Upstate doctor helps his native Nepal to heal, rebuild after disastrous earthquake

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A young girl who received treatment for a broken leg at Civil Service Hospital, where most of the orthopedic supplies were donated in the aftermath of the Nepal earthquake. (PHOTO COURTESY OF DINESH SUBEDI, MD)

After dispensing medical care and supplies in the aftermath of the April 25 earthquake in his native Nepal, Upstate hospitalist Dinesh Subedi, MD, is focusing on rebuilding.

A family assesses the damage to their home in Sindhupalchowk, a district hit hard by the Nepal earthquake.(PHOTO COURTESY OF DINESH SUBEDI, MD)

A family assesses the damage to their home in Sindhupalchowk, a district hit hard by the Nepal earthquake.(PHOTO COURTESY OF DINESH SUBEDI, MD)

The disaster killed more than 9,000 people and left nearly 3 million homeless.

Subedi traveled with locally donated supplies and joined Nepali doctors from the United States to treat 25 or 30 people in each of several villages. They mostly hiked amid flattened buildings and landslides to get to patients requiring care.

Subedi shared these photographs of his experiences.

The first house to be rebuilt by the nonprofit campaign Mission Rebuild Nepal, in the village of SipaPokhare. (PHOTO COURTESY OF MISSION REBUILD NEPAL)

The first house to be rebuilt by the nonprofit campaign Mission Rebuild Nepal, in the village of SipaPokhare. (PHOTO COURTESY OF MISSION REBUILD NEPAL)

His group supports the nonprofit campaign called Mission Rebuild Nepal,  which intends to rebuild 800 houses. Already, 75 like the one at left are near completion. He and his colleagues concluded that “people’s health will only be better once they have a good place to live. So until we can fix that, we can’t make them healthy,” said Subedi, an assistant professor of medicine.summercover

This article appears in the summer 2015 issue of Upstate Health magazine.

 Hear Subedi’s radio interview about his efforts after the Nepal earthquake on “HealthLink on Air.”

Subedi helps survivors in Majhigaun, a village in northwestern Nepal. The Upstate doctor said he hopes to return to Nepal to help with the rebuilding effort. (PHOTO COURTESY OF DINESH SUBEDI, MD)

Subedi helps survivors in Majhigaun, a village in northwestern Nepal. The Upstate doctor said he hopes to return to Nepal to help with the rebuilding effort. (PHOTO COURTESY OF DINESH SUBEDI, MD)

 

 

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Soothe your sunburn with ketchup and aspirin, dermatologist advises

Obviously it’s best to avoid getting a sunburn in the first place, said Ramsay Farah, MD. But if your skin ends up reddened after a day in the sun, here’s what Upstate’s division chief of dermatology advises:

Ketchup: It's not just for hamburgers.

Ketchup: It’s not just for hamburgers.

  1. Gauge the severity of the burn. If you have blisters, he said to make a trip to your health care provider, “just to make sure it’s examined and that no possibility of scarring arises.”
  1. Take an aspirin. Its anti-inflammatory effects can help during the initial stage of a sunburn, if you take it promptly.
  1. Apply cool compresses on the affected area.
  1. Use a low-strength (1 percent) hydrocortisone cream, available over-the-counter, to help decrease inflammation but not affect wound healing. “You want to be careful not to put very strong steroids on the burn,” he said.
  1. Head to your kitchen for a bottle of ketchup. Yes, you read that right. Farah explained that, “Ketchup has a lot of lycopenes and other anti-inflammatory factors, and it’s cold because it comes from the refrigerator. So if you put that on right away, along with your aspirin, you will decrease the inflammatory response.”

None of these measures will reverse the damage, but they should help the burn heal better and feel better.

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Romance, murder, drugs make potent mix in nurse practitioner’s fast-paced mystery novels

When Tony Cerminaro started writing his mystery series, the nurse practitioner planned to draw on his medical background in the hematology/oncology department at Upstate University Hospital. He crafted the fictional doctor Hank Milson as a main character in his first book, “The Ten Knife Murders.” Hank returns for a new mystery in Cerminaro’s latest novel, “Bonding Over Bullets.”

Tony Cerminaro, NP, with two of the murder mysteries he has written.

Tony Cerminaro, NP, with two of the murder mysteries he has written.

