New option for breast cancer treatment combines surgery with radiation

From left, breast surgeons Mary Ellen Greco, MD, Lisa Lai, MD, and Kristine Keeney, MD, and radiation oncologist Anna Shapiro, MD, in the operating room with the new intraoperative radiation therapy unit. (photos by Susan Kahn)

From left, breast surgeons Mary Ellen Greco, MD, Lisa Lai, MD, and Kristine Keeney, MD, and radiation oncologist Anna Shapiro, MD, in the operating room with the new intraoperative radiation therapy unit. (photos by Susan Kahn)

Surgeons and radiation oncologists at Upstate are teaming up to provide intraoperative radiation therapy to women with early-stage breast cancer. This allows for an intensive dose of radiation to be applied during surgery in the space where the tumor is removed.

The aim is to kill any microscopic disease that remains after a tumor is removed, explains Anna Shapiro, MD, associate professor of radiation oncology. Instead of waiting for the patient to heal from surgery and then completing a three- to six-week course of radiation, this intraoperative option allows the radiation oncologist to precisely deliver radiation to the tumor bed at the end of the operation.

Surgeon Lisa Lai, MD, says, “We’re able to complete both the surgery and the radiation in one day, so patients get back to their normal lives much quicker.”

Women whose breast cancer has not spread may be candidates for this new procedure. Lai and Shapiro explain that every patient’s situation is reviewed by a team of specialists who make recommendations for her best treatment.

Shapiro gives targeted radiation during surgery, eliminating the need for post-surgery radiation treatments for some cases of breast cancer.

Shapiro gives targeted radiation during surgery, eliminating the need for post-surgery radiation treatments for some cases of breast cancer.

Cancer Care magazine summer 2018 coverThis article appears in the summer 2018 issue of Cancer Care  magazine. Hear a podcast/radio interview where Lisa Lai, MD, and Anna Shapiro, MD, discuss this breast cancer treatment.

 

Posted in cancer, health care, medical imaging/radiology, surgery, technology, women's health/gynecology

Will immunotherapy work for your cancer?

BY AMBER SMITH

Our immune system fights off colds. Why not cancer?

Stephen Graziano, MD. (photo by Robert Mescavage)

Stephen Graziano, MD. (photo by Robert Mescavage)

“Cancers develop mechanisms to get around the immune system,” explains Stephen Graziano, MD, chief of hematology/oncology at Upstate. “They express a protein on their surface which basically paralyzes the T-cells, which are the part of the immune system that’s active in the immune response.”

Immunotherapy drugs such as Keytruda and Opdivo are designed to be antibodies to that protein, “so they basically release the tumor from the immune cells, allowing them to do their job.”

It’s a concept that is more than a century old. In the last 30 or 40 years, scientists have been able to harness the body’s immune system to fight cancer, “and we’re starting to see advances that translate to patients,” Graziano says.

“It’s almost dizzying as an oncologist to keep up with the advances.”

Various immunotherapy medications are already in use for cancers of the lung, stomach, bladder, head and neck, and also for Hodgkin’s disease. In addition, Graziano says Upstate has clinical research underway that uses immunotherapy to treat patients with three stages of lung cancer, melanoma, sarcoma, cancers of the kidney, colon and head and neck.

Patients are selected for those research studies, known as clinical trials, after cells from their tumors are tested, so doctors know the likelihood the drug will work. Patients with serious autoimmune disease are not candidates for immunotherapy, since the medications could stimulate their autoimmune disease.

Also, as with any treatment, immunotherapy has potential side effects. Patients may develop fatigue, rash, diarrhea, cough or other symptoms. In those instances, immunotherapy is halted while patients receive steroid treatment.

“The nice thing about these immune therapies is they don’t have the side effects we usually associate with chemotherapy. They don’t have the nausea and vomiting, the fatigue, the hair loss, the low blood counts. Most patients feel well after they receive their treatment.”

Graziano says that in his experience, about a third of patients receiving immune therapy see a remarkable prolonged remission, about a third experience a stabilization of their disease for a period of time, and a third may see no response.

“We do have patients with advanced cancer who were on these drugs in early clinical trials for two years. And now, some patients have eight years of follow-up and are still in remission,” he says. “I think immunotherapy has great potential.”

Cancer Care magazine summer 2018 coverThis article appears in the summer 2018 issue of Cancer Care  magazine.

