Health UPSTATE
U P S TAT E M E D I C A L U N I V E R S I T Y
Spring 2015 A NEW SHOULDER REPLACEMENT OPTION page 5
PROMPTING THE BODY TO HEAL ITSELF page 12
DOES YOUR CHILD HAVE ADHD? page 14
ASSESSING THE 7-MINUTE WORKOUT page 17
A pill that prevents the spread of HIV page 6
WELCOME
Future doctors get funky in music video
Selecting stroke care: What’s the difference?
A music video created by fourth-year medical students quickly garnered more than 100,000 views within 48 hours of posting it to YouTube and Facebook. “Upstate Funk” is a parody, using Upstate lyrics, of Mark Ronson and Bruno Mars’ “Uptown Funk.” It celebrates the day in March known as Match Day, when medical students learn where they will go for their hospital residencies. Watch the video on YouTube by searching for “Upstate Funk.”
A comprehensive stroke center is typically the largest and best-equipped hospital in a given geographical area that can treat any kind of stroke or stroke complication. Upstate University Hospital was the first hospital in the Central New York region to be certified as a DNV* Comprehensive Stroke Center, encompassing the full spectrum of stroke care — diagnosis, treatment, rehabilitation and education. “Accreditation and certification in health care provide much more than recognition,” says Yehuda Dror, president of DNV Healthcare. “These programs help establish standards of excellence and best practices that directly impact patients’ lives.”
Neurosurgeon Satish Krishnamurthy, MD, left, with residents PHOTO BY DEBBIE REXINE Meg Riordan, MD, and Ali Hazama, MD *DNV stands for Det Norske Veritas, the name of a certification company that originated in 1864 in Norway. HERE’S A LOOK AT THE DIFFERENCE BETWEEN PRIMARY AND COMPREHENSIVE STROKE CENTERS: PRIMARY STROKE CENTER
COMPREHENSIVE STROKE CENTER (UPSTATE)
Patient care Takes care of most ischemic strokes caused by blood vessel blockages.
Patient care Takes care of brain aneurysms and all types of strokes, including ischemic and hemorrhagic, those caused by bleeding.
Minimally invasive catheter procedures Not required.
Minimally invasive catheter procedures 24/7 access to minimally invasive catheter procedures to treat stroke.
Specialized ICU No requirement for a separate intensive care unit for stroke patients.
Specialized ICU Dedicated neuroscience intensive care unit for stroke patients.
Neurosurgery Access to neurosurgery within two hours.
Neurosurgery On-site neurosurgical availability 24/7 with the ability to perform complex neurovascular procedures such as brain aneurysm clipping, vascular malformation surgery and carotid endarterectomy.
Patient transfers Sends complex patients to a comprehensive stroke center.
Patient transfers Receives patients from primary stroke centers.
PRIMARY STROKE CENTERS
COMPREHENSIVE STROKE CENTERS (IN CENTRAL NEW YORK, ONLY AT UPSTATE)
(UPSTATE)
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WELCOME
Contents 5
PATIENT CARE
cover story
8
19
12
11
FROM OUR EXPERTS
DEPARTMENTS
Surgery replaces silence with sound
page 5
New shoulder replacement option
page 5
What to do if you think your child has ADHD
page 14
A pill that prevents the spread of HIV
page 6
How you can help find a vaccine for dengue fever
Lessons from Upstate page 9 Putting babies on backs in hospitals
page 15
Replacing hormones with bioidenticals
page 7
Is there value in the 7-minute workout?
page 17
In the Know page 12 The promise of regenerative medicine
Back on the bike – after successful brain surgery
page 8
On the cover: Elizabeth Reddy, MD, director of Upstate’s Immune Health Services. Photo by Susan Kahn.
What’s Up at Upstate
How a health proxy is a gift page 11
IN OUR COMMUNITY
page 4
Health How-to page 9 Prepare for a neurological exam
Upstate Answers page 16 Why don’t we hear about cancer of the heart?
7 virtues of medicine
page 18
Running an Ebola clinic in Liberia
page 19
Movie extras
page 20
Why I Love Rowing
page 21
Dancing students
page 23
IN OUR LEISURE
Recipe page 22 Black Bean & Avocado Enchiladas Science is Art is Science back cover Exploring promising proteins
Need a referral?
Contact Upstate Connect at 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.
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.
Health
Spring 2015
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
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
Visit us online at www.upstate.edu or phone us at 315-464-4836.
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WHAT’S UP
WHAT’S UP AT UPSTATE A man who sustained a spinal cord injury in a sledding accident in Syracuse more than 25 years ago was in the news recently for his work as a basketball referee. Joe Slaski, 47, now lives in Macedon. The Rochester Democrat & Chronicle identified him as the only person among about 300 referees in Section V who officiates high school basketball from a wheelchair. At the age of 22, he was paralyzed at the waist after going down a steep hill on a plastic sled. He lost control and landed on his back and spent about three months at Upstate University Hospital, plus several months more in rehabilitation. “To be informed by the doctors that my life would be dramatically changing certainly was a hard pill to swallow,’ Slaski told the newspaper. “But they say whatever doesn’t break you makes you stronger, and there certainly has been a lot of good that has come about from a tragic situation.” Slaski played wheelchair basketball for the Rochester Wheels and the Syracuse Flyers before becoming an official. l
oe S a k o Ma edon o
Vicky Brannon’s 14-year-old son, Matthew John McIntyre II, was killed in what police called an accidental shooting in July 1996 across the street from the family’s home in Fulton. She agreed to donate his heart, liver, pancreas and kidneys. More than a year later, she sought to connect with the organ recipients. The Tampa Bay Times explained how Brannon followed organ donor network protocols, writing to each recipient and awaiting their responses. She received an immediate response from the person who received Matthew’s pancreas and one of his kidneys. Soon after, she relocated to Florida. The newspaper explained that Brannon never received letters from the 14-year-old girl who received Matthew’s heart. That girl, Jennifer Lentini, sent letters via the network for 10 years, until her home was gutted by fire. Recently she went through boxes salvaged from the fire and came upon Brannon’s original letter. Lentini, 32, renewed her search. She turned to Facebook. There, she connected with Matthew’s brother, Chad. Earlier this year, she traveled to Florida to meet Matthew’s mother. It was Valentine’s Day — which is also National Organ Donor Day — when Brannon was able to press a stethoscope to Lentini’s chest and hear her son’s heart beating. l
A diagnosis of attention deficit hyperactivity disorder puts a person at a higher risk of dying young — usually in a car crash or other accident — than those without the disorder, according to a study published in February in The Lancet. In covering the research, The New York Times contacted Upstate psychiatry professor Stephen Faraone, PhD, who told the newspaper that parents should not be alarmed.
a e h gh hoo ba ke ba PHO O BY HAWD DOWD ROCH
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“But this is a large, well-done study, and I see it as a reason to identify and treat ADHD,” he said. Researchers analyzed nearly 2 million Danish medical records to come to the conclusion that children diagnosed with ADHD died at roughly twice the rate of premature death among those without the disorder. Those who were diagnosed after the age of 18 had an even higher risk of dying early. Faraone told the Times the heightened risk may reflect a late diagnosis. Children with untreated ADHD are likely to get off track, academically and socially, and may live more recklessly than their peers. While conduct disorders, antisocial behaviors and substance use are likely to happen along with ADHD, Faraone pointed out that “only one of these is easily treatable. And that’s ADHD.” (See related story on page 14.) l
Several images from Upstate’s historical collections were part of an exhibit at Syracuse Stage called “Electricity, Medicine and Morals in Victorian Syracuse.” The panel exhibit gave a local perspective that was reflected in the play, “In the Next Room.” The play, set in the 1880s when electricity was new, centers on an instrument doctors used to treat female “hysteria.”
