A way to help you communicate your pain to your doctor

Doctors rely on patients to accurately describe their pain in order to create an effective pain management plan.

You can use a printout of the chart below to keep track of your pain, noting when it began, its intensity, what it feels like, its location and whether it expands. Also, take note of any medication’s effects on your pain. Some doctors ask patients to maintain a pain diary.
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cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.

 

Posted in aging/geriatrics, arthritis, autoimmune, bones/joints/orthopedics, cancer, health care, illness

How can you help patients at Upstate?

State Police Sgt. Jeff Cicora, who is battling stage 4 cancer, threw a party for patients at the Upstate Golisano Children's Hospital to take his mind off his health problems. Cicora was joined by about 20 fellow troopers and police dogs. (PHOTO BY KATHLEEN PAICE FROIO)

State Police Sgt. Jeff Cicora, who is battling stage 4 cancer, threw a party for patients at the Upstate Golisano Children’s Hospital to take his mind off his health problems. Cicora was joined by about 20 fellow troopers and police dogs. (PHOTO BY KATHLEEN PAICE FROIO)

Some of the best gifts for a person facing a medical crisis are simple, with a “thinking of you” message, and many Central New Yorkers with giving spirits make such donations to Upstate University Hospital.

If you would like to donate something to patients at the Upstate Cancer Center, contact Matt Capogreco at 315-464-3605 or capogrem@upstate.edu. To donate to patients at the Upstate Golisano Children’s Hospital, contact Margaret Nellis at 315-464-7547 or nellism@upstate.edu (all donation ideas must be approved).

Some examples of recent gifts that were well received:

* New teddy bears, donated to children at the Upstate Golisano Children’s Hospital by State Police Sgt. Jeff Cicora of Baldwinsville, who has a rare form of cancer.

* Adult coloring books, donated by Adam Thomson of Cazenovia. The books were collected for his bar mitzvah.

* Totes, bags and pillows from Thirty-One Gifts, donated by a variety of Central New York consultants.

* Comfort items that stock a cart made available to outpatients and inpatients. Brandon Spillett of Syracuse receives monetary donations through his organization Room 2 Smile, and the funds pay for playing cards, puzzle books, greeting cards and personal care items for the cart.

* Hats and caps, 400 of which were donated by students from Norwich Elementary School.

* Blankets, donated by Central New York Subaru dealers and The Leukemia & Lymphoma Society.

Are you grateful?

There are many ways to make donations to the Upstate Cancer Center and the Upstate Golisano Children’s Hospital. For details, contact the Upstate Foundation at 315-464-4416.

Posted in adolescents, cancer, community, health care, illness, Upstate Golisano Children's Hospital/pediatrics, volunteers

Breast cancer diagnosis? Next step: surgeon consult

The Upstate Cancer Center will soon provide the services of four breast surgeons, including Mary Ellen Greco, MD (left), and Kristine Keeney, MD (right). In the accompanying article, Keeney discusses the role of fellowship training specifically for breast cancer and disease. (PHOTO BY ROBERT MESCAVAGE)

The Upstate Cancer Center will soon provide the services of four breast surgeons. From left are Mary Ellen Greco, MD, and Kristine Keeney, MD. In the accompanying article, Keeney discusses the role of fellowship training specifically for breast cancer and disease. (PHOTO BY ROBERT MESCAVAGE)

If a woman has an abnormal finding on a mammogram, further tests will confirm or rule out cancer.

While the vast majority will turn out to be benign conditions, the first stop for a woman who has a diagnosis of breast cancer is usually a breast surgeon.

“Getting seen quickly is important, both to relieve the woman’s anxiety and to plan her next steps, as the treatment plan is highly personalized to each patient,” commented Scott Albert, MD.

Albert is a surgeon and a member of a multidisciplinary team of breast cancer experts. Together, the team creates the treatment approach for breast patients.

The team also offers the expertise of fellowship-trained breast surgeons.

A fellowship is additional, advanced training after medical school and residency.

The Society of Surgical Oncology, which oversees the fellowship program for breast surgeons, accepts a few dozen surgeons each year.

The yearlong training covers breast imaging, surgery, genetics, medical oncology, plastic and reconstructive surgery, radiation oncology and psychological oncology.

The goal of the training is to use the expertise to provide excellent care and contributions to the treatment team, as these areas all relate to the care of breast patients, says Kristine Keeney, MD.

