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Health UPSTATE

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

Fall 2016

SHE GAVE AWAY HER SPARE KIDNEY page 6

FAST STROKE CARE MADE THE DIFFERENCE page 9

CONCUSSION ANSWERS page 12

THE LASTING REPERCUSSIONS OF A METH LAB EXPOSURE page 13

EXPERT INSIGHTS ON DEMENTIA page 15

HOW EMERGENCY DOCTORS KEEP THEIR HOMES SAFE page 18


WELCOME

YOU MAY SEE doctors, nurses or technicians wearing buttons that say, “I CARE.” More than a clever acronym, I CARE expresses a sentiment while also describing some of the ways in which caregivers at Upstate University Hospital make the hospital experience as pleasant as possible. e campaign started in the oen-busy environment of the emergency department and has expanded throughout the hospital.

e message behind I CARE: I–

INTRODUCE yourself to patients and their loved ones.

C–

CONNECT with patients and their family members in a meaningful way, using eye contact and communication.

A–

ACKNOWLEDGE the concerns of patients and their loved ones.

R–

REVIEW the plan of care so people understand what you are communicating and what tests and treatments are ordered.

E–

EDUCATE patients and loved ones about what to expect, discharge instructions and medications.

Pictured: Rasheedah Vereen, a hospital clinical  technician at Upstate University Hospital. PHOTO BY KATHLEEN PAICE FROIO

MEET THE UPSTATE UROLOGY TEAM Chairman Urologic oncology; robotic and laparoscopic surgery of prostate, kidney, bladder and adrenal

General urology, andrology

GENNADY BRATSLAVSKY, MD ZAHI N. MAKHULI, MD Female and reconstructive urology, urinary incontinence in women, pelvic floor treatment and neurourology

NATASHA GINZBURG, MD Pediatric urology, treatment of hernias and hydroceles, robotic surgery, urinary tract infections, penile abnormalities

MATTHEW D. MASON, MD

Urologic oncology robotic and laparoscopic surgery of prostate, kidney, bladder, and adrenal

RAKESH KHANNA, MD General urology, male health, urologic oncology, enlarged prostate, kidney stones At Upstate Urology of Auburn.

RYAN SIDEBOTTOM, DO

Urologic oncology and endourology; robotic and laparoscopic surgery of prostate, kidney, bladder and adrenal; kidney stone

OLEG SHAPIRO, MD General female urologic health, MRI fusion or prostate cancer and kidney stones

TIMOTHY K. BYLER, MD

General urology, female and reconstructive urology

ELIZABETH FERRY, MD

Kidney stones, enlarged prostate, urination problems, voiding dysfunction, bladder and kidney surgery

JESSICA E. PAONESSA, MD

Pediatric urology, treatment of hernias and hydroceles, robotic surgery, urinary tract infections, penile abnormalities

JONATHAN RIDDELL, MD

Incontinence, urethral stricture disease, vesicovaginal fistula, reconstructive surgery, transgender care

DMITRIY NIKOLAVSKY, MD

Male reconstructive surgery, urinary diversions, general urology

STEPHEN BLAKELY, MD

Male infertility, erectile dysfunction, andrology, general urology

JC TRUSSELL, MD

General urology

IMAD NSOULI, MD

FOR QUESTIONS OR TO MAKE A REFERRAL, CALL 315.464.1500 UROLOGY

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WHAT’S UP AT UPSTATE

Contents 5

13

CARING FOR PATIENTS

The meaning of “I CARE” page 2

cover story

page 5

See the new pediatric emergency room

page 5

A kidney unites them

page 6

Relief for a digestive disorder

page 7

FAST stroke care saved her

page 9

Antidiarrheal drug dangers — from a former addict who almost died page 10

Health UPSTAT E

U P S TAT

On the cover:   Nurse Jody Adams See story, page 6. PHOTO BY SUSAN KAHN

FROM OUR EXPERTS

6 answers about heroin

The pancreas transplant option

E MED IC

AL UN IV

SHE GAV E AWAY HER SPARE KID NEY

ERSIT

Y

Fall 2016

page 6

20

21

22

IN OUR LEISURE page 11

Preserving nature with photographs

page 21

A Zumba nurse

page 22

What to do for a concussion

page 12

Recipe: Berry wraps

page 23

An app for people with diabetes

page 14

The fastest Corporate Challenge runner

page 23

4 things you need to know if you care for someone with dementia page 15

IN OUR COMMUNITY Carey and Sally are friends with autism page 16

DEPARTMENTS What’s Up at Upstate

page 4

Lessons from Upstate Repercussions of meth lab exposure

page 13

page 14

Conversations with low-wage workers

page 17

Upstate History The story of infective endocarditis

Inside the safe houses of emergency doctors

page 18

Science Is Art Is Science back cover X-ray crystallography

FAST STRO MADE THE KE CARE DIFFERENC E

page 8

CONCUSS ANSWERS ION

page 12

THE LAST REPERCUSING OF A METHSIONS EXPOSURE LAB

page 13

4 INSIG HTS FOR CAREGIVE PEOPLE RS OF WITH DEMENTIA page 15

WHAT EMER DOCTORS GENC BAN FROMY THEIR HOM ES page 18

Health

Fall 2016

EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications EDITOR-IN-CHIEF

Amber Smith

WRITERS

Susan Cole Jim Howe Amber Smith

DESIGNER

Susan Keeter

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

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

Need a referral? Contact Upstate Connect at 315-464-8668 or 800-464-8668, day or night, for appointments or referrals to the health care providers on these pages or anywhere at Upstate or for questions on any health topic.

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U P S TAT E H E A LT H

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WHAT’S UP UP AT AT UPSTATE UPSTATE WHAT’S

A look at Upstate’s education, health care, research and community endeavors Department of Health will help prevent the spread of the human immunodeficiency virus, which causes AIDS. Doctors at Upstate’s Immune Health Services will provide preRETENTION & ADHERENCE SERVICES exposure prophylaxis, a daily pill ES VICE RV PrEP SER E T UPSTAT Y AT SIT called Truvada, to healthy HIVER PrEP SER UNIV RV VI ES A TAL AT T UPSTAT CE HOSPIT E UNIVERSIT negative adults and adolescents Y HOSPIT TAL A who are at risk for HIV or other sexually transmitted infections. HIV screening and health assessments are also available. Y

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is is part of Gov. Andrew Cuomo’s goal to reduce the annual number of new HIV infections in New York state to 750, from an estimated 3,000, by the end of 2020. Studies show that people who take the medication as prescribed reduce their risk of getting HIV by more than 90 percent. Young Adult Yo Adoolescent &Care Center Sppecialized

Adoolescent & Young Adu Sppecialized Yo Care Centerlt

Students enjoy the courtyard of Weiskotten Hall at Upstate Medical University. 

A renewed curriculum for the first two years of medical school at Upstate introduces students to the body, organ by organ, and provides them with clinical exposure earlier in their academic careers. eir study begins with molecules, cells and microbes and then focuses on the musculoskeletal system, skin and blood before moving to the nervous system, the circulatory and respiratory systems and more. In each unit, students learn what an organ and its cells look like, what they do, how they work and how they relate to the other organs and systems of the body. Woven throughout each unit are the basic sciences, including anatomy and cell biology, biochemistry and molecular biology, physiology and neuroscience, microbiology and immunology, pathology and pharmacology.

Upstate University Hospital offers a 20-bed transitional care unit on a newly renovated floor for patients who no longer require acute care but continue to need specialized medical, nursing or other hospital services before returning to their homes. Patients who may receive transitional care include someone with a new diagnosis of diabetes, someone recovering from surgery and needing complex wound care, or someone requiring intravenous antibiotics for a systemic infection.

