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Don’t Believe That E-Cigarettes And Vaping Are Safe. They’re Not.

Westchester Health Blog - Wed, 07/18/2018 - 10:28

The good news is that the rates for adolescents smoking tobacco have dipped slightly. The bad news is that e-cigarette use in middle and high school students has tripled. Many people, especially teens, think that e-cigarettes are a safe alternative to smoking. Unfortunately, this is simply not true. E-cigarettes are just another way of absorbing nicotine—which is a highly addictive drug—into your body. To learn more, read this blog by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group.

Electronic cigarettes (e-cigarettes) are battery-powered smoking devices often designed to look and feel like regular cigarettes

E-cigarettes use cartridges filled with a liquid that contains nicotine, flavorings, and other chemicals. A heating device then converts this liquid into a vapor, which the person inhales. This is why using e-cigarettes is known as “vaping.”

Lauren Adler, MD, FAAP

Because e-cigarettes do not burn tobacco, you don’t inhale the same amounts of tar and carbon monoxide as you would with a regular cigarette. But anyone using an e-cigarette is still putting an unhealthy dose of nicotine and other chemicals into their lungs.

The very real health dangers of e-cigarettes

Even though e-cigarettes do not fill the lungs with harmful smoke, they are not a healthy alternative to regular cigarettes.

  1. When you vape, (use an e-cigarette), you’re still putting nicotine—which is absorbed into the bloodstream through your lungs—into your body. In addition to being a highly addictive drug, nicotine is also toxic in high doses. (It used to be used as an insecticide to kill bugs.) There have even been fatal cases when the nicotine liquid in e-cigarettes has been ingested or absorbed through the skin.
  2. Nicotine affects your brain, nervous system and heart. It raises blood pressure and heart rate. The larger the dose of nicotine, the more a person’s blood pressure and heart rate go up. This can cause an abnormal heart rate (arrhythmia). In rare cases, especially when large doses of nicotine are involved, arrhythmias can cause heart failure and death.
  3. After its initial effects wear off, the body starts to crave nicotine. You might feel depressed, tired and irritable (known as nicotine withdrawal), and crave more nicotine to perk up again. Over time, nicotine use can lead to serious medical problems, including heart disease, blood clots and stomach ulcers.
Vaping is not a way to stop smoking, no matter what the ads say

Electronic cigarettes are marketed to smokers as a way to help them quit, but there’s no evidence that they actually help people stop smoking. Instead, they have actually been found to be a health risk for people who use them, as well as for bystanders who breathe in the secondhand vapor (which comes out of the device as well as exhaled from the user’s mouth) and third-hand vapor (which sticks to surfaces such as upholstery, clothing, bedding and floors).

Effective ways to stop smoking, either regular cigarettes or e-cigarettes

Because nicotine is so addictive, the best way to quit smoking or stop using e-cigarettes is not to start. But if you smoke and want to quit, e-cigarettes probably aren’t your best option. Using an e-cigarette mimics the experience of smoking tobacco cigarettes more closely than other quitting options (like nicotine gum or patches). You don’t want to give up smoking only to find you’re now hooked on e-cigarettes.

From our years of experience here at Westchester Health helping our patients quit smoking (either tobacco cigarettes or e-cigarettes), here are the 7 steps that have proven to produce the best results:

  1. Make a specific plan. Set a date to begin the quitting process. If you smoke cigarettes, try quitting altogether before relying on e-cigarettes to help. If that doesn’t work, create a specific goal, such as using one less e-cigarette a day for a week. Keep cutting back until you no longer smoke or vape.
  2. Stay busy. Take your mind off cigarettes by exercising or doing something that involves your hands, like drawing, playing music or basketball. Be aware of specific times and situations that make you want cigarettes (like at a party or after a meal), and come up with a plan to handle those times.
  3. Delay giving in to a craving. When you crave a cigarette or e-cigarette, put off giving in to the urge. Sometimes it’s easier to wait than to tell yourself “no.” Do something else to take your mind off the craving.
  4. Keep focused on why you want to quit. Write down all the reasons you want to stop using cigarettes or e-cigarettes, like the money you’ll save or the extra energy you’ll have or how much better you’ll feel. Keep the list where you can see it. Read it every day, even though you already know the reasons. Doing this helps your brain automatically remind you of a reason when you feel a strong craving.
  5. Get support. Turn to your family or a trusted friend or doctor for moral support when you really want a cigarette. It also helps strengthen your resolve to tell other people that you are quitting. If you don’t want friends and family to know you smoke or use e-cigarettes, join an online or in-person support group. See if friends will join you in quitting. If not, ask them not to smoke or use e-cigarettes in front of you.
  6. Be good to yourself. Believe in yourself and give yourself lots of praise each time you avoid reaching for a cigarette. Remember, you’re doing this for you: your life, your health and your future.
  7. Nicotine is an addictive drug. It’s not easy to stop using it once you’ve started. That’s why we stress that the best strategy is to never start smoking or vaping in the first place. If it’s too late for that, remind yourself that it is possible to quit. You can do it. You really can.
Check out these resources to help you or your teen stop smoking or vaping: Concerned that your teen is smoking, vaping or might start soon? Come see us.

