10 Foods That Boost Your Immune System

Westchester Health Blog - Thu, 04/20/2017 - 17:47

Even though we’re well into spring, here at Westchester Health, we’re still seeing a lot of colds and viruses. To try and help keep everyone healthy and germ-free, we continually emphasize to our patients that their diet plays an important role in the strength of their immune system. Certain foods may actually decrease their chances of getting sick, while others can help them recover more quickly if they do get ill.

Regularly consuming the foods listed below can make a real difference in strengthening your immune system, helping you resist illnesses and shortening the time you are sick.

If you are unable to eat some of them, you may want to consider taking supplements which have immunity-boosting properties. No matter the season, keeping your immune system healthy is very important to your overall health and well-being.

10 foods to eat if you want to boost your immune system
  1. Iron-rich foods

    Margaret Andersen, MD

    Iron plays an important role in immune function. A diet containing too little iron can cause anemia and weaken the immune system. Foods rich in iron include meat, poultry, fish, shellfish, legumes, nuts, seeds, cruciferous vegetables and dried fruit. You can also improve your absorption of iron from foods by using cast-iron pots and pans to cook with, and avoiding tea or coffee with meals. Combining iron-rich foods with vitamin C can help boost your absorption even further. Keep in mind, however, that overly high iron levels in your blood can be harmful and may actually suppress the immune system. Therefore, it’s best to take iron supplements only if you have an iron deficiency or on the advice of a doctor.

  1. Probiotic-rich foods

Probiotics are beneficial bacteria that live in your gut and help stimulate your immune system. They also help maintain the health of your gut’s lining, which may help prevent unwanted substances from “leaking” into the body and provoking an immune response. In fact, recent studies show that probiotics may reduce the risk of developing upper respiratory tract infections by up to 42%. Studies also show that when people do get sick, those who regularly consume probiotics are 33% less likely to need antibiotics. In certain cases, regularly consuming probiotics may also lead to a faster recovery from illness. Effective sources of probiotics include sauerkraut, naturally fermented pickles, yogurt, kefir, buttermilk, kimchi, tempeh, miso, natto and kombucha.

  1. Citrus

Vitamin C is known for its antibacterial and anti-inflammatory properties. It also helps maintain the integrity of your skin, which acts as a protective barrier against infection. In addition, vitamin C can act as an antioxidant, helping protect your immune cells against harmful compounds formed in response to viral or bacterial infections. Therefore, getting enough vitamin C is a great way to strengthen your immune system and may reduce your likelihood of infection. Some studies also report that increasing your vitamin C intake during a cold may help you get better more quickly. Fruits like oranges, grapefruits and tangerines are high in vitamin C. Other foods high in vitamin C include bell peppers, guavas, dark leafy greens, broccoli, berries, tomatoes, papaya and snap peas.

  1. Ginger

Ginger is rich in gingerol, a bioactive substance thought to help lower the risk of infections. In fact, ginger has antimicrobial properties that may inhibit the growth of several types of bacteria, including E. coli, Candida and Salmonella. Fresh ginger may also help fight the human respiratory syncytial virus (HRSV), a virus responsible for many respiratory infections. However, more studies on this are needed. As many people know, ginger is also effective at combatting nausea, and may help decrease your nausea symptoms when you have the flu.

  1. Garlic

Like ginger, garlic also contains active compounds that may help reduce your risk of infection and improve your immune cells’ ability to fight off colds and the flu. Garlic also seems to have antimicrobial and antiviral properties that may help it fight bacterial and viral infections. To maximize garlic’s immune-boosting effects, eat one clove two to three times per day. Crushing the garlic and allowing it to stand for 10 minutes prior to cooking can also help increase its immune-supportive effects.

  1. Berries

For centuries, berries have been used by Native Americans to treat infections like the common cold. This could be because berries are a rich source of polyphenols, a group of beneficial plant compounds with antimicrobial properties. Studies show that berries and their polyphenols have the ability to protect against the influenza virus responsible for the flu. They may even offer a defense against bacterial infections such as Staphylococcus, E. coli and Salmonella infections. Berries also contain good amounts of vitamin C, which adds to their immune-boosting properties.

  1. Coconut oil

Coconut oil contains medium-chain triglycerides (MCTs), a category of fats with antimicrobial properties. The most common type of MCT found in coconut oil is lauric acid, which is converted into a substance known as monolaurin during digestion. Both lauric acid and monolaurin have the ability to kill harmful viruses, bacteria and fungi. In fact, researchers report that coconut fats may help fight off the types of bacteria that cause stomach ulcers, sinusitis, dental cavities, food poisoning and urinary tract infections. Researchers also believe that coconut oil may be effective against the viruses responsible for influenza and hepatitis C. It may also help fight Candida albicans, a common cause of yeast infections in humans. You can easily add coconut oil to your diet by using it instead of butter or vegetable oils in cooking or baking. Consuming up to two tablespoons (30 ml) per day is recommended, allowing you to include other healthy fats in your diet, such as avocados, nuts, olives and linseed oil.

  1. Licorice

A spice made from the dried root of the Glycyrrhiza glabra plant, licorice has been used in traditional Asian and European herbal medicine for thousands of years. Studies show that licorice has the ability to fight some fungi and bacteria, including E. coli, Candida albicans and Staphylococcus aureus. It may also be able to fight the viruses responsible for the flu, gastroenteritis and polio. However, many products containing licorice are also very high in sugar. If you are trying to reduce your sugar intake, look for lower-sugar options, such as licorice tea. In addition, consuming too much licorice may have a number of adverse effects, including high blood pressure, abnormal heart rhythm and an increased risk of premature birth. If you’re at risk for any of these, you should limit your consumption.

  1. Nuts and seeds

Nuts and seeds are incredibly rich in nutrients, including selenium, copper, vitamin E and zinc, all of which play a role in maintaining a healthy immune system. Sesame seeds and almonds are particularly good sources of copper and vitamin E, while pumpkin seeds and cashews are rich in zinc. To get your daily requirement of selenium, eating just a single Brazil nut per day will do it. Nuts and seeds are also great sources of fiber, antioxidants and healthy fats, all of which are beneficial for health.

  1. Sweet potatoes

Sweet potatoes not only taste great but they’re also rich in vitamin A. Not consuming enough vitamin A can lead to a deficiency, which studies link to a weaker immune system and a higher sensitivity to infections. However, excessive vitamin A intake can lead to adverse effects such as nausea, headaches, weaker bones, coma and even premature death, especially if you take vitamin A in supplement form. High intakes of vitamin A supplements during pregnancy may also increase the risk of birth defects. Therefore, it might be safest to meet your vitamin A requirements through diet instead of supplements. As well as sweet potatoes, other foods that are high in vitamin A include carrots, dark-green leafy vegetables, squash, romaine lettuce, dried apricots, red peppers, fish and organ meats.

Immunity-boosting supplements

A well-functioning immune system requires an adequate and consistent intake of several nutrients. Individuals eating a well-balanced diet rich in the foods described above should have no difficulty reaching their daily requirements. However, some may be unable to meet their recommended daily nutrient intakes through diet alone.

If this is the case for you, consider adding the following supplements to your diet:

  1. Probiotics

Ideally, Lactobacillus or Bifidobacterium strains in amounts between 2–3 billion colony-forming units (CFUs) per day.

  1. Vitamin C

Take approximately 75–90 mg per day, and increasing your daily dose to 1 gram per day may provide extra benefits during illness.

  1. A multivitamin

Look for one containing iron, zinc, copper, vitamin E and selenium in amounts sufficient to help you meet 100% of the RDIs.

  1. Zinc lozenges

Doses of at least 75 mg per day at the first onset of cold symptoms may help reduce the duration of the infection.

  1. Vitamin D

Low blood levels of vitamin D may increase the risk of respiratory infections, including the flu, sinus infections and bronchitis. Therefore, those living in northern climates where sunlight is limited might also want to consume at least 600 IU (15 mcg) from vitamin D supplements per day.

Want to know more about boosting your immune system? Come see us.

If you’d like more information on ways to improve your body’s immune system, please make an appointment with Westchester Health to see one of our specialists. We can discuss the details of an immune-boosting diet with you and determine if you would benefit from certain supplements. We can also perform tests to determine if you have a weakened immune system and should make adjustments to your diet and lifestyle.

By Margaret Andersen, MD, an internist with Women Caring For Women, an internal medicine practice focused solely on women.

Categories: Blog

4 Tips To Help Your Child Safely Make It Through Puberty

Westchester Health Blog - Mon, 04/10/2017 - 11:50

Puberty is an exciting time for kids and parents, but it can also be scary, emotional and frustrating. Lots of children are not comfortable with all the changes happening to them or what they mean. They may be concerned or embarrassed about their skin, their body image, their voice, sexual feeling, romantic attraction and/or any number of other changes. At Westchester Health, we understand all the changes your teen or pre-teen is going through and we’re here to help, with advice, information and a listening ear. To make what can be a rough ride a little smoother, we recommend this recent blog by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group.

4 tips to help your child safely navigate the ups and downs of puberty
  1. Reassure your child that everything that’s happening is normal. Their friends are also going through the same changes and probably have similar feelings, although they may not admit it.
  2. Celebrate the changes. Puberty signals that your child is becoming an adult – a young man or woman. Respond with praise, encouragement and support. Also, it’s important at this stage of your child’s development to increase their responsibilities and in a parallel way, your trust of them.

    Lauren Adler, MD, FAAP

  3. Emphasize inner and outer beauty. If you have a daughter, she may say things like, “I’m fat” or “I’m ugly.” Reassure her that she is beautiful, inside and out, and that her body will eventually reach a balanced state.
  4. Encourage your son or daughter to eat healthy, get enough sleep (a tough one at this age), exercise regularly and find healthy ways to de-stress.
Physical development


  1. In girls, the first sign of puberty is usually breast development. Your daughter’s breasts may swell or feel sore, and one breast might be larger than the other. This is normal, but if one breast is significantly different in size, or if the size doesn’t level out in time, you may want to consult your pediatrician.
  2. After breast development, girls will start growing hair in the pubic area and armpits. If your daughter doesn’t already use deodorant, now is a good time to start. Most girls want to start shaving their legs and armpits at this stage, and become very interested (obsessed?) with makeup, body shape, clothes and overall appearance.
  3. They will start to develop hips.
  4. Girl will also start their menstrual period, usually between 12 and 14.


  1. The first physical sign of puberty in boys is testicle and penis growth.
  2. Like girls, they will grow hair in their armpits and pubic areas.
  3. Their muscles will grow and their voices will deepen.
  4. Facial hair usually shows up last.
  5. They develop an Adam’s apple in their throats.

