How to stifle a sneeze

This is most effective when you first feel that tickle of a sneeze starting to form.

Find the center space below your nose and just above where the pigment of your upper lip stops. Take your index finger and press that spot. You can strike a contemplative pose.

“Press for a moment, and that will short-circuit the sneeze,” says Upstate neurologist Anuradha Duleep, MD.

You’ll be blocking a branch of the trigeminal nerve, which will literally reroute the neurologic signal that is sent when your body is preparing to sneeze.

This article appears in the spring 2017 issue of Upstate Health magazine.

 

Posted in brain/neurology | Tagged , , , ,

How much exercise do kids need?

 

Upstate’s weekly radio show/podcast, “HealthLink on Air,” spoke recently with pediatrician Travis Hobart, MD, about exercise for kids. He says government guidelines prescribe an hour a day of moderate to vigorous activity for most kids from age 6 into the teens.

The types to include:

* Aerobic

Examples: walking, running, bike riding

As they reach school age, youngsters may become involved in activities (gymnastics, soccer, karate) that raise their heart rate and are structured for kids at various developmental stages.

* Muscle strengthening

Examples: climbing, playing on playground equipment

Weightlifting is OK starting around age 12 or 13 for those who want to build muscle with low weight and high repetition.

* Bone strengthening

Examples: hopscotch, running, jumping, basketball

Travis Hobart, MD

Exercises that involve impact with the ground help strengthen bones. By our teens or early 20s, our bones reach peak bone density.

Parents, keep in mind, school-age kids in New York get some physical education during school – 120 minutes per week for elementary schoolchildren, and 90 minutes per week for grades seven to 12.

Depending on the school, kids may or may not get any unstructured play, since some schools have done away with recess. Hobart says “for young kids, part of their developmental process is learning how to play with other kids, learning what rules mean and making their own rules, not necessarily rules imposed on them by adults.”

In other words, kids also need time to be kids – and that can count toward their daily exercise.

This article appears in the spring 2017 issue of Upstate Health magazine. Hear the radio interview/podcast in which Hobart explains how much exercise children need.

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

How best to protect your bones

 

Appropriate weight-bearing and muscle-strengthening exercises help improve bone density.

BY JIM HOWE

Our bodies are always breaking down old bone and rebuilding new. Changes in this process can cause problems in later adulthood, but an Upstate expert says there are ways to help keep bones healthy.

Karen Kemmis

“Bone is constantly remodeling. We get new bone laid down, and some goes away, and unfortunately, as the years go on, more goes away than is being laid down,” says Karen Kemmis, a doctor of physical therapy at Upstate.

“You need calcium and vitamin D to get bone laid down, and what happens over the years is that the thickness of the bone tends to decrease at a microscopic level, and so the whole structure of the bone gets weaker,” she says.

People can develop a condition called osteopenia as their bones thin, or the more serious osteoporosis, in which bones become fragile and can fracture easily. Both conditions can lead to decreased height, stooped posture and pain.

Gender, age, diet, body size, race and family history are all risk factors for osteoporosis. About 80 percent of the people with osteoporosis are women, mostly those past menopause. Both genders are at fairly high risk by the time they reach their 80s.

The foundation of good bones is usually built before adolescence, Kemmis says, noting that “osteoporosis is a pediatric problem with geriatric consequences.”

10 protective steps that promote bone health in adulthood:

  1. Know your risk of fractures. The American College of Rheumatology offers an online assessment at www.rheumatology.org.
  2. Measure your height annually. A loss of more than 1½ inches could indicate vertebral fractures, which are often silent.
  3. Estimate your calcium intake, and increase food/fluid sources and supplements as needed.
  4. Know your vitamin D levels, which can be learned from a blood test. Take in more if needed.
  5. Discuss medications with your health care provider.
  6. Improve bone density by performing appropriate weight-bearing and muscle-strengthening exercises.
  7. Check your posture and do exercises to decrease strain on the spine; also, use proper body mechanics through the day.
  8. Prevent falls: Most osteoporotic fractures are the direct result of a fall.
  9. Assess and improve your balance.
  10. Move safely: Avoid positions that increase the risk of spine fractures, especially flexing (rounding) the spine. Activities such as yoga, Pilates and golf have benefits but may need to be modified.This article appears in the spring 2017 issue of Upstate Health magazine. Hear a radio interview/podcast in which Kemmis talks about achieving good bone health.
Posted in aging/geriatrics, bones/joints/orthopedics, fitness, health care, HealthLink on Air, physical therapy/rehabilitation, prevention/preventive medicine | Tagged , , ,

