Upstate Health magazine, winter 2013
Healthy lifestyle publication produced by Upstate Medical University, the academic medical center in Syracuse, NY.
37722 SUMU-_37722 1/4/13 2:05 PM Page 1 Health UPSTATE UPSTATE MEDICAL UNIVERSITY cancer bringing precision to the Taking fight your child to the hospital dangers of energy drinks ok Should you a feeding tube? what it takes to win a marathon Winter 2013 37722 SUMU-_37722 1/4/13 2:05 PM Page 2 CONTENTS Health 4 5 6 7 A stem cell transplant saved this young man’s life The pump that gives sick heart patients a chance Making progress toward an artificial pancreas Advice Five features of pediatric emergency care 9 10 How to manage cancer fatigue Googling about gallstones Coping with stress Community 11 14 15 16 ‘Oz’ author had heart disease Memorializing patients What the Community Campus looks like now In every issue Work 17 Helping refugees settle in Syracuse Food 18 20 Meet systems engineer Mark Torres Behind the scenes in the hospital kitchen Dangers of energy drinks Leisure 21 23 2 8 The Upstate Ethicist 20 Calorie Burn 9 Questions & Answers 22 Good Reads 10 Advice for Caregivers from Caregivers 23 Lessons from Upstate 13 In the Know 24 Science is Art is Science Balsamic Roasted Portobello Sandwich ON THE COVER: OLAMIDE (‘MIDE) AJAGBE MD IS ONE OF NINE PEDIATRICIANS WHO CARE FOR PATIENTS AT THE GOLISANO AFTER HOURS CARE CENTER AT UPSTATE’S COMMUNITY CAMPUS. DR. AJAGBE IS ASSISTANT PROFESSOR OF PEDIATRICS AT UPSTATE MEDICAL UNIVERSITY. PHOTO BY ROBERT MESCAVAGE. Under the sea with Jason Meany Why Sue Milliman loves singing Good for You U P S TAT E H E A LT H 4 Lung cancer screening winter 2013 6 Pertussis vaccine 14 Fresh air 19 Fruits & vegetables 21 Yoga w w w. u p st ate . e d u 37722 SUMU-_37722 1/4/13 2:05 PM Page 3 WHAT’S UP AT UPSTATE ou may not have your ears tuned to radio station WSYR-FM 106.9 from 9 to 10 a.m. Sunday mornings. But you can still listen to the weekly talk radio show produced by Upstate for the last 7 1/2 years. Y It’s easier than ever to visit upstate.edu/healthlinkonair to listen to that week’s show, or search for a medical topic. All of our interviews are archived for easy retrieval at the “Health Link on Air” website. You will find clips from some of our top researchers and leading doctors and caregivers sharing health information of importance to Central New Yorkers. Interviews featuring specific doctors are also attached to that doctor’s profile page – available at the upstate.edu home page by searching “Find a Doc.” Examples: • Has your family faced a stroke? Hear Eric DeShaies MD, Upstate’s neurovascular director, explain the care available at Upstate. • Are you grappling with the feeding tube issue? Upstate’s chief of geriatrics, Sharon Brangman MD, offers some new ways of thinking. (Also on page 9.) • Is weight loss surgery a consideration? Howard Simon MD, bariatric surgery chief, explains the process. Many of our radio interviews form the basis for articles you’ll read on these pages, or on the What’s Up at Upstate blog at upstate.edu/whatsup. So even if you aren’t close to the radio dial on Sunday mornings, you can still be informed. Need a referral or more information? For appointments or referrals to the health care providers on these pages, or for questions about health topics, contact a registered nurse at Upstate Connect at 315-464-8668 or 1-800-464-8668, day or night. Health by the numbers 32 masks of hope and healing were exhibited in October, the creations of young artists who have been patients at the Upstate Golisano Children’s Hospital. 154 years since the New York State Inebriate Asylum, a Gothic Revival style “castle,” opened in Binghamton. Vacant since the 1990s, the building is being restored to become an Upstate campus satellite which will provide medical and health professions education. 3 or 4 UPSTATE Winter 2013 pUblisHer Wanda Thompson PhD Senior Vice President for Operations execUtive editor Melanie Rich Director, Marketing & University Communications editor-in-cHief Writers designer Amber Smith Amber Smith, Jeff Kramer, Jim McKeever, Susan Keeter Susan Keeter pHotograpHy Robert Mescavage (cover, 7, 18, 19, 20) Susan Kahn (pgs. 3, 4, 10, 17, 23) William Mueller (pgs. 5, 12, 14, 20) Medical Photography (pgs. 5, 6, 9, 10) Susan Keeter (pgs. 14, 16) Richard Whelsky (pg. 8) Stephen D. Cannerelli (pg. 22) Lucy Barbera (pg. 3) Shweta Shreyarthi (pg. 14) Roger Luther (pg. 3) illUstrations Dan Cameron (pgs. 13, 15) Randy Glasenberg (pg. 2) Hope and Serenity, mask artists (pg. 3), W.W. Denslow (pg. 11), times per day that patients refer to Emily Hollywood MD as “Doc Hollywood.” She is completing her third year of residency in Upstate University Hospital’s Emergency Department and says she hasn’t tired of the nickname yet, “but that’s my maiden name, so if I ever do get tired of it, theoretically I could change it.” For more information, 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 firstname.lastname@example.org additional copies: 315-464-4836. Upstate Health offices are located at 250 Harrison St., Syracuse, NY 13202 Upstate Health is published by the Office of Marketing and University Communications. Upstate Medical University in Syracuse, NY, is an academic medical center with four colleges – Medicine, Nursing, Health Professions and Graduate Studies – as well as an extensive clinical health care system that includes Upstate University Hospital’s downtown and community campuses, the Upstate Golisano Children’s Hospital and numerous satellite sites. Affiliated with the State University of New York, Upstate is Onondaga County’s largest employer. Knowing changes everything.SM winter 2013 U P S TAT E H E A LT H 3 37722 SUMU-_37722 1/4/13 2:05 PM Page 4 HEALTH first PATIENTS neW screening for lUng cancer A new lung cancer screening program is now offered by the Upstate Cancer Center and the Upstate Radiology Department. Low-dose computerized tomography (CT) scans are for smokers between the ages of 55 and 74 or former smokers who quit within the past 15 years and who have a smoking history of at least 30 pack years (a pack a day for 30 years, or two packs a day for 15 years.) The scans cost $235 and are not covered by medical insurers. They do not require injections or medications. Lung scans can be scheduled, or gift certificates can be purchased for someone you feel should be screened, by calling 315-464-6303. Participants also receive: • an interpretation of the findings by a dedicated chest radiologist, • a CD with the images for the participant’s personal records, • letters to their personal physicians, • smoking cessation classes, • referrals to other medical professionals and Upstate’s multidisciplinary Thoracic Oncology Program if necessary. Medical director Leslie Kohman MD said the program was created because of a recent landmark study showing that screening with a low-dose CT scan of the lungs can detect tumors early and can reduce lung cancer mortality by up to 20 percent for high-risk smokers and ex-smokers. Listen to this interview at upstate.edu/ healthlinkonair by searching for “lung cancer.” 4 U P S TAT E H E A LT H Cord blood bank will contribute to research, treatment options ared Saya was 2 when his mother brought him to Upstate University Hospital’s pediatric emergency department with bruises on his arm. She thought he had fallen. He had cancer. J “We stayed at Upstate for six months from that day, getting chemotherapy,” recalls his mother, Geralyn Saya of Syracuse. For 18 months he was in remission. Then at age 4, Jared relapsed. Doctors said he needed an infusion of healthy stem cells, since his bone marrow was not producing enough. So he underwent a stem cell transplant, relying on the generosity of an anonymous mother who donated blood from her newborn baby’s umbilical cord or placenta. Jared was hospitalized in isolation for five months, in Rochester since Upstate did not offer stem cell transplants at the time. Jared is 14 today, a freshman soccer player at Christian Brothers Academy who also plays for the indoor club team, Fusion. He recently attended the groundbreaking ceremony for Upstate’s new $15 million public cord blood bank. The bank, being built at Upstate University Hospital’s Community Campus, will store cord blood donations that may be used in treatment or for research. It is expected to open in 2014. Eventually, Upstate may offer cord blood transplants. “Through the donations of cord blood from families all across our region, we have the ability to save lives through transplantation and further fuel the biomedical research that may move us closer in finding breakthroughs for dozens of diseases,” Upstate President David Smith MD told The Post-Standard newspaper. For all the promise cord blood transplants carry, Saya says she would change one practice. She would like to know who donated the stem cells that changed her son’s blood type and allowed him to become healthy again. “Somebody saved my son’s life, and she doesn’t even know that. What a gift to give somebody. I can only thank everybody who donates.” ● Jared Saya, 14, is wild about soccer today. As a preschooler he battled cancer. Kids made fun of him when he was bald during chemotherapy. Listen to a related interview at upstate.edu/healthlinkonair by searching for “cord blood.” winter 2013 w w w. u p st ate . e d u 37722 SUMU-_37722 1/4/13 2:05 PM Page 5 HEALTH Impella device assists patients with severe heart disease ardiologists at Upstate are using a new pumping device to extend the lives of patients with severe forms of heart disease. Patients suffering heart failure, and those whose hearts are too weak to tolerate angioplasty are candidates for the device called Impella®. C Doctors insert the pump through a catheter that enters the heart through its main artery, the aorta. The pump is about the size of a triple A battery. It spins rapidly, like a corkscrew, propelling blood backward from the left ventricle out to the body to maintain circulation. Hani Kozman MD said some patients require the Impella during a medical crisis such as a severe