If you’re worried that your child is smoking, either tobacco cigarettes or e-cigarettes, or might start smoking, please come in and see one of our Westchester Health pediatricians. Together, we’ll talk it out with you and your child, and together figure out the best way forward. If needed, we’ll also help your child find the right support network to stop smoking. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Taking Your Kids To The Doctor Is Just As Important When They’re Well As When They’re Sick

Westchester Health Blog - Wed, 07/11/2018 - 11:07

Here at Westchester Health, we want to make sure parents know that it’s just as important to take their children to the doctor when they are well as when they are sick. These well-child visits are not only a chance to review a child’s physical, cognitive, emotional and social development, but they’re a good time to review health issues and answer any questions our parents or young patients may have. To learn more about why we recommend annual physicals, read this blog (excerpted here) by Mason Gomberg, MD, a pediatrician with our Westchester Health Pediatrics group, can help.

At the well-child visit, healthy behaviors such as diet, sleep, social skills and physical activity will be discussed

Mason Gomberg, MD

At Westchester Health, our pediatricians use the well-child visit to discuss such issues as prevention of injury and illness, reviewing car seat and seat belt usage, safe firearm storage, fire prevention and safety, screen time, and current and up-to-date immunizations. For teens, part of the exam should be done in private between the teenager and physician, allowing the doctor to ask sensitive questions and get important answers concerning such issues as substance abuse, mental health concerns, sexual activity and puberty.

A complete physical examination, blood pressure test, and vision and hearing screens

These additional tests may also be included in your child’s annual exam: testing for anemia, lead exposure, tuberculosis, cholesterol and depression.

If you are seeing a new doctor

Make sure to bring your child’s most recent and complete immunization records and health reports, any school reports that you are concerned about, your list of questions and any school or sports forms that need to be filled out.

To schedule your well-child visit, or to learn more about why your child needs one, give us a call

If it’s time for your child’s annual well-child visit, or if you have questions about any aspect of your child’s health, please make an appointment with Westchester Health to see one of our pediatricians. We’ll examine your child, perform age-appropriate tests and screenings, administer needed vaccinations, offer advice and guidance, and answer any questions you or your child might have. Always, our #1 goal is for your child to grow up healthy and happy. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

How Can I Protect My Baby From Dying From SIDS?

Westchester Health Blog - Wed, 07/04/2018 - 10:43

Sudden infant death syndrome (SIDS) is the unexplained death, usually during sleep, of a seemingly healthy baby less than a year old. SIDS is sometimes called “crib death” because the infants often die in their cribs. What makes SIDS so frightening is that it strikes babies who seem to have nothing wrong with them. To do everything we can to prevent this, Westchester Health offer this very informative blog (excerpted here) by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group.

Is your baby at risk of SIDS? Here’s how to know. Physical factors that can increase an infant’s risk of SIDS:
  1. Brain abnormalities. Some infants are born with problems that make them more likely to die of SIDS. It is believed that the portion of the brain that controls breathing and arousal from sleep does not work properly.
  2. Low birth weight. Premature birth or being part of a multiple birth increases the likelihood that a baby’s brain doesn’t mature completely, resulting in less control over such automatic processes as breathing and heart rate.
  3. Respiratory infection. Many infants who died of SIDS had recently had a cold, which may contribute to breathing problems.
  4. Boys are more likely to die of SIDS.
  5. Infants are most vulnerable during the 2nd and 3rd months of life.
  6. For reasons we don’t understand, African-American, American Indian and Alaska Native infants are more likely to develop SIDS.
  7. Family history. Babies who’ve had siblings or cousins die of SIDS are at higher risk themselves.
  8. Secondhand smoke. Babies who live with smokers have a higher risk of SIDS.
Environmental factors that can increase an infant’s risk of SIDS:
  1. Sleeping on stomach or side. Babies who are placed on their stomachs or sides to sleep may have more difficulty breathing than those placed on their backs.
  2. Sleeping on a soft surface. Lying face down on a fluffy comforter or a waterbed can block an infant’s airway. Draping a blanket over a baby’s head also is risky.
  3. Sleeping with parents. While the risk of SIDS is lowered if an infant sleeps in the same room as his or her parents, the risk increases if the baby sleeps in the same bed, partly because there are more soft surfaces to impair breathing.
Maternal risk factors that can increase an infant’s risk of SIDS:

The mother:

  1. Is younger than 20
  2. Smokes cigarettes
  3. Uses drugs or alcohol
  4. Has inadequate prenatal care
10 things that can reduce the likelihood of your baby dying from SIDS
  1. Place your baby to sleep on his/her back, every time. Babies up to 1 year of age should always be placed on their backs to sleep during naps and at night. However, if your baby has rolled from his back to his side or stomach on his own, he can be left in that position if he is already able to roll from tummy to back and back to tummy. If your baby falls asleep in a car safety seat, stroller, swing, infant carrier or infant sling he/she should be moved to a firm sleep surface as soon as possible.
  2. Place your baby to sleep on a firm sleep surface. Your crib, bassinet, portable crib or play yard should meet current safety standards. Check to make sure the product has not been recalled. Do not use a crib that is broken or missing parts, or that has drop-side rails. Cover the mattress that comes with the product with a fitted sheet. Do not put blankets or pillows between the mattress and the fitted sheet. Most important: Never put your baby to sleep on a chair, sofa, water bed, cushion or sheepskin. For more information about crib safety standards, visit the Consumer Product Safety Commission website at www.cpsc.gov.
  3. Keep soft objects, loose bedding or any objects that could increase the risk of entrapment, suffocation or strangulation out of the crib. Pillows, quilts, comforters, sheepskins, bumper pads and stuffed toys can cause your baby to suffocate so keep them out of the crib.
  4. Place your baby to sleep in the same room where you sleep but not the same bed. Babies who sleep in the same bed as their parents are at greater risk of SIDS, suffocation or strangulation. Parents can roll onto babies during sleep or babies can get tangled in the sheets or blankets.
  5. Breastfeed as much and for as long as you can. Studies show that breastfeeding your baby can help reduce the risk of SIDS.
  6. Keep up with all well-baby visits. Your baby needs important immunizations and other crucial health checks at regularly scheduled well-baby visits.
  7. Don’t smoke around your baby and keep him/her away from smokers and places where people smoke. If you smoke, quit. Plus, don’t allow anyone to smoke near your baby, even if he/she is outside.
  8. Don’t let your baby get too hot. Keep the room where your baby sleeps at a comfortable temperature. In general, dress your baby in no more than one extra layer than you would wear. If you are worried that your baby is cold, dress him/her in clothing designed to keep babies warm but that doesn’t cover their heads.
  9. Offer a pacifier at naptime and bedtime. Studies show that this helps reduce the risk of SIDS.
  10. Do not use products that claim to reduce the risk of SIDS. Products such as wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS. In addition, some infants have suffocated while using these products.
If you are worried about SIDS, please come see us.

At Westchester Health, one of our top priorities is to do everything we can to prevent SIDS. If you’re concerned about the possibility of your baby succumbing to SIDS, please come in and meet with us. From our years of experience with all kinds of babies, we have advice, guidance and support to give you information and more importantly, peace of mind. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Should I Take My Child To The Pediatrician Or The ER? Here’s How To Know.

Westchester Health Blog - Wed, 06/27/2018 - 10:19

At Westchester Health, we know it’s really hard not to panic when your child has a broken bone, high fever, open wound or is vomiting uncontrollably. In many instances, it would make sense to rush him/her to your local ER. However, there are times when the best course of action is to see your local pediatrician who knows your child and his/her health history. How do you know what to do when? This insightful blog (excerpted here) by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group, can help.

When to take your child to the ER Head straight to the ER if your child:
  • is less than 2 months old and has a fever. Fever is defined as a (rectal) temperature of 100.4 degrees Fahrenheit or higher
  • has a broken bone, particularly if there is visible swelling or unevenness/bumps in the injured area (a sign that the broken bone is misaligned)

    Lauren Adler, MD, FAAP

  • hits his/her head and appears to pass out or lose consciousness for a few seconds
  • has had a seizure
  • is showing signs of dehydration, such as very dry/cracked lips and mouth, absence of urination for more than 12 hours, lethargy and confusion
  • has heavy, fast breathing, is gasping for air or manages to utter only 2-3 words before taking a breath
  • has gaping cuts on the face, especially younger children who need sedation while the injury is being repaired
Negative consequences of going to the ER
  1. The ER can expose your already sick child to potentially dangerous germs and other infections carried by everyone there in the ER (not just the patients but also the families waiting for the patients to be seen).
  2. ER care is almost always going to be more expensive than going to your own pediatrician.
  3. Emergency departments are, by definition, designed to care for the sickest or most seriously injured patients first, meaning that those with less severe illnesses or injuries will have longer waits.
  4. In an ER, your child is a stranger, but here at Westchester Health, we know your child personally, as well as his/her health history, family history, record of immunizations, risk factors, mental health issues, STDs and any other related health conditions. We strongly feel that this enables us to give more accurate, more informed and more compassionate care.
When to take your child to your pediatrician Go to the doctor if your child:
  • has fever accompanied by cold symptoms and you suspect it may be the flu
  • maybe has an ear infection—symptoms include drainage from the ear, earache and pulling on the ears
  • has a sore throat with or without white patches on the tonsils, a possible sign of strep infection
  • has pink eye (conjunctivitis)—symptoms include red, inflamed eyes with or without discharge
  • has had a few episodes of vomiting or diarrhea (without blood in the stool) but has no belly pain or signs of dehydration
If you think your child is experiencing a true emergency, call 911 immediately. For more information on when to take your child to the ER vs. pediatrician, please come see us

Questions? Still unsure of what to do when? We urge you to come in and see one of our pediatricians at Westchester Health. If your child is sick or injured, we will try our very best to see him/her as soon as possible and treat the problem so your child can feel better soon. If we feel your child should indeed go to the ER, or needs to see a specialist, we’ll speed that process along right away. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Does Your Child Has Type 1 Diabetes? 8 Ways To Know.

Westchester Health Blog - Wed, 06/20/2018 - 10:51

If you’re the parent of a child with type 1 diabetes, you know how challenging this disease can be, from giving injections to counting carbohydrates to monitoring blood sugar. At Westchester Health, we have many patients with this condition and are very experienced at helping our parents and young patients (when old enough) adequately manage it. To learn more, read this blog (excerpted version) by Rodd Stein, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group.

