Move cleaners and chemicals to another room to reduce the chance of mixing them with food products. Check perishables every week so your loved one doesn’t consume something that has spoiled. Keep high protein healthy snacks visible, as a reminder to eat. Dilute wine with water or swap it with nonalcoholic beverages to reduce your loved one’s alcohol intake. Alcohol does not mix well with memory impairment, unsteady gaits and/or prescription medications.

clip and save!

What to do for chest pain Chest pain is one of the primary reasons people seek care at a hospital emergency room, and it can signal a variety of medical conditions, says William Paolo, MD, an assistant professor of emergency medicine at Upstate University Hospital. Among the most serious is a heart attack or acute coronary syndrome. Differentiating heart attack-induced chest pain from other types of chest pain is tricky. “Your heart doesn’t have the same kind of nerves as your skin does. With your skin, when you have pain you can pinpoint where that is; that’s called somatic pain. When you have heart pain or pain in your internal organs, that is supplied by a different system; that’s called visceral pain. It’s very vague and nonspecific, more generalized. Sometimes you’ll feel like it’s in the middle of your chest, sometimes in your neck.”

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bedroom & living room: Minimize blankets and pillows on the bed, so there is less to fall off, and keep floors uncluttered to reduce the risk of tripping. Tuck away power cords and label remote controls with simple “on” and “off” instructions. Replace any burned out light bulbs, and strategically place automatic nightlights in outlets to assure safe navigation at night. Use rug pads or tack down rugs with nails to help prevent falls. If your loved one refuses to quit smoking, establish one “safe” smoking spot that is away from the bed, the stove and any chemicals. Consider taking control of bank and credit accounts. Television shopping networks or online buying can become an addiction, and your loved one may find it impossible to say no to telemarketers.

Doctors pay attention to associated symptoms, as well: Is the person sweating, nauseous or short of breath? Paolo says it’s simple: If you have chest pain you have never experienced before, get to the hospital emergency room. If you are with someone who suffers chest pain: • s it them down and make sure they do not exert themselves, • c all 911 for an ambulance, so that paramedics will be able to start treatment, and • c onsider giving an aspirin, a blood thinner, as long as the person is not allergic. Listen to an interview at upstate.edu/healthlinkonair by searching “chest pain.”

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F RO M OUR EXPERTS

How to keep your cool (The secrets of one manager’s success)

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an Malay is one of the people who for more than two years has orchestrated the meticulous and monumental conversion of Upstate University Hospital’s medical records into a new electronic medical records system called Epic. His title is manager of clinical systems, but what Malay is really known for is unflustered professionalism in times of high stress. Some of that may be explained by his Irish Catholic upbringing, the strong work ethic instilled by parents adept at managing chaos (his mother is a nurse; his father, a police officer.) He admits that the last few months have been “very, very, very busy” — at work and at home. He and his wife, Erin added a third daughter to their young brood just weeks before the Epic deadline. So, what is Malay’s secret for keeping calm and carrying on? He strives to understand where people are coming from. When people are contrary, he says, “most of the time it’s because they are worried about what you are proposing, how it will impact what they’re comfortable with.” He removes emotion, so people don’t feel threatened. He determines what is most important. “I try prioritizing the most important things, those that impact the quality of the care we provide and the safety of our patients, and knowing which things you can do something about and which things you can’t. You have to be able to accept the things you cannot change.” He realizes that some people are not easy to work with, and some have expectations that are not reasonable. He avoids dictating. “People usually don’t respond well when you roll in and tell them how it’s going to be.” He listens. He takes time to chill. Running, and spending time with his wife and daughters, are his favorite ways. He follows the habits ingrained through golf and running, high school sports he enjoyed. “Those are not traditional team sports,” he explains. “Those are sports where it’s pretty much on you to stay in control and to pace yourself to continue to perform. You’ve got to stay calm, cool and collected.” What happens when he has a bad day? Does Malay ever want to jump up and down, pull out his hair, scream, throw something, melt down? No, he says plainly. “That wouldn’t do anybody any good.”

Spring 2014

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FROM OUR EXPERT S

Reducing stroke risk in patients with a-fib

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f you have been diagnosed with atrial fibrillation, new guidelines to reduce your risk of stroke include talking to your healthcare provider about taking an oral anticoagulant.

Upstate neurologist Antonio Culebras, MD, is the lead author of the new guidelines from the American Academy of Neurology. “These guidelines are not commandments. They are recommendations,” he says, acknowledging that some people may be at greater risk of bleeding than of stroke. Atrial fibrillation is an irregular heartbeat which can be fast or slow and cause symptoms including fatigue, dizziness or lightheadedness. It can be constant, or it can come and go. “Because the heart does not beat regularly, there is a change in the circulation of the blood,” Culebras explains. Blood may sit in the corner of the heart, facilitating the formation of a clot that later migrates to the brain, causing a stroke.

Antonio Culebras, MD, is interviewed by Syracuse media about the new guidelines.

Q

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if you have a question for the experts at Upstate, please submit it to whatsup@ upstate.edu. We may feature your question – and answer – in an upcoming issue of Upstate Health.

