Keeping a healthy back; janitors' key role; symptoms of dementia: Upstate Medical University's HealthLink on Air for Sunday, March 9, 2025

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a physical therapist talks about maintaining a healthy spine your whole life.

Ryan Martin, DPT: ... Posture is one of the most important things for spine health, and it's definitely something for my patients when I'm working with patients in the clinic, coming in for spine issues, it's always one of the main topics and things that we're working on. ...

Host Amber Smith: Researchers share a study about the value of hospital environmental services workers.

Telisa Stewart, DrPH: ... We got to learn about what their experiences are like on the floor every day, working with people and families and communities and working with the clinical teams. We got to learn about all the things that make them feel supported and make them feel proud. And we found some areas that we could improve on. ...

Host Amber Smith: And a geriatrician answers whether memory problems signal dementia.

All that, plus a visit from The Healing Muse, 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, an important part of the health care team you may overlook. Then, a geriatrician tells whether memory problems signal dementia. But first, how to keep your spine healthy from childhood into old age.

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

Today we'll be talking about what to do or not to do in order to maintain a healthy spine with Ryan Martin, a doctor of physical therapy at Upstate.

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

Ryan Martin, DPT: Thanks, Amber. Thanks for having me.

Host Amber Smith: From early childhood, I remember being told about the importance of good posture. Does posture in childhood impact the spine in adulthood?

Ryan Martin, DPT: Yeah. Absolutely. Posture, I would say, is probably one of the most important things, really, when it comes to spine health. So, the earlier of an age that you're learning good postural habits and practicing that, and that's kind of becoming your default position and postures, then you're setting yourself up for success there. You're avoiding placing excessive and unnecessary stresses on the spine. So I would definitely say that's true, and starting from a young age, again, you're setting yourself up for success there.

Host Amber Smith: What are the most common mistakes you see with posture with adults and children?

Ryan Martin, DPT: It's usually pretty common to see that as we're sitting down, we often slouch to some degree, right? So as opposed to sitting upright a little bit more, we tend to slouch out in our chair. If you think of when you're standing and you place your hand on your lower back, you can feel that there's a little bit of a curvature there, right? A little bit of a lordosis, as we call it. So when we sit down, often, again, we slouch. That lordosis, or that curvature, kind of decreases and flattens out, and that, again, puts you in a position where there's increased pressure on your spine from the lumbar spine, the low back, right up through your upper back and your neck. So I think most people can probably relate to that and have caught themselves slouching at times. So that's most commonly what we see, typically.

Host Amber Smith: Does poor posture give you back pain? I mean, how would you know that you have bad posture?

Ryan Martin, DPT: Again, posture is one of the most important things for spine health, and it's definitely something for my patients when I'm working with patients in the clinic, coming in for spine issues, it's always one of the main topics and things that we're working on. Not just to maybe help get them out of that episode of pain, but also to help maintain a healthy spine after the fact, after they've recovered.

Host Amber Smith: Does footwear contribute to posture?

Ryan Martin, DPT: Yeah. So any time we're standing, we're on our feet, everything kind of starts there at your feet, really, right?

So, if you're wearing maybe not the most supportive footwear, not really giving you great arch support, and that's allowing your arch to maybe collapse more than we'd like, that affects everything up the chain as far as your lower extremity. You know, your foot collapses into that position. It's going to affect the knee, which is going to affect the hip. So it all kind of starts there.

Host Amber Smith: So, yeah, you want to make sure you're wearing some appropriate footwear with some decent support. So for people who have jobs where they're sitting at a desk all day, how do you feel about standing desks, or I know there's a variety of specialized chairs. Do those help with posture?

Ryan Martin, DPT: I think the standing desks or the adjustable work desks, I think those are a great option, like you said, especially for people that have a more sedentary desk job. That prolonged sitting is probably one of the biggest stressors on the spine. I know people typically tend to think of maybe bending over, lifting, things like that, which does stress the spine, but that prolonged sitting, probably even moreso, like you said, especially for those folks that have a sedentary-based job at desk work.

So those standing desks, they allow you to stand up, change positions. It maybe wouldn't be the best thing, either, to be standing there all day, but it gives you that option to break things up throughout the day. So that's, again, something I'll often recommend to patients of mine if they're dealing with a spine issue, and they have a desk job, that's something that I'll often recommend to them. There's varying versions of that from the whole desktop raising up and down to other ones that you can basically just kind of set your computer on, and that'll raise up and down. So those are a great option.

