20-Minute Health Talk

Facial feminization surgery

Approximately 1.4 million people in the U.S. identify as transgender or gender diverse. One of the biggest challenges to transgender individuals is acceptance in society. Facial feminization surgery (FFS) is a gender-affirming procedure that not only helps trans women become their authentic selves, it saves lives. 

The goal of FFS – which employs multiple facial procedures of the brow, nose and chin – is to ease the transwoman’s psychosocial burden. It has been associated with improved mental health and quality of life.

James Bradley, MD, vice chair of plastic surgery at Northwell Health, and his colleagues were the first to show that virtual treatment planning before FFS provides superior results in terms of accuracy, safety and efficiency. They were the first to confirm that both facial recognition software, which uses artificial intelligence, and people correctly classify transwomen as “women” 98 percent of the time after surgery. 

Joining Dr. Bradley on the podcast are Northwell physician assistant Sabrina Sam and FFS patient Rubi, who underwent the procedure in 2020 amid the COVID-19 pandemic. She shares her story and why she says FFS saves lives.

 

The problem

Despite hormonal therapy, voice training, make-up and hair, transwomen are at risk for mis-gendering. Even with the growing number of non-discriminatory protections for this population, many continue to face bias in employment, healthcare and housing. This, along with the effects of gender dysphoria, can lead to high rates of depression, anxiety, self-harm and suicide.

 

Artificial intelligence and virtual planning

Building on the surgical techniques originally developed in the 1980s, Dr. Bradley has made the various operations involved in FFS safer and more efficient through years of research. His first study focused on improving the safety, accuracy and efficiency of FFS through the use of virtual surgical planning, which entails developing computer models and physical prototypes before the surgery to use as aids during the procedure. 

Two more studies examined whether facial recognition software and people could differentiate between cis- and trans-women after successful FFS based on images of faces. These were the first studies ever to evaluate the impact of FFS on how transwomen are gender-typed by both artificial and human intelligence.

Hear from more transgender women about FFS. 

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Catching up on cannabis

New York legalized recreational cannabis in 2021, but researching its medical applications remains difficult. Diana Martins-Welch, MD, got involved with the state's medical cannabis program in 2016 and has certified more than 2,000 patients as a medical cannabis provider through her role as a palliative care expert. 

On this episode, Dr. Martins-Welch discusses misinformation, the effect of cannabis on cancer patients and opioid use, and the need for federal legalization. She also compares New York state's relatively young medical cannabis program to those in other states like California and Colorado. 

The director of supportive oncology services at the Monter Cancer Center also chairs Northwell's Medicinal Cannabis Workgroup, which brings together physicians, nurse practitioners, pharmacists, researchers and other medical professionals to discuss medicinal cannabis expansion, increased access for patients and advocacy efforts. It has developed a comprehensive learning series and hopes to be recognized and used an approved course by New York state for health care practitioners registering as medical cannabis providers.

The medical cannabis workgroup is carrying out important research, which includes evaluation of the effects o medical cannabis on quality of life of cancer patients. Another looks at pelvic floor dysfunction in females and the use of medical cannabis suppositories. 

Read Dr. Matins-Welch's op-ed in Newsday on the need to widen access to medical cannabis. 

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COVID vaccine safety surveillance

The medical safety net ensuring vaccine safety is historic, says Henry Bernstein, DO, MHCM, FAAP, a voting member of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and a professor of pediatrics at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. 

00:55 - Dr. Bernstein explains his role on the ACIP

03:02 - He explains the four reporting programs they use to monitor and learn from data on possible reactions to vaccines. Three of those have been around for many years, with the CDC's V-safe after vaccination health checker a new addition during COVID-19. 

1. V-safe: a text messaging-based system that enables people who received the COVID-19 vaccine to report any post-vaccine side effects via a free app. Users receive weekly messages for up to six weeks; then three-, six-, and 12-month check ins after the final dose of vaccine. Users are also reminded to get the second vaccine dose and a check-in afterward about their experience.
2. VAERS (Vaccine Adverse Event Reporting System): a national database to which providers, vaccine manufacturers and the public can report side effects. The "early warning system" provides the CDC and FDA with information that helps identify health concerns and ensure vaccine safety.

3. Clinical Immunization Safety Assessment Project (CISA): a national network of vaccine safety experts from the CDC’s Immunization Safety Office (ISO) and medical research centers. There are seven centers around the county that serve as consultants around these less common events and also do research relating to vaccine safety, as well as work with health care providers when vaccine safety questions arise, or adverse events following immunization occur domestically.

4. Vaccine Safety Datalink (VSD): yet another monitoring system created by the CDC that gathers electronic health record data from nine participating integrated health care organizations on more than 12 million people each year.

07:34 - Dr. Bernstein shares insights from recent ACIP meetings reviewing reports of myocarditis and pericarditis following vaccination with either the Pfizer or Moderna mRNA vaccines. 

10:57 - ACIP's latest meeting in July focused on reports of Guillain-barre syndrome (GBS) after inoculation using the J&J vaccine. Of the roughly 100 reported cases of GBS in the US among recently vaccinated individuals (with the J&J vaccine), not all cases have been confirmed as GBS. 

13:41 - In both cases - myocarditis, pericarditis and GBS, patients recover well. Emergency use authorization fact sheets, available to the public, now contain information about these findings to help inform individuals getting the vaccines. 

16:33 - The 3 guiding principles of the CDC Advisory Committee on Immunization Practices (ACIP).

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In addition to a professor of pediatrics, Dr. Bernstein is an Ex-Officio member of the American Academy of Pediatrics’ (AAP) Committee on Infectious Disease (COID Red Book Committee) and Associate Editor of Red Book Online. He is board certified by the American Board of Pediatrics. 

How to handle youth sports during COVID-19

Pediatric orthopedic surgeons Allison Spitzer, MD, and Elaine Tran, MD, explain how kids can avoid injury, and COVID-19, as they return to their favorite sports. (Recorded June 8, 2021)

More from the experts:

• 6 tips to avoid pickleball injuries
• Northwell STARS Rehabilitation gets pickleball player back on the court. Read more.
• 4 reasons for rising ACL tears and other knee injuries

Preventing sports injuries

New York Islanders legend Bobby Nystrom teams up with Certified Athletic Trainer Roger Gerland, MSPT/ATC, to talk sport injury prevention. As a director at Northwell Health's STARS Rehabilitation, Roger treats athletes at all levels and offers tips on how to stay in the game, as well as what to look for in a doctor if you do get hurt. After his playing career, Bobby refocused his energy on bicycling, marathons and spartan races. He shares how he has adapted his training to fit his new passions.  

Watch episodes of the podcast on YouTube.

More from the experts

• 6 tips to avoid pickleball injuries
• Northwell STARS Rehabilitation gets pickleball player back on the court. Read more.
• 4 reasons for rising ACL tears and other knee injuries

Global health experts reflect on first mission trip since COVID-19

Shari Jardine spent the last week in Ecuador vaccinating locals as part of Northwell's Center for Global Health (CGH) and joins the podcast from one of its vaccination pods. In March 2020, COVID-19 grounded Northwell's growing Global Health program, which had developed core sites in Guyana, India, and Ecuador. Eric Cioe-Pena, MD, CGH director, explains how the team maintained their global relationships virtually, and eventually resumed travel, starting with this three-week mission. 

More from the experts

Dr. Cioe-Pena explains how to develop an effective global public health program.

How pipeline programs boost diversity in medicine

Designed to expose minority students to careers in medicine, the Medical Scholars Pipeline Program is now in its 12th year. Britney Nathan, MD, was among the first students to participate, and this week begins her residency as an OB/GYN at Long Island Jewish Medical Center and North Shore University Hospital. She joins Gina Granger, assistant director of pipeline programs at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, to discuss the value the program brings to students and the communities they go on to serve. 

Fred Guttenberg and Dr. Chethan Sathya

After his 14-year-old daughter, Jaime, was killed in a school shooting in 2018, Fred Guttenberg devoted his life to gun violence prevention and firearm safety. Now, he is helping Northwell's Center for Gun Violence Prevention (CGVP) in its mission to mobilize the health care industry around this public health issue. He joins Chethan Sathya, MD, director of the CGVP and a pediatric trauma surgeon, to discuss how they plan to do that. 

More from the experts

Dr. Sathya details why health care must drive gun violence prevention, and how to do it.

Watch episodes of 20-Minute Health Talk on Youtube.

The future of the flu and other common illnesses in the age of COVID-19

As states like New York and California lift mandates on COVID-19 safety precautions and fully reopen, we will likely see other viruses like influenza and the common cold resurge. David Hirschwerk, MD, interim chair of the department of medicine at Northwell Health and an infectious disease attending, explains what to expect going into the summer and fall months.

Post-COVID recovery programs offer hope

The lingering effects of COVID-19 can be alarming for patients, some of whom are still dealing with shortness of breath, brain fog or other symptoms for weeks, months, or longer after recovering from the virus. Ankita Sagar, MD, is the director of Northwell's COVID Ambulatory Resource Support (CARES) program, which offers its patients, currently more than 4,000, everything they may need to safely and comfortably recover. She joins David Battinelli, MD, chief medical officer, to discuss Northwell's unique approach and the latest research being done on post-acute sequelae of COVID-19.