Health UPSTATE
UPSTATE MEDICAL UNIVERSITY
Fall 2018
ANEURYSM REPAIR OPTIONS page 4
SKILLFUL SURGERY, MEDICAL EXPERTISE AND HIS WILL TO LIVE page 6 WORKING TO SOLVE THE OPIOID CRISIS page 8
SHOULD YOU BUY A GENETIC TEST KIT? page 17
SOCCER FOR FITNESS AND FUN page 22
HOW TO GO TO MEDICAL SCHOOL— AS A ‘PATIENT’ page 21
What’s Up at Upstate..
In case you mIssed It...
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GERIATRICS DEPARTMENT: Upstate has become one of a handful of academic medical centers in the United States to have a department devoted to geriatrics. For the past 20 years, the branch of medicine dealing with the health and care of older adults has been a division, or subset of a department, at Upstate. Sharon Brangman, MD, a State University of New York distinguished professor and a former president of the American Geriatrics Society, has led the division — and now leads the department. “Geriatrics is an increasing need and will be so for many decades ahead,” she said. ●
CANCER CENTER EXPANDS: When the Upstate Cancer Center opened in July 2014, only the first three floors of the five-story building were completed and occupied. e fourth and fih floors were constructed, anticipating future Upstate needs. e fourth floor is now devoted to exam rooms, increasing the number from 14 to 35. e second floor became all infusion rooms, upping the number from 27 to 44. e fih floor is for Upstate’s Clinical Pathology Lab, above. ●
APPLE STORAGE: Upstate is the first health system in Syracuse to partner with Apple, so patients with iPhones can, if they choose, store all of their health records in Apple’s Health app. e app comes preloaded on the iPhone and tracks such things as heart rate, steps, calories consumed and other information. Now patients can request their Upstate records be stored there as well. Upstate already makes medical records data available to patients through UpstateMyChart. Patients use a website or app to view test results, request appointments or medication refills, send questions to their physicians and more. e data remains on Upstate’s servers. Storing records in the Apple Health app means they can be mingled with records from other health providers. Chief Medical information Officer Neal Seidberg, MD, says keeping all health information in one convenient place empowers patients. “A major consideration to partner with Apple was to provide our patients with a new and important way to monitor, manage and gain a better understanding of their overall health,” he says. “For families who are on the go, the ability to have access to all kinds of health information in the palm of your hand can give one peace of mind.” ●
CONCUSSION APP: Associate professor of family medicine Eugene Bailey, MD, teamed up with an athletic trainer to create an app that provides a step-by-step protocol for the diagnosis of concussion. e “Easy SCAT Sideline” app helps coaches and athletic trainers know what to do when a player is injured, so that the possibility of concussion is not overlooked. 2
U P S TAT E H E A LT H
STUDENT PARTNERS: Newborns in the neonatal intensive care unit oen need to be repositioned to aid in their growth. “If they are on their tummy, they push up; then they can develop their shoulders,” Upstate College of Nursing associate professor Karen Klingman, PhD, explained to SU News. “If they are on their back that doesn’t happen, so there is this trade-off nurses in the NICU need to think about. Should babies be on their backs or on their tummies to help with development?” For help designing a monitor for those NICU babies, Klingman turned to bioengineering students from Syracuse University’s College of Engineering and Computer Science. As part of their capstone project, the students developed a prototype. Sensors beneath fabric connect to a custom-coded microcontroller board and measure pressure from an infant’s shoulders, bottom, head, stomach and knees. ●
NEW MEDICAL COMPLEX: Physicians affiliated with Upstate plan to open a new medical complex featuring more than a dozen specialty services next fall at Township 5 in Camillus. e group expects to build a one-story, 25,528-square-foot building behind Costco and the Movie Tavern. It would provide office space for family medicine, cardiology, pulmonology, rheumatology, pain medicine, neurology, neurosurgery, orthopedics, physical medicine and rehabilitation, urology, otolaryngology, vascular surgery and psychiatry and behavioral health. ●
NURSING ONLINE: Starting this spring, Upstate’s College of Nursing will offer a Bachelor of Science program fully online. e degree is 121 credits and will take students about 18 months to two years with full-time study, or up to four years with part-time study. e program requires a 135-hour practicum. Students must complete 60 credit hours from a basic nursing program or an associate’s degree in nursing beforehand and must have a New York state registered nurse license by the start of his or her second semester. For more information, visit upstate.edu/con or call admissions at 315-464-4570. upstate.edu l fall 2018
welcome
Contents 4
5
patIent care
Different types of aneurysms call for different types of repairs page 4 She got back on her feet, humbled page 5 He survived a lifethreatening infection
page 6
Solving the opioid crisis
page 8
UPSTATE
UPSTATE MEDICAL
UNIVERSITY
Stroke facts you may not know
In her own words: ‘If something doesn’t seem right, it’s better to call’ page 15 Is it diabetes? Or pancreatic cancer?
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8
SHOULD A GENE YOU BUY TIC TEST KIT?
page 17
SOCCER AND FUNFOR FITNESS page 22
HOW TO MEDICA SCHOO L AS A ‘PAT L— IENT’
11
15
In our communIty page 14
Something to think about before buying a genetic test kit
Fall 2018
SKILLFUL SURGERY, MEDICAL EXPERTISE AND HIS TO LIVE WILL page SOLVING OPIOID THE CRISIS page
From our experts
A new antidepressant precaution
Health
ANEURYSM REPAIR OPTIONS page 4
6
page 16 page 16
page 17
How you can become a ‘standardized patient’
page 21
In our leIsure Nurse prescribes soccer for fitness and fun
page 22
departments What’s Up at Upstate
page 2
Lessons from Upstate
page 16
Ask the Expert
page 19
Science Is Art Is Science
back cover
Back pain, birth control, cancer cure and more page 18
page 21
On the cover: Annette Adams-Brown, actor and standardized patient. Story on page 21.
Rising rate of black lung disease
back cover
PHOTO BY DEBBIE REXINE
Health UPSTATE
Fall 2018
EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications EDITOR-IN-CHIEF
Amber Smith
WRITERS
Jim Howe Amber Smith
DESIGNER
Susan Keeter
Visit us online at www.upstate.edu or phone us at 315-464-4836. For corrections, suggestions and submissions, contact Amber Smith at 315-464-4822 or smithamb@upstate.edu ADDITIONAL COPIES: 315-464-4836 Upstate Health offices are located at 250 Harrison St., Syracuse, NY 13202
Upstate Health magazine is a community outreach service of Upstate Medical University in Syracuse, N.Y. Upstate is an academic medical center with four colleges (Medicine, Nursing, Health Professions and Graduate Studies); a robust research enterprise and an extensive clinical health care system that includes Upstate University Hospital’s Downtown and Community campuses, the Upstate Cancer Center and the Upstate Golisano Children’s Hospital. Part of the State University of New York, Upstate is Onondaga County’s largest employer.
need a referral? Contact Upstate Connect at 315-464-8668 or 800-464-8668, day or night, for appointments or referrals to the health care providers on these pages or anywhere at Upstate or for questions on any health topic.
