Shining a blue light on bladder cancer

Joseph Jacob, MD, demonstrates Blue Light Cystoscopy. Bladder cancer is the fourth most common cancer in American men, but it’s less common in women. The most common symptom is blood in the urine, which is never normal. (photo by Susan Kahn)

Upstate urologist Joseph Jacob, MD, demonstrates Blue Light Cystoscopy. Bladder cancer is the fourth most common cancer in American men, but it’s less common in women. The most common symptom is blood in the urine, which is never normal. (photo by Susan Kahn)

BY AMBER SMITH

Bladder cancers typically appear in multiple spots in the bladder, and they tend to recur.

So, patients undergo repeated cystoscopies, procedures in which doctors peer into their bladders with cameras in search of cancerous cells.

A new tool, available at Upstate, is helping to locate cancerous cells that previously may have gone unnoticed, says Upstate urologist Joseph Jacob, MD.

“It’s a new technology that solves a pretty big problem that we’ve had for years,” he explains.

He injects a medication into the bladder before the cystoscopy; it’s a contrast solution that is taken up by rapidly growing cells, such as bladder cancer cells. Jacob examines the bladder with regular white light. Then he turns on the blue light. Subtle cancer cells are suddenly revealed as bright pink targets. “It picks up these cancers that we weren’t picking up before.”

Jacob says Blue Light Cystoscopy can catch aggressive cancers before they invade the muscle of the bladder. It can also catch small cancers, reducing the recurrence rate and helping patients avoid repeated surgical procedures.

HealthLink on Air logo(Click here to hear Jacob discuss Blue Light Cystoscopy in a podcast/radio interview with Upstate’s “HealthLink on Air.”)

To reach Upstate’s department of urology, click here   or call 315-464-1500.

cover of summer 2019 Cancer Care magazineThis article appears in the summer 2019 issue of Cancer Care magazine.

 

 

 

 

 

 

 

 

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

A quick guide for when you need a cancer screening

cancer screening guidelines

cover of summer 2019 Cancer Care magazineThis article appears in the summer 2019 issue of Cancer Care magazine.

Posted in cancer, health care | Leave a comment

A long-term relationship: Cancer monitoring and checkups go on for a lifetime

Survivors of childhood cancer have access to the Upstate Survivor Wellness Program team, which will track their health for the rest of their lives. Team members, seated from left, are Jody Sima, MD, program director; Tanesha Keene, scheduler; and nurse practitioner Brooke Fraser. Standing from left are nurse Robin Monteleone, program manager; Melanie Comito, MD, chief of pediatric hematology/oncology; and clinical social worker Stephanie Barry. (photos by Robert Mescavage)

Survivors of childhood cancer have access to the Upstate Survivor Wellness Program team, which will track their health for the rest of their lives. Team members, seated from left, are Jody Sima, MD, program director; Tanesha Keene, scheduler; and nurse practitioner Brooke Fraser. Standing from left are nurse Robin Monteleone, program manager; Melanie Comito, MD, chief of pediatric hematology/oncology; and clinical social worker Stephanie Barry. (photos by Robert Mescavage)

BY JIM HOWE

A diagnosis of cancer can focus the patient’s attention on short-term concerns, such as getting through a round of tests and treatment while coping with daily life.

It isn’t until much later that patients enter into a long-term stage of cancer care: survivorship.

Survivorship involves what can be a lifelong relationship between people who get cancer and the specialists who will monitor their health and progress.

“There are a lot of definitions of survivors. We say someone is a survivor from the moment of diagnosis, no matter how long you survive,” says Jody Sima, MD, the pediatric oncologist, or childhood cancer specialist, who directs the Survivor Wellness Program at the Upstate Cancer Center. In years past, childhood cancer survivors were monitored under the KNOT program, which stood for Kids No longer On Treatment.

Sima sees more than 200 cancer survivors annually, in addition to her regular work dealing with young patients currently getting treatment.

Survivors typically get a physical and blood tests, in addition to a talk with Sima on how they are doing. Further tests might be ordered for patients who need long-term monitoring regarding the possible effects of certain drugs or radiation. Sima will send the results to the patient’s primary doctor and help the patients to understand their particular health issues and to take possession of their care as they move from parent supervision into adulthood.

