Emergency care for kids expands

Upstate’s new pediatric emergency department. (PHOTOS BY ROBERT MESCAVAGE)

 A $3 million expansion doubles the size of Upstate University Hospital’s pediatric emergency department and separates the children from the adults seeking emergency care.

Children and their families still use the main emergency entrance on East Adams Street, then take an elevator to the fourth floor.

Richard Cantor, MD, director the pediatric emergency department.

The new department, which opened in August, can hold up to 24 patients and includes 18 private rooms, plus a pediatric diagnostic radiology unit. It’s designed and furnished with kids in mind, with plenty of gaming systems for all ages.

As a result of the pediatric expansion, the adult emergency department also grows. The 13 beds that were previously reserved for children are now being used for adults.

magazine-fall16cvrHLOA-4C-VERT-REVThis article appears in the fall 2016 issue of Upstate Health magazine. Click here for a radio interview/podcast with Cantor on the new pediatric emergency room.

Posted in adolescents, community, emergency medicine/trauma, health care, HealthLink on Air, illness, Upstate Golisano Children's Hospital/pediatrics | Tagged ,

Meet Carey and Sally: Kids’ book explains, embraces children with autism

Carroll Grant, PhD, with Carey (left) and Sally, the puppet characters who inspired the book “Carey & Sally: Friends With Autism.” (PHOTO BY ROBERT MESCAVAGE)


“Sally and I are kids just like you,” says Carey. “We have autism and learn a little differently, but we want friends just like you.”

Carey and Sally are the main characters of a new children’s book that aims to create a sense of understanding and acceptance of children with autism.

These children can be talkative and highly functioning, like Carey, or mostly nonverbal, like Sally, and “Carey & Sally: Friends With Autism,” explains autism’s spectrum of behaviors and also how each person with the condition is unique.

Or, as Carroll Grant, PhD, the book’s author says, recalling an old saying, “If you’ve seen one autistic kid, you’ve seen one autistic kid.”

Grant, director of Upstate’s Margaret L. Williams Developmental Evaluation Center, has been working with children with autism for decades. The book, with illustrations by Jerry Russell of Chittenango, grew out of KidSpeak (see “How the book came about,” below) that follows), a program Grant developed.

That program uses large puppet versions of Carey and Sally to demonstrate autistic behaviors while entertaining in schools and other locales with children. The book will stay in the classroom after the program ends and includes suggestions for children to help deal with peers who have autism.

Carey, either as a book character or a puppet, helps other children and teachers “to understand that spectrum (autistic) kids have a social ineptness, and because he’s cute and funny, it helps people be more accepting,” Grant says.

To explain his difficulties reading social cues, Carey says, “My friends tell me I talk too much. I am not good at knowing what other kids think or feel, so sometimes I bother my friends.”

Carey also explains that he likes to have his mom or his teacher write him a list each day. “This helps me know what to expect and what to do. Then I feel calm,” he says

To illustrate a more severe form of autism, Sally is shown with her tablet and “choice board,” which has a happy face/yes and a sad face/no that she points to when answering questions. She sometimes likes to rock back and forth and wave her hands, Carey explains.

Carey also shows how to be a “detective” to figure out what is making Sally upset, such as checking to see whether he is standing too close or whether the room is too noisy or too bright.

The puppets help “normalize” autism for other children, says Charissa Taylor, who works in instructional support and is one of the puppeteers in the traveling program. They are teaching that “a difference can mean different, not handicapped. The bottom line is that everyone seeks friends.”

Taylor notes that one or more audience members usually says they know someone with autism and recognizes the puppets’ behaviors.

How the book came about

With help from the Upstate Foundation, Carroll Grant got funding from Kohl’s department stores to start a puppet workshop about autism and later to create a companion book, “Carey & Sally: Friends With Autism.” Help with the puppetry for what became the KidSpeak program came from Open Hand Theater of Syracuse, where Grant, a board member, had seen skits and shows using puppets to shape attitudes about acceptance and making the world a better place.


magazine-fall16cvrThis article appears in the fall 2016 issue of Upstate Health magazine. For more about “Carey & Sally: Friends With Autism,” click here.

