Alzheimer's update; hospital robots and drones; ideal nurses: Upstate Medical University's HealthLink on Air for Sunday, Sept. 22, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," an update on Alzheimer's disease, including new medications and blood tests -- and what's best for brain health.

Sharon Brangman, MD: ... There's a connection looking at the risk of air pollution exposure in Alzheimer's disease. And even though we don't understand all these mechanisms, we know that air pollution isn't good for our heart and our lungs, and whatever isn't good for your heart isn't good for your brain. ...

Host Amber Smith: And a look at the role of robots and drones in modern health care.

Steve Roberts: ... The robots will do things like deliver food trays or pick up the trays when people are done, deliver pharmaceuticals and even supplies to nursing floors. ...

Host Amber Smith: All that, a description of what kind of person makes a good nurse, plus a visit from The Healing Muse, right 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 autonomous machines are helping health care workers. Then, a rundown of who would make a good nurse. But first, an update on Alzheimer's disease and brain health.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Alzheimer's disease seems to be in the news every other day, so I've invited Upstate's chief of geriatrics to discuss some developments that may have an impact on this disease, which affects so many lives.

Dr. Sharon Brangman directs the center of excellence for Alzheimer's disease. It's the region's only comprehensive center for evaluation and treatment of memory problems. And she's here to talk about some new research about what may increase the risk for Alzheimer's, a couple of promising medications, a study of a possible new treatment that's underway at Upstate, and a rundown of things we can do for brain health.

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

Sharon Brangman, MD: Oh, thanks for inviting me again.

Host Amber Smith: Let's start with what is newly considered to have a potential impact on Alzheimer's development. Some of these items we've already heard are not healthy, but how firm of a connection are researchers finding between things like shingles and the development of Alzheimer's?

Sharon Brangman, MD: Well, there's intense research to try to figure out what could trigger Alzheimer's disease. And there was one study, I think it was a Swedish study that showed that people who had shingles, which is related to the same virus that gives us chickenpox, seems to have a correlation. And it may also connect with the herpes virus, which are all in the same family. And so in this one study, people who had this virus had an increased risk of developing Alzheimer's disease. The mechanism isn't quite clear, but this is a virus that lives in our bodies and just reemerges, especially as we get older. So there's a theory that it might cause some sort of long-term nerve damage that then increases as we get older.

But there's still a lot of research. There are so many other pieces that are being looked at. There was recently a study that looked at the connection between increased risk for Alzheimer's and eating processed red meat. So it could be that the nitrates and other ingredients that are used to make things like bacon and bologna and ham are toxic to nerve cells. So they found a correlation that people who eat a lot of processed foods, especially red meat, had an increased risk for Alzheimer's. And that kind of connects to what we know about eating a healthy diet, which is good for our bodies and good for our brains.

But there are other things, too. For example, there's a connection looking at the risk of air pollution exposure in Alzheimer's disease. And even though we don't understand all these mechanisms, we know that air pollution isn't good for our heart and our lungs, and whatever isn't good for your heart, isn't good for your brain. So we may not have all of the answers yet. We have these associations. And a lot more research needs to be done.

Host Amber Smith: I've been reading a lot about climate change and extreme heat and all of the things that that can do. Are researchers seeing a connection with Alzheimer's, with extreme heat?

Sharon Brangman, MD: Well, that one isn't quite as clear, but we know that people who have Alzheimer's don't do well in extreme heat, and most humans in general don't do well in extreme heat, but we don't have a clear connection there. There's a lot of research that's looking into all sorts of things that impact our change from normal aging and the trajectory that puts you on track to get Alzheimer's disease.

Host Amber Smith: What about diabetes? Because I know that affects so many people. Is that a risk factor for Alzheimer's?

Sharon Brangman, MD: Yes, that's a well known risk factor for Alzheimer's disease.

We know that the brain is very sensitive to sugar. It needs sugar, and when you have diabetes, your body doesn't process sugar well, and that can cause a cascade of events that starts to damage the nerve cells. We also know diabetes affects the lining of our blood vessels, and the lining of your blood vessels is what helps to ensure good circulation to your heart, your brain, your kidneys. So we know that people with diabetes have an increased risk for heart attacks and kidney failure. And it looks like that similar association is also involving the brain.

Host Amber Smith: Now, recently there was news about a new blood test that can diagnose Alzheimer's. Can you tell us about that?

