Upstate Health magazine, fall 2019

Health UPSTATE

connecting you to health and medical expertise

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Celebrating 10 years of the Upstate Golisano Children’s Hospital

3 health careers for teens to consider

Tackling a rare disease

How to stop a nosebleed Which ‘milk’ should you drink?

From the experts at

Fall 2019

WHAT’ S UP AT UPSTATE

Children’s Hospital turns 10 As the Upstate Golisano Children’s Hospital celebrates 10 years of service, we asked a variety of people to share their impressions.

TOP turns 20 oracic Oncology Program relies on team care

Thomas Welch, MD, founding director of the Upstate Golisano Children’s Hospital “When we got down to the nitty gritty of designing the hospital, we visited several children’s hospitals around the country. The architects were good about working with children and actually met with children in the hospital. We had input from families, from children, from staff, from the site visits. All of that went into the design,” Welch said.

He recently bumped into one of the architects of the children’s hospital, in San Francisco. Welch told him, “After 10 years of working in the hospital, I honestly can’t think of anything I would have done differently in terms of design.”

Jason Wallen, MD, center, contemplates a treatment plan for a lung cancer patient PHOTO BY SUSAN KAHN during a TOP multidisciplinary team meeting.

s the Upstate Golisano Children’s Hospital

A

celebrates its 10th birthday, Upstate’s Thoracic Oncology Program (TOP) marks its 20-year anniversary.

TOP follows a “multidisciplinary” team approach. Specialists from multiple disciplines make up the team, which collaborates on the care of individual thoracic and lung cancer patients. Team members include medical, surgical and radiation oncologists, pathologists, imaging specialists, pulmonary specialists, nurse practitioners with specialized training, nutritionists, social workers and patient navigators.

Such a team approach — which is typical at major cancer institutes — has been shown to significantly boost a patient’s survival.

Aria Morris of Camillus While she underwent cancer treatment at Upstate, Aria, 6, saw plaques decorating the halls. She asked her mother about them.

Melissa Morris is a nurse practitioner at the Upstate Cancer Center. She explained that the names on the plaques were people who donated money to help support the care of patients like her. So, Aria embarked on a fundraising campaign, selling T-shirts, bracelets and candles. She raised $5,000 to donate a window bench in the children’s hospital.

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Read more about the children’s hospital starting on page 6.

U P STAT E H E A LT H l fall 2019 l upstate.edu

The Upstate Cancer Center has several multidisciplinary teams for various types of cancers, including breast cancer, head and neck cancers, gastric and esophageal cancers, and pediatric cancers.

Leslie Kohman, MD, championed the team concept at Upstate two decades ago “because it gives better care to the patient, and it saves the patients a tremendous amount of time in appointments,” she says.

She notes that almost all cancer patients need more than one type of treatment.

“Very few patients are treated with just surgery, or just chemotherapy or just radiation,” Kohman says. “To have experts from all those disciplines discuss treatment up front is very beneficial to the patient.”

Thoracic surgeon Jason Wallen, MD, is medical director for TOP. He says the team approach means every patient has all options open for discussion.

“It’s like getting eight or 10 second opinions all at once, in a single visit.”

Such team care is natural at an academic medical center, where doctors and caregivers are encouraged to seek input from one another. u

Health C O N T E N T S

Fall 2019

UPSTATE

Upstate Health magazine is a community outreach service of Upstate Medical University in Syracuse, N.Y. Upstate is an academic medical center with four colleges (Medicine, Nursing, Health Professions and Graduate Studies); a robust research enterprise and an extensive clinical health care system that includes Upstate University Hospital’s Downtown and Community campuses, the Upstate Cancer Center and the Upstate Golisano Children’s Hospital.

Part of the State University of New York, Upstate is Onondaga County’s largest employer.

PATIENT CARE He plays football at SU with a rare blood disorder page 4

ILLUSTRATION

BY DAN DIPPEL

How a children’s hospital was built in Syracuse

ON THE COVER Sam Heckel, a lineman on the Syracuse University football team, gets regular treatments at Upstate for a rare blood disorder.

PHOTO COURTESY OF SYRACUSE UNIVERSITY ATHLETICS SEE STORY, PAGE 4.

Need a referral?

IN OUR COMMUNITY

Quiz on special events at the children’s hospital page 11

FROM OUR EXPERTS

page 6

DEPARTMENTS

Meet the Upstate grad who helped discover the rubella virus page 18 Encouraging careers in health care page 20

What’s Up at Upstate

Science Is Art Is Science

page 2 back cover

IN OUR LEISURE

Contact Upstate Connect at 315-464-8668 or 800-464-8668, day or night, for appointments or referrals to the health care providers on these pages or anywhere at Upstate or for questions on any health topic.

UPSTATE HEALTH

EXECUTIVE EDITOR Leah Caldwell Assistant Vice President, Marketing & University Communications EDITOR-IN-CHIEF WRITERS DESIGNER

Amber Smith 315-464-4822 or smithamb@upstate.edu

Jim Howe Darryl Geddes Amber Smith Susan Keeter

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

For corrections, suggestions and submissions, contact Amber Smith at 315-464-4822 or smithamb@upstate.edu

What to do if a kid swallows a coin page 15 Which ‘milk’ is right for you?

page 16

How to stop a nosebleed

page 17

ADDITIONAL COPIES: 315-464-4836 Upstate Health offices are located at 250 Harrison St., Syracuse, NY 13202

Have you tried Vietnamese food?

page 22

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Tackling a disease SU offensive lineman keeps rare disorder in check with infusions at Upstate

BY JIM HOWE

Syracuse University football player Sam Heckel is prepared by nurse Abby Falconer for one of his 12- to 16-hour infusions of plasma at Upstate.

PHOTO BY RICHARD WHELSKY

H

e’s 6 foot 4, weighs 295 pounds and plays

football for Syracuse University.

And, about every three weeks, Sam Heckel settles in for 12 to 16 hours of infusion treatment at Upstate to deal with a rare blood-clotting disorder. He might start by getting the very slow plasma drip at the Upstate Cancer Center, then finish up at the Upstate Golisano Children’s Hospital, or vice versa.

Although he towers over the other pediatric patients and turns 22 this year, he is cared for by pediatricians until graduating from college, as are most young people in long-term treatment.