Posted in adolescents, autism, education, mental health/emotional health, Upstate Golisano Children's Hospital/pediatrics | Tagged , , , , , , , , ,

What ‘I CARE’ is all about

Rasheedah Vereen, a hospital clinical technician at Upstate University Hospital. (PHOTO BY KATHLEEN PAICE FROIO)

You may see doctors, nurses or technicians wearing buttons that say, “I CARE.”

More than a clever acronym, I CARE expresses a sentiment while also describing some of the ways in which caregivers at Upstate University Hospital make the hospital experience as pleasant as possible. The campaign started in the often-busy environment of the emergency department and has expanded throughout the hospital.

The message behind I CARE:

I –- Introduce yourself to patients and their loved ones.

C –- Connect with patients and their family members in a meaningful way, using eye contact and communication.

A –- Acknowledge the concerns of patients and their loved ones.

R – Review the plan of care, so people understand what you are communicating and what tests and treatments are ordered.

E – Educate patients and loved ones about what to expect, discharge instructions and medications.


Posted in community, emergency medicine/trauma, health care

Dementia insights: Advice for caring for someone in mental decline

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The Alzheimer’s Association estimates 5.4 million American are living with Alzheimer’s disease, a number that is expected to escalate rapidly as the baby-boom generation reaches retirement age. The number of people caring for someone with dementia is substantial, and growing, as well.

Upstate geriatrician Andrea Berg, MD, has something to say about four issues that are bound to come up in the course of caregiving:

Never correct; just redirect.

Reflexive as it may be to correct something a loved one says that is incorrect, Berg and other geriatricians caution against it.

Andrea Berg, MD

Andrea Berg, MD

“When you correct somebody, it throws them on their heels and makes them lose their confidence a little bit more. Typically people are already self conscious about losing memory and to some degree aware of memory problems in the earlier stages of the disease.”

“In the moderate to advanced stages, people can perseverate on a concept such as ‘I want to go home’ even if they might be in their home. They’re referencing a different time because their time frame is skewed. Instead of correcting them, which is usually a futile effort, focus on the concept of home and engage them on what is appealing about being home. In acknowledging and validating the emotional content of what is being said, you often can drive the conversation into a different direction — as opposed to creating conflict if you try to correct them.”

Eating should be pleasurable.

Beyond providing sustenance, “eating should remain one of those primal pleasurable activities,” Berg says. “I caution people to not get hung up on the details or place undue dietary restrictions on their loved one. In the late stages, if they want to eat ice cream three times a day, go for it. This isn’t the time to be overly concerned about watching your salt or sugar.”

Eating is likely to become more challenging as the disease progresses. Berg is a proponent of hand feeding.

“It doesn’t have to be fast. Go slow,” she advises. “Meal time could be a positive interaction between a loved one and their caregiver, a way to care for somebody and show love, so that it’s not just nutritional nourishment but also a social support.”

They don’t wander — until they do.

It’s not an early hallmark of the disease, but as it progresses, Berg says people with dementia may wander and become lost, without warning.

“It’s something that should be on your radar, especially for people who are functionally independent and can walk around on their own,” she says.

Berg directs caregivers to Safe Return, a 24-hour nationwide emergency response service provided by MedicAlert and the Alzheimer’s Association.

Caring for yourself is a must.

Often caregivers will say they don’t have time to take a yoga class or walk around the block, or anything else that would allow them to recharge.

“Rates of depression and anxiety and overall poor health outcomes are rampant in caregivers of loved ones with dementia,” Berg points out. “You have to maintain your own level of health, or else you’re not going to be much help to those for whom you care.”

That includes paying attention to nutrition, getting adequate sleep, going to your own doctor appointments, exercising and taking time for yourself.  It also includes allowing others to help and taking people up on offers to sit, cook, clean or run errands.  Knowing you are not alone can be a huge stress reliever. “It’s not selfish,” she says. “It’s necessary.”

magazine-fall16cvrHLOA-4C-VERT-REVThis article appears in the fall 2016 issue of Upstate Health magazine. Click here for a radio/podcast interview with Berg. For another interview on Alzheimer’s disease, click here.



