Health

UPSTATE
FROM UPSTATE MEDICAL UNIVERSITY

Fall 2011

Great Hikes

18

warming up

with salsa 14
IS THE

unwinding
FOR YOU?

16
HUMORIST JEFF KRAMER GETS SERIOUS ABOUT HIS HEALTH

10

19

CONTENTS

3 4 5 8 9 12 13

Whats Up at Upstate By the Numbers

Health
A Cure for Epilepsy Surgery can fix seizure disorderseven in babies. How CPR and an AED saved a lacrosse players life No more narcissism? Phasing out the diagnosis What to say to friends who are sick

Community
Upstate creates health promotion videos for new Americans Reducing Diabetes Onondaga County workers improve their health

Work
Meet Scientist Yanli Zhang-James

Food

In every issue
7 8 10 12 17 19 20
Lessons from Upstate Advice for Caregivers from Caregivers In the Know The Upstate Ethicist Good To Know The Humorist Science is Art is Science

14 15 16 18

A savory shrimp and avocado salsa recipe Low-fat or low-carb for weight loss?

Leisure
Unwinding with Music Because of the amount of work that is expected of students, students often feel dehumanized. Music helps feed their soul. The Adirondoc Takes a Hike Pediatrician/outdoor enthusiast Thomas Welch prescribes three Adirondack hikes.

On the cover: Lily Craparo with Zulma Tovar-Spinoza MD, director of pediatric neurosurgery at the Upstate Golisano Childrens Hospital in Syracuse, New York
PHOTO BY SUSAN KAHN

Good 0 for 9 You 4

Cardiac Assessments

Healthy Monday

13

Elbows

14

Apples

16

Writing

18

The Immortal Life of Henrietta Lacks

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WHATS UP AT UPSTATE

Health
Fall 2011
publisher Wanda Thompson PhD Associate Senior Vice President for Operations executive editor Melanie Rich Director, Marketing and University Communications editor-in-chief design Amber Smith Susan Keeter

W
Our new blog Good news

elcome to Upstate Health, a magazine produced by Upstate Medical University to inspire healthy living. You will find stories about medical care and wellness, of course, but also a variety of articles that pertain to life in Central New York. Our experts share advice on caregiving, food and leisure activities.

Our pages also showcase important work in our community and interesting news from the Upstate campus. You will meet researchers, students, healthcare providers, volunteers and patients. We hope you will appreciate the artistry within our science on our back page every issue.

photography Susan Kahn, Robert Mescavage, Debbie Rexine, Richard Whelsky, William Mueller, Dan Cameron, James McKeever Archival photograph from the Historical Collections, Health Sciences Library upstate health is published by the Office of Marketing and University Communications. Upstate Medical University in Syracuse, NY, is an academic medical center with four colleges Medicine, Nursing, Health Professions and Graduate Studies as well as an extensive clinical health care system that includes Upstate University Hospital, Upstate University Hospital at Community General, the Upstate Golisano Childrens Hospital and numerous satellite sites. Affiliated with the State University of New York, Upstate is Onondaga Countys largest employer. For more information, visit us online at www.upstate.edu or phone us at 315-464-4836. For corrections, suggestions and submissions, contact Amber Smith at 315-464-4822 or smithamb@upstate.edu for additional copies call 315-464-4836. Upstate Health offices are located at 250 Harrison St., Syracuse, NY 13202

Stay current with the new Whats Up at Upstate blog at upstate.edu/whatsup. This blog was created as a guide to the vast institution (and Syracuses largest employer) that is Upstate. Youll find news and information from the halls of academia, to the research laboratories and throughout the patient care areas of the hospitals.

Upstate was featured in the Aug. 30 issue of U.S. News & World Report. Only 140 hospitals were nationally ranked in one or more specialties and we ranked in four, including cancer; ear, nose and throat; nephrology; and urology. We are also featured in an advertisement from the American Heart Association, praising the hospitals that follow specific guidelines for treating patients with heart failure or stroke.

Your feedback
Got a story idea? Want a free subscription, or extra copies for your office? Contact us at whatsup@upstate.edu or by phone at 315-464-4836.

Your health
For appointments or referrals to the health care providers on these pages, or for questions about health topics, contact a registered nurse at Upstate Connect at 315-464-8668 or 1-800-464-8668, day or night.

BY THE NUMBERS

320
years since President Franklin D. Roosevelt laid the cornerstone of our medical school building, now known as Weiskotten Hall.

number of applicants who applied for 16 slots in the physician assistant (PA) program.

9.9

weight in pounds and ounces of the first baby born a healthy boy, at 12:53 p.m. on July 7 at Upstate University Hospital, the day the Community General Hospital campus became part of Upstate.

75

therapy dogs (Daphne, Sebastian, Nala and Coletrane) immortalized on trading cards given to patients at Upstates Golisano Childrens Hospital.

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HEALTH

0 heart
Tests

Sweet, Sassy and Seizure-free

New surgery treats Lilys epilepsy

Recommended

ne in three deaths in America is attributed to heart disease, making it the No. 1 cause of death in the United States. The variety of screenings available for heart disease has grown significantly in recent years, but many are not cost effective in preventing deaths from heart disease. The American Heart Association recommends, in the absence of risk factors: 1. Regular blood pressure checks for people over age 20, at every doctors visit or at least once every two years. High blood pressure, or hypertension, can cause stroke, heart failure and heart attack. A normal reading for a healthy person is below 140/90. 2. Cholesterol screening, or fasting lipoprotein profile, every five years for men under age 45 and women under age 50 who have no other risks for heart disease. This standard blood work can help detect problems in arteries, including coronary artery disease, the most common type of heart disease, by monitoring total cholesterol levels, levels of lousy LDL and healthy HDL cholesterol, and the level of fats called triglycerides. 3. An annual fasting blood sugar test for people who are overweight or obese. This monitors for the development of diabetes, which can increase your risk of heart disease. A level of blood sugar, or glucose, higher than 126 signals a problem.

