Summer 2017 Upstate Health magazine

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

STROKE EXPERTISE REACHES REMOTE AREAS page 5 5 BEHAVIORS COMMON IN DEMENTIA page 11

LIMITING LYME DISEASE page 16 INNOVATIVE URETHRAL REPAIR

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WHY YOU MAY BE AWAKENED DURING YOUR HOSPITAL STAY page 9

#SHOWUSYOURSTETHOSCOPE page 10

Summer 2017

WELCOME

Here’s what patients Match game: say about doctors IF YOU’VE EVER BEEN A PATIENT in the hospital, you may have received a survey aer your stay. Administrators take the feedback to heart because it provides a unique look at the hospital and its providers, from the patient’s point of view. ey regularly share some of the comments with hospital staff.

See if you can match the comments (taken verbatim from surveys received this winter and spring) to the physician.

Answers at the bottom of the page, upside down.

1. “Gave excellent attention and care to a scared patient in crisis.”

2. “My condition is stable because of her expertise and thorough care.”

3. “His quick response and skill saved my life.”

Andrea Berg, MD (Geriatrics)

Brian Changlai Jr., MD Joan Dolinak, MD (Medicine) (Surgery)

Anuradha Duleep, MD (Neurology)

4. “We have much faith in him providing the best support for our child.”

5. “Takes time to consider my concerns, and I certainly value her expert opinions.”

6. “Very knowledgeable, kind and patiently answers questions.”

7. “Impresses me with the time he spends with me and how much he cares about me.”

Natasha Ginzburg, MD Roberto Izquierdo, MD (Pediatric (Urology) Endocrinology)

Ajay Jain, MD (Surgery)

Jennifer Kelly, DO (Endocrinology)

8. “Made me feel at ease and more positive regarding my prognosis and progress.”

9. “Kind, concerned and helpful. Awesome bedside manner.”

10. “She is very sensitive and caring.

She listens. I wish there were more doctors like her.”

Melissa Ko, MD (Neurology)

Lisa Lai, MD (Surgery)

John Leggat Jr., MD (Nephrology)

Luis Mejico, MD (Neurology)

11. “The kindest, most concerned, most intelligent, most informed and helpful doctor I have ever had.”

12. “Answered every question completely and didn’t make me feel I was asking foolish questions.”

13. “Personable, informative, compassionate.”

14. “From beginning to end took great care of our son.”

15. “Always impresses me with his knowledge and caring for his patients.”

Robert Michiel, MD (Cardiology)

John Sun, DO Joseph Mora, MD Jennifer Stanger, MD (Anesthesiology) (Pediatric Surgery) (Gastroenterology)

16. “Highly intelligent, caring. The best MD I have ever had.”

17. “A kindhearted person who genuinely takes pride in her profession.”

18. “Very kind and compassionate during a scary time.”

Tamas Szombathy, MD Charles Woods III, MD Eufrosina Young, MD (Neurology) (Otolaryngology) (Electrophysiology)

Jianghong Yu, MD (Rheumatology)

19. “My mother always gets upset when she has to go to these appointments, but once (this doctor) arrives, she is all smiles and always leaves the appointment in a good mood.”

20. “Very clear and explanatory.”

ANSWERS: 1. MORA; 2. KO; 3. SUN; 4. WOODS; 5. YU; 6. YOUNG; 7. MICHIEL; 8. DOLINAK; 9. LEGGAT; 10. LAI; 11. MEJICO; 12. GINZBURG; 13. DULEEP; 14. STANGER; 15. IZQUIERDO; 16. SZOMBATHY; 17. KELLY; 18. JAIN; 19. BERG; 20. CHANGLAI 2

U P S TAT E H E A LT H

upstate.edu l summer 2017

WELCOME

page 10 A stethoscope from the early 1900s

Contents PATIENT CARE

Stroke expertise reaches remote areas Living with PKU

page 5

page 10

Health

On the cover: Urologist Dmitriy Nikolavsky, MD. See story, page 12.

UPSTATE

U P S TAT

E MED IC

AL UN IV

ERSIT

5 BEHAVIOR S COMMON DEMENTIA IN

IN OUR COMMUNITY

5 behaviors common in dementia

page 11

Urethral repair includes tissue from mouth

page 12

Sleep, depression, medication triad

page 14

Baby boomer health concerns

page 15

Fighting with sticks – for fitness

How to limit Lyme disease

page 16

DEPARTMENTS

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Summer 2017

STROKE EXPERTISE REACHES REMOTE AREAS page 5

What is a disability?

page 18

Treatments for eating disorders

page 19

A scientific mystery in Onondaga Lake

page 20

IN OUR LEISURE page 22

page 11

LIMITING DISEASE LYME page 16

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INNOVATIV URETHRAL E REPAIR

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WHY YOU AWAKENE MAY BE D DURI YOUR HOSP NG ITAL

PHOTO BY SUSAN KAHN

FROM OUR EXPERTS

page 8

A most ubiquitous medical device

PHOTO BY WILLIAM MUELLER FROM THE HISTORICAL COLLECTIONS, HEALTH SCIENCES LIBRARY, UPSTATE MEDICAL UNIVERSITY

page 9

#SHOWUS YOURSTE THOSCOP E

page 12

A rare complication of Lyme

What’s Up at Upstate page 17

Lessons from Upstate page 7 Avoiding an MS misdiagnosis Science Is Art Is Science Sperm freezing

Health UPSTATE

Summer 2017

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

Amber Smith

WRITERS

Jim Howe Susan Keeter 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

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back cover

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.

summer 2017 l upstate.edu

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News you may have missed

WHAT’S UP AT UPSTATE

GRADUATION. Upstate President Danielle LaraqueArena, MD, awarded 463 degrees and five professional certificates to graduates of the colleges of Graduate Studies, Health Professions, Medicine (shown at le) and Nursing during ceremonies May 21.

Seventy of the new physician graduates signed the “1 in 5 Pledge,” to serve patients who receive Medicaid, the government health plan for those with low incomes.

In 2017, about one in five Americans is part of the Medicaid program.

“Since our first day as medical students, when we receive our white coats, we pledge to do no harm and not discriminate in our care and to treat all individuals with respect,” said new graduate Emily Commesso, MD. “is pledge continues that spirit and encourages social responsibility for some of our most vulnerable patients.”

PHOTO BY RICHARD WHELSKY

AUTISM SYMPOSIUM. “e message of our book,” said the co-author of a Pulitzer Prize finalist work about autism, “is that the larger community needs to change, needs to step up and not freak out over people who are different.” at’s how John Donvan, an ABC newsman and co-author of the bestselling “In a Different Key: e Story of Autism,” kicked off a two-day autism symposium at Upstate this spring. e conference attracted noted researchers from around the country.

