10 Ways Parents Can Try to Prevent Teen Suicide

Westchester Health Blog - Wed, 01/17/2018 - 09:50

All teenagers go through a range of emotional ups and downs as a normal part of growing up, as they deal with the pressures of school, friends, physical changes, sexual feelings and the expectations of their peers. However, sometimes these mood swings signal that something more serious is going on. Here at Westchester Health, we know how important it is for parents to recognize if their teen is exhibiting signs of suicide, which is why this blog by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group, is so important.

10 things parents can do to help prevent teen suicide
  1. Don’t let your teen’s depression or anxiety snowball.

    Lauren Adler, MD, FAAP

Depressed teens often retreat into themselves, when secretly they’re crying out to be rescued. Often they’re too embarrassed to reveal their deep unhappiness, especially to their parents. Boys in particular hide their emotions, believing that revealing their feeling is a sign of weakness. Don’t wait for your child to come to you with their problems or concerns. Knock on their door, sit on their bed and try saying, “You seem sad. Can we talk about it? I want to understand what you’re going through and maybe I can help.”

  1. Listen to your child.

Studies have found that one trait common to families that have experienced a son’s or daughter’s suicide is poor communication between parents and child. However, there are usually three or more issues going on in a child’s life when he/she is thinking suicide.

These include but are not limited to:

  • Major loss (i.e., girlfriend/boyfriend breakup or death of a loved one or pet)
  • Substance use
  • Peer or social pressure
  • Access to weapons
  • Public humiliation
  • Severe chronic pain
  • Chronic medical condition
  • Impulsiveness/aggressiveness
  • Family history of suicide

Talk to your teen as much as he/she will allow you to. Also, we often recommend that parents seek help from a mental health professional.

  1. Never shrug off comments about suicide as typical teenage melodrama.

Any written or verbal statement of “I want to die” or “I don’t care anymore” should be treated seriously. Often, children who attempt suicide tell their parents repeatedly that they intend to kill themselves.

If you notice any of these red flags, seek professional help for your child right away:

  • “Nothing matters.”
  • “I wonder how many people would come to my funeral?”
  • “Sometimes I wish I could just go to sleep and never wake up.”
  • “Everyone would be better off without me.”
  • “You won’t have to worry about me much longer.”
  • “I just want the pain to stop.”

Most importantly, do not respond by saying, “Oh c’mon, you don’t mean that.” What your child is really saying, is: “I need your love and attention because I’m in tremendous pain, and I can’t seem to stop it on my own.” Be willing to listen nonjudgmentally. Your focus needs to be on consoling, such as, “I hear you. You must really, really be hurting inside. Together, let’s see what we can do to help you feel better.”

  1. Get professional help.

If you are concerned (or even alarmed) at your teenager’s behavior, don’t wait to contact your pediatrician. Go straight to a mental health provider who works with children to have your child evaluated as soon as possible so he/she can start therapy, counseling or treatment as soon as possible. If you believe your child is actually suicidal and in danger of self-harm, call your local mental health crisis line or take your child to the emergency room.

  1. Share your own feelings with your teenager.

Let your teen know he or she is not alone and that everyone feels sad or depressed or anxious now and then, including moms and dads. Without minimizing what he/she is going through, be reassuring that these bad times won’t last forever and that you are committed to getting him/her help.

  1. Try to prevent your teen from isolating himself/herself from family and friends.

It’s usually better to be around other people than to be alone.

  1. Exercise is of great benefit.

Physical activity, as simple as walking or as vigorous as lifting weights, can help mediate mild to moderate depression. There are several theories why:

  • Working out causes the brain to release endorphins which improve mood and ease pain. Endorphins also lower the amount of cortisol, a hormone linked to depression.
  • Exercise distracts people from their problems and makes them feel better about themselves.
  • Any form of exercise will do. What matters most is that your child enjoys the activity and continues to do it on a regular basis.
  1. Urge your teen not to demand too much of himself/herself.

Whenever possible, suggest that he/she divide large tasks into smaller, more manageable ones and participate in favorite, low-stress activities. The goal is to rebuild confidence and self-esteem.

  1. If your teen is undergoing treatment, advise him/her not to expect immediate results.

Therapy and/or medication usually take time to improve mood. Your child shouldn’t become discouraged if he or she doesn’t feel better right away.

  1. If you keep guns at home, store them safely or move them to another location until your child’s crisis has passed.

Fact: Most teenage suicide deaths by firearm involves a gun belonging to a family member. Many of these deaths could have been prevented if a gun wasn’t available. If you suspect your child might be suicidal, it is extremely important to keep all firearms, alcohol and medications secured locked away.

Important warning signs of depression or suicide

The following may be signs of a mental health problem, such as a mood disorder, or may relate directly to suicidal thoughts or behavior.

Changes in activities:

  • A drop in grades or school performance
  • Neglect of personal appearance
  • Neglect of responsibilities

Changes in emotions:

  • Appearing or talking about feeling sad, hopeless, bored or overwhelmed
  • Having outbursts, severe anger or irritability
  • Appearing or talking about feeling anxious or worried

Changes in behavior:

  • Getting in trouble, being rebellious, aggressive or impulsive
  • Running away or threatening to run away
  • Withdrawing from friends or family or changing friends
  • Eating or sleeping less or more
  • Losing interest in activities
  • Using drugs or alcohol
  • Hurting themselves, such as cutting or severe dieting
  • Talking or writing of suicide or death
  • Any suicidal behavior, even if it could not have been lethal, such as taking a small amount of pills

Family support and professional treatment can help teens who are at risk of suicide deal with their difficulties. Current treatments for mood disorders and other mental health problems, such as individual and family counseling, medications and other therapies, along with long-term follow-up, can be very helpful.

Additional resources: Worried that your child might be suicidal? Come see us, we can help.

If your child is exhibiting any of the above warning signs, or if you just have a feeling that something’s not right, please come see us at Westchester Health right away. One of our pediatricians will examine your child and may refer him/her to a mental health specialist for professional treatment. Working together, we’ll make sure your child gets the help he/she needs. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

You may have seen it in the news or

Westchester Health Blog - Tue, 01/16/2018 - 20:41

You may have seen it in the news or read it online but here at Westchester Health, we want to emphasize that this is a particularly bad year for the flu — one of the worst in years — and if you have not yet gotten a flu shot, you really should.

Nancy R. Beran, MD

According to a recent article in The New York Times, due to an imperfect vaccine and steady cold weather, the flu is now widespread across the country. About 80% of the cases are the H3N2 strain, a particularly nasty one. It’s easier to catch than other strains and once you’ve got it, you get really sick. Also, this strain is particularly bad for children and the elderly.

The entire continental United States is experiencing widespread flu right now, the first time in the 13 years of the current tracking system that this has happened, according to the Centers for Disease Control and Prevention.

Hospitals nationwide report clogged emergency rooms and pharmacies are experiencing shortages of over-the-counter and prescription flu remedies. And we’re just at the start of the flu season, which doesn’t end until May.

Experts, and all of us at Westchester Health, still recommend getting the flu shot even at this late date because the season still has 3 more months to go and because even when the shot fails to stop infection, it often prevents the worst complications: pneumonia and death.

Flu remains a major killer

Even in the absence of a pandemic, a severe flu year kills nearly 650,000 people worldwide, while a mild one kills just under 300,000, according to a recent study published in The Lancet.

In recent years, the CDC estimates, flu has killed about 12,000 Americans in mild years and 56,000 in moderately severe ones.

This flu season is particularly bad

This year’s flu season is shaping up to be an unusually bad one mainly because of 3 factors:

  • The Northeast, Southeast and Midwest got hit with a bitterly cold stretch, causing more people to be crowded together inside. This helps the flu (and many other illnesses) spread much more quickly and easily.
  • The H3N2 strain is more virulent than most.
  • According to the scientific community, this year’s vaccine is particularly ineffective. This has caused many people to question whether they should still get a flu shot. The answer is an emphatic yes.
How the flu is spread

Flu is spread predominantly through droplets in the air, so if you are with 3-6 feet of someone who is infected, you are pretty likely to breathe in their germs in their exhaled breath. The virus will then latch onto the mucous membranes that line the back of your nose, throat and bronchial tubes. Next, the germs invade the epithelial cells that make up the mucous membranes, replicating and making even more virus, infecting adjacent cells.

This initial phase talks 1-4 days. In the beginning, you don’t feel sick. Most people don’t even know they have the flu.

Eventually, your body rallies its immune system, releasing proteins called interferons. This leads to fever, headache and muscular aches and pains — what usually distinguishes the flu from a normal cold.

5 best ways to fight the flu once you have it
  • Drink fluids. This will lessen your headache and bolster your immune system. Be aware that the hard work your body is doing to fight the flu can lead to dehydration. (You may notice your urine getting darker.) Drink 1 cup of water or other liquid every hour, avoiding caffeine and alcohol.
  • Sit in an elevated position, rather than lying flat. Although you want to rest, lying flat all the time collapses your lungs so you can’t cough as efficiently, trapping bacteria in your respiratory tract. If the virus destroys enough cells in your bronchial tubes, this creates openings for bacteria to get into your lungs, which can lead to pneumonia. This can be life-threatening, especially in older people and young children.
  • Take Tamiflu (an antiviral drug), particularly if you are hospitalized, at high risk of complications of the flu, pregnant, or immunocompromised.
  • Rest. As much as you can.
  • Let in fresh air and sunlight into your room. Natural air ventilation dilutes the concentration of the flu germs by exchanging stale air with fresh, some say twice as much as fans do.

To prevent friends, family members and colleagues from getting sick too, keep to yourself until 48 hours with no fever and you’re feeling better.

How do scientists come up with each year’s flu shot?

Yes, it’s a bit of a guessing game, but with an educated guess. Each summer, infectious disease specialists try to make a best guess on which variants of the flu virus are likely to be most common in the U.S. in the coming year. One clue is to look at data from countries such as Australia (whose flu seasons starts before the U.S.). They then create a flu vaccine to counteract which virus (or combination of viruses) they think will be active during the coming U.S. winter.

This year, the scientists’ guess wasn’t far off. The current vaccine was formulated to fight H3N2, the strain that’s making the most people sick. It also is most effective against the H1N1 and B/Victoria strains, and some vaccines are protecting against a B/Yamagata strain.

Last year’s shot will not protect you this year

The flu virus is unstable and very good at mutating, and therefore changes each season. This means that the immunity you got from last year’s shot won’t protect you this year.

Even when you’re vaccinated, you can still get the flu

The flu shot is all about reducing your risk, not eliminating it. But even in years when the flu vaccine is less effective, it is still very important to get it.

The downside of getting a flu shot are almost nonexistent, and significant side effects are very rare. Even in a so-called ineffective year, the benefits greatly outweigh the harms.

What you can do to minimize your risk of flu

No vaccine is ever 100% perfect so it’s important to practice good hygiene to try and minimize your exposure to the flu and/or your ability to pass it along. This includes regular hand washing — especially before eating — and limiting your contact with others when either you or they are sick.

