Dealing with ticks and mosquitoes; cosmetic-surgery tourism and its risks; streamlining special-needs services for kids: Upstate Medical University's HealthLink on Air for Sunday, April 24, 2022

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a tick expert explains why we have so many ticks this spring and what you can do to protect yourself.

Saravanan Thangamani, PhD: ... The most important thing is to stop mosquitoes from laying eggs in or near the water. ... .

Host Amber Smith: A plastic surgeon has some words of warning in case you're thinking of combining cosmetic surgery with a vacation.

Sara Neimanis, MD: ... When you're at these exotic locations and resorts, it's tempting to go out and lay by the pool or go for a swim or do activities that are probably not a good idea to do immediately after surgery. ...

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: ... Having all the providers in the same space is really helpful for communication. ...

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, a plastic surgeon talks about the trend of cosmetic surgery tourism. Then we'll hear how an expansion is streamlining services for children at the Golisano Center for Special Needs. But first, a tick expert tells what's important to know about the abundance of ticks this season.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." As the weather in Central New York gets warmer, ticks and mosquitoes become more active. And so do humans and their pets. Because ticks and mosquitoes can transmit disease, it's important to know how to protect yourself and your loved ones. I'm talking with Dr. Saravanan Thangamani. He's a professor of microbiology at Upstate who specializes in medical entymology and vector-borne diseases, and he leads a very popular laboratory devoted to tick testing. Welcome back to "HealthLink on Air," Dr. Thangamani.

Saravanan Thangamani, PhD: Oh, thank you, Amber.

Host Amber Smith: Why is it that ticks and mosquitoes are likely to be more prevalent in Central New York this season?

Saravanan Thangamani, PhD: Well, there are two things I want to mention: Mosquitoes are active in our area from April to October. And during this time mosquitoes look to lay eggs in slow-moving and standing water. And as far as the ticks are concerned, they are active throughout the year. You have different types of ticks that can be active even winter as well. It's just that they lay under the leaf litter, shielded from harsh winter, but as soon as the ground thaws, they come out. So, that actually segues to the next thing -- why we are seeing more ticks and mosquitoes, or why we will be seeing more ticks and mosquitoes this season is that the first culprit is the climate change.

You know, climate change impacts human health by increasing the vector-borne diseases. So when I say vector, vector is an organism such as ticks or mosquitoes that can transmit a pathogen that can cause disease to human or animals. The climate changes, in a way, alter the condition of the biology of the vector biology of the tick or a mosquito, and also the pathogen they carry. For example, the development and survival of ticks, and the animal hosts such as deer, and the bacteria that causes Lyme disease are strongly influenced by climatic factors, especially temperature, precipitation and humidity. And also the rising global temperatures can lengthen the season and the geographic range of these vectors. The reason being is that warmer average temperature means longer warm season. So when I say longer warm season, it means earlier spring, shorter, milder winters, and hotter summers. These conditions are perfectly suitable for mosquitoes and ticks and the pathogens they transmit to perpetuate. And so overall, we are seeing rising temperatures, and that's one reason why I'm actually thinking that this year, we will see more tick and mosquito-borne disease emergence in New York.

Host Amber Smith: Do they prefer warm and dry weather, or warm and wet weather, or does it matter that much?

Saravanan Thangamani, PhD: That's a very good question. Warm and dry are good for ticks. Warm and wet is good for mosquitoes. So it is a caveat. You know, mosquitoes like to lay eggs near the water bodies, so they require more moist, wet environments. And ticks on the other hand, they like to have more humidity, but they don't want it to be too overtly wet. So that is a little bit of biology there, but at the end of the day, the climate change impacts are in increases in the abundance of both mosquitoes and ticks.

Host Amber Smith: Are there things that people can do around their homes to reduce ticks and mosquitoes?