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The risk is even greater in people with atrial fibrillation who have had a stroke or TIA, transient ischemic attack, which has symptoms that mimic those

of stroke but are temporary. (See page 4 to learn more about stroke.) Culebras says in patients who suffer a stroke for which doctors can find no cause, “we strongly suspect atrial fibrillation is the culprit.” The guidelines also suggest that these people be evaluated for atrial fibrillation, which may require wearing a heart monitor for several days. Anticoagulants are designed to prevent clots by thinning the blood, but they can put some patients at risk for bleeding complications. A new series of anticoagulants — including dabigatran, rivaroxaban and apixaban — are safer and perhaps more effective than warfarin, Culebras says. The World Health Organization calls atrial fibrillation a “growing and serious global health problem” and projects one in 20 people around the world have this condition, which tends to develop as people age. Other factors that put a person at risk for developing atrial fibrillation include underlying heart disease, high blood pressure, binge drinking and sleep apnea, along with thyroid problems, diabetes, asthma and other chronic medical conditions, according to the American Heart Association.

Listen to an interview at upstate.edu/healthlinkonair by searching “Culebras.”

Upstate Answers Studies are underway in other countries, and a couple in the United States using a product that helps with regenerating one’s injured knee. The procedure uses both your own stem cells and umbilical stem cells. How soon will we have such treatments in Syracuse? – Sally White, Syracuse I’m actually starting to develop some FDA trials for this procedure – which is not just for the knee – so we’re hoping by this summer. Stem cell therapy is pretty new in the United States, but it is already in use in Asia and Europe, and it holds a lot of promise. Stem cells are cells which haven’t differentiated yet. In the right environment, they can differentiate into the tissues you would like. There are three trials we are designing protocols for now. One is for overuse

U PSTATE HEALTH

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injuries such as tennis elbow and Achilles tendonitis. The second one is for tendon repair, for certain tendons that are stubborn and don’t like to heal. The third trial we want to do is looking at how to use stem cells to treat arthritis. Anyone who wants to learn more about these trials can contact me at 315-464-8634. – Kevin Setter, MD, associate professor of orthopedic surgery at Upstate

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F RO M OUR EXPERTS

Struggling to conceive? Consider an alternative lubrication

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sk a question at an academic medical center, and you just may inspire research to get the answer.

That is how andrology lab director Kazim Chohan, PhD, lit up the Internet recently with news that sexual lubricants may impede a couple’s chances of conceiving.

A fertility patient asked how a store-bought lubricant affected sperm. Chohan and his team of students crafted a study to find out. They tested several commercial lubricants found on store shelves in Central New York. “We looked at their impact on sperm motility, and interestingly we found that majority of commercial lubricants – except for PreSeed – significantly decreased sperm motility. KY products (warming and tingling) were almost spermicidal. So if a couple is using them as a coital lubricant, the possibility is, they may not conceive,” says

Chohan, a professor of pathology and of obstetrics and gynecology at Upstate. His findings, published in the journal, Fertility and Sterility, made headlines on a variety of national and international news websites. The team also tested some household products that may be used for lubrication: canola oil, baby oil, sesame oil and mustard oil. Except for sesame oil, the oils turned out to be sperm-friendly. “Mustard oil gave us really good results. It enhanced the sperm motility. The sperm were consistently hyperactive during incubation under mustard oil, ” Chohan says. “This needs to be studied further.” Family planning expert Renee Mestad, MD, is quick to point out that couples who are not seeking to become pregnant should not assume a commercial lubricant will prevent conception. “They do need to use an additional method of contraception,” she says.

Mustard oil provided surprising results compared with other lubricants.

Listen to an interview at upstate.edu/ healthlinkonair by searching “lubricant.”

Verified.

The American College of Surgeons has verified Upstate as the state’s first Level 1 trauma center for adults and children. www.upstate.edu 9,000 New Yorkers taking care of New York.

Syracuse POST

Spring 2014

Strip ad 6 col. (10.87” wide) x 2.5” deep

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patients first

Stroke survivor continued from page 4

Stroke is a leading cause of disability in the United States and the fourth most prevalent cause of death. It happens when a blood vessel carrying oxygen and nutrients to the brain ruptures or becomes blocked by a clot. High blood pressure is one of the leading causes of stroke and the most important controllable risk factor. “For all strokes, the sooner you get to the hospital, the greater your chances that something can be done,” says Gene Latorre, MD, the associate professor of neurology at Upstate who took care of Darby.

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alley Men’s Field Days were under way at Syracuse’s Meachem Park. Organizers opened the rides and games specifically for children with special needs that July 18 morning, and Darby looked forward to joining the other police, fire and emergency medical services professionals assisting the kids. Several decades earlier, his daughter, Kimberly, who has Down syndrome, enjoyed the field days.

Symptoms

These sudden symptoms of stroke warrant an immediate call to 9-1-1: • numbness or weakness of the leg, arm or face • confusion or trouble understanding • trouble seeing in one or both eyes • trouble walking, dizziness, loss of balance or coordination • severe headache with no known cause • facial drooping or numbness on one side • slurred speech

Darby’s day began as usual, eating breakfast around 7 a.m. and taking medication that controls his blood pressure. Then he put on his uniform and drove to work. Darby climbed out of his car about 8 a.m. He felt off balance. He steadied himself and carefully walked into his office at the sheriff ’s headquarters in downtown Syracuse. He sat at his desk doing paperwork. About 45 minutes later, he stood and felt the same imbalanced sensation. He called his wife, Joan, a nurse. She drove into Syracuse and dialed his cell phone when she arrived. Darby stood up and again felt imbalanced. His left leg felt asleep. “That made me think, this is possibly a stroke,” recalls Darby.

