Crisis control: A hospital responds to a pandemic

The first thing that happened at Upstate — long before the first COVID-19 patient was identified in Central New York — was the establishment of an Incident Command. This group of approximately 75 individuals has a conference call twice each day. Led by Stephen Thomas, MD, chief of infectious disease, each call covers all aspects of operations, patient care and safety, logistics, communications and materials management across the entire medical university during the crisis. Here, a screen shot shows participants as they gather online for their morning call. (photo by Kathleen Froio)

The first thing that happened at Upstate — long before the first COVID-19 patient was identified in Central New York — was the establishment of an Incident Command. This group of approximately 75 individuals has a conference call twice each day. Led by Stephen Thomas, MD, chief of infectious disease, each call covers all aspects of operations, patient care and safety, logistics, communications and materials management across the entire medical university during the crisis. Here, a screen shot shows participants as they gather online for their morning call. (photo by Kathleen Froio)

BY AMBER SMITH

It felt like the world turned upside down.

So many changes, so suddenly, so surreal.

Medical classes moved online. Research laboratories shut down. Fever checks. Face masks. Toilet paper shortages. Rationing of pasta and butter and sugar. Elective surgeries postponed. Almost no hospital visitors allowed. Daily briefings by the governor and an order that all but essential businesses must close. Employees who could work from home began to do so. Upstate University Hospital’s daily operations were turned over to an “incident command” structure reserved for major disasters.

Upstate University Hospital CEO Robert Corona, DO (center), and Stephen Thomas, MD, chief of infectious diseases  (right), share their COVID-19 expertise with Dan Cummings, NewsChannel 9 anchor. (photo courtesy of NewsChannel 9)

Upstate University Hospital CEO Robert Corona, DO (center), and Stephen Thomas, MD, chief of infectious diseases  (right), share their COVID-19 expertise with Dan Cummings, NewsChannel 9 anchor. (photo courtesy of NewsChannel 9)

While the coronavirus tore through civilization, many in health care continued caring for the sick, feeling more like they were reporting for duty in a war against a microscopic villain. Others were isolated at home, watching grimly as the Johns Hopkins University global coronavirus map turned redder as more cases of COVID-19 were reported on every continent except Antarctica, and as federal health officials predicted maybe 200,000 Americans could die. Just like in the movie “Contagion,” this virus got its start in a bustling Asian city some 7,500 miles from Syracuse.

Infectious disease experts at Upstate were aware of the novel coronavirus and the respiratory syndrome it causes. It was similar in some ways to the SARS outbreak in 2002, and the MERS outbreak in 2012, both respiratory illnesses caused by other types of coronaviruses. After the first case of COVID-19 was diagnosed in the United States in January, Stephen Thomas, MD, Upstate’s chief of infectious disease, said what’s still true today: “We don’t know more than we do know. It’s an evolving story.”

Upstate nurse Julia Burns greeted a patient at the coronavirus testing site at the Upstate Specialty Services at Harrison Center. To minimize contact, gowned and masked staff took nasal swabs in the parking lot, so patients did not have to leave their vehicles. The swabs were tested for dozens of respiratory illnesses in the pathology lab at Upstate. If those were negative, the swabs were sent to Albany for coronavirus testing. (photo by Susan Keeter)

Upstate nurse Julia Burns greeted a patient at the coronavirus testing site at the Upstate Specialty Services at Harrison Center. To minimize contact, gowned and masked staff took nasal swabs in the parking lot, so patients did not have to leave their vehicles. The swabs were tested for dozens of respiratory illnesses in the pathology lab at Upstate. If those were negative, the swabs were sent to Albany for coronavirus testing. (photo by Susan Keeter)

Common symptoms of fever, cough and achiness are well-known, but there is no proven treatment. This disease is more infectious than seasonal influenza, and deadlier. Scientists, including some at Upstate, are developing tests for the virus and for the antibodies that would indicate a person had recovered. Others are working on a vaccine. And others are involved in ventilator research and efforts to treat those infected.

At Upstate, some 75 hospital leaders gather twice a day – virtually – in “incident command” meetings so that everyone is aware of issues related to the coronavirus pandemic: how many beds are available, the supply of masks and other personal protective equipment (PPE), staffing issues, requests from county or state emergency management officials and more. With incident command in place, the meetings launched March 16, the same day the first case of COVID-19 was confirmed in a patient in Onondaga County.

