Mysterious ‘door’ guards cancer secrets: Researchers work to halt a strange, deadly process in the spread of breast cancer

Here’s how breast cancer can spread: A tumor cell (green, No. 1), is in direct contact with a macrophage (blue, No. 2) and an endothelial cell (red, No. 3). The macrophage is a part of the immune system, and the endothelial cell is part of a blood vessel wall. The tumor cell makes an invasive protrusion called an invadopodium (white arrow) that cuts a doorway into the blood vessel. Other tumor cells (green, marked with *) then leave the tumor, pass through that opening into the bloodstream and travel to new parts of the body, where they can start new tumors. Collagen fibers are shown in purple. This illustration is based on live microscopic imaging of a mouse with a mammary tumor (image courtesy of Peng Guo)

How breast cancer can spread: A tumor cell (green, No. 1), is in direct contact with a macrophage (blue, No. 2) and an endothelial cell (red, No. 3). The macrophage is a part of the immune system, and the endothelial cell is part of a blood vessel wall. The tumor cell makes an invasive protrusion called an invadopodium (white arrow) that cuts a doorway into the blood vessel. Other tumor cells (green, marked with *) then leave the tumor, pass through that opening into the bloodstream and travel to new parts of the body, where they can start new tumors. Collagen fibers are shown in purple. This illustration is based on live microscopic imaging of a mouse with a mammary tumor. (image courtesy of Peng Guo)

BY JIM HOWE

Double agents, secret doorways, infiltration … it sounds like a spy thriller, but it’s how some breast cancers can spread, and eventually kill, a prominent researcher says.

Scientists hope that this medical drama, which plays out at a microscopic level, holds keys to better diagnosis and treatment of breast cancer.

While primary breast cancer tumors can often be treated effectively, comparatively little progress has been made in treating breast cancer after it has spread.

In most cases, death from breast cancer happens only after it spreads to places like the brain, lungs, bone marrow or liver.

John Condeelis, PhD, is a professor, co-chair and holder of the Judith & Burton P. Resnick Chair in Translational Research at Albert Einstein College of Medicine, where he also co-directs the Biophotonics Center and Integrated Imaging Program.

John Condeelis, PhD, is a professor, co-chair and holder of the Judith & Burton P. Resnick Chair in Translational Research at Albert Einstein College of Medicine, where he also co-directs the Biophotonics Center and Integrated Imaging Program.

Researchers can study cancer cells in a laboratory, but they learn much more by watching those cells inside a living body — how they sneak away from the tumor and what role the body’s immune system might play, says John Condeelis, PhD, a professor at Albert Einstein College of Medicine in New York City.

In the past several years, high-powered microscopes and special lasers have allowed his research team to peek inside a live mouse with breast cancer at a magnification not previously possible, says Condeelis.

He spoke of his findings in a lecture at Upstate Medical University sponsored by the Carol M. Baldwin Breast Cancer Research Fund of CNY. Doctors and scientists at academic medical centers such as Upstate have frequent opportunities to hear from leading researchers this way.

Condeelis’ team has learned that migrating cancer cells commandeer strands of nearby collagen tissue as miniature highways and head toward blood vessels.

That’s when a strange thing happens. Bloblike immune cells called macrophages, which would normally engulf and kill invaders, do not destroy these traveling cancer cells.

Instead, when they are in a cancerous environment, the macrophages act as double agents, he says. Rather than trying to kill the cancer cells, the macrophages send messages that encourage cancer cells to migrate.

What’s more, the macrophages and the cancer cells pair up, move to a nearby blood vessel and conspire with a blood vessel wall cell there to create a doorway into the vessel that will open and close at regular intervals. Condeelis and his fellow researchers describe this doorway as a “tumor micro-environment of metastasis,” or TMEM for short.

This doorway is what allows cancer cells to pass into the bloodstream and travel all over the body. These circulating cancer cells then form new tumors in distant spots and begin the process all over, creating additional doorways and more tumors.

“This is how metastases kill people,” Condeelis said. “It’s the perfect killing machine, an absolute catastrophe,” he says of the circulating cancer cells. “You have to stop tumor cells before they can get out of the tumors, wherever these tumors are in the body.”

He hopes that drugs can be developed to intercept that communication between macrophages and cancer cells, then “shut the doorway, block the highway and kill cancer cells.

