Shocking news in ’64: Smoking causes lung cancer

Cigarettes were prominently displayed for sale at the gift shop of  the former Community-General Hospital. ND. Pictures are hospital volunteers Peg Roth and Jayne Hayes. From Health Science Library, Upstate Medical University

Cigarettes were prominently displayed at the gift shop of the former Community-General Hospital, circa 1970. Pictured are hospital volunteers Peg Roth and Jayne Hayes. From the Health Sciences Library, Upstate Medical University.

Fifty years ago, Upstate’s hospitals opened their doors and the US Surgeon General issued the first report on Smoking and Health, linking cigarette smoking to lung cancer and heart disease. That report — the first of 31 issued by the US Surgeon General — laid the foundation for the tobacco control efforts that we know today.

In 1964, close to half of adults in the United States smoked. Televisions blared cigarette commercials  and newspapers were filled with ads that claimed cigarettes “refresh while you smoke” and tobacco’s “good taste never quits.”

Upstate President Carlyle “Jake” Jacobsen PhD smokes a cigarette at the opening ceremony for SUNY Upstate University Hospital, July 1964.

Upstate President Carlyle “Jake” Jacobsen PhD puffs on a cigarette during the opening ceremony for Upstate University Hospital, July 1964.

Hospital gift shops sold cigarettes, and Upstate’s president smoked in the medical school’s corridors and during campus events.

Today, it’s hard to imagine that people ever smoked in hospitals. But Cindy Cary and Linda Veit, both of whom have worked at Upstate for 28 years, remember when social norms were very different, and second-hand smoke was rampant.

“There were ash trays at nurses’ stations. Patient rooms were smoking and non-smoking,” explains Cary, who was a respiratory therapist and is now director of Upstate’s smoking cessation program.

Researchers were in the lab studying the effects of smoke inhalation. Down the hall, secretaries were smoking cigarettes,” describes Veit, who was a lab technician and is now special projects manager for the Upstate Cancer Center. “Most people knew smoking shouldn’t happen in a hospital, but they still did it.”

Today, Cary and Veit are dedicating their careers to tackling lung cancer and tobacco use. Cary runs free smoking cessation classes, year-round, at multiple locations through Upstate’s HealthLink program. Veit administers a lung cancer screening program as part of her work for the Upstate Cancer Center.

Ten years ago, Upstate President Gregory Eastwood MD announced plans to institute a smoke-free campus. At the time, 13 percent of Upstate employees and students smoked. By August 2005, Upstate had become the first smoke-free SUNY campus.

Several years later, Upstate worked with Onondaga County to expand tobacco control at area hospitals. The 2009 Smoke-free Sidewalk Ordinance prevents smoking within 100 feet of hospital property.

Today 17.7 percent of New Yorkers use tobacco.

 

Posted in cancer, community, education, health care, Health Link, Health Link on Air, history, hospital, public health, volunteers | Leave a comment

Good read: Christopher Hitchens travels from ‘Welltown’ to ‘Tumortown’ in ‘Mortality’

By Joel Potash, MD

41hDeBUldEL._SY344_BO1,204,203,200_Christopher Hitchens was a famous author, journalist, and lecturer who loved to debate religion with representatives of various religions. He was an atheist and perhaps best know for his book, “God is Not Great: How Religion Poisons Everything.”

In 2010, on the day of a book signing event for his new memoir, “Hitch 22,” he experienced chest pain and went to a hospital emergency room, where an x-ray showed lung cancer, later found to be metastatic from cancer of the esophagus. “Mortality” tells his story until his death in 2011, from “Welltown” to “Tumortown.”

Hitchens chose aggresssive treatments in hopes of prolonging his life, and if not, then of adding to medical knowledge of cancer treatment that might help others. His treatment side effects included loss of his voice, hair loss, fatigue, inability to swallow food, and nerve weakness that caused the loss of function of his writing arm. Writing and speaking were the two most important things to him.

Yet, he endured.

