What Patients with Breast or Gynecologic Cancer Need to Know About COVID-19

Updated on Jun 30, 2022 | Breast Cancer, COVID-19, Gynecologic Cancer, Your Health

People with breast or gynecologic cancer may be at increased risk for COVID-19. This may be because of the cancer itself or due to cancer treatment weakening the immune system and making them more susceptible, or because they have more encounters with the healthcare system. Elisa R. Port, MD, Director of the Dubin Breast Center and Chief of Breast Surgery for The Mount Sinai Hospital, and Stephanie V. Blank, MD, Director of Gynecologic Oncology for the Mount Sinai Health Stem and Director of Women’s Health at the Blavatnik Family- Chelsea Medical Center at Mount Sinai, discuss what you need to know about breast and gynecologic cancer and COVID-19.

Is it safe to go to my oncology appointment?

Dr. Blank: Whether you should keep your appointment depends on the purpose of the visit. If you are having a routine mammogram or an annual check-up, you may be able to reschedule your appointment for later. It is a matter of weighing the risks and benefits of going to the appointment with possibly exposing yourself to the virus. Talk with your doctor to see what he or she recommends.

The Centers for Disease Control and Prevention has recommended that people do not go to the doctor for non-essential appointments. They want to protect you from people who might have or be carrying COVID-19. While we do our best to keep our offices as safe as possible, we cannot guarantee that someone who is asymptomatic has not been in the waiting or exam room. That said, we do limit the number of people entering the facility, so waiting rooms are empty and very few patients are on site.

The other question is how to get to the appointment. I would try to avoid public transportation if possible. If you do not have another option, I would encourage you to wear a face mask, carry hand sanitizer, wash your hands frequently, and be careful about what you touch. You would also want to distance yourself from people. Luckily, public transportation is a lot less crowded than usual, so it should be easier than usual to keep your distance from others.

Why did my doctor cancel my appointment?

Dr. Blank: If your doctor cancelled your appointment, chances are your doctor considered the reason for the appointment and the risk of exposure to COVID-19 and determined that the benefits of the appointment did not outweigh the risks. But, if you are concerned, contact your doctor and ask. The first question is whether the appointment was cancelled altogether or delayed for a period.

If you really want to talk to your doctor sooner rather than later, telehealth is an option in most health care systems. This allows you to discuss your concerns with your doctor without physically being in the same space. If your doctor does not have telehealth capabilities, try setting up a telephone conversation.

I think I might have COVID-19. What do I do?

Dr. Port: If you develop symptoms that suggest COVID-19, such as cough, fever or difficulty breathing, you should call your doctor. Discuss these symptoms with your doctor and get his or her advice. Availability of COVID-19 testing varies across the county, so your ability to be tested will depend on where you are. In addition to talking to your doctor, you should isolate yourself in your home to avoid possibly spreading the virus. Keep away from others in your home to protect them as well. Your doctor should be able to provide additional advice.

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Mount Sinai Program Allows Home-Based Care for Elderly COVID-19 Patients

Updated on Jun 30, 2022 | COVID-19, Geriatrics, Your Health

In the face of the COVID-19 pandemic, hospitals and health systems are exploring ways to increase their capacity. One of these approaches involves offering home-based programs for people who qualify.  Mount Sinai Hospitalization at Home provides hospital-level care in the homes of patients who might otherwise need to be in the hospital. Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, answers questions about how Mount Sinai’s Hospitalization at Home program is adapting to COVID-19.

How does the Hospitalization at Home Program work?

A team of doctors, nurse practitioners, registered nurses, and other professionals treat and monitor your health at home for a condition that would have usually been treated in the hospital. We communicate regularly with you both in your home and by video chat. That way you don’t have to leave your home and compromise social distancing. We deliver and provide medication, routine lab tests, and durable medical equipment and IVs. Social workers are also available to coordinate care and provide access to social resources.

Our staff are available 24/7 to answer any questions or concerns you might have. Following discharge, we will follow up with you or your loved one as determined by your health plan.

Has COVID-19 changed any of the Program’s requirements? 