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U P S TAT E H E A LT H
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Different types of aneurysms call for different types of repairs
PATIENT care
BY AMBER SMITH
WHEN A BLOOD VESSEL WEAKENS, a balloonlike dilation called an aneurysm sometimes develops. is happens most oen in the abdominal section of the aorta, the largest blood vessel in the body.
three ways oF repaIrIng abdomInal aortIc aneurysms
If an abdominal aortic aneurysm ruptures, it can be deadly, so learning whether you have an aneurysm and seeking treatment are important. Medicare pays for screenings for people who are at increased risk for what’s known in medical shorthand as AAA, says Michael Costanza, MD, a professor of surgery specializing in vascular and endovascular services. at includes people age 65 to 75 with a family history of aneurysms, and men who are, or were, smokers. Screening involves a painless ultrasound that provides doctors with images of the blood vessels.
Traditional open surgical repair
Costanza says the size of an aneurysm helps determine its treatment. “As the aneurysm gets bigger, the stress on the wall of the artery increases. When it increases too much, it would obviously break,” he says. “We would like to repair all aneurysms before they get to that breaking point.” Michael Costanza, MD Small aneurysms can be monitored without treatment, but aneurysms that are larger than 5½ centimeters in diameter are recommended for repair, Costanza says.
Repair originally meant a surgeon opened a patient’s abdomen, clamped the aorta above and below the aneurysm, and then replaced the ballooned area by sewing an artificial blood vessel in its place. at’s still an option for a minority of patients. Endovascular repair is the predominant method of repair today. Introduced in the late 1990s, endovascular repair eliminates the abdominal incision, instead using a needle puncture into a large vessel of the leg. Surgeons use X-ray guidance to pass a wire through the vessel and deploy a fabric-covered metallic stent to the area of the aneurysm. e stent reinforces the vessel without removing the aneurysm. Some patients have aneurysms that are located too close to their kidneys for using regular stents. In those cases,
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Endograft for AAA repair
Fenestrated endograft
Costanza offers a custom-made fenestrated endogra, a stent made with built-in openings for the kidney arteries. “e fenestrated endogra is a much more involved procedure, but it’s still all done through needle punctures. e patients still go home very quickly aer surgery,” Costanza says. He continues to see aneurysm patients every year, aer they have recovered from their repair. is allows the doctor to monitor the integrity of the repair and to be on the lookout for the development of any new aneurysms. To schedule your screening, contact Upstate vascular services at 315-464-1800 or 315-492-5881.●
abdomInal aortIc aneurysms are:
• more common in older men than in women, by a 3- or 4-to-1 ratio, but as women live longer, their rates of AAA are climbing. • responsible for the deaths of 30,000 Americans per year and are the 10th leading cause of death among older men. • typically located in the abdominal space between the lower breastbone and belly button. • likely triggered by environmental factors, such as smoking, although they are thought to have a genetic component.
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PATIENT care
Getting back on her feet
Deeply humbled during recovery BY JACKIE WARREN-MOORE
IT WAS SURREAL. I remember the dark, almost slowmotion fall. e scream, mine. en the confusion, pain, red lights, movement and assurances that I would “be fine.” I was in Upstate University Hospital downtown. I had tripped over my 100-pound German shepherd and fractured the femur in my le leg. ings were not looking “fine.” Aer the emergency surgery, the surgeon smilingly informed me that he had to “be very creative” to put my leg back together, but aer rehab, I’d be “fine.” ere was that word again. And I knew I’d have to do my own assessment of fine. I was told I could not put any weight on that leg. My one attempt to put weight on it assured me they were right. ey also assured me the place for me was at the Physical Medicine and Rehabilitation Program at Upstate’s Community Campus. I’d previously witnessed scenes on television of people in physical therapy, but my focus had always been on the person between the bars struggling for that first step. Now, I was deeply humbled to have some incredible people inside those bars with me. I was the one teetering and struggling to stand and attempting a first step. A young man (I later found out in conversation that he knew my oldest grandson) stood behind me, soly saying, “I got you,” as he held onto the strong Velcro belt that encircled me. ere was the physical therapist, small yet strong, who stood in front of me, gently nudging her foot beneath my le foot and urging me not to put any weight on my foot. She talked to me about what she planned to do on her upcoming vacation to California. I recall the gentle slap to my hand as I tearfully admitted my pain level. On a scale of 1 to10, it was a 9. e beautiful, sassy young registered nurse assured me she’d return with medication and that I’d be “fine.” ere were the daily visits of the so-spoken nurse practitioner who knelt beside my bed and proclaimed my leg looked good and was healing well. During the course of nearly a month, I was oen seated in a welcome shower with an occupational therapist who shared the plans of her teenage son’s prom and the description of his tuxedo while teaching me how to shower with my weight on only one foot. I’m grateful to the strong male aide who I discovered loved brown-eyed Susans as much as I do. We discovered this as he lent me his strength as I made the “slide transition” from a commode to my bed.
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Author Jackie Warren-Moore shares her story. Below: her dog, Sasha PHOTO BY ROBERT MESCAVAGE
I could go on and tell about the woman on evenings who always made me laugh and showed me pictures of her beautiful 14-year-old granddaughters. I could tell you about the ever-helpful young aide who shyly told me her dream is to become an RN. ese people and others will forever be a part of a most difficult, yet hopeful, part of my life. ey are part of a highly professional and uncommonly compassionate group of caregivers. We are fortunate to have them in our community. In mid-June, I rolled in a wheelchair down a ramp on the side of my house, constructed by my 12-year-old grandson and my husband. I sat in my backyard, listened to the birds, felt the breeze on my face, stretched out my healing leg to the sun. I’m fine. ● This essay originally appeared on Syracuse.com, where Jackie Warren-Moore regularly writes. She is a poet and playwright whose latest book is “Where I Come From” (Nine Mile Books, 2016).
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‘A perfect example of why we became doctors’
PATIENT care
Survival depended on a medical team, skillful surgery and a patient’s will to live BY AMBER SMITH
PAT GRAHAM OF LANSING wasn’t feeling well the evening of Aug. 31, 2017. A self-described borderline diabetic, he asked his wife to bring a glucose test kit when she came home from her job at Rite-Aid. By the time she arrived, Graham felt worse. He was in no pain. He just felt lethargic. Something wasn’t right. “You better get me an ambulance. I just don’t know what’s happening,” he said to her. Turns out, Graham had an aggressive, life-threatening infection. He remembers being loaded into an ambulance but was unconscious until he was transferred to Upstate University Hospital, where myriad doctors, nurses and technicians worked to save his life. “He came in very sick and basically had to be taken to the operating room emergently, just to stabilize him,” says Joe Jacob, MD, one of the urologic surgeons who took care of Graham. “If he wasn’t taken to the operating room immediately, the infection would have killed him.” At age 59, Graham faced a grim decision from his hospital room. e odds were not in his favor. When he arrived at Upstate, a team of doctors diagnosed Fournier’s gangrene, and it was clear that the bacterial infection ravaged his
body. He could go home and prepare for an imminent death. Or, he could submit to a risky operation to remove the infected tissue. “He had only a 10 percent chance of survival,” recalls his wife, Margery Lipinski. Graham decided he wanted to live. Within the next 10 hours, Graham would undergo two major operations, the first by Jacob and the second by Gennady Bratslavsky, MD, the chief of urology at Upstate. ey removed more than 60 pounds of infected tissue. During that scary time, one thing stood out to Graham. Bratslavsky asked his wife for her cellphone. Nervous and confused, she handed it over. e surgeon punched in his personal number and handed the phone back, telling Lipinski she should call him — anytime — with any concerns. Graham spent 20 days in the hospital, many of them in the care of surgeon Lucy Ruangvoravat, MD, and her team in the intensive care unit. Life-threatening infections like the one Graham had frequently have detrimental effects on the heart, lungs, kidneys and other organs, requiring the advanced intensive care for which Upstate is known. Ruangvoravat says many of her patients with severe continued on page 7
From left: Urology chair Gennady Bratslavsky, MD; trauma surgeon Lucy Ruangvoravat, MD; patient Patrick Graham; Graham’s wife, Margery Lipinski-Graham; plastic surgeon Prashant Upadhyaya, MD; and urology residents Jeffrey Spencer, MD; Priyanka Kancherla, MD, and Garrett Smith, MD. PHOTO BY SUSAN KAHN
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‘A perfect example’
PATIENT care
continued from page 6
infections are transferred to Upstate from hospitals in surrounding counties, so they can benefit from the expertise of the ICU team, comprised of doctors from a variety of specialties.