However, to truly minimize your chances of getting the flu this year, yes, you should get the flu shot. Every year.

Worried that you might have the flu? Come see us.

If you think you have the flu, please make an appointment to come in and see one of our Westchester Health physicians as soon as possible. We’ll examine you and if you do in fact have the flu, it’s important to start treatment right away before you get worse.

If you have not had the flu shot, we can give you one, but not if you are sick. Once you feel better, come back in for the vaccine. Our #1 goal is to help you stay healthy and prevent or alleviate illness, especially the flu, in any way we can. Whenever, wherever you need us, we’re here for you.

By Nancy R. Beran, MD, Chief Medical Officer, Westchester Health, member of Northwell Physician Partners

Categories: Blog

Why Do My Allergies Get Worse In The Winter?

Westchester Health Blog - Wed, 01/10/2018 - 09:57

Even though ice, snow and freezing temperatures bring an end to pollen, many people still suffer from winter allergies, primarily due to more time spent indoors. In fact, the most common allergens—house dust mites, animal dander, cockroach droppings, fabric fiber, bacteria and forced-air furnaces circulating airborne dust—are actually worse in winter when there is less ventilation. For allergy sufferers, the old saying “Home is where the heart is” could be “Home is where the allergens are.”

Winter symptoms similar to spring/summer/fall ones

Although specific data is hard to come by, I would estimate that roughly 5-20% of Americans suffer from some form of winter allergy, based on the number of patients I see in my Westchester Health practice.

James Pollowitz, MD, FAAAAI, FACAAI

The symptoms of winter allergies are fairly identical to those of spring, summer and fall:

  • sneezing
  • runny or stuffy nose
  • coughing
  • postnasal drip
  • itchy eyes, nose and throat
The main triggers of winter allergies

Most winter allergies are caused by the same allergens of other seasons but winter can actually intensify those triggers, especially:

  1. Pet dander: Because cold weather usually causes pets to be indoors more often, exposure to dander escalates in the winter months, leading to a corresponding increase in symptoms.
  2. Mold and mildew: Decaying leaves and other yard waste gives mold and mildew an ideal breeding ground. Shoes and clothes then provide these damp, clingy irritants with an easy way inside.
  3. Temperate climates: Milder climates where there are few frosts or hard freezes means that allergens like pollen are present all year round. In addition, people with allergies often experience a spike in symptoms when they visit warmer climates in winter.
  4. Damp wood: Cut wood stored outside easily becomes a moist haven for mold spores. When this wood is brought inside, it easily becomes an allergy trigger.
  5. Indoor heat: When people turn up the heat, it makes the indoor air even drier which leads to dry noses, which increases nosebleeds and dry, cracking skin, which in turn raises infection risk of nasal passages which are already inflamed from allergies. Nasal saline sprays and rinses lower the risk of contracting a secondary viral infection.
Things you can do at home to tame winter allergies
  1. Avoid allergens. The best treatment for winter allergies is to avoid what you’re allergic to. For example, stay indoors when the wind is whipping up damp leaves in the yard. Keep indoor allergens to a minimum by mopping, sweeping and dusting often.
  2. Bathe often. Frequently washing your hands and face reduces the number of allergens you carry and spread. When allergy symptoms are really bothering you, take a shower and change your clothes. Added bonus: the steam of a hot bath or shower may relieve allergy symptoms like sinus congestion.
  3. Wash your bedding often. Most bedrooms are havens for pet dander and dust mites. You can keep these and other allergens at a minimum by washing your sheets, pillowcases and blankets in hot water, every week if possible, to kill dust mites. Also, use hypoallergenic cases for mattresses and pillows to keep dust mites trapped.
  4. Look for allergy-reducing bedding that’s specially designed to be less permeable to allergens like dust mites.
  5. Use a nasal saline solution. Irrigation with saltwater is a great home remedy to relieve the nasal congestion that comes with winter allergies.
  6. Drink more water. When you’re blowing your nose all the time and the thermostat is cranked up, it’s easy to get dehydrated. Keep up your fluids by drinking lots of water, eating more water-rich fruits and vegetables, and if you like, drinking hot tea. A benefit to hot drinks: the steam may reduce nasal congestion.
  7. Moisturize the air around you. Too little moisture in the air in your home or office may irritate your nose and throat—too much encourages mold and mildew growth. A humidity monitor can help you track the moisture in the air and a humidifier or dehumidifier can adjust it, accordingly.
  8. Take allergy medication. OTC allergy medicine can relieve symptoms like itchy eyes and nasal congestion. Note: Managing winter allergies is easier if you take medication before symptoms appear.
  9. Avoid wall-to-wall carpeting, which provides a favorable environment for dust mites. Use area rugs instead.
  10. Clean, dust and vacuum regularly, using a vacuum with a high-efficiency particulate air (HEPA) filter.
  11. To minimize dander, bathe pets once a week and keep them out of the bedrooms of family members who have allergies.
Treatments for your symptoms

Although many of my patients flock to over-the-counter medications, some of them can do more harm than good. A lot of people don’t really understand how to match their symptoms to the product and end up taking the wrong ones.

For example, some OTC allergy medications contain decongestants like pseudoephedrine which can raise a user’s heart rate. Likewise, the active ingredient in the antihistamine Benadryl (diphenhydramine) causes some tissues to dry out and promotes urinary retention. If you have prostate problems and have trouble urinating, this can make your condition worse.

Better options are decongestants that contain loratadine (Claritin) and cetirizine (Zyrtec), two drugs that moved from prescription to OTC status in recent years. In addition, prescription steroid nasal sprays tend to be more effective than antihistamine tablets, though individual responses vary and the two types of drugs are often used in combination.

Suffering from winter allergies? Come see us.

If you’re experiencing any of the allergy symptoms discussed above, or want to know how to better manage your allergies, please make an appointment with Westchester Health to see one of our allergy/immunology specialists. He/she will determine the best course of treatment and/or medication and order any necessary tests so that you’ll soon be able to enjoy this wonderful winter season. Whenever, wherever you need us, we’re here for you.

By James Pollowitz, MD, FAAAAI, FACAAI, an allergy and immunology specialist with Westchester Health, member of Northwell Health Physician Partners

Categories: Blog

7 Tips For Diabetic Winter Foot Care

Westchester Health Blog - Thu, 01/04/2018 - 00:14

Each winter in the US, approximately 15-20% of people with diabetes end up in the hospital because of a foot ulcer or infection. In some cases, these foot problems lead to amputation. That’s why I tell all of my diabetic patients at Westchester Health that foot care is always very important but during the winter, it is even more crucial to keep your feet healthy. Winter moisture, cold and dryness can easily cause numbness and decreased circulation, increasing the risk of a diabetic foot problem.

7 important steps to take to keep diabetic feet healthy

John Viscovich, DPM, MBA, FACFAS

To keep your feet healthy through the winter and avoid problems, I offer the following essential tips:

1) Inspect your feet every day

If you have diabetes, you need to have a daily protocol for foot inspection and stick to it. Look carefully at all the pressure areas of your feet and between your toes. Inspect for any breaks in the skin, discharge, changes in color, changes in odor and/or painful corns or calluses. Let your doctor know about any changes you find. Also, inspect your socks for any stains and your shoes for any stones or rough edges. If you have trouble seeing your feet closely, ask a friend, family member or medically-trained person to help with your diabetic foot care.

2) Choose the right footwear

Winter cold and dampness combined with decreased circulation in your feet can increase your risk for a diabetic foot ulcer. To avoid this, make sure your winter shoes and boot provide warmth, protection from snow and ice, and proper padding. Also make sure they are roomy enough not to constrict blood flow to your feet. Avoid synthetic shoe or boot materials that lock in moisture (your feet need to breathe, even in the cold), and choose the right socks. I recommend wool socks which provide cushioning protection and warmth. You might also consider wearing polypropylene stockings under your socks to wick away moisture.

3) Keep your feet dry

Sloshing through wet snow or icy puddles can lead to dangerously damp feet for a diabetic person. Moisture that collects for too long between your socks and feet, and between your toes, allows potentially problematic bacteria to grow. When your feet get wet from winter weather, you need to dry them carefully and completely, including between your toes. Inspect your feet for areas that are pale in color, which could mean they haven’t been thoroughly dried and still contain too much moisture. Also, it’s vital to change out of wet socks as soon as possible.

4) Moisturizing your feet is essential

Diabetic nerve damage and poor circulation can cause decreased function of the moisturizing glands of your feet. Dry winter heat (from a fire, electric space heater or a car heater blowing on your feet), can make dryness worse and lead to skin breakdown. Be on the lookout for red, shiny areas when you perform your daily foot inspection. Ask your doctor or podiatrist to recommend a good moisturizer for diabetic foot care. Use this moisturizer after bathing your feet every day but avoid leaving too much between your toes.

5) Trim your toenails

Untrimmed or infected toenails are a frequent cause of infections and ulcers and can potentially lead to amputation. Ask your doctor or podiatrist how to trim your toenails correctly or make an appointment to have him/her trim them. If you’re trimming them yourself, soak your feet first to soften the nails, then cut them straight across. Nails that are thick, crumbly or discolored may need professional care and should not be ignored.

6) Never burn your feet

Nerve damage in your feet caused by diabetes can make keeping them warm in winter dangerous because you may not feel when they are getting dangerously hot. Be very careful when using electric blankets, hot soaks, heating pads or warming your feet on a radiator—you could seriously burn your feet and not know it. Always check the water temperature with your hands or a bath thermometer before putting your feet in. A second or third degree burn can cause a major foot problem. If this happens, contact your doctor immediately.

7) Control your blood sugar

Keeping your diabetes under control is one of the most important aspects of diabetic foot care. Because your feet absorb much of the weight and daily wear and tear of your body, they are one of the first places insufficient diabetes control will show up. Work with your doctor for successful ways to control your blood sugar. Also, monitor your diet, maintain your weight (maybe lose weight), exercise regularly and avoid smoking. This way, during the winter and all through the year, your feet—and you—will be healthier.

If you have a foot problem of any kind, come in and see me

If you have diabetes and are concerned about the condition of your feet, ankles and toes, have pain in your feet or heels, or are experiencing any other problems with your feet, make an appointment to come see me at one of my Westchester Health offices. I’ll examine your heels, ankles and feet, evaluate your condition, and together with you, determine the best course of treatment for your specific condition.

By John Viscovich, DPM, MBA, FACFAS, board certified podiatrist with Westchester Health, member of Northwell Health Physician Partners

Categories: Blog

Why You Really Need Folic Acid When You’re Pregnant

Westchester Health Blog - Wed, 01/03/2018 - 10:17

If you’re pregnant or might become pregnant, it’s critically important for you to get enough folic acid, the synthetic form of vitamin B9, also known as folate. Folic acid plays an important role in the production of red blood cells and helps prevent neural tube defects (NTDs) which are serious birth defects of the spinal cord (such as spina bifida) and the brain (such as anencephaly). The neural tube is the part of the embryo where your baby’s spine and brain development begin. NTDs affect approximately 3,000 pregnancies annually in the U.S.

