Download - Upstate Health Spring 2012
Spring 2012UPSTATE MEDICAL UNIVERSITY
Meet the doctorwho survived
a stroke
Pedal
liver
cancer
diabetes
sleep problems
how to donateyour body
to science
7
Health UPSTATE
because he came to Upstate
WHAT TO DO ABOUT
fishing
to work
w w w . u p s t a t e . e d u2 UP STAT E H E A LTH spring�2012
CONTENTS
Lessons from Upstate
Advice for Caregivers from Caregivers
Questions & Answers
In the Know
The Upstate Ethicist
GoodJob
CalorieBurn
Good Read
The Humorist
Science is Art is Science
1819
Thyroid Protection
Hand Hygiene
Sleep Colonoscopy Farro Bicycling
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1416
78
17
4 9 11 11 18 20
9
10
11
12
16
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20
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24On�THe�cOver:�ricHarD�O’neill�pHD,�assOciaTe�prOfessOr�Of�psycHiaTry�anD�beHaviOral�science�aT�UpsTaTe�MeDical�UniversiTy,bikes�TO�wOrk.�see�sTOries�On�pages�8�anD�20.�pHOTO�by�sUsan�kaHn
In everyissue
HealthPatients First: A full recovery from stroke
Brush with death leads to career in health care
How alcohol hurts teens long term
What is your health care provider?
Adventures with Alzheimer’s
AdviceHow to live with a child who has diabetes
Understanding stroke care
CommunityHow to donate your body to Upstate
Artistry in wood
WorkAvoid on-the-job burnout
FoodMarinated fresh berries
Cooking for someone with cancer
LeisureMeet three bicycle commuters
Dave Sikora goes fishing
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Goodfor
You
2022
“It’s good for me, and it’sgood for the planet.”
–TeresaHargrave�MD,�
page�20
Knowing changes everything.SM 3spring�2012� UP STAT E H E A LTH
WHAT’S UP AT UPSTATE
pUblisHer Wanda Thompson PhDSenior Vice President
for Operations
execUtive editor Melanie RichDirector, Marketing and
University Communications
editor-in-cHief Amber Smith
designer Susan Keeter
pHotograpHy & illUstrationSusan Kahn, Susan Keeter,
Robert Mescavage, Dan Cameron,Chuck Wainwright, William Mueller
For more information, visit us online at www.upstate.edu or phone us at 315-464-4836.
For corrections, suggestions and submissions, contact Amber Smith at315-464-4822 or [email protected]
for additional copies call 315-464-4836.
Upstate Health offices are located at 250 Harrison St., 4th floor, Syracuse, NY13202
HealthSpring 2012
free�medical�apps�fordoctors�and�medical�students�that�Upstategrad�Joshua�steinberg�MDhas�built�through�collaboration�with�computer�science�professors�and�studentsat�binghamton�University.(find�them�by�searching“joshua�steinberg�md”�in�itunes.)
percent�of�Upstate’s�radiation�Therapy,�respiratory�Therapy�andperfusion�students�whopassed�state/national�certification�or�licensureexams�in�2010�and�2011.
Strokes can be devastating, no question. But someof our patients experience amazing recoveries.Meet one of them in our Patients First feature onpage 4, a physician from Auburn who believes he
is alive today because of the skill of the stroke team at Upstate. The team includes interventional neuroradiologists,a type of doctor you never want to need, but are glad thatUpstate has just in case. These doctors train for years in radiology and neurosurgery before merging the disciplinesin a neuroradiology or neurointerventional surgery fellowship. Their tools include a device that travels into the brain to trap and remove a blood clot during a stroke.
In addition to our detailed look at the continuum of strokecare, this issue of Upstate Health also features the closestthing to a real ‘magic bullet’ in medicine, a procedure calledradioembolization, along with some of the most commonsleep disorders in children. You’ll find help decipheringwhat can seem like an alphabet soup of credentials on your health care provider’s nametag. And, you’ll find a personal account of psychologist Rich O’Neill’s journey with his mother’s illness in a new column called Adventures with Alzheimer’s.
If you or a loved one have ever talked about making ananatomical gift, find out exactly how one man’s contribu-tion helped others. If you are hungry for a healthy sweettreat you can make at home, check out the recipe from executive sous chef Bill Gokey. If you like reading, learn which book compelled one woman to read “like a madwoman.”
All this and more is packed into this issue of Upstate Health. Enjoy!
Connect with us online
Be first to know about news from Upstate by liking “Upstate Medical University” and the “Upstate GolisanoChildren’s Hospital” on Facebook, or by subscribing to the “What’s Up at Upstate” blog at upstate.edu/whatsup.
If you are on Twitter, follow us @upstatehealth, @upstategolisano and @upstatenews.
Your health
For appointments or referrals to the health care providerson these pages, or for questions about health topics, contact a registered nurse at Upstate Connect at 315-464-8668 or 1-800-464-8668, day or night.
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Upstate Health is published by the Office of Marketing and University Communications.Upstate Medical University in Syracuse, NY, is an academic medical center with four colleges – Medicine, Nursing, Health Professions and Graduate Studies – as well as an extensive clinical health care system that includes Upstate University Hospital, UpstateUniversity Hospital at Community General, the Upstate Golisano Children’s Hospital and numerous satellite sites. Affiliated with the State University of New York, Upstate is Onondaga County’s largest employer.
years�difference�in�life�expectancy�between�people�inkathmandu�and�those�in�surrounding�areas�of�nepal,part�of�the�justification�for�the�patan�academy�of�Health�sciences,�a�medical�school�whose�studentspledge�to�practice�rural�medicine.�The�school�opened�in�2010;�its�founder,�arjun�karki�MD,�did�his�residency�at�Upstate.
16,221adults�and�children�who�received�cancer�treatment�at�Upstate�University�Hospital�in�2009,�twice�the�number�of�patients�as�were�served�in�1999.�
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w w w . u p s t a t e . e d u4 UP STAT E H E A LTH spring�2012�
HEALTH
Patrick Buttarazzi MD was enjoying a night out at Lasca’sRestaurant in Auburn with hiswife, Alice, and son, Michael,
on Jan. 2, 2010. Feeling himself drool, he reached for a napkin.
The next thing he knew, Buttarazzi was ona ventilator in the emergency department atUpstate University Hospital in Syracuse, unable to move his left side or breathe onhis own and with no memory of why hewas there.
The Auburn urologist had suffered a massive stroke. An ambulance drovethrough a blinding snowstorm to get Buttarazzi to Upstate. His wife and three of his 14 children gathered at his bedside. A priest read Last Rites.
A computerized tomography scan revealeda blood clot in the major artery on the rightside of Buttarazzi’s brain. Interventionalneuroradiologist Amar Swarnkar MDthreaded a flexible wire made of nickel tita-nium through a blood vessel in Buttarazzi’sleg and advanced the wire to the blockage.
The device trapped the clot, removing it asthe wire was withdrawn. He also put in astent in the right carotid artery to preventadditional clots from migrating to thebrain.
Fast forward two years, and Buttarazzi, 77,has retired from a lengthy medical career.He says he is grateful for the medical carethat kept him alive. “It was the speed andskill with which everything transpired thatsaved me,” he says.
Time is critically important when someonesuffers a stroke.
Whenever a blood vessel is completelyblocked, as in the case of a stroke or a heartattack, tissue can die because it is deprivedof the oxygenated blood that keeps ithealthy. “In the body, the brain and theheart are two tissues that do not regenerateafter they are damaged. It’s imperative thatyou restore the blood flow as quickly aspossible so that you avoid tissue death,”says C.J. Ryan MD, a vascular surgeon andfamily friend who met Buttarazzi at Upstatewhen the ambulance arrived.
do-it-yoUrselftHyroid cHeck
The incidence of thyroid canceris growing, partly because
more lumps are being discoveredwhen they are tiny. Someone mayhave a computerized tomographyscan of his or lungs or a carotidultrasound, and the radiologistincidentally discovers a thyroidnodule.
The majority of nodules are benign and are monitored tomake sure their growth does not interfere with surroundingtissues. Ultrasound exams andbiopsies show that about 5 percent of nodules are cancerous. Most thyroid cancers are easily treated by surgery to remove the thyroid.
“There is some epidemiologicalevidence that there is an increased risk of thyroid cancer in patients exposed to many dental x-rays,” sayd RobertoIzquierdo MD, medical director ofUpstate’s Thyroid Cancer Center.
He recommends wearing a thyroid shield during dental x-rays for protection.
He also recommends checkingyour own thyroid.
You need a mirror and a glass ofwater. Locate the area of yourthyroid, below the Adam’s appleand above the collarbone, andkeep this in view as you leanyour neck back. Swallow thewater, and watch carefully forany bulges or enlargementsaround your thyroid.
