Care that evolves: Youngster with leukemia graduates to monthly checkups

Greyson Trottier proudly wears his cancer survivor's T-shirt. (PHOTOS BY WILLIAM MUELLER)

Greyson Trottier proudly wears his cancer survivor’s T-shirt. (PHOTOS BY WILLIAM MUELLER)

BY AMBER SMITH

During the entire time from when their toddler was diagnosed with acute lymphoblastic leukemia, to his stay at the Upstate Golisano Children’s Hospital, and through his nine months of chemotherapy, Christina and Thomas Trottier never used the word “cancer.”

So three years later, their son surprised his parents when he greeted a new baby sitter. “I had cancer,” Greyson Trottier announced.

“He understands way more than he lets on,” says his mother, Christina Trottier of Watertown.

Greyson, now 5, was diagnosed in January 2014, when he was 21 months old.

He had fallen at day care, leaving a bruise on his head. In examining him that afternoon, Greyson’s pediatrician noticed additional bruises on his legs. Blood test results came back about 5:30 p.m. Suddenly the Trottiers were scrambling to find people to watch Greyson’s twin, Jameson and older brother McKennon. Four hours later, Christina and Tom Trottier checked Greyson into the children’s hospital in Syracuse.

“The doctor who checked us in kept saying he didn’t look like a cancer kid. He was going like the Energizer bunny,” Christina Trottier recalls. “He didn’t have a lack of appetite, or coughing or fevers. He didn’t have any of the symptoms.”

But the next day, a bone marrow biopsy confirmed the blood test results. Greyson was hospitalized for a week, receiving the first of his chemotherapy treatments.

At a checkup session in May, nurse Yvonne Dolce pricks Greyson's fingers to get a blood sample while he is absorbed in an electronic game, thanks to child life specialist Sarah Buck, right.

At a checkup session in May, nurse Yvonne Dolce pricks Greyson’s fingers to get a blood sample while he is absorbed in an electronic game, thanks to child life specialist Sarah Buck, right.

“It was pretty intense,” Trottier says, recalling the infections and the seizures and the spinal taps that happened during the months he was on chemotherapy. Greyson saw neurologists, cardiologists and oncologists at Upstate, plus eye doctors and dentists closer to his Watertown home. He bonded most tightly with nurse Yvonne Dolce. She’s got twin daughters.

Trottier calls her a saint. “She is a constant calm in the storm. We would be lost without her.”

Greyson completed chemotherapy in March. A few months later, he finished pre-kindergarten. The specter of cancer remains. Anytime he gets a bruise, his mother freaks out. These months after cancer treatment are nerve-wracking for the family.

Greyson sees Dolce and Andrea Dvorak, MD, every month for a checkup. “They love him,” Trottier says, “and he loves them.”

At the same checkup session, pediatric oncologist Andrea Dvorak, MD, checks Greyson's heart rate and lung function.

At the same checkup session, pediatric oncologist Andrea Dvorak, MD, checks Greyson’s heart rate and lung function.

About acute lymphoblastic leukemia

Acute lymphoblastic leukemia (also known as ALL or acute lymphocytic leukemia) is a type of cancer in which the bone marrow makes too many immature lymphocytes, a type of white blood cell.

— Signs of ALL include fever and bruising.

— Tests that examine the blood and bone marrow are used to diagnose ALL.

— Red blood cells, white blood cells and platelets may be affected.

— ALL typically gets worse quickly if it is not treated.

— Treatment options and prognosis depend on several factors, including age at diagnosis.

Source: National Cancer Institute

Summer 2018 Cancer Care coverThis article appears in the summer 2017 issue of Cancer Care magazine.

 

 

 

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

First chemo … then vacation, for this Upstate patient

Margit Foti, who is being treated for bladder cancer, on the last day of her 24-week chemotherapy regimen. (PHOTO BY SUSAN KAHN)

BY SUSAN KEETER

“I am so sorry you have to give me this bad news,” Margit Foti, 71,  remembers telling her urologist, Elizabeth Ferry, MD, on the day Foti learned that she had a rare bladder cancer with a poor prognosis.

Sam Benjamin, MD, medical oncologist

“I could see the upset in her face,” explained Foti.

Her symptoms began late last summer, when Foti was traveling on a dream-come-true vacation in Hungary, her childhood home.  During the trip, she developed pelvic discomfort that she suspected was caused by a urinary tract infection. When Foti returned home in September, her primary care physician prescribed an antibiotic to treat what they agreed was likely an infection.

