Rethinking schizophrenia: Researchers believe the digestive tract links to the brain disease

Editor’s note: This is one of three articles on Upstate’s “renegade researchers” — scientists who are providing new ways of looking at long-standing medical problems, including schizophrenia (detailed below), Kaposi sarcoma and hydrocephalus.

BY DARRYL GEDDES

A breakthrough study published in the journal Science Advances provides evidence of a link between schizophrenia and the gut.

Researchers from Upstate, along with colleagues at universities in China, say their findings could transform treatment for schizophrenia, a severe, chronic mental illness that impacts how a person behaves.

Julio Licinio, MD, PhD

Julio Licinio, MD, PhD

Julio Licinio, MD, PhD, a professor of psychiatry, medicine and pharmacology at Upstate, together with a team of international researchers, have been searching for the past five years to show the effect of the gut microbiome on behavior and the brain. Peng Zheng, MD, is the study’s first author. An associate professor at Chongging Medical University in China, Zheng is currently a visiting scholar at Upstate.

The gut microbiome refers to microbes that live in the intestines. While people share some of the same microbiomes, most of the organisms differ from person to person.

As part of the study, Licinio and his team, through genetic sequencing of the gut microbiomes of healthy individuals and people with schizophrenia, found a vast difference in the makeup of the microbiomes. There were far fewer different gut microbiomes in people with schizophrenia.

The next step of the study was to transplant the microbiomes taken from people with schizophrenia into germ-free mice.

“The mice then behaved in a way that is reminiscent of the behavior of people with schizophrenia,” Licinio recalls. “The brains of the animals given microbes from patients with schizophrenia also showed changes in glutamate, a neurotransmitter that is thought to be dysregulated in schizophrenia.”

Mice that received microbiomes from healthy individuals showed no unexpected behavior.

Licinio says the way the microbiome from people with schizophrenia affected the mice behavior suggests that a promise of new treatment of the mental disorder could be on the horizon.

Ma-Li Wong, MD, PhD

Ma-Li Wong, MD, PhD

“This would give us a completely new pathway toward treating schizophrenia,” he says. “No treatments that we give today are based on a change of the microbes in the gut. So if you could show that would change behavior in a positive way, we would have a whole new way to approach schizophrenia.”

Ma-Li Wong, MD, PhD, was a co-investigator in the research with Licinio. She’s a professor of psychiatry and behavioral science and neuroscience and physiology at Upstate.

“We understand schizophrenia solely as a brain disease,” she says. “But maybe we need to re-examine this line of thinking and consider that maybe the gut has an important role.”

Upstate Health magazine summer 2019 issue coverThis article appears in the summer 2019 issue of Upstate Health magazine.

Posted in health care

Rethinking hydrocephalus: Neurosurgeon asks: Would a medication work better than surgery?

Neurosurgeon Satish Krishnamurthy, MD. He is wearing a necktie from the charitable organization Save the Children in honor of his many pediatric patients. (photo by Susan Kahn)

Neurosurgeon Satish Krishnamurthy, MD, wears a necktie from the charitable organization Save the Children in honor of his many pediatric patients. (photo by Susan Kahn)

Editor’s note: This is one of three articles on Upstate’s “renegade researchers” — scientists who are providing new ways of looking at long-standing medical problems, including hydrocephalus (detailed below), Kaposi sarcoma and schizophrenia.

BY AMBER SMITH

Brain surgery to install a shunt is currently the only solution for hydrocephalus, a buildup of fluid in the brain. Most research on this condition is related to devising a better shunt.

Satish Krishnamurthy, MD, goes a step further.

The Upstate neurosurgeon seeks a better solution — one that  could more certainly help a greater number of people, one without so many risks, one that doesn’t even involve surgery.

He thinks in a new way about the enduring problem of hydrocephalus. It’s a condition that can affect anyone. Bleeding in the brain is the most common cause, but 180 disorders can lead to hydrocephalus — in older kids, adults, senior citizens. Sometimes babies are born with it. Any condition that results in the accumulation of cerebrospinal fluid through brain cavities known as ventricles can result in hydrocephalus.

“We really don’t understand how, exactly, this process of extra fluid damages the brain, but we do know that if you don’t treat hydrocephalus it causes both cognitive and physical handicap,” Krishnamurthy says.

Surgical treatments were developed based on the idea that excess fluid accumulates in the ventricles because of a blockage in the pathways that help absorb the fluid. Thisdiscrepancy between the amount of fluid produced and then absorbed in the ventricles results in hydrocephalus.

“There are two different kinds of surgeries that we do,” Krishnamurthy explains. “One is to put a tube into the ventricles and put the other end of the tube elsewhere — the most popular place is the belly — so the extra fluid is diverted through this tube into the belly. This is called a shunt.

“Another way to treat the hydrocephalus is to make a hole in the bottom of the brain, called endoscopic third ventriculostomy,” he says. “But it doesn’t work in everybody. Especially in infants, it doesn’t work very well at all. In adults, it works in two-thirds of people.”

Either operation may require adjustments, and serious and life-threatening complications are possible. Care includes close monitoring, which includes repeated medical imaging to make sure the shunt or ventriculostomy is working properly, and additional surgery for adjustments.

“For the patients and their families, this means that a diagnosis of hydrocephalus condemns them for multiple surgeries,” Krishnamurthy explains. “Since there is little warning before the shunt gets blocked, resulting in deadly hydrocephalus, the patient has to live with the constant fear of shunt blockage or infection.

“All of these issues compel us to seek better solutions that are predictable and more effective.”

