Team tackles complex skin cancers

Members of the multidisciplinary melanoma team, from left: surgeon Scott Albert, MD; medical oncologist Adham Jurdi, MD; medical oncologist Abirami Sivapiragasam, MD (known as Abby Siva, MD); and surgical oncologist Ajay Jain, MD. (PHOTO BY SUSAN KAHN)

Melanoma accounts for about 1 percent of skin cancers, but it’s the skin cancer most likely to spread and the deadliest.

The majority of melanomas are superficial, discovered at an early stage and easily treated with surgery.

But some patients have more advanced melanomas that require more complex treatment, says Upstate surgeon Scott Albert, MD.

Close-up of a melanoma.

He is part of a multidisciplinary team of doctors at Upstate from surgical oncology, radiation oncology, medical oncology and dermatology who meet monthly to discuss the care of patients with complicated melanoma, “so we can come up with treatment plans for each patient that suits them,” Albert says, explaining that “having a lot of input from other specialties can be very beneficial.”

The experts put their heads together to consider surgical options and whether chemotherapy, radiation therapy or other types of treatment are appropriate.

Reduce your risk of skin cancer

— Limit your exposure to ultraviolet rays.

— Seek shade, or wear sunscreen, sunglasses, hats and shirts when in the sun.

— Avoid the use of tanning beds and sun lamps.

Source: American Cancer Society

This article appears in the spring 2017 issue of Cancer Care magazine. Click here for a radio/podcast interview with Albert about melanoma.

Posted in cancer, dermatology/skin care, health care, prevention/preventive medicine, surgery | Tagged ,

Creative coping: Pediatric art therapist brings art to the bedside

This gallery contains 7 photos.

The therapy Maria Fazzini provides may involve paints, crayons or other art supplies. She’s the art therapist at the Upstate Golisano Children’s Hospital. “I really enjoy the little smile that starts to form on a patient’s face, and on the … Continue reading

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Anatomage Table offers virtual anatomies and much more

Upstate’s Molecular Pathology Next Generation Sequencing Lab has an Anatomage Table, an advanced anatomy visualization system that can display patient scans to accommodate virtual autopsies, educational opportunities, pre-surgical planning and research. Sam Carello, director of laboratory informatics at Upstate, and nurse practitioner Bridget McCarthy are shown using the table, which was purchased with support from the Upstate Foundation. (PHOTO BY ROBERT MESCAVAGE)

 This item appears in the spring 2017 issue of Upstate Health magazine.

Posted in medical education, research, technology | Tagged

A more colorful life: Pathology specialist enjoys painting, drawing

This oil painting, “Chinese Tea Set,” by Joyce Yue Qi, was used on the brochure for CNY Arts’ “On My Own Time” exhibition of works by employees of local businesses and organizations.

BY JIM HOWE

After a day working with an electron microscope in Upstate’s pathology department, Joyce Yue Qi might pick up an artist’s paintbrush or a pastel crayon and create a picture.

Qi has won awards for her work each of the three times she entered CNY Arts’ “On My Own Time” exhibition, which displays works by employees of local businesses and organizations at the Everson Museum of Art.

Qi often uses an electron microscope as part of her job in Upstate’s pathology department.

In 2015, her oil painting “Chinese Tea Set” was used for the exhibit’s reception brochure.

Qi’s interest in art as a hobby began about five years ago, when a co-worker, now retired, encouraged her to attend some sessions with her art group. Qi, 58, found that she liked painting, drawing and sketching as well as being able to learn from experienced artists.

“I like oil the best because as a beginner, I need to make lots of corrections on each piece, so if you did it wrong, you can put another layer on top of it,” she says with a smile. For the same reason, she likes sketching, where she can erase anything she doesn’t like.

Qi, who grew up in Beijing, uses Joyce as a first name because it’s easy for Americans to pronounce and because her Chinese name means “joy.” She was an ophthalmologist before coming to the United States in 1992 to do eye research in the laboratory of the late Barbara Streeten, MD. Qi’s current job as a technical support specialist finds her doing mostly pathology related to kidney diagnoses. Her husband, Hengsheng Fang, is a researcher in Upstate’s medicine department.

She creates many of her works from photographs she took, such as one of herself canoeing near Old Forge with her younger son, Alan, 21, a student at Clarkson University. Another work shows her older son, Kun, 28, a biological researcher in Massachusetts, holding a chunk of ice in Alaska.

