Up-close look at a precision surgical tool

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Surgery on the lungs was done as an open operation as early as 1911. Starting in the 1950s, lung surgery became more commonplace because of the increase in lung cancer. Open surgery remains an option today, and the best option for some patients. But the percentage of procedures done in a minimally invasive style is increasing.

Robert Dunton, MD

Robert Dunton, MD

Some patients who need biopsies of lesions in a lung or lymph nodes undergo endobronchial ultrasound, a technique offered by pulmonary and thoracic surgeons, says Robert Dunton, MD, chief of cardiac and thoracic surgery at Upstate University Hospital. The convex probe (magnified in the photo) is slightly thicker than a standard ballpoint pen. It’s inserted through a bronchoscope positioned in the patient’s windpipe. A rectangular ultrasound scanner near the end of the probe acquires images to project on a screen in the operating room. Once the probe is at the proper location, a balloon on its tip is inflated with sterile water to keep it stable. A small needle or knife is deployed from an opening in the probe to retrieve a sample of tissue.

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‘In good hands’: Patient appreciates Cancer Center’s energized staff, warm, vibrant surroundings

Carol Pesko (right) with his husband, Tom Krahe, at the Upstate Cancer Center. (PHOTOS BY ROBERT MESCAVAGE)

Carol Pesko (right) with his husband, Tom Krahe, at the Upstate Cancer Center. (PHOTOS BY ROBERT MESCAVAGE)

BY AMBER SMITH

When Carl Pesko is at the Upstate Cancer Center for treatment, he receives chemotherapy for eight to 10 hours the first day, and then two to three hours the next. He has had plenty of opportunity to chat with staff and to observe various procedures taking place. He says he has been extremely impressed.

Pesko is a retired high school guidance counselor who worked for 35 years at Fayetteville-Manlius High School. He knows how emotionally taxing it must be to take care of individuals with cancer, many of whom appear to suffer far more than he does. Yet, among the nurses and doctors providing care, “everyone seems to be excited about what they’re doing. They see improvements in their patients, and they know there is a progressive forward movement in dealing with cancer.”

Pesko, 71, of Syracuse began treatment for a type of non-Hodgkin lymphoma called follicular lymphoma in November. He returned from a vacation with his husband, Tom Krahe, feeling overly tired, lacking energy and experiencing difficulty walking.

He expected his friend and primary care doctor, Paul Cohen, MD, would tell him something was wrong with his heart. What Pesko described sounded more like a form of cancer. Testing confirmed Cohen’s suspicions, and the doctor referred Pesko to Upstate oncologist Teresa Gentile, MD, PhD, for treatment.

He was scheduled for chemotherapy every five weeks. After the first two sessions, Pesko says 90 percent of his cancer disappeared. The treatments have not caused him pain or nausea, nor hair loss. His suppressed immune system, however, requires him to avoids crowds to protect himself against infections. He drinks lots of water, avoids caffeine and alcohol, gets extra sleep and carefully washes all fruits and vegetables to help strengthen his immune system.

In addition, every Monday he comes to the Upstate Cancer Center to undergo blood tests that give Gentile feedback on how well the medications are working. Pesko says he appreciates the design of the center, its warm, vibrant colors and the artistic elements, “which almost make you forget the seriousness of the disease you are facing.”

He also appreciates the people who take care of him, who make the experience as positive as possible. “I know I am in very, very good hands,” he says.

Kelly O'Shaughnessy draws Pesko's blood weekly while he is being treated for lymphoma.

Kelly O’Shaughnessy draws Pesko’s blood weekly while he is being treated for lymphoma.

About follicular lymphoma

Lymphomas begin in lymphocytes, white blood cells that are part of the body’s immune system. Because lymph tissue exists throughout the body, lymphomas can start almost anywhere. The most common sites are in the chest, neck or underarms.

