UPSTATE MEDICAL UNIVERSITY

Taking to the

hospitalyour child

bringing precision

to the cancerfight

energydrinks

dangersof

marathonwhat it takes

to win a

Should you

a feeding tube?ok

Winter 2013Health UPSTATE

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CONTENTS

The Upstate Ethicist

Questions & Answers

Advice for Caregivers from Caregivers

In the Know

CalorieBurn

Good Reads

Lessons from Upstate

Science is Art is Science

1114

1615

Lung cancerscreening

Pertussisvaccine

Fresh air Fruits &vegetables

Yoga

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6

4 6 14 19 21

8

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10

13

20

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ON THE COVER: OLAMIDE (‘MIDE) AJAGBE MD IS ONE OF NINE PEDIATRICIANS WHO CARE FOR PATIENTS AT THE GOLISANO AFTER HOURSCARE CENTER AT UPSTATE’S COMMUNITY CAMPUS. DR. AJAGBE IS ASSISTANT PROFESSOR OF PEDIATRICS AT UPSTATE MEDICAL UNIVERSITY. PHOTO BY ROBERT MESCAVAGE.

In everyissue

HealthA stem cell transplant saved this young man’s life

The pump that gives sick heart patients a chance

Making progress toward an artificial pancreas

Five features of pediatric emergency care

AdviceHow to manage cancer fatigue

Googling about gallstonesCoping with stress

Community‘Oz’ author had heart disease

Memorializing patients

What the Community Campus looks like now

Helping refugees settle in Syracuse

WorkMeet systems engineer Mark Torres

FoodBehind the scenes in the hospital kitchen Dangers of energy drinks

Balsamic Roasted Portobello Sandwich

LeisureUnder the sea with Jason Meany

Why Sue Milliman loves singing

910

GoodforYou

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Knowing changes everything.SM 3winter 2013 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 &

University Communications

editor-in-cHief Amber Smith

Writers Amber Smith, Jeff Kramer,Jim McKeever, Susan Keeter

designer Susan Keeter

pHotograpHyRobert Mescavage (cover, 7, 18, 19, 20)

Susan Kahn (pgs. 3, 4, 10, 17, 23) William Mueller (pgs. 5, 12, 14, 20)

Medical Photography (pgs. 5, 6, 9, 10)Susan Keeter (pgs. 14, 16) Richard Whelsky (pg. 8)

Stephen D. Cannerelli (pg. 22) Lucy Barbera (pg. 3)

Shweta Shreyarthi (pg. 14)Roger Luther (pg. 3)

illUstrationsDan Cameron (pgs. 13, 15)Randy Glasenberg (pg. 2)

Hope and Serenity, mask artists (pg. 3), W.W. Denslow (pg. 11),

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 smithamb@upstate.edu

additional copies: 315-464-4836.

Upstate Health offices are located at 250 Harrison St., Syracuse, NY 13202

Health UPSTATE

Winter 2013

You may not have your ears tuned to radio stationWSYR-FM 106.9 from 9 to 10 a.m. Sunday mornings. But you can still listen to the weekly talk radio show produced by Upstate for the last 7 1/2 years.

It’s easier than ever to visit upstate.edu/healthlinkonair to listen to that week’s show, or search for a medical topic.All of our interviews are archived for easy retrieval at the “Health Link on Air” website. You will find clipsfrom some of our top researchers and leading doctors and caregivers sharing health information of importance to Central New Yorkers.

Interviews featuring specific doctors are also attached tothat doctor’s profile page – available at the upstate.eduhome page by searching “Find a Doc.” Examples:

• Has your family faced a stroke? Hear Eric DeShaies MD,Upstate’s neurovascular director, explain the care availableat Upstate.

• Are you grappling with the feeding tube issue? Upstate’s chief of geriatrics, Sharon Brangman MD, offers some new ways of thinking. (Also on page 9.)

• Is weight loss surgery a consideration? Howard SimonMD, bariatric surgery chief, explains the process.

Many of our radio interviews form the basis for articlesyou’ll read on these pages, or on the What’s Up at Upstateblog at upstate.edu/whatsup. So even if you aren’t close to the radio dial on Sunday mornings, you can still be informed.

Need a referral or more information?

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

Upstate Health is published by the Office of Marketing and University Communications. Upstate Medical Uni-versity in Syracuse, NY, is an academicmedical center with four colleges –Medicine, Nursing, Health Professionsand Graduate Studies – as well as an ex-tensive clinical health care system thatincludes Upstate University Hospital’sdowntown and community campuses,the Upstate Golisano Children’s Hospitaland numerous satellite sites. Affiliatedwith the State University of New York,Upstate is Onondaga County’s largestemployer.

by thenumbers

times per day that patients refer to

Emily Hollywood MD as “Doc Hollywood.” She is completing her third year of residency in Upstate University Hospital’s Emergency Department and says

she hasn’t tired of the nickname yet,

“but that’s my maiden name, so if I ever do get tired of it, theoretically

I could change it.”

32masks of hope and healing were

exhibited in October, the creations ofyoung artists who have been patients atthe Upstate Golisano Children’s Hospital.

years since the New York State Inebriate Asylum, a Gothic Revivalstyle “castle,” opened in Binghamton.Vacant since the 1990s, the building is being restored to become an Upstate campus satellite which will provide medical and health professions education.

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HEALTH

Jared Saya was 2 when his motherbrought him to Upstate UniversityHospital’s pediatric emergency department with bruises on his arm.

She thought he had fallen. He had cancer.

“We stayed at Upstate for six months fromthat day, getting chemotherapy,” recalls his mother, Geralyn Saya of Syracuse. For 18 months he was in remission.

Then at age 4, Jared relapsed. Doctors saidhe needed an infusion of healthy stem cells,since his bone marrow was not producingenough. So he underwent a stem cell transplant, relying on the generosity of ananonymous mother who donated bloodfrom her newborn baby’s umbilical cord or placenta. Jared was hospitalized in isolation for five months, in Rochester sinceUpstate did not offer stem cell transplantsat the time.

Jared is 14 today, a freshman soccer playerat Christian Brothers Academy who alsoplays for the indoor club team, Fusion. He recently attended the groundbreakingceremony for Upstate’s new $15 millionpublic cord blood bank.

The bank, being built at Upstate UniversityHospital’s Community Campus, will storecord blood donations that may be used intreatment or for research. It is expected toopen in 2014. Eventually, Upstate may offer cord blood transplants.

“Through the donations of cord bloodfrom families all across our region, we have the ability to save lives through trans-plantation and further fuel the biomedicalresearch that may move us closer in findingbreakthroughs for dozens of diseases,” Upstate President David Smith MD toldThe Post-Standard newspaper.

For all the promise cord blood transplantscarry, Saya says she would change one practice. She would like to know who donated the stem cells that changed herson’s blood type and allowed him to become healthy again.

“Somebody saved my son’s life, and shedoesn’t even know that. What a gift to give somebody. I can only thank everybodywho donates.”

Cord blood bank will contribute to research, treatment options

neW screening for lUng cancer

Anew lung cancer screeningprogram is now offered by

the Upstate Cancer Center andthe Upstate Radiology Depart-ment. Low-dose computerizedtomography (CT) scans are forsmokers between the ages of 55 and 74 or former smokerswho quit within the past 15years and who have a smokinghistory of at least 30 pack years(a pack a day for 30 years, ortwo packs a day for 15 years.)

The scans cost $235 and are not covered by medical insurers. They do not require injections or medications. Lung scans can be scheduled, or gift certifi-cates can be purchased forsomeone you feel should bescreened, by calling 315-464-6303.

Participants also receive:

• an interpretation of the findings by a dedicated chest radiologist,

• a CD with the images for theparticipant’s personal records,

• letters to their personal physicians,

• smoking cessation classes,

• referrals to other medical professionals and Upstate’smultidisciplinary Thoracic Oncology Program if necessary.

Medical director Leslie KohmanMD said the program was created because of a recent landmark study showing thatscreening with a low-dose CTscan of the lungs can detect tumors early and can reducelung cancer mortality by up to 20 percent for high-risk smokersand ex-smokers.

Listen to this interviewat upstate.edu/healthlinkonair by searching for “lung cancer.”

�

Jared Saya, 14, is wild about soccer today. As a pre-schooler he battled cancer. Kids made fun of him when hewas bald during chemotherapy.

Listen to a related interview at upstate.edu/healthlinkonair by searching for “cord blood.”

PATIENTSfirst

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Cardiologists at Upstate are using a new pumping device to extendthe lives of patients with severeforms of heart disease. Patients

suffering heart failure, and those whosehearts are too weak to tolerate angioplastyare candidates for the device called Impella®.

Doctors insert the pump through a catheterthat enters the heart through its main artery, the aorta. The pump is about thesize of a triple A battery. It spins rapidly,like a corkscrew, propelling blood back-ward from the left ventricle out to the body to maintain circulation.

