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Why We Believe So Strongly In Getting Vaccinated

Wed, 04/17/2019 - 10:56

At Westchester Health, we firmly believe in the importance of vaccinations, for children and adults. Even though some people choose to “opt out” of getting immunized against disease, we recommend to all our patients, now more than ever, that they vaccinate themselves and their families, every year.

Rajiv Punn, MD

Short of basic sanitation and nutrition, no medical intervention has done more to save lives and prevent disease than vaccinations.

According to the World Health Organization, immunizations are the safest and most cost-effective way of preventing disease, disability, death and inequity worldwide. It’s estimated that vaccines annually prevent almost 6 million deaths worldwide. Just in the U.S. alone, there has been a 99% decrease in the top nine diseases for which vaccines have been recommended.

Do vaccines work? Yes.

Vaccines are the best protection we have against many serious diseases. Ever since vaccines were invented, the number of babies and adults who get sick or die from vaccine-preventable diseases has decreased dramatically. In fact, some diseases have been wiped out altogether. As long as diseases are around, people will continue to get sick, which is why it’s so important to get vaccinated.

Are vaccinations safe? Yes.

Before being approved, all vaccines administered in the U.S. must be tested by the Food and Drug Administration (FDA). The FDA will not allow a vaccine to be given unless it has been proven to be safe and to actually work. Then this data is reviewed again by the Centers for Disease Control and Prevention (CDC) and the American Academy of Family Physicians before a vaccine is officially permitted to be administered.

Here is additional information from the FDA website:

Vaccines, as with all products regulated by FDA, undergo a rigorous review of laboratory and clinical data to ensure the safety, efficacy, purity and potency of these products. Vaccines approved for marketing may also be required to undergo additional studies to further evaluate the vaccine and often to address specific questions about the vaccine’s safety, effectiveness or possible side effects.

According to the Centers for Disease Control and Prevention, vaccines have reduced preventable infectious diseases to an all-time low and now few people experience the devastating effects of measles, pertussis and other illnesses.

The Center for Biologics Evaluation and Research (CBER) regulates vaccine products. Many of these are childhood vaccines that have contributed to a significant reduction of vaccine-preventable diseases.

The FDA also monitors where and how vaccines are made. Laboratories manufacturing vaccines must be licensed and are regularly inspected. Plus, each vaccine lot is safety-tested.

Do vaccinations cause autism? No.

In 1998, a British researcher named Andrew Wakefield published a fraudulent research paper proposing a hypothetical link between the MMR vaccine and autism, a link that has long since been thoroughly debunked. (Because a number of parents believed this now-discredited theory and chose not to immunize their children, an outbreak of measles occurred and many children died.) We’ve actually written several blogs on this subject that we encourage you to read.

Over the last two decades, extensive research has studied whether there is any link between childhood vaccinations and autism. The results of this research are clear: vaccines do not cause autism — all the more reason why at Westchester Health, we strongly advise immunizing yourself and your family.

Herd immunity benefits all of us

Most vaccine-preventable diseases are spread from person to person. When an individual has been vaccinated for a particular disease, he/she is then immune to that disease and cannot infect others. The greater number of people who are vaccinated, the fewer opportunities there are for a disease to spread, and the entire community is less likely to get the disease. This is known as herd, or community, immunity.

When enough people are vaccinated, everyone — including those who are too young or too sick to be immunized — receives some protection from the spread of diseases, even those who are unvaccinated. This means that even people who don’t get vaccinated will have some protection from getting sick. Because of herd immunity, a disease can become rarer and sometimes, disappear altogether.

What would happen if we stopped vaccinating?

Before immunizations, diseases like whooping cough, polio, measles, rubella and the flu affected hundreds of thousands of babies, children and adults in the U.S., killing thousands (even millions in some cases) every year. As vaccines were developed and became widely used, these diseases greatly declined until today, most of them are nearly gone from this country.

Examples of the effectiveness of vaccines
  • In 1921, before there was a vaccine against diphtheria, more than 15,000 Americans died from this preventable disease. Since 2004, only one case of diphtheria has been reported to the CDC.
  • An epidemic of rubella (German measles) in 1964-65 infected 12½ million Americans, killed 2,000 babies and caused 11,000 miscarriages. In 2012, only 9 cases of rubella were reported to the CDC.
  • Before the measles vaccine, there used to be thousands of cases in the U.S. each year. After the development of the vaccine, there were less than 100 in 2000. However, because some parents choose not to vaccinate their children against measles, more than 600 cases were reported in 2014. Now in 2019, we’re seeing a similar outbreak of measles due to parents not vaccinating their children.
Are there side effects from getting a vaccine?

After getting a vaccination, you may experience mild side effects such as swelling, redness or tenderness where the injection was given, but these do not last long. You may also have a slight fever for a short time. It is rare for side effects to be serious, but contact your doctor right away if you have:

  • A very high fever (more than 103°F)
  • Hives or black-and-blue areas at places where the injection was not given
  • A seizure
Vaccines we recommend

To stay healthy, we recommend the following immunizations:

  • Hepatitis A and hepatitis B vaccines: help prevent serious liver diseases
  • Tdap vaccine: helps prevent diphtheria, tetanus (lockjaw) and pertussis (whooping cough)
  • Hibvaccine: helps prevent Haemophilus influenzae type b (a cause of meningitis)
  • Pneumococcal vaccine: helps prevent ear infection, pneumonia, bacterial meningitis and infections of the blood
  • Polio vaccine: helps prevent a crippling viral disease that can cause paralysis
  • Influenza vaccine: helps prevent the flu
  • MMR vaccine: helps prevent measles, mumps and rubella (German measles)
  • Varicella vaccine: helps prevent chickenpox and its many complications, including flesh-eating strep, staph toxic shock and encephalitis (inflammation of the brain)
  • Meningococcal vaccine: helps prevent serious bacterial diseases that affect the blood, brain and spinal cord
  • HPV (human papillomavirus) vaccine: helps prevent viral infections in teens and adults that cause cancers of the mouth and throat, cervix and genitals, as well as genital warts
  • Shingles vaccine: helps prevent shingles, a painful rash that usually develops on one side of the body, the face or torso.
For a list of vaccine-preventable diseases and the vaccines that prevent them, click here. For a list of CDC recommended vaccines by age, click here. To learn more about the importance of immunizations: If you want to know more about the effectiveness and safety of vaccines, please come see us

If you have questions or concerns about the efficacy or safety of vaccines for you and your family, please contact us at Westchester Health. We’ll meet with you, explain our belief in the necessity of vaccines, and make sure all your questions are answered. Whenever, wherever you need us, we’re here for you.

By Rajiv Punn, MD, a Family Medicine practitioner with Westchester Health, member of Northwell Health Physician Partners

Categories: Blog

Is It A Cold Or The Flu? How To Tell The Difference.

Wed, 04/10/2019 - 10:34

You feel tired, weak, achy and overall lousy. Your nose is running, your throat hurts, you’re sneezing and coughing, you have a headache and you’re running a fever. Do you have a cold or the flu? Is the flu even something you should still worry about in April?

What’s the difference between a cold and the flu?

If you can’t tell if you have a cold or the flu, it’s no wonder. Because they have similar symptoms, it can be hard to tell the difference based on symptoms alone. Tests that must be done within the first few days of the illness can identify whether a person has the flu.

The common cold and the flu are both respiratory illnesses but are caused by different viruses

In general, the flu is worse than the common cold and symptoms are more intense, whereas colds are usually milder and people with colds are more likely to have a runny or stuffy nose. While cold symptoms can make you feel bad for a few days, flu symptoms can make you feel quite ill for a few days to 2-3 weeks. Also, colds generally do not result in serious associated complications, such as pneumonia, bacterial infections or hospitalizations, but with the flu, this is a very real concern.

                                                                                                                                              Courtesy of the CDC

Flu symptoms

Influenza (the flu) is a contagious respiratory illness caused by flu viruses.  According to the New York State Department of Health alert on March 28, influenza season continues and there has been an increase in influenza A.  People suffering from the flu typically experience some or all of these symptoms:

  • Fever or feeling feverish (but not everyone with the flu will have a fever)
  • Chills
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Muscle or body aches
  • Headaches
  • Fatigue (tiredness)
  • Vomiting and diarrhea (more common in children than adults)
Complications from the flu

Most people who get the flu will recover in a few days to two weeks, but some develop complications, some of which can be life-threatening or even fatal. These complications can include:

  • Sinus and ear infections
  • Pneumonia
  • Inflammation of the heart (myocarditis)
  • Inflammation of the brain (encephalitis)
  • Inflammation of the muscle (myositis, rhabdomyolysis) tissues
  • Multi-organ failure (e.g., respiratory and kidney failure)
  • An inflammatory response in the body which can lead to sepsis (life-threatening response to infection)

The flu also can make chronic medical problems worse. For example, people with asthma may experience asthma attacks while they have flu, and people with chronic heart disease may experience a worsening of this condition.

