Healthy now, after final chemotherapy in October

drKerr

After receiving her final chemotherapy treatment in October, Sadie Wilson, 4, was escorted to her port removal surgery by her doctor, Karol Kerr, MD. Sadie was diagnosed at 22 months of age with acute lymphoblastic leukemia and was cared for at the Upstate Cancer Center. Today, she is a healthy pre-kindergartner in her family’s hometown of Oswego. She is the twin sister of Layla and daughter of Michael and Meghan Wilson, who took this photo. It appears on the back cover of the winter 2015 issue of Cancer Care magazine.

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Improved shoulder implant designed to last

Upstate is one of two health care facilities in New York state and among only six facilities nationwide to use the FDA-approved implantable SMR TT metal back glenoid implant for shoulder replacements.

Upstate is one of two health care facilities in New York state and among only six facilities nationwide to use the FDA-approved implantable SMR TT metal back glenoid implant for shoulder replacements.

Patients who need shoulder replacements have a new option in a novel, improved implantable device available at Upstate Medical University. Upstate is one of two health care facilities in New York state and among six facilities nationwide to use the FDA-approved SMR TT metal back glenoid implant for should replacements.

Kevin Setter, MD, performs the surgeries through the Upstate Bone and Joint Center.

The implant allows for complex replacements to be done in a less invasive manner, and for patients to achieve a greater range of motion following surgery. A cup-shaped device replaces the glenoid and creates a secure, long-lasting bond by allowing for bone ingrowth. The device is made of a special metal, tantalum titanium (TT), which is a porous material that allows bone to grow in and around the device.

Setter said the device is significantly better than the more traditional shoulder prostheses used in shoulder replacement surgery, and it is an appealing option for younger patients. He is an associate professor of orthopedic surgery at Upstate.

“Traditional artificial glenoids use bone cement to secure the prosthesis,” said Setter. “In time, the cement bone interface loosens. This may lead to pain, decreased function and possible need for revision surgery. The fixation of cemented components is greatest when first implanted. Over time this fixation will loosen. The SMR  TT metal back glenoid gains its fixation from a tantalum coated peg, available in various sizes to fit anatomical needs.

“The hope is that with this new design, the fixation of the component will increase over time as the patient’s bone grows into the implant, forming a more solid bond. This in turn will hopefully lead to an improvement in already good long-term results with shoulder replacement surgery.”

That’s why younger patients may be suited for the new design.

The first of the TT glenoids was implanted in Italy in October 2013. Upstate was one of two centers in the country chosen by Lima Corporate for implantation of this special prosthesis. Setter has performed complex shoulder replacement surgery in Italy, Germany, Switzerland and England and has both trained with and taught some of the most well-respected shoulder surgeons in the world.

To learn more about the SMR  TT metal back glenoid, contact the Upstate Bone and Joint Center at (315) 464-8634.

Shoulder replacement is featured in the March 2015 issue of Physicians Practice

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Recipe: Frozen Pumpkin Mousse Pie

Photo courtesy of Morrison's.

Photo courtesy of Morrison Healthcare, food service provider for Upstate Medical University.

When you crave something decadent and sweet, it can be tricky not to go overboard on calories.

Here’s a recipe from Morrison Healthcare, the food service provider for Upstate Medical University, that can satisfy a sweet tooth with a reasonable amount of calories – as long as you stick with a single 1/10th-of-the-pie slice. As an added bonus, the pumpkin provides a strong helping of vitamin A.

Organs including the heart, lungs and kidneys depend on vitamin A to work properly, and the vitamin is important for normal vision, the immune system and reproduction.

Ingredients

Crust

30 small gingersnap cookies (about 7 ½ ounces)

2 tablespoons raisins

1 tablespoon canola oil

Filling

1 cup canned pumpkin puree

1/3 cup packed brown sugar

½ teaspoon ground cinnamon

¼ teaspoon ground ginger

½ teaspoon freshly grated nutmeg

2 pints (4 cups) frozen low-fat vanilla ice cream, softened

Preparation

1. Preheat oven to 350 degrees Fahrenheit. Coat a 9-inch deep-dish pie pan with cooking spray.

2. To prepare crust, combine gingersnaps and raisins in a food processor and pulse until finely chopped. Add oil and pulse until blended. Press evenly into the bottom and up the sides of the prepared pan.

3.  Bake the crust until set, about 10 minutes. Transfer to a wire rack to cool completely.

4. To prepare filling, combine pumpkin, brown sugar, cinnamon, ginger and nutmeg in a   large bowl and mix well. Add ice cream and stir until blended. Spoon the mixture into the cooled pie crust. Freeze until firm, at least 2 hours. Let the pie soften slightly in the refrigerator for 20 to 30 minutes before serving.

