Health UPSTATE
U P S TAT E M E D I C A L U N I V E R S I T Y
Winter 2015
PRECISION HIP, KNEE SURGERIES page 5 EMBRACING LIFE WITH A SPECIAL NEEDS CHILD page 13 RESTORING HEARING IN ETHIOPIA page 14 PUMPKIN MOUSSE PIE
page 18
Healed from a broken neck page 6
On the cover: Edward St. George with his neurosurgeon Lawrence Chin, MD. Photo by Susan Kahn.
Contents
PATIENT CARE Suite spot: where MRI scans can take place during surgery Robotic arm improves precision in hip, knee surgeries cover story
He broke his neck, recovered to walk again Surgery repairs urethral stricture
FROM OUR EXPERTS page 5
page 5
IN OUR COMMUNITY
Upstate Answers: research on children’s cancer
page 9
Confusion could signal epilepsy
page 9
page 6
Lessons from Upstate: How weight loss surgery affects the heart
page 8
Cystic fibrosis drug extends lives
page 12
Free antibiotics = more filled prescriptions
page 13
Embracing life with a special needs child
page 13
IN THE KNOW Red lights and sirens
page 10
Researching respiration
page 20
page 12
Restoring hearing in Ethiopia
page 14
IN OUR LEISURE Bowling for fun
page 17
How many calories can you burn?
Page 17
Recipe: pumpkin mousse pie
page 18
Need a referral?
Contact Upstate Connect at 1-315-464-8668 or 1-800-464-8668, day or night, for appointments or referrals to the health care providers on these pages or anywhere at Upstate or for questions on any health topic.
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
Winter 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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WELCOME
Did you know? ■ Upstate’s prostate cancer team helped raise money for prostate cancer research at Upstate Medical University through a Movember Mustache Challenge involving the Syracuse Crunch hockey team. The men grew facial hair throughout the month of November, and fans voted by making online donations which totaled $4,467.58.
■ Bar codes on sharps containers — where needles are disposed after use — allow for the containers to be tracked as they are sterilized and reused up to 600 times. The new Stericycle containers are expected to save money as well as improve safety for nurses and other medical care providers, says Jason Rupert, assistant director for outpatient operations and materials. The lids on previous containers opened like post office boxes. The new ones have holes on top, a design that Rupert says has been shown to reduce accidental needle sticks by up to 80 percent.
Participating in the check presentation at the hockey game are, from left, Upstate’s Gennady Bratslavsky, MD, Michael Lacombe, MD, Dmitriy Nikolovsky, MD, and Srinivas Vourganti, MD. Joining them is Jim Sarosy of the Syracuse Crunch.
■ The roof of the Upstate Golisano Children’s Hospital is marked with an H in a big cross symbol so that helicopter pilots can locate their landing target in the midst of the downtown buildings in Syracuse.
■ Upstate University Hospital receives about 12,000 packages per month, ranging from letters to new pieces of research or medical equipment.
■ Upstate’s College of Graduate Studies conferred 27 degrees in 2014, including 14 doctorates, 10 masters and three MD/PhD degrees. Programs of study include biochemistry and molecular biology, cell and developmental biology, microbiology and immunology, neuroscience, pharmacology, and physiology. Learn more at upstate.edu/grad/
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WHAT’S UP
TimoThy A. ClAry/GeTTy imAGes
Upstate’s Brian Thompson, MD, behind Leonardo DiCaprio’s left shoulder, at the People’s Climate March.
What’s Up at Upstate Brian Thompson, MD, an assistant professor of obstetrics and gynecology and a Native American, was invited to attend the first World Conference on Indigenous Peoples as a representative of Upstate Medical University in September at the United Nations. His visit coincided with the People’s Climate March, which drew hundreds of thousands of people. His friend, faithkeeper Oren Lyons of the Turtle Clan, Onondaga Nation, (pictured above, left) marched with the Indigenous Environmental Network and was joined by actor Leonardo DiCaprio (center) and Onondaga Nation Tadodaho Sidney Hill (right.) Thompson is pictured in traditional Onondaga clothing, behind DiCaprio’s left shoulder. He is director of obstetrics at Upstate University Hospital’s Community Campus and medical director of the Upstate Midwifery Program. He also serves as assistant dean for diversity. ●
The American Red Cross recognized an Upstate nurse with its Real Hero award in December. Earlier this year while traveling on a highway with her daughter, nurse Shannon Tilbe saw a motorcycle spin out of control. Its driver was catapulted over an embankment into a water-filled muddy creek. Tilbe had her daughter call 911 as she climbed down to the motorcyclist, waded into knee-deep water and tended to the young woman’s wounds. Later, Tilbe got to meet her as she recovered at Upstate University Hospital.
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More long-time smokers may seek screening for lung cancer now that the federal Medicare program has indicated it will pay for the test. Upstate’s lung cancer screening program began two years ago, with patients paying for the test out of pocket. The test consists of a low-dose computerized tomography scan designed to identify small tumors. Call 315-464-8668 for appointments and details. A draft decision from Medicare in November said the annual screenings would be covered; the decision is expected to become final in February. ●
A conference room at the Occupational Health Clinical Center of the Southern Tier was dedicated in October in the name of Nell Theresa Connor, who saved several of her coworkers from a deadly fire in Binghamton. The center is affiliated with Upstate. Thirty workers were killed in the 1913 fire at the Binghamton Clothing Company. Coming just two years after the devastating Triangle Shirtwaist Factory fire in Manhattan, the Binghamton fire aided in pressing New York officials to create the state’s Workers Compensation system and advance fire-fighting capabilities.
