Upstate Health magazine, fall 2021 edition

Health UPSTATE

connecting you to health and medical expertise

Rehab targets long-COVID symptoms A prostate ‘lift’ instead of surgery How neurosurgery helped 3 people

Prayers, luck and intensive care

Trendy medical tattoos From the experts at

Fall 2021

ICYMI

IN CASE YOU MISSED IT p_Layout 10/18/21 9:46 AM Page _Layout 111 10/18/21 p_Layout 10/18/21 9:46 9:46AM AM Page Page222

What’s up at Upstate Meanwhile, trials continue with children from 6 months to 5 years of age.

The Federal Communications Commission awarded Upstate $2 million to help upgrade and support its telehealth infrastructure with a focus on video consultations and remote patient monitoring as part of its electronic medical records. The upgraded platform will connect dozens of Upstate clinics and physical sites and streamline telehealth options for Upstate patients, many of whom live far away from Syracuse.

FOLLOW US l

The Nappi Wellness Institute, being built across East Adams Street from the Upstate Cancer Center, marked its Upstate University Hospital CEO Robert Corona, DO, 045 FALL Upstate Health HealthLink Social media art.qxp_Layout 1 10/18/21 9:46 AM progress Page 2 with a ceremonial beam raising and tree-topping at the opening of the Upstate Outpatient Pharmacy ceremony in August. The facility will become the centerpiece on Onondaga Hill. of Upstate’s outpatient care, with a focus on geriatric care. It The Upstate Outpatient Pharmacy added a second will also serve as home to nearly a dozen medical specialties, location, at 5000 W. Seneca Turnpike in the town of such as mental health, pediatrics and family medicine. The Onondaga, across the street from the Upstate Community Nappi Wellness Institute is set to open in 2023.

Hospital campus. The new pharmacy supports the Meds l to Beds program at the hospital, handles all of Upstate’s A pair of physical therapy rooms in the Upstate Golisano mail-order prescriptions and specializes in compounding, Children’s Hospital was redecorated to resemble playrooms or the mixing of complex pharmaceuticals in specialized rather than clinical spaces, to help lessen anxiety for young dosages and forms. It also houses Upstate’s new pill patients. The rooms are painted in an undersea theme and packaging machine, which produces individualized outfitted with toys that double as therapy aids. The redesign pill packs based on dosing times. was made possible by the Dunkin’ Joy in Childhood l Foundation and the Starlight Children’s Foundation Vincenzo “Enzo” Mincolla was 8 months old when he l made international news in May. The infant – son of BaldUpstate opened a first-of-its-kind Vector Biocontainment winsville physicians Mike Mincolla, MD, and Marissa MinLaboratory, pictured on page 3, which allows researchers colla, MD – was the youngest person in the world to receive to conduct more extensive research on infectious diseases, two doses of the Pfizer COVID-19 vaccine through a clinical including coronavirus disease, Lyme disease, West Nile trial conducted at Upstate. The Upstate site was one of encephalitis, Zika and more. The lab has an advanced four where a phase I dose selection study using the Pfizer biosafety level. Its director is Saravanan Thangamani, PhD, vaccineLink wasE-News tested in children under Health - banner art 12 years old. Joseph an internationally renowned expert in tick-borne disease Domachowske, MD, who specializes in pediatric infectious research, who is collaborating with researchers to develop diseases, is the principal investigator. a universal anti-tick vaccine.

Pfizer announced in September that the vaccine safely For more news, visit upstate.edu/news induced a robust antibody response in this age group. The Food and Drug Administration agreed to prioritize its review.

ON ON SOCIAL SOCIAL MEDIA MEDIA

FOLLOW US

ON SOCIAL MEDIA

UPSTATE

Follow us on social media you to health @upstatehealth connecting you you to to health healthconnecting connecting

Health

connecting you to healthand medical expertise FOLLOW US ON SOCIAL MEDIA C O N N E C T I N G Y O U T O H E A LT H A N D M E D I C A L E X P E RT I S E and medical expertise FOLLOW US ON SOCIAL SOCIAL MEDIA MEDIA and medical expertise FOLLOW US ON 2

U P STAT E H E A LT H l fall 2021 l upstate.edu

Health C O N T E N T S UPSTATE

fall 2021

PATIENT CARE COVID-19 CARE One man’s survival story

page 4

Therapy to help with lingering symptoms

page 6

Thanks to a neurosurgeon Her pain and numbness are gone

page 8

She got treated for kidney cancer, too

page 9

He’s hiking again

page 10

Navigating uncertainty— Parents of children with serious medical conditions have choices

page 12

FROM OUR EXPERTS A prostate ‘lift’ instead of surgery

page 16

Is a one-day knee or hip replacement for you?

page 17

Connecting and communicating

page 18

IN OUR COMMUNITY Opioid ‘bridge’ clinic documents success

page 19

Body art is trending

page 20

IN OUR LEISURE O say can she sing

page 23

DEPARTMENTS What’s Up at Upstate

page 2

Lessons from Upstate page 14 Hallucinations, penicillin allergy & bright light therapy Science Is Art Is Science: Flowery reflections

back cover

ON THE COVER Bill Croft is a retired Syracuse police officer who survived a severe case of PHOTO BY ROBERT MESCAVAGE. COVID-19.

SEE STORY, PAGE 4

Upstate Health magazine is a community outreach service of Upstate Medical University in Syracuse, New York. 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, Upstate Community Hospital, 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.

The Vector Biocontainment Lab at Upstate.

PHOTO BY WILLIAM MUELLER

UPSTATE HEALTH

Visit us online at www.upstate.edu

EXECUTIVE EDITOR

Leah Caldwell Assistant Vice President, Marketing & University Communications

For corrections, suggestions and submissions, contact Amber Smith at 315-802-9152 or smithamb@upstate.edu

Amber Smith 315-802-9152 or smithamb@upstate.edu

ADDITIONAL COPIES: 315-464-4836

EDITOR-IN-CHIEF

WRITERS

DESIGNER

Jim Howe Susan Keeter Emily Kulkus Amber Smith Susan Keeter

Upstate Health offices are located at 750 East Adams St., Syracuse, NY 13210

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. upstate.edu l fall 2021 l U P STAT E H E A LT H

3

PATIENT CARE

After their COVID-19 crisis, Bill Croft and his wife, Melissa, (both holding dogs) gathered at their Geddes home with their children, from left to right: Elizabeth Croft, Lynda Croft and Arden Croft.

PHOTO BY ROBERT MESCAVAGE

Prayers, luck and intensive care How one man survived COVID-19

BY AMBER SMITH

e got sick right after Christmas. He was on a

H

ventilator for three weeks in an intensive care unit at Upstate University Hospital. When he

was discharged, he was 60 pounds lighter, tethered to oxygen and required assistance to walk. Bill Croft sees himself as one of the lucky ones. “Lucky, in that I didn’t die from COVID,” he says.

4

U P STAT E H E A LT H l fall 2021 l upstate.edu

Croft is a retired Syracuse police officer who works for the Syracuse Downtown Committee, patrolling on foot in the evenings. He has asthma, so he was cautious since the start of the pandemic.

“I knew if I got COVID, I was in trouble.”

He says he was exposed on Dec. 27, 2020, when an officer stopped into the committee office. At the end of the conversation, the officer mentioned getting tested for COVID-19. Results later

PATIENT CARE

An ambulance arrived soon after and took Bill Croft from his home in Geddes to Upstate in downtown Syracuse. His family wasn’t sure they would see him again.

Melissa Croft remembers feeling distraught. “When someone gets COVID and ends up in the hospital, they’re taken away from you. You can’t be with them. You can’t hold their hand. You can’t do anything,” she says. “And no one ever expects them to say, ‘Your husband is on life support in critical condition.”

She called about five times a day to check on him. She started at 5 a.m., to talk to the caregivers from overnight.

Later she talked with the nurses caring for her husband during the day, and again later at night.

Melissa and the children spoke with Bill via iPad. There was no crying, no visible fear. They would talk about good things that were happening. They would pray. They would stay strong.

