Kidney disease in children; water-based therapy; forgetful or demented? -- Upstate Medical University's healthLink on Air for Sunday, May 18, 2025

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a pediatric nephrologist explains how kidney disease impacts children.

Scott Schurman, MD: ... Particularly in children, we stress to the kids and their families that dialysis is a bridge to a transplant. And sometimes we're able to go directly to transplant without the kids needing dialysis. ...

Host Amber Smith: And a pair of physical therapists talk about the benefits of water-based therapy.

Morgan Phillips, DPT: ... Aquatic therapy is meant to help improve mobility. Our pool is a therapeutic pool, so it's kept between 86 to 90 degrees, so usually the warmth of the water helps people move a little bit better and improve range of motion. ...

Host Amber Smith: All that, a look at whether memory problems signal dementia, and a visit from The Healing Muse. But first, the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, we'll learn about aquatic physical therapy. Then, an answer to whether memory problems signal dementia. But first, how kidney disease affects children, including how it's diagnosed and treated.

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

Today I'm talking about kidney disease in children, including dialysis and transplant options, with Dr. Scott Schurman. He's an associate professor of pediatrics and the director of nephrology at Upstate. Welcome back to "HealthLink on Air," Dr. Schurman.

Scott Schurman, MD: Thanks for having me.

Host Amber Smith: Let's start by going over the most common causes of kidney disease in children. How frequently are babies born with a kidney malformation or related birth defect?

Scott Schurman, MD: Approximately 1% of children have some type of structural abnormality of their kidneys, but almost all the times it is minor, very mild and doesn't affect their long-term kidney function.

More severe structural abnormalities in which the kidneys do not form properly, so that the number of filters that we generally have at birth are markedly reduced and may lead to future kidney failure, that occurs much less frequently, maybe one or two in a thousand babies.

Host Amber Smith: Now these birth effects, is there a genetic cause for them?

Scott Schurman, MD: Sometimes there is. Sometimes there is an inherited abnormality in which one of the parents will have a problem or a predisposition to a problem, and it'll be inherited by their children. Most of the time, there's not such a direct link. There's a genetic predisposition sometimes, but sometimes there's not even that.

Host Amber Smith: Is it common to see infections that lead to kidney disease in children?

Scott Schurman, MD: Urinary infections in infants and particularly young children are common, much more common in girls than in boys. They sometimes can lead to very high fevers, sometimes even requiring hospitalization.

It's rare, though, that urinary infections lead to severe kidney scarring that could eventually lead to things like kidney failure, reduced kidney function. Most of the time the infections can be treated effectively without that.

Host Amber Smith: Now in children, do you see diseases like diabetes or high blood pressure causing kidney disease like they might in adults?

Scott Schurman, MD: It's definitely different than in adults. Over half of the adults on dialysis have diabetes. Most of them have Type 2 diabetes. Most children, not all, but most children with diabetes have Type 1 diabetes, in which their bodies aren't making insulin properly. It's rare for that to cause severe kidney disease in childhood. When they become adults, it certainly can, but it's rare for them to need something like kidney dialysis or a kidney transplant in childhood.

Hypertension is more and more common in children, as we've seen children become heavier and heavier, like our population in general. Hypertension leading to reduced kidney function, while fairly common in adults, is fortunately uncommon in children. Most of our children with reduced kidney function were either born with abnormal kidneys, kidneys that were born with a reduced number of filters from typical, or they developed some other type of kidney problem before age 10 or when they were teenagers.

Host Amber Smith: Do you ever see kidney damage from injuries in children?

Scott Schurman, MD: That's super rare, fortunately. The risk of significant traumatic injury is less than one in a quarter million. So in the many years I've been practicing, I've seen renal injuries with various athletic activities, but they are extremely, extremely rare.

Host Amber Smith: Now, what are the signs and symptoms of kidney disease in children? How would you, or how would a parent, know that the child had something wrong with their kidneys?

Scott Schurman, MD: The majority of children born with abnormal kidneys have that discovered on ultrasounds done before birth. So, most mothers have an anatomic screening ultrasound done around 20 weeks' gestation. And those ultrasounds can pick up the majority, not all, but the majority of severe structural kidney abnormalities. We then are alerted to that and see the children shortly after birth and then follow them. Some of them ultimately require some type of surgical intervention that may reduce their problems early on, but they might have problems then, later in life.