heart attack. Other patients are considered high-risk for repairs to their coronary arteries, and the Impella is placed before the patients undergo their procedures. The disposable pumps, which may remain for a few hours up to several days, connect to monitors that provide the electrical source. Upstate has two monitors. his options, and Grugan said he appreciated the doctor’s honesty. His heart would need help pumping during the Hani Kozman MD procedure. Grugan would be on the Impella pump while additional stents were inserted into his heart arteries. Grugan agreed. “I thought I was going to be there for the weekend, because I had this done on a Thursday,” he recalled. But the day after the Luna Bhatta MD procedure, Kozman said Grugan could go home. Grugan recovered well. His symptoms have improved significantly, and he is able to continue on with life as usual. ● Upstate at commUnity plans geriatric emergency Unit S enior citizens can be challenging patients. Often they have other medical conditions and/or multiple prescriptions that complicate their emergency. They may agitate or confuse easily, and they may have trouble expressing themselves. Often, it's not long before they are back at the hospital because underlying issues weren't addressed. Not only is this inconvenient and costly, it’s not the best medicine. With that in mind, Upstate is creating a new Geriatric Emergency Medicine Unit called GEM Care, The Senior ED. The unit, led by emergency physician James Ciaccio MD, will open by early summer in a dedicated section of the emergency department at Upstate University Hospital, Community Campus. “It’s for the really, really sick patients, for whom there is no alternative,” said Kozman, director of the Cardiac Catheterization Laboratory at Upstate. David Grugan was just such a patient. The 62-year-old Auburn man said he has come close to death twice and is grateful to Kozman and the Impella (made by Abiomed). After a heart attack in 2009, Grugan had four stents placed to prevent blockages in his coronary arteries. Later, Luna Bhatta MD, director of Upstate’s Electrophysiology Laboratory, implanted a defibrillator in his chest that would automatically restart his heart if it stopped beating. Details are being worked out, but GEM Care will be characterized by a calm, measured approach to care in a quiet environment. Clocks will have larger, more visible numbers. Rails will line the walls, floors will be nonskid, paint colors will be soothing, and mattresses will be thicker. Most important, staff working in the unit will be specially trained to treat patients 60+, address their unique sociological and psychological needs — and the concerns of their families — and ultimately make their emergency stay as stress-free as possible. Months later, he began having very limiting chest pain and trouble breathing. He was found to have additional blockages forming in his coronary arteries. However, with his weak heart function, fixing these would be risky. Kozman spoke with Grugan about Listen to this interview at upstate.edu/healthlinkonair by searching for “Impella.” Knowing changes everything.SM James Ciaccio MD winter 2013 Listen to this interview at upstate.edu/ healthlinkonair by searching for “geriatric emergency unit.” U P S TAT E H E A LT H 5 37722 SUMU-_37722 1/4/13 2:05 PM Page 6 HEALTH taking steps toWard a more normal life for tHose WitH diabetes W ithout a pancreas that makes enough insulin, people with type 1 diabetes must continually check their blood sugar, track what they eat and when, and make sure they receive proper injections of the hormone insulin that is crucial to metabolism. whooping cough There are continuous glucose (sugar) monitors. And there are insulin pumps which deliver varying amounts of insulin. But these two technologies have not “talked to each other” – until now. Some patients from Upstate’s Joslin Diabetes Center are testing a new device that monitors blood sugar levels and transmits that information to an insulin pump. It sounds an alarm if the blood sugar level drops dangerously low while the person is asleep. If he or she awakes and responds to the device, it resumes monitoring with no change in insulin delivery. If there is no intervention, however, the device halts its programmed insulin infusions for up to two hours. “The ultimate goal is to be able to deliver insulin in a way the pancreas would normally deliver it to keep the blood sugars normal, to prevent the very high and low blood sugars that are problematic with current treatments,” says Ruth Weinstock MD PhD, division chief of endocrinology, diabetes and metabolism. “This is the first baby step to actually achieving a full artificial pancreas.” Listen to this interview at upstate.edu/ healthlinkonair by searching for “diabetes.” THE TIME TO LEARN ABOUT OUR ADVANCED STROKE CARE IS BEFORE YOU NEED IT. STROKE CENTER 6 U P S TAT E H E A LT H Why is a vaccine-preventable illness on the rise? hy is a vaccine-preventable illness on the rise? No, this is not a trick question. W The fact is, more than 34,000 cases of pertussis were reported to the United States Centers for Disease Control and Prevention, and 48 states – including New York – saw increases in infection rates in 2012. In Central New York, the number of cases of the vaccine-preventable illness, also known as whooping cough, has quadrupled from last year. The highly contagious bacterial infection causes a cough that lingers for weeks and can be deadly, especially to young children. Of the 16 deaths reported to the CDC, most were of infants under 3 months of age. “We are experiencing, statewide, a real serious problem,” says pediatric infectious disease expert Joseph Domachowske MD, a professor of pediatrics and microbiology and immunology at Upstate. The outbreak seems to be fueled both by adults who are unaware they need a booster vaccination and adults who don’t want their children to be vaccinated. “Whooping cough was always considered an infection of babies because they whoop when they get this infection, but adolescents and adults get pertussis as well. They develop a prolonged cough illness and are just as contagious as Joseph Domachowske MD the babies are. They have the worst cough illness of their lives, and this cough illness can last for months,” Domachowske says. He says incidence of whooping cough dropped to historic lows after a vaccine was made available; but around 2005, medical providers began to see resurgence. Older children and adults with prolonged cough illnesses were found to have pertussis, which explained why babies were still occasionally infected – and illustrates why it’s still important for adolescents and adults to be immunized. The vaccine does not confer lifetime immunity.● Listen to this interview at upstate.edu/healthlinkonair by searching for “whooping cough.” winter 2013 w w w. u p st ate . e d u 37722 SUMU-_37722 1/4/13 2:05 PM Page 7 HEALTH Richard Cantor MD with a patient. 5 improvements for pediatric emergencies I The center is open evenings and weekends. Its colorful furnishings are based on the Upstate Golisano Children’s Hospital. There are lots of comfortable chairs, and a big TV, a fish tank and fun-house style mirrors that provide entertainment. Nights & weekends: here for sick, injured kids BY SUSAN KEETER hese are situations familiar to any parent: the pediatrician’s office is closed, and your child has an ear ache, or a fever, or a nasty cut from a playground accident. You don’t think a trip to the emergency room is warranted, but your child needs to be seen by a doctor...and you can’t wait until morning. T The center is staffed by nine pediatricians, including McCrone, and two emergency medicine physicians. All are on the faculty at Upstate Medical University. Olamide Ajagbe MD, assistant professor of pediatrics, divides her time between working at the After Hours Care center, caring for patients in the children’s hospital, and teaching medical students and residents. She arrived at Upstate in 2011 after completing pediatric residencies at both the Nassau County Medical Center and the Mount Sinai School of Medicine. “I interviewed at many medical centers,” Knowing changes everything.SM ● “Family care” is a recognition that the child is not the only patient, that often a sibling and parents are also present. Child life specialists – made possible through donations from the Children’s Miracle Network – now staff the department to assist families. ● Wait times have decreased. Average time from walking through the door to meeting a triage nurse is 14 minutes; from triage to room placement is about 35 minutes; and from room placement to health care provider entering the room is 12 minutes. Upstate came up with a solution, and last February opened Upstate Golisano After Hours Care, the first of its type in the area. Located on the Community Campus, the After Hours Care center sees an average of 430 patients per month, and 2,893 children and teens were treated in the first six months. “It fills the gap between the pediatrician’s office and the emergency room,” explains Alison McCrone MD, medical director. “After Hours is for minor illnesses and injuries. We have lab and x-ray services, and can offer a 24-hour supply of prescriptions so parents can take their child home instead of running to a pharmacy.” f you haven’t been to the emergency department with an ill or injured child lately, you may not realize how things are changing. Here’s a run-down from Upstate’s Richard Cantor MD, director of the Pediatric Emergency Department: Olamide Ajagbe MD with Mia, 5, who was at Upstate’s Golisano After Hours Care because her “ear hurted.” Ajagbe explains. “Upstate had amazing, warm and welcoming people on its staff. “I am astounded by the need for after hours care in this community,” she continues. “Over and over, parents tell me how glad they are that this kind of service is available. It’s great working here.” The center sees patients from birth through age 21, so the staff see college students as well as toddlers. This winter, they expect to treat lots of patients