Helen Ouyang (@drhelenouyang) is an emergency physician at NewYork-Presbyterian Hospital and an assistant professor at Columbia University.
Editor’s Note: Dara Kass, an assistant professor of emergency medicine, donated part of her liver to her son. Adam Griesemer, an assistant professor of surgery, performed the transplant.
Mary D’Alton, chair of the Department of Obstetrics and Gynecology, responds to alarming national statistics indicating poor health outcomes for America’s new moms.
Still, as a neuroscientist who has studied schizophrenia for decades, I am optimistic. The story of chlorpromazine, an antihistamine that was repurposed for schizophrenia, offers a powerful lesson. We now have the ability to find other drugs that could be repurposed to treat brain diseases, thanks to new technologies. Medicines already on our shelves may hold untapped promise for treating brain diseases—if only pharmaceutical companies can be prompted to share their data with scientists.
Joseph Gogos is a neuroscientist at Columbia University’s Zuckerman Institute.
“Your body is equipped with immune cells to fight infections and, in the case of strep [that leads to PANDAS], that immune system is fighting the strep infection then erroneously begins to attack other organs,” explains Dritan Agalliu, an assistant professor of pathology and cell biology in neurology and pharmacology at the Columbia University Irving Medical Center. … Scientists including Agalliu have revealed in mice how exactly, at the cellular and molecular level, the immune cells triggered by a strep infection can cross from the blood into the brain and cause inflammation. Others are studying why it doesn’t do so in most cases, though it seems to be related to genetics, exposure to the type of strep that causes a recurrent sore throat, and an “immature immune system,” Agalliu says.
Your primary care doctor may be able to help you with most lung conditions, but in certain cases you may need a lung specialist, called a pulmonologist, “a physician who specializes in the diagnosis and management of lung diseases and disorders,” says Dr. Luke J. Benvenuto, a pulmonologist at NewYork-Presbyterian/Columbia University Irving Medical Center in New York City. These lung specialists complete extensive training in internal medicine and pulmonary medicine and have specialized expertise in managing and treating a broad spectrum of lung conditions. … For some severe cases of certain diseases, such as advanced COPD, cystic fibrosis, pulmonary hypertension or interstitial lung disease, you may end up needing a lung transplant. Benvenuto specializes in transplantation for patients who have idiopathic pulmonary fibrosis, a form of interstitial lung disease, and says transplantation is “definitely a last resort. The lung transplant is far from perfect, and there’s a large shortage of donors out there.”
According to the American Cancer Society, many of the more than 5 million skin cancer cases diagnosed each year in the U.S. could be prevented by protecting skin from excessive sun exposure.
Health Matters spoke with Dr. Larisa Geskin, a skin cancer expert and the director of the Comprehensive Skin Cancer Center at NewYork-Presbyterian/Columbia University Irving Medical Center, to discuss moles, melanoma, and the importance of regularly checking your skin for signs of changes.
Dr. Craig Blinderman, the director of adult palliative medicine at the Columbia University Medical Center, hears lots of accounts. Yet evidence-based data is elusive, if nonexistent, he said. Aside from the challenges of catching dying people at the moment of springing back, it’d be tough to get the medical ethics board to determine that the research would benefit the patient. This type of study would require the constant drawing of blood and monitoring of patients, which runs counter to the quiet fade away that is a signature element of palliative care.
Dr. Blinderman has theories about causes, however. He postulated that as organs shut down, they can release a steroid-like compound that briefly rouses the body. In the specific case of brain tumors, swelling occurs in the confined space of the skull. The edema shrinks as hospice patients are weaned off food and drink, waking up the brain a bit.
And the impact of those high deductibles might go beyond a patient’s finances, said Miriam Laugesen, an associate professor of health policy and management at Columbia University’s Mailman School of Public Health in New York City, and author of “Fixing Medical Prices.” “Financial toxicity or insecurity is potentially going to influence their health,” said Laugesen, who is unaffiliated with the new research. “That’s why it’s really important to make sure that health care is affordable.”
Cardiologists say it can absolutely be done without the help of medication. In fact, lifestyle changes are the first approach they often try in patients with hypertension. So what are the best ways to lower your blood pressure without pills? We asked two experts:
• Dr. Ron Blankstein, a preventive cardiologist at Brigham and Women’s Hospital in Boston, associate professor at Harvard Medical School and a member of the American College of Cardiology’s Prevention of Cardiovascular Disease Section Leadership Council.
• Dr. Jennifer Haythe, an assistant professor of medicine and co-director of the Women’s Center for Cardiovascular Health at the Columbia University Medical Center.
According to study senior author Charles Branas, “Greening vacant land is a highly inexpensive and scalable way to improve cities and enhance people’s health while encouraging them to remain in their home neighborhoods.” Branas is chair of epidemiology at Columbia University in New York City and an adjunct professor in the department of biostatistics and epidemiology at UPenn. “Revitalizing the places where people live, work and play may have broad, population-level impact on mental health outcomes,” he added.
