Future physicians hear transgender patients’ perspectives

SUNY Upstate College of Medicine

Participants in Upstate's annual Trans Health Panel included members of the local transgender community and Upstate physicians Harold Husovsky MD and Barbara Feuerstein MD. Photos by Jordana Gilman.

Upstate medical student Jordana Gilman envisions the day when patients in physicians’ waiting rooms see these categories on the intake form: Your Gender Identity and Your Preferred Pronoun.

Gestures like that, Jordana said, will send a message to transgender patients: “We treat people like you here, you are welcome here, we will give you our best.”

That was more or less the theme of the annual Transgender Health Panel Jan. 14, hosted by Upstate’s LGBT club and co-sponsored by more than a dozen other campus groups and clubs.

Four members of the local transgender community were on the panel, along with two physicians: Harold Husovsky MD, associate professor of medicine at Upstate, and Barbara Feuerstein MD, an endocrinologist at the Joslin Diabetes Center.

“I’m encouraged by the turnout,” Dr. Husovsky told the crowd of about 75 people, mostly Upstate students, in Weiskotten Hall’s ninth-floor auditorium. “Every year we get more and more, and that’s the way it should be,” he said.

Jordana, LGBT club vice-president and a second-year medical student, said the panel was designed as an introduction to the challenges transgender patients face in the health care system, and to educate future health care professionals as they strive to provide the best possible care for patients.

SUNY Upstate College of Medicine

Second-year medical student Allison Hall, president of Upstate's LGBT club, welcomes the audience at the start of the Jan. 14 Trans Health Panel.

Jordana credited physicians who care for the unique health needs of trans patients – “the cross hormone use, the sexual health care, and even surgery if that is what patients require,” she said. “Those doctors deserve our greatest respect and support.”

The medical profession in recent years has seen some advances in awareness, acceptance and treatment of transgender patients.

In 2013, the American Psychiatric Association formally did away with the term “gender identity disorder” to describe the incongruity transgender people feel.

“Part of removing stigma is about choosing the right words,” according to the APA. “Replacing ‘disorder’ with ‘dysphoria’ in the diagnostic label is not only more appropriate and consistent with familiar clinical sexology terminology, it also removes the connotation that the patient is ‘disordered.’”

Fifty percent of transgender patients with dysphoria try to kill themselves, Dr. Husovsky said. They are in true pain, and have higher percentage of smoking and alcohol use. If untreated, he said, “it turns out badly for some of them.”

A New York State law went into effect Jan. 20 making it illegal to discriminate against or harass people based on gender identity, transgender status or gender dysphoria.

Dr. Husovsky said he has seen 60 to 80 trans patients since 1998, and each one is a unique individual. Sexual identity is a spectrum, he said, echoing an audience member’s comment that labels are meaningless.

Dr. Feuerstein said there are trans patients of all ages, and the timing of hormone treatments can be crucial – for instance, in the case of a young female transitioning to male, halting puberty through hormone treatments can delay breast development.

Here are some observations from the members of the trans community on the panel:

“Nothing ever felt right,” said Jamie, who grew up in a “masculine” home and is transitioning from male to female. “I hated what I was. I knew it was wrong for me.”

At medical appointments, Jamie said she knows as soon as the physician walks into the exam room whether it will be a good match. She’ll tell a joke, and the right response can make all the difference. “Most of us just want to be accepted,” Jamie said.

In response to a medical student’s request for advice in treating their future transgender patients, Tyler – who transitioned to male several years ago starting at age 20 — said he has had “some awkward gynecological experiences. One doctor wouldn’t even look me in the eye. I never saw him again.”

Tyler pointed out that he’s had the benefit of a supportive family and the ability to shop around for the right physician, something that a lot of transgender people don’t have.

Josh, who’s transitioning from male to female, began hormone treatments 16 months ago and said, “It’s the best thing I’ve done. It calmed a lot of nerves.”

A parent of a transgender child said their family has been fortunate, thanks in part to an understanding pediatrician. “The longer we deal with it, the easier it gets,” the parent said. “But it’s still scary.”

Afterward, Jordana said the event was a huge success.

“I know everyone walked away having learned something,” she said. “We will carry what we learned in that room with us throughout our careers, wherever they may lead.”

The panel was co-sponsored by these Upstate student groups: Endocrine Club, AMWA, COM Class of 2018, Cross Cultural Awareness, Docs for Tots, Emergency Medicine, Integrative Medicine, Jewish Med Association, Med Students for Choice, Muslim Students Association, Ob/Gyn Club, Physicians for Human Rights, Radiology Club and the Secular Students Association.

SUNY Upstate College of Medicine

Panelists listen to a question from an audience member at the Jan. 14 Trans Health Panel.

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Upstate’s Women in Medicine chapter hosts mentoring brunch

SUNY Upstate College of Medicine

Upstate's Women in Medicine chapter hosts a mentoring brunch Feb. 13 on campus. From left to right, in front of portraits of pioneering physicians Sarah Loguen Fraser and Elizabeth Blackwell, are: Shivani Agarwal; Elizabeth Presutto; Gabrielle Ritaccio; McKinzie Neggers; Marleny Acosta; Amanda Gemmiti; Anudariya Dean; Angela Rios; Jennifer Liano; Alice Chu, and Lauren McNeill.

The medical students in Upstate’s chapter of the American Medical Women’s Association (AMWA) host a brunch and mentoring event Feb. 13 in the Setnor Academic Building.

“It’s important for women to meet other women in medicine, to have opportunities to make connections and ask questions specific to women in medicine,” said chapter co-president McKinzie Neggers, a second-year medical student. “It’s important to have those resources and be a part of a support team.”

The event — free and open to men and women in the Upstate community — runs from 10 a.m. to 1 p.m. in the Dr. Gregory Eastwood Atrium. Anyone planning to attend is encouraged to RSVP by Feb. 10 to neggersm@upstate.edu or macneill@upstate.edu.

McKinzie and chapter vice president Gabrielle Ritaccio said the event will be informal. They’re hoping physicians and third- and fourth-year medical students attend to offer their insights and guidance.

“We need a forum so we can understand the challenges and pitfalls and also be aware of the resources and be part of a community,” Gabrielle said.

The organization’s work is especially relevant in light of statistics from the Association of American Medical Colleges. According to the AAMC:

  • The percentage of females applying to medical schools peaked in 2003 (50.8%) and has declined in recent years.
  • The percentage of females enrolling in medical schools also peaked in 2003 (49.6%) and has dropped to 46.8% this year.

While percentages are down, the actual number of women enrolled in medical school has increased from 35,392 a decade ago to 40,634 this year because because more spots are available in medical schools. (During the same time frame, however, the number of men enrolled in medical schools rose from 37,505 to 46,108.)

The AMWA is marking the first National Women Physician Day Feb. 3 in honor of the birthday of Elizabeth Blackwell MD, the first woman to receive a medical degree in the United States (in 1849 from Geneva Medical College, forerunner of Upstate Medical University.)

Upstate’s AMWA chapter has been active this year – it invited Lynn Cleary MD, professor of medicine and vice president for academic affairs, to speak about her career path. Other gatherings focused on topics such as female physicians who choose surgery as a specialty.

A new slate of officers, now first-year medical students, is poised to take over in the next academic year. The current officers are: McKinzie Neggers and Anudariya Dean, co-presidents; Gabrielle Ritaccio, vice president; Jennifer Liano, secretary, and Shivani Agarwal, treasurer.

The incoming officers are: Lauren McNeill, president; Alice Chu and Elizabeth Presutto, co-vice presidents; Marleny Acosta, secretary; Amanda Gemmiti, treasurer, and Angela Rios, public relations.

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Neuroscience student explores link between emotion, appetite

SUNY Upstate

Upstate graduate student Patrick Sweeney with his research advisor, Yunlei Yang MD, PhD.

Patrick Sweeney wants to help solve a mystery.

“What interests me most is how individuals can lose the ability to want to eat,” he said. “If you can understand how that works, you can help a lot of people.”

Patrick is a fourth-year Neuroscience PhD student in Upstate’s College of Graduate Studies, in the lab of Yunlei Yang MD, PhD, assistant professor of Neuroscience and Physiology.

The pair collaborated on a paper that was published in the scientific journal Nature Communications in December, with Patrick as first author. The study examines the neural circuitry involved in emotion and its link to eating behaviors and disorders.

“The link (emotion and appetite) is very interesting and important,” Patrick said. “Obesity and anorexia are major problems, and they’re deadly.”

Much of Patrick’s research relates to anorexia, an eating disorder characterized by an obsessive refusal to eat. Obesity also can be deadly, but is a slower process characterized by the overconsumption of food. Anorexia has been classified as a mental illness by the American Psychiatric Association, as have bulimia (purging) and binge eating.

“I’ve always been interested in behavior and emotion since I was a kid, and changing behaviors,” Patrick said. “This lab is right up my alley. The makeup of the brain is fascinating.”

The Yang lab is using advanced techniques such as chemical genetics, electrophysiology and optogenetics, a technique that targets specific neurons in the brain with light. The light is converted to electrical signals that allow scientists to “turn on” or “turn off” specific neurons to determine how these neurons control behavior.

“We’re taking advantage of these approaches to study the neural circuits governing behavior,” Patrick said. “We’re linking memory and emotion to feeding, looking at the mechanisms in the neural circuits.”

