Sexually transmitted infections on the rise; a podcast for future medical professionals; preventing kidney disease: Upstate Medical University's HealthLink on Air for Sunday, May 22, 2022
Infectious disease expert Dr. Elizabeth Asiago-Reddy gives an update on sexually transmitted infections. Admissions official Krystal Ripa, PhD, and medical student John Cote tell about the "Admission Granted" podcast, aimed at those considering a medical career. Nephrology chief Michael Lioudis, MD, addresses how to reduce one's risk of kidney disease.
Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," an infectious disease doctor tells how to protect yourself against various sexually transmitted infections.
Elizabeth Asiago-Reddy, MD: ... There are changes in sexual practices, which include reduction in the use of condoms pretty much across the board. Dating apps is another one that is frequently blamed as a reason why people have more sexual encounters and also sexual encounters that may be more anonymous ...
Host Amber Smith: And we'll hear about a podcast created by medical students for anyone interested in pursuing a career in health care, called "Admission Granted."
John Cote: ... I wanted to kind of give other prospective students who are coming into the medicine programs and any other medical graduate programs, kind of some guidance on really wherever you are in the process ...
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, we'll hear about the "Admission Granted" podcast for people who are interested in medical or health care careers. But first, we'll learn about the most troublesome sexually transmitted infections and what steps you can take to protect yourself.
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." The rate of sexually transmitted infections has been rising in recent years, but then pandemic quarantines and fears of COVID transmission wound up restricting sexual contact for a lot of people over the last couple of years. Today, I'm talking with Dr. Elizabeth Asiago-Reddy about what happens when Americans start having sex again. Dr. Asiago-Reddy is the chief of infectious disease at Upstate. Welcome back to "HealthLink on Air," Dr. Asiago-Reddy.
Elizabeth Asiago-Reddy, MD: Thank you so much for having me.
Host Amber Smith: If I understand correctly, infection rates have been up across the line, regardless of race, gender and age. Is that right?
Elizabeth Asiago-Reddy, MD: Yes, you are correct. And particularly for certain sexually transmitted diseases.
Host Amber Smith: So what are the reasons for that?
Elizabeth Asiago-Reddy, MD: It looks like there are a combination of factors contributing.
There are changes in sexual practices, which include reduction in the use of condoms pretty much across the board.
Dating apps is another one that is frequently blamed as a reason why people have more sexual encounters and also sexual encounters that may be more anonymous than what we used to see in the past. And then also there has been reduced funding for sexual health pretty much across the board in all of the states. So that also has likely contributed to increased rates of infection.
Host Amber Smith: Why do you think there's a decrease in condom use?
Elizabeth Asiago-Reddy, MD: My thought on that one: I don't think anyone knows for sure, so this is somewhat theorizing and based on speaking with others who are experts in the field. I think there was a certain level of complacency after a lot of the fear associated with the HIV epidemic in the '80s. So during the height of the HIV epidemic, there was an increase in condom use. And I think over time, as things became safer and better protected from the HIV perspective, there was also a significant decline in public messaging surrounding the ongoing risk of other sexually transmitted infections.
And some of that translated into people's behaviors and reductions in condom use. In a lot of parts of the country, there's increased access to alternate methods of preventing pregnancy, and so condoms, for many people, may not be the mainstay of preventing pregnancy, so you need to remember that your pregnancy prevention methods may not protect against sexually transmitted infections. And then, depending on where you are, you may or may not be receiving health education specific to sexual health or sexually transmitted infections in school.
And so that's an important message that can really contribute to healthy sexual behaviors as people get older.
Host Amber Smith: I read that some of the greatest increases in sexual activity have been among 15- to 25-year-olds. And I wonder, is that generation just more promiscuous?
Elizabeth Asiago-Reddy, MD: That's the time in life where people tend to be, most likely to be, sexually active. I would say pretty much across the board, that's a time where puberty is ending or else really entering the phase where people become particularly interested in having sex and then throughout young adulthood, of course, people have more freedom and independence to explore their sexuality. And so, yes, I would say that's been for a long time the group of individuals who are, at the same time, more likely to be impacted by sexually transmitted infections.
Host Amber Smith: If people's sexual activity has been dormant during the pandemic, what do you think is happening as people are starting to socialize again?
Elizabeth Asiago-Reddy, MD: That actually became obvious pretty quickly.
So there was a very brief dip in the rates of sexually transmitted infections early on in 2020. And in most cases that dip ended pretty quickly by late 2020 and end of 2021. And the only sexually transmitted infection that continued to experience lower rates is chlamydia. And unfortunately, it's theorized that it truly doesn't reflect a decrease in the actual prevalence of chlamydia, but in testing. So it's important to remember that there are recommendations for screening for sexually transmitted infections. And if people are not going in for doctor's visits in person, and especially for routine health screenings, you might miss out on some of those diagnoses.