Nutritional information

Pie makes 10 servings. Per serving:

231 calories

5 grams of fat

4 milligrams cholesterol

42 grams carbohydrates

26 grams added sugars

4 grams protein

2 grams fiber

158 milligrams sodium

149 milligrams potassium

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Study: Free antibiotics meant more patients filled prescriptions

Doctors have a tendency to prescribe medications for which they have free samples to give to patients, according to several previous studies. Would doctors similarly prescribe medications that patients could get for free at Wegmans?

That’s what a group of Upstate emergency medicine researchers wondered as they compared data provided by Wegmans for its pharmacies in Onondaga County. The grocery chain headquartered in Rochester offered nine generic oral antibiotics for free starting in 2009. So researchers lead by Jeremy Joslin, MD, compared 214,892 antibiotic prescriptions from the first six months of 2008 with 221,480 from the first half of 2009.

“The promotional pricing of the antibiotics had a significant impact on the number of prescriptions filled,” Joslin wrote in a study published in September in the journal, Pharmacy Practice, with colleagues Susan Wojcik, PhD and William Grant, PhD. The number of antibiotics filled that were included in the promotion increased by 13 percent, while the number filled that were excluded from the promotion decreased by 20 percent.

Joslin says to help ensure that patients fill their prescriptions, doctors should pay attention to promotional programs when appropriate.

Today, Wegmans sells many generics for $4 for a 30-day supply, and several other retail pharmacies offer similar deals.

 

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Eight ways to burn calories in Central New York in winter

Say you’ve got two hours on a Sunday afternoon in Syracuse. The way you spend that time will determine whether you burn a whole bunch of calories – or not.

Keep in mind, the precise number of calories a person burns is influenced by the person’s age, body weight, gender, activity level and movement efficiency. Use these numbers — calculated for an 180-pound person — only as a guide.

couchpotatoCouch potato: burn 132 calories

icehockeyPlay ice hockey: burn 1,420 calories

poolShoot pool: burn 397 calories

skiSnow ski, at moderate speed: burn 972 calories

mother and children making cookiesBake cookies: burn 240 calories *

snowmobileSnowmobile: burn 572 calories

cardsPlay cards: burn 200 calories

Winter'sActivitiesASnowshoe: burn 1,308 calories

* not counting the calories you add from the cookies you eat

This list was reviewed by exercise physiologist Carol Sames, PhD, director of the Vitality fitness program at Upstate’s Institute for Human Performance.

 

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He recovered from a broken neck

Edward L. St. George, a seasonal resident in Cape Vincent, looks out toward the St. Lawrence River near the spot from which he fell last summer and broke his neck. Photo by Amanda Morrison, Watertown Times

Edward L. St. George, a seasonal resident in Cape Vincent, looks out toward the St. Lawrence River near the spot from which he fell last summer and broke his neck. Photo by Amanda Morrison, Watertown Times

One minute, Edward St. George was on the deck of his family cottage on the St. Lawrence River in Cape Vincent, taking measurements for vinyl siding work he was doing that day.

The next, he was falling from the granite ledge the deck overlooked. His neck and upper back struck the edge of the rock about five feet down. He fell over the cliff, slamming against rock abutments for 15 or 20 feet on his way to the ground. Two or three barrel rolls later, his body came to rest against the back of a neighbor’s cottage.

“All I could do was breathe and blink my eyes. I couldn’t even make a sound. I remember looking out of the corner of my eye and seeing what I thought was my hand, and I couldn’t move it. I couldn’t move anything,” St. George recalls.

The drama that unfolded among the boulders in Cape Vincent stretched into the emergency department and operating rooms at Upstate University Hospital in Syracuse and into the physical and occupational therapy unit at Strong Memorial Hospital, near St. George’s home in suburban Rochester.

Edward St. George with neurosurgeon, Lawrence Chin, MD.

Edward St. George with neurosurgeon, Lawrence Chin, MD.

St. George, 62, – an engineer who worked in middle management at Eastman Kodak, Co. and ITT/Exelis before taking early retirement – may not have survived to walk again were it not for the careful handling by rescuers. In cases of spinal injury, movement could cause further damage. “You could take someone who would otherwise have a recovery, and make it a complete injury,” says Lawrence Chin, MD, who leads the department of neurosurgery at Upstate.

