Expert Advice on Protecting Your Kids From Ticks

Being outside is wonderful for children’s development and health. However, if your plans include being in grassy or wooded areas, remember to try to protect your family from ticks and the risk of illnesses like Lyme disease.

The best protection is prevention. You can have children help in a way that also allows them to practice their developmental skills and understand the health benefits of avoiding ticks. Blair Hammond, MD, a pediatrician and Co-Founding Director for the Mount Sinai Parenting Center, explains how and offers four things to keep in mind and to discuss with your family.

Blair Hammond, MD

Choice and Independence

Encourage your child to pick out pants and long-sleeve shirts they’d like to wear to decrease the chance that a tick will get on the skin. You can treat outdoor clothing with permethrin, an insecticide, or buy already made tick-repellent clothing. Giving choices is great for fostering independence.

 Apply and Explain

You can apply insect repellent with DEET to your child’s exposed areas. You can make a game of it: “Where are your ankles? Let’s protect them with the insect repellent.”  Follow recommended safety tips from the American Academy of Pediatrics (AAP) on choosing the right product for your child’s needs. Remember that back and forth conversations and explaining things helps your child learn language and connect with you.

Routines

You can have a consistent routine of bathing after being outside (this removes non-attached ticks).  Also, try to incorporate tick checks into your nightly routines (a tick needs to be on a person for at least 24 to 48 hours to transmit Lyme disease). Pay special attention to hiding places like under the arms, in and around ears, behind legs, in the groin area, and along the scalp and in the hair. Having consistent routines helps with children’s self-regulation and behavior. Keeping pets free from ticks will also help. The AAP suggests checking your pets every day and using appropriate pet products.

No Need for Panic

If you do find a tick on you or your child, don’t panic. You can carefully remove the tick with tweezers by squeezing at the head and gently pulling back. If the tick has likely been on your child for more than 24 hours, or if you have any questions, call your health care provider. You can get additional guidance from the Centers for Disease Control and Prevention about what you should do about tick bites.

What Is Leqembi (lecanemab), and Will It Revolutionize Alzheimer’s Disease Treatment?

On July 6, the U.S Food and Drug Administration (FDA) granted traditional approval to Leqembi® (lecanemab), a drug developed by pharmaceutical firms Eisai and Biogen to treat Alzheimer’s disease. This decision converts the accelerated approval Leqembi received in January, following a confirmatory trial that demonstrated verified clinical benefit.

“Up until now, no one considered this a treatable disease,” says Mary Sano, PhD, Professor of Psychiatry and Director of the Alzheimer’s Disease Research Center at the Icahn School of Medicine at Mount Sinai. The full approval of lecanemab marks an exciting chapter for treating Alzheimer’s disease, providing physicians with more options. Cognitive specialists at Mount Sinai are now offering lecanemab as a treatment.

Mary Sano, PhD, Director of the Alzheimer’s Disease Research Center at the Icahn School of Medicine at Mount Sinai

What is lecanemab and how does it tackle Alzheimer’s disease? How might a patient access it at Mount Sinai? Dr. Sano explains why this drug will make a big impact in treating this condition, which is all too common among the aging.

What is lecanemab?

Lecanemab is a monoclonal antibody treatment that’s designed to reduce amyloid beta plaques in the brain. It is delivered as an intravenous infusion, over approximately one hour, once every two weeks.

“It is widely accepted that amyloid beta is a defining agent for Alzheimer’s disease,” says Dr. Sano. While the causes of Alzheimer’s disease are not fully known, accumulations of amyloid beta and other proteins such as tau tangles have been observed in patients, and are hypothesized to cause memory and functional loss.

The drug has been approved for mild cognitive impairment (MCI) and mild dementia. Patients in this category are still able to perform daily tasks, such as driving or going to work, but might experience memory lapses, such as forgetting words or location of objects.

What does this drug mean for patients?

In the confirmatory clinical trial that helped lecanemab clinch its full approval, the drug showed a statistically significant reduction in cognitive decline compared to placebo.

What patients can expect is a slowing of cognitive and functional loss, says Dr. Sano. The outcomes measured in the study relate to instrumental activities that early-stage Alzheimer’s disease patients might struggle with—paying bills, banking, certain computer tasks.

