Seven things your radiation oncologist wants you to know

Silhouettes of men's head with connecting linesBY AMBER SMITH

Linda Schicker, MD, an assistant professor of radiation oncology at Upstate, tells what to expect when you face radiation therapy. She sees many of her patients at the Upstate Cancer Center’s radiation oncology office in Oneida, at 605 Seneca St.

Click here for a podcast/radio interview where Schicker explains what cancer patients should expect from radiation treatments.

1. Our goal is to kill the bad cells and spare the good cells.

 “Radiation is composed of little packets of energy called photons. When those photons interact with matter like the human body, they can either directly or indirectly damage the DNA strands. They don’t just damage the DNA strands of normal cancer cells. They can also damage the DNA strands of your normal cells.

Linda Schicker, MD

Linda Schicker, MD

“Cancer cells lose their repairability. Sometimes they’re killed immediately. More often, they will have breaks to that DNA strand, and they can’t fix it, and after several breaks the cell eventually dies. Depending on where the cell is in the cell cycle, it can be more sensitive to that. Chemotherapy can also make it more sensitive to that kind of damage.

“Regular cells are also damaged that way. But, if we give a minimum of six hours between hits of radiation therapy, normal cells can repair that damage, up to a point.

“So, we can’t give too much at once, and we can’t give the treatments too close together, or we would kill the normal cells too.”

2. The ionizing radiation we use is the same that is used for chest X-rays, just stronger.

“Radiation only affects what it hits. If you have a cancer cell on the end of your nose, and I’m treating your breast, it won’t do anything for the cancer cell on the end of your nose.

“The radiation travels through you, in a straight line.

It doesn’t stay in you. It doesn’t circulate in your body like chemotherapy does.

“External beam radiation is just like getting a chest X-ray. You can’t feel it, see it or touch the radiation. You won’t know anything has happened.”

 3. Treatment may also come through radioactive decay.

“Another type of radiation therapy is called brachytherapy. It’s something you either put inside the body permanently, or that you can put in temporarily with an applicator.

“When we do a radioactive seed implant in a patient with prostate cancer, we put in 80 to 100 very tiny radioactive seeds, smaller than a piece of rice. Those are implanted into the prostate. They stay there permanently. As the seeds are sitting there, they give off radiation by radioactive decay, and eventually they lose their radioactivity.

“For patients who have cervical cancer, we have an applicator that goes into the patient like a hollow tube. Then we have a machine that has a high-dose rate source, such as cesium, that’s attached to a guide wire that slides into that applicator, where it dwells for a few minutes and then it is removed.”

4. You probably will not lose your hair, and you definitely will not glow.

“Radiation passes through people. It doesn’t stay in you. So you won’t be radioactive, and you won’t glow in the dark.

“Many patients’ first thought is that they’re going to lose their hair and they’re going to be sick to their stomach. That generally doesn’t happen. If I radiate your head, yes, your hair will fall out. If I radiate your stomach, yes, you will feel nauseated – although we have great medicines now that can help prevent that. Most of the sites that we’re treating are not the head or the stomach. So you don’t get the nausea, and you don’t get the hair falling out.

“Sometimes we see a minimal skin change. It can turn pink, or a little bit tan, or get a little bit of a peel. Often we don’t see any skin change at all.

“Treatment side effects are site specific. If I treat your throat, you may get a little bit of a sore throat. If I treat your bladder area, your bladder may get a little bit irritable. These tend to be temporary things.”

5. Treatments are usually fast.

 “It only takes a few minutes to do treatments. You’re usually in and out of the office on a treatment day in about 15 minutes.”

6. You likely will have some decisions to make about your treatment.

“There are often several treatment options, and it’s important that you be able to understand what they are, so you can make an educated decision. There are short-term and long-term effects to be considered.

“The short-term effects are that generally after about two weeks, sometimes a little sooner, people will notice that they get some fatigue. It won’t really stop you from doing something you want to go, but you will notice that you’re a little bit more tired. And, just as it takes a few weeks for that to come on, at the end of treatment it takes a few weeks for that to go away. But it does go away, and you will return to your normal energy level.

“The long-term effects are very important, and we always have to talk about that because it can alter somebody’s treatment decision. If I tell you ‘if I do this, you may always have a little bit less lung capacity,’ that’s an important thing for you to know. Radiation does do damage, and some of that damage is permanent. And sometimes it doesn’t show up immediately. Sometimes the damage shows up later. So you have to have that conversation.”

7. You can help me help you by eating healthily, exercising and resting.

 “Radiation does damage, and your body will fix that damage, but it needs the building blocks to do it. People who maintain a normal, healthy diet and get enough protein tend to do better. They tend to tolerate treatment better. They tend to heal faster afterward.

“Radiation does make people a little bit tired, but people who get a little bit of exercise every day tend to feel less fatigued. Getting rest is also important. Your body has a job to do. It’s trying to repair the damage that we do with radiation. Rest helps you do that.”

Cancer Care magazine winter 2019 coverThis article appears in the winter 2019 issue of Cancer Care magazine. 

Posted in cancer, Expert Advice, health care, HealthLink on Air | Tagged , , ,

Should weight loss be part of breast cancer treatment?

The Upstate Cancer Center is taking part in a study to see whether losing weight can help prevent breast cancer from recurring.