As far as specific chairs, I don't usually recommend anything too specific there. Essentially, as long as, again, the chair has somewhat of a nice, firm back and upright back, where it's kind of promoting that upright posture, I think people are in good shape with something like that. A lumbar roll is something that can really be useful as well, like a lumbar cushion, a lumbar pillow. Again, that's something you would just place in that hollow of your lower back when you're sitting, and it helps to promote that, maintaining that hollow of your lower back, sits you up straight.

When we're sitting, that's really where our posture begins, is at the base of our spine, at our lower back. If you're sitting, and you're maintaining that curve of your lower back, it really sets you up for success elsewhere up the spine into your upper back and your neck. If you're sitting up there, it puts your shoulders and your neck and your head kind of automatically in a good position, versus, again, if you're slouched out from your lower back, it kind of tips your shoulders and your upper back forward, tends to promote that forward head posture, all of those things that are putting increased stress on your disks in your spine.

So yeah, lumbar rolls. Again, with any standard chair you can use a lumbar roll. I recommend that, again, usually to patients in the vehicle, at work, anywhere they're sitting for any length of time. And it's a great thing even if you don't have back or neck or spine pain. It's a good thing to just make a habit out of just for, again, overall spine health through the lifetime.

Host Amber Smith: This is Upstate's "Health link on Air," with your host, Amber Smith. I'm talking with physical therapist Ryan Martin about how to maintain a healthy spine.

How often do you see people who injure their backs trying to lift heavy objects?

Ryan Martin, DPT: I do see that. But like I was saying earlier, I think more than anything it's often more of these cumulative stresses on the back. I would say probably more often, again, just from poor postural habits and the cumulative stresses that come with that. Not that people, again, can't injure their back or their spine through a certain heavy force. I think sometimes when that does happen, it may just be the straw that breaks the camel's back kind of thing where they maybe had this issue kind of brewing, and that was just the extra stress on the spine that really kind of tipped the scales there.

Host Amber Smith: What advice do you have about the right way to lift?

Ryan Martin, DPT: Probably the type of thing most people have heard as far as bend at the knees and the hips. Try to make most of the movement come from there, where you can rely more on your lower extremity, your leg muscles and avoid just all that bending and motion coming from your lower back.

That's another area, again, we try to educate patients on in the clinic is good body mechanics with bending and lifting. You can get most of the way down into a squat toward the floor and really still keeping your low back and your spine in a relatively neutral position if you're really squatting down from more of the hips and the knees. So, another way, again, to reduce those stresses on the spine. A good thing just to try to make a habit out of, to set yourself up for success and avoid developing spine issues.

Host Amber Smith: How much of a role does a person's weight play in putting stress on the back?

Ryan Martin, DPT: I would say it certainly plays a role to some extent. I mean, the more weight or mass that we're carrying, the more pressure and force that's being transmitted and loaded on the spine. So I would certainly say it plays a role.

Also, I think maybe sometimes it can be maybe something of a scapegoat. I've encountered a lot of patients where they may be experiencing some spine issue or another, and sometimes they're just kind of told, "Well, you know, you're overweight. You need to lose some weight," and then that's maybe just the easiest thing sometimes to point a finger at.

So I would say it plays a role to some extent, again, in so far as the forces and stresses on your spine. The more weight you're carrying, it is increasing your stresses there. But yeah, I'm not always so quick to point my finger at that as the primary issue most often.

Host Amber Smith: Are there particular exercises that are good for your back, even for people who don't have back pain but want to prevent it? Are there exercises you recommend or things that you say not to do?

Ryan Martin, DPT: Yeah, that's a great question. Certainly general strengthening and stabilization of your core muscles, your hip muscles, that's always beneficial, again, whether you're dealing with the spine issue, or you're just trying to be preventative. So that's definitely a beneficial thing, the more core strength and stability you have.

And one of the big things we'll often explore in the clinic, if somebody's coming in for a spine issue, there's often what we call a directional preference, which just means that there's a direction you can move the spine or stretch the spine that will relieve pain and hopefully help actually resolve the problem. So depending on what the issue is and what is causing the pain, that could be bending forwards. It could be bending backwards. It could be lateral movements. But there's often a specific direction of movement for the spine that can help relieve pain, resolve these issues. That's something that you really would probably want to explore more with a physical therapist or somebody who's trained in that.

