Upstate Health magazine, winter 2021 by Upstate Medical University

Health UPSTATE

connecting you to health and medical expertise

Trauma Team: Always on duty How a COVID-19 spit test was born Why I got vaccinated A fix for A-fib

Surviving the Coronavirus

From the experts at

Winter 2021

ICYMI IN CASE YOU MISSED IT

What’s up at Upstate Upstate Medical University now has a mascot, selected through an employee voting process. The big blue wolf beat out a fox, turtle, owl and bear. Until the vote, Upstate had been one of only two SUNY campuses without a mascot. The wolf, named Hero, is introduced at a time when mask wearing was important for public health, so the mascot became the campus “mask-ot.” l

Upstate opened a new Adolescent Intensive Outpatient Program for those ages 13 to 18 with psychiatric disorders and behavioral difficulties. It provides up to six weeks of services, which may include medication management and individual, family, group or multi-family group therapy — all based on the dialectical behavior therapy model, which teaches coping skills and identification of triggers. l

Upstate University Hospital has a new way to help patients with neurologic disorders such as Parkinson’s disease, essential tremor and epilepsy. A new deep brain stimulation device, Percept PC Neurostimulator, received approval from the Food and Drug Administration in July. G. Duemani Reddy, MD, directs adult functional neurosurgery at Upstate and is an expert in DBS therapy. Neurosurgeons at Upstate have also begun using new robot technology for minimally invasive brain surgery, to offer a higher level of accuracy and shortened procedure time. The ROSA brain robot is a surgical navigation and positioning system used in pediatric laser ablation and for treating epilepsy in adults. ROSA stands for robotic surgical assistant. l

The pandemic heightened the critical need for medical technologists. Upstate’s College of Health Professions offers a two-year Bachelor of Science degree in medical technology for those with the prerequisite college credits. It’s a field that’s expected to grow more than 15% through 2026, according to the Center for Health Workforce Studies. Learn more at upstate.edu/chp l

At a time when financial pressures are great, Upstate employees contributed a record $592,963 in the 2020 Community Giving Campaign. The money pledged comes from 1,260 employees and goes to many charities. In the previous year, $569,789 was pledged. l

U P STAT E H E A LT H l winter 2021 l upstate.edu

Hundreds of SUNY students have access to mental health services thanks to a network launched by an Upstate psychiatrist. Christopher Lucas, MD, began the SUNY Student TeleCounseling Network in 2018. Since then, it has expanded to 16 campuses, and Downstate providers are joining the effort. l

Elizabeth Blackwell, MD, the first woman in America to receive a medical degree, graduated in 1849 from Geneva Medical College, the predecessor to Upstate. Her 200th birthday was Feb. 3, 2021, and sculptor Sharon BuMann is developing a model for a sculpture of Blackwell at Upstate. The Medical Alumni and the Upstate foundations are raising money for the sculpture and scholarships in her name. l

A food pantry that serves students at Upstate is being named Paley’s Pantry, in memory of Alex Paley, a medical student who died of brain cancer five months after graduating from Upstate. Initiatives began in fall 2018 to address the increasing number of college students who face food insecurity. For the last two years, Upstate students have been able to get food from the Food Center @324, a side entrance to University United Methodist Church, 1085 E. Genesee St. l

The American College of Surgeons National Surgical Quality Improvement Program named Upstate Community Hospital one of 89 facilities nationwide with meritorious outcomes for surgical care in 2019. l

Upstate University Hospital earned “most wired” recognition from the College of Healthcare Information Management Executives. The group conducts an annual survey to assess how effectively health care organizations apply technologies to improve health and care in their communities. l

Upstate officials are testing drone flight as a new way of delivering lab specimens between the downtown Upstate University Hospital, Upstate Community Hospital on Onondaga Hill and other locations. Multiple test flights took place in January. l

The Human Rights Campaign Foundation named Upstate an “LGBTQ Health Care Equality Top Performer.” Upstate’s Inclusive Health Services provides primary care services to those who identify as lesbian, gay, bisexual, transgender and queer or questioning. For more news, visit upstate.edu/news

Health C o n t e n t S UPSTATE

winter 2021

Patient Care

Nurse practitioner Aisha Lubega strikes a “We can do it!” pose after getting her COVID-19 vaccine.

The trauma team is always on duty

page 4

He survived, thanks to everyone working on floor 6K

page 7

How a COVID-19 spit test was born

page 8

FAST response saves a man from stroke

page 11

A fix for a-fib

page 12

From our exPertS

PHOTO BY KATHLEEN PAICE FROIO

What life expectancy illustrates

page 16

Researching HIV replication

page 18

in our Community Tragedy leads parents to be medication safety advocates

page 19

10 reasons for getting vaccinated page 20 These nurses stepped up

page 22

in our leiSure Horsing around

page 23

dePartmentS What’s Up at Upstate

page 2

Lessons from Upstate On cancer, skin infections, heart disease

page 14

Science Is Art Is Science: Exploring corneal scarring

back cover

on tHe Cover Greg Jenkins of Rome battled for his life with a collapsed lung after testing positive for the coronavirus. Greg and his wife, Joanna, implore people to take the virus seriously. PHOTO BY N. SCOTT TRIMBLE THE POST-STANDARD/SYRACUSE.COM SEE STORY, PAGE 7

Upstate Health magazine is a community outreach service of Upstate Medical University in Syracuse, New York. Upstate is an academic medical center with four colleges (Medicine, Nursing, Health Professions and Graduate Studies); a robust research enterprise and an extensive clinical health care system that includes Upstate University Hospital, Upstate Community Hospital, the Upstate Cancer Center and the Upstate Golisano Children’s Hospital. Part of the State University of New York, Upstate is Onondaga County’s largest employer.

uPState HealtH

Visit us online at www.upstate.edu

ExECUTIVE EDITOR

Leah Caldwell Assistant Vice President, Marketing & University Communications

For corrections, suggestions and submissions, contact Amber Smith at 315-802-9152 or smithamb@upstate.edu

Amber Smith 315-802-9152 or smithamb@upstate.edu

additional CoPieS: 315-464-4836

EDITOR-In-CHIEF

WRITERS

DESIGnER

Darryl Geddes Jim Howe Susan Keeter Amber Smith Susan Keeter

Upstate Health offices are located at 250 Harrison St., Syracuse, NY 13202

need a referral? Contact Upstate Connect at 315-464-8668 or 800-464-8668, day or night, for appointments or referrals to the health care providers on these pages or anywhere at Upstate or for questions on any health topic. upstate.edu l winter 2021 l U P STAT E H E A LT H

Pati ent Care

Upstate trauma surgeons on the helipad atop Upstate University Hospital. Pictured, from left: Rahul Dudhani, MD; Crystal Whitney, MD; Amie Lucia, DO; William Marx, DO; Jessica Summers, MD; Robert Cooney, MD; Moustafa Hassan, MD; Roseanna Guzman-Curtis, MD; Joan Dolinak, MD; Michael Luca, DO. Note: The group portrait was taken before the current pandemic masking protocols. PHOTO BY SUSAN KAHN

Complex and critically ill The team that cares for the sickest of the sick is recognized for doing it well BY AMBER SMITH

t’s 8 a.m. on a Friday. Members of Upstate

University Hospital’s trauma team, dressed in cranberry scrubs, gather in a conference room.

