Three steps to stop a nosebleed

To stop a nosebleed:

  1. Pinch the nose right below the bridge of the nose.

  2. Lean forward. That helps the clot to form in the nose and prevent ongoing bleeding.

  3. Apply a cool cloth on the back of the neck, which can also help stop the bleeding.

“You really have to pinch the nose for quite some time,” says Andrea Dvorak, MD. She recommends five to 10 minutes, or longer if you have a bleeding disorder. “You should watch the clock, because it’s much longer than you really feel like it should be.”

Dvorak, the director of Upstate’s Pediatric Bleeding Disorders Clinic, offers reassurance that the majority of nosebleeds do not signal bleeding disorders.  

She suggests that people who have recurrent nosebleeds use nasal saline solution to keep the nose moist, especially during winter, when the air is dry.

Upstate Health magazine fall 2019 coverThis article appears in the fall 2019 issue of Upstate Health magazine. Click here for the full online version of the magazine.

Posted in blood/blood-related conditions/hematology, health care, Upstate Golisano Children's Hospital/pediatrics | Tagged ,

Which ‘milk’ should you drink?

Products sold as milk come from coconuts, almonds, cows and rice.

Products sold as milk come from coconuts, almonds, cows and rice.

BY AMBER SMITH

Market shelves are filled with varieties of nondairy beverages that call themselves milk. They may taste good whirled into a smoothie or poured over cereal. But they likely cost more than cow’s milk, and they are probably not nutritionally equivalent.

Upstate registered dietitian nutritionist Maureen Franklin urges adults to read the food labels to see whether their chosen milk alternatives measure up. Many nondairy beverages add vitamins and minerals, along with sugars, so their nutritional content may differ greatly from that of regular milk.

Some people avoid milk and other dairy products because of an intolerance to lactose, a sugar found in milk, or because they prefer plant-based foods.

(Hear Maureen Franklin explain the differences between cow’s milk and its alternatives in this “HealthLink on Air” interview.)

A few surprises: Rice milk is higher in carbohydrates than you might imagine. Almond milk is far lower in protein. Pea milk has a creamy texture that Franklin finds most similar to cow’s milk. And coconut milk? Look out for saturated fats.

One cup of traditional cow’s milk contains 8 grams of what Franklin calls “good, high quality protein.” It’s also a good source of calcium and potassium and contains only natural sugars. Milk is a blend of protein, carbohydrates and fat, the total content of which depends on whether it’s whole, 2 percent, 1 percent or skim milk.

What about kids?

For dairy beverages for children over age 1, pediatricians recommend whole cow’s milk.

The American Academy of Pediatrics says infants should receive only breast milk or formula for the first six months. Then, at age 1, babies transition to whole cow’s milk for at least a year.  “The fat in the whole milk is really important for brain development,” says pediatrician Beth Nelsen, MD, associate professor of pediatrics at Upstate.

She also says new research suggests kids should keep drinking whole milk beyond their second birthday to help keep kids at a healthy weight. “If you drink a glass of whole milk with a meal, you get fuller faster,” Nelsen explains.

As children grow, calcium intake is important for lifelong bone health. Nelsen says cow’s milk remains the best dietary source for that.

Are any of the nondairy beverages more nutritious than cow’s milk?

“Some can be,” Franklin says. “They can be higher than milk in terms of calcium, or they could be higher, maybe, in terms of a certain vitamin. It really depends on what that manufacturer has chosen to add to that product.”

Your calcium needs

How much calcium your body needs changes as you age. Females have higher calcium requirements than males because of the effects of the female hormone estrogen on bone formation. Calcium is also required to keep our heart, muscles and nerves functioning properly, and for blood to clot. The Food and Nutrition Board of the Institute of Medicine provides these recommendations for daily calcium intake:

Birth to 6 months: 200 milligrams

6 to 12 months: 260 milligrams

1 to 3 years: 700 milligrams

4 to 8 years: 1,000 milligrams

9 to 18 years: 1,300 milligrams

19 to 50 years: 1,000 milligrams

Males 51 to 70 years: 1,000 milligrams

Females 51 to 70 years: 1,200 milligrams

70 years and older: 1,000 milligrams

If you don’t like milk

Cow’s milk is a great source of calcium, but if you can’t stomach it, here are some other calcium-rich options. Read food labels for exact calcium content:

Almond milk

Baked beans, canned

Bok choy

Broccoli and broccoli rabe

Cereals, fortified

Cheese (American, cheddar, mozzarella, feta or ricotta)

Collard greens

Kale

Oatmeal, fortified

Orange juice, fortified

Rice milk

Salmon, canned with bones

Sardines, canned with bones

Shrimp

Soybeans or soy milk

Yogurt

Source: National Osteoporosis Foundation

Upstate Health magazine fall 2019 coverThis article appears in the fall 2019 issue of Upstate Health magazine. Click here for the full online version of the magazine.

