Are you at risk for kidney disease?

People with diabetes, high blood pressure or a family history of kidney disease are at risk for developing kidney disease.

Sriram Parsipur, MD

Sriram Parsipur, MD

If you’re at risk, ask your primary care doctor to screen you, advises Sriram Narsipur, MD, who leads the division of nephrology at Upstate. A simple urine test can reveal abnormal levels of protein, which may signal kidney disease even before a blood test, which measures the concentration of waste products in the blood.

Your doctor may refer you to a nephrologist, who specializes in kidney problems, if your screening is abnormal. Here’s how to prepare for that appointment:

  1. Call ahead and ask if you need to alter your diet or have any lab testing done in advance, and whether you need to retrieve medical records from your primary care doctor.
  2. Bring a list of your medications and dosages, including vitamins and supplements, a list of any symptoms and key aspects of your medical history.
  3. You may want to bring a family member or friend to help you keep track of what is said, along with a notepad.
  4. Write down a list of questions, which might include:
    — What could be causing my symptoms?
    — Which tests do I need?
    — What is my kidney function, and is it getting worse?
    — Are my kidney problems made worse by other health conditions?
    — Is my blood pressure a concern?
    — Do I need to make any changes to my diet?
    — Are there any over-the-counter medications I should avoid?
    — How active should I be in terms of exercise?
    Layout 1 finalThis article appears in the spring 2016 issue of Upstate Health magazine
Posted in health care, illness, kidney/renal/nephrology

Heart of a warrior: She cherishes each moment after surviving a medical emergency

Debra Becker at the Cardiac Rehabilitation program at Upstate's Institue for Human Performance. (PHOTO BY ROBERT MESCAVAGE)

Debra Becker at the cardiac rehabilitation program at Upstate’s Institute for Human Performance. (PHOTO BY ROBERT MESCAVAGE)

BY JIM HOWE

A woman who did her best to stay fit nearly died. That experience taught her never to take her health for granted.

Debra Becker of Liverpool was a runner. She practiced yoga and worked out regularly, including a heavy-duty fitness program called CrossFit. She also held demanding jobs in public relations and advertising.

She began suffering from fatigue. And because of long, heavy menstrual bleeding, she underwent what was to have been a simple exploratory dilation and curettage procedure in early October 2014 at Upstate University Hospital.

In the recovery room after the operation, doctors discovered her heart murmur.

A cardiology team discovered that several of the supportive cords — which resemble the strings on a parachute — on Becker’s mitral valve had broken. The valve was not closing properly, causing blood to backflow toward her lungs and creating the murmur.

Her condition – severe mitral valve regurgitation and prolapse – was “extremely unusual” after a minor procedure, especially given her demanding exercise routine, notes her gynecologist, Howard Weinstein, MD.

Becker needed emergency heart surgery. If she hadn’t been in the hospital when the problem developed, she probably would have died, she recalls her heart surgeon, Gregory Fink, MD, telling her.

“When her cords ruptured, she developed pulmonary edema (congestion) and heart failure. While she was able to compensate/tolerate this for the short term (perhaps one to two weeks), for the longer term, her prognosis was very poor,” Fink says.

Becker’s husband, Steve, says it was “divine intervention” that kept her alive. That, and Fink, who was able to repair her valve without using an artificial valve. Later, Fink received the Surgeon of the Year Award from the Central New York Business Journal; Becker nominated him.

Becker spent most of October 2014 in the intensive care unit and began a long, slow recovery that involved weakness, inactivity and needing a lot of help from other people, none of which Becker was used to.

She later underwent a hernia repair and the surgical removal of wires from a pacemaker that poked through her skin. She also had surgery to fix a nasal condition caused by the oxygen tubes she had needed to breathe.

Her cardiac rehabilitation program at Upstate’s Institute for Human Performance meant three carefully monitored sessions a week for 12 weeks. Her cardiologist, Robert Carhart Jr., MD, says her recovery is going “quite well.”

Becker writes a blog about her experience and organizes a team for the American Heart Association Heart Walk. Gradually she has become more active. And, she has altered the way she looks at life.

“Now I try to live in the moment and cherish each moment,” she says. “I’m trying to encourage other people to do the same thing.”

Layout 1 finalThis article appears in the spring 2016 issue of Upstate Health magazine.