Both girls and boys:

  • Have growth spurts
  • Can develop acne or skin problems; girls may develop these earlier, around age 13
  • Produce body odor
  • Can experience “growing pains” in joints
  • Can become overly sensitive or get upset easily
  • Have an increased sense of body image
  • Experience sexual feelings
Emotional development

Boys may seem more sullen, while girls may cry or yell more easily. Of course, how your child specifically responds to changes will depend on his or her personality.

For girls, expect emotions to run high before and during menstrual periods. If mood swings are severe, your pediatrician might recommend dietary changes, vitamin supplements and more sleep.

Questions or concerns? Please come see us.

If you’re concerned about any aspects of puberty and your child, come in and talk with us at Westchester Health. We’re here to help with advice, guidance and years of experience helping kids and parents make it successfully through this often difficult time.

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

Categories: Blog

10 Ways To Help A Depressed Teen

Westchester Health Blog - Thu, 04/06/2017 - 11:17

Teenagers face a host of pressures, from the physical and emotional changes of puberty to wondering who they are and where they fit in. To help parents, teachers, coaches and anyone else involved with teenagers recognize the signs of depression and how to get help, we offer this excellent blog written by Mason Gomberg, MD, a pediatrician with our Westchester Health Pediatrics group. Here at Westchester Health, we see a lot of teenagers, which also means that we see our fair share of teenage depression.

The most common symptoms of depression in teens

Recognizing teen depression can be difficult because the signs aren’t always obvious but here are the most common signs you should look out for:

  1. Sadness or hopelessness
  2. Irritability, anger or hostility

    Mason Gomberg, MD

  3. Increased drug use (illegal or legal drugs)
  4. Absence form school
  5. Frequent crying
  6. Withdrawal from friends and family
  7. Loss of interest in activities
  8. Poor school performance
  9. Changes in eating and sleeping habits
  10. Feelings of worthlessness and guilt
  11. Lack of enthusiasm and motivation
  12. Fatigue or lack of energy
  13. Difficulty concentrating
  14. Unexplained aches and pains
  15. Thoughts of death or suicide
10 ways to help a depressed teen
  1. Focus on listening, not lecturing. Resist the urge to criticize or pass judgment once your teenager begins to talk. The important thing is that your child is communicating. Simply letting your teen know that you’re there for them, completely and unconditionally, is huge.
  2. Be gentle but persistent. Don’t give up if they shut you out at first. Talking about their depression can be very tough for teens. Even if they want to, they may have a hard time expressing what they’re feeling. Be respectful of your child’s comfort level while still emphasizing your concern and willingness to listen.
  3. Acknowledge their feelings. Don’t try to talk your teen out of depression, even if his/her feelings or concerns appear silly or irrational to you. Your well-meaning attempts to explain why “things aren’t that bad” can often come across as not taking their emotions seriously. To make your teen feel understood and supported, simply acknowledging the pain and sadness they are experiencing.
  4. Trust your gut. If your teen claims nothing is wrong but has no explanation for what is causing the depressed behavior, you should trust your instincts. If your teen won’t open up to you, consider turning to a trusted third party: a school counselor, favorite teacher or coach, or mental health professional. The important thing is for them to start talking to someone.
  5. Encourage social connection. Depressed teens tend to withdraw from their friends and the activities they used to enjoy. However, isolation only makes depression worse, so do what you can to help your teen connect to others. Encourage him/her to go out with friends or invite friends over. Participate in activities that involve other families and give your child an opportunity to meet and connect with other kids. Suggest activities—such as sports, after-school clubs, or an art, dance, or music class—that take advantage of your teen’s interests and talents.
  6. Set aside time each day to talk. The simple act of connecting face to face where you’re focused totally on your teen (no distractions or multi-tasking) can play a big role in reducing his/her depression.
  7. Promote volunteerism. Doing things for others is a powerful antidepressant and self-esteem booster. Help your teen find a cause they’re interested in and that gives them a sense of purpose. If you volunteer with them, it can also be a good bonding experience.
  8. Make physical health a priority. Physical and mental health are definitely connected. In our experience as pediatricians, we’ve seen that depression is exacerbated by inactivity, inadequate sleep and poor nutrition. As a parent, you can combat these behaviors by establishing a healthy, supportive home environment.
  9. Set limits on screen time. Teens often go online to escape their problems, but excessive computer use only increases their isolation, making them more depressed. When screen time increases, physical activity and face time with friends goes down. Both are a recipe for worsening the symptoms of depression.
  10. Encourage plenty of sleep. Teens need more sleep than adults to function optimally—up to 9-10 hours per night. Make sure your teen isn’t staying up until all hours at the expense of much-need, mood-supporting rest.
Don’t ignore the problem

Depression is very damaging when left untreated, and waiting and hoping that the symptoms will go away often just makes the situation worse. If you suspect that your child is depressed, voice your concerns in a loving, non-judgmental way. Let your teen know the specific signs of depression you’ve noticed and why they worry you. Then ask your child to share what he or she is going through—and be willing to truly listen. Refrain from asking a lot of questions but make it clear that you’re ready and willing to provide whatever support he/she needs.

Suicide and teens

Seriously depressed teens often think about, speak of, or make “attention-getting” attempts at suicide. However, since an alarming and increasing number of teenage suicide attempts are successful, suicidal thoughts, behavior or comments should always be taken very seriously.

For the overwhelming majority of suicidal teens, depression or another psychological disorder plays a primary role. In depressed teens who also abuse alcohol or drugs, the risk of suicide is even greater. Because of the very real danger of suicide, teenagers who are depressed should be watched closely for any signs of suicidal thoughts or behavior.

Suicide warning signs to watch for
  1. Talking or joking about committing suicide.
  2. Saying things like, “I’d be better off dead,” “I wish I could disappear forever” “There’s no way out,” or “I just want the pain to stop.”
  3. Speaking positively about death or romanticizing dying.
  4. Writing stories and poems about death, dying or suicide.
  5. Engaging in reckless behavior or having accidents resulting in injury.
  6. Giving away prized possessions.
  7. Saying goodbye to friends, family and pets as if for the last time.
  8. Seeking out weapons, pills or other suicide facilitators.
How to get help for a suicidal teen
  1. If you suspect that your teenager (or someone you know) is suicidal, do not delay—TAKE IMMEDIATE ACTION. For 24-hour suicide prevention and support in the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK.
  2. To find a suicide helpline outside the U.S., visit the International Association for Suicide Prevention website or
  3. To learn more about suicide risk factors, warning signs, and what to do in a crisis, read this article on Suicide Prevention by
Valuable resources to have If you think your child might be suffering from depression, please come see us.

If your teenager is showing signs of depression, please come in to talk to one of our Westchester Health to come in and  pediatricians. We will meet with you and your child and perform screening tests for signs of depression. We’ll then evaluate his/her condition, and together, try to determine the cause and severity of the problem. If we feel it is needed, we will refer your child to a mental health specialist. Rest assured, we will do everything we can to help your child become healthy and happy, physically and emotionally.

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

Categories: Blog

Is It Okay To Have Sex During Pregnancy?

Westchester Health Blog - Mon, 04/03/2017 - 11:06

Sex during pregnancy is often the absolute last thing on some women’s minds, especially when they are dealing with nausea, vomiting and constant fatigue. Other women, however, may crave sex during this special time. Similarly, men seem to fall into two groups regarding sex during pregnancy. Some find nothing sexier than a pregnant woman, but others are too afraid of hurting the baby or their partner to even attempt it. At Westchester Health, we’ve witnessed all of these emotions in our patients over the years and thought we’d offer some helpful advice on the subject.

Is sex during pregnancy safe?

For most women with uncomplicated, low-risk pregnancies, yes, sex during pregnancy is very safe. Here’s how you can think about it trimester by trimester:

Dennis McGroary, MD, FACOG

In the 1st trimester: Sex is often not on the agenda for most pregnant women—they’re tired, nauseous and trying to cope with the many changes their bodies are going through.

In the 2nd trimester: By now, they are usually feeling better and there is more genital lubrication, making sex more appealing and satisfying for both partners. Also, most women are still fairly comfortable with their bigger shape during the second trimester because their stomach is not overly rounded yet.

In the 3rd trimester: Sex becomes more physically difficult, especially during the final weeks of pregnancy as a woman’s stomach grows and fatigue returns, but with some modifications and a willingness to accommodate the bulging belly of a mom-to-be, it can certainly be enjoyed. is It’s an old wives’ tale that having sex close to your due date during the third trimester will bring on labor, but having an orgasm does cause the release of prostaglandins, which can theoretically cause contractions.

The bottom line when it comes to sex during pregnancy? Have fun, listen to your body and be open with your partner.

What about when dads-to-be are nervous that sex will hurt the baby?

In these cases, we tell them that their baby is well protected and will not be harmed by sex. It is an egg surrounded by a pillow and then another pillow and there is no way they can hurt the fetus.

Sexual positions to consider during pregnancy

As a woman’s belly grows bigger and bigger, the traditional man-on-top position becomes more uncomfortable for pregnant women. Other, more comfortable sexual positions during pregnancy may include intercourse from behind or side-to-side (spooning).

Also, at a certain point a pregnant woman should not be flat on her back because the growing uterus can compress major blood vessels, potentially causing pelvic pressure and pain. This typically occurs during the third trimester. Lying flat on her back can also cause a woman to develop supine hypotensive syndrome, which results in a change in heart rate and blood pressure that can lead to dizziness and other symptoms.

One sexual act to avoid during pregnancy is blowing air into the vagina during oral sex. This can cause an air embolus to develop, which can travel to the lung and have potentially fatal consequences.

5 reasons to avoid sex during pregnancy
  1. Sex during pregnancy may not be safe for women with a history of repeated miscarriages, preterm labor, bleeding or an incompetent cervix (when the cervix effaces and dilates without contractions in the 2nd or early 3rd trimester due to the baby’s weight putting increasing pressure on it).
  2. Women with placenta previa (a condition where the placenta is covering the cervix) are at risk of hemorrhaging if they have sex during pregnancy.
  3. Women with premature rupture of membranes (PROM), which occurs when the sac containing the developing baby and the amniotic fluid bursts or develops a hole before labor, should also avoid sex during pregnancy.
  4. If a woman has bleeding or foul-smelling discharge after sex during pregnancy. If this occurs, you should contact your doctor right away. Discharge may be a sign of an infection that can travel upward to the uterus, and bleeding may be a sign of any number of problems.
  5. If a woman’s partner has an STD, she should use a barrier method of contraception, such as a condom, to protect herself and her unborn baby.
Want to know more about sex during pregnancy? Come see us.

If you’d like more information on whether it’s safe for you and your partner to have sex during your pregnancy, please make an appointment with Westchester Health to see one of our OB/GYNs. We will evaluate your health history and current condition and from there, make a recommendation. Our #1 goal is for you to have a safe, uneventful pregnancy and deliver a healthy baby.