Three years ago as a first-year PhD student, Patrick rotated through three labs in the Neuroscience and Physiology Department. When he saw the relatively new techniques being used in Dr. Yang’s lab, “I was sold,” he said. “The technical approach sold me.”

Using those techniques with a mouse model, Patrick and Dr. Yang found that food intake can be reduced by selective activation of certain neurons that project to the lateral septum.

They spent the next year identifying and characterizing the neural circuits that travel from the brain’s ventral hippocampus (a region implicated in emotion and memory) to the lateral septum (a brain region involved in motivation and emotion).

“We determined a neural circuit for how the ventral hippocampus controls feeding (through neurons) by projecting to the lateral septum, which is also involved in emotion and feeding,” Patrick said. “The lateral septum is a ‘relay station’ in the brain. It gets input from the ventral hippocampus and directs this information to the hypothalamus, the primary brain region responsible for regulating feeding behavior.”

Dr. Yang said their work will provide insights into the neural circuitry of eating disorders that may someday lead to more effective treatments for these disorders.

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Medical student starts fundraiser for colon cancer awareness

SUNY Upstate College of Medicine

Upstate medical student Michelle Bernshteyn at the Upstate Cancer Center. Michelle has organized a fundraiser for the Colon Cancer Challenge Foundation at the Melting Pot in Destiny USA. March is Colon Cancer Awareness Month.

Second-year medical student Michelle Bernshteyn has organized a fundraiser for colon cancer, but it’s not the money that’s important.

Michelle is more focused on increasing awareness of the disease and the importance of screening.

“Everything surrounding colon cancer screening and treatment is not glamorous, and that’s an issue,” said Michelle, whose efforts include a dinner at the Melting Pot in Destiny USA Feb. 11.

Colorectal cancer was expected to claim almost 50,000 lives in the United States in 2015, according to the American Cancer Society. Excluding skin cancers, colorectal cancer is the third most commonly diagnosed cancer in both men and women.

Those figures are more than just statistics to Michelle.

On her father’s side, an uncle in Germany died of colorectal cancer in 2008, sparking her interest in gastroenterology. He was never told about screening and never had a colonoscopy, she said.

On her mother’s side, an aunt died of colon cancer and an uncle has recently been diagnosed with the disease.

In high school on Long Island and as a student at Binghamton University, Michelle shadowed gastroenterology specialists. At Upstate, after she takes the required clerkships next year and earns her MD in 2018, she may pursue internal medicine as a specialty.

Colonoscopies are routine procedures, although the risks of significant bleeding or perforation, while low, shouldn’t be disregarded, Michelle said. Those risks, and the unpleasant preparation the day before the outpatient procedure, likely contribute to reluctance to undergo a colonoscopy, Michelle said.

The American Cancer Society estimates that only about half of those eligible for colorectal cancer screening get the tests that they should.

“This may be due to lack of public and health professional awareness of screening options, financial barriers, and inadequate health insurance coverage and/or benefits,” according to the society.

Michelle wanted to find some way to increase awareness and, she hopes, increase the number of people getting screened. (March is Colon Cancer Awareness Month.)

When Michelle learned of the Melting Pot’s policy of supporting a different charitable cause each month, she contacted the Destiny USA restaurant, which agreed to support her efforts in February.

A fundraising dinner at the Melting Pot is set for 6 p.m. Feb. 11, with $7 from each guest’s check going to the Colon Cancer Challenge Foundation.  Sign up for the dinner here. There also is a GoFundMe page for the foundation, which has supplied T-shirts and other fundraising materials.

Michelle also is selling $50 gift cards from the Melting Pot that must be used during February, with $5 from each card going to the Colon Cancer Challenge Foundation. All month, the Melting Pot will leave a line on the bottom of the check for anyone to donate.

But the message Michelle is sharing may have more of an impact than the money. She is encouraging her classmates to tell three family members or friends of screening age to get colonoscopies.

“As medical students, we will be more trusted by our loved ones,” she said.

American Cancer Society, United States data

Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women.

The lifetime risk of developing colorectal cancer is about 1 in 20 (5%). This risk is slightly lower in women than in men.

Colorectal cancer is the third leading cause of cancer-related deaths when men and women are considered separately, and the second leading cause when both sexes are combined.

(The American Cancer Society projected 93,090 new cases of colon cancer and 39,610 new cases of rectal cancer for 2015, with colorectal cancer expected to cause about 49,700 deaths.)

The death rate from colorectal cancer has been dropping in both men and women for more than 20 years, in part because polyps are being found by screening and removed before they can develop into cancers.

Screening allows more colorectal cancers to be found earlier when the disease is easier to cure. There are now more than 1 million survivors of colorectal cancer in the United States.

 

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