Posted in diet/nutrition, health care, HealthLink on Air, Upstate Golisano Children's Hospital/pediatrics | Tagged , , , ,

What to do if a kid swallows a coin

child playing with coins

You would think that this would be all figured out by now, because it’s a pretty common thing for a kid to swallow a penny,” says Gregory Conners, MD, executive director of Upstate Golisano Children’s Hospital. His first three research projects examined the best way to treat a child who has swallowed a penny.

“It turns out there are lots of different ways to do it,” he says. “And if you go around the country, the same patient would be cared for in different ways in different places — less so now than when I started because — I’m pleased to say — I’ve had some impact in the field.”

His advice to parents and guardians:

Look at the child. Is he or she having trouble breathing? Are they drooling or vomiting? Do they struggle to swallow?  If so, go to the emergency department.

If the child is behaving normally, contact his or her pediatrician or primary care provider.

Unless the child has underlying health conditions, most likely a doctor will reassure that the penny will work its way through the child’s digestive system. “The problem — when there is a problem — is that the coin will maybe get stuck somewhere along the way. Most of the time, it comes right through,” Conners says.

He says it’s important to get to the hospital quickly if a child swallows a magnet or a button battery, the tiny batteries that power watches.

A child will also need to contact his or her doctor if a small object becomes stuck in his or her nose or ear — unless it is a battery. In those instances, they should go to the pediatric emergency department at Upstate.

Conners says the person who brings the child to the emergency department ideally should know the events leading up to the child’s illness or injury, so that can be communicated to the doctor.

“It’s important for us to know what the background is. In pediatrics you really rely heavily on the story, the history.”

For questions at any hour, contact the Upstate New York Poison Center at 800-222-1222.

Upstate Health magazine fall 2019 coverThis article appears in the fall 2019 issue of Upstate Health magazine. Click here for the full online version of the magazine.

Posted in emergency medicine/trauma, health care, Upstate Golisano Children's Hospital/pediatrics

One nurse’s passions: He’s dedicated to patients in the recovery room and customers at his restaurant

Upstate nurse Thanh Nguyen at the Saigon Vietnamese Kitchen, his restaurant outside Liverpool. (photo by Chuck Wainwright)

Upstate nurse Thanh Nguyen at the Saigon Vietnamese Kitchen, his restaurant outside Liverpool. (photos by Chuck Wainwright)

BY JIM HOWE

You can find him caring for patients as they wake up after surgery. You can also find him supervising a Vietnamese restaurant near Liverpool.

Thanh Nguyen (pronounced tonn wenn), says he loves working as a nurse in Upstate University Hospital’s post-anesthesia care unit. Also known as the PACU or recovery room, it’s where patients wake up after surgery. Now 32, he has lived in Syracuse since he was 3. He’s been a nurse at Upstate for the past five years.

Nguyen keeps busy. When he is not working as a nurse, he can usually be found at the Saigon Vietnamese Kitchen on Route 57 in Liverpool. It’s a business he helped to launch this spring.

(Below: Nguyen shares a Vietnamese recipe.) 

A friend of Nguyen’s, Daniel Nguyen, also of Vietnamese background but no relation to Thanh, was a cook at another local Vietnamese eatery and needed a business partner to start a new place. “Daniel wanted to create his own restaurant with his own menu and his own creations,” Thanh Nguyen said. “He covers the kitchen, and I’m basically the managing partner and oversee staff, the financial details, and making sure customers are happy and everything is correct.”

Thanh Nguyen had taken a few business classes and was interested in going into business himself before he switched to nursing. He leaves the cooking to his business partner, who he notes trained under the “Iron Chef” of Vietnam.

“There are not too many Vietnamese restaurants in the area,” he said. “And where we are in Liverpool, there is no Vietnamese restaurant for miles.” He describes Saigon Vietnamese Kitchen as “a nice family casual place, with color-changing lights and Vietnamese music rotating with American music” — and ample parking.

He points out that his restaurant is popular with vegans, who do not eat meat or dairy products. “We also have a special menu just for them.”

What is Thanh Nguyen’s favorite menu item? “Pho, a dish of beef broth that cooks for more than 16 hours, with meat, a ton of vegetables, bean sprouts, rice noodles,” he describes.