Layout 1This article appears in the summer 2016 issue of Cancer Care magazine.

 

Posted in cancer, health care, health careers, illness, medical education, medical imaging/radiology, surgery, women's health/gynecology

Why a kidney biopsy may be unnecessary

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Experts are examining when it is appropriate for the kidneys, shown in red, to undergo a biopsy.

BY AMBER SMITH

For decades, kidney experts believed that biopsies of the organ were not helpful in determining how to treat a small kidney tumor. Today, more doctors believe a biopsy helps guide treatment.

It can – sometimes, says Gennady Bratslavsky, MD, chair of Upstate’s department of urology.

Gennady Bratslavsky, MD

Gennady Bratslavsky, MD

A biopsy may be appropriate for some patients with solid kidney tumors that have not spread beyond the organ. But he says the procedure, in which tissue is removed for laboratory analysis, should not be used routinely for everyone diagnosed with a renal mass.

Bratslavsky and co-authors from the Fox Chase Cancer Center in Philadelphia and the Mayo Clinic in Rochester, Minn., argue for selective use of kidney biopsy, writing in the journal European Urology that “most patients can avoid the unnecessary procedure and its associated risks.”

Their article says a biopsy probably would not make sense for a patient with a small mass in the kidney, who is frail or has other serious medical conditions, since results are not likely to influence the patient’s treatment.

The authors give three reasons people with small kidney tumors should not automatically undergo a biopsy:

  1. Growing evidence suggests that such patients can be safely monitored through active surveillance without the tumor spreading.
  1. Kidney biopsies do a poor job of predicting how likely a tumor is to grow and spread. While learning what kind of cells make up a tumor may provide comfort — or concern — for a patient, “our experience suggests that if a renal mass in a frail, elderly or infirm patient is best managed with active surveillance, knowledge of the pathology is often irrelevant and rarely helpful for initial management,” the authors write.
  1. Many patients with kidney tumors take prescription medication that helps reduce blood clots. That increases their risk of dangerous bleeding during a biopsy.

3 patients who may require a biopsy

  • patients whose tumors have grown while they are being monitored through active surveillance.
  • frail or elderly patients with large (greater than 3 centimeters) or rapidly growing tumors.
  • patients who are extremely anxious about the tumor.

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.

 

Posted in cancer, health care, illness, kidney/renal/nephrology, prevention/preventive medicine, research, urology

Surviving cancer, celebrating life

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Brain tumor survivor Brianna Belair, 12, watches sea urchins at the National Cancer Survivors Day event at the Rosamond Gifford Zoo with her parents, Ann and Brian Belair. (PHOTOS BY SUSAN KAHN)

Breast cancer survivor Health Kraus.

Breast cancer survivor Heather Kraus.

Thanks to early detection, treatment and follow-up care, more people than ever before are living with a history of cancer. They are survivors with a shared experience.

Camilla Bowman, a 16-year cancer survivor, gets her face painted at the celebration.

Camilla Bowman, a 16-year cancer survivor, gets her face painted at the celebration.

In addition to physical side effects that may linger, survivors often struggle emotionally to come to terms with what they’ve gone through – especially if life doesn’t get back to normal as quickly as they would like. The effects of cancer, after all, don’t end when treatment does.

Cancer survivor Virginia "Gigi" Castro and her son, Marc.

Cancer survivor Virginia “Gigi” Castro and her son, Marc.

Many survivors carry memories of difficult treatment regimens. Many say cancer taught them to cherish every day and each person in their lives. Many simply celebrate life.

Upstate, since 1996, has made a point to support cancer survivors through National Cancer Survivors Day, an annual celebration of life and the spirit of survivorship. This year’s event took place at the Rosamond Gifford Zoo at Burnet Park in Syracuse.

The Cancer Center’s Survivor Wellness Program (315-464-5294) provides long-term follow-up care to people who have received treatment for pediatric and adult malignancies.

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.

 

Posted in cancer, community, health care

Instead of a biopsy: Scientists seek better, noninvasive diagnostic tool to detect liver cancer early

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Positron emission tomography images of the same patient with advanced liver cancer. At left, the large lesions are visible using F18-fluorocholine radiotracer. At right, the same lesions are not visible using a common fluorine-containing sugar tracer. The proposed new tracer will allow detection of much smaller lesions typical for the early stages of liver cancer. Presently, such small lesions cannot be detected. (PHOTO CREDIT: “DETECTION OF HEPATOCELLULAR CARCINOMA WITH PET/CT” IN THE JOURNAL OF NUCLEAR MEDICINE, OCTOBER 2010)

BY AMBER SMITH

One of the reasons liver cancer is so deadly is that people rarely discover the disease at an early stage, when it’s treatable.