Surgery undoubtedly helps most people with this condition. Before shunts were developed in the 1950s, everyone with hydrocephalus died.

Redefining the disorder

Solutions are developed based on what you think the problem is.

If you believe hydrocephalus happens because too much fluid is produced, and the brain is unable to drain the excess, you would envision a plastic bag full of water needing to be drained.

But the brain is actually permeable to water, Krishnamurthy says. Water can pass through the tissue, as it does in other organs. Proteins and other large molecules cannot move out of the brain cavities easily; they draw in water through a process known as osmosis. The surgeon says the brain is not like a plastic bag. Instead, it’s like a saturated tea bag.

Rather than a problem of fluid circulation, he says, “we have to redefine hydrocephalus as a disorder of protein transportation.” This calls for a very different solution.

To understand what Krishnamurthy proposes, you first have to understand a force called osmotic gradients. He has published several scientific papers on his research at Upstate explaining how the osmotic gradient causes hydrocephalus. Basically, it draws water into the ventricles when more proteins are inside the ventricles and pushes water out when there are fewer proteins. (Click here to hear Krishnamurthy explain his work in a radio/podcast interview with Upstate’s “HealthLink on Air.”)

“As osmotic gradients play an important role in the water transport into the ventricles, the transport of osmotically active macromolecules plays a critical role in the genesis of hydrocephalus,” he writes in the medical journal Translational Pediatrics. That means getting rid of the proteins in the ventricles will make the water go away from the ventricles, relieving hydrocephalus.

The surgeon envisions a medication that could coax the proteins and other molecules out of the ventricles and into the venous system, where the body would handle them like other wastes. He is currently working on testing several different medications, along with a new diagnostic test to understand how the proteins are transported in a given patient.

Much of Krishnamurthy’s research has been paid for by the Syracuse nonprofit REaCH Organization, whose name is an acronym for Research, Educate and Cure Hydrocephalus. His research is also sponsored by the hydrocephalus fund at the Upstate Foundation.

The downsides of shunts

Hydrocephalus is often treated surgically with the installation of a shunt, a tube that diverts excess fluid from the ventricles in the brain to the belly or elsewhere in the body. Neurosurgeon Satish Krishnamurthy points out problems with shunts:

  • Few medical devices have a higher rate of failure. Shunts often malfunction — 40 percent fail in their first year — and have to be re-implanted. Many new shunts are programmable, but the complication rates have not decreased.
  • Once in place, they provide no data and no easy method of determining if they are functioning properly.
  • When a patient with suspected shunt problems is treated in the emergency department, he or she faces radiation exposure from X-rays or other imaging scans.
  • Repeated shunt operations are common and are disruptive to patients’ lives, as they are usually emergency surgeries.
  • Patients face a lifetime of monitoring, including diagnostic tests and surgeries.

Is it hydrocephalus?

Symptoms of fluid on the brain, or hydrocephalus, vary depending on a person’s age. Infants may develop an enlarged head, and their eyes could deviate downward. Older children or adults may experience headaches, nausea, vomiting or blurred vision. Senior citizens may appear to have dementia, difficulty walking and incontinence.

Upstate Health magazine summer 2019 issue coverThis article appears in the summer 2019 issue of Upstate Health magazine.

 

 

 

Posted in brain/neurology, brain/spine/neurosurgery, health care, HealthLink on Air, research, surgery | Tagged , ,

TURNING TEN: New leader takes helm at Upstate Golisano Children’s Hospital

From the outside, the Upstate Golisano Children’s Hospital looks as though it was snapped together with brightly colored toys. To enter, you walk past the red trunks of several “trees” holding up the roof and into elevators that go directly to the “treehouse” on the 11th and 12th floors. (photo by Robert Mescavage)

From the outside, the Upstate Golisano Children’s Hospital looks as though it was snapped together with brightly colored toys. To enter, you walk past the red trunks of several “trees” holding up the roof and into elevators that go directly to the “treehouse” on the 11th and 12th floors. (photo by Robert Mescavage)

BY AMBER SMITH

When he completed his medical school applications, Greg Conners didn’t just say he wanted to become a doctor. He was one of four students in his class of 100 who knew the exact specialty for which they were suited. He was going to be a pediatrician.

“I’m a kid guy,” Conners says proudly.

(Click here for some personal impressions of the children’s hospital from both patients and staff.)

(Click here for a quiz about some of Golisano’s notable visitors.)

Now, as professor and chair of the department of pediatrics at Upstate, Conners oversees the Upstate Golisano Children’s Hospital.

One of his duties is to greet the new pediatric residents. Earlier in the week, Conners attended a dinner saluting the doctors who completed the three-year program. This day, he’s greeting those who will take their places. Such is the life cycle of an academic medical center.

These residents are medical school graduates who will work for three years in pediatrics at Upstate. (The term is a holdover from a time when new doctors actually lived in the hospital where they worked.) Upstate has 47 pediatric residents, who come to Syracuse from all over the world, plus several pediatric fellows who are pursuing specialized training after their residency.

“Taking care of kids and being a pediatrician is a privilege and a responsibility,” Conners tells the new doctors. “It’s important to take your role seriously.”

The residents join a staff of 72 pediatricians and more than 400 pediatric nurses, therapists, social workers and other dedicated pediatric staff who care for about 100,000 pediatric patients each year. The children come from 17 counties surrounding Syracuse, plus parts of Pennsylvania and Vermont.

Conners took the helm March 4, after the retirement of Thomas Welch, MD, who oversaw the creation of the children’s hospital. Although it’s part of the Upstate University Hospital building, it operates separately.