(Click hereHealthLink on Air logo for a podcast/radio interview where Jody Sima, MD, talks about surviving childhood cancer and what that means as the patients grow older. Joining her in the discussion is a parent whose daughter survived cancer in infancy.)

Patients are encouraged to call with questions or concerns, and Robin Monteleone, a nurse who is program coordinator for survivorship, will see that they get the information they need.

Survivorship involves a lot of “amped-up primary care,” Sima says. Her biggest intervention in most cases is a push to get regular exercise, which is linked to better outcomes.

Some past treatments for childhood cancer were harsh and can cause health problems later in life. Those patients might be monitored for things like fertility, blood pressure or heart problems. Different generations of survivors are watched for conditions related to treatments that were current when they were children. “It might take years to see long-term effects,” Sima says.

Because survivorship includes adults, Sima will be dealing with issues that don’t usually crop up with her pediatric patients, such as sexuality.  She has undergone training in survivorship and regularly deals with adults who had cancer as children. Survivors who first get cancer in adulthood are generally monitored by the providers of adult cancer care.

“The goal is to help them live their lives, to know where they are, and to be a resource that knows the patient and the treatments,” she says.

‘Hope for all survivors’

Jody Sima, MD, is director of the Upstate survivor wellness program.

Jody Sima, MD, is director of the Upstate survivor wellness program.

Sima, who oversees survivors of childhood cancer, describes survivorship as a journey, with a wide range of how people experience the disease, its treatment and its aftermath. She offers these thoughts on surviving cancer:

  • “Some of my survivors grow despite it.  Some grow because of it. And others really suffer. It depends on physical functioning, or if there are long-term effects like chronic pain. It helps to have a job or to do volunteer work or other things that are meaningful in the world.”
  • “In survivorship, a lot of it is dealing with the bad effects of treatment, what can go wrong, so sometimes it’s easy to lose sight of what can go right, and it’s nice to have an opportunity to celebrate the good.”
  • (Regarding her patient Dan Kosick, whose survivorship story can be read here) “It was a very hard experience to go through as a young teen, a lot to bounce back from. He’s such a lovely guy in a bright spot. His whole life is about giving back: social worker, coach, on the board of Make-A-Wish … it’s what you hope for all your survivors.”

cover of summer 2019 Cancer Care magazineThis article appears in the summer 2019 issue of Cancer Care magazine.

 

 

 

 

 

 

Posted in cancer, health care, HealthLink on Air, Upstate Golisano Children's Hospital/pediatrics | Tagged , , , , , | Leave a comment

Everyday hero: Childhood cancer survivor Dan Kosick climbs mountains, skis, runs obstacle courses

Childhood cancer survivor Dan Kosick of Endicott is shown at Synergy Athletics fitness center, where he trains and works out. (photo by Robert Mescavage)

Childhood cancer survivor Dan Kosick of Endicott is shown at Synergy Athletics fitness center, where he trains and works out. (photo by Robert Mescavage)

By JIM HOWE

Dan Kosick leads an active life. The Endicott resident is a social worker at a local middle school, a longtime youth lacrosse coach and a fitness enthusiast who typically swims three days a week, runs three days a week and fits in an obstacle course and strength training, often working out both before and after work.

Concerning his rigorous routine, he says, “I feel it’s a part of who I am.” He might include additional training for events like half-marathons or a climb up a volcano in the Andes, all while keeping an infectiously positive attitude.

He accomplishes this, as well as adaptive skiing and mountain climbing, after having his right leg amputated above the knee at the age 15 due to a rare form of cancer.

Now 42, with a prosthetic leg for everyday use and another for running, he recalls that he often noticed something felt funny in one leg when he was a boy. “I remember falling off my bike and getting a zinging sensation up my leg, like an extra funny bone,” he said.  When he was a young teen, the increasing pain led to tests that found a hard-to-diagnose tumor on a nerve in his right leg.

