If You Have Shoulder Pain, Here’s Some Expert Advice From a Shoulder Surgeon

Sep 6, 2023 | Your Health

The shoulder is one of the most movable joints in your body, and it’s a complex one that depends on the rest of your body to work properly— which is why shoulder problems can affect people of all ages.

Shoulder replacement surgery (arthroplasty), one of the most successful orthopedic surgical procedures, is evolving. Advances include much improved replacement implants, individualized planning and execution, and a more comfortable recovery. These advances are similar to those that have changed the way doctors perform knee replacement surgery.

In this Q&A, Dave Shukla, MD, explains some of the most common problems that might require surgery, the different options available to patients, and some of the latest advances, including the use of mixed reality technology to plan and execute shoulder replacement surgery at Mount Sinai Brooklyn, the first of its kind in New York City.

What are the most common job and sports-related injuries and lifestyle conditions that can cause shoulder pain?

Dave Shukla, MD

Osteoarthritis is an example of a condition that can cause shoulder pain. Anyone whose job requires repeated lifting or pushing, such as a construction worker, is prone, to shoulder injuries. Athletes in sports that involve repetitive shoulder motion, such as a baseball or tennis, are also prone to injuries. About 30 percent of people over the age of 60 develop arthritis in the shoulder joint, with most of the cases affecting women.

Your biological makeup can also predispose you to loss of cartilage. There are some genetic factors that might make some people prone to having less durable cartilage, or some people’s cartilage doesn’t stick to the bone as well.  These individuals tend to have their cartilage wear away more easily. Some  people develop shoulder arthritis even though they do not subject their shoulder to much stress and participate in low-impact sports, such as swimming. Also, a history of trauma to a joint, such as a dislocation after a fall or skiing accident or having a broken bone in the past that causes some malalignment in the joint, will predispose someone to arthritis.

What types of traumatic injuries require shoulder surgery?

A visit to an orthopedic surgeon is essential to repair a broad array of injuries, including rotator cuff tear, a tendon tear, shoulder trauma, or fractures of the humerus, clavicle, and scapula. The type and extent of the surgery depends on the severity of the injury. The surgeon will recommend if reconstruction or full joint replacement is needed.  The surgeon will try to spare the patient’s native anatomy whenever possible. In the case of soft tissue injury, surgeons try to repair rotator cuff tendons that are destabilizing the shoulder. There are situations when there is a rotator cuff tear that’s so severe, or has been there for so long, that even if the tendons are repaired, they may not heal. Once the rotator cuff has been damaged for a long time, the shoulder can start to develop arthritis, which is called rotator cuff tear arthropathy. Once the joint and the bones start remodeling and lose their shape and the cartilage wears away, we then move to recommendations on joint replacement options.

 How are shoulder injuries or conditions diagnosed?

A visit to an orthopedic surgeon begins with taking a patient’s history:  When did the pain start?  How did it start? Was there any previous trauma or injury? The doctor will perform a physical exam to determine the extent of functional impairment, range of motion, and the extent of pain.  Typically, X-rays will be the first screening test. If there is any concern for soft tissue injury that you can’t see on an X-ray, a magnetic resonance imaging (MRI) scan may be needed. The MRI would be able to help diagnose rotator cuff or labrum tears, biceps tendon injuries, the onset of arthritis, and wear and tear of the cartilage causing bone changes. The surgeon may also use computed axial tomography (CAT) scans before performing any operation involving bone work, such as a shoulder replacement, or sometimes before repairing a broken bone.

What are the most common non-surgical treatments for shoulder pain?

The majority of shoulder problems are usually initially treated with conservative management consisting of rest, activity modification (especially with rotator cuff tears), and physical therapy. That can be coupled with oral anti-inflammatory medication or possibly a steroid injection, which can be very helpful in controlling inflammation and pain.

What is arthroscopy?

Arthroscopy is a minimally invasive procedure for diagnosing and treating joint problems. During an arthroscopic procedure, the surgeon inserts a narrow video camera about the thickness of a pencil through a very small incision to view the joint. The doctor can diagnose problems as well as repair a range of injuries by inserting instruments through an additional small incision to repair. Surgeons can remove bone spurs or cleanout scar tissue that might be the cause of pain and impingement, potentially resulting in loss of motion.

What are the different types of shoulder surgery and when is each needed?

