Syphilis on the rise; live kidney donors; mild cognitive impairment: Upstate Medical University's HealthLink on Air for Sunday, March 24, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," an infectious disease specialist addresses the alarming rise in syphilis cases.

Elizabeth Asiago Reddy, MD: ... Anywhere from 21 to 90 days after the initial infection, it will spread throughout the body. It goes to the lymph nodes at the site of infection, and then from there it goes throughout the bloodstream. It very frequently actually goes into the central nervous system as well. We worry about it because it can cause a very large number of symptoms, or potentially no symptoms. ...

Host Amber Smith: A transplant surgeon explains why a growing number of people are donating one of their kidneys while they're alive.

Reza Saidi, MD: ... This is one of the best options for our patients. And, usually, with this kind of transplant, the patients have the best outcome. ...

Host Amber Smith: And a geriatric specialist gives tips for living with mild cognitive impairment. All that, and a visit from The Healing Muse, coming up after the news.

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

On this week's show, we'll explore altruistic kidney donation and the benefits to the transplant recipient. Then we'll hear some tips for living with mild cognitive impairment.

But first, why are the rates of syphilis climbing?

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

The rate of syphilis infections in the United States continues to rise by 80% since 2018. And news reports say we're recording the highest rate of new infections since 1950.

Here to explain what's going on is Dr. Elizabeth Asiago Reddy. She's the chief of infectious disease at Upstate Medical University.

Welcome back to "HealthLink on Air," Dr. Asiago Reddy.

Elizabeth Asiago Reddy, MD: Thank you so much for having me, Amber.

Host Amber Smith: So why are national rates of syphilis rising?

Elizabeth Asiago Reddy, MD: There are a couple different factors at play here. One of them is reduced condom use, which we've been seeing a trend ever since approximately 2010. And we believe a lot of that has to do with the reduction in severity of illness associated with HIV, once we had really good medications to treat HIV. So we saw a peak in condom use in the early 2000s associated with the HIV epidemic, and we're obviously very happy to see the improved treatments and accessibility for HIV care, but that does seem to have been associated with a reduction in condom use that has continued over time. So we're seeing this year over year that people are using condoms less frequently than they used to.

Another factor is dating apps. A lot of people are attributing dating apps to a general rise in sexually transmitted infections. It's a lot easier to find partners and potentially easier to find anonymous partners, 而且，追踪伴侣和治疗可能暴露于性传播感染的人可能会更加困难. In a situation where people are traveling outside of their hometown, potentially, for sexual encounters, or having sexual encounters with people that they don't know as well. So that's another feature.

And I think as it relates to syphilis in particular, 在过去几年里，似乎有一件事起了作用，那就是人们有可能拥有更开放的关系, be that by choice, so with or without their knowledge that their partner might be having other partners. And as a result, there is more of a rise in syphilis now among women, which was not the case for the previous years before these last couple of years.

Host Amber Smith: So, by comparison, what's happening with the rates of gonorrhea, because that's another sexually transmitted disease. Is that going up as well?

Elizabeth Asiago Reddy, MD: Our data for the last year indicated a drop in gonorrhea nationally, and a kind of a stabilization in gonorrhea locally. It's a little bit hard to say because the timeframe is shorter. So with syphilis, unfortunately, we've seen a pretty steady increase over the last five to six years, actually even over the last 10 years. Whereas the numbers for stabilization or drop in gonorrhea are, it's a much smaller timeframe, so it's a little bit hard say whether or not that trend will hold.

For syphilis one of the things that concerns me and that's unique to gonorrhea is that the testing is different. So syphilis is done through a blood test, 它并不总是常规的作为一揽子测试的一部分，当有人出现在妇科护理或担心他们可能有性传播感染时，可能会做. So it's important that that be looked for, and it's not always done.

Host Amber Smith: So we've been talking about nationally. Does the national picture look the same in Central New York? Are we seeing a rise, as well, with syphilis?

Elizabeth Asiago Reddy, MD: We have seen, as I mentioned, a general rise over the last 10 years. There have been some cases where, some years where it's ebbed and flowed a little bit in terms of the numbers. But unfortunately we've seen a couple of years where the numbers have risen quite a bit. They might be a little bit down the next year, and then they're back up the following year. So the trend is, unfortunately, one that matches the national trend, which is one of general increase.

Host Amber Smith: I read that the state with the highest rate of infectious syphilis, 84 cases per 100,000 people, was South Dakota, and that state has a lot of wide open spaces. What's going on with South Dakota?

Elizabeth Asiago Reddy, MD: So part of that seems to be related to an excess risk among Native Americans. And there's a large population of Native Americans in South Dakota. So I believe that that's a big part of what's happening in that state. And that's reflective of, we know that sexually transmitted infections, obviously, are going to concentrate in groups of people who are seeking the same partners. So. despite the fact that I mentioned that people are seeking partners online, we still overall tend to have partners that match us as it relates to race and ethnicity.

