Different types of aneurysms call for different types of repairs

Three ways of repairing abdominal aortic aneurysms: (from left) traditional open surgical repair, endograft for AAA repair, fenestrated endograft.

Three ways of repairing abdominal aortic aneurysms: (from left) traditional open surgical repair, endograft for AAA repair, fenestrated endograft.

BY AMBER SMITH

When a blood vessel weakens, a balloonlike dilation called an aneurysm sometimes develops. This happens most often in the abdominal section of the aorta, the largest blood vessel in the body.

If an abdominal aortic aneurysm ruptures, it can be deadly, so learning whether you have an aneurysm and seeking treatment are important.

Medicare pays for screenings for people who are at increased risk for what’s known in medical shorthand as AAA, says Michael Costanza, MD, an Upstate professor of surgery specializing in vascular and endovascular services. That includes people age 65 to 75 with a family history of aneurysms, and men who are, or were, smokers. Screening involves a painless ultrasound that provides doctors with images of the blood vessels.

Michael Costanza, MD

Michael Costanza, MD

Costanza says the size of an aneurysms helps determine its treatment. “As the aneurysm gets bigger, the stress on the wall of the artery increases. When it increases too much, it would obviously break,” he says. “We would like to repair all aneurysms before they get to that breaking point.”

Small aneurysms can be monitored without treatment, but aneurysms that are larger than 5½ centimeters in diameter are recommended for repair, Costanza says.

Repair originally meant a surgeon opened a patient’s abdomen, clamped the aorta above and below the aneurysm, and then replaced the ballooned area by sewing an artificial blood vessel in its place. That’s still an option for a minority of patients.

Endovascular repair is the predominant method of repair today. Introduced in the late 1990s, endovascular repair eliminates the abdominal incision, instead using a needle puncture into a large vessel of the leg. Surgeons use X-ray guidance to pass a wire through the vessel and deploy a fabric-covered metallic stent to the area of the aneurysm. The stent reinforces the vessel without removing the aneurysm.

Some patients have aneurysms that are located too close to their kidneys for using regular stents. In those cases, Costanza offers a custom-made fenestrated endograft, a stent made with built-in openings for the kidney arteries.

“The fenestrated endograft is a much more involved procedure, but it’s still all done through needle punctures. The patients still go home very quickly after surgery,” Costanza says.

He continues to see aneurysm patients every year, after they have recovered from their repair. This allows the doctor to monitor the integrity of the repair, and to be on the lookout for the development of any new aneurysms.

To schedule your screening, contact Upstate vascular services at 315-464-1800 or 315-492-5881.

Abdominal aortic aneurysms are:

  • more common in older men than in women, by a 3- or 4-to-1 ratio, but as women live longer, their rates of AAA are climbing.
  • responsible for the deaths of 30,000 Americans per year and are the 10th leading cause of death among older men.
  • typically located in the abdominal space between the lower breastbone and belly button.
  • likely triggered by environmental factors, such as smoking, although they are thought to have a genetic component.

Upstate Health magazine fall 2018 issue coverHealthLink on Air logoThis article appears in the fall 2018 issue of Upstate Health magazine. Click here for a radio/podcast with Michael Costanza, MD, where he discusses abdominal aortic aneurysms.

Posted in health care, surgery | Tagged , , , , | Leave a comment

Want to go to medical school – as a ‘patient’?

Third-year medical student Craig Pille practices his patient-exam skills with help from actress and standardized patient Annette Adams-Brown. (photo by Debbie Rexine)

Third-year medical student Craig Pille practices his patient-exam skills with help from actress and standardized patient Annette Adams-Brown. (photo by Debbie Rexine)

BY AMBER SMITH

One way future doctors and other health care providers learn is by practicing on people who pretend to be patients.

Upstate Medical University has a corps of paid “standardized patients” who are trained to portray certain medical situations for students who conduct exams for practice before caring for real patients. Afterward, students receive feedback from faculty instructors and from the patients.

“As instructors, we can give feedback from our expertise about communications, about what we saw as third parties,” says Steve Harris, director of Upstate’s clinical skills center. “What we can’t tell them is how did that patient feel when you were interacting with them. That’s what standardized patients can do that nobody else can do. They’re here to say, ‘This is how you made me feel.’ They’re going to give the student some feedback, so that hopefully when the student encounters a similar patient in the real world, they will have a better understanding of how their behaviors make patients feel.”

Annette Adams-Brown has been a standardized patient since 2003. She has pretended to have abdominal pain, diabetes and osteoporosis, among other diagnoses. She has a background in theater production and acting, but both she and Harris stress that is not a requirement.