So specifically for young women, less than age 25, it's recommended that if they're sexually active, they're screened every year for gonorrhea and chlamydia at annual visits, and that's regardless of symptoms.
You can imagine why. That's a group of people who may have missed out on screenings due to the pandemic, and if they're not being screened as much, then we might end up without as many diagnoses.
Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Elizabeth Asiago-Reddy. She's the chief of infectious disease at Upstate. And we're talking about sexually transmitted infections diseases that are transmitted through sexual behavior.
I wanted to ask you about the STIs that are of most concern for people in Central New York. You mentioned two of them, chlamydia and gonorrhea.
Can you quickly tell me what chlamydia is, who it affects, how it's treated?
Elizabeth Asiago-Reddy, MD: Chlamydia is a bacterial infection that infects the genital area. It's pretty strictly located to the genitals and occasionally to the rectal area as well. It can have impacts in transmission to localize infections during delivery of a baby, so particularly ocular infections is a possibility, so that would be infections of the eyes. But the biggest concern that we have with chlamydia is its association with reduced fertility and pelvic inflammatory disease in women.
And those are situations where if you have an infection that is not detected, so the infection is asymptomatic and it's not treated, then there's a likelihood of a possibility that there could be ongoing inflammation that could impact the genital tract and result in reduced fertility or increased risk of ectopic pregnancy, which is when a pregnancy does not implant in the uterus but implants instead in the fallopian tubes or another area outside of the uterus.
Gonorrhea is actually a very similar situation in terms of the types of risks associated with having gonorrhea, and another thing I want to mention with gonorrhea, that I have seen clinically that has impacted both women and men, is pelvic pain after an infection.
So there are individuals who have what seems to be a fairly standard and limited course of infection treated with antibiotics, but they continue to have pain for weeks or months after the infection. And so obviously that's something that we'd want to try to avoid.
And then I hope you will be asking me about syphilis because it's a very important thing that we need to bring up as well.
Host Amber Smith: That was my next question, because I thought syphilis was an old-time disease, but you're seeing it now?
Elizabeth Asiago-Reddy, MD: Absolutely. So, syphilis -- you're right, I mean, it's been described since ancient times -- in the 1930s and '40s in the U.S it was actually very prevalent and common, and there can be significant long-term effects from untreated syphilis.
With the advent of the availability of penicillin, people began to be able to be treated for syphilis. And to date penicillin is the recommended treatment for syphilis. So once we actually had availability of a treatment for syphilis, there started to be recommendations by most states that people test for syphilis prior to marriage. And those laws had significant impact in dropping rates of syphilis down to very low levels, with another spike that occurred during the time of the HIV epidemic, which again went way down afterwards. And so in the late 1990s, early 2000s, there was a period of time where we thought, oh, we're doing so well with syphilis, we can eradicate it. And unfortunately for the reasons that we've just described with the rise in other sexually transmitted infections reduction in condom use reduction in availability of sexual health services, rates increased, and what's especially concerning is that syphilis is an infection, which can be passed from mother to infant during pregnancy.
And it has very, potentially very, serious consequences for the developing infant, and that can impact infants or fetuses throughout pregnancy. And it's also totally preventable by identifying mothers who have infection early on in pregnancy and treating.
This is a situation that we've become particularly concerned about over the last couple of years, because looking at the data from 2016 to 2019, there was a 235% increase in congenital syphilis in the United States, and so, it's definitely something that, I think there's a huge effort at this point from public health to try and get a handle on this and bring it back down.
Host Amber Smith: So is syphilis a disease that an obstetrician would check for when a woman comes for prenatal care?
Elizabeth Asiago-Reddy, MD: Yes. And the recommendations have expanded. It initially was that there would be one check recommended at the time that care is established during pregnancy. And now it's recommended that there be three checks during the course of pregnancy: at the first prenatal visit, at the beginning of the third trimester and then again at delivery.
And really, again, that's because we're so concerned about this elevated risk and the fact that there's a possibility that syphilis could be acquired at different points throughout pregnancy. And at each point we need to be able to treat to prevent the severe kinds of outcomes that we can see in fetuses and infants.
Host Amber Smith: What about HIV, the human immunodeficiency virus, that causes AIDS? Is this still a concern in our community?
