Purple Day: Raising Awareness, Ending Stigma of Epilepsy

Mar 28, 2024 | Featured, Research, Your Health

Every year on March 26, people and organizations around the world band together in solidarity for Purple Day. They wear purple and host events to raise awareness about epilepsy, with the goal of ending its stigma. For Purple Day this year, we got together experts from the Mount Sinai Health System to explain what epilepsy is and answer other top questions people might have.

Is epilepsy contagious?
“You cannot spread epilepsy from one person to the other,” says pediatric neurologist Natasha Acosta Diaz, MD, Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai.

Epilepsy is not an infection. It is a neurological condition characterized by seizures caused by abnormal brain electrical activity, says Dr. Acosta Diaz.

Is epilepsy electroencephalogram (EEG) testing painful?
In a standard EEG test, electrodes—small metal discs—are attached to the scalp with the help of a glue. The EEG test is not painful, says Anuradha Singh, MD, Director of the Epilepsy Monitoring Unit, and Professor of Neurology at Icahn Mount Sinai.

EEG tests study brain rhythms to look for any sign of irritability.  A standard EEG test records these brain rhythms for 20 minutes to an hour, says Dr. Singh. “Sometimes you get a little glue left on your scalp but it’s not painful at all,” she adds.

Is epilepsy surgery dangerous?
“The myths about the danger of epilepsy surgery come from the past, from about the last 100 years or so,” says neurosurgeon Fedor Panov, MD, Director of the Adult Epilepsy Surgery Program and Associate Professor of Neurosurgery at Icahn Mount Sinai. “What you currently find on the internet (about the dangers) unfortunately is not appropriate and it just perpetuates this myth that epilepsy surgery is dangerous,” he notes.

Epilepsy surgery has its risks and benefits. “Most certainly, the benefits outweigh the risks,” says Dr. Panov. As the epilepsy care team might phrase it to patients, the risk of going through a year with epileptic seizures far outweighs the risk of a surgical intervention to cure the epilepsy, he says.

Can epilepsy seizures be triggered by flashing lights?
There is a type of epilepsy that can be triggered by flashing lights, called photosensitive epilepsy. “However, this is very rare,” says Dr. Acosta Diaz.

When testing a patient for epilepsy, flashing lights are used to see if they provoke a seizure, and if so, appropriate recommendations for care can be given, she adds.

Can people with epilepsy drive a car?
“You can drive a car if you’re seizure-free,” says Dr. Singh. However, different states can have different rules and regulations. People with epilepsy will have to check with their state’s Department of Motor Vehicles, she notes.

What are some epilepsy surgical options?

Vagal nerve stimulator
Involves placing a small wire around a nerve in the neck to decrease seizure activity. The wire is attached to a small battery inserted under the skin of the chest.

Stereotactic laser ablation
Uses lasers to remove a part of the temporal lobe of the brain to help control seizures. The procedure is guided by magnetic resonance imaging (MRI), allowing for very precise cuts and removal.

Staged craniotomy
A two-stage surgery that involves removal of part of the skull to expose the brain, followed by removal of the brain tissue that is causing the seizures. Removing the damaged part of the brain does not cause deficits, as other parts of the brain adapt and pick up function. The procedure improves the overall brain network because it allows the healthy areas to work without constant electrical interference from the seizure “hot spot.”

Responsive neurostimulation
A device is implanted that automatically records and detects electrographic seizures, then rapidly delivers electrical stimulation to suppress seizure activity. It is the first device that the U.S. Food and Drug Administration has approved for use in the brain to listen, learn, and respond to seizures.

Can people with epilepsy have a job?
“Absolutely,” says Dr. Panov. “It’s a myth to say you cannot work if you have seizures.” Epilepsy care teams are available to help patients be a part of their community, including having and holding jobs. The Americans with Disabilities Act prohibits discrimination against people with disabilities in several areas, including employment.

While it is not mandatory that people with epilepsy disclose their condition to employers or coworkers, it is recommended that someone at the workplace is aware, says Dr. Acosta Diaz. “Just in case you have a seizure, somebody can be with you or help you,” she says.

Can people with epilepsy have children?
People with epilepsy can have happy, healthy children, says Dr. Singh. Women with epilepsy should work with their OB/GYN and epileptologist to ensure they’re on the safest drugs for the pregnancy, says Dr. Singh.

Can people with epilepsy stop taking medications when seizures stop?
The goal of any Comprehensive Epilepsy Center is to get patients seizure-free, and ultimately off the medications, says Dr. Panov: “The idea is that you will come off your meds once the seizures stop.”

