Health UPSTATE
U P S TAT E M E D I C A L U N I V E R S I T Y
Spring 2016 HOW TO REACT TO STROKE SYMPTOMS page 7
‘CONCUSSION’ MOVIE FOCUSES ON CTE page 12
WHY SALVAGE THE ADRENAL GLAND? page 15
WHAT YOU NEED TO KNOW ABOUT HEROIN page 16
VETERANS TELL WHY THEY SERVED page 18
‘CLEAN COOKS’ SERVE UP PROTEIN PANCAKES page 22
TODAY HE’S AN ENERGETIC TODDLER page 5
WELCOME
Can you feel the compassion of your caregiver? A hallmark of good nursing care is that hospitalized patients sense the innate compassion of their caregivers. In this era of electronic medical records, it’s not as simple as tracking the amount of time a doctor spends with a patient, or the number of flu shots dispensed. Compassion is not so specific, and it’s what nurses and other caregivers at Upstate University Hospital aspire to provide, along with other important measures. The business of saving lives accompanies an aim to: • treat patients and their loved ones with courtesy and respect, • listen carefully to patients and their loved ones, • explain things in a way that patients and loved ones can understand.
Popular baby names Mom 365, the company that photographs new arrivals for Upstate’s online nursery, reports these most popular baby names at Upstate University Hospital’s community campus:
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Girls
Boys
Scarlett
Alexander
Emma
Daniel
Zoe
Matthew
Willow
Oliver
Penelope
Jeremiah
Sophia
Liam
Mia
Anthony
Madison
Mason
Abigail
Christopher
Grace
Joseph
U P S TAT E H E A LT H
Every patient should feel this sort of compassion in every encounter, says nurse Amy Szczesniak, the hospital’s chief experience officer. She joined Upstate last fall to help ensure that in addition to top-quality care, patients feel that they receive respect and compassion. One way that is measured is through a survey, which many patients receive after they are discharged. The survey asks whether their interactions with caregivers met expectations “always,” “usually,” “sometimes” or “never” during their hospitalization. Results of the survey help Szczesniak keep track of how well hospital staff communicate their compassion. ●
Hello & welcome
Upstate’s new president, Danielle Laraque-Arena, MD, is a native of Haiti who immigrated to the United States in 1962 and who speaks multiple languages. When you meet her, surprise her by saying “hello, and welcome” in a language other than English. Bonjour et bienvenue
Ou lakay ou CREOLE
SOURCES: CREOLE INSTITUTE AT INDIANA UNIVERSITY, DEPARTMENT OF LANGUAGES AT SYRACUSE UNIVERSITY
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Pronounced as “u-lakaj-u.”
Salve e benvenuta FRENCH
“Bonjour” is for morning or afternoon, but switch to “bonsoir” in the evening. “Bienvenue” sounds like “bea-venoo.”
ITALIAN
“Salve” is two syllables, and “benvenuta” is four, ending in an “a” because Laraque-Arena is female. Gender is marked by a vowel at the end of the word. “O” is for male.
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WELCOME
Contents 7
PATIENT CARE
cover story
Energetic toddler had surgery before birth
page 5
How to react to stroke symptoms
page 7
She’s got the heart of a warrior Are you at risk for kidney disease?
IN OUR COMMUNITY
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DEPARTMENTS What’s Up at Upstate
page 4
Why I served my country
page 18
Upstate History page 7 How baby formula got calcium
Strolling the Erie Canal
page 20
page 8
Sculptor shares her life story
Lessons from Upstate page 14 Jaw punch can cause concussion
page 21
page 9
Meet the ‘Clean Cooks’
page 22
Upstate Answers page 16 What’s so enticing about heroin?
Boot camp keeps surgeon in shape
page 23
New technique helps save trauma patients
page 10
Taking aim at hospital germs
page 11
FROM OUR EXPERTS
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IN OUR LEISURE
Recipe Protein pancakes
page 22
Science Is Art Is Science back cover Studying how cells communicate
‘Concussion’ movie critique page 12 Mission statements matter page 14 Why salvaging the adrenal gland makes sense page 15 Cognitive function is affected by indoor ventilation page 17 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
Health
Spring 2016
PUBLISHER Wanda Thompson, PhD, Senior Vice President for Operations EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications EDITOR-IN-CHIEF
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
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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WHAT’S UP AT UPSTATE
Upstate Medical University’s educational mission extends into community
photo by robert MescavaGe
S
ince 2000, Upstate has hosted the annual Lions Days. This January, almost 60 Lions Club International members from across New York state came for lectures and training related to vision care.
Optometrist Edward Cordes, pictured above, spoke about vision screening for children from 6 months to 6 years in Upstate’s Neuroscience Research Building. Members also heard from Upstate researchers and toured Upstate labs. The Lions Club has donated more than $250,000 to Upstate’s Center for Vision Research. Last year, two Lions Club members purchased a $15,000 piece of equipment for vision researchers at Upstate. photo by Darryl GeDDes
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“Mental Health First Aid” is an 8-hour course that is designed for first responders and people who work in schools or religious, community and youth organizations in Onondaga County. It’s funded through a $375,000 three-year federal grant from the Substance Abuse and Mental Health Services Administration. The grant will pay for up to 1,750 adults to be trained over three years.
The first alert about the current outbreak of Zika was issued in May in Brazil. Since then transmissions have been reported in many other countries and territories. The Centers for Disease Control and Prevention website maintains up-to-date information on Zika at www.cdc.gov/zika.
training to teach how to detect mental illness in youth, connect them with necessary services and help remove the stigma of mental illness is being led by colleagues from Upstate’s emergency medicine and psychiatry and behavioral sciences departments and Hutchings Psychiatric Center.
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hysicians from Upstate fielded questions about the Zika virus from dozens of Central New Yorkers who called the CNY Central television station during a special newscast in February. Timothy Endy, MD, pictured above, Upstate’s chief of infectious disease, explained that the virus is spread through the bite of an infected mosquito. “I want to emphasize, it’s not spread by personal contact or hugging or kissing.”
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PATIENT CARE
Toddler gets early boost to battle difficult diagnosis BY JIM HOWE
Before he was born, Mason Campbell underwent spinal surgery. Now an energetic 2-year-old, Mason and his parents, Jesse and Chris, aided by a variety of medical specialists, have been working to overcome his complicated diagnosis. Mason has myelomeningocele, a type of spina bifida where the bones of his spine do not completely form, and the spinal cord and tissues covering it protrude from the back, exposing them to damage. It can mean loss of bladder and bowel control, a lack of sensation or paralysis of the legs and weakness in the hips, legs or feet, possibly for life. After a test confirmed that the baby Jesse Campbell was carrying had spina bifida, the family, who live in Minoa, was referred to Children’s Hospital of Philadelphia, one of a handful of U.S. hospitals that offers fetal surgery to close the spinal opening and help lessen nerve damage. “We were trying with the surgery to preserve leg movement and avoid catheterizing his bladder and bowels. It seems to have helped so far,” Chris Campbell says. Mason pushing a
The surgery, performed at 23 weeks wooden wagon while of pregnancy, meant 14 weeks of bed his mother, Jesse rest for Jesse until Mason was born, Campbell, watches. on Oct. 14, 2013. Then he spent three photo by susan Kahn weeks in intensive care. It also meant that his parents and brother and sister spent a lot of time at the Ronald McDonald House in Philadelphia before returning to Central New York. That delicate in utero operation is “almost mystical,” says Nienke Dosa, MD, the medical director of Upstate’s Spina Bifida Center, who now sees Mason about every six months or so. She is one of the many pediatric specialists he sees.
