Upstate Health Spring 2012 by Upstate Medical University

Health UPSTATE

UPSTATE MEDICAL UNIVERSITY

Spring 2012

WHAT TO DO ABOUT

sleep problems

liver

cancer diabetes Pedal to work

7fishing Meet the doctor

who survived a stroke

because he came to Upstate

how to donate

your body to science

CONTENTS

Health

4 5

Patients First: A full recovery from stroke Brush with death leads to career in health care How alcohol hurts teens long term

7 8

What is your health care provider? Adventures with Alzheimer’s

Advice

10 12

How to live with a child who has diabetes Understanding stroke care

Community

14 16

How to donate your body to Upstate Artistry in wood

Work

In every issue

Avoid on-the-job burnout

Food

18 19

Marinated fresh berries Cooking for someone with cancer

Leisure

20 22

“It’s good for me, and it’s good for the planet.”

Dave Sikora goes fishing

Good Job

Advice for Caregivers from Caregivers

Calorie Burn

Questions & Answers

Good Read

In the Know

The Humorist

The Upstate Ethicist

Science is Art is Science

–Teresa Hargrave MD, page 20

Meet three bicycle commuters

Lessons from Upstate

On THe cOver: ricHarD O’neill pHD, assOciaTe prOfessOr Of psycHiaTry anD beHaviOral science aT UpsTaTe MeDical UniversiTy, bikes TO wOrk. see sTOries On pages 8 anD 20. pHOTO by sUsan kaHn

Good for You 2

U P S TAT E H E A LT H

Thyroid Protection

spring 2012

Hand Hygiene

Sleep

Colonoscopy

Farro

Bicycling

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WHAT’S UP AT UPSTATE

trokes can be devastating, no question. But some of our patients experience amazing recoveries. Meet one of them in our Patients First feature on page 4, a physician from Auburn who believes he is alive today because of the skill of the stroke team at Upstate. The team includes interventional neuroradiologists, a type of doctor you never want to need, but are glad that Upstate has just in case. These doctors train for years in radiology and neurosurgery before merging the disciplines in a neuroradiology or neurointerventional surgery fellowship. Their tools include a device that travels into the brain to trap and remove a blood clot during a stroke. In addition to our detailed look at the continuum of stroke care, this issue of Upstate Health also features the closest thing to a real ‘magic bullet’ in medicine, a procedure called radioembolization, along with some of the most common sleep disorders in children. You’ll find help deciphering what can seem like an alphabet soup of credentials on your health care provider’s nametag. And, you’ll find a personal account of psychologist Rich O’Neill’s journey with his mother’s illness in a new column called Adventures with Alzheimer’s. If you or a loved one have ever talked about making an anatomical gift, find out exactly how one man’s contribution helped others. If you are hungry for a healthy sweet treat you can make at home, check out the recipe from executive sous chef Bill Gokey. If you like reading, learn which book compelled one woman to read “like a madwoman.”

100 percent of Upstate’s radiation Therapy, respiratory Therapy and perfusion students who passed state/national certification or licensure exams in 2010 and 2011.

free medical apps for doctors and medical students that Upstate grad Joshua steinberg MD has built through collaboration with computer science professors and students at binghamton University. (find them by searching “joshua steinberg md” in itunes.)

All this and more is packed into this issue of Upstate Health. Enjoy!

Connect with us online Be first to know about news from Upstate by liking “Upstate Medical University” and the “Upstate Golisano Children’s Hospital” on Facebook, or by subscribing to the “What’s Up at Upstate” blog at upstate.edu/whatsup. If you are on Twitter, follow us @upstatehealth, @upstategolisano and @upstatenews.

Your health

years difference in life expectancy between people in kathmandu and those in surrounding areas of nepal, part of the justification for the patan academy of Health sciences, a medical school whose students pledge to practice rural medicine. The school opened in 2010; its founder, arjun karki MD, did his residency at Upstate.

For appointments or referrals to the health care providers on these pages, or for questions about health topics, contact a registered nurse at Upstate Connect at 315-464-8668 or 1-800-464-8668, day or night.

16,221

Health

adults and children who received cancer treatment at Upstate University Hospital in 2009, twice the number of patients as were served in 1999.

Spring 2012

pUblisHer

Wanda Thompson PhD Senior Vice President for Operations

execUtive editor Melanie Rich Director, Marketing and University Communications editor-in-cHief

Amber Smith

designer

Susan Keeter

pHotograpHy & illUstration Susan Kahn, Susan Keeter, Robert Mescavage, Dan Cameron, Chuck Wainwright, William Mueller

For more information, 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 for additional copies call 315-464-4836. Upstate Health offices are located at 250 Harrison St., 4th floor, Syracuse, NY 13202

Upstate Health is published by the Office of Marketing and University Communications. Upstate Medical University in Syracuse, NY, is an academic medical center with four colleges – Medicine, Nursing, Health Professions and Graduate Studies – as well as an extensive clinical health care system that includes Upstate University Hospital, Upstate University Hospital at Community General, the Upstate Golisano Children’s Hospital and numerous satellite sites. Affiliated with the State University of New York, Upstate is Onondaga County’s largest employer.

Knowing changes everything.SM

spring 2012

U P S TAT E H E A LT H

HEALTH

first

PATIENTS

do-it-yoUrself tHyroid cHeck

he incidence of thyroid cancer is growing, partly because more lumps are being discovered when they are tiny. Someone may have a computerized tomography scan of his or lungs or a carotid ultrasound, and the radiologist incidentally discovers a thyroid nodule. The majority of nodules are benign and are monitored to make sure their growth does not interfere with surrounding tissues. Ultrasound exams and biopsies show that about 5 percent of nodules are cancerous. Most thyroid cancers are easily treated by surgery to remove the thyroid. “There is some epidemiological evidence that there is an increased risk of thyroid cancer in patients exposed to many dental x-rays,” sayd Roberto Izquierdo MD, medical director of Upstate’s Thyroid Cancer Center. He recommends wearing a thyroid shield during dental x-rays for protection. He also recommends checking your own thyroid. You need a mirror and a glass of water. Locate the area of your thyroid, below the Adam’s apple and above the collarbone, and keep this in view as you lean your neck back. Swallow the water, and watch carefully for any bulges or enlargements around your thyroid. If you see anything unusual, Izquierdo says to consult your doctor for an evaluation.

Patrick Buttarazzi MD with his wife, Alice.

Doctor is grateful he came to Upstate when he had stroke

atrick Buttarazzi MD was enjoying a night out at Lasca’s Restaurant in Auburn with his wife, Alice, and son, Michael, on Jan. 2, 2010. Feeling himself drool, he reached for a napkin. The next thing he knew, Buttarazzi was on a ventilator in the emergency department at Upstate University Hospital in Syracuse, unable to move his left side or breathe on his own and with no memory of why he was there. The Auburn urologist had suffered a massive stroke. An ambulance drove through a blinding snowstorm to get Buttarazzi to Upstate. His wife and three of his 14 children gathered at his bedside. A priest read Last Rites. A computerized tomography scan revealed a blood clot in the major artery on the right side of Buttarazzi’s brain. Interventional neuroradiologist Amar Swarnkar MD threaded a flexible wire made of nickel titanium through a blood vessel in Buttarazzi’s leg and advanced the wire to the blockage.

The device trapped the clot, removing it as the wire was withdrawn. He also put in a stent in the right carotid artery to prevent additional clots from migrating to the brain. Fast forward two years, and Buttarazzi, 77, has retired from a lengthy medical career. He says he is grateful for the medical care that kept him alive. “It was the speed and skill with which everything transpired that saved me,” he says. Time is critically important when someone suffers a stroke. Whenever a blood vessel is completely blocked, as in the case of a stroke or a heart attack, tissue can die because it is deprived of the oxygenated blood that keeps it healthy. “In the body, the brain and the heart are two tissues that do not regenerate after they are damaged. It’s imperative that you restore the blood flow as quickly as possible so that you avoid tissue death,” says C.J. Ryan MD, a vascular surgeon and family friend who met Buttarazzi at Upstate when the ambulance arrived.