“We think we have figured out how to close the door,” he says. Using the drug Rebastinib as a doorway inhibitor, combined with chemotherapy, greatly increases survival rates by stopping the cancer’s progression, he says. The drug, still in development, is well tolerated in mice. In human trials, the vast majority of patients saw complete removal of circulating cancer cells, with no side effects, he says.

“Dissemination is the key to controlling metastasis,” he says. “You’ve contained the disease, which buys time to kill the residual cancer cells with chemo or radiation.”

The researchers have also observed markers to help in determining prognosis and treatment.

His lab has worked with other teams at Einstein as well as Montefiore Health System, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine. This work might also apply to other cancers, including those of the pancreatic ducts, prostate and lungs, he says.

See how cancer spreads

Condeelis’ lab has produced a short video, “Spying on Cancer Cell Invasion,” using animation and high-resolution microscopic images of mice cancer cells, to show how a TMEM, or cancer “doorway,” works. Click here to view it.

Breast cancer quick facts

  • The average American woman has about a 12 percent chance of developing breast cancer at some point in her life.
  • Breast cancer is the second most common cancer in American women, after skin cancers, with about 250,000 new cases diagnosed annually.
  • Breast cancer is the second leading cause of cancer death in women, after lung cancer. The chance that a woman will die from breast cancer is about 1 in 38, or 2.5 percent.
  • Overall breast cancer death rates dropped 39 percent between 1989 and 2015.
  • 81 percent of breast cancers are diagnosed among women ages 50 years and older, and 89 percent of breast cancer deaths occur in this age group. The median age at diagnosis for all women with breast cancer is 62.

Sources: American Cancer Society, National Institutes of Health

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

 

 

 

Posted in cancer, health care, research, women's health/gynecology | Tagged , , , , ,

Summer camps for kids with cancer: A chance to let them savor nature

Little girl playing on a streamBY AMBER SMITH

Summer camp means days full of swimming, hiking and s’mores, but for kids affected by cancer, it can provide more than fun memories.

Camp organizers say sleepover camps for youth with serious illnesses provide a break from a routine that is often filled with medical appointments, and a chance to regain confidence and independence.

Some camps are designed for kids with cancer and other serious illnesses, some involve siblings, some are for kids who have a parent with cancer. Several throughout New York and nearby states do not charge campers.

“The environment of camp creates such a safe space to talk about their parent’s cancer,” says Madeline Merwin, a senior at Syracuse University who volunteers at Camp Kesem. She was a camper at the age of 12, after her mother was diagnosed with cancer. At a camp in California, where she lived, Merwin remembers an empowerment ceremony where a 6-year-old boy stood up and, without crying, explained how Camp Kesem was giving him the strength to return home and celebrate his mother’s life. “I think about him often, still,” she says.

The Children’s Oncology Camping Association International is a professional organization that connects summer camps that serve children and families touched by cancer across the globe.

“What’s most important for an oncology camp is to provide a normal experience, but in an environment where medical needs can be addressed if a child needs them,” Dave Smith says on the group’s website. He’s senior director of Camp Fantastic in Virginia.

The camps shown above in New York, Pennsylvania and Maine are listed by number below.

The camps shown above in New York, Pennsylvania and Maine are listed by number below.

8 special overnight camps to consider

1. Camp Adventure

kidsneedmore.org

Origins: parents started the group, Kids Need MORE (which stands for Motivational Recovery Environments) in 1990 with the belief that fun heals

Who can go: for children ages 6 to 16 with cancer, and their siblings

When: August 19-25; day camp is offered throughout July

Where: Camp Quinipet at 99 Shore Road, Shelter Island Heights, N.Y. (Suffolk County)

2. Camp Dost

rmhdanville.org

Origins: sponsored by the Danville Ronald McDonald House, Camp Dost is designed to give pediatric cancer patients the chance to enjoy a summer camp experience without worrying about medical care

Who can go: children age 5 to 18 who have been diagnosed with cancer, plus a sibling; also a 24-hour camp option for 4- and 5-year-olds

When: July 6-12

Where: Camp Victory, a special-needs camping facility in Millville, Pa. 