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PATIENT CARE
Suite spot allows MRIs during surgery Ordinarily after Satish Krishnamurthy, MD, removes a brain tumor in a patient, he finds the family in the waiting room. “I think we took out most, if not all, of the tumor,” he tells them, “but we will get a scan to make sure we took it all out.” Sometimes after the scan, the neurosurgeon has to arrange a second operation to remove any tumor that was left behind. BY AMBER SMITH Now Krishnamurthy’s conversation has changed, thanks to the new intraoperative suite with MRI scanner in the Upstate Cancer Center. After he removed a brain tumor recently, he told his patient’s family, “I KNOW we took all the tumor out.”
“We had the ability to get an MRI scan before we closed the incision to figure out whether the tumor was, indeed, totally removed,” Krishnamurthy explains. He performed the first surgery in October in the expansive operating room which includes a powerful new magnetic resonance imaging scanner. The 3 tesla machine provides increased clarity and anatomic detail, making it an ideal choice for surgeries of the brain and spine. The suite is located in the Upstate Cancer Center, which is attached to Upstate University Hospital but is also used for patients who have noncancerous tumors. Obtaining an MRI scan during brain surgery involves additional steps that are complicated. “We had to safely move our patient — while under anesthesia, with his head fixed to a clamp and all of the attached lines — more than 20 feet from the operating room to the scanner and back 20 minutes later. We had to make sure that everything on
Nurses and MRI technologists in the new intraoperative MRI suite.
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the patient was non-magnetic (due to the scanner’s magnetic field.) Afterward, we had to re-drape the patient and complete the surgery. “The entire process, and in fact the entire surgery from beginning to end, was entirely flawless,” Krishnamurthy says. “This was not a coincidence but a result of months of preparation for the day that we brought our first patient in.”
Satish Krishnamurthy MD
As impressive as the operating room and state-of-the-art equipment are, Krishnamurthy says success relies on the expertise of the entire team which includes the operating room staff, anesthesia team and MRI technicians. ●
Robotic tool improves accuracy The orthopedic staff at Upstate University Hospital has a new tool from the MAKO Surgical Corporation that helps surgeons precisely install replacement parts for hips and knees.
In the operating room, the surgeon marks on the patient with a special marker that contains a tracker which the robotic arm reads.
“The MAKO is a robotic arm that is connected to a series of computers that allows the machine to recognize where, in a three dimensional space, the tip of that arm is located,” describes orthopedic surgeon, Robert Sherman, MD.
For hip replacements, the surgeon indicates on the 3-D model the angle and depth of where the metal cup, ball and socket should be placed. The robotic arm matches that information with the marks on the patient’s body and does not allow the surgeon to stray from those areas.
A patient undergoes computerized tomography before the operation. The surgeon uses that CT scan to build a 3-D computer model of the joint.
For partial knee replacements, the robotic arm follows the plan created by the surgeon on the 3-D model and, using an attached burr, removes the least amount of bone necessary. Then a piece of metal replaces the arthritic bone to recreate the knee joint. The MAKO “is a way to help accurately and precisely put these pieces in exactly where we want,” Sherman says. “When I leave the operating room, I know everything’s perfect. I don’t have to second guess myself.” To learn more about hip and knee replacement options at Upstate, visit www.upstate.edu/MAKO ●
Listen to a HealthLink on Air radio interview on this subject by visiting www.upstate.edu/healthlinkonair and typing “MAKO” in the search box.
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PATIENT CARE
Back from the brink He broke his neck, recovered to walk again
AmAndA morrison WATerToWn dAily Times
Edward St. George, a seasonal resident in Cape Vincent, looks out toward the St. Lawrence River near the spot from where he fell and broke his neck. BY AMBER SMITH
ne minute, Edward St. George was on the deck of his family cottage on the St. Lawrence River in Cape Vincent, taking measurements for vinyl siding work he was doing that day.
O
The next, he was falling from the granite ledge the deck overlooked. His neck and upper back struck the edge of the rock about five feet down. He fell over the cliff, slamming against rock abutments for 15 or 20 feet on his way to the ground. Two or three barrel rolls later, his body came to rest against the back of a neighbor’s cottage with a thud. “All I could do was breathe and blink my eyes. I couldn’t even make a sound. I remember looking out of the corner of my eye and seeing what I thought was my hand, and I couldn’t move it. I couldn’t move anything,” St. George recalls. The drama that unfolded among the boulders in Cape Vincent stretched into the emergency department and operating rooms at Upstate University Hospital in Syracuse and into the physical and occupational therapy unit at Strong Memorial Hospital, near St. George’s home in suburban Rochester. St. George, 62, – an engineer who worked in middle management at Eastman Kodak, Co. and ITT/Exelis before taking early retirement – may not have survived to walk again were it not for the careful handling by rescuers. In cases of spinal injury, movement could cause further damage. “You could take someone who would otherwise have a recovery, and make it a complete injury,” says Lawrence Chin, MD, who leads the department of neurosurgery at Upstate.