“The demonstrated effect is modest, but it’s robust, seen across all measures,” she notes. Those benefits were seen at month three of treatment and persisted through month 18, at the end of the study.

“I don’t want to overstate that this is the be-all and end-all of treatment,” Dr. Sano adds. “I’m not telling you this is a huge effect and the person goes back to 100 percent normal. But until the lecanemab studies, we had other monoclonal antibodies and we’ve not seen such consistent benefits.”

How can I access lecanemab?

The Centers for Medicare and Medicaid Services (CMS) announced in early July that lecanemab is eligible for Part B coverage under Medicare. One of the requirements is documented evidence of amyloid beta plaque in the brain, which requires imaging.

“If you don’t have the presence of amyloid, this means this is a drug you cannot use, even if you are symptomatic with memory or other cognitive problems,” Dr. Sano says.

Side effects for lecanemab could include amyloid-related imaging abnormalities (ARIA), and take the form of either bleeding or swelling in the brain, or both. Some genetic factors, such as the apolipoprotein E (APOE) ε4 gene, may increase the risk of ARIA. Other factors, such as whether patients are on blood-thinning medications, should also be considered before accessing treatment. At Mount Sinai, each patient who is interested in lecanemab receives a personalized evaluation to determine eligibility and appropriate counseling.

There could be economic barriers to access, Dr. Sano notes. Lecanemab has been reported to cost $26,500 per year. Under traditional Medicare, patients could expect to pay a 20 percent copay for treatment, although that might be covered by a supplemental insurance plan. Eisai has also launched a patient assistance plan.

In addition to the drug, there are other associated costs, including positron emission tomography (PET) for amyloid imaging, infusion, and travel expenses. Coverage of those expenses depends on the insurance.

“We need to make sure underrepresented groups can access this treatment,” says Dr. Sano.

Will lecanemab change how we look at Alzheimer’s disease?

Prior to lecanemab, the prevailing view of patients diagnosed with MCI or mild dementia had been a wait-and-see approach, Dr. Sano says. Practitioners might be resistant to start an early-stage patient on active treatment, and similarly, patients who are highly functional might be reluctant to compromise their autonomy.

“There’s a barrier to changing our culture, but it’s clearly surmountable,” notes Dr. Sano. “The one difference we have to consider is this: people don’t stay in mild dementia forever. We need to change the culture to get this addressed early.”

What has lecanemab shown in clinical trials?

In a placebo-controlled, double-blind randomized study of 1,795 people, lecanemab showed a statistically significant and clinically meaningful reduction in decline of the Clinical Dementia Rating (CDR), a cognitive and functional measure based on patient and caretaker reports and the trial’s primary outcome. Key secondary outcomes included measurements of change in amyloid beta and other cognitive scales and measurements of daily living capabilities.

Here are the efficacy and safety highlights:

  • Lecanemab-treated patients demonstrated a 27 percent slowing of decline in CDR compared to those on placebo at 18 months.
  • Statistical significance for CDR was seen starting as early as six months, with the difference from placebo widening every three months.
  • On a 100-point Centiloids scale, with 0 being a patient with no amyloid beta and 100 being the average amount of plaque a mild-to-moderate Alzheimer’s disease patient might have, the lecanemab group saw reduced plaque burden of 55.5 at 18 months, whereas the placebo group saw an increase of 3.6.
  • Statistical significance for amyloid burden was achieved starting at three months.
  • The most common side effects in the lecanemab group were infusion effects, with 26.4 percent having experienced it. Of those, 96 percent were considered mild to moderate.
  • Other side effects include amyloid-related imaging abnormalities—which could occur from amyloid-targeting therapies—as well as headaches and falls. Serious adverse events were reported in 14 percent of the lecanemab group and 11.3 percent of the placebo group.

Is My Stuffy Nose Congestion or Nasal Polyps?

An occasional stuffy nose due to allergies or infection can be annoying or difficult to manage. But if you are experiencing chronic nasal congestion that is also impacting your sleep and ability to breathe, it may be a sign of something more serious—nasal polyps. However, it is easy to mistake the symptoms of nasal polyps for other conditions, including allergies, a deviated septum, or chronic sinusitis.