Posted in aging/geriatrics, Alzheimer's/dementia, disability, health care, HealthLink on Air, illness, safety | Tagged , , , , , , , , ,

To avoid withdrawal, she nearly died: Former addict warns of the dangers of antidiarrheal drug

Kate Rayland was the first reported case of loperamide abuse in Upstate New York. The high doses she took caused near-fatal heart problems. (PHOTO BY SUSAN KAHN)


Katharine “Kate” Rayland never intended to become addicted to – and nearly die from – an over-the-counter drug designed to prevent diarrhea. She developed a potentially fatal heart problem and landed in the intensive care unit at Upstate University Hospital after taking too much loperamide.

Rayland, 48, of Rome unwittingly revealed to doctors the dangerous lengths to which an addict might go in seeking a high with such a common medication (scroll down for “What is loperamide?”).

She marvels that she is still alive.

Despite her brush with death in 2012, Rayland started using the drug again.

She credits an Upstate toxicologist with scaring her straight after that relapse.

Upstate toxicologist Jeanna Marraffa (left) with Rayland, whom she helped treat.

“You’re playing Russian roulette,” toxicologist Jeanna Marraffa, who holds a doctorate in pharmacy, told Rayland. “How many more shots do you think you have in that gun?”

Rayland says those words “stuck with me, so after that, I committed to staying off of it no matter what.” This November, she will mark three years of being free of loperamide.

Rayland started using the drug to counter her withdrawal from the prescription opioid Vicodin, which she had been taking for shoulder and arm pain. She read online about addicts who took large doses of loperamide to taper off opioids or get a cheap high.

The drug calmed her and let her get through the day without feeling “creepy-crawly,” paranoid or anxious — signs of opioid withdrawal. She ate a high-fiber diet and did not experience the constipation the drug is designed to induce.

Rayland began taking loperamide around 2009 and figured she would continue since nobody at that time seemed to recognize it as an addiction, it was legally available over the counter, and she was able to keep working. But as her body grew to tolerate the drug, she required higher doses. Eventually she was taking 144 tablets a day – the total contents of a two-bottle pack. The recommended dose is no more than four tablets a day. The Food and Drug Administration now warns of serious heart problems that high doses can cause.

Those dangers weren’t clear in early 2012 when Rayland found herself gasping for air and sweating. Realizing something was terribly wrong, she went by ambulance to Rome Memorial Hospital. She was transferred to Upstate.

“I should be dead at least 20 times over,” she says, referring to the number of times her heart had to be shocked with a defibrillator to get it beating correctly. “These guys got me through it,” she says of Marraffa and fellow toxicologist Michael Holland, MD, as well as the cardiology and intensive care people who treated her.

Rayland was the first reported loperamide abuse case in Upstate New York, says Marraffa, who later published research on Rayland that described loperamide’s heart risks. Marraffa has corresponded with Rayland since then and calls her “an amazing person” who “has subsequently helped tremendously in further investigation into this deadly drug of abuse.”

Getting off loperamide “wasn’t easy, and it wasn’t fun,” Rayland says, but she tapered off the drug in six weeks in late 2013. She has since seen an addiction specialist and a psychiatrist and joined a 12-step program. Her heart is healthy today.

Today Rayland is employed and taking courses to become a nurse practitioner and also maintains a blog where she warns of the dangers of addiction and posts related scientific research.

Rayland says her efforts to stay clean and inform others about drug abuse “gives me a sense of purpose that this didn’t happen for nothing.”

What is loperamide?

Loperamide is the active ingredient in many over-the-counter antidiarrheal products, including Imodium. It acts on peripheral opioid receptors in the digestive tract to slow the movement of food and slow diarrhea. Any opioid pain medication causes the same slowing, and this is responsible for the constipation caused by opioids. In recent years, however, some people have taken massive quantities of loperamide in search of a cheap high or to ease withdrawal symptoms from opioid painkillers as those drugs become more restricted. This has led to loperamide being called “the poor man’s methadone,” and it has been shown to cause dangerous, even fatal, irregular heartbeats.

