Internal Medicine; Infectious Disease
I am an attending physician on the Infectious Diseases service at Roswell Park Cancer Institute (RPCI). My clinical duties include inpatient and outpatient consultations at RPCI and on-call duties at Buffalo General Medical Center. In addition to providing clinical care, I teach medical students, residents and fellows in daily rounds and through formal didactic lectures. My primary research interest focuses on the epidemiology, pathogenesis, prevention and treatment of opportunistic infections in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation. In addition, I study the epidemiology, pathogenesis and transmission of colonization and infection by vancomycin resistant Enterococcus in patients with hematologic malignancies. My long-term goal is to define strategies to prevent transmission, determine virulence and decrease the mortality associated with these infections. Finally, I participate as a site principal investigator in several multicenter clinical trials.
My main research interests are in the areas of health economics and strategies to improve clinical reasoning skills among medical trainees. I am designing a study comparing strategies that improve cost consciousness among medical residents. I am also partnering with the School Management in using Information Technology to improve the ‘test ordering’ behavior by residents in the ambulatory care clinic. My other interests include techniques to improve clinical reasoning among students and residents.
I provide outpatient primary care service at Erie County Medical Center. I treat patients with multiple chronic medical problems such as diabetes, hypertension, obesity and high cholesterol, providing proactive, preventative and compassionate care for these complex cases. My practice emphasizes coordinating care across interdisciplinary teams and helping patients make therapeutic lifestyle changes through diet, exercise and weight loss. I take great pleasure in working with diverse, underserved patients, including patients with mental illnesses, helping them understand their disease, overcome barriers to treatment and address the causes of noncompliance. As a medical director of the Internal Medicine Clinic, I am actively engaged in several ongoing quality improvement projects to improve patient safety and the quality of care we provide. I have led initiatives to design and optimize clinical workflows and to implement Allscript Enterprise Electronic Health Records (EHR) in all outpatient clinics at ECMC, building a framework to provide consistent care throughout our health care system. Through benchmarking evidence-based national quality standards and providing physician leadership in using EHR and Patient-Centered Medical Home (PCMH) programs, I hope to lay the groundwork for a twenty-first century health care system. I am passionate about teaching and education. I provide mentoring, teaching and supervision for medical students and the 16 residents at our clinic. My goal is to create great leaders and excellent physicians for the future.
Cardiology; Cardiovascular Disease; Internal Medicine
As director of the Division of Cardiology at the Buffalo VA Medical Center (Buffalo VAMC), I oversee cardiac care, education and research. My division is one of the most efficient across similar VA facilities: it provides the full spectrum of cardiovascular diagnostic and therapeutic services while maintaining outcomes that meet or exceed all nationally mandated standards. I see outpatients in my own clinic, and I see inpatients as well, including those admitted to the Intensive Care Unit (ICU). My practice focuses on coronary artery disease (CAD), congestive heart failure, atrial fibrillation and valvular abnormalities. I approach my patients by practicing both the art and science of medicine and spend ample time getting to know my patients and the social structures that surround them. I believe that the care of a patient is much more effective when the patient is treated as a person rather than a diagnosis. I truly enjoy my clinical sessions at the Buffalo VAMC where I meet new and returning veterans who share their stories with me. It is a privilege to care for each of these amazing individuals. The abundance of complex cases at the Buffalo VAMC, along with extensive longitudinal electronic health data, allows us to conduct clinical research to improve patient care. We physician-scientists at the Buffalo VAMC are increasing our focus on clinical research to complement the bench research performed at UB. My current research is studying the role of post-traumatic stress disorder (PTSD) in heart disease. While longitudinal studies indicate a role of PTSD on CAD prevalence and outcomes, its causative mechanism has been debated. My colleagues and I are looking at mental stress-induced myocardial ischemia (MSIMI) and how this differs in patients with PTSD. I am passionate about teaching and feel a strong responsibility to mentor the next generation of physicians. I trained as a Royal College of Physicians educator in order to become a better medical educator. To me, mentorship involves more than just teaching the facts of medicine. I emphasize interpersonal and communication skills with the fellows I train, in addition to traditional bedside teaching, because these patient-centered abilities are essential to being a good physician. I also help trainees navigate increasingly complex hospital and health care environments. The knowledge I share with them about the systems that are part of modern health care is also key to providing the best care to patients.