“Decisions are made, data is updated. We execute,” explains Robert Corona, DO, chief executive officer. “It’s pivoting, and making impactful decisions hour by hour.”

Someone during each meeting summarizes important information from the World Health Organization, the Centers for Disease Control and Prevention, the state Department of Health, scientific literature and other health organizations. “We put all of that in context,” Thomas says. “Our policies are first to protect Upstate staff and second to conserve PPE. Protecting our staff is our priority. Period. Full stop.”

The leaders explore how best to care for infected patients. Dean of Upstate’s College of Medicine Lawrence Chin, MD, coordinated a 90-minute conference call between Upstate experts and Chinese doctors in Wuhan — the first COVID-19 battlefield — to learn from their experiences.

Immediate response: Restrictions to reduce possible exposure to COVID-19 change quickly. On March 16, Upstate University Hospital implemented a “no visitor” policy in response to the first two confirmed cases of COVID-19 in Onondaga County. By March 29, 146 confirmed cases and one death were reported in Onondaga County. (photo by Susan Kahn)

Immediate response: Restrictions to reduce possible exposure to COVID-19 change quickly. On March 16, Upstate University Hospital implemented a “no visitor” policy in response to the first two confirmed cases of COVID-19 in Onondaga County. By March 29, 146 confirmed cases and one death were reported in Onondaga County. (photo by Susan Kahn)

“We thought it would be really helpful to have the perspective and experience of doctors that have been dealing with this the longest,” Chin explained to Syracuse.com.

They discussed a variety of topics, including early identification of patients, chest imaging, drug use, hormone therapy, immune adjustment, plasma exchange and treatment using a machine called ECMO, extracorporeal membrane oxygenation, which adds oxygen, removes carbon dioxide and recirculates a patient’s blood.

Mental health concerns have also been addressed. Upstate interim President Mantosh Dewan, MD, asked the chief of psychiatry to talk in a webinar to all
Upstate employees about healthy ways to cope.

When Governor Andrew Cuomo ordered all hospitals in New York state to be ready to expand capacity by 50 percent, Corona says his team came up with a plan to obtain beds and staffing to increase by 77 percent. Some private rooms would be doubled up, and some other rooms in the hospital would be converted for patient care. He said nearby hotels were prepared to help as well, providing lodging for health care workers or patients.

The incident command team also works through ways to minimize the hospital services that are nonessential, for the time being, and how to keep essential services operating. Because, even as the crisis unfolds, heart attack patients are still revived, people injured
in car crashes are still put back together, babies are still born.

Mantosh Dewan, MD, interim president of Upstate Medical University, prepares for one of his videotaped updates about COVID-19 issues to Upstate’s more than 9,000 employees. (photo by William Mueller)

Mantosh Dewan, MD, interim president of Upstate Medical University, prepares for one of his videotaped updates about COVID-19 issues to Upstate’s more than 9,000 employees. (photo by William Mueller)

Upstate Health magazine cover for spring 2020, special coronavirus editionThis article is from the spring 2020 Upstate Health magazine, a special edition dealing with the coronavirus.

Posted in community, coronavirus, COVID-19, health care, infectious disease, public health | Leave a comment

A patch collection grows in the burn center

Patches from fire departments and rescue squads on display at the Clark Burn Center at Upstate.

PHOTOS BY WILLIAM MUELLER

A burgeoning collection of fire department and rescue patches is on display in Upstate’s Clark Burn Center. Two hundred eighty patches of various shapes and sizes occupy a dozen cases in a hallway where patients and family members like to stretch their legs.

The burn center is a six-bed intensive care unit that serves people from 27 counties, as far north as the St. Lawrence River and south into Pennsylvania, and from Rochester to Vermont.

Nurse Tamara Roberts, the burn program manager, says a grateful patient started the collection years ago by donating a patch from their home fire department. It grew from there. Today’s patches tend to be larger and more colorful. Plenty feature crosses formed by ladders, axes and fire hoses.

Some contain mottos. Shown above are several with distinguishing features.

Upstate Health magazine winter 2020 issue coverThis article is from the winter 2020 issue of Upstate Health magazine.

