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.
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; 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.
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.
As one of the few sleep physicians certified in behavioral sleep medicine (CBSM) in New York State, I am engaged in the full-time practice of sleep medicine. I have clinics in the main UBMD Sleep Center as well as satellite facilities. While sleep apnea is the most common issue of our patients, we evaluate a broad range of sleep disturbances in our UB affiliated clinics. Cognitive Behavioral Therapy for insomnia (CBT-I) methods are used in our insomnia practice. Having been instrumental in establishing the sleep fellowship program remains a source of great satisfaction, and besides patient care, the most rewarding aspect of my professional life is mentoring fellows in sleep medicine. In my dual roles as the chief of sleep medicine and the sleep medicine fellowship director, I understand the challenges and opportunities that face this growing, multidisciplinary field. We strive to ensure that all dimensions of the sleep program are vibrant and that the breadth of clinical and research experience is available to our sleep fellows. In addition to mentoring fellows in a clinical setting, I devote time to providing instruction in the proper evaluation and interpretation of diagnostic sleep testing. In conjunction with the fellows, I assist with the coordination of monthly sleep medicine grand rounds and selection of cases to present to the faculty. I organize these conferences to highlight sleep medicine’s multidisciplinary nature. Discussion topics vary; recent conferences have included the dental aspects of sleep medicine and the unique needs of pediatric patients with sleep disorders, for example. We have also featured presentations by faculty with pulmonary expertise on sleep apnea and on the neurological aspects of the discipline, such as the cause of neurochemical sleep mechanisms. The carefully selected discussion topics attract faculty, fellows, residents and advanced students from UB’s schools of nursing, dentistry and medicine to take part. I also teach elective classes for both medical students and residents who demonstrate an early interest in this growing and rapidly evolving discipline.