First-Time Mother Receives Life-Saving Aortic Surgery

Updated on Jun 30, 2022 | Cardiology, Featured, Patient Stories

From left, Ismail El-Hamamsy, MD, PhD, Yulia Nurikyan, and Percy Boateng, MD.

A first-time mother received life-saving heart surgery at The Mount Sinai Hospital, thanks to her quick response to her symptoms and knowledge of her family’s health history, says a leader of her surgical team, Ismail El-Hamamsy, MD, PhD, Director of Aortic Surgery, Mount Sinai Health System, and first author of a recent paper on aortic dissection repair during the COVID-19 pandemic.

The patient, Yulia Nurikyan, was 38 weeks pregnant and had not been feeling well, with a backache that she thought was caused by her late-stage pregnancy. In mid-May, in the heat of the COVID-19 pandemic, she woke up at 5 am with a heavy feeling in her throat. She got out of bed for a glass of water, then fainted. Her husband, Antoan, quickly called 911, and an ambulance rushed her to Elmhurst Hospital in Queens.

Ms. Nurikyan told the medical team at Elmhurst that her father had died of an aortic dissection in his 40s, so they ordered a CT scan and other diagnostic tests, which showed that she had a bicuspid aortic valve. This was crucial information. About half of patients with this heart defect develop an aortic aneurysm, an enlargement of the vessel that can lead to aortic dissection. This is a tear in the inner layer of the aorta, the main blood vessel that brings oxygenated blood to the rest of the body. Some people with an aortic dissection feel no pain, but common symptoms are severe sudden pain in the upper back or chest, shortness of breath, and dizziness or fainting.

Ms. Nurikyan underwent an emergency C-section, delivering a baby girl, Livia. She held her daughter for a few minutes, then she was rushed to The Mount Sinai Hospital for emergency heart surgery, since the imaging tests suggested that her aorta was about to rupture, which could have proved fatal.

Yulia and Antoan Nurikyan with baby Livia.

“In cardiac surgery, this situation is at the top of the list of emergencies,” says Dr. El-Hamamsy, who treated Ms. Nurikyan as soon as she arrived. Dr. El-Hamamsy, senior faculty in Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, is an expert in the repair of aortic dissection and recently published a study that found a significant decline in reported cases during the COVID-19 crisis.

In the study, published in May in the Journal of the American College of Cardiology, researchers compiled data on surgical repair of acute Type A aortic dissection in 11 New York City hospitals from January 1, 2018, to April 15, 2020, counting March 1, 2020, as the first day of the COVID-19 pandemic in the city. The study found that these surgical repairs fell 76 percent after the COVID-19 pandemic began—from 12.8 cases per month before the pandemic to 3 cases per month after the pandemic.

The investigators presented several potential reasons for the decline, suggesting, for example, that some aortic dissection patients did not call for help, fearing COVID-19 infection; or busy first responders were delayed in providing aid; or overburdened emergency departments may have missed or delayed diagnoses. The study said, “Although no causal relationship can be firmly established among the drop in type A aortic dissections, the COVID-19 outbreak in New York City, and the increase in at-home deaths since the last week of March 2020, this gives pause for thought.”

Ms. Nurikyan experienced a Type A aortic dissection. In a successful procedure, Dr. El Hamamsy repaired her bicuspid aortic valve, removing some of the injured blood vessel and replacing it with a synthetic graft, working with David H. Adams, MD, the Marie-Josée and Henry R. Kravis Professor and Chair of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, and the Cardiac Surgeon-in-Chief of the Mount Sinai Health System, and Percy Boateng, MD, Assistant Professor of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai.

Ms. Nurikyan’s baby, Livia, had remained at Elmhurst, placed in neonatal intensive care because of fluid in her lungs. Ms. Nurikyan and daughter spent a week at separate hospitals, and her husband could not visit either of them due to safety rules during the pandemic, though the hospitals kept them in touch through video calls. The family was happily reunited on May 23, when Ms. Nurikyan was picked up by her husband and they went together to get Livia. “My baby was the one who got me through it,” she said in an article on her care in the Daily News. She said she was grateful for her healthier heart and for the compassionate and expert care her new family received.