Graham’s surgical wound, le open to heal, continued to drain. He underwent another surgery, this one with plastic surgeon Prashant Upadhyaya, MD, to have more dead tissue removed. Upadhyaya closed the wound. Graham’s recovery progressed. “I think the reason he did so well is because he was so motivated,” Upadhyaya says. “He did exactly what we told him to do. He and his wife were a great team. “He’s a perfect example of why we become doctors.” Graham was within hours of death when he arrived at the hospital. Swi medical intervention, skillful surgery and a will to live pulled him through. For the health care providers involved, says Upadhyaya, “It’s very gratifying.” Graham has a scar stretching about three feet, from one hip to the other. “Without Dr. Bratslavsky and Dr. Upadhyaya and the team of people working with them, I wouldn’t be here today,” he says.
what Is FournIer’s gangrene?
A bacterial infection that grows from a small cut or pimple in the groin area may develop into a lifethreatening condition known as Fournier’s gangrene. People with diabetes or a compromised immune system are more prone to this type of aggressive infection. Its progression can be sudden, rapidly causing multiple organ failure and death. Even with swi medical care, antibiotics and surgery, the death rate is high. Fournier is the name of the French doctor who described five cases in clinical lectures in 1883.
Gennady Bratslavsky, MD, and Patrick Graham greet each other at the Urology Outpatient Center at Upstate’s Specialty Services Center at 550 Harrison St. , Syracuse. PHOTO BY SUSAN KAHN.
A big part of Graham’s recovery hinged on improving his overall health. at meant losing substantial weight. Bratslavsky expected Graham would do it. “I could sense that, for him, this had been a life-changing experience.” Bratslavsky challenged Graham: Could he change the way he ate to improve his health? Could he eat vegetables and healthy proteins and ditch the sodas, the pizzas, the pastas and breads? “When he told me this, it sounded like it was going to be the end of the world,” Graham admits. “But aer a couple weeks, I didn’t even miss it.” A year later, he’s dropped 190 pounds. ● Patrick and Margery Lipinski-Graham, a year after his life-saving surgeries. PHOTO BY SUSAN KAHN.
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Facing a crisis
Meet the Upstate experts working
BY AMBER SMITH
SOLVING THE OPIOID CRISIS is a team effort. Many Upstate people are involved, in multiple ways. Some are caregivers, helping those impacted by substance abuse. Some teach how to alleviate pain without using opioids. Some work to prevent addiction. Some are family members, touched in personal ways by the epidemic.
Here’s how they contribute.
The toxicologists
How did we reach the point where deaths from opioid overdoses (more than 42,249 in 2016) surpassed deaths from gun violence (38,658 in 2016)?
Willie Eggleston blames overprescribing of opioid pain medications such as oxycodone and aggressive ad campaigns from drug manufacturers. e use of opioids began William Eggleston, PharmD increasing in the late 1990s when medical experts began putting more importance on pain control. Nurses started asking patients to assess their level of pain as “the fih vital” when they recorded their four vital signs: pulse, respiratory rate, temperature and blood pressure. Eggleston is a doctor of pharmacy who works in the Upstate New York Poison Center, specializing in opioid addiction and harm reduction. He leads the Opioid Research Center for Central New York, a group whose mission is to reduce the impact of the opioid crisis by making the best use of existing resources and expanding access to treatment.
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PATIENT care
The opioid epidemic is fueled both by the abuse of street drugs such as heroin and the addiction to prescription pain killers. The Centers for Disease Control and Prevention says prescription opioids contribute to 40 percent of all opioid overdose deaths in the United States.
to solve the opioid epidemic Aer prescription painkiller abuse was recognized as a problem, the number of opioid prescriptions began to decline in 2010. Today, doctors in New York are limited to prescribing seven days’ worth of opioids. Eggleston says the crisis is like a sinkhole that suddenly opened. “We covered the sinkhole, but we didn’t bother helping those who had already fallen in.”
Without their prescription opioids, many people turned to heroin or synthetic opioids such as fentanyl. Such street drugs are dangerous because buyers don’t know what they’re getting, or the concentration. Brett Cherrington, MD, a doctor of emergency medicine with a specialization in toxicology says, “all of our heroin is now laced with fentanyl, and a lot of times when people purchase what they think is heroin, they get fentanyl.”
In an effort to minimize the side effects of opioids, which include constipation and drowsiness, some people mix an opioid along with an “upper” such as cocaine. Cherrington points out that’s also dangerous. Too big of a dose of opioids can cause a person to stop breathing. Emergency responders are equipped with a drug called naloxone that can reverse opioid effects. Regular people have also been trained in how to administer the rescue medication, which can be purchased at pharmacies throughout New York state. Eggleston says the availability of naloxone throughout CNY is helping save lives. Still, officials from the Drug Enforcement Administration say that more people report using controlled prescription drugs than cocaine, heroin and methamphetamine combined.
Brett Cherrington, MD
Fentanyl is a drug that is used in hospitals for pain control. It’s more potent than heroin, so the overdose risk is greater. A similar drug called carfentanil is used in veterinary medicine to tranquilize elephants. It’s 100 times more potent than fentanyl — and responsible in 2017 for strings of overdose deaths including in Central New York. Also that year, the Upstate New York Poison Center
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handled 59 cases of people who abused or overdosed on anti-diarrhea medication containing loperamide, an opioid. At least four of those people died.
The emergency doctors
Doctors working in the emergency departments at Upstate’s downtown and community campuses combined saw more than 1,000 patients in 2017 who were overdosing or struggling with addiction, reports Jay Brenner, MD. As with smoking cessation, he points out, “Catching people when they’re at their sickest, for counseling, is sometimes when you can catch people most willing to reconsider their lifestyle choices.”