The neighbor who heard a loud thud against her cottage and came to investigate instructed others not to move St. George before dialing 911. He was wedged between her cottage and steep terrain. Rescuers from the Cape Vincent Ambulance Squad and the Thousand Islands Emergency Rescue Service had the tricky task of getting St. George onto a backboard without jostling his body, and then onto a helicopter so he could be flown to Upstate. St. George remembers almost getting sick during the flight, and how the paramedic soothed him.

Hear an interview with St. George and Dr. Chin

More than a year after the accident, St. George believes he is 90 percent back to where he was prior to his injury. “My left arm can still sometimes be uncomfortable with nerve pain. My left hand is still numb. But my grip strength and my left arm’s range of motion have returned, thanks to therapy.”

spinalcordboxHe remains grateful to his rescuers and caregivers.

“A lot of little towns, you wouldn’t necessarily expect phenomenal response, but that is indeed what I received,” he says.

St. George underwent computerized tomography at the hospital. The doctor in the emergency department stood over him going over the imaging results. He will never forget her reaction.

“She put her hand across her chest and leaned over to me and said ‘you are my miracle today.’”

One vertebra in his neck was pushed forward. That vertebrae plus the ones above and below it were badly fractured.

Chin developed a plan to use traction to help the middle vertebra slip back into place. St. George wore a weighted halo of metal bars for about 36 hours. He could feel the tug. It was uncomfortable.

“It worked,” he says. “Luckily, a day and a half or almost two days later, I had the surgical procedure.”

Fractured bones will heal, but ligaments that connect the bones of the spine do not. So Chin made two incisions, one in the front of St. George’s neck and another in the back. He installed a plate in the front and screwed rods into place in the back, fusing three vertebrae. Several weeks later, after St. George developed severe numbness in his left arm, the surgeon operated again to fuse a fourth vertebrae.

St. George has been in physical and occupational therapy for more than a year. He has sworn off extension ladders and roof work. Life has gotten back to normal for him.

He appreciates the entire medical team at Upstate, including the emergency department and imaging technicians, nurses, therapists and surgical team, plus everyone who cared for him during his stay of more than two weeks. “The skill and genuine desire to help me were extraordinary.

“The outcome has been terrific. I couldn’t be more grateful,” says St. George. “I’m sure Dr. Chin considers it routine, what he did, but I don’t. When it’s you, it’s a miracle.”

Hear an interview with St. George and Dr. Chin

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Talking about caring in ‘Schwartz Rounds’

Health care providers at an academic medical center routinely attend lectures on a variety of topics. At Upstate, they gather with other staff for Schwartz Center Rounds, a multidiscipliary forum where caregivers discuss social and emotional issues that arise in caring for patients.

Healthcare workers spoke recently about an 85-year-old man who appeared to be at the end of life, but whose family insisted that everything be done to save him.

A nurse who cared for the man saw suffering on his face. She felt helpless. “If we can’t save a patient, the most important thing for nurses and health providers is to make the patient comfortable. And we couldn’t make this patient comfortable.”

When the man’s heart stopped, the family insisted that staff perform cardiopulmonary resuscitation for more than an hour. Some families have false hopes. The nurse told the Schwartz Rounds group that she and her coworkers have since recovered, “but it’s a case you cannot forget.”

Schwartz Rounds organizer Virginia Larson, from Upstate’s Spiritual Care Department, says “this case, and others like it, affected caregivers so profoundly because they care so much.”

Hear an interview with Larson on this subject

 

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Surgery can repair urethral stricture: One woman’s story

Even knowing how painful it was to have her urethra dilated when it was obstructed and prevented her bladder from emptying, Patricia Moro was still hesitant to pursue a surgical repair.

Moro’s life began revolving around the bathroom. She could not travel because she had to stop so frequently for bathroom breaks. She did not sleep well because she was up 10 times a night. Even dining out became difficult, as did babysitting her grandchildren. When she needed to void and couldn’t, she would end up at a hospital emergency department for a painful catheterization.

Dimitriy Nikolavsky, MD

Dimitriy Nikolavsky, MD

She underwent repeated dilations to treat her stricture, an abnormal narrowing of the tube that leads out of the body from the bladder. It’s an obstruction caused by scar tissue from surgery, inflammation, disease or injury. Each time she was catheterized, weeks later, Moro would suffer urinary retention again. Finally Moro’s doctor referred her to Dmitriy Nikolavsky, MD,  Upstate University Hospital’s director of reconstructive urology and female urology and neurourology.

Having never undergone surgery, she was nervous.

“It was very hard for me to consider surgery,” says Moro, 48, of Cicero. “I listened to Dr. Nikolavsky. He made me feel secure.”