Posted in health care, heart/cardiovascular, illness, patient story, physical therapy/rehabilitation, surgery, women's health/gynecology

‘Concussion’ conversation: Movie spotlights chronic traumatic encephalopathy

Will Smith stars in Columbia Pictures' "Concussion."

Actor Will Smith portrays Bennet Omalu, MD, in the movie “Concussion.”BY AMBER SMITH

BY AMBER SMITH

Experts from Upstate who saw the Will Smith film “Concussion” praised its accuracy, from the behavior of the characters to the under-the-microscope images of brain tissue.

Smith portrays Bennet Omalu, MD, who finds himself at dangerous odds with the NFL when he investigates brain damage called chronic traumatic encephalopathy, or CTE, in professional football players, including Pittsburgh Steelers center Mike Webster.

Corona,Robert 5x7

Robert Corona, DO, is a neuropathologist, the specialty that studies tissue of the nervous system.

Robert Corona, DO, chair of pathology and director of neuropathology at Upstate Medical University, was impressed with Omalu’s courage to follow the neuropathological science and stick with an inconvenient truth. He says the movie “took me by surprise that it was so emotional. I never would have anticipated it could have moved me so much.”

The movie tells the story surrounding research Omalu published in July 2005 in the journal Neurosurgery when he was working in the department of pathology at the University of Pittsburgh. His paper is titled “Chronic Traumatic Encephalopathy in a National Football League player.”

Since the movie was released, CTE has been in the news.

Former New York Giants safety Tyler Sash, who died from an accidental overdose of pain medication in September at the age of 27, was found to have advanced CTE in January.

Ann McKee, MD, told The New York Times that the severity of the CTE in Sash’s brain was about the same as the level found in the brain of the former NFL star Junior Seau, who committed suicide in 2012 at age 43. McKee, chief of neuropathology at the Veterans Affairs Boston Healthcare System and a professor of neurology and pathology at the Boston University School of Medicine, did the examination of Sash’s brain.

McKee also examined the brain of former Oakland Raiders quarterback Ken “the Snake” Stabler, who died of colon cancer in July at the age of 69. Stabler was elected to the Pro Football Hall of Fame in February, days after it was announced that his brain contained widespread lesions that “were quite severe, affecting many regions of the brain,” McKee told The New York Times.

A scientific mystery

CTE is not a new diagnosis. Almost a century ago, articles in medical journals described similar symptoms in old boxers, labeling the condition “punch drunk syndrome.” Later research has found the phenomenon in war veterans, as well.

Mainstream media picked up on the significance of CTE after The New York Times article in January 2007 about the suicide of defensive back Andre Waters. Omalu told the newspaper that brain trauma “is the significant contributory factor” to Waters’ brain damage, “no matter how you look at it, distort it, bend it. It’s the significant forensic factor.”

Chin

Lawrence Chin, MD, is a neurosurgeon, who diagnoses and surgically treats disorders of the central and peripheral nervous systems.

On autopsy, brains affected by CTE have a loss of nerve cells, called neurons, and an accumulation of the protein tau, which is a hallmark of Alzheimer’s disease. However, there is a distinct pattern of the tau deposits seen with CTE. Scientists don’t know how early the damage begins, and they don’t know what makes a brain vulnerable. Without a way to detect CTE in living people, its prevalence remains unknown.

Earlier this year, Omalu told ABC News that former Buffalo Bills running back O.J. Simpson more likely than not suffers from CTE. He says Simpson exhibits telltale behavioral symptoms of CTE which include explosive, impulsive behavior, impaired judgment, criminality and mood disorders. Simpson is serving time for an armed robbery that occurred 13 years after he was acquitted of the 1994 murders of his wife and her friend.

Omalu points out that Simpson’s brain was exposed to blunt force trauma thousands of times on football fields during his college and professional career.

Still, experts cannot agree on how much of a risk football presents.

Is football safe?

Parents who see “Concussion” may wonder if there is a safe way to play the game.

Rieger.Brian

Brian Rieger, PhD, is a psychologist devoted to concussion management and rehabilitation.

“The risk is not the same for everyone,” says Brian Rieger, PhD, director of the Upstate Concussion Center, “because there are people who have whole careers in football and who don’t have serious problems like this. The problem is that we don’t yet have a way to identify who is more or less at risk.”

