Conference Addresses Lack of Research on Female Brain Injury

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

Speaker Trisha Meili discussed coming to terms with brain injury.

The Friedman Brain Institute (FBI) in May cosponsored a program with the Brain Injury Research Center of Mount Sinai and the Department of Rehabilitation Medicine that focused attention on the little-known and -discussed incidence of traumatic brain injury (TBI) and chronic traumatic encephalopathy (CTE) in women. CTE is a neurotrauma-associated neurodegenerative condition that is most often found in males who are professional athletes and soldiers.

The program, held in Goldwurm Auditorium and hosted in conjunction with the nonprofit organization Pink Concussions, addressed the lack of research on CTE in women and highlighted its prevalence among females who sustain head trauma each year as a result of sports injuries, accidents, domestic violence, or military duty.

In his opening remarks, Eric Nestler, MD, PhD, Nash Family Professor of Neuroscience, Director of The Friedman Brain Institute, and Dean for Academic and Scientific Affairs, Icahn School of Medicine at Mount Sinai, said, “We know that lack of knowledge and an inability to treat brain injury in women and girls is a major gap in the medical profession.”

Dr. Nestler noted that the FBI is a strong proponent of establishing diversity in neuroscience and the advancement of women and those who are underrepresented in science and medicine. “Cohosting this program,” he said, “adds a whole other dimension to this initiative and highlights the need for greater attention to the medical conditions that affect women and girls.”

Pink Concussions founder Katherine Price Snedaker, LCSW, said she began researching the subject of brain injury when one of her sons sustained five concussions from playing sports. After hearing from the mothers of daughters who were also repeatedly experiencing them, she created a support group, which ultimately led to the establishment of Pink Concussions in 2013.

Dara Dickstein, PhD, an Adjunct Assistant Professor in the Department of Neuroscience at the Icahn School of Medicine and a co-organizer of the event, presented research she is conducting that involves neuroimaging and the use of biomarkers to aid in the diagnosis of CTE during life. Currently, the only way CTE can be definitely diagnosed is through postmortem brain analysis at autopsy. Dr. Dickstein is studying the potential efficacy of an experimental radioactive tracer that binds to tau (proteins that build up in the brains of CTE sufferers) and shows up on PET scans, to help diagnose the condition during life.

At the Mount Sinai event, Yelena Goldin, PhD, Staff Neuropsychologist at Hackensack Meridian Health in Edison, N.J., explained that after reviewing thousands of studies on outcomes of traumatic brain injury, her team could find only 54 that factored sex and gender into their analyses. Additionally, Dr. Goldin said, there was no follow-up medical literature on female athletes in high school and college six months after they had recovered and were medically cleared to return to their sports.

One of the program’s speakers, a woman who experienced injuries to her head as a result of domestic violence, said the lack of medical or scientific research left her confused about her subsequent health problems, including menstrual issues, forgetfulness, depression, and anxiety. “At the time,” she said, “the only advice I got was that I would probably get some migraines.”

Kristen Dams-O’Connor, PhD, Director of the Brain Injury Research Center at the Mount Sinai Health System and a co-organizer of the event, said recent studies from her group have not revealed any connection between traumatic brain injury and Alzheimer’s disease, although they did find damage to small blood vessels and the presence of Lewy bodies—abnormal deposits of protein, which are implicated in Parkinson’s disease.

Plenary speaker Trisha Meili said the lack of a definitive link between TBI and Alzheimer’s was welcome news to her. In April 1989, Ms. Meili, a young investment banker, survived a brutal attack while jogging in Central Park. The attack—which included a life-threatening blow to her head—made headlines around the world.

During the program, Ms. Meili discussed her recovery and her life today. “Mentally, I will never be the same as I was before the brain injury,” she said. “Acknowledging this to myself, needless to say, is not a great feeling. But in another way, it gives me peace. I can live with it. I accept it. It’s a giant step in my healing.”

New Chief Wellness Officer Named

May 22, 2018 | Featured, Patient Stories

Jonathan Ripp, MD, MPH

The Icahn School of Medicine at Mount Sinai has named Jonathan Ripp, MD, MPH, as Senior Associate Dean for Well-Being and Resilience, and Chief Wellness Officer. Dr. Ripp assumes the new post amid mounting challenges for medical professionals that include exhaustive clerical demands, increasingly burdensome documentation procedures, and numerous metric-driven requirements. Stressors such as these distract providers from the meaningful aspects of their jobs and make it harder for physicians to provide patients with the best possible care.

According to a December 2016 article in the Annals of Internal Medicine, physicians spent 27 percent of their total time on direct clinical face time with patients and 49.2 percent of their time filling out electronic health records and doing other administrative work. The study found they spent another 1 to 2 hours each night—after office hours—doing additional computer or clerical work.

