Health U P S T A T E M E D I C A L U N I V E R S I T Y

Summer 2015

UPSTATE

REBUILDING NEPAL IN EARTHQUAKE AFTERMATH

page 18

BEST BONE-BOOSTING EXERCISES

page 21

RECOVERINGFROM STROKE

page 5

KAYAKINGCO-WORKERS page 22

WEIGHT LOSS SURGERYAS A FAMILY AFFAIR page 9

DISTRACTED DRIVING ADVICE page 13

WHEN TO WORRY ABOUT BLADDER CANCER page 15

w w w . u p s t a t e . e d u2 UP STAT E H E A LTH summer 2015

WELCOME

94.2

More than 150,000

percent of first-year medical studentsat SUNY Upstate are New York state residents, according to the Associationof American Medical Colleges. InterimPresident Gregory Eastwood, MD,says, The education of New York residents is directly tied to Upstatesmission. When we commit to improving the health of our commu-nity, growing our own to be the nextgeneration of doctors is an integralpart of that process. Upstate is competitive, receiving 4,412 applications for the 154 spots in itsfirst-year medical class this year.

pounds of food scraps have been diverted from the trash at Upstate Medical University since an initiative to compost food scraps began in 2011.

527,956dollars were pledged to be donated to charities by Upstate employeesthrough payroll deduction during2015.

266mammograms wereprovided to womenliving in the SyracuseHousing AuthoritysPioneer Homes development

through a program called She Matters. A grant from the Susan G. Komen foundation helped createthe program, which relies on trainedresident health advocates to educate,support and encourage breast cancerscreenings among low-income women.A grant renewal means the program is expanding to Syracuses ToomeyAbbott Towers.

-164 degrees Celsius is the temperature at which

stem cells are stored while awaiting

transplant at the Upstate Cancer Center.

What do these numbers say about Upstate? Words tell stories, but so can numbers.

The eight below help illustrate the missions of Upstate University Hospital medical care, education and research and reveal the institutions dedication to the Syracuse-area community through charitable donations and its environmental stewardship through composting.

On the pages that follow, youll read stories that tell more about the caregivers, patients, teachers and scientists who live and work throughout Central New York and whose paths cross at Upstate.

6past and present chief executive officers for Upstate University Hospital gathered for a ceremonyin June that dedicated and renamed the main lobby afterJames H. Abbott, the hospitalsfirst leader.

is the number of the fruit fly gene named by scientists in thelaboratory of Upstates Francesca Pignoni, PhD. They chose thename Lilipod, an acronym for Lipocalin-like membrane proteinreceptor. The scientists work on fruit flies because their genomeis so similar to that of humans, and they anticipate their research will some day have an impact on cancer and other human diseases.

1,168 babies were born at the Community campusof Upstate University Hospital in 2014. Thats the highestnumber of deliveries since 2007 when it was the former Community General Hospital. The increase can be attributedto the launch of the Midwifery and Gynecology Program and Upstates partnership with the Syracuse CommunityHealth Center.

5,807

PATIENT CAREHelping stroke patients get their lives back page 5

Supporting each other through thick and thin page 9

Pain relief, robotic surgery expand at Community campus page 10

New surgical options for enlarged prostates, salivary glands page 11

FROM OUR EXPERTS5 sunburn remedies page 12

Staying focused on the road page 13

Better breathing for preemies and patients on ventilators page 14

IN OUR COMMUNITYOn a mission to teach computer skills page 17

Earthquake aftermath: rebuilding Nepal page 18

IN OUR LEISUREMeet a mystery-writing nurse practitioner page 20

Best bone-boosting exercises page 21

Kayaking co-workers page 22

DEPARTMENTSWhats Up at Upstate page 4

Upstate AnswersCan older people ride roller coasters? page 12

Lessons from UpstateWhen to worry about bladder cancer page 15

RecipeChickpea salad page 21

3summer 2015 UP STAT E H E A LTH

PUBLISHER Wanda Thompson, PhD,Senior Vice President for Operations

EXECUTIVE EDITOR Leah CaldwellAssistant Vice President, Marketing &

University Communications

EDITOR-IN-CHIEF Amber SmithDESIGNER Susan KeeterVisit us online at www.upstate.edu orphone 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 Summer 2015

Upstate Health magazine is a community outreach service of Upstate MedicalUniversity in Syracuse, NY. Upstate is an academic medical center with four colleges (Medicine, Nursing, Health Professions and Graduate Studies); a robustresearch enterprise and an extensive clinical health care system that includes Upstate University Hospitals downtown and community campuses, the UpstateCancer Center and the Upstate Golisano Childrens Hospital. Part of the StateUniversity of New York, Upstate is Onondaga Countys largest employer.

WELCOME

Need a referral?Contact Upstate Connect at 315-464-8668 or 1-800-464-8668, day or night, for appointments or referrals to the health care providers on these pages or anywhere at Upstate or for questions on any health topic.

Contents9 22175 19

coverstory

On the cover: Upstate nursesSherod Harris (left) and Andre

Poirier kayaking on Oneida Lake. Photo by Susan Kahn.

Health U P S T A T E M E D I C A L U N I V E R S I T Y Summer 2015UPSTATE

REBUILDING

NEPAL IN

EARTHQUAKE

AFTERMATH page 18

BEST BONE-

BOOSTING

EXERCISES page 21

RECOVERING

FROM STROKE

page 5

KAYAKING

CO-WORKERS p

age 22

WEIGHT LOSS SU

RGERY

AS A FAMILY AFFA

IR page 9

DISTRACTED

DRIVING ADVICE

page 13

WHEN TO WORR

Y

ABOUT

BLADDER CANC

ER

page 15

TAKING OFFICE. A graduate of Upstate Medical Universitys School of Medicine is the new president-elect of the American Medical Association, so he will likely popup in the news in the year to come.

Andrew Gurman, MD, an orthopedic hand surgeon fromHollidaysburg, Pa., will assume the office of AMA presidentin June 2016. Gurman received his medical degree from Upstate in 1980. In a recent interview for Upstates weeklytalk radio program, HealthLink on Air, Gurman spoke ofways to keeps costs and fees reasonable for patients, doctors and medical students.