Children, though, that are born with normal kidneys, structurally normal kidneys, and then later develop kidney disease, the signs and symptoms relate largely to some abnormality in how the filters of the kidney function. Each kidney on average has around a million filters, and those filter the fluids and waste products that make up your urine and keep the things you need, like blood cells and proteins. And if those filters are leaking blood cells and proteins, that can lead to symptoms. So in certain cases, they'll be leaking enough blood that you'll see that the urine is red or brown, and that generally leads to some presentation (observable sign).

Sometimes the kidneys will leak a large amount of protein that ultimately will lead to some fluid accumulation and edema, in a condition called nephrotic syndrome. And that leads to some presentation.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with pediatric nephrologist Dr. Scott Schurman about kidney disease in children.

So a lot of your patients have the diagnosis before they're even born so that you know to start caring for them after birth. But some of them develop symptoms later in childhood.

Scott Schurman, MD: That's right. We see many infants. Now, the majority of infants we see with some structural abnormality have some minor abnormality. We follow it for a period of several months to a few years, make sure that it's mild and almost always getting better and there's no long-term consequences to those children.

Others have more significant, structural abnormalities. They'll be born with much fewer than that 1 million filters per kidney, and eventually those filters wear down. Everyone, their filters in their kidneys wear down as they get older, and if you're born with fewer, they wear down faster. And so we can monitor those children. We have various interventions to help keep them healthy, to make sure they're growing properly, that their bones are developing normally, that they don't develop anemia and the significant symptoms that in the old days would occur when the problem was silent and the children would present very ill, later in childhood or as early adults.

Host Amber Smith: Now, when we talk about kidney disease, are both kidneys affected?

Scott Schurman, MD: For sure. If you have reduced kidney function, we talk to our patients about their kidney function number. It's called the estimated GFR. That's glomerular, which are the filters. Filtration. And R is rate. And a normal GFR number is greater than 90. Someone needs something like kidney dialysis or a transplant roughly when they're less than 10 to 15.

We talk to them as they get older, what their kidney function number is and what they can do and what we can do to try to slow the loss of kidney function over time.

Host Amber Smith: Well, let's talk about what's done for treatment of kidney disease. Are there medications that help?

Scott Schurman, MD: Yeah. So, you are born with the number of filters that you will have through the rest of your life, so we don't yet have the ability to make new filters. That may be something that is in the distant future, but it's not something that's anytime near reality. So if you're born with reduced number of filters, we don't have a treatment that can change that, but we can do things to slow the loss of kidney function over time. In particular, we are very aggressive, making sure the blood pressure is normal, because high blood pressure can lead to faster deterioration in kidney function.

We monitor things like urine protein and can intervene as a higher urine protein is a sign that the filters of the kidney are wearing down faster. We're very aggressive with nutrition to make sure the children are growing properly, but not getting significantly overweight, as that can put significant stress on the kidneys.

We have abilities to prevent anemia, which can occur as the kidneys deteriorate significantly. We have treatments to help prevent bone disease, which can occur as the kidneys deteriorate significantly. We have growth hormone therapy to make sure the kids grow properly, so that when I started doing this work 30 years ago the children invariably were very, very short. And now they invariably achieve a typical normal height.

So we do have things that we can do to not cure the condition in that circumstance, but keep the kids healthy, until time that they may need something like dialysis or then kidney transplant.

Someone who it develops some type of kidney disease as they get older, depending on the condition, there are often treatments that can hopefully reverse the condition.

Host Amber Smith: It sounds like there's a lot to monitor in these children.

Scott Schurman, MD: Yes. So the kidneys and what they do touch pretty much every other organ. They're important in child development and proper neurologic functioning. They affect blood pressure, so they're very important in cardiovascular health. They affect various endocrine functions and the proper development of your bones and growth. And so we monitor all those things in the context of their kidney disease.

Host Amber Smith: How do you tell when kidney disease progresses to kidney failure?

Scott Schurman, MD: So we, again, monitor blood work and can then use that to calculate, estimate this GFR number that gives us a good approximation of where they are in the process and what kind of complications we can expect through that time. It also allows us to provide a dialogue with the kids and their families of where they are in the process, how fast or not fast it's progressing, so that they can be prepared for the steps through this process.