Heckel’s disorder is known by its initials, TTP (see box, page 5).

“He is my first and currently our only patient with congenital TTP,” says Andrea Dvorak, MD. She is the Upstate pediatric hematologist/oncologist who specializes in children’s blood disorders and cancer and who oversees his treatment. A few other patients have had acquired TTP, the more common type of the disorder caused by an inherited genetic mutation.

“With the acquired form, there are treatments that can make it go away, but with Sam we don’t have that ability. Research is being done, but unless some new treatment comes up, this is his routine from now on,” Dvorak says.

Heckel hopes to contribute to research. He’s president of the Syracuse University chapter of Uplifting Athletes, a nonprofit group of college athletes that aims to create awareness of rare diseases and raise money for research.

The diagnosis Heckel learned he had TTP as a child growing up in Waukesha, Wis. “I was about 2 years old, with my mom and dad at a family get-together, and we were all 4

swimming. When my dad went to grab me and set me down, he left handprints, like bruises, where he held me,” Heckel recalls.

It was the first hint of the disorder. Andrea Dvorak, MD Young Sam was diagnosed soon after, but his family didn’t find suitable treatment until he was in second grade.

Then he began what has become his treatment routine at the Children’s Hospital of Wisconsin, in Milwaukee, about a half-hour from his family’s home.

“It normally takes about 14 hours,” he says of his infusions. Sometimes he is done by 10 p.m. Sunday, sometimes by 2 or 3 a.m. Monday.

“I usually just hang and watch movies, and if I absolutely have to do homework, I’ll do it, but usually it’s just a day to relax,” he says.

“It’s the next day that I feel it. With Continued on page 5

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PATI ENT CARE

Tackling a disease

continued from page 4

all of the medications, it does not make life enjoyable the next two days.” The plasma and medications he must take can leave him feeling bloated and out of sorts for a few days.

Having TTP means Heckel has to stay “super hydrated” to avoid straining his kidneys and be careful about catching illnesses, since he is vulnerable to infections, “but I don’t have to make a lot of adjustments in day-to-day life,” he says.

Playing football He does have to guard against excessive bruising — which might seem difficult, given that he plays on the SU offensive line.

Some doctors may have advised against contact sports for a child with TTP, but Heckel’s pediatrician agreed to monitor him closely. “It’s worked so far,” Heckel says.

He has played football regularly since second grade. The lineman job was pretty much chosen for him by his massive size, he says. He played on the defensive line in high school, and he also played tight end a little last season. He is a redshirt junior this fall and will be able to play one more season at SU after that. Heckel enjoys earth science and says he would like to teach after college.

When choosing a college, Heckel made sure a hospital that could treat him was nearby. Upstate is next door to SU and less than five minutes from where he lives. His doctor in Milwaukee knew pediatrics professor emeritus Thomas Welch, MD, who put him in touch with the pediatric hematology program. That’s how Heckel connected with Dvorak, his doctor at Upstate.

His care Dvorak closely monitors Heckel. “We check his lab reports (blood tests) weekly during football season, and we have to watch his platelet count and kidney function and have to be sure he is staying healthy,” she says.

She also keeps in touch with his athletic trainers. “Before he started, I spoke with the team doctor, and his trainer gets a copy of his labs every week. They know what he needs in order to play,” she says.

In the off-season he does not need to be monitored as closely but still needs his infusion.

“He’s a good kid. He’s motivated. The fact is that both in school and in football … he hasn’t let this stop him. This disease should not interfere with his having a long life,” Dvorak says.

Heckel echoed his doctor’s assessment when asked what he would tell a youngster diagnosed with TTP: “You can’t let that disease define you. You can’t let it limit you. You can do whatever you want.” u

Heckel blocks an opponent during an SU football game.

PHOTO COURTESY OF SYRACUSE UNIVERSITY ATHLETICS

About TTP Thrombotic thrombocytopenic purpura is a rare disorder in which people lack an enzyme called ADAMTS13.

This makes their blood “sticky” and prone to form clots, according to the TTP Foundation.

These clots are made of platelets, a blood element that normally promotes clotting at injury sites to prevent bleeding. In TTP, unnecessary clotting can restrict blood flow to the body’s organs, placing them at risk for damage.

Also, the platelets being used in unnecessary clots are not available to prevent bleeding elsewhere.

Treatment includes slow infusions of normal plasma, the liquid part of the blood, which contains the missing enzyme.

About three or four new TTP cases per million people are diagnosed each year in the United States. upstate.edu l fall 2019 l U P STAT E H E A LT H

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Turning Ten A new leader takes the helm

BY AMBER SMITH

From the outside, the Upstate Golisano Children’s Hospital looks as though it was snapped together with brightly colored toys.

To enter, you walk past the red trunks of several “trees” holding up the roof and into elevators that go directly to the “treehouse” on the 11th and 12th floors.

PHOTO BY ROBERT MESCAVAGE

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PATI ENT CARE

Pediatrics chair Gregory Conners, MD, greets the new pediatric medical residents — all doctors who began three years of training at Upstate in July. Seated next to Conners is pediatric hematologist/oncologist Gloria Kennedy, MD. PHOTO BY CHUCK WAINWRIGHT

hen he completed his medical school

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applications, Greg Conners didn’t just say he wanted to become a doctor. He was one

of four students in his class of 100 who knew the exact specialty for which they were suited. He was going to be a pediatrician.

“I’m a kid guy,” Conners says proudly.

Now, as professor and chair of the department of pediatrics at Upstate, Conners oversees the Upstate Golisano Children’s Hospital.

One of his duties is to greet the new pediatric residents. Earlier in the week, Conners attended a dinner saluting the doctors who completed the three-year program. This day, he’s greeting those who will take their places. Such is the life cycle of an academic medical center.

These residents are medical school graduates who will work for three years in pediatrics at Upstate. (The term is a holdover from a time when new doctors actually lived in the hospital where they worked.) Upstate has 47 pediatric residents, who come to Syracuse from all over the world, plus several pediatric fellows who are pursuing specialized training after their residency.

“Taking care of kids and being a pediatrician is a privilege and a responsibility,” Conners tells the new doctors. “It’s important to take your role seriously.”