The Upstate Cancer Center is taking part in a study to see whether losing weight can help prevent breast cancer from recurring.

BY AMBER SMITH

An obese woman with breast cancer is at increased risk for recurrence, compared with healthy-weight patients.

Researchers want to know whether she can reduce her risk of recurrence by losing weight.

Central New Yorkers can help find the answer.

The Upstate Cancer Center is one of several sites in the United States where women can enroll in a study that will examine the effectiveness of weight loss programs after breast cancer diagnosis. Women are eligible to participate if they have invasive breast cancer that has not spread. Participants receive encouragement via telephone, a subscription to a health magazine and various supportive mailings designed to help them lose weight.

Mijung Lee, MD

Mijung Lee, MD

Oncologist Mijung Lee, MD, says the study is important. “Right now, we can tell patients to lose weight. But how much is really therapeutic?” Losing what percentage of body weight will make a difference?  Lee says having clear data would help doctors give patients clear goals.

Most women who are diagnosed with breast cancer want to focus on treatment, Lee says. It can be a stressful time, which is perhaps not an ideal time to launch a weight-loss program.

Still, if researchers can prove that losing weight improves a woman’s outcome, that may provide incentive for her to succeed at weight loss.

Advice from major cancer groups

Five major cancer organizations agree on the importance of achieving and maintaining a healthy weight for breast cancer survivors. Among suggestions for how to do that:

— Pay attention to calories consumed and calories expended.

— Avoid high-calorie foods and beverages.

— Limit alcoholic drinks.

— Limit red meat and avoid processed meat.

— Follow a diet high in vegetables, fruits, whole grains and legumes.

— Eat foods that are low in sugar and saturated fats.

— Include foods containing carotenoids or high in calcium.

— Engage in physical activity or exercise daily, ideally more than 150 minutes of moderate or 75 minutes of vigorous activity each week.

— Include strength training with aerobics.

— Avoid prolonged sedentary behavior.

Sources: American Cancer Society, American Institute for Cancer Research, American Society of Clinical Oncology, National Comprehensive Cancer Network and World Cancer Research Fund International.

Cancer Care magazine winter 2019 coverThis article appears in the winter 2019 issue of Cancer Care magazine.

Posted in cancer, diet/nutrition, fitness, health care, research | Tagged , ,

What to do about depression when battling cancer

You may have a major depressive disorder if, for most of the day, you experience five or more of these symptoms during most days over a period of at least two weeks.

You may have a major depressive disorder if, for most of the day, you experience five or more of these symptoms during most days over a period of at least two weeks.

BY AMBER SMITH

Along with a diagnosis of cancer, people commonly experience bouts of sadness. Two or three out of 10 may develop depression. Others may experience a grief reaction with symptoms like those of depression but that come and go.

“The majority of people do get through this really stressful and emotionally laden experience without becoming depressed,” says Upstate Cancer Center psychologist Jeffrey Schweitzer, PhD. That said, people with a cancer diagnosis are at higher risk for depression — and he wants them to know help is available.

A cancer diagnosis affects the whole family. In fact, Schweitzer says, studies looking at female partners of men diagnosed with prostate cancer showed the women experience more distress. In some cases, women experienced depression or anxiety at twice the rate of men.

The best buffer? Open, direct communication and problem solving.

(Click here to hear a “HealthLink on Air” interview with Jeffrey Schweitzer, PhD, about how people with cancer can deal with depression.)

“It’s important not just to be talking about the facts of a diagnosis and what they heard from the doctors, but also how they’re feeling about all that. They may be feeling scared, perhaps. Or sad. Or even angry about the circumstances.

“For them to be able to openly communicate about those things can prevent that from turning into a depression or turning into anxiety, or isolating family members from one another. And it can also really empower them to work together to problem solve.”

Schweitzer says depression is generally treated the same, whether the person has cancer or not. However, some anti-depressants may not be prescribed if they would interfere with medications the person is taking to treat his or her cancer.

He says it’s important that depression is identified and treated. People who are depressed typically lose interest in activities they used to enjoy. Their quality of life may seem to deteriorate, and they could lose motivation to follow their prescribed treatment. They may develop anxiety, too, which amplifies their fears and worries.

All of this can have an impact on how well cancer treatment works. Schweitzer mentions studies comparing groups of cancer patients who have depression with groups that are not depressed; the group with depression has a poorer survival rate.

Easing depression in patients or caregivers “all starts with your support network,” he says. That includes family members, friends, neighbors and your team of medical providers. It’s unclear exactly how these connections help, but Schweitzer says they do.

“At best, cancer is tremendously stressful, not just for you but for your family and loved ones,” he says. “At worst, it can be life-threatening, life-altering, traumatic.”

Schweitzer encourages people to be open with their medical providers. “Talk with them about any emotional symptoms or psychological symptoms and how you’re experiencing the diagnosis. If you’re feeling it’s too overwhelming, it’s too much — if you’re engaging in that open, emotional communications with family, friends and community, and you’re actively problem solving with them and your doctors — and you’re still feeling down, it might be time to talk to a professional.”

Cancer Care magazine winter 2019 coverThis article appears in the winter 2019 issue of Cancer Care magazine.