“It’s very rewarding work, to know that you’re contributing to the educational quality of the medical industry,” she says. “Communication plays such a huge role in all walks of life.”

Standardized patients work on a temporary, as-needed basis.

They have to be at least 16 years old, with the ability to read and speak English. Harris says the program is especially in need of people in their 30s and 40s and people from a variety of ethnicities, races and sexual orientations. No acting experience or medical knowledge is needed.

“This is about education,” says Harris. “Our point here is to help our students be better communicators.”

To learn more or to apply for work as a standardized patient, visit upstate.edu/standardpatient/

 Upstate Health magazine fall 2018 issue coverHealthLink on Air logoThis article appears in the fall 2018 issue of Upstate Health magazine. To hear a podcast/radio interview about standardized patients with Annette Adams-Brown and Steve Harris, click here

Posted in health care, medical education | Leave a comment

What’s Up at Upstate: In case you missed it …

Upstate's new Clinical Pathology Laboratory is on the fifth floor of the cancer center.

Upstate’s new Clinical Pathology Laboratory is on the fifth floor of the cancer center.

CANCER CENTER EXPANDS

When the Upstate Cancer Center opened in July 2014, only the first three floors of the five-story building were completed and occupied. The fourth and fifth floors were constructed but left empty, anticipating future Upstate needs.

The fourth floor is now devoted to exam rooms, increasing the number from 14 to 35. The second floor became all infusion rooms, upping the number from 27 to 44. The fifth floor is for Upstate’s Clinical Pathology Lab.

APPLE STORAGE

Upstate is the first health system in Syracuse to partner with Apple, so patients with iPhones can, if they choose, store all of their health records in Apple’s Health app. The app comes preloaded on the iPhone and tracks such things as heart rate, steps, calories consumed and other information. Now patients can request their Upstate records be stored there as well.

Upstate already makes medical records data available to patients through UpstateMyChart. Patients use a website or app to view test results, request appointments or medication refills, send questions to their physicians and more. The difference is, the data remains on Upstate’s servers.

Storing records in the Apple Health app means they can be mingled with records from other health providers. Chief Medical Information Officer Neal Seidberg, MD, says keeping all health information in one convenient place empowers patients. “A major consideration to partner with Apple was to provide our patients with a new and important way to monitor, manage and gain a better understanding of their overall health,” he says. “For families who are on-the-go, the ability to have access to all kinds of health information in the palm of your hand can give one peace of mind.”

GERIATRICS DEPARTMENT

Sharon Brangman, MD

Sharon Brangman, MD

Upstate has become one of a handful of academic medical centers in the United States to have a department devoted to geriatrics. For the past 20 years, the branch of medicine dealing with the health and care of older adults has been a division, or subset of a department, at Upstate. Sharon Brangman, MD, a State University of New York distinguished professor and a former president of the American Geriatrics Society, has led the division – and now leads the department. “Geriatrics is an increasing need and will be so for many decades ahead,” she says.

STUDENT PARTNERS

Newborns in the neonatal intensive care unit often need to be repositioned to aid in their growth. “If they are on their tummy, they push up; then they can develop their shoulders,” Upstate College of Nursing associate professor Karen Klingman, PhD, explained to SU News. “If they are on their back that doesn’t happen, so there is this trade-off nurses in the NICU need to think about. Should the baby be on their back or on their tummy to help with development?”

For help designing a monitor for those NICU babies, Klingman turned to bioengineering students from Syracuse University’s College of Engineering and Computer Science. As part of their capstone project, the students developed a prototype. Sensors beneath fabric connect to a custom-coded microcontroller board and measure pressure from an infant’s shoulders, bottom, head, stomach and knees.

CONCUSSION APP

Associate professor of family medicine Eugene Bailey, MD, teamed up with an athletic trainer to create an app that provides a step-by-step protocol for the diagnosis of concussion. The “Easy SCAT Sideline” app helps coaches and athletic trainers know what to do when a player is injured, so that the possibility of concussion is not overlooked.

NEW MEDICAL COMPLEX

Physicians affiliated with Upstate plan to open a new medical complex featuring more than a dozen specialty services next fall at Township 5 in Camillus.

The group expects to build a one-story, 25,528-square-foot building behind Costco and the Movie Tavern. It would provide office space for family medicine, cardiology, pulmonology, rheumatology, pain medicine, neurology, neurosurgery, orthopedics, physical medicine and rehabilitation, urology, otolaryngology, vascular surgery and psychiatry and behavioral health.

NURSING ONLINE

Starting in the spring of 2019, Upstate’s College of Nursing will offer a Bachelor of Science program fully online. The degree is 121 credits and will take students about 18 months to two years with full-time study, or up to four years with part-time study. The program requires a 135-hour practicum.