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

Harnessing his immune system to fight cancer

Eugene Young talks with his oncologist, Abi Siva, MD, about encouraging results of immunotherapy medication. (photo by Richard Whelsky)

Eugene Young talks with his oncologist, Abi Siva, MD, about encouraging results of immunotherapy medication. (photo by Richard Whelsky)

BY AMBER SMITH

The tumors near Eugene Young’s liver turned up by chance.

At the age of 67, he was dealing with symptoms of acid reflux. Thinking he may have a problem with his gallbladder, Young’s doctor sent him for an ultrasound.

“That’s the first I knew I had a problem,” Young says of the imaging test he underwent in February. It showed tumors in his liver, spleen, adrenal glands and bones. Weeks later, he had a biopsy — and a cancer diagnosis. What he needed was a cancer doctor.

He chose Abi Siva, MD, a medical oncologist at Upstate who thought Young would be a good candidate for immunotherapy, a medication that works with the body’s immune system to fight cancer cells.

“She did some genetic testing,” Young recalls, “and found that I had the genes necessary for a good reaction to Opdivo.” That’s a new medication also known as nivolumab.

Young’s treatment included intravenous infusions of the drug every couple of weeks. After four doses, he developed some unusual side effects. His vision became blurry, he lost some hearing, and he developed some dizziness. Steroid treatments have helped improve his vision and hearing, he says.

Before he started taking the medication, he had an imaging test called a positron-emission tomography scan that reveals metabolic processes. After four doses, he underwent another PET scan.

“I was hoping that maybe it would show some slight decrease,” Young says. “It was like a miracle. It showed that there were no active cancer cells. We don’t know what that means: Are they dead? Are they gone? Am I cured?”

Siva was impressed with the effect of the medication.

“The scans are negative. That’s a great sign. There is no active cancer, but there could still be dormant cells.”

The oncologist says Young’s follow-up will include periodic scans, and she’s optimistic about his health.

“We know that when people have a complete response like he has, they may keep this response going for years.”

Young was able to go ahead with his wedding early this summer. He is resuming his law practice and has returned to his role as a councilman for the town of Clay.

Cancer Care magazine summer 2018 coverThis article appears in the summer 2018 issue of Cancer Care magazine.

 

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

Cancer Center expansion makes way for more patients, infusion rooms

The lobby of the newly opened fourth floor in the Upstate Cancer Center. (photos by Richard Whelsky)

The lobby of the newly opened fourth floor in the Upstate Cancer Center. (photos by Richard Whelsky)

When the Upstate Cancer Center opened its doors in July 2014, only the first three floors of the five-story building were completed and occupied. The fourth and fifth floors, each about 20,000 square feet, were constructed but left empty, anticipating future Upstate needs.

Three years later, those needs became obvious as more and more adult cancer patients have been seeking treatment at Upstate, said Dick Kilburg, associate administrator of the Cancer Center. After about a year of designing, planning and construction, the new fourth floor opened in early June. It comprises patient exam rooms, upping the number from 14 to 35.

Another view of the fourth-floor lobby.

Moving exam rooms from the second to the fourth floor allows for additional infusion rooms to be added to the second floor, increasing that number from 27 to 44.

The fifth floor is scheduled to open this fall and will house Upstate’s Clinical Pathology Lab. “Patients may never see the lab, but getting lab results to physicians quickly, so that they may initiate appropriate therapy sooner, is key to quality patient care and patient satisfaction,” said Sophia Lustrinelli, department manager of clinical pathology.

Kilburg said the fourth floor was constructed with the same patient-focused design qualities as the rest of the cancer center.

Huge, floor-to-ceiling photo murals of lush garden landscapes adorn the pillars in the reception/waiting area, and wherever you look there is art — from a huge hanging sculpture near the front to vibrant abstracts lining the hallways.

“We’ve had a lot of comments from patients and family members who said they feel like they are going to a museum rather than going for care,” Kilburg said.

“We’re trying to take their mind off why they’re here.”

Cancer Care magazine summer 2018 coverThis article appears in the summer 2018 issue of Cancer Care magazine.