 

 

 

 

 

 

Posted in cancer, depression, health care, mental health/emotional health, podcast, psychology/psychiatry

An expert’s suggestions for getting proper sleep

resting tiger

BY AMBER SMITH

The specter of cancer, the intricacies of treatment and the side effects can create enormous stress — which can lead to nights spent tossing and turning instead of sleeping.

Antonio Culebras, MD

Antonio Culebras, MD

If that describes you, or someone you love, proper management may help, says Antonio Culebras, MD, a neurologist and medical neurology director of the Upstate Sleep Center. Your doctor may be willing to prescribe hypnotic medicines, or sleeping pills, but that is the last resort.

“You have to sleep,” Culebras emphasizes. “Once you have slept, then you can deal with other problems, but first of all you have to sleep.”

Sleep quality is measured by duration, continuity and depth. If your sleep is disrupted by nightmares, loud snoring or anxiety, it may be too fragmented to be good quality. Poor sleep can impact physical, mental and emotional capabilities the next day.

Culebras says it’s important to be disciplined about sleep. The World Sleep Society gives this advice:

1. Establish a regular bedtime and waking time.

2. If you are in the habit of napping, do not exceed 45 minutes of daytime sleep.

3. Avoid excessive alcohol ingestion four hours before bedtime and do not smoke.

4. Avoid caffeine six hours before bedtime. This includes coffee, tea and many sodas, as well as chocolate.

5. Avoid heavy, spicy or sugary foods four hours before bedtime. A light snack before bed is acceptable.

6. Exercise regularly, but not right before bed.

7. Use comfortable, inviting bedding.

8. Find a comfortable sleep temperature setting and keep the bedroom well ventilated.

9. Block out all distracting noise and eliminate as much light as possible.

10. Reserve your bed for sleep and sex, avoiding its use for work or general recreation.

How much sleep do you need in 24 hours?

Giraffes: 5 to 30 minutes

Horses: 2½ hours

Humans: 7 to 9 hours

Sloth: 10 to 15 hours

Tigers: 18 hours

Koalas: 14½ to 22 hours

Sources: Antonio Culebras, MD, neurologist and medical neurology director of the Upstate Sleep Center; bbc.com/earth

Cancer Care magazine winter 2019 coverThis article appears in the winter 2019 issue of Cancer Care magazine.

Posted in brain/neurology, health care, sleep | Tagged , , , ,

‘Can Man’ closes in on cancer fundraising goal

Laurence Segal and volunteers at a can and bottle collection drive near Destiny USA mall. (photo by Susan Kahn)

Laurence Segal and volunteers at a can and bottle collection drive near Destiny USA mall. (photo by Susan Kahn)

BY JIM HOWE

A local fundraising effort is close to reaching its goal of cashing in a million returnable bottles and cans to fight cancer in Central New York.

With participating redemption centers offering 6 cents per container for the Cans for Cancer campaign, that comes to $60,000.

Laurence Segal of DeWitt and other volunteers held a Cans for Cancer drive to collect empty deposit containers recently near Destiny USA mall in Syracuse. Segal is a tireless advocate of Cans for Cancer and spends most of his time retrieving the returnables around the Syracuse area, wheeling pink collection bins or toting large plastic bags to redemption centers.

His bottles and cans come from sources including the New York State Fair and concerts at the nearby amphitheater, among other events, as well as from individual donations. The effort raised $50,000 in 2016-2017 for the Carol M. Baldwin Breast Cancer Research Fund of CNY, which pays for cancer research efforts at Upstate. The proceeds in the latest effort are to be split evenly between the Baldwin fund and the Upstate Cancer Center, which will give a portion to the American Cancer Society’s Real Men Wear Pink, a breast-cancer awareness campaign aimed at men.

“Laurence is the most passionate cancer advocate I have ever met. To give so selflessly on a program that requires so much work, and take nothing in return, speaks to the person he is,” says Matthew Capogreco, program and events coordinator for the cancer center.

Beth Baldwin, executive director of the charity that bears her mother’s name, notes that all the money raised stays in Central New York to fight cancer.

“My mother always said that Laurence is her fifth son,” she says of Segal, whom she called the face of the fundraising effort. She noted a longstanding friendship between the Baldwin and Segal families, both of which have been touched by breast cancer. Segal’s mother, grandmother and great aunt were all affected by breast cancer, as was a former male colleague.

“It’s not the dollar amount that matters to me, as long as no man, woman or child with cancer feels alone or that research is underfunded,” Segal says.

And despite his being identified with collecting thousands of containers, “I want the focus to be on research and scientists at the hospital, not the bottles and cans,” he adds.

Three ways to donate

1. Bring returnable bottles and cans to these businesses, which offer 6 cents for returns that go to Cans for Cancer:

— Bottle’s End, 101 Montrose Ave., Solvay;

— Express Bottle Return, 2312 Erie Blvd. E., Syracuse;

— E-Z Bottle & Can Return Center, 644 Bleecker St., Utica.

2. Mail a check — with a memo directing it to Cans for Cancer — to either:

— The Upstate Foundation Inc., 750 E. Adams St., CAB 326, Syracuse, NY 13210

— or the Carol M. Baldwin Breast Cancer Research Fund of CNY, PO Box 187, Warners, NY  13164.

3. Donate online by visiting the above charities’ websites:

— www.upstatefoundation.org

(The fund is listed as Laurence Segal Cans for Cancer)

— www.findacurecny.org (Cans for Cancer can be noted with the “write a note” option on the donation page).