Saravanan Thangamani, PhD: Absolutely. These are all preventable diseases. Personal protective measures are important to prevent us from getting mosquito bites or tick bites. But obviously you have to take different measures for mosquitoes and different measures for ticks. In the case of mosquitoes, I would recommend that they should use screens on windows and doors. Repair holes in the screens to keep mosquitoes outdoors. So you don't want any mosquitoes to come inside your house. And also use air conditioning if it's available, so that's not conducive for the mosquitoes. And also the most important thing is to stop mosquitoes from laying eggs in or near the water. So my recommendation would be to once a week empty or scrub or turn over items that hold water, such as tires and buckets, planters, toys, pools, bird baths, flower pots and trash containers. And I would always check for water-holding containers, both indoor and outdoor, and then all you have to do is to flip it upside down so that the water doesn't stay there. If the water is there, the mosquitoes would like to land on it and lay eggs on it. And the eggs will then hatch into larvae inside the water because they have perfect organic material in that water. And the larvae become pupae. Pupae will emerge into adult, and they will start to fly around and probably feed on the humans that are in the house. Those are the easy things for the mosquitoes, in terms of how we can prevent mosquito bites, considering the way we live.

For the ticks, again, we have to create a tick safe zone to reduce particularly deer ticks. We have to remove the leaf litter, clear tall grasses and brush around homes and at the edge of the lawns. It would be best to provide a three-feet wide barrier of white (stone) chips or gravel between lawns and wooded areas to restrict tick migration into recreational areas. Mow the lawn frequently. There are multiple other things that if you go to www.CDC/ticks, they provide a lot of information on how one can actually keep their yard tick free. But there are chemicals available that one can use to prevent the mosquito or tick bites. The most common ones are the use of tick or mosquito repellents. They can apply on themselves or on their clothing material before they actually go out. There are several chemical based repellents are available. The most popular ones are the DEET-based or the oil of lemon eucalyptus- based.

Host Amber Smith: Let me ask you, are there pesticide products to put on the yard, though? So that a person doesn't have to put the chemical on their body? Is there something you can spray on your yard that works to get rid of ticks?

Saravanan Thangamani, PhD: Yes, they are available. So you can use permethrin-based products to spray your yard. And so that will actually keep the mosquitoes and ticks away, and upon contact, they will die. You can do that, but again, permethrin products are sensitive for skin, so one has to be careful when applying to the yard.

Host Amber Smith: And I've also heard that bats like to eat mosquitoes -- I don't know if that's really true, -- but if it is, would it work to put a bat house in your yard to attract bats?

Saravanan Thangamani, PhD: It's partially true. So bat houses are good to provide a safe environment for bats. Insect-eating bats, or insectivore bats, when they roost in these bat houses, they can protect the yard from pest insects, like mosquitoes, moths and beetles. However, they are less effective at reducing the mosquito burden on a daily basis. On the other hand, we need to be careful about having bats in our backyard because they can carry deadly pathogens that can cause disease to humans.

Host Amber Smith: Well, I appreciate the tips that you gave about making the yard a little safer. If someone has dogs, are they going to be at higher risk of getting ticks in their home, if the dog goes outside and brings the ticks in with them?

Saravanan Thangamani, PhD: Pets and dogs, I consider them as tick magnets, so we have to be more vigilant. If we have a dog that goes into the yard and plays, or goes off the trail and comes back, they always bring ticks on themselves. So we have to do tick checks on the dogs and probably shower on a regular basis on the dog to look for any ticks that are crawling or attached to them.

Host Amber Smith: All right. If a human makes it a habit, when they come indoors, to shower, wash their hair, after they've been out hiking or something, is that going to be enough to dislodge the ticks or do they still need to go through their hair carefully?

Saravanan Thangamani, PhD: They have to go through their hair carefully because if the ticks are crawling on them, showering is great. But if the tick is already attached to the skin, then the shower is not going to help. They still have to look, and they still have to go manually, use some fine tweezers to pull the ticks. They still have to do tick checks on their body.

Host Amber Smith: Do ticks attach themselves to clothing? Because I wonder how important it is to shake the clothing off once you come in, or maybe you shouldn't do that because you may be shaking ticks off.

