Mystery at the lake: Researchers uncover deadly potential of obscure, long-buried chemicals

Chemical compounds found in mud near Onondaga Lake’s southern end, above, likely came from the former Allied Corp., which dumped wastes in or near the lake for years. The compounds, related to the banned pesticide DDT, are extremely toxic at low levels and would like accumulate in the lake’s fish, making them dangerous to eat, researchers say. (PHOTO BY WILSON SUMMER/NEWYORKPHOTOGRAPHY.US)

BY JIM HOWE

Among the industrial wastes that have polluted Syracuse’s Onondaga Lake for decades are two “mystery compounds” related to – and apparently more toxic than – the banned pesticide DDT.

Scientists from Upstate Medical University, Syracuse University and the SUNY College of Environmental Science and Forestry have collaborated to study the chemicals, termed diphenylethanes, and whether they might cause seizures, developmental defects, brain damage or early death.

John Hassett, PhD, a professor of chemistry at ESF, has studied the lake for years and discovered these chemicals in a mud sample he took near the southern end of the lake.

He recognized the DDT-like structure of the two chemical compounds, which have no common names because they were never used commercially.

“It was a eureka moment for me when I realized how these two compounds came to be,” Hassett said. He had researched chemical processes going back to the 1880s and theorized that the lake’s chief industrial polluter, the defunct Allied Corp., produced the two chemicals as chance byproducts of refining oil produced from coking coal. The oily, thick compounds, officially designated as PTE (1-Phenyl-1-(p-Tolyl)-Ethane) and PXE (1-Phenyl-1-(2,4-Xylyl)-Ethane), had not been identified by industrial chemists, had no commercial use and were dumped in tar pits near the lake and possibly into the lake itself, he said.

Hassett and his team analyzed the newly found lake chemicals, which matched the material in the tar pits.

“When we looked at the structure, it has the same chemical backbone as DDT, so we wondered if this stuff might have biological consequences,” Hassett said.

Hassett has found the chemicals in the water all through the lake, apparently coming from very contaminated sediments near shore. “If it’s buried in the mud and not disturbed, it should stay there. If you go down about a meter into the mud in the middle of the lake, I think there is a layer through the whole sediment of the lake. It comes up to the surface in that shallow part in the southern end; in deeper parts, it is buried. We’re going to see what’s still out there,” Hassett said.

Dredging and capping of the lake bottom, completed this spring as part of a decades-long lake cleanup, probably stirred up some of the sediment, although any tar should remain buried in deeper sections, Hassett said. Since the tar is not very soluble in water, it probably is not much of a groundwater threat, he said. It is likely accumulated by lake fish, which health officials warn people not to eat. Some refugees and possibly other people, however, have been known to ignore warnings and eat fish from the lake.

To study the compounds’ possible toxic effects, Hassett partnered with James Hewett, PhD, and Katharine Lewis, PhD, associate professors of biology at SU. Lewis conducted studies on young zebrafish, while Hewett studied mice, both of which are often used as test models for humans.

“Because it looked like DDT, which has effects in development and is neurotoxic — DDT is linked to tremors and other neurological problems — we thought we’d test the neurotoxic potential of these compounds at the earliest stages of life,” Hewett said. “DDT is linked to tremors and other neurological problems.”

“My field of research is epilepsy. There is considerable interest now in how early life environment influences disease susceptibility later in life.”

Hewett exposed pregnant female mice to PTE and found their offspring seemed normal until adulthood, when testing showed they were more susceptible to seizures, such as happens with epilepsy. While it is difficult to mimic precisely how human exposure to these chemicals might take place, the mouse study provides a model for future testing, Hewett said.

Lewis found the chemicals to be extremely toxic at very low levels, hundreds of times lower than DDT. The lowest levels that they tested were similar to the levels Hassett found in Onondaga Lake in 1994. These levels cause heart defects and increased death rates in young zebrafish, and slightly higher levels caused increased susceptibility to convulsion behaviors that are similar to human seizures.