This second book continues Cerminaro’s “Andersson and Stefani” series, in which each novel presents fictional investigators Nicklaus Andersson and Roxanne Stefani with a stand-alone mystery. Similar to “Law and Order,” Cerminaro said, the investigators’ plotlines develop across books in the series. In “Bonding Over Bullets,” for example, the romantic relationship between Roxanne and Hank develops in the context of a murder case involving a dangerous aphrodisiac drug.

“It’s got a very intense plot,” Cerminaro said. “It’s kind of like reading a movie.”

Although Cerminaro lives in Liverpool, he set his series in North Carolina so that Hank can take advantage of research opportunities at the prominent universities there. But Central New York references still crop up, he said. Hank attended Syracuse University, for example, and played lacrosse for the Orange. “I reference all the great seasons they’ve had,” Cerminaro said of the lacrosse team.

“Bonding Over Bullets” was released in October 2014 and is currently available online. He recommends it for an adult audience. The third book in the series, “The Manuscript Murders,” recently became available online as well.summercover

You can listen to an interview with Cerminaro about how he writes his books that aired on WRVO Public Media in June.

This article appears in the summer 2015 issue of Upstate Health magazine.

 

 

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Meet the doctors who help stroke patients get their lives back

Brain injury medicine specialist Bernadette Dunn, MD, discusses a patient's progress with nurse manager Virginia Castro.

Brain injury medicine specialist Bernadette Dunn, MD, discusses a patient’s progress with nurse manager Virginia Castro.

Someone suffering symptoms of a stroke is surrounded by caregivers in the emergency department.

Doctors assess the person’s consciousness, eye movement, reflexes, memory, and ability to speak. Nurses start intravenous lines for medications, fluids and blood samples. Radiologists examine the blood vessels in the person’s brain through imaging scans.

The focus is on lifesaving — determining whether the person has had a stroke and limiting its damage. This effort involves almost all of the caregivers. All but one.

Brain injury medicine specialist Bernadette Dunn, MD, sees many of her patients in the neurological intensive care unit at Upstate University Hospital, a key feature of what is Central New York's first and only comprehensive stroke center. The neurological ICU offers three levels of care for stroke patients, staffed by nurses with specialized training and credentials.

Brain injury medicine specialist Bernadette Dunn, MD, sees many of her patients in the neurological intensive care unit at Upstate University Hospital, a key feature of what is Central New York’s first and only comprehensive stroke center. The neurological ICU offers three levels of care for stroke patients, staffed by nurses with specialized training and credentials.

Bernadette Dunn, MD, is certified in brain injury medicine, a relatively new subspecialty recognized by the American Board of Medical Specialties. From the moment a stroke patient is stabilized, it’s her job to zero in on that person’s recovery.

The patient is transferred to a specialized neurological care unit on the ninth floor of Upstate University Hospital, and that’s where he or she first meets with Dunn or one of her colleagues.

Once test results show the spot in the brain that is affected by the bleed or the clot, then Dunn can provide a good idea of the stroke patient’s prognosis. She can project what types of therapy the patient will need and for how long. As she monitors their recovery, she can predict any lasting problems.

“There are a plethora of changes that you can see following brain injury,” said Claudine Ward, MD, who also specializes in brain injury medicine at Upstate. “These we hope go away but a lot of times are persistent.” She noted that patients may have neurobehavioral changes, mood disorders or agitation, or they may experience changes with their endocrine systems.

Claudine Ward, MD

Claudine Ward, MD

Having a doctor who recognizes issues and knows the best treatments to recommend can positively influence a patient’s outcome after a brain injury, Ward said.

Spotting the clues to recovery

Dunn sees patients in their own hospital rooms at Upstate. Her visits concentrate on actions that may seem minor but have huge significance. One patient, three days after a stroke, can pinch her fingers together but has trouble uttering more than one word. Another, nearly a month after a stroke, locks eyes with Dunn but struggles to lift her arm or speak.

Each movement, or lack thereof, is a clue to the location and severity of the patient’s stroke and his or her recovery potential. Dunn uses the information to help predict how soon patients may need to begin intensive rehabilitation, what sorts of physical therapy they need now, and every other aspect of their care. Brain injury medicine specialists lead a multidisciplinary team that may include surgeons, psychologists, nurses and a variety of therapists. They care for patients with a variety of brain injuries, not just strokes.