The neighbor who heard a loud thud against her cottage and came to investigate instructed others not to move St. George before dialing 911. He was wedged between her cottage and steep terrain. Rescuers from the Cape Vincent Ambulance Squad and the Thousand Islands Emergency Rescue Service had the tricky task of getting St. George onto a backboard without jostling his body, and then onto a helicopter so he could be flown to Upstate. St. George remembers almost getting sick during the flight, and how the paramedic soothed him. More than a year after the accident, St. George believes he is 90 percent back to where he was prior to his injury. “My left arm can still sometimes be uncomfortable with nerve pain. My left hand is still numb. But my grip strength and my left arm’s range of motion have returned, thanks to therapy.” He remains grateful to his rescuers and caregivers. “A lot of little towns, you wouldn’t necessarily expect phenomenal response, but that is indeed what I received,” he says. St. George underwent computerized tomography at the hospital. The doctor in the emergency department stood over him going over the imaging results. He will never forget her reaction. “She put her hand across her chest and leaned over to me and said ‘you are my miracle today.’” One vertebra in his neck was pushed forward. That vertebra plus the ones above and below it were badly fractured.
Continued on page 7
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PATIENT CARE
Back from the brink continued from page 6 Chin developed a plan to use traction to help the middle vertebra slip back into place. St. George wore a weighted halo of metal bars for about 36 hours. He could feel the tug. It was uncomfortable. “It worked,” he says. “Luckily, a day and a half or almost two days later, I had the surgical procedure.” Fractured bones will heal, but ligaments that connect the bones of the spine do not. So Chin made two incisions, one in the front of St. George’s neck and another in the back. He installed a plate in the front and screwed rods into place in the back, fusing three vertebrae. Several weeks later, after St. George developed severe numbness in his left arm, the surgeon operated again to fuse a fourth vertebrae. St. George has been in physical and occupational therapy for more than a year. He has sworn off extension ladders and roof work. Life has gotten back to normal for him. He appreciates the entire medical team at Upstate, including the emergency department and imaging technicians, nurses, therapists and surgical team, plus everyone who cared for him during his stay of more than two weeks. “The skill and genuine desire to help me were extraordinary. “The outcome has been terrific. I couldn’t be more grateful,” says St. George. “I’m sure Dr. Chin considers it routine, what he did, but I don’t. When it’s you, it’s a miracle.” ●
Neurosurgeon Lawrence Chin, MD listens to Edward St. George during a recent office visit.
susAn KAhn
Caring for someone with a spinal cord injury ● Stabilize
the spine so that the person’s neck and back do not move.
● Maintain
a healthy blood pressure, through fluids and medication if necessary. “If the blood pressure drops, you don’t get perfusion to the spinal cord, and that can lead to further damage,” says neurosurgeon, Lawrence Chin, MD.
Listen to a HealthLink on Air radio interview on this subject by visiting www.upstate.edu/healthlinkonair and typing “St. George” in the search box.
FROM DAY ONE, UPSTATE STUDENTS ARE TREATED LIKE THE PROFESSIONALS THEY WILL BECOME. The careers we educate for are rewarding in every sense of the word. students benefit from instruction from leading professors who teach in classrooms, clinics and labs; excellent job placement; and suny tuition. degree programs at our four colleges include: medicine, nursing, Phd, Public health, Cardiovascular Perfusion, medical imaging, medical Technology, medical biotechnology, Physician Assistant, Physical Therapy, radiation Therapy, and respiratory Therapy. Essentially all the students in our College of Health Professions find jobs in their fields — often before they graduate.
Learn more: www.upstate.edu/students
Education • Healthcare • Research
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PATIENT CARE
Repaired body, repaired life Surgery fixed her urethral stricture Even knowing how painful it was to have her urethra dilated when it was obstructed and prevented her bladder from emptying, Patricia Moro was still hesitant to pursue a surgical repair. Moro’s life began revolving around the bathroom. She could not travel because she had to stop so frequently for bathroom breaks. She did not sleep well because she was up 10 times a night. Even dining out became difficult, as did babysitting her grandchildren. When she needed to void and couldn’t, she would end up at a hospital emergency department for a painful catheterization. She underwent repeated dilations to treat her stricture, an abnormal narrowing of the tube that leads out of the body from the bladder. Each time, weeks later, she would suffer urinary retention again. Finally Moro’s doctor referred her to Dmitriy Nikolavsky, Upstate University Hospital’s director of reconstructive urology and female urology and neurourology. Having never undergone surgery, she was nervous. “It was very hard for me to consider surgery,” says Moro, 48, of Cicero. “I listened to Dr. Nikolavsky. He made me feel secure.” The surgeon says the use of dilation to treat strictures dates back 3,000 years to India, where practitioners worked with candles and the horns of animals to complete the task of widening the urethra. Then, as now, the procedure was not effective long-term. Another treatment called an internal urethrotomy originated with the barber surgeons of medieval Europe. It used a dilation device with a pop-up knife but it, too, does not last. Both dilation and urethrotomy procedures are still in use today, but Nikolavsky says urologists are beginning to favor urethroplasty, which is more invasive but has a success rate of 85 to 95 percent. He developed an early interest in male and female reconstructive urology during residencies in surgery and urology at William Beaumont Hospital in Michigan. During that time, he traveled to Mozambique to perform female fistula repairs, and to India where he learned from one of the world leaders in genitourinary reconstruction. Nikolavsky then honed his urethroplasty skills during a reconstructive urology fellowship at the University of Colorado School of Medicine. He joined Upstate in 2012.