Continued on page 9

U P S TAT E H E A LT H

spring 2012

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HEALTH

A brush with death, now a career in health care

pstate student Brandon Crandall RN has a lot going on. He works part-time in the neurology unit of Upstate University Hospital, and he is midway through the Nurse Practitioner program in the College of Nursing. He is a resident advisor at Clark Tower, president of its activities board, and has been involved in plans for the new Geneva Tower residence hall, opening this summer. He is also a College of Nursing representative for the Upstate Student Government. Most people who know Crandall know all those things. But most people aren’t aware that he almost died in a head-on snowmobile crash when he was 16. It happened during his junior year at Paul V. Moore High School in Central Square. Crandall was giving his sister a ride on a snowmobile on a trail near their home in Brewerton, north of Syracuse. They crested a hill and collided with a snowmobile coming in the opposite direction. The operator of the other snowmobile was killed. Brandon sustained massive facial injuries and swelling of the brain. His sister suffered a concussion and a broken finger. Brandon was in critical condition, in a coma for a week and spent six weeks at Upstate University Hospital.

by JiM Mckeever

my life. Dr. Robert Kellman, chair of the ENT Department, and about three other surgeons reconstructed my face.”

radioembolization targets liver tUmors witH tiny bUllets

Brandon doesn’t remember details of the crash and only recalls the last two weeks in the hospital, when he was in the rehabilitation unit.

He recovered enough to graduate with his high school class in 2006. After a year at SUNY Canton, he decided on nursing and earned his associate’s degree and became a registered nurse through the Crouse School of Nursing. The crash, and his successful treatment and recovery, may have played a part in Crandell’s decision to pursue nursing, but it wasn’t the primary influence. He says his brother-in-law, Joshua Harrison MD, provided a good example of the hard work and dedication needed to forge a career in health care. Harrison graduated from Upstate’s College of Medicine and is a first-year medical resident here. Crandell, in pursuit of his master’s in nursing, says he has a never-ending thirst for knowledge. He enjoys when people come to him with medical questions, and he enjoys finding the answers.

“I came this close to dying,” he says, holding his thumb and index finger about an inch apart. “Upstate saved

“You can study for the rest of your life, and there’s never an end point,” he says. For now, his goal is a career in intensive care, the specialty that helped save his life. ●

adioembolization combines radiation therapy with embolization, a process that occludes the blood vessels within a tumor. This blocks the flow of blood containing the oxygen and nutrients necessary for a tumor to grow. The vessels are filled with miniature glass beads containing the radioactive isotope yttrium Y-90, which delivers a locally high dose of focused radiation. This therapy is used to treat tumors that begin in the liver or have spread from other parts of the body to the liver. It is not a cure for cancer but rather can significantly slow or halt the growth of the disease. This can alleviate symptoms and can extend a person’s life from months to years. Radioembolization may keep some patients alive long enough to undergo a more curative option such as surgery or liver transplantation. Radioembolization is not recommended for patients with severe liver or kidney dysfunction, abnormal blood clotting or a blockage in the bile ducts. This is a new service being offered at Upstate. To learn more, contact Mitchell Karmel MD, director of vascular and interventional radiology at Upstate, at 315-464-7439.

Brandon Crandall RN and Robert Kellman MD

Knowing changes everything.SM

spring 2012

U P S TAT E H E A LT H

HEALTH GoodTo Know

Teen drinking can cause problems later in life

he dangers of youthful drinking extend beyond making poor judgments while intoxicated. Alcohol can have a lasting effect on teens, says Linda Spear PhD of Binghamton University’s Department of Psychology. She urges parents not to allow young people to drink alcohol before they reach the legal drinking age, period.

Linda Spear PhD

Steven Youngentob PhD

Here’s why: • Insensitive to cues that they are going beyond tipsy, adolescents tend to drink more, and ingesting high levels of alcohol can be toxic. • Adolescents are unusually sensitive to the social facilitating effects of alcohol, and most of their drinking occurs in social contexts. So, social enhancing effects of alcohol could serve to encourage further drinking by adolescents. • Compared to adults, adolescents are relatively resistant to alcohol’s sedative and motor-impairing effects, which may increase the likelihood that they will drink more heavily and more often and develop alcohol problems later on. • As alcohol leaves their system, adolescents are likely to become socially anxious; when they drink again, they will relax and start to socialize – so they may begin to rely on alcohol to reduce social anxiety. Spear says consuming alcohol early in life is one of the most powerful predictors of later alcohol abuse. Exposure to alcohol in the womb, also, can predict alcohol abuse in adolescence, says Upstate’s Steven Youngentob PhD. Two studies by Youngentob, a professor in Psychiatry and Behavioral Sciences, show that rats develop a preference for the taste and smell of alcohol in utero if their mothers consume alcohol during pregnancy. He says that makes the baby rats more likely to abuse alcohol as they get older. Similarly, he believes human teens are at increased risk for abusing alcohol, especially if they are risk-takers, feel social pressure to drink or have a family history of drinking. Youngentob told the website, About.com there is no safe time to drink alcohol during pregnancy. Based on his research, parents need to keep their children away from alcohol, especially if they had fetal alcohol exposure. ●

did yoU know? pHysical tHerapists may be ‘doctors’

work within the healthcare team while making their own treatment decisions.

Avers says the majority of practicing PTs do not have their doctorate, “but I think there is a little bit of pressure because the entry level therapists are coming out with that degree.” She says Upstate’s program is designed for the working PT; those with bachelor’s degrees can complete the doctoral degree in two years by taking four credits per semester.

ll physical therapy training programs have converted to doctoral programs, and as more physical therapists increase their education, more patients address their PTs as doctor. The doctoral degree ties in nicely with the increased responsibilities on the profession, says Dale Avers, a doctor of physical therapy who also has a PhD in instructional systems technology. She is director of Upstate’s post-professional doctoral program for physical therapists in the College of Health Professions, which also offers a degree program for those entering the field. PTs today can provide patients with up to 10 visits within 30 days without requiring a physician referral. They

Linda Spear PhD and her team conduct research late at night and early in the morning within a one-block area of Binghamton that has eight bars. They interview young adults who have been drinking but are not severely impaired, putting them through a series of cognitive and motor tests and breath tests and asking them to follow up with online surveys.

U P S TAT E H E A LT H

spring 2012

She says increased education is good for the PT profession and ultimately for the patients, who can expect increased levels of competence from their practitioners.

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HEALTH

The Upstate Vascular Surgery and Endovascular Services team includes: M. Asad Khan MD, Michael J. Costanza MD, Vivian Gahtan MD, and Kwame S. Amankwah MD. know yoUr doctor

A What do those initials mean?

any of the names on hospital nametags end with a cluster of capital letters. “MD” and “RN” are easy to decipher, but an academic medical center depends on more than medical doctors and registered nurses. A variety of additional professionals you may encounter include:

CRNA – certified registered nurse anesthetist

MPH –

masters of public health

MSN –

masters of nursing

MSEd –

masters of education

MSW –

masters of social work

NICN –

neonatal intensive care nursing

CCP –

clinical cardiac perfusionist

CDE –

certified diabetes educator

CNM –

certified nurse-midwife

CNS –

clinical nurse specialist

DDS –

doctor of dentistry

NP –

nurse practitioner

DO –

doctor of osteopathic medicine

OT –

occupational therapist

PA –

physician assistant

DPM –

doctor of podiatric medicine

DPT –

doctorate in physical therapy

DrPH –

doctorate in public health

FNP –

family nurse practitioner

HPSC –

hospital patient service clerk

JD –

doctorate in law

LCSW – licensed clinical social worker LPN –

licensed practical nurse

MBBS – doctor of medicine MBBA (from UK, India, other MBChB Commonwealth countries) MBE –

masters in bioethics

MD –

doctor of medicine (US & Canada)

Knowing changes everything.SM

PharmD – doctor of pharmacy PhD –

doctoral degree

PNP –

pediatric nurse practitioner

PT –

physical therapist

RD –

registered dietitian

RDCS –

registered diagnostic cardiac sonographer

RDMS – registered diagnostic medical sonographer RN –

registered nurse

RRT –

registered radiologic technologist

RT –

respiratory therapist

RVT –

registered vascular technologist

spring 2012

n “attending” physician is the one in charge of your care. A ”resident” is a physician who has completed medical school and is now caring for patients under the guidance of an attending physician; a firstyear resident is known as an “intern.” A “fellow” is a physician who has completed residency training and is undertaking additional training in a particular specialty. A physician with “DO” after his or her name is a doctor of osteopathic medicine. Just like a medical doctor, they prescribe drugs, perform surgery and use technology to diagnose disease and evaluate injury, but their approach is more holistic and appreciative of the body’s innate ability to heal itself. Physicians with “MBBS,” “MBBA” or “MBChB” attended a medical school that follows a style of education more prevalent in the United Kingdom, India and other Commonwealth countries. A physician who is “board certified” has demonstrated his or her knowledge and skills in a particular specialty and has been recognized by a certifying board. Some physicians have extra letters after their names that recognize additional professional qualifications, expertise or ethical conduct within their specialty. Examples: FACOG (fellow of the American College of Obstetricians and Gynecologists) or FACEP (fellow of the American College of Emergency Physicians.)

