Surgery — pause — more surgery: a new way to treat abdominal trauma

BY AMBER SMITH

In the past, patients who arrived at Upstate University Hospital with major abdominal trauma would go straight to the operating room, where surgeons would work for hours to repair their injuries. Already weak from blood loss and impaired organ function, such patients were not in good condition to withstand extensive surgery.

Now the strategy has changed.

Moustafa Hassan, MD

Moustafa Hassan, MD

Trauma surgeons still work swiftly to control internal bleeding and repair life-threatening tears in organs and tissues – but then they pause and send patients to the intensive care unit to be warmed, resuscitated and stabilized. The surgical opening remains open, covered by a special dressing that looks like plastic wrap.

Hours or days later, patients undergo more thorough operations to repair smaller tears and traumatic damage. This may happen multiple times before the surgical opening is finally closed.

The technique is called “damage control surgery.” Moustafa Hassan, MD, director of acute care surgery at Upstate, says it has become the standard of care among trauma surgeons who believe patients fare better with a staged approach than extensive procedures on unstable patients.

The staged approach helped save the life of Peter Corigliano, 60, who was crushed in July 2012 when a 2½-ton magnet pinned him against another piece of equipment at Rome Strip Steel where he worked as an anneal operator.

Corigliano does not remember much about the accident, which left him with a fractured pelvis and ribs, severed iliac artery and urethra, ruptured prostate, torn colon, shredded abdominal muscles and compressed nerves in his elbow.

Doctors at Upstate University Hospital kept him in a coma for almost two weeks, during which time he underwent four surgeries and recovered in the intensive care unit. As his condition improved, Corigliano began rehabilitative therapy at Upstate. He was discharged six or seven weeks after the accident.

The damage control strategy often results in the creation of a temporary hernia, which is later repaired. Hernias develop when part of an organ protrudes from the wall of the cavity where it is contained. This may happen naturally, as a result of a previous operation or through trauma caused by car wrecks or violence.

Regardless of its cause, Hassan says “the ultimate repair for the hernia is to be able to bring the patient’s muscles back together again, to give the patient the ability to function and move around, and also to reinforce the repair, usually from the undersurface, with a mesh or other strong material,” Hassan explains.

For some patients, this may be best accomplished in stages – something he says is best decided by an experienced trauma surgeon.

hloa-art2Layout 1 finalCall 315-464-1800 to reach Upstate’s Acute Care Surgery Clinic. Hear an interview with  Hassan on abdominal trauma repair from Upstate’s “HealthLink on Air.” This article appears in the spring 2016 issue of Upstate Health magazine

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

Precision improvements make radiation therapy safer

In essence, radiation therapy works by forming electrically charged particles called ions and depositing energy into the cells or tissues it passes through. That energy can kill the cells outright or prompt genetic changes that cause cancer cell death.

Anna Shapiro, MD

Cancer patients 100 years ago received radiation to prevent the cancer from recurring in the spot where it originated, but they often had to deal with severe side effects from the extensive damage radiation did to healthy tissue.

Today, improved techniques allow for more precise radiation, which spares healthy tissue from radiation damage and makes the therapy much safer. “We have been able to show that radiation can actually improve the overall outcome and improve patient survival,” says Upstate radiation oncologist Anna Shapiro, MD.

She explains that radiation treatments are customized to patients based on the extent of their disease, whether and what type of surgery they’ve had, even the distance they must travel for treatment. And, imaging is available before every treatment, so doctors are more confident in exactly where radiation is delivered.

With more options, and greater precision, Shapiro says “the benefits of radiation therapy are much more apparent because the side effects have become much less.”

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

Posted in cancer, health care, medical imaging/radiology

What is so enticing about heroin?

