The C. Olsten Wellness Program at The Corinne Goldsmith Dickinson Center for Multiple Sclerosis Helps Patients Take Control of Their Health

“Learning to live with MS is an enduring, educational process. We feel strongly that this holistic approach improves people’s long-term prognosis and significantly improves their quality of life,” says Ilana Katz Sand, MD,Co-Director of the C. Olsten Wellness Program. “We want to be able to offer this to every person we treat.”

A multiple sclerosis (MS) diagnosis is life-changing. The challenge of managing doctor appointments, MRI exams, and treatments, while also focusing on how you feel, can be extraordinarily stressful. Many essential things in life, such as exercise, nutrition, sleep, work, and family, often receive insufficient attention in the face of these demands.

“Many of our patients seek and can benefit from a more holistic approach to their MS,” says Ilana Katz Sand, MD, Co-Director of the C. Olsten Wellness Program at The Corinne Goldsmith Dickinson Center for Multiple Sclerosis. “Empowering people living with MS to take ownership of their health is the goal of our Wellness Program.”

The Wellness Program is designed to enable people with MS to live their lives as fully as possible by creating healthier habits. Since its inception in 2020, more than 500 people have participated in this program, the first of its kind at a comprehensive MS care center in the United States.

The program is open to both newly diagnosed patients and those who have been receiving care from neurologists, nurse practitioners, and other Center staff for many years. Some of the original participants from 2020 are still engaged in their wellness activities, while others have found satisfaction in charting a course of action after just a few visits.

“The duration of participation is up to the patient,” Dr. Katz Sand says. “We partner one-on-one with our patients, offering each individual options that help with changing behaviors, such as assistance with scheduling workout routines, adjustments to food shopping and eating habits, or support for addressing mental health. These are all key components of comprehensive MS care.”

Deciding to participate in the Wellness Program begins with conversations between patients and their health care providers. Before the first visit, patients undergo an evaluation through the Center’s Comprehensive Annual Assessment Program at the MS Neuropsychology Clinic, which helps identify potential areas of need. The initial visit is extensive, lasting two and a half hours, and involves individual meetings with staff.

Each specialist—nurse practitioners, dietitian, physical therapist, and social worker—assess various aspects of the patient’s health, including their abilities, living environment, and support systems. Nurse practitioners Stacie Lyras, FNP-BC, and Gretchen Mathewson, NP, conduct an overall assessment and help each patient set goals. Dietitian Jessica Gelman, MS, RDN, CDN, reviews food choices, eating schedules, how groceries are obtained, and how meals are prepared. Elizabeth Pike, PT, DPT, NCS, physical therapist, evaluates the patient’s current physical activity level and exercise program. Finally, social worker Konul Azimzade, LCSW, assesses the patient’s emotional health.

At the end of each new evaluation session, the Wellness staff meet with Belenmarie Mixon, program coordinator, and Dr. Katz Sand to make sure all providers are on the same page. Each patient has a unique set of circumstances and different ways that MS affects their life. A customized plan is prepared for and discussed with the patient.

Dr. Katz Sand notes that several of her patients have had life-changing experiences with the Wellness Program. Using strategies learned from the program, some patients regained mobility through exercise. Others addressed longstanding mental health issues, or were finally able to manage their fatigue by changing diet or other lifestyle habits.

“Patients are so appreciative of the way our team listens to what is going on in their lives and what they need to feel better. Providing care that is truly holistic is a different approach that puts patients at the center,” says Dr. Katz Sand.

Dr. Katz Sand joined the Center in 2011 on a National Multiple Sclerosis Society-sponsored fellowship and became a full-time staff member in 2013. Today, she serves as the Center’s Associate Director. In addition to treating MS patients, she has spearheaded research for more than a decade on the connections between gut health and MS. Her groundbreaking work on nutrition and how food choices affect MS was key to forming the holistic approach embraced by the Wellness Program.

