Seasonal vaccinations; tissue typing and transplants; today's hospital food: Upstate Medical University's HealthLink on Air for Sunday, Oct. 1, 2023

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," an infectious disease doctor tells which diseases adults may want protection from this fall.

Elizabeth Asiago-Reddy, MD: ... The goal is to get the vaccine in about four weeks before the flu season hits. But also you don't want to give it too early because the flu season lasts for several months. ...

Host Amber Smith: A pathologist describes the role of tissue typing in organ transplantation.

Reut Hod Dvorai, PhD: ... The problem starts when we put a kidney from another individual into our body, and that kidney expresses different tissue types. ...

Host Amber Smith: And we'll hear about trends in hospital food.

Eric Adams: ... Room service has been the biggest thing for patients, kind of like when you're in a hotel, you're hungry, you look at the menu, and you order what you want. ...

Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.

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 about the science of tissue typing. Then we'll hear how hospital food service has evolved. But first, which vaccines are recommended for adults this fall?

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

It's flu shot season, but there are additional vaccines adults may consider at the same time. For details, I'm talking with Dr. Elizabeth Asiago-Reddy. She's the chief of infectious disease and an associate professor of medicine at Upstate.

Welcome back to "HealthLink on Air," Dr. Asiago-Reddy.

Elizabeth Asiago-Reddy, MD: Thank you for having me. It's good to be with you again, Amber.

Host Amber Smith: Let's start with what's important to know about this year's flu shot. Do you have a projection for how severe this season will be?

Elizabeth Asiago-Reddy, MD: Well, last year we had an early spike in flu cases, and so that appeared to be concerning initially, and it was a rough go at the beginning. But actually as the season progressed, the numbers evened out, and so they weren't very different from pre-pandemic numbers -- though they certainly were up from a couple of years during the pandemic when we saw low numbers.

So I don't think we're expecting anything too out of the ordinary. And this may be more of a typical pre-pandemic flu season this year. There are some numbers in Australia that appear to show younger children still having a lot of experience with the flu. So we may see something like that, as the Southern Hemisphere often is our predictor for the Northern Hemisphere.

Host Amber Smith: How does this year's vaccine compare with previous years?

Elizabeth Asiago-Reddy, MD: This year it's a similar makeup in terms of the numbers of components that are in the flu vaccines. There is one adjusted component from last year. And that's just exactly what we're supposed to be doing, is trying to keep up with the trends that we see and the types of viruses that are circulating. So this is a goal to match the circulating virus strength better.

Host Amber Smith: Will there be a nasal option for people who don't like needles?

Elizabeth Asiago-Reddy, MD: Yes. It's called the LAIV (Live Attenuated Influenza Vaccine), and there are some groups of people who cannot receive that vaccine. So the individuals who are potentially eligible are aged 2 to 49 years without severe immune compromising conditions. So the patient themselves should not be severely immune compromised, and their immediate contacts also should not be severely immune compromised. So that means their close caregivers and family members. And also children who have a history of asthma between the ages of 2 to 4 should not receive this vaccine. Otherwise, it is a good option for individuals who don't like needles.

There's also a needleless option for adults. It's given through an autoinjector that goes into the muscle by a different mechanism aside from the needle. Word on the street is that it still can cause some pain, so it's not necessarily less painful, but for individuals who really can't stand the sight of a needle, that might be an option if they can locate a health care provider who's offering that.

Host Amber Smith: What about people over age 65? Are they still recommended for a higher-dose vaccine?

Elizabeth Asiago-Reddy, MD: Yes. So there are a couple of different options for individuals who are over age 65. One of them includes a higher dose of one of the components of the vaccine that's been shown to improve the immune response.

There's also an adjuvanted vaccine; that would be add a different option. Or, the recombinant vaccine. So all of those are options for people over the age of 65 and, well, 65 and older, and those are available both through primary health care providers as well as a number of pharmacies.

Host Amber Smith: Now, when should Central New Yorkers get vaccinated, and how long does the protection last?

Elizabeth Asiago-Reddy, MD: Ideally the best time is late September, early October to be vaccinated. And that's because flu season usually starts to kick in by the end of October. It's most severe during January, oftentimes, although, like I said, last year we did have an early spike in cases, so it's possible we could see something like that again.

The goal is to get the vaccine in about four weeks before the flu season hits. But also you don't want to give it too early because the flu season lasts for several months, and the immunity does wane over time, relatively quickly. So after about 12 to 14 weeks, unfortunately, you're going to experience some waning of immunity. And so we're trying to cover the best of both worlds by giving it right around the end of September, early October, so that you catch the first few cases that may be coming through, but also have immunity, hopefully, lasting long enough through the early spring when we still may see some activity.