Editor’s Note: Julia Wattacheril, an assistant professor of medicine, explains how an NIH-funded program could help her better serve her patients. The program, “All of Us”, seeks to enroll 1 million Americans into one of the world’s largest and most diverse data sets for precision health research. Columbia University Irving Medical Center is the lead partner among New York’s network of participants.
“Some juices do contain more fiber and vitamins, but some juices, such as apple juice, in fact have been used as a sweetener, and it contains a lot of sugar, so it is still not recommended in large amounts for children,” said Dr. Claire Wang, an associate professor at Columbia University’s Mailman School of Public Health who specializes in policy that fights childhood obesity. “Personally, I think [the ordinance] is one step towards the right direction. The 100 percent fruit juice in modest doses is still superior to a soda.”
“Oftentimes it’s not necessarily the emotion itself that’s bad or toxic, but how one copes with it,” said Dr. Erin Engle, clinical director of Psychiatry Specialty Services at Columbia University Medical Center. “That’s why people come to therapy, especially for something like anger — the problem is not the anger per se, but the expressing of that anger that results in some sort of negative consequence.”
“It would be interesting to know over time if restrictions in approvals and requirements for pre-certifications by insurance companies have impacted the ordering of these expensive imaging tests,” said Dr. Dawn Hershman, a professor of medicine and epidemiology and leader of the breast cancer program at the Herbert Irving Comprehensive Cancer Center at Columbia University.
“At its most fundamental, the brain’s purpose is to create an accurate and stable representation of the world around us, and we’ve long hypothesized that this noise-cancellation mechanism played a part in that,” Nathaniel Sawtell, a postdoctoral researcher at Columbia, said in a news release. “With today’s study, we offer direct evidence that this mechanism is essential to improve and enhance the brain’s ability to sense its surroundings.”
Now, a study shows that a simple intervention conducted by staff in emergency departments can reduce the risk of future attempts. The intervention involves creating a safety plan for each patient and following up with phone calls after discharge. “It reduced the odds of suicidal behavior by half,” says Barbara Stanley, a psychologist at Columbia University and the lead author of the study. “That’s a phenomenal difference.”
“Racing in these events has helped me feel better about myself and become a better person,” said Rodriguez, who lives in Parkchester and works as an executive assistant at Columbia University. “Before there were a lot of things I was afraid to do, because of my arm. I couldn’t imagine going swimming, because I was self-conscious. Riding a bike was unheard of. Now, I’m so much more confident. Doing this has changed my life.”
The boys were malnourished and weak, and doctors are probably worried that they could be susceptible to germs spread by family members or other visitors, said Dr. W. Ian Lipkin, a Columbia University infectious diseases expert. … Lipkin said more likely risks are tetanus bacteria that could infect a wound, diarrhea-causing bacteria that could have contaminated the cave waters, and inhalable fungal spores that could cause breathing problems — including pneumonia.
Dr. Roshni Rao, chief of breast surgery at New York-Presbyterian/Columbia University Irving Medical Center, said it’s common for women under 40 to find their own cancerous tumors during self-exams since patients in that age group do not receive routine mammography. Here are Rao’s tips for self-examining your breasts.
The connection may lie in how information that you hear is transferred to and processed by your brain. “Prolonged dysregulation of this relationship is thought to result in dementia,” explained Dr. Ana H. Kim, director of otologic research in the department of otolaryngology-head & neck surgery at Columbia University Herbert and Florence Irving Medical Center in New York City.
A groundbreaking clinical trial on whether diet could boost the effectiveness of cancer drugs is set to be launched by one of the world’s leading oncologists. The work, led by Siddhartha Mukherjee at Columbia University Medical Center in New York, will investigate whether a high-fat, low-carbohydrate diet could improve outcomes for patients with lymphoma and endometrial cancer.
Andrew Solomon is a professor of clinical psychology at Columbia University Medical Center, a winner of the National Book Award, and the author of Far from the Tree: Parents, Children, and the Search for Identity. A documentary film based on that book is scheduled to be released July 20. The opinions expressed in this commentary are solely those of the author.
Several experts predicted the results would spur efforts to entirely replace the Pap test with the HPV test. “It’s an important study,” said Jason Wright, a gynecologic oncologist at NewYork-Presbyterian/Columbia University Medical Center who was not involved in the study. “It shows that doing HPV testing alone provides a high degree of accuracy” on who might be at risk for cervical cancer.
