Profiles in Medicine 9/27/23 edition is published by Anton Media Group.

IN

MEDICINE PROFILES

UNDOCUMENTED FROM IMMIGRANT TEEN TO WORLDCLASS SURGEON

Advances in pediatric cancer treatment

Double neural transplant

Women’s Health Care of Garden City Committed to Personalized Care

By John L. Gomes, MD

John L. Gomes, MD, founded Women’s Health Care of Garden City in 1995. It has remained an independent, private practice providing personalized obstetrical and gynecological services.

He employs the technical advances of conventional medicine with an integrative approach to navigate women through dif cult pregnancies into the menopausal years. He treats a wide variety of OB/ GYN conditions and is dedicated to providing the highest quality of care.

All tests are conveniently done on the premises and a dedicated, compassionate staff is on call 24/7.

He is committed to excellence in patient communication, education and support as many patients come with anxiety associated with past experiences and future concerns.

Dr. Gomes received his undergraduate degree from Brown University and his Doctor of Medicine from Columbia University. He is both Board Certi ed and a Fellow of the American College of Obstetrics and Gynecology.

Women’s Health Care of Garden City is located at 1000 Franklin Avenue, Suite 200, Garden City. Call 516-222-8883 or visit online at DrGomes.com

Undocumented: From Violent Streets To A Cardiothoracic Surgeon

Harold Fernandez shares the path to his success

BY CHRISTY HINKO chinko@antonmediagroup.com

“There was a lot of violence,” Dr. Harold Fernandez, a Northwell thoracic surgeon said. “In the same streets where I played soccer every day, I saw friends and family members lose their lives.”

Fernandez recounted his days as a young boy, growing up in Medellín, historically one of the most violent cities in Colombia since the 1980s. Fernandez said, “The city was going through a lot of turmoil because of the war between the government and Pablo Escobar.” Fernandez said this is the reason that his mother, Angela, and his father, Alberto, initially came to America on temporary work visas, but overstayed. Angela supported her husband’s plan to temporarily go to the United States, acquire some new skills and earn some extra money, but she quickly fell in love with America. She could not hide her heartsickness from being separated from her sons, Harold and John Byron, who she left in their grandmothers’ care back in Medellín. “I was 13; my brother, John, was 11,” Fernandez said. “My mother imagined having her whole family join them one day, with the safety and all of the benefits that America had to offer.”

Angela cried every day, struggling with being apart from their sons. One day, a coworker mentioned that their daughter would be making the journey from Colombia to America by way of the Bahamas. The trip would take three days at most, perhaps she could chaperone Harold and John for their journey north? Angela was excited and full of hope, but Alberto was hesitant. After some discussion they decided to press forward with the trip. Fernandez and his brother began their journey on Friday, Oct. 13, 1978.

The travelers boarded a plane in Medellín headed to Nassau, the capital of the Bahamas. They then took a puddle-jumper for 130 miles from Nassau to Bimini, a small island just 50 miles due east of Miami. They landed in Bimini, but the sea conditions were treacherous, halting their passage by boat from Bimini to Miami. “We waited for two weeks in Bimini for the conditions to subside,” Fernandez said. “Communications in those days were difficult; you had to go to a payphone calling center; we could not tell our parents what was happening.”

The boys’ only option was to call back to Medellín to assure their grandmothers that they were safe and that all was still well. Their message would then be relayed to New Jersey to their presumably frantic parents. “We had to pretend to be reporting back about a vacation because we were afraid that the immigration authorities in the Bahamas would know what we were doing,” Fernandez said.

The boys feared they would be deported before they had a chance to touch American soil and get to the safety of Angela and Alberto. “We finally made our departure heading to Miami. It was at night, and by a small boat, so as to not be detected by the U.S. Coast Guard,” Fernandez said. “The ride to Miami was very rough; everyone on the boat was sure the boat would capsize.” Fernandez said what he remembers most about the boat ride to Miami was that everyone was crying and reciting the Lord’s Prayer.

The boat arrived safely at an abandoned dock in Miami. Fernandez and his brother made contact with family friends in Miami, who were in touch with their parents to give them the update. They stayed at the apartment of those friends before taking a taxi to the airport and boarding a flight from Miami to Newark. They were briefed ahead of their flight. “They told us, ‘when you see your parents, you have to make sure not to celebrate as to call attention to yourselves; this will surely alert immigration authorities,’” Fernandez remembered. “Remember, I had not seen my parents in many years now. We started running and crying and hugging each other; we were all thanking God that we were together again.”

