Winter 2012 Upstate Health
health lifestyle magazine produced by academic medical center in Syracuse, NY -- Upstate Medical University
Health UPSTATE UPSTATE MEDICAL UNIVERSITY Winter 2012 Should you have life-saving apps 20 finding time ways to heal headaches CONTENTS “It was truly the most powerful, energizing experience of my life.” Health 4 5 –Erin, pagE 11 Teen undergoes surgery, radiation for rare brain tumor This engineer has a personal interest in building Upstate’s new cancer center Doctor shares five approaches to headache treatment 8 Cancer takes the forefront in movies, TV Advice 11 Why prostate cancer screening still makes sense Community 14 15 Father and son oncologists strike that work/life balance Recycling pacemakers Work 17 In every issue The job of a recreation therapist Food 18 19 5 Lessons from Upstate 14 The Upstate Ethicist Farfalle with Sundried Tomatoes and Walnuts 6 Good To Know 21 Calorie Burn Science explores chewing gum to lose weight 10 Advice for Caregivers from Caregivers 22 Good Reads 11 Questions & Answers 23 The Humorist 12 In the Know 24 Science is Art is Science Tasty, filling low calorie meals, snacks Leisure 21 22 Six reasons to ski Good for You 2 On the cover: Father and son oncologists Drs. Bernie and Michael Poiesz with their dogs. photo by robErt MEscavagE Why I love martial arts U P S TAT E H E A LT H 4 Immunizations winter 2012 7 Preventing injuries 8 Apps that could save a life 17 Making decisions 18 Fat 20 Music w w w. u p st ate . e d u WHAT’S UP AT UPSTATE Health Winter 2012 PUBLISHER Wanda Thompson PhD Senior Vice President for Operations Look for the various ways of treating headache, from our new doctor of integrative medicine, and read about the new treatment we offer for severe frostbite. Our experts in caregiving share their best advice for helping someone with a swallowing disorder. Our weight-loss surgeons — the most experienced in the region — explain what to expect from weight-loss surgery. EXECUTIVE EDITOR Melanie Rich Director, Marketing and University Communications EDITOR-IN-CHIEF Amber Smith DESIGNER Susan Keeter PHOTOGRAPHERS Susan Kahn, Robert Mescavage, Debbie Rexine, William Mueller, Steve Sartori 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, Upstate University Hospital at Community General, 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. For more information, visit us online at www.upstate.edu or phone us at 315-464-4836. Upstate Health offices are located at 250 Harrison St., Syracuse, NY 13202 You will meet a recreation therapist who believes in her work, a pediatrician who likens adolescence to space exploration and an oncologist and researcher whose son is, almost literally, following in his footsteps. You will find advice about what to read, why to ski and whether to attempt an ultra-marathon. And, a researcher shares a look under her microscope — something you will find on the back page of every issue. We hope you enjoy your time with Upstate Health. Our radio show Stay current on medical issues with the weekly Health Link on Air radio program, which airs from 9 to 10 a.m. Sundays on Newsradio 570 106.9 WSYR. Or, listen anytime by visiting www.upstate.edu/healthlinkonair where each interview is archived. Your feedback For corrections, suggestions and submissions, contact Amber Smith at 315-464-4822 or email@example.com FOR ADDITIONAL COPIES call 315-464-4836. T hank you for reading Upstate Health, a magazine produced by Upstate Medical University that inspires healthy living throughout Central New York. We provide stories about medical care and wellness, of course, but we are proud to share much more. Got a story idea? Want a free subscription, or extra copies for your office? Contact us at firstname.lastname@example.org or by phone at 315-464-4836. Your health 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. BY THE NUMBERS 434 2,298 people who volunteered at Upstate Medical University for the american cancer society’s third national cancer prevention study. 75,674 visitors, from oct. 1 to Dec. 31 of 2011, to pages for various Upstate University hospital patients on caringbridge.org, a free website that connects people experiencing a significant health challenge to family and friends. Knowing changes everything.SM trauma patients admitted to Upstate in 2011. another 7,227 were treated and released. this makes Upstate the second most active trauma center in new york state. 22,000 maximum number of pounds that Upstate University hospital’s heliport can handle, which accommodates all but two military helicopters. winter 2012 U P S TAT E H E A LT H 3 HEALTH the benefits of immunizations Surgery, radiation treat teen’s rare brain tumor first PATIENTS S uspicion about whether vaccines cause autism remains rampant among parents, “despite all of the very hard work of epidemiologists who have already exonerated vaccines as a cause or to be implicated in autism,” Upstate’s Joseph Domachowske MD told ABC Radio recently. He is a professor of pediatrics, microbiology and immunology who believes people have lost sight of the importance of vaccines. “People have forgotten about the infections that vaccines can prevent, and there’s a misconception that vaccines are riskier than developing a vaccinepreventable infection,” says Domachowske. A majority of parents vaccinate their children, he adds, “but they seem to want to know a whole lot more than in the past before they agree to do it.” Government vaccine safety experts, including the October 2011 statement from the Institute of Medicine, and doctors from the American Academy of Pediatrics agree that the measles, mumps and rubella vaccine is not responsible for recent increases in the number of children with autism, signs of which may appear around the same time children receive the vaccine. In the decade before the measles vaccination program began, up to 4 million Americans were infected and up to 500 died each year. By comparison, fewer than 200 cases were reported in 2011 in the United States. In 2011, the Centers for Disease Control and Prevention tracked a high number of measles cases, many of which were acquired from international travel, even to developed countries. France alone reported more than 10,000 cases of measles in 2011. That’s concerning because measles, a viral disease that spreads easily, can lead to pneumonia and encephalitis — and kills nearly 200,000 people worldwide every year. 4 U P S TAT E H E A LT H G The pituitary gland is in the lower center of the brain, behind the eye and in front of the brain stem. rowing 8 inches in just over a year made Cole Bush, 15, stand out in ways he never intended. The rapid growth left him feeling uncomfortable and awkward, and then the Watertown High School student began suffering from constant, pounding headaches. “They felt like something was pounding against my skull,” Cole says. “It would stop for 10 minutes and come back.” He was taking Advil four times a day and lying down when he needed rest, but this dramatically limited Cole’s active life. Cole started playing sports at the age of seven when he signed up for Pop Warner football. He played modified lacrosse and basketball in seventh grade, and modified baseball and basketball in eighth grade. He played a season of junior varsity football for the high school, but by spring his headaches had become so bothersome he stopped playing sports. He was missing so much school that his grades dropped an average of 10 points in most subjects. His pediatrician sent him for an MRI in May 2009 which revealed a tiny spot on his pituitary gland, something not unusual. As the headaches became more intense, a second MRI was ordered in January 2010. The spot had grown to the size of a quarter. The pediatrician referred Cole and his parents, Matthew and Holly Bush of Watertown, to Walter Hall MD at Upstate University Hospital in Syracuse, where the spot on his pituitary gland was identified as a rare secreting pituitary adenoma, a benign tumor which was making too much growth hormone. The pituitary gland is the body’s “master control gland” which makes hormones that affect growth and the functions of other glands. Pituitary adenomas usually don’t affect children. They grow slowly, over decades, so a diagnosis usually doesn’t occur until well into adulthood. The only way to stop the growth of an adenoma is through surgery and radiation. Cole’s surgery took place in the spring. Surgeons reached the tumor through Cole’s nose, by making a small hole in the base of his skull. They were able to remove about 85 percent of the tumor. Holly Bush says the tumor had begun to grow through part of Cole’s sinus and attach to one of the main blood vessels in the brain, so surgeons could not reach that part safely. After the surgery, Cole was treated with Gamma Knife radiation, which should cause his hormones to return to normal. His mother says Cole seems to be “back to normal,” enjoying playing sports with his friends. He has regular followup appointments with his Upstate doctors. by rEbEcca MaDDEn. WatErtoWn Daily tiMEs, ExcErptED With pErMission winter 2012 w w w. u p st ate . e d u HEALTH Lessons FROM UPSTATE NON-STEROIDAL ANTI-INFLAMMATORIES A 46-year-old woman with chronic back pain was swallowing 200 mg of naproxen twice a day – for 20 years. She came to Upstate’s emergency room with abdominal pain, nausea and vomiting. Mark Raulli’s business is constructing the steel structure of the Upstate Cancer Center. Leo Heaphy E Building on a memory ngineer Mark Raulli, of Raulli & Sons, Inc., pored over his company’s bid to build Upstate’s new Cancer Center. It was a meticulous process that required details of how the job would be carried out and what equipment would be used, along with cost projections and timetables. It was a dark time for Raulli, and not just because it was late February in Syracuse. His wife’s father, Leo “Nipper” Heaphy of Phoenix, faced stomach cancer. The 90,000-square-foot structure on which Raulli was bidding would eventually house the doctors, nurses and staff who were taking care of his father-in-law. Heaphy developed weakness in his arms and legs in fall 2010. His doctor ordered a variety of scans, and a spinal tap. The man kept getting weaker, and finally was unable to steady himself