Hani Kozman MD said some patients require the Impella during a medical crisissuch as a severe heart attack. Other patientsare considered high-risk for repairs to theircoronary arteries, and the Impella is placedbefore the patients undergo theirprocedures. The disposable pumps,which may remain for a few hours upto several days, connect to monitorsthat provide the electrical source. Upstate has two monitors.

“It’s for the really, really sick patients,for whom there is no alternative,”said Kozman, director of the Cardiac Catheterization Laboratoryat Upstate.

David Grugan was just such a patient. The 62-year-old Auburnman said he has come close todeath twice and is grateful to Kozman and the Impella (made by Abiomed). After a heart attackin 2009, Grugan had four stentsplaced to prevent blockages in hiscoronary arteries. Later, Luna BhattaMD, director of Upstate’s Electro-physiology Laboratory, implanted a defibrillator in his chest that would automatically restart his heart if it stopped beating.

Months later, he began having very limitingchest pain and trouble breathing. He wasfound to have additional blockages formingin his coronary arteries. However, with hisweak heart function, fixing these would berisky. Kozman spoke with Grugan about

his options, and Grugansaid he appreciated thedoctor’s honesty. His heart would need help pumping during theprocedure. Grugan wouldbe on the Impella pumpwhile additional stentswere inserted into his heartarteries. Grugan agreed.

“I thought I was going tobe there for the weekend,because I had this done ona Thursday,” he recalled.But the day after the procedure, Kozman saidGrugan could go home.Grugan recovered well. His symptoms have improved significantly, and he is able to continue on with life as usual.

HEALTH

Knowing changes everything.SM 5winter 2013 UP STAT E H E A LTH

�

Impella device assists patients with severe heart disease

Listen to this interview at upstate.edu/healthlinkonair by searching for “Impella.”

Hani Kozman MD

Luna Bhatta MD

Upstate at commUnityplans geriatric emergency Unit

Senior citizens can be challenging patients. Often

they have other medical conditions and/or multiple prescriptions that complicatetheir emergency. They may agitate or confuse easily, andthey may have trouble express-ing themselves. Often, it's notlong before they are back at the hospital because underlying issues weren't addressed. Notonly is this inconvenient andcostly, it’s not the best medicine.

With that in mind, Upstate is creating a new Geriatric Emergency Medicine Unit calledGEM Care, The Senior ED. Theunit, led by emergency physicianJames Ciaccio MD, will open byearly summer in a dedicated section of the emergency depart-ment at Upstate University Hospital, Community Campus.

Details are being worked out,but GEM Care will be character-ized by a calm, measured approach to care in a quiet environment. Clocks will havelarger, more visible numbers.Rails will line the walls, floorswill be nonskid, paint colors will be soothing, and mattresses will be thicker. Most important, staff working in the unit will be specially trained to treat patients60+, address their unique sociological and psychologicalneeds — and the concerns oftheir families — and ultimatelymake their emergency stay asstress-free as possible.

Listen to this interviewat upstate.edu/healthlinkonair bysearching for “geriatricemergency unit.”

James Ciaccio MD

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HEALTH

taking steps toWarda more normal lifefor tHose WitH diabetes

Without a pancreas thatmakes enough insulin,

people with type 1 diabetes must continually check theirblood sugar, track what they eatand when, and make sure theyreceive proper injections of thehormone insulin that is crucial to metabolism.

There are continuous glucose(sugar) monitors. And there areinsulin pumps which deliver varying amounts of insulin. Butthese two technologies have not“talked to each other” – until now.

Some patients from Upstate’sJoslin Diabetes Center are testinga new device that monitors bloodsugar levels and transmits thatinformation to an insulin pump. It sounds an alarm if the bloodsugar level drops dangerouslylow while the person is asleep. If he or she awakes and respondsto the device, it resumes monitor-ing with no change in insulin delivery. If there is no interven-tion, however, the device halts its programmed insulin infusions for up to two hours.

“The ultimate goal is to be ableto deliver insulin in a way thepancreas would normally deliverit to keep the blood sugars nor-mal, to prevent the very high and low blood sugars that areproblematic with current treat-ments,” says Ruth Weinstock MDPhD, division chief of endocrinol-ogy, diabetes and metabolism.“This is the first baby step to actually achieving a full artificial pancreas.”

Why is a vaccine-preventable illness on the rise? No, this is not a trick question.

The fact is, more than 34,000 cases of pertussis were reported to the United StatesCenters for Disease Control and Prevention,and 48 states – including New York – saw increases in infection rates in 2012. In Central New York, the number of cases of the vaccine-preventable illness, alsoknown as whooping cough, has quadrupledfrom last year.

The highly contagious bacterial infectioncauses a cough that lingers for weeks andcan be deadly, especially to young children.Of the 16 deaths reported to the CDC, most were of infants under 3 months of age.

“We are experiencing, statewide, a real serious problem,” says pediatric infectiousdisease expert Joseph Domachowske MD, a professor of pediatrics and microbiologyand immunology at Upstate. The outbreakseems to be fueled both by adults who areunaware they need a booster vaccinationand adults who don’t want their children to be vaccinated.

“Whooping cough was always considered an infection of babies because they whoopwhen they get this infection, but adoles-cents and adults getpertussis as well. Theydevelop a prolongedcough illness and arejust as contagious asthe babies are. Theyhave the worst coughillness of their lives, and this cough illnesscan last for months,” Domachowske says.

He says incidence of whooping coughdropped to historic lows after a vaccine wasmade available; but around 2005, medicalproviders began to see resurgence. Olderchildren and adults with prolonged coughillnesses were found to have pertussis,which explained why babies were still occasionally infected – and illustrates whyit’s still important for adolescents and adultsto be immunized. The vaccine does not confer lifetime immunity.

Listen to this interview at upstate.edu/healthlinkonair by searching for“whooping cough.”

Why is a vaccine-preventable illness on the rise?

whooping cough

Joseph Domachowske MD

STROKE CENTER

Listen to this interviewat upstate.edu/healthlinkonair by searching for “diabetes.”

THE TIME TO LEARNABOUT OUR ADVANCED

STROKE CAREIS BEFORE YOU NEED IT.

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Nights & weekends: here for sick, injured kids

7Knowing changes everything.SM

HEALTH

These are situations familiar to anyparent: the pediatrician’s office isclosed, and your child has an earache, or a fever, or a nasty cut

from a playground accident. You don’tthink a trip to the emergency room is war-ranted, but your child needs to be seen by adoctor...and you can’t wait until morning.

Upstate came up with a solution, and last February opened Upstate GolisanoAfter Hours Care, the first of its type in thearea. Located on the Community Campus,the After Hours Care center sees an averageof 430 patients per month, and 2,893 children and teens were treated in the first six months.

“It fills the gap between the pediatrician’soffice and the emergency room,” explainsAlison McCrone MD, medical director.“After Hours is for minor illnesses and injuries. We have lab and x-ray services,and can offer a 24-hour supply of prescrip-tions so parents can take their child homeinstead of running to a pharmacy.”

The center is staffed by nine pediatricians,including McCrone, and two emergencymedicine physicians. All are on the facultyat Upstate Medical University.

Olamide Ajagbe MD, assistant professor ofpediatrics, divides her time between work-ing at the After Hours Care center, caringfor patients in the children’s hospital, andteaching medical students and residents.

She arrived at Upstate in 2011 after completing pediatric residencies at both the Nassau County Medical Center and the Mount Sinai School of Medicine. “I interviewed at many medical centers,”

Ajagbe explains. “Upstate had amazing,warm and welcoming people on its staff.

“I am astounded by the need for after hourscare in this community,” she continues.“Over and over, parents tell me how glad they are that this kind of service is available. It’s great working here.”

The center sees patients from birth throughage 21, so the staff see college students aswell as toddlers. This winter, they expect to treat lots of patients for respiratory infections, fevers, and injuries from sledding accidents and other sports.

Golisano After Hours Care is located at Upstate UniversityHospital’s Community Campus, 4900 Broad Rd., Syracuse (between the emergency room and the parking garage). Phone 315-492-KIDS (5437). Hours are Monday through Friday, 4 to 11 p.m.; Saturday and Sunday, noon to 11 p.m. Most insurancesare accepted, all patients up to age 21 are welcome.

5 improvements for pediatric emergencies

If you haven’t been to the emer-gency department with an ill or

injured child lately, you may notrealize how things are changing.Here’s a run-down from Upstate’sRichard Cantor MD, director of the Pediatric Emergency Department:

� “Family care” is a recognitionthat the child is not the onlypatient, that often a sibling andparents are also present. Childlife specialists – made possiblethrough donations from theChildren’s Miracle Network –now staff the department to assist families.

� Wait times have decreased. Average time from walkingthrough the door to meeting a triage nurse is 14 minutes;from triage to room placementis about 35 minutes; and fromroom placement to health careprovider entering the room is12 minutes.