 

A container of naloxone, which is sold under the brand name Narcan, among others, is shown for scale next to a tube of lipstick. Naloxone is an antidote for opioids. (ASSOCIATED PRESS)

A container of naloxone, which is sold under the brand name Narcan, among others, is shown for scale next to a tube of lipstick. Naloxone is an antidote for opioids. (ASSOCIATED PRESS)

Opioid analgesics such as heroin relieve pain by altering your perception of pain signals from your body.

They are “enticing” because they are also able to stimulate an area in your brain associated with reward, which leads the user to want more of the drug to gain those desirable effects again and again, says Christine Stork, an associate professor of emergency medicine and a doctor of pharmacy in the Upstate New York Poison Center.

She says the draw can be very strong, even with non-heroin opioids, which can lead the patient into addiction.

With prolonged use, the sites where the opioid works become adapted, and then it requires more of the drug to get the desired effects.

How does the sensation feel?

Users of heroin describe treatment of their pain, relaxation and a sensation of being “high.” Heroin is snorted or injected most of the time, although its vapor can be smoked.

People with chronic pain who use heroin can experience what is called hyperalgesia, where they feel as though they are in greater pain, Stork says.

Why do people start using?

Christine Stork, PharmD

Christine Stork, PharmD

People enter into their use of heroin in a variety of ways.

The classic progression of using stronger and stronger drugs of abuse, resulting in heroin use, still exists.

However, she says, “many current users started through the use of prescribed pharmaceutical opioids for pain, or through experimentation with the use of a family member’s prescription.”

The current trend of prescribing fewer opioids for long-standing pain, where it has a marginal role, has decreased access to prescription opioids. Our society lacks a good way of helping those patients with chronic pain who no longer get their prescription opioids, and some of them turn to heroin, which costs much less than the prescriptions did.

Now, with heroin abuse so widespread, we have a national epidemic, she says. In Onondaga County, deaths from heroin overdoses climbed nearly 31 percent in 2015, prompting Health Commissioner Indu Gupta, MD, to call the situation a public health crisis. Thirty-four heroin deaths were reported in 2015, up from 26 in 2014. Most of the deaths were of white men in their 20s.

What causes death?

Heroin and all opioids decrease central nervous system activity. This results in a decreased level of consciousness and eventually decreases the activity of the breathing center.

Patients usually die because they stop breathing or breath too little to allow for enough oxygen in the brain.

Will naloxone help?

Naloxone acts as a specific antidote for opioids. A patient who is not breathing will not stay alive for long. Over-the-counter naloxone has the potential to be administered when the patient is first found to be not breathing adequately, and in these cases it can be lifesaving.

It is important to note that naloxone does not treat addiction nor does it last a long time, Stork says, adding that all patients treated at home with naloxone should have an emergency evaluation.

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

 

Posted in addiction, drugs/medications/pharmacy, emergency medicine/trauma, health care, poison center/toxicology, public health

High-intensity fitness boot camp keeps surgeon in shape

Second-year surgical resident Alex Helkin works out just about every day at Fit Body Boot Camp in Liverpool. Originally from Shirley, Long Island, Helkin, 31, earned his undergraduate degree at Cornell University and his medical degree at the SUNY Stony Brook University School of Medicine.

Second-year surgical resident Alex Helkin works out just about every day at Fit Body Boot Camp in Liverpool. Originally from Shirley, Long Island, Helkin, 31, earned his undergraduate degree at Cornell University and his medical degree at the SUNY Stony Brook University School of Medicine. (PHOTO BY ROBERT MESCAVAGE)

Staying fit can be a challenge during the long Central New York winters.

Alex Helkin, MD, a second-year resident in general surgery at Upstate, follows a Fit Body Boot Camp program. He attends half-hour classes almost every day at Liverpool Fit Body Boot Camp, between his home in Baldwinsville and Upstate University Hospital in downtown Syracuse.

What made him try boot camp?

“My fiancée is a member. The first class is free if you come with a member, and after the first class, I was hooked. I was tired, sweaty and sore — and it felt great.”

What’s it like?