Posted in burns/Clark Burn Center, emergency medicine/trauma, health care | Leave a comment

Spotting a volunteer just got easier at Upstate

Halleluyah “Lou” Adebiyi, left, and Stanley Simon model the new Upstate volunteer uniforms. PHOTO BY SUSAN KAHN

Halleluyah “Lou” Adebiyi, left, and Stanley Simon model the new Upstate volunteer uniforms. PHOTO BY SUSAN KAHN

BY EMILY KULKUS

Hundreds of dedicated and valuable volunteers at Upstate University Hospital are now a little easier to spot.

With more than 800 people volunteering annually through Upstate’s Office of Volunteer Programs, volunteer services are critical to helping patients and visitors at Upstate University Hospital’s downtown and community sites. For many years those volunteers have worn navy blue shirts, vests and jackets to distinguish them from other people in the hospital. But navy blue tends to be a common color, said Kristin Bruce, director of volunteer services.

“I don’t think people know that we have volunteers because you don’t always see them,” Bruce said. “Now you won’t be able to miss them.”

All Upstate volunteers began wearing bright blue polos, T-shirts and vests this fall to make them stand out in Upstate spaces. The volunteer hue — a blue the color of a perfect summer sky — is unique among Upstate colors assigned to departments such as environmental (green), transport (purple) or operating room staff (turquoise or maroon). And the T-shirts say “Volunteer” in large white letters across the back, which should help them stand out even more.

“It’s such a bright color you’ll be able to spot a volunteer right away,” Bruce said. “And if you’re lost, that’s a big help.”

Why volunteer?

The volunteer programs office recently surveyed its volunteers about why they choose to volunteer. Here are some favorite responses:

 “To help where needed, to continue to be active, to be involved with life, to be part of something.”

— “Because I think if everyone took a second to help someone else, the world would be a better place.”

— “To gain exposure in the medical field while helping others in need.”

— “Because I can make a difference in people’s lives.”

— “To give back to the community that has given to me. Now that I am retired I have time to hopefully make someone else’s day a little brighter.”

Want to volunteer at Upstate?

Upstate offers many types of volunteer opportunities in several locations. The goal is always to find the appropriate fit for the applicant and the hospital. Adult volunteers must be 18 or older. A typical schedule is four hours per week.

Visit www.upstate.edu/volunteers for more information and to fill out the volunteer application form. You may also call 315-464-5180 with questions or for more information.

This article is from the winter 2020 issue of Upstate Health magazine.

 

 

Posted in health care, volunteers | Leave a comment

Recipe: Ginger Turmeric Butternut Squash Soup

Ginger Turmeric Butternut Squash Soup

Ginger Turmeric Butternut Squash Soup

Ingredients

1 large butternut squash, cooked (see notes)

2 tablespoons fresh ginger, peeled and chopped

1 onion, diced

1 tablespoon coconut oil or olive oil or butter

2 cups chicken stock or broth, or vegetable broth

15 ounces coconut milk

Kosher salt, to taste

Black pepper, to taste

1 teaspoon ground turmeric

Roasted squash or pumpkin seeds and fresh cilantro for serving (optional)

Preparation

  1. In large pot, saute the ginger and diced onion in oil over medium heat until softened, about 3 minutes.
  2. Add the stock and bring to a boil.
  3. Add the cooked butternut squash (see notes).
  4. Stir in the coconut milk.
  5. Season with salt, pepper and turmeric.
  6. Use an immersion blender to blend to a smooth puree. Alternatively, you can use a standing blender in batches. Taste and adjust seasonings as needed.
  7. Serve topped with roasted seeds and/or fresh cilantro, if desired.

Serves six.

Preparation: 5 minutes; cooking: 15 minutes (not including squash cooking time).

Notes

  1. To cook the butternut squash, place it whole in your slow cooker for three hours on high or six hours on low. Remove, let cool, deseed and remove the flesh from the peel. Or, halve it and roast it in your oven at 425 degrees Fahrenheit for 45 minutes to an hour, then deseed and remove the flesh from the peel.
  2. Can be frozen in an airtight container for up to six months.