3. Camp Good Days and Special Times

campgooddays.org

Origins: celebrating its 40th year, the organization provides free programming to more than 1,500 children annually, thanks to community donations

Who can go: for children affected by cancer or sickle cell disease and their siblings; also offers adult retreats

When: various weeks starting in May

Where: Keuka Lake in Branchport, N.Y. (Yates County)

4. Camp High Hopes

camphighhopes.org

Origins: because many camps do not accept children with bleeding disorders, which require specialized knowledge and care, Camp High Hopes launched a summer camp for boys with hemophilia in 1985

Who can go: boys age 7 to 17 with bleeding disorders such as hemophilia and von Willebrand disease

When: July 28-Aug. 3

Where: Camp Aldersgate, 7955 Brantingham Road, Greig, N.Y. (Lewis County) 

5-7. Camp Kesem

campkesem.org/syracuse

Origins: founded in 2000 at Stanford University and now offered through several college campuses

Who can go: for youth ages 6 to 18 who are impacted by a parent’s cancer

5. When: June 30-July 6 (through SUNY Stony Brook)

Where: Camp Herrlich, 101 Deacon Smith Hill Road, Patterson, N.Y. (Putnam County) 

6. When: Aug. 11-16 (through Syracuse University)

Where: Camp Echo Lake, 177 Hudson St., Warrensburg, N.Y. (Warren County) 

7. When: Aug. 18-23 (through Cornell University)

Where: Camp Lakota, 56 Park Road, Wurtsboro, N.Y. (Sullivan County)

7. When: Aug. 25-30 (through Columbia University)

Where: Camp Lakota, 56 Park Road, Wurtsboro, N.Y. (Sullivan County)

8. Camp Simcha

www.chailifeline.org

Origins: started in 1987 by the international children’s health support network Chai Lifeline

Who can go: youth ages 6 to 20 battling cancer and blood disorders, in active treatment or post-treatment

When: Two-week camps for girls in June and July; for boys in July and August

Where: 430 White Road, Glen Spey, N.Y. (Sullivan County)

9. Camp Sunshine

campsunshine.org

Origins: founded in 1984 as a retreat to provide respite, recreation and support 

Who can go: children with life-threatening illnesses and their families

When: 25 sessions are offered, not just in summer

Where: 35 Acadia Road in Casco, Maine, on the shores of Sebago Lake

10. Double H Ranch

www.doublehranch.org

Origins:  Philanthropist Charles R. Wood and actor Paul Newman started the Double H Ranch in 1993; it’s the second of a worldwide network of “Hole in the Wall Gang” camps for children with serious illness that Newman founded in 1988

Who can go: children and siblings between ages 6 and 16 who function at a cognitive age of at least 6 and who have a medical diagnosis of cancer, sickle cell disease or one of several other diagnoses

When: individual weeks start in June and go through August

Where: 97 Hidden Valley Road, Lake Luzerne, N.Y., in the Adirondacks (southern Warren county)

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

Posted in cancer, health care, Upstate Golisano Children's Hospital/pediatrics | Tagged

Science Is Art: A close-up look at an enzyme

V-ATPases enzyme The V-ATPases enzyme (above) is present in every cell of the body, and also in plants and yeast. It has a connection to many diseases, including cancer and Parkinson’s. Upstate biochemist Patricia Kane, PhD, focuses her research on yeast cells.

Patricia Kane, PhD

Patricia Kane, PhD

Kane, a professor who leads Upstate’s department of biochemistry, was recently awarded a four-year, $1.1 million grant from the National Institutes of Health to continue her lab’s research into how cells regulate pH.

One of her projects studies how the V-ATPases knows where and how to help cells regulate pH. Kane has shown that the enzyme interacts with lipids at specific locations in the cell, and these interactions can make the enzyme more active at those locations. “There might be a code for the lipid within the enzyme, and we want to understand that code,” Kane says.

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

 

 

 

 

 

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

Posted in health care, research | Tagged

 A historical look at 5 popular heart medications: Are you taking any of them?

heartBY AMBER SMITH

Harold Smulyan, MD

Harold Smulyan, MD

Some of the newer cardiac drugs were chemically designed in laboratories before going through years of expensive clinical trials and eventually gaining approval from the Food and Drug Administration.

Some of the older drugs, which are still in use today, were discovered by accident — and spent years becoming accepted, purified and widely used.

Harold Smulyan, MD, a professor emeritus at Upstate who specializes in cardiology and enjoys history, researched aspirin, atropine, digitalis, nitroglycerin and quinidine. He published “The Beat Goes On: The Story of Five Ageless Cardiac Drugs” in the American Journal of the Medical Sciences in 2018. This information is pulled from his work.