Kosick’s workouts include swimming, running, an obstacle course and strength training. (photo by Robert Mescavage)

Kosick’s workouts include swimming, running, an obstacle course and strength training. (photo by Robert Mescavage)

Called a triton tumor, it appeared benign at first, but a year later it had become increasingly painful and partially cancerous. Doctors at Memorial Sloan Kettering Cancer Center in New York City recommended his leg be amputated above the knee and that he undergo six months of chemotherapy to prevent the cancer from spreading.

He was 15 when his leg was amputated. His chemo was coordinated through Upstate.

“The day I had my amputation, I remember getting wheeled away and thinking, ‘This is it. I’m going to lose my leg,’” he said. At that time, he adds, his chief concerns were whether he would be able to play sports, get a girlfriend and drive a car afterward. He was able to do all three, and his high-school girlfriend is now his wife, with whom he has two daughters.

Getting back in the game

Kosick, who had always enjoyed playing sports, decided he would get back into sports after surgery. His parents supported his efforts and never showed any negativity, he said. “They always said, ‘Go ahead and try.’ As a father now, I can’t imagine going through that.”

Kosick wears the prosthetic at left for running, and the one at right for everyday use.(photo by Robert Mescavage)

Kosick wears the prosthetic at left for running, and the one at right for everyday use.(photo by Robert Mescavage)

“Originally, I went back to swimming, because I knew it was a great way to get back in shape. We had a small swim team, and I knew those guys. But my abilities started to come out, and I realized I had the potential to be an athlete again.”

He had played lacrosse as a goalie before the amputation, which was the best position to return to afterward, since he would not have to run around the field as much. His high school team was ranked at the state level in lacrosse in his senior year. He also took up adaptive skiing at Greek Peak Mountain Resort in Cortland County and planned to make the U.S. Paralympic ski team for the 2002 games in Salt Lake City.

“I did it sooner and competed in 1998 in Nagano, Japan,” he said. He repeated his performance in 2002. The International Paralympic Games, for athletes with a range of disabilities, are held in the Olympic Games venues right after each Olympics.

Last year, he climbed Mount Cotopaxi, a volcano in Ecuador, with a group of 10 amputees in a trek that included crossing a glacier with an ice ax, leaping over crevasses and reaching the nearly 20,000-foot summit in time to watch the sunrise. “It was scarier coming down,” he said, noting the climb included fully abled guides and raised money for the Range of Motion Project, a nonprofit group dedicated to providing artificial limbs and braces for those without access to these devices.

He is featured in one of the dramatic “I Train So I Can” videos for the Merrell footwear company that shows him running, working out and talking about his goals. He has also taken part in more than 25 Tough Mudders and other military-style obstacle-course endurance events.

Dealing with an artificial leg

Kosick, left, speaks with nurse Christopher White, part of the Survivor Wellness Program team, during an annual visit to the Upstate Cancer Center. (photo by Debbie Rexine)

Kosick, left, speaks with nurse Christopher White, part of the Survivor Wellness Program team, during an annual visit to the Upstate Cancer Center. (photo by Debbie Rexine)

“With a prosthetic leg, you have to learn to be comfortable with being uncomfortable,” Kosick notes. In his case, this includes having a sore tailbone and chafed skin that toughens over time, from where the artificial leg meets his body.

He takes the leg off for showering, sleeping, swimming and skiing.

He skis with outriggers, a device that looks like a ski pole with a mini-ski at the end.

One of his physical therapists, also an amputee, helped to connect him with a maker of prosthetic legs who specializes in limbs for athletes. So, when he runs, he uses a high-tech prosthetic leg, which is light and has a shock-absorbing design and a bit of a bounce to it. His everyday leg features a microprocessor that runs on a lithium battery and can read the force he is exerting, then adjust itself as needed.

A cancer survivor role model

Click here to listen to Kosick talk about surviving childhood cancer, leg amputation and rigorous athletic routine in a podcast/radio interview with Upstate's "HealthLink on Air." (photo by Jim Howe)

Click here to listen to Kosick talk about surviving childhood cancer, leg amputation and his rigorous athletic routine in a podcast/radio interview with Upstate’s “HealthLink on Air.” (photo by Jim Howe)

As for his long-ago cancer, he sometimes wonders whether it might come back, or create a new health problem, especially when his annual trip for a survivorship checkup looms, but so far, so good.