Cancer Care winter 2019 coverThis article appears in the winter 2019 issue of Cancer Care magazine.

 

 

 

Posted in cancer, community, fundraising, health care, research, volunteers | Tagged ,

Science Is Art: Black lung disease under the microscope

Microscopic views of a coal miner’s lung. The above image shows dark coal macules (collections of coal dust in the lung cells). The image below shows dust in the lungs comprised of coal (black) and silicate (bright) particles.

Jerrold Abraham, MD, and Soma Sanyal, MDUpstate pathology professor Jerrold Abraham, MD, left, and assistant professor Soma Sanyal, MD, are examining lung tissue from coal miners with black lung disease as a part of a large study into the reasons for a recent increase in the disease, which is also known as coal worker’s pneumoconiosis.

The increase may have to do with changes in coal mining technology, as well as the enforcement of safety regulations, says Abraham.

Slice of a coal miner’s lung. Black area shows progressive massive fibrosis.

Slice of a coal miner’s lung. Black area shows progressive massive fibrosis.

This article appears in the fall 2018 issue of Upstate Health magazine

Posted in health care, lung/pulmonary, pathology, research

Consider checking newly diagnosed diabetics for pancreatic cancer

The pancreas is shown in red.

The pancreas is shown in red.

BY AMBER SMITH

One of the reasons pancreatic cancer is so deadly is because early symptoms are so vague. “The majority of cases are diagnosed at an advanced, incurable stage,” a team of Upstate doctors writes in the American Journal of Emergency Medicine. Oncologist Rahul Seth, DO, and colleagues go on to explain that controversy exists among medical professionals about a link between diabetes and pancreatic cancer.

They tell of a 59-year-old woman who was diagnosed with type 2 diabetes by her primary care doctor and prescribed insulin. Five days later, she came to the emergency room saying that she was confused and lethargic, with muscle aches and worsening abdominal pain. Those are symptoms of diabetic ketoacidosis, known in medical shorthand as DKA. It’s a life-threatening complication of diabetes that can be prompted by an infection, severe stress, inadequate insulin therapy or other reasons including, although rare, pancreatic cancer.

Rahul Seth, DO

Rahul Seth, DO

She was admitted to the intensive care unit of Upstate University Hospital for intravenous insulin therapy and hydration.

During her three-day stay, medical images of the woman’s abdomen revealed a tumor in her pancreas and some suspicious cells of her liver. Biopsies of both areas confirmed pancreatic ductal carcinoma. Like 85 percent of people diagnosed with this type of pancreatic cancer, her disease was at an advanced stage, and surgery was not a treatment option. When caught early, before it has spread, pancreatic cancer can be cured with surgery.

Seth indicates in the journal article that this woman’s pancreatic cancer probably prompted her DKA symptoms. His colleagues include physicians who are completing their residency training at Upstate: Danny Markabawi, Divya Kondapi and Vikrant Tambe.

The article references multiple medical studies. Some show that diabetes and hyperglycemia, which occurs when blood sugar levels are too high, are risk factors for the development of pancreatic cancer. Others suggest that hyperglycemia and diabetes might be caused by pancreatic cancer-associated pancreatic failure. It’s difficult to discern which happens first.

People who are newly diagnosed with diabetes have up to an eight times higher likelihood of being diagnosed with pancreatic cancer within three years, according to research that examined medical images and blood sugar values of people before they were diagnosed with cancer. Another study suggests that diabetes associated with pancreatic cancer occurs at a stage when surgery might still be an option.

That’s why Seth and colleagues propose “It might be worthwhile to consider screening patients with newly diagnosed diabetes mellitus for early-stage pancreatic cancer when other risk factors for diabetes mellitus are absent.”

They say it’s rare, but symptoms of diabetic ketoacidosis can be a clue to pancreatic cancer, especially when the most common causes of DKA are absent.

Upstate Health magazine fall 2018 issue coverThis article appears in the fall 2018 issue of Upstate Health magazine. 

Posted in cancer, diabetes/endocrine/metabolism, health care, pancreas/liver/gallbladder/bile ducts, research | Tagged , ,

Facing a crisis: Meet the Upstate experts working  to solve the opioid epidemic

opioid capsulesThe opioid epidemic is fueled both by the abuse of street drugs such as heroin and the addiction to prescription painkillers. The Centers for Disease Control and Prevention says prescription opioids contribute to 40 percent of all opioid overdose deaths in the United States.

 

BY AMBER SMITH

Solving the opioid crisis is a team effort. Many Upstate people are involved, in multiple ways.

Some are caregivers, helping those impacted by substance abuse. Some teach how to alleviate pain without using opioids. Some work to prevent addiction. Some are family members, touched in personal ways by the epidemic.

Here’s how they contribute.

The toxicologists

How did we reach the point where deaths from opioid overdoses (more than 42,249 in 2016) surpassed deaths from gun violence (38,658 in 2016)?

Willie Eggleston blames over-prescribing of opioid pain medications such as oxycodone and aggressive ad campaigns from drug manufacturers.