To further encourage people living with MS in managing their nutrition, Dr. Katz Sand’s team, led by Ms. Gelman, has produced a 73-page cookbook. It puts into practice the nutrition guidance Dr. Katz Sand has long advocated. The cookbook covers the basics of kitchen equipment, nutrition guidelines, and detailed recipes. It’s user-friendly for both beginners and more experienced home chefs. The Wellness Program cookbook is available to Wellness Program participants upon request.

As the Wellness Program becomes more popular, expansion will be necessary to accommodate more patients. This growth will require more space and staff so that more patients can take advantage of its unique offerings.

“Learning to live with MS is an enduring, educational process. We feel strongly that this holistic approach improves people’s long-term prognosis and significantly improves their quality of life,” says Dr. Katz Sand. “We want to be able to offer this to every person we treat.”

By Kenneth Bandler, a multiple sclerosis patient, advocate, and member of The Corinne Goldsmith Dickinson Center for Multiple Sclerosis Advisory Board

 

Alcohol Increases the Risk for Cancer. Here’s What You Should Know.

The U.S. Surgeon General recently released a report advising the public on the link between alcohol and cancer. According to the report, alcohol consumption increases your risk for at least seven types of cancer, including liver, colon, and breast cancer, and drinking is a leading preventable cause of cancer in the United States, contributing to almost 100,000 cancer cases a year.

Frances Lee, MD

“The advisory confirms what doctors have known for many years—alcohol causes cancer,” says Frances Lee, MD, Assistant Professor of Medicine (Liver Diseases), Icahn School of Medicine at Mount Sinai. “This advisory is not meant to cause shame or fear, but to empower the public. We all have the right to know the risks of our daily choices, and this advisory is a way for people to know the risks of alcohol use from a reliable source.”

In this Q&A, Dr. Lee discusses what you need to know about the relationship between alcohol and cancer, how to reduce your risk, and how to get help if you need it.

How does alcohol cause cancer?
Alcohol and its metabolites causes inflammation and damage to DNA, which is the pathway for cancer development. Additionally, when you drink alcohol, you increase the absorption of other carcinogens in your environment—for example, chemicals from cigarette smoke. Alcohol can also increase various hormones levels, such as estrogen, increasing breast cancer risk.

What types of cancer does alcohol increase my risk for?
In addition to breast cancer, alcohol increases your risk for various digestive cancers, including in the mouth, throat, esophagus, liver, and colon. Alcohol also causes chronic liver disease, and alcohol-related liver disease is also now the leading indication for liver transplant.

Is there any safe amount of alcohol that I can drink?
There is technically no safe amount of alcohol to drink; as the surgeon general advisory notes, increases in alcohol intake leads to stepwise increases in risk for developing cancer. However, we live in a society where social events are often centered on alcohol intake. For those without risks for developing chronic diseases or certain cancers, it may be reasonable to consume no more than one standard beverage a day for women and no more than two standard beverages a day for men. In the end, you have to weigh the risks and benefits of alcohol in the context of each person’s unique risk factors.

How can I reduce my risk for alcohol-related cancers?
The only way to completely reduce your risk is to not drink alcohol. That can be difficult, even for people who are not heavy drinkers, since alcohol is part of our culture. But reducing your intake by any amount will decrease your risk for developing alcohol-related cancers.

When should I see a doctor?
Alcohol can cause various chronic disease that go unnoticed. As a liver doctor, I’m most concerned about alcohol-related liver disease that goes undiagnosed until it’s too late. Whether you are a heavy or moderate drinker, I recommend getting a regular checkup with standard blood work. If there is a problem with your liver enzymes, it is important to see a liver doctor and work together to reduce alcohol intake to allow the liver to heal and regenerate.

Are there any medications that can help me stop drinking?
There are medications that are very safe, even for people with liver disease. These medications are evidence-based and well tolerated. These medications reduce cravings by targeting the central nervous system, which has altered reward signals after years of alcohol intake. To be sure, the treatment of alcohol use disorder includes therapy/behavioral interventions, along with medications.

Three Guilt-Free Dip Recipes

Whether you have a craving for lime, mango, or guacamole, these delicious dips will make a nutritious snack for you and your guests. Enjoy!