for respiratory infections, fevers, and injuries from sledding accidents and other sports. ● Golisano After Hours Care is located at Upstate University Hospital’s Community Campus, 4900 Broad Rd., Syracuse (between the emergency room and the parking garage). Phone 315-492-KIDS (5437). Hours are Monday through Friday, 4 to 11 p.m.; Saturday and Sunday, noon to 11 p.m. Most insurances are accepted, all patients up to age 21 are welcome. winter 2013 ● Pain management is an important part of care now. Children are sedated before uncomfortable procedures, often by inhalation of medication rather than a needle injection. “The days of children crying in emergency departments are over,” Cantor says. ● A weight-based medication delivery system means a computer generates a child’s exact dosage, based on size, reducing medication errors. ● To help reduce exposure to radiation, Upstate participated in a national study to help determine which children with head injuries need CT scans and which don’t. Doctors also rely more on sonography for help quickly diagnosing children with, for instance, belly pain. Cantor says imaging that does not use radiation “is less expensive, less time consuming and less harmful to the child.” U P S TAT E H E A LT H 7 37722 SUMU-_37722 1/4/13 2:05 PM Page 8 ADVICE CHECK UP FROM THE neck up tHe Upstate Ethicist sHoUld patients leave against medical advice? A bout 1 percent of people who seek care at a hospital emergency department wind up leaving against the advice of the doctor. They may not like the doctor’s treatment plan. They may disagree with the diagnosis. They may start feeling better and decide they don’t want to be hospitalized. Regardless of the reason for a patient’s early departure, Jay Brenner MD, assistant professor of emergency medicine at Upstate, says it’s crucial that doctors make sure he or she is capable of making decisions, understands the diagnosis and is aware of the risks of refusing medical care — before the patient leaves. “Physicians should always take responsibility for their patients,” he says, noting that they should also respect a patient’s autonomy. “At some point, there is some personal responsibility here.” Patients who leave against medical advice present challenges for medical researchers. With no guarantee a patient will return to the same hospital, and no shared database, researchers cannot track what happens after the patient leaves. Thanks to new research at Montefiore Medical Center in the Bronx, they do know people who leave an emergency department prematurely have an increased risk of readmission within 30 days, and have higher death rate than those who are sent home when the doctor says they’re ready. 8 U P S TAT E H E A LT H How to feel like part of a committee BY RICH O’NEILL i was asked to join a committee at work, but after two meetings, it’s clear that the committee members have no voice. the leader calls us together to report what he’s doing, but our opinions aren’t sought or appreciated. it seems like a huge waste of my time. What can i do? Q How do you get yourself into the group and contribute in a way that brings the whole group toward its goal? One way to begin is by clarifying the committee’s job and your role in that work. There are three key words: Authority, accountability and responsibility. You can ask ‘What are we authorized to do? Who are we accountable to? What are we responsible for? What is our goal?’ Just asking can get the committee thinking and back on task again. a The assumption I have is that everybody in the room is there to help the leader be the best leader he or she can be. So you want to ask yourself, what might be useful for this leader in this situation? You might even ask the leader: How might I contribute in a way that will help you with your task here? my workplace has a shared kitchen. some coworkers are good about washing their dishes immediately while others pile their dishes in the sink. every week or so things pile up so much that my boss sends an email gently reminding us to clean up after ourselves. What else can she do? Q That sink with those dirty dishes reflects the team and the group culture. This is a great example of people living in their “person system” without a sense of responsibility to the rest of the people in the group. This can happen in any team, partnership, or family. In this case, what’s happening is people are acting as if they don’t have any relationship with other people. They don’t have any responsibility, any connection to the other people and shared goals. a One of the things the boss can do is call the whole team together and ask questions: ‘What kind of values do we want to have? Do we want to be responsible to each other? Do we want to work together as a team?’ Turn it over to the group. Say, ‘I’m concerned about this and how it reflects on our team.’ And then support people in creating a culture of responsibility. Make it clear that interpersonal responsibility and contributing to the team is what gets people ahead. The people who do not contribute, who stay inside their self-focused person and just do whatever they want without regard to the consequences for the team, those people don’t get ahead. You have to work together in order to function well as a team. ● Hear psychologist and researcher Rich O’Neill PhD during Upstate’s weekly radio show, Health Link on Air from 9 to 10 a.m. Sundays on WSYR. Submit your own question by emailing HLOA@upstate.edu. winter 2013 w w w. u p st ate . e d u 37722 SUMU-_37722 1/4/13 2:05 PM Page 9 ADVICE Feeding tubes are not for people with Alzheimer’s disease Q AT and WitH sHaron brangman md oward the end of Alzheimer’s disease, people lose their ability to chew and swallow. Family members often struggle with the proper approach once their loved one reaches this stage. Food, after all, is so symbolic of caring that to not provide nourishment may seem cruel. Sharon Brangman MD, division chief of geriatrics at Upstate, points out that Alzheimer’s is a terminal illness. “The end stages of the disease are very similar to having metastatic cancer of some sort. We know that we can’t make it all better. The focus is on taking care of the person and making him or her comfortable.” That should not include use of a feeding tube, she says. Q a What is wrong with feeding tubes? “After we’re out of the infant period, we are used to eating solid foods. The liquid nutrition that is put in a feeding tube is not absorbed by the body as well as solids are. In many cases, the liquid passes right through the person, and then he or she gets diarrhea. They can get skin irritation, and it can change the fluid balance in their bodies. “In the short term, it’s fairly easy to put the tube in. It’s a simple procedure that is often done right at the bedside with some local anesthesia. But in the long term there are a number of complications, and with ongoing research we are starting to question whether we’re causing more harm than good by inserting feeding tubes into older patients. “Inserting the tube into the stomach wall can give you local irritation. Some of the acid from the stomach can leak out and damage the skin. The tube can get blocked, the tube can get displaced and cause more damage, and it does not reduce the concern about food or fluids backing up from the stomach and getting into the lungs.” Without food and water, won’t a person starve or become dehydrated? Q a “Because the body is slowly starting to shut down, it is not missing food in the same way as you might be hungry when you are younger. “We know that sometimes when we try to introduce food and fluids to a body that is starting that downhill process, we can make that person uncomfortable. He or she can get nauseous or sick to the stomach. They can get cramps or diarrhea. There have been a number of studies that show we get to the same end point in almost the same amount of time whether we add a feeding tube or not. It doesn’t post- pone the end result, which is someone passing away, and it might actually make him or her worse in the short run. “Physiologically in terms of how the body is functioning in this end stage, there are little signals that are starting to turn off organ function. The brain isn’t working very well, and the kidneys may start to slow down, and also the ability to understand what food is for and the ability to eat is starting to change. We find it very common for people to start to pocket food in their mouths. They may chew and chew and never swallow. Or they may put food in their mouths and not know what to do with it. Or if they do swallow they may start coughing because food starts to go down the wrong way and into the lungs.” Q a What can be done instead? “Hand feeding is very important. It gives families that sense that they’re helping – as long as it’s not making the person uncomfortable or irritated in any way. “We give the person any food or fluids he or she can take by mouth, but we don’t try to force feed. Experiment with things that might be pleasant for eating. Some of the final taste buds to remain are those for sweet and salty things. We don’t worry about whether it’s low cholesterol or high cholesterol or too salty or too sweet. We figure out whatever that person wants, and we do our best to introduce it. If he or she doesn’t feel like eating, then we let it pass for that day or for that meal. “We always want to maintain hope, but we also have to temper that with what is realistic. That’s a very hard balance to strike.” ● Listen to this interview at upstate.edu/ healthlinkonair by searching “feeding tubes.” HoW to manage cancer fatigUe T he biologic effects of cancer and/or the side effects of its treatment leave more than 90 percent of patients overwhelmed by fatigue, so much so that everyday life activities become a struggle. As counterintuitive as it may sound, exercise may be the answer, says Cassi Terpening, a doctor of physical therapy who oversees Upstate’s Cancer Rehabilitation Program. “Moderate intensity exercise performed three to five days a week can decrease a person’s level of