Host Amber Smith: Do you know, does everyone in the community have access to flu shots? Are they free, or is there a charge?

Elizabeth Asiago-Reddy, MD: This is a good question, and it relates to vaccines across the board, including COVID. So, New York state does an excellent job because in general there are fewer people who are uninsured or underinsured in New York state compared to a lot of other states. So, Medicaid, Medicare, all the exchange program insurances, commercial insurances that you would get through your jobs, those are all going to cover flu vaccine as well as COVID vaccine.

For people who are in some kind of an insurance gap, the best place to look is with the health department. So the local health department, including our health department, will offer coverage for adults through the Vaccines for Children Program. So that program actually also covers adults who are underinsured as well. So again, the health department is the best place to check if you find yourself in that gap.

Host Amber Smith: Well, I've got some questions about the COVID vaccine also, but before we get into that, is there a vaccine now for respiratory syncytial virus, or RSV, for adults?

Elizabeth Asiago-Reddy, MD: Yes, there is. So this is something new that has just come out. There were actually two vaccines that were evaluated in June by the FDA (Food and Drug Administration), one that's made by GSK and one that's made by Pfizer. Those are called Arexvy and Abrysvo, respectively. And they're both highly effective in preventing severe lower respiratory tract infection from respiratory syncytial virus, or RSV.

The GSK Arexvy appears to be slightly more effective when we look at the available data. And it had a unanimous vote of approval, versus a couple of dissenters on the Pfizer vaccine. But both were approved, and both, again, are effective in preventing severe disease and specifically lower respiratory tract disease -- so that means pneumonia -- in adults, age 60 and up. So these are currently being recommended as a single dose for adults age 60 and up.

What we don't know right now, to my awareness, is whether there'll be additional recommendations for others who might have risk for respiratory syncytial virus based on immune compromise. At this point, I'm only aware of the older-adult option or recommendation at this point.

And that also matches -- I know my talk is not primarily about children -- but there is a monoclonal antibody available for children, which is new as well. So with these combinations of prevention options, we're hoping that we'll have a less severe RSV season than last year. So last year was a very severe RSV season that was somewhat unprecedented.

Host Amber Smith: Is the RSV vaccine something that people can ask about when they go to get their flu shot and potentially get them both at the same time?

Elizabeth Asiago-Reddy, MD: I would definitely recommend anyone who's eligible asking their primary care provider about all of these vaccines and how best to give them in combination. For right now, there's no contraindication to getting all three vaccines together at the same time -- so that would be flu, RSV and COVID.

It looks like, because the RSV vaccine is adjuvanted. What that means is that there's a medication put into the vaccine that boosts the immune response. There's a possibility that people might have some more symptoms associated with getting multiple vaccines delivered at once.

That having been said, when reviewing expert advice and realities on the ground, what happens when you split up vaccines is that people oftentimes just don't get them. And so it would be better to get all three, especially for those individuals who are at highest risk. So those include the people in the age groups recommended, and especially those with comorbidities.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Dr. Elizabeth Asiago-Reddy, Upstate's chief of infectious disease, about fall vaccinations for adults.

We'll be entering our fourth fall/winter of COVID. Where do things stand with vaccine boosters in terms of what's recommended?

Elizabeth Asiago-Reddy, MD: This year, actually, starting from the spring, a number of the bodies making recommendations for vaccines made things a lot simpler for COVID. And what that means is that we have done away with the primary series for COVID. What is recommended for all age groups that are eligible for vaccination is that they get a single dose of the most updated vaccine.

So right now, the most updated vaccine up until maybe a month from now is the bivalent, what we call booster, and the goal is to kind of move away from the use of the term booster and look at COVID vaccines as more of an annual vaccine. But because we knew this kind of product as a booster, that's what we're talking about. So we're talking about, right now, a bivalent booster.

So if you had a single dose of a previous booster, you may be done. So if you already have received the currently available booster, you may be done until newer products come out in about a month. Or if you were never vaccinated, then you may, if you really want to be vaccinated now, you would just get a single dose of that bivalent booster. The only exceptions to that in terms of the dosing would be people who are moderately or severely immune compromised, who may need additional doses to get up to what's recommended in terms of their level of immunity.

Now starting in September sometime -- we're being told towards the end of the month -- we anticipate that we will have new COVID annual vaccines, and those are derived from some of the omicron variants that we've seen circulating, specifically one of the variants called xbb.1.5. And so we anticipate a better immune response to currently circulating variants with the updated vaccines that are anticipated to come out in about a month. So it leaves a little bit of a gap between now and one month from now for those who might have an additional level of risk or concern. But that's where we currently stand.