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Dmitriy Nikolavsky, MD
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What is a stricture? An abnormal narrowing of the urethra, the tube that leads out of the body from the bladder, is called a urethral stricture. It’s like a kink in a straw. Strictures can be caused by inflammation or scar tissue from surgery, disease or injury and are more common in men than in women. at first, but for the last several decades urologists have realized that the buccal mucosa — as they refer to the inner cheek — makes for a perfect urethral graft. The tissue is moist, it doesn’t grow hair, and the inner cheek heals quickly. To the patient, it’s like a burn from biting into a too-hot slice of pizza.
In Moro’s case, the surgery involved Nikolavsky cutting open the urethra, removing the scar tissue and covering the area with a graft of tissue taken from the inside of her cheek.
Moro awoke from the operation with a large ice pack on the side of her face and a catheter, which she wore while her body recovered. Moro remembers that when the catheter was removed and she was able to void normally, Nikolavsky and his staff cheered.
The surgery was first described in a medical journal more than a century ago, Nikolavsky says. It wasn’t appreciated
“I have my life back,” she thought as she went home from his office that day. ●
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FROM OUR EXPERTS
Q A AND
Could confusion be epilepsy?
WITH
AMY CARUSO BROWN MD
Do results from research on children’s cancers ever shed light on cancers that adults experience? -A SYRACUSE READER
Q A
“Yes, definitely! There are a few ways to think about this question.
“First, around the world, thousands of researchers are studying cancer cells in their laboratories. Some study particular mechanisms that play a role in cancer development — for instance, changes in genes that cause cells to grow out of control — while others study how cancer cells respond to drugs. “Most researchers perform experiments on several different types of cancer cells, including both pediatric and adult cancers, and cancer researchers at all levels talk to each other and exchange ideas and information. A discovery initially found in cancer cells from pediatric leukemia patients, for instance, may turn out to help us understand and better treat colon or breast cancer, which are extremely rare in children but common in adults. “I recently worked on a protocol for a study of a new drug, a type of tyrosine kinase inhibitor, that was invented by a pediatric oncologist but also seems promising for treating some adult cancers. Since it has never been tested in humans, the first clinical trial of this new drug will be in adult patients. “Secondly, adult patients sometimes get cancers that we would consider ‘pediatric’ because they are much more likely to occur in childhood, and so most of what we know about how best to treat these adults comes from research done with children. We now know that young adults, particularly those with acute lymphoid leukemia (ALL), have better outcomes when they are treated with pediatric chemotherapy protocols and, in some cases, by pediatric oncologists. “The Children’s Oncology Group is a consortium of more than 200 pediatric cancer programs (including Upstate) that supports about 85 ongoing clinical trials. Their study of the best treatment for a specific type of ALL called high-risk pre-B is currently open to patients up to age 30. ALL is the most common type of childhood cancer, but about a third of ALL patients are adults. “Finally, outcomes for children with cancer have improved dramatically over the past 40 years, and much of that progress is due to the collaboration between pediatric oncologists and researchers around the world, through the Children’s Oncology Group and similar European research groups. “The majority of children, adolescents and young adults with cancer — 60 percent — are enrolled in clinical trials, meaning that data on the treatment they received and how they responded is collected, analyzed and used to guide future treatment options. In contrast, fewer than 5 percent of adults with cancer participate in clinical trials. “Many adult oncologists see the pediatric approach to research as one to emulate in order to more systematically improve outcomes for adults with cancer.” —AMY CARUSO BROWN, MD, ASSISTANT PROFESSOR IN PEDIATRICS AND THE CENTER FOR BIOETHICS AND HUMANITIES
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The symptoms of epilepsy may appear differently in senior citizens than in younger people, which makes the diagnosis tricky and can lead to incorrect treatment, says Dr. Rebecca O’Dwyer, a neurologist at Upstate Medical University’s geriatric epilepsy clinic. She says the incidence of epilepsy in older adults is on the rise, more than half of the cases caused by strokes. Tumors, metabolic disorders and neurodegenerative diseases can also lead to epilepsy. About 10 percent of people with Alzheimer’s disease also have epilepsy. Symptoms do not always include convulsions. “The brain can manifest many different behaviors that are also seizures. It can be something very subtle, like the inability to talk or just staring off. It could also be confusion, especially in the elderly,” O’Dwyer says. She says seniors are less likely than young people to experience auras before their seizures – and they are more likely to be treated successfully with medication. Reach the geriatric epilepsy clinic at 315-464-4243.
Listen to a HealthLink on Air radio interview on this subject by visiting www.upstate.edu/ healthlinkonair and typing “epilepsy” in the search box.
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IN THE KNOW
Always on call Upstate Squad 1: David Landsberg, MD; Christian Knutsen, MD; Derek R. Cooney, MD; Chris Tanski, MD; Jeremy Joslin, MD and Erin Wirths, DO.