Nutritional information

Each of six servings contains:

254 calories

21 grams carbohydrates

3 grams protein

20 grams fat

17 grams saturated fat

303 milligrams sodium (not counting any from seasonings added to taste)

735 milligrams potassium

4 grams fiber

6 grams sugar

Source: bowlofdelicious.com

Upstate Health magazine winter 2020 issue coverThis article is from the winter 2020 issue of Upstate Health magazine.

Posted in recipe

New medical school course emphasizes nutrition, its impact on health care

Medical student Natalie Antosh (photo by Jim Howe)

Medical student Natalie Antosh, in an interview with Upstate’s podcast and radio program “HealthLink on Air.” (photo by Jim Howe)

A new elective at Upstate Medical University teaches medical students about how food affects health.

Fourth-year medical student Natalie Antosh worked with faculty members — Beth Nelsen, MD, Barbara Feuerstein, MD, and Susan Levinsohn, MD, all from Upstate, plus Kay Stearns Bruening, PhD, from Syracuse University — to create the course, called “Food As Medicine,” which was first offered in the fall of 2019.

She says as she encountered patients during her training, she heard questions about how to lower cholesterol and what to eat to lose weight. “I realized I didn’t have the answers.” So she spoke to classmates and approached the medical school’s curriculum office.

(Hear Natalie Antosh explain how a medical school course about food relates to issues of food insecurity, the role of dietitians and overall health in a podcast for Upstate’s “HealthLink on Air.”)

The resulting course covers nutrition and its impact on multiple diseases, the role of dietitians, mindful eating, social factors that affect what people eat, and more. One of the classes makes use of the teaching kitchen at SU. Students also spend time in a soup kitchen or food bank.

“A lot of patients come to their doctor seeking nutrition information. They are looking for how they can lose weight effectively, how they can manage their high blood pressure, diabetes or high cholesterol with diet modification,” Antosh says. “I think it’s really important for doctors to know this information.

(Related story: Rural medical students learn about “culinary medicine.”)

Not many medical schools require separate nutrition courses. A growing number of schools are exploring creative ways to integrate nutrition into the curricula, according to Lisa Howley, PhD, a senior director at the American Association of Medical Colleges.

Upstate Health magazine winter 2020 issue coverThis article is from the winter 2020 issue of Upstate Health magazine.

Posted in diet/nutrition, health care, medical education, medical student

Eating better: Rural medical students learn about culinary medicine

plate of salad and cornbreadBY CHARLES McCHESNEY

Many patients know they need to eat better. They don’t know how.

That’s why “I don’t ask them what they eat. I ask them who cooks,” Joseph F. Wetterhahn, MD, told 14 first-year students in Upstate Medical University’s Rural Medical Education program. They gathered in a demonstration kitchen at Syracuse University’s Falk College to learn about “culinary medicine.”

Wetterhahn, a family medicine doctor and Upstate graduate, said focusing on cooking gives patients more control over the food they take in, how it is prepared and how much of their budget it will take.

He pointed out that the food he buys comes from the grocery store near his home in Adams, about 15 miles south of Watertown. It’s a store with far fewer offerings than Wegmans or Whole Foods. Further, he says when teaching patients about culinary medicine, he skips “chefy” things like making pasta from scratch.

Instead, Wetterhahn puts the focus on food rules popularized by author Michael Pollan. “Don’t eat anything your great-grandmother wouldn’t recognize as food.” “Don’t eat anything with more than five ingredients.” “Don’t eat anything with health claims on the label.”

Wetterhahn was joined by Upstate University Hospital pediatrician Matthew Picone, MD, a veteran chef. Picone demonstrated to students how to prepare chicken breast in a skillet and use what remained in the pan to create a sauce.

Students crowded around the demonstration, reacting as Picone sprinkled or drizzled in ingredients — onions, mustard, garlic and mushrooms — changing the fragrance of the kitchen with each addition.

Melia Wakeman, a student from Sidney in Delaware County, said the class helped her understand how important culinary medicine is. Her own family has shifted how it eats, she recounted, turning toward fruits and vegetables and away from processed foods. “You want to eat fresh food, as fresh as you can,” she said.

A graduate of Rensselaer Polytechnic Institute with a degree in chemical engineering, Wakeman entered the rural medical program when she found work as a chemical engineer unfulfilling and recognized the shortage of physicians in rural areas –— such as her hometown. “These are my people,” she said.

