A Special Lab Coat Ceremony Launches the Training of Future Scientists

Oct 7, 2019 | Featured, School

The 56 members of the matriculating classes of PhD and MD/PhD students in the Graduate School of Biomedical Sciences at the Icahn School of Medicine at Mount Sinai received white lab coats during a special ceremony held Monday, September 9, in Goldwurm Auditorium.

“It is with great pride and joy that I welcome you,” Marta Filizola, PhD, Dean of the Graduate School, and the Sharon and Frederick Klingenstein/Nathan Kase, MD Professor of Pharmacological Sciences, and Professor of Neuroscience, told the students. “This ceremony serves as a symbolic induction to your professional PhD training in the Biomedical Sciences and Neuroscience programs, as well as to the MD/PhD Medical Scientist Training Program.” The Graduate School, which began the tradition in 2018, is the only institution in New York City, and one of a few in the nation, to honor its matriculating PhD classes in this manner.

Also receiving recognition were 43 PhD and MD/PhD students who have officially joined a lab and confirmed their PhD candidature by passing their thesis proposal exams. They were presented with honorary plaques.

The PhD students recited an oath to guide them through their training, and beyond. In part, they pledged to uphold the highest levels of integrity, professionalism, scholarship, and honor, and to conduct their research and professional endeavors with honesty and objectivity.

Eric J. Nestler, MD, PhD, Dean for Academic and Scientific Affairs, Director of The Friedman Brain Institute, and Nash Family Professor of Neuroscience, who was the event’s master of ceremonies, gave this advice to the students. “The most critical dimension of your graduate student career will be finding the right laboratory in which to do your dissertation research—and the most critical aspect of that choice will be the lab’s principal investigator, who will be your mentor,” he said. “I would argue that the lab principal investigator is more important to your future than the content of the lab’s work or the experimental approaches the lab utilizes. If it works as it should, your lab mentor will be one of your more significant relationships of your professional lives.”

When keynote speaker Francesca Cole, PhD, stepped to the podium, she almost immediately acknowledged her own mentor, Robert S. Krauss, PhD, Professor of Cell, Developmental and Regenerative Biology, and Oncological Sciences, at the Icahn School of Medicine at Mount Sinai, who was in attendance. Dr. Cole received a PhD in Biomedical Sciences in 2003 at Mount Sinai, followed by postgraduate training at Memorial Sloan Kettering Cancer Center, and today she is an Associate Professor of Epigenetics and Molecular Carcinogenesis at The University of Texas MD Anderson Cancer Center.

She outlined the struggles of a typical scientist. “We have to live with the knowledge that we could be wrong, that our approach may not work, that we may not be asking the right question. In short, doing research makes you feel stupid,” said Dr. Cole. “You must accept this. If you don’t feel that way, you aren’t working hard enough or pushing the boundaries of our knowledge enough.”

Dr. Cole also encouraged the students to select a mentor wisely and to support each other. “But this is my most important message to you,” she said. “It is abundantly clear that you all belong here. So, welcome to biomedical research, and let’s make beautiful science together.”

Mount Sinai Is Taking the Lead in Transgender Medicine

Oct 7, 2019 | Engagement, Featured

In “Born to Be,” a documentary about the Mount Sinai Center for Transgender Medicine and Surgery, its Director of Surgery, Jess Ting, MD, center, headed for an operating room with Adriana Macias, RN, and patient Mahogany Phillips.

The Mount Sinai Center for Transgender Medicine and Surgery (CTMS) in three years has become a world leader in the care and support of transgender people, a journey that is the subject of Born to Be, a documentary that premiered on Saturday, September 28, at the 57th New York Film Festival.

“CTMS has treated 2,500 transgender patients since it was founded in 2016 and performed 1,200 ‘trans-related’ surgeries, such as facial feminization and genital reconstruction,” says Joshua Safer, MD, Executive Director of the Center for Transgender Medicine and Surgery, and Professor of Medicine (Endocrinology, Diabetes and Bone Disease), Icahn School of Medicine at Mount Sinai. The Center also offers services in primary care, physical therapy, endocrinology, behavioral health, and social work that are uniquely comprehensive.

Joshua Safer, MD, Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery.