Mason Campbell, 2, during one of his weekly treadmill therapy sessions. Walking on the treadmill helps Mason develop the muscle memory of walking. The harness helps support his weight, and the orthotics in his shoes help align and support his ankles and feet. Mason is pictured with physical therapy assistant Clint Stelmashuck and physical therapist Olivia Pollard, DPT, at Upstate’s Physical Medicine and Rehabilitation Center. photo by robert MescavaGe
After fetal surgery, a second operation is often required shortly after birth, notes Zulma Tovar-Spinoza, MD, Upstate’s director of pediatric neurosurgery. She operated on Mason in December 2014 to free his tethered spinal cord and remove an infected cyst. In addition, Tovar-Spinoza helped relieve a buildup of fluid in Mason’s brain, called hydrocephalus, with another surgery in February 2014. Continued on page 6
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PATIENT CARE
Mason Campell, 2, (at right) at home with his sister, Ali, 4, and his brother, Christopher, 7.
photo by susan Kahn
Toddler gets early boost Continued from page 5 “He is doing great. With all the support available, his quality of life is excellent,” Tovar-Spinoza says of Mason. At this point, she sees him about every eight months to monitor his progress. “Our local studies have shown that these patients have a fulfilling life. They go to school, college, get married, have kids like everybody else,” she continues. Dosa says Mason’s future is bright. His therapy three or four times a week at Upstate includes pool exercise and treadmill walks wearing a supportive harness. Physical therapist Jennifer Fetterman keeps close track of his progress, as she and Dosa are studying the impact of early
supported weight-bearing exercises for children with spina bifida. Jesse Campbell describes her son as a tough Nienke Dosa, MD cookie. He’s outgoing and happy, with a strong upper body. He walks with a walker, climbs and wrestles with his brother and sister. She says Ali, 4, and Christopher, 7, know to be careful of Mason’s back. Mason’s parents feel both positive and overwhelmed, and they are grateful for the medical teams that have improved their son’s Zulma Tovarchances for a full life. ● Spinoza, MD
GEM CARE EMERGENCY & URGENT CARE FOR SENIORS AGE 65+ 800.464.8668 l upstate.edu/GEM 4900 Broad Road Syracuse
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Strokes are affecting more young people
PATIENT CARE
DO YOU KNOW HOW TO REACT TO SYMPTOMS? What would you be likely to do within the first three hours of experiencing weakness, numbness, difficulty speaking or difficulty seeing? Researchers from Ronald Reagan UCLA Medical Center asked this question of more than a thousand people nationwide — and were astonished that almost three quarters of respondents under the age of 45 gave an answer that could endanger their health. Sudden weakness, numbness and difficulty speaking or seeing are symptoms of stroke. Your brain is sending signals that its blood flow is impeded — either from a burst or blocked blood vessel — and you must act quickly in order to minimize or reverse damage. That means an urgent trip to the hospital, preferably one with a comprehensive stroke center, such as Upstate University Hospital. On duty around the clock at Upstate is a medical team of experts in stroke care, including neurologists, neurosurgeons, neurointerventional radiologists, neurocritical care specialists, board-certified emergency physicians and specialized neuroscience nurses. But the team’s abilities are useless if patients don’t recognize stroke symptoms and promptly get to the hospital. The first three hours of a stroke are critical. Waiting to see whether symptoms
improve, as many survey respondents said they would do, is wrong. Neurologist Gene Latorre, MD, medical director of the stroke service at Upstate, emphasizes every minute counts. “The sooner we identify and treat acute stroke, the better the outcome.” Results of the UCLA survey are especially troubling because they reveal so many young adults are unaware of the signs and symptoms of stroke at a time when the number of strokes in people under the age of 45 has increased by as much as 53 percent since the mid-90s. Latorre says Upstate has seen an increase in patients diagnosed with stroke who are younger than 45. The increase is likely caused in part by a rise in the number of young adults with diabetes, uncontrolled high blood pressure and/or obesity, conditions that increase a person’s risk for stroke. Smoking rates also remain high among people from age 18 to 45, and smoking significantly increases a person’s risk of stroke. “If you experience sudden dysfunction in your face, arm or speech, it’s time to call 911,” says Latorre. “The sooner you get to the nearest comprehensive stroke center, the better your chance of having a good recovery.”●
Calcium in baby formula?
Thank an Upstate pediatrician
UPSTATE HISTORY
Before the 1950s, some babies who were not breast-fed developed intermittent muscular spasms known as tetany. The cow’s milk formulas they were fed contained too much naturally occurring phosphorus, relative to human milk. The high phosphorus caused a drop in calcium in the bloodstream of these infants, resulting in tetany. It was a pioneering Upstate pediatric endocrinologist, Lytt Gardner, MD, who recognized that all the babies needed were calcium gluconate supplements. He received a hat tip recently from the Pediatric Endocrine Society. “His superb study published 65 years ago led to changes in formulas and the disappearance of the problem,” the society’s newsletter says, referencing Gardner’s study published in 1950 in the journal Pediatrics. ● Pediatrician Lytt Gardner, MD, 1962
FroM upstate’s health sciences library, historical collections
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PATIENT CARE
Heart of a warrior
SHE CHERISHES EACH MOMENT AFTER SURVIVING A MEDICAL EMERGENCY BY JIM HOWE
A woman who did her best to stay fit nearly died. That experience taught her never to take her health for granted. Debra Becker of Liverpool was a runner. She practiced yoga and worked out regularly, including a heavy-duty fitness program called CrossFit. She also held demanding jobs in public relations and advertising. She began suffering from fatigue. And because of long, heavy menstrual bleeding, she underwent what was to have been a simple exploratory dilation and curettage procedure in early October 2014 at Upstate University Hospital. In the recovery room after the operation, doctors discovered her heart murmur. A cardiology team found that several of the supportive cords — which resemble the strings on a parachute — on Becker’s mitral valve had broken. The valve was not closing properly, causing blood to backflow toward her lungs and creating the murmur. Her condition — severe mitral valve regurgitation and prolapse — was “extremely unusual” after a minor procedure, especially given her demanding exercise routine, notes her gynecologist, Howard Weinstein, MD. Becker needed emergency heart surgery. If she hadn’t been in the hospital when the problem developed, she probably would have died, she recalls her heart surgeon, Gregory Fink, MD, telling her. “When her cords ruptured, she developed pulmonary edema (congestion) and heart failure. While she was able to compensate/tolerate this for the short term (perhaps one to two weeks), for the longer term, her prognosis was very poor,” Fink says. Becker’s husband, Steve, says it was “divine intervention” that kept her alive. That, and Fink, who was able to repair her valve without using an artificial valve. Later, Fink received the Surgeon of the Year Award from the Central New York Business Journal; Becker nominated him.
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Debra Becker at the Cardiac Rehabilitation program at Upstate’s Institute for Human Performance. photo by robert MescavaGe
caused by the oxygen tubes she had needed to breathe. Her cardiac rehabilitation program at Upstate’s Institute for Human Performance meant three carefully monitored sessions a week for 12 weeks. Her cardiologist, Robert Carhart Jr., MD, says her recovery is going “quite well.”
Becker spent most of October 2014 in the intensive care unit and began a long, slow recovery that involved weakness, inactivity and needing a lot of help from other people, none of which Becker was used to.
Becker writes a blog about her experience at quest4healthandwellness.com/blogs/ and organizes a team for the American Heart Association Heart Walk. Gradually she has become more active. And, she has altered the way she looks at life.