Some have been here all night. Some are coming in fresh. They discuss the progress of each of the current patients whose injuries have left them hospitalized. Later, the team visits each patient: a snowmobiler who crashed, a pedestrian run over by a car, a man who slipped from his roof, and more. “When we’re on duty, we’re on call for the entire Central New York region. Twenty four hours a day, seven days a week, 365 days a year, with a response time of under 15 minutes — now that’s dedication! Anybody with a major injury, complex surgical problem or who is critically ill, comes here,” explains Robert Cooney, MD, Upstate’s chief of surgery and a member of the trauma team. Being a Level One trauma center means that an operating room is always on standby, along with every medical and surgical specialist a trauma patient might need. Upstate’s adult trauma service, for anyone 15 and older, evaluates more than 6,000 trauma patients each year. Between 2,600 and 2,700 are admitted. Another 800 children under age 15 are admitted by the pediatric trauma team. 4

U P STAT E H E A LT H l winter 2021 l upstate.edu

“If you look at our emergency surgery outcomes, we are one of the top hospitals in the country,” Cooney proudly notes. “We have an outstanding team of trauma and emergency surgery specialists.”

nationally ranked The American College of Surgeons National Surgical Quality Improvement Program recognized Upstate for meritorious outcomes for high-risk surgical patients in 2018. Cooney is proud of this recognition because it comes from “the most highly regarded quality assessment program for surgical outcomes in the country,” partly because the data collected goes beyond a patient’s hospital stay. Composite scores are based on a weighted formula that combines eight outcomes. They include mortality,

Pati ent Care

unplanned intubation (insertion of a tube into the windpipe to aid breathing), ventilator use for more than 48 hours, kidney failure, cardiac incidents (such as heart attack or cardiac arrest), development of pneumonia, surgical site infections and urinary tract infections. Trauma was the third leading cause of death in the United States in 2019, behind heart disease and cancer. Trauma care is a high-adrenaline specialty, with interventions that can save lives. Doctors who specialize in trauma must be expert surgeons, even though treatment is constantly evolving and sometimes doesn’t involve operating. All nine of the trauma surgeons at Upstate are also boardcertified in critical care medicine. “Because this is Syracuse, we have a zone defense,” Cooney quips, in reference to the style of basketball defense for which Syracuse University is known. He means that his team is qualified to care for the wide variety of patients in the surgical intensive care unit, many of whom are not victims of trauma.

Patients transferred from smaller hospitals Among the patients the team is caring for today, for example, are two elderly women who needed complex abdominal surgeries, and a critically ill young woman with severe heart failure in need of a high-risk surgery. All were transferred to Upstate from smaller, outlying hospitals. Such transfers account for about one-third of the trauma service’s patients. “We take care of the sickest patients in the region who need surgery, and I think this quality designation shows that we do a great job of doing that,” Cooney says. The trauma team depends upon a big infrastructure: caregivers from neurosurgery, orthopedics, vascular surgery, radiology, the emergency department and others, depending on the needs of each patient. And because they practice at an academic medical center, the surgeons

and resident doctors are constantly teaching and learning, helping to advance the specialty of trauma care – and ultimately save more lives. Each day, the team visits the hospitalized trauma patients together.

auto and snowmobile accidents; falls from roofs On this day, they see a pedestrian who broke multiple bones when he was hit by a car. Both of the man’s legs are wrapped in splints. His spine was repaired. His pelvis was stabilized. He’s been here for two weeks so far and had many ups and downs. The plan is to finally get him out of bed today. He will also be evaluated for his ability to swallow on his own – and maybe have the tube removed from his throat.

“if you look at our emergency surgery outcomes, we are one of the top hospitals in the country.” –ROBERT COONEY, MD, PROFESSOR AND CHAIR OF SURGERY

Another patient is a man who slipped on ice and fell from his roof while trying to install an antenna. “It’s my hip that hurts,” the man tells Cooney. “I swore it was broken.” But it was only bruised. Cooney asks the man how physical therapy is proceeding. “The guy’s a monster,” the man says, lovingly, of his therapist. Soon he’ll be able to continue healing at home. Then there’s the snowmobiler who is recovering from a crash that left him with broken ribs, a lacerated liver, a collapsed lung and an injured spleen. Cooney uses a stethoscope to listen to the man’s bowel sounds, and he gently taps his abdomen, which sounds

Robert Cooney, MD, is Upstate’s chief of surgery and a member of the trauma team. PHOTO BY SUSAN KAHN

like a drum. He suspects the intestines are distended with air. To be sure that this is nothing serious, Cooney orders an X-ray.

revolutionary techniques The man’s belly was full of blood when he arrived at the hospital. Surgeons would have drained it — if they had operated to remove his spleen. Instead, an interventional radiologist “embolized” the organ using a catheter (hollow tube), coils and clotting materials. It’s a procedure that has revolutionized how doctors treat patients with splenic trauma, Cooney says, and one example of how treatments evolve over time. He says not to worry about the excess blood in the belly; it will be reabsorbed by the body as the man heals. It’s a raw, late winter day, and the continued on page 6 upstate.edu l winter 2021 l U P STAT E H E A LT H

Pati ent Care

Complex and critically ill conference room table contains a tub of pretzels and a box of half-eaten Thin Mint cookies, sustenance for surgeons who on busy days will not have a chance to sit and eat a proper meal. They cannot predict when traumatic injuries will occur, but when weather is cold or rainy, there is usually a dip. On this day, Cooney and two resident doctors, a physician assistant, a nurse and some medical students gather to discuss medical issues that relate to some of the patients who are currently hospitalized. For instance: management of the open abdomen. It used to be, trauma surgeons would fix everything that was wrong with a trauma patient in one lengthy and taxing surgery, even if the patient was unstable and not doing well. Now, survivability is higher for many patients if the surgeons focus on stopping the bleeding, getting rid of any contamination and letting the patients stabilize before bringing them back to the operating room for more definitive surgical repairs. Sometimes it makes sense to leave their wounds open during this process, usually 24 to 36 hours.

continued from page 5

Up to 25 percent of trauma patients who undergo abdominal surgery should have their incisions left open while they are healing in the intensive care unit, says resident physician Matthew Sporn, MD. This allows for better control of their blood pressure, changing of packing, access to vascular shunts to help remove excess fluids, and a better ability for doctors to assess the bowel’s viability.