In normal doses, loperamide cannot stimulate the brain’s opioid receptors because a membrane pump in the brain pumps it back into the blood as soon as it crosses into the brain. But when people take massive doses, it causes massive blood loperamide levels, which overwhelm the capacity of the pump to rid the brain of the drug, and it can then stimulate the brain opioid receptors and cause the “opioid high.” Extremely high levels in the bloodstream cause the dangerous heart rhythm disturbances that are never seen when people take the normal low doses recommended by the manufacturer for treating diarrhea.

Click here and here for Marraffa’s published research on loperamide abuse.

magazine-fall16cvrHLOA-4C-VERT-REVThis article appears in the fall 2016 issue of Upstate Health magazine. Click here to hear an interview with Rayland and Marraffa. Click here to hear an interview with Upstate toxicologist William Eggleston on loperamide and other drugs commonly abused by teens.  

Posted in addiction, adolescents, brain/neurology, community, digestive/gastrointestinal, drugs/medications/pharmacy, emergency medicine/trauma, health care, HealthLink on Air, heart/cardiovascular, illness, patient story, poison center/toxicology, public health, research | Tagged , , , , , , , , , , , ,

6 answers about heroin

White powderlokking like cocain on dark brown empty Kitchen table

Heroin and other opioid drugs relieve pain and can bring on feelings of relaxation and euphoria, or being high. With prolonged use, an opioid user’s body requires increasing amounts of the drug to get the desired effects.

Who uses heroin?

Experts from the Upstate New York Poison Center say that some users turn to heroin because it is cheaper than prescription pain medicine. They may inject it, inhale it by snorting or sniffing, or smoke it. About half of the young adults who inject heroin report abusing prescription opioids first, according to the National Institute on Drug Abuse.

How does it affect the brain?

Opioids relieve pain by altering a person’s perception of pain signals from their body. With prolonged use, the sites where the opioid works become adapted, and then it requires more of the drug to get the desired effects.

What does it feel like?

Heroin users describe treatment of their pain, relaxation and a sensation of being high. People with chronic pain who use heroin may experience hyperalgesia, where they feel as though they are in greater pain.

Why is this a crisis?

The death rate from drug overdoses is climbing at a much faster pace than other causes of death, according to The New York Times, a trend similar to that of the human immunodeficiency virus in the late 1980s and early 1990s.

In Onondaga County, deaths from heroin overdoses climbed nearly 31 percent in 2015. Most deaths were of white men in their 20s.

How does heroin kill?

Heroin and all opioids decrease central nervous system activity, resulting in a decreased level of consciousness and, eventually, a decrease in the activity of the breathing center. Patients usually die because they stop breathing or breath too little to allow for enough oxygen to reach the brain, and death typically happens one to three hours after injection.

What are some signs of heroin use?

Someone who has started abusing heroin may exhibit a change in behavior or mannerisms or have a new circle of friends. He or she may withdraw from family activities and may react with anger or excuses when questioned why. School grades may deteriorate.

A heroin user may display a lack of motivation, a lack of self-control and/or irrational behavior. His or her temperament may become difficult, or aggressive, and he or she may have constant fatigue.

People using heroin may neglect personal hygiene and appearance and develop an impaired sense of judgment. Their speech may slur, or they may have trouble expressing themselves verbally. The pupils in their eyes may become pinpoints, their lids may be heavy, and needle tracks may be visible on their arms. They may say they feel insects crawling all over their body.

Heroin users could have in their possession “drug paraphernalia,” including tinfoil, weight scales, zip-lock bags, square folded paper envelopes, butane torches or cigarette lighters, small porcelain bowls, hypodermic needles, balloons, mirrors or short straws.

magazine-fall16cvrThis article appears in the fall 2016 issue of Upstate Health magazine.