Welcome to New York: Refugees arrive with unique health needs

New York state, and Central New York in particular, are big refugee resettlement areas, and those refugees can face a wide range of health problems, notes Ranit Mishori, MD, a Georgetown University professor who lectured recently on the topic at Upstate.

New York state welcomed nearly 4,000 refugees in 2014, with 95 percent resettling outside of New York City and Long Island. Nearly half are from Burma (Myanmar) or Bhutan, about a quarter from Africa, fewer than 20 percent from the Middle East and about 2 percent from Cuba.

Every refugee’s case is different, says Mishori, who grew up in Israel and witnessed torture while in the Israeli military and whose grandparents were German Jews who fled the Holocaust.

She tells health care providers that:

  • refugees are not necessarily poor. They might be intellectuals or members of an elite group and may have Westernized diseases, such as diabetes.
  • refugees may have experienced malnutrition, exhaustion, rape, torture and other violence, as well as a lack of vaccinations, dental care and sanitation.
  • practices such as female genital mutilation present a range of cultural as well as health problems.
  • post-traumatic stress disorder, depression, anxiety and panic attacks are common among refugees.

Mishori cites a survey that showed doctors neglected to ask refugees whether they had been tortured, and that refugees rarely volunteered that information. As a remedy, she says a new model for refugee health care may include taking a trauma history.

This article appears in the spring 2017 issue of Upstate Health magazine

 

Posted in community, international health care, public health | Tagged ,

Sharing expertise: Doctors learn stroke care from experts at Upstate

Chief neurology residents Gurmeen Kaur, MBBS (left), and Vishal Shah, MBBS (right), facilitate a stroke simulation with resident Claribel Wee, MD, and a “patient” (Puneet Kapur, MD).

Like neurology residents throughout the United States, the doctors training in neurology at Upstate learn the National Institutes of Health “stroke scale.” This is a tool that helps health care providers measure a patient’s impairment from a stroke.

In addition, the neurology residents participate in a simulation program with details from patient care that took place at Upstate University Hospital.

“This is different from watching videos on the Internet,” says Hesham Masoud, MD. “There’s a lot of utility and advantage to practicing stroke skills in front of an audience.”

Masoud, a member of Upstate University Hospital’s stroke team, is a clinical  assistant professor of neurology, neurosurgery and radiology. That means when he is not taking care of patients, he is involved in stroke research and the education of doctors who will care for stroke patients.

Identifying and treating stroke “takes coordination and rapid analysis. It’s a sophisticated interpretation,” Masoud says. He add that through the simulation  — in which one resident plays the role of the patient while another provides the care — residents learn how to make crucial decisions quickly.

“It’s essentially a confidence-building exercise,” agrees Vishal Shah, MBBS, one of the chief residents.  He says nurses and pharmacists are part of the simulation, so that the resident in the spotlight goes through the motions as he or she would in the emergency department

After the simulation, the residents ask and answer questions, hear about pertinent research that has been published and discuss the reasoning behind certain aspects of treatment. They also take test before and after the simulations to show their level of knowledge of vascular neurology.

This article appears in the spring 2017 issue of Upstate Health magazine.

Posted in brain/neurology, health care, health careers, medical education, stroke | Tagged , ,

Young brothers battle cystic fibrosis together

Maggie Zick, a certified child life specialist at Upstate Golisano Children’s Hospital, leads the Delaney brothers, Trevor and Michel, and their sister Elizabeth in medical play at the bedside. Medical play is a tool that child life specialists use to explain procedures to patients and that offers a way to include siblings, who may feel left out. This photo was selected for the 2017-2018 Children’s Hospital Association’s traveling photo exhibition, which promotes the value of children’s hospitals nationwide. (PHOTO BY KATHLEEN PAICE FROIO)

 

BY AMBER SMITH

The day after Trevor Delaney turned 6, his mother took him for an appointment with his pulmonologist, Zafer Soultan, MD. The division chief of pediatric pulmonary medicine at Upstate was eager for Trevor to start taking a new medication for cystic fibrosis, which he could not prescribe until the boy turned 6.