Twice a month in Adams, Wetterhahn and his wife, a physician assistant, host cooking classes called “A Better You” for patients interested in learning how to prepare healthy meals. Wetterhahn is up front with the class, telling them he is not a chef, and the meals do not have to turn out perfectly to be healthier than premade foods.

“One of the things I try to stress with people is, if I can do it, you can do it.”

Upstate Health magazine winter 2020 issue coverThis article is from the winter 2020 issue of Upstate Health magazine.

Posted in diet/nutrition, health care, medical education, medical student

In case you missed it: multiple sclerosis rates, a major hospital donation, ‘quiet kits,’ early med school admission

This waiting area is part of the recently renovated main lobby at Upstate University Hospital. (photo by William Mueller)

This waiting area is part of the recently renovated main lobby at Upstate University Hospital. (photo by William Mueller)

Why are MS rates so high in Syracuse?

Experts are trying to understand why the rate of multiple sclerosis in the Syracuse area is nearly double the national average, according to a report from Blue Cross Blue Shield.

The report says the diagnosis rate of MS in the Central New York-Syracuse region is 45 per 10,000 commercially insured people. The national average is 24 per 10,000 people.

U.S. Sen. Charles Schumer called on the Centers for Disease Control and Prevention to work with experts from Upstate Medical University to learn why the Syracuse incidence is so high. The CDC is developing a database called the National Neurologic Conditions Surveillance System, to help increase understanding of neurological disorders including MS.

“To learn that Syracuse has a sky-high incidence of this often disabling neurological diseases is puzzling and concerning and cries out for prompt and professional research to find out why,” Schumer said during a news conference at Upstate in November.

Corey McGraw, MD, is an Upstate neurologist who specializes in MS. He says existing research shows that MS is more common in people who live farther from the equator, though it’s not clear why. The National MS Society estimates nearly 1 million people over the age of 18 live with MS.

Lots of ticks

Tick expert Saravanan Thangamani, PhD, asked people to send ticks they find to his lab at Upstate. From July through October 2019, he received nearly 2,000.

Researchers from his lab tested the ticks and found about a third were capable of spreading some type of disease. Most of those carried the bacteria that causes Lyme disease, but researchers also found other bacteria, as well as the Powassan virus in a tick from downstate. About 3% of the ticks carried more than one disease.

Thangamani, a professor of microbiology and immunology, is studying how tick-borne diseases are transmitted to humans.

Shhhh…

To soften the noises of a busy hospital, some patients receive “quiet kits” when they’re admitted to Upstate University Hospital. Each reusable plastic bag comes with disposable earbuds and a sleep mask, along with disposable headphones that are compatible with the television and nurse call system.

Getting into medical school

Upstate’s College of Medicine recently added three schools to its Accelerated Scholars Program, which allows students to declare their desire to enter medical school as early as their senior year of high school. Students who are part of the program are guaranteed admission to Upstate as long as their undergraduate requirements are met.

New partners include the SUNY College of Environmental Science and Forestry, Syracuse University and Spelman College, a historically black college in Atlanta. Other schools include Adelphi University, Albany College of Pharmacy and Health Sciences, Bard College at Simon’s Rock, Colgate University, Hamilton College, Hampton University, Purchase College, Rochester Institute of Technology, SUNY Polytechnic Institute, University at Albany and Yeshiva University.

A gift for kids with special needs

Paychex founder and philanthropist Tom Golisano donated $3 million to establish a center for special needs at the Upstate Golisano Children’s Hospital. This center will provide comprehensive and scientifically based medical and behavioral care for children and adolescents with many types of intellectual and developmental disabilities. Its intent is to centralize programs and services available to this population.

Golisano’s gift announcement came during the celebration of the 10th birthday of the children’s hospital, which bears his name.

Upstate Health magazine winter 2020 issue coverThis article is from the winter 2020 issue of Upstate Health magazine.

Posted in brain/neurology, health care, infectious disease, medical education, Upstate Golisano Children's Hospital/pediatrics

Chaplain donates a kidney to a dying refugee

 

The Rev. Susan Joy Huizenga, right, gave a kidney to Buddi Subba, left, in 2016. They both attended the Servant Christian Reformed Church in Grand Rapids, Michigan. (photo by Dan Davis)

The Rev. Susan Joy Huizenga, right, gave a kidney to Buddi Subba, left, in 2016. They both attended the Servant Christian Reformed Church in Grand Rapids, Michigan. (photo by Dan Davis)

BY JIM HOWE

It was a note in a church bulletin that led an Upstate chaplain to donate one of her kidneys to a Bhutanese refugee.