Posted in addiction, brain/neurology, death/dying, drugs/medications/pharmacy, poison center/toxicology, public health | Tagged , , , , ,

13 things I learned from the fall issue of Upstate Health

magazine-fall16cvrThe pages of the fall 2016 Upstate Health magazine are loaded with important information and a few surprises. If you’re not on our mailing list, you should be. Send an email with your name and mailing address to magazine@upstate.edu with “Upstate Health” in the subject line, and we’ll make sure you receive the next issue. Click on the picture of the magazine and you can read an electronic version of the fall issue. Meanwhile, I’ll share what I learned in putting it together:

  1. You’re probably familiar with the concept of kidney transplants. Did you know that pancreas transplants have the potential to dramatically improve lives? Some of the people who need kidney transplants may also benefit from pancreas transplants. Sometimes both organs are transplanted from the same donor. Upstate surgeons performed pancreas transplants this summer for the first time since Rainer Gruessner, MD, became chief of transplant services.
  2. Upstate opened a new pediatric emergency department, set apart from the main emergency department, with its own radiology unit just for kids from birth to age 19.
  3. Bezoar. This is a potentially dangerous ball of food that can cause problems for someone with a digestive disorder known as gastroparesis.
  4. Strokes are medical emergencies requiring swift response, but what happens if you’re hours away from a comprehensive stroke center when a stroke occurs? Well, Upstate stroke specialists are using telemedicine to connect with hospitals in rural areas, to help assess and properly treat patients.
  5. Some people trying to kick an opioid addiction have turned to antidiarrheal medications to counter the symptoms of withdrawal — but that’s dangerous. Toxicologists at Upstate issued a precaution by publishing research on this practice.
  6. When people who suffer from chronic pain turn to heroin, they may experience hyperalgesia, the sensation of greater pain.
  7. The increased risk of sustaining another concussion is one of at least five good reasons that athletes who sustain concussions should not continue playing. Laws in all 50 states are prompting coaches and trainers to take these mild brain injuries more seriously.
  8.  Who knew that exposure to fumes from a clandestine meth lab could put someone at risk for lasting damage to memory? Upstate experts report on the case of a firefighter who was exposed in 2001.
  9. If you care for someone facing dementia, you’ll want to read these four simple pieces of advice from Upstate geriatrician Andrea Berg, MD, starting with the axiom,  “Never correct; just redirect.”
  10. More than two-thirds of the workers in five counties around Syracuse made less than $15 an hour in 2014, and many face health problems related to their jobs, too.
  11. You know that doctors working in the emergency department treat patients with all manner of injury and illness. Have you ever wondered what impact that has on their own lives? We asked a half dozen emergency physicians with young children to  share what things they generally forbid in their homes, and why. Foam dart guns, wading pools, hand sanitizers….the list goes on.
  12. One quarter of the babies born in Onondaga County have been exposed to an opioid drug of some sort in the womb. Yes, you read correctly: One quarter of the babies born in Onondaga County have been exposed to an opioid drug of some sort in the womb. It gives Onondaga County one of the highest rates of newborn drug exposure in New York State. Neonatologist Michelle Bode, MD, provides an overview of the problem.
  13. The fastest runner at this year’s J.P. Morgan Chase Corporate Challenge was Upstate’s Lee Berube, a doctor of physical therapy. He finished the 3 1/2-mile course in 17 minutes, 36 seconds.
Posted in addiction, adolescents, aging/geriatrics, Alzheimer's/dementia, brain/neurology, digestive/gastrointestinal, emergency medicine/trauma, health care, organ donation/transplant, poison center/toxicology, public health, stroke, technology

FAST response: Swift recognition, treatment saves stroke patient


It had been a typical day for Joan Izyk, 72, of Oswego. She had enjoyed a breakfast out and was relaxing in her living room with a coloring project. When her husband arrived home, she stood up to greet him in the kitchen. She never made it. She could hear her husband calling her, but she couldn’t respond.

Joan Izyk, stroke survivor

Joan Izyk, stroke survivor

Izyk had suffered a stroke.

“I just went down, and I could not get up,“ she recalls of that morning at her home. “I couldn’t talk, so I couldn’t yell to him. He thought it was a stroke right away.”

Impaired speech is one of the signs of stroke outlined in the acronym FAST, which is designed to help people act quickly to assist someone who may be having a stroke. FAST stands for Facial drooping, Arm weakness, Speech difficulties and Time.

“Joan’s husband recognized that she was having a stroke, which helped her get the treatment she needed quickly and ultimately led to her positive outcome,” says Josh Onyan, outreach coordinator for Upstate’s Comprehensive Stroke Center.