Dr. Stephen W. Nicholas, who ran several pediatric AIDS units during the epidemic, recalled treating so-called AIDS babies in the mid-1980s at Harlem Hospital, many of whose mothers were often homeless drug addicts dying from AIDS. He remembered asking a nurse about burial arrangements for one early patient. “She said, ‘Oh no, these babies go to potter’s field,’” said Dr. Nicholas, now a dean at the Vagelos College of Physicians and Surgeons at Columbia University. “It dawned on me that many of these kids didn’t have anyplace to go for a decent burial,” he said.
Some cancer physicians now use tissue TMB tests in select cases. But the less-invasive blood test, which analyzes tumor DNA shed into a person’s circulation, could reveal TMB in the many patients where tissue testing doesn’t work. “We’ll see [TMB] more and more,” says Naiyer Rizvi, an oncologist at Columbia University Medical Center. Still, TMB testing currently takes too long for routine clinical practice, he adds, and some in the cancer field question how useful it’ll ultimately prove.
A study from Columbia University Irving Medical Center shows that women who have mild sleep problems—including those who slept for seven to nine hours a night—are significantly more likely to have elevated blood pressure, according to the findings published in the Journal of the American Heart Association. … “That’s concerning, since studies have shown that sleep deprivation and milder sleep problems may have a disproportionate effect on cardiovascular health in women,” said Brooke Aggarwal in a statement. Aggarwal is a behavioral scientist in the department of medicine at Columbia University Vagelos College of Physicians and Surgeons and the lead author of the study.
Adam Bisaga, a professor of psychiatry at Columbia University Medical Center, strongly believes that programs withholding effective treatments, intentionally or unintentionally, should not receive public funding: “Public resources, especially when limited, should be steered towards the most effective interventions.”
Even so, the results underscore the safety of abortions provided in office settings as well as surgery centers, Dr. Carolyn Westhoff of Columbia University Medical Center in New York City and colleagues write in an accompanying editorial. “Abortion care made an early shift to the office setting, for the universal reasons of convenience and cost reduction, and because the majority of abortions are technically simple and safe,” Westhoff and colleagues write. “Office-based abortion care should remain an available option for women.”
Researchers at Columbia University studied “overfed” mice and determined that the hormone helped them return to their normal weight after an excessive amount of nutrients. Their findings were published this month in the journal Cell Metabolism. “We’re now looking for this signal and we hope that once it’s found, it will induce weight loss in more typical obese individuals who have gained weight slowly over time,” Dr. Anthony Ferrante, a professor of medicine at Columbia University Vagelos College of Physicians and Surgeons, said in a press release.
During the week, Craig works as a nuclear pharmacist in NewYork-Presbyterian’s Columbia University Irving Medical Center, handling doses of radioactive drugs that help doctors diagnose cancer and other conditions. But on the weekends, he takes to the turntables to DJ pulsating parties. The work has taken him as far away as Sydney, Australia, but he’ll be closer to home when he opens Sunday’s sold-out Pride Island concert in Hudson River Park.
“Consumption of added sugars is associated with excess weight gain and obesity,” said Dr. Jennifer Woo Baidal, an assistant professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons, and director of pediatric weight management in the division of pediatric gastroenterology, hepatology, and nutrition at Columbia University Irving Medical Center, told Healthline. “And that can lead to hypertension, dyslipidemia, fatty liver disease and diabetes.”
The letter was signed by … Dr. Rahul Sharma, emergency physician in chief at New York-Presbyterian Hospital Weill Cornell and chairman of the department of emergency medicine at Weill Cornell Medicine; Dr. Angela Mills, chief of emergency medicine services at New York-Presbyterian Hospital Columbia Irving Medical Center and chairwoman of the department of emergency medicine at Columbia University Vagelos College of Physicians and Surgeons; …
There also may be confounding issues that confuse clinicians. “Older people grew up in an era when talking about a psychiatric issue was certainly frowned upon, so there may be a generational issue,” says Dr. Philip R. Muskin, a professor of psychiatry at Columbia University Medical Center and a member of the American Psychiatric Association’s Scientific Program Committee. Elderly patients also may ascribe their moods to physical impairments or other illnesses. And many of the symptoms of depression and anxiety – poor sleep, low appetite, memory and concentration problems – are also markers of simply being older.
Dr. Philip R. Muskin, a professor of psychiatry at Columbia University Medical Center and secretary of the American Psychiatric Association, said physicians must keep these side effects in mind when prescribing medications, and ask patients about whether they have a personal or family history of depression. But he said it is hard to say whether the increased use of drugs, or the combination of drugs, with side effects including depression has had an impact on society. “There’s been an increase in suicide, that we know,” Dr. Muskin said. “Does it correlate to the use of these medications? The honest answer is we don’t know. Could it play a role? The honest answer is yes, of course it could.”
Dr. Jeffrey Lieberman comments on the possible role of a mood disorder in Kate Spade’s suicide.
The new study provides the highest level of proof that the assay is an accurate tool and thus reduces uncertainty for the intermediate group, said Dawn Hershman, a breast oncologist at NewYork-Presbyterian Columbia University Medical Center.