In addition, faculty members who also care for patients at Upstate University Hospital will teach small groups of students to use problem-based learning to analyze clinical cases. Many medical schools follow a similar curriculum. ●

e new Global Maternal Child and Pediatric Health Program is designed to address the global health issues women face during pregnancy and children face during early childhood. e initiative combines research, clinical trials, education and training here and abroad. e program is part of Upstate’s Center for Global Health & Translational Science, which already has done significant work in various global health issues, such as mosquito-borne illnesses including dengue and chikungunya. “We will now have a laserlike focus on emerging areas of research during pregnancy and early childhood,” says David Amberg, PhD, Upstate’s vice president for research. A five-year, $1 million grant from the New York State 4

U P S TAT E H E A LT H

Resident health advocates help teach a parenting class as part of Healthy Neighbors, a health and wellness collaboration between Upstate and the Syracuse Housing Authority. Ten residents of Pioneer Homes completed an eight-week training program to become health advocates, learning about cancer prevention, sexual health, physical activity and nutrition. Healthy Neighbors is expanding to Toomey Abbott Towers, 1207 Almond St.,  and Almus Olver Towers, 300 Burt St. Pictured is guest instructor Gwen WebberMcLeod high-fiving Tara Harris, a resident health advocate who initiated PHOTO BY SUSAN KEETER the parenting classes.

upstate.edu l fall 2016


Renewed lives

CARE FOR PATIENTS CARING PATIENT

Pancreas transplants mean patients with diabetes can skip insulin injections BY AMBER SMITH

PATRICK NOLAN, 52, REMEMBERS spending his 11th birthday at Upstate University Hospital with a new diagnosis of diabetes. e Syracuse native lived with the disease for 41 years, routinely checking his blood sugar and injecting insulin up to six times per day. Nolan received the first pancreas transplant at Upstate since Rainer Gruessner, MD, became chief of transplant services. Days aer Nolan’s operation, Harry Tynan, 39, of Oswego also received a pancreas transplant. Both men had Patrick Nolan felt better shortly after surgery that gave him a new pancreas. 

continued on page 8

PHOTO BY KATHLEEN PAICE FROIO

Emergency care for kids expands

PHOTOS BY ROBERT MESCAVAGE

A $3 MILLION EXPANSION doubles the size of Upstate University Hospital’s pediatric emergency department and separates the children from the adults seeking emergency care.

August, can hold up to 24 patients and includes 18 private rooms, plus a pediatric diagnostic radiology unit. e department is designed and furnished with kids in mind, with plenty of gaming systems for all ages.

Children and their families still use the main emergency entrance on East Adams Street, then take an elevator to the fourth floor.

As a result of the pediatric expansion, the adult emergency department also grows. e 13 beds that were previously reserved for children are now being used for adults. ●

e new department, which opened in Richard Cantor, MD, is director of the pediatric emergency department.

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Hear more at healthlinkonair.org. Search “pediatric emergency.”

U P S TAT E H E A LT H

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A kidney unites them

CARING FOR PATIENTS

Facebook connects Upstate nurse with woman needing a kidney transplant

BY AMBER SMITH

AS JODY ADAMS SCROLLED THROUGH FACEBOOK in January, one post stuck with her. It was written from the point of view of a baby boy named Carter, seeking someone to donate a kidney to his ailing mother. A nurse for 12 years and the mother of six children, Adams says the idea of donating one of her healthy kidneys never crossed her mind — until she read that post. She didn’t want to imagine a little boy growing up without a mother, especially if she could help. And it didn’t matter to her that she did not know the family. Rereading the post, she got the feeling that her kidney would be a match for the young mother. Adams, who commutes from a small rural town in Steuben County to work as a nurse at Upstate University Hospital, called the transplant program to begin the process of becoming a living donor. e young mother, Victoria Fitzpatrick, was a stranger to Adams. “Yes, she’s a stranger,” Adams would explain to friends who questioned her plan to donate, “but this is somebody’s daughter, somebody’s mother.” Adams, 40, has a daughter named Victoria. e girl’s fih birthday is the day Adams received the call from the transplant center saying she was a match for Fitzpatrick, 30, of Lafayette. “Altruistic donation is one of the most worthy causes an individual can be involved in,” says Rainer Gruessner, MD, chief of transplant services. “It really is a gi of life.” Fitzpatrick’s health status has been challenging since she was diagnosed with Type 1 diabetes at age 10. Two years ago she developed end-stage renal disease and went on dialysis. en last summer as she was being evaluated to join the kidney transplant waiting list, she discovered she was pregnant. Her pregnancy was high risk, requiring dialysis for six hours a day, six days a week. Carter was born Nov. 4, eight weeks premature and weighing just 3 pounds, 14 ounces. ree days aer the delivery, Fitzpatrick lost her vision to diabetic retinopathy. Surgery has since restored her sight. And, she’s become engaged to Carter’s father, Daniel Bequer. Her mother, Janet Burton, craed the Facebook post seeking a kidney in January, using a picture of Fitzpatrick holding Carter. “Hi! My name is Carter. is is my mommy, Victoria, holding me. She’s pretty and smells nice. She doesn’t feel so good though,” it said. “Dad says she needs a new kid knee because hers are broken, and we

Victoria Fitzpatrick (left) hugs her kidney donor, Jody Adams. PHOTO BY KATE RUTHERFORD

need someone to give her a new one.” Transplant surgeon Vaughn Whittaker, MD, says more than 50 phone calls came into the transplant center in the days aer that Facebook post from people interested in donating. Six people were qualified to donate, and two set dates for their altruistic kidney donations. Which means two additional Central New Yorkers will come off the transplant waiting list. Staff at Upstate perform an average of two kidney transplants every week, with the majority of kidneys coming from deceased donors. Currently, living donation is the exception. Gruessner intends to build a program where living donation becomes the rule. When Gruessner completed the transplant from Adams to Fitzpatrick in May, he came to the waiting room to find their families. “What your daughter, Jody, is doing,” he began, “she really is a hero. If we had more people like her, more people would not be on dialysis.” Continued next page

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A digestive disorder

CARING FOR PATIENTS

Gastroparesis a life changer for Liverpool woman

BY JIM HOWE

Patients with gastroparesis can become so averse to eating that they can become dehydrated and malnourished as well as anxious and depressed, Manocha says.

MOST PEOPLE CAN EAT a snack or a meal without thinking about it beforehand or feeling sick aerward. Not Rhonda Ferry, for whom eating usually means a liquid dietary supplement or a quarter cup of a low-fiber, low fat food, like gelatin, taken very slowly. Nausea is likely to follow, and maybe vomiting and blood sugar problems as well.

Gastroparesis is treated with a multidisciplinary approach at Upstate, involving a nutritionist and primary care provider as well as the gastroenterologist. Treatment can involve medicines, botulinum injections to alleviate nausea and vomiting, and a feeding tube that bypasses the stomach to go directly into the small intestine.

“It’s just the simple things that you take for granted. You just don’t realize until something like this happens how much food is involved with everything you do — church picnics, whatever — I skipped a picnic yesterday because I did not want to be tempted,” the 56-year-old Liverpool resident says.

Ferry had a feeding tube implanted in November 2015. Its attached pump, which can be carried in a small backpack, sends liquid nourishment over a 10-hour period to avoid malnutrition.

Ferry suffers from gastroparesis, a disorder Rhonda Ferry carrying the backpack that Aer eight months on the tube, although she gained 5 pounds, she was struggling to in which food does not move through her holds a nutrition pump attached to her feeding tube. PHOTO BY ROBERT MESCAVAGE reach 100. Her nutritionist told her that stomach as it should. In her case, longif she can reach and maintain 115 pounds, standing Type 1 diabetes damaged her she might be able to come off the feeding tube. vagus nerve, disrupting motility, or the process of moving food through the digestive tract. e condition, which In the meantime, she has found support from her family affects about 5 million Americans, mostly women, as well as from a larger community on the Internet that has other causes, too. discusses gastroparesis and its related issues, such as a peFood tends to sit in Ferry’s stomach like a brick and can collect into a potentially dangerous food ball, or bezoar. She had suffered from digestive problems before, including acid reflux, so she thought what started in January 2015 might be related. But it gradually got so unpleasant to eat that by October 2015 she had gone from about 130 pounds to about 93 pounds. She went to see Divey Manocha, MD, a gastroenterologist at Upstate, which has a motility laboratory using manometers — tubes with pressure sensors — to help diagnose gastroparesis as well as irritable bowel or chronic constipation.

A kidney unites them

tition drive for a proposed federal law to expand research of gastrointestinal motility disorders, or how some doctors dismiss the disorder because they are unfamiliar with it. Ferry, who once loved to eat, has gotten used to a limited social life, to avoid food-laden occasions and people who don’t understand her illness and keep urging her to eat. “A good day would be no pain in the stomach and that I was able to eat something other than a liquid,” she says, adding that she has found some relief through her treatments. ● Hear more at healthlinkonair.org. Search “gastroparesis.”

Continued from page 6

In a news conference a few days later, the women spoke to reporters together, taking turns holding Carter. Adams said her recovery had been easier than when she had her appendix removed. She said she felt like an older sister to Fitzpatrick and that she was grateful Carter would have his mom. “I’ll be thinking about her every Mother’s Day.” ● Hear more at healthlinkonair.org. Search “Facebook”

fall 2016 l upstate.edu

The Facebook post that inspired Jody Adams to donate her kidney to this mother, who was a stranger.

U P S TAT E H E A LT H

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CARING FOR PATIENTS

Renewed lives for patients with diabetes

continued from page 5

Both men had Type 1 diabetes, a disease in which the pancreas does not produce the insulin necessary for the body to process sugars. Both suffered kidney damage from diabetes, and each underwent a kidney transplant, Nolan in 2011 and Tynan in 2013. Today, pancreas transplants have further improved their lives. “It’s a complete change just to look forward and not have to do injections,” says Tynan. “I’m ready to pick up the insulin pen — and now I don’t have to.” Nolan says “wow” whenever he checks his blood sugar. He’s not used to such healthy numbers, and he’s not used to the freedom of not having to check his blood sugar so frequently. “I’m reliving my youth again,” he says. e transplanted pancreas produces insulin as soon as it’s sewn into place. is helps the body maintain a stable level of blood sugar, avoiding dangerous fluctuations. A patient keeps his or her original pancreas, which continues to produce enzymes that aid in the digestion of food. Gruessner explains that “the pancreas transplant works because it is the only way to create long-term normal glycemia, so you don’t run into the problems of low blood sugar anymore. It stabilizes glucose metabolism.” While a pancreas transplant can reverse some types of damage caused by diabetes, it can halt the progression of kidney disease, retinopathy and circulatory problems that could lead to dialysis, blindness and amputation. And with diabetes under control, patients reduce their risk of heart attack and stroke.”

Left: Transplant nephrologist Oleh Pankewyz, MD. Right: Members of the  transplant surgical team include (from left) Mark Laftavi, MD, Rainer Gruessner, MD, division chief, and Vaughn Whittaker, MD.  PHOTOS BY ROBERT MESCAVAGE

Mark Laavi, MD, surgical director of the pancreas transplant program, explains that a pancreas transplant in a young person with hard-to-control diabetes “can cure diabetes in the early stages before it damages the body.” People with diabetes who have already developed kidney disease may be candidates for kidney and pancreas transplants done at the same time, using organs from the same donor. Or, as in the case of Nolan and Tynan, they may undergo two separate transplant operations. “If you have a living donor, you are better to do a living donor kidney transplant and then get a pancreas,” Laavi says. “at’s the best option available at this time.” ● Hear more at healthlinkonair.org. Search “pancreas.” Learn about transplant options at Upstate by calling 315-464-5413.

CANCER CARE FOR KIDS & TEE ENS If your child faces a diagnosis of cancer, turn to the experts at Upstate for personalized technology and support services at the Upstate Golisano Children's H Hospital and outpatient treatment at the Upstate Cancer Center. Our multidisciplin nary teams of

FOR MORE INFORMATION, CALL 855.964.HOPE OR VISIT UPSTA ATE.EDU/CANCER CARING FOR PATIENTS. SEARCH HING FOR CURES. SAVING LIVES.

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FAST response

CARING FOR PATIENTS

Swift recognition, treatment saves stroke patient IT HAD BEEN A TYPICAL DAY for Joan Izyk, 72, of Oswego. She had enjoyed a breakfast out and was relaxing in her living room with a coloring project. When her husband arrived home, she stood up to go greet him in the kitchen. She never made it. She could hear her husband calling her, but she couldn’t respond. Izyk had suffered a stroke. “I just went down, and I could not get up,“ she recalls of that morning at her home. “I couldn’t talk, so I couldn’t yell to him. He thought it was a stroke right away.” Impaired speech is one of the signs of stroke outlined in the acronym FAST, which is designed to help people act quickly to assist someone who may be having a stroke. FAST stands for Facial drooping, Arm weakness, Speech difficulties and Time. “Joan’s husband recognized that she was having a stroke, which helped her get the treatment she needed quickly and ultimately led to her positive outcome,” says nurse Josh Onyan, outreach coordinator for Upstate’s Comprehensive Stroke Center. Rescuers from the Oswego Volunteer Fire Department arrived at the Izyk home and quickly moved her into the ambulance. ey noted the right facial droop, right upper extremity weakness and slurred speech, consistent with the

Extending expertise Stroke experts in Syracuse consult with rural colleagues via telemedicine

signs of a stroke. ey rushed her to Upstate. e stroke team had received notice of the 911 call and prepared for Izyk’s arrival while the ambulance was en route. Doctors and nurses from Upstate’s Emergency Department and stroke team began treating Izyk immediately. She received the clotJoan Izyk, stroke survivor busting medication known as tissue plasminogen activator, or tPA, just 24 minutes aer arriving at the hospital. en she was injected with a dye so that a computerized tomography angiogram could produce detailed images of her brain. Endovascular neurosurgeon Grahame Gould, MD, located a blockage in one of her vessels and quickly performed a delicate clot-retrieving procedure. “e combination of tPA upon arrival, plus endovascular rescue techniques such as this have been shown to greatly reduce disabilities from stroke,” Onyan notes. ree days later, Izyk was resting at home, with mild facial weakness, grateful for the fast response of her husband, the fire department volunteers and the caregivers at Upstate. ●

CARTHAGE

OGDENSBURG

FORT DRUM

TELEMEDICINE CONNECTS STROKE SPECIALISTS from Upstate University Hospital with physicians in rural hospitals throughout Central New York, so that patients can receive prompt assessment and treatment of stroke symptoms. Five hospitals participate, including Carthage Area Hospital, Claxton-Hepburn Medical Center in Ogdensburg, Cortland Regional Medical Center, River Hospital in Alexandria Bay and Samaritan Medical Center in Watertown. e Fort Drum Regional Health Planning Organization helped deploy the equipment necessary to make these connections possible. e telemedicine network provides Upstate neurologists with access to computerized tomography scans and the ability to talk with doctors and patients in hospitals many miles from Syracuse.

fall 2016 l upstate.edu

BY SUSAN COLE

UPSTATE COMPREHENSIVE STROKE CENTER (SYRACUSE)

ALEXANDRIA BAY

WATERTOWN CORTLAND

“Our telemedicine network allows the North Country access to expert stroke care, regardless of geography,” says nurse Jennifer Schleier, program manager of Upstate’s Comprehensive Stroke Center. “We have come to think of this program as stroke care without borders. It is our mission to close the gap between expert medical care and location of the patient.” ●

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To avoid withdrawal, she nearly died

CARING FOR PATIENTS

Former addict warns of the dangers of antidiarrheal drug BY JIM HOWE

KATHARINE “KATE” RAYLAND NEVER INTENDED to become addicted to — and nearly die from — an over-the-counter drug designed to prevent diarrhea. She developed a potentially fatal heart problem and landed in the intensive care unit at Upstate University Hospital aer taking too much loperamide. Rayland, 48, of Rome unwittingly revealed to doctors the dangerous lengths to which an addict might go in seeking a high with such a common medication. She marvels that she is still alive. Despite her brush with death in 2012, Rayland started using the drug again.