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PATIENT care
Opioid abuse has reached crisis point But the emergency department is where lives are saved and patients are stabilized. It’s not designed for more involved drug interventions. Typically, emergency doctors would send those patients home with referrals to addiction treatment programs. Ross Sullivan, MD, said that wasn’t working. Oen it took days or weeks to get an appointment, and in the interim, many patients continued using opioids to stave off withdrawal.
e number of opioid deaths in Onondaga County dropped to 91 in 2017 from 142 the year before. Sullivan says that doesn’t mean fewer people are using opioids. As hopeful is he is that patients will stop using, he wants them to be safe if they don’t. He provides prescriptions for naloxone, the rescue medicine that can reverse an overdose, and instructions about using clean needles. “You don’t cure addiction,” Sullivan explains. “You learn to live with it and manage it.” Jay Brenner, MD
“ere had to be a different way to help these people, to make them safer, to make them healthier,” he says. Sullivan is one of fewer than 1 percent of emergency physicians who are also certified in addiction Ross Sullivan, MD medicine. In 2016 — the year 142 people died in Onondaga County from opioid overdoses — Sullivan established what he calls the bridge clinic. It’s a service that bridges that gap between the patients’ trip to the emergency department and their entry into addiction recovery. How it works today is, patients at the emergency department who want help getting off opioids receive a dose of buprenorphine, a tablet that melts beneath their tongue, and can help decrease drug cravings and suppress the symptoms of withdrawal for up to three days. ey also receive a follow-up appointment a few days later at Upstate. At that appointment, the patient meets with Sullivan, specialists in social work and case management, plus a “peer,” someone who is years into recovery. e patient may need help obtaining health insurance, food stamps, housing or other important services, things that need to be stabilized “before we can even think about them doing all the work they need to do to try to conquer their drug addiction,” Sullivan explains. He sees about 60 patients per month, some for up to three to four visits as they prepare to enter treatment. Sullivan says 75 to 80 percent go on to enter addiction treatment, the majority in outpatient programs in the Syracuse area. “e most rewarding thing about this work really is when a patient thanks you, and they can look you in the eyes and tell you how their life has changed,” he says.
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continued from page 9
The infectious disease specialist
Overdose is not the only risk in abusing opioids. Deaths are just the tip of the iceberg, says Timothy Endy, MD, professor and chair of Upstate’s microbiology and immunology department and an expert in infectious diseases. He’s concerned about two sets of people: those who share needles and spread infections such as hepatitis C and the AIDS virus, and those who introduce bacteria into their bloodstream when they inject a needle through skin that is not sterile. “at’s really the problem we’re seeing related to IV drug use,” Endy says before detailing the skin abscesses, muscle and bone infections that lead to paralysis or bacterial endocarditis, an infection of the heart valves. In 2011, five patients were treated for bacterial endocarditis at Upstate University Hospital; the number climbed to 37 in 2017, Endy says. “is is the underbelly that we don’t really talk about, and that the public should be aware of.” Such serious infections can require lengthy hospital stays and lifelong medical care, depending on how far the infection has progressed. If caught early, bacterial endocarditis can be treated with a six- to eight-week course of intravenous antibiotics. “e problem is, we do it through a special intravenous line called a PICC line that can stay in place for several months. With addicts and opioid users, they’re not capable of going home with PICC lines because of the potential for misuse. So they end up staying in the hospital for eight weeks,” he says. Drug addicts also are likely to have nutritional deficiencies, and their immune system is likely to be depressed because of poor nutrition and opioid use. ey may also require heart valve replacements, he says, recalling a 20-year-old who recently had to have two valves replaced. “ese are serious medical problems.” Endy speaks from experience not only as a medical provider — but also as a parent. continued on page 11
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PATIENT care
Focusing on the crisis continued from page 10
The parent
Endy’s son, Justin started misusing drugs in high school and had developed a serious heroin addiction by the age of 24. He overdosed twice. Both times he was saved with a dose of naloxone and wound up in the emergency department of Upstate University Hospital. Justin Endy spent time in jail. He failed two outpatient rehabilitation programs. ree times he tried to stop using cold turkey.
Timothy Endy, MD
“Watching him, we realized he was slowly dying,” Timothy Endy recalls of that time in 2016. “My wife and I felt like he would die in the next couple of weeks. Our son was just exhausted. We knew we had to get him into a program.” With help from a recovery specialist, they enrolled him in a 30-day residential detoxification program called Sierra Tucson in Arizona, followed by a structured yearlong 12-step program called Bringing Real Change in Austin, Texas. “e transformation in Justin was dramatic,” Endy says. “He says he has finally found peace and serenity.” e Endys’ health insurance plan did not cover the recovery programs, so the Endys paid for the treatment on their own. Subsequently, they helped sponsor 10 other people who were struggling with addiction and recovery through a charitable foundation they created at road2recoverycny.com
The addiction specialists Some people require inpatient treatment. Others succeed through outpatient detoxification programs.
Be aware: Emerging opioid substitute A DRUG USED in other countries to treat depression — and also anxiety, asthma and irritable bowel syndrome — has the potential for abuse and addiction. Tianeptine is sold under the trade names Stablon and Coaxil in Asia and Latin America and obtained through Internet channels in the United States. Poison centers in New York state handled nine cases of tianeptine overdose between 2000 and 2017, according to research by Upstate doctors of pharmacy Jeanna Marraffa and Christine Stork. One case involved a child who accidentally ingested the drug. en there were five people who meant to abuse the medication, and three who had problems while taking a therapeutic dose of the medication. Marraffa and Stork note that five patients described symptoms of opioid withdrawal, and in two cases, patients received naloxone, a medication that can save people from opioid overdose.
“We have not cured one person of addiction, but we have gotten people into recovery,” says psychiatrist Brian Johnson, MD, director of addiction medicine. Upstate Addiction Medicine is a holistic medical practice Brian Johnson, MD that offers detoxification and treats chronic pain. Walk-in appointments (if you call ahead, at 315-464-3130) are available weekdays, and patients are asked to bring a non-addicted support person with them.
Jeanna Marraffa, DPharm
Christine Stork, DPharm
continued on page 12
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Experts work to solve opioid epidemic continued from page 11
“If there’s a loved one involved, the chances that people are going to remain sober greatly increase,” explains psychiatrist Sunny Aslam, MD. at first appointment is lengthy. Some patients will make daily visits until they stabilize, and then they may come in weekly. Johnson says he’s seen more than 17,000 patients successfully detox from opioids, Sunny Aslam, MD alcohol and other substances. He prescribes buprenorphine, plus other medications that help with gut cramps and anxiety. “ey go home with their support person,” he says. “A week later, they’re off opioids, and it was no big deal.” One month out, he says 60 percent of those who stopped taking opioids remain sober. He says some people relapse and go through additional rounds of detox. He explains that drugs change the brain permanently. at’s why people continue to attend Alcoholics Anonymous even if they stopped drinking years ago. “Once you reintroduce the drug into the brain, it turns on ferocious cravings that have been dormant,” Johnson says. “If you’re addicted to tobacco, you can’t go back to cigarettes once in a while. If you’re addicted to alcohol, it’s the same. If you’re addicted to opioids, it’s the same.”
The pain specialist
Withdrawal from opioids can feel 100 times worse than the flu, with severe vomiting, diarrhea and stomach cramps. Many people who are addicted to pain killers “are not looking to get high. ey just do not want to go through withdrawal,” explains nurse practitioner eresa
Baxter. “ey’re just so desperate to feel normal. ey did not wake up saying, ‘I want to be a heroin addict’ today.” She explains that opioids are “very effective in treating that immediate, acute pain, aer a surgery or aer a terrible injury. e problem is when we continue them long term. ey’re a lot more addictive than we thought.”