因此，某些民族和种族群体的某些性传播感染的患病率更高, and that concentration of syphilis among Native Americans, I suspect, that's exactly what's going on.

Host Amber Smith: I know syphilis is caused by a bacteria. Where does that bacteria come from, and how does it infect humans to begin with?

Elizabeth Asiago Reddy, MD: So syphilis is actually, this form of treponema, which is the type of bacteria that this is, Treponema pallidum, it really only causes infections in humans. So it's endemic in humans. There are other types of Treponemes that infect other species, but Treponema pallidum is unique to our species, in terms of the diversity of diseases that it causes or illness that it causes. And it is spread by close contact. 这是梅毒的另一个独特之处它与其他性传播感染有一点不同, in that it is very efficiently spread by all forms of sexual contact, including oral sex.

And so that is something that some people practice when they are trying to reduce their risk of HIV infections. HIV is not well transmitted through oral sex at all. It's extremely rarely transmitted through oral sex. But that is not the case for syphilis.

So what syphilis does at the early stages is that it causes what's called a painless chancre. So that is a wound or ulceration at the site where the infection first occurred. So that's usually going to be on one of our mucus membranes, whether oral or genital, and it has a very unique property of being able to shut down the nervous response, the nervous system response in that area. And that causes that sore to be painless. So if you actually see one of these, you could be very surprised that it's not really painful. Occasionally it is painful, but most of the time it's not painful. And so that allows these sores. To go unrecognized in the majority of people who are suffering from them. So that is the way that this continues to spread to other people, because they don't realize that they have anything going on.

They have a sexual encounter. There's close contact with that chancre that has the syphilis bacteria in it, and that spreads to their partner at that time without them potentially even realizing that they have a problem.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Upstate infectious disease chief, Dr. Elizabeth Asiago Reddy about syphilis.

So beyond this canker, did you call it?

Elizabeth Asiago Reddy, MD: Chancre.

Host Amber Smith: What are the symptoms beyond that? Or are there any? How would a person begin to learn that they're infected?

Elizabeth Asiago Reddy, MD: One of the reasons that we worry a lot about syphilis is that it is a systemic infection, and that is different from some of our other common sexually transmitted infections.

So gonorrhea, chlamydia, even HPV, they almost exclusively live at the site of infection. They very rarely, with the exception of occasional cases of gonorrhea, but they very rarely will spread to other places outside of the site of infection. Syphilis is different. Syphilis is a systemic infection. So once you get sick with syphilis, unless it's treated in that primary stage where that chancre wound is present. So if it happens to be treated early, you may catch it before it spreads to other parts of the body.

Otherwise, within the first, usually probably about 21 days, but anywhere from 21 to 90 days after the initial infection, it will spread throughout the body. It goes to the lymph nodes at the site of infection, and then from there it goes throughout the bloodstream. It very frequently actually goes into the central nervous system as well. And so we worry about it because it can cause a very large number of symptoms or potentially no symptoms.

We already reviewed that first thing that you might catch or might not catch, which is the chancre. So, certainly any ulceration, genital ulceration that you've not already become familiar with. So, for example, for people who unfortunately have herpes outbreaks, they may be very familiar with that particular pattern in their own body. Aside from that, certainly any new genital ulceration would be something that you would want to have a provider look at.But a lot of times, as I said, people don't even realize that that has happened. So that is your primary stage of syphilis.

The secondary stage of syphilis is extremely diverse in terms of how it could present. Many people don't have any symptoms at all, and they may pass through that stage without even realizing that anything has happened to them. Other individuals can have a whole range of symptoms that include things as vague as just feeling tired, feeling under the weather, 可能出现低烧或感染部位或全身的淋巴结肿大. But others can have very serious signs and symptoms at that stage of infection, which could include things like meningitis, eye infections, changes in their hearing due to central nervous system infections, skin rash. The classic skin rash is present on the palms and soles, but it can be present literally anywhere in the body. It can also impact particular organs within the body. 肝脏可能是最常见的在相对较早的阶段受到影响，我们称之为二期梅毒. So those are the manifestations of secondary syphilis

That typically is going to last from about 90 days after initial infection through the approximately ... so if people develop symptoms that are severe, most of the time they're going to be seeking medical attention, right? And those symptoms may not go away until they're treated. If their symptoms are mild, then those symptoms may disappear on their own over the course of a couple of months, and the body kind of hides the infection at that point. Once that happens, the person has entered a latent phase.

When somebody is in a latent phase, it may be usually years before this could potentially come back. And in about 20% to 30% of people, if it's totally untreated, it will come back, and it can come back with very devastating, damaging effects in late stages.

Host Amber Smith: So it can come back years later?

Elizabeth Asiago Reddy, MD: Correct. Yeah.

Host Amber Smith: And you wouldn't necessarily even know that you ever had it or were ever infected, but years later you find out you have it.

Elizabeth Asiago Reddy, MD: Correct. Yeah. So these are reasons why we take this infection very seriously.

