Heather Ly (Host): Hi there, everyone. Thanks so much for joining us for this latest episode of Medically Speaking. Joining me today is Katrina Karas, who is the Vice President of the Cardiovascular and Neurosciences Service Line at Kaleida Health. It is a mouthful, and it entails so much. It's a very wide umbrella. Talk to me about what all of the different diagnoses and procedures sort of fall under that.

Katrina Karas: Wow, that's a great question. So, there is a lot.

Host: We need a whole episode just for that.

Katrina Karas: So, cardiovascular care really focuses on the heart, and it also focuses on the vasculature of the body. But I think, most importantly, let's just focus on the heart. So, a lot of the procedures that we do within cardiovascular are focused on the plumbing and the electricity of the heart.

Host: That's a good way to put it.

Katrina Karas: Yes, exactly. So, the plumbing is really what we think of with the coronary interventions. Those are things that happen in the cath lab. The electrician portion or the electricity portion is really what we think of with our electrophysiologists and the procedures that they perform using very similar equipment to what's used in the cath lab, but they're focused more on AFib, atrial fibrillation, meaning the heart is not beating in a regular way. So, those are kind of the two big arms of cardiovascular.

And then, obviously, we also have the surgeons. So, the cardiac surgeons are the ones who then intervene when they have something that maybe can't be fixed in the cath lab or maybe would be better fixed in the operating room. So, there are procedures that you don't actually have to, that aren't super invasive that can fix these—

Host: Problems? Some of the problems?

Katrina Karas: Yeah, yeah. So definitely, over time cardiovascular has become less invasive. But there are certain places for certain procedures, and so we need to make sure that the procedures that need to be performed with an open chest can be performed in the operating room, and then those that can be done by feeding catheters through the groin or through the wrist, those can be done in the cath lab.

Host: I actually had a relative that had stents and a valve placed, and I remember, you know, hearing about the procedure and thinking it was going to be this big, elaborate—not to diminish because, you know, it's scary for the patient. And it's a serious procedure, but just a little teeny, tiny Band-Aid on the wrist. And I'm like, "You did everything that you needed to do, you know, through the wrist? And I was amazed at what doctors can do. And I feel like we've come such a long way.

Katrina Karas: Yeah, I think so too. So, you know, medical technology is something that is ever-evolving, and it's evolving quickly. And so, what we've seen is where they used to need to always open the chest to put a new heart valve in, a new heart valve like an aortic valve or a tricuspid valve or a mitral valve, those are the little flaps that open and close to let the blood flow through the heart. Now, they can do a lot of those things what they call transcatheterly, where they're sending that wire, like your relative had through the wrist or through the groin. And they can deliver the valve. Instead of having to open the chest, they can deliver that right through a catheter that would go through the wrist and then into the heart. They use guidance fluoroscopy, and they use guidance under imaging to be able to do that.

Host: So, that's kind of like their little real-time road map of where they're going.

Katrina Karas: Exactly.

Host: What does that mean for a couple of things? Obviously, for the patient, for the recovery, I would imagine, when you're not cutting, you know, from here to here down the sternum with less chance for infections, less chance for complications. But then, also, I think from a hospital standpoint, maybe we're able to do more procedures or get people in and out quicker.

Katrina Karas: Yeah. I mean, there's a number of reasons that kind of the progression is important for the care. So, one thing is we have a lot of patients who are living longer. I think of my mother who is a very healthy 76-year-old, who is—but she's slight, she's thin. And so, I think of these more thin or sometimes they use the word frail, elderly adults who really the best approach for them is not to be that invasive. And so, these technologies have opened up this world of therapy to an older population. So, I think that certainly younger populations can access these therapies as well. However, for those populations who really can't tolerate that type of an invasive procedure, the best bet might be for this less invasive procedure, and they can still then get their valve fixed and still benefit from having that intervention.

Host: And then, live an even longer life.

Katrina Karas: Yes.

Host: When you're talking about, you know, cardiology and, like, who needs a cardiologist, I have a primary care physician, I have an OB-GYN. But who needs a cardiologist and I guess how does that pathway of care begin and bring folks to Kaleida Health?