Hear Smulyan discuss these drugs in a podcast/radio interview with Upstate’s “HealthLink 0n Air.”

willow treeAspirin

Discovered: 4,000 years ago

Came from: bark and leaves of the willow tree, whose sap contains salicin, which the body metabolizes into salicylic acid

First used: to treat pain, fever and inflammation

Documented in: clay tablets left by the Assyrians and Babylonians; also recorded use among Egyptian, Chinese and Greek civilizations in 1300 BC; by Greek physician Hippocrates (460-370 BC) and Roman anatomist Galen (200-216 AD); and by an English reverend in 1763 who wrote about the relief of fever in 50 patients, many of whom probably had malaria

Synthesized: around 1860; because salicylic acid was a gastric irritant that could cause bleeding in large doses, the Bayer company sought chemical analogues that would be better tolerated and eventually made aspirin available in tablet form in 1900

Used today to: relieve pain, reduce fever, prevent vascular heart disease

Side note: A pharmacist at Bayer who worked on an aspirin analogue was preoccupied at the time with the sales potential of a new Bayer cough remedy synthesized in 1897 called heroin.

nightshadeAtropine

Discovered: by ancient Greeks

Came from: glossy-coated black berries of the deadly nightshade plant

First used: as a cosmetic for women (Cleopatra used atropine to dilate her pupils in the last century BC), and a poison for assassins (the military made a deadly paste from atropine for the tips of their arrows during the Roman Empire and the Middle Ages)

Documented in: Greek mythology, with the plant being named Atropos, after one of the three goddesses of fate and destiny

Synthesized: by a German chemist in the 1830s

Used today to: increase slow heart rates or improve conduction in some types of irregular heart rhythms; and as an antidote to accidental organophosphate poisoning and to nerve gases used in warfare

Side note: Attracted to the sweetness of the berries, people have been poisoned accidentally

foxgloveDigitalis

Discovered: as one of more than 20 herbs brewed in home remedies for perhaps hundreds of years before the 1700s

Came from: leaves of the foxglove, a tall wildflower with purple, bell-shaped blossoms

First used: as a treatment for “dropsy,” or edema caused by a buildup of bodily fluids, as described in 1775 by English physician and botanist William Withering, who is credited with identifying the therapeutic properties of digitalis after persuading an old woman to share the ingredients of a tea she made

Documented in: a 207-page book of Withering’s records and personal observations on the use of digitalis in 158 patients

Synthesized: commercially in the 1900s

Used today to: treat heart failure and atrial fibrillation

Side note: Withering belonged to a group of intellectuals who gathered monthly and included Erasmus Darwin (grandfather of Charles Darwin, pioneer of the theory of evolution), James Watt (inventor of the steam engine), Joseph Priestley (isolator of oxygen) and Founding Father Benjamin Franklin

nitroglycerin chemical structureNitroglycerin

Discovered: in the 1840s

Came from: the nitration of glycerin

First used: as an explosive, around the same time physicians were documenting how the chemical liquid relieved intense chest pains in their patients

Documented in: British medical presentations (amyl nitrite) and papers (nitroglycerine) as early as the 1860s; by the end of the 19th century, nitroglycerin was the established form of therapy for the relief of chest pain from coronary heart disease, or angina pectoris

Synthesized: in 1882 by Parke Davis & Co., which produced a pill in five different strengths, after initial use as a liquid medication

Used today to: relieve angina pain and treat heart failure by dilating peripheral veins; also remains the active ingredient in dynamite

Side note: While studying chemistry and engineering, the Swedish scientist Alfred Nobel spent a year in Paris, where he met the Italian chemist who nitrated glycerin but believed it was too dangerous to have practical use. Nobel saw its potential and took it back with him to Stockholm, where he and his father eventually succeeded in creating dynamite. But their research led to several serious explosions, one of which took the life of Nobel’s younger brother, Emil. Later in life, Nobel developed angina pectoris. His physicians advised him to take nitroglycerin, but he declined. He died in 1896 at age 63, leaving the majority of his wealth to establish five Nobel Prizes

cinchona treeQuinidine

Discovered: around the 1630s

Came from: powdered bark of the cinchona tree; the name given to the therapeutic substance was quinquina

First used: to relieve the fever of malaria

Documented in: accounts of Jesuit missionaries in South America using the powdered bark to treat fever, although legend suggests the native population was already using it for that purpose; two volumes published in 1749 are the first to reference the use of cinchona alkaloid in the treatment “rebellious palpitation,” likely the cardiac arrhythmia known today as atrial fibrillation

Synthesized: by American scientists in 1944, quinine was too late to save thousands of World War II troops who died of malaria in Africa and the South Pacific

