Health UPSTATE
U P STAT E M E D I C A L U N I V E RS I T Y
Spring 2018
CARING FOR AGING SKIN page 14 HOW A LASER REPAIRS BURNS page 6 DISSECTING THE OATH NEW DOCTORS TAKE page 16
FROM UPSTATE TO AFRICA page 18
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Emergency care takes time DOCTORS, NURSES AND TECHNICIANS working in Upstate University Hospital’s emergency department strive to provide care quickly, but many aspects of good care take time. e typical emergency visit in the United States averages four hours, and it varies based on whether you ultimately are admitted to the hospital. Your experience may vary depending on what your problem is and depending on how many other people are seeking care at the same time. Patients are not seen on a first-come, first-served basis in emergency departments. Staff “triage” people as they arrive, putting the most seriously injured or ill at the front of the line. Diagnosing what’s wrong with someone is a thorough process that may take a while. For instance, X-ray results or the results of blood or urine analysis may not be ready for 90 minutes. Ultrasound or computerized tomography scans may not be complete for two to three hours. And if a patient requires a specialist, summoning an orthopedic surgeon, an eye doctor or cardiologist could take a few hours — again, depending on how many other people concurrently need the care of that specialist. Oen in the emergency department, patience is a requirement. Nurses Arlinda Carey and Melanie Charleston prep an incubator in the back of an ambulance at Upstate University Hospital’s downtown emergency department. They are members of Upstate’s pediatric critical care transport team who offer intensive care to critically ill children at other hospitals from the Canadian to Pennsylvania borders. They are pictured with emergency medical ● technician Marc Battaglia, at right. PHOTO BY JOHN BERRY
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Contents 4
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patiENt carE Laser-focused brain treatment
From our ExpErts
page 4
Recovering from severe burns
page 6
A fix for sunken chests How a small-town PA found a niche career Accident on the lake: a child survives Gaining acceptance after a stroke
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Why babies need tummy time
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iN our commuNity page 11
page 7
E-cigarettes are not harmless
page 12
page 8
7 ways to care for aging skin
page 14
page 9
If you could design a baby, would you? Should you? page 15
Practice of medicine a privilege, great responsibility
page 16
10 days in Ghana
page 18
Meet the CNY Bear Team page 21
iN our lEisurE The halls are alive with the sound of music page 22
DEpartmENt
page 10
Science Is Art Is Science back cover Studying breast tumor progression
On the cover: Laurie Rupracht, Upstate pediatric nurse and founder of Americans Serving Abroad Program (ASAP), holds a baby during a November 2017 mission trip in Ghana, page 18. PHOTO BY MEGHAN LEWIS
Health UPSTATE
Spring 2018
EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications EDITOR-IN-CHIEF WRITERS
DESIGNER
Amber Smith Leah Caldwell Jim McKeever Jim Howe Susan Keeter Amber Smith 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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Lasers treat pediatric brain tumors, epilepsy
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BY AMBER SMITH
Maisie Chapman of Cortland was just 3 months old when her seizures began. Ethan Stinson of Pierrepont Manor, near Watertown, was 15. Both wound up as patients of Zulma Tovar-Spinoza, MD, a pioneering pediatric neurosurgeon at Upstate University Hospital in Syracuse. Both patients were treated with image-guided laser ablation, a technique that’s an option for some patients with brain tumors or certain types of epilepsy. Guided by magnetic resonance imaging, Zulma Tovar-Spinoza, MD Tovar-Spinoza operates through a 4-millimeter opening in the skull. She directs a thin laser light beam, which uses heat to destroy the tumor or the area where seizures originate. Her work is done in a modern surgical suite that is equipped with an MRI machine. “Neurosurgery keeps progressing to try to do more less-invasive procedures,” she explains. “is technology was developed to address brain lesions without having the complexity of open surgery.” Most patients are able to go home the next day. In some cases, multiple treatments are required. Meghan Chapman’s daughter, Maisie, is 4 now and doing better aer two laser treatments performed by Tovar-Spinoza. Initially the little girl’s neurologist treated her seizures with medications. Between the seizures and the side effects, Maisie’s development from infancy into her toddler years was stalled. Neurological testing revealed that her seizures originate from one spot in her brain. Maisie underwent her first laser ablation in January 2015 and again in September 2017. “Right now, everything looks good,” Chapman’s mother says, explaining that Maisie has been free of seizures and hopes to taper off medications soon. Since the last treatment by Tovar-Spinoza, Chapman says her daughter’s development is significantly back on track. She’s optimistic because Maisie talks more. She soon started to put sentences together and use new words. Ethan Stinson is also on the mend, although he has had three treatments with the laser and expects to have more. His mother, Brittany Stinson, says, “Ethan started having seizures kind of out of nowhere. We started noticing it toward the end of February 2017.” Maisie Chapman was treated for seizures with a laser beam.
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PHOTO BY SUSAN KAHN
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Laser technology is destroying malformed blood vessels in Ethan Stinson’s brain.
He was diagnosed with eight cavernous angiomas in his brain. ose are areas where malformed blood vessels create an abnormality called a benign vascular lesion. Some vessels were bleeding in deep areas of Ethan’s brain. Open surgery offered many possible complications. Ethan’s neurologist in Watertown referred him to Tovar-Spinoza at Upstate. Ethan had recently gotten his driving permit. He was told he couldn’t drive, and he couldn’t play contact sports. “It was pretty hard for him to deal with all of that, being a high schooler,” his mother recalls. Aer the first laser treatment, she prepared herself to see Ethan in the recovery room. “I was shocked,” she says. Her son was sitting up in the hospital bed working on a Sudoku puzzle. He went home from the hospital the next day. e family hopes Ethan can finish his treatments before his senior year of high school begins in the fall. He’s been able to swim, and he expects to run track. His long-term goals are to drive, and return to playing baseball and soccer. “We are very excited, as he hasn’t had a seizure in almost five months, aer his first ablation,” Brittany Stinson says. “We’re taking it step by step by step but very grateful for having the opportunity to be treated with this modern laser technology at Upstate.” ● spring 2018 l upstate.edu
PHOTO BY SUSAN KAHN
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is a minimally invasive neurosurgical technique used to treat brain tumors and selective intractable epilepsy patients. uses magnetic resonance images before and during the operation, so neurosurgeons can precisely target the laser, avoid healthy brain tissue and verify in real time the ablation of the area of concern. gives neurosurgeons better access to tumors or lesions deep in the brain or too close to sensitive structures for traditional open surgery. uses a tiny opening in the skull that allows patients to recover more quickly and with less pain than in open surgery.