HOW TO HELP A LOVED ONE WHO SUFFERS A STROKE

“Everybody’s brain is different, and everyone has a different reaction to that injury, depending upon the area of the brain that is injured,” Dunn explained.

For a stroke patient, the injury is a clot or bleed in the brain. “We can see two people who have a similar injury, one who has significant deficits in terms of thinking processes and ability to function in daily life, and the other who had what would be considered a larger injury and fewer deficits. It really just depends on the area of the brain that is impacted.”

Nearly a dozen caregivers meet to discuss individual patients' care and progress. This meeting is led by Shernaz Hurlong, DO, and attended by additional physicians, nurses, brain injury specialists, physical therapists, occupational therapists, speech language pathologists and a rehabilitative psychologist.

Nearly a dozen caregivers meet to discuss individual patients’ care and progress. This meeting is led by Shernaz Hurlong, DO, and attended by additional physicians, nurses, brain injury specialists, physical therapists, occupational therapists, speech language pathologists and a rehabilitative psychologist.

Two patients, two types of strokes

One woman who had a stroke on a Sunday was not able to move her left arm the next day. But by Tuesday, she lifted it up and down. And when Dunn asked her to pinch her fingers together, she did. Often after a stroke, patients may retain movements that occur closest to the center of their bodies, such as flexing a knee or elbow. Movements that occur further from the core, involving the fingers or toes, may prove more difficult.

The woman’s husband of 55 years was at the side of her bed, and one of her grandsons stood at the foot. The woman tried to explain to Dunn how she had walked earlier with a therapist’s help.

Dunn moved to the end of the bed. “Can you bend this foot up yet?” The woman did, and then arched her toe. “Oh I liked that, too,” Dunn said. The woman had acquired a lot of motor skills in just three days, and Dunn wanted to build on her success. She would arrange to get her into intensive rehabilitative therapy as soon as possible. “We want to take you to rehab,” Dunn told the woman.

The second patient she checked was a woman who had a hemorrhagic stroke a month before. The woman’s recovery was slow going, as expected, given the location and severity of her stroke. The woman smiled. Warm, sparkly eyes followed Dunn, engaged more than was usual. Dunn tapped her knee, checking her reflexes. The doctor raised the woman’s leg, asking her to hold it up. She couldn’t. The leg dropped.

Still, Dunn thought it may be time to transfer her to a long-term rehabilitation facility. “She’s actually very alert and bright, and that’s good.” The woman would need a shunt to help drain the fluid from her brain, a common complication after a bleeding injury in the brain, so Dunn considered whether to recommend surgery before or after the move. She also had to make sure the woman had the ability to swallow because nutrition was crucial during rehabilitation.

A patient's ability to move and feel sensation in the toes and fingers can help predict his or her recovery from stroke; that is one of the things brain injury medicine specialist Bernadette Dunn, MD, checks as she makes rounds.

A patient’s ability to move and feel sensation in the toes and fingers can help predict his or her recovery from stroke; that is one of the things brain injury medicine specialist Bernadette Dunn, MD, checks as she makes rounds.

Importance of specialized rehabilitation

Another important issue during rehabilitation is bowel and bladder management, an area of rehabilitative nursing specialization. Dunn said many of the therapists and nurses work with patients in various stages of recovery from stroke, both in the neurological intensive care unit as well as the rehabilitation unit.

Some stroke patients with mild deficits may go home after they are discharged from the neurological care unit. They may attend outpatient rehabilitation for physical, occupational and/or speech therapy. They may also make appointments with a rehabilitative psychologist for help adjusting.

Some stroke patients are recommended for inpatient rehabilitation. Upstate University Hospital has 50 beds dedicated to rehabilitation; 30 at its downtown campus and 20 at its community campus.

LEARN ABOUT THE BRAIN INJURY MEDICINE SUBSPECIALTY

In selecting which stroke patients should remain hospitalized during rehabilitation, Dunn said she considers their medical complexities, the severity of their stroke and whether they can tolerate and benefit from six therapy sessions per day. It varies, but a typical course of inpatient rehabilitation is two weeks.

During the last part of their hospital stay, someone recovering from a stroke is surrounded by a set of caregivers, different than those who cared for him or her in the emergency department.