Sharon Brangman, MD: So we've been researching for years, and we know that many years before you even have signs of Alzheimer's disease, your body may be producing some of these abnormal proteins. These proteins are amyloid and tau, and these are associated with Alzheimer's disease. So they can be floating around in our bloodstream way before we have any signs of cognitive decline. So they have been looking at ways of correlating the presence of these abnormal proteins and connecting them with Alzheimer's disease and also with treatment for Alzheimer's disease, because with some of the new medications that are out there that actually remove these amyloid proteins from the brain, we know that the blood tests then show that they decrease in your bloodstream. So this is another source of research. We just got more information about it at a meeting I was at recently.

However, it hasn't been approved yet. It needs to be approved by the FDA and then also by the health department. And then that would decide whether insurance companies are going to pay for it. But we also need a lot of education on the best way to use these blood biomarkers because right now it doesn't look like it's good for anyone to just get the test just to see, because we know that some people who have these, abnormal proteins never develop Alzheimer's disease.

And so we don't want to cause unnecessary concern and anxiety for people who just want to test and see what the future might hold. So at this time, we don't believe that this is a good screening test for the general population. In other words, a healthy person who has no memory problems should probably not get this blood test because we don't know yet what that might mean for that person. There are some people who can have these proteins circulating who never develop Alzheimer's disease, and this would just increase someone's worry level and anxiety.

This test will most likely be used when there is a person who comes in with a memory complaint, and we as physicians are trying to sort out what could be going on. Another use for these blood biomarkers may be for people who are actually getting treatment with some of the amyloid-removing drugs, this might be a way to monitor the effectiveness of the therapy.

So there's still a lot of questions to be answered. The biomarkers have not been approved yet. And we are going to need a significant amount of education, not just to clinicians, but to the general public so that they can be used appropriately.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Dr. Sharon Brangman, the director of the Center of Excellence for Alzheimer's Disease at Upstate.

For so long there haven't been any medications for Alzheimer's, and now there are some. How promising are these new ones, Leqembi and Kisunla? I'm not sure how you say them.

Sharon Brangman, MD: The words are definitely a mouthful. The generic words are lecanemab and donanemab, and these are the fancy words for monoclonal antibodies that remove amyloid buildup in the brain. And as I mentioned earlier, there's an association with amyloid accumulation in the brain, and amyloid is an abnormal protein that kind of gets onto the nerve cells and causes them to tangle up and die so that they can't send messages to each other. And these medications can remove that amyloid buildup. They're very effective in removing the amyloid buildup.

And in the research studies, it showed that it may help to slow down the disease for a period of time, maybe from anywhere from about four to six months. But it does not change the course of the disease long term. So in other words, this doesn't cure it. It may just stabilize it for a few months. And the side effects have to be very carefully monitored because as these drugs remove that amyloid buildup, they can loosen them from, say, blood vessels that might leak a little and cause bleeding or swelling in the brain.

So we have to do MRIs (magnetic resonance imaging) of the brain on a very regular schedule to monitor for any small swelling or bleeding. For the most part, it's temporary and there hasn't been serious long-term effects from these side effects. But there have been some people that have had serious side effects and have died. So we have to be very careful who gets selected to do this therapy. And the ideal person is somebody who has very mild changes. In other words, it has to be mild cognitive impairment, which is a kind of early, early memory loss, but you are functioning normally, and also people who have early Alzheimer's disease. And so these are people who have a little bit more memory loss, but are still pretty much functioning on a normal basis.

And you can't be on any blood thinners because these drugs, as I mentioned, can cause some bleeding as the amyloid is removed from the brain. And we found that people who are on blood thinners would then have more serious bleeding. And then there's some other things that we have to look at to discuss with the patient just to make sure that they understand all the risks before initiating therapy.

Host Amber Smith: But if they work as designed, this might extend the lives of people with early stages of Alzheimer's?

Sharon Brangman, MD: So it may provide some stabilization for four to six months. There's ongoing studies to look and see what happens long term. Do these people who take the medications continue to have benefit months or years later? Or there's also some studies looking to see if they should get a touchup periodically if we notice that the amyloid has reaccumulated.

The clinical trials were only for 18 months. So we don't know if somebody takes it for, say, 24 months, are they going to get more benefit? So there's a lot of questions and a lot of ongoing research that has to happen and is happening before we know definitively what to tell people long term.

Host Amber Smith: I know we all would like a cure, but these sound pretty encouraging, right?

Sharon Brangman, MD: So yes, this is providing a lot of hope. It took 30 years to do this research, and this just tells you the long haul it is to kind of sort out all the issues with a complex disease such as Alzheimer's disease.

And amyloid is really just one piece of it. There are other factors that may be involved in Alzheimer's disease that are also being studied. And what a lot of researchers predict, and I agree with, is that everybody is going to enter this disease in a different way, and we're going to probably have to do what's called personalized medicine to figure out what that individual's triggers were so that they can get the special therapy. So for example, some people may enter the disease from amyloid with some inflammation and maybe a virus exposure and diabetes. So there are other drugs that are getting investigated right now that look at other pathways that could lead to Alzheimer's disease.

For example, there's a study that we are doing here at Upstate that's looking at thiamine and its role in developing Alzheimer's disease. And we know by doing research in rodents that mice that had low thiamine levels had a lot of changes in their brain that look very much like Alzheimer's disease. So as we get older, there are many people who have a thiamine deficiency, and the brain needs high levels of thiamine all through our life. So is there a role for taking a special preparation of thiamine to increase those levels? That's one of the studies that we're looking at.

Another study is looking at metformin, which is a well-knowndrug that's been used for diabetes. Because there's such a close correlation between diabetes and Alzheimer's disease, any medication that can reduce your risk for diabetes or can be used to treat diabetes may also have an added benefit of treating Alzheimer's disease or reducing your risk for developing it in the first place.

And we've heard about all of these drugs that have been used for weight loss -- semaglutide, for example. They seem to have a correlation of also reducing your risk for Alzheimer's disease. And this can be because, as I mentioned earlier, our brains are so sensitive for the need of glucose. When you have diabetes, your body isn't handling that glucose or sugar in the right way, and it can start a cascade of events that leads to damage of these neurons in our brain.

So we're doing studies that are looking at that here at Upstate. And one of the things I really have been so excited about is that we can offer this here in Central New York, because before that, people had to go to a big city like Boston or New York City to participate in these trials. And we're able to offer them here in Central New York at Upstate so that people who want to be involved in helping to solve this horrible disease can participate without having to travel. And we have so many volunteers that say they know this may not help them per se, but they want to help other people, or maybe prevent their grandchildren from ever getting Alzheimer's disease. So it's really one of those things that you do to help increase our knowledge so that we can help people into the future.

Host Amber Smith: Please stay tuned to "HealthLink on Air." We'll be right back with more from Dr. Sharon Brangman after this short break.

Welcome back to Upstate's "HealthLink on Air." I'm your host Amber Smith, talking with Dr. Sharon Brangman,who leads the region's only comprehensive center for evaluation and treatment of memory problems at Upstate Medical University in Syracuse.

Well, let's talk about how these trials work. If there are listeners who are interested in participating, are you still recruiting people for the thiamine trial or the semaglutide or the metformin trial?

Sharon Brangman, MD: So we have a number of trials that we are currently running, and if you're not eligible for one, you could be eligible for another.

And each trial has its own requirements for participation. So we're basically looking for adults, usually between the ages of 60 and 90, but it can vary. For the most part you should have very mild memory problems. Some people also can have early Alzheimer's disease. But it really just involves talking to our clinical research team and seeing which study you might be eligible for.

Host Amber Smith: So people who are interested in volunteering, they can learn more at (315) 464-3285. And I also understand there's an email address, Geri Research, that's [email protected]. Are those the best places for people to learn more?

Sharon Brangman, MD: Absolutely. If you call, we have a team that will answer all of your questions, tell you what each study might involve and then help you decide which one might be the best choice for you.

Host Amber Smith: So let's talk about the things that are supported by science that people can do to maybe help reduce their risk of dementia.

Sharon Brangman, MD: You know, there's a lot that's within our control that we can do to help reduce that risk. And one of those is exercise. There's a lot of studies that show that exercise is very, very important for our overall health, but especially important for brain health. We know that the brain requires a good circulation, a good blood flow, and when you exercise, that increases blood flow to the brain. The other thing that happens is that there's these chemicals that help stabilize and grow nerve cells that move from our peripheral or external circulation into the brain and help stabilize the brain. And I tell people, you don't have to go run a marathon. It's as simple as taking a walk every day. And if you can build up to taking a walk about 30 minutes a day, that is excellent. The bare minimum is 150 minutes a week.

And the other piece I say is take a walk with a friend, because socializing and talking to people is very, very good for our brains. And we learned during the pandemic when people were isolated they actually had a decline in their brain power and had an increased risk of developing Alzheimer's disease.

So socialization, meeting people in groups, in person as much as possible is the best for our brains. The screens are not as good. They're probably better than nothing, but it's really that in-person interaction that our brains do the best in.

Host Amber Smith: You're listening to Upstate's "HealthLink on Air" with your host, Amber Smith. My guest is Dr. Sharon Brangman. She's the chief of geriatrics who also leads the center of excellence for Alzheimer's disease at Upstate, and we're talking about a range of items related to Alzheimer's disease.

Now we talk about healthy diet. What is that, though? What kinds of foods should be on your shopping list?

Sharon Brangman, MD: So a healthy diet means eating foods that look as natural and normal as possible. The more they are processed, the worse they are for our bodies. So we want foods that look like what they're supposed to, and in general, those foods that are convenient, that you heat up quickly, that you get by taking out, are generally processed to the point where a lot of extra ingredients are added, such as salt and sugar and excess fats, and maybe certain chemicals to make them maintain color or last longer. Those are all bad for our body.

So you want to eat a healthy diet, which means not that much red meat, mostly fish and lean meats, lots of vegetables -- the more color in your vegetables, the better -- fruits. Stay away from things that are highly concentrated in sugar, such as sodas and fruit juices, and of course all the things we love, like chocolate and dessert. I'm not saying you should eliminate all of them. And people get all nervous because they don't want to do radical changes in their diet. So I say just start small with one thing. So maybe stop drinking soda, and don't even drink diet soda because artificial sugars aren't very good for you either. Try doing water or maybe a seltzer or something like that.

Skip the orange juice in the morning because that's usually too much sugar first thing in the morning. And maybe reduce your takeout food or your fast food and do more food preparation in your own home. And I know everyone's busy, and it gets hard to make those meals, but those are the things that may help to make the difference.

And then the other thing that most people don't want to hear is that alcohol isn't really good for our brains. And there's more and more research that shows there's no safe amount of alcohol in general for our bodies, but we know that alcohol is toxic to nerve cells, and we've seen this in people who have had problems with alcohol use who get a form of dementia from too much alcohol. So I try to encourage people to maybe save alcohol for very special occasions. Try to pass it up. Certainly don't drink it every day. And that's another way of making sure that you have good brain health.

Host Amber Smith: Let me ask you about supplements. I know a lot of people are prescribed things like fish oil, or their doctors tell them to take fish oil for their heart. Is that also good for their brain?

Sharon Brangman, MD: So that has not really panned out, even for your heart. And so the recommendation right now is it's better to eat fish than to take fish oil tablets. So having salmon is probably healthier than taking fish oil tablets.

And there's lots of commercials on TV for different supplements to help your brain and your memory as you age. Those are all a waste of money. They don't do anything for your brain. So I would say save your money. So many times I have patients who come in after they've spent the money and they show me the bottle and I tell them it doesn't do anything.

People ask me, "should I take a vitamin every day?" So it probably doesn't hurt. If you're going to take a vitamin, you should make sure it's for the 50-plus age group, because that usually doesn't have iron in it. You shouldn't take iron as you get older because your body doesn't have a way of eliminating it from the system, and iron is potentially damaging to nerve cells over time. So it's not good to take a lot of iron unless you're a woman and you're still having your monthly menses. But most older adults do not need iron replacement, unless specifically prescribed by their doctor for a certain medical conditions.

Host Amber Smith: Is there a connection between sleep quality and Alzheimer's risk?

Sharon Brangman, MD: Yes. So here's another thing that happens in our society where everybody is working real hard and not sleeping very well. But we know that sleep is a period of time when your brain actually repairs itself from the day's activities. And there's a lot of chemical reactions that our brains are doing all the time during the day. And when we're sleeping, they clean up the waste products from these chemical activities. So we really need to figure out a way to turn off the screens, turn off the TV and go to bed.