DESTROYING ODORS. A scientist can never predict his or her contribution to society. The Microsoft Network included Max Mozell, PhD, a distinguished professor emeritus in neuroscience and physiology, along with eightother experts who offered ways to deodorize bad smells.

Mozell advised what to do after gutting a fish. The networkquoted him as saying to mix a powdered bleach cleansersuch as Comet with water until it forms a thin paste. Scrubyour hands and then rinse with the hottest water you canhandle.

The Comet has an oxidizing effect, meaning it chemicallyneutralizes the smell, and the hot water may help vaporizethe odorous fish oil molecules, Mozell told the network.

STICKING TOGETHER. You werent seeing double if you attended medicalschool graduation in May.

Matthew Siegenthaler, MD, and MichaelSiegenthaler, MD, are identical twins who earned their medical degrees together and who have identical career paths. Both are pursuing family medicine, starting with residency training at St. Josephs Hospital Health Center.

The Siegenthalers were among 181 students graduatingfrom Upstates College of Medicine this year.

SHARING MEMORIES.When the film version of TheSound of Music celebrated 50 years, a pair of Central NewYork sisters relived their summer of 1964. Upstate nursepractitioner Heidi Cross and her sister, Kate Huddleston,worked as stand-ins for Louisa and Brigitta von Trapp during the filming in Salzburg, Austria. As 12- and 13-year-olds, their job was to stand in place of actresses AngelaCartwright and Heather Menzies while lighting and sound were adjusted on the set.

Their story appeared on Syracuse.com, with Cross disclosing some mischief. They were filming that scene bythe lake, and we went out in the boat, she told a reporter.We forgot to take oars with us and got stuck out there.They had to shut the production down for a bit and comeout to get us.

Their family moved to Syracuse in 1968. Cross staffs Upstates ostomy clinic and specializes in care for thoseundergoing colon and rectal surgery.

w w w . u p s t a t e . e d u4 UP STAT E H E A LTH summer 2015

WHATS UP

WHATS UP AT UPSTATE

Bariatric Surgery Program

BARIATRIC SURGERYSO I CAN SEE MY CHILDREN GROW UP

Upstates Bariatric Surgery Program is the areas longest-establishedprogram of its type, treating thousands of patients since it opened in2002. We oer two options for surgical weight loss Roux-en-Y gastric bypass and gastric sleeve. We also oer revisional surgeries,when appropriate for certain patients.

LeArN MOre Or regiSTer FOr A SeMiNAr:WWW.UPSTATE.EDU/BARIATRICS

News items you might have missed

Hear an interview at www.upstate.edu/healthlinkonair by searching Gurman.

These doctors help stroke patients get their lives back

PATIENT CARE

BY AMBER SMITH

Someone suffering symptoms of a stroke is surroundedby caregivers in the emergency department.

Doctors assess the persons consciousness, eye move-ment, reflexes, memory and ability to speak. Nurses start intravenous lines for medications, fluids and bloodsamples. Radiologists examine the blood vessels in thepersons brain through imaging scans.

The focus is on lifesaving determining whether theperson has had a stroke and limiting its damage. This effort involves almost all of the caregivers. All but one.

Bernadette Dunn, MD, is certified in brain injury medicine, a relatively new subspecialty recognized by the American Board of Medical Specialties. From themoment a stroke patient is stabilized, its her job tozero in on that persons recovery.

The patient is transferred to a specialized neurological care unit on the ninth floor

of Upstate University Hospital, and thatswhere he or she first meets with Dunnor one of her colleagues.

summer 2015 UP STAT E H E A LTH 5

continued on page 6

Brain injury specialist Bernadette Dunn, MD, greets a stroke patient as visitor James Tredo looks on. She sees many of her patients in the neurological intensive care unit at Upstate UniversityHospital, a key feature of what is Central New Yorks first and onlycomprehensive stroke center. The neurological ICU offers three levels of care for stroke patients, staffed by nurses with specializedtraining and credentials.

PhotoS BY RoBeRt MeScavage

S T R O K E R E H A B I L I TAT I O NI S A T E A M E F F O RT

6PATIENT CARE

UP STAT E H E A LTH summer 2015 w w w . u p s t a t e . e d u

Spotting the clues to stroke recovery

Once test results show the spot in the brainthat is affected by the bleed or the clot, thenDunn can provide a good idea of the strokepatients prognosis. She can project whattypes of therapy the patient will need andfor how long. As she monitors their recov-ery, she can predict any lasting problems.

There are a plethora of changes that youcan see following brain injury, said Claudine Ward, MD, who also specializes in brain injury medicine at Upstate. Thesewe hope go away but a lot of times are persistent. She noted that patients with

brain injuries, including stroke, may have neurobehavioralchanges, mood disorders or agitation, or they may experience changes with their endocrine systems. Having a doctor who recognizes issues and knows the best treatments to recommend can positively influence a patients outcome, Ward said.

Tiny movements help predict outcomes

Dunn sees patients in their own hospital rooms at Upstate.Her visits concentrate on actions that may seem minor buthave huge significance. One patient, three days after astroke, can pinch her fingers together but has trouble utter-ing more than one word. Another, nearly a month after astroke, locks eyes with Dunn but struggles to lift her arm orspeak.

Each movement, or lack thereof, is a clue to the locationand severity of the patients stroke and his or her recoverypotential. Dunn uses the information to help predict howsoon patients may need to begin intensive rehabilitation,what sorts of physical therapy they need now, and everyother aspect of their care. Brain injury medicine specialistslead a multidisciplinary team that may include surgeons,psychologists, nurses and a variety of therapists. They carefor patients with a variety of brain injuries, not just strokes.

Everybodys brain is different, and everyone has a differentreaction to that injury, depending upon the area of the brainthat is injured, Dunn explained.

For a stroke patient, the injury is a clot or bleed in thebrain. We can see two people who have a similar injury,one who has significant deficits in terms of thinkingprocesses and ability to function in daily life, and the otherwho had what would be considered a larger injury andfewer deficits. It really just depends on the area of the brainthat is impacted.

continued on page 7

A patients ability to move and feel sensation in the toes and fingers can help predict his or her recovery from stroke; that is one of the things brain injury medicine specialist Bernadette Dunn, MD, checks as she makes rounds, above.She often consults with other members of the stroke care team, including occupational therapist Kelly Van Auken, below.