She later underwent a hernia repair and the surgical removal of wires from a pacemaker that poked through her skin. She also had surgery to fix a nasal condition
“Now I try to live in the moment and cherish every breath,” she says. “I’m trying to encourage other people to do the same thing.” ●
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PATIENT CARE
Kidney transplant numbers rise The Hinton brothers represent one of the 10 living donor kidney transplants done at Upstate University Hospital in 2015. Daniel Hinton of Syracuse was a member of the U.S. Special Forces in the Iraqi War and works construction for the city of Syracuse. He donated a kidney to Chris, a chef who lives in Minoa. They posed for a photo on Christmas Eve as they were discharged from the hospital. Upstate’s transplant program expects to perform more living donor transplants this year, says Rainer Gruessner, MD, who became transplant chief in September. Living donor kidneys are preferable to those from deceased donors because they function more quickly and usually last twice as long. Last year was a busy transplant year, with surgeons at Upstate performing 80 kidney transplants, more than any year before. “Nephrologists from across Central New York are witnessing the recent growth and consistency of the program, and they are happy for their patients to be part of this development,” Gruessner says in explaining the increase.
Daniel Hinton, left, donated his kidney to his brother, Chris. Their surgery was one of 80 kidney transplants performed at Upstate in 2015. photo by Darryl GeDDes
Hear an interview with Gruessner about kidney transplants at healthlinkonair.org by searching “kidney.”
Over the past 10 years, 40 percent of kidney transplant recipients were residents of Onondaga County. Thirty-three percent came from Jefferson, Oswego and Oneida counties, and 27 percent came from other counties in Central New York.
Are you at risk for kidney disease? People with diabetes, high blood pressure or a family history of kidney disease are at risk for developing kidney disease.
3. You may want to bring a family member or friend to help you keep track of what is said, along with a notepad.
If you’re at risk, ask your primary care doctor to screen you, advises Sriram Narsipur, MD, who leads the division of nephrology at Upstate. A simple urine test can reveal abnormal levels of protein, which may signal kidney disease even before a blood test, which measures the concentration of waste products in the blood.
4. Write down a list of questions, which might include:
Your doctor may refer you to a nephrologist, who specializes in kidney problems, if your screening is abnormal. Here’s how to prepare for that appointment: 1. Call ahead and ask if you need to alter your diet or have any lab testing done in advance, and whether you need to retrieve medical records from your primary care doctor. 2. Bring a list of your medications and dosages, including vitamins and supplements, a list of any symptoms and key aspects of your medical history.
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What could be causing my symptoms?
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Which tests do I need?
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What is my kidney function, and is it getting worse?
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Are my kidney problems made worse by other health conditions?
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Is my blood pressure a concern?
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Do I need to make any changes to my diet?
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Are there any over-the-counter medications I should avoid? How active should I be in terms of exercise?
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PATIENT CARE
Surgery — pause — more surgery A N E W WAY T O T R E AT A B D O M I N A L T R A U M A
BY AMBER SMITH
In the past, patients who arrived at Upstate University Hospital and other trauma centers with major abdominal trauma would go straight to the operating room, where surgeons would work for hours to repair their injuries. Already weak from blood loss and impaired organ function, such patients were not in good condition to withstand extensive surgery.
him against another piece of equipment at Rome Strip Steel, where he worked as an anneal operator. Corigliano does not remember much about the accident, which left him with a fractured pelvis and ribs, severed iliac artery and urethra, ruptured prostate, torn colon, shredded abdominal muscles and compressed nerves in his elbow. Doctors at Upstate University Hospital kept him in a coma for almost two weeks, during which time he underwent four surgeries and recovered in the intensive care unit. As his condition improved, Corigliano began rehabilitative therapy at Upstate. He was discharged six or seven weeks after the accident.
Now the strategy has changed. Trauma surgeons still work swiftly to control internal bleeding and repair life-threatening tears in organs and tissues — but then they pause and send patients to the intensive care unit to be warmed, resuscitated and stabilized. The surgical opening remains open, covered by a special dressing that looks like plastic wrap.
The damage control strategy often results in the creation of a temporary hernia, which is later repaired. Hernias develop when part of an organ protrudes from the wall of the cavity where it is contained. This may happen naturally, as a result of a previous operation or through trauma caused by car wrecks or violence.
Hours or days later, patients undergo more thorough operations to repair smaller tears and traumatic damage. This may happen multiple times before the surgical opening is finally closed.
Regardless of its cause, Hassan says, “the ultimate repair for the hernia is to be able to bring the patient’s muscles back together again, to give the patient the ability to function and move around and also to reinforce the repair, usually from the undersurface, with a mesh or other strong material.”
The technique is called “damage control surgery.” Moustafa Hassan, MD, director of acute care surgery at Upstate, says it has become the standard of care among trauma surgeons who believe patients fare better with a staged approach than extensive procedures on unstable patients.
For some patients, this may be best accomplished in stages — something he says is best decided by an experienced trauma surgeon. ●
The staged approach helped save the life of Peter Corigliano, 60, who was crushed in July 2012 when a 2½-ton magnet pinned Moustafa Hassan, MD
Call 315-464-1800 to reach Upstate’s Acute Care Surgery Clinic. Hear an interview with Hassan at healthlinkonair.org by searching “hernia.”
Precision improvements make radiation therapy safer In essence, radiation therapy works by forming electrically charged particles called ions and depositing energy into the cells or tissues it passes through. That energy can kill the cells outright or prompt genetic changes that cause cancer cell death. Cancer patients 100 years ago received radiation to prevent the cancer from recurring in the spot where it originated, but they often had to deal with severe side effects from the extensive damage radiation did to healthy tissue. Today, improved techniques allow for more precise radiation, which spares healthy tissue from radiation damage and makes the therapy much safer. “We have been able to show that radiation can actually improve the overall
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outcome and improve patient survival,” says Upstate radiation oncologist Anna Shapiro, MD. She explains that radiation treatments are customized to patients based on the extent of their disease, whether and what type of Anna Shapiro, MD surgery they’ve had, even the distance they must travel for treatment. And, imaging is available before every treatment, so doctors are more confident in exactly where radiation is delivered. With more options, and greater precision, Shapiro says, “the benefits of radiation therapy are much more apparent because the side effects have become much less.” ●
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FROM OUR EXPERTS
Taking aim at germs NEW UV MACHINE IS PART OF INFECTION-FIGHTING EFFORT Staff who clean patient rooms at Upstate University Hospital have a new method of preventing hospitalacquired infections: three towers that emit short-wavelength ultraviolet light that kills or inactivates microorganisms. The new Surfacide system is employed, after routine cleaning and disinfection, in rooms that housed patients with contagious infections such as Clostridium difficile, an intestinal infection that can be life-threatening. In the future, the system may be used to clean operating rooms, public bathrooms and elevator cars. Studies have shown that implementing UV cleaning reduces infection rates and improves patient safety, says Paul Suits, director of infection control at Upstate University Hospital. He says the environmental cleaning staff are “essential to the hospital’s goal to provide a clean, safe environment for our patients.” With the three towers working together, one room can be cleaned in about 20 minutes, says Jason Rupert, assistant director of outpatient operations and materials for environmental services. After an unoccupied room is disinfected, a staffer will wheel in the UV towers and position them so their light will reach the maximum amount of surfaces. Curtains are drawn, doors are shut, and the staffer activates the units from outside the room. The rotating towers bathe the room in UV-C light. This process provides an additional level of disinfection beyond traditional cleaning methods. ●
Tavontae Cannon, a member of Upstate’s housekeeping staff, inspects the new ultraviolet cleaning towers at Upstate University Hospital. photo by robert MescavaGe
DID YOU HEAR? Upstate University Hospital was recently praised by the state Health Department for reducing central-line infections in intensive care units. Central lines are the tubes inserted into a vein to give medicines or fluids or to draw blood. They can also be an entry point for infections. Upstate reduced those infections by 70 percent in 2014, the state noted in a January report on hospital-acquired infections in New York. The hospital was singled out for “outstanding work” and its multifaceted approach in fighting infections, which stemmed from a task force established three years ago.