U P S TAT E H E A LT H

HEALTH UPSTATE GOLISANO AFTER HOURS CARE at Community General

The area’s first after-hours program just for kids and young adults through age 21.

HOURS: Mon. thru Fri. 4 to 11 p.m. Sat. & Sun. noon to 11 p.m. Call 492-KIDS (5437) 4900 Broad Rd. Syracuse

adventures with

Alzheimer’s

Contemplating the blessings in life by ricH O’neill pHD

wheeled my mother into her doc’s waiting room, and a guy in line at the desk asked me how old she was. I told him 94.

“You are so blessed,” came his reply. I’m not sure ‘blessed’ is the right word. And I’m not sure if the man changed his opinion a few minutes later when my mother said, loud enough for everybody to hear, “Look at that guy, Ritchie. He’s really bald!” Let me tell you a little more about how it really is.

www.upstate.edu/afterhours

award-winning care for patients witH Heart failUre In April, Upstate University Hospital received the Gold Plus award for heart failure from the American Heart and Stroke associations. Upstate University Hospital was recognized for achieving 85 percent or higher adherence to all “Get With The Guidelines” Heart Failure Achievement indicators for two or more consecutive 12 month intervals and at least 12 consecutive months of 75% or higher compliance with 4 of 9 Get With The Guidelines® Heart Failure Quality measures to improve quality of patient care and outcomes.

U P S TAT E H E A LT H

A few weeks ago she had a sore toe. So, she made a 4-inch cut in her special orthopedic shoe – with a can opener. We had taken scissors away after she used them to jam the door closed from the inside of her room at the nursing home to keep people from stealing her stuff while she slept. She had a bad cold at the time, and was confused. The staff at the home had to break the door down to get in. My mother doesn’t tolerate change, so I wanted to get the same shoe. But she can’t remember her shoe size, and getting her to the shoe store – or anywhere – can be a major undertaking at best and close to impossible if she decides to clamp her eyes shut and go limp and unresponsive like she’s dead so that I have to pick her up and put her in a wheelchair and move backward because she’ll put her feet on the ground to stop us if we go forward. Why does she do this? Who knows? Anyway, the place we’d gotten the shoes no longer carried them, but the store did record her size. So I went online. Nobody carried them any more, so I got a very, very similar pair in the exact same size and

spring 2012

color. I brought them to her when they arrived. As she prepared to try them on, she pulled her special toeless support socks down over her toes so that the shoes definitely wouldn’t fit. I fixed the socks. Then I reached to get the shoes out of the box. She pulled the socks down again. Then she noticed a detail in the new shoes. Eventually we got the shoes on her feet, and when she walked around the room, she said an emphatic “Too small!” Who knows if they really were. She wanted me to sew up her old shoe until we could get a bigger size. So an hour into my visit, I was sewing her old shoe, biting the thread because there were no scissors. The whole time, she insisted somebody stole her sewing box, even though I showed it to her when I got the needle and thread. Why am I telling you this? Because a few days later at a party, I was talking to someone about our mutually aging parents. “Boy! You’ve got a lot on your hands,” he said, and I almost started crying. It feels good when someone understands our experience. So all of you folks with a similar story, I just want to say, if ‘blessed’ is the right word, I’m not looking forward to heaven as much as I used to. Know what I mean? And, I want to give a big thanks to the nursing home staff for the skill and patience they show in caring for my mother. They are a true blessing. ●

Listen to psychologist Rich O’Neill on HealthLink on Air radio every Sunday from 9 to 10 a.m. on FM Newsradio 106.9, WSYR.

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HEALTH

Lessons from Upstate

Hygiene among Hikers

edical journals have suggested a connection between gastrointestinal illness and the quality of backcountry water ever since a report in 1976 of a group of hikers in Utah who developed giardiasis* after drinking untreated water.

Dr. and Mrs. Buttarazzi at the beach with many of their 14 children and 46 grandchildren. Doctor survives stroke —continued from page 4 Much was in Buttarazzi’s favor that night. His wife, a nurse, immediately recognized the signs of a stroke. The most even-keeled of his children was the one with him when it happened. And the emergency medical technicians drove Buttarazzi 28 miles directly to Upstate, where a neurovascular team is available 24 hours a day to conduct the sophisticated clot-removing procedure that Buttarazzi needed.

Buttarazzi awoke in the intensive care unit.

Ryan says Buttarazzi likely would have died from swelling of his brain as a result of the stroke process had the Upstate team not promptly located and removed the clot. He prepared Buttarazzi’s family – eight sons, six daughters and 46 grandchildren – by explaining that their patriarch may not survive and might never regain the use of his left side.

“They were shocked,” he recalls.

At right: Amar Swankar MD Below: CJ Ryan MD with Dr.Buttarazzi

His daughter, Amy Spin held his left hand. She thought she felt a twitch in his thumb, very slight. She ran to alert a nurse, who came into the room explaining that people who have had strokes should be able to move their lower limbs before they’re able to move their upper limbs. So Buttarazzi lifted his left leg.

After 10 days in the hospital, he was discharged to a rehabilitation center for six weeks before going home. “I would say it’s a full recovery at this point. I’m playing golf and busy every day,” he says. “The biggest thing I notice is my voice is a lot less forceful than before.” That’s a difference friends may pick up on, but others may not notice. Ryan says his friend’s recovery is remarkable.

Knowing changes everything.SM

“There’s no question in my mind that the prompt transport to the Stroke Center at Upstate and the rapid response of the neuroradiologist was the critical difference between life and death and a happy ending.”●

spring 2012

No real research has looked at the role hand hygiene may play – until Upstate’s Jana Shaw MD lead a study that was published in the January issue of the American Journal of Infection Control. Researchers at a popular trail head in the Adirondacks got 72 people on overnight camping trips to answer surveys and soak their dominant hands in bags of sterile saline – which were then analyzed in a laboratory. Fecal bacteria was found on almost a third of the hikers’ hands. The prevalence of fecal hand contamination was not much different between hikers entering the wilderness and those headed home, “which suggests that backpacking, alone, does not contribute to fecal hand contamination,” Shaw writes. “The high prevalence is concerning because poor hygiene and fecal hand contamination have been linked to diarrheal illnesses among healthy subjects,” the study says. It concludes by suggesting that hikers and groups that teach wilderness skills emphasize proper hand hygiene.

*infection of the small intestine caused by a single-cell organism

U P S TAT E H E A LT H

ADVICE

For Caregivers – from Caregivers

diabetes O How to live with a child who has type 1

nce a child is diagnosed with diabetes, he or she and their loved ones receive several hours of education about how to manage the disease from a diabetes educator. They learn about how to interpret blood sugar levels, how to administer insulin, what signals an emergency.

“When a child with diabetes is diagnosed, the whole family needs to be involved. Everyone is affected by the stressors, and everyone can play a supportive role,” says Irene Sills MD, a professor of pediatrics at Upstate. Parents may feel overwhelmed by the amount of monitoring and decision-making in the beginning, but they are well supported by the nurses and doctors who are only a phone call away. However, after they master the skills, they may be afraid to leave their child in anyone else’s care. Siblings may feel they get less attention than the child with diabetes. This is where extended family and friends can step in to assist, if they take the time to learn how. Sills’ advice begins with how to address a child with diabetes:

• Don’t call kids with diabetes ‘diabetics’ because that labels them as their disease. They are people first. • We reassure them that this is not their fault or the fault of their parents. The exact cause of type 1 diabetes is unknown. • Combat misinformation – no, children don’t “grow out” of diabetes, and no, there is no cure – by learning about the disease. Resources are plentiful on web pages for the American Diabetes Association, Juvenile Research Diabetes Research Foundation and New York State Department of Health, as well as Family Support Network’s online community at childrenwithdiabetes.com. • Blood sugar levels have to be checked four to six times a day, and insulin may have to be administered as frequently – either through injections or via a pump whose catheter requires changing every three days. Overnight blood glucose monitoring is also important, “especially for young kids whose brains are still developing and may be harmed by repeated low glucose levels,” says childrenwithdiabetes.com. • Create an emergency box containing liquids with calories, liquids without calories, a thermometer and emergency medications. Similar boxes should be kept in places where the person with diabetes spends lots of time, such as grandparent’s homes. • While we encourage healthful eating, the dietary limitations we enforced in the past decades are not really necessary. • Insulin pumps, portable insulin and the prevalence of cell phones have made excursions such as overnight camping trips possible. And, new insulin regimens allow for injections prior to meals or after meals in some situations. “For anyone who has given a toddler an injection of regular insulin and then watched him or her refuse to eat, the ability to inject after the meal is a major benefit,” says childrenwithdiabetes.com.