Ms. Nurikyan’s quick response to her symptoms was crucial, Dr. El-Hamamsy says, a point reinforced by the recent study. “It is critical, as we adjust to the pandemic, to balance the public health imperative of social distancing with the individual need to consult in the presence of sudden severe symptoms. Furthermore, additional resources, ranging from telemedicine to numbers of first responders, should be greatly increased,” the study concluded. “This serves as a word of caution for cities yet to experience a surge in COVID-19 cases, as well as for future similar events.”

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Mount Sinai Queens Nurses Share Memories With COVID-19 Patients’ Survivors

Updated on Jun 30, 2022 | COVID-19, Featured, Patient Stories, Stories of Strength

From left: The Rev. Dr. Rachelle Zazzu, Chaplain; Melissa Farmer, RN; Stefanie Dimitriadis, RN; Amparo Sullivan, RN; Jonathan Nover, RN, MBA, Senior Director of Nursing for the Emergency Department; and Francelia Thomas, RN, Nurse Manager.

The nurses of Mount Sinai Queens are giving a precious gift to families of patients who succumbed to COVID-19 during the height of the pandemic—their memories of the patients’ last days.

In one letter, carefully hand-written on lined paper, Amparo Sullivan, RN, reached out to the family of a patient who had “a nice smile behind her oxygen mask” and had spent peaceful moments chatting and holding her hand. “This courageous woman wasn’t just thinking about herself but was deeply concerned about how the pandemic was affecting us,” Ms. Sullivan wrote. “Her bravery and thoughtfulness gave me inspiration.”

Since May, Mount Sinai Queens nurses have been writing such letters to family members, in a program that arose from their determination to console families and their own need to remember the patients they worked so hard to save. The hospital is now returning to normal operations. But in April and early May, Mount Sinai Queens was hard hit by the pandemic; visitors were not allowed at that time, out of an abundance of caution, to help protect patients and staff.

“Our nurses were caring for people as they died, and I was praying for people as they died, and no family was present. And it’s heartbreaking,” says the Rev. Dr. Rachelle Zazzu, MA, DDS, Staff Chaplain for Mount Sinai Queens. “So we have been writing letters to the families, fundamentally saying, ‘Your mother was not just patient No. 1234. We cared for her, and we saw beauty in her, and we want you to know that when she died, she was taken care of with a lot of care.’”

So far about a dozen letters have been written by nurses including Ms. Sullivan, Melissa Farmer, RN, Stefanie Dimitriadis, RN, and Tamara Boncic-Heins, RN. The program began with a suggestion from Ms. Sullivan, says Jonathan Nover, RN, MBA, Senior Director of Nursing for the Emergency Department (ED) at Mount Sinai Queens.

“It was a very emotional time for everyone in the ED. So what Ampy Sullivan envisioned was this: If you are with a patient who is at an end-of-life moment and there is something you would like to share later with the patient’s family, jot down a note with the details and drop it into our Daisy box,” Mr. Nover said, referring to an awards program at the hospital. “Then the goal would be, when things calm down a little bit, to create a procedure for getting those letters to the patients’ families.

From left: Amparo Sullivan RN, Melissa Farmer RN, and Stefanie Dimitriadis RN.

That is indeed what happened. In addition to compiling the notes, Dr. Zazzu and Mr. Nover reached out to nurses for more remembrances during the daily huddles of departments such as the ED and Preoperative, Postoperative, and Palliative Care. Even after many weeks, the nurses had “amazing, vivid memories,” Mr. Nover says.

The nurses were told, “We don’t want this to be a burden, because you have a lot to do,” Dr.  Zazzu says. “We are just saying that if writing a letter can help relieve a burden for you, all you have to do is write it, and I will take care of the rest, make sure it gets to the family.”