CANCER CARE FOR KIDS & TEE ENS If your child faces a diagnosis of cancerr, turn to the experts at Upstate for personalized care and treatment options. We off ffer er access to clinical research studie es, exceptional technology and support services at the Upstate Golisano Children's H Hospital and outpatient treatment at the Upstate Cancer Center. Our multidisciplin nary teams of oncology-certified nurses and board-certified physicians are here for you.
MORE INFORMA ATION CALL 855.964.HOPE OR VISIT UPSTATE.EDU/CANCER CARING FOR PA PATIENTS. SEARCHING HING FOR CURES. SAVING LIVES.
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FROM OUR EXPERTS
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Actor Will Smith portrays Bennet Omalu, MD, in the movie “Concussion.”
‘Concussion’ conversation MOVIE SPOTLIGHTS CHRONIC TRAUMATIC ENCEPHALOPATHY
BY AMBER SMITH
Experts from Upstate who saw the Will Smith film “Concussion” praised its accuracy, from the behavior of the characters to the under-the-microscope images of brain tissue. Smith portrays Bennet Omalu, MD, who finds himself at dangerous odds with the NFL when he investigates brain damage called chronic traumatic encephalopathy, or CTE, in professional football players, including Pittsburgh Steelers center Mike Webster. Robert Corona, DO, chair of pathology and director of neuropathology at Upstate Medical University, was impressed with Omalu’s courage to follow the neuropathological science and stick with an inconvenient truth. He says the movie “took me by surprise that it was so emotional. I never would have anticipated it could have moved me so much.” The movie tells the story surrounding research Omalu published in July 2005 in the journal Neurosurgery when he was working in the department of pathology at the University of Pittsburgh. His paper is titled “Chronic Traumatic Encephalopathy in a National Football League Player.” Since the movie was released, CTE has been in the news. Former New York Giants safety Tyler Sash, who died from an accidental overdose of pain medication in September at the age of 27, was found to have advanced CTE in January. Ann McKee, MD, told The New York Times that the
Upstate researchers look at broken jaw’s connection to concussion, page 14.
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severity of the CTE in Sash’s brain was about the same as the level found in the brain of the former NFL star Junior Seau, who committed suicide in 2012 at age 43. McKee, chief of neuropathology at the Veterans Affairs Boston Healthcare System and a professor of neurology and pathology at the Boston University School of Medicine, did the examination of Sash’s brain. McKee also examined the brain of former Oakland Raiders quarterback Ken “the Snake” Stabler, who died of colon cancer in July at the age of 69. Stabler was elected to the Pro Football Hall of Fame in February, days after it was announced that his brain contained widespread lesions that “were quite severe, affecting many regions of the brain,” McKee told The New York Times.
A scientific mystery
CTE is not a new diagnosis. Almost a century ago, articles in medical journals described similar symptoms in old boxers, labeling the condition “punch drunk syndrome.” Later research has found the phenomenon in war veterans, as well. Mainstream media picked up on the significance of CTE after The New York Times article in January 2007 about the suicide of defensive back Andre Waters. Omalu told the newspaper that brain trauma “is the significant contributory factor” to Waters’ brain damage, “no matter how you look at it, distort it, bend it. It’s the significant forensic factor.” On autopsy, brains affected by CTE have a loss of nerve cells, called neurons, and an accumulation of the protein tau, which is a hallmark of Alzheimer’s disease. However,
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FROM OUR EXPERTS
Lawrence Chin, MD, is a neurosurgeon, who diagnoses and surgically treats disorders of the central and peripheral nervous systems.
Robert Corona, DO, is a neuroBrian Rieger, PhD, is a psychologist pathologist, the specialty that studies devoted to concussion management tissue of the nervous system. and rehabilitation.
there is a distinct pattern of the tau deposits seen with CTE. Scientists don’t know how early the damage begins, and they don’t know what makes a brain vulnerable. Without a way to detect CTE in living people, its prevalence remains unknown. Earlier this year, Omalu told ABC News that former Buffalo Bills running back O.J. Simpson more likely than not suffers from CTE. He says Simpson exhibits telltale behavioral symptoms of CTE, which include explosive, impulsive behavior, impaired judgment, criminality and mood disorders. Simpson is serving time for an armed robbery that occurred 13 years after he was acquitted of the 1994 murders of his wife and her friend. Omalu points out that Simpson’s brain was exposed to blunt force trauma thousands of times on football fields during his college and professional career. Still, experts cannot agree on how much of a risk football presents.
Claudine Ward, MD, is a physical medicine and rehabilitation doctor who focuses on recovery from neurological illnesses and injuries.
Chin says the movie does a good job of illustrating the symptoms of CTE, including depression and anger. “It’s dramatized, of course, but the decline of these patients, it’s very sudden and precipitous.” Claudine Ward, MD, an assistant professor of physical medicine and rehabilitation, appreciates that the filmmakers showed how Omalu’s stance changed over time. Initially emphatic that no one should play football, with the influence of his wife, Omalu softened, now expressing the opinion that players should be made aware of the potential hazard. ●
Concussion
What it is: mild traumatic brain injury caused by a blow or jolt to the head that jostles the brain, regardless of a loss of consciousness What it does: disrupts the brain’s functioning, creating neurochemical changes and microscopic structural injury
Is football safe?
Symptoms: headache, dizziness, nausea and blurred vision, with confusion or trouble concentrating and emotional changes
Parents who see “Concussion” may wonder if there is a safe way to play the game.
Diagnosis: based on patient’s history; blood tests and imaging scans are not useful unless more extensive injury is suspected
“The risk is not the same for everyone,” says Brian Rieger, PhD, director of the Upstate Concussion Center, “because there are people who have whole careers in football and who don’t have serious problems like this. The problem is that we don’t yet have a way to identify who is more or less at risk.”
Treatment: physical and mental rest is usually all that is needed, with most people recovering within a week or two; in cases of prolonged recovery, referral to a specialized clinic is recommended.
The high school athletes with the highest rate of concussion are football players and female soccer players – but the reasons are not fully understood. Further, the relationship between concussion and CTE is not clear. “One of the points in the movie that is subtle is that we don’t really know what it is that causes CTE,” says Lawrence Chin, MD, the chair of neurosurgery at Upstate. “In fact, a lot of people think that it’s not necessarily concussions but what they call subconcussive blows or the bumping of heads on a repeated basis, but not enough to cause concussion.” He and Corona, the pathologist, published a paper together about CTE in April 2013 in the journal Neurological Research. They made the point that a method is needed to assess CTE in patients prior to death.