� Pain management is an important part of care now.Children are sedated before uncomfortable procedures,often by inhalation of medica-tion rather than a needle injection. “The days of childrencrying in emergency depart-ments are over,” Cantor says.

� A weight-based medication delivery system means a computer generates a child’sexact dosage, based on size, reducing medication errors.

� To help reduce exposure to radiation, Upstate participatedin a national study to help determine which children withhead injuries need CT scansand which don’t. Doctors alsorely more on sonography forhelp quickly diagnosing chil-dren with, for instance, bellypain. Cantor says imaging thatdoes not use radiation “is lessexpensive, less time consumingand less harmful to the child.”

The center is open evenings and weekends. Its colorful furnishings are based on the Upstate Golisano Children’s Hospital.There are lots of comfortable chairs, and a big TV, a fish tank and fun-house style mirrors that provide entertainment.

Olamide Ajagbe MD with Mia, 5, who was at Upstate’sGolisano After Hours Care because her “ear hurted.”

�

BY SUSAN KEETER

winter 2013 UP STAT E H E A LTH

Richard Cantor MD with a patient.

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ADVICE

How to feel like part of a committeeBY RICH O’NEILL

Qi was asked to join a committee at work, but after two meetings, it’s clear thatthe committee members have no voice. the leader calls us together to report

what he’s doing, but our opinions aren’t sought or appreciated. it seems like a hugewaste of my time. What can i do?

How do you get yourself into the group and contribute in a way that brings the wholegroup toward its goal? One way to begin is by clarifying the committee’s job and your

role in that work. There are three key words: Authority, accountability and responsibility.You can ask ‘What are we authorized to do? Who are we accountable to? What are we re-sponsible for? What is our goal?’ Just asking can get the committee thinking and back ontask again.

The assumption I have is that everybody in the room is there to help the leader be the bestleader he or she can be. So you want to ask yourself, what might be useful for this leader inthis situation? You might even ask the leader: How might I contribute in a way that willhelp you with your task here?

Qmy workplace has a shared kitchen. some coworkers are good about washingtheir dishes immediately while others pile their dishes in the sink. every week

or so things pile up so much that my boss sends an email gently reminding us toclean up after ourselves. What else can she do?

That sink with those dirty dishes reflects the team and the group culture. This is a greatexample of people living in their “person system” without a sense of responsibility to

the rest of the people in the group. This can happen in any team, partnership, or family. Inthis case, what’s happening is people are acting as if they don’t have any relationship withother people. They don’t have any responsibility, any connection to the other people andshared goals.

One of the things the boss can do is call the whole team together and ask questions: ‘Whatkind of values do we want to have? Do we want to be responsible to each other? Do wewant to work together as a team?’ Turn it over to the group. Say, ‘I’m concerned about thisand how it reflects on our team.’ And then support people in creating a culture of responsi-bility. Make it clear that interpersonal responsibility and contributing to the team is whatgets people ahead. The people who do not contribute, who stay inside their self-focused per-son and just do whatever they want without regard to the consequences for the team, thosepeople don’t get ahead. You have to work together in order to function well as a team.

Hear psychologist and researcher Rich O’Neill PhD during Upstate’s weekly radio show, Health Link on Air from 9 to 10 a.m. Sundays on WSYR. Submit your own question by emailing HLOA@upstate.edu.

sHoUld patients leaveagainst medical advice?

About 1 percent of peoplewho seek care at a hospital

emergency department wind upleaving against the advice of thedoctor. They may not like the doctor’s treatment plan. Theymay disagree with the diagnosis.They may start feeling better and decide they don’t want to be hospitalized.

Regardless of the reason for apatient’s early departure, JayBrenner MD, assistant professor of emergency medicineat Upstate, says it’s crucial thatdoctors make sure he or she iscapable of making decisions, understands the diagnosis and is aware of the risks of refusingmedical care — before the patient leaves.

“Physicians should always takeresponsibility for their patients,”he says, noting that they should also respect a patient’sautonomy. “At some point, there is some personal responsibility here.”

Patients who leave against medical advice present chal-lenges for medical researchers.With no guarantee a patient willreturn to the same hospital, andno shared database, researcherscannot track what happens afterthe patient leaves. Thanks to newresearch at Montefiore MedicalCenter in the Bronx, they doknow people who leave an emergency department prematurely have an increasedrisk of readmission within 30 days, and have higher deathrate than those who are senthome when the doctor saysthey’re ready.

tHe Upstate

Ethicist

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a

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CHECK UPFROM THEneck up

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ADVICE

Knowing changes everything.SM 9winter 2013 UP STAT E H E A LTH

WitH sHaron brangman md

Q Aand

Feeding tubes are not for people with Alzheimer’s disease

Toward the end of Alzheimer’s disease, people lose their ability to chew and swallow. Family members often struggle with the proper approach once their lovedone reaches this stage. Food, after all, is so symbolic of caring that to not provide nourishment may seem cruel. Sharon Brangman MD, division chief of geriatrics at

Upstate, points out that Alzheimer’s is a terminal illness. “The end stages of the disease arevery similar to having metastatic cancer of some sort. We know that we can’t make it allbetter. The focus is on taking care of the person and making him or her comfortable.”That should not include use of a feeding tube, she says.

HoW to manage cancer fatigUe

The biologic effects of cancer and/or the side effects of its treatment leave more than 90 percent of patients overwhelmed by fatigue, so much so that everyday life activities become a struggle. As counterintuitive as it may sound, exercise may be the answer, says Cassi Terpening, a doctor

of physical therapy who oversees Upstate’s Cancer Rehabilitation Program. “Moderate intensity exercise performed three to five days a week can decrease a person’s level of fatigue,” she says.

Of course the type and duration of exercise is dictated by the person’s previous activity level and his or her goals. Walking, gentle biking, swimming and light strengthening moves are typical. Terpening says most people feel better after exercising. They sleep better. Their pain is lessened. Their mood is boosted. And they function better. “When they see the progress — and it doesn’t happen immediately — but when they see that change, I think it has a positive effect.”

Join the program with a doctor’s referral by calling 315-464-6543. Physical therapy is offered at offices in East Syracuse, Manlius and Syracuse.

Listen to this interview at upstate.edu/healthlinkonair by searching “cancer fatigue.”

QWhat is wrong with feeding tubes?

“After we’re out of the infant period, we are used toeating solid foods. The liquid nutrition that is put in a

feeding tube is not absorbed by the body as well as solidsare. In many cases, the liquid passes right through the per-son, and then he or she gets diarrhea. They can get skin irri-tation, and it can change the fluid balance in their bodies.

“In the short term, it’s fairly easy to put the tube in. It’s asimple procedure that is often done right at the bedside with some local anesthesia. But in the long term there are a number of complications, and with ongoing research we are starting to question whether we’re causing more harmthan good by inserting feeding tubes into older patients.

“Inserting the tube into the stomach wall can give you localirritation. Some of the acid from the stomach can leak outand damage the skin. The tube can get blocked, the tubecan get displaced and cause more damage, and it does notreduce the concern about food or fluids backing up fromthe stomach and getting into the lungs.”

QWithout food and water, won’t a person starve orbecome dehydrated?

“Because the body is slowly starting to shut down, itis not missing food in the same way as you might be hungry when you are younger.

“We know that sometimes when we try to introduce foodand fluids to a body that is starting that downhill process,we can make that person uncomfortable. He or she can get nauseous or sick to the stomach. They can get cramps or diarrhea. There have been a number of studies that showwe get to the same end point in almost the same amount oftime whether we add a feeding tube or not. It doesn’t post-

pone the end result, which is someone passing away, and itmight actually make him or her worse in the short run.

“Physiologically in terms of how the body is functioning inthis end stage, there are little signals that are starting to turnoff organ function. The brain isn’t working very well, andthe kidneys may start to slow down, and also the ability tounderstand what food is for and the ability to eat is startingto change. We find it very common for people to start topocket food in their mouths. They may chew and chew andnever swallow. Or they may put food in their mouths andnot know what to do with it. Or if they do swallow theymay start coughing because food starts to go down thewrong way and into the lungs.”

QWhat can be done instead?

“Hand feeding is very important. It gives families thatsense that they’re helping – as long as it’s not making the person uncomfortable or irritated in any way.

“We give the person any food or fluids he or she can takeby mouth, but we don’t try to force feed. Experiment withthings that might be pleasant for eating. Some of the finaltaste buds to remain are those for sweet and salty things.We don’t worry about whether it’s low cholesterol or highcholesterol or too salty or too sweet. We figure out what-ever that person wants, and we do our best to introduce it.If he or she doesn’t feel like eating, then we let it pass forthat day or for that meal.

“We always want to maintain hope, but we also have to temper that with what is realistic. That’s a very hard balance to strike.”

a

a

a

Listen to this interview at upstate.edu/healthlinkonair by searching “feeding tubes.”

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� They have a level of intimacy with their friends and family so that they feel comfortable asking for help.

