New surgical tool; a tick-borne virus; cancer information sources; heat precautions: Upstate's HealthLink on Air for Sunday, July 9, 2023

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a vascular surgeon tells about a new navigation tool for complex procedures.

Michael Costanza, MD: ... It uses its own GPS system, so it's almost like having mini satellites within that room that localize everything and then merge it with the data from the CT scan. ...

Host Amber Smith: A microbiologist warns about the dangers of tick-borne Powassan virus.

Saravanan Thangamani, PhD: ... It is very important to be aware of where we are venturing outside, how to prepare ourselves in such a way that we don't get any tick bites. Because here, as soon as the tick bites, it disseminates the virus into the human body. ...

Host Amber Smith: And a librarian shares what's available in the family resource center. All that, plus some heat illness precautions, and a visit from The Healing Muse, coming up after the news.

Host Amber Smith: This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, we'll learn how to protect ourselves from Powassan virus. Then we'll hear about the Upstate Cancer Center's family resources. But first, a vascular surgeon shares the new navigation tool he uses for some of the most complex procedures.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Surgeons at Upstate's Heart and Vascular Center are using a new surgical navigation device for complicated cases. And here to tell us about it is Dr. Michael Costanza. He's a professor of surgery at Upstate and division chief of vascular surgery and endovascular services.

Welcome back to "HealthLink on Air," Dr. Costanza.

Michael Costanza, MD: Thanks for having me.

Host Amber Smith: This device is an "interoperative position system." Can you tell us what that is?

Michael Costanza, MD: This device is an alternative to using traditional X-rays, for finding the position of catheters in the body when we do a complicated procedure on the inside part of blood vessels. And what it does is it basically makes almost like a mini GPS (global positioning system) within that room that we do the procedures so that we can localize the catheters and the wires and the stents without having to use X-rays.

And the reason that's important is that X-rays are a form of radiation, which affects not only the patient but also all of the people that are in the room helping the patient. And, over time the buildup of radiation can cause other problems, such as cataracts and cancer and skin problems and things like that. So the more that we can minimize the use of that potentially harmful radiation with an alternative system that doesn't do that and is also even more accurate than just traditional X-rays, the better. And this is really a breakthrough in that type of technology.

Host Amber Smith: Does it look like an X-ray machine to a patient?

Michael Costanza, MD: Yeah, so it actually involves an X-ray before the procedure in the form of a CT scan. And then once we get that, we load that into the computer, and then we create, like I said, kind of a mini electromagnetic field in the room, which all that involves is putting a kind of a sticker on the patient. And then we have a separate console that that shows the images from that.

Actually, the images come out as looking like 3D images, almost like a video game. But you can rotate the image in any dimension and see any angle that you need. And then you can also, because the catheters and the wires that we use have implanted chips in them, when we introduce those into the body, we can actually see that on the screen. So it's almost like a virtual reality situation, that far of a detail and that much spatial relationship.

Host Amber Smith: Does it make use of the same technology that our phones do, for the GPS, so that you know the positioning?

Michael Costanza, MD: Yeah, exactly. It uses its own GPS system, so it's almost like having mini satellites within that room that localize everything and then merge it with the data from the CT scan so that we have the anatomic data from the patient and then the GPS data from the machine and the catheters, and we fuse the two of them together, and that way we can see everything without having to go to X-rays or anything like that.

Host Amber Smith: So I know when you get an X-ray, the patient doesn't feel anything, per se. Do they feel this happening with the IOPS?

Michael Costanza, MD: Not at all. There's no external force at all. It's purely just a localization thing. Just like X-rays are an invisible force, this is the same way. So they don't feel anything. They don't have to prepare in any way. And nothing would seem different to them other than the long-term effects of not having that exposure to the extra radiation.

Host Amber Smith: Can you tell us about the types of cases that would be good for this system?

Michael Costanza, MD: Yeah. There's a lot of different applications. Right now they're primarily involved in complicated endovascular procedures -- which are the procedures that we do on the inside of blood vessels -- for a couple reasons. One is to take care of complicated aneurysms, which are abnormal enlargement of blood vessels. And, the aorta, which is the main blood vessel in the body, is the most common spot that happens.

And if that vessel starts getting larger and larger at some point, just like when you blow up a balloon, it reaches a certain tension before it breaks. If that blood vessel breaks, then that's a very bad, catastrophic event that usually most people don't survive.

So with this technology, we can go on the inside of the blood vessel, go to that weak area, and with this guidance we can put in a stent that seals off that part of the weak area above and below the weakness. And it often involves getting smaller branches to get smaller stents in so that they're not blocked by the main stent. And that's where this technology comes in because we can really see exactly where those branches are without having to subject the patient to long courses of radiation or that contrast material or the dye that people are aware of that is also potentially harmful in large exposures to the kidneys. So we can avoid all of that and still be able to very effectively locate these vessels.