If you see anything unusual,Izquierdo says to consult yourdoctor for an evaluation.
Patrick Buttarazzi MD with his wife, Alice.
Continued on page 9
PATIENTSfirst
Doctor is grateful he came to Upstate when he had stroke
HEALTH
Knowing changes everything.SM
radioembolizationtargets liver tUmorswitH tiny bUllets
Radioembolization combinesradiation therapy with
embolization, a process that occludes the blood vessels withina tumor. This blocks the flow ofblood containing the oxygen andnutrients necessary for a tumorto grow. The vessels are filledwith miniature glass beads containing the radioactive isotope yttrium Y-90, which delivers a locally high dose of focused radiation.
This therapy is used to treat tumors that begin in the liver orhave spread from other parts ofthe body to the liver. It is not acure for cancer but rather cansignificantly slow or halt thegrowth of the disease. This canalleviate symptoms and can ex-tend a person’s life from monthsto years. Radioembolization maykeep some patients alive longenough to undergo a more curative option such as surgeryor liver transplantation.
Radioembolization is not recommended for patients withsevere liver or kidney dysfunc-tion, abnormal blood clotting or a blockage in the bile ducts.
This is a new service being offered at Upstate. To learn more,contact Mitchell Karmel MD, director of vascular and interventional radiology at Upstate, at 315-464-7439.
5spring�2012� UP STAT E H E A LTH
Upstate student Brandon Crandall RN has a lot going on. He works part-time in the neurology unit of Upstate
University Hospital, and he is midwaythrough the Nurse Practitioner program in the College of Nursing.
He is a resident advisor at Clark Tower,president of its activities board, and hasbeen involved in plans for the new GenevaTower residence hall, opening this summer.He is also a College of Nursing representa-tive for the Upstate Student Government.
Most people who know Crandall know all those things.
But most people aren’t aware that he almost died in a head-on snowmobile crash when he was 16.
It happened during his junior year at PaulV. Moore High School in Central Square.Crandall was giving his sister a ride on asnowmobile on a trail near their home inBrewerton, north of Syracuse. They cresteda hill and collided with a snow-mobile coming in the opposite direction. The operator of theother snowmobile was killed.
Brandon sustained massive facialinjuries and swelling of thebrain. His sister suffered aconcussion and a brokenfinger. Brandon was incritical condition, in acoma for a week andspent six weeks at Upstate University Hospital.
“I came this close todying,” he says, holdinghis thumb and index finger about an inchapart. “Upstate saved
my life. Dr. Robert Kellman, chair of theENT Department, and about three othersurgeons reconstructed my face.”
Brandon doesn’t remember details of thecrash and only recalls the last two weeks in the hospital, when he was in the rehabilitation unit.
He recovered enough to graduate with hishigh school class in 2006. After a year atSUNY Canton, he decided on nursing andearned his associate’s degree and became aregistered nurse through the Crouse Schoolof Nursing.
The crash, and his successful treatment and recovery, may have played a part inCrandell’s decision to pursue nursing, but it wasn’t the primary influence.
He says his brother-in-law, Joshua HarrisonMD, provided a good example of the hardwork and dedication needed to forge a career in health care. Harrison graduatedfrom Upstate’s College of Medicine and is a first-year medical resident here.
Crandell, in pursuit of hismaster’s in nursing, sayshe has a never-endingthirst for knowledge. Heenjoys when people come
to him with medicalquestions, and he enjoys finding the answers.
“You can study forthe rest of your life,and there’s never anend point,” he says.For now, his goal isa career in intensivecare, the specialtythat helped save
his life.
A brush with death, now a career in health care
Brandon Crandall RN and Robert Kellman MD
by�JiM�Mckeever
�
w w w . u p s t a t e . e d u6 UP STAT E H E A LTH spring�2012�
HEALTH
Teen drinking can cause problems later in life
GoodToKnow
did yoU know? pHysical tHerapists may be ‘doctors’
All physical therapy training programs have converted to doctoralprograms, and as more physical therapists increase their education,
more patients address their PTs as doctor.
The doctoral degree ties in nicely with the increased responsibilities on the profession, says Dale Avers, a doctor of physical therapy who also has a PhD in instructional systems technology. She is director of Upstate’s post-professional doctoral program for physical therapists inthe College of Health Professions, which also offers a degree programfor those entering the field. PTs today can provide patients with up to10 visits within 30 days without requiring a physician referral. They
work within the healthcare team while making their own treatment decisions.
Avers says the majority of practicing PTs do not have their doctorate,“but I think there is a little bit of pressure because the entry level therapists are coming out with that degree.” She says Upstate’s program is designed for the working PT; those with bachelor’s degreescan complete the doctoral degree in two years by taking four credits per semester.
She says increased education is good for the PT profession and ultimately for the patients, who can expect increased levels of competence from their practitioners.
Linda Spear PhD and her team conduct research late at night and earlyin the morning within a one-block area of Binghamton that has eightbars. They interview young adults who have been drinking but are notseverely impaired, putting them through a series of cognitive and motortests and breath tests and asking them to follow up with online surveys.
The dangers of youthful drinking extend beyondmaking poor judgments while intoxicated. Alcohol can have a lasting effect on teens, saysLinda Spear PhD of Binghamton University’s
Department of Psychology. She urges parents not to allow young people to drink alcohol before they reach the legal drinking age, period.
Here’s why:
• Insensitive to cues that they are going beyond tipsy, adolescents tend to drink more, and ingesting high levels of alcohol can be toxic.
• Adolescents are unusually sensitive to the social facilitat-ing effects of alcohol, and most of their drinking occurs insocial contexts. So, social enhancing effects of alcoholcould serve to encourage further drinking by adolescents.
• Compared to adults, adolescents are relatively resistant toalcohol’s sedative and motor-impairing effects, which mayincrease the likelihood that they will drink more heavilyand more often and develop alcohol problems later on.
• As alcohol leaves their system, adolescents are likely to become socially anxious; when they drink again, they willrelax and start to socialize – so they may begin to rely onalcohol to reduce social anxiety.
Spear says consuming alcohol early in life is one of the mostpowerful predictors of later alcohol abuse.
Exposure to alcohol in the womb, also, can predict alcoholabuse in adolescence, says Upstate’s Steven YoungentobPhD.
Two studies by Youngentob, a professor in Psychiatry andBehavioral Sciences, show that rats develop a preference for the taste and smell of alcohol in utero if their mothers consume alcohol during pregnancy. He says that makes thebaby rats more likely to abuse alcohol as they get older.Similarly, he believes human teens are at increased risk forabusing alcohol, especially if they are risk-takers, feel socialpressure to drink or have a family history of drinking.
Youngentob told the website, About.com there is no safetime to drink alcohol during pregnancy. Based on his research, parents need to keep their children away from alcohol, especially if they had fetal alcohol exposure.
Linda Spear PhD Steven Youngentob PhD
�
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HEALTH
Knowing changes everything.SM spring�2012� UP STAT E H E A LTH
know yoUr doctor
An “attending” physician is the one in charge of
your care. A ”resident” is aphysician who has completedmedical school and is now caringfor patients under the guidanceof an attending physician; a first-year resident is known as an “intern.” A “fellow” is a physician who has completedresidency training and is undertaking additional training in a particular specialty.
A physician with “DO” after his or her name is a doctor of osteopathic medicine. Just like amedical doctor, they prescribedrugs, perform surgery and usetechnology to diagnose diseaseand evaluate injury, but their approach is more holistic and appreciative of the body’s innateability to heal itself.
Physicians with “MBBS,”“MBBA” or “MBChB” attendeda medical school that follows a style of education more prevalent in the United Kingdom,India and other Commonwealthcountries.
A physician who is “board certified” has demonstrated hisor her knowledge and skills in aparticular specialty and has beenrecognized by a certifying board.
Some physicians have extra letters after their names that recognize additional professionalqualifications, expertise or ethical conduct within their specialty. Examples: FACOG (fellow of the American Collegeof Obstetricians and Gynecolo-gists) or FACEP (fellow of theAmerican College of EmergencyPhysicians.)
CRNA – certified registered
nurse anesthetist
CCP – clinical cardiac perfusionist
CDE – certified diabetes educator
CNM – certified nurse-midwife
CNS – clinical nurse specialist
DDS – doctor of dentistry
DO – doctor of osteopathic
medicine
DPM – doctor of podiatric medicine
DPT – doctorate in
physical therapy
DrPH – doctorate in public health
FNP – family nurse practitioner
HPSC – hospital patient service clerk
JD – doctorate in law
LCSW – licensed clinical
social worker
LPN – licensed practical nurse
MBBS – doctor of medicine
MBBA (from UK, India, other
MBChB Commonwealth countries)
MBE – masters in bioethics
MD – doctor of medicine
(US & Canada)
MPH – masters of public health
MSN – masters of nursing
MSEd – masters of education
MSW – masters of social work
NICN – neonatal intensive
care nursing
NP – nurse practitioner
OT – occupational therapist
PA – physician assistant
PharmD – doctor of pharmacy
PhD – doctoral degree
PNP – pediatric nurse practitioner
PT – physical therapist
RD – registered dietitian
RDCS – registered diagnostic
cardiac sonographer
RDMS – registered diagnostic
medical sonographer
RN – registered nurse
RRT – registered radiologic
technologist
RT – respiratory therapist
RVT – registered vascular
technologist
What do those initials mean?