 There are four types of shoulder surgery, which offer patients options for their specific condition:

  • Shoulder reconstruction surgery: This is for patients with moderate symptoms and conditions that don’t require total joint replacement. The surgeon repairs torn or stretched ligaments and other soft tissues to stabilize the shoulder joint and to prevent future dislocations. Minimally invasive techniques are used whenever possible, but some patients need open surgery. Reconstructive surgical options include arthroscopy and open surgery.
  • Partial shoulder replacement surgery (shoulder hemiarthroplasty): This procedure replaces the upper bone in the arm with a prosthetic metal implant, leaving the other half of the shoulder joint, the socket, intact.
  • Total shoulder replacement surgery (shoulder arthroplasty): Patients who have severe arthritis in the shoulder but whose rotator cuff tendons are intact (not torn) can benefit from an “anatomic” total shoulder replacement surgery. The shoulder replacement surgery replaces both the ball and socket of the shoulder joint with an artificial joint (made of metal, ceramic, or plastic).
  • Reverse shoulder replacement surgery: If you have severe shoulder arthritis and rotator cuff tears or deformity with bone loss, your surgeon may also recommend a different type of surgery called “reverse” shoulder replacement surgery. This surgery involves replacing both the ball and socket of the shoulder joint but switches their positions. In this technique, surgeons attach a metal ball to the shoulder socket and a plastic socket to the upper end of the humerus. A reverse shoulder replacement allows the patient to use an upper arm muscle (the deltoid) rather than the rotator cuff to raise and move the arm.

What are the risks for each procedure?

Complications can happen with any surgery. The range of complications can include infections and possible nerve injury. Overall, the risk for shoulder arthroplasty is relatively low.  Risks for shoulder implants are related to implant instability or the implants’ failure to incorporate into the patient’s bone. If the surgery is for a fracture, the risk might be related to the joint not functioning exactly how you want it to function.

Is shoulder arthroplasty an outpatient procedure?

There is a national trend to performing shoulder arthroplasty as a same-day procedure. Most shoulder replacement surgeries at Mount Sinai Brooklyn are same-day surgeries. An assessment of each patient is made pre- and post-surgery to ensure they can be safely allowed to go home the same day, though if pain control is challenging or other medical issues arise, then the patient would stay overnight.

What will a successful surgery and recovery look like?

It usually takes about three months for a near-full recovery, though patient function continues to improve up to one year after surgery. Patients wear a sling for the first four to six weeks. Once out of the sling, the patient can start active range of motion followed by strengthening, often with the assistance of a physical therapist. By the end of three months, most patients feel like they have an 80 percent recovery.

Will there be activity restrictions post surgery?

Once you are fully recovered, we recommend no lifting overhead of more than 25 pounds for reverse shoulder replacement. As a rule, the more strenuous activity you place on the new joint, the less life it might have in the long term. Patients are able to resume most leisure athletic activities such as golf, swimming, and light weight lifting.

How long will the shoulder replacement last?

In general, 95 percent of shoulder replacements last about 10 years, and 85 percent of them last more than  20 years. If you live long enough and you have had replacement surgery, you can plan on having another at some point in your life. Considering the advances in surgical techniques and the materials used for the replacements, there’s a possibility that the replacement might last 30 years or longer.

What innovations or advancements are being used to improve the surgical outcomes?

There are a number of innovations and advancements in shoulder surgery, including advances in the use of CAT scan technology, the use of mixed reality to plan and execute the surgeries, and the expected use of robot-assisted surgery, similar to what is being done in total knee replacement.

  • CAT scan technology: A significant advancement has been the increased use of CAT scan technology for shoulder arthroplasty, which can provide what is called “patient-matched implants.” This is where a CAT scan of the patient is used to manufacture an implant that fits the shape of the patient’s anatomy perfectly. The surgeon can now use an individualized, custom-made implant for each patient. Creating an individualized implant used to cost tens of thousands of dollars and could have taken several months to manufacture. The length of time to produce these implants is now about five weeks. The goal is to try to reduce the wait time to two weeks.
  • Robot-assisted surgery: Over the next few years, shoulder surgeons will be able to use robot-assisted surgical technology. Currently used by some for total knee replacements, robot-assisted surgery will bring an increased level of precision. This can lead to the use of a less-invasive approach to shoulder replacement.
  • Mixed reality: This uses holographic technology combined with a surgeon’s pre-operative plan to more precisely execute each shoulder surgery.

What is mixed reality and how does it work?

One of the newest technologies available, mixed reality uses 3D holographic technology to allow surgeons to plan the operation using perfect images of your shoulder’s anatomy. This planning will allow for a greater level of precision in placing implants. Based on years of experience, the latest research informs us that if a shoulder implant is put in even two or three millimeters too high or slightly in the wrong rotation or alignment, it will drastically affect not only the range of motion and the outcome, but also how long the implant can last.