Fernandez recalled his shock at the abundance. “Back in Colombia, an apple is a luxury. Our grandmother would buy an apple and cut it into little wedges; we all would get a little wedge,” Fernandez said. “My mom had whole apples on the table in a little basket. On the first night, me and my brother, John, we couldn’t sleep thinking about those apples. We went to my mother’s bedroom and woke her up and asked, ‘Mom, could we get one of the those apples?’”

The family was all together again, but with the years of separation, there was a lot of work to be done to rebuild.

“The first months were rough in America for me. If people knew me then, they would say I was a troubled teenager, similar to other kids they might see coming from other countries. I was smoking cigarettes and was trying to learn how to drink hard liquor, getting into fights at school.”

The school principal called Angela and said if her sons continued to fight in school they would be suspended.

“I saw my mother break down,” Fernandez said. “It was then that I realized I had to change my life around.”

He made the decision to get a job delivering newspapers for the Hudson Dispatch (now merged with The Jersey Journal). Fernandez wanted the glory of being called “The best delivery boy in America” to make his mother proud. He began getting up at 4:30 a.m. to do his route, whether it was

raining or snowing. He even remembers doing his route while he was sick. He started with 90 deliveries and worked his way up to 120 papers. Within a year, he had been named “Harold Fernandez: Newspaper Carrier of the Month”. It was printed in the newspaper, a clipping that Fernandez still has in his personal papers today. “I remember my mother cut it out and carried it with her in her purse and showed it to everyone, even people she did not know,” Fernandez said. “My father also put it on his locker at work.”

That wasn’t enough for him though. “I think that was the spark,” Fernenadez said. “I believe it’s what led me to get accepted to Princeton University and eventually to Harvard Medical School.”

There was a problem. “I did not have documents. I applied to Princeton with a fake social security card and a fake Green Card,” Fernandez remembered.

Within a year, Fernnadez received a letter from the dean of foreign students at Princeton. “She wanted to see my Green Card. I thought everything was going to come to an end,” Fernandez said. “I had an amazing professor of Spanish literature [at Princeton], Professor Arcadio DíazQuiñones. I remember going to ask if I could speak with him for some advice. He agreed to see me and before I could say a word, I just

started crying inconsolably.”

Díaz-Quiñones held counsel with the then-president of Princeton University, William G. Bowen, that evening and returned to Fernandez with a message from Bowen: “Tell Harold that everything is going to be OK, not to worry and to continue with his coursework.” The university allowed Fernandez to change his status from a fraudulent citizen student to a foreign-status student, so long as he agreed to provide the correct information and documentation as a citizen of Colombia. A testament to the quality of student that Fernandez was up until that point, Princeton awarded Fernandez a complete scholarship.

Bowen, a man well before his time, made many seemingly radical, but worthy and fair decisions toward the betterment of the institution. “He was a remarkable person; he was the first president at Princeton to accept women, African American and Jewish students, and obviously in my case, an undocumented student; I am grateful for him, for DíazQuiñones, for Princeton and America in general,” Fernandez said.

Fernandez takes every opportunity to tell immigrant students today that there are a lot of good people who really do want to help make their lives better. He encourages all students to look for opportunities and take chances.

Fernandez’s story is timely, with immigration conflicts and stories headlining the news for more than half a decade. “It is a complicated situation right now because we have not seen any leadership from republicans or democrats to deal with the problem,” Fernandez said. “There is definitely a need here for workers in America, but no one has come up with a way to do it the right way. It is important for the people who are here already [citizens] to know that their own jobs are protected. It is also important for Americans to know that the borders are secure, that criminals and terrorists are not coming in. It is important for those who are coming over to come in a responsible way. Yes, I came in undocumented at a very young age. My parents were already here waiting for us. Parents who send their kids ahead first are not being responsible. There is no substitute for kids being with their parents or families.”

Fernandez loves Colombia and returns often, but his family is here and the United States is his home.

He is the author of Undocumented: My Journey to Princeton and Harvard and Life as a Heart Surgeon, independently published in 2019.