“We take care of the sickest patients in the region who need surgery.” –ROBERT COONEY, MD, PROFESSOR AND CHAIR OF SURGERY

The group also talks about methods to control bleeding. “Damage control resuscitation” is the use of blood and plasma (the liquid part of the blood) to treat patients who are in danger of bleeding to death before they get to the hospital. Should paramedics carry

plasma to trauma patients, as is done on battlefields? Cooney acknowledges that “more rapid use of blood and blood products has been shown to reduce bleedingrelated complications and mortality.” As knowledge evolves and new research is published, new protocols will need to be put into place, he explains. He goes on to describe a modern way to stop life-threatening bleeding, once the patient arrives at the hospital. REBOA stands for resuscitative endovascular balloon occlusion of the aorta. A vascular surgeon developed the procedure that involves inserting a catheter through an artery in the leg, threading it to the appropriate spot and inflating a balloon to stanch arterial bleeding. Cooney says patients are alive today because of REBOA. He says the new procedure is much faster than the way surgeons used to stanch bleeding — by cutting into a patient’s chest to clamp the great vessel that comes from the heart — and another example of how the field of trauma care continues to grow. u

Sundays 6 a.m. & 9 p.m. 89.9 & 90.3 FM/WRVO.ORG

Exploring health and medical issues of interest to Central New Yorkers

Listen anytime on www.healthlinkonair.org or find us through a podcast search for “HealthLink on Air” 6

U P STAT E H E A LT H l winter 2021 l upstate.edu

Pati ent Care

This bell is rung to share the good news that a COVID-19 patient has tested negative for the virus. 6K is a wing at Upstate University Hospital that has been dedicated to patients who have the coronavirus. In the background is a nurse donning personal protective equipment before going into a patient’s room. PHOTO BY ROBERT MESCAVAGE

Triumphs in darkness COVID-19 survivor shares his story and gratitude about the staﬀ of 6K at Upstate BY AMBER SMITH

he story was about the people working on 6K at

Upstate University Hospital, a unit dedicated to patients with COVID-19, and how they helped

save the life of a man from Rome.

It appeared on the front page of The Post-Standard on Thanksgiving, when the newspaper anticipates an increase in readership because of all the extra advertising for Black Friday, the start of the holiday shopping season. The story also was posted on Syracuse.com and shared on Facebook and Twitter – thousands of times. All of Central New York, it seemed, learned of Greg Jenkins, 58, of Rome, who loved the outdoors, hunting, fishing and hiking, and who was healthy – until he became infected with SARS-CoV-2, the virus that causes COVID-19. This year, he had much for which to be thankful, he said as he sat across the table from his wife, Joanna. The Jenkinses told the newspaper reporter, Marnie Eisenstadt, they were fairly

sure they got infected at a large event they attended in October. They were pretty much the only ones wearing masks. Greg started feeling ill three days later. He managed his illness at home and wasn’t admitted to Upstate until Oct. 23, after suffering with a fever for 11 days that left him with hallucinations. As breathing became more difficult, and he lost the strength to stand, he had Joanna drive him to Syracuse. Greg had lost 30 pounds, could not smell or taste anything and had a bad cough when he settled into a room on 6K. Joanna tested positive but never had symptoms. No one has been able to continued on page 9 upstate.edu l winter 2021 l U P STAT E H E A LT H

Pati ent Care

Cost-eﬀective, easy and reliable How scientists created a top COVID-19 test that uses saliva BY AMBER SMITH

n his career as a scientist,

Frank Middleton, PhD, has developed saliva tests to

diagnose autism, concussions and Parkinson’s disease. The RNA found in saliva carries the genetic information for those conditions, but also for many viruses. After the first coronavirus test kits from the U.S. Centers for Disease Control and Prevention were flawed, Middleton got to thinking: “We should build a better test. There’s no reason we couldn’t do this with saliva.” He worked with Upstate faculty colleagues and people from Upstate’s Start Up New York business partner, Quadrant Biosciences, to create a way to test human saliva for the presence of the virus that causes COVID-19. The test, called Clarifi COVID-19, received authorization in September. Three months later, the U.S. Food and Drug Administration cited the Clarifi test as the No. 1 ranked saliva test in the United States and the sixth most sensitive worldwide in detecting the virus. New York Gov. Andrew Cuomo credits the test with helping SUNY campuses pinpoint COVID-19 cases at early stages.

“This crucial development and expertise has played a critical role in ensuring SUNY students were tested efficiently and, if positive, isolated and on a path to recovery sooner,” Cuomo said. continued on page 9 U P STAT E H E A LT H l winter 2021 l upstate.edu

Frank MIddleton, PhD PHOTO BY DARRYL GEDDES

Pati ent Care

Triumphs in Darkness

continued from page 7

explain why the virus barely fazes some, while it means a hospital stay for others. Greg was hospitalized for two weeks. He was grateful to the whole staff, including those who were quoted in the newspaper story: assistant nurse manager Crystal Marshall, Jennifer Tyson from environmental services, Zac Shepherd, MD, and respiratory therapist Danielle Pelc. “The fight is hard on 6K. So when there are good moments, they celebrate,” Eisenstadt wrote. She described a bell on the counter of the nurse’s station, which previously was used for patients waiting in the hall for a room. “One day, early in the pandemic, someone took the bell out and rang it when a negative COVID-19 test came through. And then they began ringing it when coronavirus patients got better and left. Greg Jenkins of Rome battled for his life with a collapsed lung after testing positive for the coronavirus. Greg and his wife, Joanna, implore people to take the virus seriously.

“It is a bright little ding that hangs over the staccato machine beeps and whoosh of the sliding doors. “It has rung hundreds of times by now. But if you are around when it happens, you clap, you cheer. It is triumph in darkness.” Greg Jenkins got to ring the bell on Nov. 6. u

PROVIDED PHOTO

Cost-eﬀective, easy and reliable

continued from page 8

The Clarifi test is different than other saliva-based tests that have FDA authorization because it stabilizes the RNA in the samples, allowing them to be transported to Upstate for testing. Also, the test deactivates the coronavirus, which allows lab workers to safely handle the samples.

The additional breakthrough of “pooled testing” has allowed Upstate to accelerate the process and expand testing capacity. Individuals use a swab to collect their own saliva. Lab technicians at Upstate combine from 10 to 25 samples into one pool for the COVID-19 test.

Samples are collected using a swab, rather than requiring patients to spit. That leads to fewer false positive results. A Clarifi test kit, showing the swab and its tube.

A negative result means everyone in the pool is presumed to be free of coronavirus.

Best at early detection Middleton, who has a doctorate in neuroscience and also works in biochemistry and molecular biology, explains that the FDA reviews COVID-19 tests based on the effectiveness of finding the smallest traces of SARS-CoV-2, the virus that causes COVID-19. In the saliva testing category, Clarifi has the lowest limit of detection at 600 copies of the virus per milliliter. That means it’s the best at detecting infections at the earliest stages, when people may be infectious, but asymptomatic. “Upstate Medical's and Quadrant Biosciences' saliva test is significant for SUNY—not only fast and easy to use with results back within 48 hours, but also the test itself finds the virus within the earliest stages of the illness, so we can know who is positive more quickly and ensure they isolate from others,” SUNY Chancellor Jim Malatras said in praising the development.

A positive result means each individual sample in the pool needs to be tested again, individually, to pinpoint positive cases. This rapid retesting does not require people to submit new samples.