During the pre-surgical planning, CT scan images are loaded onto a database using a new software that allows the surgeon to plan a patient’s surgery in a 3D space. This creates a precise holographic image of the patient’s shoulder. The surgeon creates a detailed map of the patient’s anatomy that is brought into the operating room to provide precise guidance. The mixed reality technology is yet another major advancement in shoulder replacement surgery that provides individualized care based on each patient’s anatomy. The technology works with special goggles that project the 3D image and, through voice and hand control commands, allows surgeons to position and manipulate the hologram during the procedure. Surgeons can rotate and zoom in or out of the hologram model while comparing it in real time to the patient’s own anatomy. This technology allows the surgeon to minimize the risks of improper placement, reducing the risk of early joint loosening, and also to protect the soft tissues around the shoulder.

Will Artificial Intelligence (AI) play a role in shoulder arthroplasty in the future?

AI is currently being used for hip, knee, and spine surgeries to predict which patients will do well and which might have complications. In the near future, AI will play a larger role in shoulder arthroplasty. This will enable surgeons to advise patients about potential risks based on the AI algorithm of their medical chart and risk factors. This will allow for a greater understanding between the surgeon and patient about risk factors before going into the surgery.

Learn more about advances in shoulder surgery

“Like Turning Off a Light Switch”: Signs and Symptoms of Stroke

Updated on May 22, 2024 | Cardiology, Neurology, Vascular Health, Your Health

Slurred speech, an impaired gait, paralysis on one side of the face, arm, and/or leg—these are all signs of a stroke, especially if they appear suddenly. If you believe you or someone else is experiencing a stroke, call 911 immediately. Strokes are an emergency, and waiting can result in serious brain injury and even death.

Carolyn Brockington, MD

In this Q&A, Carolyn Brockington, MD, Director of the Stroke Center at Mount Sinai West and Mount Sinai Morningside, and Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai, discusses the signs and symptoms of a stroke, the difference between a stroke and a mini stroke, and why you must act fast.

What is a stroke?                                                                                                         

Simply put, stroke is an injury to the brain caused by a reduction of blood flow—for example, a blood vessel is blocked by a blood clot. Strokes are an emergency because there is a restricted time period—just a few hours—for people to come in for treatment, where doctors can try to administer certain therapies to improve blood flow in order for the affected part of the brain not to be injured.

What are the signs and symptoms?

The signs and symptoms from stroke have to do with how the brain is organized. Primarily, the left side of the brain controls the right side of the body, and the right side controls the left. Let’s say somebody is not getting enough blood flow on the left side of the brain, depending on the part of the brain affected, they might develop right-sided weakness or right-sided numbness, or difficulty speaking, or difficulty understanding speech, etc. If someone has a stroke on the left side of the brain in the back, they may have vision problems but they’ll be able to walk around and speak. If they have a stroke towards the front of the brain, they might have more of a language problem but no vision disturbance. While it’s very hard to tell people exactly what type of symptoms they would have, the appropriate thing is to understand that the symptoms are sudden, like turning off a light switch. Pay attention to balance, eyesight, face asymmetry, arm or leg movement, speech or language.

Who is most at risk?

Everyone is at risk for stroke. Most people think you only have to worry about stroke when you are old. The truth is that the incidence of stroke increases as we get older, because some of the risk factors or the medical conditions that we know that increase stroke increase over time—high blood pressure (hypertension), diabetes, heart disease, elevated cholesterol, etc. However, the most important thing to understand is that anybody can have a stroke at any age. The fact that stroke risks increase with age doesn’t mean it can only happen when you get older. There are different reasons people might have a stroke at different ages.

If I think I or someone else is having a stroke, what should I do?

If you or someone else is having a stroke, time is ticking, so call 911. As doctors, we say “time is brain,” meaning every minute that goes by it has been estimated that approximately 1.9 million brain cells are potentially dying. Emergency Medical Services will dispatch the ambulance, which will take you to the closest designated stroke center that has the ability to assess you in a timely fashion and provide the appropriate treatments. At the Mount Sinai Health System, all of our eight hospitals have been designated as certified stroke centers, meaning that we all have multidisciplinary teams to provide the appropriate therapy within the clinical guidelines for the acute treatment of stroke.

How will I be treated for an acute stroke?

Once you are in the emergency room, there is a lot that needs to be done in a very short period of time to make sure you are eligible for acute stoke treatment, including brain imaging and blood tests, etc. Afterwards, we may be able to administer certain therapies, for selected patients, within what we call the “therapeutic window.”