A month after Trevor began taking Orkambi, one of the first medications to target the underlying cause of cystic fibrosis, Tina Delaney of Fulton says her son looks better and is not getting as sick as often. She’s encouraged. Still, she has been at the Upstate Golisano Children’s Hospital with Trevor and his almost-5-year-old brother, Michael for nearly three weeks.

Both boys have cystic fibrosis, an inherited disorder that affects the lungs and digestive system. From time to time, their condition warrants a hospital stay.

“When they were younger, we were in every other week for months,” Delaney recalls.

She and her husband, George, learned about cystic fibrosis when Trevor was  born. Then when she was pregnant with Michael, an analysis of amniotic fluid revealed that their younger son would also be born with cystic fibrosis. Their daughters, Tara, 12, and Elizabeth, 7, do not have the disease – but they are affected by it.

Delaney strives to keep things normal for them, relying on help from her husband, mother, father and the doctors, nurses and child life specialists at Upstate. She is optimistic about Trevor’s new medication.

Orkambi is a combination of two drugs that work together to help a protein reach the surface of cells where it is needed to help regulate the flow of salt and fluids in and out of the cells of the lungs and other organs. Lumacaftor helps move the protein to the cell surface, while ivacaftor increases the protein’s activity once it is there. Supporting the flow of salt and fluids is important because that helps thin the mucus that builds up in the lungs of people with cystic fibrosis.

While Orkambi is promising for Trevor, Delaney says, it hasn’t changed his routine. Just like his younger brother, he still must take medicine every day, ingest enzymes before he eats and undergo nebulizer treatments and airway clearance techniques multiple times a day.

“My boys, they’re fighters,” Delaney says, describing how her sons both resist the nebulizer and other treatments. “They’re just so tired of it. I can’t blame them,” she says. “But, we’ve got to do what we’ve got to do.”

 

Cystic fibrosis treatment at Upstate

The Robert C. Schwartz Cystic Fibrosis Center is affiliated with Upstate Medical University and has been caring for the medical and emotional needs of people with cystic fibrosis since it was founded in 1970. New patients can contact the program by calling 866-543-5437.

This article appears in the spring 2017 issue of Upstate Health magazine.

Posted in digestive/gastrointestinal, drugs/medications/pharmacy, illness, lung/pulmonary, patient story, Upstate Golisano Children's Hospital/pediatrics | Tagged , , ,

Jackson’s birthday gift: Donation of blood from newborn’s umbilical cord could save a life, treat a disorder, aid medical research

 

Jackson Hunter Moore, above, was born Feb. 2 to Mark and Nicole Moore of Auburn. Blood extracted from Jackson’s umbilical cord was the first donation to the new Upstate Cord Blood Bank. (PHOTO BY SUSAN KAHN)

BY AMBER SMITH

Mark and Nicole Moore’s first act as new parents, as a family, was to give back.

After dad cut Jackson Hunter Moore’s umbilical cord and while mom cuddled the newborn in her arms, one of the labor and delivery caregivers turned attention to the remaining length of umbilical cord. Using a needle, blood was extracted from the cord and placed into a sterile bag about the size of a credit card.

That 3 to 5 ounces of stem cell-rich cord blood has the potential to save the life of someone with leukemia or lymphoma. Or it may be used in the treatment of a wide range of other cancers, blood disorders and genetic diseases. Or, it could be used to research new treatments for a variety of diseases.

The umbilical cord connects a developing baby to the placenta, the organ that grows within the uterus during pregnancy. After birth, the cord is severed and clamped, its tip becoming the baby’s belly button.

The Upstate Cord Blood Bank, on Upstate University Hospital’s Community campus, is one of 32 such banks in the United States and one of two in New York state. There is no charge to make a donation of cord blood. Families will pay a collection and storage fee if they want their baby’s cord blood stored for their own future use.