Theresa Baxter, NP
Also, with long-term use, opioids increase a person’s sensitivity to pain, she says. It’s called opioid-induced hyperalgesia. Opioids are not the only way to treat acute pain. Baxter advocates for the use of acetaminophen, ibuprofen and muscle relaxants. Nerve blocks can also be helpful, depending on the type of pain. She cares for patients with chronic pain, too, many of whom get relief from massage, chiropractic care, weight loss, muscle and core strengthening, cognitive behavioral therapy and/or medical marijuana. Not everyone can expect his or her pain to disappear. Baxter’s goal is to restore functionality, so people can go on with their lives.
The scientist
Opioids act on opioid receptors located on nerve cells throughout the brain and nervous system, producing an analgesic effect. Until recently, scientists assumed that all opioids – those produced by the body, and those ingested as drugs – interacted in the same way with opioid receptors. Recent continued on page 13
Opioid Vocabulary
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BUPRENORPHINE - an opioid medication used to help decrease drug cravings and suppress the symptoms of withdrawal.
NALOXONE – a medication that rapidly reverses the effects of opioids and can save a person from overdose.
METHADONE – an opioid medication used to help taper people off an opioid addiction.
OPIOIDS – a class of drugs that includes the prescription opiate medications codeine and morphine; plus semi-synthetics and synthetic drugs hydrocodone, oxycodone, fentanyl and others; and the illegal drug heroin.
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PATIENT care
Solving the epidemic continued from page 12
research has shown differences that may help guide the design of new non-addictive pain relievers. Not only that. Recent research has also shown the potential for impacting the effect of opioids on the brain by inducing an anti-opioid immune response. An experimental heroin vaccine induced an immune response that prevented heroin from traveling into the brain through the bloodstreams of laboratory animals, according to a study published in the Journal of Medicinal Chemistry. “By eliciting antibodies that bind with heroin in the blood, the vaccine aims to block the euphoria and addictive effects,” Gary Matyas, MD, told Science Daily. He is from the U.S. Military Research Program at Walter Reed Army Institute of Research. “We hope to give people a window, so they can overcome their addiction.”
Stephen omas, MD, professor of medicine and microbiology and immunology at Upstate, is excited by the prospect. “A heroin vaccine could play an important role in a comprehensive approach to treating people who are suffering from substance abuse disorders,” he says. Upstate and Walter Reed researchers have been awarded Stephen Thomas, MD a grant to advance the development of an experimental heroin vaccine. If successful in early development, a second grant award will support testing the vaccine in human volunteers. e clinical trial would be performed by Upstate in Syracuse. ●
Contact information:
Upstate Addiction Medicine, 315-464-3130 l Road2RecoveryCNY.com
TRUEBEAM RADIOTHERAPY AVAILABLE IN ONEIDA The expansion of cancer services in Oneida includes the TrueBeam Radiotherapy System. Fast and powerful, TrueBeam provides highly precise, threeWelcome! dimensional treatment for tumors Linda Schicker, MD, in critical locations such as prostate, is accepting pancreas, liver, head and neck, as new patients. well as tumors affected by breathing motion, including lung and breast. Upstate’s radiation oncologists: Paul Aridgides, MD, Seung Shin Hahn, MD, Anna Shapiro, MD, Alexander Banashkevich, MD, Jeffrey Bogart, MD, Michael LaCombe, MD, and Michael Mix, MD
Cancer Center at oneida
The Upstate Cancer Center offers a comprehensive team-based approach, the latest technology and state-of-the-art treatments including access to national clinical trials. If you’re facing a diagnosis of cancer, explore your treatment options — close to home.
603/605 Seneca St., Oneida, NY l Radiation Oncology: 315-606-5045 l Hematology/Oncology: 315-361-1041
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U P S TAT E H E A LT H
FROM OUR experts
7 facts about stroke
1.
5.
you probably didn’t know
2. 3. 4. 14
people having strokes usually are able to hear and comprehend what’s happening around them. at’s because the parts of the brain responsible for hearing and comprehension are rarely affected by stroke, explains stroke neurologist Hesham Masoud, MD. e exam he conducts on patients reveals how much the stroke is affecting comprehension and their ability to express themselves, and he talks to the patients as he conducts the exam, since he knows they can probably hear him. If doctors believe you are having a stroke, an imaging scan is essential. About 20 percent of strokes happen when a blood vessel bursts. About 80 percent happen because of a blockage to an artery. e treatment for each is very different, so doctors must determine which type of stroke is happening, and fast. up to a third of the people who appear to be having strokes turn out to have other medical problems that mimic strokes. Plenty of medical conditions (including seizures or urinary tract infections) cause a person to behave in an unusual way, to have an altered mental status or trouble talking. “Any neurologic deficit that is new is a stroke until proven otherwise,” Masoud says. He implores people to seek emergency care promptly. a short-term stroke whose symptoms resolve is a harbinger of a larger, more damaging stroke. ey may be labeled TIA, transient ischemic attack; RIND, reversible ischemic neurologic deficit; or mini stroke. Regardless, “any stroke is brain damage, and any stroke needs to be treated,” says Masoud. “If you have a neurologic symptom that is sudden in onset, whether it improves or not is irrelevant to me. I want you to come to the emergency department immediately, and I want you to be worked up for it. If it’s something minor, you may get your workup as an outpatient in the clinic. You may not need to be admitted. But the first step is not to make that assumption.”
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6. 7.
many people have medical conditions that increase their risk for stroke – but don’t realize they have these conditions. Two of the biggest are uncontrolled high blood pressure and an irregular heart rhythm. ese conditions are sometimes discovered aer a person has a stroke, and their treatment becomes important in prevention of additional strokes. about a quarter of stroke patients may not learn why their stroke happened. e cause may not be readily apparent in 20 percent to 30 percent of patients. Doctors may be able to pinpoint a reason as they care for a patient, but sometimes, especially in younger patients, the cause remains a mystery. rehabilitation can make a huge difference in a patient’s recovery. Masoud oen shares brain scans with patients and loved ones to facilitate discussions about the extent of damage. He explains that the length and quality of rehabilitation, and the patient’s level of engagement, influence how much functional recovery he or she will have. at’s why early on, he declines to make recovery predictions for individual patients.
three ways to help while you wait for the ambulance If you call 911 because you suspect someone is having a stroke, here’s what you can do before the paramedics arrive: • Make sure the person continues breathing, and if his or her condition changes, make another call to 911. • Take note of the time the person was last seen behaving normally. Doctors need this information to help determine treatment options. • Assemble a list of the medications the person takes, or collect the medication containers to bring to the hospital. SOURCE: NURSE JOSH ONYAN, STROKE PROGRAM MANAGER
upstate.edu l fall 2018
FROM OUR experts
In her own words
Stroke survivor JoAnn Wickman recalls the morning of Feb. 9, 2018 “I WOKE UP AT 5:20 IN THE MORNING. I woke up and thought, ‘What the heck is going on? Something’s not right,’” recalls JoAnn Wickman of Cortland. “I had this weird sensation. It felt like the tip of my tongue was somehow connected to my right cheek, with a strand like what I assume a spiderweb would feel like. It was such a weird feeling. It was pitch black outside, and I just woke up out of a sound sleep.