Upstate President Mantosh Dewan, MD, explained that pooled testing saves money. A single coronavirus test for an insured patient costs about $100. Pooled saliva testing drops that to about $25 per patient. SUNY paid for five machines to process the tests in Middleton’s lab. Upstate invested money in equipment, chemicals and other materials to launch the testing program, and both Upstate and Quadrant Biosciences are paying the salaries of lab workers. Dewan praises the collaboration as “a ringing endorsement of the excellence that can come from partnerships with industry and public academia.” u

upstate.edu l winter 2021 l U P STAT E H E A LT H

Foundation

Impacting patient care, education, research and community health and well-being through charitable giving.

Watertown fire captain grateful for care after battling horrific blaze For its annual observance and celebration of Doctor’s Day, the Upstate Foundation received nearly 1,000 notes from patients expressing gratitude to a wide array of care Upstate University Hospital. Among the most providers at inspiring stories was that of Watertown fire Capt. T.G. Kolb. Kolb’s long and still ongoing tale of perseverance began with a fire in a vacant building in Watertown, New York, in February 2018. The blaze defied entry by firefighters, leaving them with the ostensibly safer option of battling the flames from outside the structure. Suddenly, and unpredictably, a two-story brick wall collapsed, injuring two firefighters. One escaped with minor injuries; however, Kolb suﬀered major harm to the lower portion of his body. “I kept shouting to my crew, ‘Put me down, I’m OK!’ as they pulled me away from the wreckage,” said Kolb. Such is the numbing eﬀect of shock. Swiftly taken to the nearest local emergency department, it became clear trauma care would be needed. With an airlift ruled out due to inclement flight conditions, Kolb was placed aboard an ambulance and taken to Upstate. It was during this time Kolb discovered the human support structure around him was extensive and strong, even if the building that harmed him hadn’t been.

First was his older brother, also a Watertown fire captain and paramedic, who happened to be on duty that same evening and took the harrowing ride with Kolb from the North Country to Syracuse. Concurrent with that ride, Kolb’s wife made her way to Upstate, even as New York state police were dispatched to SUNY colleges at Cortland and Binghamton to notify and retrieve his daughters from school. Alerted that one of their own had been seriously injured, next came the moral support of Syracuse firefighters, who lined up in uniform as Kolb was lifted from the ambulance upon reaching Upstate’s Trauma Center. “On the ride down, I faded in and out of consciousness,” Kolb said. “But I’ll tell you, I never felt such love and support as I did at that moment those doors opened.” And then there was the expert care Kolb received from the multidisciplinary team at Upstate. Faced with immediate threats posed by numerous crushed and broken bones, serious nerve damage and injuries to multiple organs, Upstate’s trauma team tackled the immediate risks to Kolb’s life. Next, weeks of traction and multiple surgeries, led by orthopedic surgeon Brian Kistler, MD, set Kolb on the long road to recovery. And countless sessions in Upstate’s physical medicine and rehabilitation department enabled him to leave the hospital after only six weeks, so Kolb’s at-home rehabilitation could begin. 10

U P STAT E H E A LT H l winter 2021 l upstate.edu

Watertown fire Capt. T.G. Kolb’s recovery

was a long and arduous one, but it was made easier by a wide and diverse support network including family, the Upstate team, fellow firefighters and even strangers. Here’s Kolb during his time in Upstate’s physical medicine and rehabilitation department displaying a “Thank You Hero” sign autographed by students from Sherman Elementary School in Watertown. “My wife spent the first two weeks by my side in the hospital, then drove from Watertown to Syracuse for four weeks,” said Kolb. “She, my friends and my family were all so impressed by the care I received. I call Upstate my ‘miracle team,’ because I’m grateful to be alive and walking thanks to them.” Today, three years later, Kolb’s journey and health issues continue. “I have good days and bad days,” he said. Fortunately, he, like his support system, remains strong.

Are you grateful? A gift of gratitude is a meaningful way to express appreciation to special caregivers and help patients during their time of great need. To donate, contact the Upstate Foundation at 315-464-4416 or go to www.UpstateFoundation.org/donate.

Pati ent Care

FasTaction

and a 911 call save greenhouse owner suﬀering stroke in North Country BY SUSAN KEETER

delivery of hosta plants

and the fast action of friends

likely saved Chuck Olley’s life.

On June 11 in Natural Bridge, about 25 miles northeast of Watertown, Olley, 63, was home alone doing paperwork when Carol Carr delivered pots of hostas to sell at his greenhouse, which is adjacent to his house. Jamie Favry, a helper, was in the greenhouse watering plants. She greeted Carr and called for Olley. The three were walking through the greenhouse, admiring plants, when Olley said he needed to lie down. That worried his friends. Then, he fumbled and slurred his words as he tried to pay Carr for the hostas. Carr and Favry recognized Olley’s garbled speech as one of the warning signs of stroke. Deflecting his friends’ concern, Olley struggled to say, “It’s not like I’m dying,” when the left side of his face drooped.

Natural Bridge Volunteer Ambulance, Carthage Area Rescue Squad and Mercy Flight Central helped David “Chuck” Olley (above) get to the Upstate Stroke Center. PHOTOS BY SUSAN KAHN

Favry and Carr knew to call 911, despite his protests. The 911 dispatcher did a stroke assessment over the phone with Favry: “Ask him to smile.” Olley couldn’t. “Ask him to lift his left arm.” Olley couldn’t. A day earlier, Olley had gotten results from a brain scan that showed he had carotid artery stenosis. This meant that one of the main arteries in his neck was clogged by plaque, which restricted blood flow and oxygen to his brain. It is a condition that often has no symptoms and can cause strokes. Several minutes after the 911 call, Molly Manuel, a first responder from Natural Bridge Volunteer Ambulance, arrived at the greenhouse to evaluate Olley for stroke. Carthage Area Rescue Squad emergency medical technicians Lesley Jackson and Jesse Rogers arrived in an ambulance approximately 15 minutes after the 911 call. Speed was crucial, says Jackson. Damage to Olley’s brain could be minimized if he could get to a stroke center quickly. Jackson and Rogers raced Olley to the Carthage Fire Department, where they met a Mercy Flight Central helicopter. In six minutes, Olley was reevaluated, moved from ambulance to helicopter and en route to the Upstate Comprehensive Stroke Center in Syracuse. Thirty-nine minutes later, pilot Joe Carr landed the

Carol Carr, left, and Jamie Favry, right

Mercy Flight helicopter on the roof of Upstate University Hospital. The Upstate team was waiting on the helipad. Mercy Flight Central paramedic Brian Crolius and nurse Connor Miller moved Olley out of the helicopter while it was still running, saving five minutes. He was taken continued on page 13 upstate.edu l winter 2021 l upstate health

Pati ent Care

a fix for a-fib surgeon oﬀers a new technique for stubborn cases of atrial fibrillation BY AMBER SMITH

What is a-fib? Atrial fibrillation, called A-fib for short, is an irregular, often rapid, heart rate that can cause poor blood flow. The majority of the up to 6 million Americans with A-fib discovered the condition through a routine medical exam that included an electrocardiogram. A growing number of people are discovering unusual heart rhythms through commercial monitoring devices they connect to mobile phones. Only a few patients are able to feel palpitations. Other common symptoms — shortness of breath and fatigue — can be vague.