The nurses, therapists, dietitians and doctors who concentrate on recovery are focused on helping patients get on with their lives. #

Brain injury medicine specialist Bernadette Dunn, MD, discusses a case with neurosurgery resident Khalid Khalid, MBBS. Dunn is also an associate professor of physical medicine and rehabilitation who trains residents and medical and other students.

Brain injury medicine specialist Bernadette Dunn, MD, discusses a case with neurosurgery resident Khalid Khalid, MBBS. Dunn is also an associate professor of physical medicine and rehabilitation who trains residents and medical and other students.

You can listen to an interview with Dunn and Ward about the subspecialty of brain injury medicine, which aired on WRVO Public Media in April.  In addition, Dunn provided information about how to help a loved one who has suffered a stroke.

Posted in community, health care, hospital, neurology, neurosurgery, nursing, stroke | Leave a comment

When to be concerned about bladder cancer

A. shows the normal bladder appearance. Among radiographic bladder wall abnormalities are B. diffuse bladder wall thickening, C. focal bladder wall thickening and D. bladder mass.

A. shows the normal bladder appearance. Among radiographic bladder wall abnormalities are B. diffuse bladder wall thickening, C. focal bladder wall thickening and D. bladder mass.

A medical scan of your abdomen or pelvis may reveal more than what your doctor was looking for. Some specific features of your bladder could indicate cancer, even if you have no pain, bleeding or other symptoms. A follow-up is warranted, say a pair of Upstate urologists who published their work in the journal Urology this year.

Timothy Byler, MD, and Imad Nsouli, MD, created a database of 2,400 patients  who underwent cystoscopy, a procedure that examines the inside of the bladder.  From their data, they discovered:

* A mass in the bladder has a 50-percent chance of being cancerous.

* A bladder wall that was uniformly thicker than usual had a 20-percent chance of being cancerous.

* A bladder with a localized area of thickness on the inside wall is not likely to be cancerous.

The urologists admitted they were surprised that nearly 15 percent of the patients included in their database were found to have bladder cancer. Half had a more aggressive, deadlier type of cancer. Undergoing cystoscopy to explore the abnormalities that turned up by incidentally could have saved these patients’ lives.

The lesson from Upstate is: Carefully read imaging reports, and seek answers for any abnormalities.

 

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Family supports one another through weight loss surgery

David Hoistion, 46, weighs 185 pounds, down from 345 pounds before his surgery in April 2012. His wife, Tanya Hoistion (second from left) had surgery in October 2012, dropping to 140 pounds from 265 pounds. His two daughters had surgery on the same day in October 2014. Nicole Hoistion, 25, (left) has dropped to 210 pounds from 325, and Cherica, 20, (right) has dropped to 170 pounds from 272 pounds.

David Hoistion, 46, weighs 185 pounds, down from 345 pounds before his surgery in April 2012. His wife, Tanya Hoistion (second from left) had surgery in October 2012, dropping to 140 pounds from 265 pounds. His two daughters had surgery on the same day in October 2014. Nicole Hoistion, 25, (left) has dropped to 210 pounds from 325, and Cherica, 20, (right) has dropped to 170 pounds from 272 pounds.

The most successful weight loss surgery patients surround themselves with people who have had the surgery, are following the new way of eating and can support the post-operative lifestyle.

Sometimes these veteran patients are found within hospital support groups. Sometimes they are found in the same neighborhood. And in this case, the same family.

Weight loss surgery has been 100 percent life changing for David Hoistion, 46, the patriarch of a family in Calcium, outside of Watertown. He and eight of his relatives have had weight loss surgery, including his two daughters, his wife, his mother-, father- and sister-in-law, an aunt and uncle – plus the pastor and several friends from his church.

Tanya and David Hoistion before surgery.

Tanya and David Hoistion before surgery.

“They may go in and tie your stomach, but for the patient, this surgery is more mental,” Hoistion said, describing how he cried when he smelled chicken he wasn’t able to eat soon after his operation. His weight loss helped to correct his sleep apnea and high blood pressure and relieved the pressure on his knees.

Nurse Casey Hammerle, the program coordinator for bariatric surgery at Upstate University Hospital, said people often embark on weight loss surgery with a friend or family member. They arrive together at an informational session and go on to schedule their operations for the same day or several weeks apart so they can help one another recover.

“When you have that built in support, you’re able to keep each other kind of on track and accountable,” Hammerle said.

