Upstate Health, Winter 2019

Health UPSTATE

connecting you to health and medical expertise

winter 2019 A SURGEON RAPIDLY REPAIRED A TORN HEART page 4 MAYBE YOU SHOULD KEEP YOUR APPENDIX page 7 TREATING KNEE PAIN WITHOUT SURGERY page 9

HOW THE PHARMACY SAVED ONE MAN $20,537.41 page 10 CLEANING TIPS FOR WHEN SOMEONE IS SICK page 16

TREATING THE HOMELESS page 18

from the experts at

What’s Up at Upstate

In case you mIssed It...

Meet the new leadership team: a psychiatrist, a neuropathologist and a cardiologist Upstate Medical University interim President Mantosh Dewan, MD, announced two key appointments in Upstate University Hospital leadership, naming Robert Corona, DO, as chief executive officer and Amy Tucker, MD, as chief medical officer. A little background on each: CORONA has served as interim CEO since March 2018. At Upstate he has led the development and implementation of the Upstate MIND (Medical Innovation and Novel Discovery) at the CNY Biotech Accelerator.

He leads the department of pathology, and he is medical director of neuropathology and vice president for innovation and business development.

He founded Upstate’s telemedicine program while at Upstate in the 1990s. He also served as chief medical officer and vice president of medical and scientific affairs at Welch Allyn in Skaneateles before returning to Upstate.

Corona’s doctor of osteopathic medicine degree is from the New York Institute of Technology College of Osteopathic Medicine. His master’s degree in business administration is from the University of Massachusetts at Amherst. He is board certified in anatomic pathology, neuropathology and clinical informatics by the American Board of Pathology and in medical management and certified physician executive by the American College of Physician Executives.

DEWAN is a SUNY Distinguished Service Professor in the department of psychiatry and former chair of the department. roughout his career, which began at Upstate in 1979, he has written 35 books and book chapters and 75 papers and given hundreds of presentations on topics ranging from brain imaging and the economics of mental health care to psychotherapy and medical education. His work has been funded by grants from the National Institute of Mental Health and the Health Resources and Services Administration.

A Distinguished Life Fellow of the American Psychiatric Association, he has received the Scientific Achievement Award from the Indo-American Psychiatrists Association, the Exemplary Psychiatrist Award from the National

Mantosh Dewan, MD

Robert Corona, DO

Amy Tucker, MD

Alliance for the Mentally Ill and the 2010 George Tarjan Award from the APA. In 2011, SUNY designated Dewan an “Exemplary Chair.”

Dewan’s medical degree is from Bombay University (currently Mumbai University), and he completed his residency at Upstate.

TUCKER has served as interim CMO since April 2018.

She joined Upstate in 2017 as director of adult ambulatory services, aer serving on the faculty at the University of Virginia. She held various administrative roles, including as director of ambulatory and consultative cardiology services. She was founder and director of the Club Red Women’s Cardiovascular Prevention Clinic, associate chair of medicine for undergraduate medical education and director of the Cardiovascular Fellowship Training Program.

Previously she served as chief medical officer for Locus Health, a company that provides comprehensive care coordination, remote patient monitoring and performance optimization using data analytics.

Tucker’s medical degree and undergraduate degrees come from the University of North Carolina-Chapel Hill. She earned a master’s degree in health care management from the Harvard School of Public Health. Tucker is a fellow of the American College of Cardiology and the American College of Physicians. ●

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upstate.edu l winter 2019

welcome

Contents 4

8

patIent care

30 minutes later, he probably would have died page 4 What it’s like to undergo a stem cell transplant Appendectomy numbers are on the decline

page 6

page 7

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From our experts

Treating post-stroke depression Upstate, St. Camillus partner for addiction treatment

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In our communIty page 12

page 13

Working the streets to help the homeless

page 18

A Sarah Loguen, MD, mystery

page 21

Medical advances that came from the military

page 22

departments Back to soccer – after surgery for her back Treating chronic knee pain without surgery

page 8

page 9

How the pharmacy saved one man $20,537.41 page 10 Motivated to live healthier, post-stroke

page 11

Still in use today: 5 heart medications from history How to keep your home clean when someone is sick The scary truth about nicotine

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page 16

page 17

What’s Up at Upstate

page 2

Lessons from Upstate

page 17

Science Is Art Is Science On the cover: David Lehmann, MD, on a frigid day in downtown Syracuse, providing medical care to people living on the streets.

Story on page 18.

back cover

Health UPSTAT E

connecting you to healt winter 2019 h and medi cal exper tise A SURG RAPIDLYEON A TORN REPAIRED HEART page 4 MAYBE YOU SHOU KEEP YOUR LD APPENDIX page 7 TREATING WITHOUT KNEE PAIN SURGERY page 9

HOW THE SAVED ONEPHARMACY MAN $20,537.41 page 10

CLEANING TIPS FOR WHEN SOMEONE IS SICK page 16

TREATING HOMELES THE S

page 18

PHOTO BY ROBERT MESCAVAGE from the

Health UPSTATE

Winter 2019

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

Amber Smith

WRITERS

Jim Howe Susan Keeter Emily Kulkus Amber Smith

DESIGNER

Susan Keeter

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

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

experts

at

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.

need a referral?

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.

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PATIENT care

airlifted to upstate,

North Country man undergoes lifesaving heart surgery and beats the odds

BY EMILY KULKUS

CHRIS DIAZ IS NO STRANGER to fear or pain.

Diaz, 35, spent four years in the Army, including nearly a year in Iraq from 2009 to 2010. When you’re in the Army, if something hurts, you drink water and press on. at’s what Diaz tried to do on Nov. 28, 2017, when he felt a surge of pain snake up his le arm and into his chest. Diaz was studying mechanical engineering at Clarkson University at the time, and finals were looming.

He figured the pain was related to anxiety or stress because of his exams.

“Honestly it felt like razor blades up my veins,” he says.

“It felt like something I’d never had before — a crushing sensation around my heart.”

He drank water, but the pain got worse. His fiancée, a certified nurse assistant, said he looked pale and was sweating. She insisted he see a doctor. She drove him to the emergency room at Canton-Potsdam Hospital in nearby Potsdam. ere, they listened to his chest and detected a murmur. An ultrasound revealed a much more serious condition: Diaz had an aortic dissection, which is when the large blood vessel of the heart tears. e surging blood can continue to tear the aorta, causing blood that should flow through the heart to spill into the body. In more than 50 percent of cases, the injury is fatal within 24 hours. Without surgery, up to 75 percent of cases are fatal within two weeks.

Diaz needed surgery immediately. at’s when his memory of that day gets blurry. He remembers doctors starting pain medicine and telling him he was going to be airlied to Upstate University Hospital in Syracuse. He remembers the ambulance but not the helicopter. He remembers the airport but not his arrival.

Chris Diaz was airlifted to Upstate University Hospital when an ultrasound performed at Canton-Potsdam Hospital showed a tear in a blood vessel in his heart.

SUPPLIED PHOTO

If he’d arrived in Syracuse 30 minutes later, he probably would have died.

He definitely remembers what he was thinking at the time: “I’m going to miss my finals because of this. I was just really mad this was going on,” he said.