Claudine Ward,MD

continued from page 5

7summer 2015 UP STAT E H E A LTH

PATIENT CARE

Two patients, two types of strokescontinued from page 6

One woman who had a stroke on a Sunday was not able to move her left arm the next day. But by Tuesday, she liftedit up and down. And when Dunn asked her to pinch her fingers together, she did. Often after a stroke, patients mayretain movements that occur closest to the center of theirbodies, such as flexing a knee or elbow. Movements thatoccur further from the core, involving the fingers or toes,may prove more difficult.

The womans husband of 55 years was at the side of herbed, and one of her grandsons stood at the foot. Thewoman tried to explain to Dunn how she had walked earlier with a therapists help.

Building on success

Dunn moved to the end of the bed. Can you bend this foot up yet? The woman did, and then archedher toe. Oh, I liked that, too, Dunn said. The woman hadacquired a lot of motor skills in just three days, and Dunnwanted to build on her success. She would arrange to gether into intensive rehabilitative therapy as soon as possible. We want to take you to rehab, Dunn told the woman.

The second patient she checked was a woman who had ahemorrhagic stroke a month before. The womans recoverywas slow, as expected, given the location and severity of herstroke. The woman smiled. Warm, sparkly eyes followedDunn, engaged more than was usual. Dunn tapped herknee, checking her reflexes. The doctor raised the womansleg, asking her to hold it up. She couldnt. The leg dropped.

Still, Dunn thought it may be time to transfer her to a long-term rehabilitation facility. Shes actually very alert andbright, and thats good. The woman would need a shunt tohelp drain the fluid from her brain, a common complicationafter a bleeding injury in the brain, so Dunn consideredwhether to recommend surgery before or after the move.She also had to make sure the woman had the ability toswallow because nutrition was crucial during rehabilitation.

continued on page 8

When a stroke damages a persons ability to speak or talk,it can lead to frustration, anxiety and social isolation forboth the patient and his or her loved ones.

Thats why Carrie Garcia, a speech language pathologist atUpstate, co-founded the Central New York Stroke SupportGroup with Jennifer Dougherty, a speech pathologist at St.Josephs Hospital Health Center.

Our mission is to educate patients, families and caregiversand provide them an avenue for socialization and self-ex-pression of their experiences and their feelings, needs and

social networking meeting other patients and familiesthat are like themselves, Garcia said.

The group, open to all, meets from 5 to 7 p.m. the thirdMonday of each month at OASIS/HealthLink, 1 TelergyParkway/6333 state Route 298, DeWitt, just east of CarrierCircle. Meetings include a guest speaker and group sessionsfor spouses and survivors.

For more information, call the Upstate Neurology Depart-ment at 315-464-4243 or go to www.upstate.edu/stroke

Coping togetherGROUP AIDS PATIENTS AND FAMILIES RECOVERING FROM STROKE

Brain injury medicine specialist Bernadette Dunn, MD, discusses a case with neurosurgery resident Khalid Khalid, MBBS. Dunn is also an associate professorof physical medicine and rehabilitation who trains residents and medical andother students.

Hear an interview at www.upstate.edu/healthlinkonair by searching Garcia.

w w w . u p s t a t e . e d u8

PATIENT CARE

UP STAT E H E A LTH summer 2015

Specialized rehabilitation is key to stroke recoverycontinued from page 7Another important issue during rehabilitation is bowel and bladder management, an area of rehabilitative nursing specialization. Dunn said many of the therapists and nurses work with patients in various stages of recovery from stroke, both in the neurological intensive care unit as well as the rehabilitation unit.

Team of caregivers focuses on recovery

Some stroke patients with mild deficits may go home after they are dischargedfrom the neurological care unit. They may attend outpatient rehabilitation for physical, occupational and/or speech therapy. They may also make appointments with a rehabilitative psychologist for help adjusting.

Some stroke patients are recommended for inpatient rehabilitation. UpstateUniversity Hospital has 50 beds dedicated to rehabilitation, 30 at its downtowncampus and 20 at its community campus.

In selecting which stroke patients should remain hospitalized during rehabilita-tion, Dunn said she considers their medical complexities, the severity of theirstroke and whether they can tolerate and benefit from six therapy sessions perday. It varies, but a typical course of inpatient rehabilitation is two weeks.

During the last part of their hospital stay, someone recovering from a stroke is surrounded by a set of caregivers, different than those who cared for him or her in the emergency department.

The nurses, therapists, dietitians and doctors who concentrate on recovery arefocused on helping patients get on with their lives.

Nearly a dozen caregivers meet to discuss individual patients care and progress. This meeting is led by Shernaz Hurlong, DO, and attended by additional physicians,nurses, brain injury specialists, physical therapists, occupational therapists, speech language pathologists and a rehabilitative psychologist.

Brain injury medicine specialist Bernadine Dunn, MD,discusses a patients progress with nurse manager Virginia Castro.

Hear an interview at www.upstate.edu/healthlinkonair by searching brain injury.

The most successful weight loss surgery patients surroundthemselves with people who have had the surgery, are following the new way of eating and can support the post-operative lifestyle.

Sometimes these veteran patients are found within hospitalsupport groups. Sometimes they are found in the sameneighborhood. And in this case, the same household.

Weight loss surgery has been 100 percent life changing forDavid Hoistion, 46, the patriarch of a family in Calcium,outside of Watertown. He and eight of his relatives havehad weight loss surgery, including his two daughters, hiswife, his mother-, father- and sister-in-law, an aunt anduncle plus the pastor and several friends from his church.

They may go in and tie your stomach, but for the patient,this surgery is more mental, Hoistion said, describing howhe cried when he smelled chicken he wasnt able to eat soonafter his operation. His weight loss helped to correct hissleep apnea and high blood pressure and relieved the pres-sure on his knees.

Nurse Casey Hammerle, the program coordinator forbariatric surgery at Upstate University Hospital, said people

often embark on weight loss surgery with a friend or familymember. They arrive together at an informational sessionand go on to schedule their operations for the same day orseveral weeks apart, so they can help one another recover.