Host Amber Smith: So can it be diagnosed with a blood test?

Elizabeth Asiago Reddy, MD: Yes. And that is, aside from a very classic-looking chancre, the blood test currently is one of the few ways of diagnosing this. So we used to use something called dark-field microscopy, and that is a specific type of microscope setting that can see the Treponem bacterium. But that has fallen out of favor. It's rarely used anymore, and it's largely unavailable.

We're seeking molecular tests, which it would be a PCR (polymerase chain reaction) based test, which obviously we're using to diagnose a lot of other infections. 由于一些我们不太了解的原因我们不能像我们希望的那样通过分子检测来诊断梅毒. So right now there are some that are available more for research purposes than for clinical purposes. And essentially what we rely on are blood tests that look at the immune response to syphilis, so antibody tests.

Host Amber Smith: But this blood test, you would have to be, as the provider, you would have to be suspecting that it might be this, right?

Elizabeth Asiago Reddy, MD: This is where some of our challenge is coming with respect to rising rates of syphilis is, we still don't have a perfect idea of who needs to be tested.

美国疾病控制和预防中心(CDC)和美国预防服务工作组提出了建议, so for people who are men who have sex with men, as well as people who have multiple sex partners, or sex workers, and definitely people who are pregnant because of the elevated risk of passing syphilis on during pregnancy. Outside of those particular groups we are likely to miss people, and we just don't always know who are the best people who should be tested.

And the problem that potentially exists with universal testing is, first of all, it's hard to test universally for anything. And second of all, there are some false positives with these tests. 因此，如果你开始测试更多的人，那么区分什么是真阳性，什么是假阳性就变得更加困难了. So that is where I think some of this comes from in terms of the rise in syphilis, is that we are not testing all of the right people, but because of the challenges associated with testing, we're still determining who are the best people to be tested.

Host Amber Smith: Upstate's "HealthLink on Air" will take a short break, but please stay tuned for more information on syphilis.

Welcome back to "HealthLink on Air," where the subject is the rising rates of syphilis. I'm your host, Amber Smith, and my guest is Dr. Elizabeth Asiago Reddy, the chief of infectious disease at Upstate Medical University

Well, I'd like to ask you about treatment. Is penicillin effective?

Elizabeth Asiago Reddy, MD: Penicillin is highly effective, and it is the de facto treatment for syphilis. We have run into some problems recently in the last couple of years with shortages of penicillin. So, 理想的治疗方法是肌肉注射一针或三针青霉素，这取决于患者所处的阶段, 他们是否需要一次或三次注射——这确实在消除几乎所有人的感染方面做得很出色. There are rare cases where we might need to repeat treatment or offer a more intensive treatment intravenously. But in the vast majority of people, that is the optimal treatment.

So when we're dealing with a shortage, how do we handle it? We revert to our second-line treatment, which is oral doxycycline, and we don't have as good of data for the efficacy over the long run of doxycycline. It definitely is efficacious, but it may be slightly less efficacious compared to penicillin. So it's certainly our preference to use penicillin. There are certain cases of allergy where we need to use doxycycline. 头孢曲松是一种抗生素和青霉素属于同一类可以用于青霉素过敏的人, however we don't have a long-acting version of ceftriaxone, so that complicates its use for many patients. Because if we were to use that, we would actually have to have people coming back in every day for doses, which is obviously, difficult, inconvenient, and potentially painful since it's an injectable medication.

Host Amber Smith: So after treatment, does that eliminate the trouble? You talked about the latent stage. Does that do away with that, so the threat is gone?

Elizabeth Asiago Reddy, MD: It does. And I would be remiss to not bring up the fact that part of the reason we know this is because of the Tuskegee experiments, which are horrific experiments that were conducted in the U.S. South on African American people without their knowledge, to see what would happen in untreated syphilis. So this is a situation where, it's one of the many elements that go into mistrust in the U.S. Medical system for Black individuals and other people of color, other minority groups. So unfortunately, and tragically, this is how we know this information, that if people are treated, they do not experience these long-term outcomes. And if people are untreated, they have that, like I said, about 30%, 20% to 30% risk of experiencing bad long-term outcomes.

There may be some difference now in modern society, 与很久以前相比，因为人们的总体健康状况，也因为我们出于很多不同的原因使用抗生素. So for somebody to reach old age, never having taken antibiotics in the U.S. is becoming less common. So it's possible that someone could be inadvertently treated for syphilis over the course of their lives. But certainly that's not something we would want to take a risk on. And we obviously want to treat people when they need to be treated.

Host Amber Smith: Well, we don't have a vaccine for syphilis yet, do we?

Elizabeth Asiago Reddy, MD: We do not. There has been some effort to work on that. I am not aware of anything that looks imminent. Gonorrhea is another story actually, just to mention that anecdotally. There is more work on gonorrhea vaccination, and there's some promise with gonorrhea vaccination.