How can you know if your child has type 1 diabetes? The best way is to be informed and know the facts. To help, here are 8 guidelines.

8 warning signs that your child might have type 1 diabetes

NOTE: If your child has 1 or any combination of the 8 signs and symptoms listed below, he/she should see your pediatrician as soon as possible.

  1. Increased thirst and frequent urination. Excess sugar buildup in your child’s bloodstream pulls fluid from tissues. As a result, your child might be thirsty and drink and urinate more than usual. In fact, a young, toilet-trained child might suddenly experience bed-wetting.

    Rodd Stein, MD, FAAP

  2. Extreme hunger. Without enough insulin to transfer sugar to your child’s cells, his/her muscles and organs lack energy, which triggers intense hunger.
  3. Weight loss. Unexplained weight loss is often the first sign of type 1 diabetes in children. Despite eating more than usual to relieve hunger, your child may lose weight, sometimes rapidly. Without the energy that sugar supplies, muscle tissues and fat stores simply shrink.
  4. Your child is unusually tired and lethargic.
  5. Irritability or behavior changes. In addition to mood swings, your child might suddenly have a decline in performance at school.
  6. Fruity-smelling breath. Burning fat instead of sugar produces certain substances (ketones) that can cause a fruity breath odor.
  7. Blurred vision. If your child’s blood sugar is too high, fluid may be pulled from the lenses of his/her eyes, causing your child to be unable to focus clearly.
  8. Yeast infection. Girls with type 1 diabetes may develop genital yeast infections. Also, babies can develop diaper rashes caused by yeast.
Is your child at risk for type 1 diabetes? Know these risk factors:
  1. Family history. A child with a parent or sibling with type 1 diabetes has an increased risk of developing the condition.
  2. Genetic susceptibility. The presence of certain genes indicates an increased risk of developing type 1 diabetes.
  3. Race. In the U.S., type 1 diabetes is more common among non-Hispanic white children than among other races.
  4. Certain viruses. Exposure to various viruses may trigger the autoimmune destruction of the islet cells.
  5. Infant diet. No specific dietary factor or nutrient has been shown to play a role in the development of type 1 diabetes starting in infancy. However, early intake of cow’s milk has been linked to an increased risk of type 1 diabetes, while breastfeeding might lower the risk. The timing of the introduction of cereal into a baby’s diet also may affect a child’s risk of type 1 diabetes.
5 things you can do to manage your child’s type 1 diabetes
  1. Monitor blood sugar. Depending on what type of insulin therapy your child needs, you will probably be instructed to check and record your child’s blood sugar at least 4 times a day (maybe more often), requiring frequent finger sticks. This is the only way to make sure your child’s blood sugar level remains within his/her target range, determined by your pediatrician.
  2. Administer insulin and other medications. Anyone with type 1 diabetes needs insulin treatment. Because stomach enzymes interfere with insulin taken by mouth, insulin needs to be injected with a fine needle syringe or an insulin pen. An insulin pump is another option, worn outside of the body, where, a tube connects the reservoir of insulin to a catheter inserted under the skin of the abdomen. A wireless pump that uses small pods filled with insulin is yet another option, automatically dispensing specific amounts of insulin automatically.
  3. Healthy eating. At WHP, we feel it’s important to work with a registered dietician who is familiar with diabetes to ensure that your child is getting the right nutritional intake with an emphasis on the different glycemic effects of various carbohydrates. Carbohydrates should be limited to ones high in fiber, and intake should be consistent.
  4. Physical activity. All children need regular cardiovascular exercise, and those with type 1 diabetes are no exception. Encourage your child to get regular physical activity, whether it’s soccer, swimming, dance, basketball, football, jogging, bike riding or any other aerobic activity. However, be aware that physical activity usually lowers blood sugar, possibly affecting your child’s blood sugar levels for up to 12 hours after exercise. You might need to adjust your child’s meal plan or insulin doses to compensate for the increased activity.
Remember: kids with diabetes can do everything other kids can do

It takes some extra effort to keep blood sugar levels within a healthy range but this gets easier with practice.

Do you think your child might have type 1 diabetes?

If you’re concerned that your child might be developing type 1 diabetes, or already has diabetes, please make an appointment with Westchester Health to see one of our pediatricians. We have years of experience and lots of advice and guidance to help make living with this disease easier on everyone. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Is Your Child Overweight? Here’s What You Can Do.

Westchester Health Blog - Wed, 06/13/2018 - 11:24

Did you know that in the past 30 years, the number of overweight children in the U.S. has tripled? Alarmingly, it is now estimated that 1 in 5 children is overweight (18.5%). With these numbers, it’s no surprise that childhood obesity is something we encounter a lot here at Westchester Health. However, we firmly believe (and we’ve seen results proving this theory) that with a concerted effort from many people in a child’s life, overweight kids can achieve a healthier lifestyle and reduce their weight. To shed important light on the subject, Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group, has written a great blog which we excerpt here.

Why are there so many overweight and obese children in the U.S.? Many reasons.