Speech-language pathologist Lauren Freel and Lilys dad, Charles Craparo, work with Lily in her hospital room.

s soon as we heard the word surgery, we were like, no, theres not going to be brain surgery for our daughter, recalls Michele Craparo of Endicott. She did not want to believe her daughter was sick enough to require such drastic measures. Her daughter, Lily, was a perfectly healthy 2 -year-old when she went to bed March 11. Sometime in the night, her brain began a quiet but destructive seizure, which wracked her body into dawn that Saturday. Her parents heard what sounded like choking and came running. Lily couldnt speak or walk. Her left side was paralyzed. Doctors at a Binghamton hospital transferred her to Upstate Golisano Childrens Hospital, where the Craparos learned that Lily had epilepsy, and specialists set out to determine why. The term epilepsy describes seizures that are not related to a medical condition such as low blood sugar. Some children are born with epilepsy; it can also develop because of cerebral palsy, head injury or brain tumor. Lily suffered seizure upon seizure while Yaman Eksioglu MD, (pronounced ee-SHOE-lu) a pediatric neurologist

specializing in epilepsy, tried different medications and dosages. Six days into the crisis, her seizures were finally under control. But doctors remained concerned. The medications effectiveness was likely to wane, Eksioglu told the Craparos, and Lilys seizures were so severe that they might cause permanent damage to the healthy parts of her brain. He and Zulma Tovar-Spinoza MD, director of pediatric neurosurgery, proposed surgery. It would be the first pediatric epilepsy surgery done at Golisano, but both doctors had experience with the procedure, Eksioglu at Childrens Hospital in Boston, and Tovar-Spinoza at the Hospital for Sick Children in Toronto. They had come to Syracuse intent on offering epilepsy surgery to children throughout Central New York. The prospect was scary to Lilys parents, both of whom are teachers Charles in 8th grade special education, and Michele in kindergarten. Lily is the baby of the family to big brothers Christian, 6, and William, 5. She was born precocious and vibrant. They worried if removing part of her brain would change that. They worried if declining the surgery was even riskier.

continued on page 7

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HEALTH

One Amazing Save

Quick action brought DeWitt teen back to life after a lacrosse ball slammed into his chest
Dan Cochran dropped dead when a lacrosse ball slammed into his chest during all-star tryouts in June. Coaches, a trainer and nurse revived him with CPR and an Automated External Defibrillator. These four strangers came together and saved my sons life. I dont know how to thank them, says father, Sean Boland, who works as a dispatcher for Syracuses ambulance service, Rural/Metro Corporation. Cochran, 15, of Fayetteville is a junior at Jamesville-DeWitt High School this year. His mother is Danielle Boland. This is his story: Dan Cochran with his parents, Sean and Danielle Boland, several days after the accident.
rescue efforts

Some kid passed the ball to someone else. I ran up to try to cover that guy, and the guy tried to shoot, so I tried to turn clockwise to get out of the way of the shot, and it ended up just hitting me. I took two, maybe three steps. I tried to scream, but I couldnt. Nothing came out. I very faintly remember falling. Everything was just dead silent as soon as that ball hit me. It was like the world slowed down for a little bit. The next thing I remember was being woken up. I was actually somewhat angry. And I was trying to figure out where I was. I couldnt really see very well, and I couldnt remember what day it was. I fell on my face, and I woke up on my back. I think I was on the stretcher already. I got hit with that check in the arm, and thats all that hurt. My mom beat the ambulance to Upstate, somehow. As I got pulled out of the ambulance, she grabbed my hand. I just looked at her, and she was crying and crying and crying, and I told her I was OK. At that moment I didnt know what truly had happened. Ive heard about commotio cordis before. I know a goalie from Cornell University (co-captain George Boiardi) a few years ago died from the same thing. I was only hospitalized for 12 hours. My cardiologist actually told me hed rather me not sit on the couch and do nothing. Theres a very faint bruise on my left side, just under where my heart would be. And, yeah, I made the section 3 all-star team.

t was around 5:30 p.m. when I got to practice. It was like a normal day. We had just finished doing 1-on-1s, and my arm got checked. Then we went down to do 4-on-3s, a drill to see how the three defensemen can communicate and work as a system to shut down the offensive players. I was playing up near the goal.

hen Dan Cochran collapsed on the field, Upstate nurse Mike Jordan, who was at tryouts with his son, went running. He says the teen was blue. His eyes were rolled back, and no one could feel a pulse. He helped with the chest Mike compressions of CPR, a skill he Jordan RN is trained in but has never had to perform on a human. It just kicked in. I didnt feel jittery or anything. Everything happened so fast. It was instinctive, Jordan says. The AED shocked Cochran once. Jordan resumed compressions, but he wasnt through his second set of 30 before Cochran began trying to push Jordans hands off his chest. Without the AED, I dont think he would have made it, to be honest with you. That AED, it was effective, thats for sure.

medical explanation

lthough it is rare, commotio cordis, the medical term for what happened to Cochran, is one of the more common causes of sudden cardiac death in young athletes. It happens when a projectile (baseball, lacrosse ball, hockey Ali puck, karate chop) strikes a Salah MD specific area of the heart, with an exact force and at the precise stage of the heartbeat. Survival depends upon prompt cardiopulmonary resuscitation, CPR and rapid defibrillation. Upstate cardiologist Ali Salah MD says preventive efforts can include coaching young athletes to turn away from oncoming projectiles, and using softer and less dense balls when possible.

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No More Narcissism?
The official diagnosis is fading, but narcissists will still believe the world revolves around them

Q A
and
with ronald pies md

Studies of college students suggest that narcissistic traits have increased over the past few decades, though this may have an upside: positive traits like self-esteem and assertiveness may also be increasing in this population. And, for some users of Facebook or Twitter, there may be social benefits that outweigh any worsening of narcissistic traits, but this needs more study. The framers of the DSM dont pay much attention to social trends, such as the use of Facebook or Twitter. They tend to focus on whether the studies behind an existing or proposed diagnosis are convincing or not. Their conclusion was basically that the studies of narcissistic personality disorder have been severely flawed, and that the criteria are not reliable or valid. They do recognize, however, that people may have narcissistic traits.

Q A

isnt it curious that the diagnostic statistical manual, dsm, which classifies mental disorders according to symptoms, is removing narcissism as a diagnosis at a time when narcissism is flourishing through venues like facebook and twitter? Many of us in the mental health field worry that all this online self-exposure may be worsening the trend toward increasing narcissism in our society.

I doubt the removal will have any effect on patients currently in treatment. Many are probably being seen by psychoanalytically oriented therapists who have never put much stock in the symptom-based DSM approach. However, in terms of billing and third-party payers, loss of the diagnostic code might have some negative effects on reimbursement for therapy.

Q A Q A

Up to a point, narcissism can be adaptive and even healthy. At one end of the continuum, we have folks who have a positive and confident attitude about themselves, and high, but not unrealistic, self-esteem. Without these traits, I doubt many people would advance in their careers or make many friends.

U P S TAT E H E A LT H

Narcissism
Q A
what does the removal of the diagnosis code mean for narcissistic patients and their mental health providers? what is so bad about narcissism? is it just an annoying personality trait, or can it be detrimental?