“I find myself eating it all the time.”

Is it kid-friendly?

Can you take children to the Saigon Vietnamese Restaurant?

The short answer is: Yes.

While there is no specific kids’ menu, there is a wide selection of dishes offering vegetables, meat, poultry, seafood, salads, rice and noodles to choose from.

“Children usually stick to rice plates such as the fried rice dishes

or the drunken noodle dishes,” notes owner Thanh Nguyen. “We can also customize dishes per request for small children,” he adds.

Vietnamese Fresh Spring Rolls

Vietnamese Fresh Spring Rolls

Recipe: Vietnamese Fresh Spring Rolls

Thanh Nguyen recommends this recipe for spring rolls, which he says are easy to prepare and similar to what is served at the Saigon Vietnamese Kitchen restaurant.

Ingredients

2 ounces rice vermicelli

8 rice paper wrappers (8.5 inches in diameter, see note)

8 large cooked shrimp, peeled, deveined and cut in half

1  1/3 tablespoons chopped fresh Thai basil

3 tablespoons chopped fresh mint leaves

3 tablespoons chopped fresh cilantro

2 leaves lettuce, chopped

4 teaspoons fish sauce (see note)

1/4 cup water

2 tablespoons fresh lime juice

1 clove garlic, minced

2 tablespoons white sugar

1/2 teaspoon garlic chili sauce (see note)

3 tablespoons hoisin sauce (see note)

1 teaspoon finely chopped peanuts

Preparation

  1. Bring a medium saucepan of water to a boil. Boil rice vermicelli 3 to 5 minutes or until al dente, then drain
  2. Fill a large bowl with warm water. Dip one wrapper into the hot water for 1 second to soften. Lay wrapper flat. In a row across the center, place 2 shrimp halves, a handful of vermicelli, basil, mint, cilantro and lettuce, leaving about 2 inches uncovered on each side. Fold uncovered sides inward, then tightly roll the wrapper, beginning at the end with the lettuce. Repeat with the remaining ingredients.
  3. In a small bowl, mix the fish sauce, water, lime juice, garlic, sugar and chili sauce.
  4. In another small bowl, mix the hoisin sauce and peanuts.
  5. Serve rolled spring rolls with the fish sauce and hoisin sauce mixtures.

NOTE: Fish sauce, hoisin sauce, garlic chili sauce and rice paper wrappers can be found in the Asian or international section of many grocery stores or in specialty stores. The sauces might also be found alongside other bottled barbecue or meat sauces.

Prep time: 45 minutes. Cooking time: 5 minutes. Ready in: 50 minutes.

Source: allrecipes.com

This article appears in the fall 2019 issue of Upstate Health magazine. Click herefor the full online version of the magazine.

Posted in health care, nursing, recipe | Tagged , , ,

TOP cancer-care program turns 20

Jason Wallen, MD, center, contemplates a treatment plan for a lung cancer patient during a TOP multidisciplinary team meeting. (photo by Susan Kahn)

Jason Wallen, MD, center, contemplates a treatment plan for a lung cancer patient during a TOP multidisciplinary team meeting. (photo by Susan Kahn)

Thoracic Oncology Program relies on team care

Upstate’s Thoracic Oncology Program (TOP) is marking its 20-year anniversary.

TOP follows a “multidisciplinary” team approach. Specialists from multiple disciplines make up the team, which collaborates on the care of individual thoracic and lung cancer patients. Team members include medical, surgical and radiation oncologists, pathologists, imaging specialists, pulmonary specialists, nurse practitioners with specialized training, nutritionists, social workers and patient navigators.

Such a team approach – which is typical at major cancer institutes – has been shown to significantly boost a patient’s survival.

The Upstate Cancer Center has several multidisciplinary teams for various types of cancers, including breast cancer, head and neck cancers, gastric and esophageal cancers, and pediatric cancers.

Leslie Kohman, MD, championed the team concept at Upstate two decades ago “because it gives better care to the patient, and it saves the patients a tremendous amount of time in appointments,” she says.

(Leslie Kohman, MD, explains how TOP works to create treatment plans for lung cancers and other cancers of the chest, in this “HealthLink on Air” interview.).  

She notes that almost all cancer patients need more than one type of treatment. “Very few patients are treated with just surgery, or just chemotherapy or just radiation,” Kohman says. “To have experts from all those disciplines discuss treatment up front is very beneficial to the patient.”

Thoracic surgeon Jason Wallen, MD, is medical director for TOP. He says the team approach means every patient has all options open for discussion. “It’s like getting eight or 10 second opinions all at once, in a single visit.”