Host Amber Smith: Does kidney failure mean dialysis is next?

Scott Schurman, MD: If the kidney failure advances to a point in which it is affecting your ability to process waste products properly, affecting your ability to take proper nutrition, to have the kind of energy you need for daily functions like going to school or later going to work, then the next steps are what's called kidney or renal replacement therapy. And those are dialysis and then ultimately kidney transplantation.

Host Amber Smith: Well, let me ask you to walk us through how dialysis works.

Scott Schurman, MD: Sure. So in particularly in children, we stress to the kids and their families that dialysis is a bridge to a transplant. And sometimes we're able to go directly to transplant without the kids needing dialysis. But sometimes the circumstances are not right for that, and they will need a bridge of dialysis.

There are two modalities, we call them, types of dialysis. Many people in general are familiar with what's called hemodialysis in which blood is taken out of the body and it is pumped through an artificial filter, in essence, an artificial kidney that removes waste products and excess fluids and returns the cleaned blood to the patient. That requires usually a large IV to take the blood out and return it. The children are hooked up to a machine usually three days a week, four or so hours per treatment. It can take a lot of out of them, and it's definitely burdensome for them and their families in terms of normal functioning, normal school and that sort of thing.

We're fortunate here at Upstate to have our own pediatric hemodialysis center, so that we can focus on kids. We have a team of really expert nurses and support staff to be able to do that, and get them ready toward transplantation.

About a quarter to a third of our patients on dialysis get hemodialysis. The remainder get what's called peritoneal dialysis. This is a treatment that we train families to be able to do at home and allows really a more normal life for the kids and their families, including school and other activities. A catheter IV, in essence, is placed in the sack that surrounds the bowels. That sac has thousands of tiny little blood vessels, and there are small machines, about 20 pounds, that we perform the dialysis overnight while the kids sleep. A sterile fluid is pumped into this sack. It draws waste products out of these tiny little blood vessels, and then that is drained out. And that happens continually, overnight again, and then they're unhooked and can go about their day.

And then we see those patients in our office once or twice a month after they've been trained and stable.

Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break. But please stay tuned for more about pediatric kidney disease.

Welcome back to Upstate's "HealthLink on Air." I'm your host Amber Smith, talking with pediatric nephrologist Dr. Scott Schurman about kidney disease in children.

How long can dialysis be effective in kids?

Scott Schurman, MD: Well, it can be done and effective for years for sure, but it's rare for us to have a patient that's on dialysis for years and years because, again, it is largely a bridge to a transplant.

Kidneys are much better than dialysis at getting rid of waste products and providing what is necessary for normal function. So kids who get transplants do generally better in school. They are more likely to be employed later in life. They live longer, in general, than persons on longer periods of time on dialysis.

Now there are circumstances in which dialysis is necessary, and sometimes there are circumstances in which transplant is not feasible, at least for a period of time. And so dialysis is definitely a workable bridge. But our goal for all of our patients is to get a good functioning transplant.

Host Amber Smith: So they join the transplant waiting list when they go on dialysis, is that right?

Scott Schurman, MD: That's generally correct. Some of our patients are fortunate enough to have a family member or a close personal friend of the family that is willing, able -- able meaning healthy enough and compatible to be a living kidney donor. We work hard to try and identify potential living donors, as living donor kidneys generally work immediately and give a best chance of long kidney function to our kids. Sometimes, though, there is not a family member or close family friend that is able to donate. And so yes, our kids go on what's called the deceased donor transplant list.

You know, this is donors that have died under unfortunate circumstances, such that their kidneys and usually other organs are still functioning well, and their families have agreed to donate their organs.

Children under 18 do have some advantages on the list, in terms of being able to get a good functioning kidney sooner than adults. That was done intentionally just probably three or four years ago, in recognition that younger persons are going to need a good kidney for a longer period of time, and that prolonged periods of time on dialysis for children can have more effects on their development, schooling and future functioning. And so they are provided those advantages on the list.

Host Amber Smith: So are children able to accept a kidney from an adult?

Scott Schurman, MD: The adult donors are actually preferred. So even in children who are say, 18 months to two years and need a kidney, children usually have to be around 20 pounds. That's usually the minimum size in which kidney transplantation is technically feasible. Sometimes a little lower than that, but right about that threshold. And even at that age, we prefer kidneys from adults. Now at that size, we'll usually do a smaller adult.

