Upstate Health, fall 2014

Health UPSTATE

UPSTATE MEDICAL UNIVERSITY

GESTURE OF LOVE

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FINDING CARE ON FACEBOOK page 8 GETTING TOO MUCH CALCIUM? page 10 HOW TO SPOT AUTISM IN BABIES

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TONY WINNER GOT HER START AT UPSTATE TRI-ING TO STAY FIT page 20

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Fall 2014

On the cover: Brandon Hudson, left, donated a healthy kidney to his father, Timothy.

He is with nurse Ellen Havens, living donor transplant coordinator at Upstate. Photo by Robert Mescavage

Health

KATHLEEN PAICE FROIO

Fall 2014

KidzBop performing for patients and families at the Kinney Performance Center, Upstate Golisano Children’s Hospital PUBLISHER Wanda Thompson, PhD, Senior Vice President for Operations EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications EDITOR-IN-CHIEF

Amber Smith

DESIGNER

Susan Keeter

Visit us online at www.upstate.edu or phone us at 315-464-4836.

For corrections, suggestions and submissions, contact Amber Smith at 315-464-4822 or smithamb@upstate.edu ADDITIONAL COPIES: 315-464-4836 Upstate Health offices are located at 250 Harrison St., Syracuse, NY 13202

Upstate Health magazine is a community outreach service of Upstate Medical University in Syracuse, NY. 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.

This issue brought to you by the number

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years ago, the Upstate Golisano Children’s Hospital opened its doors in a “treehouse” addition above Upstate University Hospital in downtown Syracuse. members of KidzBop visited patients at the children’s hospital in June.

patents are held by Gary Nieman, who recently received a $50,000 grant from the SUNY Technology Accelerator Fund to develop minimally invasive infusion and suction therapy, a novel medical device that removes harmful abdominal fluid buildup caused by trauma, infection or burns. miles per shift is the distance that environmental services workers typically walk, helping to keep the downtown hospital campus clean and disinfected, says John Kolh, operations manager.

medical mission trips to Ethiopia have been organized by otolaryngologist Rick Kelley, MD, in recent years to provide care and to train other ear, nose and throat doctors. thousand dollar donations to the Upstate Cancer Center are recognized on a ceramic tile mural in the healing garden. So far, 33 $5,000 gifts have been received.To honor your loved one in this space, contact the Upstate Foundation at 315-464-4416.

learning communities — consisting of medical students for the class of 2017, led by faculty members, Drs. Lawrence Chin, Robert Corona, James Greenwald, Michael Iannuzzi and Robert Silverman — are named after the Finger Lakes: Canandaigua, Cayuga, Keuka, Seneca and Skaneateles.

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WELCOME

Bus banners promote Upstate missions of care, research, education he most populated areas of this region are served by the Syracuse-based Centro bus service. Upstate banners appear on the sides of some of these buses.

Being at eye level, the advertisements dominate.

Many people see the banners, as the buses travel hundreds of miles per day. Upstate has a broad reach.

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This issue of Upstate Health illustrates that reach and the breadth of what we do with the variety of our articles.

SARA TUCKER

“Cancer care for all ages at Upstate” announces this bus, heading east on East Genesee Street, Syracuse.

You’ll find stories about the medical care we provide and the research in which we’re engaged. Some of our experts share their advice. (Too much calcium? Page 10. Signs of autism? Page 11. Need to burn 600 calories? Page 21) You will also meet some students – some of whom traveled to other continents as volunteers (page 15) and a pair who developed a case of puppy love as residents of downtown Syracuse (page 21.)

Find a roundup of Upstate news on page 4, a recipe on page 22, and cool scientific artistry on page 24, this time from the laboratory of assistant professor Mehdi Mollapour, PhD.

You will learn how Tony-winning actress Jessie Mueller got her start at Upstate (page 16), why nurse Sarah Martin loves kayaking (page 19), what author Walt Wasilewski learned while researching his book about spiritual care (page 14), and the question every doctor will ask himself or herself eventually (page 16.)

Contact Upstate Connect at 1-315-464-8668 or 1-800-464-8668, 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.

We hope you enjoy making Health part of your life.

Need a referral?

Contents PATIENT CARE A son’s life-saving gesture

cover story

page 5

Protecting the heart without touching it

page 6

Would you give a kidney to a stranger?

page 7

Facebook connection

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FROM OUR EXPERTS

IN OUR COMMUNITY

How to stave off Alzheimer’s with exercise

page 9

5 questions after a car wreck

page 9

Book shares spiritual care advice

page 14

Helping others, oceans apart

page 15

Talking – without words

page 17

Meet 7 volunteer firefighters

page 18

Are you getting too much calcium?

page 10

How to tell if your baby has autism

page 11

What to do when a tooth is knocked out

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IN OUR LEISURE

Protect yourself from food-borne illness

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One with her kayak

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Tri-ing to stay fit and healthy

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How to burn 600 calories

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Students afflicted by puppy love

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Herb-stuffed tomatoes with white beans

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IN THE KNOW Inside the new Upstate Cancer Center Searching for ways to inhibit cancer

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WHAT’S UP

News from around Upstate Medical University You may recall that four runners from Upstate were invited to compete in the JP Morgan Chase Corporate Challenge in London this summer for the 3.5-mile championship race.

They sent a group post card – a cut-out of Queen Elizabeth – saying “the race experience was one-of-a-kind and inspiring.

We connected with athletes from across the country and the world.”

Upstate’s MD/PhD program adds eight new students this year, bringing to 27 the total number of future physician/scientists.

The dual degree program sandwiches a three-year PhD research segment between the first two and last two years of medical school. ●

An initiative to decrease hospital re-admissions for heart failure patients, a program offering financial assistance for childbirth classes and an annual symposium that updates medical teams on advances in cancer care are among 61 projects at Upstate to share $120,000 in funding this year from the Advocates for Upstate Medical University. The Advocates raise money through events such as Mystery, Malt and Merlot to support hospital programs that improve patient care, support medical education and enhance health.

The Upstate team’s total time was 1 hour, 32 minutes and 39 seconds. John Kolh of environmental services finished in 21:24.

Exercise physiologist Kristin Kmack finished in 22:26. Chris Loughlin, a member of the electronic medical records technical team, finished in 24:13. And registered nurse Cara Lavier finished in 24:36. ●

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Speaking of money that helps society, researchers in the Department of Psychiatry received a $2.8 million Mental Health Research Grant from the National Institute of Mental Health. Over the next five years, they will investigate genetic susceptibility to a wide range of childhood psychiatric disorders.

Happy holidays: Did you celebrate the start of summer at the LEON Festival in June? LEON (“noel” spelled backward) marks the halfway point to Christmas. There were fireworks instead of tree lights, Kidz Bop instead of carols, and no snow.

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The Upstate Cancer Center received a $50,000 grant from the Susan G. Komen CNY Affiliate to help increase the rates of mammography screening in lowincome African-American women. The grant helps create a program called “She Matters,” which will use trained health advocates to educate, encourage and facilitate mammography screening among women over age 40 who live in Syracuse Housing Authority’s Pioneer Homes development in downtown Syracuse.

Staff from Upstate Golisano Children’s Hospital distributed 500 free bicycle helmets along with advice for keeping kids safe.