“I think I surprised myself,” she says of her pastime, because she never thought she would be able to paint, and she finds the creative aspect satisfying. She estimates she spends three to five hours a week painting or drawing at home or in painting classes.

“You will never find other things you may enjoy in your life unless you spend some time and energy to give them a try,” she says. “Some hobbies will make your life more colorful and enjoyable.”

This article appears in the spring 2017 issue of Upstate Health magazine.

 

Posted in entertainment, pathology | Tagged ,

Setting an example: Pediatric gastroenterologist/amateur cook eats lots of vegetables, grains

 

Prateek Wali, MD, in his kitchen preparing a marinade for salmon (see recipe below). (PHOTO BY SUSAN KAHN)

BY AMBER SMITH

As a child growing up in Kashmir, India, Prateek Wali ate mostly locally grown vegetables and farm-raised animals. In the snowy winters, his family dined on kidney beans, turnips, hearty grains and other foods that stored well. The spring, summer and fall months meant eating whatever vegetables were in season. It was very farm-to-table.

“We shopped for dinner each morning in the local outdoor market,” he describes.

Wali, chief of pediatric gastroenterology at Upstate Golisano Children’s Hospital, brought that part of his culture with him as an 8-year-old boy when his family moved to America. He and his sister routinely helped their mother in the kitchen, developing a love of cooking. He characterizes Kashmiri cooking as rustic and flavorful. Vegetables and meats are made decadent with a range of spices to produce unique curries.

Today, he continues to expand that palate with his wife, Mikki Kollisch, through travels to experience new cultures and new food. While they enjoy making Indian food, they also try their hand at other cuisines, including Italian, French, Thai and Korean.

As a physician specializing in the organs of digestion, Wali is particularly mindful of how food and drink  can impact human health. He nudges his patients toward incorporating nutritious choices into their diets. Those with irritable bowel syndrome can benefit from diets low in sugar, fat and dairy, for instance, and patients with gastroesophageal reflux may benefit from low-acid, low-fat foods.

He says it is unusual for a particular food to be the cause of a disease, except for gluten in celiac disease. Instead, “patients who have difficulty with intestinal symptoms, or those who have a diagnosed gastrointestinal disease often can improve their health if they consult with a dietitian.”

That’s an option for children at the Karjoo Family Center for Pediatric Gastroenterology at Upstate. Wali and his colleagues care for children with celiac disease, inflammatory bowel disease, intestinal failure, allergic gastrointestinal disease, feeding and swallowing disorders, liver disease, pancreatitis and other diseases.

Wali describes himself as an enthusiastic amateur cook. He shares healthy, tasty and practical recipes such as Udon Noodles With Bok Choy and Poached Egg, Butternut Squash With Farro, and Vegetarian Stuffed Peppers on a blog that he writes mostly for family.

HaakandChai.com, as it is called, refers to Kashmiri dietary staples, collard greens and tea. Wali writes, “Both are examples of how food defines our culture and interactions among our family.”

Asian Salmon

Ingredients

2 fillets of fresh salmon
For the marinade:
1 tablespoon Dijon mustard
2 tablespoons soy sauce
4 tablespoons olive oil
1 tablespoon honey
2 tablespoons light brown sugar

Preparation

Whisk soy sauce, Dijon mustard, honey and brown sugar together to create marinade. Rub over the meaty surface (skin side down) of the salmon, and allow this to sit for 10 minutes.

Heat an iron skillet on medium-high heat with a thin layer of olive oil. Place the salmon, skin side down, into the pan. Cook for 4 minutes, then turn using a fish spatula. Cook for an additional 3 to 4 minutes until salmon is firm to the touch or registers 135 degrees Fahrenheit on a meat thermometer.

Transfer salmon to a flat plate, skin side down, and allow to rest for 10 minutes. Serve with rice and soy sauce. This pairs well with a riesling or pinot grigio wine.

Nutritional information

(For each of two servings, assuming half of the marinade is absorbed)

Calories: 395

Total fat: 25 grams

Cholesterol: 78 milligrams

Sodium: 575 milligrams

Potassium: 715 milligrams

Sugars: 9 grams

Protein: 35 grams

 This article appears in the spring 2017 issue of Upstate Health magazine.

Posted in diet/nutrition, digestive/gastrointestinal, health care, recipe, Upstate Golisano Children's Hospital/pediatrics | Tagged , , , , , , , ,

Mosquito control: Upstate scientists learn from success of malaria control effort

 

Controlling mosquitoes is crucial to controlling diseases spread by the insects, such as malaria, or, closer to Central New York, eastern equine encephalitis.