Two days after that appointment, Foti was plagued by a constant need to urinate and was in such pain that she could not sit or lie down. Her son-in-law, a nurse, insisted that she go to the emergency department at Upstate’s Community campus.

Elizabeth Ferry, MD, urologist

Through imaging, doctors saw swelling in Foti’s kidneys and increased thickness in her bladder. Suspecting kidney stones, they controlled her pain, alerted Foti’s primary care physician and referred her to Ferry in urology.

Within a week, Foti’s condition had deteriorated to the point that she needed diapers.

Ferry scheduled a CT scan of Foti’s abdomen and pelvis. Then, Ferry performed a cystoscopy, a procedure in which a lighted tube is inserted into the urethra to examine the inside of the bladder.

Kaushal Nanavati, MD, medical director of integrative therapy

The cystoscopy revealed a large tumor, and Foti was taken to surgery for removal. Surgical pathology identified signet ring cell adenocarcinoma, a type of bladder cancer so rare that just a handful of cases are reported each year, worldwide.

Oleg Shapiro, MD, urologist

Upstate’s urology team met to discuss Foti’s case. The urologists sought opinions from colleagues nationwide.  Because the condition is so uncommon, there is no protocol for treatment.

Urologist Oleg Shapiro, MD, assisted by Ferry, performed surgery on Foti . The plan was to remove the cancer from the bladder, but they found it had spread outside Foti’s bladder and into her abdomen, prohibiting removal.

Gennady Bratslavsky, MD, chief of urology

Gennady Bratslavsky, MD, chief of urology

The next day, interventional radiologists implanted tubing through Foti’s skin into her kidneys to remove urine. Cancer was blocking drainage into her bladder.

Upstate’s genitourinary multidisciplinary team — including medical oncologist Muhammad Naqvi , MD (and others shown in the accompanying photographs) — recommended six months of chemotherapy with daylong treatments every two weeks. Foti responded well to the chemotherapy and was relieved that the treatments could be done on an outpatient basis.

After three months, the chemotherapy had shrunk the cancer enough that the tubes in her kidneys could be removed, and Foti’s bladder function gradually returned to normal.

Katsuhiro Kobayashi, MD, interventional radiologist

Katsuhiro Kobayashi, MD, interventional radiologist

Throughout diagnosis and treatment, Foti has stayed busy, learning everything she can about her disease and looking forward to the possibility that new treatments may be available any day. She exercises regularly, and attends  a cancer survivors program at the YMCA that Foti describes as “a support group with giggles.” She follows a “clean” diet, as recommended by Kaushal Nanavati, MD. That is, she eats mostly unprocessed, whole foods, including fruits, vegetables, whole grains, and lean meats with no artificial ingredients or preservatives.

Through her research, Foti connected with a Long Island police officer and a woman living in England who had the same type of cancer but have since died. Foti accepts that her future is somewhat beyond her control but firmly believes that she and her  medical team are doing everything possible to battle her cancer.

Mitchell Karmel, MD, interventional radiologist

Mitchell Karmel, MD, interventional radiologist

“I especially like Dr. Naqvi. His eyes smile when he talks,” Foti explains. “He is very positive but realistic. He makes no promises but never gives up. There is always something he is ready to try to help me with.”

What’s in her immediate future? With chemotherapy treatments finished, and the cautious assumption that the cancer is in remission for now, Foti is making plans. With her doctors’ okay, she took a trip to New York City to visit friends, then packed her bags for a vacation with her two daughters and four grandchildren.

“Some day, my daughters will scatter my ashes over Jones Beach on Long Island,” Foti winks. “But first, we’re enjoying Myrtle Beach together!”

Foti with one of her oncologists, Muhammad Naqvi , MD, at the Upstate Cancer Center. (PHOTO BY SUSAN KAHN)

Foti with one of her oncologists, Muhammad Naqvi , MD, at the Upstate Cancer Center. (PHOTO BY SUSAN KAHN)

What is signet ring cell adenocarcinoma?

Signet cells are glandular cells found in the tissue that lines certain internal organs and makes and releases mucus, digestive juices or other fluids. Adenocarcinoma is a cancer that begins in those glandular cells. Signet ring cell carcinomas are found most often in the stomach lining but also develop in the bladder and other organs. The cancerous cells are called “signet ring” because their shape is similar to monogrammed rings of the same name.

