Healing kids' bones; an alternative treatment; checking on aged parents: Upstate Medical University's HealthLink on Air for Sunday. Aug. 6, 2023

Host Amber Smith: Coming up next on Upstate's "Health Link on Air," a pediatric orthopedic surgeon discusses arm and leg injuries in children.

Rajin Shahriar, MD: ... Usually there is some kind of injury to the soft tissues when a fracture happens because a bone is sort of the deepest part of the limb. So anything that's around the fracture can get damaged. ...

Host Amber Smith: A chaplain tells about the benefits of the energy healing technique known as Reiki.

Bob Crandall: ... With sleep, it actually will help a person to sleep because it relaxes them. And it's very often that when someone's getting Reiki, within 10 or 15 minutes, they're asleep. ...

Host Amber Smith: And a geriatrician explains how to tell when aging parents need help.

Sharon Brangman, MD: ... This can be a challenge for adult children, particularly those who do not live near their parents. ...

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 how Reiki is being used in the hospital. Then, a geriatrician advises how to tell when aging parents need help. But first, a pediatric orthopedic surgeon discusses arm and leg injuries in children.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Today I'm talking with a pediatric orthopedic surgeon about fractures in children. Dr. Rajin Shahriar is an assistant professor at Upstate.

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

Rajin Shahriar, MD: Thank you for having me.

Host Amber Smith: I'd like to begin by asking you to describe the role of an orthopedic surgeon.

Rajin Shahriar, MD: An orthopedic surgeon is a doctor that takes care of all musculoskeletal problems. They could be injuries such as broken bones or dislocated joints, or they could be more generalized problems likedeformities, congenital or developmental issues, things of that nature.

Host Amber Smith: And then someone like yourself, you specialize in children. Why are there orthopedic surgeons who specialize in pediatrics?

Rajin Shahriar, MD: There are orthopedic surgeons who specialize in pediatrics because pediatric patients pose a different set of problems than you encounter in adults. Children are growing. They're not just little adults. And they have a unique set of anatomy and problems that makes taking care of them a little bit more challenging and takes a little bit more care.

Host Amber Smith: So we'll get into a little bit more about that, but can you describe some of the injuries that may happen in a child when they hurt their arms or legs?

Rajin Shahriar, MD: So certainly the most common thing that comes to most people's minds are fractures. But it's also possible to have soft tissue injuries, and what we mean by that is everything around the bones. So that could be things like ligaments, tendons or even cartilage or other structures that make up our arms or legs, potentially even the nerves or blood vessels, which can be damaged in more serious injuries.

Host Amber Smith: You mentioned fracture. Is that the same thing as breaking a bone or a crack?

Rajin Shahriar, MD: I think that's a very common question, and I would define a fracture as some injury to the bone that disrupts its integrity. And you can see that that's a very generalized description because that really is a very general term for describing an injury to a bone.

Host Amber Smith: Are some fractures worse than others, then?

Rajin Shahriar, MD: Because fracture is such a general term, there are many kinds of fractures. One common analogy I like to make is dropping a dinner plate or a piece of kitchenware on the ground. And what happens is that you can get many different kinds of patterns of breakage to that when that happens. Sometimes when you drop a plate on the ground, you'll have just one crack, and the plate still holds together. So you have fractures that basically don't disrupt the integrity of the bone to cause displacement. Other kinds of fractures are like plates where if you drop them it would shatter into a thousand pieces, and those are also fractures. So, you can see that there's a wide variety of what fractures can be.

Host Amber Smith: Are there other injuries that can go along with a fracture?

Rajin Shahriar, MD: Yes. Like I mentioned earlier, there's a lot of stuff around the bones that can get injured at the same time as a fracture happens. And usually there is some kind of injury to the soft tissues when a fracture happens because a bone is sort of the deepest part of the limb. So anything that's around the fracture can get damaged. And that could be muscle, could be tendons, ligaments, could be nerves, could be blood vessels such as arteries or veins. Any of that is susceptible to injury. But the good news is that many of those injuries will heal up on their own.

Host Amber Smith: So let's talk about how a fracture in a child differs from a fracture in an adult.

Rajin Shahriar, MD: Perhaps the biggest thing that makes a child's fracture different from an adult's is their ability to remodel. So what that means is that children are growing, and their bones are also growing, and bones have something called a growth plate that allows the bone to grow over time. And the power of the growth plate is its ability to correct out deformities that fractures create.

