Damage control: Surgeons rely on Navy strategy in operating on severely injured trauma patients

Moustafa Hassan, MD, talks with his patient Peter Corigliano, who has made a profound recovery after being severely injured in an industrial accident. (photo by Susan Kahn)

Moustafa Hassan, MD, talks with his patient Peter Corigliano, who has made a profound recovery after being severely injured in an industrial accident. (photo by Susan Kahn)

BY JIM HOWE

Peter Corigliano is a living example of what “damage control surgery” can accomplish.

The Rome resident, now 62, was injured in a horrific industrial accident in 2012. He was working at Rome Strip Steel when a giant electromagnet slammed into him. The trauma shredded his abdominal muscles, broke his pelvis, ruptured his iliac artery, severed his colon and urethra, ruptured his prostate and cracked some ribs.

After he arrived by ambulance at Upstate, surgeons worked to stop the bleeding and control the immediate emergency, but they did not do definitive repairs right away.

Among other injuries, the accident caused hernias — where Corigliano’s organs protruded through the hole in his abdominal muscles. He had skin left, but no longer the underlying, supportive wall of muscle.

Instead of subjecting him to hours in the operating room that day, the surgical team controlled his injuries and sent him to the intensive care unit with a special dressing, like a plastic wrap, covering his wounds. His time in the ICU allowed his body to stabilize before undergoing the added stress of major surgery — which happened fewer than two weeks later.

Aiming for stability as well as repair

While this surgical strategy has become standard practice in academic medical centers today, it was not so as recently as the late 1990s, said the doctor overseeing Corigliano’s treatment, Moustafa Hassan, MD. He is Upstate’s chief of acute care surgery and Hernia Program.

“Many years ago, surgeons were very concerned about initial injuries and wanted to repair them right away, even if it was very complex,” Hassan said. This meant a patient who might still be bleeding or otherwise unstable faced several hours in the operating room, putting heavy demands on the body.

“Over the years, we found that doing that and keeping them unstable made them worse, with a worse outcome,” Hassan said. So, for severe cases — such as gunshot wounds, serious car accidents or nonviolent problems like a piece of intestine becoming strangulated as it pokes through a muscle wall — surgeons began opting for damage control.

“It was found that temporary repair is associated with better outcomes and survival,” Hassan said.

After preliminary surgery — which might include a colostomy, stapling or other measures and can be reversed later — the patient is carefully monitored in the ICU.

A definitive operation then takes place usually within one to three weeks, depending on the patient, he said.

A strategy borrowed from the Navy

The trauma surgery strategy known as damage control has a long history in the Navy. Damage control keeps a troubled ship afloat and stable until lasting repairs can be made.

Damage control is practiced in many types of surgery, from the hernia repairs and other abdominal work done by specialists like Hassan to repairs of the heart, bones and blood vessels.

Corigliano’s case is unusual in that he lost his abdominal wall and would have to come back for additional surgery, including getting pig tissue to replace his abdominal wall.

“I’m doing OK, but my life has changed drastically,” says Corigliano, who is on disability and faces limitations like no heavy lifting, constant nerve pain in his legs, difficulty sitting for extended periods and having to mostly give up the outdoor pastimes of hunting, fishing and motorcycle riding he used to enjoy.

He credits his wife, Carlene, with helping him get through the years of surgeries, rehabilitation and recovery. “I couldn’t have done it without her,” he says as he recounts the accident and its aftermath.

His wife in turn praises the medical care he received. “If it wasn’t for Dr. Hassan and his group and all the specialists he ended up seeing, he wouldn’t be here, so for that we’re very, very grateful,” she said. “He’s had to learn to live differently than he did before, and sometimes that’s harder than the physical component — not being able to do those things he used to enjoy.”

Still, she says, “His recovery has been remarkable, considering what he went through, because of the staff and the quality of care that he received.”

Upstate Health magazine summer 2018 issueHealthLink on Air logoThis article appears in the summer 2018 issue of Upstate Health magazine. To hear Moustafa Hassan, MD, explain the damage control strategy for hernia repairs on Upstate’s “HealthLink on Air,” click here.

 

Posted in emergency medicine/trauma, health care, HealthLink on Air, surgery | Tagged , , | Leave a comment

Scientist walks political tightrope: He deals with Taliban to help his native land rebuild

Immunologist Mobin Karimi, MD, PhD, runs a research lab at Upstate. (photo by William Mueller)

Immunologist Mobin Karimi, MD, PhD, runs a research lab at Upstate. (photo by William Mueller)

BY JIM HOWE

An Upstate faculty member who lost his mother as a baby and grew up in a refugee camp hopes he can help his war-scarred homeland, Afghanistan.

To do this, he has secured the permission of the local tribal and religious leaders and the local Taliban insurgents to create a school for both girls and boys, a clinic and a midwife training program to help war widows support themselves.