Folic acid helps prevent neural tube defects

Navid Mootabar, MD, FACOG

Neural tube defects occur at a very early stage of development, before many women even know they’re pregnant. This is why it’s so important to begin taking folic acid before you start trying to conceive.

The Centers for Disease Control and Prevention (CDC) reports that women who take the recommended daily dose of folic acid starting at least one month before conception and continuing through their pregnancy reduce their baby’s risk of neural tube defects by up to 70%.

In addition, some research suggests that folic acid may help lower your baby’s risk of other birth defects as well, such as cleft lip, cleft palate, and certain types of heart defects. It may also reduce your risk of preeclampsia, a serious blood pressure disorder that affects approximately 5% of pregnant women.

What exactly does folic acid do for you and your baby?

Your body needs the nutrient folic acid to make normal red blood cells and prevent a certain type of anemia. It’s also essential for the production, repair and functioning of DNA, our genetic map and a basic building block of cells. Getting enough folic acid is particularly important for the rapid cell growth of the placenta and your developing baby. The best food sources of folic acid are fortified cereals, and it is found naturally in dark green vegetables and citrus fruits.

When taken before and during pregnancy, folic acid may also protect your baby against:
  • Cleft lip and palate
  • Premature birth
  • Low birth weight
  • Miscarriage
  • Poor growth in the womb
Folic acid has also been suggested to reduce your risk of:
  • Pregnancy complications, especially preeclampsia.)
  • Heart disease
  • Stroke
  • Some types of cancers
  • Alzheimer’s disease
When you should start taking folic acid

Birth defects occur within the first 3-4 weeks of pregnancy, so it’s important to have folate in your system during those early stages when your baby’s brain and spinal cord are developing. Most healthcare providers and OB/GYNs, including all of us at Westchester Health, recommend that women who are trying to get pregnant should start taking a prenatal vitamin with folic acid. One study showed that women who took folic acid for at least a year before getting pregnant cut their chances of premature delivery by 50% or more.

How much folic acid do you need?

To reduce your baby’s risk of developing a neural tube defect, experts recommend that women of childbearing age take 400 micrograms (mcg) of folic acid a day, beginning at least a month before they start trying to get pregnant. If you take a multivitamin every day, check to see if it has the recommended amount. If it doesn’t, you can take folic acid supplements.

Here’s the recommended daily amount of folic acid you should take before and during your pregnancy:

  • While trying to conceive: 400 mcg
  • For the first 3 months of pregnancy: 400 mcg
  • For months 4-9 of pregnancy: 600 mcg
  • While breastfeeding: 500 mcg
You should take folic acid even if you’re not pregnant

Since half of the pregnancies in the United States are unplanned, the CDC, the U.S. Public Health Service, the March of Dimes, the American College of Obstetricians and Gynecologists (ACOG) and many other experts strongly recommend that all women of childbearing age get 400 mcg of folic acid every day. Check the label of your multivitamin supplement to be sure you’re getting enough. If you’re not, you can switch brands or take folic acid separately.

DO NOT TAKE more than 1,000 mcg of folic acid per day unless your healthcare provider advises you to. This is particularly important if you are a vegan. Vegans are at risk of being deficient in vitamin B12, and taking too much folic acid would make it hard to diagnose that deficiency.

When you might need extra folic acid

1) Women who are obese appear to be more likely to have a baby with a neural tube defect. If you’re significantly overweight, see your healthcare provider before you try to conceive. He/she may advise you to take more than 400 mcg of folic acid a day.

2) If you’ve previously been pregnant with a baby with a neural tube defect, you’ll probably be advised to take 4,000 mcg of folic acid a day. Be sure your healthcare provider is aware of your history. With no intervention, women in this situation have a 3-5% chance of having another pregnancy complicated by a neural tube defect.

3) If you’re carrying twins, your healthcare provider may recommend as much as 1,000 mcg of folic acid per day.

4) Some people have a genetic variation (methylenetetrahydrofolate reductase (MTHFR) mutation) that makes it more difficult to process folate and folic acid. If you know you have this mutation, talk with your doctor to make sure you’re getting enough folic acid.

5) Women who are diabetic or are taking certain anti-seizure medications are also more likely to have a baby with an NTD. If either of these situations applies to you, see your healthcare provider at least a month before trying to conceive to find out how much folic acid you should be taking and for him/her to monitor your condition.

Good food sources of folic acid

Food manufacturers are required by the U.S. Food and Drug Administration to add folic acid to enriched grain products, such as breakfast cereals, bread, pasta and rice. Some fortified breakfast cereals contain 100% of the recommended daily amount.

Other good sources include:
  • Lentils
  • beef liver
  • dried beans, peas and nuts
  • cooked lentils
  • avocado
  • dark green vegetables such as broccoli, spinach, collard or turnip greens, okra, Brussels sprouts and asparagus
  • egg noodles
  • citrus fruit and juice
Signs of a folic acid deficiency

The signs of folic acid deficiency can be subtle. You may have diarrhea, anemia, loss of appetite and weight loss, as well as weakness, a sore tongue, headaches, heart palpitations and irritability. If you’re only mildly deficient, you may not notice any symptoms, but the important thing to remember is that you are not getting the optimal amount for your baby’s early embryonic development. This is why it’s so important to get the recommended daily dose and to regularly see your healthcare provider.

Want to know more about folic acid? Come see us.

If you’d like more information on how much folic acid you should be taking and the part it plays in preventing birth defects, please make an appointment with Westchester Health to see one of our OB/GYNs. He/she will answer all your questions, give you lots of health and pregnancy information, and advise you on your folic acid intake so that you and your growing baby can both be as healthy as possible. Whenever, wherever you need us, we’re here for you.

By Navid Mootabar M.D. F.A.C.O.G., Chairman Department Obstetrics & Gynecology, Director at Large, Institute of Robotic & Minimally Invasive Surgery, Northern Westchester Hospital, Mount Kisco, NY, Northwell Health System

Categories: Blog

How To Know If Your Child Has Bulimia

Westchester Health Blog - Wed, 12/27/2017 - 09:52

Do you suspect that your child may have bulimia? Eating disorders like bulimia are serious health conditions that can be both physically and emotionally destructive, particularly for teenagers. Here at Westchester Health, we have a number of teenage patients who suffer from bulimia, and we want to stress to parents that early diagnosis and intervention make a big difference in recovery. Affecting boys as well as girls, eating disorders can escalate into life-threatening conditions and require professional help. To help parents understand this potentially serious issue, we reproduce here a very helpful blog from Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group.

How bulimia differs from anorexia
  1. Teens suffering from anorexia eat very little and are at least 15% below their ideal body weight.

    Lauren Adler, MD, FAAP

  2. They are dissatisfied with their bodies, have an intense fear of weight gain, are obsessed with their weight, and go to extreme measures to slim down and prevent gaining weight.
  3. Teens with bulimia are also obsessed with not gaining weight but their method is to eat huge amounts of foods followed by purging, either by vomiting, using laxatives or diuretics, or by spending abnormal amounts of time doing strenuous physical exercise.
  4. They often report feelings of being out of control during their binge-eating episodes.
  5. Half of all anorexics have episodes of bulimia at one time or another.
A diagnosis of bulimia is based on these 6 criteria:
  1. Recurrent episodes of binge eating
  2. Regularly purging in order to control weight through self-induced vomiting, laxatives, diuretics, enemas, ipecac or other medications
  3. Fasting
  4. Exercising obsessively
  5. Binging and purging at least twice a week for three months
  6. Excessive concern over weight and figure
Red flags to watch out for in your child

Because a bulimic teen’s weight generally hovers around average or above average, he/she can often hide the condition for years. In most cases, a teen with bulimia starts to diet and may also start an exercise campaign, but eventually surrenders to cravings for food. Stress or strong emotions can set off a binge, during which bulimics will devour whatever food they can lay their hands on, often starchy junk foods. It is not unheard of for teens with this eating disorder to consume 3,000-7,000 calories in a couple of hours, stopping only after they’re too full to take another bite. Somewhat ironically, bulimics barely derive any pleasure from eating and tend to chew and swallow almost mechanically.

After the binge eating, feeling guilty and ashamed, bulimic teenagers attempt to rid their bodies of the food before it is digested. Inducing vomiting by sticking their fingers down their throat is one method. They can also take excessive doses of laxatives, diuretics or emetics, drugs that promote bowel movements, urination or vomiting.

Be aware that bulimics are very secretive and plan their binges in advance—usually when nobody else is around.

Behavioral signs of bulimia

Does your teen exhibit any of these behaviors? If so, please take him/her to a pediatrician or mental health professional right away.

  • Preoccupation with food and weight
  • Distorted body image
  • Long periods of time spent in the bathroom—sometimes with the faucet running, to mask the sound of vomiting
  • Depression
  • Anxious about eating, especially dining out in public
  • Abuse of laxatives, enemas, emetics, diuretics
  • Spends less time with family and friends; becomes more isolated, withdrawn, secretive
  • Stealing food and hoarding it in unusual places, such as in the closet or under the bed
  • Excitability, difficulty sitting still, easily distracted
Physical signs of bulimia

Again, if your teen exhibits any of these physical signs, please take him/her to a pediatrician or mental health professional right away.

  • Dramatic fluctuations in weight, from alternately dieting and binging
  • Puffy face and throat from swollen salivary glands
  • Burst blood vessels in the face
  • Bags under the eyes
  • Indigestion, bloating, constipation, gas pains, abdominal cramps
  • Dehydration
  • Eroded tooth enamel from the gastric acid in vomit
  • Discolored teeth
  • Cavities
  • Inflamed, bleeding gums (gingivitis)
  • Calluses on fingers and knuckles from self-induced vomiting
  • Swelling (edema) of the feet or hands
  • Sore throat
  • Tremors
  • Dizziness, light-headedness, fainting spells
  • Stiff, achy muscles
  • Muscle weakness
  • Muscle cramps
  • Irregular menstruation
  • Extreme thirst, frequent urination
  • A constant sensation of coldness, especially in the hands and feet, because the body has lost its fat and muscle (if underweight)
  • Hair loss
  • Blurred vision
The physical damage caused by bulimia

Despite an outwardly healthy appearance, binging and purging exacts a heavy toll on vital organs and can lead to diseases of the liver, kidneys, intestines and heart. Potassium deficiency can bring about an irregular heart rhythm and possibly cardiac arrest. As in anorexia, the other major cause of death is suicide.

Along with dangerously low body weight, teens suffering from bulimia can lose their menstrual
periods. This can cause irreversible early bone loss (osteoporosis) that can lead to serious bone fractures later in life. Bulimia can also cause multiple cavities and long-term dental problems.

Can eating disorders be treated? Yes.