CTE, or chronic traumatic encephalopathy
What it is: neurodegenerative brain disease that has been seen in football players and boxers with a history of repeated blows to the head, which may include concussions What it does: depletes brain tissue and leads to accumulation of an abnormal protein called tau Symptoms: early in the disease process, symptoms can be similar to those of concussion, but as the disease progresses, a decline in mental activity and ability to interact with others, depression, anger, memory loss and impaired judgment occur. Tremors can develop in severe cases. Diagnosis: after death, during autopsy of brain tissue Treatment: symptoms such as depression or anxiety can be treated, but no cure exists for CTE SOURCES: UPSTATE CONCUSSION CENTER AND BOSTON UNIVERSITY CTE CENTER
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FROM OUR EXPERTS
LESSONS FROM UPSTATE
Broken jaw may indicate concussion Concussions caused by sports injuries and active-duty military combat have garnered lots of publicity lately. Specialists at Upstate are now calling attention to a concussion that can result from a forceful punch to the jaw. Patients with isolated mandible fractures should be screened for concussion and referred to a concussion clinic, say the authors of a paper published in October in Facial Plastic Surgery, a publication of the Journal of the American Medical Association. Seventy-five percent of patients with mandibular fractures were found to have concussions during a yearlong study at Upstate University Hospital, according to research by otolaryngologists Robert Kellman, MD, and Robert Kopp, MD, nurse practitioner Ronald Walsh and Lindsay Sobin, MD, an Upstate otolaryngology resident who is doing a fellowship at Boston Children’s Hospital. Their research included 16 patients between June 2013 and June 2014 with a median age of 27½ years old. Fourteen were male. Twelve were injured in assaults. Twelve broke their jaws in two places. Eleven reported losing consciousness.
Although half of the patients admitted drinking alcohol, the authors found no relationship between the rates of concussion and the use of alcohol. Significant force is required to break a human jaw, which is designed to protect the brain. “The horseshoe shape of the mandible and its relationship with the skull base allows it to absorb rather than transmit forces to the middle cranial vault, which often leads to fractures in two locations, providing a degree of protection to the brain,” the authors write, pointing out that highvelocity impact can overcome such evolutionary advantage. Also, they note, with increasing force, the likelihood of intracranial and cervical spine injury increases. The otolaryngologists urge medical colleagues to be alert for concussions in patients with jaw fractures. “Given the high rates of potential concussion seen in our study, and the low rates previously reported, we recommend an awareness of concussive symptoms and a high index of suspicion for mild traumatic brain injury,” they conclude. Reach Upstate’s Department of Otolaryngology at 315-464-4636. Contact Upstate’s Concussion Management Program at 315-464-8986. ●
How to train doctors who will care for the underserved An analysis of the mission statements for every American medical school reveals a recipe for producing doctors who will provide primary care to communities in need. Many students begin medical school idealistically, with a desire to become primary care doctors who care for patients from underserved populations. Some then change their minds during medical school. “We know from our own studies and those of others that idealism appears to trail off as medical students become more worried about debt, lifestyle, the prestige of their career path and specialty,” says Chris Morley, PhD, interim chair of public health and preventive medicine at Upstate, vice chair for research in family medicine and lead author of the study Kenneth Slack, aabout studentmission statements published last year athlete Le Moyne College’s in the on journal Family Medicine. soccer team, is part of a
For hisgroup research, control for the Morley study. assembled a panel of about three dozen medical school leaders, administrators, professors, researchers and students who read and rated the public mission statement of each medical school in the U.S. Then the research team looked at the percent of graduates from each medical school who go on to specialize in primary care, in designated health professional shortage areas, or with medically underserved populations. They found that schools that specify something about caring for the underserved in their reason for existence are the ones that produce the most doctors who go into primary care or practice in underserved communities.
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WHAT IS PRIMARY CARE? Primary care is comprehensive first contact and continuing medical care, as provided by physicians such as pediatricians, obstetricians and family and internal medicine specialists. Nurse practitioners and physician assistants may also provide primary care.
Morley says medical schools are not producing enough primary care doctors to replace those who are retiring, because so many new doctors — for a variety of reasons — choose specialties other than family or internal medicine, obstetrics and pediatrics. What can be done? “Medical schools as institutions can be introspective and think about their culture and the messages they give to students,” Morley says. At Upstate, in addition to being the public teaching hospital for 17 counties, a number of programs are designed to attract students who will be devoted to providing primary care in underserved areas. One focuses on rural medicine, and another combines a master’s of public health with a medical degree. Upstate offers distance learning for practitioners who care for underserved populations, and the regional branch campus in Binghamton focuses mostly on primary care. Upstate also offers training for physician assistants and nurse practitioners, health professions that have a strong focus on primary care. ●
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FROM OUR EXPERTS
Restoring peace WHY SALVAGING THE ADRENAL GLAND MAKES SENSE BY AMBER SMITH
On top of each kidney sits an adrenal gland, which produces hormones a person cannot live without. A variety of different tumors can develop in an adrenal gland. The tumor’s location, size and function influences how it should be treated. When a tumor needs to be removed, many doctors recommend taking out the entire adrenal gland. Not so fast, says Gennady Bratslavsky, MD, who leads the department of urology at Upstate. Removal of the adrenal gland — called an adrenalectomy — is not always the best option. If one gland is removed, and then problems develop in the other, patients are subject to a lifelong reliance on hormone medications. Bratslavsky says removing just a portion of the gland containing the tumor is a valid option for patients with a type of hereditary tumor called pheochromocytoma, since the likelihood of developing tumors in the other gland is high with this condition. In a partial adrenalectomy, the healthy portion of the gland is left behind to continue functioning. A study he co-authored for the American Urological Association’s Urology Practice journal in November found that 80 percent of patients with hereditary pheochromocytoma developed tumors in both adrenal glands. That’s the same month that Upstate hosted an international conference on the condition. Erica Searles of Pompey stumbled upon that conference. With a recent diagnosis of pheochromocytoma, and a surgeon in Rochester prepared to remove one of her adrenal glands, she was doing some online research. She’s glad she learned of Bratslavsky’s less invasive option. Searles had struggled for a year with symptoms including severe headaches, heart palpitations, back pain, excessive sweating, anxiety, depression and a feeling of doom. She ended up hospitalized at the age of 44 with heart failure, triggered by the excess adrenalin in her system, before doctors discovered a tumor in an adrenal gland. It was located in the center of the gland, presenting a surgical challenge because it was just behind the large vein carrying blood into the heart. Bratslavsky operated in a minimally invasive manner using robotic assistance, and Searles went home from the hospital within 48 hours. Imaging scans now show a healthy-looking gland, with no hint of the tumor “that used to exist within. Bratslavsky says Searles is able to live a normal life. She says she feels fabulous. She sleeps through the night, and she hasn’t had a headache since her surgery in September. It has been life changing. “I just feel at peace,” she say, “and I have my life back.” ●
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Gennady Bratslavsky, MD
WHAT’S SO BAD ABOUT A BENIGN TUMOR? Most tumors arising in an adrenal gland are not cancerous, but they still cause problems for the patient. “Benign does not mean harmless,” says Gennady Bratslavsky, MD, chairman of the department of urology at Upstate. “Being benign means that the tumor has not spread, yet. These tumors can still be very active hormonally, meaning that they will produce lots of substances that can very negatively affect somebody’s blood pressure, heart function, salt balance, sugar balance, weight, bone density and vision.”
Hear an interview about partial adrenalectomies at healthlinkonair.org
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FROM OUR EXPERTS
UPSTATE ANSWERS
What is so enticing about heroin?
Why do people start using? People enter into their use of heroin in a variety of ways. The classic progression of using stronger and stronger drugs of abuse, resulting in heroin use still exists. However, she says, “Many current users started through the use of prescribed pharmaceutical opioids for pain, or through experimentation with the use of a family member’s prescription.”