The residents join a staff of 72 pediatricians and more than 400 pediatric nurses,

therapists, social workers and other dedicated pediatric staff who care for about 100,000 pediatric patients each year. The children come from 17 counties surrounding Syracuse, plus parts of Pennsylvania and Vermont.

Conners took the helm March 4, after the retirement of Thomas Welch, MD, who oversaw the creation of the children’s hospital. Although it’s part of the Upstate University Hospital building, it operates separately.

Raising money Construction costs for the hospital totaled $70 million, $21 million of which the Upstate Foundation collected through a large fundraising campaign.

Public generosity was overwhelming.

Ads that depicted a gleaming new building with private rooms and gorgeous views of Syracuse, filled with pediatric specialists, prompted people to donate amounts large and small. Staff from Upstate University Hospital pledged personal donations of nearly $2 million to build the children’s hospital. Beloved Continued on page 8

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Impressions of the Upstate Golisano Children’s Hospital

Turning Ten

continued from page 7

Continued from page 2

Retired pediatrician Stuart Trust, MD Along with Thomas Welch, MD, Trust and each of their wives were co-chairs of the Upstate Foundation’s annual gala the year that proceeds went to the children’s hospital. Trust remembers purchasing a tuxedo for the occasion. He also recalls greeting “hundreds and hundreds” of people at the entrance, shaking hands and thanking them for supporting the children’s hospital.

Conners in the children’s hospital.

PHOTO BY CHUCK WAINWRIGHT

pediatrician Fred Roberts, MD, who practiced in Syracuse for more than 60 years, donated proceeds from sales of his two books. Students at schools throughout the region staged various fundraisers.

Tyler Halpin of Clay Tyler Halpin,15, has cystic fibrosis, so every three months he sees Christopher Fortner, MD, PhD, medical director of the cystic fibrosis program. Sometimes his treatment requires an overnight hospital stay.

“He actually looks forward to that,” says his mother, Erin Halperin.

“He needs extra calories. He loves the food, and he can have whatever he wants.”

Pediatrician Beth Nelsen, MD

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A pediatrics chief resident when Golisano opened in 2009, she remembers starting work at 5:30 a.m. on moving day. Nine hours later, she and a colleague finally had time to walk into the newly occupied hospital and absorb their new surroundings. “The one thing we both remarked on was how quiet it was.”

U P STAT E H E A LT H l fall 2019 l upstate.edu

Ultimately, the hospital was named after its chief benefactor: businessman Thomas Golisano.

The doors opened on Sept. 23, 2009.

Beth Nelsen, MD, says it was an honor to be a chief resident that monumental day. Ten years later, she’s an associate professor of pediatrics and pediatrics residency program director.

One of her jobs is to interview medical students who are applying for a pediatrics residency at Upstate Golisano. Many say it’s the nicest hospital they’ve visited.

“I’m a local, so I have a lot of Syracuse pride,” Nelsen says. “When somebody comes into my home and says, ‘It’s beautiful here,’ that makes me really proud.”

Attracting specialists Like patients and their families, doctors prefer to be in a space customized for the comfort of children and families, surrounded by modern equipment and a staff dedicated to

children. The hospital helps to attract pediatricians in specialties such as gastroenterology, neurosurgery, endocrinology and others.

Among the 71 beds dedicated to pediatric patients are 12 for cancer and blood diseases, 15 for intensive care and 44 for medical/surgical issues. The 285-square-foot patients’ rooms are all private, with space for a sofa bed for a parent, and bathrooms with showers.

Plans are in the works to add eight psychiatric beds for adolescents.

Conners came to Upstate from Children’s Mercy Hospital in Kansas City, Missouri. He’s a native of the Rochester, New York, area and went to medical school at SUNY Stony Brook, graduating in 1989. He completed a residency and fellowship at Children’s National Medical Center in Washington, D.C. He’s had experience with several children’s hospitals. He is impressed with this one — and with its potential.

Already he’s collaborating with children’s hospital executives from throughout Upstate New York. “What we’re working on, and it’s not easy, is to group together so that there are ways to take care of kids who have really high-tech or very specialized Continued on page 9

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Turning Ten

Impressions of the Upstate Golisano Children’s Hospital

continued from page 8

needs, without making them have to travel [out of state],” Conners says.

A highly specialized pediatric service might not have enough demand for services in a community the size of Syracuse or Rochester. But, if Syracuse offers something not available in Rochester, and Rochester offers something else that is not available in Syracuse, families in both communities can benefit.

“There’s a lot of pride in running your own place and saying, ‘We’re good on our own.’ I also think it’s important to realize there are some areas where it’s not a matter of greatness. It’s a matter of economies of scale, of doing the right thing for patients,” he says.

“We can work together to be proud of what we can do collectively.”

Building on legacies Discussion of the need for a children’s hospital goes back at least to the 1970s, when Frank Oski, MD, was chair of Upstate’s pediatrics department, says retired pediatrician Howard Weinberger, MD. Oski, who went on to lead the Johns Hopkins Children’s Center, literally wrote the book on pediatrics. His text, “Principles and Practices of Pediatrics” is still in use.

Weinberger recalls many meetings, but little consensus, until Thomas Welch, MD, arrived in the summer of 2001. Welch’s first task was to drum up support for the concept of a children’s hospital. “I had to convince the community that communities are judged by the way they take care of their children — and we really needed to do a better job,” Welch says.

“There was such universal buy-in from the community.”

Once the children’s hospital opened, eight years after his arrival, nearby hospitals stopped admitting pediatric patients, instead sending ill and injured children who required hospitalization to Golisano. Soon, plans were underway to expand Upstate’s pediatric emergency department as well.

Continued on page 10

Ilijah Barron of Liverpool “After a group of (Liverpool) High School seniors in Upstate New York found out that their classmate Ilijah Barron would be missing prom due to his battle with bone cancer, they brought the senior ball to him in the hospital,” Anchor David Muir said in introducing the story on “ABC World News Tonight” in June. Barron and more than 20 of his friends dressed in their finest and celebrated together in Golisano’s 11th floor event space. “I loved it,” Barron told Syracuse.com. “It was the most special moment ever, having everybody there, all my friends.”

Retired pediatrician and former pediatrics chair Howard Weinberger, MD

Tim Conners of Fulton

Much has changed in the way care is provided in the past decade, Weinberger points out. These days, general pediatricians whose patients require hospitalization rarely oversee the patient’s care in the hospital.