G. Randall Green, MD, chief of cardiac surgery at Upstate, was waiting for Diaz. He asked him if he wanted a mechanical valve or Randall Green, MD, chief of a tissue valve to replace the one G. cardiac surgery that was tearing. Diaz chose mechanical. He woke up many hours later in the recovery room. continued on page 5

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airlifted to upstate

continued from page 4

Which valve would be best for you?

Army veteran Chris Diaz graduated from Clarkson University six months after a life-threatening aortic dissection.

“It’s just unbelievable what the human body and the human spirit are capable of living through.”

It wasn’t until later that doctors told Diaz how dire his situation had been. “My cardiologist said, ‘We weren’t expecting to see you again,’” Diaz recalls. His surgeon told him that if he’d arrived in Syracuse 30 minutes later, he probably would have died.

Green says Diaz’s case is memorable and remarkable.

“We were doing chest compressions when he came into the operating room. He had no heart rate, no blood pressure.

He was basically not with us anymore,” Green said. “All of us looked at him and said we’ll do our best for this guy.

“It’s just unbelievable what the human body and the human spirit are capable of living through.”

Diaz spent eight days at Upstate, followed by a rigorous course of physical therapy to regain his strength. He took his finals from the fall semester the following March.

Two months later, Diaz graduated from Clarkson with a degree in mechanical engineering. During the graduation ceremony, President Anthony Collins told Diaz’s story and thanked him for his service.

No one knows why Diaz suffered the aortic dissection, something that normally occurs in much older patients.

Diaz thinks it might be genetic, since his mother has a heart murmur. Chest trauma from serving in Iraq may have also contributed, he says.

More than a year later, Diaz feels like his old self. “I feel great,” he says. Medicine regulates his heartbeat and prevents blood clots, and he exercises every day. He and his fiancée have settled in Milford, outside of Oneonta, and are planning a summer 2019 wedding. ●

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If you need a heart valve replacement, you may be asked to choose between a mechanical valve (le) or one made of tissue (right).

Generally, people younger than 60 have been apt to choose a mechanical valve because of its durability.

But a mechanical valve, made from materials such as titanium and carbon, comes with a lifelong requirement to take a medication that reduces the risk of blood clots by thinning the blood. It may not be right for some people, including women of childbearing age.

People who choose a tissue valve may face the prospect of needing a second valve replacement operation years later. at’s because tissue valves, made from pig valves or cardiac tissue from cows, last only 10 to 20 years. Tissue valves are more popular with people over age 70 who don’t want to have to take a blood thinner, says G. Randall Green, MD, Upstate’s chief of cardiac surgery.

He said options changed about six years ago with the development of the transcatheter aortic valve replacement. is is a procedure in which a doctor inserts a catheter — a thin tube — into the patient’s groin and threads it into the heart. ere, a stent is deployed with a tissue valve that takes the place of the diseased valve. TAVR, as it’s known medically, is only used for aortic valves that have stenosis, or a narrowing of the valve that restricts blood flow.

Green says doctors aren’t sure how long the transcatheter valves will last. e procedure is less taxing than an open surgery, so patients who want to avoid taking blood thinners may be OK with the idea that they may require a redo years later.

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PATIENT care

ADVENTURES WITH PHRED:

stem cell transplant resets body’s immune system

BY AMBER SMITH

DOUG REICHER, 65, was diagnosed with acute myeloid leukemia last summer. His treatment at Upstate University Hospital began with intravenous chemotherapy, which meant he would need to be connected to a device on an IV pole that would keep the medications flowing.

“He has named it Phred and dressed him up a bit. Notice Phred’s snazzy tie,” Reicher’s wife, Camille Tisdel, wrote in June on their CaringBridge website. “e two of them will be attached, literally, for a while. e adventure begins…”

Doug Reicher dressed his IV chemotherapy pole in a tie and named it ”Phred.”

Niece Erica Reicher donated her stem cells to rid her uncle of leukemia.

SUPPLIED PHOTO

e couple shared an upbeat chronology of Reicher’s adventure, which has taken place over several weeks in the hospital and included not just chemotherapy but a stem cell transplant using cells donated by one of Reicher’s nieces. Today he’s recovering at home.

stem cell treatment Doug Reicher PHOTO BY RICHARD WHELSKY

Doctors and nurses at Upstate have long offered autologous stem cell transplants, where a patient’s stem cells are extracted from his or her body before chemotherapy, and then returned. In 2018, they began offering allogeneic stem cell transplants under the direction of Jeffrey Pu, MD, PhD, director of the hematologic malignancies program and the stem cell transplantation therapy program.

Pu explains that “you can engage immune reactions” by using stem cells from a healthy donor who has been matched with the patient. “ose immune reactions can continued on page 7

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ADVENTURES WITH PHRED further kill residue or circulating leukemia cells or lymphoma cells.”

Reicher was one of the first patients to undergo an allogeneic stem cell transplant at Upstate. He is president of the housing nonprofit Christopher Community. Tisdel, his wife, works at Syracuse University.

For patients undergoing stem cell transplants, “eir white blood cell count goes to basically zero, so they are at high risk for infection,” explains nurse Meghan Lewis.

Jeffrey Pu, MD, PhD e day they receive the transplant becomes Day Zero, and patients typically remain hospitalized for two or three weeks aerward.

Reicher wrote on CaringBridge when he was allowed to go home that “my cell and immune system will be that of an infant. I have to grow a new system and will have a functioning but immature system, just like a baby.

“Infection is the greatest risk, so I will have to be very careful at home with food, the house and visitors.”

Eventually Reicher will receive a new series of immunizations against childhood diseases such as polio, measles and whooping cough. ●

continued from page 6

Two types of stem cell transplant

AUTOLOGOUS STEM CELL TRANSPLANT— a patient receives his or her own stem cells, which are removed from the patient’s body and frozen for safekeeping while he or she undergoes chemotherapy. Aerward, the stem cells are returned to the patient’s body. is is a treatment option for patients with multiple myeloma or lymphoma.

ALLOGENEIC STEM CELL TRANSPLANT— patients receive stem cells from a healthy matched donor. is is a treatment option for patients with leukemia or lymphoma that has relapsed.

Remove the appendix – or not?

THE APPENDIX FOR CENTURIES has been a misunderstood organ, hanging like a tail from the junction of the large and small intestines. When it became inflamed, surgeons were quick to remove it.

Over the last decade, the number of appendectomies has decreased partly because of a better understanding of the appendix. e organ appears to have an immunological function, since people who have an appendix are less likely to develop infections of the colon, says Moustafa Hassan, MD, an associate professor of surgery at Upstate.

A blockage in the appendix can prompt a rapid growth of bacteria and inflammation, known as appendicitis.

Symptoms may include a loss of appetite, nausea and pain around the belly button or in the right lower part of the abdomen.

Hassan says some people with appendicitis will require urgent surgery, and some will get better with just antibiotics. In some situations, an operation may be too risky.

ose who did not have surgery recovered well — but nearly half went on to develop appendicitis again and require surgery within the next five years.

Hassan helps his patients with appendicitis consider all factors as they decide whether removing the appendix makes sense. As he explains, “!n surgery, there is no one size fits all.” ●

The size of the appendix, a pouch near where the large and small intestines meet, varies from person to person but may range from less than an inch to 6 inches in length.

A recent study conducted in Finland divided patients with uncomplicated appendicitis into two groups: half underwent surgery, and half only received antibiotics.

