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

Coping With Eye Strain: What Works and What Doesn’t?

Mar 31, 2023 | Your Health

Eye strain is a common condition that can affect people of all ages. It can be uncomfortable, but it’s normally not a serious condition. Many people cope with eye strain in different ways by making minor changes in their routines, such as adjusting lighting at home or in the office, limiting the amount of time you spent on activities that require intense focus, or even trying special glasses.

In this Q&A, Christina Cherny, OD, an optometrist at the New York Eye and Ear Infirmary of Mount Sinai, New York’s top-ranked ophthalmology hospital, answers some frequently asked questions about eye strain, ways to cope, and how to know when you need to see a specialist. One suggestion: Don’t count on using blue-light blocking glasses, as research shows they don’t work.

What is eye strain and what are the symptoms?

Eye strain refers to a collection of symptoms that people may experience when their eyes are put in intense situations. These symptoms can include:

  • Watery or dry eyes.
  • Blurred vision or Increased sensitivity to light.
  • Headaches or difficulty concentrating.
  • Burning or itchy eyes.
  • Having a hard time keeping your eyes open.

A portrait of Christina Cherny, OD

Click here to make an appointment with Christina Cherny, OD

What causes eye strain?

A major cause of eye strain is when vision is not fully corrected because of an over or under correction in your prescription glasses. If the vision correction problem goes unsolved it can result in eye strain, especially when you are focusing on something for a long period of time. If you have misaligned eyes—a condition called strabismus—or other eye disorder that’s not corrected, then your binocular system (how the eyes see together) can get overworked, possibly causing eye strain. Eye strain is also frequently caused if you spend too much time staring at your computer, smart phone, or other digital device. It can also be the result of excessive reading or driving for long periods of time.

How is eye strain diagnosed?

A diagnosis of eye strain is mostly based on symptoms and a description of your daily activities. Eye care professionals offer tests that can help diagnose eye strain including refraction assessment (for nearsightedness or farsightedness) and visual field test (for peripheral vision) which will determine whether you need prescriptive eye glasses or if your current prescription is correct. Getting a complete eye exam is essential for overall eye health. Your eye care professional will recommend how often you need to have your eyes checked.

Can blue-light blocking glasses help?

This is a common question. Many consumers mistakenly believe these glasses can help. Research has shown that blue-light blocking glasses do not work as advertised. The research investigated if blue-light blocking lenses can be effective in reducing the signs and symptoms of eye strain associated with computer use. The study showed there was no difference between wearing clear glasses and wearing blue-light blocking glasses.

What can I do to cope with or prevent eye strain?

There are many tips that your eye care professional can recommend.

  • If you need a prescription for up-close viewing, make sure that you’re wearing the proper prescriptive lenses.
  • Take breaks from writing, reading, and driving.
  • Follow the 20-20-20 rule: Take a 20-second break to view something 20 feet away from you every 20 minutes.
  • Use lubricating eye drops, or screens that tilt/swivel, or a glare filter.
  • Try adjusting your light based on your activity or an adjustable chair to change your viewing angle.

Eye care professionals often suggest using low-reading prescription glasses (available in drug stores) as a way of preventing eye strain  If you have a more significant problem that might be contributing to eye strain, you may require vision therapy, which is a form of exercises for the eye.

How do I know when to see a specialist?

If you experience unresolved eye strain symptoms over an extended period of time— despite using the many coping tips or if you have any eye pain—it’s time to see an eye care professional. Getting a complete eye exam will help ensure that you are protecting one of your most important senses: vision.

New York Eye and Ear Infirmary of Mount Sinai

How to Overcome Food Anxiety When You Have Inflammatory Bowel Disease

Updated on Mar 29, 2023 | Gastroenterology, Your Health


If you are one of the more than three million people in the United States living with inflammatory bowel disease (IBD), you are likely struggling with anxiety around food. Many living with IBD associate specific foods, or even whole food groups, with getting sick, and so they avoid many foods. This common misconception has led many with the disease to become malnourished.