“For some, that’s hard to do because it’s a change in theiridentities, and that can get in the way of dealing withstress – and can be a source of stress, too,” says McKay.“If your identity is that you’re a do-it-yourself, independ-ent person, if the time comes that you need help, itchanges your sense of who you are. And it can reallychange your sense about how the world is, too.”

Friends and family may offer to help. McKay suggestshaving a list of things you can ask people to do for you.

� They accept that they have emotional reactions. Ratherthan beat themselves up for feeling angry or scared, for instance, they acknowledge their feelings and let thempass. They regularly make time for personal reflection or “time in.”

Stressful situations may tempt a person to ask: why me?“Some people go to that place, and others don’t. If you’resomebody who is used to being more reflective, it’s lessdifficult when an existential kind of crisis comes up,” she says.

� They maintain routines as much as possible, sleeping andeating at the same times each day and continuing exerciseregimens. McKay explains this provides comfort, “and it’sreally good for mental health.”

� They create workable plans for what they need to do,breaking tasks into manageable parts.

� They know whom they can talk to, and when and how.

“It’s not enough that you talk to people. Somebody couldthink ‘well I’ve had my vent for the day.’ But that’s not thesame as being able to tell your whole story about what’sbothering you to someone who is really listening and whois giving you the time to finish talking,” McKay says.

� They take “mini-vacations” without leaving. They train themselves to take deep breaths and clear their mindsevery time the phone rings. Or, they think about nothingduring their shower other than the warmth of the waterand the smell of the shampoo.

� They sleep. Some people under stress need to sleep longerand can accomplish this by going to bed earlier. For thosewho struggle to fall asleep because they can’t turn off theirminds, McKay recommends a relaxation tape. “If you listen to it every day for two weeks, it starts to becomeroutine.”

� They know what they can do, immediately, to calm themselves. It may be taking a deep breath or sitting down instead of standing up.

� Overall, they make more positive comments than negative. McKay explains that humans have a survivalmechanism that brings our attention to negativity becausewe needed to be alert to danger when we were living incaves. In modern times, we have to train ourselves to look for the positive.

w w w . u p s t a t e . e d u10 UP STAT E H E A LTH winter 2013

Coping with stress

ADVICE

�

We may not be able to control what’s happening around us, but we can determine our reactions. That is one of the primary ways to cope with stress, whether it’s brought on by sudden illness, a hurricane or job loss, says Ruth McKay, a medical family therapist who has worked at Upstate eight years.

According to Ruth McKay, people who fare best under stress possess these traits:

Listen to this interviewat upstate.edu/healthlinkonair bysearching for “gallstones.”

gallbladder

liver

For Caregivers – from Caregivers

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

exercise caUtion WHen googling ‘gallstones’

When Dr. Aakash Aggarwal searched “gallstones” on YouTube, the researcher found 228 relevant videos.Twenty percent came from health agencies; 70 percent came from independent sources; and 10 percent

were medical advertisements.

Aggarwal, a second year resident in internal medicine at Upstate, watched the videos and labeled 121 as “useful,” containing accurate and beneficial information. He found 66 to be misleading. He excluded 41 that were not in English or shorter than 1 minute in length.

Many of the misleading videos discourage surgical treatment and instead encourage natural flush therapiessuch as ingesting olive oil, apple cider and other substances in large quantities — therapies that are notproven effective and may even be harmful. Even more worrisome: Per-day viewership was significantly higher for the misleading videos than for the useful videos.

Aggarwal presented his research at the American College of Gastroenterology Annual Scientific Meeting this fall. Considering that 50 million Americans seek health information online each month, Aggarwal believes health care agencies should seize the opportunity to develop accurate videos on a variety of medical topics – so people will be able to find correct information.

Ruth McKay MA, LMFT

37722 SUMU-_37722 1/4/13 2:05 PM Page 10

LFrank Baum is said to have died from congestiveheart failure in 1919 at age 62, almost 20 years afterthe first of his legendary “Wizard of Oz” stories waspublished. Doctors at that time had limited means of

diagnosing or treating heart problems.

With the benefit of hindsight provided by multiple biographies and papers that were written about the famousCentral New Yorker, Harold Smulyan MD, a professor ofmedicine in cardiology at Upstate, questions some of theassumptions about Baum’s health and death.

Baum, born in 1856 in Chittenango, a village east of Syracuse, concocted the adventures in the Land of Oz onlyafter a “heart specialist” prescribed a sedentary job.

“Many productive authors have had their careers cut shortby serious illness, but this was not true in Baum’s case. It isprobably accurate to say that heart disease finally enabledhim, after a life of repeated failures in several occupations,to find his true calling,” Smulyan wrote in The Pharosjournal this summer with co-author, Robert Pinals MD.Pinals was part of the Upstate faculty before joining theRobert Wood Johnson School of Medicine in New Jersey.

Baum’s oldest son and biographer blames a congenital heartdefect for Frank being a frail, sensitive child, less physicallyactive than other children and prone to “heart attacks,” inwhich he fainted when emotionally stressed. Smulyan andPinals suspect these episodes were not cardiac in nature.The stethoscope, which can detect heart murmurs, waswidely used by doctors during Baum’s lifetime. Cardiacbirth defects usually are accompanied by heart murmurs ora blueness of the skin — signs that the physicians say werenever used in describing Baum.

Some biographers theorize Baum had rheumatic fever, but Smulyan and Pinals aren’t convinced of that diagnosiseither. “It is possible that he could have lived to age 62 withcongenital or valvular heart disease, but this would not account for the progressive chest pain, which was his most prominent symptom,” they write.

At the age of 12, in 1868, Baum had an especially severe

fainting episode after being disciplined at the military academy he attended in Peekskill. He had another at the age of 26, prior to his marriage to Maude Gage, the daugh-ter of Matilda Gage, a leader in the Women’s Movement.“Afterward, he was apparently stable for many years andable to work at various occupations to support his growingfamily,” Smulyan and Pinals write, listing his various occupations: farmer, actor, playwright, variety store owner,business manager for a baseball team, newspaper publisher,traveling salesman.

In 1897 at age 41, Baum developed severe nosebleeds withgripping chest pain. A doctor in South Dakota diagnosed“angina,” a term first used in 1772 to describe chest painthat was associated with exertion and which often radiatedto the left arm. Today we know this as a symptom of coronary heart disease, but back then angina was notknown to be related to a heart disorder.

Baum’s life changed when he switched occupations. He began publishing a trade journal and in his spare timemade up stories to tell his children and their friends aboutthe fantasyland of Oz and a girl named Dorothy.

“The Wonderful Wizard of Oz” was published in 1900.(And made into a movie in 1939.) The book’s financial suc-cess allowed Baum to lead a less healthful lifestyle, raisinghis risk for coronary heart disease. Smulyan and Pinalswrite: “He chain-smoked good cigars and upgraded his diet.He had meat and eggs for breakfast, with five cups of coffeelaced with heavy cream and sugar. His dinner usually in-cluded a thick cream soup, roasted meat and a rich dessert.”

Baum moved his family to a Hollywood mansion in 1909.Bad investments led to bankruptcy, and by 1914 he wasgrappling with a series of health problems. He sufferedpainful tics to one side of his face. His chest pain and

Knowing changes everything.SM 11winter 2013 UP STAT E H E A LTH

continued on pg. 16

COMMUNITY

Cardiologist researches L. Frank Baum’s life, deathBY AMBER SMITH

DID AUTHOR ozhave a heart defect?

Illustration by W.W. Denslow, from The Wonderful Wizard of Oz by L. FrankBaum, 1900. Special Collections Research Center, Syracuse University Library.

37722 SUMU-_37722 1/4/13 2:05 PM Page 11

IN THE KNOW

w w w . u p s t a t e . e d u12 UP STAT E H E A LTH winter 2013

Juntao Luo PhD holds a model of a polymer nanoparticle in his Upstate lab.

37722 SUMU-_37722 1/4/13 2:06 PM Page 12

IN THE KNOW

Knowing changes everything.SM 13winter 2013 UP STAT E H E A LTH

�

Juntao Luo PhD never imagined himself working ona cure for cancer. He had decided to be a chemist,and he set about earning a bachelor’s degree inchemistry and then a doctorate in polymer chemistry

and physics from NanKai University in China. His trainingin material science laid a solid foundation for the researchhe does today in nanomedicine.

He completed post-doctorate work in a biomaterials lab inCanada, working with biomaterials known as polymers.Later, at the University of California at Davis, Luo’s mentorchallenged him: Could he create a vehicle made of polymerto transport chemotherapy drugs directly into solid tumors?

Luo, 36, joined Upstate’s pharmacology faculty in 2011 andcontinues his research on the smaller-than-microscopictransport vehicles known as nanoparticles — a promisingnew way to shrink cancerous tumors without damaginghealthy cells around them.