Host Amber Smith: So are infectious disease experts looking now at COVID more like a seasonal flu, where people would come and get vaccinated during flu season for protection against COVID?

Elizabeth Asiago-Reddy, MD: Yes. That's the goal. The goal is to simplify the vaccine regimens and what we've seen pretty much across the board is that in climates where we experience a cold-weather winter season, that particular time of year tends to be the worst for COVID. COVID is a little bit more, I would say, unsettled in its seasonality compared to flu, where we still see some irregular spikes in disease activity that may fall outside of the typical winter season, or maybe a bit different, depending on the climate that someone's living in. So we have seen spikes in warm-weather environments when people are probably spending a lot of time indoors because of air conditioning. So there's still some irregularities with COVID.

That having been said, by and large, it makes sense for us to turn this into an annual vaccine. It's much more straightforward for people. It's going to be easier for people to get other vaccines that they need to protect them from things that may be just as severe or even more severe than COVID at this point. And it allows for taking into account, like I said, what's likely to be the most severe period of time for COVID, which is the cold-weather months.

Well, this has been very helpful, Dr. Asiago-Reddy. Thank you so much for your time.

Absolutely. I appreciate being on. It was great to talk with you.

Host Amber Smith: My guest has been Dr. Elizabeth Asiago-Reddy, the chief of infectious disease at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Finding a tissue match in organ transplants -- next on Upstate's "HealthLink on Air."

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

Upstate University Hospital has a histocompatibility lab, also known as the tissue-typing lab. Today I'm talking with its director, Dr. Reut Hod Dvorai, to learn about the role of this lab.

Welcome to "HealthLink on Air," Dr. Hod Dvorai.

Reut Hod Dvorai, PhD: Thank you so much for having me. I'm excited to be here.

Host Amber Smith: Well, I'd like to start by asking how you got started in this profession. I'm assuming you had an interest in science.

Reut Hod Dvorai, PhD: Yes, I think that's a very good question because the tissue typing is such a small niche, and I feel like most people don't even know that we exist.

We do all the work in the background, away from the spotlight, so getting into this field is kind of like ... you don't wake up in the morning and say, "This is what I want to do." You stumble upon it, I would say.

So the way I got into this field is, I went to school at the Technion, which is the Israeli Institute of Technology, and I did a bachelor's degree in biotechnology and food engineering. So, I envisioned a career in the food industry. And so the last year, I had an elective course in immunology, and I remember it very vividly. I was sitting in the lecture, it was the first lecture of the course, and the lectures started to talk about the history of immunology. And I just sat there, and it was so fascinating that I was, "OK, this is what I want to do."

So it was a total detour from what I thought I'm going to do. After that I did a PhD in immunology in the same institution, followed by a transplant immunology fellowship, and I ended up at Upstate.

Host Amber Smith: I appreciate you giving us that background and how you kind of found your way into clinical pathology. And this big word, "histocompatibility," that just means "tissue typing," right?

Reut Hod Dvorai, PhD: So, there are multiple different names. You can hear people call us the Histocompatibility Lab, the Tissue-typing Lab, we're also the HLA Lab. So either one of the terms is good to describe us.

Host Amber Smith: Let's talk about what tissue typing is and what it's used for in medicine. Can you tell us about the history of tissue typing and how it began?

Reut Hod Dvorai, PhD: Sure. I'll start by explaining what tissue typing is. Tissue typing is essentially a process where we take blood from a person, and we test the blood for their human leukocyte antigens, so, HLA for short. And HLA are proteins that are expressed on the cell surface of almost all the cells in the body. And they help our immune system to distinguish between self and non-self.

So you can think of HLA proteins as a passport that every cell in our body carries, and it shows this passport to our immune system, letting the immune system, which is our body's police, know that it's healthy or not. If the cell is not healthy, or (is) infected with a virus, for example, it shows it to the immune system and then the immune system can target and eliminate this infected cell.

So it basically helps us to protect our body against things that are not supposed to be there, but at the same time, it helps our body protect healthy cells and tissues.

Host Amber Smith: So is this a science that emerged alongside organ transplantation?

Reut Hod Dvorai, PhD: Yes, absolutely. Organ transplantation, in the modern era, began with observations of skin graft rejections in patients. Those were soldiers and civilians during World War II. So, at that era, there were a lot of people that were burn victims, and clinicians noticed that when you put a graft on a person, if it comes from the same person, the graft is usually accepted or tolerated. But if you take a graft from a different individual, then the graft is usually rejected.

