Where injured children get treated; she guides breast cancer patients; helping aged parents: Upstate Medical University's HealthLink on Air for Sunday, Nov. 10, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a pediatric trauma doctor talks about the injuries that bring kids to the hospital.

Kim Wallenstein, MD, PhD: ... Things like falls, like motor vehicle accidents, bike crashes, ATV crashes, pedestrians hit by cars. And even things, unfortunately, like a child's physical abuse would count as traumas. ...

Host Amber Smith: And a breast cancer navigator shares what to expect after a breast cancer diagnosis.

Maureen Garvey: ... When a patient is seen at our breast cancer program here at Upstate, they see almost everyone involved in their cancer treatment -- the breast surgeon, the medical oncologist, the radiation oncologist. We offer genetic testing to all of our patients, as well as our integrative medicine provider. ...

Host Amber Smith: All that, some advice about how to tell when an aging parent needs help, plus 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, tests and terminology that may come up after you're diagnosed with breast cancer. But first, the benefit of a pediatric trauma center that serves all of Central New York.

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

A team of pediatric trauma specialists stands ready to care for injured children and teens around the clock. And today I'm talking with their leader. Dr. Kim Wallenstein is an assistant professor at Upstate and the medical director for Upstate's Pediatric Trauma Team.

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

Kim Wallenstein, MD, PhD: Thank you for speaking with me today.

Host Amber Smith: Why is it important for the community to be aware that Upstate has a pediatric trauma team specifically for children?

Kim Wallenstein, MD, PhD: Well, the fact that Upstate has a pediatric trauma team is crucial for not only the local area, but also the entire region.

Upstate has the region's only Level 1 pediatric trauma center, and we can get into what that means for the community, but it provides a resource for the entire region to send their critically injured children to get the top level of care.

Host Amber Smith: So when we say region, Central New York region, how many counties, or what's the boundary, sort of?

Kim Wallenstein, MD, PhD: The Central New York region, we see 14 different counties. It's a very large region of the state that encompasses everything from up to the border with Canada to down to the border with Pennsylvania, and then side to side. And those 14 counties all funnel their patients here. The only nearby regions would be associated with Rochester and Albany. So we are all part of the Upstate region.

Host Amber Smith: So most probably come by ambulance, but also air ambulance?

Kim Wallenstein, MD, PhD: Yes, we have both available to us. There are a lot of issues with transportation, especially in the weather. As you know, in Upstate New York, we do have four distinct seasons, and in the winter, it is harder to get a lot of the transportation, especially by air.

So we do rely a lot on our ground ambulance teams, which are wonderful, but we have the air medical available, when the weather allows, in order to transport those more critically injured children.

Host Amber Smith: So let me ask a really kind of basic question. What counts as a traumatic injury?

Kim Wallenstein, MD, PhD: That's a great question because traumatic injuries have a huge definition of variety.

They come in all colors and all types. We consider traumas to be really any injuries that happen as the result of an event, so anything that's not a medical problem, that's a result of something that has happened to somebody, usually unexpectedly. Things like falls, like motor vehicle accidents, bike crashes, ATV crashes, pedestrians hit by cars. And even things, unfortunately, like a child's physical abuse would count as traumas.

Host Amber Smith: So it sounds like cuts, broken bones, a range of things, and it sounds like some could be life threatening and some could be minor.

Kim Wallenstein, MD, PhD: Exactly. And that's why it's great to have Upstate as a resource for all of those different things.

We often get phone calls or queries from other hospitals in our region asking about children that they are seeing in their emergency departments and whether they need to be transported to us because they need a higher level of care, and we're able to give them some guidance on that.

Host Amber Smith: Now, you used the term "Level 1." How many levels are there, and what does Level 1 mean?

Kim Wallenstein, MD, PhD: We go by the American College of Surgeons guidelines and definition. That is our overarching organization that accreditates the trauma centers. And the Level 1 designation indicates that we have the highest level of designation, but there are other levels, too.