Internal Medicine; Nephrology
I have a comprehensive background and practice in renal medicine. I take care of patients with acute illness and damage to their kidneys. I also care for dialysis patients and patients experiencing hypertension emergencies, fluid/electrolyte imbalances and life-threatening intoxications. My inpatient clinical practice is based at Erie County Medical Center (ECMC), Buffalo General Medical Center (BGMC) and Roswell Park Cancer Institute (RPCI). I also see my patients as outpatients at ECMC and the UBMD Youngs Road clinic, where I provide follow-up care. At these locations, I also care for patients diagnosed with end-stage renal disease and chronic kidney disease (CKD), treating their illnesses and the complications that arise from them. My clinical research interests are wide-ranging. I am particularly interested in fluids and electrolytes and glomerulonephropathy. My past research includes a project focused on rituximab on post-transplant glomerulonephritis. My faculty responsibilities include serving as a clinical educator for fellows in the Division of Nephrology. I also educate internal medicine residents and medical students regarding nephrology-related aspects of internal medicine. I teach trainees at the bedside, in small groups and in large lecture settings.
Cardiology; Cardiovascular Disease; Clinical Cardiac Electrophysiology; Internal Medicine
An internationally recognized cardiovascular physician-scientist, Dr. Cain is a specialist in abnormal heart rhythms. He is board-certified in internal medicine, cardiovascular diseases and clinical cardiac electrophysiology and pacing. He is a fellow of the American College of Cardiology, the American Heart Association and the Heart Rhythm Society. A former associate editor of Circulation, Cain is a member of the editorial boards of the American Journal of Cardiology, the Journal of Cardiovascular Electrophysiology, Nature Clinical Practice Cardiovascular Medicine and Heart Rhythm. His NIH-supported research has focused on determining the mechanisms of life-threatening heart rhythm abnormalities that occur in heart attacks and other conditions that damage heart muscle cells. This information is being used to better characterize and more accurately localize the abnormal heart tissue responsible for these abnormal heart rhythms and to improve the identification of patients at increased risk for sudden cardiac death.
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.
Internal Medicine; Public Health and General Preventive Medicine
I am a primary care physician specialized in both internal medicine and preventive medicine. As a member of the UBMD Internal Medicine primary care team, I see patients at the Hertel-Elmwood Internal Medicine Center. My clinical work focuses on providing high value care for patients with acute and complex chronic conditions, including diabetes, heart failure, asthma, chronic obstructive pulmonary disease (COPD) and hypertension. I have worked as a physician in both Peru and the United States, and my ability to speak English and Spanish fluently—in addition to my multicultural background--allows me to relate to, and care effectively for a broad patient population. My ability to reach across cultural divides helps build trust in my patients, an essential component in rendering individualized, compassionate care. I have a special interest in translating evidence-based innovations, using quality improvement tools, to enhance the care of patients with multiple chronic diseases. I am interested in research that strives to understand the social determinants of health, i.e., how socioeconomic circumstances, neighborhood environments and psychosocial factors affect the prevention and treatment of chronic conditions. I am specifically interested in how social determinants affect the treatment of patients with Type 2 diabetes. My goal in this research is to understand the multiple factors affecting health and wellness in order to help ameliorate the disparities found in the health care of vulnerable populations. I train medical students and residents as they rotate in the Hertel-Elmwood Internal Medicine Center. I emphasize to trainees that building a healing longitudinal relationship with patients is as important as mastering the science of medicine in delivering effective and compassionate patient care. Furthermore, I encourage trainees to look not only “downstream” for the causes of diseases but “upstream” as well in order to offer holistic approaches for the prevention and treatment of diseases that affect our Buffalo and Western New York community.