Raising money

Construction costs for the hospital totaled $70 million, $21 million of which  the Upstate Foundation collected through a large fundraising campaign.

Public generosity was overwhelming. Ads that depicted a gleaming new building with private rooms and gorgeous views of Syracuse, filled with pediatric specialists, prompted people to donate amounts large and small. Staff from Upstate University Hospital pledged personal donations of nearly $2 million to build the children’s hospital. Beloved pediatrician Fred Roberts, MD, who practiced in Syracuse for more than 60 years, donated proceeds from sales of his two books. Students at schools throughout the region staged various fundraisers.

Ultimately, the hospital was named after its chief benefactor: businessman Thomas Golisano.

The doors opened on Sept. 23, 2009.

Beth Nelsen, MD, says it was an honor to be a chief resident that monumental day. Ten years later, she’s an associate professor of pediatrics and pediatrics residency program director. One of her jobs is to interview medical students who are applying for a pediatrics residency at Upstate Golisano. Many say it’s the nicest hospital they’ve visited.

“I’m a local, so I have a lot of Syracuse pride,” Nelsen says. “When somebody comes into my home and says, ‘It’s beautiful here,’ that makes me really proud.”

Pediatrics chair Gregory Conners, MD, greets the new pediatric medical residents — all doctors who began three years of training at Upstate in July. Seated next to Conners is pediatric hematologist/oncologist Gloria Kennedy, MD.  (photo by Chuck Wainwright)

Pediatrics chair Gregory Conners, MD, greets the new pediatric medical residents — all doctors who began three years of training at Upstate in July. Seated next to Conners is pediatric hematologist/oncologist Gloria Kennedy, MD.  (photo by Chuck Wainwright)

Attracting specialists

Like patients and their families, doctors prefer to be in a space customized for the comfort of children and families, surrounded by modern equipment and a staff dedicated to children. The hospital helps to attract pediatricians in specialties such as gastroenterology, neurosurgery, endocrinology and others.

Among the 71 beds dedicated to pediatric patients are 12 for cancer and blood diseases, 15 for intensive care and 44 for medical/surgical issues. The 285-square-foot patients’ rooms are all private, with space for a sofa bed for a parent, and bathrooms with showers. Plans are in the works to add eight psychiatric beds for adolescents.

Conners came to Upstate from Children’s Mercy Hospital in Kansas City, Missouri. He’s a native of the Rochester, New York, area and went to medical school at SUNY Stony Brook, graduating in 1989. He completed a residency and fellowship at Children’s National Medical Center in Washington, D.C.

He’s had experience with several children’s hospitals. He is impressed with this one — and with its potential.

Already he’s collaborating with children’s hospital executives from throughout Upstate New York. “What we’re working on, and it’s not easy, is to group together so that there are ways to take care of kids who have really high-tech or very specialized needs, without making them have to travel [out of state],” Conners says.

A highly specialized pediatric service might not have enough demand for services in a community the size of Syracuse or Rochester. But, if Syracuse offers something not available in Rochester, and Rochester offers something else that is not available in Syracuse, families in both communities can benefit.

“There’s a lot of pride in running your own place and saying, ‘We’re good on our own.’ I also think it’s important to realize there are some areas where it’s not a matter of greatness. It’s a matter of economies of scale, of doing the right thing for patients,” he says.

“We can work together to be proud of what we can do collectively.”

Halloween at the children’s hospital. Patients can go trick-or-treating in the hallways, getting treats from Upstate employees, who also come in costume. (photo by Kathleen Paice Froio)

Halloween at the children’s hospital. Patients can go trick-or-treating in the hallways, getting treats from Upstate employees, who also come in costume. (photo by Kathleen Paice Froio)

Building on legacies

Discussion of the need for a children’s hospital goes back at least to the 1970s, when Frank Oski, MD, was chair of Upstate’s pediatrics department, says retired pediatrician Howard Weinberger, MD. Oski, who went on to lead the Johns Hopkins Children’s Center, literally wrote the book on pediatrics. His text, “Principles and Practices of Pediatrics” is still in use.

Weinberger recalls many meetings, but little consensus, until Thomas Welch, MD, arrived in the summer of 2001. Welch’s first task was to drum up support for the concept of a children’s hospital. “I had to convince the community that communities are judged by the way they take care of their children — and we really needed to do a better job,” Welch says. “There was such universal buy-in from the community.”

Once the children’s hospital opened, eight years after his arrival, nearby hospitals stopped admitting pediatric patients, instead sending ill and injured children who required hospitalization to Golisano. Soon, plans were underway to expand Upstate’s pediatric emergency department as well.

Before August 2016, the pediatric emergency department occupied a corner of the adult emergency department. It could get crowded and noisy. “We did great with what we had,” says pediatric emergency department Director Richard Cantor, MD, acknowledging the desire for a more peaceful space devoted to children and adolescents.

Today, the pediatric emergency department occupies a wing on the fourth floor of University Hospital, separate from the adult emergency department. Each year, it treats about 30,000 kids up to age 19.

The expansion cost $9 million, much of the money brought in through donations. Six patient rooms bear plaques in honor of Cantor. And the medication room is named in memory of Robert Kanter, MD, a renowned pediatrics professor with a long gray ponytail who opened and led the region’s first pediatric intensive care unit at Upstate, decades before the children’s hospital was built.