Painless swelling in one or more lymph nodes is a common early sign. Others include fever, persistent fatigue, persistent cough and shortness of breath, drenching night sweats, weight loss, an enlarged spleen and itchiness.

A precise diagnosis is important since there are many subtypes of lymphomas, and they are treated differently. This means patients often require imaging tests, blood tests and biopsies.

Follicular lymphoma, the type of non-Hodgkin lymphoma with which Carl Pesko was diagnosed, grows slowly and usually responds well to treatment. Some patients receive chemotherapy with or without radiation. Some may require a stem cell transplant.

— Sources: Leukemia & Lymphoma Society, American Cancer Society

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.

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She’s resilient: 11-year-old faces Ewing sarcoma

Auburn Retreat Family Pic

Part of Maddie’s resilience may come from the way her family deals with her disease. “We don’t make life about the cancer,” her mother, Amy Shaw, explains. Her sister, Alexis (left), and Maddie are shown enjoying a respite with their mom and dad and Chesapeake Bay retriever, Mocha, in Auburn in late spring. (PROVIDED PHOTOS)

BY AMBER SMITH

Maddie Shaw is covered with a plush purple blanket. She grasps an iPad Mini, on which she quietly battles digital zombies, while the last of her chemotherapy flows into her arm.

It’s a Friday at the end of May, and the sixth-grader from Binghamton is completing her cancer treatment.

Nurse Tara Ingersoll has marked the occasion with colored streamers and fringed pom-poms hanging from curtains in the Upstate Cancer Center. Maddie’s parents, Amy and Kevin Shaw, brought cupcakes and a fruit bouquet. Maddie, age 11, is reserved, engrossed in her game.

A woman leaps into her room. She’s got jazz hands, zebra sunglasses and a fervor that captures Maddie’s attention. The girl’s eyes abandon the electronic screen; her face melts into a smile. It’s Jody Sima, MD, her pediatric oncologist.

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On Maddie’s last day of chemotherapy, her father, Kevin Shaw, spent almost five hours riding his bicycle to the Upstate Cancer Center form Binghamton, as part of his training for the Ironman race taking place in July in Lake Placid. He is part of a team of athletes who participate to support Maddie. They wear shirts that say, “It’s not when you finish but why.”

“I push her when she needs to be pushed and love her when she needed to be loved,” Sima explains. Today the doctor leans over Maddie’s shoulder. The two confer privately about the best strategies for defeating the horde of zombies.

Maddie’s diagnosis came in December 2013 after she felt a pain in her hip. Doctors discovered a tumor the size of a softball in her lung. It was Ewing sarcoma, a rare bone cancer. After months of chemotherapy, Maddie underwent surgery in Philadelphia on her left hip. She was in remission until August when the cancer returned.

She renewed her cancer battle, which this time included surgery on both lungs. A month later, fire broke out in the basement of her home, killing Maddie’s hamster and destroying nearly everything her family owned.

While their house is being rebuilt, Maddie, her parents and sister, Alexis, 16, live in a nearby rental home. Her mom and dad took turns driving her to Syracuse for chemotherapy every day for a week, every three weeks, while she was in treatment. This allowed her to attend school in the morning and sleep in her own bed each night.

Sima says Maddie is doing well. “She is a pretty amazing kiddo, and she bounces back quicker than any adult ever would” the doctor told the Binghamton Press & Sun-Bulletin.

Despite missing lots of school this year, Maddie made the high honor roll.

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.

Posted in adolescents, bones/joints/orthopedics, cancer, community, health care, illness, patient story, surgery, Upstate Golisano Children's Hospital/pediatrics | Leave a comment

Quality or quantity? Serious illness prompts serious discussion

Ajeet Gajra, MD, in the second-floor lobby of the Upstate Cancer Center. (PHOTO BY ROBERT MESCAVAGE)

Ajeet Gajra, MD, in the second-floor lobby of the Upstate Cancer Center. (PHOTO BY ROBERT MESCAVAGE)

BY AMBER SMITH

Some doctors are reluctant to recommend palliative care, particularly for patients who are younger than 65 and dealing with a serious illness.