Many of the names on hospital nametags end with a cluster of capital letters.“MD” and “RN” are easy to decipher, but an academic medical center depends on more than medical doctors and registered nurses. A variety of additional professionals you may encounter include:
The Upstate Vascular Surgery andEndovascular Services team includes:M. Asad Khan MD, Michael J.Costanza MD, Vivian Gahtan MD,and Kwame S. Amankwah MD.
w w w . u p s t a t e . e d u8 UP STAT E H E A LTH spring�2012
Iwheeled my mother into her doc’swaiting room, and a guy in line at thedesk asked me how old she was. I told him 94.
“You are so blessed,” came his reply.
I’m not sure ‘blessed’ is the right word. AndI’m not sure if the man changed his opiniona few minutes later when my mother said,loud enough for everybody to hear, “Lookat that guy, Ritchie. He’s really bald!”
Let me tell you a little more about how it really is.
A few weeks ago she had a sore toe. So, shemade a 4-inch cut in her special orthopedicshoe – with a can opener. We had takenscissors away after she used them to jamthe door closed from the inside of her roomat the nursing home to keep people fromstealing her stuff while she slept. She had a bad cold at the time, and was confused.The staff at the home had to break the door down to get in.
My mother doesn’t tolerate change, so Iwanted to get the same shoe. But she can’tremember her shoe size, and getting her tothe shoe store – or anywhere – can be amajor undertaking at best and close to impossible if she decides to clamp her eyesshut and go limp and unresponsive likeshe’s dead so that I have to pick her up andput her in a wheelchair and move backwardbecause she’ll put her feet on the ground tostop us if we go forward.
Why does she do this?
Who knows?
Anyway, the place we’d gotten the shoes no longer carried them, but the store didrecord her size. So I went online. Nobodycarried them any more, so I got a very, verysimilar pair in the exact same size and
color. I brought them to her when they arrived.
As she prepared to try them on, she pulledher special toeless support socks down over her toes so that the shoes definitelywouldn’t fit. I fixed the socks. Then Ireached to get the shoes out of the box. She pulled the socks down again. Then she noticed a detail in the new shoes.
Eventually we got the shoes on her feet, andwhen she walked around the room, she saidan emphatic “Too small!” Who knows ifthey really were.
She wanted me to sew up her old shoe untilwe could get a bigger size.
So an hour into my visit, I was sewing herold shoe, biting the thread because therewere no scissors. The whole time, she insisted somebody stole her sewing box,even though I showed it to her when I got the needle and thread.
Why am I telling you this?
Because a few days later at a party, I wastalking to someone about our mutuallyaging parents. “Boy! You’ve got a lot onyour hands,” he said, and I almost startedcrying. It feels good when someone understands our experience.
So all of you folks with a similar story, I just want to say, if ‘blessed’ is the rightword, I’m not looking forward to heaven asmuch as I used to. Know what I mean?
And, I want to give a big thanks to thenursing home staff for the skill and patiencethey show in caring for my mother. Theyare a true blessing.
Listen to psychologist Rich O’Neill on HealthLink on Air radio every Sunday from 9 to 10 a.m. on FM Newsradio 106.9, WSYR.
by�ricH�O’neill�pHD
Contemplating the blessings in life
adventureswithAlzheimer’s
award-winning carefor patients witHHeart failUre In April, Upstate University Hospital received the Gold Plusaward for heart failure from theAmerican Heart and Stroke associations.
Upstate University Hospital was recognized forachieving 85 percent or higher adherence to all “Get With The Guidelines” Heart Failure Achievement indicators for two or more consecutive 12 month intervals and at least 12 consecutive monthsof 75% or higher compliance with 4 of 9 Get WithThe Guidelines® Heart Failure Quality measures toimprove quality of patient care and outcomes.
The�area’s�first�after-hours�program�just�for�kids�and�youngadults�through�age�21.
HOURS:Mon. thru Fri.4 to 11 p.m. Sat. & Sun.noon to 11 p.m.
Call 492-KIDS (5437)
4900 Broad Rd. Syracuse
UPSTATEGOLISANO AFTERHOURS CARE atCommunity General
www.upstate.edu/afterhours
�
HEALTH
Much was in Buttarazzi’s favor that night.His wife, a nurse, immediately recognizedthe signs of a stroke. The most even-keeledof his children was the one with him whenit happened. And the emergency medicaltechnicians drove Buttarazzi 28 miles directly to Upstate, where a neurovascularteam is available 24 hours a day to conductthe sophisticated clot-removing procedurethat Buttarazzi needed.
Ryan says Buttarazzi likely would have diedfrom swelling of his brain as a result of thestroke process had the Upstate team notpromptly located and removed the clot. He prepared Buttarazzi’s family – eightsons, six daughters and 46 grandchildren – by explaining that their patriarch maynot survive and might never regainthe use of his left side.
Buttarazzi awoke in the intensive care unit.
His daughter, Amy Spin held his left hand.She thought she felt a twitch in his thumb,very slight. She ran to alert a nurse, whocame into the room explaining that people who have had strokes should be ableto move their lower limbs before they’reable to move their upper limbs.
So Buttarazzi lifted his left leg.
“They were shocked,” he recalls.
After 10 days in the hospital, he was discharged to a rehabilitation centerfor six weeks before going home.
“I would say it’s a full recovery atthis point. I’m playing golf and
busy every day,” he says. “The biggest thing I notice ismy voice is a lot less forcefulthan before.”
That’s a difference friendsmay pick up on, but othersmay not notice.
Ryan says his friend’s recovery is remarkable.
“There’s no question in my mind that the prompttransport to the Stroke Center at Upstate and the rapid response of the neuro-radiologist was the critical
difference between life and deathand a happy ending.”
HEALTH
*
Hygiene among Hikers
Medical journals have suggested a connection
between gastrointestinal illnessand the quality of backcountrywater ever since a report in 1976of a group of hikers in Utah who developed giardiasis* afterdrinking untreated water.
No real research has looked atthe role hand hygiene may play –until Upstate’s Jana Shaw MDlead a study that was publishedin the January issue of theAmerican Journal of Infection Control. Researchersat a popular trail head in theAdirondacks got 72 people onovernight camping trips to answer surveys and soak theirdominant hands in bags of sterilesaline – which were then analyzed in a laboratory.
Fecal bacteria was found on almost a third of the hikers’hands. The prevalence of fecalhand contamination was notmuch different between hikersentering the wilderness andthose headed home, “which suggests that backpacking,alone, does not contribute to fecal hand contamination,”Shaw writes.
“The high prevalence is concerning because poor hygieneand fecal hand contaminationhave been linked to diarrheal illnesses among healthy subjects,” the study says. It concludes by suggesting thathikers and groups that teachwilderness skills emphasizeproper hand hygiene.
*infection of the small intestinecaused by a single-cell organism
from UpstateLessons
Doctor survives stroke —continued from page 4
Dr. and Mrs. Buttarazzi at the beach with many of their 14 children and 46 grandchildren.
Knowing changes everything.SM 9spring�2012 UP STAT E H E A LTH
At right: Amar Swankar MDBelow: CJ Ryan MD with Dr.Buttarazzi
�
• Don’t call kids with diabetes ‘diabetics’ because that labels them as their disease. They are people first.
• We reassure them that this is not their fault or the fault of their parents. The exact cause of type 1 diabetes is unknown.
• Combat misinformation – no, children don’t “grow out”of diabetes, and no, there is no cure – by learning aboutthe disease. Resources are plentiful on web pages for theAmerican Diabetes Association, Juvenile Research Dia-betes Research Foundation and New York State Depart-ment of Health, as well as Family Support Network’sonline community at childrenwithdiabetes.com.
• Blood sugar levels have to be checked four to six times a day, and insulin may have to be administered as frequently – either through injections or via a pumpwhose catheter requires changing every three days.Overnight blood glucose monitoring is also important,“especially for young kids whose brains are still develop-ing and may be harmed by repeated low glucose levels,”says childrenwithdiabetes.com.
• Create an emergency box containing liquids with calories,liquids without calories, a thermometer and emergencymedications. Similar boxes should be kept in places wherethe person with diabetes spends lots of time, such asgrandparent’s homes.