On the far end of the continuum, though, we have patients who believe that the world revolves around them, and that everybody owes them bows and curtsies. Deep down, however, we believe many of these extremely narcissistic persons are deeply insecure and often lonely individuals. They are certainly a handful for everybody else. Most people find extremely narcissistic individuals very hard to work with, socialize with, or relate to in an intimate and loving way. This leaves the narcissistic person feeling isolated and ignored, which often exacerbates his or her sense of anger and entitlement. how do you treat narcissism?

There are no validated treatments for what has been called NPD, unfortunately. There are no medications that have been shown effective, and, to my knowledge, there are very few if any controlled studies of psychotherapy. Nevertheless, some narcissistic patients seem to benefit from long-term psychotherapy, aimed at exploring the underlying issues that drive their need for praise, adulation, and constant self-involvement.

you might be a narcissist if you are unhappy if you are not constantly the center of attention. people say you are demanding and unreasonable most of the time. you are constantly angry that people dont do things exactly as you say they should be done. you become depressed and angry when you feel rebuffed or rejected. you find it hard to open up and get close to anybody who isnt constantly praising your virtues.
SOURCE: DR. RONALD PIES

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Lilycontinued from page 4

We were pushed so many times to go to a bigger hospital, Michele Craparo says. But I knew we were in the right place. She and her husband were impressed that the doctors wanted not only to control Lilys seizures but to preserve the little girls quality of life and developmental abilities. And they understood that meant acting quickly, to minimize any damage. Between 25 percent and 40 percent of children with epilepsy have whats known as a focal lesion, a spot in the brain where seizures originate. Between 5 percent and 10 percent of those patients are candidates for surgery, which has a success rate of 85 percent for curing the seizures and improving the patients quality of life but comes with the risk of infection, stroke or bleeding in the brain, Tovar-Spinoza says. The process involves a series of diagnostic tests and scans, two trips to the operating room and several harrowing days during which several dozen to a few hundred electrodes would reside on Lilys brain, recording the seizures to help doctors pinpoint the origins. But first, the child would need to let her brain rest, and regain her strength through physical therapy. Lily couldnt stand on her own when she arrived at Upstate. She was walking by the time she underwent surgery, but her left arm remained partially paralyzed. Her first operation, on April 25, revealed a brain tumor called meningioangiomatosis. It was not cancerous, but it would have to be removed in order to stop the seizures. Lily remained in her hospital bed for four days while doctors tracked the activity in her brain. She looked normal on the outside, but on the inside she was having seizures, Michele Craparo describes. They learned a lot of information from that. Using data from the electrodes and the previous tests, Tovar-Spinoza and Eksioglu came up with a strategy for reaching and removing the tumor and the areas in Lilys brain that created seizures. They mapped a path to follow, to minimize damage, and they took Lily back to the operating room. We were ready for her to be in a wheelchair. We were ready for her to wake up and not know us, Michele Craparo says. Instead, Lily awoke from surgery insisting that nurses put on her diaper and lifting her left arm, the side that had been paralyzed.

Lessons
from upstate
Lily with Drs. Eksioglu and Tovar-Spinoza
The Craparos had their sweet, sassy daughter back. And she wasnt having seizures anymore. Lilys dad says she will take anti-seizure medicines for at least the short-term, to be safe. But thanks to the doctors at Upstate, Charles Craparo says, long term, she should be able to live a normal, healthy productive life.
seizure surgery process hildren as young as a few weeks old may be candidates for epilepsy surgery if anti-seizure medicines prove ineffective, or if side effects are intolerable. A series of tests is part of the epilepsy surgery process, including: EEG electroencephalograms to show electrical activity in brain cells, and electrodes placed directly on the brain provide precise information about the brains electrical pathways, without interference from hair, skin and bone various types of magnetic resonance imaging to show detailed pictures of the brain and metabolic changes taking place in the active parts of the brain, plus functional imaging to localize the areas with important cortical functions Positron emission tomography, which provides three-dimensional cross-sectional images

wound care

ea tree oil is known as a natural antibiotic agent. A middle aged woman with diabetes used it for a wound on her foot for more than a month and then sought care at Upstate University Hospitals emergency department when the wound swelled into a dark blister. By then, the infection was gangrenous and had spread to the bone. The patients foot had to be amputated at the ankle.

MRI

PET

The theory of what she was doing was sound, says Derek Cooney MD, who wrote about the case in April in the International Journal of Emergency Medicine. He is an assistant professor of emergency medicine at Upstate who specializes in wound care. The problem is, patients may not realize that herbal remedies such as tea tree oil like any drug have limitations. Further, people with diabetes are likely to have decreased circulation to their lower legs and feet, which means their bodies struggle to heal injury or fight infections in those areas. Cooney says, diabetic patients with wounds to their lower extremities should seek medical attention rather than seek home remedies without the aid of a doctor. In this womans case, had she sought medical attention earlier, Cooney says she may have been a candidate for advanced wound care and hyperbaric oxygen therapy rather than amputation.

SPECT Single photon emission computer tomography to reveal more active and less active parts of the brain Motor and sensory mapping, done to help pinpoint which actions are controlled by which part of the brain

Lily with occupational therapist Erica Krisak OTR/L

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4things
1 2 3 4

you can always say to someone who is sicK

Author Bruce Feiler, a survivor of bone cancer, wrote in The New York Times about what to say and what not to say to loved ones who are ill. Here are four things that he says will always be welcome: Dont write me back. Insist that the person NOT write you a thank you note when you drop off chicken soup or take the dog for a walk. Thats one extra stress he or she can do without. I should be going now. Dont overstay your welcome, which should be brief, especially if the person is tired or in pain. Would you like some gossip? Ignoring the elephant in the room can be therapeutic. Chat about the underdog in the playoffs, the latest celebrity affair, the upcoming election. I love you. Simple, direct emotion can be the most powerful gift you can give a loved one, and the fact that so few of us do this makes it that much more meaningful.

For Caregivers from Caregivers

How to bathe an elderly loved one

P
I I I

ersonal care can become a challenge as people age. Those with dementia, especially, struggle with cleaning themselves. Loved ones often must provide assistance. Registered nurses Betsy Holden and Mary Sue Stever from the geriatric service at Upstate say a caregiver has to do what works for his or her individual situation. In some cases, that may mean hiring an aide to provide baths for mom or dad.