After receiving the letters, family members have been writing back in profound gratitude. One family called the Mount Sinai Queens nurses “RN angels” and offered to pray for their safety as they cared for patients.  The letter-writing program is now well-established at Mount Sinai Queens, Mr. Nover and Dr. Zazzu say. And they hope it can spread through the Health System and beyond, because even though the crisis has waned in New York City, patients can still die without family members, far from home.

“It’s nice that we can tell families about their loved ones, and their stay, and how it affected us,” Ms. Sullivan says. “We hope it will give them a little peace of mind, and it’s therapeutic for us to share these experiences.”

Here are some of the messages from nurses to families, from heart to heart.

“Your mother was in no distress when she passed peacefully. I spoke to her, and told her how much her family loves her.”

“Your father was so, so brave. I won’t forget him.”

“People show you who they are down to the core when they are in life-and-death situations. Your mother was so kind. I prayed for her on my lunch break.”

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How I Recovered From COVID-19 at Home With the Help of a New App: A Patient Story

May 19, 2020 | COVID-19, Patient Stories, Your Health

Roberto Rapalo, a patient at Mount Sinai, at home with his family

Should I go to the hospital or stay at home? This is one of the first questions that people who think they have COVID-19 wrestle with. Now, thanks to a remote monitoring platform from Mount Sinai Health System called Precision Recovery, patients can have their symptoms monitored by a provider daily, and know that their care will be escalated if necessary.

Once a patient signs up, a member of the Precision Recovery team at Mount Sinai contacts the person for an online video chat. The patient then downloads a daily symptom tracking app onto any smart device which monitors symptoms of the virus, such as body temperature, cough, breathing levels, and body aches. A provider checks in with the patient weekly through video chat. But if the symptoms get worse, the patient is contacted by a provider to discuss the new or worse symptoms and determine if increased monitoring or an emergency room visit is needed.

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David F. Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System, and Christopher Kellner, MD, a cerebrovascular neurosurgeon with the Mount Sinai Health System, developed Precision Recovery, an innovative system to monitor patients with COVID-19 symptoms remotely so they can stay home and rapidly respond to their needs when necessary. Click here to read a Q&A, in which they describe how this novel platform can help patients and hospitals in New York and throughout the United States.

“Precision Recovery worked great for me. COVID-19 was a battle—I had it for 14 days and each day was like a new round in a boxing match. Between Day 7 and 12, I was so weak it was difficult to think properly,” says Roberto Rapalo, a patient at Mount Sinai who used the new system. “I was struggling with the decision of whether to go to the hospital or not. It was scary, but the fact that my data was being monitored every day gave me confidence. Dr. Kellner was watching my symptoms progress, and I trusted the advice he gave me. He helped me get through this. In my opinion, you can’t get through COVID-19 by yourself.”

Precision Recovery was developed by David F. Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System, and Christopher Kellner, MD, a cerebrovascular neurosurgeon with the Mount Sinai Health System.

Dr. Kellner said the system allows physicians to closely monitor patients, which is important because the disease can take a different course for every one of them.

“Sometimes people are doing pretty well for a week or ten days, and they may even to start to feel better. But then they start feeling much worse for a day or two after that. That was the case with Rob,” he says. “He began having a hard time breathing and had fever again. So we initiated a video chat with him, and I was able to assess his condition. I saw that he was short of breath, but we talked through the criteria for coming to the hospital. That gave him the confidence that even though he was feeling worse, he would be able to ride it out at home. After a day of bad symptoms, he started to feel better, and he never had to come into the hospital.”

Mr. Rapalo said the system helped him track his symptoms and develop trust in his doctors.

“Every day I input my blood pressure, my temperature, my heart rate, oxygen saturation, as well as whether I had shortness of breath, chest pains, or other symptoms. And that helped me trust that the doctor really did understand what I was going through,” he says. “In the end, I really needed that pep talk. With any other disease I’ve had, once you start to feel better, that’s it. But COVID-19 is longer than any other disease I’ve had. And when I got worse after starting to feel better, that surprised me. So my conversation with Dr. Kellner made me feel that he had my back and was supporting me.”

