Addiction treatment program partners Upstate with St. Camillus

Through a $2.1 million grant, Upstate University Hospital has partnered with The Centers at St. Camillus and others to create a new treatment program for those suffering from illness and addiction that is helping people recover and freeing up hundreds of beds per year.

The Collaborations for Health Program involves Upstate and St. Camillus with support from CNY Services and ACR Health. It has been operating since April. The program was created to help an increasing number of intravenous drug users who are admitted to Upstate with life-threatening infections. They require

IV antibiotics for up to six weeks at a time, says nurse Kelly Mussi, assistant director of transitional care at Upstate. “After about three weeks, they aren’t critically ill, and they are pretty bored,” she says.

Mussi and others identified that time as an opportunity to help patients address their addiction and begin treatments to aid recovery. If patients agree to participate, once they are stabilized on antibiotics, they transfer to St. Camillus, where five beds are dedicated to the program.

St. Camillus employs full-time addiction treatment staff from CNY Services and social workers from ACR Health who help patients secure safe housing and clothing and help maintain a treatment plan after discharge. Patients receive daily counseling sessions about substance abuse and addiction.

Sixteen patients joined the program during its first six months, and 14 were discharged during that time. Of those, 11 remain engaged with addiction treatment.

Upstate Health magazine cover, winter 2019 issueThis article appears in the winter 2019 issue of Upstate Health magazine.

Posted in addiction, health care

Making the most of her rehabilitation: After a stroke, she’s motivated to live a healthier life

Occupational therapist Beth Rolland, left, with stroke rehabilitation patient Melissa Meloling, during a therapy session. (photo by Robert Mescavage)

Occupational therapist Beth Rolland, left, with stroke rehabilitation patient Melissa Meloling during a therapy session. (photo by Robert Mescavage)

BY AMBER SMITH

Melissa Meloling can walk, if she keeps an eye on her feet, so she doesn’t trip. She learned how to tell time again. She’s relearning how to fix her hair, although assembling a ponytail is still tricky. Her vision returned. She ditched cigarettes.

She was revived from a stroke in June. Since then she’s been putting her life back together. “It’s been a wake-up call,” says Meloling, 44, of Bridgeport.

Meloling takes medicine for high blood pressure, but she had skipped taking it. When her mother didn’t hear from her one morning, she came to Meloling’s house. Meloling was barely breathing. Her mother called 911 and performed cardiopulmonary resuscitation on her daughter with the help of the call center until the first responders arrived. She was rushed to St. Joseph’s Hospital Health Center. Once it became clear that Meloling was having a stroke, doctors transferred her to the Comprehensive Stroke Center at Upstate.

She was recovering in a bed in the neurological intensive care unit when Meloling regained consciousness a couple of days later. She couldn’t feel her whole right side. She was blind in her right eye. She couldn’t think of the right words to speak. She was terrified. Her mother was at her bedside.

It would be eight weeks before Meloling would be able to go home — and only after extensive rehabilitation with a multitude of therapists, many of whom she still sees regularly, more than six months after her stroke.

“At one point my doctor told me that the stroke was blood-pressure related,” she recalls.

When Meloling began working with occupational therapist Beth Rolland in August, she struggled to use a knife and fork. She had trouble brushing her teeth and washing her face. Buttons and zippers were a challenge, and she wasn’t tying her own shoes yet.

Rolland is impressed with Meloling’s determination. “She’s doing all of those things now.

“She doesn’t give up. She will keep trying and trying until she gets it.”

To benefit most from occupational therapy, patients need to continue work prescribed by their therapist at home. Rolland says some people don’t make the effort and consequently don’t see much improvement. But Meloling is motivated. “That plays a huge role in her recovery,” Rolland says.

With the support and love from her mom, stepdad and two aunts, Meloling continues to heal and work hard at rehabilitation daily, which also includes outpatient physical therapy.

Today she keeps careful track of her blood pressure, recording it three times a day. She works with her therapists to improve her brain’s ability to follow a train of thought and to recall memories. And, through her rehabilitation, she has managed to quit smoking and says she no longer craves cigarettes.

“When something like this happens, and you need to make a change,” she says, “you just do what you need to do.”

Upstate Health magazine cover, winter 2019 issueThis article appears in the winter 2019 issue of Upstate Health magazine.

 

 

Posted in health care, patient story, physical therapy/rehabilitation, stroke

 Caring for someone who is sick? Here’s how to keep your home clean

house with bubblesBY JIM HOWE

Experts who oversee cleaning operations at Upstate University Hospital — Environmental Services Director Susan V. Murphy and Assistant Director John Kolh — provide this advice for caring for a sick loved one at home:

In general

handsHand washing: Clean hands are one of the most important ways to check the spread of infection, so be sure there is access to a sink and soap or that hand sanitizer is available.