For example, for acute stroke, there’s treatment we give intravenously through the IV in the emergency department. If there is a big blockage of a blood vessel, we might be able go in and pull that clot out. The time period for the intravenous therapy is within three hours of symptom onset, and for some people we can extend it to four and a half hours. People who receive treatment earlier typically do better.

Am I having a stroke?

It’s important for everyone of all ages to know the signs and symptoms of a stroke.  F.A.S.T and B.E.F.A.S.T, acronyms used by many medical and health organizations, including the American Heart Association and the American Stroke Association, can help you quickly spot the common signs and symptoms of stroke.

B is for sudden loss of balance. Your gait is suddenly off balance, as if drunk or suddenly dizzy.
E is for sudden loss of vision in one or both eyes. You may also see double.
F is for an uneven face. You are experiencing sudden facial weakness or numbness on one side.
A is for arms or leg weakness. You can’t outstretch your arm or leg or keep it up, and there is a sudden weakness and/or numbness on one side of your body.
S is for slurred speech. Aside from slurred speech, you may not be able find the right words, or may have trouble understanding others.
T is for time. “Time is brain.” Don’t wait and hope symptoms go away—call 911.

Want to learn more about the warning signs of a stroke? Check out this interactive F.A.S.T. guide from the American Stroke Association.

Hispanohablantes: ¿Crees que alguien está sufriendo un derrame cerebral? Sea R.Á.P.I.D.O.

What’s the difference between a stroke and a mini stroke?

When people say “mini stroke,” they mean a transient ischemic attack, or TIA. “Transient” means brief; “ischemia” means reduction in blood flow; and “attack” means an event that is a shorter period of time where not enough blood gets to the brain and causes symptoms. An example might be that somebody is walking down the street, and suddenly, they feel their left arm and leg is heavy. They are having difficulty moving, they may have some difficulty walking, and then a few minutes later it goes away. Both stroke and TIAs are caused by an interruption of blood flow to the brain. The big distinction is that the TIA is a shorter period of time where not enough blood gets to the brain, so it doesn’t cause a permanent injury.

What should I do if I think I had a TIA?

Even if the symptoms resolve, a TIA is an emergency. Even though a TIA doesn’t result in an injury to your brain, we need to identify the cause. TIAs are warning signs that a stroke may be looming. If we can find that you have an artery narrowing or problems with your heart or your blood or blood pressure etc, that gives us the opportunity to try to address the issue before you have a stroke. TIAs and stroke are both considered emergencies and require fast treatment.

How can I decrease my risk for having a stroke?

There are a lot of risk factors for stroke, both modifiable and nonmodifiable. Nonmodifiable risk factors include age and family history of stroke. Modifiable risk factors include high blood pressure, heart disease, and diabetes. Hypertension (high blood pressure) is the number one reason why people have stroke and heart disease. The identification of high blood pressure, and modifying it, usually through adopting a healthier diet, regular activity, and sometimes medication, is important. Speaking to your doctor about your risks provides an opportunity to modify or control risks better long-term to reduce your chances of having a stroke.

How to tell if someone could be having a stroke

Remember the B.E.F.A.S.T. acronym:

  • You notice they are suddenly acting or walking as if drunk or dizzy, but they have not had anything to drink
  • You ask them to smile, and their face is asymmetrical
  • Their speech is slurred or they are unable to find the right words, or they seem confused and have trouble understanding you
  • They have difficulty maintaining or are unable to lift their arms or legs
  • They have double or blurred vision

If you notice any of the above, call 911 immediately.

How will having a stroke affect me?

Many individuals recover well after a stroke, and enjoy a good quality of life. The challenge is that certain types of stroke have the potential of causing significant neurological impairment, which highlights the need for prompt identification of stroke symptoms and treatment. If you think having a stroke is inevitable, you are wrong—there are many things you can do to reduce the chance of it happening. However, it starts with partnering with your primary care physician to discuss your particular risk factors and determine what you can do to modify your risks—not just today, but long-term—to reduce your risk of stroke and maintain good brain health.

Have you or someone you love experienced a stroke? Learn about Mount Sinai’s services and therapies that can help

Should I Be Concerned About “Flesh-Eating Bacteria” in New York?

Updated on Aug 29, 2023 | Infectious Diseases, Your Health

If you live in the New York City region, you probably heard news reports of a “flesh-eating bacteria” that has sickened several people. The disease is caused by an infection from a bacteria called Vibrio vulnificus, which can cause severe wound infections and, sometimes, blood stream infections, sepsis, and even death.

While worrisome, Vibrio vulnificus is extremely rare. Every year, there are about 100 cases reported in the United States. Vibrio vulnificus is less concerning for the general population, but is a major risk if you have a weakened immune system.