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spring 2012

• Depending on maturity, children age 10 or 11 may be able to give their own injections, and children from age 12 or 13 can become increasingly responsible for monitoring their sugar levels and deciding on insulin dosing. However, all adolescents still need the help of their parents and guardians. The children whose diabetes is well-managed are those whose parents are most vigilant about their care. • When a child with diabetes starts looking at colleges, health services in the college community are an important consideration. So are roommates who can help the student manage diabetes in a friendly, supportive manner. • Alcohol use is one of biggest dangers for children with diabetes. Not only can alcohol cause high or low blood sugar, children with diabetes who become drunk cannot reliably monitor their blood sugar levels. • Birth control is important for women of childbearing age because diabetes needs to be in good control at conception and early in pregnancy for the best odds of having a healthy baby. • Children with diabetes are at increased risk for mental health disorders. “If they do what they’re supposed to do, (such as counting carbs, monitoring blood sugars and giving insulin injections) it’s very demanding. Blood sugar levels that are a little high or low can create angst, and kids may tend to blame themselves. Those kids who find it hard to do all the things we ask of them can also feel terrific guilt,” Sills says. “We have better tools to treat diabetes today, but one can’t underestimate how challenging it can be to live with this chronic disease,” Sills says. ●

Attention: Caregivers, clip and save. Tips in every issue.

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ADVICE

Kids & Sleep The director of Upstate’s Pediatric Sleep Center explains why some kids have a difficult time getting a good night’s sleep.

Q A and

witH zafer soUltan md what’s the most common cause of sleep trouble in children?

Q a

“After the first year of life, the most common is what we call obstructive sleep apnea, when children have difficulty breathing to the degree that they stop breathing while they are asleep. This problem occurs most commonly secondary to large tonsils and adenoids.

“The parents may observe that there is something wrong with the child breathing. They witness the child struggling to breathe, waking up frequently at night, snoring loudly with pauses and gasping for air.”

Q a

what else is to blame?

“Behavioral problems can cause insomnia and parasomnia, difficulty falling asleep and maintaining sleep.

“With some children, it’s hard for them to fall asleep because they haven’t learned how to sleep on their own. Since they were babies, they learned that in order to sleep they need to be in the hands of the mom or the dad, or rocked in a chair, and they fall asleep in the arms of a parent and they’re put in bed. These children do not know how to sleep on their own. “This is tied to another issue which we call a ‘limit setting problem.’ This is a child who keeps having what we call curtain calls. They keep coming out to the audience, the parents, with different requests. The reason they do that is, they’re having nightmares or night fears, or just because they haven’t learned that they can sleep on their own, that they don’t have to be in the arms of the mother or the father.”

Knowing changes everything.SM

How do you differentiate a disorder from normal development?

Q a

“When there are consequences, to the family or to the children, we call it a disorder. “A lot of children snore, but not all these kids have obstructive sleep apnea. And even if they do have a few episodes of apnea, we ask whether they have developed consequences. They may have learning difficulties, cognitive deficits, hyperactivity, or they may wake up frequently and struggle to breathe. “The same for insomnia. Most types we encounter are behavioral. If the parents are happy with this arrangement, there is no disorder. In fact, it sometimes varies by type of family, traditions, cultures. They may not mind that the child wakes up and they go to the child to hold them, to carry them. But sometimes it disturbs the life of the family and the child very much, and the children eventually do not get adequate sleep, and the next day they will manifest with cognitive problems and behavioral problems.” what happens at the sleep center?

Q a

“Check with your pediatrician first, but children (age newborn to 18) who are referred to the sleep center will be evaluated by a sleep specialist to sort out the problem, and then they will recommend proper treatment. If we feel it is a breathing problem, then the patient will undergo a sleep study to identify the exact problem and determine the treatment needed. “If it’s obstructive sleep apnea secondary to large tonsils and adenoids, and it’s treated and improved, then we don’t follow them on a regular basis. If it’s a behavioral problem, then it depends on how big the problem is. Sometimes more than one session is needed. ●

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colonoscopy cUts cancer deatH risk

emoving polyps during routine colonoscopies reduces the risk of dying by 53 percent, researchers concluded by tracking 2,602 patients who underwent colonoscopy between 1980 and 1990 at Memorial SloanKettering Cancer Center in New York. For the study, published recently in the New England Journal of Medicine, researchers compared the death rate of those patients with that of the general population over as many as 23 years. Colorectal cancer is one of the few cancers that can be prevented with screening. Colonoscopy, which The New York Times called “perhaps the most unloved cancer screening test,” allows a doctor to examine the inside of the colon and lower intestine through a camera-tipped tube and remove any precancerous growths. Your chance of developing colorectal cancer increases markedly after age 50. More than nine out of 10 people diagnosed with colorectal cancer are older than 50. A personal history of colorectal polyps or inflammatory bowel diseases puts you at higher risk. Also, African Americans have the highest incidence of colorectal cancer, though the reasons are not yet understood.

U P S TAT E H E A LT H

IN THE KNOW

stroke S Specialized ensemble orchestrates

care

trokes among younger Americans are on the rise, by 51 percent for men and by 29 percent for women between ages 35 and 44. Obesity, diabetes and high blood pressure are largely to blame, according to the Centers for Disease Control and Prevention.

Survival often depends on quickly recognizing the symptoms of stroke and seeking appropriate medical care. Maximum recovery depends, also, on rapid and skillful treatment and quality rehabilitation. Upstate is uniquely qualified to care for stroke patients. The first designated stroke center in Central New York, Upstate University Hospital features the region’s only specialized neuroscience and rehabilitation floors. That means people who are wheeled into the emergency room suffering from stroke may receive acute treatment and rehabilitative care under the same roof and are followed by the same ensemble of providers.

Here’s a look at the orchestration of stroke care at Upstate: I. RECOgNITION 2. DIAgNOSIS The public performs a crucial role in recognizing the symptoms of stroke.

I VA L T O

ARR

Arm Is one arm weak or numb? Have the person raise both arms; does one drift downward?

Speech Is speech slurred? Ask the person to repeat a simple sentence.

?bof fry fleu?

Time Time is critical; if the person shows any of these symptoms, call 911 immediately.

U P S TAT E H E A LT H

15 25

within 15 minutes neurologist consults on patient within 25 minutes patient in computerized tomography (CT) scanner

MINUTES

within 45 minutes – CT scan is interpreted by radiologist

60 10

Does one side of the face droop? Ask the person to smile.

within 60 minutes intervention

within 10 minutes emergency physician evaluates the patient

Remember to act FAST: Face

NTION W E IT RV H E T

Paramedics alert the hospital if they believe their patient has had a stroke, and the “stroke team” is summoned to the emergency room. This includes an emergency physician, neurologist, a stroke coordinator and emergency department nurses. In addition, the nursing supervisor is alerted, along with the pharmacy, laboratory and radiology departments. The goal is to save a life, and also to save brain cells. The patient who arrives by ambulance often already has one IV in place, but nurses will insert a second. Blood for testing can be taken through one, and medications and fluids administered through the other.

Thomas Lavoie MD,

One of the first tests measures blood sugar, since the symptoms of Emergency Medicine hypoglycemia can mimic those for stroke. A doctor will conduct a neurological exam that tests different areas of the brain – consciousness, speech and language, memory, eye movement, reflexes and sensation and walking and balance. A magnetic resonance imaging (MRI) scan can reveal narrowing or blockages of blood vessels in the brain. Other tests or procedures may be used to measure blood flow and detect clots. The staff will also work to assemble a medical history – whether the patient has had surgery recently, if he or she takes blood thinners, has an elevated blood pressure or bleeding in the gastrointestinal tract. Such information is crucial before developing a treatment plan.