Those things are important. There are, again, stretches that can be done that help to offset a lot of the daily stresses and pressures on the spine as a whole. We tend to do more forward bending, right? As far as bending forward, picking things up, bending over towards the floor, putting our socks and shoes on. So we tend to move more in that direction in regards to the lower back. And it's less common that we move into more of a backward-bending direction.

So oftentimes, that can be beneficial for helping decrease the incidence of some of those disk issues that we commonly see. So yeah, that would be some of the main things, again, we'd work on in physical therapy, identifying any directional preference, strengthening and stabilization exercises. Those would be the main things.

Host Amber Smith: Is running a healthy activity for the spine?

Ryan Martin, DPT: Yeah, I would definitely say really any form of activity and movement and exercise, as long as it's done appropriately. I wouldn't want to see anybody try to take up running and start doing excessive mileage too quickly. That can cause injuries in and of itself. So you always want to build up to those activities and allow your body and your tissues time to adapt to those maybe new stresses you're putting on it. So as long as it's done in a smart way, and you're working your way up gradually, definitely. And again, activity, movement, exercise in general is some of best things for the spine.

Again, usually the problem is that we're spending too much time sedentary, sitting in one position, where you get that cumulative stress on tissues and on the spine.

Host Amber Smith: Well, let's talk about sleep. What is best for our spine: firm or soft mattress?

Ryan Martin, DPT: It may come down to each individual in terms of their spine and what particular issues they may be dealing with, whether they may have stenosis or if they're dealing with a disk issue, as well as what positions they tend to sleep in. If they're more of a back sleeper, a side sleeper, stomach sleeper. So that one would be another one of those things where you probably would want to talk that through with a therapist or somebody along those lines to kind of individualize that based on, again, any diagnosed conditions in patient sleeping positions and preference there.

Host Amber Smith: So sleeping on the back versus side or stomach, all three of those could potentially be OK for someone who's wanting to keep their spine healthy?

Ryan Martin, DPT: For the most part, I think as far as when I'm working with patients, when it comes to sleep, they're going to, they kind of have their set positions where they're comfortable in and that they're able to sleep in. So, again, depending on what they may or may not have going on, I'll try to work with them to find ways of making that, again, less problematic.

But as a whole, any of those positions should be fine. With a typical individual with with a healthy spine,one thing I'll often advise patients on, if they are more of a back sleeper and they're sleeping on a very, very soft surface or mattress, it can kind of promote them kind of sagging into that mattress a little bit and again, kind of having that effect of rounding out the lower back, which can increase those pressures on the disks in the spine. So that can sometimes be detrimental again, depending on the individual and what they have going on in their spine.

Host Amber Smith: What about hammocks? Are those a good idea?

Ryan Martin, DPT: That would kind of go along similar lines, and even moreso, again, if you were sleeping on your back in a hammock, that's really going to kind of curl you up into that, almost banana type shape, right, where certainly that's going to put a lot more pressure on those disks of the spine. It's putting your spine into more of that forward flex position. So that I would probably advise against for most individuals.

Host Amber Smith: Does the type of pillow matter?

Ryan Martin, DPT: As far as that goes, I usually kind of gauge our patients more sleeping on their back or on their sides. You know, if you're sleeping on your side, then with gravity, your head is going to naturally kind of fall down toward the mattress that way.

So I usually tell people there if you're laying on your side, maybe to have a little bit thicker of a pillow or a couple pillows so that is helping to keep your neck in more of a neutral alignment as opposed to allowing it to bend to the side.

If you are more of a back sleeper, I usually advise people there that less is more as far as pillows go. If you're laying on your back, the more pillows you have under your head, it's going to kink your neck and your head again, kind of into that forward bending position, bringing your chin more toward your chest, which again, will put more pressure on those intervertebral disks. So that's usually how I advise people there.

If you're a stomach sleeper, you're going to have to kind of rotate the head somewhat, one direction or the other. So that's usually my advice as far as pillow use and sleeping positions.

Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break, but we'll be back shortly with more from Doctor of Physical Therapy Ryan Martin.

Welcome back to Upstate's "HealthLink on Air." This is your host Amber Smith, talking about healthy spines with Dr. Ryan Martin, a physical therapist at Upstate.

Well, we've all heard about the dangers of smoking and the link to lung cancer, but what can smoking do to our spines?