Host Amber Smith: You're listening to Upstate's "HealthLink on Air," with your host Amber Smith. I'm talking about syphilis with Upstate infectious disease chief, Dr. Elizabeth Asiago Reddy.

You mentioned pregnancy. What happens if a woman gets syphilis when she's pregnant?

Elizabeth Asiago Reddy, MD: This is very dangerous, 这是我们非常担心的事情之一因为我们有大量的婴儿出生时患有先天性梅毒或怀孕期间因梅毒而流产. So the most dangerous time to acquire syphilis is in the first trimester of pregnancy, with a close follow by the second trimester of pregnancy.

But anytime during pregnancy is dangerous. So within the first and second trimesters of pregnancy, the majority of cases without treatment are going to end up being transmitted to the unborn infant, or fetus. And the consequences can be very grave, 从完全流产到非常严重的先天性畸形以及其他慢性感染，也就是骨骼感染, infections of the central nervous system. And, the later in pregnancy that exposure occurs, the less likely it is that significant malformations occur, but nonetheless, the infant can still experience very significant signs of infection, to include meningitis.

So the results can be really devastating and have very significant long-term consequences for the health of the infant.

Host Amber Smith: So does the baby get the syphilis through the umbilical cord or during the birth process?

Elizabeth Asiago Reddy, MD: Either one could occur. When this happens early on in pregnancy, 然后——因为我提到过这是一种全身感染，有血液传播的成分——它会在整个怀孕过程中直接通过血液传播, from a parent to child.

Host Amber Smith: I see. Now, is congenital syphilis appreciably different from just regular syphilis?

Elizabeth Asiago Reddy, MD: Yeah. Well, many of the same signs and symptoms exist, but they are more severe. Because as you can imagine, if these infections occur while body organs are actually still in the process of being formed, such a severe infection can impact the proper formation of those organs.

So that's why, or one of the reasons why the earlier in pregnancy it is, 它的破坏性更大，因为它可能对胎儿的实际生长和发育产生更大的影响.

Treatment during pregnancy can prevent these devastating outcomes. So it is extremely important to test during pregnancy. And some of the testing recommendations were revamped when we started to see a rise in numbers.

And in New York State, it does appear that that has made a difference because New York state, I think, did a good job of getting the word out. And testing has increased significantly. So, actually, there should be testing during the first trimester and the third trimester, with an additional recommendation to test during the second trimester if there's anyconcerns about risk. 纽约州的大多数人在怀孕期间都广泛使用了这种方法并测试了三次.

I just want to make sure I say that, that hope is not lost if you test positive during pregnancy. You should be treated, and that will very significantly help to prevent infection or to cure any infection that might have pre-existed.

Host Amber Smith: So are all pregnant women tested without regard to whether they think they're at risk or not?

Elizabeth Asiago Reddy, MD: Yes, and that's what I'm saying. So the first and third trimester testing was very strongly recommended in New York state across the board, regardless of risk. And then we had this recommendation for second trimester testing, which could be applied, depending on the potential risk. And I really, I know at Upstate and many of the community OBGYNs (obstetrician/gynecologists) that I've discussed this with, they just decided, "I'm just going to do it in every trimester because I don't know what people's risks are." That is the reality.

We really don't, and that's kind of what I was mentioning before. We don't always do a good job of appreciating what people's risks are. And so even though it may be a small percentage of pregnant patients who are impacted, then it becomes a very devastating situation if we miss even one of those.

Host Amber Smith: Now, 过去，县卫生部门会要求梅毒检测呈阳性的人透露他们所有的性伴侣, and then the county health department would try to reach those people and let them know. Do they still do that, do you know?

Elizabeth Asiago Reddy, MD: That is still done, and it obviously can be a difficult job, but it's very important.

So we do ask people to reveal their sexual partners, and of course we can't know for sure that all the information we receive is accurate. But, overall the tendency has been for people to be concerned about their partners and to provide us with that information. And the health department does this notification anonymously. So if somebody who has been impacted by syphilis themselves wants to be the person who is telling their partners, that's OK. But also it can be done anonymously through the health department.

So somebody might get a call saying, "we have been notified that you were exposed to syphilis." And the recommendation is that if that exposure has occurred within the last 90 days, 那个人应该接受经验治疗，因为很难知道那个人是否处于窗口期，没有表现出症状，但仍然被感染了. Whereas if it's greater than 90 days, then the recommendation is for testing.

Host Amber Smith: Now, someone who learns they may have been exposed to syphilis may panic. What advice do you offer these people?

Elizabeth Asiago Reddy, MD: I think it's better to know and be tested and treated if you need to than to not know. So yes, of course it's disconcerting, and it's information that is not welcome to, really, anybody. But at the same time, it offers you the opportunity to get the treatment that you need.

Host Amber Smith: Do they need to stop having any sexual contact until they figure out whether they are infected or not?