Although there is no quick and easy treatment for eating disorders, they are indeed treatable. This can include mental health therapy, nutritional feeding, medical monitoring and medication. Generally, the goals of eating disorder treatment are to restore the person to a healthy weight, treat any psychological problems related to the disorder, and reduce behaviors or thoughts that contribute to the eating disorder. Continuing therapy may be needed to prevent relapse and to treat related psychological problems.

The good news: we’re here to listen…and to help. Please contact us.

At Westchester Health, we want you to know that we care deeply about your child’s well-being and will do all we can to help him/her overcome bulimia or any other eating disorder. Please come in and talk with us—your teen alone, you and your teen, or you by yourself—about body image, eating habits, self-esteem, relationships, school, grades…anything.

If, together, we decide your child does, in fact, suffer from bulimia or another eating disorder, we’ll go over all the available options and make the appropriate referrals. Plus, we have an on-staff nutritionist who can help your child make smart, healthy choices about food, calories and nutrition. Most of all, we want to help your teen feel good about herself/himself and be healthy, now and throughout life. Whenever, wherever you need us, we’re here for you.

More information on eating disorders

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

Categories: Blog

How A Child’s Chronic Illness or Disability Affects the Whole Family

Westchester Health Blog - Wed, 12/20/2017 - 09:39

In our many years of caring for families, one thing we’ve observed here at Westchester Health is that the stress of a child’s serious illness, chronic health condition or disability often causes problems throughout the family, particularly if parents try to deal with their fears, frustrations and exhaustion without support. Sadly, this often leads to divorce or the parents’ other children developing issues of their own because they feel ignored. To help, we offer these words of advice and encouragement by way of an excellent blog by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group, and we hope that parents in this situation will reach out to us for help and support.

Parents of disabled children or children with chronic illnesses often endure:
  1. Guilt. Parents of a child with a chronic illness or disability often feel guilty, as if they somehow caused the condition. Self-blame is particularly prevalent when the condition was present at birth, is genetic and/or when the cause is unknown. Guilt can be an excruciating and disabling emotion, adding to the stress within the family and sometimes making it difficult for parents to be supportive of their other children and each other. If guilt or other emotional issues are interfering with the quality of your family life, we urge you to seek professional counseling.

    Lauren Adler, MD, FAAP

  2. Lack of discipline. Many parents find it hard to discipline their chronically ill or disabled child. However, all children (even those with special needs) benefit from having clear boundaries. Otherwise, they easily become overly dependent, have lower self-esteem and develop behavior and social problems. We strongly feel that parents should establish a consistent set of family rules and expectations, adjusting them as needed as the child’s health fluctuates. This helps create an environment that encourages independence and self-confidence.
  3. Financial stresses. Sometimes a parent has to give up a career to become the primary caretaker at home, especially when the child requires extensive help with daily activities. A parent may have to change jobs, or take on a second job, to bring in more income to cover additional medical bills associated with the child’s condition. The family may also have to move, relocating closer to the medical services the child needs. Fortunately, several state and federal programs are available to help families with the costs of chronic health care. Supplemental Security Income (SSI) for children, for example, now provides cash benefits to many families with children with chronic illnesses. Your pediatrician or social worker should be able to refer you to the proper agencies for help.
How to cope with a child with a chronic illness or disability

What we’ve seen many times throughout our practice is that a child with serious health problems may actually bring parents and other family members closer together. Families—especially those who are open and honest with their feelings—can be strengthened by everything that goes along with managing their child’s health condition or disability. In many cases, this provides them with a sense of cohesiveness and purpose that builds the resiliency of the family and strongly binds them together.

Remember: you don’t have to go it alone. Please take advantage of support networks.

Remember, you should not try to solve all family problems associated with your child’s illness or disability by yourself. Physicians, psychologists, social workers, family therapists and other parents of children with chronic illnesses and disabilities are very important resources for you and can make all the difference in the health of your family.

Social networks can also be valuable sources of support for you in your community, such as support groups, faith-based groups, friends, extended family members and any others who can understand what you’re going through and be a helpful source of support. We urge you to find help, support and community.

Feeling overwhelmed? Come see us, we’re here to help.

If you have a child with a chronic illness or disability, please make an appointment with Westchester Health. We have years of experience and lots of advice and guidance to offer, as well as a listening ear. Our #1 goal is to help you manage your child’s condition in such a way that you, your child and your entire family live a healthy, happy life. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Got Lice? Here’s How To Get Rid Of Them.

Westchester Health Blog - Wed, 12/13/2017 - 10:06

“Head lice? How can that be? We wash her hair every night. And we’re really clean people!” We wish we could tell you how many times we’ve heard this from parents of our patients who, despite their family’s “cleanliness,” have contracted head lice. Since lice are typically spread through head-to-head contact (school, sleepovers, camp and any other situation where people are close to each other), kids are common targets. For the best ways to get rid of the pesky intruders, we reproduce a very helpful blog from Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group.

Test your lice knowledge. Are these myths true or false?
  1. Having head lice is a sign of dirtiness, poor hygiene or low income.
    FALSE. Kids of all cleanliness and socioeconomic levels get lice, no matter how often or seldom they wash their hair or bathe. (In fact, lice prefer clean hair.)

    Lauren Adler, MD, FAAP

  2. Lice like long hair.
    FALSE. It doesn’t matter how long or short your child’s hair is.
  3. You can get lice from using someone’s brush or hat.
    FALSE. The spread of lice through brushes, combs, hats, etc. is fairly rare, although yes, it can happen.
  4. You can get lice from pets.
    FALSE. No, you cannot.
Even though they are very small, you can see lice with the naked eye

Yes, though it’s pretty yucky, you can spot lice in your child’s hair, especially white eggs clinging to dark hair. Here’s what to look for:

  1. Lice eggs (nits). These look like tiny white, yellow, tan or brown dots before they hatch, similar to dandruff, except they can’t be removed by brushing your child’s hair or shaking his/her head.
  2. Adult lice and nymphs (baby lice). The adult louse is no bigger than a sesame seed and is grayish-white or tan. Nymphs are smaller and become adult lice 1-2 weeks after they hatch. If head lice is not treated, this hatching process repeats itself about every 3 weeks.
  3. Lice bites cause itching and scratching. This does not always start right away and often depends on how sensitive your child’s skin is to the lice. Some children complain of something crawling in their scalp or tickling their heads.
  4. Small red bumps or sores from scratching. Since lice bites typically itch, some children excessively scratch their scalp which can lead to a bacterial infection which needs to be treated with an antibiotic.
Our top tips: the 10 best ways to eradicate head lice

From our years of experience dealing with head lice here at Westchester Health, we’ve put together our 10 best ways to get rid of them. But before you do anything else, the first thing we recommend is to wash any items that have come in contact with your child’s head—bedding, hats, clothing, scarves, toys, towels, car seat/stroller headrests—in hot water and dry on a hot setting. Soak combs and brushes in very hot, soapy water. Vacuum floors, pillows, upholstered furniture and car seats. Stow items you can’t wash in a sealed bag for 2 weeks. Then, check everyone else in your family for lice as well.

  1. Nitpicking and wet combing

    You cannot get rid of lice until you’ve picked out all the eggs. This should be done in conjunction with almost all other treatments. Hair should be wet and have a lubricant added to it, such as conditioner. First, comb the hair section by section, starting very close to the scalp with a fine-toothed metal comb (get one at a drugstore) to remove lice and nits. After a comb-through, use a magnification light to find and pick out any strays.

  2. Rid, a lice-killing shampoo

    Pyrethrum, the active ingredient in Rid and similar OTC products, comes from chrysanthemum flowers that harbor natural insecticides called pyrethrins. Apply to dry, clean hair that has no products applied to it, wait 10 minutes, then add water to form a lather and rinse. Comb for nits. A second application is recommended 7-10 days later to kill any live lice that remain. Watch your child for allergic reactions.

  3. Nix, another lice-killing shampoo

    Here is another permethrin-containing product that attacks live lice although some of our parents report that lice seem to have become resistant to it. Allergic reactions are possible. On damp, shampooed (but not conditioned) hair, saturate your child’s head with the lotion. Leave for 10 minutes, rinse and comb out nits. Repeat if live lice appear 7 or more days after the initial treatment.

  4. Olive oil

    This home remedy smothers and kills lice but it needs to be applied overnight under a shower cap because lice can survive without breathing for hours. You’ll also have to comb your child’s hair afterward to remove nits, but the olive oil should help loosen them from the hair shafts.

  5. Petroleum jelly (Vaseline)

    Like olive oil, many parents swear by this (other options: styling gel or mayonnaise). The thick jelly supposedly suffocates lice by clogging their breathing holes. For best results, coat the hair and scalp, cover it overnight with a shower cap, and wash out the next morning. Comb for nits. Repeat the treatment one week later.

  6. Cetaphil Cleanser

    Another product that can be used to treat lice via suffocation is Cetaphil Cleanser. This method has been shown to be 96% effective and has no toxicity. Start by coating the scalp and dry hair with a thick layer of Cetaphil. Once the hair has been saturated, wait 2 minutes to allow the product to soak in. Using a fine-toothed comb, remove the excess product. Blow dry the hair until it is completely dry (this may take longer than usual). Leave product in for at least 8 hours, then wash hair as usual. This process should be repeated 7 and 14 days later.

  7. Vinegar

    Some parents have found that vinegar dissolves the sticky glue that the female louse uses to attach her eggs to hair shafts. Also, we’ve seen that coating the hair with vinegar after using a lice-killing treatment and before combing for nits works well. (White vinegar is recommended.)

  8. Benzyl alcohol lotion 5%

    This prescription lotion (Ulesfia) works by paralyzing a louse’s breathing apparatus. Ulesfia can be prescribed for patients 6 months and older; at least two applications are needed. (Note: It can cause eye and skin irritation.) To use, saturate dry hair and scalp with the lotion, wait 10 minutes, then rinse. Use a nit comb afterward to help remove nits and dead lice.

  9. LouseBuster

    Resembling a vacuum cleaner, this device directs heated air toward the hair roots and scalp to dry out lice and their eggs. A 2006 study showed that the LouseBuster killed 98% of nits and 80% of live lice. Although safe and quick (a typical treatment takes only 30 minutes), treatments are only available through certified professional operators.

  10. Hire a nit-picking service

    There are actually de-lousing services that specialize in removing head lice. Ask us for recommendations for a reliable service in your area, or consult the National Association of Lice Treatment Professionals.

Know your rights: Lice should not keep your child from going to school

If children are found to have live lice while at school, they might be sent home (depending on school policy) where they need to be treated appropriately (as recommended by the American Association of Pediatrics and the National Association of School Nurses). Then they should be allowed to return to school.

Proper treatment will kill the live lice, though nits can hang onto the hair for longer. Nits are not as contagious because they are cemented to the hair, which is why children with nits but not live lice should be permitted to attend school.

If you are notified that a student in your child’s school has been found to have head lice, this doesn’t mean your child will necessarily contract lice, too. Check your child’s hair over the next few days and be aware of any scalp itching or scratching. If your child does develop head lice, follow the guidelines above.