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Back on the pitch – after back surgery

PATIENT care

BY AMBER SMITH

FOR WEEKS, Kendall Discenza didn’t know what was wrong. e pain in her lower back became crippling, and she was le sobbing. Surgery brought relief.

Discenza underwent a microdiscectomy at Upstate University Hospital. Lawrence Chin, MD, who leads the neurosurgery department, removed a herniated disc fragment between the 5th lumbar and 1st sacral vertebrae in Discenza’s lower back.

“You should see my scar. It’s so tiny,” she says.

Discenza, who plays soccer for Hamilton College, was liing weights in January 2018 aer her freshman season.

She was doing Romanian dead lis, intended to strengthen her hamstrings. Holding a straight metal bar, she bent forward at her waist, and then back up. She felt her back straining but didn’t think anything of it. An achiness continued and grew worse over the next several weeks.

It was March before her health insurer gave permission for a magnetic resonance imaging scan. e images showed a herniation, where the disc’s interior protrudes outward, and Discenza began physical therapy. She also had cortisone injections. “But then it got worse, and worse and worse,” she recalls. “It got so bad, it got to the point where my mom came up (from the family home near Washington, D.C.) and was taking me to doctors in Syracuse.”

Discenza got an appointment with Denise Karsten, a chiropractor and registered nurse at the Upstate Brain and Spine Center, who went over the MRI with Discenza and her mother. “is is a pretty big herniation. You’re probably going to need surgery,” Karsten predicted.

Back surgery patient Kendall Discenza plays on the soccer team at Hamilton College.

SUPPLIED PHOTO

At the time, Discenza was focused on wrapping up her spring semester. e pain was crippling at times. She remembers lying on the bed in her dorm one day, believing she was paralyzed. She realized she couldn’t put off treatment. She made an appointment to see Karsten again with Chin.

because sitting was so painful. As she researched “microdiscectomy,” she learned that she was about to undergo the same procedure that New England Patriot Rob Gronkowski had three times to repair herniated discs.

surgery brought relief

She admits she was frightened. She expected she would have to stay overnight in the hospital.

Chin explained what would be involved in a microdiscectomy, a procedure intended to minimize the skin incision, muscle involvement and amount of bone removed in order to relieve the herniation. ere is a small risk of nerve damage, but the procedure is almost always successful. Some patients go home the same day.

When she woke up from anesthesia, “My legs were extended out straight. I pointed my legs up toward my body, and I knew that the pain was gone. e pressure was gone. I lied my foot up, and the first thing I said to my mom was, ‘It’s gone. I know that it’s gone’.”

“I was asking him, ‘Am I going to be able to play soccer again?’ He was really reassuring and super kind, and he had such a good rapport. He made me feel really comfortable.”

Discenza went home with her parents for several days, worked on completing her schoolwork and prepared mentally for surgery. She pretty much had to lie flat

Chin says that’s not unusual. “If they’re in a lot of pain, they’re going to feel relief right away. at’s what I aim for.”

Discenza recovered with her parents at a Syracuse home they rented through Airbnb. “e next two days, it was tough to get up and walk,” she remembers. “It was pretty sore, but that’s part of what you have to do.”

Discenza was able to finish her schoolwork for the spring continued on page 9

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A NONSURGICAL WAY TO TREAT KNEE OSTEOARTHRITIS

BY AMBER SMITH

PEOPLE WITH CHRONIC KNEE PAIN may seek relief from physical therapy. ey may try over-the-counter pain relievers, prescription painkillers or steroid injections.

A doctor at Upstate now offers another choice for people who are unwilling or unable to undergo a surgical knee replacement.

Xiaoli Dong, MD, an assistant professor of physical medicine and rehabilitation, provides a cooled radiofrequency procedure called “Coolief,” a blend of “cool” and “relief.” It has been approved by the Food and Drug Administration to relieve chronic moderate to severe knee pain caused by osteoarthritis. e procedure is accomplished without an incision, “using radiofrequency energy to deactivate the nerves responsible for sending pain signals to our brain,” Dong explains.

Patients receive an anesthetic to numb the skin and reduce any discomfort from the needle. ey return to normal activities within a week or two. Dong says pain relief may last up to a year.

Chronic knee pain is oen the result of osteoarthritis, a degenerative condition that develops as wear and tear thins the cartilage between bones. e result can be pain and stiffness, swelling and difficulty walking. ● To learn more, contact Dong’s office at 315-464-1569.

Back on the pitch continued from page 8

semester before her surgery.

She spent the summer working with a physical therapist and personal trainer, in hopes of getting back to the soccer field by fall. It was important to her because, as she explains, “I’ve played soccer since I could walk. I’ve been playing my entire life.

“All summer, my goal was to be ready to play.”

ARE YOU GRATEFUL? Lawrence Chin, MD

She progressed from walking to doing core work to running. She had to rebuild her strength and stability to be able to play, and she had to convince herself that she was strong enough to play such a physical sport. When team training began, Discenza participated in all but scrimmages.

Gradually, as she got stronger, she played in some games. “I got to be 100 percent around early October.”

Discenza is a sophomore majoring in sociology, on a pre-medicine track. She thinks she may want to go to an osteopathic medical school. “I might want to get into rehabilitation or become a functional medicine doctor.” She’s always been interested in health and wellness — and now she has experience as a patient. ●

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A gift of gratitude is a meaningful way to both express your appreciation to special caregivers and to help patients during their time of great need. Friend in Deed, Upstate University Hospital’s annual fund, supports a variety of unmet patient needs, such as nutritional supplements for cancer patients, special pediatric needs, communication tools for the deaf and hard of hearing, and heart monitors, to name a few.

To donate, visit upstatefoundation.org or contact the Upstate Foundation at 315-464-4416. To share your story, email FDN@upstate.edu

Foundation

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How the Upstate pharmacy saved him $20,537.14

PATIENT care

BY AMBER SMITH

HE WENT THROUGH A SERIES of imaging tests, looking for an explanation for the pains in his stomach.

Aer all the scans were complete, doctors delivered the news to Reginald Sanford of Syracuse. He had cancer in his liver and also outside of his liver. Surgery would not work, but medication might slow the growth and spread of the cancer inside his liver. ey wanted to prescribe Nexavar, a drug with a price tag of more than $20,000 per month.

“It totally blew my mind. I told them there’s no way I could come up with that. I ain’t got that kind of money.

I’m retired. I’ve only got $1,000 a month. How am I going to come up with that?”

Sanford says one of his doctors consulted with someone from the Upstate Outpatient Pharmacy.

Two days later, he got a phone call from a pharmacist.

“Mr. Sanford,” he recalls the voice saying, “I’ve got some good news for you.

Heidi King with Reginald Sanford at the Upstate Outpatient Pharmacy.

King found programs and grants to pay for Sanford’s cancer medication.

PHOTOS BY ROBERT MESCAVAGE

“First of all, you don’t have to pay a penny for your Nexavar. And the other good news is, we’re going to get it out in the mail to you.”

Medication assistance coordinator Heidi King explains that aer Sanford’s Medicare coverage and personal health insurance coverage paid their portions, the remaining cost was going to be $970 for a one-month supply. She was able to enroll Sanford in an income-based New York state program called EPIC – for Elderly Pharmaceutical Insurance Coverage – which would pay $950. en she located an endowment fund that would chip in $20.