Immunologist Mobin Karimi, MD, PhD, said he was shocked that the Taliban would allow girls to attend school but noted they likely agreed because the local tribes are involved, while governmental authorities are not.

Karimi knows something about the power of Afghan tribes, as the grandson of a tribal leader in the poor, rural area where he was born, in Ghazni province, about 75 miles from Kabul, the Afghan capital.

To ensure that his project would not be viewed as a tool of any government, he has accepted no governmental aid and wants only private donations to the charity he and some friends created in 2017. Called Education for the Afghan Children, it is registered as a tax-exempt nonprofit organization with the Internal Revenue Service and can be reached at https://educationforafghanchildren.org/.

He plans to build a modest complex that will include classrooms, a clinic and a mosque. There will be coed classes through sixth grade, then separate classes for boys and girls through high school, eventually serving as many as 500 children.

The school building, still under construction. (photo courtesy of Mobin Karimi, MD, PhD)

The school building, still under construction. (photo courtesy of Mobin Karimi, MD, PhD)

The clinic would provide limited medical services and maybe some vaccinations. A doctor could see patients and help train war widows to become midwives, which would give them an income and also address problems of maternal health. If the midwives can read and write, they could be trained as nurse practitioners and donate work to the clinic.

To help the project become self-sustaining, it would also ask for 2.5 percent (a common charitable donation in Islamic countries) of local farmers’ harvest to provide free lunches for the children, which could be prepared by one cook.

The local residents are poor, so they can’t be expected to give money, but maybe they can donate labor and crops, Karimi says.

“I always wanted to do something, establish a school, a midwife training center, something that could move the country forward,” he says, noting that the country lacks schools and clinics because nothing was built during decades of wars.

Since Afghan government corruption siphons off much of the money for any project, Karimi says, he prefers to keep this operation private, with money going directly to the people involved.

In the past year, he and some friends have sent about $4,000 to build the school, but they need an estimated $70,000 for the full project. Their first aim is to get the school building completed and operational by winter, since the children are sitting on the ground to take classes now. Karimi is hoping for some grant money as well as individual donations.

He is trying to manage this on a shoestring budget while steering clear of any government involvement, keeping the tribes and community involved and not provoking the Taliban.

“We’d rather be poor and secure,” he says. “You could achieve your goal in a quicker way, but eventually you will get into trouble.”

Classes are held outdoors for now because the school building is not yet ready. Organizers are hoping the classrooms will be ready before winter sets in. (Photo courtesy of Mobin Karimi, MD, PhD)

Classes are held outdoors for now because the school building is not yet ready. Organizers are hoping the classrooms will be ready before winter sets in. (Photo courtesy of Mobin Karimi, MD, PhD)

From Afghanistan to Syracuse

Name: Mobin Karimi, MD, PhD.

Position: Associate professor of microbiology and immunology at Upstate. Runs an academic research lab that studies cancers and bone marrow transplants.

Born: 1979, in a poor, rural village in south-central Afghanistan. His father was a university professor. His mother died of severe bleeding two days after he was born, and his twin sister died at birth. He lost 35 members of his family, including his father and three brothers, to war.

Childhood: His family fled wartime violence to a refugee camp in the Afghanistan-Pakistan border region when he was 6. He learned English by working for an English-language publication at the camp and by age 14 was a translator and guide for the Red Crescent, the Islamic version of the Red Cross, in Afghanistan.

Career: He studied medicine in his home country and came to the U.S. in 1999 with the help of a California doctor he met who headed the International Red Crescent in that country. Karimi became licensed to practice medicine in the U.S. and also earned a PhD from the University of Massachusetts.

Upstate colleagues’ comments: Timothy Endy, MD, professor and chair of microbiology and immunology, praises Karimi for “coming out of a war-torn country and working his way up as a lab tech to graduate school and now a faculty member with a research program.”

Gary Winslow, PhD, professor of microbiology and immunology, notes Karimi is “genuinely interested in helping people, in many ways, with his clinical research and, of course, with his activities in Afghanistan.”

Upstate Health magazine summer 2018 issueHealthLink on Air logoThis article appears in the summer 2018 issue of Upstate Health magazine. To hear Karimi describe his Afghan project in a podcast/radio interview with Upstate’s “HealthLink on Air,” click here.

 

Posted in community, education, fundraising, health care, HealthLink on Air, international health care, public health, research, volunteers | Tagged , , , , , , , , | Leave a comment

A chance to look at occupational and physical therapy careers

Physical therapist Nicole Conese, left, and Karen Renfroe demonstrate walking with a back support in the rehabilitation center at Upstate University Hospital's Community campus. (photo by Susan Kahn)

Physical therapist Nicole Conese, left, and Karen Renfroe demonstrate walking with a back support in the rehabilitation center at Upstate University Hospital’s Community campus. (photo by Susan Kahn)

By Amani Mike, Synergy intern

I have dreamed of working in health care since I was 6 years old. Today, as a 20-year-old college student preparing for a career, I asked to spend a day shadowing occupational and physical therapists at Upstate University Hospital’s Community campus. I thought I knew what occupational and physical therapists did, but seeing them at work made me realize how much there is to their jobs.