His general-interest talk was followed by scientific topics, such as deficiencies in brain carnitine, a compound involved in metabolism (by Arthur Beaudet, MD, Baylor College of Medicine), genetic causes (Stephan Sanders, MD, PhD, University of California at San Francisco School of Medicine) and the use of DNA from saliva to identify autism (Upstate graduate Steven Hicks, MD, PhD, Penn State College of Medicine). l

HOMELESS SURVEY. Medical students from Upstate joined 40 volunteers this winter to conduct the annual Point in Time homelessness count in Central New York.

Simon Hernandez, who is entering his third year, got involved through Upstate’s Center for Civic Engagement. e count takes place nationwide.

“It showed me a new way of being compassionate,” Hernandez said of the hours he spent interviewing people who were homeless. “ey have a lot of distrust in the system. Part of what you have to do is reinstate trust.

You have to take the time to be compassionate and listen to them. … You can’t just tell them what to do.”

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NEW GARDEN. A new Patient and Family Healing Garden, reminiscent of the pocket parks that are snuggled between skyscrapers, has opened on a wedge of green space between the concrete walls of the Community campus hospital.

Research has shown that healing gardens provide patients and families with a welcome distraction from physical and emotional pain, reduce stress levels and promote a sense of well-being. l

CONTRACEPTION APP. Upstate’s Joshua Steinberg, MD, who specializes in family medicine, has created a mobile application for health care providers with patients seeking birth control.

Called “Contraception Point-of-Care,” the app comprises information about medical eligibility, which methods are most effective, contraception prerequisites and more. It’s free. l

FASTEST RUNNER. Upstate physical therapist Lee Berube finished as the top male runner with a time of 17:34, at the 2017 Syracuse JP Morgan Corporate Challenge, a 3.5-mile race held June 6 at Onondaga Lake Lee Berube Parkway. Berube beat his record from last year’s event by two seconds, when he was named the 2016 Syracuse Corporate Challenge overall top finisher and top male runner (17:36). Pharmacist Christina Phelan placed fourth in the 2017 Top Women category with a time of 22:21. is year marked Upstate’s largest Corporate Challenge team to date, with 144 participants. ●

upstate.edu l summer 2017

Extending expertise

PATIENT CARE

Stroke neurologists care for patients in remote areas

BY AMBER SMITH

THIS IS A STORY ABOUT TWO WOMEN, living in different parts of rural Central New York.

Each suffered a stroke.

Each had a loved one who summoned help.

Each saw a stroke neurologist from Upstate University Hospital long before arriving at the academic medical center in Syracuse.

Upstate’s Telestroke partnership — which allows Upstate neurologists to provide clinical care from a distance — helped save the lives of Amanda Peer of Watertown and Mary Green of Clayton.

A headache that wouldn’t stop.

Green, 49, is a licensed practical nurse who has worked for 30 years at River Hospital in Alexandria Bay. She was supposed to work there Oct. 25, but at 5:15 a.m. she remained sound asleep, snoring. Her husband, Marshall Green, tried to wake her up, twice.

When he realized she was unresponsive, he called for their son, Dustin, to help while they waited for the ambulance. ey thought Mary Green might have overdosed on her medication. e day before, Green had a headache that wouldn’t stop. She remembers going to bed early. at’s all she remembers. “I don’t remember anything for about 38 days.

I kind of lost a month of my life.”

Her husband kept notes for her. At River Hospital, the doctors consulted with Upstate neurologist Elwaleed El Nour, MD, via Telestroke. His assessment allowed for a quick decision that Green needed prompt transport by helicopter for expert care in Syracuse.

At Upstate, Green immediately underwent an angiogram, showing the blood flow — and the blockages — in the vessels of her brain. She had what is called a bilateral occipital stroke, affecting the lower back part of her brain. is region controls vision, coordination and balance, among other essential functions.

Green spent 38 days in Upstate’s specialized neuroscience intensive care unit for patients with neurological problems.

Medications helped her recover from her stroke. Aer she was stabilized, she was transferred to Upstate’s physical medicine and rehabilitation unit.

She went home Dec. 13. She continues to see neurologist Carmen Martinez, MD, who is trying to determine why

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Mary Green and her husband, Marshall.

PHOTO BY SUSAN KAHN

Green had a stroke — although the reasons remain unknown for some stroke patients.

Green is not back to work yet. She can’t drive, but she can walk, and she’s hopeful her vision will continue to improve. She considers herself “a very fortunate, lucky lady.”

A hand that went numb.

Amanda Peer, 33, lay in her hospital bed Sunday, March 12, the day aer her stroke. She watched doctors walk by her room. en she saw him. “Mom! at’s the guy who was in the car.” at guy was neurologist Gene Latorre, MD, medical director of Upstate’s Comprehensive Stroke Center. e car he was in was his own. anks to telestroke technology, Latorre was in the back seat on his laptop computer, with his wife at the wheel, conferring by video with Peer’s doctors at Samaritan Medical Center in Watertown.

Shortly before, Peer had been talking on the phone with her mother, Debra Ezell, who lives next door. She placed fish sticks in the oven, and her right hand went numb. She collapsed onto a fold-out bed in the adjacent room. Ezell came running when she got no response over the phone. continued on page 6

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PATIENT CARE

Extending expertise

Elwaleed El Nour, MD

Carmen Martinez, MD

Gene Latorre, MD

continued from page 5

Hesham Masoud, MD

“My words weren’t coming to me,” Peer recalls. “I couldn’t think of the words I was trying to say.”

She was in and out of awareness. She remembers seeing Latorre on a monitor doing an assessment. Peer thought she lied both feet when he asked, although only the le one moved. One minute she heard people talking about transferring her to Syracuse. e next, she was in Syracuse, and family members were pouring into her room.

Peer received a dose of clot-busting medication called tPA before she arrived at Upstate. A scan revealed six clots in her brain. Upstate’s neurointerventionalist and stroke neurologist Hesham Masoud, MD, used a specialized clot retrieval device to remove the largest ones. e small ones were treated with medication.

Within 12 hours, Peer says she had her speech back. Four days later, she was well enough to go home. She credits God with helping the doctors help her recover. ●

Debra Ezell and her daughter, Amanda Peer.

PHOTO BY SUSAN KAHN

e Upstate Telestroke network includes nine outlying hospitals: Carthage Area Hospital, CantonPotsdam Hospital, Claxton-Hepburn Medical Center in Ogdensburg, Clion-Fine Hospital in Star Lake, Cortland Regional Medical Center, Gouverneur Hospital, Lewis County General Hospital in Lowville, River Hospital in Alexandria Bay and Samaritan Medical Center in Watertown.

How to help your child during emergency care

1. STAY CALM. Your child will look to you to see whether to be nervous, upset or scared. e calmer you can remain, the calmer your child will be.

2. BE HONEST. Children do best when they are prepared for what is going to happen. If something is going to hurt, sting, tickle or be cold, tell your child what it will feel like and how long it will last.

3. GIVE COMFORT. Your child may need extra comfort from you and may not act how he or she would at home or in a familiar environment. Hold them on your lap, hold their hand, ask for a blanket or dim the lights to help your children feel more comfortable.