The shift from lifesaving treatment to comfort care may seem like admitting the futility of the situation.

That would mean admitting the futility of the situation, considering the patient’s quality of life and its length, and perhaps shifting efforts from life-saving to comfort care.

“It’s understandable” that doctors may wish to avoid such conversations, says Ajeet Gajra, MD, a medical oncologist at Upstate who researches the utilization of palliative care. “The doctor may know there are no other meaningful treatment options but is afraid to say that to the patient and the family.

“It’s a difficult discussion for the doctor, patient and family, so it’s often avoided. Patients may feel that the doctor is ‘giving up’ on them. It is important to have an open discussion about the patient’s hopes and wishes in the context of a limited prognosis. It is important for patients to realize that such a recommendation is being made because further treatment will cause more harm than good and that the doctor cannot put the patient knowingly in harm’s way.”

The discussion may be that much more difficult when it centers on a young patient. Regardless of the patient’s age, Gajra says, education and information regarding palliative care should be offered early in the course  of an incurable cancer. That way the patient and loved ones do not feel blindsided in the course of their fight if it’s clear that medical treatments will not help further. The patient or their loved ones can bring up a discussion regarding palliative care if the doctor does not.

In a paper published in the Journal of Geriatric Oncology this year, Gajra and four colleagues from Upstate studied the medical records of veterans with advanced cancer near the end of life. They compared those older than 65 with those from 40 to 65 years of age and discovered the older veterans were referred to palliative care an average of 12 days sooner than the younger. Younger veteran’ average time in hospice care was 13 days longer.

Gajra says other studies show that patients may have a better quality of life if they are in hospice care at their homes, rather than hospitalized in an intensive care unit, or seeking emergency care for each medical setback.

Studies also show that while timely palliative care enhances a patient’s quality of life, it can actually extend his or her length of life.

Choosing quality

Palliative care focuses on providing relief from symptoms of serious illness, rather than trying for a cure or recovery. Similarly, hospice care is meant to keep patients comfortable and pain-free during advanced illness. Both are designed to improve the quality of life for the patient and his or her loved ones.

Upstate options

Palliative care is an option for adults and children who are treated at Upstate University Hospital. Referrals are also routinely made to Hospice of Central New York. An outpatient palliative care program for adult patients with advanced cancer will start this fall.

cancercaresummerHLOA-4C-VERT-REVThis article appears in the summer 2016 issue of Cancer Care magazine. Hear an interview with Judy Setla, MD, medical director of Hospice of CNY, about hospice and palliative care. 

Posted in cancer, community, death/dying, grief/loss, health care, HealthLink on Air, illness, research | Leave a comment

A 50-year anniversary: Meet one of Upstate’s oldest living pediatric brain tumor survivors

Michelle "Shelly" Kikta-Kiner, at home with her grandchildren, Cole, 8, and Rowan, 7. (PHOTO BY SUSAN KAHN)

Michelle “Shelly” Kikta-Kiner, at home with her grandchildren, Cole, 8, and Rowan, 7. (PHOTO BY SUSAN KAHN)

BY AMBER SMITH

Some of the details are fuzzy, but 50 years after her treatment for a brain tumor at Upstate University Hospital, Michelle “Shelly” Kikta-Kiner, 62, still considers her survival a miracle. The Verona woman is one of Upstate’s oldest living survivors of a pediatric brain tumor.

She was 12 in 1965 when her nose began bleeding sporadically. She developed headaches. Then she had episodes of projectile vomiting. Her mother took her to a local doctor.

Shelly during treatment for a brain tumor in 1966. (PROVIDED PHOTO)

Shelly during treatment for a brain tumor in 1966. (PROVIDED PHOTO)

Around the same time, Kikta-Kiner’s aunt had a benign brain tumor removed at Upstate University Hospital. She mentioned Kikta-Kiner’s symptoms, and the surgeon agreed to see the young girl.

