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)
- 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*
- 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.
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)
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:
- 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.
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?
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:
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
- 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:
- Try to stay indoors whenever the pollen count is very high (it usually peaks in the morning).
- Keep your doors and windows closed whenever possible during the spring/summer months to keep out allergens.
- Use an air purifier.
- Clean the air conditioner filters in your home often.
- Clean bookshelves, vents and other places where pollen can collect.
- Wash your child’s hair after going outside (pollen can collect there).
- Vacuum twice a week. Be sure to wear a mask because vacuuming can kick up pollen, mold and dust trapped in your carpet.
Spring allergies can be treated with a number of over-the-counter medicines, including:
- 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.
- Decongestants clear mucus from the nasal passageways to relieve congestion and swelling.
- Antihistamine/decongestants combine the effects of both of the above drugs.
- Nasal spray decongestants relieve congestion and may clear clogged nasal passages faster than oral decongestants.
- 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).
- Cromolyn sodium nasal spray can help prevent hay fever by stopping the release of histamine before it can trigger allergy symptoms.
- Eye drops relieve itchy, watery eyes.
- 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 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.
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?
A parasite is any organism that lives and feeds off another organism. Examples of parasites include:
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:
- Unexplained constipation, diarrhea, gas, bloating, nausea or other symptoms of Irritable Bowel Syndrome
- You traveled internationally and got diarrhea on your trip
- You have had food poisoning and your digestion has not been the same since
- You have trouble falling asleep or you wake up multiple times during the night
- Skin irritations or unexplained rashes, hives, rosacea or eczema
- You grind your teeth in your sleep
- Painful, aching muscles or joints
- Fatigue, exhaustion, mood changes, depression or frequent feelings of apathy
- You never feel satisfied or full after your meals
- You’ve been diagnosed with iron-deficiency anemia
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
- 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.
- 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.
- 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.
- 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).
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.
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.
- Choose low impact exercise whenever possible
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
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:
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:
- 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.
- Anti-inflammatories are effective in treating knee swelling and pain for most people.
- Ice is a very safe and effective treatment and should be used after strenuous activity, including extensive walking.
- 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.
- 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.
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.
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.
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.
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.
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)
- 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.
- 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).
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
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.
- 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.
- 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
- 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.
Has your sweet, adorable child suddenly morphed into an unrecognizable little monster? Instead of wide-eyed smiles and happy giggles, are you now witnessing:
- 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
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.
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:
- 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.
- 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.
- Infants without either eczema or food allergy should have peanuts introduced with other solid foods, per family (and cultural) preferences.
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.
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
- 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?”)
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Encouragement, support and reward. All children need positive feedback and recognition—tangible signs that they are doing a good job and growing up.
- Accepting mistakes and failures. Your child needs to learn to keep going, not be defeated, when he/she makes mistakes or fails.
- 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.
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.
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
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)
- American Academy of Pediatrics: Immunization
- Centers for Disease Control and Prevention: Vaccines and Immunizations
- National Network for Immunization Information
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.
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).
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.
With the right foods, plenty of water and proper medication, you can lower your chances of kidney stones, and hopefully, never develop them.
- 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.
- 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:
- 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.
- 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.
- 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.
- 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.
- 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.
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.
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
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.
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.
- Food choices: diets high in calories (including fats and simple sugars) and lower in fruits and vegetables
- Little physical activity: lack of physical exercise, more time spent in sedentary activities such as watching TV and video games
- 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.
- Eating patterns: skipping meals or failure to maintain a regular eating schedule can result in eating too much at one time.
- Parenting style: some researchers believe that excess parental control over children’s eating can cause those children to have poor self-regulation regarding food.
- 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).
- Low birth weight: Low birth weight is a risk factor for being overweight in several studies.
- 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.
- Formula feeding: breastfeeding is generally recommended over formula feeding, and studies suggest that it may also prevent excess weight gain as children grow.
- 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.
- 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.
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:
- Poor body image
- Low self-esteem
- High risk of eating disorders
- Behavior and learning problems
- Insulin resistance
- Type 2 diabetes
- 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)
- Cardiovascular disease
- Some cancers
- Serve and eat a variety of foods from each food group.