What he experienced is typical for many COVID-19 patients, according to Dr. Kellner.

“Rob is a perfect example of what most people are going through with this disease. It’s unpredictable how it will go for each individual person. We’re still trying to figure that out as a medical profession, and sometimes there’s mixed messages,” says Dr. Kellner. “Someone might go to an urgent care center and be sent home with the instructions, if your symptoms get worse, contact your provider or call 911. If patients have this roller-coaster ride of symptoms, they need repeat assessments, and that’s what Precision Recovery provides.”

The goal of the system is to keep people out of the hospital who don’t need to go, and give people at home the assurance that they are being monitored effectively. Another goal is to catch people at home whose symptoms worsen and require hospitalization.

“That has happened—we saw that they met the criteria for being hospitalized, so we called an ambulance and contacted the emergency room to let them know that a COVID-19 patient was coming in,” says Dr. Kellner.

It’s important to note that this is a daily data entry by the patient, so doctors can’t necessarily react to an emergency. Patients may still need to call 911 in an emergency. Or they may need an urgent care visit or a virtual visit like Mount Sinai NOW.  Precision Recovery fills a role somewhere in between.

Mr. Rapalo said he began feeling better after about two weeks with the illness.

“I turned a corner around Day 13 and now I feel so much better. My cough has decreased and I’m improving every single day,” he says. “I’m still entering my data every day, so that if I do get worse, I’ve got a safety net. I have an appointment with the physical therapist of the Precision Recovery program, and I’m looking forward to getting tips on how to improve my breathing and the tightness in my chest.”

He added, “The main benefit of the Precision Recovery program is that you have people standing by your side, fighting with you. And that helps with your mental side of your recovery, and helps you make the right choices for your care. I am looking forward to being 100 percent, and I believe the program is getting me there.”

To enroll in Precision Recovery, text “Precision Recovery” to 332-213-9130.

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Large-Vessel Stroke and COVID-19 in Young Patients: New Insights

May 11, 2020 | COVID-19, Featured, Patient Stories, Research

The Icahn School Medicine at Mount Sinai team studying the relationship between stroke and COVID-19 included, from left, Thomas J. Oxley, MD, PhD; Johanna T. Fifi, MD; and J Mocco, MD, MS.

Cerebrovascular stroke specialists at the Icahn School of Medicine at Mount Sinai have reported on five patients younger than 50 years of age who presented to the Mount Sinai Health System in New York City with large-vessel stroke and COVID-19, surprising observations that were documented in The New England Journal of Medicine (NEJM) on Tuesday, April 28, 2020. Significantly, they have also determined that stroke patients may be delaying emergency care because of fear of COVID-19.

Large-vessel stroke, the most devastating form of stroke, occurs when there is a large blood clot in a major artery of the brain. It may cause severe symptoms in the patient and, when not diagnosed or treated quickly, may result in death or major disabilities. This form of stroke is typically seen in patients older than age 50.

“As the pandemic surged, we noticed a lot of the patients coming in for stroke were very young, and some of them did not have any traditional risk factors for stroke—but they were testing positive for COVID-19,” says the study’s senior author, Johanna T. Fifi, MD, Associate Director of the Mount Sinai Cerebrovascular Center, Director of Endovascular Stroke, and Associate Professor of Neurosurgery, Neurology, and Radiology. “We realized we had seen five young people with large vessel stroke within two weeks, and that was not usual,” adds Dr. Fifi. “By comparison, every two weeks over the previous 12 months, our service had treated, on average, less than one [0.73] patient younger than 50 years of age with large-vessel stroke.”

The patients described in the report were 33, 37, 39, 44, and 49 years old who presented to Mount Sinai during a two-week period, from March 23 to April 7, 2020. First author Thomas J. Oxley, MD, PhD, Instructor in Neurosurgery, and a specialist in vascular neurosurgery, was in the process of removing a blood clot from one patient. He was threading a tiny device through the artery to retrieve the clot, using an imaging monitor to guide him, and then he saw, he says, “There were new clots forming around the existing clot, in real time.” This was a very unusual finding.