The dictation room has a plaque bearing the name of Robert Dracker, MD, an Upstate graduate and pediatrician who founded Summerwood Pediatrics. Even though Upstate had pediatric specialty doctors before the children’s hospital was built, Dracker says having an actual children’s hospital “has enabled us to have pediatric-focused care with regard to facilities and nursing.”

It is the dictation room where Conners and the rest of the doctors gather at the start of his 4 p.m. shift one Wednesday afternoon in June. Here, the doctors who are getting off duty brief those coming on. A toddler gives a slow, drowsy wail somewhere down the hall, past the cleaning cart painted like a giraffe.

Conners has a beaming demeanor. He speaks softly. Draped around his neck is a red stethoscope. He rubs sanitizer between his hands while he listens to the reports about the patients in the pediatric emergency department that afternoon.

An 8-week-old with diarrhea and vomiting will probably need to be admitted. Needing to be assessed are a 19-year-old girl who was in a head-on collision, a 15-year-old girl with abdominal pain, and a 10-year-old boy with unusual swelling. And there are more patients just arriving.

Conners is on duty alongside Leah Bennett, MD, an assistant professor of emergency medicine. She’ll take care of patients in even-numbered rooms.

He gets the ones in odd numbers.

Providing care

He heads to room 11. Cartoons play silently on the wall-mounted television. On the bed looking tiny is a 2-year-old girl with pink and black beads woven into braids. The girl looks at Conners with wide eyes.

Conners in the children’s hospital. (photo by Chuck Wainwright)

Conners in the children’s hospital. (photo by Chuck Wainwright)

“Hi, Sweetheart,” he says.

Her mom explains that the girl has had a cold for a week, with a slight fever. She’s worried.

Conners talks to the girl. He holds the round end of his stethoscope.

“Can I put this on you?”

She squeaks an affirmative reply. She’s transfixed by his face.

After he listens to her breathing, Conners shows her a tool called an otoscope.

“Sweetie, this is a light,” he says, flicking it on and aiming the light onto his palm for her to see. The girl extends her hand. He moves the beam of light onto her palm. She’s thrilled. She lets him peer into her ear.

Next, Conners sees a teen boy in room 13 with a headache after a blindsided tackle during a football game at recess.

Conners wraps up with the boy. Then he heads to the dictation room.

A countertop lines three sides of the room. Seven computers are placed in front of seven stools. That’s where doctors and pediatric and emergency medicine residents document their interactions with their patients. They prescribe various tests, medications or treatments. The room usually has snacks. Today, someone has brought in a pan of homemade Rice Krispies treats, some chocolate almond biscotti and a small bowl of candy.

“Everybody good? Anyone need anything?” Conners asks, before obliging his sweet tooth. Neither of his patients appears to be seriously ill or injured. After getting lab work (the toddler girl) and medical images (the teen boy), both will go home.

Working together

At 8:35 a.m. the next Monday, Conners — as the executive director of the Upstate Golisano Children’s Hospital — led the daily “Pediatric Safety and Operations Brief.” This is a group phone call that unites people from 22 departments in the children’s hospital. Representatives from inpatient rehabilitation, respiratory care and the laboratory are part of it. So are people from materials management, clinical engineering and the physical plant.

They share information: how many pediatric patients are in the hospital this morning; whether any areas are short on staff; that public safety officers were summoned twice overnight to help with a combative patient; and a notice from the pharmacy that the injectable sedative midazolam is in short supply, so doctors should prescribe something else when possible. The issues that arise are typical for a children’s hospital.

The call is quick and helps every department start each day on the same page. Each call ends with a quote, which Conners enjoys selecting. Today he reminds the group: “Children are great imitators, so give them something great to imitate.”

Upstate Health magazine fall 2019 coverThis article appears in the fall 2019 issue of Upstate Health magazine.

Posted in community, health care, history, Upstate Golisano Children's Hospital/pediatrics

Golisano 10th anniversary quiz: Can you name these noted visitors to the children’s hospital?

Many special guests have boosted spirits by visiting patients at the Upstate Golisano Children’s Hospital over the years. Here are clues about 10 of them as the hospital marks its 10th anniversary. (For answers, scroll down.)

  1. Yummy, yummy! This children’s group was formed in Australia in 1991.
  2. Created by a Chittenango-born author, these lovable characters were brought to life in one of the first Hollywood films to be shot in Technicolor.
  3. What is equipped with six cameras and several arms, and designed to protect human life while neutralizing dangerous situations?
  4. This team’s logo was once a Native American, then a plane, then a train. Today the team is known as __________.
  5. He mixes art, magic, science and fun. This performer is known as  _______.
  6. Founded by Canadian street performers in 1984, this is now the largest theatrical producer in the world.
  7. Name these two furry Muppets. One is red with a falsetto voice that appeals to toddlers. The other is blue with a big smile and a pink nose.
  8. This Syracuse native was the first Indian American to win this crown, in 2014. What is her name and what was she crowned?
  9. An annual dance marathon that bears this college mascot’s name raises money for the children’s hospital. Who is the mascot?
  10. She was the nanny to Jane and Michael Banks.

(Click here for personal impressions of the children’s hospital from both staff and patients.)

(Click here for a look at how Golisano has come to be what it is today.)

Answers

answers to visitor's quiz

Upstate Health magazine fall 2019 coverThis article appears in the fall 2019 issue of Upstate Health magazine.

 

 

 

 

 

 

 

Posted in Upstate Golisano Children's Hospital/pediatrics

Impressions on Upstate Golisano’s Children’s Hospital’s 10th anniversary

As the Upstate Golisano Children’s Hospital celebrates 10 years of service in 2019, we asked a variety of people to share their impressions.  The above sketches of the speakers were created by Susan Keeter, assistant director of creative services in the Upstate marketing and university communications department.

(Click here for a look at how the children’s hospital has come to be what it is today.)

(Click here for a quiz about some of Golisano’s notable visitors.)

Ilijah Barron of Liverpool

“After a group of (Liverpool) High School seniors in Upstate New York found out that their classmate Ilijah Barron would be missing prom due to his battle with bone cancer, they brought the senior ball to him in the hospital,” anchor David Muir said in introducing the story on “ABC World News Tonight” in June. Barron and more than 20 of his friends dressed in their finest and celebrated together in Golisano’s 11th floor event space. “I loved it,” Barron told Syracuse.com. “It was the most special moment ever, having everybody there, all my friends.”

Professor of pediatrics Ann Botash, MD

The day of Sept. 23, 2009, Botash was responsible for discharging any patients who were well enough to go home, and transferring the others into the 11th and 12th floors of the new building. She recalls a 9-year-old girl with asthma, whom she wheeled into the children’s hospital. “I can remember her face and her getting so excited about the room.

The room was so calm and spacious by comparison, and the private television was such a luxury.

She got so excited that she started wheezing,” Botash says. “She ended up staying another two days.”

Pediatric nurse Maisha Brown

She remembers the soundtrack provided by a boy of about 12 or 13 on moving day, when children who were already hospitalized were moved into the new hospital. “He’s an adult now,” Brown points out. He lay on his hospital bed, holding his CD player, as Brown brought him to the 11th floor. “We were listening to ‘Hakuna Matata.’ ” That’s the song from “The Lion King” that means “no worries.”

Richard Cantor, MD, director of the pediatric emergency department

When he began his pediatric residency at Upstate in 1976, Cantor worked primarily on the fourth floor of University Hospital, where children were then hospitalized. At the time, the ward “really had nothing that signified that it was for children, except maybe for some wallpaper and a scattering of toys,” he recalls. More than 40 years later, Cantor works in the same physical space on the fourth floor of the main hospital. Only now, it’s been transformed into a pediatric emergency department for kids up to age 19, whom he oversees.

Tim Conners of Fulton

He spent about a week in the hospital in April 2010 when he was first diagnosed with leukemia. Seven months later, Conners was back, and it was the holiday season. “One of my nurses brought me the movie ‘Elf,’ so I got to watch ‘Elf’ in my room,” he remembers. Soon after, cancer stole his vision. Today, Conners is a motivational speaker who donates a portion of the money he raises to the children’s hospital. He is no relation to Golisano Executive Director Gregory Conners, MD.

Tyler Halpin of Clay

Tyler Halpin,15, has cystic fibrosis, so every three months he sees Christopher Fortner, MD, PhD, medical director of the cystic fibrosis program. Sometimes his treatment requires an overnight hospital stay. “He actually looks forward to that,” says his mother, Erin Halperin.

“He needs extra calories. He loves the food, and he can have whatever he wants.”

Brayden Kires of Baldwinsville

When Brayden was born with a life-threatening condition called gastroschisis, in which the intestines grow outside of the abdomen, his mother, Crystal Kires, wanted to make sure she did everything she could for her baby. She’s grateful she found Marcus Rivera, MD, a pediatric gastroenterologist at Golisano.

Brayden’s surgical team removed the malfunctioning intestines. Two months after his birth, Brayden went home. Eventually, Kires says, her son will need an intestinal transplant.

Nursing director of pediatric services Linda McAleer

Her daughter Caroline was frequently hospitalized as a child, before the children’s hospital opened. The family kept a suitcase packed, just in case she had to be admitted. Their memories of cramming into the hospital room, and McAleer sleeping on the floor, are not good ones. Now grown, Caroline visited her mother at work and saw the children’s hospital for the first time. “Mom, this is amazing,” she said. “I wouldn’t have been so scared here.” McAleer is proud of the environment. “It’s all about creating an experience that is child-friendly and way less frightening,” she says.

Hospital teacher Mary Ellen Michalenko

The architects asked her for a list of features she needed for the room where patients — from kindergarten through 12th grade — would come to do their schoolwork while they were hospitalized. Among other things, Michalenko needed a door that was big enough for a hospital bed to roll through. “Everything I put on the wish list was in the school room. Everything,” she says. Michalenko has been teaching at Upstate for 22 years.

Aria Morris, 6, of Camillus

While she underwent cancer treatment at Upstate, Aria saw plaques decorating the halls. She asked her mother about them. Melissa Morris is a nurse practitioner at the Upstate Cancer Center. She explained that the names on the plaques were people who donated money to help support the care of patients like her. So, Aria embarked on a fundraising campaign, selling T-shirts, bracelets and candles. She raised $5,000 to donate a window bench in the children’s hospital.

Pediatrician Beth Nelsen, MD

A pediatrics chief resident when Golisano opened in 2009, she remembers starting work at 5:30 a.m. on moving day. Nine hours later, she and a colleague finally had time to walk into the newly occupied hospital and absorb their new surroundings. “The one thing we both remarked on was how quiet it was.”

Retired pediatrician Stuart Trust, MD

Along with Thomas Welch, MD, Trust and each of their wives were co-chairs of the Upstate Foundation’s annual gala the year that proceeds went to the children’s hospital. Trust remembers purchasing a tuxedo for the occasion. He also recalls greeting “hundreds and hundreds” of people at the entrance, shaking hands and thanking them for supporting the children’s hospital.

Retired pediatrician and former pediatrics Chair Howard Weinberger, MD

Much has changed in the way care is provided in the past decade, Weinberger points out. These days, general pediatricians whose patients require hospitalization rarely oversee the patient’s care in the hospital. Instead, pediatric hospitalists take care of these patients. “In many ways it’s better for the patients because they have better continuity of care by specialists who are skilled in hospital care, and that care is provided 24 hours a day.”

Thomas Welch, MD, founding director of the Upstate Golisano Children’s Hospital

“When we got down to the nitty gritty of designing the hospital, we visited several children’s hospitals around the country. The architects were good about working with children and actually met with children in the hospital. We had input from families, from children, from staff, from the site visits. All of that went into the design,” Welch said.

He recently bumped into one of the architects of the children’s hospital, in San Francisco. Welch told him, “After 10 years of working in the hospital, I honestly can’t think of anything I would have done differently in terms of design.

Upstate Health magazine fall 2019 coverThis article appears in the fall 2019 issue of Upstate Health magazine.

Posted in Upstate Golisano Children's Hospital/pediatrics

Rethinking Kaposi sarcoma: Viral immunologist sees patient improve after treatment for inflammatory response

Christine King, PhD (photo by William Mueller)

Christine King, PhD (photo by William Mueller)

Editor’s note: This is one of three articles on Upstate’s “renegade researchers” — scientists who are providing new ways of looking at long-standing medical problems, including Kaposi sarcoma (detailed below), hydrocephalus and schizophrenia.

BY AMBER SMITH

Christine King, PhD, studied both virology and immunology for her doctorate. Years of laboratory research have developed her deep understanding of endothelial cells, mast cells and a disease called Kaposi sarcoma. She is known as a voracious reader of scientific journals.

So, when a 46-year-old man with Kaposi sarcoma developed seemingly random symptoms that were making him miserable soon after he had his appendix removed, infectious disease doctors at Upstate University Hospital asked King if she had any ideas.

Boy, did she.

She proposed a novel treatment that worked.

But first, some background.

A special research lab

King’s lab is focused on the origin and development of viral diseases, particularly those affecting endothelial cells, which line the blood vessels throughout the body. These cells have an innate resistance to cancer, something researchers are trying to better understand. King studies two diseases that are characterized by faulty endothelial cells: dengue fever and Kaposi sarcoma, which is caused by a herpes virus. In severe cases of dengue, endothelial cells become leaky. In advanced Kaposi, the cells proliferate uncontrollably and don’t function properly.

Many doctors who treat patients with Kaposi blame the herpes virus for getting into the endothelial cells and causing inflammation. That’s not how King sees it.

“No virus wants to make you sick. It just wants to survive,” she explains. “When you feel sick from a cold or a flu, it’s the immune response that’s making you feel sick. It’s not the virus.” It’s the same with Kaposi, she says. It’s the body’s immune reaction to the virus that causes the inflammation, which leads to skin lesions and other symptoms.

A team of scientists from various medical schools collaborates with King. They believe Kaposi is dependent not just on the herpes virus but also the body’s immune reaction, and they say the disease will go away if the inflammation goes away.

They also believe it’s not the endothelial cells that initiate the inflammation but their companion cells, mast cells, that do. Mast cells are the cells that release histamine during inflammatory and allergic reactions. They are located in connective and mucosal tissue throughout the body and work closely with endothelial cells.

King noticed that the Kaposi lesions appear in areas where mast cells are prevalent. She began thinking mast cells may play a role in the disease. Blood analyzed from people with Kaposi suggest she is on the right track. “We took random samples, and the levels of mast cell specific mediators were incredibly high, suggesting we have this constant activation going on,” she says.

Testing a theory

Soon she got the chance to test her theory, when infectious disease specialists at Upstate asked for her input on a patient.

The man had been diagnosed with HIV 14 years before, and he had the hallmark lesions of Kaposi sarcoma on his legs and feet. After an emergency appendectomy, those skin lesions began getting darker and bigger. He developed intermittent vertigo, headaches, ringing in his ears, eye pain and a worsening of longstanding symptoms such as gastroesophageal reflux, nausea and diarrhea, achy muscles and joints, night sweats and fatigue. It was like a horrible episode of allergies.

King met with the man and quickly recognized his symptoms as those of mast cell activation. She told him about her laboratory work and what she thought might help him. He was eager to try.

“We hypothesized that his worsening constitutional symptoms and progression of his previously stable Kaposi sarcoma both resulted from extensive mast cell activation triggered by his recent inflammatory appendicitis and abdominal surgery,” King and her colleagues wrote in a journal of the American Association for Cancer Research.

The man took high doses of antihistamines — cetirizine and ranitidine, or Zyrtec and Zantac — which are available over the counter, along with a prescription anti-inflammatory called montelukast, or Singulair, and vitamin C, known as a mast cell stabilizer.

“He did fabulous. His regression was dramatic, and it happened right away,” King recalls. At the man’s follow-up appointment two weeks later, many of his symptoms had gone away. “Over the next three months, they continued to resolve. His lesions shrank. He felt better. He told me he felt the best he’d felt in years and years and years.”

Success in a single patient doesn’t prove anything. But, this case gives King and her team more to explore. They’re gathering data for a future clinical trial that could find an affordable and effective way to treat Kaposi.

Meanwhile, the researchers are getting the word out by presenting their findings at international scientific conferences and in medical journals. The medications they’re working with are relatively inexpensive, have been in use long term and are readily available, so doctors with Kaposi patients may want to try the combination. Says King: “I suspect it’s going to work in most patients.”