The celebration is expected to become an end-of-the-schoolyear tradition. ●

Construction is underway to expand the Joslin Diabetes Center so that more patients can be cared for at the center at 3229 E. Genesee St., Syracuse. ●

The American Academy of Sleep Medicine reaccredited the Upstate Sleep Center, which offers sleep studies for people of all ages. Its director, Robert Westlake, MD, says this “reaffirms our dedication to sleep health.” ●

Good news for the Master of Public Health program. It received a five-year accreditation from the Council on Education for Public Health. The joint program between Upstate Medical and Syracuse universities offers an MPH degree and a certificate program.

Students include physicians and other health care professionals, plus people just entering the field of healthcare. Part-time study is an option. Learn more at upstate.edu/cnymph/academic.

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Upstate is among nine State University of New York campuses to share $900,000 in funding for biomedical research projects supported by the SUNY Health Network of Excellence.

Gerontologist Sharon Brangman, MD, is involved in two of the projects – one that will investigate frailty through a collaboration with researchers at the University of Buffalo, Downstate Medical Center and Stony Brook University, and another that explores the creation of hand-held biosensors that could detect neural diseases such as stroke, Alzheimer’s disease and traumatic brain injury.

John Epling, MD, and Christopher Morely, PhD, received a planning grant to create a SUNY-wide centralized “big data” repository of electronic health record data.

GEM CARE community

campus

4900 Broad Road, Syracuse FOR MORE INFORMATION, CALL UPSTATE CONNECT AT 800.464.8668

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(the former Community General Hospital)

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PATIENT CARE

A life-saving gesture Son donates kidney to father

BY AMBER SMITH

ROBERT MESCAVAGE

Timothy Hudson at his Syracuse home with his son, Brandon. randon Hudson acts like it was nothing. His father, Timothy Hudson, sometimes has to pause. The 56-year-old Syracuse man is rendered speechless, overwhelmed by emotion, when he thinks about how Brandon donated one of his healthy kidneys to him.

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“I was fading fast,” the father recalls. “I don’t know how much longer I would have lasted.”

In June son and father became the 11th living donor kidney transplant pair at Upstate this year. They were the third set of African Americans, which represents an upward trend in recruiting people of color to donate organs for transplant.

African Americans are the largest minority group in need of organ transplant but make up a comparatively small percentage of people willing to donate, according to the Department of Health and Human Service’s Office of Minority Health. The National Kidney Foundation says African Americans have an increased risk of developing kidney failure because of high rates of diabetes, high blood

pressure and heart disease. That drives the demand for kidney transplants — and the need for kidney donations.

Transplant surgeon J. Keith Melancon, MD, says Central New Yorkers spend an average of four to five years on the waiting list. About a third will die before a kidney becomes available. Among the rest, some will receive kidneys from deceased donors. Others may have family members or friends who offer to be living donors.

“People who get transplanted pretty much have a normal life expectancy compared to people who have end stage renal disease and have to be on dialysis,” the surgeon says.

Hudson was on dialysis and not doing well.

He had been living what he believed was a healthy life about five years ago, running 5 or 6 miles a day, lifting weights, stocking his refrigerator with milk and healthy juices. Then he developed a cough, and soon he was struggling to breathe. At the hospital, he was diagnosed

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PATIENT CARE

Protecting the heart without touching it new style of implantable defibrillator provides protection against sudden cardiac arrest without having electrical wires placed in the heart. Instead, all components of the device are sewn into place just beneath the skin.

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The device — which The Heart Group of Syracuse cardiologists Traian Anghel, MD, and Jamal Ahmed, MD, began using this year at Upstate — monitors a patient’s heart rate and delivers a shock if necessary, “which essentially resets all of the electrical activity of the heart cells,” says Anghel.

He says a battery-operated pulse generator about the size of a deck of cards is placed beneath the skin below a patient’s armpit. A wire electrode stretches below the skin from the generator to the breastbone above the heart. It senses the heart’s electrical signals and transmits that data to the generator, and delivers therapy back to the heart if needed.

Implantable defibrillators have been in use for about 40 years. Earlier models rely on a wire to be threaded through a blood vessel, into the heart, across a valve and then attached to the heart wall.

Anghel says that for patients who are prone to a rapid heart rhythm called ventricular fibrillation, the risk of sudden cardiac death can be as high as 1 in 6 per year. He says an implantable defibrillator can significantly improve those odds. ●

A son’s life-saving gesture, continued from page 5 with congestive heart failure and kidney failure and admitted to the intensive care unit. Doctors were not sure he would survive.

When he was discharged, Hudson was on dialysis. His high blood pressure was closely monitored, and he took 35 medications per day. He developed pneumonia and other infections. Three years in a row, he spent his birthday hospitalized with some type of complication.

His 23-year-old son Brandon kept offering one of his kidneys for transplant. One of Hudson’s daughters and a brother offered, too, but were ultimately unable to donate.

Hudson did not believe Brandon knew enough about what he was offering. Plus, he says, “I didn’t want him to feel like he had to do this.”

Brandon wanted to see his father healthy again. He broached the topic of donating a kidney multiple times, “and Dad would be like ‘we’ll see.’ He was kind of just putting it off.”

To be a kidney donor, you must: • undergo thorough physical and mental evaluations, including kidney function testing, cancer screenings and a variety of other tests, which are organized by living donor transplant coordinator Ellen Havens.

• be free of health problems such as uncontrolled high blood pressure, diabetes, cancer, hepatitis, HIV and organ diseases.

• fully describe your reasons for wanting to donate, and the impact it will have on all aspects of your life.

When Brandon began speaking about creatinine levels — the byproduct of muscle metabolism excreted by the kidneys that doctors use to assess renal health — Hudson knew his son had done his homework. They agreed to pursue a living donor transplant.

• understand there will be no compensation, although some expenses may be covered.

Even on the morning of surgery, Hudson told his son it would be OK to back out. He pulled aside Melancon and Vaughn Whittaker, MD. “I don’t want anything to happen to me,” he told the two surgeons, “but PLEASE don’t let anything happen to my son.”

• consider that if you are not compatible with your loved one, you still may be able to donate to someone else. That person would supply a compatible donor for your loved one in what is called a “paired exchange.”

After the surgeries, the father and son spoke briefly by telephone as they recovered in their hospital rooms.

Brandon later took a wheelchair to visit his father’s room.

He just wanted to make sure he was all right. ●

• realize that complications could include pain, infection, blood loss, blood clots, allergic reactions to anesthesia, pneumonia, injury to surrounding tissue or other organs or even death. In addition, some donors report trouble obtaining or keeping life, disability and health insurance policies.

• learn your compatibility through blood tests, tissue typing and antibody screens.

Listen to a HealthLink on Air radio interview on this subject by visiting www.upstate.edu/healthlinkonair and typing “kidney” in the search box.

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PATIENT CARE

Would you give a kidney to a stranger?

BY AMBER SMITH

ROBERT MESCAVAGE

J. Keith Melancon, MD, says surgeons usually remove the left kidney from someone who is willing to donate, since the renal vein on that side is generally longer. The donor kidney is usually sewn into place in the recipient without the recipient’s kidneys being removed.

e was about to turn 30 and feeling blessed. He had a great family, a solid support system, and he had found a way to help someone. A woman at the man’s church had severe kidney disease and was on dialysis three times a week. He could not help her.

But he could help someone.

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Transplant surgeon J. Keith Melancon, MD, removed the man’s kidney and while his colleague, Vaughn Whittaker, MD, was sewing it into the recipient, Melancon left the operating room to let the donor’s mother and father know that all was well. “You have a great boy. I know you know that,” he began.

Most people are born with two kidneys but can live normal, healthy lives with just one. Among those willing to become living donors, most donate to family members, friends or people they know. Some are willing to donate to people they have never met. The transplant team at Upstate refers to them as “altruistic” donors.