Carrying proven cancer drugs, the nanoparticles are injected into the bloodstream like any injectable medication.They are programmed to travel through blood vessels tosolid tumors. Scientists are designing nanoparticles made of various materials, in search of the best combination.Nanoparticles made of lipids, for instance, were invented decades ago but are too large to diffuse into tumors effi-ciently and are removed from the blood stream too rapidly.

The nanoparticles Luo works with are made of polymer. He says they have been effective against solid tumors in laboratory animals. In one study at UC Davis, the size of tumors shrank for days after injection, and one group of the tumors in the study subject disappeared entirely.

Encouraged by those exciting results, Luo is optimistic thathis laboratory work can be translated into a cancer treat-ment after the Food and Drug Administration approvestesting in humans. Because these nanoparticles rely ondrugs that are already proven safe and effective, he expects

the approval process will not be as lengthy as it would for a new drug.

Polymers are made of molecules strung together. How aparticular polymer behaves is determined by what moleculestructures are included and in what order. Traditional polymer materials vary in size and don’t integrate well with other functions. However, Luo has invented a way to engineer the structure of a polymer nanoparticle to suitthe medication it will carry.

“In general, one nanoparticle may not be able to deliver dif-ferent types of medications. You may need to design ananoparticle for each medication,” Luo says. He adds thatnanoparticles may need to be further tailored to individualpatients, who may respond differently to medications depending on the stage and markers of the cancer.

Dr. Luo’s nanoparticles carry the medication to the tumorsite within 24 hours. Remnants of the nanoparticles areflushed from the body through the kidneys. While they are designed to work most effectively in solid tumors,nanoparticles may also help fight some cancers of theblood, Luo says.

Luo says some types of nanoparticles show promise in penetrating the blood-brain barrier, which could lead tonew methods of treating cancer in the brain. Recent studieshave shown that polymer nanoparticles can be used in thetreatment of inflammation and Parkinson’s disease.

Luo’s work in the field of cancer research allows him tocontribute exciting, if poignant advances. He was a collegestudent majoring in chemistry in 1997 when his mother was diagnosed with breast cancer. She underwent surgeryand chemotherapy before she died in 2003. “At that time, I had no idea about cancer treatment,” Luo says. “If I hadthe knowledge I have right now, at least I could have given her hope.”

Seeking a safer, better way to deliver cancer drugs to tumors

Normal vessels have tight endotheliumAngiogenic tumor vessels are leaky and permeable

blood vessel

TUMOR

receptor

BY AMBER SMITH

37722 SUMU-_37722 1/4/13 2:06 PM Page 13

w w w . u p s t a t e . e d u14 UP STAT E H E A LTH winter 2013

COMMUNITY

Anyone who visits the children’shospital can see the red tree sculp-tures that frame its “treehouse”entrance. Last fall, a new sculp-

ture — the memory tree — was added to asmall courtyard near the main entrance.

Colorful epoxy bugs and butterflies perchon the tree’s branches, bearing the names of24 children whose families helped conceivethe memory tree. Multi-colored metalleaves are etched with the names of the 148children who died at Upstate since 2009,the year the children’s hospital opened.

“Most of our work with patients has happy endings,” says Leanna SeveranceRN, retired pediatric nurse-manager, “but not always.”

Since the children’s hospital opened, pediatric specialists have operated on20,350 children, treated 91,202 in theemergency rooms, and been able to send15,937 children home from hospital stays.

But, sometimes no amount of expert medical care can save a child, which is why this memory tree is so important.

Leola Rodgers, children’s hospital adminis-trator, explains. “We’ve always done something to remember each child. But wehad a desire to offer something consistent,permanent and affirming to commemorateall the children who have died at Upstate.”

To craft a plan for a memorial for the new children’s hospital, Upstate’s family advisory council met with Severance,Rodgers and others.

Creating The Tree

AccuFab, Inc. of Ithaca was selected for thememorial project. Gary Wojik, president,describes the inspiration for the memorytree: “We were taken by the architect’s de-sign, especially the treelike forms at the en-trance of the children’s hospital. Our ideawas to design something that related to the

building, a sculpture with a lyrical bent, soanyone would feel comfortable and drawnto it. We wanted it to have a playful quality.

“Since ancient times, trees have symbolizedlife,” continues Wojik, “and are the perfecticon for this memorial.”

Prior to building the full-scale tree sculp-ture, AccuFab presented drawings and a model. A variety of metal leaves were created, and parents selected the types and colors to be added to the tree.

Stainless steel tubing was used for the treesculpture because it is strong and relativelymaintenance-free. The steel was given anon-reflective, random-brush finish to cre-ate a warm feel. The epoxy butterflies andbugs on the tree are based on the interiorornamentation of the children’s hospital.

The Memorial Service

A dedication ceremony for the memory treesculpture was held on Sunday afternoon,Oct. 14. Patients’ families and Upstate staffand chaplains were in attendance. Amongthe speakers was Ran Anbar MD, chief ofpediatric pulmonology. He shared the fol-lowing with the 300 people who were there:

“I’ve learned three things from the children for whom I have cared. First, most every child I have spoken with believes in continued existence after death,” he paused.“Secondly, children have helped me under-stand that we can communicate with lovedones who have passed, and receive answers.We can actually interact with them.”

In closing, Anbar described the third lesson:“The consequence of the first two is that irrespective of death, your relationship with your loved one can always continue to develop and grow.”

October 14 had started as a cold and rainyday. By afternoon, the sky was blue, and awarm sun shone on the memory tree, andthe people around it. �

Much thought, artistry behind the children’s hospital memory tree

carbon dioxide levelsimpact HUman performance

As we look for ways to saveenergy in “green” buildings,

researchers from Upstate suggestwe not skimp on air quality.

A study that looked at groups ofvolunteers in office-like chambersfound significant differences indecision-making capabilitiesamong the volunteers dependingon the concentration of carbondioxide in their chambers. Thosewith the highest levels had themost trouble completing a seriesof nine simulated experiences designed to measure decisionmaking.

Usha Satish PhD and SiegfriedStreufert PhD from Upstate’s Department of Psychiatry andBehavioral Sciences collaboratedon the work with researchersfrom the Energy Technologies Di-vision of the Lawrence Berkeley National Laboratory. Our bodiesproduce carbon dioxide withevery exhalation. The gas is alsoemitted by the combustion ofcoal, natural gas and oil. Highconcentrations of carbon dioxideindoors have been associatedwith impaired work performance,increased health symptoms andpoorer perceived air quality.

“Direct adverse effects of carbondioxide on human performancemay be economically importantand may limit energy-saving reductions in outdoor air ventila-tion per person in buildings,” the team wrote in the journal,Environmental Health Perspectives. The scientists callfor additional research.

Listen to this interviewat upstate.edu/healthlinkonair bysearching for “carbondioxide.”

CO2

BY SUSAN KEETER

37722 SUMU-_37722 1/4/13 2:06 PM Page 14

1

2

3

4 5

67

COMMUNITY

New programs have been added and services expanded at Upstate University Hospital’s Community Campus in the months since themedical campus on Onondaga Hill became part

of Upstate.

Among them are the bariatric, general and thoracic surgeryservices and the Breast Care Center, all of which are accept-ing new patients. The surgery offices are in the PhysicianOffice Building North, and the breast center is in the POBSouth, across the hall from Wellspring’s women’s imagingcenter.

Upstate’s urology and obstetrics/gynecology services haveexpanded into offices in the POB North. The obstetricianswork closely with midwives who are part of the hospital’snew midwifery program and with the new team of ob/gyn hospitalists, physicians who are always in the hospital to assist women during labor and delivery.

Upstate’s wound care program now occupies offices on the fifth floor of the hospital. Also on the fifth floor, the Sleep Center takes care of pediatric patients.

Another addition is the overnight Epilepsy MonitoringUnit, a service unique to Central New York for adults whoare newly diagnosed with epilepsy or who require seizuremonitoring. It is located adjacent to the intensive care unit.

Construction will soon be under way on the new $15 mil-lion Upstate Cord Blood Bank, which will be attached tothe west side of the hospital complex. (See story, page 4.)Later this year, Upstate expects to open CNY’s first geriatricemergency unit in the Emergency Department at the Com-munity Campus. (See story, page 5.)

The region’s first pediatric after hours care center opened inFebruary. (See story, page 7.) In an area separate from theregular emergency department, pediatricians and ER per-sonnel treat minor injuries or illnesses and can facilitate asmooth transfer to the pediatric emergency department atUpstate’s Downtown Campus if that becomes necessary. Upstate Golisano After Hours Care, for newborns throughage 21, is open from 4 to 11 p.m. weeknights and noon to11 p.m. weekends.

These services augment the many existing services at the Community Campus, including a variety of surgeries and diagnostic procedures, and private physician offices. Connect with these specialties by calling Upstate Connect at 800-464-8668.