I have had entry-level jobs in hospital nutrition services and as a certified home health aide. These jobs helped me realize that I find it gratifying to help people with daily living activities such as bathing, dressing and eating. Does that mean that occupational therapy is a good “fit” for me?

Physical therapist Jennifer Tarasevich creates an at-home exercise plan for a patient. (photo by Amani Mike)

Physical therapist Jennifer Tarasevich creates an at-home exercise plan for a patient. (photo by Amani Mike)

I followed three Upstate employees at the rehabilitation centers on the Community campus: Jennifer Tarasevich and Cindy Cook, who work on the fourth-floor rehabilitation unit, and Michelle Malchak, who works on the sixth-floor acute-care unit.

Occupational therapists help patients recuperating from physical or mental illness perform activities needed in daily life. Physical therapists treat disease, injury or deformity with physical methods, such as massage, heat treatment and exercise.

I watched Tarasevich, a physical therapist, help a patient with an injured hip transfer out of bed using a sliding board, a therapy tool that helps support the patient as he or she moves.

Watching Cook with her patients, I saw that she made sure everyone was comfortable and had everything they needed. The expression on her patients’ faces told me that they were thankful to have Cook by their side. An occupational therapy assistant, Cook has worked in the profession for 27 years, 14 of them at the Community campus.

“I enjoy knowing that I make people feel better, even if I can’t fix everything that’s wrong,” Cook told me. “I feel good knowing that I’ve helped.”

Occupational therapists typically have a master’s degree in occupational therapy and must be licensed. Occupational therapy assistants typically have an associate’s degree.

Occupational therapist Michelle Malchak is shown completing a patient's evaluation. (photo by Amani Mike)

Occupational therapist Michelle Malchak is shown completing a patient’s evaluation. (photo by Amani Mike)

Physical therapists must have a master’s degree or higher in physical therapy and often complete a Doctor of Physical Therapy (DPT) program.

Between 2016 and 2026, the job market for physical therapists and occupational therapy assistants is expected to grow by 28 percent; occupational therapists by 24 percent, according to the U.S. Bureau of Labor Statistics.

Occupational therapy assistant Cindy Cook (photo by Amani Mike)

Occupational therapy assistant Cindy Cook (photo by Amani Mike)

My day shadowing the occupational and physical therapists at Upstate has encouraged me to pursue a career as a therapist. Knowing that there are different specialties – including mental health, pediatrics, low vision and feeding, eating and swallowing – is exciting. Will occupational therapy or physical therapy fulfill my desire to help people with daily living? I think so.

The writer worked as a summer intern in the marketing and university communications department at Upstate through Synergy, a nonprofit organization whose mission is to empower youth and underserved individuals to reach their highest potential and improve the community.

To read about journalist Jackie Warren-Moore’s experience as a patient in the Rehabilitation Unit at Upstate’s Community campus, click here.

Posted in community, education, health care, health careers, physical therapy/rehabilitation | Leave a comment

A remarkable recovery: His stroke care included fast-moving, coordinated efforts by his wife, ambulance crew and specialists at Upstate

Members of Upstate’s stroke team who had a role in caring for patient Dave Cartner include: seated from left, Claribel Wee, MD, neurology resident physician; Cartner; and Hesham Masoud, MD, stroke neurologist. Standing from left, nurse Lauren Kaul, emergency department; Grahame Gould, MD, neurosurgeon; Jessica Guido, X-ray technologist; nurse Michelle Vallelunga, stroke program data coordinator; Shirley Cartner, the patient’s wife; Shantel Henry, X-ray technologist; nurse Patricia Veinot, stroke data coordinator; nurse Josh Onyan, stroke program manager; and Theodore Albright, MD, emergency medicine resident physician. (photo by Robert Mescavage)

Members of Upstate’s stroke team who had a role in caring for patient Dave Cartner include: seated from left, Claribel Wee, MD, neurology resident physician; Cartner; and Hesham Masoud, MD, stroke neurologist. Standing from left, nurse Lauren Kaul, emergency department; Grahame Gould, MD, neurosurgeon; Jessica Guido, X-ray technologist; nurse Michelle Vallelunga, stroke program data coordinator; Shirley Cartner, the patient’s wife; Shantel Henry, X-ray technologist; nurse Patricia Veinot, stroke data coordinator; nurse Josh Onyan, stroke program manager; and Theodore Albright, MD, emergency medicine resident physician. (photo by Robert Mescavage)

BY JIM HOWE

Dave Cartner has a remarkable story to share.