We have begun accepting COVID-19-positive patients into the program after spending a few days in the hospital first, when appropriate. In addition, since the pandemic began, we have been able to accept more patients across the Mount Sinai Health System and more insurances. At this point, we can accept almost all health insurance plans for COVID-19 care.

 How do I qualify for the Hospitalization at Home program?

Most patients enrolled in our Mount Sinai Hospitalization at Home program came to us through the emergency room or after a few days in the hospital. In general, patients eligible for this program still require hospital level care. You may also need to meet other medical, geographic, and social criteria to ensure that the program is safe and appropriate for you. In addition, we require that you live in a stable residence that meets your needs for safety, shelter, and basic utilities.

If you qualify for admission, your provider will meet with you and your family to review the program and obtain consent. Your provider will then write an admission note with orders for care and arrange transportation home, usually by ambulance.

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Mount Sinai Medical Students Graduate Early, Some To Join a Special Medical Corps

Updated on Jun 30, 2022 | COVID-19, Featured, School

Katleen Lozada, MD, one of the first Icahn School of Medicine at Mount Sinai students to sign up for early graduation.

Seventy-seven Icahn School of Medicine at Mount Sinai students earned their medical degrees early on Wednesday, April 15, at a time when Mount Sinai Health System hospitals are experiencing extraordinary and unprecedented demands brought on by the COVID-19 public health crisis. Among them are 19 graduates who matched at Mount Sinai for residency and volunteered to join the Mount Sinai Medical Corps, helping to relieve a strained medical system while answering the call by New York Governor Andrew M. Cuomo for “all hands on deck” to assist in any way.

On that day, a number of the early graduates participated in an informal ceremony—from the safety of their homes and conducted on Zoom—reciting the modern Hippocratic Oath and marking this milestone with faculty, staff, and friends and family, all in virtual attendance. Led by Staci Leisman, MD, FASN, Associate Professor of Medicine (Nephrology), and Medical Education, each graduate made a commitment to “respect the hard-won scientific gains of those physicians in whose steps I walk,” to “respect the privacy of my patients,” to “tread with care in matters of life and death,” and to “prevent disease whenever I can, for prevention is preferable to a cure.”

Staci Leisman, MD, FASN, Associate Professor of Medicine (Nephrology), and Medical Education, led students and faculty in reciting the modern Hippocratic Oath during a virtual ceremony.

The opportunity to graduate from the Icahn School of Medicine a month early—as well as the decision to begin clinical work in the Health System through the Mount Sinai Medical Corps—was strictly voluntary. The Medical Corps is a newly formed training program that gives these newest MDs an opportunity to provide vitally needed support services to an overburdened staff—entering orders, for example, scribing, relaying updates to patient families, and facilitating discharge planning. Also joining Mount Sinai graduates in these efforts are 12 graduates from other medical schools who have matched at Mount Sinai for residency.

“We are extremely proud of the dedication and altruism of our students and their passion for helping our patients and communities at this historic time,” said David Muller, MD, Dean for Medical Education, and Professor and Marietta and Charles C. Morchand Chair in Medical Education at the Icahn School of Medicine at Mount Sinai.

Katleen Lozada was one of the first Icahn School of Medicine students to sign up for early graduation. “This is definitely not how I envisioned my graduation, but I just really want to help alleviate the intense pressure on clinical staff working on the front lines. What lies ahead is somewhat unknown, but most of all I am looking forward to helping in whatever capacity is needed,” said Dr. Lozada, who matched in the Emergency Medicine residency. The program has training sites at The Mount Sinai Hospital and Mount Sinai Beth Israel—and at Elmhurst Hospital, which is part of a New York City integrated system of health care facilities that has been particularly hard-hit with COVID-19 cases.

“I would much rather be working and helping during this crisis than sitting at home and watching other able-bodied medical professionals take the brunt of the disaster,” added Dr. Lozada, whose mother is a pediatrician.