King says “a lot of patients need financial help, especially with these types of medications.” Together with a colleague, her job is to help locate funding sources, particularly for patients whose prescription coverage leaves them with a huge copay.

Depending on each patient’s situation, she may find money through a foundation, a drug manufacturer or a government program. “e majority of the time, we’re able to get it down to a price that they can manage,” King says.

Pharmacist Eric Balotin, associate director of pharmacy enterprise, says, “We are always looking for ways to reduce copays and out-of-pocket expenses, whether it is $1,000 or $5. Our goal is to make the medications affordable to all our patients.”

Sanford believes he is doing well and that the cancer inside his liver under control. He realizes the day will come when the cancer outside of his liver will cause problems for him.

Until then, Sanford dutifully takes two Nexavar pills in the morning and two at night.● anyone can use the upstate outpatient pharmacy.

You do not have to be a patient at Upstate. The pharmacy is between the Upstate University Hospital lobby and the Upstate Cancer Center and can be reached at 315-464-3784. It’s open 8 a.m. to 6 p.m. weekdays and 9 a.m. to 2 p.m. weekends and is closed on major holidays.

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Making the most of her rehabilitation Occupational therapist Beth Rolland, left, with stroke rehabilitation patient Melissa Meloling, during a therapy session.

PHOTO BY ROBERT MESCAVAGE

After a stroke, she’s motivated to live a healthier life

BY AMBER SMITH

MELISSA MELOLING CAN WALK, if she keeps an eye on her feet, so she doesn’t trip. She learned how to tell time again. She’s relearning how to fix her hair, although assembling a ponytail is still tricky. Her vision returned.

She ditched cigarettes.

When Meloling began working with occupational therapist Beth Rolland in August, she struggled to use a knife and fork. She had trouble brushing her teeth and washing her face. Buttons and zippers were a challenge, and she wasn’t tying her own shoes yet.

She was revived from a stroke in June. Since then she’s been putting her life back together. “It’s been a wake-up call,” says Meloling, 44, of Bridgeport.

Rolland is impressed with Meloling’s determination.

“She’s doing all of those things now.

Meloling takes medicine for high blood pressure, but she had skipped taking it. When her mother didn’t hear from her one morning, she came to Meloling’s house. Meloling was barely breathing. Her mother called 911 and performed cardiopulmonary resuscitation on her daughter with the help of the call center until the first responders arrived. She was rushed to St. Joseph’s Hospital Health Center. Once it became clear that Meloling was having a stroke, doctors transferred her to the Comprehensive Stroke Center at Upstate.

She was recovering in a bed in the neurological intensive care unit when Meloling regained consciousness a couple of days later. She couldn’t feel her whole right side. She was blind in her right eye. She couldn’t think of the right words to speak. She was terrified. Her mother was at her bedside.

It would be eight weeks before Meloling would be able to go home — and only aer extensive rehabilitation with a multitude of therapists, many of whom she still sees regularly, more than six months aer her stroke.

“At one point my doctor told me that the stroke was blood-pressure related,” she recalls. winter 2019 l upstate.edu

“She doesn’t give up. She will keep trying and trying until she gets it.”

To benefit most from occupational therapy, patients need to continue work prescribed by their therapist at home.

Rolland says some people don’t make the effort and consequently don’t see much improvement. But Meloling is motivated. “at plays a huge role in her recovery,” Rolland says.

With the support and love from her mom, stepdad and two aunts, Meloling continues to heal and work hard at rehabilitation daily, which also includes outpatient physical therapy.

Today she keeps careful track of her blood pressure, recording it three times a day. She works with her therapists to improve her brain’s ability to follow a train of thought and to recall memories. And, through her rehabilitation, she has managed to quit smoking and says she no longer craves cigarettes.

“When something like this happens, and you need to make a change,” she says, “you just do what you need to do.” ●

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FROM OUR experts

Stroke patients can be at risk for depression

BY JIM HOWE

AT LEAST A THIRD of people who have a stroke become depressed or show some symptoms of depression, according to an expert who oen treats such patients.

It’s called post-stroke depression, explains rehabilitation psychologist Michelle Woogen, PsyD, who works in Upstate’s department of physical medicine and rehabilitation.

common symptoms of depression can include any of the following: l

a sad mood and possibly thoughts of wanting to die or commit suicide

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excessive crying

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feelings of worthlessness

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low motivation or energy

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changes in eating or sleeping behavior

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agitation

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loss of interest in activities the patient used to enjoy

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poor concentration or ability to make decisions

a stroke involves a lack of oxygen to the brain, due to a blocked or broken blood vessel, and this can cause a number of problems, such as: l

physical: difficulty walking, talking and dressing

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mental: having trouble solving problems, remembering things, doing tasks like paying bills and knowing what’s safe and what isn’t.

reasons for depression after stroke It is believed that there are two reasons why someone may become depressed aer a stroke: It may be in response to the stress of having a stroke in general, which is an upsetting experience, or it may be that as the brain is rewiring itself (and we know that our emotions are housed in our brain), it is accidentally rewiring itself to be more depressed. It could also be a combination of the two, Woogen said.

Strokes that limit patients’ ability to move around and take care of themselves on their own put those patients at a higher risk of developing depression, as do cognitive (thinking) difficulties and a history of depression.

Is it depression or stroke recovery?

Post-stroke depression can be tricky to diagnose, Woogen cautions, since something like sleeping more might simply be part of the recovery process.

“We are looking for symptoms of depression, but a brain injury can mimic those symptoms. e brain needs to sleep aer injury. It’s easily fatigued, so they might be sleeping a lot, but maybe they are just recovering. ey also might look like they have poor motivation, but that is also something that can be caused by brain injury. e brain has trouble telling the body to get going, so you have a plate of food in front of you, and you know it’s time to eat, but the brain is just not telling the body, ‘OK, pick up the fork, put the food on the fork, fork to the mouth,’ so it can be tricky,” she said. continued on page 13

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Stroke and depression risk addiction continued from page 12

“You don’t want to chalk these symptoms up just to the brain injury, but you also don’t want to panic and assume that any symptom is severe depression, because a stroke is upsetting. I expect there to be a degree of sadness there, and that’s OK when you notice that in yourself or your loved one aer a stroke.”

Stroke patients are grieving the loss of their abilities, Michelle Woogen, PsyD so some sadness is to be expected. Depression can start right aer the stroke or not show up for a year or more, she said, noting that stroke recovery typically takes one to two years.

treatment program partners Upstate with St. Camillus

coping When she visits with patients undergoing rehabilitation, “I am looking for something that shows me that they are also coping. So, l

are they also focused on the future, talking about wanting to get back to work, driving, being with their grandchildren?

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are they engaged in therapy, or do they just want to bury their heads in the covers all day and refuse therapy?

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are they able to focus on things other than the stroke, such as pleasant memories and how other people are doing, rather than being hyper-focused on the stroke?

THROUGH A $2.1 MILLION GRANT, Upstate University Hospital has partnered with e Centers at St. Camillus and others to create a new treatment program for those suffering from illness and addiction that is helping people recover and freeing up hundreds of beds per year.

what to do

e Collaborations for Health Program involves Upstate and St. Camillus with support from CNY Services and ACR Health. It has been operating since April. e program was created to help an increasing number of intravenous drug users who are admitted to Upstate with life-threatening infections. ey require IV antibiotics for up to six weeks at a time, says nurse Kelly Mussi, assistant director of transitional care at Upstate. “Aer about three weeks, they aren’t critically ill, and they are pretty bored,” she says.

