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Your Guide to Some of the Most Common Questions About Breast Cancer Diagnosis and Treatment

Oct 8, 2021 | Breast Cancer, Women's Health, Your Health

There have been many significant advances in the treatment of breast cancer that have helped patients to diagnose cancer earlier and to provide a range of treatment options. But patients still have many questions about what’s best for them.

In this Q&A, Michael Zeidman, MD, Assistant Professor of Surgery at the Icahn School of Medicine at Mount Sinai and a breast surgeon at Mount Sinai Brooklyn, answers some of the most common questions he gets from patients, including why it is critical to get regular mammograms, how doctors determine the stage of disease, and, if you are looking for a second opinion, the importance of visiting a leading medical center such as Mount Sinai.

Michael Zeidman, MD

How do mammograms help patients and doctors?

Mammograms are the only imaging method that’s been proven to save lives. If we go back to the early 1970s, before screening mammograms were widely implemented, the only way that a patient could discover that she had breast cancer is if she felt it. Now that we have the capability to diagnose breast cancer before it becomes symptomatic, we’re catching it much sooner. So it’s not surprising that survival rates have dramatically improved, while at the same time, we’ve been able to significantly cut back on the amount of treatment needed, which results in a better quality of life after breast cancer.

Why is it important not to delay a mammogram because of concerns about COVID-19?

We are only now starting to see the effects of the public’s general hesitancy of getting mammograms during the pandemic. It’s unfortunately increasingly common for patients who were normally very regular about getting their screening mammograms to skip getting one last year, and now they’re presenting to me with breast cancer that’s likely at a later stage than it would have been if it were discovered a year earlier. If there’s one message I want to get across is, come in, get your screening. The sooner we catch this, the sooner we can deal with it, the less treatment you need, and the better your prognosis will be.

How do you determine what stage breast cancer a patient has?

A very common question that I get from patients with a new diagnosis of breast cancer is “What’s my stage?” I explain that I can’t tell you your stage until after surgery. Determining the stage is made up of a three items: the size of the tumor, whether or not the cancer has spread to the lymph nodes under the armpit, and whether or not the cancer has spread to a distant part of the body. The pre-operative imaging does a fairly good job of estimating the size. But we won’t know the precise size of the tumor until it’s been removed. In fact, unfortunately sometimes the imaging can significantly overestimate or underestimate the true size of the tumor. The only way to tell whether or not the cancer has spread to the lymph nodes is to actually sample a few of them during the operation. We do that with a technique called a sentinel lymph node biopsy. In the operating room, we are able to determine if cancer were to spread to the lymph nodes, what are the few lymph nodes that would be the first to receive that cancer. So we identify and remove those nodes. And if the pathologist tells us that there’s no cancer in those nodes, we can safely assume that there’s no cancer in the rest of your nodes.

What do I need to know about the different stages of breast cancer?

Stage one breast cancer means that the tumor is two centimeters or less, and there’s no spread to the lymph nodes. Our goal is to catch breast cancer at this stage, because the five-year breast cancer specific survival from stage one breast cancer approaches 100 percent, which means that nearly all of those treated are alive five years after diagnosis. Also, the amount of treatment that a patient would need with stage one is much less than for later stages. It may result in smaller surgery, and patients at this stage are unlikely to need chemotherapy.
Stage two and stage three breast cancer means that the tumor is larger and it has spread to the lymph nodes. If this is the case, patients need more surgery and are more likely to need chemotherapy. Their five-year breast cancer specific survival is between 80 to 90 percent. This highlights the importance of coming in to get your screening mammogram because even though you may survive your breast cancer with a later stage, you’re going to need a lot more treatment to do so.
Stage four breast cancer is if the cancer has spread to another part of the body, other than the lymph nodes. At this stage, I tell patients that I can no longer cure them of breast cancer. The five-year survival rates drop to less than 30 percent. We can certainly treat it and, depending on how aggressive the cancer is, we can keep the cancer at bay for many years. But this is what we are trying to avoid.

I just had a COVID-19 vaccine. Should I delay getting my mammogram?