Melancon says an average of 17 people die each day waiting for a kidney transplant. “We have to do something besides wait for deceased donors,” he says.

The man had never heard the word altruistic, which means a selfless concern for the wellbeing of others. He simply wanted to help someone, without acknowledgement.

He did not want to be identified by name in this story.

Living donor coordinator Ellen Havens says this happens sometimes. “Some donors just feel like they have this calling. Some say they knew somebody that they couldn’t donate to, or they saw somebody suffering.”

The man contacted Upstate University Hospital’s transplant center and learned that he was healthy enough to donate one of his kidneys. It was a good match for a Central New York woman, whose husband was not a match for her.

The husband was still willing to donate a kidney, though, and his was a good match for another Central New York woman.

That is how transplant surgeons came to perform the first kidney exchange at Upstate: four surgeries involving two donors and two recipients on one long summer day.

The spark was the altruistic donor.

Altruistic donors can help ease the shortage. So can kidney exchanges, a practice that Melancon helped implement during his year at Upstate’s transplant center. He is now chief of the division of kidney and pancreas surgery at George Washington Hospital in Washington, DC. Instead of helping one person, an exchange can save the lives of multiple people. Google “32-person kidney swap” for coverage of 16 kidney transplants involving Melancon in 2011.

The two transplants at Upstate began to acquaint staff with the myriad details of orchestrating exchanges. As much as anything, it requires a shift in thinking. “It’s a whole new conversation that I’m having with people today,” Havens says. Instead of simply matching donors with recipients, the transplant team now asks would-be recipients if they know someone who is willing to donate a kidney.

The altruistic donor liked that his kidney would go to a woman whose husband was willing to pay it forward.

Melancon did too. “Every day I get to see the best side of humanity,” the surgeon says. “This is one person helping another person.” ●

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PATIENT CARE

Internet research leads family to Upstate for rare surgery any Facebook connections provide a quick diversion or fun way to stay in touch. Sometimes the social network makes a connection that does more — by improving someone’s life.

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A mother in Istanbul, Turkey joined a Facebook group for parents of children with tuberous sclerosis complex (TSC), a rare disease caused by a genetic mutation and marked by noncancerous tumors that grow throughout the body. She was looking for a way to help her 5-year-old daughter, Mia, who suffered from seizures related to TSC. The mother, Micheale Kovalkovic, wound up connecting with Jennifer Failla of Central Square, NY, whose daughter Arianna has TSC. Arianna underwent MRI-guided thermal laser ablation last fall at Upstate. Her parents saw steady progress afterward with her behavior and cognitive abilities.

Kovalkovic learned more about the minimally invasive procedure. It allows doctors to insert a small laser into the brain and use a burst of heat to eradicate brain tumors or the epilepsy focus. Because it does not require the skull to be cut open, or radiation therapy, which can damage surrounding tissue, ablation is safer for patients and reduces complications and recovery time.

Would it work for Mia? Kovalkovic sent an email inquiry to Zulma Tovar-Spinoza, MD, and received a quick response from the director of pediatric neurosurgery at Upstate Golisano Children’s Hospital.

“Upstate is one of the few centers in the world that is using this technique for patients with brain tumors and epilepsy,” she says, explaining how precise measurements can be taken before patients are wheeled into the MRI suite for magnetic resonance imaging and the placement of a thin fiber optic applicator.

“The beauty of this technology is that you can actually see on the monitor the change of colors and temperature of the area that you are ablating,” Tovar-Spinoza explains. “It’s so

ROBERT MESCAVAGE

Micheale Kovalkovic and her husband, Ivan Kovalkovic, stayed at the Ronald McDonald House when they brought their daughter, Mia, to Syracuse for treatment at Upstate Golisano Children’s Hospital.

ROBERT MESCAVAGE

precise. You know that are you preserving areas of the brain where you want to preserve function.”

The Kovalkovics came to Syracuse last March for the first phase of treatment from Tovar-Spinoza and her pediatric neurology colleague, Yaman Eksioglu, MD, PhD, a native of Turkey who put the family at ease. The family returned in August for the second phase and plans to come back once more this winter.

Tuberous sclerosis was detected in utero, when Micheale Kovalkovic was in her third trimester. Twice during Mia’s infancy, Micheale and Ivan Kovalkovic brought their daughter to a New York City hospital for surgery; twice, the surgeries were cancelled when the baby had a reaction to anesthesia. They began exploring options. Soon, Mia was enrolled in a special school in Turkey where she received intensive therapy seven days a week but remained nonverbal.

“We wanted to do whatever it took to get her well,” says her father, Ivan Kovalkovic, a business executive who left his job to concentrate on his family during Mia’s medical treatment.

When they are in Syracuse, the family resides at the Ronald McDonald House, 1100 E. Genesee St. “It’s like a 6-star hotel, luxurious with fine food and an enormously helpful staff,” he says.

Since her first procedure, Mia sleeps and eats better. And while they remain hopeful their daughter will speak some day, Ivan and Micheale are grateful for the elimination of most of their daughter’s seizures. ●

New hospital unit designed for seniors

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enior patients with complex medical needs, who are clinically stable but require ongoing hospital care, now have access to a new type of specialized care.

Upstate University Hospital’s Community campus opened a Transitional Care Unit this summer. Patients are expected to stay from five to 20 days in the 20-bed unit. Some will be recovering from planned surgery while others will be experiencing a medical emergency or a new diagnosis. Patients in need of wound care, IV therapy or orthopedic care may also be admitted.

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Sharon Brangman, MD, Upstate’s geriatrics division chief, will guide the interdisciplinary team of nurses, case managers, therapists, dietary staff and hospitalists assigned to the unit. Nurses selected for the unit will have completed the Nurses Improving Care for Healthsystem Elders (NICHE) program, which works to improve the care of older adults.

For more information about the Transitional Care Unit, call 315-492-5847. This new unit complements the emergency and urgent care services at GEM Care, also on Upstate’s Community campus. ●

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FROM OUR EXPERTS

Ask these 5 questions after a car wreck

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mergency physician William Paolo, MD, explains what to do if you find yourself in a car wreck. If you answer yes to any of these questions, call 911 for an ambulance.

How to stave off Alzheimer’s with exercise

1. Did your airbags deploy?

If the impact was strong enough to deploy airbags, it may have caused injury, as well. You may notice a chemical-smelling white powder from the airbag, but it’s not dangerous unless it gets into your eyes.

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2. Was there what’s known as “intrusion?” Did the car and the cabin around you collapse into you? Would you need help getting out of the car?

n all her years of presentations, physical therapist Dale Avers has never seen a hand raised when she asks audiences who aspires to live in a nursing home.

People fill conference rooms to hear Avers explain how to avoid ending up in nursing homes.

The key, she says, is a healthy brain. And the key to a healthy brain is exercise.

Our brains, which continue to generate new brain cells even in our senior years, demand 25 percent of the blood and nutrients from every beat of our hearts. So, increasing our heart rate increases blood flow to the brain.

We increase our heart rate through aerobic exercise that is strenuous, that makes us sweat for at least 15 or 20 minutes at a time. We don’t have to run marathons; we can take stairs instead of escalators, park far away rather than near. But when a particular exercise is no longer challenging, Avers says it’s time to make it more challenging — or try something new.

“The more you do, the more benefits you’re going to reap,” Avers says. People who exercise fewer than three times a week, compared with those who exercise more than three times a week, are dramatically more likely to develop Alzheimer’s disease. After age 85, the risk of developing Alzheimer’s rises to 50 percent, according to the Alzheimer’s Association.

