Pulmonary & Critical Care Medicine; Sleep Medicine
I hold clinical appointment at the VA WNY Healthcare System. Aside of my administrative duties, I attend and supervise the sleep clinic at the VA My research focuses on the association between sleep apnea and cardiovascular diseases. My laboratory examines the burden of oxidative stress on endothelial function and the link to endothelial apoptosis. As part of a VA merit review grant, we are engaged in determining the impact of obstructive sleep apnea on the manifestations of post-traumatic stress disorder (PTSD) in veterans and whether treatment of sleep apnea alleviates the debilitating symptoms of PTSD. Toward that goal, we have adopted a patented screening tool to identify patients with sleep apnea. My research in the critical care arena involves the epidemiology and risk factors of Pseudomonas infections with the type III secretory system. The goal is to develop a rapid diagnostic tool to identify these organisms early in the course of infection. My other projects include studying the role of adjuvant treatment with corticosteroids in the management of severe community acquired pneumonia, such as nursing home acquired pneumonia, the management of morbidly obese critically ill patients and the long-term outcomes of elderly patients after treatment from a critical care ailment.
Pulmonary & Critical Care Medicine
My clinical practice focuses on management of general pulmonary disease with a specialized interest in cystic fibrosis (CF) and bronchiectasis. As a physician-consultant for the inpatient UBMD pulmonary consult services at Buffalo General Medical Center (BGMC) and at Roswell Park Cancer Institute, I attend to the needs of hospitalized patients with pulmonary problems in conjunction with the UBMD pulmonary team. This talented inpatient consult team of fellows, residents and medical students works under my supervision, and through my mentoring and teaching of them I hope to share my expertise and give back to medical education by training future healthcare professionals. I see patients to evaluate and treat pulmonary disorders such as shortness of breath, lung masses, abnormal chest imaging, abnormal pulmonary function tests, chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease and bronchiectasis. My outpatient office locations are the Heart and Lung Center at BGMC and the UBMD Specialty Clinic on Youngs Rd in Williamsville. As the Adult Director of the Cystic Fibrosis Center in Buffalo, the only care facility in Western New York accredited by the national Cystic Fibrosis Foundation, I provide comprehensive care for individuals with cystic fibrosis with a specially devoted multidisciplinary team. I also provide local care for patients who have received lung transplants for cystic fibrosis, coordinating and collaborating on their care with the transplant physicians and health care providers. In addition to these responsibilities as a pulmonologist, I attend to hospitalized patients at BGMC and WCHOB who are patients of the UBMD Internal Medicine and Pediatric practices to provide continuity of care for those physicians and their patients. I am actively engaged in clinical research through many international clinical trials, and through this work strive for improved therapies and a cure for individuals with cystic fibrosis. I am excited to see the major advances made recently with genetic mutation specific therapy being delivered to individuals with CF. Research will continue to progress as a result of successful clinical trials made possible by generous patients and the concerted efforts our highly productive local research team and the Cystic Fibrosis Foundation.
Pulmonary & Critical Care Medicine
My clinical expertise focuses on comprehensive management of general pulmonary problems such as evaluation and treatment of shortness of breath and chronic cough, asthma, chronic obstructive pulmonary disease (COPD), emphysema, pulmonary fibrosis, pleural effusions. My special clinical interest is the evaluation and management of patients with suspected or proven pulmonary arterial hypertension (PAH). There are less than a dozen pulmonary hypertension care physician-consultants in upstate New York (north and west of Poughkeepsie). In conjunction with UBMD’s pulmonary and cardiology consultants and other health care staff, I attend to the very specialized needs of patients with PAH at the UBMD dedicated pulmonary clinic at UBMD Internal Medicine at Amherst and at the outpatient Heart and Lung Center at Buffalo General Medical Center (BGMC). In my role at UBMD’s dedicated pulmonary clinic at UBMD Internal Medicine at Amherst, I evaluate and treat patients with the pulmonary conditions mentioned above. I also provide local care for patients who have received lung transplants elsewhere, coordinating and collaborating on their care with the physicians and health care providers from the lung transplant center where they received the transplant. As a physician-consultant for the inpatient UBMD pulmonary consult services at BGMC and Roswell Park Cancer Institute, and in conjunction with my UBMD pulmonary team, I attend to the needs of hospitalized patients with pulmonary problems. I actively participate in clinical research to find new and better ways to help manage and treat patients with PAH. A constant of my career has been to help supervise and educate future pulmonologists in both the hospital and outpatient settings so that they can improve their pulmonary medical knowledge base and procedural skills. I mentor fellows through UB’s pulmonary and critical care medicine fellowship program by clinically supervising their patient interactions in offices and hospitals, teaching them certain testing and procedural skills and emphasizing a respectful, attentive and compassionate approach to patients.