How the flu is spread

The flu virus is spread predominantly through droplets in the air, so if you are with 3-6 feet of someone who is infected, you can easily breathe in their germs in their exhaled breath. The virus then latches onto the mucous membranes that line the back of your nose, throat and bronchial tubes. Eventually, your body’s immune system releases proteins called interferons which produce the fever, headache and muscular aches and pains that distinguish the flu from a common cold.

People at high risk for flu complications

Anyone can get the flu and serious problems related to the flu can happen at any age, but some people are particularly at high risk of developing serious flu-related complications. These include:

  • People 65 years and older
  • People with chronic medical conditions (such as asthma, diabetes or heart disease)
  • Pregnant women
  • Children younger than 5 years, but especially those younger than 2 years
Emergency warning signs of the flu In children
  • Fast breathing or trouble breathing
  • Bluish skin color
  • Not drinking enough fluids
  • Not waking up
  • Not interacting
  • Being so irritable that he/she does not want to be held, inconsolable
  • Flu-like symptoms improve but then return with fever, and cough gets worse
  • Fever with a rash
In adults
  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting
  • Flu-like symptoms improve but then return with fever, and cough gets worse
In addition to the signs above, GET MEDICAL HELP RIGHT AWAY OR CALL 911 for an infant with any of these signs:
  • Unable to eat
  • Has trouble breathing
  • Has no tears when crying
  • Significantly fewer wet diapers than normal
Common cold symptoms

Though certainly no fun to live with, cold symptoms are generally milder than those of the flu and usually last for about a week. A cold often begins with a sore throat which tends to go away after a day or two. A runny nose and congestion follow, along with a cough by the fourth and fifth days. Fever is not typical in adults, but a slight fever is possible. Children are more likely to have a fever with a cold.

Dark mucus in the nose is natural and does not necessarily mean you have a bacterial infection, such as a sinus infection. (If cold symptoms do not improve after a week, you may have a bacterial infection, which means you may need antibiotics.)

Fight the flu: get vaccinated!

At Westchester Health, we strongly believe that everyone should get immunized against the flu (the flu shot). In almost all cases, getting the flu shot prevents the disease, prevents it from spreading, and prevents deaths. Even in years when the flu vaccine is less effective, it is still very important to get it.  A flu vaccine can lessen the severity of the illness if it does not completely prevent it.

In the absence of a pandemic, a severe flu year still kills nearly 650,000 people worldwide, and even a mild year kills around 300,000. In recent years, the CDC estimates that the flu has killed about 12,000 Americans in mild years and 56,000 in moderately severe ones.

To learn more, watch these 3 videos from the CDC Worried that you or a family member has the flu? Come see us.

To know for sure, make an appointment with Westchester Health to see one of our Family Medicine physicians. We’ll examine you, evaluate your symptoms, perhaps perform some tests, then recommend the best course of treatment so that hopefully you can feel better soon. And if you don’t have the flu, there are many recommendations we can make to help support you through a cold as well. Whenever, wherever you need us, we’re here for you.

By Meghan Auten, MD, a Family Medicine physician with Westchester Health, member of Northwell Health Physician Partners

Categories: Blog

What Are The Best Ways To Treat Warts?

Wed, 04/03/2019 - 10:42

If you’ve ever had a wart, you know how unsightly, painful and downright annoying it can be. You just want it to go away, fast. Unfortunately, getting rid of warts is often a slow process, but it can be done. At Westchester Health, we’ve pooled our most effective treatments, both at-home remedies and those administered by a physician, and we share those with you here.

What causes warts?

Alison F. Stallings, MD, FAAD

Warts are skin growths that are caused by direct contact with the human papillomavirus (HPV), which is contagious. There are more than 60 kinds of HPV, some of which cause warts on the fingers, near the fingernails, or on the hands. Certain types of HPV can also cause warts in the genital area.

Three types of warts
  1. Plantar warts: Located on the soles of the feet, this type of wart usually appears as flesh-colored or light brown lumps of skin.
  2. Genital warts: These can appear in the pubic area, on the genitals, in or around the anus, and/or in the vagina. They often appear in clusters of three or four and may grow and spread rapidly. Genital warts are usually not painful although they can cause mild pain, bleeding and itching. HPV infection is the most common sexually transmitted disease in the U.S. and certain forms of the virus can cause cervical cancer.
  3. Flat warts: More common in teens and children than in adults, this type of wart generally occurs on the face but can also appear on the legs, especially in females.
Got warts? Try these treatments

In most cases, warts are harmless and will disappear on their own. However, sometimes specific treatment is needed, and more than one type of treatment may be necessary. Also, keep in mind that most methods require multiple applications.

IMPORTANT: While you’re treating your warts, don’t scratch or pick at them. This only makes them worse and can also spread them to other parts of your body.

Effective treatments include:

1. Freezing (Cryotherapy): To freeze a wart, there are several over-the-counter spray products available or you can see a doctor who will use liquid nitrogen. With cryotherapy, a blister forms around the wart and then the dead tissue falls off within 1-2 weeks.

2. Cantharidin: This substance is an extract of a blister beetle that, when applied to the skin, forms a blister around the wart which will eventually lift the wart off the skin. After application, the area needs to be covered with a bandage.

3. Medications: Two widely used prescription medications are bleomycin (which is injected into the wart to kill the virus) and imiquimod (a cream that stimulates your own immune system to fight off the wart virus).

4. Salicylic acid: Whether in the form of a gel, ointment or pad, over-the-counter wart treatments contain salicylic acid as the active ingredient. When applied on a regular basis, this acid gradually dissolves the wart tissue, but the process may take several weeks.

5. Duct tape: As unconventional as it sounds, duct tape can be effective at removing warts, layer by layer, on the hands and fingers over the course of several weeks. For this method: place a small piece of duct tape on your wart and leave it in place for 3-6 days. Remove the tape and gently scrape the wart down with a nail file or pumice stone, leaving it exposed to air for 12 hours. Reapply the duct tape and repeat this process until the wart is gone completely.

6. Minor surgery: When warts can’t be removed by other therapies, surgery may be employed to cut away the wart. The base of the wart is then destroyed using an electric needle or by cryosurgery.

7. Laser surgery: This procedure uses an intense beam of light (laser) to burn and destroy wart tissue.

To reduce your risk of warts:
  • Avoid direct contact with warts.
  • Don’t pick at warts. Picking may spread the virus.
  • Don’t use the same emery board, pumice stone or nail clipper on your warts as you use on your healthy skin and nails.
  • Don’t bite your fingernails. Warts occur more often in skin that has been broken, and chewing the skin around your fingernails opens the door for the virus.
  • Avoid brushing, clipping or shaving areas that have warts. If you must shave in a particular spot with warts, use an electric razor.
Helpful websites Do you have warts that you’d like to get rid of? Come see us.

If you have a wart and want to know the best way to make it go away, please make an appointment with Westchester Health to see one of our dermatology specialists. We’ll examine your wart, then recommend a course of treatment that will eradicate it and hopefully prevent it from coming back. Whenever, wherever you need us, we’re here for you.

By Alison F. Stallings, MD, FAAD, a Dermatologist with Westchester Health, member of Northwell Health Physician Partners

Categories: Blog

Why More Men Than Women Get Skin Cancer

Wed, 03/27/2019 - 09:42

As a dermatologist, whenever I ask people what they think is the most common type of cancer, they usually say breast cancer, lung cancer or prostate cancer. But in fact, skin cancer is the most common. Not only that, more people are diagnosed with skin cancer each year in the U.S. than all other cancers combined.

What’s also an astounding (and disturbing) fact is that many more men develop skin cancer than women, including melanoma, the most dangerous of the three most common types of skin cancer.

When it comes to skin cancer, men far outnumber women

In skin cancer statistics, there’s a glaring difference between the genders. According to The Skin Cancer Foundation, more than half (57%) of those diagnosed with one basal cell carcinoma (BCC) are men. As the number of BCCs increases, so does the gender gap: 62% of people diagnosed with 2-5 BCCs are men. And among those with 6 or more BCCs, an alarming 80% are male, as the chart below illustrates.


                                       courtesy of The Skin Cancer Foundation

For more serious skin cancers, the numbers are even worse. Men account for more than half of new cases of invasive melanoma—and almost twice as many deaths.

Why the gender gap?

There’s no single answer as to why more men develop skin cancer than women, but rather, many reasons.