Kikta-Kiner remembers spinal taps and painful testing to locate the tumor, monthslong hospital stays and a giant teletherapy machine.

Medical advances since then have provided better ways to locate tumors, says Lawrence Chin, MD, chair of the neurosurgery department at Upstate Medical University.

The painful test Kikta-Kiner described was a cerebral ventriculogram, something that seems barbaric by todays’s standards. It involved tapping into the spinal canal to inject air, and then tipping the table, so the air would travel to the patient’s head and outline the fluid space in the brain. This would reveal growths or structural changes in the brain, but it created severe headaches for the patients.

Though that equipment hasn’t been used in more than four decades, “the basic concept is still the same,” Chin says, explaining that magnetic resonance imaging scans now guide surgeons in brain biopsies.

Shelly's self-portrait at age 12, before she got sick and lost her hair.

Shelly’s self-portrait at age 12, before she got sick and lost her hair.

Radiation and chemotherapy remain standard treatments for brain tumors.

The machine that Kikta-Kiner remembers, from which she received the radioisotope cobalt-60 to kill tumor tissue, was the forerunner of today’s gamma knife, which uses cobalt radiation. “I had a lot of radiation, like 30 treatments,” she says. She missed all of eighth grade. “When I came home, my Dad got me a wig, and I went back to school.

“When I first came home, my gait was off, and my left hand shook,” she says. “It’s still not as fast as my right hand, but to look at it, you wouldn’t notice anything wrong.”

Since then, Kikta-Kiner has lived a full life. She went to college, married and in recent years has dealt with other cancers. In 2006 she had her thyroid and a nearby lymph node removed. Later, doctors removed a cancerous polyp from her intestines and treated a skin cancer on her ankle.

For a while after her childhood ordeal, she dealt with depression. Fifty years later, she has the reminder of a bald spot on her head – and the belief in her heart that her survival was a miracle.

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.

 

Posted in adolescents, brain/spine/neurosurgery, cancer, depression, health care, history, illness, medical imaging/radiology, patient story, surgery, technology | Leave a comment

Early detection of cancer appears to improve survival odds

SOURCE: ONONDAGA COUNTY COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT PLAN, 2014-2017

While the incidence of cancer is rising, death rates are dropping, presumably because of improvements in screening that allow for earlier detection and improvements in cancer treatment options. This chart shows the rate, per 100,000 people living in Onondaga County, of all types of cancer combined, showing incidence (new cases) and mortality (deaths).

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.

Posted in cancer, community, death/dying, health care, illness, public health, research | Leave a comment

Marking milestones: Patients invited to ring bell in celebration

(PHOTO BY KATHLEEN PAICE FROIO)

(PHOTO BY KATHLEEN PAICE FROIO)

When a bell rings in the Upstate Cancer Center, everyone within earshot cheers. The sound of a ringing bell means that a patient has finished treatment or reached a milestone.

“Staff members gather around to watch the patient ringing the bell, but the sound travels through the halls, and everyone who hears it knows what it means,” explains Colette Zerrillo, associate director of radiation oncology.

Summer Butkins, 30, of Lafayette remembers April 11 as one of the best experiences of her life. She was the first patient to ring the bell, marking her final radiation treatment for breast cancer. The hallway was filled with doctors, nurses and technicians who cared for her since her diagnosis in June 2015, making the experience “absolutely amazing.”

Tracy Allen, 50, of Binghamton (pictured) has similarly fond memories of ringing the bell when she finished her radiation treatments. “The people that are here are incredible people,” she says of the caregivers who exchanged hugs with her that day.

The center has three bells, one on each treatment floor. They were donated by Morganne Atutis of Oswego. She got the idea from a cancer center in Texas where her fiancé was treated. Though he passed away from his illness, Atutis remembers the bells as harbingers of hope and wanted to share that feeling with patients in Central New York.