Losing weight and keeping it off can require a significant lifestyle change, and for many people, support is the key to success. The best weight loss surgery programs provide ongoing support – as Upstate’s does. Many patients also find support from friends or relatives.

Cherica Hoision, 20, who lives in Rome, had surgery on the same day as her older sister. As she shed her excess pounds, she is no longer lactose intolerant, and she feels more confident. Today her family eats smaller portions, healthier foods and water instead of soda. She said, “We’ve all kind of gotten used to eating the gastric way.”

Listen to an interview with Upstate’s division chief of bariatric surgery,

Howard Simon, MD

Sisters Cherica and Nicole Hoistion before bariatric surgery.

Sisters Cherica and Nicole Hoistion before bariatric surgery.

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Protecting preemies and patients on ventilators

Critically ill patients who require ventilators are at risk for developing acute respiratory distress syndrome, a condition with a mortality rate higher than that of breast cancer in the United States. Four out of 10 of those patients who develop acute respiratory distress syndrome will not survive. Those who do may cope with lung problems forever.

Scientists from Upstate are leading efforts to prevent the syndrome from developing. Their research could prompt a change in the way patients all over the world are treated while they are on breathing machines, or ventilators.

Most patients who develop an acute lung injury do so within 48 hours of being connected to a ventilator and this can progress to acute respiratory distress syndrome. The current treatment is to reduce the volume of air delivered to the patient, which improves his or her survival rate by less than 10 percent.

An Upstate laboratory run by Gary Nieman, in collaboration with Nader Habashi, MD, from the R. Adams Cowley Shock Trauma Center in Baltimore, proposes a new strategy to prevent the development of acute respiratory distress syndrome. It is a type of ventilation, called airway pressure release ventilation, which lengthens the patient’s inspiration phase to open collapsed lung and shortens the patient’s exhalation phase to keeps the air sacs from collapsing. The trick is, caregivers must know what to look for so they can intervene ahead of the syndrome’s development.

“Timing of an intervention may be as critical as the intervention itself,” Nieman wrote with colleagues in the Journal of Trauma and Acute Care Surgery.

Research from his lab has shown that early intervention with airway pressure release ventilation blocks the development of acute respiratory distress syndrome and prevents swelling and inflammation in the lungs.

Now Nieman and Habashi– with assistance from Research Scientist Josh Satalin, and surgery residents Michaela Kollisch-Singule, MD, and Sumeet Jain, MD – are exploring whether this same strategy can save the lives of premature babies.

Human gestation lasts 40 weeks. Babies born before 37 weeks are likely to have organs that are not fully developed. The lungs are of particular concern because the body does not produce the surfactant they need in order to keep the lungs inflated until about week 28. The chance of survival is low for babies born before then.

The theory is that airway pressure release ventilation used on babies born as early as 25 weeks gestation could provide their bodies enough time to start producing the surfactant that will keep their lungs open and functioning for the rest of their lives.

Nieman can’t help the enthusiasm he feels for the research. “We are currently in the position to change how medicine is practiced within the next few years.”

Already, Nieman learned in July that Albany Medical Center has implemented the use of airway pressure release ventilation for all of its premature babies who weigh fewer than 1,000 grams.

“This is what basic science animal research is all about, and as you can imagine, our team is very excited about the potential benefit that these experiments will bring to the clinic.”

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Here’s the summer Upstate Health magazine

summercoverSummer for many Central New Yorkers means getting outdoors, whether at amusement parks, on lakes or beaches, or in back yards. The summer issue of Upstate Health magazine features two nurses who kayak every chance they get. We also look at why roller coasters attract a younger crowd and which remedies are best for sunburns. (Try to guess which kitchen staple our dermatology chief recommends — and then turn to page 12.)

Readers will meet a nurse practitioner who spends his leisure time writing novels and a physician who is devoted to helping Nepal rebuild after the earthquake. They will also learn why so many people embark on weight loss surgery together with a friend or family member. And, readers will get a close look at the rehabilitative team that helps patients put their lives back together after strokes and other brain injuries.

Upstate experts explain when to worry about bladder cancer, why health care proxies are necessary and which exercises are best for bone health. We also spotlight in this issue a couple of new surgical techniques that give options to patients facing prostate surgery or salivary gland surgery, as well as important research that is changing the way ventilators are used for critically ill patients and premature babies.