How serious is it? Untreated, A-fib doubles a person’s risk of heart-related death and is associated with a fivefold increased risk for stroke, according to the American Heart Association. Strokes caused by A-fib can have severe repercussions, says Stephen Waterford, MD, an Upstate surgeon who specializes in cardiothoracic surgery.

What are the treatments?

LEFT ATRIUM IN FIBRILLATION

CLOT

WATCHMAN FABRIC CLIP

A-fib can be a complex medical problem. Treatment may include controlling the heart rate, resetting its rhythm, or reducing stroke risk — or all three. Strategies differ from patient to patient. Medications may be used, along with a variety of specific procedures, including ablation.

How does ablation work? “A-fib forms a circle of current, and it just goes around and around in a circle. What ablation does is put lines across these circles of current so that the current can no longer travel in a circle,” Waterford says. The lines are made either through freezing or cauterization, either through a catheter (a hollow tube) by a cardiologist with training in electrophysiology, or through a surgical procedure. It’s something that may be considered for people in whom medications have not been effective. Waterford offers a minimally invasive ablation procedure called the TT Maze. Working through incisions in the patient’s chest that are no larger than a centimeter (about the width of a pencil), he touches the beating heart with a radiofrequency tool that makes the lines. The pattern of the lines is standardized, like the scaffolding of a building. The TT Maze is an option for a person who remains in A-fib after a year, or after catheter ablation. 12

U P STAT E H E A LT H l winter 2021 l upstate.edu

Where does the stroke risk come from? Human hearts have an appendage in the back of the upper left chamber, or atrium, of the heart. Clots can develop in this appendage. A stroke can occur if a clot moves into the atrium and travels through the bloodstream to the brain. A surgeon can place an umbrella-shaped device called a Watchman in this appendage. “It closes it off, almost like shutting the door to a room so that things like clots can’t go in and out of that room,” Waterford describes. “I can also put a fabric clip on the outside of the appendage that clips it closed. That reduces or eliminates, in many cases, the risk of stroke.” continued on page 13

Pati ent Care

a fix for a-fib

continued from page 12

Will ablation work? Catheter ablations, which may have to be repeated, have up to a 50 percent success rate, Waterford says. He says 95 percent of patients who undergo the TT Maze have a normal heart rhythm at the end of the procedure, although they may need to continue to take medications for a few months afterward. He says one patient he cared for at Upstate woke up from the procedure and felt a difference right away. Most patients will realize the treatment worked when they feel an increase in their energy level and a decrease in their shortness of breath. If they undergo an ultrasound afterward, they’ll probably see that the heart’s pumping action has strengthened. Waterford says patients also experience great relief in their stroke risk, “because with all of my TT Maze patients, I always clip off that stroke center of the heart called the appendage.” u

Waterford fields inquiries about a-fib at 315-500-aFiB (or 315-500-2342.)

FasT action

Cardiothoracic surgeon Stephen Waterford, MD PHOTO BY SUSAN KAHN

continued from page 11

immediately for a computed tomography (CT or CAT) scan, and Crolius and Miller gave a full report to the Upstate stroke team, which included Kimberly Laxton, MD, and William Santiago, MD, of emergency medicine. The CT scan confirmed an ischemic stroke, caused by a blood clot. The plaque in Olley’s neck vessels had caused the clot, which blocked blood Amar Swarnkar, flow to his brain. Because he got to Upstate within three hours of the onset MD, is director of diagnostic neuroof the stroke, Olley was able to receive radiology. tissue plasminogen activator (tPA), an intravenous medication that helps dissolve clots. To remove the clot, interventional radiologist Amar Swarnkar, MD, performed an emergency thrombectomy. He inserted a tiny tube through a blood vessel into the base of Olley’s skull and threaded the tube to the clot. Then, Swarnkar guided a retrievable metal stent through the clot and removed it. He also left a permanent stent that opened the neck artery that was obstructed by plaque. Olley was in the intensive care unit overnight. Three days

WHEN YOU SEE A STROKE ACT

CALL 911

T I M E S AV E D I S B R A I N S AV E D after the stroke, he left the hospital, just in time to attend his nephew’s wedding in Carthage. A week after the stroke, Olley was back working in his greenhouse and at several farmers’ markets. (On Saturday mornings from May to October, he can be found at the nearby Harrisville market.) More than seven months after the stroke, Olley finds that he occasionally forgets words and has some difficulty multiplying numbers in his head. Other than that, he appears to be the same robust man he was before the stroke. u

upstate.edu l winter 2021 l U P STAT E H E A LT H

From our exPertS

LESSONS

FROM UPSTATE ealth professionals who work at academic

medical centers such as Upstate Medical

University often share their expertise and

the information they learn from taking care of patients. Their work is presented at medical conferences and published in medical journals. Here are some recent findings:

Cancers can be found in unusual places Ewing sarcoma is an aggressive cancer that is most common in children and young adults. It usually affects the long bones. Rarely, this cancer may be detected elsewhere, outside of the skeletal system. In research published in the journal Radiology Case Reports, a group of doctors from Upstate points out that this cancer can show up in the adrenal gland.

adrenal gland

kidney

Their patient was a 34-year-old man who had abdominal and flank pain for a couple of weeks. Medical images revealed a mass pressing on the right kidney. It might have been a bruise, because the man remembered an injury from a while ago, but the doctors also considered several types of tumors. Then they completed additional imaging tests and saw that the mass was extending into the inferior vena cava, the large vessel that returns blood from the lower body to the heart, and they knew the mass had to be removed – and quickly. The man underwent a massive operation requiring three surgical teams. The mass, his right adrenal gland and kidney were removed, along with his gallbladder, some of his liver and diaphragm, some lymph nodes and a clot that was in his vena cava. His heart stopped during the surgery, and he was revived. He had a lengthy and complicated recovery, which radiologist Mujtaba Mohammed, MD, and colleagues detail in their paper. Pathologists found evidence of Ewing sarcoma in the mass, and it had invaded the man’s liver and vena cava. Three months later, medical images showed no evidence of cancer recurrence. Mohammed reported that the patient was improving during chemotherapy. “This case demonstrates the importance for early detection and diagnosis of Ewing sarcoma of the adrenal gland with medical imaging,”he wrote. 14

U P STAT E H E A LT H l winter 2021 l upstate.edu

Heart disease masquerades as dementia A disease of the heart muscle called stress cardiomyopathy can develop because of intense Zachary physical or emoShepherd, MD tional trauma, certain acute medical conditions or chronic psychiatric illnesses such as depression, anxiety and substance abuse. Researchers have noted cases of stress cardiomyopathy in elderly patients who have neurodegenerative diseases, but it is rare. Zachary Shepherd, MD, a doctor of internal medicine at Upstate, wrote in the Cureus Journal of Medical Science about a 78-year-old woman with a longstanding history of dementia who was brought to the hospital because of worsening agitation, memory loss and behavioral disturbances. Caregivers said she was having trouble sleeping and struggling with delusions. The woman was combative and agitated at the hospital. Doctors prescribed medication that helped calm her, and they examined her heart. They diagnosed stress cardiomyopathy after electrocardiograms and medical imaging and gave her a beta blocker medication. Shepherd says patients with dementia and agitation may be predisposed to developing stress cardiomyopathy. “The precise mechanism behind this association is not well defined; however, a catecholamine surge caused by the agitated state is a plausible explanation,” he wrote. An acute decline is often mistaken as worsening dementia, when the patient may have developed stress cardiomyopathy, Shepherd says. The condition can be reversed with supportive therapy – which is what his patient received.