And the other piece is there are really no safe sleeping pills, so don't think that you can take a sleeping pill and it's going to help. We have to figure out natural ways of getting some sleep and rest. And it can start with the caffeine that we see a lot of people taking all day. And other things that can keep you up at night so that you're not getting that important sleep that's needed for brain health.

Host Amber Smith: So does it get easier if, in retirement, you could sleep anytime you retired, right? Does that get easier for people when they don't have a job to get up for?

Sharon Brangman, MD: You don't want to wait until you retire to have a plan for brain health. You know, we want our brains to last our lifespan, so that means you should be doing good activities for brain health and general health throughout your lifespan. Don't wait till you retire. Although it's always beneficial to do healthy things, these are habits that we should have throughout our life.

So all of these things we've been talking about are kind of meant to be reducing the risk for dementia. Once a person has some symptoms, or maybe they are in early stages of Alzheimer's, do you still prescribe these same things about eating healthy and sleeping adequately? So yes. Some studies have indicated that even if you have early Alzheimer's disease, if you exercise every day, you do better than people who don't. So we still recommend people walk or exercise. Eating a healthy diet is always good because you want to give your body the nutrients it needs. And processed foods and foods that are high in sugar and fat are not helping. So yes, you want to maintain good health, even if you have symptoms of Alzheimer's disease,

Host Amber Smith: Will these same habits, if people can make them habits, will these help people who are simply aging, not necessarily with signs of dementia? Is this a good way to go into the senior years?

Sharon Brangman, MD: You know, I'm a geriatrician, so I'm always helping people to understand what we need to do to age well or age successfully. And that doesn't necessarily mean that you age without getting certain diseases, but you try to control the things that you can control. And the things that we can control are eating well, sleeping well, maintaining social contacts, exercising, keeping close eye on the amount of alcohol you're taking. Of course, if you smoke -- don't smoke. I can't think of any disease where smoking is helpful. If you have diabetes or high blood pressure, see your doctor and get those under control. If you have high cholesterol, get that under control.

These are all things that cause wear and tear on our bodies -- whether it's your brain, your heart, or your kidneys -- and can get in the way of you aging well.

Host Amber Smith: Well, Dr. Brangman, I really appreciate you taking time for this interview. Thank you.

Sharon Brangman, MD: Well, thank you.

Host Amber Smith: My guest has been Dr. Sharon Brangman. She's the chief of geriatrics at Upstate, and she's the director of the center of excellence for Alzheimer's disease, which is the region's only comprehensive center for evaluation and treatment of memory problems. Reach the center at (315) 464-5166. I'm Amber Smith for Upstate's "HealthLink on Air."

What role do robots and drones play in health care? -- Next, on Upstate's "HealthLink on Air."

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

We've talked previously about how more and more surgeons are using robots as assistants in a variety of operations, but robots have quietly assumed other important jobs in health care, and in fact, they have their own department, the autonomous machines department.

Today I am talking with Upstate's director of that department, Steve Roberts, and Jeff Causey of Causey Aviation.

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

Steve Roberts: Thank you for having us, Amber. Appreciate the time.

Jeff Causey: Thank you, Amber. We're very happy to be here.

Host Amber Smith: The autonomous machines department focuses on emerging and innovative health care technologies, including mobile robots and drones.

First, let's talk about the mobile robots. How many does Upstate have? Mr. Roberts?

Steve Roberts: Currently, Upstate has 10 robots that are on-site and purchased, and we have four more that will be here and implemented by the end of the year. So currently, a fleet of 10 robots doing different functions throughout the hospital.

Host Amber Smith: So they're throughout the hospital. Is there one location for them, or are they assigned to different floors or different units?

Steve Roberts: They are assigned to different units. That was one of the things we struggled with in the beginning, is, where do you house a fleet of robots? And what we found out is having them in the department that uses them frequently or sends them out is probably the most efficient way to have them deployed throughout the hospital.

So we have them located in pharmacy, food and nutrition, distribution and even on nursing units.

Host Amber Smith: So can you give us some examples of tasks that these robots do?

Steve Roberts: Sure. The reason we even introduced the robots into the environment was to really help out with staffing issues and sort of delays in getting deliveries throughout the hospital.

As you can imagine, it's a pretty big facility, and having people running around delivering things can be quite time consuming, so the robots will do things like deliver food trays or pick up the trays when people are done, deliver pharmaceuticals and even supplies to nursing floors.

Host Amber Smith: So how do they know where to go to deliver whatever they're delivering?

Steve Roberts: So one of the things we did when we got the TUGs (the robots, which remind some people of tugboats) is really spend a lot of time on getting the infrastructure and the environment set up.

So there's computers that manage sort of the maps that are used. There's technology we use to integrate with the elevators. And what we did in the beginning is, we created a very detailed map of each floor, and then made maps or routes throughout the hospital that the TUGs will travel on.

And then when somebody dispatches a TUG, they'll pick the starting and ending location, and the TUG will know the path that it needs to take between those locations. If it encounters an obstacle, it does have technology to either stop or slow down or take appropriate action.

Host Amber Smith: So these robots might encounter patients, or I should say the patients might encounter a robot on its way to wherever it's headed.

Steve Roberts: That's correct. They're going throughout the hospital. We did try to find routes that minimize interactions with patients, but certainly there is the opportunity to see these in the hospital and certainly for staff. So the robots are designed to be able to interact in a very dynamic environment, with lots of sensors and technology to make sure they don't run into people or go down stairwells or do things that they're not supposed to do.

Host Amber Smith: So how has the staff received the robots? Do they like them?

Steve Roberts: With any new technology, there's a lot of unknown with it and sometimes. Maybe there's fear. Some people get excited about it. So we've really seen all different ranges of acceptance and attitudes around them.

Most of the time, if it's people that are maybe afraid of them, we can explain to them how they work. I think it puts them at ease a little bit. But generally they're very, very well accepted in the environment. They've made over 25,000 deliveries, and over 4,000 miles of distance that has been traveled with the group of TUGs that we have operating right now.

So there is generally a wide acceptance to them, but there are situations that we have to deal with or work with people, but generally they're very well received.

Host Amber Smith: I should have you describe what these look like because people might be imagining "The Jetsons" (Space Age cartoon show) and that robot maid they had. These don't look like people, right?

Steve Roberts: No, these don't look like people. They look like, one of them looks like, a little mobile, I'll say filing cabinet. It's very rectangular. It's on wheels. It does have drawers. It's got a keypad you can interact with. It looks pretty much like a little cart you might push around, but it just goes by itself, which is kind of weird to see coming down the hallway, to be quite honest.

And then we have another TUG that looks like a small, maybe forklift or a tiny truck. And what that does is it allows it to interact with different types of carts, for example, a food cart, so it can take the food cart up, leave it in the nursing unit, come back down, do some other work, and then go back and get it when it's done.

So they look differently depending on the mission that they have, but typically they're not really humanoid looking. They do talk, but they don't converse, or interact with you, that way.

Host Amber Smith: And do they communicate?

Steve Roberts: Yeah.

Host Amber Smith: Do they have a way of beeping or making noises?

Steve Roberts: Yeah, they have ways of communicating.

We have some control over what that looks like, but it will tell you when it arrives at a location. It will beep if it gets stuck or doesn't know what to do.

So there are different things that we can have it say and different noises that it does make throughout the trip.

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

I'm talking with Steve Roberts, director of Upstate's autonomous machines department, and Jeff Causey of Causey Aviation.

Upstate drones have been in the news lately, but let's start at the beginning. When did Upstate start experimenting with the use of drones?

Steve Roberts: We started the program probably in the beginning of 2020, or actually at the end of 2019. And then, when COVID hit, it actually gave the program a little bit of a spark. We had a group of people that came up and helped us with the program, and we were trying to set up the delivery of COVID test kits and potentially the delivery of specimens. So that really initiated the program.

And in the beginning we found out that there are lots of regulations, lots of things you need to do to operate these safely, and it's taking us several years, but we've continued to work at it, and about a year or so into the program, we ran into Jeff Causey from Causey Aviation Unmanned, who has what they call a 135, which is a commercially run drone operation with special FAA (Federal Aviation Administration) designation. And we've partnered with him to do some of our daily operations that we're currently performing.

Host Amber Smith: So, Mr. Causey, are you the person who flies the drone?

Jeff Causey: Thankfully, no. We have very, very, well qualified team members that do this all the time and have special certification from the FAA, as well as our own internal training, and they're dedicated to fulfilling Upstate's mission every day.

And so, they are much better at that than I would be.

Host Amber Smith: So you said they have a special certification. Do they have to be airplane pilots to begin with, or is this entirely different from flying an airplane?

Jeff Causey: It's similar in terms of the way the FAA regulates it, but the FAA has found that there are many things in their regulations that apply to commercial aircraft, air carriers, that don't really apply to flying drones. And so they have given us some exemptions that allow us to take pilots that have their drone license and use them in commercial drone operations.

Host Amber Smith: I see. Now, the drones that are being used for this, in medical settings like this, how big are they?

Jeff Causey: The drones that we are currently using are fairly small, weighing around 30 pounds. And they can carry about 5 or 6 pounds of payload. And fortunately, most medical payload, if you consider pharmaceuticals, labs, blood products, things like that, easily fall within that weight and volume limitation that we have.

And the drones really allow us to provide these products on demand within the health care system. So I know most people, when they experience health care, one of the frustrating things about it is there can be long wait times. If you're in the emergency room or in a hospital, waiting for your medications, waiting for your labs to be analyzed, all these things take time.

And one of the benefits of the drone technology is that we're able to dispatch those samples immediately, or pharmaceuticals immediately, and move them around the health care system more rapidly so that the health care system can respond to its patients in a much more expedited manner.

Host Amber Smith: Now, does snow or heavy rain or cold temperatures or even hot temperatures, does that impact whether the drone can fly?

Jeff Causey: Yes, so these drones are sort of first-generation technology, and they do come with certain limitations in terms of winds and weather, as you would expect. But like with all technology, as it evolves, and it's evolving fairly rapidly, that envelope of potential operating conditions will continue to expand.

And so, eventually, it will not be very limited by weather. And even today at Upstate, we find that weather only impacts our operations a small percentage of the time. But certainly, Syracuse winters can provide weather that's beyond what we can currently fly in.

Host Amber Smith: Well, recently you completed an 18.6 mile BVLOS -- meaning "beyond visual line of sight" -- flight from Rome to Whitestown. How did that go?

Steve Roberts: So Amber, this is Steve. I'll take that one. We actually have a drone at Upstate that we purchased that looks more like an airplane than a typical drone that you would see. It does take off like a helicopter, and then it transitions to a plane, and it can go about 65 miles an hour and travel longer distances because it's, more efficient as an airplane. So that's the drone that we used for that particular operation that you're referring to. And we did a "beyond visual line of sight" from the pilot, meaning the pilot was in a control room flying the drone.

And we were able to go, to your point, about 18.6 miles. The operation went very smoothly, with a lot of planning and, of course, a lot of safety and regulations that we have to comply with, which were all taken into consideration. So it was very successful. And the idea there, it's a proof of concept, and it's a step towards being able to do longer-range deliveries, to extend our health care out even further.

Host Amber Smith: So once the drone arrives, the drone or the larger plane that you described, what happens on the other end? Does a person need to be there to meet it or catch it? Mr. Causey?

Jeff Causey: You've identified one of the biggest opportunities that we currently have, and that's the fact that in the first generation, there is quite a bit of manual interaction with the drones, to load the packages, to receive the deliveries.

But, as Steve mentioned, Upstate is already very far along the path towards having robots in the hospital. And one of the things that will be a natural evolution of these services is to integrate the drones with the robots and with other systems, like pneumatic tubes, so that we can more seamlessly move items around the Upstate health care system.

Host Amber Smith: Now, Mr. Roberts, do you envision a fleet of drones that would regularly transport samples and medications and time-sensitive materials from rural areas into Upstate, in downtown Syracuse?

Steve Roberts: Yeah, that's actually one of the visions of our hospital administration, is to be able to move things around the community more efficiently, cleaner -- it's all green technology and on demand, so it will speed up how we do health care.

So things like being able to fly lab specimens into the lab, for example, or pharmaceuticals around. Yeah, we plan on continuing to build that network out and have the drones be able to do these activities on demand.

So there will be, someday, like a hub or a place where the drones live, and they'll go out and do their job during the day, which is delivering the labs and pharmaceuticals and other medical supplies around, really around the community.

Host Amber Smith: Well, very interesting. I want to thank both of you for making time to tell us about this.

I appreciate it.

Steve Roberts: Amber, thank you so much for having us and giving us an opportunity to talk about the program. It's very exciting, some great work going on, and we appreciate the time to share our experience with everybody.