Madeleine Schaberg, MD, Director of Rhinology and Skull Base Surgery

In this Q&A, Madeleine Schaberg, MD, Director of Rhinology and Skull Base Surgery at New York Eye and Ear Infirmary of Mount Sinai, defines nasal polyps, the indications you might have them, and why it’s important to seek a diagnosis and treatment quickly.

“There is a lot of overlap between symptoms,” explains Dr. Schaberg, who is also Assistant Professor of Otolaryngology at the Icahn School of Medicine at Mount Sinai. “Furthermore, polyps tend to grow gradually, which means the symptoms can be somewhat insidious until you reach a tipping point. Many people live with nasal polyps for years before receiving a diagnosis.”

What are nasal polyps?
Nasal polyps are benign, inflammation-related growths that occur in the nose and sinuses. One of the most common causes is environmental allergies, but they are also associated with diseases such as aspirin exacerbated respiratory disease and eosinophilic granulomatosis with polyangiitis. In some cases, nasal polyps can also be the result of caustic environmental exposures, such as construction sites or toxins exposures. Although nasal polyps are often soft and painless, they can become swollen or irritated and result in sinus blockages that can have serious impacts on your quality of life.

How do I know if I have nasal polyps?
Two prominent symptoms are associated with nasal polyps: congestion and loss of smell. The degree of congestion is often serious enough that it becomes difficult to breathe through the nose. Human beings are obligate nasal breathers, which means we are much more comfortable breathing through the nose. Polyps create an obstruction, which typically leads to breathing through the mouth, which is very uncomfortable. It can also lead to several issues that can affect your overall health and well-being, such as sleep apnea, frequent sinus infections, and increased frequency of asthma attacks.

How are nasal polyps diagnosed?
If you think the symptoms that you are experiencing are associated with nasal polyps, see an ear, nose and throat (ENT) specialist for a consultation. This will typically involve an examination, a review of your medical history, and a nasal endoscopy. Endoscopy is the best in-office diagnostic tool we have to determine what is going on. It enables us to evaluate all the structures of the nasal cavity in a safe, easy manner without causing discomfort and then proceed based on what we find.

What are my treatment options for nasal polyps?
There are several treatment options depending on the severity of your polyps:

  • For mild cases, a steroid spray is often effective in reducing polyp size and relieving symptoms.
  • For more severe cases, oral steroids may be prescribed.
  • If topical and oral steroid treatments are not effective, and the nasal polyps are extensive, surgical removal may be recommended as a therapeutic approach. This is typically done in an outpatient center through minimally invasive endoscopic surgery.
  • There is also the option of treatment with a biologic medication, such as Dupixent® (dupilumab), which is administered by injection under the skin once every two weeks.

In many cases, patients will receive some combination of these treatments, and then continue treatment with a topical steroid or biologic medication following surgical removal. It is best to think of nasal polyps as a kind of long-term problem, like having high blood pressure. It will be different for every patient, but many require topical steroids, oral steroids, and surgery as an adjunct, along with a biologic medication.

How can I prevent nasal polyps from recurring?
For the most part, maintenance medications, such as topical steroids and biologics, provide the best protection against recurrence. However, nasal polyps are a chronic condition, one that requires regular follow-ups with an ENT specialist to check for signs of regrowth. Furthermore, patients who use topical steroids for maintenance should also be assessed annually by an ophthalmologist for changes in eye pressure related to their medication. As with any condition, early detection and treatment of nasal polyps is ideal. However, a later diagnosis or extreme severity in disease should not ultimately affect the outcomes that you can achieve. The medications, treatments, surgery—everything we offer for polyps—works well at many stages in the course of the disease. The important thing is to see your primary care provider or an ENT specialist if you think you have symptoms.

New Study Explores Links Between Women’s Reproductive System and Mental Health Disorders

Both psychiatric disorders and disorders of the reproductive system are common in women of reproductive age. Often, they co-occur. “There is a lot of overlap between these two disease classes—but very little research into why that is,” says Nina Zaks, MS, Clinical Research Scientist in the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai.

She wanted to learn more about that overlap. Together with Magdalena Janecka, PhD, Assistant Professor, Psychiatry, and Genetics and Genomic Sciences, and other colleagues, she spearheaded a systematic review and meta-analysis to probe the association between mental health and reproductive system disorders in women. Their paper was published in JAMA Network Open in April.

The analysis revealed some interesting patterns—and shone a light on how much more remains to be discovered.

Psychiatric and Reproductive System Disorders: Increased Odds

Nina Zaks, MS

The analysis included 50 qualitative and quantitative studies, each of which explored co-occurring psychiatric diagnoses and reproductive system disorders. The research team cast a wide net, considering a range of psychiatric diagnoses including depression, anxiety, psychosis, and neurodevelopmental disorders such as autism. On the reproductive system side, the team looked into diagnoses such as inflammatory diseases of the female pelvic organs, non-inflammatory disorders of the genital tract, and ovarian dysfunction.

The overlap between the disease classes, they found, is significant. In women with polycystic ovary syndrome (PCOS) and chronic pelvic pain, for instance, the odds of affective disorders were approximately 1.7 to almost four times greater than in women without the disorders. But the team also showed that the overlap between many other psychiatric and reproductive disorders simply has not been studied yet, revealing a considerable gap in knowledge, with potentially serious implications for women’s health.

Overall, the literature shows that women with reproductive system disorders have two to three times the odds of having psychiatric disorders compared to women without those conditions. “We see comorbidity between psychiatric and reproductive disorders everywhere we look,” Dr. Janecka says. “Despite that, there is so much about that comorbidity that has not yet been studied. It’s an urgent research priority to address this.”

Looking for Links in Mental Health and the Reproductive System

What can account for the overlap? Unfortunately, most studies in this area don’t dig into the possible causes, according to the researchers.

Scientists have suggested a number of possible explanations for the association between reproductive system and mental health disorders. For example, stress and quality of life factors associated with mental illness could affect menstrual cycles and reproductive function. Psychiatric medications might interfere with reproductive function. It’s also possible that some underlying genetic causes contribute to both types of disorders.

Though much more research is needed, there are reasons to suspect biological causes for the connection, at least in some cases. “From a mechanism standpoint, it makes sense. Many psychiatric diagnoses present differently between females and males, possibly due to a hormonal component,” Dr. Janecka notes. “Better understanding this connection will provide us with some insight into these mechanisms, while also improving quality of life for patients.”

Polycystic Ovary Syndrome: PCOS and Depression

Magdalena Janecka, PhD

Among the studies that Dr. Janecka’s team analyzed, the largest portion focused on PCOS. Those studies showed that women with PCOS have an increased rate of depression, anxiety disorders, and bipolar disorder.

PCOS is relatively common, affecting as many as 5 to 10 percent of women of reproductive age. The condition is associated with symptoms such as infertility, obesity, acne, and excessive hair growth. One explanation for the increased risk of psychiatric diagnoses in women with PCOS is that those symptoms interfere with quality of life or body satisfaction and self-esteem. However, some emerging evidence suggests that is only part of the story, the researchers found.

The studies suggest that obesity and infertility appear to exacerbate psychiatric symptoms in women with PCOS, but don’t fully explain them. Indeed, genetic factors may play a role in both conditions. In a twin study, for instance, researchers found that the risk of depression was higher not only in people with PCOS, but also in the twin who did not have the syndrome. That implies a possible genetic cause that might increase the risk of both conditions.

 Chronic Pelvic Pain

Another subset of the research the team examined focused on chronic pelvic pain. The condition affects one in seven women in the United States. In some cases, the pain can be traced to problems such as endometriosis. But for many women, the cause of their chronic pelvic pain remains elusive.

Unsurprisingly, chronic pelvic pain is associated with significantly higher rates of depression, the researchers found. Physical pain may not be the only explanation, however. “A number of studies showed that women who had chronic pelvic pain had an increased rate of childhood sexual trauma,” Ms. Zaks says. “This might point toward an environmental explanation for the increased rate of psychiatric diagnoses.”

 Psychiatric Research at Mount Sinai and Beyond

Learning more about the shared mechanisms might help researchers better understand the development of both psychiatric and reproductive system disorders and could point to new directions for treatment.

The findings also suggest that physicians should do more to screen for and treat co-occurring disorders. “It may be that if you address a patient’s reproductive problems, psychiatric treatments may be more successful,” Dr. Janecka says.

The two researchers plan to continue exploring some of these associations in greater detail, but they hope they won’t be the only ones to dig deeper. “We know this association exists, and we know there’s a gap in the research. The data are there, just waiting to be studied,” Ms. Zaks says.

“One of the main things that struck us is how little is known,” Dr. Janecka adds. “This is just the starting point.”

The Importance of Affirming LGBTQ+ Health

Pride Month, which fell on June, was a time for celebration, reflection, and remembrance of LGBTQ+ struggles and achievements. Throughout the United States’ history, the LGBTQ+ community has faced various health challenges and inequities, from the HIV/AIDS epidemic in the 1980s to the mpox outbreak last year.

Although LGBTQ+ individuals’ access to health care has improved compared to decades prior, various health concerns and disparities remain pertinent, says Erick Eiting, MD, MPH, Medical Director for the Emergency Department at Mount Sinai Beth Israel and for the Urgent Care Center at Mount Sinai-Union Square.

During Pride Month, Dr. Eiting and Antonio Urbina, MD, Medical Director of the Institute of Advanced Medicine, discussed health topics LGBTQ+ individuals should keep in mind, even as they celebrate the progress that has been made.

STI Testing: What’s Important?

Who should be thinking about getting tested for sexually transmitted infections (STIs)? Anyone who is sexually active should be considered for sexual health screening, although some groups may be more at risk, says Dr. Urbina.

While there is no hard rule for how often one should get tested, health providers at Mount Sinai offer screening every three months. These should include not only testing at genital sites, but also others including the throat and anal/rectal regions.

“That’s especially important because oftentimes, someone can have an STI in those compartments and they don’t have any symptoms at all,” says Dr. Urbina, “so the only way that you’re going to be able to detect them is if you actually swab or screen those areas as well.”

Common tests for gonorrhea, chlamydia, and syphilis help detect infection and initiate treatment if needed. But other important tests include those for HIV, meningococcal meningitis, and human papillomavirus for vaccination and preventive purposes, Dr. Urbina adds.

HIV: Counseling, Testing, Treatment, Management

As it is hard to know, through initial conversations, which patients might be at risk for HIV, it is incredibly important for health providers to make sure they are not using judgmental language or biases during their interactions, says Dr. Eiting.

“It’s really important for everybody to know their status,” notes Dr. Eiting.

Telling someone that they are HIV-positive when they don’t already know is probably one of the most difficult conversations to have, he adds.

It is really important for people to know that having HIV is considered by the medical community these days as a chronic disease that is oftentimes well-managed with medication, Dr. Eiting says. It is also important for them to have a support system in place so that they may transition into living their lives with the condition, since HIV isn’t the same kind of disease that it was decades ago.

It is important for people who test negative for HIV to consider the possibility of being on pre-exposure prophylaxis, or PrEP. In addition to a daily pill that can be taken, there is now a long-acting injectable PrEP that is given every two months by intramuscular injection into the buttocks.

“I think it’s all about empowering patients to taking steps that best fit their lifestyles for prevention,” says Dr. Urbina.

As a result of advancements in modern medicine, there are now people with HIV living into their 90s, and more attention needs to be placed on this elderly group. They tend to exhibit a little more physical vulnerability and frailty due to having lived with the virus for so long, says Dr. Urbina. More aggressive screening for malignancies or bone density loss are recommended too.

Mental Health and Substance-Use Disorders

LGBTQ+ people have been observed to have higher rates of psychosocial issues, including depression and substance-use disorder, and health institutions need to reach out to serve these communities better, says Dr. Urbina.

What is PrEP?

Pre-exposure prophylaxis, or PrEP, is a pill or injection that lowers the risk of getting HIV from sex by about 99 percent, according to the Centers for Disease Control and Prevention. Using PrEP, however, does not prevent other sexually transmitted infections (STIs).

“I think it’s important for us to sometimes take pause and take stock and remember that even though Pride Month is a month of celebration, and to acknowledge how far we’ve come, we have to remind ourselves that it can often be a time when it really enhances isolation for patients who are feeling that as well,” says Dr. Eiting.

Seeking help for mental health or addiction can be daunting for patients due to stigma. But health providers at clinics across the city, including at Mount Sinai, are being trained to make access comfortable and judgment-free, and so patients should not hesitate to tap those resources when needed, Dr. Eiting says.