The patient

Dave and Shirley Cartner (photo by Robert Mescavage)

Dave and Shirley Cartner (photo by Robert Mescavage)

The 50-year-old Marcellus resident had finished breakfast on Feb. 13 and was about to leave for his job as a meat supervisor for a local food chain. “As I was walking out to the kitchen to say goodbye to my wife, my left foot felt heavy as I was walking the three or four steps to the chair. Then I kind of slid into the chair, and as my wife was talking to me, she could notice my face was drooping a bit, and as I was trying to speak with her, my speech was very muffled. Then my whole left side — my arm down to my feet — was gone. I couldn’t feel it any longer, so she could tell something was wrong,” he said.

Cartner’s wife, Shirley, realized he was likely having a stroke and called 911, overruling his request to “just get me in the car” and drive him to the hospital.

“She’s the brains behind the whole thing. I can’t praise her enough,” her husband said of her insistence on an ambulance.

The ambulance team

A Marcellus Ambulance crew quickly arrived, did a preliminary evaluation and got him ready for transport, recalled Stephen Knapp, the ambulance service’s executive director, who took part in the call. “It was quite obvious he had had a stroke,” he said. Crew members took Cartner’s vital signs, ran an electrocardiogram to check for a possible heart attack and relayed their information ahead to Upstate University Hospital, so the stroke team would be ready to receive the patient without delay.

“The ambulance crew asked us what hospital we wanted to go to, and we picked Upstate, knowing it was the place to go for stroke, because of the specialists there,” Cartner said.

The emergency medical technicians explained to Cartner that a team of professionals trained in stroke care would be waiting to meet him at Upstate. There he would get an imaging scan of his brain to see where the problem was, and things would move quickly, since the clock is ticking when treating a stroke.

The paramedics were able to relay Cartner’s medical information to the hospital while en route, including the crucial detail that he had been taking a blood thinner for atrial fibrillation, a heart condition.

Jeff Elwood and Stephen Knapp of Marcellus Ambulance (photo by Susan Kahn)

Jeff Elwood and Stephen Knapp of Marcellus Ambulance (photo by Susan Kahn)

The resident physician

“It was pretty clear he was having a stroke, even before he opened his mouth, because one side was completely limp, his face was drooping, but his speech was intact, so he was able to answer questions,” recalled Claribel Wee, MD, the neurology resident who examined him.

Since the left side of the brain controls speech, his ability to talk signaled that the problem was likely on the right side.

The stroke turned out to be from a clot, not a bleed, which seems odd, since Cartner had been taking a blood thinner. Blood thinners, however, are not a guarantee against clots, Wee said.

Another type of blood thinner is often given in stroke cases, the “clot-buster” medicine tPA, but since an additional blood thinner could have caused heavy bleeding in his case, the doctors decided to try a different approach.

“We found the large vessel occluded (blocked) exactly where we thought,” Wee said. She summoned specialists Grahame Gould, MD, and Hesham Masoud, MD, who agreed on what to do next.

The specialists

Gould would perform a thrombectomy, or clot removal, through a process called interventional radiology. This means that, guided by an X-ray screen, he runs a slim tube up through an artery in the patient’s groin to an artery in his brain to ensnare the clot with a retrievable stent, then pull it out.

“Patients can make wonderful recoveries in a short time, even if they do not recover as fast as Dave did,” Gould said of the procedure.

Masoud oversaw Cartner’s care but stresses that resident physicians like Wee play a major role in initially evaluating the patient, determining where the stroke is and what to do about it.

“Kudos to the residents. They work very hard, and you can directly link outcomes to the speed of their diagnosis,” Masoud said.

He said the results could have been “devastating” if Cartner had not gotten to a stroke center quickly. He could easily have lost the use of his left arm or leg and had impaired vision and other problems.

Without removing the clot, the right half of his brain would have been lost. “To go from that to be able to walk home — that’s pretty incredible. But it’s kind of a typical story these days. You see a lot of these Lazarus effects,” Masoud said. The Lazarus effect, referring to a man in the Bible who was brought back from the dead, is the sudden, seemingly miraculous recovery a patient can experience in a case like this.

The outcome

After the thrombectomy, “Dr. Gould came in and checked on me. I was so glad, and he was really surprised I stood up and shook his hand,” Cartner said.

“I feel great now,” Cartner said several months after the stroke. His only lingering problem appears to be a dull feeling in his left arm that he is working to resolve.

Wee called Cartner’s recovery “pretty remarkable,” considering how fast and fully he recovered. He was discharged Feb. 14, one day after he was admitted to the hospital.

Cartner is thrilled with the outcome of his stroke and praised the EMTs, doctors and nurses who took care of him. His only regret was for his wife.

“I felt bad I ruined her Valentine’s Day,” he said.

Upstate Health magazine summer 2018 issueHealthLink on Air logoThis article appears in the summer 2018 issue of Upstate Health magazine. Listen to  Hesham Masoud, MD, and nurse Josh Onyan talk about what people need to know about strokes in this podcast/radio interview.