He has had various injuries related to his heavy-duty physical activities, including a broken arm and back pain. Some people say to him, “Why don’t you stop?”

“I know I’m healthier, even with all these lingering things,” he replies. “If at my age I don’t use it, I lose it.”

With his exercise routine, positive attitude and inspirational talks to support groups in the Binghamton area, he is often asked whether he feels like a role model to others.

“I hear that a lot, and it’s taken a while to embrace that, but I have, and I like to respond that it motivates me knowing that I’m inspiring to others,” he said.

“A lot of people cut themselves short, and I think if other people were in my shoes, especially at 15, they would continue on and do the things that they love to do and not just quit. But you don’t know it until you’re there. I don’t think I’m superhuman in any way, but it’s nice to hear.”

(Click here to read more about what survivorship means for people who had cancer as children. Click here for a podcast where pediatric cancer specialist Jody Sima, MD, discusses  survivorship with the parent of  cancer survivor. Sima directs the Survivor Wellness Program at Upstate.)

cover of summer 2019 Cancer Care magazineThis article appears in the summer 2019 issue of Cancer Care magazine.

 

 

 

 

 

 

 

Posted in cancer, fitness, health care, HealthLink on Air, patient story, Upstate Golisano Children's Hospital/pediatrics | Tagged , , , , , | Leave a comment

Science Is Art: The cerebral cortex

cerebral cortex cells

A research team at Upstate identified an unusual form of neurodevelopmental delay that is caused by deficiency in a protein called paxillin. They have discovered that brain cells that are deficient in paxillin move more slowly than healthy brain cells, and there is a corresponding delay in the development of the cerebral cortex. This tissue sample shows multiple layers of the cerebral cortex, which have been labeled red and green with specific histological markers.

The researchers: Mamunur Rashid, Judson Belmont, David Carpenter, Christopher Turner, PhD, and Eric Olson, PhD.

Upstate Health magazine summer 2019 issue coverThis article appears in the summer 2019 issue of Upstate Health magazine.

Posted in brain/neurology, health care, research

What’s Up at Upstate: Mobile mammograms, hospitality center, cord blood donations

mammogram van

Upstate’s mammogram van offers breast cancer screening to women in outlying areas.

Mobile mammography

Upstate now provides mobile mammography services with a new 45-foot van aimed at ensuring easy access to screening for women who live in Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego and St. Lawrence counties. A grant from the New York State Department of Health paid for the van, hoping it will help increase screening rates.

The van is equipped with a 3-D digital mammogram system, private exam and dressing rooms and a waiting room.

MPH program

U.S. News & World Report ranked Upstate’s Master of Public Health program in the top 100 of best graduate schools for 2020. The program, which attracts students looking for personalized attention and mentoring, takes 24 months to complete with full-time study. Part-time students have up to five years to complete the program.

Discharge hospital center

A discharge hospitality center is open at Upstate’s downtown hospital, for patients who are ready to go home and awaiting transportation, medical equipment or medication before they leave. The room is near the cafeteria and is equipped with recliners, a television, refreshments and has a nurse on duty.

Donating cord blood

young parents with sleeping baby

Parents delivering at Upstate’s Family Birth Center at its community campus have been able to donate umbilical cord blood to the Upstate Cord Blood Center since 2018.

Now, parents who deliver at Crouse Health, the hospital adjacent to Upstate University Hospital in downtown Syracuse, have the option to voluntarily donate their baby’s umbilical cord blood. Umbilical cord blood, which is typically discarded as medical waste, is rich with the blood-forming cells that can give blood cancer patients and others hope for a cure. As a public blood bank, there is no cost to donate, and donated cord blood is available to anyone who needs it.

Chair improvement

New Staxi Medical Chairs at Upstate’s downtown and Community hospitals improve the transport experience for patients and the volunteers who move them. The chairs have smaller wheels than a traditional wheelchair, a tapered seat, stationary footrest, folding armrests and brakes that engage when the handlebar is released.

Telestroke connection

Rome Memorial Hospital is the latest health care facility to join the telestroke network through Upstate’s Comprehensive Stroke Center. The network connects stroke specialists with medical staff at regional hospitals to assess and care for patients who may be having a stroke.

Mass spectrometer

Researchers at Upstate now have access to one of the most advanced mass spectrometers available today. Thanks to a $1.1 million grant from the National Institutes of Health, the new mass spectrometer enables further advances in the fields of structural and quantitative proteomics and metabolomics and drug discovery.

Upstate Health magazine summer 2019 issue coverThis article appears in the summer 2019 issue of Upstate Health magazine.

Posted in blood/blood-related conditions/hematology, cancer, health care, maternity/obstetrics, medical imaging/radiology, public health, research, stroke

A 9-letter word starting with C: After ‘Jeopardy!’ appearance, here’s a clue to her new hobby

Rachel Fabi, PhD, created this puzzle for Upstate Health magazine. The puzzle solution appears at the end of this article.

Rachel Fabi, PhD, created this puzzle for Upstate Health magazine. The puzzle solution appears at the end of this article.

BY AMBER SMITH

Rachel Fabi, PhD, starts her day with a cup of coffee and The New York Times crossword puzzle.

“It gets my brain working,” she says.

Rachel Fabi working on a crossword puzzle in the courtyard in front of Upstate’s Weiskotten Hall. (photo by Richard Whelsky)

Rachel Fabi working on a crossword puzzle in the courtyard in front of Upstate’s Weiskotten Hall. (photo by Richard Whelsky)

In the evenings, she likes to attend trivia games, watch “Jeopardy!” or create crossword puzzles (like the one above, which she created specially for Upstate Health magazine).

Fabi is an assistant professor of bioethics at Upstate.

She fulfilled her lifelong dream of appearing on “Jeopardy!” this year — a few weeks before host Alex Trebek disclosed his diagnosis of pancreatic cancer, and before James Holzhauer began his widely reported winning streak.

(Click hereHealthLink on Air logo to hear Fabi talk about her time as a contestant on the TV game show “Jeopardy!”in a podcast/radio interview with Upstate’s “HealthLink on Air.”)

 

Since she was 13, Fabi has made a daily habit of completing The New York Times crossword puzzle as a way to train for “Jeopardy!”

Fabi became a “Jeopardy!” champion her first night when she edged out her opponents by $1 by wagering nothing on a Final Jeopardy answer, which they all got wrong. She played the next night, too, but fell to a teacher from California.

After her “Jeopardy!” appearance, Fabi followed a new pursuit: to create crossword puzzles. She purchased software, found mentors willing to guide her, and so far this year has had four published in newspapers and crossword publications.

So, which is more challenging — making or solving a puzzle?

“Definitely making them.”

Can you answer the ‘Jeopardy!’ questions Fabi faced?

1. “Born in 1866, he has been called ‘The Shakespeare of Science Fiction.’”

Answer: “Who is H.G. Wells?”

2. “The title of this musical that opened in 1956 came from the last line of a nursery rhyme about a structure that spanned the Thames.”

Answer: What is “My Fair Lady”?

Puzzle solution

crossword puzzle solution

Upstate Health magazine summer 2019 issue coverThis article appears in the summer 2019 issue of Upstate Health magazine.

 

 

 

Posted in bioethics & humanities, entertainment, health care, HealthLink on Air | Tagged , , ,

Advice from the experts at Upstate about thong underwear, CBD and sunscreens

Suncreen, a hemp plant and thong underwearQ: What’s this I hear about sunscreen chemicals getting into my body?

A: A recent study found that if you apply sunscreen under maximal conditions — frequently enough, using a high enough sun protection factor and covering adequate body surface area — some of the chemicals in the sunscreen are absorbed into the bloodstream and measured at a higher concentration than was previously thought.

The federal Food and Drug Administration has called for further studies on the effects of those chemicals. “The main concern is that these chemicals may affect endocrine and reproductive systems,” explains Ramsay Farah, MD, chief of dermatology at Upstate.