Removing clutter: All areas should be clean and clutter free. Clear clutter first, then clean, then, if needed, disinfect. The less clutter you have around, the less there is to clean and worry about regarding any transfer of germs from sneezes and coughs. Less clutter also means fewer places for dust to settle or get kicked up into the air and irritate a sick person.

Ensure a supply of tissues within easy reach.

Keep “touch points” clean: These include frequently handled items like door and refrigerator handles; knobs on faucets, showers and drawers; buttons on microwave ovens and other appliances; and wall switches.

squirt bottleMake sure the materials you are using to clean are clean. Change your cleaning cloth or flip it over each time you clean a new surface. Disposable cloths might be easier and preferable during an illness. Also, clean your vacuum cleaner’s filter to keep the dirt level down.

Don’t “double dip,” or reuse a cleaning solution for another task, even one containing bleach, because it weakens the product. Also, don’t mix soap or bleach with some other cleanser, thinking it will create some sort of super cleanser, because it won’t. Allow whatever cleanser you use the time recommended to do its job.

Specific areas

faucetBathroom: Wipe down the fixtures – toilet, sink and their handles – daily, and change out the hand towels regularly. Mix one part bleach to nine parts water for bathroom cleaning and be careful not to splash it in your eyes. Bleach solutions will lose strength over time, so use it that day, then dump it down the toilet.

Another method, especially when dealing with heavy-duty infections: Bathroom surfaces can be cleaned with a soap product, rinsed off, then wiped with a bleach wipe and left to air dry. Bleach wipes, preferably hospital grade, can be found in many stores, and their short-term use is fine.

dishesKitchen: Keep the sink and counters free of dirty dishes. A dishwasher is a great way to sanitize dishes, but if one is not available, use water as hot as you can stand, agitate the soapy water and put friction on whatever you’re cleaning, then adequately rinse, preferably with hot water, and dry, using a clean, dry towel. Air drying is OK, but not if sitting in a dish rack will expose the dishes to coughs and sneezes. Change the sponge or cloth frequently to avoid contaminating dishes you are cleaning. Wash the brushes for dishes in the dishwasher, if available.

trash basketBedroom: Keep the nightstand clean, have ample tissues and a trash can available and empty the trash can regularly. Wipe down surfaces like bed rails, if any, and anything else the sick person might touch. If the sick person has a personal item like a blanket or shawl that he or she uses regularly, launder that as needed, maybe weekly, during the illness.

Family room or living room: Keep any touch points clean, such as the TV remote control. Use a bleach wipe on the device’s buttons and exterior, then let it air dry.

bucketComputers and electronics: Clean the touch points with a specifically recommended wipe or other product that won’t damage the equipment.

Floors: Mop or vacuum on a regular basis and keep them free of debris.

Other considerations

The elderly: Touch points might include eyeglasses, pens or pencils or an emergency button worn around the neck.

Children: If possible, have them play with toys that can be cleaned, such as hard plastic toys.

People with disabilities: Touch points might include the surfaces of a wheelchair, walker, cane or crutches.

Finally

The last task of cleaning is to inspect the whole area and be sure you haven’t missed anything.

Murphy adds that, in addition to its anti-infection benefits, a well-cleaned environment offers an emotional or psychological boost: “Clean, neat and organized gives that feeling of peace and calm. You’re not struggling to walk through a house when there’s no clutter.

“There’s something to be said about that.”

Upstate Health magazine cover, winter 2019 issueThis article appears in the winter 2019 issue of Upstate Health magazine.

Posted in health care

Is this Sarah Loguen, MD?

Is this Sarah Loguen, MD, class of 1876? This 3 3/8-inch tintype was published in John Ravage’s book, “Black Champions” (University of Utah Press, 2002) and is in the collection of the National Museum of African American History and Culture, part of the Smithsonian Institution.

Is this Sarah Loguen, MD, class of 1876? This 3 3/8-inch tintype (an early type of photograph) was published in John Ravage’s book, “Black Champions” (University of Utah Press, 2002) and is in the collection of the National Museum of African American History and Culture, part of the Smithsonian Institution.

National museum wonders just who is pictured in this newly discovered tintype

BY SUSAN KEETER

“An unidentified tintype in our collection bears a striking resemblance to Dr. Sarah Loguen,” wrote Emily Houf of the Smithsonian’s National Museum of African American History and Culture in Washington, D.C.

Could someone from Upstate Medical University help with identification?

Upstate responded to the museum’s request, providing biographical timeline information on Loguen, digital photographs at various ages (from her family papers at Howard University), a copy of her painted portrait, and the book “Three 19th-Century Doctors” (Hofmann Press, 2007). The photos and portrait can be used for comparison, and all items will be filed at the museum for scholarly use.

