Cardiology; Critical Care Medicine; Internal Medicine
I practice noninvasive clinical cardiology, which includes diagnosing and treating patients across the spectrum of cardiovascular disease. In the UBMD Amherst clinic, I care for patients with rhythm disturbances, cardiomyopathies, valvular heart disease, congestive heart failure, acute and chronic coronary artery disease and vascular disease. Preventive cardiology services are also an important part of my practice. I diagnose and treat patients with conditions that may put them at risk for heart disease—conditions such as hypertension, lipid disorders and nicotine addiction. I also assess the heart health of my patients by performing and interpreting electrocardiograms (EKGs), stress tests, Holter monitors and transthoracic echocardiography. I evaluate my patients for peripheral vascular disease, including measurements of their ankle-brachial index. I care as well for patients admitted to the Cardiac Care units (CCU) and the Cardiology Telemetry floors in Buffalo General Medical Center (BGMC) and at Millard Fillmore Suburban Hospital. As medical director for outpatient cardiology for UBMD, I ensure a patient-centered practice that provides the most advanced and innovative cardiac care and strives to provide patients with the best diagnostics and treatments available—all with a focus on care that is affordable and accessible. I am also a vice chair for clinical operations and outreach for the Department of Medicine. As such, I am actively involved in the department’s growth by developing a strong network of primary care and specialty practices for UBMD Internal Medicine. This effort will lead the transformation of health care delivery systems in Western New York. My research interests include evaluating modalities of cardiac imaging in diagnosing coronary artery disease, evaluating methods of diagnosing arrhythmias and assessing individuals with noncardiac chest pain. Specifically, I am an investigator in research involving preventive cardiology and lipid management. I am also collaborating with residents, fellows and colleagues in behavioral medicine to investigate how behavioral analysis affects treatment of atrial fibrillation and patient care. Another research project involves working with medical students and cardiology fellows to leverage portable technology, such as smart phones, in evaluating symptomatic arrhythmias. I am working as well with medical residents on an epidemiologic study. We expect an outcome that would identify a possible etiology of a well-recognized cutaneous manifestation of cardiac disease, which will allow us to develop a reliable test to help screen for coronary artery disease. Teaching is an important part of my day. I teach physical diagnosis to first- and second-year medical students. I also mentor eight first-year and eight second-year medical students, helping them navigate through, and succeed in medical school. I teach third-year medical students as they rotate with me in my outpatient practice. Fourth-year medical students, interns, residents and a cardiology fellow accompany me when I attend on the cardiology consult and cardiology floor services at BGMC. I find satisfaction in sharing my knowledge and experience with those in the training phase of their careers: their questions help me stay current in my field and ultimately help me render the best care to my patients.
Cardiology; Critical Care Medicine
I care for patients with diagnoses across the spectrum of heart disease. I see my patients at the UBMD Internal Medicine practice group in Amherst and in the Cardiac Care Unit at Buffalo General Medical Center (BGMC). I conduct stress tests, interpret cardiac imaging studies, read electrocardiograms (EKGs) and perform evaluations for advanced heart failure therapies and cardiac transplantation. My specialty is the diagnosis and treatment of congestive heart failure: I integrate information from patient history, physical exam findings and diagnostic studies, and I coordinate treatment for my patients with interventional cardiologists, heart rhythm specialists and heart surgeons. My research is focused on new approaches to identifying patients at risk for heart attacks and strokes. I am involved in collaborative studies addressing the treatment of heart failure, and I participate in the clinical trials of new medications for congestive heart failure. I am the principal investigator of a pilot study (STEMI-HSC) to determine if the amount of hematopoietic stem cell mobilization in myocardial infarction predicts recurrent coronary events. The study is funded by the UB Translational Pilot Studies Fund, and my collaborators include other cardiology faculty and researchers at Roswell Park Cancer Institute (RPCI). I am also an investigator in the multicenter clinical trial of the drug LCZ969 (PARAGON-HF, Novartis) in patients with heart failure. I teach and supervise internal medicine residents and cardiology fellows in all facets of my clinical practice: during inpatient hospital care, while interpreting cardiac imaging studies and in my outpatient practice. I also teach second-year medical students in small-group settings for the Human Cardiovascular System course.
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.
Critical Care Medicine; Pulmonary & Critical Care Medicine; Internal Medicine; Pulmonary Disease; Pulmonary; Bioinformatics
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 also evaluate patients with pulmonary disorders including shortness of breath, lung masses, abnormal chest imaging, abnormal pulmonary function tests, chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, pulmonary hypertension and lung cancer, at the lung and heart outpatient clinic located in BGMC. The pulmonary team to which I belong also provides inpatient pulmonary consultation at both BGMC and Roswell Park Cancer Institute. I am specifically interested in asthma, COPD and lung cancer. I am investigating the pathophysiology of lung inflammation. Recently 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. Additionally, I collaborate with the Division of Allergy and Immunology and the Institute of Laser, Photonics and Biophotonics 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 critically ill patient, as these trainees rotate in the MICU.
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.
Anesthesiology; Critical Care Medicine; Cardiac pharmacology
My clinical practice focuses on the management of critically ill patients, working in intensive care unit at the VAMC. I previously Practiced at the Rochester General Hospital, as the medical director of surgical critical care services.The experience equipped me with a wealth of expertise in caring for individuals from diverse medical and surgical conditions from around the world. I am responsible for the hospital care of patients at VAMC, where I work with anesthesiology, medicine,pulmonary critical care and cardothoracic anesthesia fellows. I provide complete inpatient management of critically adults adults. I enjoy teaching and research components of my faculty role, which include mentoring students, working with pre-med and medical students, and conducting research projects centering on management of critically adult population. I am collaborating with other medical professionals at the VAMC to conduct clinical trials as well as conducting original ressearch in critical care medicine. As of 2014, I am the medical Co-director of the medical intensive care unit and provide frequent consulation for clinicians engaging in translational and clinical research. My research focus mostly is centered on perioperative management of patient with obstructive sleep apnea.