Raise the Line Michael Carrese, Shiv Gaglani

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 (www.mountsinai.org)
Steven & Alexandra Cohen Foundation (www.stevenandalex.org)

“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

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 (www.mountsinai.org)

Steven & Alexandra Cohen Foundation (www.stevenandalex.org)

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 (www.mountsinai.org)

Steven & Alexandra Cohen Foundation (www.stevenandalex.org)

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 - https://uvahealth.com/

“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 (www.mountsinai.org)
Steven & Alexandra Cohen Foundation (www.stevenandalex.org)