Sarah LoguenSarah Loguen, MD, was an 1876 graduate of the college of medicine that is now part of Upstate. The university has scholarships and a lecture, street and building named in her honor. Her painted portrait hangs in the Health Sciences Library, and two photographs of her hang in the Sarah Loguen Center at 650 S. Salina St. in Syracuse.

Loguen was one of the nation’s first African-American female physicians and the first to graduate from a coeducational medical school. After graduation, Loguen practiced medicine in Washington, D.C., and Frederick Douglass hung up her doctor’s shingle. In 1882, Loguen moved to the Dominican Republic and became the first female doctor in that country. Later in life, she traveled, lived again in Syracuse from 1901 to 1907 and resettled in Washington, resuming her medical practice there.

Can it be determined whether the tintype at right portrays Loguen? Based on clothing, the photo in question appears to have been taken in the 1890s.

Sarah LoganCompare the tintype with the two authenticated images of Logan at right: the image on top was taken during high school or medical school, and the image below that was taken in the Dominican Republic in the 1880s or 1890s. The same deep-set eyes, long nose and strong chin appear in all three images.

Could the tintype show someone else? William Pretzer, PhD, of the national museum wrote, “Loguen was one of about 100 black women doctors at the time.” That means 99 other possible subjects. The former owner of the tintype, historian and author John Ravage, PhD, remembers buying it at an antique shop in Wyoming or Texas 25 years ago. In her travels, did Loguen visit the Western United States? Was the photograph taken elsewhere and transported out West sometime in the last 130 years?

As Houf wrote, we may never know for certain who is pictured in this tiny photo made of silver and iron (enlarged, above). But the gloved hand grasping a medical bag, the fine clothes and the determined face look like Upstate’s trailblazing graduate, Sarah Loguen, MD.

As the painter of her portrait and the author of her biography, the face is the same. I believe it is Dr. Loguen.

Susan Keeter is associate director for creative services at Upstate.

The two smaller images of Loguen appear courtesy of the Goins Collection, Moorland-Spingarn Research Center, Howard University.

More about Sarah Loguen, MD

To learn more about Loguen:

— Read “Three 19th-Century Women Doctors: Elizabeth Blackwell, Mary Walker and Sarah Loguen Fraser.”

https://www.amazon.com/Three-19th-Century-Women-Doctors-Elizabeth/dp/097005193X/ref=sr_1_1?s=books&ie=UTF8&qid=1546617166&sr=1-1&keywords=Susan+Keeter

— Read an article by Amber Smith:

https://www.syracuse.com/news/index.ssf/2003/02/sarah_loguen_fraser.html

— See Loguen’s portrait at Upstate’s Health Sciences Library (once you have gone to the link below, click on the search tool, which looks like a wrench, and type in Logan):

http://www.tiki-toki.com/timeline/entry/603560/SUNY-Upstate-Medical-University-Portrait-Collection/

— Examine Loguen’s family papers at Howard University in Washington, D.C.

https://beta.worldcat.org/archivegrid/collection/data/793005727

— To honor her:

Donate to the Sarah Loguen scholarship for Upstate medical students:

https://medalumni.upstate.edu/SLF-scholarship

Local history at the National Museum of African American History and Culture 

In addition to the tintype at the top of this page, which is likely Sarah Loguen, MD, the National Museum of African American History and Culture has nearly 30 objects from Syracuse and Central New York.

A Syracuse Nationals basketball jersey owned by hall-of-famer Earl Lloyd — the National Basketball Association’s first African-American player (1950) and assistant coach (1968) and one of the NBA’s first head coaches (Detroit Pistons) — is in the collection.

There are a number of objects from Auburn’s Harriet Tubman, the Underground Railroad conductor and Civil War spy. These include books and pamphlets, a lace collar and construction brick, utensils and photos — including the newly discovered image of Tubman as a young woman, which is being considered for use on the currently postponed redesign of the $20 bill.

Other items from Upstate New York include an audio tape of prisoner-poets from the Auburn Correctional Facility, 1848 and 1854 newspapers published by Rochester Abolitionist Frederick Douglass, a ledger from the Women of the Ku Klux Klan of Oswego County and a letter from North Elba Abolitionist John Brown to Douglass.

Upstate Health magazine cover, winter 2019 issueThis article appears in the winter 2019 issue of Upstate Health magazine. 

 

Posted in health care, history, medical education

Meet Upstate’s new leadership team — a psychiatrist, a neuropathologist and a cardiologist

Upstate Medical University interim President Mantosh Dewan, MD, announced two key appointments in Upstate University Hospital leadership, naming Robert Corona, DO, as chief executive officer and Amy Tucker, MD, as chief medical officer. A little background on each:

Corona

Robert Corona, DO

Robert Corona, DO

Corona has served as interim CEO since March 2018. At Upstate he has led the development and implementation of the Upstate MIND (Medical Innovation and Novel Discovery) at the CNY Biotech Accelerator.

He leads the department of pathology, and he is medical director of neuropathology and vice president for innovation and business development.