Source: National Cancer Institute, Cancer Research UK

Sharing a story

Foti shared her story with the Upstate Foundation. To share your story, email FND@upstate.edu. To donate to the Friends of Upstate Cancer Center, click here or call 315-464-4416.

Summer 2017 Cancer Care coverThis article appears in the summer 2017 issue of Cancer Care magazine

 

Posted in cancer, health care, medical imaging/radiology, patient story, surgery, urology | Tagged , | Leave a comment

Match game: Here’s what patients say about Upstate doctors

photos of 20 doctors to match with comments about them in storyIf you’ve ever been a patient in the hospital, you may have received a survey after your stay. Administrators take the feedback to heart because it provides a unique look at the hospital and its providers, from the patient’s point of view. They regularly share some of the comments with hospital staff.

See if you can match the comments (taken verbatim from surveys received this winter and spring) to the physicians pictured above. Answers appear at the bottom of the page.

  1. “Gave excellent attention and care to a scared patient in crisis.”
  2. “My condition is stable because of her expertise and thorough care.”
  3. “His quick response and skill saved my life.”
  4. “We have much faith in him providing the best support for our child.”
  5. “Takes time to consider my concerns, and I certainly value her expert opinions.”
  6. “Very knowledgeable, kind and patiently answers questions.”
  7. “Impresses me with the time he spends with me and how much he cares about me.”
  8. “Made me feel at ease and more positive regarding my prognosis and progress.”
  9. “Kind, concerned and helpful. Awesome bedside manner.”
  10. “She is very sensitive and caring. She listens. I wish there were more doctors like her.”
  11. “The kindest, most concerned, most intelligent, most informed and helpful doctor I have ever had.”
  12. “Answered every question completely and didn’t make me feel I was asking foolish questions.”
  13. “Personable, informative, compassionate.”
  14. “From beginning to end took great care of our son.”
  15. “Always impresses me with his knowledge and caring for his patients.”
  16. “Highly intelligent, caring. The best MD I have ever had.”
  17. “A kindhearted person who genuinely takes pride in her profession.”
  18. “Very kind and compassionate during a scary time.”
  19. “My mother always gets upset when she has to go to these appointments, but once (this doctor) arrives, she is all smiles and always leaves the appointment in a good mood.”
  20. “Very clear and explanatory.”

    Answers: 
    1. Mora; 2. Ko; 3. Sun; 4. Woods; 5. Yu; 6. Young; 7. Michiel; 8. Dolinak; 9. Leggat; 10. Lai; 11. Mejico; 12. Ginzburg; 13. Duleep; 14. Stanger; 15. Izquierdo; 16. Szombathy; 17. Kelly; 18. Jain; 19. Berg; 20. Changlai.

Summer 2017 Upstate Health coverThis article appears in the summer 2017 issue of Upstate Health magazine.

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How to brighten your life

image of clouds  and sunshine

Kaushal B. Nanavati, MD, is a doctor of family and integrative medicine at Upstate who often advises patients to “brighten up your life by getting back to the basics.”

Kaushal Nanavati, MD

Kaushal Nanavati, MD

What does he mean by that?

  1. Start by accepting yourself for who you are, imperfect and flawed, as we all are, while being a one-of-a-kind original.

2.  Forgive yourself if you have not always been your best to yourself.

3.  Be nice to yourself by taking good care of your mind, body and spirit. Follow what Nanavati calls the “CORE 4 of Wellness,” also the title of his book. That is:

— Nutrition: Eat healthy, whole foods.

— Exercise: Make it a daily appointment.

— Stress management: Focus on the things you can take care of in your life…breathe…and let go of the rest.

— Spiritual wellness: Appreciate that you have today to create a peaceful life, and then start creating it.

4. Invite things and people into your life that will add to your joy.

Summer 2017 Upstate Health coverUpstate's HealthLink on Air logoThis article appears in the summer 2017 issue of Upstate Health magazine. Hear two podcasts/radio interviews with Nanavati, one where he explains the importance of contentment and inner peace to good health and another where he discusses the four pillars of wellness.

Posted in alternative/integrative medicine, family medicine, health care, spiritual care | Tagged , , , , , , , , , | Leave a comment

Tandem treatment: Polymer ‘truck’ penetrates tumor, kills ovarian cancer cells

BY AMBER SMITH

 The ovarian cancer drug doxorubicin can be toxic to the heart. Giving a woman enough of the drug to be effective against her cancer may be too much to be safe for her heart.