“Fit Body Boot Camp classes are 30 minutes of high-intensity interval training, usually divided into a warm-up, a circuit (four to five stations, each with one or two exercises) and a burnout. Each day is different, and the week as a whole generally provides a full-body workout.

“Class size varies, but the workout is the same. You are still doing your own workout, and your only competition is how you did the day before. The trainers give personal attention to everyone to ensure correct form and provide encouragement.”

What is his favorite part?

“I have a lot of favorite parts. I was apprehensive to join a traditional gym because I didn’t know what exercises to do — when, for how long, and if I was doing them right. At Fit Body, the trainers decide all of that and provide advice on how to achieve all of your fitness goals. I just have to show up.

”I feel great all around. I am much stronger, sleep better and have less stress.”

What exercise has he tried before?

“I wrestled in the past and tried to stay in shape doing things here and there, but this is the first time I’ve been dedicated to improving my fitness.”

Can anyone do boot camp?
“Yes. The trainers accommodate limitations, such as joint pain or surgery, and make sure there is a variation each person can do, as well as providing further challenges once you meet your goals.”

 What advice does he have for a newbie?

“Try it, and stick with it.

“It is tough at first, but there’s nothing else like it.”

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

 

 

 

Posted in fitness, health care, surgery

Strokes are affecting more young people: Do you know how to react to symptoms?

What would you be likely to do within the first three hours of experiencing weakness, numbness, difficulty speaking or difficulty seeing?

Researchers from Ronald Reagan UCLA Medical Center asked this question of more than a thousand people nationwide — and were astonished that almost three quarters of respondents under the age of 45 gave an answer that could endanger their health.

Gene Latorre, MD, is medical director of Upstate's stroke program.

Gene Latorre, MD, is medical director of Upstate’s stroke service.

Sudden weakness, numbness, difficulty speaking or seeing are symptoms of stroke. Your brain is sending signals that its blood flow is impeded — either from a burst or blocked blood vessel — and you must act quickly in order to minimize or reverse damage. That means an urgent trip to the hospital, preferably one with a comprehensive stroke center, such as Upstate University Hospital.

On duty around the clock at Upstate is a medical team of experts in stroke care including neurologists, neurosurgeons, neurointerventional radiologists, neurocritical care specialists, board-certified emergency physicians and specialized neuroscience nurses. But the team’s abilities are useless if patients don’t recognize stroke symptoms and promptly get to the hospital. The first three hours of a stroke are critical. Waiting to see whether symptoms improve, as many survey respondents said they would do, is wrong.

Neurologist Gene Latorre, MD, medical director of the stroke service at Upstate, emphasizes every minute counts. “The sooner we identify and treat acute stroke, the better the outcome.”

Results of the UCLA survey are especially troubling because they reveal so many young adults are unaware of the signs and symptoms of stroke at a time when the number of strokes in people under the age of 45 have increased by as much as 53 percent since the mid-90s.

Latorre says Upstate has seen an increase in patients diagnosed with stroke who are younger than 45. The increase is likely caused in part by a rise in the number of young adults with diabetes, uncontrolled high blood pressure and/or obesity, conditions that increase a person’s risk for stroke. Smoking rates also remain high among people from age 18 to 45, and smoking significantly increases a person’s risk of stroke.

“If you experience sudden dysfunction in your face, arm or speech, it’s time to call 911,” says Latorre. “The sooner you get to the nearest comprehensive stroke center, the better your chance of having a good recovery.”

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

Posted in brain/neurology, health care, illness, public health, research, stroke

Calcium in baby formula? Thank an Upstate pediatrician

PSTATE'S HEALTH SCIENCES LIBRARY HISTORICAL COLLECTIONS)

Pediatrician Lytt Gardner, MD, 1962 (FROM UPSTATE’S HEALTH SCIENCES LIBRARY HISTORICAL COLLECTIONS)

Before the 1950s, some babies who were not breast-fed developed intermittent muscular spasms known as tetany. The cow’s milk formulas they were fed contained too much naturally occurring phosphorus, relative to human milk. The high phosphorus caused a drop in calcium in the bloodstream of these infants, resulting in tetany.