Or their Arm will be weak. e S stands for slurred speech. I say, ‘If something doesn’t seem right, it’s better to call.’ Wickman, herself, did not exhibit the classic symptoms of stroke. “I just felt weird,” she says. “In retrospect, why did I think it was a stroke? I don’t know, exactly, except for that sensation of my tongue being connected to my cheek. I was very fortunate.” ●
“Eventually I got out of bed and walked to the bathroom just fine. en I thought, ‘Something’s not right here.’ I still had this oddball sensation. “My heart wasn’t beating fast. I wasn’t dizzy. I come from a long line of people who have died of heart attacks and strokes, so I’ve been pretty vigilant about paying attention. I’ve never had any heart issues. But my blood pressure had been spiking, and it was under a doctor’s care. “I thought about how I would say, ‘Ken, wake up. Call 911. I think I’m having a stroke.’ at’s not a complicated thing to say, but my tongue wouldn’t work. I could only say ‘Ken.’ Her husband called 911. As the ambulance took her to nearby Cortland Regional Medical Center, Wickman, who was 75 at the time, remembers that she felt fine, but her blood pressure was high. “267 over something,” she recalls. A blood pressure of 120/80 is considered normal. “ey did a CT scan, and the physician came in and said, ‘ere’s something weird about this CT scan.’ So they did an MRI, and the physician came in and said, ‘I want you at a stroke center. Where do you want to go?’ Wickman chose Upstate. “By noon, exactly at noon, I was in my room at the stroke center, where I stayed for five days. By this time, I’m chatting away and walking fine. “ey did what seemed like 10,000 tests. When they looked at the MRI, it was pretty subtle, but there were two spots where they found the stroke took place that made sense with my symptoms. “e interesting thing about all of this is, nobody knows why I had the stroke. “What was memorable to me is that the care at the stroke center was exemplary and respectful. I never felt anyone was talking down to me. All kinds of people came in and out. Most people said, ‘You are so fortunate you knew what to do, and that you did it.’ “I tell people to remember FAST. Most of the time if a person’s having a stroke, their Face will look funny.
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JoAnn Wickman BY SUSAN KAHN
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FROM OUR experts
LESSONS FROM UPSTATE
Consider checking newly diagnosed diabetics for pancreatic cancer BY AMBER SMITH
ONE OF THE REASONS pancreatic cancer is so deadly is because early symptoms are so vague. “e majority of cases are diagnosed at an advanced, incurable stage,” a team of Upstate doctors writes in the American Journal of Emergency Medicine. Oncologist Rahul Seth, DO, and colleagues go on to explain that controversy exists among medical professionals about a link between diabetes and pancreatic cancer. ey tell of a 59-year-old woman who was diagnosed with type 2 diabetes by her primary care doctor and prescribed insulin. Five days later, she came to the emergency room saying that she was confused and lethargic, with muscle aches and worsening abdominal pain. ose are symptoms of diabetic ketoacidosis, known in medical shorthand as DKA. It’s a life-threatening complication of diabetes that can be prompted by an infection, severe stress, inadequate insulin therapy or other reasons including, although rare, pancreatic cancer. She was admitted to the intensive care unit of Upstate University Hospital for intravenous insulin therapy and hydration. During her three-day stay, medical images of the woman’s abdomen revealed a tumor in her pancreas and some suspicious cells of her liver. Biopsies of both areas confirmed pancreatic ductal carcinoma. Like 85 percent of people diagnosed with this type of pancreatic cancer, her disease was at an advanced stage, and surgery was not a treatment option. When caught early, before it has spread, pancreatic cancer can be cured with surgery.
Seth indicates in the journal article that this woman’s pancreatic cancer probably prompted her DKA symptoms. His colleagues include physicians who are completing their residency training at Upstate: Danny Markabawi, Divya Kondapi and Vikrant Tambe. e article references multiple medical studies. Some show that diabetes and hyperglycemia, which occurs when blood sugar levels are too high, are risk factors for the development of pancreatic cancer. Others suggest that hyperglycemia and diabetes might be caused by pancreatic cancer-associated pancreatic failure. It’s difficult to discern which happens first. People who are newly diagnosed with diabetes have up to an eight times higher likelihood of being diagnosed with pancreatic cancer within three years, according to research that examined medical images and blood sugar values of people before they were diagnosed with cancer. Another study suggests that diabetes associated with pancreatic cancer occurs at a stage when surgery might still be an option. at’s why Seth and colleagues propose “it might be worthwhile to consider screening patients with newly diagnosed diabetes mellitus for early-stage pancreatic cancer when other risk factors for diabetes mellitus are absent.” ey say it’s rare, but symptoms of diabetic ketoacidosis can be a clue to pancreatic cancer, especially when the most common causes of DKA are absent. ●
pancreas shown in red
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upstate.edu l fall 2018
FROM OUR experts
HOME GENETIC TEST KITS Some things to think about before you buy BY AMBER SMITH
IF YOU’RE INTRIGUED by offers of direct-to-consumer medical genetic testing, Robert Roger Lebel, MD, director of medical genetics at Upstate, offers something to consider. Let’s say you come from a family with many members who have had breast cancer, and you’re interested in knowing your risk. Many genes are associated with breast cancer. e genetic testing company you select may focus on a couple of different mutations in the most well-known of those genes. When your results show you do not have an increased risk for the breast cancer associated with that particular mutation on the BRCA gene, “You may think that you have investigated the question and have your answer, when you really don’t,” Lebel says. “If you talked with a board-certified genetic counselor about this, he or she might tell you that there are actually 50 different genes that could be of interest in regard to your family’s presentation. You were tested for two different things in one gene. You were not tested for thousands of things in dozens of genes.” Genetic home testing can be useful, Lebel says, in the case of positive findings. e tests cannot tell you that you will develop a particular disease. “ey can identify factors that tell you that your risk is higher than that of a member of the general population.”
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So, if your results show an increased risk for breast cancer, ovarian cancer and pancreatic cancer, “then you could talk to somebody with expertise about how to use this knowledge to minimize your long-term risk,” he says. “It would allow you to talk to your physician about how to watch for early signs.”●
WHAT ABOUT GENEALOGY? Ancestry.com, 23andMe and others offer tests using saliva samples that explore deep ancestry. “ey won’t tell you the name of your great-grandfather, but they will tell you whether your great-, great-, greatgreats came from Northern Africa or Eastern Europe or Southeast Asia,” says Lebels. How do the tests work? We all have genes or DNA sequences on chromosomes known as markers. “Some of those markers are very common in certain parts of the world and very uncommon in other parts,” Lebel explains, “so that they are able to state with some statistical clarity where those markers would have come from. “If you’ve always said that you were of mixed European ancestry, German, Swedish, Czech and Hungarian, and you really want to know in detail whether you have, say, 3 percent of your genome from East Asia — which you might, because the Hungarian part might have descended from Genghis Khan — well, you can find out.” ●
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FROM OUR experts
UPSTATE
t
answers Q: “ere are things you can look for. What you see leading up to suicide is, usually people will withdraw socially. ey may start losing their ability to function, either at school or at work. ere are going to be more strained relationships. And, the person is usually more negative; when any issue is being raised, they have a real pessimistic kind of outlook on things.
t
A:
how can I help someone who may be suicidal?