Katrina Karas: Yeah. So, the best way to get to a cardiologist is through a referral from your primary care doctor. We encourage every single person to have a primary care physician. I can remember as I was in my childbearing years from, like, 30 until 40, I don't think I saw a primary care physician. And that was really poor, right? Like, I wasn't taking good care of my health. And so, we really encourage everyone to start with their primary care physician. They are the person that knows the patient best, and they can best take care of all their needs. However, once the patient then develops hypertension or maybe they have a history of heart disease or maybe they have a family member who had bypass surgery or maybe they have some irregular heartbeats that they're feeling or maybe they're exercising and they feel some shortness of breath. Those are all things where then when you're with your primary care physician, you tell them, "These are the symptoms I'm experiencing," and then they would obviously refer you on to a cardiologist.

Host: Yeah. And I feel like the cardiovascular service line at Kaleida Health, it's one of our growing service lines. How many people, patients do we see come through Buffalo General Medical Center and Gates Vascular Institute every year?

Katrina Karas: Yeah. I mean, over 100,000 certainly within our cardiology service line. And so, some of those are only being seen in the outpatient environment. Maybe they don't ever have to come to the hospital, but maybe they get a test through, you know, they might get a diagnostic test like an echo or an EKG in one of our offices. But then, oftentimes people do need to come into the hospital, and those procedures happen in the hospital typically. And so, they'll come in and get their procedure and then go home again. So, it's a lot of people.

Host: Yeah. And we have certainly a lot of professionals and those different groups. You know, you mentioned the surgeons and, you know, everybody has sort of their specialty, their niche. Talk about the team effort though, and sort of that wider net that we're able to cast, whether it's, you know, with UB or when it comes to research. We have a lot of that right at our fingertips. Yeah. And some of that is the fact that GVI and Buffalo General are on the medical campus. I remember when GVI was built and how big of a deal that was, and just sort of the proximity to all of the other resources. How does that play into what we're able to do?

Katrina Karas: Yeah, I mean, we're sitting today in a building that I'm looking outside and I see UB, and I walked over from the GVI. And so, I mean, it's all right here. And so, it's really an amazing place to be. I think that the relationship to UB is very close because many, many of our cardiologists are actually professors or adjunct faculty at UB. They are part of the department at UB. And so, I think that connection is really important from a research and clinical trial standpoint. Dr. Iyer and I were just meeting this morning, and he shared that we have over 80 clinical trials that we're doing within cardiovascular services.

Host: That's just cardiovascular.

Katrina Karas: That's just cardiovascular.

Host: And right here in Buffalo. I think sometimes people would be amazed at what happens, you know. Because we're a mid-size city. But the talent, the brain power, the knowledge, the expertise is that of, you know, larger institutions and bigger cities across the country and really around the world too. We're lucky to have it here.

Katrina Karas: Yes, absolutely. And, you know, when we first started, we jumped right into cardiovascular. Neurosciences is my other scope of responsibility, and they too have just an incredible amount of clinical trials and research that's happening. You know, when you think about the GVI, which is located on the fourth floor here at the Buffalo General campus in its own separate building called the Gates Vascular Institute, above that is the Jacobs Institute. And that is part of UB, and that might be a little bit of a separate arm from UB, but very very closely associated with UB.

And I mean, the amount of research and building new 3D tools and things that they would use in the body, I mean, these are just things that are happening in Buffalo that put us on the map globally. So, it's really a fun place to be.

Host: I remember years ago, gosh, this had to be seven, eight, maybe even nine years ago, when I had worked in news and I interviewed Dr. Siddiqui, and the story was they were 3D printing vessels and like parts of a brain so that they could go in before they did an actual procedure to sort of test it out, almost like a test run, a dry run before they operated on a person. Obviously, you couldn't use it in emergent cases, but those are the types of things. And that was years and years ago. So, I can only imagine the types of things that we're able to do now. But that level of preparation and planning and sort of forethought puts us far and above other institutions.

Katrina Karas: Yeah. Yeah. And I think, we talk so much about the technology and the innovation. And those are so critical. But at the same time, you have people, these physicians, who care about this community. I mean, Dr. Iyer, Dr. Siddiqui, Dr. Levy, Dr. Phadke, Dr. Dalal, all these people, Dr. Kim, Dr. Bhatia, I mean, these are all people that have been in this community for a long time, and they care about this community. It is home to them. I think that might differentiate Buffalo and the GVI and Kaleida a little bit from other kind of metropolis areas, right? Where we have other medical centers, other academic medical centers, and I just don't get the sense that the people who are working in those care as much as we have in Buffalo.