And so because a child has a growing growth plate, they can straighten out many kinds of fractures and injuries and heal better than an adult would be able to with the same kind of injury.

I think another thing that's important to know is that children have more elasticity of their musculoskeletal system, and that's clear to anyone that's been around any child, that if they fall or have an injury, they bounce right back, and they almost act like they haven't sustained any injury at all sometimes.

And that's because children have, generally, a lot more flexibility than adults. And if you remember from high school physics class, whenever there's an injury, there's a lot of kinetic energy that goes into your body that gets dissipated along your tissues. So if that part of your body is very stiff, that's what creates the fracture. But if your body's able to bend and absorb that energy, then it will just bend, and a fracture won't happen. So, that's another thing that makes children different from adults.

And I think the last thing is children have much more healing potential than adults because over a lifetime, adults tend to accumulate different diseases or disorders, such as high blood pressure or diabetes or atherosclerosis. And these things essentially make it harder to heal, and children don't have most of those things, and so therefore their healing ability is much greater.

Host Amber Smith: Now let me ask you, on the growth plate that you mentioned, do children have these growth plates in their bones until the bones are fully formed?

Rajin Shahriar, MD: Yes. All children have growth plates on their bones until they're fully formed. And one thing that's also interesting to know is that many of these growth plates close at different times. So it's not that all of the growth plates in the body will close at the same time. Actually, some of them will close much later than others. Just to give you an example, the growth plate around the collarbone doesn't close until someone's in their 20s, but the growth plates around someone's femur, or the thighbone,may close closer to mid- to late adolescence.

Host Amber Smith: Are you able to tell that before you start taking care of someone? Or is there, do they show up on X-rays?

Rajin Shahriar, MD: Yeah. The growth plates show up on X-ray, and oftentimes they help us to know how quote unquote "skeletally mature" a child is. Because just because a child is a certain age doesn't mean their skeleton is also the same age. And so the appearance of the growth plates is a very helpful indication to us to assess someone's growth potential and also, the healing potential to an extent of different kinds of fractures and injuries.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Rajin Shahriar. He's an assistant professor of pediatric orthopedics. And we're talking about what to do for kids with bone fractures.

I wanted to ask you, though, are fractures involving joints necessarily more difficult to care for?

Rajin Shahriar, MD: In many ways, fractures that damage the joints are more difficult to take care of. And the reason is because fractures that go into the joint damage the cartilage of the joint. And cartilage does not heal in the same way that bone can heal. And the reason for that is because the mechanical environment and the biological environment both are different in the parts of the joint that have cartilage than the general parts of the regular bone.

Some of the things that we strive to achieve for joint fractures, as orthopedic surgeons, is that the cartilage really has to be lined up really well. And that's true for both adults and children. We don't like for there to be a large gap in the joint cartilage because that can really cause problems in the long term.

The other thing that's unique about joint fractures is that they can potentially also cause additional stiffness because we get our motion through our joint. So if there's a fracture that goes into the joint, that can predispose to greater degrees of stiffness than fractures that are outside of the joint.

Host Amber Smith: Well, let's talk about healing. What do you do to ensure that a fracture heals well?

Rajin Shahriar, MD: I think the most important things is to make sure that the fracture is lined up well. Like I mentioned earlier, children are generally able to tolerate a greater amount of malalignment than adults because of their remodeling potential. But it still needs to be lined up to a certain extent. And that means that someone who knows what that limit is needs to be involved in the care of these fractures to make sure that they are lined up well enough that they won't cause any long-term problems with regards to the functioning of the limb.

Once the fracture is lined up well, they need to be immobilized properly. Like I mentioned earlier, fractures come in different types and varieties, like the dinner plate that didn't really crack very much and didn't displace or shift, that might not need a lot of immobilization at all. Some fractures don't require a lot of immobilization. Some fractures need really good immobilization, and the purpose of that immobilization is to make sure that that alignment stays where it is.

And the third goal of treating fractures is that we achieve a balance between that immobilization and the motion and function. Just to use a silly example, if we immobilized a fracture for a year, that would probably mean that you could protect that bone and make it heal really good for a year. But that would create a lot of stiffness and other problems that would be very limiting. And so the art of treating fractures is really striking a good balance between immobilizing it just long enough so that it can heal versus removing that immobilization and allowing motion so that the function can return to the arm or leg.