You do not have to delay your mammogram if you are receiving the vaccine, but you should make your radiologist aware which arm got the shot. There has been a lot of talk in the news about how the vaccine can mimic breast cancer. This is not entirely true. The purpose of the vaccine is to activate your immune system to produce antibodies that fight the virus. The cells that make these antibodies are located in small organs throughout your body called lymph nodes. The closest group of lymph nodes to where the vaccine is administered is in the armpit. These are called the axillary lymph nodes, and they are the first group of lymph nodes where breast cancer will typically spread. After receiving the vaccine and activating the cells in the axillary lymph nodes, they will grow in size. This may result in the radiologist wanting a closer look at the lymph nodes with an ultrasound to better delineate if these nodes are large due to the vaccine or if they are concerning for cancer.

What is the difference between a biopsy and surgery?

When we talk about a biopsy, we’re mainly talking about a core needle biopsy. This is where we get a small snippet of tissue in the area of concern, as discovered by the imaging. It’s usually done under the guidance of imaging, such as an ultrasound guided biopsy or something called a stereotactic biopsy, which is done under mammographic guidance. Usually the needle biopsy is done before we do the surgery because it helps us guide what type of surgery the patient needs and because it allows us to determine if chemotherapy is the first step, rather than surgery. For surgery, you are actually coming to the operating room and we remove a large area of tissue around the cancer. If we already know that it’s a very large cancer, we may perform mastectomy to remove the entire breast.

If I am looking for a second opinion, why is it important to go a leading medical center like Mount Sinai?

The treatment of breast cancer has become increasingly complex, as we’ve learned more about it, and so it’s now more important than ever to have a team that works in a collaborative way to tailor a specific treatment program for you. The Dubin Breast Center at Mount Sinai is a true multidisciplinary Cancer Center with specialists concentrating on one problem, breast cancer. The facility is beautiful, and that produces a sense of calmness that translates to patient care and to the patients themselves. While I generally recommend that patients go for a second opinion, because of how complex breast cancer treatment is, I think it’s imperative to go to a center where that’s the primary focus, where that’s all they do.

Learn more about the Dubin Breast Center at Mount Sinai

Learn more about the Center of Excellence for Breast Cancer at Mount Sinai

What Do I Do If I Sprain My Ankle?

Oct 1, 2021 | Rehab Medicine, Your Health

There’s a good chance you—or someone you know—has had a sprained ankle. This very common condition comprises about 30 percent of injuries seen at sports medicine clinics. And not just athletes are affected, more than 23,000 people each day seek care for a sprained ankle and half of all sprains seen in the emergency room are unrelated to sports.

Mariam Zakhary, DO, Assistant Professor, Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, and Attending Physician at Mount Sinai-Union Square, explains how to treat this common injury and what to do if you have chronic ankle instability.

What happens when you sprain an ankle?

Ankle sprains happen when you turn, twist, or roll the joint in a way that causes you to stretch or tear one or more of the three thick bands of tissue (called ligaments) that keep our ankles stable. Sprains occur when we misstep and put pressure on the ankle while it is out of its normal position. Often, we sprain our ankle when we walk on an uneven surface, such as a city street, or when we’re running and changing direction. Most sprains affect the ligaments on the outer side of the ankle.

Doctors typically put sprained ankles into one of three categories:

Grade one: You have stretched at least one of your ligaments but there is no tear.
Grade two: You have stretched at least one of your ligaments and have a partial tear in another.
Grade three: You have a full tear in one or more ligaments. You’ve probably also stretched your ligaments. Your ankle will most likely feel unstable with this injury, and will require immobilization with a boot.

What should I do if I sprain my ankle?

It depends on the severity of the sprain. If you can put weight on your ankle, you should be able to do some self-care at home and walk it off. But if it hurts to stand on your ankle, you should be checked out by a doctor as this might indicate that you have done serious damage to your ligaments and ankle, or even broken a bone.

What kind of self-care can I do?

If you have a minor, grade one sprain, there are a few things you can do to heal at home. Try these for a day or two and, if your ankle does not improve by the third day, you should probably see a doctor.

Rest your ankle. The rule of thumb is: if it hurts, don’t do it.
Elevate it. Raise your ankle above your heart, especially at night. This allows you to enlist the help of gravity to drain any excess fluid.
Apply ice. I recommend icing for 20 minutes, every two or three hours for at least the first 48 hours. Then, continue to ice for pain relief as needed.
Use a brace. If your ankle feels unstable, use a brace to hold it in place.
Try compression. Wrap your ankle with an elastic bandage. The wrapping should be snug but not so tight that it hinders circulation.
Take a pain reliever. Use an over-the-counter anti-inflammatory, such as ibuprofen.

How long do I need to stay off my injured foot?

It depends on how bad a sprain you’ve got. As soon as your ankle can bear weight with minimal pain, you can walk on it. But respect the pain; it is your body’s way of communicating with you. If it hurts to walk, don’t. You may find you need to use a walking boot, crutches, or even a wheelchair for a while. If you find it hard to walk after a day or two, make an appointment with a doctor.

How long will it take to fully recover from an ankle sprain?

While a minor sprain can take about two weeks to heal, a severe sprain can take as long as three months. Listen to your body. If you try a new activity and it increases pain, that is your body’s way of telling you that you might be making the condition worse.

When should I see a doctor about my injury?

It’s never a bad idea to see a doctor about a sprained ankle—and the sooner you see one, the better. If you have a minor sprain, a doctor can tell you how to treat it and cope with the pain. If your pain is more severe, the doctor may order an X-ray to get a better idea of what is going on and see if you’ve fractured your ankle or done other damage.

I keep injuring my ankle. What can I do?

When you sprain your ankle, you stretch the ligaments, and these bands of tissue don’t recover their pre-injury tightness even after your ankle has healed. This may lead to chronic ankle instability—a tendency to turn, twist, or roll your ankle with the slightest provocation. Each time you re-sprain your ankle, you stretch the ligaments just a little more. Unfortunately, you can’t strengthen your ligaments, but you can strengthen your secondary stabilizers, which are the muscles around the ankle such as your lower leg and calf muscles.

Also, because repeated sprains may cause even more sprains, it’s not a bad idea to use an elastic bandage, tape, or an ankle brace to keep the joint stable. Many athletes with chronic ankle instability wear braces or use medical or therapeutic tape for increased stability, but the best treatment is to work on the muscles around the ankle.

How do I strengthen the muscles around the ankle?

The key is to strengthen the muscles both on the outside and inside of the ankle. Some of these muscles go all the way up to the knee. You’ll also want to strengthen the muscles in your feet.

One easy thing to do at home is to spell the alphabet out with your foot while seated. This activates the muscles in the ankle and works on conditioning them. When the ankle is more stable, you can start doing single leg exercises. An example of this is standing on one foot and hinging forward to touch an object out in front of you, close to the ground. This forces your ankle to use the surrounding muscles to remain stable. You can also do this single leg exercise as a preventative.

However, the best way to learn the right exercises is to work with a physical therapist.

Make an appointment with Dr. Zakhary

Learn more about Rehabilitation Medicine at Mount Sinai

During the COVID-19 Pandemic, You Should Still Get the Seasonal Flu Shot

Sep 30, 2021 | COVID-19, Your Health

Every fall, doctors, health care providers, and public health experts begin reminding everyone that it’s critical to get the flu shot. This year, as we continue to cope with COVID-19, it’s even more important.

There are a number of reasons why the ongoing pandemic means you should make sure to get your flu shot as soon as possible, according to Waleed Javaid, MD, Professor of Medicine at the Icahn School of Medicine at Mount Sinai and an expert on infectious diseases.

For starters, if you become infected with COVID-19, getting the influenza virus as well can make a difficult situation even worse. Doctors saw patients in this situation at the beginning of the pandemic, and they know the combination of these two infections can make it more difficult to recover and can exacerbate some of the most serious symptoms, including difficulty breathing.

“COVID-19 and the flu are not a good combination,” Dr. Javaid says.