Such team care is natural at an academic medical center, where doctors and caregivers are encouraged to seek input from one another.

Upstate Health magazine fall 2019 coverThis article appears in the fall 2019 issue of Upstate Health magazine. Click here for the full online version of the magazine.

Posted in cancer, health care, HealthLink on Air, lung/pulmonary

Up close: Meet DIANA

DIANA drug-mixing machine

DIANA, a machine used at the Upstate Cancer Center.(photo by Richard Whelsky)

This is the device that helps the pharmacy team in the Upstate Cancer Center mix chemotherapy medications for individual patients. The product name “DIANA” is a tribute to the ICU Medical founder and CEO’s wife, Diana Kostyra Lopez, MD, whose life was cut short in 2006 by breast cancer. ICU Medical is based in San Clemente, California. Upstate senior pharmacist Andrew Burgdorf, PharmD, explains that 25 to 30 percent of chemotherapy agents given at Upstate are mixed with DIANA’s assistance.

cover of summer 2019 Cancer Care magazine This article appears in the summer 2019 issue of Cancer Care magazine.

Posted in cancer, drugs/medications/pharmacy, health care, technology

‘We are your neighbors’: Money raised for pediatric cancer helps kids here in Central New York

One of the organizations that helped Archie Kulkus (in the foreground with his mother, Emily) and his family during his cancer treatment was Paige’s Butterfly Run, which has raised more than $3 million to help kids and their families in Central New York. His family and friends participate in the annual run as members of “Archie’s Orange Army.” Emily Kulkus works in public and media relations at Upstate. (photo by Susan Keeter)

One of the organizations that helped Archie Kulkus (in the foreground with his mother, Emily) and his family during his cancer treatment was Paige’s Butterfly Run, which has raised more than $3 million to help kids and their families in Central New York. His family and friends participate in the annual run as members of “Archie’s Orange Army.” Emily Kulkus works in public and media relations at Upstate. (photo by Susan Keeter)

BY EMILY KULKUS

Everywhere we go, Archie makes a new friend. He’s quick to smile and always chatty — not to mention pretty darn cute. So lately, lots of people stop to talk to us. Mostly him.

They tell me how cute he is. Then they talk with him and they tell me how smart, engaging and sweet he is. And every single time I think: If they only knew.

And then yesterday we were out running errands, and I was wearing my 2019 Mountain Goat Run shirt. The woman behind the counter asked me if I’d run this year.

“Yes, I did the relay,” I said.

She said, “Oh, my husband does it every year. He’s the one bouncing the basketball.”

Of course I know him; he’s a local celebrity.

She went on to say that he does it to raise money for leukemia and other pediatric cancers.

I tousled Archie’s hair — the hair that she and several others in the store had just admired — and said, “Well this guy right here is a cancer survivor. So please tell your husband thank you from both of us.”

The air left the room. There were audible gasps.

Sometimes I forget that “kids” and “cancer” are not things people are used to hearing. Sure, they see it on TV sometimes, but that’s someone else’s child — someone else’s problem.

I want people to see and know that pediatric cancer happens right here, too. We are your neighbors.

Archie is a beautiful, shining example of an amazing outcome.

He was 7 months old when he was diagnosed with Wilms’ tumor, a type of kidney cancer. He endured a nearly 12-hour surgery to remove the tumor and one of his kidneys and spent nearly a week in the pediatric intensive care unit at the Upstate Golisano Children’s Hospital. Over the course of eight months, Archie had eight radiation treatments, 15 chemotherapy treatments and many other tests and hospital visits to track his health.

In late March 2017, Archie received a clean bill of health, and his ongoing cancer treatment ended. Doctors will keep close tabs on him for the rest of his life. Survival rates for Wilms’ tumor are extremely high, and his future looks bright.

I don’t mind the gasps. Or the tears. I never want “kids” and “cancer” to be normal. But we have a long way to go before it’s a phrase we don’t recognize.

To donate to pediatric oncology research and patient programs at Upstate, contact the Upstate Foundation at 315-464-4416, or Paige’s Butterfly Run.

cover of summer 2019 Cancer Care magazineThis article appears in the summer 2019 issue of Cancer Care magazine.