It is important, however, that patients do not stop taking medications without discussing with their specialists, says Dr. Singh. A lot of factors go into the consideration of stopping medications, including EEG results and MRI scans, so that process should be done in consultation with an epileptologist.

Can people with epilepsy swallow their tongue?
“No way, there’s no way that you’re going to swallow your tongue,” says Dr. Acosta Diaz. During a seizure, the tongue can go to the side of the mouth and people can accidentally bite their tongue. To assist someone with a seizure, be calm and lay the person on the side, and definitely do not put anything in the mouth, such as a spoon, she says.

Does a ketogenic diet help people with epilepsy?
It does, in certain cases, says Dr. Singh. A ketogenic diet is a high-fat, adequate-protein, and low-carbohydrate diet. It is more often used in pediatric epilepsy, especially for children in whom medications do not work well, says Dr. Acosta Diaz.

Ketosis, a state where the body derives its sources of energy from fat rather than glucose, is known to have anticonvulsant properties. However, it’s not easy for a person to enter into ketosis. That is why an epilepsy care team involves overseeing a patient’s metabolism and nutrition as well, notes Dr. Acosta Diaz. “It’s not something you can try by yourself at home. It’s not just doing a keto diet to lose weight,” she says.

Caring for people with epilepsy is a team effort. At the Mount Sinai Epilepsy Center, staff members across all levels of care work together to provide exceptional care. Here’s the Center at a glance:

100+ team members

• Adult epileptologists  • Pediatric epileptologists  • Neurosurgeons  • Neuropsychiatrists  • Neuroradiologists  • Nurse practitioners  • Neurosurgery  • NPs and PAs  • Researchers  • Registered nurses  • Social workers  • Dietitians  • Recreational therapists  • EEG technicians  • Administrative staff

 

 

Designated as a Level 4 medical facility by the National Association of Epilepsy Centers (NAEC), which is the highest recognition of care and expertise for people with epilepsy

Three inpatient Level 4 epilepsy centers at The Mount Sinai Hospital, Mount Sinai Kravis Children’s Hospital, and Mount Sinai West, and six outpatient locations in New York City and Long Island.

ABRET-certified labs

Five Mount Sinai sites have received American Board of Registration of Electroencephalographic and Evoked Potential Technologists (ABRET) Lab accreditation for achieving highest levels of quality and competence performing neurodiagnostic tests.

In 2023

The Mount Sinai Health System performed more than 13,000 electroencephalograms and completed 100 surgeries to reduce or eliminate seizures for adult and pediatric patients.

To call the Mount Sinai Epilepsy Center

212-241-2627

In addition to treating patients with epilepsy, the Mount Sinai Health System and Icahn Mount Sinai conduct research to push the frontiers of understanding the neurological conditions and what is possible with treatment. Here are some examples of what Mount Sinai is doing to further science in epilepsy.

Clinical trial: Epilepsy associated with Lennox-Gastaut syndrome

Lennox-Gastaut syndrome (LGS) is a severe form of epilepsy, with seizures beginning in early childhood. To treat seizures that have not been well controlled through conventional medication, researchers are using novel responsive neurostimulation (RNS) strategies. This is the first clinical trial using RNS for LGS.

The trial is supported by a five-year grant from the National Institutes of Health, and conducted in collaboration with five other centers in the United States.

Click here for more info.

Clinical trial: Efficacy of subanesthetic doses of IV ketamine for treatment-resistant epilepsy

Ketamine is an anesthetic that provides pain relief, and came into clinical use in the 1960s. In a hospital setting, ketamine is used intravenously at anesthetic doses to treat unrelenting seizures known as status epilepticus in comatose patients. Mount Sinai researchers are exploring using ketamine at subanesthetic doses in an outpatient setting for patients who have treatment-resistant epilepsy. With subanesthestic dose-ketamine recently approved by the FDA for treatment-resistant depression, researchers are optimistic about its safety, and are hopeful that this will provide relief for patients with hard-to-treat epilepsy as well.

Click here for more info.

Clinical trial: Phase 3 trial for a once-daily, oral treatment for those living with focal seizures (XTOLE2)

Focal seizures are when brain cells on one side of the brain malfunction, causing symptoms, and are considered the most common type—making up more than half of all seizures. Symptoms could include one or more of the following: motor, sensory, autonomic, or cognitive. While treatment can stop or reduce the frequency of the seizures, for some patients, current treatment options may be insufficient. Mount Sinai is participating in a Phase 3 study with Xenon Pharmaceuticals to explore the use of XEN1101, a potassium channel opener, along with the patient’s existing medication, for focal seizures. Clinical data from previous trials have shown up to around 50 percent reduction in focal seizures among participants who have received the drug.