What might help would be a screening test, similar to the one that exists for lung cancer. People at high risk for liver cancer could undergo medical imaging, and the resulting images could give doctors a peek at the liver without need for biopsy. Unfortunately, ultrasound, computerized tomography and magnetic resonance imaging cannot detect most liver cancer lesions, which are generally less than an inch big.

Upstate radiologist Andrzej Krol, PhD, is working on such a project with Ivan Korendovych, PhD, a chemist from Syracuse University.

Andrzej Krol, PhD

Andrzej Krol, PhD

“An urgent need exists to develop new molecular imaging tools for diagnosis, response to therapy assessment and detection of recurrence of hepatocellular carcinoma,” the scientists write in a description of their work.

They want to use an imaging scan technique called PET, short for positron emission tomography. This is a sensitive quantitative molecular imaging method already in use for many types of cancer and other diseases. Most commonly, a fluorine-containing sugar (glucose) tracer molecule is injected into the patient, and a short time later the PET scan allows visualization of glucose metabolism in the patient’s body.

Cancer cells appear as bright spots on these PET images because they have higher metabolic rates, or burn more glucose, than do normal cells. But because the healthy liver cells metabolize lots of sugar, a PET scan using this tracer is not an effective test for liver cancer. The bright spots don’t discern cancer cells from normal cells.

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Ivan Korendovych, PhD,

The trick to being able to use PET for liver cancer will be to find a different tracer molecule, a task Krol says scientists have been working on for years.

He and Korendovych propose in their project to use a biological molecule that would be specific to liver cancer. The small fluorine-containing sugar molecule commonly used for PET would hitch a ride inside a larger molecule that already knows how to locate liver cancer cells, and it would remain attached to the liver cancer cell while a PET image is taken.

Krol says in the future, a PET scan for liver cancer could potentially provide an early warning system and replace the need for a biopsy to confirm liver cancer. Such an approach could possibly be used for other cancers, as well.

Layout 1This article appears in the summer 2016 issue of Cancer Care magazine.

Posted in cancer, health care, illness, liver/ gallbladder/ pancreas, medical imaging/radiology, pancreas/liver/gallbladder/bile ducts, research

Up-close look at a precision surgical tool

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Surgery on the lungs was done as an open operation as early as 1911. Starting in the 1950s, lung surgery became more commonplace because of the increase in lung cancer. Open surgery remains an option today, and the best option for some patients. But the percentage of procedures done in a minimally invasive style is increasing.

Robert Dunton, MD

Robert Dunton, MD

Some patients who need biopsies of lesions in a lung or lymph nodes undergo endobronchial ultrasound, a technique offered by pulmonary and thoracic surgeons, says Robert Dunton, MD, chief of cardiac and thoracic surgery at Upstate University Hospital. The convex probe (magnified in the photo) is slightly thicker than a standard ballpoint pen. It’s inserted through a bronchoscope positioned in the patient’s windpipe. A rectangular ultrasound scanner near the end of the probe acquires images to project on a screen in the operating room. Once the probe is at the proper location, a balloon on its tip is inflated with sterile water to keep it stable. A small needle or knife is deployed from an opening in the probe to retrieve a sample of tissue.

Posted in cancer, health care, history, lung/pulmonary, medical imaging/radiology, surgery, technology

‘In good hands’: Patient appreciates Cancer Center’s energized staff, warm, vibrant surroundings

Carol Pesko (right) with his husband, Tom Krahe, at the Upstate Cancer Center. (PHOTOS BY ROBERT MESCAVAGE)

Carol Pesko (right) with his husband, Tom Krahe, at the Upstate Cancer Center. (PHOTOS BY ROBERT MESCAVAGE)

BY AMBER SMITH

When Carl Pesko is at the Upstate Cancer Center for treatment, he receives chemotherapy for eight to 10 hours the first day, and then two to three hours the next. He has had plenty of opportunity to chat with staff and to observe various procedures taking place. He says he has been extremely impressed.