For those doing it on their own, the nurses offer this advice:
Properly outfit the bathroom. Consider a shower chair, detachable showerhead and handrails. Set aside an hour or two, and choose a time of day when you, and the person you will bathe, are not tired. Realize that you will both be exhausted afterward. Start by preparing the bathroom: Lay out supplies and adjust water temperature. Guard against slips by putting water shoes on yourself and your loved one. Dont scrub or exfoliate. Use a soft cloth and mild soap. Let your loved one participate as much as he or she is able. Respect their dignity by placing a towel over their private parts. They, or you, can reach under to clean with a soapy cloth and then rinse with the showerhead. Do the same thing, using a sheet or beach towel, if you are providing a sponge bath in bed. Start with his or her face and move down the body, uncovering or reaching under the sheet to clean. Change your water tub frequently, so the water stays warm and clean. Roll your loved one forward to wash his or her backside. End with the feet. Then take a fresh cloth to clean private parts, moving from front to back.
I

If you wash their hair, use no-tear shampoo. If its too difficult, make an appointment with a hairdresser. Understand that someone who fights you about bathing may be frightened. People with dementia may not understand the feel of water, its coldness, or the loud noise it makes filling a tub. Consider playing music that they enjoy, which can serve as a distraction. Stock adult fresh wipes for cleaning in between tub baths. Make sure to dry your loved one thoroughly. Run the edge of a towel between each toe, like flossing between teeth. Lift large breasts to dry underneath; this area is particularly susceptible to yeast infection. A moisturizing lotion, patted on gently, may be appropriate. Keep tabs on your loved ones skin and report any change sores, blisters, redness, dryness to his or her health care provider that day. Issues that surface on the skin can signal the beginning of a medical crisis. Remind your loved one, You dont need to be embarrassed. Im just helping you like you used to help me.

Listen every week to...

Sundays
9 to 10 a.m. FM 106.9 WSYR & AM 570 WSYR

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Reaching Refugees
Videos communicate health to new Americans
ome of Syracuses newest residents arrive not speaking English and unfamiliar with American customs. They are refugees from Iraq, Bhutan and Burma who need jobs, places to live and medical care. In this new world, some refugees have to learn the concept of scheduled doctor appointments and follow-up visits, and they have to navigate a health care system that includes laboratories for blood work and pharmacies for prescriptions. This is a big adjustment for them, says Peter Cronkright MD, an associate professor of medicine at Upstate who provides care to a variety of immigrants. We really have to look at every step in our delivery-of-care system and see what we can do to best accommodate them, and also our staff, so it is a positive experience.

Kamal Gautam MBBS recording a video in Nepalese with Upstate videographer Donna Joyner.

the refugees see TB as a very sick thing, a disease that often is a killer, Cronkright says. When we do the skin test and its positive, they dont think that they have TB because they only know of one type, and thats the very ill type. So, were educating as to what does it mean by that positive skin test? That when that occurs, theyre not contagious to others, but its important to take the medication so that if they get sick down the road, the TB doesnt show its face. Basically, the medications will eliminate it from the body. Additional videos will focus on immunizations, diabetes and what foods can boost levels of vitamin B12. Working with the refugees in Syracuse can have a ripple effect around the world.

Using a grant from the Central New York Community Foundation, Cronkright is making patient education videos with the help of bilingual refugees who have medical or social work backgrounds. These refugees become volunteer navigators. Staff from Upstates Educational Communications department are producing the videos.

New York state ranks third for refugee resettlement, behind California and Texas. Most refugees do not end up in New York City, says Peter Cronkright, MD, associate professor of medicine at Upstate. They end up along the Thruway, at Syracuse, Buffalo, Rochester, Utica and Albany.

Cronkright says over the past year, doctors discovered low levels of vitamin B12 among Bhutanese refugees at Upstate as did researchers at the federal Centers for Disease Control and Prevention in Atlanta. Now researchers are trying to explain the deficiency, and Cronkright, with the navigators, is crafting an educational message about B12 supplementation.

Dr. Cronkright

Cronkright says he is learning from the refugees about the best way to convey a variety of public health messages. The first video focuses on latent tuberculosis, when someone tests positive for TB but shows no symptoms of illness. What I didnt realize until talking to the navigators is that

Now they are studying the Bhutanese in Nepal, where theyre in refugee camps, to see what might be the cause, Cronkright says. Thats the neat thing about care here. It often can be transferred back to helping the refugees who are in camps in their countries of origin.

pstate Medical University is partnering with Syracuse University to inspire healthy behavior with an ongoing national Healthy Monday campaign.

Its built around the psychology of Monday as a time for thinking about doing something different. People pick Monday as a day to start something new to improve their health and well-being, says Tom Dennison, associate director of the public health program that is jointly sponsored by Upstate and SU. You might see Meatless Monday, in which vegetarian entrees are offered in cafeterias; Move It Monday, emphasizing exercise; or other promotions dreamed up by students. Each will be evaluated as part of a research project. This is all about public health messaging and behavior change, says Dennison. Healthy Monday is the brainchild of Sid Lerner, 80, a former advertising executive and 1953 SU graduate. You may recall his previous campaign: Dont Squeeze the Charmin commercials in which shoppers could not keep their hands off Charmin toilet paper. Dozens of educational institutions, non-profits, hospitals, government agencies and corporations are part of Healthy Monday. Learn more at www.mondaycampaigns.org

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IN THE KNOW

COOL TOOL
Why your doctor might recommend the da Vinci surgical robot

atients facing surgery have the same desires as their surgeons: reduced risk of infection and blood loss, brief hospital stays, minimal pain and scarring, and quick recovery. Often patients have heard about the da Vinci surgical robot and ask whether it is an option in their situation. The answer: It depends. It depends on the type of operation, the extent of disease, the surgeons judgment and experience, and the patient. As for any minimally invasive surgery, pregnant women and people with bleeding disorders or significant cardiopulmonary conditions are not candidates. (Health insurers, by the way, generally treat robotic surgery like any minimally invasive procedure.) Some surgeons believe the robot is a tool that allows them to perform certain operations better. Heres how: The da Vinci is designed for use during complex procedures in small, hard-to-reach spaces, which are reached through 1- to 2-centimeter incisions or ports. One of the four robot arms is a camera. That cameras view is magnified up to 15 times to a console where a surgeon sits near the operating table. He or she manipulates the camera and the three other arms using controls that look like computer game joysticks. The robots hands have enhanced dexterity, compared with laparoscopic or conventional surgical instruments, and they have no tremors. They fit into tiny spaces where a surgeons hands would not. The visualization with the robotic system is much superior to conventional surgery, Charles Lutz MD, director of robotic and minimally invasive cardiac surgery at Upstate, told The Post-Standard newspaper in Syracuse. At the same time, plenty of surgeries are still best done in the conventional open fashion, where surgeons have access to a wide operating field. Jack Hsu MD, associate professor in Upstates otolaryngology department, says an individualized plan of care is created for every patient, which may or may not include the robot. Upstate was the first Syracuse hospital to buy a da Vinci robot, in 2004. The newest version, purchased in 2011, features the only training simulator in the region.