Enjoy Upstate Health, brought to you by Upstate Medical University​.

Posted in bioethics, cardiac, community, ENT, fitness, neurology, neurosurgery, nursing, nutrition, patient stories, research, stroke, surgery | Leave a comment

A defensive move: Removing the ovaries before cancer develops

Rinki Agarwal, MD, performs a laparoscopic oophorectomy (ovary removal) and salpingectomy (Fallopian tube removal) on the author. (PHOTO BY SUSAN KAHN)

Rinki Agarwal, MD, performs a laparoscopic oophorectomy (ovary removal) and salpingectomy (Fallopian tube removal) on the author. (PHOTO BY SUSAN KAHN)

BY SUSAN KEETER

The day my mother spiked a fever, we had no idea it was a symptom of ovarian cancer and that we would lose her just seven weeks later. Looking back, the only other possible symptom had been several months of unexplained bouts of nausea.

During the sad time of adjusting to the death of my mother, I began to worry about my own health. Five years before, my mammogram caught early stage breast cancer, and treatment left me virtually 100 percent cured. Was there a similar test for ovarian cancer that I didn’t know about?

When I asked my oncologist, he said, “I think you’re a good candidate for ovary removal, and if you choose to have the surgery, make sure they remove your Fallopian tubes as well. That cancer can show up in the tubes, as well.”

He referred me to Rinki Agarwal, MD, the Upstate gynecological oncologist who had been part of my mother’s cancer care team. She explained that the current tests for ovarian cancer are no better than a coin toss. “There are ultrasounds and blood tests for ovarian cancer, but they have only 60 percent accuracy,” she told me. “This cancer tends to develop on the surface of the ovaries, and we can’t see it.”

Each year in New York state, about 1,500 women — including 40 in Onondaga County — are diagnosed with ovarian cancer. About two-thirds die from the disease, according to statistics from the New York State Department of Health. Those at highest risk for the disease can reduce their chances of developing it by having their ovaries and Fallopian tubes surgically removed.

My family history made me a candidate for the surgery. Breast cancer affected both my maternal and paternal aunts, one of whom was diagnosed young and died of the disease. My maternal great-grandmother had ovarian cancer, like my mother. And, I had an early-stage breast cancer known as DCIS, ductal carcinoma in situ.

Our next step was to weigh the benefits of surgery against the possible health costs.

Agarwal explained that removing the ovaries means losing the estrogen and progesterone they produce, which increases the risk of osteoporosis, heart disease and dementia for women under age 60.

That was sobering.

However, since the ovaries gradually decrease hormone production and secretion, within about five years of menopause, these risks are no longer increased by ovary removal.

At the age of 56, my risk of ovarian cancer is in front of me, counseled Agarwal, with any benefit from ovary-produced hormones likely behind.

She scheduled a couple of tests, and almost 10 months after my mother’s death, Agarwal operated laparoscopically, through three tiny incisions in my abdomen. Some patients have lengthy recovery and significant pain, but I was fortunate. I had the surgery in the morning at Upstate; that evening, I watched my daughter’s dance rehearsal.

Who gets ovarian cancer?

Women in their 50s are at the greatest risk for ovarian cancer, but the overall risk falls on women between the ages of 30 and 60. The ovaries are the two almond-shaped organs on each side of the uterus.

Ovarian cancer symptoms

— Bloating

— Pelvic or abdominal pain

— Trouble eating or feeling full quickly

— Feeling the need to urinate urgently or often

Layout 1 Fatigue, pain during sex, upset stomach or heartburn, constipation, back pain and menstrual changes can also be symptoms

They may be vague, but if these symptoms exist daily for two to three weeks, a woman should seek gynecological care. Women of all ages are at risk, especially those with a family history of breast, colon or ovarian cancer. Early detection dramatically increases survival rates.

This article appears in the summer 2015 issue of Cancer Care magazine.

Posted in cancer, community, genetics, patient stories, surgery, women's health | Leave a comment

What you need to know about second opinions

Layout 1

A variety of doctors at Upstate care for patients who are diagnosed with cancer.

We tapped some of them to share insights on second opinions.