Rescuers from the Oswego Volunteer Fire Department arrived at the Izyk home and quickly moved her into the ambulance. They noted the right facial droop, right upper extremity weakness and slurred speech, consistent with the signs of a stroke. They rushed her to Upstate. The stroke team had received notice of the 911 call and prepared for Izyk’s arrival while the ambulance was en route.

Doctors and nurses from Upstate’s emergency department and stroke team began treating Izyk immediately. She received the clot-busting medication known as tissue plasminogen activator, or tPA, just 24 minutes after arriving at the hospital. Then she was injected with a dye so that a computerized tomography angiogram could produce detailed images of her brain.

Interventional neurosurgeon Grahame Gould, MD, located a blockage in one of her vessels and quickly performed a delicate clot-retrieving procedure.

“The combination of tPA upon arrival, plus endovascular rescue techniques such as this have been shown to greatly reduce disabilities from stroke,” Onyan notes.

Three days later, Izyk was resting at home, with mild facial weakness, grateful for the fast response of her husband, the fire department volunteers and the caregivers at Upstate.

Extending expertise: Stroke experts in Syracuse consult with rural colleagues via telemedicine

stroke_chartTelemedicine connects stroke specialists from Upstate University Hospital with physicians in rural hospitals throughout Central New York, so that patients can receive prompt assessment and treatment of stroke symptoms.

Five hospitals participate, including Carthage Area Hospital, Claxton-Hepburn Medical Center in Ogdensburg, Cortland Regional Medical Center, River Hospital in Alexandria Bay and Samaritan Medical Center in Watertown. The Fort Drum Regional Health Planning Organization helped deploy the equipment necessary to make these connections possible.

The telemedicine network provides Upstate neurologists with access to computerized tomography scans and the ability to talk with doctors and patients in hospitals many miles from Syracuse.

“Our telemedicine network allows the North Country access to expert stroke care, regardless of geography,” says nurse Jennifer Schleier, program manager of Upstate’s Comprehensive Stroke Center. “We have come to think of this program as stroke care without borders. It is our mission to close the gap between expert medical care and location of the patient.”

magazine-fall16cvrThis article appears in the fall 2016 issue of Upstate Health magazine.

Posted in brain/neurology, brain/spine/neurosurgery, community, death/dying, drugs/medications/pharmacy, emergency medicine/trauma, health care, illness, patient story, stroke, technology | Tagged , , , , , , , , , , , , , , , , ,

Concussion concerns: Make sure you know how to react

It's crucial that an athlete suspected of having a concussion not return to play until he or she has been evaluated.

It’s crucial that an athlete suspected of having a concussion not return to play until he or she has been evaluated.

When concussions are properly managed, patients usually have no lasting effects. The key is to recognize the injury when it happens.

An injured athlete needs to be removed from play until he or she is properly evaluated. Symptoms vary but may include blurry vision, ringing in the ears, headaches, trouble with balance and/or concussion. Most concussions happen without the athlete losing consciousness.

Brian Rieger, PhD

Brian Rieger, PhD

Neuroimaging (such as CT and MRI scans) cannot diagnose concussion. Instead, health care providers arrive at a diagnosis based on the patient’s history and the way his or her functioning is affected. Tests may be done to rule out other problems.

The recovery period is typically three weeks and includes a lot of sleep and rest. Patients are instructed to limit their physical and mental exertion, which for students usually affects school attendance and the use of electronic devices. Athletes are usually sidelined, to protect them from the risk of re-injury.

“A concussion is almost always a short-term event, when managed properly,” says Brian Rieger, PhD, an assistant professor of physical medicine and rehabilitation and director of the Upstate Concussion Center.

He says one thing coaches and parents can do is encourage athletes to be honest about their injuries.

Ignoring the symptoms of a concussion is bad because it can delay healing.

What’s worse is to overlook a concussion — and then suffer another. The consequences can be disastrous when that happens, Rieger says, with symptoms more severe and lingering for months or years.

5 reasons athletes with concussions should not play

A concussion is usually a short-term event when it is properly managed. Ignoring the symptoms of a concussion can delay healing.