And that is because if you transplant kidneys from children into children the blood vessels of each are very small, and that can technically be very challenging and lead to certain complications. So generally we prefer adults. Not always. There are certain circumstances in which we'll use younger donors, depending, but generally adults.

Host Amber Smith: You're listening to Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with pediatric nephrologist Dr. Scott Schurman about kidney disease in children.

Now, is the transplant expected to last a lifetime in a child?

Scott Schurman, MD: No, they definitely don't generally last a lifetime. There's been significant improvements in the transplant functioning and the length of time in which they work.

When I started this work, again, over 30 years ago, the one-year survival for a deceased donor kidney transplant in a child under age 5 was 68%. So 32% did not work even one year after transplant. Now that is 99%, OK?

Host Amber Smith: Wow.

Scott Schurman, MD: So there's been tremendous improvement in surgical techniques, medications to prevent rejection. And so now the average length for a kidney is probably 15 to 17 years in children. So not forever.

We tell our kids that we are going to do everything we can to make this kidney last as long as it can. And then someday they're probably going to need a second one.

There's been some very exciting developments that have been in the news over the last year in terms of what's called xenotransplantation, using kidneys from genetically engineered pigs and using those eventually in humans. And there's some clinical trials now beginning for that, and I'm very optimistic that in the next five, 10, 15 years that this will become fairly routine. And that's very exciting for our patients because our patients are going to need more than one transplant. And it really provides a lot of optimism for our kids and our families.

Host Amber Smith: Well, let me ask you what life is like for a child after a successful transplant. There's no more dialysis, right?

Scott Schurman, MD: That's correct.

Host Amber Smith: Do they still have, quote unquote, kidney disease?

Scott Schurman, MD: About three quarters of kids after transplant have high blood pressure, so we're still treating that.

All of them have to be on medications to prevent rejection.

I tell our kids, "Look, you're going to have to take a handful of pills in the morning, a handful of pills at night. You're going to have to come see me and get blood work periodically. And then otherwise I want the rest of your life to be your life and for you to be able to do what you want to do." And that's pretty much the case.

Now there can be circumstances in which they get certain types of infections, and we monitor for that. And the kidneys generally slowly wear down over time. But for the most part, their lives can be pretty normal.

Host Amber Smith: So they can do activities, there's no restrictions on activity, or diet? Are they able to eat a regular diet?

Scott Schurman, MD: Yeah, pretty much a regular diet. It is important they stay a healthy weight. Being particularly overweight puts a lot of stress on the kidneys. But there's been two men that have played basketball in the NBA after a kidney transplant. So after a successful transplant, I think you can pretty much do almost any activity.

Host Amber Smith: How long do pediatric nephrologists continue caring for a child who received a kidney transplant?

Scott Schurman, MD: Generally we see them until around age 21 or so. I do have some young people I see beyond that, depending on the circumstance. And we've got amazing families, and so it's very bittersweet for them to move on, because they are an amazing part of our lives as well. But that's generally about when we try and transition to the adult teams.

Host Amber Smith: Well, Dr. Schurman, I appreciate you making time for this interview. Thank you.

Scott Schurman, MD: Oh, it's my pleasure. Thank you.

Host Amber Smith: My guest has been Dr. Scott Schurman. He's an associate professor of pediatrics at Upstate and the director of nephrology. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air," the benefits of aquatic physical therapy.

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

When physical therapy takes place in a pool or other body of water, it's called aquatic physical therapy. Today we'll hear about the benefits of aquatic physical therapy from my two guests, Ryan Martin and Morgan Phillips.

Both are physical therapists at Upstate.

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

Morgan Phillips, DPT: Thank you, Amber.

Ryan Martin, DPT: Thanks for having us.

Host Amber Smith: Let's talk about how aquatic therapy helps. Is it meant to improve mobility?

Morgan Phillips, DPT: Yeah, aquatic therapy is meant to help improve mobility. Our pool is a therapeutic pool, so it's kept between 86 to 90 degrees, so usually the warmth of the water helps people move a little bit better and improve range of motion. There's a lot of properties of water that also helps these patients get around easier and help them ambulate (walk or move) and function.

Host Amber Smith: So someone who's struggling to move on land has a better time in the water?