When you have that built-in support, youre able to keep each other kind of on track and accountable, Hammerle said.

Losing weight and keeping it off can require a significantlifestyle change, and for many people, support is the key to success. The best weight loss surgery programs provideongoing support as Upstates does. Many patients alsofind support from friends or relatives.

Cherica Hoistion, 20, who lives in Rome, had surgery onthe same day as her older sister. As she shed her excesspounds, she was no longer lactose intolerant, and she feltmore confident. Today her family eats smaller portions andhealthier foods and drinks water instead of soda. She said,Weve all kind of gotten used to eating the gastric way.

9summer 2015 UP STAT E H E A LTH

PATIENT CARE

SUPPORTING EACH OTHERTHROUGH THICK ANDTHIN

Top: Sisters Cherica and Nicole Hoistion before bariatric surgery; above: Tanya andDavid Hoistion before surgery.

David Hoistion, 46, weighs 185 pounds, down from 345 pounds before his surgery in April 2012. His wife, TanyaHoistion, (second from left) had surgery in October 2012, dropping to 140 pounds from 265 pounds. His twodaughters had surgery on the same day in October 2014. Nicole Hoistion, 25, (left) has dropped to 210 poundsfrom 325, and Cherica, 20, (right) has dropped to 170 pounds from 272 pounds. Photo BY SUSan Kahn

For details about weight loss surgery at Upstate,visit upstate.edu/bariatrics

BY AMBER SMITH

PATIENT CARE

w w w . u p s t a t e . e d u10 UP STAT E H E A LTH summer 2015

Upstate Squad 1: David Landsberg, MD; Christian Knutsen, MD; Derek R. Cooney, MD; Chris Tanski, MD; Jeremy Joslin, MD and Erin Wirths, DO.

Rahul Dudhani, MD, remembers whenhe was new to Syracuse and had achance but influential encounter inJune 2012 at Caf Kubal.

He was a few weeks away from startinghis surgical training at Upstate, and enjoying a rare day off, when he noticeda man looking intently at his cellphonein the downtown Syracuse coffee shop.The man turned out to be pediatric cardiologist Frank Smith, MD.

Samaritan Medical Center in Watertownhad contacted Smith for his expertise because a newborn baby was in cardiacdistress, and there was no pediatric cardiologist on hand. Smith was tryingto view the echocardiogram and highlydetailed images of the newborns heart,but his new cellphone did not immediately connect to the cafs wireless network.

Dudhani helped him. Moments later, the young physicianreceived his first lesson in cardiac pathology from Smith, amember of Upstates faculty, and a man who would becomea mentor.

Examining the echocardiogram and images of the newborns heart, Smith diagnosed a rare and dangerouscondition called total anomalous pulmonary venous return.Blood was not flowing properly within the hearts chambers. The baby would need surgery, and soon.

Rahuls help was well timed, Smith said. This was a rare heart problem, potentially a life or death situation for the baby.

The baby was transferred to the neonatal intensive care unitat Crouse Hospital and days later underwent surgery at Upstate University Hospital.

Dudhani began his surgical residency at Upstate a fewmonths after meeting Smith. Today he is a fourth-year resident, specializing in pediatric cardiac surgery.

Upstates suburban hospital has new robotic surgery optionsand pain relief services.

A team of specially trained anesthesiologists provide outpatient pain management, including injections and painpump refills for patients with chronic pain, at the UpstateUniversity Hospital community campus on Broad Road inthe town of Onondaga. This supplements service that is of-fered at the Upstate Bone and Joint Center in East Syracuse.

Most patients are being treated for chronic neck or lowback pain, chronic arthritic pain in the shoulders or kneesor nerve pain from diabetes, shingles or central nervous system disorders. Surgery to install pain pumps still takes

place at the downtown hospital.

Surgeons at the community campus are using a new da Vinci surgical system that limits the number of incisions,reduces the time a patient is in surgery and provides improved picture quality. It is being used for patients undergoing hysterectomy, hernia repair, weight loss surgery,prostate removal, pelvic prolapse surgery and a variety of operations on kidneys and bladders.

This technology helps Upstate teach future generations of surgeons and offer patients more surgical options, said David Halleran, MD, chief of surgery at the community campus.

New at community campus: Pain relief, robotic surgery

By happenstanceH O W A C O F F E E S H O P D I A G N O S I S S A V E D A N E W B O R N , G U I D E D A C A R E E R

11summer 2015 UP STAT E H E A LTH

PATIENT CARE

An enlarged prostate can affect the flow of a mans urine and create urgency and frequencyissues that can impact his daily activities and sleep. Medications are often prescribed, butthey may only offer temporary relief and intolerable side effects.

For many men, taking medicine for this condition isnt something they want to do longterm, and for other patients, the medications may not be effective, said Jessica Paonessa,MD, an assistant professor of urology at Upstate who offers an alternative. In these cases,the next step is to remove the obstructive tissue surgically.

She offers a minimally invasive surgery called holmium laser enucleation of the prostate. A high-powered laser removes the obstructive portion of an enlarged prostate in its entirety.The surgeon accesses the prostate through the urethra and uses the laser to separate the obstructive tissue from the original prostate. A device cuts the tissue into small pieces andextracts it using suction.

This allows for a thorough cleanout of the blocking tissue and offers patients many benefits, Paonessa said.

The prostate, which is left intact, retracts to its original size and allows the patient to regainthe ability to urinate without difficulty. Patients remain in the hospital for approximately 24hours and are able to return to their daily activities without restrictions in seven to 10 days.

Paonessa said the results of the surgery are long-lasting, and patients experience life-changing results. They can travel, sleep through the night and return to their normal daily activities.

Hear an interview at www.upstate.edu/healthlinkonair by searching Paonessa.

Laser targets excess tissue in prostate

People in need of salivary gland surgery have more options, thanks to a new ear, nose andthroat surgeon on staff at Upstate.

Mark Marzouk, MD, the chief of the division of head and neck oncologic surgery, is one ofthe few surgeons in New York who is trained in an endoscopic procedure that allows thesurgeon to simultaneously detect, diagnose and treat inflammatory and obstructive disordersof the salivary ductal system without having to remove the salivary gland.