Click here for more info.

Clinical trial: Phase 3 trial for Staccato® Alprazolam in participants 12 years and older with stereotypical prolonged seizures

Benzodiazepines are more commonly known for treating anxiety or panic disorders, but they can also be used to terminate most seizures in an inpatient setting. Approved therapies include a rectally-administered gel and intranasal formulations. However, there are no approved treatments for rapidly terminating an ongoing seizure in an outpatient setting. Mount Sinai is participating in a Phase 3 trial with pharmaceutical company UCB to study the effectiveness and safety of Staccato® Alprazolam, a breath-triggered device that delivers the benzodiazepine deep into the lung for rapid absorption and systemic exposure, with the goal of achieving rapid epileptic seizure termination (REST). In a previous clinical trial, in an inpatient setting, nearly 66 percent of participants who received the drug responded to the treatment, compared to 43 percent of participants who received a placebo. For participants who responded to the intervention, the Staccato® Alprazolam group saw seizure cessation in a median time of 30 seconds, compared to 60 seconds for those who had received a placebo. The Phase 3 trial tests the treatment in an outpatient setting.

Click here for more info.

Clinical trial: Electrographic seizure pattern modulation biomarkers in responsive neurostimulation for epilepsy

Although the therapeutic benefit of RNS is well established, predicting how well and when a patient might respond to the device is difficult. It may take several months for a patient to report a reliable change in seizure status, during which time the programming clinician has no objective guidance regarding whether or not to adjust settings. RNS devices can provide EEG recordings, offering an insight to seizure patterns, but there is little knowledge about how to use these recordings in individual patients. Thus, a critical need exists to develop methods for using a patient’s own data to predict when seizure reduction should be expected or to confirm objectively the presence and maintenance of a clinical response.

Icahn Mount Sinai researchers are working with Massachusetts General Hospital to apply machine learning, neurostatistics, and data science to improve the effectiveness of RNS, especially for children and adults who are not considered suitable surgical candidates.

Click here for more info.

Laboratory for Human Neurophysiology

The Laboratory for Human Neurophysiology seeks to understand how human cognition arises from the interaction of multiple brain areas and neurotransmitter systems, particularly in decision-making behavior. These research efforts involve studying prefrontal cortical and subcortical areas directly in the human brain by conducting intracranial electrophysiology recordings in patients undergoing neurosurgical treatment.

Ongoing research projects in the laboratory include investigating the neural basis of human decision-making under uncertainty using distributed intracranial EEG recordings in epilepsy patients, decoding overt subject behavior from preceding, distributed brain activity in reward-related brain regions, and studying reward and mood processing across multiple brain areas in epilepsy patients with and without comorbid depression. The lab is led by Ignacio Saez, PhD, Associate Professor of Neuroscience, Neurosurgery, and Neurology at Icahn Mount Sinai.

Click here to read more about the lab.

Botox and Other Treatments for Wrinkles: Everything You’ve Always Wanted to Know

Mar 27, 2024 | Your Health

Botox® has been one of the most popular cosmetic treatments of the last 20 years.

For many, Botox and other brands of botulinum toxin injections have been a great way to maintain their youthful appearance. Botox injections work by blocking nerve signals to muscles. The injections prevent muscles from contracting for several months. While Botox injections are used to ease certain medical conditions, the results are not a cure and always temporary.  These injections are also used to treat hyperhidrosis (sweating), overactive bladder, migraines, and neck spasms.

In this Q&A, Ahuva Cices, MD, Assistant Professor of Dermatology at the Icahn School of Medicine at Mount Sinai, discusses the ABCs of Botox and other brands, including how they work, how long they last and how to know if this is the right treatment for you.

How does Botox work?

Botox is a brand.  It’s like saying Kleenex or Coca-Cola. It’s a type of neurotoxin or neuromodulator. This neurolmodulator comes from bacteria called Clostridium botulinum. We use the toxin that it makes to temporarily paralyze or control muscles.

The way that it works is that the neurotoxin prevents the nerve from activating the muscle by preventing the release of acetylcholine, which is a neurotransmitter that stimulates muscles to contract. It’s simply blocking the signaling that allows the muscle to contract. Other brands besides Botox are Dysport®, Xeomin®, Jeuveau®, and Daxxify®.

Patients will sometimes come in and ask me for Botox, but they don’t actually mean the brand Botox, they want a neurotoxin. It’s better to speak to your provider about which one would be best for you. Your doctor can determine the best treatment for by evaluating the individual patient, including the area to be treated and the patient’s goals.

What are the conditions you typically treat with Botox?