Mental stimulation is also important in maintaining brain health, she says.

“Easy, to me, is a four-letter word. Things that are easy are not good for us.

“Somehow, as we get older we feel entitled to take things easy — and that’s the worst thing we can do.”

Walking around a flat track isn’t as beneficial as walking through hilly neighborhoods.

Crossword puzzles that are easy aren’t stimulating.

Avers — a regular speaker at Upstate’s HealthLink seminar series — suggests audience members ask themselves: “What have I quit doing because it was too tough?”

Sometimes as people become hard of hearing, they give up trying to understand a conversation. Sometimes as people age, they become reluctant to pursue new fields of study. Instead, they go easy.

“You’ve got to change your belief that easy is good,” Avers says. ●

Learn about Upstate’s HealthLink Seminar series by calling 315-464-8668 or visiting www.upstate.edu/hospital/healthlink/

Listen to a HealthLink on Air radio interview on this subject by visiting www.upstate.edu/healthlinkonair and typing “exercise” in the search box. fall 2014

3. Did you lose consciousness? Do you remember everything that happened?

4. Did you wear your seatbelt? “If you didn’t wear your seatbelt and you find yourself outside of your car, then you want to see an ambulance provider right away,” Paolo says.

5. Are you in pain? Even what seem to be minor wrecks can cause injury, so pay attention to your body.

If you are transporting a child in a car seat, keep him or her in the car seat. Paramedics will likely bring the child to the hospital that way.

Paolo says most importantly: Stay in your car unless it is on fire or about to be on fire, which would be exceedingly rare.

“We don’t want you up and moving around if we don’t know what your injuries are,” he says.

“We worry that you may have injured something that may get worse by moving around.”

Not only that, but if you get out of your car, you are liable to be injured by other vehicles.

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FROM OUR EXPERTS

CALCIUM

Are you getting too much calcium? etting enough calcium is important, to keep your bones healthy. But getting too much may increase your risk for developing kidney stones or calcium toxicity or interfere with your body’s ability to absorb other minerals.

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significant amount of calcium from your diet, if it is full of calcium-rich foods. (Yogurt, milk, cheese, salmon, collards and black eyed peas are some examples.) And—don’t forget—if you take over-thecounter antacids, most contain calcium as well.

Adults should ingest no more than 2,000 to 2,500 milligrams of calcium per day, depending on age, according to a recent government-ordered report from the Institute of Medicine. That is “elemental” calcium.

Taking the maximum amount of calcium in supplements, plus antacids puts a person “at high risk for complications associated with excess calcium intake,” writes Shristi Neupane, MD, in the August issue of the journal Public Health Nutrition.

Neupane recently completed her internal medicine residency at Upstate.

When calcium is taken as a supplement, different preparations contain different amounts of calcium, and that should be noted on the label. For example, 1,000 milligrams of calcium carbonate will contain 400 milligrams of elemental calcium, and 1,000 milligrams of calcium citrate will contain 200 milligrams of elemental calcium.

In addition to supplements, you may get a

She and co-author Stephen Knohl, MD, an associate professor of medicine at Upstate, point out that the Food and Drug Administration has not required an update in labeling on antacids, some of which still indicate that up to 3,000 milligrams per day is safe.

The lesson: Keep antacids in mind when you calculate your calcium intake. ●

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Q A AND

The Color Me Rad 5K run took place on Onondaga Lake Parkway in May.

Upstate Answers

MICHAEL GREENLAR/SYRACUSE.COM

WITH

ROBERT LENOX MD

The colored cornstarch used in promotional running events is supposedly safe for the skin, but what about the lungs? I awoke in a coughing fit the morning after the event.

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“Most likely the coughing was not related to the cornstarch. However, if you have environmental allergies, it might be possible to develop an allergy to a protein found in the cornstarch. (It is unlikely that the starch is pure starch, and there are probably some proteins from the corn in the cornstarch). This could produce an asthma attack if you develop an allergy, an IgE antibody to the protein. This would be similar to inhaling ragweed, dust mites, cat dander, or other environmental allergens and then developing an asthma attack. Sometimes asthma manifests as a cough, and one does not develop wheezing or shortness of breath.

“An alternative explanation for your cough is exercise-induced asthma. This occurs because you lose heat from your airway when you exercise, and this may precipitate an asthma attack in those who are predisposed to exercise-induced asthma.

As mentioned, asthma may manifest itself as a cough without other symptoms.

“A third explanation for the cough is that while you were running you inhaled environmental allergens such as tree pollens.

These allergens may have precipitated an asthma attack.

“Finally, you may have been coming down with a viral respiratory infection, and that caused a cough.” ●

—ROBERT LENOX, MD, PROFESSOR OF MEDICINE AND DIVISION CHIEF OF PULMONARY/CRITICAL CARE AT UPSTATE UNIVERSITY HOSPITAL.

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FROM OUR EXPERTS

Autism identifiers:

What to do when a tooth is knocked out

How to tell which babies are affected

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racturing or losing a tooth in a fall or other accident is a fairly common occurrence. When that happens, “you have a very limited timeframe in which to treat that situation,” says assistant professor and dentist, Patrick Smith.

oogle “causes of autism” and you get millions of hits — and a multitude of conjecture. Is a genetic predisposition to blame? Are environmental factors at play? Maternal or paternal age, perhaps? Some sort of pregnancy complication?

A virus, or pollutant in the air?

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We do not know for sure, but genetics and the environment likely play a combined role, says Henry Roane, PhD, an associate professor of pediatrics and division chief of the Center for Behavior, Development and Genetics at Upstate. Regardless of the cause of autism or the reason for its recent growth, he says treatment is most effective when begun early.

One in 68 children have autism spectrum disorder. The term “spectrum” is used now in reference to the range of impairment children can have, from mild to severe disability.

That represents a 30 percent increase in diagnoses from a few years ago, partly because several individual disorders are now considered part of the autism spectrum. Awareness is also behind the increase, with more parents, teachers and primary care doctors on the lookout for early signs.

“It’s not like having a medical disorder where you can do a blood test and test for certain pathogens in your bloodstream and say ‘well, you have that disease.’ Autism is not like that,” Roane says “It is, to some extent, a subjective diagnosis in many cases. What one provider sees as autism, another provider might not see it as such.”

Treatment is intensive behavioral therapy of 25 to 40 hours per week, to help improve cognitive and language skills. Roane says proper medical care plus early intervention can help change the trajectory of autism, especially in children who begin treatment before age 6. That means caregivers have to know what to look for, and what to ask the pediatrician.

Athletic facilities and school sports programs may have Save-a-Tooth preservation kits at the ready. They contain a liquid that preserves a tooth for a short period of time.

Smith says to help the tooth maintain moisture constantly.

Milk is fine. Water works, too. Or, you can place the tooth in the pouch of your cheek. “The tissue is alive, and we need to maintain it until we can re-implant it into the socket,” he says.

Make sure to handle the tooth only by its crown, or the part that you can see in the mouth.

Do not touch the root.

Get to a dentist, oral surgeon or the emergency department at Upstate University Hospital as quickly as possible, so the tooth can be re-implanted and secured.

Upstate’s Center for Development, Behavior and Genetics (315-464-6395) and the Margaret L. Williams Developmental Evaluation Center (315-472-4404) provide comprehensive reviews of children up to age 7 in 17 counties.

Red flags?

Some signs of autism may be visible when a baby is just a few months old, although experts caution that the signs and symptoms of autism are highly variable among those affected.