A container of naloxone, also known as Narcan, is shown for scale next to a tube of lipstick. associateD press
O
pioid analgesics such as heroin relieve pain by altering your perception of pain signals from your body.
They are “enticing” because they are also able to stimulate an area in your brain associated with reward, which leads the user to want more of the drug to gain those desirable effects again and again, says Christine Stork, an associate professor of emergency medicine and a doctor of pharmacy in the Upstate New York Poison Center.
She says the draw can be very strong, even with non-heroin opioids, which can lead the patient into addiction. With prolonged use, the sites where the opioid works become adapted, and then it requires more of the drug to get the desired effects.
How does the sensation feel?
Users of heroin describe treatment of their pain, relaxation and a sensation of being “high.” Heroin is snorted or injected most of the time, although its vapor can be smoked. People with chronic pain who use heroin can experience what is called hyperalgesia, where they feel as though they are in greater pain, Stork says.
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The current trend of prescribing fewer opioids for longstanding pain, where it has a marginal role, has decreased access to prescription opioids. Our society lacks a good way of helping those patients with chronic pain who no longer get their prescription opioids, and some of them turn to heroin, which costs much less than the prescriptions did. Now, with heroin abuse so widespread, we have a national epidemic, she says. In Onondaga County, deaths from heroin overdoses climbed nearly 31 percent in 2015, prompting Health Commissioner Indu Gupta, MD, to call the situation a public health crisis. Thirty-four heroin deaths were reported in 2015, up from 26 in 2014. Most of the deaths were of white men in their 20s.
What causes death?
Heroin and all opioids decrease central nervous system activity. This results in a decreased level of consciousness and eventually decreases the activity of the breathing center. Patients usually die because they stop breathing or breathe too little to allow for enough oxygen in the brain.
Will naloxone help?
Naloxone acts as a specific antidote for opioids. A patient who is not breathing will not stay alive for long. Overthe-counter naloxone has the potential to be administered when the patient is first found to be not breathing adequately, and in these cases it can be lifesaving. It is important to note that naloxone does not treat addiction nor does it last a long time, Stork says, adding that all patients treated at home with naloxone should have an emergency evaluation. ●
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IN OUR COMMUNITY
Better air = better brains
STUDY SHOWS COGNITIVE FUNCTION IMPROVES WHEN INDOOR VENTILATION IMPROVES Reducing carbon dioxide and other pollutants in the air can have a profound impact on decision making, according to a research team from Upstate Medical, Harvard and Syracuse universities. The team’s study shows that people working in “green” offices, with good ventilation and below-average levels of carbon dioxide and indoor air pollution, had significantly better cognitive functioning than when working in conventional offices. They say their results can apply to indoor environments including schools and homes. Over six full workdays, 24 volunteers were exposed to different indoor environmental quality conditions and then given cognitive assessments that tested nine key cognitive domains that are important for productive functioning in the real world. They were presented with real-world challenges and allowed to strategize and take initiatives in their own unique styles using the Strategic Management Simulation, says Usha Satish, PhD, a professor of psychiatry and behavioral sciences at Upstate who is an expert in this form of evaluation and one of the research team investigators. She says the simulation tool is well established and valuable because “it gives participants the freedom to make decisions based on their own cognitive styles and is reflective of their performance in the real world.” The cognitive scores of the volunteers were an average 61 percent higher on the days spent in the green buildings. Their scores doubled when they spent the day in an “enhanced green environment,” with improved ventilation and an optimized indoor environment. Satish points out that the assessments did not measure intelligence levels, instead focusing on real decision making as it relates to productivity. John Mandyck, chief sustainability officer for United Technologies, which supported the research, says. “We know green buildings conserve natural resources, minimize environmental impacts and improve the indoor environment, but these results show they can also become important human resource tools for all indoor environments where cognitive abilities are critical to productivity, learning and safety.” The study was published in October in the journal of Environmental Health Perspectives. It generated news coverage from newspapers and websites worldwide.
upstate students benefit from nationally recognized professors, excellent job placement and suny tuition. open houses are held each fall and spring. DEGREE PROGRAMS Biomedical Sciences (MS, PhD) Cardiovascular Perfusion (BS) Medical Biotechnology (BS) Medical Imaging (BS, BPS) Medical Technology (BS, MS) Medicine (MD, MD/PhD, MD/MPH) Nursing (BS, MS, DNP, post-master’s certificate) Public Health (MPH) Physician Assistant (MS) Physical Therapy (DPT) Radiation Therapy (BS, BPS) Respiratory Therapy (BS)
Education • Healthcare • Research
www.upstate.edu/students
To learn more about the study, visit thecogfxstudy.naturalleader.com. ●
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IN OUR COMMUNITY
Why I served my country
Upstate veterans and friends at the Central New York Veterans Day Parade, 2012.
photo by susan Keeter
VETERANS TELL HOW MILITARY EXPERIENCE OPENED DOORS, BROADENED OUTLOOKS, TAUGHT VALUABLE SKILLS BY JIM HOWE
For some it was a way to afford college or gain entry into the working world. For others, it was duty. Military service changes the lives of many Americans, including several who now work in a variety of jobs at Upstate. They are influenced by lessons and skills learned in the Army, Navy, Air Force, Coast Guard or Marine Corps. Don Sadeckas was a military police officer in the Army who retired as a sergeant first class in 2001. He still feels pride when he sees a military member in uniform, knowing that they are up to whatever comes at them. “I am proud to be a veteran, and I am also proud of those who served before and after me. I thank them every opportunity I get,” he says. When Yetta Williams enlisted in the Air Force, she at first didn’t recognize the significance of her role. It began sinking in when she arrived at Lackland Air Force Base in Texas. “We were told that we were now ambassadors for the president of the United States, and that we should be aware of that at all times and conduct ourselves accordingly,” she recalls. “It occurred to me that I didn’t just represent myself. I represented my family, my church, Christ, the company I work for. I have never forgotten that.” Williams married an airman named Austin, who now works at National Grid. Of no relation is an Upstate coworker, Elliott Williams, who says men from his family have served in every war or conflict in America’s history from the Civil War to Iraq. “Being a veteran is more than just a label or a title. It is who and what you are,” he says. “Though I am far removed from military service, I am still a soldier and always will be — just like those relatives who came before me and those who will come after me.” Among the more than 9,000 employees at Upstate Medical University are 251 military veterans. Here’s what eight have to say about their experiences serving America.
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Name: Elliott Williams of Auburn.
Upstate job: Patient registration in the emergency department. Military service: Army, 1980-83.
Reason for joining: Family obligation. “My family has produced soldiers and sailors in every war or conflict in this country’s history from the Civil War to the present-day Iraq conflict. All males in my family are expected to participate in some type of military service.”
What he gained: “Being from Brooklyn, I had already been exposed to different cultures, but going to different countries (at age 18, he was stationed in Camp Stanley, South Korea) and seeing those cultures in their native lands and living by their own traditions, I quickly learned I was wrong about thinking one group of people was fundamentally better than another group of people because of money or educational status or color or whatever. I learned that there is no better or worse when it comes to people, there is only different: different lands, norms, beliefs, languages, etc.”
Name: Gregory L. Eastwood, MD, of Jamesville.
Upstate job: Professor of bioethics and humanities and former president of Upstate Medical University. Military service: Navy, 1972-74.
Reason for joining: “During the Vietnam War, military service was required of male physicians either after one year of residency or after full training. I entered the Navy after full training in internal medicine and gastroenterology.” What he gained: “My two years in the Navy allowed me to improve my clinical skills. Also, I was able to spend about half my time doing research, and I developed close personal and professional associations with several people, which persisted for many years after I left the Navy.”