We use it for mostly for cosmetic purposes. The most common use is for the upper face, including the forehead, the glabellar area including the 11 lines between the eyebrows, and the lateral canthal lines, which are around your eyes.

Patients often say “I have these lines on my forehead” or “I look angry.” Those are some of the most common concerns. But there are many other cosmetic uses for neurotoxins. We use them in the mid face for areas like bunny lines; for correcting a “gummy” smile that shows more of your gum; and for a subtle lip enhancement with a lip flip. We can also prevent a downward turning of the mouth, which is common as we get older.

In addition, we can treat the neck. The platysmal bands can pull down on the neck, and we can get horizontal lines in the neck—we call this tech neck or necklace lines and they are becoming quite common from all the screen time. We can use neurotoxins for facial slimming by injecting the masseter muscles. We can also treat the masseters for bruxism for patients who grind their teeth or clench their teeth.

How long does Botox typically last?

In most people, these injections will last about three to four months. This can range from two to six months when patients will feel like it’s either started to wear off, fully worn off, or worn off enough to the point where they feel like another treatment is indicated.

The duration depends on the individual patient and product used. Different people have different metabolic rates of how fast their body metabolizes the injections or how it is degraded by the body. Different toxins also can last different lengths of time in different people. Over time, some people can develop antibodies to a specific toxin, and that one will not last as long or won’t be as effective. There are also certain areas where it will not last as long. For example:  if you’re correcting those lip lines, because the lips are moving so much it tends to be metabolized quicker in that area. It’s possible that people who exercise a lot tend to metabolize faster as well.

Duration also depends on the product used, dose of neuromodulator, and the concentration. For example, Daxxify lasts closer to six months and higher doses of any neuromodulator will last longer.

How soon do patients see the results?

Everyone may react a bit differently, but there are some overall trends. Daxxify works fast. It usually kicks in within 24 hours. Dysport usually kicks in within one to three days after treatment. Jeuveau is also on the quicker side, usually two to three days. Botox is a little bit slower. It can kick in at three days, but often it takes a bit longer about five days. All of the neurotoxins should have their full effect two weeks after the treatment.

At what age do you recommend patients begin these treatments?

I generally do not do these treatments on patients under the age of 18. I think anyone over 18 can be eligible. What I tell my patients is that when you start seeing lines that are staying in the skin and lingering after you make an expression, that’s the optimal time to start.

Once the lines are already etched in the skin, we can’t promise that the toxin will erase those lines. We can soften and smooth them. Over time, they may fade.  You want to catch it before those lines become etched in the skin permanently.

What are some of the potential side effects of these treatments?

Generally, these neurotoxins are very well tolerated. You can expect a little bit of discomfort with the injections. There could be a little bit of localized discomfort or temporary swelling. Bruising isn’t uncommon, but it’s not something that happens every time and it may happen just at one injection site. Some patients do develop a headache afterward, but it’s usually mild and does not last long.

Some patients  may have brow heaviness, and this is more common for a first timer, but this usually would resolve within the first few weeks and occurs from over treatment. Also, improper preparation can cause an infection at the injection site. Improper technique can cause a symmetry drooping; temporarily paralyzing a muscle not intended for treatment, which can either lead to asymmetry. All of these side effects would be temporary, so it’s still very safe.

What makes someone a good candidate?

Neurotoxin treatment is great for everybody who is not pregnant or needle phobic. It’s obviously not necessary, but I think it is a wonderful treatment for most patients.

Can you stop treatments once you start?

Completely. The effects are temporary. There’s no evidence of long-term changes or atrophy. The biggest downside is that neurotoxin treatments can be very addictive because it looks so good. You may not want to stop. In fact, many patients will do it recurrently for a long time, stop when they get pregnant, and then pick it right back up after.

What other treatments are popular?

Upper face cosmetic treatments are by far the most popular. More patients are asking about other cosmetic uses. We’re using it a lot in the lower face and in the neck. These subtle changes can actually give you the cosmetic look without being an obvious change.

Many people may not know these treatments are very versatile. Neurotoxin is covered by some insurances for underarm hyperhidrosis. But we can also use neurotoxin on the scalp to reduce sweat and allow for extended time between washes.

Learn more about Dermatology services at Mount Sinai

How Can a Skin Prick Test Help Me With My Allergies?

Mar 27, 2024 | Your Health

If you live with allergies, also referred to as allergic rhinitis, you know how annoying the symptoms can be. The itchiness, congestion, trickle in the throat—they can make it difficult to do the things you need, or want, to do.