The da Vinci surgical robot at Upstate is used in a variety of specialties, including:

cardiac
I

gynecology
I

hysterectomy for uterine cancer dissection of lymph nodes in uterine and ovarian cancers uterine and vaginal repair

mitral and tricuspid valve repair single vessel coronary artery bypass repair of atrial-septal defects tumor removal

urology
I I

removal of prostate removal of kidney tumor and repair of kidney complete or partial removal of bladder removal of pelvic or retroperitoneal lymph nodes

I I

ear, nose and throat

I I

treatment of throat cancer removal of hard-to-reach benign tumors of the head and neck

weight loss
I

bariatric surgery

general surgery
I

variety of cases

Karikehalli Dilip MD observes one of the monitors that is part of the da Vinci system.

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Cardiac surgeon Charles Lutz MD examines one of the interchangeable arms of the new surgical robot. Robot models on the horizon will have arms that bend like snakes and allow surgeons to operate through natural orifices without making external incisions.

Its called da Vinci because Leonardo da Vinci invented the first robot, using unparalleled anatomical accuracy and three-dimensional details to bring his masterpieces to life.

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COMMUNITY

Can employers make a difference in diabetes?

hat happened when 45 Onondaga County employees with diabetes or pre-diabetes met weekly at work to learn about lifestyle changes that could help prevent or control diabetes? Over the 12-week program, participants reduced their diabetes risk. They: lost weight, became more physically active, experienced less emotional or uncontrolled eating, decreased their fat intake, reduced their waist circumference, and recorded lower body mass indexes. They also said they functioned better in their daily routines and, as they lost weight, reported greater job satisfaction. Such a lifestyle change program can be successfully implemented at the worksite and has the potential to significantly improve health, Syracuse researchers wrote in the May/June issue of the Journal of Public Health Management and Practice. County workers were granted 30 minutes leave and used 30 minutes of personal time to attend the hour-long weekly meetings during the study, which ended in February 2010. The meeting curriculum was based on the National Institutes of Healths Diabetes Prevention Program, which evolved from a large national study that showed how helping people lose weight can help prevent diabetes. The researchers wanted to see whether a diabetes prevention program in a workplace could have a similar impact, since the majority of adults spend most of their waking hours at work. The results were quite positive. The only negative was and its not surprising that once the intervention stopped there was gradual regain, says Paula Trief PhD, professor of psychiatry and behavioral sciences at Upstate. That happens in most weight loss intervention studies, she says. You can help people make the changes to lose the weight, but the lasting change to keep it off is more of a challenge.

Ethicist
caring for a Killer dam Theall arrived at Upstate University Hospitals emergency room critically wounded, with at least 14 state police bullets in his body on June 22, 2010. The man from Oneida County killed his 3-month-old son, Eithen, with a shotgun blast on his front porch, then turned his gun on troopers. Troopers fired back. Theall needed medical care. Caregivers reflexively took action, few questions asked, except as they related to the medical emergency. They suspended personal feelings. That is the way doctors and nurses and technicians are taught. See a problem; fix it. Behind the conditioned response is the ancient principle, connecting to the Hippocratic tradition nearly 2,500 years ago, of treating every patient the same, without regard for whom that person is. In addition, laws and international agreements such as the Geneva Conventions require prisoners to be treated humanely and receive the medical care they require. Such rules may help condition reflexes. They do not necessarily erase conflicting feelings caregivers may have. Theall pleaded guilty and is serving a state prison term of 25 years to life.

the upstate

Paula Trief PhD and Cynthia Morrow MD

diabetes support project

R
esearch at Upstate examines whether patients with diabetes can learn to manage their disease better if their spouses/partners are involved in the education. Paula Trief PhD, professor of psychiatry and behavioral sciences, seeks volunteers for her ongoing study. Participants must have type 2 diabetes and a willingness to receive diabetes education via telephone. Learn more: 315-464-5619

Onondaga County Health Commissioner Cynthia Morrow MD, who led the study with Trief and Ruth Weinstock MD, professor of medicine at Upstate, says targeting diabetes is crucial since the disease dramatically increases ones risk of heart disease, stroke, lower extremity amputations, kidney failure and blindness. The study revealed a nice side benefit for employers who recognize the importance of a healthy workforce. One of the interesting things about the study was that people who participated who were successful at losing weight were happier at work, Morrow says. We know that when our workforce feels cared for and valued it has a positive impact.

The Upstate Ethicist is compiled from Bioethics in Brief, an online and print publication of Upstates Center for Bioethics and Humanities.

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WORK

GOODJOB

Meet Yanli Zhang-James PhD, research scientist in Psychiatry and Behavioral Sciences
collaborated with Faraone on ADHD. These two disorders share very common mechanisms, she explains. In Parkinsons, brains dont have adequate amounts of the neurotransmitter dopamine because of the neurons in the mid-brain that make the dopamine die. In ADHD, the neurons dont die, but they do not have adequate dopamine, for multiple reasons. What her day is like: It varies. Sometimes I come here at nights or weekends. Once you start a treatment on cells, you might have to wait 6 or 7 hours. Sometimes lately, people in the lab will go play racquetball and then come back and keep working. Why she likes it: I get excited to see interesting things. If we find something new, something that is novel, I just get very excited. When shes not working: I like to read about science, about brains, and I feel very fortunate that I have the opportunity to test ideas. A lot of what we do is very creative and ideadriven. Her goal: A gene called SLC9A9 has been implicated in ADHD in multiple genetic studies and has recently been identified as a risk gene for autism. Its rare. Its very rare. But a lot of autism risk genes are rare, she says. If I can understand fully what this gene does and how the mutation of this gene can cause deficits, Ill be happy with that. One challenge: I can get distracted and go into too many different directions. My mentor always tells |me to keep focused.

just graduated in 2007 with my PhD, and Ive been doing post-doctoral work with Stephen Faraone PhD. I am in transition to being an independent researcher. The award I just received (a $60,000 Young Investigator Grant from the Brain and Behavior Research Foundation) is my first step toward doing independent research.