Elizabeth Asiago Reddy, MD: Yes. That is our recommendation for all sexually transmitted infections, with the possible exception of human papillomavirus because that is so universal. But with all sexually transmitted infections, we are recommending that people do not have sex during the active phase of their treatment, so until their signs and symptoms have resolved. And we will provide them with information about what we think would be a reasonable amount of time, where they would no longer be likely to spread that to somebody else.

Host Amber Smith: If someone already had syphilis, are they more or less likely to get it again, or could they get it again?

Elizabeth Asiago Reddy, MD: They can get it again. There's some information about this from older literature. It's not very clear. There may be some degree of immunity that occurs over time, but it is not, it's definitely not universal. So, people can get reinfected, and we follow their blood tests. There are certain parts of the blood test that will stay stable over time, and there are other blood tests that change over time, as a result of exposure. So we look at those to try and figure out whether someone might have a new infection.

Host Amber Smith: Well, let me ask you about syphilis in general. Does it occur in outbreaks, like, every generation, or is it just always present?

Elizabeth Asiago Reddy, MD: It has been largely present, over the long run. In fact, if you look at the numbers, you mentioned 1950. If you look at the numbers pre-1950, we had a ton of syphilis going on, much more so than we do now, because we didn't really know how to test for it, and we didn't have any treatment for it either. And so once we actually had ready access to penicillin, that was when the decision was made to require people to become tested before they married.

And that resulted in a huge drop in syphilis all the way up until about 2013, 2014. So there was a period of time in the early 2000s when there was a lot of condom use going on, and we said at that point, well, we may be able to eliminate syphilis completely, because it was so low and it was so infrequent. But unfortunately that changed pretty drastically, and then we've had these steady increases ever since then.

So it has been around, and it's very universal. It's around throughout the world, 有很多历史证据表明，名人要么遭受了这种疾病本身的后果，要么遭受了这种治疗的后果, which used to be things like mercury and other poisons.

Host Amber Smith: Wow. Interesting.

Well, Dr. Asiago Reddy, thank you so much for taking time to tell us about syphilis.

Elizabeth Asiago Reddy, MD: Thank you for having me.

Host Amber Smith: My guest has been Dr. Elizabeth Asiago Reddy. She's the chief of infectious disease at Upstate Medical University. I'm Amber Smith for Upstate's "HealthLink on Air."

Would you donate one of your two kidneys to help someone? Next, on Upstate's "HealthLink on Air."

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

Upstate Medical University had one of the highest rates of living donor kidney transplants in New York state in 2023, and many of those were "altruistic" donations, from people who just wanted to help someone.

We'll learn more about living kidney donation from Dr. Reza Saidi. He's the director of the Upstate Transplant Center and chief of transplantation at Upstate University Hospital.

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

Reza Saidi, MD: Thank you. Glad to be with you, Amber.

Host Amber Smith: It's exciting that your team did 94 kidney transplants in 2023, and 32 involved living donors.

How does that rate compare with other hospitals in New York?

Reza Saidi, MD: A couple years ago, we used to have one of the lowest rates of live donor kidney transplant in state of New York. But in the past, I would say, four, years, we've had a significant change in our direction of the program and our different campaigns around our city area.

And I'm very pleased to announce that now we have one of the highest rates of live donor kidney transplant. Not only in the state of New York, but in the country. There are about 20 kidney transplant programs in the state of New York, and among those, I think we came third after New York University and Columbia University, when you look at the percentage of kidney transplants that came from live donors, and around the country, actually, the number of live donor kidney transplants has gone down since COVID. It used to be around 30%-40%, and now it's down to 20%.

But in our program, 35% of all the kidney transplants were done from a live donor. And this is something that we put heavy emphasis on for the past couple years, and we try to grow more because this is one of the best options for our patients. And, usually, with this kind of transplant, the patients have the best outcome.

Host Amber Smith: So what steps have you taken to increase the living kidney donors?

Reza Saidi, MD: I think the main thing I want to point out is about awareness. 我们首先会花很多时间和我们的转诊医生交谈，确保他们明白这是最好的选择. And also we talk to our patients. Now, we have a special program to basically teach our patients how to go and approach somebody and how to find a living donor.

For example, our patients put their stories on their social media, they go to their churches, schools will talk about this. I think these are the steps that we put in to increase the number. The other thing we have done, we expedite the evaluation of these donors. Now, most donors, (in) a matter of couple days, they get all the evaluation, and they get the yes-or-no answer.

I think that's also significant for the donors to be motivated to donate their kidney.

Host Amber Smith: So social media and just getting out there and sharing your story, that's working, that's making people decide that they would be willing to do this.

Reza Saidi, MD: Yes. Last year, we also had a live donor appreciation luncheon. We had this again this year. A lot of donors came, and we shared their stories, and these were aired in our area, and people (were) hearing this message, and since then, we've seen a lot of people just calling our program. They want to donate their kidneys, even to an unknown individual. We call it altruistic donation.