He founded Upstate’s telemedicine program while at Upstate in the 1990s. He also served as chief medical officer and vice president of medical and scientific affairs at Welch Allyn in Skaneateles before returning to Upstate.

Corona’s doctor of osteopathic medicine degree is from the New York Institute of Technology College of Osteopathic Medicine. His master’s degree in business administration is from the University of Massachusetts at Amherst. He is board certified in anatomic pathology, neuropathology and clinical informatics by the American Board of Pathology and in medical management and certified physician executive by the American College of Physician Executives.

Dewan

Mantosh Dewan, MD

Mantosh Dewan, MD

Dewan is a SUNY Distinguished Service Professor in the department of psychiatry and former chair of the department. Throughout his career, which began at Upstate in 1979, he has written 35 books and book chapters and 75 papers and given hundreds of presentations on topics ranging from brain imaging and the economics of mental health care to psychotherapy and medical education. His work has been funded by grants from the National Institute of Mental Health and the Health Resources and Services Administration.

A Distinguished Life Fellow of the American Psychiatric Association, he has received the Scientific Achievement Award from the Indo-American Psychiatrists Association, the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill and the 2010 George Tarjan Award from the APA. In 2011, SUNY designated Dewan an “Exemplary Chair.”

Dewan’s medical degree is from Bombay University (currently Mumbai University), and he completed his residency at Upstate.

Tucker

Amy Tucker, MD

Amy Tucker, MD

Tucker has served as interim CMO since April 2018. She joined Upstate in 2017 as director of adult ambulatory services, after serving on the faculty at the University of Virginia. She held various administrative roles, including as director of ambulatory and consultative cardiology services. She was founder and director of the Club Red Women’s Cardiovascular Prevention Clinic, associate chair of medicine for undergraduate medical education and director of the Cardiovascular Fellowship Training Program.

Previously she served as chief medical officer for Locus Health, a company that provides comprehensive care coordination, remote patient monitoring and performance optimization using data analytics.

Tucker’s medical degree and undergraduate degrees come from the University of North Carolina-Chapel Hill. She earned a master’s degree in health care management from the Harvard School of Public Health. Tucker is a fellow of the American College of Cardiology and the American College of Physicians.

Upstate Health magazine cover, winter 2019 issueThis article appears in the winter 2019 issue of Upstate Health magazine.

Posted in health care

 How civilians have benefited from battlefield medical care

soldier carries a wounded comradeBY JIM HOWE

Many advances in medicine have come from the military, where medical teams seek new ways to help wounded warriors, from the battlefield to the operating room to the research laboratory.

Wartime necessity spurred the expanded use of tourniquets, penicillin and many practices in modern emergency care.

Patrick Basile, MD, '03, giving a lecture at Upstate in 2018.

Patrick Basile, MD, ’03, giving a lecture at Upstate in 2018.

Some of these improvements were outlined by Patrick Basile, MD, in a fall 2018 lecture at Upstate, where he was honored with the Outstanding Young Alumnus award. Basile, a 2003 graduate of Upstate’s College of Medicine, cared for the wounded while serving in the Navy. He took part in the first double arm transplant at Johns Hopkins and also participated in U.S. military missions abroad to repair cleft lips and other deformities. He currently practices plastic and reconstructive surgery in Florida.

Basile worked at what is now called the Walter Reed National Military Medical Center, in Bethesda, Md., the largest military medical center in the world,where he saw many blast injuries from the Iraq War.

Among the innovations he noted:

Penicillin

Today, antibiotics are taken for granted, but less than a century ago, war wounds could easily become infected and deadly.

Penicillin, one of the first antibiotic drugs, existed chiefly in research labs before World War II. A crash Anglo-American program during the war led to wide use of the drug and greatly improved combat survival rates. Sulfa drugs, which also fought infections, were available to the public shortly before WWII but also saw widely expanded use in that war and were even carried into battle in first-aid kits. Penicillin and sulfa drugs have been widely available to the general public since then and are still widely used, although they are less effective today due to drug-resistant bacteria.

Tourniquets

These emergency devices cut off circulation to an arm or leg to stop heavy bleeding. They have existed for centuries and been used widely on battlefield injuries since the Civil War. In this century, U.S. military personnel in Afghanistan and Iraq have sometimes gone into the field equipped with loose tourniquets that can be quickly tightened if needed. Tourniquets are generally used “to save a life vs. lose a limb,” Basile says. Tourniquets, which have come into and fallen out of favor over the years, have also seen widespread use in civilian emergency care and surgery.

MAST

The name stands for military (or medical) anti-shock trousers – a pressurized garment to stop massive bleeding. “You slip these pants on and increase the pressure, and it shunts the blood to the core and the brain,” Basile says. A pressurized suit based on this principle was used in WWII to prevent blackout in pilots. MAST came into wide use during the Vietnam War, when the garment allowed injured soldiers – who would have likely died otherwise — to survive a helicopter ride to a hospital. Civilian use followed, and although studies have questioned MAST’s value, they are still used in many circumstances.