Morgan Phillips, DPT: Yeah. A lot of the patients we see are patients who might struggle exercising on land. They tolerate water therapy better because we have these properties of water such as buoyancy, which actually helps reduce weight bearing. So that's an upward force.

So for example, if you are in the water up to your belly button, you're about 50% unweighted. So depending on how deep the water is or how deep people are exercising in the water, they could be more and more unweighted. If you go all the way up to your neck, you're about 90% unweighted in the water, and it's definitely easier for people to move who have issues exercising or walking due to pain.

Host Amber Smith: What is hydrostatic pressure, and how does that help?

Morgan Phillips, DPT: Hydrostatic pressure is another property of water. Basically, it's the force that's put on patients while they're in the water. The deeper you are, the more that pressure will push on your body and help to promote blood flow. If the hydrostatic pressure is higher than diastolic pressure, that can help move fluid out of joints, too, so that can help with swelling, which can also help improve range of motion.

Host Amber Smith: Now, you mentioned the water temperature. Does that make a difference for people doing aquatic therapy?

Morgan Phillips, DPT: Yeah. Water temperature, I think, plays a big part in that because increased temperature helps increase patients' ability to move. That will increase the muscle temperature, reduces stiffness and helps with range of motion and mobility in general.

It also helps to relax muscles, so patients that are really tight usually feel a little bit looser in the water.

Host Amber Smith: What is viscosity, and what does that provide?

Morgan Phillips, DPT: Viscosity is basically the resistance that the flow of the water provides, so when a patient is moving faster through the water, that actually makes it more difficult to move through the water.

Also, if we increase surface areas, so we have special equipment that we use in the pool with these patients. The bigger the object or the bigger the surface area, the more resistance they will feel. So that's how we can kind of modify exercises, make them a little tougher. We can make things a little bit easier by controlling the surface area or how fast a patient is moving in the water.

Host Amber Smith: Well, let me ask Dr. Martin: Who can be helped by aquatic physical therapy?

Ryan Martin, DPT: There's a lot of diagnoses or patient populations that can benefit from aquatic therapy, and we can discuss some of the more common ones that we see in the pool, but we do see patients for both orthopedic and neurologic conditions in the pool here at Upstate.

Like Morgan said, we tend to try to utilize land therapy first, as that's the environment that we live in, and we would prefer to exercise and strengthen patients in that environment. However, if patients are having a difficult time tolerating land therapy due to high pain levels or decreased mobility, then that's where the aquatic therapy can come in and be really helpful.

We still tend to try to use the pool as a temporary measure and work our way back and progress back to land therapy, as tolerated. Sometimes patients will do a split treatment, alternating between land and pool visits. So we make those choices on kind of a case-to-case basis, and we reevaluate that throughout their course of care to see, again, when we can try to transition them back onto land, as able.

Host Amber Smith: Now, is this limited to adults, or do you have children that could potentially use the aquatic PT?

Ryan Martin, DPT: All would be candidates for the pool, however, we definitely primarily tend to see more adults in the pool, just based on the nature of the diagnoses that we typically get aquatic referrals for. Again, we can go through some of those, but a lot of the common ones, osteoarthritis or fibromyalgia, we tend to see more adults, but it definitely would be appropriate for children as well.

Host Amber Smith: Let's take one of the orthopedic issues, osteoarthritis. What can aquatic PT do for someone who has osteoarthritis, say, in their hips and knees?

Ryan Martin, DPT: Yeah, they're a great candidate for the aquatic therapy.

They're probably some of the most common patients that we see in the pool. As a result of the buoyancy, which Morgan explained earlier, it's essentially like being in a gravity-reduced environment. So that means there's less weight, there's less compression on your joints, so therefore those patients can typically tolerate more movement, more exercise.

They can get a better workout, more muscle strengthening, with less of the joint pain. And that buoyancy of the water can also assist with helping to move those stiff joints or assist with movement of weak muscles, so another benefit for those individuals with arthritis of the knees or the hips.

Host Amber Smith: Now, you mentioned fibromyalgia. That's someone with widespread musculoskeletal pain and maybe fatigue. Is aquatic therapy appropriate for that person?