 

Posted in cancer, health care | Tagged ,

Science Is Art: Close-up of a cancer cell

(Image courtesy of Anushree Gulvady and the lab of Christopher Turner, PhD)

(Image courtesy of Anushree Gulvady and the lab of Christopher Turner, PhD)

Turner

Turner

Gulvady

Gulvady

Cell and developmental biologists including Anushree Gulvady are studying how cancer invades and metastasizes at the cellular level. Gulvady is a doctoral student working in the laboratory of Upstate’s Christopher Turner, PhD. She works with Hic-5, a molecular scaffold that coordinates multiple interactions among proteins. Plasma membrane protrusions called invadopodia are seen reaching out from the red- yellow puncta. Gulvady’s project explores the mechanisms by which the invadopodia fuse together to form rosettes, the circular areas of red and yellow. The rosettes secrete an enzyme that helps degrade the extracellular matrix, which allows the cancer to spread. Understanding this process may help scientists develop ways to intervene.

Posted in cancer, health care, research | Tagged

Putting heads together: Brain researchers collaborate to understand and battle dementia, addiction, schizophrenia and more

Wei-dong Yao, PhD (photo by Debbie Rexine)

Wei-dong Yao, PhD (photo by Debbie Rexine)

BY AMBER SMITH

What do drug addiction, neurodevelopmental disorders and dementia have in common?

All three disorders have origins in the brain, with causes and potential treatment methods that tend to overlap.

Above and below, nerve cells (from the lab of Wei-dong Yao, PhD)

Above and below, nerve cells (from the lab of Wei-dong Yao, PhD)

For instance, they are all caused, at least in part, by a damaged prefrontal cortex, the brain structure that controls our cognition, emotion and memory, and altered neural connections and communications between this and other regions of the brain.

Neuroscientists at Upstate, led by professor Wei-dong Yao, PhD, study the brain and have a variety of collaborative research projects that deal with addiction, psychiatric diseases and dementia.

Nerve cells (from the lab of Wei-dong Yao, PhD)What they learn about dopamine — a neurotransmitter linked to reward and addiction, and synaptic plasticity — helps in the understanding of schizophrenia and other neuropsychiatric diseases.

And, learning about the synaptic loss that leads to frontotemporal dementia may actually reveal new ways of treating this devastating  early-onset neurodegenerative disease.

Yao is a professor of psychiatry and behavioral sciences, and neuroscience and physiology who came to Upstate in 2014 after 10 years on the faculty at Harvard Medical School.

Addiction

For more than a decade, Yao has been working on how cocaine impairs the brain by hijacking the dopamine reward circuits. These are the brain’s cortical and limbic structures where dopamine is made and detected that are associated with our ability to feel pleasure.

“Some people are more vulnerable or susceptible to drugs,” he says, explaining that certain mutations on certain genes influence a person’s vulnerability. But that only tells part of the story. Yao’s neuroscience research lab at Upstate is working to tell more.

Using a powerful microscope that allows them to view the junctions between neurons, called synapses, and sophisticated electrophysical recording equipment,

Yao’s research team explores how neurons communicate in addicted brains — and whether that affects how susceptible a person will be to addiction.

Ultimately, he would like to come up with a way to treat addiction by repairing the synapses and neural circuits in the brains of cocaine addicts.

Neurodevelopmental disorders

Abnormal levels of dopamine have been linked to schizophrenia and other psychiatric disorders.

The spines or synapses (circled in white) indicate sites where communication between neurons take place. (from the lab of Wei-dong Yao)

The spines or synapses (circled in white) indicate sites where communication between neurons take place. (from the lab of Wei-dong Yao)

In Yao’s lab, researchers have provided evidence on how excessive dopamine impairs synaptic plasticity in the prefrontal cortex, which represents a significant step forward in our understanding and potential treatment of schizophrenia and attention deficit hyperactivity disorder, or ADHD. They have also studied the medication clozapine to learn how it may improve cognitive deficits associated with schizophrenia.

In collaboration with colleagues at Mount Sinai School of Medicine, Yao is also studying a group of genetic switches on our DNA, known as epigenetic modifiers, that control synapse and brain development and are linked to schizophrenia, autism and depression.

Dementia

Yao is looking for a way to help people with a type of dementia that affects the frontal and temporal lobes of the brain.

Synapses change over time. This ability is called plasticity. They can become stronger or weaker or disappear, which impacts neural communication, cognitive function and behavior.