Elizabeth Asiago-Reddy, MD: It's absolutely still a concern, but I'm happy to report that we have some good news on that front, at least as of the most recently available data, which are from 2019. So it takes a lot longer because of a lot of the very detailed types of reports that we like to put out for HIV to release HIV data. The national data are from 2019, but for the first time in quite some time, there is a significant decrease, of on the order of about 30,000, so the average number of infections has been hovering around 36,000 to 37,000 for several years, and it dropped into the 34,000s, so still many more than we would want to see. But when you look at the lines, it's kind of like a flat line for several years, and then, what was really thought to be a significant drop in 2019. So that was encouraging, and some of our highest-risk groups, as well, also experienced a drop during that period of time, and we think that this is at least in part related to the use of PrEP medications of pre-exposure prophylaxis for HIV, which is a medication to help prevent HIV among people who are very high-risk.
Host Amber Smith: OK. Now what about herpes? Is there a lot of herpes in our community?
Elizabeth Asiago-Reddy, MD: Herpes is actually one of the most misunderstood infections that can cross the spectrum of nonsexually transmitted or sexually transmitted infection. So I'll explain it a little bit. There are two types of herpes, which I think many of us have heard of, Type 1 and Type 2. And Type 1 can infect the oral area, so your mouth, or it can infect the genital area. Type 2 specifically prefers to live in the genital area. Most of us actually become infected with herpes Type 1 throughout childhood or adolescence without even knowing that we have it. So herpes Type 1 most typically would cause cold sores or fever blisters, and these are blisters that typically would come out on the lips and sometimes can be provoked by stress or another infection bringing them on.
Interestingly, and for reasons that we don't understand, despite the fact that most of us have harbored this virus, not everyone gets fever blisters, right? So it's only a small proportion of people who actually have symptoms, but if you test our blood, most of us have actually been exposed.
For Type 2 herpes, which as I mentioned is specific to the genital area and can cause outbreaks of blisters in the genital area, that is impacting about one-third of people. So about one in three people has been exposed at some point, but again, whether or not someone has symptoms is highly variable. So there are many people who if you test their blood, it looks like they have been infected, but they've never had any symptoms. So this makes, as you can imagine, this makes herpes particularly difficult to control, and even to explain to patients, because it is a lifelong infection, but the degree to which people will have symptoms over time is highly variable.
Host Amber Smith: These diseases we've discussed -- chlamydia, gonorrhea, syphilis, HIV, herpes -- are they all transmitted through standard sexual intercourse, or could they be transmitted through oral sex or kissing?
Elizabeth Asiago-Reddy, MD: Yes. Actually all of these can be transmitted through oral sex as well, some better than others. HIV is very rarely transmitted through oral sex. It can be, it has been reported, but it's quite rare. Chlamydia similarly is quite rare to be transmitted through oral sex. Gonorrhea and syphilis are actually quite common. And this is a big problem, I believe, driving the syphilis epidemic, is that in order to reduce risk of sexually transmitted infections, including HIV, and not use condoms, I think a lot of people reverted to oral sex as a safer option.
And like I said, for some things that may be safer and for others, it's not. So unfortunately for syphilis, it's really not. And syphilis is very contagious even through oral sex. So I'm glad that you asked that question.
Similarly, gonorrhea: It can be more difficult to treat when somebody has a case of gonorrhea impacting the throat. Antibiotics sometimes don't work the first time around and sometimes need to be repeated. And fortunately in the U.S., we've done a good job in preventing severely drug-resistant gonorrhea by staying ahead of the curve and making new recommendations for how to treat gonorrhea. But if you look throughout the world, there have been significant challenges where there are severely drug-resistant strains of gonorrhea that may require somebody to even go into the hospital and receive IV antibiotics in order to be treated.
Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break. Please stay tuned for more information about sexually transmitted infections from Dr. Elizabeth Asiago-Reddy.
You're listening to Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Elizabeth Asiago-Reddy. She's the chief of infectious disease at Upstate. And we're talking about sexually transmitted infections, which are diseases that are transmitted through sexual behaviors.
Now, let me ask you about HPV (the human papillomavirus). That's the disease that can cause cervical cancer, right?
Elizabeth Asiago-Reddy, MD: Correct. HPV is a virus that lives on the skin, and there are specific types of the HPV virus that tend to reside more in the genital tract. And you're absolutely right, a chronic or long-term, HPV infection can result in cervical cancer or anal cancer or head and neck cancer as well, which are things that we have come to realize more in the last several years.
The good news for HPV is that the strains that are most likely to lead to cancer over time are covered in the HPV vaccine, which is widely available and recommended early in adolescence. So the more that the HPV vaccine is adopted, the less likely we are to see over time that these cancers are problematic.
Host Amber Smith: In general, what can happen when an STI is left untreated, if it's never diagnosed and the person just lives with whatever symptoms? Can that cause lasting damage?