As he was an avowed atheist, some of the public saw this as fitting punishment. Others set up prayer days, hoping for the efficacy of prayer in his healing. Hitchens disavowed both.

Hitchens is splendid in talking of the etiquette of dealing with a dying person. His comments about treating physicians remind me of the play, “W;t.” Some physicians remain uncertain about what and how much to tell patients about their diseases and treatments.

A physician who cares for dying patients recently wrote in the New York Times that when he asked his oncologist how long he had to live, the oncologist refused to answer — and the physician with cancer defended the oncologist’s choice. I’m not sure I agree, but there is no one approach to all patients with a terminal disease.

So, is it helpful (or depressing) to read books about dying? I have a shelf full of such books, both fiction and non-fiction. Neither doctors nor patients seem to have the time or energy to go in depth into patient experiences of disease and treatments, so I find these books expand my understanding of what patients (and doctors) go through in dealing with the dying process. They may also educate future patients about the medical system so they can deal with it more satisfactorily. 

Medical students and residents should be required to read some of these books. But will they prepare me for the time when I may be dying? I hope so — but all bets are off when that time comes.

Joel Potash, MD is emeritus faculty in Upstate’s Center for Bioethics and Humanities. This book review appears in the winter issue of Upstate Health magazine. 

Other books about death and dying:

“Without,” poems by Donald Hall

“W;t,” a play by Margaret Edson

“Messages from My Father,” a memoir by Calvin Trillin

“Death Be Not Proud,” by John J. Gunther

“How We Die, Reflections of Life’s Final Chapter,” by Sherwin B. Nuland

“The Last Lecture,” by Randy Pausch

“A Death in the Family,” by James Agee

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Adding electronics to patient care

MC900353907Eighty to 90 percent of communication between humans is nonverbal — which means that healthcare providers could overlook important patient information if the provider’s focus is on the Electronic Medical Record computer screen. Body position, eye engagement, gestures and facial expression can provide important information when diagnosing patients, says Joyce Scarpinato, DNP, director of the Doctor of Nursing Practice program at Upstate’s College of Nursing.

She recently spoke on campus about EMRs, urging providers to be mindful of the impact technology has on their provider-patient relationships and on daily personal communication. What are the ethical implication this technology has on the patient-provider relationship and our personal lives?

Research shows that EMRs can improve quality and safety. Scarpinato reports that studies are mixed about patient satisfaction. Some studies found that patients feel more involved in their own health care when the provider is using an EMR; however, others found that broken eye contact and a lack of face-to-face interaction (while the provider enters information into the EMR) decrease patient satisfaction. 

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Obstetrics, gynecology services expand at Upstate

Upstate expands the type of obstetrical and gynecological care it offers with the addition of fellowship-trained faculty members. These are the OB-GYNs who train many of the OB-GYNs practicing in the Syracuse area. Here’s a look at some of the services:

Dr. Spadola

Dr. Alexandra Spadola

* Comprehensive care for any high-risk pregnancy is provided through the Regional Perinatal Center, at the University Health Care Center, 90 Presidential Plaza, Syracuse. The center is one component of the Regional Perinatal Program, which has a new director. Alexandra Spadola, MD, who is fellowship trained and board certified, and oversees the program, which provides clinical support, quality review and educational outreach to 19 affiliate hospitals across a 17-county area of central and northern New York State.

* Complete care for low-risk pregnancies and comprehensive gynecology services are available through the Women’s Health Service, in two Syracuse locations: UHCC at 90 Presidential Plaza, and the Physicians’ Office Building at 725 Irving Ave., Suite 600.

* Group care for pregnant women with diabetes is now offered through Upstate’s Regional Perinatal Center. Called “Centering Pregnancy,” the program is one of the first in the country that focuses on women with diabetes.