Olamide Omidele, MD

Also among the early graduates was Olamide Omidele—now Olamide Omidele, MD—a native of Nigeria who was matched to Mount Sinai as a urology resident. “The health care system is currently strained, and I am hoping that I can provide relief in whatever way is needed,” said Dr. Omidele. “I draw my strength, optimism, and comfort about joining the workforce from my parents, who are the main reason I chose to go into medicine.”

For Dr. Lozada, who is a first-generation New Yorker raised in the Bronx, the opportunity to assist the city she loves was also a motivating factor. “What’s even more exciting is that I’ll have the honor of serving the New York City community I grew up with and am awed by every day,” she said. “I can’t wait to get started!”

Students, faculty, staff, family, and friends participated in the virtual ceremony.

 

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I’m Concerned I May Have Cancer. Can I See A Doctor During the COVID-19 Pandemic?

Updated on Jun 30, 2022 | Breast Cancer, COVID-19, Gynecologic Cancer, Your Health

The business world may be on pause due to the COVID-19 pandemic, but that does not mean medical conditions have taken a reprieve. If you are worried that you might have breast or gynecologic cancer, you need expert advice. Elisa R. Port, MD, Director of the Dubin Breast Center and Chief of Breast Surgery for the Mount Sinai Hospital, and Stephanie V. Blank, MD, Director of Gynecologic Oncology for the Mount Sinai Health System and Director of Women’s Health at the Blavatnik Family- Chelsea Medical Center at Mount Sinai, discuss what you need to know about breast and gynecologic cancer and COVID-19.

I have symptoms that make me worried I might have cancer. Should I see a doctor or wait until the pandemic subsides?

Dr. Port: If you feel a lump in your breast, have unexplained weight loss, unusual bleeding or bloating, changes to the color or texture of the skin on the outside of your genitals, or other concerning signs, you should definitely get checked out. Do not delay seeing medical attention due to the pandemic.

Most doctors, including those in the Mount Sinai Health System, are open for business to evaluate potential patients. We encourage patients to reschedule non-essential visits such as routine annual mammograms and check-ins. This helps us keep the office (and waiting room) mostly empty so we can see new or potential patients while maintaining and allowing you to maintain social distancing. When you come into the office, we take you immediately into a private exam room to limit the risk of exposure. We continue to perform imaging tests, biopsies, and other key diagnostic examinations.

If I am diagnosed with breast cancer, will I receive treatment now, or will I need to wait until after COVID-19 has subsided?

Dr. Port: The short answer is: It depends.

It’s important to remember there are dozens of types and subtypes of breast cancer. There are also a variety of treatment options; there’s no one-size-fits-all approach. We can safely delay treatment for some types of very early breast cancers. Others respond to medication that can prevent growth of the cancer until the threat of COVID-19 has decreased and we can more safely proceed with treatment. But the first step is to get an accurate diagnosis.

Fortunately, there are very few emergency situations where you need surgery or treatment within a day or two to prevent a bad or worse outcome. In most cases, we have the luxury of being able to delay treatment without affecting your overall prognosis and survival rate. It is all about balancing the risks and benefits in your individual case.

Some cancers grow very slowly, so we can safely delay care for one to three months. Others may respond to a medication, such as an anti-hormonal drug, that can allow us to hold off on care for a while. If you have a more aggressive type of cancer, we may decide to do surgery or start chemotherapy.

Of course, receiving these treatments in the setting of a pandemic carries certain risks of immunosuppression and we don’t take those risks lightly. Even just coming to the hospital carries some risk. So, we will talk with you about the risks and benefits of each care option and decide together on the most appropriate approach for your individual situation.

Is it safe to have chemotherapy now?

Dr. Blank: Again, there is no blanket answer to this question. You and your doctor need to consider your individual situation. First, it depends on the purpose of chemotherapy. Is it going to cure you? If so, you may not want to interrupt it. If it is controlling your symptoms, that may be a different conversation. You may be able to increase the time between treatments, or there may be another way to help with your symptoms.

At Mount Sinai, we test women for COVID-19 before we start chemotherapy because we know that women who have the virus and are in treatment may get significantly sicker than others. We also take measures to boost patients’ blood counts during this time to help patients fight the disease should they contract it.