Host Amber Smith: So are some of these cases done emergently?

Michael Costanza, MD: They are occasionally done emergently, but with the current technology, we really do need a pre-procedure CT scan. So in most cases these are scheduled cases, but I can see in the future that they're going to shorten the preparation time for these. So I think eventually we will be using this for more and more emergent cases. But right now they're scheduled.

Host Amber Smith: So you described how it would be used for an aneurysm. What about if there's a blockage or a clot or something? Is it useful for those circumstances, too?

Michael Costanza, MD: It is, especially within the abdominal cavity. The kidney arteries and the arteries that go through the intestines can be notoriously difficult to get a catheter into because of their location and their small size. And with this technology we can easily find them and know that we're in the right spot immediately, because of the display images and that fusion of the patient data and the GPS together.

Host Amber Smith: I wonder how commonly this is used across the nation. Is this available in most hospitals?

Michael Costanza, MD: Yeah, surprisingly this is not available in most hospitals. We're one of about nine or 10 hospitals that have it currently. They're always trying to expand their reach, but it is relatively new technology, and and I think it's kind of one of those innovations that's going to gain more traction. But fortunately, we were able to get on very early in the course.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Dr. Michael Costanza. He's a professor of surgery at Upstate and division chief of vascular surgery and endovascular services, and he is telling us about the interoperative position system.

Are there studies comparing the outcomes using this system with whatever you would've done before this was available?

Michael Costanza, MD: Yeah, they've done some studies looking at the time that it takes to do these complicated cases with the system, and it has decreased the time it takes by more than half, in the studies. So, you can imagine how that is good for everybody involved. The hospital uses less staffing. There's less radiation involved. The patients get out of the operating room sooner. And you can do more patients in one day, by cutting the time down so much.

Host Amber Smith: Well, let's talk about which patients would be suitable. Is there anything that would disqualify someone from having this?

Michael Costanza, MD: The only thing that would really keep somebody in the current setup would be if they could not have that preoperative CT scan, for whatever reason. But CT scans can be done on almost everyone. The MRIs are sometimes not available to all patients because of metal implants, or pacemakers, or things like that. But there's very few people that can't have a CT scan, so that would be the only thing. There's really nothing about the system itself that would prevent anyone from having it. There's no allergies involved or conditions that would prevent you from having it.

Host Amber Smith: Are there any risks that patients need to know about ahead of time?

Michael Costanza, MD: Really no risk involved in the procedure because it doesn't involve any radiation. And the system itself is not invasive. It's just there to guide the invasive part of it, and so, really, the greater risk is really to have traditional X-rays with the radiation involved.

If you really had a complicated procedure and had a prolonged exposure to X-rays, patients do run the risk of having complications locally and in the long term from that. But with this, because it doesn't use any radiation or any contrast, that really has minimized those risks.

Host Amber Smith: How do you advise patients to prepare for this procedure?

Michael Costanza, MD: There's no specific preparation for it. We usually talk to them about it beforehand because it does involve some positioning in the room and things, and we tell them that's going to happen. But it's nothing that they need to prepare for in advance.

Host Amber Smith: Are they asleep during the procedure, or do they hear what's happening?

Michael Costanza, MD: It depends on the procedure. A lot of our procedures are done with just some moderate sedation. So they, so some of them are awake with it. And, what they see with that is just that we move the X-ray part of the machine out of the way, and we bring in this monitor that we can just work off of. So that's the only thing that they would probably notice about the procedure itself.

The more complicated procedures that involve a longer time to do, then we would do those under anesthesia.

Host Amber Smith: And what is recovery like? How long are they in the hospital afterward?

Michael Costanza, MD: Well, these procedures are all minimally invasive because they're on the inside of the blood vessel. And so the nice thing about those are that the recovery time is very, very short. And, many of the procedures can be done on an outpatient basis. They would go home the same day. And then some of the more complicated ones, we usually bring them in overnight, just to monitor them. But then usually it's not more than a day in the hospital because we're able to use needles and catheters rather than scalpels and incisions, it really makes a big difference of recovering faster.

Host Amber Smith: Do patients notice a difference right away?

Michael Costanza, MD: Well, if you have your aneurysm fixed with a stent versus the aneurysm fixed with an open procedure, it's a world of difference. You know, it's patients are walking the next day versus being in the ICU (intensive care unit) for the first four or five days. It's a huge difference in terms of this particular technology. I think the main thing is that we really don't have those prolonged X-ray exposures that we have to worry about skin breakdown or things like that, or having the kidneys be affected by the amount of contrast used. So that would all be taken out of the equation for those patients.

Host Amber Smith: Do you have any predictions about how this technology may evolve?