This team of physicians responds to crises outside of the hospital 10
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IN THE KNOW
P
assengers dozed as Wednesday night turned into Thursday on their trip from Toronto to New York City. The Trailways bus moved south through Syracuse on Interstate 81, lit by a full moon. It made it almost to Nedrow.
That’s where a car was left unattended in the middle of the highway. The driver of a tractor-trailer had stopped to help. The bus slammed into both vehicles about 2:30 a.m. Operators from the Onondaga County 911 Center dispatched crews from 10 ambulances, plus rescuers from eight fire and three police departments on that chilly November night. They also activated Upstate’s Physician Response Team to help care for the victims of the crash.
Twenty-six people were transported to area hospitals, while rescuers worked for two hours to extricate the driver. One of the physicians rode with him in the ambulance to Upstate, where he was cared for until he was released. Members of the team staff the infirmary at the New York State Fair, provide medical oversight for large-scale events throughout Central New York and typically are summoned to incidents involving large numbers of ill or injured people. Upstate’s physician responders provide a service residents are glad to have — but hope never to need. ●
Members of the special team carry pagers 24 hours a day like volunteer firefighters. They take turns being on call, responding whenever summoned by the 911 Center. It’s a community service that Upstate provides without charge to individual patients. While overseeing patient care, the physicians — some of whom are professors at Upstate — provide real-time feedback to paramedics and emergency responders, explains Derek Cooney, MD, the team’s medical director. He says the team responds to crises both large and small. Erin Wirths, DO, was on call the night of the bus crash. She rushed to the scene in a Ford Expedition equipped with medical gear and medications. Christopher Tanski, MD, and David Landsberg, MD, who specializes in patients requiring intensive care, met her at the scene. Jeremy Joslin, MD, headed to Upstate University Hospital’s emergency department to coordinate the mass casualty accident. He is the director of the emergency department. Tanski said many of the 52 passengers from the bus were not seriously injured. So when he arrived at the crash site, “the focus turned toward the driver who was pinned in the wreckage and was critically injured.”
Sheriff and state police investigators at the scene of the multiple vehicle accident on Interstate 81 south near the Nedrow exit on Nov. 6, 2014. Photo by David Lassman, Syracuse Media Group
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FROM OUR EXPERTS
Heart rate may drop after weight loss surgery A woman in her 40s came to Upstate University Hospital’s emergency department because of bouts of lightheadedness and passing out. Five months earlier she underwent weight loss surgery. At the hospital, she was found to have a slow heart rate. Rushikesh Shah, MD, who is completing his training in internal medicine, wrote about her care in a BMJ Case Report published in July. BMJ used to be called the British Medical Journal. After extensive tests to make sure the woman wasn’t having a heart attack or other cardiac problem, doctors “concluded that her symptoms were due to an increased resting vagal tone and decreased resting metabolic oxygen demand after massive weight loss in the post-operative period,” wrote Shah. It turns out the woman was experiencing an unavoidable outcome of her surgery, her body’s way of compensating for her significant weight loss. What she faced is something more and
more people will face, as the number of Americans undergoing weight loss surgery continues to rise. People who are obese are likely to have fast heart rates. They have high levels of adipokines, cell signaling proteins released by fat cells that can have adverse effects on the cardiovascular system. Fat cells also produce hormones including leptin, which regulates the amount of fat stored in the body and also impacts the cardiovascular system. After bariatric surgery, leptin concentrations drop, and so does a person’s heart rate. Shah writes that this slowed heart rate usually does not produce symptoms or require any treatment. This woman, however, received medication to treat her lightheadedness and fainting. His paper advises that awareness of this common “physiological compensatory change” can help avoid unnecessary diagnostic tests and medical interventions. ●
Listen to an interview on this subject at www.upstate.edu/healthlinkonair by searching for “leptin.”
CF drug helps people live longer A new medication may allow some people with cystic fibrosis (CF) to live near full lifespans, says Ran Anbar, MD, director of Pediatric Pulmonary Medicine at Upstate University Hospital. People with CF have thick mucus that plugs the lungs and digestive tract, because their bodies either do not make a particular protein or make a defective version of the protein. In the 1950s, babies born with CF lived only a couple of years. Statistics today project a lifespan of about 40 years. Anbar says this is continuing to improve. Ivacaftor (Kalydeco) is the first drug to treat the underlying cause of CF, a disease that is inherited when both parents carry defective genes. Since it was approved by the Food and Drug Administration in 2012, the drug has been used to help thin the mucus in patients with a small number of CF protein mutation. More than 150 different mutations cause the disease. “For the 4 percent of patients who received it, it’s been marvelous. Their lung function improved. Their weight has improved. They feel better,” Anbar says. “This drug is powerful, and we’re still learning how it works.” He says ivacaftor is being researched in combination with another drug, lumacaftor, for people with other types of CF. Recently, this combination was shown to be effective for patients with CF who carry the most common mutation combination, which affects about half of patients with CF. Ivacaftor/lumacaftor may be available for prescription to CF patients in early 2015. In combination with a third drug that is under development, this pair may be even more effective. Of the estimated 30,000 Americans with CF, 225 live in Central New York and receive their care at Upstate.
●
Listen to an interview on this subject at www.upstate.edu/healthlinkonair by searching for “cystic fibrosis.”