Level 1 means that we are the ultimate resource for trauma care, that we have the appropriate resources to care for all trauma patients because we have all the specialists and all of the technology available to us.

Level 2 centers are just below the Level 1 center. They just have a few less resources and sometimes fewer research programs and training programs involved.

And then there are also our Level 3 centers, which are crucial to the care of trauma patients because they are able to function and do that initial assessment and resuscitation of trauma patients when they arrive to them. And those are a lot of our more rural hospitals that get trauma designations.

Host Amber Smith: So how often does the American College of Surgeons accredit trauma centers?

Kim Wallenstein, MD, PhD: We have to go through a full accreditation every three years. So every three years they come around for a two-day, really, really intensive site visit, where they go through every part of our program. We get the entire team together, including all of the administrative people at the hospital, leaders who support our program, and then all of the people involved in caring for the patients. And this happens with both our adult and our pediatric trauma programs, and we have to pass this intensive visit in order to continue on as a trauma system.

Host Amber Smith: Now the Adult Trauma Center and the Pediatric Trauma Center, what is the difference in trauma in a child versus an adult?

Kim Wallenstein, MD, PhD: The child injury pattern is a little bit different, and that's why we have both adult and pediatric trauma programs. Our pediatric trauma program sees patients age 14 and below, and that's what the American College of Surgeons has designated as being pediatric because of the difference in injury patterns and difference in how you deal with injury and the physiology of the patient. Our adult team sees the ages 15 and up. You can imagine that at age 15, 16, that's when the children start driving and getting into more adult-type activities. So the 14 and below ages, we see mostly things that are not as much the same pattern as the adult activities.

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

I'm talking with Dr. Kim Wallenstein. She's the medical director for Upstate's Pediatric Trauma Team.

How many patients does the team take care of in an average week?

Kim Wallenstein, MD, PhD: That is completely variable, and you can imagine that different times of the year, you see different numbers of patients.

So in the winter, actually, even though we have a lot of snow sports here, and you can imagine that people can get injured on the slopes and sledding and that type of thing, we actually have a little bit of a dip in volume during the winter. So we may not see as many patients during the week in a typical week in the winter.

In the summer, you can definitely tell when the kids get out of school.

Also, that first weekend in the spring or summer where it's really nice weather, and everybody opens their windows and the kids fall out of the windows, we definitely see an uptick there. So we can have our service full of up to 10 or 15 kids that have been injured, but it's much less at different times of the year.

Host Amber Smith: What type of injuries do you see the most often? You mentioned falls.

Kim Wallenstein, MD, PhD: Falls are always the No. 1, and those are pretty much the No. 1 for most age groups, even with adults. In kids, the falls are a lot of different mechanisms. So the difference between kids and adults that you asked earlier is sort of illustrated in falls.

So you can imagine that children come in all different ages, so they have all different mechanisms of falls. The babies, obviously, aren't walking. or even crawling, perhaps, at that point. So their falls have to do with dropping out of parents' arms, maybe rolling off the bed, things like that.

The toddlers can fall down stairs if they get through a baby gate or have different falls from tables or chairs. Then you get into the older, school-age group, and they have their jungle gyms and porches, balconies, that type of thing, so at every different age group, there's all sorts of different ways that you can fall.

And so falls are always the most volume.

Host Amber Smith: Now, over the summer, there were 11 victims of a house explosion that came to Upstate for trauma care. Eight of those were children.

Kim Wallenstein, MD, PhD: Yes.

Host Amber Smith: So how was the pediatric trauma team able to care for so many children at the same time?

Kim Wallenstein, MD, PhD: A multiple trauma like that definitely stresses the system, and that's why it's so great that we have real organized ways of dealing with our traumatic events, and we also have drills, and we practice these things so that we know how to get the appropriate people involved.

In this case, everything went very well and in a very organized, systematic fashion to take care of these children. We were able to get all of the specialists that we needed and all of the resources. When the number of patients overwhelms the people that are there at that moment, we have backups, so we can always get other people to triage (determine each patient's severity of injuries) and take care of the people if we need to. And so we were able to draw in all of those resources.