Smoking obviously has detrimental effects. On our bones, it can increase risk for fracture and osteoporosis. It can delay healing of fractures. By virtue of all of that, that's going to affect the spine. So, obviously not a recommended thing for spine health. Anything we need to keep in mind in terms of nutrition that's good for our skeletal system?

Ryan Martin, DPT: Yeah, I think, going back to the diagnosis of osteoporosis or osteopenia, which is just an earlier stage of osteoporosis, making sure that you're getting enough calcium and vitamin D. Your doctor may order bone density scans to assess that bone density to see if there's any stage of osteopenia or osteoporosis going on. In those situations where there is diagnosed osteoporosis, that can weaken the bone, of course, and that can result in vertebral fractures or compression fractures.

So it is important to make sure you're getting enough calcium and vitamin D, and you're doing what you can to try to prevent those diagnoses of osteopenia, osteoporosis.

Host Amber Smith: Do you recommend chiropractic care for someone who has an achy back?

Ryan Martin, DPT: I think chiropractic can definitely be a valuable treatment. I've encountered a lot of individuals who have had great success with chiropractic treatment. Chiropractic treatment tends to be different from physical therapy, just different schools of thought and different approaches.

I've seen a lot of individuals, a lot of patients that have really benefited from chiropractic care. I'll typically advise my patients, if they're coming in to see me for physical therapy, I'll usually recommend that while they're coming to see me for physical therapy that they not also do chiropractic, or at least not add that in if they haven't already been doing it, just so that they're not getting those two treatments at the same time, because that can sometimes muddy the water. If they suddenly become better or worse, and they're getting PT and chiropractic, you know, you may then wonder, OK, what made you better? What made you worse? It can just add another variable there.

But otherwise, like I say, a lot of people find great relief with chiropractic treatment. So it's definitely a proven treatment approach for primarily, especially, spinal issues.

Host Amber Smith: What about massage therapy? Are there health benefits for the spine for massage therapy?

Ryan Martin, DPT: Yes. I think massage therapy can be, again, another effective treatment. That's, of course, addressing more the musculature, the soft tissue. So if somebody is having maybe something going on that's more involved in the spine itself, deeper in the spine, whether it's a disk issue or stenosis, things along those lines, the soft tissue work or massage work probably isn't necessarily going to get at the root of that problem. But if it's more of just a muscular issue, of course that's going to help work out some muscle tension and pain there. And oftentimes, even if it is a situation of, again, a more of an issue within the spine, of stenosis, or a disk issue, often associated with that you may have increased muscle tone, increased muscle tension and guarding. So some soft tissue work, some massage, can be helpful for that too. So it can be a good adjunctive treatment for that as well.

Host Amber Smith: So what does a physical therapist do to help someone who struggles with back or neck pain?

Ryan Martin, DPT: Starting from the first visit, you would come in for the evaluation. We'll put you through some different tests and measures, to help figure out what's going on, essentially, right? What is the cause of the pain is one of the most important things to, before you can really help resolve the problem. You have to kind of help figure out what it is, right?

So putting you through a series of testing and movements to try to help determine what the cause of the problem is. Like we had discussed earlier, we're able to advise patients on the safe and effective progression of strengthening exercises, stabilization exercises, range of motion.

Another advantage, again, with physical therapy is assessing for that directional preference. Is there a certain direction or movement for the spine that's going to provide you relief? Oftentimes, probably one of the most common issues in the spine is a disk bulge or a disk protrusion -- goes by many names, right? -- a slipped disk, people call it by many names. But oftentimes in those situations, there's a particular direction that you can move the spine to help relocate that disk bulge back into place, where it belongs. So, again, we're able to help guide patients through that and hopefully identify a direction of movement that's going to provide relief.

Host Amber Smith: Do you see more men or women with back pain, or is it pretty equal?

I would say it's pretty equally distributed. What about in terms of age? Do you see young and old?

Ryan Martin, DPT: Yeah, absolutely. It's pretty common for spine issues to develop at any point in the lifetime.

Oftentimes, I think I see in the younger population, maybe it's more postural related, probably more often, versus as we age you may develop more arthritis, more wear and tear of the spine, maybe more of those diagnoses of, like, spinal stenosis. You can certainly see individuals with spine issues across the lifespan.

