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My Child Is Anxious About Returning to School In Person. How Can I Help Them?

Updated on Jun 30, 2022 | Children's Health, COVID-19, Mental Health, Psychiatry, Your Health

With the start of the new school year, many kids may be relieved to return to in-person learning. But others may feel more anxious.

In fact, experts at the Mount Sinai Adolescent Health Center anticipate that this transition may be especially challenging and anxiety-provoking.

Rachel Colon, LCSW, a social worker at the Center who treats young people ages 10-26, says that her case load has nearly doubled as adolescents seek help for anxiety and depression.

Rachel Colon, LCSW

“Young people are feeling a great deal of anxiety about returning to school,” she says. “They don’t know what they’re stepping into, who their friends are, and they’re nervous about the lack of predictability in an environment that has always been safe and provided routine.”

Ms. Colon offers some steps you can use to help your kids with the transition to in-person learning this school year:

Have lots of conversations with your kids; keep the lines of communication open.
Empathize with your children; let them know they are not alone if they feel anxious.
Reach out to your child’s school to ask what steps are being taken to familiarize students with their surroundings.
Look for signs of withdrawal, isolation, stomach aches, headaches, irritability. These can be signs of depression and/or anxiety.
If your child is headed to a new campus, or stepping up from middle school to high school, offer to take a walk to school before the first day of school.

Heading back to school can be stressful even in normal times. Over the years, the Mount Sinai Adolescent Heath Center has compiled a list of seven things for kids and adults to do to start the year off right. Click here to see them on the Center’s kid friendly blog.

One potential new issue this year is that kids may feel they have lost touch with their group of friends, or that they don’t belong, and masks, while a critical safety tool, may make things more difficult.

“Many kids are telling me they don’t have a friend group anymore. They don’t know how their classmates will look,” she says. “With the potential requirement of masks, this will likely compound social anxiety because it’s hard to read expressions when a person is masked. Are they happy or sad? Are they smiling at me? Though masks are a crucial safety tool right now, kids really need simple cues—like a broad smile—to maintain social relationships.”

The Mount Sinai Adolescent Health Center is a comprehensive, integrated health center that provides nonjudgmental and confidential care to young people ages 10-26 in New York City—all at no cost to patients, regardless of insurance or immigration status.

Learn more about the Mount Sinai Adolescent Health Center

Check out seven back-to-school tips from the Mount Sinai Adolescent Health Center

What You Need to Know About Cholesteatoma, a Rare Growth in the Ear

Updated on Dec 30, 2022 | Ear Nose Throat, Your Health

young woman with earache touches outside of ear

Unless you are experiencing hearing loss or an acute infection, you probably do not give much thought to your ear health. However, many conditions can affect this complex and very fragile part of the body that not only allows us to hear but also plays a major role in our sense of balance.

Cholesteatoma is a rare condition in which a benign skin growth develops in the middle ear, just behind the eardrum. Only nine out of every 100,000 adults in the United States are diagnosed with these skin growths each year. And, while cholesteatoma is not cancerous, it will continue to grow and may pose serious problems if not removed.

Enrique Perez, MD

“The middle ear is inside the body so it should never have any skin in it. When this condition occurs, skin has grown inward either due to a prior surgery, eardrum perforation, or from chronically reduced ventilation of the ear from conditions like eustachian tube dysfunction,” explains Enrique Perez, MD, MBA, Assistant Professor of Otolaryngology at Mount Sinai, who specializes in treating rare conditions like cholesteatoma. “The problem with this excess skin is that cholesteatomas behave destructively over time. If left untreated, they can cause infection, destroy the bones of hearing, and lead to serious issues like facial nerve paralysis or intracranial complications.”

Who is at risk of developing cholesteatoma? What are the signs and symptoms of the condition?

Patients who have a history of chronic ear infections or eardrum perforation are more likely to develop cholesteatoma. In the early stages of this condition, you may notice some mild pain, pressure, difficulty hearing, or drainage. As the cholesteatoma grows, your symptoms will get worse and may include dizziness, numbness, muscle weakness in one side of the face, or blood-tinged mucus draining from one ear.

Children can be born with a congenital form of cholesteatoma. “These kids often come to us with a history of progressive hearing loss without pain. The ear looks relatively normal, but upon close inspection we find a white structure, which is the trapped skin behind the eardrum,” explains Dr. Perez.

Even if your medical history does not put you at risk for a cholesteatoma diagnosis, make an appointment with your physician if you feel anything out of the ordinary, particularly in just one ear. A simple visit could save you from experiencing permanent damage at a later time.

How is this condition treated?

