Surgical services featured in July Physicians Practice

Dilip Kittur, MD, and Ajay Jain, MD, are hepatobiliary surgeons at Upstate.

Dilip Kittur, MD, and Ajay Jain, MD, are hepatobiliary surgeons at Upstate.

The July issue of Physicians Practice magazine gives a glimpse of the services available at Upstate. It’s written for physicians who work throughout the Central New York region, but much of the information is of interest to the community at large.

For instance, are you aware of how quickly Dilip Kittur, MD, and Ajay Jain, MD, work to see patients who need liver, gallbladder or pancreatic surgery? The lead article in this issue details the types of minimally invasive and robotic procedures they offer.

Two of our physician/scientists are responsible for research suggesting that patients who are found to have “bladder wall thickening” may be at risk for bladder cancer. Timothy Byler, MD, and Imad Nsouli, MD, share their findings, which were published recently in the journal Urology.

In addition, Mark Marzouk, MD, explains a minimally invasive alternative he now offers to salivary gland surgery. He’s the new chief of head and neck oncologic surgery. And Jessica Paonessa, MD, tells about a laser procedure that treats enlarged prostates.

Other articles tell how to locate a clinical trial at Upstate, and the expansion of pain management services and robotic surgery options at the community campus of Upstate University Hospital.

 

 

Posted in research, community, surgery, urology, ENT | Leave a comment

5 things to do to treat a sunburn

Photo courtesy of iStock

Photo courtesy of iStock

Obviously it’s best to avoid getting a sunburn in the first place, said Ramsay Farah, MD. But if your skin ends up reddened after a day in the sun, here’s what Upstate’s division chief of dermatology advises:

1. Gauge the severity of the burn. If you have blisters, he said to make a trip to your health care provider, “just to make sure it’s examined and that no possibility of scarring arises.”

2. Take an aspirin. Its anti-inflammatory effects can help during the initial stage of a sunburn, if you take it promptly.

3. Apply cool compresses on the affected area.

4. Use a low-strength (1 percent) hydrocortisone cream, available over-the-counter, to help decrease inflammation but not affect wound healing.  “You want to be careful not to put very strong steroids on the burn,” he said.

5. Head to your kitchen for a bottle of ketchup. Yes, you read that right. Farah explained that, “Ketchup has a lot of lycopenes and other anti-inflammatory factors, and it’s cold because it comes from the refrigerator. So if you put that on right away, along with your aspirin, you will decrease the inflammatory response.”

None of these measures will reverse the DNA damage, but they should help the burn heal better and feel better.

Hear Dr. Farah’s radio interview on how to treat a sunburn.

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Heart recipient’s persistence leads to emotional meeting with donor’s mother

Vicky Brannon’s 14-year-old son, Matthew John McIntyre II, was killed in what police called an accidental shooting in July 1996 across the street from the family’s home in Fulton. She agreed to donate his heart, liver, pancreas and kidneys. More than a year later, she sought to connect with the organ recipients.

The Tampa Bay Times explained how Brannon followed organ donor network protocols, writing to each recipient and awaiting their responses. She received an immediate response from the person who received Matthew’s pancreas and one of his kidneys. Soon after, she relocated to Florida.

The newspaper explained that Brannon never received letters from the 14-year-old girl who received Matthew’s heart. Jennifer Lentini sent letters via the network for 10 years, until her home was gutted by fire. Recently she went through boxes salvaged from the fire and came upon Brannon’s original letter. Lentini, 32, renewed her search. She turned to Facebook. There, she connected with Matthew’s brother, Chad. Earlier this year, she traveled to Florida to meet Matthew’s mother.

It was Valentine’s Day — which is also National Organ Donor Day — when Brannon was able to press a stethoscope to Lentini’s chest and hear her son’s heart beating.

 

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Their work to solve kidney disease may also answer cancer questions

Sirotkin

Sirotkin

Carroll

Carroll

These green ovals (in the image below) are fission yeast, organisms that scientists Vladimir Sirotkin, PhD, and Robert Carroll, a PhD candidate, in the Department of Cell and Developmental Biology use for their study of endocytosis, the process by which a cell brings material into itself. They focus on the roles of the actin cytoskeleton and the motor protein myosin-1 in endocytosis. The red in these images represents the dynamic sites of endocytosis, where actin and myosin-1 help internalize material into the yeast cells. The green shows stable linear structures on the surface of the cells. Understanding the function of myosin-1 is important to understanding a particular kidney disease that is caused by a mutation in the myosin. Actin and myosin-1 are also implicated in cancer, and the Upstate scientists believe the proteins may prove to be good targets for medications.

This article appears in the spring 2015 issue of Upstate Health magazine.

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Premature death rates about double for people with ADHD, study says

A diagnosis of attention deficit hyperactivity disorder puts a person at a higher risk of dying young — usually in a car crash or other accident — than those without the disorder, according to a study published in February in The Lancet.

In covering the research, The New York Times contacted Upstate psychiatry professor Stephen Faraone, PhD, who told the newspaper that parents should not be alarmed. “But this is a large, well-done study, and I see it as … a reason to identify and treat ADHD,” he said.