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IN THE KNOW 3. TREATMENT

Ischemic Stroke (clot)

About 87 percent of strokes are “ischemic,” meaning a clot is blocking a blood vessel. They are not painful. Instead, patients may feel numbness or a weakness or heaviness. Interventions may include a clot-busting drug called tPA, tissue Plasminogen Activator, which must be administered within three hours of the onset of a stroke. In some cases, concentrated doses of the drug can be placed at the site of the stroke within the brain.

reDUceD blOOD flOw

Neurologist J. Gene Latorre MD on rounds with the stroke team

blOOD clOT

Upstate also offers a clot-retrieval procedure in which a stent device is threaded through a catheter in a blood vessel to the clot. An interventional neuro-radiologist captures the clot, restoring blood flow and removing the clot and stent from the body through the catheter.

blOOD clOT

Hemorrhagic Stroke (bleed)

Both of these treatments are time-sensitive and may not be options for patients who have been slow to seek care. In Syracuse, the clot-retrieval procedure is only performed at Upstate.

blOOD On THe brain

About 13 percent of strokes are “hemorrhagic,” meaning a vessel in the brain has burst or an aneurysm has formed and is about to burst. However, because Upstate receives patients with complicated medical emergencies sent from hospitals throughout the region, more like 30 percent of stroke patients at Upstate have had this type of injury.

blOOD in THe brain

rUpTUreD aneUrysM

Depending on the location and severity of the aneurysm, surgeons may be able to place a clip at the base of the aneurysm so blood cannot escape. Or, they may elect to treat the aneurysm from inside the blood vessel, by placing platinum micro-coils that act as a mechanical barrier to blood flow.

arTery wiTHin THe brain arTery On sUrface Of THe brain

Some patients undergo a cooling process during the treatment of their brain injuries. In some patients, staff monitor the oxygen level of brain tissue.

Neurologist Ashok Devasenapathy MD and neurosurgeon Eric Deshaies MD

Margaret Turk MD of physical medicine and rehabilitation with physical therapist Vicki Kalina

Stroke coordinator Maria Lumbrazo, a family nurse practitioner

4. RECOVERY

5. REHABILITATION

6. SUPPORT

Stroke patients are likely to recover in one of the 11 beds in Upstate’s neuroscience intensive care unit. Staff in the ICU, mindful of circadian rhythms, dim the lights from 1 to 3 a.m. and from 1 to 3 p.m. and avoid scheduling treatments during those times. A harpist plays on Tuesday afternoons.

Within 24 hours of a stroke patient’s admission to the hospital, physical, occupational and speech therapists and a physiatrist evaluate to determine the needs of the patient. Rehabilitative therapy begins almost immediately, depending on the severity of the stroke.

Rehabilitation counselors at Upstate provide help for patients in returning to work or school.

Patients may be transferred to other units as their conditions improve, as 35 additional beds are devoted to patients with neurological problems. Nurses and therapists who specialize in stroke care are stationed on these floors.

The location of the stroke determines which body functions are affected. Physical therapist Lori Holmes says patients may be able to recover many functions by retraining healthy parts of the brain through therapy.

Knowing changes everything.SM

In addition, a stroke quality group meets monthly at the hospital to review stroke care provided. Stroke Program Coordinator Maria Lumbrazo says an education group for families of stroke patients is in development.

Upstate has an inpatient rehabilitation unit, where patients may be moved when they are able to handle three hours per day of therapy. People who have had ischemic strokes stay an average of seven days, while those who have had hemorrhagic strokes stay an average of 20 days.

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U P S TAT E H E A LT H

COMMUNITY

Good to Know

baby boomers are aging

he United States in 1980 had 720,000 people age 90 and older. Just 30 years later, 1.9 million Americans were age 90 and older. By 2050, the ranks of the oldest old is expected to reach 9 million, according to a census report commissioned by the National Institute on Aging. The report says the majority of the 90-plus population are widowed white women who live alone or in a nursing home and rely on Social Security for half of their income. Other findings • The life expectancy for someone who has lived to 90 is 4.6 more years; for someone who lives to 100, it’s 2.3 more years. • Women age 90 and older outnumber men nearly three to one. • Eighty-five percent of those 90 and older have one or more physical limitations; 66 percent have trouble walking or climbing stairs. • The likelihood of living in a nursing home increases sharply with age. Three percent of those 75 to 79 live in a nursing home, 11 percent of those 85 to 89, 20 percent of those 90 to 94, 31 percent of those 95 to 99 and up to 38 percent of centenarians.

College of Medicine Class of 2015 students Theresa Ogundipe, left, Matthew Auyong (piano) and John Charitable (flute) performed during the ceremony in April.

Anatomical gifts advance learning for future doctors, medical professionals

ylvia White squeezed her daughter’s hand. They were in Weiskotten Hall, in the medical school building where their patriarch culminated a lifetime fascination with science by donating his body after he died. White — along with son, Ed; daughter-in-law, Bonnie; daughter, Susan Bonnet; and son-in-law, Bob — was there to retrieve her husband’s ashes, and to hear details about his contribution. An orthopedic surgeon planning a unique surgery practiced the operation first on Eugene White. Paramedic students and young military medics from Fort Drum practiced medical procedures on Eugene White before they faced live patients. And the Department of Pathology at Upstate hosted a teaching conference in March for pathologists and neurosurgeons concerning glioblastomas, the type of tumor found in Eugene White’s brain. “Gene was fascinated by the mapping of his glioblastoma,” Sylvia White recalls. “He was interested in how far it had grown, and whether the medicine he was taking was effective.” While the procedures did not reveal those answers, White’s family was glad they had

U P S TAT E H E A LT H

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honored his wishes. Like 235 Central New Yorkers the year before, White donated his body to Upstate when he died in January. Medical students take anatomy in the first half of their first year, with six students assigned to a single cadaver. Students studying to become physician assistants or physical therapists also train with cadavers, as do paramedic students. “Students think we’re all the same inside, but there are differences,” says N. Barry Berg PhD, a professor who helps them learn what variations are meaningful in terms of quality of life. Berg is also the director of the Anatomical Gift Program. Berg has taught anatomy for 41 years at Upstate. He went to college not knowing what he wanted to study or do with his life. He took an anatomy class as a physical education major and loved it, so he pursued a doctorate in anatomy. When his young son developed allergies, his family decided to leave New York City for cleaner air. “Everyone said Upstate would be great,” Berg remembers. “No one ever told me about the weather.” One of Berg’s earliest students — Nathan Riles Jr. MD of Chesapeake, Va. — was an

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COMMUNITY

How to donate yoUr body • Request a brochure from the CNY Anatomical Gift Program by calling 315-464-4348. • Adults who are free of infectious disease and not excessively overweight are eligible donors. • Sign an “anatomical gift pledge” found on the Upstate.edu website or in the program brochure. • Let your family know your wishes. If you anticipate disagreement, learn how to appoint an agent to carry out your wishes by calling 315-464-4348. • Make sure a funeral director delivers the body, with a death certificate, within two days of death. • Realize that professors and students are not licensed to conduct autopsies and cannot make determinations concerning the cause of death. However, if they find something interesting or unusual, they can let your loved ones know.

ordained minister who approached Berg saying he wanted to give thanks for the opportunity to learn with a cadaver. Upstate’s first annual cadaver memorial service was held in 1980. Then a few years later, Berg says, “we were one of the first medical schools, if not the first, to invite the families to participate.” Today, many families of people who made donations in the previous year attend the ceremony, which includes music and other artistic presentations by students.

Eugene White’s family was delighted to share his story. He was diagnosed with a brain tumor in November 2010, after a curious round of the strategic family board game, Sequence. White contemplated his move longer than usual, then placed an ace of spades on a jack. His children immediately knew something was seriously wrong, Bonnet recalls. Her father was a solid, muscular man of 80 who was active and healthy until doctors found the tumor. He had surgery to remove the tumor and came home from the hospital in time for Christmas. Children and grandchildren called the zig-zag scar on the back of his head his Harry Potter scar. He underwent 36 sessions of radiation, and then chemotherapy. He died 13 months after his diagnosis. He had made his wishes known, to make an anatomical gift of his body when he died.