While such observations are limited, and did not receive full peer review, NEJM says that it is sharing case reports like these that offer important teaching points or novel findings to communicate information on the global clinical effort against COVID-19. J Mocco, MD, MS, Director of the Cerebrovascular Center for the Mount Sinai Health System, Vice Chair of Neurosurgery, and Professor of Neurosurgery, says these five cases served as “an alert” to his stroke peers. The discovery of clots forming in the small vessels of many organs—in the lungs, heart, liver, and kidney—had already been reported in COVID-19 patients by several physicians from around the world, including pulmonologists and cardiologists at Mount Sinai.

One case highlighted in the NEJM report was that of a 33-year-old patient—a female who was described as previously healthy, and not having any of the usual risk factors for stroke.

She had reported symptoms of cough, fever, and chills for one week—possible symptoms of COVID-19—which were followed by progressive slowing or slurring of speech, with both numbness and weakness in the left arm and left leg over a period of 28 hours—symptoms of stroke. When she presented to Mount Sinai Brooklyn, her score on the National Institutes of Health Stroke Scale (NIHSS) was 19 (scores range from 0 to 42, with higher numbers indicating greater stroke severity). Dr. Mocco described it as “profound” stroke—the type, he said, that has the potential to result in the most severe physical and cognitive deficiencies.

Adding to the medical challenge was this patient’s delay in seeking medical care. Large-vessel strokes are very treatable, says Dr. Oxley, especially when treated within 6 hours, and up to 24 hours of the onset of symptoms. This patient, however, took more than a day to seek medical care. “She delayed seeking emergency care because of fear of COVID-19,” the report says. “She told us that she lives with elderly relatives, and she was afraid of exposing her family by going to the hospital, so she stayed home,” says Dr. Fifi.

Computed tomography (CT) and CT angiography showed a partial infarction of the right middle cerebral artery with a partially occlusive thrombus (blood clot) in the right carotid artery in the neck. Significantly, patchy ground-glass opacities in the lungs—a finding characteristic of COVID-19—were also seen on CT angiography. Testing to detect SARS-CoV-2, the virus that causes COVID-19, was positive.

The patient received antiplatelet therapy, which was subsequently switched to anticoagulation therapy. After a repeat CT angiography on Day 10 showed a complete resolution of the blood clot, the patient was discharged to a rehabilitation facility.

Among the four other patients, one was discharged home, another to a rehabilitation facility, one to the Mount Sinai stroke unit, and the fourth succumbed to his illness.

Since submitting their NEJM report, Dr. Mocco and his team have begun to analyze every stroke case that occurred while Mount Sinai hospitals were treating COVID-19 patients. “We saw a doubling in the rate of severe strokes, and more than half of the patients were positive for COVID-19,” he says. “And, we saw that they looked very different from the normal stroke population—they looked younger, and they were more likely to be men. It appears—very strongly—that there is an association here between the virus and forming blood-clots.” All of this requires more rigorous research, and the Mount Sinai stroke team will continue to observe and to collaborate on new investigations to increase understanding of the stroke and COVID-19 relationship.

In the meantime, each of them urges any individual who has stroke symptoms to seek immediate help. “Social distancing, isolation, and reluctance to present to the hospital may contribute to poor outcomes,” they wrote in the NEJM report. “Two patients in our series delayed calling an ambulance because they were concerned about going to a hospital during the pandemic.” Adds Dr. Oxley: “You need to call the ambulance urgently if symptoms such as facial drooping, arm weakness, and speech difficulties appear.”

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Medical Team Safely Delivers Baby in Critical Care Unit

Mar 10, 2020 | Patient Stories

Patient Leslie Echeverria, front row in hospital gown, with members of the Mount Sinai medical team who coordinated care from four specialties to ensure the safe delivery of her baby.

At around 5 pm on Wednesday, January 8, Leslie Echeverria, 24, gave birth to a healthy baby girl at The Mount Sinai Hospital—the norm at Mount Sinai under ordinary circumstances, where physicians and medical staff perform thousands of uneventful deliveries every year.