Hospital ships

Ships have been used for evacuating and/or treating the wartime wounded for centuries, with the idea of floating hospitals coming into use on a massive scale during World Wars I and II. Today, the U.S. Navy has two hospital ships, the USNS Mercy for the Pacific Fleet and USNS Comfort for the Atlantic Fleet, which Basile says are “an amazing tool — basically floating trauma centers.” While their primary mission is to provide emergency care for combat forces, they can also go anywhere in the world on short notice and anchor offshore to provide disaster relief or humanitarian work, such as after the 2010 Haitian earthquake. The ships have also undertaken missions to perform surgery on congenital deformities and other problems in countries lacking such resources. Nowadays, there are also non-military, privately run hospital ships that perform charitable work around the world.

Nerve grafts

Basile describes a sailor with a sciatic nerve damaged by a gunshot wound who was in danger of never walking again. The sciatic nerve runs from each side of the lower spine down to the foot and connects to leg and foot muscles. Surgeons at Walter Reed used a piece of nerve from a cadaver as a graft — like an extension cord — to reconnect the torn nerve. “We got him able to walk at two years, and to run at three years,” he says.

Nerve grafts are usually taken from elsewhere on the patient’s own body and are known as autografts. Surgery to implant a specially treated cadaver nerve segment, or allograft, is seeing more widespread use to repair damaged or severed nerves and is an example of the military’s constant study of how to repair traumatic injuries.

Amputations

“In the Vietnam era, if you had a wounded leg that looked like it couldn’t be salvaged, you got an above-the-knee amputation,” Basile says. Such amputations make it harder to walk when later fitted with a prosthetic leg than would a below-the-knee amputation. “Now, if the knee joint is intact, we work to preserve the knee joint. That’s something that’s much different now than even in the late 1900s.”

Triage

The system of sorting which patients should be the first to receive care originated in Napoleon’s army, evolved and spread, reaching U.S. civilian health care by the early 20th century. Triage, in some form, is widely used in wartime, as well as in emergency rooms and civilian disasters, to evaluate patients quickly, then treat the most serious patients first.

Blood transfusions

This practice was rare and dangerous for centuries, but advances took place just before and during World War I that greatly expanded its use: identifying blood types; discovering anticoagulants to prevent clotting; and storing blood in advance, rather than doing patient-to-patient transfusions. These practices took years to catch on in civilian medical care, but transfusions continued to improve and greatly reduced battlefield deaths in World War II and since then.

Looking ahead

Basile predicts the military will contribute to the field of regenerative medicine. “When you need a kidney or another organ or tissue fixed from a burn or whatever, you’ll be able to harvest your own tissue and grow your own organs and tissue that are specific to you,” he says. “Regenerative medicine, and learning from other animals that can regenerate organs and figuring out how they do it and seeing how we can do it to some degree. Some organs regenerate to some degree on their own. A fetus has an innate ability to heal wounds without a scar in utero that we lose as adults,” he said, noting that researchers are trying to figure out why a fetus can be operated on in the womb and heal without a scar.

Upstate Health magazine cover, winter 2019 issueThis article appears in the winter 2019 issue of Upstate Health magazine.

Posted in health care, history | Tagged , , , , , ,

Remove the appendix – or not? Medicine’s understanding of the organ has changed

The appendix, shown in the circled area, is a pouch near where the large and small intestines meet. It varies in size from person to person but may range from less than an inch to 6 inches in length.

The appendix, shown in the circled area, is a pouch near where the large and small intestines meet. It varies in size from person to person but may range from less than an inch to 6 inches in length.

The appendix for centuries has been a misunderstood organ, hanging like a tail from the junction of the large and small intestines. When it became inflamed, surgeons were quick to remove it.

Over the last decade, the number of appendectomies has decreased, partly because of a better understanding of the appendix. The organ appears to have an immunological function, since people who have an appendix are less likely to develop infections of the colon, says Moustafa Hassan, MD, an associate professor of surgery at Upstate.

Moustafa Hassan, MD

Moustafa Hassan, MD

A blockage in the appendix can prompt a rapid growth of bacteria and inflammation, known as appendicitis. Symptoms may include a loss of appetite, nausea and pain around the belly button or in the right lower part of the abdomen.

Hassan says some people with appendicitis will require urgent surgery, and some will get better with just antibiotics. In some situations, an operation may be too risky.

A recent study conducted in Finland divided patients with uncomplicated appendicitis into two groups: half underwent surgery, and half only received antibiotics. Those who did not have surgery recovered well — but nearly half went on to develop appendicitis again and require surgery within the next five years.