A concussion is usually a short-term event when it is properly managed. Ignoring the symptoms of a concussion can delay healing.

All 50 states now have sports concussion laws, and with a better understanding of the seriousness of concussion, coaches and trainers take these mild traumatic brain injuries more seriously.

With proper management, the majority of concussions are short-term injuries. But, it’s crucial that an athlete suspected of sustaining a concussion not return to play until he or she has been evaluated.

An athlete with a concussion who continues to play:

* increases the risk of sustaining another concussion;

* is liable to aggravate concussion symptoms including fatigue, dizziness, blurred vision, irritability, anxiety, depression, headache, nausea and vomiting, clumsiness, fogginess, trouble reading and poor mental stamina;

* might prolong his or her recovery time with associated medical, psychological and academic difficulties;

* increases the risk of long-term problems which could include headaches, cognitive and emotional changes and sleep difficulties; and

* in rare cases, risks severe disability or death if he or she sustains another concussion.

The Upstate Concussion Center (315-464-8986) provides comprehensive evaluation and treatment services for concussion and sports concussion. Click here to learn more.

HLOA-4C-VERT-REVmagazine-fall16cvrThis article appears in the fall 2016 issue of Upstate Health magazine. Click here for a radio interview/podcast with Rieger about the latest concussion information, including diagnosis and management, here for an interview about protecting skiers and skaters from concussions and here for an overview of  sports-related concussions, including myths and symptoms.

Posted in adolescents, brain/neurology, disability, health care, HealthLink on Air, illness, medical imaging/radiology, mental health/emotional health, physical therapy/rehabilitation, prevention/preventive medicine, research, safety, Upstate Golisano Children's Hospital/pediatrics | Tagged , , , , , , , , , , , ,

Once fatal, now curable: Story of infective endocarditis ‘a miracle of medical progress’

heartUpstate cardiologist Harold Smulyan, MD, and infectious disease expert Donald Blair, MD, tell the tale of infective endocarditis in the August 2015 issue of the American Journal of the Medical Sciences. They call the nearly complete conquest of the disease “a miracle of medical progress.”

Donald Blair, MD

Donald Blair, MD

Endocarditis is an infection of the heart valves and/or the lining of the heart. It’s usually caused by bacteria. It’s not contagious.

Their paper explains that endocarditis was first reported during routine autopsies in the early 1800s, although it was several years before its bacterial cause was identified and a century before medicines were developed to fight the bacteria.

“Before the development of antibiotics, this disease was almost uniformly fatal,” Blair says. Surgery to remove infected tissue was occasionally helpful, but survival rates improved only after antibiotics were added.

The next breakthrough came in the 1970s with the development of a method of capturing ultrasound images of the beating heart.

Harold Smulyan, MD

Harold Smulyan, MD

Smulyan recalls that “echocardiography enabled us to actually look at the valves in the inside of the heart and see infections almost directly.” Doctors could confirm the bacterial infection with a blood test and, through medical imaging, know the location and severity of its damage.

This soon led to the practice of replacing damaged heart valves.

Today, patients who develop infective endocarditis receive antibiotics, often followed by valve replacement surgery.

Heart valves are susceptible to infection because they do not receive a blood supply of their own. For this reason, white blood cells and antibiotics, which fight infection, cannot reach the valves internally and must rely on the circulating blood to reach their targets.

Smulyan and Blair point out that infective endocarditis is a different disease now than when it was discovered two centuries ago. Different types of bacteria are responsible, and different types of patients are affected. Patients who develop this disease today are generally older and likely to have medical problems such as kidney disease or heart disease.

The doctors marvel at the progress made toward curing infective endocarditis. They write in their paper that although the infection can now be cured, prevention remains elusive.

magazine-fall16cvrHLOA-4C-VERT-REVThis article appears in the fall 2016 issue of Upstate Health magazine. Click here for a radio interview/podcast with Smulyan and Blair about their research into infective endocarditis.

Posted in aging/geriatrics, death/dying, drugs/medications/pharmacy, health care, HealthLink on Air, heart/cardiovascular, history, illness, infectious disease, pathology, research | Tagged , , , , , , , , , , , , ,