This issue of Upstate Health is brought to you by the number 5

KidzBop performed for patients and families at the Kinney Performance Center at Upstate Golisano Children's Hospital. Photo by Kathleen Paice Froio.

KidzBop performed for patients and families at the Kinney Performance Center at Upstate Golisano Children’s Hospital. Photo by Kathleen Paice Froio.

Lots of important “fives” around Upstate these days, including:

5 years ago, the Upstate Golisano Children’s Hospital opened its doors in a “treehouse” addition above Upstate University Hospital in downtown Syracuse.

5 members of KidzBop visited patients at the Upstate Golisano Children’s Hospital in June. (Photo by Kathleen Paice Froio)

5 patents are held by Gary Nieman, who recently received a $50,000 grant from the SUNY Technology Accelerator Fund to develop minimally-invasive infusion and suction therapy, a novel medical device that removes harmful abdominal fluid buildup caused by trauma, infection or burns.

5 miles per shift is the distance that environmental services workers typically walk, helping to keep the downtown hospital campus clean and disinfected, says operations manager John Kolh.

IMG_15605 thousand dollar donations to the Upstate Cancer Center are recognized on a ceramic tile mural in the healing garden. So far, 33 $5,000 gifts have been received. To honor your loved one in this space, contact the Upstate Foundation at 464-4416.

5 medical mission trips to Ethiopia have been organized by otolaryngologist Rick Kelley, MD, in recent years to provide care and to train other ear, nose and throat doctors.

learning communities — consisting of medical students for the class of 2017, lead by faculty members, Drs. Lawrence Chin, Robert Corona, James Greenwald, Michael Iannuzzi and Robert Silverman — are named after the Finger Lakes: Canandaigua, Cayuga, Keuka, Seneca and Skaneateles.

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Bus banners promote Upstate missions of care, research, education

bus 2

The most populated areas of this region are served by the Syracuse-based Centro bus service. Upstate banners appear on the sides of some of these buses. Being at eye level, the advertisements dominate. Many people see the banners, as the buses travel hundreds of miles per day. Upstate has a broad reach.

Kidney donor Brandon Hudson appears on the cover of Upstate Health magazine with living donor transplant coordinator Ellen Havens.

Kidney donor Brandon Hudson appears on the cover of Upstate Health magazine with living donor transplant coordinator Ellen Havens.

This issue of Upstate Health illustrates that reach and the breadth of what we do with the variety of our articles.

You’ll find stories about the medical care we provide and the research in which we’re engaged, plus a peek at our new Upstate Cancer Center. Some of our experts share their advice. (Too much calcium? Signs of autism?  Need to burn 600 calories?) You will also meet some students – some of whom traveled to other continents as volunteers and a pair who developed a case of puppy love as residents of downtown Syracuse.

You will learn how Tony-winning actress, Jessie Mueller got her start at Upstate, why nurse Sarah Martin loves kayaking, what author Walt Wasilewski learned while researching his book about spiritual care, and the question every doctor will ask him- or herself eventually.

Find a roundup of Upstate news, a vegetarian recipe that uses tomatoes from your garden, and cool scientific artistry, this time from the laboratory of assistant professor, Mehdi Mollapour, PhD.

We hope you enjoy making Health part of your life.

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.

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What to do when a tooth is knocked out

Fracturing or losing a tooth in a fall or other accident is a fairly common occurrence. When that happens, “you have a very limited timeframe in which to treat that situation,” says assistant professor and dentist, Patrick Smith.

Athletic facilities and school sports programs may have Save-a-Tooth preservation kits at the ready. They contain a liquid that preserves a tooth for a short period of time.

Smith says to help the tooth maintain moisture constantly. Milk is fine. Water works, too. Or, you can place the tooth in the pouch of your cheek. “The tissue is alive, and we need to maintain it until we can re-implant it into the socket,” he says.

Make sure to handle the tooth only by its crown, or the part that you can see in the mouth. Do not touch the root.

Get to a dentist, oral surgeon or the emergency department at Upstate University Hospital as quickly as possible, so the tooth can be re-implanted and secured.

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Medical students suffer from puppy love

Medical students Connor Policastro and Tim Lentini Photo by Kate Collins, Syracuse.com

Upstate students Connor Policastro and Tim Lentini walk their pups. Photo by Kate Collins, Syracuse.com

Two Upstate students sharing an apartment in downtown Syracuse have developed enduring – and contagious – cases of puppy love.

First Tim Lentini got Freya, a golden retriever. Then he and his puppy went with roommate, Connor Policastro to choose Leila, a Weimaraner.

“We agreed that there was no way that either of us was going to get a puppy unless we were both in agreement,” Policastro says. “It’s all about teamwork. It’s tough being a single parent.”