Posted in brain/neurology, emergency medicine/trauma, health care, HealthLink on Air, medical imaging/radiology, patient story, stroke, surgery | Tagged , , , , | Leave a comment

How to save someone from an opioid overdose

BY AMBER SMITH

In preparation

Purchase naloxone (trade name, Narcan), available without a prescription in New York pharmacies. Keep it with you, but do not store it in extreme temperatures (such as a car glove box), which can damage the medication.

Willie Eggleston, a clinical toxicologist with the Upstate New York Poison Center.

Willie Eggleston, a clinical toxicologist with the Upstate New York Poison Center.

Naloxone can be lifesaving for someone who has overdosed on opioids. It is a very safe medication, and if given incorrectly to a person who is having another medical problem, like a heart attack or stroke, it will not harm them, says clinical toxicologist Willie Eggleston of the Upstate New York Poison Center. He says you can find naloxone at more than 2,000 pharmacies in New York state and that the New York State Naloxone Co-Payment Assistance Program (N-CAP) will cover up to $40 of the cost.

The drug can be administered in a variety of ways. During the New York State Fair, researchers from the Poison Center and Upstate’s department of emergency medicine conducted a study to see which method was quickest and easiest for regular people. A single-step nasal spray (available as Narcan nasal spray) won out over an intramuscular injection and a nasal atomizer. The nasal spray is a device that delivers medication into the nostril, where it is rapidly absorbed through nasal membranes, regardless of whether the person is breathing.

The poison center will provide naloxone training to groups. Call 315-464-8906 for details.

How naloxone works

The chemical structure of naloxone.

The chemical structure
of naloxone.

“It’s an antidote that goes to the sites in your body where opioid drugs work, and it kicks those opioid drugs out, so that you can reverse the effects,” Eggleston explains. “That helps people who have overdosed to start breathing again and to start to wake up. You still want to call 911 and get that patient to a health care facility, so they can get the treatment that they need.”

Naloxone does not always successfully revive a person, but administering the medication offers the best chance of saving a life.

Eggleston recalls a Central New Yorker who called 911 after discovering what appeared to be a dead body in a wooded area. Police arrived, found a faint pulse on the person, administered naloxone — and the person recovered.

Signs of overdose

  • Person is drowsy or unconscious and will not awaken.
  • Breathing is slow, gurgling or stopped.
  • Pupils are small or pinpoint.
  • Lips and fingers are bluish or gray.

What are opioids?

  • Prescription painkillers including morphine, OxyContin, Vicodin and others that are designed to provide short-term pain relief.
  • The illegal drug heroin.
  • Synthetic opioids such as fentanyl, which is 50 times as potent as heroin, and carfentanil — used in veterinary medicine to sedate elephants — which is up to 5,000 times as potent. “It takes a much smaller dose to have lethal effects,” Eggleston says.

What to do

If you come upon someone that you believe has overdosed,

  1. First, make sure it’s safe to approach that person. Try to awaken him or her.
  2. If they do not respond, call 911. The person may have a different medical emergency. Even if he or she overdosed, the naloxone you administer may not be enough to revive him or her. Or, there could be complications. Better to have emergency medical services on the way.
  3. Administer the naloxone. Place the tip of the nasal spray into one nostril. Press the plunger on the opposite end. Effects may not kick in for five minutes.
  4. If the person is not breathing, do rescue breathing. Tilt the head back, lift the chin, and pinch the nose. Give two breaths into the mouth and continue with one breath every five seconds. The person’s chest should rise and fall. Continue rescue breathing until the person wakes up or help arrives.
  5. The person may be disoriented as they awaken. Do your best to keep him or her calm. Place the person on their side, in case they get sick. Stay with them until help arrives.

Protections

Good Samaritan laws protect people who act in good faith to render aid.

New York state law protects the person who overdoses, and the people who try to revive him or her, from charges or prosecution for possession of small quantities of drugs or alcohol, or for sharing drugs, with some exceptions.

The law does not protect against charges or prosecution for possession of felony quantities of drugs, for intent to sell drugs, for violation of probation or parole or for open warrants.

Upstate Health magazine summer 2018 issueHealthLink on Air logoThis article appears in the summer 2018 issue of Upstate Health magazine. Hear a podcast/radio interview with Willie Eggleston in which he describes how to naloxone can save a life. Additional information about naloxone is available through the New York State Department of Health website.