Upstate scientists credit international collaboration with keeping a region along the border of Ecuador and Peru free of malaria since 2012.

The coastal area of El Oro Province in Ecuador and the city of Tumbes, Peru, were once endemic with the mosquito-borne viral infection. From the 1980s into the early 2000s, this region experienced an upsurge of malaria. Climatic fluctuations and livelihoods that involve water contact, such as rice farming, are some of the factors that increase this region’s risk for malaria.

Working together over 20 years, leaders from both nations strengthened surveillance and treatment strategies, Upstate researchers point out in the Nov. 28 issue of the Malaria Journal. A grant from the Department of Defense helped pay for the research, done through Upstate’s Center for Global Health and Translational Science.

The study highlights key principles of a successful malaria elimination program, which can inform the next generation of public health practitioners, says Mark Polhemus, MD, director of the center. He and co-authors Rosemary Rochford, PhD, and Anna Stewart Ibarra, PhD, found these elements important:

* National policies and standards were translated into local realities.

* An active case-finding surveillance system was paired with a strict treatment plan.

* A small team of dedicated public health practitioners were nimble and effective because they were empowered by regional and national networks.

The scientific trio suggest that the systems and technologies that were necessary for a successful malaria elimination program should be maintained, in order to prevent a relapse. They also hope this collaborative approach can be a model to reduce mosquito-borne diseases in other areas of the world.

Closer to home, EEE remains a threat

Denise Broton of Cicero was flown by airplane to Upstate University Hospital from the hospital in Lake Placid three summers ago after she was diagnosed with the eastern equine encephalitis virus. Hospitalized for four weeks, Broton slowly has recovered.

She shared her experience with reporters, hoping her story can convince others to guard against mosquito-borne illnesses. The EEE virus can be deadly; those who survive may be left with disabling and progressive mental and physical difficulties. Broton told reporters she struggles with balance and coordination and light sensitivity.

Mosquito prevention techniques include the use of insect repellent when outdoors; wearing pants and long-sleeved shirts; keeping door and window screens in good repair; and eliminating standing water around your home to reduce mosquito breeding sites. Some county health departments offer aerial spraying to help combat mosquitoes.

This article appears in the spring 2017 issue of Upstate Health magazine. Hear an interview with further details about Upstate’s part in international efforts to combat mosquito-borne diseases.

 

 

Posted in health care, infectious disease, international health care, prevention/preventive medicine, public health, sustainability/environment | Tagged , , , , , , ,

When good drugs have bad effects: Seniors are susceptible to medication interactions

BY AMBER SMITH

An 83-year-old woman arrived at the hospital emergency department with a loss of energy, low blood pressure and slowed heart rate. While a myriad of medical problems could cause such symptoms, ultimately hers came from an adverse drug event, a problem that is not uncommon among senior citizens.

Adverse drug events can happen when someone receives the wrong drug, or the right drug in the wrong dosage, or when a drug is administered incorrectly. Even the correct drug in the correct dose could cause potentially deadly problems if a person has a change in his or her ability to clear the drug.

The risk for adverse drug events rises with a person’s age, the number of health problems they have and the number of medications they take. The risk is greater in those with low body mass or impaired kidney function and in those with visual problems or cognitive impairment that makes it difficult to take medicines correctly.

The woman’s doctor had recently doubled the dose of her blood pressure medicine, metoprolol, and switched her heart medicines from amlodipine to diltiazem. She was also taking digoxin, another heart medicine. She had diabetes, kidney insufficiency and a history of an irregular heart rhythm called atrial fibrillation.

The diltiazem clashed with the digoxin, and her body reacted to the increased dosage of metoprolol, the Upstate New York Poison Center staff wrote in the Toxicology letter, produced quarterly by the New York State Poison Centers.

The woman got worse – lapsing into unconsciousness and requiring a breathing tube — before she got better.

But the whole episode may have been avoided, wrote toxicologist Christine Stork, PharmD, Michael Holland, MD, and Benjamin Craxton, a fourth-year medical student at Upstate.

They describe a vicious cycle.

When the woman’s blood pressure dropped, so did the blood flow to her organs. That exacerbated her kidney problems and impacted the absorption and clearance of the drugs she took. As they accumulated in her system, so did their effects, eventually landing her in the hospital.

Craxton, Holland and Stork suggested that a more gradual increase in her blood pressure medicine, with an attempt to reduce the number of her prescription heart medications, could help avoid future adverse drug events.

5 reasons drugs work differently in seniors

* A person’s percentage of body fat increases with age, and more body fat can mean an increase in the duration of action for fat-soluble drugs such as the antidepressant amitriptyline and the antianxiety drug diazepam.

* We lose muscle mass as we age. That leaves our bodies with less space to distribute certain medications that circulate to lean tissue, including caffeine, the pain reliever acetaminophen and the blood pressure medicine digoxin. Therefore, the drugs may end up in a higher concentration than intended.

* Our blood changes, with levels of the protein, albumin declining. This could lead to decreased drug-protein binding and result in higher-than-desired active drug levels in the blood.

* Some of the liver’s ability to process drugs decreases with age. So, depending on how they are metabolized, some medications – including the blood thinner warfarin and the anti-seizure medicine phenytoin – are likely to have a longer therapeutic duration in older people than in young.

* Most people have kidneys whose filtering ability declines with age, although up to a third of elderly patients have kidneys that function just the same as in their younger days. Toxicologists recommend assuming that elderly patients have reduced kidney function and using extra care when prescribing drugs that are processed in the kidneys, including the heart medicine digoxin, the antacid cimetidine and opioid painkillers.

Source: Article by toxicologist Christine Stork, PharmD, Michael Holland, MD, and Benjamin Craxton, a fourth-year medical student at Upstate, in the Toxicology letter, October 2016.

This article appears in the spring 2017 issue of Upstate Health magazine.

Posted in aging/geriatrics, drugs/medications/pharmacy, health care, heart/cardiovascular, poison center/toxicology | Tagged , , , , , , , ,

Healthy humility: In caring for patients, doctors better themselves

From left are neurologist Gene LaTorre, MD, medical director of Upstate’s stroke service; emergency physician William Paolo, MD, and pediatrician Beth Nelsen, MD. (PHOTOS BY SUSAN KAHN)

BY AMBER SMITH

Some of the most profound pieces of medical education have little to do with medicine. They are lessons that come from the experience of caring for patients. A neurologist, an emergency physician and a pediatrician from Upstate share their stories below.

Everyone deserves quality care

Emergency physician William Paolo, MD, trained for four years at NYC Health + Hospitals/Bellevue, the oldest hospital in America. Now a world-renowned academic medical center comprising 11 acute and community hospitals, Bellevue opened as a six- bed infirmary in 1736, when George Washington was 4 years old.

Paolo recalls an early lesson in the importance of treating patients equally.

Nurses and doctors who work at Bellevue are used to caring for a diverse population that often includes wealthy, powerful dignitaries and celebrities.

Paolo’s mentor during his residency training was Lewis Goldfrank, MD, one of the founding fathers of modern emergency medicine. One day, Goldfrank pulled Paolo aside. He told the young protégé to prepare himself for a special patient. Escorting him toward the patient’s bed, Goldfrank explained that the patient had a sensitive problem and would require Paolo’s complete attention and best care.

Goldfrank pulled back the curtain.

Paolo’s VIP sat on the bed in soiled and smelly clothing. He reeked of alcohol. His head was infested with lice.

Paolo recalls Goldfrank’s lesson that emergency medicine was an egalitarian specialty — and every patient was a VIP, deserving of the same quality of care.

“We can’t make it as a society unless everyone makes it,” Goldfrank is known for saying.

If doctors were to discriminate, to overlook the disenfranchised or offer substandard care, Goldfrank warned, “we fall apart as a humanistic group.”

It’s a foundational belief that Paolo carries with him in his role as an associate professor and residency program director in emergency medicine at Upstate University Hospital.

Listen; patients will tell you the problem

Medicine is so much about storytelling, about the story the patient tells the doctor when the doctor asks some variation of “What seems to be the problem?”

Nelsen stresses the importance of listening to what a patient is saying, including when that patient is too young to speak.

Patients have taught pediatrician Beth Nelsen, MD, the importance of listening.

“If you are not listening, you are going to miss what you need to know,” she says, explaining that it’s a lot more difficult than it sounds. “It’s almost a meditative experience. You have to quiet your mind.”

She recalls a new mom and dad who brought in their 3-month-old son because he was not gaining weight, a potentially serious complication for an infant. In the exam room, he was whiny and clearly miserable.

Nelsen had the couple start from the beginning with their story.

The whole family had suffered from a terrible stomach bug. Only, everyone else had gotten better, and the baby continued to be cranky. He continued to vomit, didn’t sleep well and had recently begun refusing his bottle.