- Use small portions. Compared to adult portions, child portions should be very small. More food can always be added if needed.
- Bake, broil, roast or grill meats instead of frying them.
- Limit use of high calorie, high fat and high sugar sauces and spreads.
- Use low-fat or nonfat dairy products for milk, yogurt and ice cream.
- Encourage participation in play, sports and other physical activity at school, church or community leagues.
- Be active as a family: go on walks, bike rides or hikes together.
- Limit TV time.
- Avoid eating while watching TV. TV viewers typically eat too much, too fast, and are influenced by the foods and drinks that are advertised.
- Replace sugary drinks, especially sodas, with water and/or low fat milk.
- 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.
- Encourage free play in young children and provide environments that allow children to play indoors and outdoors.
- Model healthy dietary practices, nutritional snacks and lifestyle activities.
- Avoid using food as a reward for good behavior or good grades.
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.
There is abundant evidence that circumcision has many important health benefits for males, regardless of the age at which they are circumcised. Here at Westchester Health Associates, we strongly feel that before parents make the important decision to circumcise, or not circumcise, their son, they need to carefully weigh the health benefits, risks, their religious beliefs and their personal preferences. To help you with your decision, we offer this informative blog by Rodd Stein, MD, FAAP, a pediatrician in our Westchester Health Pediatrics group.Circumcision has been proven to reduce the risk of:
- HIV infection among heterosexual males
- syphilis and genital herpes
- penile and prostate cancers
- urinary tract infections (some of which are serious enough to require hospitalization)
- cervical cancer in female sex partners
- a circumcised penis is easier to care for and keep clean than an uncircumcised one
- Circumcision is the surgical removal of the foreskin, which is the tissue covering the head (glans) of the penis. During the 5-10 minute procedure, the foreskin is freed from the head of the penis and the excess foreskin is clipped off. The circumcision area generally heals in 5-7 days.
- Circumcision is usually performed on the first or second day after birth. In the Jewish faith, it is performed on the eighth day by a trained mohel.
- If you decide to have your son circumcised at the hospital, a physician can perform the procedure before you bring your baby home.
- Circumcision becomes more complicated and riskier in older babies, children and men, and usually requires general anesthesia.
- Premature babies or those who have special medical concerns may not be circumcised until they’re ready to leave the hospital. Also, babies born with physical abnormalities of the penis that need to be surgically corrected often aren’t circumcised at all because the foreskin may eventually be used as part of a reconstructive operation.
- Immediately after circumcision, the tip of the penis is covered with gauze coated with petroleum jelly to keep the wound from sticking to the diaper.
- After every diaper change, you should gently wipe the penis tip clean with warm water, then re-apply petroleum jelly to prevent sticking.
- Any irritation or redness of the penis should heal within a few days, but if it increases or if pus-filled blisters form, there may be an infection. If this happens, call your pediatrician immediately.
At Westchester Health Associates, we understand that circumcision is a very personal decision. If you would like to talk with us before taking this step, please make an appointment to come in and meet with one of our pediatricians. Whenever you need us, we’re here for you.
To read Dr. Stein’s blog in full, click here.
To make sure you get all the information you need to give your newborn a healthy start, Westchester Health Associates is offering a series of prenatal talks once a month from January-June 2017. Our next one is Monday, February 20th, 5:30-7:00pm in Mt. Kisco. Please join us!Monthly prenatal talks at our Westchester Health Associates Mt. Kisco OB/GYN office
Each month, a Westchester Health Pediatrics pediatrician and a Westchester Health Associates OB/GYN will host a 1½ hour presentation. You’ll learn everything you need to know about how to give your newborn the best start in life. You probably have a lot of questions, especially if this is your first pregnancy. Rest assured, we have answers, as well as lots of practical advice and years of experience.Where and when: 5:30-7:00pm
Westchester Health Associates OB/GYN office
105 S. Bedford Road (side entrance)
Mount Kisco, NY 10549 Please RSVP to Lisa at (914) 241-4900 Topics include:
- developmental stages
- handling your newborn/bathing
- umbilical cord care
- how to tell when your baby is sick
- cord blood banking
- postpartum blues
- over 35 and pregnant
- Monday Jan 16 (Martin Luther King, Jr. Day)
- Monday Feb 20
- Monday March 20
- Monday April 17
- Monday May 15
- Monday June 19
At Westchester Health Associates, we want to get to know you, answer your questions, listen to your concerns and give you the information and support you need at this very important time. Come in to see us so we can help you raise a healthy, happy baby, child and young adult!