Fortunately, we have vaccinations for both the flu and COVID-19 that will help prevent you from experiencing the worse of either virus. In fact, the U.S. Centers for Disease Control and Prevention (CDC) strongly recommends that you receive the flu shot if you are eligible—even if you are fully vaccinated against COVID-19. And if you have not yet received the COVID-19 vaccine, or are eligible for a booster dose, you do not need to space out dosing, the CDC says you can receive both shots on the same day. The COVID-19 vaccine and the flu shot do have similar, mild side effects, which include fever, body aches, headache, and nausea. So, if you are concerned about side effects, the vaccines can also be taken on different days.

Face masks—which have become a wardrobe staple since the start of the pandemic—may do double duty by helping to reduce the risk of contracting both COVID-19 and the flu. But Dr. Javaid notes that additional measures are still warranted. This includes proper hand hygiene, avoiding those who have a respiratory illness, and getting your flu shot.

The CDC recommends getting a flu shot as early as September or October. But if you miss this window, it is not too late. You can get the shot as long as the flu is circulating, which is normally through early spring.

Another reason reducing the incidence of seasonal flu this year will be especially important is that it can be difficult to distinguish between the flu and COVID-19, according to Dr. Javaid. The symptoms are almost exactly the same: fever and chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, sore throat, and congestion or runny nose. You can read more about these similarities from the CDC. One potential difference is that if you are infected with COVID-19, you may experience a new loss of taste or smell. The similarities could result in confusion as doctors try to diagnose patients.

Of course the flu shot doesn’t guarantee you won’t get the flu. But the CDC estimates the vaccine each year typically reduces serious cases of the flu by 50 to 60 percent. For those who get the flu even though they have gotten the vaccine, the shot helps reduce the severity of the illness and avoid hospitalizations.

For those who may be wondering, there is no evidence that the flu shot can make you more susceptible to getting COVID-19. That being said, if you are infected with COVID-19 or the flu, the timing of your vaccination may need to be adjusted. If you are in this situation, Dr. Javaid says, you should contact your health care provider, who can advise you on the latest recommendations.

Vaccine Facts: COVID-19 Vaccines Are Safe—and Essential—for Pregnant Women

Sep 23, 2021 | COVID-19, Featured, OB/GYN, Vaccines, Women's Health, Your Health

For those who are pregnant or considering getting pregnant, there are so many health questions, from “Is caffeine okay?” to “Can I still exercise?” But during the COVID-19 pandemic, some are also wondering if the COVID-19 vaccines are safe to take.

In this Q&A, Joanne Stone, MD, MS, Director of Maternal Fetal Medicine at the Mount Sinai Health System, explains the dangerous risks of COVID-19 during pregnancy, shares the facts on why you should get the vaccine, and offers reassurance for those who may be worried.

New Guidance on COVID-19 Vaccines: In April 2023, the Food and Drug Administration and the Centers for Disease Control and Prevention announced some major changes for COVID-19 vaccines. Click here to read more about what you need to know.

Update: The Centers for Disease Control and Prevention on September 29, 2021, strongly recommended COVID-19 vaccination either before or during pregnancy because the benefits of vaccination outweigh known or potential risks. Read more from the CDC

If someone is pregnant, or trying to get pregnant, should they get vaccinated?

Yes, if you’re pregnant, or thinking of getting pregnant, or even if you’re breastfeeding, this is absolutely the time to get the vaccine. I would not wait one extra day. I would get it today because there’s a lot of data that shows the vaccine is very safe and it’s not associated with miscarriage or infertility. Also, it’s the most important way to prevent COVID-19 infection.

Joanne Stone, MD, MS

Are pregnant people especially at risk for COVID-19?

Pregnant women who get COVID-19 infection are at a much higher risk for adverse outcomes, such as severe disease and even maternal death. There’s also higher risk for complications, including preeclampsia, which is high blood pressure in pregnancy, as well as increased risk for the baby, including preterm delivery. For all these reasons, the risks of COVID-19 infection are much higher for both mom and baby. So it’s extremely important to prevent this disease during pregnancy through vaccination plus other measures like mask wearing and social distancing.

What else should patients know about the vaccines and pregnancy?

