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

Categories: Blog

How To Know If You Have A Yeast Infection

Westchester Health Blog - Wed, 01/31/2018 - 10:00

It itches. It burns. It’s embarrassing to talk about. If you’ve ever had one, you know what it’s like. If not, you’re lucky. I’m referring to a yeast infection, a non-serious but very uncomfortable vaginal condition that I see frequently in my female patients at Westchester Health. (Although relatively rare, men can also get yeast infections from having unprotected sex with a woman who has a yeast infection.)

There are many over-the-counter treatments for yeast infections but the best course of action is to see your doctor, because other infections can cause similar symptoms, including some sexually transmitted diseases (STDs).

Is it a yeast infection or a UTI? How to tell.

Tiffany Werbin-Silver, MD, FACOG

The typical symptoms of a yeast infection:

  • itching and irritation in the vagina
  • swelling and irritation of the vulva (the area and folds of skin outside the vagina)
  • pain or burning when urinating or having sex
  • thick, white vaginal discharge that resembles cottage cheese

Symptoms are more likely to occur the week before a menstrual period. Some women experience several of these symptoms, while others may only notice one or two.

The typical symptoms of a UTI:
  • burning while urinating
  • frequent or intense urge to urinate, even though little comes out when you do
  • pain or pressure in your back or lower abdomen
  • cloudy, dark, bloody or strange-smelling urine
  • feeling tired or shaky
  • fever or chills
What causes a vaginal yeast infection?

Yeast is a fungus that normally lives in the vagina in small amounts, but a vaginal yeast infection means that too many yeast cells are present, which causes symptoms. This “over-growth” of yeast cells can be caused by:

  • taking antibiotics which can kill too much “good” bacteria and result in too much yeast growing in the vagina
  • high estrogen levels caused by pregnancy or hormone therapy
  • certain health problems, like diabetes or HIV infection
  • problems with the immune system
  • corticosteroids which can weaken the immune system
  • tight-fitting, nonabsorbent pants or undergarments that hold in warmth and moisture
  • feminine hygiene sprays, talcs or perfumes used in the vaginal area
  • douching

Contrary to popular belief, yeast infections are not sexually transmitted. After having unprotected sex with a partner who has a yeast infection, you may have more than the normal amount of yeast in your vagina. However, if after having sex you develop a yeast infection with symptoms, it is most likely because other health factors are involved.

How to treat

If you’re not pregnant, you can treat yourself at home with common OTC remedies such an antifungal cream, a vaginal suppository or antifungal tablets. Alternatively, if your symptoms are mild, you may just want to wait and see if they clear up on their own.

NOTE: If you use a cream or suppository to treat a yeast infection, do not depend on a condom or diaphragm for birth control. The oil in some yeast infection medicines weakens latex, the material often used in condoms and diaphragms.

If your yeast infection regularly comes back

If you have more than 4 yeast infections in one year, see your doctor. He/she will perform tests to see if your yeast infections are being caused by another health problem, such as diabetes.

7 ways to prevent yeast infections

By practicing good genital hygiene and following these 7 guidelines, you can help prevent most (if not all) vaginal yeast infections:

  1. Keep your vaginal area clean. Use mild, unscented soap and water. Rinse well.
  2. After using the toilet, wipe from front to back to avoid spreading yeast or bacteria from your anus to the vagina or urinary tract.
  3. Wear underwear that helps keep your genital area dry and doesn’t hold in warmth and moisture (cotton is best).
  4. Avoid tight-fitting clothing, such as pantyhose and tight-fitting jeans. These may increase body heat and moisture in your genital area.
  5. Change out of a wet bathing suit right away. Wearing a wet suit for many hours keeps your genital area warm and moist.
  6. Change sanitary pads or tampons often.
  7. Don’t douche or use deodorant tampons, feminine sprays, powders or perfumes. These items can change the normal balance of organisms in your vagina.
Concerned that you may have a yeast infection? Come see us.

If you think you may have a vaginal yeast infection, or have yeast infections that keep coming back, please make an appointment with Westchester Health to see one of our OB/GYNs. He/she will make a diagnosis, determine if a related health condition is also involved, and together with you, choose the best course of treatment so you can soon get relief and feel better. Whenever, wherever you need us, we’re here for you.

By Tiffany Werbin-Silver, MD, FACOG, an OB/GYN with Westchester Health, member of Northwell Health Physician Partners

Categories: Blog

We Have The Flu Vaccine. Come In And Get A Flu Shot!

Westchester Health Blog - Fri, 01/26/2018 - 03:11

The flu is really bad this year so it’s more important than ever to get your family (and yourself) vaccinated. It protects you from getting this dangerous disease and also protects the rest of the community. We still have plenty of supplies of the flu shot so please come in and get immunized TODAY.


Categories: Blog

10 Do-It-Yourself Treatments For Plantar Fasciitis

Westchester Health Blog - Wed, 01/24/2018 - 09:49

As a podiatrist with Westchester Health who specializes in conditions of the feet and ankles, I see a lot of plantar fasciitis, the most common cause of heel pain. Whether caused by overuse, flat arches, a job that keeps you on your feet or badly-fitting shoes, for many people the pain of this condition can be excruciating. To help relieve the symptoms and causes of plantar fasciitis, and possibly prevent it altogether, I offer this blog of remedies and preventative actions you can do at home.

What exactly is plantar fasciitis?

John Viscovich, DPM, MBA, FACFAS

The plantar fascia is the flat band of ligament tissue that connects your heel bone to your toes. Its function is to support the arch of your foot, but if you strain the fascia, it becomes swollen, irritated…and very painful, resulting in plantar fasciitis. Patients actually tell me that it feels like someone is hammering nails into their heel.

Plantar fasciitis pain is usually at its worse first thing in the morning when you get out of bed, although it can also be triggered by getting up from a seated position or by standing for long periods.

What causes it?

Strenuous sports or vigorous activities that place a lot of stress on your heel and attached tissue—such as long-distance running, basketball, ballet dancing and dance aerobics—can contribute to plantar fasciitis. Additional causes that may increase your risk of developing plantar fasciitis are:

  • Your age. Plantar fasciitis is most common between the ages of 40 and 60.
  • The natural construction of your foot. Being flat-footed, having a high arch or an abnormal pattern of walking.
  • Being overweight. Excess pounds put extra stress on your plantar fascia.
  • Occupations that keep you on your feet. Factory workers, waiters/waitresses, chefs, nurses, pharmacists, teachers and others who spend most of their work hours walking or standing on hard surfaces have an increased incidence of plantar fasciitis.
10 home remedies for plantar fasciitis Here are 10 treatments you can do on your own at home to lessen and even prevent the pain of this condition:
  1. Lose weight and/or maintain a healthy weight. Less weight that your feet and ankles need to support will minimize the stress on your plantar fascia.
  2. Wear supportive shoes. Choose shoes with a low to moderate heel, substantial arch support and good shock absorbency.
  3. Do not go barefoot, especially on hard surfaces.
  4. Avoid high heels.
  5. Do not wear worn-out athletic shoes. Replace old, tattered, non-supportive athletic shoes. If you’re a runner, buy new shoes every 500 miles.
  6. Change your sport. Try a low-impact sport, such as swimming or bicycling, instead of high-impact ones such as basketball, tennis or running.
  7. Apply ice. Place a cloth-covered ice pack over the painful area for 15-20 minutes, 3-4 times a day or after athletic activity. You can also fill a paper cup with water and freeze it, then roll the ice over the area until the pain subsides.
  8. Stretch your arches. Your lower legs, calves, ankles and feet need to be stretched several times a day. Here are 3 great stretches:
  • Stand at a doorframe holding the edges of the frame. Place your heel on the floor close to the frame and the ball of your foot up against the frame. Pulling gently with your hands, slightly bend your knee and press your foot into the doorframe while leaning forward. Hold for 30 seconds and repeat.
  • Sit with your legs stretched out in front of you and a towel wrapped around your foot. Gently pull back on the towel and hold for 30 seconds. Repeat, then go to the other foot. It’s important to stretch both feet, even if one is not injured.
  • Stand barefoot on the affected leg on a stair or box, with a rolled-up towel resting beneath the toes of the sore foot and the heel extending over the edge of the stair or box. The unaffected leg should hang free, bent slightly at the knee. Slowly raise and lower the affected heel to a count of 3 seconds up, 2 seconds at the top and 3 seconds down. You can add a backpack stuffed with books to add weight.
  1. Massage. While sitting, roll a tennis ball around under your foot, massaging the area. A frozen water bottle also works well.
  2. Rest. Your feet need time off from whatever is causing the plantar fasciitis. Stop or at least cut back on whatever activity you feel might be triggering the pain.

By following these home remedy treatments, your plantar fasciitis should become less painful and hopefully after a few weeks of icing, massaging, stretching and resting, it may go away altogether.

Additional treatments

Here are some additional treatments and therapies I recommend for relief from plantar fasciitis pain:

  • Physical therapy. A physical therapist can show you a series of exercises to stretch the plantar fascia and Achilles tendon and strengthen lower leg muscles, all of which will stabilize your ankle and heel, helping to alleviate the condition and reduce the pain.
  • Night splints. Wear a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight, which helps stretch them.
  • Arch supports.Custom-fitted arch supports (orthotics) or OTC heel cups or cushions help distribute pressure to the feet more evenly.
If you think you have plantar fasciitis

If you’re experiencing pain in your heel(s) which you think might be due to 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

10 Ways Parents Can Try to Prevent Teen Suicide

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

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

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

    Lauren Adler, MD, FAAP

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

  1. Listen to your child.

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

These include but are not limited to:

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

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

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

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

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

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

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

  1. Get professional help.

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

  1. Share your own feelings with your teenager.

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

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

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

  1. Exercise is of great benefit.

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

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

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

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

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

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

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

Important warning signs of depression or suicide

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

Changes in activities:

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

Changes in emotions:

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

Changes in behavior:

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

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

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

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

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

Categories: Blog

You may have seen it in the news or

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

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

Nancy R. Beran, MD

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

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

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

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

Flu remains a major killer

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

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

This flu season is particularly bad

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

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

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

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

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

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

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

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

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

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

Last year’s shot will not protect you this year

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

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

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

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

What you can do to minimize your risk of flu

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

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

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

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

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

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

Categories: Blog

Why Do My Allergies Get Worse In The Winter?

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

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

Winter symptoms similar to spring/summer/fall ones

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

James Pollowitz, MD, FAAAAI, FACAAI

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

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

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

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

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

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

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

Suffering from winter allergies? Come see us.

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

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

Categories: Blog

7 Tips For Diabetic Winter Foot Care

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

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

7 important steps to take to keep diabetic feet healthy

John Viscovich, DPM, MBA, FACFAS

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

1) Inspect your feet every day

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

2) Choose the right footwear

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

3) Keep your feet dry

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

4) Moisturizing your feet is essential

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

5) Trim your toenails

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

6) Never burn your feet

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

7) Control your blood sugar

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

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

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

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

Categories: Blog

Why You Really Need Folic Acid When You’re Pregnant

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

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

Folic acid helps prevent neural tube defects

Navid Mootabar, MD, FACOG

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

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

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

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

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

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

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

How much folic acid do you need?

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

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

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

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

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

When you might need extra folic acid

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

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

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

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

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

Good food sources of folic acid

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

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

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

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

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

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

Categories: Blog

How To Know If Your Child Has Bulimia

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

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

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

    Lauren Adler, MD, FAAP

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

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

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

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

Behavioral signs of bulimia

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

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

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

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

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

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

Can eating disorders be treated? Yes.

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

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

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

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

More information on eating disorders

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

Categories: Blog

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

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

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

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

    Lauren Adler, MD, FAAP

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

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

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

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

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

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

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

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

Categories: Blog

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

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

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

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

    Lauren Adler, MD, FAAP

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

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

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

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

  1. Nitpicking and wet combing

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

  2. Rid, a lice-killing shampoo

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

  3. Nix, another lice-killing shampoo

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

  4. Olive oil

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

  5. Petroleum jelly (Vaseline)

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

  6. Cetaphil Cleanser

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

  7. Vinegar

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

  8. Benzyl alcohol lotion 5%

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

  9. LouseBuster

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

  10. Hire a nit-picking service

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

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

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

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

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

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

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

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

Categories: Blog

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

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

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

How colds are spread

Lauren Adler, MD, FAAP

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

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

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

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

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

Best treatments for a cold
  1. Rest and fluids

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

  2. Give acetaminophen or ibuprofen

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

  3. No OTC cough and cold medicines

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

  4. When to see your pediatrician

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

  1. Saline nose drops and suction bulb

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

  2. Vaporizer

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

  3. Keep in touch with your pediatrician

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

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

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

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

Categories: Blog
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