Knowing changes everything.SM

Eugene White’s daughter, wife and son. In all, eight of his family members attended the memorial service. “My dad was fascinated by science,” Bonnet says. He was an industrial engineer, and when he retired from Miller Brewing Company in Fulton he began volunteering with the CNY Eye Bank and was introduced to cadaver research. “He and Mom knew that the research behind the replacement knee joint was based on cadaver research and were fascinated with the progress made between the first and second replacements Mom received. “He really believed in paying it forward and being part of the bigger picture that science could offer, and we believe that the anatomical gifting program gave him that opportunity.” ●

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U P S TAT E H E A LT H

COMMUNITY

tHe Upstate

Ethicist sHoUld science be sHared tHis way? “The nature of science in general has been one of openness and sharing, even before we called science ‘science,’ back to Plato and Aristotle,” says Gregory Eastwood MD, professor of bioethics and humanities at Upstate. That philosophy pervades science today – for the most part. When scientists at two laboratories tinkered with a bird flu virus to make it more contagious, they sparked debate over whether to share details in scientific journals. Some criticized the value of the research itself. Others wanted to keep information out of the hands of terrorists and amateur biologists who might recreate the mutated virus and release it on purpose or by accident. Not all science is open. The theory of the earth revolving around the sun was suppressed in the 1600s for religious and political reasons, for example, and the atom bomb was developed in secret during World War II. In the case of bird flu research, once revisions were made, the National Science Advisory Board for Biosecurity supported publication. Eastwood reminds us that science is ethically neutral. It’s how the science is used and the moral consequences of the uses that may raise ethical concerns.

U P S TAT E H E A LT H

The table Sean Behm made has two angled leg supports, which attach with wooden pegs he made. It is sealed with five coats of tung oil and three coats of briwax, a cabinet maker’s wax.

Carpenter turns black walnut tree into commemorative table

o hear Sean Behm describe his work at Upstate, you wonder what his specialty must be.

bookshelves when he was 8 or 10 years old. “I was just helping Dad out at that point, but it was something that was ingrained in my head forever.”

“It’s a step-by-step process,” he says. “It’s nothing you can rush through. You have to take your time and do it right.”

Behm became a carpenter and spent the early years of his career working for a custom deck builder, and attention to detail was critical. Since then he’s made countless sets of bookshelves, hope chests, kitchen cabinets and bathroom vanities. He works with oak, maple, ash and exotics such as Honduran rosewoods and South American ipe, but his favorite is walnut.

Neurosurgery? Heart valve replacement? “It’s very enjoyable,” he continues. “It can be nerve-wracking, but the end product is something you can be proud of forever.” Rehabilitative therapy? Orthopedics? … Woodworking? Behm is a carpenter in the physical plant, and he proves that skillful precision is not the exclusive province of surgeons in the operating room. He crafted a table out of the wood from a black walnut tree which was planted the year Weiskotten Hall was built in 1936. The tree was cut down last year because disease made it a safety hazard. Behm, 43, of Liverpool says woodworking was “something to do way out in the sticks” growing up in the town of Savannah, west of Syracuse in Wayne County. He learned the craft from his father, who was a welder. Behm remembers helping him make

spring 2012

“I really like the grain. I like the dark color. It’s got the cream on the outside. New growth of the tree is what that cream color is. The rest of it, where it’s turning darker toward the center, is called the heartwood.” He spent two weeks working on the table. Inspired by the work of architect/ woodworker George Nakashima, Behm worked up a plan in his head before putting pencil to paper. “I love a challenge,” he says, and crafting a table out of a tree “is definitely a challenge.” Behm’s table has become part of the furnishings in Weiskotten Hall. ●

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WORK

GOODJOB Meet Doug Clark, information management technologist

avoiding bUrnoUt

oogle Vice President Marissa Mayer believes that burnout is about resentment. “You beat it by knowing what it is you’re giving up that makes you resentful,” she writes in Bloomberg Businessweek. She suggests finding your rhythm, what matters to you so much that when you miss it, you’re resentful of your job. It could be a standing dinner with friends, your kids’ recitals and soccer games, or something else. Once you understand what matters, Mayer says to do everything you can to protect that. It will help you focus and work efficiently, and avoid burnout.

e’s not someone hospital patients would encounter during their stay, but Doug Clark, 54, of Liverpool plays a role that’s essential to campus operations. He works for the Information Management Technology department. Most shifts operate 8 a.m. to 5 p.m., with technicians on call for after-hours support. What he does: “Install and support Windows-based applications on client servers. We also work with vendors planning the installation and making sure that the servers are built to meet their requirements for operation. We do a lot of remote access with those vendors. “After the installations are complete, we work with the vendors to troubleshoot any problems that may arise, such as upgrading or applying fixes to the various applications.” How he got his start: His freshman year at Nottingham High School in Syracuse, Clark’s guidance counselor (Regina Reilly) helped him secure an apprenticeship with IBM. He also worked retail jobs at Dey Brothers and JC Penney where he learned his customer service skills. He majored in business administration at Onondaga Community College and then took a job at Syracuse Savings Bank as a key punch operator and later, a computer operator. He worked for Health Care Data Systems

Knowing changes everything.SM

at Crouse Hospital for 14 years before joining Upstate in 1997. What his day is like: “I start by monitoring any jobs or scheduled tasks to make sure they worked properly. Then I work on any special projects that may have been assigned by my manager, RJ Dollard. “I do a lot of restoring of files (documents or databases) for our customer base on campus. I have sort of crowned myself the ‘Restore King’ of Upstate. I have had people literally bow to me for saving their databases, documents or six years of research that may have been deleted or become corrupt. I tell them, ‘You don’t have to bow to me. I’m just doing my job.’” What his parents think: Stanley and Drucilla Clark of Syracuse are proud their son for putting his education to good use. They don’t have a computer. “My sisters and I keep trying to get them into the 21st century, so that they will stop asking us to look things up for them on the Internet,” Clark says. His back-up career: The restaurant industry. “I do a lot of baking and cooking. I’ve got some of our family recipes that I’ve been improving upon. Pound cake is my specialty.

“You can’t have everything... but you can have the things that really matter to you.” “You can’t have everything you want, but you can have the things that really matter to you,” she writes. “And thinking that way empowers you to work really hard for a really long period of time.” Martha Beck, author of “Finding Your Way in a Wild New World,” says it’s never too late to pursue a passion. Think back and remember experiences that caused you to forget that time was passing, she suggests in Parade magazine. Look for patterns to determine which activities are “hot tracks” for you, things that connect you with your passion. Next, look at your schedule and notice the activities that range from cool to warm. Replace one cool thing with something warm instead. “This way, you can find your passion without quitting your job,” Beck writes. “Over time, little steps may lead to big changes.”

“One day I would like to open up a cafeteria-style restaurant similar to the ones that are in the Southern states.” ●

spring 2012

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FOOD

farro provides fiber, protein

Marinated Fresh Berries with Yogurt Cheese and Toasted Pecans

by bill gOkey

ne of our planet’s oldest cultivated grains, farro was the primary grain consumed by the Roman Empire, and today the Whole Grain Council says the ancient wheat grain, farro is making a comeback as a gourmet specialty. It’s also a great nutritional choice because it is high in fiber and protein and is a good source of complex carbohydrates. Farro has no sugar, no cholesterol, almost no sodium and a low gluten content. Some farros require soaking overnight but most can be used in any dish that calls for pasta, rice, barley or wheat. To prepare farro, boil until soft but still crunchy. Eat it plain, or blend it into a soup, salad or pilaf. Farro has a nutty flavor. “The Splendid Table” columnist recently suggested eating farro hot or at room temperature, with a twirl of olive oil, a few torn leaves of herbs and grinds of black pepper.

executive sous chef for Morrison Healthcare, which provides food services for Upstate Medical University

he berry harvest is prime time for enjoying this light dessert, which is simple to assemble. With the right mesh strainer or cheese cloth, the yogurt cheese practically makes itself – perhaps while you’re out picking fresh berries. Berries, especially blueberries and blackberries, are powerful sources of antioxidants, compounds believed to prevent or repair cell damage that occurs during oxidation.

Ingredients 2 2⁄3 cup plain low-fat yogurt, or Greek yogurt ¼ cup toasted pecans or other nuts ¼ teaspoon kosher salt 1 teaspoon honey 11⁄3 tablespoons sugar ⁄2 teaspoon fresh lemon peel, grated

⁄2 cup water

⁄8 teaspoon pure vanilla extract

4 ounces fresh blueberries 4 ounces fresh strawberries 4 ounces fresh raspberries ½ teaspoon fresh lime peel, grated

4 mint sprigs

Juice from ½ lemon Juice from ½ lime

Note: Berries may be substituted for one another based on availability.