Hassan helps his patients with appendicitis consider all factors as they decide whether removing the appendix makes sense. As he explains, “!n surgery, there is no one size fits all.”

Upstate Health magazine cover, winter 2019 issueHealthLink on Air logoThis article appears in the winter 2019 issue of Upstate Health magazine. Click here to hear Hassan discuss the latest thinking about appendix removal in a podcast/radio interview with Upstate’s “HealthLink on Air.”

 

 

Posted in health care, surgery | Tagged , , , ,

Working the streets: Upstate physician provides medical care to the homeless

David Lehmann, MD, dispenses medical care to homeless people in Syracuse. He accompanies workers from In My Father's Kitchen, which distributes food and clothing to the needy. (photo by Robert Mescavage)

David Lehmann, MD, dispenses medical care to homeless people in Syracuse. He accompanies workers from In My Father’s Kitchen, which distributes food and clothing to the needy. (photo by Robert Mescavage)

BY AMBER SMITH

David Lehmann, MD, was focused on how best to provide medical care to the homeless. He was aware of 60 “street medicine” programs around the world, most based at academic medical centers. He was intent on launching the 61st at Upstate.

So, Lehmann attended community meetings to learn about Syracuse’s homeless population and how he could start helping the men and women living on the streets. Also at the meetings was John Tumino, the former chef/owner of Asti’s restaurant who operates In My Father’s Kitchen, an outreach service that distributes lunches and other necessities to homeless people.

As a meeting wrapped up last spring, Tumino leaned over to Lehmann. “Hey, Doc,” he offered, “I could just take you out.”

That’s how Lehmann found himself riding shotgun in Tumino’s van, the side of which bears the message: “You are not invisible. Building hope. Changing lives.”

Throughout the warmer months, Lehmann brought medical care to the homeless twice a week, alongside Tumino’s distribution of lunches. Lehmann is building the infrastructure of a street medicine program. Eventually he would like to involve medical students so that he can seed the next generation of street medicine providers. For the time being, Tumino describes, “He’s out here doing it, learning the cracks in the system.”

Using a van as a patient room, Lehmann examines a homeless man’s wounds. (photo by Robert Mescavage)

Using a van as a patient room, Lehmann examines a homeless man’s wounds. (photo by Robert Mescavage)

On a recent weekday, Lehmann settles into the van with Tumino and his employee Kat Schofield. Before they head out, they update one another on the people they hope to see that day. Then, they bow their heads. Tumino speaks: “Thank you, Lord, for this opportunity to hit the streets today. Give us wisdom to give a soft word and a soft touch to someone who is in need.”

Since 2011, 21 homeless people have died in Syracuse. Some were murdered. Some overdosed. Some perished in a fire they started to keep warm. Some succumbed to disease. In its seven years of existence, In My Father’s Kitchen has helped 105 homeless people find housing.

Lehmann hopes he can help make a difference. Most of what he provides is routine medical care: blood pressure monitoring and medication, treatment of infections and such. Colleagues of his from Upstate’s department of psychiatry and behavioral sciences participate in similar fashion, offering addiction treatment and psychiatric interventions.

They are all familiar with statistics that show the longer a person lives on the street, the greater his or her risk of death.

Beyond the physical care he provides, Lehmann’s medical diagnoses can be used to help some people qualify for supportive housing and get off the streets, Tumino explains.

They stop to check on a man who lives in a tent off of Interstate 81, not far from the Destiny USA shopping mall. They park and follow a dirt trail to his campsite. (Days later, the man would be attacked by someone with a brick, who would steal his bicycle. During his hospital stay recovering from the attack, the man’s campsite would go up in flames. And, an apartment complex owner reading news coverage of the man’s plight would contact Tumino to offer housing.)

Blocks away at another campsite, Tumino and Lehmann call out for the occupant. Over the summer, this man developed a painful cyst on his backside. He sobbed with gratitude when Lehmann drained the cyst and Tumino supplied clean underwear. But he’s nowhere to be found today.

Later, the van drives by a man holding a sign at the end of a highway off-ramp. Tumino pulls into a nearby parking lot and signals to the man. It’s someone who has been homeless off and on since the age 16, and who grappled with alcoholism for many years. He’s 49 now and recently lost his spot at a shelter when he arrived a half-hour past curfew.

The man climbs into the back of the van. Tumino pours coffee and produces a container of pasta — his grandmother’s pasta sauce recipe with his meatballs — with steam still accumulated on the lid.

Schofield gathers gloves and boots for the man, who is wearing wet sneakers – along with two hoodies, a flannel shirt and denim jacket and a Jets hat.

Lehmann prepares to check his blood pressure.

The man reports that he is staying clean but has nowhere to go. “There is no one that I know that I can go to that don’t do drugs.” He says he’s had trouble getting a job because he lacks a birth certificate.

fTumino tells him that he will pay to obtain a copy of his birth certificate.