Elizabeth Asiago-Reddy, MD: Yes, it definitely can. And it depends a lot on which one it is that we're talking about. The two most significant chronic sexually transmitted infections are HIV and syphilis. So HIV -- certainly, it's critically important that people get into care as soon as possible. And if they do, then, the life-restoring treatment is available, and we can very much limit any kind of damage caused to the immune system by HIV, by starting treatment as soon as possible. So that's the case for HIV.
And then syphilis is a fully curable sexually transmitted infection, but it also is a systemic infection, meaning that it goes into your entire body: your lymph nodes, frequently it goes into the brain as well. And if it's not treated within 10 to 30 years after the initial infection, somebody could develop very severe symptoms, to include things like problems with your cardiovascular system, like the aorta, the big blood vessel that sends blood to most of your body, that can become infected and become weakened.
You can develop dementia or neurocognitive problems, such as along the dementia spectrum, related to syphilis. So it's very important to be tested and treated, again, early in the course of an infection, to prevent these types of things from happening over the long run. And of course, we already talked about the situation with transmission during pregnancy.
Host Amber Smith: Regarding fertility, because I've heard some of these diseases can impact a woman's fertility, is it all female fertility, or do any of the diseases affect a man's ability to father children?
Elizabeth Asiago-Reddy, MD: It appears to be primarily female fertility that's impacted. And very unfortunately for women, women are more likely to be asymptomatic, specifically with chlamydia and gonorrhea. So chlamydia and gonorrhea can impact fertility, but they also may go undetected because women may not have symptoms at all, so men are more likely to have symptoms, which can include things like burning during urination or a discharge from the penis, whereas women might not feel anything at all. And in fact, they do have this, which is why there's recommendation for standard screening for all sexually active women, less than age 25, as I had mentioned, because that falls into that age group that you had brought up earlier as being the highest risk. So we want to try and identify those individuals and treat them before any kind of chronic inflammation or damage occurs.
Host Amber Smith: If someone has developed one sexually transmitted disease, is it common for them to also become infected with another? Or could they get more than one disease at the same time?
Elizabeth Asiago-Reddy, MD: Yes, for two reasons. One is that there are certain subpopulations of people who tend to have sex with each other. So basically, we live in certain social groups, and we often have sex within certain social groups as well. So if there are certain groups of people that are at higher risk for sexually transmitted infections, that can often stay within one community.
Additionally, just from the perspective of the fact that sexually transmitted diseases cause inflammation of the genital tract, and then inflammation can put you at risk for acquiring another sexually transmitted disease So this has very classically been looked at with HIV in trying to understand why it is that some individuals and populations seem to have increased risks of HIV, and across the board, all of the sexually transmitted infections that we've discussed, such as gonorrhea, chlamydia, herpes and syphilis, they're going to be associated with an increased risk of acquiring HIV because of the inflammation that exists in the genital tract at the time somebody might be exposed to HIV.
Host Amber Smith: Just talking about these diseases, they can sound scary. So if people are going to be sexually active, what steps can they take to minimize their risk of infection?
Elizabeth Asiago-Reddy, MD: Great question. Regular testing is very important, so if you're getting a new partner, then I am always very happy to see that. I used to work over at the STD center at the county Health Department. And we would have folks show up sometimes with their partners saying, "You know, we've met each other, and now we want to be tested before we have sex." And that would really literally make me happy to see because that's exactly a safer approach to trying to enjoy a relationship, where you're not worried about that being a part of it.
And then obviously, again, condom use. Condom use remains incredibly effective for people who are having sex, where a condom could be beneficial. And, again, it's unfortunate that condoms have waned in popularity. Their effectiveness is very, very high, and there were periods of time where, similar to how certain groups of people were very pro-masking and pro-testing before going to public gatherings due to COVID, there were periods of time where things like that would be expected, related to condoms.
Not even thinking about having sex without a condom was much more common in the past than it is now, and many of us in public health hope that that will change. And then, I like the type of teaching that is offered in schools where it's a holistic approach to sexual health and really wanting to have all the options on the table: Who are your partners? Do you want to have sex right now? Do you not want to have sex right now? Are you in a good place to have sex from an emotional standpoint? So all of those factors can go into actually improving rates of sexually transmitted infections.
Host Amber Smith: Well, Dr. Asiago-Reddy, this has been very informative, and I appreciate your time.
Elizabeth Asiago-Reddy, MD: Thank you so much for having me.
Host Amber Smith: My guest has been the chief of infectious disease at Upstate, Dr. Elizabeth Asiago-Reddy. I'm Amber Smith for Upstate's "HealthLink on Air."
Next on Upstate's "HealthLink on Air": a podcast for people seeking careers in medicine.