• While we encourage healthful eating, the dietary limitations we enforced in the past decades are not really necessary.
• Insulin pumps, portable insulin and the prevalence of cellphones have made excursions such as overnight campingtrips possible. And, new insulin regimens allow for injections prior to meals or after meals in some situations.“For anyone who has given a toddler an injection of regular insulin and then watched him or her refuse to eat, the ability to inject after the meal is a major benefit,” says childrenwithdiabetes.com.
• Depending on maturity, children age 10 or 11 may be ableto give their own injections, and children from age 12 or13 can become increasingly responsible for monitoringtheir sugar levels and deciding on insulin dosing. However, all adolescents still need the help of their parents and guardians. The children whose diabetes iswell-managed are those whose parents are most vigilantabout their care.
• When a child with diabetes starts looking at colleges,health services in the college community are an importantconsideration. So are roommates who can help the student manage diabetes in a friendly, supportive manner.
• Alcohol use is one of biggest dangers for children with diabetes. Not only can alcohol cause high or low bloodsugar, children with diabetes who become drunk cannotreliably monitor their blood sugar levels.
• Birth control is important for women of childbearing age because diabetes needs to be in good control at conception and early in pregnancy for the best odds of having a healthy baby.
• Children with diabetes are at increased risk for mentalhealth disorders. “If they do what they’re supposed to do,(such as counting carbs, monitoring blood sugars and giving insulin injections) it’s very demanding. Blood sugarlevels that are a little high or low can create angst, andkids may tend to blame themselves. Those kids who findit hard to do all the things we ask of them can also feelterrific guilt,” Sills says.
“We have better tools to treat diabetes today, but onecan’t underestimate how challenging it can be to live with this chronic disease,” Sills says.
For Caregivers – from Caregivers
w w w . u p s t a t e . e d u10 UP STAT E H E A LTH spring�2012�
ADVICE
How to live with a child who has type 1
Once a child is diagnosed with diabetes, he or she and their loved ones receive several hours of education about how tomanage the disease from a diabetes educator. They learn about how to interpret blood sugar levels, how to administer insulin, what signals an emergency.
“When a child with diabetes is diagnosed, the whole family needs to be involved. Everyone is affected by the stressors, and everyone can play a supportive role,” says Irene Sills MD, a professor of pediatrics at Upstate.
Parents may feel overwhelmed by the amount of monitoring and decision-making in the beginning, but they are well supported by the nurses and doctors who are only a phone call away. However, after they master the skills, they may be afraid to leave their child in anyone else’s care. Siblings may feel they get less attention than the child with diabetes. This is where extended family and friends can step in to assist, if they take the time to learn how.
Sills’ advice begins with how to address a child with diabetes:
Attention: Caregivers, clip and save. Tips in every issue.
�
diabetes
colonoscopy cUtscancer deatH risk
Removing polyps during routine colonoscopies
reduces the risk of dying by 53 percent, researchers concluded by tracking 2,602 patients who underwentcolonoscopy between 1980 and 1990 at Memorial Sloan-Kettering Cancer Center in New York.
For the study, published recentlyin the New England Journal ofMedicine, researchers comparedthe death rate of those patientswith that of the general popula-tion over as many as 23 years.
Colorectal cancer is one of the few cancers that can be prevented with screening.Colonoscopy, which The NewYork Times called “perhaps themost unloved cancer screeningtest,” allows a doctor to examinethe inside of the colon and lower intestine through a camera-tipped tube and removeany precancerous growths.
Your chance of developing colorectal cancer increasesmarkedly after age 50. More thannine out of 10 people diagnosedwith colorectal cancer are olderthan 50. A personal history ofcolorectal polyps or inflammatorybowel diseases puts you athigher risk. Also, African Americans have the highest incidence of colorectal cancer,though the reasons are not yet understood.
Knowing changes everything.SM 11spring�2012� UP STAT E H E A LTH
ADVICE
Qwhat’s the most common cause of sleep trouble in children?
“After the first year of life, the mostcommon is what we call obstructive
sleep apnea, when children have difficultybreathing to the degree that they stopbreathing while they are asleep. This problem occurs most commonly secondary to large tonsils and adenoids.
“The parents may observe that there issomething wrong with the child breathing.They witness the child struggling tobreathe, waking up frequently at night,snoring loudly with pauses and gasping for air.”
Qwhat else is to blame?
“Behavioral problems can cause insomnia and parasomnia, difficulty
falling asleep and maintaining sleep.
“With some children, it’s hard for them to fall asleep because they haven’t learnedhow to sleep on their own. Since they werebabies, they learned that in order to sleepthey need to be in the hands of the mom orthe dad, or rocked in a chair, and they fallasleep in the arms of a parent and they’reput in bed. These children do not knowhow to sleep on their own.
“This is tied to another issue which we call a ‘limit setting problem.’ This is a childwho keeps having what we call curtaincalls. They keep coming out to the audi-ence, the parents, with different requests.The reason they do that is, they’re havingnightmares or night fears, or just becausethey haven’t learned that they can sleep on their own, that they don’t have to be in the arms of the mother or the father.”
QHow do you differentiate a disorderfrom normal development?
“When there are consequences, to the family or to the children,
we call it a disorder.
“A lot of children snore, but not all thesekids have obstructive sleep apnea. And even if they do have a few episodes ofapnea, we ask whether they have developed consequences. They may have learning difficulties, cognitive deficits, hyperactivity,or they may wake up frequently and struggle to breathe.
“The same for insomnia. Most types we encounter are behavioral. If the parents arehappy with this arrangement, there is nodisorder. In fact, it sometimes varies by typeof family, traditions, cultures. They may not mind that the child wakes up and theygo to the child to hold them, to carry them.But sometimes it disturbs the life of thefamily and the child very much, and thechildren eventually do not get adequatesleep, and the next day they will manifestwith cognitive problems and behavioralproblems.”
Qwhat happens at the sleep center?
“Check with your pediatrician first,but children (age newborn to 18)
who are referred to the sleep center will be evaluated by a sleep specialist to sort outthe problem, and then they will recommendproper treatment. If we feel it is a breathingproblem, then the patient will undergo asleep study to identify the exact problemand determine the treatment needed.
“If it’s obstructive sleep apnea secondary tolarge tonsils and adenoids, and it’s treatedand improved, then we don’t follow themon a regular basis. If it’s a behavioral problem, then it depends on how big the problem is. Sometimes more than one session is needed.
witH zafer soUltan md
Q Aand
Kids & Sleep
The director of Upstate’s Pediatric Sleep Center explains whysome kids have a difficult time getting a good night’s sleep.
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IN THE KNOW
Specialized ensemble orchestrates
w w w . u p s t a t e . e d u12 UP STAT E H E A LTH spring�2012
Paramedics alert the hospital if they believe their patient has had a stroke, and the “stroke team” is summoned to the emergency room. This includes an emergency physician, neurologist, a stroke coordinator and emergency department nurses. In addition, the nursing supervisor is alerted, along with the pharmacy, laboratory and radiology departments. The goal is to save a life, and also to save brain cells.
The patient who arrives by ambulance often already has one IV in place, but nurses will insert a second. Blood for testing can be taken through one,and medications and fluids administered through the other.
One of the first tests measures blood sugar, since the symptoms of hypoglycemia can mimic those for stroke. A doctor will conduct a neurologicalexam that tests different areas of the brain – consciousness, speech and language, memory, eye movement, reflexes and sensation and walking and balance. A magnetic resonance imaging (MRI) scan can reveal narrowing or blockages of blood vessels in the brain. Other tests or procedures may be used to measure blood flow and detect clots.
The staff will also work to assemble a medical history – whether the patient has had surgery recently, if he or she takes blood thinners, has an elevated blood pressure or bleeding in the gastrointestinal tract. Such information is crucial before developing a treatment plan.
strokeS
trokes among younger Americans are on the rise, by 51 percent for men and by 29 percent for women between ages 35 and 44. Obesity, diabetes and high blood pressure are largely to blame, according to the Centers for Disease Control and Prevention.
Survival often depends on quickly recognizing the symptoms of stroke and seeking appropriate medical care. Maximum recovery depends, also, on rapid and skillful treatment and quality rehabilitation.
Upstate is uniquely qualified to care for stroke patients. The first designated stroke center in Central New York, Upstate University Hospital features the region’s only specialized neuroscience and rehabilitation floors. That means people who are wheeled into the emergency room suffering from stroke may receive acute treatment and rehabilitative care under the same roof and are followed by the same ensemble of providers.
care
?boffryfleu?
I. RECOgNITION
The public performs a crucial role in recognizing the symptoms of stroke.
Remember
to act FAST:
FaceDoes one side of the face droop? Ask the person to smile.