He emphasizes that “the study did not suggest that people should not wear sunscreen. On the contrary. The study still recommended that people wear sunscreen.

“Look for sunscreens with zinc oxide and titanium dioxide. These are physical blockers. Yes, they are absorbed into the bloodstream, but they are absorbed less than the chemical blockers. And even though they are absorbed, they are considered inert, so they don’t have the same potentially disruptive effects on the endocrine and reproductive systems.”

HealthLink on Air logoClick here to hear Farah discuss sunscreens and skin protection in a “HealthLink on Air” podcast/radio interview.

 

How high of an SPF does he recommend?

“Thirty or above. There’s nothing wrong with using 50 or 60, but the general principle is using SPF 30 properly — meaning every two hours — is better than using 50 and just applying it once. So 30 is the minimum number. Reapplication is the key.”

Q: How does CBD work?

A: Hemp and marijuana are like cousins from the same plant family. The Farm Bill that became law in December legalized hemp cultivation. CBD, short for cannabidiol, is extracted from hemp. THC, short for tetrahydrocannabinol, the compound that creates a high, is found in higher concentrations in the marijuana plant.

Marijuana contains some CBD, and hemp may contain small amounts of THC – no more than 0.3 percent, according to the Farm Bill. “By itself, CBD does not cause a high,” says Caitlin Sgarlat Deluca, DO, who specializes in rheumatology and integrative medicine at Upstate.

She explains that CBD and THC both work on the body’s endocannabinoid system, which regulates certain inflammatory processes, functions such as sleep and immune system and pain responses. CBD is thought to inhibit inflammatory and neuropathic pain processes.

Click hereHealthLink on Air logo to hear Deluca explain what CBD can and can’t do in a “HealthLink on Air” podcast/radio interview.

 

“Some preliminary research shows that CBD may help curb addictions to heroin and other dangerous opioids. There’s also some preliminary evidence of efficacy in certain pain syndromes and rheumatoid arthritis,” Deluca says. “I think there’s great potential with CBD.”

But, she says, scientific studies are needed to answer what dose is safe and effective, and how CBD interacts with medications.

Q: What’s wrong with thong underwear?

A: Especially when worn while working out, thongs can set a woman up for infection. Thongs tend to slide from back to front, moving fecal bacteria, Renee Mestad, MD, told a fitness newsletter called Greatist.com. Mestad is division chief of general obstetrics and gynecology at Upstate.

Sweating during your workout is liable to make things worse.  “As the area gets damp, you’re going to experience a lot more friction,” Mestad says. “You might find yourself with small abrasions or other irritations that can then cause issues, which makes it easier for skin bacteria to penetrate the area.”

Mestad recommends breathable underwear made with performance-ready fabrics, especially if you can’t shower immediately after working out. “If you’re running, doing hot yoga or any other activities that result in a significant amount of sweating, it would benefit you to change out of your clothes, all the way down to the underwear, and into something fresh afterward.”

Upstate Health magazine summer 2019 issue coverThis article appears in the summer 2019 issue of Upstate Health magazine.

Posted in alternative/integrative medicine, dermatology/skin care, drugs/medications/pharmacy, health care, HealthLink on Air, pain/pain treatment, women's health/gynecology | Tagged , ,

Scientists come to Upstate for in-depth opportunity to study ticks

 Saravanan Thangamani, PhD, shows test tubes of ticks harvested from other parts of the world, so his research team can compare them to ticks found in Central New York. (photos by Chuck Wainwright)

Saravanan Thangamani, PhD, shows test tubes of ticks harvested from other parts of the world, so his research team can compare them to ticks found in Central New York. (photos by Chuck Wainwright)

BY AMBER SMITH

Saravanan Thangamani, PhD, moved from Galveston, Texas, to Central New York for the ticks. So did five members of his lab, which is devoted to research on tick-borne and mosquito-borne diseases. Recently they collected 115 ticks to study from Green Lakes State Park, near Fayetteville.

“Our lab tries to understand what really happens at the feeding site of the tick,” Thangamani describes. “That is the only time the tick is delivering the germ to a human. If we can decipher what really happens at the time of the virus delivery — at the time of the Lyme disease agent delivery — we can develop novel countermeasures to stop the transmission.”