Photo by Kate Collins, Syracuse.com

Leila is a Weimaraner. Photo by Kate Collins, Syracuse.com

Policastro grew up in Connecticut and attended Syracuse University; he is in the MD/PhD program at Upstate. Lentini, who grew up in Queens, is a second-year medical student.

The men share dog care duties. Their apartment in an old watch factory is a half block from a small park. Dog lovers in nearby apartments are willing to pitch in with feedings or walks if Policastro and Lentini are tied up in laboratories or classrooms on campus — which is an 8-minute bike ride away.

Policastro grew up with many dogs and other pets. Lentini had one German shepherd briefly in childhood. Both were anxious to have dogs of their own. They chose puppies they could train over summer, when their schedules were lighter. Today, Freya and Leila fight like sisters, mostly over toys and attention. They’ve brought a warmth to the apartment.

“It’s nice having somebody be SO excited to see you when you get home,” Lentini says.

 

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Autism identifiers: How to tell which babies are affected

iStock_000024537973LargeGoogle “causes of autism,” and you get millions of hits — and a multitude of conjecture. Is a genetic predisposition to blame? Are environmental factors at play? Maternal or paternal age, perhaps? Some sort of pregnancy complication? A virus, or pollutant in the air?

We do not know for sure, but genetics and the environment likely play a combined role, says Henry Roane, PhD, an associate professor of pediatrics and the division chief of the Center for Behavior, Development and Genetics at Upstate. Regardless of the cause of autism or the reason for its recent growth, he says treatment is most effective when begun early.

LISTEN TO THIS INTERVIEW

One in 68 children have autism spectrum disorder. The term “spectrum” is used now in reference to the range of impairment children can have, from mild to severe disability.

That represents a 30 percent increase in diagnoses from a couple years ago, partly because several individual disorders are now considered part of the spectrum. Awareness is also behind the increase, with more parents, teachers and primary care doctors on the lookout for early signs.

“It’s not like having a medical disorder where you can do a blood test and test for certain pathogens in your bloodstream and say ‘well, you have that disease.’ Autism is not like that,” Roane says “It is, to some extent, a subjective diagnosis in many cases. What one provider sees as autism, another provider might not see.”

Treatment is intensive behavioral therapy of 25 to 40 hours per week, to help improve cognitive and language skills. Roane says proper medical care plus early intervention can help change the trajectory of autism, especially in children who begin treatment before age 6. That means caregivers have to know what to look for, and what to ask the pediatrician.

Red flags?

Some signs of autism may be visible when a baby is just a few months old, although experts caution that the signs and symptoms of autism are highly variable among those affected. These 15 behaviors are possible signs:

* lack of sustained eye contact, especially to people or visually-interesting objects

* slow progression of language or delayed speech formation (not babbling, or making a single repetitive sound)

* not responding to their name by 12 months of age

* preference for playing alone

* flat or inappropriate facial expressions

* not pointing at objects by 14 months of age

* flapping hands, rocking body or spinning in circles

* avoiding or resisting physical contact

* unusual reactions to the way things sound, smell, taste, look or feel

* not playing pretend games (such as “feeding” a doll) by 18 months

* reversing pronouns (“you” instead of “I”)

* talking in flat, robot-like or sing-song voice

* lining up toys or other objects, or playing with them the same way every time

* repetitive movements, in older children

* getting upset by minor changes

Sources: Centers for Disease Control and Prevention and the National Institute of Mental Health.

LISTEN TO THIS INTERVIEW 

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New implantable defibrillator protects the heart without touching it

The device is sewn beneath the skin.

The device can improve a patient’s chances of surviving ventricular fibrillation, an often-lethal heart rhythm.  Photo courtesy of Boston Scientific.

A new style of implantable defibrillator provides protection against sudden cardiac arrest without having electrical wires placed in the heart. Instead, all components of the device are sewn into place just beneath the skin.

The device — which The Heart Group of Syracuse cardiologists, Traian Anghel, MD, and Jamal Ahmed, MD, began using this year at Upstate — monitors a patient’s heart rate and delivers a shock if necessary, “which essentially resets all of the electrical activity of the heart cells,” says Anghel.

He says a battery-operated pulse generator about the size of a deck of cards is placed beneath the skin below a patient’s armpit. A wire electrode stretches below the skin from the generator to the breastbone above the heart. It senses the heart’s electrical signals and transmits that data to the generator, and, if needed, delivers therapy back to the heart.

Implantable defibrillators have been in use for about 40 years. Earlier models rely on a wire to be threaded through a blood vessel, into the heart, across a valve and then attached to the heart wall.

Anghel says that for patients who are prone to a rapid heart rhythm called ventricular fibrillation, the risk of sudden cardiac death can be as high as 1 in 6 per year. He says an implantable defibrillator can significantly improve those odds.