Host Amber Smith: Are there things that the patient or their family need to do to help the healing go smoothly?

Rajin Shahriar, MD: Yeah. The first thing is having the fracture evaluated at the appropriate time interval. So that means coming in to see the pediatric orthopedic surgeon when the fracture happens, having it evaluated and making those decisions on the alignment and immobilization, and then checking to see if the alignment is stable over time or if it loses alignment over time, then additional interventions may have to be done, and then removing the immobilization at an appropriate time. So really following up and treating the fracture as the evidence would indicate.

I would say the other things to do, from a general standpoint, is just to make sure that we create a safe environment for the kids while the fracture is healing. So for instance, the day after having a fracture and being placed into a cast probably is not the best time to go jumping on the trampoline. So just making sure that the environment that we have for our kids is safe while the fracture heals. And then lastly, having just general good health and nutrition, making sure that we're eating appropriately balanced diet and have appropriate vitamin intake.

Host Amber Smith: When might a fracture require surgery?

Rajin Shahriar, MD: That's a really good question. When the alignment is not satisfactory, that is the most common reason for needing potential surgery. Sometimes the fractures that are in poor alignment can be realigned just by manipulation, like for example, in the emergency room. But many fractures are not able to be restored to the appropriate alignment with just that method alone and may need surgery. Some fractures are very, very difficult to immobilize, so you can imagine, for example, a fracture in the hip is quite difficult to immobilize. And some surgery is needed for the purposes, even if the alignment is not terribly off, need surgery for internal immobilization or immobilization with plates and screws or other implants, to be able to provide the sufficient level of immobilization to keep that from displacing further.

And I would say rarely is it needed in pediatrics, in particular, to do surgery because there's a very strong need for early motion. There are a few examples of that I can mention if people are interested. But, that would be the most rare reason for needing surgery.

Host Amber Smith: In general, how long does a fracture take to heal in a child?

Rajin Shahriar, MD: Generally fractures have a three-part process by which they heal. And the first part of the healing process is actually the fracture itself creates bleeding and injury that the body knows to respond to. So what happens is that when the bone breaks, it bleeds, and the signals from that bleeding create an inflammatory response. And the body sends themselves and other tissue-healing properties to regenerate that area of damaged bone. And that process starts immediately after the fracture happens and continues for several weeks.

Then, there's a process by which the body will try to unite or bring those two pieces of bone back together. Oftentimes, the way that the body will do that is by actually forming cartilage first. And that cartilage basically increases the stiffness at the fracture site, and that callus eventually turns into bone through the body's healing process. But interestingly, you can't see a lot of that callus on the X-ray. So many times when we see families in clinic, we have to tell them about the way the fractures healed because oftentimes they're looking for the signs of healing very early on when it is probably healing, but we can't see it on X-ray.

So once the bone has joined back up together, we call that "union," basically the fracture having joined back together. But there's a third phase called remodeling, and that takes many months to years. The way that I like to talk about remodeling is comparing it to when you get a big cut on your skin. So the first thing that happens is that, just like with bone, it bleeds, but then it heals together, and it makes a scab. So that scab is what we call callus, or union, for bone. And then remodeling is when that scab falls off, and then the skin is usually a little bit hyperpigmented or dark. And then it takes months for that color to fade away and go back to normal.

So that's what remodeling is in bone as well, where the bone will change shape, straighten out, do other things in order to go back to its final form. And that takes many months to years.

Host Amber Smith: What would you advise parents to do if their child injures their arm or leg?

Rajin Shahriar, MD: I think the most important thing to do is to assess your child. As the parent, we often have a really good idea of our children, how they behave normally. How does my child typically respond to injuries? Are they getting better? Is there a visible deformity that I can see on the arm or leg? Is there significant swelling that just developed? Is it getting worse? Are there things going on with the color? Like, is the arm or leg turning white? so those would be signs that something more major is going on.

And sometimes, there's a dramatic injury, and within a few hours, the child is almost back to normal. And so that's a positive sign. But sometimes these injuries are not getting better within a reasonable timeframe. And really at that point in time, there should be an attempt to get additional evaluation.