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PHOTO BY ROBERT MESCAVAGE

4. SPEAK UP. If your child is in pain or you have a question or concern regarding your child’s care, please speak up. You know your child best, and the staff needs your help to provide the best care for your child.

5. PROVIDE DISTRACTION. Playing games or helping your children focus on something else can help distract them if they are in pain or nervous. Counting, I-spy, 20 questions, singing, storytelling and deep breathing can all work to distract your child and require no extra equipment. ● upstate.edu l summer 2017

PATIENT CARE

Two questions to ask if you’re told you have multiple sclerosis

LESSONS FROM UPSTATE

AMONG PATIENTS TREATED FOR MULTIPLE SCLEROSIS, up to 10 percent have been mistakenly diagnosed and treated for the disorder.

“In many cases they are treated for 10 years or longer, causing for them financial, emotional and physical hardship,” says Upstate neuropsychologist Dominic Carone, PhD. Carone wrote in the journal Applied Neuropsychology: Adult about a middle-aged woman who for five years was treated for MS, a disease of the central nervous system, and for a hereditary and rare form of stroke.

When her condition declined, her neurologist referred her to Carone, the coordinator of the Neuropsychology Assessment Program at Upstate.

It turns out that MS and this rare stroke disorder have never been known to occur in the same person. Since genetic testing, imaging scans and other evidence proved the woman had the rare stroke disorder, Carone convinced her neurologist that she did not have MS. is case highlights how neuropsychological consultations can help improve diagnostic decision-making and stresses the importance of doctors distinguishing a particular disease or condition from others with similar features.

It also provides two lessons for patients who receive an MS diagnosis.

Carone suggests asking: “On what criteria is my diagnosis based?” and “Can I have a second opinion?”●

Dominic Carone, PhD, at Upstate’s Institute for Human Performance, where the Neuropsychology Assessment PHOTO BY SUSAN KAHN Program is located.

ARE YOU GRATEFUL? A gift of gratitude is a meaningful way to both express your appreciation to special caregivers and to help patients during their time of great need.

Friend in Deed, Upstate University Hospital’s annual fund, supports a variety of unmet patient needs, such as nutritional supplements for cancer patients, special pediatric needs, communication tools for the deaf and hard of hearing, and heart monitors, to name a few.

To donate, visit upstatefoundation.org or contact the Upstate Foundation at 315-464-4416. To share your story, email FND@upstate.edu

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Foundation

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No bread, no dairy, no meat

PATIENT CARE

Living with PKU means eating lots of vegetables, fruits

BY SUSAN KEETER

EZEKIEL SANFORD WAS 2 DAYS OLD when his Binghamton pediatrician told his parents: “You have to take him to Upstate.”

A routine blood test showed that Ezekiel had a rare inherited disorder called phenylketonuria, or PKU, which affects one in 15,000 newborns. e pediatric geneticist and medical specialists he needed were a short drive away, in Syracuse.

At the Upstate Golisano Children’s Hospital, Ezekiel is seen by pediatric geneticist Joan Pellegrino, MD, and her team, which includes a dietitian, nurse practitioner, genetic counselor, social worker and nurse. His first year, Ezekiel had many appointments and lots of blood work done at the children’s hospital.

One of their first tasks was to help Ezekiel’s mother, Melissa Sanford, figure out how to breast-feed her son safely. It required alternating breast milk with a special formula for infants with PKU, counting the minutes he nursed and measuring the ounces of formula he drank. e family has become accustomed to this level of watchfulness.

For the rest of his life, Ezekiel will need to follow a strict diet that limits his intake of phenylalanine, an amino acid found in most foods, particularly those that contain protein.

Ezekiel’s diet includes no bread, no dairy and no meat.

He eats fruits and vegetables and gets one-third of his calories from a formula that contains a synthetic protein that lacks phenylalanine. Everything he eats has to be weighed in grams and calculated for its phenylalanine content. Fortunately, Ezekiel loves fruits and vegetables and is happy to remind anyone who’s listening that “cooked carrots are yum, yum, yum.”

“Ezekiel is receptive to his diet, and we are vigilant,” explains his father, George Sanford.

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Above: Ezekiel Sanford.

At left: Joan Pellegrino, MD PHOTOS BY SUSAN KAHN

With guidance from the Upstate team and their own research, Ezekiel’s parents have found conferences, support groups and medical food companies, all of which help Ezekiel lead a healthy, normal life. His parents read food labels carefully, contact manufacturers and order products from medical food companies. As a result, Ezekiel is able to enjoy pizza and garlic bread, as long as it’s made with a special flour designed for people with PKU. Today, Ezekiel is 5, and he’s used to the biweekly, at-home blood tests that will always be part of his life. He sees his Upstate team twice a year and will start kindergarten in the fall.

Ezekiel, his parents and three siblings are looking forward to moving to a farm — where they plan to grow lots of fruits and vegetables. ● TESTING FOR PKU

All babies in the United States, plus many other countries, are routinely screened for metabolic disorders including phenylketonuria, or PKU, at least 24 hours aer birth. A few drops of blood are collected from the heel or the bend in the arm.

In PKU, the body is unable to break down the amino acid phenylalanine. If it builds to harmful levels in the body phenylalanine can cause intellectual disability, neurological disorders and other serious health problems.

People with PKU must limit their intake of dietary protein and may take a nutritional supplement that provides adequate protein without phenylalanine.

upstate.edu l summer 2017

Why you may be awakened during your hospital stay

PATIENT CARE

KEEPING PATIENTS SAFE sometimes involves disturbing them in the middle of the night, explains pediatrics chief omas Welch, MD, the medical director of the Upstate Golisano Children’s Hospital.

Fluids or medications can leak from a patient’s intravenous line into surrounding tissue if the IV gets jostled aer it’s placed. It’s called IV infiltration. Complications can be serious, but damage can be minimized if it’s caught early. is complication goes by the name “peripheral IV infiltration and extravasation” or “pivie.” Welch explained that the children’s hospital is part of a national consortium of children’s hospitals looking at the causes and prevention of pivies. at is why nurses inspect intravenous sites at regular intervals, around the clock, during a hospital stay.

Welch says what may seem like a bothersome intrusion is a critical component of an effort to protect patients from adverse events. And depending on a patient’s sleeping position, nurses may be able to see and feel the IV while their patients remain sound asleep. ●

Thomas Welch, MD, center, with a group of medical residents and students at the Upstate Golisano Children’s Hospital.

PHOTO BY SUSAN KAHN

If you’re facing a diagnosis of breast cancer, turn to the experts at the Upstate Cancer Center. Each patient receives personal care, tailored to individual needs. Our multidisciplinary team is powered by radiologists (imaging), surgeons, radiation oncologists, medical oncologists and pathologists to plan the most effective diagnosis and treatment. Upstate now offers the area’s only 3-D guided biopsy done while a patient is seated in a comfortable chair. This minimally invasive procedure uses X-ray imaging to target areas that cannot be seen with standard mammography. The new procedure reduces biopsy time by more than half. As with all digital mammography, low-dose radiation is used.