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PATIENT CARE
Surgery replaces silence with sound A rare developmental disorder left Mason Drake deaf since birth. He heard nothing in his first six years of life.
His parents brought him to Upstate University Hospital for BY AMBER SMITH surgery in November. Charles Woods III, MD, installed a pair of cochlear implants that allowed Mason to hear sound for the first time. The implant’s receiver was secured to the youngster’s skull, electrodes were inserted into the inner ear, and weeks later — after the usual swelling had subsided — audiologist Jeffrey Vantassel turned the device on. Mason heard the voices of his parents, Jessica and Kevin Drake of Oswego, both of whom used sign language to augment their speech. Megan Coleman, a news anchor for CNY Central, described Mason’s response as “part uncertain, part afraid, clearly overwhelming.” The news station covered Mason’s implant surgery in a three-part series that aired late last year. “What the implant actually does is stimulate the eighth nerve, which is our hearing nerve, directly to the brain,” Woods, an assistant professor in otolaryngology and communication sciences, told the news crew. Jessica Drake said her son is still getting used to the devices. He takes them off for bathing because they cannot get wet, and he takes them off when he sleeps. Sometimes when he gets home from kindergarten, he takes them off to give himself a break from all the sound.
Mason Drake at the moment he heard sound, thanks to cochlear implants. PHOTO BY KATHLEEN PAICE FROIO
speech therapist and audiologist at school, and he has follow-up appointments with Vantassel every month. Eventually, the Drakes hope Mason will develop speech. “Everything that we thought was out of reach seems more attainable now,” Kevin Drake said. To learn about cochlear implant options, contact otolaryngologists Charles Woods III, MD, or Brian Nicholas, MD, at 315-464-4678. ●
Study compares shoulder replacements A remote controller adjusts the volume of the implants. His mom or dad increases it a little each day. Mason has a
People facing shoulder replacement surgery could be candidates for a study at Upstate that tests the safety and effectiveness of a new shoulder replacement system. The study compares the Arthrex Eclipse shoulder prosthesis with a more conventional prosthesis.
“People with different types of arthritis and other conditions causing pain and disability are candidates for the procedure,” said Kevin J. Setter, MD, associate professor of orthopedic surgery at Upstate. The shoulder is a ball-and-socket joint with the top of the upper arm shaped like a ball. Traditional shoulder replacement surgery attaches the new ball joint to a large metal stem inserted into the upper arm. The new “stemless” procedure under investigation fixes the ball joint at the top of the upper arm with a special screw, without inserting a stem all the way through the upper arm.
Since the Arthrex Eclipse avoids the insertion of a long stem, it is a much less invasive surgery, designed to preserve more healthy bone and tissue in the shoulder. This may reduce pain and make the new joint function more naturally.
While it remains an investigational device in the United States, the Arthrex Eclipse has been approved for use in Europe and Canada, where thousands of procedures have been completed. Upstate is one of 15 sites in the United States testing the system. Learn more by contacting the Upstate Orthopedics Clinical Research Office at 315-464-8618.●
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PATIENT CARE
Preventing the spread of HIV with a pill Infectious disease experts in the early 1980s were trying to make sense of clusters of gay men with unusual infections and failing immune systems. It was the beginning of the AIDS epidemic. Soon researchers identified the human immunodeficiency virus as responsible, and attention turned to finding a cure, or at least a vaccine.
Now, 35 years later, a pill exists that can halt the spread of HIV.
How to obtain Truvada
Upstate’s Immune Health Services is prepared to prescribe Truvada. Call 315-464-5533 for an appointment. Also, some primary care doctors in Central New York will prescribe the drug. Before a person receives preexposure prophylaxis, a blood test must confirm that they are not infected with HIV. People taking Truvada for prevention are supposed to be tested regularly for HIV and other sexually transmitted diseases, which can increase a person’s risk for HIV.
Truvada is a medication that is commonly paired with other medications to treat HIV infection. It is also being used — together with safe sex practices — to help reduce the risk of becoming infected. Used this way, the therapy is called pre-exposure prophylaxis, or PrEP. “If people taking PrEP take the medicine regularly and it is detectable in their system, they have about a 90 percent reduction in acquisition of HIV. So it’s highly effective,” said Elizabeth Reddy, MD, medical director of Upstate’s Immune Health Services. Just taking Truvada is not enough to protect someone from getting HIV, however. Condom use is important, as is limiting exposure by limiting the number of sex partners. Gilead Sciences, the maker of Truvada, cautions that Truvada can cause serious liver problems, or a buildup of lactic acid in the blood, which would be a medical emergency. It can also worsen hepatitis B symptoms if a person suddenly stops taking Truvada. The medication can also cause kidney problems including kidney failure, bone problems that may make one prone to fractures, changes in body fat and changes to the immune system. Reddy said that “for the most part, Truvada is extremely well tolerated. It has no side effects in most people.” Most side effects, including headache, abdominal pain and
Elizabeth Reddy, MD, leads Immune Health Services. PHOTO BY SUSAN KAHN
decreased weight, subside within a few weeks. Truvada is designed for people who are healthy, uninfected, free of kidney disease and at high risk for HIV transmission. Those at highest risk in America are young men having sex with men, Reddy said. With the proportion of new HIV infections in the United States increasing. Reddy said infectious disease experts believe Truvada is a crucial new weapon in the public health arsenal. If its use can reduce the number of people who become infected, we may finally begin to see the end of the epidemic. ●
Hear an interview at www.upstate.edu/healthlinkonair by searching “Truvada.”
