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Ask the Doc: Do I Need to Be Concerned About Endometriosis?

Updated on Apr 21, 2023 | Your Health

Endometriosis occurs when tissue similar to the lining of the uterus grows outside of your uterus. Common symptoms include chronic pelvic pain, painful sexual function, infertility, and many others.

Endometriosis may affect more than 11 percent of women between the ages of 15 and 44, according to the Office on Women’s Heath of the U.S. Department of Health and Human Services.

In this Q&A, Susan Khalil, MD, a gynecologist at The Mount Sinai Hospital and Mount Sinai West, answers frequently asked questions about endometriosis, including possible treatments and options if you might be considering getting pregnant.

Who is most likely to have endometriosis?

Endometriosis is very common in women, affecting about 60 percent of those who have infertility issues. It’s also very common in those who have chronic pelvic pain, affecting up to 80 percent of those patients. Across the entire U.S. population, endometriosis is estimated to affect from eight to ten percent of women.

Endometriosis may affect more than 11 percent of women between the ages of 15 and 44. To schedule an appointment with one of our endometriosis specialists, call 646-412-9894.

What are the symptoms of endometriosis?

Endometriosis can present in many different ways. That’s why it’s sometimes called the “Grand Masquerader,” presenting with pelvic pain, painful periods, sometimes infertility, sometimes painful urination, painful bowel movements, or painful sexual function. At the same time, some women with the condition have no symptoms.

What is the typical age for endometriosis to occur?

Endometriosis commonly affects reproductive age women and persons. That includes anywhere from the start of menstrual periods, which is known as menarche, all the way up to menopause. So that’s a large range.

What are the risk factors?

There are several risk factors. Family history is a strong risk factor. Another risk factor is early start of the menstrual period. Other factors include obstructive anomalies, or congenital anomalies, which can obstruct the uterus and the uterine flow, and these can be associated with a higher risk of endometriosis.

Is it possible to get pregnant after endometriosis?

It is possible to get pregnant after being diagnosed with endometriosis. Endometriosis can present in ways that do not affect your ability to become pregnant. But some will need infertility or assisted reproductive techniques in order to achieve their reproductive goals.

What happens if endometriosis is left untreated?

If left untreated, endometriosis sometimes can be a progressive condition that can lead to mechanical obstruction of the various areas in the reproductive tract, causing chronic pain as well as infertility. Sometimes there is a slight association with an increased risk for certain types of gynecologic cancers.

What are the treatment options?

One of the treatment options for endometriosis is surgical excision therapy, which includes minimally invasive techniques with laparoscopy or robotic surgery. At Mount Sinai, we offer specialty surgical services, where we collaborate with our specialists to provide excellence in endometriosis surgery in the operating room as well as in an outpatient setting. Pain medication and hormone therapy can also be used for treatment.

Five Common Questions About Seasonal Allergies Answered

Apr 18, 2023 | Allergy, Your Health

If you find yourself sneezing and wheezing each spring, then you probably have seasonal allergies. And you’re not alone. About one in four adults, and about one in five children have these allergies, according to the Centers for Disease Control and Prevention.

In this Q&A, Rachel Miller, MD, FAAAAI, System Chief of the Division of Clinical Immunology, answers five of the most frequently asked questions about seasonal allergies. Dr. Miller is also Dr. David and Dorothy Merksamer Professor of Medicine (Allergy and Immunology), and Environmental Medicine and Public Health at the Icahn School of Medicine at Mount Sinai, where her research focuses on the causes of asthma.

What are the symptoms of seasonal allergies?

Sometimes commonly known as hay fever, allergies can affect the nose and eyes and cause congestion and sneezing, eye itchiness, sore throat, and fatigue. The symptoms can be triggered during certain seasons by pollens, such as those from trees during the spring and those from ragweed during the fall. Symptoms may be unrelated to seasons if triggered by exposure to dust or animals that emit allergens year round. Some people with allergies develop allergic asthma, where the inflammation is focused in the lower airways. This can manifest as shortness of breath or wheeze.

Who is prone to having environmental allergies?

Allergic rhinitis, whether seasonal or nonseasonal, occur in people who are genetically predisposed but also re-exposed to triggers in the environment. The symptoms can be worsened by other factors such as stress, air pollution and smoking.

What is the best way to control environmental allergies?

There is no cure for allergies. But you can manage allergies with prevention and treatment. The best way to control allergic rhinitis is to first identify the triggers. They differ for different people. This can be assessed by visiting an allergist who could perform skin or blood tests after taking a careful history. If tree pollen, for example, is identified as a trigger, then wearing hats, sunglasses outdoors and removing shoes and showering upon return indoors, can minimize exposure. If dust, then avoiding sweeping and instead mopping or vacuuming can minimize exposure. A second step is treating with medicines. We have many medicines now to treat this. These may be nose sprays, pills, or eye medications. They are usually well tolerated. If someone cannot tolerate the medicines or has persistent symptoms, then allergen immunotherapy either through injections, known as allergy shots, or medicine under the tongue, can be considered.