Posted in addiction, drugs/medications/pharmacy, health care, poison center/toxicology, public health | Tagged , , , | Leave a comment

Off-duty nurse spots stroke in progress, springs into action at restaurant

Cassandra "Sandi" Bradford helped a woman at a restaurant who she correctly suspected was having a stroke. The woman said she was a diabetic, and Bradford, a diabetes nurse educator with Upstate's Joslin Diabetes Center, happened to have a glucometer and plastic gloves in her car, which allowed her to check the woman's blood sugar while waiting for the ambulance. (photo by Jim Howe)

Cassandra “Sandi” Bradford helped a woman at a restaurant who she correctly suspected was having a stroke. The woman said she was a diabetic, and Bradford, a diabetes nurse educator with Upstate’s Joslin Diabetes Center, happened to have a glucometer and plastic gloves in her car, which allowed her to check the woman’s blood sugar while waiting for the ambulance. (photo by Jim Howe)

BY JIM HOWE

If an Upstate nurse had not decided to take a photo after dining out with a friend, another restaurant patron’s stroke could have turned out much worse.

Cassandra “Sandi” Bradford, a diabetes nurse educator, was dining with a high school friend at the Bonefish Grill in Fayetteville Towne Center. After their meal, they stepped outside to take a photo together near the restaurant sign.

Bradford had left her purse in the waiting area. When she returned for it, she noticed an elderly woman with a walker who seemed lost. The woman, who was 90, said she was about to leave with a relative after their dinner.

Bradford and the woman then left at the same time, Bradford through a revolving door, and the woman though a regular-style door beside it.

“Now, you’ve got to picture that I’m in the glassed-in revolving door, and I notice her arm drop off of the walker, and then I notice she couldn’t lift her foot to walk through the door, and I’m looking at her, and I’m saying, ‘She didn’t look like that a second ago,’ so I go back.

“And I hear the person holding the door say, ‘Come on,’ and I looked at her face, and I said, ‘Something’s wrong with her.’ And her relative said, ‘You look like you’ve had a stroke.’ I saw her face, and I turned her around, and I said, ‘Let’s get her back in and have her seated.’”

Bradford let it be known she was a nurse. She asked a hostess to call 911. Then she got the woman seated and tried to get some medical information from her while keeping her calm.

“She could still talk, but her speech was slurred. The right side of her faced drooped, and her eye was closing on her right side,” Bradford recalls. She checked the woman’s pulse and borrowed a light from someone’s cellphone to check her pupils, while waiting for the ambulance.

The woman was initially upset at her relative, Bradford said. “She didn’t realize she was having a stroke and just wanted to go home.” Bradford says the stroke’s effects got noticeably worse before the ambulance arrived.

The woman had a massive stroke. Bradford visited her in the intensive care unit the next day and befriended the woman’s daughters. They stay in touch. The woman has recovered but has lingering speech and movement problems.

Although she now works for the Joslin Diabetes Center at Upstate’s downtown campus, Bradford previously worked with patients recovering from strokes. She has seen how tough the condition and its aftermath can be.

“I don’t think I did anything different than I would want someone to do for me,” Bradford says.

“It really, really touched my heart that I was able to help someone.”

Act FAST if you suspect a stroke

The letters in the word “FAST” stand for “face, arms, speech, time” — the things to keep in mind when you suspect someone is having a stroke.

Face: Ask the person to smile. Does one side of the face droop?

Arms: Ask the person to raise both arms. Does one arm drift downward?

Speech: Ask the person to repeat a simple phrase, like “The sky is blue.” Is the person’s speech slurred or strange?

Time: If you see any of these signs, even if they go away, call 911 immediately.

— Sources: American Stroke Association, National Stroke Association

This article appears in the summer 2018 issue of Upstate Health magazine.

Posted in brain/neurology, diabetes/endocrine/metabolism, health care, Joslin Diabetes Center, nursing, patient story, stroke | Tagged , , , , | 1 Comment

A small box that saves lives: Fayetteville man recovers from infection, thanks to ECMO machine

Marcela and Robert Crain with their daughter, Isabella, 8, in the chapel at Upstate University Hospital on Feb. 14, when he was discharged.(Photo by Elizabeth Doran/Syracuse Media Group)

Marcela and Robert Crain with their daughter, Isabella, 8, in the chapel at Upstate University Hospital on Feb. 14, when he was discharged.(Photo by Elizabeth Doran/Syracuse Media Group)

BY AMBER SMITH

Robert Crain, 47, awoke on Jan. 8 from a medically induced coma. Slowly he pulled together memories from three months before.

The Fayetteville podiatrist had a nagging cough in early October. When he began feeling short of breath, his wife, Marcela, suggested they go to the emergency department. Crain collapsed before they could leave their home. An ambulance brought him to Upstate University Hospital.

His temperature was 104 degrees Fahrenheit. He drifted in and out of consciousness. Crain had developed bacterial pneumonia, explains Christopher Tanski, MD, who directs Upstate’s extracorporeal membrane oxygenation program. That technology, known ECMO, kept Crain alive for 61 days.

Christopher Tanski, MD, with the ECMO machine. (Photo by William Mueller)

Christopher Tanski, MD, with the ECMO machine. (Photo by William Mueller)

ECMO does for lung function what dialysis does for kidney failure, explains lung surgeon Jason Wallen, MD, the chief of thoracic surgery at Upstate. Wallen also helped care for Crain during his stay.