Host Amber Smith: What sorts of injuries did these children have, and what sort of challenges did you face?

Kim Wallenstein, MD, PhD: You can imagine with an incident like a house explosion, and I won't go into details about the specific patients, but in general, with a house explosion, you can imagine that there's going to be burn injuries because of the heat component of it.

But there's also, in this case, blunt injuries and blast injuries because you imagine that the patients have been in an explosion, basically. And so we saw a variety of these type of things and had to get a lot of specialties involved.

Host Amber Smith: Let me ask you, for a parent who brings their child to the pediatric emergency room after, let's say falling off a bike, can you walk us through what they should be prepared for?

Kim Wallenstein, MD, PhD: When a parent brings the child in, and it really depends on the pattern of injuries and how injured the child is, the trauma team sees mainly, at least when they arrive, the most injured type of patients, and they may even go through what's called an "activation," where we have the entire trauma team assembled in a very systematic fashion to evaluate that patient.

That's a very intense experience, where the kid is rolled into the trauma bay. There's a lot of people around the child to evaluate them all at once. We go through a very systematic way of evaluating the patient. It can be a little bit overwhelming to parents.

Usually, we allow the parents to watch a lot of these things, but sometimes they're sort of sitting in the hallway on a chair and waiting for that update. So we do try to update the parents as much as we can about what is going on and what is next for their child.

The less injured patients, or the ones that do not come in as activations, go to the pediatric emergency department, where they are looked at by the pediatric emergency staff, and then they get the trauma team involved if there's an injury that needs our care.

Host Amber Smith: So right after the accident happens, and the child falls off the bike, a parent may wonder: How serious is this? Should I drive them? Do I need to call an ambulance? Should I call 911?

Do you have some advice for what they should consider in deciding what to do?

Kim Wallenstein, MD, PhD: It's such a subjective thing, but it's never a bad idea to call for a higher level of care. What I don't want to suggest is that any parent just, no matter what the accident, scoop their child up and throw them in the car and come into the emergency department, because that could actually worsen any injury that's existing.

If it's a serious bike accident and the child has hit their head or has some other obvious fracture injury, it's always better to get a medical team involved, like calling 911 so that they can evaluate them, make sure that they don't have a significant head or neck injury and be able to immobilize what needs to be immobilized so that there's not further injury in the process of transport.

There are certainly kids that have very minor injuries; this happened to all of us in our lifetimes, and those are handled differently.

But if it's a significant accident, I would always recommend calling 911.

Host Amber Smith: What are the benefits of coming to the hospital versus an urgent care?

Kim Wallenstein, MD, PhD: The hospital just has more resources.

Urgent care is wonderful for scrapes and bumps and things that are able to be evaluated at a place with less resources. The great thing about a trauma center is we have all the resources. So if the child needs specialized X-rays or CAT scans, then we have those available, and we have the specialists and the pediatric radiologists that can interpret all of those.

Host Amber Smith: Now, is there anything that parents should bring, or not bring, to the hospital with them when they bring their child?

Kim Wallenstein, MD, PhD: It's hard for them to remember anything in that period of time because it's such a stressful situation. So I wouldn't recommend packing up a lot of stuff. If their child is very injured, they'll probably be admitted to the hospital, so bringing some things that will make the child feel more comfortable in the environment is helpful, but that's something to think of later.

In the short term, it's sometimes helpful to, say, bring the helmet that the child was wearing, just so that we can look at it and see what kind of damage that that sustained. It gives us more of an idea of how much force was in the incident.

Host Amber Smith: What's your secret for calming a child who is scared?

Kim Wallenstein, MD, PhD: It's hard in that environment because especially with the activations, there's so many people around the child, and it is a bit of a scary environment, even for an adult, in that situation.

So we always find out the child's name, we refer to them by name and tell them that everything's going to be OK and that everybody is taking care of them.