Kate Rayland 

She credits an Upstate toxicologist with scaring her straight aer that relapse.

Rayland began taking loperamide around 2009 and figured she would continue since nobody at that time seemed to recognize it as an addiction. It was legally available over the counter, and she was able to keep working. But as her body grew to tolerate the drug, she required higher doses. Eventually she was taking 144 tablets a day — the total contents of a two-bottle pack. e recommended dose is no more than four tablets a day. e Food and Drug Administration now warns of serious heart problems that high doses can cause.

“You’re playing Russian roulette,” Jeanna Marraffa, who holds a doctorate in pharmacy, told Rayland. “How many more shots do you think you have in that gun?” Rayland says those words “stuck with me, so aer that, I committed to staying off of it no matter what.” is November she will mark three years of being free of loperamide. Rayland started using the drug to counter her withdrawal from the prescription opioid Vicodin, which she had been taking for shoulder and arm pain. She read online about addicts who took large doses of loperamide to taper off opioids or get a cheap high. e drug calmed her and let her get through the day without feeling “creepy-crawly,” paranoid or anxious — signs of opioid withdrawal. She ate a high-fiber diet and did not

PHOTO BY SUSAN KAHN

experience the constipation the drug is designed to induce.

ose dangers weren’t clear in early 2012 when Rayland found herself gasping for air and sweating. Realizing something was terribly wrong, she went by ambulance to Rome Memorial Hospital. She was transferred to Upstate. “I should be dead at least 20 times over,” she says, referring to the number of times her heart had to be shocked with a defibrillator to get it beating correctly. “ese guys got me Continued on page 11

WHAT IS LOPERAMIDE?

Loperamide is the active ingredient in many over-thecounter antidiarrheal products, including Imodium A-D. It acts on peripheral opioid receptors in the digestive tract to slow the movement of food and slow diarrhea. Any opioid pain medication causes the same slowing, and this is responsible for the constipation caused by opioids. In recent years, however, some people have taken massive quantities of loperamide in search of a cheap high or to ease withdrawal symptoms from opioid painkillers as those drugs become more restricted. is has led to loperamide being called “the poor man’s methadone,” and it has been shown to cause dangerous, even fatal, irregular heartbeats. 10

U P S TAT E H E A LT H

In normal doses, loperamide cannot stimulate the brain’s opioid receptors because a membrane pump in the brain pumps it back into the blood as soon as it crosses into the brain. But when people take massive doses, it causes massive blood loperamide levels, which overwhelm the capacity of the pump to rid the brain of the drug, and it can then stimulate the brain opioid receptors and cause the “opioid high.” Extremely high levels in the bloodstream cause the dangerous heart rhythm disturbances that are never seen when people take the normal low doses recommended by the manufacturer for treating diarrhea.

upstate.edu l fall 2016


6 answers about heroin

FROM OUR EXPERTS

Who uses heroin?

How does heroin kill?

Experts from the Upstate New York Poison Center say that some users turn to heroin because it is cheaper than prescription pain medicine. ey may inject it, inhale it by snorting or sniffing, or smoke it. About half of the young adults who inject heroin report abusing prescription opioids first, according to the National Institute on Drug Abuse.

Heroin and all opioids decrease central nervous system activity, resulting in a decreased level of consciousness and, eventually, a decrease in the activity of the breathing center. Patients usually die because they stop breathing or breathe too little to allow for enough oxygen to reach the brain, and death typically happens one to three hours aer injection.

How does it affect the brain?

What are some signs of heroin use?

Opioids relieve pain by altering a person’s perception of pain signals from their body. With prolonged use, the sites where the opioid works become adapted, and then it requires more of the drug to get the desired effects.

Someone who has started abusing heroin may exhibit a change in behavior or mannerisms or have a new circle of friends. He or she may withdraw from family activities and may react with anger or excuses when questioned why. School grades may deteriorate.

What does it feel like? Heroin users describe treatment of their pain, relaxation and a sensation of being high. People with chronic pain who use heroin may experience hyperalgesia, where they feel as though they are in greater pain.

Why is this a crisis? e death rate from drug overdoses is climbing at a much faster pace than other causes of death, according to e New York Times, a trend similar to that of the human immunodeficiency virus in the late 1980s and early 1990s. In Onondaga County, deaths from heroin overdoses climbed nearly 31 percent in 2015. Most deaths were of white men in their 20s.

A heroin user may display a lack of motivation, a lack of self control and/or irrational behavior. His or her temperament may become difficult or aggressive and he or she may have constant fatigue. A person using heroin may neglect personal hygiene and appearance and develop an impaired sense of judgment. eir speech may slur, or they may have trouble expressing themselves verbally. e pupils in their eyes may become pinpoints, their lids may be heavy, and needle tracks may be visible on their arms. ey may say they feel insects crawling all over their body. Heroin users could have in their possession “drug paraphernalia,” including tinfoil, weight scales, zip-lock bags, square folded paper envelopes, butane torches or cigarette lighters, small porcelain bowls, hypodermic needles, balloons, mirrors or short straws. ●

She experienced antidiarrheal drug’s dangers through it,” she says of Marraffa and fellow toxicologist Michael Holland, MD, as well as the cardiology and intensive care people who treated her. Rayland was the first reported loperamide abuse case in Upstate New York, says Marraffa, who later published research on Rayland that described loperamide’s heart risks. Marraffa has corresponded with Rayland since then and calls her “an amazing person” who “has subsequently helped tremendously in further investigation into this deadly drug of abuse.” Getting off loperamide “wasn’t easy, and it wasn’t fun,”

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continued from page 10

Rayland says, but she tapered off the drug in six weeks in late 2013. She has since seen an addiction specialist and a psychiatrist and joined a 12-step program. Her heart is healthy today. Today Rayland is employed and taking courses to become a nurse practitioner and also maintains a blog at madmargaret.wordpress.com where she warns of the dangers of addiction and posts related scientific research. Rayland says her efforts to stay clean and inform others about drug abuse “gives me a sense of purpose that this didn’t happen for nothing.” ●

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FROM OUR EXPERTS

Concussion Concerns

Make sure you know how to react WHEN CONCUSSIONS ARE PROPERLY MANAGED, patients usually have no lasting effects. e key is to recognize the injury when it happens.

5 reasons athletes with concussions should not play

An injured athlete needs to be removed from play until he or she is properly evaluated. Symptoms vary but may include blurry vision, ringing in the ears, headaches, trouble with balance and/or concussion. Most concussions happen without the athlete losing consciousness.

All 50 states now have sports concussion laws, and with a better understanding of the seriousness of concussion, coaches and trainers take these mild traumatic brain injuries more seriously.

Neuroimaging (such as CT and MRI scans) cannot diagnose concussion. Instead, health care providers arrive at a diagnosis based on the patient’s history and the way his or her functioning is affected. Tests may be done to rule out other problems. e recovery period is typically three weeks and includes a lot of sleep and rest. Patients are instructed to limit their physical and mental exertion, which for students usually affects school attendance and the use of electronic devices. Athletes are usually sidelined, to protect them from the risk of re-injury. “A concussion is almost always a short-term event, when managed properly,” says Brian Rieger, PhD, an assistant professor of physical medicine and rehabilitation and director of the Upstate Concussion Center. He says one thing coaches and parents can do is encourage athletes to be honest about their injuries. Ignoring the symptoms of a concussion is bad because it can delay healing. What’s worse is to overlook a concussion — and then suffer another. e consequences can be disastrous when that happens, Rieger says, with symptoms more severe and lingering for months or years. Upstate’s Concussion Center provides comprehensive evaluation and treatment services for people struggling with the lingering effects of concussion. ●