By Dennis McGroary, MD, FACOG, Department of OB/GYN, Westchester Health

Categories: Blog

10 Ways to Help Minimize Morning Sickness

Westchester Health Blog - Mon, 03/27/2017 - 11:29

For many of our patients here at Westchester Health, morning sickness should really be called “morning-noon-and-night sickness.” For some pregnant women, the symptoms are worse in the morning and ease up over the course of the day. For others, they last all day long. The intensity of symptoms can also vary from woman to woman. Although morning sickness usually subsides after the first three months of pregnancy, it can be a real hardship for some women. Even a mild case of nausea can wear women down, and constant nausea and vomiting can leave them exhausted and miserable (on top of all the other demands on their body from the pregnancy).

As we tell our expectant mothers-to-be, pregnancy can be really tough but it’s all worth it in the end!

What causes morning sickness

Although doctors don’t know with certainty what causes nausea during pregnancy, it’s probably a combination of:

  • Human chorionic gonadotropin (hCG), a hormone that rises rapidly during the early stages of pregnancy

    Tiffany Werbin-Silver, MD, FACOG

  • Estrogen, another hormone which rises rapidly in early pregnancy
  • An enhanced sense of smell and sensitivity to odors (possibly resulting from higher levels of estrogen)
  • A sensitive stomach
  • Stress
How long will it last?

About 50% of women who experience nausea during pregnancy will feel complete relief around 14 weeks. For many others, however, it takes another month or so for the queasiness to ease up. In either case, it may return later and/or come and go throughout pregnancy. A small percentage of women have symptoms that persist continually until delivery.

NOTE: If you have severe, persistent nausea and vomiting and are unable to take in fluids (causing dehydration), see your doctor right away, as this may be a condition called “hyperemesis gravidarum” (H.G.). H.G. is characterized by severe nausea, vomiting, weight loss and an imbalance of electrolytes. Mild cases are treated with dietary changes, rest and antacids, but more severe cases often require an inpatient stay in the hospital so that the patient can receive intravenous (IV) fluids and nutrition.

To help lessen the severity of morning sickness, we offer these 10 important tips:
  1. Eat small, frequent meals and snacks throughout the day so your stomach is never empty.
    An empty stomach can make nausea worse so eat several small meals through the day instead of three large meals. High-protein foods and complex carbohydrates might be especially helpful. And whatever you eat, eat it slowly.
  2. Keep simple snacks, such as crackers, by your bed.
    When you first wake up, nibble a few crackers and then rest for 20-30 minutes before getting up. When you do get up, do so slowly. Snacking on crackers may also help you feel better if you wake up nauseated in the middle of the night.
  3. Avoid lying down after eating (especially on your left side).
    This can slow digestion. Stay upright for 1 hour after meals.
  4. Stay hydrated.
    Drink a lot of fluids, such as a sports hydration drink, as well as water, broth, juice or ginger ale.
  5. Eat more protein and cut out fatty foods.
    Avoid barbecue ribs, fried chicken, cheesy pizza and burger with fries which can only make your morning sickness worse (and your baby doesn’t need the grease).
  6. Avoid smells and foods that make you feel nauseated.
    Citrus juice, milk, coffee and caffeinated tea typically make nausea worse.
  7. Get lots of rest.
    Stress and fatigue can make morning sickness worse so if at all possible, get as much rest as you can, even it’s just a short nap or taking a few minutes to put your feet up.
  8. Get fresh air.
    Taking a walk or opening a window might ease your nausea.
  9. Try aromatherapy.
    Some women find scents such as lavender, lemon, mint or orange useful in combatting morning sickness. Try putting a drop or two of an essential oil on a handkerchief of Kleenex to sniff when you start to feel queasy.
  10. Consider anti-nausea medication.
    If you’ve been unable to find relief from your nausea no matter what you’ve tried, talk with your doctor about prescription medication that could help. There’s no need to suffer, and waiting too long to take appropriate medication may make your condition more difficult to treat.
Some pregnant women are more likely than others to get morning sickness

You’re more likely to have nausea or vomiting during your pregnancy if any of the following apply:

  • You’re pregnant with twins or higher multiples. This may be from the higher levels of hCG, estrogen or other hormones in your system.
  • You had nausea and vomiting in a previous pregnancy.
  • You have a history of nausea or vomiting as a side effect of taking birth control pills (This is probably related to your body’s response to estrogen.)
  • You have a history of motion sickness.
  • If your mother or sisters had severe morning sickness, there’s a higher chance you will, too (genetic predisposition).
  • You have a history of migraine headaches.
  • You’re carrying a girl. Several studies have found that about 55% of women with severe nausea and vomiting in the first trimester give birth to a girl.
Having a hard time with morning sickness? Please come see us.

If you’re experiencing persistent morning sickness and want some relief, please make an appointment with Westchester Health to see one of our OB/GYNs. The sooner we can evaluate and start treating your symptoms, the sooner we can help you feel better and enjoy your pregnancy.

By Tiffany Werbin-Silver, MD, FACOG, an OB/GYN with Westchester Health.

Categories: Blog

How Often Should You Get a Colonoscopy?

Westchester Health Blog - Tue, 03/21/2017 - 10:31

A colonoscopy is a diagnostic screening exam that a physician, usually a gastroenterologist, uses to look inside your large intestine for colon polyps or possible signs of colorectal cancer.  How often you should be screened depends on the specific test, your age and your risk for colon cancer.

At what age and how often to have a colonoscopy

If you’re at average risk of colon cancer, we at Westchester Health, recommend that you have a colonoscopy every 10 years, starting at age 50. The procedure may be performed earlier and more often in people at increased risk, including those with a personal or family history of:

  • polyps (abnormal growths)

    Elie M. Abemayor, MD, Sc.M.

  • colorectal cancer
  • inflammatory bowel disease
  • a hereditary syndrome such as familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer (Lynch syndrome)

Colorectal cancer screening generally starts at age 50 because colon cancer risk increases with age, and more than 90% of cases occur in people aged 50 and over.

Most colorectal cancers start as polyps. The progression from precancerous polyp to cancer is believed to take 10 years or more, although experts don’t really know because clinicians remove polyps when they find them, before they become cancerous. Screening also identifies colon cancer early, when it’s most treatable.

Some guidelines recommend that routine screening continue until age 76, with screening then being an option between ages 76 and 85, depending on overall health and risk factors. Screening is not recommended after age 85.

If you choose colonoscopy, seek out a gastroenterologist with plenty of experience performing the procedure and a facility equipped to handle potential problems.

Why get tested? It’s the best way to prevent colon cancer.

The American Cancer Society believes that preventing colorectal cancer (not just detecting it early) should be a major reason for every individual to get tested. There are a variety of tests currently available. Those that have the best chance of finding both polyps and colon cancer are preferred, if these tests are available to you and you are willing to have them.

Starting at age 50, men and women at average risk for developing colorectal cancer should get one of the screening tests below:

Tests that find polyps and cancer
  • Flexible sigmoidoscopy every 5 years*
  • Colonoscopy every 10 years
  • Double-contrast barium enema every 5 years*
  • CT colonography (virtual colonoscopy) every 5 years*
Tests that mainly find cancer
  • Guaiac-based fecal occult blood test (gFOBT) every year**
  • Fecal immunochemical test (FIT) every year**
  • Stool DNA test every 3 years*

*Colonoscopy should be done if test results are positive.
**Highly sensitive versions of these tests should be used with the take-home multiple sample method. A gFOBT or FIT done during a digital rectal exam in the doctor’s office is not enough for screening.

Is a rectal exam enough to screen for colorectal cancer?

In a digital rectal examination, a healthcare provider examines your rectum with a lubricated, gloved finger. Although a DRE is often included as part of a routine physical exam, it’s not recommended as a stand-alone test for colorectal cancer. This simple test, which is not usually painful, can find masses in the anal canal or lower rectum. However, by itself it’s not a good test for detecting colorectal cancer because it only checks the lower rectum.

Doctors often find a small amount of stool in the rectum when doing a DRE. But testing this stool for blood with a gFOBT or FIT is not an acceptable way to screen for colorectal cancer. Research has shown that this type of stool exam will miss more than 90% of colon abnormalities, including most cancers.

People at increased or high risk

If you are at an increased or high risk of colorectal cancer, you might need to start colorectal cancer screening before age 50 and/or be screened more often. The following conditions make your risk higher than average:

  • A personal history of colorectal cancer or adenomatous polyps
  • A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
  • A strong family history of colorectal cancer or polyps (see Colorectal cancer risk factors)
  • A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
How to prepare for a colonoscopy

For your colonoscopy to be diagnostically successful, your colon must be empty and “clean.” This means you need to restrict your diet at least 24 hours before the procedure. Clear liquids rather than solids are recommended, such as:

  • Coffee
  • Broth
  • Water
  • Sports drinks

Then you need to empty your bowel the night before and the morning of the procedure, typically by taking a series of enemas or drinking a solution of magnesium citrate that causes you to go to the bathroom.

You’ll need someone take you home after the colonoscopy. You will be sedated during the procedure, therefore it won’t be safe for you to drive or operate machinery for at least 8 hours afterward.

How is a colonoscopy performed?

During your colonoscopy, sedatives will be administered through an IV in your arm, putting you to sleep. Then your physician will put a tube-like instrument called a colonoscope into your rectum, with a light and video camera on the tip so he/she can see the lining of your colon and detect if there is a problem. The colonoscope also includes a tube that lets your physician pump in air and inflate your colon, giving him/her a better view of your colon and its lining.

During the exam, your physician can use the tool to take tiny samples of your colon for testing (biopsy). He can also use the tool to remove polyps.

Is it time for you to have a colonoscopy? Please come see us.

If you are age 50 or over and have never had a colonoscopy, please make an appointment with Westchester Health to see one of our gastroenterologists. If you have had the procedure but it’s time to have another one, please make an appointment, too. The sooner we can detect potential problems, the sooner they can be treated before they become more serious.

By Elie M. Abemayor, MD, Sc.M., a gastroenterologist with Westchester Health.

Categories: Blog

7 Effective Ways to Manage Spring Allergies

Westchester Health Blog - Mon, 03/20/2017 - 10:46

Spring is on its way! While many people look forward to this season of renewal, warm weather and beautiful blossoms, for those with allergies it can be something to dread. At Westchester Health, our patients with eye, nose and respiratory spring allergies usually find themselves symptomatic from late March until late May, although the onset of symptoms could be earlier depending on warm weather trends.

What causes spring allergies?