Saravanan Thangamani, PhD: Well, I think that if you want to shake, you can shake it outside the home. I would say, not inside, because whatever ticks that are crawling on the surface of the clothing material will drop off there. So you don't want to have ticks in your home. So the best thing is, I tell people, don't shake off the dress, just take off the dress, put directly into the dryer or washer. So if any ticks are still crawling or are hiding in the seams they will die when you put them into the washer or dryer.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Saravanan Thangamani. He's a professor of microbiology at Upstate and an expert in ticks. If you have a tick you want to send in for analysis, go to his website at NYticks.org. That's N-Y-T-I-C-K-S-dot-O-R-G.

So there are instructions on your website, but let me ask you to go over with us, how people need to submit a tick that they pull from themselves or their dog. What are the steps they need to take?

Saravanan Thangamani, PhD: The first step is that, pull the tick very carefully, and use blunt-tip tweezers. I know sometimes people use sharp-tip tweezers, but depending on the location where the tick is attached, you may want to use a blunt-tip tweezer. Just go right underneath where the tick is attached onto the skin, and then gently pull upwards with gentle pressure. Once you pull the tick, then you sanitize the area where the tick was attached and then put the tick on a moist towel. Fold it, and then put it inside a Ziploc bag and send it to us. Our lab is providing free Ziploc bags with printed information on how to ship it, how to pack it and send it to the lab.

So once you put the tick inside the Ziploc bag, go to our website, NYticks.org, click on the tick "submission" tab and provide the information about where you found the tick and what date you found the tick, because we use that information for scientific analysis. So once you provide that information and you complete the form, we then give you a unique tick ID for the tick that you submitted. And we advise you to submit this form -- one tick per form and also one tick per Ziploc bag -- so that we can actually track which ticks carry which pathogens. And then, we provide information on our Ziploc bags where to send it. Once you send it to the lab, we then send an acknowledgment email to you as soon as we receive the tick in the lab. And then it takes about three to five days for us to process each tick. And once tick processing is done, tick testing is done, we then send a results email to the submitter. So for that reason, if anyone wants the results to be sent back to them, they need to provide an email address to us because we do not send results via post. We only send by email.

Host Amber Smith: So can someone obtain your Ziploc bags by visiting your website?

Saravanan Thangamani, PhD: If anyone wants Ziploc bags from our lab, all they have to do is to send us a regular self-addressed, stamped envelope to my lab, and we'll be more than happy to fill 10 or 20 bags in that envelope and send it back to whoever wants it, and they can use that to send it. So we are providing this for free to all New Yorkers.

Host Amber Smith: Now, what percentage of the ticks that you receive are found to be carrying a pathogen?

Saravanan Thangamani, PhD: So, between 35 and 40% of the ticks carry at least one pathogen. And it is, depending on the season, During the spring season, which is the highest that I would say, nearly 45 to 50% of the ticks carry at least one disease-causing agent. Of that, the Lyme disease agent is the dominant factor.

Host Amber Smith: And so people would, perhaps, receive an email back telling them that they had this particular pathogen?

Saravanan Thangamani, PhD: So we send out what type of tick it is, and what life stage it is, and do they carry a disease-causing agent or not? If it is yes, then we provide the name of the pathogen.

Host Amber Smith: And then what determines if the pathogen has been transmitted to the person? Because just because you found it in the tick, does that mean that they got it?

Saravanan Thangamani, PhD: No, that's a very good point. Just because the tick that you sent to us was positive, it doesn't mean that you got that agent as well. So that needs to be verified in a clinical setting with your primary care provider. But if a tick that is positive from our testing, if it stays attached on your human skin or in a pet's skin for a good number of hours, that determines that what is the chance of someone getting a pathogen or not? So, for example, for the Lyme disease agent, the tick needs to be attached on a human or a pet for at least 24 to 48 hours for the Borrelia to successfully transmit to a human. That is a qualitative measure. So one needs to know how long the tick stayed attached. It's very difficult to tell that. My advice to the public is that if they receive a result from us saying that it is positive for a particular agent, and if they thought that it stayed attached on the skin for a good number of hours, they should take that information to the clinician, and the clinician will make a proper decision based on the information. So we are providing additional set of information for the clinician to make a differential diagnosis.

Host Amber Smith: Now, the protective measures we've talked about sound like kind of a lot of work, really, but I'd like to talk a little bit more about why it's important, because some of the diseases that can be transmitted, I mean, you mentioned Lyme disease. What's the other one? Borrelia?