Jeff Causey: Thank you, Amber. It was a real pleasure to be with you today. And I just want to thank Upstate for the spirit of innovation that exists throughout your health care system. Our drones have been so well received, and everybody is excited about what's going to be possible, and everybody is just so focused on serving patients, and it's inspiring for us to be a part of your community.

Host Amber Smith: My guests have been Steve Roberts -- he's the director of the autonomous machines department at Upstate -- and Jeff Causey of Causey Aviation.

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

Here's some expert advice from Chief Nursing Officer Scott Jesse from Upstate University Hospital. What kind of person would make a good nurse?

Scott Jessie: The profession attracts a really wide variety of people, and I think that's the beauty of the profession. Honestly. There is a lot of pressure in some kinds of nursing, for sure.

It can be very, very intense and in other different types of nursing practice, maybe a little bit less so, and I think that gives a lot of different people options when they get into the career. I do think you have to. Definitely be a committed and caring person. I think everybody who gets into nursing at the base level likes to work with people, likes to help people. That's why they do it.

Everybody knows health care is stressful. Whether you work in a physician's office where you see an awful lot of patients a day, or you work in the emergency department or in acute care, med-surg (medical-surgical) unit taking care of patients, patients' lives are in your hands. It's a high responsibility position.

It's stressful. It is beyond rewarding, and I think that's why people do it. But yeah, it is stressful, it's challenging, and I do think people who get into it, I don't know if they're all graded, dealing with pressure initially. They learn that over time. I think what they do realize or come to profession with often is the ability and acknowledgement that they need to be flexible.

Our day is never the same, no matter what we do, and you have to be able to pivot, and that's really important. We end up getting nurses with all different kinds of backgrounds and degrees. We have a lot of nurses ultimately going up, going back to school after they've earned a bachelor's in something else, for example, and end up in the health care profession.

I think naturally you have to be an inquisitive person. To be a nurse, you have to like and understand how the body works. That's really important from that perspective. Do you have to love chemistry? Maybe not so much. I could certainly tell you a lot of nurses would say they didn't love their chemistry classes.

You have to have some basic understandings. The amount of knowledge that you need to be a nurse is tremendous in reality. We take care of all ages of patients under all circumstances and all disease types, and the number of medications, for example, that are available has grown exponentially over the years.

And you have to know how they work and how they interact. And we thank goodness have tremendous partners and pharmacists help us with those things. At the bedside, you are the person giving the medication. Nobody else is. And you have to know the risks and the safety concerns and how they interact and if it's the right medication.

And so, yes, science is very important. Excellent communication skills are very important. Being a people person is very important. A good, broad background is really important, I think, for people who are interested in getting into the field, though.

Host Amber Smith: You've been listening to Scott Jesse, the Chief Nursing Officer at Upstate University Hospital.

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: Leah Johnson is the author of "Bindweed," published by Cherry Grove Collections in 2021. The poem she sent us is called "Trauma," and it captures the steady horror of living in pandemic times when we cannot relax our vigilance.

"Trauma"

A squatter in the landscape

of the body, this beast. This echo

from childhood. The well-loved child

unsafe at home, unsafe at play.

And the habit of vigilance learned

so early is exhausting. I drag

the days and nights of pandemic

and deaths and riots, politics

and murders and insurrection,

the noise of the news. The incessant

noise. We wonder why we feel dread

gnawing at the edges of our beings.

Wonder what is this bitter flavor?

And I remember. It's the scent

of the beast in our mouths.

Jacqueline Jules is the author of "Manna in the Morning," from Kelsay Books 2021. Her poem "Every Death" asks us to consider what part we all play when spreading misinformation and demonizing anyone who disagrees with us.

"Every Death"

Should I be sad?

Watching a father of five, filming himself

from a hospital bed, pleading with others

not to make the same choice he did.

Does he deserve my grief

when he had the chance

to trust the truth as I see it?

My Facebook feed isn't filled

with posts tempting me to take

a drug meant for horses and cows

But I'm guilty, too,

clicking on headlines

to confirm my opinions,

seeking spaces

where my own thoughts

are echoed.

When chemo failed,

we tried everything

from onions to turmeric.

Every death,

preventable or not, leaves

loved ones gasping for air.

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

Next week on "HealthLink on Air," how parents turn to social media when their child is in cancer treatment.

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.