to walk. His doctor referred him to Upstate in November 2010. Caregivers found a tumor attached to the outside of Heaphy’s stomach, near where the esophagus connects, and they discovered the cause of his weakness. A rare encephalitis caused by the cancer was squeezing his spinal cord. Knowing changes everything.SM Surgeons removed Heaphy’s stomach and some of his esophagus in December 2010. He was released from the hospital for rehabilitation about a week before Christmas, and his family brought him home to celebrate the holiday. Several weeks later, a scan revealed spots on his liver. Heaphy began chemotherapy, but when the spots tripled in size within a month, he made the decision to halt chemo and live out his life. “He got weaker every day,” Raulli recalls. Heaphy rallied for a party on July 3 at Green Lakes State Park. He was able to kick back and drink a beer with his brother and enjoy his extended family. “That was about as happy as he could be,” Raulli says. During surgery, doctors located multiple ulcers and scars within the last segment of the small intestine, called the ileum. They also found that diaphragmlike strictures had developed, “an extreme manifestation of ongoing intestinal wall damage,” Divey Manocha MD writes in October 2010 in the Journal of Clinical Medicine Research. Manocha is an internal medicine fellow in geriatrics. The woman’s ileum was removed, and she recovered well. Manocha, an internal medicine fellow in geriatrics, says the ileum and colon are most susceptible to deleterious effects of non-steroidal anti-inflammatory drugs known as NSAIDs, which include naproxen, ibuprofen and others. Ulcers, erosions and diaphragms that form can lead to bowel obstruction. He says problems like this are seen more frequently in the elderly, but a person’s risk increases based on the dosage and how long he or she has been taking it. NSAIDS also increase the risk of bleeding. Heaphy died two days later, at age 71. He donated his body to science, through Upstate. Two days after that, Raulli’s wife, Wendy, learned she was pregnant. Raulli’s company won the bid to erect the steel and is working at the construction site in front of the hospital. “It’s hard to put into words,” Raulli says of the pride he feels in helping to build the Upstate Cancer Center. “It means a lot.” winter 2012 U P S TAT E H E A LT H 5 HEALTH HEADache ways to treat GoodTo Know ADVANCED CARE FOR SEVERE FROSTBITE A mputation is often the treatment for severe frostbite, but an interventional radiologist at Upstate offers therapy that could change that. Dianbo Zhang MD uses the drug, tPA (tissue plasminogen activator) to dissolve blood clots and restore circulation to limbs that have frozen. It is commonly used to treat certain types of strokes. He says patients have a significantly better chance of avoiding amputation when trans-arterial thrombolysis is administered within 24 hours. A study of severe frostbite patients in Utah showed 41 percent who did not receive tPA lost fingers, hands, toes or feet. Only 10 percent who received tPA had amputations. Zhang inserts a catheter into the femoral artery in the patient’s groin and injects a dye that, combined with Xray, allows him to see blockages. The medication is directed to the area of injury and given over 12 to 24 hours. Central New Yorkers are most familiar with stage 1 frostbite, known as frostnip. It’s when we stay outside for too long and our fingers start burning or tingling. We go inside, remove our gloves, and our pale fingers turn red as we warm up. People with stage 2 frostbite temporarily lose some sensation as skin freezes and blisters form. If deep tissue is affected, frostbite is classified as stage 3 or 4. Blisters that form fill with blood, and people lose the ability to feel their fingers. These are the patients Zhang is poised to help with tPA. Some damage from severe cases of frostbite cannot be reversed, but even in those instances Zhang says he may be able to reduce the amount of tissue that must be amputated. 6 hronic headaches have a variety of triggers and a variety of potential remedies. They plague some 45 million Americans – along with their health care providers, who grapple with ways to offer relief. What works for one patient may be ineffective in another. “One of the most important things to understand is, many times it is not just one thing that causes headache,” says Kaushal Nanavati MD, an assistant professor in family medicine who is new to the Upstate faculty. Nanavati practices “integrative medicine,” merging a traditional allopathic medical training with alternatives such as nutrition and herbal therapy, Chinese medicine, homeopathy and Ayuerveda, ancient Eastern Indian medicine. Zhang joined Upstate in July after fellowships at Massachusetts General Hospital/Harvard University and Brigham and Women’s Hospital. Though Nanavati is open to the plethora of treatments, he cautions headache sufferers who try alternative remedies “to at least inform their health care providers. Some of these remedies may have a negative effect.” U P S TAT E H E A LT H winter 2012 w w w. u p st ate . e d u HEALTH Kaushal Nanavati MD, assistant professor of family medicine, Upstate Medical University Integrative medicine specialist shares treatment approaches to headaches On your own you could: • Make sure you drink adequate amounts of water; up to 80 percent of headache sufferers are dehydrated. A doctor may prescribe: • Blood work to check for a magnesium deficiency, which can trigger migraines. • Medications to prevent or treat recurrent headaches. • Imaging scans to rule out tumors and other abnormalities • Physical therapy, if appropriate. • Sleep study if sleep apnea is suspected. • Cognitive behavioral therapy, or counseling. • Keep a food diary to help identify and eliminate trigger foods. • Hyperbaric oxygen therapy, shown in a small study to have benefit. • Check your sleep habits. Some headaches are associated with muscle tightness, which may occur if you sleep in a chilly room, or with your neck in an abnormal position. • Miniature nerve stimulator, implanted beneath the skin, to treat profoundly disabling headaches. • Maintain a schedule for eating and physical activity. • Do something to reduce stress. A nutritionist may recommend: • Increased consumption of foods rich in magnesium, such as nuts, legumes, leafy greens, grains, red meat and seafood. • Riboflavin, which in high doses can significantly reduce the number of migraine headaches. • The amino acid, 5 hydroxytryptophan, which helps the body produce serotonin. • Coenzyme Q10 or fish oil supplements to reduce inflammation. • An elimination diet in which you remove all common trigger foods (caffeine, alcohol, nitrates, nuts, aged cheese, wheat) and methodically replace them one by one to determine your sensitivities. Knowing changes everything.SM A mind/body practitioner may suggest: • Yoga. • Acupuncture, which has been shown to be more effective in relieving headaches than taking a prescription. • Reflexology. • Massage, Reiki, or other touch therapy. • Biofeedback or relaxation therapy. • Chiropractic adjustment, particularly for tension type headaches. • Hypnotherapy, or self hypnosis. An herbalist may advise: PREVENTING INJURIES T raumatic injury is the leading cause of death during the first four decades of life. Most trauma is preventable, “depending on the choices we make and the prevention we initiate,” says Upstate Trauma Outreach Coordinator Steve Adkisson RN. “I tell people that you’re going to have that feeling — I call it the roller coaster feeling — that feeling in the pit of your gut. It’s your instinct saying something’s not right. You get it when you’re in a roller coaster and you’re going over the top and your instincts say ‘get out of here, you don’t belong here,’ but we do it anyway. “Prevention, a lot of time, is listening to those instincts. “With younger people, I tell them, you’re going to be with someone and they’re going to be doing something that you know they shouldn’t be. Your roller coaster feeling is going to kick in. Learn to listen to that feeling. Keep away from those situations.” • Peppermint oil as a topical pain reliever. • Melatonin, especially if sleep disturbance is an issue. • Butterbur to relieve spasms and decrease swelling. • Feverfew to relieve muscle spasms. winter 2012 U P S TAT E H E A LT H 7 HEALTH APPS THAT COULD SAVE A LIFE S oliant Health, one of the largest healthcare staffing companies in the country, recently compiled a list of smartphone apps with lifesaving potential. Among the freebies are: iTriage Find out what might be causing your symptoms, and then locate the nearest treatment options, complete with maps and turn-byturn directions. Store your own medical information, and learn about various medications and procedures. ICE Standard Store your important medical and contact information so that “in case of emergency” – what ICE stands for – first responders can gain quick access. You can even set ICE as your lock screen. WebMD Check your symptoms, learn about a variety of conditions, drugs and treatments and find first aid information. You can also search for nearby doctors, hospitals and pharmacies. i911 This app provides a one-touch 911 dial button (or buttons for other contacts you identify) which eliminates you having to open your phone app, click on the keypad and input the numbers when you have an emergency. Look for these and other health apps in iTunes, the Droid marketplace and AppWorld. Movies, TV spotlight characters with cancer Films such as The Express (pictured above) feature main characters with cancer. N ot long ago, cancer was spoken about only in whispers. Today, lead characters in movies and TV shows face cancer with a mixture of realism, omissions of the mundane and compressed drama. Awareness campaigns are part of the reason. In addition, writers and directors have “either gone through it or have people in their lives who have gone through it” and want to base their work on the real world, says Tula Goenka, a breast cancer survivor and professor of filmmaking at Syracuse University’s S.I. Newhouse School of Public Communications. Of course the shows don’t always have happy endings. Upstate nurse practitioner Lisa Cico says “Terms of Endearment,” in which the daughter dies from breast cancer, is one of the saddest movies she has seen, but she knows other shows feature cancer survivors. “I think it’s good to have both out there because the reality is, you will see both.” Mary Kate Hartmann of Syracuse, who cared for her fiance Evan Schoeberlein until he died from Ewing’s sarcoma in July 2008, says dramatizations often overlook the emotional impact that cancer has on couples, and the everyday moments they share during treatment. “They don’t show the time you are sitting there with a loved one getting chemo, and it doesn’t last 45 minutes; it lasts five hours. They don’t show the tiny TV screens and the chairs that aren’t comfy or the time when you are waiting two or three days to hear how a scan looked. You don’t see all that waiting.” Breast cancer survivor Stephanie Zumbuhl of DeWitt says the portrayal of cancer in movies can spark conversation. 