Host: Maybe they're a little more transient.

Katrina Karas: Yeah.

Host: Yeah. And I would say that there's something probably really special about, you know, changing lives, saving lives of your friends, your neighbors, and like you said, the place where you live. I don't want to say you're more invested because obviously when you're a surgeon or a doctor, you're going to care about your patients, but there's that extra little something about being able to do it for a lot of these folks has become their hometown. They're not from here, but they've made it home.

Katrina Karas: Yep. There is a lot of pride here. And the pride shows up in the way that they care for patients.

Host: And let's face it, they are so talented, all of these names and many more that we have here at Kaleida Health. That they could go to other places.

Katrina Karas: Yes, of course.

Host: But they choose to stay here. But top-tier talent right in our own backyard. What does that mean for patients not only in Western New York, but we also see patients come in from other places to come to GVI because they're getting care that maybe they're not finding close to their home?

Katrina Karas: Yes. Yeah. So, certainly Kaleida has a very broad geography that we serve. So Olean, Springville, Jamestown, Dunkirk, Fredonia. I mean, we do Lockport. We serve a very broad range of geography here at Kaleida, but even beyond that range. So, we have people coming from other countries in order to get their services. Sometimes we have people from Canada who want to come and get their services here. So, we definitely have a broad reach. A lot of that has to do with the reputation of our proceduralist surgeons, doctors. And I think we're just so grateful that we can be able to mobilize services for people within our geographic region and beyond.

Host: And I think part of that geographical region, you talk about our network of hospitals. I think of, you know, Olean, but also the new hospital that will be coming in a few years in Chautauqua County. What does that mean to have that connection and sort of that funnel, if need be, to Buffalo General and GVI? You know, maybe somebody starts their care at Olean, but maybe needs a little something extra to be under that Kaleida umbrella, I would imagine, makes facilitating that a little bit easier.

Katrina Karas: Yeah. I'm thinking of Dr. Mallavarapu, who is our interventional cardiologist in Olean, and he is an amazing resource for that community. And we have also Dr. Michaeles who works there in the cath lab. I don't want to leave anyone out. But certainly, if a patient is having a STEMI or what we call an ST elevation, that is an infarction, a heart attack. If the patient is having that, they can go right to our Olean Hospital and get the intervention. Dr. Mallavarapu, Dr. Michaeles, they would do that. They would open up those arteries with stents. If they're not able to do that for some reason, the anatomy is a certain way or whatever might be the case, they can pick up the phone and call one of our interventionalists right here at the GVI, and that patient gets transferred here.

So, there is that connection, both to make sure that those acute services are available for the patients that are in the more remote areas, but they also are connected to all of the resources that we have. So Dr. Michaeles, for example, sees patients here at Buffalo General as well.

Host: Okay.

Katrina Karas: Dr. Mallavarapu has a very close relationship where he's able to reach out and get those interventionalists at any time. And so, I think what we're doing is we're offering the services that can be provided close to home, close to home in Olean or in Springville or in Fredonia, like in the new place in Chautauqua County. Or if the service cannot be provided in that location, we have those quick connections to be able to get patients where they need to be.

Host: And I've interviewed patients before, you know, for a variety of different procedures and diagnoses, and they said, if not for GVI in our backyard, they might have had to go somewhere else, to New York City, to Cleveland, to Boston. Again, what can you say about having this, you know, amazing center right here?

Katrina Karas: Yeah. I think it's easy to take for granted, right? Because we as a community know that the care is here, and it's typically pretty easy to access. And so, I think it's something that we can easily take for granted. But I don't think that it is something we should take for granted. I think we need to recognize the wealth of knowledge, of talent, of resources that we have right here in our community.