ArmIs one arm weak or numb? Have the person raise both arms; does one drift downward?
SpeechIs speech slurred? Ask the person to repeat a simple sentence.
TimeTime is critical; if the person shows any of these symptoms, call 911immediately.
Thomas Lavoie MD, Emergency Medicine
4515
1060
25
within 60 minutesintervention
within45 minutes – CT scan is interpretedby radiologist
within 25 minutes
patient in computerized tomography (CT) scanner
within 15 minutesneurologist
consults on patient
within 10 minutes
emergency physician evaluates
the patient
2. DIAgNOSIS
ARRIVALTOIN
TERVENTION WITHIN60MINUTES
Here’s a look at the orchestration of stroke care at Upstate:
IN THE KNOW
Knowing changes everything.SM 13spring�2012� UP STAT E H E A LTH
3. TREATMENT
About 87 percent of strokes are “ischemic,”meaning a clot is blocking a blood vessel. They are not painful. Instead, patients may feel numbness or a weakness or heaviness.
Interventions may include a clot-busting drug called tPA, tissue Plasminogen Activator, whichmust be administered within three hours of theonset of a stroke. In some cases, concentrated doses of the drug can be placed at the site of the stroke within the brain.
Upstate also offers a clot-retrieval procedure in which a stent device is threaded through acatheter in a blood vessel to the clot. An interventional neuro-radiologist captures the clot, restoring blood flow and removing the clot and stent from the body through the catheter.
Both of these treatments are time-sensitive and may not be options for patients who have been slow to seek care. In Syracuse, the clot-retrieval procedure is only performed at Upstate.
About 13 percent of strokes are “hemorrhagic,” meaning a vessel in the brain has burst or an aneurysm has formed and is about to burst. However, because Upstate receives patientswith complicated medical emergencies sent from hospitals throughout the region, more like 30 percent of stroke patients at Upstate have had this type of injury.
Depending on the location and severity of the aneurysm, surgeons may be able to place a clip at the base of the aneurysm so blood cannot escape. Or, they may elect to treat theaneurysm from inside the blood vessel, by placing platinum micro-coils that act as a mechanicalbarrier to blood flow.
Some patients undergo a cooling process during the treatment of their brain injuries. In some patients, staff monitor the oxygen level of brain tissue.
4. RECOVERY
Stroke patients are likely to recover in one of the 11 beds in Upstate’s neuroscience intensive care unit. Staff in the ICU, mindful of circadian rhythms, dim the lights from 1 to 3 a.m. and from 1 to 3 p.m. and avoidscheduling treatments during those times. A harpist plays on Tuesday afternoons.
Patients may be transferred to other units as their conditions improve, as 35 additionalbeds are devoted to patients with neuro-logical problems. Nurses and therapists who specialize in stroke care are stationed onthese floors.
5. REHABILITATION
Within 24 hours of a stroke patient’s admission to the hospital, physical, occupational and speech therapists and a physiatrist evaluate to determine the needs of the patient. Rehabilitative therapy beginsalmost immediately, depending on the severityof the stroke.
The location of the stroke determines whichbody functions are affected. Physical therapistLori Holmes says patients may be able to recover many functions by retraining healthyparts of the brain through therapy.
Upstate has an inpatient rehabilitation unit,where patients may be moved when they areable to handle three hours per day of therapy.People who have had ischemic strokes stay anaverage of seven days, while those who havehad hemorrhagic strokes stay an average of 20 days.
6. SUPPORT
Rehabilitation counselors at Upstate provide help for patients in returning to work or school.
In addition, a stroke quality group meetsmonthly at the hospital to review stroke careprovided. Stroke Program Coordinator Maria Lumbrazo says an education group forfamilies of stroke patients is in development.
Ischemic Stroke (clot)
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Hemorrhagic Stroke (bleed)
Neurologist Ashok Devasenapathy MD and neurosurgeon Eric Deshaies MD
Margaret Turk MD of physical medicine and rehabilitation with physical therapist Vicki Kalina
Stroke coordinator Maria Lumbrazo,a family nurse practitioner
Neurologist J. Gene Latorre MD on rounds with the stroke team
w w w . u p s t a t e . e d u14 UP STAT E H E A LTH spring�2012
COMMUNITY
baby boomers are aging
The United States in 1980 had720,000 people age 90 and
older. Just 30 years later, 1.9 mil-lion Americans were age 90 andolder. By 2050, the ranks of theoldest old is expected to reach 9 million, according to a censusreport commissioned by the National Institute on Aging.
The report says the majority of the 90-plus population arewidowed white women who livealone or in a nursing home andrely on Social Security for half of their income.
Other findings
• The life expectancy for someone who has lived to 90 is 4.6 more years; for someone who lives to 100, it’s 2.3 more years.
• Women age 90 and older outnumber men nearly three to one.
• Eighty-five percent of those 90 and older have one or morephysical limitations; 66 percenthave trouble walking or climbing stairs.
• The likelihood of living in anursing home increases sharplywith age. Three percent ofthose 75 to 79 live in a nursinghome, 11 percent of those 85to 89, 20 percent of those 90to 94, 31 percent of those 95to 99 and up to 38 percent ofcentenarians.
Anatomical gifts advance learning for future doctors, medical professionals
Sylvia White squeezed her daughter’s hand. They were inWeiskotten Hall, in the medicalschool building where their
patriarch culminated a lifetime fascinationwith science by donating his body after he died. White — along with son, Ed;daughter-in-law, Bonnie; daughter, SusanBonnet; and son-in-law, Bob — was thereto retrieve her husband’s ashes, and to heardetails about his contribution.
An orthopedic surgeon planning a uniquesurgery practiced the operation first on Eugene White. Paramedic students andyoung military medics from Fort Drumpracticed medical procedures on EugeneWhite before they faced live patients. Andthe Department of Pathology at Upstatehosted a teaching conference in March forpathologists and neurosurgeons concerningglioblastomas, the type of tumor found in Eugene White’s brain.
“Gene was fascinated by the mapping ofhis glioblastoma,” Sylvia White recalls.“He was interested in how far it hadgrown, and whether the medicine he was taking was effective.”
While the procedures did not reveal thoseanswers, White’s family was glad they had
honored his wishes. Like 235 Central NewYorkers the year before, White donated hisbody to Upstate when he died in January.
Medical students take anatomy in the firsthalf of their first year, with six students assigned to a single cadaver. Students studying to become physician assistants orphysical therapists also train with cadavers,as do paramedic students.
“Students think we’re all the same inside,but there are differences,” says N. BarryBerg PhD, a professor who helps themlearn what variations are meaningful interms of quality of life. Berg is also the director of the Anatomical Gift Program.
Berg has taught anatomy for 41 years atUpstate. He went to college not knowingwhat he wanted to study or do with his life.He took an anatomy class as a physical education major and loved it, so he pursueda doctorate in anatomy. When his youngson developed allergies, his family decidedto leave New York City for cleaner air.“Everyone said Upstate would be great,”Berg remembers. “No one ever told meabout the weather.”
One of Berg’s earliest students — NathanRiles Jr. MD of Chesapeake, Va. — was an
Good toKnow
College of Medicine Class of 2015 students Theresa Ogundipe, left, Matthew Auyong (piano) and John Charitable (flute)performed during the ceremony in April.
COMMUNITY
ordained minister who approached Bergsaying he wanted to give thanks for the opportunity to learn with a cadaver. Upstate’s first annual cadaver memorialservice was held in 1980. Then a few yearslater, Berg says, “we were one of the firstmedical schools, if not the first, to invite the families to participate.” Today, manyfamilies of people who made donations in the previous year attend the ceremony,which includes music and other artistic presentations by students.
Eugene White’s family
was delighted to share his story.
He was diagnosed with a brain tumor inNovember 2010, after a curious round ofthe strategic family board game, Sequence.White contemplated his move longer thanusual, then placed an ace of spades on ajack. His children immediately knew some-thing was seriously wrong, Bonnet recalls.
Her father was a solid, muscular man of 80who was active and healthy until doctorsfound the tumor. He had surgery to removethe tumor and came home from the hospitalin time for Christmas. Children and grand-children called the zig-zag scar on the backof his head his Harry Potter scar. He underwent 36 sessions of radiation, andthen chemotherapy. He died 13 monthsafter his diagnosis. He had made his wishesknown, to make an anatomical gift of hisbody when he died.
“My dad was fascinated by science,” Bonnet says. He was an industrial engineer,and when he retired from Miller BrewingCompany in Fulton he began volunteeringwith the CNY Eye Bank and was introduced to cadaver research. “He andMom knew that the research behind the replacement knee joint was based on cadaver research and were fascinated with the progress made between the firstand second replacements Mom received.
“He really believed in paying it forward and being part of the bigger picture that science could offer, and we believe that the anatomical gifting program gave himthat opportunity.”