Saravanan Thangamani, PhD: Borrelia burgdorferi is the causative agent of Lyme disease. It is the bacterium that causes the Lyme disease.

Host Amber Smith: And then what are some of the other tick-transmitted diseases or pathogens that we should be aware of? Because you're finding more than just Lyme, right?

Saravanan Thangamani, PhD: Exactly. The deer ticks that are most commonly presenting in our part of New York carry multiple disease causing agents. The Lyme disease agent is the dominant one, followed by anaplasmosis agent and babesiosis, the agent Babesia microti. These three are the major ones that we detect in our testing program. And they all are acute febrile illnesses. If detected early, in the health care setting, they can be treated. However, if it is not detected early, it can have lifelong consequences as well.

Host Amber Smith: But again, if you find one of these pathogens and the person gets the report back from your lab, they can at least be alert to the common symptoms and see if they develop them.

Saravanan Thangamani, PhD: Exactly. So what I advise to people is that if they get the result from us to be a positive tick, I tell them, watch out symptoms for the following 30 days. Do you develop a rash? A fever? Or fatigue? A headache or muscle pain? If you have one of those symptoms within the first 30 days of a tick bite, I would then recommend them to visit their health care provider. Take the tick results that came from the lab. It's up to the discretion of the health care provider to use our data or not because we are not a clinically certified laboratory. We are a research laboratory. It is up to the discretion of health care provider, but it is important for them to actually monitor symptoms for at least 30 days for, like, an acute febrile illness. If they find, if they observe anything, then maybe they should visit the doctor immediately.

Host Amber Smith: We've talked a lot about the tick-borne diseases, but what mosquito-borne diseases do we need to be aware of or concerned about in Central New York?

Saravanan Thangamani, PhD: There are two major things that we need to be concerned in Central New York for mosquito-borne diseases, which is the most common one that everybody aware is the West Nile virus that causes West Nile encephalitis. The other important one that we should know about is the eastern equine encephalitis virus -- which is otherwise called triple E virus -- which is caused by Culiseta melanura. Both the West Nile virus and the triple E virus are transmitted by bird-feeding mosquitoes, and humans accidentally come in contact with those mosquitoes, and we get exposed and we succumb to the disease. But I must mention that both triple E and West Nile are neuroinvasive encephalitis viruses with deadly outcomes, and we don't have vaccine or any therapeutics, so, not getting a mosquito bite is only prevention at this time. It's the same thing with the tick-borne diseases, you know, minimizing the exposure is the only prevention we have at this time.

Host Amber Smith: And of course with the mosquitoes, the mosquito bites and flies away or get slapped. If you smash it, there's nothing left to test, I guess, right?

Saravanan Thangamani, PhD: No, but there is nothing left to test exactly. However, county health departments and state health departments, they collect mosquitoes throughout the state, and they monitor for rate of prevalence. So they do have a robust mosquito surveillance program that county health departments are participating in.

Host Amber Smith: Well, Dr. Thangamani, once again, I thank you for making time for this interview. And I'll remind listeners that your website is NYticks.org.

Saravanan Thangamani, PhD: Thank you. Appreciate it.

Host Amber Smith: My guest has been Dr. Saravanan Thangamani. He's a professor of microbiology at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air": Is it really a good idea to combine cosmetic surgery with a vacation?

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Maybe you've seen ads for all-inclusive vacations to exotic places all over the world that include cosmetic surgery. In the past decade, cosmetic-surgery tourism has grown in popularity. If you're tempted to sign up for one of these trips, listen first to my guest, Dr. Sara Neimanis. She's a plastic surgeon at the University of Rochester, and she recently gave an educational talk to primary care providers at Upstate all about cosmetic-surgery tourism. Welcome to "HealthLink on Air," Dr. Neimanis.

Sara Neimanis, MD: Thank you, amber, for having me.

Host Amber Smith: Plastic surgery procedures that are quote-unquote cosmetic, that would be things like face-lifts, liposuction, breast augmentation, things that are not medically necessary. Is that right?