  1. It is estimated that in 2018, 55,000 new cases of invasive melanoma in the U.S. will be diagnosed in men vs. 36,000 cases in women, reports The Skin Cancer Foundation. In the same year, an estimated 9,320 people will die of melanoma in the U.S. Of those, 5,990 will be men and 3,330 will be women. Clearly, there’s more work to do in communicating to men the need for sun protection and early detection.
  2. Many more men than women develop melanoma after age 49, possibly the result of a lifetime of sun exposure and poor sun protection. All of this unprotected sun exposure has a cumulative effect over the years. (Before age 49, more women than men develop melanoma, probably due to women’s greater use of tanning beds.)
  3. Men tend not to wear sunscreen. While they don’t lie out in the sun as much as women to get tan, men are definitely less likely to take measures to protect themselves from sun damage, whether they’re fishing or playing golf or taking their shirt off for basketball.
  4. Men don’t get their skin checked regularly. As the saying goes, women go to the doctor, men go to the emergency room. Men simply do not go to the doctor if they can help it, which is why women are men’s best health advocates. In many instances in my practice, I’ve been able to catch potentially serious skin cancer in an early stage because a wife or girlfriend made the appointment for the male patient after seeing a suspicious-looking mole on his back.
  5. Men rarely examine their skin. Women are taught from a young age to examine their breasts regularly, so when they read (often in women’s magazines which are more health-oriented than men’s) that they should examine their skin regularly too, they are more likely to comply.
  6. Men cannot see the area of their body that’s at the highest risk for developing a melanoma, which is the back. (For women, the deadliest cancers appear on the legs.) This means that men don’t detect developing cancer once it has started to bleed, scab, change or grow, all of which are skin cancer warning signs. It is crucial to catch melanoma early when it is 100% curable, and waiting even a few months too long can mean the difference between life and death.
Women have some advantages regarding skin cancer
  1. Women’s long hair may help protect them from developing some forms of skin cancers of the head and neck. Men develop many more precancerous lesions, such as actinic keratosis, on the scalp and ears, due to their thinning hair or bald heads.
  2. Women tend to use sunscreen more than men. They’re used to applying moisturizer and other types of creams, so adding sunscreen to their daily skin care routines isn’t a big deal. This makes women more proactive when it comes to protecting their skin, whereas men tend to wait until there is a problem and then try to fix it.
  3. Women think about their skin, a lot. This makes them more diligent about using sunscreen, wearing hats and sunglasses, and seeking shade because of the way the sun can cause their skin to age faster and make them look older. Approximately 90% of the skin changes that occur as a person ages, including wrinkles, sunspots and textural abnormalities, are attributable to UV exposure. In contrast, men usually don’t think much about their skin until there’s a problem.
  4. Women go to the doctor much more often than men. This means that women are more likely to be referred to a dermatologist because their primary physician or OB/GYN has detected a potential problem.
Good sun protection habits both men and women should follow
  1. Whether you’re a man or a woman, it’s important to make an appointment with a dermatologist as soon as an irregular mole, scaly or crusty area, or any other unusual skin issue is detected.
  2. Even it takes many years for a bad sunburn to turn into skin cancer, it’s important to teach children from a young age how to properly protect their skin from the harmful rays of the sun. This includes using sunscreen not just at the beach but on the playground, on the soccer field, mowing the lawn and anywhere else they’re in the sun. Encourage them to wear hats and sunglasses when they’re outdoors, and as they get older, to have their skin checked regularly.
  3. Daily sunscreen use reduces the risk of developing SCC squamous cell carcinomas (SCC) by 40% and melanoma by 50%.
  4. Apply sunscreen not just to the obvious places—face, arms and legs—but also to the back, ears, scalp, back of the neck, hands and feet.
  5. When swimming outdoors, wear a swim shirt and water-resistant sunscreen, reapplied frequently.
  6. Avoid tanning beds. Studies show that people who use a tanning bed for the first time before age 35 increase their risk for developing melanoma by 75%.
Worried that you may have skin cancer? Come see us.

If you’ve noticed a suspicious looking mole or area of skin and think you may be developing skin cancer, or want to learn ways to lower your risk of skin cancer, please make an appointment with Westchester Health to see one of our dermatologists. He or she will examine your skin, take a sample of the questionable area and have it tested, remove a pre-cancerous or cancerous mole, and/or refer you to an oncologist if needed. Our specialist will also take as much time as is necessary to listen to your concerns and answer your questions so that you fully understand your condition and treatment options. Whenever, wherever you need us, we’re here for you.

By Alison F. Stallings, MD, FAAD, a Dermatologist with Westchester Health, member of Northwell Health Physician Partners

Categories: Blog

Got Psoriasis? 10 Best Home Remedies To Manage The Itching

Wed, 03/20/2019 - 09:01

At Westchester Health, we have a lot of patients come to us wanting relief for their psoriasis, a common but chronic skin condition that’s primarily caused by an overactive immune system which produces inflammation, triggering new skin cells to form too quickly. Normally, skin cells are replaced every 10-30 days but with psoriasis, new cells grow every 3-4 days. It’s the buildup of old cells being replaced by new ones that signals psoriasis.

Do you have psoriasis?

Psoriasis usually appears in early adulthood but can come and go throughout a person’s life.  Typical symptoms include thick, red, bumpy patches covered with silvery, flaking scales. The affected skin itches, cracks and can bleed easily if a person picks or rubs off the scales. Finger- and toenails can form pits, thicken, crack and become loose.

Alison F. Stallings, MD, FAAD

These patches can pop up anywhere, but most commonly appear on the scalp, elbows, knees and lower back. In severe cases, psoriasis can afflict large parts of the body and be quite painful.

People with psoriasis can also get a type of arthritis called psoriatic arthritis which causes pain and swelling in the joints. The National Psoriasis Foundation estimates that 10-30% of people with psoriasis also have psoriatic arthritis.

Fortunately, psoriasis can’t be passed from person to person but it does sometimes occur in members of the same family.

More than just a skin condition

Depending on where it is on your body, psoriasis can be an embarrassing disease. Often, people with psoriasis won’t be allowed in a swimming pool. Fellow passengers on a crowded train move away from them. Friends don’t want them to handle food or help out in the kitchen when making a meal.

All of this can make people with psoriasis feel isolated and excluded, which can have serious psychological side effects. Combine these emotions with the pain and discomfort psoriasis can cause and this condition becomes very stressful, which only makes it worse.

In fact, studies have shown that psoriasis detracts more from the quality of life than any other condition except depression, and that’s including life-threatening illnesses such as heart disease and diabetes.

10 best ways to treat psoriasis

At this time, there’s no outright cure for psoriasis but it does respond well to certain creams, ointments, prescription retinoids and phototherapy. In addition, here are our 10 best suggestions for home remedies you can administer yourself at home:

Tip 1: Keep your skin moist

After applying thick lotions or creams onto the affected area, seal in the moisture with ointments like petroleum jelly, shortening or olive oil. Dry skin makes the irritation and itchiness of psoriasis worse. Be careful not to use too much during hot, sticky summer months. Sweat mixed with thick creams can make psoriasis worse.

Tip 2: Take fewer showers and baths

Over-bathing can strip your skin of natural oils. We suggest bathing every other day or every third day, especially in the winter. Make sure the water’s not too hot—lukewarm is best. To help your skin retain moisture, add non-fragrance salts, oil or finely ground oatmeal to your bathwater.

Tip 3: Before you go to bed, wrap the affected skin with a bandage or plastic wrap.

In the morning, wash the area gently. Over time, this can help with scaling.

Tip 4: Spend time in the sun

Sunlight can help psoriasis but sunburn makes it worse. For this reason, use a sunscreen that contains zinc oxide and has an SPF of 30 or higher on areas that don’t have psoriasis, and limit how much sun you get. Twenty minutes a day 3 days a week is good.

Tip 5: Stop smoking

Smoking makes psoriasis worse. In one study, people who smoked more than a pack a day were twice as likely to have a serious case of psoriasis compared to those who smoked half a pack or less. The effects were even stronger in women who already had psoriasis.

Tip 6: Drink moderately or not at all

Psoriasis is more common in people who drink heavily, and alcohol may affect men’s psoriasis more than women’s.

Tip 7: Change your diet

There’s no solid evidence that any particular food makes psoriasis better or worse. However, many people report that their patches of affected skin get better when they cut back on sugar, white flour and caffeine.

Tip 8: Pay attention to your mental health

Try not to let psoriasis negatively affect your self-esteem. If this condition is dragging you down, please get help. Talking to a therapist or joining a support group of other people who understand what you’re going through can really help.

Tip 9: Try to minimize stress

Stress can make psoriasis worse so we encourage you to seek out activities that help you reduce your stress levels, such as yoga, exercise or even a stress management course.

Tip 10: Be careful with skin injuries

A harmless cut or scrape can sometimes develop into a full-blown psoriasis flare-up, due to something called Koebner’s Phenomenon. In fact, some people will develop a new psoriasis lesion every time their skin is injured. Try not to get scratches, scrapes or cuts, but if you do, contact your doctor if you see any signs of skin infection such as redness, swelling or warmth at the site of the injury.

Helpful websites to learn more Worried that you have psoriasis, or that it’s getting worse? Come see us.

If you have psoriasis and want to know the best ways to treat it, please make an appointment with Westchester Health to see one of our dermatology specialists. We’ll examine your skin, evaluate your symptoms and recommend a course of treatment that will hopefully greatly improve your condition. Whenever, wherever you need us, we’re here for you.