Researchers analyzed nearly 2 million Danish medical records to come to the conclusion that children diagnosed with ADHD died at roughly twice the rate of premature death among those without the disorder. Those who were diagnosed after the age of 18 had an even higher risk of dying early.

Faraone told the Times the heightened risk may reflect a late diagnosis. Children with untreated ADHD are likely to get off track, academically and socially, and may live more recklessly than their peers. While conduct disorders, antisocial behaviors and substance use are likely to happen along with ADHD, but Farone pointed out that “only one of these is easily treatable. And that’s ADHD.” (A related story appears in the spring 2015 issue of Upstate Health magazine.)

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Your health care proxy is a gift to your loved ones

Timothy Creamer, MD, holds a photo of his father, George. Creamer is division chief of hospital medicine at Upstate University Hospital, Community Campus. PHOTO BY SUSAN KAHN.

Timothy Creamer, MD, holds a photo of his father, George. Creamer is division chief of hospital medicine at Upstate University Hospital, Community Campus. PHOTO BY SUSAN KAHN.

BY TIMOTHY CREAMER, MD 

I sat with my father on a cool early summer afternoon. I forget what we were chatting about specifically, though probably it was something financial. That was his expertise.

The conversation drifted, and we sat silently for a moment.

“I’m ready, you know.”

He had a second knee surgery about four months prior. He had an operation to remove a blockage from his neck a year before that. He had an irregular heartbeat and mini strokes. Trans-ischemic attacks, they call them.

“There’s nothing more I can offer this world. I have faith that I’ll be taken care of.”

His openness caught me by surprise. But I realized fairly quickly that he was letting me know that he was comfortable with his ultimate demise. I think he wanted me to feel more comfortable when the time came.

Less than a year later, I received a phone call from my father. “I can’t get on the stupid computer!”

I packed up what I was doing and drove the five miles to my parents’ condominium.

In his prime, my father commuted 45 minutes to work each day in New York City from his home in Thornwood in Westchester County. Now, with a bad back and knees, he and my mother were settled into condominium living. The computer had extended my father’s life, allowing him to manage stocks. But today he could not remember how to click the start button.

When I got him signed into his accounts and numbers filled the screen, his eyes blinked. He cursed. I realized he was unable to process the data. His mind, which had carried him through his 88 years, was failing. I sent a note to my sisters.

Soon after, he was admitted to the hospital with circulatory problems. Although his illness was not considered serious, I knew from my medical training that any hospitalization in a person seven years beyond their 81-year life expectancy had the potential to be complicated.

My father’s wishes were appropriately dictated on paper. I visited him daily. I had not been completely comfortable with his decisions when he spoke to me about them, but now as he was beginning to suffer, I understood. I felt empowered to let his suffering end.

Any journey is easier when we have directions. My father not only gave me the directions, he gave me the strength through his faith to be able to follow those directions.

Give your loved ones directions to follow. Complete a health care proxy. Help them be able to help you when your time comes.

Find health care proxy forms at upstate.edu/bioethics/consult/hcp.php.

This article appears in the spring 2015 issue of Upstate Health magazine.

 

Posted in bioethics, community, dementia, health care, hospital, stroke | 1 Comment

A sacred space to say goodbye

ARTWORK BY GRACIA SEARS

ARTWORK BY GRACIA SEARS

Administrators, doctors and hospital staff gathered in a unique room at Upstate University Hospital one weekday this winter for a rededication ceremony. Technically the room is known as the viewing room, and like those found at funeral parlors, it is for loved ones who need a place to say goodbye. The space was updated with furniture and artwork painted by hospital volunteer Garcia Sears.

The Rev. Terry Culbertson, who leads the spiritual care program at Upstate, said the Irish have another name for the space: The Thin Place. Culbertson spoke at the ceremony.

“The Thin Place is a place where the veil between the heaven and earth is very thin, and a place where the two worlds coexist in a loosely knitted relationship,” she said. “It’s also called the liminal space. ‘Liminal’ is from the Latin, meaning ‘threshold,’ which we walk across between this world and the next.

“Describing the meaning of the Thin Place is like trying to describe what is love, or what does it feel like to hold your firstborn child or your firstborn grandchild, or the existence of God,” Culbertson continued.

“When you’re in the Thin Place, time seems to stand still. There’s a communion with human spirits, both those who have gone before us, those who are here, and those who will come to be with us. It’s about connection to the sacred. And so, we are very grateful for this Thin Place, this special room.”

 

 

 

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Finding the virtue in medical practice

You may have heard of the seven deadly sins – pride, anger, envy, lust, greed, gluttony and sloth. Well, there are also seven so-called “primary” virtues, which derive from ancient sources — four cardinal virtues come from Plato, and three transcendental virtues come from Paul of Tarsus, also known as St. Paul or the apostle Paul.

Robert Roger Lebel, MD, who directs medical genetics at Upstate, recently gave a brief video chat explaining where he sees the seven primary virtues in the practice of medicine.

“Prudence is the primary virtue,” he began. “It is the virtue that informs the other six and without which the other six become empty or hollow, almost useless, efforts.”