Sara Neimanis, MD: Yes. That is mostly correct. People can travel anywhere for any sort of medical treatment, but that's specifically what we're talking about today: cosmetic.

Host Amber Smith: So what are the most popular procedures for cosmetic-surgery tourism?

Sara Neimanis, MD: The most popular ones that we see, and I'm speaking from what types of procedures we see patients for that come back from these places are things like breast augmentation; liposuction; fat grafting to the buttocks, which is also known as a Brazilian butt lift; abdominoplasty, or tummy tuck -- mainly those few things. And then some combination of them, which a lot of people will call a "mommy makeover."

Host Amber Smith: So are we talking mostly about females and what age range?

Sara Neimanis, MD: We are definitely talking about mostly females. Men are not exempt from any of this, but in my experience, it tends to be women in the, like, 20 to 50 age range.

So some pretty young women, and then some women who are doing these things after having kids and trying to reclaim their bodies.

Host Amber Smith: Does health insurance help pay for these trips?

Sara Neimanis, MD: No, this is all cosmetic, not considered medically necessary. And insurance is not involved in any of this.

Host Amber Smith: If part of the attraction is that it's cheaper to take this trip and go to this exotic location and have a mini vacation than it is to stay in the United States and have the surgery done when you're paying out of pocket, I can see where it would be a popular draw for people.

We're going to talk about the things patients should consider aside from the cost. But first, I'd like to understand why surgery costs so much in the U.S. in the first place.

Sara Neimanis, MD: There's a lot of factors that go into that. When you are paying for a surgical procedure in a hospital or a surgery center, for example, you're paying a surgeon's fee.

You may be paying if you're having breast implants for the actual implants themselves, which are expensive. You're paying for an anesthesiologist. A facility fee for using that operating room, which needs to be cleaned, for instruments that need to be sterilized. So it's not just the surgeon pocketing all of the money.

There's a lot of factors that go into it. And that is why things cost so much.

Host Amber Smith: Well, the world is full of skilled and qualified surgeons, but how can a patient make sure that the doctor that they'll have at whatever location they're going to has the proper training and credentialing?

Sara Neimanis, MD: That's one of the difficult parts about this. In the United States, we have the American Board of Plastic Surgeons, and it's always good to know that your surgeon is board certified in their specialty. In other countries, there are similar sorts of board-certifying um programs, but a little bit harder to keep track of what's what, and there are so many, even in the United States, I don't want to say fake board certifications, but people who are, say, board certified in cosmetic surgery, which is not the same thing as being board certified in plastic surgery. You don't have to have done an entire plastic surgery residency to say that.

So that's one of the difficult parts of this whole thing is keeping track of what sort of training your doctor has had, are they qualified to do these procedures and anybody can put anything on the internet. That's one of the difficult parts about this.

Host Amber Smith: So that regards the physician. What about the facility and the staff? How can you verify ahead of time that they follow accepted guidelines for safety?

Sara Neimanis, MD: Also very difficult in other countries. In the U.S., we have specific certifications and rigorous checklists (for) surgery centers, including some plastic surgeons have ORs (operating rooms) in their offices. And even those have checklists and certifications to go through to be considered safe. For example, if you're not at a hospital and you have a patient who has an anaphylactic reaction or has problems breathing and needs to be transferred to a higher level of care.

You need to have you know the appropriate equipment on site to manage that patient in the interim before they can get to a hospital, for example.

How you could know that your surgery center has that when you're going to a foreign country that may not speak the same language as you is extremely difficult.

And I don't even know how you would necessarily find that out.

Host Amber Smith: Well, in the U.S., we also have the Food and Drug Administration that approves medical products and devices. Does Thailand and Brazil and Costa Rica have the same sort of standards for devices and equipment?

Sara Neimanis, MD: They do. I mean, every country that I'm aware of, and I don't know each individual protocol, has some version of that.

You often hear in Europe that a drug might be approved before it's approved in the U.S., so there are some differences in, for example, breast implants, which types of implants are approved for use in different types of patients in different countries. But in general, there are regulations for these things, but whether people follow them or not, we don't know.