Preparation To make the yogurt cheese, strain yogurt in fine mesh strainer or wrap it in several layers of cheese cloth placed over a container to catch the liquid for two hours in the refrigerator. Then discard the liquid. To toast pecans, preheat sauté pan over low heat. Add pecans and toast gently for 2 to 4 minutes. Remove from heat. Stir in honey and toss to coat. Lay out on flat surface, sprinkle with salt, and reserve. In a saucepan, combine the sugar, water, vanilla and zest from both lemon and lime. Simmer gently for 5 minutes or until sugar is dissolved and liquid looks syrupy. Place washed and cut fruit in large bowl. Pour warm syrup over fruit and gently toss. Marinate for 30 minutes in refrigerator. To assemble, place ½ cup of yogurt cheese (or plain Greek yogurt) in dish or wide glass. Top with ½ cup marinated berries. Sprinkle with 1 tablespoon toasted pecans, and garnish with mint sprig. Serves four. ●

Nutritional information, per serving 215 calories; 8 grams fat, including 2 grams saturated fat; 10 grams protein; 10 milligrams cholesterol; 264 milligrams sodium; and 23 grams sugar

U P S TAT E H E A LT H

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FOOD

What to eat during cancer treatment

“I

n addition to affecting physical health, food plays a major role in your mental health and well-being,” according to the Betty Crocker Living with Cancer Cookbook. “The food you eat affects your energy level and how well you sleep and think.”

Here are some considerations for three common cancer treatments: Radiation

Surgery

Chemotherapy

Check with your doctor: about iron supplements, since preventing anemia can help radiation work better.

Check with your doctor: to see if you need vitamin or mineral supplements, since vitamin C, calcium, iron, magnesium and potassium are considered essential healing nutrients.

Check with your doctor: if nausea prevents you from eating.

Eat: iron-rich foods, along with an orange or another food high in vitamin C, so that your body more easily absorbs the iron; and low-residue foods if your treatment is in the abdominal or pelvic area. Iron-rich foods include fortified cereals, red meats, peas, nuts, and spinach and other green leafy vegetables. Foods high in vitamin C include citrus fruits, broccoli, cabbage and sweet red peppers. Foods low in residue include meats and fish; eggs; milk (up to 2 cups per day), potatoes; cooked spinach, asparagus, beets, eggplant, green beans and rutabaga; applesauce and fruit cocktail; fruit and vegetable juices or purees; white pasta and couscous; white flour bread, crackers and pancakes; graham crackers; broth and bouillon.

Eat: protein-rich foods to help restore your strength and build new cells in the first few weeks after surgery. Also, look for lower-fat versions of foods to avoid cramping and bloating. Your body likely will tolerate six small meals per day better than three larger meals. Protein-rich foods include meat, fish and poultry; eggs; milk, yogurt and cheese; lentils and beans; nuts and peanut butter. Avoid: any foods that your doctor restricts.

Eat: simple meals of foods you like, and know that changes in the taste of foods is common. You may not have much of an appetite, but remember that nutrition is important for healing. Avoid: raw or undercooked meat or fish; raw eggs or milk products; aged cheeses such as brie, blue, feta, sharp cheddar; honey, nuts, fruits or vegetable juices; raw fruits (other than peeled and washed thick-skinned fruits such as cantaloupe, honeydew melon, watermelon, oranges and bananas.) The concern is to reduce your risk of infection, especially if your white blood cells count drops dangerously low. Also: rest often and try to do some activity every day to fight fatigue. If constipation is an issue, ask your doctor about increasing your fluid intake, eating more fiber or taking a stool softener or laxative.

Also: don’t forget about hydration. Sip beverages, particularly water, throughout the day.

Avoid: popcorn, since it can cause diarrhea or bowel obstruction soon after abdominal or pelvic radiation therapy; onions and seeds. overweigHt doctors avoid talking aboUt weigHt

f your doctor is overweight or obese, he or she may be less likely to counsel you about losing weight. Research by a team at Johns Hopkins Bloomberg School of Public Health found that heavy doctors discuss weight loss less frequently with obese patients (18 percent) than doctors who have normal body mass indexes (30 percent.) “It seems to be the case that doctors are less likely to diagnose the patient until the patient’s weight meets or exceeds their own,” Sara Bleich told National Public Radio. She is an assistant professor of health policy and lead author of the study, published in the journal, Obesity. The heavier doctors were also significantly less confident of their abilities to counsel patients about diet or exercise. Bleich did find that heavy doctors surpassed those of normal weight in one area. They were more confident prescribing weight-loss drugs – maybe because of personal experience, or because they understand how difficult it is to change behaviors.

Knowing changes everything.SM

spring 2012

U P S TAT E H E A LT H

LEISURE

calorie

Burn T

he exact number of calories you burn is affected by your age, body size and composition and your level of physical fitness. Use this as a guide, for a person weighing 176 pounds who does the activity for an hour:

Fishing

300 calories

Should you consider a bicycle commute? Whitewater rafting, recreational 420 calories

ith gas hovering around $4 a gallon, the concept of pedaling to work, instead of driving, may be more appealing. Bike riding can save money and help you combine your workout with your commute. Meet three Upstate people who have decades of experience as bike riders:

Teresa Hargrave MD Squash

1,020 calories

assisTanT prOfessOr Of psycHiaTry anD beHaviOral sciences

What she rides: A blue Cannondale 21 speed hybrid. How long she has been commuting: “It’s been more than 20 years. I rode a bike as a kid, but I’ve become a lot more avid biker in my adult life, particularly since I married a biker.”

Window washing

312 calories

Where she lives: The Westcott area of Syracuse, a little more than a mile from Upstate. Why she rides: “It’s good for me, and it’s good for the planet.”

Billiards

204 calories

U P S TAT E H E A LT H

In bad weather: “I do not bike in icy weather. If the road is dry, or even wet but above freezing, then I’m up for biking. Sometimes, if it’s really nasty I don’t do it, even though I could. I have rain gear.” Safety measures: “I choose my route very carefully. I prefer to take an alternate route other than East Genesee Street. I wear clothing so that people are going to see me. I wear reflective items for the dark. And I always wear a helmet. Always.” Advice to would-be bicycle commuters: “Take the plunge and do it. You have to not worry about how you look, and wear whatever clothing you need to stay warm and protected and safe.”

Once at work: She removes her backpack, peels off some layers and is ready to see patients.

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LEISURE Bicycle Commuting —continued from page 20

Richard O’Neill PhD assOciaTe prOfessOr Of psycHiaTry anD beHaviOral sciences

What he rides: “An inexpensive mountain bike, a hand-me-down from my son when he went off to college. I prefer it because it has bigger tires for managing cracks and potholes. The first couple of times I rode my road bike to work, I got a flat tire each day.” How long he has been commuting: “Four or five years. I was running back and forth before that.”

Michael Lyon PhD assOciaTe prOfessOr Of OTOlaryngOlOgy anD cOMMUnicaTiOn sciences

What he rides: “Sometimes a recumbent bike, and sometimes a Cannondale or a Giant.” How long he has been commuting: “Since 1995.” Where he lives: “Memphis, 18 miles from Upstate.” Why he rides: “For pleasure and for fitness. I like to eat, and when I bike I can eat. This does create a problem in the winter when my miles decrease.” Once at work: “It is too long a commute to wear work clothes. I shower there.”

Where he lives: “Exactly four miles from campus. I go through Thornden Park and then across Westcott. I try to stay off the main roads so I have less traffic.” Why he rides: “I’m a runner. I started to bike ride to work because I wanted to get in more training, I didn’t want to spend more time running, and I wanted to have less pounding on my joints.” Once at work: “I have a closet in my office, and I keep several sets of clothes in it. And I have curly hair, so I just fluff it up after I take off my helmet.” In bad weather: “With the right kind of gear you can manage virtually any kind of weather. I ride in the rain and the cold. The Syracuse Public Works people do a great job keeping the streets plowed and salted. There are very few days when you can’t ride your bike. Two winters ago, there were only about 15 days when I couldn’t ride – and on those days I run.”