MORE INFORMATION: CALL 315-464-HOPE OR VISIT UPSTATE.EDU/CANCER

EXPERTISE. COMPASSION. HOPE. summer 2017 l upstate.edu

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PATIENT CARE

Stethoscopes

At 200 years old, the stethoscope is one of the most ubiquitous, recognizable medical devices, used to listen to the heart. lungs and abdomen and determine blood pressure.

Elizabeth Blackwell, MD “Ear trumpets,” like this one from the historical collections at the Upstate Health Sciences Library, were in use in 1849, the year Blackwell — the first woman to receive a medical degree in the United States — graduated from Upstate’s predecessor, Geneva Medical College.

Luna Bhatta, MD Cardiologists use the bell (with the smaller diameter) to listen to patients’ heart sounds, which are typically low in pitch, says Bhatta, director of Upstate’s electrophysiology lab.

Respiratory therapist Jennifer Casler Respiratory therapists use their stethoscopes to concentrate on the sound of air moving in and out of the lungs. For patients who are ventilated by machine, stethoscopes are used to listen for leaks around the cuffs of endotracheal tubes, which go into the windpipe.

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Pediatric nurse Rebecca Mesmer, RN Like many nurses, Mesmer got her stethoscope from Bayberry Uniform Shop in Liverpool.

She hangs it around her neck when she’s using it for patient care.

William Marx, DO Trauma specialists such as Marx, a surgeon, rely on the same types of stethoscopes as their medical colleagues, but they are more likely to need to listen to sounds within the patients’ abdomens.

Nancy Page, RN When she began her nursing program in 1979, Page’s parents presented her with a stethoscope. Today, as chief nursing officer at Upstate, Page keeps it in her office for nostalgia.

She uses a more current model.

Antonio Culebras, MD Culebras, a neurologist in the Upstate Comprehensive Stroke Center, uses a stethoscope made by Littmann, the dominant stethoscope manufacturer.

Hospital staff Upstate University Hospital stocks disposable “isolation” stethoscopes, for use with highly infectious patients.

Nurse practitioner Mary Foster, NP Foster works with pediatric respiratory patients, where she frequently presses the diaphragm of her stethoscope (opposite the heart) firmly against her patients’ backs and chests to listen for the high-pitched sounds of breathing.

Connect with us on Instagram. #showusyourstethoscope

Neal Seidberg, MD Upstate’s chief of critical care uses a digital stethoscope with wireless Bluetooth technology. upstate.edu l summer 2017

FROM OUR EXPERTS

A form of communication Social worker makes sense of 5 behaviors common in dementia FIVE CLASSIC BEHAVIORS that typically arise in someone who has Alzheimer’s disease or another type of dementia can be confusing and frustrating to caregivers.

Understanding what drives those behaviors may help.

“Most of the behaviors that become common when someone enters the middle stages of the disease are really just ways of communicating needs or discomforts or emotions,” says Whitney Hadley, a social worker at the Central New York Chapter of the Alzheimer’s Association.

Here’s a rundown from Hadley:

Behavior: Anxiety or agitation Looks like: Restlessness and pacing, or over-reliance on a caregiver.

Explanation: If the person is feeling anxious or uncertain about something while losing control due to the disease, he or she is likely seeking out what’s most familiar, to feel safe.

Action: Recognize and act on any physical or emotional needs tied to their behavior. If they pace at dinner time, make sure they wear shoes that fit well.

Behavior: Confusion or suspicion Looks like: Accusation that a lost item was taken.

Explanation: With dementia, people lose the ability to retrace their steps. If you are sitting near where they usually place their keys, and they cannot find their keys, they may logically believe you took them.

Action: Instead of arguing that you don’t have their keys, say, “Let me help you find your keys. at must be very stressful for you. Let’s look for them together.”

Behavior: Repetition Looks like: Asking what time is lunch, over and over.

Explanation: ey may want to engage and talk to someone, they may be having trouble processing information, or they may be forgetting that they have asked already.

summer 2017 l upstate.edu

Action: Consider whether they are actually hungry; did they eat a small breakfast several hours ago and now they need a snack? Are they thirsty? Answer the same way each time, and briefly. Say, “lunch is at noon.” en redirect with something such as “let’s go take a walk” or “let’s fold these towels.”

Behavior: Aggression or anger Looks like: Sudden verbal or physical outburst.

Explanation: An aggressive episode is usually more scary than it is dangerous.

Action: Aer things have settled down, piece together what prompted the outburst for clues of how to prevent more. Consider what factors frustrated them. Are they in pain? Did the tone of your voice provoke them? Could they be overly tired? What about medication side effects?

Behavior: Wandering Looks like: Becoming lost, from disorientation or confusion.

Explanation: About 60 percent of people with dementia will wander at some point, and usually without warning.

It may be tied to boredom, the person trying to follow old habits, trying to find something or someone, or trying to get away from something unpleasant or stressful.

Action: Have safety precautions in place, including a list of places the person may wander to, such as previous job locations, former homes, places of worship or favorite restaurants. Also, the Alzheimer’s Association offers MedicAlert + Safe Return. Learn more at 800-272-3900. ● A PIECE OF ADVICE

“Keep a notebook,” says social worker Whitney Hadley.

“Taking notes is one of the best things a caregiver can do.

It helps you identify a progression of symptoms, helps you to work through, if you start to see a behavior more frequently, what could be causing it.

“If you start to write these things down — What time of day is it happening? What’s going on that could be triggering it? — you’ll start to see patterns, and that will help you in the future.”

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FROM OUR EXPERTS

Open wide and say aha!

Urologist looks to patients’ mouths for urethral stricture repair

BY AMBER SMITH

ONLY AN INNOVATIVE SCIENTIST with expertise in reconstructive urology would look at the inside lining of the cheek and wonder how those cells would behave if transplanted into the urethra, the tube that carries urine from the bladder.

Dmitriy Nikolavsky, MD, is that urologic scientist.

As director of reconstructive urology at Upstate University Hospital, Nikolavsky has completed more than 250 urethral reconstructions over the past four years. Many of the reconstructions were necessary because of patients with urethral strictures, a narrowing of the urethra from a variety of causes, including inflammation, infection, injury and previous surgeries or catheterizations.

He’s on a quest to find solutions for these patients.

He earned a “Young Investigator” grant this year from the northeastern section of the American Urologic Association. And in May the Journal of Urology chose his research paper as best paper in investigative urology in 2016.

Spray paint or wallpaper?

Among the traditional treatments for urethral stricture are a urethral dilation meant to stretch scar tissue without injuring the lining of the urethra, or an endoscopic procedure that involves internal cutting to widen the urethra, called a urethrotomy. ese procedures oen do not provide lasting relief.

An open surgery called urethroplasty has a better success rate, but not many urologists have the proficiency to offer it as an option to patients.

