Mild cognitive impairment; a druggist for kids; crossword puzzle clues: Upstate Medical University's HealthLink on Air for Sunday, July 23, 2023

[00:00:00] Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a geriatrics expert explains that most people with mild cognitive impairment will not develop dementia.

[00:00:08] Sharon Brangman, MD: ... People just feel like their brain is not working like it used to, and they feel like they have more memory problems than they should be having. But when we talk to them, they're still functioning normally. ...

[00:00:21] Host Amber Smith: And a pediatric pharmacist discusses his role in the children's hospital and how he gets kids to take their medicine.

[00:00:28] Peter Aiello, PharmD: ... Pharmacists can add flavoring and sweeteners to certain medications and formulate them so that they're more palatable to infants, toddlers and children. ...

[00:00:36] Host Amber Smith: All that, some crossword puzzle advice, 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 meet a pediatric pharmacist from the Upstate Golisano Children's Hospital. But first, we'll delve into what living with mild cognitive impairment is like with Upstate's chief of geriatrics.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." More than one in every eight people aged 60 and older is living with mild cognitive impairment, according to a special report from the Alzheimer's Association, and about a third of them will develop dementia within five years. Those are some sobering numbers, so for help understanding our individual risk, I'm talking with Dr. Sharon Brangman. She's the chief of geriatrics at Upstate, where she's a distinguished service professor and the director of the Center for Excellence for Alzheimer's Disease.

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

[00:01:48] Sharon Brangman, MD: Thanks for inviting me.

[00:01:50] Host Amber Smith: The Alzheimer's Association report said from 12 to 18% of people aged 60 and older are living with mild cognitive impairment. Have they all been diagnosed, or are there significant number of people with MCI who don't know it?

[00:02:04] Sharon Brangman, MD: Well, I think there are significant numbers of people who do not know it, and one of the main questions we get asked is, "I'm losing my memory. I think I have dementia because I can't find my cellphone or I can't remember the name of somebody who I've known for years. It's at the tip of my tongue." And those are some of the symptoms that we see with normal aging.

So as we age, our brain does undergo some changes that make it harder for some people to retrieve information. And I kind of explain it like a big hard drive full of information on a computer, and it has to start going through a lot of files to pull out the information. So you may see someone that you know, and you recognize their face, and you can remember so many other things about them, but you can't remember their name. And it may take you several minutes or hours later to remember their name, but generally you can pull it up. Or you may be talking, and you kind of lose your train of thought, but then after a period of time, you remember, and you can get back on track. These are things that happen normally as we get older.

So if we think of our brain aging, like on a path where we're functioning normally, and then we might start to have problems with slow retrieval, and it may take us longer to remember someone's name, but we're still functioning normally. We can get through the day. We can take care of our finances. We can drive. We can dress ourselves. We can cook and figure out what to eat. You're still functioning normally. That is not considered dementia.

Mild cognitive impairment is a different entity along this path. And in mild cognitive impairment, people just feel like their brain is not working like it used to, and they feel like they have more memory problems than they should be having. But when we talk to them, they're still functioning normally. So it can get a little tricky sometimes to make that designation between what is normal aging and what might be mild cognitive impairment.

[00:04:34] Host Amber Smith: Does mild cognitive impairment affect men and women equally?

[00:04:38] Sharon Brangman, MD: Yes. It doesn't seem to have any gender specificity. Although women tend to get Alzheimer's disease more often, it doesn't appear that mild cognitive impairment has any specific racial or gender designations in terms of risk. And the majority of people with mild cognitive impairment never advance into dementia. About 80% to 85% may just have this aggravation where they just feel like they're not quite up to speed in terms of their brain power, but it doesn't get any worse, and sometimes it gets better over time.

[00:05:24] Host Amber Smith: So there may be people with mild cognitive impairment who never go on to develop dementia, is that what you're saying?

[00:05:30] Sharon Brangman, MD: Yes, that's absolutely true. But we focus on those 10 to 15% who every year do seem to progress into what we can then diagnose as Alzheimer's disease. And the trick about mild cognitive impairment is there's no definite X-rays or blood work or anything else that helps us make that decision. It really is left up to the clinical judgment of a physician who has heard these stories so many times and can start to sort them out.

There is a blood test and a brain scan that's a special kind of brain scan. It's called an amyloid PET (positron emission tomography) scan. And it can pick up abnormal buildup of this amyloid protein in the brain. And research has shown that if you have mild cognitive impairment, and you have buildup of this abnormal amyloid protein in the brain, then your risk for progressing to full-blown Alzheimer's disease is very high.

