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The Pivot to Online

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By Kathryn Ruscitto

Friday, February 26, 2021

COVID-19 has taught us so many lessons, many of which we didn’t know we needed to learn. Some have been big surprises to organizations and others have helped to accelerate the work they do. In my world, board meetings, social events, fundraisers, conferences and educational forums have all worked in an online environment. We certainly lose some of the conversations and networking we experience in person but the expense, travel, time spent attending an event and the ability to interact from anywhere are big pluses.

I recently attended a Lyme disease research forum online that was hosted by State University of New York and organized by Saravanan Thangamani, MD. About 150 people attended, there were thirty presentations, materials were easily visible, and comments and questions were easily posted. It was an experience I am not sure would have happened at the same level in person.

“The online meeting allowed researchers like me to save time and resources on long-distance travel and reduce the carbon footprint,” Dr. Thangamani says. “Besides, increased participation and sharing information with a broader audience could not have happened if I had organized this meeting in a physical university building.”

On another day, I participated in a legislative breakfast via Zoom for a new organization. Ten elected officials attended without staff and then stayed to answer questions. It was efficient not having to travel to the event and the organization was able to share its message. The platform turned out to be a great way to educate.


Kathryn Ruscitto

I have also attended and helped plan five online fundraisers. I think it’s safe to say that while it’s helped during this time, it’s probably something we may discontinue when social events are able to return to normal. Organizations have tried hard to make the experience pleasant, but most people I have spoken with have had their fill of Zoom fundraising, although it may continue to work for organizations with a national reach.

So what are the implications for health care? Telemedicine has taken off, and software allows primary care physicians and specialists to more easily communicate and provide follow-up care and education for a wide range of health conditions.

Are all patients able to take advantage of this new world? Watching citizens attempt to register for COVID-19 vaccines has brought concern to this issue.

Sandra Sulik, MD, a family physician at St. Joseph’s Health with more than 27 years experience in the medical field, spoke about the importance of connecting with her elderly patients while keeping them safe at home.

“It not only allows us to continue the medical care for their chronic illnesses but also provides a touch-base point for many of the folks who live alone and are so isolated,” Dr. Sulik says. “Many of our visits are ideally suited to telemedicine, such as follow-up care for depression and anxiety and many other chronic illnesses that require mostly discussion.

“It does provide some challenges. Many situations require hands-on examination and of course that can’t be done via telemedicine. The technology, especially with the video visits, can be challenging for some clinicians and patients as well. Most of the time though, a really good visit can be accomplished.”

The reality is we are not going back to a pre-COVID-19 world, but we need to understand what has worked and what needs further analysis. How will we debrief these experiences and build toward a better future? This is an opportunity for our professional societies to explore.

Hopefully, we will see a return to a more normal environment later this year — let’s take the learning forward.

Kathryn Ruscitto, Advisor, can be reached on LinkedIn at KathrynRuscitto or through email at krusct@gmail.com

Kidney Care at Nephrology Associates of Syracuse, PC Remains Focused on Patients

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By Cari Wade Gervin

Tuesday, December 22, 2020

Despite a less than ideal 2020, Nephrology Associates of Syracuse, PC is looking ahead to the future.

The Team at Nephrology Associates of Syracuse, PC
 

As Nephrology Associates of Syracuse, PC began its 42nd year in business in January 2020, the future seemed as bright as it had ever been. A massive renovation was in the works. There were plans to add telemedicine to the practice to help improve ongoing outreach to rural patients.

And then came March — and the coronavirus pandemic.

“No one could have ever imagined what this pandemic would be like,” says Matthew Chaffin, MD, a nephrologist and the compliance officer for Nephrology Associates of Syracuse, PC. “It significantly altered how we took care of people.”

But after months of logistical challenges, Nephrology Associates of Syracuse has adjusted to the new normal. The team continues to provide management and treatment of advanced kidney disease, while leveraging telemedicine and remote mobile care teams to bridge the gap between cautious patients and in-office care.

“I think this was a good stress test,” says Adebowale Oguntola, MD, President of Nephrology Associates of Syracuse, PC and Medical Director of DaVita Kidney Care Central New York Dialysis Center. “The pandemic highlighted one of our key strengths — teamwork.”

“It’s satisfying to take care of complex problems and help patients feel better and to know we are making a difference in their life.”
— Matthew Chaffin, MD, nephrologist and compliance officer, Nephrology Associates of Syracuse, PC

Left to right: Jacquelyn Spencer, NP; Marcia Van Buren, NP; Tracy O’Neill, PA; Joanna Woodruff, NP; and Alyssa Miles, PA

Personalized Care for Kidney Disease

Despite the challenges presented by COVID-19, Nephrology Associates of Syracuse continues to be on the forefront of kidney disease management and treatment. The practice specializes in the treatment of chronic kidney disease, providing care for patients with diabetes-related kidney issues, high blood pressure and anemia, as well as those on dialysis and those who have had a kidney transplant.

“When you combine passion with training and excellence in what you do, it’s very powerful,” Dr. Oguntola says. “It’s contagious. People see that, and they feel that, and they have a sense of wanting to be part of something greater.”

At Nephrology Associates of Syracuse, PC, physicians personally see their patients on a regular basis. Nephrologists such as Dr. Chaffin may develop years-long relationships with patients.

“The reason why I became a nephrologist was because you could see one patient and follow them for years,” Dr. Chaffin says. “I know many of my patients so well that when I open the door and I walk in and I look at their face, I can tell if something’s going on,” Dr. Chaffin says. “I like that personal interaction with the patients. At the same time, it’s quite satisfying to treat complex problems and help patients feel better and to know that we are making a difference in their lives.”

Collaborative Approaches to Complexity

At Nephrology Associates of Syracuse, PC, most patients have multiple comorbidities, which can make care complicated at times. The nephrologists must stay aware of each patient’s status and treatment plan in terms of heart function, blood sugar and many other medical indicators.

“We remain in contact with multiple care providers about each patient,” Dr. Chaffin says. “And some cases are complicated enough that we see a patient frequently — sometimes once a month.”

This collaborative and personalized approach to care is what makes Nephrology Associates of Syracuse, PC different, as providers constantly work closely with both patients and other healthcare organizations to create integrated care for each patient. The six board-certified physicians on staff share similar philosophies and often consult with one another, too.

Ties Forged by Compassion

Many patients spend years at Nephrology Associates of Syracuse, PC, including at the end of their lives. Not all patients, however, have chronic conditions. Sometimes, nephrologists can provide treatment that resolves a medical episode entirely.

“At the beginning of my practice, I saw one patient — a young lady with high blood pressure,” says Adebowale Oguntola, MD, President of Nephrology Associates of Syracuse, PC and medical director of DaVita Kidney Care Central New York Dialysis Center. “She didn’t want to see me initially because she thought I was a young doctor. She expected to see a gray-haired doctor.”

After several months of treatment, Dr. Oguntola cured the underlying problem that caused the woman’s high blood pressure.

“I informed her that her blood pressure was good and she did not need to see a nephrologist anymore,” Dr. Oguntola says. “She seemed kind of disappointed.”

That patient is not the only one who has been sad when their care at Nephrology Associates of Syracuse, PC has ended, even though the cause is a happy one.

“I think examples like that are a testament to the kind of services we provide,” Dr. Oguntola says. “That is why we are the practice of choice for our patients.”

“We care deeply about our patients,” Dr. Oguntola says. “We enjoy collaboratively working together to provide excellent care. And when we collaborate with other specialties, people respect us because of the excellence we strive for.”

“Nephrologists are very independent-minded people,” Dr. Chaffin adds. “To have a large group of nephrologists who all can work together and believe the same philosophy is unusual. It’s one of the reasons I came to Syracuse.”

“When you combine passion with training and excellence in what you do, it’s very powerful. It’s contagious. People see that, and they feel that.”
— Adebowale Oguntola, MD, President of Nephrology Associates of Syracuse, PC and medical director of DaVita Kidney Care Central New York Dialysis Center

Continuing Care During COVID-19

After the onset of the pandemic, the practice modified workflows and adopted protocols to ensure safety and health precautions for both patients and staff.

“Every member of the group rolled up their sleeves,” Dr. Oguntola says. “We were able to restructure the workflow with the appropriate screenings and CDC guidance. The staff were unbelievably amazing and continued to work under hard conditions with a good attitude.”

Despite the safety protocols, many patients stayed away.