He was put on a ventilator a few days after his arrival. He developed pneumonia and underwent a procedure to remove a mucous plug. He was removed from the ventilator two days before he turned 51. He awoke on his birthday, Feb. 7, to see the staff had decorated his hospital room. Several days later, he was moved from the intensive care unit to a regular hospital room.

“The nursing staff and the doctors, they were phenomenal,” he recalls. “As horrible as it was being there, they made it just enough un-horrible for me.”

The first day Melissa was allowed to visit, Bill pulled her close to ask: “Why am I in the hospital? What happened to me?” His legs were so weak he couldn’t move them, and he feared he had broken them in a car wreck or something.

This image of Croft on a ventilator came from a virtual visit with his wife when he was in intensive care at Upstate.

PROVIDED PHOTO

came back positive. Croft and two coworkers had been exposed. All developed symptoms a week and a half later.

Croft’s wife, Melissa Croft, also tested positive. She has lupus, a chronic autoimmune condition that puts her at greater risk for a severe case of COVID-19. His daughter Lizzie, 19, also got sick. Caring for the family was Lynda, 22, who had already had COVID-19. Arden, 25, who lives in Buffalo, was spared.

Five days after Bill tested positive, a contact tracer called.

Bill coughed during the call, and Melissa says it seemed like the house shook with each cough. The contact tracer said his cough was the worst she had heard, “and I’ve talked to 1,000 people with COVID.” She summoned her supervisor, who dialed 911.

Soon he transferred into an area dedicated to rehabilitation. He had a setback when his right lung collapsed. He ended up back in intensive care. It was scary. Bill remembers a particular nurse. “She sat with me, holding my hand and calming me down, for an hour. She saved me. Mentally, it was terrifying.”

When he was able to be discharged, Bill needed a hospital bed at his house. He relied on a walker, and he was tethered to an oxygen tank device. Coworker friends were there to greet him, having shoveled the snow from his walkway and provided meals for his family all the while he was hospitalized. For a month, physical therapists and occupational therapists came to his home for sessions. He rode a stationary bike for exercise and took walks in his neighborhood. He followed up with Ioana Amzuta, MD, a pulmonologist at Upstate. By July, even though he still required supplemental oxygen while he slept, Amzuta said he could return to work.

“There are so many people right now, who had COVID much less than I did, and they still can’t work. They have symptoms — neuropathy, fatigue, gastrointestinal issues or migraines — and they still can’t work,” Bill says.

Returning to a job he loves, Bill got teary with appreciation. u upstate.edu l fall 2021 l U P STAT E H E A LT H

5

PATIENT CARE

Post-COVID patient John DiGesare, in dark sweater, exercises under the guidance of physical therapist Matt Bowman at the Upstate Rehabilitation at Western Lights, 4671 Onondaga Blvd., Syracuse.

Bowman has since taken a teaching position at Binghamton University. Physical therapy for postCOVID patients is offered at several locations in and around Syracuse. Occupational and speech/ language therapy are only offered at the Institute for Human Performance, 505 Irving Ave., Syracuse.

PHOTOS BY ROBERT MESCAVAGE

Coming back from COVID Rehabilitation therapists are key to helping patients with post-COVID medical problems

BY JIM HOWE

ehabilitation therapists play a key role in

R

helping patients with lingering medical problems after a COVID-19 infection.

Here’s why:

After the initial infection has subsided, from 10% to 30% of patients will experience debilitating symptoms for weeks or months, such as fatigue, shortness of breath and “brain fog,” trouble concentrating, remembering and focusing.

6

U P STAT E H E A LT H l fall 2021 l upstate.edu

Some estimates suggest up to 80% of patients will later experience fatigue and/or brain fog, especially those who were hospitalized.

This collection of symptoms, highly variable and not well understood, is called by various names, such as “postCOVID,” “long COVID,” “long-haul COVID” or “post-acute COVID.” Caring for these patients usually falls

PATIENT CARE

to a primary care provider – such as a family doctor, pediatrician or internist – who will likely send the patient to rehabilitation specialists: physical therapists, occupational therapists and/or speech therapists. Other specialists may also be called in as needed for specific problems.

Taking aim at specific problems

chair. This can lead patients to become anxious, depressed and ashamed, even to the point of avoiding treatment, she notes, so medical experts should be “validating their symptoms, letting them know they aren’t alone, meeting the person where they’re at and trying to get them out of that box they’re feeling in.”

Rehabilitation therapists work out plans to help patients deal with or overcome their particular problems, whether it’s tiredness, lack of stamina or trouble with breathing, speaking or thinking straight.

Brown, Bowman and Upstate occupational therapist Beth Rolland note that some post-COVID symptoms they have seen resemble those of concussion, traumatic brain injury, stroke or even dementia, such as patients struggling to do simple arithmetic, to remember to take their daily medication or even to name everyday household items.

That observation is echoed by Claudine Ward, MD, a specialist in brain injury and medical director of the Upstate Concussion Center.

Ward adds that the “invisible effects” of post-COVID symptoms mean that others may not believe the patient is really sick, because there is no visible sign, such as a bandage or a wheel-

Where to go for treatment Upstate’s Regional Rehabilitation Center, which provides physical, occupational and speech/language therapy at several sites, offers individualized treatment for post-COVID symptoms (as well as other illnesses).

For example, if a patient needs to conserve energy to make it through a day, Rolland will design therapy with that in mind. “We adapt their activities in various ways, such as how to manage fatigue, what are we going to spend energy on, and come up with a plan for that,” she says.

A patient is often dealing with several symptoms at once, which means that even simple daily tasks can be exhausting, says physical therapist Matt Bowman, a clinical assistant professor at Binghamton University.

“What often happens is ‘energy debt,’ where people with long COVID only have a certain amount of energy for the day,” he says. This means having to stop therapy exercises if the patient gets too tired, Bowman said.

Kim Brown, a speech/language therapist at Upstate, notes that “all of my patients are fatigued by the end of a session and say they are going home to take a nap. Many even have a headache afterward.”

The medical experts also stress the need for individualized treatment plans, since each case offers a unique set of symptoms.

This might involve breaking large tasks into smaller tasks, or getting a ride to the grocery store to avoid adding the stress of driving to shopping.

As part of his physical therapy program, DiGesare walks on a tread mill to regain strength as he recovers from COVID-19.

Elizabeth Asiago-Reddy, MD, agrees.

She is the chief of infectious disease at Upstate. “A huge part of treating post-COVID patients is reassurance, validating that what they are experiencing is very real, that they aren’t alone, and that we will look at the symptoms they are struggling the most with to seek a plan moving forward.”

Asiago-Reddy has treated patients with acute COVID infections as well as post-COVID problems; she and Ward both see similarities to symptoms that can follow other viral infections.

“My experience overall with postCOVID as well as with other post-infection syndromes is that people will get better over time. In the meantime, how can I best help the patient sitting before me to take the time and seek the help they need to recover?” says Asiago-Reddy.

Plans to address each patient’s needs and goals can include exercises and activities designed to help patients with a wide range of activities, including endurance, breathing, daily tasks, driving, concentration, speech, swallowing, sleep, depression and anxiety.

Upstate offers physical therapy for post-COVID patients in Camillus, East Syracuse, Manlius and two sites in Syracuse: Western Lights and the Institute for Human Performance, or IHP. Occupational and speech/language therapy are only offered at the IHP, which is on Irving Avenue, a few blocks from Upstate University Hospital.

Masking and other diseaseprevention protocols are followed at all the treatment sites. u

A referral from a primary care provider or specialist is needed to set up treatment. Call 315-464-6543 to schedule an appointment.

upstate.edu l fall 2021 l U P STAT E H E A LT H

7

PATIENT CARE

Bernadette DeMott, center, got lots of help from her children, Maximiliana and Scott, while she was recovering from a brain tumor.

PHOTO BY SUSAN KAHN

Brain tumor gone, back to tutoring

BY AMBER SMITH

B

ernadette DeMott, 60, of Syracuse had a tumor between her brain stem and spinal cord.