Unfortunately, the majority of American children are not eating enough nutritious foods or getting sufficient physical activity. Many children have limited access to safe places to play, while others live in “food deserts” where there are few neighborhood places nearby for their parents to buy affordable, healthy food. Studies show that the odds of a child being obese or overweight increase by 20-60% when they live in poor housing, unsafe surroundings and/or limited access to sidewalks, parks and recreation centers. Contributing factors:

  1. 91% of American children have poor diets
  2. Less than half get the recommended 60 minutes of daily physical activity

    Lauren Adler, MD, FAAP

  3. Almost two-thirds of American youth consume a sugary beverage daily
  4. 25% of American high school students spend 3 or more hours a day staring at a screen
  5. Schools have reduced recess time in favor of academic instruction, particularly among older children
Several factors contribute to childhood obesity
  1. Unhealthy food choices: Diets high in calories (including fats and simple sugars) and lower in fruits and vegetables
  2. Lack of physical activity: Too much time spent in sedentary activities such as watching TV, video games and/or on phones
  3. Obese parents: Children of obese parents are more likely to be overweight themselves.
  4. Eating patterns: Skipping meals or not having a regular eating schedule can result in eating too much at one time.
  5. Parenting style: Overprotective parents regarding their children’s eating can cause those children to have poor self-regulation regarding food.
  6. Diabetes during pregnancy: Overweight and type 2 diabetes occur with greater frequency in the offspring of diabetic mothers (who are also more likely to be obese themselves).
  7. Low birth weight: A risk factor for being overweight in several studies.
  8. Excessive weight gain during pregnancy: Excessive maternal weight gain during pregnancy is associated with increased birth weight and being overweight later in life.
  9. Formula feeding: Breastfeeding is generally recommended vs. formula feeding, and studies suggest that it may also prevent excess weight gain as children grow.
  10. Parental eating and physical activity habits: Parents with poor nutritional habits and sedentary lifestyles model these unhealthy behaviors for their children, who often copy them in their own choices.
  11. Demographic factors: Certain demographic factors are associated with an increased risk of being overweight in childhood. For example, statistics show that African-American, Hispanic, Asian and Pacific Islander children are more likely to be overweight.
In spite of the statistics, childhood obesity can be reversed with healthy eating and exercise

Fortunately, healthy habits, including healthy eating and physical activity, can be taught—and when put into practice, can change a child’s life, both physically and mentally.

  • Schools play a critical role in influencing a child’s weight by establishing a safe and supportive environment that supports healthy behaviors. They also provide opportunities for students to learn about and practice healthy eating and physical activity (the dreaded gym class!).
  • Your child’s pediatrician also plays a vital role in helping your child reach and maintain a healthy weight. He/she can explain the health risks and benefits of a healthy and physically active lifestyle, create a customized diet and exercise plan, and encourage your child when he/she is struggling. Also, with regular checkups, your child’s doctor is more likely to notice changes in your child’s weight, both positive and negative, and can respond quickly to issues.
  • Parents probably have the most influence on a child’s eating and exercise habits. They can make sure there are healthy foods available at home, consult a nutritionist for meal guidelines, take their child to the gym with them, and be a cheerleader or a drill sergeant, whichever is needed.
What you can do to fight childhood obesity

From our years of experience here at Westchester Health, here are our tips that have proven to be most effective:

  1. Serve and eat a variety of foods from each food group.
  2. Serve small portions. Compared to adult portions, child portions should be very small. More food can always be added if needed.
  3. Bake, broil, roast or grill meats instead of frying them.
  4. Limit use of high calorie, high fat and high sugar sauces and spreads.
  5. Use low-fat or nonfat dairy products for milk, yogurt and ice cream.
  6. Encourage participation in sports and other physical activity at school, church or community leagues.
  7. Be active as a family: go on walks, bike rides or hikes together.
  8. Limit screen time.
  9. Avoid eating while watching TV. TV viewers typically eat too much, too fast, and are influenced by the foods and drinks that are advertised.
  10. Replace sugary drinks, especially sodas, with water and/or low fat milk.
  11. Limit fruit juice intake to two servings or less per day (one serving = ¾ cup). Many parents allow their children unlimited intake of fruit juice because of the vitamins and minerals it contains. However, children who drink too much fruit juice may be consuming excess calories.
  12. Encourage physical play in young children and provide environments that allow children to play indoors and outdoors.
  13. Model healthy dietary practices, nutritional snacks and lifestyle activities.
  14. Avoid using food as a reward for good behavior or good grades.
Concerned that your child is overweight or obese? Please come see us

If you are worried about your child’s weight and the effect this is having on his/her health, please make an appointment with Westchester Health to come in and talk to one of our pediatricians. We will meet with you and your child, assess their weight and overall health, and together with you, decide on the best course of action to steer him/her toward a healthier lifestyle and weight. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

10 Best Ways To Bring Down Your Blood Pressure

Westchester Health Blog - Wed, 06/06/2018 - 11:00

At Westchester Health, a great many of our patients have high blood pressure (also known as hypertension) but not all of them fully understand what this condition means. Blood pressure refers to the force of your blood pushing against your artery walls as it flows throughout your body. Too much force, i.e., high blood pressure, can damage your arteries and lead to life-threatening conditions such as heart disease and stroke.