And so, slowly they began to understand the basic concept of transplant immunology. And the progress of surgical techniques and medicine in general, and development of new drugs, all of that made transplantation possible. Histocompatibility came a little later. The first observations that led to the discovery of the HLA, or tissue-typing, system in humans came from patients who were either pregnant or had multiple transfusions. And so these individuals, they noticed that when they get blood transfusions that had white blood cells in them, they would often react against the white blood cells. But when the white blood cells were removed from the transfused products, the transfusion reaction didn't happen.

So they realized there is something on the white blood cells (leukocytes) that makes people react against. And, the first description of the human leukocyte antigens, or HLA antigens, came in 1958. The first successful kidney transplant was in 1954, four years earlier, so they didn't even know about HLA when they transplanted the first successful kidney, but their luck was that the recipient and the donor in that scenario were identical twins, so they had the same HLA, and that was one of the reasons why the transplant was successful.

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

I'm talking to Dr. Reut Hod Dvorai. She's an assistant professor and the director of clinical pathology -- histocompatibility at Upstate.

Why do you have to determine HLA compatibility prior to transplant?

Reut Hod Dvorai, PhD: Because our body knows to recognize our own kidneys as self. The problem starts when we put a kidney from another individual into our body, and that kidney expresses different tissue types, or different HLA antigens.

And at that point our immune system looks at the kidney and recognizes something that is foreign that shouldn't be there, so it starts attacking and wants to reject that kidney. So, in order to avoid that, we want to match between donors and recipients. And there's a few testings that we perform in the lab to do that.

The first test is we do HLA tissue typing for the donor and the recipient to determine how well matched they are.

The second test that we perform is HLA antibodies present in the serum (the liquid part of the blood) of the recipient. And basically we want to know if the antibodies that the patient has are aimed against a specific donor.

And the third type of assay that we perform is what we call a crossmatch. That's an assay where we actually take blood from the patient and blood from the donor, and we incubate them together to look for reaction.

Host Amber Smith: So, is this histopathology done when a person joins the transplant waiting list, or do you wait until you think you might have a match with a donor?

Reut Hod Dvorai, PhD: So, that depends on the testing. So, the tissue typing is done at the very first stage, when the patient presents at the transplant clinic for evaluation. They take the blood, and they send to the HLA lab. We do the tissue typing one time, because tissue typing, it's a genetic test, essentially. We test the DNA for the HLA genes, and so the DNA doesn't change; we only have to do that one time, at the initial stage of evaluation. And then we test for the presence of HLA antibodies in the patient's serum. But in order to be up to date, because antibody profile of the patient may change over time, that we have to repeat every three to four months. So while the patient is waiting to be transplanted, he's waiting on the wait list, we need to update his antibody testing every few months.

The crossmatch assay is only performed when there's an actual donor, or an actual kidney offer, for that recipient, because then we take the specific donor and the recipient, and we look for reaction between them.

Host Amber Smith: We're talking about kidney transplants, but would this be the same whether it was a liver transplant or a heart transplant? Do you have the same sort of concerns and tests?

Reut Hod Dvorai, PhD: So, we perform the same testing for the different types of organs. The concern for rejection itself is slightly different between the different organs.

So, for example, liver is an exception. Liver has a lower rate, or a lower risk, for rejection because it has this amazing ability to absorb antibodies, and it's more resistant to rejection. But even the liver can be rejected.

For hearts, for example, transplant centers may choose to take more risk when it comes to transplant because when the kidney fails, there's an option to continue care on dialysis, long term. When the heart fails, there's not many options, so it's more medically urgent, and so you might be inclined to take more risk.

Host Amber Smith: Now, are you working with blood samples, or do you need actual tissue to examine, to do the histocompatibility?

Reut Hod Dvorai, PhD: So, we usually test a patient's blood. We isolate the DNA from the patient's blood, but we can also use other types of samples, such as cheek swabs, or we can use saliva, too.

Host Amber Smith: We've always heard, like with transplants, that the donor and recipient, their blood has to match. Is that the case? That the blood has to match, and then, on top of that, you have to have a tissue match as well?

Reut Hod Dvorai, PhD: Yes. The blood group system, the ABO blood group system, is totally separate of the HLA antigens. So those are two separate things.

So for transplant, we try to match for both. We try to match for the blood group, and we try to match for HLA.

We can sometimes do transplants across what we call ABO incompatible pairs. So, that means that there's not necessarily a match of the ABO blood group system. But with HLA we try to avoid situations where there's incompatibility, meaning that the recipient has antibodies against the HLA antigens on the donor cells.

Host Amber Smith: Are twins always a match?