Host Amber Smith: You're listening to Upstate's "Health Link on Air," with your host, Amber Smith. I'm talking with Doctor of Physical Therapy Ryan Martin about maintaining a healthy spine.

It seems like a real common injury or complaint to have back pain, but does that mean that it's normal? I'm trying to get at what point, if you have back pain, should you seek medical attention, or will it get better on its own?

Ryan Martin, DPT: Yeah, like you said, it's a very common thing at some point throughout the lifetime to experience some sort of back pain or neck pain, and that's often the question, what's a normal ache or pain, and when should I seek treatment?

So I think some of the big things that, symptom wise, that would stand out, that would warrant seeking some medical attention would be, if you're experiencing, like, radiating or what we would call radicular pain. So, if there's nerve compression occurring in the spine, if that's occurring in the neck, you could experience symptoms traveling into the shoulder and down the arm. It could be pain. It could be numbness or tingling, more of those nerve-related symptoms. It could cause weakness of the arm.

And as far as the low back, all of those same symptoms would pertain to the leg, right? Commonly known as sciatica. Certainly if you're experiencing symptoms into your arm or your leg, again, of numbness, tingling, pain, that would be worth getting checked out, seeking some medical help.

If these symptoms of back or neck pain or arm or leg symptoms are occurring in the context of any other changes, such as like bladder or bowel function, that can be a red flag for some more serious issues that you would definitely want to get checked out, any difficulty controlling bladder or bowel or increased urgency, anything like that.

If you have any other kind of general health symptoms associated with the new onset of these symptoms, kind of overall malaise or fatigue or, again, other even seemingly unrelated symptoms that are kind of occurring around the same time that would, you know, warrant seeking some medical attention.

But as a whole, it's very common, again, to experience some localized back pain or neck pain here or there. If it's something that resolves quickly on its own, and it's not recurring often, then I don't think necessarily that's anything to worry about. Oftentimes in the clinic, by the time maybe somebody gets in to see me, they may get to me for that first visit, that evaluation, and say, "You know, a month ago I was having this severe pain, and you know, now I'm actually feeling a lot better. I really am not having too much pain or issue at this point, but can you teach me maybe some exercises, some things that I can do to kind of help break that cycle?" Because oftentimes these spine issues, they are recurring, and they'll show back up, over and over again.

So I think that's something, too. If it's an issue that tends to keep popping back up, and you continue to have issues with that, even if it tends to resolve on its own, usually as more and more episodes show up, things often get worse with each progressive episode. So sometimes it's a good idea, even if you're not in an acute episode, to say, "OK, let me go get some treatment. You know, let me learn what I can do to break this cycle and prevent this from continuing to recur."

Host Amber Smith: So for an acute episode where someone has some back pain that develops, before they get in to see a health care provider, do you recommend ice or heat?

Ryan Martin, DPT: You can really go either way. If it's something going on deeper within the spine, probably neither of those modalities are really going to be penetrating your muscles and all your soft tissue to really have a significant effect on the spine itself.

That being said, most people tend to do better with heat. It's going to have more of an effect of decreasing the muscle tone, usually providing some pain relief.

Ice, on the other hand, that also will usually kind of numb things out, if you will, and decrease the pain levels. It tends to have more of an anti-inflammatory effect. But again, it's different from an ankle sprain, where you can kind of put the ice right on the ankle, and it's really getting at that area. If the problem is deeper within the spine, again, that cold therapy is probably not really penetrating deep enough there to have much of an anti-inflammatory effect. So I usually advise my patients, whatever you find to be giving you better relief. Most people tend to respond better to heat.

Host Amber Smith: Well, Dr. Martin, thank you so much for making time to tell us about healthy spines. Thank you.

Ryan Martin, DPT: Absolutely. Thanks for having me on.

Host Amber Smith: My guest has been Doctor of Physical Therapy Ryan Martin from Upstate Medical University. I'm Amber Smith for Upstate's "HealthLink on Air."

They help prevent the spread of infections -- next on Upstate's "HealthLink on Air."

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

Today we're talking about some important members of the hospital health care team who may be overlooked: the men and women who work in environmental services. I have three guests from Upstate. Telisa Stewart is an associate professor of public health and preventive medicine, Nick Allis is a medical student, and Anita Rouse is a janitor.

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

Nick Allis: Hi. Thank you so much for having me.

Anita Rouse: Thank you for having me.

Telisa Stewart, DrPH: Hi. Thank you.