“Very few people were willing to come to the office for about two months, appropriately afraid of catching COVID-19,” Dr. Chaffin says. “That set the practice back. When patients started to return, however, we were overwhelmed trying to catch up on two months’ worth of patients who hadn’t been seen.”

Toward the end of 2020, the team continues to see patients who have delayed care since March, sometimes to deleterious effects.

Implementing telemedicine started as a challenge due to the nature of nephrology care. The technology allowed for safe, remote visits but could not meet nephrology patients’ need for detailed physical exams and lab work. Additionally, some patients had difficulty adapting to the medium.

“Many of our patients are over age 65, so the practice helped patients acclimate to the technology in order to complete telemedicine appointments,” says Anne Zaccheo, MBA, FACMPE, Practice Director of Nephrology Associates of Syracuse, PC. “Through creative thinking and patience, the practice identified appointment alternatives and offered multiple telemedicine options to allow for audio and visual communication in an attempt to meet each patient’s care needs.”

Zaccheo is also the President of the New York Medical Group Management Association (NY MGMA), “an active association of professional medical group practice leaders from all across New York […] whose members are dedicated to the advancement of group practice management through educational programs and the exchange of information and knowledge among and between colleagues.” Zaccheo shares that the practice benefitted from the sharing of local best practices and collaborative problem solving related to COVID-19 and other practice challenges among other healthcare practice leaders in NYMGMA.

As the pandemic spread, the practice began offering private blood draws for transplant patients who were nervous to go to the office, a practice that they still continue. Nephrology Associates of Syracuse also continues to operate satellite locations in Camillus, Fayetteville, Fulton and Vernon to provide access to nephrological care for patients without a mode of transportation. A mobile team consisting of a physician, advanced practice provider, medical assistant and phlebotomist travels together to ensure ongoing care is available to patients.

“Providing access to rural areas and to patients who are unable to travel to the main office is an important value and priority for the practice,” Zaccheo says.

Renovations — and Innovations — Continue

The renovations at Nephrology Associates of Syracuse will better support the new workflows and provide an enhanced patient experience. There will be a new clinical laboratory, a new blood draw room, two new patient bathrooms, a renovated waiting room, a new reception area, two new bariatric exam rooms, a new medical assistant area and a new break room for employees.

Matthew Chaffin, MD, Compliance Officer


Adebowale Oguntola, MD, President


Phillip Ondocin, MD


Anne Zaccheo, MBA, FACMPE, Practice Director at Nephrology Associates of Syracuse, PC and President at New York Medical Group Management Association


At the time of publishing, the COVID-19 pandemic has entered a second wave, and there is hope with a vaccine to be available in the U.S. shortly.

“Our goal is to enhance the patient experience and improve collaboration among team members,” Zaccheo says. “The changes will enable our team to further optimize clinical workflows and enhance communication, as well as upgrade the office and work environment for patients, staff and providers.”

Learn more about Nephrology Associates of Syracuse, PC at nephrologysyracuse.com.

St. Joseph’s Health Extends Access to Heart Care

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Tuesday, December 22, 2020

Heart failure affects more than 6 million people in the United States and is escalating rapidly, with an estimated 960,000 newly diagnosed cases annually. In many cases, patients who visit the emergency room (ER) for heart issues do not attend the recommended follow-up visit with a cardiologist. This leads to continued cardiac issues down the road.

Russell Silverman, MD, FACC, Medical Director of the St. Joseph’s Health Heart Failure Clinic and Chief Medical Officer at Rome Memorial Hospital, (pictured on screen) using the Bluetooth technology on a patient.

With that in mind, the St. Joseph’s Health Cardiovascular Institute has opened a Heart Failure Clinic at its Brittonfield Cardiology office. The Heart Failure Clinic will provide early follow-up (within one week) to patients without an established physician/cardiologist, provide care to the uninsured and serve as a bridge for patients who aren’t able to make a follow-up appointment within one week.

“We see it time and again. People end up in the ER with heart conditions, and when they are released, they don’t see a cardiologist fast enough, or they don’t start their medications right away,” says Russell Silverman, MD, FACC, Medical Director of the St. Joseph’s Health Heart Failure Clinic and Chief Medical Officer at Rome Memorial Hospital (RMH). “This can cause continuing heart issues. The incorporation of the Heart Failure Clinic at St. Joseph’s Health will further improve access to timely, quality care and improve outcomes for our heart failure patients.”

The Heart Failure Clinic is a partnership with University of Rochester Medical Center. URMC cardiologists Leway Chen, MD, and Mark Tallman, MD, will each see patients at the Brittonfield location, reducing the need for patients to travel to Rochester for routine care. Developing an advanced heart failure treatment clinic also allows St. Joseph’s Health to provide care to its left ventricular assist device (LVAD) patient community — care that is not currently available.

Bluetooth stethoscope

“The Heart Failure Clinic improves access to timely, quality care and improve outcomes for our failure patients,” Dr. Silverman says. “There’s been a need for a clinic like this for many years. St. Joseph’s Health saw that need and stepped up to offer this important resource for the community.”

Strategic placement of the heart failure clinic within the Brittonfield practice offers availability to stress, echo and EKG services, as well as access to on-site cardiologists. It also supports the goal of reducing preventable readmissions in heart failure patients.

Dr. Silverman performs a stress test on a patient.

 

Improving Access in the Mohawk Valley

St. Joseph’s Health is also teaming up with RMH to offer patients in rural areas access to highly advanced cardiac care. “Bluetooth stethoscope” technology is now being used at the Cardiovascular Institute at RMH to connect cardiologists to patients without physically being together.

“This is truly remarkable technology. It’s the first of its kind in the region,” Dr. Silverman says. “It enables us to bring high quality heart care to areas that might otherwise not be served by these types of subspecialties.”

During a consultation, the patient at RMH is accompanied by a nurse or respiratory therapist (RT). They connect via computer to the cardiologist in Syracuse. The cardiologist speaks with the patient to assess how he/she is feeling. Then, the nurse or RT moves the Bluetooth stethoscope to different parts of the patient’s chest and neck so the physician can hear and see the patient’s heart activity.

“Our goal is to use this remarkable technology to keep patients close to home,” Dr. Silverman says. “By treating their heart issues using the Bluetooth stethoscope, we hope to limit the number of patients who need to be transferred out of town to St. Joseph’s Health if they don’t need tertiary care. They can stay close to their loved ones, which is what we strive for.”

St. Joseph’s Health and RMH are the only hospitals in the region using this technology. It is currently being utilized for inpatient and ER consultations.

To refer patients to the St. Joseph’s Health Cardiovascular Institute in the Dorothy G. Griffin Cardiovascular Center at RMH, call 315-338-7220.

To refer patients who need advanced heart failure management to the Heart Failure Clinic at St. Joseph’s Health, call (315) 703-5090. In addition, any patient being released from hospitalization at St. Joseph’s Health Hospital and other Central New York hospitals, as well as those being discharged from rehabilitation centers, can be referred to the Heart Failure Clinic.

St. Joseph’s Health is one of only eight hospitals in the nation to be named an American Heart Association Center of Excellence. It was also listed as one of America’s 50 Best Hospitals for Cardiac Surgery in a national study by Healthgrades, and it received the highest performance rating for Heart Bypass Surgery by U.S. News & World Report. For more information, visit everybeatmatterssjh.org.

Comprehensive, Leading-Edge MRI Services at Magnetic Diagnostic Resources of Central New York

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By Thomas Crocker

Tuesday, December 22, 2020

Celebrating 35 years as Central New York’s premier provider of MRI services, Magnetic Diagnostic Resources of Central New York (MDR of CNY) draws on the expertise of dozens of fellowship-trained radiologists and a relentless commitment to quality to provide an exceptional experience for patients and referring clinicians.

The prostate MRI patient experience begins with compassion and care and ends with image quality excellence. Pictured: MRI technologist Paul Mingle 
 
Established in 1985, MDR of CNY’s mission is to provide superior, specialized MRI services in a welcoming, warm and patient-focused environment, transforming what often is an apprehensive experience into a notably calm one.
 

“A variety of factors distinguish our services from others in the region,” says Jacqueline Floyd, ARRT(R)(MR), MBA, CEO of MDR of CNY. “We have nine convenient locations throughout Central New York, and we invested in the latest specialized software to offer organ-specific specialty scans, some of which are not available at other organizations in our region. We think it’s important to offer a host of MRI services to Syracuse and surrounding communities.”