“If you know this person’s hurting and in trouble, if you don’t ask the question, you’re not going to know. It’s easy for me to say, ‘Just ask the person: Are you having thoughts about suicide lately?’ It’s very hard to actually do, partly because of social stigma. You don’t want to insult the person. Some people are concerned it might put the idea into the person’s head. “What we know from research is, it doesn’t put the thoughts into the person’s head. It actually is protective. You’re actually diminishing the risk of suicide by asking about it. ‘Have you ever tried to hurt yourself?’ ‘How close have you come lately?’ ‘Do you think you might actually carry out those thoughts?’ “Someone who is at imminent risk needs to be evaluated — and may even need to be hospitalized — by a professional who can determine risk. Upstate’s Psychiatry High Risk Program offers evidence-based treatment for high risk youth and young adults who are not in need of immediate hospitalization. Call 315-464-3117. “Access to firearms is maybe the single most preventable thing that we can do as family or community. If there is someone at risk, make sure they don’t have access to firearms.” — PSYCHIATRIST ROBERT GREGORY, MD, DIRECTOR OF UPSTATE’S PSYCHIATRY HIGH-RISK PROGRAM
what’s the best way for
t
Q: athletes to determine how A: t
ese answers are excerpted from “HealthLink on Air,” Upstate’s weekly podcast/talk radio show in which experts share information on a variety of subjects. Listen at 6 a.m. or 9 p.m. Sundays on WRVO Public Media, visit upstate.edu/healthlinkonair, or search for “HealthLink” in iTunes or other podcast sources.
much water to drink when they train or compete? “You don’t need a formula. You don’t need to do any calculations. e rule is: Drink when you are thirsty. Your body actually knows what it is doing. It will make you thirsty if you need more water.”
— EMERGENCY PHYSICIAN JEREMY JOSLIN, MD, MEDICAL DIRECTOR OF ENDURANCE EVENTS AROUND THE WORLD
continued on page 19
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FROM OUR experts
UPSTATE answers continued from page 18
— RENEE MESTAD, MD, CHIEF OF GENERAL OBSTETRICS AND GYNECOLOGY
t
Q:
are immunotherapy drugs a cure for cancer?
“e jury is still out on that. We have patients with advanced cancer who were on these drugs in early clinical trials for two years, and now they have eight years of follow-up, and they are still in remission. So, I think immunotherapy has great potential. As with many therapies, we first use these drugs in patients with advanced disease. en, if they’re beneficial, we try them in earlier-stage disease, and that’s really where there may be greater potential for a curative effect.”
t
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— STEPHEN GRAZIANO, MD, CHIEF OF ADULT HEMATOLOGY ONCOLOGY
t
do women awaken to Q: why use the bathroom at night?
t
A:
“Most times, it’s systemic diseases, not necessarily related to just the bladder. It can be things like diabetes, heart disease or heart failure, even sleep apnea. Nocturia can also be the initial sign of depression.
“People who have fluid overload, or too much fluid in them, they can also urinate at night because when they lay down, the fluid shis, and they make more urine, and they then have to urinate. “It’s not uncommon to have this problem. If you’re having this problem, you should mention it because a lot of physicians don’t routinely ask, especially women, about urination at night. Unless you bring it up, no one knows it’s a problem for you. And, it’s important to make sure this is not the first sign of diabetes or heart disease.”
t t
— MAUREEN FRANKLIN, REGISTERED DIETITIAN NUTRITIONIST
Q: A:
If I had chickenpox as a child, and I’m 50 now, why do I need a shingles vaccine? “If you had chickenpox as a child, or if you don’t know if you had it, you are at risk for developing shingles later in life.
“e virus that causes chickenpox (varicella zoster) can actually remain latent in your nerve fibers, and then later in life can reactivate as the zoster virus, or shingles. We’re not exactly sure why it reactivates, but as we get older our immunity toward varicella starts to decrease. We might have other medical conditions or be on medications that suppress our immune system or our ability to fight off infection. “e Centers for Disease Control and Prevention now recommends healthy adults ages 50 years and older to get the Shingrix vaccine. It is the new, preferred vaccine. And that’s even if you already had the Zostavax shot previously. Zostavax, the old vaccine, has about a 70-percent efficacy that wanes over time. As you get older the efficacy of the vaccine actually decreases. In comparison, Shingrix is essentially a protein and an immune booster that are mixed together, and it has about 90- to 99-percent efficacy.” — PHARMACIST ALI SCRIMENTI, PHARMD
Q: A: t
— UROLOGISTS TIMOTHY BYLER, MD, AND MICKEY DAUGHERTY, MD
A:
t
“It’s called the lactational amenorrhea method, or LAM.”
“Look at what you’re doing. Are you drinking sodas? Are you eating processed foods? Are you NOT eating vegetables? Look at what you’re doing, and look at what can you change. Can you say, ‘I’m going to try to have a salad every day?’ Or, say you’re drinking two bottles of soda every day. Can you go down to one bottle, instead of saying, ‘I’m never having soda?’ You want to make a change in a way that it just gradually becomes part of your routine, and it’s not so drastic that it isn’t sustainable.”
t
t
A:
“As long as a woman is exclusively breast-feeding — she can pump and bottle-feed breast milk, but she cannot use any supplementation, no formula or anything else, whatsoever — it is effective birth control for six months. But aer that, it doesn’t work very reliably.
Q:
how do I begin to overhaul my poor eating habits?
does a firm mattress prevent back pain?
t
t
Q:
will a new mother get pregnant if she has sex during the time she is nursing her newborn?
“What I advise my patients is to sleep on the mattress that’s most comfortable. Some people like a firmer mattress, but there is no evidence that makes any long-term difference in your back health.”
— DARYLL DYKES, MD, ORTHOPEDIC SURGEON AND SPINE SPECIALIST
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Grateful for lifesaving medical advice
IN OUR communIty
FRED PRICE IS BEING TREATED at Upstate University Hospital for amyotrophic lateral sclerosis (ALS), which he has had for six years. It was unsettling when he learned that his doctor was moving to another state, but he soon learned he would continue to be provided with comprehensive care by another highly trained doctor, Eufrosina Young, MD Eufrosina Young, MD, director of the ALS clinic at Upstate. Price and his wife, Estelle, say they could not be more pleased with their new doctor.
is care was underscored when Fred’s health was further compromised when he fell and hit his head. As six weeks went by before debilitating symptoms appeared, Estelle Price associated them with ALS and not the fall. She placed a worried call to Young. Although Young recognized that the symptoms weren’t related to ALS, she immediately orchestrated Fred’s care — first from an airport from which she was traveling, then late at night following another urgent call from Estelle. Doctors in the emergency department were recommending immediate brain surgery for Fred. “Of course we were scared and needed reassurance what we were being told was the right medical treatment,” said Estelle. Young spoke with her medical colleagues and called back. She explained to the Prices what was happening, why the surgery was necessary and lifesaving, and reassurance that it was the correct next step.
Fred and Estelle Price
e Prices credit Young for saving Fred’s life with her continual responsiveness and turn to her to manage his care every step of the way, whether related to ALS or not. “We are so grateful for her extraordinary care, compassion and commitment to her patients,” Fred noted.
are you grateful? A gi of gratitude is a meaningful way to express appreciation to special caregivers and help patients during their time of great need. To donate to Friends of Neurology, contact the Upstate Foundation at 315-464-4416.