If loved ones or caregivers see symptoms of depression aer a stroke, Woogen advises talking with the patient’s physiatrist — doctor of physical medicine and rehabilitation — or, if the patient doesn’t have one, with the primary care provider. ey can help figure out whether it’s depression and help recommend a treatment plan that might include a mood-stabilizing medication and/or seeing a mental health provider. “Sometimes, talk therapy is the best medication,” she said.

Mussi and others identified that time as an opportunity to help patients address their addiction and begin treatments to aid recovery. If patients agree to participate, once they are stabilized on antibiotics, they transfer to St. Camillus, where five beds are dedicated to the program.

As patients receive treatment and support, the depression oen lis.

St. Camillus employs full-time addiction treatment staff from CNY Services and social workers from ACR Health who help patients secure safe housing and clothing and help maintain a treatment plan aer discharge. Patients receive daily counseling sessions about substance abuse and addiction.

“If they are able to have other conversations, that is a sign that they are coping, so I look for those as well.”

Post-stroke depression can limit a patient’s participation in rehabilitation, which is part of the process of the brain’s recovery; it interferes with people’s quality of life and their involvement in the community; it increases the need for medical visits; and it increases the risk of death and suicide, Woogen said.

Woogen also treats people in rehab for a variety of traumatic and other brain injuries and works with their family members and caregivers.

advice for caregivers Woogen noted the toll a stroke and post-stroke depression can take on family members and caregivers. “It’s hard to watch a loved one experience depressive symptoms, and it’s very easy to want to tell them that everything is going to be OK. at’s a good thing to say, and it’s also a good thing to sit with them and say, ‘I know this is hard, and I’m here with you, and you let me know if there is something that you need.’ Try not to just say everything is good again, because it’s not. ey’re grieving, and that’s appropriate.” ●

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Sixteen patients joined the program during its first six months, and 14 were discharged during that time. Of those, 11 remain engaged with addiction treatment. ●

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FROM OUR experts

a historical look

at 5 popular heart medications Are you taking any of them?

BY AMBER SMITH

SOME OF THE NEWER cardiac drugs were chemically designed in laboratories before going through years of expensive clinical trials and eventually gaining approval from the Food and Drug Administration.

Some of the older drugs, which are still in use today, were discovered by accident — and spent years becoming accepted, purified and widely used.

Harold Smulyan, MD, a professor emeritus at Upstate who specializes in cardiology and enjoys history, researched aspirin, atropine, digitalis, nitroglycerin and quinidine. He published “e Beat Goes On: e Story of Five Ageless Cardiac Drugs” in the American Journal of the Medical Sciences in 2018. is information is pulled from his work.

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aspirin

atropine

Discovered: 4,000 years ago

Discovered: by ancient Greeks

Came from: bark and leaves of the willow tree, whose sap contains salicin, which the body metabolizes into salicylic acid

Came from: glossy-coated black berries of the deadly nightshade plant

First used: to treat pain, fever and inflammation Documented in: clay tablets le by the Assyrians and Babylonians; also recorded use among Egyptian, Chinese and Greek civilizations in 1300 BC; by Greek physician Hippocrates (460-370 BC) and Roman anatomist Galen (200-216 AD); and by an English reverend in 1763 who wrote about the relief of fever in 50 patients, many of whom probably had malaria Synthesized: around 1860; because salicylic acid was a gastric irritant that could cause bleeding in large doses, the Bayer company sought chemical analogues that would be better tolerated and eventually made aspirin available in tablet form in 1900 Used today to: relieve pain, reduce fever, prevent vascular heart disease

First used: as a cosmetic for women (Cleopatra used atropine to dilate her pupils in the last century BC), and a poison for assassins (the military made a deadly paste from atropine for the tips of their arrows during the Roman Empire and the Middle Ages) Documented in: Greek mythology, with the plant being named Atropos, aer one of the three goddesses of fate and destiny Synthesized: by a German chemist in the 1830s Used today to: increase slow heart rates or improve conduction in some types of irregular heart rhythms; and as an antidote to accidental organophosphate poisoning and to nerve gases used in warfare Side note: Attracted to the sweetness of the berries, people have been poisoned accidentally

Side note: A pharmacist at Bayer who worked on an aspirin analogue was preoccupied at the time with the sales potential of a new Bayer cough remedy synthesized in 1897 called heroin. upstate.edu l winter 2019

FROM OUR experts

digitalis

nitroglycerin

Quinidine

Discovered: as one of more than 20 herbs brewed in home remedies for perhaps hundreds of years before the 1700s

Discovered: in the 1840s

Discovered: around the 1630s

Came from: the nitration of glycerin

Came from: powdered bark of the cinchona tree; the name given to the therapeutic substance was quinquina

Came from: leaves of the foxglove, a tall wildflower with purple, bell-shaped blossoms First used: as a treatment for “dropsy,” or edema caused by a buildup of bodily fluids, as described in 1775 by English physician and botanist William Withering, who is credited with identifying the therapeutic properties of digitalis aer persuading an old woman to share the ingredients of a tea she made Documented in: a 207-page book of Withering’s records and personal observations on the use of digitalis in 158 patients Synthesized: commercially in the 1900s Used today to: treat heart failure and atrial fibrillation Side note: Withering belonged to a group of intellectuals who gathered monthly and included Erasmus Darwin (grandfather of Charles Darwin, pioneer of the theory of evolution), James Watt (inventor of the steam engine), Joseph Priestley (isolator of oxygen) and Founding Father Benjamin Franklin

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First used: as an explosive, around the same time physicians were documenting how the chemical liquid relieved intense chest pains in their patients Documented in: British medical presentations (amyl nitrite) and papers (nitroglycerine) as early as the 1860s; by the end of the 19th century, nitroglycerin was the established form of therapy for the relief of chest pain from coronary heart disease, or angina pectoris Synthesized: in 1882 by Parke Davis & Co., which produced a pill in five different strengths, aer initial use as a liquid medication Used today to: relieve angina pain and treat heart failure by dilating peripheral veins; also remains the active ingredient in dynamite Side note: While studying chemistry and engineering, the Swedish scientist Alfred Nobel spent a year in Paris, where he met the Italian chemist who nitrated glycerin but believed it was too dangerous to have practical use. Nobel saw its potential and took it back with him to Stockholm, where he and his father eventually succeeded in creating dynamite. But their research led to several serious explosions, one of which took the life of Nobel’s younger brother, Emil. Later in life, Nobel developed angina pectoris. His physicians advised him to take nitroglycerin, but he declined.

He died in 1896 at age 63, leaving the majority of his wealth to establish five Nobel Prizes

First used: to relieve the fever of malaria Documented in: accounts of Jesuit missionaries in South America using the powdered bark to treat fever, although legend suggests the native population was already using it for that purpose; two volumes published in 1749 are the first to reference the use of cinchona alkaloid in the treatment “rebellious palpitation,” likely the cardiac arrhythmia known today as atrial fibrillation Synthesized: by American scientists in 1944, quinine was too late to save thousands of World War II troops who died of malaria in Africa and the South Pacific Used today to: treat atrial and ventricular arrhythmias in selected patients, but quinidine is no longer recommended by the American Heart Association for treatment of atrial fibrillation; medications other than quinine are now used to treat malaria Side note: A Portuguese doctor isolated the first alkaloid of quinquina, calling it cinchonine, but the more effective second alkaloid was isolated by two French pharmacists, who called it quinine.