But Ms. Echeverria, born deaf and with severe congenital heart disease, was a high-risk patient. She had severe pulmonary valvular regurgitation, stenosis of the pulmonary valve, tricuspid valve regurgitation, and enlargement of the right side of her heart—both the right atrium and ventricle with right ventricular dysfunction. The delivery of her baby took place in the Hospital’s Cardiac Care Unit (CCU), a first for Mount Sinai Heart and Mount Sinai’s Department of Obstetrics, Gynecology and Reproductive Science.

The smooth birth was the result of meticulous planning and coordination among four of Mount Sinai’s medical disciplines, involving also the Department of Anesthesiology, Perioperative and Pain Medicine, the Institute for Critical Care Medicine, and the new Mount Sinai Adult Congenital Heart Disease Center.

“It was pretty unusual,” says Lauren Ferrara, MD, Assistant Professor of Obstetrics, Gynecology and Reproductive Science, and a specialist in Maternal and Fetal Medicine, who managed Ms. Echeverria’s pregnancy. “The CCU certainly wasn’t used to this. But everyone loves when a baby is born.” Jill Berkin, MD, Assistant Professor of Obstetrics, Gynecology and Reproductive Science, and a specialist in Maternal and Fetal Medicine, worked with Dr. Ferrara and delivered the baby, whom Ms. Echeverria named Shayla.

The makeshift delivery room in the CCU was crowded, periodically, with as many as 10 people. Dr. Berkin and her Maternal and Fetal Medicine team were accompanied closely by clinicians from Mount Sinai Heart, led by Ali N. Zaidi, MD, Associate Professor of Medicine (Cardiology), and Pediatrics, Director of the Mount Sinai Adult Congenital Heart Disease Center, and the Director of Pediatrics to Adult Transition of Care Program. Also on hand was Joshua (Zevy) Hamburger, MD, Assistant Professor of Anesthesiology, Perioperative and Pain Medicine, who managed Ms. Echeverria’s anesthesia care with Yaakov Beilin, MD, Director of Obstetric Anesthesia, and Professor of Anesthesiology, Perioperative and Pain Medicine, and Obstetrics, Gynecology and Reproductive Science. Ms. Echeverria’s mother was in the room, along with a sign-language interpreter and a critical care specialist.

“This story highlights how we take care of someone with complex congenital heart disease,” says Dr. Zaidi, who credits the entire Mount Sinai team with ensuring the safe delivery of baby Shayla. “We formulated a comprehensive plan. If Leslie or her baby ran into trouble we wanted to have all of our services there.”

Interestingly, it was not until Ms. Echeverria became pregnant that she learned about the seriousness of her heart condition. “After I got pregnant I found out so much more about my heart, because my parents didn’t really tell me, and I didn’t really know,” she says.

Infected by the rubella virus while her mother was pregnant with her in Ecuador, Ms. Echeverria had two open-heart surgeries a few years after she was born. But growing up in Queens, she played sports and did not experience pain or other symptoms. At the end of her first trimester, she came under the care of Drs. Ferrara and Zaidi, who began to carefully coordinate her delivery.

“We took a team approach that helped dispel concerns,” says Dr. Ferrara. “Even the day she was admitted to the hospital, everyone re-affirmed the plan.” Ms. Echeverria was admitted to The Mount Sinai Hospital at 35 weeks gestation and doctors induced labor at 38 weeks, with plans for the delivery to take place in the CCU.

Dr. Zaidi—trained and certified in Adult Congenital Heart Disease, and board certified in Adult Cardiology and Pediatric Cardiology—now oversees Ms. Echeverria’s cardiovascular care. He says medical advances over the past 30 years have made it possible for women with all forms of congenital heart disease to live long lives and have children of their own. But, he adds, many of these women do not receive the cardiovascular care they need as they transition from childhood to adulthood and lack the full understanding of their medical needs, which is something he would like to see changed.