As glad as she is that a team led by Michael Galgano, MD, was able to remove the tumor — and that pathologists declared it benign — DeMott recognizes nurses, rehabilitative therapists and her adult children helped her get back on her feet.

DeMott, a retired Syracuse City Schools teacher, dealt with symptoms over the years including radiating pain in her leg and numbness and tingling on her right side. It kept getting worse. Her doctor sent her for X-rays and a magnetic resonance imaging scan that revealed a slow-growing intramedullary spinal cord tumor at the base of her brain, in the medulla. This is the part of the brain that regulates the body’s cardiovascular and respiratory systems.

Surgery was Dec. 4, 2020, at Upstate University Hospital. DeMott recovered in the intensive care unit, and because of pandemic restrictions, could only see her family through an iPad. She does not remember the conversations. She spent the holidays in the hospital, focused on rehabilitation. Waleed Hamam, MD, oversaw her care in the physical medicine and rehabilitation unit. continued on page 9 8

U P STAT E H E A LT H l fall 2021 l upstate.edu

DeMott says rehabilitation was a full-time job. She worked with physical therapist Kristin Overend, occupational therapist Ami Petosa and speech/ language pathologists Lauren Westby and Kim Brown. “They were able to support and encourage me with the things I wanted to do and try,” she says.

The nurses were also crucial.

“The nurses were wonderful. They were my village to support me and keep me from being scared. They kept me going.

They kept me washed and taken care of,” DeMott says.

“I was pretty dependent on the nurses at the hospital – and my kids when I got home.” continued on page 11

PATIENT CARE

Brienza’s blessings: A skillful surgeon, a well-timed MRI, restored health

BY AMBER SMITH

ain that shot down Lisa Brienza’s legs

P

turned out to be a symptom of a tumor in her lower spine called a paraganglioma.

Brienza, 54, who lives north of Syracuse in Phoenix, had planned to watch a movie with her adult children for Mother’s Day 2020, but the constant pain in her legs left her unable to sit.

She went to an urgent care center, where she was told she had a bulging disc. She got a prescription for steroids and physical therapy. When she continued to struggle with pain, a magnetic resonance imaging scan, or MRI, in January 2021 revealed what appeared to be two masses in Brienza’s spine – and another in her right kidney.

Michael Galgano, MD PHOTO BY SUSAN KAHN

Amid the distressing news, Brienza found blessings.

First of all, her primary care doctor sent her to a surgeon, and she was grateful that surgeon arranged for her to see Michael Galgano, MD, an assistant professor of neurosurgery at Upstate with spinal expertise.

“From what I hear, Galgano is it, if you’re going to have something done to your spinal canal,” she says. “I was blessed the other guy was willing to say that.”

Secondly, Brienza realized her good fortune in having an MRI of her lower back that happened to reveal renal cell carcinoma, the most common type of kidney cancer. She had no symptoms and otherwise may not have learned she had the cancer until it was more advanced.

The plan was to remove a portion of her kidney that contained the cancer after her spine operation. continued on page 11

upstate.edu l fall 2021 l U P STAT E H E A LT H

9

PATIENT CARE

Asher Anken, center, with his stepfather, Josh Lewis (left), and grandfather Ron Whitford (right). Asher was hiking when he got inspired to make walking sticks. ..PHOTO BY PATTY LOUISE/WATERVILLE TIMES

The tale behind Beaver Stickz Young boy’s rehabilitation after brain surgery included hiking

BY AMBER SMITH

sher Anken was a 6-year-old taking gymnastics

A

classes in December 2019 when his coach noticed something unusual.

He couldn’t bear weight on his left arm or leg, and he was having trouble moving.

Asher’s pediatrician told his parents to bring him to the pediatric emergency department at Upstate University Hospital. Pediatric neurologists examined the young boy, and medical images revealed a large mass in his brain stem.

During a four-day stay in the pediatric intensive care unit, Asher underwent additional testing.

The mass turned out to be a cluster of abnormal blood vessels called a cavernoma. Not only did Asher have this rare malformation in his brain, it was situated in an area of the brain where cavernomas are difficult to treat. It was also bleeding. continued on page 9 10

U P STAT E H E A LT H l fall 2021 l upstate.edu

A blood clot was putting pressure on the nerve fibers going through the brain stem to the extremities and cranial nerves, which was why he was having weakness on his left side.

Virginia Whitford is Asher’s mother.

She remembers meeting with neurosurgeon Satish Krishnamurthy, MD. Given time, the blood clot might dissipate on its own, so the plan was to let the family return to their home in Deansboro, Oneida County, with plans to have Asher undergo another MRI, or magnetic resonance imaging scan, a month later to see whether the cavernoma had stopped bleeding.

PATIENT CARE

“Dr. Krishnamurthy is just absolutely incredible in terms of bedside manner and making the right decisions at the right times. He provided just really incredible care,” Whitford says.

Brienza’s blessings

They returned to the emergency department on Feb. 1, when Asher started slurring his speech and vomiting. Krishnamurthy operated a few days later.

continued from page 9

In a six-hour procedure, he was able to remove the clot and a good portion of the cavernoma. But several days later, he had to take Asher back to the operating room. The remaining cavernoma had formed an additional clot that had to be removed.

Whitford says after a month recovering in the pediatric intensive care unit, Asher was ready for intensive rehabilitation in the hospital. By mid-March, he was able to return home.

As he built up his strength, Asher wanted to go hiking with his family.

It was mid-April, and his mom recalls that first hike “was a really hard hike for him.” That’s when he found a stick that had been gnawed on by a beaver that was just the right height for him to use on the hike.

He got an idea.

Asher decided to sell beaver sticks – at www.BeaverStickz.com – and return half of the profits to the hospital as a way of giving back.

Whitford says her father, Asher’s grandfather Ron Whitford, is a carpenter who helps in the endeavor, and so does Asher’s stepdad, Josh Lewis.

Adult-sized sticks are $25. Kid-sized sticks are $20. And the website has an offer to “Pay what you can afford.”

Two years after his surgeries, Asher is in second grade at Madison Central School, where he continues to receive physical and occupational therapy. He also sees Krishnamurthy and has MRI scans regularly.

“He’s very, very blessed,” Whitford says of her son. “He has a very supportive family and extended family, and a very supportive school. He’s got a lot of angels around him.” u

Galgano said doctors feared that the masses in her spine might be kidney cancer that had spread to her spine.

They would not know until after they had removed them.

Waleed Hamam, MD, oversaw DeMott’s post-surgery rehabilitation at Upstate.

Brain tumor gone, back to tutoring continued from page 8

Two of her children took family medical leave from their jobs, so they could help with her recovery.

Despite the progress she made with rehabilitation in the hospital, DeMott says she could barely walk when she went home. She used a wheelchair to get around and soon graduated to a walker. By mid-March she was using a cane. DeMott says her secret was building therapy into her regular day, sidestepping along the kitchen counter while her coffee brewed, and walking laps around the dining room table.

Finally she was able to get back on a stationary bike. She tries to exercise 15 minutes a day on the bike, which she realizes is not much. Over time she worked up to 45 minutes. And she began driving lessons.

She retired from teaching, but DeMott enjoys working part time as a tutor. She says her desire to return to tutoring motivated her to progress with her rehabilitative therapy. She had to relearn how to speak, how to write and how to use a computer.

“I get frustrated with myself. I want to be able to do more. But then I have to remember, it took 10 years for that tumor to grow.” u

“A lot of the nerve roots that go to the legs were completely wrapped around the periphery of the tumor,” Galgano said of the operation, which took place in February 2021. He described the tumor as vascular, meaning it would bleed if it were cut into.

The tumor was removed intact. But sometime before, it had hemorrhaged, and blood had pooled near Brienza’s tailbone. That’s what the second mass was. So Galgano drained the fluid during the same operation.

The tumor was a paraganglioma that had nothing to do with her kidney cancer.

Paragangliomas are rare tumors that may develop near certain blood vessels and nerves outside of adrenal glands.

Usually they are benign, but some can become cancerous and spread to other parts of the body. Galgano says certain genetic conditions can predispose a person to developing kidney cancer and tumors such as paragangliomas.