Reut Hod Dvorai, PhD: Identical twins are. Identical twins will have the same HLA because they have the same genes. With non-identical twins, it's a 25% chance of having the same HLA, same as just regular siblings. And in general, within the family you have 25% chance of having an HLA-identical sibling. You have 50% chance of having a half-matched sibling, and you have 25% chance of having a sibling that has nothing shared with you.

Host Amber Smith: So that's for siblings. Would that be the same for parents or aunts or uncles or grandparents?

Reut Hod Dvorai, PhD: The HLA genes are inherited from the parents.

So that means that you get one gene from your mom and one gene from your dad. So, essentially, the parents are always half matched. So 50% match always.

Host Amber Smith: Does the person's gender affect the match?

Reut Hod Dvorai, PhD: It shouldn't. No, those are two separate things. So you can be male and female, and you can have the exact same HLA typing, or you can be two females but have a different HLA typing.

Host Amber Smith: So, what is the likelihood, if you are on the waiting list for a kidney transplant, what is the likelihood of finding an HLA-matched donor?

Reut Hod Dvorai, PhD: I'll start with first saying that we don't look for an identical donor when it comes to organ transplants. That's a different case with stem-cell transplants, but for solid organ transplants, we can't find, it's just not feasible to find, someone who has the exact HLA as the patient because the HLA genes are so diverse. There are thousands of different variants of those genes, which means that different individuals have different HLA types, so having someone that has the exact same HLA, it's very unlikely to find, especially if it's an unrelated donor. So, we're not looking for an exact match.

The one thing that we want to focus on when we determine compatibility is looking for antibodies in the recipient and making sure that these antibodies are not aimed against the donor HLA. So a patient can have HLA antibodies, but as long as they're not aimed against the specific donor that we're evaluating for that patient, that should be OK.

Host Amber Smith: So does a strong tissue match with a transplanted organ, does that reduce the amount of anti-rejection medicine an organ recipient has to take afterward?

Or does it improve the chances for a successful transplant?

Reut Hod Dvorai, PhD: Yes, absolutely, 100%. As a rule of thumb, a person cannot develop HLA antibodies against their own HLA, so if your donor has the exact HLA as you, then you won't be able to develop antibodies against your donor, which means that you are very unlikely to reject the organ, which means that you can probably be managed on lower immunosuppression, which is a good thing for patients because immunosuppression has its tolls. It makes you more susceptible to infections and malignancies, so having lower immunosuppression is something very beneficial. So, the better the match is going to be, the better the outcome is going to be.

Host Amber Smith: Well, thank you for taking time to explain this to us. I appreciate it, Dr. Hod Dvorai.

Reut Hod Dvorai, PhD: Of course. Thank you for having me.

Host Amber Smith: My guest has been Dr. Reut Hod Dvorai. She's an assistant professor and the director of clinical pathology -- histocompatibility at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air" -- Hospital food is healthier.

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

Today I'm talking about food, specifically hospital food, with two of the people who oversee the food operation at Upstate Medical University. Daniel Ellithorpe is the senior director of food services, and Eric Adams is the system director of food service and hospitality.

Welcome, both of you, to "HealthLink on Air."

Eric Adams: Morning, Amber. Thanks for having us.

Daniel Ellithorpe: Thank you.

Host Amber Smith: I want to give listeners an idea about the scale of the food operation at Upstate. About how many people do you feed per day?

Daniel Ellithorpe: So, in our patient services format, we serve about anywhere, on average, from 325 to 350 patients per meal.

So, about 1,050 people per day, just in the patient meal side.

Host Amber Smith: So, that's just patients, but you may also have visitors, and then employees, right?

Daniel Ellithorpe: Correct.

So, during our retail operations, on average, of Monday through Friday, I mean, we'll have about anywhere from 1,600 people go through the register.

It's just how many rings (of the cash registers) are actually put through. So they can be buying anywhere from a soda to a muffin to a full-course meal.

Host Amber Smith: It sounds like you're busy from before sunup probably until after sundown.

Daniel Ellithorpe: Correct.

Yeah, and on the weekends our private transactions are about half of that, on a Saturday and a Sunday.

Host Amber Smith: So, how early does your breakfast shift arrive to start preparing the food for the day?

Daniel Ellithorpe: So, our cooks come in at 4:30 in the morning. Our patient services breakfast meal begins service at 7 o'clock in the morning, and our retail cafe operations begin at 6 in the morning.

Host Amber Smith: So you probably at 4:30 start making breakfast foods and things like that, but you probably also start with lunch and afternoon meals, too, right?