Advances In Pediatric Cancer Treatment

BY ANTON MEDIA STAFF specialsections@antonmediagroup.com

As medical research and technology continue to advance, there have been significant developments in the field of pediatric cancer in recent years. These developments have improved our understanding of the disease, diagnostic capabilities, treatment options, and outcomes for young cancer patients. Here are some of the newest and most promising developments in pediatric cancer:

Precision Medicine and Targeted Therapies

Precision medicine has been a game-changer in pediatric oncology. Researchers are increasingly able to identify genetic mutations and alterations specific to a child’s cancer, allowing for the development of targeted therapies. These therapies are designed to attack the cancer cells while sparing healthy cells, reducing side effects and improving treatment effectiveness. Targeted therapies have shown promising results in clinical trials for various pediatric cancers, including neuroblastoma and certain types of leukemia.

Immunotherapy

Advancements

Immunotherapy has emerged as a groundbreaking treatment approach in pediatric cancer. CAR-T cell therapy, for

instance, involves modifying a patient’s own immune cells to target and destroy cancer cells. This therapy has shown remarkable success in treating pediatric patients with acute lymphoblastic leukemia (ALL) and certain types of lymphoma. Ongoing research aims to expand the application of immunotherapies to other pediatric cancer types.

Liquid Biopsies

Liquid biopsies are non-invasive tests that can detect genetic alterations and biomarkers associated with cancer in a patient’s blood or other bodily fluids. This technology is particularly promising in pediatric oncology, as it offers a less invasive and more accessible method of monitoring disease progression, detecting relapses, and guiding treatment decisions. Liquid biopsies hold the potential to improve early diagnosis and reduce the need for painful tissue biopsies in children.

Advancements in Radiotherapy

Radiotherapy techniques have evolved to be more precise and less harmful to healthy tissues in pediatric patients. Proton therapy, for example, delivers radiation more precisely, minimizing damage to surrounding organs and tissues. This advancement is particularly beneficial for children, as it reduces the risk of long-term

side effects and improves the quality of life for survivors.

Genomic Profiling and Research Collaborations

Collaborative efforts among researchers and institutions worldwide have led to extensive genomic profiling of pediatric cancers. Large-scale projects, such as the Pediatric Cancer Genome Project, have identified numerous genetic mutations and drivers of pediatric cancer. This wealth of genetic data is invaluable in developing targeted therapies and improving treatment strategies for children with cancer.

Supportive Care and Survivorship Programs

There is a growing focus on improving the quality of life for pediatric cancer patients and survivors. Survivorship programs are expanding to address the unique medical and psychosocial needs of childhood cancer survivors. This includes addressing long-term side effects, monitoring for secondary cancers, and providing comprehensive support for survivors and their families.

Patient-Centered Research and Advocacy

Patient-centered research has gained prominence in pediatric oncology. Children and their families are

increasingly involved in the research process, contributing to study design, decision-making, and advocacy efforts. This approach ensures that research aligns with the needs and priorities of pediatric cancer patients and their families. Despite these significant developments, challenges remain in pediatric cancer research and treatment. These include the need for increased funding, access to cutting-edge therapies, and the development of therapies for rare and less well-studied pediatric cancers. The progress made in recent years provides hope for improved outcomes and a brighter future for children facing cancer. As research continues to advance, breakthroughs that will enhance the diagnosis, treatment, and overall care of pediatric cancer patients is always on the horizon.

(Getty Images)

Moo, MD Breast Surgical Oncologist MSK in Nassau & Commack

Double Neural Bypass: First Of Its Kind

Long Island man regains use of arm through implant, machine learning

BY AMANDA OLSEN aolsen@antonmediagroup.com

Aparalyzed man regains hope, and so much more, in a first-of-its-kind clinical trial that’s giving him the ability to move his hands/arms but also regain the sense of touch again, without being hooked up to the computer.

Keith Thomas became a quadriplegic in a diving accident off Montauk in July 2020, at the height of COVID. Thomas lost all sensation and movement below his chest, and in the time following the accident, Thomas says he wasn’t sure he’d live or if he wanted to.

Now, thanks to what researchers are calling a “double neural bypass” he’s determined to lead by example and become participant #1 in this groundbreaking clinical trial at The Feinstein Institutes for Medical Research at Northwell Health.

Alone and isolated in the hospital for more than six months, Thomas found new hope by participating in Prof. Bouton’s clinical trial and is grateful to be a part of something so historic and larger than himself. “The only thing I want to do is to help others. That’s always been the thing I’m best at. If this can

help someone even more than it’s helped me somewhere down the line, it’s all worth it,” Thomas said.