Scientists at Upstate Medical University are pairing doxorubicin with regular vitamin B2 in a new nanoformulation (that is, using microscopic particles) to treat ovarian cancer – with encouraging results that are gentle on the heart.

Juntao Luo, PhD

“We were able to demonstrate significantly inhibited tumor growth and prolonged survival,” Juntao Luo, PhD, says in describing his  research in the journal Biomaterials. Luo is an assistant professor of pharmacology whose research focuses on the use of nanocarriers for drug delivery.

A key piece of the success of the doxorubicin-vitamin B2 project is the creation of what is known in scientific terms as a “well-defined linear-dendritic telodendrimer nanoplatform.”

It’s known colloquially as a truck — a teeny-tiny truck made of a polymer.

Used separately, such high concentrations of doxorubicin are required in order to achieve the antitumor effects, which exposes the heart to toxic levels of the drug molecules. Doctors often warn patients not to take vitamin B2 if they are taking doxorubicin because the vitamin can weaken the drug.

In this model, doxorubicin is represented by spheres and vitamin B2 is indicated by interlocking sticks. (FROM THE LAB OF JUNTAO LUO, PhD)

When doxorubicin and vitamin B2 are paired on the drug-carrying truck, however, they have what scientists call “synergy,” working more favorably to kill cancer cells than either could alone.

The presence of vitamin B2 helps keep the doxorubicin molecules bound together on the polymer truck, minimizing the impact on the heart as it travels the bloodstream en route to the tumor.

Another form of doxorubicin used to treat ovarian cancer is Doxil, a medication that is incorporated into another style of truck, made of lipids. Doxil reduces heart toxicity, but its truck structure is too large to effectively penetrate the tumor, Luo describes.

The blood vessel leading to the tumor has an opening that is comparatively wide. Luo’s truck is small enough to travel deep into the tumor, delivering the drug where it can be most effective. This allows more cancer cells to be killed than by Doxil or by plain doxorubicin without Luo’s polymer truck.

Rinki Agarwal, MD

After its work is done, the truck exits the body undetected through the urine.

“The nanoparticle reaches the tumor site easier and releases the drug, with minimal effects on the heart,” Luo describes. “Our formation inhibits tumor growth much more efficiently.”

This summer, Luo is working with gynecologic oncologist Rinki Agarwal, MD, to establish protocols for collecting samples of ovarian tumors from Central New York women. The samples would provide the next step toward testing this new treatment strategy. The scientists believe that testing this novel formulation directly on patient-derived samples will bring them a lot closer to bringing it to clinical trials.

This article appears in the summer 2017 issue of Cancer Care magazine. For a first-person story about surgery Agarwal performed to remove the ovaries in a patient at high risk of cancer, click here. 

Posted in cancer, drugs/medications/pharmacy, health care, heart/cardiovascular, research, women's health/gynecology | Tagged , , , , , , | Leave a comment

No bread, no dairy, no meat: Living with PKU means eating lots of vegetables, fruits

Ezekiel Sanford, 5, must eat a carefully monitored diet to avoid complications from phenylketonuria. (PHOTOS BY SUSAN KAHN)

BY SUSAN KEETER

Ezekiel Sanford was 2 days old when his Binghamton pediatrician told his parents: “You have to take him to Upstate.”

A routine blood test showed that Ezekiel had a rare inherited disorder called phenylketonuria, or PKU, which affects one in 15,000 newborns. The pediatric geneticist and medical specialists he needed were a short drive away, in Syracuse.

Joan Pellegrino, MD

At the Upstate Golisano Children’s Hospital, Ezekiel is seen by pediatric geneticist Joan Pellegrino, MD, and her team, which includes a dietitian, nurse practitioner, genetic counselor, social worker and nurse. His first year, Ezekiel had many appointments and lots of blood work done at the children’s hospital.

One of their first tasks was to help Ezekiel’s mother, Melissa Sanford, figure out how to breast-feed her son safely. It required alternating breast milk with a special formula for infants with PKU, counting the minutes he nursed and measuring the ounces of formula he drank. The family has become accustomed to this level of watchfulness.

For the rest of his life, Ezekiel will need to follow a strict diet that limits his intake of phenylalanine, an amino acid found in most foods, particularly those that contain protein.