Our ability to visualize and treat the specific cause of the inflammation or obstruction allows us to save the salivary gland, leaving the patient with no external scars and at no riskof facial nerve injury, Marzouk said. Other benefits include less recovery time, same-daydischarge, and the resumption of normal activity the next day.

The salivary glands play a role in digestion, keeping the mouth moist and supporting healthyteeth by producing saliva. Depending on the severity of their condition, patients who havesurgery on the salivary glands may be able to return home the same day.

Hear an interview at www.upstate.edu/healthlinkonair by searching salivary.

Salivary treatment leaves gland intact

Delicate maneuversNEW SURGICAL TECHNIQUES PROVIDE PATIENTS WITH OPTIONS

Question

Roller coasters and other wild rides provided so much enjoyment in my youth, but as Ive gotten older, riding these rides leavesme feeling ill, with nausea, dizziness and/or headaches that last for hours afterward. Whats going on?

Answer

You have described not uncommon symptoms related to the vestibular system contained in the inner ear,says physical therapist Dale Avers, DPT, PhD, left, who directs Upstates post-professional program for physicaltherapists who want to obtain their doctorates.

As we get older, the vestibular system gets less efficient, meaning it doesnt respond as easily to motion of thehead or to movement around us. Normally the inner ear responds to movement automatically, so we arentaware that it is working until the movement is too much for our vestibular system to handle.

When that happens, such as riding a roller coaster or even riding in a car or airplane, we experience motionsickness, which are symptoms you describe.

The good news is that you can train the vestibular system to be less sensitive, although the training isnt fun. Basically you have to provoke the symptoms so that the vestibular system becomes more tolerant.

Or, you can just avoid those roller coaster rides.

UPSTATE ANSWERS

Can older people ride roller coasters?

12 UP STAT E H E A LTH summer 2015

FROM OUR EXPERTS

w w w . u p s t a t e . e d u

Battling sunburns with cream and ketchupObviously its best to avoid getting a sunburn in the first place, said Ramsay Farah, MD. But if your skin endsup reddened after a day in the sun, heres what Upstates division chief of dermatology advises:

1. Gauge the severity of the burn. If you have blisters, he said to make a trip to your health care provider, just to make sure its examined and that no possibility of scarring arises.

2. Take an aspirin. Its anti-inflammatory effects can help during the initial stage of a sunburn, if you take it promptly.

3. Apply cool compresses on the affected area.

4. Use a low-strength (1 percent) hydrocortisone cream, available over-the-counter, to help decrease inflammation but not affect wound healing. You want to be careful not to put very strong steroids on the burn, he said.

5. Head to your kitchen for a bottle of ketchup. Yes, you read that right. Farah explained that Ketchup has a lot of lycopenes and other anti-inflammatory factors, and its cold because it comes from the refrigerator. So if you put that on right away, along with taking aspirin, you will decrease the inflammatory response.

None of these measures will reverse the damage, but they should help the burn heal better and feel better.

13summer 2015 UP STAT E

FROM OUR EXPERTS

ADVICE FOR TEENS:

l Turn o your cellphone while driving, or at least put it on safe mode. If you mustuse your phone, pull o the road andpark safely first.

l Refuse to ride in a car with a driver who isunder the influence of alcohol or drugs. Create a backup plan with your parents or othercaregivers, so you can count on a safe ride home.

l Limit your vehicle to one passenger if possibleand reduce conversation and movement while on the road.

l If you are a passenger, do not encourage speeding or other negative behavior.

l Find your preferred radio station or playlist before you start the car and stick with it until you reach your destination. Keep music at a low level and no dancing while driving.

l Review maps and directions before you leave for an unfamiliar destination. If you need to consult a global positioning device, pull over first.

l Keep sunglasses in your car to minimize the outside distraction of the sun. Reduce the glare from reflective surfaces such as glass and polished metal by purchasingsunglasses labeled UV 40.

ADVICE FOR PARENTS OF TEENS:

l Lead by example. Dont text and drive. Wear seat belts. Follow trac laws.

l Explain the dangers of driving under the influenceand make sure your teen knows the use of alcohol

or drugs is non-negotiable.

l Consider a no passengers policy for newteen drivers.

l Look into smartphone applicationsthat monitor a teens texting and

phone calls while they are driving.

Lets Not Meet by Accident is a free interactive injury

prevention program designedby the Upstate Trauma Center. Its oered once amonth for up to 150 studentsfrom schools throughoutCentral New York. Learnmore by calling 315-464-4779.

How to stay focused on the road

LETS NOT MEET BY ACCIDENT PROGRAM BATTLES DISTRACTED DRIVING

Cell phones, alcohol or drug use, passenger conversation and the car radio are the most common distractions for teendrivers, said Kim Nasby, the Upstate Trauma Centers injuryprevention coordinator and an instructor in the Lets NotMeet by Accident program.

She said motor vehicle accidents remain the leading cause ofdeath for drivers age 15 to 19. Health care providers at Upstate want to help teens drive safely. Here is their advice:

w w w . u p s t a t e . e d u14 UP STAT E H E A LTH summer 2015

FROM OUR EXPERTS

Critically ill patients who require ventilators are at risk fordeveloping acute respiratory distress syndrome, a conditionwith a mortality rate higher than that of breast cancer in theUnited States. Four out of 10 of those patients who developacute respiratory distress syndrome will not survive. Thosewho do may cope with lung problems forever.

Scientists from Upstate are leading efforts to prevent thesyndrome from developing. Their research could prompt achange in the way patients all over the world are treatedwhile they are on breathing machines, or ventilators.

Most patients who develop an acute lung injury do sowithin 48 hours of being connected to a ventilator and thiscan progress to acute respiratory distress syndrome. Thecurrent treatment is to reduce the volume of air delivered tothe patient, which improves his or her survival rate but byless than 10 percent.

An Upstate laboratory run by Gary Nieman, in collabora-tion with Nader Habashi, MD, from the R. Adams CowleyShock Trauma Center in Baltimore, proposes a new strat-egy to prevent the development of acute respiratory distresssyndrome. It is a type of ventilation, called airway pressurerelease ventilation, which lengthens the patients inhalationphase to open collapsed lungs and shortens the patients exhalation phase to keeps the air sacs from collapsing. The trick is, caregivers must know what to look for, so theycan intervene ahead of the syndromes development.