Used today to: treat atrial and ventricular arrhythmias in selected patients, but quinidine is no longer recommended by the American Heart Association for treatment of atrial fibrillation; medications other than quinine are now used to treat malaria

Side note: A Portuguese doctor isolated the first alkaloid of quinquina, calling it cinchonine, but the more effective second alkaloid was isolated by two French pharmacists, who called it quinine. In the 1850s, an impurity of quinine was isolated and called quinidine

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

Posted in drugs/medications/pharmacy, health care, heart/cardiovascular, history, research | 1 Comment

Adventures with Phred: Stem cell transplant resets body’s immune system

Doug Reicher, left, with Jeffrey Pu, MD, PhD. (photo by Richard Whelsky)

Doug Reicher, left, with Jeffrey Pu, MD, PhD. (photo by Richard Whelsky)

BY AMBER SMITH

Doug Reicher, 65, was diagnosed with acute myeloid leukemia last summer. His treatment at Upstate University Hospital began with intravenous chemotherapy, which meant he would need to be connected to a device on an IV pole that would keep the medications flowing.

Doug Reicher dressed his IV chemotherapy pole in a tie and named it ”Phred.” (supplied photo)

Doug Reicher dressed his IV chemotherapy pole in a tie and named it ”Phred.” (supplied photo)

“He has named it Phred and dressed him up a bit. Notice Phred’s snazzy tie,” Reicher’s wife, Camille Tisdel, wrote in June on their CaringBridge website. “The two of them will be attached, literally, for a while. The adventure begins …”

The couple shared an upbeat chronology of Reicher’s adventure, which has taken place over several weeks in the hospital and included not just chemotherapy but a stem cell transplant using cells donated by one of Reicher’s nieces. Today he’s recovering at home.

Stem cell treatment

Doctors and nurses at Upstate have long offered autologous stem cell transplants, where a patient’s stem cells are extracted from his or her body before chemotherapy and then returned. In 2018, they began offering allogeneic stem cell transplants under the direction of Jeffrey Pu, MD, PhD, director of the hematologic malignancies program and the stem cell transplantation therapy program.

Pu explains that “you can engage immune reactions” by using stem cells from a healthy donor who has been matched with the patient. “Those immune reactions can further kill residue or circulating leukemia cells or lymphoma cells.”

Niece Erica Reicher donated her stem cells to rid her uncle of leukemia. (supplied photo)

Niece Erica Reicher donated her stem cells to rid her uncle of leukemia. (supplied photo)

Reicher was one of the first patients to undergo an allogeneic stem cell transplant at Upstate. He is president of the housing nonprofit Christopher Community. Tisdel, his wife, works at Syracuse University.

For patients undergoing stem cell transplants, “Their white blood cell count goes to basically zero, so they are at high risk for infection,” explains nurse Meghan Lewis. The day they receive the transplant becomes Day Zero, and patients typically remain hospitalized for two or three weeks afterward.

Reicher wrote on CaringBridge when he was allowed to go home that “my cell and immune system will be that of an infant. I have to grow a new system and will have a functioning but immature system, just like a baby.

“Infection is the greatest risk, so I will have to be very careful at home with food, the house and visitors.” Eventually Reicher will receive a new series of immunizations against childhood diseases such as polio, measles and whooping cough.

2 types of stem cell transplant

Autologous stem cell transplant — a patient receives his or her own stem cells, which are removed from the patient’s body and frozen for safekeeping while he or she undergoes chemotherapy. Afterward, the stem cells are returned to the patient’s body. This is a treatment option for patients with multiple myeloma or lymphoma.

Allogeneic stem cell transplant — patients receive stem cells from a healthy matched donor. This is a treatment option for patients with leukemia or lymphoma that has relapsed.

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

Posted in blood/blood-related conditions/hematology, health care, patient story | Tagged , , ,

Airlifted to Upstate, North Country man undergoes lifesaving heart surgery and beats the odds

Chris Diaz was airlifted to Upstate University Hospital when an ultrasound performed at Canton-Potsdam Hospital showed a tear in a blood vessel in his heart. (supplied photo)

Chris Diaz was airlifted to Upstate University Hospital when an ultrasound performed at Canton-Potsdam Hospital showed a tear in a blood vessel in his heart. (supplied photo)

BY EMILY KULKUS

Chris Diaz is no stranger to fear or pain.