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FROM OUR EXPERTS
Embracing life with a special needs child BY LINDSAY PELTON
To Parents of Children with Cystic Fibrosis: That first pregnancy test: joy, happiness, excitement. Everyone says, “Boy or girl, I don’t care, as long as the baby is healthy.” Well, what if the baby is not healthy? What if you are told you have a sick child, physically or mentally? What if you are told your child will have to struggle his whole life just to be “normal”? You suddenly enter a different world. It is not a horrible world, just different from the one you expected. You will mourn the loss of the life you thought you would have. Will your life still be happy? Yes. Will there still be joy and excitement? Yes. Will the flowers still bloom in the spring? Yes. Sooner or later you will realize that the world you entered when you learned your child was not healthy does contain the makings of a happy life, where dreams and hope are still possible. And you will realize that maybe, just maybe, this life could be better than the life you had imagined. Your child begins to grow, and he is smart, funny and beautiful. He has a zest for life that only a child of his nature could possess. He has so much strength, determination and spirit inside his little soul. This child chose you to raise him, nurture him and teach him about life — although it is almost certain he will teach you more than you will ever teach him. He impacts the lives of those around him. He is a beautiful being, perfect in every way. Day-to-day life will sometimes be a struggle. But then one day he will smile at you. His laughter will be intoxicating. In this moment, everything will be well and safe. His eyes will reveal the wisdom unique to a special needs child. His
Lindsay Pelton’s 3-year-old son, Dylan, has cystic fibrosis. They live with his father, Paul Pelton, and brothers, Luke and Carter, in Rome. eyes appear as though he carries the whole world inside them. He radiates light and love. He is special. He is yours. Your gift. You have an epiphany. You realize you wouldn’t trade him for all the healthy children in the world. You would rather nurture a sick child than a healthy one, because he needs it more. He is yours for a reason. He has a bigger purpose, and you do, too. You, and only you, can provide your child with the love he needs. He, and only he, can show you that the life you have is better than the one you imagined. You gain insight that you would otherwise never have received. This child, you realize, is a gift sent to show you a secret about life that most people will never have the privilege to understand. It is an honor to raise this precious child. He is here to teach about love and life. He shows you that in times of pain, there is love. ●
Free antibiotics = more scripts filled Doctors have a tendency to prescribe medications for which they have free samples to give to patients, according to several previous studies. Would doctors similarly prescribe medications that patients could get for free at Wegmans? That’s what a group of Upstate emergency medicine researchers wondered as they compared data provided by Wegmans for its pharmacies in Onondaga County. The grocery chain headquartered in Rochester offered nine generic oral antibiotics for free starting in 2009. So researchers lead by Jeremy Joslin, MD compared 214,892 antibiotic prescriptions from the first six months of 2008 with 221,480 from the first half of 2009. “The promotional pricing of the antibiotics had a
significant impact on the number of prescriptions filled,” Joslin wrote in a study published in September in the journal, Pharmacy Practice, with colleagues Susan Wojcik, PhD and William Grant, PhD. The number of antibiotics filled that were included in the promotion increased by 13 percent, while the number filled that were excluded from the promotion decreased by 20 percent. Joslin says to help ensure that patients fill their prescriptions, doctors should pay attention to promotional programs when appropriate. Today, Wegmans sells many generics for $4 for a 30-day supply, and several other retail pharmacies offer similar deals. ●
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Outreach to Ethiopia Otolaryngologists help restore hearing after ear infections
Medical students in the Ethiopian city of Awassa examine a patient using an otoscope donated by Drs. Rick Kelley and Charles “Sam” Woods, after the Upstate physicians demonstrated how to conduct the exam. ive years ago, Rick Kelley, MD, and his wife, Ashley, decided their home could hold more children. They looked into international adoption and wound up in Ethiopia.
F
Now they have three daughters and a son, ranging in age from 3 to 10 — along with a mission to help prevent hearing loss in the kids’ birth country.
Kelley, an associate professor of otolaryngology and communication sciences at Upstate, has made the 7,500-mile trek to Ethiopia a dozen times, providing medical care and making connections and plans for how to help. A variety of colleagues from the Syracuse area have accompanied him.
riCK Kelley, md
Using a flexible scope, Rick Kelley, MD, examines a patient’s nasopharynx and voice box with Muluken Bekelle, MD, the first ear, nose and throat doctor Kelley trained in Ethiopia, equipping him with clinical and operating room instruments.
“Over the years it has grown, and what we’ve been able to accomplish and do has grown,” he says. The country of Ethiopia has 10 ear, nose and throat doctors, located in the capital city of Addis Ababa, and 4 outside Addis, to look after 85 million people.