It was a pioneering Upstate pediatric endocrinologist, Lytt Gardner, MD, who recognized that all the babies needed were calcium gluconate supplements.

He received a hat tip recently from the Pediatric Endocrine Society. “His superb study published 65 years ago led to changes in formulas and the disappearance of the problem,” the society’s newsletter says, referencing Gardner’s study published in 1950 in the journal Pediatrics.

Layout 1 final

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

Posted in diabetes/endocrine/metabolism, diet/nutrition, health care, history, illness, public health, research, Upstate Golisano Children's Hospital/pediatrics

How Maxine Thompson’s life lessons mirror Upstate’s diversity advances

Maxine Thompson (then Summerhill), center, with her parents and sisters in their Syracuse home in the early 1960s.

Maxine Thompson (then Summerhill), center, with her parents and sisters in their Syracuse home in the early 1960s.

Upstate’s Maxine Thompson was asked to give a talk titled “My Story” as part of Crouse Hospital’s Black History Month celebration. This is an excerpt.

My presentation has two parts. Part one is my personal story, as requested. Part two outlines work we’re doing to build a more diverse and inclusive environment at Upstate Medical University.

I am one of five daughters of Charles and Eugenia Summerhill. Our parents grew up on farms in Florence, Ala., and neither had the luxury of a high school education. They married young and left Alabama with a cardboard box and a baby on the way. They were searching for a better life, first by moving to St. Louis, then to Syracuse, where we lived with relatives, then in public housing.

My parents scrimped and saved and bought a three-family house on South State Street, which was a predominantly white neighborhood in 1957. We were pioneers of integration.

Dad worked in a factory, and Mom was a nurse’s aide at Community General Hospital (now Upstate). Eventually, they both worked at General Motors.

My parents gave me religious and family values, and taught me:

Life Lesson 1: If you work hard, you will get ahead in life.

Life Lesson 2: Education is something that no one can take away from you.

Maxine Thompson, MSW, LCSW-R, assistant vice president for diversity and inclusion

Maxine Thompson, MSW, LCSW-R, assistant vice president for diversity and inclusion, is a member of Upstate’s Leadership Council.

My parents sent me to Head Start, the Dunbar Center and the library. I was an honors student at Corcoran High School.

It was in high school that I was profoundly affected by preconceived notions of race.

I had my heart set on an Ivy League education, but my well-intentioned guidance counselor encouraged me to apply to a historically black college instead. That wasn’t what I wanted. She thought I couldn’t get into Cornell University or shouldn’t be there. Her doubt fueled my determination.

When I got accepted at Cornell, my classmates were jealous and disbelieving.

I was an Honor Society member and a Regents scholar. Why was my Ivy League acceptance a surprise?

Life Lesson 3: When people discourage me from pursuing my goals, I take that as a challenge and set out to prove them wrong.

 I loved Cornell, but there were exceptions.

I remember sitting in class listening to a professor say, as a matter of fact, “Minorities are behind in school and work because of their childhood experiences. Minority mothers don’t talk to their children. That leads to delayed speech and other developmental issues.”

It was 1970. A bunch of the black students voiced their disgust, and some walked out. Not me. I knew what I thought about that professor’s so-called facts. I silently vowed to dispel another myth about black folks.

Life Lesson 4: It’s not my style to challenge. I observe, work within the culture to make change, and build relationships. I take a soft approach rather than use the stick.

After graduating from Cornell, I earned a master’s degree in social work from Smith College. My professional life at Upstate Medical University began right after graduation. As a hospital social worker, I worked with a variety of patient populations. Eventually, I supervised staff and college students doing field placements.

Several co-workers and I decided to create a Faculty and Staff Association for Diversity. Our goals were to increase awareness of the contributions of faculty and staff of color, promote the business case for diversity and offer diversity education for hospital employees.

