Does A Large Waist Mean You Have A Metabolic Disorder?

Westchester Health Blog - Wed, 05/23/2018 - 10:38

Here at Westchester Health, we often get questions from our patients wanting to know the difference between metabolic syndrome, metabolic disorder and metabolic diseases. Since there seems to be some confusion, we thought we’d offer this blog as a way to clarify these conditions that, if left untreated, pose serious risks to your health, particularly diabetes and cardiovascular disease.

Some metabolic definitions Metabolism

This is the process your body uses to get energy from the food you eat (nutrition), which is made up of proteins, carbohydrates and fats. Chemicals in your digestive system then break down foods into sugars and acids, which are your body’s fuel.

Metabolic syndrome or metabolic disorder

Mindy Sotsky, MD, FACE

This is a group of conditions—increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels—that occur together, increasing your risk of heart disease, stroke and diabetes. A metabolic disorder occurs when the metabolism process fails and causes the body to have either too much or too little of the essential factors needed to perform its functions and stay healthy. For example, the brain needs calcium, potassium and sodium to generate electrical impulses, and lipids (fats and oils) to maintain a healthy nervous system.

Other names for metabolic syndrome:
  • Dysmetabolic syndrome
  • Hypertriglyceridemic waist
  • Insulin resistance syndrome
  • Obesity syndrome
  • Syndrome X
Metabolic syndrome is becoming more common due to rising obesity rates in adults

Metabolic syndrome is closely linked to obesity and a lack of physical activity. In fact, it may overtake smoking as the leading risk factor for heart disease. In addition, your risk for heart disease, diabetes and stroke increases with the number of metabolic risk factors you have.

Metabolic risk factors to be aware of

Most metabolic syndrome risk factors have no signs or symptoms, although a large waistline is a visible sign. The 5 conditions below are metabolic risk factors — you can have any one of them by itself, but they tend to occur together. NOTE: You must have at least 3 metabolic risk factors to be diagnosed with metabolic syndrome.

  1. A large waistline. This also is called abdominal obesity or “having an apple shape.” Excess fat in the stomach area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips.
  2. A high triglyceride level (or you’re on medicine to treat high triglycerides, a type of fat in the blood).
  3. A low HDL cholesterol level (or you’re on medicine to treat low HDL cholesterol). HDL sometimes is called “good” cholesterol because it helps remove cholesterol from your arteries. A low HDL cholesterol level raises your risk for heart disease.
  4. High blood pressure (or you’re on medicine to treat high blood pressure). Blood pressure is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and cause plaque buildup, which can lead to a heart attack or stroke. Symptoms can include dull headaches, dizzy spells or nosebleeds.
  5. High fasting blood sugar (or you’re on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes. Symptoms of high blood sugar include increased thirst, increased urination especially at night, fatigue and blurred vision.
  6. Insulin resistance, a condition in which the body cannot use its insulin properly (a hormone that helps move blood sugar into cells where it is used for energy). Insulin resistance can lead to high blood sugar levels and is closely linked to obesity.
  7. Diabetes. You’re more likely to have metabolic syndrome if you had diabetes during pregnancy (gestational diabetes) or if you have a family history of type 2 diabetes.
  8. Genetics. Ethnicity and family history
  9. Older age. Your risk of metabolic syndrome increases with age.
  10. Race. In the U.S., Mexican-Americans appear to be at the greatest risk of developing metabolic syndrome.
  11. Other diseases. Your risk of metabolic syndrome is higher if you have ever had cardiovascular disease, nonalcoholic fatty liver disease or polycystic ovary syndrome.
You can prevent or delay metabolic syndrome with lifestyle changes

What we tell our patients at Westchester Health is that the best way to prevent metabolic syndrome is to adopt heart-healthy lifestyle changes. These include:

  • Heart-healthy eating
  • Achieving and maintaining a healthy weight
  • Managing stress
  • Physical activity
  • Quitting smoking
  • Routine doctor visits to keep track of your cholesterol, blood pressure and blood sugar
  • A blood test called a lipoprotein panel, which reveals your levels of total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides
  • Regularly taking any medicines your doctor recommends
Concerned that you may have a metabolic disorder? Come see us.

If you think you may have a metabolic disorder, or are experiencing some of the symptoms mentioned above, please make an appointment with Westchester Health to see one of Internal Medicine specialists. He/she will perform a thorough examination, determine which conditions you may have, and together with you, choose the best course of treatment to improve your health and prevent future disease. Whenever, wherever you need us, we’re here for you.

By Mindy Sotsky, MD, FACE, an endocrinologist with Westchester Health, member of Northwell Health Physician Partners

Categories: Blog

What Is Dry Eye Disease And What To Do If I Have It

Westchester Health Blog - Wed, 05/16/2018 - 10:57

Here in my ophthalmology practice at Westchester Health, I often have patients come to me complaining about dry eyes, a common and often chronic problem, particularly in older adults. Dry eye disease (also called keratoconjunctivitis sicca) is a condition in which a person doesn’t have enough natural tears to lubricate and nourish the eye. 

Tears are necessary for maintaining the health of the front surface of the eye and providing clear vision.

William B. Dieck, MD, FAAO

Every time you blink, tears spread across the surface of your eye, known as the cornea. Tears provide lubrication, reduce the risk of eye infection, wash away foreign matter in the eye, and keep the surface of the eyes smooth and clear. Excess tears in the eyes flow into small drainage ducts in the inner corners of the eyelids, which drain into the back of the nose. It’s when this tear production and drainage is not in balance that dry eyes can occur. If dry eyes are not treated and the condition becomes advanced, this can damage the front surface of the eye and impair vision.

People with dry eyes may experience:
  • irritated, gritty, scratchy or burning eyes
  • a feeling that something is in their eyes
  • excess watering
  • blurred vision
 What causes dry eyes?

People with dry eyes either do not produce enough tears or their tears are of poor quality. Tears are produced by several glands in and around the eyelids. Typically, tear production tends to diminish with age, as a result of various medical conditions or as a side effect of certain medicines.

Environmental conditions, such as wind and dry climates, can also decrease tear volume due to increased tear evaporation. When the normal amount of tear production decreases or tears evaporate too quickly from the eyes, symptoms of dry eye can develop.

Tears are made up of three layers: oil, water and mucus. Each component protects and nourishes the front surface of the eye. A smooth oil layer helps prevent evaporation of the water layer, while the mucin layer spreads the tears evenly over the surface of the eye. Subsequently, if the tears evaporate too quickly or do not spread evenly over the cornea due to deficiencies with any of the three tear layers, dry eye symptoms can develop.

Dry eyes can develop for many reasons, including:
  • Dry eyes are a part of the natural aging process. The majority of people over age 65 experience some symptoms of dry eyes.
  • Women are more likely to develop dry eyes due to hormonal changes caused by pregnancy, the use of oral contraceptives and menopause.
  • Certain medicines, including antihistamines, decongestants, blood pressure medications and antidepressants can reduce tear production.
  • Medical conditions. People with rheumatoid arthritis, diabetes and thyroid problems are more likely to have symptoms of dry eyes. Also, problems with inflammation of the eyelids (blepharitis), inflammation of the surfaces of the eye or the inward or outward turning of eyelids can cause dry eyes to develop.
  • Environmental conditions. Exposure to smoke, wind and dry climates can increase tear evaporation, resulting in dry eye symptoms. Failure to blink regularly, such as when staring at a computer screen for long periods of time, can also contribute to drying of the eyes.
  • Other factors. Long-term use of contact lenses can be a factor in the development of dry eyes. Refractive eye surgeries, such as LASIK, can decrease tear production and contribute to dry eyes.
How are dry eyes diagnosed?

Dry eyes can be diagnosed through a comprehensive eye examination by a qualified ophthalmologist. Tests, with emphasis on the evaluation of the quantity and quality of tears produced by the eyes, may include:

  • An evaluation of your health history to determine your symptoms and to identify any general health problems, medications or environmental factors that may be contributing to your dry eye problem.
  • External examination of the eye, including lid structure and blink dynamics.
  • Evaluation of the eyelids and cornea using bright light and magnification.
  • Measuring the quantity and quality of tears for any abnormalities. Special dyes may be put in the eyes to better observe tear flow and to highlight any changes to the outer surface of the eye caused by insufficient tears.
What’s the treatment for dry eyes?

Dry eyes can be a chronic condition, but there are several treatments that can keep your eyes healthy and comfortable and prevent your vision from being affected.

  1. Adding tears. Mild cases of dry eyes can often be managed using over-the-counter artificial tear solutions to supplement natural tear production. Preservative-free options are recommended because they contain fewer additives which can further irritate the eyes.
  2. Conserving tears. Keeping natural tears in the eyes longer can reduce the symptoms of dry eyes. This can be done by blocking the tear ducts through which the tears normally drain, with tiny silicone or gel-like plugs. Alternatively, a surgical procedure can permanently close the tear ducts. In either case, the goal is to keep the available tears in the eye longer.
  3. Increasing tear production. Prescription-strength eye drops can increase tear production, as well as omega-3 fatty acid nutritional supplements.
  4. Treating the contributing eyelid or ocular surface inflammation. Prescription eye drops or ointments, warm compresses, lid massage or eyelid cleaners all can help decrease inflammation around the surface of the eyes.
5 things you can do at home to help dry eyes
  1. Blink regularly when reading or staring at a computer screen for long periods of time.
  2. Increase the humidity in the air at work and at home.
  3. Wear sunglasses outdoors, with wraparound frames if possible, especially when it’s very dry and/or windy.
  4. Nutritional supplements containing essential fatty acids may help decrease your dry eye symptoms.
  5. Avoid becoming dehydrated by drinking plenty of water (8-10 glasses) a day.
Do you think you have dry eyes? Come see us.

If your eyes are bothering you and you think you may have dry eye disease, please make an appointment to come in and see one of our Westchester Health ophthalmologists. He/she will examine you, perform any needed tests, answer all your questions, and together with you, determine the best course of action to help relieve your dry eyes so you can feel better and be more comfortable, as soon as possible. Whenever, wherever you need us, we’re here for you.