As Brienza recovered for five days in the hospital, she remembers being sore and numb. “That was a little scary,” she says, “but everyone up there was so wonderful.” She was up and walking, with assistance, the next day.

She could feel little shocks in the days after she was back home. Her physical therapist explained that her nerves were simply reengaging. Brienza got used to bringing a cane with her when she left the house, just in case.

“It takes me a bit longer, but I’m beginning to walk more normal,” she says. “I’m hoping that will all get better.” u

upstate.edu l fall 2021 l upstate health

11

PATIENT CARE

Anthony, 12, and Giovanni, 6, Pavia of Liverpool have a severe form of epilepsy. Their parents say that the CHOICES team is always available to help them make decisions about their sons’ complex care.

PROVIDED PHOTO

Navigating uncertainty Palliative care supports families of children with life-altering illnesses

BY SUSAN KEETER

hat’s it like raising a child

W

with a life-threatening or life-altering medical

condition?

Uncertain.

That’s the answer families and caregivers often give. The uncertainty is rooted in the difficult paths they travel, and the unclear future: Will his sniffles lead to another hospitalization? Can Irene Cherrick, MD she tolerate the new medication?

What’s causing these new symptoms?

Upstate’s pediatric palliative care program helps families navigate the uncertainty.

It’s called CHOICES — Courage. Hope. Insight. Compass.

Empathy. Support. Team members provide care from the prenatal stage of development through early adulthood.

12

U P STAT E H E A LT H l fall 2021 l upstate.edu

A team that understands “Many people misunderstand the meaning of ‘palliative’ care,” says Liz Hilton of Oneonta, whose 6-year-old daughter, Caitlyn, was referred to the program after two diagnoses: a condition that causes her immune cells to attack her body, and interstitial lung disease, a progressive condition that causes irreversible scarring of the lungs.

“It’s not about giving up. It’s about working with people who understand the complexities of the illness, who see the whole person in the child, and who care for the entire family that is affected by the illnesses.”

Caitlyn was born prematurely and with breathing and feeding problems. She spent her first days in the neonatal intensive care unit of the hospital near her home. She was transferred to Upstate Golisano Children’s Hospital when she was 9 days old. She has undergone multiple surgeries and received care at hospitals in Binghamton, Albany and Boston. Her Upstate doctors are pulmonologist Christopher Fortner, MD, PhD, cardiologist Matthew Egan, MD, hematologist/oncologist Amy Caruso Brown, MD, and CHOICES Director Irene Cherrick, MD.

PATIENT CARE

Will Clark (with candlelight reflecting around his head) celebrated his 16th birthday with his family in January 2021.

From left: His mother, Karen Clark; brothers Zachary and Andrew and father, Brian Clark.

PROVIDED PHOTO

Hilton says her daughter, the youngest of six children, has given her greater empathy for others who struggle with illness. Caitlyn has a medical aide at school who monitors her oxygen throughout the day. She sleeps with a mask connected to a machine that keeps her lungs open, and she has a tube in her stomach for food and medications. Despite her challenges, Caitlyn lives a pretty normal life. Her parents and doctors have even come up with a way for her to swim.

They help make decisions Will Clark was born seemingly healthy, says his mom, Karen Clark of Chittenango. At around 10 weeks old, he began making strange movements, which turned out to be seizures. Upstate neurologist Carl Crosley, MD, who has since retired, taught the Clarks how to give their baby steroid injections and put him on a special diet to help control seizures.

By the time Will was 3 years old, they learned that his seizures were symptoms of a neurological degenerative disease that would slowly take away his “normal”abilities. Will required round-the-clock nursing care, and had developed a serious respiratory condition. Two years later, the Clarks were introduced to the CHOICES program. Will is 16 now, and seizures remain frequent. One evening last winter, Clark called Cherrick, who advised her to bring Will to the emergency department. He needed an anticonvulsive treatment to stop the seizures, but the medication also sedated his central nervous system, leaving Will unable to breathe on his own.

Cherrick and the Clarks discussed options.

Clark says she and her husband were grateful to discuss a difficult decision with a doctor who understood their options and knew their child. “We needed honest information.” Together they decided against a tracheotomy — a hole made in the windpipe to help him breathe — understanding that the procedure would likely make it more difficult for Will to ever breathe on his own again. A risky decision, but it worked. Will was able to handle the treatment and breathe.

Caitlyn Hilton, 6, of Oneonta needs round-the-clock oxygen and is able to swim wearing extra-long tubing that connects to an oxygen tank.

PROVIDED PHOTO

They’re always accessible Anna Pavia of Liverpool also relies on the CHOICES team for help in making decisions. “CHOICES bridges the gaps between home and community and the hospital,” she explains. “I text the CHOICES team any time I need to talk through issues. They help us make decisions about care.”

Both of Pavia’s sons have Lennox-Gastaut syndrome, a severe, difficult-to-treat form of epilepsy. Anthony, 12, and Giovanni, 6, were both born with microcephaly. Their skulls were smaller than normal, and their brains have abnormalities including in the areas that control breathing and heart rate. They are blind and unable to speak. Cognitively, they function like 4-month-olds.

The brothers have a team of Upstate doctors, including Cherrick, pulmonologist Zafer Soultan, MD, neurodevelopmental pediatrician Nienke Dosa, MD, gastroenterologist Marcus Rivera, MD, orthopedic surgeon William Lavelle, MD, several cardiologists, and geneticist Robert Roger Lebel, MD. Pavia is a social worker who works from home, which is important because the boys need round-the-clock nursing care. Her husband teaches at a school nearby. Maternal grandparents live next door. She says the boys are homeschooled. Twice a week, they enjoy music therapy and water therapy – using very warm water because of their temperature sensitivity. She says “they respond well to voices, touch, music and water.” u upstate.edu l fall 2021 l U P STAT E H E A LT H

13

FROM OUR EXPERTS

LESSONS

FROM UPSTATE

Hallucinations could reveal stroke Not all patients with vivid hallucinations need psychiatric care.

Patients who have had certain kinds of strokes who describe hallucinations may have what’s known as peduncular hallucinosis, according to members of Upstate University Hospital’s stroke team.

A French neurologist first described this form of hallucination in 1922. It’s a rare form of visual hallucination that comprises colorful, nonthreatening visions of people and animals. Researchers have tied most cases of peduncular hallucinosis to lesions in the thalamus, a small structure in the middle area of the brain.

Members of Upstate’s stroke team took care of a 75-year-old man who was transferred to Upstate University Hospital with symptoms of a suspected stroke. The left side of his face was drooping, and he had weakness in his upper and lower extremities. An imaging scan of his brain revealed damage in the right thalamus.

While recovering in the hospital, the man described his wife sleeping on his hospital bed, his favorite book on the table where he left it at home, his dogs and a particular TV show on his room television while it was off.

“He was easily redirectable, and the hallucinations resolved over two days without pharmacological intervention,” they wrote in a case report for the BMJ, a journal published by the British Medical Association. Authors included Hesham Masoud, MD, an assistant professor in neurology, neurosurgery and radiology, and three resident physicians: Mohammad Shahab, MBBS, Rashid Ahmed, MD, and Navreet Kaur, MD. Their paper suggests physicians should inquire about hallucinations in patients who have stroke damage in areas of their midbrain. Also, “new onset hallucinations in a patient with no prior psychiatric history presenting with concerns for stroke should prompt physicians to strongly consider peduncular hallucinosis.”

14

U P STAT E H E A LT H l fall 2021 l upstate.edu

FROM OUR EXPERTS

Pharmacists can help verify penicillin allergy

Bright-light therapy is simple, safe, cost-effective

Penicillin allergies are among the most commonly reported allergies – yet only 10 percent of the people who say they are allergic are truly allergic.

People with seasonal affective disorder have sought relief through bright lights during the dark days of winter.

Could light therapy help those who are hospitalized with nonseasonal unipolar depression?

Upstate infectious disease pharmacist Wesley D. Kufel, PharmD, addresses this issue, writing with colleagues in the journal Pharmacy. Kufel is also a clinical assistant professor at Binghamton University’s School of Pharmacy and Pharmaceutical Sciences.