Willie Eggleston, PharmD

Willie Eggleston, PharmD

The use of opioids began increasing in the late 1990s when medical experts began putting more importance on pain control. Nurses started asking patients to assess their level of pain as “the fifth vital” when they recorded their four vital signs: pulse, respiratory rate, temperature and blood pressure.

Eggleston is a doctor of pharmacy who works in the Upstate New York Poison Center, specializing in opioid addiction and harm reduction. He leads the Opioid Research Center for Central New York, a group whose mission is to reduce the impact of the opioid crisis by making the best use of existing resources and expanding access to treatment.

After prescription painkiller abuse was recognized as a problem, the number of opioid prescriptions began to decline in 2010. Today, doctors in New York are limited to prescribing seven days’ worth of opioids. Eggleston says the crisis is like a sinkhole that suddenly opened.

“We covered the sinkhole, but we didn’t bother helping those who had already fallen in.”

Without their prescription opioids, many people turned to heroin or synthetic opioids such as fentanyl. Such street drugs are dangerous because buyers don’t know what they’re getting, or the concentration.

Brett Cherrington, MD, a doctor of emergency medicine with a specialization in toxicology, says, “All of our heroin is now laced with fentanyl, and a lot of times when people purchase what they think is heroin, they get fentanyl.”

Brett Cherrington, MD

Brett Cherrington, MD

Fentanyl is a drug that is used in hospitals for pain control. It’s more potent than heroin, so the overdose risk is greater. A similar drug called carfentanil is used in veterinary medicine to tranquilize elephants. It’s 100 times more potent than fentanyl — and responsible in 2017 for strings of overdose deaths including in Central New York.

Also that year, the Upstate New York Poison Center handled 59 cases of people who abused or overdosed on anti-diarrhea medication containing loperamide, an opioid. At least four of those people died.

In an effort to minimize the side effects of opioids, which include constipation and drowsiness, some people mix an opioid along with an “upper,” such as cocaine. Cherrington points out that’s also dangerous.

Too big of a dose of opioids can cause a person to stop breathing. Emergency responders are equipped with a drug called naloxone that can reverse opioid effects. Regular people have also been trained in how to administer the rescue medication, which can be purchased at pharmacies throughout New York state. Eggleston says the availability of naloxone throughout CNY is helping save lives.

Still, officials from the Drug Enforcement Administration say that more people report using controlled prescription drugs than cocaine, heroin and methamphetamine combined.

The emergency doctors

Doctors working in the emergency departments at Upstate’s downtown and community campuses combined saw more than 1,000 patients in 2017 who were overdosing or struggling with addiction, reports Jay Brenner, MD. As with smoking cessation, he points out, “Catching people when they’re at their sickest, for counseling, is sometimes when you can catch people most willing to reconsider their lifestyle choices.”

Jay Brenner, MD

Jay Brenner, MD

But the emergency department is where lives are saved and patients are stabilized. It’s not designed for more involved drug interventions. Typically, emergency doctors would send those patients home with referrals to addiction treatment programs.

Ross Sullivan, MD, said that wasn’t working. Often it took days or weeks to get an appointment, and in the interim, many patients continued using opioids to stave off withdrawal.

“There had to be a different way to help these people, to make them safer, to make them healthier,” he says. Sullivan is one of fewer than 1 percent of emergency physicians who are also certified in addiction medicine. In 2016 — the year 142 people died in Onondaga County from opioid overdoses — Sullivan established what he calls the bridge clinic.

It’s a service that bridges that gap between the patients’ trip to the emergency department and their entry into addiction recovery.

How it works today is, patients at the emergency department who want help getting off opioids receive a dose of buprenorphine, a tablet that melts beneath their tongue, and can help decrease drug cravings and suppress the symptoms of withdrawal for up to three days. They also receive a follow-up appointment a few days later at Upstate.

Ross Sullivan, MD

Ross Sullivan, MD

At that appointment, the patient meets with Sullivan, specialists in social work and case management, plus a “peer,” someone who is years into recovery. The patient may need help obtaining health insurance, food stamps, housing or other important services, things that need to be stabilized “before we can even think about them doing all the work they need to do to try to conquer their drug addiction,” Sullivan explains.

He sees about 60 patients per month, some for up to three to four visits as they prepare to enter treatment. Sullivan says 75 to 80 percent go on to enter addiction treatment, the majority in outpatient programs in the Syracuse area. “The most rewarding thing about this work really is when a patient thanks you, and they can look you in the eyes and tell you how their life has changed,” he says.

The number of opioid deaths in Onondaga County dropped to 91 in 2017 from 142 the year before. Sullivan says that doesn’t mean fewer people are using opioids. As hopeful is he is that patients will stop using, he wants them to be safe if they don’t. He provides prescriptions for naloxone, the rescue medicine that can reverse an overdose, and instructions about using clean needles.

“You don’t cure addiction,” Sullivan explains. “You learn to live with it and manage it.”

The infectious disease specialist

Overdose is not the only risk in abusing opioids. Deaths are just the tip of the iceberg, says Timothy Endy, MD, professor and chair of Upstate’s microbiology and immunology department and an expert in infectious diseases.

He’s concerned about two sets of people: those who share needles and spread infections such as hepatitis C and the AIDS virus, and those who introduce bacteria into their bloodstream when they inject a needle through skin that is not sterile.