Our group started prejudice-reduction workshops on campus. We believed the workshops would lead to better communication between staff and patients and between staff and co-workers.

We hit a stumbling block. The workshops pushed people to share personal, often painful, experiences with negative stereotypes and discrimination. In the 1990s, the Upstate campus wasn’t ready for this. We needed a new approach that was more intellectual, less emotional.

Life Lesson 5: Learn to read the landscape and work within the system to affect change.

Today, 20 years after those first prejudice-reduction workshops, Upstate has a number of programs designed to create a more diverse and inclusive environment. We introduce our diversity statement at new employee orientation, offer customized staff training to address cultural change, have annual all-employee training on cultural competency and humility, host lectures by diversity experts, and select employees to serve as diversity ambassadors across campus. We have a staff member dedicated to expanding employee recruitment efforts and identifying talented applicants from underrepresented groups.

I am particularly proud of Upstate’s outreach to our neighbors at Pioneer Homes, the low-income housing near our downtown hospital. Our first step was to help residents plant a vegetable garden. Then we added a children’s reading program and workshops to help residents quit smoking.

In 2013, Upstate began offering classes at Pioneer Homes so that residents could become health advocates. We call our program Healthy Neighbors.

Healthy Neighbors expanded to include She Matters, a breast cancer program. It is gratifying to see Pioneer Homes’ resident health advocates go door to door teaching about breast cancer and signing up their neighbors for mammograms. This collaboration exemplifies Upstate’s mission of improving the health of the community we serve.

In closing, let me mention Upstate’s efforts to “grow our own” diverse workforce. We offer Presidential Scholar and Synergy/Mercy Works internships for college and graduate students, the Hillside Work Scholarship Connection for at-risk high school students, and Project SEARCH, the school-to-work program for students with developmental and physical disabilities. In 2008, Upstate became the first hospital in New York state to host Project SEARCH.

Thank you for inviting me to share my life lessons, and the progress we’re making moving Upstate to become a more empowered, diverse and inclusive community.

The graphic below — given to me by Upstate President Danielle Laraque-Arena, MD —  sums up why I do the work that I do, and why black history is important, today and every day.

This image, comparing equality and justice, hangs in Thompson’s office at Upstate.

This image, comparing equality and justice, hangs in Thompson’s office at Upstate.

 

Posted in community, disability, education, health careers, history, volunteers | 1 Comment

Up Close: Upstate Cancer Center Pharmacy

Pharmacy technicians Joanne McCollum and Jeremy Gleason at work in the Upstate Cancer Center. (PHOTO BY ROBERT MESCAVAGE)

Pharmacy technicians Joanne McCollum and Jeremy Gleason at work in the Upstate Cancer Center. (PHOTO BY ROBERT MESCAVAGE)

While nurses help patients settle in for their infusion appointments at the Upstate Cancer Center, the chemotherapy drugs they will receive are prepared in a sterile room just a few steps away by pharmacy technicians and pharmacists who specialize in oncology. Having a dedicated pharmacy team nearby allows for easy collaboration among providers, nurses and pharmacists. In addition, pharmacists are readily available to field patient questions, assist when a patient has an adverse drug reaction and provide answers about oncology medications.

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

Posted in cancer, drugs/medications/pharmacy

Sleep first: 7 tips for healthy slumber

MOON-1Good sleep habits become even more crucial when a person is dealing with cancer.

After a diagnosis, people understandably may develop anxiety and/or depression, both of which can impact their ability to get to sleep and stay asleep.

“The loss of sleep affects the quality of life. If the quality of their life has already been reduced by cancer, and by anxiety and depression, the goal is not to further reduce it with a loss of sleep,” says Antonio Culebras, MD, a neurologist who specializes in sleep medicine at Upstate.