Michael Costanza, MD: Yeah, it's very exciting. I've seen some of the kind of research done with this particular device, and what they will envision is that this will become more like virtual reality. I think the surgeons will eventually put on the glasses, and the image will actually be projected right onto the patient, him or herself. And we'll just work off of that. Instead of working off a monitor, you'll just look straight down and see everything that you see on the X-rays, just see it on the patient, which will be really a very intuitive way to do these things. And we'll just speed the process and take us to the next level.

But I've already seen the prototypes for that, and it's really exciting what's coming up.

Host Amber Smith: Very encouraging. Well, thank you so much for making time to tell us about it, Dr. Costanza.

Michael Costanza, MD: It's a pleasure. Thanks for having me.

Host Amber Smith: My guest has been Upstate professor of surgery, Dr. Michael Costanza, who leads the division of vascular surgery and endovascular services at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Ticks transmit Powassan virus, so preventing tick bites is key -- next on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Powassan virus is a rare disease spread by ticks, but it can be deadly. The first fatal case of 2023 was confirmed in Maine. To learn more about Powassan virus, I'm turning to Upstate's tick and Powassan virus expert, Dr. Saravanan Thangamani. He's a professor of microbiology and immunology at Upstate, and he's the director of the SUNY Center for Vector-Borne Diseases.

Welcome back to "HealthLink on Air," Dr. Thangamani.

Saravanan Thangamani, PhD: I'm glad to join you and discuss about Powassan virus.

Host Amber Smith: Some of the symptoms of Powassan virus are pretty scary. Can you go over them with us?

Saravanan Thangamani, PhD: Well upon a tick bite, if the tick is infected at the Powassan virus, in the next week to three weeks, one would actually have initial symptoms like fever, headache, vomiting and muscle weakness. It's like any other acute febrile illness. But if the disease progresses to the next stage. That is a stage the virus enters the brain or spinal cord, causing meningitis or meningoencephalitis. So those are the worst case scenario where the virus infects the brain and spinal cord.

Host Amber Smith: So how long might it take for some of these symptoms to appear?

Saravanan Thangamani, PhD: Between one to four weeks after a tick bite.

Host Amber Smith: So it could be quite a ways distant. You might not remember that you had a tick bite.

Saravanan Thangamani, PhD: Absolutely. Even in a normal situation, it's very difficult to know if you had a tick bite or not, unless and until you do a regular tick check and other things. So in this case, yeah, it could be, it's highly possible that one would not remember that they had a tick bite. And then when they go to a clinic or when they're hospitalized, two to three weeks post, a potential tick bite.

Host Amber Smith: There was the death in Maine earlier this year from Powassan virus, but what percentage of people who are in infected will go on to have either lasting brain damage or go on to die from the virus?

Saravanan Thangamani, PhD: From the data that I have access to, nearly 15% of the human infections can result in death. And 50% of the survivors could actually have long-term neurological complications as well. So it is a rare disease to get, but it can be fatal in 15% of the cases approximately.

Host Amber Smith: So it sounds like it's something we should take seriously.

Saravanan Thangamani, PhD: Absolutely. Absolutely. So the one thing that I always tell people when it comes to the tick-borne viruses, is that unlike Borrelia, the Lyme disease-causing agent that takes about 24 hours to 48 hours post a tick bite. It gets transmitted to the human skin. But in this case, viruses are transmitted immediately upon tick attachment. So it is very important to be aware of where we are venturing outside, how to prepare ourselves in such a way that we don't get any tick bites. Because here, as soon as the tick bites, it disseminates the virus into the human body.

Host Amber Smith: Once someone is infected with Powassan virus, are they infectious to other people?

Saravanan Thangamani, PhD: In a traditional sense, they are not infectious, because person-to-person transmission has never been reported for Powassan virus. However, if someone is donating blood, they may have to wait for at least four months before they can donate blood.

Host Amber Smith: Let's talk about how it's diagnosed. If someone goes to the doctor with the symptoms of Powassan, how would a doctor confirm that that's what they have?

Saravanan Thangamani, PhD: I think this is a great question because oftentimes most of the Powassan cases, they go unnoticed or misdiagnosed because of the fact that the initial symptoms from this virus infection mimics many other disease symptoms.

So unless and until the clinician has a prior knowledge or the patient has a prior knowledge in such a way that the patient is coming from a Powassan virus-endemic area, and the person may have encountered a tick. Then the clinician has a higher chance of prescribing a diagnostic test. So that's why it is very important to know if someone got a tick bite or not. So if someone gets a tick bite and someone goes through this acute febrile illness, normally the traditional way of checking is to take the spinal fluid and then look for markers of Powassan virus infection.