The Rev. Susan Joy Huizenga, the palliative care chaplain at Upstate since August 2018, was living in Michigan at the time. She was working as a chaplain at a VA hospital and attended a church where “I see this bulletin announcement that says a kidney is needed for a refugee, and I said, ‘What!?  How audacious is that!?’”

She saw the ad again the following week, and by the third week, she started thinking that she might qualify as a donor. She met the basic medical requirements, had given a lot of blood over the years, and “felt this nudge that I ought to do something,” she said.

The ad had been placed for a gravely ill woman named Buddi Subba, whose kidneys began to fail while she was living in a refugee camp in Nepal. She was among tens of thousands of minority ethnic residents forced out of Bhutan.

(Read how a firefighter donated a kidney to help a longtime friend.)

The only donor

The United Nations sent Subba on an emergency basis to Grand Rapids, Michigan, where she had a niece, and where she started what would be two years of kidney dialysis treatments. She also became a Christian and started attending the same church where Huizenga was teaching weekly classes in English as a second language.

Huizenga had heard about Subba’s enthusiastic church attendance, her desire to learn English and to read the Bible and how her disease had made her look much older than someone in her mid-40s.

As it turned out, Huizenga was also the only person who stepped up to be tested as a possible kidney donor.

She underwent a battery of tests and heard about the possible risks of surgery. She also felt comfortable with the surgeon, who had graduated the year after her at Calvin University in Grand Rapids.

“He really made me feel a lot better, and he was compassionate. When I went to see him, he said, ‘Thank you for giving the gift of life.’  I had a good feeling about him, and it made a big difference. He explained in great detail about what he would do and why,” Huizenga said.

No regrets

“One of the things they later told me was, ‘How rare that you would be a match, out of the one person to get tested, one person was a match.’ If it was meant to be, it was meant to be. I guess I would say it’s not just about Buddi, it’s about all the people in her life who still have her in their life, and the effect is like throwing a pebble into a pond, and the waves, they keep going and they impact on others.”

“I don’t regret it for a second. I’m 56 now; I was 52 at the time. It should last her the rest of her life.”

One of the first things Huizenga did after the transplant operation was to go to Subba’s room and give her a hug.

“When I went to see her the day after surgery, her color was better, she was smiling, and she said, ‘You have given me life. Thank you. God bless you.’ She was so happy.” Subba’s brother, on Facebook from Nepal, also thanked Huizenga for saving his sister’s life, as did others.

The transplant surgery took place in September 2016 in Grand Rapids. Today, Subba and Huizenga are both in good health.

Upstate Health magazine winter 2020 issue coverThis article is from the winter 2020 issue of Upstate Health magazine.

 

Posted in health care, international health care, kidney/renal/nephrology, organ donation/transplant, patient story, spiritual care, surgery

Firefighters share an extra bond: Kidney donor was glad to help his longtime friend

Dave Warren, left, donated one of his kidneys to fellow firefighter and longtime friend Steve Preston, right. (photo by Robert Mescavage)

Dave Warren, left, donated one of his kidneys to fellow firefighter and longtime friend Steve Preston, right. (photo by Robert Mescavage)

BY JIM HOWE

It’s a dramatic story of sickness, friendship, sacrifice and the wonders of modern medicine.

A retired firefighter with failing kidneys does not want to live on dialysis, so he goes on the waiting list for a kidney transplant from a deceased donor. But he also asks around to see whether a living person might donate a kidney.

The top candidate turns out to be a fellow firefighter — a longtime friend who was the best man at his wedding.

Since the transplant, performed in January 2019 at Upstate, the recipient has been recovering step by step, regaining his strength and telling the world how grateful he is to his pal, his wife and the transplant team.

His friend is doing fine with one kidney.

The two men, and their transplant surgeon, hope their story can inspire others to donate a kidney and help save a life.