Diaz, 35, spent four years in the Army, including nearly a year in Iraq from 2009 to 2010. When you’re in the Army, if something hurts, you drink water and press on.

That’s what Diaz tried to do on Nov. 28, 2017, when he felt a surge of pain snake up his left arm and into his chest. Diaz was studying mechanical engineering at Clarkson University at the time, and finals were looming. He figured the pain was related to anxiety or stress because of his exams.

Army veteran Chris Diaz  graduated from Clarkson University six months after a life-threatening aortic dissection.

Army veteran Chris Diaz  graduated from Clarkson University six months after a life-threatening aortic dissection. (supplied photo)

“Honestly it felt like razor blades up my veins,” he says. “It felt like something I’d never had before — a crushing sensation around my heart.”

He drank water, but the pain got worse. His fiancée, a certified nurse assistant, said he looked pale and was sweating. She insisted he see a doctor. She drove him to the emergency room at Canton-Potsdam Hospital in nearby Potsdam. There, they listened to his chest and detected a murmur. An ultrasound revealed a much more serious condition: Diaz had an aortic dissection, which is when the large blood vessel of the heart tears. The surging blood can continue to tear the aorta, causing blood that should flow through the heart to spill into the body. In more than 50 percent of cases, the injury is fatal within 24 hours. Without surgery, up to 75 percent of cases are fatal within two weeks.

Diaz needed surgery immediately.

That’s when his memory of that day gets blurry. He remembers doctors starting pain medicine and telling him he was going to be airlifted to Upstate University Hospital in Syracuse. He remembers the ambulance but not the helicopter. He remembers the airport but not his arrival.

He definitely remembers what he was thinking at the time: “I’m going to miss my finals because of this. I was just really mad this was going on,” he said

G. Randall Green, MD, chief of cardiac surgery at Upstate

G. Randall Green, MD, chief of cardiac surgery at Upstate

G. Randall Green, MD, chief of cardiac surgery at Upstate, was waiting for Diaz. He asked him if he wanted a mechanical valve or a tissue valve to replace the one that was tearing. Diaz chose mechanical. He woke up many hours later in the recovery room.

It wasn’t until later that doctors told Diaz how dire his situation had been. “My cardiologist said, ‘We weren’t expecting to see you again,’” Diaz recalls. His surgeon told him that if he’d arrived in Syracuse 30 minutes later, he probably would have died.

Green says Diaz’s case is memorable and remarkable.

“We were doing chest compressions when he came into the operating room. He had no heart rate, no blood pressure. He was basically not with us anymore,” Green said. “All of us looked at him and said we’ll do our best for this guy.

“It’s just unbelievable what the human body and the human spirit are capable of living through.”

Diaz spent eight days at Upstate, followed by a rigorous course of physical therapy to regain his strength. He took his finals from the fall semester the following March. Two months later, Diaz graduated from Clarkson with a degree in mechanical engineering. During the graduation ceremony, President Anthony Collins told Diaz’s stor and thanked him for his service.

No one knows why Diaz suffered the aortic dissection, something that normally occurs in much older patients. Diaz thinks it might be genetic, since his mother has a heart murmur. Chest trauma from serving in Iraq may have also contributed, he says.

More than a year later, Diaz feels like his old self. “I feel great,” he says. Medicine regulates his heartbeat and prevents blood clots, and he exercises every day. He and his fiancée have settled in Milford, outside of Oneonta, and are planning a summer 2019 wedding.

replacement mitral valvesWhich valve would be best for you?

If you need a heart valve replacement, you may be asked to choose between a mechanical valve (left) or one made of tissue (at right).

Generally, people younger than 60 have been apt to choose a mechanical valve because of its durability. But a mechanical valve, made from materials such as titanium and carbon, comes with a lifelong requirement to take a medication that reduces the risk of blood clots by thinning the blood. It may not be right for some people, including women of childbearing age.

People who choose a tissue valve may face the prospect of needing a second valve replacement operation years later. That’s because tissue valves, made from pig valves or cardiac tissue from cows, last only 10 to 20 years. Tissue valves are more popular with people over age 70 who don’t want to have to take a blood thinner, says G. Randall Green, MD, Upstate’s chief of cardiac surgery.

He said options changed about six years ago with the development of the transcatheter aortic valve replacement. This is a procedure in which a doctor inserts a catheter — a thin tube — into the patient’s groin and threads it into the heart. There, a stent is deployed with a tissue valve that takes the place of the diseased valve. TAVR, as it’s known medically, is only used for aortic valves that have stenosis, or a narrowing of the valve that restricts blood flow.