That's how you normally look for an acute phase infection, because virus will actually move away from the blood very quickly. So the virus, it will be in the human blood only for a short period of the time. So if the patient doesn't go to the clinic at that particular window of time that no one can predict, it's impossible to detect. So for Powassan virus infection, the primary way of collecting sample is spinal fluid, and then look for infection markers.

Host Amber Smith: So it moves from the bloodstream into the spinal fluid?

Saravanan Thangamani, PhD: Exactly. So it moves quickly from the skin. It actually goes to the spinal cord and then to the brain. So it stays in the bloodstream only for a short amount of period.

Host Amber Smith: Does the human immune system fight this?

Saravanan Thangamani, PhD: Yes, our immune system fights it. So what we think is happening is that the asymptomatic infection, or people who never end up in hospital due to Powassan virus result of their body responding to the infection.

So if someone is healthy and very responsive, their body immune system will attack this virus and eliminate it from their body. So they might have just an initial symptoms, but they would recover like a flu, right? You are sick for a few days, and then we recover.

However, if it's a person who is immunocompromised from either cancer therapy or immunotherapy or old age, they will succumb to the disease. The virus will actually march from the skin to the spinal cord to the brain.

So I think that is one good thing that I want to highlight here is that majority of the Powassan virus infections are in the population about 60, 60 and above years old. Because their immune system is weakened at the time. So that kind of answers your question.

Host Amber Smith: Well, are there medications that can be used to treat someone who's in the hospital with Powassan virus?

Saravanan Thangamani, PhD: Unfortunately not. So only supportive therapy, fluids and hospital care is only way. There is no vaccine. There is no therapy. And antibiotics will not work because these are viruses. Antibodies will work only against bacteria. So basically supportive therapy is the only therapy we have at this time.

Is Powassan virus a threat to dogs and cats? They are not threat, as threatful, as they are to the humans, but they do get Powassan virus infection, but their body clears it because in our surveillance program, we have received ticks that fed on dogs and cats that there are positive for Powassan virus. However, they never got sick. So, which means that it's like any other reservoir animals, that they would recover from the infection.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith.

I'm talking with Dr. Saravanan Thangamani. He's a professor of microbiology and immunology at Upstate and the director of the SUNY Center for Vector-borne Diseases.

Which ticks carry the Powassan virus, and how do the ticks get it to begin with?

Saravanan Thangamani, PhD: There are three ticks that we believe transmit Powassan virus -- the groundhog tick, the squirrel tick and the deer tick. And deer tick are the ones that humans often encounter. Groundhog tick and squirrel ticks are rarely encountered by humans. So those two ticks are normally one would encounter if they're a hunter or a logger because they are normally deep in the woods.

Deer ticks are the ones that often people encounter, both in the rural and urban settings. So how do ticks acquire the virus is the objective of my lab's research, and we are trying to answer that. That is the question we don't know. Scientists like me, we don't know exactly how ticks acquire and why the Powassan virus-infected ticks are perpetuating in a small environment or micro foci environment, compared to Lyme disease agent that are throughout the state.

So we are trying to decipher that and what are the factors that determines that. We still don't know what are the amplifying reservoirs for the virus. Like for Lyme disease agent, we know the white-footed mouse are the reservoirs for the agent. But for this particular virus, we don't know. So that is one of the research objectives of my laboratory.

Host Amber Smith: Do you know how common it is for a tick that carries Powassan virus to also have other pathogens?

Saravanan Thangamani, PhD: Oh, I must tell that pretty much 80% to 90% of the Powassan virus infected ticks, they do carry either a Lyme disease agent or anaplasma or a babesiosis agent. So they often actually come together with other agents.

Host Amber Smith: So, again, to go over this, if a person has a tick bite and that tick is infected with Powassan, immediately they have that virus in their system, but if they remove the tick that afternoon, they might not have the Lyme disease pathogen transmitted?

Saravanan Thangamani, PhD: Absolutely. You're right. So tick-borne pathogens are delivered in a, I would say, timed delivery mechanism. The first one that is delivered is a virus, followed by anaplasma agent, the agent of anaplasmosis, followed by the Lyme disease agent. So immediate, 12 to 24, 24 to 40 hours post tick bite. These are like timed delivery of a pathogen from a tick to a human.

Host Amber Smith: Well, let's talk about prevention because that seems like maybe the best way to deal with this. What is your advice to prevent tick bites from, let's say, deer ticks? Because that would be the most common way someone in Central New York might catch Powassan, right?

Saravanan Thangamani, PhD: Absolutely. Prevention is the only way. So that's what I would like to educate people is that because we don't have vaccine for any of the agents that are causing disease in North America.

So, prevention is the best way. And the first thing to know is where the ticks are, where are the hotspots for human tick encounters? So we need to know that, and that is what our citizen science is helping people to know where are the hotspots, so they can try to avoid it.