8 U P S TAT E H E A LT H winter 2012 The gravity of her disease didn’t register with her daughter until they watched “The Express,” the movie about Syracuse University football star Ernie Davis, who died from leukemia. “My girl said ‘wait a minute. He had cancer, and he died?’ That was tough.” The Big C Cico, the nurse practitioner, appreciates Showtime’s “The Big C,” in which the main character has melanoma and refuses treatment almost the whole first season. “I see that a lot in people,” Cico says, “where they don’t want to try anything and then change their minds.” She says many of the story lines are realistic, such as when the woman enrolls in a clinical trial, when she makes friends with a patient who dies, and when her husband loses his job and has to fight for health coverage. But Upstate oncologist Michael Poiesz MD takes issue with the “highly unprofessional” flirtatious interactions the woman in the show has with her oncologist. He says it makes him wonder if viewers understand they are watching fiction. “The Big C” contains some strong messages, such as the husband’s heart attack at the end of season two. “Nobody gets off scot-free in a show about mortality,” writer Darlene Hunt explains on “The Big C” blog. “And I really liked re-emphasizing that truth we bring up a lot in this show: We are all dying. “Just because someone has cancer, it doesn’t mean they’re the next to go. They could live another 50 years while the seemingly healthy person next to them may not.” w w w. u p st ate . e d u HEALTH Mom: Erin Tapia of Baldwinsville Baby: Isabella Grace Born: March 27, on her due date Weight: 8 pounds, 2.4 ounces Mom: Jennifer Godlewski of Syracuse Baby: Jackson Born: Oct. 31, four days after due date Weight: 9 pounds Mom: Danielle Booher of Syracuse Baby: Lucas Born: Oct. 8, two days before due date Weight: 8 pounds, 5 ounces Three MoMs who delivered babies in 2011 at Upstate’s Community campus Labor began: after a busy day of work, school, and family activities that included a science fair and karate belt testing for baby Isabella’s 8- and 9-year-old stepbrothers. Once home, Tapia looked to her husband, James: “I sighed and said, ‘we’re ready; she can come now.’ My contractions started 10 minutes later.” Delivered by: certified nurse midwife* Susan Kneeland, on a blanket on the delivery room floor, as Tapia desired. What was special: Tapia wanted a ‘hypnobirth,’ which relies on deep relaxation and involves lots of breathing and freedom of movement. “It was very free and empowering. It was amazing,” she recalls. “The whole time I just listened to my body’s signals and James, Susan, and Lisa, my labor nurse, enabled me to do whatever I needed to feel comfortable and strong throughout.” Tapia says her midwife was calming. “I felt like she was a sister of mine or somebody I’ve known always. It was just incredible. “It was truly the most powerful, energizing experience of my life.” Labor began: with cramping overnight Oct. 29. As it became apparent that she was in labor the next day, Godlewski and her husband, Jody, came to Upstate’s Community General campus. Medication helped her rest while contractions continued into Halloween morning. Delivered by: certified nurse midwife* Jan Beaman. What was special: Godlewski, a physician assistant, has seen several births, and those experiences helped ease her mind about her own delivery. Still, she was excited. Labor began: with contractions every half hour all day Friday, quickening by Saturday to about 5 minutes apart. Booher and her husband David waited for his mother to come to the house to care for baby Lucas’s 2-year-old sister Madelyn. Then they drove up the hill to Upstate’s Community General campus. A wheelchair and admissions bracelet was already waiting and they quickly settled into a birthing suite. “I wanted Mom in the delivery room. It was wonderful to have a big room. She wasn’t in the way,” Booher says. Delivered by: certified nurse midwife* Jan Beaman. She enjoyed the Jacuzzi tub, in which she soaked for about 20 minutes that morning. “I got myself out and realized the contractions were getting much closer together.” Her husband and her mother were present for Jackson’s birth. Godlewski admits that she was in pain, “but it was the best experience I could have hoped for.” What was special: If she had been asked beforehand, Booher says she would have declined to directly assist in her son’s delivery. But Beaman asked her in the throes of labor. “His shoulders had just come out. She said ‘put your hands under his shoulders, and on your next push, just pull him up.’ “Looking back, I’d recommend that to any mom, so you’re the first one to touch your baby. As soon as they’re born, you can cuddle and hold them.” *WHAT IS A MIDWIFE? C ertified nurse midwives are licensed midwives who are also nurses. They can prescribe medications, order diagnostic tests and care for the health needs of pre-adolescent, adolescent and adult women. Midwives provide gynecological care, primary care, health screenings, family planning and menopausal counseling, and they manage normal pregnancy, in-hospital childbirth and postpartum care. Although a midwife in New York State is considered an independent practitioner with expertise in the care of essentially healthy women, he or she is required to have a “collaborative relationship” with a board certified obstetrician-gynecologist. Nurse midwives Kneeland and Beaman, who is also a nurse practitioner, are part of Advanced Ob-Gyn, a practice with offices in Auburn and Syracuse. Myron Luthringer MD and Jennifer Marziale MD are board certified physicians in that practice. Knowing changes everything.SM winter 2012 U P S TAT E H E A LT H 9 ADVICE For Caregivers – from Caregivers How to feed someone with a swallowing difficulty W e like to break bread with others, and we like to think a person who is eating is on the road to recovery. But when a loved one has trouble swallowing, “we don’t realize how dangerous food can be,” says speech therapist Kim Brown of Upstate University Hospital. Choking is an obvious hazard. Aspiration pneumonia develops more subtly, after food particles or liquids slip down the windpipe and infect the lungs. Getting adequate nutrition into a person who struggles to swallow can be a challenge, even for professional caregivers. Brown, along with speech language pathologist Jenna Gardner and clinical dietitian Traci Hourigan have picked up a few tricks in their careers. Here are their strategies for keeping mealtime safe, and palatable: • Focus on eating, without the distraction of television or side conversation. Host separate social gatherings that aren’t centered around mealtime. • Some diseases leave people unable to smell food, while other diseases may prompt a heightened sense of smell. Just be aware of this. • Take advantage of the times of day you are hungriest, and make that the biggest meal. • If you are pureeing food, Brown acknowledges that “it’s a big challenge to make it look presentable and make it taste good.” But it can be done. She says to soften foods with milk. To thicken foods, use a cornstarch-based product such as Thick-It, or pureed mashed potatoes. • Be deliberate with each bite. Maybe serve a single food at a time. • Eating smaller meals more frequently may help get in adequate calories, if big meals tire your loved one. Drink fluids (including soups and shakes) throughout the day. • Increase calories by adding cream, butter, sour cream or milk to recipes, and jellies or honey to sweeten foods. • To increase protein intake, use milk instead of water in recipes and add powdered milk to cereals, puddings and mashed potatoes. Make smoothies with yogurt, milk and peanut butter. Add eggs to casseroles. Grate cheese on favorite foods. • Avoid feeding someone in bed. Sitting the person upright in a chair can help direct food away from the airway. • Coach your loved one to put a bite of food in his or her mouth, then lower chin to chest before they swallow. This may seem awkward, but it helps block the airway so food goes down the esophagus to the stomach. • In cases of dementia, swallowing difficulty is often a matter of cognition, of forgetting to swallow, so this can be coached, too. • For some people with facial weakness or oral cancers, straws are a necessity – although Brown is not a fan of straws, since using them makes it difficult to know how much liquid a patient takes in. • Recognize that taste buds may be compromised in some diseases, leaving food unappealing. Someone who suffers a brain injury, for instance, may dislike foods he or she used to crave. Attention: Caregivers Clip and save. Tips in every issue. 