Neuroscientists have learned that symptoms of cognitive impairment and dementia arise with synaptic loss. Keeping neurons active and maintaining existing synaptic connections can help alleviate symptoms, Yao says, adding that exercise, including mental exercise such as meditation, can help preserve brain plasticity and prevent the loss of synapses. Exactly how that is achieved is currently unknown.

Yao’s team is working on strengthening and stabilizing synapses by tweaking some proteins within the neurons. Eventually, Yao believes, scientists will find a more physiological way to keep neurons healthy and synapses stable. He also hopes to find a way to delay or prevent the death of neurons, through controlling the brain’s natural electric activity, a project he’s working on with a colleague at the University of Massachusetts Medical School.

Neuroscience terms to know

Neurons are nerve cells that, once born, can live for many years and often for a person’s lifetime. Debate exists over whether the brain has the ability to continue making neurons after a person is born. Some neuroscientists believe neurogenesis takes place into adulthood in the hippocampus, a region of the temporal lobe near the center of the brain, but research published this spring in the journal Nature questions that. Neurons are not like other cells in the body, which are constantly being replaced as they die.

A molecular signaling pathway is a coordinated series of biochemical reactions within a cell that control specific cellular functions, such as cell division or cell death.

Synapses are the “wiring” of the brain, the junctions between neurons where communication takes place. Each neuron starts out with many thousands of synapses. As a person learns, he or she builds more synapses. So yes, there is science behind games that are promoted for brain health.

Plasticity refers to the brain’s ability to change, physically but also functionally and chemically throughout a person’s life. If the synapses weaken as a person ages, communication among the neurons diminishes.

Dopamine is a neurotransmitter that facilitates communication among neurons. It is also known as the pleasure molecule of our brain.

Frontotemporal dementia is the second most common form of dementia after Alzheimer’s disease and results from the progressive degeneration of the frontal and temporal lobes of the brain.

Chemical compounds used to regulate the activity of genes are called epigenetic modifiers. In some instances, modifications remain as cells divide and can be inherited through the generations. Scientists are studying what effect the modifications have on gene function, protein production and human health, according to the Genetics Home Reference from the National Institutes of Health.

Upstate Health magazine summer 2018 issueThis article appears in the summer 2018 issue of Upstate Health  magazine.

 

 

Posted in addiction, aging/geriatrics, Alzheimer's/dementia, brain/neurology, health care, psychology/psychiatry, research | Tagged , , , , , , , , , , , , , ,

Yoga for all: Physical therapist adapts exercise for those with developmental disabilities

The downloadable booklet on yoga for people with a range of developmental disabilities.

The downloadable booklet on yoga for people with a range of developmental disabilities.

From its origins in India more than 3,000 years ago, yoga in America today has a reputation for improving flexibility, balance and muscle strength.

Rebecca Alexander, who graduated from Upstate with her doctor of physical therapy degree this spring, extols the versatility of yoga, which can be done sitting in a chair or wheelchair. She hopes to work with patients who have neurological impairments. “Yoga can provide significant benefit,” she promises.

“Yoga is about intention and the breath. It doesn’t matter if you can’t get your arms all the way over your head. The intention doesn’t get lost.”

Alexander has been involved with “Unified Yoga,” a program that grew out of a mainstream yoga program at the Southwest Community Center in Syracuse.

Mainstream yoga, adapted for people with a range of developmental disabilities, such as autism, Down syndrome and cerebral palsy, was an effort by Upstate pediatrician Nienke Dosa, MD, for people between the ages of 16 and 40.

Yoga classes were held outdoors in good weather, with students unfurling colorful yoga mats on the grass at Thornden Park and Burnet Park, and then following Alexander through a series of poses.

Alexander teamed up with Joy Papazides-Hanlon, a teacher at the community center, to create a 28-page booklet for the Inclusive Fitness Initiative, a three-year pilot program paid for by the New York State Developmental Disabilities Planning Council.

Download the booklet, for free, at www.inclusiverec.org under the “resources” and “useful articles” tabs.

Upstate Health magazine summer 2018 issueThis article appears in the summer 2018 issue of Upstate Healthmagazine.