fatigue,” she says. Of course the type and duration of exercise is dictated by the person’s previous activity level and his or her goals. Walking, gentle biking, swimming and light strengthening moves are typical. Terpening says most people feel better after exercising. They sleep better. Their pain is lessened. Their mood is boosted. And they function better. “When they see the progress — and it doesn’t happen immediately — but when they see that change, I think it has a positive effect.” Join the program with a doctor’s referral by calling 315-464-6543. Physical therapy is offered at offices in East Syracuse, Manlius and Syracuse. Listen to this interview at upstate.edu/healthlinkonair by searching “cancer fatigue.” Knowing changes everything.SM winter 2013 U P S TAT E H E A LT H 9 37722 SUMU-_37722 1/4/13 2:05 PM Page 10 ADVICE For Caregivers – from Caregivers Coping with stress e may not be able to control what’s happening around us, but we can determine our reactions. That is one of the primary ways to cope with stress, whether it’s brought on by sudden illness, a hurricane or job loss, says Ruth McKay, a medical family therapist who has worked at Upstate eight years. W Ruth McKay MA, LMFT According to Ruth McKay, people who fare best under stress possess these traits: ● They have a level of intimacy with their friends and family so that they feel comfortable asking for help. “For some, that’s hard to do because it’s a change in their identities, and that can get in the way of dealing with stress – and can be a source of stress, too,” says McKay. “If your identity is that you’re a do-it-yourself, independent person, if the time comes that you need help, it changes your sense of who you are. And it can really change your sense about how the world is, too.” Friends and family may offer to help. McKay suggests having a list of things you can ask people to do for you. ● They accept that they have emotional reactions. Rather than beat themselves up for feeling angry or scared, for instance, they acknowledge their feelings and let them pass. They regularly make time for personal reflection or “time in.” Stressful situations may tempt a person to ask: why me? “Some people go to that place, and others don’t. If you’re somebody who is used to being more reflective, it’s less difficult when an existential kind of crisis comes up,” she says. ● They maintain routines as much as possible, sleeping and eating at the same times each day and continuing exercise regimens. McKay explains this provides comfort, “and it’s really good for mental health.” ● They create workable plans for what they need to do, breaking tasks into manageable parts. ● They know whom they can talk to, and when and how. “It’s not enough that you talk to people. Somebody could think ‘well I’ve had my vent for the day.’ But that’s not the same as being able to tell your whole story about what’s bothering you to someone who is really listening and who is giving you the time to finish talking,” McKay says. ● They take “mini-vacations” without leaving. They train themselves to take deep breaths and clear their minds every time the phone rings. Or, they think about nothing during their shower other than the warmth of the water and the smell of the shampoo. ● They sleep. Some people under stress need to sleep longer and can accomplish this by going to bed earlier. For those who struggle to fall asleep because they can’t turn off their minds, McKay recommends a relaxation tape. “If you listen to it every day for two weeks, it starts to become routine.” ● They know what they can do, immediately, to calm themselves. It may be taking a deep breath or sitting down instead of standing up. ● Overall, they make more positive comments than negative. McKay explains that humans have a survival mechanism that brings our attention to negativity because we needed to be alert to danger when we were living in caves. In modern times, we have to train ourselves to look for the positive. ● Attention: Caregivers, clip and save. Tips in every issue. exercise caUtion WHen googling ‘gallstones’ liver W hen Dr. Aakash Aggarwal searched “gallstones” on YouTube, the researcher found 228 relevant videos. Twenty percent came from health agencies; 70 percent came from independent sources; and 10 percent were medical advertisements. Aggarwal, a second year resident in internal medicine at Upstate, watched the videos and labeled 121 as “useful,” containing accurate and beneficial information. He found 66 to be misleading. He excluded 41 that were not in English or shorter than 1 minute in length. gallbladder Many of the misleading videos discourage surgical treatment and instead encourage natural flush therapies such as ingesting olive oil, apple cider and other substances in large quantities — therapies that are not proven effective and may even be harmful. Even more worrisome: Per-day viewership was significantly higher for the misleading videos than for the useful videos. Aggarwal presented his research at the American College of Gastroenterology Annual Scientific Meeting this fall. Considering that 50 million Americans seek health information online each month, Aggarwal believes health care agencies should seize the opportunity to develop accurate videos on a variety of medical topics – so people will be able to find correct information. 10 U P S TAT E H E A LT H winter 2013 Listen to this interview at upstate.edu/ healthlinkonair by searching for “gallstones.” w w w. u p st ate . e d u oz 37722 SUMU-_37722 1/4/13 2:05 PM Page 11 DID COMMUNITY AUTHOR have a heart defect? Cardiologist researches L. Frank Baum’s life, death BY AMBER SMITH Frank Baum is said to have died from congestive heart failure in 1919 at age 62, almost 20 years after the first of his legendary “Wizard of Oz” stories was published. Doctors at that time had limited means of diagnosing or treating heart problems. L With the benefit of hindsight provided by multiple biographies and papers that were written about the famous Central New Yorker, Harold Smulyan MD, a professor of medicine in cardiology at Upstate, questions some of the assumptions about Baum’s health and death. Baum, born in 1856 in Chittenango, a village east of Syracuse, concocted the adventures in the Land of Oz only after a “heart specialist” prescribed a sedentary job. “Many productive authors have had their careers cut short by serious illness, but this was not true in Baum’s case. It is probably accurate to say that heart disease finally enabled him, after a life of repeated failures in several occupations, to find his true calling,” Smulyan wrote in The Pharos journal this summer with co-author, Robert Pinals MD. Pinals was part of the Upstate faculty before joining the Robert Wood Johnson School of Medicine in New Jersey. Baum’s oldest son and biographer blames a congenital heart defect for Frank being a frail, sensitive child, less physically active than other children and prone to “heart attacks,” in which he fainted when emotionally stressed. Smulyan and Pinals suspect these episodes were not cardiac in nature. The stethoscope, which can detect heart murmurs, was widely used by doctors during Baum’s lifetime. Cardiac birth defects usually are accompanied by heart murmurs or a blueness of the skin — signs that the physicians say were never used in describing Baum. Some biographers theorize Baum had rheumatic fever, but Smulyan and Pinals aren’t convinced of that diagnosis either. “It is possible that he could have lived to age 62 with congenital or valvular heart disease, but this would not account for the progressive chest pain, which was his most prominent symptom,” they write. Illustration by W.W. Denslow, from The Wonderful Wizard of Oz by L. Frank Baum, 1900. Special Collections Research Center, Syracuse University Library. fainting episode after being disciplined at the military academy he attended in Peekskill. He had another at the age of 26, prior to his marriage to Maude Gage, the daughter of Matilda Gage, a leader in the Women’s Movement. “Afterward, he was apparently stable for many years and able to work at various occupations to support his growing family,” Smulyan and Pinals write, listing his various occupations: farmer, actor, playwright, variety store owner, business manager for a baseball team, newspaper publisher, traveling salesman. In 1897 at age 41, Baum developed severe nosebleeds with gripping chest pain. A doctor in South Dakota diagnosed “angina,” a term first used in 1772 to describe chest pain that was associated with exertion and which often radiated to the left arm. Today we know this as a symptom of coronary heart disease, but back then angina was not known to be related to a heart disorder. Baum’s life changed when he switched occupations. He began publishing a trade journal and in his spare time made up stories to tell his children and their friends about the fantasyland of Oz and a girl named Dorothy. “The Wonderful Wizard of Oz” was published in 1900. (And made into a movie in 1939.) The book’s financial success allowed Baum to lead a less healthful lifestyle, raising his risk for coronary heart disease. Smulyan and Pinals write: “He chain-smoked good cigars and upgraded his diet. He had meat and eggs for breakfast, with five cups of coffee laced with heavy cream and sugar. His dinner usually included a thick cream soup, roasted meat and a rich dessert.” Baum moved his family to a Hollywood mansion in 1909. Bad investments led to bankruptcy, and by 1914 he was grappling with a series of health problems. He suffered painful tics to one side of his face. His chest pain and At the age of 12, in 1868, Baum had an especially severe Knowing changes everything.SM continued on pg. 16 winter 2013 U P S TAT E H E A LT H 11 37722 SUMU-_37722 1/4/13 2:06 PM Page 12 IN THE KNOW Juntao Luo PhD holds a model of a polymer nanoparticle in his Upstate lab. 12 U P S TAT E H E A LT H winter 2013 w w w. u p st ate . e d u 37722 SUMU-_37722 1/4/13 2:06 PM Page 13 IN THE KNOW TUMOR receptor blood vessel Normal vessels have tight endothelium Angiogenic tumor vessels are