Many people can have high blood pressure for years without any symptoms

James W. Catanese, MD, FACC

The only way to know if your blood pressure is too high is through regular checkups, which is why annual physicals are so important, no matter your age. In the U.S. alone, more than 30% of American adults have high blood pressure.

High blood pressure, not heart attack or stroke, is the most common cardiovascular disease

If left untreated, it can lead to serious consequences and possibly death.

How blood pressure is measured

Your blood pressure is represented by two numbers, the systolic (the top number) and diastolic (the bottom number). These numbers are determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

When your heart beats, it squeezes and pushes blood through your arteries to the rest of your body. This force creates pressure on those blood vessels, which is the systolic blood pressure.

  • A normal systolic pressure is below 120.
  • A reading of 120-129 is elevated.
  • 130-139 is stage 1 high blood pressure (also called hypertension).
  • 140 or more is stage 2 hypertension.
  • 180 or more could be a hypertensive crisis and you should call your doctor right away.

The diastolic reading, or bottom number, is the pressure in the arteries when the heart rests between beats. This is when the heart fills with blood and gets oxygen.

  • A normal diastolic blood pressure is lower than 80, but even if your diastolic number is below 80, you can still have high blood pressure if the systolic reading is 120-129.
  • 80-89 is stage 1 hypertension.
  • 90 or more is stage 2 hypertension.
  • 120 or more is a hypertensive crisis and you should call 911 right away.
How to know if you have high blood pressure: what to look for

If you have any of the following symptoms, see a doctor immediately. You could be having a hypertensive crisis that could lead to a heart attack or stroke.

  • Severe headache
  • Dizziness
  • Severe Fatigue
  • Confusion
  • New Vision problems
  • Chest discomfort
  • Difficulty breathing
  • Irregular heartbeat
  • Nosebleeds
  • Blood in your urine
  • Pounding in your chest, neck or ears
10 things you can do to lower your blood pressure

If you can successfully control your blood pressure with a healthy lifestyle, you may avoid, delay or reduce the need for medication and hopefully prolong your life. Here are 10 important lifestyle changes you can make to lower your blood pressure and keep it down.

  1. Lose extra pounds and watch your waistline

Weight loss is one of the best ways to control blood pressure. Losing just 10 pounds can help bring it down. But as well as shedding pounds, you also need to keep an eye on your waistline. Carrying too much weight around your waist can put you at greater risk of high blood pressure.

  • Men are at risk if their waist measurement is greater than 40 inches
  • Women are at risk if their waist measurement is greater than 35 inches
  1. Exercise regularly

Regular physical activity—at least 30 minutes several days a week—can lower your blood pressure significantly. It’s important to be consistent because if you stop exercising, your blood pressure can rise again.

  1. Eat a healthy diet

Eating a diet that is rich in whole grains, fruits, vegetables and low-fat dairy products and low in saturated fat and cholesterol can lower your blood pressure by up to 14 mm Hg.

  1. Reduce sodium in your diet

Even a small reduction in the sodium in your diet can reduce blood pressure by 2 to 8 mm Hg. To decrease sodium in your diet, follow these tips:

  • Read food labels. When possible, choose low-sodium alternatives of the foods and beverages you normally buy.
  • Avoid processed foods. Only a small amount of sodium occurs naturally in foods. Most sodium is added during processing.
  • Don’t add salt. Just 1 level teaspoon of salt has 2,300 mg of sodium. Instead, use herbs or spices to add flavor to your food.
  1. Limit alcohol

If you drink alcohol, do so in moderation. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.

  1. Quit smoking

Each cigarette you smoke increases your blood pressure for several minutes after you finish. The good news: quitting smoking helps your blood pressure return to normal. People who quit smoking, regardless of age, have substantial increases in life expectancy.

  1. Cut back on caffeine

Caffeine can raise blood pressure by as much as 10 mm Hg.

  1. Reduce your stress

Chronic stress is a major contributor to high blood pressure, particularly if you react to stress by eating unhealthy food, drinking or smoking. Instead, look for healthy ways to relieve stress, such as exercise, yoga, group activities or meditation.

  1. Monitor your blood pressure at home and see your doctor regularly

Home monitoring can help you keep up to date with your blood pressure, find out if your lifestyle changes are working, and alert you and your doctor to potential health complications. Blood pressure monitors are widely available without a prescription.

  1. Get support

Having supportive family and friends can really help in your efforts to lower or control your blood pressure. If you find you need support beyond your family and friends, consider joining a support group which can put you in touch with others who can give you valuable encouragement and advice to cope with your condition.