He says by avoiding penicillin in patients who are not truly allergic, doctors often end up prescribing broad-spectrum antibiotics. These drugs can be less effective and cost more.

They can lead to adverse reactions, such as severe diarrhea, for the patient. Their use also contributes to development of bacterial resistance.

Penicillin allergies are often misdiagnosed. Or, if an allergy exists, it may diminish over time. About 80 percent of people lose the sensitivity of their initial allergic reaction after 10 years, Kufel points out.

Allergy assessment and penicillin skin testing can be used to clarify whether someone is allergic. It’s important to know because it can influence what medications can be prescribed.

Skin testing is more common for patients who are hospitalized, but Kufel says “this process is becoming increasingly important in the outpatient setting.”

He argues that pharmacists could be enlisted to help, especially since many people already seek medical advice at community pharmacies. “Skin testing is a reasonable, safe procedure that is already being performed in outpatient allergy clinics but has a potential to reach even more patients with pharmacist involvement,” he writes. Some states have laws that would allow for this. Other states, including New York, would need to modify laws.

In the journal, Kufel suggests that pharmacists ask patients open-ended questions to learn about the severity of any previous reaction to penicillin. Also, because many patients may be unaware that they have since tolerated antibiotics that are similar to penicillin, he advises pharmacists to name a variety of these medications to help jog the person’s memory.

When the patient cannot remember details of previous reaction or if they are at high risk for a true allergic reaction, a skin test may be necessary.

Kufel adds that patient education is an important component. Unless people understand they are not allergic to penicillin, they may mistakenly continue to report a penicillin allergy.

Unipolar or major depression involves persistent sadness and negative emotions, as opposed to bipolar depression, which includes periods of mania.

Not much research exists on this topic, so a team from Upstate’s departments of psychiatry and behavioral sciences and public health and preventive medicine decided to find out.

“A way to augment pharmacotherapy and attain a breakthrough from the debilitating symptoms of depression is needed, especially in the inpatient setting, where the most severe cases are treated,” Upstate’s director of inpatient psychiatry, Luba Leontieva, MD, PhD, writes with colleagues in the journal Cureus. The team included psychiatry resident Alyssa Trinh, MD; psychiatric observer and research volunteer Pratik Jain, MBBS; psychiatric nurse practitioner Shaikh Sabahath; Dongliang Wang, PhD, statistician from the department of public health and preventive medicine; and psychiatrist James Megna, MD, PhD. Participating patients at Upstate University Hospital completed questionnaires before and after bright-light therapy was initiated, in addition to their usual psychopharmacological and psychotherapy treatments. Thirtyminute bright-light therapy sessions were done daily using a device called a SunSquare in a private room.

The study included 100 patients and was conducted over 150 days, between January and August 2020. Seven people dropped out because they didn’t perceive any benefit, one because of headaches and one because of sensitivity to bright light. Those who stuck with it reported depressive symptoms decreased by more than 50 percent. They also indicated significant improvement in symptoms of distress, interpersonal relationships and social functioning.

Although overall improvement among patients was not statistically significant, Leontieva and colleagues say that they saw a meaningful improvement in depressive symptoms in patients who had five sessions of bright light therapy.

Bright-light therapy has few side effects, is well tolerated and easy to administer. “It offers a simple, safe and costeffective approach to augmenting depressive treatment on an acute psychiatric floor,” the team concludes. u

upstate.edu l fall 2021 l U P STAT E H E A LT H

15

FROM OUR EXPERTS

A prostate‘lift’ instead of surgery A treatment option for men with enlarged prostates

BY AMBER SMITH

t’s a procedure that can improve urinary symptoms

I

in men with enlarged prostates – without surgery or the removal of tissue. And it doesn’t cause

sexual side effects.

The UroLift is a new option for some men. The urologist pulls the sides of the prostate away from the urethra, using steel sutures to hold the prostate tissue back – like the tiebacks that keep window draperies open (see illustration).

This is meant to widen the urethra to allow for a better flow of urine.

“What I usually tell my patients is that we are basically Moses opening the sea.

We are creating a nice channel for urine to flow,” says Hanan Goldberg, MD, an assistant professor of urology at Upstate.

The sutures remain for life. Goldberg says they meld into the prostate tissue within two or three weeks. Men who feel burning, frequency or urgency after the procedure usually see those side effects go away within two to four weeks.

He says the procedure can improve a man’s quality of life. Success rates after five years are about 87 percent.

Goldberg says UroLift does not affect a man’s ability to have an erection or to ejaculate normally. Other treatments for benign prostatic hyperplasia might involve those sexual side effects.

Some men take medications, either to relax the smooth muscles of the prostate or to block the effects of testosterone. Some choose a surgical procedure called transurethral resection of the prostate, or TURP, which is considered the “gold standard” because of its lasting success rate. Some opt for a laser ablation, which vaporizes tissue rather than cutting it out.

Each treatment comes with side effects. Urologists can explain what each patient can expect.

Goldberg advocates men be screened for prostate cancer regularly starting in their early 50s, or earlier if they are at high risk for prostate cancer. This involves a blood test. He says there is no link between prostate cancer and benign 16

U P STAT E H E A LT H l fall 2021 l upstate.edu

prostatic hyperplasia, or BPH. But he uses screening appointments to discuss urinary symptoms. “It’s important to talk about this, to put it on the table and see if there are any issues that need to be treated.” u

Do you need care?

If you’re having urinary symptoms – frequency, trouble emptying your bladder or others – it’s time to see a urologist.

Blood tests, urine tests, a physical exam and medical history will help the urologist rule out prostate cancer.

If the diagnosis is benign prostatic hyperplasia, or BPH, treatment options will depend upon: l

how bothersome your symptoms are,

l

the size and shape of your prostate,

l

your age and medical history,

l

whether you can tolerate anesthesia or surgery, and

l

your ability to accept certain side effects.

To reach Upstate Urology, visit upstate.edu/urology or call 315-464-1500. Offices are located in downtown Syracuse, suburban Syracuse, Auburn, Camillus, Cortland, Johnson City/Binghamton, Oneida and Utica.

FROM OUR EXPERTS

Swift fix Many patients go home the same day they get new hips, knees

BY AMBER SMITH

rthopedic surgeons at Upstate offer one-day total knee and total hip

O

replacement options called “Swift Knee” and “Swift Hip” for people who are relatively healthy and motivated to recover quickly.

Many patients who undergo standard hip or knee replacement surgery are hospitalized overnight, and in the not-so-distant past a two- to three-day stay was the norm. However, Timothy Damron, MD, says “outpatient total joint replacement surgeries are increasingly becoming the new normal for our total joint population.” Damron is vice chair at Upstate Orthopedics and one of three total joint surgeons, including Robert Sherman, MD, and Emil Azer, MD. “When I started in training, we actually admitted the patients the night before and kept them in the hospital about a week or so. Now patients are going home the next morning and sometimes the same day following surgery” Damron says. “Trends have changed drastically over the time I’ve been in practice.”

He says patients who spend fewer days in the hospital are less likely to develop complications, such as infections. “The shorter time that they spend in the hospital, the better the outcome.”

Pain management and physical therapy are important aspects of the Swift total joint procedures.

Close collaboration with the anesthesiology team has led to improvements in postoperative pain control, Damron says. Preoperative physical therapy is an integral part of the Swift Knee program in particular, given the importance of range of motion exercises after total knees.

Here’s how to explore your options: 1.

Find out if you are a candidate for a Swift Knee or Swift Hip operation by making an appointment with an orthopedic surgeon.

(Call 315-464-4472.) Read about what you can expect during and after surgery. Attend a jointreplacement class.

2.

Designate a friend or family member who will help you as you prepare for surgery as well as after the operation.

3.

Talk with your orthopedic nurse navigator about your individual care plan. Schedule the date and time of your surgery and complete any pretests, which may include blood work and/or medical imaging.

4.

Prepare for rehabilitation.

Particularly for total knees, “pre-hab” will mean one to three physical therapy appointments before your surgery.