Stephanie Gold, MD

In this Q&A, Stephanie Gold, MD, Instructor of Medicine (Gastroenterology) at the Icahn School of Medicine at Mount Sinai, explains why IBD patients struggle with food anxiety, how they can overcome this problem, and where to get more information.

What is IBD, and how is it different from having a food intolerance or allergy?
IBD is a condition that includes Crohn’s disease and ulcerative colitis. Both are characterized by chronic inflammation of the gastrointestinal tract that often leads to diarrhea, abdominal pain, and rectal bleeding. IBD can also lead to fatigue, weight loss, malnutrition, and vitamin and mineral deficiencies. Specific foods are not known to trigger IBD flares. IBD is different from irritable bowel syndrome (IBS), food allergies, and food intolerances, as it is a chronic inflammatory condition of the entire digestive tract (Crohn’s disease), or specifically, the large intestine (ulcerative colitis), which can inhibit absorption and impair digestion.

How common is malnutrition among people with IBD, and what are the symptoms?
While the exact prevalence of malnutrition in patients with IBD is unknown, we estimate that about 30 percent of patients seen in our outpatient IBD clinic are malnourished, and up to 80 percent of those requiring hospitalization are malnourished. Malnutrition can produce few or mild symptoms, or it can result in more serious symptoms of increased fatigue and weakness, as well as specific symptoms associated with vitamin and mineral deficiencies, such as rash, mouth ulcers, muscle spasm, pins and needles, loss of appetite and irritability, and many other symptoms.

Why do many people with IBD have food anxiety, and how does this affect their everyday lives?
Patients with IBD often associate their gastrointestinal symptoms—abdominal pain, diarrhea, rectal bleeding, nausea or even vomiting—with the foods they eat. More specifically, patients commonly believe that a food they ate immediately prior to the development of an IBD flare or complication is the cause of their worsening disease, and naturally tend to avoid these foods in the future. While certain foods may contribute to gastrointestinal symptoms in some patients, food does not directly worsen IBD or cause disease flares. Unfortunately, IBD-related food anxiety can lead to a very restrictive diet overtime, which can result in long-term malnutrition and vitamin and mineral deficiencies.

I have IBD. What should I eat?
All patients with IBD are unique and therefore should discuss diet and nutrition with their gastroenterologist. However, in general, here at Mount Sinai, we encourage our patients with IBD to eat a wide variety of foods and to have an overall healthy diet that is rich in fruits and vegetables, lean proteins, whole grains, and heart healthy fats. While many used to believe that all patients with IBD need to avoid fruits and vegetables, we now understand that the micronutrients and certain types of fiber found in fresh produce can be very beneficial for the gastrointestinal tract. While raw fruits and vegetables may contribute to symptoms in some IBD patients, texture modification, such as peeling, cooking, and even pureeing specific, easier-to-tolerate fresh fruits and vegetables, can make these vital foods better tolerated in patients with active disease or ongoing symptoms. However, we guide dietary recommendations based on type of IBD as well as disease location, activity, and complications, and therefore, it is really important for patients to seek specific nutrition guidance from their gastroenterologist or dietitian. This is especially true of those with an ileostomy or intestinal narrowing (stricture), as this requires additional dietary modification. There is a lot of ongoing research in this area, and we hope to be able to better define a more specific, ideal diet for IBD patients in the future.

What resources are there to help me improve my diet?
It is essential that people with IBD ensure they are getting adequate nutrition from a wide variety of foods. The best thing they can do is seek out professional guidance from a registered dietitian who specializes in working with IBD patients. Since there is not one specific diet that we can recommend for all patients with IBD, a registered dietitian can help evaluate and broaden the diet based on your specific disease type, location, activity, and current symptoms. To find a dedicated IBD dietitian, you can ask your gastroenterologist for a referral. In addition, many of the gastroenterology societies, including the American Gastroenterological Association, have lists of registered dietitians who specialize in IBD that are available to the public. Patients with IBD should feel empowered to ask their gastroenterologist any nutrition-related questions and inquire about additional support from a registered dietitian when needed.

Contact the Nutrition-IBD clinic at The Susan and Leonard Feinstein Inflammatory Bowel Disease Center at Mount Sinai

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