A sacred space to say goodbye Administrators, doctors and hospital staff gathered in a unique room at Upstate University Hospital one weekday this winter for a rededication ceremony. Technically the room is known as the viewing room, and like those found at funeral parlors, it is for loved ones who need a place to say goodbye. The space was updated with furniture and artwork painted by hospital volunteer Gracia Sears. The Rev. Terry Culbertson, who leads the spiritual care program at Upstate, said the Irish have another name for the space: The Thin Place. Culbertson spoke at the ceremony. “The Thin Place is a place where the veil between heaven and earth is very thin, and a place where the two worlds coexist in a loosely knitted relationship,” she said. “It’s also
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called the liminal space. ‘Liminal’ is from the Latin, meaning ‘threshold,’ which we walk across between this world and the next. “Describing the meaning of the Thin Place is like trying to describe what is love, or what does it feel like to hold your firstborn child or your firstborn grandchild, or the existence of God,” Culbertson continued. “When you’re in the Thin Place, time seems to stand still. There’s a communion with human spirits, both those who have gone before us, those who are here, and those who will come to be with us. It’s about connection to the sacred. And so, we are very grateful for this Thin Place, this special room.” ●
ARTWORK BY GRACIA SEARS
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PATIENT CARE
Hormone replacement can include compounded estrogens Roxanne Eyler trains at Ultimate Goal in Marcellus.
PHOTO BY SUSAN KAHN
As she entered her late 50s, suddenly Roxanne Eyler’s cholesterol and triglyceride levels started to creep up. A trainer at Ultimate Goal in Marcellus, she ate well and was physically fit but found she was gaining weight and awakening in the middle of the night. Eyler’s doctor wanted to prescribe a pill to lower her cholesterol. She wanted to understand why it was rising and what else was going on. She attended a lecture on hormone replacement therapy at the Marcellus Free Library. At the end, she decided to make an appointment with the speaker, certified nurse midwife Heather Shannon. “She doesn’t rush me out of her office. She takes her time,” Eyler said of Shannon. Shannon talked to Eyler about her lifestyle, nutrition, energy level, mood, sleep habits and the symptoms she was having. Then she had saliva and blood samples analyzed. Based on the results, Shannon told Eyler to take a series of B vitamins, one pill at each meal. “Within a week, I could not believe the difference that I saw,” Eyler said. The vitamins helped her gastrointestinal tract better absorb the nutrients from her food. In addition, Shannon designed a bioidentical hormone preparation that Eyler would apply to her skin in the morning and evening. Such preparations are a combination of the estrogens estriol and estradiol. The exact dose of each is customized to the patient. “It’s a wonderful option, as long as you are a candidate,” Shannon said of the customized plant-based preparation that is available at pharmacies that compound medications. “If you are estrogen-dominant, we’re not going to give you extra estrogen. We’re going to give you a little more progesterone, and possibly some testosterone to help balance your hormones.” Shannon said women taking bioidentical hormones have to be as concerned about the risk of breast cancer and cardiovascular disease as women taking traditional hormone replacement. Also, patients are followed closely so that adjustments to the preparations can be made if necessary.
Women make three principal types of estrogen: Estrone is the strongest of the estrogens and is linked to breast and uterine cancer if levels are too high. Estradiol, the secondstrongest estrogen, is produced by the ovaries and requires certain nutrients at specific levels to be metabolized properly. Estriol levels increase with pregnancy and create few side effects.
In Eyler’s case, she has been taking the vitamins and bioidenticals for a couple of years. Her cholesterol and triglyceride levels are in check, and she believes she is in better shape now than she was in her 30s and 40s. ●
Hear an interview at www.upstate.edu/healthlinkonair by searching “bioidentical.” Reach Heather Shannon at her office on Upstate’s Community Campus or by calling 315-464-8668. spring 2015
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PATIENT CARE
He races cyclo-cross after successful brain surgery Jordan Pone was 5 when he abruptly lost the ability to hear. As doctors searched for the cause of his hearing loss, they came across unusual lesions in his brain.
The lesions were not cancerous, but they were serious. At the time, doctors advised keeping close watch on the lesions and any symptoms they might cause, such as seizures or headaches. This was almost 10 years ago, and surgery on the lesions would have meant open brain surgery for Jordan. Today, Jordan is 15. He wears hearing aids, rides cyclo-cross and “with regard to this, shows a great maturity that is just amazing,” said his father, Daniel Pone. The hearing loss is not related to the lesions, which doctors continue to monitor. When one of the lesions began growing and bleeding in late 2013, the Pones explored treatment options. They found pediatric neurosurgeon Zulma Tovar-Spinoza, MD, at Upstate. She told them they could continue monitoring the lesions, perform open surgery to remove them, or use a new focused laser technology to ablate and reduce their size. Daniel and Simmone Pone of Constantia liked the laser option for their son; he had not suffered seizures or headaches, and they wanted to make sure he would not. Doctors had never before treated a pediatric patient with lesions like Jordan’s using laser ablation, Tovar-Spinoza explained. She performed the first operation in February 2014, targeting the largest lesion. In another operation in November, she focused lasers on two other lesions that were showing signs of bleeds. That surgery took place in Upstate’s new surgical suite that provides direct access to a magnetic resonance imaging machine, so scans can be taken during surgery. Pone said his son recovered quickly. After both surgeries, Jordan was back home the next day. He has been able to return to the sports he loves: bicycle racing and cyclo-cross. And, follow-up exams show that the lesions are shrinking. ●
Jordan Pone of Constantia bike races cross country. PHOTO COURTESY THE PONE FAMILY
Hear an interview at www.upstate.edu/healthlinkonair by searching “Tovar-Spinoza.”
Steps of Jordan’s operation 1. He is placed under anesthesia in the operating room. 2. A frame is positioned around his head. 3. He is moved into the MRI machine for imaging. 4. He returns to the operating room, where the frame is fixed to a clamp. 5. Dr. Zulma Tovar-Spinoza introduces lasers into his brain through tiny incisions. 6. The patient is moved to the MRI machine. 7. New images show that lasers are in the planned position. 8. The lesions are ablated, or destroyed, while live images from the MRI machine are visible. 9. After a final post-ablation scan, he is moved back to the operating room. 10. The lasers are removed, and the small incisions are closed with a single stitch.
Zulma Tovar-Spinoza, MD, operates on Jordan Pone in November. PHOTO BY ROBERT MESCAVAGE
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FROM OUR EXPERTS
What to expect from a neurological exam At your exam, the doctor is likely to:
• assess your mental status, test your memory and/or your ability to speak and understand; • assess your cranial nerve function by testing your eyesight and hearing and examining how you move your face; • conduct a motor exam to check the strength of your arms and legs; If you’re feeling anxious about an upcoming neurological exam, “take a deep breath, and try not to be scared,” said Dr. Larry Chin. Realize that a referral to a neurologist or neurosurgeon simply means that your doctor is seeking advice. Chin directs Upstate Medical University’s Department of Neurosurgery and also oversees the Gamma Knife Center and the Neuro-Oncology Program at Upstate University Hospital. Before your appointment, write down your symptoms, any relevant problems that exist in your family and any recent illnesses you have had. Also, prepare a list of the medications you take.