Internal Medicine; Nephrology
My breadth of clinical practice is broad; I care for patients with a wide range of both acute and chronic renal diseases. This includes patients with electrolyte abnormalities, autoimmune and/or secondary glomerulonephritides and polycystic kidney disease as well as those who have undergone kidney transplantation. My training at the Weill Cornell Hypertension Center has provided me with focused training in the management of refractory, secondary and perinatal hypertension.Therefore, I also see patients with refractory or difficult-to-control hypertension even though they may not have kidney dysfunction. As medical director of the Erie County Medical Center (ECMC) Living Donor Kidney Transplant Program, I see many prospective living donor kidney candidates during their donor evaluation process, and I follow them in the post-operative period. I see patients in a variety of inpatient and outpatient settings. I serve as the nephrology attending physician on the inpatient Renal Medicine and Renal Consultation services at ECMC as well as the Renal Consult service at the Buffalo Niagara Medical Campus (BNMC). My outpatient clinics include my weekly general UBMD Nephrology and Transplant clinics at ECMC and my weekly general UBMD Nephrology clinic at the Niagara Falls Renal Office. I care for both in-center and home hemodialysis as well as peritoneal dialysis (PD) patients receiving services at numerous dialysis centers located throughout Erie and Niagara Counties. I work with national and global kidney care groups such as Fresenius and Davita to provide care for my patients, and I serve as medical director for several of their Western New York dialysis centers. My clinical research interests are also wide-ranging. I have particular interests in medication, chemotherapy and toxin-induced kidney injury. I have worked on a project that investigated the long-term renal impacts of the chemotherapy agent ifosfamide in adult cancer patients. I also have a research interest in autosomal dominant adult polycystic kidney disease (AD-PKD). I am involved in a multicenter clinical trial to compare the efficacy and safety of the drug Tolvaptan to determine if it can help to slow, or even halt the progression of renal cysts and thereby delay or prevent progression of end-stage kidney disease in people with AD-PKD. I supervise and teach physicians at all stages of their training, including interns and residents from UB’s internal medicine residency program as well as fellows in UB’s nephrology training program. I supervise trainees on both the inpatient Renal Medicine and Renal Consult services and in the outpatient Renal and Hypertension Clinic and the outpatient Transplant Clinic. In addition to bedside teaching, I sometimes teach small group nephrology seminars for third- and fourth-year medical students rotating on their medicine clerkships. I also provide lectures for the internal medicine resident teaching program and for the nephrology fellowship teaching program.
Internal Medicine; Internal Medicine - General
I graduated from the University of Buffalo School of Medicine and completed a residency in Internal Medicine at UB as well. I was a Chief Resident in 1990 and subsequently joined the Department of Medicine as a faculty member in the Division of General Internal Medicine. I served as an Associate Program Director for the Internal Medicine resident training program until 2008. From 2002 until 2008 I became involved in hospital administration and served as the Chief Medical Officer for the Erie County Medical Center. From 2008 until 2011 I served as the Chief Medical Officer for the Seneca Nation Health Department. During that time I completed a Masters of Public Health at the Mailman School of Public Health at Columbia University. In 2011 I returned full time to the Department of Medicine as Division Chief of General Internal Medicine and to ECMCC as VP for Clinical Integration. Throughout my career I have been very interested in medical education, quality improvement and patient safety. In my role at ECMCC as Vice President for Clinical Integration I have been charged with improving the patient experience and have focused on patient and physician communication. We are currently assessing barriers to effective communication and developing interventions to improve the quality of physician and patient interactions. I have always maintained that physicians need to actively participate in their communities and for this reason I have been involved with the P2 Collaborative of Western NY and currently am Chair of its Board of Directors. P2 has recently been designated as Western NY‘s population health improvement collaborative and will be actively involved in helping to promote a health prevention agenda for our community.
As the Clerkship Director for 3rd and 4th year required Medicine Clerkships, my main interest is student education. My goal is for every student, regardless of their future career goals, to acquire the knowledge, skills and attitudes to provide basic medical care to their patients. For the 3rd year students, I have developed a practical examination to assess interpretation of commonly encountered problems on chest radiographs, ECGs, hematologic smears, microbiologic samples and electrolyte disorders. The 4th year in-house exam requires students to manage 2 patients initial presentation to discharge in a step wise manner. As a management attending on the inpatient teaching service at Buffalo General Medical Center, my focus is to serve as a role model for providing effective and empathetic care to all patients.