But while that assessment is happening, right after the injury, the next few hours or days, some supportive care that may be helpful is, first of all, immobilization. So no matter what the injury is, whether it's a fracture or a strain or a sprain, there is going to be some injury to the tissues that causes pain when those tissues are stretched or moved. So immobilization will allow those tissues to rest right after the injury and start to feel better. And so that can be done. If it's an acute injury, they may need a makeshift splint that you make from whatever materials you have available. If it's over a longer period of time, they sell little splints and things that you can get at your local pharmacy or a grocery store or department store. And all those options are good for immobilization. Amazon or Walmart also has options that can be obtained online.

Icing is very helpful to decrease inflammation as well. And pain medications that are available over the counter, such as Tylenol or Motrin, can also help with the pain.

Host Amber Smith: Well, Dr. Shahriar, thank you so much for making time for this interview.

Rajin Shahriar, MD: You're welcome. Thank you for having me.

Host Amber Smith: My guest has been pediatric orthopedic surgeon Dr. Rajin Shahriar. I'm Amber Smith for Upstate's "HealthLink on Air."

Learn about the energy healing technique known as Reiki, next on Upstate's "Health Link on Air."

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

Today I'm talking about an energy healing technique known as Reiki with Bob Crandall. He's an assistant chaplain in Upstate's spiritual care department, and he coordinates the adult Reiki team. Welcome to "HealthLink on Air," Mr. Crandall.

Bob Crandall: Thrilled to be here.

Host Amber Smith: People may have heard of Reiki without understanding what it is or how it works. Can you explain?

Bob Crandall: The National Cancer Institute defines energy healing as form of complementary and alternative medicine based on the belief that a vital energy flows through the human body. The goal of energy healing is to balance the energy flow in the patient.

So let me put it in terms that people already knew, that they don't realize that it's energy healing. One -- if a person if comes up behind you, and you just feel uncomfortable, their energy is off from yours, it feels creepy, if I can use that word. And then on the other side of that, the positive side, a toddler's running around, skins their knee, comes running to mom, and as soon as mom gets close, the pain actually goes away, and the child settles down. She's actually using positive energy, which actually has a healing effect.

We also know that when a person is in a negative zone, so to speak, the immune system doesn't seem to work as well. When they are comfortable and relaxed, the immune system is at its peak. That's why doctors try to relax the patient before going into an operation. We know from research it just works better and that's why we use energy healing.

Host Amber Smith: Well, Reiki has been around for a while. Can you tell us about the history?

Bob Crandall: Well, the term has been around from the early 1900s, or 1920s or so. The actual energy healing piece has been around for 2,500 years. There's a Greek physician, back 500 years before Christ, a guy named Hippocrates. And he is quoted as saying, "It is believed by experienced doctors that the heat which oozes out of the hand on being applied to the sick is highly salutory." Now he actually goes on to say that disease and infection can sometimes be pulled from the patient. So this energy healing stuff has been around for 2,500 years.

Now he was Greek. In the time of Christ, there's people mentioned called gentiles. Many of the gentiles were Greek physicians, so they were doing this hands-on type of thing, in addition to Christ. And I'm not going to say the results were the same. They weren't. But that's how it continued on. Down through the Christian world, there's still some of that going on. It's not as prevalent. But in the Eastern side of this, Eastern medicine, it continued. Now it kind of died down a little bit, 19th, 20th century.

But like I -- we like to say "refound" it. A guy named Usui Mikao, he was doing some meditation in that, and he found that he had this power. Again, we all have it, but the bigger issue is learning to get out of the way of it and allowing it to work.

Now, I also should say the term Reiki, many people think that's a Japanese term, meaning "re" and "kei," which it is not. It's a Sanskrit word. Sanskrit is a language that was around way, way, way, way, way back, thousands and thousands of years ago before the languages split to different languages. It was all one. So Sanskrit is a base language, and in Sanskrit, Reiki means "spiritual healing." You could say it means "laying on of hands." Same concept.

Host Amber Smith: So today, in modern times, is Reiki used instead of, or in addition to, medical treatment?

Bob Crandall: I would never say "instead of." There's good reason why the great medical care that we give here at Upstate, for example, there's reasons for pain meds. There's reason for other kinds of medical techniques. Reiki is what we like to call a complimentary, or the better term, integrative, medicine. It's used "with." An example of that would be, we work with pain management. Pain meds are really important. We found that if we do a lot of pain meds, that sometimes it can have a lasting effect. So they take pain down where it's manageable. But sometimes they will ask us to go also, and we can take it down some more, without messing with the brain.

An interesting piece of that is an amputation. When there's an amputation, there is a phantom pain. So very often orthopedics or pain meds, pain management, will ask us to go, and we'll do Reiki on that limb. And the phantom pain goes away, probably within five or 10 minutes. So we work with, never instead of.

Host Amber Smith: Are there scientific studies backing up that Reiki works?

Bob Crandall: Absolutely. Let me go back a little ways: 1963, Syracuse University. A couple of professors were playing around with a device, and they found that there was some energy coming from the heart, emanating. And they measured it. And it's actually what got us going with the EKG that we use today.

That's energy within the body and the heart, so it's there. Later on around the 1980s, a couple of guys at the University of Colorado started playing around with this body energy and found that certain organs of the body work on certain frequencies, anywhere from a half a cycle to 30. For example, bones work on seven cycles. Later on, probably around the year 2000, when people were using Reiki, or healing touch, they measured what was coming from a practitioner's hands. They found it was a half a cycle, a 30. And in so doing, they found that that complemented the normal energy of the body.

Host Amber Smith: Let's talk about the potential health benefits of Reiki. Who's a good candidate, and what sorts of conditions have you been able to use Reiki to help?

Bob Crandall: Let me tell you how we got going with this. My background is actually as an engineer, electrical engineer for 30 years. When I came to Upstate, which was in 2014, one of the things that I wanted to find out, or kind of just understand myself, is what benefit there was going to be for both cancer patients and inpatients. So I was taking some data. Now it's not an official research project, you know, with all the control studies and all that, but it gives an idea, at least subjectively what was going on. And we found a 60%, 65% reduction in pain. Now, that's for someone who has pain. If they don't have pain, we didn't count them. Someone who was anxious, we found up to 70% reduction in anxiety. We also found with sleep, it actually will help a person to sleep because it relaxes them. And it's very often that when someone's getting Reiki, within 10 or 15 minutes, they're asleep. So we've had cases where they haven't slept well for two or three days, and yet we'll provide some Reiki and they will actually fall asleep.

We've had all sorts of things. We work a lot with pain management, as I mentioned. Pain meds are awesome. We believe in them. The staff will provide pain meds, and they'll take it down to where it's manageable, to a four or five. They may ask us to integrate with them and take it down some more. And very often we can take it to zero.

Host Amber Smith: Do you think that Reiki could be of help as someone who is skeptical of its powers?

Bob Crandall: If they're skeptical it will probably still work. If they're totally uncomfortable with it, then it will not. And it's funny how many people are like, "Well, I don't know." And then we'll try it, and they go, "Whoa!" We find that a lot with people who are in pain. They may be really skeptical if is this even going to help. "My pain is so bad." And then they're amazed at how well it will work. We do a lot of work with burn patients, who always have pain.

Host Amber Smith: Now, do you recommend people commit to a series of Reiki sessions, or is there benefit from a single session?

Bob Crandall: I'm going to separate here, the outside world with us here at Upstate.

The outside world, when practitioners are doing Reiki, very often it's a preventive type of thing, where they come in every couple of weeks or once a month, similar to having massage therapy. It's a great preventive for things.

In the hospital, we kind of triage it. Someone's got a lot of anxiety, we'll try it, see how it's working. They go back a couple times a week. Someone with pain, we try to see them more often, because the pain typically will come back because of their condition. So we try to see them three, maybe four times a week, wherever we have enough folks to do that. So it's really a triaged kind of thing.

With cancer patients, we see them when their appointments are. So if someone's on a treatment schedule of chemotherapy every two weeks, we set up, we see when their appointment is, and we'll do it during those treatments.

Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break, but please stay tuned for more of our talk about Reiki with Upstate assistant chaplain Bob Crandall.

Welcome back to Upstate's "HealthLink on Air." This is your host, Amber Smith, and I'm talking with Bob Crandall. He's an assistant chaplain from Upstate's spiritual care department, and he's the coordinator of the adult Reiki team. We're talking about the potential benefits of Reiki.