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Burn survivor
Burn surgeon Joan Dolinak, MD, uses a laser to restore skin on the back and arms of Stephanie Bridge, who survived a fire that destroyed her home. PHOTO BY SUSAN KAHN
New laser assists in patient’s recovery from house fire BY AMBER SMITH
SHE LIES ON HER STOMACH, exposing her bare back to a laser wielded by her surgeon. “Dr. Dolinak saved my life,” Stephanie Bridge says emphatically, as she positions herself for treatment that will help restore the texture of her skin. Burn surgeon Joan Dolinak, MD, took care of Bridge when a helicopter brought her to Upstate University Hospital in the early morning hours of Nov. 19, 2016. e skin of Bridge’s back and arms was burned by the flames of a house fire that nearly killed her. Bridge remembers hoisting both her boxer and her bullmastiff puppy out a first-floor bathroom window. Opening the window created a backdra; Bridge ended up on the floor outside the bathroom. She reached for a towel to cover her face. She heard wood crackling. She prayed. She was unconscious when firefighters just before 1 a.m. pulled her from the burning house in Rotterdam (Schenectady County) where she lived with friends. Firefighters never determined what started the fire. e house was a total loss. For a month Bridge was a patient in Upstate’s Clark Burn Center intensive care unit. She spent the first week on a ventilator. She has vivid memories of skin being graed from her legs to her back and arms. Stephanie Bridge shows her skin grafts prior to laser treatments.
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Burn survivor
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“Usually I’m pretty tough,” she says, “but I cried.
Dolinak told Bridge the itching — a symptom of nerve regrowth — would probably last a couple of years. Lotion also helps, and Bridge wears compression shirts to muffle the sensation.
“It was excruciating. I had to get up and move. If I didn’t keep stretching the skin, I would have had really limited motion.” A year aer the fire, Bridge makes regular trips to Upstate for laser treatments that help reduce her scarring.
Stephanie Bridge after the fire
Dolinak and the technicians, and Bridge, must wear protective glasses over their eyes when the laser is on. Dolinak moves the device above Bridge’s back, and along her arms. Aerward, Bridge says she feels like she has a sunburn, and ibuprofen helps. e Upstate Foundation is partnered with the Burn Foundation of Central New York to raise $150,000 to buy the laser therapy system, which is currently being leased. Bridge credits the laser with smoothing her skin. She also says it helps with itching.
Joan Dolinak, MD, burn surgeon
e road to recovery has been long. Sometimes she has nightmares about the fire. Aer she was released from the hospital, Bridge went in person to thank the South Schenectady volunteer firefighters who saved her.
Because of their swi action, and Dolinak’s expert care, Bridge, 44, was alive to become a grandmother in August. ● To support the Burn Center’s purchase of the scar laser therapy system, go to upstatefoundation.org/ScarLaser or contact the Upstate Foundation at 315-464-4416.
Surgical solution
a fix for sunken chests
THORACIC SURGERY CHIEF JASON WALLEN, MD, offers surgery to repair sunken chests, a somewhat rare condition some people are born with called pectus excavatum. ose affected may be self-conscious and also have trouble breathing. “It’s not felt to be due to compression of the lungs as much as it is from compression of the heart,” the surgeon explains. “Heart trouble can cause people to have the symptom of difficulty breathing.” Surgery can lead to permanent improvement. e procedure is almost always done with small incisions, one on either side of the rib cage. “It involves placing a bar across the chest underneath the sternum, to li it up and cause it to be nearly flat or completely flat,” Wallen describes. e bar provides structural support while bone and cartilage remodel to provide natural support (see X-ray at right). Wallen says he places two small holes in the sternum (breastbone) so that he can secure the bar to the underside of the sternum with sutures. is is meant to prevent the bar from slipping. e bar — made of stainless steel or titanium — stays in place for two or three years before it is removed. Surgery takes a couple of hours, followed by a three- or four-day hospital stay. “ere is some soreness,” Wallen acknowledges, “so we utilize a number of different pain medications to make sure the patient is comfortable in the short term.” Patients are encouraged to get up and around as soon as they feel able. Aer a recovery of four to six weeks, Wallen says they can usually return to all activities, including contact sports. ● spring 2018 l upstate.edu
To learn more about treatment for pectus excavatum, contact Upstate’s thoracic surgery clinic at 315-464-1800.
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Rural care
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How a small-town PA found a niche career BY JIM HOWE
“PHYSICIAN EXTENDERS” — such as physician assistants and nurse practitioners — have proved their worth to health care, especially in small towns and rural areas, where doctors are oen scarce. “Doctors have found out that there is value in having PAs and NPs available. In a rural area, the biggest problem is trying to see all the patients, so if you have a PA or NP that can help you function, you can almost double the amount of patients you care for,” says Gary Engle, a PA at the South Lewis Health Center in Lyons Falls, a family practice satellite clinic of Lowville’s Lewis County General Hospital. Engle, 67, grew up in rural Madison County and got into medicine when PAs and NPs were just becoming a reality, more than 40 years ago. For his work as a voluntary PA trainer, he was honored with a President’s Award for outstanding service to the Upstate College of Health Professions. Engle, who plans to retire this spring, spoke recently about being a rural PA.
Gary Engle is a physician assistant in Lyons Falls and preceptor, or trainer, for Upstate’s College of Health Professions. PHOTO BY SUSAN KAHN
upstate Health: you got a nursing degree from morrisville college. what made you go from nursing to the new specialty of physician assistant? Engle: “I was working as a night supervisor at
you have worked in both hospital and office settings in lowville, carthage, boonville, watertown and, for the past 10 years, lyons Falls. what do you like about working in a small town or the country?
Community Memorial Hospital (in Hamilton), and I worked with a couple of PAs. It looked like something I would enjoy doing and could do with proper training. at was back when we were just getting into this concept of somebody who could do a lot of what doctors do but weren’t really doctors.”
“I grew up in Madison (a village in eastern Madison County) — basically a crossroads, where we jokingly said, ‘You’re entering Madison’ was written on both sides of the same sign. I do like a rural area, a small town, with friendly people. I feel like I’ve gotten to know my patients. I have some four-generation families I take care of.
after you got your pa degree, in 1977, where was your first pa job?
“I think you can be an individual here, not that you can’t in other places, but people come to see me because they want to see me. In a lot of other areas, you’re just one of the PAs there.
“I ended up in Lewis County General, in the emergency room for the first several years, where the ER was literally one room — the nurse had one chair, and when I worked, I stole her chair. I was the guy provider in the ER, with the attending staff (doctors) backing me up, so if I needed a surgeon, I called the on-call surgeon. But most of the stuff I could handle, with a doctor reviewing the chart later. “Prior to my being there, a doctor would have to leave office patients, go see a patient in the ER, then go back to the office.”
“e need for PAs in rural areas has been there for a long time.”
Have patients ever balked at seeing a pa instead of a doctor? “At the start, there was some mistrust, but the vast majority of people get over the mistrust in the first few minutes. I’ve always tried to treat people respectfully. I remember a 9-year-old boy having an asthma attack, and continued on page 9
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I was told he was the son of the president of the hospital board of managers. I felt a momentary sense of panic, and then I thought, ‘I treat everybody like they’re the son of the president of the hospital board of managers,’ and people respond to that.”
what is it like to work as a preceptor, or trainer, of aspiring pas?
I get out of bed and say to myself, ‘I don’t want to listen to Mrs. Jones talk about her gout,’ and the student will say, ‘Hey, we get to see a lady with gout!’ So, it changes the way I look at things. When you have these young professionals come here, they’re excited, and it reminds me what my attitude should be. “When I got this award for being a volunteer, I remember what my dad said when I was 8, explaining why he volunteered with the fire department. ‘We’re in a small town, so it’s up to everyone who can to volunteer.’”●
‘She’s alive today because of them’
“I learn as much from them as they learn from me. My patients love them. Aer 40 years, there are mornings when
BY SUSAN KEETER
EIGHT-YEAR-OLD KAELYNNE DRISCOLL and her father, Christopher, were riding an inner tube on Skaneateles Lake on July 6, 2016, when a wave knocked them off the tube and under water. ey were struck by a boat and injured, Kaelynne severely. Two nearby boaters, Dave Goetzman and Eric Marcinkowski, heard screaming, helped the family pull the two out of the water and used towels and a shirt as tourniquets to slow blood loss from Kaelynne’s injuries.When the rescuers got the father and daughter to the dock, paramedics were waiting, thanks to the family’s 911 call. e pediatric trauma team members saved Kaelynne’s life, said pediatric neurosurgeon Zulma Tovar-Spinoza, MD. Kaelynne’s mother, Amber Ousler, remembers TovarSpinoza holding her hands and telling her, “Kaelynne is out of surgery. She has traumatic brain injury, but she’s alive.” It would be several days before they would know if Kaelynne had permanent brain damage. Because of brain swelling, Tovar-Spinoza had to remove the le part of Kaelynne’s skull. Kaelynne was on a breathing machine for a week, so she could begin to heal. She spent the first two of six weeks at the Upstate Golisano Children’s Hospital in the pediatric intensive care unit. During that time, Kaelynne would undergo 10 surgeries, including two neurosurgeries to manage the swelling and bleeding in her injured brain. Four surgeries — amputation of her le leg above the knee, amputation of her le arm at the elbow, and the shaping of limbs for prosthetics — were performed by orthopedic surgeon Kathryn Palomino, MD, and plastic surgeon Jon Lous, MD. Aer four weeks in the hospital, Kaelynne was sitting up
and beginning to talk again. ankfully, cognitive testing showed no brain impairment. She started physical and occupational therapy. Six weeks aer the accident — wearing a helmet to protect her brain — Kaelynne and her family went to Boston’s Spaulding Rehabilitation Hospital for specialized pediatric amputee rehabilitation. Five weeks later, Kaelynne walked out on her first prosthetic leg and returned home to begin third grade. She started school a few days late because of her rehabilitation, attended for half days and tired easily. She was learning to walk again and still wearing her helmet. Kaelynne was healing. It was time to replace the part of her skull that had been removed. Tovar-Spinoza designed a 3-dimensional model of the missing portion of Kaelynne’s skull, had it fabricated in plastic and installed it during a 1½-hour surgery. Kaelynne was back in the hospital for two weeks, disappointed to have part of her hair shaved again but remaining positive. Kaelynne was stable for several months, but fluid buildup and swelling in her head became a problem. Trauma to her head was so extensive — continued on page 10
Kaelynne Driscoll and Zulma TovarSpinoza, MD. PHOTO BY WILLIAM MUELLER
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‘She’s alive today because of them’ Kaelynne’s jaw had been broken in three places during the accident — that it was difficult to locate the sources of swelling and fluid. She had MRIs and treatments at Upstate.
During the February 2017 school break, Kaelynne had another setback. While vacationing with her father and family in Disney World, she ended up in the emergency room of an Orlando hospital. Pockets of fluid caused the scars on Kaelynne’s head to burst. When they returned to Syracuse, Tovar-Spinoza met with Kaelynne and her parents, and they made the difficult decision to remove the prosthetic skull, knowing it was likely contaminated when the scars opened. is meant another surgery and another hospitalization. Kaelynne was back to wearing a helmet. A new piece of skull was fabricated, and plastic surgeon Prashant Upadhyaya, MD, was brought in for a consult. e portion of Kaelynne’s scalp covering the prosthetic had weakened and shrunk. In November 2017, TovarSpinoza and Upadhyaya performed a joint surgery to install the new skull piece and move the scalp so that stronger skin would cover the site.
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roughout her ordeal, Kaelynne has remained the spunky, smart girl who amazes her parents, and her doctors. She’s at the top of her class at Homer Intermediate School and is an avid reader who loves to write stories and draw. She has worked with staff at Hanger Clinic in East Syracuse to select the features of her prosthetic leg and arm. Kaelynne is playing soccer, swimming and has a prosthetic arm with movable parts so she can do gymnastics and dance. She’s designing leggings with sturdy fabrics for girls with prosthetic legs and front-zippered shirts for kids with prosthetic arms. Kaelynne dreams of becoming a fashion designer and an interior designer. She loves to create and has designed and built a nine-room dollhouse, with help from her mother and a family friend.
What do her parents think about the people who have cared for their daughter? “Beautiful humans who are great professionally,” says her mother. Her father says, “Amazing. She’s alive today because of them.”