Host Amber Smith: Now, Mr. Allis, I know you had a paper published recently about "Perceptions of Clinical Connectedness Among Hospital Environmental Services Workers."

Why did you choose to look into this topic?

Nick Allis: So this topic was something that we chose to work on during my MPH year, last year here at Upstate. We felt that this was a topic that there isn't much research on trying to figure out perceptions and perspectives from the environmental services workers.

There isn't a lot of literature (published research) out there, and we feel like we needed to address that because of how crucial the environmental services workers are to the clinical care team, and we just wanted to help shed light on that topic.

Host Amber Smith: So MPH, that's for a master's (degree) in public health, right?

Nick Allis: Yes, that is correct.

Host Amber Smith: OK. So this topic really fits into that pretty well.

So, Dr. Stewart, can you explain how the study was done?

Telisa Stewart, DrPH: We used a really exciting process. We used a method called PhotoVoice. And PhotoVoice is a method where we give people cameras, or we ask them to use their cameras on their phone, and they take pictures of their lived experience.

So we asked the EVS (environmental services) workers, we had 10 EVS workers, and we asked them: Show me a picture about how you feel proud of being an EVS worker, show me a picture of how you feel connected to your clinical team, and then show me a picture of how you feel not connected to your clinical team.

And the group of EVS workers, met. We met regularly, and we talked about the pictures that they took. They wrote really beautiful vignettes of each of those pictures, of what it represented and how it made them feel. And they worked with students to make a vignette that's paired with the picture.

And through that process, we got to learn a lot. We got to learn about what their experiences are like on the floor every day, working with people and families and communities and working with the clinical teams. We got to learn about all the things that make them feel supported and make them feel proud. And we found some areas that we could improve on.

And then once we were done with that process, we hosted an event called a community event. And we brought all the leaders of the institution together, and their pictures were on display, and the leaders of the institution came, and they learned, and they listened, and they connected. And they came up with areas of celebration and lots of critical thinking of how to improve what's happening on the floors with EVS workers.

That was a really inspiring process for me because, I didn't know EVS, right? What I saw every day were people cleaning and doing various tasks, but Ididn't know what it was like to be an EVS worker. and I didn't know all the critical things that they do for patients, for families, for the clinical team.

And it kind of changed my entire view of EVS workers.

Host Amber Smith: So why did you choose photos?

Telisa Stewart, DrPH: So photos, as you imagine, speak a thousand words, right? And so you could ask somebody, what is it like to be an EVS worker? And they could tell you, and you could write a sentence down, but to see a picture and to reflect on a picture and to experience that picture through the eyes of somebody else, that's a powerful tool. And I don't feel like it fades away quite like words, right? You have this image that's left over that people can continue to reflect on. And it helps us stay current in what's happening on the floor in real time, real place.

Host Amber Smith: Can you describe for me some of the images that told about pride or connectedness? What were some of the pictures of?

Telisa Stewart, DrPH:

The participants took pictures of various things at the institution. They may have taken pictures of a particular sign, like the Upstate sign, and described how long they had been working at Upstate and how many years they had been engaging, even personally or professionally, at the institution. We had pictures of the amount of work that people did with images upon images of clean and shiny floors and no dust, and making sure that the areas that patients were in were pristine and clean and really a place where you'd want your family member to be.  (For photos: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829076; see supplement)

Or feeling as a part of a team. We had pictures of people's shoes and the sea of people that worked together, and some of it was very symbolic, the images, and other ones were just kind of your factual place at Upstate.

Host Amber Smith: This is Upstate's "Health Link on Air," with your host, Amber Smith. I'm talking with three people from Upstate. Doctor of Public Health Telisa Stewart, medical student Nick Allis and janitor Anita Rouse.

Ms. Rouse, can you tell us what your responsibilities are working in environmental services?

Anita Rouse: I start my day off every day about 5 o'clock. And I come in early, just so I could get the schedule ready just in case we have call-ins. I could try to replace where people call in at. And the people come in about 6 o'clock. The other employees come in about 6 o'clock. And I just make sure that everybody's in the right place and do our work.

And then I go ahead and start my day by cleaning my area or help out where there's need.

Host Amber Smith: So the nurses, if they have a task that comes up that they didn't anticipate, they can reach you and ask you to come back and help out with something?

Anita Rouse: Correct.

Host Amber Smith: What do you like most about your job?