[00:06:38] Host Amber Smith: So you could use that to try to help predict. Are there other clinical signs? Can you differentiate a person who has MCI who's going to go on and develop dementia versus the one who's not?

[00:06:51] Sharon Brangman, MD: No. There's no way by the story that they tell us, or a physical exam that we know the difference. And the challenge is, is that many insurance companies, including Medicare, won't authorize coverage for an amyloid PET scan. So there's only rare cases where we can actually get that PET scan to see if they might have amyloid buildup.

There is a blood test that is being developed where we can do a blood sample and pick up those amyloid proteins in the blood, but it's still not completely approved by the Food and Drug Administration, and it's not readily available. So there may be an opportunity in the future to do a blood test, which would be cheaper than a PET scan, which is a specialized MRI of the brain. But right now it's very hard to get insurances to cover those.

[00:07:51] Host Amber Smith: Well, how do you go about diagnosing mild cognitive impairment, then, if someone comes in who's worried about forgetfulness or things that could be normal aging, but also could be mild cognitive impairment?

[00:08:04] Sharon Brangman, MD: So we have to listen to their story and listen to things that they're forgetting. And if it seems to be an accumulation of not just memory loss, but maybe problems making decisions or making decisions, especially where you need good judgment and problem solving, that starts to sound a little bit different than somebody who says, "I just couldn't remember somebody I saw this party, and I couldn't remember their name until I was driving home." There's nuances. There are nuances to it, and you have to go to someone who's experienced to help you sort it out.

[00:08:44] Host Amber Smith: You're listening to Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Sharon Brangman. She's the chief of geriatrics at Upstate and the director of the Center for Excellence for Alzheimer's Disease, and we're talking about mild cognitive impairment.

What do you do for someone who you feel has mild cognitive impairment? Is there medication?

[00:09:06] Sharon Brangman, MD: So, right now we are on the verge of getting approval from the Food and Drug Administration on new medications, if you do have that amyloid buildup in the brain, that may help to give you a few more months of stability if you have mild cognitive impairment. So as I mentioned earlier, if you have mild cognitive impairment and a PET scan shows that you have amyloid buildup, you have a very high risk for progressing to Alzheimer's disease.

And so these new medications remove this amyloid. They're very effective in removing the amyloid. And a couple of them that are under review for approval now show that they may reduce your progression for several months.

[00:09:58] Host Amber Smith: Are there any other diets or lifestyle changes, like common day-to-day advice? What are you able to tell people to try to do?

[00:10:06] Sharon Brangman, MD: We have a lot of non-pharmacological approaches, but as a society, we always want a pill. So we don't want to hear things unless there's a pill. But there's a lot you could do for brain health, and as I mentioned, for some people with MCI, it gets better.

There are a number of things that we encourage people to do. The No. 1 is exercise. Exercise is probably better than any prescription I could write. And we try to tell people that they need about 150 minutes a week of good activity. And that could be walking. You don't have to run a marathon. It could be swimming. I recommend that my patients figure out a way to take a walk for a half an hour a day. You could break it up into 15 minutes, twice a day. But it's very important that we figure out a way to incorporate exercise into our life, just like we brush our teeth every day.

The other thing you want to do is make sure you get a good night's sleep, because when we are sleeping well, that's when our brain cleans up all these little abnormal particles that build up during the day. And research shows that when we're in deep sleep, that's when our brain cleans up all of these little particles. So it's important to get a good night's sleep.

The other thing that people usually don't like to hear too much is that alcohol really isn't good for your brain. You know, there were a lot of studies -- many of them were supported by the alcohol industry -- that said red wine was good for your brain. And we're starting to understand that alcohol is actually a toxin to nerves, and there is really no safe level of alcohol for our bodies in general and for our brains. So I try to encourage patients to keep alcohol use to a minimum and to stay away from the very high alcohol content beverages if they have to have a drink. But maybe just save it for special occasions.

The other thing is to not smoke, to control your blood pressure, If you have diabetes, control diabetes, and to eat a heart-healthy diet. Any diet that helps your heart stay healthy helps your brain stay healthy because it's the same blood vessels that we're working on. And what they call the Mediterranean diet, minus the wine, is probably one of the healthiest diets you can have.

And then the other piece that's important is being socially engaged. If you have connections with people around you, if you volunteer in your community, if you have friends that you meet with regularly, it's important that you maintain social connections. And we're just coming out of a period where everybody was very isolated, and that took its toll on a lot of people and their brain power.

And then the final thing that's important is to make sure that you can hear well and that you can see well. Because if you don't get good sensory input from your ears and your eyes, then your brain has less to work with. And studies show that that can be a risk factor for developing dementia. And a lot of people don't want to wear hearing aids, or they deny that they have a hearing problem. It's very important to get your hearing checked and have your vision checked and to get them corrected if needed.

[00:13:40] Host Amber Smith: That's interesting. I hadn't heard that before, but it makes sense.

Now, let me ask you a follow-up about exercise. If someone has not been physically active all along, is it too late to see benefit from this after they're diagnosed with mild cognitive impairment?

[00:13:56] Sharon Brangman, MD: No. The interesting thing is that people in their 90s who increased their level of activity actually do very well. So it's really not too late.

And again, I'm not talking about going out and running a marathon. It is just making sure that you walk and move every day.

The other thing to avoid are long periods of sitting still. There's a lot of research that shows that if you sit still for long periods of time, that's not good for your health. So I also tell my patients it's good every hour or so to get up and do a few loops around your house. Just so that you're not sitting for hour after hour on end. And that's true for younger adults who are middle aged, because you should really be thinking of brain health when you're in your 30s and 40s, because it's the same brain that's going to have to serve you when you're in your 70s or 80s.

[00:14:54] Host Amber Smith: What about crossword puzzles and memory games, jigsaw puzzles, things like that? Are those important or thought to be important?

[00:15:02] Sharon Brangman, MD: Those are things that I encourage people to do if they enjoy it, but if it frustrates you and it's making you aggravated, I wouldn't do it. It doesn't necessarily improve brain power. Our brains are much more complex than putting together a jigsaw puzzle. But if you enjoy doing it, that's fine. I would say do it with a group of friends so that you include socialization with it.

It's important to read and to listen to music and to use both sides of your brain, if you're creative, to paint or learn a language or do something new. You want to make sure that you're having different experiences.

Now, back in the day, when I went to medical school, we were told that brain power starts to decline in our 30s or 40s. But we now know that you can continue to learn into your 80s and 90s. So you can teach an old dog new tricks. It's just that you might learn a little bit differently, but it's still good to learn new things because every time you learn something new, you make new nerve connections in the brain. And that's something that we want to keep doing throughout our lives.

[00:16:18] Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break, but please stay tuned as we continue our discussion about mild cognitive impairment with Upstate's Dr. Sharon Brangman from the Center for Excellence for Alzheimer's Disease.

Welcome back to Upstate's "HealthLink on Air." This is your host Amber Smith, talking about mild cognitive impairment with Dr. Sharon Brangman, who leads Upstate's Center for Excellence for Alzheimer's Disease.

Well, I understand that the majority of people who are diagnosed with mild cognitive impairment will not develop dementia, but for those who do, how fast have you seen that happen, and what is the progression like?

[00:16:58] Sharon Brangman, MD: So, it's a very individual thing because it often depends on other risk factors that the person may have, and that includes hypertension, diabetes, high cholesterol levels, educational background and other things like that. But if we say over 10% to 15% of people convert every year, and the whole span of Alzheimer's disease could last 10 to 15 years, so, it could take a couple of years to start to see more early signs and more definitive signs of Alzheimer's disease. And then once we make the diagnosis for early, it could take another six or seven years for someone to become moderate.

And these are all general rules of thumb because everyone is different. We're all individuals, and we're all products of our life events and our health and other things, so I'm talking in very general terms.

I've seen some people have very quick declines. And just the other day I saw someone in my office who I've been following since 2004, and I would say at this point they're more advanced, but they're still very functional. And so it's very hard to predict what each individual is going to experience with this really dreaded disease.

[00:18:23] Host Amber Smith: Is there any way for loved ones to try to get ahead and plan for what is coming or what this person may need as the disease progresses?

[00:18:33] Sharon Brangman, MD: So that's what we do in our office, and we have a great team of social workers and we try to help anticipate needs. The worst time to make a decision is in the middle of a crisis, so we try to help patients and families as they move along with this disease, make appropriate plans. And we can tell them some of the kind of guidelines we've come up with when we know when it's time to do the next step. And that's why it's so important to make an early diagnosis because then the person can participate in these discussions and in these plans. So then we know that we're doing things the way they would want them to happen.

[00:19:14] Host Amber Smith: When does a person with mild cognitive impairment have to stop working or driving?

[00:19:21] Sharon Brangman, MD: We usually recommend a driving test, for example, to assess somebody who is experiencing mild cognitive impairment. But for the most part, these are people who are still very functional. And they should still be able to live independently and take care of themselves and drive. And many are still working. It really depends on what they're doing. So it is not until we get to early Alzheimer's disease that we start to look at predictive safety measures to make sure the person stays safe and others around them stay safe.

[00:20:00] Host Amber Smith: How long can the person continue to make decisions for themselves, or how do you go about determining when they can't make decisions for themselves?

[00:20:10] Sharon Brangman, MD: So, that's a very good question. And again, it's a very tricky one because everyone is different. We can generally say that most people with mild cognitive impairment and even mild Alzheimer's disease can make decisions for themselves. Many people, not all, but many people with moderate Alzheimer's disease can make decisions for themselves and can still participate in their care.

By the time someone has advanced Alzheimer's disease, that is less likely to be realistic. And that's why we want to make sure, when they're in their early stages, that they select a health care proxy or someone who can represent their wishes when they're no longer able to do it. And that health care proxy has to be someone you trust, and it has to be somebody who will make decisions for you, not their own personal decisions. And that can get a little tricky. So those are some of the discussions that we start early on, so that someone has time to think about it and consider it and select the right person.

[00:21:15] Host Amber Smith: And make their wishes known either in writing or to a person that they trust?

[00:21:20] Sharon Brangman, MD: Exactly. We want to make sure that we're doing things the way you would want them to be done.

[00:21:26] Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Sharon Brangman. She's the chief of geriatrics at Upstate and the director of the Center for Excellence for Alzheimer's Disease, and our topic is mild cognitive impairment.

Is psychological counseling part of this, along the way?

[00:21:45] Sharon Brangman, MD: So, yes. There are many people with mild cognitive impairment and even early Alzheimer's disease who would benefit from talk therapy. As long as you still have the ability to have some insights and to remember and follow suggestions, that sort of thing, there are a number of therapists in the area that we refer our patients to on a regular basis -- and sometimes not only the patient, but their caregivers and their families because, generally, this is a very stressful time and everyone needs some help and support getting through.

[00:22:24] Host Amber Smith: Are there medical issues that are more likely to arise in someone with mild cognitive impairment?

[00:22:32] Sharon Brangman, MD: A person with mild cognitive impairment would have the same medical issues that most other people have. And in our work in the Center of Excellence for Alzheimer's Disease, we find that there are many people with memory problems who have the triad, as we call it -- hypertension, diabetes and elevated cholesterol or triglycerides -- because those are things that impact the health of our blood vessels. And the health of our blood vessels are very, very important for keeping our brains healthy.

The other thing we have found is that the brain is very sensitive to sugar levels. And, if you have diabetes, that means your body is having trouble managing sugars. And there are some studies right now looking at certain diabetes medications as possible treatments for Alzheimer's disease because some people with Alzheimer's disease have resistance to metabolizing or using their blood sugar. So just like you could have diabetes, you can have the same problem in the brain where the brain can't use sugars correctly. And that may increase your risk for dementia. So the brain is connected to the rest of our body. And if the rest of your body isn't healthy, your brain may not be, either.

[00:24:02] Host Amber Smith: Well, the whole idea of dementia or Alzheimer's or mild cognitive impairment can be pretty scary to people, especially if they're grasping at remembering names and that sort of thing.

There's a lot of products available that promise to make your thinking sharper. I'm thinking of things like Prevagen and some of these other supplements. Is there anything that helps?

[00:24:27] Sharon Brangman, MD: I would say save your money, and don't use Prevagen. It does not work. They have some very compelling commercials, but it does not work.

One interesting study that recently came out was that adults that took one senior vitamin a day seem to have better cognitive function over time. So we used to tell people that you can get all the nutrients you need from your food and you don't need to take any vitamins or vitamin supplements. But there is increasing evidence that, especially B vitamins, may be a little bit trickier for our brains to work with as we get older. And so you might need a higher dose, or you might need more than you would've when you were younger.

In fact, we are going to be starting a clinical trial soon that's going to look specifically at that thiamine mechanism.

But in the meantime, I think it's a good idea to take a "senior vitamin." And the reason why I say a senior vitamin is because they don't have iron in it. You don't want to take a vitamin with iron in it, because as we get older, there's no way for your body to get rid of that iron. And the iron can build up, and the iron is toxic to nerve cells. So when you look at vitamins that say "specially formulated for adults 65 and older," that would be the kind of vitamin you would want to take because it doesn't have iron. And if you can afford it, because sometimes vitamins can be expensive, I think it's a pretty low-risk thing to take one vitamin a day.

[00:26:17] Host Amber Smith: Well, like you said, we're all looking for that magic pill, and it's just not there.

[00:26:22] Sharon Brangman, MD: It's not there. No, it's going to take a little bit more effort. And you know what? It has to start when you're 30 or 40. It's not one of those things that you just wait until you're 80. Although you still get benefits if you start when you're 80, if you want to maximize it, you've got to move back a few decades because all of the things we do to our body accumulate over time, and your body remembers it.

It's kind of like those people who played sports and hurt their knees or their hips, and then later on, they've got very bad arthritis pain. And they need some attention to their knees and their hips. Well, the same thing is true for our brain health. We want to wear seat belts so that if we get in an accident, we don't hit our head on the dashboard. You want to wear a helmet when you're riding a bike. You want to be very careful if your kids are playing football or soccer or hockey or lacrosse because head injuries, even when you're younger, can have implications on your brain health as you get older.

And we've all heard those stories of football players who were playing since peewee leagues and in high school and had lots of concussions. And then years later in their 30s or 40s, their brains are pretty beat up, and they start to get a form of dementia. So we have to take care of our bodies across the lifespan.

[00:27:53] Host Amber Smith: Well, this has been very informative, and I appreciate you making time for this interview, Dr. Brangman.

[00:27:59] Sharon Brangman, MD: Thank you for inviting me.

[00:28:01] Host Amber Smith: My guest has been Upstate chief of geriatrics Dr. Sharon Brangman. She's a distinguished service professor and director of the Center for Excellence for Alzheimer's Disease at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air," how pediatric pharmacists ensure the safe delivery of medication to children.

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

Upstate Medical University and the Upstate Golisano Children's Hospital are full of different types of specialists, and today I'll be speaking with someone who specializes in medications for children.

Peter Aiello is an assistant professor of pharmacy at Upstate.

Welcome to "HealthLink on Air," Dr. Aiello.

[00:28:51] Peter Aiello, PharmD: Thank you Amber, for having me.

[00:28:53] Host Amber Smith: Let me start by asking you, do kids have their own medications that have been approved just for use in kids, or is it generally the same medications as adults, just in smaller doses?

[00:29:06] Peter Aiello, PharmD: Generally, most medications are originally formulated for adult patients, and they're usually approved by the Food and Drug Administration. That's the government body that regulates medications for use in patients, for adult patients. And a lot of the dosing that we use in pediatric patients is kind of extrapolated, or inferred, from adult doses based on a patient's weight.

[00:29:30] Host Amber Smith: So, medications are tested in adults, and then, if they're safe for adults, they're assumed to be safe for children.

Is that right?

[00:29:39] Peter Aiello, PharmD: They're not always assumed to be safe for children. Children will have their own studies where we look at the use of these medications in children, but generally they start out in adults, and then their use will get moved to children.

[00:29:52] Host Amber Smith: Is dosing for children based only on their weight?

[00:29:56] Peter Aiello, PharmD: Generally dosing for children is based on their weight, although sometimes there are different measurements that your doctor or pharmacist may look at, such as height and body surface area, which is a really complicated way of looking at the size of the body to dose medications.

[00:30:13] Host Amber Smith: Are all medications for kids available as liquids?

[00:30:19] Peter Aiello, PharmD: Most medication formulations that are given to children are available commercially as liquids. Sometimes though, we have to make tablets or capsules into a special formulation for children, and this is known as a process called compounding. And this is something that pharmacists specialize in while they're in pharmacy school.

So sometimes your doctor may prescribe a medication that's only for an adult patient and is in a tablet or a capsule, and then the pharmacist will have to break those capsules or tablets up and mix them with different liquids to create a liquid where none is available.

[00:30:54] Host Amber Smith: What happens if a child chews a pill that's supposed to be swallowed? It's going to taste bad, right?

[00:31:01] Peter Aiello, PharmD: Sometimes we have pills that are made to be chewed, and those are called chewable tablets and are meant for pediatric patients, for children, to consume.

In other instances, if that situation that you described has occurred, sometimes they'll taste bad, and other times they may be an overdose if they have a full adult dose of the medication. So in that case, you would have to call the poison center, and that number is available widely on the internet (the Upstate New York Poison Center can be reached at 800-222-1222, 24 hours a day, every day).

[00:31:30] Host Amber Smith: This is going to sound very simplistic, but why do medications taste so bad?

[00:31:37] Peter Aiello, PharmD: Medications are formulated in such a way that we don't really think about taste for the actual drug ingredient. And that's because if it's going to be in a liquid, we'll add other things to make it not bitter, we'll make it sweet, and the drug ingredients may be what we call an acid or a base. And that's just based off of the chemical structure of the drug. And those acids and bases just don't taste well, because in history, if someone were to have something that were too either acidic or basic, it could mean that it was a poison. So that's why they actually taste poor to us as human beings.

[00:32:13] Host Amber Smith: But for children especially, you're able to add flavoring sometimes so that it doesn't taste so bad?

[00:32:20] Peter Aiello, PharmD: Yeah. There's commercially available products, suspensions, chewable tablets, that already have flavorings in them, like amoxicillin or Tylenol, that everybody thinks of.

But sometimes if there is a liquid medication that still tastes bad, even though it is supposed to be formulated. There are ways that pharmacists can add flavorants and sweeteners to them to make them taste better.

[00:32:43] Host Amber Smith: How do you tell if a new medication is causing an adverse reaction in a child that cannot speak, or a baby?

[00:32:51] Peter Aiello, PharmD: This is a really good question that a lot of parents need to look out for when they give their child a new medication. So one of the things, the first telltale signs of a reaction, is either that you give the medication to the child and then a few minutes later, after they've swallowed it, they throw up, or they get a rash, or they start to have swelling in their face.

Any of those instances, you really need to call your doctor's office. But if it involves anything with breathing where their face swells, they sound like they're gasping for breath, they're coughing. you really should call 911 and get evaluated in the emergency department.

[00:33:29] Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.

I'm talking with assistant professor of pharmacy at Upstate Peter Aiello.

Can you tell us about what a typical day is like as a pharmacist in a children's hospital?

[00:33:44] Peter Aiello, PharmD: Yes, and Amber, this is something I'm very passionate about. I think a lot of folks think of pharmacists as somebody who is behind the drugstore counter dispensing medications, and that's a really vital role for a lot of pharmacists.

But there's also a whole team of pharmacists that have gone on to specialize in various areas of medicine. I specialized in pediatrics, and we actually round with the medical team. We work in the emergency department alongside our nursing colleagues to help in emergency situations. We take medication histories if you're coming into the hospital.

It's something that's really important and that a lot of families get frustrated with. The nurse asks them what medications their child's on. The provider may ask the question, and then they have a pharmacist come in the room and ask the same question. It's really important, though, that you provide that information, even if it's a couple times, because that information will help us provide better care for your child.

So the next time you see a pharmacist in the hospital, please say hi to us. And it doesn't necessarily mean that your child's going to get medication. It just means that we're there to help ensure the safe delivery of medication to your child.

[00:34:51] Host Amber Smith: So what is your educational training? What is it like to go to pharmacy school?

[00:34:57] Peter Aiello, PharmD: I went to six years of pharmacy school. I did not get an undergraduate degree, so I actually went straight from high school, and in six years graduated with my doctorate in pharmacy.

And then I went on to complete two years of additional postgraduate training, known as a residency. So pharmacists do, and can do, residencies, and those were both completed here at Upstate. And there was that second year of residency that I specialized in pediatric pharmacy.

[00:35:24] Host Amber Smith: Well, let's talk about some of the most common medications that kids may take.

You already mentioned amoxicillin. That's that pink liquid. That's got to be one of the most popular, and I doubt there's any child who makes it through childhood without taking that. Are there special concerns about antibiotic use in children compared with those used in adults?

[00:35:44] Peter Aiello, PharmD: Antibiotics used in children are some of them, amoxicillin is one of the most common, and like you said, most children are exposed to it at some point in their early childhood. It's used to treat a lot of common conditions, like ear infections and strep throat. Amoxicillin is also used in our adult patients as well, and there's a lot of common antibiotics between the two populations.

We use very similar drugs. I think the most important thing is, is that if you are prescribed an antibiotic, just like as if an adult were, you should take the full course as directed by your doctor and make sure that if you have any questions about what medications can be given with the antibiotic that you ask your pharmacist or your doctor.

But in terms of specialty antibiotics versus adults? In pediatric patients, I think it's more the formulation that we all talk about, like the liquid amoxicillin.

[00:36:32] Host Amber Smith: Steroids are another type of medication kids may be prescribed. Are there side effects to be aware of with steroids?

[00:36:40] Peter Aiello, PharmD: Steroids are generally very well tolerated in children.

Sometimes it can make them have a little bit more energy, it may make them anxious, but that usually very quickly goes away once you stop the steroid. We usually give children steroids for shorter periods of time. If for some reason there are any side effects that just don't make sense, that would be a question to please ask your pharmacist.

They serve a really important role. When you go to the pharmacy counter and pick up any prescription, to make sure that you have that conversation with your pharmacist and develop a relationship with them because they have great information, and it's not always good to just walk away if you haven't had those questions answered.

[00:37:19] Host Amber Smith: What are the best pain relief options for babies, toddlers, preschoolers, teens? There's a lot on the market over the counter. What would you recommend?

[00:37:30] Peter Aiello, PharmD: There is a lot of over-the-counter options. I think the most important thing is, if there's any type of pain or fever, to make sure that your child, especially if they're less than 6 months old, that they get evaluated by their pediatrician right away and that you don't delay going to your pediatrician or calling your pediatrician's office.

I think Tylenol is probably the cornerstone of pain and fever relief in children, and liquid Tylenol is what we recommend for pretty much everything, fever- or pain relief-wise.

I think with Tylenol though, it's important to remember that many products, liquid cough medicines and things, can contain Tylenol.

So it's important to just give plain Tylenol and not use any cough or cold liquid medications with your child, unless you've been specifically pointed to those by a doctor and have gone over that dosing with a doctor or a pharmacist.

[00:38:22] Host Amber Smith: So some of those over-the-counter cough and cold remedies already have Tylenol in them.

Is that what you're saying?

[00:38:28] Peter Aiello, PharmD: That is correct, yes.

[00:38:29] Host Amber Smith: Do you ever encounter children who are taking herbal supplements, and I wonder if that complicates what medications they can be prescribed?

[00:38:40] Peter Aiello, PharmD: Herbal supplements are becoming more common these days.

I think before starting your child on any herbal supplement or dietary supplement, that should be a conversation between the parent and the doctor.

I also think that you should, if you do decide to start an herbal supplement, it's very, very important that you tell your pharmacist that you're on those medications, so they can check for drug interactions. So if you are filling your prescriptions at any chain drugstore or independent drugstore to let the pharmacist know. They're not going to have that information, and there's not going to be a prescription for that herbal supplement, so it's really important that it's put on the patient's profile so that they can do interaction checking to make sure that the medications that have been prescribed are safe and are not going to interact.

[00:39:28] Host Amber Smith: I'd like to get your advice for parents or caregivers who are trying to get a child to take a medicine they don't want to take.

What strategies can you suggest?

[00:39:39] Peter Aiello, PharmD: I think we've touched on one of the most important ones, is that pharmacists can add flavoring and sweeteners to certain medications and formulate them so that they're more palatable to infants, toddlers and children.

I think some of the other strategies that are really important are maybe offering something with a glass of cold water to help the medication go down easier.

And if the child's in the hospital and is started on a new medication, and there's issues with taking it, certainly asking the medical team to involve pharmacy, the inpatient pharmacy. We can help counsel families on how to start that medication.

And then there's also another group of professionals that I always like to work side by side with, and those are our child life specialists. So they are a wonderful addition to our children's hospital and provide a wonderful service of helping children cope with their hospitalizations. And they also have some techniques to help our children take medication easier, so definitely making it an interdisciplinary approach if you're in the hospital.

But if you're not, and your pediatrician's just prescribed something that's new, let your pharmacist know at the counter when you pick it up that you're concerned, and they can offer some techniques tailored to that medication.

[00:40:51] Host Amber Smith: What age do you think you can start coaching a child to swallow a pill?

[00:40:56] Peter Aiello, PharmD: It's really dependent on their developmental status and things like that. And I've seen a wide range of ages when children can start taking pills. Again, that's a conversation best suited for that specific child, between the doctor and the family and the pharmacist and the family.

[00:41:13] Host Amber Smith: Good to know. Well, thank you so much for making time for this interview.

[00:41:17] Peter Aiello, PharmD: Thank you Amber, for having me.

[00:41:19] Host Amber Smith: My guest has been Peter Aiello. He's an assistant professor of pharmacy at Upstate specializing in pediatrics. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Rachel Fabi from Upstate Medical University. What advice do you have for solving crossword puzzles?

[00:41:38] Rachel Fabi, PhD: I would recommend checking out the New York Times Wordplay column, especially with the early week puzzles. So the Monday, Tuesday, Wednesday puzzles of The New York Times are the easiest ones of the week. Those are also the columns that I write. I write the Monday, Tuesday and Wednesday columns.

The goal of my column is to help new solvers get better and to learn to recognize patterns and the sorts of things that you'll see in clues. Like, what does it mean when there's a question mark? Or what does it mean when a clue is in quotation marks? Or what does it mean if it ends with comma, say, question mark. If you don't do a lot of puzzles, and you're just getting into it, you have no idea what that means. And so we write the column for new solvers with the idea being, here's some tips to get into it.

Aside from plugging my own column, other things that I recommend to new solvers is to just keep solving, because the more exposure you get to these things that are just in crossword puzzles, these clues to what's going on with the clues, the more you see that, the more you'll understand it quickly.

And the third thing I recommend is to solve the USA Today puzzle. It is written at the easiest level of all of the daily puzzles that are published in newspapers. It is consistently really high quality. It is consistently really inclusive. The constructor slate is really diverse. I think 75% of their puzzles are written by women, compared with other puzzles out there where it's closer to 25%. They've been really intentional about shifting that gender ratio. And so the USA Today is just my favorite beginner puzzle for new solvers to check out.

