Raise the Line

One key theme in this episode of Raise the Line is that attention to details matters for both patients with post-acute infection syndromes and the clinicians helping them as they grapple with often debilitating symptoms caused by dysautonomia, cardiac complications and other disorders. For patients, it’s about paying close attention to their bodies and diet, and being intentional about their use of energy. For providers, it’s listening very carefully to patients as they describe their fatigue, pain, lightheadedness and other symptoms and keeping up with the latest research on  treatments so there are options to offer if there’s little or no progress being made in physical therapy, which is sometimes the case. “Don't just assume therapy is gonna go smooth. It rarely goes smooth. So, have an answer for the patient who says, ‘I'm not feeling better, what should I try next,’” says Dr. David Putrino, director of the Cohen Center for Recovery from Complex Chronic Illnesses (CoRE) at Mount Sinai. It’s also important to set expectations for patients who may think a few weeks of PT will resolve their issues, as is often the case with recovery from an injury. “What we're looking to do is reduce the number of flare-ups that happen, reduce the severity of those flare-ups, and ideally reach a point of symptom stability,” says Dr. Jenna Tosto, a leading expert in neurophysiological rehabilitation at Mount Sinai. To help patients understand the amount of progress happening, if any, host Dr. Raven Baxter, a long COVID patient herself, says keeping a daily journal and using fitness trackers can reveal important details. This expansive conversation includes valuable insights for patients and providers alike on breathwork, emotional regulation and other techniques to try during the search for improvement and recovery in complex chronic illnesses. 

Mentioned in this episode:

Mount Sinai Health System

Steven & Alexandra Cohen Foundation 

If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

We continue our Year of the Zebra focus on rare diseases today by exploring the ability of AI technology to aid in the diagnosis of rare and other conditions by analyzing the voice and speech of the patient. This approach is promising enough that the National Institutes of Health has invested in research projects to test its effectiveness, and the private sector is pursuing it as well, including the company Canary Speech whose technology can be trained to detect conditions that are traditionally difficult to identify, or those where early identification is crucial to treatment. “With just seconds of conversational speech, we can screen for multiple behavioral and cognitive conditions,” says Caitlyn Brooksby, Canary's vice president of Marketing and Strategic Partnership. One prime example she offers is a study on Huntington’s disease done in collaboration with Beth Israel Deaconess Medical Center in which more than a thousand features of speech were identified differentiating healthy patients from those with the disease. “Every ten seconds, we're looking at millions of data points, but we don't look at the words you say. We're looking at biomarkers within speech such as duration per word, word-per-second, bandwidth and contrast. It's really incredible what we can gather from speech alone,” she explains. Canary is in the second iteration of its Huntington’s model which is showing accuracy rates of 90% and above, and it recently added mild cognitive impairment, Alzheimer's, and Parkinson's disease to its offerings. Join host Lindsey Smith on this episode of Raise the Line to learn more about this promising approach to diagnosis.

Mentioned in this episode:
Canary Speech 

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Exercise is good for you, except in very specific cases when it isn’t. One of the few examples, post-exertional malaise (PEM), is the subject of today’s Raise the Line episode in our series on post-acute infection syndromes produced in collaboration with the Cohen Center for Recovery from Complex Chronic Illnesses at Mt. Sinai. “The key to understanding PEM is that it's not just fatigue. It's really the worsening of symptoms or the onset of new symptoms after exercise,” says Dr. Rob Wust of Vrije University Amsterdam.  His research group is one of several around the world now focused on this previously obscure phenomenon due to the prevalence of long COVID in which PEM is a nearly universal symptom. And while it’s good news that this debilitating affliction is receiving new attention, no clear picture of causes and treatments has yet emerged. In terms of suspects, the body’s energy suppliers, mitochondria, are a popular target, but while Wust’s team and others attempt to unravel the mysteries of mitochondrial dysfunction, millions of patients suffering with PEM need strategies to avoid exhaustion. In that regard, Dr. David Putrino of the Cohen Center says patients and clinicians alike need to take all use of bodily energy into account, not just obvious activities such as walking. “The brain uses a lot of energy, so cognitive exertion will cause crashes. Emotional exertion will cause crashes and so will digestion and even sweating.” Join host Raven Baxter of the Cohen Center as she explores what can be done for patients as the race to find better diagnostics and treatments for PEM continues in some of the world’s top scientific centers. 