From our exPertS

Piercing leads to skin infection A 25-year-old woman had the upper part of her outer ear, known as the helix, pierced three days prior. Her ear became tender and progressively more sore. Now everything but the earlobe was swollen and red, with a throbbing pain. Upstate resident Meghan Klawonn, MD, reported the case in the Journal of Family Practice with her diagnosis: auricular perichondritis, an inflammation of the connective tissue surrounding the cartilage of the ear. One clue to the diagnosis is the sparing of the earlobe, since it does not contain cartilage. But what was causing the condition in this woman? Autoimmune disorders can cause auricular perichondritis, but that usually affects both ears at once. Various infections, also, can cause the condition. Klawonn and colleagues wrote that infections after piercing or traumatic injury should raise suspicion of a pseudomonal infection, a bacterial infection that requires prompt treatment: “Untreated, infection can spread quickly and lead to permanent ear deformity.” The woman had been pierced with a piercing gun, which causes more infections than do piercings using sterile straight needles, according to the researchers. She also took frequent showers after working out, which may have exposed her to the bacteria in fresh water.

Either way, treatment with the antibiotic ciprofloxacin every 12 hours for 10 days helped the woman recover without complication. She saw improvement within two days. The researchers note that other antibiotics are not as effective against this type of infection, and prescribing the wrong medication could mean the loss of valuable time and subsequent cosmetic disfigurement. u

CONNECTED FOR YOUR CARE

We now oﬀer telehealth visits for patients seeking second opinions on their cancer diagnosis. During this visit, our physicians are ready to help you understand your options or to oﬀer the reassurance that you are on the right path for treatment. Should you need to be seen for care, Upstate has the dedicated experts and technologies already in place to treat your specific type of cancer.

YOU HAVE OPTIONS FOR YOUR CANCER CARE.

SYRACUSE

ONEIDA

OSWEGO

UPSTATE.EDU/OPTIONS 315 464-HOPE (4673) upstate.edu l winter 2021 l U P STAT E H E A LT H

From our exPertS

Life expectancy has dropped:

Why it matters BY AMBER SMITH

mericans born in 1959 could expect to

live 69.9 years, on average. By 2014, life expectancy had improved to 78.9 years.

By 2017, it was down slightly to 78.6 years. Working-age Americans are now less likely to live to retirement age than at any time in recent history, according to a study about life expectancy in the United States that appeared in the Journal of the American Medical Association. In studying the years 1955 to 2017, researchers found downward trends in life expectancy for three successive years since 2014. Life expectancy at birth in the U.S. had steadily increased over the past several decades. Now, the decline reveals the U.S. with a health disadvantage compared with other high-income nations, even though the U.S. maintains the highest per capita health care spending in the world. Christopher Morley, PhD, chair of public health and preventive medicine at Upstate, helps explain the significance of this data:

What is the point of studying life expectancy? As an indicator, life expectancy provides a rough guide to what’s happening within the population. How long you expect to live is a good measure of the overall health of your population. However, it is important to explore the details underlying life expectancy to really see what’s going on. The details give us a picture of our society that can tell us both what we need to pay attention to and what we 16

U P STAT E H E A LT H l winter 2021 l upstate.edu

need to fix, as well as who we are and what we value.

Why are life spans shorter now? For many and complex reasons. We have shifted as a society away from the single-income household model, at least among some middleclass Americans, to jobs that are more sedentary and pay lower wages. We’ve shifted from jobs one might expect to hold for life, such as unionized manufacturing jobs, to itinerant labor for many people, or what is known as the “gig economy.” Many people are working multiple jobs. At the same time, people don’t have time to prepare meals, and they end up eating takeout or processed food. This is a shift that is felt in the middle class but is familiar to underserved communities, which have historically relied upon service industries for jobs and fast-food restaurants for meals,

From our exPertS

since their neighborhoods often lacked stores that sell fresh produce. When you combine economic instability with the increasingly sedentary lifestyle and the way we eat, you see a real change in lifestyle and a demographic shift. When we combine all of these things together with economic changes to the way people expect their lives to proceed, we see a rise in mortality from “diseases of despair,”such as deaths from drug overdoses, suicide and alcohol-related diseases. Since 1999, researchers found these three causes of death generally increased for adults from the ages of 25 to 64. Tied into the same changing economic and social conditions are resultant lifestyle shifts, which are cumulative and contribute to conditions including diabetes, high blood pressure, obesity and kidney failure.

How does where you live affect life expectancy? Within the city of Syracuse, you can see differences in life expectancy across ZIP codes, and it follows a change in socioeconomic levels. In the 13224 ZIP code – along the well-off neighborhoods of Syracuse’s East Side, and further east into the suburbs of DeWitt, Fayetteville and Manlius – life expectancy is 79.8 years of age, which is a little higher than state and national averages.

About 5 miles down the road is 13205, which has lower economic status and a host of other disadvantages noted below. The life expectancy in that ZIP code is 72.6 years. This strip of land along routes 11 and 81 runs from just south of downtown Syracuse to Nedrow.

In terms of the broad impact on overall life expectancy across the U.S., it will probably have a negligible effect, because the severest rates of mortality appear in those who are older than average life expectancy.

It’s a massive difference, just 5 miles apart.

However, this is not true among some subgroups.

You can compare levels of lead abatement in housing, the amount of environmental toxins, fatality from violence, economic disadvantages, access to food and health care, and many other factors. These things vary remarkably between the populations in ZIP codes that are very close to each other.

For example, we are already seeing higher death rates among the AfricanAmerican and Latino communities. Some early research predicts life expectancy to drop further in these communities due to the pandemic.

All of these things add up cumulatively to a shorter life expectancy. As more of the population across demographic segments begins to face similar challenges, overall life expectancy will decline.

Will the Covid-19 pandemic shorten life expectancy?

This is related to fundamental inequities that show themselves in higher underlying chronic illness rates, which are risk factors for death from COVID19, and further highlights inequity as a root cause of decreasing life expectancy. u upstate.edu l winter 2021 l U P STAT E H E A LT H

in our C omm uni ty

Research by Harry E. Taylor, PhD, provides insight into the way that HIV fuels infection. PHOTO BY DEBBIE REXINE

Understanding HIV BY DARRYL GEDDES

hen activated, CD4 T cells lead the body’s

immune system in fighting off infection. But not so with HIV, the virus that causes AIDS.