Ezekiel’s diet includes no bread, no dairy and no meat. He eats fruits and vegetables and gets one-third of his calories from a formula that contains a synthetic protein that lacks phenylalanine. Everything he eats has to be weighed in grams and calculated for its phenylalanine content. Fortunately, Ezekiel loves fruits and vegetables and is happy to remind anyone who’s listening that “cooked carrots are yum, yum, yum.”

“Ezekiel is receptive to his diet, and we are vigilant,” explains his father, George Sanford.

With guidance from the Upstate team and their own research, Ezekiel’s parents have found conferences, support groups and medical food companies, all of which help Ezekiel lead a healthy, normal life. His parents read food labels carefully, contact manufacturers and order products from medical food companies. As a result, Ezekiel is able to enjoy pizza and garlic bread, as long as it’s made with a special flour designed for people with PKU.

Today, Ezekiel is 5, and he’s used to the biweekly, at-home blood tests that will always be part of his life.  He sees his Upstate team twice a year and started kindergarten this fall.

Ezekiel, his parents and three siblings are looking forward to moving to a farm — where they plan to grow lots of fruits and vegetables.

Testing for PKU

All babies in the United States, plus many other countries, are routinely screened for metabolic disorders, including phenylketonuria, or PKU, at least 24 hours after birth. A few drops of blood are collected from the heel or the bend in the arm.

In PKU, the body is unable to break down the amino acid phenylalanine. If it builds to harmful levels in the body, phenylalanine can cause intellectual disability, neurological disorders and other serious health problems.

People with PKU must limit their intake of dietary protein and may take a nutritional supplement that provides adequate protein without phenylalanine.

This article appears in the summer 2017 issue of Upstate Health magazine.

 

 

Posted in diabetes/endocrine/metabolism, diet/nutrition, genetics, health care, patient story | Tagged , , | Leave a comment

News about Upstate you may have missed

Upstate College of Medicine’s Class of 2017 at graduation ceremonies in the John H. Mulroy Civic Center in Syracuse. (PHOTO BY RICHARD WHELSKY)

Autism symposium

“The message of our book,” said the co-author of a Pulitzer Prize finalist work about autism, “is that the larger community needs to change, needs to step up and not freak out over people who are different.”

That’s how John Donvan, an ABC newsman and co-author of the best-selling “In a Different Key: The Story of Autism,” kicked off a two-day autism symposium at Upstate this spring. The conference attracted noted researchers from around the country.

His general-interest talk was followed by scientific topics, such as deficiencies in brain carnitine, a compound involved in metabolism (by Arthur Beaudet, MD, Baylor College of Medicine), genetic causes (Stephan Sanders, MD, PhD, University of California at San Francisco School of Medicine) and the use of salivary DNA to identify autism (Upstate graduate Steven Hicks, MD, PhD, Penn State College of Medicine).

Contraception app

Upstate’s Joshua Steinberg, MD, who specializes in family medicine, has created a mobile application for health care providers with patients seeking birth control.

Called “Contraception Point-of-Care,” the app comprises information about medical eligibility, which methods are most effective, contraception prerequisites and more. It’s free.

Homeless survey

Some medical students from Upstate joined 40 volunteers this winter to conduct the annual Point in Time homelessness count in Central New York. Simon Hernandez, who is entering his third year, got involved through Upstate’s Center for Civic Engagement. The count takes place nationwide.

“It showed me a new way of being compassionate,” Hernandez said of the hours he spent interviewing people who were homeless. “They have a lot of distrust in the system. Part of what you have to do is reinstate trust. You have to take the time to be compassionate and listen to them. … You can’t just tell them what to do.”

Graduation

Upstate President Danielle Laraque-Arena, MD, awarded 463 degrees and five professional certificates to graduates of the colleges of Graduate Studies, Health Professions, Medicine (shown above) and Nursing during ceremonies May 21.

Seventy of the new physician graduates signed the “1 in 5 Pledge,” to serve patients who receive Medicaid, the government health plan for those with low incomes. In 2017, about one in five Americans takes part in the Medicaid program.

“Since our first day as medical students when we receive our white coats, we pledge to do no harm and not discriminate in our care and to treat all individuals with respect,” said new graduate Emily Commesso, MD. “This pledge continues that spirit and encourages social responsibility for some of our most vulnerable patients.”

New garden

A Patient and Family Healing Garden, reminiscent of the pocket parks that are snuggled between skyscrapers, has opened on a sliver of green space between the concrete walls of the Community campus hospital.