The new wide bore 1.5T GE 450W high-field scanner will enhance breast MRI comfort with a unique range of exclusive, patient-friendly features so you can relax in comfort during the scan. Pictured: MRI technologist Paula Mulholland
 

A Variety of Specialty Scans

MDR of CNY has long been known for providing breast MRI. In certain cases, this modality can complement mammographic findings during diagnostic evaluation, help measure the extent of known breast cancer, assist in assessing eligibility for or response to hormone therapy or chemotherapy, provide additional information about suspicious findings, and screen patients at high risk due to genetic mutations or history of radiation therapy to the chest, according to The American Society of Breast Surgeons Consensus Guideline on Diagnostic and Screening Magnetic Resonance Imaging of the Breast. MDR of CNY was an early adopter of dedicated breast coils — components that play a key role in creating images of the breasts by transmitting and receiving radio waves during a breast MRI — and CADstream, a software program that helps radiologists visualize abnormalities and plan interventions in a timely manner. MDR of CNY was also one of the first MRI providers to offer MRI-guided breast biopsy. The American College of Radiology (ACR) has accredited MDR of CNY for nine MRI accreditations and four breast MRI accreditations. The organization maintains its status by seeking reaccreditation every three years.

“MDR of CNY has always focused on ACR accreditation for MRI in general and for subspecialty MRI,” says Scott Buckingham, MD, partner radiologist at MDR of CNY. “ACR accreditation is a hallmark of quality and the most widely recognized guarantee for patients that an outside entity has reviewed the capabilities, experience and training of the professionals who conduct MRI studies.”

In addition to breast MRI, MDR of CNY is a high-volume provider of prostate MRI — which can help determine whether a biopsy is warranted and provide guidance during that procedure, as well as aid prostate cancer staging and radiation therapy planning — and many other specialty MRI services, including:

  • Cardiac MRI
  • Conditional pacemaker MRI
  • Enterography
  • Elastography
  • Fetal MRI
  • Inhance, non-contrast MRA
  • MR arthrography
  • MR urography
  • Spectroscopy
  • Stroke and advanced neurofunctional imaging

Patients who have a specialty scan at MDR of CNY can be confident they will receive an accurate reading of their images, as one of the organization’s key differentiators is its team of 47 board-certified, fellowship-trained partner radiologists from two of Central New York’s largest radiology groups, CRA Medical Imaging and St. Joseph’s Imaging Associates. These radiologists possess subspecialty training in a variety of fields, including breast imaging, neuroradiology, musculoskeletal imaging and body imaging.

“Our team has many years of experience performing subspecialty reads,” Dr. Buckingham says. “That’s important because patients whose images are read by a radiologist with specific training in an MRI subspecialty and high-volume experience tend to enjoy more accurate results.”

The patient experience and excellence in quality starts with an experienced and professional leadership team.

 

Prioritizing Safety

Patient safety is paramount for MDR of CNY, which is why its technologists and other members of the team take all necessary steps to safeguard patients before conducting scans. Those steps include verifying that patients’ medical implants are MRI compatible, analyzing records of patients’ previous studies and evaluating kidney function, as the use of a gadolinium-based contrast agent during an MRI can cause problems for certain patients, such as those with diabetes or chronic kidney disease. When appropriate, the MDR of CNY team uses a handheld device called i-STAT to conduct a point-of-care blood analysis that can reveal kidney function.

“Patients can undergo testing with i-STAT in the office at the time of the scan rather than having lab work at a different facility,” Dr. Buckingham says. “That’s a much more convenient way of determining whether a patient is suitable to receive a contrast agent because it doesn’t require separate office visits and eliminates unnecessary cancellation of studies.”

If a patient needs an MR angiogram but has suboptimal kidney function, the MDR of CNY team can perform his or her study using Inhance, a technique that allows technologists to capture images of the renal arteries without using a contrast agent.

Highly trained radiologists at MDR of CNY are board certified with the American Board of Radiology and considered experts in their field. Pictured: MRI technologist Stephanie Labulis and radiologist David Wang, MD

Convenient and Compassionate

Providing a seamless, one-phone-call scheduling experience for referring providers is a point of pride for MDR of CNY, as is the organization’s ability to accommodate urgent imaging requests and its commitment to scheduling appointments within a two-week timeframe. When needed, MDR of CNY can accommodate STAT requests.

When patients arrive at one of MDR of CNY’s nine locations, they encounter an atmosphere designed to allay any anxiety they may feel about undergoing an MRI. The staff sets the tone.

“Patients have never met a kinder or more compassionate staff,” Floyd says. “Our technologists truly understand how to calm and reassure patients. If a patient is feeling exceptionally anxious, we may give him or her the option to visit the office a day or two before the appointment to talk with our staff about the scan and observe the machine. Our experienced technologists ensure that the patient feels safe and comfortable and stay in voice contact throughout each exam.”

For patients with claustrophobia, a wide-bore MRI scanner and an open unit are available at neighboring locations on Brittonfield Parkway in East Syracuse.

“We do what is best for our patients,” Floyd says. “Our technologists treat every patient with compassion and professionalism, which is why we routinely receive comments in our patient satisfaction surveys singing their praises.”

Timely Communication

Swift communication with referring providers and seamless transmission of scan results is a priority for Magnetic Diagnostic Resources of Central New York. That is why the organization, its partner radiology groups CRA Medical Imaging and St. Joseph’s Imaging Associates, and their associated health systems use a shared picture archiving and communication system. Referring providers receive nonurgent image reports within 24 hours. Providers receive urgent results as soon as a radiologist finishes reading the images.

For more information, visit mdrcny.com. Click on “Referring Physicians” to request an appointment for a patient or call 315-454-4810, press 1.

A Healing State of Mind: SUNY Upstate Medical University Is Advancing the Landscape of Neurology and Neurosurgery

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By Katy Mena-Berkley

Monday, November 2, 2020

At the State University of New York Upstate Medical University, neurologists, neurosurgeons and neuroscience researchers work together to offer a robust spectrum of neurological solutions to the Central New York community.

Ruham Nasany, MD, is leading a multi-disciplinary team for the new Neuro-Oncology program.
 

Located in Syracuse, Upstate is the region’s main referral center for specialized medical care and the only one to have a comprehensive neurological disorders program.

“Central New York is a large territory that covers one-third of the state and is home to one-tenth of New York’s population,” says Luis Mejico, MD, Professor and Chair of the Department of Neurology at SUNY Upstate Medical University. “In order to satisfy and meet the needs of our community, we have expanded our established programs to form the Upstate Neurological Institute. This is critically important at a time when neurology and neuroscience is the most sought-after specialty in the country.”

In the past 15 years, SUNY Upstate Medical University’s neuroscience offerings have expanded tremendously. Together, the departments of Neurology and Neurosurgery have doubled its number of faculty, recruiting the best and brightest clinical minds from all corners of the United States, and have also retained a significant portion of SUNY Upstate Medical University trainees and residents.

“Our clinical neuroscience program is the most advanced in the region, touching on the three pillars of neurological clinical care, education and research,” Dr. Mejico says. “We have invested a lot of effort into generating programs that provide the best care for our community, and we continue to expand and improve high quality care here in Central New York.”


Luis Mejico, MD, is the Chair of Neurology and is part of the multidisciplinary Neuro-Ophthalmology clinic, one of the dozen specialty clinics in the department.

Satish Krishnamurthy, MD, leads the Neurosurgery department and is a funded researcher. In Fall 2020 he received a $324,000 DOD grant to find a pharmacological solution for hydrocephalus instead of repeated shunt surgery.

Leading-Edge Solutions Close to Home

While people may need to travel for specialized operations such as neurosurgery, Upstate provides a more convenient option for patients and families in Central New York, as well as northern and western Pennsylvania.

“We cover the length and breadth of neurosurgery, offering the treatment options that our community needs,” says Satish Krishnamurthy, MD, MCh, FAANS, Professor and Interim Chair of the Department of Neurosurgery at SUNY Upstate Medical University. “The idea is to have the country’s best care right here in our patients’ backyard.”

Established in 1966, the Department of Neurosurgery has a long-standing history of training neurosurgeons to manage a wide variety of disorders found in the brain and spinal cord.

“Neurosurgery at Upstate has always catered to the sickest of the patients, while also contributing to education and making sure neurosurgeons not only do a good job, but provide the community with the best care possible,” Dr. Krishnamurthy says. “We have a specially trained team and high-end technology right here.”

Stroke Care and Telemedicine

Patients in rural communities who experience stroke can trust the board-certified stroke physicians at Upstate University Hospital to provide expert care via telemedicine. Using and interactive video conferencing, Upstate’s team can connect with emergency departments at partnering regional hospitals in real time. Each patient may see a consulting neurologist and Upstate’s stroke specialists. Together, this team provides timely medical evaluation and administration of tPA treatment to improve outcomes and minimize risk of long-term complications.

Upstate Brain & Spine Center is staffed by the largest team of neurosurgical specialists in Central New York, providing a spectrum of services to patients at Upstate University Hospital. The team also provides support to patients at multiple Upstate facilities, including its Level I trauma center — the only one in the region — Upstate Cancer Center, Upstate Golisano Children’s Hospital, neonatal care units and Upstate Comprehensive Stroke Center.

Intensive Care for Neurological Conditions

Upstate University Hospital is home to the only structured neurocritical care service in Central New York. The dedicated unit is designed to treat, manage and evaluate patients with the most severe and complex conditions affecting the brain and spine. During the past decade, Upstate’s Neuro ICU has nearly more than tripled in size, expanding from an eight-bed unit to a 27-bed unit.

“The expansion meets the growing needs of the region,” says Julius Gene Latorre, MD, MPH, Medical Director of the Upstate Comprehensive Stroke Center. “This was in part fueled by the advancement in acute stroke care and in medical advances in the management of neurosurgical conditions and traumatic brain injuries.”

The neurology specialists in the Neuro ICU typically treat patients with intercranial hemorrhage that may be related to a spontaneous hemorrhage of the brain or traumatic hemorrhage of the brain. They are also practiced in managing the care of patients experiencing brain injury related to loss of oxygen from cardiac arrest. Other conditions these specialists may see include uncontrollable seizures and complex neuromuscular conditions, such as Lou Gehrig’s disease.

In addition to technology and equipment commonly found in ICUs, the Neuro ICU at Upstate University Hospital also has monitoring equipment specially designed to monitor brain function, such as continuous electroencephalogram (CEEG) monitoring critical in the detection of non-convulsive seizures.


Julius Gene Latorre, MD, MPH, Medical Director of Upstate Comprehensive Stroke Center, the first in the region

Harish Babu, MD, Assistant Professor of Neurosurgery at Upstate, is one of the clinicians providing care to patients with surgical disorders of the brain and spine. Together with his colleagues, Dr. Babu provides intensive neurosurgery embracing sophisticated technologies. The neurosurgeons and neurosurgical researchers specialize in brain bleeds, brain tumors, hemorrhages, pediatric care, nerve and spine problems, and strokes. Upstate’s neurosurgical technologies include:

  • Minimally invasive robotic surgery — Operating through small incisions, can avoid some complications associated with surgery that requires a larger opening. Using stereotactic laser ablation, the neurosurgery team can address multiple neurological conditions, including epileptic foci and tumors.
  • Endoscope — “Using an endoscope, we are able to investigate the nooks and crannies of the brain in a manner that does not disturb surrounding tissue,” Dr. Babu says. “We can use endoscopes through the nose to reach the brain for surgeries. Then we can use pointed lasers to burn tumors. We also have computerized microscopic navigation techniques, which are like a GPS for the brain that allows you to target a specific pinpointed area.”
  • Fluorescein-guided neurosurgery — Using a green-water soluble dye known as sodium fluorescein, neurosurgeons can more accurately investigate a tumor site. The dye accumulates on areas of the brain where the blood-brain barrier has been damaged, highlighting the tumor tissue more clearly.
    “In some patients, we do not think that we can see every single cell with our eyes or an MRI machine,” Dr. Babu says. “When we inject the dye as part of surgery, the tumor cells will light up differently compared to the normal brain. That helps us remove those tumors and keep the normal parts of the brain in intact.”
  • Focused radiation Gamma Knife — This computerized treatment planning software helps neurosurgeons precisely locate targets in the brain and deliver concentrated doses of radiation to the affected area. As a result, surrounding tissue is spared. Gamma Knife radiation may be used to treat a variety of neurologic conditions, including benign brain tumors, such as meningiomas and pituitary adenomas, malignant brain tumors, such as primary brain tumors and metastatic tumors, blood vessel defects, such as arteriovenous malformations, and functional complications like trigeminal neuralgia. The region’s only Gamma Knife is considered to be patient friendly as it is a one-time outpatient procedure.
  • Awake craniotomy — Using specialized anesthesiology techniques, neurosurgeons are able to operate while a patient is still awake. Neurosurgeons may ask a patient who is undergoing an awake craniotomy to perform an action, such as playing the violin or singing, during the surgery.
    “We do this to make sure that the function of the brain is preserved, and we are not cutting into important brain tissue,” Dr. Krishnamurthy says.

Expert Epilepsy Care

A Level 4 comprehensive epilepsy center, Upstate University Hospital is equipped with the technology and expertise to deliver effective epilepsy care. The epilepsy program has expanded during recent years, increasing the monitoring unit in the hospital. If surgery is needed, fellowship-trained neurosurgeons can perform a range of procedures, including Robotic Stereotactic Assistance (ROSA) for localization and treatment of the epileptic foci using minimally invasive surgical methods.

Robert Beach, MD, monitoring patient Amyee Rodriguez of Gouverneur, New York

An Exploration of Possibility

The Brain Tumor Research Laboratory at SUNY Upstate Medical University is a unique resource that works hand in hand with the Department of Neurosurgery to enhance patient care and outcomes.

“The laboratory is a research unit, a self-contained research facility that is completely integrated with the clinical mission of the Department of Neurosurgery,” says Mariano Viapiano, PhD, Associate Professor of Neurosurgery and Neuroscience and Director of the Brain Tumor Research laboratory. “We support the work of the clinicians by allowing them to perform research activities with clinical specimens. That research allows them to receive better details about the clinical case of the patients and more information about the tumors, enabling a better diagnosis and prognosis.”

Frozen samples of brain cancer tumors can be carefully thawed, put in a nourishing medium and placed in a body-temperature incubator to bring them back to life at Upstate’s Brain Tumor Research Laboratory.

Dr. Viapiano works with a multidisciplinary team of experts in the laboratory, including two senior scientists who are biochemists, two research fellows, one junior trainee and a laboratory manager, Sharon Longo.

“Sharon has been lab manager for 24 years,” Dr. Viapiano says. “I am fortunate to have her here. She runs day-to-day operations, and we have an outstanding relationship.”

Together, the specialists in the Brain Tumor Research laboratory facilitate a bench to bedside pipeline to support clinical experts treating tumors associated with primary brain cancer, including glioma, neuroblastoma, rare tumors, skull-based tumors and brain metastases.

For this pipeline, a clinician may collect a tumor specimen, with patient consent, during surgery to send to the lab. Dr. Viapiano’s team performs genetic and molecular analysis on the specimen and can even reproduce the tumor. The research team can further investigate by administering experimental therapies.

“We generate a wealth of information that we can provide back to the clinicians to improve the patient’s diagnosis and prognosis,” Dr. Viapiano says. “We can provide that information to pathologists, and they can initiate therapeutic strategies based on that data.”

The Brain Tumor Research Laboratory also has an established protocol for tissue collection, allowing the team to collect specimens from every patient who consents to provide tumor tissue for research.

Expert Neuro- Oncologic Care

Upstate University Hospital is pleased to welcome Ruham Alshiekh Nasany, MD. A graduate of Upstate’s residency program, Dr. Nasany serves as Assistant Professor of Neurology, Director of the Brain Tumor and Neuro-Oncology program at the Upstate Cancer Center.

“Dr. Nasany completed her neuro-oncology fellowship at Memorial Sloan Kettering Cancer Center in New York City, which is a major cancer institute in the world,” says Luis Mejico, MD, Professor and Chair of the Department of Neurology at SUNY Upstate Medical University. “She has special training in neuro-oncology, which allows us to develop a program that will inspire new protocols.”

“Collecting those specimens has helped us to create a large repository or tumor bank that we can use for research purposes.”

Additionally, if a physician thinks that a unique tumor case would be of particular importance, the lab may set up a protocol to reproduce the tumor in animal models or in vitro.

“We are proud to have the best technology at the national level to provide care and the expertise we provide adds a whole component that allows us to evolve brain cancer care,” Dr. Viapiano says. “If you refer your patients to Upstate, you can count on not only the highest standard of care but also the best standard of analytical services in diagnostic prognosis and research.”

Upstate Neurological Institute

SUNY Upstate Medical University Interim President Mantosh Dewan, MD, has announced the formation of the Upstate Neurological Institute.

The new Institute unites two prominent departments — Neurology and Neurosurgery — to create the largest team dedicated to neurological disorders in Central New York.

In addition to patient care within these core departments, the Neurological Institute membership will expand to include collaboration with the 14 other clinical and basic science departments at Upstate Medical University, which have services or research to improve the health of persons with neurological disorders.

The setting supports the endeavor with many services that are one of a kind in the region. Upstate University Hospital has an entire hospital floor dedicated to patients with brain injuries. It was the region’s first comprehensive stroke center and has a level-4 level epilepsy center. Advanced neurosurgical technologies include intra-operative MRI, minimally invasive robotic and laser surgery tools, and the region’s only Gamma Knife. The Institute also is part of a medical university that offers robust neuroscience research aimed at treatments and cures.


SUNY Upstate Medical University Interim President Mantosh Dewan, MD

For more information, visit upstate.edu/neuro.

Minimal Medication, Maximum Care at Genesee Orthopedics & Plastic Surgery Associates

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By Cari Wade Gervin

Monday, November 2, 2020

Andrew Wickline, MD, FAOSS, FAAHKS, uses a joint replacement program that minimizes opioid use to promote holistic healing and better outcomes.


Andrew Wickline, MD, with a robotic surgical system. He is now also using a different type of technique called kinematics alignment for personalized fit. The negative to the robot is that it shoe horns people into the same size fit no matter what their pre-existing pre-arthritic alignment was. Kinematic alignment allows for that. Genessee Orthopedics will be performing a trial of an augmented reality system in the near future.

 

Total knee replacement is one of the more painful surgeries.

“My patients used to say, ‘I’d rather have another child than do this again,’” says Andrew Wickline, MD, FAOSS, FAAHKS, an orthopedic joint reconstruction specialist at Genesee Orthopedics & Plastic Surgery Associates.

The level of pain associated with a total knee replacement typically results in a large prescription for narcotic pain medication post-surgery. With opioid use and addiction up across the state, however, Dr. Wickline created a different approach for his patients. He now uses multiple non-opioid choices and a game-changing home therapy plan he created.

“There’s somewhere between an 8% to 14% risk of permanent opioid addiction after a total knee replacement for a patient who didn’t use opioids before,” Dr. Wickline says. “That’s at least eight out of 100 people or at least 50,000 people a year nationally. That’s a frightening number.”


Dr. Wickline

“There’s somewhere between an 8% to 14% risk of permanent opioid addiction after a total knee replacement for a patient who didn’t use opioids before.”
— Andrew Wickline, MD, FAOSS, FAAHKS, orthopedic joint reconstruction specialist at Genesee Orthopedics & Plastic Surgery Associates

The Problem With Opioids

In 2018, opioids were involved in almost 47,000 overdose deaths — 69.5% of all drug overdose deaths. Although New York has not been hit as hard as some other states, the problem continues to grow.

“Once you become an opioid user, you end up costing the medical system double the average amount of cost for a year,” Dr. Wickline says. “For commercial payers, for example, the average cost is around $11,000. But if you’re an opioid user, it goes up to almost $20,000.”

Even just a 24-hour prescription of narcotics has a 6% risk of chronic opioid addiction. So, after studying the issue and working with patients, Dr. Wickline published a study — 23-hour TKA in 10 Opioid Pills or Less Through 90 Days: A Non-Selected Prospective Consecutive One Year Cohort — earlier this year outlining his approach.

Dr. Wickline (center) with Uday Myneni, MS, MBBS, MCH, and his resident team at the first annual arthroplasty conference in Hyderabad, India. Dr. Wickline performed the first anterior hip replacement with the HANA table, televised live to over 400 surgeons.

 

Dr. Wickline’s Study

Published in the Journal of Orthopaedic Experience & Innovation in July and co-authored with Maryann Stevenson, RPh, the study focused on 386 patients who underwent a total knee arthroplasty (TKA).

During a four-month period, the patients received education, home-based physical therapy and a continuous adductor canal block with ropivacaine during surgery. Pain levels were recorded pre-surgery and through the first three postoperative days, then again at three weeks, six weeks and 12 weeks post-surgery.

The study found that 86% of patients were able to get through the 90-day period with 10 opioid pills or less. This is the lowest published opioid use in the nation, five times lower than the next best paper, which found people used 50 pills post-surgery on average. In addition, 85% did not need formal physical therapy, saving them around $720 and reducing their exposure to COVID-19.

“I have a lot of patients who live up in the Adirondacks, and they have no access to therapy,” Dr. Wickline says. “Patients who went to rehabilitation and had two hours of therapy every day had more pain and took more narcotics. My patients who live up north and had no access to therapy followed my simple exercises and experienced less pain.”

The formal study confirmed Dr. Wickline’s anecdotal experience, he says. His patients also experienced a 1.2% readmission rate through 90 days, one of the lowest in the nation based on CMS data. In addition, 64% of TKA patients were able to go home the same day as surgery, and 91% of patients left the hospital within 23 hours.

“By getting patients out of the hospital sooner, we prevent complications, lower the risk of MRSA and COVID 19, and lower the risk of C. diff-caused colitis,” Dr. Wickline says.

“What I saw with patients who went to rehab and had two hours of therapy every day, they had more pain and took more narcotics … than the patients who lived up north and had no access to therapy and just followed my simple exercises.”
— Dr. Wickline

Improved Outcomes, Faster

According to the study, Dr. Wickline’s patients reached 110 degrees of flexion on average within three weeks. That’s seven weeks earlier than the 2018 American Academy of Orthopaedic Surgeons textbook on rehabilitation states is normal.

Dr. Wickline stresses that his patients haven’t been cherry-picked to improve outcomes, either, which is documented in the study.

“The protocol fits everyone,” Dr. Wickline says. “If you have medical comorbidities, I might have to keep you overnight but the study shows that most patients can go home the same day. You can decrease your complications by following this protocol, and you don’t have to be a 57-year-old marathon runner with a bad knee and no medical history to qualify for this.”

Dr. Wickline’s protocol includes a daily progress plan he says is simple for patients to follow.

“Patients do a little bit of exercise each hour and then immediately sit down, elevate and ice to control the swelling,” Dr. Wickline says. “They get the range of motion, but they create the least amount of swelling, so the pain goes away quicker.”

Dr. Wickline says the exercises take five to eight minutes each hour. Combined with ice, elevation and NSAIDs, most patients’ pain is manageable, he says. And the protocol is also a great option for people who have struggled with addiction, whether with opioids or other substances.

“We had around 30% of patients who did not take any opioid medication after discharge,” Dr. Wickline says. He also offers cryoablation that can freeze the nerves around the knee for up to three months for patients who want zero opioids in or out of the hospital.

“Anxiety is a prime culprit in reaching for a pain pill,” Dr. Wickline says. “I have a very detailed education book on what to expect, so my patients know exactly what is normal during their joint replacement recovery.”

Visit andrewwicklinemd.com or call 315-735-4496 to learn more about outpatient joint replacement with the least opioid use in the nation.

The Best Foot Forward at Syracuse Orthopedic Specialists

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By Cari Wade Gervin

Monday, November 2, 2020

The foot and ankle team at Syracuse Orthopedic Specialists provides quality care for patients.

Feet are something most of us take for granted once we learn to walk — until the pain starts. If patients stand all day at their jobs, run dozens of miles every week or wear too-high heels for long periods of time, foot or ankle pain eventually creeps up on them. While many minor injuries can be fixed with time and rest, more serious injuries require expert help.

That’s where the foot and ankle team at Syracuse Orthopedic Specialists (SOS) comes in. The team of surgeons, podiatrists, physician assistants, nurse practitioners, physical therapists and a pedorthist offer comprehensive foot and ankle care at the SOS Heritage Commons office in North Syracuse, providing patients with the ability to have comprehensive foot and ankle in the same building.

“SOS is a one-stop location for everything,” says Frederick R. Lemley, MD, foot and ankle orthopedic surgeon at SOS. “Patients can have their feet and ankle needs, operative and nonoperative, taken care of here.”

Surgical Specialties

Dr. Lemley is one of two board-certified, fellowship-trained orthopedic foot and ankle surgeons at SOS, along with Naven Duggal, MD. A Long Island native, Dr. Lemley started his surgical practice at SOS 14 years ago, after attending SUNY Upstate Medical Center. Dr. Duggal moved to Syracuse in 2013 after eight years at Boston’s Beth Israel Deaconess Medical Center and Harvard Medical School to be closer to his family in Canada.

“The region is great from the standpoint of what I do, because there’s a lot of athletes, sports and activities,” Dr. Duggal says. “Not only do I like to participate in those activities — and my family does as well — but, I get to take care of athletes who experience injuries to ligaments and tendons, as well as fractures.”

Of course, Dr. Duggal’s expertise is much broader than treating athletes.

“I perform reconstructions and tendon repairs, and I fix fractures,” Dr. Duggal says. “I’ll also do fusions for correcting deformities of the ankle and foot, as well as replacements of the ankle.”

Total ankle arthroplasty, along with ankle instability surgery, are Dr. Lemley’s specialties.

“There are not many people who do total ankle replacements in Syracuse,” Dr. Lemley says.

SOS physicians also have expertise in treating rheumatoid arthritis and common ailments like bunions and hammer toes.

“I think what sets SOS apart is how we have a bevy of longtime orthopedic surgeons who are experts within their field of orthopedics,” Dr. Lemley says. “We have exceptional subspecialty care at SOS. As opposed to trying to do a little bit of everything, each team works in one specific area of orthopedics.”

“Syracuse Orthopedic Specialists is really a one-stop shop for everything. Patients can have their foot and ankle needs, operative and nonoperative, taken care of here.”
— Frederick R. Lemley, MD, foot and ankle orthopedic surgeon and partner at Syracuse Orthopedic Specialists

Complete Foot Health Management

When treating patients with chronic foot pain — rather than a sudden, severe fracture — Drs. Duggal and Lemley both emphasize that they prefer conservative approaches and will only recommend surgery if nonoperative measures have not worked.

“We’ll use physical therapy, and we’ll use bracing, including orthotics, that can help people avoid surgery, which is great,” Dr. Duggal says.

Because the SOS foot and ankle team has two podiatrists, Christopher J. Fatti, DPM, and Stephanie Hook, DPM, on staff, patients with conditions like plantar fasciitis and tendinitis can easily receive care. The podiatrists also specialize in diabetic foot care, along with SOS pedorthist Maureen Kaljeskie, C.Ped.

“Maureen works closely with Dr. Lemley and me, as well as our podiatrists, to help treat patients,” Dr. Duggal says. “As the person who makes all of these orthotics, she helps accommodate that niche patients look for as well.”

SOS takes the team approach seriously when treating patients, which is what makes it such a special practice, the physicians say.

“You can always say the technology is great, and I think it is, but we have a fantastic team at SOS including our nurses, administrators, x-ray techs, and so many more departments all working together,” Dr. Duggal says. “It’s just a good place for patients. We take care of our neighbors.”

“I think people tend to underestimate that foot and ankle surgery can improve patients’ quality of life. For patients who have end-stage arthritis or a tendon that’s been chronically torn, getting it taken care of can help their symptoms.”
— Naven Duggal, MD, orthopedic foot and ankle surgeon and partner at Syracuse Orthopedic Specialists

When Is Surgery Needed?

Foot and ankle surgeries for non-acute injuries can often lead to long recovery times, which can be a big problem for people who work on their feet, live alone or have other mobility issues. And in past decades, certain procedures have gained a reputation for poor outcomes.

“I think there’s a consensus within the medical community that you should never have [non-acute] foot or ankle surgery,” Dr. Lemley says. “But what I would counter is that there are some surgeries that work very well, have excellent outcomes, and are worth the time and investment. You just have to find a surgeon who will give an honest opinion.”

Dr. Duggal says that when surgery may be needed, it’s a great option to be able to get it done in an outpatient facility.

“I think people tend to underestimate that foot and ankle surgery can improve patients’ quality of life,” Dr. Duggal says. “For patients who have end-stage arthritis or a tendon that’s been chronically torn, having it taken care of can help their symptoms and help restore some of the functionality that they’ve been missing.”

Find out more about foot and ankle surgery at Syracuse Orthopedic Specialists by calling 315-883-5881 or visiting sosbones.com/specialties/foot-ankle.

Syracuse Orthopedic Specialists Foot and Ankle Team

Surgeons: 

Naven Duggal, MD

Frederick Lemley, MD

Podiatrists:

Christopher J. Fatti, DPM

Stephanie Hook, DPM

Pedorthist:

Maureen Kaljeskie, CPed

Child Surrogacy Legalized, Finally

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By Bruce Wood, Esq.

Monday, November 2, 2020

On April 3, 2020, Governor Cuomo signed into law the Child-Parent Security Act (CPSA) of 2020, which will be effective Feb. 15, 2021, removing New York from the short list of only three states that still outlaw surrogacy contracts.

In 1992, New York outlawed surrogacy contracts in large part due to the publicity surrounding the high-profile Baby M case in New Jersey where the egg of the surrogate was fertilized by the sperm of a man who was not her husband. After the child was born, the surrogate and her husband had a change of heart and refused to turn over custody of the child to the intended parent.

There are two kinds of child surrogacy arrangements. In a gestational surrogacy, the surrogate carries to term an egg from another woman that was fertilized in vitro by the sperm of a man who was not the surrogate’s husband. The intent is for the surrogate to relinquish the newborn baby to the intended parent(s), regardless of whether the surrogate is to be paid for her services or is acting out of friendship to the intended parents.

In a genetic surrogacy, the surrogate contributes her own egg for the conception. The CPSA only authorizes gestational surrogacy arrangements, if they meet certain requirements, while genetic surrogacies will remain illegal in New York.

In adopting the CPSA, the legislature recognized that New York failed to keep pace with medical advances in assisted reproduction, causing uncertainty about who the legal parents of a child are upon birth (for example, there is a legal presumption that any child born of a married couple is legally their child). The CPSA is intended to provide clear and decisive legal procedures to ensure that children born through third party reproduction have secure and legally recognized parental relationships with their intended parents.

The requirements for a valid surrogacy agreement are quite detailed. Here are a few of the most important ones:

  • The surrogate must be at least 21 years of age (even though 18 is generally the age of majority in New York).
  • It must be a written agreement signed by all parties before two non-party witnesses.
  • The surrogate must complete a medical evaluation and provide her informed consent concerning the possibility of multiple births, risks of medications taken for the surrogacy, risk of pregnancy complications, psychological risks, and impacts on her personal life.
  • If the surrogacy agreement provides for payment of compensation to the surrogate, the funds for the compensation and reasonable anticipated additional expenses must be placed in escrow with an independent escrow agent before the surrogate takes any medications or commences any medical procedures.
  • The surrogacy agreement must disclose how the intended parent(s) will cover the medical expenses of the surrogate and child (usually through a comprehensive health insurance policy).
  • The surrogate and her spouse (if any) must receive a copy of the Surrogate’s Bill of Rights.
  • The surrogate has the right to make all health and welfare decisions regarding herself and her pregnancy, including whether to consent to a C-section for delivery. Notably, the surrogate retains the right to abort or continue the pregnancy.
  • The intended parent(s) must agree to assume the support of all children born as result of the surrogacy.
  • The surrogate and her spouse (if any) must be represented throughout the surrogacy contract by independent legal counsel of their choosing, whose fees must be paid by the intended parents (except in the case of a “compassionate” surrogacy where the surrogacy is not compensated and waives the right to have the intended parents pay for legal representation). The intended parents must also be represented by independent legal counsel.

Most significantly, and notwithstanding the historical prohibition against “selling” babies, the surrogate can now be compensated for the medical risks, physical discomfort, inconvenience and responsibilities the surrogate is undertaking (but not to purchase gametes or embryos). The compensation must be reasonable and negotiated in good faith and payments to the surrogate cannot exceed the duration of the pregnancy and a recuperative period of up to 8 weeks. Compensation to an embryo donor is limited to storage fees, transportation costs and attorneys’ fees.

The CPSA will usher in a new era of third-party reproduction in the State of New York.

Bruce Wood is a member at CCB Law, a boutique law firm focused on providing counsel to physicians and healthcare professionals. He can be reached at 315-477-6292 or bwood@ccblaw.com.

Solid Preparation and a Spirit of Innovation: Upstate Medical University’s Response to COVID-19

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By Jennifer Webster

Thursday, September 3, 2020

Even before the coronavirus arrived in the United States, forward-thinking physicians at Upstate Medical University saw the signs and got ready for action. Their quick response, paired with a culture of institutional preparedness and creativity, helped Upstate respond effectively to the crisis. Today, its hospitals and practices are open for business across all of its clinical areas, as the commitment to addressing COVID-19 continues.