SURGERY AND RADIATION FOR BREAST CANCER IN AS LITTLE AS ONE DAY The Upstate Cancer Center is the first in the region to offer intraoperative radiation therapy (IORT) as a treatment option for early stage breast cancer. IORT can reduce or completely eliminate the need for weeks of follow-up radiation treatments. This means patients can get back to their normal lives, sooner. With IORT, the breast surgeon removes the tumor during the operation, then the radiation oncologist delivers a concentrated dose of radiation to the site. The localized, single treatment means healthy tissue is less impacted by radiation, thus reducing side effects. Talk to your provider to see if you are a candidate for intraoperative radiation therapy or call the Upstate Cancer Center.
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upstate.edu l fall 2018
Want to go to medical school – as a ‘patient?’
IN OUR communIty
BY AMBER SMITH
ONE WAY FUTURE DOCTORS and other health care providers learn is by practicing on people who pretend to be patients. Upstate Medical University has a corps of paid “standardized patients” who are trained to portray certain medical situations for students who conduct exams for practice before caring for real patients. Aerward, students receive feedback from faculty instructors, and from the patients.
“As instructors, we can give feedback from our expertise about communications, about what we saw as third parties,” says Steve Harris, director of Upstate’s clinical skills center. “What we can’t tell them is how did that patient feel when you were interacting with them. at’s what standardized patients can do that nobody else can do. ey’re here to say, ‘is is how you made me feel.’ ey’re going to give the student some feedback, so that hopefully when the student encounters a similar patient in the real world, they will have a better understanding of how their behaviors make patients feel.” Annette Adams-Brown has been a standardized patient since 2003. She has pretended to have abdominal pain, diabetes and osteoporosis, among other diagnoses. She has a background in theater production and acting, but both she and Harris stress that is not a requirement. “It’s very rewarding work, to know that you’re contributing to the educational quality of the medical industry,” she says. “Communication plays such a huge role in all walks of life.” Standardized patients work on a temporary as-needed basis. ey have to be at least 16 years old, with the ability to read and speak English. Harris says the program is especially in need of people in their 30s and 40s and people from a variety of ethnicities, races and sexual orientations. No acting experience or medical knowledge is needed. “is is about education,” says Harris. “Our point here is to help our students be better communicators.” ● To learn more or to apply for work as a standardized patient, visit upstate.edu/standardpatient Third-year medical student Craig Pille practices his patient-exam skills with help from actress and standardized patient Annette Adams-Brown. PHOTO BY DEBBIE REXINE
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IN OUR leIsure
Upstate nurse Isaac Kissi, playing for the Rochester Lancers in the blue jersey, has played soccer both professionally and for fun. PHOTO BY ROB DANIELS
Nurse prescribes soccer
( W H I C H H E P L AYS P RO F E S S I O N A L LY )
for fitness and fun BY JIM HOWE
TO ISAAC KISSI, soccer means many things. Kissi works as a nurse at Upstate while studying to become a nurse practitioner in Rochester, where he lives. A native of Ghana, he first came to the United States on a college soccer scholarship and plays professional soccer in Rochester. “It gave me a chance to change my life, get a scholarship and come to the States,” Kissi, 31, said of the sport. “It was
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my first livelihood, and it provides a different channel or escape to de-stress from working long hours of nursing.” He thinks almost anyone can enjoy playing soccer at some level to stay active and have fun — he also plays in informal lunchtime matches with people of varied skill levels and ages, just to keep playing. He offers these thoughts about soccer: continued on page 23
upstate.edu l fall 2018
IN OUR leIsure
Nurse prescribes soccer continued from page 22
equipment: “A good cleat is always vital; the right shoes give the right traction and ball control. en all you need is some soccer shorts, and throw a T-shirt on if you don’t have a jersey.”
how old can someone be and still play soccer? “I’ve seen guys still playing in their 70s. We have a lady who is close to 70, called Rosie (who plays in coed lunchtime pickup games with people of various skill and age levels). She is always smiling. It keeps the wheels turning. Playing soccer keeps you younger, but your body will get a bit sore aer you play. If you keep playing, once you have it in your heart, it keeps you young and fresh. It’s all about the attitude you put into it.”
how long will you keep playing professionally? “I think I will push till maybe 35, if the wheels are still going. I might go into coaching. I will keep playing, coaching, even being a nurse practitioner or whatever I’m doing at that time in the nursing profession, I don’t think I’m ever going to get away from the game.”
can soccer relate to your career? “It teaches you how to be a team player, and in nursing, you have to be a team player. In a team setting, you’ve got to be there for the guys on the field or for the nurses on the unit, when anything can change. It’s also my escape” from job stress.
describe the non-professionals you play informal soccer with: “Some of them are just there to get a good sweat and exercise. We always laugh and have good camaraderie. It’s a good thing, a good escape (from stress), it’s my way of life, I just love it.”
do you pursue other activities to bolster your soccer skills? “I go to the gym and work out. I do a lot of rehab workouts, where I’m not going too crazy but building muscles around my knees and calves, also my arms, as a forward, to look bigger (and intimidate opponents). I also ride a spin bike, which is better than running on concrete for cardio, then just getting out there to play with guys for cardio, too. Most of my exercises are rehab based. I’m still careful with my knee (see box), which still feels great right now.”
how do you advise dealing with injuries? “It’s very important you listen to your body, for sure. Be smart and draw the good line on where you push through the pain threshold or draw back and heal better.”
fall 2018 l upstate.edu
Kissi says soccer offers a good way to stay fit and deal with stress. PHOTO BY ROB DANIELS
Meet Isaac Kissi Age: 31. Born and raised: Ghana, West Africa, where his daughter, Giy Nyarkoa Kissi, 13, her mother and the rest of his family still live. Current hometown: Rochester. College: Won a soccer scholarship to the University of Dayton, Ohio, in 2007. Professional soccer career: Draed in 2010 to Major League Soccer, but a knee injury meant he never played in MLS. He played with the Rochester Rhinos, one level below MLS, from 2010 to 2012, and has had knee surgery and worked on rehabilitating his knee since then. He currently plays with the Rochester Lancers, one level below the Rhinos. Position: Midfielder (in college), forward (as a pro). Health care career: Nursing degree from the University of Rochester in 2016; worked as a nurse in various locales, including Upstate, where he now works part time in physical medicine and rehabilitation while enrolled in the U of R’s nurse practitioner program. Health care career goal: “Being a nurse practitioner specializing in family psychiatry, because I feel like a majority of what is going on medically is going to have a mental component to it. It’s about time we pay more attention to that, and it’s my way of trying to make a difference.” Other sports he plays: Volleyball and pingpong, neither of which he claims to play well.
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750 East Adams Street l Syracuse, NY 13210
SCIENCE IS ART IS SCIENCE IS ART 1S SCIENCE
Above: Slice of a coal miner’s lung. Black area shows progressive massive fibrosis. At right: Microscopic views of a coal miner’s lung. Top shows dark coal macules (collections of coal dust in the lung cells). Bottom shows dust in the lungs comprised of coal (black) and silicate (bright) particles.
Upstate pathology professor Jerrold Abraham, MD, and assistant professor Soma Sanyal, MD, are examining lung tissue from coal miners with black lung disease as a part of a large study into the reasons for a recent increase in the disease, which is also known as coal worker’s pneumoconiosis. e increase may have to do with changes in coal mining technology, as well as the enforcement of safety regulations, says Abraham.
IMAGES FROM THE LAB OF JERROLD ABRAHAM, MD
Abraham
Sanyal
18.287 1018 44.55M ELsk