Pesko is a retired high school guidance counselor who worked for 35 years at Fayetteville-Manlius High School. He knows how emotionally taxing it must be to take care of individuals with cancer, many of whom appear to suffer far more than he does. Yet, among the nurses and doctors providing care, “everyone seems to be excited about what they’re doing. They see improvements in their patients, and they know there is a progressive forward movement in dealing with cancer.”

Pesko, 71, of Syracuse began treatment for a type of non-Hodgkin lymphoma called follicular lymphoma in November. He returned from a vacation with his husband, Tom Krahe, feeling overly tired, lacking energy and experiencing difficulty walking.

He expected his friend and primary care doctor, Paul Cohen, MD, would tell him something was wrong with his heart. What Pesko described sounded more like a form of cancer. Testing confirmed Cohen’s suspicions, and the doctor referred Pesko to Upstate oncologist Teresa Gentile, MD, PhD, for treatment.

He was scheduled for chemotherapy every five weeks. After the first two sessions, Pesko says 90 percent of his cancer disappeared. The treatments have not caused him pain or nausea, nor hair loss. His suppressed immune system, however, requires him to avoids crowds to protect himself against infections. He drinks lots of water, avoids caffeine and alcohol, gets extra sleep and carefully washes all fruits and vegetables to help strengthen his immune system.

In addition, every Monday he comes to the Upstate Cancer Center to undergo blood tests that give Gentile feedback on how well the medications are working. Pesko says he appreciates the design of the center, its warm, vibrant colors and the artistic elements, “which almost make you forget the seriousness of the disease you are facing.”

He also appreciates the people who take care of him, who make the experience as positive as possible. “I know I am in very, very good hands,” he says.

Kelly O'Shaughnessy draws Pesko's blood weekly while he is being treated for lymphoma.

Kelly O’Shaughnessy draws Pesko’s blood weekly while he is being treated for lymphoma.

About follicular lymphoma

Lymphomas begin in lymphocytes, white blood cells that are part of the body’s immune system. Because lymph tissue exists throughout the body, lymphomas can start almost anywhere. The most common sites are in the chest, neck or underarms.

Painless swelling in one or more lymph nodes is a common early sign. Others include fever, persistent fatigue, persistent cough and shortness of breath, drenching night sweats, weight loss, an enlarged spleen and itchiness.

A precise diagnosis is important since there are many subtypes of lymphomas, and they are treated differently. This means patients often require imaging tests, blood tests and biopsies.

Follicular lymphoma, the type of non-Hodgkin lymphoma with which Carl Pesko was diagnosed, grows slowly and usually responds well to treatment. Some patients receive chemotherapy with or without radiation. Some may require a stem cell transplant.

— Sources: Leukemia & Lymphoma Society, American Cancer Society

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.

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

She’s resilient: 11-year-old faces Ewing sarcoma

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Part of Maddie’s resilience may come from the way her family deals with her disease. “We don’t make life about the cancer,” her mother, Amy Shaw, explains. Her sister, Alexis (left), and Maddie are shown enjoying a respite with their mom and dad and Chesapeake Bay retriever, Mocha, in Auburn in late spring. (PROVIDED PHOTOS)

BY AMBER SMITH

Maddie Shaw is covered with a plush purple blanket. She grasps an iPad Mini, on which she quietly battles digital zombies, while the last of her chemotherapy flows into her arm.

It’s a Friday at the end of May, and the sixth-grader from Binghamton is completing her cancer treatment.

Nurse Tara Ingersoll has marked the occasion with colored streamers and fringed pom-poms hanging from curtains in the Upstate Cancer Center. Maddie’s parents, Amy and Kevin Shaw, brought cupcakes and a fruit bouquet. Maddie, age 11, is reserved, engrossed in her game.

A woman leaps into her room. She’s got jazz hands, zebra sunglasses and a fervor that captures Maddie’s attention. The girl’s eyes abandon the electronic screen; her face melts into a smile. It’s Jody Sima, MD, her pediatric oncologist.

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On Maddie’s last day of chemotherapy, her father, Kevin Shaw, spent almost five hours riding his bicycle to the Upstate Cancer Center form Binghamton, as part of his training for the Ironman race taking place in July in Lake Placid. He is part of a team of athletes who participate to support Maddie. They wear shirts that say, “It’s not when you finish but why.”