If you think (or you know) that your child has head lice, please come in and see us

If your child is showing signs of head lice and you want to know the best ways to get rid of them, or if he/she has developed a scalp infection from scratching, please make an appointment at Westchester Health to see one of our pediatricians. We’ll examine your child, determine if he/she does, in fact, have head lice, and if so, give you advice and guidance on the best, fastest way to eradicate them so you and your family can rest easy. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

What Can I Do To Keep My Child From Getting So Many Colds?

Westchester Health Blog - Wed, 12/06/2017 - 10:27

Cold season is on its way, and in many places, is already here. Just in the first two years of life, most children have 8-10 colds. And if your child is in childcare, or if there are older school-age children in your house, he/she may have even more, since colds spread easily among children who are in close contact with one another. To help lessen the symptoms and help your child feel better, read this blog full of great advice from Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group.

How colds are spread

Lauren Adler, MD, FAAP

Colds are caused by viruses, which are very small infectious organisms (smaller than bacteria). A sneeze or a cough can easily pass a virus from one person to another. The virus can also be spread indirectly:

  1. A child or adult infected with the cold virus transfers virus particles onto his/her hand by coughing, sneezing or touching her nose.
  2. He/she then touches the hand of a healthy person.
  3. The healthy person touches their newly contaminated hand to their own nose, thus introducing the infection to an area where it can multiply and grow—the nose or throat. Symptoms of a cold soon develop.
  4. The cycle then repeats itself, with the virus being transferred from this newly infected child or adult to the next susceptible one, and on and on.
Cold symptoms

Once the cold virus is present in your child and multiplying, he/she will develop the following familiar symptoms and signs:

  • Runny nose (first, a clear discharge; later, a thicker, often colored one)
  • Sneezing
  • Mild fever (101–102 degrees F), particularly at night
  • Decreased appetite
  • Sore throat and often, difficulty swallowing
  • Cough
  • Irritability
  • Slightly swollen glands
  • Pus on the tonsils, especially in children over 3 years. This may indicate strep infection.

If your child has a typical cold without complications, these symptoms should disappear gradually in 7-10 days.

Best treatments for a cold
  1. Rest and fluids

    Unfortunately, as we’ve all heard our whole lives, there’s no cure for the common cold. Antibiotics can combat bacterial infections but have no effect on viruses, so the best you can do is make your child comfortable. You want to make sure he/she gets extra rest and drinks lots of fluids.

  2. Give acetaminophen or ibuprofen

    If your child has a fever and is very uncomfortable, give him/her single-ingredient acetaminophen or ibuprofen. Ibuprofen is approved for use in children 6 months of age and older; however, it should never be given to children who are dehydrated or are vomiting repeatedly. Be sure to follow the recommended dosage for your child’s age and the time interval for repeated doses.

  3. No OTC cough and cold medicines

    Over-the-counter (OTC) cough and cold medicines should not be given to infants and children under 2 years old because of the risk of life-threatening side effects. Several studies now show that cold and cough products do not work in children younger than 6 years and can have potentially serious side effects. Also, coughing is actually a good thing; it clears mucus from the lower part of the respiratory tract, so ordinarily there’s no reason to suppress it.

  4. When to see your pediatrician

    An older child with a cold usually doesn’t need to see a doctor unless the condition becomes more serious. Children 3 months or younger, however, should see their pediatrician at the first sign of illness. With a young baby, symptoms can be misleading and what seems like a cold can easily be a more serious illness such as bronchiolitis, croup or pneumonia.

  1. Saline nose drops and suction bulb

    If your infant is having trouble breathing or drinking because of nasal congestion, clear the nose with OTC saline (salt water) nose drops or spray. Follow this with a rubber suction bulb every few hours, before each feeding or before bed. For the nose drops, use a dropper that has been cleaned with soap and water and rinsed well with water. Place 2 drops in each nostril 15-20 minutes before feeding your baby, then immediately suction with the bulb. Never use nose drops that contain medication, since excessive amounts can be absorbed. Only use normal saline nose drops.

  2. Vaporizer

    Putting a cool-mist humidifier (vaporizer) in your child’s room also will help keep nasal secretions more liquid and make him/her more comfortable. Put the vaporizer close to your child (but safely out of reach) so that he/she can breathe in the extra moisture. Be sure to clean and dry the humidifier each day to prevent bacterial or mold from growing. We don’t recommend hot-water vaporizers because they can cause serious scalds or burns.

  3. Keep in touch with your pediatrician

    If you call your pediatrician and describe your child’s symptoms, he/she may want to see your child or may ask you to watch him/her closely and report back if the condition doesn’t improve and your child has not completely recovered within one week from the start of the cold.

How to prevent your child from getting colds
  1. If your child is under 3 months old, the best way to prevent colds is to keep him/her away from people who have them. This is especially important during the winter when many of the viruses that cause colds are circulating in larger numbers and being passed from person to person. Remember, a virus that causes only a mild illness in an older child or an adult can cause a much more serious one in an infant.
  2. If your child is in childcare with other children who are sick, washing his/her hands regularly during the day can help keep germs at bay. Also, teach your child to try not to share food, utensils, crayons, toys, etc. with other kids, but this is often hard to do. Also, if possible, teach your child to avoid rubbing his/her eyes or putting fingers in his/her mouth without washing hands first. This will cut down on the spread of viruses.
  3. When sneezing and coughing, teach your child to use a tissue or a handkerchief. This helps keep the cold virus from coming into contact with the hands where it can easily be passed on to others.
  4. Help your child get enough sleep. It’s a proven fact that when children (and adults) are overtired and run down, they’re more susceptible to colds and other infections. Encourage your child to eat nutritious meals and get the recommended hours of sleep for his/her age, particularly in the winter during cold and flu season.
Does your child get a lot of colds? Come see us, we’re here to help.

If your child gets one cold after another or has colds that routinely seem to last a long time, please make an appointment with Westchester Health. One of our pediatricians will evaluate your child, listen to his/her history, and determine if there is maybe something more serious going on. He/she will also answer your questions and offer advice and guidance for ways to minimize the number of colds your child picks up so that he/she can be as healthy and happy as possible. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

New Dad? 5 Great Tips For Surviving Your New Stage of Life

Westchester Health Blog - Wed, 11/29/2017 - 10:19

Are you a new dad with a new baby? Cherish every moment and hang on for the ride of your life. Remember: we’re here for you at Westchester Health, with tips, advice and guidance in this exhilarating but exhausting time in your life. To help you cope, check out this great blog by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group.

5 tips for new dads
  1. Let go of your need to control everything

    Lauren Adler, MD, FAAP

Even though you and your partner are the most mature people in the house, guess who’s in control? That’s right, your baby! He/she needs to be fed, needs endless diaper changings, needs bathing, needs burping, needs to be held, needs to be put down, needs sleep…that’s a lot of needs. That means you have to come second. And remember, things with a baby rarely (if ever) go as planned. So inhale, exhale, let go, and enjoy this wonderful time.

  1. Take a time out

Due to stress, sleep deprivation, and your partner’s hormonal changes, the first three months with a newborn could drive any new parents over the edge. When things are escalating and one (or both) of you are at your wit’s end, take a time out. Take a walk, go to the gym, meet a friend, shoot some hoops, go for coffee. After taking a break, things often seem a lot calmer and the crisis doesn’t seem so big after all.

  1. Be a student of your child

While there’s no shortages of books, articles, friends and relatives telling you how you should be taking care of your new baby, there’s no one right way to do things. Every child is different, every family is different. This is your time to figure out what works best for you, your partner and your baby.

  1. Find a routine

Apart from injury or sickness, there are 3 main reasons babies cry: they need to sleep, they need to be cleaned or they need to be fed. Sometimes all three. Your baby will decide when diapers need to be changed, but you can be proactive in setting up an eating and sleeping routine. It will take awhile for your newborn to sync up with your schedule, but establishing a routine will give your life more structure.

  1. Get your sleep (yeah, right)

This sounds crazy but try to get as much sleep as you can. There’s no reason why both you and your partner need to be up at 3am or getting up at the crack of dawn to take care of the baby. Take turns so one of you can sleep. You’ll all be better for it.

Want to know more about caring for a newborn? Come see us, we’re here to help.

If you’re a new dad feeling a little overwhelmed, or want more information about caring for a newborn, or maybe just want to talk, please make an appointment with Westchester Health to see one of our pediatricians. He/she will happily answer all your questions and offer advice and guidance for raising a healthy child. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Best Ways To Treat Your Child’s Vomiting

Westchester Health Blog - Wed, 11/22/2017 - 10:11

At Westchester Health, we often get frantic calls from parents with a child that can’t seem to stop vomiting. The majority of the time, vomiting is caused by a virus and will get better on its own, but there are some things you can do at home to help your child feel better. There are also some warning signs to look out for, which we share with our parents here in a blog by Lauren Adler, MD, FAAP, a pediatrician in our Westchester Health Pediatrics group.

If your baby is vomiting

Lauren Adler, MD, FAAP

  • We recommend small frequent sips of fluids when vomiting to avoid dehydration. If breastfed, nurse him/her more often. Offer each breast for 1-2 minutes every 10 minutes. In addition, you may have to pump or offer Pedialyte in between breastfeedings, even as little as a teaspoon (from a spoon or in a syringe) every 5-10 minutes.
  • If your baby is bottle fed, increase the number of feedings to make up for lost fluids. The amount of extra fluid your baby needs depends on his/her age and size. For example, a newborn may need as little as 1 fl oz (30 mL) at each extra feeding, while a 12-month-old may need as much as 3 fl oz (90 mL) at each extra feeding.
  • Ask your pediatrician if you should use an oral rehydration solution (ORS) if your baby still isn’t getting enough fluids from formula or the breast. The amount of ORS your baby needs depends on your baby’s age and size. You can give the ORS in a dropper, spoon or bottle.
  • No solids until your baby has stopped vomiting for several hours.
  • Once several hours have passed with no vomiting, if your baby has started eating cereal, you can replace lost fluids with cereal. You also may feed your baby strained bananas and mashed potatoes if your child has had these foods before.
How to help children ages 1-11 stop vomiting
  • Nothing to eat or drink until it is has been an hour since the last vomit.
  • Make sure your child is drinking enough fluids. Once an hour has passed with no vomiting, frequent, small amounts of fluids are best. He/she can also suck on flavored ice pops
  • Once several hours have passed with no vomiting, you can allow your child to drink as much fluid as he/she wants. Note: Do not give your child fruit juice or soda. These contain too much sugar and not enough of the essential minerals (electrolytes) that are being lost.
  • Cereal mixed with milk or water may also be used to replace lost fluids after several hours have passed with no vomiting.
  • If your child still is not getting enough fluids, you can try an ORS such as Pedialyte.
  • Gradually start to offer your child regular foods after 6 hours with no vomiting.
  • Offer your child solid foods if he/she was eating solids before, such as crackers, toast, broths, mild soups, mashed potatoes, rice and bread.

Avoid high-fiber foods, such as beans, and foods with a lot of sugar, such as candy or ice cream.

How to treat vomiting in older children

After talking with your child’s pediatrician, you can give your older child an OTC antinausea medicine, such as Zofran, meclizine (Antivert or Bonine) or dimenhydrinate (Dramamine). NOTE: Follow the package instructions carefully.

VERY IMPORTANT: Watch for dehydration

If your child is vomiting continuously, you need to make sure that he/she does not get dehydrated, which is when the body loses so much water that it can no longer function efficiently. If dehydration becomes severe, it can be life-threatening. To prevent this, make sure your child consumes enough extra fluids to restore what has been lost through throwing up. If he/she also vomits the replacement fluids, notify your pediatrician.

Common signs of dehydration:
  • dry, cracked lips and a dry mouth
  • a decrease in urine output, no urine for 8-12 hours, or dark-colored urine
  • drowsiness or irritability
  • cold or dry skin
  • low energy levels, seeming very weak or limp
  • no tears when crying
  • sunken eyes or sunken soft spot (fontanelle) on baby’s head
When to call your pediatrician

Call your child’s doctor if any of the following occur during home treatment:

  • Your child can’t keep down clear liquids
  • Dehydration develops. Signs include your child being thirstier than usual and having less urine than usual.
  • Your child’s vomiting returns or becomes severe
  • Blood or yellow or green liquid (bile) is present in your child’s vomit
  • Your child’s vomiting does not get better
  • Your child’s symptoms become more severe or more frequent
  • If your child’s vomiting is associated with a bad headache
Call 911 if your child:
  • Is less than 1 month old and vomits after every attempt to feed. Frequent, forceful vomiting in an infant under 3 months may be a sign of pyloric stenosis.
  • Is vomiting and has severe stomach pains or is complaining of a headache, which may be meningitis if he/she has a fever and is vomiting, especially if he/she does not have diarrhea. Other danger signs of meningitis include a stiff neck and skin rashes.
  • Is vomiting after a head injury. This may indicate that your child has a concussion or a brain hemorrhage.
  • Vomits blood or a substance that looks like coffee granules, which is a sign that there is blood in the stomach.
  • Vomits green (bile-colored) substances and has severe abdominal pain, which may be a blockage in his intestines.
  • Has an abdomen that feels hard and that is tight and tender between episodes of vomiting.
  • Has a dramatic change in mental status, such as seems extremely tired or dazed, which may be a sign of an infection in the brain or spinal cord.
Want to know more about how to stop vomiting? Come see us, we’re here to help.

If your child vomits from time to time, possibly due to stomach viruses, please make an appointment with Westchester Health to see one of our pediatricians. He/she will examine your child, listen to his/her medical history, and determine if there is maybe something more serious going on. He/she will also answer your questions and offer advice and guidance for ways to prevent or shorten the duration of vomiting so your child can get back to feeling better soon. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

How To Avoid Poison Ivy, Even In The Fall

Westchester Health Blog - Wed, 11/15/2017 - 10:47

You may think that summertime is the worst season for contracting poison ivy, but actually it’s highly active in the fall, too. In fact, here at Westchester Health, we see a spike in poison ivy cases during this time of year (mid to late fall) because many families go apple picking, and poison ivy tends to hug the bases of apple trees. To know how to avoid poison ivy, and treat a reaction to it, refer to this timely blog by Mason Gomberg, MD, a pediatrician in our Westchester Health Pediatrics group.

Best 6 ways to avoid poison ivy

Mason Gomberg, MD

  1. Steer clear of areas where you know poison ivy grows.
    It typically grows as a vine or shrub, and it can be found throughout much of North America (except in the desert, Alaska and Hawaii). It grows in open fields, wooded areas, on the roadside and along riverbanks. It can also be found in urban areas, such as parks or backyards.
  2. Cover up.
    If you know you will be walking/hiking in areas where poison ivy is present, cover all exposed skin with closed shoes, socks, long pants, long sleeves and gloves.
  3. Wash your skin asap.
    Immediately wash skin that has come in contact with the plant. This may help remove some of the oil from your skin and lessen the severity of your reaction.
  4. Wash the clothes you were wearing, along with anything that may have touched the plant. Although the rash can’t spread, the oil that caused it can.
  5. Scrub under your fingernails.
    You can spread poison ivy to other parts of your body if the oil is on your fingers. Try not to scratch because this will only make things worse. While it may bring immediate comfort, scratching will only prolong symptoms. You may even develop an infection if you break the skin, causing itching to intensify.
  6. Wash gardening tools and other outdoor items with soap and water
    that may have come in contact with the plant. Unfortunately, oil from poison ivy can remain potent for as long as 5 years.
Poison ivy changes color with the seasons. Here’s how to know what to look for

Just when you think you know how to identify poison ivy, it changes color. Depending on the season, its leaves are:

  • Reddish in the spring
  • Green in the summer
  • Yellow, orange or red in the fall

The main thing to remember is the old saying: leaves of three, let it be. In addition, with some types of poison ivy, the leaves have notched edges. With others, the edges are smooth. It can grow as a bush or vine, can grow up trees, and sometimes has white berries. Plus, the leaves can have a shiny sheen to them or be dull. Nature doesn’t make it easy!

8 important facts about poison ivy
  1. Poison ivy isn’t really poisonous.
    The plant itself isn’t the problem, it’s the plant’s sticky, long-lasting oil called urushiol that causes an itchy, blistering rash after it touches your skin. Even slight contact, such as brushing up against the leaves, exposes your skin to the oil.
  2. A poison ivy rash is not contagious.
    Once you have washed the urushiol oil off your skin, the rash itself is not contagious. It may continue to spread due to varying amounts of exposure on different areas of the body, but touching the rash does not cause it to spread. The rash usually peaks within a week, can last as long as 3 weeks, and looks like patches or streaks of red, raised blisters.
  3. Urushiol adheres to your skin within minutes.
    If you know you’ve come into contact with poison ivy, wash the area with lukewarm water and soap. If there’s no water available, rubbing alcohol or alcohol wipes can remove it. Keep the area cool, dry and clean. Thoroughly wash your clothes and clean your boots or shoes, and also hose down any garden tools that might have touched the plant.
  4. Urushiol can cling to your dog or cat’s fur and rub off on you.
    If your pet has been in areas where poison ivy is growing and then rubs against your skin, you can definitely have a reaction. To avoid this, bathe your pet with soap and cool water wearing gloves, then locate the poison ivy plants he/she is coming in contact with and remove them.
  5. See your doctor if a rash develops close to your eyes or is widespread over your body.
    Once a rash appears, keep it clean, dry and cool. Calamine lotion, an antihistamine such as Benadryl, and/or hydrocortisone cream can help control itching. Cool compresses or baths with baking soda or oatmeal can also soothe the rash. Don’t scratch—it won’t spread the rash, but can cause scars or infection. There are also prescription medications you can take by mouth that will help with swelling and itching. If you experience a severe reaction in addition to a rash, such as nausea, fever, fainting, shortness of breath, extreme soreness at the rash site or swollen lymph nodes, call 911 or get to an emergency room immediately.
  6. Never burn poison ivy. 
    Particles of urushiol remain in the fire’s smoke and can severely aggravate your eyes, nose and respiratory tract, as well as your skin. Instead of burning poison ivy to get rid of it, completely cover yourself with clothing and dig out the plant, getting as much of the root as possible. Then put it in a plastic trash bag and throw it away. Weed whacking poison ivy plants is also not recommended because when the leaves and stems are cut, urushiol is released into the air as vapor and can easily come into contact with your eyes, lungs and skin. Alternatively, a plant killer may work on poison ivy but be sure to read the label carefully and use it at the right time of the year. Remember: Urushiol remains active, even on dead plants, so be careful when handling them.
  7. Subsequent exposures to poison ivy are usually worse each time. That’s why it’s really important to try to avoid coming into contact with it in the first place.
  8. When using OTC cortisone creams, apply 3 times a day for at least one week.
If your child is having a severe reaction to poison ivy, please come see us

If your child has developed a rash from poison ivy that is not going away or is getting worse, please make an appointment with Westchester Health to see one of our pediatricians as soon as possible. Together, we’ll determine the best course of treatment to control the reaction so your child can feel better soon and not develop scarring. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Ever Wondered What Determines The Color of Your Eyes?

Westchester Health Blog - Wed, 11/08/2017 - 10:23

Do you like the color of your eyes? Do you wish it was different? Do you wonder what color your children’s eyes will be? Here at Westchester Health, we get these kinds of questions all the time, especially from our younger patients, so we thought we’d create a blog explaining the fascinating subject of eye color.

What makes your eyes the color they are?

William B. Dieck, MD, FAAO

There are two main factors that determine your eye color:

1) the amount and pattern of dark brown pigment (called melanin) in the part of your eye called the iris, and

2) the way in which the iris scatters light that passes through the eye. The more important of the two factors is pigment, which is determined by your genes.

It’s all in the genes

Inside the nucleus of your body’s cells are 46 chromosomes, divided into 23 pairs. You inherited one chromosome from each parent to make each pair of your chromosomes.

Chromosomes are made up of strings of DNA called genes. These genes, which also come in pairs, determine the range of characteristics you inherited (hair color, eye color, height, body type, straight or crooked teeth, foot size, and much, much more). Researchers believe that as many as 16 different genes play a role in determining eye color. The two main genes believed to be responsible are OCA2 and HERC2, both of which are part of chromosome 15.

Furthermore, genes are made up of alleles that ultimately determine which particular characteristics you will develop. For most inherited traits, there are generally two alleles. If the two alleles are the same, they are homozygous. If they are different, they are heterozygous.

For each trait, the dominant allele is expressed, while the recessive allele is unexpressed. Recessive alleles are only expressed if there is no dominant allele present.

The alleles for eye color can be separated into blue, green and brown.
  • green alleles are dominant over blue alleles
  • brown alleles are dominant over both blue and green alleles
  • If you received a blue allele and a brown allele, your eye color would be brown because brown is the dominant allele.
  • If you have blue eyes, this means you received blue alleles from both parents.

Your genes also determine your eye color by dictating how much (and where) melanin is produced in your iris. The more melanin produced, the darker the eye color will be.

Why are babies’ eyes blue?

Since melanin production does not begin at birth, babies’ eyes appear blue. Their true eye color will be determined over time. It’s usually not until age three that a child’s permanent eye color becomes apparent.

Can your eye color change?

Have you ever noticed how some people’s eyes seem to change color depending on the lighting? That happens because the iris has two layers and sometimes there is pigment in both layers. In people with blue or green eyes, however, the front layer will have very little or no melanin. Depending on the amount and diffraction of light, their eyes may appear to change colors.

What about people with two different eye colors?

This results from a condition called heterochromia, which occurs due to differences in the early stages of their iris development.

Have questions about your eye color? Come see us.

If you’re concerned about the color of your eyes, or are wondering what eye color you might pass on to your children, please make an appointment to come in and see one of our eye specialists at Westchester Health. He/she will answer all your questions and if needed, perform a thorough eye exam to make sure your eyes are healthy. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Men, Don’t Delay! 10 Signs That You Should See A Urologist

Westchester Health Blog - Wed, 11/01/2017 - 10:06

If you have a possible urological issue, even if it seems like no big deal, it’s important to visit a urologist to get it checked out. If it’s minor, it can often be treated quickly and easily, and if it’s something more serious, the earlier it’s detected, the better your chances of a positive outcome and full recovery. At Westchester Health, we remind our male patients all the time, particularly as they get older, how crucial it is for them to pay attention to warning signs. To help men everywhere know what to look for, we put together this list of signs and symptoms to look out for.

10 signs that you need to see a urologist…soon

Jerry Weinberg, MD

As important as good nutrition and proper exercise, a urologist needs to be part of your overall health maintenance too. Even though urologic and sexual problems are uncomfortable to talk about, they’re a crucial part of your overall health and need to be monitored by a urologic specialist.

A urologist can correctly identify and diagnose a problem, determine the level of severity and offer the best treatment options for you. Remember: The sooner you catch a potential health issue, the better the chances of treating and reversing it before it develops into something major.

If you notice any of the following 10 signs, we urge you to visit a urologist.

1. Erectile Dysfunction: Erectile Dysfunction, or ED, is the inability to achieve or maintain an erection. As well as affecting sexual performance, it can also reveal potentially serious conditions such as vascular disease, hypertension or renal failure. It may be uncomfortable to talk to a doctor about ED but remember, if you have underlying conditions, it’s really important to treat them as early as possible.

2. Blood in your urine: If you see this, you should see a urologist immediately because it could be an early sign of bladder or kidney cancer. Even if you only experience blood in your urine from time to time, it means that you have a condition that needs immediate attention.

3. Testicular pain, lump or masses: If you have pain in your testicles that is persistent and does not go away within two weeks, it’s time to see a urologist because it could signal testicular cancer. Fortunately, when caught early, cancer in the testes is one of the most curable cancers.

4. Abnormal prostate exam: Men over the age of 40 are advised to get a yearly exam by the same doctor, if possible. This way, any changes can be monitored more closely and early detection of prostate cancer is more likely. If any firmness, small nodules or irregularities are detected, you should then be referred to a urologist to diagnose your condition and discuss treatments, if necessary. Remember: If caught early, prostate cancer has a high cure rate.

5. Difficulty urinating: While not life-threatening, difficulty with urination can be annoying and uncomfortable. A common symptom of getting older, this is typically caused by an enlarged prostate. To help with urination, medications can relieve the symptoms and even shrink the prostate.

6. Painful urination: Infections can occur along any part of the urinary tract, most often caused by bacteria. A urologist can determine the cause of the infection and recommend targeted treatment.

7. Frequent urination or the urge to urinate often: It’s time to see a urologist if incontinence (leaking urine) starts suddenly and/or is interfering with your lifestyle. Male urinary incontinence is fairly common and can usually be managed and treated successfully.

8. An elevated or change in Prostate Specific Antigen (PSA) level: The PSA test is one of the ways doctors can detect early prostate cancer. Typically, a very low level of PSA is present in men’s bloodstream. When there is a change or a higher level of in the blood, a urologist needs to determine the cause.

9. Kidney abnormality: If your doctor detects anything unusual on an abdominal X-ray, you should be referred to a urologist.

10. Male infertility: Though rare, male infertility (including decreased sexual desire) can be a sign of testicular cancer and you should be seen by a urologist right away.

Concerned that you may have a urologic issue? Come see us.

If you’re experiencing any of the signs and symptoms discussed above, or have questions about your sexual or urologic health, please make an appointment with Westchester Health to see one of our urology specialists. After examining you, conducting a thorough health history and answering all your questions, he/she will determine if you need treatment, medication or any further tests. Always, our #1 goal is to do whatever we can to help you be as healthy as possible. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

How To Reduce Your Child’s Risk Of Heart Disease

Westchester Health Blog - Wed, 10/25/2017 - 11:06

Although most parents would not want to admit it, the beginnings of heart disease can be seen in kids as young as 10 years old. The important fact here is that if the beginnings of this serious disease are left untreated, children can develop heart disease later in life, which can prove to be fatal. But there is good news, which you can learn about in a recent blog by Mason Gomberg, MD, a pediatrician in our Westchester Health Pediatrics group.

Heart disease risk factors

Mason Gomberg, MD

Heart disease is the #1 killer of men and women in the U.S. and often stems from unhealthy childhood habits. The chief risk factors of heart disease are:

  • Smoking
  • High blood pressure
  • Diabetes
  • High blood level of cholesterol
  • Physical inactivity
  • Obesity
  • Family history of early-onset heart disease
The most important way your child can avoid heart disease is by a healthy diet

Unfortunately, American children and adolescents, on average, eat more saturated fat and have higher blood cholesterol levels than young people their age in most other developed countries. Not surprisingly, the rate of heart disease tends to keep pace with cholesterol levels. One study from autopsies showed early signs of hardening of the arteries (atherosclerosis) in 7% of children between ages 10 and 15 years. The rate was twice as high between ages 15 and 20.

Heredity is clearly an important risk factor for conditions such as heart disease, cancer and diabetes. However, researchers are finding more and more that there is a direct link between diet and the development of diseases. According to the American Heart Association, a heart-healthy diet from an early age lowers cholesterol, and if followed through adolescence and beyond, should reduce the risk of coronary artery disease in adulthood.

Do you have a family history of heart disease?

When you first took your child to a pediatrician, you may have been asked if there was a history of heart or vascular disease in your family. This is important information for both you and your child’s doctor to know. Has either set of grandparents, maternal or paternal, ever had a heart attack, stroke or any other type of heart disease? If the answer is yes, be sure to bring it to your pediatrician’s attention.

Get your cholesterol tested

At your child’s next checkup, your pediatrician may recommend a cholesterol and triglyceride screening blood test. For adopted children, even for those adopted in open proceedings, complete biological family medical histories are often not available. To help prevent heart disease linked to high blood cholesterol levels, we at Westchester Health strongly recommend that adopted children are screened periodically for blood lipid (fat) levels throughout their childhood.

3 important ways you can help reduce your child’s risk of heart disease
  1. Nutrition

Starting even at birth, good nutrition can decrease the risk of heart disease. What can you do? Encourage your child to eat vegetables and fruits every day. Reduce soda, sugary beverages and empty-calorie foods such as potato chips, candy bars and cookies. Saturated fats should be definitely avoided. A saturated fat is generally solid at room temperature and includes fatty meats, cream, butter, cheese, palm and coconut oils. Discuss portion control with your child, but before that, learn how much or how little constitutes a healthy portion.

  1. Physical Activity

Physical activity in childhood sets the tone for good exercise habits in adulthood. Children under 17 should exercise at least 60 minutes a day. You can help motivate your child to exercise by doing the activity with them, such as biking, hiking, swimming, soccer, basketball, rollerblading or running. Even jumping rope for 20 minutes is an excellent exercise!

  1. Smoking/Tobacco

One of the most important things you can do to help prevent heart disease in your child is to maintain a smoke-free environment in your home and your car so that your child is not exposed to the harmful effects of secondhand smoke. Because children’s lungs are still developing, they are especially vulnerable to the effects of breathing in secondhand smoke. At Westchester Health Pediatrics, we also strongly advise you to discourage your child from smoking or other forms of tobacco use.

A nutritious diet and active family routine can help all of us lead healthier lives

Adhere to these guidelines to reduce your entire family’s risk of heart disease:

  • Eat a healthy breakfast every day
  • Eat low-fat dairy products such as low fat cheese, yogurt skim milk
  • Regularly eat meals together as a family
  • Limit fast food, takeout food and eating out at restaurants (typically high in sodium)
  • Avoid fried foods and highly-processed fatty foods
  • Prepare foods at home as a family
  • Eat a diet rich in calcium
  • Eat a high fiber diet
  • Try to eat 5 servings of fruits and vegetables every day
Want to know more about preventing heart disease in your child? Come see us, we’re here to help.

If you’d like an evaluation of your child’s current heart disease risk, as well as advice for improving your child’s diet and exercise level, please make an appointment with Westchester Health. One of our pediatricians will examine your child, discuss the findings with both of you, and offer guidance on things that can be done to reduce the risk. Our #1 goal is for your child to be as healthy and happy as possible. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Achoo! How To Survive Fall Allergy Season

Westchester Health Blog - Wed, 10/18/2017 - 11:24

For many people with allergies, spring is the worst season of the year. But here at Westchester Health, we’ve observed that for a large number of our patients, fall is right behind it in severity. People with nasal and eye allergies, as well as asthma, often suffer throughout the fall, from late August thru November.

2 ways fall allergies differ from spring allergies 1. Ragweed pollen

James Pollowitz, MD, FAAAAI, FACAAI

Ragweed is the best known fall allergen, pollinating between August 15th and the first frost (usually late September‒early October), usually hitting its peak around Labor Day. Ragweed pollen is very small and light and amazingly, can travel up to 200 miles.

Symptoms of ragweed allergy include:

  • nasal congestion
  • sneezing
  • watery, runny nose
  • eye itching, tearing and redness
  • itchy throat
  • post nasal drainage

Asthmatic patients who are allergic to ragweed often experience an increase of symptoms (coughing, wheezing, shortness of breath, chest tightness). In addition to ragweed, other weed pollens can cause allergies too, including lambs quarters, pigweed and cocklebur.

2. Molds

Molds are another very common fall allergen. The mold season is somewhat later than weeds, usually October and November. Molds grow on dead vegetation (especially fall leaves) and its spores (the mold equivalent of pollen) are then carried by the wind, causing the same type of allergy symptoms as pollens. Molds grow well in low light and in areas of high moisture, both of which often occur in the fall.

Being indoors more in the fall also triggers allergies and asthma

In the fall, most of us spend more time indoors (home, school, office) and are thus more exposed to indoor allergens such as pets (especially dogs and cats), mold and dust mites. Allergic reactions usually increase during this season and trigger asthma attacks and sinus and ear infections. Cold air, cigarette smoke and climatic changes are other important triggers. Typical asthma symptoms include cough, chest tightness, wheezing and shortness of breath.

Best ways to treat fall allergies

Treatment of fall allergies (or any allergies) involves taking three important actions:

1) Avoid or eliminate triggers

To reduce the irritants that are triggering allergic reactions:

  • use allergen encasings on all pillows and mattresses
  • remove and control mold in your home by frequently cleaning and repairing any water leaks or dampness
  • remove pets or restrict them to certain areas in the house
2) OTC medications

Many medications used to treat allergies are now available without a prescription. These include long acting, less sedating antihistamine OTC medications such as Claritin, Zyrtec Allegra (also available as generic brands) and most recently Xyzal. There are now several OTC nasal steroids: including: Nasacort AQ, Flonase, Flonase Sensimist and Rhinocort. They have also become available without a prescription over the past few years. These medications are more effective than antihistamines, especially for relief of nasal congestion.

3) Rescue medications

Rescue medications such as albuterol are important in managing acute symptoms but should not be used regularly. Using them more than twice a week indicates that you need asthma controller medication such as inhaled steroids (Flovent, Asmanex or Qvar) or a non-steroid such as Singulair (montelukast).

More severe asthma is often treated with combined steroid/long-acting bronchodilator inhaled medications such as Advair, Symbicort, Dulera or Breo Ellipta. Persistent asthma requires a treatment action plan and ongoing follow-up, similar to other chronic diseases such as diabetes, hypertension or arthritis.

4) Immunotherapy (allergy shots)

Allergy shots (immunotherapy) are a very beneficial therapy and have been used for more than 100 years for millions of patients. People with pollen, cat and dust mite allergies can experience as much as 90% improvement compared to medical therapy alone. A usual course of therapy is 3-5 years of treatment. When the shots are stopped, most patients do not relapse for at least 5-10 years.

5) Immunotherapy (tablets)

A new type of allergy immunotherapy involves tablets placed in the mouth under the tongue, where they dissolve. Currently, there are now four available products: Grastek and Oralair to treat grass pollen allergies, and Ragwitek for ragweed allergy. A product to treat dust mite allergies (Odactra) was recently approved for treatment of patients age 18 to 65. This product will be on the market soon (by early 2018).

Even with allergies, you can still enjoy the fall

If you dread the fall because of allergies, you’re not alone. But neither should you suffer unnecessarily. The correct diagnosis and treatment for your allergies can actually help you enjoy this beautiful time of the year.

Suffering from fall allergies? Come see us.

If you’re experiencing any of the allergic reactions discussed above, or want to know how to better manage your allergies, please make an appointment with Westchester Health to see one of our allergy/immunology specialists. Along with you, he/she will determine the best course of treatment and/or medication, and order any necessary tests so that hopefully, you’ll soon be able to enjoy the fall season, every year. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Parents: It’s Not Tainted Candy You Need to Fear On Halloween, It’s Car Injuries

Westchester Health Blog - Wed, 10/11/2017 - 20:17

With Halloween just around the corner, now is the time that parents and children need to be reminded about how to stay safe while trick-or-treating. Many parents worry about tampered candy and strangers approaching their children, but we at Westchester Health want everyone to know that the real danger is injury from car accidents. For your child’s safety, read this timely and very important blog from Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group.

Halloween is the #1 day for child-pedestrian car accidents and fatalities

Lauren Adler, MD, FAAP

Car accidents constitute the majority of Halloween fatalities. Kids between 12-18 years old account for 1/3rd of all fatalities, followed by 5-8 year olds, who account for 23%.

BE AWARE: The peak time period for car accidents on Halloween is 6:00-7:00pm.

Thrown objects and propellants (i.e., shaving cream, paints, silly string, eggs) can also cause serious injury, especially if they collide with your child’s eyes and/or head.

How to prevent your child from being injured by a car on Halloween
  1. Parents should make sure that costumes and masks do not obscure their child’s vision or ability to walk.
  2. Children, if walking without their parents or other adult, should carry glow sticks or flashlights, or have reflective tape on their costumes.
  3. Children should not use cell phones or other electronic devices while trick-or-treating because they not only distraction them while they’re walking but they can prevent them from noticing or hearing an approaching car.
  4. Children should trick or treat in communities that they’re familiar with, especially those with sidewalks and well-lit areas.
  5. Adults should supervise their children’s trick-or-treating if they are under the age of 12.
  6. If you’re following your children’s trick-or-treating in your car, drive slower and with caution, keeping on the lookout for children who may not see you.
The fear of tampered candy is a common (but overblown) concern

Even though the public seems to think that tainted candy can be found in every trick-or-treat bag, in reality, the incidence is extremely low. However, you should check that the treats your child brings home are sealed in the original packing and have not been opened.

TIP: Children should avoid large amounts of candies that contain sorbitol (sugar substitute) to avoid abdominal pain and diarrhea.

Remember your child’s teeth

At Westchester Health, we recommend that parents set a limit on the amount of Halloween candy their children eat after the event. Parceling out small portions each day often works well, with a time limit for getting rid of what hasn’t been eaten (say, a month after Halloween). You should also make sure your children brush their teeth each time after eating their candy.

Especially on Halloween, an ounce of prevention is worth a pound of cure

By following our tips on this Halloween, hopefully accidents can be prevented and you and your child will have a happy, exciting time. If you have further concerns about Halloween safety or worry that your child has eaten something tainted after the fact, please make an appointment at Westchester Health to see one of our pediatricians. We’ll examine your child, answer your questions and do whatever we can to put your mind at ease. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Tips On How To Talk To Your Children About Recent Tragedies

Westchester Health Blog - Fri, 10/06/2017 - 21:28

There has been a lot of disturbing news information and images recently, concerning a number of tragedies. Whether it is a natural disaster or terrorist/deranged citizen attack, we at Westchester Health want parents to know that we think it’s very important to discuss these difficult issues with their children, when appropriate. They should, of course, consider the child’s age and developmental stage in deciding what information to share or watch on TV or the computer. Very good guidance about how to do this is offered in a recent blog by Mason Gomberg, MD, a pediatrician in our Westchester Health Pediatrics group.

It is important to be honest with your child when discussing a disturbing recent event

Mason Gomberg. MD

A good place to start is by asking your child what they have heard or know about the event. Focus on the basics. Ask what they understand about the event and correct any misinformation they might have. Also, address any underlying fears they may have. Answer questions truthfully and at a level they can understand without going into great detail or speculation. Parents should convey that it is ok to be bothered by this event and that they are here to support their child and make him/her as safe as possible.

If your younger child gets scared by news coverage of an upsetting event, try to shield them from graphic details

Parents need to reassure a younger child that they are safe. They may also need help separating fantasy from reality. Young children might become “clingy” or regress in behavior. This may include bedwetting, sucking one’s thumb and/or using baby talk. It is important at such a time to support your child and give extra hugs and kisses.

For older children who have access to more information, discuss the news together

Adolescents and teenagers will have more questions and want more in-depth information and suggestions about preventing future tragedies. They may want to help in the recovery efforts. Together, your family can organize donations to victims or charity organizations.

Above all, reassure your children that they are safe

Our suggestions for helping children get through difficult times:

  • Review your family’s plans for an emergency
  • Maintain your usual routines
  • Try to keep on a regular time schedule for meals, homework and school/sports/outside activities
  • Spend extra family time together
  • Foster a sense of security and encourage your child to express his/her feelings
  • Stay as calm as possible
  • If you see signs that your child is not coping well, call your pediatrician. These include: sleep disturbances, behavioral regression, physical complaints (fatigue, headaches, abdominal pains), sadness and anxiety.
If you need help with these difficult topics, all of us at Westchester Health are here for you

If you’re concerned about your child’s ability to cope with recent tragic events, or want guidance regarding how to talk to your child about difficult issues, please make an appointment with Westchester Health to talk with one of our pediatricians. We understand that times like these can be very difficult for children of all ages, and we want you to know that whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Signs That Indicate That Your Child Might Have A Vision Problem

Westchester Health Blog - Wed, 10/04/2017 - 11:55

Have you noticed that your child sits too close to the TV or computer screen? Holds a book too close when reading? Closes one eye when trying to see something? Does he/she have trouble seeing things up close, or far away? These are signs that your child might have a vision problem. To learn more, here is an excellent blog by Lauren Adler, MD, FAAP, a pediatrician in our Westchester Health Pediatrics group.

Signs to look for to determine if your child has a vision problem: Babies up to 1 year of age

Lauren Adler, MD, FAAP

  • Before 4 months, most babies’ eyes occasionally look misaligned (strabismus). However, after 4 months of age, inward crossing or outward drifting that occurs all the time is usually abnormal. If one of these is present, let your child’s doctor know.
  • Babies older than 3 months should be able to follow or track an object with their eyes, such as a toy or ball, as it moves across their field of vision. If your baby can’t make steady eye contact by this time or seems unable to see the object, let your pediatrician know.
Preschool age

If your child’s eyes become misaligned, contact your pediatrician right away. Other vision problems, such as a lazy eye (amblyopia), may have no warning signs, and your child may not let on that he/she is having trouble seeing things. That’s why at Westchester Health Pediatrics, we tell our parents that it’s important to have your child’s vision checked before he/she starts school, because there are special tests that can be performed even before your child can read.

All children

If you notice any of the following signs or symptoms, contact your pediatrician:

  1. Eyes that are misaligned (are crossed, turn out or don’t focus together)
  2. White or grayish-white color in the pupil
  3. Eyes that flutter quickly from side to side or up and down
  4. Eye pain, itchiness or discomfort reported by your child
  5. Redness in either eye that doesn’t go away in a few days
  6. Pus or crust in either eye
  7. Eyes that are always watery
  8. Drooping eyelids
  9. Frequent eye rubbing
  10. Over-sensitive to light
  11. Squinting to read
  12. Sitting too close to the TV or computer, or holding a book too close in order to see the print
  13. Frequent complaints of headaches
  14. Lower-than-expected grades in school
  15. Using a finger to guide eyes when reading
  16. Closing one eye to read
When to get your child’s eyes checked by an eye professional

Vision screening is a very important way to identify vision problems in your child. During a typical eye exam, a vision specialist checks to see if the eyes are working properly and looks for signs of eye disease. Children with a family history of vision problems are more likely to have them also.

The American Academy of Ophthalmology and the American Academy of Pediatrics recommend that children have their eyes checked by a pediatrician at the following ages:

  • All babies should have their eyes checked for infections, defects, cataracts or glaucoma before leaving the hospital. This is especially true for premature babies, babies who were given oxygen for an extended period, and babies with multiple medical problems.
  • By 6 months of age. As part of each well-baby visit, eye health, vision development and alignment of the eyes should be checked by your child’s pediatrician.
  • 1 to 2 years. Special screening techniques allow your child’s pediatrician to start detecting potential eye problems.
  • 3 to 4 years. Your child’s eyes and vision should be checked for any abnormalities that may cause problems with later development.
  • 5 years and older. Your child’s vision in each eye should be checked separately every year. If a problem is found during an exam, your child’s pediatrician may refer him/her to a pediatric ophthalmologist, an eye doctor specially trained and experienced in the diagnosis and care of children’s eye problems.
Concerned that your child might have a vision problem? Come see us, we can help.

If you’re noticing signs that might indicate that your child may have a vision problem, please make an appointment with Westchester Health. One of our pediatricians will examine your child’s eyes and vision, make a diagnosis and if warranted, refer you to an eye specialist (ophthalmologist) so that hopefully your child will be seeing clearly soon. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog
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