Anita Rouse: The thing I like about my job is really just being me, just helping everyone here. I love my job. I love what I do because I love helping people. I just love it. I just love my job.

Host Amber Smith: Do you get to interact with patients very much?

Anita Rouse: Sometimes I do. Well, on the weekends I do, because I'm working more in patient care on the weekend. During the weekday, I do clinics. I have one clinic that I do, but I really don't see patients as much down there because I clean before they get there.

Host Amber Smith: Would you say that you do feel like you're part of a team when you're working?

Anita Rouse: Oh, definitely, definitely. I feel if I can't do my job, the nurses or the doctors can't do their job. So I feel that we are here for the same thing. Take care of the patient.

Host Amber Smith: Mr. Allis, in your abstract you describe how environmental services workers have a critical role in the hospital infrastructure.

Can you tell us more about that?

Nick Allis: Yeah, of course. Like Anita was saying, that this is definitely a team effort when it comes to the clinical team, and they're for sure on it because it has been shownthroughout the (research) literature that without environmental services workers -- that's what the term EVS means -- in general, patients are at an eight times greater risk of getting a hospital-acquired infection.

So without EVS it's very difficult for patients to stay healthy, other workers, employees at the hospital to stay healthy. Anybody that comes within the hospital infrastructure in general. So that also includes, obviously, family members. And everybody has a role in the team, and in my personal opinion, EVS's role is just as important as any other role in the team because, again, without them, this wouldn't be possible.

Host Amber Smith: So it sounds like they're key for infection prevention.

Nick Allis: Certainly. I would definitely say that they are at the front line of infection prevention because without them, that wouldn't exist.

Host Amber Smith: What do they contribute to infection prevention? What do they do?

Nick Allis: The EVS workers, when it comes to infection prevention, they are managing all forms of waste. Whether that's biohazardous waste, normal trash recycling, all aspects of waste, they are the ones who are at the front of that. So without them, that puts at risk patient safety, family safety, employee safety, and they're the most critical part of the team when it comes to infection prevention for those reasons.

Host Amber Smith: Mr. Allis, what year of medical school are you in?

Nick Allis: I am a current first-year medical student here at Upstate.

Host Amber Smith: And you were able to be involved in research like this in your first year?

Nick Allis: Yes. So this started last year, during my Master's in Public Health program here at Upstate. And what initially started as what seemed at first of just being another project, like another assignment for school, it turned into so much more. Because throughout my entire high school career, undergraduate career at Le Moyne College, my first master's degree at Rutgers University, and then here now at Upstate for the Master's in Public Health, and now, my first year of medical school, this is by far the most meaningful and important project that I've ever been a part of because it's something tangible. It's something real. It's something that clearly needed to be done and for the world to see something of this magnitude because it just needed to have light shed on EVS workers and how crucial they are to the clinical care team. And I know that I'm able to speak for my cohort that was a part of this project that everyone will definitely agree with me when I say all that.

Host Amber Smith: I imagine it was pretty eye-opening. Because if you don't think about what environmental services workers do, and you don't really know the depth of what their responsibilities are, to learn that is probably pretty eye-opening.

Nick Allis: Most definitely, and that's also why I think it is so meaningful, because prior to this and being a part of this project, we, as students, definitely didn't realize how crucial they are to the team and how big of a role that they play. And after going through the process, being a part of the PhotoVoice, the photos, the vignettes, the community event, everyone was able to see truly how important they are.

And open everyone's eyes to that. And I think that is why this was such a big deal for all of us.

Host Amber Smith: Well, Ms. Rouse, what do you think can be done to raise the profile of environmental services jobs and attract more people to these positions?

Because it sounds like you have a job that you really enjoy and you get a lot out of, and you're a key member of a health care team. How can we let other people know about that?

Anita Rouse: To have the PhotoVoice class more often than what we did. To have this program every year, so others can experience and tell their story of how they feel about environmental services.

Host Amber Smith: Do you think some of your coworkers maybe don't think about these things until they're asked: What makes you feel like part of the team and what are you proud of?

Anita Rouse: I'm proud of being here where I can sanitize and help it stay clean for our patients.

Host Amber Smith: Well, all of you. I appreciate you making time for this interview. Thank you for telling us about your research.

Nick Allis: Thank you so much for having us.

Anita Rouse: Thank you.

Telisa Stewart, DrPH: Thank you.