Eugene White’s daughter, wife and son. In all, eight of his family members attended the memorial service.
How to donate yoUr body• Request a brochure from the
CNY Anatomical Gift Programby calling 315-464-4348.
• Adults who are free of infectious disease and not excessively overweight are eligible donors.
• Sign an “anatomical giftpledge” found on the Upstate.edu website or in the program brochure.
• Let your family know yourwishes. If you anticipate disagreement, learn how toappoint an agent to carry out your wishes by calling 315-464-4348.
• Make sure a funeral directordelivers the body, with a death certificate, within two days of death.
• Realize that professors andstudents are not licensed to conduct autopsies and cannot make determinationsconcerning the cause of death.However, if they find something interesting or unusual, they can let your loved ones know.
15spring�2012� UP STAT E H E A LTHKnowing changes everything.SM
�
COMMUNITY
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To hear Sean Behm describe hiswork at Upstate, you wonderwhat his specialty must be.
“It’s a step-by-step process,” he says.“It’s nothing you can rush through. Youhave to take your time and do it right.”
Neurosurgery? Heart valve replacement?
“It’s very enjoyable,” he continues. “It can be nerve-wracking, but the endproduct is something you can be proudof forever.”
Rehabilitative therapy? Orthopedics? …Woodworking?
Behm is a carpenter in the physical plant,and he proves that skillful precision isnot the exclusive province of surgeons in the operating room. He crafted a tableout of the wood from a black walnuttree which was planted the year Weiskotten Hall was built in 1936. The tree was cut down last year becausedisease made it a safety hazard.
Behm, 43, of Liverpool says wood-working was “something to do way outin the sticks” growing up in the town ofSavannah, west of Syracuse in WayneCounty. He learned the craft from his father, who was a welder. Behm remembers helping him make
bookshelves when he was 8 or 10 yearsold. “I was just helping Dad out at thatpoint, but it was something that was ingrained in my head forever.”
Behm became a carpenter and spent theearly years of his career working for acustom deck builder, and attention to detail was critical. Since then he’s madecountless sets of bookshelves, hopechests, kitchen cabinets and bathroomvanities. He works with oak, maple, ash and exotics such as Honduran rosewoods and South American ipe, but his favorite is walnut.
“I really like the grain. I like the darkcolor. It’s got the cream on the outside.New growth of the tree is what thatcream color is. The rest of it, where it’s turning darker toward the center, is called the heartwood.”
He spent two weeks working on thetable. Inspired by the work of architect/woodworker George Nakashima, Behm worked up a plan in his head before putting pencil to paper.
“I love a challenge,” he says, and crafting a table out of a tree “is definitely a challenge.”
Behm’s table has become part of the furnishings in Weiskotten Hall.
Carpenter turns black walnut tree into commemorative table
The table Sean Behm made has two angled leg supports, which attach with wooden pegs he made. It is sealed with five coats of tung oil and three coats of briwax, a cabinet maker’s wax.
tHe Upstate
Ethicist
sHoUld science be sHared tHis way?“The nature of science in generalhas been one of openness andsharing, even before we calledscience ‘science,’ back to Platoand Aristotle,” says Gregory Eastwood MD, professor ofbioethics and humanities at Upstate. That philosophy pervades science today –for the most part.
When scientists at two laboratories tinkered with a bird flu virus to make it morecontagious, they sparked debateover whether to share details inscientific journals. Some criticizedthe value of the research itself.Others wanted to keep informa-tion out of the hands of terroristsand amateur biologists whomight recreate the mutated virus and release it on purpose or by accident.
Not all science is open. The theory of the earth revolvingaround the sun was suppressedin the 1600s for religious and political reasons, for example,and the atom bomb was developed in secret during World War II. In the case of birdflu research, once revisions weremade, the National Science Advisory Board for Biosecuritysupported publication.
Eastwood reminds us that science is ethically neutral. It’show the science is used and themoral consequences of the usesthat may raise ethical concerns.
�
WORK
He’s not someone hospital patients would encounter dur-ing their stay, but Doug Clark,54, of Liverpool plays a role
that’s essential to campus operations. He works for the Information ManagementTechnology department. Most shifts operate8 a.m. to 5 p.m., with technicians on callfor after-hours support.
What he does: “Install and support Windows-based applications on clientservers. We also work with vendors planning the installation and making surethat the servers are built to meet their requirements for operation. We do a lot of remote access with those vendors.
“After the installations are complete, wework with the vendors to troubleshoot any problems that may arise, such as upgrading or applying fixes to the variousapplications.”
How he got his start: His freshman year atNottingham High School in Syracuse,Clark’s guidance counselor (Regina Reilly)helped him secure an apprenticeship withIBM. He also worked retail jobs at DeyBrothers and JC Penney where he learnedhis customer service skills. He majored inbusiness administration at Onondaga Community College and then took a job at Syracuse Savings Bank as a key punchoperator and later, a computer operator. He worked for Health Care Data Systems
at Crouse Hospital for 14 years before joining Upstate in 1997.
What his day is like: “I start by monitoringany jobs or scheduled tasks to make surethey worked properly. Then I work on anyspecial projects that may have been assignedby my manager, RJ Dollard.
“I do a lot of restoring of files (documentsor databases) for our customer base oncampus. I have sort of crowned myself the ‘Restore King’ of Upstate. I have hadpeople literally bow to me for saving theirdatabases, documents or six years of research that may have been deleted or become corrupt. I tell them, ‘You don’t have to bow to me. I’m just doing my job.’”
What his parents think: Stanley and Drucilla Clark of Syracuse are proud theirson for putting his education to good use.They don’t have a computer. “My sistersand I keep trying to get them into the 21st century, so that they will stop asking us to look things up for them on the Internet,” Clark says.
His back-up career: The restaurant industry. “I do a lot of baking and cooking.I’ve got some of our family recipes that I’ve been improving upon. Pound cake is my specialty.
“One day I would like to open up a cafeteria-style restaurant similar to the ones that are in the Southern states.”
avoiding bUrnoUt
Google Vice President MarissaMayer believes that burnout
is about resentment. “You beat it by knowing what it is you’regiving up that makes you resentful,” she writes inBloomberg Businessweek.
She suggests finding yourrhythm, what matters to you so much that when you miss it,you’re resentful of your job. Itcould be a standing dinner withfriends, your kids’ recitals andsoccer games, or something else.Once you understand what matters, Mayer says to do every-thing you can to protect that. It will help you focus and work efficiently, and avoid burnout.
“You can’t have everything you want, but you can have thethings that really matter to you,”she writes. “And thinking thatway empowers you to work really hard for a really long period of time.”
Martha Beck, author of “FindingYour Way in a Wild New World,”says it’s never too late to pursue a passion. Think back and remember experiences thatcaused you to forget that timewas passing, she suggests in Parade magazine. Look for patterns to determine which activities are “hot tracks” foryou, things that connect you with your passion.
Next, look at your schedule andnotice the activities that rangefrom cool to warm. Replace onecool thing with something warminstead. “This way, you can findyour passion without quittingyour job,” Beck writes. “Overtime, little steps may lead to big changes.”
Meet Doug Clark, information management technologist
17spring�2012�� UP STAT E H E A LTHKnowing changes everything.SM
“You can’t have everything...but you can have the thingsthat really matter to you.”
�
GOODJOB
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FOOD
Preparation
To make the yogurt cheese, strain yogurt in fine mesh strainer or wrap it in several layers ofcheese cloth placed over a container to catch the liquid for two hours in the refrigerator.Then discard the liquid.
To toast pecans, preheat sauté pan over low heat. Add pecans and toast gently for 2 to 4 minutes. Remove from heat. Stir in honey and toss to coat. Lay out on flat surface,sprinkle with salt, and reserve.
In a saucepan, combine the sugar, water, vanilla and zest from both lemon and lime. Simmer gently for 5 minutes or until sugar is dissolved and liquid looks syrupy. Place washed and cut fruit in large bowl. Pour warm syrup over fruit and gently toss. Marinate for 30 minutes in refrigerator.
To assemble, place ½ cup of yogurt cheese (or plain Greek yogurt) in dish or wide glass. Top with ½ cup marinated berries. Sprinkle with 1 tablespoon toasted pecans, and garnish with mint sprig. Serves four.
Ingredients
2 2⁄3 cup plain low-fat yogurt, or Greek yogurt
¼ cup toasted pecans or other nuts
¼ teaspoon kosher salt
1 teaspoon honey
11⁄3 tablespoons sugar
1⁄2 teaspoon fresh lemon peel, grated
Juice from ½ lemon
Juice from ½ lime
1⁄2 cup water
1⁄8 teaspoon pure vanilla extract
4 ounces fresh blueberries
4 ounces fresh strawberries
4 ounces fresh raspberries
½ teaspoon fresh lime peel, grated
4 mint sprigs
Note: Berries may be substituted for oneanother based on availability.