Instead, pediatric hospitalists take care of these patients. “In many ways it’s better for the patients because they have better continuity of care by specialists who are skilled in hospital care, and that care is provided 24 hours a day.”

He spent about a week in the hospital in April 2010 when he was first diagnosed with leukemia. When Conners returned during the holiday season, “One of my nurses brought me the movie, ‘Elf,’ so I got to watch ‘Elf’ in my room,” he remembers.

Today, Conners is a motivational speaker. He donated a portion of the money he raised to the children’s hospital after he climbed Mount Kilamanjaro in 2017. He is no relation to Executive Director Gregory Conners, MD.

Hospital teacher Mary Ellen Michalenko

Professor of pediatrics Ann Botash, MD

The architects asked her for a list of features she needed for the room where patients — from kindergarten through 12th grade — would come to do their schoolwork while they were hospitalized. Among other things, Michalenko needed a door that was big enough for a hospital bed to roll through. “Everything I put on the wish list was in the school room. Everything,” she says.

Michalenko has been teaching at Upstate for 22 years.

The day of Sept. 23, 2009, Botash was responsible for discharging any patients who were well enough to go home, and transferring the others into the 11th and 12th floors of the new building. She recalls a 9-year-old girl with asthma, whom she wheeled into the children’s hospital. “I can remember her face and her getting so excited about the room.

The room was so calm and spacious by comparison, and the private television was such a luxury.

She got so excited that she started wheezing,” Botash says. “She ended up staying another two days.” upstate.edu l fall 2019 l U P STAT E H E A LT H

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Impressions of the Upstate Golisano Children’s Hospital

Pediatric nurse Maisha Brown She remembers the soundtrack provided by a boy of about 12 or 13 on moving day, when children who were already hospitalized were moved into the new hospital. “He’s an adult now,” Brown points out. He lay on his hospital bed, holding his CD player, as Brown brought him to the 11th floor. “We were listening to ‘Hakuna Matata.’ ” That’s the song from “The Lion King” that means “no worries.”

Richard Cantor, MD, director of the pediatric emergency department When he began his pediatric residency at Upstate in 1976, Cantor worked primarily on the fourth floor of University Hospital, where children were then hospitalized. At the time, the ward “really had nothing that signified that it was for children, except maybe for some wallpaper and a scattering of toys,” he recalls.

More than 40 years later, Cantor works in the same physical space on the fourth floor of the main hospital.

Only now, it’s been transformed into a pediatric emergency department for kids up to age 19, whom he oversees.

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Turning Ten Before August 2016, the pediatric emergency department occupied a corner of the adult emergency department. It could get crowded and noisy.

“We did great with what we had,” says pediatric emergency department Director Richard Cantor, MD, acknowledging the desire for a more peaceful space devoted to children and adolescents.

Today, the pediatric emergency department occupies a wing on the fourth floor of University Hospital, separate from the adult emergency department. Each year, it treats about 30,000 kids up to age 19.

The expansion cost $9 million, much of the money brought in through donations. Six patient rooms bear plaques in honor of Cantor. And the medication room is named in memory of Robert Kanter, MD, a renowned pediatrics professor with a long gray ponytail who opened and led the region’s first pediatric intensive care unit at Upstate, decades before the children’s hospital was built.

The dictation room has a plaque bearing the name of Robert Dracker, MD, an Upstate graduate and pediatrician who founded Summerwood Pediatrics. Even though Upstate had pediatric specialty doctors before the children’s hospital was built, Dracker says having an actual children’s hospital “has enabled us to have pediatric-focused care with regard to facilities and nursing.”

It is the dictation room where Conners and the rest of the doctors gather at the start of his 4 p.m. shift one Wednesday afternoon in June.

Here, the doctors who are getting off duty brief those coming on. A toddler gives a slow, drowsy wail somewhere down the hall, past the cleaning cart painted like a giraffe.

Conners has a beaming demeanor.

He speaks softly. Draped around his neck is a red stethoscope. He rubs

U P STAT E H E A LT H l fall 2019 l upstate.edu

continued from page 9

hand sanitizer between his hands while he listens to the reports about the patients in the pediatric emergency department that afternoon.

An 8-week-old with diarrhea and vomiting will probably need to be admitted. Needing to be assessed are a 19-year-old girl who was in a head-on collision, a 15-year-old girl with abdominal pain, and a 10-year-old boy with unusual swelling. And there are more patients just arriving.

Conners is on duty alongside Leah Bennett, MD, an assistant professor of emergency medicine. She’ll take care of patients in even-numbered rooms.

He gets the ones in odd numbers.

Providing care He heads to room 11. Cartoons play silently on the wall-mounted television.

On the bed looking tiny is a 2-year-old girl with pink and black beads woven into braids. The girl looks at Conners with wide eyes.

“Hi, Sweetheart,” he says.

Her mom explains that the girl has had a cold for a week, with a slight fever. She’s worried.

Conners talks to the girl. He holds the round end of his stethoscope.

“Can I put this on you?”

She squeaks an affirmative reply.

She’s transfixed by his face.

After he listens to her breathing, Conners shows her a tool called an otoscope.

“Sweetie, this is a light,” he says, flicking it on and aiming the light onto his palm for her to see. The girl extends her hand. He moves the beam of light onto her palm. She’s thrilled.

She lets him peer into her ear.

Next, Conners sees a teen boy in room 13 with a headache after a blindsided tackle during a football game at recess.

Continued on page 14

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Quiz

Look who visits the children’s hospital Answers to quiz from page 11

1. The Wiggles.

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2. Syracuse Stage’s Cowardly Lion, Dorothy, Scarecrow and Tin Man from L. Frank Baum’s “The Wizard of Oz.”

3. The Onondaga County Sheriff’s Department’s bomb squad robot.

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4. Syracuse’s pro baseball team, then the Chiefs, now the Syracuse Mets.