“I would be very surprised if the effects these chemicals have on zebrafish are fundamentally different than those on humans, but there may be subtle differences,” Lewis said. “It’s highly likely that the same effects would also occur in humans, but you can never say for sure.”

Also participating in the research, now in its third year and paid for by a grant from the Hill Collaboration on Environmental Medicine, is Frank Middleton, PhD, an associate professor of neuroscience and physiology and director of the SUNY Molecular Analysis Core at Upstate. Middleton assessed changes in gene expression – the process by which genetic information is made into a product, such as a protein — in the brains of the exposed mice offspring and zebrafish embryos. He was seeking clues that might help explain the altered seizure susceptibility and birth defects using a high-powered approach referred to as next generation sequencing (NGS).

“The NGS data are very compelling and indicate disruption of very specific genes and cellular signaling pathways is occurring as a result of the PTE and PXE exposures,” said Middleton.

The researchers all hope to continue studies based on this work.

“I would like to test other chemicals and see which genes might be turned on or off because of these chemicals. That could teach more about what can cause seizure or early development toxicity and might give more potential targets for therapy,” Lewis noted.

What is DDT?

DDT was a commonly used pesticide until it was banned in the U.S. in 1972 because it persists in the environment, accumulates in fatty tissues and can cause adverse health effects on wildlife, becoming more toxic as it moves up the food chain.

The two chemical compounds found in the Onondaga Lake mud — PTE and PXE — are related to DDT and appear to be more toxic. They have no known commercial value and have never been studied extensively before.

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

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Upstate stroke neurologists care for patients in remote areas

Mary Green, shown with her husband, Marshall, was airlifted to Syracuse from Alexandria Bay for stroke treatment after a consultation through the Upstate Telestroke network. (PHOTO BY SUSAN KAHN)

BY AMBER SMITH

This is a story about two women, living in different parts of rural Central New York.

Each suffered a stroke.

Each had a loved one who summoned help.

Each saw a stroke neurologist from Upstate University Hospital long before arriving at the academic medical center in Syracuse.

Upstate’s Telestroke partnership – which allows Upstate neurologists to provide clinical care from a distance — helped save the lives of both Amanda Peer of Watertown and Mary Green of Clayton.

A headache that wouldn’t stop

Green, 49, is a licensed practical nurse who has worked for 30 years at River Hospital in Alexandria Bay. She was supposed to work there Oct. 25, but at 5:15 a.m. she remained sound asleep, snoring. Her husband, Marshall Green, tried to wake her up, twice.

Elwaleed El Nour, MD

When he realized she was unresponsive, he called for their son, Dustin to help while they waited for the ambulance. They thought Mary Green might have overdosed on her medication.

The day before, Green had a headache that wouldn’t stop. She remembers going to bed early. That’s all she remembers. “I don’t remember anything for about 38 days. I kind of lost a month of my life.”

Her husband kept notes for her. At River Hospital, the doctors consulted with Upstate neurologist Elwaleed El Nour, MD, via Telestroke. His assessment allowed for a quick decision that Green needed prompt transport by helicopter for expert care in Syracuse.

At Upstate, Green immediately underwent an angiogram, showing the blood flow – and the blockages – in the vessels of her brain. She had what is called a bilateral occipital stroke, affecting the lower back part of her brain. This region that controls vision, coordination and balance, among other essential functions.

Carmen Martinez, MD

Green spent 38 days in Upstate’s specialized neuroscience intensive care unit for patients with neurological problems. Medications helped her recover from her stroke. After she was  stabilized, she was transferred to Upstate’s physical medicine and rehabilitation unit.

She went home Dec. 13. She continues to see neurologist Carmen Martinez, MD, who is trying to determine why Green had a stroke – although the reasons remain unknown for some stroke patients.

Green is not back to work yet. She can’t drive, but she can walk, and she’s hopeful her vision will continue to improve. She considers herself “a very fortunate, lucky lady.”