The second one is that before getting out of your house to do an outdoor activity, make sure that you have a tick repellent spread on your exposed skin areas. Also, make sure that the outdoor clothes are treated with permethrin. These information are available through a CDC (Centers for Disease Control and Prevention) website, and the concentration that need to be treated as well.

And then when they go for trail walking or trekking, to stay in the middle of the trail rather than the edges of the trail. Ticks are waiting at the edges of the trail. And if we walk with the dogs and pets, it's best that we keep a tight leash on them, particularly in the areas that we know that can have more ticks, because pets are tick magnets. When they walk off the trail edges and come back, they will come back with the ticks. So it is very important that we also do tick check on them. Also, keep them on a tight leash in a way.

And then upon coming back to home and after outdoor activities, important to do tick check on themselves, take a shower, and put our clothes into the dryer for at least 10 minutes at a high heat to kill off the ticks. And do the tick check on the pets as well.

Host Amber Smith: What do you tell people to do if they find a tick?

Saravanan Thangamani, PhD: So I tell them to gently pull the tick, either with the blunt-end tweezers or sharp-end if they're using sharp-end tweezers, I tell them to be careful so they don't poke themselves. Pull the tick gently upward from the skin, and then as slow as possible in such a way that they pull the entire mouth parts as well, because ticks are very clever. When they attach themselves into the skin, they actually secrete a substance called cement protein -- they are like glue -- so to secure themselves strongly onto the skin. So it's important to pull gently and swiftly, at a right angle, or perpendicular to the skin.

And then, do a gentle soap wash at the site of a tick bite or alcohol wash there. And then keep the tick in the fridge in a Ziploc bag and send to a lab for tick testing. It is important to actually test the tick that bit them so that they can actually assess the risk. They can only assess the risk. It's not a direct correlation that if the tick is carrying an agent, it doesn't mean that human got the agent as well, but it actually gives them a risk factor. So that information, if that is relayed to the clinician, the clinician then makes an informed diagnosis based on that information.

So I would definitely recommend the public to pull the tick, gently save it, and then send it to a tick testing facility to get it tested.

Host Amber Smith: But there's no need to contact your doctor just to report that you had a tick bite if you're not having any symptoms, right?

Saravanan Thangamani, PhD: Yes. I would definitely say that post tick bite, I would definitely advise the public to monitor any symptoms of sickness for 30 days. And if you, if anyone sees sickness or anyone feels like they are sick, they need to contact the health care provider right away. But it's important to monitor the symptoms, acute febrile illness symptoms, for at least 30 days post tick bite.

Host Amber Smith: Now the person who died with Powassan virus earlier this year lived in Maine. Do we have ticks carrying Powassan virus here in Central New York?

Saravanan Thangamani, PhD: Yes, of course. So New York is one of states that have high rate of Powassan virus infections in the United States. It used to be primarily in the lower Hudson Valley, but now from our research we are able to detect Powassan virus-infected ticks, even in Central New York, even in Onondaga county.

Host Amber Smith: So does it look like their numbers are increasing?

Saravanan Thangamani, PhD: Yes. That's what our surveillance is telling. So based on our citizens and surveillance data comparing to 2019, 2020, 2021, 2022, we see a trend in the increasing number of ticks that are submitted to us. So I can confidently say that in the future, in the near future, the number of Powassan virus infections will increase.

Host Amber Smith: Well, Dr. Thangamani, you're always very informative. Thank you so much for your time.

Saravanan Thangamani, PhD: Thank you. I appreciate your having me again.

Host Amber Smith: My guest has been Dr. Saravanan Thangamani, professor of microbiology and immunology at Upstate and director of the SUNY Center for Vector-borne Diseases. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air," a librarian describes resources available for families battling cancer.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

One of the features of the Upstate Cancer Center is a Family Resource Center. Today, we'll learn about what that is. My guest is Sarah Lawler. She's a clinical outreach librarian at Upstate's Health Sciences Library.

Welcome to "HealthLink on Air," Sarah Lawler.

Librarian Sarah Lawler: Hi. Thank you so much for having me.

Host Amber Smith: So, tell us about the Family Resource Center.

Librarian Sarah Lawler: So, the Family Resource Center is the library space in the Upstate Cancer Center. It is located on the first floor of the cancer center. So as you face the information desk on the first floor, it is directly to your right behind the stairs. And also the fantastic staff at the front desk can also direct you as well, if that is helpful.

So the gist of the Family Resource Center is, it's a room that has a few computers in it, which can be very helpful if you need to look something up, if you are not able to be in the room with your loved one during their appointment, you can Zoom into the meeting using one of our computers.