leaky and permeable Seeking a safer, better way to deliver cancer drugs to tumors BY AMBER SMITH untao Luo PhD never imagined himself working on a cure for cancer. He had decided to be a chemist, and he set about earning a bachelor’s degree in chemistry and then a doctorate in polymer chemistry and physics from NanKai University in China. His training in material science laid a solid foundation for the research he does today in nanomedicine. J He completed post-doctorate work in a biomaterials lab in Canada, working with biomaterials known as polymers. Later, at the University of California at Davis, Luo’s mentor challenged him: Could he create a vehicle made of polymer to transport chemotherapy drugs directly into solid tumors? Luo, 36, joined Upstate’s pharmacology faculty in 2011 and continues his research on the smaller-than-microscopic transport vehicles known as nanoparticles — a promising new way to shrink cancerous tumors without damaging healthy cells around them. Carrying proven cancer drugs, the nanoparticles are injected into the bloodstream like any injectable medication. They are programmed to travel through blood vessels to solid tumors. Scientists are designing nanoparticles made of various materials, in search of the best combination. Nanoparticles made of lipids, for instance, were invented decades ago but are too large to diffuse into tumors efficiently and are removed from the blood stream too rapidly. The nanoparticles Luo works with are made of polymer. He says they have been effective against solid tumors in laboratory animals. In one study at UC Davis, the size of tumors shrank for days after injection, and one group of the tumors in the study subject disappeared entirely. Encouraged by those exciting results, Luo is optimistic that his laboratory work can be translated into a cancer treatment after the Food and Drug Administration approves testing in humans. Because these nanoparticles rely on drugs that are already proven safe and effective, he expects Knowing changes everything.SM the approval process will not be as lengthy as it would for a new drug. Polymers are made of molecules strung together. How a particular polymer behaves is determined by what molecule structures are included and in what order. Traditional polymer materials vary in size and don’t integrate well with other functions. However, Luo has invented a way to engineer the structure of a polymer nanoparticle to suit the medication it will carry. “In general, one nanoparticle may not be able to deliver different types of medications. You may need to design a nanoparticle for each medication,” Luo says. He adds that nanoparticles may need to be further tailored to individual patients, who may respond differently to medications depending on the stage and markers of the cancer. Dr. Luo’s nanoparticles carry the medication to the tumor site within 24 hours. Remnants of the nanoparticles are flushed from the body through the kidneys. While they are designed to work most effectively in solid tumors, nanoparticles may also help fight some cancers of the blood, Luo says. Luo says some types of nanoparticles show promise in penetrating the blood-brain barrier, which could lead to new methods of treating cancer in the brain. Recent studies have shown that polymer nanoparticles can be used in the treatment of inflammation and Parkinson’s disease. Luo’s work in the field of cancer research allows him to contribute exciting, if poignant advances. He was a college student majoring in chemistry in 1997 when his mother was diagnosed with breast cancer. She underwent surgery and chemotherapy before she died in 2003. “At that time, I had no idea about cancer treatment,” Luo says. “If I had the knowledge I have right now, at least I could have given her hope.” ● winter 2013 U P S TAT E H E A LT H 13 37722 SUMU-_37722 1/4/13 2:06 PM Page 14 COMMUNITY carbon dioxide levels impact HUman performance A s we look for ways to save energy in “green” buildings, researchers from Upstate suggest we not skimp on air quality. A study that looked at groups of volunteers in office-like chambers found significant differences in decision-making capabilities among the volunteers depending on the concentration of carbon dioxide in their chambers. Those with the highest levels had the most trouble completing a series of nine simulated experiences designed to measure decision making. Usha Satish PhD and Siegfried Streufert PhD from Upstate’s Department of Psychiatry and Behavioral Sciences collaborated on the work with researchers from the Energy Technologies Division of the Lawrence Berkeley National Laboratory. Our bodies produce carbon dioxide with every exhalation. The gas is also emitted by the combustion of coal, natural gas and oil. High concentrations of carbon dioxide indoors have been associated with impaired work performance, increased health symptoms and poorer perceived air quality. “Direct adverse effects of carbon dioxide on human performance may be economically important and may limit energy-saving reductions in outdoor air ventilation per person in buildings,” the team wrote in the journal, Environmental Health Perspectives. The scientists call for additional research. CO2 Listen to this interview at upstate.edu/ healthlinkonair by searching for “carbon dioxide.” 14 U P S TAT E H E A LT H Much thought, artistry behind the children’s hospital memory tree BY SUSAN KEETER nyone who visits the children’s hospital can see the red tree sculptures that frame its “treehouse” entrance. Last fall, a new sculpture — the memory tree — was added to a small courtyard near the main entrance. A Colorful epoxy bugs and butterflies perch on the tree’s branches, bearing the names of 24 children whose families helped conceive the memory tree. Multi-colored metal leaves are etched with the names of the 148 children who died at Upstate since 2009, the year the children’s hospital opened. “Most of our work with patients has happy endings,” says Leanna Severance RN, retired pediatric nurse-manager, “but not always.” Since the children’s hospital opened, pediatric specialists have operated on 20,350 children, treated 91,202 in the emergency rooms, and been able to send 15,937 children home from hospital stays. But, sometimes no amount of expert medical care can save a child, which is why this memory tree is so important. Leola Rodgers, children’s hospital administrator, explains. “We’ve always done something to remember each child. But we had a desire to offer something consistent, permanent and affirming to commemorate all the children who have died at Upstate.” To craft a plan for a memorial for the new children’s hospital, Upstate’s family advisory council met with Severance, Rodgers and others. Creating The Tree AccuFab, Inc. of Ithaca was selected for the memorial project. Gary Wojik, president, describes the inspiration for the memory tree: “We were taken by the architect’s design, especially the treelike forms at the entrance of the children’s hospital. Our idea was to design something that related to the winter 2013 building, a sculpture with a lyrical bent, so anyone would feel comfortable and drawn to it. We wanted it to have a playful quality. “Since ancient times, trees have symbolized life,” continues Wojik, “and are the perfect icon for this memorial.” Prior to building the full-scale tree sculpture, AccuFab presented drawings and a model. A variety of metal leaves were created, and parents selected the types and colors to be added to the tree. Stainless steel tubing was used for the tree sculpture because it is strong and relatively maintenance-free. The steel was given a non-reflective, random-brush finish to create a warm feel. The epoxy butterflies and bugs on the tree are based on the interior ornamentation of the children’s hospital. The Memorial Service A dedication ceremony for the memory tree sculpture was held on Sunday afternoon, Oct. 14. Patients’ families and Upstate staff and chaplains were in attendance. Among the speakers was Ran Anbar MD, chief of pediatric pulmonology. He shared the following with the 300 people who were there: “I’ve learned three things from the children for whom I have cared. First, most every child I have spoken with believes in continued existence after death,” he paused. “Secondly, children have helped me understand that we can communicate with loved ones who have passed, and receive answers. We can actually interact with them.” In closing, Anbar described the third lesson: “The consequence of the first two is that irrespective of death, your relationship with your loved one can always continue to develop and grow.” October 14 had started as a cold and rainy day. By afternoon, the sky was blue, and a warm sun shone on the memory tree, and the people around it. ● w w w. u p st ate . e d u 37722 SUMU-_37722 1/4/13 2:06 PM Page 15 COMMUNITY Upstate expands services at Community Campus Construction will soon be under way on the new $15 million Upstate Cord Blood Bank, which will be attached to the west side of the hospital complex. (See story, page 4.) Later this year, Upstate expects to open CNY’s first geriatric emergency unit in the Emergency Department at the Community Campus. (See story, page 5.) ew programs have been added and services expanded at Upstate University Hospital’s Community Campus in the months since the medical campus on Onondaga Hill became part of Upstate. N Among them are the bariatric, general and thoracic surgery services and the Breast Care Center, all of which are accepting new patients. The surgery offices are in the Physician Office Building North, and the breast center is in the POB South, across the hall from Wellspring’s women’s imaging center. The region’s first pediatric after hours care center opened in February. (See story, page 7.) In an area separate from the regular emergency department, pediatricians and ER personnel treat minor injuries or illnesses and can facilitate a smooth transfer to the pediatric emergency department at Upstate’s Downtown Campus if that becomes necessary. Upstate Golisano After Hours