Actually, last year about 30% of all the live donor kidney transplants were done from the altruistic donors. It's also very important that you get this message out there, that people, especially if people are healthy and have a healthy lifestyle, can have a healthy life with one kidney, and donating one kidney to a stranger or family member doesn't jeopardize their health and their life.

Host Amber Smith: Well, I want to talk to you more about what it means for the person who's willing to donate, but tell us again, why does it matter? Why is a living kidney transplant better than a transplant from a deceased donor?

Reza Saidi, MD: Because a living donor, we screen all these donors and make sure that they're healthy, they have a good kidney function.

But when somebody passes away, there's a reason that the patient passed away. Now, the average deceased donor age in this country is in mid-50s, and a lot of these donors have a lot of comorbidities (other medical problems), like high blood pressure, diabetes or obesity, and the quality of the kidney is not good.

But for living donors, we screen them, and we pick the best. That's why the outcome's always better. And again, living donors is like elective surgery, compared to deceased donors, which is kind of a semi-urgent operation. The time that kidney is out of body for a deceased donor usually is a matter of 15 to 20 hours, but for a living donor, because both donation and transplant surgery are done adjacent to each other, they call it ischemic time, meaning the time that kidney is out of body without any blood flow, is a matter of couple minutes. That's why this kidney works right away. There's less damage to the kidney, and that's why these patients have the best outcome after live donor kidney transplant.

Host Amber Smith: Well, 让我们来谈谈当人们听说他们关心的人正在寻找肾脏捐赠者时可能会有的一些问题.

You said that people can live a healthy life with one kidney instead of the two that most people are born with. Beyond that, who makes a good kidney donor? What are you looking for?

Reza Saidi, MD: You know, let me tell you a little bit about the scope of this problem we have. One out of seven people in United States has kidney disease, and unfortunately, a majority of people progress to the point that there is no treatment option for them unless they stay on dialysis forever.

But dialysis has its own ups and down, and about 10% of people on dialysis will die, on an annual basis. That's why this is a huge problem, and there are close to a hundred thousand patients on the list waiting to see a kidney transplant. And each year about 5,000 people on the list will die because there is no suitable kidney.

On the other hand, somebody who's healthy, with a good kidney function, can donate their kidney safely. Now, this operation is done through a minimally invasive approach, without any big incision, and the recovery is quick. And we've been doing this for 60 years.

Data clearly show that with one kidney you can have a healthy life, and it doesn't jeopardize your health or your longevity.

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

I'm talking with Dr. Reza Saidi. He's the director of the Upstate Transplant Center, and we're talking about living donor kidney transplants.

Now, are blood relatives necessarily the best donors?

Reza Saidi, MD: Not necessarily. In the past, we thought that if you have a blood relative, you're maybe genetically more close, so that patient and the outcome is better. But now, with new drugs that we have, people have showed that even comparing the live donor kidney transplant from relatives versus non-relatives, the outcome is about the same. It's not a huge difference.

That's why this matter of "the blood relatives are better outcomes," I think, is a myth. As long as the quality of the kidney is good, relative, non-relative, doesn't make a huge difference.

Host Amber Smith: Are there conditions that would disqualify someone right off the bat from donating?

Reza Saidi, MD: Yeah, absolutely. Actually, that's why we screen these donors, make sure they're in good health, they don't have, for example, kidney disease, or they have no other comorbidities, like significant cardiovascular disease or respiratory problems.

That's why the other outcome is the best, because we screen these donors and pick up the best. A donor has to go through extensive examination.

First of all, all these donors that contact us, we do a screening questionnaire on them and make sure there's no red flag. If there's no red flag, we get the labs on them, make sure they have adequate kidney function. Then we see them, evaluate them, do extensive testing on them, make sure they're in good health, and they can tolerate an operation, and then they proceed to donation.

But the other thing we did to our program, actually it has been very helpful. We basically jam all this, evaluation into one visit. When the patients call us, we do the questionnaire. If they pass the questionnaire, we do the testing, and then they come one day, see all the providers. And if everything's good, they get their CT scan to look at the anatomy of the kidney.

And then we have a meeting; the committee decides whether or not that donor is suitable. And for the past couple years, we've adjusted our processes, and now the evaluation time for donors, as I said, in our program is about nine days. Nine days, they get a yes or no answer.

Host Amber Smith: So I'm assuming a person needs to be at least 18 or an adult.

Reza Saidi, MD: Yes. Absolutely.

Host Amber Smith: Do they need to be living in Syracuse or Central New York?

Reza Saidi, MD: No. We have one person, his cousin came from California, and one of these altruistic donors that I mentioned came from Portugal, used to live in Syracuse, saw one of his friends on Facebook needs a transplant, and he came all the way from Portugal to donate. We had a ceremony a couple weeks ago, 那个病人来到镇上的一家电视台，讲述了她的历史，以及她是如何从一个来自葡萄牙的无私的捐赠者那里得到肾脏的.