The remaining length of umbilical cord has been discarded as medical waste, but new parents are now being asked to donate their baby’s cord blood to the Upstate Cord Blood Bank, which opened in February. Such blood is rich with young stem cells, which are valuable because they can develop into many different types of cells or be used to repair many types of tissue.

When a stem cell divides, each new cell can either remain a stem cell or become another type of cell with a specialized function, such as a muscle cell, a red blood cell or a brain cell. Under certain physiologic or experimental conditions, stem cells may be induced to become tissue- or organ-specific cells with special functions. Stem cells offer new potential for treating diabetes, heart disease and other diseases because of their unique regenerative ability.

“We understood it has the potential to help,” Mark Moore said as he cradled Jackson during the bank’s ribbon-cutting event. That’s why he and his wife were eager to make the donation, the bank’s first. “Even if it’s not used for a patient,” Nicole Moore said, “they can still use it for research.”

Each donation is tested, processed and stored at the bank, a 20,000-square foot building on Upstate University Hospital’s Community campus. They are kept in liquid nitrogen tanks at minus 196 degrees Celsius.

Each donation becomes part of a database and could be used for transplant locally, nationally or internationally. There is no cost to donate.

Families soon will have the option of storing their babies’ cord blood at the bank for a fee. The blood would then be available for transplants or stem cell therapy for family members or others, as determined by the family. This may appeal to families who are prone to certain conditions.

Contact the bank at 315-492-2600.

 

This article appears in the spring 2017 issue of Upstate Health magazine.

 

Posted in maternity/obstetrics, research, technology | Tagged , , ,

Upstate news you may have missed

Kelli Maher (left) donated one of her kidneys in September to help someone in need, but she did not know whose life she saved until two days before Christmas. That’s when she met Cecilia Brown, 8, a girl from Ilion who suffered from double renal failure. Their transplant was one of the 109 performed by surgeons at Upstate in 2016, more than triple the number of transplants that took place in 2010. (PHOTO BY WILLIAM MUELLER)

Researcher seeks drug to fight painful condition

An Upstate researcher is testing drugs to treat shingles, a painful skin rash caused by the varicella zoster virus. Jennifer Moffat, PhD, is working with a Connecticut company called NanoViricides to find an antiviral drug that’s safe and effective for clinical trials. “Using nanoparticles to target viruses is an innovative approach, and we’re eager to collaborate on this project,” said Moffat, an associate professor of microbiology and immunology.

For a podcast/radio interview with Moffat about shingles and her work, click here.

Total knee replacement has robotic assistance

Robert Sherman, MD, performed the region’s first total knee replacement using the Mako robotic-assisted surgery system, in February. His patient was discharged to home rehabilitation two days after surgery. The surgeon-controlled robotic-arm system allows for more precise alignment and positioning of implants to achieve greater accuracy than through conventional surgery. “More precise alignment of the implant means less wear and tear, less initial pain and greater lifespan of the implant,” Sherman said. Upstate has used the Mako system for partial knee and hip replacements since late 2014, but the Food and Drug Administration only recently approved the system for total knee replacements.

Upstate recognized by 2 national organizations

— The national ALS Association and its Upstate New York chapter certified Upstate’s ALS Research and Treatment Center as a Treatment Center of Excellence. This signifies that the center exhibits the highest levels of established national standards of care in the management of amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease. In addition, the national association and local chapter both awarded separate grants of $25,000 each to benefit patient care. Upstate treats nearly 185 patients with ALS from throughout Central New York.

— Upstate was named a National Pancreas Foundation Center for Care and Treatment of Pancreas Disease, one of only 37 medical institutions nationwide and the only one in New York outside of New York City.

State awards HIV grant

The state Department of Health awarded Upstate a five-year $1 million grant to support Upstate’s newly created program to keep vulnerable populations free of HIV, the virus that causes AIDS.

Charity run makes donation to fight childhood cancer

Chris Arnold, Ellen Yeomans and members of the Paige’s Butterfly Run Committee presented a check early this year for $232,000, money raised from the 2016 run named in honor of their daughter, Paige Yeomans Arnold.