The patient

Steve Preston, 62, is retired from the Brighton Fire Department, outside Rochester, and lives nearby in Penfield, where he was also a volunteer firefighter. He had survived esophageal and testicular cancer when he found out in 2012 that his kidneys were declining. By 2017 the organs were failing, and he went on a transplant candidate list in January 2018. As he got sicker, his arms and legs swelled, and he was told he would need either dialysis or a kidney transplant.

“It’s a disease that is so slow in progression that if you were a real macho guy and blew it off, you’d get to the point of almost being dead before you throw in the towel and go see a doctor,” Preston said.

He had seen how difficult a life on dialysis was —  the exhaustion, the frequent trips to a treatment center, the many limitations — and was determined to get a transplant instead.

Preston, pictured with his wife, Carol, enjoys wearing his “recycled parts” T-shirt to encourage kidney donation. (photo by Robert Mescavage)

Preston, pictured with his wife, Carol, enjoys wearing his “recycled parts” T-shirt to encourage kidney donation. (photo by Robert Mescavage)

The patient’s wife

Carol Preston, his wife of 22 years, is a nurse whose training came in handy as she helped him handle his medications.

The couple publicized his search for a donated kidney through TV and radio interviews, social media, their church and fire departments, and potential donors in the Rochester area underwent screenings to see if they would qualify. The alternative to finding a live donor: Wait his turn for a kidney from a deceased donor.

Carol, who later oversaw his recovery at home, recalled, “He didn’t know how sick he was until he started to get better after the kidney transplant. He didn’t realize how much energy he didn’t have.”

The donor

Of all the people screened, the donor who was decided on was Dave Warren, who is seven years younger than Preston. They met in the 1980s when a teenage Warren joined the Brighton Fire Department’s Explorer program, then overseen by Preston. Preston became Warren’s mentor and friend, and Warren became a full-time firefighter; he is now is a lieutenant in the Rochester Fire Department.

Preston, left, and Warren in 1989. (provided photo)

Preston, left, and Warren in 1989. (provided photo)

Warren recalls the extensive exams he underwent to qualify, agreeing with a nurse who told him it would be the most thorough physical he’d ever have.

Reflecting on his donation, Warren said, “I’m glad I did it. I have no regrets,” and noted that there are three levels of living donors: “One is the person who gives to a family member. The next level is the person that gives to a friend. And then there’s the person that gives to a perfect stranger, and that’s the ultimate donation.”

“Since the operation, it’s been great. There’s been no change in my physical activity,” said Warren.

(Upstate chaplain donates a kidney to a refugee she didn’t know.)

The surgeon

Preston came to Upstate in Syracuse for his transplant because the wait is shorter than in Rochester and because Upstate’s assertive program will work with candidates and organs that other programs might reject. Preston, as a two-time cancer survivor, would not have been accepted in all transplant programs, said Mark Laftavi, MD, professor of surgery and the interim director of the kidney and pancreas transplant program at Upstate.

Mark Laftavi, MD, interim chief of transplant services and director of the pancreas transplant program at Upstate. (photo by Robert Mescavage)

Mark Laftavi, MD, interim chief of transplant services and director of the pancreas transplant program at Upstate. (photo by Robert Mescavage)

When a live donor is involved, the operation can be scheduled quickly. The donor and recipient undergo simultaneous operations, and the donor can return fairly quickly to a normal life with just one kidney.

The recipient, however, goes through a more gradual process of recovery, at first avoiding strenuous activity and exposure to germs and crowds, while being sure to drink plenty of fluids and take anti-rejection drugs. The drugs are taken for life but are eventually reduced to a maintenance level.

“The beauty of a kidney transplant is the patient goes back to a normal life,” Laftavi said, and the new kidney should last Preston his whole life.

Although Preston is from the Rochester area, “because of Upstate’s program, our reputation, he came to us. The waiting list is longer in Rochester. We do robotic surgery here at Upstate, a way to perform this surgery that is new in this country and relatively rare.”

Laftavi further noted, referring to cadaver kidneys, that “our waiting time in Upstate New York is the shortest in the entire state. Fifty percent of our patients get transplants within 18 months. We at Upstate are the most aggressive program in the state. We know how to successfully use organs that are otherwise considered high risk for transplant.”

Also, he said, “for a living donor, there is practically no wait time. We are committed to do a living donor transplant anytime a patient and donor are ready. Bigger programs might take several months or a year for a living donor transplant.”