(Click hereHealthLink on Air logo to hear Thangamani explain tick-borne illnesses, including Lyme disease, as well as disease prevention efforts and his lab’s research efforts, in a podcast/radio interview on Upstate’s “HealthLink on Air.”)

Thangamani is a SUNY Empire Innovation Professor in the department of microbiology and immunology at Upstate, and he leads the Center for Environmental Health and Medicine. He shared some of what he knows about ticks:

Ticks are numerous. Hundreds of species of ticks exist. However, not all ticks carry or transmit disease-causing germs to humans or pets. About 20 to 50 species have medical importance, meaning they carry pathogens that could cause significant human disease or veterinary disease.

Ticks are germy. Multiple pathogens can be transmitted by a single tick, including the bacterium Borrelia, which causes Lyme disease and the Powassan virus that can lead to encephalitis, both of which are carried by the deer tick.

Ticks are patient. Just as people have favorite cuisines, ticks prefer certain mammals on which to feed. If they don’t find a preferred host immediately, they wait. “That’s why the tick life cycle in nature takes about two to three years to complete, from eggs to larvae to nymphs to adults,” Thangamani says.

Thangamani and his team collect ticks by dragging white fabric through fields and woods in Green Lakse State Park.

Thangamani and his team collect ticks by dragging white fabric through fields and woods in Green Lakes State Park.

Ticks are tiny. During their larval stage, some ticks including deer ticks are smaller than poppyseeds. As nymphs (adolescents) ticks grow to maybe twice that size. Adult ticks are bigger and easier to spot. “That’s one reason we don’t often get bitten by adult ticks,” Thangamani says.

“It’s easy to find them on the human body, and we can pick them out.” Some species of ticks are three or four times bigger than the deer tick.

Ticks are transmitters. Mother ticks almost never transmit bacteria to the eggs they lay. But if the mother tick carries a virus, almost 90 percent of the time she will transmit that to her babies. “It depends on what germ we are talking about,” Thangamani says. Ticks that are born free of the bacterium Borrelia may contract it by feeding on white-footed mice. Ticks that carry pathogens can pass them to the humans and pets.

Ticks are slow. Ticks spend from 10 minutes to an hour looking for a place to attach. “It crawls on your skin and tries to find a perfect hiding spot. Then, it actually injects its mouthpart,” Thangamani says. “Deer ticks particularly have longer mouthparts, and they have to stay attached to the human body at least three to five days, so they try to latch on and anchor themselves nicely.”

Ticks are (potentially) dangerous. “The deer tick has to stay attached to a human for at least 24 hours for the bacterium Borrelia to be transmitted. The Powassan virus will be transmitted to the human within the first hour after the bite,” Thangamani describes. “That means when you have a co-infected tick, the virus gets in first, and it primes the feeding site. Then when the Borrelia comes 24 hours later, it makes it easier for the Borrelia to infect and make the clinical outcome worse.”

The public can send ticks they find for testing at Upstate (details below).

The public can send ticks — such as this one, shown with a blade of grass — for testing at Upstate (details below).

Submit your tick

The Center for Environmental Health and Medicine offers free tick testing, to learn the species of the tick and whether it carries any of 10 pathogens. The test is not a diagnostic tool but rather is used for academic research purposes. Learn more at www.thangamani-lab.com

1. Put the tick, dead or alive, in a plastic bag with a piece of moist tissue or grass.

2. Place the bag in an envelope with this information: A. date, B. ZIP code where the tick was found, C. whether the tick came from a human or a pet, and D. an email address for the results.

3. Ship the envelope to: Thangamani Lab, 4209 Institute for Human Performance, 505 Irving Ave., Syracuse, NY 13210

Upstate Health magazine summer 2019 issue coverThis article appears in the summer 2019 issue of Upstate Health magazine.