One thing that we have as a resource, which is wonderful, is our Child Life Team, and they are a wonderful adjunct to come in and help us with exactly that type of thing because they know exactly the little tools and tricks to talk to the child and make them feel more comfortable.

Host Amber Smith: Well, that's good to know. And I want to thank you so much for making time for this interview, Dr. Wallenstein.

Kim Wallenstein, MD, PhD: Well, thank you very much for talking to me today.

Host Amber Smith: My guest has been Dr. Kim Wallenstein. She's an assistant professor and medical director of the Pediatric Trauma Team at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air," what to expect after a breast cancer diagnosis.

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

Treatment options for breast cancer have changed over the years, and today we'll hear about what may lay ahead after diagnosis from nurse Maureen Garvey. She's the breast cancer navigator for the Upstate Cancer Center.

Welcome to "HealthLink on Air," Ms. Garvey.

Maureen Garvey: Good morning, Amber. Thank you for inviting me to speak on something that's so passionate to me.

Host Amber Smith: So what is a breast cancer navigator?

Maureen Garvey: As the breast navigator here at Upstate Cancer Center, I'm the liaison. So I introduce myself to all the patients that are referred to the breast cancer program here at Upstate. Our breast cancer program here at Upstate is very unique. We have the ability to meet as a multidisciplinary team. So when a patient is seen at our breast cancer program here at Upstate, they see almost everyone involved in their cancer treatment -- the breast surgeon, the medical oncologist, the radiation oncologist, we offer genetic testing to all of our patients, as well as our integrative medicine provider.

Host Amber Smith: So by the time they meet you, they've been diagnosed with a biopsy. They know they have some form of breast cancer, right?

Maureen Garvey: All of the patients that come through the breast cancer program have been diagnosed with breast cancer. When they come to us, they're coming from all aspects. They're coming from primary care providers. They're coming from their OB/GYN (obstetrician/gynecologist) providers. Or they may be coming from our breast and endocrine center. So they're coming from very many other aspects of understanding and knowing about their diagnosis.

Host Amber Smith: So what happens after diagnosis? What do you do with these -- and then I assume it's mostly -- women?

Maureen Garvey: The majority of our patients are women. Here at the cancer center at Upstate, we've hadover a handful of men come through the program.

When they come to me and I introduce myself, they have a general idea that they have breast cancer. They don't really know their staging. And a lot of it is confusing because many of our primary care providers and our OB/GYNs are not specialists. So when they come here, it's a lot of working with them and trying to make them understand.

One of the first questions that the patients ask is, "What stage am I?" And when I talk to them, I explain to them that the staging is very difficult based on a biopsy. We need more information. And when we come in, we go over everything with them to explain staging and what it entails.

Host Amber Smith: So there's other testing that may be involved to get the right staging. And the staging is kind of telling them how far advanced the cancer is, right?

Maureen Garvey: Yes. Staging is how far it's advanced. What is very confusing is now, with modern technology, many of our patients receive their pathology reports before they come here. Many of them are trying to research what certain things mean. When they're looking at a pathology report, there's things in there that may be confusing to them. Like if a pathology says "invasive," invasive can mean many things. We don't know unless they've had a lymph node biopsy if that cancer has spread anywhere else. Invasive means it's established and invaded into that part of the breast. So that's very confusing for patients.

They also now can see other things on their pathology report, like estrogen and progesterone receptors, as well as HER2 (human epidermal growth factor receptor 2) receptors and what we call a Ki-67 (a nuclear protein associated with a proliferation of cancer cells.)

And they can see the grade. People get confused. The grade of their pathology report can be grade 1, 2 or 3. That tells the provider if it's -- I don't want to use the word aggressive -- but the tumor is a little, maybe less slower growing, a little bit less aggressive. Middle is middle of the road. And grade 3 lets the provider know that it's a little bit more aggressive, and we need to keep an eye on it. People get very confused between grade and stage.

When we talk about stage, we talk about the progression of the disease. That tells us about the tumor, where the cancer may have gone, the size of the tumor, if it went to the lymph nodes. That is the stage. That helps with the treatment plan.