Critical Care Medicine; Internal Medicine - General; Pulmonary; Pulmonary & Critical Care Medicine; Sleep Medicine
I provide intensive care to patients admitted to the intensive care unit (ICU) at the Veterans Administration Medical Center (VAMC), I care for adult patients with pulmonary diseases such as chronic obstructive pulmonary disease (COPD)/emphysema, asthma, sarcoidosis, cough, lung nodules, pneumonitis and bronchitis, and patients with sleep disorders such as sleep apnea, narcolepsy, insomnia and restless legs syndrome. I have a special interest in the value of good physician-patient communication, and its effect on outcomes. Explaining disease process to patients, listening to their concerns and involving them in their medical decisions may have a positive effect on the results of treatment and interventions, and on their outcomes. I emphasize the importance of physician-patient communication with the students, residents and fellows I teach, train and mentor. I teach medical students in small group sessions in their first and second years, including courses in respiratory pathophysiology. Third- and fourth-year students rotate with me in the ICU and on the pulmonary service. I also supervise residents in the ICU and on the pulmonary consult service, and I mentor pulmonary, critical care and sleep medicine fellows in all aspects of their training. My sleep medicine research interest is focused on the pathophysiology of cardiovascular disease in patients with sleep breathing disorders, and on the interplay between PTSD and sleep disorders. My pulmonary and Critical Care Medicine research focuses on the relation between PTSD and Critical illness, and on pneumonia. Fellows are welcome to work with me on research projects.
Pulmonary & Critical Care Medicine
My clinical responsibilities include care of inpatient and outpatient veterans at the Buffalo VA Medical Center. My clinical interests include diagnosis and management of a broad range of pulmonary and sleep disorders including hemoptysis, chronic cough, dyspnea, chronic obstructive pulmonary disease, lung cancer, interstitial lung disease, pulmonary hypertension, sleep apnea, insomnia, restless leg syndrome and narcolepsy. I serve as the section chief of pulmonary, critical care and sleep medicine and as the director of the pulmonary function laboratory at the Buffalo VA Medical Center where I perform pulmonary function tests (PFTs) to evaluate a patient‘s respiratory status. I am a pioneer in the use of telemedicine and use electronic communications to evaluate patients with sleep disorders. I am in the process of expanding the use of this technology in the care of pulmonary patients — particularly those patients with suspected lung cancer.
Pulmonary & Critical Care Medicine; Sleep Medicine
My patient care responsibilities are centered at the Veterans Administration Western New York Healthcare System (VA) where I care for hospitalized patients with pulmonary problems as well as maintain two active outpatient clinics in the VA system: the pulmonary clinic and the sleep medicine clinic. I also supervise the continuity clinics at the VA. My research interests dovetail with my clinical work. I conduct research on skeletal muscle function in patients with chronic obstructive pulmonary disease (COPD) and those patients in pulmonary rehabilitation. I investigate predictors of the response to pulmonary rehabilitation, and I am also interested in sleep apnea research, comparing the occurrence of complications (postoperative and others) between patients with sleep apnea and those without. I examine sleep apnea treatment options and their success rate in special patient populations, such as patients with psychiatric disease or those on chronic opioid therapy. I run multicenter trials in patients with COPD, and I am presently involved in two NIH-sponsored studies: one examining the effects of long-term oxygen therapy in patients with mild hypoxemia and one examining whether administration of a statin can reduce the exacerbation rate in optimally-treated patients with COPD. I teach medical students primarily in the respiratory physiology course. I enjoy working with students throughout the full spectrum of medical education from first-year medical students to senior fellows in pulmonary critical care or sleep medicine. As the fellowship director for pulmonary critical care medicine I am responsible for the educational curricula for the fellowship.