A change of plans
And her doctors believe Kaelynne is a brave young lady who never complained and always has a plan for her future. ●
Stroke affects family routine, son’s career path BY JIM MCKEEVER
JOHN LICATA HAD A DECADE of experience in TV/film, print and marketing when he made an abrupt career change.
an independent study course in his physical therapy program. It’s called “e Steaks Are Marinating: Reflecting on Life Aer Dad’s Stroke.”
It was Father’s Day weekend of 2013. His father, John Licata Sr., suffered a stroke that le him with partial paralysis, some neurological deficits and blindness, which, fortunately, went away five days later.
“My Dad was an awesome cook,” he recalls. “at Father’s Day weekend, he had marinated steaks. e plan was to play golf in the morning and cook out in the aernoon.”
ose five days, the lengthy recovery process and the caregiving role that was thrust upon John Licata’s mother, Sue, helped make him aware of the rewarding role of physical therapist. As he saw physical therapists interacting with patients, Licata says, “I could see myself energized to do this, to contribute to somebody’s life.” He had no science background, so Licata enrolled at Onondaga Community College. In two years, he completed the required courses, applied to and was accepted into Upstate’s Doctor of Physical erapy program. He’s on track to graduate this spring. Licata and his sister help their mother care for their father. As hard as it is on all of them, they realize the benefit of having each other for support. Licata, who loves to write, is working on a book as part of
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e stroke changed those plans and others. From his hospital room, as his speech returned, Licata’s father told his family: “e steaks are still marinating.” Later when Licata and his mother and sister finally went home, they cooked those steaks. As they ate, they realized it was likely the last meal they would enjoy that had been prepared by their patriarch. “It was a symbolic moment of a family trying to gain acceptance,” says Licata. “It was the transition from what we were, to what we were becoming.” Licata is not certain in which area of physical therapy he will specialize. But he knows he will strive to connect with his patients and contribute to their lives. ● John Licata
upstate.edu l spring 2018
FROM OUR ExpErts
Why your baby needs tummy time
BY AMBER SMITH
THE AMERICAN ACADEMY OF PEDIATRICS says babies need to be placed to sleep on their backs to reduce the risk of sudden infant death syndrome during the first year of life. But daily supervised play time while on their tummies is recommended for developmental reasons. “You really want to start tummy time as soon as the baby is born, as long as they’re medically stable,” says Erin Wentz, PhD, an assistant professor of physical therapy at Upstate. “Early tummy time can be done on the parent’s chest because the baby is most familiar and most comfortable around their parent. By placing them on their chest, the baby can smell their parent, they can hear their parent, and when they li their head up, they’re close enough to see their parent.” Wentz says this supervised time is important for babies to help strengthen their neck and trunk but also to stimulate exploration. If you put your baby on his tummy and he sees a rattle lying on the floor nearby, he will naturally want to figure out what to do with his body in order to obtain the rattle. “at is developing their cognitive abilities. ey are problem-solving. ey’re learning to persevere and stick with a task until they achieve it,” Wentz explains. “Once they obtain the rattle, then they want to talk about it — in their own way, of course — but they want to interact with
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What is tummy time? Tummy time is the deliberate placement of babies on their tummies for exercise and developmental reasons while they are awake. It should always be supervised. An Upstate researcher is trying to determine how much tummy time is best — and she is conducting a study that you can join. those whom they are most familiar with. So that promotes not only their language development but their social development.” Wentz is leading a study to determine the best daily cumulative amount of “tummy time” and seeks full-term newborns up to 8 weeks of age to participate. Families are placed into one of three categories: 0 to 30 minutes, 31 to 60 minutes, or 61 minutes or more. “We ask the families to do their best to accumulate that much tummy time per day until the baby can transition in and out of sitting.” e study continues with monthly home visits by Wentz until the baby reaches 18 months of age. “We want to compare the developmental curves from each of these groups, and that way we can get a better idea of how much tummy time we should be recommending.” ● To learn more about the study, send Wentz an email at wentze@upstate.edu.
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FROM OUR ExpErts
Maybe less harmful – but not harmless
Use of e-cigarettes carries health risks BY AMBER SMITH
A PHARMACIST IN CHINA in 2007 developed the first of what scientists call an electronic nicotine delivery system — what’s now known as an electronic cigarette or e-cig. Seeking to kick his own smoking habit, the pharmacist designed the device as a substitute for combustible tobacco products, explains Lee Livermore, public education coordinator for the Upstate New York Poison Center. Ten years later, it’s not clear whether e-cigs are a better choice than regular cigarettes. But the use of e-cigs has soared, especially among American youth who may be attracted by the multitude of sweet flavorings and a new generational take on the old rebellious act of smoking. Ecig devices today come in a variety of styles. Some look like cigarettes or pipes. Others are disguised as asthma inhalers or thumb drives. One of the most popular devices among youth is a brand called Juul, which is powered by a USB charger to provide an “intensely satisfying vapor.” e Boston Globe referred to ‘juuling’ as the most widespread phenomenon you’ve never heard of. Livermore suggests parents learn more about this trend because it’s showing up in junior and senior high schools throughout Central New York. Both conventional and electronic cigarettes contain nicotine, plus other chemicals. Even e-cig liquid labeled “nicotine-free” has been found to contain the highly addictive substance, Livermore says. E-cigs typically contain a smaller amount of nicotine, but vaping (inhaling) habits may mean a person ingests a larger overall quantity of nicotine. Some users carry their e-cig devices on lanyards around their necks, so it’s convenient to vape mindlessly and continually without scheduling any sort of smoking break, says Livermore. “If you’re using it more frequently and at higher and deeper rates, then you’re actually getting a higher level of nicotine into your system,” he says. Some users put drugs other than nicotine into their e-cigs. Any chemical that can be converted into an oil or a liquid may be used; some devices are designed to burn finely ground plant material. E-cigs don’t typically have the stink of tobacco cigarettes. 12
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Livermore says that disguises how harmful the products can be. As for the dangers of breathing in the secondhand vapor of an e-cig, he says studies are ongoing. A report from the National Academies of Sciences, Engineering and Medicine analyzed the evidence available on vaping. It indicated that e-cigs may help adult smokers transition off of tobacco cigarettes, just as the pharmacist from China intended, but that the devices also may entice younger smokers to transition to tobacco cigarettes. Livermore has studied the report’s findings. Depending on how it’s used, an e-cig may be less harmful than a conventional cigarette. “However, it by no means is harmless or safer,” he says. “You’re still consuming chemicals into the human body.” ● The Upstate New York Poison Center is receiving an increased number of inquiries from school districts throughout Central New York concerned about the student vaping trend. The center provides public education. To learn more, call 315-464-5375.