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With proper management, the majority of concussions are short-term injuries. But, it’s crucial that an athlete suspected of sustaining a concussion not return to play until he or she has been evaluated. An athlete with a concussion who continues to play: l l

l

l

l

increases the risk of sustaining another concussion; is liable to aggravate concussion symptoms including fatigue, dizziness, blurred vision, irritability, anxiety, depression, headache, nausea and vomiting, clumsiness, fogginess, trouble reading and poor mental stamina; might prolong his or her recovery time with associated medical, psychological and academic difficulties; increases the risk of long-term problems which could include headaches, cognitive and emotional changes and sleep difficulties; and in rare cases, risks severe disability or death if he or she sustains another concussion.

e Upstate Concussion Center (315-464-8986) provides comprehensive evaluation and treatment services for concussion and sports concussion. Learn more at upstate.edu/concussion. Hear more at healthlinkonair.org. Search “concussion.”

upstate.edu l fall 2016


Meth lab dangers

FROM OUR EXPERTS

LESSONS FROM UPSTATE

Exposure can cause lasting effects RESCUERS WHOSE JOBS TAKE THEM TO CLANDESTINE METHAMPHETAMINE LABS risk exposure to chemicals that can cause what appears to be permanent damage to their memory-making ability. Specialists in anesthesiology and neurology at Upstate Medical University tell about a middle-aged firefighter who developed profound anterograde amnesia in 2001 aer he was exposed to fumes from spilled material that was used to synthesize meth. Chemicals commonly used in labs that produce the illegal stimulant are known to cause headaches, respiratory and eye irritation, and nausea and vomiting. Exposure to certain toxic chemicals can produce detrimental cognitive deficits, including amnesia. In a study from 2009, more than three-quarters of police officers reported memory loss aer exposure to clandestine meth labs. Amnesia is memory loss, which may be partial or complete and may relate to stored memories or the ability to commit something new to memory. Anterograde amnesia is when the ability to memorize new things is impaired. Its development indicates that particular regions of the brain have been affected.

BY AMBER SMITH

Awss Zidan, MD, and Amy Sanders, MD, write about the firefighter’s case in the March issue of the Journal of Neurology and Stroke. e firefighter lost consciousness and was hospitalized. He had trouble recalling events of the recent past. “He could not remember dates or names for more than a few minutes,” the researchers write. Aer he went home, he developed “out-of-body experiences,” generalized shaking, angry outbursts, depressed moods and impaired cognitive functioning. He had trouble memorizing new things. e man sought care at Upstate University Hospital 12 years aer the incident. “Although there has been no improvement in his memory impairment since the time of the injury, he has learned to cope with his limitations,” Zidan and Sanders write. “His family provides him with written notes, organizing his chores and tasks, such as shopping or household maintenance, on a daily basis; he is able to follow these instructions. He is able to drive with the help of a global positioning device.” e researchers suggest the connection between meth lab exposure and memory deficits warrants further study. ●

Awss Zidan, MD

Amy Sanders, MD

FIREFIGHTER PHOTO BY ROBERT MESCAVAGE

People with anterograde amnesia may: l repeat l not

comments or questions several times.

recognize people they have just met.

l have

suffered damage to the hippocampus or medial temporal lobe of their brains.

l retain

the ability to learn new skills and habits (procedural memory).

l lose

the ability to recollect some facts (declarative memory). While they might not recall autobiographical information, they may be able to remember language, history and geography.

l recover

functioning for some memories, over time, if the damage is limited to one side of the brain.

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Diabetes app

FROM OUR EXPERTS

WHAT’S THE WAY BEST WAY TO TRACK YOUR ACTIVITY, if you have diabetes?

You can spend lots of money for a fancy activity-tracking device. You can invest in a pedometer to count your steps. Or, consider downloading a free app on your smartphone created by the American Association of Diabetes Educators. Upstate physical therapist Karen Kemmis is an executive board member of the association. “is helps a person set and track goals related to seven self-care behaviors for diabetes self-management, including increasing physical activity,” Kemmis says. e others include eating healthier, monitoring blood glucose, taking medications as prescribed, learning how to solve ordinary and unusual problems, reducing the risk for complications and coping with emotional issues. ●

Once fatal, now curable UPSTATE HISTORY

WHAT TO IF YOU ARE CAUGHT IN‘a ANmiracle ‘ACTIVE of SHOOTER’ Story of DO infective endocarditis medicalSITUATION progress’ UPSTATE CARDIOLOGIST HAROLD SMULYAN, MD, and infectious disease expert Donald Blair, MD, tell the tale of infective endocarditis in the August 2015 issue of the American Journal of the Medical Sciences. ey call the nearly complete conquest of the disease “a miracle of medical progress.” Endocarditis is an infection of the heart valves and/or the lining of the heart. It’s usually caused by bacteria. It’s not contagious. eir paper explains that endocarditis was first reported during routine autopsies in the early 1800s, although it was several years before its bacterial cause was identified and a century before medicines were developed to fight the bacteria. “Before the development of antibiotics, this disease was almost uniformly fatal,” Blair says. Surgery to remove infected tissue was occasionally helpful, but survival rates improved only aer antibiotics were added. e next breakthrough came in the 1970s with the development of a method of capturing ultrasound images of the beating heart. Smulyan recalls that “echocardiography enabled us to actually look at the valves in the inside of the heart and see

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infections almost directly.” Doctors could confirm the bacterial infection with a blood test and, through medical imaging, know the location and severity of its damage. is soon led to the practice of replacing damaged heart valves. Today, patients who develop infective endocarditis receive antibiotics, oen followed by valve replacement surgery. Heart valves are susceptible to infection because they do not receive a blood supply of their own. For this reason, white blood cells and antibiotics, which fight infection, cannot reach the valves internally and must rely on the circulating blood to reach their targets. Smulyan and Blair point out that infective endocarditis is a different disease now than when it was discovered two centuries ago. Different types of bacteria are responsible, and different types of patients are affected. Patients who develop this disease today are generally older and likely to have medical problems such as kidney disease or heart disease. e doctors marvel at the progress made in the treatment of infective endocarditis. ey write in their paper that although the infection can now be cured, prevention remains elusive. ●

upstate.edu l fall 2016


Dementia insights

FROM OUR EXPERTS

Advice about caring for someone in mental decline

THE ALZHEIMER’S ASSOCIATION ESTIMATES 5.4 MILLION AMERICANS are living with Alzheimer’s disease, a number that is expected to escalate rapidly as the baby-boom generation reaches retirement age. e number of people caring for someone with dementia is substantial, and growing, as well. Upstate geriatrician Andrea Berg, MD, has something to say about four issues that are bound to come up in the course of caregiving:

Never correct; just redirect. Reflexive as it may be to correct something a loved one says that is incorrect, Berg and other geriatricians caution against it. “When you correct somebody, it throws them on their heels and makes them lose their confidence a little bit more. Typically people are already self-conscious about losing memory and to some degree aware of memory problems in the earlier stages of the disease.” “In the moderate to advanced stages, people can perseverate on a concept such as ‘I want to go home’ even if they might be in their home. ey’re referencing a different time because their time frame is skewed. Instead of correcting them, which is usually a futile effort, focus on the concept of home and engage them on what is appealing about being home. In acknowledging and validating emotional content of what is being said you oen can drive the conversation into a different direction — as opposed to creating conflict if you try to correct them.”

Eating should be pleasurable. Beyond providing sustenance, “eating should remain one of those primal pleasurable activities,” Berg says. “I caution people to not get hung up on the details or place undue dietary restrictions on their loved one. In the late stages, if they want to eat ice cream three times a day, go for it. is isn’t the time to be overly concerned about watching your salt or sugar.” Eating is likely to become more challenging as the disease progresses. Berg is a proponent of hand feeding. “It doesn’t have to be fast. Go slow,” she advises. “Meal time could be a positive interaction between a loved one and their caregiver, a way to care for somebody and show love, so that it’s not just nutritional nourishment but also a social support.”

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WHAT IS DEMENTIA? Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. It’s marked by a progressive loss of cognitive functioning, including memory, thinking and reasoning. Alzheimer’s disease is the most common type of dementia.