Pulmonary & Critical Care Medicine; Bioinformatics; Gene Expression; Genomics and proteomics; Immunology; Protein Function and Structure
I am engaged in clinical, teaching and research responsibilities related to the evaluation and treatment of patients with pulmonary disease or patients who are critically ill. My inpatient practice is primarily located at the medical intensive care unit (MICU) at the Buffalo General Medical Center (BGMC). The MICU provides ongoing medical care to patients who are critically ill and require significant life support therapies to sustain life or vital bodily functioning. I am specifically interested in asthma, COPD, interstitial lung disease, pleural disease, pulmonary hypertension and lung cancer, but deal with a variety of disease. I evaluate patients with pulmonary disorders including shortness of breath, lung masses, abnormal chest imaging, abnormal pulmonary function tests, chronic obstructive pulmonary disease (COPD), asthma, pleural disease, interstitial lung disease, pulmonary hypertension and lung cancer, at the UBMD practice location at Conventus. As a member of the UBMD pulmonary division I provide inpatient pulmonary consultation at both BGMC and Roswell Park Cancer Institute. Currently I am focusing on the analysis of Big Data in medical/healthcare fields. I am particularly focused on the application of drug repurposing in translation and clinic research. Additionally, I am engaged in the study of the human airways microbiome and metagenome. The human microbiome is the the collection of all the microbial organisms in a human body, and the corresponding metagenome is the collection of the genes, and gene products of the microbes. Due the potential impact of the microbiome on human health and disease, I am interested in studying the putative effects the interaction with human hosts, specifically innate immunity interaction with the metagenome in lung disease. My collaborators include the Division of Allergy and Immunology. We endeavor to elucidate immune cell function in airway diseases such as asthma and COPD. Our research focuses on the development of therapeutics aimed at novel targets identified as important in the molecular basis of pulmonary disease; efficacious laboratory results will generate more effective treatment plans for patients. I am actively involved in teaching medical students, residents and fellows about the appropriate care of the patient with pulmonary disease and the critically ill patient.
Critical Care Medicine; Pulmonary & Critical Care Medicine; Internal Medicine; Pulmonary; Sleep Medicine
My clinical responsibilities include serving as an intensivist to patients requiring critical care and participating in the care of hospitalized patients with pulmonary problems at the Buffalo VA Medical Center (Buffalo VAMC). I also diagnose and manage outpatients with sleep problems at the Buffalo VAMC. My clinical research interests include asthma in the elderly and the impact of passive smoke on respiratory health. I also have been exploring novel appreciative assessment approaches to raise resilience and prevent burnout in faculty and medical trainees. In addition, I have a keen interest in working on strategies to enhance faculty mentoring skills. In addition to my clinical and research responsibility, I am passionate about educating future generations of health care professionals, and I help train and mentor medical students from the first to final year of medical school. I am one of the seminar leaders for the Clinical Practice of Medicine course. As such, I help train first-year students in clinical skills. I also play an active role in mentoring medical students, helping them to develop into compassionate and well-rounded physicians who have sound clinical skills as well as the humanistic qualities that are exhibited in the best medical care. As a member of the steering committee for the medical school’s Center for Medical Humanities, I am involved in designing a humanistic curriculum to prepare the next generation of physicians. I facilitate sessions with second- and third-year medical students, with the goal of supporting and fostering humanism. I teach students how to develop their ability to use self-awareness of knowledge, skill and emotional limitations in order to engage in appropriate help-seeking behaviors. As the associate clerkship director in internal medicine, I run “brain teasers” sessions to excite and activate my students as they embark on their clerkship journey into medicine. I conduct lectures and small group sessions in pulmonary and critical care medicine, on topics such as asthma, chest x-ray interpretation, pulmonary function testing and shock--and on topics diverse from my subspecialty such as rheumatology, infectious disease and hematology. In addition, I teach medicine residents and the pulmonary, critical care and sleep medicine fellowship trainees who rotate with me on the inpatient and outpatient services. As a preceptor and member of the Resident Clinical Competency Committee, I provide support and career advice to residents during their training. I believe the ability to think creatively is essential in the medical field, and I strive to help students and physicians-in-training overcome creative barriers. I develop methods to guide students to think “out of the box” and to be inquisitive, and I encourage them to apply these skills to help recognize problems, solve medical cases and design research and clinical treatment.