Has your period started slowing down, or even stopped? Are you having hot flashes or night sweats? Are people telling you that you seem a lot more moody lately? Guess what – you may be going through menopause.
Some women go through menopause without any noticeable complications or symptoms. If you’re one of those, good for you! For other women, menopause causes very unpleasant symptoms, sometimes beginning during perimenopause (the pre-menopause stage) and lasting for years. At Westchester Health Associates, we have patients of both types, those who have a hard time with menopause and those who glide smoothly through “the change.” Whichever one you are, we’re here for you with advice, guidelines, and if need be, medication to make this life transition easier.What causes menopause? Blame it on 2 hormones.
The symptoms that women experience are primarily related to a lowered production of two female sex hormones: estrogen and progesterone. Symptoms vary widely because of the different effects these hormones have on each individual woman.
Estrogen regulates a woman’s menstrual cycle and affects the following parts of the body:
- reproductive system
- urinary tract
- blood vessels
- mucous membranes
- pelvic muscles
- Changes in your menstrual cycle
An obvious signal that your body is changing, and the symptom that women typically recognize first, is that your period may not be as regular as it used to be. It may be heavier or lighter, shorter or longer, than usual and you may occasionally spot. If you do miss a period, make sure to rule out pregnancy.
If you think you may be pregnant, please come see us at Westchester Health Associates. We’ll perform a more accurate pregnancy test than those you can get over-the-counter. If you’re not pregnant, a missed period could indicate the onset of menopause. NOTE: If you begin spotting after not having your period for 12 consecutive months, make sure to see a physician right away so you can rule out serious conditions, such as cancer.
- Hot flashes
For many women going through menopause, hot flashes are their main complaint. These usually feel like a sudden acceleration of body heat, either in the upper portion of the body or all over. Your face and neck might turn red, and you may feel sweaty or flushed. The intensity of a hot flash can range from mild to very strong, keeping you awake at night or even waking you from sleep. It usually lasts between 30 seconds and 10 minutes, and most women experience them for a year or two after their final menstrual period. Hot flashes may still continue after menopause, but they lessen in intensity over time.
- Vaginal dryness, vaginal atrophy and pain with intercourse
Women can experience vaginal dryness at any age, but it can be a particular problem for women going through menopause. The decreased production of estrogen and progesterone can affect the thin layer of moisture that coats the vaginal walls. Signs include itching around the vulva and stinging or burning. Vaginal dryness can make intercourse painful and may cause you to feel like you need to urinate frequently. To combat dryness, we suggest using an OTC water-based lubricant.
Vaginal atrophy is a condition caused by the decline in estrogen production, characterized by the thinning and inflammation of the vaginal walls. This can make sexual intercourse painful for women, which can decrease their interest in sex. Over-the-counter water-based lubricants or prescription treatments such as an estrogen cream can improve the condition.
- Insomnia or problems sleeping
During menopause, many women find it hard to fall asleep or stay asleep. Here are the suggestions we give our patients:
- Try relaxation and breathing techniques, particularly yoga
- Exercise during the day so you’re tired once you go to bed
- Don’t leave your computer or cell phone near your bed. The lights, buzzers and rings can disrupt your sleep.
- Bathe, read or listen to mellow music before bed to help you relax
- Drink a hot cup of herbal tea
- Go to bed at the same time every night
- Avoid foods and drinks that affect sleep like chocolate, caffeine and alcohol
- Frequent urination or urinary incontinence
It is common for women going through menopause to lose control of their bladder. They may also feel a constant need to urinate even without a full bladder, or they may experience painful urination. This is due to the fact that during menopause, the tissues in the vagina and urethra lose their elasticity and the lining of those two areas thins. The surrounding pelvic muscles may also weaken. To fight urinary incontinence, we suggest abstaining from excessive alcohol, staying hydrated and strengthening your pelvic floor with Kegel exercises or other core-strengthening movements. If the issues persist, there are prescription medications that can help.