It was unusual in such a little kid, but Nelsen suspected the baby was suffering from a severe case of reflux. “This kid had already figure out that when he ate, it hurt.” She prescribed a baby-sized dose of the anti-reflux medicine Zantac and told the parents how to safely raise the head of his crib.

Two weeks later, the couple returned with what appeared to be a new baby. He was happy. He’d been sleeping better. And he was putting on weight.

In some babies, the lower esophageal sphincter muscle is not fully developed at birth and can cause reflux where stomach acid or bile irritates the lining of the esophagus. The condition can be treated with medication until the sphincter strengthens, usually by the time the baby reaches 6 to 9 months of age — but only if the condition is diagnosed, which only happens if the doctor listens to the patient story.

“That probably took 20 minutes, but it’s so important to do that,” Nelsen says of the time she spent during the first visit. “If I hadn’t heard the story from the beginning, I would have missed it.”

Miracles happen

With four years of medical school and three years of a neurology residency under his belt, Gene LaTorre, MD, believed he had a pretty good idea of how the brain behaves. Then he did fellowships in neurocritical care, vascular neurology and clinical neurophysiology. During those years, he encountered hundreds of patients who taught him even more about the brain and the practice of medicine.

Miraculous recoveries help remind doctors to stay humble, LaTorre says.

Today, as medical director of Upstate’s stroke service, LaTorre easily admits: “The more patients I see, the more I have this healthy doubt that we don’t exactly know how our bodies are going to work. We have an idea, but we can never be sure.

“A number of patients have given me this humility.”

One, for example, was a man in his 30s who suffered a horrible motorcycle crash. The man broke multiple bones. A severe head injury caused a stroke. His kidneys shut down. And he developed severe pneumonia. He was liable to be paralyzed, unable to speak and dependent on others for the rest of his life, if he recovered at all, LaTorre thought.

The man’s condition eventually improved enough that he was discharged to a nursing home.

A year later, LaTorre saw a patient who looked vaguely familiar in the hospital’s stroke clinic, where patients receive follow-up care.

It was the man from the motorcycle crash.

He sat next to his mother in the exam room. He had a request of the neurologist: “I would like you to tell my mom to let me go back to my own apartment.”

LaTorre was shocked. He considers the man’s recovery a miracle, as well as a lesson.

“Now I have a healthier respect,” he says. “There’s definitely something more than medicine  that’s working here, making this outcome possible.”

This article appears in the spring 2017 issue of Upstate Health magazine.

Posted in brain/neurology, emergency medicine/trauma, health care, stroke, Upstate Golisano Children's Hospital/pediatrics | Tagged , ,

Follow the leader: Be flexible, adaptable, imaginative, focused, decisive and emotionally intelligent

Robert Corona, DO, MBA, was recently asked about the qualities of good leadership by the Syracuse Media Group in “CNY Conversations.”

Robert Corona, DO, MBA

“Flexibility and adaptability are key,” he told the news organization. “So is humility.

“When good things happen, take less of the credit.
When bad things happen, take a disproportionate amount of the credit. Really take the responsibility. Don’t just say “I’m responsible” and not change anything.

“Have imagination. I’m a huge Disney fan. I love the idea of not accepting that there’s only one solution.

“Sometimes, when you have to be really focused on a problem, military-style leadership works. You focus. You have to make decisions that may irritate people, but you have to get that problem solved.

“When the tension isn’t so bad, you have to be softer and use emotional intelligence and get people to buy in and build them a bridge, so they have a pathway to the side that you’re hoping to get them to.”

Corona, the John B. Henry Chair of Pathology and Laboratory Medicine and vice president for innovation at Upstate, leads the Central New York Biotech Accelerator center.

This article appears in the spring 2017 issue of Upstate Health magazine.

Posted in health care, pathology | Tagged ,

How to stifle a sneeze

This is most effective when you first feel that tickle of a sneeze starting to form.

Find the center space below your nose and just above where the pigment of your upper lip stops. Take your index finger and press that spot. You can strike a contemplative pose.

“Press for a moment, and that will short-circuit the sneeze,” says Upstate neurologist Anuradha Duleep, MD.

You’ll be blocking a branch of the trigeminal nerve, which will literally reroute the neurologic signal that is sent when your body is preparing to sneeze.

This article appears in the spring 2017 issue of Upstate Health magazine.

 

Posted in brain/neurology | Tagged , , , ,