So if you are stage zero, which is typically ductal carcinoma in situ, which is, I guess if you want to talk about a tree, it's like seedlings. So it's seeding, and it's sitting around there. When we talk about invasive, like I said before, it's established itself -- either in the ducts, in the lobes -- so that's considered invasive.

Then you're moving on to a stage 1, and then stage 1 can vary depending on the size of the tumor. Then we move up to 2, which could be bigger size tumor and maybe some lymph nodes. Stage 3, a little bit more, a little bit bigger, maybe a few more lymph nodes.

When we get to stage 4, it has left the breast and the axillary lymph nodes and traveled to another part of the body -- the liver, the bones, the lungs, or the brain. Stage 4, there still is treatments that can be given. And with our technology, we have a lot to offer patients. So stage 4, for people before, when they hear stage 4 makes them feel like, "Oh my, it's my end of life." And we never know when the end of our life will be, but we know now with stage 4, we have so much more to offer.

When we talk about grade of the tumor, that would be on the pathology report. Grade goes 1, 2 and 3, and it looks at different parts of the tumor, like a Nottingham scale is what they use for how aggressive the tumor may be. It tells them that if you come in, and it's ductal carcinoma in situ, grade 1, ER-PR-positive (estrogen and progesterone positive), they know that that's an early tumor, hopefully early treatment, as long as the ductal carcinoma isn't somewhere else.

They come in stage 2, ER-PR-negative, HER2-negative, and their grade is grade 2, we know that we got to keep an eye on that. It's getting a little bit more. Grade 3, they're always keeping an eye on because it's the top of the grade. So it makes it a little bit more -- and I hate to use the word aggressive -- but they know that it's a more serious tumor with a grade 3.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with the Upstate Cancer Center's breast cancer navigator, nurse Maureen Garvey.

So it sounds like there's a lot to consider in just getting the full diagnosis. There's a lot of factors.

Maureen Garvey: There are a lot of factors. A lot of factors are what we see when we talk about their imaging, what is the next step that they need. If we do an MRI, the patients -- because MRIs are so sensitive, some people like them, some people don't -- but we don't want to pedal backwards in the treatment of our patients. If something shows up on the MRI, and someone's recommending on the opposite side of the breast, or if they see something in the affected breast, do we need to go in and do another biopsy? And very often that's happening. But we want to make sure if we see something else that we're not going back six months later and finding something different. Not that that can't happen, but we want to know upfront before we've scheduled them for surgery or we've started their treatment plan.

Host Amber Smith: I see. So at what point might you recommend or help facilitate a second opinion? Does that ever come up?

Maureen Garvey: It does come up. It comes up a lot. I can very often tell when a patient feels uncomfortable, and they're not understanding, or they're hesitant. I always tell my patients, you need to feel comfortable no matter where you go. The most important thing for their care and their treatment is that they feel comfortable. So I always offer to them, is there someone else you'd like to see? Is there somewhere I can set you up? Have you got an idea of maybe who you want to see?

In the world of technology and communication, people really communicate back and forth, and sometimes they have an idea that they would like a second opinion somewhere. So I help facilitate that, getting them their records and things like that. But I like to get a feel of where they're considering. I don't like to say where they should go, but sometimes they have an idea.

Host Amber Smith: So in terms of thinking about treatment, do you need to know the stage and the grade before the patient knows what their options are?

Maureen Garvey: So when we talk about staging, there's clinical staging and there's pathological staging. Clinical staging is based on the information that we obtain. It talks about the size of the tumor. Are there lymph nodes involved? The estrogen and progesterone receptors? So that's important as far as that goes.

The pathological staging is when the surgery is actually done, and they can look at all of those things. Many times patients come in and have a breast biopsy, and only a breast biopsy, because maybe they didn't see anything in their lymph nodes or something like that.

When they meet is our multidisciplinary approach. Before they come in for that visit, the providers all sit down. We have a breast radiologist that goes through all of the images. The staff talks. The providers talk amongst each other and say, "Do we need more testing?" "Do I see something different there?" "Do they need an MRI?" Not everyone gets an MRI. It's all how they talk about what needs to be done, the density of the breasts.