Ryan Martin, DPT: Yeah, that's another one of the most common diagnoses we see in the pool. They'll have all those same benefits, again, of the buoyancy, like we've talked about, but again, that little bit of a warmer temperature to the water may actually help them, especially to kind of promote relaxation and a decrease of that muscle tone or muscle tension, so that can help alleviate some pain. That would probably be another benefit, especially for those patients with fibromyalgia.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Upstate physical therapists Ryan Martin and Morgan Phillips about aquatic physical therapy.

Now, you mentioned neurological conditions. What sorts of things might you see?

Ryan Martin, DPT: Perhaps stroke would probably be a common one that comes to mind. Morgan and I are both part of the orthopedic PT team here, so we don't handle those patients ourselves, but we do have our specialized neurotherapists who work with more of those patient populations that have the neurologic diagnoses. So stroke would probably be one of the big ones that would come to mind, maybe multiple sclerosis.

Morgan Phillips, DPT: Yeah. And I know some of our neurotherapists have been seeing patients who have had spinal cord injuries in the pool. We have a lot of equipment, which we'll go over too, that helps with mobility. And even if these patients aren't able to walk independently, these therapists do have tools where they are able to participate in aquatic therapy.

Host Amber Smith: Are there any precautions to aquatic therapy? I'm wondering about people who aren't great swimmers.

Morgan Phillips, DPT: For patients who aren't great swimmers, that is definitely a precaution for therapy, but that doesn't mean that they can't participate. For the most part, we keep the pool at around 5 feet, so people really aren't swimming, they're moreso just moving and exercising in the water, so they definitely still can participate in therapy.

Going back to precautions or contraindications:

If people have any DVTs, (they're) not permitted to be in the water.

Any (patients with) severe cardiovascular, cardiopulmonary compromise shouldn't be in the water.

HIV -- chemicals in the pool may exacerbate symptoms.

Some other precautions that we would have to look at, for these patients: Epilepsy is a precaution for getting in the water, certain kidney disorders, any UTIs (urinary tract infections) or bladder incontinence are all big things that we look at. And we screen these patients at a land appointment before we send them to the pool to make sure that they are appropriate, and they don't have any of these precautions to getting in the water or to make sure they're safe when doing so.

Host Amber Smith: And you said "DVT," what is that?

Morgan Phillips, DPT: Yes, that's a blood clot. A deep venous thrombosis.

Host Amber Smith: Gotcha. Well, what can you tell us about the Upstate pool?

Morgan Phillips, DPT: Our pool is unique in the fact that it raises both up and down. Like I said, we typically keep it around 5 feet, but we can modify that, depending on the patients we have in the water. But the pool is the same depth the entire way around. And, like I said, we can modify that to kind of play around with that buoyancy and the hydrostatic pressure a little bit.

Also, we do have a ramp for patients to enter and exit the pool. So if stairs are an issue, they can use the ramp with a railing. And then we do have your typical stairs that you can use.

Host Amber Smith: So you raise and lower it. The floor of the pool moves?

Morgan Phillips, DPT: Correct.

Host Amber Smith: OK. Does the physical therapist get in the water with the patient?

Morgan Phillips, DPT: We can get in the water with the patient, if that's something that they would benefit from. Like Ryan was saying earlier, him and I mostly treat patients with orthopedic conditions, and for the most part, we are on the pool deck, in a group session.

So we might have a couple patients at once, but they're going through their own exercises, and we're giving them the instruction from outside the pool. But if a patient is not safe, or they might need more hands-on help, we definitely can put them in a one-on-one session and enter the pool with them.

Host Amber Smith: So you do individual and group?

Morgan Phillips, DPT: Correct.

Host Amber Smith: OK. How do you know that aquatic therapy is helping an individual?

Morgan Phillips, DPT: We make sure that at least every 10 visits, we see the patient again on land, just for a typical PT session. And like I was saying earlier, the first day, we screen them for contraindications, make sure that they're appropriate to enter the pool, they do their pool sessions and then we'll see them back there to remeasure some stuff. So we might look at range of motion, strength, walking, balance and then having a conversation with the patient. And we want to know, subjectively and objectively, are they getting better with aquatic therapy?

Like Ryan was saying earlier, our ultimate goal is to get them out of the pool and functioning on land, because that's where they typically have to function, so that's kind of how we measure progress and make sure that they are getting better.

Host Amber Smith: Is aquatic therapy covered by insurance, like regular PT?