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IN OUR COMMUNITY
Name: Don Sadeckas of Cicero.
Upstate job: Director of equipment and supply logistics. Military service: Army, 1980-2001.
Reason for joining: “It was a great opportunity to travel, meet great people, and do things that I never imagined or thought I would do. I was fortunate to serve during a time when there were not many conflicts in the world and only a small portion of the military needed to deploy.”
What he gained: “Three lessons I took with me: 1. Appearance matters. Dress for who you will meet, not for the day of the week. 2. You can’t do everything on your own. Most successes come from teamwork. 3. Confidence is king. Don’t second-guess yourself.”
Name: William Marx, DO, of Jamesville.
Upstate job: Chief of the division of trauma, critical care, burns and acute-care surgery. Military service: Army, 1978-2001.
Reason for joining: “I had a Health Professions Scholarship to pay for medical school.”
What he gained: “I learned structure, leadership skills and surgery. My residency was at Letterman Army Medical Center on the Presidio of San Francisco. We had a very close relationship with the University of California at San Francisco, so I was able to learn from the surgical faculty at UCSF and from the faculty at Letterman. The residency was excellent, and I am fortunate to have had the opportunity. “I think my service affects all aspects of my career and life. I appreciate the things most people take for granted. To use a cliché, freedom isn’t free.”
Name: Willie White of Jamesville.
Upstate job: Central receiving manager. Military service: U.S. Army, 1977-98.
Reason for joining: “I was ill-equipped to attend college. I was still in high school and decided in advance that I was going to join the Army to get experience in something that would become a career.”
What he gained: “Leadership qualities. Being a team player. Diversity. Multitasking. Opportunities that I never would have had if I remained in my small world and surroundings, opportunities to travel and experience different cultures,
countries and even other states; to learn skills and earn a living through my experiences and travels; and just being a part of something bigger while serving my country.”
Name: Yetta Williams of Syracuse.
Upstate job: Staff assistant in environmental services. Military service: Air Force, 1974-78; Army wife, 1980-1983.
Reason for joining: “I couldn't get the kind of job I wanted because I had no experience, and I couldn’t get any experience because no one would hire me without experience.”
What she gained: “I learned to be flexible and adapt to change. Life is full of changes on and off the job. I learned to change direction and to take a stand, as necessary. When told to do a task that I really don’t want to do, military service taught me to grit my teeth and do it without complaint.”
Name: Nancy K. Markowski of Erieville. Upstate job: Nursing station clerk in the medical intensive care unit. Military service: Army, 1979-81.
What she gained: “Discipline, strength, training — and how much I love this country.”
Name: Timothy P. Endy, MD, of Manlius.
Upstate job: Chief of infectious disease division. Military service: Army, 1982-2006.
Reason for joining: “Medical education, and to serve my country.” He grew up on Air Force bases around the world, watching B-52 bombers taking off from Plattsburgh during the Cuban Missile Crisis, and watching medical evacuation planes landing in Japan near the end of the Vietnam War.
What he gained: “As an active-duty medical officer, I helped soldiers prepare for both Gulf wars and vaccinated soldiers as they pre-deployed in Kuwait for Gulf II. I remember the strength of the wounded soldiers with terrible wounds and amputations as I took care of them and their infections at Walter Reed (Army Medical Center in Washington, D.C.) I’m proud to have served with such great Americans.”●
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IN OUR LEISURE
Grateful patient and orthopedic surgeon ride Erie Canal, side by side Are you grateful too?
Do you have a personal understanding of how extraordinary care has impacted your health and quality of life or that of a loved one? Go to www.Upstate Foundation.org and click on Upstate Grateful Patients & Families and tell us your story. Richard Tallarico, MD, joins Patricia Martin, his former surgery patient, before the 68-mile ride begins.
Several years ago, at age 68, Patricia Martin organized the Erie Canal Ride and challenged her doctor, orthopedic surgeon Richard Tallarico, MD, to ride the two-day, 68-mile ride alongside her. They rode those miles and, over five years, raised more than $50,000 for Upstate University Hospital. Martin was a health care provider who loved what she did, but a back injury left her nearly unable to walk. In constant pain, she slept in a recliner chair and was told that without surgery, she would need to use a wheelchair. Finding her orthopedic surgeon at Upstate was “a blessing” Martin explains. Today, she says, after many years of pain, she is pain free. The experience affected Martin, a licensed practical nurse, so profoundly that she wrote a book about her journey and dedicated it to Tallarico, her surgeon and friend.
her life so dramatically, she never dreamed she would be able to ride a bike for a total of 374 miles. Grateful that she could return to her active life, she wanted to give back in a meaningful way, and the Ride was born. Many friends and family have joined them, and the money raised supports pediatric and adult patient services through funds established at the Upstate Foundation. Last September, Martin decided to get back out on the trail and complete a one-day, 34-mile ride. Again, Tallarico joined her, and they rode side by side. The 2015 Erie Canal Ride raised $4,625 to support services for children with developmental disabilities at Upstate’s Center for Development, Behavior and Genetics, and for recreation therapy in the Physical Medicine and Rehabilitation department, where Martin volunteers. “Volunteering is rewarding,” she says, “and sometimes I share my story with patients on the unit and I think it gives them hope.”●
She says her back injury was so debilitating and impacted
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IN OUR LEISURE
A sculptor shares her life history BY JOEL POTASH, MD
On the back wall of Upstate University Hospital’s lobby is a bronze plaque memorializing the Syracuse Dispensary. It was created in 1964 by the artist Dorothy Riester. As she neared her 99th birthday last fall, Riester published an enlightening and enjoyable book of her life called “The Art of a Life, a Memoir, by Dorothy Riester as told to Victoria Kennedy.” Reading it called to my mind two things: a sign on the Onondaga Nation that says “Respect The Elders” and a lesson in communication skills taught to medical students called a “life history.” The value of a life history comes both from the listener paying close attention to the uniqueness of a person’s life story and the therapeutic exercise of the teller/writer letting herself be known. Riester was born in Pittsburgh on Thanksgiving in 1916. She was the product of a happy marriage and had a sister named Bet. Her father instilled in her a love of nature, taking her on long rambles and encouraging her sense of freedom: “I was adventurous and impulsive all my life,” she writes. Her mother may be responsible for her love of flowers and floral design. Riester began art lessons at age 12, “as a physical way to feel experience.” Before attending Carnegie Institute of Technology (now known as Carnegie Mellon University), she went to the College of William and Mary. She remembers hearing novelist Gertrude Stein say, “When you know what you want to do, just do it.” She studied ceramics at the University of Pittsburgh and was apprenticed to a wood-carver, but mostly Riester developed her own talents. She met the man who would become her husband in the detention room in high school in the 10th grade, and her book relates their wonderful love story. Bob Riester was an inventor, a silent type, pipe in hand or mouth at all times — and supportive of her art. They married in 1939. While at Carnegie, where she later taught design and art, Riester and her husband bought an old farmhouse/barn with no heat, light or water. They restored the structure and built an art studio. At that time sculpture was primarily the reproduction of the human form in clay or bronze. Riester introduced the use of steel and abstract art, requiring heavy machinery and welding, to Carnegie. When the Riesters moved to Syracuse, where she received a master’s degree and taught art at Syracuse University, they bought a house on Townsend Street and restored it as a home and studio. Later they designed and built, with some help, their home on Stone Quarry Road in Cazenovia. It
Dorothy Riester speaks at the 45th anniversary of the opening of Upstate University Hospital as hospital CEO John McCabe, MD, listens. In the background is her bronze commemorative plaque, which was reinstalled in the hospital lobby in 2010. photo by WilliaM Mueller, nov. 23, 2010
Riester’s book is $25 plus shipping at stonequarryhillartpark.org or by mail at PO Box 251, Cazenovia NY 13035. Proceeds go to the Stone Quarry Hill Art Park.