Host Amber Smith: So 10 of your living donor transplants last year were from altruistic donors who just wanted to help someone. Some of them were strangers, they didn't know them from the past or anything. Can you tell us more about what motivates these people? Is it the same thing as someone who's willing to donate blood?

Reza Saidi, MD: Yeah, I think they're just (showing) good citizenship. They hear these stories, and obviously a lot of these donors are very highly motivated and well educated. They go read about it and find out, "Oh, this is not a dangerous thing to do." And they look to donate to complete strangers, to just be a good citizen.

Host Amber Smith: So if someone contacted you and said they wanted to donate their kidney to someone in need, would that kidney go to someone here in Syracuse or someone on the waiting list at Upstate?

Reza Saidi, MD: Yes, when they contact our program, we look at people on our list -- we have about 400 patients on the list -- and see who's the match for that kidney.

Host Amber Smith: That's what I was going to ask. How do you choose who gets it? You choose the best match?

Reza Saidi, MD: Yeah, we try to choose the best match and give it to somebody that we know that's going to get the most out of that kidney.

Host Amber Smith: Now, how much would the donor and the recipient find out about each other in the future? Might they go their separate ways and never know who the other was?

Or do they get to know each other afterward?

Reza Saidi, MD: That depends on the donor, basically, if he wants to meet his recipient or not. Yeah.

Some people have said that "I don't want to do this." And some people, after a couple months, said, "Yeah, I want to meet my donor."

This is something that we give the donor the option: "What do you want to do?" That live donor luncheon that I mentioned to you? One of these stranger-donor/recipient pairs actually met each each other, and there was a very touching story. Both, actually, were in tears, when they recognized each other, and it was a very touching story. I think these stories actually can also promote live donation, hopefully, in our area, because, as I said, there are 400 patients on our list, and, unfortunately, some of these patients might die because there is no suitable kidney donor.

There could be someone who's willing to donate their kidney to a person that they're friends with or a family member, but they're not a good match. Can you still make use of that kidney? Yes. There's also a national donor exchange program that if your donor is not a match, they can go on that pool and they can find a similar situation around the country, that somebody else has a donor that doesn't match, and they can exchange.

We have participated in this program for now, two years. And last year we had a case that one of our donors donated here, the kidney went to Cleveland, Ohio. And another donor who donated from Cleveland went to the Mayo Clinic in Rochester (Minnesota). Another one donated in Rochester went to South Carolina. We can create these chains and use the incompatible donors, called the National Kidney Registry, which is a pool around the country that, because, unfortunately, some of these donors might not especially be a blood type match. And with this program, we can transplant those patients in a relatively short period of time.

Host Amber Smith: So if someone wants to donate their kidney, can they choose who on the list that it goes to?

Reza Saidi, MD: Absolutely. They can have a choice who they want to donate to.

Host Amber Smith: By name, or by characteristic? Can they say, "I only want it to go to a woman or only to a man, or ...?"

Reza Saidi, MD: I never had a patient that they said, "I want to donate only to a woman or man." They can say a name if they're their friend or relatives, or if there's another match, they can go on this national exchange program that you mentioned.

Host Amber Smith: That's good to know. Now, let's talk about once someone is willing to donate their kidney, and they are a match, and you've decided this is going to work. What happens next?

Reza Saidi, MD: Yes, that's a very good question. When there's a match, then we try to coordinate with the patient and their donors, see what's the best time for them to have this live donor kidney transplant. And usually we do it the same day. Usually there are two ORs (operating rooms). Usually first, the donor's going to go to the OR, and when they make enough progress, we take the recipient to the OR, get the recipient ready, and as soon as the kidney comes out of that donor, we transplant that in the recipient.

And as I said, because the amount of time that the kidney's out of body is very short, this kidney works right away.

Usually a donor, as I said, has a minimally invasive surgery through small holes and stays in the hospital maybe one or two nights, maximum, then they go home. And the recipient is usually in the hospital for about two, three nights, and they go home.

But the full recovery from the donor who donates their kidney is about two, three weeks. And usually they go back to their work, and they basically have a healthy, normal life after that.

Host Amber Smith: Are there potential medical risks after you're a donor?

Reza Saidi, MD: Yes, like any kind of surgery, there's risk of infection, for example, or risk of developing hernia. But these risks, they're very small. The risk of death is still there, but it's extremely rare. Understand this is still a surgery, despite the fact that we're doing it through the minimal approach.

I would say, it's a surgery, and there are risks, but with experience and passing the learning curve, we have a very good outcome. We have no donor complications so far, except maybe minor complications, like a wound infection, stuff like that.

At our program, the past, I would say, four or five years that I've been here, we never have had a major complication.

Host Amber Smith: If someone who donated went on years later to develop some sort of a kidney problem, would their donor history impact their future care?

Reza Saidi, MD: Yes. This is a very rare incident but can happen.