15winter 2013 UP STAT E H E A LTHKnowing changes everything.SM

Upstate expands services at Community Campus

1. Bariatric Surgery Center2. Breast Care Center3. Cord Blood Bank site4. Epilepsy Monitoring Unit

5. Golisano After Hours Care6. Upstate Orthopedics 7. Sleep Center8. Upstate Urology

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37722 SUMU-_37722 1/4/13 2:06 PM Page 15

COMMUNITY

w w w . u p s t a t e . e d u16 UP STAT E H E A LTH winter 2013

irregular heartbeats became more frequent. Hedeveloped trouble breath-ing and abdominal pain.

In December 1917 he hadhis gallbladder removed,along with what was described as his “badly inflamed” appendix. Thesurgery was said to havefurther damaged his heart.Baum also developed “kidney trouble.” After five weeks in the hospital, he went home and wasconfined to his bed, wherehe remained for the rest ofhis life. Baum continued towrite, smoking cigars andtaking morphine for pain.He finished “Glinda of Oz”before lapsing into a coma.

Just before death, his heartbeat was erratic andhis breathing difficult.“This might reasonably beascribed to atrial fibrilla-tion or frequent atrial orventricular premature beatsand congestive failure,”Smulyan and Pinals say, describing common cardiacdiagnoses of today. “Evenif Baum died, as we suspect, of coronary heart disease, his physicianswould probably not havebeen able to recognize it.”

�

�

Upstate medical student SeanHaley sums up his life journeythis way: “I always end up in the place I’m supposed to be,planned or not.”

Those places include El Salvador, Thailand,New York City – and Syracuse’s north side,where Haley helped found the not-for-profit organization, HopePrint.

“We’re all motivated by what brings ushappiness and joy,” he said. “What bringsme joy is serving. HopePrint provides that –it’s international but in our own back yard,it’s culturally diverse, urban and under-resourced.”

For his academic success and HopePrintwork, Haley won a SUNY Association of Council Members and College Trusteesscholarship.

“He is an exceptional medical studentwhose work with the refugee population is unprecedented in our community,”wrote Susan Stearns PhD, assistant dean of student affairs.

Two summers ago, Haley found himself delivering a couch to a refugee family onSyracuse’s north side. He and Nicole Watts,HopePrint’s executive director, talked aboutthe needs of the city’s refugee population,which grows by several hundred each year.

Haley’s no stranger to different cultures anddifferent lands. Several years ago, he wentto El Salvador as a leader of a Young Lifegroup. There, he worked with Upstatephysician Joseph Domachowske MD at aclinic during the day, and helped build a school at night.

“Once you see poverty, it never leaves your head,” Haley said.

In summer 2011, he went to Thailand with a group that was fighting againsthuman trafficking, especially of children.

These experiences abroad, and the day-to-day challenges he sees among refugees inSyracuse, have shaped his worldview.

Working with refugees, Haley said, “is aconstant reminder of how lucky we are.They provide such a different view. I askeda Somali man why he was wearing flip-flops in six inches of snow, and he said hehad to go to the doctor. The mentality is‘survival first.’ It’s humbling.”

It also is a time management challenge forHaley to help run HopePrint while going tomedical school and pursuing his master’sdegree in public health.

“In a way, it makes medical school easier,”he said. “It helps you remember that there’s a world outside of Weiskotten Hall,one with serious problems.”

HopePrint tries to tackle some of them.Among other services, it provides refugeeswith English language instruction and college preparation courses (11 refugeeswere accepted into Onondaga CommunityCollege), helps with socialization and navigating the health care and social service systems.

It’s a simple concept, really.

“People just need someone to walk alongside them,” said Haley.

Listen to this interview at upstate.edu/healthlinkonair by searching for “HopePrint.”

Muheyidin Mohammed, center, meets weekly for tutoring sessions with HopePrint volunteers Sean Haley, a medical student,and Chelsea Ingrassia, a nurse practitioner student, at his African International Restaurant at 717 N. Salina St., Syracuse.

Students befriend refugees through HopePrint

Listen to this interviewat upstate.edu/health-linkonair by searchingfor “Wizard of Oz.”

OZ author –continued from page 11

L. Frank BaumFrom Onondaga Historical Association

BY JIM MCKEEVER

37722 SUMU-_37722 1/4/13 2:06 PM Page 16

WORK

17winter 2013 UP STAT E H E A LTHKnowing changes everything.SM

�

Mark Torres of Dryden joined Upstate last summer after teaching for two years at CornellUniversity in Ithaca. He is a systems engineer by training, and he was eager to apply his

knowledge to health care.

His day: “I spend a lot of time looking at a bunch of datathat’s already been collected and measured and trying tomake sense of what it’s saying — because it will tell you astory if you look at it and try to determine cause and effect.

“If you look at the process from start to finish, you typically have numbers at the beginning, let’s say ‘admissions,’ and at the end, let’s say ‘discharges.’ You cancompute the length of stay between the two. But what youreally want to do is figure out what happens along the way,during the stay. Who sees the patient, what happens, howlong does it take? That’s what you really want to find soyou can focus on what’s the biggest holdup, what’s thebiggest bottleneck?”

His mindset: “We focus on the concept of total qualitymanagement. It’s all about the customer, what the customeris willing to pay for, what’s valuable for him or her. Our patients aren’t willing to pay for all the time they spend inthe emergency department waiting room, waiting to beseen. What they really want to do is come in, be treated and then leave. So in general, we try to look for improvementsand efficiencies where we can find them.”

His skills: Science and math are important, but examiningcustomer interactions can be subjective. “Some of thosethings are more difficult to measure than what we would doin a traditional engineering field, but we try to measure asmuch as we can. Because if we can’t measure it and we can’t

collect data on something,then we can’t say that we’recertain about it.”

His favorite question:“Somebody working in an organization is told how andwhat to do, but what oftengets lost through repetition isasking why. I think one of ourstrongest tools is to observe aprocess and to ask why. Why isthis really happening? Because in some cases it’s because ‘well,that’s how we’ve always done it.’Or, ‘we don’t really know.’

“Hopefully, having this kind ofquestioning attitude about theprocess is contagious. Ultimately it’sthe process that achieves the end state,which is the product or the quality. A lot of times people get blamed fordoing something poorly, but in reality it’s the process that allows those things to happen.”

His limitation: “We want to preservethat non-quantifiable provider-patient relationship. That’s kind of sacred. If you can improve efficiencies all around that, then the patient can still receive that individual care that we provide.”

Listen to a related interview at upstate.edu/healthlinkonair by searching for “efficiency expert.”

Meet Mark Torres, hospital systems engineer

GOODJOB

37722 SUMU-_37722 1/4/13 2:06 PM Page 17

FOOD

Jokes about bad hospital food seemhopelessly outdated the moment youenter Thomas Kiernan’s block-longkitchen at Upstate. Whether it’s

celebrating a perfect pot roast or heapingpraise on local squash, the one indispensa-ble ingredient in every recipe is passion. On this bright, brisk November day, eventhe humble chickpea has Upstate’s top chefwhipped into a zestful froth. Those blandlittle orbs, you see, are the magic ingredientin an orange muffin recipe that draws raves.

“It’s a phenomenal recipe because it’s solight and airy,” enthuses Kiernan. “If I didn’t tell you (it has chickpeas), you’dnever know.” Plus, he notes, “you’re gettinga protein and a complex carbohydrate.”

A towering, bearish man on bad knees,Kiernan wears a big white chef’s hat andhas a title to match: Regional ExecutiveChef for Morrison Healthcare, the con-tracted food service company that managesUpstate’s Food and Nutrition Services Department. At Upstate alone he oversees50 production workers who each day crank out 1,050 patient meals plus enoughcafeteria victuals to sate 2,500 customers.Menus must accommodate nine differentdiets and 273 food allergies. The kitchenpurchases nearly $3 million of food annually. And yes, they cater.

Kiernan also has general oversight for food

service at 13 other hospitals in New Yorkand Pennsylvania.

“It’s a huge undertaking,” says Kiernan, buthe seems to feed off it ... literally. After all,to get the perfect muffin recipe, one has totaste a lot of muffins. It’s the same withmeatloaf, orzo salad and post-op wholewheat fajitas. “By the time you’ve eaten it,we’ve eaten it 10 times.”

With the unveiling in December of TheGreat Living Menu, Kiernan’s taste budsare working overtime. Morrison spent almost three years developing the concept,which is transforming Upstate’s food servicefrom “almost steam table cooking to almostshort-order cooking.”

Kiernan came to Upstate more than fouryears ago, and has been on a mission eversince to emphasize fresh, local ingredients.Before that he was Chef de Cuisine at Cornell and Executive Chef at SUNY Cortland. He’s a graduate of the prestigiousCulinary Institute of America in Hyde Park.It’s an impressive background, yet like allchefs Kiernan has had a few failures, nonemore glaring than combining fresh crab andwatermelon into perhaps the worst-tastingappetizer in gastronomic history.

Kiernan was trying for something fresh andfun for the opening of the Upstate GolisanoChildren’s Hospital in 2009. Watermelonswere in season and particularly succulent.

