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How To Recognize Scoliosis In Your Child And What To Do Next

Westchester Health Blog - Wed, 09/20/2017 - 11:56

About 1 in 25 adolescent girls and 1 in 200 teenage boys develops scoliosis. At Westchester Health, scoliosis is something we see often. It’s a fairly serious condition that we feel parents need to be aware of so they can recognize the symptoms in their child and if need be, seek treatment. That’s why we’d like to share this excellent blog by Lauren Adler, MD, FAAP, a pediatrician in our Westchester Health Pediatrics group, about the causes of scoliosis and the different ways it can be treated.

Scoliosis shows up most often during growth spurts, usually when children are between 10 and 15 years old. Scoliosis that is diagnosed during the teen years usually continues into adulthood. The greater the angle of the spinal curve, the more likely it is to increase over time.

The many causes of scoliosis of the spine

Lauren Adler, MD, FAAP

When looking at someone’s back, the spine should run straight down the middle. When a person has scoliosis, the backbone curves to the side in a pronounced S shape. The angle of the curve may be small, large or somewhere in between, but anything that measures more than 10 degrees is considered scoliosis. You can often tell that someone has scoliosis by their body posture. They tend to lean to one side, have a sunken chest and have uneven, rounded shoulders.

Scoliosis can occur as a complication of polio, muscular dystrophy or other central nervous system disorder, but 80% of cases are idiopathic—of unknown cause. Very often, a family member has also had scoliosis. If you or one of your children has scoliosis and you have other children, make sure they are screened regularly.

But having said that, some kinds of scoliosis do have clear causes. These are divided into two types: structural and nonstructural.

In nonstructural scoliosis, the spine works normally but looks curved. This may be due to one leg being longer than the other, muscle spasms or inflammations (such as appendicitis). When these problems are treated, this type of scoliosis often goes away.

In structural scoliosis, the curve of the spine is rigid and cannot be reversed. This can be caused by:

  • Cerebral palsy
  • Muscular dystrophy
  • Birth defects
  • Infections
  • Tumors
  • Genetic conditions such as Marfan syndrome and Down syndrome

NOT TRUE: Contrary to what some people believe, scoliosis is not caused by childhood sports injuries, heavy backpacks or poor posture.

2 most common treatments for scoliosis

The decision to treat scoliosis depends upon both the severity of the curve as well as the patient’s skeletal maturity.  Patients who are less skeletally mature have more growth ahead of them and therefore their curve is more likely to progress.

  • Curvature of the spine of more than 25 degrees may call for bracing. There are two main types of orthopedic back braces: 1) The Milwaukee brace has a neck ring and can correct curves anywhere in the spine, and 2) the thoracolumbosacral orthosis corrects deformities involving the vertebrae of the thoracic spine and below. The device fits under the arm and wraps around the ribs, hips and lower back. Scoliosis patients can expect to wear the brace all but a few hours a day until their spinal bone growth is complete, which for girls is usually between ages 17 and 18, and between 18 and 19 for boys. Wearing an orthopedic brace usually interferes only minimally with a person’s physical activity, with contact sports and trampolining being the only “off-limits” activities.
  • The procedure to surgically correct scoliosis is called posterior spinal fusion and instrumentation, and is typically recommended when the spine’s curvature is 40 degrees or more. It fuses the affected vertebrae using metal rods and screws to stabilize that part of the spine until it has fused together completely. People who have this surgery still face some restrictions on physical activity but can stop wearing the brace.
How you can help your child wear a back brace

Only about 50% of teenage scoliosis patients wear their braces. This is why parents play such a significant role in getting their child to comply with their doctor’s instructions, hopefully by explaining how it will pay great benefits in the future.

At the same time, we stress to our parents that they need to be sensitive to the tremendous impact this condition has on a young person’s body image, self-confidence and social standing at school, not to mention the restrictions it puts on their physical activity. In some cases, we refer young patients who are having trouble with the emotional aspects of scoliosis to get professional help from a therapist or counselor.

Does your child have scoliosis? Come see us, we can help.

If your child has scoliosis, or if you are concerned that he/she might be developing it, please make an appointment with Westchester Health. One of our pediatricians will examine your child, make a diagnosis and if warranted, refer you to a specialist for further diagnosis and treatment. Working together, we’ll make sure your child gets the help he/she needs. Whenever, wherever you need us, we’re here for you.

To read Dr. Adler’s blog in full, click here.

Categories: Blog

The Flu Vaccine Is In!

Westchester Health Blog - Fri, 09/15/2017 - 11:46
Our flu vaccine is in! Book your appointment now to get your family vaccinated.

Even though winter is still a few months away, now is the time to get your family vaccinated. Don’t delay — protect yourself and everyone in your family by getting the flu vaccine at any of our Westchester Health locations. Call (914) 232-1919 and we’ll help you find the Westchester Health office closest to you or click here.

Yes the flu shot works and at Westchester Health, we strongly recommend it!

Some people do not get the flu shot because they say it gives them the flu. This is a misconception; whenever you get any vaccine, your body mounts an immune response to produce antibodies to defend itself in case it contracts that illness in the future. REMEMBER: A mild reaction to the flu shot is always better than what the actual flu virus would be like.

Learn more about the flu
  • Maryann Buetti-Sgouros, MD, one of our WHP pediatricians, has written a very informative blog about the flu, the difference between the flu and a cold, and why everyone should get vaccinated. To read Dr. Buetti-Sgouros’ blog, click here.
  • Rodd Stein, MD, FAAP, another of our WHP pediatricians, has written a detailed, in-depth white paper and produced a highly educational webinar on immunization, its history, its importance, and what would happen if we all stopped vaccinating ourselves and our children. To download the free white paper and webinar, click here.
Call for an appointment for a flu shot.

Please call now to make an appointment with Westchester Health to get your family vaccinated against the flu. Whenever, wherever you need us, we’re here for you.

Categories: Blog

How To Take The Stress Out of Flying With Your Baby

Westchester Health Blog - Tue, 09/12/2017 - 11:37

There’s nothing worse than being seated near a screaming baby on an airplane (unless, of course, you’re that baby’s parent). To help everyone—babies, parents and fellow passengers—have a more pleasant flight, Maryann Buetti-Sgouros, MD, FAAP, a pediatrician in our Westchester Health Pediatrics group, offers these important bits of advice in a recent blog.

Best ways to keep your baby from crying on an airplane

Maryann Buetti-Sgouros , MD, FAAP

First, is your baby hungry, wet or dirty, cold or hot, or bored? If it’s bright outside, try closing the window shade. If your baby seems to want a view, direct his/her attention outside of the window or in the pages of the airline’s magazine. If all else fails and your little one wails incessantly no matter what you do, try not to let other passengers’ dirty looks bother you.

Ear pain might be the problem

Anyone who’s flown before knows that ears can be very sensitive to changes in pressure. This is because the outer ear is separated from the middle ear by a thin membrane called the tympanic membrane, or ear drum. Experiencing a difference in pressure across this membrane causes a sensation that as many as 1 in 3 passengers (children more so than adults) experience as temporary muffled hearing, temporary discomfort, or even pain. Unfortunately, having a stuffy nose or a head cold increases a child’s chances of ear problems.

If your baby has a cold or ear infection and absolutely needs to fly, consider giving him/her an infant pain reliever. (Decongestants are not recommended for infants.) If your baby is exhibiting significant ear discomfort from the cold and/or ear infection, it may simply be best, if possible, to postpone the flight. If your travel plans are not flexible, be aware that you may very well be dealing with ear pain and be prepared.

Giving your baby something to suck on works wonders

As many a parent knows, a tried and true deterrent to crying on an airplane is sucking. Try to get your baby to take a bottle, breast or pacifier during the times when the pressure changes in the cabin are likely to be greatest, namely, during takeoff and initial descent (not landing). The pressure change is typically most noticeable as much as a half hour or more before landing, depending on a flight’s cruising altitude. The higher up you are, the earlier in the flight the descent usually starts. If sucking doesn’t keep your baby quiet, or if he/she won’t take the bottle/breast/pacifier, try rubbing the ears, rocking and singing a soothing song.

Anxious about flying with your baby? Come see us, we can help.

If you’re planning a trip with your baby that involves flying, please make an appointment with Westchester Health. One of our pediatricians will answer all your questions and offer guidance and advice for preventing crying while in the air, as well as ways to deal with it if it does happen, in spite of all your efforts. Whenever, wherever you need us, we’re here for you.

To read Dr. Buetti-Sgouros’s blog in full, click here.

Categories: Blog

How To Recognize And Avoid Asthma Triggers In Your Child

Westchester Health Blog - Tue, 09/05/2017 - 11:24

At Westchester Health, we see a lot of kids with asthma and a lot of worried parents wondering how to treat and/or prevent this disease. To help kids and their parents know how to manage this challenging condition, Mason Gomberg, MD, a pediatrician in our Westchester Health Pediatrics group, offers the following information, tips and advice in a recent blog.