10 U P S TAT E H E A LT H winter 2012 • Thicken beverages with avocado, which adds healthy fats without changing flavors. • Enliven pureed foods with hot sauce, herbs or spices. Blend with your loved one’s taste in mind. • Restaurants can be tricky, but they are not necessarily off limits. Gardner knows patients who bring portable blenders out to eat. Others disassemble foods from the menu, breaking apart a hamburger, for instance, into edible chunks. • Some people on pureed diets don’t mind the taste of jar baby food. Preserve your loved one’s dignity by serving the food on tableware rather than from the jar. • The thinnest liquids (water, broth) can cause the most problems, particularly for people with a loss of sensation, which can happen after a stroke. Since they can’t feel where the liquid is going, they are at risk of aspirating. • Be extra careful when feeding foods of mixed consistency, including chicken noodle soup, which blends broth and noodles and vegetables, and dry cereal, which blends milk with crunchy morsels. Breads are another treacherous food since they can crumble apart when eaten. • Oral care after meals is an important step in preventing aspiration. Help your loved one brush his or her teeth, or at least inspect the mouth after eating to remove any leftovers. • Keep a food journal, noting what and how much your loved one ate at each meal. This will help track nutrition and pinpoint any problem foods. And monitor weight weekly so you can alert health providers of changes. w w w. u p st ate . e d u ADVICE Q A AND WITH JAMES ALEXANDER MD What to do about heavy menstruation Menorrhagia has many causes. Gynecologists have many methods of diagnosis and treatment. Upstate’s James Alexander MD explains: Q How much is too much? Many women in my practice are shocked to hear it’s really quite a small amount. It’s about five tablespoons of blood for each menstrual cycle. A “But, it’s very subjective. If things are staying the same, then that probably defines you and the way that you are. If there’s a significant change, that’s the time to address the issue and meet with your gynecologist.” Q A What causes menorrhagia? Heavy bleeding is not a diagnosis. Heavy bleeding is cause to seek a diagnosis. “There can be structural problems within the uterus, like fibroids or polyps. There can be low-grade or even quite severe infections of the uterus that can cause heavy bleeding. You could have, for example, a clotting disorder, or you could have an abnormality with your platelets. The platelets are the little sticky substances in your blood that help you clot. You could have a pre-malignant or malignant condition in your uterus that could result in bleeding. “Defining the cause is critical to tailoring the appropriate therapy.” Q A How do you make a diagnosis? Part of the workup for this is a good history — asking the right questions, finding out when this is occurring, how long it’s lasting, is there a history of this in your family — and then doing a really good physical exam and further defining from there, based on the age of the patient and based on the symptoms, what else needs to be done. “Sometimes it’s simply, ‘let’s initiate a therapy and see how it goes.’ Other times, it requires further evaluation.” James Alexander MD is a board-certified gynecologist at Upstate University Hospital at Community General. Knowing changes everything.SM Q A What about treatments? You tailor the medical treatment to the problem. For example, if someone has thyroid dysfunction, if someone has a platelet dysfunction, if someone has leukemia, you need to address those issues head on. Treat the problem and usually the bleeding issue will resolve on its own. “More typically we’re using things like estrogen and progesterone, most commonly in the form of birth control pills. We use these in teenagers and we use these all the way up until the menopause in appropriately selected women. It’s very, very effective therapy. Most women find tremendous relief with hormonal therapy. “Another way of delivering the progesterone which is very effective is to use a progesterone IUD. That’s a device that’s placed in the uterus and stays in place five years and gives excellent relief of heavy bleeding. Actually about 30 to 40 percent of women stop bleeding altogether — which is fine if it’s medically induced. “Deciding on a treatment can really put women at an impasse in deciding: is my heavy bleeding more significant than my desire to get pregnant? If there is a desire for pregnancy, we need to come up with other ways. Sometimes you can use something as simple as ibuprofen with each cycle, and that will reduce your menstrual bleeding.” Q A Is surgery an option? For the last five years or so, all of our surgery has been laparoscopic, where you just have several small incisions, you’re in the hospital overnight and home the next morning. “Sometimes we’ll do something called an endometrial ablation. There’s a number of different ablation technologies available, using either electrical energy or hot water to destroy the endometrial lining. About 50 percent of the time after this procedure women won’t have periods any longer.” winter 2012 WHY PROSTATE CANCER SCREENING STILL MAKES SENSE W hen the U.S. Preventive Health Task Force recommended recently that healthy men skip routine PSA tests to detect prostate cancer, Upstate’s Gennady Bratslavsky MD disagreed. Bratslavsky leads the Department of Urology as chair and professor of urology. Since the prostate-specific antigen test was introduced more than 20 years ago, the United States has seen a steady and significant decline in prostate cancer deaths. “Such a trend cannot be explained away by citing healthier lifestyles and better eating,” he says. Screening for prostate cancer does not mean treatment will follow. “Many prostate cancers diagnosed today may not require therapy or treatment.” Bratslavsky acknowledges that PSA results can be affected by benign prostate enlargement or other conditions but says that’s no reason to stop screening. Not offering a PSA “could deprive many men from early treatment of their cancer to avoid this potentially devastating disease.” Bratslavsky says he has cared for young, otherwise healthy men with advanced disease that could have been caught earlier had they undergone PSA screening. “Early diagnosis of cancer in any form is some of the best advice medical practitioners can offer, because it saves lives. Nevertheless, the risks and benefits of prostate cancer screening need to be honestly discussed with the patient.” U P S TAT E H E A LT H 11 IN THE KNOW weighing Y o u r o p t i o n s What to expect from weight loss surgery I f you or someone you care about is considering weight loss surgery, choosing a surgeon and a hospital with a track record is important. Upstate University Hospital’s weight loss surgery program has been in place since the 1970s, and its surgeons handle about 450 cases per year. They train doctors to become weight loss surgeons, and they are involved in research related to weight loss. The program is comprehensive, meaning it includes in-house dietitians and pre- and postoperative services, and it serves as the region’s tertiary center, meaning it welcomes referrals of patients with complications. But scheduling surgery isn’t as simple as circling a date on the calendar. Would-be patients must be morbidly obese — at least 100 pounds overweight, or a body mass index of 40 or more, or a BMI of 35 or more along with weight-related health conditions such as high blood pressure or diabetes. They must also have made multiple weight loss attempts and be willing to attend an informational session to learn how surgery would change their lives. Then they can obtain an appointment with a surgeon and begin what may be a three- to six-month or longer process before any operation. During that time, they will undergo medical and psychological evaluation, attend support groups, learn the lifestyle and dietary modifications that will be necessary for surgery to be successful, and lose 5 percent of their weight as a demonstration of their seriousness. Upstate bariatric surgeons Taewan Kim MD (below) and Howard Simon MD (at right) have performed more than 3,000 bariatric surgeries. “We fully realize that most patients would prefer to be operated on right away, but that’s actually counter-productive,” says Howard Simon MD, director of Upstate’s Bariatric Surgery Center. Already an experienced surgeon, Simon began offering laparoscopic gastric bypass surgery at Upstate in 2002. Taewan Kim MD was a fellow then. Today, Simon has completed about 2,000 cases, and Kim has completed about 1,000, making them the most experienced laparoscopic weight loss surgeons in Central New York. They tell their patients that surgery, alone, will not take the weight off. “The operation is necessary, but it’s not sufficient,” Simon emphasizes. Patients will regain the weight if they become grazers, constantly nibbling on small amounts of food. “The other thing is, you’ve got to exercise,” Simon says. Patients range in age from the late teens to the late 60s. Many have diabetes, which usually resolves after surgery. Many also see improvement in high blood pressure, high cholesterol and sleep apnea, and women are likely to experience improved fertility. The gastric bypass used to take six to eight hours. Today, Simon and Kim usually complete the surgery in an hour. They keep their leak rate low by hand-sewing the jejunum, the middle part of the 12 U P S TAT E H E A LT H winter 2012 w w w. u p st ate . e d u IN THE KNOW Types of weight loss surgery Surgeons at Upstate tailor weight loss surgery to individual patients, but of the three main operations, the gastric bypass is most popular. It allows patients to lose the most weight. small intestine, to the stomach. Nationally 2 to 3 percent of gastric bypass patients experience leakage; at Upstate, leaks affect fewer than ½ percent, Simon says. The majority of weight loss surgeries today are minimally invasive procedures, accomplished through a few tiny holes. Most of the surgeries done in the traditional “open” style are on patients who have had previous stomach surgeries. After surgery, patients start consuming liquids and then soft foods before they are able to eat a regular diet — just smaller portions than they were used to. Patients have four or five followup appointments the first year, two in the second year, and then annually after that so that surgeons can track progress and measure vitamin levels, which can be impacted by the surgery. Weight loss surgery patients face a slightly increased risk of ulcers, so they must avoid smoking and non-steroidal anti-inflammatory drugs. Kim says patients on the day of surgery are generally excited about the prospect of improving their lives. The day after, faced with nausea and belly pain from surgery, about two-thirds of them experience “buyer’s remorse” and lament why they chose surgery. Ask those same patients about their decision six months later, Kim says, “and they’ll tell you ‘this is the best thing I ever did.’” ESOPHAGUS GALL BLADDER LIVER STOMACH DUODENUM JEJUNUM COLON Bypass SMALL INTESTINE LARGE INTESTINE Sleeve Band Sleeve – part of the stomach is removed, leaving behind a stomach about the size of a banana. Band – a band wraps around the upper part of the stomach, creating a pouch about ½-cup in size. The band can be periodically adjusted. Sleeve — The stomach is made smaller, thus limiting the amount of food that can be eaten at once. You feel full sooner and stay full longer. You eat less so your body uses fat for energy. Band — The stomach is made smaller, thus limiting the amount of food that can be eaten at once. You feel full sooner and stay full longer. You eat less so your body uses fat for energy. 