Timothy Sullivan, MD

In this Q&A, Timothy Sullivan, MD,  an infectious diseases physician and Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, discusses why people are getting infected with Vibrio vulnificus in New York City, how to prevent it, and what to do if you’ve been infected.

Why are people suddenly getting infected with Vibrio vulnificus in the New York City region?

Vibrio vulnificus tends to grow in brackish water, which is a mixture of saltwater and freshwater that occurs in estuary areas where rivers meet ocean water, such as the Long Island Sound. As the bacteria tend to grow more rapidly in warm water, the disease has always been more common during the summertime. However, there seems to be a link between climate change and these infections. In recent years, it seems these infections have become increasingly common in more northern climates as ocean water temperatures rise globally.

What are the risks?

Those most at risk are people with weakened immune systems, which can be caused by a number of issues, including having an underlying liver disease, if you are a transplant recipient, or if you are undergoing cancer treatment. Among these individuals, you are at risk if you have open wounds, recent tattoos or piercings, and have been exposed to brackish water, or if you eat raw or undercooked shellfish.

What are the symptoms?

The symptoms depend on whether you were exposed to Vibrio vulnificus through brackish water or by eating raw or undercooked shellfish. If you were exposed through water, you can develop a wound infection, which would include redness, pain, and swelling near the wound. With this disease in particular, wound infections can progress very rapidly and progress to a condition called necrotizing fasciitis that destroys tissue beneath the skin, which is why the disease is referred to as “flesh-eating bacteria.” That infection can develop into severe redness and pain that spreads rapidly from the area of initial infection. The first signs and symptoms of infection following eating raw or undercooked shellfish include nausea, vomiting, diarrhea, and abdominal pain. If a severe infection develops, you may experience fevers, chills, rapid heart rate, low blood pressure, and confusion, which are all signs of a very severe bloodstream infection.

How is the disease treated?

A Vibrio vulnificus infection is typically treated with intravenous antibiotics. If you develop a severe wound infection, you may need to undergo surgery. In the most severe cases that develop into necrotizing infections, amputation may be required.

What should I do to avoid infection?

These recommendations are not for the general population but primarily for people who have weakened immune systems. Do not eat raw or undercooked shellfish, not only to avoid infection from Vibrio vulnificus but other potentially harmful bacteria, as well. You should also avoid direct exposure to brackish water or estuary regions. Even if you don’t have open wounds, avoid brackish water and handling shellfish, since you could injure yourself, such as being in a boating accident or cutting yourself while shucking oysters. If you are at risk for severe infection and have a wound that has been exposed to brackish water, raw seafood, or seafood juices, wash the wound as soon as possible with soap and water. If you want to eat shellfish, make sure it is well cooked.

What should I do if I think I’m infected?

A Vibrio vulnificus infection may be a medical emergency, so if you have a possible exposure to Vibrio vulnificus and signs of infection, you should go to the hospital immediately. You would need to be started on appropriate antibiotics and, if necessary, undergo surgery. Communicate to your doctor your risk factors and exactly how you were exposed, so they can accurately diagnose you and start your appropriate treatment as soon as possible.

 

Learn more about Your Health.

How to Protect Yourself From COVID-19, Flu, and RSV This Fall

Updated on Sep 13, 2023 | COVID-19, Featured, Your Health

Respiratory viruses, such as influenza and respiratory syncytial virus (RSV), tend to pick up during fall. On top of that, COVID-19 is still circulating, with cases increasing in recent weeks. To fight off what some are calling a “tripledemic” of all three viruses, state and federal health officials are urging people to protect themselves with vaccines.

In an interview, Bernard Camins, MD, Professor of Medicine (Infectious Diseases), and Jennifer Duchon, MD, Associate Professor of Pediatrics (Newborn Medicine), at the Icahn School of Medicine at Mount Sinai, provided additional background about vaccines that will be available this fall.

COVID-19

COVID-19 cases and hospitalizations are not as high as they used to be at the height of the pandemic. But hospitalization counts—which are still being reported—have risen in recent weeks.

“We can’t just forget about COVID-19 yet,” says Dr. Camins.

On Monday, September 11, the U.S. Food and Drug Administration (FDA) cleared updated COVID-19 vaccines for use that are formulated to more closely target currently circulating variants. The FDA approved the Pfizer and Moderna vaccines—known as “messenger RNA” or “mRNA” vaccines for the type of technology they use—for people 12 and over. It granted emergency use authorization to the same vaccines for people six months to 11 years old.