Tiny Lime Scoops

Ingredients:

1/2 to 1 small red bell pepper, chopped into small cubes
3 peaches (fresh or canned), chopped into small cubes
3 tangerines, peeled (fresh or canned, drained)
1 lime, cut into wedges
Bag of multigrain tortilla chips

Preparation:

Place the pepper, peaches, and tangerines into a bowl. Squeeze the lime over the fruit and vegetables. Stir.

Dip and scoop the mixture with multigrain grain chips and enjoy.

Each serving:
13 chips and 1/4 cup dip
200 calories per serving

While I was taking nutrition class for a certification, I learned how to put fruits and vegetable together. The lime in this dip reminds me of my culture in Puerto Rico, and the bright colors are inviting. I enjoy this while watching my son’s baseball games, and I serve it at parties. This is a guilt-free treat, because of the nutritional value of the dip. – Taynisha, Jr Secretary/Scheduler, Mount Sinai Queens

Mango Salsa

Ingredients:

3 ripe mangos, diced
1 medium red bell pepper, chopped
1/2 cup of chopped red onion
1/4 cup of packed fresh cilantro leaves, chopped
1 large lime, juiced (about 1/4 cup)
1/8 to 1/4 t salt, to taste

Preparation:

In a serving bowl, combine the prepared mango, bell pepper, onion, and cilantro.

Drizzle with the juice of one lime.

Using a large spoon, stir the ingredients together. Season to taste with salt, and stir again.

For best flavor, let the salsa rest for 10 minutes or longer.

Nutrition:

Serves 6
Calories 48
Total Carbohydrates 11.8g
Protein 0.9g
Fat 0.3g

Growing up I always loved mango which is a tropical fruit from my native Dominican Republic. It is a simple recipe that can be prepared in minutes. This tropical and colorful mango salsa is simple to make. Serve it as a healthy appetizer or side, with tortilla chips, tacos, meal bowls, seafood, and more! -Ana, Director Community Affairs, Mount Sinai Queens

Guacamole Dip

Ingredients:

4 large ripe avocados
1 clove garlic, finely minced
2 tablespoon of lime juice
1/4 teaspoon salt
2 slices whole-wheat pita bread

Preparation:

Add lime juice, garlic, and salt to a medium-sized bowl and combine. Cut avocados in half, removing the pits, and scoop the flesh into the bowl with the lime juice mixture. Mash the avocado with a fork until a creamy dip is formed, leaving some large chunks for texture.

Toast pita bread for one to two minutes until slightly crispy. Once toasted, use a sharp knife to cut into six equal triangles for dipping.

Serve the guacamole dip immediately with the toasted pita slices and cut-up vegetables, like carrots, celery sticks, or zucchini spears.

Recipe Tip: This classic guacamole is mild and creamy, making it a hit with kids. If making ahead of time, squeeze extra lime juice over the top and cover very tightly with plastic wrap to keep from browning.

Nutrition:
270 calories per serving
Makes 4 servings

How Can I Avoid Norovirus?


Norovirus, also known as stomach flu, is a group of viruses that cause inflammation in the stomach and intestines. There are an estimated 2,500 reported norovirus outbreaks in the United States each year, according to the Centers for Disease Control and Prevention (CDC). While norovirus is common in the winter and spreads easily, there are actions you can take to keep yourself and others safe.

Bernard Camins, MD

In this Q&A, Bernard Camins, MD, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System, explains how to prevent and treat norovirus.

What are the symptoms of norovirus?
The most common symptoms are nausea, vomiting, and diarrhea. Some people may have fevers and chills.

How long does norovirus infection last?
About one to three days.

How contagious is norovirus, and for how long?
Norovirus is very contagious. Most people are contagious for at least three days, and some people are contagious for up to two weeks, even after symptoms are gone.

How does norovirus spread?
Norovirus is primarily spread through fecal-oral transmission—for example, restaurant staff or members of the same household fail to thoroughly wash their hands after using the bathroom, then spread it to others through contaminated food. You can also get it by touching shared surfaces from a sick person after they use the bathroom and less commonly from droplets contaminated with the virus when an infected person vomits.