The surgeon says the use of dilation to treat strictures dates back 3,000 years to India, where practitioners worked with candles and the horns of animals to complete the task of widening the urethra. Then, as now, the procedure was not effective long-term.

Another treatment called an internal urethrotomy originated with the barber surgeons of medieval Europe. It used a dilation device with a pop-up knife but it, too, does not last.

Both dilation and urethrotomy procedures are still in use today, but Nikolavsky says urologists are beginning to favor urethroplasty, which is more invasive but has a success rate of 85 to 95 percent.

He developed an early interest in male and female reconstructive urology during residencies in surgery and urology at William Beaumont Hospital in Michigan. During that time, he traveled to Mozambique to perform female fistula repairs, and to India where he learned from one of the world leaders in genitourinary reconstruction. Nikolavsky then honed his urethroplasty skills during a reconstructive urology fellowship at the University of Colorado School of Medicine. He joined Upstate in 2012.

In Moro’s case, the surgery involved Nikolavsky cutting open the urethra, removing the scar tissue and covering the area with a graft of tissue taken from the inside of her cheek.

The surgery was first described in a medical journal more than a century ago, Nikolavsky says. It wasn’t appreciated at first, but for the last several decades urologists have realized that the buccal mucosa — as they refer to the inner cheek –makes for a perfect urethral graft. The tissue is moist, it doesn’t grow hair, and the inner cheek heals quickly. To the patient, it’s like a burn from biting into a too-hot slice of pizza.

Moro awoke from the operation with a large ice pack on the side of her face and a catheter, which she wore while her body recovered. Moro remembers that when the catheter was removed and she was able to void normally, Nikolavsky and his staff cheered.

“I have my life back,” she thought as she went home from his office that day.

Posted in community, surgery, urology, women's health | Leave a comment

A parent shares how to embrace life with a special needs child

The Pelton family.

The Pelton family resides in Rome, NY.

By Lindsay Pelton

To Parents of Children with Cystic Fibrosis,

That first pregnancy test: joy, happiness, excitement. Everyone says, “Boy or girl, I don’t care, as long as the baby is healthy.”

Well, what if the baby is not healthy? What if you are told you have a sick child, physically or mentally? What if you are told your child will have to struggle his whole life just to be “normal?”

You suddenly enter a different world. It is not a horrible world, just different from the one you expected.

You will mourn the loss of the life you thought you would have. Will your life still be happy? Yes. Will there still be joy and excitement? Yes. Will the flowers still bloom in the spring? Yes.

Sooner or later you will realize that the world you entered when you learned your child was not healthy does contain the makings of a happy life, where dreams and hope are still possible. And you will realize that maybe, just maybe, this life could be better than the life you had imagined.

Dylan Pelton

Dylan Pelton

Your child begins to grow, and he is smart, funny and beautiful. He has a zest for life that only a child of his nature could possess. He has so much strength, determination and spirit inside his little soul. This child chose you to raise him, nurture him and teach him about life — although it is almost certain he will teach you more than you will ever teach him. He impacts the lives of those around him. He is a beautiful being, perfect in every way.

Day-to-day life will sometimes be a struggle. But then one day he will smile at you. His laughter will be intoxicating. In this moment, everything will be well and safe. His eyes will reveal the wisdom unique to a special needs child. His eyes appear as though he carries the whole world inside them. He radiates light and love. He is special. He is yours. Your gift.

You have an epiphany. You realize you wouldn’t trade him for all the healthy children in the world. You would rather nurture a sick child than a healthy one, because he needs it more. He is yours for a reason. He has a bigger purpose, and you do, too. You, and only you, can provide your child with the love he needs. He, and only he, can show you that the life you have is better than the one you imagined.

You gain insight that you would have never otherwise received. This child, you realize, is a gift sent to show you a secret about life that most people will never have the privilege to understand. It is an honor to raise this precious child. He is here to teach about love and life. He shows you that in times of pain, there is love.

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No, this is not bubble wrap

Normal rat alveoli. From the laboratory of senior research Gary Nieman.

Normal rat alveoli. From the laboratory of senior research scientist Gary Nieman.

This issue’s “Science is Art is Science” feature comes from the laboratory of senior research scientist Gary Nieman. And no, it’s not bubble wrap. It’s a microscopic look at the air sacs in the lungs of a rat during mechanical ventilation. Nieman developed a viewing technique which aids in his investigation of the pathogenesis and treatment of acute respiratory distress syndrome and ventilator induced lung injury. Nieman is an associate professor in Upstate’s department of surgery. He also directs the cardiopulmonary and critical care laboratory, where research focuses on the pathophysiology and treatment of septic and traumatic shock.

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