Ms. Echeverria will need heart surgery in the near future. But right now, she says, “I am not worrying too much about my heart problems. I want to keep fighting for my goals and keep surviving. I just want to be successful with my baby.”

Football Star Brings Inspiration to Young Patients

Updated on Jun 30, 2022 | Asthma, Featured, Patient Stories

2019 Heisman Trophy winner Joe Burrow met with pediatric patients, including Ryan Diaz.

Patients and families at the Child Life Zone at Mount Sinai Kravis Children’s Hospital received a special visit on Sunday, December 15, from Joe Burrow, just a day after he was named the 2019 Heisman Trophy winner. The Louisiana State University quarterback hosted a special trivia-themed episode on KidZone TV, answered questions, opened up about his personal life and adversity, and provided inspiration to patients and their families in an appearance made possible through the Companions in Courage Foundation.

Mr. Burrow also signed football keepsakes for the patients, much to the delight of one 13-year-old patient, Ryan Diaz, an aspiring football player himself. Ryan already has helped his Harlem Jets youth football team win two championships—no easy feat for this offensive guard and center who happens to have severe asthma.

“He has had asthma since he was a baby, and he has been in and out of the hospital,” recalled his mother, Christina Ortiz. “He would miss up to 18 days a year of school.” Added Ryan: “It was really hard. I would miss so many things because I couldn’t control my asthma. I struggled so much from something I didn’t cause.”

“We have many, many patients like Ryan with severe asthma,” said Alfin G. Vicencio, MD, Vice Chair for Clinical Affairs and Strategy, and Division Chief for Pediatric Pulmonology at Kravis Children’s Hospital, who started treating Ryan in September 2018. “He has multiple triggers, and it’s hard to isolate one thing, so what is your recourse, stay inside a bubble?”

Ryan Diaz with Alfin G. Vicencio, MD

Dr. Vicencio is primarily treating Ryan with an injection of omalizumab, a monoclonal antibody, every two weeks. “This medication targets very specific molecules that are important in the asthma-inflammation cascade,” said Dr. Vicencio. The treatment acts to decrease the number of sudden episodes of wheezing, shortness of breath, and trouble breathing in individuals whose symptoms are not controlled with inhaled steroids.

“Mount Sinai has a very active program for the diagnosis and treatment of children with severe asthma,” said Dr. Vicencio. “This includes some important research initiatives that are starting to identify new subtypes of asthma, some of which may be driven by unsuspected infections.”

Other components of the research program, he added, are starting to identify new genes in the airway that may contribute to severity. This is part of a collaborative project with Supinda Bunyavanich, MD, MPH, MPhil, Professor of Pediatrics, and Genetics and Genomic Sciences, aimed at finding new therapeutic targets for patients with severe disease.

Following this protocol has allowed Ryan to keep active—except for when he was sidelined for two weeks in February with the flu and pneumonia. He is now able to resume his strenuous four-hour weekend football workouts and continue his participation in a dance and theater program.

Throughout it all, he has excelled in middle school, which has earned him an academic scholarship to Archbishop Stepinac High School in White Plains, New York, a football powerhouse.

“I just love football,” said Ryan, whose father, Juan Diaz, a registrar in Mount Sinai’s Institute for Advanced Medicine, played football for George Washington High School in New York City and has been a coach for the Harlem Jets since 2013. “It is a bond,” said Ryan.

Mr. Burrow is now certainly part of this bond, too. “It was really inspiring to speak with someone of that caliber,” said Ryan. “We talked about football, staying in school, and doing your best. One thing that made me proud—he signed my football jersey, and I gave him a signed Ryan Diaz #74 Harlem Jets hat, which he wore for the entire event.”

As for the football that Mr. Burrow signed, Ryan said he no longer has it. “We decided to give it to Dr. Vicencio because he has done so much for me. He let me lead a normal life. He really likes football, and I felt he really deserved that,” said Ryan. “I felt very, very touched,” said Dr. Vicencio. “I told Ryan that when he is in the National Football League, I will ask for one of these signed by him.”

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