The high school athletes with the highest rate of concussion are football players and female soccer players – but the reasons are not fully understood. Further, the relationship between concussion and CTE is not clear.

“One of the points in the movie that is subtle is that we don’t really know what it is that causes CTE,” says Lawrence Chin, MD, the chair of neurosurgery at Upstate. “In fact, a lot of people think that it’s not necessarily concussions but what they call subconcussive blows or the bumping of heads on a repeated basis, but not enough to cause concussion.”

Claudine Ward, MD, is a physical medicine and rehabilitation doctor who focuses on recovery from neurological illnesses and injuries.

Claudine Ward, MD, is a physical medicine and rehabilitation doctor who focuses on recovery from neurological illnesses and injuries.

He and Corona, the pathologist, published a paper together about CTE in April 2013 in the journal Neurological Research. They made the point that a method is needed to assess CTE in patients prior to death.

Chin says the movie does a good job of illustrating the symptoms of CTE, including depression and anger. “It’s dramatized, of course, but the decline of these patients, it’s very sudden and precipitous.”

Claudine Ward, MD, an assistant professor of physical medicine and rehabilitation, appreciates that the filmmakers showed how Omalu’s stance changed over time. Initially emphatic that no one should play football, with the influence of his wife, Omalu softened, now expressing the opinion that players should be made aware of the potential hazard.

Concussion

What it is: mild traumatic brain injury caused by a blow or jolt to the head that jostles the brain, regardless of a loss of consciousness

What it does: disrupts the brain’s functioning, creating neurochemical changes and microscopic structural injury

Symptoms: headache, dizziness, nausea and blurred vision, with confusion or trouble concentrating and emotional changes

Diagnosis: based on patient’s history; blood tests and imaging scans are not useful unless more extensive injury is suspected

Treatment: physical and mental rest is usually all that is needed, with most people recovering within a week or two; in cases of prolonged recovery, referral to a specialized clinic is recommended

CTE, or chronic traumatic encephalopathy

What it is: neurodegenerative brain disease that has been seen in football players and boxers with a history of repeated blows to the head, which may include concussions

What it does: depletes brain tissue and leads to accumulation of an abnormal protein called tau

Symptoms: early in the disease process, symptoms can be similar to those of concussion, but as the disease progresses, a decline in mental activity and ability to interact with others, depression, anger, memory loss and impaired judgment occur. Tremors can develop in severe cases

Diagnosis: after death, during autopsy of brain tissue

Treatment: symptoms such as depression or anxiety can be treated, but no cure exists for CTE

Sources: Upstate Concussion Center and Boston University CTE Center

Layout 1 finalThis article appears in the spring 2016 issue of Upstate Health magazine.

Posted in Alzheimer's/dementia, brain/neurology, death/dying, depression, entertainment, health care, illness, mental health/emotional health, pathology, physical therapy/rehabilitation, public health, research, safety

Popular baby names at Upstate

illustration [Converted]pinkMom 365, the company that photographs new arrivals for Upstate’s online nursery, reports these as the most popular baby names at Upstate University Hospital’s community campus .

Girls

Scarlett

Emma

Zoe

Willow

Penelope

Sophia

Mia

Madison

Abigail

Grace

Boys

Alexander

Daniel

Matthew

Oliver

Jeremiah

Liam

Anthony

Mason

Christopher

Joseph

This article appears in the spring 2016 issue of Upstate Health magazine.

 

 

 

 

Posted in community, maternity/obstetrics

How to train doctors who will care for the underserved

An analysis of the mission statements for every American medical school reveals a recipe for producing doctors who will provide primary care to communities in need.

Many students begin medical school idealistically, with a desire to become primary care doctors who care for patients from underserved populations. Some change their minds during medical school.

Chris Morley, PhD

Chris Morley, PhD

“We know from our own studies and those of others that idealism appears to trail off as medical students become more worried about debt, lifestyle and the prestige of their career path and specialty,” says Chris Morley, PhD, interim chair of public health and preventive medicine at Upstate, vice chair for research in family medicine, and lead author of the study about mission statements published last year in the journal Family Medicine.