Nikolavsky says the success of urethroplasty can be improved with the use of a buccal mucosa gra, which many reconstructive urologists have used for several decades. at’s where the surgeon cuts a section of tissue from the patient’s inner cheek and transplants it like wallpaper onto the inside of the urethra.

Tissue from inside the mouth is a natural substitute for

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Normal cross-section of urethra

FROM THE LAB OF DMITRIY NIKOLAVSKY, MD

urethral tissue because both are from wet, hairless environments and because surgeons can easily access the inside of the mouth. Also, the inside of the cheek typically heals quickly, similar to the way a pizza burn would heal.

Unfortunately, transplanting tissue directly from the mouth and onto the urethral defect requires an open surgery that is technically difficult and not widely available from all urologists.

So, Nikolavsky is experimenting with a couple of ways to complete a two-step process that he hopes will become a feasible alternative option. Instead of a surgeon “wallpapering” the damaged area of the urethra with buccal mucosa in an open surgery, Nikolavsky wants to be able to “spray paint” a buccal mucosa solution through an endoscope, a tubular instrument.

Here’s how it might work.

In one version, the tissue could be removed from the patient’s mouth and immediately processed into a liquid. en, the urologist could place a catheter (tube) in the urethra, and the liquid buccal mucosa would be injected

upstate.edu l summer 2017

FROM OUR EXPERTS

Dmitriy Nikolavsky, MD, is director of reconstructive urology at Upstate University Hospital. He has completed more than 250 urethral reconstructions over the past four years. His wife, Daniela Nikolavsky, works in the urology laboratory.

PHOTO BY SUSAN KAHN

How to brighten your life

KAUSHAL B. NANAVATI, MD, is a doctor of family and integrative medicine at Upstate who oen advises patients to “brighten up your life by getting back to the basics.”

What does he mean by that?

Buccal mucosal engraftment

FROM THE LAB OF DMITRIY NIKOLAVSKY, MD

around the catheter. e catheter would stay in place for a week, until the urethra heals.

Another method Nikolavsky is exploring would remove the tissue from the patient’s mouth and send it to a laboratory. Fragments of the buccal mucosa would become part of a liquid solution containing a fibrin glue, designed to help the solution adhere to the damaged area of the urethra. e patient would return another day for the second step, in which the liquid gra would be added to the urethra through an endoscope.

“Buccal mucosal cells have increased metabolism and contain numerous fibroblast and epithelial progenitor cells with stem cell properties,” which means they are ideal to help with wound healing, Nikolavsky and colleagues describe in the Journal of Urology in 2016.

Urologists are not the only ones excited about the potential of buccal mucosa gras. Scientists studying regenerative medicine are looking at such gras for use in reconstruction of the cornea, esophageal (food pipe) strictures and skin burns. ●

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1 2 3

Start by accepting yourself for who you are, imperfect and flawed, as we all are, while being a one-of-a-kind original.

Forgive yourself if you have not always been your best to yourself.

Be nice to yourself by taking good care of your mind, body, and spirit. Follow what Nanavati calls the “CORE 4 of Wellness,” also the title of his book. at is:

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Nutrition — Eat healthy whole foods.

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Exercise — Make it a daily appointment.

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Stress management — Focus on the things you can take care of in your life...breathe...and let go of the rest.

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Spiritual wellness — Appreciate that you have today to create a peaceful life and then start creating it.

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Invite things and people into your life that will add to your joy. ●

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FROM OUR EXPERTS

catio n edi . . . l m e

BY AMBER SMITH

WHEN PATIENTS BEGIN TAKING antidepressants, their health care providers typically warn that the medication may reduce sexual desire and performance and may increase appetite and weight gain. Oen missing is a discussion about how the medication may affect sleep. at’s an important omission, especially for older adult patients, says Muhammad Tahir, MD, who is completing his residency in psychiatry and behavioral sciences at Upstate. He says antidepressants can interrupt sleep for senior citizens and may raise their risk of developing dementia.

Tahir lead a team of researchers who analyzed studies published between 2011 and 2016 about sleep disorders and antidepressant use in people over age 50. He presented their work at a mental health services conference last fall.

Antidepressants significantly affect what doctors refer to as “sleep architecture,” the way a person cycles through the stages of sleep, according to Tahir’s findings.

In older adults, the situation can be a vicious circle.

Sleep disturbances become more common as people age, oen with light sleep increasing while deep sleep wanes.

Such changes can cause physical and mental problems, including depression, which is not unusual among the elderly. Antidepressants used to treat depression are liable 14

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S l . eep . . o t s tr d a

ion...le a d ess s t pr

leads to e l de b u o

to cause more — and potentially more serious — sleep disturbances.

Older adults taking antidepressants may have more trouble falling asleep, Tahir’s review shows. ey may also experience less REM sleep, the paralyzing dream state so-named for the rapid eye movements that occur.

Some older adults taking antidepressants may experience REM sleep without the natural muscular paralysis called atonia. is may lead to nightmares or the acting out of vivid or violent dreams. Such behavior can happen while taking any type of antidepressant, but Tahir noticed that older adults taking selective serotonin reuptake inhibitors, the most commonly prescribed type of antidepressant, were more likely to report it.

Studies he reviewed indicate that such behavior may be an early sign of neurodegeneration.

Tahir concludes that health care providers should be careful about prescribing selective serotonin reuptake inhibitors, including Prozac, Celexa and Lexapro, in elderly patients.

He also cautions that before a senior citizen begins taking an antidepressant, he or she should realize that sleep may be affected and be screened for signs and symptoms of neurodegeneration. ●

upstate.edu l summer 2017

FROM OUR EXPERTS

Are you age 52 to 72?

Three health conditions to check

BY JIM HOWE

BABY BOOMERS CAN SAVE THEIR HEALTH, their lives and lots of money and trouble by getting themselves checked for three major but oen neglected health problems, says New York State Health Commissioner Howard Zucker, MD. e conditions — high blood pressure, prediabetes and hepatitis C — are the focus of a statewide campaign to encourage those born from 1945 to 1965, who are prime candidates for all three, to be screened and, if needed, treated. e diseases oen go undiagnosed because they may not have obvious symptoms, says Zucker, who toured the state this spring with other physicians for a series of talks to increase awareness. He suggests baby boomers ask their doctors about:

Prediabetes Prediabetes involves a high blood sugar level. It’s possible to change diet and exercise routines to delay or prevent full-blown Type II diabetes, Zucker said at Upstate Medical University, which hosted one of the talks.

Diabetes can lead to numerous complications, including heart disease, blindness, kidney failure and lower-limb amputations.

More than a third of U.S. adults have prediabetes, and most don’t know it. More than half of Type II diabetes cases are

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preventable, according to the U.S. Centers for Disease Control and Prevention.

High blood pressure Known as the “silent killer,” high blood pressure (hypertension) might go unnoticed for years if a person does not get regular checkups. About half of baby boomers have high blood pressure — defined as two consecutive readings of 140/90 or greater — and only about a half of them have it under control, Zucker said.