We also have a book collection that we're very proud of, all types of information for people who have cancer, for caregivers, for loved ones, and that is our book collection. And we also have a printer in there and various different brochures of all the different services the cancer center offers, as well as services in our local community for cancer patients and cancer survivors.

Host Amber Smith: So it sounds like it's kind of aimed at family members or friends of patients that are either coming, I guess mostly for outpatient care or a medical appointment, or it does it also apply to someone who's hospitalized?

Librarian Sarah Lawler: It applies to anyone who has cancer, who's receiving treatment, anyone who loves that person, family members, friends, caregivers. And yes, absolutely people are hospitalized with cancer. They could absolutely find information in the Family Resource Center that would hopefully be useful.

Host Amber Smith: Now, is there any way to assist someone who can't be there in person who can't come into the Family Resource Center? Can they reach your services online or by phone?

Librarian Sarah Lawler: Absolutely. They can give me a call, and we can chat about their needs, and they can also email me. My phone number is (315) 464-7192. And my email is Lawler Sa at upstate dot edu, and that is spelled lawlersa@boy4life.com.Most of the request I receive are actually via email or via phone.

Host Amber Smith: Well, let's talk about what resources are available in the center. Is it a lending library like a public library would be?

Librarian Sarah Lawler: So interestingly, it is not a lending library. Because there isn't a staff member in the space the entire time that the center is open -- I am in there from 10 to 11 on Thursdays, but the rest of the time it's unstaffed -- so we don't have a staff member to check in and out books. And there were also infection control concerns because we want to keep our patients as healthy as possible an incredibly generous grant from the cancer center to purchase brand-new books and give them out for free to our patients and their family members and their friends.

Host Amber Smith: So what type of books are these?

Librarian Sarah Lawler: They are all types. I would say the most common type of book that we have in the space are cookbooks. So these are cookbooks that are geared toward people who have cancer and also cooking for the entire family or your loved ones in a way that helps out and hopefully helps lessen some of those common side effects from cancer treatment, while still being good family options that hopefully everyone in the family would enjoy. So cookbooks are a huge one.

We also have informational texts on cancer, on caregiver info, things like that. We also have fiction in the Family Resource Center that isn't cancer related. We know that people sometimes get inundated with information. You know, when you have cancer, it's all this information, cancer, cancer, cancer, and sometimes you need a little break. So we definitely want to provide resources for that as well. And there are also books in there that are geared toward children who have cancer as well.

Host Amber Smith: Are you able to help people who want to do their own research? Is that the request that you get?

Librarian Sarah Lawler: Absolutely. So we have a couple of options.

Some people really prefer to do their own internet searching, and that is great. When that's the case, I sit down with them, either virtually, in person, over the phone, whatever works best for them, and I teach them some tips, some strategies for how to find quality health information on the internet and to be reasonably certain that the information that they're finding is quality.

Host Amber Smith: Do you ever find yourself searching through medical journals?

Librarian Sarah Lawler: Absolutely. So some people are interested in the cutting edge research that is being done, and if that's the case, I do search those medical journal articles and send them to them. The thing that's a little bit tricky about those is that they are written for medical professionals, so doctors, nurses, people who have degrees and experience in the medical field. So they include a lot of jargon, a lot of words that people who don't have those degrees may not know, and it might take them a longer to get through the articles. So usually I default to the information that is written specifically for patients and family members. But it is certainly an option if someone is interested in that.

Host Amber Smith: Well, I'm interested in your background and how you trained to become a librarian working in an academic medical center.

Librarian Sarah Lawler: So to become a librarian, you have to have a master's in information science, and so I got my master's at Syracuse University in 2013. And I actually started in public libraries. So the first five years that I was a librarian, I was a librarian at the Fayetteville Free Library in Fayetteville, New York. And I did similar things to what I'm doing now. It was a lot of outreach, it was a lot of instruction. But five years ago I transitioned to being a medical librarian, which was a lot of the same things, because it was a lot of outreach, which is pretty similar, but it was a steep learning curve in terms of learning how to search databases, learning about medical information, learning the lingo, learning what different medical professionals do. So it was quite a big change. But I enjoy both roles, for sure.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with clinical outreach librarian Sarah Lawler.

What types of requests do you most often get from patients or their families?

Librarian Sarah Lawler: I would say most frequently they are looking for information on the type of cancer that they have or their loved one has. Sometimes there's requests for side effects. Treatment options is a huge one. Frequently people want to know what treatments are available.

Host Amber Smith: And so you can help them look for treatments or even, I imagine, clinical trials for treatments that are being developed, maybe?

Librarian Sarah Lawler: Absolutely. Yeah. So if someone was interested in clinical trials, I could help them do a search to identify ones that would fit whatever parameters, whatever needs they had.

Host Amber Smith: What's the most unusual request you've received?