Joan drove him to his physician’s office. “Dr. Mitchell Brodey examined me, and the next thing I knew, I was in an ambulance on the way to the stroke center.” Darby’s 52-year career in public service includes leadership roles in emergency medical services, fire services and law enforcement. For 16 years he served as president of the Central New York Regional Emergency Medical Services Council, and represented the local council on the New York State Emergency Medical Services Council. That’s how he was involved in the New York State stroke center designations.

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pstate University Hospital was the first designated stroke center in Central New York, and its staff provide stroke care that is not available elsewhere. Darby felt confident as paramedics wheeled him into the downtown hospital. A team of providers was already mobilized and ready for him. Quickly it was determined that Darby had a small bleed on the right side of his brain, which made sense, given that he experienced symptoms on his left side. Next, they searched for the cause. The neurologist, Latorre, told Darby that a weakened capillary deep in his brain had burst. He was suffering a hemorrhagic stroke. It would take 6 to 8 weeks for his body to absorb the blood and reveal any lasting debilitation, but first the team had to get the bleeding to stop. Typically, the larger blood vessel will shut off the bleeding capillary, as long as the blood pressure is brought under control and the swelling managed. This is done chiefly through medication. “For the most part, unless the blood pressure is not controlled, it resolves on its own,” Latorre says. He adds that “the size of the hemorrhage is not as important as the location.” Some patients have minimal symptoms despite fist-sized collections of blood, and others are rendered comatose from a pea-sized bleed. The worst spot to have a stroke is in the brain stem. Darby’s stroke was in the area above the brainstem known as “deep territory.” He reacted promptly to his symptoms and got to the right designated stroke center quickly. Darby received medication to lower his blood pressure and was admitted to the Neuroscience Intensive Care Unit on the ninth floor. He had a headache and nausea his first night. He underwent many tests during his four-day stay as doctors monitored the bleeding and swelling. The stroke affected Darby’s left leg and balance, but he suffered no cognitive deficits. “I still think with time, God willing, I may lose all of the debilitation that I have,” he says. continued on page 13

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TWO TYPES OF STROKE HEMORRHAGIC STROKE

CAUSED BY BURST CAPILLARY

ISCHEMIC STROKE

CAUSED BY OBSTRUCTED BLOOD VESSEL

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arby was discharged with a walker. Through weeks of rehabilitation at Upstate, under the care of physical therapist Sara Bullock, he weaned himself to a cane. Now he walks carefully on his own; most people cannot tell that he suffered a stroke. He continues to deal with fatigue, which may be the longest lasting weakness from the stroke. When his body is overtired, Darby feels numbness in his left foot and lower leg. Doctors have told him to take a nap when that happens. “Sleep is the best way to let the body repair a brain injury,” Darby recalls. “Regaining stamina is usually the last thing to return, if it ever fully returns.” He has even been fishing and hunting since the stroke. “Doc, is fishing considered rehabilitation?” Darby recalls asking Latorre. The doctor smiled, nodded yes and told him to be careful getting in and out of the boat and not to lift anything greater than 10 pounds for the next two weeks. “I haven’t caught a fish over 10 pounds in Oneida Lake for many years,” Darby replied, “and if I do, I will gladly hand the pole to my fishing partners.” From the first Saturday in May (walleye opening) until hunting season begins in November, Darby fishes with friends two or three times per week from the boat he keeps at his Brewerton home. Last year 2,364 fish were caught on his boat, including mostly walleye, perch, bass and lots of pan fish. Darby was able to work a few hours a day in the month after his stroke, and that built up to half days in September. Since October he has been working full time with breaks for naps. “Patience is required for recovery from a stroke, because it does not happen quickly,” he says.

Spring 2014

About strokes Undersheriff Warren Darby suffered a hemorrhagic stroke, meaning a small capillary burst in his brain. The majority of strokes, however, are ischemic, meaning they are caused by clots that obstruct blood vessels in the brain. Symptoms alone don’t reveal which type of stroke a person is having; a computerized tomography scan can usually differentiate. At Upstate University Hospital, interventional neuroradiologists treat some patients with ischemic strokes using stent devices to retrieve clots from the brain. And, neurologists offer clinical trials to some patients with hemorrhagic strokes near the surface of the skull. The trials use a medication injected through a catheter at the site of the hemorrhage to break up the clotted blood and reduce swelling. These are among the unique services that are available at Upstate, the first designated stroke center in Central New York.

Today Darby takes blood pressure medicines at breakfast and after supper every night and charts his vitals with his wife, using the same detail he puts into the fish tally on his boat. He plans to retire later this year at the end of Sheriff Kevin Walsh’s last term — and, he says with a smile, to keep Oneida Lake from flooding by continuing to remove fish from the water. Looking back on this experience, he counts his blessings: “The system worked.”