The
ART of a Life
DOROTHY RIESTER
A Me M em moiirr mo AS TOLD TO VICTORIA KENNEDY
began as a summer home, in 1958. They expanded it and moved there year-round in 1965. In 1991 they incorporated the 104-acre Stone Quarry Hill Art Park as a not-for-profit, “a place where artist and nature could interact,” and where Riester was truly an artist in residence. Twenty years later, National Geographic listed the Art Park No. 2 among sculpture parks and trails in “Secret Journeys of a Lifetime, 500 of the World’s Best Hidden Travel Gems.” The home and studio were placed on the National Register of Historic Places in 2014. For those of us getting up in years and for younger people with visions and hopes for a future long life, this book is an inspiration. It includes many photos of Riester throughout her life as well as photos of her art and sculptures. ● Joel Potash, MD, is an emeritus professor at Upstate’s Center for Bioethics and Humanities and a member of the Board of Directors of Stone Quarry Hill Art Park.
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IN OUR LEISURE
Clean cooking
MOTHER-DAUGHTER TEAM TURNS LOVE OF HEALTHY FOOD INTO BLOG BY JIM HOWE
A lifelong interest in fresh, healthy food and a love of cooking together inspired an Upstate physical therapist and her mother to launch a food blog in their spare time. Jillian Cardinali, DPT, of Liverpool, grew up on a farm in Fredonia, south of Buffalo, where her mother, Michelle Johnson, still lives. Together, they started The Clean Cooks blog — at thecleancooks.com — in 2014. “Clean” means not processed. Their recipes avoid white sugars and highly processed grains. “We’ve always loved to cook, and then when I moved away, I missed cooking with my mom,” Cardinali explains. “We still call each other to share recipes. The blog evolved from there.” Much of the blog is devoted to advance preparation. “Because we both work full time, meal prep is a huge part of our blog,” says Cardinali. “A lot of people say, ‘I want to eat healthy, but I don’t have time.’ If you prepare ahead of time what you want, what your diet is going to be, then you have more control.” For someone just starting out with meal prep, Cardinali suggests preparing a week’s worth of snacks, and then building up to the larger meals. She spends part of each weekend making a list for the week of the foods she plans to eat for breakfasts, lunches and dinners. Typically she cranks a Taylor Swift album while cooking. Cardinali is known for her mason jar salads, wide-mouthed jars containing all the makings of a green salad.
Jillian Cardinali in her kitchen with protein pancakes. photo by susan Kahn
“If you build your salad with your heaviest ingredients on the bottom and your light greens on top, I have successfully eaten salads that are made eight days prior. No one believes me until they do it.” Meats, cheeses or croutons can be kept atop the salad in a zip-lock bag or small recycled fruit cup. Cardinali and Johnson aim to post one new recipe each week. Most are original, although they choose some recipes from elsewhere and “clean” them to eliminate sugar or gluten. ●
Protein pancakes with blueberry sauce FROM THE CLEAN COOKS
Pancake Ingredients
1 cup egg whites 1 cup cottage cheese 1 cup old-fashioned oats 2 teaspoons vanilla 1 teaspoon cinnamon
Preparation
1 teaspoon lemon juice (optional) 1 teaspoon baking powder (optional) ¼ cup coconut flour (optional) Coconut oil for griddle
Nutritional informaNote: The lemon juice, baking powder and coconut flour can be omitted without affecting the recipe, but adding them will bring depth to the flavor.
Combine all ingredients in a blender and blend until smooth. Cook on a griddle with coconut oil. Flip pancakes when bubbles appear and edges are slightly dry. Serve with Blueberry Sauce. Makes 15 pancakes (3 pancakes per serving).
Blueberry Sauce Ingredients
1 cup blueberries 1 cup raspberries 1 cinnamon stick 1-inch piece of fresh ginger
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2 tablespoons water 1 teaspoon honey ¼ teaspoon vanilla powder (ground vanilla bean)
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Pancakes Serving size: 3 pancakes 173 calories 16.7 grams protein 19.2 grams carbohydrates 3.1 grams sugar 2.7 grams total fat 2.3 milligrams cholesterol 448.4 milligrams sodium 4.2 grams fiber
Blueberry Sauce Serving size: 2 tablespoons
Preparation
Bring all ingredients to a boil in a saucepan. Allow to simmer for 10 minutes, stirring occasionally. Remove cinnamon stick and ginger.
11 calories 3 grams carbohydrates 2 grams sugar 1 gram fiber 0 protein 0 fat 0 cholesterol 0 sodium
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IN OUR LEISURE
Originally from Shirley, Long Island, Alex Helkin, 31, earned his undergraduate degree at Cornell University and his medical degree at the SUNY Stony Brook University School of Medicine.
High-intensity fitness boot camp keeps surgeon in shape
photo by robert MescavaGe
Staying fit can be a challenge during the long Central New York winters. Alex Helkin, MD, a second-year resident in general surgery at Upstate, follows a Fit Body Boot Camp program. He attends half-hour classes almost every day at Liverpool Fit Body Boot Camp, between his home in Baldwinsville and Upstate University Hospital in downtown Syracuse. What made him try boot camp? “My fiancée is a member. The first class is free if you come with a member, and after the first class, I was hooked. I was tired, sweaty and sore — and it felt great.” What’s it like? “Fit Body Boot Camp classes are 30 minutes of highintensity interval training, usually divided into a warm-up, a circuit (four to five stations, each with one or two exercises) and a burnout. Each day is different, and the week as a whole generally provides a full-body workout. “Class size varies, but the workout is the same. You are still doing your own workout, and your only competition is how you did the day before. The trainers give personal attention to everyone to ensure correct form and provide encouragement.”
What is his favorite part? “I have a lot of favorite parts. I was apprehensive to join a traditional gym because I didn’t know what exercises to do — when, for how long, and if I was doing them right. At Fit Body, the trainers decide all of that and provide advice on how to achieve all of your fitness goals. I just have to show up. “I feel great all around. I am much stronger, sleep better and have less stress.” What exercise has he tried before? “I wrestled in the past and tried to stay in shape doing things here and there, but this is the first time I’ve been dedicated to improving my fitness.” Can anyone do boot camp? “Yes. The trainers accommodate limitations, such as joint pain or surgery, and make sure there is a variation each person can do, as well as providing further challenges once you meet your goals.” What advice does he have for a newbie? “Try it, and stick with it. “It is tough at first, but there’s nothing else like it.” ●
spring 2016
U P S TAT E H E A LT H
23
Non Profit Org. US Postage
PAID Permit No 110 Syracuse, NY
750 East Adams Street l Syracuse, NY 13210
S C I E N C E I S A RT I S S C I E N C E I S A RT 1 S S C I E N C E As an associate professor of otolaryngology and communication sciences, Mike Lyon, PhD, studies the way cells communicate and work together. Connexins form junctions between cells, allowing for passage of large molecules, as shown here. Different surfaces of the epiglottis, located at the root of the tongue, have different connexins, which are influenced by the substances that come in contact with the epiglottis during swallowing, as well as other factors.
16.047 0316 38.9M Kenyonsk
Mike Lyon, PhD