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.

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Sun smart: Teaching kids to protect themselves from skin cancer

BY JIM McKEEVER

Protecting your skin from the sun starting at an early age is an important way to guard against skin cancer. That’s the message a group of medical students shares with elementary school students each spring.

sun“Our goal is to make the kids understand that what they do now will affect them in the future,” says Nathalie Morales, a first-year medical student and president of Upstate’s Dermatology Interest Group. Members share “sun smart” messages through the Sun Smart Syracuse project.

The project began with the Salt City Road Warriors, a group of local runners that wanted to help raise awareness about the dangers of skin cancer, which is on the rise in younger populations. Warrior Maureen Clark contacted Upstate dermatologist Ramsay Farah, MD, who got the dermatology students involved.

In age-appropriate presentations, the students cover the ABCs of sun protection and point out the dangerous societal pressures that encourage tanning, either in the sun or in tanning beds. Then they hand out sunscreen donated by Wegmans and Australian Gold, UV detection bracelets and sunscreen application-tracking calendars.

The dermatology group is interested in scheduling presentations to school and youth groups for spring 2017. Contact vice president Amanda Gemmiti at gemmitia@upstate.edu.

How your group can donate

The running group Salt City Road Warriors raises money for the Upstate Foundation, which manages a variety of funds that support Upstate’s mission. To learn how to set up a fund, contact the foundation at 315-464-4416.

Layout 1This article appears in the summer 2016 issue of Cancer Care magazine.

Posted in cancer, community, dermatology/skin care, education, health care, medical student, prevention/preventive medicine, public health, Upstate Golisano Children's Hospital/pediatrics, volunteers | Leave a comment

Sugar and soy: dispelling the 2 biggest food myths about cancer

Don’t blame sugar

Maria Erdman

Maria Erdman

Glucose feeds all cells in the body, and cancer cells use more blood sugar than do less active cells. But that doesn’t mean eating sugar (or not eating sugar) influences how rapidly cancer spreads, says Upstate registered dietitian nutritionist Maria Erdman.

Sugar’s impact on the body and how it is processed is complicated. Erdman generally cautions people against eating too much added sugar because of the risk of obesity or diabetes, regardless of whether they have cancer.

She also favors natural sugars, such as those found in fruits, over foods that have added sugars. That’s because foods with added sugars typically lack nutrients. Even so, Erdman points out, a person who eats a healthy, plant-based diet can still afford the occasional sweet indulgence.

Don’t ban soy

Erdman says most recent research shows that soy foods, eaten in moderation, can be part of a healthy diet.

The worry that soy foods might cause or worsen breast cancer arose because soybeans contain phytoestrogens, plant estrogens similar in some ways to human estrogens. High levels of human estrogen have been linked to an increased risk of breast cancer.

Recent research shows eating two or three servings of soy foods, such as tofu, edamame or soy milk, per day is fine and may be protective, even for patients with hormone-receptor-positive breast cancers, Erdman says, adding that research is not conclusive about the use of soy extracts or soy protein supplements.

Layout 1This article appears in the summer 2016 issue of Cancer Care magazine.

Posted in cancer, diet/nutrition, health care, public health, women's health/gynecology | Leave a comment

Window to an ill youngster’s world: Therapy with miniatures and sand goes beyond child’s play

Knai Bridges, 13, creates a sandplay assemblage as Ruth McKay, medical family therapist looks on. (PHOTOS BY SUSAN KAHN)

Knai Bridges, 13, creates a sandplay assemblage as Ruth McKay, medical family therapist looks on. (PHOTOS BY SUSAN KAHN)

BY JIM HOWE

A box of sand and an assortment of  miniatures helps young patients portray their world, and perhaps make sense of it, at the Waters Center for Children’s Cancer and Blood Disorders and the Pediatric Hematology-Oncology unit at the Upstate Golisano Children’s Hospital.