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." If you're contemplating a career in medical care or health sciences, you need to know about a podcast hosted by Upstate students called "Admission Granted." I'm talking about this podcast with director of special admissions programs Dr. Krystal Ripa and medical student John Cote, who's one of the hosts. Welcome to "HealthLink on Air," Dr. Ripa and Mr. Cote.
Krystal Ripa, PhD: Thank you so much for having us, Amber. We're excited to talk about "Admission Granted" today.
John Cote: Thanks for having us.
Host Amber Smith: I know this podcast got started last year, and "Admission Granted" now has at least seven episodes available in Apple podcasts. It's about preparing for and gaining admittance to medical school or a college for advanced training in health sciences. Whose idea was it to create a podcast hosted by medical students?
Krystal Ripa, PhD: So originally, our Upstate Accelerated Scholars Program is a BS/MD (bachelor's and doctor of medicine degrees) program where students with strong academics apply to undergraduate and medical school, and that program has a task force of faculty and students. And we got talking about how do we connect with the youth of today and how do we connect and stay relevant. And the idea of a podcast came up, and at that time the faculty around the table and the students around the table were like, "Oh, we could have a podcast for our BS/MD students." But I said, you know, those students are already a captive audience, and I find myself, personally, after being in admissions as long as I have, repeating kind of the same hidden rules of engagement. And I feel like from my perspective, I have a certain lens, and our students have a lived lens. And so we started this podcast last spring, and John and Andrea, who is our other inaugural host, really helped to get it off the ground and imagine what it could and would be. Originally it was started for medical school. We have since made it a little bit more diverse and related to many different health professional programs that students are really trying to figure out the complexities of, the many nuances associated with applying and the hidden rules of engagement. So that's a little history.
Host Amber Smith: So your target audience is a student who already has a bachelor's degree, right? I mean, people don't come into Upstate without that. This is advanced training, right?
Krystal Ripa, PhD: So I think that John could probably talk about target students, too, but I find that we get high school students listening to these, that are really trying to get prepared. And if you think about, if students are shopping, like, "Hey, I just, met my doctor for the first time, and I adored them," or "I met my PT ( physical therapist) for the first time, and I adored them. How do I do that?" And maybe today's youth would refer to their Apple podcasts. And if they were looking on admissions, they'd find us. And me as a rural first-generation student, sometimes I just made it up as I went along. So it could go back to students with a bachelor's degree in high school, even in middle school the students are becoming more aware of the careers surrounding them, and we hope that this can connect them with how to make it all happen. What do you think, John? Who is our target?
John Cote: The goal for at least my vision, was for it to be toward anybody who's just interested in medicine at, really, any stage of the process. When the idea kind of first came to Andrea and I -- Andrea Price, my cohost, has worked with Krystal for a lot of different things in admissions -- and she came to me saying, "Oh, we have this idea for this podcast," and we kind of were, we were thinking about like, what would be a good idea, and what we could bring to the table, and what we might have ideas for. And we kind of altogether agreed that this would be something that we thought wasn't well covered. Like for me, when I was applying, I like podcasts, so I was listening to a lot of, like, application podcasts and things about how to best apply, how to prepare. And this was kind of toward the end of my college career. And then during my gap year, when I was applying, and I didn't find that there was a ton of great resources like for podcasts out there in terms of helping students apply and giving them all the real, like nitty-gritty things that they really need to know about the application process. I came from like a liberal arts school, and to be honest, they didn't really have the best guidance, I felt. And so I kind of felt like I was doing it on my own. And so I wanted to kind of give other prospective students who are coming into the medicine programs and any other medical graduate programs some guidance on really wherever you are in the process. So that's kind of what we tried to do is, even if you were in high school, or maybe you were in middle school, just to get involved in at whatever step you're in, you know, kind of lay out a timeline, a framework, so wherever you are in your process you can look at it and say, 'OK here's where I am. Here's what I can do from here to prepare myself for a graduate degree in medicine."
Host Amber Smith: So it sounds like this information may apply, not just for people coming to Upstate, but it looks like it would be applicable to anyone that's interested in a career in medicine.
John Cote: Exactly. That was the goal. Because we really wanted to help the broadest range of people possible. And we didn't feel like the resources that were there currently didn't cover everything that we thought could be covered. And so hopefully this is a good holistic view on how best to prepare yourself for a career.
Krystal Ripa, PhD: I think it's fair to say, also, that we want students to go where they thrive, and where maybe their support systems are regionally not in Central New York. And so we wanted to make the information palpable and of use to the broadest audience. And selfishly, we love Upstate, but everyone may not be able to come to Upstate, afford Upstate, have a support system near Upstate Medical University, and we still want to help those people have the information to aspire to this goal. And so it really isabove and beyond Upstate. I hope it gives our audience a sense that at Upstate we have a vision of making the process transparent and helpful to anyone.
Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Krystal Ripa from Upstate's student affairs office and John Cote, who's a third-year medical student at Upstate, and we're talking about the podcast called "Admission Granted."
I'm curious about how you prepare for your episodes. So, do you research a topic and do you rehearse? Or do you just decide on a topic and then just chat?
John Cote: So the way that Andrea and I approached it, at the beginning we kind of sat down and said, here's the big, we have our six keys is what we call it, right? So each step of the process in terms of, like, one being GPA (grade point average) and coursework and undergrad and another one being the standardized tests, so like the MCAT (Medical College Admission Test). And then also, like, research experience and then shadowing. And then also, like, the timing of everything and making sure that it all is done at the right time. So we kind of had those loose kind of outlines that we gave for our keys. And then once we had that, we kind of set a brief outline of just the things we want to hit. So we kind of go through it from our combined experience, because we both had kind of unique ways of applying. And so we brainstorm together, OK, here's the things we want to hit: we want to talk about making sure that if we're doing GPA and coursework, making sure you're hitting your grades, you know, you're studying correctly, you're doing all these things right you're talking to your pre health adviser, you're doing all these things. And so we had kind of like a brief outline that we'd write. And then we basically would just kind of talk once we got on the mic, we would just kind of go with it. Sometimes we'd have to redo takes if it was bad. We wanted to make it more like off the dome and conversational then like really just having a script that we wrote down. So we had the topics, but we more or less just kind of talked with each other and got good takes out of that.
Host Amber Smith: Dr. Ripa, I gather that applying for medical school is not the same as applying for an undergraduate college. Can you walk us through, briefly, the typical process?
Krystal Ripa, PhD: There are several routes to apply to medical school, and some of those are early acceptance, and some of those are applying traditionally. Early acceptance is a somewhat different process, because you aren't utilizing the AMCAS, or the American Medical Common Application System, for an early acceptance.
So I'm going to focus on the traditional process, and that's through the AMCAS application. And so typically, a student applies the year prior to their anticipated matriculation to medical school. And that application is really where a student inputs every single thing ever. So they list every single course they've taken from every single school, the MCAT exam that they took in order to have an entrance exam, it's a standardized exam to go to medical school. They have 15 places to put down their experiences, and three of those can be their most meaningful. They input their letters of recommendation into AMCAS. And then AMCAS does a pretty rigorous verification process that takes four to six weeks This is really just the culmination of years and years of them working toward submitting that application, preparing academically to have high scores on their MCAT, for them getting clinical experience and insight for them committing their lives to service and really showing I want to be at service to people above and beyond being a physician, I've made that kind of a theme of my life. When I'm applying or preparing to apply and the letters of recommendation some institutions use what's called a committee letter. And if you don't have a committee letter from a pre-health department or pre-med department at an undergraduate institution, there's a substitute for that pre-health committee letter. So applying to medical school is very complex. And that application may be a culminating experience, but you put in years, you put in years. And so the podcast really helps us to address all of the different components that are captured by that application. And AMCAS is the application, but our governing body, the Association of American Medical Colleges, really captures what students need to -- not explicitly communicate in their application, but -- display as competencies in your application. And those are the double AMC pre-medical competencies. Those pre-medical competencies are also what we use to review applications and what we use in our pre-matriculation programming for early accepted students, to continue to prepare them to come into medical schools and really have a baseline, not just for the academic rigor, but also the interpersonal rigors the cultural competency, the interpersonal skills that really build them to be their best possible physician at the end of their journey.
Host Amber Smith: And for someone who wants to become a researcher or a physical therapist, not a doctor, is the process the same?
Krystal Ripa, PhD: It is not. It is not. And I would encourage anyone in this journey, where they're hearing about medical school, to also consider all of the options. Medical school is one of those things, or being an MD is probably one of those things, that kind of is most understood, but there's all these other allied health professions and research careers that are highly valuable and really amazing. One of our programs -- say clinical perfusion, many people don't even know what that is, and there are very few programs across the nation for clinical perfusion -- and so I think anybody who's interested in being a doctor, exploring all those options and understanding what's out there and really intrinsically understanding what do I love doing? What puts a fire in my belly? I think that one of the most understated professions is research, and research is the foundation of all of health care, from something as simple to a bandaid to a vaccine. Research is really the way that we have modern medicine, that we have the practice and the everyday work of a physician. So I really encourage them, and at Upstate we're a perfect kind of facility to do that. We have $40 million in research funding, a ton of translational research opportunities. So if you're interested in medicine, but research is really calling you, puts a fire in your belly, you can still work on truly impactful clinical and translational research here, so I would just implore anyone interested in science and medicine in helping, to look into all of the options, not just MD. Also DO, osteopathic medicine, is an amazing route. It's just newer than allopathic, or MD, programs. So it's a little bit different. It's more about manipulative medicine, but I just encourage our listeners, anyone considering this path, to know all the options and to get picky, right? This is a life choice, and it's an investment, and it should put a fire in your belly and keep it burning for years to come.