The man is stunned.

“You would do that?”

Tumino and Schofield assure him they will, and soon Schofield and the man are at the Onondaga County Office of Vital Statistics.

Blocks away from the Dinosaur Bar-B-Que, another man holding a sign stops panhandling when he sees the van. He settles into the back, next to Lehmann, who checks his blood pressure and examines some bumps on his arms and neck. The man receives a pair of size 10 boots along with coffee and pasta from Tumino. Lehmann phones in two prescriptions for the man; Tumino makes plans to retrieve the medications and deliver them to him the next day.

Lehmann sees parallels between the needs of people who are homeless in Syracuse and the people he has helped during international relief trips to Nepal, Kenya, Ecuador, Puerto Rico and Haiti over the years. “Both are underserved, indigent populations that have no health care, or spotty health care,” he says.

Teaming up with someone who already had the trust of the homeless community made sense, and Lehmann appreciates how Tumino invited him to tend to medical needs while he distributes lunches. In a community as small as Syracuse, Tumino says efforts like this can help in meaningful ways.

They haven’t solved homelessness – at least 35 people in Syracuse sleep on the streets, plus others stay in shelters run by Catholic Charities, the Rescue Mission and Salvation Army — but they make incremental improvements in the lives of individuals.

Instead of being discouraged at the end of the day, Lehmann says, “you look for the little wins:” The freshly-obtained birth certificate. The medicine that keeps a man’s blood pressure from climbing too high. The boots that replace wet sneakers and will keep a man’s feet warm tonight.

Sunny Aslam, MD, shown at the Gifford Street railroad overpass near the Rescue Mission in Syracuse, offers mental health care to the homeless. (photo by John Berry)

Sunny Aslam, MD, shown at the Gifford Street railroad overpass near the Rescue Mission in Syracuse, offers mental health care to the homeless. (photo by John Berry)

Tending to mental health needs

A portion of those who are homeless grapple with mental illness and/or addiction. So psychiatrist Sunny Aslam, MD, is establishing a program to provide psychiatric care and addiction treatment to the homeless.

Aslam, an assistant professor at Upstate who specializes in addiction medicine and pain management, distributes his business card at shelters and with advocates for the homeless. He and psychiatry colleagues offer to help people who want help getting off drugs or need treatment for various mental illnesses.

He collaborates with David Lehmann, MD. Both began volunteering their services through the street outreach organization In My Father’s Kitchen as a way to reach homeless people who refuse services at shelters.

Upstate Health magazine cover, winter 2019 issueHealthLink on Air logoThese articles appear in the winter 2019 issue of Upstate Health magazine. To hear each doctor talk about his outreach efforts, click here for an interview with Lehman; click here for an interview with Aslam.

Posted in addiction, community, health care, HealthLink on Air, mental health/emotional health, psychology/psychiatry, public health | Tagged , , , , ,

Stroke patients can beat risk for depression

troubled mindBY JIM HOWE

At least a third of people who have a stroke become depressed or show some symptoms of depression, according to an expert who often treats such patients.

It’s called post-stroke depression, explains rehabilitation psychologist Michelle Woogen, PsyD, who works in Upstate’s department of physical medicine and rehabilitation.

Common symptoms of depression can include any of the following:

  • a sad mood and possibly thoughts of wanting to die or commit suicide
  • excessive crying
  • feelings of worthlessness
  • low motivation or energy
  • changes in eating or sleeping behavior
  • agitation
  • loss of interest in activities the patient used to enjoy
  • poor concentration or ability to make decisions

A stroke involves a lack of oxygen to the brain, due to a blocked or broken blood vessel, and this can cause a number of problems, such as:

  • physical: difficulty walking, talking and dressing
  • mental: having trouble solving problems, remembering things, doing tasks like paying bills and knowing what’s safe and what isn’t.

Reasons for depression after stroke

Michelle Woogen, PsyD

Michelle Woogen, PsyD

It is believed that there are two reasons why someone may become depressed after a stroke: It may be in response to the stress of having a stroke in general, which is an upsetting experience, or it may be that as the brain is rewiring itself (and we know that our emotions are housed in our brain), it is accidentally rewiring itself to be more depressed. It could also be a combination of the two, Woogen said.

Strokes that limit patients’ ability to move around and take care of themselves on their own put those patients at a higher risk of developing depression, as do cognitive (thinking) difficulties and a history of depression.

Is it depression or stroke recovery?

Post-stroke depression can be tricky to diagnose, Woogen cautions, since something like sleeping more might simply be part of the recovery process.

“We are looking for symptoms of depression, but a brain injury can mimic those symptoms. The brain needs to sleep after injury. It’s easily fatigued, so they might be sleeping a lot, but maybe they are just recovering. They also might look like they have poor motivation, but that is also something that can be caused by brain injury. The brain has trouble telling the body to get going, so you have a plate of food in front of you, and you know it’s time to eat, but the brain is just not telling the body, ‘OK, pick up the fork, put the food on the fork, fork to the mouth,’ so it can be tricky,” she said.