Sara Neimanis, MD: And that's true in the U.S., too. This is not exempting plastic surgeons and people performing plastic surgery procedures in the United States that are not following the rules, either.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Rochester plastic surgeon Dr. Sara Neimanis about some things to consider about plastic-surgery or cosmetic-surgery tourism.

Now these cosmetic-surgery vacations are usually at beautiful resorts. Would that help the healing process? If you go there and you have your surgery and then you're recovering there. You're not having to make your own meals and do your own laundry and things like that. Would that be a benefit?

Sara Neimanis, MD: Having help when you're recovering from surgery is wonderful, and making sure that you have people that are assisting you with heavy lifting, making sure that you're eating well, all of that is great.

But oftentimes when you're at these exotic locations and resorts, it's tempting to go out and lay by the pool or go for a swim or do activities that are probably not a good idea to do immediately after surgery. So, what's the point in being in a beautiful place if you're inside a hotel room all day?

Sara Neimanis, MD: So, it's not the recovery inside that I'm worried about. It's what people might be doing in addition to recovery.

Host Amber Smith: And what happens if you don't speak the language?

Sara Neimanis, MD: Well, the informed consent process is part of the basic principles of practicing medicine. I haven't been part of any of these sorts of consultations in foreign countries to know what the interpreting process is, but here, if we have a patient that doesn't speak English, we make sure that we have an appropriate interpreter before providing the risks and benefits of surgery and obtaining consent.

The other problem with this in terms of consent is that sometimes these people sign up for surgery and haven't actually met the person who's doing the surgery. And they haven't even determined if they're a good candidate. So you're signing up for something, and you may not even be an appropriate candidate for that procedure. And then you show up and they either do it, and you're not appropriate, or you might be switching plans, and that can be really confusing and not necessarily great for your understanding of exactly what is happening.

Host Amber Smith: I know there's a risk of complication for any surgical procedure. What happens if a patient at one of these resorts develops, say, an infection after surgery? Do you hear about people who end up having to be sent to the local hospital?

Sara Neimanis, MD: Honestly, the biggest problem with this that we see, or at least that I see, here in Rochester, is that these people are not actually recovering where they had the surgery.

They're actually getting on planes and coming back almost immediately after, even the next day, so they haven't even had the opportunity to have a problem wherever they had the surgery, which is the scary part. I imagine if they did, then they would go to a local hospital, but the issue that we're seeing here is they are showing up in our emergency room in Rochester days later and having just flown back from what could be a pretty lengthy procedure with a long recovery.

Host Amber Smith: I thought there was a risk of blood clots or pulmonary embolism, where a blood clot lodges in the lungs. I thought people were generally advised not to fly soon after surgery because of that risk, but you're seeing patients that are doing that and coming back home to Rochester?

Sara Neimanis, MD: Absolutely. I think this is one of the scariest things about this whole process. It's not necessarily the surgery or the surgeon or the hospital where this is taking place. It's the hours afterwards. And a long plane flight is a risk for a deep-vein thrombosis, or a DVT, in the legs, especially in people who have recently had a surgery that also predisposes them to that. So abdominoplasty is a surgery that comes with a risk of DVT. So you're compounding those two things. And then sometimes these patients may be on a hormonal birth control or some other medication that may also predispose them to DVT.

And then you have a lot of factors coming together, and that can be life-threatening. So that's really one of the scariest and deadliest concerns that we have about plastic-surgery tourism.

Host Amber Smith: If I understand you correctly, though, these people may have a complication that has to be dealt with immediately, but they could also have a bad outcome from the surgery they went to have.

Do you see patients like that, that come to you for help fixing something that was broken by going to another country to have the surgery done?

Sara Neimanis, MD: Yes, we do. So, caveat, I work in a university, at the University of Rochester, and I mainly do pediatric plastic surgery. I don't do cosmetic surgery on a regular basis, so the patients that I'm seeing are ones that come to us through the emergency room while I'm on call.

And yeah, we have patients who have two issues, exactly as you said, infections, wound breakdown, things that happen in the early post-op period that are more medical problems. And then you do have patients who just aren't pleased with their outcomes, mostly because they had one of those complications.