55 percent 43 percent HOW IT’S DONE Bypass – a small pouch is fashioned from the stomach and connected to a section of small intestine, so food bypasses part of the small intestine. WHAT THE SURGERY DOES Bypass — The stomach is made smaller, thus limiting the amount of food that can be eaten at once. You feel full sooner and stay full longer. And, your body absorbs fewer calories because the food passes through a shorter small intestine. You eat less so your body uses fat for energy. The stomach and intestine remnants left inside continue to function hormonally. AVERAGE PERCENT OF BODY WEIGHT LOSS 60-70 percent OTHER BENEFITS OF WEIGHT LOSS SURGERY Most patients who lose weight through surgery see an improvement in their quality of life and live longer. Surgery has been shown to resolve: Type 2 diabetes High cholesterol High blood pressure Migraines Knowing changes everything.SM Depression Obstructive sleep apnea Asthma Gastroesophageal reflux disease winter 2012 Polycystic ovarian syndrome Urinary stress incontinence Osteoarthritis Gout U P S TAT E H E A LT H 13 COMMUNITY Cover Story Father and son strike that work/life balance I THE UPSTATE Ethicist REPORTING CHILD SEXUAL ABUSE H ealth care providers are not legally required to notify parents about an adolescent’s pregnancy or sexually transmitted disease, for fear that minors may not seek care if their confidence is broken. But in situations of abuse, the rules change. Doctors, nurses and social workers are among the professionals obligated under New York State law to report suspected child abuse – physical or sexual. Neglecting to do so is a class A misdemeanor. What happens if an adolescent discloses abuse to a healthcare provider and says he or she does not want family members or police notified? Providers may feel conflicted, with a responsibility to both their patients and their patients’ parents. They should address the concerns of the patient, who may not have the maturity to understand such complex situations, by explaining the consequences of reporting the abuse. And they should arrange appropriate medical and emotional care. ce crystals coat the boardwalk as first light dawns in the marshes of Labrador Hollow, south of Syracuse, almost into Cortland County. Snow dusts the mountain tops. Wild holly berries are stark against foliage turned to brush. This swath of nature is quiet – until you hear bells. That’s right: bells. Beacan and Finnegan wear bells attached to their collars so that wildlife gets early warning of the Irish setters out for their weekly long run with their owners, Bernie Poiesz MD and his son, Michael Poiesz MD. The men — both doctors specializing in cancer care and cancer research at Upstate — cherish early Saturday mornings together with their dogs. The younger Poiesz runs 8 miles of trails with the dogs. The older Poiesz hikes part way and meets up at various points along the route. This is their time, an efficient mix of bonding and fitness, and they don’t muddle it with medical talk. “I put in long hours at work, but I learned long ago not to take it home,” Bernie Poiesz says. The tips of his ears start to redden as wind ruffles his hair, and he presses ungloved hands into the pockets of his sweat pants. Michael Poiesz moved back to Central New York in the fall, joining the Upstate faculty after completing a fellowship in cancer and blood disorders at New York University Medical Center. He and his wife, Lisa moved in with his parents in Tully, on property Bernie Poiesz purchased in the mid-1970s when he was a resident at Upstate. Poiesz is a big name at Upstate and within the biomedical sciences in general. It was Bernie Poiesz who helped identify the first retrovirus in humans, isolating the human T-cell leukemia virus, or HTLV, while working in the lab of Robert Charles Gallo, the scientist best known for his role in the discovery of HIV, the Human Immunodeficiency Virus. Michael Poiesz began following in his father’s footsteps when he worked in his father’s lab for a 7th grade science fair project. He helped design polymerase chain reaction primers that could be used to detect HIV. This was before the Nobel Prize was awarded to the developers of the PCR technique, which amplifies a single piece of DNA to generate millions of copies of a particular DNA sequence. “When I was in the 7th grade and doing this, the technology of PCR was in its infancy,” he says. His father points out that the work lead to the creation of the first HIV-2 test using PCR in the United States, and it is still in use today. Throughout school, the younger Poiesz was far more interested in science classes than literature. He played saxophone and for a while dreamed of becoming a musician. When he visited the lab at Upstate, his father says, “I think he probably saw that we were all having fun doing what we were doing,” and that got him thinking of a career in academic medicine. Providers have a duty to work with child abuse specialists to assist the family in reaching the best possible outcome for the victim of abuse. The Upstate Ethicist is compiled from “Bioethics in Brief,” a publication of Upstate’s Center for Bioethics and Humanities. 14 U P S TAT E H E A LT H winter 2012 w w w. u p st ate . e d u COMMUNITY The Poiesz family always had Irish setters as companions. “They were always with us. I grew up like that,” Michael Poiesz recalls. “When I don’t have a dog, it feels like something is missing.” So he and his wife, Lisa added Finnegan during their time in New York City. They went to the same breeder who supplied his parents with Beacan who will be 4 in May. They drove to Whitney Point in Broome County to look at a new litter of puppies. Finnegan is the pup who approached them first. Park became their ritual. It was good for both of them. “More so than the others, I felt he had personality, which is a double-edged sword,” Michael Poiesz explains. “He was clearly the male of the litter, the dominant male.” Finnegan proved to be “quite a handful” as a puppy. Poiesz worked with him constantly to channel the dog’s high energy. The father and son don’t cross paths often at Upstate, although they both take care of a mix of patients with cancer and blood disorders in the hospital and in offices throughout Central New York. Bernie Poiesz still researches retro-viruses in his lab. Michael Poiesz is likely to develop his own field of study as his career progresses. If his father has taught him anything, his weeks will continue to include long runs with dogs. “If you don’t exercise and run long distances, you don’t get an Irish setter,” Poiesz says. “You have to be willing to be outdoors, and you have to like it.” Even in New York City. So, a nightly run in Central Did you know? “I’m so busy, there’s not a lot of room in my life outside of work,” Poiesz says. Running with Finnegan keeps him, and the dog, in shape and in good spirits. Now Finnegan lives under the same roof as Beacan, at least temporarily, while Poiesz gets used to earning a paycheck. He says his father spoils both dogs. “He’s like the fun uncle who lets you do what you want.” PACEMAKERS MAY BE RECYCLED P oor patients in developing countries generally do not get cardiac pacemakers because the lifesaving devices are expensive. But a recent study suggests recycled pacemakers donated from funeral homes in the United States could be a safe way of extending access. “It makes a lot of sense to me,” Luna Bhatta MD, director of cardiac electrophysiology at Upstate’s Heart and Vascular Center, says of research presented in the American Journal of Cardiology. US researchers followed 53 heart patients in India who received pacemakers explanted from people who died of non-heart-related causes in America. No infections, pacemaker malfunctions or significant complications were reported within two years after implanting the pacemakers, each of which had more than three years of battery life left. Lead researcher Bharat Kantharia MD, from the University of Texas Health Science Center in Houston, told Reuters Health: “All we are saying is, there are people who need a pacemaker and would not otherwise get one. Maybe this will help them.” Bhatta says further study is needed on the safety of the process, and on whether health regulations will allow such donations. Reuters says a survey of morticians in Michigan and Illinois found that 19 percent of the deceased had a pacemaker or other heart device – and a large majority of these devices are buried with the bodies or removed and thrown away as medical waste. Knowing changes everything.SM winter 2012 U P S TAT E H E A LT H 15 COMMUNITY Adolescents are like astronauts Pediatrician writes book about parenting teens R obert Michael Cavanaugh, Jr. MD provides two simple pieces of advice for parents of adolescents: 1. Give unconditional love. 2. Stay connected. Kids need the presence of their parents to be felt, if even from a distance,” says the pediatrician and father of four who has been Upstate’s director of adolescent medicine for the past 30 years. WHAT’S YOUR DEFAULT? W e’ve grown accustomed to high fructose corn syrup, to spending hours in front of electronic screens, to eating large portions of food. It doesn’t have to be this way. We can improve our health – reduce heart disease, diabetes and obesity – if we reprogram ourselves as individuals and as a society, says Cynthia Morrow MD, health commissioner for Onondaga County. “We know that if people don’t feel like it is safe to walk because there are no sidewalks, they will not walk. If there’s no safe place to ride your bike, you will not ride your bike,” Morrow says. “We need to look from a societal perspective at how we can create our environment to have healthy defaults as opposed to unhealthy.” Examples: Make foods with lower fat and sugar content more readily available, offering them side by side – and for the same price as – not-too-healthy foods. Use smaller plates at home and at work. Post signs near elevators to encourage people to take the stairs. Before long, multiple small steps toward health will become our default. 