On Tuesday, September 12, a panel of the Centers for Disease Control and Prevention (CDC) voted to recommend the updated vaccines for everyone six months and older. The CDC recommended that most people get one dose of the new vaccine, at least two months after their most recent vaccine dose. People who are immunocompromised, and parents of young children, should consult their doctor for recommended dosing.

Dr. Camins said the updated COVID-19 shots from Pfizer and Moderna are monovalent vaccines—meaning they are designed to target a single variant of SARS-CoV-2, the virus that causes COVID-19—but are expected to provide broad protection against the other currently dominant circulating variants of SARS-CoV-2 as well. He said patients should check with their primary care doctor’s office or local pharmacy to find out how and when they can get the new vaccines.

“Based on past developments, it could be within a matter of days for the shots to be available to the public once the recommendation is made,” says Dr. Camins.

The number of people hospitalized due to COVID-19 has been rising steadily in the city in August. Source: NYC Department of Health and Mental Hygiene

RSV

The respiratory syncytial virus commonly causes mild, cold-like symptoms in most healthy adults and goes away after a few days. However, for infants and older adults with pre-existing heart disease or lung disease, RSV can cause severe disease. This year, new vaccines are available for these vulnerable groups.

“RSV is ubiquitous,” says Dr. Duchon. “You can try to prevent it, but even then options are limited. While parents can practice good hand hygiene and stay away from other sick people, babies often have siblings who go to school or go to daycare.”

Most of the deaths or severe disease—typically lower-respiratory-tract disease—from RSV occur in infants ages 0 to 6 months, says Dr. Duchon.

In July, the FDA approved Beyfortus™ (nirsevimab-alip), marketed by Sanofi in the United States, for use in infants entering their first RSV season and up to 24 months of age for those in vulnerable groups. In August, the FDA approved Abrysvo™, from Pfizer, as a maternal vaccine to protect infants from birth through six months of age. Beyfortus is administered directly to infants after they are born, while Abrysvo is given to mothers at 32 weeks through 36 weeks of gestation.

ACIP has recommended that Beyfortus be given to all infants younger than 8 months born during—or entering—their first RSV season, typically fall through spring. For children 8 to 19 months who are at increased risk of severe RSV disease, such as those who are immunocompromised, a second dose is recommended.

Abrysvo has yet to receive ACIP recommendation, though news reports have stated that meeting could likely occur in September.

~1-3%

of children under 12 months of age in the U.S. are hospitalized each year due to RSV

~60,000-120,000 hospitalizations and ~6,000-10,000 deaths

among adults 65 years of age and older are due to RSV

Source: CDC

It is possible that the ACIP could recommend Abrysvo on top of Beyfortus. “We are hoping that the infant vaccine will help prevent severe disease, and that the maternal vaccine will add an additional layer of protection,” says Dr. Duchon. However, she notes that given how the clinical trials were set up, the expert panel will likely examine the data closely and deliberate on the messaging.

“This could be a shared decision-making situation between a mother and her doctor,” Dr. Duchon adds.

For older adults, the FDA approved Arexvy™ as a vaccine for people ages 60 and older, in May. “Particularly for people with  heart or lung disease, RSV can exacerbate their conditions,” says Dr. Camins.

Older people in that vulnerable group should speak with their health provider on whether they should take the vaccine, especially as RSV season approaches, says Dr. Camins.

Influenza

The influenza virus season from fall 2022 to spring 2023 was marked by an early peak in November and December last year, according to the CDC. When the 2023-2024 flu season will peak is hard to pinpoint, but the CDC issued a recommendation in August for people to receive their flu shots in September or October.

“We are starting to see some influenza A cases here in our  health system, which has a connection to how influenza A and B trends might play out through fall and winter,” says Dr. Camins. It is not a prediction of an early or bad flu season by any means, but he recommends that unless contraindicated, everyone older than six months of age take the flu shot.

The annual flu vaccine has been updated with a new formula, as is common, to target strains most likely to circulate this season. Anyone six months and older is recommended to receive it, according to the CDC.

Last year, the City Department of Health and Mental Hygiene encouraged people to receive both their flu shots and COVID-19 shots together, where possible. Officials have been urging a similar message for New Yorkers to be caught up on their routine vaccinations.

“Even if you’re not at high risk for complications from the flu, getting the vaccine may prevent you from getting sick, or even if you do get sick, your symptoms will be milder if you take the shot than if you didn’t,” says Dr. Camins. “Everyone should be getting the flu vaccine.”