• conduct a sensory exam that may involve touching your skin or pressing it with a safety pin; • test your reflexes using a small rubber hammer tapped on your joints; and • assess your walking ability and coordination. Depending on what the doctor finds, you may be asked to give a blood sample, or go for an imaging study. You may also be recommended for additional tests that stimulate the nerves and muscles of your body. Chin said, “It’s all designed for the neurologist or neurosurgeon to help your doctor figure out if there is something that needs further treatment.” ●
LESSONS FROM UPSTATE
Back to sleep policy sets good example For 20 years, parents have been advised by the American Academy of Pediatrics to put babies to sleep on their backs, to help reduce the risk of Sudden Infant Death Syndrome. It’s especially important for a baby born prematurely, whose SIDS risk is four times greater than that of a full-term baby. Pre-term infants are routinely hospitalized, sometimes for months. During that time, nurses position babies on their sides and tummies for medical and developmental reasons. The problem, says a researcher from Upstate’s College of Nursing, is that parents are liable to replicate practices they see in the hospital. Sherri McMullen, PhD, an assistant professor of nursing, recommends the babies be transitioned to sleep on their backs before they are sent home “so that both the infant and parents are comfortable prior to discharge and use this position after discharge,” she wrote with a colleague in the journal Advances in Nursing Science.
“Twenty-four hours is not enough time before discharge for an infant to be transitioned to their back,” McMullen said. “Educating the parents about sleep safety and modeling correct practices for positioning the infant before the family leaves the hospital is essential.” The researchers acknowledge that a balance must be found that allows enough time for the infant to become acclimated to the supine position without impacting neurodevelopment. They say hospital policies that promote a “back to sleep” transition can potentially help protect babies from SIDS after discharge. ●
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FROM OUR EXPERTS
FIR RST AND ONLY O Y
Severa al members of the Ups p tate Stroke Center’s multidisciplinary p y tteeam
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Your health care proxy is a gift to your loved ones
FROM OUR EXPERTS
BY TIMOTHY CREAMER, MD
I sat with my father on a cool early summer afternoon. I forget what we were chatting about specifically, though probably it was something financial. That was his expertise. The conversation drifted, and we sat silently for a moment. “I'm ready, you know.” He had a second knee surgery about four months prior. He had an operation to remove a blockage from his neck a year before that. He had an irregular heartbeat and mini strokes. Trans-ischemic attacks, they call them. “There’s nothing more I can offer this world. I have faith that I’ll be taken care of.” His openness caught me by surprise. But I realized fairly quickly that he was letting me know that he was comfortable with his ultimate demise. I think he wanted me to feel more comfortable when the time came. Less than a year later, I received a phone call from my father. “I can’t get on the stupid computer!” I packed up what I was doing and drove the five miles to my parents’ condominium. In his prime, my father commuted 45 minutes to work each day in New York City from his home in Thornwood in Westchester County. Now, with a bad back and knees, he and my mother were settled into condominium living. The computer had extended my father’s life, allowing him to manage stocks. But today he could not remember how to click the start button.
When I got him signed into his accounts and numbers filled the screen, his eyes blinked. He cursed. I realized he was unable to process the data. His mind, which had carried him through his 88 years, was failing. I sent a note to my sisters. Soon after, he was admitted to the hospital with circulatory problems. Although his illness was not considered serious, I knew from my medical training that any hospitalization in a person seven years beyond the 81-year life expectancy had the potential to be complicated. My father’s wishes were appropriately dictated on paper. I visited him daily. I had not been completely comfortable with his decisions when he spoke to me about them, but now, as he was beginning to suffer, I understood. I felt empowered to let his suffering end. Any journey is easier when we have directions. My father not only gave me the directions, he gave me the strength through his faith to be able to follow those directions. Give your loved ones directions to follow. Complete a health care proxy. Help them be able to help you when your time comes. ●
Find health care proxy forms at upstate.edu/bioethics/consult/hcp.php
Timothy Creamer, MD, holds a photo of his father, George. Creamer is division chief of hospital medicine at Upstate University Hospital, Community Campus. PHOTO BY SUSAN KAHN
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IN THE KNOW
The next generation?
Regenerative medicine teaches the body to repair itself
This slice of a frog retina is stained with antibodies that recognize rods (red), cones (green) and cell nuclei (blue). Frogs have the same retinal cell types as the human retina. FROM THE LAB OF MICHAEL ZUBER, PHD
Imagine your grandfather develops trouble with his vision. Straight lines appear distorted. The center of whatever he looks at turns blurry and dark. His color perception diminishes. You bring him to a doctor, in hopes that he doesn’t go blind. What will the doctor do to help? A solution is not clear yet, but Michael Zuber, PhD, believes it may one day be possible. He’s part of the exciting field known as “regenerative medicine,” learning how to prompt the body to grow new tissues and organs to replace those that wear out and die. Like many vision researchers across the country, Zuber and his colleague Reyna Martinez-De Luna, PhD, embrace the goals of the National Institutes of Health’s National Eye Institute, to regenerate neurons and neural connections in the eye and visual system, in response to the increasing prevalence of blinding diseases such as age-related macular degeneration, glaucoma and diabetic retinopathy. Zuber and Martinez-De Luna, who work in the Center for Vision Research at Upstate Medical University, focus on the retina, the light-sensitive layer at the back of the eye. They want to find a way to prompt regeneration in the retina to
prevent blindness due to injury or disease. Animals other than mammals can regenerate retinal cells when the original cells die, but somehow that ability was lost through evolution, Zuber said. The African clawed frog that he studies is one of the animals that has retained the ability to regenerate. If the retina is surgically removed from a tadpole or from an adult frog, it grows back in as little as a month. The newly regenerated retina contains the same architecture and cell types as the original retina. Research in the field of regenerative medicine has concentrated mostly on reprogramming stem cells into retinal neurons that can be used to restore vision. Zuber and Martinez-De Luna are taking a different approach. They want to identify the signals and molecules that instruct the retina how to replace its lost or dying cells. To accomplish this goal, they are studying the African clawed frog because this non-mammalian vertebrate regenerates retinal cells. These frogs have what scientists call intrinsic progenitors, a pool of cells that constantly produce new cells as needed. In addition, the frogs’ mature cells have the ability to turn themselves into a different cell type in a process called transdifferentiation.
continued on page 13
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IN THE KNOW
RETINA
The retina is the light-sensing tissue at the back of the eye that converts light into electrical signals that are interpreted as visual images by the brain. Animals that have backbones, called vertebrates – which includes humans, as well as frogs – have the same types of retinas, comprised of six major neurons, or nerve cells, and one glial cell: ganglion cells, horizontal cells, cone photoreceptors, rod photoreceptors, amacrine cells, bipolar cells and Muller glial cells. The retinal pigmented epithelium is the pigmented cell layer outside the neural retina that supports photo-receptor function. Whether due to age or an inherited condition, retinal diseases that lead to blindness usually affect a particular cell type first. Death of one type of cell leads to subsequent loss of other neurons in the retina, progressive retinal degeneration and, often, blindness.