5.

At your pre-hab visits, you will review exercises, devices you’ll use after surgery and how to prepare your home to make rehab and recovery easier. You’ll also schedule your postoperative appointments.

6.

Choose pull-on pants and secure, comfortable walking shoes to wear the day of your surgery.

Leave all electronic devices and jewelry (including wedding rings) at home or with the friend or family member who accompanies you to the hospital.

7.

Meet with your surgeon, anesthesia team and surgery staff after you are admitted for your operation. The anesthesiologist will talk about options for anesthesia and postoperative medication.

8.

Know that you may feel pain or discomfort while in the recovery area after surgery — and your care team will help manage the pain.

9.

You’ll also have an X-ray, and a physical therapist will begin rehab, to help improve mobility.

Once you can safely navigate stairs, perform your exercises and bathe and dress yourself, you’ll be eligible for discharge.

The goal is to go home the same day.

10. Plan on seeing your doctor for a follow-up visit, to make sure your recovery is on track. u

upstate.edu l fall 2021 l U P STAT E H E A LT H

17

IN OUR COMMUNITY

Human connection Even during challenging circumstances, doctors find ways to communicate with patients and their families

BY AMBER SMITH

s they learn to perfect the practice of medicine,

A

doctors also learn how to communicate during stressful situations, such as when a patient is

near the end of life.

Sometimes families are estranged. They may not speak English. Some might not understand much about diseases and medical interventions. Emotions may be particularly raw if the patient who is dying is young. During the pandemic, the protective measures of masking and distancing complicated communications even more.

No matter the challenge, doctors learn how to help vulnerable families make vital decisions.

One neurosurgery resident at Upstate fielded all of these challenges, all at once, in caring for a patient during the pandemic. George Koutsouras, DO, reflects on what helped him help his patient in a paper he wrote for the American Journal of Bioethics Neuroscience with Upstate mentors Gregory Eastwood, MD, and Satish Krishnamurthy, MD. Eastwood is a professor of bioethics and humanities who teaches about medical ethics and has written about end-of-life issues, and Krishnamurthy is a professor and interim chair of neurosurgery.

The patient was a middle-aged man with an impaired blood clotting ability, who had profound bleeding in his brain. He became more confused as doctors worked to save him. The man was an immigrant and did not speak English. His wife was deaf and spoke only in the sign language of their native country.

As the man’s condition deteriorated, nurse manager Jessica Urtz and the palliative care team obtained permission for an in-person meeting with the wife and the patient’s oldest son, a teenager who spoke a little English.

To facilitate communication, Koutsouras explains, the staff located a sign language interpreter who knew the sign language of the patient’s native country 18

U P STAT E H E A LT H l fall 2021 l upstate.edu

as well as American sign language.

Because this interpreter was deaf, a second interpreter who knew American sign language was called in who could also speak in English.

The conversation between Koutsouras and the patient’s wife moved slowly because of the translations.

“I described the natural history of her husband’s disease and that, despite our greatest attempts, his condition was irreversible,” Koutsouras says. The wife signed an emotional reply. “Just by observing her body language, I could see clearly the sadness and fear of losing her husband.”

To help the wife make decisions about whether to prolong her husband’s time on ventilator support, the hospital staff contacted another relative who worked in health care. They communicated through a video chat.

At one point, the son spoke, to make sure his father was not in pain.

Koutsouras admits feeling anxious throughout the family meeting. “I found myself also relying on my own life experiences to provide an added sense of empathy and relieve my continued on page 19

IN OUR COMMUNITY

The bridge clinic Emergency opioid clinic documents success

BY EMILY KULKUS

A

program that uses medication and peer support is helping people decrease unsafe opioid use.

Ross Sullivan, MD, founded the Upstate Emergency Opioid Bridge Clinic in 2017 to help address opioid use disorder in Central New York. Opioid use disorder — of both illegal drugs such as heroin and prescribed medication — has been a growing problem across the United States for many years. The pandemic only increased the number of lethal overdoses.

Sullivan, director of medical toxicology and an assistant professor of emergency medicine at Upstate, published a paper about the success of the bridge clinic in the Journal of Substance Abuse Treatment. The article, “Bridge Clinic Buprenorphine Program Decreases Emergency Department Visits,” drives home one of Sullivan’s primary goals and hypotheses about the clinic.

“I really wanted to publish it because I felt that it helps answer the question related to the biggest barrier, which is: ‘Do patients come to the emergency department more if we offer them buprenorphine or treatment?’” he said.

He estimates about 1,000 patients have been cared for through the bridge clinic.

The article notes a 42% reduction in return visits to the emergency department among patients who completed a bridge clinic consultation.

Part of the treatment includes a medication to help patients who are abusing opioids and at risk for overdose. Buprenorphine decreases cravings and helps patients suffering from withdrawal.

Patients can be referred to the bridge clinic from any department within the hospital, but most are referred through the emergency department, Sullivan explains.

Bridge clinic staff strive to have the first consultation appointment within one to three days after the initial referral. Bridge clinic services also include connecting patients to additional services in the community to help with food, housing, transportation and more.

Human connection

Ross Sullivan, MD PHOTO BY ROBERT MESCAVAGE

A top priority of the clinic and its staff has also been to shed the stigma associated with opioid use disorder.

That, combined with the social services offered by support staff provided by Onondaga County, called peers, has greatly contributed to the program’s success, Sullivan says. Peers are support specialists who are themselves in recovery and serve as a resource for individuals and families.

“The medicine is part of it, but the peers are the biggest part of it,” he says.

“Having the peers is as important if not more important than anything else. We work with phenomenal peers.” u

continued from page 18

anxiety. I, too, have been on the receiving end of terrible news of a family member’s health condition and have had to make end-of-life decisions for a dear loved one.”

They understood that their patriarch would likely not survive his injury. Even if he did, he would not be the person they knew before.

He knew the importance of being with loved ones near the end of life. The pandemic made that impossible for so many families, which meant doctors and nurses were there to help relieve fear and suffering. In this case, he worried that important points would get lost through the multiple translations.

The wife asked that her husband be made comfortable until he died.

Koutsouras soon realized that his major points were getting through to the family.

“To appreciate the significance of this moment for this family,” Koutsouras says, “I realized that we did not need to understand the language to appreciate their grief and anguish.” u

upstate.edu l fall 2021 l U P STAT E H E A LT H

19

IN OUR COMMUNITY

Tattoo trends Body art expresses medical connections

BY AMBER SMITH

ook around, and

L

you see more artistically painted

skin than a few years ago.

Tattoos are trendy today.

Whatever tattoos are – fashion choice, lifestyle, even memorials – they’ve become a cultural phenomenon. Glamour magazine recently showcased tattoos especially for women. The Trend Spotter reports on the best places for women to get inked.

(Directly beneath cleavage is a favorite spot.) And a Netflix series, “Tattoo Redo,” features skilled tattoo artists who remake disastrous tattoos.

On the campus of Upstate Medical University, we found several people with ink that has a medical theme. Meet seven of them:

s

The industry is estimated to be worth $1.2 billion in the United States, up 3 percent since 2016, according to IBISWorld, which tracks a variety of industries worldwide.

The AuthorityTattoo.com website cites a poll from 2019 that revealed 30 percent of all Americans have at least one tattoo, up from 21 percent in 2012. Tattoos are more popular with younger generations, the website writes, because they were taboo in the 1960s and 1970s when today’s parents/grandparents were coming of age. The group also tells of a survey of the social media site Instagram that showed rose tattoos are the most featured body art, followed by skulls, pop art, birds and text of names or phrases.

Nurse Caitlin M. Nye of Syracuse is a clinical assistant professor in the College of Nursing. She added a tattoo to her upper left arm in 2018 of a nurse wearing a traditional nursing cap. “Being a nurse and supporting nurses isn’t just my professional role. It’s a big part of my identity,” she says. “Having a nurse tattoo seemed a fitting tribute to the work I've done and the pride I have in my profession.” Nye was flattered when someone once told her the nurse on her arm resembled Rosie the Riveter, the character designed to recruit female workers during World War II.

s

Becky Hogle of Kirkville is an administrative assistant in nursing. Her tattoo shows the COVID-19 virus looking terrified as a vaccine-filled syringe comes toward it on her upper left arm, where she had a scar from the smallpox vaccine many years ago. She got the tattoo because she participated in the Pfizer vaccine trial starting in August 2020.