Timing of an intervention may be as critical as the intervention itself, Nieman wrote with colleagues in theJournal of Trauma and Acute Care Surgery.

Research from his lab has shown that early interventionwith airway pressure release ventilation blocks the development of acute respiratory distress syndrome andprevents swelling and inflammation in the lungs.

Now Nieman and Habashi with assistance from researchscientist Josh Satalin and surgery residents Michaela Kollisch-Singule, MD, and Sumeet Jain, MD are exploring whether this same strategy can save the lives of premature babies.

Human gestation lasts 40 weeks. Babies born before 37weeks are likely to have organs that are not fully developed.The lungs are of particular concern because the body doesnot produce the surfactant they need in order to keep thelungs inflated until about week 28. The chance of survivalis low for babies born before then.

The theory is that airway pressure release ventilation usedon babies born as early as 25 weeks gestation could providetheir bodies enough time to start producing the surfactantthat will keep their lungs open and functioning for the restof their lives.

Nieman cant help the enthusiasm he feels for the research.We are currently in the position to change how medicine ispracticed within the next few years.

Protecting preemies and patients on ventilators

UPSTATEDISCOVERIES

RESEARCH POINTS TOWARD TREATMENT CHANGES

BY AMBER SMITH

A medical scan of your abdomen or pelvis may reveal morethan what your doctor was looking for. Some specific fea-tures of your bladder could indicate cancer, even if you haveno pain, bleeding or other symptoms. A follow-up is war-ranted, say a pair of Upstate urologists who published theirwork in the journal Urology this year.

Timothy Byler, MD, and Imad Nsouli, MD, created a database of 2,400 patients who underwent cystoscopy, a procedure that examines the inside of the bladder.

This data suggests that patients with bladder wall thicken-ing reported should undergo cystoscopy to exclude cancer.If your patients CT report comes back with bladder wallthickening, get a urologic consult, Byler said.

From their data, they discovered:

l A mass in the bladder has a 50-percent chance of beingcancerous.

l A bladder wall that was uniformly thicker than usual hada 20-percent chance of being cancerous.

l A bladder with a localized area of thickness on the insidewall is not likely to be cancerous.

The urologists admitted they were surprised that nearly 15 percent of the patients included in their database were

found to have bladder cancer. Half had a more aggressive,deadlier type of cancer. Undergoing cystoscopy to explorethe abnormalities that turned up incidentally could havesaved these patients lives.

The lesson is: Carefully read imaging reports and seek answers for any abnormalities.

FROM OUR EXPERTS

15summer 2015 UP STAT E H E A LTH

By appointing a health care proxy, or agent, you can makesure someone you trust carries out your wishes when youcannot make your own decisions, and you can help avoidconflict and confusion among loved ones at a stressful time.A proxy will speak for you if you are unable to speak foryourself even temporarily while receiving medicaltreatment.

Tom Curran, MD, and Robert Olick, JD, PhD, members of the ethics consultation service at Upstate University Hospital, recently spoke about the benefits of designating a health care proxy.

They said the hospital promotes New Yorks health careproxy form as the preferred type of advance directive. You can download the form at www.upstate.edu/bioethics.(Click on ethics consultation and then health care proxyforms.)

Instructions can be as general or specific as you like. Either

way, it is a good idea to discuss your wishes with yourproxy and your doctor, then give a copy to each of them aswell as to the hospital where you will receive care andyou can carry a wallet-size card with you.

Your proxy and your health care providers are required tofollow your wishes. Your wishes may be based on yourmoral and religious beliefs, your view of quality of life, concern for your family or other factors that matter to you. You can appoint a backup proxy, and you can cancelthe proxys authority at any time.

A person maintains the right to make his or her own healthcare decisions as long as he or she is able. Decision-makingpower only passes to the proxy when a doctor determinesyou are unable to make health care decisions yourself.

You must be 18 or older to be a proxy or to complete ahealth care proxy form.

Who knows your wishes?APPOINT A PROXY TO SPEAK FOR YOU IN CASE YOU CANT SPEAK FOR YOURSELF

LESSONS FROM UPSTATE

A. Shows the normal bladder appearance. Among radiographic bladder wall abnormalities are B. diffuse bladder wall thickening, C. focal bladder wall thickening and D. bladder mass.

Scans reveal symptom-free bladder cancerWHEN YOU AND YOUR DOCTOR SHOULD BE CONCERNED

w w w . u p s t a t e . e d u16 UP STAT E H E A LTH summer 2015

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17summer 2015 UP STAT E H E A LTH

Soldiers, families, neighborsTACKLING HEALTH NEEDS AT FORT DRUMTwo years after earning his masters degree in public health,Ian Grant said he never would have imagined hed be managing an annual budget of $1.5 million in state grantsfor population health.

Thats exactly what hes doing as population health program manager for the Fort Drum Regional Health Planning Organization in Northern New York.

My role is identifying health needs and leveraging resources to address those needs through partnerships,Grant said recently during a grand rounds presentation at Upstate. Our coalition includes insurers, schools, chambers of commerce and numerous community-based organizations.

The organizations three-county service area includes theU.S. Army base at Fort Drum, family members of the soldiers and the surrounding communities, which aremostly rural. Compared with urban populations, residentsof rural areas tend to be older, poorer, sicker and morelikely to be uninsured, Grant said. New York state healthstatistics indicate North Country residents have higher rates

of adult and child obesity, binge drinking, diabetes, smoking and suicide.

Grant works with nine hospitals, three public health agencies and several community organizations to protect and improve the health of more than 250,000residents. His group relies on a web-basedhealth information system at www.ncny-HealthCompass.org to inform and engagecommunity members and monitor healthimprovements.

He said the public health training he received through the CNYMPH program which makes use of experts at Upstate and at Syracuse University informs hiswork every day.

I get to use my CNYMPH training in research, data analysis, administration,health planning and program evaluation to help create a healthier community.

A senior programmer at Upstate spends some of hisfree time helping to close the digital divide. Thats thedivision between those with computer and Internet access and skill sets, and those without.