Posted in cancer, health care, kidney/renal/nephrology, patient story, research, Upstate Golisano Children's Hospital/pediatrics | Tagged

Tackling a disease: SU offensive lineman keeps rare disorder in check with infusions at Upstate

Syracuse University football player Sam Heckel has worked since childhood to keep a rare blood disorder in check. (photo courtesy of Syracuse University Athletics)

Syracuse University football player Sam Heckel has worked since childhood to keep a rare blood disorder in check. (photo courtesy of Syracuse University Athletics)

BY JIM HOWE

He’s 6 foot 4, weighs nearly 300 pounds and plays football for Syracuse University.

And, about every three weeks, Sam Heckel settles in for 12 to 16 hours of infusion treatment at Upstate to deal with a rare blood-clotting disorder. He might start by getting the very slow plasma drip at the Upstate Cancer Center, then finish up at the Upstate Golisano Children’s Hospital, or vice versa.

Although he towers over the other pediatric patients and turns 22 this year, he is cared for by pediatricians until graduating from college, as are most young people in long-term treatment.

Heckel’s disorder is known by its initials, TTP (see “About TTP,” below).

Andrea Dvorak, MD, oversees Heckel’s care at Upstate.

Andrea Dvorak, MD, oversees Heckel’s care at Upstate.

“He is my first and currently our only patient with congenital TTP,” says Andrea Dvorak, MD. She is the Upstate pediatric hematologist/oncologist who specializes in children’s blood disorders and cancer and who oversees his treatment. A few other patients have had acquired TTP, the more common type of the disorder caused by an inherited genetic mutation.

“With the acquired form, there are treatments that can make it go away, but with Sam we don’t have that ability. Research is being done, but unless some new treatment comes up, this is his routine from now on,” Dvorak says.

Heckel hopes to contribute to research. He’s president of the SU chapter of Uplifting Athletes, a nonprofit group of college athletes that aims to create awareness of rare diseases and raise money for research.

Sam Heckel is prepared by nurse Abby Falconer for one of his 12- to 16-hour infusions of plasma at Upstate. (photo by Richard Whelsky)

Heckel is prepared by nurse Abby Falconer for one of his 12- to 16-hour infusions of plasma at Upstate. (photo by Richard Whelsky)

The diagnosis

Heckel learned he had TTP as a child growing up in Waukesha, Wis. “I was about 2 years old, with my mom and dad at a family get-together, and we were all swimming. When my dad went to grab me and set me down, he left handprints, like bruises, where he held me,” Heckel recalls.

It was the first hint of the disorder.

Young Sam was diagnosed soon after, but his family didn’t find suitable treatment until he was in second grade. Then he began what has become his treatment routine at the Children’s Hospital of Wisconsin, in Milwaukee, about a half-hour from his family’s home.

“It normally takes about 14 hours,” he says of his infusions. Sometimes he is done by 10 p.m. Sunday, sometimes by 2 or 3 a.m. Monday.

“I usually just hang and watch movies, and if I absolutely have to do homework, I’ll do it, but usually it’s just a day to relax,” he says.

(Heckel talks about his disease and football in this video interview.)

“It’s the next day that I feel it. With all of the medications, it does not make life enjoyable the next two days.” The plasma and medications he must take can leave him feeling bloated and out of sorts for a few days.

Having TTP means Heckel has to stay “super hydrated” to avoid straining his kidneys and be careful about catching illnesses, since he is vulnerable to infections, “but I don’t have to make a lot of adjustments in day-to-day life,” he says.

Heckel, (No. 75), blocks defensive tackle Malik Manciel (No. 93) during an SU vs. Middle Tennessee State University game. (photo courtesy of Syracuse University Athletics)

Heckel, (No. 75), blocks defensive tackle Malik Manciel (No. 93) during an SU vs. Middle Tennessee State University game. (photo courtesy of Syracuse University Athletics)

Playing football

He does have to guard against excessive bruising — which might seem difficult, given that he plays on the SU offensive line.

Some doctors may have advised against contact sports for a child with TTP, but Heckel’s pediatrician agreed to monitor him closely. “It’s worked so far,” Heckel says.

He has played football regularly since second grade. The lineman job was pretty much chosen for him by his massive size, he says. He played on the defensive line in high school, and he also played tight end a little last season. He is a redshirt junior this fall and will be able to play one more season at SU after that. Heckel enjoys earth science and says he would like to teach after college.

When choosing a college, Heckel made sure a hospital that could treat him was nearby. Upstate is next door to SU and less than five minutes from where he lives. His doctor in

Milwaukee knew Upstate pediatrics professor emeritus Thomas Welch, MD, who put him in touch with the pediatric hematology program. That’s how Heckel connected with Dvorak, his doctor at Upstate.

(Click here for Heckel’s SU football profile and here for an SU football overview.)