“I push her when she needs to be pushed and love her when she needed to be loved,” Sima explains. Today the doctor leans over Maddie’s shoulder. The two confer privately about the best strategies for defeating the horde of zombies.

Maddie’s diagnosis came in December 2013 after she felt a pain in her hip. Doctors discovered a tumor the size of a softball in her lung. It was Ewing sarcoma, a rare bone cancer. After months of chemotherapy, Maddie underwent surgery in Philadelphia on her left hip. She was in remission until August when the cancer returned.

She renewed her cancer battle, which this time included surgery on both lungs. A month later, fire broke out in the basement of her home, killing Maddie’s hamster and destroying nearly everything her family owned.

While their house is being rebuilt, Maddie, her parents and sister, Alexis, 16, live in a nearby rental home. Her mom and dad took turns driving her to Syracuse for chemotherapy every day for a week, every three weeks, while she was in treatment. This allowed her to attend school in the morning and sleep in her own bed each night.

Sima says Maddie is doing well. “She is a pretty amazing kiddo, and she bounces back quicker than any adult ever would” the doctor told the Binghamton Press & Sun-Bulletin.

Despite missing lots of school this year, Maddie made the high honor roll.

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.

Posted in adolescents, bones/joints/orthopedics, cancer, community, health care, illness, patient story, surgery, Upstate Golisano Children's Hospital/pediatrics

Quality or quantity? Serious illness prompts serious discussion

Ajeet Gajra, MD, in the second-floor lobby of the Upstate Cancer Center. (PHOTO BY ROBERT MESCAVAGE)

Ajeet Gajra, MD, in the second-floor lobby of the Upstate Cancer Center. (PHOTO BY ROBERT MESCAVAGE)

BY AMBER SMITH

Some doctors are reluctant to recommend palliative care, particularly for patients who are younger than 65 and dealing with a serious illness.

The shift from lifesaving treatment to comfort care may seem like admitting the futility of the situation.

That would mean admitting the futility of the situation, considering the patient’s quality of life and its length, and perhaps shifting efforts from life-saving to comfort care.

“It’s understandable” that doctors may wish to avoid such conversations, says Ajeet Gajra, MD, a medical oncologist at Upstate who researches the utilization of palliative care. “The doctor may know there are no other meaningful treatment options but is afraid to say that to the patient and the family.

“It’s a difficult discussion for the doctor, patient and family, so it’s often avoided. Patients may feel that the doctor is ‘giving up’ on them. It is important to have an open discussion about the patient’s hopes and wishes in the context of a limited prognosis. It is important for patients to realize that such a recommendation is being made because further treatment will cause more harm than good and that the doctor cannot put the patient knowingly in harm’s way.”

The discussion may be that much more difficult when it centers on a young patient. Regardless of the patient’s age, Gajra says, education and information regarding palliative care should be offered early in the course  of an incurable cancer. That way the patient and loved ones do not feel blindsided in the course of their fight if it’s clear that medical treatments will not help further. The patient or their loved ones can bring up a discussion regarding palliative care if the doctor does not.

In a paper published in the Journal of Geriatric Oncology this year, Gajra and four colleagues from Upstate studied the medical records of veterans with advanced cancer near the end of life. They compared those older than 65 with those from 40 to 65 years of age and discovered the older veterans were referred to palliative care an average of 12 days sooner than the younger. Younger veteran’ average time in hospice care was 13 days longer.

Gajra says other studies show that patients may have a better quality of life if they are in hospice care at their homes, rather than hospitalized in an intensive care unit, or seeking emergency care for each medical setback.

Studies also show that while timely palliative care enhances a patient’s quality of life, it can actually extend his or her length of life.

Choosing quality

Palliative care focuses on providing relief from symptoms of serious illness, rather than trying for a cure or recovery. Similarly, hospice care is meant to keep patients comfortable and pain-free during advanced illness. Both are designed to improve the quality of life for the patient and his or her loved ones.

Upstate options

Palliative care is an option for adults and children who are treated at Upstate University Hospital. Referrals are also routinely made to Hospice of Central New York. An outpatient palliative care program for adult patients with advanced cancer will start this fall.

cancercaresummerHLOA-4C-VERT-REVThis article appears in the summer 2016 issue of Cancer Care magazine. Hear an interview with Judy Setla, MD, medical director of Hospice of CNY, about hospice and palliative care. 

Posted in cancer, community, death/dying, grief/loss, health care, HealthLink on Air, illness, research