Regenerative medicine
EYE DRAWING COURTESY OF ABIGAIL ZUBER AND ADAPTED FROM AN EYE DIAGRAM FROM THE NATIONAL EYE INSTITUTE. THE RETINA SCHEMATIC IS COURTESY OF ANDREA VICZIAN, PHD.
continued from page 12
For a review paper in the Journal of Ophthalmic Vision Research last year, Zuber and Martinez-De Luna summarized the current knowledge of endogenous mechanisms of regeneration in frogs and how understanding those mechanisms could lead to new approaches for repairing the human retina. “The mammalian retina has the potential to initiate a program of regeneration under favorable conditions,” they wrote. They are studying how new rods, the cells responsible for night vision, regenerate after the original rods are eliminated and how retinal degeneration caused by prolonged rod death affects this regeneration. Some of the questions they are exploring include: l
How long does it take for rods to regenerate after they are eliminated?
l
Where do the regenerated rods come from? Do they come from the retinal pigmented epithelium or from the intrinsic pool of progenitors present in the frog retina?
l
What are the cellular and molecular events that define the critical point beyond which regeneration is no longer possible?
“Understanding how animals such as the frog can regenerate new retinal cells will help us to identify
Reyna Martinez-De Luna, PhD, and Michael Zuber, PhD, at the Center for Vision Research in Upstate’s Neuroscience Research Building. PHOTO BY SUSAN KAHN
the reasons our own retina cannot repair itself, and in the long term lead to new therapies for replacing retinal cells in patients who have lost their vision due to damage or disease,” explains Zuber. It’s a scientific challenge they are up for. Ultimately, Zuber and Martinez-De Luna are optimistic that their work will help find a regenerative solution, someday giving doctors a way to help patients who face blindness. ●
Hear an interview at www.upstate.edu/healthlinkonair by searching “regenerative.” spring 2015
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FROM OUR EXPERTS
Advice for parents
DO YOU THINK YOUR CHILD MAY HAVE
If you believe your child may have attention deficit hyperactivity disorder, “the most important thing is not to wait,” said scientist Stephen Faraone, PhD. Faraone, a professor in Upstate’s departments of psychiatry and neurosciences and physiology, has authored more than 700 journal articles, editorials, chapters and books having to do with the nature and causes of mental disorders in childhood. He said most pediatricians are well trained in diagnosing and treating ADHD. Parents should explain to the pediatrician why they have concerns. The doctor may say that the child has a normal level of exuberance. “If they tell you the child has ADHD, don’t delay treatment,” Faraone said. “Every year that you delay treatment is a year that your child is exposed to many risks — the risks of having difficult friendships, not socializing properly, of failing in school, not doing as well
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as they might. (By delaying treatment,) your child’s self esteem goes down, and their problems get worse.” Many ADHD medications have been used safely since the 1960s. Faraone says few alternatives have been shown to be effective. One exception is an omega 3 fatty acid known as eicosapentaenoic acid or EPA, which may be modestly helpful for children with ADHD. Still, it is only about half as effective as medications, he said. Monitoring how well your child’s treatment is going is also important. The pediatrician may change the prescription before finding the medication that is most effective. The child may also need interventions at school. And, parents may benefit from behavioral family therapy. Faraone is reassuring: “They will do well if they’re treated and you monitor them. Most people with ADHD are able to live productive and happy lives.” ●
Hear an interview at www.upstate.edu/healthlinkonair by searching “ADHD.”
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Dengue fever
FROM OUR EXPERTS
Learning to reduce transmission
Studies in the urban coastal city of Machala, Ecuador, taught an international team of researchers, including some from Upstate, what’s necessary to reduce the transmission of dengue fever. The most vulnerable populations must be targeted, and local governments and community leaders must collaborate in order to establish a dengue early warning system. Efforts to contain the viral disease — which is spread from the bite of an infected mosquito and not from person to person — have mostly focused on developing nations. But dengue fever has been transmitted in the United States, on Long Island, and experts believe it will become more of a concern. Dengue fever is usually not fatal, but it can cause severe pain behind the eyes, headaches, very high fevers and joint and muscle aches so severe that the virus was nicknamed “break bone fever.” There are four strains of dengue. Once a person is infected with one strain, he or she is protected from that strain. However, a subsequent infection with one of the other three strains puts him or her at greater risk for a severe immune response, says Mark Polhemus, MD, an associate professor of medicine and microbiology and immunology at Upstate. Social risk factors and climate seem to play a role in the spread of dengue, according to the research team’s findings, which were published in the online medical journals BMC Infectious Disease and BMC Public Health. A 2010 dengue outbreak in Machala occurred during an unusually hot and rainy season, the research article says. Researchers found that older people and those living in poor housing conditions were most affected by the outbreak. “We found that social and political conditions have to be considered when designing dengue control interventions, especially for high-risk, marginalized populations,” says Anna M. Stewart Ibarra, PhD. An assistant professor of medicine at Upstate, Stewart Ibarra is the Latin America Research Program director in Upstate’s Center for Global Health and Translational Science. Findings from the studies are intended to be used to develop dengue vulnerability maps and climate-driven dengue seasonal forecasts. This will allow Ecuador’s health minister to “target high-risk regions and seasons, allowing for more efficient use of scarce resources.”
Anna M. Stewart Ibarra, PhD, traveled to Ecuador for her work on understanding the challenges of diagnosing and managing dengue fever. She is pictured with Regan Deming, summer research coordinator.
Study seeks participants
Upstate researchers are looking for healthy adult volunteers to help find an effective vaccine for dengue fever. Upstate’s Mark Polhemus, MD, directs the Center for Global Health and Translational Science, where two promising dengue vaccines have been evaluated over the past two years. Because animals do not contract the human forms of dengue, researchers seek humans between the ages of 18 and 45 who are willing to be injected with an attenuated, or weakened, dengue virus. “Our goal is to be able to produce an uncomplicated dengue, a mild form of dengue,” Polhemus explains. If that develops consistently in the people who participate in the trials, the researchers will be able to use the attenuated virus for vaccine trials involving many people, in areas of the world where dengue fever is prevalent. Volunteers will have to commit to about a month’s worth of medical appointments every other day at the center, with phone calls on alternate days. Those who become ill will be admitted to a room at Upstate University Hospital’s Community campus for care and monitoring. “In all clinical trials, there is a level of danger,” Polhemus says. “But this sort of trial has been done before with dengue. This has been done before with other diseases. This virus is attenuated, and we have multiple safety measures in place to ensure that this goes well without complications.” Learn more by visiting the center’s website at upstate.edu/cghats, calling 315-459-3031 or emailing trials@upstate.edu ●
Hear an interview at www.upstate.edu/healthlinkonair by searching “dengue.”