They don’t wander — until they do. It’s not an early hallmark of the disease, but as it progresses, Berg says people with dementia may wander and become lost, without warning. “It’s something that should be on your radar, especially for people who are functionally independent and can walk around on their own,” she says. Berg directs caregivers to Safe Return, a 24-hour nationwide emergency response service provided by MedicAlert and the Alzheimer’s Association: www.medicalert.org/safereturn

Caring for yourself is a must. Oen caregivers will say they don’t have time to take a yoga class or walk around the block, or do anything else that would allow them to recharge. “Rates of depression and anxiety and overall poor health outcomes are rampant in caregivers of loved ones with dementia,” Berg points out. “You have to maintain your own level of health, or else you’re not going to be much help to those for whom you care.” at includes paying attention to nutrition, getting adequate sleep, going to your own doctor appointments, exercising and taking time for yourself. It also includes allowing others to help and taking people up on offers to sit, cook, clean or run errands. Knowing you are not alone can be a huge stress reliever. “It’s not selfish,” she says. “It’s necessary.” ● Hear more at healthlinkonair.org. Search “Andrea Berg.”

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Meet Carey and Sally

IN OUR COMMUNITY

Kids’ book explains, embraces children with autism “SALLY AND I ARE KIDS JUST LIKE YOU,” says Carey. “We have autism and learn a little differently, but we want friends just like you.” Carey and Sally are the main characters of a new children’s book that aims to create a sense of understanding and acceptance of children with autism. ese children can be talkative and highly functioning, like Carey, or mostly nonverbal, like Sally. “Carey & Sally: Friends With Autism,” explains autism’s spectrum of behaviors and also how each person with the condition is unique. Or, as Carroll Grant, PhD, the book’s author says, recalling an old saying, “If you’ve seen one autistic kid, you’ve seen one autistic kid.” Grant, director of Upstate’s Margaret L. Williams Developmental Evaluation Center, has been working with children with autism for decades. e book, with illustrations by Jerry Russell of Chittenango, grew out of KidSpeak (see box), a program Grant developed. at program uses large puppet versions of Carey and Sally to demonstrate autistic behaviors in schools and other locales with children. e book will stay in the classroom aer the program ends and includes suggestions for children to help deal with peers who have autism.

Carroll Grant, PhD, with Carey (left) and Sally, the puppet characters who inspired the book, “Carey & Sally: Friends with Autism”. PHOTO BY ROBERT MESCAVAGE

BY JIM HOWE

HOW THE BOOK CAME ABOUT

With help from the Upstate Foundation, Carroll Grant got funding from Sally CaFrireendys w& Kohl’s department stores ith Autism to start a puppet workshop about autism and later to create a companion book, “Carey & Sally: Friends with Autism.” Help with the KidSpeaK puppetry for what became the KidSpeak program came from Open Hand eater of Syracuse, where Grant, a board member, had seen skits and shows using puppets to shape attitudes about acceptance and making the world a better place. t, PhD ll Gran By Carro

ted by Illustra sell Jerry Rus

ION COMPAN

A

Carey, either as a book character or a puppet, helps other children and teachers “to understand that spectrum (autistic) kids have a social ineptness, and because he’s cute and funny, it helps people be more accepting,” Grant says. To explain his difficulties reading social cues, Carey says, “My friends tell me I talk too much. I am not good at knowing what other kids think or feel, so sometimes I bother my friends.” Carey also explains that he likes to have his mom or his teacher write him a list each day. “is helps me know what to expect and what to do. en I feel calm,” he says. To illustrate a more severe form of autism, Sally is shown with her tablet and “choice board,” which has a happy face/yes and a sad face/no that she points to when answering questions. She sometimes likes to rock back and forth and wave her hands, Carey explains. Carey also shows how to be a “detective” to figure out what is making Sally upset, such as checking to see whether he is standing too close or whether the room is too noisy or too bright. e puppets help “normalize” autism for other children, says Charissa Taylor, who works in instructional support and is one of the puppeteers in the traveling program. ey are teaching that “a difference can mean different, not handicapped. e bottom line is that everyone seeks friends.” Taylor notes that one or more audience members usually says they know someone with autism and recognizes the puppets’ behaviors. ●

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upstate.edu l fall 2016


SYRACUSE’S POOREST WORKERS:

IN OUR COMMUNITY

HEALTH PROBLEMS, LOW WAGES BY JIM HOWE

AN ONGOING STUDY OF THE SYRACUSE AREA’S LOWEST-PAID WORKERS finds they oen face aching backs, constant stress and a lack of respect as well as a skimpy paycheck. ese workers, oen in service jobs, deal with sore muscles, ever-changing work schedules and the fear that if they even mention a health problem, they’ll lose their job — a job that may not be secure to begin with. ese concerns are documented in “Healthy Work in Syracuse? Conversations With Low-Wage Workers,” the second phase of the Low-Wage Workers’ Health Project. It’s a study from the Occupational Health Clinical Centers, a state operation based in Syracuse that serves 26 counties and is affiliated with Upstate Medical University. Defining who is a low-wage worker is difficult, explains project manager Jeanette Zoeckler, but in this study it means workers struggling to survive at a basic level, earning less than $15 an hour, depending on family size and other factors. About 39 percent of workers in the five-county region around Syracuse made $15 or less an hour in 2014, according to the Bureau of Labor Statistics, including cashiers, food preparers and servers, cleaners, office and stock clerks, health aides and unskilled laborers. “Occupations that are giving people less than a living wage tend to have certain characteristics that impact health. ese can range from poor air quality to poor ergonomics, physical factors on the job that influence health and also mental factors on the job that influence health. So, in the new economy we’re curious about how the low-wage worker’s work impacts their health,” Zoeckler says. e project saw national trends mirrored in Central New York, such as the move from manufacturing to low-skilled work — “basically a proliferation of lousy jobs or less meaningful or less satisfying jobs that also have poor conditions associated with them,” she says.

INDUSTRIES EMPLOYING LOW-WAGE WORKERS (as represented by 275 surveyed workers)

Accommodation and Food Services 18%

Transportation and Warehousing

14%

Health Care and Social Assistance 16%

Construction

12%

Administrative Support, Waste Management and Remediation Services

Educational Services 14%

2%

SOURCE: OCCUPATIONAL HEALTH CLINICAL CENTERS

ese jobs are described as “precarious” because they can end suddenly and “dead-end” because they tend to offer little long-term chance for a raise, promotion or desirable career. More than 450 people were interviewed over the first two years of the study. “I think we’re starting to get a good picture of the kinds of struggles that the workers are facing on the job with regard to their health,” Zoeckler says. Among the physical problems, muscle and joint pain were common, with roughly a third of respondents saying they experienced pain daily at work and many also facing barriers to getting medical care. Workers also reported stress from being bullied and disrespected, having poorly defined duties and not being paid what they are owed by employers. e report’s contributors have met in the past year with Gov. Andrew Cuomo’s task force on exploited workers, distributed the report to lawmakers and hope it will help point the way to both short- and long-term solutions to low-wage workers’ problems. e third phase of the report is to be published in the coming months. ● Find more about the report at the Occupational Health Clinical Centers website at ohccupstate.org

Hear more at healthlinkonair.org. Search “Zoeckler.”

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IN OUR COMMUNITY

Safe houses

11 things emergency doctors ban from their homes BY AMBER SMITH

DOCTORS AT UPSTATE UNIVERSITY HOSPITAL’S EMERGENCY DEPARTMENT are on the front lines of the mayhem and mishaps that befall young Central New Yorkers.

says Louise Prince, MD. “I do not permit my children to ride them at friends’ houses, either.”

ey care for people with every imaginable injury or illness at their workplace, the Level 1 trauma center for a region stretching from the state capital through Finger Lakes wine country, from the border of Pennsylvania to Canada.

ey’re tiny when compared to a fullsize swimming pool, but that doesn’t make them safe. A small plastic or inflatable wading pool can be a drowning risk when kids are unsupervised, reminds Farber-Heath.

ey handle crises with calm.