His care

Dvorak closely monitors Heckel. “We check his lab reports (blood tests) weekly during football season, and we have to watch his platelet count and kidney function and have to be sure he is staying healthy,” she says.

She also keeps in touch with his athletic trainers. “Before he started, I spoke with the team doctor, and his trainer gets a copy of his labs every week. They know what he needs in order to play,” she says.

In the off-season he does not need to be monitored as closely but still needs his infusion.

“He’s a good kid. He’s motivated. The fact is that both in school and in football … he hasn’t let this stop him. This disease should not interfere with his having a long life,” Dvorak says.

Heckel echoed his doctor’s assessment when asked what he would tell a youngster diagnosed with TTP: “You can’t let that disease define you. You can’t let it limit you. You can do whatever you want.”

About TTP

Thrombotic thrombocytopenic purpura is a rare disorder in which people lack an enzyme called ADAMTS13.

This makes their blood “sticky” and prone to form clots, according to the TTP Foundation.

These clots are made of platelets, a blood element that normally promotes clotting at injury sites to prevent bleeding. In TTP, unnecessary clotting can restrict blood flow to the body’s organs, placing them at risk for damage. Also, the platelets being used in unnecessary clots are not available to prevent bleeding elsewhere.

Treatment includes slow infusions of normal plasma, the liquid part of the blood, which contains the missing enzyme.

About three or four new TTP cases per million people are diagnosed each year in the United States.

Upstate Health magazine fall 2019 coverThis article appears in the fall 2019 issue of Upstate Health magazine. Click here for the full online version of the magazine.

Posted in blood/blood-related conditions/hematology, genetics, health care, patient story, Upstate Golisano Children's Hospital/pediatrics | Tagged , , , , , , ,

Quests to outsmart cancer: 5 research projects underway at Upstate

 

Alaji Bah, PhD, is searching for ways to keep cancer-suppressing genes “turned on”— research that may lead to new medications. (photo by William Mueller)

Alaji Bah, PhD, is searching for ways to keep cancer-suppressing genes “turned on”— research that may lead to new medications. (photo by William Mueller)

BY AMBER SMITH

Of the 268,600 women who will be diagnosed with breast cancer in America this year, 90 percent will live for at least another five years. Breast cancer is survivable, especially when it’s caught early, but it remains the most common cancer in women, not counting skin cancers. The National Cancer Institute reports that 7 percent of all cancer deaths are from breast cancer.

Researchers are coming at the disease from multiple directions. They are designing new ways to target tumor cells, new methods of halting its spread, new approaches to drug resistance. With money from the Carol M. Baldwin Breast Cancer Research Fund, scientists at Upstate are on a quest to outsmart breast cancer. Here’s a look at five projects underway.

1. Putting the brakes on cancer

Using both chemistry and biology, Alaji Bah, PhD, is on a quest to improve breast cancer targets. He is searching for ways to keep cancer-suppressing genes “turned on” — research that may lead to new medications.

A biology-class refresher: Genes are sequences of nucleotides encoded within DNA. That same DNA is in every cell of our bodies, wrapping tightly around clusters of proteins. As they mature in our bodies, cells go through developmental changes to become skin cells, brain cells or other cells. Depending on how the cell develops, certain genes are turned on or off.

Bah’s laboratory is targeting one of the mechanisms by which genes are turned on or off: DNA methylation. When it is heavily present, tumor suppressor genes turn off and lose their ability to suppress cancer. They are the body’s cancer-braking system.  

Many anti-cancer drugs prevent the global DNA methylation of genes, including tumor suppressors. Because of the lack of specificity of these drugs, other vital genes are also affected, resulting in unwanted side effects. The Bah lab focuses on five proteins that interpret DNA methylation to turn off the tumor suppressor genes.

Now for the chemistry class: Remember what happens if you put sugar in water? The sugar molecule dissolves, and the two substances mix and become inseparable. They bind, like a married couple.

What happens if you put oil and water together? They don’t mix. Chemists call this “phase separation.” Phase separation is like two random strangers standing near one another.

The proteins Bah studies appear to phase-separate like oil and water. “We believe that these proteins are not binding but phase-separating with the methylated DNA,” he says. “Some scientists think they are binding, but that’s not what our data is showing.”

If his idea is proven, Bah says it could lead to new, better anti-cancer medications.

When chemotherapy drugs stop working, it is called chemoresistance. It is a major hurdle in the management of breast cancer. Identifying the genes involved in drug resistance, such as the work being done in the Bah lab, is a crucial step toward developing a way to overcome it.