Mentioned in this episode:

Mount Sinai Health System 

Steven & Alexandra Cohen Foundation 

Long COVID Physio 

If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

It’s hard for many to believe a tick bite or case of COVID can lead to severe mental illness, but we’ll be hearing from someone on this episode of Raise the Line who lived through just that experience. Dr. Raven Baxter also happens to be the host of this special series on post-acute infection syndromes produced in collaboration with the Cohen Center for Recovery from Complex Chronic Illnesses at Mt. Sinai. While struggling with long COVID, Raven developed panic attacks and other mental health problems, and even though she explained to providers that she previously had no history of mental illness, there was reluctance to attribute the symptoms to her body’s reaction to SARS‑CoV‑2. Unfortunately, this is not surprising to Dr. Shannon Delaney, a psychiatrist whose patients share similar stories. “People who are going through this can be suffering a lot, not only because of their symptoms, but because of invalidation from the medical community,” says Delaney, who believes brain inflammation caused by immune system dysregulation can explain why mental health issues emerge in this context. While Raven’s other guest, Dr. Mike VanElzakker, concurs, his research at Massachusetts General Hospital and the PolyBio Research Foundation focuses on the vagus nerve as a contributing factor to symptoms of various types. “I would argue at least part of what people with these complex chronic illnesses are experiencing is an ongoing sickness response and that may be because there is a signal that's constantly bombarding the vagus nerve, which may be sensitized by inflammation.” This is an eye-opening look at mind-body connections that are challenging conventional wisdom.  

Mentioned in this episode:

Mount Sinai Health System 

Steven & Alexandra Cohen Foundation 

If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

“I think education is very much of an artistic process. I love to think of this as kind of being in a museum. It's about curation of an experience,” says Alex Kendall who oversees the physician assistant training program at Emory University. As he takes on the role of director, Kendall’s background in art and anthropology give him an interesting perspective from which to build on and realize the program’s vision and mission, which are rooted in evidence-based education, leadership development, interprofessional education and creating patient-centered, community-oriented clinicians. Toward that end, one curated experience is participation in the longstanding Emory Farm Worker project in which students care for thousands of migrant workers from Florida, Georgia and other states. Among other things, it’s a great opportunity to deepen awareness of the social determinants of health and practice caring for diverse populations. Looking to the future, Kendall and colleagues are keen to prepare their students for growing trends that will impact their work as clinicians including team-based care, the aging of the population and the increase in climate-related health problems. “We ask ourselves what does the future of health and society look like in ten years and what is needed from physician assistants? Our job is to identify what medical education then needs to look like in order to meet those future challenges.” This expansive conversation with host Hillary Acer also touches on Emory’s cognitive apprenticeship curriculum, scaffolded learning, making primary care an easier choice of specialty and the growing interest in point of care ultrasound.

Mentioned in this episode:

Emory University School of Medicine PA Program 

Emory Farm Worker Project

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Why do patients with long COVID have such a wide array of symptoms affecting so many bodily systems? That bedeviling question is the focus of this episode of Raise the Line featuring Dr. Resia Pretorius, head of the Department of Physiological Sciences at Stellenbosch University in South Africa and a renowned researcher in coagulation. “The underlying concept of what is happening, in our minds, is that long COVID is a widespread vascular endotheliitis, which is driven by the presence of all sorts of inflammatory molecules in circulation,” she tells host Dr. Raven Baxter of the Cohen Center for Recovery from Complex Chronic Illnesses (CoRE). Because endothelial cells line blood vessels that travel to every part of the body, their impairment produces a range of symptoms. Dr. Pretorius and her research colleagues have discovered that “microclots” – abnormal proteins that prevent clots from breaking down – are another ingredient in the long COVID recipe due to their possible role in reducing oxygen flow to the brain and other organs. Because of their unusual structure, microclots are not detected by customary blood tests, leading Dr. Pretorius to add her voice to the chorus of stakeholders calling for the development of new diagnostic tests and additional treatments. “We need a concerted effort for trials. We need FDA approval for the laboratory test that we developed. I’m confident we will get it done, but it will take time, which is sad.” Tune in to learn about the possible causes of microclots, promising research on anticoagulation therapy and why long COVID is not a “checklist” disease, as our special series on post-acute infection syndromes continues. 

Mentioned in this episode:

Mount Sinai Health System

Steven & Alexandra Cohen Foundation

If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

In a word cloud generated from this episode of Raise the Line, ‘communication’ would dominate: communication between the immune system, nervous system and connective tissue; communication between patients and providers; and communication among providers to solve challenging diagnostic puzzles. As our special series on post-acute infection syndromes continues, host Raven Baxter of the Cohen Center for Recovery from Complex Chronic Illnesses (CoRE) is joined by neurologist Dr. Ilene Ruhoy, immunologist Dr. Anne Maitland and physical therapist Dr. Valerie Iovine Rogers to unravel the interconnectedness at work in these diseases and reveal key insights about caring for patients. “In the complex disease world, there isn’t a nice protocol that we have in other parts of medicine, so it takes a lot of listening and a lot of trial and error,” says Dr. Ruhoy. “The most important thing is to continue digging into that story and building that practitioner-patient relationship so that there's trust there,” adds Dr. Maitland. All agree that a lack of specialists in mast cell activation syndrome, hypermobility disorders and related areas puts a premium on developing referral networks so that diagnostic roadblocks do not end the search for answers. “It really harps on the importance of an interdisciplinary care team where all of us have to communicate with one another and educate the patient so they know what they're advocating for and where they need to go,” Dr. Rogers explains. Don’t miss this instructive conversation on both the art of patient care and the science of these often debilitating illnesses. 