5. Dishwasher detergent pods

en they go home.

Kelsey Stack, DO, says dishwasher detergent pods look like bright, yummy candy to kids “but can cause all sorts of issues, the most significant being caustic burns to the mouth, esophagus or airway.

Some aspects of the job go with them, visions such as struggling to revive a child who wandered into a backyard pool, or comforting a parent whose teen who put a gun to his head. Such experiences inform the rules they put in place for their own children in their own households. Here are 11 things that are so dangerous as to be generally forbidden in the homes of emergency doctors:

1. Trampolines Side nets and completely covered springs are safety features of modern trampolines but Derek Cooney, MD, still won’t allow a trampoline at his house. “ey’re just too dangerous. “Many of the most serious injuries are related to falls from the trampoline, collisions when multiple people are jumping, and exposed springs that lead to gruesome extremity lacerations,” he explains, adding that serious neck and back injuries, joint or limb fractures are not uncommon.

2. Bounce houses Inflatable bounce houses can lead to collision injuries and falls, as with trampolines, but there’s a secondary reason they’re not welcome in the home of Risa Farber-Heath, DO. “ey spread germs.”

3. Motorcycles, snowmobiles or all-terrain vehicles “I see a large number of patients with severe trauma while riding these. Your body is unprotected, and you are going at a high rate of speed,”

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4. Wading pools

“Aer seeing many kids in the emergency department who have bitten into them, and the consequences of that one bite, I banned them from our house.”

6. Riding mowers Growing up with a pediatric surgeon for a father, Cooney heard of horrible lawn mower accidents long before he began taking care of patients who were injured by lawn mowers. Every summer, he sees children who are run over by parents on riding lawn mowers who did not know their child was anywhere nearby. Some of the children lose limbs or are permanently disfigured, and some of them die. When the lawn is being mowed, the Cooneys follow the rule that “children should not be outside unless a second adult is directly supervising them and ensuring they are kept well away from the yard,” he says. ey do not have a riding mower. If they did, they would not allow older children to use it. Too oen he’s seen the result of judgment errors: a mower operated on slope that rolls and crushes a person, or someone loses a hand or a foot while working on a mower with the engine still running.

7. Hand sanitizers “I want my kids exposed to everything and building a strong and healthy immunity,” Jeremy Joslin, MD, says in explaining why his family skips hand sanitizer products in favor of plain soap and water.

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IN OUR COMMUNITY 8. Foam dart guns

11. Gaming systems

“I won’t let my kids play with Nerf type guns unless they are wearing goggles,” says Alison McCrone, MD, medical director for Upstate Golisano Aer Hours Care. She’s concerned about poor aim, accidental close shots and other moves with the potential for injury.

“It isn’t exactly a safety issue as much as the belief that they are time consuming, addictive and have many violent games,” says Prince in explaining why her home contains no game system. “We want our kids to do other things with their time.” ●

9. Teapots and coffeepots “I have seen so many kids coming in with burns to the face, chest and arms from hot coffee or tea that they have pulled over on themselves, or that a caregiver had spilled on them. It’s terrible,” Stack says. “I only boil water on the back burners and always make sure while cooking that pan handles are turned toward the inside and not sticking out for little hands to grab.”

THREE MORE DANGERS

So far this year authorities from the Upstate New York Poison Center, which fields phone calls from 54 counties outside of New York City, have noticed an increase in the number of calls about emergencies involving someone 19 or younger and laundry pods (similar to dishwasher detergent pods), electronic cigarettes and button batteries. Item

All of 2015

First half of 2016

217

105

10. Co-sleeping

Laundry pods

Joslin will not sleep with a baby in his bed. He always makes children sleep by themselves. “I’ve taken care of too many dead babies from co-sleeping arrangements.”

E-cigarettes

2

4

Button batteries

35

26

SOURCE: MICHELE CALIVA, UPSTATE NEW YORK POISON CENTER

Grateful patient loses his voice … creates Voice of PALS BY BETHANN KISTNER

CLIFF MAUS WOKE UP ONE MORNING with slurred speech. He and his wife knew something was wrong, but neither imagined he had amyotrophic lateral sclerosis, more commonly known as Lou Gehrig’s disease. Aer several appointments with physicians who specialize in neurological disorders, who all agreed that he had ALS, Maus was referred to Upstate’s ALS Research and Treatment Center. Maus, a retired Canandaigua police officer, was diagnosed with a rare form of ALS called progressive bulbar palsy, which impacts the throat and lungs. Globally, 20 percent of ALS patients who have trouble with speaking and swallowing at diagnosis are classified as bulbar-onset. ese patients lose the ability to speak early in the course of the disease. Most other ALS patients develop speech loss as the disease progresses. Maus cannot speak, but he communicates using his iPad. Motivated to help find a cure, he enrolled in a clinical trial at Upstate. He also organized a Frank Sinatra tribute in Geneva last winter and used $6,500 in proceeds to open a Voice of PALS (Persons with ALS) fund through the Upstate Foundation to benefit ALS treatment and research at Upstate. In addition, Maus’ friends at the National Barrel Horse Association held a fundraiser in June at the Seneca County Fairgrounds in his hometown of Waterloo, raising $1,200 fall 2016 l upstate.edu

for the Voice of PALS. Supporters are planning a golf tournament for summer 2017. “With a disease that has no cure or treatments to stop the progression, research is our only hope,” Maus says. Neurologist Eufrosina I. Young, MD, directs the center and leads a study using transcranial magnetic stimulation to diagnose ALS. at research also involves Upstate’s department of neurosurgery.

Cliff Maus

Voice of PALS was established through the foundation’s Grateful Patient and Family Program, which identifies and establishes relationships with patients and their families who are grateful for the care provided by Upstate health care professionals. “What Cliff Maus is doing to help Upstate’s ALS clinic is more than meaningful. It is brave and selfless,” says Eileen Pezzi, vice president for development at Upstate. “We are extremely grateful for patients like Cliff who make a difference in research and patient care.’ To donate to this fund, visit upstatefoundation.org/PALS or contact the Upstate Foundation at 315-464-4416. ●

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IN OUR COMMUNITY Still, Bode says the numbers are troubling. In 2001, 5 percent of newborns were exposed to an opioid during pregnancy. Today it’s up to 25 percent. e majority of exposures come from prescription opioids such as hydrocodone or oxycodone, but Michelle Bode, MD the number of babies exposed to illicit opioids such as heroin has increased, too. Bode says data from birth certificates for babies living along the Interstate 81 corridor shows 2.1 percent were affected by illicit drug use in 2006. Almost three times as many — 5.9 percent — were affected in 2015.

Helping newborns by helping moms off drugs BY AMBER SMITH

ONE QUARTER OF THE BABIES BORN in Onondaga County have been exposed to an opioid drug of some sort in the womb, making for one of the highest rates of newborn drug exposure in New York state. at doesn’t mean women in Central New York are more prone to drug use. Neonatologist Michelle Bode, MD, an assistant professor of pediatrics at Upstate, explains that “in New York City they don’t have a problem because they don’t test.” Pediatricians who serve the three Syracuse hospitals with maternity care screen for drug use in the same way, Bode says, “so we’ve got some cohesiveness that isn’t necessarily found in other areas of the state.” Upstate University and Crouse hospitals and St. Joseph’s Hospital Health Center deliver most of the babies from Onondaga and 14 surrounding counties.