It can also be difficult to determine the cause of your allergies (allergic rhinitis). For example, you could be allergic to airborne or environmental factors, such as ragweed or something in your home. Or it could be a seasonal condition. Whatever the cause, Alexandra Demeglio, a Physician Assistant in the Department of Otolaryngology at Mount Sinai Doctors – East 85th Street, says patients can get relief.

“Knowing what you are allergic to is helpful because there are ways to manage or eliminate the symptoms you are experiencing,” she says.

To make an appointment with Alexandra Demeglio, PA, call 212-241-9410.

Understanding your airborne and environmental triggers starts with a simple, rapid skin prick (also called a puncture or scratch) test. The test takes about two minutes to administer, and in as little as 15 minutes you can get results that can be used to develop a treatment plan. In this Q&A, she explains how that process works.

What are common allergy (allergic rhinitis) symptoms?

The most common allergy symptoms include:
• Nasal congestion, which may be accompanied by clogged ears
• Itchiness in the eyes, nose, ears, or throat
• Watery eyes or nose
• Post-nasal drip—mucus from your nose or sinuses that drips down your throat
• Red eyes or dry eyelids
• Worsening asthma symptoms
• Fatigue or brain fog

What is causing my allergy symptoms?

Many environmental and seasonal factors can trigger allergy symptoms. These include:
• Pollen (grass and trees in spring and summer; ragweed, pigweed, and mugwort in fall)
• Mold and mold spores
• Pets and other animals
• Pests, such as mice and roaches
• Feathers
• Changes in humidity
• Dust mites

Some causes are not just seasonal but also regional in nature, such as mold, which is relatively common in some states, including New York, but virtually nonexistent in other states, such as Arizona. Also, your home furnishings and décor can contain months—even years—of allergens, so keeping them clean will help to reduce or prevent symptoms.

Should I be concerned about my symptoms?

If over-the-counter medications are not providing relief from allergies and your symptoms are worsening or severe enough that they affect your quality of life, you should see an otolaryngologist about testing and treatment options.

Untreated allergies can lead to conditions such as nasal polyps, eczema, and asthma. To prevent that from happening, it is important to desensitize your immune system to affecting allergens. That starts with getting a better understanding of what you are allergic to.

A consultation with an otolaryngologist usually begins with a review of your medical history and symptoms followed by a nasal endoscopy of your nose and sinuses. Based on the findings, the otolaryngologist may prescribe an over-the-counter medication and lifestyle changes, recommend further consultation with a rhinologist, or refer you for a skin prick test.

What is a skin prick test?

The skin prick test is designed to deliver quick insights about the seasonal or environmental factors that are triggering your allergic symptoms. It is typically performed using the forearm among adults.

Before the test begins, the health professional will clean the forearm skin with alcohol. Using a device with multiple small needles, the professional will make gentle scratches along the skin and apply 40 different allergen extracts, such as pollen, cat hair, and mold. In cases involving suspected food allergies, a referral will be made to an allergist for the skin prick test.

The process typically takes two minutes. During the test, the health professional will apply two other substances to measure patient reactions to the allergens—histamine, which is released by the body during an allergic reaction, and a glycerin saline solution, which typically produces no reaction.

How do I prepare for a skin prick test?

To prepare for a skin prick test, you should:
• Stop taking prescription and over-the-counter antihistamine medications, including sprays, at least one week before the test. This will ensure that the test is accurate in identifying allergies and the degree of severity.
• Discontinue oral acid reflux medications up to three days before the test.
• Delay taking any blood pressure medication until after the test.

Patients who are taking steroid-based nasal sprays or other medications to treat asthma or allergic asthma can continue to do so.

Skin prick tests are not recommended for patients who are not able to suspend medications that can interfere with the outcomes of the test. In these cases, a blood test will be performed. Skin prick tests are also not recommended during pregnancy to prevent the risk of a bad reaction that affects blood flow to the fetus.

What happens after the test?

Once the allergen extracts have been applied to the skin, the health professional will wait 15 minutes and then check the patient’s forearm for reactions. They are looking for anything that resembles a mosquito bite, which is a positive. They will also look at the degree of sensitivity, which they measure using a scale from one to four, with four meaning a large hive. That tells providers what a patient is very allergic to.

The results, which are revealed the day of your appointment, will determine treatment recommendations. Patients who demonstrate a mild reaction are typically prescribed a six-to-eight-week regimen of over-the-counter antihistamines. Patients who demonstrate a severe reaction, or whose symptoms are not controlled, or worsen, during antihistamine treatment, are referred to an allergist or immunologist for further assessment and, in some cases, allergy immunotherapy shots. Patients whose test results are negative despite displaying symptoms will be referred to an allergist for intradermal testing, in which the allergens are injected under the skin.