Have questions about kids and allergies? Click here for more information on pediatric allergy and immunology at Mount Sinai.

What kinds of medication can I take to lesson my symptoms?

Two of the main types of medications used to treat allergies are antihistamines and steroids. These medications are available over the counter in the form of pills, nasal sprays, eye drops, and by prescription. Here are some suggestions:

Look for products containing a nondrowsy antihistamine if you suffer from sneezing or a runny nose.
A steroid nasal spray can be used on its own or in conjunction with an antihistamine nasal spray to quickly clear the nasal passages. A saline rinse prior to using a nasal spray may help wash away pollen and ensure better penetration of the medication.
Itchy, watery eyes can be treated by trying artificial tears to wash away the offending pollen or antihistamine eye drops can be prescribed.

When should I consult a physician about my seasonal allergies?

Environmental allergies can occur at any time in life and vary in occurrence and severity. If your symptoms are not easily managed or well-understood, you can consult with an allergist/immunologist. Symptomatic treatment in combination with prescribed medications can successfully treat most situations. An allergist/immunologist can conduct skin testing to see what specific substances you are allergic to. If so, arrangements can be made for you to receive allergy injections that can help desensitize you to the offending allergens. However, this takes time and does not afford immediate relief of symptoms.

Learn more about Allergy and Immunology at Mount Sinai

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Three Things You May Not Know About Asthma

Updated on Jun 27, 2024 | Asthma, Your Health

If you or someone you know has asthma, then you probably know what it can be like when asthma causes that wheezing, chest tightness, and coughing.

In fact, more than 25 million people in the United States have asthma, and it is one of the most common and costly diseases, according to the Asthma and Allergy Foundation of America.

Asthma symptoms are caused by airway inflammation, airway swelling, accumulation of mucus, and constriction of airway muscle. Symptoms can be triggered by a variety of different things, including allergens like dust or pet dander, or can be developed in response to certain foods or exercise.

Linda Rogers, MD

Though this condition is widespread, many people may also have some misconceptions about asthma. Linda Rogers, MD, an Associate Professor in the Division of Pulmonary, Critical Care and Sleep Medicine, explains three things you may not know.

Asthma is not just a children’s disease

Although asthma and allergies are common in children, asthma can develop at any age. Some of the types of asthma that develop in adults are associated with sinus disease, including nasal polyps and late onset asthma in older people, and symptoms can present suddenly, seemingly out of nowhere, and are at times severe. Inhaled treatments can help keep symptoms in check and prevent flare-ups for those with asthma at all ages. For some people with asthma, there are new medicines given by injection if inhaled therapies are not keeping asthma under control.

Using albuterol alone as your only treatment for asthma may not be safe

Airway inflammation is an important driver of asthma symptoms. Albuterol is a medication delivered by an inhaler that helps to open airways when you have an asthma attack by relaxing the muscles. It is sold under brand names such as Ventolin, Proventil, and Proair. Albuterol does not treat inflammation and only provides quick relief without treating the underlying cause of asthma. Using albuterol alone has been linked to worsening airway inflammation, decreased sensitivity to albuterol for quick relief when it is most needed, and worsening of asthma over time. Instead of using albuterol alone, treatment with combination inhalers that have a medication to open the airways quickly (albuterol or formoterol) mixed together in one inhaler with a low dose anti-inflammatory inhaled steroid has been found to be a safer approach and is better at preventing flare-ups that land you in urgent care, the emergency room, or in the hospital. This is true for patients who may feel that they have mild asthma and only need treatment when they have symptoms. Some of these treatments can be used only when you have symptoms with better results than just albuterol alone.

Low dose inhaled steroids are safe and effective

Many patients with asthma are concerned about side effects from using inhaled steroids, and this concern leads them to use albuterol alone and to avoid inhaled steroids entirely. We now have almost 50 years of experience using inhaled steroids to treat asthma. Side effects that have been reported generally occur with high doses. When using low doses, inhaled steroids are extremely safe and better than albuterol alone at controlling symptoms and preventing flare-ups. New approaches that combine these medications in one inhaler with a quick relief medication (such as albuterol or formoterol) allow many patients with asthma to use these as needed for symptoms and get similar results to using daily medication while keeping the dose of inhaled steroids low.

To make an appointment, call 212-241-5656.

Find a Mount Sinai doctor for your asthma symptoms

Questions to Ask Your Doctor About HPV-Related Oral Cancer

Updated on Apr 11, 2023 | Cancer, Head and Neck, Sexual Health, Your Health

To make an appointment with Raymond Chai, MD, call 212-844-8775.

Did you know that the human papillomavirus (HPV) can cause cancers of the oropharynx (tongue, tonsils, and back of the throat), similar to how HPV causes cervical cancer?

Most oral HPV infections can clear naturally without treatment. But if the virus persists in the system, it could incite more serious health issues, such as these cancers. Additionally, the incidence is low, with about 12,000 new cases of these HPV-associated cancers diagnosed each year in the United States, but 80 percent affect men.

Raymond Chai, MD, a head and neck surgeon at the Mount Sinai Union Square location of the Head and Neck Institute/Center of Excellence for Head and Neck Cancers, answers some frequently asked questions about oral HPV infections.

What are my options for treatment?

The two main approaches are upfront radiation treatment with chemotherapy versus a primary surgical approach.

Do you offer transoral robotic surgery (TORS)?

This technology has largely replaced traditional surgery, which typically required splitting the lip and cutting the jaw to access the tumor.

Do you have a true multidisciplinary approach to this disease?

Both surgical and non-surgical treatments should be on the table and discussed. In select cases, the use of TORS can either completely eliminate postoperative radiation, lower the dose of postoperative radiation, or eliminate the need for chemotherapy. This may reduce the risk of long-term side effects from high-dose radiation and chemotherapy.

What is your experience level with TORS? How many cases have you performed?

Experience matters with this new technology and as with any new surgery, there is a learning curve. Even seasoned surgeons who are experts with open approaches need to have the appropriate training and experience to become proficient in performing this surgery. Robotic surgery does not have the same tactile feedback that surgeons typically rely on in performing procedures. In addition, in TORS, complex anatomy needs to be re-learned from the inside-out, since the surgeon is now operating from inside the mouth instead of outside from the neck.

What is your rate of complications, particularly bleeding?

TORS has been shown to be very safe in expert hands, with a low rate of postoperative bleeding of 2-4 percent.

What is your average length of stay for TORS patients?

Studies have demonstrated that for high-volume TORS practices, patients on average leave the hospital two days following surgery.

Do you work closely with a swallowing therapist?

Whether the treatment is radiation with chemotherapy or surgery, the best post-treatment swallowing outcomes are seen when patients are followed closely with a seasoned speech-language pathologist.

What are your research efforts with TORS?

Across the country, investigators are actively recruiting patients in clinical trials that are using TORS as a platform for de-intensifying their cancer treatment. Mount Sinai was one of the early adopters of TORS and continues research activities related to the reduction of complications. We are leading efforts in de-intensification with the SIRS 2.0 trial, which relies on a novel blood test evaluating circulating tumor DNA (ctDNA). If HPV ctDNA becomes undetectable after surgery, patients are either observed without additional treatment or receive a highly de-intensified regimen of chemotherapy and radiation.

What is your protocol for follow-up care?

Nearly 100 percent of distant metastases for classic head and neck cancers related to smoking occur within the first two years of treatment. However, for HPV-related throat cancers, recent studies have suggested that distant metastases can occur even five years following treatment. Patients with this disease require long-term close follow-up. Mount Sinai has been a pioneer in the use of ctDNA for follow-up care. This highly accurate test can allow for earlier detection and treatment if the cancer recurs.

Should I get a second opinion?

The answer should always be ‘yes.’ Patients need to be able to fully explore their options and to familiarize themselves with centers that have the most experience with all treatment options for this disease, whether that be TORS or non-surgical therapy.

Learn More about the Head and Neck Institute/Center of Excellence for Head and Neck Cancers

Mount Sinai Morningside Launches Incidental Lung Nodule Program to Promote Early Diagnosis of Lung Cancer

Mar 31, 2023 | Featured, Mount Sinai Morningside, Your Health

A photo showing Javier Zulueta, MD, Rahul Agarwal, MD, and Fernando Carnavali, MD.

Javier Zulueta, MD, right, is joined by, from left, Rahul Agarwal, MD, and Fernando Carnavali, MD.

Lung cancer is by far the leading cause of cancer deaths in the United States accounting for about one in five cancer deaths. It is difficult to detect because there are often no symptoms in its earliest stages—only 16 percent of lung cancers in the United States are detected at a localized stage.

Lung cancer screening for smokers and former smokers, like the Early Action Lung Cancer Action Program (I-ELCAP), has been found effective in detecting lung cancer at earlier stages. However, as more lung cancers are being detected in non-smokers and many are ineligible for screening under the I-ELCAP guidelines, additional tools are needed to detect lung cancers early and save lives.

The newly launched Incidental Lung Nodule Program (ILNP) at Mount Sinai Morningside opens a new path for early detection guided by methodically identifying the patients with lung nodules at most risk for lung cancer and ensuring they receive timely interventions.