(Click here to hear King discuss her work in a podcast/radio interview on Upstate’s “HealthLink on Air.”)

About Kaposi sarcoma

This cancer develops from the cells that line lymph or blood vessels and usually appears as lesions on the skin (which may be purple, red or brown) or mucous membranes inside the mouth, lungs, stomach or intestines.

In America, most cases of Kaposi are seen in people with human immunodeficiency virus, or HIV, but the disease can also affect people with reduced immunity, such as those who have undergone an organ transplant. In other parts of the world, Kaposi is prevalent among the general population, including people who do not have HIV.

Kaposi can be treated with chemotherapy, radiation or surgery to remove the lesions, but the disease often returns.

Source: American Cancer Society

This is what helped the patient

A 46-year-old man with Kaposi sarcoma suffered multiple symptoms that went away soon after he started taking:

  • 20 milligrams cetirizine, daily (commonly used for allergy relief, it is a type 1 histamine receptor antagonist also known as Zyrtec, available over the counter)
  • 300 milligrams ranitidine, twice a day (commonly used to relieve stomach acid and digestive problems, it is a type 2 histamine receptor antagonist also known as Zantac, available over the counter)
  • 10 milligrams montelukast, daily (commonly used to treat asthma, it is a leukotriene receptor antagonist also known as Singulair, which requires a prescription)
  • 1 gram vitamin C, daily (a mast cell stabilizer)

Source: a journal of the American Association for Cancer Research called Clinical Cancer Research, July 2018.

Upstate Health magazine summer 2019 issue coverThis article appears in the summer 2019 issue of Upstate Health magazine.

Posted in cancer, drugs/medications/pharmacy, health care, HealthLink on Air, research | Tagged

The future is now: Innovation comes from reimagining health care

metallic robotic hand grasping a CPU

The future of health care is likely to involve a mix of technological innovations and a recycling of old ideas in new ways, says state Health Commissioner Howard Zucker, MD, JD.

BY JIM HOWE

An animated cartoon that premiered in 1962 offered a whimsical glimpse of a future where science and technology made everyday tasks a breeze. Who could have predicted six decades ago that several of the advances imagined in the Jetsons’ world of 2062 would come true much sooner?

Consider the “future” world of the Jetsons:

George Jetson uses a flat-screen TV to consult with his doctor.

Telemedicine looks a lot like that today.

The Jetson family gets a robotic dog named Lectronimo.

Robotic cats and dogs in use today provide companionship or stimulation to lonely or demented people who are unable to deal with real pets. (Click here for a look at how Upstate is using animatronic pets.)

Young Elroy Jetson travels to school by drone.

Small, unmanned aircraft are being used for small package deliveries that may include medical transports someday.

New York State Health Commissioner Howard Zucker, MD, JD, uses the 1960s animated cartoon show "The Jetsons" to show how health care has advanced in the past several decades.

New York State Health Commissioner Howard Zucker, MD, JD, uses the 1960s animated cartoon show “The Jetsons” to illustrate how health care has advanced in the past several decades.

Health care is constantly being reimagined, New York State Health Commissioner Howard Zucker, MD, JD, said during a recent presentation at Upstate.

He said it doesn’t hurt to dream a little about how to improve public health.

At one time, he noted, horse manure created a terrible health problem in cities; someone had to come up with the idea of a future with automobiles.

Our future may hold some of the technology depicted on “The Jetsons,” along with a revival of older practices, such as the house call, Zucker said.

In the early 1900s, doctors provided care in peoples’ homes. By the 1940s, doctors tended to dispense care from offices, and medical testing became more prevalent. “Today, we’re moving more toward home care, allowing patients to do things we couldn’t do before, such as using a smart watch to look at an electrocardiogram and tell you things about your health,” he said.

Many more innovations are in the works. Zucker mentioned:

a “spider sense” body suit equipped with pressure or motion sensors to detect what’s going on in the environment;

a gene-altering technology known as CRISPR that might be able to fight cancer (click here for a “HealthLink on Air” interview explaining CRISPR);

and the ability of fitness trackers, clothing and home appliances to record and transmit personal information in a way that may be useful for health monitoring.

Working together, government officials, medical professionals and the public will decide what is needed to improve the well-being of society. Zucker says, “Collective will, rather than money, will drive these changes.”

Will doctors someday wield tricorders the way Dr. Leonard “Bones” McCoy did in the 1960s TV show “Star Trek”? Despite many attempts, the medical version of that fictional multifunctional handheld device has not been duplicated in real life. Yet.

Upstate Health magazine summer 2019 issue coverThis article appears in the summer 2019 issue of Upstate Health magazine. Click here to hear a “HealthLink on Air” radio/podcast interview in which state Health Commissioner Howard Zucker, MD, JD, discusses Syracuse’s role in the 1918 Spanish flu epidemic and current health issues ranging from AIDS and opioid addiction to electronic cigarettes.

 

 

 

 

This article appears in the summer 2019 issue of Upstate Healthmagazine.

Posted in health care, HealthLink on Air, history, public health, technology

‘Pets’ for patients

Battery-operated companion dog and cat (photo by Richard Whelsky)

Battery-operated companion dog and cat (photo by Richard Whelsky)

Upstate has a dozen animatronic pet puppies and kittens available to help older patients who are hospitalized with dementia, loneliness or depression related to a prolonged hospitalization. Donations from the Upstate Foundation’s “Friend in Deed” fund made this program possible.