Ying Huang, MD, PhD, is studying a protein that makes breast cancer resistant to chemotherapy. (photo by Richard Whelsky)

Ying Huang, MD, PhD, is studying a protein that makes breast cancer resistant to chemotherapy. (photo by Richard Whelsky)

2. Tackling drug resistance in breast cancer

Research in the Upstate pharmacology laboratory of Ying Huang, MD, PhD, has led to the identification of a protein called RBEL1A that appears to play an important role in breast cancer cell survival and drug resistance. Excessive levels of this protein are found in a majority of human breast cancers. Huang’s team has found that when breast cancer cells have higher levels of this protein, they become more resistant to certain anti-cancer drugs.

 Her team has also identified several small molecules that can be used to lower the levels of this protein. When levels of RBEL1A are lowered, Ying explains, cancer cell resistance should drop, and response to anti-cancer drugs should increase.

Studies in her laboratory are underway to see if these molecules can be combined with chemotherapy drugs to overcome chemoresistance, which is when the drugs stop working.

Christopher Turner, PhD, examines cancerous breast tissue donated by patients of Lisa Lai, MD, to study how the tissue environment serves as a host for cancer. (photo by William Mueller)

Christopher Turner, PhD, examines cancerous breast tissue donated by patients of Lisa Lai, MD, to study how the tissue environment serves as a host for cancer. (photo by William Mueller)

3. Potentially slowing the spread of cancer

Cells in the body are physically supported by a “scaffolding” called the extracellular matrix. Known as the ECM, this support structure is made of up of collagen and other fibrous proteins. Cancer develops when normal cells transform into tumor cells. When this occurs, fibroblasts — the cells that create the support structure — also activate. If they create a rigid and dense structure, cancer cells can use the fibers as “tracks” to more easily escape and spread through the body. A less dense structure, though, can make it more difficult for the cancer cells to migrate.

Lisa Lai, MD (photo by Robert Mescavage)

Lisa Lai, MD (photo by Robert Mescavage)

Cell and developmental biologist Christopher Turner, PhD, focuses his work on a protein called Hic5 found in these cancer-associated fibroblasts, or CAFs. The Hic5 protein promotes a rigid and dense matrix. In laboratory research in mice, he has shown a connection between the protein levels and tumor cell invasion, proliferation and metastasis. He believes Hic5 plays a role in certain aggressive breast cancers.

To test this idea, Turner has teamed with Upstate breast surgeon Lisa Lai, MD. Some of Lai’s patients are contributing to the research effort by donating tissue from their surgeries. Kyle Alpha, a student working toward a medical degree and a doctoral degree, splits his time between Lai’s operating room and Turner’s laboratory. He’s the one who has isolated CAFs from a dozen or so tissue samples from patients in the past year.

“We have just begun our analyses, but we have noticed that, similar to our animal studies,there are indeed differences in the levels of Hic5 in the CAFs from patient to patient,” Turner says. Their ongoing work will compare Hic5’s impact in aggressive breast cancers to that in slower-growing cancers and potentially identify Hic5 as a new therapeutic target for slowing cancer’s spread.

Christine King, PhD, is working to deactivate a molecule that allows breast cancer cells to grow and invade. (photo by Richard Whelsky)

Christine King, PhD, is working to deactivate a molecule that allows breast cancer cells to grow and invade. (photo by Richard Whelsky)

4. Halting cancer spread via a new target?

Microbiologist Christine King, PhD, is investigating a key molecule called STAT3 that allows breast cancer cells to grow, move and invade other cells. It’s active in more than half of all breast tumors. But it’s a molecule we need in order to survive, so getting rid of it entirely is not an option.

Her goal is to find a way for STAT3 to peacefully exist, without its ability to impact breast cancer cells. She has to find a way to keep the molecule from being activated.

Medications designed to inhibit STAT3 have not shown success.

So, King is working backward, unraveling a chain reaction and searching for a new target. She has discovered that another molecule influences STAT3. It’s called TRIM28.

When TRIM28 binds with STAT3, STAT3 behaves.

But if TRIM28 is phosphorylated, or altered, by an enzyme called MK2, TRIM28 cannot bind to STAT3, and the whole deal falls apart.

Scientists in King’s lab suspect that Trim28 is present in breast tissue, but they are trying to determine its phosphorylation state. That’s part of the work that is paid for by the Baldwin grant.

King envisions her work leading to a new target: MK2. If she can keep that enzyme away from TRIM28, then TRIM28 can bind to STAT3, and STAT3 would not be able to allow breast cancer cells to grow and spread and invade other cells.