“The one thing that transgender people have in common is that their gender identity is not aligned with the physical anatomy that we see,” Dr. Safer says. “But there is great variability in what they want to do about that, and we think patients should have customized choices, just like treatment for any other medical circumstance.”

The new documentary, directed by Tania Cypriano and produced by Michelle Hayashi, focuses on five patients seeking to transform their lives with surgery performed by Jess Ting, MD, Director of Surgery, Center for Transgender Medicine and Surgery, and Assistant Professor of Surgery (Plastic and Reconstructive Surgery), Icahn School of Medicine at Mount Sinai. They were a varied group, including a self-described survivor of the 1980s drag ball culture, a young professional, and a former model. One patient seemed to speak for many in describing life before the surgery. “You are fighting every day,” he said. “You are fighting to be respected, you are fighting to be comfortable in your own skin.”

The film depicts CTMS in its early days, when Dr. Ting was just transitioning into his role. Since then, Dr. Ting created the nation’s first transgender surgery fellowship and hired the first two graduates of the program. “One new surgeon is coming out of this program every year,” Dr. Ting says. “Over time, we will be able to multiply our expertise and our ability to address health care disparities for transgender patients.”

CTMS has also added two luminaries in gender-affirming surgery: Marci Bowers, MD, a San Francisco-based pioneer in vaginoplasty, and Miroslav Djordjevic, MD, PhD, a specialist in female-to-male genital surgery who leads the Belgrade Center for Genital Reconstructive Surgery in Serbia. Both teach and practice at Mount Sinai several times a year. “These collaborations build upon an already strong program and make CTMS a world leader in gender-affirming surgery,” Dr. Ting says.

Miroslav Djordjevic, MD, PhD, left, and Marci Bowers, MD, two leaders in gender-affirming surgery, are collaborating with the innovative team at Mount Sinai.

In other innovations, CTMS created the first psychiatric fellowship in transgender medicine, and is now training its second fellow. In addition, all endocrine fellows and plastic surgery residents rotate through the transgender program, making Mount Sinai one of the only centers to incorporate the care of transgender and nonbinary patients into its physician training curriculum.

These fellowships are part of the larger mission of CTMS, to provide guidance in a field that is at a crucial “inflection point,” Dr. Safer says. “Until a few years ago, the universe of trans surgery has been really ad hoc,” he says. “The better-known surgeons in North America operated out of freestanding surgery centers, because conventional medical centers would not let them use their operating rooms.” Medicare specifically banned coverage for transgender procedures, and patients paid out of pocket. But in 2015 the government reversed its policy, leading many states—including New York—to obligate private insurers to provide coverage of transgender procedures. This has made such treatment affordable for many more patients, and transgender medicine is rapidly expanding to meet the demand.

Leveraging its resources as a large academic medical center, Mount Sinai is taking the lead in efforts to elevate and standardize important aspects of patient care, including the training of nurses, physical therapy for patients undergoing genital surgery, and the pre- and postsurgery process. To create a national conversation on best practices, CTMS held the first Live Surgery Conference for Gender Affirmation Procedures in spring 2018, co-sponsored by Mount Sinai and the World Professional Association for Transgender Health (WPATH), the leading professional and educational organization for transgender health care. The second such conference, in spring 2019, held panels on social and ethical issues in transgender care and featured live surgeries by experts, including Dr. Ting, Dr. Bowers, and Dr. Djordjevic.

CTMS plans another conference in spring 2020 focusing on medical issues such as perioperative care and adolescent health. “CTMS has become a national model for providing a full-service and integrated system of affirmative patient-centered care, accessible to all transgender and nonbinary patients,” says Barbara Warren, PsyD, Director, LGBT Programs and Policies, Office for Diversity and Inclusion, Mount Sinai Health System. “It also serves as a much-needed resource for educating the next generation of health care providers in culturally and clinically competent care.”

David L. Reich, MD, President and Chief Operating Officer, The Mount Sinai Hospital, who was a driving force in creating CTMS along with Dr. Warren, says: “In so many areas of medicine, we tend to be competitive. In gender affirmation surgery and transgender medicine, however, we need to think broadly to support a community that has for so long been underserved. Our mission and our vision is to bring the care of the community to the next level by sharing our expertise.”