Here’s what they had to say:

1. You don’t need my permission to get a second opinion. And, don’t worry that you are betraying me or hurting my feelings by asking for one. “I don’t know one physician who would take this personally,” said Srinivas Vourganti, MD, a urologist at Upstate Medical University who advised firing any doctor who did not support a patient who did so.

Srinivas Vourganti, MD

Srinivas Vourganti, MD

2. I can probably suggest two or three doctors you might want to see for a second opinion, and my office staff might even be able to help schedule that appointment.

3. One of my partners can render a helpful second opinion. Just because we work together does not mean we think alike.

4. It may make sense to seek an opinion from a doctor who is not in the same specialty. An orthopedic surgeon may say you need surgery, for instance, while a rheumatologist may recommend physical therapy.

5. Second opinions should be automatic in situations where a doctor proposes an experimental procedure or a treatment that is unproven.

6. Check with your health insurer about coverage, because I have seen policies that won’t pay for second opinions at out-of-state facilities. Also, be prepared for the costs involved in traveling out of the area, since those are usually not reimbursed.

7. If what you really want is a different perspective, see a doctor from a different region of the country, where medical practice styles are likely to differ. Some institutions facilitate electronic second opinions so that patients don’t have to travel.

Robert Dunton, MD

Robert Dunton, MD

8. As your doctor, part of my job is to help you digest the information you find through your own research and decide whether a second opinion makes sense. “People come armed with a lot of information — not all of it good or pertinent,” said Robert Dunton, MD, chief of cardio-thoracic surgery at Upstate University Hospital. “I will tell you if I think you’re making a bad decision, but,” Dunton said, “if a patient picks an inferior choice knowing their options, that’s their prerogative.”

9. We’re in this together. If your gut is telling you to see what another doctor thinks, you are not going to feel right until you do.

10. You may not think you need a second opinion, but I may want you to get one. Perhaps you need surgery and there are different ways to do the operation. Another surgeon’s input could help determine the best approach for your case.

11. Even though they are not in your possession, every note and every slide that pertain to your care belong to you. If you want biopsy tissue to be reviewed, for instance, you can grant permission for it to be released. Just realize that gathering all of your records, particularly if you have seen multiple physicians, is likely to require a lot of your time.

Ajeet Gajra, MD

Ajeet Gajra, MD

12. If you face cancer, enlisting an oncologist may be more important than only obtaining a second opinion. An oncologist can help you manage your disease and your decisions. You’d be surprised how many people who receive a cancer diagnosis go straight to surgery or another treatment without considering the impact. “They get a procedure view, but they don’t get a life view. It’s not cancer management,” said Ajeet Gajra, MD, a medical oncologist at the Upstate Cancer Center.

13. There are instances where you may want a third opinion or tiebreaker. Consider the diagnosis of pectus excavatum, the abnormal development of the rib cage in which the breastbone caves inward. One doctor may recommend no intervention. Another may favor an elaborate insertion of metal bars into the chest. Additional input may help you make a decision.

14. If your second opinion differs considerably from the first, “it’s time to have an honest discussion with your provider,” said Gajra. “People need to understand there can be more than one valid approach.”

15. I would not want to lose you as a patient, but if you prefer the second doctor, I would tell you to get care where you feel most comfortable.

16. You may not need a second opinion. Many patients at the Upstate Cancer Center, particularly those with complex cancers, have their cases presented at a weekly multidisciplinary conference. This is where a variety of cancer and medical specialists discuss your situation and reach a consensus on your best options — so you essentially receive multiple professional opinions. This style of multidisciplinary care is becoming the gold standard.

17. If I’m the doctor providing a second opinion, I’ll do my best to give an unbiased opinion, regardless of whether I agree with the first doctor. If he or she has made mistakes, I’ll find a professional way to let you know.

18. I really do care what’s best for you. I’ll tell you if your condition warrants treatment elsewhere. Some rare conditions are best treated by highly specialized physicians.

Layout 119. I do not want to dampen your hopes, but I will be straight with you. You are probably hoping that another doctor will be able to tell you that you don’t have cancer, or that it is not so advanced, or that he or she has a miracle cure. That almost never happens.

20. Most of the time after a patient gets a second opinion, there is no change in his or her treatment plan. However, they feel as if they are better educated — and that’s a good thing.

This article appears in the summer 2015 issue of Cancer Care magazine.

Posted in cancer, community, health care, hospital, surgery | Leave a comment