HIV – the human immunodeficiency virus – overtakes these activated CD4 T cells, disarming their ability to fight the invading infection. What’s puzzling for scientists is why HIV prefers to replicate in these active CD4 T cells and not in resting CD4 T cells. An Upstate scientist has solved this puzzle. Harry E. Taylor, PhD, published his work in the scientific journal Cell Reports. Taylor joined the Upstate faculty in the fall of 2019 as an assistant professor of microbiology and immunology. He earned his doctoral degree from the Johns Hopkins School of Medicine. “Only activated CD4 T cells have the required resources to fuel the intracellular steps necessary to support HIV replication factory assembly lines at full throttle,” Taylor describes. “These activated T cells have ample stockpiles of the building blocks that HIV needs to make copies of itself. “These building blocks are at much lower levels in resting CD4 T cells,” he says. “Therefore these resting CD4 T cells are of little use to expand an army of progeny of the invading virus.” Taylor says HIV replicates in the hospitable intracellular environment of activated CD4 T cells — while at the same time inactivating the immune response that 18

U P STAT E H E A LT H l winter 2021 l upstate.edu

protects individuals from infections. “In our current study we have delineated the steps that HIV needs for replication and how they are supported by the various building blocks in these activated T cells,” he says. An estimated 1.2 million people have HIV in the United States, and one in seven are living with HIV but don’t know it since they are likely showing no symptoms and have not been tested. Antiretroviral drugs have made HIV infection a manageable chronic condition, for some. But many of these drugs have significant side effects, and a missed dose can have serious implications for reawakening dormant virus in these individuals. Taylor says that much work is being done to identify new therapeutics and treatments for people with HIV, but it’s important to remember that there is neither a cure nor a vaccine, and drugs don’t eliminate the virus from the body. u

in our C ommunity

A pill accidentally dropped on the floor at a neighbor’s house caused the fatal poisoning of 9-month-old Maisie Gillan. PROVIDED PHOTO

Medication safety Bereaved parents are passionate advocates BY AMBER SMITH

dam and MaryBeth Gillan of Rochester lost

their daughter Maisie in January 2019 after the

9-month-old swallowed a pill that had fallen

on the floor of a neighbor’s home. They share their tragedy in an effort to help improve medication safety. “We just really do not want to have this happen to anyone else,” MaryBeth Gillan says. The family, settling into a new home, had accepted a neighbor’s invitation to dinner. Maisie spent most of the night in her mother’s arms, except for a few minutes when she was on the kitchen floor, surrounded by six adults. It was past Maisie’s and her older sister Rhona’s bedtime when the Gillans walked back to their home, with Maisie drifting asleep in MaryBeth Gillan’s arms. Her parents slipped her into her pajamas and her crib for the night. Maisie did not awaken. Weeks later, police informed her parents she had died from an overdose of methadone. They didn’t know what that was. They couldn’t figure where Maisie would have gotten it. The police investigation determined an elderly family member of the neighbor had a methadone prescription and must have dropped a pill on the kitchen floor. “The pill itself is very small,” says Adam Gillan, “so it would have been tough to see a white pill on a kitchen floor.” Unintentional poisonings are a significant problem in the United States, says Jeanna Marraffa, PharmD, the assistant clinical director of the Upstate New York Poison Center, which is located at Upstate Medical University. She says more than 900,000 calls to poison centers across the nation each year are regarding children under age 6 who have been exposed to medications or other substances that can be toxic.

“A lot of medications, even medications that are available over the counter, can be quite toxic and even deadly in a child in very, very small doses,” Marraffa says. Methadone is an opioid pain reliever similar to morphine and is used for pain control as well as medicationassisted treatment for patients with opioid use disorder. One pill can be deadly to a small child. Other medications such as those used for heart conditions, high blood pressure or antidepressants can also be deadly in a single dose to a small child. Marraffa says research published in the Journal of the American Medical Association indicated that in more than 40 percent of child medication poisonings, inappropriate storage or removal from its original packaging was the reason. One way to help keep children safe is to keep medication in its original packaging. continued on page 21

For a five-minute video about the Gillan family tragedy, visit the Upstate New York Poison Center at upstate.edu/ poison. Type “Gillan” in the search box. upstate.edu l winter 2021 l U P STAT E H E A LT H

in our C omm uni ty

Upstate University Hospital CEO Robert Corona, DO, and nurse Jacqueline Roe moments after receiving the COVID-19 vaccine. PHOTOS BY KATHLEEN PAICE FROIO

I got vaccinated because...

ow that a vaccine against COVID-19 is available, at some point everyone will

face the question of whether to be vaccinated.

Getting vaccinated will help protect us by prompting an antibody response without our becoming sick with COVID-19. The vaccine might keep us from getting COVID-19 or keep us from serious illness if infected. It may also help us prevent the spread of the virus to others. Ten people explain why they got the shots:

“… if everyone wants to go back to a normal life, it’s important that everyone get this vaccine.” –Suzanne Buck, Upstate University Hospital nurse and the third person at Upstate to receive the vaccine, on Dec. 15.

U P STAT E H E A LT H l winter 2021 l upstate.edu

“… as educators, we need to learn what is real, convey the facts and practice what we teach.” –Lawrence Chin, MD, dean, College of Medicine, Upstate Medical University

in our C ommunity

Medication safety continued from page 19

How to protect children from medication poisoning l

Environmental services staffer Kenzo Mukendi, the first person in Central New York to receive the vaccine, is interviewed by the news media on Dec. 15. PHOTO BY KATHLEEN PAICE FROIO

“… nobody can predict how the virus will affect them; being Pat prepared by being vaccinated puts some of that control back in your hands.”

–Robert Corona, DO, chief executive officer, Upstate University Hospital

“… doing the right thing now will mean we can have a better recovery, in every sense of the word.”

–Mantosh Dewan, MD, president, Upstate Medical University

“… this is the start of the end of so much stress and turmoil and awfulness that we’ve gone through this year.”

–Christian Knutsen, MD, emergency physician, Upstate University Hospital

“… this marks the beginning of the end of a very painful time in our history. i want to instill public confidence that the vaccine is safe.” –Sandra Lindsay, intensive care unit nurse working in Queens and the first person in America to receive the vaccine (outside of clinical trials) on Dec. 14.

“… it is my duty. the vaccine will help your body be ready to fight against the virus, so i encourage people to get the vaccine.” –Kenzo Mukendi, environmental services worker, Upstate University Hospital, and the first person at Upstate to receive the vaccine, on Dec. 15.

“… i am over 60 years old, i am a cancer survivor and have medical concerns that place me at high risk for Covid complications.” –Nancy Page, chief nursing officer, Upstate University Hospital

“… i trust the vaccine, even though it was developed quickly. We achieved a vaccine in one year because we had a decade-long head start working with mrna technology, and developers took financial risks they don’t normally take. the Fda review process was very much the same.” –Stephen Thomas, MD, chief of infectious disease at Upstate and the lead principal investigator for the Pfizer/BioNTech global phase 3 COVID-19 vaccine trial

“… getting the vaccine is not just about protecting myself but also about protecting vulnerable people around me, so that i do not get and inadvertently transmit the virus.”

