Photographs by Chris Ware
“In the past 10 to 15 years, more medical attention has turned to wound care,” Goldman notes. “Wounds have become a sort of silent epidemic, and I became very interested in that. A lot of patients with wounds that won’t heal are elderly or diabetic, or both. It leads to a lot of pain and suffering.”
Basic understanding of wound healing hasn’t changed in the past 5,000 years, he says. “The idea of cleansing and treating a wound, and applying a bandage — these principles have been used throughout the ages. But the science of wound healing has really gone through a revolution. We now study the biochemistry and physiology of what’s going on when a wound won’t heal. And we have advanced modalities to stimulate cells, to ‘kick-start’ the wounds into healing; some involve cells that are applied like a skin graft but are more effective in stimulating the cells.”
Another method to treat some nonhealing wounds: the hyperbaric oxygen chamber. Some people, Goldman says, think of the technique as a fad, largely due to publicity when the late pop star Michael Jackson would sometimes use a hyperbaric chamber for its health benefits.
“A lot of people think it’s smoke and mirrors and witch oil,” says Goldman of the procedure. “That’s because it’s not understood.” Hyperbaric oxygen therapy actually dates back to at least the 1600s, he says, and pressurized operating rooms were used in the 1800s. Studies of the effects of rapid decompression on coal miners led to using hyperbaric oxygen therapy for their treatment. And, Goldman adds, during the days of building the first rail tunnels under the Hudson River around the turn of the 19th century, the effect of decompression sickness on workers became an issue. “That’s when people really began to understand the effects of oxygen, of air pressure, on physiology. Later on, the Navy and Air Force, too, got tremendously interested in the effects of pressure on pilots and divers.”
Nowadays, he says, there are 40 to 50 conditions for which hyperbaric oxygen treatments can be effective — including treating brain injuries, gangrene, bone infections, radiation exposure, and profound anemia.
Patients generally sit or lie in a large chamber during treatment (which lasts about 90 minutes on average), during which time pressurized oxygen is pumped into the room. The patient breathes 100 percent pure oxygen, which delivers concentrated amounts into the bloodstream — or, in the case of a nonhealing wound, into the wound bed — which speeds up the healing process. Vassar Brothers
Medical Center now offers three state-of-the-art chambers. “They’re very comfortable. Patients can even watch TV during treatment,” Goldman says.
“Hyperbaric oxygen can also be used to treat problems like carbon-monoxide poisoning; we had a case of that recently. And it doesn’t happen often, but we’re also prepared to treat divers, such as police searching in the Hudson River, should they ever need help,” says Goldman, who recently became certified in Undersea and Hyperbaric Medicine by the American Board of Preventive Medicine, making him one of only 490 doctors nationwide to receive that title.
Goldman, who has four grown children, lives in Poughkeepsie. He enjoys golf — and yes, he still plays piano sometimes. But only for pleasure, he says.
» For more information on hyperbaric oxygen treatment, read “The Oxygen Connection” from our archives.
» Next: Meet OB/GYN Tanya Mays, M.D.
Tanya Mays, M.D.
Obstetrics and gynecology
Even though there were several nurses in her family, as a youngster, Dr. Tanya Mays originally thought she wanted to be a lawyer when she grew up. A favorite high school teacher, however, encouraged her to pursue another field. “Science came easily to me, and I liked it, so she urged me to go in that direction,” says Mays, who was born and raised in Brooklyn.
“The teacher would say, ‘Tanya, you’re a natural, why are you fighting this?’ ” Mays laughs. “Because she knew I wanted to go into law. She told me we need more women in science, more in medicine.”
At her mentor’s urging, Mays began to volunteer at a hospital across the street from her high school. “I loved it, even though some of the doctors actually tried to steer me away from a future in medicine. They would say, ‘The hours are so long, you get so overworked,’ which instead made me even more curious about it!”
She decided, indeed, to go into medicine and graduated from the Albert Einstein College of Medicine in the Bronx, followed by residency at the University of Medicine and Dentistry of New Jersey in Newark. “With six kids in our family — and I was number four going to college — I took out a lot of student loans and needed to pay them back. So when I finished training, the recruiter suggested I look for a position in an underserved area, which would assist in paying back my loans.”
She wanted to remain relatively near her home, and with her fiancé then working in Manhattan, she opted to take a medical position in the city of Hudson. “I didn’t even know it was in New York State at first,” Mays laughs. She and her future husband were both surprised how rural the region was when they checked it out in 2000. “We said, ‘Wow, this is really out in the country.’ We felt a bit out of place and thought, we’ll only stay a few years.
“Now we love it; we’ll never go back to the city,” she says.
Mays is a board-certified specialist in obstetrics and gynecology. She sees patients at the Women’s Health Center affiliated with Columbia Memorial Hospital in Hudson. “I think I chose the OB/GYN field partly because I always preferred having female doctors myself. My mother is also a very compassionate person, so I got some of that urge to help women from her.” Her practice also includes performing laparoscopic surgery, as well as treating fibroids, ovarian cysts, abnormal and perimenopausal bleeding, and hormonal issues.
Another key part of treating patients is listening to their emotional needs. “They might sometimes not be very sick, per se, but they’re depressed,” she explains. “We’re seeing it more, especially in the past few years; it might be due partly to the economy. A person can tolerate minor aches and pains or a minor medical problem if everything else is good in their life. But constant stress can magnify those ills. Women are pretty much the leaders of their families; they bear most of the burden of raising the kids and doing the housework and juggling schedules. You have to sift through all that when you talk with patients, to help them get their bearings and get back on track. It’s almost like being a psychologist sometimes.”
She loves her close interaction with patients: “I feel like I’m talking with my girlfriends; it may be over a Pap smear instead of a cup of tea, but we chat and get to know each other.” She also enjoys taking part in outreach programs, such as giving talks and hosting programs for medical professionals and the public alike. A topic that’s especially close to her heart: “I try to get the word out to women about the importance of cardiac health.”
When she’s not busy in her office — or with her three children, all under the age of eight — Mays might be found just about anywhere in the world. “I love to travel,” she explains, her favorite destinations being Africa, the Caribbean, and Europe.
She notes an essential part of her philosophy of medicine, which goes back to her medical school days. “I remember one teacher — a doctor — told me that the key to being a good doctor is treating your patients like they’re family; to think, ‘This could be my aunt, my sister, my mother.’ He said that when you look at a patient that way, you’ll always do the best job. You’ll go the extra mile. I’ve always remembered that.”
» Next: Meet Urologist Jose Sotolongo, M.D.
Jose Sotolongo, M.D.
“Like father, like son,” might seem a natural career path if you grow up with a dad who’s a doctor.
“But it was never assumed that I’d automatically become one, too,” recalls Dr. Jose Sotolongo, whose father was an internist in Cuba, where Sotolongo was born. “Sometimes I would go with him to the hospital where he worked, and I became very comfortable with the ambience, the atmosphere.”
But, adds Sotolongo — whose family moved to the U.S. when he was a child — as a youngster “I toyed with the idea of going into the arts; later I decided, after all, that I did want to study medicine.”
He graduated from medical school in Guadalajara, Mexico and did his residency and fellowship at Mount Sinai Medical Center in New York. During clinical rotation, where med students get a glimpse of various medical specialties, Sotolongo decided to focus on urology, which deals with the male and female urinary tract, as well as the male reproductive system.
“When I was a med student,” says Sotolongo, “the people who seemed happiest with their work were the urologists. And they told me their field doesn’t involve a lot of hectic emergencies, so you could have a reasonable lifestyle. Also, you see a variety of patients: men and women, adults and children. I thought, ‘This makes a lot of sense.’ ” Sotolongo practices general urology at Hudson Valley Urology P.C. in Kingston. He deals with prostate problems, as well as incontinence and other bladder malfunctions, kidney stones, and related conditions.
Some patients have bladder injuries due to accidents; in other cases, urinary problems are related to neurological conditions ranging from Parkinson’s disease to multiple sclerosis and diabetes. “You might not think of diabetics as neurological patients. But in fact, they sometimes have neuropathy (the nerves aren’t working properly), which can affect the bladder,” Sotolongo says. Treatment of urinary problems can vary. “Sometimes medication, and retraining of the bladder using certain exercises, is required. And in certain cases, surgery is sometimes indicated, especially in women.”
Sotolongo urges anyone who experiences that “gotta go” feeling to a noticeable extent to have it checked out medically. “If your bladder is impacting the way you lead your life, go for a consultation. It’s not about just a little bit of leakage. If your bladder doesn’t work properly, it could lead to something very serious, such as renal failure — a breakdown of kidney function.”
Some patients are skeptical or embarrassed about getting help for urinary problems, especially incontinence, notes Sotolongo, who is affiliated with Benedictine Hospital. “Some have had symptoms for months or even years. They basically adapt and just live with the inconvenience. Their lives revolve around a constant ‘Where’s the next bathroom?’ But after proper treatment, they come back and say, ‘I got my life back. I’m like a new person.’ That’s very gratifying to hear.”
Out of the office, Sotolongo, who lives in Ulster County, hasn’t given up his childhood love of the arts. He’s a photography fan and takes photo courses in Woodstock. “I also think it’s important to keep in shape, so I exercise regularly, usually three times a week,” he says.
» Next: Meet infectious diseases doctor Cyndi Miller, M.D.
Cyndi Miller, M.D.
A family legacy in science and teaching helped inspire Dr. Cyndi Miller to pursue her medical career.
“My father wanted to be a physician when he was a young man,” she explains. “He was what they then called a medic in World War II — not what they’re thought of today; he wasn’t in the battlefield, but at a hospital in Philadelphia, assisting surgeons in the operating room when wounded soldiers came in.”
Later, he became a microbiologist, “and actually, he made an amazing contribution to the world,” she says proudly. “He developed a medication called ivermectin that prevents river blindness, a disease that used to blind millions of people, especially in Africa. The drug company Merck has been giving it away free for decades now. So there’s a science background in our family.” And her mom was a teacher, as were several other relatives.
This background inspired Miller to combine her medical training with a love of teaching. She does both at Albany Medical Center, where she’s now based, heading up the hospital’s HIV clinic.
She grew up in New Jersey, went to Duke University, and got her medical degree at Bowman Gray School of Medicine, now part of Wake Forest University in North Carolina. She then did her internal medicine residency at a Yale Hospital affiliate in Greenwich, Connecticut.
Miller came to her career in the HIV field by chance, she explains. “In the mid-1980s, right after I finished my residency, my husband, who’s also a doctor, was getting ready to go to medical school in Minnesota the next year.”
With 12 months free before the move west, she kept an eye out for a temporary medical position. “One day, I read a magazine article about how Montefiore Hospital in the Bronx was treating a growing number of AIDS patients. That was back when the epidemic was just starting to get public awareness. I wrote a letter to them, basically saying, ‘Do you need help? I’m available.’ They said, ‘Yes, we do need help!’ So I went, and began working in the AIDS field. I knew right away it was a good fit for me.”
Treatment was in its infancy in those days, she recalls. “Some people were still afraid to touch AIDS patients, not being sure how it was transmitted. But Montefiore was in the vanguard of those who clearly established that AIDS couldn’t be transferred by casually touching someone.
“At that time, all we could do for treatment was basically order an HIV test to measure T-cells” (the white blood cells linked to the body’s level of immunity). “The first year I started, the drug ADT was approved. But it wasn’t an easy time; patients would get better for a while, then often their bodies would basically just fail.” Miller says that in those early days, the hospital would be treating 30 to 35 AIDS patients at a time. “And that number kept growing — fast.”
She adds: “There are people whose names, and medical stats, and what they died from, are still in my mind on a regular basis. It was tough work, but I had the feeling of being at home with what I was doing. I was helping others; that made it easier.”
Miller and her husband moved to Minnesota while he studied at the Mayo Clinic; meanwhile, she did a fellowship in infectious diseases at the University of Minnesota. They returned east in 1991, and she’s been with Albany Medical Center ever since.
“We serve about 1,500 patients now at the Albany clinic; people often don’t realize how high the number is.” They see patients of all ethnic groups, and all ages. “We’ve even had patients in their 80s.”
The treatment for HIV has evolved dramatically, she says. “Strong medication came out in the late 1990s, and most of our patients now live a normal lifespan. The majority, even when they are ill, can now be helped. But you don’t want to wait that long for a diagnosis of HIV. People can go up to 12 years being infected, without being identified as HIV-positive, in normal circumstances. We try to treat people before then. And just because we now have medications, doesn’t mean people shouldn’t be careful and not practice safe sex.”
Her central medical message is twofold, Miller says: “First, you’ve absolutely got to know your own and your partner’s sexual history to be safe if you’re not going to use condoms. Second, we’re recommending that physicians test every sexually active adult once in their lives for HIV. The test is cheap and easy, and can be done along with a regular blood test. Of course, anyone at high risk should be tested as often as necessary.”
Miller says her team generally sees their HIV patients every three or four months. “I have people I’ve been following now for 15 to 19 years. We’re like old pals.” Yet the inevitable deaths are still tough to handle, she admits. “We see about 30 to 40 deaths a year. Every one is a tragedy. Even if they die from something else, a stroke or heart attack — they were all HIV patients, and all someone you’ve known and cared about.”