In the 1850s, an impurity of quinine was isolated and called quinidine

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FROM OUR experts

CARING FOR SOMEONE WHO IS SICK?

Here’s how to keep your home clean

BY JIM HOWE

EXPERTS WHO OVERSEE CLEANING operations at Upstate University Hospital — Environmental Services Director Susan V. Murphy and Assistant Director John Kolh — provide this advice for caring for a sick loved one at home.

product. Also, don’t mix soap or bleach with some other cleanser, thinking it will create some sort of super cleanser, because it won’t. Allow whatever cleanser you use the time recommended to do its job.

In general:

Bathroom: Wipe down the fixtures – toilet, sink and their handles – daily, and change out the hand towels regularly. Mix one part bleach to nine parts water for bathroom cleaning and be careful not to splash it in your eyes.

Bleach solutions will lose strength over time, so use it that day, then dump it down the toilet.

Hand washing: Clean hands are one of the most important ways to check the spread of infection, so be sure there is access to a sink and soap or that hand sanitizer is available.

Removing clutter: All areas should be clean and clutter free. Clear clutter first, then clean, then, if needed, disinfect. e less clutter you have around, the less there is to clean and worry about regarding any transfer of germs from sneezes and coughs. Less clutter also means fewer places for dust to settle or get kicked up into the air and irritate a sick person.

Ensure a supply of tissues within easy reach.

Keep “touch points” clean: these include frequently handled items like door and refrigerator handles; knobs on faucets, showers and drawers; buttons on microwave ovens and other appliances; and wall switches.

Make sure the materials you are using to clean are clean. Change your cleaning cloth or flip it over each time you clean a new surface. Disposable cloths might be easier and preferable during an illness. Also, clean your vacuum cleaner’s filter to keep the dirt level down.

Don’t “double dip,” or reuse a cleaning solution for another task, even one containing bleach, because it weakens the

specific areas:

Another method, especially when dealing with heavy-duty infections: Bathroom surfaces can be cleaned with a soap product, rinsed off, then wiped with a bleach wipe and le to air dry. Bleach wipes, preferably hospital grade, can be found in many stores, and their short-term use is fine.

Kitchen: Keep the sink and counters free of dirty dishes. A dishwasher is a great way to sanitize dishes, but if one is not available, use water as hot as you can stand, agitate the soapy water and put friction on whatever you’re cleaning, then adequately rinse, preferably with hot water, and dry, using a clean, dry towel.

Air drying is OK, but not if sitting in a dish rack will expose the dishes to coughs and sneezes. Change the sponge or cloth frequently to avoid contaminating dishes you are cleaning. Wash the brushes for dishes in the dishwasher, if available.

Bedroom: Keep the nightstand clean, have ample tissues and a trash can available and empty the trash can regularly.

Wipe down surfaces like bed rails, if any, and anything else

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FROM OUR experts

LESSONS FROM UPSTATE

E-cigarette liquid can be deadly

BY AMBER SMITH

NICOTINE IS among the most toxic substances on Earth.

Death can occur aer ingestions as small as 40 to 60 milligrams in adults or just 1 to 2 milligrams in children, depending on their size.

Toxicologists at the Upstate New York Poison Center have consulted about children ingesting whole cigarettes or cigarette butts. Considering that each cigarette contains from 13 to 30 milligrams of nicotine and each butt contains 5 to 7 milligrams of nicotine, a child could have significant toxicity aer ingesting one cigarette or a few butts. (at’s just 1 to 2 milligrams per kilogram of body weight.)

As electronic cigarettes gain in popularity, more calls come to the poison center regarding the liquids used in e-cigarettes. e liquids generally have concentrations of 10 milligrams of nicotine per milliliter of liquid. at means adults and children could develop significant toxicity aer ingestion of just a few drops of liquid.

Toxicity can lead to paralysis and a slowed heart rate and breathing. Seizures are also possible.

Here’s the scary truth: “ere is no antidote for nicotine toxicity,” toxicologists Robert Seabury and Christine Stork write on a blog for health care professionals. ey advise prompt emergency medical care that is tailored to the patient’s symptoms. ●

protect your children Ingesting the nicotine from one cigarette, two or three butts or just one milliliter* of e-cigarette liquid could prove fatal for a 25- to 30-pound toddler.

Keep products containing nicotine out of reach of children.

1 milliliter = 1/5 teaspoon

CARING FOR SOMEONE the sick person might touch. If the sick person has a personal item like a blanket or shawl that he or she uses regularly, launder that as needed, maybe weekly, during the illness.

Family room or living room: Keep any touch points clean, such as the TV remote control. Use a bleach wipe on the device’s buttons and exterior, then let it air dry.

Computers and electronics: Clean the touch points with a specifically recommended wipe or other product that won’t damage the equipment.

Floors: Mop or vacuum on a regular basis and keep them free of debris.

other considerations:

The elderly: Touch points might include eyeglasses, pens or pencils or an emergency button worn around the neck.

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Children: If possible, have them play with toys that can be cleaned, such as hard plastic toys.

People with disabilities: Touch points might include the surfaces of a wheelchair, walker, cane or crutches.

Finally: e last task of cleaning is to inspect the whole area and be sure you haven’t missed anything.

Murphy adds that, in addition to its anti-infection benefits, a well-cleaned environment offers an emotional or psychological boost: “Clean, neat and organized gives that feeling of peace and calm. You’re not struggling to walk through a house when there’s no clutter. ere’s something to be said about that.” ●

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IN OUR communIty

Working the streets

Physician provides medical care to the homeless

BY AMBER SMITH

DAVID LEHMANN, MD, WAS FOCUSED on how best to provide medical care to the homeless. He was aware of 60 “street medicine” programs around the world, most based at academic medical centers. He was intent on launching the 61st at Upstate.

So, Lehmann attended community meetings to learn about Syracuse’s homeless population and how he could start helping the men and women living on the streets. Also at the meetings was John Tumino, the former chef/owner of Asti’s restaurant who operates In My Father’s Kitchen, an outreach service that distributes lunches and other necessities to homeless people.

As a meeting wrapped up last spring, Tumino leaned over to Lehmann. “Hey, Doc,” he offered, “I could just take you out.” at’s how Lehmann found himself riding shotgun in Tumino’s van, the side of which bears the message: “You are not invisible. Building hope. Changing lives.” roughout the warmer months, Lehmann brought medical care to the homeless twice a week, alongside Tumino’s distribution of lunches. Lehmann is building the infrastructure of a street medicine program. Eventually he would like to involve medical students so that he can seed the next generation of street medicine providers. For the time being, as Tumino describes, “He’s out here doing it, learning the cracks in the system.”

On a recent weekday, Lehmann settles into the van with Tumino and his employee Kat Schofield. Before they head out, they update one another on the people they hope to see that day. en, they bow their heads. Tumino speaks: “ank you, Lord, for this opportunity to hit the streets today. Give us wisdom to give a so word and a so touch to someone who is in need.”