Is it safe to have surgery now?

Dr. Blank: Here, too, the answer is not simple. In general, we are trying to delay all the surgeries that we believe can be safely postponed. The reason is that you really don’t want to be in a hospital right now. There are a lot of COVID-19-positive patients there and you may well be exposed to the virus. We look at the risks and benefits and discuss the issues with our patients. We are not delaying the procedures permanently, just until we have a safe environment for our patients so we can perform procedures again. This is not unusual. We often delay surgery when it is safe to do so. Sometimes a patient wants to delay so she can attend a daughter’s wedding or a grandson’s graduation.

Sometimes we can change our treatment approach to avoid or delay surgery. We can change the order of treatment. For instance, if someone was recently diagnosed with ovarian cancer, we may start with chemotherapy instead of surgery. Then we can perform the surgery later, when it is safer. We know that’s safe cancer-wise; we have a lot of data that show this.  Sometimes we can use a different treatment approach. For example, we can treat certain endometrial cancers with hormones. Talk with your cancer doctors; they can tell you what the options are in your individual situation.

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Advice on Distance Learning for Individuals with Hearing Loss

Updated on Jun 30, 2022 | Children's Health, COVID-19, Ear Nose Throat, Your Health

According to UNESCO, school closures in response to the COVID-19 pandemic have impacted approximately 1.4 billion students. Children in pre-primary through high school, as well as adults in collegiate and graduate education are now engaged in “distance” or “remote” learning. While this allows education to continue despite school closures, it is not without drawbacks.  Poor audio quality is an impediment for learners at all levels, and can be especially difficult for those with hearing loss. Maura Cosetti, MD, Director of the Ear Institute of New York Eye and Ear Infirmary at Mount Sinai and David Spritzler, MED, Education Specialist at the Ear Institute, share guidance for distant learners with hearing loss.

Guidance for All Distance Learners

As with a classroom setting, individuals with hearing loss have specific needs related to online education. These steps will improve auditory access for all participants in distance learning.

Request that the presenter uses a wearable microphone and is well-lit throughout the lesson.

Using a built-in mic on tablets or computers can produce muffled audio. A wearable microphone doesn’t have to be anything fancy; a Bluetooth headset or the headphones that come free with a phone will significantly improve sound quality.

Additionally, presenters should be well-lit throughout so that students can speech read their mouths.

Ask for a sound check before the lesson and that student microphones are muted throughout the lesson.

A sound check will ensure that the audio is working on both ends. Teachers or presenters can do this by asking each student a different open-ended question, such as, “What’s the last movie you saw?”

Also, having other learners mute their microphones prevents students from talking over each other and introducing distracting background noise to the lesson. Teachers can have students use a signal, such as waving or holding a thumbs up, when they want to speak.

Reduce background noise. 

Turn off music, TV, and loud appliances and be sure to close windows and doors. If your child must share space with other people during lessons, ask everyone to try to be as quiet as possible.

Let the teacher know when you cannot hear.

Adults are likely to know when they are having trouble hearing, and what to do about it.  However, children are often unaware that they are not hearing well and may be shy about speaking up when there is a problem.  Help your child learn to identify problems by encouraging them to ask themselves if they understand what is being said and to let an adult know if they cannot.

Guidance for Children Who Are Distance Learning

Children with hearing loss have additional challenges regarding distance learning. Parents and guardians should adhere to the following tips to ensure that their child has the best experience while distance learning.

Ask for hearing assistive technology from your child’s school.

Ask your child’s school to send home their hearing assistive technology. This equipment, commonly referred to as “FM”, is usually used to improve the signal-to-noise ratio in the classroom, but it can also be used to connect the audio output from a laptop or tablet directly to a child’s hearing aids or cochlear implants, greatly improving sound quality. Some hearing devices can also connect via Bluetooth, ask your child’s audiologist.

Check your child’s hearing equipment.

Make sure your child’s hearing equipment has been freshly charged and that replacement batteries are on hand.