In bad weather: “If it is raining before I leave the house I tend to avoid it, but I have ridden in some really bad rain. Snow, I also try to avoid. That is when I ride the Giant, my ‘winter rat.’ Coming in to work, I frequently leave before the sun is up, but this is not like leaving late from work. I can’t always leave here early enough in the winter to avoid the dark. That is not my favorite time to ride.”

Safety measures: “Ninety-five percent of bicycle fatalities happen to people who are not wearing a helmet. So you have to wear a helmet.” He also wears clear ultraviolet goggles to protect his eyes from the sun and any flying road debris.

Safety measures: “I have a number of lights and reflective clothing items. I always try to let the cars know well in advance what I plan on doing.”

Advice to would-be bicycle commuters: “You will get very good at minimizing the amount of stuff that you carry. You will get very good about how to dress and how many layers. It takes a little time, but if you start in the summer, by the time winter rolls around you’ve learned how to ride in virtually any kind of weather.” ●

Advice to would-be bicycle commuters: “Just do it.”

Knowing changes everything.SM

“I have two headlights, one that blinks and one that’s constantly on for riding in the dark, and a flashing red light in the rear.”

spring 2012

U P S TAT E H E A LT H

LEISURE

Why I love fishing by Dave sikOra by Dave sikOra

good rEAd

I find solitude. It’s just relaxing. The bottom line is being out by yourself, being out in the wild where there’s no phone and no traffic and nothing to bother you. You get a better outlook on life after going fishing.

Fishing was a major part of growing up. I remember going with Dad after work. We’d go out to the river or the lake. We’d pack a lunch and fish right into dark. I’d learn a lot of lessons, and not just about fishing but good father-son things about respect, integrity and being yourself.

I enjoy actually catching fish. I’ve fished for just about every species there is in the last 55 years, including trout, bass, perch, pike, bullheads, salmon, walleye.

You’ve got to know what type of species you’re fishing for. Each species has different traits. Trout like nice clear water. When the sun comes out, they like to hide under banks. To increase your success, you’ve got to know what they eat and how they survive and when they feed.

eborah Tarbell, who supervises the snack bar in the Campus Activities Building, is a fan of The Hunger Games by Suzanne Collins, the first book in a trilogy that was made into a movie this spring. “It's written for the young adult but, believe me, it is excellent,” she promises, explaining that she read the first book “like a madwoman” before devouring the next two. The series is set in a postapocalyptic United States, with the country divided into 12 districts. A capitol district (called Panem) has all the riches and controls everything. Once a year districts are required to choose “tributes” via lottery and send one male and one female between the ages of 12 and 19 to the hunger games held in the capitol. The tributes fight to the death. Because Panem forbids hunting, Katniss puts herself in great danger in order to prevent her family from starving. She is a teen who lost her father in a mining accident and feels responsible for providing food for her mother and little sister, Primm. When Primm is chosen for the hunger games, Katniss steps in to take her place.

In the middle of the day when it’s hot, you may as well stay home and read a book. You’re only going to catch a fish when he opens his mouth, and he opens his mouth to eat. You’ve got to be there when they’re hungry.

Everything I catch, I eat. It’s an added bonus when you catch a nice fish and take it home. I enjoy the bounty of fresh fish.

I have a scrapbook of all the fish we have caught and places we have gone to fish. It includes a picture of a 41-pound king salmon caught Sept. 19, 1989 on Lake Ontario. That’s one of my favorite successful fishing stories. I went with my uncle, who was sick at the time. And a week or 10 days later, he passed away. Catching that fish together was like a gift from the gods.

I’m teaching my granddaughter, Abagail, who is 9, how to fish. She really likes it. I take her fishing along Owasco Lake, on the shore, for bluegills and sunfish. When you have a little child with you, she wants action. She wants to catch fish after fish after fish.

There’s no such thing as a bad day fishing – even if you don’t catch a lot. ●

Dave Sikora, 58, of Auburn fishes about four times a week, year round. He works in campus physical plant administration.

Tarbell says, “It’s a fast, entertaining series that will take you far away from the here and now – and isn’t that why we read fiction?”

U P S TAT E H E A LT H

spring 2012

w w w. u p st ate . e d u

THE HUMORIST

How conditioned are your willpower muscles? illpower is on the defensive these days, and with good reason. It’s too much work, and it’s not as effective as it’s cracked up to be. That isn’t to say I don’t enjoy people coming up to me and praising my willpower as the key to my recent weight loss. Taking credit for something I don’t deserve is one of the perks of being a recovering fat guy. “You must have incredible willpower,” I hear again and again.

“Why, thank you,” I say. And I think: They don’t get it. Willpower has been conning us for eons. It passes itself off as a cure-all for everything that ails mankind, yet almost always disappoints: If weight is your issue, willpower will talk a good game early, then dump you as heartlessly as Ashton Kutcher dumped Demi Moore. It’s about time science exposed the truth about willpower, and that’s starting to happen. Willpower is not — as we’ve been conditioned to believe — some vast Sea of Good inhabited only by the naturally virtuous while the rest flail about on the Beach of Self-indulgence. The better analogy is that willpower is a muscle. Some people have self-control muscles that are better conditioned than others, but all of them fail when sufficiently taxed. What does this mean for dieters? It means that if willpower is your primary strategy to take off weight and keep it off, you should spare yourself the bother and proceed directly to the donut shop. All that extra sugar might even boost your willpower, and that’s no joke. A European research team has shown that even simple acts of willpower are so physically draining on the brain and body that they cause blood glucose levels to drop. I’m experiencing that phenomena at this moment as I write this article at the Freedom of Espresso in Fayetteville. For more than an hour I have been casting baleful looks at the bakery case, resisting the urge to consume a giant oatmeal cookie. This act of self-control has depleted my glucose levels to the point that I am now making a scientifically valid decision to order and eat the cookie.

cookies, gave up on the puzzle an average of 11 minutes sooner than the cookie eaters. Conclusion: People who eat radishes are lazy. In its defense, willpower can be strengthened, retrained and cajoled into being more of an asset. It’s useful in quick bursts and for jump-starting positive change. But a new article in Scientific American Mind focuses on strategies that go beyond impulse control. Make small changes and build on them. Account for inevitable setbacks. Find specific internal (versus external) sources of motivation. For example, “I am going to stop eating triple bacon cheeseburgers because my doctor wants me to lose weight” probably won’t spur a lifestyle shift. But thinking, “I am going to stop eating triple bacon cheeseburgers because I want to buy a Mini Cooper and I will enjoy it more if I can physically fit behind the steering wheel” just might work. The idea is to align your desires, thoughts, actions and goals so they all pull in the same direction. For this reason I may be the only person in America who is happy about Pink Slime. When news broke about the widespread adulteration of ground beef with meat byproducts sanitized in ammonia and turned into a fine paste, consumers went bonkers. Not me. Thanks to the specter of Pink Slime it’s now easier for me to resist fatty, caloric cheeseburgers and red meat in general. The less willpower I require to resist the burgers the greater my chances for success. Plus it means I have more willpower left for other mentally challenging tasks such as finding my car keys and yelling at my dog for stealing zucchini bread. As you go forward with your self-improvement goals, it might be helpful to think of willpower as the cognitive equivalent of New York City. Yes, it’s a fine place to visit. But would you really want to live there? ●

There. Much better. With my glucose levels restored, I am able to once again resist eating a cookie. You see where this cycle leads: Nowhere … which is exactly the point. Willpower is a black hole of self-denial and surrender. A famous study from the late 90s supports the notion that willpower is finite and exhaustible. A group of college students was ushered into a room redolent of baking chocolate chip cookies. Half were told to eat two cookies; the other half were told to eat at least two radishes but no cookies.

Veteran journalist Jeff Kramer also writes for the “What’s Up at Upstate” blog the first Monday of every month at upstate.edu/whatsup.

Later, the students were given a puzzle to solve without knowing that the puzzle was unsolvable. Researchers discovered that the radish eaters, fatigued from resisting

Knowing changes everything.SM

spring 2012

U P S TAT E H E A LT H

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s a young graduate student he was interested in understanding our perception of the world, physiologically. Today Peter Calvert PhD conducts research that Peter focuses on visual transCalvert PhD duction at Upstateâ&#x20AC;&#x2122;s Center for Vision Research. He studies the proteins inside the photoreceptors in the retinas of African clawed frogs to understand how proteins are transported and what happens to that process during degenerative diseases such as retinitis pigmentosa.

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