The only way to treat cholesteatoma is to remove the skin growth. Without surgery, the cyst will become larger and damage the surrounding bone and tissue. If it is left untreated, cholesteatoma can lead to permanent hearing loss, debilitating vertigo, and irreversible nerve damage.

“I tell my patients upfront that cholesteatoma is a surgical disease, and they will need an operation. There is no medication that can remove this growth,” says Dr. Perez.

Since the growths are difficult to remove fully—and the surrounding areas of nerve, bones, and tissues are extremely fragile—it is important to find a surgeon who has experience treating cholesteatoma. Once the skin is removed, there may be a hole in the eardrum or bones in the middle ear that requires reconstruction. There is also a risk that cholesteatoma will grow back if it is not removed properly.

What happens during the cholesteatoma removal procedure?

Most removal procedures are outpatient and, depending on the complexity of the cholesteatoma, the surgery can take anywhere between one to four hours.

At Mount Sinai, Dr. Perez and his surgical colleagues are trained in minimally invasive procedures and often use fully endoscopic approaches to treat cholesteatoma. Instead of making an incision in the back of the ear, these experts can access the growth through the natural opening in the ear canal. Operating rooms at Mount Sinai use the latest technology, including a 4K endoscopic camera system that provides more precise real-time images for surgeons during the procedure.

What is the prognosis for patients following cholesteatoma removal?

Cholesteatoma disease can be quite variable. In patients with recurrent cholesteatoma who have already undergone prior surgeries, it is possible that they will need to undergo a more extensive procedure like a tympanomastoidectomy—a procedure that repairs the middle ear in patients with chronic ear infections. In those cases, the prognosis for ending the infection is high but regaining prior hearing is not as good.

However, in a patient with an early stage of the disease that has not been operated on, the odds of achieving a good hearing outcome as well as successful removal of the cholesteatoma is quite high.

“People often underestimate a recurrent draining ear. It is not just a hassle but a problem you should take care of right away,” says Dr. Perez. “If you come in early, the procedure is more straightforward . By addressing the problem, we can improve a patient’s hearing and quality of life.”

Make an appointment with Dr. Perez

How Can I Treat My Plantar Fasciitis?

Updated on Jun 30, 2022 | Orthopedics, Your Health

man doing flatfoot correction self massage at home

Plantar fasciitis (pronounced PLAN-taar-fa-shee-AY-tus) is one of the most common causes of heel pain. According to the American Academy of Orthopedic Surgeons, about two million people are diagnosed with the condition every year. Fortunately, you can often address the pesky heel pain associated with the condition in the comfort of your own home.

In this Q & A, Meghan Kelly, MD, Assistant Professor of Orthopedics at the Icahn School of Medicine at Mount Sinai, provides at-home stretching tips that treat heel pain in more than 90 percent of plantar fasciitis patients and advises on how to prevent developing the painful condition.

How do I make my heel stop hurting?

To immediately deal with the pain associated with plantar fasciitis, you can use ibuprofen (ex. Advil) or naproxen (Aleve). In addition, rolling a frozen water bottle under the arch of your foot can also relieve the pain.

What can I do to treat plantar fasciitis?

The way to treat about 95 percent of plantar fasciitis cases is by stretching. There are two main stretches which, if done well every day, should make the condition go away in about a month. This method worked for me and every one of my patients.

On the left, Dr. Kelly shows how patients can stretch their plantar fascia and, on the right, she demonstrates an Achilles tendon stretch.

Attend to your plantar fascia.

Plantar fasciitis is an inflammation of the plantar fascia—a thick band of tissue at the bottom of the foot. You can address this inflammation by stretching that tissue. Do this by putting your leg in a “figure four” position with the ankle over the opposite knee. Then, grab your toes and pull them toward your shin and massage the plantar fascia for 5 minutes. You should do this stretch two or three times a day.

Your Achilles tendon is tight. Loosen it.

Almost everyone has a tight Achilles—it’s just the way we’re built—and a tight Achilles tendon can affect the plantar fascia. There are a couple of stretches that can help. The one I like, and that I show my patients, involves standing on a stair or curb with both heels facing out. Hold onto the railing, then move the heel that is painful off the edge of the stair or curb and let it drop. Allow your other foot to relax. Hold this position for five minutes. I know that’s a really long time, but the Achilles tendon is a very large tendon and it takes time to stretch it. Do this twice a day. It doesn’t always feel great at the time, but it really does help.

The hardest part about treating this condition is being diligent about doing these stretches twice a day, every single day. I often recommend taping a reminder on your refrigerator, or some place you can’t avoid seeing. If your heel hurts after you stretch, that’s normal. That’s when you can ice it and/or take a painkiller.

Should I try to stay off my feet? Do I need to wear special shoes in the house or outside?