Daniel Ellithorpe: That doesn't usually start till around 7, 7:30 for lunch. Then, like, our dinner meals will start around 10:30, 11 o'clock.

Host Amber Smith: Can you walk us through how hospitalized patients get their meals these days?

Daniel Ellithorpe: Well, from start to finish, I can kind of run through that.

We have what we call a patient dining associate, and they are assigned to certain floors. And when they go up to the floors, or to the units, they visit the patient in the room, and we'll take their menu. We do have a standardized menu that we use, but it features chef's specials for each day for each meal.

So they'll kind of walk the patient through what our options are and what we have, and they'll take the order. And then from that point, the order is put into our meal ordering system. And when it's actually time to prepare the meals or the trays, they print off the tickets for that unit that they're assigned to.

And then they'll start producing the trays. They put everything on the tray, from the hot food or cold entree, whichever ones they decide, to their silverware, their drinks, any side of fruit or dessert that they have. Once all those trays are completed for that whole unit or floor, they bring the cart. They, first of all, put all that in the cart, and they bring it upstairs, and then they pass it out to every patient that they've taken their order for. About an hour after that, they'll go through and pick up all the dirty trays after, and then it kind of runs into that cycle again for the next meal.

Host Amber Smith: So, what happens to people who maybe are in the emergency room waiting for a bed to become available? Do they get a meal service in the emergency room?

Daniel Ellithorpe: They do. There's two different options there. I mean, we do supply what we call, like, a house tray. So, our house trays typically are chef's specials for that day because we don't have anybody that can actually get down there and take those orders. So we do supply meals for those folks while they're there, during the mealtime. And if they happen to come in after operations for us have closed, like, 11 (p.m.) to 7 in the morning, there is what we call a box lunch down there that has, like, a turkey sandwich and pretzels and a beverage and a cookie for them to have until they either get moved to a floor or a hot meal for the next meal.

Host Amber Smith: How often is it that you need to accommodate a special diet for someone, who may have to eat a special diet when they're in the hospital, pureed food or low sodium, things that are medically required?

Daniel Ellithorpe: A lot. That's a big part of the patient meal services because there are many people that come in with different diets and different consistencies of food that they need to have.

When we design our menu that has our chef's specials on it, it is meant to hit a lot of different diets, whether it's low fat, low sodium, low cholesterol. Those are all kind of built in when we create those menu items. And I want to say currently there are, like, 20 different diets that we have here, whether it be low fat, low salt, low cholesterol, you got the diabetic diets, and there's probably three or four different tiers within those. Now you have the gluten-free diets, you have vegan and stuff of that nature, so it's pretty vast, yeah.

Host Amber Smith: Well, Mr. Ellithorpe, both you and Mr. Adams have experience in the food industry and in health care. So I wanted to ask you what trends you've seen over the years in terms of what things have changed in the industry.

Mr. Adams?

Eric Adams: Sure. I've been doing this for the last 13 or 14 years, and man, there has definitely been a lot of changes. I think as far as patient services go, room service has been the biggest thing for patients, kind of like when you're in a hotel, you're hungry, you look at the menu, and you order what you want. But obviously, within the hospital, if you do have a certain diet that you need to adhere to, that is followed as well.

It's something that we're working on to do here. We'd like to do that here at the hospital, at Upstate, as well as at Community (both Upstate University and Upstate Community hospitals), because it is a huge patient satisfier. So I think that is a trend that hospitals are trying to get to. I think that just stuff like Dan's talking about. Gluten-free and vegan have become very popular. We just started selling a lot of vegan sandwiches and other types of meals in the cafeteria, and it's going like crazy. So, just the different types of diets, I think, are just progressing.

Host Amber Smith: I was going to ask if there's a particular food that is popular these days that you're getting requests for, but vegan apparently is popular, right?

Eric Adams: It is.

Daniel Ellithorpe: Yeah, I'd have to say a lot of people just didn't know that they had like a gluten allergy before, but that seems to be a pretty predominant ask, or a diet, that people need nowadays. In addition to what Eric was saying, whole grains are kind of a big part of people's mindset and what they want to eat now, too.

Host Amber Smith: For people that don't see something that they like in the cafeteria, do you see a lot of food deliveries from restaurants coming to the hospital?

Or is that even allowed?

Eric Adams: I can take that one. I think that every single person, you know, us on this call, everybody -- everybody eats a little different. We have, I think we have, a ton of options in the cafeteria. I think that if you ate at the same restaurant every single day, you'd want to eat somewhere else every once in a while, too.