16 U P S TAT E H E A LT H Cavanaugh is the author of Dying to be Perfect: How Teens Can Stay Happy, Healthy and Alive, a book that uses the metaphor of space flight to explain adolescent development. As with puberty, the adolescent mind matures in early, middle and late stages, Cavanaugh says, adding that “the adolescent brain should not be expected to be thinking like an adult brain. “It must be expected that adolescents will respond to the pressures of daily living in a unique and personal way, which is highly influenced by the stage of mental growth they have reached,” he says. Cavanaugh says adolescents are besieged by societal messages telling them how to feel, look and act, along with peer pressure and examples of behavior in movies, television and the Internet. Having a physician they can confide in “is another avenue among many channels of communication. “As long as you go about it in the right way, it’s amazing how much they will open up,” Cavanaugh says. The key is to deal with the teen on his or her developmental level, not necessarily the level that matches the chronological age. Cavanaugh does not preach, but he tells his patients that abstinence is the only way to guarantee no pregnancy or sexually transmitted diseases. If a teen makes the decision to have sex, the doctor goes over protective options. When he addresses alcohol, he tells his patients to have a backup plan for how to get home safely in case they wind up drinking or if the friends who are driving have been drinking. “I think the message they should get from us physicians is what’s safe and what’s not,” he says. “Do they listen? Many times they do.” Cavanaugh and Karen Teelin MD welcome referrals for second opinions and consultations. Among the services they provide: behavioral evaluation and counseling, comprehensive physicals and preventive exams, contraceptive counseling, gynecologic exams, immunizations, pregnancy testing and counseling, risk-reduction assessment and counseling, sports physicals as part of a comprehensive exam, and substance abuse evaluation and referral. Reach them at 315-464-5831. MISSION: ADULTHOOD age 10 to 14, adolescents start to develop attitude and independence. age 15 to 17, they seem unreachable, as if in orbit – but open channels of communication with home base are important in order to complete the mission successfully. age 18 to 21 or later, they re-enter the atmosphere as adults. winter 2012 w w w. u p st ate . e d u WORK GOODJOB Meet Donna Sims, recreation therapist D onna Sims joined Upstate 20 years ago, the hospital’s first certified therapeutic recreation specialist. She works with a variety of adult and pediatric patients who have had traumatic injuries or medical problems that have impacted their ability to function. Her training: “I graduated in 1988, which seems forever ago, from SUNY Brockport with a bachelor’s degree in therapeutic recreation. Before coming here, I worked in adolescent psychiatry, and drug and alcohol rehabilitation, and adult psychiatry.” Her workplace: “My day room looks like a living room. We very purposefully have tried to make it warm and comfortable. It’s very different from the rest of the physical medicine and rehabilitation floor. It offers patients and families the opportunity to forget that they’re patients. Her patients: “Every person who comes in here, we look at them as individuals first, and what are their needs as people, and then as patients. They have real human needs in the hospital. The loneliness when you don’t have family who can visit, the fear of loss of function, even something as simple as missing a family pet can add to the sadness of being in the hospital. Sometimes a patient comes in and just needs to sit and cry. “We give patients what they need, whatever that might be. Yes, we work on their physical needs, their fine motor skills and their thinking skills. We might be working on their attention or their memory or their word finding, but sometimes they just need to have fun. “What I say to my students is, one of the most important things you can be is flexible.” Her care: “All of our patients do physical therapy and occupational therapy. I look at recreational therapy as dessert. If a patient goes home and sits on the couch and walks to the kitchen and back to the couch, if that is the whole routine, yes he or she will exist. But, we all need some pleasurable activities to help relieve stress and enjoy life. We all need some dessert.” “Every patient is evaluated when he or she comes to this floor: What are the patient’s goals? What are the problem areas that we see? What are their physical, cognitive and psychosocial, emotional and spiritual needs? What were their recreational and leisure interests? “We look to see if we can use any of those recreation and leisure interests to make their therapy more enjoyable. We look to make sure that when they are discharged from here, they have recreation and leisure activities that they can enjoy safely while they are recovering. They may not be able to go back to work or school right away, so they need to have things that they can do and enjoy that bring some quality to their lives.” Her longevity: “One of my patients said this morning, ‘you like what you do.’ I said, ‘you know what, I believe in what I do.’” HOW TO MAKE UP YOUR MIND B efore you can make a good decision regarding your medical care — say authors Jerome Groopman MD and Pamela Hartzband MD in their book, Your Medical Mind: How to Decide What is Right for You (The Penguin Press) — you first must reflect on your mindset. Do you, like 60 percent of Americans, believe in natural therapies and the notion that the body can often heal itself if given the proper environment? Or do you fall closer to the other end of the spectrum, believing in cutting edge research that yields new medications and innovative therapies? Groopman and Hartzband say we each have a spot along a second spectrum, too, “depending on whether we want maximal or minimal treatment. “Some people are proudly proactive about their health, believing that more is usually better,” they write. “In contrast, those with a minimalist mindset aim to avoid treatment if at all possible, and if that is not possible, they try to use the fewest medications at the lowest possible doses or to select the most conservative surgery or procedure.” Believers may believe in the healing power of nature, or the promise of modern medicine, but they believe that there is a successful solution out there somewhere. Doubters approach treatment options with profound skepticism. They are deeply risk-averse, acutely aware of the potential side effects and typically prefer minimal treatment. Once you know your mindset, they write, educate yourself so you can “better understand the often hidden influences that can sway your thinking and distort your judgment.” Knowing changes everything.SM winter 2012 U P S TAT E H E A LT H 17 FOOD FATS ARE NECESSARY TO HEALTHY DIET f all the parts of the “Oaverage diet that we’ve been told to avoid, it’s fats that have gotten beaten up the most. The very word seems to be an indictment of the substance: We don’t want to be fat, so why in the world should we eat fat?" Mehmet Oz MD asks in a recent Time magazine article. He goes on to make the case for whole milk. “It’s true that kids who drink a lot of whole milk drink a lot of calories, but milk can actually help control weight, since calcium binds with a fat in the food digesting in your gut, meaning that you absorb less of that fat. Some studies have seen no significant difference among skim, low-fat and whole milk when it comes to weight control. “What’s more, when you take all the fat out of milk, you’re left with too high a concentration of natural sugars, which interacts like candy with your hormones, especially insulin." Oz suggests moderation. He says you maximize your health benefit and minimize your calories if you consume no more than 16 ounces of whole milk or two servings of any dairy per day. Farfalle with Sundried Tomatoes and Walnuts W by bill gokEy arm your kitchen with the aroma of this simple, yet elegant vegetarian dish that makes for a filling meal on a cold winter’s day. All you need is a pasta pot, a sauté pan and serving bowl, and a knife for chopping tomatoes, garlic and basil. Ingredients ¼ cup extra virgin olive oil, divided in half 1 pound farfalle (bowtie pasta), dry 5 ounces parmesan cheese, shaved from a wedge 1 cup walnuts, halves and pieces ½ cup basil, thinly sliced ¾ cup sundried tomatoes, finely chopped 1/8 teaspoon salt, optional 2 cloves garlic, peeled and crushed 1 teaspoon black pepper Preparation Bring approximately 1 gallon water to a boil. Cook pasta according to package directions. Drain and set aside. Saute walnuts in sauté pan over medium heat 1 to 2 minutes, until slightly browned. Reserve in large bowl. Saute sundried tomatoes, garlic and half of the olive oil until garlic begins to turn color slightly. Add this to the bowl with walnuts. Blend in the pasta, remaining oil and shaved parmesan, basil and black pepper. Mix and taste. Add salt if desired. Makes six 8-ounce portions. Nutritional information, based on an 8-ounce serving Bill Gokey is executive sous chef from Morrison Healthcare, which provides food service for Upstate Medical University. 