Part of the trial included a grueling 15hour surgery—portions of which Keith was awake—during which researchers implanted

five electrodes into Keith’s brain. “Because we had Keith’s images and he was talking to us during parts of his surgery, we knew exactly where to place the brain implants,” said Dr. Ashesh Mehta, professor at the Feinstein Institutes’ Institute of Bioelectronic Medicine, director of Northwell’s Laboratory for Human Brain Mapping and the surgeon who performed the brain implant. “We inserted two chips in the area responsible for movement and three more in the part of the brain responsible for touch and feeling in the fingers.”

Now, through those implants, machine learning and novel stimulation technology, scientists can reconnect Thomas’s brain to his body to his spinal cord. This double neural bypass forms an electronic bridge that allows information to flow once again between the man’s paralyzed body and brain to restore movement and sensations in his hand with lasting gains in his arm and wrist outside of the laboratory.

Back in the lab, through two ports protruding from Thomas’s head, he connects to a computer that uses AI to read, interpret and translate his thoughts into action, known as

thought-driven therapy and the foundation of the double neural bypass approach.

Chad Bouton, professor in the Institute of Bioelectronic Medicine at the Feinstein Institutes, vice president of advanced engineering at Northwell Health, developer of the technology and principal investigator of the clinical trial, described the way the nervous system works in an uninjured person: “So normally, you’d have signals traveling from your brain, these are areas right above your ear on each side of your head. The motor strip, as it’s called, is this vertical kind of strip above your ear and then right behind that is the sensory area. So normally, your signals would travel from your brain and the motor and sensory areas. Say you want to open your hand. Well, that signal would travel down the brainstem and down to the spinal cord. Well, the problem when you have a spinal cord injury like Keith is that it blocks or dramatically reduces those signals.”

He then went on to detail how the neural bypass works in both directions, hence making it a “double bypass”: “What we’ve done is put chips in the brain, first in the motor area to pick up the signals and then reroute

Feinstein Institutes AI Researchers Receive NIH Grant For Risk And Prevention Tools

Hospitalized adult patients whose medical conditions worsen after being admitted, requiring escalation of care, such as transfer to the intensive care unit (ICU) or intervention of a rapid response team, may benefit from monitoring by artificial intelligence (AI). Scientists at The Feinstein Institutes for Medical Research were recently awarded $3.1 million from the National Institutes of Health (NIH) to fund a new study that would harness AI and machine learning (ML) to help doctors and nurses monitor patients in busy medical and surgical wards to identify and prevent deterioration and ultimately improve patient outcomes.

The study team is led by Theodoros Zanos, PhD, associate professor at the Feinstein’s Institute of Health System Science and Institute of Bioelectronic Medicine, and includes Karina Davidson PhD, Michael Oppenheim MD, Alex Makhnevich MD, Beth Friedman RN, and others at the Feinstein Institutes and Northwell Health, New York’s largest health system. The group will develop and implement ML models with the goal of

improving the monitoring of patients once they are admitted in order to identify who might undergo a rapid decline to address it sooner.

“Some patients who are admitted for one condition are not explicitly showing symptoms of other concerns, which can lead to their health deteriorating and even dying,” said Dr. Zanos. “This research will leverage vast patient data, new continuous

monitoring technologies and AI to identify those often-unidentified risks and subtle early worrisome trends and enable life-saving interventions.”

Dr. Zanos and his team will turn to Northwell’s large, diverse clinical dataset using electronic health records (EHRs) from more than 2.4 million hospitalizations to generate ML predictive models. The clinical support tools will help clinicians and nurses identify in advance patients at risk of deterioration and clinical reasons to enable timely interventions. These tools also will identify those patients who are more stable. The study will collect and leverage patient data using a continuous monitoring (CM) device, the VitalConnect VitalPatch, that will be placed on patients upon admission to the hospital, to develop more accurate prediction models.

Dr. Zanos is a leader in health care AI. His research revolves around developing algorithms that will enable early diagnosis, disease severity assessment, personalization and adaptability of effective therapies. In 2020, he and his

lab developed a digital tool that predicts a hospitalized patient’s overnight stability and determines whether they could be left undisturbed overnight to sleep, recover and discharge faster. This vital sign monitoring tool, called “Let Sleeping Patients Lie,” used a vast body of clinical data from the patient visits, including respiratory rate, heart rate, systolic blood pressure, body temperature and age.

Last year, Dr. Zanos published in Nature Communications results of a two-and-ahalf-year-long study which used 35,000 COVID-19 diverse patients to develop a new digital clinical support tool that accurately predicts a patient’s outcomes and aids in clinical care decision-making.