So why does Upstate offer Reiki?

Bob Crandall: I think partially, you know, being a teaching hospital, they're open to a lot of different modalities, integrative therapies. There's more than just Reiki that's done here. I mean, that's my forte. But we find it's a good mix. It's like with anxiety, you can do some things with pain meds for anxiety, but it's not, per se, the best way. So a lot of times we'll use reiki, where we can settle a person down. Same way with sleep. You can use sleeping pills, but we're using this in conjunction with all of the other things very effectively.

So, we do it for patients. We do it for cancer patients, outpatients. We do it for staff. We also do it for caregivers. I had a guy, he was working on something, a doctor, and he was holding his back, and I just said, "Would you want to try some Reiki?" And he continued doing what he was doing, and I just did something to his back and took that pain away. We feel if we can do it for staff, then they can take care of their patients that much better. So we offer to them, and we're trying to take the stress down one nurse or one doctor at a time.

So it's always open to them. With families, we try to do it through the caregiver. So if we have a husband, let's say, who's had a heart attack or whatever, and they're looking for Reiki, and the wife is there, we will have the wife put her hand over, her husband. And I will do Reiki, or any one of us will do Reiki, on the wife's back. She will get the benefit of it, but she'll also provide it to her husband, which has a huge, I don't know if it's psychological, whatever it is, but when you're visiting a patient, it can be exhausting because there's not a lot you can do. You can get them a drink of water, but it's a little frustrating. It's like us guys, when our wives are having children, you know, it's hard not to be able to have something to do. By doing it through, they're now part of the solution. And I find it makes it much better.

I'll give you a little funny story of a person who, they were Oriental, and mom didn't speak much English. But I went in to see her daughter who was probably 25, 30. And I was doing some reiki for her, and then I asked Mom, "Would you like to help?" And the daughter translated. And she came over and sat and again, we were doing it through. The next time I came in, the mom was sitting in the chair, and I just said that her daughter, "Would like some Reiki today?" And the mom goes, "Wait, wait, wait, wait, wait," and come over and sat down next to her. So it was kind of cute, but she, I think partially too, she wanted to be able to do something. So that's something we do.

Host Amber Smith: So how does a patient set up a session of Reiki, and is there a charge?

Bob Crandall: Everything is free, whether it's in the hospital or out of the hospital. And to be honest with you, part of that is we don't want to get into the hassle of recording it and not putting it in insurance, all that kind of stuff is just too much of a hassle. We're doing it because we want to do it. I happen to be on staff because I'm coordinating it, but our six volunteers are here because they love it, love doing it for people.

But how does this happen? We'll take burn patients. When burn patients come in, I'm part of that team, and I will go to them and ask them if they would like it. For others, we may get a consult from a nurse, sometimes from a nurse practitioner or even a doctor who asks us to go try it with them. So it's all sorts of different ways. Sometimes we're just looking at the (patient) census, and if we see somebody that's come in with a lot of pain, well, one of us will just go and talk to them.

The other piece of it, and I think this is unique for Upstate, is that if you get Reiki today, we go into your chart, and we put a note in a comment section that says, "Reiki." If you're discharged tomorrow and come back two years from now, that pops up again. So we will go right back to providing it again. It doesn't take another referral.

It's the same way with cancer patients. We actually look at when their appointments are, and we set it up for someone to go see them when they're there. Now it doesn't mean we don't miss somebody. But a patient also sometimes just tells the nurse, can you ask someone to come over? And we do that. So it's a lot of different ways, but what we're trying to be is proactive. Some of that, I think, is my engineering piece of making lists and databases and all those kinds of things.

How do you tell people to prepare for a session of Reiki? They can be comfortable, is what it amounts to, but there's nothing special. When it's a cancer patient, they're usually sitting, and we'll do it behind a chair and do it on their back. We also have a room in the cancer center that's set up with a massage table, nice lights and music. That's the conventional way in the real world. We don't have that luxury typically, but if someone's getting radiation treatments, for example, they certainly can't do it in the middle of that. They can make an appointment before or after, and we'll use that room. For an inpatient, we take it as it is. However that patient is comfortable, we never move them. And it's going to work no matter what. A lot of people have a concept that it's got to be laying down and relaxed and all that. I've actually had cases where I have followed a patient down the hall as they were doing their physical therapy, someone who's in a lot of pain. It still works, even though they're doing something else. But if a patient's on the chair, and they're comfortable there, we'll do it there. We've done it to people in wheelchairs. It doesn't matter. We actually had one not too long ago, a patient who was very, very anxious about a procedure that was going on. I got there when they were getting her ready to go for that procedure, and I just walked with her, and we talked, and did it as she was going along. And when she got down just before the procedure, she was calm and a little bit more comfortable.