Listen to an interview at upstate.edu/ healthlinkonair by searching “stroke.”

Gene Latorre, MD

Sara Bullock

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in our communit y

Book about hospital during Hurricane Katrina warns of failing to prepare by christopher dunham “Five Days at Memorial” by Sheri Fink is an amazing book, and I cannot recommend it enough. While Hurricane Katrina is still relatively fresh in our collective memories, I continue to be awestruck at the number of obstacles the staff at Memorial Medical Center had to overcome. The first part of “Five Days” details Katrina’s initial impact on the New Orleans hospital in 2005. Author Sheri Fink ­— a doctor who became a journalist and won the Pulitzer Prize for this work — details both the lackluster preparedness and the chaotic response in amazing detail of what went wrong and the assumptions regarding what should have happened. In this book we get to spend time not only with the clinical staff but administration, support staff and all the others who played a critical role. From an emergency preparedness standpoint, one of the many items that surprised me was the lack of hospitalbased incident command integration into the local and state response partners by Memorial and its parent corporation, Tenet Healthcare. They both seemed to fumble almost every opportunity to obtain critical resources and rescue assistance in the aftermath of the storm. The second half of the book deals with individual staff members, whose lives become more complicated as authorities look into whether physicians euthanized patients. We spend time with the patients’ families, which paints an interesting picture of what they endured during and after the storm. One of the more interesting parts of this book is a discussion regarding end-of-life procedures for medical

staff during a disaster. The book uses recent studies as well as personal stories from the 2012 Superstorm Sandy in New York City to detail examples when scarce critical resources become a determining factor on which patients should receive care and for how long. Emergency Management is, at its core, a process that enables rational, organized groups of leaders to develop realistic plans in order to overcome events that could cripple an organization. The monumental obstacles presented to Memorial during Katrina offer real insight into the fragile state of a complex healthcare organization’s ability to withstand a disaster of significant duration. “Five Days at Memorial” is a stark and well-written account of a significant event in American history as well as a graphic warning to all those who fail to prepare.

Christopher Dunham is director of emergency management for Upstate University Hospital. Sheri Fink spoke at Syracuse University this spring.

Surviving a flood evacuation closer to home More than 11 inches of rain fell Sept. 7 and 8, 2011, and the resulting floods in Broome County forced the evacuation of 30,000 residents. Up to 1,800 of those residents sought shelter at Binghamton University’s Events Center during a prolonged 11-day evacuation, says Christopher Ryan, MD, medical director for the Broome County Health Department and an associate professor of family medicine at Upstate. Ryan spoke of the challenges of managing an evacuation center full of people ranging from age 3 to 94. Staff filled 867 prescriptions, supplied 360 oxygen cylinders and transported

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56 people to the hospital. They dealt with a small outbreak of diarrhea, brought in hospital scrubs for people who did not have clean clothes and provided extra emotional support to those with autism, dementia and mental health issues. “This was hard work. But it’s probably one of the most rewarding things I’ve done,” Ryan says. If this happens again he says he will have more cots to accommodate people who are obese or mobility-impaired and portable toilets to supplement bathrooms. He suggests residents who have to evacuate bring more than a 3-day medication supply — in case the evacuation lasts longer.

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Q&A

With Nicholas Nacca, MD, and Michele Caliva, RN

Opioid misuse tied to heroin dangers

Q A

 e Upstate New York Poison Center fielded 14 calls about heroin Th overdose in 2009, compared to 84 in 2013, and there has been a dramatic increase in the number of heroin-related deaths, too. Why the increase in heroin use? ( Nacca) “A lot of it has to do with the epidemic proportion of people addicted to prescription painkillers right now. “Back in the ’80s and early ’90s there was a big push for physicians in general to treat all of their patients’ pain. There was even some drug company misinformation that some prescription painkillers are not addictive, but in fact they are. “Many people are on prescription painkillers such as Lortab, Vicodin and Oxycontin for chronic back pain when, in fact, those drugs really are not efficacious in the long term for chronic pain at all. What we’ve ended up doing is creating a lot of people who have opioid addiction. Then, as we start to recognize this, and we start to cut off some of the prescribing practices of these prescription pain medications, patients who have developed an addiction have to turn to an alternative like heroin, which is much cheaper and easier to get ahold of.”

Q A

What makes heroin so available?

(Caliva) “Back a year or two ago when the synthetic drug problem was rampant throughout our community, the folks who distribute heroin had to stay competitive, so they dropped the prices. So heroin now is fairly inexpensive on the streets.”

Q A

What you can do 1. Be aware that opioid abuse is a serious problem that can affect anybody. No one is exempt. 2. If you have prescription pain medications you are no longer taking, get rid of them, and lock up any that you are still taking. 3. Seek emergency medical care for anyone who uses heroin and appears to be sleeping. Opioids slow the respiratory and central nervous systems and can rapidly lead to death.

Are people drawn to heroin for the high? ( Nacca) “There’s definitely a euphoria associated with it, and they’re definitely looking for a high. If you talk to addicts, they’re always talking about their first high and trying to get back to that same feeling of euphoria they experienced. “A common story that I find when I interview my patients in the emergency department is – with a lot of the young people, especially – that their parents had a prescription pain medication in the cabinet from a surgery. They found that, they used it once or twice and liked the feeling. They maybe just ate the tablet, and then they realized if they crush it up and snort it they get an even stronger effect of the drug. As that runs dry, they find a source for the heroin. “They may start by snorting heroin, because that’s not a needle. That’s not as scary. But eventually they find if they inject it, it’s an even stronger high. “So it’s kind of this progression, going from the prescription pain medication that was left over from a surgery to a full-blown heroin addiction.”

Spring 2014

Michele Caliva, RN, is the administrative director of the Upstate New York Poison Center. Nicholas Nacca, MD, is a medical toxicology fellow.

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Childhood.

Brought to you in part by the only children’s hospital for 700,000 families from Pennsylvania to Canada. We offer a host of specialized services available only at Upstate and the only nationally verified pediatric trauma center in New York state.

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Upstate Medical University. 9,000 New York ers tak ing care of New York . U PSTATE HEALTHHospital cares for children from 19 counties. Upstate Golisano Children’s

ww w. u p st ate . e d u Tak ingCareofNewYork .com

in our communit y

When politics clash with science “We need to have an FDA that bases its decisions on science, not politics.”

Once a clinic for the poor, building now houses child abuse professionals by susan keeter

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n the days before Medicare and Medicaid, sick and injured Syracusans who had no money for doctors’ bills could be seen at the Syracuse Free Dispensary, at 610 East Fayette St. in Syracuse.

Howard Weinberger, MD, was a medical student and resident from 1954 to 1961 at Upstate, and he remembers working at the free dispensary. “Patients were lined up in the hallway, waiting to be seen. Medical students would sit between them, asking one after another about their medical issues,” he explained. “There was no privacy, no confidentiality. It was like something out of Dickens.” Then came 1964 and the construction of what is now called Upstate University Hospital at 750 East Adams St. Weinberger had just returned to Upstate, as a faculty member in pediatrics. The dispensary had moved to the newly built hospital. “It was like heaven,” Weinberger says in describing the outpatient clinic. “There were private rooms with doors. All the latest equipment was here.” The building that once housed the dispensary has had a transformation as well. For many years, it was home to Syracuse University’s University College and, for a few years, a charter school. In August 2011, the McMahon/Ryan Child Advocacy Center moved into the former dispensary building, increasing the size of the center tenfold and enabling it to offer services for abused children under one roof. The McMahon/Ryan Center has been completely renovated, and the first floor is a combination living room/playroom. The professional staff housed in the former dispensary includes law enforcement, child protective, mental health specialists, and the doctors and nurses of Upstate’s Child Abuse Referral and Evaluation Program.

That was the message students in a health care ethics course at Upstate heard from a guest speaker who resigned eight years ago from the Food and Drug Administration during the controversy over Plan B emergency birth control.

Susan Wood, PhD, was an assistant commissioner for women’s health at the FDA when the George W. Bush administration indefinitely delayed a decision about FOR OUR COMMUNITY whether to make emergency contraceptives available over the counter. Adding Wood resigned “when I felt ighty to means I could no longer defend if the p positio the actions taken by the information wh of Nursing Prac FDA leadership.” The She recently spo first Plan B application was impact technolo communication made in 2003. provider relatio the upstAte Research shows A judge’s ruling last year are mixed abou Ethicist in their own he made the medication broken eye con information int available.

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Plan B contains a higher concentration of Thinking pink — and gre synthetic progestin than is found in regular hen Community General Hospit part of Upstate in July 2011, Vol birth control pills. When taken soon after Services Director Kristin Bruce w wondering what to do with 300 unprotected intercourse, it works to prevent teer smocks, many embellished with the old hos The smocks in great condition, so it made the ovary from releasing an egg, thewere sperm try to recycle them. from fertilizing an egg and any fertilized Volunteers Dick and egg Barb Bratt suggested that s be donated to Robinson Presbyterian Ch from implanting. It has to besmocks taken quickly There, a missionary group was collecting clothin for people in need living in Uganda. to be effective — which is why so many Months later, an email arrived from Ngamije M of Kasese, Uganda with thanks for the smocks, w scientists and medical professionals lobbied put to use in the distribution of goods to men, w children. for it to be available on store and shelves without Closer to home, more than 70 of the smocks we to the Syracuse City School District, for student a prescription.

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Wood says “there was complete agreement Winter is more than a se all the way up the chain inside FDA that it eslie and Linda Berry were expecting thei should be approved fully over the counter in February 1982.for The blissful mom-to-b reading a book – she can’t recall which o any woman who needed it…. And thisnamed Winter. She liked with ayet, character Her baby would be born in winter, after all. product was being blocked from outside the Winter Berry was born on Valentine’s Day and r the wintery climate of New Hampshire. “I liked agency … for some ideological or political different name that no one else shared. Growing four or five Kaitlyns in my grade.” reasons.”

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She played violin and until 10th grade wanted to teacher because she loved kids. She was good at by age 16 decided to become a pediatrician inste

Today Wood is the executive director of the Jacobs Institute of Women’s Health at 14 U P SsTAT E H E A LT H George Washington University’ School of Public Health.

winter2014

In honor of the 1964 transfer – and transformation – of the dispensary, artist Dorothy Riester created a bronze plaque for the hospital. It hangs in the lobby.

Spring 2014

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VITAL services What happens after sexual assault Upstate University Hospital is a center of excellence in the provision of sexual assault services. The hospital has a contract with Vera House, Inc. to provide sexual assault nurse examiners for patients who have experienced sexual assault or abuse. These nurses have completed specialized education and clinical preparation in the medical forensic care of patients. This includes a detailed physical exam with evidence collection and the option of taking medications to prevent sexually transmitted infections.

DNP Doctor of Nursin g Pr ac t ice

Achieving a doctorate – in nursing  nline degree program designed O for advanced practice nurses With 28 years and counting as an Upstate University Hospital nurse, Ray Muldoon is a lifelong learner both on the job and in school. Muldoon is a student in Upstate’s Doctor of Nursing Practice program, a part-time, online doctoral program for master’s trained nurses. In another year or so, Muldoon will add the DNP to the other professional degrees after his name. “I’ve always liked school, and I thought it particularly advantageous for me to use the opportunities that exist here for educational support,” he says. “I came to Upstate because of the academic environment, and when you love learning as I do, this is where I wanted to be.”

Founded in 1977, Vera House provides services to victims of domestic and sexual violence in Onondaga County. Vera House has a 24 hour crisis and support line, assuring that a trained professional is always available. If you are the victim of sexual assault, contact the Vera House hotline at 315468-3260. They will provide you with information about your options and offer support in whatever you decide to do. You can also go to the hospital if you are injured or were assaulted within 96 hours and request a forensic exam.

For the past 13 years Muldoon has served as a psychiatric mental health nurse practitioner, primarily as a liaison to the Emergency Department and pediatric units. Prior to that, he spent 15 years as a staff nurse working with adult psychiatric patients on 4B. Muldoon is transitioning to a new position of Assistant Director of Nursing for Advanced Practice Services at University Hospital. It’s the kind of nursing leadership position the DNP degree prepares master’s trained nurses to tackle. “The thing I like about the DNP is that it’s meant to prepare future nursing leaders,” Muldoon says, adding that Upstate’s online program is convenient and thorough. “The content is all in support of developing the skills and knowledge base a health care leader needs.” Muldoon said the DNP is suited for nurses who see themselves working in a leadership role, either clinically, administratively or academically. “If you want to optimize what you want to do as a nurse and a nurse leader providing effective, safe, high-quality care,” Muldoon says, “this program is essential.” For details about the program, visit www.upstate.edu/ con/dnp/

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Why I love floor hockey Stacey Karasinski, an employee in payroll services at Upstate, recently competed in the state Special Olympics Winter Games with her floor hockey team. The 11-player roster includes a goalkeeper and two “lines” of five players that the coach swaps out throughout the game. Only six players play at a time. Here’s what Karasinski likes about floor hockey, a sport she has played for 10 years: 1. S  he likes being the only female on the team, even though sometimes the guys are a little rough. 2. S  he plays offense and prefers the face-off position. 3. S  he enjoys flicking the puck (made of heavy felt with a hole in the middle) into the air and knowing that it is destined for the goal. 4. S  he makes new friends through the games. 5. She loves to win.

Upstate Stroke Center is the region’s first designated stroke center with specialized neuroscience nurses and the only dedicated neuroscience intensive care unit in the region. Strokes are emergencies. Time saved is brain saved. If you suspect a stroke, call 911 and request Upstate.

Time is Brain. upstate.edu/stroke

9,000 New Yorkers taking care of New York.

Spring 2014

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IN OUR LEISURE

the challenge They met

Four runners from Upstate head to London

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eet the JP Morgan Chase Corporate Challenge mixed team that will travel to London this summer to run in the 3.5-mile championship race. Collectively, Kristin Kmack, John Kolh, Cara Lavier and Chris Loughlin had a finishing time of 1 hour, 30 minutes and 31 seconds in last summer’s race in the Syracuse area. They will compete on July 9 in London’s Battersea Park. Winners of JP Morgan Chase Corporate Challenge races this year – the one in Syracuse is June 17 – will qualify for the 2015 series final at a site and date to be announced.

Meet the team:

Runner

Kristin M. Kmack, 31, of Fayetteville.

Finishing time: 22 minutes, 55 seconds. Shoes: Asics Kayanos. Job: exercise physiologist. “I work primarily with older adults and individuals with chronic disease and/or disability in developing, implementing, and monitoring exercise prescriptions aimed at improving overall health, fitness and quality of life.” Runs: 50 to 60 miles per week. Pre-race fuel: a banana and some form of nutrition or energy bar. Started running: in middle school. “I remember running around the block and feeling tired, and the sense of accomplishment that came when I realized I could do it again after sitting on the curb for a few minutes. As my running progressed, I was able to get around the block more times without needing the rest break. I was on the track team in high school, and ran my first marathon when I was a freshman in college. To some extent running seemed to come naturally to me and was something that helped me to develop a sense of self-confidence.” Likes least: “The pressure associated with racing is sometimes a negative for me. I like running for the simplicity of it, not necessarily always for the comparisons or competition it can draw.”

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Chris Loughlin, Kristin Kmack, Cara Lavier and John Kolh took first place in last summer’s Corporate Challenge race as a mixed team representing Upstate Medical University.

Favorite place to run: the canal towpath that runs through the eastern suburbs. “Running sections along the canal provides variety in my running routes, free of vehicle traffic, which is a big plus for me. I logged a lot of miles along the canal towpath while training for my most recent marathon.”

Runner

John Kolh, 36, of Camillus.

Finishing time: 22 minutes, 28 seconds. Shoes: “I recently started running in a pair of Brooks Trancends, and they are super comfortable. I also have a few pairs of Nike Lunar Fly.” Job: operations manager with environmental services supervising the overnight shift. “We are responsible for cleaning and disinfecting all areas of the hospital, over 1 million square feet. It is not uncommon to have walked five or more miles or to have climbed 15+ flights of stairs throughout the course of a night at work.” Runs: Currently 30 to 45 miles a week but hoping to get that number up to 65 to 80 by the end of the summer. Pre-race fuel: “Generally I try not to eat too much in the hours before a race. The one booster I do utilize is gummy bears. Nothing gives that extra bit of energy before a run like some gummy bears.” Race strategy: “I like to arrive very early to races. This gives me plenty of time to warm up and stretch out. During this time I get into the competitive zone and focus on the

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IN OUR LEISURE

upcoming race by listening to my iPod. I don’t like to get caught up in all the humanity that is the starting line, so I try to get there early and line up toward the front.” Likes most: competing in events. “I’m normally a very modest person by nature, but when it comes to running I am VERY competitive. Setting a goal, whether it is to beat a time or to place at a certain level, and then beating it brings a tremendous sense of accomplishment.” Favorite place to run: “The Erie Canal trails between Camillus and Weedsport are excellent places to get away and run. They are very scenic, yet fairly quiet. The hills of Camillus are very challenging, plentiful and rewarding. There are some amazing views if you’re willing to make the trek up them. The countryside between Jordan, Memphis and Baldwinsville is a very nice place to run in the warmer weather, as is the area around Otisco Lake.”

Runner

Cara Lavier, 35, of Chittenango.

Finishing time: 22 minutes, 47 seconds. Shoes: Asics. Job: registered nurse in the Medical Intensive Care Unit. Runs: early mornings or on days off, the distance varying. Pre-race fuel: bagel or Clif bar. Started running: around the age of 9. “My dad would do occasional races, and I wanted to run with him.” Race strategy: “For a 5K, go out strong and try to maintain.” Likes most: “You can run anywhere. You just zone out and enjoy the scenery and freedom.” Likes least: “Buying new shoes every few months.” Other exercise: “Walk my dogs, ride bikes, go to the gym and play with my kids.” Favorite place to run: Green Lakes State Park.

Spring 2014

Runner

Chris Loughlin, 36, of Cicero.

Finishing time: 22 minutes, 21 seconds. Shoes: Mizuno Inspires. “They’re the lightest stability shoe I’ve come across, and they’re incredibly comfortable. I set PRs (personal records) in almost every single distance I ran last year in my Mizunos.” Job: member of the electronic medical records technical team, helping to design, procure, install, configure and administer all the infrastructure on top of which Upstate University Hospital’s EMR system runs. Runs: “I’ve taken up the sport of triathlon this year, so I’ve reduced my running slightly to accommodate bike training and swimming, but I rarely ever drop below 40 miles a week. In 2013, I ran a total of 2,507 miles, or an average of 48 a week.” Pre-race fuel: A PB&J bagel, homemade beet juice when in season or peanut butter crackers. Started running: in the beginning of 2007. “Back then, I was 60 to 70 pounds heavier, and my first born child was getting close to 1 year old and was getting mobile. I was having a hard time keeping up with her without running out of breath. That, combined with seeing some pictures of myself as a lighter man, inspired me to lose some weight, and running was something I’d always wanted to get into, due to the popularity of The Boilermaker 15K race in Utica. I got instantly addicted. I fell in love with the numbers that go along with it; running X distance in X time and trying to outdo myself. And then, once I started racing, the competition is like a drug for me.” Likes most: “The way it makes me feel. Each day, no matter what happened that day, as long as I got a run in I’ve felt I’ve accomplished something.” Favorite place to run: “I love the course that The Mountain Goat Run traverses. It’s such a diversity of neighborhoods and offers some great sights.”

Listen to an interview at upstate.edu/healthlinkonair by searching “corporate.”

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IN OUR LEISURE

What it takes to write a children’s book

• The illustrator, Michael Conway, was the elementary school art teacher for Yates’ children. She had not seen him in a few years and then, at a time when she was frustrated by her search for an illustrator, she ran into him four times in one week.

Janine Werchinski-Yates of Baldwinsville appreciates exercising the creative side of her brain. “I’ve always liked writing,” she says. “I think it’s a nice release to get your ideas out there and use your imagination.”

At the Baldwinsville Public Library, she asked him, “Why do we keep seeing each other?”