Diagnosing asthma is sometimes very difficult

Mason Gomberg, MD

Especially in young children, it’s sometimes hard to be entirely certain that asthma is the diagnosis. The following details help us determine if your child does, in fact, have asthma:

  • The type of symptoms: specifically, wheezing, coughing, shortness of breath, vocal cord dysfunction
  • What triggers the symptoms or when the symptoms get worse
  • Medications that were tried and if they helped
  • Any family history of allergies, asthma or eczema (allergic triad)

After gathering this information, the next thing we do is test your child’s airway function. One way to do this is with a pulmonary function test using a device called a spirometer. This measures the amount of air blown out of the lungs over time.

We may also test your child’s pulmonary function after administering asthma medication. This helps confirm that the blockage in the air passages that shows up on pulmonary function tests goes away with treatment.

Most common triggers
  1. Allergens (things your child might be allergic to). Most children with asthma have allergies, and allergies are a major cause of asthma symptoms.
  • House dust mites
  • Animal dander
  • Cockroaches
  • Mold
  • Pollens
  1. Infections of the airways
  • Viral infections of the nose and throat
  • Other infections, such as pneumonia or sinus infections
  1. Irritants in the environment (outside or indoor)
  • Cigarette/cigar smoke and other smoke
  • Air pollution
  • Cold air and/or dry air
  • Odors, fragrances, irritating compounds in sprays, and cleaning products
  • Wood burning stoves in the winter
  1. Exercise. Approximately 80% of people with asthma develop wheezing, coughing and a tight feeling in the chest when they exercise.
  1. Stress
7 best ways to help your child avoid asthma triggers

While it is impossible to make your house completely allergen or irritant-free, there are many things you can do to reduce your child’s exposure to triggers and limit the severity of a possible asthma attack. In addition, limiting your child’s exposure to triggers will help decrease symptoms as well as the need for asthma medications.

  1. Do not smoke or let anyone else smoke around your child.
  2. Reduce exposure to dust mites. The best way to do this is to cover your child’s mattress and pillows with special allergy-proof casings, wash his/her bedding in hot water every 1-2 weeks, remove stuffed toys from the bedroom, and vacuum and dust regularly. Other avoidance measures, which are more difficult or expensive, include reducing the humidity in the house with a dehumidifier or removing carpeting in the bedroom. Bedrooms in basements should not be carpeted.
  3. If your child is allergic to furry pets, the only really effective means of reducing exposure to pet allergens is to remove the pets from your home. If this is not possible, keep the pets out of your child’s bedroom and consider: putting a high-efficiency particulate air (HEPA) filter in his/her bedroom, removing the carpeting, covering mattress and pillows with mite-proof casings, and washing the pets regularly.
  4. Reduce cockroach infestation by regularly exterminating, setting roach traps, repairing holes in walls or other entry points, and not leaving food or garbage exposed.
  5. Mold in homes is often due to excessive moisture indoors, which can result from water damage due to flooding, leaky roofs, leaking pipes or excessive humidity. It’s important to repair any sources of water leakage and to control indoor humidity by using exhaust fans in the bathrooms and kitchen. Add a dehumidifier in areas with high humidity. Clean any mold contamination with detergent and water. You may need to replace porous materials (such as wallboards) if they have become contaminated with mold.
  6. Pollen exposure can be reduced by using an air conditioner in your child’s bedroom (with the vent closed) and leaving doors and windows closed during high pollen times.
  1. Reduce indoor irritants by using unscented cleaning products and avoiding mothballs, room deodorizers and scented candles.
  1. Diligently check air quality reports (radio weather forecasts or on the internet). When air quality is poor, keep your child indoors and be sure he/she takes the prescribed asthma control medications.
Worried that your child may have asthma? Come see us, we’re here to help.

If you think your child might have asthma, or if you want guidance for managing his/her asthma and the triggers that make it worse, please make an appointment with Westchester Health. One of our pediatricians will diagnose whether or not your child does indeed have asthma and if so, we will decide on the best course of treatment. Our #1 goal is for you and your child to be as informed as possible about this serious health condition so that you can better manage it and help your child live a healthy, happy life. Whenever, wherever you need us, we’re here for you.

To read Dr. Gomberg’s blog in full, click here.

Categories: Blog

What You Need To Know About Lyme Disease Going Into Fall

Westchester Health Blog - Tue, 08/29/2017 - 11:56

Even though the summer is winding down and we’re heading into fall, we at Westchester Health still want to emphasize what a serious disease this is. For up-to-date information about how to avoid Lyme disease and what to do if you think you’ve been bitten by a tick, we refer you to an excellent blog written by Lauren Adler, MD, FAAP, a pediatrician in our Westchester Health Pediatrics group.

Lyme disease has three stages: early localized, early disseminated and late Early stage

Lauren Adler, MD, FAAP

Fortunately, 90% of children infected with Lyme disease exhibit the classic red “bullseye” rash that is typical of this early stage, developing within 7-14 days after a tick bite. This rash is usually flat, not painful, is at least 5 cm in diameter and continues to expand over days, possibly weeks. It may also be accompanied by additional symptoms, including fever, headache, dizziness, body aches and fatigue. Testing for Lyme infection at this stage is not helpful because results are often negative and an accurate diagnosis can be made visually. Early stage Lyme disease is easily treated with 14-21 days of oral antibiotics and 90% of patients have complete resolution of symptoms.

Early disseminated stage

The early disseminated stage of Lyme disease occurs 3-5 weeks after the initial bite and can cause multiple red bullseye rashes, facial nerve palsies (Bell’s palsy), meningitis and carditis. In children with Lyme, 3% will exhibit facial nerve palsy and 1% meningitis.

Late stage

Late stage Lyme disease includes arthritis with redness, pain and swelling of a joint, as well as more significant cardiac and neurologic symptoms. Depending upon the individual case, early disseminated Lyme and late stage Lyme can be treated with 21-28 days of oral or IV antibiotics.

What to do if you’ve been nitten by a tick

Checking your children and yourself for ticks at the end of a day spent outdoors is the best prevention. If a tick is removed quickly, it cannot transmit Lyme.

The best way to remove a tick: Using a wet, soapy towel, rub counterclockwise over the tick. This technique removes the majority of ticks without leaving mouth parts behind. However, it is important to note that if parts are left behind, they are not dangerous and will not cause Lyme disease. Similar to removing a splinter, the best thing to do is clean the area with soap and water, then continue to soak the area with wet compresses or in the tub until they come out.

Insect repellent is also important. The most effective repellents are ones that contain 10-30% DEET. If used properly, they are safe to use on infants and children over the age of 2 months.

We do not recommend sending a tick to a lab for testing. Many of our parents ask us if they should get a tick tested for Lyme after they have removed it. This is not helpful for several reasons. First, if the test is positive, it does not mean that the tick has actually transmitted Lyme to its human host, and therefore treatment would not be recommended. Second, chances are that it will take several weeks for the test results to come back. However, if a child develops symptoms during that time, we would recommend starting treatment regardless, right away. Third, a negative test can give a false sense of security. Many cases of Lyme disease are likely contracted from tick bites that go undetected, and even though one test may be negative, it does not mean that a different bite from an infected tick has not happened as well.

Antibiotic prophylaxis for a tick bite. In certain cases, a single dose of doxycycline can be used as prophylaxis after a tick bite. Small studies have shown effectiveness when the tick was an adult or nymphal ixodes tick, it was attached for at least 36 hours, treatment is initiated within 72 hours of the bite and the patient is able to take doxycycline. Doxycycline is not recommended for children less than 8 years of age due to concerns over tooth enamel hypoplasia and permanent discoloration of the teeth. Again, it is important to remember that many cases of Lyme are caused by undetected tick bites. If the tick is detected and removed within 48 hours, Lyme disease will not have been transmitted.

If you think you or your child has been bitten by a tick, please contact us

If you suspect you or your child may have contracted Lyme disease from a tick bite, please make an appointment with Westchester Health to see one of our physicians for an accurate diagnosis and treatment. The sooner we can begin treatment, the faster we can stop the development of the disease and prevent long-lasting consequences.

To read Dr. Adler’s blog in full, click here.

Categories: Blog

How To Know If You Have A Detached Retina

Westchester Health Blog - Mon, 08/21/2017 - 11:32

A detached retina is a serious condition that could possibly cause vision loss in that eye, and occurs when the retina becomes separated from its underlying supportive tissue. If the retina gets torn, the fluid inside the eye can leak underneath and separate the retina from its underlying tissue. Because the retina cannot function when these layers are detached, it needs to be reattached as soon as possible or permanent vision loss can result. I tell all of my patients that if they experience any of the symptoms of a detached retina, they should not wait but come see me, or another eye doctor, immediately.

Symptoms and signs of a detached retina

William B. Dieck, MD, FAAO

If you suddenly notice spots, floaters (small flecks or threads), flashes of light or a darkening of your peripheral (side) vision, you may be experiencing the warning signs of a detached retina. Your vision might become blurry, or you might have poor vision. Another sign is seeing a shadow or a curtain descending from the top of the eye or across your field of vision from the side.

These signs can occur gradually as the retina pulls away from the supportive tissue, or they may occur suddenly if the retina detaches all at once. Up to 50% of people who experience a retinal tear will have a retinal detachment. No pain is associated with retinal detachment, so sometimes people don’t realize what is happening.

If you experience any of these signs, consult your eye doctor right away. Immediate treatment greatly increases your odds of regaining any lost vision.

What causes retinal detachments?
  1. An injury to the eye or face.
  1. Extreme nearsightedness (myopia) because very nearsighted people have longer eyeballs with thinner retinas that are more prone to detaching.
  1. LASIK surgery in very nearsighted people (on rare occasions).
  1. Cataract surgery, tumors, eye disease and systemic diseases such as diabetes and sickle cell disease.
  1. New blood vessels growing under the retina (which can happen in diseases such as diabetic retinopathy) may push the retina away from its support network.
  2. Sometimes fluid movement in the eye pulls the retina away.
  3. Family history of retinal detachment.
How to treat a detached retina

If you have a detached retina, you’ll need surgery to repair it. The procedure is usually performed by a retinal specialist—an ophthalmologist who has undergone advanced training in the medical and surgical treatment of retinal disorders.

The sooner the retina is reattached, the better your chances that your vision can be restored. There a few surgical procedures used to treat a retinal detachment, including:

1. Scleral buckling surgery. This is the most common retinal detachment surgery. This procedure consists of attaching a small band of silicone or plastic to the outside of the eye (sclera). This band compresses (buckles) the eye inward, reducing the pulling (traction) of the retina and thereby allowing the retina to reattach to the interior wall of the eye. The scleral buckle is attached to the posterior portion of the eye and is invisible after surgery.

2. Scleral buckling surgery often is combined with one of the following procedures to fuse the retina to its underlying supporting tissue:

a) Vitrectomy. In this procedure, the clear jelly-like fluid is removed from the posterior chamber of the eye (vitreous body) and replaced with clear silicone oil to push the detached portion of the retina back onto the RPE.

b) Pneumatic retinopexy. In this procedure, the eye surgeon injects a small bubble of gas into the vitreous body to push the detached portion of the retina onto the RPE. If the detachment is caused by a tear in the retina, the surgeon usually uses a laser or a freezing probe to attach the retina firmly onto the RPE and underlying tissues and thereby seal the tear.

Be aware that surgical reattachment of the retina is not always successful, and depends on the location, cause and extent of the retinal detachment, as well as other factors.

Also, successful reattachment of the retina does not guarantee normal vision. Generally, visual outcomes are better after surgery if the detachment is limited to the peripheral retina and the macula is not affected.

Things you can do to prevent a detached retina
  1. See your eye doctor immediately if you develop new floaters, see flashing lights or notice any other changes in your vision.
  2. Get regular eye exams. A vision specialist can detect problems that you may not have noticed. Treating them early could prevent more serious problems later.
  3. Get your eyes checked more often if you have conditions such as diabetes that make eye disease more likely. Regular eye exams are also important if you’re very nearsighted, which makes detachment more likely.
  4. Keep diabetes or high blood pressure under control. That will help keep the blood vessels in your retina healthy.
  5. Wear eye protection for sports or work if you need it. Try sports goggles with polycarbonate lenses if you play racquetball or other sports that could harm your eyes. You may also need special glasses if you work with certain machines, chemicals or tools.
Concerned that you may have a detached retina? Come see us.

If you’re experiencing any of the symptoms mentioned above, you may indeed have a detached retina and should see an eye specialist right away. Please come see us at Westchester Health to see one of our ophthalmologists as soon as possible. He/she will examine you, make a diagnosis and start treatment right away so that hopefully you can retain your vision. Whenever, wherever you need us, we’re here for you.

By William B. Dieck, MD, FAAO, Vice President, Westchester Health; Director, Ophthalmology Division

Categories: Blog

Are You Color Blind? Here’s How To Tell.

Westchester Health Blog - Tue, 08/15/2017 - 04:11

Do you have trouble distinguishing between red and green? Do you confuse the colors blue and purple? Do many of the crayons in a box look the same? If you answered yes to any (or all) of these, you may be color blind.

William B. Dieck, MD, FAAO

Affecting approximately 1 in 12 men and 1 in 200 women, color blindness is the inability to distinguish the differences between certain colors. This condition results from an absence of color-sensitive pigment in the cone cells of the retina, the nerve layer at the back of the eye.

Most color vision problems are inherited and are present at birth, although some people become color blind as a result of diseases such as diabetes or multiple sclerosis, or they develop the condition over time as they age.

There are different levels of severity of color blindness

Almost half of all color blind people are unaware of their condition, while 60% of sufferers experience many problems in everyday life.

Most color blind people are able to see things as clearly as other people but they are unable to fully distinguish red, green or blue light. In extremely rare cases, some color blind people are unable to see any color at all (achromatopsia).

The most common form: red/green color blindness

Most color blind people suffer from this type of color blindness. The term red/green, however, does not mean people mix up red and green—it means that they see red and green as the same color, and they also mix up colors which have some red or green in them. For example, a red/green color blind person will confuse blue and purple because they can’t “see” the red element of the color purple.

Similar problems can arise across the whole color spectrum, affecting not reds and greens but oranges, browns, purples, pinks and greys as well. Even black can be confused as dark green or dark blue.

What does a color blind person see?

Most people with a moderate form of red/green color blindness will only be able to accurately identify 5 or so colored pencils from a standard box of 24 pencil crayons.

They may have:

  • deuteranopia (green color blindness)
  • protanopia (red color blindness)
  • tritanopia (blue-yellow color blindness).

  4 visual tests for color blindness

Typical color vision tests check for the most common types of color vision deficiencies. Here are 4 that you can try yourself!

1.

If you have normal color vision, you see a 42.
Red color blind people see a 2.
Green color blind people see a 4.

2.

If you have normal color vision, you see a 73.
If you are color blind, you do not see a number.

3.

If you have normal color vision, you see a 74.
If you are red/green color blind, you see a 21.
If you are totally color blind, you do not see a number.

 4.

If you have normal color vision, you see a 26.
If you are red color blind, you see a 6.
I
f you’re only mildly red color blind, you also see a faint 2.
If you are green color blind, you see a 2.
If
you’re mildly green color blind, you also see a faint 6.

Treating color blindness

There is currently no treatment for inherited color blindness. Color filters or contact lenses can be used in some situations to enhance the brightness between some colors, but many color blind people find these actually confuse them further rather than help.

Wondering if you’re color blind? Come see us.

If you’re having trouble distinguishing certain colors and think you might be color blind, please make an appointment to come in and see one of our eye specialists at Westchester Health. We will perform a thorough eye examination, get a detailed family history and determine if indeed you have some form of color blindness. Also, we may suggest some adjustments you could make in your lifestyle to feel more confident about your inability to see certain colors. Whenever, wherever you need us, we’re here for you.

By William B. Dieck, MD, FAAO, Vice President, Westchester Health; Director, Ophthalmology Division

Categories: Blog

10 Ways to Keep Pollen Allergies From Ruining Your Life

Westchester Health Blog - Tue, 08/08/2017 - 11:44

If you have seasonal allergies, you know awful they can make your life, especially in summertime when you really want to be outdoors. They can make you feel tired, keep you from sleeping at night and negatively effect the way you function at work. Here at Westchester Health, a good number of our patients suffer from seasonal allergies, especially pollen. What we’ve found over the years is that if people can make certain adjustments to their lifestyles, they can minimize their exposure to a lot of the things that are making them sneeze, cough and feel miserable. We share those here:

10 ways to prevent, avoid or at least minimize pollen allergies
  1. Don’t exercise outside in the morning

    James Pollowitz, MD, FAAAAI, FACAAI

    The pollen count is highest in the morning, so exercising outdoors at this time can really affect how you feel for the rest of the day. Instead, work out in the evening when the pollen count is lower, or indoors where your pollen exposure is much less.

  2. Track your local pollen count

    The National Allergy Bureau has pollen counters situated across the country which reveal how high the pollen is for different types of plants on any given day in any given location. We advise checking these often. On a low pollen day, you’re probably fine depending on how severe your allergies are, but on a high pollen day, it’s best to stay indoors as much as possible to limit your symptoms.

  3. Get some big sunglasses

    During allergy season, pollen spores float through the air and land all over your body, including in your eyes. We recommend investing in a pair of oversized sunglasses and wearing them as much as possible when you’re outside. It may seem farfetched but the glasses really can act as a physical barrier to prevent pollen from getting in your eyes, where it can cause redness, itching and watering.

  4. Scale back on your hair products

    Hair gels and sprays can actually turn your hair into a pollen magnet. This can cause pollen to end up on your pillow at night where it can stir up your allergies while you sleep.

  5. Shower and change your clothes as soon as you get home

    If you’ve been outside, it’s highly likely that some amount of pollen has ended up on your hair, skin and clothes. That’s why it’s a good idea to change out of your clothes and wash your hair and body when you come inside. If you don’t, you can drop pollen all over your house, making it more likely that it will continue to bother you even indoors.

  6. Don’t line-dry clothes outside

    Since pollen is constantly blowing around during allergy season, drying your sheets, blankets and clothes outside and then bringing them into your house brings the pollen inside, too.