These 15 behaviors are possible signs:

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lack of sustained eye contact, especially to people or visually interesting objects

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not pointing at objects by 14 months of age

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reversing pronouns (“you” instead of “I”)

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slow progression of language or delayed speech formation (not babbling, or making a single repetitive sound)

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flapping hands, rocking body or spinning in circles

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talking in flat, robot-like or sing-song voice

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avoiding or resisting physical contact

lining up toys or other objects, or playing with them the same way every time

not responding to his/her name by 12 months of age

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unusual reactions to the way things sound, smell, taste, look or feel

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repetitive movements, in older children

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getting upset by minor changes

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preference for playing alone

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not playing pretend games (such as “feeding” a doll) by 18 months

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flat or inappropriate facial expressions

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Sources: Centers for Disease Control and Prevention and the National Institute of Mental Health

Listen to a HealthLink on Air radio interview on this subject by visiting www.upstate.edu/healthlinkonair and typing “autism” in the search box. fall 2014

U P S TAT E H E A LT H

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IN THE KNOW

STEVE GARLOCK

The Central New York community contributed $17.4 million — almost a quarter of which came from Upstate employees, advocates, volunteers and foundation board members – to help build the $74 million Upstate Cancer Center.

Cancer care expands with new center he gleaming new Upstate Cancer Center is more than a hub for a nearly $18 million investment in revolutionary cancer-fighting equipment.

It signals a progressive multidisciplinary approach to cancer care at Upstate University Hospital — and communicates hope.

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Designers sought to create “a cutting-edge modern look that would reassure people of the level of care they’re going to receive,” says architect Saul Jabbawy, director of design for EwingCole, the architectural and engineering design firm. The building also is meant to instill calm. Patients helped select a “healing through nature” theme, and local artists provided more than 100 pieces of art that are displayed throughout the center, offering visual escape.

In addition, the adult infusion area overlooks a healing garden on the roof between the center and Upstate University Hospital.

Patients receiving outpatient care in the center can easily get to imaging and testing appointments in the hospital.

Hospital inpatients will have easy access to diagnostic and treatment services available in the center. Also, the parking garage is accessible through a walkway that is protected from the weather.

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Cancer care at Upstate is coordinated across disciplines, rather than segregated by department.

“For example, if a patient has breast cancer, a medical oncologist, radiation oncologist and surgeon may come together to plan the best therapy,” says associate administrator Dick Kilburg. “We needed the physical structure to match what we were beginning to accomplish organizationally.”

The center provides comprehensive care for children and adults with cancer or blood disorders with an unmatched breadth of options in the Central New York region.

Complementing Upstate’s existing diagnostic and treatment arsenal are some new key pieces of technology.

Advanced Technology

• an intra-operative suite dedicated to cancer procedures and neurosurgery that is one of only 10 similar facilities in the country. Advanced imaging is provided in rooms that connect to the full-service operating room.

• the Varian TruBeam, with a rotating arm that allows physicians to target tumors with extreme precision, while sparing healthy tissue.

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IN THE KNOW

ROBERT MESCAVAGE

Ajeet Gajra, MD, is one of the many cancer experts who sees patients in the new Upstate Cancer Center.

• the Vero stereotactic body radiotherapy system for advanced treatment of lung, liver, prostate and other cancers. “The Vero system permits what I refer to as 4-D imaging, with the fourth dimension being time,” says Jeffrey Bogart, MD, professor and chair of radiation oncology and co-director of the prostate cancer program.

“By that I mean we can visualize the tumor in the patient’s anatomy in three dimensions and also track its changes across time and modify our treatment accordingly.”

Along with the new technology are the sort of extras that patients appreciate.

Within the center is a meditation room and a Family Resource Center with access to Upstate’s academic medical library. There is also space for nutritional assessment and guidance, genetic counseling, cancer rehabilitation and consultations for pain management and integrative medicine.

Plus, a grant from a generous donor allows for the addition of a cancer center music coordinator. Greeting visitors in the main atrium, providing ambient music at certain times, is a baby grand piano.

Listen to an interview at upstate.edu/ healthlinkonair by searching “cancer.”

SUSAN KAHN

The “Tree of Hope” sculpture by Ellen Steinfeld at the entrance of the Upstate Cancer Center is one of 100 pieces of artwork with a “healing in nature” theme.

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U P S TAT E H E A LT H

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IN OUR COMMUNITY

A way to help the homeless and hospitals Master of Public Health student at Upstate is calling for more consistent identification of hospital patients who are homeless and for more attention to the health issues faced by this special patient population.

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To complete her degree, Lauren Wetterhahn analyzed 760 homeless patient visits to the emergency departments of four hospitals in Onondaga County from 2006 to 2011.

Drawing from statewide hospital discharge data, she compared homeless patients to non-homeless patients at the same hospitals.

She found that homeless patients’ diagnoses tended to be related to mental illness and drug and alcohol use. They were less likely to be discharged from the emergency department the same day they arrived and, once admitted, their hospital stays were usually longer. Those lengthy stays are especially costly, Wetterhahn says, because hospitals’ reimbursements from insurers do not increase for longer patient stays.

More attention to the health issues facing the homeless – including better patient screening and research on their health care needs – and a focus on special transitional housing after discharge might help the hospital bottom line as well as provide better care for patients without homes. ●

Inspiration inside Book shares advice from spiritual care volunteers book called “Open the Eyes of My Heart” showcases the spiritual care that takes place within the hospital as part of professional and volunteer chaplaincy provided by the Department of Spiritual Care.

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Spiritual care volunteer Walt Wasilewski crafted the book from interviews with 18 spiritual care volunteers. He is a journalist who teaches at Syracuse University’s S.I. Newhouse School of Public Communications. In his spare time, he meets with patients who request a spiritual care visit.

“I felt like it was a 6-month intensive tutorial in the best practices in spiritual care,” he says of the time he spent researching. “I learned so many things, some esoteric, some fairly difficult to ponder, but a lot of practical things: What do you say when this happens? How do you react when that happens?

“It has affected the way I relate to patients,” says Wasilewski. “And the hope is that the book will do the same for people in other places, other hospitals, other settings, where they might read this and be a little bit inspired.”

One story is about a volunteer in her 30s who uses Reiki to connect with patients. Another tells of a woman who began volunteering in her 70s and who glowed as she spoke of her days visiting patients.

“Open the Eyes of My Heart” was published by Upstate’s Center for Spiritual Care through a Friend in Deed grant from the Upstate Foundation. Imani Shabazz, a summer 2013 Synergy/Mercyworks spiritual care intern, also contributed to the book. It sells for $5 through the center, at upstate.edu/hospital/spiritualcare.

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More than 100 people volunteer through the center, says the Rev. Terry Culbertson, who manages the center.

She says the program includes a full spectrum of faith traditions. “Offering spiritual care as a volunteer can add a fulfilling dimension to life. There are so many ways our volunteers offer spiritual care, whether it is through prayer, Reiki, music, a gentle touch or merely just by spending quiet moments with patients.”

Wasilewski was impressed with the volunteers he met during his research. “How knowing and wise these volunteers are about how to prepare a place in time – our place, in this hospital – so that the spirit can do its work.

“The doctors and nurses are always doing their work.

The spirit is, as well.” ●

Listen to a radio interview about this book at upstate.edu/healthlinkonair by searching for “spiritual care.”

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IN OUR COMMUNITY

STEPHEN JOHNSON

Adlin Noel takes blood pressure at a clinic in Ghana. At right: Noel and Stephen Johnson at Upstate’s commencement.