Additionally, do daily “listening checks”: while standing behind your child, ask them to repeat various letter sounds (could try the “Ling” sounds) in random order, then answer open-ended questions.

Request accommodations from the teacher.

Ask that teachers use captioning for videos and that they send presentations and other materials in advance. This will allow you to “pre-teach” new words and familiarize your child with new content.

Also, get in touch with your child’s teacher of the deaf and educational audiologist. They can help troubleshoot problems as they arise and can provide support to you and your child.

Make sure your child takes a break.

Listening through technology is hard work! Give your child plenty of time to rest in between lessons.

Even in the best of times, children with hearing loss have to work harder than their peers to learn, and commonly experience “listening fatigue” from the increased expenditure of energy. Distance learning is proving to be much more challenging than regular school for all students, and the added stresses of not seeing friends or playing outside make it even harder for kids to pay attention and learn. Therefore, it’s not reasonable to expect children to do the same work that they would in normal circumstances. In order to learn, children need to be presented with activities that are challenging, but achievable. Stress is counterproductive. If your child is resistant to doing schoolwork or participating in distance learning, discuss ways to adjust expectations with teachers.

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Mount Sinai’s Antibody Test for COVID-19 Receives Emergency Use Authorization from FDA

Updated on Jun 30, 2022 | COVID-19, Featured, Research

A renowned team of virologists, pathologists, and clinicians at the Mount Sinai Health System developed, validated, and launched a blood test for COVID-19 antibodies that received the U.S. Food and Drug Administration’s (FDA) emergency use authorization late Wednesday.

The blood test determines whether individuals have antibodies to the SARS-CoV-2 virus that causes COVID-19. It is used for the qualitative detection of human IgG antibodies in serum and plasma that is collected from individuals suspected of having been infected with SARS-CoV-2.

Early development of the assay, led by Florian Krammer, PhD, Professor of Microbiology at the Icahn School of Medicine at Mount Sinai, enabled Mount Sinai to become the first health system in the nation to undertake a convalescent plasma program that transfers the antibody-rich plasma from recovered COVID-19 patients into those who are critically ill.

To date, Mount Sinai has identified more than 1,900 donors who are eligible to provide their antibodies. A total of 141 patients have received the protocol, and the results are being evaluated clinically.

Under the leadership of Peter Palese, PhD, Horace W. Goldsmith Professor and Chair of the Department of Microbiology, Mount Sinai has built one of the world’s leading academic institutions for the study of viruses and emerging pathogens. “The COVID-19 antibody test is not only helpful in identifying individuals who could be donors for the convalescent plasma program but also identifies persons who can safely go back to work now that they are immune to the virus,” Dr. Palese says. This important step would allow the nation to return to economic productivity.

“We are grateful to the FDA for granting this expanded authorization so that we can deploy this vital test to the community at large,” says Carlos Cordon-Cardo, MD, PhD, Irene Heinz Given and John LaPorte Given Professor and Chair of Pathology, Molecular and Cell-Based Medicine. Dr. Cordon-Cardo oversaw the validation of the test that is produced by the Mount Sinai Laboratory, Center for Clinical Laboratories. The Mount Sinai Hospital’s Clinical Laboratories are certified by the Clinical Laboratory Improvement Amendments and accredited by the College of American Pathologists.

According to Dr. Krammer, the antibody test can, in some cases, pick up the body’s response to infection as early as three days post-symptom onset and is highly specific and sensitive. “We have shared the toolkit needed to set up the test with more than 200 research laboratories worldwide to help mitigate this global crisis,” Dr. Krammer says.

David L. Reich, MD, President of The Mount Sinai Hospital, and Judith A. Aberg, MD, Chief of the Division of Infectious Diseases and Immunology in the Department of Medicine, have led Mount Sinai’s convalescent plasma program. “The exchange of ideas between clinicians and scientists and our intense drive to innovate is the catalyst that led to this achievement,” says Dr. Reich. “Mount Sinai will continue to advance the science and medicine in the fight against COVID-19.”

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