Green says doctors aren’t sure how long the transcatheter valves will last. The procedure is less taxing than an open surgery, so patients who want to avoid taking blood thinners may be OK with the idea that they may require a redo years later

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

 

 

 

Posted in health care, heart/cardiovascular, patient story, surgery | Tagged , , , ,

 How the Upstate pharmacy saved him $20,537.14

Heidi King with Reginald Sanford at the Upstate Outpatient Pharmacy. (photos by Robert Mescavage)

Heidi King with Reginald Sanford at the Upstate Outpatient Pharmacy. (photos by Robert Mescavage)

BY AMBER SMITH

He went through a series of imaging tests, looking for an explanation for the pains in his stomach.

After all the scans were complete, doctors delivered the news to Reginald Sanford of Syracuse. He had cancer in his liver and also outside of his liver. Surgery would not work, but medication might slow the growth and spread of the cancer inside his liver.

Reginald Sanford

Reginald Sanford

They wanted to prescribe Nexavar, a drug with a price tag of more than $20,000 per month.

“It totally blew my mind. I told them there’s no way I could come up with that. I ain’t got that kind of money. I’m retired. I’ve only got $1,000 a month. How am I going to come up with that?”

Sanford says one of his doctors consulted with someone from the Upstate Outpatient Pharmacy.

Two days later, he got a phone call from a pharmacist. “Mr. Sanford,” he recalls the voice saying, “I’ve got some good news for you.

“First of all, you don’t have to pay a penny for your Nexavar. And the other good news is, we’re going to get it out in the mail to you.”

Medication assistance coordinator Heidi King explains that after Sanford’s Medicare coverage and personal health insurance coverage paid their portions, the remaining cost was going to be $970 for a one-month supply. She was able to enroll Sanford in an income-based New York state program called EPIC – for Elderly Pharmaceutical Insurance Coverage – which would pay $950. Then she located an endowment fund that would chip in $20.

King says “a lot of patients need financial help, especially with these types of medications.” Together with a colleague, her job is to help locate funding sources, particularly for patients whose prescription coverage leaves them with a huge copay.

Depending on each patient’s situation, she may find money through a foundation, a drug manufacturer or a government program. “The majority of the time, we’re able to get it down to a price that they can manage,” King says.

Pharmacist Eric Balotin, associate director of pharmacy enterprise, says, “We are always looking for ways to reduce copays and out-of-pocket expenses, whether it is $1,000 or $5. Our goal is to make the medications affordable to all our patients.”

Sanford believes he is doing well and that the cancer inside his liver under control. He realizes the day will come when the cancer outside of his liver will cause problems for him. Until then, Sanford dutifully takes two Nexavar pills in the morning and two at night.

Anyone can use the Upstate Outpatient Pharmacy

You do not have to be a patient at Upstate. The pharmacy is between the Upstate University Hospital lobby and the Upstate Cancer Center and can be reached at 315-464-3784. It’s open 8 a.m. to 6 p.m. weekdays and 9 a.m. to 2 p.m. weekends and is closed on major holidays.

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

 

Posted in cancer, community, drugs/medications/pharmacy, health care, patient story | Tagged ,

A nonsurgical way to treat knee osteoarthritis

Pronounced MARE uh nee STOBBBY AMBER SMITH

People with chronic knee pain may seek relief from physical therapy. They may try over-the-counter pain relievers, prescription painkillers or steroid injections.

A doctor at Upstate now offers another choice for people who are unwilling or unable to undergo a surgical knee replacement.

Xiaoli Dong, MD, an assistant professor of physical medicine and rehabilitation, provides a cooled radiofrequency procedure called “Coolief,” a blend of “cool” and “relief.” It has been approved by the Food and Drug Administration to relieve chronic moderate to severe knee pain caused by osteoarthritis.

The procedure is accomplished without an incision, “using radiofrequency energy to deactivate the nerves responsible for sending pain signals to our brain,” Dong explains. Patients receive an anesthetic to numb the skin and reduce any discomfort from the needle. They return to normal activities within a week or two. Dong says pain relief may last up to a year.

Chronic knee pain is often the result of osteoarthritis, a degenerative condition that develops as wear and tear thins the cartilage between bones. The result can be pain and stiffness, swelling and difficulty walking.