“If this turns out to be true in breast cancer, then we have a new target,” King says, “a highly specific target.”

Mehdi Mollapour, PhD, is looking at ways to make anti-cancer medications more powerful. He’s seated next to a 3-D print of the cancer chaperone, Hsp90 protein. (photo by Susan Kahn)

Mehdi Mollapour, PhD, is looking at ways to make anti-cancer medications more powerful. He’s seated next to a 3-D print of the cancer chaperone, Hsp90 protein. (photo by Susan Kahn)

5. Paralyzing a protein that helps cancer cells

A protein called Hsp90 is a chaperone that looks after other proteins, making sure they work properly. However, cancer cells hijack the Hsp90 protein, so they too can survive and grow.

Several Hsp90 drugs are being tested in clinical trials. They are designed to selectively accumulate in tumor cells and paralyze Hsp90 so that it can no longer protect the tumor cells. “If you target the chaperone, you target the cancer cells,” describes Mehdi Mollapour, PhD, a professor of urology, biochemistry and molecular biology, and vice chair for translational research in the Department of Urology.

Mollapour and his research team study tissues from breast tumors and compare them with adjacent healthy breast tissues. He believes that chemical modifications of Hsp90 protein make them more attractive to the Hsp90 inhibitors, which would make the medications more potent.

While Hsp90 inhibitors hold promise, none will be a solution for every type of tumor, in every patient. So Mollapour wants to find a way to identify those tumors that respond better to the Hsp90 inhibitors. He’s looking for what scientists call a biomarker.

One of his projects focuses on FNIPs, which assist Hsp90 in chaperone duties. Mollapour knows that when FNIPs are “downregulated,” tumor cells are less sensitive to Hsp90 inhibitors. When they are “upregulated,” the inhibitors more readily bind to Hsp90 in tumor cells.

“Our findings suggest that FNIPs expression can potentially serve as a predictive indictor of tumor response to Hsp90 inhibitors,” he describes in an article in the journal Nature Communications.

cover of summer 2019 Cancer Care magazineThis article appears in the summer 2019 issue of Cancer Care magazine.

 

 

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

Help for eating with a sore mouth, plus a recipe

glad of yogurt drink

BY AMBER SMITH

Cancer treatment can harm the fast-growing cells in the lining of your mouth and lips. You may develop little cuts or ulcers in your mouth, or tender gums, which will most likely feel better once treatment ends. Here are some strategies from the National Cancer Institute to help manage this problem:

  • Choose foods that are easy to chew or that you can drink, such as milkshakes, scrambled eggs, cottage cheese, creamy peanut butter, mashed potatoes or liquid meal replacements.
  • Cook foods until they are soft and tender.
  • Cut foods into smaller pieces or puree foods using a blender or food processor.
  • Drink with a straw. This can help push the drinks beyond the painful parts of your mouth.
  • Use a very small spoon, like a baby spoon. This will help you take smaller bites, which may be easier to chew.
  • Eat cold or room-temperature food. Your mouth may hurt more if foodis too hot.
  • Suck on ice chips. Ice may help numb and soothe your mouth.
  • Avoid certain foods and drinks that may irritate, including citrus fruits and juices, tomatoes and ketchup, salty foods, sharp crunchy foods, raw vegetables and drinks containing alcohol.
  • Do not use items that can hurt or burn, such as mouthwash containing alcohol, toothpicks, cigarettes or other tobacco products.
  • Ask your doctor about medicine for pain. He or she may suggest lozenges or sprays that numb your mouth while eating.
  • Rinse your mouth three or four times a day. Mix 1/4 teaspoon baking soda and 1/8 teaspoon salt with 1 cup warm water. Rinse with plain water after using this mixture.

Canned peach halves in bowl isolated on white background.

Fruit and Cream

Ingredients:

1 cup whole milk

1 cup vanilla ice cream or frozen yogurt

1 cup canned fruit (peaches, apricots, pears) in heavy syrup with juice

Almond or vanilla extract to taste

 Preparation:

Blend ingredients in a blender and chill well before serving.

Nutritional Information:

This yields two 1½-cup servings.

Per serving:

If made with ice cream:

  • 302 calories
  • 7 grams of protein

If made with frozen yogurt:

  • 268 calories
  • 9 grams of protein

Source: The National Cancer Institute, part of the National Institutes of Health.

spoon

cover of summer 2019 Cancer Care magazineThis article appears in the summer 2019 issue of Cancer Care magazine.

 

Posted in cancer, diet/nutrition, health care, recipe