How can I prevent norovirus?
Number one is to wash your hands thoroughly with soap for 20 seconds before eating or preparing meals. Alcohol-based sanitizers do not work as effectively against norovirus. Stay home if you are sick and avoid preparing food for others or sharing food, and avoid shared bathrooms, if possible. If you do have to share a bathroom, disinfect the toilet, sink, door handles, and any other shared surfaces, after you use it. Do not share dishes, utensils, or cups.

How can I treat norovirus?
The most important thing is to prevent dehydration by drinking water, juice, or a sports drink. Eat bland foods if you can tolerate them.

How do I know if I should see a doctor?
While norovirus symptoms are often severe, most infections clear on their own after a few days and do not require a doctor. However, if you are not able to keep liquids down, you should seek medical attention.

What should I do if my child has norovirus?
Keep them home. Norovirus can lead to severe dehydration in babies and children with underlying health problems. Learn more about what to do if you suspect your child has norovirus.

Is norovirus worse this year than previous years, and if so, why?
There is no evidence that norovirus is worse this year compared to previous years. Norovirus outbreaks usually happen around January due to people gathering for the holidays. Peak season for norovirus is November through April.

Trying to Conceive? Here’s the Difference Between IUI and IVF.

If you have been trying to conceive for some time and are considering fertility treatment, you may have been told about the options of intrauterine insemination (IUI) and in vitro fertilization (IVF).

In this Q&A, Devora Aharon, MD, reproductive endocrinologist and infertility specialist at RMA of New York, explains the advantages of each approach and how to choose the path that is right for you. RMA of New York is the Division of Reproductive Endocrinology and Infertility for the Department of Obstetrics, Gynecology and Reproductive Science at Mount Sinai Health System.

What is IUI?

Devora Aharon, MD

IUI involves preparing a concentrated sample of sperm that is inserted into the top of the uterus using a soft catheter. This brings the sperm in closer proximity to the egg to fertilize it, bypassing some of the barriers in the vagina and cervix. IUI is timed around ovulation, but for patients who do not ovulate regularly, oral medication may be used to augment your chances of success. In you ovulate monthly, these medications may cause multiple eggs to be released, increasing the chance that at least one egg will be healthy and result in pregnancy.

What is IVF?

IVF involves the use of injection medication for 1½ to 2 weeks to stimulate the ovaries to mature multiple eggs in one cycle. The eggs are extracted through a vaginal egg retrieval procedure under anesthesia and then fertilized with sperm to form embryos. The embryos can be biopsied to test for chromosomal abnormalities or specific genetic conditions before being frozen. In the same or subsequent cycle, the uterus is prepared for embryo implantation using estrogen and progesterone.

 

What are advantages of IUI vs. IVF?

From a practical perspective, an IUI cycle involves fewer medications and visits for monitoring and does not involve a procedure under anesthesia. However, IVF has a higher chance of success compared to IUI. Moreover, more than one healthy embryo is often created from one IVF cycle. All of these embryos can be tested and frozen for future use when age may present a greater barrier.

 What are specific situations in which one might choose IUI vs. IVF?

Depending on your individual diagnosis and personal circumstances, there are important factors to consider when choosing between IUI and IVF to build your family. While the following is not an exhaustive list, below are diagnoses and factors that might lead one to choose IUI or IVF: 