You can walk as much as you want with plantar fasciitis. If it starts to hurt, you can stop—but you aren’t damaging anything if you keep walking.

In terms of footwear, the best shoes for plantar fasciitis are ones that fit correctly—both in length and width—and provide arch support. You can also use removable inserts (called orthotics) to “fix” a pair of shoes that does not have the support you need. I recommend trying over-the-counter orthotics first, to see if they help as custom-made ones can be very expensive. If you have really flat feet or very high arches, you can get over-the-counter orthotics that are designed to help with that.

I don’t routinely recommend wearing shoes inside—I’m a big fan of bare feet—but, if you’re having pain from plantar fasciitis, wearing supportive shoes in the house can sometimes help. Try it and see if it works for you.

Should I use a foot brace or splint, or a boot?

There are splints available at your local pharmacy that hold your foot at a right angle while you sleep. This will keep your plantar fascia stretched out overnight, and then, when you get up in the morning, you won’t have heel pain as you step out of bed. Some people swear by this method. The majority, however, tell me that they tried an overnight splint but woke up in the middle of the night to take it off because it was uncomfortable. If you want to try using a splint, that’s fine; it won’t do any damage. But, there are no research studies that prove its effectiveness.

Occasionally, I prescribe a walking boot for plantar fasciitis patients as it can take some pressure off the heel. But that can backfire. If you’re wearing the boot all the time and not doing the stretching exercises, your calf muscles may weaken. That won’t help with the pain. Sometimes, I give patients a walking boot for about a week, just to get them walking until the pain becomes bearable. During that time, I urge them to continue doing their stretches and, as soon as they can, I encourage them to stop using the boot altogether.

All in all, the best—and most effective—treatment for plantar fasciitis is stretching.

What if I’ve tried all this and am still having pain?

If none of this works, you might try formal physical therapy. A physical therapist may be able to help you do your stretches more effectively. Sometimes they have equipment in the physical therapy suite that you don’t have at home and can be beneficial.

If none of that works, there are also some procedures available. Extracorporeal shock wave therapy is a noninvasive method of stretching the plantar fascia that involves applying waves of electricity to the tissue. Another option is the Tenex FAST procedure. With this approach, we poke tiny holes in the plantar fascia with a needle. perform these procedures and those who do will likely only try them if everything else has failed.

How can I prevent plantar fasciitis?

The best way to prevent the condition is to avoid unsupportive shoes and to stretch before and after you exercise. But sometimes you do everything right and still end up with plantar fasciitis. That’s why it’s good to know what stretches can treat it.

Make an appointment with Dr. Kelly

Learn more about Orthopedics at Mount Sinai

Should I Change My Skin Care Routine With the Seasons?

Updated on Jun 30, 2022 | Skin Health, Your Health

Mature African American woman using a cotton pad to clean her face while looking in a bathroom mirror in the morning

Going from hot, humid summers to cold, dry winters can mean more than just a wardrobe change. Temperature fluctuations may also prompt a change to your skin. For some, winter brings dry skin and exacerbates conditions like eczema and psoriasis, while the humidity of summer can make skin look very oily.

Angela J. Lamb, MD, Associate Professor of Dermatology at the Icahn School of Medicine at Mount Sinai, shares what you need to know about protecting your skin and how to have healthy, glowing skin year-round.

Why does the weather have an effect on your skin?

When the weather is hot and humid outside, your skin ramps up its oil production, which can produce an oily sheen. Alternatively, when the weather is cooler, and maybe the radiators are on more, the low air humidity causes moisture in your skin to evaporate faster, making skin drier.

Should you change your skin care routine as the seasons change?

There are definitely considerations you have to take into account with seasonal change.

For the summer, you want to use a gel-based cleanser and then moisturizers that are a bit lighter—typically products that have hyaluronic acid in them—to avoid clogging your pores.

For the winter, you want to use a thicker, cream-based moisturizer, which will fuse moisture into your skin and not strip it of the oils that are being made naturally. Look for products that contain a humectant—which traps water—like glycerin or glycol. These ingredients will prevent moisture from evaporating off the skin’s surface.

Is there a general rule to a good skin care routine?

I always say that a good skincare routine is simple, simple, simple. Often people are doing far too much to their skin. They come in to my office with bags of 10 different products, and I always say: try to simplify.

I recommend having a cleanser, what I call a ‘power product’—which can be something like a serum or an eye cream—and then a moisturizer. You want to do the same thing morning and night, even if you use slightly different products.