The Feinstein Institutes continues to invest in the use of technology and artificial intelligence to help improve patient outcomes and bridge health disparities. Most recently, the Feinstein Institutes received a $10 million gift from Scott and Debby Rechler to create the Scott and Debby Rechler Center for Health Outcomes within the Institute of Health System Science.

—Submitted by Feinstein Institutes

Keith Thomas is able to feel his sister hold his hand for the first time since a diving accident in 2020 left him paralyzed from the chest down.

(Photo by Northwell Health)

Theodoros Zanos, PhD.

(Photo by Feinstein Institutes)

them from the brain around the spinal cord injury and go we go straight to the muscles, and so every time he thinks about moving, we reroute those signals and activate the muscles that he’s thinking about.

For sensation, we go the other direction. So we have tiny sensors on his fingertips that pick up pressure or the feeling of somebody’s hand, and the bypass reroutes them around the spinal cord injury.”

The bypass starts with Thomas’s intentions (e.g. he thinks about squeezing his hand), which sends electrical signals from his brain implant to a computer. The computer then sends signals to highly-flexible, non-invasive electrode patches that are placed over his spine and hand muscles located in his forearm to stimulate and promote function and recovery. Tiny sensors at his fingertips and palm send touch and pressure information back to the sensory

area of his brain to restore sensation. This two-arm electronic bridge forms the novel double neural bypass aimed at restoring both movement and the sense of touch.

“This is the first time the brain, body and spinal cord have been linked together electronically in a paralyzed human to restore lasting movement and sensation,” said Bouton. “When the study participant thinks about moving his arm or hand, we ‘supercharge’ his spinal cord and stimulate his brain and muscles to help rebuild connections, provide sensory feedback, and promote recovery. This type of thought-driven therapy is a game-changer. Our goal is to use this technology one day to give people living with paralysis the ability to live fuller, more independent lives.”

The goal of the trial is to restore lasting movement and sensation by reconnecting the brain/body and translating real-time thoughts into actions outside of the lab. This technology may one day help millions of others like Thomas who suffer from paralysis, stroke or other disorders.”

Thomas can now move his arm at will and feel his sister’s touch as she holds his hand in support. This is the first time he has felt anything in the three years since his accident.

Thomas said he hopes people read his story and it gives them hope. “People keep telling me I’m an inspiration in. So I hope that comes across. I’m just very hopeful. I’m thankful for the team and Northwell for giving me the opportunity to be the first person to do this.”

—with information from Northwell Health

Partnership To Lower Healthcare Costs

Catholic Health and Empire BlueCross BlueShield announced on Sept. 6 an agreement focused on new care delivery models designed to lower costs and increase value for people on Long Island. This latest multi-year agreement builds upon the longstanding relationship between the two organizations.

Through this innovative partnership, Catholic Health’s payment rates will be connected to improved health outcomes and quality-of-care indicators, reflecting Catholic Health’s ongoing commitment to delivering high-quality care.

“Value-based care is transforming the health care industry and Catholic Health is at the forefront of that transformation,” said Julie Kapoor, Senior Vice President, Revenue Management and Managed Care at Catholic Health. “Our partnership with Empire BlueCross BlueShield helps us to proactively identify opportunities to reduce the costs of care while improving patient health. The signing of this agreement will allow us to stay focused on the delivery of exceptional care while also improving access to affordable health services on Long Island.”

Aligning payment to quality outcomes like readmission rates, patient safety, and

patient satisfaction increases preventive care, improves chronic condition management, reduces hospital admissions, incentivizes whole health and ultimately lowers costs for Long Island healthcare consumers and their employers.

“Our continued partnership with Catholic Health will keep care affordable for Long Islanders by aligning payments with health outcomes instead of on the volume of care provided—a win-win for employers and consumers,” said Daniel Jorgenson, Vice President, Healthcare Networks at Empire BlueCross BlueShield. “At Empire, we are focused on our mission to improve the health of all New Yorkers. When we have an innovative partner like Catholic Health, who shares our openness to creative thinking, we are better able to make a real difference in the lives of our members. There is no health system that has made a more meaningful commitment to our value-based relationship, including being the first system in New York to join with us on the Epic Payer Platform to support communications between payers and providers. We look forward to continuing to grow this important partnership.”

—Catholic Health

Dr. Chad Bouton

(Photo by Northwell Health)