Affirming Across the Entire Spectrum

Even though the L in LGBTQ+ comes first, the lesbian community can sometimes be forgotten with respect to health care, notes Dr. Eiting. It is important for health providers to be aware of things like breast cancer or cervical cancer screening for this population.

Studies suggest that some lesbian and bisexual women get less routine health screenings than their heterosexual counterparts due to various factors, including fear of discrimination or low rates of health insurance.

Transgender health care encompasses not just gender-affirming surgeries, but also primary care. For transgender patients, sometimes seeking health care can be stressful because if the conversations are not conducted in a respectful way, they can cause dysphoria.

But stigma should not get in the way of having people live their fullest lives, and transgender individuals should take stock of what their health needs are and have conversations with their doctors, says Dr. Urbina.

Given the current climate of anti-transgender sentiment and legislation across the country, health providers should acknowledge that these developments do leave an impact on their transgender patients. “It’s just important for us to acknowledge that that’s out there… and to make sure that we’re using principles of trauma-informed care whenever we’re talking to our patients about their health care,” says Dr. Eiting.

Read more about how Mount Sinai is empowering health care for LGBTQ+ communities

How to Find an LGBTQ+ Experienced Medical Provider and Why That’s Important

Clearing Misconceptions About Gender-Affirming Care for Transgender and Gender-Diverse People

Is Swimmer’s Ear Causing Your Child’s Ear Pain?

It’s the time of  year when you and your kids may head to the pool to beat the heat. But for some people, swimmer’s ear may ruin the fun.  Aldo Londino, MD,  Assistant Professor of Pediatric Otolaryngology at the Mount Sinai Health System and Chief of the Division of Pediatric Otolaryngology at the Mount Sinai Kravis Children’s Hospital, explains the pesky condition, its treatment, and how parents can best guard against it.

What is swimmer’s ear and how would my child contract it?

Swimmer’s ear is the name commonly given to an infection of the ear canal, also known as acute otitis externa.  This infection can happen at any time of the year but tends to peak in the summer months as people spend more time in the water.  Lingering moisture in the ear canal after swimming can create an environment in which bacteria love to grow.  Swimming can also wash away healthy ear wax that protects the ear canal from infections.

How is swimmer’s ear different than a ‘regular’ ear infection?

When people mention an ear infection, they are often speaking of a middle ear infection. Also known as acute otitis media, this is an infection behind the eardrum. It is often treated with antibiotics by mouth unless the child has ear tubes, is most common in very young children, and is often associated with an upper-respiratory-tract infection. A middle ear infection is not caused by bath water or pool water getting into the ears because the eardrum keeps the water from getting inside the body.

How do I know if my child has swimmer’s ear or a middle ear infection?

Children may have swimmer’s ear if they complain of pain and the ear canal has drainage or appears swollen.  Often a light tug backwards and upwards on the outer ear will produce pain in the ear canal.  Swimmer’s ear infections usually do not cause a fever.

Your child may have a middle ear infection if there is pain with a bulging ear drum on your pediatrician’s exam.  There can sometimes also be drainage if the build-up of pus has leaked through the eardrum; however, the ear canal should not be swollen.  Children with a middle ear infection also often have a fever or a cold associated with the infection.

Is the treatment for swimmer’s ear different?

Yes.  Swimmer’s ear should be treated with ear drops alone. In fact, the ear drops often help faster and do a much better job at treating the infection than antibiotics taken by mouth.  From time to time, the ear canal may be too swollen or have too much drainage for the ear drops to enter. A trip to the ear, nose, and throat doctor may be necessary in these instances to help remove excess drainage or place a small sponge in the ear to allow the ear drops to enter and work effectively. If your child is in pain, you can give them acetaminophen or ibuprofen.

What can I do to prevent my child from contracting swimmer’s ear?

If your child suffers from frequent swimmer’s ear, you may want to consider using earplugs to limit the amount of water getting into the ear canal.  A hairdryer on a low cool setting after swimming can also help dry up excess water and reduce the frequency of swimmer’s ear infections.

Aldo Londino, MD, is an Assistant Professor of Pediatric Otolaryngology at the Mount Sinai Health System and is Chief of the Division of Pediatric Otolaryngology at the Mount Sinai Kravis Children’s Hospital.

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