If they' ve had a lymph node that's positive, do we need to do staging scans? And staging scans will tell us if the cancer went outside the axillary lymph nodes. The first place that breast cancer travels to is the lymph nodes, so that helps us. If, depending on their cancer type, do they need to have what we call a sentinel node biopsy? And that's when the surgeon goes in and does surgery. They take an injection into the breast, that the injection in the dye leads to that portion of the breast that the drain it drains to in the lymph system. Then they'll take -- hopefully if they don't see anything or worry about anything -- they'll take one or two lymph nodes. And that will give them more of a idea about the staging and stuff like that.

It's very complicated because there's so many directions now. There's so much more that we know about breast cancer. The biggest thing that I tell people is that your breast cancer is your breast cancer. Years ago, we used to treat very much the same: Biopsies for surgery if it was positive, then you go back. Now we know by looking at the receptors, looking at all the things that we have, we treat that patient based on their tumor.

A lot of the patients will get feedback from other people, and I say, that's great. Support is great. If you have any questions why Mary Smith may have had this, this, and this, please reach out and ask us. Because we do want people to have support from other people, but we want them to understand why their treatment plan may be different.

Host Amber Smith: So as the navigator, do you set up appointments and make sure that the patients get where they need to go on the right day and time?

Maureen Garvey: So I am like the liaison. I help them through this process or journey, because it's definitely a process and definitely a journey. It's ups and downs. Before, you'd follow one path. Now we may get a report that's good or bad. We may need to proceed. I may sure that if they have questions on who to call, because the team is confusing to them. They've got three or four different providers. They're not all in the same office. The patients don't always know who to call. So I always say to them, as long as it's not a medical emergency, please reach out to me. I can figure out where to go, who to call. Get your forms to me, and we'll figure out everything.

I don't always set up appointments. I have our multidisciplinary team that will schedule anything that we need done from that visit. But I also make sure that they get to where they need to go if they need help. Do they need transportation? We'll figure out transportation. Do they need funds to get somewhere? We have a lot of people coming from out of the (Onondaga) county, a lot of people that are limited resources, and we here at Upstate really try and help them meet those barriers. So a lot of what I'm doing is helping them with their barriers.

When they come in to visit us, I give them a sheet of all their doctors from the cancer center, so they have the numbers, they have the locations, because after they leave here, they go to the other offices. I make sure that moving forward, we're following their plan. If something changes, I may change the appointment. I no longer just set up appointments for them. We make sure that we have everything for that next visit. If they have surgery, did all their tests come back? Are they going to radiation oncology first, or are they going to medical oncology first?

So that's kind of what I do. I'm here. They call, they talk to me, if they are upset about something or they're angry about something or they don't know where to turn, they all have my work cell phone number or can text me. And so I'm kind of their liaison.

Host Amber Smith: So you keep things organized, and you prevent things from falling through the cracks and and just kind of navigate.

Maureen Garvey: Yeah. It's like navigating the waters. It's hard for the patients. It's very overwhelming. There is so much as far as breast cancers out there, and our treatments and what we can offer patients, and the technology has changed so much, and it's ever changing.

Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break. Please stay tuned for more about breast cancer care with nurse Maureen Garvey.

Welcome back to Upstate's "HealthLink on Air." This is your host, Amber Smith, talking with my guest, Maureen Garvey. She's the Upstate Cancer Center's breast cancer navigator.

Is surgery usually involved?

Maureen Garvey: Surgery is usually involved. Our stage 4 patients generally don't go for surgery. The research and the providers say that it's not a benefit. And stage 4 is metastatic breast cancer that's gone outside of the axillary lymph nodes. So, local metastatic is just to the lymph nodes. Anything past the lymph nodes, in the bones or liver, brain, lungs is considered stage 4.

Host Amber Smith: I see. And then radiation, chemo, those are still options for a lot of women, right?