Posted in blood/blood-related conditions/hematology, health care, HealthLink on Air, infectious disease, public health, research | Tagged , ,

On a mission to help: Doctor’s intensive-care skills help poor children with heart trouble in Peru

To care for a Peruvian child with a heart condition, I. Federico Fernández Nievas, MD, created this elaborate life-support apparatus, which included a ventilator, monitors, pumps, a maze of tubes and electrical cords and an inflated rubber glove as a support. (photos courtesy I. Federico Fernández Nievas, MD)

To care for a Peruvian child with a heart condition, I. Federico Fernández Nievas, MD, created this elaborate life-support apparatus, which included a ventilator, monitors, pumps, a maze of tubes and electrical cords and an inflated rubber glove as a support. (photos courtesy I. Federico Fernández Nievas, MD)

BY JIM HOWE

A career spent caring for very sick children, plus some mechanical ingenuity, helped I. Federico Fernández Nievas, MD, when he accompanied a medical charity team to Peru.

He joined about two dozen other medical professionals from around the United States to treat poor children with congenital heart problems. The nonprofit humanitarian Hearts with Hope Foundation, which sponsored the trip, needed a specialist in pediatric intensive care.

I. Federico Fernández Nievas

Fernández Nievas

Fernández, who works in the pediatric intensive care unit at the Upstate Golisano Children’s Hospital, heard about the trip through a former colleague and volunteered to go.

The mission took place in a city hospital in a poor, dangerous area of the capital, Lima. Vans carrying the volunteers had to pass through various security checkpoints and fences to get into or out of the hospital.

“It was like a jail, with police, security and so much poverty,” he says.

“Children have very little access to heart surgery there, especially the farther they live from Lima,” he says. “I was told that people with money will go to Mexico or Chile for pediatric cardiac surgery.”

Cardiac specialists in Lima preselected patients, then, together with the American team, chose the 10 children to be operated on. Some of the work done was corrective, some palliative. “We tried to choose surgeries that are meaningful for the patients, what is possible and sustainable to improve the quality “of life, at least, if not correct it,” Fernández explains.

In addition, several other children underwent cardiac catheterization, where a thin tube is threaded through a blood vessel to diagnose a heart problem or plug a small hole in the heart without surgery. The doctors also held a clinic to examine additional children.

“We did about 10 complex cardiac surgeries in five days,” Fernández says. The team arrived at 5 a.m. on a Saturday, was in the hospital discussing cases through that evening and got the equipment ready on Sunday. On Monday they started performing two surgeries a day. By Friday night, they removed the breathing tube that the last child had needed. They left the next day.

The patients, ranging in age from infants to midteens, all came through well and have received follow-up care from the local doctors in Lima.

Because certain supplies were not always available, the team had to improvise. Fernández cobbled together an elaborate life-support apparatus for one child that included a ventilator, monitors, pumps, a maze of tubes and electrical cords and an inflated rubber glove to support some of it. He also rigged up breathing devices for some patients.

This was his first such trip. It was humbling. It reminded him why he chose medicine for a career.

“It was very intense, the emotions, and the people were so grateful. There was a sense of special connection,” he says.

“When I was young and idealistic, people asked, ‘Why do you want to be a doctor?’ This is the answer.”

The team completed 10 complex heart surgeries in five days.

The team completed 10 complex heart surgeries in five days.

What’s a pediatric intensivist?

Pediatric intensivists are doctors who specialize in the care of infants and children and who usually work in a pediatric intensive care unit, or PICU. They see children who have long-term illnesses as well as those temporarily in need after surgery, serious injury, septic shock, seizures or various heart and lung problems. Monitoring children’s breathing and setting up machines to help them breathe is a major concern.

I. Federico Fernández Nievas, MD, the son of a pediatrician, has a lifelong interest in using technology to help the sickest patients, which led him to decades of work in pediatric intensive care, life support and pulmonary medicine. He came to Upstate in 2015, where he is medical director of respiratory therapy and of the ECMO program, which uses a life-support machine to keep the heart and lungs going.

He has worked in major hospitals around the United States and Canada, and before that in his native Argentina — from the capital, Buenos Aires, to remote Tierra del Fuego, at the tip of South America, where he set up a training program for pediatric intensivists.

Upstate Health magazine summer 2019 issue coverThis article appears in the summer 2019 issue of Upstate Health magazine.

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