At a screening of the documentary “Born to Be” at the 57th New York Film Festival, from left: the film’s producer, Michelle Hayashi; patients Garnet Rubio and Jordan Rubenstein; Jess Ting, MD, Director of Surgery, Mount Sinai Center for Transgender Medicine and Surgery; patient Mahogany Phillips; and the film’s director, Tania Cypriano.

Grateful Patient Acknowledges Neurosurgical Team

Oct 7, 2019 | Featured, Patient Stories

The team involved in the treatment and care of patient Jeannie Gaffigan included, from left: Colleen Geary, OTR/L, Rehabilitation Specialist in Occupational Therapy, Department of Rehabilitation and Human Performance; Jeffrey T. Gilligan, MD, Neurosurgery Resident (PGY-5); Neha S. Dangayach, MD, MSCR; Robert J. Rothrock, MD, Chief Neurosurgery Resident (PGY-6); Leslie C. Schlachter, PA-C; Joshua B. Bederson, MD; Kurt A. Yaeger, MD, Neurosurgery Resident (PGY-5); Johanna T. Fifi, MD, Associate Professor of Neurosurgery, Neurology, and Radiology, and Associate Director, Cerebrovascular Center; Joseph Waugh, NP, Neurosurgery Intensive Care Unit; and Holly E. Oemke, Program Manager, Neurosurgery Simulation Core.

In 2017, Jeannie Gaffigan, a popular director, producer, and comedy writer, urgently needed to consult with a neurosurgeon. An MRI had revealed that the seemingly harmless symptoms that she had been experiencing, and ignoring for at least a year—including headaches, dizzy spells, and loss of hearing in one ear—were the result of a massive, life-threatening brain tumor, pushing against her brainstem. Ms. Gaffigan, the mother of five children with her husband, comedian Jim Gaffigan, feared she was going to die.

Joshua B. Bederson, MD, Professor and Chair of Neurosurgery for the Mount Sinai Health System, reassured her that he could perform complex surgery and safely remove the tumor. In a 10-hour operation, Dr. Bederson and his team—relying on years of experience combined with advanced augmented reality technologies—were able to precisely see the brain’s delicate structures, allowing Dr. Bederson to systematically separate each of the nerves and myriad blood vessels from the 6-cm pear-shaped choroid plexus papilloma, a rare type of slow-growing benign tumor.

Now, in a book that was released this month, When Life Gives You Pears, Ms. Gaffigan recounts—with characteristic humor—her extraordinary medical journey at Mount Sinai, acknowledging those who provided her with expert and compassionate care.

Jeannie Gaffigan

“There are many people involved with a patient’s neurosurgical care beyond the surgeon,” says Dr. Bederson. “In Jeannie’s case, she was helped not only by me and my immediate team, but also by neuroendovascular surgeons, neurocritical care staff, pulmonologists, otolaryngologists, physiatrists, physical therapists, and others.”

Leslie C. Schlachter, PA-C, the Department of Neurosurgery’s Chief Physician Assistant and Clinical Director, played a significant role in guiding Ms. Gaffigan through the surgical process and coordinating care across specialties. “Our relationship continues to this day with intermittent text messages where I assure her that she is on the road to an excellent recovery,” says Ms. Schlachter.

After surgery, Ms. Gaffigan spent a period of time in The Mount Sinai Hospital’s Neurosurgery Intensive Care Unit (NSICU), and she later required more hospitalization and a prolonged period of rehabilitation.

Says Neha S. Dangayach, MD, MSCR, Assistant Professor of Neurosurgery, and Neurology, and Co-Director of the NSICU, “Because Jeannie’s surgery was very complex, she required extensive neurocritical care to help her embark on the perfect trajectory for a successful recovery.” Dr. Dangayach adds, “I commend Jeannie for being a great team player, for her sense of humor, and exceptional patience with us. I also commend our team of neurointensivists, fellows, physician assistants, nurse practitioners, specialty-trained nurses, and rehabilitation specialists for providing her exceptional care throughout her weeks-long stay.”

South Nassau Communities Hospital Is Renamed Mount Sinai South Nassau

Oct 6, 2019 | Community, Featured

Mount Sinai South Nassau in Oceanside, New York.