Debra Ezell and her daughter, Amanda Peer. After she suffered a stroke, Peer’s doctors in Watertown conferred remotely with the director of Upstate’s Comprehensive Stroke Center before deciding to transfer her to Syracuse. (PHOTO BY SUSAN KAHN)

A hand that went numb

Amanda Peer, 33, lay in her hospital bed Sunday, March 12, the day after her stroke. She watched doctors walk by her room. Then she saw him. “Mom! That’s the guy who was in the car.”

That guy was neurologist Gene Latorre, MD, medical director of Upstate’s Comprehensive Stroke Center.

Gene LaTorre, MD

The car he was in was his own. Thanks to telestroke technology, Latorre was in the back seat on his laptop computer, with his wife at the wheel, conferring by video with Peer’s  doctors at Samaritan Medical Center in Watertown.

Shortly before, Peer had been talking on the phone with her mother, Debra Ezell, who lives next door. She placed fish sticks in the oven, and her right hand went numb. She collapsed onto a fold-out bed in the adjacent room. Ezell came running when she got no response over the phone.

“My words weren’t coming to me,” Peer recalls. “I couldn’t think of the words I was trying to say.”

Hesham Masoud, MD

She was in and out of awareness. She remembers seeing Latorre on a monitor doing an assessment. Peer thought she lifted both feet when he asked, although only the left one moved. One minute she heard people talking about transferring her to Syracuse. The next, she was in Syracuse, and family members were pouring into her room.

Peer wound up receiving a dose of clot-busting medication called tPA before she arrived at Upstate. A scan revealed six clots in her brain. Upstate’s neurointerventionalist and stroke neurologist Hesham Masoud, MD, used a specialized clot retrieval device to remove the largest ones. The small ones were treated with medication.

Within 12 hours, Peer says she had her speech back. Four days later, she was well enough to go home. She credits God with helping the doctors help her recover.

Telestroke network hospitals

The Upstate Telestroke network includes nine outlying hospitals:

— Carthage Area Hospital

— Canton-Potsdam Hospital

— Claxton-Hepburn Medical Center in Ogdensburg

— Clifton-Fine Hospital in Star Lake

— Cortland Regional Medical Center

— Gouverneur Hospital

— Lewis County General Hospital in Lowville

— River Hospital in Alexandria Bay

— Samaritan Medical Center in Watertown.

This article appears in the summer 2017 issue of Upstate Health magazine. Click here to hear more about how to deal with a stroke if you suspect one is occurring, and also about Upstate’s outreach efforts in stroke care.

 

 

Posted in brain/neurology, brain/spine/neurosurgery, emergency medicine/trauma, health care, patient story, stroke, technology | Leave a comment

Are you age 52 to 72? Three health conditions to check

 

A state campaign aims to spread awareness among baby boomers about prediabetes, hepatitis C and high blood pressure, three conditions that can go unnoticed for years.

BY JIM HOWE 

Baby boomers can save their health, their lives and lots of money and trouble by getting themselves checked for three major but often neglected health problems, says New York State Health Commissioner Howard Zucker, MD.

The conditions – high blood pressure, prediabetes and hepatitis C – are the focus of a statewide campaign to encourage those born from 1945 to 1965, who are prime candidates for all three, to be screened and, if needed, treated.

The diseases often go undiagnosed because they may not have obvious symptoms, says Zucker, who toured the state this spring with other physicians for a series of talks to increase awareness. He suggests baby boomers ask their doctors about:

Prediabetes

Prediabetes involves a high blood sugar level. It’s possible to change diet and exercise routines to delay or prevent full-blown Type II diabetes, Zucker said at Upstate Medical University, which hosted one of the talks.

State Health Commissioner Howard Zucker, MD, hopes to raise awareness among baby boomers about major health issues they should have checked. (PHOTO BY JIM HOWE)

Diabetes can lead to numerous complications, including heart disease, blindness, kidney failure and lower-limb amputations.