Host Amber Smith: My guests have been Doctor of Public Health Telisa Stewart, medical student Nick Allis and janitor Anita Rouse. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from geriatrics chief Dr. Sharon Brangman from Upstate Medical University's Center of Excellence for Alzheimer's disease. Do memory problems signal dementia?

Sharon Brangman, MD: Memory problems, we have learned, are one of the biggest concerns that people have as they get older. And they automatically think if they have a memory problem, that they have dementia or Alzheimer's disease. And so that often makes people so afraid it paralyzes them, and they don't do anything about it, or they make up excuses.

But what we want people to know is that not every memory problem is dementia or Alzheimer's disease. It could be related to a number of things that it would be good to get it evaluated so that we can address them. And then if it turns out to be something like a dementia, it's better to catch it as early as possible because the current treatments are most effective in the early stages. And then we also find that families and caregivers benefit from education and support services, and the patient can actually participate in making decisions for themselves and other things because then down the line, we don't want people to be in a crisis when their options are limited.

There are a lot of things that can happen as we get older that can have a negative impact on our memory, but it doesn't mean that you have dementia. So what we try to do is optimize someone's health and tell them what they can do to reduce their risk, if we find that they don't actually have a real memory problem.

Now, there are certain memory changes that happen as we get older that are completely normal, and that's when people get nervous. So, for example, it takes us maybe a little bit longer to remember someone's name. You meet someone at a party, or if you're out in the grocery store and you see someone coming, and you suddenly can't remember their name. You can remember other things about them and where you knew them from, but you just can't remember their name. And then, about a half an hour later or something, maybe you're driving home and you remember their name. That's called slow retrieval. That's actually normal as we get older.

So I like to tell my patients, it's like your brain is a big computer full of information. And as you get older, it has more and more pieces of information. It can take a little bit longer to dig through those files in your brain and pull out that name. So that doesn't necessarily mean you have dementia. That's called slow retrieval. That's OK. Or you might forget where you put your glasses, your cellphone, your keys, and you're looking all over for them. Generally, as we get older, we are thinking of too many things at the same time. So when you put your cellphone down, you don't remember where you put it. But if you sit and think for a minute, you can retrace your steps and find it.

So what we're doing generally, most of us, is that we're on overload. We get so much information. We have breaking news, we have big newspapers to read on the weekend. I probably have too much information about the Kardashians in my brain. So we get all these idle, useless pieces of information, and they take up room. So that is not necessarily dementia. That means we're not focusing on the task at hand. We're thinking of too many things at once. So that's some of the things that we talk about with patients and families and reassure them what's normal and what may not be normal.

Host Amber Smith: These are the things we all worry about. These are the everyday concerns, and it's not necessarily dementia.

You've been listening to Dr. Sharon Brangman from Upstate Medical University's Center of Excellence for Alzheimer's Disease.

Host Amber Smith: 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: Shiwei Zhou is an infectious diseases physician from Michigan. Her poem, "Sort by Date of Death," reveals that a caring physician can't stop questioning if there was something else she could have done for her patient.

"Sort by Date of Death"

There is a place in the medical record, a tab

labeled Date of death. Click and you'll find

autopsy results; final discharge summary

or last documented phone call.

Why do this? Simple curiosity; professional

reflection and practice. Doesn't everyone?

Certainly nothing to do with the ceaseless interlocutor

asking of each name with an end date if

they died because of something you missed

that should not have been missed

or because of something you did

that should not have been done

or maybe because there was one more question

you should have asked -- the right question --

a question someone else would have asked

someone not you. Someone better.

Sometimes it is clear: a massive stroke. Or aspiration event,

PEA arrest, 45 minutes of CPR, anoxic brain injury.

Sometimes it is not: the autopsy is declined,

the last call is about a refill or a new mole.

It doesn't matter which names

on this list find you blameless,

because there will always be the other names, to which these

are added (clear water cannot clear an ink-stained glass):

the wife to whom you said, go home tonight, he'll be fine,

Deirdre Neilen, PhD: the young woman dead before her second anniversary.

Those are numbered in a different list, maintained

on a different server, the one in your head.

Stories are judged on how they end. Perhaps physicians are

judged on how their patients end.

Yes, there is a place you can go in the medical record

seeking revelation -- or is it absolution?

Though by now it can only be hoped

that you have come to realize

you will find neither.

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

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 and graphic design by Dan Cameron.

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