PATI ENT CARE

5. The Amazing Bubble Man.

6. Cirque du Soleil.

PHOTOS BY KATHLEEN PAICE FROIO AND MEDICAL PHOTOGRAPHY

7. Elmo, above, and Grover, right.

8. Nina Davuluri, Miss America 2014

9. Syracuse University’s Otto the Orange.

COURTESY SYRACUSE UNIVERSITY

10. Mary Poppins (pictured with the cast from the Syracuse Stage production). upstate.edu l fall 2019 l U P STAT E H E A LT H

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Impressions of the Upstate Golisano Children’s Hospital

Brayden Kires of Baldwinsville

Halloween at the children’s hospital. Patients can go trick-or-treating in the hallways, getting treats from Upstate employees, who also come in costume.

PHOTO BY KATHLEEN PAICE FROIO

Turning Ten

continued from page 10

Conners wraps up with the boy.

Then he heads to the dictation room.

A countertop lines three sides of the room. Seven computers are placed in front of seven stools. That’s where doctors and pediatric and emergency medicine residents document their interactions with their patients. They prescribe various tests, medications or treatments. The room usually has snacks. Today, someone has brought in a pan of homemade Rice Krispies treats, some chocolate almond biscotti and a small bowl of candy.

“Everybody good? Anyone need anything?” Conners asks, before obliging his sweet tooth. Neither of his patients appears to be seriously ill or injured. After getting lab work (the toddler girl) and medical images (the teen boy), both will go home.

Working together At 8:35 a.m. the next Monday, Conners — as the executive director of the Upstate Golisano Children’s Hospital — led the daily “Pediatric Safety and Operations Brief.” This is a group 14

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When Brayden was born with a life-threatening condition called gastroschisis, in which the intestines grow outside of the abdomen, his mother, Crystal Kires wanted to make sure she did everything she could for her baby. She’s grateful she found Marcus Rivera, MD, a pediatric gastroenterologist at Golisano.

Tamer Ahmed, MD removed the malfunctioning intestines. Two months after his birth, Brayden went home.

Eventually, Kires says, her son will need an intestinal transplant.

phone call that unites people from 22 departments in the children’s hospital.

Representatives from inpatient rehabilitation, respiratory care and the laboratory are part of it. So are people from materials management, clinical engineering and the physical plant.

They share information: how many pediatric patients are in the hospital this morning; whether any areas are short on staff; that public safety officers were summoned twice overnight to help with a combative patient; and a notice from the pharmacy that the injectable sedative midazolam is in short supply, so doctors should prescribe something else when possible. The issues that arise are typical for a children’s hospital.

The call is quick and helps every department start each day on the same page. Each call ends with a quote, which Conners enjoys selecting. Today he reminds the group: “Children are great imitators, so give them something great to imitate.” u

Nursing director of pediatric services Linda McAleer Her daughter Caroline was frequently hospitalized as a child, before the children’s hospital opened. The family kept a suitcase packed, just in case she had to be admitted. Their memories of cramming into the hospital room, and McAleer sleeping on the floor, are not good ones. Now grown, Caroline visited her mother at work and saw the children’s hospital for the first time. “Mom, this is amazing,” she said. “I wouldn’t have been so scared here.” McAleer is proud of the environment. “It’s all about creating an experience that is child-friendly and way less frightening,” she says. u

FROM OUR EXPERTS

What to do if a kid swallows a coin ou would think that this would be all figured out

Y

by now, because it’s a pretty common thing for a kid to swallow a penny,” says Gregory Conners,

MD, executive director of Upstate Golisano Children’s Hospital. His first three research projects examined the best way to treat a child who has swallowed a penny.

“It turns out there are lots of different ways to do it,” he says. “And if you go around the country, the same patient would be cared for in different ways in different places — less so now than when I started because — I’m pleased to say — I’ve had some impact in the field.”

His advice to parents and guardians: Look at the child. Is he or she having trouble breathing? Are they drooling or vomiting? Do they struggle to swallow? If so, go to the emergency department.

If the child is behaving normally, contact his or her pediatrician or primary care provider.

Unless the child has underlying health conditions, most likely a doctor will reassure that the penny will work its way through the child’s digestive system. “The problem — when there is a problem — is that the coin will maybe get stuck somewhere along the way. Most of the time, it comes right through,” Conners says.

He says it’s important to get to the hospital quickly if a child swallows a magnet or a button battery, the tiny batteries that power watches.

A child will also need to contact his or her doctor if a small object becomes stuck in his or her nose or ear — unless it is a battery. In those instances, they should go to the pediatric emergency department at Upstate.

Conners says the person who brings the child to the emergency department ideally should know the events leading up to the child’s illness or injury, so that can be communicated to the doctor.

“It’s important for us to know what the background is. In pediatrics you really rely heavily on the story, the history.” u

For questions at any hour, contact the Upstate New York Poison Center at 1-800-222-1222.

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FROM OUR EXPERTS

Which ‘milk’ should you drink?

BY AMBER SMITH

Products sold as milk come from coconuts, almonds, cows and rice.

arket shelves are filled with varieties of

M

nondairy beverages that call themselves milk. They may taste good whirled into

a smoothie or poured over cereal. But they likely cost more than cow’s milk, and they are probably not nutritionally equivalent.

Upstate registered dietitian nutritionist Maureen Franklin urges adults to read the food labels to see if their chosen milk alternatives measure up. Many nondairy beverages add vitamins and minerals, along with sugars, so their nutritional content may differ greatly from that of regular milk.

Some people avoid milk and other dairy products because of an intolerance to lactose or because they prefer plant-based foods.

A few surprises: Rice milk is higher in carbohydrates than you might imagine.

Almond milk is far lower in protein. Pea milk has a creamy texture that Franklin finds most similar to cow’s milk. And coconut milk? Look out for saturated fats.

16

U P STAT E H E A LT H l fall 2019 l upstate.edu

One cup of traditional cow’s milk contains 8 grams of what Franklin calls “good, high quality protein.” It’s also a good source of calcium and potassium and contains only natural sugars. Milk is a blend of protein, carbohydrates and fat, the total content of which depends on whether it’s whole, 2 percent, 1 percent or skim milk.

What about kids?

For dairy beverages for kids over age 1, pediatricians recommend whole cow’s milk.

The American Academy of Pediatrics says infants should receive only breast milk or formula for the first six months. Then, at age 1, babies transition to whole cow’s milk for at least a year. “The fat in the whole milk is Continued on page 17

FROM OUR EXPERTS

Which ‘milk’ should you drink? really important for brain development,” says pediatrician Beth Nelsen, MD, associate professor of pediatrics at Upstate.