More than a third of U.S. adults have prediabetes, and most don’t know it. More than half of Type II diabetes cases are preventable, according to the U.S. Centers for Disease Control and Prevention.

High blood pressure (hypertension)

Known as the “silent killer,” high blood pressure might go unnoticed for years if a person does not get regular checkups. About half of baby boomers have high blood pressure – defined as two consecutive readings of 140/90 or greater — and only about a half of them have it under control, Zucker said.

Medicines are available to control high blood pressure, which, if untreated, can lead to a stroke, heart attack or kidney problems.

Hepatitis C

Hepatitis C is the most common chronic viral disease in the United States. It is estimated that three out of four baby boomers are infected with the hepatitis C virus and that most don’t know it.

Spread through blood, this common infection might have been contracted years before from injecting illegal drugs, even once, or from people who received blood transfusions before 1992, when strict screening methods started.

The virus can destroy the liver but is curable through medications, noted David Bernstein, MD, a hepatitis C specialist who spoke at the Upstate event.

This article appears in the summer 2017 issue of Upstate Health magazine. Click here to hear an interview with Zucker in which he discusses the above-mentioned health issues as well as loneliness.

 

 

 

 

 

 

 

 

Posted in aging/geriatrics, diabetes/endocrine/metabolism, health care, HealthLink on Air, heart/cardiovascular, infectious disease, liver/ gallbladder/ pancreas, prevention/preventive medicine, public health, stroke | Tagged , , , , , | Leave a comment

Open wide and say ‘aha!’: Urologist looks to patient’s mouths for help repairing urethral strictures

Dmitriy Nikolavsky, MD, is director of reconstructive urology at Upstate University Hospital. He has completed more than 250 urethral reconstructions over the past four years. He is shown with his wife, Daniela Nikolavsky, who works in the urology laboratory. (PHOTO BY SUSAN KAHN)

BY AMBER SMITH

Only an innovative scientist with expertise in reconstructive urology would look at the inside lining of the cheek and wonder how those cells would behave if transplanted into the urethra, the tube that carries urine from the bladder.

Dmitriy Nikolavsky, MD, is that urologic scientist.

As director of reconstructive urology at Upstate University Hospital, Nikolavsky has completed more than 250 urethral reconstructions over the past four years. Many of the reconstructions were necessary because of patients with urethral strictures, a narrowing of the urethra with a variety of causes, including inflammation, infection, injury and previous surgeries or catheterizations.

He’s on a quest to find solutions for these patients. He earned a “Young Investigator” grant this year from the northeastern section of the American Urologic Association. And in May the Journal of Urology chose his research paper as best paper in investigative urology in 2016. (For a video presentation of that paper, in which Nikolavsky wrote on liquid grafts with several co-authors from Upstate), click here.

A normal cross-section of a urethra. (FROM THE LAB OF DMITRIY NIKOLAVSKY, MD)

Spray paint or wallpaper?

Among the traditional treatments for urethral stricture are a urethral dilation meant to stretch scar tissue without injuring the lining of the urethra, or an endoscopic procedure that involves internal cutting to widen the urethra, called a urethrotomy. These procedures often do not provide lasting relief.

An open surgery called urethroplasty has a better success rate, but not many urologists have the proficiency to offer it as an option to patients.

Nikolavsky says the success of urethroplasty can be improved with the use of a buccal mucosa graft, which many reconstructive urologists have used for several decades. That’s where the surgeon cuts a section of tissue from the patient’s inner cheek and transplants it like wallpaper onto the inside of the urethra.

Tissue from inside the mouth is a natural substitute for urethral tissue because both are from wet, hairless environments, and because surgeons can easily access the inside of the mouth. Also, the inside of the cheek typically heals quickly, similar to the way a pizza burn wound heal.

Unfortunately, transplanting tissue directly from the mouth and onto the urethral defect requires an open surgery that is technically difficult and not widely available from all urologists.