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Nicotine intake among experienced adult e-cigarette users can be comparable to that from conventional cigarettes. Exposure to toxic substances other than nicotine from e-cigarettes is significantly lower than from conventional cigarettes. Completely switching from conventional cigarettes to e-cigarettes results in reduced short-term adverse health outcomes in several organ systems. E-cigarette use by youth and young adults increases their risk of ever using conventional cigarettes. E-cigarette use increases airborne concentrations of particulate matter and nicotine in indoor environments. Adolescents who use e-cigarettes have increased coughing and sneezing and increased asthma exacerbations. Drinking or injecting e-liquids can be fatal. SOURCE: NATIONAL ACADEMIES OF SCIENCES, ENGINEERING AND MEDICINE STUDY SPONSORED BY THE U.S. FOOD AND DRUG ADMINISTRATION.
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LUNG CANCER EXPERTS
THORACIC SURGEONS JASON WALLEN, MD, AND MARK CRYE, MD If you’re facing a diagnosis of lung cancer, turn to the experts at the Upstate Cancer Center. We provide the advanced knowledge, skills and leading technology found at the region’s only academic medical university. The power of teamwork brings together board-certified physicians and oncology-certified nurses to meet with each patient and create a highly personalized treatment plan. Upstate also offers a unique robotic thoracic surgery program, which provides a high degree of precision within the lungs and chest wall. The minimally-invasive approach typically means less scarring and a faster recovery for each patient.
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7 ways to care for aging skin
FROM OUR ExpErts
BY AMBER SMITH
WHAT CAUSES OUR SKIN TO LOOK OLD?
You can blame intrinsic processes, such as changes in lipid content and shortening of the capillaries, which are universal and inevitable. But the most visible signs of aging — including wrinkles and blotchiness — come from extrinsic factors, such as our sun or tanning bed exposure, smoking habits and other factors. Ramsay Farah, MD, the chief of dermatology at Upstate, says that changes in the skin can affect the whole body. ermoregulation is one function of skin. “Our internal core body temperature has a lot to do with our skin,” Farah explains. “When the skin is diseased, whether it’s in the young or in the old, that ability to regulate our core body temperature is compromised.” e nerves in our skin undergo physiologic changes and don’t work as well when we are old as they did when we were young. at relates to a common complaint. “e elderly tend to itch,” Farah says, providing the medical term: pruritis. “We don’t know exactly why they itch, but it must surely have something to do with cutaneous nerve endings.” Also, “the skin is one of the first barriers or points of contact our immune system has with the outside world,” the dermatologist says. With a depleted number of immune cells in the skin, an older person’s immune system is less effective against germs of all types. We can’t stop time. So, what can we do to care for aging skin? 1. SUNSCREEN IS STILL IMPORTANT. Older skin has less of an ability to repair DNA damage that occurs during exposure from the sun or ultraviolet light, so making sure skin is protected will help reduce that threat. And, be aware of skin changes. Decades of DNA damage can lead to skin cancers in one’s senior years.
3. BATHE USING LUKEWARM WATER, with a soap such as Dove or Aveeno that contains oil. Avoid products containing perfumes because they can contribute to dry skin.
4. USE A HUMIDIFIER. Moisture in our skin evaporates when the surrounding air is dry. A humidifier can combat that dryness. 5. EAT A HEALTHY DIET. Vitamins and minerals in fruits and vegetables are good for your whole body, including the skin. 6. PRACTICE GOOD HYGIENE. If an older person has become infirm, he or she may need help with this. 7. CONSIDER HORMONAL THERAPY. Women who take estrogen supplements may improve their skin’s ability to retain moisture.
as it agEs, skiN: l is
drier because it retains less water.
l becomes l loses l is
thinner and more sensitive.
the ability to regenerate quickly.
more prone to inflammation.
l has
fewer immune cells.
l loses
sweat glands, decreasing the ability to regulate body temperature.
l experiences
decreased blood flow.
l can
bruise more easily because of a reduction in collagen.
l undergoes
physiological changes in the nerves.
l may
develop skin cancer from cumulative DNA damage.
2. MOISTURIZE. Farah says this is the least costly and most effective step you can take to protect your skin. Find an over-the-counter lotion or cream that contains ceramides. Blot dry aer showering, leaving a little bit of water on the skin. Within three minutes, liberally apply the moisturizer. 14
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FROM OUR ExpErts
Creating a
designer
‘
BABY
’
...raises thorny questions, few answers BY JIM HOWE
IF PARENTS COULD CREATE A “better” baby, should they?
He offered these points: l
“If we start selecting children based on characteristics, then we will start treating our children more and more like products or pets, rather than as real human beings.”
Should scientists and doctors help parents to genetically customize an embryo that would become that better or “designer” baby?
l
A United Nations declaration against the genetic engineering of humans exists but carries no enforcement mechanism.
e issue — still theoretical — brings up more questions than answers, as a visiting expert told an Upstate Medical University audience recently.
l
It’s almost impossible in the United States today to get a broad societal consensus on anything, let alone how to handle genetic engineering. Scientists would need to mount a tremendous effort to educate a scientifically illiterate public before an informed debate could even start. Getting the world to a consensus would be even harder.
l
Faith in genes as a sort of guarantee to how a child will turn out — he used the term “genism” — downplays the role played by the child’s upbringing and environment.
Would “better” mean a healthier child than the average baby? Cuter? Smarter? Taller?