Joe Huber volunteers at the Rescue Mission in Syracuse, where he teaches computer skills to clientsof the Rescue Mission and serves on its InformationTechnology steering committee.

His Digital Bridge Class is offered to Rescue Missionclients who are seeking employment or general computer skills. They learn Microsoft Windows andOffice, including Word, and they learn how to searchthe Internet and use email. In addition, they learnabout identity security and how to be safe in cyber-space. At the successful completion of the course, students are awarded personal computers that have been donated by supporters of the mission.

Its been a real eye-opener. Its been one of the mostinteresting things Ive ever done, Huber said. Theclass had to be adapted. Some of the students neededbeginner-type training which focused on the keyboard,punctuation and literacy, before they could move onto computer skills.

The first group recently graduated, and Huber said he looks forward to future classes. He enjoys teaching, and he enjoys learning about the peoplewhom he helps.

Joe Huber (background, standing) works with (from front to back) Robert Chapman, Jorge Varona and Patrick Carroll at the computer lab at the Rescue Mission on Gifford Street in Syracuse.

Photo BY RoBeRt MeScavage

Ian Grant

On a MissionTECH EXPERT OFFERS COMPUTER TRAINING

IN OUR COMMUNITY

RoBeRt MeScavage

w w w . u p s t a t e . e d u18 UP STAT E H E A LTH summer 2015

After dispensing medical care and supplies inthe aftermath of the April 25 earthquake in hisnative Nepal, Upstate hospitalist Dinesh Subedi,MD, is focusing on rebuilding.

The disaster killed more than 9,000 people andleft nearly 3 million homeless.

Subedi traveled with locally donated suppliesand joined Nepali doctors from the UnitedStates to treat 25 or 30 people in each of severalvillages. They mostly hiked amid flattenedbuildings and landslides to get to patientsrequiring care.

Photographs Subedi shared show some of hisexperiences.

In photo A, a family assesses the damage totheir home in Sindhupalchowk, a district hithard by the earthquake.

Photo B shows a young girl who receivedtreatment for a broken leg at Civil ServiceHospital, where most of the orthopedic supplieswere donated.

Photo C is of the first house to be rebuilt by anonprofit campaign called Mission Rebuild

Earthquake aftermath: Rebuilding Nepal

www.upstate.edu/students

Upstate students benet from nationally

recognized professors,excellent job placement

and SUnY tuition.

Degree programs:Medicine, nursing,

PhD, Public health,

cardiovascular Perfusion,Medical Imaging,

Medical technology, Medical Biotechnology,

Physician assistant, Physical therapy,

Radiation therapy and

Respiratory therapy.

Education Healthcare Research

A

19summer 2015 UP STAT E H E A LTH

IN OUR COMMUNITY

Nepal, in the village of SipaPokhare. Subedi's group supports themission, which intends to rebuild 800 houses. Already, 75 like this oneare near completion. He and his colleagues concluded that "people'shealth will only be better once they have a good place to live. So untilwe can fix that, we can't make them healthy," said Subedi, an assistantprofessor of medicine.

In photo D, Subedi helps survivors in Majhigaun, a village innorthwestern Nepal. The doctor said he hopes to return to Nepal tohelp with the rebuilding effort.

Hear an interview at www.upstate.edu/healthlinkonairby searching Nepal.

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w w w . u p s t a t e . e d u20 UP STAT E H E A LTH summer 2015

IN OUR LEISURE

Hes bookedNURSE PRACTITIONER BUSIES HIMSELF WRITING MYSTERIES

When Tony Cerminaro started writing his mystery series, the nurse practitioner planned to draw onhis medical background in the hematology/oncology department at Upstate University Hospital. He crafted the fictional doctor Hank Milson as a main character in his first book, The Ten KnifeMurders. Hank returns for a new mystery in Cerminaros latest novel, Bonding Over Bullets.

This second book continues Cerminaros Andersson and Stefani series, in which each novel presents fictional investigators Nicklaus Andersson and Roxanne Stefani with a stand-alone mystery. Similar to Law and Order, Cerminaro said, the investigators plotlines develop acrossbooks in the series. In Bonding Over Bullets, for example, the romantic relationship betweenRoxanne and Hank develops in the context of a murder case involving a dangerous aphrodisiac drug.

Its got a very intense plot, Cerminaro said. Its kind of like reading a movie.

Although Cerminaro lives in Liverpool, he set his series in North Carolina so that Hank can takeadvantage of research opportunities at the prominent universities there. But Central New York references still crop up, he said. Hank attended Syracuse University, for example, and playedlacrosse for the Orange. I reference all the great seasons theyve had, Cerminaro said of thelacrosse team.

Bonding Over Bullets was released in October 2014 and is currently available online. He recommends it for an adult audience. The third book in the series, The Manuscript Mysteries, is anticipated this summer.

READING RECOMMENDATION

Peek at a doctors early daysBY JOHN LOFRESE

Terrence Holt, MD, PhDs book, Internal Medicine: A Doctors Stories, follows itsauthor under the pseudonym Harper through his residency training in a series of ninevignettes that capture the gravity, intensity and absurdity of medical educations mostformative years.

Neither sterile case review nor dramatic storytelling, each chapter seamlessly falls somewhere in between, demonstrating both the authors talent and the reality of daily life as a resident. Sharingthe experience of a residents nerve-wracking first night on call, the guilty pleasure of an exciting diagnosis and misguided feelings of detached expertise, readers are brought to Holt's conclusionthat the study of medicine is never truly over.

For busy medical professionals, this collection of short stories is the perfect way to relax and reflect.

Lofrese is a medical student at Upstate Medical University.

Tony Cerminaro

21summer 2015 UP STAT E H E A LTH

IN OUR LEISURE

Exercise is important for bone health, to increase bone thickness and strength during the growing years, and to help preventosteoporosis during adulthood. What activities provide the most bone-boosting benefit?

SOURCE: KAREN KEMMIS, AN INSTRUCTOR OF PHYSICAL MEDICINE AND REHABILITATION AT UPSTATE WHO HAS A DOCTORATE IN PHYSICAL THERAPY

242 calories10 grams protein26 grams carbohydrates12 grams total fat14 milligrams cholesterol804 milligrams sodium

RECIPE FROM MORRISON HEALTHCARE, FOOD SERVICE PROVIDER FOR UPSTATE MEDICAL UNIVERSITY.