How the Incidental Lung Nodule Program Works

CT scans ordered for other illnesses and injuries are methodically scanned by computerized search—a more equitable and inclusive tool for detecting lung cancer early. All of those scans with a reported and documented incidental lung nodule are reviewed by a team led by a pulmonologist with special expertise in lung nodules.

Research has shown that about 25 percent of individuals who have a CT scan of the chest will have an incidental lung nodule detected, most of which need follow-up. Approximately five percent of the individuals with lung nodules may have lung cancer. With an early diagnosis, lung cancer can be successfully treated in the majority of patients.

All scans with findings are entered into a database for tracking and follow-up. The ILNP team notifies the ordering physician and the patient’s primary care provider, if available, via Epic, phone call, or letter, with a specific follow-up recommendation. If the ordering physician was in the Emergency Department and there is no primary care provider available, the ILNP team will reach out to the patient directly.

Click here to see a flowchart showing the communication pathway.

How Do Patients Seek Evaluation and Treatment

Javier Zulueta, MD, a lung nodule expert and pulmonologist at Mount Sinai Morningside, leads a multidisciplinary clinic that accepts referrals from physicians and is available directly to patients. Patients who need evaluation by the nodule clinic will be offered an appointment within one week of notification. They will be evaluated by a pulmonary specialist, and a plan will be established according to guidelines, including a wide variety of diagnostic and treatment options depending on the characteristics of the nodule:

Blood test for cancer biomarkers
PET scan
Pulmonary function tests
Biopsy by robotic bronchoscopy or CT guidance
Evaluation by Thoracic Surgery

Smoking cessation will be offered to anyone who is a current smoker. All patients will be given a plan for CT scan follow-up within a predetermined period of time—anywhere between three and 12 months.

Patients may require exam and follow-up or diagnostic interventions like image-guided bronchoscopy or percutaneous biopsy. If cancer is diagnosed, the patient will be presented at Mount Sinai Morningside’s weekly multidisciplinary lung cancer and nodule conference. After review of all diagnostic and staging tests, a decision regarding treatment will be made. This can vary depending on the stage but includes thoracic surgery for early stages and oncologic assessment for all.

Patient Follow-Up

Patient not requiring immediate care will be prompted to repeat their CT scan on a recommended schedule and will continue to receive evaluation through the ILNP. The ILNP program navigators will contact the primary care physician, other provider, or the patient directly if patient is not getting the recommended diagnostics.

For more information or to refer a patient to the Lung Nodule Clinic, please call 212-523-3589.

New Wireless Monitoring Technology Now Offers Patients a Better Birthing Experience at Mount Sinai West

Mar 31, 2023 | Featured, Your Health

The maternal and fetal wireless technology is a single patch system placed on the birth parent’s abdomen.

Wireless technology has transformed virtually all aspects of our life, and now it is ready to transform the birthing and labor experience.

Mount Sinai West recently launched advanced wireless monitoring technology that allows patients the freedom to safely move around during the labor process.

The maternal and fetal wireless technology is a single patch system placed on the birth parent’s abdomen, allowing providers and nurses to monitor fetal heart rate, contractions, and uterine activity while offering patients more freedom of movement during the birth experience.

This technology is a cord-free, belt-free solution that increases the comfort of laboring patients. Without cords connecting the patient to a fetal monitor, laboring patients are free to get up, move around their room or the hospital, and change positions as needed. It can even be worn in the shower or tub. The Mount Sinai Hospital will soon offer this service to patients.

“Wireless technology has become a standard for all things modern. By utilizing wireless monitoring, we can significantly increase our patients’ comfort and mobility,” says Desmond Sutton, MD, Medical Director, Labor and Delivery in the Department of Obstetrics and Gynecology at Mount Sinai West and Assistant Professor of Obstetrics and Gynecology at the Icahn School of Medicine at Mount Sinai. “This really transforms the birth and labor experience, and we are pleased to have it available to all patients.”

The small device, about the size of computer mouse, uses a peel-and-stick patch to stay on the abdomen and Bluetooth technology, which sends data directly to monitors so the care team can effectively track contractions, and maternal and fetal heart rates.

In addition, the monitor allows patients to choose how they want to labor, improving patient satisfaction and comfort, which Mount Sinai West prioritizes for all their patients.

“We continue to focus on providing technology that supports a greater patient experience, so this technology tremendously assists us in our support of patients owning their birth plans and birth experience,” Dr. Sutton says.

Specialists at the Mount Sinai West Obstetric Service support patient needs, choices, and preferences with skilled, compassionate care. Obstetricians, midwives, maternal-fetal medicine experts, and nurses partner with you to ensure you receive comprehensive services personalized to your goals.

Learn more about pregnancy and birth experience at Mount Sinai West

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