To help ease the stress of her career, Miller says she loves to relax with gardening. She and her husband have two children; a daughter, 15, and a son who’s 20. “Neither of them are interested in going into a medical career,” she laughs. “They say their father and I both work too hard.”
Even though her field can be emotionally grueling, Miller says it’s extremely satisfying. “The most exciting thing is the first time a patient realizes how much better they feel after they’re on medication. They come in and say their energy is back, their skin rash is gone, their hair is growing, and they feel like a person again. Then we get to tell them their tests show they’re doing well and their T-cells are up 200 points. They’re so happy. We can tell them they’re now dealing with treating a chronic condition, and that they’re going to survive — they’re going to make it.”
» Next: Meet Thoracic Surgeon Lyall Gorenstein, M.D.
Lyall Gorenstein, M.D.
“It was somewhere in high school that the idea first crossed my mind to go into medicine,” recalls Dr. Lyall Gorenstein, who grew up in Toronto. He went on to graduate from the University of Toronto Medical School, where he also did his surgical residency. Gorenstein, — who specializes in thoracic surgery and operates on the organs of the thorax (chest), including the lungs, esophagus, heart, and other related areas — also did fellowships in thoracic and cardiovascular surgery in Toronto and at the MD Anderson Cancer Center in Texas.
He and his family have lived in the Hudson Valley since 1992, when he joined the Rockland Thoracic and Vascular Associates practice, based in Pomona and Goshen. Gorenstein is affiliated with Nyack Hospital and New York-Presbyterian/Columbia hospital in New York City.
“We deal with both benign and malignant diseases, including a lot of cases of lung cancer,” explains Gorenstein, who says treatment for lung cancer has improved vastly over the years. “We’re doing a lot of minimally invasive surgery now, which wasn’t the case even 10 years ago. About 70 percent of patients who undergo lung surgery now have minimally invasive procedures — which means we’re not cracking ribs, not doing big incisions, so there’s faster recovery, too.
“It’s encouraging that survival rates for lung cancer have improved dramatically compared to 20 years ago,” Gorenstein notes. “That’s most likely due to several factors, including earlier detection, better surgical therapy, and improved radiation and chemotherapy.
“Our field is constantly changing,” he adds. “Along with more minimally invasive procedures, we also use a multi-modality approach to treating lung cancer. We interact with oncologists, radiation therapists, internists, pulmonologists — we definitely stress a team approach.” He believes, too, that it’s crucial to not only treat the disease, but to address the emotional needs of each patient and his or her family.
Research breakthroughs frequently redefine medical knowledge, he says. “One interesting thing is that, in the past, a lung cancer patient’s prognosis was traditionally based on the stage of the cancer — on the tumor size or whether it had spread to nearby nodes. But now we’re learning that the tumor’s gene profile — its genetic characteristics — also impact the prognosis. That means that possibly, more important than the stage of the cancer, is its biology. We can now determine the likeliness, for example, of a patient responding well to a certain type of chemotherapy.”
New treatment drugs are consistently being developed, too, he says. “Some of the newest ones work on what’s known as the specific molecular ‘pathways’ of tumor cells. Traditional chemotherapy is like a shotgun: it kills a lot of cells. But now there are more targeted therapies that can stop proliferation of cells, but don’t have as many side effects.”
Gorenstein and his family — which includes four kids — live in Piermont; they all enjoy the great outdoors when he’s not in the office or surgical suite. “My kids grew up as avid alpine skiers, so we would spend lots of time at Whiteface Mountain or Lake Placid,” he says. The kids are also competitive swimmers, so race meets are often on the weekend agenda. And when the weather’s right, the family loves to hit the golf course, too.
A career that involves dealing with a large number of cancer cases can obviously be challenging, Gorenstein says. But it’s rewarding, especially when lives are saved. “The field is constantly evolving. And we’re definitely able to have a large impact on improving the quality of people’s lives. That’s very satisfying.”
» Next: Meet Cardiologist Sherma Winchester-Penny, M.D.
Sherma Winchester-Penny, M.D.
By the time she was five years old, Dr. Sherma Winchester-Penny was already drawn to helping others. “My great-grandmother was ill and I would take care of her, and I realized that I kind of enjoyed it,” Winchester-Penny recalls. But as a little girl growing up in Trinidad, her career options were limited. “At that time, you didn’t think of going into medicine; you thought of nursing. So I wanted to be a nurse.”