By William B. Dieck, MD, FAAO, Vice President, Westchester Health, member of Northwell Health Physician Partners; Director, Ophthalmology Division 

Categories: Blog

On National Bike to School Day, Watch This Important Video On Bike Safety

Westchester Health Blog - Wed, 05/09/2018 - 11:08
Today is National Bike to School Day and May is Bike Safety Month

To emphasize bike and helmet safety, here’s an excellent video from Cohen Children’s Medical Center Trauma Team on how to properly put a bike helmet on your child AND yourself. (Click here to view the video)


Now that Westchester Health is part of Northwell Health and its physician organization, Northwell Health Physician Partners, we’re also affiliated with Cohen Children’s Medical Center. We’re pleased that we have a lot of things in common, such as a commitment to child safety, especially biking and bike helmets.

So stay safe and enjoy many wonderful bike rides with your child. It’s great exercise and a fun way to spend time together!

Categories: Blog

How To Know If Your Child Has Celiac Disease

Westchester Health Blog - Wed, 05/09/2018 - 10:45

Does your child have frequent headaches, skin rashes, stomach aches, is not gaining weight and/or is frequently tired? He or she may have celiac disease, an immune disorder caused by an intolerance to gluten. To find answers, read this informative blog by Mason Gomberg, MD, a pediatrician in our Westchester Health Pediatrics group.

What foods to eliminate or avoid to help your child’s condition improve

Mason Gomberg, MD

If your child is diagnosed with celiac disease, your pediatrician will advise you regarding which foods he/she can eat and which to avoid. Because these dietary changes can also affect the rest of your family and your daily routine, we suggest that you meet with a nutritionist for further guidance.

In general, your child should stay away from foods that contain the following gluten-related ingredients. NOTE: Because there is currently no law requiring food manufacturers to list gluten on food labels, avoiding gluten can be really hard to do in some cases.

  • wheat, barley rye, and related grains should be eliminated
  • bouillon and broths
  • breading (such as the coating on breaded chicken cutlets, etc.)
  • brown rice syrup (often made from barley)
  • cake flour (made from wheat)
  • caramel color (occasionally made from barley)
  • communion wafers
  • couscous
  • creamed or breaded vegetables
  • dextrin (a rare ingredient that may be made from wheat—maltodextrin is OK)
  • dry roasted nuts (processing agents may contain wheat flour or flavorings)
  • fried chicken
  • french fries (if coated in flour)
  • gravies and sauces (including some tomato and meat sauces)
  • imitation bacon, crab or other seafood
  • luncheon and processed meats
  • malt or malt flavoring (usually made from barley)
  • marinades
  • matzo
  • modified food starch (most food manufacturers now list the source of this ingredient, e.g., modified cornstarch, which is OK, or modified wheat starch, which is not)
  • nondairy creamer
  • pasta
  • salad dressings
  • seasonings (pure spices are OK but check seasoning mixes for gluten-containing additives)
  • some herbal teas and flavored coffees
  • soup mixes and canned soups
  • soy sauce and soy sauce solids (they may be fermented with wheat; don’t use them unless you verify with a dietitian that they’re OK)
  • spreads, soft cheeses, and dips
  • stuffings
  • thickeners
  • udon noodles
  • wheat-free products (many wheat-free cookies and breads instead contain barley or rye flour which contains gluten and other gluten-containing ingredients)
  • yogurts with wheat starch
  • certain 0ver-the-counter medications
  • vitamin, nutritional and herbal supplements
  • toothpaste
  • Play-Doh
  • lipstick products
3 important things to remember
  1. To avoid gluten—and prevent triggering your child’s celiac symptoms—it’s important to carefully read the labels of all foods before you buy them or let your child consume them. Help your child learn to do this, too. When in doubt, the safest thing to do is to assume the product contains gluten and avoid it.
  2. In the U.S., all foods must be clearly labeled if they contain any of the top 8 food allergens, including wheat. However, wheat-free doesn’t mean gluten-free. Some wheat-free products may still have gluten-containing grains like barley and rye in them. Lawmakers are working to make labels easier to understand by requiring companies to identify these “hidden ingredients.”
  3. It’s generally safe for kids with celiac disease to eat oats that come from an uncontaminated source—oats that have been processed in a mill that doesn’t process grains that contain gluten with the same equipment. The label on the package should clearly state if this is the case.
What causes celiac disease?
  • We don’t know for sure what triggers the immune system to react to gluten and then develop into celiac disease. In some people, the disease has been linked to other health conditions, including Turner syndrome, autoimmune thyroid disorder, Addison’s disease, rheumatoid arthritis, microscopic colitis, Down syndrome, diabetes, Williams syndrome, thyroid disorders and selective immunoglobulin IgA deficiency. In addition, a rash called dermatitis herpetiformis is associated with intestinal gluten.
  • Unfortunately, there is no cure (other than avoiding gluten), although researchers are working on developing enzyme pills to help with the digestion of the toxic part of gluten that causes intestinal damage.
  • Celiac disease tends to run in families, so if there is a family history of celiac disease, children may have a higher risk of developing it. If one child is diagnosed with celiac disease, his or her siblings, parents and grandparents should be tested too, as they may have the disease but no symptoms.
  • Celiac disease that goes undiagnosed or untreated can lead to weight loss, loss of calcium and bone density, reproductive issues, lactose intolerance, dental enamel disease, seizures and increased risk for small bowel cancer and lymphoma.
 Celiac disease can lead to a wide variety of symptoms in different people
  • In infants, this might mean that they aren’t gaining weight and height as expected (“failure to thrive”), often accompanied by diarrhea and/or stomach pain.
  • Older kids can have diarrhea, abdominal pain, bloating, weight loss, fatigue, acne or skin rashes (especially around the elbows, buttocks, and knees). Over time, kids with celiac disease might develop anemia and mouth sores, and become withdrawn or irritable. On the other hand, some people with celiac disease have no symptoms at all.
  • It’s also important to know that the symptoms of celiac disease can happen at any time in your child’s development. Some kids have symptoms the first time they are exposed to gluten, while others develop symptoms after safely eating gluten for years.

Fortunately, celiac disease symptoms improve quickly when gluten is eliminated from the diet (often in a few weeks to months).

Learn more about celiac disease

There are several websites and support groups which are available to help you navigate through the lifestyle changes required for children with celiac disease. Here are some suggestions:

If you think your child may have celiac disease, please come see us

If your child is showing signs of celiac disease, please make an appointment with Westchester Health to come in and see one of our pediatricians. We will meet with you and your child, review the symptoms, possibly order some tests, and together with you, decide on the best course of action which may include avoidance of gluten. Whatever the diagnosis, our #1 goal is for your child to get answers and feel better as soon as possible. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Internet Safety: Best Ways To Protect Your Child Online

Westchester Health Blog - Wed, 05/02/2018 - 05:05

These days, more than ever before, parents need to be aware of what their kids see and hear on the internet, who they meet there, and what they share about themselves online. As with any safety issue that concerns the health and safety of your children, we at Westchester Health urge you to 1) share your concerns about the internet with your kids, 2) take advantage of available resources to protect them, and 3) keep a close eye on their activities. To learn more, read this excellent blog by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group.

Is your child is being targeted by an online predator? Here are warning signs to watch for:
  1. spending long hours online, especially at night
  2. phone calls from people you don’t know
  3. unsolicited gifts arriving in the mail
  4. your child suddenly turns off the computer when you walk in the room

    Lauren Adler, MD, FAAP

  5. withdrawal from family life
  6. reluctance to discuss online activities

If you observe any of these warning signs, contact your local law enforcement agency or the FBI, especially if your child has received pornography through the internet or has been the target of an online sex offender.

Get involved in your kids’ online activities

All of us at Westchester Health strongly encourage you to take an active role in protecting your children from internet predators and sexually explicit materials online. Here is what we advise:

  1. Become computer literate and learn how to block objectionable material.
  2. Keep your children’s computers in a common area, not in individual bedrooms, where you can watch and monitor their use.
  3. Monitor whenever your kids are on smartphones or tablets.
  4. Share an email or social media account with your child so you can monitor messages.
  5. Bookmark kids’ favorite sites for easy access.
  6. Spend time online together so you can teach and model appropriate online behavior.
  7. Forbid your child from entering private forums. Block them with safety features provided by your internet service provider or with special filtering software. Be aware that posting messages to forums publicly reveals a user’s email address.
  8. Monitor your credit card and phone bills for unfamiliar account charges.
  9. Find out if any online protection is offered by your child’s school, after-school center, friends’ homes, or anywhere that kids could use a computer without your supervision.
  10. Take your child seriously if he or she reports an uncomfortable online exchange.
  11. Call the National Center for Missing and Exploited Children at (800) 843-5678 if you’re aware of the transmission, use, or viewing of child pornography online. Contact your local law enforcement agency or the FBI if your child has received child pornography via the Internet.
  1. Ask your internet service provider how to disable “cookies” that track specific information about the user, such as name, email address and shopping preferences. Cookies can be disabled.
Set up guidelines for your kids to use while they’re online
  1. Never post or trade personal photographs.
  2. Never reveal personal information, such as address, phone number, or school name or location. Use only a screen name.
  3. Never agree to meet anyone from a chat room or social media site in person.
  4. Never respond to a threatening email, message, post or text.
  5. Always tell a parent about any communication or conversation that was scary.
  6. If your child has a new “friend,” insist on being “introduced” online to that friend.
Chat rooms: potentially dangerous

Forums, or chat rooms, are virtual online rooms where chat sessions take place. They’re organized around a shared interest, sport or hobby (ex: a favorite TV show). Because members can communicate with each other alone or in a group, these “rooms” can be popular online destinations, especially for kids and teens.

However, these sites can be very dangerous. Some kids have met “friends” in chat rooms who were interested in exploiting them. Predators and pedophiles (adults who are sexually interested in children) are known to frequent chat rooms. These predators sometimes prod their online “acquaintances” to exchange personal information, such as addresses and phone numbers, thus putting the kids they are chatting with—and their families—at risk.

BE AWARE that pedophiles often pose as teenagers in chat rooms. Because many kids have been told by parents not to give out their phone number, pedophiles sometimes ask kids to call them. If your child does this, caller ID will give this potentially dangerous person your child’s phone number.

Know the internet safety laws

In 1998, a federal law, the Children’s Online Privacy Protection Act (COPPA), was created to help protect kids younger than 13 when engaged in online activities. It’s designed to keep anyone from getting a child’s personal information without a parent knowing about it and agreeing to it first. COPPA requires websites to explain their privacy policies on the site and get parental consent before collecting or using a child’s personal information, such as a name, address, phone number or Social Security number. The law also prohibits a site from requiring a child to provide more personal information than necessary to play a game or participate in a contest.

Even with this law, your children’s best online protection is you. By talking to them about potential online dangers and monitoring their computer use, you can help them use the internet safely.

Many online tools enable you to control your kids’ access to adult material and help protect them from internet predators

Several internet service providers (ISPs) provide parent-control options to block certain material from coming into a computer. You can also get software that helps block access to certain sites based on a “bad site” list which your ISP creates and restricts personal information from being sent online. Other programs can monitor and track online activity.

If you think your child has been approached by an online predator, or if you ‘re concerned about any aspect of his/her internet use, please contact us

If you have concerns about any facets of your child’s internet safety, please make an appointment at Westchester Health to come in and talk with us. We have years of experience in this area and have helped hundreds, possibly thousands, of our parents learn how to cope with this very large, very common and very worrisome issue so that their children can remain safe in the internet age. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Why You Really Need Folic Acid When You’re Pregnant

Westchester Health Blog - Wed, 04/25/2018 - 11:17

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

Best Ways To Treat Your Child’s Headaches

Westchester Health Blog - Wed, 04/18/2018 - 11:24

At Westchester Health, the most common causes of headaches that we see in children are viral illnesses, stress, fatigue and migraines. Rarely do headaches signal a more serious illness but if your child’s headache is accompanied by a high fever, rash or vomiting, see your pediatrician right away. Still have questions about what to do? Read this excellent blog by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group.

Typical causes of headaches

Lauren Adler, MD, FAAP

Commonly, a tension headache (usually in response to stress, in children and adults) escalates over the course of the day, producing pressure on both sides of the scalp and down the neck as scalp muscles tighten around the skull. Headaches are also associated with many illnesses, including viruses, strep throat, allergies, sinus infections and urinary tract infections. Other common causes of headaches include:

  • Extreme hunger or thirst
  • Not getting enough sleep
  • Specific foods and drinks, such as chocolate, hard and aged cheeses, pizza, yogurt, nuts, lima beans, processed meats, some fruits and fruit juices
  • Food additives (monosodium glutamate, nitrates, nitrites)
  • Certain nonprescription dietary supplements and/or prescription drugs (birth-control pills, tetracycline, excessive doses of vitamin A)
  • Caffeine (sodas, coffee, chocolate)
  • Alcohol, cocaine and other illicit substances
  • Eye strain, including sun glare
  • Fatigue
  • Tooth infections or abscesses
  • Hormonal changes during the menstrual cycle
  • Changes in the weather
  • Emotional stress, depression, anxiety, intense anger, extreme excitement
  • Noisy, hot, stuffy environments
  • Flickering or glaring lights
  • Strong smells
  • Clenching or grinding teeth
  • Physical exertion
  • Head injury
Most common headache symptoms Tension headaches
  • Constant, dull ache on both sides of the forehead
  • Tightness in the head, radiating down the neck
Migraine headaches
  • Throbbing, incapacitating pain on one side of the head
  • Mental dullness
  • Moodiness
  • Fatigue
  • Fluid retention
  • Sensitivity to light
  • Diarrhea
  • Nausea and vomiting
What you can do to treat your child’s headaches

Headaches respond best to treatment when they’re still in their early stages.

  1. Simple, at-home remedies
  • If your child has a tension headache, encourage him/her to lie down with the head elevated slightly.
  • A hot bath or shower can help, as well as a warm or cold compress on the forehead and/or neck.
  • For migraine sufferers, you want to minimize sensory stimulation. Turn off the lights in the room, close the curtains, try to maintain quiet. A cold compress helps but do not apply heat—that will only make the pain worse.
  1. Drug therapy

Tension headaches and migraines frequently respond well to over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).

If these don’t bring relief or if the symptoms recur, the next step might be a prescription for one of the “triptans” (sumatriptan, zolmitriptan, naratriptan rizatriptan) which block the action of the neurotransmitter serotonin. And because triptans are nonsedating, children usually can return to school or other activities more quickly without having to sleep off the headache or migraine.

  1. Keep a “headache diary”

This may help you and your child pinpoint the cause of the headaches. Keep a record of the following information:

  • when the headache occurred
  • how long it lasted
  • what your child was doing when the headache started
  • foods eaten that day
  • amount of sleep the night before
  • what seems to make the headaches better or worse
  1. Relaxation exercises

Yoga, Pilates, stretching and breathing exercise can help your child handle stress more effectively and hopefully prevent or at least decrease tension-related headaches. Biofeedback, a mind-body technique, has also proved useful in reducing both the frequency and the duration of headaches, especially migraine. Psychotherapy, too, may help in treating migraines.

  1. Preventative medicines for migraines

Teenagers plagued by 3 or more migraines a month may be candidates for antidepressants such as amitriptyline, beta-blockers, calcium-channel blockers or anti-seizure medications.

What your child can do to prevent headaches

These tips may help your child keep headaches from starting:

  • Get the proper amount of sleep
  • Eat regular meals, or if not possible, eat frequent healthy snacks
  • Exercise regularly
  • Be aware of any pattern to their headaches that might help them identify headache triggers
Concerned about your child’s headaches? Come see us, we can help.

If your child is experiencing frequent headaches or migraines, please make an appointment with Westchester Health. One of our pediatricians will listen to the symptoms, examine your child to try to figure out the cause of the headaches, and possibly prescribe medication, all with the goal of helping your child feel better soon and avoid more headaches in the future. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

6 Best Exercises During Pregnancy

Westchester Health Blog - Wed, 04/11/2018 - 10:50

If you’re pregnant, you’ve probably been told by your OB/GYN that exercising during your pregnancy is a great idea, even highly recommended, for a number of reasons. At Westchester Health, we agree. Regular exercise during all three trimesters can improve health, reduce the risk of excess weight gain and back pain, and make delivery easier. It also can give your newborn a healthier start in life.

But before you dive into an exercise program, either light, moderate or vigorous, it’s very important to discuss your plans with your healthcare provider to make sure you do the right kind of exercise at the right stage of your pregnancy.

The many benefits of exercising during pregnancy

Lisa Roth-Brown, MD, FACOG

For your baby:

Research shows that when pregnant women exercise, the baby’s heart rate is lower. Newborns whose moms exercised may also have a healthier birth weight, a lower fat mass, improved stress tolerance and advanced neurobehavioral maturation.

For you, exercising while pregnant can:
  • increase heart rate
  • improve heart health and stamina
  • improve circulation
  • decrease fatigue
  • decrease constipation
  • keep your body flexible and strong
  • boost mood and energy levels
  • maintain healthy weight gain
  • improve muscle strength
  • prepare your muscles for labor and birth
  • shorten the labor process
  • increase the chances of a natural birth
  • decrease the need for pain relief
  • speed up recovery after delivery
  • reduce the risk of gestational diabetes and hypertension
  • decrease the likelihood of preterm labor and birth
What to keep in mind
  • If you were exercising regularly before getting pregnant, and are healthy during your pregnancy, you should be able to continue exercising as before, with slight changes depending on your trimester.
  • Women who have not been exercising before pregnancy should choose a low-intensity program and gradually move to a higher activity level.
  • Exercise is recommended for 20-30 minutes each day, several days a week. Most exercises are safe to perform during pregnancy if done with caution.
How to exercise safely

Regular physical activity can boost maternal and fetal health and can make pregnancy, labor and post-delivery recovery easier. However, it is important to stay safe during exercise.

Here are some tips for staying safe while you exercise.

  • Begin by warming up for 5 minutes and stretching for 5 minutes
  • Finish with 5-10 minutes of gradually slower exercise that ends with gentle stretching
  • Wear loose-fitting, comfortable clothes and a good support bra
  • To help prevent injury, wear supportive shoes designed specifically for the exercise you’re doing
  • Exercise on a flat, level surface to avoid injury
  • Eat small, frequent meals throughout the day
  • Don’t exercise for at least 1 hour after eating
  • Drink plenty of water before, during and after exercise to keep hydrated
  • Stand or sit up slowly and gradually to prevent dizziness
  • The body needs more oxygen and energy during pregnancy
  • The hormone relaxin, produced during pregnancy, causes the ligaments that support the joints to stretch, increasing the risk of injury
  • Your changing weight will alter your center of gravity, putting extra strain on the joints and muscles in the lower back and pelvis, increasing the chance of losing your balance
What to avoid when exercising:
  • Avoid overheating
  • Avoid exercising in high humidity
  • Avoid heavy weightlifting and activities that require straining
  • Avoid exposure to extremes in air pressure, such as high altitude exercise or scuba diving
  • Avoid activities that increase the risk of abdominal trauma
  • Never exercise to the point of exhaustion
  • If you cannot talk while exercising, slow down the activity
Who should not exercise

Exercise is rarely harmful during pregnancy but anyone with a medical condition, such as asthma, heart disease, hypertension, diabetes or a pregnancy-related condition should speak to their healthcare provider first.

You may be told not to exercise if you have:
  • vaginal bleeding or spotting
  • low placenta or low-lying or placenta previa
  • a history or possibility of miscarriage or preterm delivery
  • weak cervix
Stop exercising if you:
  • feel very fatigued
  • develop persistent pain
  • experience vaginal bleeding
  • have regular contractions more than 30 minutes after exercise, as this may be a sign of pre-term labor
6 best exercise to keep you fit and healthy

These 6 exercises carry little risk of injury, benefit your entire body, can be done until delivery and can help prepare you for labor.

  1. Brisk walking

If your pre-pregnancy exercise level was low, a quick stroll around the neighborhood is a good way to start. This will give you a cardiovascular workout without too much impact on your knees and ankles. It can be done for free, almost anywhere, and at any time during your pregnancy.

Safety tips: As your pregnancy progresses, your center of gravity changes, possibly causing you to lose your sense of balance and coordination. Therefore, choose smooth surfaces, avoid potholes, rocks, and other obstacles, and wear supportive footwear.

  1. Swimming

Swimming, walking in water and aqua aerobics all give you a good range of motion without putting pressure on your joints. Plus, the buoyancy provided by the water may give you some relief from the extra weight.

Safety tips: Choose a swimming stroke that feels comfortable and that does not strain or hurt your neck, shoulders or back muscles (for example, breaststroke). A kickboard is a great way to help strengthen the leg and buttock muscles.

Additional tips:

  • To prevent slipping, use the pool railing for balance when entering the water
  • Avoid diving or jumping—this could impact the abdomen
  • To minimize the risk of overheating, avoid warm pools, steam rooms, hot tubs and saunas
  1. Stationary cycling

Cycling on a stationary bike, aka spinning, is usually safe even for first-time exercisers. It’s particularly beneficial because it helps raise your heart rate without putting too much stress on your joints, helps support your body weight, and because it is stationary, the risk of falling is low

  1. Yoga

A lot of our pregnant patients at Westchester Health love prenatal yoga classes because they keep their joints limber and help maintain their flexibility. In addition, yoga strengthens muscles, stimulates blood circulation and enhances relaxation, all of which may contribute to healthy blood pressure during pregnancy. The techniques you learn in yoga classes might also help you stay calm and in control during labor.

Safety tips: As your pregnancy progresses, skip positions that could cause you to overbalance. From the second semester on, avoid poses that involve lying on the abdomen or flat on the back (can cause the weight of the fetus and the uterus to put pressure on major veins and arteries and decrease blood flow to your heart). Don’t overstretch—this could lead to injury.

  1. Low-impact aerobics

Aerobic exercise strengthens the heart and lungs and helps maintain muscle tone. By low-impact aerobics, we mean that you should not be doing jumping, high kicks, leaps or fast running. Also, in low-impact exercise, one foot should stay on the ground at all times.

Benefits of low-impact aerobics:

  • limits stress on the joints
  • helps maintain balance
  • reduces the risk of weakening the pelvic floor muscles (a weak pelvic floor increases the chances of urine leakage)

Some aerobics classes are designed especially for pregnant women and can be a good way to meet other pregnant women, as well as exercising with an instructor who is trained to meet your specific needs. If you already attend a regular aerobics class, be sure to let the instructor know that you are pregnant so he/she can modify the exercises and advise you on which movements would be right for you.

  1. Preparing for labor: squatting and pelvic tilts

The American Pregnancy Association recommends the following exercises specifically for pregnancy, as they prepare the body for labor and delivery.

Squatting: During labor, squatting helps open up the pelvis

  1. Stand with your feet flat on the floor, shoulder-width apart, back straight
  2. Lower yourself slowly, keeping your feet flat and your knees no further forward than your feet
  3. Hold for 10-30 seconds, then slowly push up.

Pelvic tilts: These strengthen the abdominal muscles and help reduce back pain

  1. Go down on your hands and knees
  2. Tilt your hips forward and pull your abdomen in, arching your back
  3. Hold for a few seconds
  4. Release, let the back drop
  5. Repeat this up to 10 times
When to stop exercising

Stop exercising and consult your healthcare provider if you:

  • experience pain, including abdominal, chest or pelvic pain
  • have muscle cramps
  • feel faint, dizzy or nauseous
  • feel cold or clammy
  • notice vaginal bleeding
  • have a sudden gush of fluid from the vagina or a trickle of fluid that leaks steadily, possibly indicating a rupture of the amniotic membrane
  • have an irregular or rapid heartbeat
  • notice sudden swelling in the ankles, hands, face or all of three
  • experience increased shortness of breath
  • have persistent contractions that continue after rest
  • have difficulty walking
Have questions about exercising during pregnancy? Come see us.

If you’d like more information about how much exercise you should be doing during your pregnancy, and which ones to do and not do, please make an appointment with Westchester Health to see one of our OB/GYNs. After examining you and determining your fitness level, he/she will advise you on the best exercise plan for you and your growing baby so that both of you can be as healthy as possible. Whenever, wherever you need us, we’re here for you.

By Lisa Roth-Brown, MD, FACOG, an OB/GYN with Westchester Health, member of Northwell Health Physician Partners

Categories: Blog

5 Best Ways to Alleviate the Pain of Plantar Fasciitis

Westchester Health Blog - Wed, 04/04/2018 - 11:42

Have you ever gotten out of bed in the morning, taken three steps across the floor and suddenly felt like someone had smashed your heel with a hammer while you were sleeping? You might have plantar fasciitis, something that, as a podiatrist, I see a lot of in my Westchester Health practice.

What causes plantar fasciitis

John Viscovich, DPM, MBA, FACFAS

Plantar fasciitis is caused by inflammation of the thick tissue, or fascia, that run along the bottom of your foot connecting your heel bone to your toes. It tends to affect long distance runners with tight hamstrings, calves and Achilles tendons; people with low arches; people who are on their feet all day; athletes who participate in strenuous high impact sports; and people who are overweight. It can also be caused by a muscular imbalance in the hips or pelvis which places more stress on one leg than the other.

5 things you can do to relieve the pain of plantar fasciitis

Here are some easy, do-it-yourself home treatments that can relieve the pain and inflammation of plantar fasciitis and hopefully even cure it.

  1. Stretch the fascia

Stretching your lower legs, feet and ankles several times a day can help minimize the pain. Before your feet hit the ground in the morning, actively flex your ankles a couple of times to stretch the calf muscles, and extend your toes. Pull your toes up with your hand until you feel a stretch along the ball of your foot and hold this position for 30 seconds. (You may feel the stretch anywhere from the ball of your foot to your heel.) Throughout the day, continue stretching and strengthening your calf muscles and other leg muscles throughout the day.

  1. Roll a frozen water bottle under the arch

Applying ice helps control inflammation. Freeze a water bottle and roll it under your foot for 10 minutes at the end of each day, paying particular attention to your arch.

  1. Wear a night splint

To prevent the soft tissue in your foot from tightening during the night, a night splint is very effective. Looking somewhat like a shoe boot but not as solid, a night splint keeps the angle of your foot and lower leg at 85-90 degrees, the optimal level of stretch for relieving plantar fasciitis. Wearing a splint to bed might be awkward but if you wear it faithfully for a period of time, your foot will soon feel a lot better and your plantar fasciitis may go away altogether.

  1. Tennis ball massage

Tight shoulders can cause plantar fasciitis if your arm swing throws off your proper hip alignment and the way your feet strike the ground. Rolling a tennis ball under and around these muscles can help keep them loose. Place the ball on the floor and gently roll it under your foot for a few minutes to loosen up your plantar fascia. Then lying on the ball, move it up your legs, back and shoulders, all the way up to your neck. Put enough pressure on the ball to get a deep massage. You may feel some soreness but discontinue if you feel overwhelming pain.

  1. Support your arch

Once the bottoms of your feet have become sore and painful from plantar fasciitis, you need to offer them protection and relief. The best shoes for this are hiking boots. The stiff sole protects the foot while it heals, the rocker-bottom shape of the boot sole relieves stress on the foot, and the leather uppers give the entire ankle and foot more stability. If you’re not the hiking boot type, get an insole (from a podiatrist, not over-the-counter) with an arch bump to push on the plantar and keep it from flexing. Wear this support in all of your shoes, if possible.

Freedom from pain

By following these home remedy treatments, your first few steps in the morning should become less painful. After a few weeks of icing, massaging, stretching and resting, your plantar fasciitis will hopefully be cured. Let me know how these worked for you and I hope these tips lead to pain-free walking and running.

If you’re experiencing plantar fasciitis pain

If you think (or know) that you have plantar fasciitis, 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 to alleviate and hopefully, eliminate your pain.

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

Categories: Blog

Can I Get Pregnant While Breastfeeding?

Westchester Health Blog - Wed, 03/28/2018 - 11:05

Getting pregnant again may be the last thing you want to do after having a baby and caring for a demanding newborn. But once sexual activity has resumed, we at Westchester Health advise couples that they should think about their birth control options if they want to prevent another pregnancy from occurring right away.

Yes, you can get pregnant even when you’re breastfeeding

Dennis McGroary, MD, FACOG

Since many couples don’t wait 6 weeks to start having sex again, it’s important to understand that women are still able to become pregnant even when breastfeeding. And, contrary to popular belief, it is perfectly safe to take birth control pills while breastfeeding.

Why people think breastfeeding prevents pregnancy

During pregnancy, a woman’s menstrual period stops. For many women, it also stops while they are breastfeeding. This has led people to believe that you can’t get pregnant while breastfeeding because you’re not having a period. However, this is not universally true for all women and should not be relied upon as a reliable method of contraception.

When breastfeeding can act as birth control: the LAM method

One form of natural contraception brought about by breastfeeding is the lactational amenorrhea method, or LAM. (Amenorrhea refers to the absence of menstruation.) This method is grounded in the scientific belief that exclusive breastfeeding suppresses a woman’s fertility, thereby preventing pregnancy.

LAM can be a very effective family planning method as long as certain conditions are met:

  • the woman’s period has not returned since she gave birth
  • the baby is exclusively breastfeeding on demand and is not eating any other foods or liquids
  • the baby is less than 6 months old

If the mother and baby meet all of these conditions, the chance of pregnancy is very low (less than 2%, according to World Alliance for Breastfeeding).

However, once you stop exclusively breastfeeding and your baby starts taking supplemental foods, such as formula or baby cereal, your body will begin preparing for another pregnancy and ovulation will begin.

Two types of birth control: hormonal and non-hormonal

Regardless of what method of contraception you choose, it’s important for you to discuss your options with your doctor and your partner, if appropriate.

Non-hormonal birth control

If you don’t want to get pregnant right away after having a baby but do not want to take hormones for birth control, here are several options to consider. These range from readily available and relatively inexpensive choices, such as condoms, to devices requiring a prescription or even surgery. Some of these options include:

  1. Barrier contraception. Physical barriers to conception, such as condoms, diaphragms or the cervical cap, are effective methods of contraception. They do not contain any hormones so they do not affect a woman’s milk supply, her ability to breastfeed or her own health.
  2. Copper intrauterine device (IUD). There are two different types of IUDs: copper and hormonal. Copper IUDs are a highly effective form of birth control that do not have any effect on the milk supply. The IUD is a small coil that, in this case, is wrapped in a small amount of copper and prevents implantation, sperm movement and fertilization. A doctor needs to insert an IUD, which is effective in preventing pregnancy for up to 10 years. If a woman decides that she wants to get pregnant again, the IUD can be easily removed.
  3. Sterilization (getting your tubes tied). This method is a permanent form of birth control and involves cutting the fallopian tubes, which connect the ovaries to the uterus. Tying up or blocking the tubes then completely prevents sperm cells from meeting with an egg. Many women choose to have this procedure done during a planned cesarean delivery, and it will not have any effect on a woman’s milk supply.
Hormonal birth control

According to the InfantRisk Center, most forms of hormonal contraceptives are safe and will not affect a nursing infant. However, the bigger concern is the effect that these forms of contraception will have on a woman’s milk supply.

Hormonal birth control usually contains forms of the hormones estrogen and progesterone. While some women may tolerate hormonal contraceptives without an issue, sometimes the estrogen in these products can cause a woman’s milk supply to dry up completely. This is a bigger risk in women who are nursing an older baby, or those who are already dealing with low milk supply issues.

As a result, most doctors will recommend using a progesterone-only option:

  1. Progestin-only pills (POPs). POPs are similar to the traditional birth control pill but they only contain progesterone. Unlike the standard “pill,” these types of pills do not contain any sugar or placebo pills, so each one is active. This option is less likely to adversely affect a woman’s milk supply.
  2. Depo-Provera. Depo-Provera is a progesterone-only injection that will prevent pregnancy for up to 3 months. Some women can be sensitive to progesterone, however, and there is no way to reverse the medication once injected. As a result, a woman’s doctor may suggest that she take POPs for a month or two to see how the progesterone affects her and her milk supply before committing to a longer-acting dose.
  3. IUDs. In addition to the copper IUD, some IUDs are coated in progesterone. This type of IUD works in the same way as POPs and the Depo-Provera injection. In some women, however, the hormonal IUD has been found to decrease the milk supply. Hormonal IUDs are effective for 3-5 years depending on the brand, and can be easily removed if a woman changes her mind about pregnancy.
Birth control and STDs

At Westchester Health, we stress to all of our female patients of childbearing age that hormonal forms of birth control do not protect against the transmission of sexually transmitted diseases (STDs). If you do not know the sexual health status of your sexual partner, or if you have multiple sexual partners, you should always use a condom during intercourse to protect yourself against STD transmission.

Want to know more about birth control methods? Come see us.

If you’d like more information about your options when it comes to birth control methods, whether or not you’ve just had a baby, please make an appointment with Westchester Health to see one of our OB/GYNs. He/she will answer all of your questions, give you plenty of practical information, and advise you on the pros and cons of each contraception option so you can make an informed decision about your reproductive health. Whenever, wherever you need us, we’re here for you.

By Dennis McGroary, MD, FACOG, Department of OB/GYN, Westchester Health, member of Northwell Health Physician Partners

Categories: Blog

8 Best Ways To Prevent Foot Problems Caused By Diabetes

Westchester Health Blog - Wed, 03/21/2018 - 10:22

As a podiatrist with Westchester Health, I see a lot of foot problems caused by diabetes, because these tend to be among the most common complications associated with diabetes. Some of my patients take good care of their feet, but sadly, some do not. If not managed properly, diabetes can cause irreversible damage to the feet and in the worst cases, amputation. As I tell all my diabetic patients, 95% of their diabetes care depends on them.

Two types of foot problems caused by diabetes

John Viscovich, DPM, MBA, FACFAS

Good, regular foot care is always very important but for people with diabetes, it is even more crucial in order to keep your feet healthy. Diabetics face two main dangers in relation to their feet:

1. Diabetes can cause neurological damage by destroying the nerves that give sensitivity to the feet (diabetic neuropathy). This can impact the ability to feel pain, resulting in foot injuries from cuts, blisters and inflammation because the person cannot feel them.

2. Diabetes can also cause vascular damage, impacting blood vessels that nourish the tissues of the feet (diabetic vasculopathy). When there is decreased blood flow and/or lack of oxygen, the nutrient supply is reduced, leading to slow healing of wounds or other injuries. This increases the risk of infection and foot ulcers. In severe cases, untreated foot ulcers may require amputation.

The combination of these two types of damage can threaten your fingers and toes.

8 ways to prevent complications in diabetic feet

Remember, 95% of diabetes care depends on you. If you have diabetes, it’s absolutely critical that you take good care of your feet and avoid complications. Following these 8 guidelines will help you maintain healthy feet, ankles and toes and hopefully prevent serious complications.

  1. Be under the constant medical supervision of a physician, preferably a specialist (podiatrist). Monitor your blood sugar levels, take your medications, practice good foot care and do not skip medical checkups.
  2. Check your feet every day. Use a mirror for the areas you can’t see or ask someone to help you. Look for cuts, swelling, redness or any change in nails and skin.
  3. Keep your feet clean and dry. Wash your feet every day with cold or lukewarm water. NEVER use hot water. To check the temperature, touch the water with your hands or elbows or use a thermometer. Be sure to dry your feet well, especially between your toes.
  4. Use an easily absorbed moisturizer. Be sure to put it between your toes as well as the top of your feet and heels. This reduces dryness that can lead to injury caused by rubbing from socks or shoes.
  5. Increase your blood circulation. Spend 5-10 minutes every day doing simple exercises. For example: Sit down and put your feet up, moving your fingers up and down your legs. Avoid sitting with your legs crossed for long periods of time. Do not wear tight socks.
  6. Wear clean socks every day. It’s critically important to wear the right type of socks. Choose ones that are comfortable with padding and without seams or elastic bands. Acrylic and acrylic-blend socks will minimize the impact pressure on your feet.
  7. Be very careful when cutting your toenails. Ask your physician or podiatrist which tools you should use to properly trim your nails and manage calluses on the bottom of your feet. Better yet, get him/her to trim them for you. If there is any change in the color or appearance of your nails, you should alert your doctor immediately.
  8. Wear comfortable shoes that do not cause friction. Avoid high heels because they tend to generate pressure on the toes and heels. Do not walk barefoot, not even at home.
If you have diabetes, you should check your feet twice a day

Regularly performing foot checks is an essential part of your diabetes management. Foot checks should also be carried out by your healthcare professional at your office visits and annual checkups. Also, if you have neuropathy, you may not be able to feel the pain of wounds (large or small) in your feet—another important reason you need to do daily foot checks.

If you have a diabetic foot problem of any kind, come 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

How To Recognize And Treat Cystic Fibrosis In Your Child

Westchester Health Blog - Wed, 03/14/2018 - 09:23

At Westchester Health, we often get questions from our parents who have noticed their child having trouble breathing, and they want to know if their he/she might have asthma or some other lung disease. After performing many in-depth tests, we sometimes find that the child has cystic fibrosis. Because many people are unfamiliar with this condition, we offer this informative blog by Glenn Kaplan, MD, a pediatrician with our Westchester Health Pediatrics group, so that parents can be better informed if their child has this condition and needs to begin treatment.

Cystic fibrosis (CF): a life-threatening genetic disease

Glenn E. Kaplan, MD, FAAP

Cystic fibrosis (CF) is a genetic disease that causes the body’s mucus, sweat and digestive juices to be unusually thick and sticky. These secretions can clog organs and airways, leading to dangerous infections. According to the Cystic Fibrosis Foundation Patient Registry, more than 30,000 people are living with cystic fibrosis in the U.S. and more than 75% of those are diagnosed by age 2.

Of all ethnic groups, Caucasians have the highest inherited risk for CF, and Asian Americans have the lowest. Although the chances of inherited risk may vary, CF exists in every geographic area of the world among every ethnic population.

Typically, people with CF do not live into their 40s. Currently, the average life expectancy is 37.4 years but this figure includes all patients followed by the CF Foundation, many of whom were born in the 1970s and 1980s. Children born today can expect to live longer as treatment continues to develop and improve.

Symptoms of cystic fibrosis

The diagnosis of CF is being made earlier and earlier, usually in infancy. (Approximately 15% of those with CF are diagnosed later in life). Symptoms involve the lungs and digestive organs, and they vary in severity, including:

  1. Meconium ileus. Some children with CF begin having symptoms at birth, and are born with a condition called meconium ileus. Although all newborns have meconium (the thick, dark, putty-like substance that usually passes from the rectum in the first few days of life), the meconium of a baby with CF can be too thick and sticky to pass and can completely block the intestines.
  2. Failure to gain weight. Babies born with CF typically fail to thrive, in spite of a normal diet and a good appetite. This is because mucus blocks the passageways of the pancreas and prevents pancreatic digestive juices from entering the intestines. Without these juices, the intestines cannot absorb fats and proteins completely, meaning that nutrients pass out of the body unused rather than helping the body grow. Poor fat absorption makes the stools oily and bulky and increases the child’s risk for deficiencies of the fat-soluble vitamins A, D, E, and K. Unabsorbed fats may also cause excessive intestinal gas, an abnormally swollen belly and abdominal pain.
  3. Salty skin. Because CF also affects epithelial cells in the skin’s sweat glands, children with CF may have a salty “frosting” on their skin or taste salty when their parents kiss them. They also may lose abnormally large amounts of body salt when they sweat on hot days.
  4. Breathing and sinus problems. Because CF produces thick mucus within the respiratory tract, children with CF may suffer from nasal congestion, sinus problems, wheezing and asthma-like symptoms. As CF symptoms progress, children can develop a chronic cough that produces globs of thick, heavy, discolored mucus. They also may suffer from repeated lung infections.
  5. Problems breathing. As chronic infections reduce lung function in a child with CF, the ability to breathe often decreases. He/she may begin to feel short of breath, even when resting. Despite aggressive medical therapy, lung disease develops in nearly all patients with CF and is a common cause of disability and shortened lifespan.
How to know if your child has CF
  1. Genetic testing. By performing genetic tests during pregnancy, parents can now learn whether their unborn child may have CF. In 2001, less than 10% were diagnosed by newborn screening.  In 2014, over 60% were diagnosed by newborn screening. Yet even when genetic tests confirm CF, we are still unable to predict beforehand whether a child’s CF symptoms will be severe or mild. Genetic testing also can be performed on a child after birth, as well as parents, siblings and other relatives who are considering having a family.
  2. Sweat test. After a baby is born, the standard diagnostic test for CF is called the sweat test: an accurate, safe and painless way to diagnose CF. In this test, a small electric current is used to carry the chemical pilocarpineinto the skin of the forearm which stimulates sweat glands in the area to produce sweat. Over a period of 30-60 minutes, sweat is collected on filter paper or gauze and tested for chloride. A child must have a sweat chloride result of greater than 60 on two separate sweat tests to warrant the diagnosis of CF.
  3. Once diagnosed, several other tests are used to monitor a child’s CF:
  • chest X-rays
  • blood tests to evaluate nutritional status
  • bacterial studies that confirm the growth of Pseudomonas aeruginosa, Staphylococcus aureus or Haemophilous influenzabacteria in the lungs (common in CF)
  • pulmonary function tests to measure the effects of CF on breathing
Caring for a child with CF

When a child is first diagnosed with CF, he/she may need to spend some time in a hospital, depending on the severity of their condition. If indeed they are admitted, they will undergo a variety of diagnostic tests, especially baseline measurements of their breathing (lung function) and a nutritional assessment.

Before leaving the hospital, the child’s doctors will make sure that their lungs are clear and that they’ve started a diet specifically containing digestive enzymes and vitamins that will help them gain weight. Once home, they will probably see their pediatrician for follow-up visits every 1-3 months.

The daily care program for CF varies from child to child, but usually includes pulmonary therapy (treatments to maintain lung function) and nutritional therapy (a high-calorie, high-fat diet with vitamin supplements). Kids with CF also can take oral doses of pancreatic enzymes to help them digest food better. They may occasionally need oral or inhaled antibiotics to treat lung infections and mucolytic medication (a mucus-thinning drug) to keep mucus fluid and flowing. We have seen improved outcomes occur because of communication between pediatricians and specialists, especially pulmonologists, by treating aggressively with appropriate antibiotherapy when complications occur.

Gene therapy. A new treatment for CF, which is still being researched, is an inhaled spray containing normal copies of the CF gene. These normal genes deliver the correct copy of the CF gene into the lungs of CF patients. Since 1993, more than 100 CF patients have been treated with CF gene therapy, and test trials are underway in at least nine different U.S. medical centers and others around the world. Another new therapy, called protein repair therapy, aims to repair the defective CFTR protein. Numerous medicines, including a spice called curcumin, are also being tested.

Resources, help and support

Caring for a child with CF can be tough at times, but parents need not feel alone. Most communities have a local support group linked to the Cystic Fibrosis Foundation. You can find a local chapter here. Here are some additional resources:

Does your child have cystic fibrosis? Do you need support and guidance? Come see us, we’re here to help.

If you have a child with cystic fibrosis, or are concerned that he/she may be developing this condition, please make an appointment with Westchester Health. One of our pediatricians will examine your child, make an evaluation, and offer treatment, guidance and referrals. Our #1 goal is for your child to be as healthy and happy as possible, no matter the diagnosis. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Painful Footwear: The Worst Shoes for Your Feet

Westchester Health Blog - Wed, 03/07/2018 - 10:01

I realize that people love flashy, high-fashion shoes but as a podiatrist with Westchester Health, I see firsthand the damage they can cause to feet and ankles. As well as exacerbating toe deformities, calluses, corns, bone spurs and other problems, wearing the wrong or too-high shoes puts tendons, joints and entire muscle groups at risk of serious injury.

The main cause of far-reaching joint and tissue damage are high heels. They drastically alter the wearer’s posture, displace the foot and ankle bones, strain the knee joints and tighten the surrounding tendons. This can lead to osteoarthritis, a painful and sometimes debilitating joint condition.

To promote healthy feet and ankles, I offer the following guide to problem shoes to avoid, as well as ways to minimize your risk of injury.

8 painful foot problems caused by shoes

John Viscovich, DPM, MBA, FACFAS

  1. Bone bump (from high heels)

The rigid backs and straps of high heels can irritate the heel, causing a boney enlargement know as Haglund’s deformity or “pump bump.” This can lead to blisters, swelling, bursitis, even pain in the Achilles tendon. Ice, orthotics and heel pads may provide pain relief but the best solution is a change of shoe.

  1. Unnatural foot position (from high heels)

As well as causing the “pump bump,” sky-high heels force the feet into an unnatural position that puts undue stress on the ball of the foot. In this joint, the long metatarsal bones join the small pea-shaped sesamoid bones as well as the toe bones (phalanges). Too much pressure can inflame these bones and/or the nerves that surround them. Chronic stress to the foot bones can even lead to hairline fractures. Switching to lower heels will help avoid problems with the metatarsal bones. The lower the heel (I recommend no more than 2 inches), the more natural the foot position. If you must wear high heels, wear them in moderation.

  1. Ankle sprains (from high heels)

High heels also increase the risk of an ankle sprain. The most common is a lateral sprain which happens when you suddenly roll onto the outside of your foot, stretching the ankle ligaments beyond their normal length. A severe sprain may even tear these ligaments. The risk of developing osteoarthritis also increases with a severe sprain or fracture of the ankle. Over time, ligament and nerve damage in the ankle leads to complications in the legs and back. A sprained ankle should be immobilized immediately and may need physical therapy to heal properly.

  1. Stilettos

Although all high heels can cause problems, the ultra-narrow heels of stilettos are particularly hazardous because your weight is pinpointed all on one area, causing you to wobble as if walking on stilts. This instability can make you much more likely to trip and sprain your ankle. One solution is to switch from stilettos to chunky heels which have more surface area and distribute your weight more evenly, making your feet much more stable. Although thick high heels can still put stress on the ball of your foot, they reduce your risk of tripping by minimizing unsteadiness.

  1. Ballet flats and flip flops

On the opposite end of the spectrum from super-high heels are ballet flats and flip flops, which in terms of your feet are similar to walking on cardboard. They provide no arch support whatsoever which can lead to knee, ankle, hip and back problems. In addition, poor arch support is associated with a painful foot condition called plantar fasciitis. To prevent these problems, consider over-the-counter arch inserts, heel pads for extra cushioning, and custom orthotics to reduce pressure on sensitive areas.

  1. Pointy-toed shoes

They might be stylish but shoes with pointy toes squeeze the entire front of your foot together. Over time, this can cause nerve pain, bunions, blisters and hammertoes. Some women even develop bruises under their toenails from the constant pressure. Altering your footwear may be the smartest solution.

  1. Bunions

A bunion is a painful bone protrusion at the base of the big toe which can cause the toe to bend unnaturally. Bunions form when the main bone in the toe joint gets displaced which most often occurs after years of abnormal pressure and movement. Pointy-toed shoes are the most common culprit, which explains the prevalence of bunions among women.

  1. Shoes that are the wrong size

Nine out of ten women wear shoes that are too small, resulting in calluses, blisters, bunions, corns and other foot problems. Also, the constant rubbing of a too-small shoe can irritate the joints in the foot and lead to arthritis. The solution? Buy shoes that are the right size for your feet!

How to find the best shoes for your feet

Treat your feet properly and try to avoid injuring them and they’ll serve you well, all throughout your life. You can start by following these 3 simple tips:

  1. Choose shoes that bend at the toe box but are not too flexible.
  2. Make sure there is sufficient arch support.
  3. Avoid stilettos and instead, choose a wide heel no more than 2 inches high.
If you are experiencing foot or heel pain, possibly from shoes

If you have mild, moderate or severe pain in your feet or heel(s), 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 to alleviate and hopefully, eliminate your pain.

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

Categories: Blog

Westchester Health Now Part Of Northwell Health

Westchester Health Blog - Thu, 03/01/2018 - 09:17
Westchester Health Now that we’re part of Northwell Health, we’re even better

A year ago today, March 1, 2017, Westchester Health joined Northwell Health and its 2,700-member physician organization, Northwell Health Physician Partners. This important new partnership connects us to Northwell Health’s extraordinary resources, enabling us to greatly expand our services to bring you and your family the best possible care in the region.

What this means for you and your family

Our new relationship with Northwell Health now links us to an outstanding network of highly specialized services that includes 21 hospitals, Hofstra Northwell School of Medicine, The Feinstein Institute for Medical Research, rehabilitation and skilled nursing facilities, a home care network, a hospice network and numerous progressive care centers. As New York State’s largest healthcare provider, Northwell Health is always close to home, with over 550 outpatient facilities ready to care for you and your family.

Yet even with this big change, you can rest assured that Westchester Health physicians and staff will continue caring for you and your family at the state-of-the-art locations where you currently see us and at the local hospitals where we currently provide your care.

Yes, some things have changed but the most important ones stay the same

At Westchester Health, even though our affiliation has changed, the most important thing about us has not: our commitment to delivering the highest quality of compassionate, patient-centered care to you, our valued patients.

Thank you for allowing us to provide your care

Now and always, we are committed to doing everything we can to deliver the best possible medical care, and we look forward to seeing you and your family soon.

Our Mission

To deliver compassionate, community-based medical care of the highest quality.

Wherever, whenever you need us, we’re here for you.
Categories: Blog

Yes, Breast Really Is Best For Mom And Baby

Westchester Health Blog - Wed, 02/28/2018 - 10:06

It’s often said that breast milk is nature’s perfect food, and at Westchester Health, we thoroughly agree. Not only does it greatly benefit a growing newborn, but the act of breastfeeding has a number of very important health benefits for a nursing mom, too.

How moms benefit from breastfeeding

Navid Mootabar, MD, FACOG

Breastfeeding provides a number of health benefits for mothers beyond emotional satisfaction.

  1. Helps you lose pregnancy weight faster

Breastfeeding actually helps you lose your baby weight! When your infant sucks on your breast, this triggers the release of oxytocin, the “feel-good” hormone that also spurs the shrinking of your uterus and reduces postpartum bleeding. Even though you’ll be adding more calories to your diet to make milk, they won’t translate into extra pounds (unless you eat more calories than you need).

  1. Lowers your risk of several cancers

Breastfeeding reduces your risk of uterine, ovarian and breast cancer, as well as bone loss after menopause.

  1. Reduces your risk of developing many serious diseases

Some studies have found that breastfeeding may reduce the risk of developing type 2 diabetes, rheumatoid arthritis and cardiovascular disease, including high blood pressure and high cholesterol.

  1. Delays the return of your period

Exclusive breastfeeding delays the return of your menstrual period, which can help extend the time between pregnancies. However, it’s important to note that breastfeeding is not a foolproof method of contraception and should not be used as your sole form of birth control.

  1. Easy and convenient feedings

When you breastfeed, your baby’s milk supply is always ready and waiting, the right temperature and free! You won’t need to purchase formula or a bottle warmer, or be constantly sterilizing baby bottles.

How babies benefit from breastfeeding
  1. Boosts immunity and prevents illnesses

It’s a proven fact that breastfed babies are less likely to suffer from ear infections, asthma, allergies, childhood cancers, respiratory tract infections, GI illnesses and other common childhood ailments, in large part because their immune system is strengthened by antibodies passed on through their mothers’ milk. Colostrum (the protein-rich, low-fat “pre-milk” produced by your breasts before your real milk comes in) is particularly rich in these antibodies and is very important for your baby in those first few days of life.

  1. Decreases the likelihood of childhood obesity, now and later on

Babies who are breastfed are less likely to be obese as children.

  1. Important opportunity for mommy and baby to bond

There are few experiences in life that match the close emotional connection that comes from breastfeeding. No matter how close your child becomes with dad, there’s something wondrously special about skin-on-skin contact with your baby.

  1. Reduces allergies and skin rashes

Studies have shown that breastfeeding significantly contributes to a decreased incidence of allergies and eczema.

  1. Creates strong jaws, healthy teeth, fewer braces

Because breastfed babies have to work extra hard for their meals, they build stronger jaws, have better-developed teeth and palates, and experience fewer cavities later in life. They also have better jaw alignment and are less likely to need orthodontic braces as they get older.

  1. Encourages more adventurous taste buds

Since breast milk takes on the flavor of whatever you’re eating, your baby early on develops an acceptance of a wide range of tastes and flavors.

  1. Establishes crucial cognitive and emotional development

All those hours of close bodily contact while breastfeeding do more than fill your baby’s tummy. In addition to helping your newborn feel nurtured and safe, that close contact with you builds a strong emotional foundation for self-confidence throughout life.

If you don’t have time to breastfeed, you can pump

The ability to pump milk has revolutionized breastfeeding for the mother whose lifestyle prevents her having from regular nursing sessions with her baby. If you’re new to pumping, here are some helpful tips:

  • Many insurance companies cover the cost of breast pumps
  • Ideally, you should pump every 2-4 hours when separated from your infant
  • It takes the typical first-time mother about 20 minutes to empty her breasts. Pumping time usually decreases with each month of expressing milk.
  • After each successive pregnancy, pumping time should decrease
  • Breast milk can be stored in bottles or bags
  • Breast milk can be refrigerated for 3 days and frozen for 3 months (in a deep freezer, it can be frozen for 6 months).
  • Freeze your milk in small containers to avoid waste
  • Label the milk with the date
  • Hands-free bras are available to allow multi-tasking while pumping
  • Cars’ electrical adapters make it possible to pump in a car
  • Battery adapters are available for international travel
Additional benefits of breastfeeding
  • Breast milk is much less expensive than formula, which costs between $4-10 per day, depending upon the brand, type (powdered versus liquid) and amount.
  • At night, attaching your baby to your breast is much simpler and faster than getting up to warm a bottle of formula.
  • Breastfeeding allows you to gather your baby and go (for a quick errand or a day-long trip) without having to carry a bag full of feeding equipment.
  • Breastfeeding is also good for the environment, since there are no bottles to wash or formula cans/bottles to throw away.
How often to breastfeed

Generally, we recommend that babies be fed on demand, which is whenever they seem hungry. Your baby will tell you when he/she is ready for a meal. Crying, putting fingers in his/her mouth or making sucking noises are common tell-tale cues. Typically, a newborn needs to be fed every 2-3 hours and should nurse about 10-15 minutes at each breast.

Breastfeeding resources

Got questions about breastfeeding or need some help? Come see us.

If you’re having a hard time getting your newborn to breastfeed, want assurance that your baby is getting enough milk, or just have questions, please come see us at Westchester Health. We will personally work with you and your baby so that breastfeeding becomes a positive, successful experience for both of you. 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

9 Essential Tips for Foot Wound Care

Westchester Health Blog - Wed, 02/21/2018 - 10:23

No matter how careful you try to be as you go through life, minor cuts, scrapes, bruises and sometimes even more serious wounds do happen. When the injury occurs on your feet, heels or ankles, it can be especially painful and hard to heal. That’s why proper care and treatment for a foot wound from the very moment it occurs is very important to ensure proper healing.

John Viscovich, DPM, MBA, FACFAS

As a podiatrist with Westchester Health, I’ve noticed over the years that many people lack a good working knowledge of how to care for wounds that need immediate attention but are not serious enough to warrant a trip to the emergency room. To help rectify that, I’ve put together some guidelines that explain what to do in case you do sustain an injury to the foot, ankle or lower leg.

9 first aid tips for proper wound care

First and foremost, before treating any kind of wound or burn, WASH YOUR HANDS. In addition, wear disposable protective gloves, if possible.

Next, follow these 9 tips to avoid infection and promote healing.

1. A little blood is good

Blood helps clean a wound, so a little bleeding is actually beneficial. Most small cuts and scrapes stop bleeding fairly quickly on their own, but you can help the process by applying firm, gentle pressure to the site with a sterile gauze, towel or tissue. If blood soaks through the wrapping, add another layer of gauze or tissue on top. Do not remove the original dressing or you may pull open the wound and start the bleeding again.

2. Clean wounds right away

For any cut or scrape, the first thing to do is clean the wound with cool water. Remove any gravel or splinters with alcohol-sterilized tweezers. Gently wash around the wound with soap and a washcloth. Do not use iodine, alcohol or hydrogen peroxide— just soap and water.

3. Apply antibiotic cream

Antibiotic creams and ointments not only keep wounds moist but they can also reduce the risk of infection. Apply a thin layer on the wound, but if a rash develops, discontinue use.

4. Cover with a bandage

If your wound will be rubbed by clothing or shoes, cover it with a bandage. An uncovered cut or scrape is at risk of reopening or developing an infection. What often works best is to cover the wound with gauze, then wrap a fabric bandage over and around that to prevent bacteria from coming in contact with the wound. Change the bandage daily.

5. Watch for signs of adhesive or latex allergy

If you feel itchiness or burning under your bandage, you may have an allergy to the adhesive used in some bandages. If this happens, try switching to sterile gauze and paper tape or an adhesive-free dressing.

6. Healing begins almost immediately

Almost as soon as you sustain a wound injury, your body begins the healing process. White blood cells attack infection-causing bacteria. Platelets, red blood cells and fibrin create a jelly-like clot over the wound, enabling a protective scab to form.

7. Treating minor burns

The best treatment for a minor burn is to cool the area right away with a cold cloth or cool water to keep the skin from retaining the heat and continuing to burn. After cooling it to stop the burning process, wash the burned area with soap and water and dress it lightly. Leave blisters alone and do not pop them; they help protect the skin as it heals.

8. Look for signs of infection

If redness spreads out from the injury site, if there is swelling, if green or yellow fluid is emerging from the wound, or if the area around the wound is warm or tender, you may have an infection. Other signs include body aches, chills, fever and/or swollen lymph nodes at your neck, armpit or groin. If you have any of these symptoms, call your doctor right away.

9. See a doctor right away if your wound:
  • won’t stop bleeding after 5-10 minutes of pressure
  • is deeper or longer than a half-inch
  • is near the eye
  • is gaping or ragged
  • was caused by something dirty or rusty
  • has dirt or gravel stuck in it
  • is very painful
  • shows signs of infection
  • was caused by an animal or human bite
  • includes a broken or fractured bone
  • if you aren’t sure if you’re up to date on your tetanus vaccine
First aid tools everyone should have

Since you never know when you or something around you will sustain a minor or major injury, it’s a good idea to keep these first aid items handy:

  • tweezers
  • hydrocortisone cream
  • hand sanitizer
  • sterile gloves
  • pain relievers
  • gauze and tape
  • antiseptic wipes
  • antibiotic cream
  • antihistamines for allergic reactions
If you’ve been injured and are concerned about the wound

If you’ve sustained a cut, scrape or something more serious and want to know if it’s healing correctly, make an appointment to come see me at one of my Westchester Health offices. I’ll examine the wound, evaluate the overall condition of your feet, and together with you, determine the best course of treatment to bring about proper healing.

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

Categories: Blog

How to Know If Your Child Has a Learning Disability

Westchester Health Blog - Wed, 02/14/2018 - 10:05

At Westchester Health, we see a wide variety of children, some of whom have a learning disability, such as a reading or writing issue, speech and language delays, ADHD, or a combination of all of these. What we say to these parents is that the sooner they know their child has a disability, the sooner they can get help for him/her. We also reassure them that their child can definitely succeed in school, work and relationships, even with an LD. For more information, read this excellent blog by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group,

What is classified as a learning disability (LD)

Lauren Adler, MD, FAAP

The term “learning disability” actually describes a range of learning problems which stem from the way the brain gets, uses, stores and sends out information. As many as 15% of children have an LD and characteristically have trouble with one or more of the following skills:

  • reading (the most common type of LD is a reading disorder)
  • writing
  • listening
  • speaking
  • reasoning
  • math

Note: A child is not considered to have an LD if the learning problems are due to another cause, such as ADHD (attention-deficit/hyperactivity disorder), intellectual disability, or a hearing, vision or motor problem. However, some children may have an LD and one or more other conditions that can also affect learning, and many children have more than one LD.

An LD does not have just one specific cause

No, there can be many possible causes. These aren’t always known, but in many cases children with LDs have a parent or relative with the same or similar learning difficulties. Other factors that can influence the development of LDs include:

  • low birth weight
  • prematurity
  • an injury or illness during childhood (head injury, lead poisoning, childhood illness like meningitis)
How to determine if your child has an LD

Learning disabilities aren’t always obvious. However, there are some signs that could mean your child needs help in various areas and with certain skills. Keeping in mind that children develop and learn at different rates, it’s important to let your child’s pediatrician know if he/she shows any of the following signs:

Preschool children:
  • Delays in language development. By 2½ years of age, your child should be able to talk in phrases or short sentences.
  • Trouble with speech. By 3 years of age, your child should speak well enough so that adults can understand most of what he/she says.
  • Trouble learning colors, shapes, letters and numbers.
  • Trouble rhyming words.
  • Trouble with coordination. By 5 years of age, your child should be able to button his/her clothing, use scissors to cut shapes out of paper, and hop. They should also be able to copy a circle, square or triangle.
  • Short attention spans. Between 3-5 years of age, your child should be able to sit still and listen to a short story. As he/she gets older, your child should be able to pay attention for a longer time.
School-aged children and teens:
  • Follow directions
  • Get and stay organized at home and school
  • Understand verbal directions
  • Learn facts and remember information
  • Read, spell and sound out words
  • Write clearly (may have poor handwriting)
  • Do math calculations or word problems
  • Focus on and finish schoolwork (tend to daydream)
  • Explain information clearly with words or in writing
Common LDs to be aware of

Keep in mind that not every child with an LD fits neatly within one of the following types. What’s very important is to have your child evaluated by a pediatrician or learning disorder professional.

Reading disorder

Children with a reading disorder (also called dyslexia or reading disability) may have difficulty with:

  • Remembering the names of letters and the sounds they make
  • Understanding that words are made up of sounds and that letters stand for those sounds
  • Sounding out words correctly and at the right speed
  • Spelling words correctly
  • Understanding what they read
Writing disorder

Children with a writing disorder may have difficulty with:

  • Using a pen or pencil
  • Remembering how letters are formed
  • Copying shapes, drawing lines, or spacing things out correctly
  • Organizing and writing their thoughts, feelings and ideas on paper
  • Spelling and punctuation
Math disorder

Children with a math disorder may have difficulty with:

  • Recognizing and drawing shapes
  • Math concepts such as number values, quantity and order
  • Understanding time, money and measuring
Other learning problems

Some children with learning problems may not exactly fit the types of LDs listed above. These problems may include the following:

Nonverbal learning skills

Children who have trouble with nonverbal learning skills (often called nonverbal LD) may have:

  • Trouble copying designs and understanding 3-dimensional patterns
  • Trouble understanding abstract concepts
  • Trouble with math, writing and reading comprehension
  • Problems with social skills and understanding nonverbal cues like body language
  • Poor coordination
Speech and language delays

Children with speech and language delays may have:

  • Trouble reading and writing
  • Trouble with math word problems
  • Trouble following directions
  • Trouble answering questions

Children with ADHD may have:

  • Trouble focusing or paying attention
  • Trouble remembering information
  • Trouble completing schoolwork or homework
Many ways you can help your child

If you’re concerned about your child’s problems with learning or think your child may have an LD, we recommend that you talk with your child’s teacher and pediatrician. Teachers and other education specialists can perform screening or evaluation tests to determine if there really is a problem.

Your child’s doctor may want to test your child’s vision and hearing to rule out other possible problems. He/she may refer your child to a pediatrician who specializes in neurodevelopmental disabilities, developmental and behavioral pediatrics, or child neurology. Other professionals who can help are psychologists and educational specialists.

Most children who have learning problems can still be successful in school by developing different ways of learning. Special educational services to help children with LDs may be available in your school district. These may include specialized instruction, non-timed tests, or sometimes changes in the classroom that are geared toward your child’s specific learning style.

One effective way to ensure that your child is indeed getting help is for teachers to develop a written plan that clearly describes the services your child needs, when and how they are administered, and if they are benefiting your child. This plan is called an Individualized Education Program (IEP). Once an IEP is in place, it should be reviewed regularly to make sure your child’s needs are being met.

3 specific things you can do
  1. Focus on strengths. All children have special talents. Your child might be good at math, music or sports, or skilled at art, working with tools or caring for animals. Find your child’s strengths and help him/her learn to use them, then praise your child often when he/she does well or succeeds at a task.
  2. Help your child develop social and emotional skills. Learning disabilities combined with the challenges of growing up can easily make your child sad, angry or withdrawn. Help your child by providing love and support while acknowledging that learning is hard, and that everyone’s brain learns in a different way. Try to locate clubs, teams and other activities that focus on friendship, fun and building confidence rather than all-out competition and winning.
  3. Plan for the future. Many children with LDs are very bright and grow up to be successful in life. You can help your child plan for adulthood by encouraging him/her to consider their strengths and interests when making education and career choices. Also, there are special career and vocational programs that help build confidence by teaching decision-making and job skills, and many colleges have programs designed for students with LDs.
Additional resources Concerned that your child may have a learning disability? Come see us, we’re here to help.

If you’d like your child to be evaluated for a learning disability, as well as advice for actions you can take to help your child improve and succeed, 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 and referrals. Our #1 goal is for your child to be as healthy and happy as possible, whatever the diagnosis. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

How To Know If You Should Have Foot Or Ankle Surgery

Westchester Health Blog - Wed, 02/07/2018 - 10:02

In my Westchester Health podiatry practice, my goal is to help you achieve freedom of movement without pain. Foot and ankle pain can be especially difficult to deal with, especially since as upright humans, we spend a good majority of our lives on our feet. In fact, most people put 75,000 miles on their feet by the time they reach age 50.

Many of my patients experience foot and ankle pain but do not require surgery. As a highly experienced foot and ankle specialist, I will examine you and give you my professional opinion as to whether I think surgery of the foot or ankle is necessary—whether your condition stems from an injury, arthritis, osteoporosis, an ongoing problem or simply general wear-and-tear. If together, we determine that surgery is the best option for you, I will thoroughly explain the surgical procedure so that you fully understand what to expect.

To know whether or not your particular condition warrants surgery, I’ve put together this list of guidelines to help you assess if you are a good surgical candidate.

Your feet and ankles are very vulnerable to injury

John Viscovich, DPM, MBA, FACFAS

The feet and ankles are complicated musculoskeletal structures. Because they support the weight and bear the impact of the entire weight of the body, they are easily injured. Twisting, spraining, fracturing and even breaking the foot or ankle are common injuries, caused by strenuous athletic activities, a trip or misstep, or even ill-fitting or high-heeled shoes. In addition, once any of the many ligaments and tendons in the area are damaged, they become looser and more prone to injury in the future.

Although foot and ankle injuries are common for everyone, athletes are especially prone to damage in these areas. High-impact running and jumping can pound the relatively unstable ankle joints and delicate metatarsals of the foot, making these areas more susceptible to injury.

Signs that you may need foot and/or ankle surgery
  • Chronic foot and ankle pain
  • Constant heel pain
  • Pain with motion
  • Pain that causes you to limp
  • Bunion: an enlargement of the bone and tissue around the joint of the big toe
  • Hammertoe: a contracture of the toe(s), frequently caused by an imbalance in the tendon or joints of the toe
  • Bone spur: an overgrowth of bone as a result of pressure, trauma or stress of a ligament or tendon
  • Blisters
  • Corns
  • Neuroma: enlargement of a nerve segment, commonly found between the 3rd and 4th toes
  • Pain that flares up with vigorous activity
  • Tenderness when pressure is applied to the joint
  • Joint swelling, warmth and redness
  • Increased pain and swelling in the morning, or after sitting or resting
  • Difficulty in walking due to any of the above symptoms
Arthritis: a major cause for surgery

The 3 major types of arthritis that affect the foot and ankle and may warrant surgery are osteoarthritis, rheumatoid arthritis and posttraumatic arthritis.

  1. Osteoarthritis

Osteoarthritis is a common problem for many people after they reach middle age, but it can occur in younger people too. With osteoarthritis, the cartilage in the joint gradually wears away. This can result in bone rubbing on bone and often causes painful osteophytes (bone spurs). Osteoarthritis develops slowly, causing pain and stiffness that worsen over time.

  1. Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease in which the immune cells attack the synovium covering the joint, causing it to swell. Over time, the synovium invades and damages the bone and cartilage, as well as the ligaments and tendons, often causing serious joint deformity and disability. The exact cause of rheumatoid arthritis is not known. Although it is not an inherited disease, researchers believe that some people have genes that make them more susceptible to it. There is usually a “trigger,” such as an infection or environmental factor, which activates the genes. When the body is exposed to this trigger, the immune system begins to produce substances that attack the joints.

  1. Post-traumatic arthritis

Posttraumatic arthritis can develop after an injury to the foot or ankle, and in some cases, does not show up for many years after the initial injury. Dislocations and fractures—particularly those that damage the joint surface—are the most common injuries that lead to posttraumatic arthritis. Like osteoarthritis, posttraumatic arthritis causes the cartilage between the joints to wear away.

Most common types of foot and ankle surgery
  • Ankle arthroscopy/arthroscopic surgery
  • Bunion surgery (bunionectomy)
  • Hammer toe surgery
Benefits of foot and ankle surgery

The main advantage of foot and ankle surgery is the alleviation of pain, although there are many other benefits as well, depending on the surgery:

  • Ability to walk, stand and run without pain
  • Correction of deformity
  • Improved quality of life, ability to return to normal activities
  • Increased gait stability
  • Increased mobility and movement
  • Reduced foot and ankle pain
  • Return to competitive sports
Foot and ankle pain is not normal and needs attention right away

Your feet and ankles should not be hurting you. If they are and you’re wondering if maybe you need surgery, 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 (possibly surgery) to alleviate and hopefully, eliminate your pain.

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

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