So, Nikolavsky is experimenting with a couple of ways to complete a two-step process that he hopes will become a feasible alternative option. Instead of a surgeon “wallpapering” the damaged area of the urethra with buccal mucosa in an open surgery, Nikolavsky wants to be able to “spray-paint” a buccal mucosa solution through an endoscope, a tubular instrument.

A buccal mucosa engraftment. (FROM THE LAB OF DMITRIY NIKOLAVSKY, MD)

Here’s how it might work:

In one version, the tissue could be removed from the patient’s mouth and immediately processed into a liquid. Then, the urologist could place a catheter (tube) in the urethra, and the liquid buccal mucosa would be injected around the catheter. The catheter would stay in place for a week, until the urethra heals.

Another method Nikolavsky is exploring would remove the tissue from the patient’s mouth and send it to a laboratory. Fragments of the buccal mucosa would become part of a liquid solution containing a fibrin glue, designed to help the solution adhere to the damaged area of the urethra. The patient would return another day for the second step, in which the liquid graft would be added to the urethra through an endoscope.

“Buccal mucosal cells have increased metabolism and contain numerous fibroblast and epithelial progenitor cells with stem cell properties,” which means they are ideal to help with wound-healing, Nikolavsky and colleagues describe in the Journal of Urology in 2016.

Urologists are not the only ones excited about the potential of buccal mucosa grafts. Scientists studying regenerative medicine are looking at such grafts for use in reconstruction of the cornea, esophageal (food pipe) strictures and skin burns.

This article appears in the summer 2017 issue of Upstate Health magazine. To hear a “HealthLink on Air” interview in which Nikolavsky and fellow Upstate urologist Jonathan Riddell, MD, discuss innovations in minimally invasive surgery, click here

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Disability is a matter of both perception and reality

BY JIM HOWE

Defining who have disabilities and how to meet their health needs is tricky because there is no standard formula and because disabilities can take so many forms.

Some researchers look at disability as a medical problem needing medical care.

Others take a functional view and define people with a disability in terms of the work or activities they can perform.

Still others look at disability through a social lens, considering conditions in the social environment that prevent participation in society and how to remedy that.

Add to that the general tendency to view someone who uses a wheelchair as having a disability, but to overlook those with less visible disabilities, such as deafness or psychological issues, and it becomes clear how muddled the definition of “disability” actually is.

Even people with disabilities might disagree with the term.

Varying definitions

Studies have shown almost 75 percent of those who cannot hear and more than half of those who cannot see don’t consider themselves as having a disability, nor do 20 percent of people who use manual wheelchairs or 16 percent who use powered wheelchairs. Many people with an impairment don’t claim a disability, says Margaret Turk, MD, an Upstate professor of physical medicine and rehabilitation, pediatrics, public health and preventive medicine.

Margaret Turk, MD

She says such varying definitions and methods of estimating the population of people with disability are among the challenges to delivering health care to this group. The federal Centers for Disease Control and Prevention report these percentages of Americans as having a disability:

  • 13 percent of the total population;
  • 5 percent of children ages 5 to 15 years; and
  • 22 percent of adults.

Improving lifespans

Turk spoke about the challenges people with a disability face in health care in a recent lecture at Upstate. Just getting into an office for a medical appointment can be difficult. So can dealing with health insurers and health care providers, some of whom may view people with disabilities as time-consuming and complicated.

Another complicating factor is how people with disability view their health. When asked how they rate their health, people with disability report good and excellent health ratings even with a relatively large number of days of poor physical health. Seeing so many days of poor health, health care providers tend to view people with disability as having poor health and, therefore, poor quality of life – which may not be the case.

While it’s true that people with certain disabilities generally face shorter life expectancies, Turk says that is improving. She also points out that people with disability can participate in the same wellness activities as people without disability, such as exercise and smoking cessation programs, with the same positive health effects.

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

 

 

Posted in disability, health care, physical therapy/rehabilitation | Tagged

Sleep trouble leads to depression, which leads to medication, which leads to sleep trouble

BY AMBER SMITH

When patients begin taking antidepressants, their health care providers typically warn that the medication may reduce sexual desire and performance and may increase appetite and weight gain. Often missing is a discussion about how the medication may affect sleep.