Keep medicines in their original packaging. Children are at risk as soon as a medication is taken from its bottle to be put in a pill minder or a case for travel. Store medicines up and away, in a safe place, out of the reach of children. And don’t assume your child cannot open a child-resistant container. Consider a lock box, especially if your home includes children or adolescents. Combination and key lock varieties are available. Make sure purses and bags (your own and any guest’s) that may contain medications are kept out of the reach of kids at all times. Ask your pharmacist if your medication is available in unit dose packaging. Teach children that medicines can be dangerous and never refer to pills as “candy.” Take your medicines over a sink, so you will notice if you drop a pill. And, if you drop a pill on the floor and cannot find it, vacuum thoroughly. Turn on a light to take medicines at night, so you can make sure you dispense the right amount of the right medication. Dispose of unused or expired medications. Ask whether your pharmacy will take them. Or, mix the pills with kitty litter or coffee grounds in a plastic bag and throw them out with household trash. Before children spend time at a relative’s or friend’s house, ask how their medications are stored. SOURCES: UPSTATE NEW YORK POISON CENTER, CENTERS FOR DISEASE CONTROL AND PREVENTION, KIDSHEALTH.ORG

–Amy Tucker, MD, chief medical officer, Upstate University Hospital upstate.edu l winter 2021 l U P STAT E H E A LT H

in our C omm uni ty

The plasma project uses plasma from people who have recovered from COVID-19 to help others fighting the disease. These are the specially trained Upstate nurses who collect convalescent plasma. From left: Amy Bielicki, Connie Capone, Vicki Morey, Michele Weber and Deborah Willson. PHOTOS BY ROBERT MESCAVAGE AND RICHARD WHELSKY

Fighting COVID-19 with donated blood BY AMBER SMITH

pheresis is the process of separating blood

components from whole blood. The components could be stem cells from a person undergoing

cancer treatment, red blood cells from someone with sickle cell disease, or plasma to help someone with a neurological condition or a kidney transplant. It’s a specialized treatment. Nurses who work in apheresis spend about a year in training, perfecting all of the procedures – some of which are provided on an emergency basis. Early in the coronavirus pandemic, an emergency clinical trial was launched. A person who recovered from COVID-19 had developed antibodies, which were believed to have the power to help someone else fighting the disease. Those antibodies first had to be extracted from the plasma of donors who survived COVID-19. Who better to collect what’s known as “convalescent plasma” than nurses trained in apheresis? “The technology that they were already familiar with for performing plasma exchanges, which they do routinely, is the same technology used to perform convalescent plasma collections,” says Kelly Dolan, assistant director of nursing at Upstate. Nurse Deborah Willson says when they heard about the convalescent plasma project, the apheresis team volunteered to get involved. They arranged for the necessary machines and training and wrote the applicable policies. “We were excited we could help out in our own way,” Willson says. She explains that donors may feel as if they are making a routine blood donation. Blood is removed through tubing inserted into their arm that connects to a machine where the blood components are separated. The antibody-containing plasma is collected in bags. The remaining blood cells are returned to the donor, 22

U P STAT E H E A LT H l winter 2021 l upstate.edu

through the same tubing. The process may take a half-hour and usually involves collecting 600 milliliters of plasma (about 2½ cups). Donors receive an anticoagulant called citrate to help prevent the blood from clotting during the procedure. Willson says unless donors do strenuous work, they are usually able to return to regular activities right after their donation – as long as they replenish their fluids. The antibody-rich plasma is tested and processed in an Upstate laboratory and stored in the hospital’s blood bank before it is considered for use in patients with COVID-19. u

Want to volunteer? The convalescent plasma project is recruiting COVID-19 survivors. If you are 18 years of age or older, have tested positive for COVID-19 and are now 14 days out from your last symptom, call Upstate Clinical Trials at 315-464-9869 to arrange a screening appointment. Researchers at Upstate are preparing COVID-19 vaccine studies for children, which are planned to begin enrollment later this year.

in our l eiSure

Shelley White rides Magdelena in a field at Baraka Arabians Farm, the property near Brewerton that she built with her husband, Tom DeSalvia. White rises early to feed the horses before going to Upstate University Hospital, where she is director of patient access services, which provides information and support to patients and their families during the admission process. PHOTOS BY SUSAN KAHN

saddling up for good health Horsewoman finds riding helps her battle immune condition BY SUSAN KEETER

t was the free ice cream that got little Shelley White to

the Mother’s Day Horse Show in Phoenix, New York, every year. Her best friend was “horse-crazy,” but not

her. Then, at age 12, White had a change of heart that she can’t fully explain. She woke up on Mother’s Day and thought, “I’ve got to see the horses.” She went to the show, alone, talked with riders and owners and learned

White with Magdelena, the half Arabian champion she raised and trained.

about their horses. The next day, she took her first lesson.

better at creating hospital plans and supervising the 200 Upstate staffers who make sure our patients get the access they need.”

At the time, White had difficulty walking. When she mounted the saddle, it hurt to put her feet in the stirrups. White had been diagnosed with rheumatoid arthritis at age 2 and was a regular Upstate patient by the time she was 12. She was part of several juvenile rheumatology clinical research trials and had had her first partial joint replacement surgery at age 16. Since then, White has had five other joint replacements, including one surgery that gave her a French-made custom ankle. Today, White is an award-winning horsewoman with four champion halfArabians and a 44-acre farm. She credits the strenuous exercise and discipline of training horses with keeping her healthy and skilled at her job at Upstate University Hospital. “When you and your horse are in tune, it looks effortless. But I’m exercising my entire core — torso, hips, shoulders — to communicate with the horse I’m riding. It’s a workout. The focus and discipline I’ve developed make me

What is White’s advice about living with a chronic medical condition? “If you have an immune condition, find something you’re passionate about. You need the physical exercise. Try to stay fit and strong. Avoid letting the disease take over. If I hadn’t found equestrian sports as an outlet, at 55, I’d be in a very different place, healthwise.” u upstate.edu l winter 2021 l U P STAT E H E A LT H

Non Profit Org. US Postage

PAID 750 East Adams Street l Syracuse, NY 13210

Permit No 110 Syracuse, NY

SCIENCE IS ART IS SCIENCE IS ART IS SCIENCE IS

Corneal scarring is one of the leading causes of blindness worldwide. The World Health Organization estimates that 23 million people suffer from unilateral vision loss due to corneal disease. Causes of blindness from corneal disease include infection, inflammation, ulcers and trauma. The cornea refracts light as it enters the eye so that a properly focused image reaches the Audrey retina, at the back of the eye. The normal cornea is transparent, Bernstein, PhD making it an important model system in which to study fibrotic PHOTO BY scarring. Corneal scarring results from the persistence of WILLIAM MUELLER myofibroblasts, cells that excessively contract tissue and secrete disorganized extracellular matrix, the proteins that surround the cells.

Pictured is a myofibroblast in culture. The actin is shown in red. This is the skeleton (called the cytoskeleton) that keeps the cell’s shape. The green dots are proteins that bind to each other under scarring conditions. The blue is the nucleus. u PICTURE BY EDWARD BOUMIL, PHD, IN THE BERNSTEIN LAB AT UPSTATE

20.186022135.165MSKEL

Researchers in the lab of Audrey Bernstein, PhD, at Upstate are working on the proteins and molecular pathways that cause the development and persistence of these scarring cells in a healing wound. Bernstein is an associate professor in the departments of ophthalmology and visual sciences with secondary appointments in biochemistry and molecular biology, and cell and developmental biology.