Care, for newborns through age 21, is open from 4 to 11 p.m. weeknights and noon to 11 p.m. weekends. Upstate’s urology and obstetrics/gynecology services have expanded into offices in the POB North. The obstetricians work closely with midwives who are part of the hospital’s new midwifery program and with the new team of ob/gyn hospitalists, physicians who are always in the hospital to assist women during labor and delivery. These services augment the many existing services at the Community Campus, including a variety of surgeries and diagnostic procedures, and private physician offices. Connect with these specialties by calling Upstate Connect at 800-464-8668. ● Upstate’s wound care program now occupies offices on the fifth floor of the hospital. Also on the fifth floor, the Sleep Center takes care of pediatric patients. Another addition is the overnight Epilepsy Monitoring Unit, a service unique to Central New York for adults who are newly diagnosed with epilepsy or who require seizure monitoring. It is located adjacent to the intensive care unit. ■ 1. Bariatric Surgery Center ■ ■ 2. Breast Care Center ■ 5. Golisano After Hours Care 6. Upstate Orthopedics ■ 7. Sleep Center ■ 8. Upstate Urology ■ 3. Cord Blood Bank site ■ 4. Epilepsy Monitoring Unit 8 1 4 5 2 7 6 3 Knowing changes everything.SM winter 2013 U P S TAT E H E A LT H 15 37722 SUMU-_37722 1/4/13 2:06 PM Page 16 COMMUNITY L. Frank Baum From Onondaga Historical Association OZ author – continued from page 11 irregular heartbeats became more frequent. He developed trouble breathing and abdominal pain. In December 1917 he had his gallbladder removed, along with what was described as his “badly inflamed” appendix. The surgery was said to have further damaged his heart. Baum also developed “kidney trouble.” After five weeks in the hospital, he went home and was confined to his bed, where he remained for the rest of his life. Baum continued to write, smoking cigars and taking morphine for pain. He finished “Glinda of Oz” before lapsing into a coma. Just before death, his heartbeat was erratic and his breathing difficult. “This might reasonably be ascribed to atrial fibrillation or frequent atrial or ventricular premature beats and congestive failure,” Smulyan and Pinals say, describing common cardiac diagnoses of today. “Even if Baum died, as we suspect, of coronary heart disease, his physicians would probably not have been able to recognize it.”● Listen to this interview at upstate.edu/healthlinkonair by searching for “Wizard of Oz.” 16 U P S TAT E H E A LT H Muheyidin Mohammed, center, meets weekly for tutoring sessions with HopePrint volunteers Sean Haley, a medical student, and Chelsea Ingrassia, a nurse practitioner student, at his African International Restaurant at 717 N. Salina St., Syracuse. Students befriend refugees through HopePrint BY JIM MCKEEVER pstate medical student Sean Haley sums up his life journey this way: “I always end up in the place I’m supposed to be, planned or not.” U “Once you see poverty, it never leaves your head,” Haley said. In summer 2011, he went to Thailand with a group that was fighting against human trafficking, especially of children. Those places include El Salvador, Thailand, New York City – and Syracuse’s north side, where Haley helped found the not-forprofit organization, HopePrint. These experiences abroad, and the day-today challenges he sees among refugees in Syracuse, have shaped his worldview. “We’re all motivated by what brings us happiness and joy,” he said. “What brings me joy is serving. HopePrint provides that – it’s international but in our own back yard, it’s culturally diverse, urban and underresourced.” Working with refugees, Haley said, “is a constant reminder of how lucky we are. They provide such a different view. I asked a Somali man why he was wearing flipflops in six inches of snow, and he said he had to go to the doctor. The mentality is ‘survival first.’ It’s humbling.” For his academic success and HopePrint work, Haley won a SUNY Association of Council Members and College Trustees scholarship. “He is an exceptional medical student whose work with the refugee population is unprecedented in our community,” wrote Susan Stearns PhD, assistant dean of student affairs. Two summers ago, Haley found himself delivering a couch to a refugee family on Syracuse’s north side. He and Nicole Watts, HopePrint’s executive director, talked about the needs of the city’s refugee population, which grows by several hundred each year. Haley’s no stranger to different cultures and different lands. Several years ago, he went to El Salvador as a leader of a Young Life group. There, he worked with Upstate physician Joseph Domachowske MD at a clinic during the day, and helped build a school at night. It also is a time management challenge for Haley to help run HopePrint while going to medical school and pursuing his master’s degree in public health. “In a way, it makes medical school easier,” he said. “It helps you remember that there’s a world outside of Weiskotten Hall, one with serious problems.” HopePrint tries to tackle some of them. Among other services, it provides refugees with English language instruction and college preparation courses (11 refugees were accepted into Onondaga Community College), helps with socialization and navigating the health care and social service systems. It’s a simple concept, really. “People just need someone to walk alongside them,” said Haley. ● Listen to this interview at upstate.edu/healthlinkonair by searching for “HopePrint.” winter 2013 w w w. u p st ate . e d u 37722 SUMU-_37722 1/4/13 2:06 PM Page 17 WORK GOOD JOB Meet Mark Torres, hospital systems engineer ark Torres of Dryden joined Upstate last summer after teaching for two years at Cornell University in Ithaca. He is a systems engineer by training, and he was eager to apply his knowledge to health care. M His day: “I spend a lot of time looking at a bunch of data that’s already been collected and measured and trying to make sense of what it’s saying — because it will tell you a story if you look at it and try to determine cause and effect. “If you look at the process from start to finish, you typically have numbers at the beginning, let’s say ‘admissions,’ and at the end, let’s say ‘discharges.’ You can compute the length of stay between the two. But what you really want to do is figure out what happens along the way, during the stay. Who sees the patient, what happens, how long does it take? That’s what you really want to find so you can focus on what’s the biggest holdup, what’s the biggest bottleneck?” His mindset: “We focus on the concept of total quality management. It’s all about the customer, what the customer is willing to pay for, what’s valuable for him or her. Our patients aren’t willing to pay for all the time they spend in the emergency department waiting room, waiting to be seen. What they really want to do is come in, be treated and then leave. So in general, we try to look for improvements and efficiencies where we can find them.” His skills: Science and math are important, but examining customer interactions can be subjective. “Some of those things are more difficult to measure than what we would do in a traditional engineering field, but we try to measure as much as we can. Because if we can’t measure it and we can’t collect data on something, then we can’t say that we’re certain about it.” His favorite question: “Somebody working in an organization is told how and what to do, but what often gets lost through repetition is asking why. I think one of our strongest tools is to observe a process and to ask why. Why is this really happening? Because in some cases it’s because ‘well, that’s how we’ve always done it.’ Or, ‘we don’t really know.’ “Hopefully, having this kind of questioning attitude about the process is contagious. Ultimately it’s the process that achieves the end state, which is the product or the quality. A lot of times people get blamed for doing something poorly, but in reality it’s the process that allows those things to happen.” His limitation: “We want to preserve that non-quantifiable providerpatient relationship. That’s kind of sacred. If you can improve efficiencies all around that, then the patient can still receive that individual care that we provide.”● Listen to a related interview at upstate.edu/healthlinkonair by searching for “efficiency expert.” Knowing changes everything.SM winter 2013 U P S TAT E H E A LT H 17 37722 SUMU-_37722 1/4/13 2:06 PM Page 18 FOOD Caffeine alert too mUcH is dangeroUs H igh-caffeine energy drinks can be dangerous, leading to heart irregularities, neurological complications, brain injuries and even death. People drink the beverages for help staying awake, but depriving our brains of sleep is not wise, says Sanjiv Patel MD, a family physician and assistant professor at Upstate’s Binghamton campus. “These energy drinks should not be taken lightly," Patel told WBNG channel 12 action news. “We’re not consuming CocaCola, Pepsi, or Jolt Cola. We’re consuming a product that contains an insurmountable amount of caffeine." Officials at the Food and Drug Administration in October said they were investigating five deaths and a nonfatal heart attack that happened within a three-year period that may be linked to energy drink ingestion. In its coverage of the investigation, The New York Times said the number of reports that the FDA receives about any product it regulates usually understates by a large degree the actual number of problems. A person’s reaction to caffeine depends on how much he or she usually drinks, his or her age, body mass, medication use and other health conditions, according to the Mayo Clinic. Too much can cause: ● Insomnia ● Nervousness ● Restlessness ● Irritability ● Stomach ● Fast upset heartbeat ● Muscle tremors Thomas Kiernan with “small bites,” delicious fresh-fruit desserts prepared with an eye toward portion control. Cooking up comfort HOSPITAL KITCHEN DISPENSES FRESH, LOCAL FOODS BY JEFF KRAMER okes about bad hospital food seem hopelessly outdated the moment you enter Thomas