The Vagelos College of Physicians and Surgeons at Columbia University announced last month that it would eliminate student loans with scholarships for all students who qualify for financial aid. More than half of school’s students – 55 percent – receive some form of aid. Starting this August for the 2018-2019 school year, more than 300 students will receive scholarships to cover either part or all of their tuition, school administrators say. Nearly 20 percent of the school’s students will receive full-tuition scholarships. Some students broke down in tears when they saw that their financial aid packages included no loans, says Dr. Lee Goldman, dean of the Faculties of Health Sciences and Medicine at Columbia’s medical school. “When they actually saw it on paper, they started to cry from joy, even though they knew it was happening,” he says.
“The findings are very intriguing,” says Alan Brown, a professor of psychiatry and epidemiology at Columbia University Medical Center who was not involved in the study. “To me, the key thing in this paper is the recognition that environmental factors in early development, prenatal factors, are likely to be very important in schizophrenia and just as important as genes.”
“It just is stunning how poor our information was as to what was happening in Puerto Rico,” said Leslie Roberts, a professor and director of the program on forced migration and health at the Columbia University Mailman School of Public Health.
“The findings are very intriguing,” says Alan Brown, a professor of psychiatry and epidemiology at Columbia University Irving Medical Center who was not involved in the study. “To me, the key thing in this paper is the recognition that environmental factors in early development, prenatal factors, are likely to be very important in schizophrenia and just as important as genes.”
Bryan Stanifer, a thoracic surgeon and director of the Women’s Lung and Health Center at NewYork-Presbyterian Columbia University Medical Center, suspects that some women have “a genetic predisposition” that makes them more susceptible to lung cancer, especially when combined with some sort of environmental toxin such as secondhand smoke. What’s puzzling, he said, is that many of his patients haven’t been around smoke.
This February Ruth Landau, an obstetric anesthesiologist at Columbia University Medical Center in New York City, was making rounds when she got a disturbing call from one of the hospital’s pharmacists. The center was due to run out of bupivacaine, a local anesthetic used in virtually every baby delivery. Fast-acting and predictable, the numbing agent has long been the drug of choice for supporting childbirth, administered as an epidural for women in labor or as a spinal anesthetic for those having a cesarean section. Prepared in a dextrose solution, the syrup-like injection is especially critical in emergency deliveries.
“It’s a way of looking at genetics but without having any genetic data,” said Nicholas Tatonetti, a data scientist at Columbia University Medical Center and one of the researchers who came up with the novel approach, which was outlined in a paper published Thursday in the journal Cell.
And on Mother’s Day, New York-Presbyterian/Columbia Hospital is opening The Mothers Center, the first-of-its-kind center focused on care for all kinds of maternal complications, especially for high-risk women with heart disease, diabetes or autoimmune diseases. At least 60 percent of childbirth-related deaths are preventable, says Dr. Mary D’Alton, chair of obstetrics and gynecology at New York Presbyterian and Columbia University Medical Center. Under D’Alton’s guidance at the Mothers Centers, doctors and nurses get special simulation training to recognize warning signs and quickly treat new mothers for postpartum hemorrhage, one of the most common causes of maternal deaths.
Dr. Coady — she took her name from her marriage to Patrick Coady, which ended in divorce — studied music at the College of the Pacific (now the University of the Pacific) in Stockton, Calif., before deciding to pursue medicine. She was inspired by two female pediatricians who ran a camp for diabetic children, where she worked as a counselor, and graduated from Columbia University’s College of Physicians and Surgeons in 1965. Four years later she received a master’s degree in public health from Harvard University.
“An orgasm, eye contact, hugs, soft touch—all these things release oxytocin,” says Bianca J. Marlin, a postdoctoral researcher at Columbia University’s department of neuroscience.
“Your mom is half the answer. Your dad is also half the answer,” said Dr. Wendy Chung, a geneticist at NewYork-Presbyterian and Columbia University Irving Medical Center. “You don’t inherit 100 percent of your mom’s genes.” She added, “So even though [your mother] may have followed a certain path, it’s not a fait accompli that you’re going to follow the same path.”
Alfred Ogden, a neurosurgeon at the Spine Center at Columbia University Medical Center, said anti-inflammatories are especially useful in golf, which puts significant stress on the spine. When asked about the potential side effects, Ogden said, “None of these things are surprising. Like any medicine, they have ill effects. Having said that, most people tolerate them pretty well. They’re effective. And those risks can be mitigated by not taking them continuously.”
As Dr. Charles A. Popkin, a pediatric orthopedic surgeon at Columbia University Medical Center, said at the meeting, “Sadly, what parents want and what parents hope to gain from their children’s participation in youth sports is often at a significant extreme to what the kids actually want.”