rubbing elbows: a germ-free way to say hi

Zhang-James studies a specific gene and its connection to autism or Attention Deficit Hyperactivity Disorder, trying to determine whether it affects learning and memory. Our lab is a translational neuroscience lab. Dr. Faraone, my mentor, works with geneticists, psychiatrists and epidemiologists all over the world who are looking for risk genes for ADHD. In our lab we find out what kind of genetic mutations are associated with the disorder, and how genetic or environmental risk factors affect the disease. How she got started: I went to medical school in China. My parents wanted me to be a medical doctor. I have an uncle in China who is a neurologist, and my parents are both doctors. I came to Upstate Medical University in 2002 to be a PhD student. Her interests lay in research more than direct patient care. She studied Parkinsons disease with Frank Middleton PhD, and

s a gesture that commonly accompanies friendly greetings, the handshake is an ingrained habit for most Americans. But along with good will, handshakes have the potential for spreading germs even among those in health care, who wash their hands multiple times per day. Thats why Elvira Szigeti PhD, RN, dean of Upstates College of Nursing, has turned to elbows. Meet her, and shell rub her elbow against yours. Public health officials have urged people to cough or sneeze into the crook of their elbows instead of their hands. Szigeti took that one step further when she gave up handshakes two years ago. She did not want to give up human contact, however, so she developed the elbow tap. I just think its a safer way to do it, she explains. My big thing is, you dont touch other people, and you dont spread germs. I just realized, you never touch your elbows. Sure, the elbow tap generates chuckles, but Szigeti doesnt mind. She credits the move with keeping her healthy.

Upstate University Hospital: Recognized for excellence in cancer, urology, ENT and nephrology

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FOOD

why eat apples? Registered dietitian Pam Blackmer gives four reasons:
G

Shrimp and Avocado Salsa

BY BILL GOKEY

Apples are fat free, cholesterol free and sodium free. According to the 2010 Dietary Guidelines for Americans, consumption of saturated fats, cholesterol and sodium should be limited to help reduce the risks of high blood pressure and cardiovascular disease. Apples contain boron, which is an essential trace mineral. Boron helps to strengthen bones and prevent osteoporosis and fractures. Apples are high in both soluble and insoluble fibers. An increase in dietary fiber (and fruit intake) is recommended in the Dietary Guidelines. Fiber can provide a feeling of fullness and help with weight control. It also improves bowel regulation. Diets high in soluble fiber have been shown to lower blood cholesterol and glucose levels, thus reducing the risk of heart disease and type 2 diabetes. And, apples are grown throughout Central New York and abundant this time of year!

Autumns chill provides enticement to warm your palate. This spicy salsa can act as appetizer, or meal. The heat is easily adjusted. If fresh shrimp will be used within two days after purchase, store it in the refrigerator. Otherwise, wrap it tightly in moisture-proof freezer paper or foil to protect it from air leaks, and store it in the freezer. Use care when preparing frozen shrimp. Place it in the refrigerator overnight. If you must thaw it quickly, either seal it in a plastic bag and immerse it in cold water or if the food will be cooked immediately microwave on the defrost setting and stop the defrost cycle while the fish is still icy but pliable.

Ingredients
4 ripe avocados 2 tablespoons fresh lime juice 4 ounces shrimp, cooked and peeled 1 ripe tomato, seeded and chopped 2 tablespoons onion, finely chopped

1 tablespoon poblano pepper, finely chopped 1 teaspoon lime zest teaspoon ancho chili powder teaspoon cumin salt and pepper to taste chipotle-garlic Tabasco to taste

Preparation
Peel and seed ripe avocados. In a plastic or ceramic bowl, mash the avocados and fold in the lime juice. Fold in your shrimp, tomatoes, onions, peppers, zest and spices. Season to taste with salt and/or pepper. Adjust the heat to your liking with tabasco. Serve with fresh tortilla chips. Makes 16 portions.

Bill Gokey is executive sous chef for Morrison Healthcare, which provides food services for Upstate Medical University. He received the chef professionalism award from the Syracuse Chapter of the American Culinary Federation this year.

Nutritional information, per 2 ounce serving:

119 calories; 10.3 grams fat (1.6 saturated, 8.7 unsaturated); 79 milligrams sodium; 0 grams cholesterol; 1.6 grams protein

Shrimp is a low-calorie, low-fat alternative to meat protein; a four-ounce serving supplies 24 grams of protein for a mere 112 calories and less than a gram of fat. Shrimp is also a good source of the mineral, selenium, and vitamins D and B12.

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Burn
T
he exact number of calories you burn is affected by your age, gender, body size and composition and your level of physical fitness. Use this as a guide, for a person weighing 176 pounds who does the activity for an hour:

calorie

What works best for weight loss: low carb or low fat?

dont think either a low carb or a low fat diet is an effective way of going about losing weight, says Kerry Dal, a registered dietitian in Upstates Bariatric Surgery Center.

Also, people following low-carb diets tend to ingest large amounts of unhealthy fats. Following a low-fat diet does not guarantee weight loss. Consider that a gram of carbs and a gram of protein each contain 4 calories. A gram of fat contains 9 calories. If you cut the fat from your diet, you may lose the satiety factor, and overcompensate with carbs. That may leave you with the same or greater overall calorie intake. Entirely cutting out fats is dangerous, too. Your body actually needs fat, Dal says. Vitamins A, D, E and K are fat soluble. They need fat in order to be absorbed. She says if youre trying to lose weight, the best strategy is to incorporate regular exercise, eat the proper amounts of the macronutrients (carbs, proteins and fats) and make sure the calories you eat dont exceed what you need.
Competitive Tennis: 690 calories Leisure canoeing: 360 calories

Truly, truly, it is a healthy balance of carbohydrates, proteins and fats. With exercise, with movement. You need an active lifestyle, in some form. Dal says people who try to lose weight may try diets that cut out fats, or cut out carbs. Neither is effective, long term. Most people who overeat, overeat on carbohydrates. When they go on a low-carb diet, they may see a rapid weight loss from a loss of water. For every gram of carbohydrate the body stores, it stores two grams of water. When you stop eating carbs and start burning them out of your body, all that water is going with them, Dal explains.