To learn more, contact Dong’s office at 315-464-1569; click here to hear Dong explain the procedure in a podcast/radio interview with Upstate’s “HealthLink on Air.”

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

Posted in arthritis, bones/joints/orthopedics, health care, HealthLink on Air, physical therapy/rehabilitation | Tagged ,

Back on the pitch – after back surgery

Back surgery patient Kendall Discenza plays on the soccer team at Hamilton College.

Back surgery patient Kendall Discenza plays on the soccer team at Hamilton College. (supplied photo)

BY AMBER SMITH

For weeks, Kendall Discenza didn’t know what was wrong. The pain in her lower back became crippling, and she was left sobbing.  Surgery brought relief.

Discenza underwent a microdiscectomy at Upstate University Hospital. Lawrence Chin, MD, who leads the neurosurgery department, removed a herniated disc fragment between the 5th lumbar and 1st sacral vertebrae in Discenza’s lower back.

“You should see my scar. It’s so tiny,” she says.

Lawrence Chin, MD

Lawrence Chin, MD

Discenza, who plays soccer for Hamilton College, was lifting weights in January 2018 after her freshman season. She was doing Romanian dead lifts, intended to strengthen her hamstrings. Holding a straight metal bar, she bent forward at her waist, and then back up. She felt her back straining but didn’t think anything of it.  An achiness continued and grew worse over the next several weeks.

It was March before her health insurer gave permission for a magnetic resonance imaging scan. The images showed a herniation, where the disc’s interior protrudes outward, and Discenza began physical therapy. She also had cortisone injections. “But then it got worse, and worse and worse,” she recalls. “It got so bad, it got to the point where my mom came up (from the family home near Washington, D.C.) and was taking me to doctors in Syracuse.”

Discenza got an appointment with Denise Karsten, a chiropractor and registered nurse at the Upstate Brain and Spine Center, who went over the MRI with Discenza and her mother. “This is a pretty big herniation. You’re probably going to need surgery,” Karsten predicted.

At the time, Discenza was focused on wrapping up her spring semester. The pain was crippling at times. She remembers lying on the bed in her dorm one day, believing she was paralyzed. She realized she couldn’t put off treatment. She made an appointment to see Karsten again with Chin.

Surgery brought relief

Chin explained what would be involved in a micro-discectomy, a procedure intended to minimize the skin incision, muscle involvement and amount of bone removed in order to relieve the herniation. There is a small risk of nerve damage, but the procedure is almost always successful. Some patients go home the same day.

“I was asking him, ‘Am I going to be able to play soccer again?’ He was really reassuring and super kind, and he had such a good rapport. He made me feel really comfortable.”

Discenza went home with her parents for several days, worked on completing her schoolwork and prepared mentally for surgery. She pretty much had to lie flat because sitting was so painful. As she researched “microdiscectomy,” she learned that she was about to undergo the same procedure that New England Patriot Rob Gronkowski had three times to repair herniated discs.

She admits she was frightened. She expected she would have to stay overnight in the hospital.

When she woke up from anesthesia, “My legs were extended out straight. I pointed my legs up toward my body, and I knew that the pain was gone. The pressure was gone. I lifted my foot up, and the first thing I said to my mom was, ‘It’s gone. I know that it’s gone’.”

Chin says that’s not unusual. “If they’re in a lot of pain, they’re going to feel relief right away. That’s what I aim for.”

Discenza recovered with her parents at a Syracuse home they rented through Airbnb. “The next two days, it was tough to get up and walk,” she remembers. “It was pretty sore, but that’s part of what you have to do.”

Discenza was able to finish her schoolwork for the spring semester before her surgery. She spent the summer working with a physical therapist and personal trainer, in hopes of getting back to the soccer field by fall. It was important to her because, as she explains, “I’ve played soccer since I could walk. I’ve been playing my entire life.

“All summer, my goal was to be ready to play.”

She progressed from walking to doing core work to running. She had to rebuild her strength and stability to be able to play, and she had to convince herself that she was strong enough to play such a physical sport. When team training began, Discenza participated in all but scrimmages. Gradually, as she got stronger, she played in some games. “I got to be 100 percent around early October.”

Discenza is a sophomore majoring in sociology, on a pre-medicine track. She thinks she may want to go to an osteopathic medical school. “I might want to get into rehabilitation or become a functional medicine doctor.” She’s always been interested in health and wellness — and now she has experience as a patient.

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

Posted in brain/spine/neurosurgery, health care, patient story, surgery | Tagged ,

 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