It is the latest chapter in a debate that stretches back at least as far as the early 20th century, when proponents of eugenics claimed they could improve society by selective breeding and forced sterilization. Genetic engineering has proved popular in science fiction, from “Brave New World” to “Jurassic Park” and “Gattaca,” noted George Annas, JD, MPH, the William Fairfield Warren Distinguished Professor at Boston University and director of the Center for Health Law, Ethics and Human Rights at the BU School of Public Health, who has written and lectured extensively on health law and bioethics, including “Genomic Messages” co-authored with his longtime geneticist colleague, Sherman Elias.
spring 2018 l upstate.edu
e biggest questions about the genetic engineering of humans: Who should decide whether such experiments should be carried out? And, would parents and scientists accept the strong possibility of unintended, even disastrous, results? “We wouldn’t know whether genetic engineering is safe until we have followed at least three generations of humans, so it would take 60 to 80 years to know whether it’s safe,” he said. “We’re in a situation where we can’t do this until we know it’s safe, and we can’t know it’s safe till we do it,” he concluded. ●
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The oath physicians take
IN OUR commuNity
Comparing what new graduates promise BY AMBER SMITH
ALTHOUGH NEW DOCTORS ARE NOT REQUIRED to take an oath, medical students graduating from Upstate Medical University have traditionally recited a version of the Hippocratic oath, which was written around 400 BC by the Greek physician, Hippocrates. It’s meant to reinforce that the practice of medicine is both a privilege and a great responsibility. e World Medical Association in 1948 adopted a contemporary successor to the Hippocratic oath called the Declaration of Geneva. It outlined professional duties and ethical principles. Only minimal changes have been made in the intervening 70 years — until now. e association in October approved a revised declaration, which medical schools may ignore, alter or use verbatim during graduation ceremonies.
Elizabeth Blackwell (1821-1910) was an 1834 graduate of Geneva Medical College, a forerunner of SUNY Upstate Medical University.
e oath new doctors recite in Syracuse has been tweaked over the years. Many phrases are the same or similar (in blue) in Upstate’s oath as in the association’s declaration and the original Hippocratic oath. In all the vows, new physicians agree to serve humanity, to respect patients’ secrets, to show gratitude to their teachers and to share their medical know-how. Some differences: e Hippocratic oath differentiates (in red) between physicians and surgeons and speaks of physicians “gaining the respect of all men for all time.” e association’s updated declaration includes a sentence (in green) about self-care. “is clause reflects not only the humanity of physicians but also the role physicians’ self-care can play in improving patient care,” describes an article in the Journal of the American Medical Association. Upstate’s oath describes (in purple) a “joy of healing” those who seek the physicians’ help. Hippocrates
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Hippocratic Oath
IN OUR commuNity
(2002 National Library of Medicine translation)
“I will keep this Oath and this contract: To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or contract; and that by the set rules, lectures, and every other mode of instruction, I will impart a knowledge of the art to my own sons, and those of my teachers, and to students bound by this contract and having sworn this Oath to the law of medicine, but to no others. I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion. In purity and according to divine law will I carry out my life and my art. I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this cra. Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves. Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private. So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate.”
The Physician’s Pledge
(revised Declaration of Geneva from the World Medical Association)
The Physician’s Oath
(in the tradition of Hippocrates and Elizabeth Blackwell. from Upstate Medical University)
“As a member of the medical profession, I solemnly pledge to dedicate my life to the service of humanity;
“I enthusiastically commit my life to serving patients.
e health and well-being of my patient will be my first consideration;
I will practice my profession with integrity, dignity and humility.
I will respect the autonomy and dignity of my patient;
e welfare of my patients will be my first consideration, and I will advocate for them; may I never see in a patient anything but a fellow human in need.
I will maintain the utmost respect for human life; I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient; I will respect the secrets that are confided in me, even aer the patient has died; I will practice my profession with conscience and dignity and in accordance with good medical practice; I will foster the honor and noble traditions of the medical profession; I will give to my teachers, colleagues and students the respect and gratitude that is their due; I will share my medical knowledge for the benefit of the patient and the advancement of health care;
I will treat all patients with compassion, no matter how much they differ from me. I will preserve my patients’ confidentiality and respect my patients’ choices. I will work together with my colleagues in service of our patients. I will acknowledge my limits, maintain my skills and seek help when needed. I will give to my teachers the respect and gratitude that is their due, be a role model for students and share my knowledge with patients and colleagues. I make these promises solemnly, freely and upon my honor. May I keep this oath and, in so doing, experience the joy of healing those who seek my help.” ●
I will attend to my own health, well-being and abilities in order to provide care of the highest standard; I will not use my medical knowledge to violate human rights and civil liberties, even under threat; I make these promises solemnly, freely and upon my honor.”
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IN OUR commuNity
Nearly 1,000 girls assembled in an open-air classroom at Namong Senior High School in Offinso, Ghana, to receive menstrual education from a team of ASAP volunteers. Students with the greatest need received reusable menstrual kits made by the nonprofit organization, Days for Girls. At right in the blue flowered dress is Nancy Addo, headmistress of the school. At far right, seated, is Upstate nurse Maisha Brown, an ASAP volunteer.
Upstate volunteers
PHOTO BY MEGHAN LEWIS
10 DAYS IN
ghana BY SUSAN KEETER
NEAR THE END OF AN 11-HOUR FLIGHT from New York’s John F. Kennedy International Airport, we finally see Ghana out the plane’s windows: saffron-colored earth and lush green foliage dotted with bright blue and pastel pink buildings. e country’s beauty is overwhelming. We descend into Accra, the African nation’s capital, and the plane passes over the Gulf of Guinea, which I later learn has the most beautiful white sand beach that I have ever seen.
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help build community in Africa
ago. is is her ninth mission trip to Ghana. is time she is leading seven volunteers — Upstate nurses Maisha Brown, Cyndy Carr and Meghan Lewis; Qiana Williams, an educator from Syracuse; Traci Bender, a social worker from Buffalo; Sara Tucker, a college student; and me, an Upstate graphic artist. We are on a 10-day mission trip to work with women and children in rural Ghana to address needs identified by the Ghanaian nonprofit organization Sem Fronteiras: menstrual education, oral health, dementia awareness and literacy.
Getting through checkpoints and searches of some of our 24 suitcases and backpacks at the airport takes a couple of hours. e place is huge, confusing and packed with humanity, reminding me of Manhattan’s Penn Station. ankfully, all signs are in English, the official language of Ghana.
We are greeted by Agyapong Gyamfi, chief operating officer of Sem Fronteiras, and his assistants, Lawrence Osei Asamoah and Isaac Appiah, who we quickly learn will be our guides, protectors and teachers for the entire trip.
e head of our team is Lauri Rupracht, an Upstate nurse and director of the Americans Serving Abroad Program (ASAP), a nonprofit organization she founded four years
We board a small school bus and take off on the highway, which was built with support from the United States during the administration of President George W. Bush.