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FROM OUR EXPERTS
UPSTATE ANSWERS
Why don’t we ever hear about heart cancer?
“It’s not something we see very often,” said Robert Dunton, MD, chief of cardiothoracic surgery at Upstate University Hospital. He went on to provide this answer:
Benign tumors of the heart are probably more common than malignant (cancerous), but both are pretty rare. The most common of the benign tumors is known as a myxoma, but there is a whole host of other benign Robert Dunton, MD tumors. When you consider malignant tumors, they are either a primary heart tumor, or metastatic, meaning it spread to the heart from somewhere else. Usually it’s from somewhere else. It’s very unusual for the heart to have its own malignant tumor. That’s probably because the heart is made up of specialized muscle cells. Although the heart is composed of other types of connective tissue, most of it is a very specialized muscle, and muscle, as a rule, is a rare place to have malignant tumors. The predominant symptom is often one of breathing difficulties. Folks may feel short of breath, have what we call dyspnea. That’s because these tumors, when they’re inside the heart, can kind of roll around and get in the way and block blood flow for short periods of time, and the patient will feel those symptoms. Less commonly, folks will have either chest pains or palpitations, feel their heart skip a beat. Sometimes with myxomas, patients can have a flu-like illness, with fevers, muscle aches and pains. These are diagnosed with a cardiac echocardiogram, which can be done from the outside as well as the inside. If we do an echo of the heart from the outside, we’re limited because we have to look between the ribs. So there’s a probe that can go down the patient’s esophagus, and from the inside, there’s nothing in the way, so we get much better pictures. It’s called a trans-esophageal echo. Another test that’s really quite elegant is called cardiac magnetic resonance imaging, using the MRI machine. Sometimes we’ll use an MRI picture of the heart to further diagnose or plan what type of operation the patient may require. Generally, most tumors in the heart have to be removed. The benign tumors, we remove because they can certainly, even though they’re benign, cause some significant
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Four patients have been cared for with cardiac tumors in the last 18 months at Upstate. Three had myxomas, which are benign cardiac tumors like the one pictured in the illustration above. The fourth had a primary tumor, meaning it developed in the heart, that turned out to be cancerous. ILLUSTRATION BY A.D.A.M., INC.
problems. They can create blockage in terms of blood flow. In other words, they get in the way. They can create arrhythmias or heart irregularities, palpitations or other heart rhythm disturbances. One of the concerns we have about tumors inside the heart is that pieces of them can break off. They can go through the circulation and create injury. If a particle comes off of a tumor, it can go to the brain and cause a stroke or go to the kidney and cause kidney damage. We remove malignant tumors to prevent those same problems, but also because malignant tumors can grow and get much worse and can also spread. Like any cancer, we would consider trying to remove it all. The problem is, in the heart we are limited to how much tissue we can remove. There are surgeons who have reported operating on a patient for a malignant tumor by actually removing the heart, like you would if your patient was going to have a transplant. They remove the heart, and on the table in the operating room, work on it to remove the malignant tumor, reconstruct things and then put it back in. That is called auto-transplantation. Some patients have even been treated with a transplant. These are definitely unusual, but here at Upstate, we’ve seen four in the last 18 months. It’s not so uncommon that we don’t ever see it, so it has to be part of a physician’s diagnostic thinking. ●
w w w. u p st ate . e d u
FROM OUR EXPERTS
How much exercise do you need? The Department of Health and Human Services recommends that most healthy adults get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity each week.
Even the time-crunched can spare 7 minutes to work out
The “plank” is one of 12 moves in the 7-minute workout, which also includes jumping jacks, wall sits, push-ups, abdominal crunches, step-ups onto chairs, squats, tricep dips, high-knee running in place, lunges, push-ups with rotations and side planks.
Ask people why they don’t exercise, and they are liable to say they don’t have time.
So, exercise scientists set about crafting a short but beneficial workout. They wound up with a dozen highintensity intervals they call “The 7-Minute Workout.” Carol Sames, PhD, an exercise physiologist who directs the Vitality! Fitness Program at Upstate, is a fan of the workout because it can be adapted to people of various abilities, it can be done in the home, and it’s a good substitute for people who say they cannot fit in the recommended weekly 150 minutes of moderate or 75 minutes of vigorous exercise. “This workout is about interval training, which has been around for years, but just packaged slightly differently,” Sames explained. Each of the 12 exercises takes 30 seconds and is separated by 10 seconds of rest. One circuit takes 7 minutes, and ideally, people would repeat the circuit two or three times, extending their time commitment. She said the 7-minute workout can be helpful. It can increase muscular fitness and aerobic capacity, improve the body’s insulin use and burn calories at a higher rate than lower-intensity exercise, which can help shed fat.
The intensity is likely too high for people with high blood pressure or cardiovascular disease, or for someone who has been sedentary or is significantly overweight. It may also be too much for those with significant osteoarthritis or rheumatoid arthritis. Adaptations can be made in the selection of the specific exercises to reduce the intensity.
The 7-minute workout can be used as supplementary training to improve aerobic fitness and strength in athletes or for someone who is training for a distance run. The 7-minute workout is better than not working out. “If you just want to improve some cardio and strength,” Sames said, “you get a lot of bang for your buck in 7 minutes.”
Is the 7-minute workout for you? Upstate exercise physiologist Carol Sames, PhD, said to ask your health care professional if this workout is appropriate for you. If so, start slowly — perhaps by lengthening the amount of rest between exercises — and modify the moves as needed.
It’s not for everyone, however.
Hear an interview at www.upstate.edu/healthlinkonair by searching “7 minute.” spring 2015
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IN OUR COMMUNITY
ADVANCED TECHNOLOGY, MULTIPLE LOCATIONS
Goodness:
Finding 7 virtues in medical practice
You may have heard of the seven deadly sins — pride, anger, envy, lust, greed, gluttony and sloth. Well, there are also seven so-called “primary virtues,” which derive from ancient sources — four cardinal virtues come from Plato, and three transcendental virtues come from Paul of Tarsus, also known as St. Paul or the apostle Paul.
Robert Roger Lebel, MD, who directs medical genetics at Upstate, recently gave a brief video chat explaining where he sees the seven primary virtues in the practice of medicine. “Prudence is the primary virtue,” he began. “It is the virtue that informs the other six and without which the other six become empty or hollow, almost useless efforts.” 1. Prudence means wisdom. It is making sound judgments when faced with uncertainty. This is what doctors and other health care providers do every day. Upstate Breast Imaging offers the most advanced technology and services expected from the region’s only academic medical center.