Medicines are available to control high blood pressure, which, if untreated, can lead to a stroke, heart attack or kidney problems.

Hepatitis C Hepatitis C is the most common chronic viral disease in the United States. It is estimated that three out of four baby boomers are infected with the hepatitis C virus and that most don’t know it.

Spread through blood, this common infection might have been contracted years before from injecting illegal drugs, even once, or from people who received blood transfusions before 1992, when strict screening methods started. e virus can destroy the liver but is curable through medications, noted David Bernstein, MD, a hepatitis C specialist who spoke at the Upstate event. ●

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FROM OUR EXPERTS

Limiting Lyme

How you can protect your family

SIXTEEN OF EVERY 100,000 NEW YORKERS were infected with Lyme disease in 2015, the latest year for which statistics are available. In 2015, 95 percent of Lyme diagnoses came from 14 states, including New York.

Lyme disease is caused by bacteria that are transmitted to humans through the bite of an infected tick, called Ixodes scapularis but better known as a deer tick because of its habit of parasitizing the white-tailed deer. Ticks acquire Lyme disease microbes by feeding on infected mice and other small rodents. ey may also spread other organisms.

Prevention advice Ticks do not jump or fly or drop from trees. ey start from the ground and crawl upward until they find a place to attach. Tuck pants legs into socks to keep ticks on the outside, where they may be seen or brushed off.

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Use repellents on your skin (that contain DEET) and your clothes (that contain permethrin.) Be sure to spray shoes and the insides of pants and shorts, too.

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Ticks may live where yards border wooded areas. ey like shady areas and leaves with high humidity.

Keeping leaves raked and shrubs and low branches trimmed can ruin their habitat. You may also consider pesticide treatment along the yard’s perimeter.

Check for ticks daily – especially the scalp, ears, underarms, belly button, waist and back, behind knees and pelvic area – and remove any promptly.* e smallest deer ticks may resemble poppy seeds.

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row clothing in a hot dryer for 10 minutes to kill ticks. Washing clothes even in hot water does not kill ticks.

*THE RIGHT WAY TO REMOVE A TICK “Use tweezers to grab the tick at the very bottom, close to the skin, and gently pull up,” says Jana Shaw, MD, an associate professor of pediatrics and public health and preventive medicine at Upstate.

She says not to try choking or burning the ticks, or other home remedies, because they are not effective — and stressing a tick can make it expel bacteria into your skin.

“Just a gentle pull with the tweezers – and cleaning the skin with alcohol afterwards — is all that is needed.”

Dispose of a live tick by submerging it in alcohol, placing it in a sealed bag or container, wrapping it tightly in tape or flushing it down the toilet. Never crush a tick with your fingers.

SOURCES: CENTERS FOR DISEASE CONTROL AND PREVENTION, CORNELL COOPERATIVE EXTENSION, TICK ENCOUNTER RESOURCE CENTER FROM THE UNIVERSITY OF RHODE ISLAND AND UPSTATE MEDICAL UNIVERSITY PHOTO BY DAN CAMERON

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upstate.edu l summer 2017

FROM OUR EXPERTS

What happens when Lyme attacks the heart

BY AMBER SMITH

EVERY TIME HE STOOD, he would feel dizzy. But since he was fasting for the Muslim holy month of Ramadan in the summer of 2015, Upstate medical student Hamza Murtaza figured he was just lightheaded from not eating.

He was also tired, and he had abdominal pain. When he felt his pulse, it was an abnormally slow 30 to 40 beats per minute.

“It got to the point where I walked from my apartment to the library, and I had to stop two or three times,” Murtaza says. “I wasn’t winded or short of breath. I was just tired.”

Murtaza, 25, took a detour to the student health center at Upstate. Among the tests he submitted to was an electrocardiogram, which showed the electrical functioning of his heart.

Murtaza had complete heart block. e impulses from his heartbeat were not working properly. at’s why his heart rate was so low and why he was getting dizzy.

He was promptly admitted to Upstate University Hospital. A temporary pacemaker was installed. As doctors set about trying to determine what caused Murtaza’s heart problems, Murtaza started thinking.

He’d been married early that summer, and for a quick honeymoon, he and his wife traveled to Maine for a long weekend at Acadia National Park. One morning, he awoke with joint pain and shoulder pain. He thought he had pulled a muscle or slept wrong. e pain went away, and he forgot about it. en his right elbow started hurting. en his le thumb started to hurt.

Looking back, Murtaza realized he had “migratory arthritis,” something that is sometimes seen in Lyme disease. He never noticed a rash. Nevertheless, the heart block he developed was blamed on a rare complication of Lyme called Lyme carditis.

Doctors put him on antibiotics for seven days in the intensive care unit, and he continued taking the medicine for two weeks aer he was discharged.

He eventually recovered.

Murtaza wrote about his experience in a poster presentation for this year’s Charles R. Ross Student Research Day at Upstate. “Of the 30,000 Lyme cases reported each year, only 1 percent present with meningitis or Lyme carditis,” says his poster. “My case elucidates the value of a complete history and demonstrates that a lack of the hallmark rash can oen lead to the underestimation of symptoms.” is happened between Murtaza’s first and second year of medical school. When classes resumed, he attended an infectious diseases lecture — and the professor discussed an interesting case of Lyme disease. Murtaza volunteered that he was the patient, providing a perspective not usually available in a medical class lecture. ●

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Hamza Murtaza, 25, is a fourth-year medical student at Upstate Medical University who wrote about his personal experience with a complication of Lyme disease.

PHOTO BY ROBERT MESCAVAGE

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IN OUR COMMUNITY

DISABILITY A matter of both perception and reality

BY JIM HOWE

DEFINING WHO HAVE DISABILITIES and how to meet their health needs is tricky because there is no standard formula and because disabilities can take so many forms.

Some researchers look at disability as a medical problem needing medical care.

13 percent of the total population; 5 percent of children ages 5 to 15 years; and ● 22 percent of adults.

Others take a functional view and define people with a disability in terms of the work or activities they can perform.

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Still others look at disability through a social lens, considering conditions in the social environment that prevent participation in society and how to remedy that.

Improving lifespans

Add to that the general tendency to view someone who uses a wheelchair as having a disability, but to overlook those with less visible disabilities, such as deafness or psychological issues, and it becomes clear how muddled the definition of “disability” actually is.

Even people with disabilities might disagree with the term.

Varying definitions Studies have shown almost 75 percent of those who cannot hear and more than half of those who cannot see don’t consider themselves as having a disability, nor do 20 percent of people who use manual wheelchairs or 16 percent who use powered wheelchairs. Many people with an impairment don’t claim a disability, says Margaret Turk, MD, an Upstate professor of physical medicine and rehabilitation, pediatrics, public health and preventive medicine.

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She says such varying definitions and methods of estimating the population of people with disability are among the challenges to delivering health care to this group. e federal Centers for Disease Control and Prevention report these percentages of Americans as having a disability:

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●

Turk spoke about the challenges people with a disability face in health care in a recent lecture at Upstate. Just getting into an office for a medical appointment can be difficult. So can dealing with health insurers and health care providers, some of whom may view people with disabilities as time-consuming and complicated.

Another complicating factor is how people with disability view their health. When asked how they rate their health, people with disability report good and excellent health ratings even with a relatively large number of days of poor physical health. Seeing so many days of poor health, health care providers tend to view people with disability as having poor health and, therefore, poor quality of life — which may not be the case.

While it’s true that people with certain disabilities generally face shorter life expectancies, Turk says that is improving.

She also points out that people with disability can participate in the same wellness activities as people without disability, such as exercise and smoking cessation programs, with the same positive health effects.

upstate.edu l summer 2017

●

Increasing awareness of a common mental disorder

IN OUR COMMUNITY

BY JIM HOWE

UPSTATE GRADUATE NICOLE CIFRA, MD, trained with a mentor who told her of his early years as a doctor, some 35 years prior. When he heard a patient had anorexia, he had no idea what that was because he never heard of the eating disorder in medical school or during residency training. ese days, people are more aware of eating disorders, and professionals no longer blame families or exclude loved ones when treating a young patient, Cifra says. She earned her medical and master of public health degrees at Upstate and is now a pediatric resident physician at the University of Rochester.

About one in 20 young women has an eating disorder, and “everybody knows somebody” who has had one, Cifra notes. Between 4 percent and 20 percent of young women practice unhealthy patterns of dieting, purging and/or binge eating.

At a recent talk at Upstate, Cifra explained that researchers are looking for the cause of anorexia and other eating disorders. Current thinking suggests a brain-based genetic illness.

She also spoke of challenges in diagnosing and treating patients, who may try to hide the disorder out of shame or guilt or whose obsessions with weight and food can seem commonplace. Since many health insurers do not cover the cost of treatment for eating disorders at the same level as

Nicole Cifra, MD, shown in an Upstate cafeteria, is concerned by how many PHOTO BY WILLIAM MUELLER young women practice unhealthy eating.

for other mental disorders, families are liable to face high out-of-pocket costs. Finding appropriate care can be difficult, too.

Still, Cifra sees progress.

A medical care standards guide for eating disorders, which Cifra helped develop as a member of the Academy for Eating Disorders, offers information to care providers if no treatment is available nearby. Parents also use the guide to advocate for their children. ●

She provided care in Ghana BRANDY BAILLARGEON OF WATERTOWN, a family psychiatric mental health nurse practitioner, traveled to Ghana through Upstate nurse Lauri Rupracht’s Americans Serving Abroad Project. She was touched by the gratitude of those she helped in several villages during the eight-day medical mission, including a baby girl who has problems with her feet. Baillargeon helped fashion some braces for her, using tongue depressors and high-top sneakers, and made arrangements for her to be seen at a hospital a few hours from her village. Baillargeon is a student in Upstate’s doctor of nursing practice program. Learn more at americansservingabroad.com ●

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IN OUR COMMUNITY

Chemical compounds found in mud near Onondaga Lake's southern end, above, likely came from the former Allied Corp., which dumped industrial wastes in or near the lake for years. The compounds, related to the banned pesticide DDT, are extremely toxic at low levels and would likely accumulate in the lake's fish, making them dangerous to eat, researchers say.

PHOTO BY WILLSON CUMMER/NEWYORKPHOTOGRAPHY.US

MYSTERY AT THE LAKE Researchers uncover deadly potential of obscure, long-buried chemicals that are similar to DDT

BY JIM HOWE

AMONG THE INDUSTRIAL WASTES that have polluted Syracuse’s Onondaga Lake for decades are two “mystery compounds” related to — and apparently more toxic than — the banned pesticide DDT. Scientists from Upstate Medical University, Syracuse University and the SUNY College of Environmental Science and Forestry have collaborated to study the chemicals, termed diphenylethanes, and whether they might cause seizures, developmental defects, brain damage or early death.

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John Hassett, PhD, a professor of chemistry at ESF, has studied the lake for years and discovered these chemicals in a mud sample he took near the southern end of the lake.

He recognized the DDT-like structure of the two chemical compounds, which have no common names because they were never used commercially.

“It was a eureka moment for me when I realized how these two compounds came to be,” Hassett said. He had researched chemical processes going back to the 1880s continued on page 21 upstate.edu l summer 2017

IN OUR COMMUNITY

Mystery at the lake and theorized that the lake’s chief industrial polluter, the defunct Allied Corp., produced the two chemicals as chance byproducts of refining oil produced from coking coal. e oily, thick compounds, officially designated as PTE (1-Phenyl-1-(p-Tolyl)-Ethane) and PXE (1-Phenyl-1(2,4-Xylyl)-Ethane), had not been identified by industrial chemists, had no commercial use and were dumped in tar pits near the lake and possibly into the lake itself, he said.

Hassett and his team analyzed the newly found lake chemicals, which matched the material in the tar pits.

“When we looked at the structure, it has the same chemical backbone as DDT, so we wondered if this stuff might have biological consequences,” Hassett said.

Hassett has found the chemicals in the water all through the lake, apparently coming from very contaminated sediments near shore. “If it’s buried in the mud and not disturbed, it should stay there. If you go down about a meter into the mud in the middle of the lake, I think there is a layer through the whole sediment of the lake. It comes up to the surface in that shallow part in the southern end; in deeper parts, it is buried. We’re going to see what’s still out there,” Hassett said.

Dredging and capping of the lake bottom, completed this spring as part of a decades-long lake cleanup, probably stirred up some of the sediment, although any tar should remain buried in deeper sections, Hassett said. Since the tar is not very soluble in water, it probably is not much of a groundwater threat, he said. It is likely accumulated by lake fish, which health officials warn people not to eat.

Some refugees and possibly other people, however, have been known to ignore warnings and eat fish from the lake.

To study the compounds’ possible toxic effects, Hassett partnered with James Hewett, PhD, and Katharine Lewis, PhD, associate professors of biology at SU. Lewis conducted studies on young zebrafish, while Hewett studied mice, both of which are oen used as test models for humans.

“Because it looked like DDT, which has effects in development and is neurotoxic, we thought we’d test the neurotoxic potential of these compounds at the earliest stages of life,” Hewett said. “DDT is linked to tremors and other neurological problems.”

“My field of research is epilepsy. ere is considerable interest now in how early life environment influences disease susceptibility later in life.”

Hewett exposed pregnant female mice to PTE and found their offspring seemed normal until adulthood, when testing showed they were more suseptible to seizures, such as happens with epilepsy. While it is difficult to mimic precisely how human exposure to these chemicals might take place, the mouse study provides a model for future testing, Hewett said.