- Urinary tract infections
During menopause, some women may experience more urinary tract infections (UTIs). Lowered levels of estrogen and changes in the urinary tract make you more susceptible to infection. If you feel a persistent urge to urinate, are urinating more frequently, or feel a burning sensation when you urinate, see your doctor. You may need antibiotics.
- Decreased libido
It’s common to feel less interested in sex during menopause, brought on by reduced estrogen. On the other hand, some women have more interest in sex as they age. If the decrease in sexual desire becomes an issue for you, talk to your doctor about possible remedies.
- Cognitive function
Two common complaints of menopause are memory loss and difficulty concentrating. There is substantial evidence that estrogen may play an important role in cognitive function. Likewise, there may be midlife factors contributing to memory issues such as stress, fatigue, depression, insomnia, medication effects and certain illnesses that should be explored with your physician.
- Depression and mood swings
Similar to a woman’s menstrual cycle, menopause often brings with it feelings of irritability, depression and mood swings, going from extreme highs to severe lows in a short period of time. It’s important to remember that the hormone fluctuations brought on by menopause do affect your brain and that “feeling blue” is normal.
- Changes in your skin and hair
As you age, the loss of fatty tissue and collagen makes your skin drier and thinner, including the elasticity and lubrication of the skin near your vagina and urinary tract. Reduced estrogen may contribute to hair loss or cause your hair to feel brittle and dry. We recommend to our patients of menopausal age to use extra-thick hand and body lotions and to avoid harsh chemical hair treatments which can cause further damage to already-fragile hair.Going through menopause? Come see us.
Menopause symptoms can last for months or years depending on the person. At Westchester Health Associates, we strongly advise our patients going through menopause to schedule regular appointments with us so we can monitor their health, catch any issues early and answer any questions they may have about menopause and its symptoms.
Straight or gay, a teenager or a retiree, having unprotected sex can expose you to sexually transmitted diseases (STDs), some of which can seriously affect your health. Although condoms are highly effective for reducing the transmission of STDs, they (or any method of birth control except abstinence) are not 100% foolproof. At Westchester Health Associates, we think the more informed a person is about his or her sexual health, the better choices they can make. That’s why we offer this blog so that everyone can understand the different STDs that exist and can take steps to protect themselves against them.Always use a condom
Using condoms (male or female versions) is the safest and most reliable way to reduce the risk of STDs and we recommend to our patients who are sexually active that they should always use them. Condoms also are a highly-effective, but not 100% dependable, method of birth control.The most common STDs 1) Chlamydia
Chlamydia is a bacterial infection of the genital tract. It may be hard to detect because in its early stage, it causes few or no symptoms. Symptoms usually show up 1-3 weeks after you’ve been exposed. Chlamydia is spread from person-to-person during unprotected sex: vaginal, anal or oral. It can also be passed to the eye by a hand or other body part moistened with infected secretions, and can be passed from a woman infected with chlamydia to her baby.
Signs and symptoms include:
- Painful urination
- Lower abdominal pain
- Vaginal discharge in women
- Discharge from the penis in men
- Pain during sexual intercourse in women
- Testicular pain in men
Like chlamydia, gonorrhea is a bacterial infection of the genital tract. Symptoms usually appear 2-10 days after exposure. However, some people may be infected for months before symptoms occur. Gonorrhea not only affects the reproductive tract but also the mucous membranes of the mouth, throat, eyes and rectum. It is transmitted through sexual contact with an infected person involving the penis, vagina, anus or mouth.