Shared educational options, an ocean apart pring and summer breaks don’t necessarily mean sunny beaches for students who are training for careers in the health professions. Upstate students volunteer for additional medical experience and training at sites all over the world.

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“We are continually building international medically related educational opportunities,” says Sue Stearns, PhD, director of the Center for Civic Engagement. “We encourage our students to explore new horizons but are always concerned about their safety as well as the value of their experiences.”

Respiratory therapy roommates Stephen Johnson and Adlin Noel spent some of their break between classes last year in countries on opposite sides of the Atlantic Ocean.

Johnson headed to the jungles of Honduras for what turned out to be “the highlight of my medical experiences.”

He volunteered with an organization called Adventure in Missions and spent four weeks providing care to hundreds of families.

He found reactive airways disease, or asthma, was prevalent. This is because household kitchens there are almost always thatch huts right next to the homes. “The black smoke from the stove rises and quickly fills up the kitchen hut, and children breath this their entire lives. The constant airways irritation leads to the development of chronic in-

flammation and narrowing of the bronchioles, which then leads to asthma-like symptoms.” Johnson distributed many metered dose inhalers to help treat acute bronchospasms.

Noel volunteered with medical and nursing students for two weeks last summer to provide rural medical care in Nicaragua. He jumped at the opportunity earlier this year to deliver medical care to people in rural villages of Ghana through the Americans Serving Abroad Projects. The trip was organized by Upstate nurse Lauri Rupracht. As part of his work there, Noel conducted research that revealed a significant lack of knowledge of the detrimental effects of smoking among villagers.

Noel says his experience “renewed my purpose as a future health professional to respond to the medical needs of those less fortunate.”

He also inspired other respiratory therapy students to seek out international opportunities. Catie Zopf and Alex Tabone traveled to Nicaragua this summer along with nine Upstate medical students as volunteers helping rural health care providers.

Johnson says his experience in Honduras “has given me an entirely new perspective on what it means to serve, and a renewed drive to make sure I am providing the best care when they do find themselves in my hospital.”●

Low-wage jobs provide hardships, uncertainty

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study of low-wage workers in Syracuse reveals unstable and unpredictable work lives on many levels, says Jeanette Zoeckler, a public health project manager at Upstate’s CNY Occupational Health Clinical Centers.

“Imagine working two or three jobs just to put food on the table, having no transportation other than buses to get to those jobs and no security that their job or the wages agreed upon will be available tomorrow. Low-wage workers face these hardships and this uncertainty on a daily basis,” she says.

Zoeckler and colleagues queried 275 Syracuse adults whose low-wage jobs necessitated support from government programs to subsidize basic household needs. Survey questions dealt with working conditions, access to health care, wages and hours, and more. Participants were also asked what they would change in their workplace. Top answers were the need for respect and less discrimination in the workplace.

The data collected in the survey will be used for longer-term goals meant to improve conditions for workers with low-wage jobs. For a copy of the study contact the center at 315-432-8899, extension 103.

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U P S TAT E H E A LT H

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IN OUR COMMUNITY

Tony winner played the role of a patient at Upstate

BY AMBER SMITH

efore she won a Tony for her role in “Beautiful: the Carole King Musical,” Jessie Mueller performed as a patient for medical students at Upstate. Like many drama students at Syracuse University, she was a standardized patient.

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Amber Hansel, who helps oversee Upstate’s standardized patient program now, remembers Mueller well. “I was working at Syracuse Stage when she appeared in several performances there,” Hansel says. “I got to know her a little when she was in the SU Drama production of ‘Kiss Me Kate.’”

Actors chosen to be standardized patients are carefully trained to portray patients who simulate common medical conditions.

Encounters give medical students, residents or other health care professionals the opportunity to learn and practice effective communication and examination techniques with real people without fatiguing actual patients. Hansel says sophomores, juniors and seniors are considered for the roles, which are paid.

Hansel joined Upstate in 2005. “I now use the skills I learned studying directing at SU when I train/coach the standardized patients to portray their patient cases.”

Mueller, 31, is a resident of Astoria, Queens. She is expected to continue in “Beautiful” for months to come.

Carole King told The New York Times that during “Beautiful” tryouts, “Jessie just came across to me as very devoted to the material, respectful about the music and the story, and had a wonderful energy to her.”

King performed “I Feel the Earth Move” with Mueller during the Tony’s telecast.

●

The question every doctor asks eventually

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pstate Neurosurgery Chairman Lawrence Chin, MD, spoke at Upstate’s annual White Coat Ceremony last summer, when medical students receive the jackets they will wear during their clinical rotations.

He told of a patient who had back pain that left him unable to walk because cancer had spread to his spinal cord. One surgeon said the patient was not fit for surgery, but Chin’s resident felt that the patient deserved a chance. The resident proposed an operation that would be complicated and time-consuming, to decompress the patient’s spinal cord and remove as much of the tumor as possible.

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The date was July 4.

Chin and the resident both had plans to spend the day with family in town for the holiday. Maybe the surgery could wait until tomorrow?

“There comes a time when every doctor has to ask: Am I doing the best thing for this patient?” Chin told the medical students.

He and the resident faced that question on July 4 – and the surgery took place that day.

Chin said it was the right decision. “Three weeks later, that man walked out of the hospital.” ●

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IN OUR COMMUNITY

ADVANCED TECHNOLOGY, MULTIPLE LOCATIONS

A new way of talking – without words

BY RICH O’NEILL, PHD

y mom is 97, has Alzheimer’s and has become less verbal and logical. She now lives in a residential health care facility, a nursing home. This has been a hard journey for her, and for me.

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One of the most difficult things has been being with her when her words are nonsense. She starts a sentence with three or four words and then says unrelated words. What does she mean? What can I say back? For a long time I got frustrated, sad, even desperate.

Upstate Breast Imaging offers

But I’ve discovered that we can converse and both feel good if I just let go of her words, tune in to her emotional message, and respond from there.

the most advanced technology

I had to let go of my idea that as a grown woman she should talk sensibly and understand me, too.

the region’s only academic

Attuning emotionally now, I’m surprised that once in a while she listens to my emotion and responds to me there. For example, last week we were lunching. Now, she eats extremely slowly, almost one grain of rice at a time. I was getting antsy because of other obligations but hadn’t said anything. Somehow she knew and said, “Do you have to go home to your family now?”

Wow. The other day I went over for lunch. She was at her table. I was expecting her usual greeting for me, which I call her “whole body smile.” This is when she lights up, looks right in my eyes, beams a smile, coos “Oh! Oh! You! You’re here! So good!” and stretches out her arms.

And I smile back and hug and kiss her. “Hi, Sweetie. Nice to see you.”

But this day she was slumped, eyes closed, not eating the lunch in front of her even though eating is one thing she still enjoys. I thought she might be sleeping. So I gently said “Hi sweetie,” and patted her shoulder. No response. I rubbed her back, gave her some kisses, made sure her hearing aid was on and said more soothing words. Her eyes remained shut, her body slumped.

I found her nurse’s aide, who told me she had to be a bit forceful cleaning her in the bathroom, and right after that experience Mom had gone into this whole body frown, possibly angry but who knows? I went back to her again, but she still did not respond, so I said goodbye and headed for the door. Before I could leave, the aide caught me: “She’s looking for you now.”

I returned to find those loving eyes and gentle smile. With soothing tones and kisses and love pats, we shared a very pleasant meal.

and services expected from

medical center.