South Nassau Communities Hospital—a 90-year-old institution that serves 900,000 residents on the South Shore of Long Island—will now operate as Mount Sinai South Nassau to reflect its partnership with the Mount Sinai Health System.

“The new name reflects not only the hospital’s proud history and regional geography, but also its future,” says Kenneth L. Davis, MD, President and Chief Executive Officer of the Mount Sinai Health System. “South Nassau’s team of highly skilled physicians, nurses, and support staff will now have the opportunity to expand services to the community through new synergies with Mount Sinai, including access to an array of specialists and clinical trials that have, until now, only been available by traveling into the city.”

Mount Sinai and South Nassau announced their plan to establish a partnership in January 2018 and received New York State regulatory approval in December 2018. During the past two years, administrative and clinical leaders have worked to combine the Mount Sinai Health System’s academic, clinical, and research expertise with the award-winning community-based care of Mount Sinai South Nassau. “The rebranding reflects a shared vision and collective goal to provide the highest quality of care to patients on Long Island,” says Arthur A. Klein, MD, President of the Mount Sinai Health Network.

Mount Sinai South Nassau is one of the region’s largest hospitals, with 455 beds, more than 900 physicians, and 3,500 employees. It has added new services that are growing rapidly, such as maternal fetal medicine, interventional endoscopy, and pediatric cardiology, and plans to expand its cardiac surgery, cancer care, neuroscience, and colon and rectal surgery programs. Mount Sinai South Nassau is in the midst of a $400 million long-term strategic growth initiative that will transform its campuses in Oceanside and Long Beach, New York. Richard J. Murphy, President and Chief Executive Officer of Mount Sinai South Nassau, says, “While the hospital has a new name, our legacy of serving this community and providing patients with extraordinary health care will only grow stronger as a result of our partnership with Mount Sinai.”

The Mount Sinai Hospital is ranked No. 14 nationally in the 2019-2020 “Best Hospitals” issue of U.S. News & World Report and is ranked nationally in 8 adult medical specialties. South Nassau is ranked No. 20 among the 170 hospitals in the state of New York, as well as No. 20 among the 118 hospitals in the New York metropolitan area, while its Division of Urology is ranked 35th nationally. The Mount Sinai Health System includes more than 400 ambulatory practices and other community locations, and more than 7,000 primary and specialty care physicians, as well as 200 physicians and other experts at 11 multidisciplinary practices based on Long Island.

Combined with Mount Sinai South Nassau’s roster of approximately 900 physicians and 22 ambulatory practices, Long Islanders now have access to a vast continuum of community-based specialty physician practices, including cardiology, internal medicine, primary care, men’s and women’s health, physical medicine and rehabilitation, orthopedics, cancer care, and many other services.

Mount Sinai South Nassau operates the only Trauma Center on the South Shore of Nassau County, along with Long Island’s only freestanding Emergency Department in Long Beach. The hospital also is nationally recognized for its nursing care and has received honors for orthopedic treatment and women’s care from Healthgrades, a national independent rating agency.

At the announcement of the hospital’s new name, from left: Adhi Sharma, MD, Executive Vice President for Clinical and Professional Affairs, and Chief Medical Officer, Mount Sinai South Nassau; Stephen J. Silich, Vice President, Business Development, Mount Sinai Health System; Rajiv Datta, MD, Chair of the Department of Surgery, Mount Sinai South Nassau; Arthur Klein, MD, President, Mount Sinai Health Network; Richard J. Murphy; President and Chief Executive Officer, Mount Sinai South Nassau; and Aaron Glatt, MD, Chair of the Department of Medicine, Mount Sinai South Nassau.

What Does a Brain Tumor Feel Like?

Oct 1, 2019 | Featured, Neurosurgery, Your Health

After ignoring seemingly harmless symptoms for at least a year, Emmy-nominated producer Jeannie Gaffigan was diagnosed by a medical team at The Mount Sinai Hospital with a pear-shaped brain tumor. The large mass was severely compressing her brain stem, causing headaches, dizzy spells, and a loss of hearing in one ear. She had attributed the symptoms to being a busy working mom. Her doctors wondered how she was even able to walk or talk normally.