Cardiovascular Disease; Internal Medicine; Nephrology; Pathophysiology; Vascular and Interventional Radiology; Cardiac pharmacology
(1) Role of the sympathoadrenal system in hypertension, postural adaptation, and long-term cardiovascular adaptation (2) Control of regional and systemic blood flow during acute stress responses (3) Mechanisms of stress responses and vasoreactivity, both in vivo and in vitro, including metabolic interactions (4) Cardiovascular drug effects (5) Outcomes of drug therapies
Cardiology; Cardiovascular Disease; Internal Medicine; Molecular Basis of Disease
I am a board-certified cardiologist trained in multimodality cardiovascular imaging. I have completed the most advanced training possible in echocardiography and nuclear cardiology, and I am also certified to perform and interpret cardiac computed tomography (CT) and adult and congenital cardiac magnetic resonance imaging (MRI). I supervise and interpret these studies at the Buffalo General Medical Center (BGMC) and the Gates Vascular Institute (GVI). As a clinical cardiologist, I care for patients in the BGMC coronary care unit and the cardiac step-down unit. I provide consultative services at BGMC as well. I also leverage my background in epidemiology and public health to advise appropriate utilization of imaging at BGMC and the GVI for patients with known or suspected ischemic heart disease. I use my training to educate providers about the best way to determine the likelihood of ischemic heart disease in their patients and how they can improve the application of these tests to diagnose patients, determine their prognoses and institute appropriate therapies. As a clinical investigator, my research is geared toward imaging arrhythmogenesis in patients with heart failure. The goal of my research is to use imaging-based approaches to guide cardiac device therapies in heart failure patients. This includes implantation of defibrillators and biventricular pacemakers. I use nuclear cardiology-based imaging approaches to assess dyssynchronous cardiac contraction and sympathetic denervation in patients with heart failure to guide whether a particular device should be implanted or not. Once a decision is made to implant a device, these imaging approaches can also guide how the device should be implanted. My research helps identify the patients who will benefit from devices as treatment modalities, since these devices are invasive and expensive. My research also helps identify patients who will not benefit, which protects patients from a needlessly invasive and costly procedure. As a faculty member in the Division of Cardiovascular Medicine, I teach my team of fellows, residents and students during and after rounds when I am on consult and inpatient services. I also supervise the fellows’ clinic at BGMC.
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 am specifically interested in asthma, COPD 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, 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. Currently I am pursuing additional training in the analysis of Big Data in medical/healthcare fields. I am particularly focused on the application of drug repurposing in translation and clinic research. I also am heavily focused on the specific analysis of large VA associated clinical and genomic data sets as a fellow in the VA and NCI sponsored Big-Data Scientist Enhancement Program. 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.
Cardiology; Internal Medicine
I am a noninvasive cardiologist focused on the detection and treatment of heart disease. I practice cardiology and internal medicine and care for patients with a wide variety of cardiac diseases at the Buffalo VA Medical Center (VAMC). My responsibilities include attending on the cardiology consult service, covering the medicine hospitalist service, performing transesophageal echocardiograms (TEEs), cardioversions and other cardiac procedures and interpreting echocardiograms, stress tests, electrocardiograms (EKGs) and Holter/Event monitors. In addition to treating patients in the acute setting, I am the director of cardiac rehabilitation at the VAMC, which is a multidisciplinary approach for improving cardiovascular health and preventing repeat cardiac events. I am also involved in quality improvement projects at the VAMC to ensure that our patients receive the best possible care. I have a background in health research methodology, research methods skills that enable researchers to improve clinical practice, strengthen health systems and enhance population health. My area of interest is guideline development. I am collaborating with researchers at McMaster University in Canada on projects that include guideline development, economic evaluations and research methodology. I am passionate about teaching. I mentor medical students as they rotate on both the general medical service and cardiology consult service at the VAMC. I also supervise medicine residents rotating on these services. I supervise cardiology fellows during their clinics, inpatient and noninvasive rotations at the VAMC, and I give didactic talks aimed at residents and fellows from various disciplines. I am an advanced cardiac life support (ACLS) instructor with the VAMC-based program.