TWO CONVENIENT LOCATIONS ALLOW FOR EASY ACCESS AND TIMELY APPOINTMENTS: WOMEN’S IMAGING AT 550 HARRISON
2. Justice is taking appropriate action with patients, to help solve their problems. 3. Temperance is a soundness of mind. It is tolerance and social decorum. 4. Fortitude is also known as courage, and it does not mean the absence of fear. It is overcoming fear or other obstacles in order to do what’s right. 5. Faith, as a virtue, has nothing to do with religion. It is the assurance of things hoped for and the conviction of things not seen. Health care providers must have faith in themselves, in their colleagues, in their patients, in treatment plans. 6. Hope is rational optimism, an expectation of favorable outcomes, and Lebel said it is essential to the practice of medicine. 7. Love, otherwise known as charity, is why people enter the medical profession. They practice medicine because they love the work, they love the science, they love the patients and their colleagues. Within the profession of medicine are many examples of good and virtuous behavior. Politeness, gentleness, punctuality and more. Each is a species of one of the primary virtues — still compelling after more than 2,000 years. ●
315.464.2588 Upstate Specialty Services 550 Harrison St. Syracuse, NY 13210
WELLSPRING BREAST CARE CENTER
PRUDENCE
315.492.5702
TEMPERANCE
Upstate University Hospital Community Campus Physicians Office Building South 4900 Broad Rd. Syracuse, NY 13215
JUSTICE
FORTITUDE
FAITH
HOPE
LOVE/ CHARITY
UPSTATE.EDU/BREASTIMAGING ROBERT MESCAVAGE
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IN OUR COMMUNITY
An
Ebola fighter
with ties to Syracuse
BY AMBER SMITH
Ebola was ravaging her native Liberia, and Margaret Tandoh, MD, felt pulled to assist. Her surgical skills might not be needed, but she could certainly provide basic medical care.
After a colleague agreed to cover for her so she could take time away from her duties at the University of Vermont College of Medicine, Tandoh joined AmeriCares. She spent November and December helping to build and staff an Ebola treatment center in Buchanan, a couple of hours from Liberia’s capital city, Monrovia. Tandoh thought she would find Ebola victims in the streets. But the country looked much as it did in March 2014, when Tandoh was there for a niece’s wedding. The visible difference was outside of homes and stores, where someone took temperatures of people before they entered, and where buckets of water reminded people to wash their hands. The Centers for Disease Control and Prevention reports 9,712 probable, suspected or confirmed cases of Ebola in Liberia and 4,332 deaths during the largest and most complex outbreak of Ebola in history. Born and raised in Liberia, Tandoh moved to America as a teenager. She got her medical degree from Meharry Medical College in Nashville and completed a residency and fellowship in Ohio. She formerly was a trauma surgeon at Upstate University Hospital who oversaw the Clark Burn Unit.
Margaret Tandoh, MD, cradles Josephine, a 3-month-old baby she cared for in Liberia while the baby’s mother was being treated for Ebola. Tandoh is dressed in full personal protective equipment because she is outside of a ward for people who are suspected of being infected with Ebola. The white board lists the names of patients and their temperatures. The “0.5%” refers to the strength of the chlorine medical workers used for cleaning body fluids.
Her AmeriCares group comprised 24 expatriates from multiple countries. Tandoh was one of five doctors who were teamed with several nurses, water and sanitation engineers and others. Their training involved learning how to properly don protective gear, practicing how to care for patients using people who survived Ebola, and working in an established Ebola treatment unit. “The night before my first encounter in the Ebola unit, I have to say I was a little scared,” Tandoh recalls. “I wasn’t so much scared of contracting Ebola. I was afraid of passing out in the protective equipment because it was so hot.” It was Liberia’s dry season, with temperatures of 85 to 90 degrees. Tandoh drank up to 6 liters of water each day to replace the fluids she lost in sweat.
ing a new mother, were confirmed to have Ebola. Seven were suspected to be infected, including the mother’s 3-month-old daughter. “Mom was still breast feeding up until the day we saw her. We were very concerned that the baby was going to test positive,” Tandoh says. “Mom tested positive, and the baby tested negative, so we separated them. “I really enjoyed taking care of that baby. Luckily, she never tested positive.” Tandoh saw the mother every day to tell her that little Josephine was looking good and eating well. The mother survived. Soon after, on Dec. 22, the 50-bed clinic that Tandoh helped establish was opened. ●
At the clinic where she did her training, 27 people, includ-
Hear an interview at www.upstate.edu/healthlinkonair by searching “Ebola.” spring 2015
UPSTATE.EDU/BREASTIMAGING
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IN OUR LEISURE
GEM CARE
Extra, extra!
Researchers experiment with acting roles BY STEPHANIE DEJOSEPH
FOR MORE INFORMATION, CALL UPSTATE CONNECT AT
800.464.8668
Watch carefully when “Irrefutable Proof” hits the big screen next year, and you may recognize a pair of women dressed as members of a religious order. Two diabetes researchers from Upstate got roles as non-paid extras in the psychological thriller that was filmed in January in Syracuse.
Paula Trief, PhD, and Ruth Weinstock, MD, PhD, in costume for the movie, “Irrefutable Proof.”
Ruth Weinstock, MD, PhD, is a longtime friend of the film’s writer and producer, Richard Castellane. When he sought extras, she and colleague Paula Trief, PhD, signed up.
community
campus
They assembled costumes from their own closets, “and the makeup artists made sure we looked like old ladies,” Weinstock said. The filming of the movie took place over several weeks at Syracuse University, the Onondaga County Courthouse in downtown Syracuse, the Landmark theater, the Regional Market, St. Paul’s Episcopal Cathedral, and Highland Forest. The film is now in post production. “It was fascinating to see how complex the movie process is, and to see some of the behind-the-scenes work,” Weinstock said.
4900 Broad Road Syracuse (the former Community General Hospital)
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Trief admitted she once fantasized about performing musical comedy on Broadway, “even though I can’t dance, and my singing is just so-so.” Weinstock is medical director of the Joslin Diabetes Center at Upstate and chief of endocrinology, diabetes and metabolism in the Department of Medicine. Trief is a professor and senior associate dean for faculty affairs and faculty development at Upstate. Neither has plans to pursue a second career in acting. ●
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IN OUR LEISURE
Jennifer Moffat (front) with rowing partner, Mindy Holgate. Moffat is an associate professor of microbiology and immunology. PHOTO BY SUSAN KAHN
WHY I LOVE ROWING BY JENNIFER MOFFAT
1. It gives me something for myself. Soon after I moved here from California in 1999, when my girls were just 2 and 4, I went to a wellness program at the high school, and a woman there spotted me and said, “Hey, you’re strong. Why don’t you join me?”