James Pollowitz, MD, FAAAAI, FACAAI

The biggest spring allergy trigger is pollen: tiny grains released into the air by trees, grasses and weeds for the purpose of fertilizing other plants. When these pollen grains get into the nose of someone who is allergic to them, their immune system mistakenly sees them as foreign invaders and releases antibodies to attack the allergens. This leads to the release of chemicals called histamines which trigger a runny nose, itchy eyes and other symptoms of allergies. The higher the pollen count, the greater the symptoms.

Allergy symptoms tend to be particularly high on windy days when the wind picks up pollen and carries it through the air. Rainy days, on the other hand, cause a drop in pollen counts as the allergens get washed away.

The worst culprits for allergy-causing tree pollen

Some of the more common trees that can cause allergies in the Northeast are:

  • birch
  • maple
  • elm
  • oak
  • sycamore
  • alder
  • ash
  • beech
  • hickory
Symptoms of spring allergies

As trees and flowers start to bloom and pollen takes to the air, spring allergy sufferers begin to sniffle and sneeze. The typical symptoms are:

  • Runny nose
  • Watery eyes
  • Sneezing
  • Coughing
  • Itchy eyes and nose
  • Dark circles under the eyes

Allergens also can trigger asthma, a condition in which the airways narrow, making breathing difficult and leading to coughing, wheezing and shortness of breath.

How to manage spring allergies

It’s nearly impossible to completely avoid spring allergies if you live in an area with an abundance of trees, flowers and plants. However, you can lessen the sniffling, sneezing and watery eyes by avoiding spring allergies’ main triggers. At Westchester Health, we recommend:

  1. Try to stay indoors whenever the pollen count is very high (it usually peaks in the morning).
  2. Keep your doors and windows closed whenever possible during the spring/summer months to keep out allergens.
  3. Use an air purifier.
  4. Clean the air conditioner filters in your home often.
  5. Clean bookshelves, vents and other places where pollen can collect.
  6. Wash your child’s hair after going outside (pollen can collect there).
  7. Vacuum twice a week. Be sure to wear a mask because vacuuming can kick up pollen, mold and dust trapped in your carpet.
Treatment for spring allergies

Spring allergies can be treated with a number of over-the-counter medicines, including:

  1. Antihistamines reduce sneezing, sniffling and itching by lowering the amount of histamine (the substance produced during an allergic reaction) in the body. Note: All of the 24-hour non-sedating antihistamines (Claritin, Allegra and Zyrtec) are now OTC as brand and generic products. The older medications such as Benadryl last only 2-4 hours and are very sedating.
  2. Decongestants clear mucus from the nasal passageways to relieve congestion and swelling.
  3. Antihistamine/decongestants combine the effects of both of the above drugs.
  4. Nasal spray decongestants relieve congestion and may clear clogged nasal passages faster than oral decongestants.
  5. Steroid nasal sprays reduce inflammation. Several products are now available over-the-counter including: Nasacort AQ, Flonase (both of these are available as generic store brands), Clarispray (the same medication as Flonase), Rhinocort and Flonase sensimist (previous brand name was Veramyst).
  6. Cromolyn sodium nasal spray can help prevent hay fever by stopping the release of histamine before it can trigger allergy symptoms.
  7. Eye drops relieve itchy, watery eyes.
  8. Immunotherapy (allergy shots) should be considered when medical management with nasal sprays, eye drops and oral liquid/pills do not adequately control allergic symptoms.
If your suffer from spring allergies, please come see us

If spring allergies are making you miserable, please make an appointment with Westchester Health to see one of our allergy, asthma and immunology specialists. The sooner we can diagnose the triggers and symptoms, the sooner we can get you relief so you can start enjoying the spring.

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

Categories: Blog

10 Signs You May Have A Parasite

Westchester Health Blog - Mon, 03/20/2017 - 10:43

Even though the thought of having a parasite is pretty unpleasant, parasites are far more common than you might think. We actually see quite a few cases of them here at Westchester Health. Not restricted to underdeveloped countries, parasites exist around the world and can afflict anyone of any race, gender or socioeconomic status. They can cause a myriad of symptoms, only a few of which affect the digestive tract, but the good news is that yes, they are treatable.

What is a parasite?

Elie M. Abemayor, MD, Sc.M.

A parasite is any organism that lives and feeds off another organism. Examples of parasites include:

  • roundworms
  • tapeworms
  • pinworms
  • whipworms
  • hookworms
  • lice
  • giardia
  • mosquitos
  • bedbugs
  • scabies

Because parasites come in so many different shapes and sizes, they can cause a very wide range of problems. Some consume your food (from inside your body), leaving you hungry after every meal and unable to gain weight. Others feed off your red blood cells, causing anemia. Some lay eggs that can cause itching, irritability and even insomnia.

How do you get parasites?

There are a number of ways to contract a parasite. Here are the most common causes:

  • contaminated food and water
  • undercooked meat
  • contaminated water
  • unclean or contaminated fruits and vegetables
  • the bottom of your foot

Once a person is infected with a parasite, it’s very easy to pass it along. If you have a parasite and don’t wash your hands after using the restroom, you can easily pass microscopic parasite eggs onto anything you touch: the bathroom door handle, salt shaker, your phone or anyone you touch. Traveling overseas is another way that foreign parasites can be introduced to your system. It’s also very easy to contract a parasite when handling animals.

10 signs that may mean you have a parasite

The signs of a parasite are often caused by the toxins that it releases into the human bloodstream. Here are the most common symptoms:

  1. Unexplained constipation, diarrhea, gas, bloating, nausea or other symptoms of Irritable Bowel Syndrome
  2. You traveled internationally and got diarrhea on your trip
  3. You have had food poisoning and your digestion has not been the same since
  4. You have trouble falling asleep or you wake up multiple times during the night
  5. Skin irritations or unexplained rashes, hives, rosacea or eczema
  6. You grind your teeth in your sleep
  7. Painful, aching muscles or joints
  8. Fatigue, exhaustion, mood changes, depression or frequent feelings of apathy
  9. You never feel satisfied or full after your meals
  10. You’ve been diagnosed with iron-deficiency anemia
How to test for parasites

The best way to test for a parasite is to get a stool test. Most doctors will run a conventional stool test if they suspect a parasite.

Treatment options
  1. Drug therapies. Your doctor will choose the drug that is most effective for your particular parasite. You may need just one dose or you may have to take the medication for several weeks. Be sure to take the medicine exactly as it is prescribed or it may not work.
  2. Complementary and alternative therapies. Conventional medical treatments can get rid of parasites more quickly and with fewer side effects than most alternative treatments. Yet, alternative treatments may be helpful alongside conventional medications. However, your doctor must find out what kind of organism is causing your problems before you start treatment.
  3. Nutritional guidelines to help keep parasites from growing:
  • Avoid simple carbohydrates, such as those found in refined foods, fruits, juices, dairy products, and all sugars, except honey.
  • Eat raw garlic, pumpkin seeds, pomegranates, beets and carrots, all of which have been used traditionally to kill parasites.
  • Drink a lot of water to help flush out your system.
  • Eat fiber, which may help get rid of worms.
  • Probiotics (Lactobacillus acidophilus, Lactobacilus plantarum, Saccharomyces boulardii and bifidobacteria) help keep your digestive tract healthy but they may not be appropriate in some severely immune compromised patients.
  • Digestive enzymes will help restore your intestinal tract to its normal state, which makes it inhospitable to parasites.
  • Vitamin C supports the immune system. Lower the dose if diarrhea develops.
  • Zinc supports the immune system but may interact with certain medications, particularly some antibiotics, and it may not be appropriate for people with HIV/AIDS.
  1. Herbs are a proven, effective way to strengthen the body’s systems. As with any therapy, you should work with your doctor to diagnose your problem before starting treatment. You can take herbs as dried extracts (capsules, powders or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts).
Worried that you may have a parasite? Please come see us.

If you’re experiencing any of the symptoms listed above and think you may have a parasite, please make an appointment with Westchester Health to see one of our physicians. The sooner we can test for parasites, identify which type you have and start treating you, the sooner you can start to feel better.

By Elie M. Abemayor, MD, Sc.M., a gastroenterologist with Westchester Health.

Categories: Blog

10 Tips for Keeping Your Joints Healthy and Pain Free

Westchester Health Blog - Thu, 03/16/2017 - 10:36

Exercise is an excellent way to tone up and lose weight. Plus, it builds muscle which supports your bones (which helps prevent osteoporosis) and improves your cardiovascular health. However, exercise can also be hard on the joints, often making them stiff or sore after a workout. If joint pain is severe enough, it can keep you from exercising, which negatively affects your health by keeping you from getting the benefits of physical activity. The best course of action is to keep your joints, muscles, ligaments and bones strong and stable. To help lessen and even prevent joint pain, we at Westchester Health recommend these 10 tips to follow before, during and after exercise.

10 ways to prevent joint pain

In cases other than arthritis, joint pain is most often caused by overuse or injury (for example, tennis elbow, pitcher’s elbow or weightlifter’s knee). We tell our patients to follow these guidelines for 2-3 months and see if they experience less joint pain. The goal is to enjoy exercise, not be in pain because of it.

  1. Choose low impact exercise whenever possible

Bryan E. Dorf, DO, MBA

For many people, the best type of physical exercise involves activities that do not pound the joints, such as walking, bicycling, swimming, yoga or strength training.

  1. Don’t stretch before exercise

Contrary to popular belief, it is not good for your muscles and joints to stretch when they are cold. Instead, we recommend stretching daily or at least three times a week, but not immediately prior to a workout. Before exercising, start with a light warm-up, such as walking for 10 minutes, to loosen up your joints, ligaments and tendons, then gradually build up the exertion.

  1. Build muscle to support your joints

Strong muscles give your joints better support. This is especially important for people with weakened bones due to osteoporosis. Even a little more strength makes a difference. If you have joint problems, it is best to avoid quick, repetitive movements; slow and fluid is better.

  1. Improve your flexibility

If your joints are stiff and not very flexible, it’s important to increase your range of motion. The more flexible you are, the better your balance and overall joint health, and the less likely you are to fall.

  1. Keep your bones and muscles strong

For strong bones, it is vital to take in enough calcium and vitamin D every day. Dairy products are the best sources of calcium, but other good sources are green, leafy vegetables such as broccoli and kale. If you think you are not getting enough calcium from your diet, consider supplements. In addition, your muscles need protein. Exactly how much you need depends on your age, sex, and how active you are. Good sources include lean meats, seafood, beans, legumes, soy products and nuts.

  1. Apply ice to painful or swollen joints

Ice is a natural pain reliever which also reduces swelling. For a sore joint, apply a cold pack or ice wrapped in a towel, leaving it on for up to 20 minutes at a time. You can also try a bag of frozen vegetables (green peas are best) wrapped in a towel. Never apply ice directly to your skin, as this could cause freeze burns or blistering.

  1. Pay attention to your posture

To protect your joints from your neck down to your knees, always stand and sit up straight. When walking, making sure your shoulders are back and your spine is straight. If you work at a desk, take a break every hour to stretch and readjust your posture. Swimming is also a good way to help keep your posture aligned.

  1. Develop a strong core

Strong abs and back muscles greatly improve your balance, making you less likely to fall or get injured. Concentrate on core strengthening exercises which work on your abdominal, back and hip muscles when you exercise. Pilates and yoga are great workouts for strengthening your core.

  1. Maintain a healthy weight

The amount of weight your skeleton must carry around directly affects your hips, knees and back. If you are overweight, it’s important to slim down. Even a little weight loss can help your joints. Consider this: Every pound you lose takes 4 pounds of pressure off your knees.

  1. Treat joint injuries right away

A joint injury (shoulder, knee, ankle, wrist, neck, back) can quickly cause the loss of cartilage in that joint, making the injury more serious. If you have injured a joint, come see us right away for evaluation, diagnosis and treatment. But just as important as getting your injury treated is taking steps to avoid more damage in the future (such as following these 10 tips). If your joint injury is serious enough, you may have to stop doing certain activities that put too much stress on that joint, or use a brace to stabilize it.

In some cases, joint pain might signal something more serious

If following these tips do not alleviate your joint pain, you may have a more serious condition such as Lyme disease, rheumatoid arthritis, bursitis, osteoporosis or tendonitis. If your symptoms persist or get worse, it’s important to see a physician right away so you can get a proper diagnosis.

If you are experiencing stiff or sore joints, come see us

If you are feeling pain in any of your joints, please make an appointment with Westchester Health. The sooner we can evaluate and start treating the problem, the sooner you feel better and start enjoying exercising again.

By Bryan E. Dorf, DO, MBA, an Internist with Westchester Health.

Categories: Blog

5 Best Ways To Treat Knee Arthritis Without Surgery

Westchester Health Blog - Thu, 03/16/2017 - 10:00

If you’re like a lot of people over age 50, knees that have served you well for years gradually start hurting and swelling. They may start making cracking or popping sounds, and you may even feel a grinding sensation in your knees as you move. Most likely, you’ve developed arthritis of the knee, something we see quite often at Westchester Health.

The term “arthritis” simply means inflammation of a joint and is used to describe 200 rheumatic diseases and conditions that affect joints, the tissues that surround the joint, and other connective tissue. Healthy cartilage is shiny white and smooth, and its function is to allow joints to glide and move smoothly. Arthritis is the damage or loss of this cartilage between bones in a joint. When it is damaged, it results in pain and swelling.

Arthritis can result from many causes:
  • Trauma or injury

    Lori Sloane, MD

  • Normal wear and tear
  • Age
  • Inflammation
  • Infection
The knee joint is the most common joint to develop arthritis

The joint that most frequently develops arthritis is the knee, and osteoarthritis is the most common form of arthritis in the knee. This is a degenerative, “wear-and-tear” type of arthritis that occurs most often in people 50 and older, but may occur in younger people, too. In osteoarthritis, the cartilage in the knee joint gradually wears away. Knee pain that wakes you up from sleep can be a symptom of osteoarthritis.

Another type of arthritis that can develop in the knee, usually following an injury to the knee joint, is called post-traumatic arthritis. This can result from a torn meniscus, an injury to a ligament, or a fracture of the knee, sometimes years later.

Arthritis pain can begin suddenly but typically it develops slowly

Knee arthritis pain is usually worse in the morning and after a lot of walking or running. Going up and down stairs is especially painful, as well as squatting. Some of our patients with arthritis say that damp weather or other changes in weather can bring on pain.

5 things you can do to treat knee arthritis without surgery

There are many effective options for relieving the pain of arthritis of the knee and improving joint function before resorting to surgery. Here are the 5 most effective ones:

  1. Physical therapy. The first line of treatment for arthritis of the knee is physical therapy. Stretching your quadriceps and hamstrings takes stress off the knee. In addition, strengthening these muscles helps maintain proper knee alignment and helps decrease the pain.
  1. Anti-inflammatories are effective in treating knee swelling and pain for most people.
  1. Ice is a very safe and effective treatment and should be used after strenuous activity, including extensive walking.
  1. If your knee pain persists after trying the above three therapies, the next treatment for knee arthritis is injections. Steroid injections work quickly and are effective for most people, but only last an average of 4 weeks. Injections of hyaluronic acid, a natural lubricant and anti-inflammatory, are also very effective and last an average of 6 months but may take a few weeks to work.
  1. PRP therapy. Another highly-effective type of injection is Platelet Rich Plasma (PRP). In this treatment, platelets are taken from your own blood, spun in a high speed centrifuge and then specific portions are injected into your knee. Many physicians consider PRP treatment to be experimental, but several studies have shown it to be very effective.
Sometimes, knee surgery is your best option

If none of these non-surgical treatments work, your pain is still significant and you cannot function the way you’d like, it may be time to consider knee replacement surgery, one of the most successful surgeries today. The procedure involves removing the damaged cartilage and underlying bone and replacing it with smooth metal and plastic. Pain relief is almost immediate and dramatic.

How to know if you have knee arthritis

Arthritis of the knee is very common but before you begin treatment for it, it’s wise to make sure you have the correct diagnosis. The only way to be certain is to have a thorough physical exam by a specialist.

If you think you have arthritis in one or both of your knees, come see us

If you are experiencing pain, swelling and/or stiffness in your knee(s), please make an appointment to see one of our Westchester Health specialists. If you do in fact have knee arthritis, we can determine the course of action that will give you the best possible outcome.

By Lori Sloane, MD, a specialist in rheumatology and internal medicine with Westchester Health.

Categories: Blog

For Working Moms: 10 Tips For Balancing Work And Family

Westchester Health Blog - Mon, 03/13/2017 - 10:36

Something we often hear from our full-time working moms is that they feel guilty and stressed because of having to divide their time and attention between work and family. And with more mothers than ever in the workforce, these emotions are only going to increase. To help moms find a balance between the job and the kids, Maryann Buetti-Sgouros, MD, FAAP, a pediatrician in our Westchester Health Pediatrics group and herself a working mom, offers these tried-and-true strategies in a recent blog.

10 tips for busy, multi-tasking working moms

1. Do work at home, do home at work 

Exactly where you complete the tasks you need to get done each day doesn’t matter. Think of your day as a fluid river rather than rigid silos. The key is to know how you perform best.

Maryann Buetti Sgouros, MD, FAAP

2. Make your home office Command Central

Who says to work at home, you have to be cordoned off in a room far away from anyone who can bug you? Figure out which location in your house provides some privacy while allowing you to still be accessible when needed.

3. Limit your morning expectations

Getting out the door in the morning (without anyone in tears) is the only thing you have to achieve before 8:30 a.m. Not everyday is doing to go smoothly but, if you don’t try to squeeze in too many things, the greater your chances of getting out of the house with a smile on your face.

4. If you have a sick family member, go with your gut

Our rule is: “If there is any possibility that I might have to run out of work to pick my child up due to illness at school, my child stays home.”

5. Don’t obsess over things no one will remember in 5 years

In time, no one, not even you, will still be upset that you showed up with store-bought cupcakes for the class party when everyone else baked theirs. Or that your child was the last to be potty-trained. These will soon be way in the past so let them go.

6. Night-before, and even week-before prep

Since you’re probably exhausted at the end of each day, save yourself a ton of stress and time by doing some quick preparations at night to be ready for the morning. Make one large weekly shopping trip to cook meals throughout the week. Prepare lunches in advance. Develop a clean-up routine at night where you put everything away, getting the kids (even if they’re toddlers) and your partner to help.

7. Streamline chores when possible

Schedule your bills to pay automatically or through your bank. Join a carpool for after-school activities to save driving time. Shop online for everything that makes sense.

8. Make lists

Don’t rely on your memory; chances are you have a million things on your mind at any given time. Prioritize the items so if you run out of time, the really important ones get done.

9. Learn to say “no”

Most likely, you’re over-scheduled. Moms try to be everything to everybody, and it’s just not possible. You don’t need to join every group, volunteer for every committee, sign your kids up for every activity or attend every event. Decide which things are truly important to you and your family and make them a priority.

10. Take care of yourself first

Yes you have responsibilities and needs, but if you do not take care of yourself, who is going to take care of everyone else? Find the time to exercise, even if it only means doing a short daily workout. Join a weekly activity such as a music lesson, a book club or a dance class. And don’t forget your own health maintenance, such as an annual mammogram, physical and 6-month dental check-up.

If you’re having a hard time juggling kids and work, please come see us

At Westchester Health, we understand the many challenges of raising kids while working. (We’re working moms and dads, too.) Please come in and talk with us if you’re stressed and want some help figuring it all out. Know that we’re here for you as well as your child, with advice and guidance. Together, we will find solutions so that you, your child and your family can enjoy this time together.

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

Categories: Blog

How to Know if You Have Glaucoma and What to Do About It

Westchester Health Blog - Mon, 03/13/2017 - 10:05

At Westchester Health, we often see older patients who have developed glaucoma, a condition that causes damage to the eye’s optic nerve and unfortunately, may get worse over time. Linked to a buildup of pressure inside the eye, glaucoma tends to be genetic and may not show up until later in life. This increased pressure, called intraocular pressure, can damage the optic nerve. If the damage continues, glaucoma can lead to permanent vision loss.

Without treatment, glaucoma can cause total permanent blindness within a few years. Less common causes include a blunt or chemical injury to your eye, severe eye infection, blocked blood vessels inside the eye and inflammatory conditions. Glaucoma usually affects both eyes, but it may be worse in one than the other.

How to recognize the symptoms of glaucoma

Most people with glaucoma have no early symptoms or pain. This is why it is so important to see your eye doctor regularly so he/she can diagnose and treat glaucoma before long-term visual loss happens.

William B. Dieck, MD, FAAO

Detecting glaucoma early is one reason you should have a complete exam with an eye specialist every 1-2 years. If you are over age 40, have health problems such as diabetes or a family history of glaucoma, or are at risk for other eye diseases, you should get checked more often.

The first sign is often a loss of peripheral, or side, vision, but this can go unnoticed until late in the disease. Occasionally, pressure inside the eye can rise to severe levels. In these cases, you may have sudden eye pain, headache, blurred vision or the appearance of halos around lights.

If you have any of the following symptoms, seek immediate medical care:

  • Seeing halos around lights
  • Vision loss
  • Redness in the eye
  • Eye that looks hazy (particularly in infants)
  • Nausea or vomiting
  • Eye pain
  • Narrowed vision (tunnel vision)
Two main types of glaucoma
  1. Open-angle glaucoma. This is the most common type of glaucoma, also called wide-angle glaucoma. The drain structure in the eye (trabecular meshwork) looks normal but fluid does not flow out like it should.
  2. Angle-closure glaucoma. This is also called acute, chronic angle-closure or narrow-angle glaucoma. Because the angle between the iris and cornea is too narrow, the eye does not drain correctly because the iris is in the way, which can cause a sudden buildup of pressure in the eye. This type of glaucoma is also linked to farsightedness and cataracts (clouding of the lens inside the eye).
Who is most likely to develop glaucoma?

Glaucoma mostly affects adults over 40 but young adults, children and even infants can develop it. African-Americans tend to get it more often, when they’re younger, and with greater vision loss.

You are more likely to develop glaucoma if you:

  • Are of African-American, Irish, Russian, Japanese, Hispanic, Inuit or Scandinavian descent
  • Are over 40
  • Have a family history of glaucoma
  • Have poor vision
  • Have diabetes
  • Take certain steroid medications, like prednisone
  • Have had trauma to the eye or eyes
How glaucoma is diagnosed

Glaucoma tests are painless and take very little time. An ophthalmologist uses drops to dilate your pupils, then tests your vision and examines your eyes. He/she checks your optic nerve, which if you have glaucoma, will exhibit certain signs. The doctor may take photographs of the nerve to help him/her track your disease over time, then performs a test called tonometry to check your eye pressure. He/she also does a visual field test, if necessary, to determine if you’ve lost your peripheral vision.

How it is treated

At this time, there are three ways to effectively treat glaucoma.

  1. Eye drops. These are used to either reduce the formation of fluid in the eye or increase its outflow. Side effects may include allergies, redness, stinging, blurred vision and irritated eyes. Some glaucoma drugs may affect the heart and lungs. Be sure to tell your ophthalmologist about any other medications you’re taking or are allergic to.
  2. Laser surgery. For those with open-angle glaucoma, this type of surgery can slightly increase the flow of fluid from the eye and can stop fluid blockage if you have angle-closure glaucoma. Procedures include:
  • Trabeculoplasty: Opens the drainage area
  • Iridotomy: Makes a tiny hole in the iris to let fluid flow more freely
  • Cyclophotocoagulation: Treats areas of the middle layer of your eye to reduce fluid production
  1. Microsurgery. Using a procedure called a trabeculectomy, the ophthalmologist creates a new channel to drain fluid and ease eye pressure. He/she might implant a tube to help drain fluid. Be aware that surgery can cause temporary or permanent vision loss, as well as bleeding or infection.

Open-angle glaucoma is most often treated with various combinations of eye drops, laser trabeculoplasty and microsurgery. Infant or congenital glaucoma is primarily treated with surgery, because the cause of the problem is a distorted drainage system.

Talk to your eye doctor to find out which glaucoma treatment would be best for you.

Is there a way to prevent glaucoma?

No. But if you diagnose and treat it early, you can control the disease.

If you think you may have glaucoma, come see us

If you are experiencing any of the symptoms of glaucoma mentioned above, please make an appointment to see one of our specialists at Westchester Health right away. If you do in fact have glaucoma, we will start treatment right away. The sooner we can diagnose the disease, the sooner further damage to the eye or eyes can hopefully be prevented.


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

Categories: Blog

6 Crucial Tips For Surviving The Terrible 2s

Westchester Health Blog - Thu, 03/09/2017 - 10:34

Has your sweet, adorable child suddenly morphed into an unrecognizable little monster? Instead of wide-eyed smiles and happy giggles, are you now witnessing:

  • screaming
  • temper tantrums
  • kicking and biting
  • grabbing toys
  • fighting with siblings
  • every word is “No”
  • total meltdowns  ???

Welcome to the terrible 2s!

The reason for the terrible 2’s? Your toddler’s need for independence vs. lack of control

Lacking the language skills to express what they want and need at this stage, they get overwhelmed very easily, explains Mason Gomberg, MD, a pediatrician in our Westchester Health Pediatrics group, in a recent blog. The perfect recipe for multiple meltdowns! In fact, children who don’t express themselves well will have more temper tantrums.

6 ways to avoid, or even prevent, toddler tantrums

Mason Gomberg, MD

At Westchester Health, we’ve helped thousands of parents shepherd their 2-year-olds through the “terrible” years, and we’re ready to help you with yours, with information, advice and maybe most of all, a listening ear. Here are 6 tried-and-true, parent-tested tips to help you survive this very trying phase in your child’s development:

1) Make sure your child has enough to eat

Three meals a day aren’t always enough to satisfy a hungry toddler, especially a picky eater. Your growing child needs 1,000-1,200 calories a day, which translates into 3 meals and 1-2 snacks.

2) Keep your cool

No matter how bad a tantrum gets, try not to lose it yourself, too. Take a deep breath, leave the scene if necessary (and if possible), and regroup so you can calmly deal with the behavior.

3) Pay attention to naptime when scheduling outings and playdates

Try not to plan activities at times when you know your child is most likely to fall apart, usually near nap time or meal time.

4) Try to prevent a tantrum before it starts

Temper tantrums often happen when your child is hungry, tired, bored or feeling overwhelmed. When you sense an explosion building, quickly redirect: change the environment, give him/her a snack, sing a song, read a book or play a quiet game. When a full-blown temper tantrum does occur, walk away and let him/her come to you in a different room when he/she is done.

5) Give your toddler some control

Letting your 2-year-old have a say in some aspects of his/her life will work wonders in diffusing the “terrible 2s” attitude. Let your child choose what to wear or what snack have.

6) Teach your child healthy ways to vent anger

When your toddler wants to react to a frustrating situation by yelling and screaming, help him/her find an acceptable outlet for the anger instead, like running around outside, bouncing a ball or singing loudly. Just make sure the alternate behavior does not entail violence that can be acted out later on others, like punching a pillow or hitting a doll.

At the end of your rope with your toddler? Come see us.

If you’re finding it hard (or impossible!) dealing with your 2-year and would like some advice and guidance, or if you have questions about any aspects of your child’s health and well-being, please come in to see one of our pediatricians at Westchester Health. Together, we’ll figure out a way forward that works for everyone and helps relieve the stress of the toddler years.

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

Categories: Blog

What The New Peanut Allergy Guidelines Mean For You And Your Child

Westchester Health Blog - Mon, 03/06/2017 - 10:13

For many years, expert opinion said that the best way to prevent food allergy, especially an allergy to peanuts, was to not feed that food to a child until age 3. However, a landmark study published in 2015 (the LEAP study) has disputed this long-held belief and instead, demonstrated that children at risk for peanut allergy in fact had a much lower incidence of allergy by age 5 if they were fed peanuts regularly by age 6 months, compared to children who avoided peanuts. James A. Pollowitz, MD, FAAAAI, FACAAI, an allergy, asthma and immunology specialist with our Westchester Health Pediatrics group, explains these dramatic new findings in a recent blog.

New guidelines for preventing peanut allergy

In light of this new data from the LEAP study, an expert panel recently released new guidelines for preventing the development of peanut allergies in children. The panel separated infants with food allergies into three (3) groups:

  1. Infants with severe eczema, egg allergy or both should be tested for peanut sensitivity by either blood or skin testing. The new guidelines specify that infants who exhibit levels that suggest early peanut sensitivity and risk should be fed peanuts between ages 4-6 months. If the test results are low/negative, feeding peanuts can start at home (between ages 4-6 months). If the blood or skin tests show increased reactivity, then feeding peanuts should proceed under the guidance of a physician trained in treating allergic reactions (i.e. a trained allergist). Feeding instructions are included in the guidelines (i.e., whole peanuts can cause choking in infants and never should be used). There are instructions regarding thinning peanut butter with hot water, using peanut flower or Bamba, a peanut snack.

    James A. Pollowitz, MD, FAAAAI, FACAAI

  2. Infants with mild to moderate eczema without egg allergy should start eating peanut products by six (6) months of age. The guidelines do not mandate physician supervised feeding. Instead, they suggest in-office supervised feeding, per parent and provider preference.
  3. Infants without either eczema or food allergy should have peanuts introduced with other solid foods, per family (and cultural) preferences. 
The goal of the new guidelines: to decrease peanut allergy in children

Given the increasing incidence of food (especially peanut) allergies over the past 20 years, it is hoped that these guidelines with help to decrease the frequency of peanut allergy in children and adults.

Concerned that your child might have peanut allergy? Come in and see us.

If you think your child might be allergic to peanuts and you’d like guidance about how to proceed, please come in and see one of our allergy, asthma and immunology specialists at Westchester Health, Member of Northwell Health Physician Partners. The sooner we can examine and diagnose your child, the sooner we can start to manage or even prevent a peanut allergy.

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

Categories: Blog

12 Simple Tips to Help Your Child Develop Healthy Self-Esteem

Westchester Health Blog - Thu, 03/02/2017 - 10:27

In children, self-esteem is influenced not only by their own internal perceptions and expectations but by how they are thought of and treated by parents, siblings, teachers, coaches and friends. How people value themselves, get along with others, perform at school, achieve at work and relate in marriage all stem from their self-image, and it all begins in childhood. In addition, parents need to be good role models for their children and exhibit good self-esteem themselves because their children will follow their example, good or bad, writes Mason Gomberg, MD, a pediatrician in our Westchester Health Pediatrics group, in a recent blog.

 12 characteristics your child needs to develop for positive self-esteem
  1. A sense of security. Your child needs to know he/she is loved and cared for, and to feel secure about himself/herself, his/her place in the family and the future. (“Do I matter?” “Where am I going in life?”)

    Mason Gomberg, MD

  2. Belonging. Your child needs to feel accepted by others, beginning with your family and then extending outward to groups: friends, schoolmates, sports teams, religious organizations and clubs.
  3. A sense of purpose. Your child can greatly benefit from goals that give him/her purpose, direction and an outlet for achievement and self-expression. Without a sense of purpose, children easily feel bored, aimless and resentful when parents or other authority figures try to push them to achieve goals.
  4. Personal competence and pride. Your child should feel confident in his/her ability to meet the challenges of life. This sense of personal worth evolves from having successful life experiences in solving problems, being creative, achieving goals and getting results for efforts.
  5. Your child needs to feel trust from you. It’s important for you to keep your promises, be supportive of what he/she is going through in all stages of life, and give your child opportunities to be trustworthy.
  6. Taking responsibility. Regularly give your child opportunities to show what he/she is capable of. Allow him/her to take on tasks without you checking in all the time.
  7. Contributing to something meaningful. Your child will develop a deeper sense of self-worth and belonging when he/she has opportunities to participate and contribute to something in a meaningful way.
  8. Making real choices and decisions. Your child will feel empowered and more in control of his/her life when he/she is able to make important decisions and experience the outcome of those decisions.
  9. Self-discipline and self-control. As children strive to gain more independence, they need to feel they can do things on their own without parents hovering over them all the time or making decisions for them.
  10. Encouragement, support and reward. All children need positive feedback and recognition—tangible signs that they are doing a good job and growing up.
  11. Accepting mistakes and failures. Your child needs to learn to keep going, not be defeated, when he/she makes mistakes or fails.
  12. Family self-esteem. Your child’s self-esteem starts right in your home, in your family, and is in large part influenced by the perceptions your family has of itself.
Concerned about your child’s self-esteem? Come see us.