U P S TAT E H E A LT H
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IN OUR commuNity
If it weren’t for the sheep and chickens by the side of the road, I’d think we were driving through the Bronx. e traffic is crazy. We see gleaming high-rise office and apartment buildings, but much of the roadside looks like a ramshackle farmers’ market. ere are sheds built of scrap wood, corrugated tin and palm fronds, plus the occasional crashed car or truck le by the side of the road. Street vendors maneuver between the lanes of whizzing cars, selling plantain chips, chocolate bars and small plastic bags of drinking water (tap water in Ghana is not safe to drink.) Most are women carrying their wares on their heads. It is a six-hour drive north to Offinso, the district where we will be doing most of our work. We quickly become accustomed to the unpredictable functioning of things in Ghana. A public bathroom may have sinks, but no running water. e guest house may have air-conditioning, but multiple power outages. Ghana is, as Rupracht tells us, “a good place to practice flexibility.” e villages are quieter and more peaceful than the capital, and I continue to be wowed by the beauty that is everywhere: the artistry of kente cloth clothing, the rich colors of buildings, the golden dirt paths and tropical flowers. Everywhere, groups of children play outside, women walk and talk, and clusters of men sit together in the shade. e atmosphere is warm and sociable. e sun sets at 6 p.m., as it does year-round. e first morning in Offinso, we begin by meeting with street women and children at a market in Kumasi, the capital city of the Ashanti region. We do a presentation on the menstrual cycle, answer questions and distribute reusable menstrual kits, multivitamins and mosquito tents to protect the women and children from malaria, a leading cause of death in children under 5. Over 10 days, we provide services to more than 1,500 people. e November 2017 mission was a community development trip. is spring, Rupracht is leading a larger mission of volunteers to provide medical care. To learn how to donate or participate, go to healthlinkonair.org and search “Ghana” or visit, www.asap.ngo Continued on page 20
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A young woman holds the “Days for Girls” reusable cloth menstrual kit she received at an ASAP presentation for street women in Kumasi, Ghana. PHOTO BY SUSAN KEETER
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IN OUR commuNity
Maisha Brown, a pediatric nurse at Upstate, shows a chart of the reproductive system to female students at Fufulso Presbyterian Primary School. The students and teachers speak different Ghanaian languages, but all read and speak English.
Cyndy Carr, an oncology nurse at Upstate, with a group of Ghanaian students who received toothbrushes and toothpaste — and instruction on good brushing habits — as part of an oral health program.
PHOTO BY MEGHAN LEWIS
PHOTO BY MEGHAN LEWIS
10 DAYS IN ghana
Four areas of mission work in Ghana:
continued from page 19
women’s health/menstrual education
Dental health
For girls in Ghana, starting their periods may lead to ending their education. Many, especially in poor, rural communities, lack access to sanitary napkins or any equipment to manage menstruation. As a result, they miss several days of school each month, which leads to falling behind in classes and eventually quitting school. An unfinished education oen condemns women to lives of limited opportunity and poverty.
e challenge was to find practical dental care solutions for children who have limited access to safe drinking water and no access to dentists. Volunteers used illustrated posters to explain the causes and progression of tooth decay and played a game challenging students to identify foods that are good for teeth (yams and bananas) and bad for teeth (so drinks and candy). Students took turns demonstrating proper brushing on a large anatomic model of teeth. Volunteers gave fluoride treatments to the youngest students and distributed toothbrushes and toothpaste donated by dental offices in Central New York.
To begin to combat this problem, volunteers used flip books to teach students about the menstrual cycle, female anatomy and ways to care for the body. Upstate nurse Meghan Lewis answered questions such as, “If the menses does not come, should I drink medicine to make it come?” e team demonstrated how to use the reusable cloth menstrual kits that are made by Days for Girls sewing groups across the United States. All female students received the training, and those with the greatest need received kits. In addition to visiting schools, volunteers distributed kits and did the training with a group of women living in the streets in Kumasi. e goal of future missions is to provide manufacturing equipment and train staff and students at a vocational school in Offinso to sew the kits.
Dementia awareness According to Agyapong Gyamfi, ASAP founder Lauri Rupracht’s counterpart in Ghana, dementia is a misunderstood and undiagnosed condition in Ghana, resulting in the isolation and, in some cases, mistreatment of elders. e volunteers’ goal was to help children recognize dementia symptoms and develop constructive ways to interact with elders affected by the disease. Rupracht created role-playing skits for the classrooms. Volunteers asked students, “Does an elderly person in your family forget things or get confused?” and described scenarios such as, “ere are lots of visitors and noise in continued on page 21
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IN OUR commuNity
Meghan Lewis, an oncology nurse at Upstate, and Traci Bender, a social worker from Buffalo, give fluoride to two of the 372 students who received treatments. PHOTO BY AGYAPONG GYAMFI
10 DAYS IN
ghana
continued from page 20
your home and the elderly person starts to get agitated.” Volunteers took turns portraying the elderly person and family members who behaved badly (yelling) or constructively (talking soly and helping the elder to a quiet place). en, students were asked to come up with ideas for good ways to help elderly people with dementia. Keeter, Rupracht and Gyamfi are creating a book on dementia for children in Ghana.
These young men are making their books during the literacy program. They walk four hours to attend school in an outdoor classroom with a dirt floor and metal roof supported by tree branches. PHOTOS BY SUSAN KEETER
literacy English is the official language of Ghana, and classes are taught in English beginning in elementary school, but there are more than 50 Ghanaian languages. Volunteers visited schools in the Ashanti region, where Twi is the primary language spoken. ey began by reading a children’s book aloud and asking students to repeat the text to practice their spoken English language skills. Each child created his or her own book by completing sentences such as “I am…” and “I like…” on preprinted sheets and illustrating their words with colored markers donated by ASAP. “Beautiful,” “gied,” “talented,” “clever,” “helpful,” “intelligent” and “good boy” were words the students used to describe themselves in the books they created. ● One of 300 students who created his own English-language picture book.
Calming kids with teddy bears GLENDA STOWELL AND HER HUSBAND, FRED, donated 10 teddy bears to the Upstate Golisano Children’s Hospital in 2011. Aer they retired, they wanted a new way to spend their time, and they liked the idea that the stuffed animals would go to children who arrived at the hospital needing something to cuddle.
Stowell says she’s always looking for more volunteers. Her group also accepts donations of money, fabric or sewing machines. ●
Today, the CNY Bear Club that the Stowells launched has donated more than 7,500 teddy bears, puppies and other stuffed animals. e organization donates about 1,600 stuffed animals per year for pediatric surgery patients and children in treatment for cancer.