As word of COVID-19 reached the U.S. in January, infectious disease specialists at Upstate, including Stephen Thomas, MD, Division Chief of Infectious Disease and Director of the Institute for Global Health and Translational Sciences, began tracking developments in China. These physicians communicated with Upstate’s leadership, who responded with alacrity. The promptness took some of their colleagues by surprise, but their forethought was soon lauded.

“In early January, Paul Suits, Director of Infection Control, convinced our Logistics Department to purchase a big shipment of N95 masks,” Dr. Thomas says. “Initially, they asked, ‘Why are we doing this?’”

Suits, Dr. Thomas and their colleagues pointed out that when the Ebola virus outbreak took place in West Africa, equipment was difficult to obtain worldwide because only a limited number of sources make medical-grade protective gear. If the coronavirus reached the U.S., it would be problematic.

Obtaining masks represented just one aspect of the preparedness Upstate demonstrated in the early days. Robert Corona, DO, MBA, Chief Executive Officer of Upstate University Hospital, knew that Upstate, and the entire Central New York region, could soon be facing some serious needs. When approached by Chris Dunham, Director of Emergency Management at Upstate, Dr. Corona activated the Incident Command structure, which stands ready to respond to crises.

“Even before executive orders or recommendations were issued, we had a team of more than 70 people discussing our response to COVID-19,” Dr. Corona says. “This is the longest-serving Incident Command we have had.”

Formally convening in mid-March, Incident Command met twice daily, discussing needs that included rescheduling elective procedures, freeing hospital beds for potential COVID-19 patients, cleaning and decontaminating, and testing and communicating with the wider community. The meetings were held twice daily — weekends included — with more than 100 people on the Zoom calls to hear and act on the reports. Everyone wanted to play a part and learn as much as they could about how to keep patients safe.


University Hospital staff working with PPE

In early spring, Upstate rapidly transitioned most outpatient visits in the majority of its 19 clinical departments to telemedicine and continues to offer the option for many types of visits. When patients do not need to be physically present, telemedicine provides a convenience and helps both patients and providers maintain social distance.

“Telemedicine has been something we have been readying ourselves to do for years at scale, and the crisis showed that this was viable,” Dr. Corona says.

Nursing Heroism

If science guided Upstate Medical University’s COVID-19 response, nursing care made up the backbone of that response. Nurses managed patients, communicated with families, and continuously donned and doffed protective equipment. Even though their jobs became exponentially harder, nurses found the resilience to do difficult work and even to travel to Long Island in downstate New York to render assistance in hard-hit hospitals.

Nancy Page, MSN, RN, NEA-BC, Chief Nursing Officer at Upstate University Hospital, oversaw that effort. One of the most important parts of a nurse’s role, before and especially during the pandemic, is teaching patients to advocate for themselves, she observes. Over and over, Page’s staff helped empower patients to ask providers and family members questions, such as if they’d washed their hands, and in other ways become active participants in their own care.

Observation skills also came into play.

Nancy Page, Chief Nursing Officer at Upstate University Hospital, with the team

“Nurses don’t diagnose, but we’re experts in looking at the whole person,” she says. “In COVID-19, nurses pioneered looking at people in the ICU and proning patients to improve their long-term function. Nurses and respiratory therapists were key to that intervention.”

Caring for patients with COVID-19 can be emotionally and physically stressful. Nurses at Upstate clinical locations that did not have dedicated COVID-19 units proposed a “job swap” with nurses at locations with COVID-19 wards, at University Hospital and Upstate Community Hospital.

“A nurse could come into a non-COVID unit for two weeks and vice versa,” Page says. “Numerous nurses took advantage both ways. Some wanted experience caring for people with COVID-19, while others were glad to have a short break.”

Volunteerism went far beyond the Central New York region, as Upstate’s nurses traveled downstate to help their colleagues working in the most urgent of settings. The nurses traveled in three waves, along with a cadre of respiratory technicians. Each group served for a period of time at Stonybrook University Hospital on Long Island, a SUNY sister university to Upstate. In total, Page recalls, 46 nurses along with 11 other staff members traveled to help their colleagues get through the crisis.

“Each of our departments is focused on safely handing referrals, being in touch with referring physicians and seeing patients within their comfort zones. Every service at Upstate Medical University is open for referral.”
— Robert Corona, DO, MBA Chief Executive Officer of Upstate University Hospital

Resources of an academic medical center

From the start of the pandemic, Upstate took its position as an academic medical center seriously — caring for patients, pursuing research into COVID-19 and possible treatments, analyzing data, and advising the public about the crisis as it developed. In their public-facing role, Upstate leadership drew on data modeling from its own public health experts to predict the spread of the pandemic. Drs. Corona and Thomas, as well as others, became a reliable “voice of the pandemic” for Central New York.

Robert Corona, DO, MBA, Chief Executive Officer of Upstate University Hospital, and Stephen Thomas, MD, Division Chief of Infectious Disease and Director of the Institute for Global Health and Translational Sciences, became trusted voices of the pandemic for Central New York. Both doctors gave interviews to local media, including Channel 9 TV.

Some of the communication resulted from information gathered about the virus and the population’s influence on its spread, sharing that information with the public and, in turn, influencing the public’s response. For instance, Upstate public health experts discovered that cell phone data could help predict the virus’ spread. Areas where people were on the road more frequently experienced a surge in cases shortly thereafter.

Dr. Thomas, who was a frequent commentator in the media explains, “The data could be used as a ‘stick’ and ‘carrot.’ Based on what was happening in our community I could tell the public, ‘You’re out too much, and there’s a direct association with infections growing’ or ‘You’re doing a great job staying home, and infections are going down.’”

Upstate’s Department of Public Health and Preventive Medicine supplied much of the data and analyses that informed the public, government officials and countless areas within Upstate. As part of the College of Medicine, the department consists of epidemiologists, biostatisticians, data analysts, coordinators, community health and social scientists, who continue to provide ongoing reports and monitoring. Department Chair Christopher P. Morley, PhD, says the team is helping Upstate create a playbook that can be used for future waves of the coronavirus or another pandemic. For real time updates, faculty members Telisa Stewart, MPH, DrPH, public health, and Kathryn Anderson, MD, PhD, medicine and microbiology, immunology, helped to establish systems with a dedicated internal IMT team to collect, analyze and report infection data to Upstate leadership and Central New York.

“Being an academic medical center creates a huge advantage during this time,” Dr. Corona says. “We have experts to talk in public forums, answer media questions and meet with large groups, like manufacturing associations and other entities, to talk about how they can keep people safe. Now as more is known about the effects of COVID-19 on patients, we also have experts to address those varying aspects — from pulmonary to neurological to cardiovascular.”

Ingenuity in a Crisis

Teams at Upstate University Hospital leveraged technological savviness to protect staff and improve communications while keeping patients, providers and families in touch.

  • The chatbot, an AI addition to Upstate’s online presence, triaged COVID-19 questions, answering common ones and routing complex issues to live operators. The chatbot was designed to “speak” both English and Spanish. In five months, the chatbot supported 22,758 users.
  • iPads at the bedside helped patients safely chat with families. Providers, including physicians, nurses and dietitians, also hold consults through the more than 200 iPads now in place throughout the hospital. The tablets also function as a video call bell, saving PPE as some needs can be addressed without entering the patient’s room.
  • In-hall IV pumps and patient monitors allowed nurses to check the vital signs of patients with COVID-19 from outside patient rooms without having to don full protective gear.
  • Telemedicine expanded to include almost every service line, allowing patients to visit providers online from the safety of their homes. Continuing medical education also moved online.
  • In post-COVID recovery groups, patients obtain the support and specialized care they need. Physicians check in daily via telehealth visits, following patients until they are free of symptoms. As providers are discovering, COVID-19 can cause chronic symptoms in some people and Upstate has expertise across the areas patients need.


The coronavirus pandemic has made telehealth an integral part of the care plan.

Recovery and Resilience

After more than two months of constant vigilance, Incident Command wound down and was replaced by a month in Recovery Mode, guiding the safe, full reopening of clinical services in late June. Upstate has now transitioned to a phase dubbed “Resilience” by the C-suite. The aim for Resilience is continue to improve by optimizing operations and rapidly adopting innovations using a Tiger Team model. Amy Tucker, MD, Chief Medical Officer at Upstate University Hospital, led the recovery effort, and is now spearheading its Tiger Teams initiative. She explains that these goal-oriented teams convene for a focused period to rapidly meet emerging needs. The process is tied to the hospital’s strategic pillars, with each member of the C-suite overseeing teams that relate to their areas.