If you would like some advice and guidance on helping your child develop good self-esteem, or if you have questions about any aspects of your child’s health and well-being, come in to see one of our pediatricians  at Westchester Health, Member of Northwell Health Physician Partners. Together with you and your child, we’ll talk about what’s going on and come up with ways to strengthen your child’s positive sense of self-worth and value.

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

Categories: Blog

Guidelines For Keeping Your Child’s Vaccinations Up To Date

Westchester Health Blog - Mon, 02/27/2017 - 09:00

Short of basic sanitation and nutrition, no medical intervention has done more to save lives and prevent disease than immunizations. That’s why at Westchester Health Associates, we strongly believe in immunizations and strongly recommend giving your child all recommended vaccines from birth until age 18. In addition, the American Academy of Pediatrics (AAP) officially recommends immunizations as the safest and most cost-effective way of preventing disease, disability and death, and that it is always better to prevent a disease than to have to treat it or live with the consequences of contracting it.

Yes, vaccinations are safe

Before being approved, all vaccines must be tested by the Food and Drug Administration (FDA). The FDA will not let a vaccine be given unless it has been proven to be safe and to work well in children. Then the data is reviewed again by the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics and the American Academy of Family Physicians before a vaccine is officially recommended to be given to children.

No, vaccinations DO NOT cause autism

A 1998 fraudulent research paper proposing a hypothetical link between the MMR vaccine and autism has long-since been thoroughly debunked. Also, extensive reputable research over the last two decades has studied whether there is any link between childhood vaccinations and autism and has in every case concluded that vaccines do not cause autism—all the more reason why we strongly advise immunizing your child.

We recommend the following tests and screenings:

1) Weight check—within 48 hours after discharge from hospital
2) 6 well-baby visits, birth-9 months—at 1, 2, 3, 4, 6 and 9 months
3) 5 well-baby visits, 1-3 years old—at 12, 15, 18, 24 and 30 months
4) Well-baby visits, after 3 years old—annually
5) Hearing and vision tests—annually starting at age 4
6) Routine blood tests and lead test—at 1 and 2 years
7) Routine blood tests—at 10 and 18 years old, earlier if a family history
8) Screening for STDs (sexually transmitted diseases)—annually
9) HIV testing is available
10) Autism screening—at 18 and 24 months
11) Depression screening—annually starting at age 12
12) Screening for alcohol and drug abuse—annually starting at age 12
13) Tuberculosis testing—as needed
14) Vitamin D, insulin and glucose testing—as needed
15) Urinalysis—at 10 and 18 years

We recommend the following vaccination schedule:

1) Given in hospital nursery—Hepatitis B: 1st vaccine
2) At 1 month—Hepatitis B: 2nd vaccine
3) At 2 months—Pentacel (combination vaccine), Prevnar (pneumococcal disease) and Rotateq (rotavirus): 1st vaccine
4) At 4 months—Pentacel, Prevnar and Rotateq: 2nd vaccine
5) At 6 months—Pentacel, Prevnar and Rotateq: 3rd vaccine
6) At 9 months—Hepatitis B: 3rd vaccine
7) At 12 months—MMR (measles, mumps, rubella) and Varivax (chicken pox)
8) At 15 months—Pentacel and Prevnar: 4th vaccine
9) At 18 months—Hepatitis A: 1st vaccine
10) At 24 months—Hepatitis A: 2nd vaccine
11) Between 11 and 12 years old—Menactra (meningitis A, C, W and Y vaccine)
12) Between 11 and 12 years old—Gardasil (HPV vaccine)
13) Between 10 and 11 years old—Adacel (tetanus)
14) Between 10 and 25 years old—Bexsero (meningitis B vaccine)

Valuable resources for you to learn more about the importance of immunizations: Come in and talk with us; we’re here to help

If you have questions about immunizing your child, or about any aspect of your child’s health, please come in and see us at Westchester Health Associates. We’re here for you, whenever and wherever you need us.

Categories: Blog

6 Easy Ways to Prevent Kidney Stones

Westchester Health Blog - Thu, 02/23/2017 - 10:51

Did you know that 1 in 10 people will develop a kidney stone over the course of their lifetime? Although the exact reason isn’t known, one explanation may be that there are a lot of myths and misconceptions about what causes kidney stones. In order to de-bunk these false beliefs, shed light on what really causes kidney stones, and help people hopefully stay stone-free, we at Westchester Health offer these 6 important tips.

Who’s at risk of kidney stones?

“Kidney stones” is a one-size-fits-all term for what are actually different types of small, solid crystals. A number of things can cause them, such as kidney infections, or because you have too much of certain minerals in your system.

Although it is true that men in their 30’s, 40’s and 50’s are at higher risk for kidney stones than women, women are at risk, too. The most common age group is in the younger population, late 20’s and older. Most of these either have inherited the risk from a family member or they have a metabolic problem that puts them at higher risk which first manifests itself when they’re younger. Genes can play a role, also. Of the people who get kidney stones, 40% have a family history of them. In these cases, their bodies may create too much calcium or too little citrate (a chemical found in citrus fruits).

Jerry Weinberg, MD

Other conditions that make kidney stones more likely include:

  • Obesity—When you’re overweight, you tend to get kidney stones more often.
  • Surgery—If you’ve had gastric bypass surgery or other intestinal surgery, your chance of stones is higher.
  • Disease—One example of this is polycystic kidney disease, in which clusters of cysts grow in your kidneys.
Top 6 facts about kidney stones and how to prevent them

With the right foods, plenty of water and proper medication, you can lower your chances of kidney stones, and hopefully, never develop them.

  1. Sweating can cause kidney stones

Saunas, hot yoga and heavy exercise may be good for your health but they also may lead to kidney stones. Why? Loss of water through sweating, whether due to these activities or just the heat of summer, leads to less urine production. The more you sweat, the less you urinate, which allows for stone-causing minerals to settle and bond in the kidneys and urinary tract.

What you can do: Hydrate yourself with water. One of the most effective things you can do to avoid kidney stones is to drink plenty of water, especially when engaging in exercise or activities that cause a lot of sweating, causing you to urinate a lot.

  1. Watch your intake of foods high in oxalate

Most kidney stones are formed when oxalate binds to calcium while urine is produced by the kidneys, and calcium oxalate stones are the leading type of kidney stones. Oxalate is naturally found in many foods, including:

  • Fruits
  • Vegetables
  • Nuts
  • Seeds
  • Grains
  • Legumes
  • Chocolate
  • Tea
  • Peanuts
  • Rhubarb
  • Spinach
  • Beets
  • Sweet potatoes

Moderating your intake of these foods may help prevent the formation of calcium oxalate kidney stones.

What you can do: Eat and drink calcium and oxalate-rich foods together during a meal. By doing this, oxalate and calcium are more likely to bind to one another in the stomach and intestines before the kidneys begin processing, making it less likely that kidney stones will form.

  1. A diet low in calcium actually increases your risk of developing kidney stones

Many of our patients think that calcium is the main culprit in calcium-oxalate stones. Not true, in fact, just the opposite. A diet low in calcium actually increases one’s risk of developing kidney stones.

What you can do: Do not reduce your calcium intake. Instead, cut back on the sodium in your diet and pair calcium-rich foods with oxalate-rich foods.

  1. Kidney stones are usually a recurring condition

Passing a kidney stone is often described as one of the most painful experiences a person can have, but unfortunately, this is not always a one-time event. Studies have shown that having even just one stone greatly increases your chances of having another. Further research has also shown that even after proclaiming that they never again want to go through the experience of passing a stone, most people do not make the changes they need to after their first stone event and tend not to heed the advice of their nephrologists and urinary specialists which might keep stones from recurring.

What you can do: Follow your doctor’s advice. Without the right medications and diet adjustments, stones can come back. Recurring kidney stones could also be an indicator of other problems, including kidney disease.

  1. Pay attention to your diet, not just your medication

Preventative dietary adjustments need to take place in concert with prescription medications. While it may seem easier to just take a pill to fix a kidney stone problem, consider what lifestyle changes you can also make to positively impact your health.

What you can do: Drink lemonade! Chronic kidney stones are often treated with potassium citrate, but studies have shown that limeade, lemonade and other fruits and juices high in natural citrate offers the same stone-preventing benefits. Citrate in the urine may prevent the calcium from binding with other constituents that lead to stones, and also may prevent crystals that are already present from binding with each other, thus preventing them from getting bigger. Control the sugar, though, which can increase kidney stone risk. Either drink sugar-free lemonade or make your own by mixing lime or lemon juice with water and using a sugar substitute.

  1. Eat less meat and shellfish, more fruits and vegetables

In addition to calcium oxalate stones, another common type of kidney stones is uric acid stones. Red meat, organ meats and shellfish have high concentrations of a natural chemical compound known as purines, and high purine intake leads to a higher production of uric acid which in turn produces a larger acid load for the kidneys to excrete. Higher uric acid excretion leads to lower overall urine pH, which means the urine is more acidic. The high acid concentration of the urine makes it easier for uric acid stones to form.

What you can do: To prevent uric acid stones, cut down on high-purine foods such as red meat, organ meats and shellfish, and follow a healthy diet that contains mostly vegetables and fruits, whole grains, and low-fat dairy products. Limit sugar-sweetened foods and drinks, especially ones that contain high fructose corn syrup. Limit alcohol because it can increase uric acid levels in the blood, and avoid crash diets for the same reason. Eating less animal-based protein and eating more fruits and vegetables will help decrease urine acidity, which will help reduce the likelihood of stone formation.

Worried that you may have a kidney stone? Come see us.

If you think you have a kidney stone, or you want to learn more about how to avoid developing one, please make an appointment with Westchester Health to see one of our specialists. We can perform tests to determine if you do in fact have a kidney stone, or if you are at risk of developing one, and can guide you as to how to adjust your diet. We also may prescribe medication, if appropriate.

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

Categories: Blog

How To Know How Much Sleep Your Child Needs

Westchester Health Blog - Thu, 02/23/2017 - 10:42

At Westchester Health Associates, one question we get asked almost more than any other is, “How much sleep does my child need?” Our answer: It depends on the age of your child. Our rule of thumb is that if your child wakes up groggy or is overly sleepy during the day, he/she is not getting enough sleep. To help you know how much is enough, we offer this recent blog by Jacklyn Alfano, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group, in which she includes sleep guidelines grouped by age of the child.

How much sleep your child should get, by age 1-4 Weeks Old: 15-16 hours per day

Newborns typically sleep about 15-18 hours a day in short periods of 2-3 hours. Premature babies may sleep longer and colicky ones shorter.

1-4 Months Old: 14-15 hours per day

By 6 weeks old, babies begin to settle down a bit and start developing more regular sleep patterns. The longest periods of sleep run 4-6 hours and tend to occur more regularly in the evening.

4-12 Months Old: 14-15 hours per day

While 15 hours of sleep is ideal, most infants up to 11 months old typically sleep about 12 hours. Regarding napping, babies typically take three naps at this age, decreasing to two around 6 months old, at which time they are physically capable of sleeping through the night. Mid-morning naps usually start around 9am and last about an hour. Early afternoon naps start between noon and 2pm and last an hour or two. And late afternoon naps may start anywhere from 3-5pm, varying in length.

1-3 Years Old: 12-14 hours per day

As a child matures toward 18-21 months of age, he/she will likely lose the morning and early evening nap and nap only once a day. While toddlers need up to 14 hours a day of sleep, they typically get only about 10. Most children from about 21-36 months of age still need one nap a day, which may range from one to 3½ hours long. They typically go to bed between 7-9pm and wake up between 6am and 8am.

3-6 Years Old: 10-12 hours per day

Children at this age typically go to bed between 7-9pm and wake up between 6-8am, just as they did when they were younger. At age 3, most children are still napping, while at age 5, most are not. Naps gradually become shorter, too.

7-12 Years Old: 10-11 hours per day

At these ages, bedtimes gradually become later and later, with most 12-years-olds going to bed around 9pm but this can range anywhere between 7:30-10pm. There is also a range of total sleep time (9-12 hours) although the average is only about 9 hours.

12-18 Years Old: 8–9 hours per day

Sleep is just important for a teenager’s health and well-being as it is for younger children, maybe more so. It turns out that many teenagers actually may need more sleep than in previous years, but most of them get less, unfortunately.

Negative consequences of not getting enough sleep

If your child is not sleeping enough, this could translate into problems with behavior, attention, learning and memory. Less sleep, especially under 4 years old, has also been found to increase hyperactivity-impulsivity and lower cognitive performance on neurodevelopmental tests. Also, there is growing evidence that not getting enough sleep results in metabolic changes that may contribute to the development of obesity, insulin resistance, diabetes and cardiovascular disease.

If you’re concerned that your child is not getting enough sleep or is developing sleep issues, please come see us

If your child’s sleep is becoming an issue for your child and your family, please come in and talk to one of our pediatricians. We will meet with you and your child, examine and diagnose the problem, and together with you, decide on the best course of action so that hopefully everyone can rest easy.

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

Categories: Blog

10 Important Survival Tips For Stay-At-Home-Dads

Westchester Health Blog - Mon, 02/20/2017 - 10:19

At Westchester Health Associates, we know that raising kids is hard work, whether you’re a dad or a mom. But even today, sometimes stay-at-home dads encounter particular challenges. To help dads everywhere navigate the wonderful but exhausting world of babies, kids, teenagers and everything in between, Mason Gomberg, MD, a pediatrician with our Westchester Health Pediatrics group, offers these 10 valuable bits of advice.

10 essential tips for stay-at-home dads 1. Commit to your role as dad caretaker

Mason Gomberg, MD

Wear your title as full-time dad proudly and unapologetically, no matter what how others react. What do you care about people’s negative, narrow opinions anyway?

2. Stay-at-home doesn’t have to mean stay at home

Get out of the house! As part of your daily schedule, incorporate activities to get you and your child out and about, such as the library, music lessons, nature walks, etc.

3. Find a Dad Group and get connected

Besides the support of your partner, having a community of fellow stay-at-home dads around you is probably the key factor in your happiness as a stay-at-home parent. Check out the Find a Dad Group page on the National At-Home Dad Network‘s site. Go on Facebook and join the conversation at their online discussion group. If possible, attend the annual At-Home Dad Convention.

4. Establish your specific duties with your partner

From the beginning, you and your partner need to decide what your duties and responsibilities are going to be. Exactly what does “taking care of the kids” include? Cooking dinner every night, cleaning the house, doing laundry, running errands, time off on weekends…all these need to be discussed up-front to reduce conflict and resentment later on.

5. Schedule daddy time-outs

Make sure you take breaks, whether it’s an hour in the morning before the chaos starts, time in the evening after everyone is settled down for the night, a half hour by yourself in a coffee shop, or any regular opportunity you can grab to talk to adults. Trust me, it will do wonders.

6. When it comes to parenting, trust your gut

There are many different ways to bring up an infant, child, adolescent and teenager. Having a set routine and structured environment helps, and all caregivers should be on the same page.

7. Remember: this role is not forever

Being an at-home dad may not be your job forever, which is helpful to keep in mind during the seemingly endless diaper changes, ear infections, playdates and carpools.

8. You can change attitudes by example

At-home dads rarely get the respect and recognition they deserve. Your example that fathers can be nurturing, competent and caring parents can go a long way to bringing society at large up to speed.

9. It’s ok to ask for help

As much as you think you can) raise kids all on your own, this can lead to unhealthy levels of stress. For your own sanity and the safety and happiness of your kids, ask for help when you need it. Maybe hire a cleaning person to help with housework or a sitter so you can get to the gym. Call other dads—they’ll know what you’re going through. If you’re really feeling overwhelmed, please seek professional help to help you get through the really tough times.

10. Try to savor every moment

Try to enjoy this precious, all-too-fleeting time. Spend at least as much time down on the floor playing with your children as you spend trying to accomplish tasks while they are distracted or napping. Remember, these days will be gone, all too soon.

Questions? Freak outs? Please come see us.

At Westchester Health Associates, we’re here for you with expert advice and guidance to help you raise happy, healthy kids so please come in and see us. We’ll take as long as you need to answer your questions and to help you in any way we can. 

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

Categories: Blog

What To Do If Your Child Is Obese

Westchester Health Blog - Thu, 02/16/2017 - 11:52

Here at Westchester Health Associates, every week we see young patients who are overweight and obese, and parents who are anxious and worried. In fact, childhood obesity is one of the most common problems seen by pediatricians. Can it be reversed? Yes, overweight children can change and commit to a healthier lifestyle but it takes a coordinated effort from patients, their parents and their pediatrician. To help navigate this very important issue, we offer a recent blog by Nicholas Germanakos, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group.

There is no one cause of childhood obesity. Rather, there are many contributing factors.
  1. Food choices: diets high in calories (including fats and simple sugars) and lower in fruits and vegetables
  2. Little physical activity: lack of physical exercise, more time spent in sedentary activities such as watching TV and video games

    Nicholas Germanakos, MD, FAAP

  3. Parental obesity: children of obese parents are more likely to be overweight themselves. Parental obesity may also reflect a family environment that promotes excess, unhealthy eating and insufficient activity.
  4. Eating patterns: skipping meals or failure to maintain a regular eating schedule can result in eating too much at one time.
  5. Parenting style: some researchers believe that excess parental control over children’s eating can cause those children to have poor self-regulation regarding food.
  6. Diabetes during pregnancy: overweight and type 2 diabetes occur with greater frequency in the offspring of diabetic mothers (who are also more likely to be obese).
  7. Low birth weight: Low birth weight is a risk factor for being overweight in several studies.
  8. Excessive weight gain during pregnancy: Several studies have shown that excessive maternal weight gain during pregnancy is associated with increased birth weight and overweight later in life.
  9. Formula feeding: breastfeeding is generally recommended over formula feeding, and studies suggest that it may also prevent excess weight gain as children grow.
  10. Parental eating and physical activity habits: parents with poor nutritional habits and sedentary lifestyles model these unhealthy behaviors for their children, who often copy them in their own choices.
  11. Demographic factors: certain demographic factors are associated with an increased risk of being overweight in childhood. For example, there is evidence that African-American, Hispanic, Asian and Pacific Islander children are more likely to be overweight.
Childhood obesity has many negative consequences other than extra pounds

As well as being too many pounds overweight, childhood obesity has both immediate and long-term effects on a child’s health and psychological well-being.

Psychological consequences:
  • Depression
  • Poor body image
  • Low self-esteem
  • High risk of eating disorders
  • Behavior and learning problems
Physical consequences:
  • Insulin resistance
  • Type 2 diabetes
  • Asthma
  • Hypertension
  • High Total and LDL cholesterol and triglyceride levels in the blood
  • Low HDL cholesterol levels in the blood
  • Sleep apnea
  • Early puberty
  • Orthopedic problems
  • Non-alcoholic steatohepatitis (fatty infiltration and inflammation of the liver)
  • Stroke
  • Cardiovascular disease
  • Diabetes
  • Some cancers
The good news: Obesity can be reversed and even avoided with healthy eating and exercise patterns. Here are some specific tips:
  1. Serve and eat a variety of foods from each food group.
  2. Use small portions. Compared to adult portions, child portions should be very small. More food can always be added if needed.
  3. Bake, broil, roast or grill meats instead of frying them.
  4. Limit use of high calorie, high fat and high sugar sauces and spreads.
  5. Use low-fat or nonfat dairy products for milk, yogurt and ice cream.
  6. Encourage participation in play, sports and other physical activity at school, church or community leagues.
  7. Be active as a family: go on walks, bike rides or hikes together.
  8. Limit TV time.
  9. Avoid eating while watching TV. TV viewers typically eat too much, too fast, and are influenced by the foods and drinks that are advertised.
  10. Replace sugary drinks, especially sodas, with water and/or low fat milk.
  11. Limit fruit juice intake to two servings or less per day (one serving = ¾ cup). Many parents allow their children unlimited intake of fruit juice because of the vitamins and minerals it contains. However, children who drink too much fruit juice may be consuming excess calories.
  12. Encourage free play in young children and provide environments that allow children to play indoors and outdoors.
  13. Model healthy dietary practices, nutritional snacks and lifestyle activities.
  14. Avoid using food as a reward for good behavior or good grades.
If you’re concerned that your child is overweight or obese, please come see us

If you are worried about your child’s weight and the effect it is having on his/her health, please come in and talk with one of our pediatricians. We will meet with you and your child, assess the situation, and together with you, decide on the best course of action to steer him/her toward a healthier lifestyle, better choices and a healthier weight.

To read Dr. Germanakos’ blog in full, click here.

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