That’s an important omission, especially for older adult patients, says Muhammad Tahir, MD, who is doing an externship in psychiatry and behavioral sciences at Upstate. He says antidepressants can interrupt sleep for senior citizens and may raise their risk of developing dementia.

Tahir led a team of researchers who analyzed studies published between 2011 and 2016 about sleep disorders and antidepressant use in people over age 50. He presented their work at a mental health services conference last fall.

Antidepressants significantly affect what doctors refer to as “sleep architecture,” the way a person cycles through the stages of sleep, according to Tahir’s findings.

In older adults, the situation can be a vicious circle.

Sleep disturbances become more common as people age, often with light sleep increasing while deep sleep wanes. Such changes can cause physical and mental problems, including depression, which is not unusual among the elderly. Antidepressants used to treat depression are liable to cause more – and potentially more serious – sleep disturbances.

Older adults taking antidepressants may have more trouble falling asleep, Tahir’s review shows. They may also experience less REM sleep, the paralyzing dream state so named for the rapid eye movements that occur.

Some older adults taking antidepressants may experience REM sleep without the natural muscular paralysis called atonia. This may lead to nightmares or the acting out of vivid or violent dreams. Such behavior can happen while taking any type of antidepressant, but Tahir noticed that older adults taking selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed type of antidepressant, were more likely to report it.

Studies he reviewed indicate that such behavior may be an early sign of neurodegeneration.

Tahir concludes that health care providers should be careful about prescribing SSRIs, including Prozac, Celexa and Lexapro, in elderly patients.

He also cautions that before a senior citizen begins taking an antidepressant, he or she should realize that sleep may be affected and be screened for signs and symptoms of neurodegeneration.

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

Posted in aging/geriatrics, brain/neurology, depression, drugs/medications/pharmacy, mental health/emotional health, psychology/psychiatry, research | Tagged , , ,

This common medical device dates back centuries

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

Posted in health care, history, technology | Tagged

Have you seen the new ‘Upstate Health’ magazine?

As a mother, I cannot select one child as my favorite. As an editor, I don’t have one favorite magazine issue. I love them all.magCVR

That said, this summer issue of Upstate Health is a particularly good one, for a bunch of reasons:

1. The urologist on the cover is conducting some really cool research (which you can read about on page 12) that may lead to a new way to treat urethral strictures.

2. We made a game out of patient satisfaction surveys. See if you can match the comment to the doctor, on page 2.

3. So much is going on at Upstate that you’re bound to find at least one news item on page 4 that you missed.

4. Ever wonder how people who suffer strokes in rural areas receive care from the experts at Upstate, even before they arrive at the hospital in Syracuse? On page 5, meet two women who will tell you all about it.

5. If you have been told you have multiple sclerosis, consult page 7 for two important questions to ask.

6. Newborn babies are screened for phenylketonuria with a few drops of blood collected from the heel or the bend in the arm. What is life like for those who have PKU? We feature an adorable 5-year-old who has PKU on page 8.

7. A story on page 9 explains one reason you may be awakened during your hospital stay.

8. Page 10 features one of the most ubiquitous, recognizable medical device, which is 200 years old. Can you guess what it is?

9. The next page offers terrific explanations of five behaviors that are common in dementia, from a social worker at the Central New York Chapter of the Alzheimer’s Association. It’s a must-read if you are a caregiver or have a loved one with dementia.

10. When someone begins taking an antidepressant, they may not realize how it could affect their sleep. Sleep disturbances can lead to physical and mental problems, including depression. And the antidepressants used to treat depression are liable to cause more — and potentially more serious — sleep disturbances. A vicious circle. Learn more about it on page 14.

11. The state health commissioner visited campus earlier this year, calling attention to three health conditions that are important for baby boomers. On page 15, you can read more about pre diabetes, high blood pressure and hepatitis C.