Antonio Culebras, MD

Antonio Culebras, MD

Sleep is a brain function, and the majority of chemotherapy medications affect brain function. Many patients taking chemotherapy show signs of memory lapses, trouble concentrating and/or a sleep disorder, Culebras says.

He says patients need to bring their sleep issues to the attention of their doctors. A variety of prescription medications may help. “You have to sleep. Once you have slept, then you deal with other problems. But first of all, you have to sleep.”

7 tips for better sleep
Sleep hygiene techniques take on even more importance during cancer treatment. Here’s a refresher, from the National Sleep Foundation:

sheep-21. Avoid napping during the day, since that can disturb one’s normal patterns of sleep and wakefulness.

2. Close to bedtime, avoid caffeine, nicotine, alcohol and large meals. And remember, chocolate contains caffeine.

3. Be aware that dietary changes can disrupt sleep routines, so now is not the time to experiment with spicy new dishes.

4. Exercising vigorously in the morning or late afternoon can promote good sleep at nighttime. A relaxing exercise such as yoga in the evening can help initiate a restful night’s sleep.

5. Get adequate exposure to natural light, which helps your body maintain a healthy sleep-wake cycle.

6. Associate your bed with sleep. Establish a regular relaxing bedtime routine, and avoid using your bed for watching TV.

7. Create a comfortable sleep environment that is dark and neither too hot nor too cold.

Sleep-cancer connection

We already know that sleep apnea raises a person’s risk of stroke and heart disease, and dementia. Now research shows a link with cancer.

Laboratory studies have demonstrated that low levels of oxygen – the hallmark of sleep apnea – can lead to inflammation, which can fuel cancer cell production.  Culebras says people with severe sleep apnea may have as much as a 50 percent higher risk of developing cancer.

hloa-art2Layout 1This article appears in the winter 2016 issue of Cancer Care magazine. Hear Culebras’  radio interview about getting a good night’s sleep.

Posted in brain/neurology, cancer, community, HealthLink on Air

Understanding how cancer produces estrogen within a tumor

 

iStock_000012934701_Full copyBY JIM HOWE

Picture a flower blooming in a desert, and you have the key to a mystery that puzzled cancer researchers for years.

A common type of breast cancer needs the female hormone estrogen and somehow finds a way to obtain it in the bodies of postmenopausal women, who have low levels of estrogen.

Hironobu Sasano, MD, PhD

Hironobu Sasano, MD, PhD

Just as a desert flower might find a novel way to get water, such as from the air, estrogen-dependent breast cancer can survive in the “hostile environment” of a postmenopausal woman, explains Hironobu Sasano, MD, PhD, a renowned Japanese pathologist. He and other researchers have shown that when little or no estrogen is available in the body, the cancer can produce the hormone within the tumor itself.

This discovery marked Sasano as a “pioneer” in cancer research and intracrinology, a part of endocrinology that studies what takes place within cells, says Upstate pharmacology professor Debashis Ghosh, PhD.

Another way to think of this is to view the cancer as using “homegrown” rather than “imported” estrogen, says Ghosh, who has collaborated on research with Sasano and hosted his recent visit to Upstate to deliver a lecture on breast cancer, estrogen and obesity sponsored by the Carol M. Baldwin Breast Cancer Research Fund of CNY.

In postmenopausal women, the enzyme aromatase can convert the male hormone androgen into estrogen, Sasano says, explaining the promise and limitations of aromatase-inhibitor drugs in blocking this process.

Obesity is involved in the development, recurrence and spread of breast cancer, he says, and reaching and maintaining a healthy body weight means a “significantly better prognosis” for a breast cancer patient, although many other factors come into play.

Sasano, chair of the pathology department at Tohoku University School of Medicine in Sendai, Japan, and president of the Japanese Hormone and Cancer Society, also says that the concepts he outlined could be applied to endometrial cancers, as well as to diseases such as osteoporosis, atherosclerosis and even dementia.

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

Posted in cancer, research, women's health/gynecology