“You don’t want to chalk these symptoms up just to the brain injury, but you also don’t want to panic and assume that any symptom is severe depression, because a stroke is upsetting. I expect there to be a degree of sadness there, and that’s OK when you notice that in yourself or your loved one after a stroke.”

Stroke patients are grieving the loss of their abilities, so some sadness is to be expected. Depression can start right after the stroke or not show up for a year or more, she said, noting that stroke recovery typically takes one to two years.

Coping

When she visits with patients undergoing rehabilitation, “I am looking for something that shows me that they are also coping. So,

  • are they also focused on the future, talking about wanting to get back to work, driving, being with their grandchildren?
  • are they engaged in therapy, or do they just want to bury their heads in the covers all day and refuse therapy?
  • are they able to focus on things other than the stroke, such as pleasant memories and how other people are doing, rather than being hyper-focused on the stroke?

“If they are able to have other conversations, that is a sign that they are coping, so I look for those as well.”

Post-stroke depression can limit a patient’s participation in rehabilitation, which is part of the process of the brain’s recovery; it interferes with people’s quality of life and their involvement in the community; it increases the need for medical visits; and it increases the risk of death and suicide, Woogen said.

What to do

If loved ones or caregivers see symptoms of depression after a stroke, Woogen advises talking with the patient’s physiatrist — doctor of physical medicine and rehabilitation — or, if the patient doesn’t have one, with the primary care provider. They can help figure out whether it’s depression and help recommend a treatment plan that might include a mood-stabilizing medication and/or seeing a mental health provider. “Sometimes, talk therapy is the best medication,” she said.

As patients receive treatment and support, the depression often lifts.

Woogen also treats people in rehab for a variety of traumatic and other brain injuries and works with their family members and caregivers.

Advice for caregivers

Woogen noted the toll a stroke and post-stroke depression can take on family members and caregivers. “It’s hard to watch a loved one experience depressive symptoms, and it’s very easy to want to tell them that everything is going to be OK. That’s a good thing to say, and it’s also a good thing to sit with them and say, ‘I know this is hard, and I’m here with you, and you let me know if there is something that you need.’ Try not to just say everything is good again, because it’s not. They’re grieving, and that’s appropriate.”

Upstate Health magazine cover, winter 2019 issueHealthLink on Air logoThis article appears in the winter 2019 issue of Upstate Health magazine. Click here to hear Woogen discuss post-stroke depression in a podcast/radio interview with Upstate’s “HealthLink on Air.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Posted in brain/neurology, health care, HealthLink on Air, mental health/emotional health, physical therapy/rehabilitation, psychology/psychiatry, stroke | Tagged , ,

E-cigarette liquid can be deadly, especially to children

Protect your children: Ingesting the nicotine from one cigarette, two or three butts or just one milliliter of e-cigarette liquid (that's one-fifth of a teaspoon) could prove fatal for a 25- to 30-pound toddler. Keep products containing nicotine out of the reach of children, experts advise.

Protect your children: Ingesting the nicotine from one cigarette, two or three butts or just one milliliter of e-cigarette liquid (that’s one-fifth of a teaspoon) could prove fatal for a 25- to 30-pound toddler. Keep products containing nicotine out of the reach of children, experts advise.

BY AMBER SMITH

Nicotine is among the most toxic substances on Earth.

Death can occur after ingestions as small as 40 to 60 milligrams in adults or just 1 to 2 milligrams in children, depending on their size.

Toxicologists at the Upstate New York Poison Center have consulted about children ingesting whole cigarettes or cigarette butts. Considering that each cigarette contains from 13 to 30 milligrams of nicotine and each butt contains 5 to 7 milligrams of nicotine, a child could have significant toxicity after ingesting one cigarette or a few butts. (That’s just 1 to 2 milligrams per kilogram of body weight.)

As electronic cigarettes gain in popularity, more calls come to the poison center regarding the liquids used in e-cigarettes. The liquids generally have concentrations of 10 milligrams of nicotine per milliliter of liquid. That means adults and children could develop significant toxicity after ingestion of just a few drops of the liquid.

Toxicity can lead to paralysis and a slowed heart rate and breathing. Seizures are also possible.

Here’s the scary truth: “There is no antidote for nicotine toxicity,” toxicologists Robert Seabury and Christine Stork write on a blog for health care professionals. They advise prompt emergency medical care that is tailored to the patient’s symptoms.

Upstate Health magazine cover, winter 2019 issueThis article appears in the winter 2019 issue of Upstate Health magazine.

Posted in health care, poison center/toxicology, public health, safety, Smoking Cessation, Upstate Golisano Children's Hospital/pediatrics | Tagged , , , , , ,