18 U P S TAT E H E A LT H winter 2012 568 calories; 30 grams fat (7 saturated, 22 unsaturated); 459 milligrams sodium; 17 milligrams cholesterol; 21 grams protein; 5 grams fiber w w w. u p st ate . e d u Science explores chewing gum to lose weight HOW LOW CAN YOU GO? R Vitamin B12 molecule (lower left) is connected to appetite-supressing PYY hormone (helical structure on right). From the lab of Syracuse University’s Robert Doyle PhD, also an adjunct associate professor of medicine at Upstate Medical University. A team of scientists at Syracuse University designed a chewing gum to help overweight people suppress their appetites the way nicotine gum helps people stop smoking. funding the research) wanted us to use,” Meguid says. The rats drinking the PYY water wound up eating more than the rats drinking plain water — the opposite of what scientists expected. “It is a brilliant idea,” says Michael Meguid MD, PhD, editor of the international journal, Nutrition, and a professor emeritus at Upstate who focused his research on nutrition. “To get these peptides into the body is very difficult because they are very large.” “We couldn’t understand why these rats were eating more, so we tasted it,” he says of the PYY water. “It was sweet. PYY is a hormone released into the bloodstream when people eat or exercise which suppresses appetite. But stomach acids break down the PYY, and any remnants of the hormone have difficulty crossing into the bloodstream through the intestines, Syracuse University chemist Robert Doyle explains in a news release. His team came up with a way to disguise the PPY by attaching it to vitamin B12, which passes through the digestive system and into the bloodstream because it is absorbed in the ileum, the last section of the small intestine. They demonstrated that they could deliver “clinically relevant” amounts of PYY into the bloodstream using this method. News of this development brought back memories of a study Meguid conducted using PYY in the early 1990s. Scientists used two groups of rats, one that got drinking water containing PYY and the other that got plain drinking water. “The problem we faced was: what dose do you use? At that time, we used the dose that the chemical company in Japan (which was Knowing changes everything.SM “Were the rats eating more because the water was so sweet?” Meguid is not sure. But he says if Doyle’s chewing gum is sweet in taste, it could counteract the effects of the hormone. PYY is not the only hormone involved in digestion and appetite regulation. When you start eating, levels of the appetitestimulator ghrelin are high. As food enters the small intestine, the body releases PYY, which dampens the effect of ghrelin. The gum is designed to be chewed after a meal, so that the synthetic PYY in the B12 vitamin teams up with the PYY produced naturally by the body to suppress appetite. One key will be to find the right dose of PYY, alone or in combination with other hormones, Meguid says. Also, the PYY ends up in the liver. While it’s unclear what percentage of the hormone is broken down there, scientists know that the brain reacts to whatever makes it through the liver. So, again, the key will be finding the right dose of PYY. Meguid says finding an appetite-suppressing solution will not be simple. “We are culturally and scientifically under the naïve impression that there is a silver bullet — and there isn’t.” Nevertheless, Meguid says Doyle’s approach holds promise. winter 2012 an Anbar MD succeeded in “right-sizing,” as he describes his 70-pound weight loss, by eating three 400-calorie meals and three 100-calorie snacks per day. Even though that’s significantly below the 2,400 calories per day he consumes now to maintain his target weight, Anbar often eats meals of about 400 calories and low-calorie snacks – and happily. “You can be satisfied with fewer calories,” he says. “You can have a healthy, fulfilling meal for 400 calories.” Some of his favorites: ● Large bowl of raisin bran cereal mixed with granola and skim milk ● Chicken noodle soup and green salad with turkey with 1 tsp. of drizzled dressing, plus two Tim Horton doughnut holes ●3 ½ ounces of salmon with 2 pounds of vegetables (broccoli, cauliflower, string beans) ● Skinless chicken breast, a scoop of rice and a scoop of broccoli, with a slice of bread (no butter) Ran Anbar MD is a professor of pediatrics and medicine and director of pediatric pulmonary medicine at Upstate Medical University and president of the American Society of Clinical Hypnosis. U P S TAT E H E A LT H 400 CALORIE MEALS ● 100 CALORIE SNACkS FOOD 19 LEISURE music A FEEL-GOOD RX M usic works like a drug, says Daniel J. Levitin, a neuroscientist from McGill University who wrote “This is Your Brain on Music: The Science of a Human Obsession.” Do you dare run an ultramarathon? ULTRARUNNING REQUIRES: • time commitment to training He told the New York Times “listening to music with others causes the release of oxytocin, a chemical associated with feelings of trust and bonding. That’s partly why music listeners become so connected to the artists they like. Plus, the nucleus accumbens – the brain’s wellknown pleasure center – modulates levels of dopamine, the so-called feel-good hormone. “Lots of people use music for emotional regulation,” Levitin continues. “It’s similar to the way people use drugs such as caffeine and alcohol: they play a certain kind of music to help get them going in the morning, another kind to unwind after work. Brain surgeons perform their most concentration-intensive procedures while music plays in the background.” Lawrence Chin MD, chairman of neurosurgery at Upstate, listens to music during operations. “I have an eclectic mix that includes classic rock, 70s, 80s, and 90s pop, some jazz and a tiny bit of rap,” he says. “I like music that is upbeat and energetic. I find it relaxing during a difficult case because it provides some relief from a tense part of the case. During very routine portions of the case, it helps break the monotony.” • gradual increase in distance • adequate rest • learning about nutrition and hydration • awareness of your body’s signals • understanding that it’s OK to stop running and walk during a race • being friendly, supportive of others • fortitude to keep going T “ hey’re not as hard as I think people think they are,” says Ryan O’Dell, 26, a neuroscience and physiology MD/PhD student at Upstate who runs 65 to 90 miles per week. An ultramarathon is any distance greater than the 26.2 miles of a marathon. O’Dell compares ultras to feats of every day life, such as the quest for medical and doctoral degrees. When the going gets tough, you take a breather, “and then you get up and carry on,” he says. O’Dell was the slow kid on the high school track and cross country teams. Today he realizes that “in these ultras you can do really well at a slower pace if you keep that pace.” He began college at the University of Rochester intent on focusing on his studies. But he missed running. He began signing up for 5Ks, then 10Ks and half marathons. By Thanksgiving of his sophomore year, he completed a marathon. Then he began tackling ultras. His first 100-mile race was in 2007. Two years later, he ran 250 miles from Syracuse to New Haven, Ct., to propose to Nilda Alicia-Velazquez, now his wife. “She was very surprised,” he recalls. If you want to tackle an ultra-marathon, O’Dell advises building your training from a solid base. He prefers doing two “long” runs of 18 to 24 miles each on backto-back days “so you get your legs used to running when they’re tired.” Overuse injuries such as shin splints and plantar fasciitis are one of the biggest dangers of ultrarunning, so increase your mileage gradually. Rest is also important, so your muscles can recover. “I take a day off a week, sometimes two,” O’Dell says. “Otherwise, you are just breaking down muscle constantly without building it up.” He says ultrarunners have to train themselves to eat and drink before hunger or thirst sets in. Over time they will learn what works for them. Some runners strictly ingest a certain number of calories per hour; others go with their cravings. When the race begins and everyone blasts off quickly, O’Dell says it’s tempting to try to stay with the pack. Resist that urge. Let them go, and tell yourself you’ll see them in 60 miles, O’Dell says, adding, “You want to run your own race.” Ryan O’Dell ran 200 miles from Jeffersonville, Vermont to Burlington in June 2011. In July, he competed at a ski park in New Jersey, repeatedly running up and down a 1 ½-mile 1,100-foot climb. “That kind of drained me, so I figured I’d take August off,” he says. 20 U P S TAT E H E A LT H winter 2012 w w w. u p st ate . e d u LEISURE 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. Use this as a guide, for a person weighing 176 pounds who does the activity for an hour: Kevin Neville likes to ski with his family: wife, Lisa, and children, Ella, 15, Lucas, 12 and Clara, 9. “As a family, this is one of the most enjoyable things we have done,” he says, adding that they enjoy the variety of trails at Labrador Mountain on Route 91 in Truxton. Ice hockey: 750 Soccer: 654 Hunting: 420 Playing violin: 216 Baking: 168 Six reasons to ski A lmost every weekend in winter, the Neville family downhill skis. Their activity means that for them, “winter flies by. We’re looking forward to every Saturday,” says Kevin Neville, a clinical assistant professor of physical therapy in Upstate’s College of Health Professions. That’s reason No. 1 to ski. Neville provides five more: • You can stay toasty with the right gear. Outdoor clothing is less bulky these days, but layers are still important. Start with long underwear and include a turtleneck. Be prepared to zip up your jacket on the lift, when you’re most apt to catch a chill. Safety helmets also do a great job of keeping your head warm. For your hands, make sure to wear good gloves, maybe even with disposable hand warmers on particularly cold days. • You don’t have to spend a fortune. Buy used equipment, especially for growing children and especially if you are new to the sport. Shop around and you can find packages that include boots, skis and poles for less than $200. Choose boots that fit properly. “Your feet actually work when you’re skiing. They need to be comfortable,” Neville says. •You can choose your challenge; downhill skiing is not just for thrill-seekers. “I’m not a skier who skis for the edge of disaster,” Neville says. “That did not even appeal to me as a teenager.” Today he likes to take easy runs with his