Host: And GVI continues to grow, not only, you know, the service lines, but the talent that we bring in. I feel like when GVI first started, it was more of like a if you build it, they will come. We have this great facility. So, you have this great facility, then you can bring in top talent. If you get some top talent, you get more top talent, because they want to work with the best of the best. You bring in new technology. You can bring in, you know, people. I think of, you know, Dr. Berger, who came from New York City. And, you know, now we have incredible—some things that we can talk about. You know, HIFU is coming. But he had experience with that before, and now he's bringing his knowledge and technical expertise to use that equipment here. Let's dive right into HIFU.

Katrina Karas: Absolutely.

Host: This fall is a very exciting time for us.

Katrina Karas: Yes, it is.

Host: Explain what HIFU is and how it's going to be used.

Katrina Karas: Yeah. So, there are so many acronyms for this. So, the company that we use, that we purchased the equipment from, and what I mean when I say equipment, it's a head cage, like a halo type of thing. It's a halo that is put over the head in order to be able to deliver high-frequency ultrasound waves to be able to ablate or stop the parts of the signals that are going through the brain that are causing an essential tremor. So, I'm a patient who has essential tremor. I have shaking. Sometimes it can be both hands. Sometimes it can be one hand or the other. And so, this tremor might be fast. It might be slow. It might be, you know, more severe. It might be less severe. But I'm a patient, I'm trying to drink my water, and I can't because my hand is tremoring.

Host: I mean, we're talking about—this falls under, you know, functional neurosciences and neurosurgery. This is everyday tasks. Yes. This is trying to button up your shirt. Trying to perhaps write a check, eat, drink, that some folks are—

Katrina Karas: Put on my makeup.

Host: Right. Yeah. Folks are severely affected by that. So, the high-intensity focused ultrasound and Insightec, this is different from another procedure that we can currently do. This is sort of like that, the next level, right?

Katrina Karas: Yeah. So, let me break it down, I guess, from the top. So, functional neurosurgery and restorative neurosurgery really focuses on things like movement disorders, Parkinson's disease, tremor. And it takes and tries to think about how can we manage or intervene in the course of this condition so that we can get people back to higher function so that we can restore their part of their life that may be affected by this condition. And so with that comes a bunch of different types of procedures that can be done for different conditions.

ClearPoint, which is the procedure you were mentioning, is another arm or another intervention that can be performed. Another type of procedure is called deep brain stimulation or DBS. And so, all of these procedures, this whole kind of portfolio of interventions can now be performed at Kaleida Health.

And I think what's exciting about that is that we are unique in, you know, Dr. Hopkins was the predecessor of all of this, building this neurosciences community in Buffalo. Dr. Levy, Dr. Siddiqui have helped to really move us forward, and they've recently recruited—well, not recently, Dr. Riley's been here for several years, and now Dr. Berger joined us a few years ago. And these surgeons are people who are experts in this functional neurosurgery or neurorestorative medicine, neurorestorative surgery. And they really have brought, like you said, they did these procedures elsewhere, and they brought it here, and now we're able to offer these procedures here.

Host: And it's sort of the evolution of the procedures. We had Dr. Levy as one of our guests, and he basically flat out said, he's like, "Nobody in the history of the world has ever been excited about brain surgery," about "I'm going to go in and it's going to be invasive, and you know, there's incisions and lots of healing and scars." He's like, "Nobody's excited about that." But what they are excited about is the potential outcome of the restoration, what could happen because of the surgery or the procedure.

And when you talk about HIFU this is non-invasive. There's, you know, you're not going in and making massive incisions. Talk about a little bit again how it works. So, yeah, they're able to then pinpoint the ultrasound, that energy. So, they're doing this and, I mean, you know, cutting off connections or doing the ablations with energy.

Katrina Karas: Yes.

Host: I mean, it seems like, like sci-fi almost. A little bit, right?

Katrina Karas: It absolutely does. And, you know, I had the opportunity as we're implementing this new procedure. A whole team of us went to Brigham and Women's in Boston to be able to watch them do procedures live.

Host: Wow, what was that like?

Katrina Karas: It was so incredible because what you see is the patient who is before—the surgeon there, Dr. Cosgrove, I think was his name, he does video of the patients before and after. And so, you see this patient go in before, and he videos it, and the patient that I saw had a big significant tremor. And he has them, like, try to drink a bottle of water and, you know, different things to really demonstrate kind of how bad the tremor is. And then, after the procedure, he didn't have a tremor.

Host: That's wild.