Paige’s Butterfly Run has raised more than $2.5 million in 20 years to support pediatric cancer research and patient and family services at the Waters Center for Children’s Cancer and Blood Disorders at the Upstate Cancer Center and Upstate Golisano Children’s Hospital.   The money goes into a permanent endowment established with the Upstate Foundation.

This year’s run is June 3 in downtown Syracuse. Learn more about it here.

This article appears in the spring 2017 issue of Upstate Health magazine

Posted in bones/joints/orthopedics, brain/neurology, cancer, health care, infectious disease, kidney/renal/nephrology, organ donation/transplant, research, Upstate Golisano Children's Hospital/pediatrics | Tagged , , , , , , , ,

Why you must come to Upstate for trauma care

Upstate University Hospital offers the only Level I trauma center in Central New York, The staff has the training and facilities needed to handle anything from minor to major traumatic injuries, 24 hours a day. (PHOTO BY SUSAN KAHN)

If you’re seriously hurt in a car wreck, a lawn mower mishap or knife fight, your chances of survival are higher if you quickly get to a Level I trauma center.

Upstate University Hospital is the only Level I trauma center within the 14 counties of Central New York. Paramedics know this, so if your injury is severe and renders you unconscious, the ambulance likely will bring you to Upstate. If you are not near Upstate, you may first be stabilized at an outlying hospital and then transferred to Upstate.

Trauma centers didn’t exist until physicians began studying the survival of trauma patients in the late 1960s. They discovered people who would have lived if they had not bled to death and others who would have lived if they had been able to breathe. That led to the concept of the “golden hour,” the time within which trauma patients need definitive care for the best odds of survival.

Upstate has separate emergency rooms for adults and children. (PHOTO BY WILLIAM MUELLER)

Officials from the American College of Surgeons visit Upstate every three years for an extensive evaluation that ensures that staff are capable of providing the highest level of medical care for adults and children 24 hours a day, seven days a week.

Trauma patients receive prompt attention when they arrive at Upstate University Hospital.

— Imaging scans that are needed are obtained immediately, most in a suite in the emergency department.

— A surgeon with expertise in trauma and critical care can be at the bedside of the most severely injured patients within 15 minutes. Since most traumatic injuries are unique, having a doctor with a wide range of experience caring for trauma patients is valuable.

— An operating room is always available for immediate surgery if necessary.

— Specialty doctors, such as orthopedic surgeons or plastic surgeons, are available within a half hour.

Upstate also maintains an intensive care unit staffed by trauma surgeons trained in critical care and a burn unit staffed by physicians with expertise in burn care, plus a rehabilitation unit if the injuries require extensive recovery.

Staff at a Level I trauma center care for people with severe injuries, but they apply that same expertise to those with minor traumatic injuries — making the trauma center the best place to go for treatment of any trauma.

This article appears in the spring 2017 issue of Upstate Health magazine. Hear a radio interview/podcast about the trauma center with Upstate surgeon William Marx, DO, chief of trauma, critical care and burns; and nurse Jolene Kittle, trauma program manager.

 

Posted in emergency medicine/trauma, health care, HealthLink on Air | Tagged ,

Up Close images: Raising awareness about cancer

 

Light-filled luminarias greeted visitors to the Upstate Cancer Center for the annual Lung Cancer Vigil on a crisp autumn evening in November. Indoors, the Rev. Terry Culbertson asked visitors to set their cellphones to flashlight mode as she read from a poem: “Faith is the bird that feels the light and still sings when the dawn is dark.”

Not counting skin cancer, lung cancer is the second most common cancer in women (behind breast cancer) and men (behind prostate cancer) but it is the deadliest. More than half of people with lung cancer die within one year of being diagnosed.

The vigil at Upstate celebrates survivors and memorializes the departed, as illustrated by sentiments on the luminarias. “Keep the faith, Sis,” read one. Another said simply, “Hope. Peace. Love.”

This article appears in the winter 2017 issue of Cancer Care magazine.

Posted in cancer, community, death/dying, health care, lung/pulmonary, spiritual care | Tagged ,