Nutritional information, per serving
215 calories; 8 grams fat, including 2 grams saturated fat; 10 grams protein; 10 milligrams cholesterol; 264 milligrams sodium; and 23 grams sugar
Marinated Fresh Berries with Yogurt Cheese and Toasted Pecansby�bill�gOkeyexecutive sous chef for Morrison Healthcare, which provides food services for Upstate Medical University
The berry harvest is prime time for enjoying this light dessert, which is simple to assemble. With the right mesh strainer or cheese cloth, the yogurt cheese practically makes itself – perhaps while you’re out picking fresh berries. Berries,especially blueberries and blackberries, are powerful sources of antioxidants,
compounds believed to prevent or repair cell damage that occurs during oxidation.
farro provides fiber, protein
One of our planet’s oldest cultivated grains, farro was
the primary grain consumed bythe Roman Empire, and today theWhole Grain Council says the ancient wheat grain, farro ismaking a comeback as a gourmet specialty.
It’s also a great nutritional choicebecause it is high in fiber andprotein and is a good source ofcomplex carbohydrates. Farro hasno sugar, no cholesterol, almostno sodium and a low gluten con-tent. Some farros require soakingovernight but most can be usedin any dish that calls for pasta,rice, barley or wheat.
To prepare farro, boil until softbut still crunchy. Eat it plain, orblend it into a soup, salad orpilaf. Farro has a nutty flavor.“The Splendid Table” columnistrecently suggested eating farrohot or at room temperature, witha twirl of olive oil, a few tornleaves of herbs and grinds ofblack pepper.
�
Knowing changes everything.SM 19
overweigHt doctors avoid talking aboUt weigHt
If your doctor is overweight or obese, he or she may be less likely to counsel you about losing weight. Research bya team at Johns Hopkins Bloomberg School of Public Health found that heavy doctors discuss weight loss less
frequently with obese patients (18 percent) than doctors who have normal body mass indexes (30 percent.)
“It seems to be the case that doctors are less likely to diagnose the patient until the patient’s weightmeets or exceeds their own,” Sara Bleich told National Public Radio. She is an assistant professor ofhealth policy and lead author of the study, published in the journal, Obesity.
The heavier doctors were also significantly less confident of their abilities to counsel patients about diet or exercise.
Bleich did find that heavy doctors surpassed those of normal weight in one area. They were more confident prescribing weight-loss drugs – maybe because of personal experience, or because they understand how difficult it is to change behaviors.
FOOD
Radiation
Check with your doctor: about ironsupplements, since preventing anemiacan help radiation work better.
Eat: iron-rich foods, along with an orange or another food high in vitamin C, so that your body more easily absorbs the iron; and low-residue foods if your treatment is in the abdominal or pelvic area.
Iron-rich foods include fortified cereals, red meats, peas, nuts, andspinach and other green leafy vegetables. Foods high in vitamin Cinclude citrus fruits, broccoli, cabbageand sweet red peppers.
Foods low in residue include meatsand fish; eggs; milk (up to 2 cups per day), potatoes; cooked spinach,asparagus, beets, eggplant, greenbeans and rutabaga; applesauce andfruit cocktail; fruit and vegetablejuices or purees; white pasta and couscous; white flour bread, crackersand pancakes; graham crackers; broth and bouillon.
Avoid: popcorn, since it can cause diarrhea or bowel obstruction soonafter abdominal or pelvic radiationtherapy; onions and seeds.
Surgery
Check with your doctor: to see ifyou need vitamin or mineral supple-ments, since vitamin C, calcium, iron,magnesium and potassium are considered essential healing nutrients.
Eat: protein-rich foods to help restoreyour strength and build new cells inthe first few weeks after surgery. Also, look for lower-fat versions offoods to avoid cramping and bloating.Your body likely will tolerate six small meals per day better than three larger meals.
Protein-rich foods include meat, fish and poultry; eggs; milk, yogurtand cheese; lentils and beans; nuts andpeanut butter.
Avoid: any foods that your doctor restricts.
Also: don’t forget about hydration.Sip beverages, particularly water,throughout the day.
Chemotherapy
Check with your doctor: if nauseaprevents you from eating.
Eat: simple meals of foods you like,and know that changes in the taste offoods is common. You may not havemuch of an appetite, but rememberthat nutrition is important for healing.
Avoid: raw or undercooked meat orfish; raw eggs or milk products; agedcheeses such as brie, blue, feta, sharp cheddar; honey, nuts, fruits orvegetable juices; raw fruits (other than peeled and washed thick-skinnedfruits such as cantaloupe, honeydewmelon, watermelon, oranges and bananas.) The concern is to reduceyour risk of infection, especially ifyour white blood cells count drops dangerously low.
Also: rest often and try to do some activity every day to fight fatigue. If constipation is an issue, ask yourdoctor about increasing your fluid intake, eating more fiber or taking a stool softener or laxative.
In addition to affecting physical health, food plays a major role in yourmental health and well-being,” according to the Betty Crocker Livingwith Cancer Cookbook. “The food you eat affects your energy level andhow well you sleep and think.”
Here are some considerations for three common cancer treatments:
“What to eat during cancer treatment
spring�2012�� UP STAT E H E A LTH
w w w . u p s t a t e . e d u20 UP STAT E H E A LTH spring�2012
LEISURE
Burncalorie
Should you consider a bicycle commute?
The exact number of caloriesyou burn is affected by your
age, body size and compositionand your level of physical fitness.Use this as a guide, for a personweighing 176 pounds who doesthe activity for an hour:
Teresa Hargrave MD
assisTanT�prOfessOr�Of�psycHiaTry�anD�beHaviOral�sciences
What she rides:A blue Cannondale 21 speed hybrid.
How long she has been commuting:“It’s been more than 20 years. I rode a bikeas a kid, but I’ve become a lot more avidbiker in my adult life, particularly since I married a biker.”
Where she lives:The Westcott area of Syracuse, a little more than a mile from Upstate.
Why she rides:“It’s good for me, and it’s good for the planet.”
Once at work:She removes her backpack, peels off somelayers and is ready to see patients.
In bad weather:“I do not bike in icy weather. If the road isdry, or even wet but above freezing, thenI’m up for biking. Sometimes, if it’s reallynasty I don’t do it, even though I could. I have rain gear.”
Safety measures:“I choose my route very carefully. I preferto take an alternate route other than EastGenesee Street. I wear clothing so that people are going to see me. I wear reflectiveitems for the dark. And I always wear a helmet. Always.”
Advice to would-be bicycle commuters:“Take the plunge and do it. You have to not worry about how you look, and wear whatever clothing you need to stay warmand protected and safe.”
With gas hovering around $4 a gallon, the concept of pedaling to work, instead of driving, may be moreappealing. Bike riding can save money and help
you combine your workout with your commute. Meet three Upstate people who have decades of experience as bike riders:
Fishing 300 calories
Billiards 204 calories
Window washing 312 calories
Squash 1,020 calories
Whitewater rafting, recreational 420 calories
Knowing changes everything.SM 21spring�2012�� UP STAT E H E A LTH
LEISURE
Michael Lyon PhD
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What he rides:“Sometimes a recumbent bike, and sometimes a Cannondale or a Giant.”
How long he has been commuting:“Since 1995.”
Where he lives:“Memphis, 18 miles from Upstate.”
Why he rides: “For pleasure and for fitness. I like to eat, and when I bike I can eat. This does create a problem in the winter when my miles decrease.”
Once at work:“It is too long a commute to wear work clothes. I shower there.”
In bad weather:“If it is raining before I leave the house I tend to avoid it,but I have ridden in some really bad rain. Snow, I also tryto avoid. That is when I ride the Giant, my ‘winter rat.’Coming in to work, I frequently leave before the sun is up,but this is not like leaving late from work. I can’t alwaysleave here early enough in the winter to avoid the dark.That is not my favorite time to ride.”
Safety measures: “I have a number of lights and reflective clothing items. I always try to let the cars know well in advance what I plan on doing.”
Advice to would-be bicycle commuters:“Just do it.”
Richard O’Neill PhD
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What he rides:“An inexpensive mountain bike, a hand-me-down from my son whenhe went off to college. I prefer it because it has bigger tires for manag-ing cracks and potholes. The firstcouple of times I rode my road biketo work, I got a flat tire each day.”
How long he has been commuting: “Four or five years. I was runningback and forth before that.”
Where he lives:“Exactly four miles from campus. I go through Thornden Park and then across Westcott. I try to stay off the main roads so I have less traffic.”
Why he rides:“I’m a runner. I started to bike ride to work because I wanted to get in more training, I didn’t want to spendmore time running, and I wanted to have less pounding on my joints.”