We wear tight spandex shorts or tights in order not to get caught in the rowing seat. And we don’t even wear shoes over our socks. The shoes are built into the boat. Rowers wear some kind of shirt that’s not too long in back. And hats and sunglasses.
2. On national “Learn to Row Day” — which takes place June 6 this year — I just thought pulling on that oar was the best thing I’d ever done. I was with a great group of women, some a little older, some a little younger, but all of us grown-ups and ready to get out there and try something challenging.
10. What’s appealing to me is how you get a sort of calming, focusing experience. It’s very present tense. It’s highly meditative. You do the stroke over and over again, and every time you try to make it the best stroke. You end up feeling very refreshed, mentally. Your body is exhausted, but your mind is refreshed. You feel like you’ve had a break from all the other thoughts in your head.
3. I like being outdoors, and I love Cazenovia Lake. 4. Rowing is highly aerobic. You can push yourself to a point where it’s very intense. You get out of it what you put into it. You can challenge yourself, or you can take it easy. 5. It’s a really good full-body workout. All the power of your legs gets transferred to your core. It is really tough on your hands, and we don’t all wear gloves. So you have to deal with blisters on your hands. 6. Rowing is the kind of thing where you can become proficient very quickly, but it takes years to master. 7. You learn a universal language. The crazy vocabulary of rowing is a real tradition. 8. You can jump in a boat and row with anyone. I travel for my job as a scientist. I contact rowing clubs when I travel and join them. I’ve gone rowing in Madison, Wis., San Diego and Finland. 9. You really don’t have to invest in a lot of clothing.
11. Most of our races are on Onondaga Lake, or in Rochester or Albany. Now and then we row in Boston. As a novice my first year, I won a gold medal. Hundreds of people of all ages show up for the regattas. It’s usually a day trip when you get up really early. It’s a big picnic. You watch other people race, you cheer your team, you set up a food tent. 12. Both daughters became rowers around eighth grade. Laurel is the older one. She participated in the rowing program at Fayetteville-Manlius High School and attends Cornell University now. Last summer she was an assistant coach for the Cazenovia Rowing Club. Dana is the younger one. She is an FM High School senior who won a silver medal in the World Rowing Junior Championship in Hamburg, Germany, last summer. Later, she competed in the Youth Olympics in China. I derive a lot of joy watching their efforts. ●
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Black Bean
&
For a nutritious meal high in fiber and protein, pair black beans with avocados. You’ll also get a healthy serving of B vitamins and folic acid. Just remember that canned black beans, while convenient, are loaded with sodium. So, rinse them with water.
Nutritional information, per serving A two-enchilada serving includes: 375 calories 10 grams protein 48 grams carbohydrates 19 grams total fat 3 grams saturated fat 0 milligrams cholesterol 504 milligrams sodium 14 grams dietary fiber
Avocado Enchiladas Ingredients 2 tablespoons olive oil 1 cup diced onion 1 tablespoon minced garlic cloves 1/4 teaspoon kosher salt 1/4 ounce dried Mexican oregano
3 cups diced avocado
1/2 teaspoon ground cumin
12 6-inch corn tortillas
1/2 teaspoon chili powder 1/8 teaspoon ground black pepper
1 cup canned red enchilada sauce 1/4 cup chopped cilantro
1 1/2 cups canned black beans, drained and rinsed
Preparation
Heat oil in pan, and sautĂŠ onions and garlic. Add the salt, spices and black beans. Cook until heated through. Place in a food processor and pulse to mash. Leave coarsely ground. Transfer to a bowl and gently fold in diced avocados. Set aside. Heat tortillas to make pliable either in a steamer, microwave or oven. Pour a quarter of the enchilada sauce into a baking pan and spread evenly. Roll 1/3 cup of filling into each tortilla and place seam down in the pan. Pour remaining sauce on top. Bake covered at 350 degrees until heated through, about 20 to 30 minutes. Serve garnished with fresh chopped cilantro. RECIPE FROM MORRISON HEALTHCARE, FOOD SERVICE PROVIDER FOR UPSTATE MEDICAL UNIVERSITY.
UP STATE U RO LO GY
Gennady Bratslavsky, MD
Timothy K. Byler, MD
Rakesh Khanna, MD
Zahi N. Makhuli, MD
Dmitriy Nikolavsky, MD
Imad Nsouli, MD
Jessica E. Paonessa, MD
WWW.UPSTATE.EDU/UROLOGY
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IN OUR LEISURE
Out of the laboratory and onto the dance floor BY JIM McKEEVER
Upstate students Andrew Banas and Kayla Crouch are conferring, but not about class assignments or laboratory research. For an hour each week, the pair dance. They waltz, tango and foxtrot to the sounds of Henry Mancini, Frank Sinatra, Van Morrison. They discuss steps, turns, posture and form. Crouch is a first-year medical technology student, and Banas is a first-year doctoral student in the College of Graduate Studies. They dance mostly for fun and fitness.
Andrew Banas and Kayla Crouch
They connected last semester when Banas put out the word that he wanted to start a ballroom dancing club on campus. “Though we were not able to set up the club right away, we decided to start practicing ourselves,” said Crouch. She started dancing salsa at age 8 while growing up in the Bronx. Then, as a student at Binghamton University, she joined a Latin dance team and a ballroom dancing club.
Banas credits his older sister Elizabeth with sparking his interest in dancing. “She was moving away to college, and I was still at home (in Michigan), and it became a way for us to still stay connected. Her interest remains, and we still dance at social events when I am home for the holidays.” Dancing provides a change of pace and a break from Banas’ studies in cell and developmental biology. For Crouch, dancing is her time to relax. As she explained, “you can’t have all work and no play.” ●
ADVANCED TREATMENT, TRAINING, TECHNOLOGY
UROLOGY Jonathan Riddell, MD
Oleg Shapiro, MD
JC Trussell, MD
Srinivas Vourganti, MD
F O R M O R E I N FO R M AT I O N O R TO M A K E A R E F E R R A L C A L L 3 1 5 . 4 6 4 . 1 5 0 0
spring 2015
U P S TAT E H E A LT H
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Sirotkin
Carroll
These green ovals are fission yeast, organisms that scientists Vladimir Sirotkin, PhD, and Robert Carroll, a PhD candidate, in the Department of Cell and Developmental Biology use for their study of endocytosis, the process by which a cell brings material into itself. They focus on the roles of the actin cytoskeleton and the motor protein myosin-1 in endocytosis. The red in these images represents the dynamic sites of endocytosis, where actin and myosin-1 help internalize material into the yeast cells. The green shows stable linear structures on the surface of the cells. Understanding the function of myosin-1 is important to understanding a particular kidney disease that is caused by a mutation in the myosin. Actin and myosin-1 are also implicated in cancer, and the Upstate scientists believe the proteins may prove to be good targets for medications. 15.126 0415 34M ELsk
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