younger children and mix it up with more challenging runs with his teenager. Trails down the mountain are labeled as green circles, blue squares or black diamonds – for beginner, intermediate or advanced skiers. Some ski centers have double black diamond runs that are reserved for experts. Many also have terrain parks for stunt skiing. • It counts as exercise. “It’s not exercise like going for a 30-minute jog, but coming down the hill, you’re working,” Neville says. And it beats sitting on the couch all weekend. • It provides quality time. What inspires bonding better than a thermos of cocoa in the lodge between runs? In addition, riding the lift takes several minutes, providing a stretch of one-on-one time with father and child, or father and mother. As Neville explains, “It’s a chance to have 10 minutes talking time with my wife — without a child interrupting.” And, make sure your bindings are adjusted to the individual. Knowing changes everything.SM winter 2012 U P S TAT E H E A LT H 21 LEISURE Jodi Dowthwaite PhD is a 3rd degree black belt in karate who trains at LaVallee’s USA Black Belt Champions. She conducts osteoporosis prevention research at Upstate. good rEAds 2 B ill Shepard, a contract administrator at Upstate, favors the classics. He recommends James Fenimore Cooper’s The Deerslayer. The book is “a true coming-of-age story in which the main character, Natty Bumppo (a.k.a. Leatherstocking), receives lessons about life, love and the importance of friendship. Throughout the novel, there are many uplifting passages, all of which deal with the nearly indescribable beauty that surrounds us here in Upstate New York,” Shepard says. “Although a long novel, it is easy to lose oneself in the fascinating adventures of Natty Bumppo. Cooper gives us a story which is both substantial and fulfilling.” Jane Ann Kogut, who works in nursing administration at Upstate’s Community General campus, raves about James Patterson. She recently finished The 8th Confession from his Women’s Murder Club series, featuring a detective, medical examiner, lawyer and newspaper reporter who team up to solve murders. “They’re good reads. They’re interesting,” Kogut says, adding that the books do not have to be read in order. “He shares a little history in each one, of what happened prior.” Why I love martial arts training by JoDi DoWthWaitE 1 It’s great for your body. I do mixed martial arts, which primarily involves karate and kick-boxing, but we also train in a variety of martial arts styles from other countries, including jiu jitsu (Brazil), muay thai (Thailand) and kung fu (China). We get an awesome total body workout, which is great for the cardiovascular system, muscles and bones. Our activities move limbs in many directions over a wide range of motion, which helps to improve and maintain flexibility. We do lots of push-ups and other calisthenics to improve and maintain muscular strength. The muscle forces and impacts during target punching and kicking are good for building and maintaining bone strength. All of the single leg stance movements are wonderful for balance and coordination. Of course, we can’t forget that exercise reduces the risk of strokes and dementia. Many martial artists continue to train well into their senior years, providing great examples of health and vitality. 2 It’s great for your mind. With the challenges of daily life, it is easy to develop a negative state of mind. In martial arts programs that include character education, we don't just train our bodies, we train our brains to maintain a positive mindset, self-discipline and self-control. This has worked well for me, as I find it much more difficult to get sucked into a negative thinking spiral now than I did before training. It is fantastic for stress relief, to be able to punch and kick targets after a tough day. Research indicates that martial arts training that includes character education can help improve the functioning of individuals with attention deficits and hyperactivity. Plus, 22 U P S TAT E H E A LT H winter 2012 over the long term, such training is projected to improve school performance and employment potential, as well as reduce risk of criminal behavior. 3 It’s great for your social life. I started martial arts training to meet new people. I wanted to find a positive peer group for my family and good mentors for my children. I got all of that and then some. Our dojo, or training center, is a wonderful family social club. This environment is great for self-esteem, providing a sense of community and just plain fun. If ever we are feeling low, we just head to the dojo to hang out with our buddies. 4 It’s great for self-defense. Some people worry that the martial arts are violent and dangerous, but in our system, we strive to keep the contact level safe. Along with the skills and movements we practice, we learn methods of avoiding confrontation. Our instructors introduce students to physical contact gradually, and we train as friends, not opponents. Our aim is to touch our training partners without hurting them. We never want to be forced to use our skills outside the classroom. However, it is reassuring to know that we have been trained to defend ourselves. Activities such as martial arts training are wonderful for lifelong health and fitness, helping to reduce the risk of diabetes, heart disease, cancer, osteoporosis and bone fractures. If you have already developed one of these conditions, consult your caregiver before starting any exercise program. Otherwise, consider martial arts training as a great way to gain and maintain a healthy body, mind and spirit. w w w. u p st ate . e d u THE HUMORIST Humorist Jeff Kramer gets serious about his health et’s have a show of hands: How many of us ate sensibly during the holidays and stayed on course with our weight reduction goals? L Okay, I was afraid of that, but I’ve got some exciting news for the horizontally challenged. In this, my first holiday season as a Recovering Big Guy, l learned something valuable: Grotesque, almost mythical explosions of gluttony can be part of a healthy eating regimen. My Season of Gorging started early, on Nov. 9, with a visit to New Orleans. For a Big Man struggling to lose weight it was the equivalent of putting Charlie Sheen in charge of a medical marijuana dispensary. In New Orleans moderation is highly relative if it exists at all. These are people for whom a 16-ounce Mudslide Daiquiri with an extra shot of grain alcohol for a buck versus the 32-ouncer with two extra shots is moderate. Ditto for skipping the legendary pork-belly breakfast sandwich at Patois and opting for the warm biegnets spackled with powdered sugar at Cafe Du Monde. You can’t win the food battle in New Orleans, and why try? This might seem like a shocking thing to say in a health magazine, but we all have to die sometime. There are worse options than collapsing face-first into the ribeye bathed in peppercorn sauce at Besh Steak. The carnage lasted four days. I flew home Sunday night, hoisted myself onto the bathroom scale and got the biofeedback I’d been dreading: I’d gained about 6 pounds, up to 256. Holy bread pudding with rum sauce! But what happened the next week will give hope to every fat person who loves food. That Monday I re-boarded the weight loss bus and found that my transfer pass was still valid. It was back to the multigrain cereal with a banana for breakfast. Back to yogurt mixed with protein powder for a snack. Back to half-sandwiches and small cups of soups for lunch. I used the same method for Thanksgiving and Christmas. My weight is now 245. Here’s my theory: Human beings — those with a pulse at least — are built to cut loose periodically. Emphasis on periodically. It s something most of us can handle. Moderation is fine ... in moderation. There’s some evidence to back me up. Studies show that the average American gains only a pound during the holidays. That’s a little misleading because people who are already overweight gain an average of five pounds, but even that wouldn’t be catastrophic if not for the fact that most of us — and this is key — NEVER LOSE those extra holiday pounds. Algebra was never my best subject, but this is an equation I understand all too well: 1 pound x 35 years = a closet full of “Relaxed Fit” Levis with most of the belt loops broken. Look, I’m no doctor. Truth is, I don’t even have a job. But I believe that the key to occasional overindulgence as a large person is to shed its effects immediately — before the fat can take up permanent residency next to your heart. Eat sparingly before and after major feeds. Don’t leave home without your bathroom scale. Take it everywhere: important business meetings, arraignments, the Carrier Dome. Double your workouts until the celebration weight is gone. Whatever it takes. The first day, I’ll admit, was a downer. No matter how committed one is to losing weight, it’s dispiriting to transition from fried Oyster po-boys and Bloody Marys to tuna on whole grain bread. But as the week wore on a sense of comfort and control replaced the gloom. The scale ticked downward. By week’s end all evidence of the binge was gone. I was back under 250. You’ll know you’re on the right track when vacations, birthdays and holidays feel like Navy Seals Hell Week. Read more about Kramer’s efforts the first Monday of every month at upstate.edu/whatsup Knowing changes everything.SM Happy New Year! winter 2012 U P S TAT E H E A LT H 23 Non Profit Org. US Postage PAID Permit No 110 Syracuse, NY 750 East Adams Street l Syracuse, NY 13210 T 1S SCIE NC E NC IS T AR IS SC I IS SCIE A RT C IS EN E IS A RT S CIEN C E 11.3400212 31.2M ELsk IS AR E T his image of a portion of a mouse kidney is from the laboratory of Mira Krendel PhD, assistant professor of Cell and Developmental Biology in the College of Graduate Studies. She was one of Mira seven researchers across the Krendel PhD United States who received a total of more than $1.7 million from the NephCure Foundation for research into kidney disease, and she played a role in discovering a gene linked to Focal Segmental Glomerulosclerosis, a kidney disease that affects children. The image shows cells that are important for kidney filtration, with cell nuclei shown in green and the rest of the cells in red.