Since 2011, 21 homeless people have died in Syracuse. Some were murdered. Some overdosed. Some perished in a fire they started to keep warm. Some succumbed to disease. In its seven years of existence, In My Father’s Kitchen has helped 105 homeless people find housing.

Lehmann hopes he can help make a difference. Most of what he provides is routine medical care: blood pressure monitoring and medication, treatment of infections and such. Colleagues of his from Upstate’s department of psychiatry and behavioral sciences participate in similar fashion, offering addiction treatment and psychiatric interventions. ey are all familiar with statistics that show the longer a person lives on the street, the greater his or her risk of death.

Beyond the physical care he provides, Lehmann’s medical diagnoses can be used to help some people qualify for supportive housing and get off the streets, Tumino explains.

David Lehmann, MD PHOTO BY ROBERT MESCAVAGE

ey stop to check on a man who lives in a tent off of Interstate 81, not far from the Destiny USA shopping mall. ey park and follow a dirt trail to his campsite. (Days later, the man would be attacked by someone with a brick who would continued on page 20

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Tending to mental health needs A PORTION OF THOSE who are homeless grapple with mental illness and/or addiction. So psychiatrist Sunny Aslam, MD, is establishing a program to provide psychiatric care and addiction treatment to the homeless.

Aslam, an assistant professor at Upstate who specializes in addiction medicine and pain management, distributes his business card at shelters and with advocates for the homeless. He and psychiatry colleagues offer to help people who want help getting off drugs or need treatment for various mental illnesses.

He collaborates with David Lehmann, MD. Both began volunteering their services through the street outreach organization In My Father’s Kitchen as a way to reach homeless people who refuse services at shelters.

Sunny Aslam, MD, at the Gifford Street railroad overpass near the Rescue Mission in Syracuse.

PHOTO BY JOHN BERRY

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Working the streets

continued from page 18

steal his bicycle. During his hospital stay recovering from the attack, the man’s campsite would go up in flames. And, an apartment complex owner reading news coverage of the man’s plight would contact Tumino to offer housing.)

Blocks away at another campsite, Tumino and Lehmann call out for the occupant. Over the summer, this man developed a painful cyst on his backside. He sobbed with gratitude when Lehmann drained the cyst and Tumino supplied clean underwear. But he’s nowhere to be found today.

Later, the van drives by a man holding a sign at the end of a highway off-ramp. Tumino pulls into a nearby parking lot and signals to the man. It’s someone who has been homeless off and on since age 16, and who grappled with alcoholism for many years. He’s 49 now and recently lost his spot at the Salvation Army shelter when he arrived a half-hour past curfew. e man climbs into the back of the van.

Tumino pours coffee and produces a container of pasta — his grandmother’s pasta sauce recipe with his meatballs — with steam still accumulated on the lid.

Schofield gathers gloves and boots for the man, who is wearing wet sneakers — along with Using a van as a patient room, David Lehmann, MD, examines a homeless man’s wounds. two hoodies, a flannel shirt, denim jacket and SUPPLIED PHOTO a Jets hat. are homeless in Syracuse and the people he has helped Lehmann prepares to check his blood pressure. during international relief trips to Nepal, Kenya, e man reports that he is staying clean but has nowhere Ecuador, Puerto Rico and Haiti over the years. to go. “ere is no one that I know that I can go to that “Both are underserved, indigent populations that don’t do drugs.” He says he’s had trouble getting a job have no health care or spotty health care,” he says. because he lacks a birth certificate.

Teaming up with someone who already had the trust of Tumino tells him that he will pay to obtain a copy of the homeless community made sense, and Lehmann his birth certificate. appreciates how Tumino invited him to tend to medical needs while he distributes lunches. In a community as e man is stunned. small as Syracuse, Tumino says efforts like this can help “You would do that?” in meaningful ways.

Tumino and Schofield assure him they will, and soon ey haven’t solved homelessness — at least 35 people in Schofield and the man are at the Onondaga County Syracuse sleep on the streets, plus others stay in shelters Office of Vital Statistics. run by Catholic Charities, the Rescue Mission and Blocks away from Dinosaur Bar-B-Que, another man Salvation Army — but they make incremental holding a sign stops panhandling when he sees the van. improvements in the lives of individuals.

He settles into the back, next to Lehmann, who checks his Instead of being discouraged at the end of the day, blood pressure and examines some bumps on his arms and Lehmann says, “you look for the little wins”: e freshly neck. e man receives a pair of size 10 boots along with obtained birth certificate. e medicine that keeps a coffee and pasta from Tumino. Lehmann phones in two man’s blood pressure from climbing too high. e prescriptions for the man; Tumino makes plans to retrieve boots that replace wet sneakers and will keep a man’s feet the medications and deliver them to him the next day. warm tonight. ● Lehmann sees parallels between the needs of people who

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Is this Sarah Loguen, MD?

BY SUSAN KEETER

National museum wonders just who is pictured in this newly discovered tintype

“AN UNIDENTIFIED TINTYPE in our collection bears a striking resemblance to Dr. Sarah Loguen,” wrote Emily Houf of the Smithsonian’s National Museum of African American History and Culture in Washington, D.C. Could someone from Upstate Medical University help with identification?

Upstate responded to the museum’s request, providing biographical timeline information on Loguen, digital photographs at various ages (from the her family papers at Howard University), a copy of her painted portrait, and the book, “ree Nineteenth Century Doctors” (Hofmann Press, 2007). e photos and portrait can be used for comparison, and all items will be filed at the museum for scholarly use.

Sarah Loguen, MD, was an 1876 graduate of the college of medicine that is now part of Upstate. e university has scholarships and a lecture, street and building named in her honor. Her painted portrait hangs in the Health Sciences Library, and two photographs of her hang in the Sarah Loguen Center at 650 S. Salina St. in Syracuse.

Loguen was one of the nation’s first African-American female physicians and the first to graduate from a coeducational medical school. Aer graduation, Loguen practiced medicine in Washington, D.C., and Frederick Douglass hung up her doctor’s shingle. In 1882, Loguen moved to the Dominican Republic and became the first female doctor in that country. Later in life, she traveled, lived again in Syracuse from 1901 to 1907 and resettled in Washington, resuming her medical practice there.

Can it be determined whether the tintype at right portrays Loguen? Based on clothing, the photo in question appears to have been taken in the 1890s.

Compare the tintype with authenticated images of Loguen, above: the image on top was taken during high school or medical school and the second was taken in the Dominican Republic in the 1880s or 1890s. e same deep-set eyes, long nose and strong chin appear in all three images.

Could the tintype show someone else? William Pretzer, PhD, of the national museum wrote, “Loguen was one of about 100 black women doctors at the time.” at means 99 other possible subjects. e former owner of the tintype, historian and author John Ravage, PhD, remembers buying it at an antique shop in Wyoming Above: Identified photographs of Sarah Loguen, MD.

Is this Sarah Loguen, MD, class of 1876? This 3 3/8-inch tintype was published in John Ravage’s book, “Black Champions” (University of Utah Press, 2002) and is in the collection of the National Museum of African American History and Culture, part of the Smithsonian Institution.

or Texas 25 years ago. In her travels, did Loguen visit the Western United States? Was the photograph taken elsewhere and transported out West sometime in the last 130 years?