Read more about Mount Sinai and vaccines

Tips to Ease Back-To-School Anxiety

Updated on Aug 25, 2023 | Featured, Your Health

As the back-to-school season approaches, it’s not uncommon for young children to experience butterflies in their stomachs. Back-to-school feelings of anxiety are a natural and often healthy response to change.

The team at the Mount Sinai Parenting Center at Mount Sinai Kravis Children’s Hospital has developed some simple and effective ways to help your child learn how to get through the discomfort of uncertainty. Remember your job as a parent is not to spare your child the anxiety, it is to help them prepare for, sit with, and manage their feelings of anxiety.

The Mount Sinai Parenting Center Team:

  • Blair Hammond, MD, Co-Founding Director for the Mount Sinai Parenting Center and pediatrician in the Department of Pediatrics
  • Aliza Pressman, PhD, Co-founder, Mount Sinai Parenting Center, and Assistant Clinical Professor, Pediatrics, Icahn School of Medicine at Mount Sinai
  • Mariel Benjamin, LCSW, Director of Programs, Mount Sinai Parenting Center

Here are 10 simple tips to make the process smoother for both you and your child:

  • Create a Routine: Start by establishing a consistent daily routine a few weeks before school begins. Set regular mealtimes, playtimes, and bedtimes. Predictability provides some certainty in an uncertain experience. Click here to watch a special video about sticking to consistent morning and bedtime routines.
  • Feelings: Get Hold of Our Own Feelings and All Are Welcome: Make sure you have support managing some of the anxiety that comes with watching kids try new things and feel new feelings. Model and remind your child that there are no “bad” feelings and that feelings serve to give us information. Let them know it makes sense to feel a little nervous with new experiences. Share your own stories of first-day jitters from your childhood, showing them that many people feel this way.
  • Keep Sleep Sacred: Help make sure your child is getting enough sleep. A tired brain is more vulnerable to anxiety and has fewer resources to call on the tools that will help them manage their anxiety.
  • Play “School” at Home: Incorporate pretend play to familiarize your child with the idea of school. Take turns playing the teacher and student, using stuffed animals or dolls as classmates. This playful approach can ease their fear of the unknown.
  • Explore the School Together: Arrange a visit to the school before the first day. Walk around the campus, visit classrooms, and playgrounds. Let your child ask questions and share their thoughts. Familiarity can ease their apprehensions.
  • Get Creative with Supplies: Involve your child in choosing their school supplies, backpack, and lunchbox. Letting them make decisions empowers them and creates excitement about the upcoming adventure.
  • Positive Stories and Imagery: Read age-appropriate books or tell stories about positive school experiences. Use positive imagery and stories to help your child envision a happy and exciting school day.
  • Practice Separation: If separation anxiety is a concern, practice short separations at home. Leave them with a trusted caregiver for a brief period and gradually extend the time. This can help them build confidence in being apart. Remember not to sneak out, but to explicitly state when you will be away and when you will be reunited.
  • Encourage Friendship Building: Arrange playdates with potential classmates or neighbors. Familiar faces on the first day can make a big difference in how comfortable your child feels.
  • Teach Relaxation Techniques: Simple techniques like taking deep breaths or holding a soft toy can help soothe anxious feelings. Practice these techniques together so they can use them when needed.

Back-to-school feelings of anxiety in young children is a natural part of growing up. By implementing these tips, you can help your child transition with ease and excitement.

Your support and understanding play a crucial role in making this new experience a positive one. With your guidance, your child can step into the classroom with confidence and enthusiasm.

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Here’s What to Know About the First Approved Pill Treatment for Postpartum Depression

Updated on Aug 17, 2023 | Featured, Research, Your Health

On Friday, August 4, 2023, the U.S. Food and Drug Administration (FDA) approved Zurzuvae™ (zuranolone), developed by pharmaceutical firms Biogen and Sage Therapeutics, to treat postpartum depression. The treatment is a pill taken once daily for 14 days, and is the first oral treatment approved for this condition.

“We’re happy there’s attention for a disease that has not gotten much attention thus far,” says Veerle Bergink, MD, PhD, Director of the Women’s Mental Health Program, and Professor of Psychiatry, and Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai. Zurzavae had received Fast Track and Priority Review designations from the FDA, deemed as having potential to address a serious unmet need.

Veerle Bergink, MD, PhD (left) and Kimberly Mangla, MD (right)

Postpartum depression occurs often enough in mothers, yet the public’s understanding of it remains limited, says Kimberly Mangla, MD, Clinical Director of the Women’s Mental Health Program at Icahn Mount Sinai. “I’m glad we have an additional, possibly effective treatment for patients, and hopefully it will raise conversations and awareness of postpartum depression resources and treatment options,” she adds.