For his research, Morley assembled a panel of about three dozen medical school leaders, administrators, professors, researchers and students who read and rated the public mission statement of each medical school in the U.S. Then the research team looked at the percent of graduates from each medical school who go on to specialize in primary care, in designated health professional shortage areas, or with medically underserved populations.  They found that schools that specify something about caring for the underserved in their reason for existence are the ones that produce the most doctors who go into primary care or practice in underserved communities.

Morley says medical schools are not producing enough primary care doctors to replace those who are retiring, because so many new doctors – for a variety of reasons – choose  specialties other than family or internal medicine, obstetrics and pediatrics.

What can be done?

“Medical schools as institutions can be introspective and think about their culture and the messages they give to students,” Morley says.

At Upstate, in addition to being the public teaching hospital for 17 counties, a number of programs are designed to attract students who will be devoted to providing primary care in underserved areas. One focuses on rural medicine, and another combines a master’s of public health with a medical degree. Upstate offers distance learning for practitioners who care for underserved populations, and the regional branch campus in Binghamton focuses mostly on primary care. Upstate also offers training for physician assistants and nurse practitioners, health professions that have a strong focus on primary care.

What is primary care?

Primary care is comprehensive first contact and continuing medical care, as provided by physicians such as pediatricians, obstetricians and family and internal medicine specialists. Nurse practitioners and physician assistants may also provide primary care.

This article appears in the spring 2016 issue of Upstate Health magazine.

Posted in community, education, health care, medical education, medical student, public health, research

Can you feel the compassion of your caregiver?

Hands23A hallmark of good nursing care is that hospitalized patients sense the innate compassion of their caregivers.

In this era of electronic medical records, it’s not as simple as tracking the amount of time a doctor spends with a patient, or the number of flu shots dispensed.

Compassion is not so specific, and it’s what nurses and other caregivers at Upstate University Hospital aspire to provide, along with other important measures. The business of saving lives accompanies an aim to:

  • treat patients and their loved ones with courtesy and respect,
  • listen carefully to patients and their loved ones,
  • explain things in a way that patients and loved ones can understand.
Chief Experience Officer Amy Szczesniak

Chief Experience Officer Amy Szczesniak

Every patient should feel this sort of compassion in every encounter, says nurse Amy Szczesniak, the hospital’s chief experience officer. She joined Upstate last fall to help ensure that in addition to top-quality care, patients feel that they receive respect and compassion.

One way that is measured is through a survey, which many patients receive after they are discharged. The survey asks whether their interactions with caregivers met expectations “always,” “usually,” “sometimes” or “never” during their hospitalization. Results of the survey help Szczesniak keep track of how well hospital staff communicate their compassion.

This article appears in the spring 2016 issue of Upstate Health magazine.

 

Posted in community, health care, nursing

Want to support Paige’s fund for kids with cancer but reluctant to run a race?

These New Boundaries coaches are working with people new to running who want to train for the 5k Paige's Butterfly Run on June 4. Training begins March 26.

These coaches are helping people who are new to running train for Paige’s Butterfly Run, which will be held on June 4. Training for the run begins March 26.

Paige Arnold. The run was founded in 1997 by teachers, friends, and family in her memory.

Paige Arnold. The run was founded in her memory in 1997.

Alan Pack remembers the spring day in 2010 when Chris Arnold visited his running group to talk about his daughter, Paige, and the children’s cancer fund that was created in her memory. Pack’s running group — the 10-week No Boundaries  program hosted by Fleet Feet — was training for the 5K Paige’s Butterfly Run in June. Arnold wanted the aspiring runners to understand the importance of the fundraising  event. The money raised stays local, and supports everything from holiday parties for hospitalized kids to research on pediatric cancer. Proceeds from Paige’s Butterfly Run go to the Waters Center for Children’s Cancer and Blood Disorders at Upstate’s Golisano Children’s Hospital and Cancer Center in Syracuse.

“My goals were personal,” explains Pack when he talks about why he started running. “But it’s not just about me. It’s a good feeling that the money you give helps someone.”

Now, six years later, Pack is coaching a group of new runners who are training for Paige’s Butterfly Run, which will be held on Saturday, June 4, at the National Grid and Hanley Federal buildings in downtown Syracuse.