Kiernan’s block-long kitchen at Upstate. Whether it’s celebrating a perfect pot roast or heaping praise on local squash, the one indispensable ingredient in every recipe is passion. On this bright, brisk November day, even the humble chickpea has Upstate’s top chef whipped into a zestful froth. Those bland little orbs, you see, are the magic ingredient in an orange muffin recipe that draws raves. J “It’s a phenomenal recipe because it’s so light and airy,” enthuses Kiernan. “If I didn’t tell you (it has chickpeas), you’d never know.” Plus, he notes, “you’re getting a protein and a complex carbohydrate.” A towering, bearish man on bad knees, Kiernan wears a big white chef’s hat and has a title to match: Regional Executive Chef for Morrison Healthcare, the contracted food service company that manages Upstate’s Food and Nutrition Services Department. At Upstate alone he oversees 50 production workers who each day crank out 1,050 patient meals plus enough cafeteria victuals to sate 2,500 customers. Menus must accommodate nine different diets and 273 food allergies. The kitchen purchases nearly $3 million of food annually. And yes, they cater. Kiernan also has general oversight for food 18 U P S TAT E H E A LT H The hospital kitchen on the second floor, Downtown Campus. winter 2013 service at 13 other hospitals in New York and Pennsylvania. “It’s a huge undertaking,” says Kiernan, but he seems to feed off it ... literally. After all, to get the perfect muffin recipe, one has to taste a lot of muffins. It’s the same with meatloaf, orzo salad and post-op whole wheat fajitas. “By the time you’ve eaten it, we’ve eaten it 10 times.” With the unveiling in December of The Great Living Menu, Kiernan’s taste buds are working overtime. Morrison spent almost three years developing the concept, which is transforming Upstate’s food service from “almost steam table cooking to almost short-order cooking.” Kiernan came to Upstate more than four years ago, and has been on a mission ever since to emphasize fresh, local ingredients. Before that he was Chef de Cuisine at Cornell and Executive Chef at SUNY Cortland. He’s a graduate of the prestigious Culinary Institute of America in Hyde Park. It’s an impressive background, yet like all chefs Kiernan has had a few failures, none more glaring than combining fresh crab and watermelon into perhaps the worst-tasting appetizer in gastronomic history. Kiernan was trying for something fresh and fun for the opening of the Upstate Golisano Children’s Hospital in 2009. Watermelons were in season and particularly succulent. w w w. u p st ate . e d u 37722 SUMU-_37722 1/4/13 2:06 PM Page 19 FOOD BY frUits, veggies may Help smokers QUit P revious studies have shown that smokers eat fewer fruits and vegetables than nonsmokers. Researchers from the University of Buffalo explored that correlation with a national telephone survey of 1,000 smokers age 25 and up. They found people who ate the most fruits and vegetables were three times more likely than those who ate the fewest to remain tobacco free at 1-month and 14-month followups. Fruit and vegetable consumers also waited longer to smoke their first cigarette of the day and scored lower on a common test of nicotine dependence. “Foods like fruit and vegetables may actually worsen the taste of cigarettes,” Jeffrey Haibach, first author of the study, stated in the university website, Futurity.org Researchers also theorize that nicotine dependency may be lower for people who eat a lot of fruits and vegetables, or that the high fiber content of produce makes people feel fuller, and less likely to confuse hunger with an urge to smoke. Their work appeared in the journal, Nicotine & Tobacco Research. Curtis Darbey uses local Byrne Dairy milk to make macaroni and cheese. He also had a beautiful shipment of crab legs. Why not combine the two, he figured, and add a spritz of fresh lime juice? Free, Multi-Session Classes QUIT SMOKING FOR GOOD & FOR FREE! “It is the most disgusting flavor combination I’ve ever tasted,” Kiernan says, laughing in his windowless office. “You know when they spray farms with that liquid rotted fish juice? That is what it was like.” Did you know that Upstate’s healthLink center offers free smoking cessation classes? You’ll get the extra support you need to kick the habit. Happily such stinkers are rare and, needless to say, that experiment was not served. Despite his experimental bent, Kiernan gets that he’s not here to reinvent the meal — just to make it taste better with less salt and fat. His crew spends a lot of time upgrading classics. “A good lasagna, a good cobbler, there’s something comforting in that,” he says. “Food is part of healing.” ● Karoline Simpson prepares food trays for patients. Knowing changes everything.SM winter 2013 call 800.464.8668 to find out when the next classes start and how to sign up. U P S TAT E H E A LT H 19 37722 SUMU-_37722 1/4/13 2:06 PM Page 20 FOOD calorie BURN T he exact number of calories you burn is affected by your age, body size and composition, and your level of physical fitness. For example, a person weighing 176 pounds who does the activity for an hour would burn this many calories: Balsamic Roasted Portobello Sandwich on Whole Wheat Sandwich Thin Bowling 462 calories BY BILL GOKEY ere’s a hearty vegetarian meal that is simple to prepare and provides a classy, satisfying taste. Milking a cow by hand 258 calories Ingredients H 4 tablespoons balsamic vinaigrette dressing 4 slices (.75 ounces each) provolone cheese ½ cup cream cheese 4 individual lettuce leaves ¼ cup roasted garlic spread* 4 roasted portobello mushrooms 4 garlic cloves, peeled* 4 ounces canned roasted red peppers, drained ¼ teaspoon olive oil, canola blend* 4 100-percent whole wheat sandwich thins ¼ teaspoon ground black pepper* Preparation *Ingredients make up the roasted garlic spread. Preheat oven to 350 degrees. 1. Prepare oven roasted portobello mushrooms: Clean mushrooms and dry well. Gently remove black gills from mushrooms with a spoon and discard. Brush both sides with balsamic vinaigrette. Fencing competition 756 calories 2. Place mushrooms, gill side down, on lightly oiled baking pan. Roast in 350o oven for 10 to 12 minutes, until tender. Then brush mushrooms with remaining dressing and cool. Preheat oven to 375 degrees. 3. Prepare the garlic spread: In medium mixing bowl, toss garlic cloves with oil and pepper to coat. Then place garlic onto a small square of aluminum foil, and seal edges to form a loose pouch. Place that on a baking sheet and bake in 375o oven for 20 to 25 minutes, until garlic is caramelized. Remove from oven and allow to cool. Then, using a mixer, whip cream cheese on medium speed for 3 minutes. Add garlic and whip for another minute. Scrape sides and whip for another 30 seconds Painting indoors 162 calories 4. Make the sandwiches by spreading a tablespoon of the garlic spread on the bottom and top of each thin. Lay a slice of provolone across the bread. Then add 1 ounce of roasted red peppers, the mushroom and then the lettuce. Running at a 6-minute mile pace* 834 calories Serves four. *roughly Scott Ulberg’s marathon pace. See page 22. Nutritional information, per serving 267 calories 129 milligrams of cholesterol 13 grams of fat 560 milligrams of sodium 29 grams of carbohydrates 7 grams of dietary fiber Bill Gokey is executive sous chef for Morrison Healthcare, which provides food services for Upstate Medical University. 20 U P S TAT E H E A LT H winter 2013 w w w. u p st ate . e d u 37722 SUMU-_37722 1/4/13 2:06 PM Page 21 LEISURE Jason Meany teaches scuba diving and brokers dive trips through his company, Deep Stop Scuba. breatHing easier WitH astHma tHroUgH yoga xercise scientists at Syracuse University showed how yoga can improve the lives of women with asthma in research recently published in the Journal of Alternative and Complementary Medicine. e Interest in scuba leads toward a respiratory therapy career ason Meany taught science at Christian Brothers Academy, the school Dr. Joseph Domachowske’s children attended. Now Meany takes classes at Upstate, where Domachowske is professor of pediatrics and microbiology and immunology. J This twist of life occurred when Meany found his way into respiratory therapy by way of scuba diving. Meany says he always felt a draw toward the ocean, even as a child growing up in Liverpool, attending CBA. A track and field standout, he graduated in 1998 and went to Clemson University to run track. He got a degree in physical science and education and then ran professionally for Adidas for a year. Later he got a master’s degree from LeMoyne College and took a job teaching science at his high school alma mater. Soon after, he married and enjoyed a Caribbean honeymoon with his wife, but kicked himself for not becoming certified to scuba dive before their time in Anguilla. That became a priority for him when they returned home to Camillus. Meany took classes at Freedom Scuba USA in Baldwinsville for three years and later taught classes there. He did open water dives in Skaneatelas Lake, and on trips to the Outer Banks of the Carolinas and Knowing changes everything.SM Aruba. His wife has no interest in diving. “She loves to read. She sits on the beach and reads, and I scuba dive,” Meany says. He chaperoned an ecology trip to Florida at CBA; a year later he began organizing his own trips for CBA students, some of whom – like the Domachowskes – brought their families. Meany’s trips include some scuba diving, along with education. The trips have grown in popularity, and so has Meany’s interest and expertise in diving. Last year he escorted student groups to Bonaire in the Caribbean. This year, groups will go to Bermuda, Key Largo and Australia’s Great Barrier Reef. Meany will continue offering trips and scuba training through his company, Deep Stop Scuba, but he quit teaching to pursue a health career in respiratory therapy. The science of respiration during scuba is very similar to the science of respiratory therapy. Yoga, used as an alternative therapy to improve symptoms associated with various diseases, has also been shown to improve autonomic body functions in healthy people. Researchers at SU’s Department of Exercise Sciences wanted to see if 10-week yoga classes would improve heart rate variability and quality of life in women with mild to moderate asthma. Nineteen women were divided into two groups, one who did yoga and the other who did not. They answered questions about respiratory symptoms and did a handgrip exercise to assess their heart rates. “Significant improvements in quality of life were observed with the yoga training, while no changes were found in the control group,” the researchers wrote. “Resting hemodynamic measures improved significantly in the yoga group compared to the control group.” That’s news that can warm the hearts of yogis everywhere. He is a few years older than the typical student, with an unusual background, but Upstate faculty members were so impressed with Meany’s enthusiasm and expertise that he became one of the class tutors. Later this year, using the pool in the Campus Activities Building, Meany plans to offer scuba lessons for Upstate faculty, staff and students. ● winter 2013 U P S TAT E H E A LT H 21 37722 SUMU-_37722 1/4/13 2:06 PM Page 22 LEISURE good READS A uthor Ann Patchett has five novels and two nonfiction books to her name, and one of her fans – Nancy Schreher – works in Educational Communications at Upstate. Schreher, who majored in English in college, first read Patchett’s acclaimed “Bel Canto.” 