Host Amber Smith: Well, Mr. Cote, why did you want to become a doctor?
John Cote: I didn't really know what I wanted to do until I got to college. I was kind of one of those people who wasn't super sure. I got to college, and my parents had always said, "Oh, you know, maybe consider something in medicine." I've always liked kind of being around people and helping others. And I was really interested in sports medicine at the time. And so, I decided to just kind of be pre-med, and I ended up really liking the courses. And, I did some time, you know, we talk about on the podcast a lot about shadowing and getting volunteer experience and making sure that you get some type of work in the field. And so by doing that, I had chatted some physicians that had treated me and then I'd also done a lot of volunteer work. I volunteered in the hospice unit and also an emergency department. Through doing all those things, I really kind of started to value the clinical side of medicine and really loved just being around and helping people and helping others. My biggest story would be when I was in high school, I played a lot of sports, and I got injured a lot. And so I had a couple of surgeries, and my physician really made me feel a lot better about that at the time, which felt so important, those injuries. He really made me feel comfortable, and I really always appreciated him for that. And then going back and shadowing him and watching what he could do for others really kind of inspired me, and so it's just kind of taken off from there.
Krystal Ripa, PhD: John, do you still have that fire in your belly even after the first two years of medical school?
John Cote: Of course, if it's stronger, if anything, but it's definitely there.
Krystal Ripa, PhD: Good.
Host Amber Smith: Some people are intimidated by microphones, but you really seem like a natural. Did you have media training before medical school?
John Cote: I did not. No, I make a lot of music. I had all the equipment here to be able to record in my apartment. And so Andrea and I just kind of used, I just kind of did all of it through my recording software that I have here. And it just was something that would kind of felt like a natural fit almost. But I appreciate you saying that. Yeah. It's definitely something we've been working on.
Host Amber Smith: I was going to ask how you record the episodes So you're not in person with your guests there. It's by phone or by WebEx or something?
John Cote: For the times that we had guests, we did it over, I believe we did it over, Zoom, but Andrea and I would just kind of do it through our microphone, kind of taking turns. It wasn't the best process, but now that we have the access to the studio at Upstate, we have a transition now where we're we've started recording. The first episode for our new season has recorded there, which has been great.
Host Amber Smith: I'd like to have you give us sort of a rundown of your first episodes, your favorites. What are some of the topics that you covered that you are most proud of?
John Cote: I really was passionate about this first season, because it's something that when I was going through the process, I really felt that I needed to get out there to others because I just had always felt like I didn't have that guidance. Just maybe because from being from liberal arts school where the science program wasn't as strong, I just didn't feel like I had that guidance. And so I was really glad that we were able to put together some of the most important things that we thought, when we were applying, if we could go back, here's what we would have done.
If I had to pick one thing that maybe I thought was the biggest kind of undervalued piece of what we did is, I think getting the shadowing, the clinical experience as an undergrad, is really important. And for me, like, I would have started doing that in high school, had I gone back, even just like taking one hour a week and volunteering at a hospital to getting some volunteer experience in, I think that's a really important piece that often gets overlooked because research is so important as an undergrad. Everyone's trying to get research experience, but they forget to do the very simple clinical things. And it's also tough because oftentimes it's not paid. For me, going in and during college, I was volunteering at a hospice unit, and I also volunteered at home in an emergency department. Doing those things are really important. So we had a whole episode where we outlined all the different things that we talked about for clinical experiences, things that you can do, when to get involved, how to get involved. And so I think that's one of the biggest things that I thought was kind of the most important. And so I think for me, that episode was a really important and great kind of piece to have. So I would recommend that episode I believe that's episode maybe four or five I'd have to look back. But it's called like clinical experiences and extracurricular activities
Host Amber Smith: And let me ask you about shadowing. That is something that a student who's interested in medicine might ask if they could shadow their physician and spend part of the day with them. Is that how that works?
John Cote: Exactly. Yeah. So if you have a good relationship with any of your physicians, you know, most people have at least a physician that they're comfortable with or that they have been going to. And, so they're just following around during their day to day. It is almost a separate category from, like, volunteering, which is also just as important. And so you kind of need all of those pieces right. You need the research, you need the extracurriculars not related to medicine, but then you also need the shadowing experience, where you're just literally following a physician around and you're learning the lifestyle. And then also the volunteering, where you're going in, and you're actually getting a little bit of hands-on experience working with patients.