She also says new research suggests kids should keep drinking whole milk beyond their second birthday to help keep kids at a healthy weight. “If you drink a glass of whole milk with a meal, you get fuller faster,” Nelsen explains.

As children grow, calcium intake is important for lifelong bone health.

Nelsen says cow’s milk remains the best dietary source for that.

Are any of the nondairy beverages more nutritious than cow’s milk?

“Some can be,” Franklin says. “They can be higher than milk in terms of calcium, or they could be higher, maybe, in terms of a certain vitamin. It really depends on what that manufacturer has chosen to add to that product.” u

Your calcium needs How much calcium your body needs changes as you age. Females have higher calcium requirements than males because of the effects of the female hormone estrogen on bone formation.

Calcium is also required to keep our heart, muscles and nerves functioning properly, and for blood to clot. The Food and Nutrition Board of the Institute of Medicine provides these recommendations for daily calcium intake:

continued from page 16

If you don’t like milk Cow’s milk is a great source of calcium, but if you can’t stomach it, here are some other calcium-rich options. Read food labels for exact calcium content: Almond milk Baked beans, canned Bok choy

200 milligrams

Broccoli and brocolli rabe

6 to 12 months:

260 milligrams

Cereals, fortified

1 to 3 years:

700 milligrams

Birth to 6 months:

Oatmeal, fortified Orange juice, fortified Rice milk Salmon, canned with bones Sardines, canned with bones

4 to 8 years:

1,000 milligrams

9 to 18 years:

1,300 milligrams

Cheese (American, cheddar, mozzarella, feta or ricotta)

19 to 50 years:

1,000 milligrams

Collard greens

Soybeans or soy milk

Males 51 to 70 years:

1,000 milligrams

Kale

Yogurt

Females 51 to 70 years: 1,200 milligrams 70 years and older:

Shrimp

SOURCE: NATIONAL OSTEOPOROSIS FOUNDATION

1,000 milligrams

ree steps to stop a nosebleed 1.Pinch the nose right below the bridge of the nose.

2.Lean forward. That helps the clot to form in the nose and prevent ongoing bleeding.

3.Apply a cool cloth on the back of the neck, which can also help stop the bleeding.

“You really have to pinch the nose for quite some time,” says Andrea Dvorak, MD. She recommends five to 10 minutes, or longer if you have a bleeding disorder. “You should watch the clock because it’s much longer than you really feel like it should be.”

Dvorak is the director of Upstate’s Pediatric Bleeding Disorders Clinic. She offers reassurance that the majority of nosebleeds do not signal bleeding disorders.

She suggests that people who have recurrent nosebleeds use nasal saline to keep the nose moist, especially during winter when the air is dry. u upstate.edu l fall 2019 l U P STAT E H E A LT H

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IN OUR C OMM UNI TY

e power of vaccines What we can learn from science – and a pioneering Upstate graduate

BY AMBER SMITH

Paul Parkman, MD, graduated first in his class at Upstate in 1957. He became a pediatrician and virologist who helped isolate the rubella virus, develop the first widely applicable test for rubella antibodies and the first rubella vaccine. “With the exception of safe drinking water, vaccines have been the most successful medical interventions of the 20th century,” Parkman says.

RUBELLA VACCINE: SCIENCESOURCEIMAGES PHOTO OF DR. PARKMAN COURTESY OF ARCHIVES AND SPECIAL COLLECTIONS, UPSTATE HEALTH SCIENCES LIBRARY

H

ow do we know, for sure, that vaccines don’t cause autism?

“Science has a funny thing about absolutes. If you ask a scientist, ‘Can you say for sure?’ the scientist will say, ‘I can’t go beyond my data. But the data, which involves multiple studies and thousands of children convincingly shows that it’s not associated. I believe it’s not associated,’” says Paul Parkman, MD. Parkman, now 86, is a Weedsport native and Upstate graduate who helped isolate the rubella virus in the early 1960s, then developed an antibody test and vaccine. He started his career as a doctor at Walter Reed Army Medical Center and served as director of the Food and Drug Administration’s Center for Biologics Evaluation and Research from 1987 to 1990.

In 2005, he gave an oral history at the National Institutes of Health in which he shared his worry of people who mistrust vaccines. He told the story of rubella, also known as German measles. It was thought to be a mild childhood disease, which had to be differentiated from the more serious rash-causing diseases of measles and 18

scarlet fever. Only later did doctors learn that rubella caused pregnant women to miscarry or to deliver babies with severe congenital deformities.

Parkman remembers the last major rubella epidemic, in 1964. If a pregnant woman developed a rash, she would worry about the potential for miscarriage and whether her doctor would recommend abortion, so she would not deliver a baby damaged by the virus. Women feared the disease, with good reason.

Parkman says some parents today mistakenly believe they don’t need to have their kids immunized. Young Continued on page 19

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IN OUR C OMM UNI TY

Protection today

e power of vaccines

continued from page 18

adults today weren’t alive to remember previous epidemics.

“Maybe the immunization of all the other children in your neighborhood will protect you,” Parkman continues in the oral history, “but if you and the lady next door and the guy down the street decide not to be immunized, you’ll have a problem again, sure enough.”

Reading Parkman’s words today, he seems to have predicted the growing measles epidemic with which the United States is now grappling.

When Parkman was studying rubella viruses, the epidemics seemed to come in waves, every six to nine years. So with a rubella vaccine available in 1969, government leaders at the Division of Biologics Standards of the National Institutes of Health and the Centers for Disease Control and Prevention made some decisions that proved wise. They had to decide who got the vaccine first.

“We made the decision to use it in

children 1 year of age, the first time when you really could get good antibody responses. Before that, the antibody response can be interfered with by maternal antibodies,” he explains. “So, you start immunizing at one year of age up until puberty.

“If you really push hard and get all those kids immunized, you’re going to stop the epidemics, because children are the ones who really spread the virus.

“And we did it. If you look at those epidemic curves, they bumped up and down every six to nine years. After 1969, no more big epidemics.”

An estimated 12.5 million Americans got rubella during the epidemic from 1964 to 1965, including 11,000 pregnant women who lost their babies, according to the CDC. Once the vaccine was in widespread use, the number of people infected with rubella dropped. Today fewer than 10 Americans are reported with rubella each year. u

The MMR vaccine protects against measles, mumps and rubella. The Centers for Disease Control and Prevention recommends children receive two doses, the first between 12 and 15 months of age, and the second between 4 and 6 years of age.