Risk factors for high blood pressure
  • The risk of high blood pressure increases as you age. Men are more likely to develop high blood pressure around age 45, while women are more likely to develop it after age 65.
  • High blood pressure is more common among African Americans, often developing at an earlier age than in Caucasians. Serious complications, such as stroke, heart attack and kidney failure, also are more common in African Americans.
  • Family history. High blood pressure tends to run in families.
  • Being overweight or obese. The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
  • Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the likelihood of being overweight.
  • Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure. Note: Secondhand smoke also can increase your blood pressure.
  • Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
  • Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don’t get enough potassium, you can accumulate too much sodium in your blood.
  • Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than 2 drinks a day for men and more than 1 drink a day for women may affect your blood pressure.
  • High levels of stress can lead to a temporary increase in blood pressure. But if you try to counteract stress by eating more, smoking or drinking, you may only increase your risk of high blood pressure.
  • Chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.
  • Sometimes pregnancy contributes to high blood pressure.
If you’re concerned about your blood pressure and want to get it checked, please come see us

If you think you may have high blood pressure, have been experiencing symptoms, or want to know what your exact numbers are, please contact us at Westchester Health. We’ll measure your blood pressure, evaluate if it is normal or too high, and together with you, decide on the best treatment plan to keep you as healthy as possible. Whenever, wherever you need us, we’re here for you.

By James W. Catanese, MD, FACC, a cardiologist with Westchester Health, member of Northwell Health Physician Partners

Categories: Blog

The Most Effective Treatments for Male Infertility

Westchester Health Blog - Wed, 05/30/2018 - 10:57

At Westchester Health, an issue that some of our male patients suffer from is infertility, and we know how stressful and frustrating this can be for men. Fortunately, infertility is not always a permanent prognosis—it can be treated and in a great many instances, can be reversed.  In this blog, we hope to dispel some myths and offer helpful information so that men with this condition can get help and hopefully, conceive a child.

What causes male infertility?

Male infertility is due to low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices, environmental effects and other factors can all play a role in causing male infertility.

Medical causes

Jerry Weinberg, MD

A number of health issues and medical treatments can cause infertility, namely:

1) Varicocele. The most common reversible cause of male infertility, a varicocele is a swelling of the veins that drain the testicle and results in reduced quality of the sperm. Although it’s unknown why varicoceles cause infertility, the reason may be related to abnormal testicular temperature regulation.

2) Infection. Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis), as well as some sexually transmitted infections, including gonorrhea or HIV. Although some infections can result in permanent testicular damage, sperm can still be retrieved in most cases.

3) Ejaculation issues. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. This can be caused by various health conditions, including diabetes, spinal injuries, medicationsand surgery (of the bladder, prostate or urethra). Some men with spinal cord injuries or certain diseases are unable to ejaculate semen, even though they still produce sperm. However, in these cases sperm can still be retrieved for use in assisted reproductive techniques.

4) Obstruction. An obstruction can occur anywhere between the testicles and the penis.

5) Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them by attacking them.

6) Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, or through other, unknown causes. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.

7) Undescended testicles. During fetal development of some men, one or both testicles fail to descend from the abdomen into the scrotum, the sac that contains the testicles. Decreased fertility is more likely in men who have had this condition.

8) Hormone imbalances. Infertility can sometimes result from disorders of the testicles themselves, or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands.

9) Defects of tubules that transport sperm. Many different tubes carry sperm. These can become blocked due to injury from surgery, prior infections, trauma or abnormal development such as with cystic fibrosis or similar inherited conditions. Blockage can occur at any point, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.

10) Chromosome defects. Inherited disorders such as Klinefelter’s syndrome (a male born with two X chromosomes and one Y chromosome instead of one X and one Y) cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener’s syndrome.

11) Problems with sexual intercourse. These can include trouble keeping an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities (such as having a urethral opening beneath the penis) or psychological or relationship issues that interfere with sex.

12) Celiac disease. Celiac disease, a digestive disorder caused by sensitivity to gluten, can cause male infertility, but this can improve after switching to a gluten-free diet.

13) Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production and decrease male fertility.

14) Prior surgeries. Certain surgeries may prevent the presence of sperm in a man’s ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse these blockages or to retrieve sperm directly from the epididymis and testicles.

Environmental causes

Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include:

1) Industrial chemicals. Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.

2) Heavy metal exposure. Exposure to lead or other heavy metals also may cause infertility.

3) Radiation or X-rays. Exposure to radiation can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, however, sperm production can be permanently reduced.

4) Overheating the testicles. Elevated temperatures impair sperm production and function. Although research findings are mixed, frequent use of saunas or hot tubs may temporarily impair a man’s sperm count. Sitting for long periods (such as truck driving), wearing tight clothing or working on a laptop computer for long stretches of time also may increase the temperature in the scrotum and may slightly reduce sperm production.

Health, lifestyle and other causes

Some other causes of male infertility include:

1) Illicit drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may also temporarily reduce the number and quality of sperm.

2) Alcohol use. Frequent drinking of high levels of alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking may also lead to fertility problems.

3) Tobacco smoking. Men who smoke may have a lower sperm count than those who don’t smoke. Secondhand smoke also may affect male fertility.

4) Emotional stress. Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect sperm count.

5) Weight. Obesity can impair fertility in several ways, including directly impacting sperm and causing hormone changes that reduce male fertility.

Symptoms to watch for

The most obvious sign of male infertility is the inability to conceive a child. Although most men experiencing infertility do not notice any other symptoms, other signs and symptoms include:

  • Problems with sexual function: difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire or difficulty maintaining an erection (erectile dysfunction)
  • Pain, swelling or a lump in the testicle area
  • Recurrent respiratory infections
  • Inability to smell
  • Abnormal breast growth (gynecomastia)
  • Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
  • Having a lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)
Treatments for male infertility

If you’re experiencing the frustration of infertility, the good news is that there are a number of effective treatments that in many cases can reverse this condition and allow you to father a child.

1) Surgery. A varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.

2) Treating infections. Antibiotic treatment might cure an infection of the reproductive tract which may also restore fertility.

3) Treatments for sexual intercourse problems. Medication or counseling can help improve infertility related to erectile dysfunction or premature ejaculation.

4) Hormone treatments and medications. Your doctor might recommend hormone replacement or other medications in cases where infertility is caused by high or low levels of certain hormones, or problems with the way your body uses hormones.

5) Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and decisions. The sperm are then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.

Some lifestyle and home remedies you can do that can also help

There are many steps you can take at home to increase your chances of conception:

1) Have sex more often. Having sexual intercourse every day or every other day beginning at least 4 days before your partner’s ovulation increases your chances of getting her pregnant.

2) Have sex when fertilization is most possible. A woman is likely to become pregnant during ovulation, which occurs in the middle of the menstrual cycle, between periods. This will ensure that your sperm, which can live several days, is present when conception is most likely.

3) Avoid lubricants. Products such as Astroglide or K-Y jelly, lotions and saliva can impair sperm movement and function. Ask your doctor about sperm-safe lubricants.

4) Cut out things that hurt your chances of having healthy, viable sperm: marijuana, cocaine, tobacco, and more than two alcoholic drinks a day harm sperm production. Avoid hot baths and whirlpools.

5) Don’t take testosterone or any steroids.

6) Getting enough sleep and good nutrition will improve your fertility.

Have questions about male infertility? Come see us.

If you or your partner are experiencing male infertility and want to talk to a doctor about it, please make an appointment with Westchester Health to see one of our urology specialists. After examining you and conducting a thorough health history, he/she will discuss treatments that will be the most effective for your specific condition, answer all your questions, and possibly order a number of diagnostic tests so that hopefully, you will soon be able to conceive a child. Whenever, wherever you need us, we’re here for you.

By Jerry Weinberg, MD, a Urologist with Westchester Health, member of Northwell Health Physician Partners

Categories: Blog

Does A Large Waist Mean You Have A Metabolic Disorder?

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

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

Some metabolic definitions Metabolism

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

Metabolic syndrome or metabolic disorder

Mindy Sotsky, MD, FACE

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

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

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

Metabolic risk factors to be aware of

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

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

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

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

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

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

Categories: Blog

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

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

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

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

William B. Dieck, MD, FAAO

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

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

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

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

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

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

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

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

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

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

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

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

Categories: Blog

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

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

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

 

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

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

Categories: Blog

How To Know If Your Child Has Celiac Disease

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

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

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

Mason Gomberg, MD

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

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

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

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

Learn more about celiac disease

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

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

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

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

Categories: Blog

Internet Safety: Best Ways To Protect Your Child Online

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

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

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

    Lauren Adler, MD, FAAP

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

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

Get involved in your kids’ online activities

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

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

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

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

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

Know the internet safety laws

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

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

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

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

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

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

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

Categories: Blog

Why You Really Need Folic Acid When You’re Pregnant

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

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

Folic acid helps prevent neural tube defects

Navid Mootabar, MD, FACOG

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

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

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

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

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

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

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

How much folic acid do you need?

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

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

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

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

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

When you might need extra folic acid

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

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

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

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

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

Good food sources of folic acid

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

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

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

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

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

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

Categories: Blog

Best Ways To Treat Your Child’s Headaches

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

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

Typical causes of headaches

Lauren Adler, MD, FAAP

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

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

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

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

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

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

  1. Keep a “headache diary”

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

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

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

  1. Preventative medicines for migraines

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

What your child can do to prevent headaches

These tips may help your child keep headaches from starting:

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

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

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

Categories: Blog

6 Best Exercises During Pregnancy

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

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

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

The many benefits of exercising during pregnancy

Lisa Roth-Brown, MD, FACOG

For your baby:

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

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

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

Here are some tips for staying safe while you exercise.

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

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

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

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

  1. Brisk walking

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

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

  1. Swimming

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

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

Additional tips:

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

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

  1. Yoga

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

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

  1. Low-impact aerobics

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

Benefits of low-impact aerobics:

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

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

  1. Preparing for labor: squatting and pelvic tilts

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

Squatting: During labor, squatting helps open up the pelvis

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

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

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

Stop exercising and consult your healthcare provider if you:

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

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

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

Categories: Blog

5 Best Ways to Alleviate the Pain of Plantar Fasciitis

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

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

What causes plantar fasciitis

John Viscovich, DPM, MBA, FACFAS

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

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

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

  1. Stretch the fascia

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

  1. Roll a frozen water bottle under the arch

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

  1. Wear a night splint

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

  1. Tennis ball massage

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

  1. Support your arch

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

Freedom from pain

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

If you’re experiencing plantar fasciitis pain

If you think (or know) that you have plantar fasciitis, make an appointment to come see me at one of my Westchester Health offices. I’ll examine your heels, ankles and feet, evaluate your condition, and together with you, determine the best course of treatment to alleviate and hopefully, eliminate your pain.

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

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