Ryan Martin, DPT: So aquatic therapy can be covered by insurance, just like typical land-based physical therapy. You would still need a referral for regular physical therapy, but to do aquatic PT, you have to have a referral from a physician specifically requesting aquatic therapy, is the only difference there. So yeah, typically it is covered by insurance, so yes, absolutely.

Host Amber Smith: Do most of your patients when they complete the aquatic PT, do they stay with you doing land-based PT for some time, or do they ever just graduate back to home?

Ryan Martin, DPT: Again, often the goal is to get these patients in the pool initially, maybe again when they're not tolerating land therapy so well, and try to improve their strength and their mobility and then transition them back to land as needed.

With any sort of physical therapy, whether it's land-based or aquatic-based, it's not a perpetual thing, right? It's only ever a temporary measure, coming to physical therapy. So we're always trying to educate patients on what they can do at home, establish them with a home exercise program to kind of prepare them for discharge and to set them up to be able to continue to manage independently outside of here.

So if patients are discharging from aquatic therapy, we'll often just kind of point them in the direction if they want to continue with doing some aquatic exercise. We'll give them options of local community pools that they can take advantage of, whether that's free public pools, through like the City of Syracuse Parks and Rec Department, or YMCAs, getting a paid membership or doing group classes sort of thing. So yeah, some patients may transition to land therapy prior to discharging. Others may continue on with aquatic exercise or aquatic group classes on their own once we've discharged them from the pool here at Upstate.

Host Amber Smith: What about lakes in the area? Do you ever have patients who are planning to go to a lake?

Ryan Martin, DPT: Yeah, anything that we teach them and that they learn, as far as exercises and activities that they're doing with us in the pool, that can be carried over.

It can be done if they have a pool at home or if they have a neighbor or a friend with a pool, or if, like you say, they have a lake, any other body of water they can swim in. Definitely, again, we want to educate them, give them the tools to where they're able to continue working on that stuff on their own independently.

For a lot of exercises in the pool, you don't need a lot of equipment or just a few simple things. In our pool here at Upstate, obviously we have different equipment that we can utilize, so they may not be able to replicate all of those things without some of those pieces of equipment. But there again, there's a lot they could do at home in a pool or in a lake that they can carry over and continue doing.

Host Amber Smith: Now, how would someone who's listening to this be able to connect with you to see if they could come and have their physical therapy done in the pool?

Morgan Phillips, DPT: I think the first step would be, they'd have to be evaluated by their doctor. And their doctor would have to write a script specifically saying aquatic therapy.

And then they'd call us and get set up for that evaluation, and we would meet them, get to know them on land, figure out what their goals are for therapy. And then we can talk about that schedule. Maybe we send them completely to the pool, or maybe we do a little bit of pool therapy and a little bit of traditional, land-based PT.

But the first step would be contacting your primary care or a doctor to write a script for physical therapy.

Host Amber Smith: For Upstate physical therapy.

Morgan Phillips, DPT: Yep. And it just has to say aquatic therapy on it.

Host Amber Smith: Good to know. Well, thank you both for telling us about this.

Morgan Phillips, DPT: No problem.

Ryan Martin, DPT: Yeah. Thanks for having us.

Host Amber Smith: My guests have been Dr. Ryan Martin and Dr. Morgan Phillips, both of whom are physical therapists at Upstate. 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 cell phone, 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 cell phone 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.

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

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

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: Poet Nancy Christopherson captures a particular generation and its style in her lovely poem "Dearfoams." A mother and daughter walk the carefully tended grounds of the nursing home, happy to be together outside, accepting all that is given.

"Dearfoams"

We are meant to suffer

so that by the time the suffering

eases, we can no longer feel it as such

and it seems like nothing less

than the highest form

of praise.

That's how I'd put it.

The two of us walking the grounds outside

the nursing home along the smooth

paved sidewalk well beyond the high rise,

apartments built for retirees.

A few ash trees, some maples,

some lovely dense azaleas, boxwood along

the edges, and flowers in pots

on balconies, their doors slid open, screens

exposed on the windows.

Happy, relaxing days near the end.

Mom with her softly slippered feet

padding alongside my sneakered ones

holding my hand and

gazing around at all the marvelous

wonders, saying not one word

but two, mahvalous dahling, in her tiny

size 6 ivory Dearfoams.

Her hair by then

pure-as-a-seagull's-wing white.

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.