“Our physicians and clinicians care for patients and families in need in an evolving health care system,” says Dr. Ripp. “They are driven in this pursuit to put the patient first, but often their own well-being suffers. We need to support their mission by improving the system-level factors that facilitate their purpose and provide them with the resources to promote well-being.”

Dr. Ripp has assumed a national leadership role in this endeavor. In April, he and colleagues from the Mayo Clinic and University of California San Francisco School of Medicine published a widely circulated “Charter on Physician Wellbeing” that appeared in the Journal of the American Medical Association.

David O. Barbe, MD, MHA, President of the American Medical Association (AMA), wrote, “Achieving national health goals depends on an energized, engaged, and resilient physician workforce. The AMA strongly supports the Charter and its declaration that the nation is best served by a health system that promotes professional fulfillment by allowing physicians to meet their patients’ needs for high-quality care.”

In his new role at Mount Sinai, Dr. Ripp will identify areas of excessive administrative and clinical burden that can be targets for intervention and workplace redesign efforts. He will also lead new initiatives that optimize physical and mental health.

“My role is to understand the local drivers of job burnout and to solve difficult problems,” he says. Initial initiatives will engage focus groups of faculty, students, and trainees and include gathering survey data on the drivers that erode well-being. He plans to identify a cohort of department-level faculty wellness champions who are eager to partner in implementing change.

Dr. Ripp—a faculty member in the Department of Medicine since 2004—has overseen the development of numerous wellness initiatives in Graduate Medical Education (GME) for the past two years. These include the expansion of mindfulness and reflection programs, codification of a policy that meets accreditation for well-being requirements, and the establishment of a GME-funded well-being grant program to decrease trainee work intensity and administrative burden. In addition to this work, he provides primary care to homebound New Yorkers through the Mount Sinai Visiting Doctors Program.

As Dr. Ripp pursues new programs within the Icahn School of Medicine and the Mount Sinai Health System, he also will continue his work on a national level. Over the course of their careers, physicians can expect to encounter patients who are dealing with extreme pain and suffering. Incorporating resilience-building strategies into medical training and education can provide physicians with the emotional awareness and support they need during these stressful encounters.

The development of clinician well-being initiatives will take a large effort, says Dr. Ripp, but the rewards for the nation’s doctors and patients are potentially huge.

Mount Sinai Adolescent Health Center Hosts Conference on Violence Against Children

May 8, 2018 | Featured, Patient Stories, Research

“When a young person is traumatized, it sets the stage for a life that is more difficult.” Dennis S. Charney, MD

“Is anything more important than ending violence against children and adolescents?”

That rhetorical question was posed by Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System, in his opening remarks at a recent conference sponsored by the Mount Sinai Adolescent Health Center and the World Childhood Foundation USA. “When a young person is traumatized,” said Dr. Charney, a renowned expert in the neurobiology and treatment of mood and anxiety disorders, “it sets the stage for a life that is more difficult.”

The conference, “Ending Violence Against Children: Developing a Roadmap to a Healthy Childhood and Adolescence,” was held Thursday, March 22, and Friday, March 23, in Stern Auditorium, and kicked off the 50th anniversary of the Mount Sinai Adolescent Health Center, a unique New York City-based program that delivers comprehensive medical and mental health services and prevention education to people ages 10 to 22.

More than 70 percent of the young people who come to the Adolescent Health Center have a history of trauma, according to conference co-director Angela Diaz, MD, PhD, MPH, Director of the Mount Sinai Adolescent Health Center and the Jean C. and James W. Crystal Professor of Pediatrics, and Professor of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai.

“Young people are our present and our future,” said Dr. Diaz. “Together, we can create a model for ending violence against children.”

Sixty experts served on panel discussions that included research into the long-term consequences of early childhood abuse and neglect, the economic impact of violence in childhood, and ways to safeguard the mental health of children and adolescents. Panel participants covered topics such as abuse prevention, support for survivors, the role of the justice system, and ways to find innovative solutions.

David Finkelhor, PhD

Rachel Lloyd, Founder and President of Girls Educational and Mentoring Service (GEMS), participated in a panel discussion on helping victims of sexual trafficking. “Poverty is the baseline for almost every child who ends up being sexually trafficked,” she said. “Sexual trafficking is a matter of demand and supply, but it’s driven by sexual abuse at home, poverty, domestic violence, and running away from Child Protective Services.”

The audience was comprised of hundreds of clinicians, researchers, policymakers, philanthropists, and youth advocates, who came together to identify solutions to defend children’s rights and promote better living conditions for children. Joanna Rubinstein, DDS, PhD, President and Chief Executive Officer, World Childhood Foundation USA, also served as co-director of the conference.