She moved to the U.S. with her family at age 11 and grew up in the Bronx. Combining vocational high school and nursing studies, Winchester-Penny got LPN certification, then went to Lehman College in the Bronx for her nursing degree.
“After that, I worked for about four years as a nurse and a nursing supervisor. But there was something still there, a yearning inside me. I said to myself, ‘You know what, this is not Trinidad. You can become a doctor!’ ” With constant support and encouragement from her uncle (an M.D.) and church pastor, she was inspired to continue her education to reach her goal.
Settled on her career path, she received her medical degree at Temple University School of Medicine in Philadelphia, then trained at Bronx Municipal Hospital/Albert Einstein College of Medicine, where she was chief medical resident. This was followed by a fellowship at Albert Einstein-Montefiore, serving as chief cardiology fellow.
Winchester-Penny specializes in noninvasive, consultative cardiology; nuclear cardiology (which consists of introducing very small amounts of radioactive materials, called tracers, into the body to allow cameras to take clear pictures of the heart); and has a special interest in treating women with heart disease. She deals with “the entire cardiology spectrum,” from diagnosing heart problems, all the way through treatment. “In some cases, we refer patients when interventional procedures are needed,” she says.
Winchester-Penny believes that her nursing roots make her a better doctor. “It’s not that doctors aren’t empathetic,” she laughs. “But nursing has that special connection with people, and you never lose that. You use therapeutic touch, you hug patients. Some doctors are intimidated by that sort of thing, but nurses understand the close contact, they understand really getting to know a patient.”
Her early days of working in the Bronx also helped her connect with patients. “A lot of the local people there weren’t getting much health care; many lived in deprived circumstances. I wanted to make a difference; those were the kinds of patients I wanted to focus on helping — and I wanted to teach my patients about good health.”
Winchester-Penny and her family live in Orange County, where she heads the nuclear cardiology department at Crystal Run Healthcare LLP, based in Middletown.
What does she want the public to know about cardiovascular care? “Mostly, that there are things you can do to decrease cardiovascular disease risk. And that if you do have heart disease, it is nearly always treatable.” One key, Dr. Winchester-Penny says, is to tune in to your body. “If you sense that something is wrong, pursue it. Even a stress-test result or EKG that turns out normal doesn’t always mean there’s no problem. Tell your doctor if you don’t feel right — and be persistent in following up.”
Winchester-Penny recalls one patient who turned up at her office, reporting mild chest discomfort. “We did tests, and nothing turned up. But I told her that, after she left my office, if she felt worse — if something seemed wrong — to go straight to the emergency room.”
Sure enough, the next weekend, the woman’s chest pains worsened. She went to the ER, and tests still came back negative. “They wanted to send her home. But she remembered what I’d told her: that if she had a gut feeling something wasn’t right, she should insist on getting more tests,” recalls Winchester-Penny. The woman did insist and within 24 hours she was transported to Westchester Medical Center for open-heart surgery. “She’s fine now, and she still thanks me for encouraging her to advocate for her own care,” says Winchester-Penny.
“This wasn’t to say the physicians did something wrong in her diagnosis,” Winchester-Penny stresses. “But some patients, especially women, don’t always have the traditional ‘there’s an elephant sitting on my chest’ kind of pain with heart disease. Women, in particular, need to be aware of mild symptoms like ‘I feel fatigued every time I walk the dog’ or ‘I have shortness of breath when I climb stairs.’ Women get their mammograms every year, but some don’t think as much about heart problems — when, in fact, the number one killer of women isn’t cancer, it’s cardiovascular disease.”
Fortunately, more folks — men and women alike — do seem to be getting the message about heart disease, she notes. “One of my patients recently came in, saying he had indigestion. People were telling him to just take Tums, but he’d heard somewhere that indigestion can be a sign of heart disease. Luckily he had it checked out, because he does have a heart blockage and may be getting cardiac catheterization.”
She’s a strong believer in focusing on each patient as a person. “Medicine can’t be rushed,” she says. “Seeing someone for five minutes is not good medicine. It’s not about just examining them and telling them something and then they leave. You can offer the best MRIs, the most sophisticated CAT scans, but you also have to listen to what a patient says. The best diagnostic tool any physician has is the patient’s medical history. You need to spend time talking with a person to find out what’s really going on with them.”
She sums up: “I love my patients. And I want them to have input, to be part of their health plan. It’s not like I’m up here on a pedestal and they’re down there. We’re all at the same level. And on my part, being able to listen, have patience, sympathy, and to make my patients feel comfortable — it all makes a difference in their medical care.”
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