Maureen Garvey: Yep. It depends on the surgery that the women are having. Lumpectomy, depending on what their pathology shows, ductal carcinoma in situ, depending on if -- nothing is standard anymore; it's all individual -- but if they have ductal carcinoma in situ and they have a lumpectomy, they'll have a lumpectomy, most likely radiation, and then if they're estrogen- and progesterone-positive, they may get what we call an aromatase inhibitor, which blocks estrogen and progesterone.

Women don't understand that post-menopausal women still make estrogen and progesterone in our bones and in our muscles. We know that with estrogen- and progesterone-positive cancers that the tumor feeds off of estrogen and progesterone, so our goal -- not that we start with it right away, unless surgery's going to be delayed -- we know that these women benefit in survival rate of getting a recurrent breast cancer.

Host Amber Smith: Is chemotherapy part of the treatment for most women as well?

Maureen Garvey: Amber, chemotherapy can be a large part of a patient's treatment, depending on their, once again, their pathology, their estrogen receptor results, as well as their HER2. The HER2 receptor tells us a little bit about if they're at increased risk for recurrence. So that's another way that we treat patients a little bit differently.

And the other thing that we now have is what we call genomic testing. Genomic testing is genetics on the surgical sample, not the patient's blood, but the actual tumor itself. That recurrence score tells us if the patient is at high risk or low risk for distant metastatic disease in the future. So we know now that these women that are high risk, or many young premenopausal women that we can give chemotherapy, or some of the immunotherapies to help prevent. So, like the flu shot, a little bit different, but we're looking to prevent future occurrences.

So the thing about chemotherapy is that it's improved from what it did in the past, but there's still patients that have trouble with taking the therapy -- nausea, vomiting and things like that. Here at Upstate, we have our Palliative Care Team. I know it sounds very scary because people think of palliative care as hospice or end of life. That is not the fact here at Upstate. Our Palliative Care Team here is amazing. They help with symptom management, so if you're having a hard time with your chemotherapy, you know you've got a decreased appetite, marijuana medication and stuff to help them get through that, other medications that may help get them through that. So we are at Upstate really trying to encourage our Palliative Care Team to meet with the patients. Patients become very anxious about when we mention palliative care, but I like to share that because it's very important that there are means out there for patients.

And in chemotherapy there's some new technology. Some of the chemotherapies -- not all of them in breast cancer -- we can give mitts and booties they wear on their hands and feet because it helps with the neuropathy and pain from some of the taxane medications that we give for chemotherapy. Here at Upstate we also offer -- for certain chemotherapies, not all of them -- the cooling cap. We actually have a grant for the cooling cap that they can wear that helps them from losing their hair. They will still lose some of their hair. I've worked with a lot of patients. It's a commitment. It adds to your time. But a lot of women said their hair has grown back quicker, and it gives them another option, maybe, to feel a little bit better about themselves.

So, as far as chemotherapy, we have options here. They just need to ask. Ask any questions that you have.

Host Amber Smith: The newer forms of treatment, the targeted therapy and immunotherapy, how often are those used?

Maureen Garvey: The immunotherapy and the targeted therapy depends on the, once again, the pathology report. Triple negative women, which means their estrogen and progesterone and HER2-negative patients, sometimes can benefit from these targeted therapies. And they're immunotherapy, so it's actually working on your immune system to fight off these cells.

Triple negative breast cancer, we don't have the ability to give estrogen and progesterone blockers because the tumor with triple negative breast disease is not, it won't work for them. Because we don't know that avenue of treating the breast cancer, as far as the estrogen, progesterone receptors.

Host Amber Smith: You're listening to Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with the Upstate Cancer Center's breast cancer navigator, nurse Maureen Garvey.

Are the treatment options the same for men who are diagnosed with breast cancer?

Maureen Garvey: Yes. Many of the treatments are very similar for men. If they needed to have surgery, they would have mastectomy, lumpectomy, depending on where the cancer was. If they had a lumpectomy, radiation, and then men still, their body still, makes estrogen and progesterone. Their pathology is tested the same way that a female's is.