In 2018, Upstate transplanted about 115 organs, mostly kidney and some pancreas.

Laftavi operated on Preston, while his fellow surgeon Rauf Shahbazov, MD, PhD, operated on Warren.

A nurse (one of many)

Preston, his wife and Warren all said they were impressed with the Upstate transplant team, which includes people who handled everything from explaining the procedures to checking on their condition, adjusting medications and scheduling appointments.

Nurse Jayne Vamvakias

Nurse Jayne Vamvakias

One person Preston singled out for praise was Jayne Vamvakias, one of the nurses who cared for him in Upstate University Hospital both before and after the operation.

“Steve was a special patient. We were able to be right there when he needed us and check on him frequently,” Vamvakias said, speaking of her nursing team. “And we do that for all of our patients. We try to go above and beyond.”

“My favorite part is being that bridge between them getting the organ and feeling better. I’m the middleman. My favorite part is watching the teamwork, feeling special because this is a very special time; they’re getting an organ that can save their life,” she said.

A final thought on giving

Preston saves his biggest praise for his old pal: “From a recipient’s standpoint, the big thing is that Dave is so generous, not just with his kidney but with having donated 15 gallons of blood over the years. That’s a lot of blood to save a lot of lives.”

Preston gives back, too, in a task with a personal meaning for him. He volunteers to deliver stem cells — immature blood cells, such as those found in bone marrow — anywhere they are needed around the country for transplant into patients with certain cancers. He has made more than 100 such transports since retiring from firefighting.

Transplant Q&A

— Who are the best candidates to donate a kidney?

Generally, people in good physical and mental shape, older than 18 and free from a list of conditions and diseases. The younger the donor, the better, but donors can be as old as 60 or 70. The transplant team will help determine eligibility.

— What does it cost?

There is no cost to the donor for any transplant-related tests or care; it is covered by the recipient’s insurance, and any travel costs can usually be paid through charitable foundations. Also, if the donor should ever need an organ transplant, he or she would immediately be placed at the top of the waiting list.

— How do you sign up?

Contact Upstate Transplant Services at 315-464-5413 with any questions.

This article is from the winter 2020 issue of Upstate Health magazine.

 

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

Why you should care about sleep apnea

Sleep apnea is often treated by having the patient use a continuous positive airway pressure (CPAP) device when sleeping. The device includes a mask to wear over the face, as shown above.

Sleep apnea is often treated by having the patient use a continuous positive airway pressure (CPAP) device when sleeping. The device includes a mask to wear over the face, as shown above.

BY AMBER SMITH

You may have sleep apnea if…

• a bedmate cannot sleep with you because you snore so loudly,

• a relative can hear you snoring from outside of your bedroom,

• you awake during the night gasping for breath,

• you’re obese and sleepy during the day, or

• you fall asleep inappropriately.

Neurologist Antonio Culebras, MD, director of medical neurology at the Upstate Sleep Center, explains that sleep apnea means you have shallow respirations or stop breathing while asleep, more than five times an hour.

He advises speaking with your doctor about a referral for a sleep study.

“Very seldom do people die in their sleep as a result of sleep apnea,” Culebras says. “The brain has an alerting system.

“When the brain senses that not enough air or oxygen is coming to the brain, it wakes up the patient. We call that arousals. Those are awakenings of 30 seconds or less, so they are not recorded in memory. The patient does not remember them. But if there are hundreds of arousals during the night, you can imagine how the sleep is fragmented and of poor quality — and as a result, the patient is very tired and fatigued the following day.”

Sleep apnea increases blood pressure and may indicate that the oxygen level in your blood is low, which can be perilous for your heart and your brain. You are at higher risk for atrial fibrillation, a heart rhythm disturbance that increases your chance of a stroke. Low oxygen levels can also cause “microinfarcts” in the brain, which can lead to vascular dementia.

Doctors believe that treating sleep apnea — usually by wearing a continuous positive airway pressure device when you sleep — can reduce those risks.

“We know that treatment can lower blood pressure,” Culebras says. “Patients also notice their level of fatigue during the day improves.”

Upstate Health magazine winter 2020 issue coverThis article is from the winter 2020 issue of Upstate Health magazine.

Posted in health care