Librarian Sarah Lawler: This always makes me laugh because I think through my experience being a librarian, both public librarian and medical librarian, people who ask questions, they frequently think that their question is really unusual and really strange. And that's never the case, quite frankly. We have heard it all. And most of the time what they're asking is a really common question. It's a need that a lot of people have. And so, I just really want to release the stigma around asking your librarian for help. They're not judging you. They're not thinking you're really strange. They are here to help you, and they want to help you.

Host Amber Smith: Do you ever get requests that take a lot of time to fulfill?

Librarian Sarah Lawler: It takes more time when someone is interested in medical journal articles just because the searching for that takes a little bit more time, but it's always worth it.

Host Amber Smith: Do you have a favorite request that you think back to?

Librarian Sarah Lawler: I would say my favorite type of request is when someone comes to me looking for, to help a loved one, a friend, a family friend, someone they know, who is going through cancer.

So frequently people will come to me and say, "My relative, my friend is going through a cancer treatment. I don't know how to help. I want to help them. I know they're overwhelmed. What should I do?" And I think it's really wonderful when someone wants to get resources for their friend. They want to be there for their friend, they want to help out. And usually the result of that kind of ask is me giving them some books, some book titles that they might take to their loved one and share with them.

And usually that's a great interaction because you can just tell that these people are very loving, very kind people who want to help.

Host Amber Smith: And so you can help them pick the right sort of title, or the right sort of book, that would be helpful?

Librarian Sarah Lawler: Absolutely. Yes. That's what I'm here for.

Host Amber Smith: Well, before we wrap up, since I know you work with patients and families whose loved ones have cancer, what advice do you have for someone who's newly diagnosed?

Librarian Sarah Lawler: I would say, while the cancer treatment process can be really intimidating -- it usually involves meeting with a lot of different health care professionals, a lot of new things, a lot of, words and treatment options that you may not have heard before -- I would say don't be afraid to ask questions of your treatment team. I know that it can be intimidating, but they're absolutely there to help you, and a lot of them are really kind, really thoughtful individuals who want to help.

Host Amber Smith: Are there resources that people can turn to other than the Family Resource Center? You know, if they get home from after their appointment and are thinking back on either notes they took or the conversation they had, and maybe there's a word that they don't understand, is there a resource that you recommend for learning different medical terms?

Librarian Sarah Lawler: Yeah, so, there is a really great website put out by the National Library of Medicine. It's called medlineplus.gov. And that information on that website is, has information from the National Library of Medicine on a lot of different terms. A lot of different health related topics of all kinds, not just cancer. And that's good-quality health information, generally. It's a website that I recommend to a lot of different people, and it does have links to information, other places on the internet. So they may link out to American Cancer Society, different government websites and organizations. And those links are vetted by librarians from the National Library of Medicine. Nothing is foolproof, but that's generally a really good resource.

Host Amber Smith: That's really good to know. Well, Sarah Lawler, thank you so much for making time for this interview.

Librarian Sarah Lawler: Thank you for having me.

Host Amber Smith: My guest has been Sarah Lawler. She's a clinical outreach librarian at Upstate's Health Sciences Library. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Carol Sames from Upstate Medical University. What's important to know about heat illnesses?

Carol Sames, PhD: Heat cramps are, probably, if you've been out and you've done something that's fairly strenuous, you're used to heat cramps. It's almost like night cramps, where you have a muscle group, sometimes the calf muscle or the upper leg muscles, they just start to cramp. And it is very uncomfortable. Sometimes they'll continue to cramp. They won't relax. And that's a heat cramp. And really, it occurs because there's an imbalance between body fluid and electrolytes. What you need to do is stop, and you need to drink water or sports drink.

That should resolve. It's not going to resolve immediately, though. You're not going to just drink and be like, "Heat cramps are gone!" Most likely, what you're going to have to do is, if you were running, you're going to need to walk. If you were cycling, and it's bad enough, you're going to have to get off that bike. But that's what you need to do to resolve that situation.

The next two are what we consider more extreme heat illnesses. So, heat exhaustion, and that's when we don't have enough circulation to evaporate that heat that we're building up, and so, we start to lose blood volume, and we start to lose body volume.

In terms of "How do I know I'm kind of moving from heat cramps to heat exhaustion?" -- if I would take my pulse, it would be weak and very rapid. Usually when we're exercising, you can feel your pulse. It's nice and hard and steady. But with heat exhaustion, it's weak. You also might start to experience a headache because you're not getting enough blood flow to your brain, dizziness, and you just generally don't feel well.

You need to stop exercising. You need to move to a cooler location, under a tree, somewhere where there's shade. If you can get indoors where there's some type of air conditioning, that's even better, and you need to replace fluids. You might even need to go to the hospital and get an IV (intravenous fluids) -- kind of depends on how depleted you are.