For example, let's say somebody donated their kidney and gets in a car accident, and the kidney's destroyed, and now they have no kidney, and they need a kidney. The system, because they want to appreciate their heroic act, they get highest priority for these donors.

If something happens and they need a kidney transplant, they're going to get the first kidney available, basically.

But that's an extremely rare indication to have a kidney transplant. It's a safety net that the system put in place for live donors, that if, God forbid, this happened, they get highest priority to receive the next available kidney.

Host Amber Smith: Well, Dr. Saidi, thank you so much for this interview and congratulations on the living donor kidney transplant numbers.

Reza Saidi, MD: OK, thank you.

Host Amber Smith: My guest has been Dr. Reza Saidi, the director of the Upstate Transplant Center and chief of transplantation at Upstate.

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

Here's some expert advice from Dr. Sharon Brangman, chief of geriatrics at Upstate Medical University. What can a person do if they have mild cognitive impairment (MCI)?

Sharon Brangman, MD: We have a lot of non-pharmacological approaches, but as a society, we always want a pill. So we don't want to hear things unless there's a pill. But there's a lot you could do for brain health, and some people with MCI, it gets better.

There are a number of things that we encourage people to do. The No. 1 is exercise. Exercise is probably better than any prescription I could write. And we try to tell people that they need about 150 minutes a week of good activity. And that could be walking. You don't have to run a marathon. It could be swimming. I recommend that my patients figure out a way to take a walk for a half an hour a day. You could break it up into 15 minutes, twice a day. But it's very important that we figure out a way to incorporate exercise into our life, just like we brush our teeth every day.

The other thing you want to do is make sure you get a good night's sleep, because when we are sleeping well, that's when our brain cleans up all these little abnormal particles that build up during the day. And research shows that when we're in deep sleep, that's when our brain cleans up all of these little particles. So it's important to get a good night's sleep.

The other thing that people usually don't like to hear too much is that alcohol really isn't good for your brain. You know, 有很多研究——其中很多都得到了酒精行业的支持——表明红酒对大脑有好处. And we're starting to understand that alcohol is actually a toxin to nerves, and there is really no safe level of alcohol for our bodies in general and for our brains. 所以我尽量鼓励病人尽量少喝酒，如果他们必须喝酒的话，不要喝酒精含量很高的饮料. But maybe just save it for special occasions.

The other thing is to not smoke, to control your blood pressure. If you have diabetes, control diabetes, and to eat a heart-healthy diet. 任何有助于心脏健康的饮食都有助于大脑健康，因为我们正在研究的是同样的血管. And what they call the Mediterranean diet, minus the wine, is probably one of the healthiest diets you can have.

And then the other piece that's important is being socially engaged. If you have connections with people around you, if you volunteer in your community, if you have friends that you meet with regularly, it's important that you maintain social connections. And we're just coming out of a period where everybody was very isolated, and that took its toll on a lot of people and their brain power.

And then the final thing that's important is to make sure that you can hear well and that you can see well. Because if you don't get good sensory input from your ears and your eyes, then your brain has less to work with. And studies show that that can be a risk factor for developing dementia. And a lot of people don't want to wear hearing aids or they deny that they have a hearing problem. It's very important to get your hearing checked and have your vision checked and to get them corrected if needed.

The majority of people with mild cognitive impairment never advance into dementia. 大约80%到85%的人可能会有这种恶化，他们只是觉得自己的脑力跟不上速度, but it doesn't get any worse, and sometimes it gets better over time.

Host Amber Smith: You've been listening to chief of geriatrics, Dr. Sharon Brangman from Upstate Medical University.

Deirdre Neilen, PhD: Two of our poets provided us a sense of how appearances are only a small part of any story. It takes a perceptive observer to see within.

Erin McConnell is a pediatric physician from Ohio who is also working on a master's degree in medical humanities. Look at how the patient she describes has tried so hard to be good.

This is "The Easy Patient":

You aim to be the easy patient:

meds memorized,

seeing enough specialists

to not be a burden or

cause cognitive strain

Just a few refill requests

no additional concerns

Paperwork completed

arrival on time

even disposing of your own

patient gown

No need for receipt

no follow-up scheduled

making as small a

carbon chain footprint as possible.

布法罗的Mick Cochrane让我们思考航空公司是如何通过他们的区域等级来强化我们的价值感的. But we don't know the real story.

Here is "In Zone Three":

no one thanks us for our service

we have accumulated no

points no perks we have no

right to upgrade no hope

of extra leg space or complimentary

anything it doesn't matter what indignity

our poorly packed luggage suffers to make

it fit we are nobodies red-eyed

sleepless lumps of coffee fear

we wear cargo shorts and Crocs

we are the army of the un-

fashionable we are a-stylish we

take no selfies because

we don't want to know we are

flustered by TSA and pet

the wrong dogs we belong

on a bus but we are here please

forgive us our sorry state

our heartache is too sudden

so this one time we must

find a way to fly

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," protecting your eyes during the total solar eclipse. 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.