Mentioned in this episode:

Mount Sinai Health System 

Steven & Alexandra Cohen Foundation 

If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

If we didn’t know Dr. Brian Ogendi, we might be concerned about someone being able to pull off a residency and two fellowships while being a father of two young boys, but we do know Brian through his work with our Osmosis Medical Education Fellows (OMEF) program in which he played a major role while earning both his MD and MBA degrees. In other words, we’re not worried. Host Hillary Acer checked in with Brian recently as he was wrapping up med school and preparing to start a residency in Internal Medicine/Physician-Scientist Pathway at UVA Health with a fellowship in infectious disease and critical care medicine. “For me, medicine and research really go hand in hand. They enhance each other, they sharpen each other,” he explains. He’s already demonstrated that in his role as research advisor to the OMEF program where he drew on his work at the NIH and elsewhere to provide grounding and encouragement to learners. Brian is hoping to put all of this education and experience to work providing care to underserved communities both in the United States and in his native Kenya, leveraging a global network built through Osmosis to do so. Don’t miss this uplifting installment in our Next Gen Journeys series full of advice on juggling heavy workloads and family responsibilities while gaining the skills to become an effective, community-minded physician.

Mentioned in this episode: 

UVA Health

If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

Diagnosing Post-Acute Infection Syndromes: Special Series from The Cohen Center for Recovery from Complex Chronic Illnesses at Mount Sinai

“Tick-borne illnesses are incredibly stealthy and complicated and if I wasn't living and breathing it every day and seeing the intensity of these symptoms in patients, I would never believe it,” says Shannon Delaney, a psychiatrist in private practice in New York City. The complexity of such illnesses and the symptoms they cause is a key reason it can often take years to reach a diagnosis, which is the focus of this episode of Raise the Line, part of a special series on post-acute infection syndromes that Osmosis from Elsevier has created in partnership with the Cohen Center for Recovery from Complex Chronic Illnesses (CoRE) at the Icahn School of Medicine at Mount Sinai Hospital. In addition to Dr. Delaney, host Dr. Raven Baxter of CoRE welcomes Dr. Amy Kontorovich, an associate professor in Cardiology and Genomic Medicine at the Icahn School and Dr. David Putrino, director of Rehabilitation Innovation at Mount Sinai, to explore the limitations of current diagnostic tools and protocols and what changes are needed to improve patient care. Key themes include developing better tests for pathogens and educating providers to listen more carefully to patients. “In a typical medical encounter, the biggest dropped ball is completely disregarding an acute infection in the medical history,” stresses Putrino. All agree that providers need to be more comfortable with uncertainty and resist the urge to develop treatment plans that don’t address root causes. “If more doctors could just say, ‘I don't know’ I think it would do a great service to patients," adds Kontorovich. This is a candid and enlightening discussion about the importance of developing a collaborative, patient-centered mindset to provide the best care for those suffering with a range of post-acute infection syndromes.

Mentioned in this episode: 

Mount Sinai Health System

Steven & Alexandra Cohen Foundation 

If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

Today, we add another voice to our ongoing conversation on Raise the Line about how to improve the nurse staffing crisis faced by the US healthcare system. That voice belongs to Bhavdeep Singh, founder and CEO of Global MedTeam, a startup focused on bringing foreign-born nurses to the US to fill staff shortages. When Singh, who has deep experience in healthcare management, learned from a hospital executive that the annualized cost of employing one travel nurse can reach into hundreds of thousands of dollars in some locations, he realized there was room, and a need, for new approaches. “There's some wonderful work being done in this space, whether it's process improvement, remote monitoring, or software to make sure that we have the right kind of scheduling…all of these things are very helpful, but that's not going to get us to where we need to be. We will still have a huge shortage.” Singh believes employing pre-credentialed nurses from abroad, especially from the Philippines which has a long history of sending nurses to the US, is a viable part of the solution and his firm has put processes in place to make it a turnkey experience for employers. “We handle everything for the client including immigration from start to finish.” Join host Michael Carrese as he explores potential healthcare impacts on the “supplying” countries, the storied reputation of Filipino nurses and how this approach might also work for shortages in allied health professions. 

Mentioned in this episode: Global MedTeam

If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast