COVID's relationship to obesity; how seniors are faring in the pandemic; adding services for special-needs kids: Upstate Medical University's HealthLink on Air for Sunday, Jan. 30, 2022

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air": A surgeon explains research showing how the coronavirus occupies fat cells and immune cells within body fat.

Timothy Shope, MD: This virus in particular, however, also appears to be able to evade some of the body's innate defenses a little bit better, and it probably directly infects some of the immune cells that are in the fatty tissue.

Host Amber Smith: A geriatrician discusses the impact of the pandemic on older adults.

Sharon Brangman, MD: I've seen some that have very mild to no symptoms, maybe just having a cough and a runny nose. And I've seen some that have gotten sicker.

Host Amber Smith: And the executive director of the Golisano Center for Special Needs tells how a recent expansion is streamlining services.

Henry Roane, PhD: For intellectual and developmental disabilities, now the vast majority of all their medical and behavioral health care are under one roof.

Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, the chief of geriatrics at Upstate discusses the impact of the pandemic on older adults. Then we'll hear how a recent expansion is streamlining services for children at the Golisano Center for Special Needs. But first, the chief of bariatric surgery goes over research showing how the coronavirus infects fat cells and immune cells within body fat.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Starting early in the pandemic, one thing that stood out was that the coronavirus seemed to be more severe in people who were overweight or obese. Recent research shows that the virus actually infects fat cells and certain immune cells within body fat.

I've asked Dr. Timothy Shope for help understanding this research. Dr. Shope is the chief of bariatric (weight-loss) surgery at Upstate. Thank you for making time for this interview, Dr. Shope.

Timothy Shope, MD: Thank you for having me, Amber.

Host Amber Smith: Now, didn't most medical experts assume that people who were overweight or obese got sicker from COVID-19 because of other health conditions that they had, such as diabetes?

Timothy Shope, MD: That's generally true. We weren't certain exactly if it was the virus itself or the comorbid (simultaneously existing) conditions that come along with being obese that was the most important.

Host Amber Smith: So were you surprised about this research that was showing that the virus infects fat cells and immune cells?

Timothy Shope, MD: Somewhat. We've known for many years that viruses can certainly live in adipose tissue.

The virus that causes HIV, for example, and the standard flu virus, both of these can live in fatty tissue. This virus in particular, however, also appears to be able to evade some of the body's innate defenses a little bit better, and it probably directly infects some of the immune cells that are in the fatty tissue.

Host Amber Smith: Now, you use the word "adipose" tissue. Is that fatty tissue, another word for fatty tissue?

Timothy Shope, MD: It is. It's the medical or scientific word for fatty tissue.

Host Amber Smith: Does this adipose tissue do anything in the body, or what do we know about it? Does it have a role?

Timothy Shope, MD: It does have a role. Generally speaking, it's historically been considered a place where we can store energy. It's a place where we can essentially insulate ourselves. But more recently we've started to think about this as essentially an endocrine organ, in that it generates substances called cytokines that sends a signal to other cells and causes other cells to respond. Most of these signals that it sends out cause a low-grade, chronic inflammatory state in the body.

Host Amber Smith: I've heard that the fat that surrounds internal organs, the visceral fat, I guess it's called, is the most dangerous. Is that still the case? Is that still the belief?

Timothy Shope, MD: This is called visceral adiposity, and yes, it is considered to becertainly much more of a risk factor for multiple medical problems, such as diabetes, high blood pressure, problems with cholesterol and lipids.

We think that it has an especially high capacity for creating that inflammatory state that I mentioned earlier.

Host Amber Smith: OK. And in terms of where the fat accumulates in the body, there's no rhyme or reason, sometimes it feels like weight is going on in different areas of the body. Do we have any control over where it ends up?

Timothy Shope, MD: Largely, no. Some of that is genetically based. This visceral adiposity that we're talking about is largely the fat that you can't see on a person. It's the fat that's in and around the organs, particularly in the abdominal cavity, but also in the chest, as well.

Host Amber Smith: Well, the research that made headlines recently came from scientists at Stanford University School of Medicine, and it helped confirm some similar findings of researchers at Weill Cornell Medicine in New York and elsewhere.

You were not part of these studies, but can you explain how this research was done?

Timothy Shope, MD: Sure. And I was not part of the studies, and I think it's also important to mention that this has not yet been published in a peer-reviewed journal, but the data does seem compelling. Basically, these scientists took some fat cells that they obtained from human surgical specimens, patients that were undergoing weight-loss surgery, undergoing cardiac surgery,and they were able to take those cells, culture them in a lab and then directly infect them with the coronavirus.They then were able to identify that the macrophages, those immune cells in that adipose tissue, were also able to become infected, and that that led to a substantial inflammatory response, which we believe likely creates a systemic response.

They've identified an increase in the markers that are present in patients that have severe disease, patients that are in the ICU (intensive care unit) for other reasons, patients that have progressive disease, for example, and then subsequently they were able to find evidence of the virus in the adipose tissue from autopsy specimens, from patients that were known to have died with COVID.

They then felt that this adipose tissue was basically a relatively safe harbor for the virus and that it allowed for it to increase the negative effects of that inflammatory response. If this is all true, then we could usethat adipose tissue and those immune cells in the adipose tissue as a target for treatment.

That's why it's important.

Host Amber Smith: Now, the immune cells, the macrophages, if they develop a robust inflammatory response to a coronavirus infection, does that mean that the person's got an immune system that's working well?

Timothy Shope, MD: Maybe. The inflammatory response is certainly needed to fight off a normal infection and to promote healing, and just to maintain a healthy individual.

The problem is when this becomes unregulated or responds too vigorously, it can then damage normal cells and tissue, and that's going to then promote more inflammation, and it's going to set off this dangerous sort of self-propagating cycle.

Host Amber Smith: Can you help us understand why someone who's overweight and has a strong immune response to COVID-19 is at risk for dying or for a lengthy and severe illness?

You mentioned cytokine storm earlier, and that has something to do with the fat cells. Can you explain that again?

Timothy Shope, MD: So these cytokines are, again, inflammatory mediators that send a signal from one cell to another, and if that signal then causes more inflammation, that's going to again be this self-propagating cycle.It seems that those folks that are overweight or classified as obese will have, additionally, those medical troubles you talked about earlier: diabetes, high blood pressure, primary problems with their lungs and other organs.

Host Amber Smith: So does this research, and I understand it hasn't been published in a peer-reviewed journal yet, but does this research, is it leading to a consensus for why patients with excess pounds are more vulnerable?

Timothy Shope, MD: I think we're all understanding that obesity is a risk factor for a lot of medical problems, including new ones or ones that we haven't yet experienced, unfortunately, and I think that controlling that obesity prior to experiencing some of these other troubles is really the key to this.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Timothy Shope. He's the chief of bariatric surgery at Upstate. And we're talking about research showing that the coronavirus infects fat cells and certain immune cells in the body fat.

I'd like to ask you about bariatric surgery patients and COVID-19. I wanted to ask you to tell us about research that compares people who had bariatric surgery with those who qualified for it but did not have the surgery.

Timothy Shope, MD: Sure. There were some actually recently published studies just within the past few months, from New York City and also from the Cleveland Clinic. Patients that had bariatric surgery compared to a group of patients that were eligible for bariatric surgery but did not have the procedure were less likely to be admitted to the hospital, less likely to require ICU care.

They had shorter ICU care length of stay. If they were in the ICU, they all had shorter overall lengths of stay. The Cleveland Clinic study also found that they were less likely to need dialysis, and both studies show that they were less likely to have a death occur as a result of being infected with the virus.

Host Amber Smith: So what about bariatric surgery seems to be protective, or what do you think it is?

Timothy Shope, MD: Well, I think it's probably both the loss of weight and the control of the comorbid conditions. Again, we know that even non-obese patients with advanced diabetes, non-obese patients with underlying medical troubles, were more likely to die from this virus.

So clearly, the control of those medical troubles is part of it, but also I think that this newer research showing that the virus can maybe have a safe harbor in excess adipose tissue. Losing that extra tissue probably helped as well.

Host Amber Smith: What about vaccines? Do you think that the vaccines are as protective in people who are obese or overweight as in people who are at normal weight?

Timothy Shope, MD: Well, we've got no reason to believe that they're not; they appear to be protective, and it doesn't appear that obesity is a reason to not become vaccinated. There is some question out there about the dosages, but there's still no data to support that. I think that the dosage data may be more important regarding medications to treat the disease, not to prevent disease.

Host Amber Smith: Are people who are obese considered at high risk? Would they be one of those categories that maybe would need additional doses?

Timothy Shope, MD: Hard to know yet. They're certainly at high risk, but again, it's hard to know just exactly what that right dose is just yet.

Host Amber Smith: Well, let me ask you what you would say to people who have had bariatric surgery, as well as people who are overweight, in terms of how best to protect themselves during the pandemic.

Timothy Shope, MD: Same thing that (I would say to) the rest of us, you know, the counsel that I would give to the rest of us: Make sure that you use appropriate hand hygiene, practice social distancing, it's appropriate in most cases for people to be vaccinated. I think that for the obese patients, they also need to do whatever they can to lose weight and to control those underlying medical conditions.

Most people are probably aware that there's largely a pause on surgical procedures at this time based on the need to provide care for the COVID-positive patients across the country, so right now we're not performing as many of these procedures as we'd like to. But that doesn't mean that the patients can't pursue other weight-loss methods in the meantime, it doesn't mean that they can't do their best to control their other underlying medical problems.

Host Amber Smith: Well, thank you again for your time, Dr. Shope.

Timothy Shope, MD: Sure. Thank you for having me.

Host Amber Smith: My guest has been Dr. Timothy Shope. He's the chief of bariatric surgery at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

How older adults are dealing with the effects of the pandemic, next on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Today I'm speaking with Dr. Sharon Brangman, Upstate's chief of geriatrics, about the impact of the pandemic on senior citizens. Dr. Brangman is a distinguished service professor of geriatric medicine at Upstate, and she's a former president of the American Geriatric Society. Thank you for making time for this interview, Dr. Brangman.

Sharon Brangman, MD: Thanks for inviting me, Amber.

Host Amber Smith: I wanted to check in with you and see how older adults are faring in general during the pandemic. At the start, older adults were considered high risk because of their age, and they were the among the first to be offered vaccines a year ago. Are seniors who become infected having a rougher time than younger people who are infected?

Sharon Brangman, MD: So in my patient population, I've seen the full spectrum of how the COVID virus impacts older adults. I've seen some that have very mild to no symptoms, maybe just having a cough and a runny nose. And I've seen some that have have gotten sicker. So one of the things we've learned about this virus is that it impacts people in different ways. And I think it depends on your own personal risk factors. So we know in general that older adults tend to get worse outcomes when they get sick with COVID. However, it doesn't mean that everyone is going to get the same response.

And most of my patients got their first round of vaccinations early on. And when I talk to patients now, most of them have gotten their booster. And, you know, we're starting to think that this isn't really a booster. This is really just the third vaccine in a three-step vaccination process. So you're really considered fully vaccinated when you've had all three of either the Pfizer or the Moderna or two of the Johnson & Johnson.

Host Amber Smith: Is there a difference when it comes to your patients? Are you recommending one over the other?

Sharon Brangman, MD: No. I basically encourage my patients to get vaccinated with whichever vaccine they can obtain. The biggest issues that we have found is that not all older adults have access to technology, so they can't make appointments online. I have many patients who have landlines or maybe they have a flip phone. So when we make all of these public health rules, we tend to forget that not everybody has equal access to the internet and technology. Not everyone has a laptop and a smartphone. And we forget the people, usually the people who have income restrictions or older adults who may not have the technological skills. So our biggest focus has been making sure that our patients can access the vaccine. They want it, but they may have mobility problems, so that it's hard for them to go somewhere and stand in line, and they have difficulty making appointments.

The first round of vaccines, the nurses in our office were helping older adults work out the appointment process online because they may not have had someone to help them at home. So I think it's very important when we're working in a community with people of all different incomes and ages and technological skills that we have to remember a one-size-fits-all policy doesn't work well.

Host Amber Smith: What has been your advice to patients who develop symptoms and test positive?

Sharon Brangman, MD: It depends on what their individual circumstance is. We really don't want people to go to the hospital right now, unless they're very sick. If you have mild symptoms, you should not go to the emergency room. You should not go to a hospital.

So if somebody has a cough, runny nose, maybe a fever, but they're otherwise able to eat and drink, they are not short of breath, they don't have chest pain, I would encourage them to stay in touch with their physician and stay home. If they start to get very, very high fevers that they can't keep up with, or they get chest pain or have real significant problems breathing, then that might be a time to consider speaking with your doctor about going to the emergency room. But as you know, our emergency rooms right now are completely overloaded. And so anyone who has mild symptoms should not be in the emergency room.

Host Amber Smith: Are you concerned about older adults who've not been able to get into regular medical appointments during the pandemic?

Sharon Brangman, MD: So there has been a big concern about the disruption in basic health care because of the pandemic. So we know the people who have had COVID, that's a direct impact from the virus. But then there are indirect or unintended consequences of COVID, and that's the ones that I'm concerned about. So these are people who may not go for their normal checkups. They are so afraid of catching the virus, they don't want to go and maybe get a mammogram or sign up for a colonoscopy if they're in the right age group for that. A lot of elective surgeries have been put on hold because the hospitals are so overloaded, and elective surgeries are not necessarily minor surgeries. When we hear the word "elective," we think that must mean they're not very important. And so we've had people who have significant health problems who have put them on hold, because the hospital may not have the capacity to take care of them.

Host Amber Smith: It sounds like this makes preventive care almost impossible, because if you're not seeing these people to catch things early, you're not going to be able to catch the things early before they become a bigger problem.

Sharon Brangman, MD: This is a national concern, and I think that there have been calculations about how many preventive measures have not happened or have been postponed, and how many people may have lost the ability to get a handle on very serious diseases because they have not been able to get into see their physician or their health care provider on their usual schedule.

Host Amber Smith: Have you seen racial or ethnic inequities among older adults with COVID or seeking COVID care?

Sharon Brangman, MD: Well, I think that's been very clearly delineated and discussed. Again, this has to do with so many different factors, but it's usually a one-size-fits-all policy does not fit all. And so when we have groups of people who have been marginalized from the health care system and may not have complete trust or may not be able to get complete information, these are people who may not know enough about the vaccine or have concerns about it, then we do see some inequities. And this is primarily in African-American and Latino communities. I have found, though, that information coming from a trusted and reliable source, combined with making access to the vaccines very easy, goes a long way to making sure people get vaccinated. So, again, we talked earlier about people who may not have the technological skills or internet service to go online. But if we bring the vaccine to convenient locations and neighborhoods that people can readily access, we see a huge increase in people getting vaccinated. When people have the chance to speak with trusted community leaders about the virus and about the vaccine and have their questions answered, we see an increase in people getting vaccinated. And the same thing stands for boosters, or for that third dose, if you're getting either the Pfizer or the Moderna.

So we have to make sure that trusted leaders in the community are speaking to people. And that we make the vaccine easy to get. You shouldn't have to jump through many hoops to get something this important.

Host Amber Smith: I read about some studies that link COVID infections to cognitive impairment months later. And I wonder if your practice has patients who survived COVID and then months later are experiencing cognitive declines or accelerated Alzheimer's disease symptoms. Are you seeing anything like that?

Sharon Brangman, MD: So I have seen very interesting events related to COVID and cognition. First, we see people who have been spending more time with each other than they ever have, who suddenly start to notice their partner or their loved one has some memory problems. And this may not have been evident if they hadn't been spending so much time together. So we see that as one piece.

Another piece is that people who are socially isolated often have an increase in their dementia progression. So social connection is so important for all of us, and it's especially true as we get older. And it's even more true when we have any kind of dementia or memory problem. So people who have been isolated and haven't had regular interaction with the world and their family, we have seen a decline in not only their brain function, but their physical function. So we have people who haven't been getting out to walk or move and they're getting weaker, and they're more likely to fall and get hurt. So that is another unintended consequence of COVID for people who may not have even had COVID.

Then for people who have had COVID, we typically think of COVID as affecting their lungs or the respiratory system. But we know that COVID, especially the delta variant, can affect all parts of the body. And one of the things it can cause is a brain fog where people feel, after they've recovered from COVID, that their brain is just not working as sharply as it had in the past. One person described it as they felt like they were sleepy and groggy. And we're starting to understand that in some people, the COVID virus may be causing some inflammation of the nerves in the brain. And this may give them this foggy feeling. What we don't know yet is what the long-term effects are. And this is what we're learning. So, we are understanding that there are long-term effects of COVID. We've heard of long COVID syndrome, where people feel tired and may have a chronic cough or other problems, including brain fog. So we're learning as we go, because this is all very new.

Host Amber Smith: Are there any treatments, or what's being experimented with to treat people with brain fog?

Sharon Brangman, MD: Well, we have to try to figure out if this is permanent or not, and we're following people over time. We're encouraging them to get good rest, good nutrition, to exercise -- all of the things that you would normally do to stay healthy, maybe limit alcohol, because we know alcohol isn't good for the brain in general, and certainly if you have brain fog, you may not want to add to that with alcoholic beverages. But this is going to be a matter of waiting and seeing what happens. This is all new territory.

Host Amber Smith: Thanks for listening to Upstate's HealthLink on Air. I'm your host, Amber Smith, talking with Dr. Sharon Brangman, the chief of geriatrics at Upstate.

Now, you mentioned a little bit about loneliness, and I know that can be a concern for older adults anytime, let alone during the pandemic. I wonder, has it become more of an issue? Have you seen it in the patients in your practice, and how are you dealing with it?

Sharon Brangman, MD: This is a significant issue because people often live far away now, and they may not have the technological skills to reach out and talk to people. Or if people are in their neighborhood and nearby, there's been great concern about catching the virus. And so people have put distance between themselves and others. Their normal routines have changed. So people may not be going to church or out to senior centers or doing some of the other social activities they used to do. I've also had patients who have been avoiding seeing their grandchildren, especially if they're younger children who are not yet eligible for the vaccine. So there are concerns about younger children who might pass the virus on to grandparents and just so many different issues.

You remember in the beginning of the pandemic, people who are in nursing homes or assisted living facilities couldn't get visitors. And we decided as a society that it was better for older adults not to have visitors than to have visitors and risk getting the infection. And I've talked to patients who said "you took away my right to decide what was important for me." And I don't think there's any other age group where we as a society come in and tell you what is better for you without your input. So I think that's a whole issue about how we treat older adults, but in any case, visitation is now allowed in most nursing homes, as long as the visitors can show proof of vaccination and a negative COVID test. But isolation is a significant problem for older adults in this age of COVID.

Host Amber Smith: And loneliness isn't just an emotional thing, right? It can have a physical impact on people?

Sharon Brangman, MD: Loneliness is something that can affect the way your body functions. It can affect the way your brain functions, as well as the rest of your body. And we don't understand all the mechanisms yet, but it may create stress hormones and other things that then make it hard for your brain to work as it normally would, as well as the rest of your body. So we are social beings. We don't really relate well through electronic screens. We do better with face-to-face contact. So even though being able to reach out electronically is probably better than nothing, it's not the same as having face-to-face contact with people. And that's exactly what has been risky, or considered risky, during this pandemic.

Host Amber Smith: You mentioned the electronics, and I wanted to ask about telemedicine. Are your patients adapting to telemedicine? Are you able to offer that to them as a way to take the place of a physical in-person visit?

Sharon Brangman, MD: So we offer telemedicine, but it often isn't ideal. There are some people who do very well with it. Again, this is not a one-size-fits-all. Our office serves a 15-county area, and there are some people up in the North Country who really appreciate telemedicine because coming to see us used to be an all-day event. But I also have patients who have memory problems who don't really relate to a voice coming to them out of a screen. And I have other patients who do not have the equipment to even do a visit, and we're talking on the telephone, which is less than ideal. I have had situations where I've had patients who are home with a home health aide who has a smartphone but doesn't have a very good data plan. So in order for that home health aide to use their cellphone, it would have been a very expensive visit, which really isn't fair to the home health aide. So we need to figure out a way to reach people and to make sure that everyone has access to high-speed internet. We have people in the North Country who still don't have high-speed internet. So this pandemic has really highlighted our digital divide about who has access to the internet, who can afford it and who can afford all the equipment that's needed.

Host Amber Smith: Well, I'm interested in what the health care system will learn from this pandemic, and that's one good example. If we could rewind to late 2019, what could we have done differently that would have reduced the impact of this pandemic, specifically on older adults?

Sharon Brangman, MD: Wow. There's a big question. First of all, recognizing it as an important and contagious virus and not something that would go away immediately. A lot of the infrastructure that's needed to address our digital inequities takes long-term planning, and I think that for telemedicine, for example, that that was something that was discussed for years and years, and within a matter of weeks, we were up and doing it. So there are some things that we do not do as a society until there is an emergency and a reaction. And that is part of human nature, but it's also part of our bureaucratic process, is that we're reactionary, and we don't like to be strategic and plan ahead.

And I think it's time for us to be strategic and to plan ahead.

Host Amber Smith: Are there policy issues that have been raised by the pandemic? Broadband access is one, but are there others that groups like the American Geriatric Society are working on?

Sharon Brangman, MD: So, yes. Certainly access to care has always been a big issue. Health care workforce issues have been very significant during the pandemic. Having input from a specialist in older adults, I think is very important when we're making decisions about people in nursing homes. And in many instances, decisions about medical care in nursing homes were not being made by the experts in geriatrics. I think that we should be looking at the role of caregivers and how important they are to taking care of older adults.

We understand how important caregivers are to children, but they are very significant in taking care of older adults. And considering how we excluded so many caregivers from assisted living and nursing homes, to the detriment of patients, is something that we should look at. So I think when my kids were little, I wanted to put them in bubble wrap and protect them, but that wasn't necessarily for their best interest. And I think the same is true for older adults. To cut them off from everyone around them to protect them is not in their best interest. And so we need to look at how we make decisions as a society, as they pertain to older adults. They should not lose their voice in these kinds of decisions.

Host Amber Smith: Well, thank you so much for your time and your expertise on this subject.

My guest has been Dr. Sharon Brangman. She's the chief of geriatrics at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air": how care for children with special needs has expanded.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." The Golisano Center for Special Needs opened in 2021 to provide comprehensive, coordinated and scientifically based medical and behavioral care for children and adolescents with many types of intellectual and developmental disabilities. Here with me to talk about how the center is operating is Dr. Henry "Hank" Roane, the executive director. Dr. Roane is a professor of pediatrics and the division chief for the center for behavior development and genetics at Upstate. Welcome back to "HealthLink on Air," Dr. Roane.

Henry Roane, PhD: Thanks for having me.

Host Amber Smith: I know that you, for a long time, have wanted to combine Upstate's services for children with intellectual and developmental disabilities under one umbrella. Does this center accomplish that goal?

Henry Roane, PhD: Yeah. For many years, parents had to take their children to multiple sites to see multiple providers, and often communication across those sites was really poor. So when we set out to establish a vision for the program, we really started with a series of focus groups with family members of the children with intellectual and developmental disabilities. And the No. 1 thing they expressed as a need was a one-stop shop where all their doctors and all their services were in one place. And that's what we've done for intellectual and developmental disabilities, now the vast majority of all their medical and behavioral health care are under one roof.

Host Amber Smith: That's great. It streamlines it, it sounds like.

Henry Roane, PhD: Absolutely.

Host Amber Smith: What age are the children the center serves, and what diagnoses might they have?

Henry Roane, PhD: We typically serve children from ages 2 to 18. The majority of children, about 87%, have a diagnosis of autism spectrum disorder, though that's not a prerequisite to get into the program. We see many children for diagnostic questions. Some of them might have ADHD or other conditions. We also see a number of children with genetic conditions like Down syndrome, physical disabilities like cerebral palsy, and a range of other condition.

Host Amber Smith: Do they arrive with a diagnosis already in place, or do they come to the center in search of a diagnosis?

Henry Roane, PhD: Both, really. One of the branches of our center is focused on diagnostic services for children, and this program is staffed by clinical psychologists and a developmental pediatrician, Dr. Lou Pellegrino, speech and occupational therapists and social workers. And this team really reviews referrals that come in weekly, and they determine really what's the best course of assessment services for the child. And then they identify the appropriate diagnostic services that the child needs.

On the other hand, we have branches of our clinical service that are all based around treatment. And this includes ongoing medical management, home-based early intervention and clinic-based behavioral treatment. So for the treatment services, children typically come in already having a diagnosis.

Host Amber Smith: So from a family's point of view, what might their experience be like today compared with what it would have been like before the center existed?

Henry Roane, PhD: I hope it's better. Before, they had to go to a lot of different places, be on different wait lists and had to wait for one provider to communicate with another provider or the providers to read each other's reports and then to coordinate care. Now they come to one place, and we coordinate the care for them. And so, where they go to get their initial diagnosis is where they come back for therapy, and it's the same front-desk people. So they get to know the child. They get to know the family. And I think that coordination of care is really important. Having all the providers in the same space is really helpful for communication.

And then the clinics are essentially able to feed into one another. And so if we have a diagnostic assessment that says the child has problems with tantrum behavior, we can get that child into our behavior clinic. And while the child's in the behavior clinic, if the parent expresses a need for medication management, we can get the child back into a developmental pediatrician. So having all of those services and being able to flow together really helps to decrease delays in accessing care, which is really important for this population.

Host Amber Smith: What is the typical wait time to get a new appointment for a new patient?

Henry Roane, PhD: It's about 60 days right now, which is still a little bit longer than we'd like it to be. But that's an improvement relative to where we started, which was about 200 days when we first set out on this project. And one of our big goals with the Golisano Center for Special Needs is to continue to drive down wait times. In the next four to six weeks, we'll be bringing in another pediatrician and two more licensed psychologists. And these are folks who are going to be involved in the diagnostic process and in follow-up care. So adding of these other providers really will help us to decrease wait times and get more children into care more quickly.

Host Amber Smith: Do the children that come to the center, do they stay with you up until adulthood?

Henry Roane, PhD: Not typically. You know, the goal for a child is really to develop treatment procedures when they're young, because that's when the developmental processes are most malleable. And that's also when learning is the easiest time to occur. And what we like to do is try to treat the child intensively for a maybe six-month period, multiple hours a day, and then hand over the care to a family practitioner or to state services. So we work very closely with the New York State Office for People with Developmental Disabilities to bring a child's treatment from our clinic, integrated into the home, and then turn those services over and move to more of a follow-up care model after that.

Host Amber Smith: This is Upstate's "HealthLink on Air." I'm your host, Amber Smith, talking with Dr. Hank Roane. He's the executive director of the Golisano Center for Special Needs. Can you tell us about the feeding disorders clinic? I understand you're able to see more patients with feeding disorders now.

Henry Roane, PhD: In our feeding disorders clinic, we see many children both with and without autism who simply do not eat enough food to sustain their growth or health. So these are children who come into our clinic, they've received a multidisciplinary evaluation with a speech therapist and with gastroenterology, and that really ensures that they're good to progress with our feeding program. And then once they're in the program, we really focus on things like structuring the meal, repeating and structuring the way that we present foods, what type of texture the food needs to be, setting expectations for the child and for the family. And we have a really heavy focus on parent training. So we essentially build out a mealtime routine for the child in terms of here's how you present the foods. Here's what foods to present. Here's how you deliver rewards. And then we train the parents to do that. To your point, yeah, due to the funds that we receive from Tom Golisano and from the Upstate Foundation, we've essentially doubled the size of our feeding program. And in addition to that, we've hired a new provider who's going to start in February, and we anticipate that we'll be able to expand the clinic further this spring.

Host Amber Smith: Why is language skills development part of the feeding disorders clinic?

Henry Roane, PhD: Well, you know, language is just such a huge thing for any child with a developmental disorder, and it's deficits in language and communication (that) are one of the core symptoms of autism spectrum disorder. So for any child that we see, you can often view their behavior as being a form of communication. And so, for example, a child may cry or get upset or tantrum because they don't necessarily know the words or know how to appropriately communicate their wants and needs. So when we develop treatments, we often target communication as a form of replacement behavior under the notion that teaching language can really help us to open doors for treatment and further skill development.

Host Amber Smith: Let me shift gears a little bit. I know you have an equipment loan closet. How does that work? And what kinds of equipment are we talking about?

Henry Roane, PhD: Yeah, this is a, it's a really exciting project run by Dr. Nienke Dosa, who's one of the center's developmental pediatricians and her team. Dr. Dosa sees many children with physical disabilities and is really focused on physical fitness among that population. And so, Dr. Dosa and her team, as well as the Golisano Center, have started partnering with Access CNY to develop this loan closet for equipment that's used by children who have physical disabilities. Oftentimes this equipment is very expensive, and having access to a loan closet, it essentially works for a family to almost, like, test-drive equipment. And so it helps the family to make sure that the equipment that they're using works well for them. That can include things like standers to help children stand upright, pieces of equipment that facilitate gross motor movement, like walking, as well as adaptive physical activity devices. We've been real fortunate to work with places like the Boeheim Foundation to get funding for promoting a range of fitness activities for children with physical disabilities. And the loan closet really feeds into that and allows us to bring more children in to get access to physical activity.

Host Amber Smith: So a family might use a piece of equipment for a period of time and then return it?

Henry Roane, PhD: Exactly. Yeah.

Host Amber Smith: Now, one aspect of the center's operation that I know is important to you is helping to train the next generation of providers like yourself. Can you talk about how that's accomplished?

Henry Roane, PhD: Yeah, absolutely. We've worked really closely with Upstate's College of Health Professions and have developed a master's program training students in applied behavior analysis. Applied behavior analysis is a form of therapy that's the primary evidence-based practice for treating symptoms of autism spectrum disorders. And we have a pretty unique program in that our classes are taught by providers who work in our clinics, and our students do all of their field work and the clinics. So, if you think about it, they can go to class, learn about a various treatment approach in the classroom, and then the next day go into a physical environment where they can literally practice the skills that they learned the night before. This is a really unique model. There's very, very few places around the country that have that kind of embedded master's program that's so interlaced with the treatment program. And it really helps us to further build capacity. You know, we're interested in increasing the workforce of providers in the field so that more children can get helped, and they can get helped in more diverse settings or new clinics or other areas of the community where it's harder for families to travel to.

Host Amber Smith: Well, that's good to know. Now, I know the center is also doing research that's funded by the National Institutes of Health. Can you tell us about some of the projects you're focused on?

Henry Roane, PhD: Sure. Yeah. Dr. Nicole DeRosa is leading a funded project right now from the National Institutes of Health. And she's looking at teaching broad communication repertoires to children with autism who also display challenging behavior. So one of the core symptoms of autism is that children have behavioral rigidity and that they tend to be inflexible in how they respond. So for example, they might repeat the same phrase over and over. So what Dr. DeRosa's work is looking at is to teach children to vary up their responding so that they have a broader communication repertoire. And that ultimately increases socialization that goes along with one of the deficits that we see with children with autism. We also have other lines of research going on related to identifying best practices for how to treat challenging behavior, working with multiple institutions across the United States to do that work. And also how to prevent treatments from essentially falling apart or how to prevent children from relapsing once they leave the clinic and go back into the home, because that can be, obviously, a source of high stress for parents. We have some really exciting lines of research. We're very lucky to have a strong research team led by Dr. Andy Craig, and the department of pediatrics has been extremely supportive of our research work.

Host Amber Smith: It sounds like it. I want to thank you so much for making time for this interview.

Henry Roane, PhD: Thank you for having me..

Host Amber Smith: My guest has been Dr. Hank Roane. He's a professor of pediatrics at Upstate and the executive director of the Golisano Center for Special Needs.

I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Ruban Dhaliwal from Upstate Medical University. How can a person prevent osteoporosis?

Ruban Dhaliwal, MD: Healthy nutrition is very important during childhood and throughout adult life to build bones as well as maintaining bone health, especially for children. As they are accruing bone mass, it is very important that they have a calcium- and vitamin D-rich diet and in general stay very active. This is key.

By the time we reach age 20, we have accrued 90% of bone mass. So we really want to take advantage of the childhood years to build a good bone mass. We call it peak bone mass, so that we could start out our adult years with a good bone mass and then work on , maintaining that bone mass through healthy diet through regular physical activity and weight-bearing exercise, limiting excessive alcohol intake, avoiding smoking, avoiding falls. These are all universal measures that can be applied throughout life stages.

Host Amber Smith: You've been listening to Dr. Ruban Dhaliwal from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical Universitiy's literary and visual arts journal, The Healing Muse, with this week's selection:

Deirdre Neilen, PhD: To be on call for a physician means that one may not be physically present in the hospital, but one must be available by phone for the residents or nurses who are on duty to call .

Tabor Flickinger practices as a general internist. Her work has appeared in Pulse magazine and Yale Journal for Humanities and Medicine. Her short poem "On Call" shows us the balancing act the physician maintains as he or she is at home with family while simultaneously thinking about the patients in the hospital.

"On Call"

A hospice nurse desired an opiate elixir

For a body past swallowing,

A soul rattling its way out

I sent it as an offering to smooth his path

After five more calls for other people's problems

Hospice again

He has passed on, now at peace

We speak in tones hushed not only for his gravity

But to preserve unrippled my child's dream

The vibration of others' peril infiltrates my home

And brings the whole to sharp relief.

I whisper benediction into the dark.

Nicholas Bellacicco is in his fourth year of medical school and has already published a book of poetry, "Pouring Echoes." He sent us a poem, "writing on the wall." It bears witness to a physician's diagnostic analytics, still allowing room for empathy and care.

"writing on the wall"

A slight shuffling gait.

Moderate cogwheel.

Slowness in speech.

Minimal stooped posture.

I see it.

It is written like sloppy graffiti.

You ask me to interpret.

It's like reading a telegram

to a soldier's wife.

I pause, and give you a second more

of a life without a diagnosis.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air," what to do about arthritis of the hands. If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Stephen Shaw. This is your host, Amber Smith, thanking you for listening.