Dr. Eddie Sze

Dr. Eddie Sze

* Eddie Sze, MD, Director of Urogynecology and Pelvic Reconstructive Surgery, recently achieved board certification at the first offering of this specialty certification. He and colleagues see patients at the physician office buildings at the Upstate University Hospital Community Campus and at 725 Irving Ave., Suite 600, Syracuse.

* Midwifery services are based at the Upstate University Hospital Community Campus. The team provides personalized pregnancy care before, during and after childbirth and routine gynecology. Deliveries take place at the Jim and DeDe Walsh Birth Center in the hospital.

Dr. Renee Mestad

Dr. Renee Mestad

* Renee Mestad, MD is a fellowship-trained physician who specializes in all aspects of family planning, particularly for patients with complex medical histories.

* Gynecologic oncologists Rinki Agarwal, MD, Douglas Bunn, MD and Mary Cunningham, MD provide comprehensive care for women with gynecologic malignancies to include radical surgery, laparoscopic surgery, radiation therapy and chemotherapy. Also, patients have the opportunity to participate in regional and national clinical trials through the division’s participation with the National Cancer Institute’s Gynecologic Oncology Group. Dr. Agarwal sees patients at 725 Irving Ave., Suite 600.

Dr. Frederick Sengstacke

Dr. Frederick Sengstacke

* Upstate offers assisted reproductive technology through its IVF Program (phone 315-464-7249) and a variety of services for women and men through the Division of Reproductive Endocrinology and Infertility at 725 Irving Ave Suite 600. The division offers evaluation and treatment of all aspects of both male and female reproductive endocrinology, infertility and andrology, and Frederick D. Sengstacke II, MD, the director of the In Vitro Fertilization Program, offers fertility preservation in cancer patients along with other in vitro fertilization services.

In addition, several general Board Certified OB-GYNs have recently joined the department, including Leah Kaufman, MD, Brian Thompson, MD and Jodi Wallis, DO. They are available for the comprehensive care of women in all facets of their life cycle including pregnancy and menopause.

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Modern birth control options for women

Karen Teelin, MD tells her patients the ABCs of sexuality. A is for abstinence, B is for be faithful, and C is for condom. She is quick to point out that condoms have a 10- to 20-percent failure rate and that sexually-active teens need to use two forms of birth control.

Karen Teelin, MD tells her patients the ABCs of sexuality. A is for abstinence, B is for be faithful, and C is for condom. She is quick to point out that condoms have a 10- to 20-percent failure rate and that sexually-active teens need to use two forms of birth control.

Q&A

with Karen Teelin, MD

Q Why are the rates of sexual activity among American teens the same as in other developed countries, but our rates of teen pregnancy and abortion are higher?

A “That’s partially because of the use of highly effective contraception in other countries. 

“There is a 2011 Centers for Disease Control and Prevention study showing 50 percent of teens by 12th grade have had sex, and if you go up to age 20, it’s about 70 percent. There is a decreasing age of menarche (age at a woman’s first period) and an increasing age of first marriage, so there is a longer period of fertility when women need birth control.

“Eighty to 82 percent of teen pregnancies in America are unplanned. It’s a huge public health problem and a very stubborn public health problem and a difficult one to address. Part of the answer, really, is education and contraception.”

Q What is the most effective contraceptive?

A “The LARCs — long-acting reversible contraceptives — are as effective as sterilization, but they are reversible. That would include the implant and two types of intrauterine devices.

“The current implant is one little rod, a couple centimeters long. It goes into the arm. It’s called Nexplanon, and it releases a small amount of progesterone. It lasts for three years. The procedure to implant it is very simple. It takes about 5 minutes. It hurts as much as getting a shot would, or even less than that. Once it’s in there you can completely forget about it for three years.

“The IUD is a small T-shaped device a couple centimeters long that is inserted by a doctor into the uterus. It can be put in teenagers, young women or women who have had children or women . It stays in the uterus. There is one with no hormones that stays in for 10 years. The progesterone IUDs release a small amount of progesterone locally. The Mirena will last five years, and the Skyla, which is smaller and has less progesterone, and will last three years. They’re both highly effective.