Grocery shopping:

300 calories

Carbohydrates 45 to 65 percent (all ages) Protein 5 to 20 percent (ages 1 to 3) 10 to 30 percent (ages 4 to 18) 10 to 35 percent (age 19 and older) Fat 30 to 40 percent (ages 1 to 3) 25 to 35 percent (ages 4 to 18) 20 to 35 percent (age 19 and older)
SOURCE: FEDERAL DIETARY GUIDELINES FOR AMERICANS, 2010:

Wallpapering:

228 calories

backpacking with a 22-pound pack:

672 calories

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LEISURE

Unwinding: Music strikes a chord with medical students

M
gather your thoughts ime Magazine asked historian/author David McCullough how the study of history would be affected by the lost art of writing letters on paper. The loss of people writing writing a composition, a letter or a report is not just the loss for the record. Its the loss of a process of working your thoughts out on paper, of having an idea that you would never have had if you werent (writing.) And thats a handicap, he says. People (I research) were writing letters every day. That was calisthenics for the brain.

ichael Iannuzzi MD was lecturing medical students on cardiology, using musical excerpts in his presentation of how to listen to heart sounds. He asked for a show of hands: How many students had taken music lessons? About three quarters of the students raised their hands. I was a bit surprised at just how high the percentage of students who took music lessons was, but it does make sense to me, says Iannuzzi, chair of Upstates Department of Medicine. These students are highly competitive, and most come from families who invest resources in their childrens success. These types of families view music lessons as a way to enrich their childrens education, he says.

Music lessons teach discipline, and discipline helps develop high college grade point averages and impressive scores on the medical college admissions test. Music provides many benefits, Iannuzzi says. Graduate school, particularly medical school, is stressful. Music helps reduce stress and is mood-altering. Because of the amount of work that is expected of students, students often feel dehumanized. Music helps feed their soul. Students find ways to wedge music into their schedules. Some are involved in a music and medicine initiative that would support research into music therapy and efforts to make pianos and other instruments available to students, patients and doctors. Some perform in vocal groups or bands. Some play alone, to break up study time and stay in touch with themselves.

Meet seven future doctors who love music:

PIANO Chethan Sarabu, 25, from New Hartford (below)
Why he chose piano: Theres something really special about the piano, because you have to integrate your left and right hands together. Its also very relaxing to be playing. Its something that helps take your mind away from all of the stress. He also played trombone in his high school jazz band. Why he likes jazz: You really have to improvise, but at the same time be part of a group. How he fits music into his day: He studies near a piano in the Upstate Golisano Childrens Hospital, so he can take 5-minute piano breaks.

McCullough is the author of three award-winning biographies of Presidents Theodore Roosevelt, Harry S. Truman and John Adams.

continued on next page

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PIANO Emily Cupelo, 24, from Syracuse (at right)

Unwinding continued from previous page

Good To Know

UKULELE Dan Harris, 24, from Wellsville (above)

How he got started: I stumbled upon a cheap soprano ukulele in my attic back home, while looking for a bowling ball, and brought it back for my last semester of college. A jazz pianist friend helped me learn some basic music theory, so I was able to figure out how to play chords on the ukulele. How he hopes to use it in medicine: Im curious about using sing-a-longs (a\ la Pete Seeger), rhythm workshops and easy instrument lessons in music therapy, as well as harmonicas in respiratory therapy.

How piano helped her education: With just 88 keys there are infinite possibilities to create anything that you want. Being a scientific-minded person, having an outlet to explore creativity definitely helped me to think about things in different ways and to use my imagination. Why she continues to play: I can zone out and just channel my feelings into whatever song I am playing. Its almost like I am not thinking, and can detach my mind and just relax by playing piano.

Tis the season for sneezing

curtailing holiday allergies

PIANO Sam Schueler, 24, from Camillus

Why music is part of his life: Playing piano for 15 minutes clears my head and reminds me that growth in areas outside of medicine is important in becoming a complete person. How he fits music into his day: A few of my classmates and I started a band. While we practice somewhat sporadically and have never performed, jamming for a few hours is a lot of fun and gets our minds out of the books for a while.

PIANO Bradley Klein, 24, from Commack, NY

Why music is part of his life: Music means everything. It is what I turn to during the best and the worst of times. Whether it be classical music, jazz or heavy metal, there is always some sort of music I can rely on to get me through the day. How he fits music into his day: I watch YouTube videos and DVDs of the great pianists performing. When I become desperate for a quick fix, I take out sheet music and practice on my desk, playing along with an audio version of the same piece.

pstate pediatricians and staff provided clippings of holiday trees for a study that showed molds are prevalent on conifers and may be responsible for the epidemic peaks of respiratory illness that occur before and after December 25. The clippings harbored a variety of molds, says Josephine Przepiora, an instructor in the College of Health Professions who co-authored the study, appearing in the journal, Annals of Allergy, Asthma and Immunology. Most molds that were identified are potential allergens and have been shown to increase the risk of wheeze, persistent cough, and allergic sensitization in infants.

VOCALS Kasandra Scales, 30, from Detroit (at right)

Her background: Though I was never formally trained, I developed an ear for music. Growing up in a small Baptist church around so many who were trained shaped my voice into what it is today. One memorable performance: At the end of our first year of medical school, each class puts together a program to celebrate the lives of our anatomical donors, to show our appreciation to their families. I chose to sing an acappella gospel song that I would often sing to myself to comfort me after the loss of my aunt two years earlier. In the audience was one of our custodians, whose loved one had passed away and donated his body. A few weeks later he saw me in the hall and told me how much that song meant to him, and from then on we were friends.

VOCALS Rhonda Diescher, 25, from Cortland (at right)

Her background: She has performed all over the world, including at the Cathedral Notre Dame de Paris, the Kennedy Center and the Carrier Dome, twice, where she sang the National Anthem. Why music is part of her life: When I start singing a great song, its like I am worlds away from a hard test, a bad grade, a bad breakup or a patient that cant be helped. Also, I feel like music helps keep me connected to my humanity and the part of me that cares about people ultimately what I think will make me a good doctor.

What to do?
Artificial trees may not be the answer, since they can harbor dust and mold if stored improperly. The American College of Allergy, Asthma and Immunology suggests wearing gloves to avoid contact with sap, and using a leaf blower in a well-ventilated area to help remove visible pollen grains before bringing conifer trees into the home. The Asthma and Allergy Foundation also suggests wiping the trunk of the tree with a solution of lukewarm water and diluted bleach (1 part bleach to 20 parts water) to eliminate mold.