Measles, mumps and rubella are contagious, viral childhood infections that can be avoided through vaccination.

Measles can be serious, even fatal.

Measles outbreaks have been reported across the United States, with the majority of cases occurring in people who have not been vaccinated.

Mumps causes swelling in the glands that produce saliva, and complications can lead to hearing loss. Mumps was common in the United States until vaccination became routine.

Rubella (German measles) is usually not as severe as measles, and its symptoms are generally so mild they may be difficult to notice, especially in children. The virus can cause fetal death or serious birth defects if contracted by a woman who is pregnant.

The CDC declared rubella eliminated in the United States but cautions that children need to be vaccinated to prevent its re-emergence.

Thank you!

From your friends at the

Upstate Foundation

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IN O UR CO MMUNITY

Encouraging health Retired doctor helps high schoolers see opportunity in hospital work e retired a couple of years

H

ago after 43 years practicing pediatrics, but Stuart Trust,

MD, still works with youth.

Rather than providing medical care, he now provides medical inspiration.

He meets with small groups of teens who have expressed interest in science or medicine. He provides a personal tour of the children’s hospital and answers questions about career options.

“I explain that the health care field is wide open. It’s inclusive and diverse,” he says. “Whatever you do, you can earn a good living — and you’ll get to help other people.”

Here are three health care careers that high school students might consider: • Apply to an associate’s degree program in nursing.

At the same time, apply for early admission to the College of Nursing at Upstate. (Upstate provides further education for registered nurses, who often work while earning their Bachelor of Science in Nursing.) Provided you maintain good grades, you have guaranteed admission to Upstate’s RN-to-bachelor’s program.

• Through a 2 + 2 program in Upstate’s College of Health Professions, you can attend two years of college — often a community college — and then transfer to Upstate for your junior and senior years. Upstate offers six programs through which you can earn a bachelor’s degree in this way: medical biotechnology, medical imaging sciences/ X-ray, medical imaging sciences/ultrasound, medical technology, respiratory therapy or radiation therapy. The advantage for students is in cost saving and a highly focused education.

Stuart Trust, MD, leads tours for high school students interested in science and medicine.

PHOTO BY RICHARD WHELSKY

• If you think medical school may be in your future, Upstate offers a master’s in medical technology. This rigorous oneyear program gives students who have graduated from college the chance to strengthen academic, clinical and analytical skills. If you are accepted into this program, you are guaranteed an admissions interview at Upstate’s College of Medicine.

Learn more at upstate.edu/education 20

U P STAT E H E A LT H l fall 2019 l upstate.edu

IN OUR C OMMUNITY

care careers Scholarship helps launch grads

Scholarships honor James L. Potts, MD, the first African-American member of Upstate’s clinical faculty.

Tracking 24 award winning doctors Potts Prize Winners

Orthopedic surgeon Daryll Dykes, MD, PhD, JD, was the first award recipient; pediatrician Windy Grant, MD, was the most recent.

ix are working in

S

New York state, including one

(Daryll Dykes, MD, PhD, JD) at Upstate. Many are at hospitals or private practices in the Northeast, although one is in California and three are in Houston. One (Nicole Alexander-Scott, MD) is the director of the Rhode Island Department of Health.

What they have in common: When each graduated from Upstate’s College of Medicine, he or she received a $500 prize established in honor of James L. Potts, MD, the first African-American

member of Upstate’s clinical faculty.

After completing his cardiology fellowship, Potts joined Upstate in 1972. He directed the cardiac catheterization laboratory and initiated the echocardiography program, in addition to taking care of patients and teaching students. He left in 1994 to become chief of cardiology at his medical alma mater, Meharry Medical College in Nashville.

“He was an important role model for all students and residents,” Harold Smulyan, MD, said of Potts. Donations from cardiology fellows and hospital staff funded the Potts Prize.

The first award 25 years ago went to Dykes, an orthopedic surgeon who grew up in Syracuse and earned his medical degree and a doctorate at Upstate. Dykes went to the University of Minnesota in Minneapolis for further training in orthopedic, spine and trauma surgery and later joined the faculty there. He returned to Upstate as a faculty member in 2018.

The most recent winner, this year, was Windy Grant, MD, who is starting a pediatrics residency at Yale New Haven Hospital. She intends to care for children in her homeland, Haiti. u

YEAR NAME SPECIALTY 1995 Daryll Dykes, MD, PhD, JD orthopedics

LOCATION Upstate Medical, Syracuse

1996 Esme Anne Riley, MD

Maryland

anesthesiology

1997 Toycina Aguilh-Figaro, MD pediatrics

Brooklyn

1998 Pierre Frederique, MD

pulmonology

Pennsylvania

1999 Vonda Johnson, MD

family medicine

Dannemora, NY

2001 Nicole AlexanderScott, MD

internal medicine, pediatrics

Rhode Island

2002 Madison Cuffy, MD

transplant surgeon Cincinnati

2004 Lauren Brewington, MD

infectious diseases Atlanta

2004 Donna Thomas, MD

internal medicine

Long Island

2006 Dalton Foster, MD

anesthesiology

Houston

2007 Peter Guirguis, MD

obstetrics/ gynecology

Brooklyn

2008 Francois Boubert, MD

obstetrics/ gynecology

New Haven, Conn.

2008 Jacqueline Busingye, MD ophthalmology

New York

2010 Jewel Appleton, MD

radiology

Houston

2010 Tesha English, MD

anesthesiology

Greater Los Angeles

2012 Jacqueline Minasso, MD

dermatology

Long Island

2012 Richard Ogbuji, MD

neurosurgery

Boston

2013 Tiffani Cherry, MD

pediatrics

Kentucky

2014 Kilali Iyalla, MD

surgery

Houston

2014 Andrea LuncheonHilliman, MD

anesthesiology/ critical care

University of Pennsylvania

2015 Krista Tookhan, MD

pediatrics

Maryland

2016 Marie Fleury, MD

surgery

Stony Brook University

2018 Nicodeme Wanko Agassy, MD

orthopedic surgery Rutgers University

2019 Windy Grant, MD

pediatrics

Yale New Haven

Two winners were awarded some years, and no winners were awarded some years. Of the 24 winners, 16 are women and eight are men.