12. In addition to the advice for protecting your family from Lyme disease on page 16, a medical student shares his frightening experience with a rare complication of Lyme called Lyme carditis.

13. If you know someone with a disability, be sure to read page 18. Disability is a matter of both perception and reality. Even the use of the word ‘disability’ may not be proper.

14. Scientists from Upstate, Syracuse University and the SUNY College of Environmental Science and Forestry have worked together to study the industrial waste that has polluted Syracuse’s Onondaga Lake for decades. In a story on page 20, they talk about two mystery compounds that are apparently more toxic than the banned pesticide, DDT.

15. Page 22 showcases a fitness class that uses wooden sticks. It’s a martial art called kali, and several enthusiastic students practice together every week. It looks like fun.

There’s more, of course. I haven’t highlighted everything. I did, however, count the number of Upstate faculty, staff, health care providers, students, graduates, patients and community partners who are named on the pages of this issue: 71.

Upstate Health is a free publication that is distributed quarterly. To join our mailing list, send an email to magazine@upstate.edu with “Upstate Health” in the subject line and your name and address in the body of the email. In the meantime, you can check out all of our issues electronically.

Posted in aging/geriatrics, alternative/integrative medicine, Alzheimer's/dementia, brain/neurology, brain/spine/neurosurgery, community, depression, disability, drugs/medications/pharmacy, education, emergency medicine/trauma, Expert Advice, family medicine, fitness, health care, heart/cardiovascular, history, infectious disease, Joslin Diabetes Center, medical student, mental health/emotional health, nursing, patient story, public health, research, sleep, stroke, Upstate Golisano Children's Hospital/pediatrics, urology

How to help your child during emergency care

PHOTO BY ROBERT MESCAVAGE

  1. Stay calm. Your child will look to you to see if they should be nervous, upset or scared. The calmer you can remain, the calmer your child will be.
  2. Be honest. Children do best when they are prepared for what is going to happen. If something is going to hurt, sting, tickle or be cold, tell your child what it will feel like and how long it will last.
  3. Give comfort. Your child may need extra comfort from you and may not act how they would at home or in a familiar environment. Hold them on your lap, hold their hand, ask for a blanket, or dim the lights to help your children feel more comfortable.
  4. Speak up. If your child is in pain or you have a question or concern regarding your child’s care, please speak up. You know your child best, and the staff needs your help to provide the best care for your child.
  5. Provide distraction. Playing games or helping your children focus on something else can help distract them if they are in pain or nervous. Counting, I-spy, 20 questions, singing, storytelling and deep breathing can all work to distract your child and require no extra equipment.This article appears in the summer 2017 issue of Upstate Health magazine.
Posted in emergency medicine/trauma, family medicine, health care, Upstate Golisano Children's Hospital/pediatrics

Why you may be awakened during your hospital stay

Thomas Welch, MD (center), with a group of medical residents and students at the Upstate Golisano Children’s Hospital. (PHOTO BY SUSAN KAHN)

Keeping patients safe sometimes involves disturbing them in the middle of the night, explains pediatrics chief Thomas Welch, MD, the medical director of the Upstate Golisano Children’s Hospital.

Fluids or medications can leak from a patient’s intravenous line into surrounding tissue if the IV gets jostled after it’s placed. It’s called IV infiltration. Complications can be serious, but damage can be minimized if it’s caught early.

This complication goes by the name “peripheral IV infiltration and extravasation,” or “pivie.”  Welch explained that the children’s hospital is part of a national consortium of children’s hospitals looking at the causes and prevention of pivies.

That is why nurses inspect intravenous sites at regular intervals, around the clock, during a hospital stay.

Welch says what may seem like a bothersome intrusion is a critical component of an effort to protect patients from adverse events. And depending on a patient’s sleeping position, nurses may be able to see and feel the IV while their patients remain sound asleep.

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

Posted in health care, nursing, Upstate Golisano Children's Hospital/pediatrics | Tagged , ,