Raise the Line Michael Carrese, Shiv Gaglani

Today on Raise the Line, we make a stop in Northern Europe on our ongoing tour of medical education around the globe and bring you the perspective of Dr. Povilas Ignatavicius, a hepato-pancreato-biliary and liver transplant surgeon and vice dean at Lithuanian University of Health Sciences, which is the largest institution of higher education for biomedical sciences in that country. In particular, Dr. Ignatavicius shares his insights on medical simulation and student evaluations, which are among his areas of responsibility. As he describes to host Michael Carrese, his school takes an approach to simulation that values a continual presence of instructors and distributes resources so that individual programs such as surgery and nursing can offer access to what he describes as improved simulation technology. “Our students are exposed to medical simulation starting in year one. Our plan for the next year is that they will spend about 30% of the time with medical simulation at different levels,” he explains. This enlightening conversation also touches on the growth of international students at the university, how AI is impacting education, and a key quality that he thinks sets his school apart from others in Europe.

Mentioned in this episode: Lithuanian University of Health Sciences (https://lsmu.lt/en/)

Last year’s declaration by the U.S Surgeon General that loneliness and isolation are a public health crisis was based on research showing that they have a negative impact on mental health, blood pressure, cognitive performance and, most relevant to our discussion today on Raise the Line, immune system function. That’s why it’s important for people dealing with chronic illnesses to stay socially connected at whatever level they are capable of, says our guest Dr. Rose Perry, a neuroscientist and executive director of an applied research non-profit called Social Creatures. “When your symptoms aren't good, being isolated can be like throwing gasoline on the fire. I don't think lack of social connection is a cause of chronic illness, it's really about setting conditions that make healing maximally possible,” she says. At Social Creatures, Dr. Perry and her team create programs designed to help populations at risk for social isolation feel like they are connected and supported. As she explains to host Raven Baxter of the Cohen Center for Recovery from Complex Chronic Illnesses at Mount Sinai, providers should be aware of programs like hers and affinity groups (e.g. knitting clubs) in their locality and engage in “social prescribing” as part of a treatment plan. “A lot of doctors will develop a resource list so they can pull it up and then kind of matchmake their patient with an organization.” Don’t miss this final episode in our special series on Post-Acute Infection Syndromes where you’ll hear about practical strategies providers can use to help address an often overlooked factor in someone’s ability to be as healthy as possible.

Mentioned in this episode:
Mount Sinai Health System (www.mountsinai.org)
Steven & Alexandra Cohen Foundation (www.stevenandalex.org)

Medical school and residency are daunting enough without dealing with a chronic illness on top of it, but that has been the reality for our guest today, Dr. Kyle Dymanus. In this candid interview with Raise the Line host Hillary Acer, Dymanus shares a wealth of wisdom about balancing studies, work and wellbeing gained during her years as a med student at Medical College of Georgia and her current residency in urology at Rush University Medical Center. A key for her was having a network of supporters outside of her professional circle to help her manage ulcerative colitis, a condition she was hesitant to disclose to colleagues and supervisors. “My friends and family were literally the ones on the ground calling my doctors to schedule appointments and following up when they didn't send medications to my pharmacy. I honestly could not have done it without them,” she shares. On a promising note, Dymanus believes more support is being made available within residency programs as recognition grows about the mental and physical health impacts that can result from the demanding, high stakes work involved. “The traditional thinking with residents and doctors is you need to be strong, you need to kind of suffer through this, but I think a lot of programs are now being more proactive, and they’re providing supportive resources for residents ahead of time.” Hillary and Dr. Dymanus also touch on her interests in medical device development, outcomes research, quality improvement, and global health inequities. You won’t want to miss this inspiring episode in our Next Gen Journeys series featuring fresh perspectives on education, medicine, and the future of healthcare.

Mentioned in this episode:
Rush University Medical Center (https://www.rush.edu/)

Having a child with a complex illness can be especially challenging for parents because of differing opinions among providers about causes, symptoms and treatments for disorders such as long COVID and chronic Lyme. “A common theme I would hear from parents is that they really had to push their providers to consider Lyme. Sometimes they even had to beg for testing to be done because it just wasn't considered a possibility,” says Dr. Charlotte Mao, a pediatric infectious disease physician working with leading foundations in the Lyme disease and associated infections arena. Adding to challenge is that kids often have trouble explaining their symptoms, says Dr. Lael Yonker, a pediatric pulmonologist at Massachusetts General Hospital. “I think takes a lot of patience by the pediatrician, listening carefully to the parents and patient, and really trying to dig into what their symptoms actually mean.” Join host Raven Baxter of The Cohen Center for Recovery from Complex Chronic Illnesses at Mount Sinai as she draws out valuable guidance on how providers can work effectively with both children and parents during a journey laden with uncertainty. Key tips include having humility for the limits of your own knowledge, keeping an open mind for unexpected possibilities and having respect for what patients know about their own body. Don’t miss this wisdom drop from these deeply experienced pediatricians and researchers as our 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)

“Helping patients with complex illnesses is a lot like rock climbing. You're looking for toe holds and finger grips that you can use to get from where you are to where this patient wants to be,” says Dr. Leo Galland, an internist and author who specializes in undiagnosed or difficult to treat illnesses. His fellow guest on this episode of Raise the Line, co-founder of the California Center for Functional Medicine Dr. Sunjya Schweig, agrees and says figuring out that next anchor point depends on taking the time to learn about all aspects of a patient’s life and lifestyle, and building a cooperative relationship with them. “Listening is the first therapeutic step,” he tells host Raven Baxter of The Cohen Center for Recovery from Complex Chronic Illnesses (CoRE) at Mount Sinai. In this deeply informative conversation, both experts underscore that working in this realm requires moving past differential diagnosis and symptom management and persisting in the search for root causes. “You have to embrace the complexity and the individuality of illness. Thinking for yourself and always questioning is really important and, you know, being a real pain in the butt kind of person is what you've got to be,” adds Galland. This special episode is packed with valuable insights on the limits of testing, the role of disease triggers and mediators, the power of lifestyle changes and much more as our 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)

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