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.

 

Posted in community, entertainment, fitness, nutrition | Leave a comment

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 the agent of choice for many radiologists.

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 into a 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 the 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: “At the time, it could find bone tumors six to 12 months before they could 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 a crystal in the camera, causing it 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.

 

 

 

Posted in education, research, health care, hospital, cancer, community, history, radiology | Leave a comment

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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How to guard against food-borne illnesses, especially during pregnancy

When pregnant, a woman’s ability to fight infection is lowered, and she becomes more susceptible to illness. Registered dietitian Juliann Mellen explains how to prevent three common foodborne illnesses:

* Listeria is a harmful bacteria that grows in refrigerated ready-to-eat foods such as unpasteurized milk and milk products, ciders and lunchmeats. To stay safe, avoid hot dogs and lunchmeats unless they are reheated until they are steaming hot; and brie, feta and other soft cheeses unless they are pasteurized.

* Mercury in high levels can harm a baby’s developing nervous system, so skip eating shark, swordfish and king mackerel, which have high levels of mercury. Instead, Mellen says it is OK to eat up to 12 ounces per week of fish that are lower in mercury, including shrimp, tuna, salmon and catfish.

* Toxoplasma is a parasite that can be ingested by eating undercooked meats, contaminated water or produce that has not been thoroughly washed. It is also found in the feces of infected animals, particularly cats. So, pregnant women should have someone else change cat litter boxes and always wear gloves when gardening, Mellen advises.

“Good food safety practices will benefit you and your family for a lifetime.”

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Book shares advice from hospital spiritual care volunteers

opentheeyesA book called “Open the Eyes of My Heart” showcases the volunteer spiritual care that takes place within Upstate University Hospital as part of professional chaplaincy provided by the Department of Spiritual Care.

Spiritual care volunteer Walt Wasilewski crafted the book from interviews with 18 spiritual care volunteers. He is a journalist who teaches at Syracuse University’s S.I. Newhouse School of Public Communications.

“I felt like it was a 6-month intensive tutorial in the best practices in spiritual care,” he says of the time he spent researching. “I learned so many things, some esoteric, some fairly difficult to ponder, but a lot of practical things: What do you say when this happens? How do you react when that happens?

“It has affected the way I relate to patients,” says Wasilewski. “And the hope is that the book will do the same for people in other places, other hospitals, other settings, where they might read this and be a little bit inspired.”

One story is about a volunteer in her 30s who uses Reiki to connect with patients. Another tells of a woman who began volunteering in her 70s and glowed as she spoke of her days visiting patients.

“Open the Eyes of My Heart” was published by Upstate’s Center for Spiritual Care through a Friend in Deed grant from the Foundation for Upstate Medical University. Imani Shabazz, a summer 2013 Synergy Mercyworks spiritual care intern, also contributed to the book. It sells for $5 through the center.

More than 100 people volunteer through the center, says the Rev. Terry Culbertson, who manages the center. She says the program includes a full spectrum of faith traditions. “Offering spiritual care as a volunteer can add a fulfilling dimension to life. There are so many ways our volunteers offer spiritual care, whether it is through prayer, Reiki, music, a gentle touch or merely just by spending quiet moments with patients.”

Wasilewski was impressed with the volunteers he met during his research. “How knowing and wise these volunteers are about how to prepare a place in time – our place, in this hospital – so that the spirit can do its work.

“The doctors and nurses are always doing their work. The spirit is, as well.”

Listen to an interview about the book

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Sneak peek of fall 2014 ‘Upstate Health’

fallcoverComing soon to waiting rooms throughout the Upstate campus is the fall issue of Upstate Health magazine. The cover features living donor transplant coordinator Ellen Havens with a man who donated his healthy kidney to his father.

Click on the image of the magazine for a digital sneak peek. Inside you’ll find stories about patient care, expert advice, and a look at Upstate’s role in the community around us, as well as activities that occupy our leisure.

At the top of this blog, you’ll find links to previous issues of Upstate Health along with its new sister publication Cancer Care.

Posted in community, surgery, transplant | Leave a comment

Students gain education as volunteers, an ocean apart

Upstate respiratory therapy student Adlin Noel takes blood pressure at a clinic in Ghana.

Upstate respiratory therapy student Adlin Noel takes blood pressure at a clinic in Ghana.

Spring and summer breaks don’t necessarily mean sunny beaches for students who are training for careers in the health professions. Upstate students volunteer for additional medical experience and training at sites all over the world.

“We are continually trying to build our repertoire of international medically related educational opportunities,” says Sue Stearns, PhD, director of the Center for Civic Engagement. “We encourage our students to explore new horizons but are always concerned about their safety as well as the value of their experiences.”

Respiratory therapy roommates Stephen Johnson and Adlin Noel spent some of their break between classes last year in countries on opposite sides of the Atlantic Ocean.

Johnson headed to the jungles of Honduras for what turned out to be “the highlight of my medical experiences.” He volunteered with an organization called Adventure in Missions and spent four weeks providing care to hundreds of families.

He found reactive airways disease, or asthma, was prevalent. This is because household kitchens there are almost always thatch huts right next to the homes. “The black smoke from the stove rises and quickly fills up the kitchen hut, and children breath this their entire lives. The constant airways irritation leads to the development of chronic inflammation and narrowing of the bronchioles, which then leads to asthma-like symptoms.” Johnson distributed many metered dose inhalers to help treat acute bronchospasms.

Noel volunteered with medical and nursing students for two weeks last summer to provide rural medical care in Nicaragua. He jumped at the opportunity earlier this year to deliver medical care to people in rural villages of Ghana through the Americans Serving Abroad Projects. The trip was organized by Upstate nurse Lauri Rupracht. As part of his work there, Noel conducted research that revealed a significant lack of knowledge of the detrimental effects of smoking among villagers.

Noel says his experience “renewed my purpose as a future health professional to respond to the medical needs of those less fortunate.”

He also inspired other respiratory therapy students to seek out international opportunities. Catie Zopf and Alex Tabone traveled to Nicaragua this summer along with nine Upstate medical students as volunteers helping rural health care providers.

Johnson says his experience in Honduras “has given me an entirely new perspective on what it means to serve, and a renewed drive to make sure I am providing the best care when they do find themselves in my hospital.”

Adlin Noel and Stephen Johnson graduated from Upstate's respiratory therapy program.

Adlin Noel and Stephen Johnson graduated from Upstate’s respiratory therapy program.

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Would you give a kidney to a stranger?

Transplant surgeon, J. Keith Melancon, MD, operates earlier this summer.

Transplant surgeon, J. Keith Melancon, MD, operates earlier this summer. Photo by Robert Mescavage.

He was about to turn 30 and feeling blessed. He had a great family, a solid support system, and he had found a way to help someone. A woman at the man’s church had severe kidney disease and was on dialysis three times a week. He could not help her. But he could help someone.

Most people are born with two kidneys but can live normal, healthy lives with just one. Among those willing to become living donors, most donate to family members, friends or people they know. Some are willing to donate to people they have never met. The transplant team at Upstate refers to them as “altruistic” donors.

The man had never heard the word altruistic, which means a selfless concern for the wellbeing of others. He simply wanted to help someone, without acknowledgement. He did not want to be identified by name in this story.

Living donor coordinator Ellen Havens says this happens sometimes. “Some of them just feel like they have this calling. Some of them say they knew somebody that they couldn’t donate to, or they saw somebody suffering.”

The man contacted Upstate University Hospital’s transplant center and learned that he was healthy enough to donate one of his kidneys. It was a good match for a Central New York woman, whose husband was not a match for her. The husband was still willing to donate a kidney, though, and his was a good match for another Central New York woman.

That is how transplant surgeons came to perform the first kidney exchange at Upstate: four surgeries involving two donors and two recipients on one long summer day. The spark was the altruistic donor.

Transplant surgeon J. Keith Melancon, MD, removed the man’s kidney and while his colleague, Vaughn Whittaker, MD, was sewing it into the recipient, Melancon left the operating room to let the donor’s mother and father know that all was well. “You have a great boy. I know you know that,” he began.

Melancon says an average of 17 people die each day waiting for a kidney transplant. “We have to do something besides wait for deceased donors,” he says.

Altruistic donors can help ease the shortage. So can kidney exchanges, a practice that Melancon helped implement during his year at Upstate’s transplant center. He is now chief of the division of kidney and pancreas surgery at George Washington Hospital in Washington, DC.

Instead of helping one person, an exchange can save the lives of multiple people. Google “32-person kidney swap” for coverage of 16 kidney transplants involving Melancon in 2011.

The two transplants at Upstate began to acquaint staff with the myriad details of orchestrating exchanges. As much as anything, it requires a shift in thinking. “It’s a whole new conversation that I’m having with people today,” Havens says. Instead of simply matching donors with recipients, the transplant team now asks would-be recipients if they know someone who is willing to donate a kidney.

The altruistic donor liked that his kidney would go to a woman whose husband was willing to pay it forward. Melancon did too. “Every day I get to see the best side of humanity,” the surgeon says. “This is one person helping another person.”

 Listen to Dr. Vaughn Whittaker talk about kidney transplant advances

Listen to Dr. J. Keith Melancon talk about the importance of kidney transplants

Read one family’s story of kidney transplant

A kidney transplant operation over the summer at Upstate University Hospital.

A kidney transplant operation over the summer at Upstate University Hospital. Photo by Robert Mescavage.

Posted in community, surgery, transplant | 1 Comment