  • Male factor infertility: If sperm counts are low, IUI can help give sperm a boost and increase chances of pregnancy. If sperm counts are extremely low, IUI is less likely to work and IVF is typically recommended. 
  • Tubal factor infertility: If the fallopian tubes are blocked or abnormal, IVF is needed to bypass the tubes. 
  • Polycystic ovary syndrome (PCOS): Many patients with PCOS do not ovulate regularly. Oral medications can induce ovulation, and intercourse or IUI timed around ovulation can be effective in achieving pregnancy. IVF is also effective in patients with PCOS because these patients often have a high ovarian reserve, which can lead to a high response to ovarian stimulation.
  • Advanced reproductive age: Pregnancy becomes more difficult to achieve in your late 30s and 40s due to decreases in the quality and quantity of eggs. IVF with preimplantation genetic testing can help identify normal embryos that have a high chance of achieving a healthy pregnancy. 
  • Using sperm donation, egg donation, or surrogacy: Patients using a sperm donor will often start with IUI, especially if the patient does not have an underlying diagnosis of infertility. However, even in these cases, IVF can increase chances of achieving a healthy pregnancy sooner. Egg donors will undergo ovarian stimulation and egg retrieval, and the eggs will be fertilized with sperm and then transferred to a patient’s uterus or that of a gestational carrier. Patients using a gestational carrier with their own eggs will undergo ovarian stimulation and egg retrieval before the eggs are fertilized with partner or donor sperm, and an embryo will be transferred into the uterus of the gestational carrier.

The choice to undergo IUI or IVF is highly personalized based on individual factors like your age, diagnoses, timeline, and desired family size.

Ten Holiday Wellness Tips From Mount Sinai

The holidays are a joyous time. But they can also be a very busy time, which can cause us to overlook the things we should be grateful for, the simple pleasures of life, and the importance of our health and well-being. Here are 10 holiday wellness tips from Mount Sinai Fit, whose staff of nutritionists—all certified diabetes educators—work year round to support the wellness of Mount Sinai employees and patients and help them to achieve their health goals. 

Express Gratitude

Take a moment to reflect on your relationships with family, friends, and colleagues and all that is positive in your life. As you prepare for the holidays, set your intention to approach each celebration with gratitude, less stress, and greater happiness. Many experts believe that feeling grateful and expressing gratitude is beneficial to your health.

Celebrate Together, in Person or Virtually

This year, some of us may not be able to be with family and friends to celebrate the holidays in large gatherings. Consider sharing a recipe with them to make in their homes, and enjoy it together virtually.

Scale Back

It is okay to scale back your menus, to reduce food waste and not feel obligated to eat leftovers for days. Consider making fewer dishes, or try healthy alternatives, like a whole roasted cauliflower head as the main course or as a side dish. Use the holidays to try something new and seasonal for you.

Follow the One Plate Rule

Put the one plate rule into practice by implementing mindful eating. Enjoying your food and eating slowly. Take time in between bites to drink water and catch up with friends or family. Practicing mindful eating and portion control is one of the best ways you can allow yourself some indulgences while sticking to your eating plan.

Eat Vegetables

Fill at least half of your plate with non-starchy vegetables such as salad, other greens, and roasted vegetables. These healthy options will add volume, fiber, vitamins, and minerals to your meal. You will still have room, but less room, on your plate for other types of dishes. Roasting cauliflower, broccoli, butternut or delicata squash or carrots are delicious, healthy and satisfying.  After they are roasted, they can be pureed with some olive oil and serve a nice substitution for mashed potatoes.

Keep Dessert to a Few Bites

Desserts can tack on a large amount of calories, fat, and sugar. Enjoy just a few bites of your favorite sweet treats and take a moment to savor them. Take time to appreciate the flavor and feel satisfied.

Drink Wisely

Sweet cocktails and beverages such as juice and soda are high in calories and sugar, which can increase blood sugar. Why not choose beverages such as seltzer, water or unsweetened iced tea to quench your thirst?

Move

Exercise and movement help to burn calories, improve blood sugar levels, increase energy and boost your mood. Plan to get in at least 30 minutes of activity each day. Invite family or friends to take a walk with you after each holiday meal.

Listen to Your Body

Eat slowly so that you notice when you are satisfied. Once you feel you are getting full, put down your fork and save the remaining contents of your dish for leftovers. Your body will feel better and you will be happy with your choices.

When Invited, Bring Your Own Healthy Dish (BYOHD)

Why not bring a healthy dish to share with your host and other guests? Everyone will appreciate your thoughtfulness.

 

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