So, I do think there's some ordering. They have the DoorDash (food delivery service) and all those fun things now, so I think there is some of that. I don't think, I KNOW, there's some of that. And then we also have done a good job partnering with a lot of food trucks, so between this (downtown) campus and Community campus, almost Monday through Friday, we have a food truck at the campus that just gives not only families, but staff, just another option.

What I've learned over the years is: People want options. They don't want to be either told what to eat or have only one option to eat; they want to have options. So we really try to do a good job of providing as many options as possible.

Host Amber Smith: Each hospital has a main cafeteria, right?

Eric Adams: Yup.

Host Amber Smith: Each campus, and then you also have some grab-and-go stations, is that right? Mostly for, I guess, visitors and employees and students?

Eric Adams: We have a small, what we call, like, a mini-mart, where people can come, and it's kind of supervised by video. There's nobody physically there. So they can come at any time of the day and grab stuff.

We do have tons of vending throughout the hospital. We're working with another vending company to try to provide some even healthier options. One's called Farmer's Fridge, and actually, daily, they load it with fresh salads, so salads and fruit. So we're trying to partner with them.

There's just all those options, and this campus also has a lot of retail locations that we're also trying to fill. We're starting to partner with some new vendors to get some more of the retail locations that were open before COVID. You know, the food industry took a big hit during COVID. So we're trying to get those open as well.

We were able to open a location over at 550 Harrison (an Upstate facility a few blocks from the main hospital) with Hope Café, and that seems to have been a great partnership so far.

Host Amber Smith: Well, let's get back to the daily cafeteria menu. When you set about to create the menu, what sorts of things do you take into consideration? Mr. Ellithorpe?

Daniel Ellithorpe: We are actually what we call a WellPower platform (a system stressing healthy eating) for our cafeteria, so we have certain criteria for our entrees and our sides so that you have what they call "fit criteria," which is the lower fat, the lower salt content. There's more whole grains used, kind of staying away from beef and doing more chicken and fish.

As of now, pretty much all our coolers, our set for our bottled beverages, is 80% healthy beverages and 20% are sugar. We're kind of trying to not really push people that way, but, if we make it predominant, in front, and I like to call, like, "stealth health," where you're just kind of presenting foods that just look appealing and taste good. And people don't know that they have a better health benefit for them, but I think it's going a long way. So there are certain criteria when we plan our menus that we look at.

Host Amber Smith: Do you have a really popular item that when you have it on the menu, it sells out really quick?

Daniel Ellithorpe: Out of all the stations, consistently, our salad bar is the busiest station on a day in, day out, out of any item that we sell. Monday through Friday, we do have what we call an "entree reimagined" station, where it's kind of like a "build your own," and it varies from different types of concepts. One day it'll be a Latin theme, next time it'll be a Mediterranean, next time it'll be, like, Indian cuisine, it'll be like a loaded-type baked potato. But people are kind of able to go in there and create their own, like, meal, for the most part. There's bases and toppings and proteins and stuff that you can put on there to customize it, to make it your own.

Host Amber Smith: Well, since your career is sort of devoted to cooking for people who are ill or recovering from injury, is there any advice you can offer for people who are at home taking care of someone who's under the weather or recovering? Are there certain foods that are good for that? Or certain foods maybe to stay away from?

Daniel Ellithorpe: Well, definitely keep on your water and your fluids, staying away from sugary beverages.

Meals high in protein do have great healing values to them, as opposed to deep-fried chicken fingers, stuff like that. I'd say, definitely, home-cooked meals, roasted meats, steamed vegetables, stuff of that nature, are definitely better for you, and they're going to help with the healing process.

Host Amber Smith: Let me ask each of you to share your favorite meal and your favorite healthy snack. Mr. Ellithorpe, do you want to go first?

Daniel Ellithorpe: Oh, jeez. Favorite meal? I like to eat a lot. Culinary is my background. So, I mean, I can't say I have like one favorite meal. Healthy snack? I love hummus. I'll dip anything in hummus and make a good snack of it.

But yeah, I just like too much. If I had a preference over fish, it'd be sea bass. At a preference over, like, chicken, it would probably be like a quarter chicken or something like that. So it all depends on the situation and stuff I'm in.

Host Amber Smith: Mr. Adams?

Eric Adams: For me. I'm definitely a chicken guy. I try to get as many different recipes for chicken as possible, so I do that, but I also love hibachi. I don't know what it is about getting good food from a hibachi, but I love that with some sushi.

Snacks? I, unfortunately, am a chip guy, so I really have to be careful with myself. I love me a good crunch, but the boring side is I definitely drink a lot of protein shakes, so, got to get your protein intake.

Host Amber Smith: Do you have any predictions for how food service in the hospital is liable to change in the coming years? Are there trends that you see?