The Joy for All Companion Pets are gifts for selected patients to use in the hospital and take home with them, explains Assistant Director of Nursing Kelly Dolan. They are not shared among patients because of infection control concerns.

The pets have built-in sensors that respond to motion and touch, and a heartbeat that patients can feel. With a lifelike coat, authentic sounds and the ability to respond to the patient’s voice, the dog and cat are meant to provide comfort. They operate on alkaline batteries.

The manufacturer sells the yellow Lab puppy for $120 and cats for $100, with your choice of an orange tabby, tuxedo or silver with white mitts.

To donate to the Friend in Deed fund, contact the Upstate Foundation at 315-464-4416 or upstatefoundation.org

Upstate Health magazine summer 2019 issue coverThis article appears in the summer 2019 issue of Upstate Health magazine.

Posted in aging/geriatrics, Alzheimer's/dementia, health care

How does your story end? 6 considerations toward the end of life

Gregory Eastwood, MD, at a signing event for his book "Finishing Our Story: Preparing for the End of Life" at the Barnes & Noble Booksellers store in DeWitt. (photo by Susan Keeter)

Gregory Eastwood, MD, at a signing event for his book “Finishing Our Story: Preparing for the End of Life” at the Barnes & Noble Booksellers store in DeWitt. (photo by Susan Keeter)

BY AMBER SMITH

Gregory Eastwood, MD, is a physician and ethicist who served for many years as president of Upstate Medical University.

In his new book, “Finishing Our Story: Preparing for the End of Life,” he discusses the dying process, how the quality of life may influence a person’s death, physician-assisted death, palliative care and the importance of making one’s wishes known.

“Each of us will confront our own mortality someday, if we haven’t already,” he says.

Aside from practical advice, such as the selection of a health care proxy, Eastwood’s book also offers guidance in making the end of life more fulfilling.

  1. Reflect on what quality of life means to you and how much importance it has compared to biological life. In other words, would you want everything to be done to keep you alive if your quality of life would be greatly diminished? Do you want your life extended at all costs — financial, social and emotional?
  2. Think about what could happen to you in different health and social circumstances, and talk about that with loved ones. If you have a chronic disorder, such as diabetes or heart trouble, anticipate the types of decisions you may face in the future. Would you want to be resuscitated if your heart stops? Are you OK with having a breathing tube in your trachea? What about intravenous fluids and a feeding tube? Would you want to remain in the hospital or go home?
  3. “Bear in mind that some of the characters who populated the earlier chapters of your story are likely to reappear in the last chapter,” Eastwood writes. “What are the implications of that to you?
  4. Do you have any emotional debts to pay, someone to whom you need to apologize or explain an earlier behavior?
  5. If you are nostalgic, you may want to reinforce memories by revisiting places that have meaning to you, reconnecting with friends or reliving certain experiences.
  6. You may find yourself thinking more about the legacy you will leave. While you cannot change facts or experiences, you may find opportunities to renew context or derive different meanings so that you conclude your story in a way that satisfies you.

The book may be purchased at local bookstores or online through Barnes & Noble, Amazon or the Oxford University Press.

Click here for a “HealthLink on Air” interview with Gregory Eastwood, MD, about end-of-life issues.

Upstate Health magazine summer 2019 issue coverThis article appears in the summer 2019 issue of Upstate Health magazine.

Posted in death/dying, health care, HealthLink on Air, palliative care

Nurses are raising the bar

Jolene Kittle is one of Upstate’s most-certified nurses. She is the trauma program manager and holds six certifications: as a flight registered nurse, adult gerontology clinical nurse specialist, trauma registered nurse, adult critical care nurse, emergency nurse and nurse executive. (photo by Robert Mescavage)

Jolene Kittle is one of Upstate’s most-certified nurses. She is the trauma program manager and holds six certifications: as a flight registered nurse, adult gerontology clinical nurse specialist, trauma registered nurse, adult critical care nurse, emergency nurse and nurse executive. (photo by Robert Mescavage)

More than 570 of the nurses working at Upstate University Hospital hold specialty certifications, awarded for acquiring additional skills, knowledge and expertise in a special area. Many hold multiple certifications.

Experts say certified nurses raise the standard of practice in the profession and ultimately improve patient safety and care.

“Nursing is a very dynamic profession with new information and techniques being disseminated every day. Certification is a way to validate specialty knowledge and remain current while constantly enhancing skills and knowledge base,” says Upstate chief nursing officer Nancy Page, who holds the advanced nurse executive specialty certification.

To earn a certification, nurses must meet various eligibility requirements that include experience in the specialty, a specific number of continuing education hours in the specialty and participation in a rigorous program of study before taking an exam required for each specialty.

Upstate nurses, by the numbers

Of 95 nursing specialties, these 10 certifications are held by the highest number of Upstate nurses:

90 — CMSRN, certified medical-surgical register nurse

89 — CCRN, acute- or critical-care registered nurse, including adult and pediatric

53 — CPN, certified pediatric nurse

40 — SCRN, stroke-certified registered nurse

34 — OCN, oncology-certified nurse

26 — NP-C, certified family nurse practitioner (by American Academy of Nurse Practitioners)

21 — FNP-BC, board certified family nurse practitioner (by American Nurses Credentialing Center)

20 — CNOR, certified nurse, operating room

18 — CEN, certified emergency nurse

15 — ONC, orthopedic nurse certified

Upstate Health magazine summer 2019 issue coverThis article appears in the summer 2019 issue of Upstate Health magazine.

Posted in health care, nursing | Tagged