Addictions; Gastroenterology; Internal Medicine; Liver (Hepatology); Infectious Diseases
I care for patients with liver disease and addiction disorders, including opiate dependency, viral hepatitis, alcoholic and fatty liver disease, in an outpatient setting at Erie County Medical Center where I am the medical director of hepatology. In collaboration with the division of infectious diseases, I also evaluate and treat patients with hepatitis C virus (HCV) and HIV co-infection. I also treat veterans with opiate dependency at the Buffalo VA Medical Center, in the addiction medicine unit. My patient-care efforts include digital outreach: I co-authored an article for the inaugural issue of the patient-oriented online magazine “HCV Next.” My research involves improving hepatitis C treatments in populations disproportionately affected by HCV but with limited access to health care (including many American veterans, ethnic minority groups, injection drug users, and patients with psychological disorders) as well as developing novel modalities to deliver care. The goal of my research is to expand HCV treatment services to a wide-ranging group of patients, especially those without immediate access to care, in an effort to reduce global disease burden. This may include training primary care or other providers to treat HCV and using telemedicine and co-localization as a way to increase treatment uptake in areas such as rural primary care clinics and methadone clinics. My team is also investigating barriers to hepatitis C screening and treatment. Using the data we collect (e.g., patients’ knowledge of the disease, their perceptions regarding treatment, their willingness to be treated), we can design initiatives to improve patient-based HCV education and work toward the goal of increasing treatment uptake. This component of my research also looks at the same issues on the provider side: provider HCV knowledge and screening, referral and treatment practices. These data will help us understand what the provider-level barriers are to disease control, and we can design provider-based HCV educational initiatives to improve screening and referral for care. I am also a co-investigator on numerous clinical trials related to new therapeutic agents for hepatitis C and fatty liver disease, including a study funded by the Centers for Disease Control and Prevention (CDC) to evaluate the use of telemedicine to treat HCV in methadone maintenance clinics. I present and lecture nationally about hepatitis C with an emphasis on opiate dependence and special populations. I am a member of the New York State Hepatitis C Demonstration Project expert panel. I teach medical students in small group settings in the area of gastroenterology and hepatology. I also precept internal medicine residents and gastroenterology fellows in the outpatient clinics.
I am board-certified in internal medicine, and my primary focus is the high quality and compassionate medical care of hospitalized patients at Buffalo General Medical Center (BGMC). Because my entire day is devoted to hospitalized patients, I am readily available to my patients and their families. The time I spend with my patients gives me a great deal of experience in the unique aspects of my patients’ needs during their hospital stays, which helps me deliver the best possible medical care. In addition, by practicing evidence-based medicine, I bring prompt and complete attention to all my patient care, including diagnosis, treatment and management. I also collaborate, coordinate and communicate with all physicians and health care professionals caring for hospitalized patients, all of which fosters excellent patient care. I am responsible as well for ensuring the safe transition of patient care both within the hospital and from the hospital to the community. My oversight of safe patient transition may include patient care in post-acute care locations that facilitate continued patient recovery such as inpatient rehabilitation facilities and skilled nursing facilities. My current research interest is in seeking to understand the significance of visceral thrombosis in gastrointestinal malignancies, with special interest in pancreas adenocarcinoma.
I am a primary care physician, board-certified in internal medicine. I see patients at the UBMD Internal Medicine office on Youngs Road in Williamsville. I take a holistic approach to my patients and am part of a “medical home” model of patient care. This means I work as part of a team: I collaborate with other physicians and health care professionals to provide comprehensive and continuous medical care to my patients, with the goal of obtaining the best possible health outcomes. I focus, too, on preventive care and believe that it is important to help patients lead a lifestyle that will maximize their health. I also teach medical students. My goal is to teach students to become compassionate physicians who care for patients holistically and in the context of their families, their cultures and their communities. I have been recognized with numerous teaching awards throughout my career. I serve as well as the senior associate dean for student and academic affairs. As such, I am responsible for medical admissions, multicultural affairs, student services, registrar services, student disciplinary matters and the school’s Clinical Competency Center and simulation centers. I am also the program director for STEP (Science and Technology Entry Program) and director of the post-baccalaureate program. My overall goals are to support strong pipeline programs that help ensure a diverse student body, attract academically talented students who show the potential to become compassionate physicians, provide our students with a variety of hands-on opportunities in research, training and innovative learning experiences--and help our students succeed at every stage in their medical education. My office is structured to support our students throughout the four years of medical school, both with academic advising and personal counselling services.