“That’s really the problem we’re seeing related to IV drug use,” Endy says before detailing the skin abscesses, muscle and bone infections that lead to paralysis or bacterial endocarditis, an infection of the heart valves.

In 2011, five patients were treated for bacterial endocarditis at Upstate University Hospital; the number climbed to 37 in 2017, Endy says. “This is the underbelly that we don’t really talk about, and that the public should be aware of.”

Such serious infections can require lengthy hospital stays and lifelong medical care, depending on how far the infection has progressed.

If caught early, bacterial endocarditis can be treated with a six- to eight-week course of intravenous antibiotics. “The problem is, we do it through a special intravenous line called a PICC line that can stay in place for several months. With addicts and opioid users, they’re not capable of going home with PICC lines because of the potential for misuse. So they end up staying in the hospital for eight weeks,” he says.

Drug addicts also are likely to have nutritional deficiencies, and their immune system is likely to be depressed because of poor nutrition and opioid use.

Timothy Endy, MD

Timothy Endy, MD

They may also require heart valve replacements, he says, recalling a 20-year-old who recently had to have two valves replaced. “These are serious medical problems.”

Endy speaks from experience not only as a medical provider — but also as a parent.

The parent

Endy’s son, Justin, started misusing drugs in high school and had developed a serious heroin addiction by the age of 24. He overdosed twice. Both times he was saved with a dose of naloxone and wound up in the emergency department of Upstate University Hospital.

Justin Endy spent time in jail. He failed two outpatient rehabilitation programs. Three times he tried to stop using cold turkey.

“Watching him, we realized he was slowly dying,” Timothy Endy recalls of that time in 2016. “My wife and I felt like he would die in the next couple of weeks. Our son was just exhausted. We knew we had to get him into a program.”

With help from a recovery specialist, they enrolled him in a 30-day residential detoxification program called Sierra Tucson in Arizona, followed by a structured yearlong 12-step program called Bringing Real Change in Austin, Texas. “The transformation in Justin was dramatic,” Endy says. “He says he has finally found peace and serenity.”

The Endys’ health insurance plan did not cover the recovery programs, so the Endys paid for the treatment on their own. Subsequently, they helped sponsor 10 other people who were struggling with addiction and recovery through a charitable foundation they created at road2recoverycny.com

The addiction specialists

Brian Johnson, MD

Brian Johnson, MD

Some people require inpatient treatment. Others succeed through outpatient detoxification programs.

“We have not cured one person of addiction, but we have gotten people into recovery,” says psychiatrist Brian Johnson, MD, director of addiction medicine.

Upstate Addiction Medicine is a holistic medical practice that offers detoxification and treats chronic pain. Walk-in appointments (if you call ahead, at 315-464-3130) are available weekdays, and patients are asked to bring a non-addicted support person with them.

“If there’s a loved one involved, the chances that people are going to remain sober greatly increase,” explains psychiatrist Sunny Aslam, MD. That first appointment is lengthy. Some patients will make daily visits until they stabilize, and then they may come in weekly.

Sunny Aslam, MD

Sunny Aslam, MD

Johnson says he’s seen more than 17,000 patients successfully detox from opioids, alcohol and other substances. He prescribes buprenorphine, plus other medications that help with gut cramps and anxiety. “They go home with their support person,” he says. “A week later, they’re off opioids, and it was no big deal.”

One month out, he says 60 percent of those who stopped taking opioids remain sober. He says some people relapse and go through additional rounds of detox.

He explains that drugs change the brain permanently. That’s why people continue to attend Alcoholics Anonymous even if they stopped drinking years ago.

“Once you reintroduce the drug into the brain, it turns on ferocious cravings that have been dormant,” Johnson says. “If you’re addicted to tobacco, you can’t go back to cigarettes once in a while. If you’re addicted to alcohol, it’s the same. If you’re addicted to opioids, it’s the same.”

The pain specialist

Withdrawal from opioids can feel 100 times worse than the flu, with severe vomiting, diarrhea and stomach cramps. Many people who are addicted to pain killers “are not looking to get high. They just do not want to go through withdrawal,” explains nurse practitioner Theresa Baxter. “They’re just so desperate to feel normal. They did not wake up saying, ‘I want to be a heroin addict’ today.’”

Theresa Baxter

Theresa Baxter

She explains that opioids are “very effective in treating that immediate, acute pain, after a surgery or after a terrible injury. The problem is when we continue them long term. They’re a lot more addictive than we thought.”

Also, with long-term use, opioids increase a person’s sensitivity to pain, she says. It’s called opioid-induced hyperalgesia.

Opioids are not the only way to treat acute pain. Baxter advocates for the use of acetaminophen, ibuprofen and muscle relaxants. Nerve blocks can also be helpful, depending on the type of pain.

She cares for patients with chronic pain, too, many of whom get relief from massage, chiropractic care, weight loss, muscle and core strengthening, cognitive behavioral therapy and/or medical marijuana.

Not everyone can expect his or her pain to disappear. Baxter’s goal is to restore functionality, so people can go on with their lives.

The scientist

Opioids act on opioid receptors located on nerve cells throughout the brain and nervous system, producing an analgesic effect.

Until recently, scientists assumed that all opioids — those produced by the body, and those ingested as drugs – interacted in the same way with opioid receptors. Recent  research has shown differences that may help guide the design of new non-addictive pain relievers.