Patients should understand there are a lot of myths out there that have not proven to be true. For example, there’s no increased risk of infertility if you get the vaccine prior to getting pregnant. Pregnant people should also know that there are complications associated with COVID-19 in pregnancy, and these complications that can be prevented by getting the vaccine. Also, the vaccine has been studied extensively. All the major organizations involved with women’s health care—including the Society for Maternal-Fetal Medicine and the Centers for Disease Control and Prevention—are strongly advocating that people who are pregnant get the vaccine.

Face Masks Are Still a Fact of Life, Here’s What You Need to Know About Safe Use

Sep 20, 2021 | COVID-19, Your Health

Woman who is alone on street, takes mask off while outside

Now, almost two years into the fight against COVID-19, face coverings have become a necessary addition to our everyday wardrobe. Along with proper hand washing and social distancing, their use has helped to prevent the spread of COVID-19. As the pandemic goes on and the effort to get people vaccinated continues, the U.S. Centers for Disease Control and Prevention (CDC) has issued additional guidance about face coverings. Importantly, the CDC now clarifies that while some outdoor, unmasked activity is relatively safe, both unvaccinated and vaccinated individuals should continue masking when indoors to protect themselves and others from the highly contagious Delta variant.

Krystina Woods, MD, Hospital Epidemiologist, Medical Director of Infection Prevention, and Deputy Chief Medical Officer at Mount Sinai West, explains the care and use of masks over the long haul and why those vaccinated against COVID-19 still need to mask up.

Why is it important that vaccinated people continue to wear face coverings?

We now know that vaccinated people can both become infected with COVID-19 and pass it on to others. And because of that, in certain settings, it is extremely important for even vaccinated people to wear masks.

Is it still less risky to be unmasked while outdoors? If so, why?

When you’re outdoors, there’s better ventilation. So, for example, if there is someone nearby who has been infected with COVID-19, the amount of virus can be diluted by all the freely moving air, making it less likely that others will be infected.

It is also important to remember that part of the thinking about being unmasked outdoors is that you’re unmasked while still being socially distant. If you are in a really, really large crowd; the protection is not going to be as good. You are much safer choosing to take your mask off outdoors if you have the ability to have a little bit of distancing.

So, being unmasked when on an early morning walk through a sparsely populated Prospect Park is okay, but if you’re window shopping on the weekend on a packed street in SoHo, throw on a face covering.

If my risk of severe illness is low, why should I continue to take precautions once I am fully vaccinated?

We need to continue to be careful. You don’t always know what the health problems are of those around you and, there’s a certain amount of civic responsibility that we have to each other.

None of us live completely isolated and, over the last 18 months, we’ve all felt what it is like to have to isolate ourselves from those we care about. So, we need to be careful about the fact that there are still people who have not gotten vaccinated, those who are not eligible for vaccination—like children—, and those who are otherwise vulnerable—like the elderly and immunocompromised. We have a duty to protect those amongst us who do not have the protection of vaccination.

Should I upgrade to a better face mask?

I wouldn’t see this as a necessity. The most important thing is that the face mask is multi-layered and fits well. If you are using a cloth mask, it is a good idea to double mask by using a surgical mask underneath the cloth mask. In place of that, a regular surgical mask is sufficient. However, if someone feels more comfortable wearing an N95 or its international equivalent (the KN95 or KF94), they certainly can—just make sure the masks are legitimate. The CDC has advice on how to identify counterfeit masks.

How do I know if my face mask has a proper fit?

Your mask should not fall off of your nose as you’re talking and it should fully cover your nose and the mouth. Additionally, it should not have large gaps around the perimeter of the mask—around the sides or the top and bottom. And, you should be able to tolerate wearing the mask for an extended period of time without feeling uncomfortable.

How should I take care of my cloth face masks?

Reusable masks should be washed at least daily, by hand or in your regular washing machine. And you can put them in the dryer, or hang them up to dry. If you have a disposable face mask, throw it away after wearing it once. And always wash your hands after handling or touching a used mask. The CDC has a lot more information about masking here.

Get more COVID-19 information from Mount Sinai

What Should I Eat Before and After My Workout?