Sandplay therapy, as it is called, allows the children to process their feelings and thoughts about their diagnoses and treatment for life-threatening illnesses and the impact of treatment on their daily lives.

“The box of sand offers a safe place to express some of the intense experiences that can come with treatment for life-threatening illnesses,” says medical family therapist Ruth McKay. “Children engaged in sandplay therapy may not consciously understand or be able to speak about what they are going through, but they can explore their experience nonverbally with the miniatures in the sand.”

The box, or sandtray, measures about 28½ inches by 18½ inches, often with a blue interior to represent water or the sky. The patient selects from hundreds of miniature people, animals, toys, cars, household items — almost anything you might find in the real world, including the world of medical treatment, including hospital beds and IV poles.

McKay, who is certified as a sandplay practitioner by the Sandplay Therapists of America, adds that sandplay tends to be a part of therapy, not the only therapy a child does. A patient and his or her family may also be engaged in family therapy, or a child may be learning skills to reduce post-traumatic stress symptoms.

Among what she has seen in sandtrays, McKay cites:

— a child adjusting to having his port accessed and blood drawn by his nurses places witches watching over sleeping children in the sand.  Later he decides that he likes the nurses, because even though they do scary things, they are trying to help him get better.

— another patient leaves just a handprint in the sand like a signature, saying “I am here.”.

— a boy creates a “car family,” consisting of a mommy car, a daddy car, a child car — and a car being transported inside an ambulance, much like his experience of his first treatment.

— a dying boy whose family was reluctant to talk openly about his impending death repeatedly hides a coffin containing a skeleton in different spots in McKay’s office, indicating that death was present, but not out in the open.

— a girl who usually made animals run around endlessly one day places them by the water for a “spa day,” at about the same time her family was no longer feeling in crisis mode, but getting use to the new normal of treatment.

McKay makes sandplay therapy available in her office, or she wheels a well-stocked cart to patients who can’t come to her.

Knai Bridges, 13, of Syracuse, is being treated for sickle cell disease at the Waters Center and enjoys her time with sandplay. “It’s like a box of sand where you can put your toys and special friends,” she says, adding, “it’s like doing a video.”

Among the miniatures she has used are a bride and groom, various animals, hearts, a shell, a dancer and a hospital bed with an IV pole. McKay notes that Knai uses sandplay to help her to hold on to the whole of her life, not just the times when she is receiving treatment. The eighth-grader used to be in the hospital frequently and appreciates sandplay.

“She loves it. She talks about it all the time,” Knai’s mother, Nailah Beyah, says of the sandplay.

Most of the children McKay sees will have one or maybe two sandplay sessions, sometimes  spaced several months apart while some may engage in sandplay therapy for months. She follows a strict hospital protocol for cleaning the figures and changing the sand.

Bridges Knai_McKay Ruth_231

Sandtrays, the boxes that hold sand and miniature figures and other objects, can be arranged any way a person likes. This sandtray scene was one created by Knai.

What is sandplay?

Sandplay is a therapy in which a person, usually a child, expresses thoughts or feelings by creating a scene with miniature objects in a box of sand (called a sandtray), which often has a blue interior to represent water or the sky. The therapist quietly witnesses the creative process and photographs the finished scene to observe themes developing over time. Developed by Dora Kalff a follower of Swiss psychiatrist Carl Jung, sandplay therapy can work for people of any age.

How is it possible?

If you contribute to Paige’s Butterfly Run or related events such as Pedaling for Paige or the Pajamarama, your donation helps make sandplay possible at Upstate. Sandplay therapy is offered to pediatric hematology-oncology patients free of charge, thanks to a grant from Paige’s Butterfly Run.

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.

 

Posted in adolescents, cancer, community, health care, mental health/emotional health, patient story, psychology/psychiatry, Upstate Golisano Children's Hospital/pediatrics | Leave a comment