Continued on page 15 Wendy hoWArd, md
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susAn KeeTer
Asnake Kassa, MD, otolaryngologist, gave a talk at Upstate as part of his visit to America this fall. He presented case studies of patients and discussed Ethiopia’s medical schools (there are three) and otolaryngology residency programs (there are none). In the background is Rick Kelley, MD. Charles “Sam” Woods, MD, takes Muluken Bekelle, MD, through an eardrum replacement surgery, called a tympanoplasty, in Awassa, a city in Ethiopia.
riCK Kelley, md
Upstate surgeons help patients, doctors in Ethiopia continued from page 14 Kelley’s first trip to provide medical care was preceded by a radio announcement. Organizers told him to expect maybe 10 or 15 patients. Instead, about 250 people were there. Some had traveled for days to get there. More than 90 percent had ear disease and hearing loss. “What we figured out on that very first trip is that although it may feel good to go on a medical trip and treat a couple hundred people, it’s really just a drop in the bucket,” Kelley says. He wanted to make a bigger, more lasting impact. Back in Syracuse, he enlisted the help of Charles “Sam” Woods, MD, a colleague and fellow ear, nose and throat doctor at Upstate who specializes in hearing loss and disorders of the ear. When Ethiopians get ear infections, they aren’t necessarily able to get to doctors for antibiotics; a huge portion of the population lives a rural life, walking everywhere. Untreated, ear infections can lead to perforated eardrums, which cause hearing loss of 45 to 50 percent. Caught early, surgery can repair perforated eardrums and restore hearing. Woods realized “if we did nothing else but train some of the otolaryngologists there to repair eardrums, that would make a huge difference for these people.” So that’s what he has done.
Kelley, Woods and other physicians became mentors to the physicians from Ethiopia, teaching the fine points of how to examine and diagnose ear disease and hearing loss. They are developing training programs in audiology for hearing testing, and they are supporting surgical training in otolaryngology. Partners for Global Hearing – the name of their nonprofit – acquires equipment for training and care centers and is working to establish ear/hearing clinics in different zonal capitals. The organization’s largest expense is for shipping equipment and supplies to Ethiopia. Doctors pay their own travel expenses, and there are no administrative costs. Woods says he volunteers mostly because “these people are so thankful.” Kelley feels likewise. “It kind of reinvigorates why we went into medicine in the first place,” he says. “You get there, and it boils down to you and the patient and your ability to help.” Learn more about Partners for Global Hearing at HLP-Ethiopia.org. HLP stands for Hearing Loss Prevention. The group also has a Facebook presence. ●
Listen to a HealthLink on Air radio interview on this subject by visiting www.upstate.edu/healthlinkonair and typing “Ethiopia” in the search box. winter 2015
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WilliAm mueller
Reeling in relaxation Scientist tends to salt-water aquarium BY JIM MCKEEVER
As the dean of Upstate’s College of Graduate Studies and a professor of biochemistry and molecular biology, Mark Schmitt, PhD, divides his time among two offices and a research laboratory.
sterilizer, protein skimmer, a sump filter, bioreactor and special lights. Plastic “bio beads” are a carbon source for the bacteria, which eat harmful impurities like phosphates and then are removed by the protein skimmer.
His favorite space is a fourth-floor office in Weiskotten Hall, which he shares with a 120-gallon salt-water reef fish tank. Schmitt inherited the massive tank five years ago from professor Richard Cross, PhD, who moved his office down the hall.
“There’s a lot of science involved in maintaining the whole reef tank,” Schmitt says. “I find it to be very fascinating. The bright green coral — that’s where a type of fluorescent protein comes from, and that’s used a lot in science.”
The tank is home to more than 30 kinds of live coral and seven colorful fish – a purple tang and a hippo tang (like Dory from Disney’s Finding Nemo), a pair of clownfish (Nemo), a coral beauty, a royal gramma and a very shy Mandarin that is rarely seen. Students and colleagues often stop by to check out the colorful array. Some students have their own reef tanks and trade coral fragments with Schmitt. “The coral grows and gets bigger, so you can break off fragments and pass them around to other people,” he explains. The tank is an ecosystem all its own, with biochemical processes taking place thanks to the live coral, an ultraviolet
Schmitt feeds the fish three times a week, using a combination of flakes, frozen brine shrimp and seaweed. He doesn’t add new ones often because of the risk of a new addition spreading disease. The fish, it seems, get along better than the coral. “Corals, as they grow, have toxins that kill corals around them and keep expanding,” Schmitt says. “As some grow, depending on who’s the better fighter, they kill the coral next to them, so you have to sort of weed them back.” Despite the reef tank’s high maintenance factor, Schmitt says it can be a relaxing distraction. “It has a great calming effect when you’re working on a paper or a grant, and you need a five-minute break.” ●
Watch a video about Schmitt’s aquarium at tinyurl.com/upstatefishtank
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8 ways to burn calories Say you’ve got two hours on a Sunday afternoon. The way you spend that time will determine whether you burn a whole bunch of calories – or not. Keep in mind, the precise number of calories a person burns is influenced by age, weight, gender, activity level and movement efficiency. Use these numbers, calculated for an 180-lb. person — only as a guide.
Bowling for fun Carrie Garcia’s father played in a bowling league when she was growing up. The family used to bowl for fun, but she confesses “I was never particularly good at it.”
Shoot pool: burn 397 calories
Today Garcia — a speech language pathologist who works with patients who have had strokes — organizes an annual bowling fundraiser called Strikes for Stroke. The event raises money to support stroke care at Upstate while celebrating a sport that thrives throughout Central New York winters, is easy to learn and is accessible and adaptable to people with varying abilities. The United States Bowling Congress says bowling is as easy as walking down the street. “As a matter of fact, that’s what bowling really is, just walking and swinging your arms,” the organization says on its website, www.bowl.com. “The only difference being, you have a weight in one hand, your bowling ball, but if that ball fits your hand properly, it will feel light as a feather.”