Cooking up comfort

w w w . u p s t a t e . e d u18 UP STAT E H E A LTH winter 2013

too mUcH is dangeroUs

High-caffeine energy drinkscan be dangerous, leading to

heart irregularities, neurologicalcomplications, brain injuries andeven death.

People drink the beverages forhelp staying awake, but deprivingour brains of sleep is not wise,says Sanjiv Patel MD, a familyphysician and assistant professorat Upstate’s Binghamton campus.

“These energy drinks should notbe taken lightly," Patel toldWBNG channel 12 action news.“We’re not consuming Coca-Cola, Pepsi, or Jolt Cola. We’reconsuming a product that contains an insurmountableamount of caffeine."

Officials at the Food and DrugAdministration in October saidthey were investigating fivedeaths and a nonfatal heart attack that happened within athree-year period that may belinked to energy drink ingestion.In its coverage of the investiga-tion, The New York Times said thenumber of reports that the FDAreceives about any product it regulates usually understates by a large degree the actual number of problems.

A person’s reaction to caffeinedepends on how much he or sheusually drinks, his or her age,body mass, medication use and other health conditions, according to the Mayo Clinic.

Too much can cause:

� Insomnia

� Nervousness

� Restlessness

� Irritability

� Stomach upset

� Fast heartbeat

� Muscle tremors

HOSPITAL KITCHEN DISPENSES FRESH, LOCAL FOODSBY JEFF KRAMER

Thomas Kiernan with “small bites,” delicious fresh-fruitdesserts prepared with an eye toward portion control.

The hospital kitchen on the second floor,Downtown Campus.

Caffeinealert

37722 SUMU-_37722 1/4/13 2:06 PM Page 18

Knowing changes everything.SM 19

FOOD

winter 2013 UP STAT E H E A LTH

BY

He also had a beautiful shipment of crablegs. Why not combine the two, he figured,and add a spritz of fresh lime juice?

“It is the most disgusting flavor combina-tion I’ve ever tasted,” Kiernan says, laugh-ing in his windowless office. “You knowwhen they spray farms with that liquid rotted fish juice? That is what it was like.”

Happily such stinkers are rare and, needlessto say, that experiment was not served.

Despite his experimental bent, Kiernan getsthat he’s not here to reinvent the meal —just to make it taste better with less salt andfat. His crew spends a lot of time upgradingclassics. “A good lasagna, a good cobbler,there’s something comforting in that,” he says. “Food is part of healing.”

frUits, veggies mayHelp smokers QUit

Previous studies have shownthat smokers eat fewer

fruits and vegetables than nonsmokers. Researchers from the University of Buffaloexplored that correlation with a national telephone survey of1,000 smokers age 25 and up.

They found people who ate themost fruits and vegetables werethree times more likely thanthose who ate the fewest to remain tobacco free at 1-monthand 14-month followups. Fruitand vegetable consumers alsowaited longer to smoke theirfirst cigarette of the day andscored lower on a common test of nicotine dependence.

“Foods like fruit and vegetablesmay actually worsen the taste ofcigarettes,” Jeffrey Haibach, firstauthor of the study, stated in the university website, Futurity.org

Researchers also theorize thatnicotine dependency may belower for people who eat a lotof fruits and vegetables, or that the high fiber content ofproduce makes people feelfuller, and less likely to confusehunger with an urge to smoke.

Their work appeared in the journal, Nicotine & Tobacco Research.

Karoline Simpson prepares food trays for patients.

Curtis Darbey uses local Byrne Dairy milk to make macaroni and cheese.

Free, Multi-Session Classes

QUIT SMOKING

FOR GOOD & FOR FREE!

Did you know that Upstate’s healthLink

center offers freesmoking cessation

classes? You’ll get theextra support you need

to kick the habit.

call 800.464.8668 to find out when

the next classes startand how to sign up.

�

37722 SUMU-_37722 1/4/13 2:06 PM Page 19

w w w . u p s t a t e . e d u20 UP STAT E H E A LTH winter 2013

FOOD

Preparation

Preheat oven to 350 degrees.

1. Prepare oven roasted portobello mushrooms: Clean mushrooms and dry well. Gently remove black gills from mushrooms with a spoon and discard. Brush both sides with balsamic vinaigrette.

2. Place mushrooms, gill side down, on lightly oiled baking pan. Roast in 350o oven for 10 to 12 minutes, until tender. Then brush mushrooms with remaining dressing and cool.

Preheat oven to 375 degrees.

3. Prepare the garlic spread: In medium mixing bowl, toss garlic cloves with oil and pepperto coat. Then place garlic onto a small square of aluminum foil, and seal edges to form aloose pouch. Place that on a baking sheet and bake in 375o oven for 20 to 25 minutes,until garlic is caramelized. Remove from oven and allow to cool. Then, using a mixer,whip cream cheese on medium speed for 3 minutes. Add garlic and whip for anotherminute. Scrape sides and whip for another 30 seconds

4. Make the sandwiches by spreading a tablespoon of the garlic spread on the bottom andtop of each thin. Lay a slice of provolone across the bread. Then add 1 ounce of roasted red peppers, the mushroom and then the lettuce.

Serves four.

Ingredients

4 slices (.75 ounces each) provolone cheese

4 individual lettuce leaves

4 roasted portobello mushrooms

4 ounces canned roasted red peppers, drained

4 100-percent whole wheat sandwich thins

4 tablespoons balsamic vinaigrette dressing

½ cup cream cheese

¼ cup roasted garlic spread*

4 garlic cloves, peeled*

¼ teaspoon olive oil, canola blend*

¼ teaspoon ground black pepper*

*Ingredients make up the roasted garlic spread.

Nutritional information, per serving

267 calories

13 grams of fat

29 grams of carbohydrates

129 milligrams of cholesterol

560 milligrams of sodium

7 grams of dietary fiber

Here’s a hearty vegetarian meal that is simple to prepare and provides a classy, satisfying taste.

Bill Gokey is executive sous chef for Morrison Healthcare, which provides food services for Upstate Medical University.

Balsamic Roasted Portobello Sandwich on Whole Wheat Sandwich Thin BY BILL GOKEY

BURNcalorie

Bowling 462 calories

Running at a 6-minute mile pace* 834 calories

*roughly Scott Ulberg’smarathon pace.See page 22.

Paintingindoors162 calories

Fencing competition 756 calories

Milking a cowby hand 258 calories

The exact number of caloriesyou burn is affected by your

age, body size and composition,and your level of physical fitness.For example, a person weighing176 pounds who does the activity for an hour would burn this many calories:

37722 SUMU-_37722 1/4/13 2:06 PM Page 20

Knowing changes everything.SM 21winter 2013 UP STAT E H E A LTH

LEISURE

breatHing easier WitHastHma tHroUgH yoga

exercise scientists at SyracuseUniversity showed how yoga

can improve the lives of womenwith asthma in research recentlypublished in the Journal of Alternative and ComplementaryMedicine.

Yoga, used as an alternative therapy to improve symptoms associated with various diseases,has also been shown to improveautonomic body functions inhealthy people. Researchers atSU’s Department of Exercise Sciences wanted to see if 10-week yoga classes would improve heart rate variability and quality of life in women withmild to moderate asthma.

Nineteen women were dividedinto two groups, one who didyoga and the other who did not.They answered questions aboutrespiratory symptoms and did ahandgrip exercise to assess theirheart rates. “Significant im-provements in quality of life were observed with the yoga training,while no changes were found in the control group,” the researchers wrote. “Resting hemodynamic measures improved significantly in theyoga group compared to the control group.”

That’s news that can warm thehearts of yogis everywhere.

Jason Meany teaches scuba diving and brokers dive tripsthrough his company, Deep Stop Scuba.

Jason Meany taught science at Christian Brothers Academy, theschool Dr. Joseph Domachowske’schildren attended. Now Meany

takes classes at Upstate, where Domachowske is professor of pediatricsand microbiology and immunology.

This twist of life occurred when Meanyfound his way into respiratory therapy by way of scuba diving.

Meany says he always felt a draw towardthe ocean, even as a child growing up inLiverpool, attending CBA. A track and fieldstandout, he graduated in 1998 and wentto Clemson University to run track. He gota degree in physical science and educationand then ran professionally for Adidas for ayear. Later he got a master’s degree fromLeMoyne College and took a job teachingscience at his high school alma mater.

Soon after, he married and enjoyed a Caribbean honeymoon with his wife, butkicked himself for not becoming certified to scuba dive before their time in Anguilla.That became a priority for him when theyreturned home to Camillus.

Meany took classes at Freedom Scuba USAin Baldwinsville for three years and latertaught classes there. He did open waterdives in Skaneatelas Lake, and on trips tothe Outer Banks of the Carolinas and

Aruba. His wife has no interest in diving.“She loves to read. She sits on the beachand reads, and I scuba dive,” Meany says.

He chaperoned an ecology trip to Florida atCBA; a year later he began organizing hisown trips for CBA students, some of whom– like the Domachowskes – brought theirfamilies. Meany’s trips include some scubadiving, along with education.