  7. Take off your shoes at the door

    Pollen tends to settle on the ground where it then gets picked up by your shoes. And if you wear your shoes around your house, you’re spreading that tracked-in pollen everywhere, increasing your exposure and making your symptoms worse.

  8. Use your air conditioning

    Many people like to open windows on low pollen count days but be aware that pollen is still floating around, even when counts are low. Opening your windows—especially often—not only brings it into your home but allows it to accumulate.

  9. Try a saline rinse

    A simple OTC nasal saline rinse used daily can help lessen your allergy symptoms significantly. If you don’t want to rinse every day, at least use it on high pollen count days—it can make a big difference in how you feel.

  10. Invest in a HEPA filter

    Common air purifiers don’t do a great job of blocking pollen since it’s too small of a particle to filter out. HEPA filters, on the other hand, use a fine mesh that more effectively traps pollen in your indoor air. We recommend running one in your bedroom to decrease the allergen load while you’re sleeping.

Pollen allergies got you down? Come see us.

If you suffer from pollen or any other type of allergy, please make an appointment with Westchester Health to see one of our Allergy and Immunology specialists. He/she will examine you, make a diagnosis and determine the best course of treatment so you can soon get relief and feel better, now and during future allergy seasons. Whenever, wherever you need us, we’re here for you.

By James Pollowitz, MD, FAAAAI, FACAAI, an allergy and immunology specialist with Westchester Health.

Categories: Blog

Prostate Cancer Screening: What All Men Should Know

Westchester Health Blog - Sat, 08/05/2017 - 02:20

Screening—which basically means testing for a disease in people without symptoms—can help find some types of cancer early, such as prostate cancer, when it’s more easily treated. But for some men, the risks of prostate cancer screening may outweigh the benefits. This is something we emphasize to our male patients at Westchester Health, make sure they understand both the risks and benefits before deciding to undergo screening. To clarify the subject, here is some helpful information.

The 2 main screening tests for prostate cancer: 1. PSA test

Jerry Weinberg, MD

Prostate-specific antigen (PSA) is a substance made by cells in the prostate gland (both normal cells and cancerous ones). PSA is mostly found in semen, but a small amount is also found in the blood. The chance of having prostate cancer goes up as the PSA level goes up.

Most men without prostate cancer have PSA levels under 4 nanograms per milliliter (ng/mL) of blood. When prostate cancer develops, the PSA level usually goes above 4. However, a level below 4 does not guarantee that a man doesn’t have cancer. About 15% of men with a PSA below 4 will have prostate cancer on a biopsy.

Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer. If the PSA is more than 10, the chance of having prostate cancer is over 50%.

If your PSA level is high, your physician may advise either waiting a certain amount of time and then repeating the test, or getting a prostate biopsy to find out if you have cancer. When considering whether to do a prostate biopsy to look for cancer, not all physicians use the same PSA cutoff point. Some may advise it if the PSA is 4 or higher, while others might recommend it starting at a lower level, such as 2.5 or 3. Other factors, such as your age, race and family history, may affect this decision.

Factors that might affect PSA levels

A number of factors other than prostate cancer can also raise PSA levels:

  • An enlarged prostate: Conditions such as benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate that affects many men as they grow older, can raise PSA levels.
  • Older age: PSA levels normally increase slowly as you get older, even if you have no prostate abnormality.
  • Prostatitis: This refers to infection or inflammation of the prostate gland, which can raise PSA levels.
  • Ejaculation: This can make the PSA increase for a short time, and then decrease again. This is why some physicians suggest that men abstain from ejaculation for a day or two before testing.
  • Riding a bicycle: Some studies have suggested that cycling may raise PSA levels (possibly because the seat puts pressure on the prostate), although not all studies have found this.
  • Certain urologic procedures: Some procedures that affect the prostate, such as a prostate biopsy or cystoscopy, can result in higher PSA levels for a short time. Some studies have suggested that a digital rectal exam (DRE) might raise PSA levels slightly, although other studies have not found this. Still, if both a PSA test and a DRE are being done during a screening exam, some physicians advise having the blood drawn for the PSA before having the DRE.
  • Certain medicines: Taking male hormones like testosterone (or other medications that raise testosterone levels) may cause a rise in PSA.

Some factors that might cause PSA levels to go down (even if a man has prostate cancer):

  • 5-alpha reductase inhibitors: Certain drugs used to treat BPH or urinary symptoms may lower PSA levels. These drugs can also affect prostate cancer risk. Tell your physician if you are taking these medicines because they may lower your PSA levels.
  • Herbal mixtures: Some dietary supplements may also mask a high PSA level. This is why it’s important to let your doctor know if you are taking any type of supplement, even ones that are not necessarily meant for prostate health.
  • Obesity: Extremely overweight men tend to have lower PSA levels.
  • Aspirin: Some research has suggested that men taking aspirin regularly may have lower PSA levels. This effect may be greater in non-smokers. If you take aspirin regularly (e.g., to help prevent heart disease), talk to your physician before you stop taking it for any reason.
  • Statins: Some studies have linked the long-term use of cholesterol-lowering drugs known as statins with lower PSA levels.
  • Thiazide diuretics: Thiazide diuretics are a type of water pill often used to treat high blood pressure. Long-term use is linked to lower PSA levels.

For men not known to have prostate cancer, it’s unclear whether lowering the PSA is helpful.

In some cases, what lowers the PSA may also lower a man’s risk of prostate cancer. But in other cases, it might lower the PSA level without affecting the risk. This could actually be harmful, if it were to lower the PSA from an abnormal level to a normal one, as it might result in not detecting a cancer. This is why, again, it’s important to talk to your physician about anything that might affect your PSA level.

2. Digital rectal exam (DRE)

A digital rectal exam (DRE) is less effective than the PSA blood test in finding prostate cancer, but it can sometimes find cancers in men with normal PSA levels. For this reason, it may be included as a part of prostate cancer screening.

For a DRE, a physician inserts a gloved, lubricated finger into the rectum to feel for any bumps or hard areas on the prostate that might be cancer. Prostate cancers often begin in the back part of the gland, which might be felt during a rectal exam. This exam can be uncomfortable (especially for men who have hemorrhoids), but it usually isn’t painful and only takes a short amount of time.

At what age should you have your first screening test?

The American Cancer Society recommends that men at average risk of prostate cancer should be screened starting at age 50. Men at higher than average risk should be screened at age 40 or 45.

Some men are at higher risk than others

African American men and men who have a father, brother or son who were diagnosed with prostate cancer when they were younger than 65 are at high risk. Men with more than one close relative diagnosed before age 65 are at even higher risk.

Should all men be screened for prostate cancer?

It would seem to make sense to check all men to determine if they have prostate cancer. But screening isn’t perfect. Sometimes screening misses cancer, and sometimes it finds something suspicious that turns out to be harmless. Also, there aren’t reliable tests yet to tell the difference between prostate cancer that’s going to grow so slowly it will never cause problems, and dangerous cancer that will grow quickly. Plus, studies have not been able to show that annual PSA screening helps men live longer.

Additionally, treatments for prostate cancer can sometimes have urinary, bowel and sexual side effects that may seriously affect a man’s quality of life. Therefore, screening really is a decision that each individual man should make after having all the information available.

Resources to learn more Wondering when and if you should get screened for prostate cancer? Come see us.

If you think you should get screened for prostate cancer but want more information, please make an appointment to come in and see us at Westchester Health. We will perform a thorough examination, get a detailed family history, discuss all your options with you and take all the time as is necessary to answer your questions. Then together, we’ll decide the best course of action. Whenever, wherever you need us, we’re here for you.

By Jerry Weinberg, MD, a Urologist with Westchester Health.

Categories: Blog

Best Ways To Treat, And Even Prevent, Your Child’s Chronic Nosebleeds

Westchester Health Blog - Tue, 07/25/2017 - 11:58

At Westchester Health, we’ve seen our share of nosebleeds over the years. Starting when your child is in preschool and continuing through the teenage years, periodic nosebleeds are just a fact of life, explains Heather Magnan, MD, a pediatrician with our Westchester Health Pediatrics group, in a recent blog. Although nosebleeds can be alarming, most are not serious. Here’s what might be causing them and how you can treat, and hopefully even prevent, them.

What causes nosebleeds

A wide range of factors can cause nosebleeds, including:

  1. Colds and allergies: A cold or allergy causes swelling and irritation inside the nose and may lead to spontaneous bleeding.
  2. Trauma: A child can get a nosebleed from picking his/her nose, or putting something into it, or just blowing it too hard. A nosebleed can also result from being hit in the nose by a ball or other object, or from falling hitting the nose.
  3. Low humidity or irritating fumes: If your house is very dry, or if you live in a dry climate, the lining of your child’s nose may dry out, making it more likely to bleed. In addition, if he/she is frequently exposed to toxic fumes, this can cause nosebleeds.
  4. Anatomical problems: Any abnormal structure inside the nose can lead to crusting and bleeding.
  5. Abnormal growths: Abnormal tissue growing in the nose may cause bleeding. Although most of these growths (usually polyps) are benign, they still should be evaluated promptly by your child’s pediatrician.
  6. Abnormal blood clotting: Anything that interferes with blood clotting can lead to nosebleeds. Medications, even common ones like aspirin, can alter the body’s blood-clotting mechanism just enough to cause bleeding. Blood diseases, such as hemophilia or platelet disorders, also can provoke nosebleeds.
  7. Chronic illness: A child with a long-term illness, or who requires extra oxygen or other medication that can dry out or affect the lining of the nose, is likely to have nosebleeds.
The do’s and don’ts of treating nosebleeds Do:
  1. Remain calm. A nosebleed can be scary, for you and your child, but is rarely serious.
  2. Keep your child in a sitting or standing position. Tilt the head slightly forward and have your child gently blow his/her nose if old enough.
  3. Pinch the lower half of your child’s nose (the soft part) between your thumb and finger and hold it firmly for a full ten minutes. If your child is old enough, he/she can do this him/herself. Do not release the nose to see if it is still bleeding. After ten minutes, release the pressure and wait, keeping your child quiet. If the bleeding has not stopped, repeat this step. If after ten more minutes of pressure, the bleeding has still not stopped, call your pediatrician or go to the nearest emergency department.
Don’t:
  1. Panic. This will just scare your child more.
  2. Have your child lie down or tilt back the head.
  3. Stuff tissues, gauze or any other material into your child’s nose to stop the bleeding.
It’s time to call your pediatrician if:
  1. You think your child may have lost too much blood. (Keep in mind that blood coming out of the nose always looks like a lot.)
  1. Blood is coming from your child’s mouth, or he/she is coughing up or vomiting blood or brown material that looks like coffee grounds.
  1. Your child is unusually pale or sweaty or is not responsive. Call your pediatrician immediately in this case and take your child straight to the emergency room.
  1. Your child has a lot of nosebleeds, along with a chronically stuffy nose. This may signal a broken blood vessel in the nose or on the surface of the lining of the nose, or a growth in the nasal passages.
How to prevent your child’s nosebleeds
  1. Keep the inside of the nose moist. Nasal dryness can cause nosebleeds. An over the counter nasal saline spray or gel may be used daily as often as needed.
  2. Use a vaporizer or humidifier. Your child’s nostrils might be dry because the air in your house is dry. A humidifier or vaporizer will help maintain your home’s humidity at a level high enough to prevent nasal drying.
  3. Don’t smoke. Smoking (including secondhand smoke) can irritate the inside of the nose and dry it out.
  4. Don’t pick the nose. Also, don’t blow or rub it too hard. If your child is getting nosebleeds, keep his/her fingernails short and discourage him/her from picking his/her nose.
  5. Don’t use allergy nose sprays too often. These can also dry out the nose. In some cases, certain medications can cause nosebleeds or make them worse so discuss all medications with your child’s doctor.
If you’re concerned about your child’s nosebleeds, please come see us.

If your child is experiencing nosebleeds more frequently than seems normal, please come in and see one of our Westchester Health pediatricians. Together, we’ll figure out what might be causing them and what would be the most effective ways to stop and/or prevent them from recurring. Whenever, wherever you need us, we’re here for you.

To read Dr. Magnan’s blog in full, click here.

Categories: Blog

How Breathing Secondhand Smoke Seriously Damages Your Child’s Health

Westchester Health Blog - Thu, 07/20/2017 - 23:57

Most people know that smoking is seriously harmful to their health, potentially even deadly. But what they often overlook are the dangers of secondhand smoke. Here at Westchester Health, what we find especially troubling is the fact that secondhand smoke is especially harmful to children, explains Rodd Stein, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group, in a recent blog.

Millions of children breathe in secondhand smoke from their parents

Rodd Stein, MD

If you smoke around your children, or if they are continually exposed to secondhand smoke from other people or environments, their health, especially their still-developing lungs, are in danger. Even if you only smoke outside, your children are still exposed to the harmful chemicals found in secondhand smoke. The best way to eliminate this health danger? Quit smoking, as soon as possible.

Secondhand smoke is what a smoker breathes out after inhaling a cigarette, cigar, pipe or other smoking device

This inhaled/exhaled smoke typically contains around 4,000 chemicals, many of which are known to cause cancer. When children breathe in this secondhand smoke, they are exposed to these chemicals. Also, there are harmful toxins that remain on materials where people have smoked, such as car seat upholstery or even a child’s hair, these are also harmful.

How secondhand smoke hurts your baby

If you smoke while pregnant, you are exposing your unborn baby to the harmful chemicals contained in tobacco smoke. This can lead to many serious health problems, including:

  • Miscarriage
  • Premature birth
  • Low birth weight (possibly resulting in a less healthy baby)
  • Sudden infant death syndrome (SIDS)
  • Learning problems and attention-deficit/hyperactivity disorder (ADHD)

These health risks increase the more you smoke. Quitting anytime during pregnancy helps—the sooner the better.

How secondhand smoke hurts your children
  • Children who breathe in secondhand smoke have a higher risk of serious health problems, and existing health problems may become worse.
  • They typically have more:
    • Ear infections
    • Coughs and colds
    • Respiratory problems, such as bronchitis and pneumonia
    • Tooth decay
  • Children of smokers cough and wheeze more and have a harder time getting over colds.
  • They miss many more school days than those of non-smokers.
  • Secondhand smoke causes many other issues, including stuffy nose, headache, sore throat, eye irritation and hoarseness.
  • Children with asthma are especially sensitive to secondhand smoke. It may cause more and more severe asthma attacks, requiring trips to the hospital.
The long-term effects of secondhand smoke on children’s health

Kids who grow up with parents who smoke are themselves more likely to smoke. Furthermore, children who smoke are themselves affected by the same health problems that affect adults, including:

  • Lung cancer
  • Heart disease
  • Cataracts
  • Poor circulation
  • COPD
  • Vascular disease
If you smoke, one of the most important things you can do for your own health and the health of your children is to stop.

Quitting smoking is the best way to prevent your children from being exposed to secondhand smoke and safeguard their health. it’s also the best thing you can do for your own health. To help you on this journey, there are many OTC and prescription medicines that can help you quit. Also, every state has a QuitLine. Call 1-800-QUIT-NOW to be connected to the one in your area and for local resources to help you quit.

Additional information and resources: Concerned that your children are being exposed to secondhand smoke? Come see us.

If you smoke and are trying to quit, and are worried about how your smoking might be affecting your children’s health, please come in and see one of our Westchester Health pediatricians. Together, we’ll figure out the best way forward for everyone, and if needed, help you get help to stop smoking. Whenever, wherever you need us, we’re here for you.

To read Dr. Stein’s blog in full, click here.

Categories: Blog

Is It a Cold or Sinus Infection? How To Tell.

Westchester Health Blog - Mon, 07/17/2017 - 11:54

Even though we’re in the middle of summer, here at Westchester Health we still see a fair amount of colds and sinus infections (sinusitis). Patients come in sneezing and coughing with watery eyes and a stuffy nose, and want to know: is it a cold or a sinus infection? Our answer: the type of symptoms and long they last give us clues as to whether it’s a virus (cold) or an infection.

If it’s a cold

If what you have is a “common cold,” most of the time it will get better on its own. Typically, you’ll have a runny nose for 2-3 days, followed by a stuffy nose for 2-3 days. After that, most people begin to feel better. However, that’s little comfort when you’re suffering from the following symptoms and feeling pretty lousy:

  • Sore throat

    David T. Ennis, MD

  • Cough
  • Headache
  • Stuffy nose
  • Mucus buildup
  • Sneezing
  • Fatigue
  • Swollen sinuses
  • Fever (usually low-grade in adults but higher in children)
3 best ways to treat a cold
  1. Because a cold is a virus, antibiotics won’t help. But over-the-counter medications may make you feel better. Choose ones that target your specific symptoms, i.e., headache, cough, congestion and/or fever.
  2. Rest is still the best remedy but for many people, that’s hard. They don’t want to miss work, plus they may have a hard time sleeping because they can’t breathe through their nose.
  3. Sinus irrigation. A neti pot filled with a mix of distilled water and salt will help thin the mucus and flush out the sinuses. Studies show that people who irrigate when they have a cold usually feel better and get over it quicker.
If it’s a sinus infection

When your nasal passages become infected, that’s not a cold, that’s a sinus infection, which is harder to get over. Viruses, bacteria or even allergies can lead to sinus infections which will hang around for 7 days or more. Sinus infections are sometimes accompanied by a low-grade fever, while colds typically are not. Also, colds generally produce clear mucus, while bacterial infections tend to produce greenish or yellow mucus.

Colds do not usually cause sinus infections but they do offer a breeding ground for them. You touch your nose a lot when you’re sick, and each time you do this, you bring more bacteria to the sinuses. Because your sinuses can’t drain, the bacteria stay there and grow. So yes, a cold can lead to a sinus infection.

Look for the following symptoms:
  • Sinus pressure behind the eyes and cheeks
  • A runny, stuffy nose that lasts more than a week
  • A headache that gets worse
  • Fever
  • Cough
  • Bad breath
  • Thick yellow or green mucus draining from your nose or down the back of your throat (postnasal drip)
  • Fatigue
  • Decreased sense of smell
3 best ways to treat a sinus infection

If you think you may have a sinus infection, see your doctor right away because you most likely need antibiotics, and the sooner you start, the sooner you’ll feel better.

Sinus irrigation is also recommended for sinus infections as well for colds. It can help ease your symptoms while you wait for the antibiotics to start working. Steroids, decongestants and over-the-counter mucus thinners can also ease your discomfort.

When to see a specialist

If your sinus infection does not go away after 1 or even 2 courses of antibiotics, you should see an ear, nose and throat (ENT) specialist.

Some people get sinus infections over and over (especially people who smoke or have allergies and smoking. If these cases, a recurring infection can become chronic if not treated successfully and sinus surgery may be needed.

Wondering whether you’ve got a cold or sinus infection? Come see us.

If you’re feeling lousy and think you have either a cold or sinus infection, please make an appointment with Westchester Health to see one of our Internal Medicine physicians. He/she will examine you, make a diagnosis and start treatment right away so you can soon start to feel better. Whenever, wherever you need us, we’re here for you.

By David T. Ennis, MD, an Internal Medicine specialist with Westchester Health.

Categories: Blog

Best Ways To Prevent Eczema Flare-Ups

Westchester Health Blog - Thu, 07/13/2017 - 11:30

Here at Westchester Health, we see a fair amount of eczema. Fortunately, it’s not contagious, but it does tend to run in families with a history of eczema or other conditions such as hay fever and asthma. Different triggers can make it worse, such as stress, allergies and sweating, which can cause itchy, painful flare-ups.

Eczema flare-ups can be especially problematic

Eczema is a condition which requires constant monitoring because excessive rubbing and scratching of the itchy areas can tear the skin, which in turn can lead to infection. A chronic skin problem, eczema can appear anywhere on the body or in just a few areas, and the symptoms are different with each person. Typically, eczema appears as a rash in the following places:

  • on the face and scalp
  • in the folds of the elbows and knees
  • on the hands, feet, arms and the backs of knees

    Jeffrey Sturza, MD, FAAD

Typical symptoms of eczema include:
  • Dry, scaly skin
  • Small bumps that “weep” when scratched
  • Redness and swelling of the skin
  • Thickening of the skin
Most effective ways to prevent eczema flare-ups

One of the best things you can do to manage flare-ups is to try to prevent them from happening. Here are some preventative steps you can take:

  1. Keep your skin moisturized. Thorough moisturizing should be a part of your daily routine.
  • Use fragrance-free moisturizers.
  • Cream or ointment is more moisturizing than lotion.
  • After a bath, gently pat the skin with a towel and then apply moisturizer to the damp skin.
  • Apply moisturizer at least once a day, more often if needed, applied to the face and entire body.
  1. Avoid irritants. People who are sensitive to scratchy fabrics or chemicals in soaps and detergents should:
  • Wear soft fabrics such as 100% cotton clothing.
  • Use mild, fragrance-free body cleansers.
  • Take short baths with room temperature water.
  • Take less frequent baths.
  • Use mild laundry detergent with no dyes or perfumes.
  • Skip using fabric softener in the dryer.
  1. Don’t scratch.
    Scratching can make the rash worse and lead to infection. Also, the more you scratch, the more the area will itch. To avoid this, keep fingernails short and smooth.
  2. Ask your doctor if allergies could be causing your eczema.
    Sometimes allergies such as food, pets, pollens or dust mites (in bedding) can trigger eczema or make it worse. If your eczema is caused by an allergy, avoid the trigger if possible. Also ask your doctor of other things could be causing flare-ups, such as overheating, sweating and stress.
You may need to treat your eczema with medication

Your physician may recommend medication to help keep the symptoms of your eczema under control. The type of medicine recommended will depend on how severe the eczema is and where it appears on your body. Treatments typically include OTC and/or prescription topical medications and oral ones.

Remember, eczema is a chronic skin problem, which means that it can come and go. It requires ongoing management by you and your doctor. If after several treatments your condition does not improve, you may need to see a dermatologist for severe or resistant eczema.

Additional resources to learn more If you have eczema and it’s becoming a problem, come see us

If you’re experiencing any of the symptoms mentioned above, please come see us at Westchester Health to see one of our Allergy and Immunology specialists. He/she will examine you, make a diagnosis and determine the best course of treatment so you can soon get relief and feel better. Whenever, wherever you need us, we’re here for you.

By Jeffrey Sturza, MD, FAAD, a dermatologist and dermatologic surgeon with Westchester Health.

Categories: Blog

The Best Ways To Treat Your Child’s Swimmer’s Ear

Westchester Health Blog - Mon, 07/10/2017 - 05:04

Summer is here, which means a lot of swimming and therefore, a lot of swimmer’s ear. Here at Westchester Health, we tend to see a lot of this condition and offer parents this information to help them know how to treat it and better yet, avoid it altogether, because it can be very painful.

Infancy and early childhood are the peak years for middle-ear infections like swimmer’s ear

Mason Gomberg, MD

As Mason Gomberg, MD, a pediatrician with our Westchester Health Pediatrics group, writes in a recent blog, swimmer’s ear is an inflammation of the outer ear canal and occurs when water gets into the ear, usually during swimming or bathing, and does not properly drain out. The stagnant water then causes the ear canal to become irritated and infected.

Children with this condition typically com­plain of itching or pain in the ear, particularly when the head or the ear itself is moved or pulled. As the canal swells, hearing might be affected and the infected ear may ooze yel­lowish pus.

Symptoms of swimmer’s ear
  • Severe ear pain that gets worse when the ear is touched or tugged
  • Jaw pain
  • Sore throat
  • Itching in the ear canal
  • Greenish-yellowish discharge
  • Temporary hearing loss in the affected ear, due to the canal’s becoming swollen or filled with pus
  • Redness around the ear canal opening
Best ways to treat swimmer’s ear

NOTE: Children under treatment for swimmer’s ear can still go into a pool/lake but should not get their head or ears wet while taking medicine for this condition.

From our years of experience, these are the 4 best ways to treat swimmer’s ear:

  1. Ear drops. After cleaning the infected ear, your pediatrician will begin treatment with medicated eardrops to kill bacteria and fungus, as well as reduce inflammation. The average course of treatment runs approximately one week. Note: It is not unusual for ear pain from swimmer’s ear to intensify for a day or two before the drops take effect.
  2. Antibiotics. Occasionally, the ear infection is severe enough to warrant the additional use of an oral antibiotic.
  3. Keep your child’s ears dry, and continue giving the medication for 2-3 weeks after the symptoms fade. When showering or washing your child’s hair, cover his/her head with a plastic cap or protect the ear canals with a soft earplug such as a cotton ball covered with Vaseline or OTB ear putty.
  4. A warm compress or heating pad against the ear will help reduce pain. Pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs will also help.
Preventing swimmer’s ear
  1. Once your child has had a swimmer’s ear in­fection, you should try to prevent future episodes. To do this, place drops in the ears after swimming—either a 70% alcohol solu­tion or a mixture of ½ alcohol, ½ white vinegar. Also, dry the ears with a towel immediately after swimming or bathing.
  2. It’s also recommended to dry out your child’s ears by having him/her sit out for 10-15 min for every 1-2 hours in the water.
  3. Never use a Q-tip to dry out the ear canal.
Come see us, we’re here to help

If you think your child might have swimmer’s ear, please make an appointment with Westchester Health. One of our pediatricians will diagnose whether or not your child does indeed have swimmer’s ear. If this is the case, together with you, we will decide on the best course of action to treat the infection so your child can feel better as quickly as possible. Whenever, wherever you need us, we’re here for you.

To read Dr. Gomberg’s blog in full, click here.

Categories: Blog

At What Age Should You Have Your Child Evaluated For ADHD?

Westchester Health Blog - Thu, 07/06/2017 - 11:16

Here at Westchester Health, a lot of our parents want to know whether or not their child has ADHD (Attention Deficit Hyperactivity Disorder), what it means, and what to do about it. When a child is not doing well in school, finds it hard to sit still, is constantly restless and/or seems to have trouble concentrating, it’s understandable that parents become concerned.

Researchers say that 3-10% of all children in the U.S. have ADHD. Most often, the condition is recognized when a child starts school but for many, the signs and symptoms can appear at a younger age. Most experts agree that it’s hard to be sure whether a child has ADHD until he/she is 6 or 7 years old.

Lauren Adler, MD, FAAP

Evaluating a child for ADHD is not an exact science

Many children of all ages have trouble paying attention, but that doesn’t mean they have a disorder. Depression, anxiety, and learning disabilities can all be mistaken for ADHD. In some cases, a child may actually be suffering from both ADHD and depression, or ADHD and a learning disability (such as a speech and language delay).

At Westchester Health, if we feel your child might have ADHD, we will do a Vanderbilt screening (a psychological assessment tool for ADHD). If the results of the testing indicate that your child does have ADHD, we can refer your child to a psychologist or neurologist who can recommend medication.

An ADHD evaluation typically includes:
  • A thorough personal, family, and medical history. ADHD tends to run in families and it’s common for a brother or sister to have the disorder, or for parents to have symptoms even though they’ve never been diagnosed. For this reason, we will ask you a lot of questions about your child’s and your family’s health history, how long your child has been having ADHD symptoms (should be longer than 6 months) and whether he/she is having them in more than one setting, such as at school and home.
  • Interview with the patient. Often, kids will speak more freely when their parents are not in the room. To accurately determine the presence (or absence) of ADHD, we may ask your child age-appropriate questions without you present, such as, “What’s your favorite subject in school? Your least favorite? Why?”
  • Interview with the parents. We will also want to give you ample time (without your child present) to talk about your questions, concerns and frustrations with your child, such as short attention span, failure to follow through on homework or chores, non-stop activity or frequently losing his/her temper. Also, we might ask you to fill out a questionnaire about your child’s abilities and symptoms.
  • Interview with your child’s teacher(s). If your child is in school, we may want to speak with his/her teacher. Does your child have trouble waiting his/her turn, seems overly fidgety or restless, is easily distracted, or has a hard time following directions?
  • Physical examination. We will give your child a thorough physical exam, if his/her current one is out of date, to rule out any health issues that could be causing ADHD-like symptoms, such as vision or hearing problems.
  • Treatment options and follow-up. In addition to medication (if warranted), treatment options may include behavior therapy (changing your child’s environment to help improve behavior), working with you, the parents, to give you skills to deal with your child’s behavior, changes in the school environment, and a number of other alternative treatments. We will also want to see you and your child for follow-up visits to check on his/her progress.
Learn more about ADHD

To read American Academy of Pediatrics articles on causes of ADHD, common symptoms of hyperactivity, behavioral side effects of medication, and more, click here.

Come see us, we’re here to help

If you think your child might have ADHD, please make an appointment with Westchester Health. One of our pediatricians will meet with you, diagnose whether or not your child does indeed have ADHD, and together with you, come up with a plan to help your child have the best opportunities for a happy, healthy life.

To read Dr. Adler’s blog in full, click here.

Categories: Blog

How Nutritious Food And Plenty Of Exercise Help Create A Healthy Kid

Westchester Health Blog - Mon, 07/03/2017 - 11:13

At Westchester Health, we often get questions from our parents concerning their children’s exercise level or eating habits, and we’d like to share some of our knowledge here. We firmly believe that the health and well-being of your child to a large degree involves fitness and nutrition.

Physical activity should be a regular part of your child’s day

Rachel Managed, MD, FAAP

To help your child get more exercise and become more physically fit, suggest activities that he/she enjoys and can do regularly, advises Rachel Menaged, MD, a pediatrician in our Westchester Health Pediatrics group, writes in her recent blog. Fitting exercise into a daily routine doesn’t have to be a chore—almost anything that gets your son or daughter moving is beneficial.

Here are some exercise suggestions:
  • Dancing
  • Walking
  • Biking
  • Jogging
  • Rollerblading
  • Swimming
  • Basketball/football/soccer/baseball/track/gymnastics
  • Walking the dog
Activity levels per age

Preschoolers: Preschoolers need play and exercise to develop important motor skills, such as kicking or throwing a ball, playing tag or follow the leader, hopping on one foot, riding a tricycle or bike with training wheels, freeze dancing or running obstacle courses.

School-age: With elementary and middle school kids spending more time on sedentary pursuits like watching TV and playing computer games, the challenge for parents is to help them find physical activities they enjoy and feel successful doing. These can range from traditional sports like baseball and basketball to martial arts, biking, hiking and just playing outside.

Teenagers: Teens have many choices when it comes to being active, from school sports to after-school classes. It’s important to remember that physical activity must be planned and often has to be sandwiched between various responsibilities and commitments.

Healthy foods help build healthy kids

Your child should consume a variety of foods from the five major food groups that make up the U.S. Department of Agriculture’s “Choose My Plate” guidelines. Each food group supplies important nutrients, vitamins and minerals for your child’s growth and overall health.   

The USDA’s 5 recommended food groups and typical servings
  1. Vegetables: 3-5 servings per day.
  2. Fruits: 2-4 servings per day. Suggestions: ½ cup of sliced fruit or a medium-sized whole fruit, like an apple, banana or pear.
  3. Grains: 6-11 servings per day. Each serving should equal 1 slice of bread, ½ cup of rice or pasta or 1 ounce of cereal.
  4. Protein: 2-3 servings of 2-3 ounces of cooked lean meat, poultry, or fish per day. (Vegetarian alternatives: ½ cup of cooked dry beans, one egg or 2 tablespoons of peanut butter for each ounce of lean meat.)
  5. Dairy: 2-3 servings per day of 1 cup of low-fat milk or yogurt or 1½ ounces of cheese
Concerned that your child may not be eating well or exercising enough? Come see us.

If you’re concerned about your child’s diet, eating habits and/or fitness level, or if you have other questions relating to his/her health and well-being, please come in and see one of our Westchester Health pediatricians. He/she will provide guidance and advice on how to make healthy changes in your child’s life. Whenever, wherever you need us, we’re here for you.

To read Dr. Menaged’s blog in full, click here.

Categories: Blog

Why It’s So Important To Burp Your Newborn

Westchester Health Blog - Thu, 06/29/2017 - 11:16

Babies often swallow air when they feed, either from breast or bottle, which hurts their tummies and can make them fussy. This trapped air, or gas, needs to be released, and burping is the best way to help your baby get rid of that gas, writes Lauren Adler, MD, a pediatrician in our Westchester Health Pediatrics group, in a recent blog. By burping your baby frequently during and after each feeding, you can hopefully keep painful gas pains to a minimum.

For breastfeeding moms, we at Westchester Health recommend burping before switching breasts. For bottle-feeding moms, we recommend burping between every 2-3 ounces for newborns up to 6 months old.

The 4 best positions for burping your baby
  1. Hold your infant upright with his/her head on your shoulder. Support your baby’s head and back while gently patting him/her on the back with your other hand.
  2. Sit your baby on your lap. Support your infant’s chest and head with one hand by cradling his/her chin in the palm of your hand and resting the heel of your hand on your baby’s chest (be careful to grip your baby’s chin, not throat). Use the other hand to gently pat your baby’s back.
  3. Lay your newborn face-down on your lap. Support your baby’s head, making sure it’s higher than his/her chest, and gently pat or rub your baby’s back.
  4. If your baby doesn’t burp after a few minutes, change the position and try burping for another few minutes before feeding again. Always burp your baby when feeding time is over, then keep him/her in an upright position for at least 10-15 minutes to avoid spitting up.
There are many reasons why babies need to burp

Lauren Adler, MD, FAAP

When gas bubbles get stuck in your baby’s stomach, they can easily cause your baby to feel full and uncomfortable, which then most likely will cause him/her to squirm or cry.

  1. Digestion. The bacterial breakdown of certain foods in the large intestine can naturally create gas. This includes food that the baby consumes as well as what the mother eats or drinks and passes on in her breast milk.
  2. Allergic reaction or food intolerance. If your baby is breastfeeding and has an intolerance to certain foods from your diet or to a type of formula, his/her body may react by creating more gas. Dairy intolerance is the most common culprit in this instance.
  3. Your diet. If you’re breastfeeding it is possible that something in your diet could be causing your baby’s discomfort. According to the National Institutes of Health, foods that contain carbohydrates are more likely to cause gas, as well as dairy (milk, cheese, ice cream), beans, certain vegetables (broccoli, cauliflower, cabbage, Brussels sprouts), sugar-free candies and gum, soda and fruit drinks. Changing your diet can help but it can be hard to pinpoint which food or drink is causing the gas because some foods take weeks to get out of your system. Plus, foods that produce gas in one person may not cause gas in another.
  4. Allowing too much air to enter your baby’s formula. Shaking vigorously after adding water to formula actually adds lots of air to the liquid, which then can lead to excess gas. Instead, try premixed formula, or let the bottle settle before giving it to your baby.
  5. Nipple flow. Bottle nipples come in a variety of flow options that are usually classified by age (preemie, newborn, 3-6 months, 6+ months, etc.). If you’re using a nipple that is too advanced for your baby, it may be releasing the milk or formula too fast, making the baby gulp, sputter and swallow a lot of air in the process. At the same time, if you are using a nipple that is too slow for your baby, it may cause your baby to suck too hard to get the milk out faster, thus swallowing a lot of air. Instead, choose an age-appropriate nipple to try to limit the amount of air swallowed during feedings.
Want more advice about burping your baby? Come see us.

If you’re wondering whether you’re burping your baby properly, if your baby seems overly gassy and you want some advice on what to do, or if you have other questions relating to your baby’s health and well-being, please come in and see one of our Westchester Health pediatricians. He/she will help you work out solutions that will bring relief to both you and your baby.

To read Dr. Adler’s blog in full, click here.

Categories: Blog

Having A Baby Over Age 35 Has Its Own Special Joys and Risks

Westchester Health Blog - Tue, 06/27/2017 - 00:59

If you’re 35 or older and expecting a baby, you have many advantages over younger moms, such as being more financially secure and having years of life experiences to draw upon when raising your child. As the average age at marriage rises in the U.S., so does the average age of new mothers. We can attest to that: many of our moms-to-be are in their late 30s and early to mid-40s.

Mason Gomberg, MD

As Mason Gomberg, MD, a pediatrician in our Westchester Health Pediatrics group, writes in his recent blog, the majority of older moms have perfectly normal pregnancies and deliver healthy babies, but it’s very important for you to take extra special care of yourself because your chances of developing certain health problems are greater when you’re 35 or older.

Being an older mom-to-be carries some risks

Over age 35, the risks for you and your baby are a little higher than average, but still very low. Some of these risks include:

  1. Birth defects. Older women are more likely to have a baby with a chromosome disorder such as Down syndrome. If you are 25, the chance of Down syndrome is about 1 in 1,250. If you are 35, the risk increases to 1 in 400. By age 45, it is 1 in 30.
  2. Miscarriage. Most miscarriages happen in the first 13 weeks of pregnancy. As you get older, your risk of early miscarriage rises. At age 35, the chance is about 20% and by age 45, it’s 80%.
  3. High blood pressure and diabetes. You may be more likely to develop high blood pressure
    or diabetes during pregnancy, which can cause problems including miscarriage, growth problems in your baby or complications during birth.
  4. Placenta problems. Placenta previa happens when the placenta covers all or part of your cervix. This can lead to risky bleeding during delivery. If you’re in your 40s, you’re three times more likely to have placenta problems than a woman in her 20s. Even so, this problem is rare.
  5. Premature birth and low birth weight. Older women are more likely to deliver their babies prematurely, before 37 weeks. As a result, they are at risk of having babies weighing less than 5.5 pounds at birth.

With good prenatal care, you can control many of these risks. Routine prenatal screenings and testing will usually reveal if your baby has a problem before birth.

7 things that can help you have a healthy pregnancy over 35 1. Take a prenatal vitamin before getting pregnant.

We recommend one that contains ARA and DHA, 2 substances that promote good eye and neurological development. Your prenatal vitamin should also contain folic acid to help prevent neural tube birth defects such as spina bifida.

2. See your doctor regularly.

If you’re planning to become pregnant, get a pre-pregnancy checkup. Your healthcare provider will answer all your questions about your pregnancy, your diet, what exercises are safe, any environmental factors you should avoid for the next nine months, and a host of other topics. He/she will also review any medications you are taking. If you are planning on breastfeeding (breast is best, for you and your baby), there are certain preparations you can do ahead of time to help ensure a successful experience.

3. Manage pre-existing and chronic conditions.

Be sure you’re aware of any existing health problems such as high blood pressure or diabetes.

4. Lose weight if you’re overweight.

Women who are overweight when they get pregnant are more likely to develop problems during pregnancy (and often have more issues with labor and delivery).

5. Eat healthy and avoid certain foods.

Include a wide variety of nutritious foods in your diet, especially ones that contain folic acid such as spinach, beans, lentils and sunflower seeds. Avoid shark, tilefish, king mackerel, swordfish and more than 6 oz. of albacore tuna per week.

6. Exercise regularly.

Join a workout class, start walking or jogging, try some at-home exercise DVDs…anything that gets you moving. Note: make sure you work out on a regular basis, not intermittently.

7. Make sure you’re getting enough sleep.

It’s very important to get lots of sleep during a pregnancy. Not only does your body need the rest and the chance to recharge, the growing baby benefits from your hours of sleep.

If you’re expecting a baby over 35 and pregnant, come see us.

If you’re pregnant and over 35, and have questions relating to your pregnancy, please come in and see one of our Westchester Health OB/GYNs. He/she will give you tips and guidance to help you have a healthy pregnancy, labor and delivery. Whenever, wherever you need us, we’re here for you.

To read Dr. Gomberg’s blog in full, click here.

Categories: Blog

Is Fruit Juice Good Or Bad For Your Child?

Westchester Health Blog - Fri, 06/23/2017 - 00:40

At Westchester Health, we were pleased to learn that the American Academy of Pediatrics recently issued new guidelines limiting the recommended amount of 100% fruit juice that should be given to children AND recommending no fruit juice in a child’s first year of life. In fact, this is what we have been recommending to our patients for years. Why? Because juice offers no nutritional benefits early in life and can actually take the place of what babies need most: breast milk (or formula), protein, fat and minerals like calcium.

Lauren Adler, MD, FAAP

Lauren Adler, MD, a pediatrician in our Westchester Health Pediatrics group, explains in a recent blog that this might come as a surprise to parents who thought that 100% fruit juice was healthy for babies. The new guidelines also limit the amount of juice recommended for older children as well as for babies, now saying that four ounces for children ages 1-3, six ounces for children 4-6 and only 8 ounces (down from 12) for children 6-18 is best.

Believe it or not, fruit juice is nutritionally not much better than soda

Four ounces of apple juice has no fiber, 60 calories and 13 grams of sugar. By comparison, a half cup of apple slices has 1.5 grams of fiber, 30 calories and 5.5 grams of sugar. That’s a big difference. While whole fruit offers fiber, calories and sugar, while fruit juice has no fiber, only sugar and empty calories. Nutritionally, the two are not even close.

100% fruit juice is also bad for your child’s teeth

Not only is fruit juice not nutritious for babies and children, its high levels of sugar can promote tooth decay. That’s why at Westchester Health, we strongly believe that the healthiest beverages for your child are water and milk (cow’s milk or otherwise). Water is important for adequate hydration and milk offers fat and calcium, both important for growing children.

Questions about your child and fruit juice? Come see us, we’re here to help

If you’d like more information about how much fruit juice is recommended for your child’s particular stage of development, please make an appointment with Westchester Health to see one of our pediatricians. He/she will meet with you and give you the information, advice and guidance you need. Whenever, wherever you need us, we’re here for you.

To read Dr. Adler’s blog in full, click here.

Categories: Blog

How Much Should You Exercise While Pregnant?

Westchester Health Blog - Mon, 06/19/2017 - 23:52

At Westchester Health, here’s what we advise pregnant women who ask us if it’s safe to exercise while they’re expecting: if they were physically active before their pregnancy, they can continue their activity in moderation. We firmly believe that maintaining a regular exercise routine throughout a pregnancy can help both the mom-to-be and her baby stay healthy.

Lauren Adler, MD, FAAP

As Lauren Adler, MD, a pediatrician in our Westchester Health Pediatrics group, writes in her recent blog, exercising while pregnancy not only helps a woman stay in shape but also helps relieve stress, builds the stamina she’ll need for labor and delivery, and may even prevent gestational diabetes (diabetes that develops during pregnancy).

Recommended: 30-60 minutes or more of moderate exercise per day

The American College of Obstetrics and Gynecology recommends 30-60 minutes or more of moderate exercise per day while you’re pregnant, unless you have a medical or pregnancy complication (asthma, heart disease, diabetes, low placenta, history of miscarriage or early labor, weak cervix). However, if you haven’t exercised regularly before getting pregnant, you can still follow an exercise program while you’re expecting after consulting with your OB/GYN.

Be careful: underdoing it is actually riskier than overdoing  it

It is actually more hazardous to your health not to exercise while pregnant. This contributes to excess weight gain, high blood pressure, aches and pains, and a higher risk for Cesarean section and gestational diabetes. Approximately 70-80% of women with gestational diabetes develop type 2 diabetes later in life, and their babies are themselves more likely to become overweight and develop diabetes.

8 exercises you can safely do until delivering

Most exercises are safe to perform during pregnancy, as long as you are careful not to overdo it. We recommend the following:

  1. swimming
  2. brisk walking
  3. yoga
  4. indoor stationary cycling
  5. step or elliptical machines
  6. low-impact aerobics (taught by a certified aerobics instructor)
  7. jogging (in moderation, especially if you were doing this before your pregnancy)
  8. strength and toning exercises, such as Pilates
11 exercises you should avoid during your pregnancy
  1. Be aware that there are certain exercises and activities that can be harmful if performed during pregnancy, including:
  2. holding your breath during any activity
  3. sports where falling is likely (such as skiing, ice skating or horseback riding)
  4. contact sports such as softball, football, basketball and volleyball
  5. any exercise that may cause even mild abdominal trauma, jarring motions or rapid changes in direction
  6. activities that require extensive jumping, hopping, skipping, bouncing or running
  7. deep knee bends, full sit-ups, double leg raises and straight-leg toe touches
  8. bouncing while stretching
  9. waist-twisting movements while standing
  10. heavy exercise spurts followed by long periods of no activity
  11. exercising in hot, humid weather
Want to know more about exercising while pregnant? Come see us.

If you want more information on how exercising while pregnant benefits you and your baby, or if you have questions about labor and delivery or any other aspects of having a baby, please make an appointment with Westchester Health to see one of our OB/GYNs. We’re here for you with years of experience, advice and guidance.

To read Dr. Adler’s blog in full, click here.

Categories: Blog

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