Child life specialist Gina Lozito-Yorton, left, with Glenda and Fred Stowell, who create and donate stuffed animals to children at the Upstate Golisano Children’s Hospital.
Find CNY Bear Team on Facebook, or contact the Stowells at 315-298-5308 or CNYBearTeam@aol.com
PHOTO BY KATHLEEN PAICE FROIO
“We make them look like nurses and doctors. ey’re wearing scrubs. ey have a hat and face mask, and shirt and pants and two booties,” Stowell says, explaining that the scrub outfits are sewn by volunteers. Each takes about four hours to make. “e philosophy behind that was so kids wouldn’t be afraid.” Most of the CNY Bear Team critters are from 9 to 15 inches tall. “ey’re the cuddly size, the size of a baby.” spring 2018 l upstate.edu
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IN OUR lEisurE
The halls are alive with the sound of music Medical students Benjamin Meath and Joe DeRaddo perform in the hospital lobby as Abigail and Stephen McSweeney listen.
PHOTO BY SUSAN KAHN
BY JIM HOWE
SOME VOLUNTEERS are bringing live music — and, they hope, a smile — to patients and staff at Upstate University Hospital.
really supported us and our music. We further relayed their support in us to the patients by donating the $64 we raised to the Upstate Cancer Center.”
e Music at Upstate group includes strolling violinists and a guitar and vocal duo who play in the lobby at the downtown campus. Some of the performers have known each other since their high school days.
Oen joining Ly and Rim are violinist Dona Occhipinti, who works at the private firm Welch Allyn, and pianist Ben Craxton, an Upstate graduate who is now a resident physician in family medicine at St. Joseph’s Hospital Health Center. ey sometimes can be heard practicing a mix of classical and other tunes in the early evening around the piano at the Upstate Cancer Center, which has long encouraged music as part of a healing atmosphere.
“Everyone is so welcoming and appreciates the music,” says Joshua Rim, a fourth-year medical student from New York City who helped organize the free performances. “We really love playing for patients. We can forget about life for a while.” Rim plays the violin, as does Christine Ly, a fourth-year MD/PhD student. Also a native of New York City, she and Rim played in the same orchestra while in high school. Ly says their performances “bring a bit of the outside world to the patients in the hospital, giving them a sense of change and sense of escape.” She recalled an autumn day where the group played for fun in the Weiskotten Hall courtyard. “While we were just enjoying ourselves, the people listening came up to us and put money in our instrument cases. is meant a lot to me because their random act of kindness showed me that they
Sometimes just a couple of them will play together, strolling through the hospital or performing at Café Kubal in the Upstate Golisano Children’s Hospital. e music program was organized through Upstate’s employee health series, Pathway to Wellness. Rim also recruited the duo of Joe DeRaddo and Benjamin Meath, both third-year medical students. DeRaddo, from Seneca Castle, and Meath, from Clion Springs, both attended Midlakes High School, outside Geneva. DeRaddo played trumpet before moving to electric bass guitar. Meath played the drums, including in church, and trombone before teaching himself acoustic guitar in continued on page 23
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IN OUR lEisurE
The halls are alive
Medical student Joshua Rim and Dona Occhipinti of Welch Allyn perform for Aaron Johnson, a patient.
PHOTO BY SUSAN KAHN
continued from page 22
college. Each played also played in garage bands in high school.
vocals, with DeRaddo doing harmonies.
“We take pop songs and make them kind of ‘coffee-shoppy’ and acoustic. We’ll take (songs) like “Wagon Wheel,” “Wonderwall,” some Jackson Five and John Mayer and give a kind of easy-listening feel to it — definitely things you could hum along to,” DeRaddo says. Meath does the lead
e two have done some open-mic performing at the Campus Activities Building in addition to playing at the hospital.
was nice to be where we work and go to class every day and see other people, see some fun, some joy in other people’s lives. It’s a nice alternative to the rigors of medical school.”
“It’s just fun to be able to do what we enjoy in that kind of a setting,” Meath says. “A lot of people would give us a thumbs-up and crack a smile, and it
DeRaddo agrees. “Music is definitely a way we can escape and ground ourselves every once in a while, and get out of the books.” ●
Grateful for answers IT WAS FRIGHTENING. Five days aer she had a pacemaker inserted, Nancy Barreca was home and recovering well. Or, so she thought. She was having a conversation with her son when suddenly she couldn’t speak. “I would pause and wait a couple of minutes,” Barreca said, “and I could talk again.” But these mysterious episodes kept happening, and aer a week her family took her to Upstate University Hospital. Once it was determined that her pacemaker was working correctly, Barreca was transferred to the department of neurology. ere, she met neurologist Anuradha Duleep, MD. Barreca observed, “Dr. Duleep is gentle, compassionate and was dedicated to finding an explanation spring 2018 l upstate.edu
of these mysterious and frightening episodes.” Duleep performed tests that ruled out various diagnoses, leading her to monitor Barreca’s brain activities. As a result of an electroencephalogram (EEG), Nancy was prescribed anti-seizure medication and she hasn’t had an episode since. Barreca’s experience is an example of the “we will find an answer” philosophy of the neurologists at Upstate. Barreca says that she and her family are thankful. ey found their answer, experiencing firsthand how clinical problem-solving can unlock a medical mystery and improve care for patients and their families. ●
Nancy Barreca
arE you gratEFul? A gi of gratitude is a meaningful way to express appreciation to special caregivers and help patients during their time of great need. To donate to Friends of Neurology, contact the Upstate Foundation at 315-464-4416.
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750 East Adams Street l Syracuse, NY 13210
SCIENCE IS ART IS SCIENCE IS ART 1S SCIENCE
Turner
Xu
THIS IMAGE IS A MINIATURIZED and simplified version of the mouse mammary gland grown in the laboratory — which may hold clues to how a normal breast develops. From the Upstate laboratory of cell and developmental biologist Christopher Turner, PhD, doctoral student Weiyi Xu studies a protein called paxillin. It plays a role in mammary gland development and in breast tumor progression. Paxillin helps the mammary gland ducts branch, polarize and penetrate, which is important for future milk production. is image shows branching that takes place as part of that mammary gland development. When scientists completely “knock out” paxillin in laboratory mice, lethal problems develop in the mammals’ vital organs.
17.415 0318 44M ELsk