Host Amber Smith: What advice do you have for someone who's going through breast cancer treatment?

Maureen Garvey: The biggest thing is that: Ask your questions. Anything people don't understand, it's prying on them. They're thinking about it constantly. To them, it may seem silly. But if it's something that is pressing in their mind, they can't move forward.

And the other thing that I tell people is it's one step at a time. One test at a time. One office visit at a time. You know, in the beginning of your breast cancer journey and your diagnosis, depending on how many tests you need to have, it's going to be a lot of visits. It'll be a lot of visits, something new, and then all of a sudden things -- depending on your diagnosis and your staging -- things calm down a little bit.

Sometimes the patients feel like all of a sudden they're just kind of left. But they're not. We are hoping that they're transitioning into being a little bit more independent, starting to feel better and things like that. So my biggest thing is ask your questions.

Host Amber Smith: Any advice for the best ways loved ones can help?

Maureen Garvey: For loved ones, it's hard. Because breast cancer is so advertised and so much in the media, people are beginning to think that, oh, it's not as bad. Well, our technology is better. People are living longer. Our treatments are better. But I've had many women -- because I run our Pink Champion support group -- that say once they got that diagnosed, their whole life changed. Everything that they looked at and the way they felt about things were different.

And I think that for family members, it's difficult because they don't know what to say. They don't know what to act and what to do. People will shy away because they don't know what to say. The biggest thing for many of the patients is you got to talk about it. If they're willing to talk about it, you got to talk about it. You got to share. The person that's helping care for that person needs to share what they're feeling as well.

And the other thing is, keep your loved ones active. My thing I tell patients all the time, if you're having a bad day, you don't feel good, chemo's not going good, get up, take a walk, even if it's to the end of the driveway, come back. It's proven that exercise and getting up and moving will make you feel better.

Host Amber Smith: Well, that's good advice. Thank you, Ms. Garvey, for making time for this interview.

Maureen Garvey: Thank you very much for inviting me.

Host Amber Smith: My guest has been nurse Maureen Garvey, the breast cancer navigator for the Upstate Cancer Center. 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, 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: Is there anything better than a love poem? Especially in these times? Vincent Casaregola, who teaches at St. Louis University, sent us a gorgeous and yet bittersweet testament of a love now gone. Here is "This Poem Is Just About You":

This poem is just about you, not you,

not some substitute to hold you

out of time's reach and cost --

this poem cannot touch you, cannot

feel the softness of your skin beneath

a fleeting brush of fingers,

cannot reclaim the sight of you

reclining on a chaise or standing

in the window's morning light,

cannot be the light reflected

in your glance across the table

or be the gentle tilt of your head

when listening, or speak your thoughts

with your voice, tender or alarmed,

angry or soft, as moods propel.

No, this is a thing of words, poor

currency that barely pays the price

of simple goods on ordinary days,

passing words, mortal and fleeting,

with no eternity in store, no marble

meaning etched in history.

And when your rebel cells collude

again, rise in secret, then strike,

bringing insurrection to the lung

or brain, these words, bring no relief

from any throbbing pain, no salve

for the sting of doubt and fear

as you, sleepless, outstare

the darkened midnight ceiling, nor

can they ease the ache that grows

stronger with each morning, or feel

the tangled tightness in your grip

as you reach for help to cross a room.

These words bring me no comfort,

not even cold comfort, but lie

dry as old paper in the musty attic,

less comfort, even, than a cold,

post-mortem final kiss that seals

the moment in the dim, grey room.

These words themselves have little or no

life, no breath for me to hear as from you

when you'd lain asleep beside me,

and they will fade, as ink on paper fades

in heat and angry sun, or as screens will

fade when the grid itself will die --

carve them on our stones, if you will,

the stones themselves erode to dust,

and even while they last, the sharp carving

smooths with age, making words clefts

for blown sand, for spores of lower plants,

for fibers of what, once, had flowered.

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," healthy eating for the holiday season.

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.