I like to add, sometimes, a guided meditation. It seems to fit with the relaxation, and then it also gives control to them.

Host Amber Smith: How long does a session typically last?

Bob Crandall: Again, outside world, the typical session is an hour. But what we're trying to do is we're trying to maximize the time that we have, but also the amount of sessions that we can provide. Now for pain, we'll ask how their pain is. A lot of times it's five or 10 minutes, and the pain is down appreciably. Sometimes it's a little longer, and if it takes a little longer, we'll stay until we get it down where it stops going down. But typical sessions for us, maybe 10 or 15 minutes is all they need.

A lot of times even if they've got a lot of pain, they fall asleep. We know their pain's gone down, or they wouldn't be able to sleep. So 10 or 15 minutes, that's typically it.

Now there's another piece to this, is that we are spiritual care volunteers who happen to do Reiki. So we're visiting patients and trying to work on the whole person. So we're going in, we're visiting, see how they're doing. If they're angry, we let them yell at us. And if they're frustrated, we let them download the frustrations and all that, which goes directly with this calming down, helping them feel comfortable. And the Reiki becomes integrated with that. And that's the big picture of spiritual healing.

We're not talking about religious healing. Spiritual care -- if I can here a minute --spirituality is the big picture of what gives you some foundation or what is your purpose of those kinds of things. And that's what we're working on. You know, you got the physical, mental, emotional and spiritual. So we're working on that. And sometimes the person says "I don't want Reiki, but I'd like to talk." So our people will still do that because that's what's important to them.

Host Amber Smith: I'm curious, will a person feel anything during a Reiki session?

Bob Crandall: Yes. Most times people will feel heat, and that's an interesting thing, too. When you're with people that you're really comfortable with, your temperature actually goes up a little bit anyway. You may not notice it. But sometimes that can occur, getting a hug from someone, and all of a sudden you feel warmth. But that's what comes from our hands, typically warmth, sometimes a buzzing.

Another funny story: I had a guy -- you know, we had gloves on at that point -- and I was doing some Reiki on him, and he said, "Wow, let me see those gloves. Those are really cool. They're warm." He didn't realize it was coming from my hands.

Host Amber Smith: Interesting.

Bob Crandall: Well, Mr. Crandall, I appreciate you making time for this interview and telling us about Reiki.

I am thrilled to be able to share all the good work we're doing here at Upstate, always.

Host Amber Smith: My guest has been Bob Crandall. He's an assistant chaplain in Upstate's spiritual care department, and he coordinates the adult Reiki team. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from geriatrics chief Dr. Sharon Brangman. How do adult children know when their parents need help?

Sharon Brangman, MD: Well, it's a very individual thing, and actually the holiday season is a time when we often get the most calls. And that's because that's when families come into town, and they may get a totally different impression as to what's going on compared to what they got while they were talking on the telephone or FaceTiming with their parents. They can see up close and personal what's actually going on in the home. And so many adult children, especially if they don't live in the area, call us during the holidays, wanting to get things organized.

And so the first thing they often notice is that the house is not really being kept up well, and maybe their parent is just having more and more trouble with repairs and managing the mail, keeping the refrigerator stocked, getting rid of clutter and those sorts of things. And that is often the first sign that something may be amiss. Sometimes they will notice the car has a lot of unexplained dents on it or things that look like little fender benders, and usually the parent will minimize it and try to say that the son or the daughter is making a big deal about nothing, or something like that. But those are usually the early telltale signs.

And then when they're spending more time with their parents, they may notice that the day just doesn't go in an organized way. There may be long periods of sleeping or not getting dressed and ready for the day, or difficulty organizing meals. I had one family, for example, who came for Thanksgiving, and usually the mother would prepare this enormous meal for everyone. And when they got there, things were in disarray. The food was not prepared. And when you think about making a big meal like for Thanksgiving, that involves many, many little decisions in order to get the food on the table and cooked and ready to go at the right time. And some people, as we get older, start to have trouble keeping track of all those little details.