Once at work:“I have a closet in my office, and I keep several sets ofclothes in it. And I have curly hair, so I just fluff it up after I take off my helmet.”
In bad weather:“With the right kind of gear you can manage virtually any kind of weather. I ride in the rain and the cold. TheSyracuse Public Works people do a great job keeping thestreets plowed and salted. There are very few days whenyou can’t ride your bike. Two winters ago, there were only about 15 days when I couldn’t ride – and on thosedays I run.”
Safety measures:“Ninety-five percent of bicycle fatalities happen to peoplewho are not wearing a helmet. So you have to wear a helmet.” He also wears clear ultraviolet goggles to protecthis eyes from the sun and any flying road debris.
“I have two headlights, one that blinks and one that’s constantly on for riding in the dark, and a flashing red light in the rear.”
Advice to would-be bicycle commuters: “You will get very good at minimizing the amount of stuffthat you carry. You will get very good about how to dressand how many layers. It takes a little time, but if you startin the summer, by the time winter rolls around you’velearned how to ride in virtually any kind of weather.”
Bicycle Commuting —continued from page 20
�
Why I love fishingby�Dave�sikOra
LEISURE
Deborah Tarbell, who super-vises the snack bar in the
Campus Activities Building, is afan of The Hunger Games bySuzanne Collins, the first book ina trilogy that was made into amovie this spring.
“It's written for the young adultbut, believe me, it is excellent,”she promises, explaining that she read the first book “like amadwoman” before devouringthe next two.
The series is set in a post-apocalyptic United States, with the country divided into 12districts. A capitol district (calledPanem) has all the riches andcontrols everything. Once a yeardistricts are required to choose“tributes” via lottery and sendone male and one female be-tween the ages of 12 and 19 tothe hunger games held in thecapitol. The tributes fight to thedeath.
Because Panem forbids hunting,Katniss puts herself in great danger in order to prevent herfamily from starving. She is ateen who lost her father in amining accident and feels re-sponsible for providing food forher mother and little sister,Primm. When Primm is chosenfor the hunger games, Katnisssteps in to take her place.
Tarbell says, “It’s a fast, entertaining series that will takeyou far away from the here andnow – and isn’t that why weread fiction?”
goodrEAd
w w w . u p s t a t e . e d u22 UP STAT E H E A LTH spring�2012
1I find solitude. It’s just relaxing. The bottom line is being out by yourself, being out in the wild where there’s no phone and no traffic and nothing to bother you.
You get a better outlook on life after going fishing.
2Fishing was a major part of growing up. I remember going with Dad after work. We’d go out to the river or the lake. We’d pack a lunch and fish right into dark.
I’d learn a lot of lessons, and not just about fishing but good father-son things about respect, integrity and being yourself.
3I enjoy actually catching fish. I’ve fished for just about every species there is in the last 55 years, including trout, bass, perch, pike, bullheads, salmon, walleye.
You’ve got to know what type of species you’re fishing for. Each species has different traits.Trout like nice clear water. When the sun comes out, they like to hide under banks. To increase your success, you’ve got to know what they eat and how they survive and when they feed.
In the middle of the day when it’s hot, you may as well stay home and read a book. You’re only going to catch a fish when he opens his mouth, and he opens his mouth to eat.You’ve got to be there when they’re hungry.
4 Everything I catch, I eat. It’s an added bonus when you catch a nice fish and take it home.
I enjoy the bounty of fresh fish.
5I have a scrapbook of all the fish we havecaught and places we have gone to fish.
It includes a picture of a 41-pound king salmoncaught Sept. 19, 1989 on Lake Ontario. That’s one ofmy favorite successful fishing stories. I went with myuncle, who was sick at the time. And a week or 10 dayslater, he passed away. Catching that fish together was like a gift from the gods.
6I’m teaching my granddaughter, Abagail, who is 9, how to fish.
She really likes it. I take her fishing along Owasco Lake, on the shore, for bluegills and sunfish. When you have a little child with you, she wants action. She wants to catch fish after fish after fish.
7There’s no such thing as a bad day fishing – even if you don’t catch a lot. �
Dave Sikora, 58, ofAuburn fishes aboutfour times a week, year round. He works in campus physicalplant administration.
by�Dave�sikOra
THE HUMORIST
How conditioned are your willpower muscles?
Willpower is on the defensive thesedays, and with good reason.It’s too much work, and it’s not as effective as it’s
cracked up to be. That isn’t to say Idon’t enjoy people coming up to meand praising my willpower as the key tomy recent weight loss. Taking credit forsomething I don’t deserve is one of theperks of being a recovering fat guy. “You must have incredible willpower,” I hear again and again.
“Why, thank you,” I say. And I think: They don’t get it.Willpower has been conning us for eons. It passes itself offas a cure-all for everything that ails mankind, yet almost always disappoints: If weight is your issue, willpower willtalk a good game early, then dump you as heartlessly asAshton Kutcher dumped Demi Moore.
It’s about time science exposed the truth about willpower,and that’s starting to happen. Willpower is not — as we’vebeen conditioned to believe — some vast Sea of Good inhabited only by the naturally virtuous while the rest flail about on the Beach of Self-indulgence.
The better analogy is that willpower is a muscle. Some people have self-control muscles that are better conditionedthan others, but all of them fail when sufficiently taxed.What does this mean for dieters? It means that if willpoweris your primary strategy to take off weight and keep it off,you should spare yourself the bother and proceed directly tothe donut shop. All that extra sugar might even boost yourwillpower, and that’s no joke.
A European research team has shown that even simple actsof willpower are so physically draining on the brain andbody that they cause blood glucose levels to drop. I’m experiencing that phenomena at this moment as I write thisarticle at the Freedom of Espresso in Fayetteville. For morethan an hour I have been casting baleful looks at the bakerycase, resisting the urge to consume a giant oatmeal cookie.This act of self-control has depleted my glucose levels to the point that I am now making a scientifically valid decision to order and eat the cookie.
There. Much better.
With my glucose levels restored, I am able to once again resist eating a cookie. You see where this cycle leads:Nowhere … which is exactly the point. Willpower is ablack hole of self-denial and surrender.
A famous study from the late 90s supports the notion thatwillpower is finite and exhaustible. A group of college students was ushered into a room redolent of baking chocolate chip cookies. Half were told to eat two cookies;the other half were told to eat at least two radishes but no cookies.
Later, the students were given a puzzle to solve withoutknowing that the puzzle was unsolvable. Researchers discovered that the radish eaters, fatigued from resisting
cookies, gave up on the puzzle an average of11 minutes sooner than the cookie eaters.
Conclusion: People who eat radishes arelazy. In its defense, willpower can bestrengthened, retrained and cajoledinto being more of an asset. It’s usefulin quick bursts and for jump-starting
positive change. But a new article in Scientific American Mind focuses on
strategies that go beyond impulse control.
Make small changes and build on them. Account forinevitable setbacks. Find specific internal (versus external)sources of motivation. For example, “I am going to stopeating triple bacon cheeseburgers because my doctor wantsme to lose weight” probably won’t spur a lifestyle shift. But thinking, “I am going to stop eating triple baconcheeseburgers because I want to buy a Mini Cooper and I will enjoy it more if I can physically fit behind the steering wheel” just might work.
The idea is to align your desires, thoughts, actions and goalsso they all pull in the same direction.
For this reason I may be the only person in America who is happy about Pink Slime. When news broke about thewidespread adulteration of ground beef with meat byproducts sanitized in ammonia and turned into a finepaste, consumers went bonkers. Not me. Thanks to thespecter of Pink Slime it’s now easier for me to resist fatty,caloric cheeseburgers and red meat in general. The lesswillpower I require to resist the burgers the greater mychances for success. Plus it means I have more willpowerleft for other mentally challenging tasks such as finding mycar keys and yelling at my dog for stealing zucchini bread.
As you go forward with your self-improvement goals, itmight be helpful to think of willpower as the cognitiveequivalent of New York City. Yes, it’s a fine place to visit.But would you really want to live there?
Knowing changes everything.SM 23
Veteran journalist Jeff Kramer alsowrites for the “What’s Up at Upstate”blog the first Monday of every month at upstate.edu/whatsup.
spring�2012�� UP STAT E H E A LTH
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750 East Adams Street l Syracuse, NY 13210
SCIENCE
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PeterCalvert PhD
11.3400212 31.2M ELsk
As a young graduate student he was interested
in understanding our perception of the world, physiologically. TodayPeter Calvert PhD conducts research that focuses on visual trans-duction at Upstate’s Center for Vision Research. He studies the proteins inside thephotoreceptors in the retinas of African clawedfrogs to understand howproteins are transportedand what happens to that process during degenerative diseases suchas retinitis pigmentosa.