Another coach, Dianna Joslyn, remembers when she trained with Pack two years ago. “I wasn’t an exerciser, and the thought of running a 5K was overwhelming,” Joslyn remembers. But the non-competitive training style — alternating between walking and slowly jogging — made it less daunting. “You don’t give up because the 30-second intervals make it easy to persevere,” explains Joslyn, who now runs half marathons.

Her advice to people who are thinking about running?

“No Boundaries is a safe place to get comfortable with running,” says Joslyn. “It’s for really scared people to feel better.”

The No Boundaries program starts March 26. Participants choose from two times and locations: Saturday mornings at Green Lakes State Park and Monday evenings at Onondaga Lake Park. There is a fee to register.

The coaches, pictured above. Front row: Debbie Deming, Jen Dougherty, Mallory Mitchell; second row: Nancy Walker, Marg Ventrone, Patti Tripp, Janice McNamara, Mandy Howard, Cathy Verginio, Harold Smith; third row: Steve Challis, Ellen Griffin, Bob Manfredi; standing: Cherise Wilkins, Brittany Ellis, Bob Savage, Bill Karl, Alan Pack; Dianna Joslyn, Seth Tucker.

Paige's Butterfly Run, 2014

Paige’s Butterfly Run, 2014. Photo courtesy of the Upstate Foundation.

Posted in cancer, entertainment, fitness, fundraising, research, Upstate Golisano Children's Hospital/pediatrics

Grateful patient and orthopedic surgeon ride Erie Canal, side by side

iStock_000054051978_Large copySeveral years ago, at age 68, Patricia Martin organized the Erie Canal Ride and challenged her doctor, orthopedic surgeon Richard Tallarico, MD, to ride the two-day, 68-mile ride alongside her.

They rode those miles and, over five years, raised more than $50,000 for Upstate University Hospital.

Martin was a health care provider who loved what she did, but a back injury left her nearly unable to walk. In constant pain, she slept in a recliner chair and was told that without surgery, she would need to use a wheelchair. Finding her orthopedic surgeon at Upstate was “a blessing,” Martin explains.

Richard Tallarico, MD, joins Patricia Martin, his former surgery patients, before the 68-mile ride begins.

Richard Tallarico, MD, joins Patricia Martin, his former surgery patient, before the 68-mile ride begins.

Today, she says, after many years of pain, she is pain free.

The experience affected Martin, a licensed practical nurse, so profoundly that she wrote a book about her journey and dedicated it to Tallarico, her surgeon and friend.

She says her back injury was so debilitating and impacted her life so dramatically, she never dreamed she would be able to ride a bike for a total of 374 miles. Grateful that she could return to her active life, she wanted to give back in a meaningful way, and the Ride was born. Many friends and family members have joined them, and the money raised supports pediatric and adult patient services through fund established at the Upstate Foundation.

Last September, Martin decided to get back out on the trail and complete a one-day, 34-miles ride. Again, Tallarico joined her, and they rode side by side.  The 2015 Erie Canal Ride raised $4,625 to support services for children with developmental disabilities at Upstate’s Center for Development, Behavior and Genetics, and for recreation therapy in the physical medicine and rehabilitation department, where Martin volunteers.

“Volunteering is rewarding, she says, “and sometimes I share my story with patients on the units, and I think it gives them hope.”

Are you grateful, too?

Do you have a personal understanding of how extraordinary care has impacted your health and quality of life or that of a loved one? Click here for details on how to tell your story to the Upstate Foundation.

This article appears in the spring 2016 issue of Upstate Health magazine.

 

Posted in bones/joints/orthopedics, community, fundraising, health care, illness, patient story, surgery

Restoring peace: Why salvaging the adrenal gland makes sense

iStock_000017841982_Large copy

BY AMBER SMITH

On top of each kidney sits an adrenal gland, which produces hormones a person cannot live without.

A variety of different tumors can develop in an adrenal gland. The tumor’s location, size and function influences how it should be treated. When a tumor needs to be removed, many doctors recommend taking out the entire adrenal gland.

Not so fast, says Gennady Bratslavsky, MD, who leads the department of urology at Upstate. Removal of the adrenal gland – called an adrenalectomy — is not always the best option. If one gland is removed, and then problems develop in the other, patients are subject to a lifelong reliance on hormone medications.