Pulmonary & Critical Care Medicine
As a faculty member in the division of pulmonary, critical care and sleep medicine, I split my time among the medical intensive care unit (MICU), the outpatient pulmonary clinic and the inpatient pulmonary consult services at Buffalo General Medical Center (BGMC) and Roswell Park Cancer Institute. In the MICU we are responsible for the care of critically ill patients from within the Kaleida Health system and, as a tertiary care center, routinely accept transfers from surrounding hospitals. On pulmonary service, I am consulted for a wide range of disorders, including chronic obstructive pulmonary disease (COPD), asthma, pulmonary arterial hypertension, lung masses and interstitial lung disease. I also provide pre-operative assessments and ventilator management for our non-medical critical care services. Together with other faculty from the division, I oversee the training of residents, interns, medical students and pulmonary critical fellows who rotate through the MICU and pulmonary services. As a division, we are actively involved in didactic teaching sessions as well as day-to-day bedside teaching. In addition, I teach at UB’s School of Medicine and Biomedical Sciences and provide core lectures for students rotating through internal medicine at BGMC.
Pulmonary & Critical Care Medicine; Immunology; Membrane Transport (Ion Transport)
My clinical responsibilities include working as one of five Intensive Care Unit physicians at the Buffalo VA Medical Center (Buffalo VAMC). I also have a pulmonary medicine outpatient clinic at the UBMD multispecialty practice in Williamsville. My outpatient clinic accepts all patients, with a focus on interstitial lung disease (associated with collagen vascular disorders such as systemic lupus erythematousus [SLE]), scleroderma, rheumatoid arthritis, Sarcoidosis, the idiopathic pulmonary pneumonitis syndromes (IPF/UIP) and advanced chronic obstructive pulmonary disease (COPD). We are one of the founding sites of the Greater New York Sarcoidosis Consortium and work closely with our neurology colleagues in managing patients with respiratory complications of neuromuscular disorders such as ALS, Duchenne‘s Muscular Dystrophy and others. I focus my research on understanding the impaired immune response to infection that occurs in patients with COPD. This impaired immune response leads to more frequent disease exacerbations and more rapid disease progression. My lab has optimized a noninvasive macrophage model (monocyte-derived macrophage) to study how to restore the immune function of alveolar macrophages in patients with COPD. Using this model, we study cell surface receptor expression, cytokine responses and intracellular signaling using flow cytometry, bead arrays and molecular biology techniques. My research team collaborates with Dr. Sanjay Sethi and other researchers in the areas of pulmonary, sleep medicine, critical care, infectious disease and microbiology. Undergraduates, medical students, residents and fellows are welcome in my lab. I am committed to teaching the next generation of physicians. I teach medical students in years two through four; in addition, I teach the residents and the pulmonary and critical care medicine fellowship trainees who rotate with me on the inpatient and outpatient services. I also teach the internal medicine and anesthesia residents and provide grand rounds lectures for the Buffalo VAMC, Buffalo General Medical Center and Erie County Medical Center. I serve on the Resident Clinical Competency Committee and as a formal resident advisor, shepherding my mentees through residency and helping them launch their professional careers. My door is always open to any trainee at any level.
Pulmonary & Critical Care Medicine
As chief of the division of pulmonary, critical care and sleep medicine, I oversee clinical, teaching, research and administrative tasks related to the evaluation and treatment of adult patients with lung diseases and sleep disorders as well as critically ill patients. My practice is primarily located at the VA Medical Center (VA) in Buffalo; however, members of my division provide care at sites throughout Buffalo, including the UBMD clinic at UBMD Internal Medicine at Amherst, UBMD Sleep Center and other UB-affiliated hospitals. I also conduct research on one of the most common lung diseases: chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, and lung infections such as bronchitis and pneumonia. Interestingly, patients with COPD become more prone to lung infection, and understanding why and how this happens is my main research interest. In addition to bench research in this field, I am also working to develop better ways to prevent and treat these infections by leading and participating in several clinical research studies in this field that are open to both veterans and the general public. I lead a multidisciplinary research team based at the VA that includes pulmonary and infectious disease physicians, post-doctoral scientists, nurse coordinators and research assistants. Through mentored research programs, our laboratories train undergraduate and graduate students, residents and fellows. I am active in several professional organizations and have served as a consultant on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.