Signs and symptoms include:
- Thick, cloudy or bloody discharge from the penis or vagina
- Pain or burning sensation when urinating
- Abnormal menstrual bleeding
- Painful, swollen testicles
- Painful bowel movements
- Anal itching
Syphilis is a highly contagious disease spread primarily by sexual activity, including oral and anal sex. It develops in stages, and symptoms vary with each stage. The first stage involves a painless sore on the genitals, rectum or mouth. After the initial sore heals, the second stage is characterized by a rash. Then, there are no symptoms until the final stage which may occur years later. This final stage can result in damage to the brain, nerves, eyes or heart. Syphilis is treated with penicillin, and sexual partners should also be treated. Pregnant women with the disease can spread it to their baby because it can cause abnormalities or even death to the child.
Signs and symptoms include:
- A small, painless sore (chancre) on the part of your body where the infection was transmitted, usually the genitals, rectum, tongue or lips
- Enlarged lymph nodes
- Rash marked by red or reddish-brown, penny-sized sores over any area of your body
- Fatigue and a vague feeling of discomfort
- Soreness and aching
- Neurological problems
- Cardiovascular problems
HIV (human immunodeficiency virus) interferes with your body’s ability to effectively fight off viruses, bacteria and fungi that cause disease. Certain body fluids—blood, semen, rectal fluids, vaginal fluids and breast milk—from a person who has the virus can transmit HIV. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur. HIV can lead to AIDS (acquired immune deficiency syndrome) which is a chronic, life-threatening disease but one that can now be managed throughout a person’s life with medication, in a similar fashion to diabetes. When first infected with HIV, some people develop flu-like symptoms. These early symptoms usually disappear within a week to a month and are often mistaken for other viral infections. During this period, a person with HIV is very infectious. More severe symptoms of HIV infection may not appear for 10 years or more after the initial infection.
Early signs and symptoms include:
- Sore throat
- Swollen lymph glands
- Weight loss
- Cough and shortness of breath
Signs and symptoms of later stage HIV infection include:
- Persistent, unexplained fatigue
- Soaking night sweats
- Shaking chills or fever higher than 100.4 F for several weeks
- Swelling of lymph nodes for more than three months
- Chronic diarrhea
- Persistent headaches
- Unusual, opportunistic infections
Genital herpes is highly contagious and caused by a type of the herpes simplex virus (HSV). HSV enters your body through small breaks in the skin or mucous membranes and is spread by having vaginal, anal or oral sex with someone who has the disease. Fluids found in a herpes sore carry the virus but you can also get herpes from an infected sex partner who does not have a visible sore or who may not know he or she is infected because the virus can be released through your skin and spread the infection to your sex partner(s). Most people with HSV never know they have it because they have no symptoms, or symptoms are mild and go unnoticed.
Signs and symptoms include:
- Small, red bumps, blisters (vesicles) or open sores (ulcers) in the genital, anal and nearby areas
- Pain or itching around the genital area, buttocks and inner thighs
- Painful urination
- Pain and tenderness in the genital area
- During an initial episode, you may have flu-like signs and symptoms, such as headache, muscle aches and fever, as well as swollen lymph nodes in your groin.
Genital warts are growths on the skin of the genital area and around the anus and are caused by the human papillomavirus (HPV), are one of the most common types of STDs. (There are more than 100 types of HPV.) Some types of HPV produce warts on different parts of the body, like plantar warts on the feet and common hand warts. HPV-related cancers are more treatable when diagnosed and treated promptly.
Signs and symptoms include:
- Small, flesh-colored or gray swellings in the genital area
- Several warts close together that take on a cauliflower shape
- Itching or discomfort in the genital area
- Bleeding during intercourse
Hepatitis A, hepatitis B and hepatitis C are all contagious viral infections that affect the liver. Hepatitis B and C are the most serious, but each can cause your liver to become inflamed. Some people never develop symptoms, but for those who do, they may occur several weeks after infection. Hepatitis A is most commonly contracted from contaminated food or water or from close contact with someone who is infected. Mild cases of hepatitis A do not require treatment, and most people who are infected recover completely with no permanent liver damage. Hepatitis B virus (HBV) and hepatitis C virus (HCV) are both spread through contact with contaminated blood, and HBV is also sexually transmitted. Both HBV and HCV can lead to serious liver damage, liver cancer and the need for liver transplantation.