Listen to Dr. Anghel and nurse Amy Tetrault in an interview for HealthLink on Air

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How much are those apple fritters going to ‘cost’ you in calories?

So you indulged in a pair of apple fritters. (No one is blaming you.) But now you want to undo the damage.

Each fritter is about 300 calories, according to CalorieKing.com. Here are some ways a 145-pound person could burn off 600 calories. The precise number of calories a person burns are influenced by the person’s age, body weight, gender, activity level and movement efficiency. Use this only as a guide.

canoe3 hours, 2 minutes of leisurely canoeing

2 hours, 46 minutes of walking at 3.4 miles per hour on a flat surface

2 hours of vigorous housecleaning

1 hour, 2 minutes of cycling at 12 to 13.9 miles per hour on a flat road

50 minutes of vigorous lap swimming

–reviewed by exercise physiologist Carol Sames, PhD, director of the Vitality fitness program at Upstate’s Institute for Human Performance.

 

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5 questions to ask after a car wreck

Emergency physician William Paolo, MD explains what to do if you find yourself in a car wreck. If you answer yes to these questions, call 911 for an ambulance.

1.   Did your airbags deploy? If the impact was strong enough to deploy airbags, it may have caused injury, as well. You may notice a chemical-smelling white powder from the airbag, but it’s not dangerous unless it gets into your eyes.

2.  Was there what’s known as “intrusion?” Did the car and the cabin around you collapse into you? Would you need help getting out of the car?

 3.  Did you lose consciousness? Do you remember the wreck?

 4.  Did you wear your seatbelt? “If you didn’t wear your seatbelt and you find yourself outside of your car, then you want to see an ambulance provider right away,” Paolo says.

 5. Are you in pain? Even what seem to be minor wrecks can cause injury, so pay attention to your body.

If you are transporting a child in a car seat, keep him or her in the car seat. Paramedics will likely bring him or her to the hospital that way.

Paolo says most importantly: Stay in your car unless it is on fire or about to be on fire, which would be exceedingly rare.

“We don’t want you up and moving around if we don’t know what your injuries are,” he says. “We worry that you may have injured something that may get worse by moving around.”

Not only that, but if you get out of your car, you are liable to be injured by other vehicles.

 

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1970s discovery makes bones ‘light up like a Christmas tree’

John McAfee MD, chairman of radiology and radiological sciences, 1965-1989, and Robert Richardson PhD, associate professor of radiology,  in the nuclear medicine lab at Upstate University Hospital, circa 1970.

John McAfee MD, chairman of radiology and radiological sciences, 1965-1989, and Robert Richardson PhD, associate professor of radiology, 1970-2014, in the nuclear medicine lab at Upstate University Hospital, circa 1970.

If you’ve read or seen the teen romance, “The Fault in Our Stars,” you remember the moment that Gus tells his girlfriend about his cancer recurrence by explaining that he had had a bone scan that “lit up like a Christmas tree.”

Gus, who had osteosarcoma, was likely referring to a scan of his skeleton performed using technetium-99m-methylene diphosphonate (Tc99m-MDP), an imaging agent that was developed at Upstate Medical University in the 1970s and is still used world wide.

Gopal (Mani) Subramanian PhD (1937-2000),  assistant professor of radiology, 1970-2000

Gopal Subramanian PhD, assistant professor of radiology, 1970-2000

Two Upstate faculty members — John McAfee MD (1926-2008) and Gopal Subramanian PhD (1937-2000) — led the research that developed Tc99m-MDP, a short-lived radioactive material that is injected through the vein and absorbed by the bones. The bone metabolizes the agent and shows high- and low-concentrations of it, indicating tumors or lesions in the bone.

Tc99m-MDP proved better than other imaging agents because it moves quickly from blood  to bones, stays long enough for nuclear medicine staff to get good images, and leaves the body quickly through the urinary tract, reducing the patient’s exposure to radiation.

Robert Richardson PhD and Marsha Roskopf, today

Robert Richardson PhD and Marsha Roskopf, today

Several Upstate employees and retirees — Robert Richardson PhD, Marsha Roskopf and Ted Duxbury – worked with Drs. McAfee and Subramanian in the 1970s.

Richardson and Roskopf explain the importance of this discovery: “It finds bone tumors six to 12 months before they can be seen on an x-ray.”

(A bone x-ray shows the anatomy of the bone, a nuclear medicine bone scan demonstrates function.)

Duxbury, retired chief technologist, describes nuclear medicine in the 1960s. “Bone imaging was in its infancy. Rectilinear scanners were slow and the images were inferior,” he explains. “Once the gamma camera came out, patients could be scanned using lower doses of radioactive material with better images. That’s when McAfee and Subramanian started researching technetium compounds.”

Roskopf, a 1973 graduate of Upstate’s College of Health Professions, was a research technologist in the lab of Drs. McAfee and Subramanian.