Posted in community, disability, fitness, health care, physical therapy/rehabilitation | Tagged , , ,

How do you choose between a medical and a musical career? Find a way to do both

Kaitlyn DeHority (photo by Durst Breneiser/courtesy of Ithaca College)

Kaitlyn DeHority (photo by Durst Breneiser/courtesy of Ithaca College)

BY JIM McKEEVER

Future Upstate medical student Kaitlyn DeHority started classes at Ithaca College as a music major. She decided to add chemistry in her second semester. Four years later, she graduated with a dual degree in music and chemistry.

“I sat down and planned every semester of courses, so I could do both, and I checked in with my advisers and associate deans each semester to make sure I was on track,” DeHority recalls. “I put a ton of effort into it.”

Accomplished in both fields — she was an Ithaca College Presidential Scholar and the principal trumpet player in the college’s Chamber and Symphony orchestras — DeHority had to make a decision which to pursue after graduation. How did she decide?

“A lot of people have a ‘light bulb’ moment. Not me,” she says. “It was a series of little things along the way.”

Her passion for music became obvious in elementary school. DeHority performed throughout middle school and high school in the Fayetteville-Manlius school district, earning honors at county, state and national levels. Her involvement continued throughout her time at Ithaca College.

In high school, she attended a 10-day National Youth Leadership forum on medicine in Boston. Then in college, she spent a summer doing electrochemistry research. And she shadowed Upstate experts in anesthesiology, oncology and pathology. All of those experiences made a lasting impression.

When she arrived at Upstate in 2016, DeHority was used to rehearsing 15 hours a week, practicing another hour or two each day and performing regularly. She missed it. So, she joined the Syracuse University Brass Ensemble, where she performs almost weekly, along with Upstate’s James Greenwald, MD, a professor of family medicine who also plays trombone.

“I’m busier,” she says of the music in her life, “but more balanced.”

DeHority’s two passions complement each other. Dedication, preparation and practice are required, whether it’s with a patient or for a performance.

“Medicine is moving toward a team-based approach,” she describes. “It’s impossible for one person to know everything, so you rely on your colleagues. It’s the same with an ensemble. You bring your highest level, but you rely on your colleagues.”

Study music and medicine

An initiative called the Upstate Guaranteed Entrance Program for Select Majors aims to enroll about 10 high-caliber students each year to medical school who come from a diverse range of undergraduate programs.

Students will be accepted into Upstate’s College of Medicine directly from high school, with the understanding that they will complete a bachelor’s degree at SUNY Purchase College or another of SUNY campus before starting medical school.

They are able to pick from a range of pre-med degrees, including a bachelor of fine arts, bachelor of arts, bachelor of music or bachelor of science. Students will have to maintain a 3.5 grade point average in college and would not have to take the Medical College Admission Test.

Interested high schoolers must apply to the SUNY campus and interview at Upstate for consideration. To qualify they must have an average of at least 90, extracurricular activities having to do with health care, and an SAT score of at least 1360 or an ACT score of at least 29.

Upstate Health magazine summer 2018 issueThis article appears in the summer 2018 issue of Upstate Health magazine.

Posted in education, health care, health careers, medical education, medical student | Tagged

Interventional radiologist loves solving problems

Close-up of Mitchell Karmel, MD, performing a nephrostomy tube check, a procedure to evaluate whether a kidney remains obstructed and to evaluate the position of the tube. (photo by Susan Kahn)

Close-up of Mitchell Karmel, MD, performing a nephrostomy tube check, a procedure to evaluate whether a kidney remains obstructed and to evaluate the position of the tube. (photo by Susan Kahn)

BY AMBER SMITH

In a typical day, Mitchell Karmel, MD, may take a biopsy of a liver tumor in one patient, install a port, so another patient can receive chemotherapy, and drain an abscess from deep within the abdomen of another.

He may treat a woman’s uterine fibroids using particle embolization, an alternative to hysterectomy, and then treat a liver tumor with radiation particles before caring for a baby who needs long-term intravenous access.

Karmel is an interventional radiologist (see explanatory note at the end of this story).

He chose the specialty, he says, “because I liked that it was very goal-directed and problem-solving.” Many patients arrive in the interventional radiology department because other doctors need assistance in making a diagnosis or because they need intravenous access installed in the form of a port or a PICC line. That’s medical parlance for peripherally inserted central catheter, a way to provide long-term venous access, for patients who require repeated intravenous medications or blood draws.