Ultimately, once you have a better idea of what is causing your symptoms, you have options that can provide relief from allergies. Mount Sinai’s team of otolaryngologists, allergists, and immunologists are available to help you.

“Our otolaryngology program spans everything from head and neck to rhinology,” Ms. Demeglio says. “Our clinicians are on the cutting edge in treating people efficiently and effectively. We know the appropriate treatments, and we can individualize them so that we can improve your quality of life.”

Make an appointment with Alexandra Demeglio, PA

How to Safely Observe a Solar Eclipse

Updated on Mar 27, 2024 | Featured, Your Health

Mount Sinai researchers used state-of-the-art imaging to closely examine a patient’s retina after the solar eclipse of August 2017 burned a crescent shape into her eye.

The tricky thing about a partial solar eclipse is that if you look at it directly, you won’t feel any immediate pain. But the sun’s energy can still permanently damage your retina—and your vision.

In this Q&A, Avnish Deobhakta, MD, Associate Professor of Ophthalmology at the New York Eye and Ear Infirmary of Mount Sinai, explains how to safely look at a solar eclipse and the potential harm that can occur if you do not follow basic precautions for viewing this spectacle, which will take place Monday, April 8.

Avnish Deobhakta, MD

Why should I avoid looking at a solar eclipse? What damage can it do to the eye?

The solar eclipse is a very, very dangerous event for your eyes. Light beams from the sky carry a lot of energy that can be transmitted into the retina and damage it. Usually, the sun is very bright and it’s almost impossible to look directly at it without discomfort. But during a solar eclipse, you can look at the sun for a long period of time and be fooled into thinking that it’s safe because it doesn’t hurt. This is because most of the sun’s rays are blocked off by the eclipse. But the sun’s rays that you see during a partial eclipse are the most damaging to the eye. It’s almost like you’re getting a disproportionate helping of the most energetic and damaging rays because all of the other rays are blocked and the ones that make it through are not so bright that they force you to look away.

What can happen if I take a quick peek?

Even a very quick look at a solar eclipse can burn your retina. During the last solar eclipse, in 2017, one of my patients looked at the eclipse and sustained damage to her retina. She thought she was using protective glasses—but they weren’t the right type. She still has a blank section, a visual blind spot, in the center of her visual field. I used groundbreaking technology to take a close look at the damage to her eye. The damage was in the exact shape as the moon—a crescent shape. We were one of the few sites that had that prototype machine and could take that photo. It may not help the patient, but it gave us new information about the damage caused by exposure to the sun’s rays. Other people have been known to have visual distortions in part of their visual field. Even with a total solar eclipse, there will always be a moment when the sun re-emerges, and some of those rays can damage the retina.

Is the damage permanent?

Yes. We cannot fix it. At the New York Eye and Ear Infirmary of Mount Sinai, we have the technology to take an image and see the part of the retina that is damaged, but there is nothing a doctor can do to treat it. The damage doesn’t go away. Even decades later, your vision will still be impaired.

Can I look using a mirror?

No. Mirrors reflect the damaging sun rays. Looking in a mirror is the equivalent of looking directly at the solar eclipse–it’s not safe.

What about special sunglasses? Are those safe?  

It’s fine to use approved sunglasses that have the right filters. However, you have to make absolutely sure that you have those filters, and you need to obtain them from a reputable vendor. If you are not sure of either of those things, then you should not look at the eclipse, and instead look at a projection of the rays. Most of the people I’ve seen whose eyes were damaged by looking at a solar eclipse thought they were wearing the right glasses. And if you think you’re protected, you’re going to look longer, which increases the chances—and the extent—of damage. (Click here to learn more about safe viewing on the JAMA Patient Page created by the Journal of the American Medical Association.)

How about using a camera, like the one on my phone?

Generally speaking, if you look through your phone camera, you’re looking at an image rendered through the camera. You’re not actually looking directly at the sun, which means, theoretically, that it is safe. What worries me is not the phone camera—it’s that when people hold the camera up toward the sun, they might look around it for even just a brief period of time and can end up with a damaged retina. Think about a concert, when people have their phones out and are recording the concert, but they’re also looking around and watching the band on the stage. That’s not safe during a solar eclipse.

Is there a safe way to look at a solar eclipse?

Pinhole cameras are safe. They reflect light off an object and onto a surface such as a cardboard box or a wall. That way you’re not looking at the rays themselves, you’re looking at a projection of what the rays look like. You can watch a pinhole camera image as long as you’d like; you can even watch the entire solar eclipse reproduced on a pinhole camera and it’s perfectly safe. (Click here to get instructions on how to make your own pinhole camera.)