Gennady Bratslavsky, MD

Gennady Bratslavsky, MD

Bratslavsky says removing just a portion of the gland containing the tumor is a valid option for patients with a type of hereditary tumor called pheochromocytoma, since the likelihood of developing tumors in the other gland is high with this condition. In a partial adrenalectomy, the healthy portion of the gland is left behind to continue functioning.

A study he co-authored for the American Urological Association’s Urology Practice journal in November found that 80 percent of patients with hereditary pheochromocytoma developed tumors in both adrenal glands. That’s the same month that Upstate hosted an international conference on the condition.

Erica Searles of Pompey stumbled upon that conference. With a recent diagnosis of pheochromocytoma, and a surgeon in Rochester prepared to remove one of her adrenal glands, she was doing some online research. She’s glad she learned of Bratslavsky’s less invasive option.

Searles had struggled for a year with symptoms including severe headaches, heart palpitations, back pain, excessive sweating, anxiety, depression and a feeling of doom. She ended up hospitalized at the age of 44 with heart failure, triggered by the excess adrenalin in her system, before doctors discovered a tumor in an adrenal gland.

It was located in the center of the gland, presenting a surgical challenge because it was just behind the large vein carrying blood into the heart. Bratslavsky operated in a minimally invasive manner using robotic assistance, and Searles went home from the hospital within 48 hours. Imaging scans show a healthy-looking gland, with no hint of the tumor that used to exist within. Bratslavsky says Searles is able to live a normal life.

She says she feels fabulous. She sleeps through the night, and she hasn’t had a headache since her surgery in September. It has been life changing. “I just feel at peace,” she say, “and I have my life back.”

What’s so bad about a benign tumor?

Most tumors arising in an adrenal gland are not cancerous, but they still cause problems for the patient.

“Benign does not mean harmless,” says Bratslavsky.

“Being benign means that the tumor has not spread, yet. These tumors can still be very active hormonally, meaning that they will produce lots of substances that can very negatively affect somebody’s blood pressure, heart function, salt balance, sugar balance, weight, bone density and vision.”

Layout 1 finalhloa-art2This article appears in the spring 2016 issue of Upstate Health magazineHear an interview about partial adrenalectomy with Bratslavsky and Searles. 

Posted in health care, HealthLink on Air, illness, podcast, surgery, urology

Better air = better brains: Study shows cognitive function improves when indoor ventilation improves

cloud2Reducing carbon dioxide and other pollutants in the air can have a profound impact on decision-making, according to a research team from Upstate, Harvard and Syracuse universities.

The team’s study shows that people working in “green” offices, with good ventilation and below-average levels of carbon dioxide and indoor air pollution, had significantly better cognitive functioning than when working in conventional offices. They say their results can apply to indoor environments including schools and homes.

Usha Satish, PhD

Usha Satish, PhD

Over six full workdays, 24 volunteers were exposed to different indoor environmental quality conditions and then given cognitive assessments that tested nine key cognitive domains that are important for productive functioning in the real world. They were presented with real-world challenges and allowed to strategize and take initiatives in their own unique styles using the Strategic Management Simulation, says Usha Satish, PhD, a professor of psychiatry and behavioral sciences at Upstate who is an expert in this form of evaluation and one of the research team investigators.

She says the simulation tool is well established and valuable because “it gives participants the freedom to make decisions based on their own cognitive styles and is reflective of their performance in the real world.”

The cognitive scores of the volunteers were an average 61 percent higher on the days spent in the green buildings. Their scores doubled when they spent the day in an “enhanced green environment,” with improved ventilation and an optimized indoor environment.

Satish points out that the assessments did not measure intelligence levels, instead focusing on real decision making as it relates to productivity.

John Mandyck, chief sustainability officer for United Technologies, which supported the research, says “we know green buildings conserve natural resources, minimize environmental impacts and improve the indoor environment, but these results show they can also become important human resource tools for all indoor environments where cognitive abilities are critical to productivity, learning and safety.”

The study was published in October in the journal of Environmental Health Perspectives. It generated news coverage from newspapers and websites worldwide.

Layout 1 finalThis article appears in the spring 2016 issue of Upstate Health magazine.

Posted in brain/neurology, health care, mental health/emotional health, psychology/psychiatry, public health, research, sustainability/environment