Stephen Thomas, MD

Stephen Thomas, MD

Not only that. Recent research has also shown the potential for impacting the effect of opioids on the brain by inducing an anti-opioid immune response.

An experimental heroin vaccine induced an immune response that prevented heroin from traveling into the brain through the bloodstreams of laboratory animals, according to a study published in the Journal of Medicinal Chemistry.

“By eliciting antibodies that bind with heroin in the blood, the vaccine aims to block the euphoria and addictive effects,” Gary Matyas, MD, told Science Daily. He is from the U.S. Military Research Program at the Walter Reed Army Institute of Research. “We hope to give people a window, so they can overcome their addiction.”

Stephen Thomas, MD, professor of medicine and microbiology and immunology at Upstate, is excited by the prospect. “A heroin vaccine could play an important role in a comprehensive approach to treating people who are suffering from substance abuse disorders,” he says.

Upstate and Walter Reed researchers have been awarded a grant to advance the development of an experimental heroin vaccine. If successful in early development, a second grant award will support testing the vaccine in human volunteers. The clinical trial would be performed by Upstate in Syracuse.

Contact information: 

Upstate Addiction Medicine, 315-464-3130; Road2RecoveryCNY.com

assorted tablets and capsulesOpioid Vocabulary

Buprenorphine — an opioid medication used to help decrease drug cravings and suppress the symptoms of withdrawal.

Methadone — an opioid medication used to help taper people off an opioid addiction.

Naloxone — a medication that rapidly reverses the effects of opioids and can save a person from overdose.

Opioids — a class of drugs that includes the prescription opiate medications codeine and morphine; plus semi-synthetics and synthetic drugs hydrocodone, oxycodone, fentanyl and others; and the illegal drug heroin.

Be aware: Emerging opioid substitute

Jeanna Marraffa, PharmD

Jeanna Marraffa, PharmD

Christine Stork, PharmD

Christine Stork, PharmD

A drug used in other countries to treat depression — and

also anxiety, asthma and irritable bowel syndrome — has the potential for abuse and addiction. Tianeptine is sold under the trade names Stablon and Coaxil in Asia and Latin America and obtained through Internet channels in the United States.

Poison centers in New York state handled nine cases of tianeptine overdose between 2000 and 2017, according to research by Upstate doctors of pharmacy Jeanna Marraffa and Christine Stork. One case involved a child who accidentally ingested the drug. Then there were five people who meant to abuse the medication, and three who had problems while taking a therapeutic dose of the medication.

Marraffa and Stork note that five patients described symptoms of opioid withdrawal, and, in two cases, patients received naloxone, a medication that can save people from opioid overdose.

Upstate Health magazine fall 2018 issue coverThis article appears in the fall 2018 issue of Upstate Health magazine

 

 

Posted in addiction, drugs/medications/pharmacy, emergency medicine/trauma, health care, infectious disease, poison center/toxicology, prevention/preventive medicine, psychology/psychiatry, public health, research | Tagged , , ,

Nurse prescribes soccer — which he plays professionally — for fitness and fun

 

Upstate nurse Isaac Kissi, playing for the Rochester Lancers in the blue jersey, has played soccer both professionally and for fun (photos by Rob Daniels)

Upstate nurse Isaac Kissi, playing for the Rochester Lancers in the blue jersey, has played soccer both professionally and for fun (photos by Rob Daniels)

BY JIM HOWE

To Isaac Kissi, soccer means many things.

Kissi works as a nurse at Upstate while studying in Rochester to become a nurse practitioner, where he lives. A native of Ghana, he first came to the United States on a college soccer scholarship and plays professional soccer in Rochester.

“It gave me a chance to change my life, get a scholarship and come to the States,” Kissi, 31, said of the sport. “It was my first livelihood, and it provides a different channel or escape to de-stress from working long hours of nursing.”

He thinks almost anyone can enjoy playing soccer at some level to stay active and have fun — he also plays in informal lunchtime matches with people of varied skill levels and ages, just to keep playing. He offers these thoughts about soccer:

Equipment:

“A good cleat is always vital; the right shoes give the right traction and ball control. Then all you need is some soccer shorts, and throw a T-shirt on if you don’t have a jersey.”

How old can someone be and still play soccer?

“I’ve seen guys still playing in their 70s. We have a lady who is close to 70, called Rosie (who plays in coed lunchtime pickup games with people of various skill and age levels). She is always smiling. It keeps the wheels turning. Playing soccer keeps you younger, but your body will get a bit sore after you play. If you keep playing, once you have it in your heart, it keeps you young and fresh. It’s all about the attitude you put into it.”

How long will you keep playing professionally?

“I think I will push till maybe 35, if the wheels are still going. I might go into coaching. I will keep playing, coaching, even being a nurse practitioner or whatever I’m doing at that time in the nursing profession, I don’t think I’m ever going to get away from the game.”

Can soccer relate to your career?

“It teaches you how to be a team player, and in nursing, you have to be a team player. In a team setting, you’ve got to be there for the guys on the field or for the nurses on the unit, when anything can change. It’s also my escape” from job stress.

Describe the non-professionals you play informal soccer with:

“Some of them are just there to get a good sweat and exercise. We always laugh and have good camaraderie. It’s a good thing, a good escape (from stress), it’s my way of life, I just love it.”