Katrina Karas: It was incredible. And he has them draw lines too, like, circles.

Host: The spirals. Yeah.

Katrina Karas: Yeah. And so, you can see kind of how that looks. I mean, it is just almost unbelievable. Like you said, it's almost like sci-fi. And this patient that I was able to observe was just almost in tears after because he was just so excited about what had occurred. And yes, I mean, there are pieces of this procedure that are not ideal, right? So, you're not getting an incision in your head. But we do have to shave the patient's head. And so, for some people that really love their hair, that is something that they really need to be aware of as they go in for the procedure.

And then, the other thing is in the cage or the helmet or the halo, there are four points where they do have to poke into the skin—

Host: To stabilize. Right.

Katrina Karas: To keep it in place. Yes. And so, they deliver some pain-relieving gel as well as an injection or some pain reliever so that those four points are less painful. But thinking of the fact that you go in With a big tremor and you leave without a tremor, I think I'm certainly not in that position, so I would never want to, you know, assert how that might feel for someone. But I think it is incredible that we have the ability to do it here.

Host: Yeah. And it's been a long time coming to get this Insightec here. And A huge reason, you know, a big reason why we have it is because of philanthropy.

Katrina Karas: Yes.

Host: Because people believe in this. They believe in the possibilities. Some folks I know who maybe have donated or contributed to this either maybe have a tremor themselves or know somebody. It can be very personal. But talk about the support and what that has meant to bring this technology to Buffalo.

Katrina Karas: Yeah. So thankfully, we have people in this community who have means that are able to share those means with our organization. You know, they have learned about what this procedure can mean. And through the Kaleida Health Foundation, they have donated some of them hundreds and hundreds of thousands of dollars in order to be able to help to pay for this new equipment. This equipment was a huge investment, we could not have done it without the support of those folks who donated their money. Some of them donated time and, you know, talking to other people that then could make donations. And so, the fact that people would invest their money in this cause really shows that they trust in our surgeons and that they trust in our organization to be able to make a difference in people's lives.

Host: I was able to host a couple of panel discussions, you know, with Dr. Riley, Dr. Reynolds, Dr. Berger, Dr. Levy, two different ones, you know, with two different groups of people to explain sort of the technology and why it was neededand how people could help.

And I think one of the overarching themes was, you know, it's an investment in the technology certainly, but it's an investment in your community, Because it's bettering the health of your community, It's bettering, you know, the options that we have so that people don't have to go elsewhere. It's almost that positive domino effect or that trickle-down effect. It might just seem like a procedure for one particular person. but really,the positive effect, it's exponential. I don't think you can put into words how important a piece of equipment like this is.

Katrina Karas: Yeah. And, you know, as we talk with the surgeons about it, both Doctors Berger and Dr. Riley, you know, they want us to always remember that it's part of a bigger program. And it's a part of a bigger scope of services that we are able to offer to people in this community. But you're right, it becomes a destination. And so, I think that whether we have patients that come from other states, other countries, other continents, we are going to be able to offer this service to them in a way that, you know, we would not have been able to do before the people who donated their money to this. We just would not have been able to do it without that.

Host: Yeah. Any clinical trials? I know that you said there were what, 80? That was just for cardio. Anything on the horizon that you can give us a little glimpse of?

Katrina Karas: I mean, there are just so many. I think one of the biggest things that Dr. Iyer and his team are working on is related to the tricuspid valve. So as I said, there's those three valves in the heart, and one of the valves cannot be replaced through a surgical approach, so an open heart approach. So the way that they can replace that valve or repair that valve is through this transcatheter valve replacement process, which is, again, going through the groin or the wrist in order to repair or replace that valve. So, this is new technology.

And so, I think there are some that have already been FDA-approved and some that have not. And so, what this is allowing us to do is offer these services to patients that maybe they wouldn't be able to get otherwise because they're not FDA-approved. And so, I think that this is a super exciting one that he's working on. There's probably so many others, and I wish I could, you know, be able to kind of speak a little bit more eloquently to all of them. And probably some that we can't really talk about just yet, right?

Host: Yeah, that's true too.

Katrina Karas: But I think that might be a future podcast, is to have Dr. Iyer talk about. Or Dr. Courtney, he also has a great research team. And so, we may want to bring some of them here as well.