So there can be any number of little hints, and adult children start to recognize this when they spend time with their parents.

If there is signs of that house not being kept up, and it may just be too much, too much house. You know, after children are gone, and there's no need for three or four bedrooms and a lawn to mow and a driveway to shovel and a house that needs painting or some sort of repairs. You know, a house constantly needs repairs, and that can just become overwhelming.

So, it's time to have a frank conversation. And it's usually not settled in one discussion. And it has to be approached with respect and consideration. Now, if the parent does not have dementia or any kind of cognitive impairment, they really have the ability and the right to live the way they want to live. So we cannot impose what we think is appropriate, even though it may be safer, and it may make sense. You can't make someone do anything. And you know, it just doesn't work that way.

So this can be a challenge for adult children, particularly those who do not live near their parents. So, you know, we have a very mobile society, and many of us do not live close to our parents or where we grew up. Or our parents may still live in our hometown, and we adult children have moved elsewhere. So the ability to kind of reach back across the miles can be very challenging. Now, there are a lot of resources for people who recognize a problem and want to seek help, but it can take a while for some parents to have that level of insight to get there.

It could be that the parent has too many things to keep track of, and it may be time to simplify their routine or downsize, or get help taking care of some of the details in life. It doesn't always correlate with an illness, but sometimes it can be the first signs of a memory problem, or someone who's just becoming what we call physically frail. That is someone who may not have that robust vitality that they used to have, maybe to mow the lawn or to clear the driveway of snow. And they may not have dementia or any specific medical problem, but just physically it's harder to keep up their previous routines.

The challenge is, often the parents don't see the same problems or have the same level of concern. So this is often a challenging discussion. There are very few older adults who have that same level of alarm, for example, that an adult child might have. They also are not comfortable with that role reversal, with a child telling them what should be done.

You know, we spend our whole lives looking for autonomy and independence and doing things the way we want, and it's inevitable at some point that we are all going to need some help when we get older. There are very few people that have the insight to recognize when they need that help. And so that's a bit of a challenge for adult children, and for parents. And it can be a source of friction if it isn't approached properly.

Host Amber Smith: You've been listening to Dr. Sharon Brangman, 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: Some of our most visual and poignant poems are those describing family members. Sibling love. Here are two from our latest issue.

First is Jeremy Gadd from Australia, who offers us a portrait of opposites when young, but now finding common ground.

Here is "We Were":

We were orange and apple,

yin and yang, chalk and cheese

as children; quiet to your loud,

near to your far, circle to your square,

sharing only unruly hair and shelter

from the storm of parental repression

and mutual amusement at our

teenage indiscretions but, now,

more bonded in dying than

in life by a genetic disease,

we share more laughter than depression,

more love than any previous sibling aggression.

Zoe FitzGerald-Beckett is from Maine, and she takes us back and forth in time to pay tribute to sisters' love. Here is "Sleeping with My Sister":

We were sleeping together again, rain drumming

on the roof. Rain and tears in torrents, and the salt

and sweat of love's labor to save her. To vanquish

all fears, and the monster growing in her brain.

Our childish fears often drove us both out of bed

in the past. Her fear of everything. My fear our parents

might disappear. We'd meet in the dark and cling together,

crying and comforting, in whatever bed would have us.

Our grown-up fears were in bed with us that night, silencing

the hard questions. What is her brain tumor doing? Is there

nothing left we can do? Truth banished to the darkest

corner. No answers but the drumbeat of rain on the roof.

She was the beauty of the family; the baby sister who followed

me everywhere, sure I knew everything. She always asked, Where

are you going? Can I come too? I'd say, Yes. Sometimes. Or, No.

Leave me alone. That night I prayed, Don't ever leave me.

The rain was slowing. Her voice a drifting mist. She said, Listen,

it sounds like music. What does it mean? Knowing nothing, I

could only ask, What? She said, The back and forth, the back

and forth. And I could only whisper -- O, Pioneer. O, Dear Heart.

Host Amber Smith: This has been Upstate's "Health Link on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "Health Link on Air," why fungal infections are on the rise. 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 Broekel.

This is your host, Amber Smith, thanking you for listening.