Research has shown that healing gardens provide patients and families with a welcome distraction from physical and emotional pain, reduce stress levels and promote a sense of well-being.

Fastest runners

Lee Berube

Upstate physical therapist Lee Berube finished as the top male runner with a time of 17 minutes and 34 seconds at the 2017 Syracuse JP Morgan Corporate Challenge, a 3.5-mile race held June 6 at Onondaga Lake Parkway. Berube beat, by two seconds, his record from last year’s event, when he was named the 2016 Syracuse Corporate Challenge overall top finisher and top male runner (17:36).

Christina Phelan of pharmacy placed fourth in the 2017 Top Women category with a time of 22:21. This year marked Upstate’s largest Corporate Challenge Team to date, with 144 participants.

Berube and Phelan also led Upstate’s winning mixed team, which included John Kolh of environmental services with a time of 21:57, and Cara Lavier of nursing with 23:06. The mixed team’s overall time was 1:24:58, which was 4:12 ahead of the second-place mixed team.

This article appears in the summer 2017 issue of Upstate Health magazine.

Posted in autism, community, fitness, health care, health careers, medical education, medical student, public health, sexuality, sustainability/environment, technology, women's health/gynecology

She provided care in Ghana

 

Nurse practitioner Brandy Baillargeon and a baby girl she provided care for in Ghana, West Africa.

Brandy Baillargeon of Watertown, a family psychiatric mental health nurse practitioner, traveled to Ghana through Upstate nurse Lauri Rupracht’s Americans Serving Abroad Project. She was touched by the gratitude of those she helped in several villages during the eight-day medical mission, including a baby girl who has problems with her feet. Baillargeon helped fashion some braces for her, using tongue depressors and high-top sneakers, and made arrangements for her to be seen at a hospital a few hours from her village. Baillargeon is a student in Upstate’s doctor of nursing practice program.

This article appears in the summer 2017 issue of Upstate Health magazine. To hear more about the Americans Serving Abroad Project in Ghana and how you might participate or help out, listen to this podcast/radio interview with Rupracht and fellow Upstate nurse Caitlin Phalen on Upstate’s “HealthLink on Air.”

Posted in community, health care, HealthLink on Air, international health care, public health, volunteers | Tagged , , , ,

Science is art: Preserving fatherhood

Sperm cells, which can be stored for future use by men who, because of cancer or other reasons, might not otherwise be able to father children.

Kazim Chohan, PhD (right), leads Upstate’s Male Fertility Preservation Program, which came about through the efforts of Chohan and colleagues including pediatric oncologist Jody Sima, MD (left); urologist JC Trussell, MD; oncologist Rahul Seth, DO; and pathology chair Robert Corona Jr., DO. (PHOTO BY ROBERT MESCAVAGE)

The andrology department at Upstate helps men preserve their ability to become fathers by offering:

— sperm banking, where semen is collected and frozen in liquid nitrogen;

— testicular sperm extraction, a surgical procedure for men with no sperm in their semen, in which sperm are extracted directly from testicles, and then frozen;

— testicular tissue freezing, an experimental process that involves surgically removing and freezing tissue from the testicles of boys who are not old enough to produce sperm. The tissue could potentially be used later to restore fertility or produce sperm.

These techniques help men with a cancer diagnosis or temporary or permanent infertility issue. Learn more about fertility preservation by calling Upstate’s andrology department at 315-464-6550.

This article appears in the summer 2017 issue of Upstate Health magazine.  Hear a “HealthLink on Air” podcast/radio interview with Chohan and Sima where they discuss fertility preservation and the patients it can help.

 

 

Posted in health care, HealthLink on Air, men's health, research, sexuality, technology

Limiting Lyme disease: How you can protect yourself and your family

Long sleeves and pant legs tucked into boots can help prevent ticks from biting. (PHOTO BY DAN CAMERON)

Sixteen of every 100,000 New Yorkers were infected with Lyme disease in 2015, the latest year for which statistics are available. In 2015, 95 percent of Lyme diagnoses came from 14 states, including New York.

Lyme disease is caused by bacteria that are transmitted to humans through the bite of an infected tick, called Ixodes scapularis but better known as a deer tick because of its habit of parasitizing the white-tailed deer. Ticks acquire Lyme disease microbes by feeding on infected mice and other small rodents. They may also spread other organisms.