Host: I love it. Now, I know that we don't typically do a lot of adolescent cases. However, we have a champion kid who, as his mom put it, he was a little bit larger. He's a little bit, you know, larger stature, so he was able to go. He needed an implantable defibrillator. And Mom was just amazed at the fact that he was able to go from Children's right across the bridge to Buff General and then GVI. She goes, "We were back in Children's in 90 minutes." I think that goes to show just the location and the collaboration, how in some cases—you know, not all cases—how that can happen right here in Buffalo. They didn't have to go somewhere else.

Katrina Karas: Yeah. I think, you know, I've had lots of interaction with Children's more recently, thinking about other services that we might be able to bring within the cardiovascular kind of landscape to Children's Hospital. But you're right. I mean, Children's Hospital being adjacent to Buffalo General, GVI, there's the ability to be able to just take care of patients in a very expeditious way without having an ambulance transfer, all those things. That is unique, I think, again, to the Buffalo community to have the adjacency of the hospitals.

So yeah, it's exciting to hear about that specific patient, and I'm sure there's so many more like that where they have the opportunity to just go right across the bridge and get their care.

Host: Yeah. For anybody that is in need of cardiovascular care, I know that you said it starts with your primary care physician and then a referral, why Kaleida Health? Why trust in Kaleida Health for your cardio care or your neuro care?

Katrina Karas: Yeah. I think, you know, lots of what makes Kaleida Health unique has to do with our volume of care that we provide. So, we are the busiest center from a standpoint of the amount of the number of procedures that we perform.

And whenever people do more, they are the best, right? They become the best. They are the best. And so, I think that, you know, that is what makes Kaleida Health, the Gates Vascular Institute, cardiovascular and neurosciences, the place to get your care because of the volume.

And as I had mentioned earlier, you know, it is truly the care, the multidisciplinary care, the, uh, coordination of care with UB, with the Jacobs Institute, with the research, with the clinical trials, it all differentiates us. And so, I think being able to access care here is just a privilege. And so, I think there's just so many reasons, but those are just some.

Host: Yeah. Awesome. Thank you so much. We talked about so much, and we've already decided there's going to have to be a future episode talking about all of the clinical trials because that could be 60 minutes on its own. Did we miss anything? Is there anything else that you wanted to touch on about the tremendous care that's happening right here?

Katrina Karas: Yeah. You know, I think what I'd love for this community to understand and for our viewers and our listeners to understand is really how they can access care has changed recently because we went live with a completely new electronic medical record.

Host: Yes.

Katrina Karas: So, Epic is our new EMR. And what that does is it opens up a whole new relationship that the patient can have with the organization, with the clinical care, the clinical providers. And so, I think one of the things I would love for the community to know is that we are constantly thinking about how we can be more forward-facing, more innovative with how patients can access their care. Yeah. One of the things we were just talking about this morning is making sure that we have a very quick turnaround for patients to be able to access cardiac care a cardiologist, an advanced practice provider, so that people are not sitting waiting around to access care.

So, our goal is to be able to provide services in a timely fashion in an efficient way. And so I think we want the community to know that as the world modernizes, as we have more tools at our disposal to reach patients and make it convenient for patients, that is our goal. And so, that is very much what we're focused on over these next, you know, few years as we optimize our new medical record.

Host: Yeah. So with Epic comes myChart. So if you don't have myChart already, you can go to the App Store, you can download it, and it's really your health information at your fingertips. You can communicate with your providers. You can get refill or prescription refills. All of the stuff I feel like before that may have been a little annoying, waiting on the phone, you know, trying to coordinate my lunch break when somebody else isn't on a lunch break to make an appointment. You can do all of that stuff and so much more.

Katrina Karas: Yes.

Host: So, be sure to download myChart.

Katrina Karas: Yes.

Host: Thank you so, so much. This was a great conversation, a lot to talk about, a lot more to come. I feel like we're just like this is the tip of the iceberg when it comes to cardiac and neuro care in Western New York.

Katrina Karas: Yes.

Host: All right. Awesome. Thank you. Thank you so much.

Katrina Karas: Thank you.

Host: Yes. And thank you for listening. Thank you for watching, and we will see you next time on Medically Speaking.