By Alison F. Stallings, MD, FAAD, a Dermatologist with Westchester Health, member of Northwell Health Physician Partners

Categories: Blog

Important Tips for Recognizing and Preventing Alcoholic Liver Disease

Wed, 03/13/2019 - 09:59

Here at Westchester Health, many of our adult patients drink, some of them heavily. In these cases, we do our best to warn them of the dangers of heavy drinking over a long period of time, explain how this can damage many of their vital organs and threaten their life, and refer them to support groups and/or treatment facilities.

Our main concern is the damage long-term alcohol consumption can do to the liver. Alcoholic liver disease, the main cause of liver disease in the U.S., leads to a buildup of fats and scarring of the liver, both of which are very serious. To try and prevent this potentially fatal disease, we offer these guidelines for recognizing the causes, stages and risk factors, as well as ways to try to reverse its effects.

Why your liver is so important

Steven Silverman, MD

After the brain, the liver is the most complex organ in the human body, performing over 500 functions, including:

  • producing proteins to fight infection and disease
  • filtering out blood toxins
  • manufacturing hormones, proteins and other vital chemicals
  • regulating blood cholesterol and sugar levels
  • producing proteins that enable blood clotting after an injury
  • storing energy

If your liver is damaged, it can affect your whole body. Unfortunately, this damage can take a long time to become noticeable since the liver is generally effective at repairing and regenerating itself. Often, by the time the damage is found, it is irreversible.

What causes alcoholic liver disease

Acetaldehyde is a toxic chemical produced by alcohol. It damages the liver and leads to liver scarring, such as cirrhosis or end-stage liver disease. Not all heavy regular drinkers develop liver damage, and it is not known why alcoholic liver disease affects some people and not others.

Risk factors for alcoholic liver disease

A number of factors increase the risk of developing alcoholic liver disease.

  1. People who drink beer and liquor are more likely to experience liver disease compared to those who consume wine or other alcoholic beverages.
  2. Women metabolize alcohol more slowly than men, making them more susceptible to developing alcoholic liver disease. Evidence suggests that women are twice as sensitive to alcohol-related liver damage as men.
  3. Women who consume high amounts of alcohol and also carry excess body weight have a greater chance of developing chronic liver disease and dying as a result of liver disease.
  4. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 13% of women who drink in the U.S. consume more than seven drinks in a week.
  5. Hepatitis C increases the risk of developing alcoholic liver disease. In addition, a regular drinker who has had any type of hepatitis has a higher chance of developing liver disease.
  6. Genetic factors can also affect someone’s risk. If a person experiences changes in the genetic profiles of particular enzymes that are key to alcohol metabolism, such as ADH, ALDH or CYP4502E1, they will have a higher chance of developing alcoholic liver disease.
The 4 stages of alcoholic liver disease 1) Alcoholic fatty liver disease

Heavy drinking can cause fatty acids to collect in the liver. Sometimes, heavy drinking over a short period, even less than a week, can cause this to happen. There are normally no symptoms, and this stage is reversible if the person abstains from alcohol for at least 2 weeks. If the accumulation of fatty acids in the liver is severe, the person may experience:

  • weakness
  • nausea
  • abdominal pain
  • loss of appetite
  • feel generally unwell
2) Alcoholic hepatitis

Hepatitis describes the inflammation, or swelling, of the liver from any cause. In alcoholic liver disease, this can happen after many years of heavy drinking. It can also occur after binge drinking or heavy drinking over a relatively short period. Alcoholic hepatitis is usually reversible if the person abstains from alcohol for several months, or for some people, several years.

Symptoms may include:

  • pain or tenderness in the abdomen
  • jaundice (yellowing of the skin and whites of the eyes)
  • spider-like veins on the skin
  • general tiredness
  • fever
  • nausea
  • loss of appetite
3) Fibrosis

Fibrosis is an excessive accumulation of certain types of protein in the liver, including collagen. Fibrosis is present in most types of chronic liver diseases, and advanced liver fibrosis results in cirrhosis.

4) Cirrhosis

Cirrhosis of the liver occurs when the liver has been inflamed for a long time, resulting in scarring and loss of function. This can be a life-threatening condition. Cirrhosis damage is irreversible, but the person can prevent further damage by abstaining from alcohol. This can improve liver function, but if the damage is permanent and severe enough, the person may need a liver transplant to survive.

Early-stage cirrhosis:

  • feeling tired and weak
  • palms may be blotchy and red
  • weight loss
  • itchy skin
  • insomnia
  • abdominal pain and tenderness
  • loss of appetite

End-stage cirrhosis

  • hair loss
  • continued weight loss
  • jaundice
  • dark urine
  • black or pale stools
  • dizziness
  • fatigue
  • loss of libido
  • bleeding gums and nose
  • easily bruised skin
  • edema (swelling)
  • vomiting with blood in the vomit
  • muscle cramps
  • irregular breathing
  • accelerated heartbeat
  • increased abdominal girth
  • personality changes
  • confusion
  • infections
  • problems walking (staggering)

At this stage, since the liver no longer processes toxins properly, the person will have heightened sensitivity to medications and alcohol.

Guidelines for safe alcohol consumption

To prevent alcoholic liver disease and other conditions linked to the overconsumption of alcohol, we at Westchester Health advise our patients to follow the CDC national guidelines for alcohol consumption. NOTE: It’s important to keep in mind that everyone is different, and some people are more at risk than others from the effects of alcohol.

One drink is equivalent to:

  • 12 fluid ounces of beer at 5% alcohol
  • 5 fluid ounces of wine at 12% alcohol
  • 5 fluid ounces of spirits at 40% alcohol.

The guidelines classify moderate drinking as:

  • up to 1 drink a day for women
  • up to 2 drinks for men

And define high-risk drinking as:

  • 4 or more drinks in a day or 8 or more drinks in a week for women
  • 5 or more drinks in a day or 15 or more drinks in a week for men

Binge drinking is when a woman consumes 4 or more drinks, or a man consumes 5 or more drinks within 2 hours.

Resources and support groups to help you stop drinking Concerned about your alcohol consumption and risk of liver disease? Come see us.

If you’ve become concerned about the amount of alcohol you’re drinking on a daily or weekly basis and the implications this might have for liver disease, please make an appointment to come in and see one of our Westchester Health gastroenterologists (liver specialists).

He/she will examine you, perform any needed tests, answer all your questions, explain what steps you can take to improve your liver function, and possibly refer you to a support group and/or treatment facility. If your condition is serious enough, you may need liver surgery or a transplant, which our gastroenterologist will discuss with you as well. Our #1 goal is to try to reverse disease and help you become as healthy as possible. Whenever, wherever you need us, we’re here for you.

By Steven Silverman, MD, a Gastroenterologist and Internist with Westchester Health, member of Northwell Health Physician Partners

Categories: Blog

If You’re A Teen In An Abusive Relationship, Please Contact Us. We Can Help.

Wed, 03/06/2019 - 09:46

Here at Westchester Health, we want you to be safe as well as healthy and happy, which is hard to do if you’re you’re in an abusive relationship. According to a survey by the CDC, 23% of females and 14% of males who have experienced abuse by an intimate partner first experienced it between the ages of 11 and 17 years. And because much of abuse is not reported, those numbers are probably much higher. If you’re in an abusive relationship and are wondering what to do or how to get out of it, please read this blog by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group (excerpted below). Remember, there’s help out there. You don’t have to suffer in silence. 

How healthy is your relationship? Here’s how to know.

To find out if you are in a healthy or abusive relationship, ask yourself these 10 questions from Psychology Today. Answering “yes” to any of them is a warning sign that you may be in a relationship that is not good for you.

  1. Does your partner isolate you from your family and friends?

    Lauren Adler, MD, FAAP

  2. Does your partner make you feel like everything is your fault?
  3. Does your partner physically, verbally, sexually, emotionally, mentally and/or financially abuse you?
  4. Does your partner control where you go?
  5. Does your partner control what you say, who you can or can’t talk to?
  6. Does your partner control what you wear?
  7. Does your partner threaten you in any way?
  8. Does your partner force you to do things you don’t want to do (including sex or other sexual things)?
  9. Does your partner make you cry more than smile?
  10. Does your partner argue with you all the time? Call you names? Put you down?
Why teen dating violence happens

Violence in a relationship is often related to certain risk factors. The risk of having unhealthy relationships increases for teens who:

  • Believe that dating violence is acceptable
  • Are depressed, anxious or have other symptoms of trauma
  • Display aggressive behaviors
  • Use alcohol, drugs or other illegal substances
  • Engage in early sexual activity and have multiple sexual partners
  • Have a friend involved in teen dating violence
  • Have conflicts with a partner
  • Witness or experience violence at home
Need help getting out of an abusive relationship? Here are some important tips.
  1. Communicating with your partner, learning how to manage anger and jealousy, and treating each other with respect are a few ways to keep relationships healthy and nonviolent.
  2. However, if you’re in an abusive relationship, you need to get out of it. Breaking up with someone who’s abusive can be really hard, especially if you love them. Just keep reminding yourself that you have to do what’s best for you. It’s not right for anyone to hurt you, make you feel bad about yourself, or pressure you to do things you don’t want to do.
  3. Don’t be afraid to ask your parents, friends, a relative, a teacher or school counselor for help. Tell them what the other person has done to you and how they are treating you. Remember, the first step is telling someone about it.
  4. When you’re ready to break up, don’t let your partner talk you out of it. If they threaten to hurt you or themselves or someone else, tell an adult you trust right away. Your safety is the most important thing. For more advice on ending abusive relationships, visit LoveisRespect.com.
Need help? Call these numbers Helpful websites What is discussed with us stays with us

At Westchester Health, we want you to know that you can talk to us about relationships, your body, sex, sexuality, drugs, your parents, peer pressure, anything at all — and we will keep it confidential. Most of all, we want to help you be healthy, happy and safe, in any way we can.

Need to talk to someone about an abusive relationship? Come see us.

If you think you might be in an abusive relationship, or you know that you are, please come in and talk with one of our Westchester Health pediatricians. We’re here for you and we can get you help. We want you to know that we’ll do everything we can to support you and what you’re going through, and help you get a safe, healthy resolution. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Yes, Dads Can Get Postpartum Depression Too. Here’s Help.

Wed, 02/27/2019 - 09:21

Although postpartum depression in new moms is well known, it’s much less acknowledged that fathers can also become depressed after their baby’s birth. Often, the first few months are filled with the joy of a new baby, but after that, things can get tough for many men. Sound familiar? For help, please read this very helpful blog by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group (excerpted below).

Paternal postnatal depression (PPND): a serious, often overlooked, illness

Postpartum depression in dads or PPND (Paternal Postnatal Depression) is a very serious health condition that needs to be treated, just like a heart murmur or an injured knee. Without effective treatment, PPND can result in damaging, long-term consequences for a father, his baby and his entire family. But with proper treatment and support, men can fully recover from PPND.

Symptoms of PPND: do you have any?

Lauren Adler, MD, FAAP

Men and women can experience depression very differently. According to the Pacific Post Partum Support Society, here are some symptoms that are common in men suffering from PPND:

  • Increased anger and conflict with others
  • Increased use of alcohol or drugs
  • Frustration or irritability
  • Violent behavior
  • Significant weight gain or loss
  • Change in appetite
  • Isolation from family and friends, withdrawal
  • Easily stressed
  • Impulsiveness or risk-taking (including reckless driving or extramarital affairs)
  • Feeling discouraged, cynicism
  • Headaches or stomach problems
  • Problems with concentration or motivation
  • Loss of interest in work, hobbies and/or sex
  • Working constantly
  • Fatigue, low energy
  • Crying for no reason
  • Sadness lasting more than 2-3 weeks
  • Sleep problems
  • Thoughts of suicide or death
What causes PPND?

There is no single reason why dads become depressed. According to the PPPSS, some factors that can contribute to depression in new dads include:

  • Loss of sleep
  • Colicky, constantly-crying newborn
  • Personal/family history of depression
  • Financial worries
  • Feeling overwhelmed in your role as a father
  • Lack of social and/or emotional support
  • Stress in relationship with partner and/or family
  • Lack of sex with partner
  • Stressful birthing experience
  • Feeling excluded from the bond between mom and baby
How to deal with PPND
  • Talk to friends or co-workers who are also new parents. They may be facing some of the same challenges as you.
  • Take care of yourself. Make time to do things that you enjoy.
  • Make an effort to talk with your partner, even if it’s just a few minutes each day, to connect and work on your relationship.
  • Don’t expect to fix everything. Things will go wrong, problems will come up that you won’t be able to solve. Accept that this is okay.
  • If possible, try to take some time off work.
  • Find someone you trust whom you can talk honestly with about your experiences. This can be your partner, a family member, friend or counselor.
  • Keep yourself healthy. Eat well, exercise and see your family doctor if you have any health concerns.
Please get help…which will benefit you, your partner and your baby

If you feel you could be experiencing paternal postpartum depression, it’s very important to get help from a mental health professional. Support groups, and in some cases, medication, can also be very helpful.

2 helpful articles Want to know more about male postpartum depression? Come see us.

If you, your partner, or someone you know is experiencing postpartum depression, please make an appointment with one of our Westchester Health pediatricians. We’re here for you to talk to, and if need be, we can refer you to a mental health professional. As well as helping you raise a happy, healthy baby, we’ll do everything we can to support you and your mental and physical health. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

The Very Real Dangers of Vaping: What You Need To Know

Wed, 02/20/2019 - 10:07

Did you know that the amount of nicotine in an e-cigarette nicotine pod is equal to the amount in a pack of 20 cigarettes? And that because the teen brain is still developing, teen users are more susceptible to the addictive nature of nicotine? Maybe that’s why the use of e-cigarettes among adolescents has skyrocketed in recent years, according to the Food and Drug Administration (FDA), something that greatly alarms us at Westchester Health. To give parents some guidelines for helping their teens make good decisions regarding vaping, we offer this very informative blog on the subject by Cindee J. Ivker, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group (excerpted below)

Vaping is becoming more and more popular with teens

Originally developed to help smokers quit the use of traditional cigarettes, vape pods have infiltrated the teen market to a huge degree. One is the main reasons? The variety of flavors which the manufacturers add to the base of the device to lure young people (such as chocolate, strawberry, cherry, mint, fruit medley, Virginia tobacco and crème brûlée). Teens like the taste and then get hooked.

Does your teen JUUL?

Cindee J. Ivker, MD, FAAP

JUUL is the most common nicotine pod product. It is small and discreet and can easily be hidden from the untrained eye. Some JUUL products resemble a computer flash drive and can even be used in a classroom setting without being detected. In fact, according to a 2018 Truth Initiative survey, almost 1 in 5 of middle and high schoolers (20%) have seen JUULs used in school. They can easily be purchased online, in retail stores and through friends. By law, people under the age of 18 (or 21 in some areas) should not be able to purchase any tobacco products, including JUUL, but there are few safeguards and so it happens all the time.

Dangerous metals and other harmful substances are in e-cigarettes
  1. Nicotine. No matter what tobacco and e-cigarette manufacturers might report, nicotine is a very harmful, very dangerous drug. It affects the brain, nervous system and heart. The larger the dose of nicotine, the more a person’s blood pressure and heart rate go up, which 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.
  1. Propylene glycol, the chemical that allows the nicotine to be vaped or inhaled, can cause lung and eye irritation. It is not clear what long-term effects propylene glycol has on the lungs.
  1. Aluminum, when inhaled, can cause a chemical-induced pneumonia. In teens, aluminum has also been reported to damage developing bone. 
  1. Cadmium, which is also in batteries, causes nausea, vomiting and diarrhea. 
  1. Silver causes breathing problems, lung and throat irritation, and stomach pain. 
  1. Lead when inhaled can result in nerve damage and digestive issues. 
  1. Diacetyl, also found in butter-flavored microwave popcorn, when inhaled can cause scarring of the lungs. “Popcorn lung” is the scarring of the tiny air sacs in the lungs and will result in wheezing, coughing and/or shortness of breath.
  2. Benzoic acid is a naturally occurring acid found in the tobacco plant. When inhaled, it can cause irritation to the nose, throat and lungs, which like diacetyl, may cause coughing, wheezing and/or shortness of breath.
The good news: suspension of sales of most flavored vapes

As of November 2018, JUUL Labs announced that it would suspend sales of most of its flavored e-cigarette pods in retail stores and would discontinue its social media promotions, facing mounting government pressure and a public backlash over an epidemic of teenage vaping, reports The New York Times.

What you can do

Once your child starts using a vape, it is hard to get them to stop. At Westchester Health, we strongly urge you to talk to your teen about smoking abstinence in any form, whether it’s a cigarette, e-cigarette, vape, JUUL or hookah. Detecting and monitoring the use of a JUUL or nicotine pod can be difficult. Their design makes the device easy to hide and its lack of exhaled smoke makes it hard to tell that your teen is actively using it.

Suggestions for talking to your teen
  1. Be direct and tell him/her why vaping is really damaging to their health
  2. Give them the facts about lung cancer, safety issues and the long-term effect on their brain, heart and lungs
  3. Reinforce that the use of vapes are addictive like other drugs and alcohol
  4. Stress the social issues and financial impact on users
  5. Teach them to say “NO”
  6. Come to us for help—at Westchester Health, we are here for you
For more information on the dangers of vaping and e-cigarettes, you might find these articles helpful: Concerned that your teen is vaping or might start soon? Come see us.

If you’re worried that your child is vaping now or might start, please come in and see one of our Westchester Health pediatricians. Together with you and your child, we will figure out the best way forward. If needed, we will also help your child find the right support network to stop vaping. As always, our #1 goal is to help your child stay healthy and happy, in any way we can. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

How To Help Your Toddler Go To Sleep

Wed, 02/13/2019 - 08:47

At Westchester Health, we feel strongly that sleep is an essential component of healthy living, yet something that’s sometimes hard to come by (especially for exhausted parents of toddlers). Since we often get questions from bleary-eyed moms and dads wanting advice for getting their 2- or 3-year-old to go to sleep, we thought we’d share some guidelines that really seem to work, gleaned from our many years of helping parents of toddlers master the art of bedtime. Here’s a great blog on the subject by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group (excerpted below).

How much sleep toddlers should get

Toddlers need different amounts of sleep at various stages of development. According to Healthy Families BC, most, but not all, follow this pattern:

  • 12 months: Sleeps about 14 hours per day, partly during morning and afternoon naps.
  • 12-18 months: the morning nap disappears and is replaced with one longer afternoon nap.
  • 24 months: Sleeps 11-12 hours at night with a nap in the afternoon lasting 1-2 hours.
  • 36 months: Sleeps about 12 hours at night and may or may not take a short nap.

Lauren Adler, MD, FAAP

10 best ways to help your toddler fall asleep

The following suggestions from the Cleveland Clinic will hopefully (fingers crossed) help your little one fall asleep, stay asleep and establish good sleep habits:

  1. Adopt a nightly routine so your child has a quiet, calm time before bedtime and understands that it will soon be time to go to sleep.
  2. Maintain a consistent sleep schedule. Your child’s bedtime and wake up time should be the same every day, whenever possible, whether it is a school day or not.
  3. Avoid caffeinated drinks or foods. Incidentally, at Westchester Health we don’t believe that children should be consuming much caffeine, in general.
  4. Give your child a bath, read him/her a story, followed by a cuddle and soft music. Avoid active play which will only excite your child and make sleep more difficult.
  5. Give your child some choices at bedtime. Let him/her pick the bedtime story or which pajamas to wear.
  6. Let your child take a favorite object to bed at night: a teddy bear, special blanket or favorite toy. It can help him/her fall asleep, and fall back asleep if he/she awakens during the night.
  7. Avoid watching TV before bedtime. TV is stimulating for your toddler, not relaxing.
  8. Make sure your child is comfortable. If he/she wants a drink of water or the night-light turned on, do these but then tell him/her it’s time to go to sleep.
  9. Make exercise part of your child’s daily routine. Not only does exercise help make your child tired and ready for sleep, it’s a healthy routine that will benefit your child throughout life.
  10. Do not let your child sleep in your bed. Even though some parents like to have their child sleep in bed with them, this makes it harder for him/her to fall asleep when alone. Also, studies show that letting your young child sleep in your bed increases the risk of SIDS.
If your child cries as soon as you leave the room

As physicians and as parents, our advice is to wait several minutes before you go into your toddler’s room if he/she cries or calls for you after you’ve put him/her down for the night. Then each time your child calls, wait longer before responding. Reassure him/her that you are there, even when you’re out of sight, and that it’s time to go to sleep now. Remain firm! Don’t keep going in! You may have to put up with several minutes (hopefully not hours) of crying before your toddler figures out you’re not going to come in and pick him/her up every time they cry.

Articles you might find helpful: Questions about your toddler’s sleep? Come see us.

If you’re having trouble getting your child to go to sleep, or he/she is having sleep issues, or you simply have questions about any aspect of your child’s growth and development, please make an appointment with one of our Westchester Health pediatricians. We will meet with you and your child, see if there is indeed a problem, and together with you, decide on the best strategy so hopefully everyone can rest easy. Our #1 goal is to help you raise a happy, healthy child and for you to feel confident as a parent. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Am I Holding My Newborn The Right Way?

Wed, 02/06/2019 - 09:04

If you’re like a lot of first-time parents, handling your newborn baby can be kind of scary. Are you doing it right? What if you drop the baby? Are you supporting his/her head properly? It’s a lot to deal with. At Westchester Health, we get it. We’re parents too. And we want you to know that we’re here for you with guidance, tips and advice for properly and safely handling your newborn, especially new parents. To start you on your way, here’s a great blog on the subject by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group (excerpted below). 

2 important things to know before even picking up your baby

1. Be sure to support the head and neck. When carrying, picking up or laying your baby down, make sure to support his/her head and neck with your hands. Your baby’s head is the heaviest part of his/her body at birth and the neck muscles are not yet strong enough to support it on their own. (This typically takes 4 months.)

Lauren Adler, MD, FAAP

2. Wash your hands. Healthline.com says that you should always make sure your hands are clean before you pick up your baby. Newborns have not developed a strong immune system yet, making them very susceptible to germs that are easily transmitted from people’s hands.

Many positions and holds to choose from

Different “baby holds” work better for different purposes, such as breastfeeding, burping or soothing. Here are our 6 favorite holds, from Mom Junction.com:

1. The cradle hold

  • With your baby horizontal at chest level, slide your hand from their bottom up to support their neck.
  • Gently nudge your baby’s head into the crook of your elbow.
  • While still cradling their head, move your hand from your supporting arm to your baby’s
  • Your free arm can provide extra support or perform other tasks.

2. The shoulder hold

  • With your baby’s body parallel with your own, lift their head to shoulder height.
  • Rest their head on your chest and shoulder so they can look out behind you.
  • Keep one hand on their head and neck, and your other hand supporting baby’s bottom. This position also lets your baby hear your heartbeat.

3. The belly hold

  • Lay your baby, stomach down, across your forearm with the head up toward your elbow.
  • Their feet should land on either side of your hand, angled closer to the ground so your baby is at a slight angle.
  • This position is helpful if your baby is gassy and needs to be burped. Gently stroke your baby’s back to work out the gas.

4. The lap hold

  • Sit in a chair with your feet firmly on the ground and place your baby in your lap. Their head should be at your knees, face up.
  • Lift their head up with both of your hands for support and your forearms under their body. Your baby’s feet should be tucked in at your waist.

5. The face-to-face hold

  • Support your baby’s head and neck with one hand.
  • Offer support to his/her bottom with your other hand.
  • Hold your baby just below the chest facing you.

6. The football hold

  • Support your baby’s neck and head with your hand, and the rest of their back with your same forearm.
  • Adjust your baby’s head and neck with your other hand.
  • Encourage your baby to curl towards your body side, with the legs extended behind.
  • Draw your baby close to your chest.
  • Use the other free hand for offering extra support to the head or to feed your baby.

Vigorously shaking your baby is very dangerous and can cause bleeding in the brain and even death. At Westchester Health, we understand that a constantly crying or colicky baby is hard to endure at times. When this happens, we recommend playing music, gently rocking your baby, or making soft, soothing, cooing sounds to help stop the crying. Put the baby down and leave the room to take a break if you need to. Whatever you do, don’t shake. If you feel like you’re at the end of your rope, please ask for help. Call your partner, a friend or your pediatrician and we’ll talk you through it.

Helpful articles on baby holds: Questions about how to hold your baby? Come see us.

If you’d like more information about the best ways to hold and handle your newborn, or any aspect of raising your baby, please make an appointment with one of our Westchester Health pediatricians. We’ll answer all your questions, offer advice and guidance, and be a listening ear if that’s what you need. Our #1 goal is to help you raise a happy, healthy baby and for you to feel confident as a parent. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Worried That Your Child Might Be Using Drugs? We Can Help With Solutions.

Wed, 01/30/2019 - 09:35

Sometimes it seems like every kid in American has either tried drugs, is using them now, or knows someone who is using them. At Westchester Health, we get it. We’re parents too, and we want you to know that we’re on your side and will do everything we can to help your child avoid these substances and instead, make smart, healthy choices, now and throughout their lives. The first step? Read this very insightful blog by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group (excerpted below). There is also helpful information and advice specifically for teens on the WHP website which you can access here.

As a parent, you have a major impact on your child’s decision not to use drugs.

Lauren Adler, MD, FAAP

In fact, parents are the strongest influence a child can have. There is no guarantee that your child won’t use drugs, but drug use is much less likely to happen if you talk with him/her about the dangers of drugs and how—and why—not to use them.

Listening to your child is also vitally important. Your child has a lot to say and probably knows more about drugs than you think. Above all, open, honest and frequent dialogue is key to helping your child avoid drugs, especially in his/her adolescent, teen and young adult years.

At Westchester Health, we also play a part in helping your child avoid, or stop, using drugs. Because we believe so strongly that a trusting patient-physician relationship is crucial for healthy behavior, we will take as much time as is necessary to work through all the drug-related issues facing your child, and together with you, find solutions.

Substance abuse support and referrals are just one of the many ways we help parents raise healthy, happy kids. To learn about all the services we offer, click here.

Facts about teen alcohol use

Adolescents who drink usually start with beer, wine or flavored malt alcohol (a sweet-tasting blend of alcohol and carbonated fruit juice). Because every child’s height, weight, metabolism and physical build is different, it’s hard to say how much alcohol it takes for your child to get drunk. Nevertheless, the legal definition of drunkenness is a person’s blood alcohol concentration, or BAC. All 50 states except Utah define a BAC of 0.08 percent as the legal limit for driving under the influence (DUI) or driving while impaired (DWI).

Signs of alcohol use
  • Slurred speech
  • Impaired judgment and motor skills
  • Poor coordination
  • Confusion
  • Tremors, shaking
  • Drowsiness
  • Agitation, combative behavior
  • Nausea and vomiting
  • Depression
  • Weight gain
  • False i.d. card
  • Smell of alcohol on breath
Possible long-term effects
  • Blackouts and memory loss
  • Vitamin deficiencies, malnutrition
  • Suppression of the immune system, which leaves a person open to infectious diseases such as pneumonia and tuberculosis
  • Hormonal deficiencies, sexual dysfunction, infertility
  • Inflammation of the pancreas (pancreatitis)
  • Alcoholic hepatitis
  • Alcoholic cirrhosis
  • Cardiovascular disease and stroke
  • Alcohol-withdrawal delirium, or delirium tremens
  • Car accidents
  • STDs
  • Unwanted pregnancy
Facts about teen marijuana use

Similar to alcohol, kids who smoke marijuana can easily lose control and become addicted. They often perform poorly in school or sports, lose interest in hobbies, and develop relationship problems with family and friends. As with alcohol, the younger a person starts smoking marijuana, the more likely they will become addicted.

Signs of marijuana use
  • Spends less time with family and friends and more time alone or away from home
  • Often seems moody or irritable
  • Skips classes, often shows up late for school, has a drop in grades
  • Likes t-shirts with pro-marijuana messages or symbols
  • Loses interest in hobbies
  • Comes home high (talkative, giggly, red- or glassy-eyed) and goes straight to their room
  • Smells of marijuana
  • Possesses drugs or drug paraphernalia
What you can do
  • Set high expectations and clear limits
  • Instill strong values. Let your child know that you expect him/her not to use drugs.
  • Talk with your child, starting at an early age, about the dangers of drug use, including marijuana
  • Do not lecture or do all the talking.
  • Use teachable moments, like car accidents and other tragedies that are caused by drug use
  • Help your child handle peer pressure
  • Help your child find positive interests that build self-esteem
  • Help your child deal with emotions, especially during the teen years
  • Set a good example. Avoid using tobacco and illicit drugs. Minimize alcohol use, and always avoid drinking and driving.
  • Get a professional evaluation. If you think your child is using drugs, alert your child’s pediatrician, who can help.
Facts about teen vaping use

Many people, especially teens, think that vaping (smoking e-cigarettes) is a safe alternative to smoking but THIS IS NOT TRUE. Vaping is just another way of inputting nicotine—a highly addictive drug—into the body. To alert parents about the dangers of e-cigarettes and vaping, here are two 2 blogs on our WHP website that we strongly urge you to read:

1.      How Dangerous Are E-Cigarettes/Vaping?
2.      Does Your Child JUUL (“jewel”) or PHIX (“fix”)? Here’s Why You Should Worry.

Facts about teen tobacco use

90% of daily tobacco users begin by age 18. Alarmingly, trying tobacco just one time puts young people at risk for addiction to nicotine. Factors that can encourage teen tobacco use:

  • Use of tobacco products by friends or family members
  • Lack of parental support or involvement
  • Accessibility and availability of tobacco products
  • Low academic achievement
  • Low self-esteem
  • Exposure to tobacco advertising (movies, TV, video games)

To learn more about teens and the dangers of smoking, please read this WHP blog: Smoking And Teenagers: A Very Harmful Combination

Facts about teen opioid use

Opioids are highly addictive narcotic drugs, including prescription pain medicine and illegal substances like heroin. Large doses can slow the body’s heart and breathing rate to the point of stopping them completely. The effects of opioids on teens

  • Parents who become addicted to opioids often neglect to properly care for their children.
  • Long-term damage from prenatal exposure. Since 2000, there has been a fivefold increase in the number of children born with neonatal abstinence syndrome (NAS) after opioid exposure during their mother’s pregnancy. Babies with NAS are more likely to have low birth weight, respiratory complications, feeding difficulties and seizures, as well as developmental problems that affect learning and behavior.
  • Poisoning and overdose. Children and teens hospitalized for opioid poisoning tripled between 1997 and 2012. While most of the overdose patients were teens, the largest overall increase in poisonings was among toddlers and preschoolers.
What you can do
  • Talk to your kids. Tell your children how dangerous, even deadly, opioid drugs can be. Children who learn about the risks of drugs at home are less likely to use drugs than those who don’t. Surveys show two-thirds of teens who misuse prescription painkillers got them from friends, family members and acquaintances.
  • Safe storage. Keep opioids and other prescription medications in a secure place. Ask your friends, family members, and babysitters to do the same.
  • Destroy leftover or unused prescription medication. We recommend flushing them down the toilet instead of throwing them in the trash where they can be retrieved and used.
  • Ask for help. If you think you or your child may be using opioids and/or developing an addiction, don’t hesitate to seek help.
  • Know what to do in an overdose emergency. Ask your pediatrician about Naloxone nasal spray (brand name Narcan®) which can prevent opioid overdose deaths. And don’t hesitate to call 911 if you believe your child is experiencing an overdose.
Important articles you should read: Above all, our goal is to help your child grow up healthy and happy, without drugs

If you’re worried that your child might be using drugs, please come in and see one of our Westchester Health pediatricians. We will examine your child, listen to your concerns, answer your questions, and together with you and your child, determine the best way forward to achieve a healthy, drug-free life. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Nutritional Assessments Are An Important Way We Make Sure Your Child Is Growing Up Healthy

Wed, 01/23/2019 - 08:59

At Westchester Health, your child’s nutrition is one of our top priorities and something we really pay attention to each time your child comes in to see us for an office visit. To help parents understand what developmental signs and benchmarks we’re looking for, we offer this highly informational blog by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group (excerpted below). Nutritional assessments are just one of the many ways we help parents raise healthy, happy kids. To learn about all of the services we offer, click here.

Whether we’re seeing your child for a routine visit, illness or injury, we make sure to check his/her overall health status.

If we feel your child is not getting adequate nutrition (underweight) or is eating more than necessary (overweight), we’ll discuss this with you and your child, and together, decide on the best course of action. This might include referring your child to our on-staff nutritionist, suggesting vitamin supplements, or discussing which foods he/she should be eating for a healthy diet.

Lauren Adler, MD, FAAP

How to know if your child is overweight or obese

Obesity is usually defined as being more than 20% above the ideal weight for your child’s particular height and age. If your child falls within this range, it’s important to find ways to help him/her achieve and maintain a healthy weight, now and in the years to come. To calculate your child’s BMI (Body Mass Index), use this chart from Kid’s Health.

Signs that your child might be underweight

Although a lot of attention is paid to overweight kids, at Westchester Health we also become concerned when a child is underweight. In general, this occurs when someone is in the bottom 5th percentile for weight compared to their height. Here are some things to look for:

  • If your child’s weight percentile consistently decreases on growth charts at his/her annual well-child visit, this is cause for concern.
  • If a younger child does not outgrow clothes after several months, bring him/her in to see us. For an older child, if clothes seem to hang too loosely on their body (i.e., your child routinely is not “filling out” his/her clothes), this is cause for concern.
  • At bath time, or while swimming or at the beach, notice whether you can see your child’s ribs. Ribs that stick out or are easily visible are a sign that your child may be underweight and is not getting enough nutrition.
Eating disorders

Although eating disorders are more common in girls, boys can experience them too. There are several types of eating disorders but they typically have to do with a preoccupation with body image and being thin. To learn more, please visit these pages and blogs on our WHP website:

Additional articles you might want to read: Above all, our goal is to help your child get and stay healthy

If you’re concerned about your child’s weight, nutritional intake or any other aspect of his/her health, please come in and see one of our Westchester Health pediatricians. We will examine your child, listen to your concerns, answer your questions, and together with you and your child, determine what steps would be best to achieve the optimal health for your child. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Will It Hurt The Baby To Have Sex During Pregnancy?

Wed, 01/16/2019 - 08:56

“Can sex during pregnancy harm the baby?” At Westchester Health, this is one of the most frequent questions we get asked by expecting couples. Our answer (unless there’s a problem) is almost always no. To learn why, we urge you to read this informative blog on the subject by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group (excerpted below). There is also a good deal of helpful information and advice for expecting parents on the WHP website which you can access here.   

For most women with low-risk pregnancies with no complications, sex during pregnancy is very safe and will not harm the developing fetus.

The amniotic sac and the strong muscles of the uterus protect the unborn baby, and the thick mucus plug that seals the cervix helps guard against infection. During intercourse, the penis does not go beyond the vagina, so it won’t reach the baby.

Lauren Adler, MD, FAAP

“Pregnant sex” trimester by trimester  

1st trimester: 
Sex in the first weeks of pregnancy is usually not on the minds of most moms-to-be due to morning sickness (which is usually at its worse during this time).

2nd trimester: 
By this stage, morning sickness for most women has passed (or at least decreased) and they’re feeling much better. In addition, for most women, their stomach has not become overly huge yet.

3rd trimester:
At this point, sex becomes more physically difficult, especially during the final weeks of pregnancy.  A woman’s belly is now really large, she is usually tired all the time, and being done with pregnancy is often the only thing on her mind.

Can having sex trigger labor?

Contrary to popular belief, no (if you are low-risk). Sexual stimulation or orgasm cannot start labor or cause a miscarriage. While orgasm may cause mild uterine contractions (as can nipple stimulation), those contractions are generally temporary and harmless.

You should NOT have sex while pregnant if you have:
  1. A history of repeated miscarriages, preterm labor or premature birth.
  2. Placenta previa (the placenta is covering the cervix) which puts you at risk of hemorrhaging if you have sex during pregnancy.
  3. Premature rupture of membranes which occurs when the sac containing the developing baby and the amniotic fluid bursts or develops a hole before labor. If this occurs, you should contact your doctor right away.
  4. Vaginal bleeding or foul-smelling discharge after sex. If this occurs, you should contact your doctor right away. Discharge may be a sign of an infection that can travel upward to the uterus, and bleeding may be a sign of any number of problems.
  5. A partner with an STD. In this circumstance, you must use a barrier method of contraception, such as a condom, to protect yourself and your unborn baby.
  6. Leaking amniotic fluid. If this occurs, you should contact your doctor right away.
  7. Your cervix begins to open prematurely (cervical incompetence).
Some helpful articles on the subject: Concerned about sex while pregnant? Come see us.

If you’d like more information on whether it’s okay for you and your partner to have sex during pregnancy, or if you’re worried about the safety of the baby, please make an appointment with one of our Westchester Health pediatricians or a Westchester Health OB/GYN. Our #1 goal is for you to have a safe pregnancy and deliver a healthy baby. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Morning Sickness? 14 Best Ways To Ease The Misery

Wed, 01/09/2019 - 09:50

As we tell our patients at Westchester Health who are pregnant, expecting a baby is a wonderful thing but morning sickness can sure take the fun out of it. To help ease their symptoms so they can feel better throughout their pregnancy, we offer this informative blog by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group (excerpted below). There is also helpful information and advice for expecting parents on the WHP website which you can access here.  

Here’s how to prevent, or at least minimize, the symptoms of morning sickness
  1. Eat small, frequent meals and snacks throughout the day so your stomach is never empty.
  2. Eat slowly.
  3. Keep simple snacks, such as crackers, by your bed.
  4. Avoid lying down after eating (especially on your left side).
  5. Stay hydrated.
  6. Eat more protein and cut out fatty foods.
  7. Avoid smells and foods that make you feel nauseated.
  8. Get lots of rest.
  9. Get fresh air regularly.
  10. Try aromatherapy.
  11. Raise your upper body in bed by putting a pillow under the mattress.
  12. Avoid late night meals.
  13. Give up alcohol and smoking.
  14. Consider anti-nausea medication.
What exactly causes morning sickness?

Lauren Adler, MD, FAAP

Up to 85% of pregnant women suffer from morning sickness at some point in their pregnancy, usually kicking in around the 4th week and continuing until around the 12th week. It often strikes first thing in the morning but it’s not unusual to experience it at any time of the day or night.

We don’t really know what causes morning sickness but researchers think that it’s most likely a combination of causes, including:

  • Human chorionic gonadotropin (hCG), a hormone that rises rapidly during the early stages of pregnancy
  • Estrogen, a female hormone which also rises rapidly in early pregnancy
  • An enhanced sense of smell and sensitivity to odors (possibly resulting from higher levels of estrogen)
  • A sensitive stomach
  • Stress, worry
Important warning

NOTE: If you have severe, persistent nausea and vomiting and are unable to take in fluids (which puts you at risk of dehydration), see your doctor right away, as this may be a condition called “hyperemesis gravidarum” (H.G.). H.G. is characterized by severe nausea, vomiting, weight loss and an imbalance of electrolytes. Mild cases are treated with dietary changes, rest and antacids, but more severe cases often require an inpatient stay in the hospital so that you can receive intravenous (IV) fluids and nutrition.

Some articles that you might find of interest: Having a hard time with morning sickness? Come see us.

If you’re experiencing morning sickness and want some relief, please come in and see one of our Westchester Health pediatricians or a Westchester Health OB/GYN. The sooner we can evaluate and start treating your symptoms, the sooner you can start feeling better and enjoying your pregnancy. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog

Newborn Hospital Visits: 8 Things You Can Expect

Wed, 01/02/2019 - 09:19

For our patients who have just had a baby, we at Westchester Health want you to know that we will do everything we can to ensure that your precious little one is healthy, getting enough to eat and developing properly. Even before you leave the hospital, we’re here for you every step of the way. 

In addition to checking your baby’s vital signs, weight and progress, we will give you guidance and some preliminary education on how best to take care of your newborn. So you know what to expect from this first hospital visit, we offer this blog by Lauren Adler, MD, FAAP, a pediatrician with our Westchester Health Pediatrics group (excerpted below). There is also of helpful information and advice for new parents on the WHP website which you can access here.

Lauren Adler, MD, FAAP

8 tests and evaluations we perform while your newborn is in the hospital

At Westchester Health, it’s very important to us to make sure your baby’s first few days are healthy ones. That’s why we check your baby’s progress every day you’re in the hospital—typically 2 days for a vaginal birth, 3 days for a Caesarean section.To ensure that your newborn is healthy and progressing well, we perform the following actions while you and your baby are in the hospital before discharge:

  1. We visit you and your baby every day you’re in the hospital

We want to make sure your baby’s first few days are healthy ones so we check his/her progress every day you’re in the hospital—typically 2 days for a vaginal birth, 3 days for a Caesarean section.

  1. We check your baby’s color, weight, length, temperature, breathing (lungs), heart rate and activity

An average full-term baby should weigh 6-9 pounds and measure 18-21 inches long. If we feel your baby is losing too much weight, we’ll monitor how much and how often you’re feeding your newborn to ensure he/she regains the weight properly.

  1. We check your baby’s hearing

There are two different tests we use to evaluate your baby’s hearing: otoacoustic emission (OAE) and auditory brainstem response (ABR). The OAE test involves placing a mini earphone and microphone in your baby’s ear to measure sound reflection in the ear canal. For the ABR test, electrodes are placed on your baby’s head to measure how the hearing nerve responds to sound. The purpose of both tests is to detect hearing abnormalities.

  1. We measure the shape and circumference of your baby’s head

Because of pressure during a vaginal birth, your baby’s head may be temporarily misshapen but don’t worry: normal head shape usually returns by the end of the first week. (Babies delivered by Caesarean section usually don’t have as much head flattening.) We also check the circumference and soft spots on your baby’s head (fontanels), which typically disappear within 12-18 months when the skull bones fuse together.

  1. We evaluate your baby’s food intake, whether breastfeeding or formula feeding

Whether feeding by breast or bottle, monitoring the number of wet and poopy diapers that your baby is producing (optimal: 4-5 per day) is also a good way to tell if he/she is getting enough nutrition. For many moms, breastfeeding is a real challenge and very emotional. To help, we have two certified lactation specialists who work with you and your baby so that breastfeeding becomes a positive, successful experience for both of you. For more information about our support of breastfeeding, click here.

  1. We make an appointment for your first office visit

To continue to make sure your baby is progressing well and thriving, we make an appointment for your newborn’s first well-baby visit in our office, which should take place within 48 hours of your being discharged from the hospital.

  1. We teach you how to recognize signs that your baby may be sick

Generally, if your newborn is active, feeding well and can be comforted when crying, small differences in activity level or crying are normal. But if your baby seems fussy, is crying more than usual, has low energy, is noticeably irritable and/or seems hot and feverish, call or come in to see us right away. It might be nothing, but then again, it might be the beginning of something serious. For more tips and guidelines, click here for a blog on the subject.

  1. We answer all your questions and address your concerns

As well as monitoring your baby’s vital signs and progress, the newborn hospital visit is also a great time for us to address any questions or concerns you may have. Now and throughout the years to come, we’re your committed partners in raising a healthy, thriving baby.

Important advice on best ways to take care of your baby

At Westchester Health, we’ve helped raise hundreds of babies and we can’t wait to help you with yours. For helpful tips and advice on the ins and outs of caring for your newborn, please refer to the New Parents page on our WHP website.

Some helpful articles you might like:

Want more information about caring for your newborn? Come see us.

Are you burping your baby properly? Is he/she getting enough to eat? Is that a fever or do you need to remove the sweater? If you have any questions relating to your baby’s well-being (and we really mean any questions), please come in and see one of our Westchester Health pediatricians. We have lots of advice and guidance to offer you, and if something is wrong, together we’ll choose the best course of action going forward. Whenever, wherever you need us, we’re here for you.

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

Categories: Blog