Whether exposed to legal or illegal substances, the babies are born with what is called neonatal abstinence syndrome. “ese infants do not have a normal newborn experience,” Bode says. Oen free of symptoms at birth, the babies within the first week become irritable and jittery, with a shrill cry. ey don’t feed well, or sleep well, and they have diarrhea. Hospitalization may last three days or more than three weeks as they go through withdrawal, depending on the substance they were exposed to and for how long. Long-term consequences can include birth defects, problems with development and behavior and a greater risk for sudden infant death syndrome. If the mother gets help for her addiction, and if she brings the baby into a loving and stable home, there may be no lasting effects. “e environment the child is raised in will determine their outcome,” Bode says. She points out that mothers-to-be who admit to opioid use during prenatal visits can receive expedited referrals to addiction treatment services in Central New York. Studies show that pregnancy can be a window of opportunity to get women into treatment. Ask 100 pregnant women how important their baby’s health is to them, and Bode says more than 99 percent will say it’s important. If health care providers explain how halting opioid use can help the woman have a healthy baby, she is likely to be receptive to addiction treatment. And, Bode notes, women have a slightly higher success rate for treatment when they are pregnant. ● Hear more at healthlinkonair.org. Search “Michelle Bode.”

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IN OUR LEISURE

Photography, writing provide creative outlet for program coordinator A newborn fawn photographed by Patty Mondore at her camp in Redwood, in the Thousand Island region. BY JIM HOWE

WHETHER IT’S WITH A CAMERA, a keyboard or a microphone, Patty Mondore likes to express herself and share her world. A 25-year employee of Upstate, where she is the pediatric residency program coordinator, Mondore has written numerous newspaper columns and books to express her thoughts, oen of a devotional nature, and usually featuring photographs she has taken of her beloved ousand Islands region, where she and her husband have a camp. “I’ve always loved nature. I’ve always been outdoors since I was a little kid, when I had a Brownie,” she said, recalling her first Kodak camera.

camera that has a good zoom lens for capturing animals. “Someone once told me that being a good photographer is strictly a matter of showing up at the right time and place,” she notes. Two of her photos — of a butterfly and a rainbow, both taken near her Jamesville home — hang in the Upstate Cancer Center. Her photos can be seen on her website, gold-mountain.com/pattypages.html, which also features songs and keyboard music by Mondore.

“When I am outdoors I like to shoot photos. I just want to bring it all back in with me.” Her photos, and some videos, include views of the St. Lawrence River and its islands and wildlife, including a chipmunk that she and her husband, Bob Mondore, a retired Upstate clinical data staffer, named Hoover. e energetic Hoover — named for the way he practically vacuums up his food — has achieved something of a following on YouTube. She takes pictures with an inexpensive, point-and-shoot

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Mondore captured this image of a butterfly and butterfly bush at her home in Jamesville. U P S TAT E H E A LT H

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IN OUR LEISURE

Nurse relieves stress, has fun with Zumba

Barbara Mcginley, center, teaches zumba at the YMCA in downtown Syracuse.

BY JIM HOWE

“IF YOU LOVE TO DANCE, you’re going to love a Zumba class,” says Barbara Mcginley. “Do you love to dance? And get a workout at the same time?”

She gradually introduces new songs into the mix, since “sometimes the gals (the classes tend to be all or mostly women) like the same songs over and over again.”

A highly energized dance class, set to anything from Caribbean salsa to hip-hop, is what Mcginley, a psychiatric nurse at Upstate’s community campus, leads each Monday aernoon for an enthusiastic crowd at the downtown Syracuse YMCA. She also teaches a class at Syracuse’s Unity church.

“I want my class to feel like you’ve been to a Latin country. Like you just took a mini trip to Puerto Rico or to South America,” she said.

Mcginley, 65, of Syracuse, had studied African dance and cardio salsa and been an aerobics instructor when she heard about Zumba being offered at the Y about five years ago. Curious, she took some classes, said, “Wow, this is what I want to do,” and soon got certification as a Zumba instructor. She choreographs each song, which probably takes her students a couple of the hourlong classes to learn. e moves are basic, oen repeated and can incorporate fitness moves like squats. “It’s more like fun moving in a way that you probably have not ever moved, and anybody can do it. We’re here to have fun and to have a workout and enjoy the music, and most people who come into the class come back again,” she said. 22

PHOTO BY SUSAN KAHN

U P S TAT E H E A LT H

“I love my job,” said Mcginley, who has been a nurse at her campus for 43 years, and Zumba “is a great way to be able to be able to cope with life and its stressors.” ● WHAT IS ZUMBA?

It’s a trademarked dance and exercise program set to Latin and world music, designed to be simple, energetic and fun. It was created in the 1990s when Colombian aerobics instructor Beto Perez forgot the music for the class he was teaching and improvised with his own Latin music. at happy mistake led to a worldwide sensation. Today, Zumba is practically a lifestyle, with variations including Zumba Kids and Zumba Gold (for seniors) as well as themed clothing, DVDs, cruises and more. upstate.edu l fall 2016


IN OUR LEISURE

Berry Good Wraps High in vitamin C and antioxidants, berries of all sorts are good food choices eaten as they are. But you can also include them in recipes for meals. is wrap showcases strawberries, which are rich in a B vitamin called folate, which is responsible for making healthy new cells and preventing anemia and neural tube defects in developing fetuses. is recipe serves two.

Ingredients 2 cups diced strawberries 1 diced peach ¼ cup finely chopped cilantro 2 tablespoons fresh orange juice two 12-inch flour tortillas 4 to 6 slices of reduced-sodium deli turkey ½ cup fresh spinach leaves

Nutritional information Serving size: one tortilla 286 calories 16 grams protein 46 grams carbohydrates 5 grams fiber

17 grams sugars 5 grams fat 24 milligrams cholesterol 889 milligrams sodium

Preparation Combine the fruit, cilantro and orange juice into a fruit salsa. Heat the flour tortillas in a microwave for 30 seconds. Layer two or three slices of turkey on each of the warm tortillas. en, spoon on the fruit salsa, and top with spinach. Fold tortilla to make a wrap.

Renowned chef Cary Neff, left,  is vice president of culinary for Morrison Management Specialists, which operates Upstate’s food services. He visited cafeterias on campus in June promoting Flavors 450, a hospital dining menu that features an array of more than  60 rotating recipes, each under 450 calories. 

Physical therapist first to cross finish line Upstate Medical University’s Lee Berube was the fastest man to finish the 3 1/2-mile J.P. Morgan Chase Corporate Challenge race this June at Onondaga Lake Park. Berube finished in 17 minutes, 36 seconds.

Berube, 25, of Syracuse is a doctor of physical therapy who has been running since he was 6 years old. “I really do love it,” he says of running, which is like a hobby for him now. He rises at 5 a.m. to run five or six days a week, and he does speed work with the Syracuse Track Club every week. Upstate co-worker Cara Lavier wasn’t far behind Berube, with a time of 22 minutes, 17 seconds. She was the fourth woman to cross the finish line. Lavier, 37, of Chittenango is a registered nurse who began running around the age of 9 with her father. In 2014 she was part of a four-person team from Upstate that traveled to London to compete in the Corporate Challenge championship race. ●

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Men’s winner Lee Berube of Syracuse representing Upstate Medical University in the J.P. Morgan Chase Corporate Challenge. PHOTO BY DENNIS NETT/SYRACUSE.COM

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750 East Adams Street l Syracuse, NY 13210

SCIENCE IS ART IS SCIENCE IS ART 1S SCIENCE A proton pump called vacuolar ATPase plays an essential role in several biological processes. Malfunctions in this pump lead to a wide spectrum of human diseases, including bone and kidney diseases, diabetes and cancer. Biochemistry and molecular biology scientists in the laboratory of Stephan Wilkens, PhD, use X-ray crystallography to study the 3-D structure of the pump to understand its role in disease and to aid in the design of therapeutics. ese colorful images illustrate how sectors of the proton pump — the sectors responsible for using cellular energy to drive transport through the pump — pack together to form the crystals that the researchers study. is work involves postdoctoral researcher Rebecca Oot, PhD, and Wilkens in collaboration with Patricia Kane, PhD, and Edward Berry, PhD, from Upstate’s department of biochemistry and molecular biology.

Wilkens

Oot

16.267 0916 41.4M ELsk

Kane

Berry

Upstate Health magazine, fall 2016  

Upstate Health magazine is produced by Upstate Medical University, the academic medical center in Syracuse, NY.