Krystal Ripa, PhD: In order to create some equity in our low socioeconomic students, we actually also advise students that they can pursue paid positions for clinical experience, like being a CNA ( certified nurse assistant), a patient care tech, an EMT (emergency medical technician), just because we understand that sometimes you have to make a decision between managing your time, trying to be competitive for medical school, bringing in a paycheck. So, those are other really great ways, above and beyond shadowing, to get that hands-on experiences.
I think that John is also being humble, and I didn't want to forget this. John created the music for "Admission Granted." That's all John. I also think that our inaugural hosts and even our next series of hosts have that legacy mentality that John mentioned, about just wanting to be transparent and address maybe the parts of the process that weren't as well stated or understood by and for them. So I really, really think that they've been a special part of making sure that the process for the next in line is more palpable.
Host Amber Smith: Well, before we wrap up, let me know where can people find "Admission Granted"? I know it's on Apple podcasts, but is,there other places people can go to find it?
Krystal Ripa, PhD: So it's on our website. It is on Apple. It is on iHeartRadio. And it is on Spotify. Am I missing any, John? I think I got them all.
John Cote: Unless Google has, like, a Google podcast, but I think those are the big ones.
Krystal Ripa, PhD: Yes.
Host Amber Smith: That's good to know.
Krystal Ripa, PhD: And we will continue releasing around at one episode a month. We will continue to transition hosts from year to year so our upcoming hosts are a little bit more interprofessional. So we have a researcher, and we have two students in the MD program and all women in STEM, (science, technology, engineering, mathematics).
Host Amber Smith: Good. That's very good to know. I appreciate both of you for making time for this interview.
Krystal Ripa, PhD: Thank you so much for having us.
John Cote: Thanks for having us. It's been really fun.
Host Amber Smith: My guests have been Upstate's director of special admissions programs, Dr. Krystal Ripa, and third-year medical student John Cote. I'm Amber Smith for Upstate's "HealthLink on Air." Here's some expert advice from nephrologist Dr. Michael Lioudis from Upstate Medical University. What can people do to reduce their risk of kidney disease?
Michael Lioudis, MD: It really is about being able to identify kidney disease to begin with. And that means going to your primary physician or advanced practice provider on a yearly basis for routine checkups.
You want to know about being able to prevent other disease or other problems that can come up as you're getting evaluated, and being able to identify kidney disease at that point in time is part of a routine checkup. Being able to prevent kidney disease or think about kidney disease, it is about getting your diabetes under good control, if you happen to have diabetes. It's about taking care of our blood pressure, if you have high blood pressure, medications, checking your blood pressures at home, it's about avoiding a certain line of medications called NSAIDs, nonsteroidal anti-inflammatory drugs, like Motrin, ibuprofen, Advil, Aleve, on a long-term basis. Your doctor or advanced practice provider can help to guide you about how long you should be able to take those medications.Getting your flu shot. Physical activity. If you have high cholesterol, getting that under control.
And really sharing your medical history and your family history with your medical team. They want to know what's happened in your family. Some diseases can run through families, and understanding what that family history is can make a big difference.
Host Amber Smith: You've been listening to Dr. Michael Lioudis from Upstate Medical University.
And now, Deirdre Neilen, editor of Upstate's literary and visual arts journal, The Healing Muse, with this week's selection.
Deirdre Neilen, PhD: Alexandra Tatarian is a second-year medical student here at Upstate. She won the F. Sean Hodge Prize for Poetry in Medicine with this beautiful lyric called "One Pandemic Perspective":
We grieve the 500,000 lives taken too soon,
the suffering, isolation, and virtual goodbyes
led by healthcare heroes with heavy hearts,
our beings dampened, tinted, jarred, snuffed.
We then grieve what we never knew,
trips, gatherings, embraces, every
facet of life taken for granted as
plans unraveled around spinning spools.
and masked up
dreamed of faraway places
and bright smiles
longed for rich experiences
and full facial expressions
that were never ours to share
as human nature receded.
attempted to imagine the Unknown
and read under the mask
draw its every detail
and remember each dimple
until it only grew stranger
how odd it is to ask
How best can we grieve you?
Do you have a mustache?
We bear such great grief
it may help not to dwell
on the what ifs and instead
appreciate what we know.
fine-tuned family recipes
and found fabrics that speak
while enjoying time at home
after attempting to sew.
realized our connectedness
in changing dressing habits
with new daily routines
when the pandemic ceases
and the masks come off
we will visit new places
feel the sunshine on our skin
That's where we will go!
That's what you look like!
What a beautiful view.
What a lovely smile.
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," the connection between COVID and diabetes. 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 healthhinkonair.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.