The ECMO machine, a bit larger than a shoebox, handles oxygen delivery to the patient’s body, allowing his or her lungs to rest and heal. Cardiovascular surgeons since the 1970s have relied on similar “heart-lung machines” during surgeries that last an hour or two. Today, the use of ECMO has been extended to several days for some patients with various lung injury.

“It’s used to provide support for either the heart or the lungs, or both if they’re not functioning properly,” explains Tanski.

Crain underwent a dozen procedures to remove fluid from his lungs. Because his kidneys failed, he also underwent dialysis regularly. During his coma, his muscles basically shut down, including those involved with chewing and swallowing. Intensive speech, physical and occupational therapy are helping him rehabilitate.

The Crains shared their story with Syracuse.com. While Robert Crain doesn’t remember his time in a coma, Marcela told the news organization, “It was awful. My brain heard them say he wasn’t doing well and wasn’t improving, but my heart wouldn’t accept it. I went to the chapel every day at the hospital and prayed, and my daughter and I prayed every night.”

Crain was hospitalized during Halloween, Thanksgiving and Christmas. He awakened a week after New Year’s, and he was well enough to go home on Valentine’s Day.

“I had a huge support system, with my family and friends, and I never gave up,” Crain says. “I always told myself I would recover.”

Upstate Health magazine summer 2018 issue

This article appears in the summer 2018 issue of Upstate Health magazine.

Posted in health care, infectious disease, kidney/renal/nephrology, lung/pulmonary, patient story, technology | Tagged , , , , , ,

‘Living a miracle’: Recovering from rare disorder that causes nerve damage, paralysis

Barbara King, left, works with occupational therapist Kelly Ryan. (Photo by Susan Kahn)

Barbara King, left, works with occupational therapist Kelly Ryan. (Photo by Susan Kahn)

BY SUSAN KEETER

March 16 was a typical day for Barbara King, 79. She cooked meals and did housekeeping for the brothers at Christian Brothers Academy. She took her huskies, Cody and Daisy, on a two-mile walk. That Friday evening, King felt a little off and asked her granddaughter, Amy Windhausen, to spend the night.

King awoke the next morning paralyzed from the waist down.

King’s daughter, Rebecca Mazuryk, called an ambulance, which took King to an area hospital. Pain — which ran from King’s toes to her waist — made sitting in a wheelchair unbearable, so she lay on the floor of the emergency department. King was admitted to the hospital, told she had a virus and released.

Shortly after she returned home, the weakness and pain spread to King’s arms.

Her daughter again called an ambulance. This time,  King insisted she go to Upstate University Hospital’s Community campus. She underwent more blood tests and X-rays. A team of health care providers including  Marc Iqbal, MD, Anupa Mandava, MBBS, and Theodore Koh, MD, worked together in search of the cause of her symptoms.

“The pain was so bad I prayed to die,” remembers King. The painkiller morphine helped.

Getting the diagnosis

On March 23, physician assistant Alisa Albanese identified Guillain-Barré syndrome — a rare condition in which the body’s immune system attacks the peripheral nervous system — as the source of King’s debilitating symptoms (see explanation at the end of this story). Her diagnosis was confirmed by Matthew Glidden, MD, who had King transferred to the care of neurologists at Upstate’s downtown hospital. There, she received intravenous immunoglobulin treatments designed to reset her immune system, so it would stop doing damage.

Fortunately, King was diagnosed and treated before nerve damage spread to her chest, which would have required that she be placed on a ventilator to breathe. King remembers little of the time between diagnosis and her transfer back to the Community campus on April 6 for physical medicine and rehabilitation.

She could barely move. To get in and out of bed, she had to be hoisted by a mechanical lift with support from several staff members. King was unable to move her hands. She used a catheter.

Gradually, with daily physical and occupational therapy, King regained her abilities. She developed her motor skills by learning to stack conical cups, later by planting flowers and chopping vegetables. King strengthened her legs, first by touching her feet to the floor while supported by a swing, eventually by walking on a treadmill, gripping handrails and being supported by a physical therapist.

By the end of April, King was able to get in and out of bed, in and out of a chair, and walk with a walker.

“It was nice watching her do more and more,” remarked nurse Sarah Hirsch, a clinical leader of the rehabilitation unit.

Nearly two months after she woke up paralyzed, King returned to her one-story home in East Syracuse. Therapists from The Centers at St. Camillus provide physical and occupation therapy three times a week, and her daughter and granddaughter rotate staying with her so she has round-the-clock attention. King continues to do exercises and is able to walk with a cane.

King realizes that it may take a year or two to fully recover from the damage done by the Guillain-Barré disorder, but she is grateful for the progress she has made.

“I’ve lived a miracle,” King says tearfully. “I wouldn’t be able to walk if it weren’t for the people in this hospital. They worked their hearts out for me.”

