Immunology; Membrane Transport (Ion Transport); Pulmonary & Critical Care Medicine
My clinical responsibilities include working as one of five Intensive Care Unit physicians where I am the Co-Director of the ICU, and providing Pulmonary consultation 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 neuromuscular respiratory failure, interstitial lung disease (associated with collagen vascular disorders such as systemic lupus erythematosus [SLE]), scleroderma, rheumatoid arthritis, Sarcoidosis, the idiopathic pulmonary pneumonitis syndromes (IPF/UIP) and advanced chronic obstructive pulmonary disease (COPD). I am the Director of our Center for Specialized Care in Sarcoidosis, and we are a recognized World Association for Sarcoidosis (WASOG) Clinic. I am also the Adult Pulmonologist within our Center for Specialized Care in Neuromuscular Disorders, working closely with our UBMD and community Neurology colleagues in managing patients with respiratory complications of neuromuscular disorders such as ALS, Duchenne Muscular Dystrophy, myotonic dystrophy and others.
My research has three tenants, and dovetails with my clinical expertise. My translational research is focused on understanding the impaired immune response to infection that occurs in patients with COPD and improving quality of life. 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. I am also the Director of the COPD Clinical Trials Consortium within the VA, working with VA Medical Centers across the nation to allow our veterans access to cutting edge research opportunities. We are now also working with our UBMD colleagues in Palliative Medicine, to explore the impact of a structured palliative program on patient reported quality of life, as well as systemic inflammatory markers and functional status.
Through the Center for Specialized Care in Neuromuscular Disorders, our research is starting to better understand the barriers to effective use of respiratory assistive devices in ALS, and to determine modifiable risks associated with procedural sedation. Our Sarcoidosis Consortium is starting to establish a clinical research program.
My research team collaborates with Dr. Sanjay Sethi, Dr. Jaclyn Schneider, Dr. M. Jeffrey Mador and other researchers in the areas of Pulmonary, Sleep Medicine, Critical Care, Infectious disease, Neurology and Cardiology. Undergraduates, medical students, residents and fellows are welcome to consider a project in either my research lab or my clinical research programs.
I am committed to teaching the next generation of physicians at all levels of training. I teach medical students in years two through four, Internal Medicine, Med/Peds, Med/Preventive Med and Anesthesia Residents and the Pulmonary and Critical Care Medicine Fellow trainees who rotate with me on the inpatient and outpatient services. I also co-Chair the Early Career Working Group for senior trainees and junior faculty within the Clinical Problems Assembly for the American Thoracic Society. I serve on the Resident Clinical Competency Committee for the Department of Internal Medicine, 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.
In addition to direct bedside, classroom lecture format teaching and mentorship to the trainees, I also speak at the Citywide Grand Rounds at least annually, provide lectures within the Catholic Health System, speak regionally at the Annual Respiratory Therapy conference, the New York State Thoracic Society. I speak at the national level at the American Thoracic Society and CHEST annual conferences and am currently serving on the national Home Mechanical Ventilation Network for the American Academy of Chest Physicians (CHEST Network).