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.
Internal Medicine; Pulmonary Disease; Infectious Disease
My area of expertise is in infectious diseases in adults and I evaluate and treat adults with all infections, without restriction to a special area, and see patients within the Veterans Affairs hospital system. I act as a consultant for other physicians treating patients who have, or are suspected to have, infectious diseases in hospital settings or outside the hospital. Prior to becoming an infectious disease specialist, I had training and work experience in surgery as well as internal medicine. This exposure has helped me in my current clinical practice since infections occur in patients after surgical procedures. Having a firsthand understanding of what surgeons do allows me to understand the patient’s overall situation better. I teach first- and second-year medical students, primarily in pulmonary, in small group sessions. My research is focused on bacterial infections in patients with chronic obstructive pulmonary disease (emphysema and chronic bronchitis, known also as COPD). I am especially interested in how the host (the human body) reacts to the pathogen (the bacteria), and how differences in the host determine the outcome of the encounter between host and pathogen. Recently, we found that airway epithelial cells from patients with COPD respond to pathogenic bacteria in a manner that is different from healthy, non-COPD people. My goal is to further characterize and understand the cellular mechanisms underlying this aberrant behavior in COPD. I expect this research to open new avenues of therapy specially tailored to intervene in the host-pathogen interaction. Students and fellows have the opportunity to conduct research with me. I collaborate with Sanjay Sethi, MD and Charles Berenson, MD from the department of medicine and with Anders Hakansson, PhD, from the department of microbiology and immunology.
I see patients two days a week at my primary office site, Hertel-Elmwood Internal Medicine. My philosophy of medical care is to work with each individual patient and come to the best plan of action for the issues facing that patient. I believe in a cooperative model of care that incorporates my experience and judgment along with the patient‘s values and preferences. Education is a significant part of my work and I believe that my role as a physician is not only to diagnose and treat, but to educate patients. Since information and education is often not the only thing patients need, I practice and believe in techniques that can improve motivation for healthy choices. I consider my experience in motivational interviewing to be an important component of my clinical expertise.
Cardiology; Cardiovascular Disease; Internal Medicine; Radiology; Cardiopulmonary physiology; Immunology; Gene Expression; Cardiac pharmacology; Stem Cells
I am a cardiologist with specialized training in advanced cardiac imaging. I see outpatients at the Heart and Lung Center of Buffalo General Medicine Center (BGMC), and I care for inpatients through the cardiology consult and inpatient services at BGMC. As an advanced imaging cardiologist, I am responsible for developing and advancing the cardiac computed tomography (CT) and magnetic resonance imaging (MRI) programs at the Gates Vascular Institute (GVI) and providing these services to patients. These advanced, noninvasive imaging techniques allow physicians to perform in-depth, 3-D evaluation of the coronary tree, myocardium, heart valves, pericardium and great vessels. These imaging tools allow for the best possible diagnoses and care of patients. My research spans basic science, translational and clinical fields and combines the cross-discipline expertise on magnetic resonance (MR) technology with molecular biology. My overall goal is to study the consequences of ischemia-induced myocardial injury, with a focus on their therapeutic reversal. My research laboratory at UB’s Clinical and Translational Research Center (CTRC) is devoted to the development of novel time-and-tissue-targeted MRI methods for integrative understanding of cardiovascular pathophysiology in preclinical models. We have several interesting research projects, e.g., we have recently discovered that the presence of high-risk plaques in the carotid arteries predict future incidence of myocardial infarction and stroke. The results emphasize that the nature of atherosclerosis and the use of comprehensive non-invasive computed tomography angiography (CTA) will help identify patients who are at higher risk of developing ischemic stroke. These research results will help physicians employ early therapeutic strategies for these high-risk patients. I mentor medical students, residents and fellows both in clinical and research settings, and I precept cardiology fellows at the Heart and Lung Center at BGMC. In addition, I am deeply engaged in furthering the research and clinical education of our house staff. Our trainees have published their research in highly esteemed peer-reviewed journals, and many have routinely presented their work at national and international scientific conferences. I am committed to facilitating the career goals of my mentees while I continue to advance my own career as a clinician, researcher and mentor.