Play ice hockey: burn 1,420 calories
Snow ski, at moderate speed: burn 972 calories
Carrie Garcia wears her “Strikes Against Stroke” T-shirt and holds her son, Gavin, at last year’s event. She says the 6th annual event will take place Friday, May 1.
The congress says you can avoid making rookie mistakes by realizing that street shoes are not allowed in the bowling area, and neither is food or drink. Be ready when it’s your turn to bowl, and do not linger on your approach. If you approach at the same time people approach in the adjacent lanes, the person to the right goes first. Keep any post-shot celebrations (or anger) to your own lane. And, be respectful of your opponents. ●
Bake cookies: burn 240 calories (not counting the added calories from eating cookies)
Know before you go Here are 14 bits of bowling lingo that will help you join the conversation:
Greek Church: The 4-6-7-8-10 or 4-6-7-9-10
180: When the pin sweep gets stuck in the back position
Blind score: The score assigned to a bowler who is absent
7-10 split: Typically referred to as the toughest split
Brooklyn: Getting a strike hitting the other pocket
Arrows: The triangles on the lane used to aid in aiming
Deadwood: A pin that is not able to be swept into the back
Pocket: Between the 1-3 for right handers and 1-2 for left handers
Baby Split: The 2-7 or 3-10
Foul line: The line that separates the approach and the lane
Scratch: The score before any handicap is applied
Big Four: The 4-6-7-10
Couch potato: burn 132 calories
Snowmobile: burn 572 calories
Snowshoe: burn 1,308 calories
Play cards: burn 200 calories
Handicap: The number of pins received to equalize the competition
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—reviewed by exercise physiologist Carol Sames, PhD, director of the UPSTATE.EDU/BREASTIMAGING Vitality fitness program at Upstate’s Institute for Human Performance. U P S TAT E H E A LT H
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4 cancer challenges Appetites often change during cancer treatment. “Even if you’re not feeling particularly well, remember that nutrition is an important part of your treatment,” says registered dietitian nutritionist, Maria Erdman of the Upstate Cancer Center. She provides this advice: ● For
nausea and vomiting, ask your healthcare provider if medication is warranted, and use any prescribed medication as directed. Some prevent nausea and others treat nausea. Eat small meals or snacks. Avoid warm foods with strong smells, and fried or greasy foods.
● For
decreased appetite, eat small protein- and calorie-rich snacks throughout the day. Don’t sit down to a big meal at a set time. Instead, keep snacks such as Greek yogurt or peanut butter crackers handy, for times when you feel you could eat something.
● For
dry mouth, suck on sugar-free candies to keep the saliva flowing. This may also help mask bad tastes.
● For
changes in the way foods taste, make your own changes. If foods taste bitter, experiment with adding sweeteners. If they taste metallic, trade your silverware for plastic utensils.
Listen to an interview on this subject at upstate.edu/healthlink onair by searching “Erdman.”
Frozen Pumpkin Mousse Pie When you crave something decadent and sweet, it can be tricky not to go overboard on calories. Here’s a recipe that can satisfy a sweet tooth with a reasonable amount of calories – as long as you stick with a single 1/10th-of-the-pie slice. As an added bonus, the pumpkin provides a strong helping of vitamin A. Organs including the heart, lungs and kidneys depend on vitamin A to work properly, and the vitamin is important for normal vision, the immune system and reproduction.
Ingredients Crust
Filling
30 small gingersnap cookies (about 7 ½ ounces)
1 cup canned pumpkin puree
2 tablespoons raisins 1 tablespoon canola oil
Preparation
1/3 cup packed brown sugar ½ teaspoon ground cinnamon
½ teaspoon freshly grated nutmeg 2 pints (4 cups) frozen low-fat vanilla ice cream, softened
¼ teaspoon ground ginger
1. Preheat oven to 350 degrees Fahrenheit. Coat a 9-inch deep-dish pie pan with cooking spray. 2. To prepare crust, combine gingersnaps and raisins in a food processor and pulse until finely chopped. Add oil and pulse until blended. Press evenly into the bottom and up the sides of the prepared pan. 3. Bake the crust until set, about 10 minutes. Transfer to a wire rack to cool completely. 4. To prepare filling, combine pumpkin, brown sugar, cinnamon, ginger and nutmeg in a large bowl and mix well. Add ice cream and stir until blended. Spoon the mixture into the cooled pie crust. Freeze until firm, at least 2 hours. Let the pie soften slightly in the refrigerator for 20 to 30 minutes before serving.
Nutritional information, per serving
Pie makes 10 servings. Per serving:
231 calories 5 grams fat 4 milligrams cholesterol
RECIPE FROM MORRISON HEALTHCARE, FOOD SERVICE PROVIDER FOR UPSTATE MEDICAL UNIVERSITY. roberT mesCAvAGe
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No, this is not bubble wrap It’s a microscopic look at the air sacs in the lungs of a rat during mechanical ventilation. Senior research scientist Gary Nieman developed a viewing technique which aids in his investigation of the pathogenesis and treatment of acute respiratory distress syndrome and ventilator-induced lung injury. Nieman is an associate professor in Upstate’s department of surgery. He also directs the cardiopulmonary and critical care laboratory, where research focuses on the pathophysiology and treatment of septic and traumatic shock.
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