David Finkelhor, PhD, Director, Crimes against Children Research Center, University of New Hampshire, delivered the conference’s keynote address, and proposed the creation of a common field of study to examine the full scope of violence against children, including bullying and peer victimization, as well as abuse by adults and how the risk of violence changes over the course of development.

“Children suffer five times more violence than adults,” he said. “Why are they so vulnerable? They are small, dependent, inexperienced. Kids don’t choose their families, schools, or neighborhoods.”

Dr. Diaz and Dr. Rubinstein concluded the conference with a call to action that would include addressing barriers to identifying victims and integrating a “trauma-informed” approach into programs that interact with children and youth. “This is the beginning of a movement,” Dr. Diaz said.

Angela Diaz, MD, PhD, MPH

 

Read more about Research at Mount Sinai

Introducing Mount Sinai Future You, a New Television Series

May 2, 2018 | Featured, Future You, Patient Stories, Research


A new television series called Mount Sinai Future You, which highlights innovation at Mount Sinai, is being broadcast on CUNY TV, the non-commercial educational-access cable channel run by The City University of New York.

Mount Sinai Future You takes viewers behind the scenes as doctors at Mount Sinai Health System leverage innovative science to change patients’ lives every day. The series  highlights preventative care and treatment models that will lead to better health and longer lives.

New episodes of Mount Sinai Future You will run monthly, in the first week of each month, on Wednesdays at 9:30 pm, Thursdays at 6:30 am and 5 pm, and Saturdays at 11 am. They will cover newsworthy topics in medicine, as well as highlight new treatments, innovations, and preventive care for patients. The series is produced by Mount Sinai.

In its first 30-minute episode, Mount Sinai Future You highlights:

  • Dennis Charney, MD, Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai, who discusses the anniversary of the Icahn School of Medicine, a leader in medical breakthroughs since 1968, and shares his own story of resilience after recovering from a traumatic event.
  • Breakthroughs in operating room technologies, such as augmented reality, simulation, and 3D printing, by surgeons and researchers in the Department of Neurosurgery.
  • The science of addiction, with Eric Nestler, MD, PhD, Dean for Academic and Scientific Affairs and Director of The Friedman Brain Institute, who is researching addiction and depression, and Yasmin Hurd, PhD, Ward-Coleman Chair of Translational Neuroscience and Director of the Addiction Institute at Mount Sinai, who is investigating how a component of the marijuana plant may aid in treatment of opioid addiction.
  • How vaccines developed in the lab of Joshua Brody, MD, Assistant Professor of Medicine (Hematology and Medical Oncology), are targeting cancer cells.
  • Douglas Dieterich, MD, Professor of Medicine (Liver Diseases), and a patient of his, who relate their shared journey with hepatitis C.

‘Scarless’ Thyroid Surgery Wins a Patient’s Gratitude

Updated on Jun 30, 2022 | Featured, Patient Stories

Sarah Bird during a follow-up visit with Hyunsuk Suh, MD.

 

Sarah Bird, a 27-year-old accounting supervisor, had a “very rough” month about a year ago. She went to Mount Sinai Union Square to check out a lump on her neck that she had first spotted in a photograph. During follow-up visits, an ultrasound scan and biopsy of her thyroid found a nodule the size of a golf ball, and she was advised to have it removed.

“I went from not even knowing I had this condition to being told, ‘You have to have surgery pretty quickly,’” she says.

Ms. Bird was worried about a long recuperation after surgery. And because she is fair-skinned and prone to thick, raised keloid scars, she also worried that she would have “this huge worm across my throat for the rest of my life.”

But those fears were put to rest by Hyunsuk Suh, MD, who used an advanced robotic procedure to remove the nodule. Ms. Bird says she is “just so thankful” that she was referred to Dr. Suh, Assistant Professor of Surgery at the Icahn School of Medicine at Mount Sinai, who in 2015 was the first in the United States to perform robotic bilateral axillo-breast approach (BABA), a “scarless” technique in which part or all of the thyroid is removed through four small incisions to the breasts and axilla (underarms). Mount Sinai is still one of only a few health systems in the nation to perform the procedure.

Dr. Suh also was the first in the nation to use robotic BABA to perform a radical modified neck dissection—removing a patient’s metastatic thyroid cancer and neck lymph nodes. Radical modified neck dissection typically requires an incision of about 10 centimeters, but the BABA technique uses four very small incisions, from 8 to 12 millimeters, making it unique among thyroidectomy approaches.