“Back in the ‘70s and early ‘80s there was an IUD (the Dalkon Shield) that had been associated with an increased risk of pelvic infections, however those studies were fraught with methodological errors. In the more current studies, there is actually a decreased risk of pelvic infections with some of these IUDs.

“There are noncontraceptive benefits, too. The Mirena, for instance, can reduce menstrual bleeding and menstrual pain, and many women don’t get periods on it. That is one of the reasons they’re so popular.”

Q Are other methods still used?

A “We have a lot of young women who choose the pill, and it can work, but you do need to take it every day.

“The patch is like a birth control pill, except instead of taking it every day, you have a sticker, a little bit bigger than a Bandaid, that you change every week. Some people really like the patch because you don’t have to think about it every day — but you have to remember it each week.

“The shot is commonly referred to as Depo, (short for Depo-Provera.) That is a shot that you would get every 12 weeks. That is also progesterone-only, like the implant, but there might be more side effects.

“The ring is like the birth control pill, with the same medicines of estrogen and progesterone, but it is inserted into the vagina, and it stays for three weeks, and it releases a small amount of the hormones. Some people really like that. The teens can put it in themselves. It’s a small ring. It’s flexible. You just sort of bend it and put it in.”

Listen to an interview with Dr. Teelin on HealthLink on Air

Posted in community, Golisano, women's health | Leave a comment

Doc puts toxicology in a box for medical education

Dr. Brian Kloss. Photo by Susan Keeter.

Dr. Brian Kloss. Photo by Susan Keeter.

An assistant professor of emergency medicine is using comic illustration to teach clinical toxicology.

mouse03“Toxicology in a Box” is a deck of 154 full-color flashcards designed to teach how to recognize and treat drug overdoses and poisonings. Brian Kloss, DO is co-author. 

The backs of the cards provide signs and symptoms and a description of how patients are likely to appear, along with treatments and advice. The collection, with a price of $49, is meant to help doctors and other medical professionals study on the go, quiz themselves or brush up before exams.

Kloss appeared on the AMC Television program,“Comic Book Men,” in the fall to talk about the concept of medical education through comic illustration. He hopes to create a second flash card set on infectious diseases.

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Why I love shooting pool

Like many billiards enthusiasts, Christopher Sanders has no pool table in his home, preferring instead to frequent a pool hall. His favorite is Premium Billiards, 228 Chapel Dr., Syracuse, which sponsors him. During the day he is an EEG technician at Upstate University Hospital.

Like many billiards enthusiasts, Christopher Sanders, 47, has no pool table in his home, preferring instead to frequent a pool hall. His favorite is Premium Billiards, 228 Chapel Dr., Syracuse, which sponsors him. During the day Sanders is a technician in Upstate’s clinical neurophysiology department. His wife, Elsie Sanders is a nursing supervisor.

By Christopher Sanders

1. Fond childhood memories.

We had a table when I was growing up probably 40 years ago. I hit the balls around there and just kept playing.

2. Leagues.

The 9-ball league is broken into skill levels from 1 to 9, with 9 being the highest. I’m a 9. The 8-ball league is different; the highest is a 7, and the lowest is a 2. I’m a 7.

Anybody can play in this league. It’s not just for the best. Every person on the team is just as important. We want the beginners. In 9-ball, it’s a maximum of 23, and you have five players that play. If I’m a 9, the other four players have to total no more than 14 all together. Everything is computerized, as far as your skill level. When you get a new player, they automatically, for the first few weeks, come in as a 4.

It’s just fun. We have great people of all ages. We’ve got people in their 70s, to their early 20s.

3. Mentoring.

I am a captain on my 8-ball and 9-ball teams. I help the lower-skilled players. I try to make it fun for them, not to get too intimidating. I’ll go in and have practice sessions with them. I’ll show them the basics of how to stand. I show them how to stroke the ball three times, every time.

If you don’t start out on the right foot in pool, you can pick up a few bad habits, like keeping your arm in and keeping your dominant eye over the stick.

EEG tech-Pool master4. Premium Billiards. 

It’s not a bar. It’s a nice place near Camillus (228 Chapel Drive, Syracuse) with all new tables and felt. They sponsor me.

You bring your own sticks. You usually have one to break with and one to shoot with. Your breaking stick is usually a stiff shaft, and it’s a lot heavier so you can break the balls harder. The other one, some of them have very flexible shafts to where you can get a deflection on the balls better.

5. Fills the calendar.

I play Mondays and Wednesday nights. I take off Tuesdays and Thursdays, maybe Fridays. League is on Sunday, and on Saturday I go in to play with friends who aren’t in the league.

6. Opportunity for improvement.

Here in Central New York, we have a really big pro tournament twice a year at Turning Stone Resort & Casino. There will be 126 players, and 100 of them are professional. They bring in tables from California, 16 tables that are brand new. These are world-class players that come and play. That is really good to go and watch. You can learn to improve your game by watching.

7. Vegas, baby!

The league I’m playing in is a world-class league. What they do is take the best 8-ball team, the best 9-ball team, the best doubles and have tournaments. Then the national and international tournament is in Las Vegas. Usually they have 10,000 people out there playing. In the master’s division — that’s the best of the best — there were 272 teams, and we placed 16th. There was only three of us on the team. We played teams from Japan, Canada and the United States.

8. Chance to give back.

My wife’s mother passed away at the age of 39. She had a massive heart attack. I’ve been a team captain for the American Heart Association’s Heart Walk for 10 years. My master’s team this time, we are donating $2 for every point we score — plus we have a backer who will double that — to the heart association.

The most you can score is 21 points per match. There are 14 teams. We’ll play each team probably twice. We play two games every three weeks. It starts Nov. 24 and goes to the first week of May.

EEG tech-Pool master

Posted in cardiac, community, entertainment, neurology | Leave a comment

Why breakfast matters so much

If you’re trying to lose weight, make sure you eat breakfast. Upstate registered dietitian Terry Podolak explains why:

* You need to “break” the “fast” by refueling after a good night’s sleep, ideally with a meal containing protein, fiber and fat. This will help keep you satisfied for four or more hours.

* Studies show that people who skip breakfast are likely to become over-hungry, and then overeat as the day goes on.

* Your metabolism can be altered when you go for longer periods without food.

* More body fat accumulates when you eat fewer large meals than when you eat smaller more frequent meals.

You may not be hungry when you first wake up, but that is OK. Work at being mindful of when hunger kicks in – likely by mid-morning — and have healthy foods at the ready. Some ideas: whole grain toast with peanut butter, yogurt topped with nuts or fruit, quick breads with nuts, seeds or berries, or eggs paired with some fruit.

This is excerpted from “Healthy Eats” on Upstate’s weekly radio program, “HealthLink on Air,” heard at 9 p.m. Sundays on WRVO Public Media.

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Are you still dragging from the time change?

Katie Gibas of Time Warner Cable News interviews Dr. Antonio Culebras.

Katie Gibas of Time Warner Cable News interviews Dr. Antonio Culebras. Photo by Kathleen Paice Froio.

We lost an hour when Daylight Savings Time took effect at 2 a.m. March 9, and some of us are still recovering.

Not only is the time set forward (until Nov. 2) “but that is compounded by the fact that many people are unable to fall asleep at the conventional time according to the clock,” Dr. Antonio Culebras told Time Warner Cable News. Culebras is a neurologist specializing in sleep medicine specialist at Upstate.

He said people may take as many as 10 days to get over the loss of sleep, and he explained the possible health consequences, notably motor vehicle accidents from drowsy driving.

Read/watch the Time Warner Cable News report

Listen to an interview with Dr. Culebras about sleep problems

Learn more about Dr. Culebras

 

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Photojournalist spotlights patients in series of films

Photojournalist Ross Taylor captures an interaction between music therapist Claire Arezina and patient Aiden Erwin, as Aiden’s mom looks on.

Patient Kayla Smith touches the guitar as music therapist Claire Arezina sings to her, a moment caught on film by photojournalist Ross Taylor.

A child without hair reaches inquisitive fingers to the strings of a guitar during a “music therapy” session.

A man with kidney failure tears up when his sister — “she’s my everything,” he describes — offers her healthy kidney for transplant. 

A mother and father remind themselves “one day at a time,” as their preschooler battles a brain tumor. 

Ross Taylor of The Virginian-Pilot. (Stephen M. Katz/The Virginian-Pilot)These video vignettes tell the poignant stories of Upstate University Hospital patients. They were produced by Pulitzer Prize-nominated photojournalist Ross Taylor, a fellow at the Multimedia Photography and Design Department at the S.I. Newhouse School of Public Communications at Syracuse University. Working closely with Kathleen Paice Froio of Upstate’s Public and Media Relations Department, Taylor spent many days at the hospital last fall talking with patients, family and staff who allowed him to be present during many personal and emotional moments.

Taylor, a photojournalist for 20 years, is known for his sensitive ability to tell deeply personal stories. He has shot on assignment in six countries and is co-creator of The Image Deconstructed, a nationally recognized blog that highlights an image and asks the photographer to deconstruct the creation of the image, and the psychology and emotion behind the photograph.

He has won the prestigious National Photojournalist of the Year award, and he was nominated for a Pulitzer for his documentary photographs in a trauma hospital in Afghanistan.

For his projects at the hospital, Taylor is working in video, rather than still photography. 

“Film is much more difficult to do, and even harder to do well. It takes much more time and investment on both my part, but also the hospital and the patients who are willing to share their story,” he says. “I believe, though, that in the end, it’s a very powerful way to share someone’s story, and it’s worth the extra work.”

His three Upstate films include:

* “Music Therapy” showcases the work of board certified music therapist Clare Arezina,  who uses music as a tool to help connect with and heal patients in the Upstate Golisano Children’s Hospital. 

“I do have days where I feel like there should be ‘Rocky’ theme music playing in the background behind me, and it’s fantastic,” Arezina says. “It’s those very clear moments of ‘this is absolutely why my job has worth,’ and ‘this is why I do what I do.’ It’s really rewarding those days to be able to have that kid smile, to have a kid reach who hasn’t reached for anything, to have a kid play and interact who hasn’t been playful or interactive.”

She goes on to explain that musical performers are focused on how they sound. But she is focused on how the child is experiencing the music and what it’s doing for his or her body, mind, emotions and spirit.

* “This Changes Everything” tells the sort of Aiden Erwin, 4, and his parents, Melanie Overy and Glen Erwin, as they cope with their son’s brain cancer diagnosis. They have been basically living at the hospital.

“Just one day at a time. That’s what you tell yourself every day,” Overy says. “Things change very quickly, and you don’t want to get your hopes up or have your hopes too low. You just kinda want to take it as it comes.”

* “A New Beginning” follows a brother and sister through a living kidney donation. LaToya Alexander says when she learned that her brother Robert Barnes was suffering kidney failure, she said “I’ll do it. Yeah. I’ll get tested, and I’ll donate my kidney if it’s a match.

“He said, ‘what’s your blood type?’ And I said, ‘O postive.’ And he said, ‘that’s the same one I am.’ 

Loved ones prayed with Barnes and Alexander before their surgery on Nov. 12, 2013 with transplant director, J. Keith Melancon, MD.

“If you don’t have good kidney function, your life is tremendously shortened. Even a young person is not going to have a normal life expectancy. So when someone donates a kidney to you, they’re really vastly extending your life. They’re saving your life,” the surgeon explains.

“These people are different after that operation. Everybody is transformed by this experience.”

 

Posted in cancer, community, Golisano, physical therapy, surgery, transplant | Leave a comment