“The imaging agent (Tc99m-MDP) is injected and absorbed by the bones in two to three hours. MDP is the chemical that concentrates in the bone, Tc99m is the radioactive component,” explains Roskopf. “The patient is scanned with a gamma camera. Gamma rays from the skeleton are absorbed by crystals in the camera, causing the crystal to flash. Then,  through complicated electronics, a picture of the patient’s skeleton is created.”

David Feiglin MD, chairman of radiology and director of nuclear medicine, and Ted Duxbury, retired nuclear medicine chief technologist

David Feiglin MD, chairman of radiology and director of nuclear medicine, and Ted Duxbury, retired nuclear medicine chief technologist

How does the use of Tc99m-MDP and the gamma camera compare with other diagnostic tools available today?

Today, CTs and MRIs give the same information, reports David Feiglin MD, chairman of radiology and director of nuclear medicine. But, bone scans done with Tc99m-MDP show the entire skeleton and are easier, quicker, and less expensive to use. CTs provide images of particular areas of the body, and MRIs are time-consuming and costly.

However,  CT and MRI show information outside the skeleton that the Tc99m-MDP bone scan cannot.

“A Tc99m-MDP bone scan is one alternative,” says Feiglin, “and the best one in many instances.”

Top-tier equipment and dedicated staff remain the standard for radiology and nuclear medicine at Upstate.

“We have the best imaging equipment in the region, the best PET CT scanner,” notes Feiglin. “Patients would have to travel to New York City for the same quality.”

Feiglin leads a radiology staff of nearly 300, including 34 radiologists, three PhD medical physicists, 24 medical residents and scores of nurses and technicians.

Imaging services are available at five locations: the hospital’s community and downtown campuses, the Harrison Specialty Services Center, the Upstate Health Care Center and the new Upstate Cancer Center.

Feiglin is proud of his department and indebted to McAfee and Subramanian for their influence on the fields of nuclear medicine and radiology. “They were internationally renowned,” says Feiglin. “People came from all around the world to do fellowships with them at Upstate.”

Thank you,  Marsha Roskopf,  for sharing this history with the hospital’s 50th anniversary committee.

An update from Scott Macfarlane, director, Technology Transfer: Discovered in 1937, technetium-99m began to be used in medical imaging in the 1960s. Used in over 20 million diagnostic nuclear medical procedures each year, it is currently the most widely used radiotracer. McAfee and Subramanian’s innovation was to chemically attach technetium-99m to methylene-diphosphonate (MDP), a ligand known to be preferentially taken up by bone. Attached to MDP, the radiotracer is transported to bones where it concentrates in areas with increased physiological function, such as the site of a fracture or cancerous lesion, creating a radioactive “hot spot” which can easily be detected. Two patent applications were filed on behalf of SUNY and McAfee and Subramanian in 1971 and 1972, resulting in the issue of three patents covering: the technetium-99m-tin-methylene diphosphonate complex and how to make it (US 3,989,730); an aqueous solution containing the complex suitable for intravenous administration (US 4,032,625); and a method of using the solution for skeletal imaging (US 4,115,541).

A current bone scan done using Tc99m-MDP, an imaging agent developed at Upstate in the 1970s. Courtesy Department of Radiology, Division of Nuclear Medicine

A current bone scan done using Tc99m-MDP, an imaging agent developed at Upstate in the 1970s. Courtesy of the Department of Radiology, Division of Nuclear Medicine.

 

 

 

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Upstate Answers: Is colored cornstarch safe for the lungs?

The Q: The colored cornstarch used in promotional running events is supposedly safe for the skin, but what about the lungs? I awoke in a coughing fit the morning after the event.

Providing the A: Robert Lenox, MD, professor of medicine and division chief of Pulmonary/Critical Care at Upstate University Hospital, says:

“Most likely the coughing was not related to the cornstarch.  However, if you have environmental allergies, it might be possible to develop an allergy to a protein found in the cornstarch. (It is unlikely that the starch is pure starch, and there are probably some proteins from the corn in the cornstarch). This could produce an asthma attack if you develop an allergy, an IgE antibody to the protein. This would be similar to inhaling ragweed, dust mites, cat dander, or other environmental allergens and then developing an asthma attack.  Sometimes asthma manifests as a cough, and one does not develop wheezing or shortness of breath.

“An alternative explanation for your cough is exercise-induced asthma.  This occurs because you lose heat from your airway when you exercise, and this may precipitate an asthma attack in those who are predisposed to exercise- induced asthma.  As mentioned, asthma may manifest itself as a cough without other symptoms.

“A third explanation for the cough is that while you were running you inhaled environmental allergens such as tree pollens.  These allergens may have precipitated an asthma attack.

“Finally, you may have been coming down with viral respiratory infection, and that caused a cough.”

 

 

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