About Guillain-Barré syndrome

Guillain-Barré syndrome is a rare, difficult-to-diagnose disorder that causes the immune system to attack the peripheral nervous system. These nerves connect the brain and spinal cord with the rest of the body. Damage to the nerves makes it hard to transmit signals, so muscles have trouble responding to the brain. The first symptom is usually weakness or tingling in the legs. This can spread to the upper body, becoming life-threatening. In severe cases such as King’s, the person becomes almost paralyzed. Most recover, but recovery can take a few weeks to a few years. The cause of the syndrome is unknown.

— Source: National Institute of Neurological Disorders and Stroke

Upstate Health magazine summer 2018 issue

This article appears in the summer 2018 issue of Upstate Health magazine.

 

Posted in brain/neurology, health care, physical therapy/rehabilitation | Tagged

At higher risk for breast cancer, she’s vigilant about self-exams and doctor visits

The flowers on Dakoata Wilcox’s forearm are a memorial to her mother, who was diagnosed with breast cancer at age 30 and died of a stroke at age 40. (Photo by Susan Kahn)

The flowers on Dakoata Wilcox’s forearm are a memorial to her mother, who was diagnosed with breast cancer at age 30 and died of a stroke at age 40. (Photo by Susan Kahn)

BY SUSAN KEETER

Dakoata Wilcox was 27 when she felt a lump in her breast during a self-exam.

“I was young,” she remembers. “I didn’t think breast cancer could happen to me.”

Still, she made an appointment with breast surgeon Mary Ellen Greco, MD, who took a family history. Wilcox’s mother had been diagnosed with breast cancer at age 30 and died from a stroke at age 40. Wilcox’s maternal aunt developed breast cancer in her early 40s and her maternal grandmother was diagnosed at age 64.

Such a family history puts Wilcox at a higher risk for breast cancer.

To analyze Wilcox’s lump, Greco ordered a diagnostic mammogram and sonogram. Imaging was normal, but clinical findings warranted a fine needle aspiration, which Greco performed at her office. It was benign. She had Wilcox undergo genetic testing, a simple blood sample taken in her office at the Upstate Community campus.

Wilcox was found to have a variation of the Rad51D gene. This variant is often benign, but since genetic profiles on Wilcox’s relatives are unavailable, it is possible that the familial genetic cancer link may be there.

A year after Wilcox found the first lump, she found another. She underwent a second diagnostic mammogram, sonogram and fine-needle biopsy. The second lump was also benign.

Because of her family history of breast cancer and her personal history of lumps in her breasts, Wilcox sees Greco every six months for breast exams, and she does self-exams in the shower weekly.

Wilcox is vigilant — and cancer free. Her message to other young women: “Don’t think cancer can’t happen to you,” she says. “Do breast self-exams. Some lumps are normal, but they need to be checked out.”

Upstate Health magazine summer 2018 issue

This article appears in the summer 2018 issue of Upstate Health magazine.

Posted in cancer, health care, surgery, women's health/gynecology | Tagged , , , ,

1 weekend sees 4 organ donors improve lives of 12 people

The transplant surgery team, from left: Mark Laftavi, MD, Tamer Malik, MBBCh, Zeki Acun, MD, Rauf Shahbazov, MD, and physician assistant Sharon Denise. (Photo by Robert Mescavage)

The transplant surgery team, from left: Mark Laftavi, MD, Tamer Malik, MBBCh, Zeki Acun, MD, Rauf Shahbazov, MD, and physician assistant Sharon Denise. (Photo by Robert Mescavage)

BY AMBER SMITH

One busy weekend in April saw the Upstate transplant team caring for four patients who made the decision to donate their organs upon death. In all, 12 people received lifesaving organ transplants thanks to the four donors.

Each of the donors — including two men and two women — were able to donate both their left and right kidneys to eight different people. Two of the kidneys were transplanted at Upstate, where surgeons perform more than 100 kidney transplants per year. Two hearts, two livers and the six other kidneys were transplanted to patients elsewhere in New York state.

“The transplant business is unpredictable,” said Mark Laftavi, MD, professor of surgery and the interim chief of transplant services at Upstate. “Sometimes you have a couple donors in one day, and sometimes you have none. So, we are always prepared.”

More than 7,000 people died waiting for an organ transplant in 2016, according to the United Network for Organ Sharing. Laftavi is proud to help improve lives through transplant.

“There’s nothing more rewarding than saving a mother, a father or a child, who regain their lives,” he said.

Upstate Health magazine summer 2018 issue

Upstate Health magazine summer 2018 issue

HealthLink on Air logoThis article appears in the summer 2018 issue of Upstate Health magazine. Click here for a podcast/radio interview with Mark Laftavi, MD, about transplants, organ donation and the busy weekend for transplants described above.

Posted in health care, kidney/renal/nephrology, organ donation/transplant, surgery | Tagged , , , ,