The Upstate University Hospital laboratory technologist recently published a children’s book called “The Secret Sock Club.” Here’s what it took: • The idea emerged from time spent in laundromats. “I saw this little sock peeking out from under a clothes dryer, and I said ‘oh, so that’s where they go,’ ” Yates says. Then her imagination conjured the Secret Sock Club. • The time investment was about six years, start to finish. “It’s a learning curve to try to figure out how to put this together to make it happen.”

“I don’t know,” he responded. “Do you have an art project or something?” “Actually, I do,” she said. It turned out, Conway had always wanted to illustrate a book. Yates was looking for an illustration with an old fashioned, comic feel, and Conway’s sketches were right on. “He’s really, really good at getting the emotions out of these socks,” she says. • The cost of self publishing goes beyond the price of printing. There is also the cost of copyediting and layout, cover design and page illustrations, marketing and distribution, along with the fees to obtain the copyright, barcode and Internationl Standard Book Number. Depending on the number of copies and quality of materials, you may spend as little as $500 or more than $20,000. • The assistance Yates needed, she got mostly from family members. Her oldest daughter, Francesca, fine-tuned Yates’ language and helped edit the copy. Her youngest daughter, Ellie, made suggestions about the story. Her son, Harrison, set up her website at www.thesecretsockclub.com. Her sister, Rose, put her in touch with someone who designed the book. “I’ve had a lot of help, really, and a lot of good luck – which is sort of the theme of the book.”

“The Secret Sock Club” sells for $15.99. Author Janine WerchinskiYates says the book has been shipped to 16 states, plus five countries – Canada, Mongolia, Ghana, Sweden and Germany.

Calorie Burn The 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 155 pounds would burn if he or she did the activity for an hour:

bowling

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milking a cow

222

walking a dog

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Apple Farro Salad with Chicken If you like pasta or rice, try farro. It’s a nutty-flavored grain high in fiber and protein and low in fat and calories. This simple dish is easy to prepare and makes for a colorful, filling meal. ingredients 8 ounces farro, dry 6 ounces boneless skinless chicken breast 1 teaspoon olive oil 1/8 teaspon kosher salt pinch ground black pepper 1 cup unpeeled cucumber, diced 1 cup unpeeled Granny Smith apple, diced 1 cup unpeeled Gala apples, diced 1/2 cup parsley, chopped 1/2 cup basil, chopped 1/4 teaspoon kosher salt 1/8 teaspoon ground black pepper 2 tablespoons extra virgin olive oil 1 tablespoon balsamic vinegar preparation Cook farro in boiling water until tender, about 20 minutes. Drain and cool. Place in bowl. Mix oil with 1/8 teaspoon of salt and a pinch of pepper and rub on raw chicken. Grill until cooked through. Chill and dice. Combine remaining ingredients in the bowl and mix thoroughly. This makes four 1 ½ cup servings.

nutritional information For 1 ½ cup serving: 342 calories 18 grams protein 47 grams carbohydrates 9 grams fat

26 milligrams cholesterol 285 milligrams sodium 5 grams fiber 1 gram saturated fat

Recipe supplied by Morrison Healthcare, food service provider for Upstate Medical University.

Healthy eats

Carbohydrates are not the enemy Carbohydrates such as bread, rice, potatoes and pasta provide great energy, but Kaushal Nanavati, MD, from Upstate’s department of family medicine advises eating them early in the day. “The point is, you don’t fuel your car up when you pull back in the garage. You fill it up before you go out on a long trip,” he says. “Carbohydrates early in the day are great fuel to use up the rest of the day, but you don’t want to eat them and then sit. So, the idea is, you can have some of these things early in

Spring 2014

the day, but continue with your protein and your vegetables throughout the rest of the day.” He tells his patients to eat seven to nine servings of vegetables per day, preferably including some cruciferous vegetables such as kale, cabbage, broccoli or cauliflower. He favors beans, lentils and legumes for protein. For people who eat meat, Nanavati suggests fish, turkey or chicken.

Listen to an interview at upstate.edu/healthlinkonair by searching “integrative nutrition.”

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A glimpse of research history

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The resulting book — Cell & Developmental Biology: 1968-2013 — is being published this spring. On its cover is this stylized image of zebrafish embryos from the lab of Jeffrey Amack, PhD. According to Amack, “The zebrafish embryo provides a useful model to investigate development and disease of several organ systems.”

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The title page of that binder, now reproduced digitally and housed in the archives at Upstate’s Health Sciences Library, read “by J. Howard Ferguson, MD, 1968.” It contains the history of anatomical study from 1834 to 1967. Spring-Mills and colleagues decided to tackle research and coursework conducted by their department after 1967.

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More than 175 years ago, the medical school faculty was conducting research to understand disease and search for cures. Two years ago, Elinor Spring-Mills, PhD, was part of a group charged with studying and compiling Upstate’s long history of research in an accessible, easy-to-read fashion. Spring-Mills’ work began when she uncovered “an unmarked, shabby binder with a black cover” on a shelf in Weiskotten Hall. “Pieces broke off as I opened the cover and turned the pages,” she reports.

More than 30 clinical and basic science departments conduct research at Upstate Medical University. J. Howard Ferguson, MD ’26, chair of pathology, 1942-1968 Elinor Spring-Mills, PhD, SUNY Distinguished Teaching Professor (retired) Jeffrey Amack, PhD, associate professor of cell and developmental biology

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