“It’s hard to wrap your head around this when you’re in the midst of it, that this is a historic event,” Hogle says.

PHOTO BY ROBERT MESCAVAGE

20

U P STAT E H E A LT H l fall 2021 l upstate.edu

IN OUR COMMUNITY

Respiratory therapy student Jerica Bonvino of Auburn has a star of life tattoo on the back of her leg, which she got in 2018 to remind her of her time as an emergency medical technician. She added this tattoo of lungs in 2020 because she is working toward becoming a respiratory therapist “and the lungs are incredibly fascinating.” She says she has been asked if the lungs really look like they appear in her tattoo. (They do.)

s

Alyssa Bittel of Syracuse is a certified surgical technologist. In 2017, she got a watercolor caduceus symbol on her left forearm. “I wanted something pretty and feminine that resembled the medical field. I got this tattoo six years into being in the medical field, and it’s even more of a symbol of pride today in 2021 after everything we've been through as medical professionals these past 18 months.”

Jacquelyn Cox of Nedrow is a licensed practical nurse in the emergency department. She got a caduceus with her best friend’s initials on her left forearm in 2019. She loves Greek mythology, and nursing, and her friend who died in 2017 had been her biggest supporter during nursing school.

“I wanted to incorporate the three things that are most important to me into one tattoo,” Cox says.

s

s

s

Nurse practitioner Marissa Edwards of Syracuse works in the Golisano Center for Special Needs.

She added the word “hope,” with the loop in the “h” being a cancer awareness ribbon, to the outside of her foot on World Cancer Day in 2012. The tattoo honors her grandmother, Delores, who was in treatment for endometrial cancer and was a big motivation for Edwards choosing a nursing career. “She passed away later that year as the cancer ultimately advanced to her lungs, but I only remember her walking through each day of her fight with humor in her loud and bright laugh, intention in her presence and love for family and girlfriends, and beauty in both her selfless heart and perfectly placed lipstick, always,” Edwards says. “She never let me forget how proud she was of me for going to nursing school.”

s

Caitlyn Blumer of Bridgeport is a nurse in the neurological intensive care unit. Her tattoos are an anatomical heart connected to a willow tree and an anatomical brain. They are on the outer portion of her left arm and on the inner right bicep. She got the heart and willow tree in 2016 in honor of her daughter “because everything I do is for her, and the willow tree is her birth tree.” The anatomical brain was added in 2020 to celebrate her accomplishment of getting through nursing school and landing a position in a neuro ICU while working overnights as a single mom.

PHOTO BY SUSAN KAHN

upstate.edu l fall 2021 l U P STAT E H E A LT H

21

Impacting patient care, education, research, and community health Impacting care, education, research and community Impacting patient care, patient education, research, and community health and well-being through charitable giving. health and well-being through charitable giving. and well-being through charitable giving.

Foundation

Watertown fiin re captain grateful Watertown fire captain forfor Giving back, grief, tograteful help others care after battling horrifi c blaze care after battling horrifi c blaze Family honors son by promoting addiction medicine program Unaware ofGould the impending coronavirus “On rideI faded down,inI faded in anE Unaware of the impending coronavirus ride the down, anE out of out of For years, Evan struggled with anxiety“On andthe obsessivepandemic, the Upstate Foundation began consciousness,” Kolb said.

“But I’ll tell pandemic, the Upstate Foundation began consciousness,” Kolb said.

“But I’ll tell compulsive disorder. At 23, the young man with the gentle preparing for its annual observance you, I never felt such love or support preparing for its annual observance you, I never felt such love or support smile and zest for movies, sports and debate had not found a and celebration of Doctors’ Day. As in years asthat I didmoment at that moment and celebration of worked Doctors’ Day.for As him, in years as I did at those those treatment that well despite several attempts. past, Foundation staff received nearly 1,000 doors opened.” past, Foundation staff received nearly 1,000 doors opened.”

While hepatients was open aboutexpressing his illness,gratitude he also hid the depths of there was notes from patients notes from expressing gratitude And then And then there was from his family and had been the managetoarray a wide array offriends. care providers atthat Upstate to it a wide of care providers atAnxiety Upstate expert the expert care Kolbcare Kolb able in high school was amplified during then University Hospital.

Among most college andreceived University Hospital.

Among UIF mostUIF received from thefrom the heightened the of the pandemic. inspiring stories was that of Watertown fire inspiring storiesduring was that ofisolation Watertown fire coronavirus multidisciplinary multidisciplinary On the surface, captain Kolb. Evan seemed to be holding things captain T.G. Kolb.T.G.though, team at Upstate. team at Upstate. together.

He wasand attending classes, with Faced family,with immeKolb’s still ongoing taleconnecting of perseverKolb’s long andlong still ongoing tale of perseverFaced with immeand working a full-time job each day.

His friends from West ancewith began with fire in abuilding vacant building in threats diate threats posed ance began a fire in aa vacant in diate posed Genesee High School and the University at Buffalo speak of Watertown, NFX YPSL, in February 2018.

The by numerous Watertown, NFX YPSL, in February 2018. The by numerous a caring person they could on during their owncrushed and broblaze defied by ficount refi leaving them blaze defi ed entry byentry firefighters –ghters leaving– them crushed and brodifficulties as well as for fun. the ostensibly saferofoption of battlingken bones, kenserious bones, serious The Gould family – Tyler, Evan, Lori and Andrew – with thewith ostensibly safer option battling the fl ames from outside the structure. nerve damage, and enjoyed a West Virginia University football game in theFor flames from outside the structure. nerve damage, and his anxiety and OCD, he turned to his own ways to cope, Suddenly, and unpredictably, a two-story injuries to multiple Suddenly, and unpredictably, a two-story injuries to multiple including alcohol and benzodiazepines —a class of drugs November 2019. In addition to golfing and outdoor brick wall collapsed, injuring firefi ghters. organs, Upstate’s sports, their elder son, Evan, was a fan of the New York brick wall collapsed, injuring twothat firefitwo ghters. organs, Upstate’s including Valium and Xanax have a sedative effect.

It was One escaped withinjuries; minor trauma team tackled Jets, the New York Yankees and the Chicago Bulls.

One escaped with minor however, team tackled a cycle of self-medication thatinjuries; would however, end histrauma life. In January Kolb suff ered major harm to the lower porthe immediate Kolb suff ered major harm to the lower porthe immediate risks 2021 a “benzo” pill laced with fentanyl caused a fatal seizure. to risks to tion of his body.

Kolb’s Next, weeks tion of his body.

Kolb’s life.

Next,life. weeks His parents, Lori and Andrew Gould, and brother, Tyler, weremultiple of traction andTraditional multiple rehabilitation programs didn’t resonate with of traction and “I kept shouting to my crew ‘1ut me down, “I kept shouting mydeath. crew ‘1ut me down, Evan, and his parents believe the approach offered in the devastated bytohis They wanted to honor him in a way surgeries, led by orthopedic led by orthopedic I’mthey OK!’pulled as theyme pulled me away from the surgeries, I’mthat OK!’would as away from Upstate program — which addresses the dual diagnosis of help others facing thethe same struggles.

In particusurgeon %S Brian Kistler Kistler lb on lb on wreckage,” said Kolb.

Such is the numbingsurgeon %S Brian wreckage,” said Kolb.

Such isword the numbing psychiatric issues and medicine addiction — would be a lar, they want to spread of an addictionthe program they long road to recovery.

And countless road to recovery.