Drs. Bergink and Mangla explain what postpartum depression is, and how Zurzuvae could potentially treat it.

What is postpartum depression?

Postpartum depression can appear similar to other forms of clinical depression, with symptoms that include general low mood, lack of enjoyment, low energy, and low motivation, says Dr. Mangla. But there are unique aspects, such as difficulty bonding with the baby.

Postpartum depression is also different from what is commonly called “baby blues,” which is a common phenomenon of feeling overwhelmed, tearful, or being “hormonal,” notes Dr. Mangla. Baby blues tend to go away after two weeks. “What would be alarming might be feelings of hopelessness, suicidality, or a complete disconnect from the baby that aren’t necessarily a component of baby blues—those are reasons to seek support for what might be postpartum depression,” Dr. Mangla says.

While regulatory or insurance entities might define postpartum depression as occurring within four weeks after delivery, experts in the field—clinicians and researchers—agree that onset can be highly variable, even up to 12 months after delivery, says Dr. Bergink.

“From a psychological or physiological point of view, we know that it could take half a year for a woman’s hormones and immune system to go back to normal,” says Dr. Bergink. “And we have heard women say it could take up to a year before they feel like the person they were before delivery, and psychologically used to the new state of being a mother.”

What is Zurzavae, and how does it work?

Many current antidepressants work by targeting the serotonin system, but this drug works by targeting the gamma-aminobutyric acid receptor GABAA. While there are other drugs in this class of antidepressants, this is the first one approved for postpartum depression, says Dr. Bergink.

How common is postpartum depression?

One in Eight

or about 13 percent of women, have symptoms of depression after birth of baby.

>15 percent

of women in NYC experience depression symptoms after childbirth.

One in Five

women were not asked about depression during a prenatal visit.

>50 percent

of pregnant women with depression were not treated.

Source: Centers for Disease Control and Prevention

However, it is important to note that while this differs from serotonergic antidepressants, there have been no comparative studies done to demonstrate that Zurzavae is any better or worse than other antidepressant treatments out there, she points out. It is also unknown to what extent there is an antidepressant effect beyond the sedative effect, she adds.

What treatment options had been available for postpartum depression?

If the depression is not so severe, options include support therapy, such as cognitive behavioral therapy or psychotherapy, says Dr. Bergink. If it is more severe, then the doctor might consider using antidepressants, such as selective serotonin reuptake inhibitors (SSRIs).

How might Zurzavae differ from other antidepressants?

The way the drug has been marketed is that it works more rapidly than SSRIs, says Dr. Mangla. “Whether or not that’s true, and whether or not that benefit is sustained, we still have no idea,” she says, “but it would be wonderful to have a medication that starts working in three days instead of a few weeks.”

There are still some open questions clinicians might have with Zurzuvae at this point, notes Dr. Bergink. These include its effect on women who are breastfeeding, and whether the drug will keep depression away long beyond the study period, which was 45 days, she says.

What sources of support can mothers experiencing depression seek?

Generally, a mom experiencing depression symptoms should talk to anyone who is in her support system, says Dr. Mangla. This could include friends and family, but also a primary care doctor who might be able to make a referral to a general psychiatrist.

“Because the treatment of depression in postpartum is so similar to treatment of depression outside of postpartum, the disease is often well treated by general practitioners or general psychiatrists,” says Dr. Mangla.

Seeking help from social workers can be useful too. There are many ways mothers can access social workers, including through a local health institution, or even via online resources, such as Postpartum Support International, notes Dr. Mangla.

“Postpartum depression is a very treatable condition,” says Dr. Bergink. “We should do all we can to help mothers feel comfortable about reaching out for support.”

Learn more about women's mental health services and reproductive psychiatry

What has Zurzuvae shown in clinical trials?

Zurzuvae was approved based on data from two randomized, placebo-controlled trials in postpartum depression.

Here are the efficacy and safety highlights:

  • Both studies achieved their primary endpoint: a significant mean reduction from baseline in the Hamilton Rating Scale for Depression (HAMD-17) total score, a 17-item questionnaire on depression symptoms compared to placebo.
  • In one study, Zurzuvae achieved a significant reduction in depressive symptoms as early as day three.
  • Most common side effects of patients on Zurzuvae included drowsiness, dizziness, diarrhea, fatigue, and urinary tract infection.
  • The FDA has included a warning on Zurzuvae’s label that instructs health care providers to advise patients that the drug causes driving impairment due to sedative effects, and patients should not engage in activities that require mental alertness until at least 12 hours after the 14-day treatment.

 

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