What if I’m outside during a solar eclipse but I don’t look up?

I don’t want anyone to think if they’re just in the presence of a solar eclipse they’re going to go blind. It’s okay to be outside during a solar eclipse, just be very careful. Be very mindful not to look directly at the sun in any way–and certainly not on purpose. The problem is that if you don’t know what’s going on and the sky looks different all of a sudden, your first instinct is to look up at the sun. The first instinct of all humankind is to look up. But that instinct can be dangerous during a solar eclipse.

Learn more about patient services at New York Eye and Ear Infirmary of Mount Sinai

Colorectal Cancer Is Rising Among Younger People. Here’s What We Know.

Updated on Mar 12, 2024 | Gastroenterology, Your Health

Colorectal cancer (cancers of the colon and rectum) is rising globally among people under 50 years old, prompting the American Cancer Society in 2018 to change their screening recommendation from age 50 to 45. While rates are also rising among those in their 20s and 30s, colorectal cancer is still less common among this age group.

Pascale White, MD, MBA, MS, FACG

Experts don’t know why more younger people are getting colorectal cancer, but it’s clear that early-onset colorectal cancer (affecting those under 50 years old) is becoming an important public health issue. In this Q&A, Pascale White, MD, MBA, MS, FACG, Director of the Gastroenterology Clinic, and Associate Professor of Medicine (Gastroenterology), Icahn School of Medicine at Mount Sinai, discusses warning signs younger people should look out for and when to see a doctor.

Why are many people in their 20s and 30s going undiagnosed with colorectal cancer?

Many young people don’t have primary care doctors or are ignoring their symptoms until they already have late-stage colorectal cancer. They may go to an urgent care center for strep throat or the flu, but they are ignoring important symptoms like rectal bleeding. They think they are too young to have cancer or are embarrassed. Regardless of how old you are, you should have a relationship with a primary care doctor who knows you and your patterns, who will be able to tell if something is wrong.

Younger patients are more likely to be diagnosed with advanced stage colorectal cancer (stages III and IV). A majority of cases are occurring in the rectum and the distal colon (the last part of the colon). The earlier colorectal cancer is diagnosed, the greater your chances are for survival.

What increases my risks as a younger person?

Some of the risk factors for younger people are the same as those who are older. These include having a family history of colorectal cancer or having a hereditary condition like Lynch syndrome; being obese; not getting enough physical activity; using alcohol and tobacco, which have both been shown to be independent risk factors for colorectal cancer; and eating a low-fiber diet high in processed meat.

Are certain groups more at risk than others?

Early-onset colorectal cancer is increasing in both men and women; the most significant increase is occurring among non-Hispanic white patients. However, there are racial disparities that exist in early-onset colorectal cancer. Studies have shown that young Black patients have overall worse survival rates.

What type of family history puts me at risk?

The majority of young people who are getting early-onset colorectal cancer don’t have a family history of cancer. That said, any family history of colorectal cancer could be relevant. Knowing first-degree family history (mom/dad/brother/sister) helps your doctor determine if there is a higher risk. However, second-degree family history (aunts/uncles/grandparents/grandchildren/half siblings/nieces and nephews) can help spot potential patterns that might put you at risk. Mount Sinai has genetic counselors that can help identify these patterns.

What symptoms indicate that younger people should see a doctor?

A majority of people who are coming to see the doctor with early-onset colorectal cancer are symptomatic, and a majority of symptoms are blood in stool and abdominal or rectal pain. Other symptoms include unintentional weight loss, changes in bowel habits, diarrhea, and iron deficiency anemia. Young people need to understand seeing blood in the stool (whether it is bright red blood or black stool) should not be ignored. Bleeding could be caused by something benign like hemorrhoids or something malignant like colorectal cancer. If you experience these symptoms, see a doctor as soon as possible. If colorectal cancer is caught early, your chances of survival are higher.

Should I Be Worried About Changes in My Stool?

How can I reduce my risk?

Some things may not be in your complete control. For example, we are investigating whether there are certain environmental exposures that put younger people at risk. That said, there are actions you can take regardless of age that reduce overall risk for colorectal cancer. These include eating a well-balanced diet of high-fiber foods (fruits, vegetables, nuts, legumes, and whole grains); reducing your intake of processed foods, especially processed meat; getting regular exercise; and monitoring any health conditions you have, such as diabetes and obesity.

What is a colonoscopy?