As Houf wrote, we may never know for certain who is pictured in this tiny photo made of silver and iron (enlarged, above). But the gloved hand grasping a medical bag, the fine clothes and the determined face look like Upstate’s trailblazing graduate, Sarah Loguen, MD. As the painter of her portrait and the author of her biography, the face is the same. I believe it is Dr. Loguen. ● Susan Keeter is associate director for creative services at Upstate.

local HIstory at tHe natIonal museum

In addition to the tintype above, the National Museum of African American History and Culture has another object from a famous Syracusan: A Syracuse Nationals basketball jersey owned by hall-of-famer Earl Lloyd — the NBA’s first African-American player (1950) and assistant coach (1968) and one of the NBA’s first head coaches (Detroit Pistons).

COURTESY OF THE GOINS COLLECTION, MOORLAND-SPINGARN RESEARCH CENTER, HOWARD UNIVERSITY.

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IN OUR communIty

How civilians have benefited from battlefield medical care

BY JIM HOWE

MANY ADVANCES IN MEDICINE have come from the military, where medical teams seek new ways to help wounded warriors, from the battlefield to the operating room to the research laboratory.

Wartime necessity spurred the expanded use of tourniquets, penicillin and many practices in modern emergency care.

Some of these improvements were outlined by Patrick Basile, MD, in a fall 2018 lecture at Upstate, where he was honored with the Outstanding Young Alumnus award. Basile, a 2003 graduate of Upstate’s College of Medicine, cared for the wounded while serving in the Navy. He took part in the first double arm transplant at Johns Hopkins and also participated in U.S. military missions abroad to repair cle� lips and other deformities. He currently practices plastic and reconstructive surgery in Florida.

Basile worked at what is now called the Walter Reed National Military Medical Center, in Bethesda, Md., the largest military medical center in the world, where he saw many blast injuries from the Iraq War. Among the innovations he noted: Penicillin: Today, antibiotics are taken for granted, but less than a century ago, war wounds could easily become infected and deadly.

Penicillin, one of the first antibiotic drugs, existed chiefly in research labs before World War II. A crash Anglo-American program during the war led to wide use of the drug and greatly improved combat survival rates. Sulfa drugs, which also fought infections, were available to the public shortly before WWII but also saw widely expanded use in that war and were even carried into battle in first-aid kits. Penicillin and sulfa drugs have been widely available to the general public since continued on page 23

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Battlefield medical care then and are still widely used, although they are less effective today due to drug-resistant bacteria.

Tourniquets: ese emergency devices cut off circulation to an arm or leg to stop heavy bleeding. ey have existed for centuries and been used widely on battlefield injuries since the Civil War. In this century, U.S. military personnel in Afghanistan and Iraq have sometimes gone into the field equipped with loose tourniquets that can be quickly tightened if needed.

Tourniquets are generally used “to save a life vs. lose a limb,” Basile says. Tourniquets, which have come into and fallen out of favor over the years, have also seen widespread use in Patrick Basile, MD, ‘03, giving a lecture at civilian emergency care and surgery.

Upstate in 2018.

MAST: e name stands for military (or medical) anti-shock trousers – a pressurized garment to stop massive bleeding. “You slip these pants on and increase the pressure, and it shunts the blood to the core and the brain,” Basile says. A pressurized suit based on this principle was used in WWII to prevent blackout in pilots. MAST came into wide use during the Vietnam War, when the garment allowed injured soldiers – who would have likely died otherwise — to survive a helicopter ride to a hospital. Civilian use followed, and although studies have questioned MAST’s value, they are still used in many circumstances.

Hospital ships: Ships have been used for evacuating and/or treating the wartime wounded for centuries, with the idea of floating hospitals coming into use on a massive scale during World Wars I and II. Today, the U.S. Navy has two hospital ships, the USNS Mercy for the Pacific Fleet and USNS Comfort for the Atlantic Fleet, which Basile says are “an amazing tool — basically floating trauma centers.” While their primary mission is to provide emergency care for combat forces, they can also go anywhere in the world on short notice and anchor offshore to provide disaster relief or humanitarian work, such as aer the 2010 Haitian earthquake. e ships have also undertaken missions to perform surgery on congenital deformities and other problems in countries lacking such resources. Nowadays, there are also non-military, privately run hospital ships that perform charitable work around the world.

Nerve grafts: Basile describes a sailor with a sciatic nerve damaged by a gunshot wound who was in danger of never walking again. e sciatic nerve runs from each side of the lower spine down to the foot and connects to leg and foot muscles. Surgeons at Walter Reed used a piece of

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nerve from a cadaver as a gra — like an extension cord — to reconnect the torn nerve. “We got him able to walk at two years, and to run at three years,” he says.

Nerve gras are usually taken from elsewhere on the patient’s own body and are known as autogras. Surgery to implant a specially treated cadaver nerve segment, or allogra, is seeing more widespread use to repair damaged or severed nerves and is an example of the military’s constant study of how to repair traumatic injuries.

Amputations: “In the Vietnam era, if you had a wounded leg that looked like it couldn’t be salvaged, you got an abovethe-knee amputation,” Basile says. Such amputations make it harder to walk when later fitted with a prosthetic leg than would a below-the-knee amputation.

“Now, if the knee joint is intact, we work to preserve the knee joint. at’s something that’s much different now than even in the late 1900s.”

Triage: e system of sorting which patients should receive care first originated in Napoleon’s army, evolved and spread, reaching U.S. civilian health care by the early 20th century. Triage, in some form, is widely used in wartime, as well as in emergency rooms and civilian disasters, to evaluate patients quickly, then treat the most serious patients first.

Blood transfusions: is practice was rare and dangerous for centuries, but advances took place just before and during World War I that greatly expanded its use: identifying blood types; discovering anticoagulants to prevent clotting; and storing blood in advance, rather than doing patient-to-patient transfusions. ese practices took years to catch on in civilian medical care, but transfusions continued to improve and greatly reduced battlefield deaths in World War II and since then.

Looking ahead: Basile predicts the military will contribute to the field of regenerative medicine. “When you need a kidney or another organ or tissue fixed from a burn or whatever, you’ll be able to harvest your own tissue and grow your own organs and tissue that are specific to you,” he says. “Regenerative medicine, and learning from other animals that can regenerate organs and figuring out how they do it and seeing how we can do it to some degree. Some organs regenerate to some degree on their own. A fetus has an innate ability to heal wounds without a scar in utero that we lose as adults,” he said, noting that researchers are trying to figure out why a fetus can be operated on in the womb and heal without a scar. ●

U P S TAT E H E A LT H

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750 East Adams Street l Syracuse, NY 13210

SCIENCE IS ART IS SCIENCE IS ART 1S SCIENCE e V-ATPases enzyme is present in every cell of the body, and also in plants and yeast. It has a connection to many diseases, including cancer and Parkinson’s. Upstate biochemist Patricia Kane, PhD, focuses her research on yeast cells.

Kane, a professor who leads Upstate’s department of biochemistry, was recently awarded a four-year, $1.1 million grant from the National Institutes of Health to continue her lab’s research into how cells regulate pH.

One of her projects studies how the V-ATPases knows where and how to help cells regulate pH. Kane has shown that the enzyme interacts with lipids at specific locations in the cell, and these interactions can make the enzyme more active at those locations. “ere might be a code for the lipid within the enzyme, and we want to understand that code,” Kane says.

Patricia Kane, PhD

19.017 0319 43.8M ELsk