“With our Tiger Teams we aim to streamline operations and to nimbly adopt innovation so that we serve patients and our colleagues even more effectively,” Dr. Tucker commented.

“Today, as we have been all year, we are finely attuned and responsive to the needs of the community,” Dr. Corona says. “We are committed to being a safe place for patients to come. And, we are committed to being a supportive partner to the physicians who refer their patients to us. We want the community to know that we are open and safe.”

Director of Transitional Care Diane Nanno, MS, CNS, RN, NE-BC, CCCTM, with the comfort care kit

As Upstate breathes a sigh of relief and resumes visits and scheduled procedures at every location, Dr. Thomas also notes that the pandemic has enhanced the mutual respect and solidarity between the academic medical center and Central New York’s community practices. It’s a dynamic he hopes will flourish into the future.

“Everybody who works in the medical environment stepped up to ensure hospitals had space to care for the sickest patients,” he says. “For that to happen, we had to have all hands on deck. Primary care providers and community subspecialists knew they would see people who might have COVID-19. We had multiple meetings with our medical community, and physicians told us, ‘We signed up for this. We understand the risks. If you provide the PPE, the training and the means to take samples, we will see these people in our offices.’ The community really came together, and it went well.”

A Response Undergirded by Science

Scientists and the physicians at Upstate University Medical Center took every opportunity to learn about the pandemic and to use that knowledge to help protect the community. Among the projects is participation in the National COVID-19 Convalescent Plasma Project, in which patients with COVID-19 receive blood plasma from survivors of the disease, and both groups are tracked.

Tim Endy, MD, MPH, Professor and Chair of Microbiology and professor of Preventive Medicine and Public Health was the lead on that project. Upstate’s Institute for Global Health and Translational Science worked with the Red Cross to get the project up and running.”

Under the direction of Matt Elkins, MD, PhD, Director of Hemapherisis, Director of Transfusion Medicine, Medical Director of Upstate Cord Blood Bank and Associate Professor of Pathology, Upstate created its own plasmapheresis unit in support of the Convalescent Plasma Project. More than 200 people volunteered and dozens have donated, with numerous patients benefitting from those plasma donations.

Other trials investigated the effectiveness of medical treatments, while the most prominent current trial is examining the effectiveness of a new COVID-19 vaccination. In conjunction with Pfizer, Upstate started vaccinating volunteers the last week of July.

“We’ve experienced an outpouring of interest,” says Stephen Thomas, MD, Director of the Institute for Global Health and Translational Sciences and principal investigator. “The investigators are tightly focused on enrolling a diverse group of participants, ages 18–85, especially focusing on people at high risk for infection or of having a bad outcome from an infection.”

He added, “This is why we have an academic medical university, so we can bring together education and care with treatment of patients and research.”

For more information, visit upstate.edu/together.

A New Internal Medicine Practice in Skaneateles: Patsy Iannolo, MD, PhD, PC

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By Jennifer Webster

Thursday, September 3, 2020

Two generations of Central New York patients have benefitted from the expertise and respect shown to them by internal medicine physician Patsy M. Iannolo, MD, PhD. Now, Dr. Iannolo is expanding his Taft Road practice to open a second office in Skaneateles. The new location will offer a range of amenities, as well as the patient-centered care Dr. Iannolo is known for.

Patsy M. Iannolo, MD, PhD, PC, and Tina L. Finlayson, NP

 

As an Internal medicine physician with a doctorate in pharmacology Dr. Iannolo cares for adult patients who have a range of concerns, including diabetes, hyperlipidemia, hypertension, rheumatoid conditions and neurologic disorders, among others. Many of these patients have more than one complicated condition, and managing multiple comorbidities is a specialty of Dr. Iannolo’s.

“Internal medicine practices focus on the sickest patients,” he says. “My pharmacology training helps me streamline medicines. I offer consultations on the appropriate medications for each patient’s age and condition. Other physicians also reach out to me as a consultative resource for toxicology and medication improvements.”

In addition to diagnosing illness and prescribing medications, Dr. Iannolo performs in-office excision of skin lesions and other dermatology treatments, as well as joint and tendon injections. He offers psychiatric services and men’s endocrine treatments, as well.

Dr. Iannolo’s colleague, Tina Finlayson, MS, FNP-BC, offers women’s endocrine services, gynecologic exams and geriatric medicine, as well as routine internal medicine services. Together, these two providers have more than 45 years in the medical field, forming a practice where patients can find effective, experienced medical care from young adulthood through advanced age.

 

“My philosophy of care is to be part of the family of the patient. Our practice is family oriented. Everyone knows and respects each other. We are accessible around the clock. It’s essential to be available to patients in times of need.”
— Patsy M. Iannolo, MD, PhD

The Gift of Time

Dr. Iannolo exemplifies the words of the founder of internal medicine, Sir William Osler: “The good physician treats the disease; the great physician treats the patient who has the disease.”


“At our practice, everyone is treated as if they are important and special,” Finlayson says.

This approach is especially evident in the time Dr. Iannolo, Finlayson and their staff spend with patients. While traditional physician visits may allow 15 minutes with a provider, Dr. Iannolo typically schedules 30 minutes or more with each patient and over an hour for physical exams. That allows him to make detailed assessments and give expert guidance, especially in cases of patients on multiple medications or people who require treatment for depression or anxiety.

When patients have an urgent need or question, they can reach out any time, 24 hours a day, seven days a week, to speak to the provider on call. Same and next-day appointments are often available. Additionally, Dr. Iannolo and Finlayson make house calls under select circumstances.

“We maintain a comfortable pace,” Dr. Iannolo says. “There’s no rushing during appointments. That way, we’re able to offer comprehensive physical exams and follow-ups. At the same time, our around-the-clock availability allows us to provide a level of responsiveness and sense of urgency about patients’ needs that is rare in medicine today.”

Exam Room

Convenient Care in a New Location

Dr. Iannolo’s new practice contains many of the lab and imaging services frequently offered separately from medical practices, including pulmonary function testing, ankle brachial testing, EKG, and endocrine and laboratory services. The Skaneateles location also has an X-ray machine.

“Patients will be able to avoid trips to Syracuse or Auburn,” Finlayson says. “They’ll be able to access internal medicine close to home. We’re opening in September, and we’ll be available for walk-in care for our patients as well as anyone in the community.”

Known for cordial relations with his colleagues (especially for his willingness to consult over complex pharmacological issues), Dr. Iannolo welcomes referrals to his Skaneateles location. He keeps in close contact with referring providers, maintaining those relationships that have made him a reliable colleague and trusted physician across decades of practice.

Patsy Iannolo, MD, PhD, PC

5180 W. Taft Road
North Syracuse, NY 13212
315-458-4622
driannoloandassociates.com

1551 US Route 20
Skaneateles, NY 13152
315-291-7069
driannoloandassociates.com

Patsy Iannolo, MD, PhD, PC

Tina Finlayson, MS, FNP-BC

Meet the Providers

Patsy Iannolo, MD, PhD, PC, a native of Syracuse, attended Cornell University, and then obtained his medical degree and a doctorate in pharmacology at Upstate Medical Center, where he completed a residency in internal medicine. Also trained in emergency medicine, Dr. Iannolo has been practicing in local hospitals and in private practice since 1984. In addition to his practice on Taft Road in North Syracuse, Dr. Iannolo is Director of the Emergency Department at Auburn Community Hospital and on the medical faculty at SUNY Upstate Medical University, where he teaches pharmacology. Dr. Iannolo is board-certified in emergency and internal medicine.

Dr. Iannolo has been recognized for excellence numerous times by his colleagues. In 2009, the Central New York Regional Emergency Medical Services Council named him a Physician of Excellence for the CNY region. In 2019, Dr. Iannolo received the President’s Award for Outstanding Voluntary Faculty from SUNY Upstate Medical University.

Tina Finlayson, MS, FNP-BC, worked in industry for 18 years before attending nursing school. After beginning her career as a nurse, she obtained a master’s degree in nursing and became a family nurse practitioner in order to diversify her scope of practice. Her scope of practice includes internal medicine, urgent care, women’s health, as well as geriatric and emergency medicine.

For more information, call 315-458-4622. Visit the Skaneateles location online at driannoloandassociates.com.