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LEISURE

good REAd
The Immortal Life of Henrietta Lacks by Rebecca Skloot cientists all over the world know of HeLa, a prolific line of cancer cells used in research. Most believe the cells came from a woman named Helen Lane or Helen Larson. Read journalist Rebecca Skloots thoroughly researched book, The Immortal Life of Henrietta Lacks (Crown Publishing) to learn the real story. The cells belonged to a 31-year-old mother of five who died of cervical cancer in Baltimore in 1951, whose family learned of the cell line 25 years after her death. Joel Potash MD, emeritus professor in Upstates Center for Bioethics and Humanities and a clinical professor in the Department of Family Medicine, says Skloot poses many intriguing questions: Should you be able to restrict the use of your tissue? Should you be able to control whom has access to your tissue, since genetic information gathered may be harmful to you and your family? Is there a public responsibility to advance knowledge and help others through research? Should patients be told that tissues may be patented and used for profit? Should they receive compensation, such as royalties and tax write-offs? This book makes fascinating reading and should renew concerns about the ethics of research on patients, their cells, and their tissues, Potash says. Obtaining informed consent from patients is now the rule for medical care and research, but many questions still remain about exactly what patients understand when they sign these forms.

Three great hikes, prescribed by the Adirondoc

rials and tribulations of everyday life got you down? Hit the trail. With proper planning, solid skills and appropriate gear, Thomas Welch MD says enjoying the Adirondack backcountry can be just the antidote. When hes not caring for sick and injured children and teaching the pediatricians of tomorrow, Welch, chair of Upstates Department of Pediatrics, can often be found in the wilderness. He is a licensed New York state guide and a certifying instructor for the Wilderness Education Association who regularly teaches field courses and guide groups in Alaska, Montana and New York. Hes known as the Adirondoc. Which of his recommended hikes is right for you?

The Starter
Bald (Rondaxe) Mountain trail Generations of New Yorkers took their first Adirondack hike climbing this mountain. The trail begins off Route 28, between Old Forge and Inlet. The hike is over easy terrain for less than a mile and less than 400 feet in elevation change. There is an abandoned, but still usable, New York state fire tower at the top, with spectacular views of the Fulton Chain of Lakes.

The Adirondoc hiking on Mt. McKinley, the highest mountain peak in Alaska. The Advanced
Dix Mountain While it is only the sixth tallest of the Adirondack High Peaks, Dix Mountain, (at 4,857 feet), is vastly more remote than the tallest five. While one can often find hundreds of hikers on Mounts Marcy (5,344 feet) and Algonquin (5,114 feet) on nice days, it is common to find oneself alone on Dix, which is between the towns of North Hudson and Keene. The peak is open with steep slides on its sides and breathtaking vistas. With a nearly 14-mile round trip, and about 3,000-feet of elevation change, it is a real challenge. Moreover, this hike provides serious wilderness activity. Even the parking lot is more than five miles from the highway on a dirt road, and the highway doesnt get much traffic. That means an emergency on the top of Dix can quickly become a catastrophe. This hike should only be attempted by an experienced hiking group carrying maps, compass, emergency shelter and food, and preparations for sudden weather change, even in summer.

The Novice
High Falls of the Oswagatchie This is one of New Yorks most remote rivers. High Falls is a short (15 feet) but spectacular drop in the river, surrounded by loads of flat rocks for sunning and some awesome swimming spots. You can canoe to High Falls, but there is a nice hike, which begins in Wanakena, one of New Yorks most unique hamlets, on the shore of Cranberry Lake. The hike is about 15 miles round trip, but the trail is mostly flat, scenic and easy to follow. Anyone in reasonably good shape, including children older than 8 years, with past hiking experience, should be able to do this in a long day. It can also be made into an overnight, since many designated campsites are nearby. Among other wonders, the area has some of the largest examples of virgin white pine (Pinus strobus) remaining in North America.

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THE HUMORIST

Humorist Jeff Kramer gets serious about his health

BY JEFF KRAMER

here are many things we can do to motivate ourselves to lose weight, but heres one I dont recommend: Getting rushed to the E.R. with symptoms resembling a heart attack....
Yes, its an effective appetite suppressant I wont deny that. My life-long cravings for burgers, pizza, pancakes and pastry have miraculously vanished since 8 p.m. Friday, May 27. At that hour, while fumbling with the remote to watch the Stanley Cup Finals, I was overcome by intense vertigo and a terrible pounding in my chest that left me almost unable to speak. Call 9-1-1. Heart! was all I could tell my wife. Then I sat down in a chair, all 305 pounds of me, broke into an icy sweat and waited for the sirens. Once or twice I turned my head to look at my two bewildered young daughters. By the time the paramedics arrived, my wife had sent them down to the basement. They dont need that kind of drama in their lives, and neither do you. Thats why I hope youll join me on this new adventure in health and wellness. The premise behind my mission is simple: Im going to lose 50 pounds, maybe a bit more, by using every applicable weightloss weapon in Upstate University Hospitals arsenal. Then Upstate is going to help me keep it off. Some day, deep in the future, the battle will be won and the focus of my mission will be revised. But for now its all about shockand-aweing all those extra pounds out of existence. My qualifications to be your guinea pig are as follows:
G 49

years old. 6-foot-2. 305 pounds.

G Often

referred to as Big Guy even by those who dont know me. broke examining table during follow-up exam.

G Recently

GI

love food. Healthy food. Unhealthy food. Pet food. It doesnt matter. Somewhat incongruously, I also love vigorous exercise. The evidence suggests that I love the former more than the latter.

I do have a few things in my favor: genetically low cholesterol and, apparently, a healthy heart, based on my treadmill test at the hospital. At present Im feeling weirdly lucky about my Memorial Day weekend scare. My annoyingly thin doctor believes my episode might be sleep apnea-related. He also believes most of my health issues apnea, high blood pressure, acid reflux, arthritis in my left knee will be greatly alleviated by weight loss. Of course, he has said this for years, but sometimes its hard to understand his obtuse technical jargon, phrases such as, Youre too heavy, We need to get some weight off you, and Youre overweight. But the message has finally registered. All it took was a ride in an ambulance. Its time to get to work. Lets roll. Make that half a roll. No butter.

Recovering Big Guy Jeff Kramer, a journalist for 25 years, will write in each issue about his efforts to slim down with help from Upstate University Hospital. For more about his efforts, read his dispatches at upstate.edu/whatsup.

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Non Profit Org. US Postage

PAID
Permit No 110 Syracuse, NY
750 East Adams Street l Syracuse, NY 13210

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his is a breast cancer cell under study in Christopher Turners laboratory at Upstate Medical University. Researchers are studying how cancer spreads, or metastasizes, because Christopher that is the fatal step in Turner PhD cancer progression, the primary reason there is a high mortality with these types of cancer, says Turner, a professor in Cell and Developmental Biology. Post-doctoral fellow Nicholas Deakin Nicholas PhD photographed this Deakin PhD cell in motion. He is the recipient of the Paper of the Year Award from the Molecular Biology of the Cell editorial board.

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