Sep 16, 2021 | Diet and Nutrition, Your Health

Whether you are just starting to work out or committed to a regular workout program, the right nutrition can help you feel better, recover quicker, and get more out of your workouts. Brittany DeLaurentis, RD, CDN, a Clinical Nutrition Coordinator at Mount Sinai West and Mount Sinai Morningside, provides some valuable tips on what to eat before and after your workout.

Should I eat before a workout?

You definitely don’t want to go into your workout feeling hungry. However, you don’t want to have a large portion or eat the wrong things, otherwise you may feel fatigued or groggy during your workout. It also matters how soon you plan to work out after eating. For example, if you have a light meal or a snack—like a banana, an energy bar, or a smoothie—I’d recommend postponing your workout for one to three hours. If you have a larger meal, you want to wait a full three or four hours, just to make sure that the meal is well digested. In the morning, I’d stick to a small meal or a snack—just so you’re in that shorter window of one to three hours.

What foods would you recommend eating prior to a workout?

Make sure that you’re loading your body with carbohydrates. That said, the type of carbohydrates really matters. So choose complex carbohydrates—like a piece of whole grain toast or some whole grain cereal—over simple carbohydrates—like candy or packaged baked goods. It’s important that you choose complex carbohydrates, because simple carbohydrates can cause your body to crash and burn from the sugar high.

What about the trend of taking a scoop of dry protein before a workout?

Dry scooping is a very dangerous trend. Many protein powders have a large amount of caffeine. For comparison, a single scoop can have 200 mg caffeine as opposed to 65 mg in a small cup of coffee. Ingesting this plain without dilution can cause damage to the heart arteries, which can lead to a heart attack and organ failure. It also should be remembered that protein powders are not regulated by the FDA, so it is difficult to even know what they truly contain.

What foods would you avoid?

High fat foods like fried foods can make you feel bloated and groggy during your workout. And again, avoid simple carbohydrates so you don’t have that sugar high, and then a crash and sudden fatigue.

What drinks would you recommend during a workout?

Water is very important. You want to make sure that you’re going into a workout having had a minimum of two to three cups of water. And throughout the workout, you should also be hydrating. The general recommendation is about a half cup to a full cup every 15 to 20 minutes of working out. And, of course, the amount of hydration needed depends on the weather. If it’s a hot and humid day, you’ll need more.

Also, don’t forget to hydrate after your workout. Avoid sugar-filled beverages like soda or lemonade, and opt for plain water. The recommendation is to drink at least eight ounces of water afterwards. But, if you have completed a more intense workout, such as running, cycling, tennis, you might want to include a beverage that contains electrolytes, like Gatorade.

What foods are best to eat after a workout—and how soon after?

After a workout, you want complex carbohydrates to replenish the glycogen that your body just ran through as well as protein because working out actually breaks down your muscles. The ratio of your post-workout meal should be three to one, with carbohydrates being the majority, and you should eat within two hours of exercising, to replenish your glycogen stores and help your muscles recover.

Examples of post-workout meals could be yogurt and fruit, a peanut butter sandwich, turkey on whole grain bread, oatmeal with protein powder and fruit, or grilled chicken with vegetables. It depends on the time of day—but you want to make sure you’re combining carbohydrates and protein.

How should I change my eating habits, depending on whether I work out in the morning or in the evening?

In the morning, I would recommend sticking to a small meal or a snack. For most people’s schedules, it is probably better to only wait one to three hours before exercising. You also want to make sure that you are drinking water before working out. Also, studies show that drinking caffeine is beneficial before working out, so a cup of coffee is definitely appropriate if you like an early workout.

In the evening, I recommend having a post-workout meal, but make sure that you allow your body time to digest before going to bed. Give your body a good three to four hours before bedtime.

Should I change what I eat depending on whether I’m doing cardio or weightlifting exercises?

If you are doing endurance activities that involve aerobic exercises like running or swimming, your body burns through your glycogen stores more quickly. So you will need more carbohydrates when you are engaging in those types of workouts.

But whether you are doing cardio or weightlifting, you want to have carbohydrates before, and carbohydrates along with protein afterward.

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