Mix lettuces and herbs together. Place all vegetables, except onions, in abowl and toss gently with the dressing. Garnish with feta cheese and red onions.

6 ounces spring mix lettuce

4 ounces Romaine lettuce,chopped

1/4 cup fresh parsley,chopped

1/4 cup fresh mint,chopped

1 1/2 cups cucumbers,sliced like half moons

2 cups fresh diced tomatoes

1 1/2 cups canned garbanzo beans, rinsedand drained

2 ounces feta cheese,crumbled

1/4 cup fresh red onions,julienne sliced

6 tablespoons Greek feta vinaigrette

Nutritional information,per 2-cup serving

Ingredients

Preparation

Heres a light meal that you can change with the addition of seasonal greens, such as spinach, kale, arugula or frisee. This recipe yields four 2-cup portions.

Mediterranean chickpea salad

HOW EFFECTIVE ARE EXERCISES FOR BONE HEALTH?

HEAD TO A FARMERS MARKET

Bone-boosting exercises

VERY:

MODERATELY:

LEAST:

jUMpINg RopE l RUNNINg l hIKINg l CLIMbINg sTAIRs l hIgh-IMpACT AERobICs

ELLIpTICAL MAChINE l bRIsK WALKINg l sTAIR MAChINEs l DANCINg l LoW-IMpACT AERobICs

sWIMMINg l RIDINg A bIKE l pEDALINg A sTATIoNARY bIKE l WATER AERobICs l YogA

w w w . u p s t a t e . e d u22 UP STAT E H E A LTH summer 2015

IN OUR LEISURE

Unwinding on the waterFar from the demands and stress of hospital work, two Upstate nurses find peace and quiet on Adirondack waters.

When they both worked in the Cardiopulmonary IntensiveCare Unit several years ago, Sherod Harris discovered he and Andre Poirier shared a love of camping and the outdoors. Harris introduced Poirier to kayaking, which led to the pair taking an annual kayak trip, usually to theAdirondacks, for about the last 10 years. They also kayaklocally, mountain bike and hike.

Poirier, 45, who now works in the cardiac catheterizationlab, said he likes the quiet, the solitude, getting back intouch with nature that kayakers experience.

I love it its almost spiritual, agreed Harris, 52, whonow works on an elite team of critical-care nurses who respond to medical emergencies within the hospital.

While a canoe gives the feel of an open boat, I personallylike being in a kayak and putting my hand out in the water,and youre one with the water, Poirier said. I like notknowing whats around the next bend.

Their trip stories lightened the mood around the work-place, recalled one of their former managers, nurse LorrieLangdon. They reminded people you could have fun outside of the workplace, and it contributes to making the workplace a better place to be, said Langdon, who is now coordinator of the heart failure program.

Why kayak in the Adirondacks?

Why do Upstate nurses Andre Poirier and Sherod Harris like to kayakin New Yorks Adirondack Mountains? You could spend a lifetimeexploring the Adirondacks and never see the same thing twice, said Poirier.

Favorite spot

Lows Lake, south of Cranberry Lake, to name one. Theres no onearound. Its only accessible by boat, Poirier said.

Other favorite spots

The Raquette River and Blue Mountain Lake. Outside the Adirondacks, the pair has enjoyed Algonquin Provincial Park in Canada and the Allegheny Reservoir in Pennsylvania.

Take the plunge

Someone who wants to give the sport a try could buy a life vest, paddle and a cheap beginners kayak with a flatter bottom for a few hundred dollars, Harris says. Once you decide you like the sport, you can upgrade.

No tipping

Some people fear they will tip over in a kayak. It takes an effort totip over in a touring kayak, Poirier says, because you sit low in thewater, and the craft is long enough 16 to 18 feet to stabilize it.Further, he and Harris favor calmer waters, not whitewater or areaswith lots of motorboats. Its the shorter, narrower kayaks, such asprofessionals use, that are less stable.

Upstate nurses Sherod Harris, foreground, and Andre Poirier kayaking in Muskrat Bay on Oneida Lake.

CO-WORKERS TAKE TO KAYAKS EVERY CHANCE THEY GETBY JIM HOWE

Photo BY SUSan Kahn

23summer 2015 UP STAT E H E A LTH

FOR MORE INFORMAT ION OR TO MAKE A REFERRAL CALL3 1 5 .464. 1 500

GEM CARE EMERGENCY & URGENT CARE

FOR SENIORS AGE 65+

Upstates geM care oers a calm, easy-access setting especially for seniors. Located at the community campus (4900 Broad Rd., Syracuse), geM cares benets include a high level of geriatric knowledge; dedicated space with dedicated trained sta; coordination with your own doctor, with the goal of returning you home safely; and immediate hospital care for those who need it.

TO LeArN MOre ABOUT geM CAre, CALL UPSTATe CONNeCT AT800.464.8668 Or ViSiT WWW.UPSTATE.EDU/GEMCARE

located at the former Community General Hospital

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15.126 0415 34M ELsk

W O R K I N G T O WA R D A C U R E F O R B L I N D N E S S

Growing retinal cells in frogs may teach us how to do the same in humans, which could restore sight to

those whose vision has been impaired.

This image is a close-up section of a tadpole eye with theretinal rod photoreceptor cells marked in red. The tadpolereceived retinal progenitor cells (which would develop into

eye cells) that were derived from pluripotent frog cells,marked in green. Like human stem cells, pluripotent frog cells have the ability to develop into any type of cell in the body. The blue dye marks the cell nuclei.

To make the pluripotent cells turn into retinal cells, scientists Andrea Viczian, PhD, and Michael Zuber, PhD,discovered the cocktail of proteins that are normally found

in the developing tadpole eye at the time when the eyeis first forming. Viczian and graduate student Kim Wong, PhD, built on that work with the discovery of a new signaling pathway that

directs retina formation.

SCIENCE

ISARTISSCI ENCE

I SART

1 S SC I ENCEI SARTISSCIENC

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