When you see a clue in quotations, it means that it is looking for an entry that is colloquial, that means the same thing. And so it just means what is something that you might say that means the same thing as the thing in quotes.

If your clue is a noun and it's plural, then your entry is going to be plural, so the part of speech has to match. The tense has to match. That sort of thing.

Brackets usually mean that the clue is not necessarily a word, or that the entry is not necessarily a word that you would say. It's more of an action. So for instance, in brackets you might see this is a clue that I wrote: brackets -- "more tuna, please" -- close brackets. And the answer was meow. Right? You're not speaking the word meow. It's just something that means the same thing.

When you have ellipses (written as three dots, like this: ...) In the middle of a clue, it means that the first part of the clue before the ellipsis is the clue to the entry, and so is the second part. But they're not necessarily related to each other. So it's basically giving you two clues to the same entry. And the "dot dot dot" is sort of a way of saying, isn't it funny that these two things are related? Or that they can both mean the same thing even though they seem different.

Another common thing that you'll see in crossword clues is an indication that the answer is going to be in a non-English language. And so sometimes that will be in the form of, like, at the end of the clue, you'll see (fr), which just means "in French," right? But more commonly in the clue itself, you'll have a word in that language. So you'll see a French word in this clue, or a Spanish word or a German word in the clue, and that tells you that what you're looking for is going to be in French or Spanish or German or whatever language.

If getting deeper into crosswords more than just solving occasionally is something that you're interested in, again, starting with the USA Today is a good on-ramp. And I think people who really, this is meant for people who really love this, will find from that entry point a lot of different directions that you can go.

You can get involved with sort of crossword Twitter, and that's a whole space where you can connect with other constructors and other solvers. There are tournaments that you can do. Many of them have been online over the last two years, for obvious reasons, but I think you have opportunities to compete and connect with other people either online or in real life.

And yeah, it's a really welcoming, kind, generous community. People are always looking to mentor new constructors and people who want to learn how to make puzzles. People are generous with their time and happy to help new constructors, and so it's a fun space to sort of explore.

[00:46:17] Host Amber Smith: You've been listening to Dr. Rachel Fabi 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.

[00:46:34] Deirdre Neilen, PhD: Sharon Pretti is a poet, a teacher and a medical social worker. She gave us two poems that speak to each other. They craft a portrait of a family's strength and love through even the hardest times. First is "Lunch at Sea Level":

My mother sliced her dill into quarters,

forked the rust-edge of an iceberg leaf,

a tower of fries between us. Our talk

didn't stop; fence rot, her leg cramps,

the ghost click persisting under my hood,

then a poem she told me she'd read

in her life-long learning class,

the circle sparring over which word

sang: rock or stone.

Did I mention it was my birthday?

Whorls of gift bag glitter, turquoise tissue

escaping skyward? This piling of decades

and I couldn't say: my brother, your son's chemo is failing.

I spoke about the cliff-side cypress instead,

the red-tails spiraling above them.

She ooohed over the lupine unleashed

below and told me the class chose stone

for how it descends at the end of a line.

The waitress wiped our table clear

of crumbs. And no, there was nothing

more we wanted. We knew better,

but didn't soften, our grief guarded

and me motioning to the wind-topped waves,

how they seemed to ride in from nowhere,

how they swept against rock, fractured like light,

how none of the breaking stopped.

Her second poem is called "Weekend at Rush Ranch":

A grove of oaks to shade us, our feet

propped on a paddock holding the biggest

horse we'd ever seen, daylight pouring

over its flanks, its withers and forelock.

The neck, we wanted our hands there,

the shiver and sway of all things possible.

Dust clouds rose when we walked,

my brother's back to me, a narrowness

that was new, his shoulder blades jutting

like windows cranked into the heat-drunk day.

Fields of needle grass beyond the fence,

bent, then upright. A progression, he told me,

the cancer beetle-burrowing into his spine.

All those summers and we never learned

to ride, never mastered the tension and release

of reins, the weight shifts signaling a beast

toward speed or stillness. How does the body

know when to stop?

Lucky horse, my brother said. braided mane,

a diamond crest. We had to tilt our heads

to meet its eye, that amber globe, its center

flecked with our reflection. What could

this creature know of us? The storm inside

each breath? Our wildness?

We wanted a miracle: limb, cell, bone, lymph. All of it.

[00:49:31] 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 OnAir," a detailed look at the newly approved drug to prevent RSV in babies.

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.