The Neurosurgery team at Mount Sinai, headed by Joshua B. Bederson, MD, Professor and Chair of Neurosurgery for the Mount Sinai Health System, quickly scheduled surgery to remove the life-threatening mass, which turned out to be benign (non-cancerous).

Read more about Jeannie Gaffigan’s story

Ms. Gaffigan’s case sheds light on the importance of paying attention to persistent symptoms. But not every dizzy spell is cause for concern.

Leslie Schlachter, PA-C, Clinical Director of Neurosurgery at The Mount Sinai Hospital, works closely with Dr. Bederson and was there to greet Ms. Gaffigan and her husband, comedian Jim Gaffigan, when they arrived looking for answers. Drawing on the numerous cases she has seen over the years, she explains which symptoms you should never ignore and why you are—probably—fine.

What specific symptoms may point to a brain tumor?

The brain is complex. It controls everything we do, allowing us to see, smell, and move. Because of this, symptoms of a brain tumor depend on where the tumor is located and what section of the brain it is pressing on. Generally, changes in your sensory, motor, or visual function that linger for more than a few days need to get checked. For example, if you have played tennis every weekend for the past twenty years and one day you cannot hold your racquet; that is a problem. Or, if you suddenly cannot see well out of your right eye, that is concerning.

I experienced dizziness for a few days last month. Should I check in with my doctor?

Nausea, vomiting, or a change in balance that lingers and does not respond to medicine warrants a visit to your doctor, especially if these symptoms are limiting your ability to function. Keep in mind: if you have a neurological condition, things are not going to get better. So, if your symptoms subside after a few days, there is likely no cause for concern.

Should I go to the emergency room if I am concerned? Will I seem like a hypochondriac?

If you are concerned, make an appointment with your medical provider first, whether that be a doctor, nurse practitioner, or physician assistant. I always tell people, you are going to get a cold, the flu, and food poisoning, and you may feel terrible. That is normal. However, if you are experiencing symptoms that progressively worsen and do not go away, call your medical provider. Not seeking medical help is the problem.

The only time you should panic is if you are having what I call “The Worst Headache of Your Life.” If your headache is so severely debilitating that all you want to do is sleep because you feel as though your head is going to explode, seek medical assistance immediately as you may have a brain bleed.

What happens if my doctor is concerned about my symptoms? Will I see a neurosurgeon right away?

No. If your medical provider is concerned about your symptoms, he or she may recommend a CT scan or, depending on your symptoms, refer you to an ear, nose, and throat specialist or neurologist. You will only see a neurosurgeon if you have been diagnosed with a neurosurgical condition that requires intervention.

What should I do if my doctor is not taking my symptoms seriously?

Unfortunately, there are times when a patient’s concerns are not heard. And sometimes, your doctor may chalk up your symptoms to stress. The most important message I can give to patients is: Advocate for yourself. You know your body. If something does not feel right, get a second opinion.

Learn more about Neurosurgery at Mount Sinai

No Laughing Matter: In a New Book, Comedy Writer and Producer Jeannie Gaffigan Explains How Mount Sinai Saved Her Life

Sep 30, 2019 | Featured, Patient Stories

Jeannie Gaffigan with Joshua B. Bederson, MD, Professor and Chair of Neurosurgery, Mount Sinai Health System, the surgeon she credits with saving her life. Click here to watch Jeannie Gaffigan and Dr. Bederson on CBS Sunday Morning

From the moment her doctor told her a magnetic resonance imaging (MRI) scan had revealed a large mass in her brain, Jeannie Gaffigan found her life filled with fear and anxiety—until she and her husband walked into The Mount Sinai Hospital and the office of Joshua B. Bederson, MD, Professor and Chair of Neurosurgery, Mount Sinai Health System.

Dr. Bederson and his staff quickly confirmed that she had a massive, life-threatening, benign pear-shaped tumor at the base of her skull that was severely compressing her brainstem. Just as important, they offered her a plan and a team of top-notch doctors and staff to whom she would entrust her life.

“We had hit the jackpot,” she writes of the team at Mount Sinai in her new book “When Life Gives You Pears,” in which she recounts her journey from sickness to health and the role that humor, faith, and family—plus her extended medical team—played in her recovery.

Watch: Jeannie and Jim Gaffigan tell their story on CBS Sunday Morning

Days after that first visit, Dr. Bederson removed the tumor during a 10-hour operation, one in which Dr. Bederson and his team relied on years of experience, combined with innovative augmented reality technology to systematically separate each of the nerves and myriad blood vessels from the tumor. By working above and below these nerves within the tumor and along the brainstem, eventually a complete removal of the tumor was accomplished.

Now, two years later, Jeannie Gaffigan, 49, a director, producer, and comedy writer and the wife of comedian Jim Gaffigan, is back to normal and savoring the simple pleasures of her life as a mother of five young children, still very grateful for the exceptional care she received from Dr. Bederson and many others at Mount Sinai.

“Every single person who has touched my life here has been an angel, and I just am so thankful for this institution,” she said during an emotional speech last year at a Mount Sinai fund-raising event. “Every single person who I’ve been treated by has been like the best and the top of their profession. I thank you, my husband thanks you, my five children thank you.”

In fact, she begins the acknowledgements at the end of her book by thanking by name a dozen Mount Sinai doctors, specialists, and staff members who cared for her in the weeks after surgery.

Learn more about the podcast

Her story also contains an important lesson: For at least a year, she had ignored a number of seemingly harmless symptoms, including headaches, dizzy spells, and loss of hearing in one ear. Otherwise, doctors might have found the tumor at an earlier stage, before it grew to about six centimeters, which could have reduced some of the complications and side effects from the surgery.

She had dismissed her symptoms as the result of her hectic life, mixing a career in entertainment with caring for young children. “I just compartmentalized all my symptoms because I was so busy,” she said in an interview as part of Mount Sinai’s Road to Resilience podcast. “So I just made them all their own separate things. So separately they seemed like little, mild annoyances.”

She might have continued to ignore her symptoms if not for the Gaffigan family’s physician, according to the book. During a routine checkup for her kids, Jeannie Gaffigan couldn’t hear something the doctor said. The doctor asked how long she had had trouble hearing. All Jeannie Gaffigan could say was that it had been a while. The doctor urged her to go a specialist. An ear, nose, and throat (ENT) specialist confirmed she was deaf in her left ear. Not seeing anything wrong with her ear during an examination, the doctor ordered an MRI on the chance there might be some obstruction deep inside the ear. The MRI showed a large mass in her brain.

At that point, she needed to see a neurosurgeon quickly. A dear cousin urged her to go to Mount Sinai. After a call from her ENT doctor, she had an appointment with Dr. Bederson, who was able to see her immediately, joined by his senior physician assistant Leslie Schlachter, PA-C, Clinical Director of Neurosurgery at The Mount Sinai Hospital. Looking at her MRI scan, Dr. Bederson said the tumor had probably been growing for years and was pushing against her brainstem, leading to a range of symptoms she had been feeling. Immediate brain surgery was needed to remove the tumor.

“I have just one question: Am I going to die?” she asked Dr. Bederson. Dr. Bederson said no. His response “was all that I needed. I knew everything else was going to be okay,” she writes in her book. (After the surgery, Dr. Bederson would diagnose the tumor as a choroid plexus papilloma, a rare type of slow-growing, non-cancerous (benign) tumor.)

A family photo of the Gaffigans

The surgery marked the beginning of a lengthy recovery, with her husband leading her caregiver team. Immediately afterwards, she spent about two weeks in the intensive care unit at The Mount Sinai Hospital, and then several more weeks in the hospital. She could not eat or drink because the surgery had left her unable to swallow. She left the hospital with a feeding tube, which was removed months later. Thanks to speech and swallow therapy, she has regained the ability to talk and eat.

Despite her personal ordeal, Jeannie Gaffigan is expecting something good to come out of her experience.

She had not intended to write a book; it began as notes she kept for herself. She hopes it may help others. “It’s not a textbook, but it’s something I wish that I had read going into this,” she told Mount Sinai’s podcast team.

And she and her husband have launched a campaign to help Dr. Bederson and Mount Sinai’s Department of Neurosurgery purchase the latest equipment for his operating room. Their fundraising goal: $500,000.

Watch a video about Jeannie Gaffigan's life-saving surgery

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