The trips have grown in popularity, and so has Meany’s interest and expertise indiving. Last year he escorted student groupsto Bonaire in the Caribbean. This year,groups will go to Bermuda, Key Largo and Australia’s Great Barrier Reef.

Meany will continue offering trips andscuba training through his company, DeepStop Scuba, but he quit teaching to pursuea health career in respiratory therapy. Thescience of respiration during scuba is verysimilar to the science of respiratory therapy.

He is a few years older than the typical student, with an unusual background, butUpstate faculty members were so impressedwith Meany’s enthusiasm and expertise that he became one of the class tutors.

Later this year, using the pool in the Campus Activities Building, Meany plansto offer scuba lessons for Upstate faculty,staff and students.

Interest in scuba leads toward a respiratory therapy career

�

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LEISURE

w w w . u p s t a t e . e d u22 UP STAT E H E A LTH winter 2013

He runs every day. No matterwhether he spends the day studying, or working all day andleaving the hospital at 8:30 p.m.,

third-year medical student Scott Ulberg, 24,always gets his run in. He logs 110 to 120miles per week.

“It’s not a matter of having time. It’s a matter of making time," he says. “I justpack my bag in the morning and throw it in my trunk. There are no excuses.”

His training paid off Oct. 21 when Ulberg won the Empire State Marathon inSyracuse with a time of 2 hours, 38 minutesand 49 seconds. It was Ulberg's thirdmarathon. He ran the New York Citymarathon last year in 2:37:44, and theLong Island Festival of Races in 2010 in2:53:08. Since coming to medical school atUpstate, Ulberg has been active in runningevents throughout Central New York.

He ran cross country at Stony Brook University, and for his high school on Long Island before that. Now he trainswith Kevin Collins, the running director at the YMCA.

Ulberg has been working on his runningform, trying to stay up on his toes. He believes that – along with the hillycourse between miles 7 and 20 – may havecontributed to the leg cramps he experi-enced during the 26.2-mile run in October.He wore compression shorts, a tank, blackgloves and Nike Lunaracers.

While he expected he would finish towardthe front of the pack, he planned to run his own race.

“I wasn’t winning the whole race. I was insecond place around mile 13,” Ulberg recalls. Of the runner he was following, he says, “he pretty much came to a walkaround mile 21.” That’s when Ulbergpassed him, although Ulberg wound upstopping three times in the final two milesto stretch his calves.

His parents were waiting for him at the finish line – along with a heavy finisher’strophy and a bottle of chocolate milk.�

2 hours, 38 minutes, 49 seconds Medical student wins Empire State MarathonAuthor Ann Patchett has five

novels and two nonfictionbooks to her name, and one ofher fans – Nancy Schreher –works in Educational Communi-cations at Upstate. Schreher, whomajored in English in college, first read Patchett’s acclaimed“Bel Canto.”

“It’s about a groupof diplomats andbusiness peoplewho are heldhostage by terror-ists somewhere inSouth America. Therelationships thatdevelop betweenthe hostages andthe terrorists

become very interesting, verytouching. They work a lot ofthings out. So, in the end whenthe police come in shooting, you think, ‘why are you doingthis? These people are gettingalong well.’

“Patchett has a knack for takinga situation and making you thinkof it in a different way. There aretwo sides to every story.”

Schreher also recommends “The Patron Saintof Liars,” Patchett’sfirst book.

“It takes place inKentucky at St.Elizabeth's homefor unwed motherswhich is run by theCatholic church.

This young lady, Rose, grew up inCalifornia, got married and thencame to the realization she is notin the place that she should be.She leaves her husband, eventhough she is pregnant, anddrives to Kentucky and becomesa resident at St. Elizabeth's. It’s aperspective you wouldn’t ordinar-ily get. You meet all these youngladies and learn their stories. Ifind it very similar to ‘Bel Canto’in the sense that you get a veryintimate view of the story fromthe inside.”

good READS

BY AMBER SMITH

Stephen D. Cannerelli/Courtesy of the Post-Standard

Listen to this interview at upstate.edu/healthlinkonairby searching for “marathon.”

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LEISURE

I’ve been singing as long as I’ve beentalking. My first solo was in elementaryschool. I did a verse of ‘White Christ-mas,’ and then the chorus came in.

My mother sings. She is the choir director,and we sing in the choir at church. I’ve always had music.

It’s my sanity. You have a bad day at workor at home or whatever, but you go to rehearsal or sing in a concert, and it’s like being in a different world.

It’s a social thing. It’s kind of a bond to participate in something together, togetheras a choir. You’re getting across the messageof the music. It’s a bond. You go throughrehearsals, and sometimes you think ‘oh,my goodness, we’re never going to get this.’And then you get to the concert, and itcomes together.

I like all kinds of music. I sing with theSyracuse Chorale. We do some classicalconcerts. Then we also have a cabaret in thespringtime. I also sing with Master’s TouchChorale. That’s a Christian singing group.We do everything from Beethoven to bluegrass.

I rehearse once a week for Syracuse Choraleand once a week for church choir from October to June. Then for the Master’sTouch, we have concerts or rehearsals everyother week. Of course at home, I’m warm-ing up and going over parts that I need to.

I sing in the shower. That’s kind of where I

do my warmups. The shower has greatacoustics. And I sing when I’m driving. I’m sure people think I’m crazy drivingdown the road.

It’s so hard to pick one favorite song. Myfavorite hymn, I would say is ‘AmazingGrace.’ And a favorite song would be‘Somewhere Over the Rainbow.’

One of the ladies who I sing with in theSyracuse Chorale went to the BerkshireChoral Festival in Sheffield, Mass., and shecame back raving about it. The festival isfour weeks during the summer. I went thefollowing summer and have gone everysummer since. I go for one week. It’s likefantasy camp for musicians. You’re just surrounded by music all week. There arepeople from college age up through the 70s.

Music affects people emotionally. You cango to a concert or be immersed in a showand just get caught up in the music, and it’shard to put into words. There’s somethingthat I learned a long time ago that says ‘it’seasy to believe that God hears music aboveall else.’ It can carry you to a differentplace. It’s emotional. It can be spiritual. It can be uplifting. It can be what you need it to be.

I would be lost without music in my life. I know that.

Knowing changes everything.SM 23winter 2013 UP STAT E H E A LTH

�

snoWboarding pUtsWrists, spleen at risk

Snowboarders, especiallyyoung males, are at risk of

injuring their arms and/or internal abdominal organs aftera fall while snowboarding.

That’s the conclusion of a studyin which Alison McCrone MD analyzed all of the medicalcharts for children ages 6 to 21who were brought to a pediatrictrauma center in Buffalo between January 2000 andMarch 2007 with injuries related to snowboarding.

Of 213 patients during that time,79 percent were male, and 55percent were in the 12- to 14-year-old age group, McCronewrote in the March issue of thejournal, Pediatric EmergencyCare. Today McCrone is an assistant professor of emergencymedicine and medical director ofthe Upstate Golisano After HoursCare at the Community Campus.

Among the injuries in those patients, 58 percent were wristor shoulder injuries; 27 percentwere head or neck injuries; 19percent were trunk injuries; and 10 percent were knee or leginjuries. McCrone says of thosewith trunk injuries, 74 percent involved injury to internal or-gans, most commonly the spleen.She also found that children who fractured or dislocated theirupper extremities were at higherrisk of suffering abdominal orpelvic trauma.

In another study from the University of Vermont College of Medicine in Burlington, researchers looked at patients ofa ski resort clinic from 1988 to2006 and determined that wristinjuries were the most commonsnowboarding injury.

from UpstateLessons

Sue Milliman of Lakeland, a human resources assistant atUpstate’s Community Campus, has a passion for musicthat began in childhood. She sings soprano and has playedthe piano since age 5.

Why I love singing BY SUE MILLIMAN

Hear Sue Milliman at upstate.edu/whatsup

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750 East Adams Street l Syracuse, NY 13210

Non Profit Org.US Postage

PAIDPermit No 110Syracuse, NY

Adoctoral studentat Upstate is among the groupof scientists who

are first to demonstrate –in a living organism –how formins help organize muscle structure. Forminsare a group of proteins thatgovern cell shape, adhesion,division and positioning.

Lei Mi-Mi had her research paper, “Formins’Muscle Building Routine,”published in the July 9 issue of The Journal of CellBiology. Her photograph,at right, was chosen for thecover. She works in the labof David Pruyne PhD, an assistant professor of Cell and Developmental Biology.

Working with worms, Mi-Mi pinpointed the location of two forminsthat act as key proteins involved in muscle move-ment. She also showed howa reduction or absence ofthose proteins stunted muscle growth. Mi-Mi suggests that what shedemonstrated in the worm are likely to holdtrue in other species. SCIEN

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Lei Mi-Mi

DavidPruyne PhD

12.1650812 31.2M ELsk

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