Prevention advice

  1. Ticks do not jump or fly or drop from trees. They start from the ground and crawl upward until they find a place to attach. Tuck pants legs into socks, to keep ticks on the outside, where they may be seen or brushed off.
  2. Use repellents on your skin (that contain DEET) and your clothes (that contain permethrin.) Be sure to spray shoes and the insides of pants and shorts, too.
  3. Ticks may live where yards border wooded areas. They like shady areas and leaves with high humidity. Keeping leaves raked and shrubs and low branches trimmed can ruin their habitat. You may also consider pesticide treatment along the yard’s perimeter.
  4. Check for ticks daily – especially the scalp, ears, underarms, belly button, waist and back, behind knees and the pelvic area – and remove any promptly (See “The right way to remove a tick,” below.)) The smallest deer ticks may resemble poppy seeds.
  5. Throw clothing in a hot dryer for 10 minutes to kill ticks. Washing clothes even in hot water does not kill ticks.

 The right way to remove a tick

An adult tick on a blade of grass.

“Take tweezers and grab the tick at the very bottom, close to the skin, and gently pull up,” says Jana Shaw, MD, an associate professor of pediatrics and public health and preventive medicine at Upstate.

She says not to try choking or burning the ticks, or other home remedies, because they are not effective — and stressing a tick can make it expel bacteria into your skin.

“Just a gentle pull with the tweezers — and cleaning the skin with alcohol afterwards — is ll that is needed.”

Dispose of a live tick by submerging it in alcohol, placing it in a sealed bag or container, wrapping it tightly in tape or flushing it down the toilet. Never crush a tick with your fingers.

— Sources: Centers for Disease Control and Prevention, Cornell Cooperative Extension, Tick Encounter Resource Center from the University of Rhode Island and Upstate Medical University

What happens when Lyme attacks the heart

BY AMBER SMITH

Every time he stood, he would feel dizzy.

Hamza Murtaza, 25, is a fourth-year medical student at Upstate Medical University who wrote about his personal experience with a complication of Lyme disease. (PHOTO BY ROBERT MESCAVAGE)

But since he was fasting for Ramadan in the summer of 2015, Upstate medical student Hamza Murtaza figured he was just lightheaded from not eating.

He was also tired, and he had abdominal pain. When he felt his pulse, it was an abnormally slow 30 to 40 beats per minute.

“It got to the point where I walked from my apartment to the library, and I had to stop two or three times,” Murtaza says. “I wasn’t winded or short of breath. I was just tired.”

Murtaza, 25, took a detour to the student health center at Upstate. Among the tests he submitted to was an electrocardiogram, which showed the electrical functioning of his heart.

Murtaza had complete heart block. The impulses from his heartbeat were not working properly. That’s why his heart rate was so low and why he was getting dizzy.

He was promptly admitted to Upstate University Hospital. A temporary pacemaker was installed. As doctors set about trying to determine what caused Murtaza’s heart problems, Murtaza started thinking.

He’d been married early that summer, and for a quick honeymoon, he and his wife traveled to Maine for a long weekend at Acadia National Park. One morning, he awoke with joint pain and shoulder pain. He thought he had pulled a muscle or slept wrong. The pain went away, and he forgot about it. Then his right elbow started hurting. Then his left thumb started to hurt.

Looking back, Murtaza realized he had “migratory arthritis,” something that is sometimes seen in Lyme disease. He never noticed a rash. Nevertheless, the heart block he developed was blamed on a rare complication of Lyme called Lyme carditis.

Doctors put him on antibiotics for seven days in the intensive care unit, and he continued taking the medicine for two weeks after he was discharged. He eventually recovered.

Murtaza wrote about his experience in a poster presentation for this year’s Charles R. Ross Student Research Day at Upstate. “Of the 30,000 Lyme cases reported each year, only 1 percent present with meningitis or Lyme carditis,” says his poster. “My case elucidates the value of a complete history and demonstrates that a lack of the hallmark rash can often lead to the underestimation of symptoms.”

This happened between Murtaza’s first and second year of medical school. When classes resumed, he attended an infectious diseases lecture – and the professor discussed an interesting case of Lyme disease. Murtaza volunteered that he was the patient, providing a perspective not usually available in a medical class lecture.

This article appears in the summer 2017 issue of Upstate Health magazine.

Posted in arthritis, health care, heart/cardiovascular, infectious disease, medical student, patient story, public health | Tagged , , , ,