Karmel reviews a CT scan of a chest to evaluate whether fluid around the lung needs to be drained. (photo by Richard Whelsky)

Karmel reviews a CT scan of a chest to evaluate whether fluid around the lung needs to be drained. (photo by Richard Whelsky)

After medical school, Karmel completed a yearlong internship and four years of residency training at Cornell University Cooperating Hospitals, plus an additional year of fellowship training at Harvard Medical School. Today, as an associate professor of radiology at Upstate, he is director of vascular and interventional radiology.

He and his colleagues staff Upstate University Hospital around the clock.

They provide minimally invasive, image-guided diagnosis and treatment of a broad range of diseases and conditions, for a broad range of patients. Most of the procedures they offer are alternatives to open surgeries, with generally less risk, quicker recovery time and lower cost than open surgeries.

Interventional radiologists are sometimes summoned for emergencies. It was an interventional radiologist who stopped the bleeding and stabilized U.S. Rep. Steve Scalise, R-La., so that a surgeon could repair the damage the congressman suffered in June 2017 when he was shot in the hip during practice for a charity baseball game near Washington, D.C.

Venous access

One of the most common procedures interventional radiologists perform is the insertion of a PICC line when other services have failed, or in pediatric patients.

On a recent weekday, Karmel walks into a hospital room to talk with a mother who cradles her baby girl. The 10-month-old was not growing properly. He explains how he would install a line in the big vein of her neck that would help with her therapy.

A short time later, the interventional radiology team assembles in an operating room, the baby looking like a small doll on a vast operating-room table. She wears a tiny blood pressure cuff, and a tiny mask covers her nose and mouth. Nurses roll a baby blanket, position it beneath her neck and turn her head to the left.

Karmel places a nephrostomy tube in a patient with blocked drainage of the kidney while a fourth-year medical student observes. (photo by Susan Kahn)

Karmel places a nephrostomy tube in a patient with blocked drainage of the kidney while a fourth-year medical student observes. (photo by Susan Kahn)

It would be Karmel’s job to insert a central catheter into the baby’s jugular vein, a big vessel on either side of the neck that carries blood from the head and face to the lungs. Not all interventional radiologists are comfortable inserting a PICC line on a child, especially one this little.

The secret, Karmel discloses, is to use ultrasound guidance to find and puncture the vein, a technique interventional radiologists are comfortable with. Using his left hand, Karmel presses a probe along the baby’s neck. Images of her vessels appear on a television screen on the opposite side of the table.

Karmel’s right hand wields a tiny needle, destined for the jugular. Not only are baby vessels small, they are rubbery and difficult to puncture. After Karmel makes his insertion, it’s time for an X-ray.

“Has everyone got lead on?” he asks the room. Nurses, technicians and the anesthesiologist check to make sure they’re wearing protective gear. A machine shaped in a giant C is rolled near the bed and arcs around the patient. The X-ray it produces confirms that Karmel has placed the line correctly.

His most challenging case in 35 years was a 26-week-old premature infant who needed long-term vascular access — just like this 10-month-old, but even smaller.

Performing image-guided biopsy

Biopsies are another typical procedure done by interventional radiology. That’s where ultrasound, computerized tomography or fluoroscopy provide image guidance while the physician places small needles into areas of abnormality. Tissue samples or cells can be removed for analysis, often to help diagnose cancer or rule it out.

His white hair now keeps most patients from asking Karmel, “So, how many of these biopsies have you done?” But one patient asked him recently.

Karmel had to stop and think. He has done so many that he has lost count: more than 4,000, probably closer to 5,000.

What is an interventional radiologist?

Interventional radiologists diagnose and treat a variety of benign and cancerous conditions of the thorax, abdomen, pelvis and extremities. In caring for patients, they use imaging to guide minimally invasive techniques that help open blood vessels, stop bleeding, obtain tissue for biopsy, and other varied procedures.

Upstate Health magazine summer 2018 issueBoard-certified interventional radiologists at Upstate University Hospital see patients at both the downtown and Community campuses and can be reached at 315-464-5189. This article appears in the summer 2018 issue of Upstate Health magazine.

 

Posted in health care, medical imaging/radiology, technology | Tagged , , , , , ,

Clot-busting medicine saved her from stroke: Retired physician assistant knew something wasn’t right

Speech-language pathologist Carrie Garcia, left, works with stroke survivor Eileen Rosecrants. (photo by Susan Kahn)

Speech-language pathologist Carrie Garcia, left, works with stroke survivor Eileen Rosecrants. (photo by Susan Kahn)

BY JIM HOWE

Eileen Rosecrants became alarmed during a phone call.