Daniel Ellithorpe: Well, we started using robots actually to deliver food. I mean, there's been a few bumps in the road, but I think there'll be more of that, that will happen. I think it'll be more, like, I know some places are starting with the patient ordering their meals by themself through an app, so they can kind of see what their options are and then order it that way. Then it's just delivered.

More whole grains, definitely. Besides that, I mean, I think it'll be a little bit of a change. Eric did mention before, room service, that's probably still going to be at the top of everybody's mind as time progresses.

Eric Adams: To add to that, I also think one thing that hospitals have done over the last few years is really recruit chefs. There's always been a stigma over hospital food, just going to plop some stuff on a tray, and it's no good. But over the last few years, chefs have become really predominant in health care and have done a great job helping design and improve the food for the patients, because let's face it, when the patients are here, they don't have a lot of choices. And, we want to try to provide a good meal for them then, so at least maybe they have something to enjoy for the day.

And I think our chefs are doing a great job with that.

Host Amber Smith: Well, I appreciate both of you making time for this interview. Thank you.

Daniel Ellithorpe: Yep, no problem.

Eric Adams: Thanks for having us.

Host Amber Smith: My guests have been Eric Adams and Daniel Ellithorpe. Mr. Adams is the system director of food service and hospitality at Upstate, and Mr. Ellithorpe is the senior director of food services at Upstate.

I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from dermatologist Ramsay Farah from Upstate Medical University. How does a person choose the right moisturizer?

Ramsay Farah, MD: Well, rather than look for specific ingredients, I think it's probably better to consider what your skin type is, and then choose your moisturizer accordingly.

So, for example, when you consider your skin type, you should think about the texture, right? And so, for example, normal skin does best with a light, kind of non-greasy moisturizer, while dry skin may need a heavier, creamier formulation that kind of locks in that moisture.

And so you sort of want to see what the formulation is, whether it's a very heavy ointmentlike product or it's a very sort of light, more lotion-type, product depending on your skin texture.

The other thing you can consider is whether it has an SPF (sun protection factor), right? So some moisturizers have an SPF, and I think that's very useful. You want to see whether the moisturizer has a fragrance to it or not. And so, for example, if you have very sensitive skin and you have a lot of allergies, you want to try and probably avoid scented moisturizers with fragrances or perfumes.

Also with regard to your skin, if you have a tendency for allergies and sensitive skin, you want to see whether it's been allergy tested. If you have acne-prone skin, you want to make sure that it doesn't cause acne. So for example, the very heavy moisturizers that someone with very dry skin might need, those might make acne worse if you apply them on acne-prone skin. So it should say non-comedogenic, which means it's not going to make acne worse.

And what I would say is oftentimes it's a little bit of trial and error. I think there are a lot of good products out there, but you want to try and see how it feels on your face, whether you like the way it feels, because if you like it, then you're going to use it. And then you want to see how your face reacts to it. If it reacts well, meaning it absorbs it, and the skin looks plumper, and it looks better, that's great. That's a win. If you find that your skin doesn't do well with it and gets a little bit irritated and red, then you probably want to stay away from that formulation.

Host Amber Smith: You've been listening to Dr. Ramsay Farah 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: Two of our poets provided us a sense of how appearances are only a small part of any story. It takes a perceptive observer to see within.

Erin McConnell is a pediatric physician from Ohio who is also working on a master's degree in medical humanities. Look at how the patient she describes has tried so hard to be good.

This is "The Easy Patient":

You aim to be the easy patient:

meds memorized,

seeing enough specialists

to not be a burden or

cause cognitive strain

Just a few refill requests

no additional concerns

Paperwork completed

arrival on time

even disposing of your own

patient gown

No need for receipt

no follow-up scheduled

making as small a

carbon chain footprint as possible.

Mick Cochrane from Buffalo asks us to think about how the airlines reinforce our sense of worthiness with their zone hierarchies. But we don't know the real story.

Here is "In Zone Three":

no one thanks us for our service

we have accumulated no

points no perks we have no

right to upgrade no hope

of extra leg space or complimentary

anything it doesn't matter what indignity

our poorly packed luggage suffers to make

it fit we are nobodies red-eyed

sleepless lumps of coffee fear

we wear cargo shorts and Crocs

we are the army of the un-

fashionable we are a-stylish we

take no selfies because

we don't want to know we are

flustered by TSA and pet

the wrong dogs we belong

on a bus but we are here please

forgive us our sorry state

our heartache is too sudden

so this one time we must

find a way to fly

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," using cannabis for chronic pain relief may backfire.

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.