Do you pursue other activities to bolster your soccer skills?

“I go to the gym and work out. I do a lot of rehab workouts, where I’m not going too crazy but building muscles around my knees and calves, also my arms, as a forward, to look bigger (and intimidate opponents). I also ride a spin bike, which is better than running on concrete for cardio, then just getting out there to play with guys for cardio, too. Most of my exercises are rehab based. I’m still careful with my knee (more on that below), which still feels great right now.”

How do you advise dealing with injuries?

“It’s very important you listen to your body, for sure. Be smart and draw the good line on where you push through the pain threshold or draw back and heal better.”

Kissi, seen here in a yellow jersey, says soccer offers a good way to stay fit and deal with stress.

Kissi, seen here in a yellow jersey, says soccer offers a good way to stay fit and deal with stress.

Meet Isaac Kissi

Age: 31.

Born and raised: Ghana, West Africa, where his daughter, Gifty Nyarkoa Kissi, 13, her mother and the rest of his family still live.

Current hometown: Rochester.

College: Won a soccer scholarship to the University of Dayton, Ohio, in 2007.

Professional soccer career: Drafted in 2010 to Major League Soccer, but a knee injury meant he never played in MLS. He played with the Rochester Rhinos, one level below MLS, from 2010 to 2012, and has had knee surgery and worked on rehabilitating his knee since then. He currently plays with the Rochester Lancers, one level below the Rhinos.

Position: Midfielder (in college), forward (as a pro).

Health care career: Nursing degree from the University of Rochester in 2016; worked as a nurse in various locales, including Upstate, where he now works part time in physical medicine and rehabilitation while enrolled in the U of R’s nurse practitioner program.

Health care career goal: “Being a nurse practitioner specializing in family psychiatry, because I feel like a majority of what is going on medically is going to have a mental component to it. It’s about time we pay more attention to that, and it’s my way of trying to make a difference.”

Other sports he plays: Volleyball and pingpong, neither of which he claims to play well.

Upstate Health magazine fall 2018 issue coverThis article appears in the fall 2018 issue of Upstate Health magazine. 

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Different types of aneurysms call for different types of repairs

Three ways of repairing abdominal aortic aneurysms: (from left) traditional open surgical repair, endograft for AAA repair, fenestrated endograft.

Three ways of repairing abdominal aortic aneurysms: (from left) traditional open surgical repair, endograft for AAA repair, fenestrated endograft.

BY AMBER SMITH

When a blood vessel weakens, a balloonlike dilation called an aneurysm sometimes develops. This happens most often in the abdominal section of the aorta, the largest blood vessel in the body.

If an abdominal aortic aneurysm ruptures, it can be deadly, so learning whether you have an aneurysm and seeking treatment are important.

Medicare pays for screenings for people who are at increased risk for what’s known in medical shorthand as AAA, says Michael Costanza, MD, an Upstate professor of surgery specializing in vascular and endovascular services. That includes people age 65 to 75 with a family history of aneurysms, and men who are, or were, smokers. Screening involves a painless ultrasound that provides doctors with images of the blood vessels.

Michael Costanza, MD

Michael Costanza, MD

Costanza says the size of an aneurysms helps determine its treatment. “As the aneurysm gets bigger, the stress on the wall of the artery increases. When it increases too much, it would obviously break,” he says. “We would like to repair all aneurysms before they get to that breaking point.”

Small aneurysms can be monitored without treatment, but aneurysms that are larger than 5½ centimeters in diameter are recommended for repair, Costanza says.

Repair originally meant a surgeon opened a patient’s abdomen, clamped the aorta above and below the aneurysm, and then replaced the ballooned area by sewing an artificial blood vessel in its place. That’s still an option for a minority of patients.

Endovascular repair is the predominant method of repair today. Introduced in the late 1990s, endovascular repair eliminates the abdominal incision, instead using a needle puncture into a large vessel of the leg. Surgeons use X-ray guidance to pass a wire through the vessel and deploy a fabric-covered metallic stent to the area of the aneurysm. The stent reinforces the vessel without removing the aneurysm.

Some patients have aneurysms that are located too close to their kidneys for using regular stents. In those cases, Costanza offers a custom-made fenestrated endograft, a stent made with built-in openings for the kidney arteries.

“The fenestrated endograft is a much more involved procedure, but it’s still all done through needle punctures. The patients still go home very quickly after surgery,” Costanza says.

He continues to see aneurysm patients every year, after they have recovered from their repair. This allows the doctor to monitor the integrity of the repair, and to be on the lookout for the development of any new aneurysms.

To schedule your screening, contact Upstate vascular services at 315-464-1800 or 315-492-5881.

Abdominal aortic aneurysms are:

  • more common in older men than in women, by a 3- or 4-to-1 ratio, but as women live longer, their rates of AAA are climbing.
  • responsible for the deaths of 30,000 Americans per year and are the 10th leading cause of death among older men.
  • typically located in the abdominal space between the lower breastbone and belly button.
  • likely triggered by environmental factors, such as smoking, although they are thought to have a genetic component.

Upstate Health magazine fall 2018 issue coverHealthLink on Air logoThis article appears in the fall 2018 issue of Upstate Health magazine. Click here for a radio/podcast with Michael Costanza, MD, where he discusses abdominal aortic aneurysms.

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