2 hours, 38 minutes, 49 seconds Medical student wins Empire State Marathon BY AMBER SMITH e runs every day. No matter whether he spends the day studying, or working all day and leaving the hospital at 8:30 p.m., third-year medical student Scott Ulberg, 24, always gets his run in. He logs 110 to 120 miles per week. H “It’s about a group of diplomats and business people who are held hostage by terrorists somewhere in South America. The relationships that develop between the hostages and the terrorists become very interesting, very touching. They work a lot of things out. So, in the end when the police come in shooting, you think, ‘why are you doing this? These people are getting along well.’ “It’s not a matter of having time. It’s a matter of making time," he says. “I just pack my bag in the morning and throw it in my trunk. There are no excuses.” His training paid off Oct. 21 when Ulberg won the Empire State Marathon in Syracuse with a time of 2 hours, 38 minutes and 49 seconds. It was Ulberg's third marathon. He ran the New York City marathon last year in 2:37:44, and the Long Island Festival of Races in 2010 in 2:53:08. Since coming to medical school at Upstate, Ulberg has been active in running events throughout Central New York. He ran cross country at Stony Brook University, and for his high school on Long Island before that. Now he trains with Kevin Collins, the running director at the YMCA. “Patchett has a knack for taking a situation and making you think of it in a different way. There are two sides to every story.” Schreher also recommends “The Patron Saint of Liars,” Patchett’s first book. “It takes place in Kentucky at St. Elizabeth's home for unwed mothers which is run by the Catholic church. This young lady, Rose, grew up in California, got married and then came to the realization she is not in the place that she should be. She leaves her husband, even though she is pregnant, and drives to Kentucky and becomes a resident at St. Elizabeth's. It’s a perspective you wouldn’t ordinarily get. You meet all these young ladies and learn their stories. I find it very similar to ‘Bel Canto’ in the sense that you get a very intimate view of the story from the inside.” Ulberg has been working on his running form, trying to stay up on his toes. He believes that – along with the hilly course between miles 7 and 20 – may have contributed to the leg cramps he experienced during the 26.2-mile run in October. He wore compression shorts, a tank, black gloves and Nike Lunaracers. While he expected he would finish toward the front of the pack, he planned to run his own race. “I wasn’t winning the whole race. I was in second place around mile 13,” Ulberg recalls. Of the runner he was following, he says, “he pretty much came to a walk around mile 21.” That’s when Ulberg passed him, although Ulberg wound up stopping three times in the final two miles to stretch his calves. His parents were waiting for him at the finish line – along with a heavy finisher’s trophy and a bottle of chocolate milk. ● Stephen D. Cannerelli/Courtesy of the Post-Standard Listen to this interview at upstate.edu/healthlinkonair by searching for “marathon.” 22 U P S TAT E H E A LT H winter 2013 w w w. u p st ate . e d u 37722 SUMU-_37722 1/4/13 2:06 PM Page 23 LEISURE Lessons from Upstate snoWboarding pUts Wrists, spleen at risk S nowboarders, especially young males, are at risk of injuring their arms and/or internal abdominal organs after a fall while snowboarding. That’s the conclusion of a study in which Alison McCrone MD analyzed all of the medical charts for children ages 6 to 21 who were brought to a pediatric trauma center in Buffalo between January 2000 and March 2007 with injuries related to snowboarding. Why I love singing BY SUE MILLIMAN ’ve been singing as long as I’ve been talking. My first solo was in elementary school. I did a verse of ‘White Christmas,’ and then the chorus came in. I My mother sings. She is the choir director, and we sing in the choir at church. I’ve always had music. It’s my sanity. You have a bad day at work or at home or whatever, but you go to rehearsal or sing in a concert, and it’s like being in a different world. It’s a social thing. It’s kind of a bond to participate in something together, together as a choir. You’re getting across the message of the music. It’s a bond. You go through rehearsals, and sometimes you think ‘oh, my goodness, we’re never going to get this.’ And then you get to the concert, and it comes together. I like all kinds of music. I sing with the Syracuse Chorale. We do some classical concerts. Then we also have a cabaret in the springtime. I also sing with Master’s Touch Chorale. That’s a Christian singing group. We do everything from Beethoven to bluegrass. I rehearse once a week for Syracuse Chorale and once a week for church choir from October to June. Then for the Master’s Touch, we have concerts or rehearsals every other week. Of course at home, I’m warming up and going over parts that I need to. I sing in the shower. That’s kind of where I Hear Sue Milliman at upstate.edu/whatsup Knowing changes everything.SM do my warmups. The shower has great acoustics. And I sing when I’m driving. I’m sure people think I’m crazy driving down the road. It’s so hard to pick one favorite song. My favorite hymn, I would say is ‘Amazing Grace.’ And a favorite song would be ‘Somewhere Over the Rainbow.’ One of the ladies who I sing with in the Syracuse Chorale went to the Berkshire Choral Festival in Sheffield, Mass., and she came back raving about it. The festival is four weeks during the summer. I went the following summer and have gone every summer since. I go for one week. It’s like fantasy camp for musicians. You’re just surrounded by music all week. There are people from college age up through the 70s. Music affects people emotionally. You can go to a concert or be immersed in a show and just get caught up in the music, and it’s hard to put into words. There’s something that I learned a long time ago that says ‘it’s easy to believe that God hears music above all else.’ It can carry you to a different place. It’s emotional. It can be spiritual. It can be uplifting. It can be what you need it to be. Of 213 patients during that time, 79 percent were male, and 55 percent were in the 12- to 14year-old age group, McCrone wrote in the March issue of the journal, Pediatric Emergency Care. Today McCrone is an assistant professor of emergency medicine and medical director of the Upstate Golisano After Hours Care at the Community Campus. Among the injuries in those patients, 58 percent were wrist or shoulder injuries; 27 percent were head or neck injuries; 19 percent were trunk injuries; and 10 percent were knee or leg injuries. McCrone says of those with trunk injuries, 74 percent involved injury to internal organs, most commonly the spleen. She also found that children who fractured or dislocated their upper extremities were at higher risk of suffering abdominal or pelvic trauma. In another study from the University of Vermont College of Medicine in Burlington, researchers looked at patients of a ski resort clinic from 1988 to 2006 and determined that wrist injuries were the most common snowboarding injury. I would be lost without music in my life. I know that. ● Sue Milliman of Lakeland, a human resources assistant at Upstate’s Community Campus, has a passion for music that began in childhood. She sings soprano and has played the piano since age 5. winter 2013 U P S TAT E H E A LT H 23 37722 SUMU-_37722 1/4/13 2:06 PM Page 24 Non Profit Org. US Postage PAID Permit No 110 Syracuse, NY 750 East Adams Street l Syracuse, NY 13210 doctoral student at Upstate is among the group of scientists who are first to demonstrate – in a living organism – how formins help organize muscle structure. Formins are a group of proteins that govern cell shape, adhesion, division and positioning. A E NC T AR IS SC I IS SCIE A RT C IS EN E IS A RT S C I E N C E 12.1650812 31.2M ELsk T 1S SCIE R A NC S I IS Working with worms, Mi-Mi pinpointed the location of two formins that act as key proteins involved in muscle movement. She also showed how a reduction or absence of those proteins stunted muscle growth. Mi-Mi suggests that what she demonstrated in the worm are likely to hold true in other species. David Pruyne PhD E Lei Mi-Mi had her research paper, “Formins’ Muscle Building Routine,” published in the July 9 issue of The Journal of Cell Biology. Her photograph, at right, was chosen for the cover. She works in the lab of David Pruyne PhD, an assistant professor of Cell and Developmental Biology. Lei Mi-Mi