The worst heat illness is heatstroke, and it is an immediate medical emergency. This is not something where people are like, "Should I go to the hospital or not?" because it's a cascade of events. Basically we have no more heat regulation going on, so we're no longer sweating. Our skin is hot to the touch. It is not moist anymore. Core temperature is at about 104 degrees or higher, and the body does not tolerate that type of extreme temperature. You end up with central nervous system failure, so a person might start to look very uncoordinated all of a sudden. They can't stand. They may stumble and fall. You're starting to get organ failure, kidney failure, and people can progress really quickly from delirium to convulsions to coma. That's why this is a medical emergency. They need to get immediately to the hospital. They need to be immersed in cold water, ice, they need immediate fluid, IV immediately.

And you'd be surprised; even highly trained athletes have died from heatstroke. It is really problematic because when it starts, it's like a downhill car. It moves quickly.

Know what your limits are, right? So, like, you can't go from zero to hero. If I've not been active, I need to know that it's going to be a slow and steady progress. I need to make sure that I'm not dehydrated, and that I'm taking in enough fluid.

So that might mean if I'm out doing an activity, that I bring water, sports drink, with me, or that I have stops along the way where I can drink. In terms of older adults, it's very important to understand that we lose a thirst drive as we get older. Essentially, what we say is that after the age of 65, almost every adult is dehydrated, to start. So, if you're dehydrated to start, and then you go out, and it's warm, and you're exercising, you're becoming even more at risk of dehydration, and then, kind of that cascade of heat illness. So, that's really important.

I just really think it's always good to carry something with you, some kind of fluid. You never know. Especially if you're going to go out, you don't really know how hot it's going to get. The way we protect ourselves and keep our body temperature low, the primary mechanism, is evaporation of sweat. So when sweat is rolling off of us, we are not evaporating. And if we're not evaporating, we're not cooling, because that evaporation is going to cool the blood that is at the surface.

And so in the morning, usually the sun is lower, so you don't have that direct thermal heat on you, and it's usually cooler out. It could still be high humidity, but it's cooler, and so, we are able to evaporate. If it's a hot day, and there's no wind at all, and it's humid, you need to be smart. You want to make sure you have proper clothing. I might want to have a hat on. I have fluids with me. I might want to be with somebody, or I might want to go to an area where there are other people, that I'm not completely isolated.

Generally speaking, unless you acclimatize to running at noontime in the summer, you're going to run into trouble. Yes, you can see people outside; I see noon runners all the time, but they have been doing that consistently. And so they have acclimatized to training, and there's actual changes that occur in the body that your body gets used to not producing as much salt-laden sweat. You tend to conserve. And we're also assuming these individuals are hydrating themselves properly before they go run at noon.

There's a reason why I, personally, run in the morning. I don't heat-acclimatize well. I don't feel good in the heat, and so I would much rather get up in the morning before it gets really hot and just get something done. I'm impressed by those noon runners, but it could never be me.

We all have to listen to our body, right? So if it's really hot, and I'm out there, and maybe I didn't really hydrate well, I'm out in the sun, I'm maybe running on some type of asphalt, and I start to feel, like, hot, and I start to feel maybe a little dizzy, and I'm just not feeling well. That's your body saying, "This is not the right situation for you."

You have to listen to your body. The body usually tells us, and it's just when we try to ignore our body that we generally run into issues.

Host Amber Smith: You've been listening to exercise physiologist Carol Sames from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Ubong Johnson, a fourth-year medical student from Nigeria, sent us a poem about how his brother's tragic death both inspired his decision to become a doctor and helped him avoid a public humiliation during his training.

"Locked Jaw"

i walk into the pediatric ward today,

blue scrubs, sticking to my black skin like kin,

and i am reminded of that Tuesday my mother lost herself.

that morning, my twin brother,

who was born a bright-eyed flower, died a tree.

stiff necked. jaws locked. limbs like branches.

death had weeks before crawled into his eight-year-old

body through a dirty puncture wound underneath his big toe,

seizing him by the nape like a bully.

he died a faulty machine, jerking and spasming, doctors

racing to keep life from escaping through his nostrils, my mother's

wails slicing into the air; my father's sclerae like wet red clothes.

i silently complete the arc of medical students around a small bed,

and my consultant's eyes regard me as though she considers tossing

me outside for arriving late for rounds yet again.

she withdraws her glare, and the question meant to

humiliate me, my punishment, clambers out of her throat:

you, tell me what you think afflicts this child? everything about it, i mean.

and God save you if you don't know.

i look down, and i smile. another chance to tell

my twin brother's story. to describe clostridium tetani;

the reason i have chosen to become a doctor.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air," understanding the process of developing new drugs and how it could be improved. If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.Org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel. This is your host, Amber Smith, thanking you for listening.