A lot of them are actually really happy with the way things turned out, and they may have an infection or something that you deal with in the immediate post-op period. But there are a lot of people who have unfavorable outcomes, and they don't have their surgeon to just pop into their office and talk to about it.

Sara Neimanis, MD: We do see a lot of patients who are actually coming from Florida lately, which is clearly not a foreign country, but similar situation where they have surgery, and then they come home, and they don't really have contact with the surgeon anymore. And I ask the patients sometimes, have you talked to the surgeon who did this? And I either get "No" or "I tried, and they didn't answer" or "They said to come to the emergency room."

Host Amber Smith: Does health insurance typically pay for medical care related to problems that developed from cosmetic surgery when they get back home?

Sara Neimanis, MD: This part's a little dicey. For the most part, from what I've seen, yes. If somebody has an infection that they could become septic from and have a serious problem, I have seen insurance covering problems related to complications, but if somebody just didn't like how their tummy tuck looked, for example, then that certainly would not be covered by insurance.

Host Amber Smith: If someone is adamant about wanting to have their work done in another country, because they can save a lot of money by doing that, do you have any advice for what they can do to increase their chances of having a good experience?

Sara Neimanis, MD: Obviously, I think it's in the patient's best interests not to travel for surgery for the reason of not having good follow-up, which is important in post-op care. However, there are people in other countries who are excellent surgeons and do great work. So, I don't mean to discredit them in any way. The best that you can do is do your research, find out more information about the facility, about the surgeon, how they've been trained, are they actually trained to do these operations?

What we see a lot of is, the patients here, they're not dumb. They've had friends and family who have gone to these same people and have had good outcomes. So, I can see why this happens. It's not like somebody is like, "I just want to save a few bucks, I'm going to go to this clinic that is horrible."

They've had friends and family who have gone to these people. And so, why wouldn't they have a similar outcome? And what I would advise people to do is to take time to recover while you're there, ideally, because flying back is one of the really dangerous parts. Also, be honest with whoever is taking care of you if you do have a complication when you come home, because there are pathogens and microbes and types of bacteria that we don't tend to see infections from here, but people, for example, that have surgery in the Dominican Republic may have a different type of infection. And so it's important for us to know where the surgery was done, not to judge you, but to be able to best treat you and understand what might be going on. But not flying home days after an abdominoplasty is probably my best advice, and something that seems like it's going to save a few bucks might end up costing you more in the long run.

Host Amber Smith: I appreciate you making time for this interview, Dr. Neimanis.

Sara Neimanis, MD: Thank you very much for having me. It's an important topic, and I want to make sure that people are informed of their decisions before they do them.

Host Amber Smith: My guest has been Dr. Sara Neimanis. She's a plastic surgeon affiliated with the University of Rochester medical system.

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

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

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 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 conditions.

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 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 behavioral 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, like for 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 months 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 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. Henry 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 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: OK. Interesting. 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 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 up right, 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: OK. 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 in 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 Institute 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 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: Oh yeah. Thank you for having me..

Host Amber Smith: My guest has been Dr. Henry 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."

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

Deirdre Neilen, PhD: Claudia Reder teaches at California State University at Channel Islands. Her poem "Brain Fog" attests to the hard work rehabilitation takes as a patient strains to return to her former state.

Between each read sentence,

I rest. I stare at my PhD dissertation

then copy the complex syntax of one sentence,

then substitute words. I imitate my former self,

mirror, the text with my new handwriting

sloppy as a ten-year-old's scrawl.

I think about Elizabeth Bishop's toucan

because I could use uncomplicated mirth,

and not think about the leak in the roof

which cannot be located, or the

sieve of my brain through which words fall

like tufts of feathers drifting off the planet.

Life collapses to one room surrounded

by books I love that I can no longer read,

my own Leaning Tower of Pisa.

Yet, having left the East Coast years ago

I can still summon the red sumac

when driving north on I-95, a mark of transition

between seasons and counties: the red berry talisman

letting us know we are nearer our goal,

it still grows on that bit of highway

and I am still driving by, hoping

for a glimpse of this berry,

hungry for something I can name.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. 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.