Signs and symptoms include:
- Nausea and vomiting
- Abdominal pain or discomfort, on your right side beneath your lower ribs (liver area)
- Loss of appetite
- Dark urine
- Muscle or joint pain
- Yellowing of the skin and the whites of your eyes (jaundice)
Trichomoniasis is caused by a microscopic, one-celled parasite called Trichomonas vaginalis which spreads during sexual intercourse with someone who has the infection. It usually infects the urinary tract in men and the vagina in women.
Signs and symptoms include:
- Clear, white, greenish or yellowish vaginal discharge
- Strong vaginal odor
- Vaginal itching or irritation
- Discharge from the penis
- Itching or irritation inside the penis
- Pain during sexual intercourse
- Painful urination
If you think you have a STD, or suspect that you have been exposed to one, it’s very important for you to come in and see us so you can get tested. If you do in fact have an STD, it’s crucial that you get treated right away.Worried that you may have an STD? Come see us
If you think you may have contracted an STD and want to get tested, or want to know more about how to reduce your risk, please make an appointment with Westchester Health Associates. The sooner we can determine if you do indeed have an STD, the sooner we can catch the disease in its early stages and start treating it.
It’s that time of year again when the stomach bug seems to be going around. Here at Westchester Health Associates we’re seeing lots of cases of it and wanted to put out this helpful information from a recent blog by by Lauren Adler, MD, FAAP, a pediatrician in our Westchester Health Pediatrics group, as soon as possible. Sometimes called the stomach flu (although it has nothing to do with the flu), a stomach virus is caused by rotavirus, norovirus or adenovirus and brings along with it nausea, vomiting and watery diarrhea.
The best way to prevent a stomach bug? Wash your hands.
Stomach viruses are most contagious for about 2-3 days before someone has any symptoms and for up to 2 weeks after they are sick. This is why viruses are so easily passed from person to person because people are contagious even when they are not sick.Symptoms of a stomach virus
The stomach bug most often starts with nausea and vomiting. Other symptoms can include abdominal pain, fever and headache. Diarrhea can start a day or two into the illness. While the vomiting usually only lasts for 1-2 days, diarrhea can last 5-7 days.Best ways to treat a stomach bug in your child
The first step in treatment is to prevent dehydration.
- Do not offer your child anything to eat or drink for one hour after he/she vomits. After that hour, you can start giving small amounts of fluid.
- Water is ok, but it is better to offer something that has sugar and electrolytes such as Pedialyte (Gatorade for an older child).
- If your child drinks too much at once, it is likely he/she will vomit again. Therefore, you should only give them small sips: 1 teaspoon every 5-10 minutes.
- For small children, you can use a medicine syringe; ice chips work well for older children.
- After your child tolerates small sips for a few hours, he/she can advance to larger volumes of liquid and then bland foods such as toast, oatmeal or rice.
- If your child does not want to eat anything for a few days, that’s ok. Don’t force him/her to eat. As long as they are drinking fluids, they will make up the calories later.
If you child is having diarrhea, you do not want to stimulate the intestines too often. We suggest larger, infrequent meals. Also:
- Take dairy out of your child’s diet for 24 hours. After that, dairy is ok.
- We recommend the B.R.A.T. diet for patients with diarrhea: Bananas, Rice, Apples and Toast.
- You might want to give a probiotic capsule or tablet to children who develop diarrhea.
Any child less than the age of one with vomiting and diarrhea should probably be seen in the office to rule out dehydration. If your child has severe abdominal pain, high fever or vomiting that will not stop, it is highly advised to see your doctor. Severe abdominal pain and persistent vomiting can also be signs of more serious illnesses, such as appendicitis, that could require further treatment. If your child has diarrhea lasting more than a week, you should see your pediatrician.The dangers of dehydration
Children, especially young children under the age of 2, are at risk for dehydration. Signs of dehydration can include:
- decreased urine output
- lack of tears
- sunken eyes
If your child is showing signs of fever, nausea, vomiting and/or diarrhea, please come in and see us at Westchester Health Associates. The sooner we can diagnose and start treating the virus, the sooner your child can start feeling better. Plus, we want to prevent a virus from turning into something more serious. We’re here for you, whenever and wherever you need us.
To read Dr. Adler’s blog in full, click here.