Dr. Suh, who earned his medical degree at the Johns Hopkins School of Medicine, trained with the physicians who developed the BABA procedure at Seoul National University in South Korea. When that six-month fellowship ended in 2015, he came to the Mount Sinai Health System, where he works closely with his mentor William B. Inabnet III, MD, Chair of Surgery, Mount Sinai Beth Israel, and Professor of Surgery, Icahn School of Medicine at Mount Sinai.

Robotic surgery is common in other specialties, such as urology and gynecology, Dr. Suh says, but it is an innovation in his field. “As surgeons we take great joy in learning new skills, new approaches, and new techniques,” he says, “and being in a place like Mount Sinai where there is an abundance of research and interests and innovations—that is very special.”

The BABA technique is as safe and effective as conventional thyroid surgery, Dr. Suh says, but some patients still prefer conventional surgery, which is typically performed through the front of the neck.

“Some people are apprehensive and fearful of something that is new. That is a natural response,” Dr. Suh says.“You have to explain to the patient how you were trained, and what the surgery entails, and what it means to do robotic surgery. Some people think you push a button and a robot comes out of a closet!”

Hyunsuk Suh, MD, was first in the nation to perform the advanced robotic procedure known as BABA.

Thyroid surgery—whether conventional or robotic—is usually ambulatory, meaning that patients are discharged after a few hours of observation. So Dr. Suh calls patients at home for a few days to check in. “Otherwise,” he says, “it is possible to lose the connection to the patient—being able to follow up on their symptoms and listen to their concerns.”

During Ms. Bird’s surgery, in March 2017, Dr. Suh removed the left lobe of the thyroid, including a benign four-centimeter nodule. Ms. Bird went home that day, and Dr. Suh called soon after.

“That was great,” she says. “I’ve never had a doctor who calls you at home and asks you how you’re doing.”

After some initial hoarseness and pain, Ms. Bird recovered quickly and was left with scars in her armpits that she says are “pretty much nonexistent.” In April 2017, she ran the SHAPE Women’s Half Marathon in 2 hours, 24 minutes. “It was my slowest half marathon ever,” Ms. Bird says. “But at least I finished, and it was very cool to be able to say, ‘You know, I had surgery a month ago, and I was down and out for a week, and now here I am crossing the finish line.’”

Two Mount Sinai Hospitals Work as One to Save a Life

Updated on Jun 30, 2022 | Featured, Patient Stories

Amit Pawale, MD

When 24-year-old Andrea Giraldo arrived in New York City from Miami to ring in 2018 with friends in the East Village, she had no idea how gravely ill she would soon become.

Her ordeal began with terrible leg pain, which sent Ms. Giraldo to a New York City hospital that is not affiliated with the Mount Sinai Health System. There, she was treated for blood clots in her leg vein and sent home. But later that night in her friend’s apartment, she had trouble breathing and collapsed.

The Emergency Medical Services ambulance took her to Mount Sinai Beth Israel (MSBI). Now unconscious, with very low blood pressure and a low blood-oxygen level, Ms. Giraldo was placed on a breathing machine. A CAT scan revealed that she had large life-threatening clots in her lung arteries. She received clot-busting medication (tPA) with no effect.

MSBI physicians contacted Amit Pawale, MD, Assistant Professor of Cardiovascular Surgery at The Mount Sinai Hospital, and a team of ECMO (Extracorporeal Membrane Oxygenation) specialists led by Dr. Pawale was dispatched immediately. They placed Ms. Giraldo on an ECMO machine, which supported her heart and lungs and prevented imminent cardiac arrest. ECMO works by draining blood from a patient’s vein and pumping it to an artificial lung or oxygenator that adds oxygen, removes carbon dioxide, and sends it back to the patient.

Her blood pressure and oxygen level normalized, and Ms. Giraldo was transported to The Mount Sinai Hospital on ECMO support. Dr. Pawale and his team performed open heart surgery, removed large blood clots from her arteries, and discontinued ECMO support. Vascular surgeons implanted an intravascular filter to prevent future clots from reaching her heart.

Four weeks after her surgery, Ms. Giraldo returned home to Miami, where she gradually resumed her work and daily activities. “I’m so glad I ended up at Mount Sinai,” Ms. Giraldo says. “I got the best care. The nurses were amazing, and Dr. Pawale literally saved my life.”

Dr. Pawale attributes Ms. Giraldo’s excellent outcome to exceptional teamwork throughout the Mount Sinai Health System: the Pulmonary Embolism Response Team, and the doctors, nurses, and technicians in the Cardiothoracic Surgery Intensive Care Unit.

 

The ECMO machine was used to help provide Andrea Giraldo with life-sustaining support.

Pin It on Pinterest