Students must complete 60 credit hours from a basic nursing program or an associate’s degree in nursing beforehand and must have a New York state registered nurse license by the start of their second semester. For more information, visit upstate.edu/con or call the admissions office at 315-464-4570.

This article appears in the fall 2018 issue of Upstate Health magazine

Posted in aging/geriatrics, brain/neurology, cancer, health care, nursing, pathology, technology, Upstate Golisano Children's Hospital/pediatrics | Leave a comment

Questions on the body’s water needs; immunotherapy drugs; suicide prevention; back pain — answered by Upstate’s experts

Abstract illustration showing businessman thinking. Q: How can I help someone who may be suicidal?

A: “There are things you can look for. What you see leading up to suicide is, usually people will withdraw socially. They may start losing their ability to function, either at school or at work. There are going to be more strained relationships. And, the person is usually more negative; when any issue is being raised, they have a real pessimistic kind of outlook on things.

“If you know this person’s hurting and in trouble, if you don’t ask the question, you’re not going to know.

It’s easy for me to say, ‘Just ask the person: Are you having thoughts about suicide lately?’ It’s very hard to actually do, partly because of social stigma. You don’t want to insult the person. Some people are concerned it might put the idea into the person’s head.

“What we know from research is, it doesn’t put the thoughts into the person’s head. It actually is protective. You’re actually diminishing the risk of suicide by asking about it. ‘Have you ever tried to hurt yourself?’ ‘How close have you come lately?’ ‘Do you think you might actually carry out those thoughts?’

“Someone who is at imminent risk needs to be evaluated — and may even need to be hospitalized — by a professional who can determine risk. Upstate’s Psychiatry High Risk Program offers evidence-based treatment for high risk youth and young adults who are not in need of immediate hospitalization. Call 315-464-3117.

“Access to firearms is maybe the single most preventable thing that we can do as family or community. If there is someone at risk, make sure they don’t have access to firearms.”

— Psychiatrist Robert Gregory, MD, director of Upstate’s Psychiatry High-Risk Program

Upstate University HospitalQ: What’s the best way for athletes to determine how much water to drink when they train or compete?

A: “You don’t need a formula. You don’t need to do any calculations. The rule is: Drink when you are thirsty. Your body actually knows what it is doing. It will make you thirsty if you need more water.”

— Emergency physician Jeremy Joslin, MD, medical director of endurance events around the world

Q: Will a new mother get pregnant if she has sex during the time she is nursing her newborn?

A: “As long as a woman is exclusively breast-feeding — she can pump and bottle-feed breast milk, but she cannot use any supplementation, no formula or anything else, whatsoever — it is effective birth control for six months. But after that, it doesn’t work very reliably.

“It’s called the lactational amenorrhea method, or LAM.”

— Renee Mestad, MD, chief of general obstetrics and gynecology

Q: Are immunotherapy drugs a cure for cancer?

A: “The jury is still out on that. We have patients with advanced cancer who were on these drugs in early clinical trials for two years, and now they have eight years of follow-up, and they are still in remission. So, I think immunotherapy has great potential. As with many therapies, we first use these drugs in patients with advanced disease. Then, if they’re beneficial, we try them in earlier-stage disease, and that’s really where there may be greater potential for a curative effect.”

— Stephen Graziano, MD, chief of adult hematology oncology

Q: Why do women awaken to use the bathroom at night?

A: “Most times, it’s systemic diseases, not necessarily related to just the bladder. It can be things like diabetes, heart disease or heart failure, even sleep apnea. Nocturia can also be the initial sign of depression.

“People who have fluid overload, or too much fluid in them, they can also urinate at night because when they lay down, the fluid shifts, and they make more urine, and they then have to urinate.

“It’s not uncommon to have this problem. If you’re having this problem, you should mention it because a lot of physicians don’t routinely ask, especially women, about urination at night. Unless you bring it up, no one knows it’s a problem for you. And, it’s important to make sure this is not the first sign of diabetes or heart disease.”

— Urologists Timothy Byler, MD, and Mickey Daugherty, MD

Q: How do I begin to overhaul my poor eating habits?

A: “Look at what you’re doing. Are you drinking sodas? Are you eating processed foods? Are you NOT eating vegetables? Look at what you’re doing, and look at what can you change. Can you say, ‘I’m going to try to have a salad every day?’ Or, say you’re drinking two bottles of soda every day. Can you go down to one bottle, instead of saying, ‘I’m never having soda?’ You want to make a change in a way that it just gradually becomes part of your routine, and it’s not so drastic that it isn’t sustainable.”