Lewis found the chemicals to be extremely toxic at very

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continued from page 20

low levels, hundreds of times lower than toxic levels of DDT. e lowest levels that they tested were similar to the levels Hassett found in Onondaga Lake in 1994. ese levels cause heart defects and increased death rates in young zebrafish, and slightly higher levels caused increased susceptibility to convulsion behaviors that are similar to human seizures.

“I would be very surprised if the effects these chemicals have on zebrafish are fundamentally different than those on humans, but there may be subtle differences,” Lewis said. “It’s highly likely that the same effects would also occur in humans, but you can never say for sure.”

DDT?

WHAT IS

DDT was a commonly used pesticide until it was banned in the U.S. in 1972 because it persists in the environment, accumulates in fatty tissues and can cause adverse health effects on wildlife, becoming more toxic as it moves up the food chain. e two chemical compounds found in the Onondaga Lake mud — PTE and PXE — are related to DDT and appear to be more toxic. ey have no known commercial value and have never been studied extensively before.

Also participating in the research, now in its third year and paid for by a grant from the Hill Collaboration on Environmental Medicine, is Frank Middleton, PhD, an associate professor of neuroscience and physiology and director of the SUNY Molecular Analysis Core at Upstate.

Middleton assessed changes in gene expression — the process by which genetic information is made into a product, such as a protein — in the brains of the exposed mice offspring and zebrafish embryos. He was seeking clues that might help explain the altered seizure susceptibility and birth defects using a high-powered approach referred to as next generation sequencing (NGS). “e NGS data are very compelling and indicate disruption of very specific genes and cellular signaling pathways is occurring as a result of the PTE and PXE exposures,” said Middleton. e researchers all hope to continue studies based on this work.

“I would like to test other chemicals and see which genes might be turned on or off because of these chemicals. at could teach us more about what can cause seizure or early development toxicity and might provide more potential targets for therapy,” Lewis noted. ●

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Sticking to it

IN OUR LEISURE

Kali Club offers enjoyable route to self-defense skills

A Kali Club practice session at Upstate’s Institute for Human Performance. From left: Alan Blayney, MD/PhD student; John Sprey, master of nursing student; Karen Cyndari, MD/PhD student and the club’s founder; and Breanna Felldin, medical student.

PHOTO BY SUSAN KAHN

BY JIM HOWE

ABOUT TWO DOZEN PEOPLE BATTLE each other with wooden sticks every week on the Upstate campus, displaying skills that look like a mix of a fencing class, a pirate raid and a street brawl.

But no one gets hurt. ese Upstate employees and students are only tapping their sticks lightly, not hitting each other, as they go through their moves. ey are learning a martial art called kali, which is increasingly popular in the United States. Also called arnis or eskrima, the fighting style developed in the Philippines as natives learned to take whatever weapons were available — sticks, knives or bare hands — to defend themselves from foreign invaders or each other.

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e club is open to any adult at Upstate.

“I like kali because it is surprisingly difficult. For me, the challenge is in learning the moves. Moving around while swinging sticks with precision and coordination is not something I'm used to doing,” says Marten Peterson, 27, a second-year medical student.

Another second-year med student, John Frandina, 26, said, “I like how much strategy is involved in kali. ere are moves and countermoves, kind of like playing chess, only you’re attacking each other with wooden sticks.”

“I always thought a fighting style that involved weapons would be very primal; however, kali is strategic and methodical,” he noted.

Karen Cyndari, who is in the sixth year of her MD/PhD program, studied kali for eight years before starting the SUNY Upstate Kali Club this year. Club practice sessions are free and usually held twice a week. She loans wooden or rattan sticks to members who don’t have their own.

Marleny Acosta, 29, also in her second year of medical school, says the idea of learning self defense appealed to her. “I thought this would be a great way to learn how to best defend myself from an attacker. What I like most is knowing that I am learning something that is not only ‘cool’ but also beneficial.”

Cyndari, 30, who met her future husband a few years ago in a kali class, teaches at a beginner level and emphasizes kali’s skills and strategies, such as how to move when attacking or being attacked, and its camaraderie and fun.

She does not want a hard-core fight atmosphere where people just “bang sticks,” get hurt or feel intimidated, she said.

Club members learn the basic moves — the types of strikes, plus footwork — fairly quickly, and then they practice, practice, practice while adding new moves.

Although kali club sessions involve a lot of movement, they’re not designed to help people get fit. “ere’s boot camp or Zumba for that,” Cyndari said. “My classes are calm and focused.” ●

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upstate.edu l summer 2017

Here’s one way people with disabilities can enjoy nature

IN OUR LEISURE

REAL-LIFE SCAVENGER HUNTS using GPS assistance can involve people with disabilities.

A booklet called “Accessible Geocaching” explains how to find accessible nature areas and instructions for novice geocachers.

It’s an effort to promote inclusion of young adults with developmental disabilities in community-based wellness programs.

“Accessible Geocaching” is part of the New York State Developmental Disabilities Planning Council’s Inclusive Fitness Initiative. Upstate pediatrician Nienke Dosa, MD, assembled the booklet with help from several students and collaboration from the City of Syracuse Department of Parks, Recreation and Youth Programs, Syracuse University, SUNY Cortland department of therapeutic recreation and physical education, and the state Department of Environmental Conservation.

Download a copy of the booklet at fitnessinclusionnetwork.org ●

AD

DREAM BIG,, LITTLE ONE We’re Expecting Something New Upstate University Hospital’s Community Campus will open its expanded Birth Center and nursery unit this fall.

Highlights include: • Large, private rooms designed for quality time with family members • A “sibling center” featuring a game table, books and movies

The Birth Center offers a safe, comfortable place to welcome your baby to the world. We work with you and your doctor to provide the birth experience you seek, and further support you with physicians, neonatal nurse practitioners and anesthesia on site, around the clock.

To learn more, go to upstate.edu/birthcenter

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750 East Adams Street l Syracuse, NY 13210

SCIENCE IS ART IS SCIENCE IS ART 1S SCIENCE THE ANDROLOGY DEPARTMENT at Upstate helps men preserve their ability to become fathers by offering: l

sperm banking, where semen is collected and frozen in liquid nitrogen;

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testicular sperm extraction, a surgical procedure for men with no sperm in their semen, in which sperm are extracted directly from testicles, and then frozen;

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testicular tissue freezing, an experimental process that involves surgically removing and freezing tissue from the testicles of boys who are not old enough to produce sperm. e tissue could potentially be used later to restore fertility or produce sperm.

ese techniques can help men with a cancer diagnosis or temporary or permanent infertility issue. Learn more about fertility preservation by calling Upstate’s andrology department at 315-464-6550.

Kazim Chohan, PhD (right), leads Upstate’s Male Fertility Preservation Program, which came about through the efforts of Chohan and colleagues including pediatric oncologist Jody Sima, MD (also pictured); urologist JC Trussell, MD; oncologist Rahul Seth, DO; and pathology chair Robert Corona Jr., DO. PHOTO BY ROBERT MESCAVAGE

17.208 0717 42M QMCsk