And countless eff ect ofSwiftly shock.taken Swiftly to the nearest longthe effhad ect of shock. totaken the lifetime: nearest better fit for people likeand their son, who faced both.fire captain not heard of during Evan’s the addiction and in Upstate’s medicine Watertown in Upstate’s physicalphysical medicine and Watertown fire captain local emergency department, it became sessionssessions local emergency became pain medicinedepartment, program at it Upstate Universityrehabilitation Hospital. rehabilitation department enabled him to T.G. T.G. Kolb’s recovery department enabled him to The Goulds hope that raising awareness for an option that Kolb’s recovery clear trauma care would be needed.

With clear trauma care would be needed. With leave the hospital after only six weeks, so leave the hospital after only six weeks, so was a long and arduous treats both medicine addiction and mental health will help was a long and arduous an airlift ruled out due to inclement fl ight an airlift ruled out due to inclement flight Kolb’s at-home rehabilitation could begin.possibly save Kolb’s at-home rehabilitation could begin. other families, and quite lives. one, but it was made conditions, Kolb was placed aboard an one, but it was made conditions, Kolb was placed aboard an by aand wide and ambulance and to Upstate. wife spent rst twoby weeks by easier easier by a wide ambulance and taken totaken Upstate.

“My wife“My spent the first the twofiweeks my side in the hospital, then drove from diverse support network diverse support network It wasthis during time Kolb discovered themy side in the hospital, then drove from It was during timethis Kolb discovered the Watertown to Syracuse for four weeks,” including including family,family, the the human support around human support structurestructure around him washim wasWatertown to Syracuse for four weeks,” said Kolb.

“She, myand friends and my family Upstate said Kolb.

“She, my friends my family Upstate team, fellow extensive and strong, even if the building team, fellow extensive and a strong, even if the building To become patient in Upstate’s addiction and pain medicine abyweek for an hour. outpatient detox option is available, were all so impressed by the care I An received. were all so impressed the care I received. fi refi ghters, and that harmed him hadn’t been. firefighters, and even even that harmed ahim hadn’t been. program, person must call 315-464-3130 toI make his orUpstate with dailybecause visits first week and then twice a week I call my ‘miracle team,’the because call Upstate my ‘miracle team,’ strangers. strangers.

Here’s Here’s Kolb Kolb First was his older brother, also a Watertown First hisappointment. older brother, also a Watertown herwas own Some same-day appointments I’m grateful tothereafter. be and walking I’m grateful to be alive andalive walking thanks thanks hisintime in duringduring his time fire and captain and paramedic who happened fireare captain paramedic who happened available. to them.”to them.”

Brian Johnson, MD, is director of addiction medicine at Upstate’s rehabilitation Upstate’s rehabilitation to be on duty that same evening and took to be on duty that same evening and took Today, more than two years later, Kolb’s jour- is designed Today, more than two years later, Kolb’s jourPatients need to bring along a sober support person who Upstate.

He says the program to help the patient department displaying the harrowing ride with Kolb from the department displaying the harrowing ride with Kolb from the ney andissues health issuesunderstand continue.

“I have good ney and health continue.

“I have good will support them during detoxification, and they must arrive better his or her addiction and manage its a “Thank You North Country to Syracuse.

Concurrent a “Thank You Hero” Hero” North Country to Syracuse. Concurrent days and bad days,” hePatients said. Fortunately he, days and bad days,” he said.

Fortunately he, to start the program in withdrawal from alcohol, opioids or effects. learn to tolerate feelings that arise with that ride, Kolb’s wife made her way to sign autographed by with that ride, Kolb’s wife made her way to signthe autographed by like his support system, remains strong. like his support system, remains strong. benzodiazepines. within relationships and learn to depend on people Upstate, even as New York state police were Upstate, even as New York state police were students fromrather Sherman students from Sherman than drugs to address their issues. dispatched SUNY colleges at Cortland dispatched topatient SUNYto colleges atan Cortland Elementary in Elementary SchoolSchool in Each new receives evaluation and physical and Binghamton to notify and retrieve his and Binghamton to notify and retrieve his Watertown. examination that takes about two hours and may involve The Upstate addiction and pain medicine program is in Watertown. daughters fromfrom school.

Alerted that one A gift daughters from school.

Alerted that onedepartment gift of gratitude is217 a meaningful way to St. in Syracuse. of Agratitude is a Suite meaningful multiple physicians Upstate’s of psychiatry atway 600to E. Genesee of their had been seriously of and theirbehavioral own hadown been seriously injured, injured, express tocaregivers special caregivers express appreciation to special sciences.

Subsequent visits are usually twice appreciation next came the moral support of Syracuse and helpand next came the moral support of Syracuse help patients during their patients during their time of time of firefiwho ghters, who up in uniform as great need. firefighters, lined uplined in uniform as great To contact donate, the contact the Toneed. donate, was lifted the ambulance Kolb wasKolb lifted from thefrom ambulance upon uponUpstate Upstate Foundation at 315-464-4416 Foundation at 315-464-4416 or go or go reaching Upstate’s Trauma Center. reaching Upstate’s Trauma Center. to www.UpstateFoundation.org/donate. to www.UpstateFoundation.org/donate.

A gift is a meaningful way to help patients during their time of great need.

To donate, contact the Upstate Foundation at 315-464-4416 or go to www.UpstateFoundation.org/donate.

Do you want help?

Are grateful? you grateful?

Are you

A gift of support

22

U P STAT E H E A LT H l fall 2021 l upstate.edu

IN OUR LEISURE

Upstate nurse Kim Fetters performs on “Lest We Forget,” a 2020 musical tribute to singer Benny Mardones, who died that year.

O say, can she sing Upstate nurse belts out anthem in stadium

BY AMBER SMITH

Fetters sings the national anthem at the 2021 opening day of the Syracuse Mets.

A

nurse from Upstate sang the national anthem at opening day for the Syracuse Mets this spring.

Kimberly Fetters, 56, of Syracuse has been a nurse for 12 years. She’s been singing for four times as long.

“Ever since I was 5 years old, I knew I wanted to be a singer. It all kind of started with the Carpenters,” Fetters says. “Then when I was in 10th grade and MTV came out, and Pat Benatar hit the screen, I was like ‘I want to be just like her.’ “ She performed in “South Pacific” and “Bye Bye Birdie” during high school in Cazenovia. Then she spent eight years performing on the road with a couple of different bands. When she returned to Central New York, Fetters auditioned in 1996 for singer/songwriter Benny Mardones, who was known for his hit “Into the Night.”

Fetters performing with Benny Mardones at Vernon Downs in 2012.

impossible. Fetters says she was honored that the Syracuse Mets invited her to sing on opening day.

Mardones later described Fetters as “the best female singer I have ever worked with in my life.” They sang together for 23 years. Mardones died in 2020.

“People think the national anthem is this really hard song. It can be if you don’t start in the right key for yourself.

You have to find that perfect place to start,” she says. “I’ve done it so many times, I know what note to start on.”

Fetters lives across the street from Upstate Community Hospital, where she works in the pretesting unit, caring for patients who are preparing for surgery. She is glad to be singing again, after the pandemic made live in-person performances

Find the video of Fetters on YouTube by searching “Kimberly Fetters and National Anthem and Syracuse Mets.” u upstate.edu l fall 2021 l U P STAT 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

SCIENCE IS ART IS SCIENCE IS ART IS SCIENCE IS

Flowery reflections

Weiyi Xu, PhD

hen she strolled by the cherry trees around the

W

PHOTO BY WILLIAM MUELLER

Campus Activities Building, Weiyi Xu, PhD, snapped a photo of a flowery pink blossom.

Later, Xu was preparing slides of breast tumor cells for fluorescence imaging. Xu is a postdoctoral student in the laboratory of Christopher Turner, PhD, a cell and developmental biologist with expertise in how cancer spreads.

Xu looked through the epifluorescence microscope, which uses high-intensity light to illuminate and study specific features of small specimens, such as cancer cells. She was amazed.

An island of cancer cells was shaped like a flower, like her cherry blossom.

In her microscopic image, the red and green lines outline cells. Nine are clumped together.

The blue area is a cytoskeleton component of the cell known as actin. u

21.216112129.9MSKEL

“They always cluster together,” she says of the cancer cells, “but the shapes of these islands can be variable. It could be hundreds of cells or tens of cells. And they don’t always look like a flower.”