— Maureen Franklin, registered dietitian nutritionist

Q: If I had chickenpox as a child, and I’m 50 now, why do I need a shingles vaccine?

A: “If you had chickenpox as a child, or if you don’t know if you had it, you are at risk for developing shingles later in life.

“The virus that causes chickenpox (varicella zoster) can actually remain latent in your nerve fibers, and then later in life can reactivate as the zoster virus, or shingles. We’re not exactly sure why it reactivates, but as we get older our immunity toward varicella starts to decrease. We might have other medical conditions or be on medications that suppress our immune system or our ability to fight off infection.

“The Centers for Disease Control and Prevention now recommends healthy adults ages 50 years and older to get the Shingrix vaccine. It is the new, preferred vaccine. And that’s even if you already had the Zostavax shot previously. Zostavax, the old vaccine, has about a 70-percent efficacy that wanes over time.  As you get older the efficacy of the vaccine actually decreases. In comparison, Shingrix is essentially a protein and an immune booster that are mixed together, and it has about 90- to 99-percent efficacy.”

— Pharmacist Ali Scrimenti, PharmD

Q: Does a firm mattress prevent back pain?

A: “What I advise my patients is to sleep on the mattress that’s most comfortable. Some people like a firmer mattress, but there is no evidence that makes any long-term difference in your back health.”

— Daryll Dykes, MD, orthopedic surgeon and spine specialist

Hear the experts

HealthLink on Air logoThese answers are excerpted from “HealthLink on Air,” Upstate’s weekly podcast/talk radio show in which experts  share information on a variety of subjects. Listen at 6 a.m. or 9 p.m. Sundays on WRVO Public Media, visit upstate.edu/healthlinkonair, or search for “HealthLink” in iTunes or other podcast sources.

Upstate Health magazine fall 2018 issue coverThis article appears in the fall 2018 issue of Upstate Health magazine. 

Posted in health care, HealthLink on Air | Tagged , , | Leave a comment

Things to think about before you buy a home genetic test kit

 illustration of a generic family tree

 

BY AMBER SMITH

If you’re intrigued by offers of direct-to-consumer medical genetic testing, Robert Roger Lebel, MD, director of medical genetics at Upstate, offers something to consider.

Let’s say you come from a family with many members who have had breast cancer, and you’re interested in knowing your risk. Many genes are associated with breast cancer. The genetic testing company you select may focus on a couple of different mutations in the most well-known of those genes.

When your results show you do not have an increased risk for the breast cancer associated with that particular mutation on the BRCA gene, “You may think that you have investigated the question and have your answer, when you really don’t,” Lebel says.

Genetic home testing cannot tell you that you will develop a particular disease but can identify factors that tell you that your risk is higher than that of the general population,” says Robert Roger Lebel, MD, director of medical genetics at Upstate. (photo by Jim Howe)

Genetic home testing can’t tell you that you will develop a particular disease, but it can identify factors that tell you your risk is higher than that of the general population,” says Robert Roger Lebel, MD, director of medical genetics at Upstate.
(photo by Jim Howe)

“If you talked with a board-certified genetic counselor about this, he or she might tell you that there are actually 50 different genes that could be of interest in regard to your family’s presentation. You were tested for two different things in one gene. You were not tested for thousands of things in dozens of genes.”

Genetic home testing can be useful, Lebel says, in the case of positive findings.

The tests cannot tell you that you will develop a particular disease. “They can identify factors that tell you that your risk is higher than that of a member of the general population.”

So, if your results show an increased risk for breast cancer, ovarian cancer and pancreatic cancer, “then you could talk to somebody with expertise about how to use this knowledge to minimize your long-term risk,” he says.

“It would allow you to talk to your physician about how to watch for early signs.”

What about genealogy?

Ancestry.com, 23andMe and others offer tests using saliva samples that explore deep ancestry.

“They won’t tell you the name of your great-grandfather, but they will tell you whether your great-, great-, great- greats came from Northern Africa or Eastern Europe or Southeast Asia,” says Lebel.

How do the tests work?

We all have genes or DNA sequences on chromosomes known as markers. “Some of those markers are very common in certain parts of the world and very uncommon in other parts,” Lebel explains, “so that they are able to state with some statistical clarity where those markers would have come from.

“If you’ve always said that you were of mixed European ancestry, German, Swedish, Czech and Hungarian, and you really want to know in detail whether you have, say, 3 percent of your genome from East Asia — which you might, because the Hungarian part might have descended from Genghis Khan — well, you can find out.”

Upstate Health magazine fall 2018 issue coverHealthLink on Air logoThis article appears in the fall 2018 issue of Upstate Health magazine. Click here to hear Robert Roger Lebel, MD, discuss home genetic testing in a podcast/radio interview with Upstate’s “HealthLink on Air.”

Posted in genetics, health care, HealthLink on Air | Tagged , , , | Leave a comment

In her own words: Stroke survivor JoAnn Wickman recalls the morning of Feb. 9, 2018

JoAnn Wickman (photo by Susan Kahn)

JoAnn Wickman (photo by Susan Kahn)

“I woke up at 5:20 in the morning. I woke up and thought, ‘What the heck is going on? Something’s not right,’” recalls JoAnn Wickman of Cortland. “I had this weird sensation. It felt like the tip of my tongue was somehow connected to my right cheek, with a strand like what I assume a spiderweb would feel like. It was such a weird feeling. It was pitch black outside, and I just woke up out of a sound sleep.

“Eventually I got out of bed and walked to the bathroom just fine. Then I thought, ‘Something’s not right here.’ I still had this oddball sensation.

“My heart wasn’t beating fast. I wasn’t dizzy. I come from a long line of people who have died of heart attacks and strokes, so I’ve been pretty vigilant about paying attention. I’ve never had any heart issues. But my blood pressure had been spiking, and it was under a doctor’s care.

“I thought about how I would say, ‘Ken, wake up. Call 911. I think I’m having a stroke.’ That’s not a complicated thing to say, but my tongue wouldn’t work. I could only say ‘Ken.’”

Her husband called 911. As the ambulance took her to nearby Cortland Regional Medical Center, Wickman, who was 75 at the time, remembers that she felt fine, but her blood pressure was high. “267 over something,” she recalls. A blood pressure of 120/80 is considered normal.

“They did a CT scan, and the physician came in and said, ‘There’s something weird about this CT scan.’ So they did an MRI, and the physician came in and said, ‘I want you at a stroke center. Where do you want to go?’”

Wickman chose Upstate. “By noon, exactly at noon, I was in my room at the stroke center, where I stayed for five days. By this time, I’m chatting away and walking fine.

“They did what seemed like 10,000 tests. When they looked at the MRI, it was pretty subtle, but there were two spots where they found the stroke took place that made sense with my symptoms.

“The interesting thing about all of this is, nobody knows why I had the stroke.

“What was memorable to me is that the care at the stroke center was exemplary and respectful. I never felt anyone was talking down to me. All kinds of people came in and out. Most people said, ‘You are so fortunate you knew what to do, and that you did it.’

“I tell people to remember FAST. Most of the time if a person’s having a stroke, their face will look funny. Or their arm will be weak. The S stands for slurred speech (and the T stresses that time is of the essence). I say, ‘If something doesn’t seem right, it’s better to call.’”

Wickman, herself, did not exhibit the classic symptoms of stroke. “I just felt weird,” she says. “In retrospect, why did I think it was a stroke? I don’t know, exactly, except for that sensation of my tongue being connected to my cheek. I was very fortunate.”

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

Posted in emergency medicine/trauma, health care, medical imaging/radiology, patient story, stroke | Leave a comment

Getting back on her feet — and deeply humbled during recovery

Author Jackie Warren-Moore shares her story of recovery. Below: her dog, Sasha. (photos by Robert Mescavage)

Author Jackie Warren-Moore shares her story of recovery. Below: her dog, Sasha. (photos by Robert Mescavage)

BY JACKIE WARREN-MOORE

It was surreal. I remember the dark, almost slow-motion fall. The scream, mine. Then the confusion, pain, red lights, movement and assurances that I would “be fine.”

I was in Upstate University Hospital downtown. I had tripped over my 100-pound German shepherd and fractured the femur in my left leg. Things were not looking “fine.”

After the emergency surgery, the surgeon smilingly informed me that he had to “be very creative” to put my leg back together, but after rehab, I’d be “fine.” There was that word again. And I knew I’d have to do my own assessment of “fine.”

‘”I was told I could not put any weight on that leg. My one attempt to put weight on it assured me they were right. They also assured me the place for me was at the Physical Medicine and Rehabilitation Program at Upstate’s Community campus.

Sasha, Jackie Warren-Moore's dogI’d previously witnessed scenes on television of people in physical therapy, but my focus had always been on the person between the bars struggling for that first step.

Now, I was deeply humbled to have some incredible people inside those bars with me. I was the one teetering and struggling to stand and attempting a first step.

A young man (I later found out in conversation that he knew my oldest grandson) stood behind me, softly saying, “I got you,” as he held onto the strong Velcro belt that encircled me.

There was the physical therapist, small yet strong, who stood in front of me, gently nudging her foot beneath my left foot and urging me not to put any weight on my foot. She talked to me about what she planned to do on her upcoming vacation to California.

I recall the gentle slap to my hand as I tearfully admitted my pain level. On a scale of 1 to 10, it was a 9.

The beautiful, sassy young registered nurse assured me she’d return with medication and that I’d be “fine.”

There were the daily visits of the soft-spoken nurse practitioner who knelt beside my bed and proclaimed my leg looked good and was healing well.

During the course of nearly a month, I was often seated in a welcome shower with an occupational therapist who shared the plans of her teenage son’s prom and the description of his tuxedo while teaching me how to shower with my weight on only one foot.

I’m grateful to the strong male aide who I discovered loved brown-eyed Susans as much as I do. We discovered this as he lent me his strength as I made the “slide transition” from a commode to my bed.

I could go on and tell about the woman on evenings who always made me laugh and showed me pictures of her beautiful 14-year-old granddaughters. I could tell you about the ever-helpful young aide who shyly told me her dream is to become an RN.

These people and others will forever be a part of a most difficult, yet hopeful, part of my life. They are part of a highly professional and uncommonly compassionate group of caregivers. We are fortunate to have them in our community.

In mid-June, I rolled in a wheelchair down a ramp on the side of my house, constructed by my 12-year-old grandson and my husband. I sat in my backyard, listened to the birds, felt the breeze on my face, stretched out my healing leg to the sun. I’m fine.

Upstate Health magazine fall 2018 issue coverThis article appears in the fall 2018 issue of Upstate Health magazine. The essay originally appeared on Syracuse.com, where Jackie Warren-Moore regularly writes. She is a poet and playwright whose latest book is “Where I Come From” (Nine Mile Books, 2016).

Posted in bones/joints/orthopedics, health care, patient story, physical therapy/rehabilitation, surgery

7 facts about stroke you probably didn’t know

A stroke is a brain emergency, so if a stroke is suspected, call 911 immediately to summon medical help. About one-fifth of strokes happen when a blood vessel bursts. The rest happen when an artery is blocked. The treatment for each type is different, so doctors must quickly determine which type of stroke is happening.

A stroke is a brain emergency, so if a stroke is suspected, call 911 immediately to summon medical help. About one-fifth of strokes happen when a blood vessel bursts. The rest happen when an artery is blocked. The treatment for each type is different, so doctors must quickly determine which type of stroke is happening.

Are you aware of the following facts about stroke?

  1. People having strokes usually are able to hear and comprehend what’s happening around them. That’s because the parts of the brain responsible for hearing and comprehension are rarely affected by stroke, explains Upstate stroke neurologist Hesham Masoud, MD. The exam he conducts on patients reveals how much the stroke is affecting comprehension and their ability to express themselves, and he talks to the patients as he conducts the exam, since he knows they can probably hear him.

  2. If doctors believe you are having a stroke, an imaging scan is essential. About 20 percent of strokes happen when a blood vessel bursts. About 80 percent happen because of a blockage to an artery. The treatment for each is very different, so doctors must determine which type of stroke is happening, and fast.

  3. Up to a third of the people who appear to be having strokes turn out to have other medical problems that mimic strokes. Plenty of medical conditions (including seizures or urinary tract infections) cause a person to behave in an unusual way, to have an altered mental status or trouble talking. “Any neurologic deficit that is new is a stroke until proven otherwise,” Masoud says. He implores people to seek emergency care promptly.

  4. A short-term stroke whose symptoms resolve is a harbinger of a larger, more damaging stroke. They may be labeled TIA, transient ischemic attack; RIND, reversible ischemic neurologic deficit; or mini stroke. Regardless, “Any stroke is brain damage, and any stroke needs to be treated,” says Masoud. “If you have a neurologic symptom that is sudden in onset, whether it improves or not is irrelevant to me. I want you to come to the emergency department immediately, and I want you to be worked up for it. If it’s something minor, you may get your workup as an outpatient in the clinic. You may not need to be admitted. But the first step is not to make that assumption.”

  5. Many people have medical conditions that increase their risk for stroke – but don’t realize they have these conditions. Two of the biggest are uncontrolled high blood pressure and an irregular heart rhythm. These conditions are sometimes discovered after a person has a stroke, and their treatment becomes important in prevention of additional strokes.

  6. About a quarter of stroke patients may not learn why their stroke happened. The cause may not be readily apparent in 20 percent to 30 percent of patients. Doctors may be able to pinpoint a reason as they care for a patient, but sometimes, especially in younger patients, the cause remains a mystery.

  7. Rehabilitation can make a huge difference in a patient’s recovery. Masoud often shares brain scans with patients and loved ones to facilitate discussions about the extent of damage. He explains that the length and quality of rehabilitation, and the patient’s level of engagement, influence how much functional recovery he or she will have. That’s why early on, he declines to make recovery predictions for individual patients.

While waiting for an ambulance to arrive, be sure the patient keeps breathing and make a list of his or her medications for the medical personnel.

While waiting for an ambulance to arrive, be sure the patient keeps breathing and make a list of his or her medications for the medical personnel.

3 ways to help while you wait for the ambulance

If you call 911 because you suspect someone is having a stroke, here’s what you can do before the paramedics arrive:

  • Make sure the person continues breathing, and if his or her condition changes, make another call to 911.

  • Take note of the time the person was last seen behaving normally. Doctors need this information to help determine treatment options.

  • Assemble a list of the medications the person takes, or collect the medication containers to bring to the hospital.

Source: Nurse Josh Onyan, stroke program manager at Upstate

Upstate Health magazine fall 2018 issue coverHealthLink on Air logoThis article appears in the fall 2018 issue of Upstate Health magazine. For a “HealthLink on Air” interview about stroke with stroke neurologist Hesham Masoud, MD, and stroke program coordinator and nurse Josh Onyan, click here. For an interview about ways to lessen your stroke risk, with stroke nurse Michelle Vallelunga and registered dietitian nutritionist Rebecca Hausserman, click here.

Posted in brain/neurology, emergency medicine/trauma, health care, stroke

‘A perfect example of why we became doctors’: Survival depended on a medical team, skillful surgery and a patient’s will to live

Pat Graham and his wife, Margery Lipinski-Graham, a year after his life-saving surgeries. (photo by Susan Kahn)

Pat Graham and his wife, Margery Lipinski-Graham, a year after his life-saving surgeries. (photos by Susan Kahn)

BY AMBER SMITH

Pat Graham of Lansing wasn’t feeling well the evening of Aug. 31, 2017. A self-described borderline diabetic, he asked his wife to bring a glucose test kit when she came home from her job at Rite-Aid. By the time she arrived, Graham felt worse.

He was in no pain. He just felt lethargic. Something wasn’t right. “You better get me an ambulance. I just don’t know what’s happening,” he said to her.  

Turns out, Graham had an aggressive, life-threatening infection. He remembers being loaded into an ambulance but was unconscious until he was transferred to Upstate University Hospital, where myriad doctors, nurses and technicians worked to save his life.

“He came in very sick and basically had to be taken to the operating room emergently, just to stabilize him,” says Joe Jacob, MD, one of the urologic surgeons who took care of Graham. “If he wasn’t taken to the operating room immediately, the infection would have killed him.”

Gennady Bratslavsky, MD, and Graham greet each other at the Urology Outpatient Center at Upstate's Specialty Services Center, 550 Harrison St., Syracuse.

Gennady Bratslavsky, MD, and Graham greet each other at the Urology Outpatient Center at Upstate’s Specialty Services Center, 550 Harrison St., Syracuse.

At age 59, Graham faced a grim decision from his hospital room. The odds were not in his favor. When he arrived at Upstate, a team of doctors diagnosed Fournier’s gangrene (see explanation below), and it was clear that the bacterial infection ravaged his body. He could go home and prepare for an imminent death. Or, he could submit to a risky operation to remove the infected tissue. “He had only a 10 percent chance of survival,” recalls his wife, Margery Lipinski-Graham. Graham decided he wanted to live.

Within the next 10 hours, Graham would undergo two major operations, the first by Jacob and the second by Gennady Bratslavsky, MD, the chief of urology at Upstate. They removed more than 60 pounds of infected tissue.

During that scary time, one thing stood out to Graham. Bratslavsky asked his wife for her cellphone. Nervous and confused, she handed it over. The surgeon punched in his personal number and handed the phone back, telling Lipinski she should call him — anytime — with any concerns.

Graham spent 20 days in the hospital, many of them in the care of surgeon Lucy Ruangvoravat, MD, and her team in the intensive care unit. Life-threatening infections like the one Graham had frequently have detrimental effects on the heart, lungs, kidneys and other organs, requiring the advanced intensive care for which Upstate is known. Ruangvoravat says many of her patients with severe infections are transferred to Upstate from hospitals in surrounding counties, so they can benefit from the expertise of the ICU team, comprised of doctors from a variety of specialties.

Graham, shown here with his wife, says, “Without Dr. Bratslavsky and Dr. Upadhyaya and the team of people working with them, I wouldn’t be here today.”

Graham, shown here with his wife, says, “Without Dr. Bratslavsky and Dr. Upadhyaya and the team of people working with them, I wouldn’t be here today.”

Graham’s surgical wound, left open to heal, continued to drain. He underwent another surgery, this one with plastic surgeon Prashant Upadhyaya, MD, to have more dead tissue removed. Upadhyaya closed the wound. Graham’s recovery progressed.

“I think the reason he did so well is because he was so motivated,” Upadhyaya says. “He did exactly what we told him to do. He and his wife were a great team.

“He’s a perfect example of why we become doctors.”

Graham was within hours of death when he arrived at the hospital. Swift medical intervention, skillful surgery and a will to live pulled him through. For the health care providers involved, says Upadhyaya, “It’s very gratifying.”

Graham has a scar stretching about three feet, from one hip to the other. “Without Dr. Bratslavsky and Dr. Upadhyaya and the team of people working with them, I wouldn’t be here today,” he says.

A big part of Graham’s recovery hinged on improving his overall health. That meant losing substantial weight. Bratslavsky expected Graham would do it. “I could sense that, for him, this had been a life-changing experience.”

Bratslavsky challenged Graham: Could he change the way he ate to improve his health? Could he eat vegetables and healthy proteins and ditch the sodas, the pizzas, the pastas and breads?

“When he told me this, it sounded like it was going to be the end of the world,” Graham admits. “But after a couple weeks, I didn’t even miss it.” A year later, he’s dropped 190 pounds.

What is Fournier’s gangrene?

A bacterial infection that grows from a small cut or pimple in the groin area may develop into a life-threatening condition known as Fournier’s gangrene. People with diabetes or a compromised immune system are more prone to this type of aggressive infection.

Its progression can be sudden, rapidly causing multiple organ failure and death. Even with swift medical care, antibiotics and surgery, the death rate is high. Fournier is the name of the French doctor who described five cases in clinical lectures in 1883.

From left: Urology chair Gennady Bratslavsky, MD; trauma surgeon Lucy Ruangvoravat, MD; patient Patrick Graham; Graham’s wife, Margery Lipinski-Graham; plastic surgeon Prashant Upadhyaya, MD; and urology residents Jeffrey Spencer, MD; Priyanka Kancherla, MD, and Garrett Smith, MD. (photo by Susan Kahn)

From left: Urology chair Gennady Bratslavsky, MD; trauma surgeon Lucy Ruangvoravat, MD; patient Patrick Graham; Graham’s wife, Margery Lipinski-Graham; plastic surgeon Prashant Upadhyaya, MD; and urology residents Jeffrey Spencer, MD; Priyanka Kancherla, MD, and Garrett Smith, MD. (photo by Susan Kahn)

Upstate Health magazine fall 2018 issue coverThis article appears in the fall 2018 issue of Upstate Health magazine. 

Posted in health care, infectious disease, patient story, surgery, urology, weight loss | Tagged

Up close: Cancer cells on the move

Some scientists have said the search for CTCs is like looking for a needle in a haystack. One millimeter of blood contains a few million white blood cells, around a billion red blood cells, and – perhaps – one to 10 circulating tumor cells. (illustration by Dan Cameron)

Some scientists have said the search for CTCs is like looking for a needle in a haystack. One millimeter of blood contains a few million white blood cells, around a billion red blood cells, and – perhaps – one to 10 circulating tumor cells. (illustration by Dan Cameron)

“You’ve got to respect the complexity of cancer,” Dario Marchetti, PhD, reminded researchers who gathered for his lecture at the Upstate Cancer Center recently. Marchetti is the director of the biomarker research program at the Institute for Academic Medicine at the Houston Methodist Research Institute.

Upstate frequently hosts guest speakers.

Marchetti spoke about efforts to detect the presence of circulating tumor cells, known as CTCs. These are cells that break off from a tumor and travel through the bloodstream. Most die in the blood, but some embed in tissues of distant organs, where they may form new tumors.

That’s what happens most often in the case of brain cancer. Marchetti says just one in 10 cases arise from a tumor that originated in the brain. The rest are cancers that spread from other parts of the body.

The Food and Drug Administration has approved one CTC test, CellSearch, which helps doctors monitor patients with metastatic breast, colorectal or prostate cancers by tracking the volume of CTCs in the blood. But it is not designed to find all CTCs.

Other methods of isolating CTCs are in development. Researchers want to be able to analyze CTC DNA to identify tumor progression and potential drug targets. That would allow doctors to determine the most effective medications without subjecting the patient to a tissue biopsy.

Cancer Care magazine summer 2018 coverThis article appears in the summer 2018 issue of Cancer Care magazine.

 

 

 

 

 

 

 

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