1.  Prudence means wisdom. It is making sound judgments when faced with uncertainty. This is what doctors and other health care providers do every day.

2.  Justice is taking appropriate action with patients, to help solve their problems.

3.  Temperance is a soundness of mind. It is tolerance and social decorum.

4.  Fortitude is also known as courage, and it does not mean the absence of fear. It is overcoming fear or other obstacles in order to do what’s right.

5.  Faith, as a virtue, has nothing to do with religion. It is the assurance of things hoped for and the conviction of things not seen. Health care providers must have faith in themselves, in their colleagues, in their patients, in treatment plans.

6.  Hope is rational optimism, an expectation of favorable outcomes, and Lebel said it is essential to the practice of medicine.

  1. Love, otherwise known as charity, is why people enter the medical profession. They practice medicine because they love the work, they love the science, they love the patients and their colleagues.

Within the profession of medicine are many examples of good and virtuous behavior. Politeness, gentleness, punctuality and more. Each is a species of one of the primary virtues — still compelling after more than 2,000 years.

This article appears in the spring 2015 issue of Upstate Health magazine.

Posted in bioethics, community, education, genetics, health care, spiritual care | Leave a comment

Paralyzed referee: ‘whatever doesn’t break you makes you stronger’

A man who sustained a spinal cord injury in a sledding accident in Syracuse more than 25 years ago was in the news recently for his work as a basketball referee.

basketball

Joe Slaski, 47, now lives in Macedon. The Rochester Democrat & Chronicle identified him as the only person among about 300 referees in Section V who officiates high school basketball from a wheelchair.

At the age of 22, he was paralyzed at the waist after going down a steep hill on a plastic sled. He lost control and landed on his back and spent about three months at Upstate University Hospital, plus several months more in rehabilitation.

“To be informed by the doctors that my life would be dramatically changing certainly was a hard pill to swallow,” Slaski told the newspaper. “But they say whatever doesn’t break you makes you stronger, and there certainly has been a lot of good that has come about from a tragic situation.”

Slaski played wheelchair basketball for the Rochester Wheels and the Syracuse Flyers before becoming an official.

 

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He races cyclocross after successful brain surgery

Jordan Pone of Constantia bike races cross country. PHOTO BY THE PONE FAMILY

Jordan Pone of Constantia bike races cross country. PHOTO BY THE PONE FAMILY

Jordan Pone was 5 when he abruptly lost the ability to hear. As doctors searched for the cause of his hearing loss, they came across unusual lesions in his brain.

The lesions were not cancerous, but they were serious. At the time, doctors advised keeping close watch on the lesions and any symptoms they might cause, such as seizures or headaches. This was almost 10 years ago, and surgery on the lesions would have meant open brain surgery for Jordan.

Today, Jordan is 15. He wears hearing aids, rides cyclo-cross and “with regard to this, shows a great maturity that is just amazing,” said his father, Daniel Pone. The hearing loss is not related to the lesions, which doctors continue to monitor.

When one of the lesions began growing and bleeding in late 2013, the Pones explored treatment options. They found pediatric neurosurgeon Zulma Tovar-Spinoza, MD, at Upstate. She told them they could continue monitoring the lesions, perform open surgery to remove them, or use a new focused laser technology to ablate and reduce their size.

Daniel and Simmone Pone of Constantia liked the laser option for their son; he had not suffered seizures or headaches, and they wanted to make sure he would not.

Doctors had never before treated a pediatric patient with lesions like Jordan’s using laser ablation, Tovar-Spinoza explained. She performed the first operation in February 2014, targeting the largest lesion. In another operation in November, she focused lasers on two other lesions that were showing signs of bleeds. That surgery took place in Upstate’s new surgical suite that provides direct access to a magnetic resonance imaging machine, so scans can be taken during surgery.

Pone said his son recovered quickly. After both surgeries, Jordan was back home the next day. He has been able to return to the sports he loves: bicycle racing and cyclo-cross. And, follow-up exams show that the lesions are shrinking.

Zulma Tovar-Spinoza, MD, operates on Jordan Pone in November. PHOTO BY ROBERT MESCAVAGE

Zulma Tovar-Spinoza, MD, operates on Jordan Pone in November. PHOTO BY ROBERT MESCAVAGE

Steps of Jordan’s operation

  1. He is placed under anesthesia in the operating room.
  2. A frame is positioned around his head.
  3. He is moved into the MRI machine for imaging.
  4. He returns to the operating room, where the frame is fixed to a clamp.
  5. Dr. Zulma Tovar-Spinoza introduces lasers into his brain through tiny incisions.
  6. The patient is moved to the MRI machine.
  7. New images show that lasers are in the planned position.
  8. The lesions are ablated, or destroyed, while live images from the MRI machine are visible.
  9. After a final post-ablation scan, he is moved back to the operating room.
  10. The lasers are removed, and the small incisions are closed with a single stitch.

Hear an interview with Zulma Tovar-Spinoza, MD, and Lawrence Chin, MD, about the surgical suite where Justin had his operation. The interview was part of HealthLink on Air, on WRVO.

This article appears in the spring 2015 issue of Upstate Health magazine.

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