“I couldn’t speak clearly,” she recalls of that evening last fall. It wasn’t that her speech was slurred. She couldn’t figure out what to say, so she abruptly hung up, thinking, “I’m not right.”

Someone else then phoned her, and Rosecrants couldn’t handle that call, either, so she hung up again. Then, the 73-year-old Baldwinsville resident phoned her sister in Syracuse, thinking she would understand something was wrong and call for help.

Her sister figured out there was a problem and alerted 911.

Rosecrants didn’t call 911 herself because she worried that her inability to speak would delay help — but now she knows it’s best to call 911 directly.

Rosecrants, a few months after her stroke. (photo by Susan Kahn)

Rosecrants, a few months after her stroke. (photo by Susan Kahn)

She was able to let the ambulance crew into her home, but when she tried to tell them where to take her, “I couldn’t say the whole thing, just ‘Up … Ups …,’” she recalled.

They understood that she meant Upstate University Hospital. She was relieved on arrival to see not only her sister but a team of stroke specialists awaiting her.

She was familiar with Upstate’s comprehensive stroke treatment program, after spending nearly 10 years as a physician assistant in geriatrics at Upstate before retiring in 2013.

She got the clot-dissolving drug, tissue plasminogen activator (tPA) quickly, once the stroke team determined that bleeding was not a problem. Five or six hours later, in the neurological intensive care unit, Rosecrants began to feel better.

A day and a half later, she could repeat words and follow simple directions, such as lifting her arm. She was able to go home. “I was so much better. I had the words back. I could make sentences. I could be socially appropriate. But there was, and is, a deficit,” she said.

She had weekly outpatient therapy to help restore speech and executive function — that is, the way people take in, think about and act on information.

Carrie Garcia, a speech-language pathologist at Upstate, helped her to regain skills including finding the right words, organizing her thoughts and following a set of directions.

“People can relearn these things and gain them back,” Garcia says, “not always to the exact same level as before the stroke, but sometimes a modified or adapted level.”

Meanwhile, Rosecrants has been living independently in her home, exercising at the YMCA three times a week, driving a car and shopping. She is grateful for Garcia’s help, especially for her suggestion to use a white board each month to write down all her activities and plans, which Rosecrants says greatly helps to organize her thoughts.

“For somebody who made my living putting pieces together, it’s hard,” she said, referring to her years of treating patients.

Antonio Culebras, MD

Antonio Culebras, MD

Upstate neurologist Antonio Culebras, MD, who treated Rosecrants after the stroke, said, “She did the right thing by coming to the hospital as soon as she knew it was the beginning of a stroke.

“The key is to give tPA as soon as possible. Every minute, literally, counts,” he said.

The drug has saved many people from ending up in a nursing home, he said.

Upstate experts also have other methods for removing clots and restoring blood flow. Culebras says the techniques allow for recovery that was unimaginable 50 years ago.

Although each case is unique, the neurologist noted that recovery can take a year or more.

As for what to do when someone is suspected of having a stroke, Rosecrants knows to tell people: “Call 911 as fast as you know there is something wrong.”

Call 911 — even if you cannot speak

If someone cannot speak because of a stroke or other problem, he or she should still call 911.

The 911 operator will try to keep the caller on the line and figure out what is going on, to rule out mistaken or crank calls. If a medical emergency is suspected, he or she will dispatch an ambulance, according to the Onondaga County Emergency Communications Department/911 Center.

The 911 operator can usually figure out the caller’s location.

If you think you are having a stroke, don’t drive yourself (which is dangerous) and don’t have someone drive you (which wastes time), advises Upstate neurologist Antonio Culebras, MD. Call 911 for an ambulance. The crew will be able to begin your care, monitor you and communicate with doctors at Upstate University Hospital, so the specialists from the stroke team are ready for your arrival.

Upstate Health magazine summer 2018 issueThis article appears in the summer 2018 issue of Upstate Health magazine.

 

Posted in brain/neurology, emergency medicine/trauma, health care, patient story, physical therapy/rehabilitation, stroke | Tagged , , , ,