A colonoscopy is a safe and effective procedure where a doctor uses a camera to examine the lining of the colon and rectum for growths called polyps and/or other abnormalities including colorectal cancer. During the examination, you are given some sedation to keep you comfortable. If polyps are found they are removed and sent to the pathologist for evaluation. Some polyps are benign while others could be precancerous. The type of polyps removed will determine when the colonoscopy should be repeated in the future.

Will my insurance cover it?

Insurance companies cover colonoscopies for people who are 45 years and older for screening colonoscopies. A screening colonoscopy is what the procedure is called when it is being done on a patient who has no symptoms. If you are under age 45 but are experiencing symptoms, you would be sent for a diagnostic colonoscopy because the procedure is being done to find the diagnosis that would explain the symptoms. In either case, we encourage patients to communicate with their insurance company prior to procedures to ensure they will cover the cost.

How can I get a colonoscopy if I don’t have insurance?

Call your health provider to see what resources may be available for free or low-cost colonoscopies. They can help navigate patients to centers that accommodate people who do not have insurance

Learn more about Digestive Diseases and Gastroenterology at Mount Sinai
Schedule an appointment with a Mount Sinai primary care doctor near you

At the Mount Sinai Morningside Spine Program, the Personal Touch Is Key to Healing

Updated on Mar 5, 2024 | Featured, Mount Sinai Morningside, Your Health

Team members at the Spine Program at Mount Sinai Morningside include, from left, Kiran Ballani, Rachel Newman, PA-C, Patrick Reid, MD, Lauren Mcnoble, PA-C, Divaldo Camara, MD, and Priscilla Garcia

If you are having problems with your back and believe you may need to consult with a surgeon, then Mount Sinai has a program for you.

Mount Sinai Morningside has launched a Spine Program with a uniquely personalized and integrated approach. In addition to its advanced and compassionate clinical providers, the Spine Program is one of the few in New York City to have a care coordinator who focuses on helping patients find the right specialist for their needs.

Priscilla Garcia, a clinical navigator for the Spine Program, is one of the many people who make it work. She helps patients get what they need as soon as possible, prioritizing non-surgical treatments when possible.

“My role is to triage patients,” she says. “Some patients think they need a neurosurgeon right off the bat, but if they’re in pain, I schedule them with one of our pain management specialists first.”

If patients need multiple appointments, she often will try to schedule appointments in the same day for the patient’s convenience. A pain management specialist may order an MRI and notice something that a neurosurgeon should evaluate, so she will try to make that happen on the same day—a more efficient and convenient option for patients.

“It’s great for the patient because they don’t have to go home and come back again in a short timeframe. And the patients feel that we are addressing all their needs in a holistic way” she says.

Patrick Reid, MD, left, and Divaldo Camara, MD. “What sets us apart is how we try to make it easier for patients,” says Dr. Reid. “Some try to do it with computer systems or software, but we are devoting human resources to it.” To make an appointment, call 212-523-8500.

Patrick C. Reid, MD, Director of the Spine Program and Chief of Neurosurgery at Mount Sinai Morningside, makes every effort to help patients get care quickly and easily.

“When people go to the doctor, it can be confusing, especially with something as complex as the spine and surgery. Many times, people are forced to navigate the system themselves and hope for the best,” he says. “But an easy way to improve care is to get the patient in the right room with the right specialist, and that’s what we do in our program.”

Patients with spine issues are often older, and reducing the number of trips to the doctor’s office is beneficial.

“Any patient who sees us needs to have things simplified as much as possible,” says Dr. Reid. “People who have jobs, childcare needs—they all need help coordinating their health care. You don’t want to miss two days of work. That’s the benefit of having a navigator who’s had a lot of experience coordinating these things—it’s invaluable.”

The program at Mount Sinai Morningside has all the advantages of a major academic medical system, including access to the latest equipment and to the most advanced treatment techniques.

“But what sets us apart is how we try to make it easier for patients,” says Dr. Reid. “Some try to do it with computer systems or software, but we are devoting human resources to it.”

Only a small percentage of patients at the Spine Center actually receive surgery.

“There are a full range of treatments we can try before suggesting surgery,” says Dr. Reid. “But if our colleagues are running out of options trying to make a patient feel better, then we start having the discussion about surgery—the risks and benefits and likely outcomes.”

In addition, patients with back or neck pain often have health issues that contribute to their condition, and one of the advantages at Mount Sinai Morningside is ready access to specialists in many other areas throughout the Mount Sinai Health System.

“We see many patients with conditions such as diabetes, hypertension, or heart disease, and we will help them get the any additional treatments as quickly as we can,” Dr. Reid says.

Learn more about the Spine Program at Mount Sinai Morningside
To make an appointment, call 212-523-8500

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