I have started my life in rural India. I was born in a small town, Tenali, known for its unusual number of highly skilled individuals scattered around in the world. Every house has somebody in the United States from there.
I started school early and was found to pick up knowledge at an accelerated pace and was sent to a big city for further studies. This happened at an age of four. I went to a catholic school from then until I joined medical school. I was the youngest in my class and this continued into my graduate education.
St. Patrick’s high school in Secunderabad, India was known for its discipline, strict curriculum and high achievers. I stood first in the class in languages and social studies on a regular basis. In the ninth standard, I further improved to get into the top spot for all subjects. My skills in communication and awards in elocution in both English and telugu language along with acting skills on stage made me eligible to become the vice captain for the entire high school. I was awarded the certificate of excellence.
The state of Andhra Pradesh in India has a population of 70 million now. The top junior college to get into was little flower junior college. An entrance test was used to select us for one out of only 120 seats per year in biological sciences there. I got into the college successfully. My scores in the Intermediate Board exam
84 percent, (not percentile) was one of the highest from that college.
An entrance test conducted throughout the state of Andhra Pradesh selects only 900 candidates to go to various medical schools in the state that year. Of these schools OsmaniaUniversity is the most sought after. It is in the capital of the state and is the oldest in that part of the country. About 50,000 people apply for this test. There are several second, third and fourth time takers of this test conducted annually. I got thru the test the very first time and entered medical school at an age of 17. Gandhi medical college, OsmaniaUniversity had 100 students in each class. At this time when I look back at my class, I am one of only three students who made it to this level of expertise.
I came to the United States soon after the medical school in 1991 and took the NBME and USMLE exams along with the FLEX exam to qualify for licensure, all in a span of 9 months and successfully completed the ECFMG certification in 1992. Though I did take these tests in a hurry, I got in USMLE step 1, 89 percentile. At that time that was a good score making it possible for me to get into a good residency program.
I was chosen to go to State University of New York, Brooklyn and The long island Jewish medical center, Albert Einstein college of medicine. I chose the latter.
I had declared at that time two goals, one to get into the prestigious fellowship in gastroenterology and the second to take the expertise down to India for some time and train in all the tropical aspects of it there.
In the residency program, I was selected with the leadership qualities I exhibited to lead the class and create schedules for all the rest of the interns and residents at my level of training. I had these responsibilities for all three years of my residency. I was awarded the Leadership Award for the same. I was nominated for the best teaching award at the medical center also, one among three doctors that year.
I rotated in gastroenterology in that hospital and presented Hepato cellular Carcinoma in gastroenterology grand rounds. My work ethic and the presentation skills made the chief of gastroenterology, Simmy Bank of the Bank’s criteria of pancreatitis fame to choose me as their top pick for the countrywide match for the gastroenterology fellowship. The department was ranked 39th countrywide by U.S. health and world reports. During the fellowship, I learned the subject and the procedures at an accelerated pace and was put in charge of therapeutic endoscopies including ERCP for a six month period in the second year of training. Understanding that I would benefit form additional liver disease expertise before I start practicing the subject, I applied for the prestigious one-year fellowship of liver Diseases and transplantation at Mount SinaiHospital and Medical School, New York, New York. There are only a handful of programs offering liver diseases training in the entire country and the competition to get into these is stiff. The mount Sinai hospital in New York City and the liver diseases program are coveted positions for the physicians who practice digestive diseases. The journal Seminars in Liver diseases originates from Mount Sinai hospital. Mount Sinai is ranked among the top ten institutes in digestive diseases according to US health and World reports every year and is currently ranked 7th. I participated in journal clubs and international conference exhibitions while I was at Mount Sinai.
I was given the honor to speak on the behalf of all the fellows at the awarding of our fellowship certificate in June of 1999.
I proceeded as planned to Apollo hospitals in Hyderabad, India and was given the post of a senior consultant immediately. Apollo hospital is a tertiary care hospital that caters to a catchments area of more than 70 million population. It is a hospital that enjoys getting the best doctors from all over the country as the salaries are high and the variety of cases is spell bounding. I was there for five years at which time I participated in various regional gastroenterology conferences, presenting lectures at a wide radius of 300 miles all around our hospital. I was chosen to be the faculty in gastroenterology and hepatology for the Emergency medicine and Family medicine residency programs at the hospital. I was also elected office bearer for the local chapter of the Indian medical Association, the Umbrella organization for all practicing physicians in India.
During the five years there my weekends were spent in traveling to rural India, on some occasions into tribal belts to serve the poor for token remunerations. This was my routine for four of the five years. Working in India gives you no vacations and on top of it the volunteering in the weekends tired me. I wrote a weekly column in theAndhra Jyothi Newspaper with a circulation across the whole state informing the general population about various gastroenterology ailments during that time. I appeared on Teja television, which is one of the special channels on DISH network, here in USA and the most watched TV newscast of the evening for 70 million people, in the middle of their evening news informing public about the dangers of Alcoholism.
Once the self-designated five years were over, I applied to get back into the United States. Once the decision was made, it took only a short time of 3 months to gather Massachusetts license, federal DEA, temporary visa and all other formalities to start work at U.Mass memorial Health Alliance hospital in LeominsterMA.
I have been here since October of 2004. I have a busy practice where is see close to 3000 patients yearly and do about 1300 procedures yearly. Apart from the clinical practice, I was selected by the university to be a faculty for their Family Practice Residency program here. Residents rotate on two-week rotations that I solely teach and evaluate. I have participated in community out reach giving presentations to the public. I have visited and presented counselors and patients of drug rehabilitation about the scare and cure of hepatitis C. The HabitatCenter in Leominster works in concert with my office for hepatitis C treatment for more than two years. I volunteered to treat inmates at the federal prison at Devens which is in a nearby town. I have been selected to be on the speaker bureau for the American Cancer Society on whose behalf I have presented lectures about colon cancer screening to all the nearby hospitals in this county.
AREAS OF EXPERTISE
A.CLINICAL:
1.HEPATOLOGY – 8 years experience
Currently there are only a handful of training programs in hepatology in the US, of which the Mount Sinai hospital is one of the oldest and best known. It is ranked in the U.S. Health and world reports in the top ten centers for digestive diseases every year.As a result, there are very few qualified doctors who have had specialized training in the field of Hepatology.It is now one of the most rapidly growing areas in medicine.With the advent of chronic hepatitis C and Non-Alcoholic Steato hepatitis are major public health problems, and with major advances in liver transplantation, it is estimated that there will be a severe shortage of qualified hepatologists in the future.
I have received my special one Year long Fellowship in Liver Diseases and Liver transplantation at one of the best centers in the country for expertise in liver diseases, the Mount Sinai Hospital and Medical school, New York, New York.
The Mount SinaiHospital is a premier Hospital that took care of liver diseases in the country. Numerous pioneering studies in liver diseases were done at Mount Sinai. Primary Biliary Cirrhosis was discovered and treatment criteria established in Mount Sinai Hospital, New York. The teams of pathologist, Hans Popper and hepatologist Fenton Schaffner have brought United States on the map of the world for liver diseases. To date Liver transplantation and the care of chronic liver disease assume one of the main fields of interest in clinical treatment and research at Mount SinaiHospital. Scott Freidman who has done pioneering work on stellate cell in the liver that leads to fibrosis and ultimately leading to Cirrhosis was one of my teachers. Henry Bodenheimer Jr., one of the most prominent among those who establish criteria how to treat hepatitis C was the program director at the time of my training.
Mount Sinai is the hospital that handles the largest number of liver transplantations per year in the entire northeastern United States. We did more than 200 liver transplants in the academic year I trained there.
Hepatology refers to the study of the liver and diseases affecting the liver.I treat and care for patients with liver diseases that range from simple to highly complex ones. Liver disease is the third leading cause of death in the US among people aged 25-59.
Some of the common disorders that I diagnose and treat are cirrhosis of the liver and it’s complications, acute and chronic viral hepatitis, autoimmune hepatitis, alcoholic liver disease, primary biliary cirrhosis, metabolic diseases like Wilson’s disease, Primary Sclerosing Cholangitis, benign and malignant liver tumors and drug-induced liver diseases, Fulminant hepatic failure, Acute Viral hepatitis, Veno Occlusive Disease of the Liver, hemochromatosis and graft versus host reactions. Extensive knowledge and training are required to diagnose these diseases, differentiate them from other similar diseases and to manage them successfully.
I have acquired training in Hepatology at one of the nation’s very best center for excellence in Hepatology, Mount Sinai hospital, New York, New York. While training at Mount Sinai, I have had the opportunity to evaluate complicated and challenging cases from all over the US and the rest of the world. I have also acquired skills in taking care of patients after liver transplantation. Care of these patients is very specialized as the patients are on immunosuppressive medications that not only potentially toxic, but also make them prone to serious infections.
Some of the Liver diseases I treat and teach:
Hepatitis:Hepatitis refers to inflammation of the liver. It can be caused by many factors including viruses, drugs, alcohol, increased fat deposition in the liver (Non-alcoholic steatohepatitis) and/or the immune system itself (Autoimmune hepatitis).The wide variety of causes of hepatitis and the similarity of their presentations mandates a thorough knowledge and understanding of the various mechanisms underlying these different causes and prudent use of available therapeutic modalities.Since a lot remains to be learnt about many of these common liver diseases, treatment may sometimes involve enrolling patients in clinical trials utilizing promising experimental modalities.
2. Hepatitis C, caused by the hepatitis C virus, is now one of the most important emerging public health problems in the US.There are an estimated 4 million cases in this country, the vast majority of whom have not yet been diagnosed, as most infected patients do not have any symptoms.The annual cost of treating this disease in now about $600 million and is expected to increase exponentially in the future.Hepatitis C has been described as an epidemic that has already happened and the burden of illness from hepatitis C is expected to peak by 2015.There is expected to be a critical shortage of hepatologists skilled in managing diseases like hepatitis C in the future.The virus is spread through infected blood and blood products and sharing needles and unfortunately 75-80% of infected patients go onto develop chronic liver disease.Research continues to look for treatments and cure for hepatitis C.
Although the success rate of treatment has improved significantly in recent years due to extensive research, almost half the patients treated do not respond to currently available therapy.This makes managing patients with chronic hepatitis C very complex.Success of treatment depends on a good understanding of factors like viral load, genotype of the virus, etc.In many instances it may entail enrolling the patient in clinical trials utilizing different dosages and duration of currently available therapies or experimental drugs..
Therapy of chronic hepatitis C currently utilizes two antiviral agents, an injection called Interferon and a pill called ribavirin, usually used in combination.These medications can cause significant toxicity or side effects and hence sufficient expertise is essential in treating patients using these agents.I have been involved in the treatment and close follow-up of numerous patients with chronic hepatitis C, both within and outside of clinical trials.Due to the high level of expertise needed, only hepatologists or gastroenterologists usually treat these patients.What makes treating this disease even more important is that there is currently no vaccine for hepatitis C and a person infected with the virus is at increased risk for cirrhosis (‘scarring’ of the liver), liver failure and liver cancer.Hepatitis C is currently the leading cause of liver transplantation in the US.
I see close to 25 new cases monthly and treat at any given time 30 patients for this disease. My clinic boasts of higher remission rates than the national average. My special training in Liver diseases at Mount Sinai hospital and my continued interest to provide the best have given us these superior results.
2.The hepatitis B virus that is spread through infected blood products and body fluids causes Hepatitis B.It can cause an acute hepatitis; however 5-10% of adults remain infected for life.These patients are at increased risk for cirrhosis, liver failure and liver cancer.Current therapy for chronic hepatitis B includes the use of Interferon and Lamivudine. Therapy of hepatitis B is undergoing constant improvement and I have been involved in managing complex cases of hepatitis B here in the United States as well as in India where hepatitis B is more prevalent. I have treated more than 200 such patients till now. Newer therapies with Entacavir and Adefovir have already been incorporated in our clinical practice.
3. Cirrhosis of the liver refers to extensive scarring and damage to the liver that can be due to a wide variety of causes, including many of those described above.Management of cirrhotic patients demands a very high level of expertise and skill.It is often considered to be too complex to be managed by someone without adequate training and experience.
Some of the complications seen in advanced cirrhosis include accumulation of fluid within the abdomen (ascites), massive bleeding from ruptured varices (engorged veins) in the esophagus, alterations in mental status ranging from confusion to coma (Hepatic encephalopathy), kidney failure directly as a consequence of the failing liver (hepatorenal syndrome) and infection of the fluid within the abdomen (spontaneous bacterial peritonitis).Most of these complications can be life-threatening and management of these patients may involve complex procedures such as removal of large amounts of fluid from the abdominal cavity by inserting a needle (paracentesis) and endoscopy (inserting an endoscope with a camera into the stomach) to ligate the bleeding veins in the esophagus.
Ascites (accumulation of fluid within the abdomen) is a common complication of cirrhosis of the liver.But it can also be seen in a variety of other conditions and hence determining the underlying cause can be quiet challenging.During my fellowship training I have been exposed to a wide variety of such cases as most of these patients get referred to hepatologists.
5. Liver cancer is a complication of cirrhosis from various cases. Worldwide, Hepatitis B and C are important factors for the development of liver cancer.The management of patients with liver cancer is highly complex and requires a multi-disciplinary approach involving hepatologists, surgeons and radiologists.
6. Hepatitis A and E are acute viral illness that are seen more in tropical climates and are considered water borne. In United States we see them in patients with mental retardation, institutionalized psychiatric wards and in illicit drug using populations and cohorts. Hepatitis E is often a fatal illness leading to high mortality in pregnant women.
7. Alcoholic Liver diseases are widely prevalent in all societies. I deal all acute alcoholic hepatitis and alcoholism leading to end stage liver diseases. Alcoholic cirrhosis is a major etiology for liver transplantation in the Untied states. Care of these patients under the hepatologist is of prime importance for best results.
Liver Transplantation
My second area of expertise is in the management of patients before and after liver transplantation. I have acquired this expertise during my training at the Mount Sinai hospital. The only definitive treatment available for acute liver failure and for end stage chronic liver disease or cirrhosis is liver transplantation from another human being. The number of patients waiting for liver transplantation is growing rapidly and there is a long wait before a suitable liver can become available. For successful transplantation, a liver that can match the patient has to be available in a very short time.
I have been involved in the management of patients waiting for a liver. These patients are very sick and have complications from cirrhosis like vomiting blood, kidney failure, fluid in the abdomen, infection and may even be comatose. After transplant, patients may have complications from surgery, immunosuppression medications, infections and even recurrence of disease that initially caused the liver disease. These are usually managed in the intensive care unit. I was also involved in the selection committee, which includes the surgeons, liver transplant physicians, psychiatrist, social workers, etc. This committee selects patients and puts them on the waiting list for liver transplantation.
Procedures in Hepatology
As a fellow in hepatology at the Mount Sinai Hospital, New York, New York and Mount SinaiMedicalSchool, I acquired expertise in specialized procedures relating to hepatology, including abdominal paracentesis and liver biopsy.
Paracentesis or ascitic tap refers to removal of fluid from within the abdomen by inserting a needle through the abdominal wall. Some cases require removal of as much as several liters of fluid within the abdomen.In therapeutic paracentesis, a large amount of fluid (up-to several liters) is removed to relieve symptoms such as difficulty breathing.After anaesthetizing the skin on the side of the abdomen, a long needle is inserted until it reaches the abdominal cavity.Once it has been correctly positioned, suction will reveal ascitic fluid. In a therapeutic procedure, the needle is then connected via a tubing system to vacuumed bottles to collect large amounts of fluid.Performance of the procedure requires sufficient skill and expertise, as it is not without risks.Possible complications include bleeding into the abdomen, injury to or perforation of bowel and infection of the peritoneum (the inner lining of the abdomen).These complications can be potentially life threatening.
Liver biopsy is the procedure by which hepatologists obtain a tissue sample from the liver.Examination of tissue obtained by liver biopsy is crucial in diagnosing a wide variety of liver diseases, in evaluating the response to therapy and to determine progression of disease.Only hepatologists and gastroenterologists are allowed to perform this procedure.If not done properly, it can result in serious complications.In patients with advanced liver disease and cirrhosis, particular caution is advised as these patients are at increased risk of bleeding due to low levels of platelets (type of blood cell that helps blood to clot) and clotting factors that are made by the liver.The procedure involves inserting a long wide bore liver biopsy needle into the liver after anaesthetizing the skin overlying the liver.The needle is usually inserted between the ribs on the right side of the abdomen.It is extremely important to coordinate the patient’s breathing movement with the insertion of the needle, to avoid injury to the lung.After the needle is inserted, with a quick suction action, a piece of liver tissue is aspirated.Liver biopsy is a potentially risky procedure, if not performed properly as it has a very narrow margin of error.The possible complications include bleeding, injury to the lung, injury to the gall bladder and infection.These are potentially life-threatening complications.It is also extremely important to obtain an adequate amount of tissue to permit a proper histopathological examination.
I also acquired expertise in examining liver biopsy specimens under the microscope.Although generally performed by trained pathologists, the role of the hepatologist in correlating the biopsy and clinical findings is crucial.Through interaction with faculty and teaching conferences, I have gained valuable experience in interpreting liver biopsy tissue slides.I have also been trained to interpret various imaging (x-ray) studies of the liver.
B.GASTROENTEROLOGY- experience of 10 years of treating and teaching:
The Gastroenterology program at Long Island Jewish hospital, Long island campus for Albert Einstein college of medicine, is renowned for performing complex diagnostic and therapeutic endoscopic procedures. The hospital was ranked 39th in the entire country at the time of my training by U.S. Health and world reports. I have performed a very wide range of endoscopic procedures in large numbers. I have gained special expertise in performing the following procedures that I routinely now perform and teach. I have been doing many of these procedures for 10 years now.
My area of expertise is Gastrointestinal Diseases. Gastroenterology is a vast field which deals with various diseases of the digestive system including the entire length of the GI tract, Liver, Biliary system and Pancreas. Every day there are new technological advances being introduced that makes the diagnosis and treatment of previously difficult to treat digestive diseases easier. There is an increasing demand for and acute shortage of specialists in the field of gastroenterology.
Gastrointestinal and liver diseases inflict a heavy burden on the health and well being of Americans. The economic consequences for the nation are enormous. A recent survey was conducted by the AGA (American Gastroenterological Association) to establish the burden of GI disease in the US population. The results were published in May 2002 volume of Gastroenterology (the official journal of AGA). The most prevalent seventeen gastrointestinal diseases were surveyed, and the total number of people affected was 289 million. Based on 1998 data, the most prevalent of these diseases are: non–food-borne gastroenteritis and other GI infections (135 million cases), food-borne illness (76 million), gallbladder disease (20.5 million), heartburn related disease (18.6 million), and irritable bowel syndrome (15.4 million). Reducing these numbers to avoid overlap, results in a burden of approximately 185 million individuals in the United States affected by GI disease yearly. The report estimated that these disorders were responsible for approximately $43 billion in the year 2000. In aggregate, acid-related disorders accounted for the highest direct costs ($12.4 billion), followed by gallbladder and pancreatic disorders ($7.8 billion), and GI cancers including colorectal cancers ($7.3 billion). The numbers are steadily increasing due to the aging of the “baby boom” cohort of individuals born between 1945 and 1970. A conservative estimate is that 35%–40% of this population (or 45–50 million individuals) will have one or more GI symptoms or health issues in any year. This would result in a burden of more than 10 million office visits per year. The data from the National Cancer Institute showed that gastrointestinal cancer is on the rise, leading to increasing morbidity and mortality. Every year 150,000 new cases of colorectal cancer alone are diagnosed in the United States.
In the broad field of gastroenterology, I have special interest and expertise in Colorectal Cancer, Gastroesophageal Reflux Disease, Gastrointestinal Bleeding, Irritable Bowel Synrome, Inflammatory Bowel Disease, Hepatology and Liver Transplantation, Pancreatitis and pancreatic cancer; and various kinds of complicated endoscopic procedures, both diagnostic and therapeutic.
I- Colorectal cancer:
It is the second leading cause of death due to cancer for males and females in the U.S. About 6% of Americans will develop colorectal cancer and 40% of this population will die of the disease; however, colorectal cancer remains curable if it is detected at an early stage. Individuals over 50 years of age, and those with a family history of colorectal cancer, other hereditary factors and a personal history of IBD are at increased risk for colorectal cancer. The direct and indirect costs associated with colorectal cancer exceed $5 billion per year.
I see 30 to 35 patients in the weekly clinics for colorectal cancer screening. My expertise involves management of all aspects of colorectal cancer including screening, diagnosis, treatment and follow-up. I have superior skills in colonoscopy. In this geographic area American Cancer Society has picked me to be as the partner to promote Colon Cancer Screening. I speak at various forums on their behalf.
WOW Case:
A 40 year old gentleman came to our office with the complaint of rectal bleeding. The bleeding was painless and profuse. Considering that he had no localizing signs a colonoscopy was done. At colonoscopy a large exophytic mass was seen in the right colon and biopsies proved that it was a malignancy. The man was sent to colorectal surgery. As the diagnosis was made in a timely manner, we could save this man with a favorable outcome. Colon cancer identified early has 10% five year mortality and if identified late has 90% five year mortality.
II- Gastroesophageal Reflux Disease (GERD):
GERD is one of the most prevalent gastrointestinal disorders. Population-based studies show that up to 15% of individuals have heartburn and/or acid regurgitation at least once a week and 7% have symptoms daily. Symptoms are caused by backflow of gastric acid and other gastric contents into the esophagus due to incompetent barriers at the gastroesophageal junction. The development of Barrett's esophagus is a complication of severe reflux esophagitis, and it is a risk factor for esophageal adenocarcinoma. Barrett’s esophagus is present in 10-15% of patients with reflux disease. Chronic GERD can also lead to peptic strictures of the lower esophagus.
My expertise involves management of gastroesophageal reflux disease both medically and endoscopically. I see 7-8 patients of GERD and related complications in the weekly gastroenterology clinic. I am proficient in the diagnosis of GERD by using a novel technique, Bravo wireless capsule. It’s replacing the older nasally placed catheters. These transnasal catheters were a source of great patient’s discomfort, and many patients had refused these. The Bravo capsule has no attached wires, and is painless. I have done research and recent literature-review on the pathogenesis of GERD and use of Bravo capsule. I have been many lectures on this topic.
III- Gastrointestinal Bleeding:
There are over 350,000 hospitalizations a year in the United States for acute upper gastrointestinal bleeding, with a mortality rate of 10%. Approximately half of patients are over 60 years of age, and in this age group the mortality rate is even higher. The most common presentation of upper gastrointestinal bleeding is hematemesis or melena. Hematemesis may be either bright red blood or brown "coffee grounds" material. Melena develops after as little as 50–100 ml of blood loss in the upper gastrointestinal tract, whereas hematochezia requires a loss of more than 1000 ml. Although hematochezia generally suggests a lower bleeding source (e.g., colonic), upper gastrointestinal bleeding may present with hematochezia in 10% of cases. Virtually all patients with upper tract bleeding should undergo upper endoscopy, performed after the patient is hemodynamically stable, usually within 12 hours after admission. High-risk patients or those with continued active bleeding require more urgent endoscopic evaluation. Hemostasis can be achieved in actively bleeding lesions with highly skilled endoscopic modalities such as cautery with bipolar probe, epinephrine injection, or endoclips for the bleeding artery. Low risk patients can be safely discharged from the emergency department following prompt endoscopy, thus minimizing resource utilization.
I am proficient in all modalities in the management of acute gastrointestinal bleeding that can be life saving. Although almost all gastroenterologist are trained to manage GI bleeding, it takes a lot of experience and expertise to manage these cases efficiently and reduce the mortality from GI bleeding. I have managed more than 100 cases in only one year, including a large number of complex and difficult cases of bleeding.
WOW Case:
Massive upper gastro-intestinal bleeding is a routine inpatient case that I deal with. One such case I would like to detail here is the case of a 35 year old man with end stage liver disease who came into the ER with massive amount of hemetemesis. We got the patient into the intensive care unit and proceeded to perform upper endoscopy. As we suspected we found esophageal varices but they were not bleeding. Proceeding into the stomach we saw a grape cluster of gastric varices bleeding. Cyano acrylate glue is approved for injection in India, we proceeded to inject the substance into the varix which saved that man;s life that day. The effect of our therapy was dramatic. He did not rebleed and subsequently was discharged from the hospital.
IV- Irritable Bowel Syndrome (IBS):
IBS afflicts over 15 million patients in the U.S. each year. IBS is a disorder of motility of the entire GI tract that produces cramping, abdominal pain, constipation and/or diarrhea. While IBS is not associated with life-threatening conditions, it causes great physical discomfort and embarrassment to many of its sufferers. There is no consensus currently as to an organic cause of the disease which incurs direct and indirect costs over $1.6 billion annually. Psychiatric illness and physical and sexual abuse are common in patients with IBS.
I have great expertise in diagnosis and management of all aspects of IBS.I worked for about 2 years as an Internist on the Psychiatry floor at InterfaithMedicalCenter, BrooklynNY. I managed my patients with IBS. It has given me a definite edge over my fellow gastroenterologists in the management of IBS. The symptoms can be confusing, leading to misdiagnosis in many cases. I see 2-3 patients with IBS in the weekly gastroenterology clinic. Due to my expertise in this area, I was asked to give a lecture on IBS.
WOW Case :
Cases of irritable bowel syndrome are commonplace in gastroenterology clinical practice. I saw a young 18-year-old girl who had profuse diarrhea. The lady gave us history in great detail; her parents were quite anxious and insisted on immediate work-up.
All the investigations including stool and serum studies proved to be in vain. We proceeded with colonoscopy and upper endoscopy including 5 HIAA levels and biopsies for celiac disease proved in vain. The patient was found to be undergoing considerable stress from a break up from her boyfriend over the last few months. Irritable bowel syndrome was diagnosed and patient was put on codeine sulfate daily. Patient was asked to stay away from lactose containing diets; liquids containing sorbitol and a course of probiotic saccharamyces boulardii were tried. It took us 2 months to finally get some credible results. I see this patient once every 6 months now.
V- Inflammatory Bowel Disease (IBD):
IBD is one of the most debilitating chronic intestinal disorders. Over 1 million patients are treated annually for the two most common forms of IBD, Crohn’s disease and ulcerative colitis, at cost in excess of $1.2 billion. Children who suffer from IBD can experience stunted growth due to the body’s inability to absorb and retain nutrients. IBD is prevalent in North America and Europe, and family history exposes persons to higher risk for the disease.
My expertise also involves diagnosis and management of IBD. Early stages of IBD can be easily confused with a common condition called irritable bowel syndrome (IBS), especially in young females. I have successfully managed many difficult to diagnose and manage cases. I participated in ‘IBD Consultant’s Course” at Mount Sinai School of Medicine on September 23rd, 2005. It was an educational activity aimed for gastroenterology fellows and attending physicians about the latest advances in IBD management.
WOW Case:
A 39 year old white male was referred from primary care for evaluation of chronic abdominal pain and on-and-off diarrhea. The man was subjected to a variety of tests to identify anemia and was loosing weight and blood over the past few weeks.He has been evaluated by gastroenterologist before, and was told to have irritable bowel syndrome (IBS). During history and physical examination, he admitted to have internal hemorrhoids and on-and-off small rectal bleed. I disagreed with her previous diagnosis of IBS, and recommended colonoscopy to rule out IBD. he agreed, and on colonoscopy was confirmed to have Ulcerative colitis. I started medial therapy for Ulcerative colitis, and his symptoms took another 6 months to get better. A father of two young kids, he is very satisfied with our care.
VII- Pancreatic & Biliary Diseases:
According to 1998 AGA (American Gastroenterology Association) survey, direct costs from pancreatic & biliary diseases was $7.8 billions. I have great expertise in managing different kinds of pancreatic & biliary diseases. I have a large experience in handling these disease states. I perform independently 50 ERCPs yearly and I am able to identify the right therapy, surgical, endoscopic or medical, to cater to the needs of this sector of medicine. I do both therapeutic as well as diagnostic ERCP. Biliary stent placement, biliary stricture dilatation and sphincterotomies are routinely done by me independently.
WOW case:
A 75 year old African American male was seen by me in the hospital admitted with severe right sided abdominal pain and jaundice. Ultrasound of the abdomen indicated that there is biliary ductal dilatation and we proceeded with a ERCP. At the procedure we noted that the duct had a filling defect and we tried to maneuver that with a balloon. After a sphincterotomy we saw a thick block of mucus with a small piece of tissue was extracted. The materiel later was shown to be hepatocellular malignant tumor embolus into the common bile duct. Mucobilia is a rare condition associated with cancer in the bile duct. The patient was sent to NYU for liver transplantation. He was rejected as he had tumor in the bile duct.
VIII- HIV related Gastrointestinal and Liver Diseases:
As of December 2001, more than 360,000 people are reported to be living with AIDS. An estimated 40,000 new HIV infections occur in the United States each year. Although African Americans and Hispanics combined represent about one-quarter of the United States population, they account for more than two-thirds of both new HIV infections and new AIDS cases. Realizing the needs of the community, Interfaith Medical Center (IMC)
Description of some of the procedures I perform in Gastroenterology :
Upper endoscopy with or without dilatation
This is a procedure which involves the use of advanced fiber-optic technology to view and image the inside lining of the gastrointestinal organs such like esophagus, stomach and small intestine. It is used for the diagnosis of conditions such as ulcers in the stomach and duodenum, cancer of the stomach, esophagus, etc. Dilation is used in patients who are not able to swallow. A plastic balloon is inserted through the endoscope into the esophagus and then expanded gently to stretch the esophagus. This procedure carries a high risk of tearing the esophagus, which can result in fatal infections and bleeding.
I have done one hundred such procedures independently.
Therapeutic upper endoscopy for treatment of life-threatening gastrointestinal bleeding
Besides its diagnostic value, Upper endoscopy also has advanced therapeutic applications in the endoscopic management of life-threatening internal gastrointestinal bleeding. Patients can experience serious bleeding from various sources such as ulcers of the stomach and duodenum or esophageal varices (dilated varicose veins of the esophagus that develop in patients with cirrhosis of the liver). A variety of techniques are employed to control the bleeding. These patients are at a high risk to accidentally aspirate their own blood into their lungs and may choke to death. The patient is sedated and may have to be put on an artificial respirator prior to the procedure. A flexible endoscope is passed down into the patient’s stomach and duodenum. Following this, a variety of techniques are employed to control the bleeding, depending on the source of bleeding.I have used advanced techniques such as use of
-Bipolar electric cautery devices (application of electric current at the site of bleeding using special probes passed though the endoscope),
-Argon plasma coagulation
-Banding (putting rubber band like devices on the bleeding varicose veins using specially designed attachment at the tip of the endoscope)
-Placement of hemoclips
These procedures require a high degree of precision and expertise and often have to be performed in emergency situations. Lack of adequate experience and expertise on part of the Gastroenterologist can mean certain death of the patient.
I have done more than 300 such procedures independently.
Endoscopic placement of Gastrostomy Tubes
These are specialized feeding tubes, that are used to feed patients who are unable to swallow for a variety of reasons such as strokes or other neurologic conditions and patients with terminal cancer of the mouth, larynx or esophagus who cannot eat normally. By performing this procedure, a feeding tube is placed directly in the patient’s stomach so that feeding can be easily accomplished. This tube placement was done surgically in the past, but can be achieved endoscopically sparing the patient risky abdominal surgery. This is a complex procedure associated with complications such as bleeding, perforation or serious injury to other internal abdominal organs.
I have done more than one hundred such procedures independently.
Esophageal Stricture Dilatation;
This procedure is performed in patients who have difficulty in swallowing due to narrowing in esophagus caused by acid reflux or cancer. A plastic balloon or a dilator is inserted and then slowly expanded to achieve dilatation. There is a risk of tear of esophagus (perforation) that may expose the patient to life threatening infections. I have performed around 20 dilatations without any complications using endoscopic guidance with or without fluoroscopy.
Stent Placement in Esophagus/Stomach/Duodenum:
A polyurethane meshed tube (stent) is frequently used for ulcer narrowing in esophagus to keep the lumen expanded. After 2 months the stent can be removed by a skilled endoscopist. More commonly a metal stent is placed in patients with cancer for palliation if they are not candidates for surgery. Both procedures require considerable expertise and training. Potential complications include bleeding, tear of the structure or improper positioning of the stent. I have successfully performed 20 cases that helped patients swallow food with satisfaction.
4. Diagnostic and Therapeutic Colonoscopy
Colonoscopy involves passing a 1.5-meter long flexible fiberoptic endoscope through the patient’s anal opening and advancing it into the cecum. This is performed after giving the patient intravenous sedation. It takes about 30-60 minutes to perform and is used:
-To examine the colon to diagnose conditions such as colon cancer
-To diagnose and remove colon polyps in order to prevent colon cancer
-For diagnosing and treating bleeding in the colon
-Evaluation of patients with conditions of the colon such as Crohns disease and Ulcerative Colitis
Most colon cancers start as polyps (small wart like growths in the colon). It has now been proven that if these polyps are removed at an early stage, cancer of the colon can be prevented and death from colon cancer can be significantly reduced. At present, colon cancer is the second most common cause of death from cancer in the US. Colorectal screening for colon cancer has now been universally accepted as the major cancer preventative strategy. Medicare has now approved colonoscopy as the best screening strategy for everybody over the age of 50. The procedure of colonoscopy and removal of polyps requires a fair amount of expertise. For removal of a polyp, a wire loop (called snare) is passed through the endoscope, around the polyp and an electric current is applied via the snare to cut the polyp at its root. This procedure requires a high degree of precision. The colon wall is only 1-2 mm thick and can easily tear or perforate if the application of the current is not accurate or if the endoscopist is not experienced in advancing the endoscope safely. The other serious complication is bleeding at the site of polyp removal, which can be very serious and requires a high degree of expertise to precisely apply electrocoagulation current to the bleeding site to stop bleeding. If an endoscopist is not highly experienced in these skills, the patient may require major abdominal surgery to treat these complications. The rate of complications is significantly lower in experienced and expert hands as with so many other procedures.
I am now performing about one thousand colonoscopies every year independently.
Endoscopic Retrograde Cholangio Pancreatography :
This technique is currently used to evaluate the biliary tract and the pancreatic duct disorders. The procedure requires expertise beyond a general gastroenterologist. A therapeutic endoscopy course and or a special part of the fellowship should be dedicated to the learning of this procedure. A special endoscope called the duodenoscope that visualizes the anatomy sideways is skillfully advanced into the second portion of the duodenum and special catheters are advanced into the bile duct and the pancreatic duct.
Visualization of the duct system is done with the help of X-ray equipment. Commonly stones that block the flow of bile are extracted with the help of balloons or baskets. Advanced procedures involve stent placement, stricture dilatation and sampling of tissue to rule out cancer are undertaken. I perform 50 of these procedures annually. Across a radius of 20 miles and for about 30 miles west of our hospital, I am the only one performing these procedures.
Small-Bowel Enteroscopy:
This technique is currently used to evaluate the small intestine, most often in patients with unexplained small-bowel bleeding. Push enteroscopy is performed with a long endoscope similar in design to an upper endoscope. The enteroscope is pushed down the small bowel with the help of stiffening over tube that extends from the mouth to the duodenum. The mid-jejunum is usually reached, and the endoscope's instrument channel allows for biopsies or endoscopic therapy. I have performed over 20 small bowel endoscopies in one year.
Gastrointestinal Motility and Manometry studies.
Esophageal Manometry:
This is a procedure performed and interpreted by gastroenterologists trained in the area of gastrointestinal motility for evaluation of patients with difficulty in swallowing, and can provide diagnostic information on the cause of the difficulty in swallowing. This is a procedure, which requires considerable skill and expertise.During this study a plastic tube is passed through the nose into the stomach and gradually withdrawn while recording pressures at different levels of the esophagus. I have performed, supervised
technicians and interpreted 50 of these procedures during my special training in Gastrointestinal Motility.
Ambulatory Esophageal pH Monitoring:
This is a study performed in patients with heartburn.In this procedure a thin catheter is passed through the nose to the stomach and left for a period of twenty-four hours.This will help in recording pH of the stomach and esophageal contents and diagnose the acid reflux into the esophagus from the stomach and also help in the adjustment of medication for treatment of reflux disease.
I have performed, supervised and taught technicians the technique of calibrating and placing the catheter, and interpreted 50 of these procedures.
BRAVO Capsule pH Monitoring:
This is a novel technique of measuring acid reflux into the esophagus and to establish the diagnosis of Gastroesophageal Reflux Disease or GERD. In this a small capsule is fixed to the lining of lower part of the esophagus during endoscopy. The capsule records the acidity by constantly monitoring the pH of the esophageal contents and sends the signals to an external receiver. Patient can continue to do their regular activities and after 2 days the data is downloaded from the receiver to a computer and analysed for the amount of acid reflux into the esophagus. This is a significant new development in technology and prevents the need for placing any tubes into the esophagus which is very uncomfortable.
All the above mentioned procedures are performed and interpreted only by gastroenterologists specially trained in gastrointestinal motility. I have performed many such procedures, and given lectures on the unique role of wireless capsule.
Endoscopic Procedures
No. Required for Credentialing
No. Performed approximately independently
Esophagogastroduodenoscopy (EGD)
130
4000
Esophageal Dilatation
20
50
Percutaneous Endoscopic Gastrostomy (PEG)
15
150
Colonoscopy
140
5000
Colonoscopy with Polypectomy
30
1000
GI Bleed (non-variceal)
25
400
GI Bleed (variceal)
20
250
Percutaneous Liver Biopsy
20
50
ERCP
50
250
Infra red coagulations for hemorrhoids
20
80
A single year (last year) procedure documentation is attached.
Wide Variety of Gastro intestinal procedures include,
Upper endoscopy with or without dilatation (Esophagogastroduodenoscopy) (EGD)
Foreign body retrievals from upper G.I. tract
Esophageal dilatation with savory dilators
Esophageal Dilatation with Balloon dilators
Achalasia Cardia management with dilatation
Mucosal resection of esophagus mass lesions
Mucosal resection of gastric mass lesions
Gastric polypectomies
Colonoscopy for Colon Cancer Screening
Colonic stricture dilatations
Intra mucosal injection therapies.
Polypectomy
Procedures to control Gastrointestinal bleeding (non-variceal)
Procedures to control Gastrointestinal bleeding (Variceal)
Intra luminal stent placements in Esophagus and in the colon
Push Enteroscopy – Inspection and therapy of the small intestines.
Capsule endoscopy – Inspection of the small intestines.
Infra red coagulation of internal hemorrhoids
Hemostatic clip application
Endoloop application to arrest bleeding
Argon Plasma Coagulation for radiation proctitis
Argon Plasma coagulation for gastric Arterio Venous ectasias.
·Academic and professional distinctions/Awards/ prizes
Acceptance to Medical school:
I graduated form GandhiMedicalCollege, OsmaniaUniversity. A common entrance test like the MCAT is conducted in India. It was called EMCET ( Engineering and medicine common entrance test). The test is conducted on one single day a year that attracts state wide students. More than 50,000 applicants take the test and only 900 are chosen to get into the medical school. Among the schools in the state, the candidates compete for the best and osmania university schools in the capital, hyderabad are considered the best.
Candidates take the test annually and some who compete are under graduate and graduate students taking the test multiple times. I got into the best of schools and in the first ever attempt I made.
Performance at medical School:
I passed all the tests taken to got thru the medical school in the first attempt. I got marks that put me in the top ten in the class several times. My performance also included leadership. Active participation in conducting the annual celebrations, Active participation in the student body and participation in cultural activities like drama
And poetry were a regular affair. Volunteer work to help the Cyclone affected areas in 1990 and Malaria Epidemic areas in 1991 were well appreciated and singled out in reference letters from the professor of Surgery.
Performance in Qualifying Examinations:
I took NBME Part 2, USMLE part 1 and FLEX part 1 and 2 tests in the United States. I had come here in late 1991 and took the next available dates for all these tests within a span of 9 months. I got thru them in the first ever attempt. In USMLE part one I scored 89 percentile in the test. Not being acclimatized to the American way of testing and not being exposed to Western clinical medicine did not hamper my efforts.
Acceptance into Residency
Financial constraints of that time as a young immigrant without a family had made me apply only for programs in New York City. I had limited time after the tests to apply for 1993 July season. As I had performed well in the interview, I was selected by State University of New York, Brooklyn, and The Coney Island hospital and by the Long Island Jewish Medical Center. I chose LIJMC where I stayed unto the end of my G.I. fellowship. These programs chose me before the NRMP matching as a choice candidate that they did not want to fore go. I signed onto the LIJMC program before the matchever came out in January 1993. Long Island Jewish Medical Center is the Long island campus of the AlbertEinsteinCollege of medicine. Long Island Jewish Medical Center shares the title of clinical and academic hub of the North Shore-Long Island Jewish Health System. It is an 827-bed voluntary, non-profit tertiary care teaching hospital serving the greater metropolitan New York area. Our 48-acre campus is 15 miles east of Manhattan, on the border of Queens and NassauCounties.
LIJMedicalCenter is comprised of three components: Long Island Jewish Hospital, Schneider Children’s Hospital and The Zucker Hillside Hospital. Long Island Jewish Hospital is a 452-bed tertiary adult care hospital with advanced diagnostic and treatment technology, and modern facilities for medical, surgical, dental and obstetrical care. As the Long Island Campus for the Albert Einstein College of Medicine, LIJMC’s graduate medical education program is one of the largest in New YorkState, and programs are in divisions headed by full-time faculty.
LIJ's full-time staff includes more than 500 physicians, who supervise care in all major specialties and participate in the medical center’s extensive teaching and research programs. We welcome you to explore Long Island Jewish Medical Center online and see how we are setting new standards in healthcare.
Performance in Residency
The residency program had two tracks, a single year track to got into specialties like dermatology ad a three year categorical track that led to board certification in Internal medicine and beyond. I was selected for the prestigious three year categorical track and within the first month chosen to become the class leader to do schedules of residents of both the tracks. I remained as the class leader for three straight years and was awarded the leadership award at the end of my residency program.
I have attached several referral letters that I go in that period helping me get into G.I. fellowship in the same hospital. We had a unique course of Advanced Clinical Skills directed by psychiatrist cum internist Dr. Gordon for a month in the internship that was detailed in the mass media. It was intended to make the best out of us in interviewing skills and to train us beyond our level of training in such difficult things as informing bad news to patients. Our interviews were all recorded and I performed throughout the course in an exemplary fashion. The course paved the way towards a successful career for me as the confidence of dealing with difficult situations in clinical care was made easy by it.
Teaching was the strong point of my residency training. I was nominated for the best teaching resident award and the skills continued to help me to finally become a member of various speaker bureaus and also helped me become a faculty in all the hospitals I worked in.
The in service tests graded me consistently high and my clinical skills appreciated. David Danztker, world expert in research on Oxygen transport to tissues was the Chairman of medicine at that time. Kanti Rai, the man who gave the world Rai’s classification of chronic lymphocytic leukemia was one my teachers.
Presentations during Residency:
Constipation presentation and treatment
Prostate cancer presentation and treatment
Pneumonia presentation and treatment
Splenomegaly causes and recognition
Lung cancer presentation and treatment
Recognition for teaching other residents and medical students
I was nominated for the best teaching resident award and was given the leadership Award at the end of my internal medicine residency.
Diplomate ABIM
I took the test for Board Certification In Internal medicine soon after I completed the required three-year training in 1996 and got thru the test in the first ever attempt.
Acceptance into Gastroenterology Fellowship
Gastroenterology fellowship is the toughest sub specialty to get into. The lure of fascinating visual appeal and the wide range of clinical scenarios along with handsome remuneration attract the best into this fellowship. I applied for this fellowship in the second year of my training at Long Island Jewish medical Center in 1994. I had finished an elective in gastroenterology department at our hospital by that time. During the elective I presented to the G.I. grand rounds and participated in learning the smaller procedures of flexible sigmoidoscopy. The chief of G.I., Simmy Bank , MD who is of the Bank’s criteria for Pancreatitis fame took a liking along with the rest of the faculty and made me their number one choice on the NRMP matching for the fellowship positions. I liked my hospital and felt that the G.I. program had the right mix of clinical and endoscopic skills for me. The match result was no surprise and I got into the fellowship at LIJ. The Mount Sinai program at Elmhurst hospital also chose me at that time. The Digestive diseases department at Long Island Jewish hospital was ranked 39 the in the entire country by U.S. news and World report of that time.
Performance in Gastroenterology Fellowship
We had two fellows per year and an advanced fellow doing only ERCPs that are considered highly complex procedures in gastroenterology. Through out the two year stay, I was considered as the fellow with superior medical knowledge and was lauded for my diligence. I gained skill in Endoscopic procedures as well as clinical skills in the field of gastorenterology rapidly. I was given a chance to try the procedures earlier than the others that trained with me and I was chosen to do 6 months of an ERCP advanced rotation in the second year of my training itself. This helped me hone my skills early and for an extended period of time. Six to ten ERCPs were done in a week during that period and Bernard Stark, MD who taught me these procedures was just the second-generation physicians doing these procedures and one of the first to teach students on video endoscopes. The G.I. faculty at Long Island Jewish including the voluntary staff was more than 30. The fellows learned form every body. Seymour Katz, who was the president of the AmericanCollege of Gastorenterology was one of my teachers in LIJ.
As my chief was known for his contribution in acute pancreatitis, several trials of medications like lexipafant for pancreatitis, studies on predicting prognosis of acute pancreatitis were conducted. I also contributed to his unpublished studies on intermittent use of prilosec for prolonged periods and Studies on Interferon therapy in Methadone clinics for hepatitis C during that time.
Original Contribution:
Bank S, Pandaraboyina N, Stark B, et al. Factors that have resulted in the reduced mortality of acute pancreatitis from 1978-1997. ... www.jcge.com/pt/re/jclngastro/fulltext.00004836-200207000-00012.htm
Journal Clubs in fellowship:
Acute pancreatitis and lexipafant
Crohn’s disease and infliximab
ERCP and blocking acetyl choline receptors to avoid post ERCP pancreatitis
Mimicking diseases of IBD
Presentations during the fellowship:
Gastric cancer – an update
Esophageal cancer – an update
Hepato cellular carcinoma – an update
Carcinoid syndrome—presentation at the long island group hospitals
Mucobilia – presentation at the new york society of gastrointestinal endoscopy fellow’s conference at New York hospital medical center, cornell university 1998 april.
MALT lymphomas – long island program meetings.
Acceptance to Hepatology fellowship
Hepatology fellowships are few in number in this country and across the world. The world of Liver diseases and treatment has been the realm of the most eclectic of physicians. The study is considered complex and worthy of reverence. Mount Sinai is the hospital and medical school in existence for more than 125 years. This is the place where the famous journal Seminars in Liver diseases originates. The faculty here is a who’s who in New York City. This has made U.S.news and World report rank Mount Sinai in the top ten consistently in digestive diseases. It is currently ranked as 7th countrywide. I was interviewed for a one year fellowship in Liver diseases and liver transplantaion in 1998. As I had completed most of my gastroenterology skills including ERCP and other therapeutic procedures like Push Enteroscopy, I felt that this was my chance to try for this position. The interview selected me right away with the help of excellent referral letters that I have attached to this text. It was bittersweet to leave Long island Jewish hospital.
Performance in Hepatology Fellowship
We were only 3 fellows in the program. The program was rigorous and demanding. The initial month at the hospital clearly showed my lack of skills in liver diseases. By the end of the year, I was the valedictorian giving the speech on behalf of the fellows at the fellowship awarding dinner.
Swan Thung, a reputed pathologist of Liver diseases who is an author of the book in her name presented me a copy of her book as an appreciation of my hard work.
Several journal clubs included key discussions on forwarding the science in hepatitis c and non-alcoholic steato hepatitis.Dr. Scott Freidman who is the world reputed researcher on Stellate cells that lay the foundation for fibrosis and cirrhosis in the liver was my mentor.
Dr. Bodenheimer, the chief of hepatology and a leading authority on hepatitis C was teaching us weekly.
I was known for the endoscopic procedure of Band Ligation for esophageal varices, liver biopsies and for paracentesis in the hospital and my services were requested by patients repeatedly.
Journal Clubs:
Significance of fatty liver in Hepatitis C
CYP 2 E pathway and steatosis in Alcoholism
Recurrence of Overlap syndrome after Liver transplantation
Hepato cellular carcinoma in hepatitis B
Presentations:
Hepatitis C after liver transplantation: a seminar at Mount SinaiHospital, 1999.
Alcoholic liver disease and Obesity: a seminar at Mount SinaiHospital. 1999.
Role of CYP2A and Stellate cell in fibrogenesis in Alcoholic Liver Disease: a research seminar at Mount SinaiHospital, 1999
Appointment as faculty at Apollo hospitals
Apollo hospitals are the best tertiary care hospital system in India. It has several hundred affiliated hospitals feeding the tertiary centers. The main hospitals of the system are located in Hyderabad, Chennai and New Delhi.
I applied to get into the Hyderabad hospital that has about 300 beds and caters to cardiothoracic surgery and kidney transplantation included, a myriad of specialities of which gastroenterology was one of them. They did not have hepatology and were interested in me because of the same. The reference letters, copies of which are attached helped me get into the hospital with a single interview. The ICU facilities and other ward amenities mimicked those in the USA and it was the first hospital-to-hospital information systems with advanced soft ware back up.
Well-trained specialists from reputed institutes from India, United Kingdom and the United States competed for these jobs. The attending physicians are called consultants and the senior consultants were the best among them. The post of senior consultant was offered to me from the beginning that I continued to have until I left the hospital to come to university of Massachusetts in 2004.
Performance at Apollo hospitals:
We saw the most complicated cases of gastroenterology and liver diseases there. The diseases were somewhat different from the ones I saw in the USA. I saw severe malaria causing liver disease, Hepatitis A and hepatitis E that are uncommon here in the USA. I also saw cases of Non cirrhotic portal hypertension, Indian Childhood cirrhosis and various presentations of hepatitis B.
I was selected to be the faculty of family medicine residency program and Emergency medicine residency program that were run at the hospital. The programs were one of the very few offered across India and attracted candidates across the length and breadth of the country.
Presentations at Apollo hospitals:
Gastro intestinal bleeding at Apollo hospital seminar – a statewide conference
Non Alcoholic Steato hepatitis – Indian gastroenterology association conference at hyderabad
Hepatitis acute and chronic – a key note lecture at MARPHCON, a state wide conference in Maharastra, India.
Portal Hypertension : guest lecture at IFCON 2001.hyderabad, India.
Autoimmune hepatitis, experience and treatment update at City Gastro Meet in Hyderabad, India.2004.
Appointment as faculty at U mass Memorial health Alliance hospitals
University of Massachusetts medical school is ranked 48th in the entire country. The Leominster branch is a community hospital with more than 100 beds that cater to various needs of this community. Residents of the Family practice residency program rotate for a total 2 year period when they are stationed and operate fully at this medical center. I had applied for this hospital from India. I was selected again with the help of the interview and the strength of the references.
The need in this hospital on terms of introduction of hepatology as a specialty and increase the level of care in gastroenterology to therapeutic level including ERCP mainly got me here. The additional skill of teaching residents came along with it.
Performance at Health Alliance hospitals
There is a large need for gastroenterology, hepatology and Interventional gastroenterology in this hospital, a void I readily filled. I introduced to the hospital, Argon Plasma Coagulation, Advanced Liver failure care in the ICU along with nurse training, colon cancer screening program and Comprehensive care of hepatitis C patients.
In two years, my work was appreciated and I was made the Medical Director of Endoscopy, a position highly sought after.
I see more than 3000 patients in the outpatient clinic every year and perform 1200 to 1300 procedures annually.
Presentations while at health Alliance hospitals:
Portal Hypertension, an Update: grand rounds at HealthAllianceHospital, Leominster, MA in January 2005.
Hepatitis C- update, grand rounds at Health alliance hospital, Leominster
March 2006
Nighttime Heart burn, a grand rounds presentation at Athol memorial hospital. March 2006
Series of Lectures to the community about awareness of common ailments like Hepatitis C, Chronic liver diseases, GERD etc.
Hepatitis C, an update: grand rounds at health AllianceHospital, Leominster, MA in 2006.
Colon Cancer screening, an Update: grand rounds at health alliance hospital, Leominster, MA in 2006
Colon cancer screening, an Update: lecture series on behalf of American cancer society at Athol memorial hospital 2006 and NashobaValley medical Center, MA 2006.
Community programs were taken up, examples are cited below,
“Got GERD? Get the facts”January 10, 2005leominster, MA
“What you need to know about irritable bowel syndrome”, may 17, 2006, Leominster, MA
“Living with Liver disease”, October 12, 2006, Leominster, MA
Presentation for Hepatitis C prevention and treatment options at Drug rehabilitation center. Habitiat center, LeominsterMA
Presentation for hepatitis C prevention at City Hall, LeominsterMA
Keynote speaker for Colon Cancer Screening seminar conducted thru American Cancer Society on March 1st, 2007. A conference for convergence of ideas from 5 neighbour-hood hospitals about strategies for colon cancer prevention and treatment.
SPEAKER BUREAU :
Member of the speaker bureau for American Cancer Society
Member of the speaker bureau for Hoffman-la Roche Inc.
Member of the speaker bureau for Wyeth pharmaceuticals
Member of the speaker bureau for TAP pharmaceuticals
Publications
Senior project on Streptococcus bovis bacteremia in a patient with AIDS.
Long term prilosec usage and benefits of spacing dosages, an 8 yr. Follow-up. Unpublished.
Post liver transplant recurrence of overlap syndromes of autoimmune hepatitis, a case series. Exihibition Poster at Indian association for the study of Liver conference April 1999.
MALT lymphomas, an update at Long Island program meetings.1997.
Squamous cell carcinoma , esophagus, an update at Grand rounds at LIJMC.1997
Hepatocellular carcinoma, an Update at Grand rounds at LIJMC.1997
Carcinoid of the rectum and sigmoid colon, an update at Long island program meetings.1998
Mucobilia, and tumor emboli in CBD, a case report, presentation at Cornell University.1998.(NYSGE fellows conference April1998)
Down The G.I. tract , innovative teaching visual slides in gastroenterology, a presentation at a teaching seminar to the residents of internal medicine at LIJMC.1998.
Gastric carcinoma, an update at grand rounds at LIJMC.1998.
Mycobacterium Avium Intracellulare infection of the CBD causing papillary stenosis, a case report at Inter hospital G.I. conference.
Hepatitis C after liver transplantation: a seminar at Mount SinaiHospital, 1999.
Alcoholic liver disease and Obesity: a seminar at Mount SinaiHospital. 1999.
Role of CYP2A and Stellate cell in fibrogenesis in Alcoholic Liver Disease: a research seminar at Mount SinaiHospital, 1999.
Non Alcoholic Steato Hepatitis, an Update at State conference of Indian society of Gastroenterology 2000.
Viral hepatitis : extensive review on Hepatitis E, At MARPHYCON , in Nanded, Maharastra, India. 2002.
Portal Hypertension : guest lecture at IFCON 2001.hyderabad, India.
Autoimmune hepatitis, experience and treatment update at City Gastro Meet in Hyderabad, India.2004.
CME lectures, conducted for local members of the Indian medical Association , a dozen, yearly from 1999 to 2004, in wide ranging topics in gastroenterology and liver diseases throughout the state of Andhra pradesh and parts of the Maharastra state in India.
Portal Hypertension, an Update : grand rounds at HealthAllianceHospital, Leominster, MA in January 2005.
Heartburn, A lecture to the community in Leominster, Massachusetts, January 2005.
Hepatitis C…an update, grand rounds at Health alliance hospital, Leominster
March 2006
Night time Heart burn, a grand rounds presentation at Athol memorial hospital. March 2006
Series of Lectures to the community about awareness of common ailments like Hepatitis C, Chronic liver diseases, GERD etc.
Hepatitis C, an update : grand rounds at health AllianceHospital, Leominster, MA in 2006.
Colon Cancer screening, an Update : grand rounds at health alliance hospital, Leominster, MA in 2006
Colon cancer screening, an Update : lecture series on behalf of American cancer society at Athol memorial hospital 2006 and NashobaValley medical Center, MA 2006.
LEADING & CRITICAL ROLES IN ORGANIZATIONS
At Long Island Jewish MedicalCenter:
Clinical:
As senior house staff in the Internal medicine residency program I was responsible for admitting acutely ill patients from the emergency room, triaging their care and supervising their management on medical floors and in the intensive care units.
The hospital serves a very large indigent population, with more than a third of the patients being Medicaid eligible.The ethnicity of the community includedAfrican American and Hispanic.The community health needs in this part of New York City are great.
On an average, I took care of 15 to 20 patients at a given time and supervised two interns and a medical student. As a senior medical resident, I was in charge of the intensive care and coronary care units at different times.During this period, I had the responsibility of evaluating patients needing intensive care, taking care of these very sick patients, performing life-saving and difficult procedures like cardiopulmonary resuscitation, central line placement, endotracheal intubation, artificial ventilation and treating complex and life-threatening medical conditions like heart attacks, strokes, kidney failure, liver failure, respiratory failure, drug overdoses, comatose patients, etc.
I have independently performed and taught junior residents procedures like basic life support, advanced cardiac life support, endotracheal intubation and mechanical ventilation, insertion of central venous catheters, lumbar punctures and drainage of fluid from the abdomen (paracentesis).
Teaching:
From the beginning of the internship to the end of my residency, for three years, I have taught third and fourth year medical students of AlbertEinsteinCollege Of medicine.
Interns and fellow residents were a part of the teaching at morning rounds and regular rounds on the floor and at the time of admissions.
As senior house-staff, my teaching responsibilities included preparing and presenting interesting cases at morning report, attending and professor’s rounds.The discussions that followed included differential diagnoses, decision making trees, review of the literature, diagnostic and therapeutic approaches and were a valuable learning experience for residents, medical students and physician who attended these conferences.
Other junior staff and medical student teaching experiences included instruction and supervision of various emergent and non-emergent interventional procedures, one on one teaching of bedside clinical skills on ward rounds, analysis of laboratory data, x-rays, urine, sputum and blood smear examinations, reviewing admission & progress notes and ensuring that medication and other orders were accurate and appropriate.
I have taught junior residents and medical students complex medical procedures like lumbar puncture, central venous line placement, arterial puncture, etc. In addition, I assisted junior residents and medical students with their clinical presentations and evaluated their performance at the end of their rotations.
Administrative:
I ran the Cardiac care unit in the second year and the Intensive care unit in the third year of residency.
I was incharge of admissions to the most critically ill medical patients and was the incharge person on call to all inpatient cardiac arrests and other emergencies. I decided the place of admission had the right of discharging a patient.
As G.I. fellow at Long Island Jewish medical center
Teaching
Teaching was an integral part of the fellowship with regular rotations from the internal medicine residency program as an elective to our service and medical students from other medical schools.
Students were taught at G.I. service rounds and on weekly presentations. My teaching was specifically cited on appreciation letters by the program Director of medicine to the G.I. chief, (proof attached).
Residents were trained by me to perform procedures such as flexible sigmoidoscopies, naso gastric tube insertions and abdominal paracentesis.
Administrative
The day-to-day administration of call schedules, fellow rotations and the G.I. inpatient care was a part of the fellowship throughout the two years of G.I. fellowship. Admissions and discharges along with permissions for various procedures were given at that time.
As a fellow at Mount Sinai hospital:
Teaching:
Teaching medical students and internal medicine house staff was an integral part of my fellowship.
Morning rounds in the ward were supervised nd treatment of patients was guided by me.
We also helped the house staff prepare for journal clubs and presentations.
Procedures such as abdominal paracentesis and Liver biopsy were supervised and taught.
Administrative:
Decision making of fellow schedules, patient admission and discharge from floors and decision to move a patient in or out of intensive care units and participation of decision about awarding a patient as the suitable candidate for organ donation were done by me.
As a Consultant at Apollo hospitals:
Teaching :
As faculty in Family medicine and Emergency medicine residency programs, I have given various lectures and guided the students with appropriate steps of patient care in and out of the hospital including the emergency room.
Conducting tests was a part of the training that was instituted.
Adminstrative:
The entire G.I. service was at times catered to solely by me. Decisions about equipment choices, Putting various new drugs on the formulary and supervision of the nursing and allied staff at the G.I. department was a part of my duties.
At the Health Alliance hospitals in Leominster, MA
Teaching:
As a faculty of the Family practice residency program, year round schedule of G.I. teaching is my duty at this hospital. The house staff is well versed with the management of cirrhosis patients in this hospital.
I have also taken up the responsibility of teaching the nursing staff to upgrade their knowledge of handling gastroenterology and liver patients including in-serive of endoscopy nurses about new equipment.
Grand rounds at the hospital and the medical staff meetings are used as forums to teach the attending physicians of the hospital.
Administrative:
As recently appointed Director of the Endoscopy and Minor Surgery area and before the official responsibility was given to me, choices about equipment purchase, choices of method of patient care including choice of administration of conscious sedation were a part of my duties.
I also oversee the staff in my office including the office work, billing and the nursing staff. I also oversee the hepatitis C treatment program in the office.
Judge of Work of Others
Clinical:
As senior resident
As G.I. fellow
As Hepatology fellow
Evaluating medical students at LIJ
Evaluating Residents in g.I. fellowship
Evaluating medical students and interns at Mount Sinai
Lectures to Residents and Fellows
G.I. Grand rounds
Liver grand rounds
Apollo hospitals mortality and morbidity conferences
Leominster medical staff meetings and morbidity assessments of collegues in medicine and gastroenterology
Presentations at Apollo Hospitals
presentations at Leominster
Contributions to my field
Clinical
Teaching
Administrative
Presentations and lectures
MALT lymphomas, an update at Long Island program meetings.1997.
Squamous cell carcinoma , esophagus, an update at Grand rounds at LIJMC.1997
Hepatocellular carcinoma, an Update at Grand rounds at LIJMC.1997
Carcinoid of the rectum and sigmoid colon, an update at Long island program meetings.1998
Mucobilia, and tumor emboli in CBD, a case report, presentation at Cornell University.1998.(NYSGE fellows conference April1998)
Down The G.I. tract , innovative teaching visual slides in gastroenterology, a presentation at a teaching seminar to the residents of internal medicine at LIJMC.1998.
Gastric carcinoma, an update at grand rounds at LIJMC.1998.
Mycobacterium Avium Intracellulare infection of the CBD causing papillary stenosis, a case report at Inter hospital G.I. conference.
Hepatitis C after liver transplantation: a seminar at Mount SinaiHospital, 1999.
Alcoholic liver disease and Obesity: a seminar at Mount SinaiHospital. 1999.
Role of CYP2A and Stellate cell in fibrogenesis in Alcoholic Liver Disease: a research seminar at Mount SinaiHospital, 1999.
Non Alcoholic Steato Hepatitis, an Update at State conference of Indian society of Gastroenterology 2000.
Viral hepatitis : extensive review on Hepatitis E, At MARPHYCON , in Nanded, Maharastra, India. 2002.
Portal Hypertension : guest lecture at IFCON 2001.hyderabad, India.
Autoimmune hepatitis, experience and treatment update at City Gastro Meet in Hyderabad, India.2004.
CME lectures, conducted for local members of the Indian medical Association , a dozen, yearly from 1999 to 2004, in wide ranging topics in gastroenterology and liver diseases throughout the state of Andhra pradesh and parts of the Maharastra state in India.
Portal Hypertension, an Update : grand rounds at HealthAllianceHospital, Leominster, MA in January 2005.
Heartburn, A lecture to the community in Leominster, Massachusetts, January 2005.
Hepatitis C…an update, grand rounds at Health alliance hospital, Leominster
March 2006
Night time Heart burn, a grand rounds presentation at Athol memorial hospital. March 2006
Series of Lectures to the community about awareness of common ailments like Hepatitis C, Chronic liver diseases, GERD etc.
Hepatitis C, an update : grand rounds at health AllianceHospital, Leominster, MA in 2006.
Colon Cancer screening, an Update : grand rounds at health alliance hospital, Leominster, MA in 2006
Colon cancer screening, an Update : lecture series on behalf of American cancer society at Athol memorial hospital 2006 and NashobaValley medical Center, MA 2006.
Community Participation :
Presentation for Hepatitis C prevention and treatment options at Drug rehabilitation center. Habitiat center, LeominsterMA
Presentation for hepatitis C prevention at City Hall, LeominsterMA
Keynote speaker for Colon Cancer Screening seminar conducted thru American Cancer Society on March 1st, 2007. A conference for convergence of ideas from 5 neighbour-hood hospitals about strategies for colon cancer prevention and treatment.
Memberships to distinguished societies, licensure and certification
B.Membership of societies
·American Medical Association(AMA)-AMA is one of the finest and oldest physician organizations in the world. It is found in 1847 and is the nation’s leader in promoting professionalism in medicine and setting standards for medical education, practice, and ethics. This medical society has also been the powerhouse of medical publishing. AMA keeps a profile of physicians and their outstanding achievements in the field of medicine. This association is represents all physicians in the United States. To be eligible for membership, a physician must have passed the United States Medical Licensing Examinations and hold an active license to practice medicine in the United States. After successfully passing through a complete background check, physicians are accepted into membership in the AMA.
·AmericanCollege of Physicians-American Society of Internal Medicine (ACP-ASIM)-ACP-ASIM is the nation’s largest medical specialty society. It is the only society of internists dedicated to establishing standards, providing information and education, advocating for the public, patients and members, promoting research and recognizing excellence in the field. To be promoted to full membership with voting rights, the candidate must be board certified in internal medicine by the ABIM and have outstanding characters, ethics and medical activities. In order to be a member of the American College of Physicians, the candidate must holds a degree of Doctor of Medicine acceptable to the Board of regents and be a licensed physician (in good standing) in practice, teaching or research. The candidate must also present evidence of having satisfied the qualifications for admission to the American Board of Internal Medicine; be sponsored and seconded by two current members, with reference to character, ethics, and medical activities; and be endorsed by the appropriate ACP governor.
Member of American Gastroenterological Association
The American Gastroenterological Association (AGA) is dedicated to the mission of advancing the science and practice of gastroenterology. Founded in 1897, the AGA is the oldest medical-specialty society in the United States. Comprised of two non-profit organizations — the AGA and the AGA Institute — our 15,500 members include physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver.
The AGA, a 501(c6) organization, administers all membership and public policy activities, while the AGA Institute, a 501(c3) organization, runs the organization’s practice, research and educational programs. On a monthly basis, the AGA Institute publishes two highly respected journals, Gastroenterology and Clinical Gastroenterology and Hepatology. The organization's annual meeting is Digestive Disease Week®, which is held each May and is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
Member of the American Association for the Study of Liver Diseases:
For generations, The American Association for the Study of Liver Diseases (AASLD) has been a catalyst for the investigation and treatment of liver diseases. The American Association for the Study of Liver Diseases (AASLD) upholds the standards of the profession and fosters research that generates improved treatment options for the millions of patients with liver disease.
As the leading organization focused solely on advancing the science and practice of hepatology, The American Association for the Study of Liver Diseases (AASLD) offers scientific educational symposia developed by leading hepatologists. Each event offers Continuing Medical Education (CME) and features expert speakers presenting the finest data in the most current and critical topics of liver disease. Only The American Association for the Study of Liver Diseases (AASLD) events meet the increasing demand of hepatology's growing importance as a medical specialty by providing participants the opportunity to exchange research, discuss outcomes, and interact with colleagues focused on liver and biliary diseases.
The Liver Meeting: The American Association for the Study of Liver Diseases (AASLD) ’s Annual Meeting- the premier event in the science and practice of hepatology where the cutting edge in the study and treatment of liver and biliary diseases is defined. The more than 2,000 abstracts submitted undergo an extensive, blinded peer-review process to identify the best selection for presentation in both poster and oral sessions. With four and a half days of courses and workshops, plenary, parallel and poster sessions, scientific exhibits and state-of-the-art lectures, The Liver Meeting meets a wide range of professional needs.
Postgraduate Course: Held each year in conjunction with The Liver Meeting, the postgraduate course highlights a significant issue of liver research facing physicians today.
Digestive Disease Week®: DDW® is sponsored through the partnership of four leading medical societies focused on the digestive system: The American Association for the Study of Liver Diseases (AASLD), American Gastroenterological Association (AGA), American Society for Gastrointestinal Endoscopy (ASGE), and Society for Surgery of the Alimentary Tract, Inc. (SSAT). Held in conjunction with DDW®, the The American Association for the Study of Liver Diseases (AASLD) Clinical Research Workshop draws a capacity crowd to discuss key developments in the clinical investigation of liver disease.
Single Topic Conferences: Developed by leading hepatologists, these limited-attendance events focus on the most current and critical topics of liver disease and provide participants the ideal opportunity to exchange research, discuss outcomes, and develop new research interests. Each year, The American Association for the Study of Liver Diseases (AASLD) sponsors two to four Single Topic Conferences in clinical, basic, hepatitis, or pediatric hepatology.
HEPATOLOGY: The official journal of The American Association for the Study of Liver Diseases (AASLD) is the most cited reference on liver and biliary tract information. The publication delivers the latest research findings, as well as other relevant information, to subscribers monthly.
Liver Transplantation: The peer-reviewed, monthly journal of the The American Association for the Study of Liver Diseases (AASLD) and International Liver Transplantation Society, is an excellent source of new data regarding the research and practice of surgery of the liver.
The American Association for the Study of Liver Diseases (AASLD) 's membership encompasses ALL professionals dedicated to hepatobiliary discoveries and patient care. Mentoring, the sharing of knowledge, and dedication to professional growth and development are among the core values of The American Association for the Study of Liver Diseases (AASLD) and its members. From complimentary journal subscriptions, to no or reduced registration fees for meetings and educational events, membership in The American Association for the Study of Liver Diseases (AASLD) offers an economical opportunity to learn from, interact with and remain in contact with the leading professionals in the field.
Member of The AmericanCollege of Gastroenterology
(ACG) was founded in 1932 to advance the scientific study and medical practice of diseases of the gastrointestinal (GI) tract. The College promotes the highest standards in medical education and is guided by its commitment to meeting the individual and collective needs of clinical GI practitioners.
To advance knowledge of gastrointestinal disease
To educate specialists in gastrointestinal disease
To represent the interests of the clinician practicing in the field of gastroenterology
To ensure quality in patient care
To promote patient education on gastrointestinal conditions and digestive health
More than 9,000 physicians from 75 countries are members of the ACG. Through annual scientific meetings, the American Journal of Gastroenterology, regional postgraduate training courses and research grants, the ACG provides its members with the most accurate and up-to-date scientific information on digestive health and the etiology, symptomatology and treatment of GI disorders. ACG's advocacy in the public policy arenas, and the work of the ACG's 22 committees have made tremendous strides with many premiere accomplishments to improve the future of clinical gastroenterology and the quality of care available to patients with GI conditions and diseases, today. The information exchange and training acquired through College membership provide physicians with the knowledge necessary to offer the most effective patient care and to meet the challenges of today's changing health care system.
Member of Massachusetts Medical Society
The Massachusetts Medical Society, the oldest continuously operating medical society in the United States, was established as a professional association of physicians by the Commonwealth of Massachusetts in an Act of Incorporation, Chapter 15 of the Acts of 1781, just days after the Revolutionary War’s climactic Battle of Yorktown.
One of the key powers that the state legislature gave the Society was the power to, in effect, license physicians. The president and fellows of the Society were given the power to “examine all Candidates for the Practice of Physic and Surgery … and if upon such Examination said Candidates shall be found skilled in their Profession, and fitted for the Practice of it, they shall receive the Approbation of the Society.”
A written public notice in 1781 by John Warren, one of the Society’s 14 founding members, provides an important additional intention of the founding members.
“The design of the institution,” he wrote, “is to promote medical and surgical knowledge, inquiries into the animal economy & the promotion & effects of medicine.” In time, the power to license was assumed by the Commonwealth. Yet the missions of education and advocacy continue to guide the Society’s activities today, more than 200 years later.
The Public's Health
In 1842, the Massachusetts Medical Society, in concert with the American Statistical Association and the AmericanAcademy of Arts and Science, led the effort to establish a statewide system to collect and publish vital statistics of the Commonwealth. In a memorial to the state legislature calling for passage of the act, a committee established by the Medical Society stated:
"Many of the causes of disease, as they affect different communities engaged in a great variety of occupations, can only be ascertained by observations on an extensive scale, far beyond the reach of individual research. An accurate return of deaths from the different sections of the state, for a series of years, would greatly aid in the investigation of these causes, and would doubtless do much towards enabling us to find means for the removal of some of them."
The result was the passage of the first state vital statistics registration act in the United States. This act would serve as a model for other states as they began to establish their own systems of registration.
The Massachusetts Medical Society continued to serve the public's interest throughout the nineteenth century. In 1861 the Medical Society petitioned the legislature to establish a State Board of Health for the "purposes of looking after the sanitary interests of the people." It would take eight more years before the legislature established the State Board of Health, which later became the Massachusetts Department of Public Health.
Medical Information
The incorporators of the Medical Society in 1781 envisioned a Society that would "engage in the publication and distribution of journals and periodicals to be devoted primarily to the science and practice of medicine and to conduct educational programs." In 1812, John Collins Warren, M.D., who later became president of the Medical Society (1832), established The New England Journal of Medicine and Surgery and the Collateral Branches of Science. In 1828 this journal merged with the Medical Intelligencer (established in 1823) and became the weekly Boston Medical and Surgical Journal. In 1914 the Boston Medical and Surgical Journal became the official organ of the Medical Society and began publishing the Medical Society's proceedings. In 1921 the Medical Society purchased the Boston Medical and Surgical Journal for one dollar.
One hundred years after its founding, the Boston Medical and Surgical Journal's name was changed in 1928 to The New England Journal of Medicine. The Journal has become the premier medical publication in the world, achieving a position in medical publication that could not have been imagined by the MMS incorporators in 1781.
In 1969, through an act of the state legislature, the Society updated its mission to read: "The purposes of the Massachusetts Medical Society shall be to do all things as may be necessary and appropriate to advance medical knowledge, to develop and maintain the highest professional and ethical standards of medical practice and health care, and to promote medical institutions formed on liberal principles for the health, benefit and welfare of citizens of the commonwealth."
Member of AmericanCollege Of Gastroenterology
Membership in the AmericanCollege of Gastroenterology is multidisciplinary, including gastroenterologists, surgeons, radiologists, hepatologists, pediatricians, pathologists and others with a shared interest in the care of patients with digestive diseases. The College promotes the highest standards in medical education and is guided by its commitment to meeting the needs of clinical gastroenterology practitioners. More than 9,000 physicians from 75 countries are members of the ACG.
·Member of AAPI (Association of American physicians of Indian origin):AAPI is a national organization representing 41,235 physicians, and 12,000 medical students, residents and fellows of Indian Origin in the US. It serves as an umbrella organization representing over 130 regional, alumni and specialty organizations.The organization envisages a vision to promote professional solidarity in the pursuit of excellence in patient care, teaching and research.
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LICENSE:
LICENSED TO PRACTICE IN NEW YORKSTATE FROM 1999. NO.214720.
LICENSED TO PRACTICE IN MASSACHUSETTS FROM 2004.
No. 222879
LICENSE TO PRACTICE IN ANDHRAPRADESHSTATE IN INDIA FROM 1991.
CERTIFICATIONS
2000NOVEMBER – AMERICAN BOARD OF INTERNAL MEDICINE, SUBSPECIALITY BOARDS – GASTROENTEROLOGY. Valid till 2010.No. 169113
1996AMERICAN BOARD OF INTERNAL MEDICINE – VALID TILL 2006 No. 169113
A weekly column about various topics in gastroenterology and hepatology was published by me in the newspaper ANDHRA JYOTHI, circulated in India that reaches the needs of 70 million population. This was for a period of one whole year starting February 2004.
Some of the copies of these are attached.
Appearance in Teja television evening newscast enumerating the perils of Alcoholism.
Mention in Leominster Sentinel.
Article heavily quoting me in Gardner News.
Community service
To the general public to increase awareness,
“Got GERD? Get the facts”January 10, 2005leominster, MA
“What you need to know about irritable bowel syndrome”, may 17, 2006, Leominster, MA
“Living with Liver disease”, October 12, 2006, Leominster, MA
Presentation for Hepatitis C prevention and treatment options at Drug rehabilitation center. Habitiat center, LeominsterMA
Presentation for hepatitis C prevention at City Hall, LeominsterMA
Keynote speaker for Colon Cancer Screening seminar conducted thru American Cancer Society on March 1st, 2007. A conference for convergence of ideas from 5 neighbour-hood hospitals about strategies for colon cancer prevention and treatment.