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IN OUR L EISURE

One nurse’s passions He’s dedicated to patients in the recovery room and customers at his restaurant

BY JIM HOWE

Nurse Thanh Nguyen at the Saigon Vietnamese Kitchen, his restaurant outside Liverpool.

PHOTOS BY CHUCK WAINWRIGHT

ou can find him caring for patients as they wake

Y

up after surgery. You can also find him supervising a Vietnamese restaurant near Liverpool.

Thanh Nguyen (pronounced tonn wenn), says he loves working as a nurse in Upstate University Hospital’s post-anesthesia care unit. Also known as the PACU or recovery room, it’s where patients wake up after surgery. Now 32, he has lived in Syracuse since he was 3. He’s been a nurse at Upstate for the past five years.

Nguyen keeps busy. When he is not working as a nurse, he can usually be found 22

U P STAT E H E A LT H l fall 2019 l upstate.edu

at the Saigon Vietnamese Kitchen on Route 57 in Liverpool. It’s a business he helped to launch this spring.

A friend of Nguyen’s, Daniel Nguyen, also of Vietnamese background but no relation to Thanh, was a cook at another local Vietnamese eatery and needed a business partner to start a new place. “Daniel wanted to create his own restaurant with his own menu and Continued on page 23

IN OUR LEI SURE

One nurse’s passions

RECIPE

continued from page 22

his own creations,” Thanh Nguyen said. “He covers the kitchen, and I’m basically the managing partner and oversee staff, the financial details, and making sure customers are happy and everything is correct.”

Thanh Nguyen had taken a few business classes and was interested in going into business himself before he switched to nursing. He leaves the cooking to his business partner, who he notes trained under the “Iron Chef” of Vietnam.

“There are not too many Vietnamese restaurants in the area,” he said. “And where we are in Liverpool, there is no Vietnamese restaurant for miles.” He describes Saigon Vietnamese Kitchen as “a nice family casual place, with colorchanging lights and Vietnamese music rotating with American music” — and ample parking.

He points out that his restaurant is popular with vegans, who do not eat meat or dairy products. “We also have a special menu just for them.”

What is Thanh Nguyen’s favorite menu item? “Pho, a dish of beef broth that cooks for more than 16 hours, with meat, a ton of vegetables, bean sprouts, rice noodles,” he describes.

“I find myself eating it all the time.” u

Is it kid-friendly?

Can you take children to the Saigon Vietnamese Restaurant?

The short answer is: Yes. While there is no specific kids’ menu, there is a wide selection of dishes offering vegetables, meat, poultry, seafood, salads, rice and noodles to choose from.

“Children usually stick to rice plates such as the fried rice dishes or the drunken noodle dishes,” notes owner Thanh Nguyen. “We can also customize dishes per request for small children,” he adds.

Vietnamese Fresh Spring Rolls Thanh Nguyen recommends this recipe for spring rolls, which he says are easy to prepare and similar to what is served at the Saigon Vietnamese Kitchen restaurant.

Ingredients 2 ounces rice vermicelli

4 teaspoons fish sauce (see note)

8 rice paper wrappers (8.5 inches in diameter, see note)

2 tablespoons fresh lime juice

8 large cooked shrimp, peeled, deveined and cut in half 1 1/3 tablespoons chopped fresh Thai basil 3 tablespoons chopped fresh mint leaves 3 tablespoons chopped fresh cilantro 2 leaves lettuce, chopped

1/4 cup water 1 clove garlic, minced 2 tablespoons white sugar 1/2 teaspoon garlic chili sauce (see note) 3 tablespoons hoisin sauce (see note) 1 teaspoon finely chopped peanuts

Preparation 1. Bring a medium saucepan of water to a boil. Boil rice vermicelli 3 to 5 minutes or until al dente, then drain.

2. Fill a large bowl with warm water. Dip one wrapper into the hot water for 1 second to soften. Lay wrapper flat. In a row across the center, place 2 shrimp halves, a handful of vermicelli, basil, mint, cilantro and lettuce, leaving about 2 inches uncovered on each side. Fold uncovered sides inward, then tightly roll the wrapper, beginning at the end with the lettuce. Repeat with the remaining ingredients.

3. In a small bowl, mix the fish sauce, water, lime juice, garlic, sugar and chili sauce.

4. In another small bowl, mix the hoisin sauce and peanuts.

5. Serve rolled spring rolls with the fish sauce and hoisin sauce mixtures.

NOTE: Fish sauce, hoisin sauce, garlic chili sauce and rice paper wrappers can be found in the Asian or international section of many grocery stores or in specialty stores. The sauces might also be found alongside other bottled barbecue or meat sauces.

Prep time: 45 minutes. Cooking time: 5 minutes. Ready in: 50 minutes.

SOURCE:ALLRECIPES.COM

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Non Profit Org. US Postage

PAID 750 East Adams Street l Syracuse, NY 13210

Permit No 110 Syracuse, NY

SCIENCE IS ART IS SCIENCE IS ART IS SCIENCE IS combination of genes and environmental

A

factors combine to trigger attention deficit hyperactivity disorder, according to researchers

who identified 12 ADHD susceptibility genes.

They say genes account for roughly 76% of cases of ADHD. “That does not mean that the environment is not important. We know that the environment accounts for the other 24%, but we also know that the environment interacts with some of those genes that are responsible for the 76% of the variability, so both genes and environment are important,” says Stephen Faraone, PhD, distinguished professor of psychiatry and behavioral sciences at Upstate.

After analyzing data from more than 55,000 people, he and a team of researchers identified 12 gene regions that are linked with ADHD. Their work was published in the journal Molecular Psychiatry.

This chart represents the entire genome. Each dot shows a locus on the genome.

Any dot above the dotted line indicates a genomewide significant finding. In other words, at that locus is a DNA variant that increases risk for ADHD.

19.055 0819 44.0553mQMCsk

The dots form a “tower” because those markers on the genome are marking the same locus. Each tower corresponds to a separate locus; at each locus, there is more than one gene. More studies are needed to disentangle which genes are responsible. u

19.204 0919 44.115M ELsk

Stephen Faraone, PhD