TWO CONVENIENT LOCATIONS ALLOW FOR EASY ACCESS AND TIMELY APPOINTMENTS: WOMEN’S IMAGING AT 550 HARRISON

315.464.2588 Upstate Specialty Services 550 Harrison St. Syracuse NY 13210

WELLSPRING BREAST CARE CENTER

315.492.5702 Upstate University Hospital — Community Campus Physicians Office Building South 4900 Broad Rd. Syracuse NY 13215

Who knows when we share our last one. I’m careful not to exhaust myself, to both care for myself and do the best I can caring for Mom, hoping our kids and theirs and theirs, will learn this talking without words. ●

Psychologist Rich O’Neill, PhD, shares “Check Up From the Neck Up” on Upstate’s weekly talk radio program, HealthLink on Air. Listen to the show from 9 to 10 p.m. Sunday on WRVO Public Media or anytime at www.upstate.edu/healthlinkonair

fall 2014

UPSTATE.EDU/BREASTIMAGING

U P S TAT E H E A LT H

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IN OUR LEISURE

Thriving on thank-yous

They give back to the community as volunteers

Several Upstate employees extend public service into their private lives, as volunteer firefighters. Meet seven public safety officers who do: Dominick Albanese, 21 Moyers Corners Fire Department Experience: almost 2 years Roles: interior firefighter. “My duty is to respond to the fire house and provide service to every call, no matter the nature, that we are dispatched for.”

Time investment: “I do about three calls a day, so it turns out I provide about 30 hours a week.”

Aspiration: “I want to become a police officer. Providing service to my community and being the ‘help’ that people call for is/was my dream.”

Reward: “I love helping people. Seeing the smiles on their faces after providing the service needed is great. Other than that, I love the adrenaline rush when entering a burning building.”

Troy Barrett, 21 Moyers Corners Fire Department Experience: 5 years Time investment: about 20 hours per week Aspiration: Make a career of firefighting.

Reason: family tradition Jess Brown, 49 Minoa Fire Department Experience: 25 years Roles: firefighter, first responder Best part: “Being there to help.”

Evan Buschbascher, 28 Liverpool Fire Department Experience: 3 years Roles: interior firefighter, first aid Reason: I am all about the community.

I love helping out the people of the Town of Salina. It is something different every time the bell rings.

Time investment: 15 to 20 hours per week Reward: Nothing is better than when you are at someone’s house to assist them, and they say ‘thank you for coming.’

Stephen L. Mauser, 58 Moyers Corners Fire Department (MCFD) Experience: 40 years Roles: fire captain, dive team, underwater recovery team, driver, fire police lieutenant, paramedic Inspiration: “My father was a volunteer with MCFD in the 1960s. At the age of 18, I witnessed MCFD operate during a fatal car accident. The way they all worked as a team and used all of their power tools was just amazing. I knew then I wanted to be a part of this fire department helping the public.”

Time investment: “It’s hard to say. We drill weekly, along with specialty drills or classes on any given day, plus we get called out any time 24 hours a day, seven days a week.”

Memory: “I delivered a baby solo one time, and it was one of the greatest days of my life to be a part of actually help bringing life into the world.”

William O’Connor, 22 Marcellus Fire Department Experience: 8 years, including junior firefighting Roles: firefighter, fire prevention education, emergency medical technician How he began: “My family has a history of becoming both career and volunteer firefighters, so I guess you could say it is in my blood. My parents always taught me to help others when in need and give back as much as possible.”

Best part: “Not only do I have the opportunity to help my community, but my fellow firefighters are like a family. We are always there for each other, whether someone is moving or needs help fixing their house.

Cooking dinner around the fire house and sitting at the table is just like sitting at home—except for maybe some jokes that mom probably would not be fond of.”

Richard Powell, 39 Camillus Fire Department Experience: “I have been a volunteer here for about 1½ years, but I volunteered with a fire department in North Carolina outside of Charlotte for about 10 years.”

Position: scene support, emergency medical technician Time investment: about 20 hours per week.

Why: “I got into the fire/emergency medical services back in 1994, but really got involved in 1999 after my mother passed away of a massive heart attack at the age of 50.”

Upstate public safety officers — and volunteer firefighters — Stephen Mauser, Jess Brown, William O’Conner and Dominick Albanese.

ROBERT MESCAVAGE

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IN OUR LEISURE

One with her kayak l.

hen she’s not caring for patients in the spring, summer and fall, nurse Sarah Martin makes time for kayaking at least once a week.

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“I love to be in nature. I love the peacefulness of it.

When you are out on a body of water, your problems are so far away from you. For me, it’s spiritual,” Martin says. She works at Upstate University Hospital at the Community campus.

Martin is an experienced boater who discovered as she got older that she preferred boats without motors. She bought her lilac kayak a couple years ago and quickly became an enthusiastic disciple of kayaking.

She tells people who are interested in joining the activity: 1. Get the best kayak you can afford. You can get a molded plastic one for probably $600. I would suggest going to a kayak specialty store. This one was probably $1,800 used.

It would have been $2,300 new.

2. The longer your kayak, the more stable it will be. Shorter kayakers are for the more advanced. Kayaks are pretty sturdy. I bought this particular kayak because I wanted to learn how to roll it. I have yet to master that. It’s very difficult to get it to roll. The biggest thing is getting in and out of it; you may end up in the water.

3. Paddles make a huge difference in fatigue level and overall maneuverability of the boat. Get the lightest one you can find.

4. I wear a dry suit, especially in the spring when the water is still cold. I bring my phone, something to drink and a rain jacket to keep in a little porthole right in front of me.

Also, I keep flotation gear in the boat with me.

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IN OUR LEISURE

Tri-ing to stay fit and healthy ix Upstate women got the chance to compete in the annual Iron Girl triathlon this year as representatives of Upstate’s Women’s Health Network. That means on Aug. 3 they swam 600 meters, biked 30K and ran 5K at Oneida Shores Park with 1,094 other women.

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For weeks and months leading up to that day, these women swam, biked and ran, fitting their training between jobs, classes and families.

Heather Nelson, 24, bicycles to and from the laboratory where she is a graduate student in cell and developmental biology, and on weekends she bikes as much as 40 miles.

That’s part of how she trains, in addition to the running she has done regularly since the age of 12. She is enthusiastic for all kinds of physical activity. Iron Girl was Nelson’s first triathlon — and she finished first in her age category with a total time of 1 hours, 30 minutes and 21 seconds.

Iron Girl was to be the first triathlon for Wendi Burnette, 43, who works in the department of neuroscience and physiology. She has been a runner for 20 years, and a few years ago a friend reintroduced her to the pleasures of cycling. “I had forgotten how much fun it is to ride a bike,” she says. Two months before race day, she assessed her readiness. “That means I just have to learn how to swim, something stronger than a dog paddle.”

Fresh off her second half marathon, physical therapy student Liz Van Nortwick, 23, was searching for a new challenge. She got a new bike at the end of last summer, so

she was anxious to try a triathlon. Iron Girl was perfect, she says, “because my second clinical finishes the last week of July, so I will be back in Syracuse just in time to compete.”

Catarina Walter, 40, a programmer analyst in information management and technology, is an experienced triathlete who has competed in Iron Girl. “Last year there was a 69-year-old woman who beat my time by approximately 2 minutes,” she says. “I’m not ashamed of my time. Rather, I am proud of the 69-year-old who beat someone 30 years younger than her. I’m hoping I can still do this at 69, too.”