I am a member of the Division of General Internal Medicine, which consists of a team of dedicated professionals providing exceptional preventive care, acute care, and chronic disease management for adults across the entire spectrum of health and disease. I work closely with and supervise University at Buffalo students and residents in their care of patients at the Internal Medicine Center at ECMC and in the care of hospitalized patients at ECMC. I am also engaged in research on alcoholism and alcohol-related disease, including the detection and treatment of these commonly encountered conditions in medical settings. Alcohol-related problems are often unrecognized due to a lack of specific diagnostic testing or simply not linking heavy drinking to problems that are not always or not usually alcohol-related (e.g., hypertension). If alcohol is recognized as a problem, tools to treat alcoholism have not typically been adapted for primary care nor have many physicians received specific training in managing alcoholism. With the support of the National Institutes of Health and other organizations, I conduct cutting-edge research on the assessment and treatment of patients with alcohol-related disease using brief counseling methods and medications that are appropriate for primary care practices. I am also heavily involved in studying the use of novel laboratory tests for detecting unhealthy drinking patterns and alcohol-related organ damage. My goal as a clinical researcher is to provide tools that enable physicians to provide care for alcohol-related disorders as they do for other chronic diseases such as diabetes and high cholesterol. This includes the use of laboratory tests to monitor control of the disease, guide the use of medications and brief counseling in busy medical settings, and determine the need for more intensive treatment or referral to addiction specialists.
I am Clinical Faculty in the Division of General Internal Medicine. I see patients and supervise residents in Internal Medicine and medical students at the Primary Medicine Center at Buffalo General Hospital. I am interested in scholarship relating to medical education, quality of care, and helping patients adopt healthy behaviors.
Cardiology; Cardiovascular Disease; Internal Medicine; Apoptosis and cell death; Cell Cycle; Cell growth, differentiation and development; Gene therapy; Stem Cells
I am a researcher with formal training and practice in both general and interventional cardiology. My research expertise is in coronary physiology and physiological studies in large animals with ischemic heart disease. Based on my background, my research is focused on therapeutic approaches to effect cardiac regeneration in large animals with acute and chronic ischemic heart disease. In my laboratory, I use a preclinical porcine model of hibernating myocardium with chronic left anterior descending (LAD) coronary artery occlusion and collateral-dependent myocardium or infarcted myocardium caused by coronary ischemia-reperfusion. I have addressed the problem with several different therapeutic approaches involved in gene therapy, pharmacological and stem cell therapies. We routinely perform physiological studies on these porcine models with quantitative analyses of myocardial morphometry and immune-histochemical analyses. The information we have collected in completed work demonstrates remarkable functional recovery and myocyte regeneration in the adult porcine heart. Intracoronary adenoviral gene transfer with fibroblast growth factor (FGF-5), the HMG-CoA inhibitor pravastatin and intracoronary mesenchymal stem cells (MSCs) all stimulate the proliferation of endogenous cardiac myocytes and, to some extent, generate new myocytes and vessels. Our current work is focused on understanding the regenerative capability of cardiosphere-derived cells (CDCs) originating from heart tissue in acute or chronic ischemic myocardium. The result of this work will play an important role in advancing the care of many patients with acute and chronic ischemic heart disease. In my laboratory, I mentor research fellows through their rotation. Fellows who work in my laboratory have the unique opportunity of being exposed to large animal experimentation and learning skills related to it--in physiology and coronary angiography, as well as computed tomography (CT) and magnetic resonance imaging (MRI) techniques. Under my supervision, fellows also may work on independent projects and learn about cell biology and molecular biology, with the chance to present at international meetings and to publish as an author in international journals.