Social worker Kimberlee Garver, 45, did not expect to be a top finisher but kept reminding herself that someone would win, but many would not even try. “For me, participating and finishing will be victory.” After nearly two decades of shuttling her children to sports practices and games, she’s finally focusing on her own physical and mental health.

Plus, she suspects that her children were inspired by seeing their mom cross the Iron Girl finish line.

Marika Toscano, 26, is a fourth-year medical student who says the focus required for long days in the operating room is similar to that required for training for endurance events such as triathlons. She relies on the same protein shakes, protein bars and sports beverages to keep her going at the hospital, and she says she intends to remain an athlete throughout her medical training and beyond. “I want to be able to motivate my future patients to stay fit, live well and eat healthy,” Toscano says. “If I’m not practicing this lifestyle, I cannot ask my patients to do the same.” ●

Kimberlee Garver, Catarina Walter, Wendi Burnette and Heather Nelson are members of Upstate’s Women’s Health Network IronGirl team.

ROBERT MESCAVAGE

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IN OUR LEISURE

Downtown dogs Medical students open their home to puppies

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wo Upstate students sharing an apartment in downtown Syracuse have developed enduring – and contagious – cases of puppy love.

First Tim Lentini got Freya, a golden retriever. Then he and his puppy went with roommate, Connor Policastro, to choose Leila, a Weimaraner.

“We agreed that there was no way that either of us was going to get a puppy unless we were both in agreement,” Policastro says.

“It’s all about teamwork. It’s tough being a single parent.”

Policastro grew up in Connecticut and attended Syracuse University; he is in the MD/PhD program at Upstate. Lentini, who grew up in Queens, is a second-year medical student.

The men share dog care duties. Their apartment in an old watch factory is a half block from a small park. Dog lovers in nearby apartments are willing to pitch in with feedings or walks if Policastro and Lentini are tied up in laboratories or classrooms on campus — which is an 8-minute bike ride away.

Policastro grew up with many dogs and other pets. Lentini had one German shepherd briefly in childhood. Both were eager to have dogs of their own. They chose puppies they could train over summer, when their schedules were lighter. Today, Freya and Leila fight like sisters, mostly over toys and attention. They’ve brought a warmth to the apartment.

“It’s nice having somebody be SO excited to see you when you get home,” Lentini says.

●

Medical students Connor Policastro and Tim Lentini with their puppies.

KATE COLLINS, SYRACUSE.COM

calorie BURN So you indulged in a pair of apple fritters. (No one can blame you.) But now you want to undo the damage.

Each fritter is about 300 calories, according to CalorieKing.com. Here are some ways a 145-pound person could burn off 600 calories. The precise number of calories a person burns is influenced by the person’s age, body weight, gender, activity level and movement efficiency. Use this only as a guide.

3 hours, 2 minutes of leisurely canoeing

2 hours, 46 minutes of walking at 3.4 miles per hour on a flat surface

1 hour, 2 minutes of cycling at 12 to 13.9 miles per hour on a flat road

2 hours of vigorous housecleaning

50 minutes of vigorous lap swimming

—reviewed by exercise physiologist Carol Sames, PhD, director of the Vitality fitness program at Upstate’s Institute for Human Performance.

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IN OUR LEISURE

HEALTHY

eats

GUARD AGAINST FOODBORNE ILLNESS

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hen pregnant, a woman’s ability to fight infection is lowered, and she becomes more susceptible to illness. Registered dietitian Juliann Mellen explains how to prevent three common foodborne illnesses: ● Listeria

is a harmful bacteria that grows in refrigerated ready-to-eat foods such as unpasteurized milk and milk products, ciders and lunchmeats. To stay safe, avoid hot dogs and lunchmeats unless they are reheated until they are steaming hot; and brie, feta and other soft cheeses unless they are pasteurized.

● Mercury

in high levels can harm a baby’s developing nervous system, so skip eating shark, swordfish and king mackerel, which have high levels of mercury. Instead, Mellen says it is OK to eat up to 12 ounces per week of fish that are lower in mercury, including shrimp, tuna, salmon and catfish.

● Toxoplasma

is a parasite that can be ingested by eating undercooked meats, contaminated water or produce that has not been thoroughly washed. It is also found in the feces of infected animals, particularly cats. So, pregnant women should have someone else change cat litter boxes and always wear gloves when gardening, Mellen advises.

“Good food safety practices will benefit you and your family for a lifetime.”

Herb Stuffed Tomatoes with White Beans

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ooking for a healthy meal that makes use of the abundance of fresh tomatoes in Central New York? Here’s a tasty meatless solution.

Ingredients

2 ½ pounds fresh tomatoes (look for tomatoes at least 8 ounces) ¼ teaspoon kosher salt

½ ounce green olives, pitted and chopped 2 tablespoons capers, drained and chopped 1 tablespoon fresh parsley, chopped

2 tablespoons olive oil

1 ½ tablespoons fresh oregano, chopped

1 cup yellow onion, diced

1 ½ tablespoons fresh mint, chopped

1 tablespoon garlic cloves, minced 2 tablespoons Kalamata olives, pitted and chopped

1 ½ cups cannellini beans, drained and rinsed ¾ cup Panko bread crumbs

Preparation Cut the top ½-inch off the tomatoes and, using a melon baller or spoon, remove the inside of the tomato. Sprinkle insides with salt and leave upside down while preparing remaining ingredients.

Heat oil in a hot pan and sauté onions and garlic for 1 minute. Add the chopped olives and capers and toss.

Remove from heat and combine with remaining ingredients. Gently stuff each tomato with about ½ cup of filling. Then roast in a preheated 325-degree oven for 30 to 45 minutes, until inside is heated to 165 degrees Fahrenheit.

Yields five servings.

Chef’s note: Filling can also be used to stuff portabella mushrooms, zucchini or eggplant.

Nutritional information, per serving

186 calories

25 grams carbohydrates

0 milligrams cholesterol

7 grams protein

7 grams fat

509 milligrams sodium

RECIPE FROM MORRISON HEALTHCARE, FOOD SERVICE PROVIDER FOR UPSTATE MEDICAL UNIVERSITY.

22

U P S TAT E H E A LT H

fall 2014

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The third Vero in the U.S. is close to home.

The Upstate Cancer Center provides advanced cancer-fighting technology, including the third Vero SBRT installed in the nation.

Skilled radiation oncologists, such as Upstate’s Anna Shapiro, MD, use the Vero to locate, target and treat tumors in real time.

The Vero provides a 3-D view then precisely delivers radiation through beams concentrated on the tumor, sparing healthy cells and tissues. The Vero also can be used for tumors that have spread or that are hard to reach with surgery.

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S C I E N C E I S A RT I S S C I E N C E I S A RT 1 S S C I E N C E I S A RT SEARCHING FOR WAYS TO INHIBIT CANCER protein called Hsp90, short for “heat shock protein-90,� acts as a chaperone or guardian of cancer cells, helping them grow and survive. This image shows the carefully folded parts of the protein, and the resulting pockets, which are occupied by energy chemicals called ATP (Adenosine Triphosphate) at one ten-billionth of a meter atomic resolution.

Drugs compete with ATP to occupy these pockets, which cuts off the energy supply to the protein, consequently killing cancer cells. Assistant professor Mehdi Mollapour, PhD, and colleagues are exploring ways to selectively inhibit Hsp90 using natural products and hope to enhance the efficacy of Hsp90 inhibitors in cancer patients. Mollapour splits his time between the departments of urology and biochemistry and molecular biology.

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14.243 0814 34.150M ELsk

Mehdi Mollapour, PhD