Most people should wash their face twice a day. So, for oily or acne prone skin, you want to use a cleanser with salicylic acid or glycolic acid to help with skin cell turnover and a moisturizer that is a light oil or hyaluronic acid based. For dry skin, you want to use a cleanser that is cream based, which does not have anything in it that’s like a detergent, and a thick moisturizer. So, you should avoid products that have sulfates and look for moisturizers with oils and thick emollients like petrolatum or dimethicone.

How should I change my routine from daytime to nighttime?

Sunscreen is fundamental for a daytime routine, even if you’re not going to be outside for a long time. It is one of the main things you can do for your skin to combat advanced aging, brown spots, wrinkles—all the things people do not want to see on their skin.

A simple daytime routine includes a cleanser, a ‘power product’ for daytime could be a serum with vitamin C or a cream for around the eyes that makes them look less puffy, a sunscreen, and a moisturizer.

You want to do some things that are very similar at night, but—obviously—you will not need a sunscreen. Additionally, in the evening, you may want to use a moisturizer that absorbs oil.

A simple nighttime routine includes a cleanser, a ‘power product’ for nighttime could be a retinol or some type of vitamin A derivative, and a moisturizer.

While sunscreen is the best thing for skin cancer prevention and anti-aging, retinols can almost turn back the clock on fine lines, and wrinkles. They also help build up collagen and can even the tone and texture of skin. I think everyone should be using retinol at night.

How important is it to incorporate sunscreen in your daily routine, particularly for Black women and women of color?

Sunscreen is foundational for anti-aging. While it is true that people who have more pigment in their skin are at a decreased risk of skin cancer—which people often think of as the main reason for using sunscreen—it is also essential for preventing wrinkles. The sun’s rays increase aging. Using sunscreen daily helps to ward off that aging, regardless of your complexion.

And then, of course, the skin cancer prevention is important. It’s very difficult to prevent skin cancer if you’re not wearing sunscreen.

To sum up, use a good cleanser based on your skin type, a good moisturizer based on your skin type, and everyone should be using something—be it a serum or a moisturizer—that has retinol at night.

And, you really shouldn’t be using more than five or six products on your face. I find that people are stressing themselves out trying to do too many things which can cause problems, like irritation or allergic reactions. I encourage people to keep it simple.

Make an appointment with Dr. Lamb

Learn more about Dermatology at Mount Sinai

Vaccine Facts: No, the COVID-19 Vaccines Were Not Made Too Quickly

Aug 12, 2021 | COVID-19, Vaccines, Your Health

One of the many misconceptions that some have about the COVID-19 vaccines is that they were developed too quickly. In fact, all of the normal safety steps were followed in developing the vaccines, and they are helping to bring the pandemic to an end. In a roundtable talk, experts from Mount Sinai answer some frequently asked questions.

Did scientists and the government take short cuts and develop the vaccines too quickly?

Scientists followed all of the normal safety steps that are taken when we create new vaccines. No safety steps were skipped. The Pfizer-BioNTech and Moderna vaccines were made with technology that has been studied for many years, and the Johnson & Johnson vaccine was made using traditional methods.

So how did we produce and test these vaccines as quickly as we did?

COVID-19 vaccines became the priority for everyone. Researchers around the world dedicated themselves at the same time to finding solutions. We quickly understood how well the vaccines worked because COVID-19 spread so rapidly. It became clear that people who were vaccinated weren’t getting hospitalized, weren’t in ICUs, and weren’t dying of COVID-19.

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.

How do we know the vaccines are safe?

In the United States alone, nearly 200 million people have safely received the COVID-19 vaccines—twice as many as the flu vaccine. If you haven’t yet, we encourage you to get vaccinated.

Get more information from Mount Sinai about COVID-19 vaccines

Is It Safe to Eat That? — Debunking Pregnancy Dietary Myths

Updated on Jun 30, 2022 | Diet and Nutrition, OB/GYN, Women's Health, Your Health

Cropped side view portrait of pregnant African-American woman buying groceries while shopping in supermarket

Old wives’ tales about pregnancy have been around for centuries. While some myths vary from the lighthearted—carrying high? You’re having a girl—to those of a serious nature—spicy foods causes blindness in babies. Not true!—, we wanted to debunk some of those rumors.

Valerie D. Lewis-Morris, MD, Assistant Professor of the Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, gives us the facts on what to eat and what to avoid to ensure a healthy pregnancy.

If I didn’t eat a healthy diet before becoming pregnant, is it too late to start while I’m pregnant?

It’s never too late to change your dietary habits. And once you find out that you are pregnant, it’s really important to begin eating nutritious food for the health of you and your baby. If you need help with healthy meal planning, Mount Sinai nutritionists are available to answer your questions.

Can I drink coffee while I am pregnant?

Yes, but pregnant women should not consume more than 200 milligrams of caffeine each day—that’s about two, eight ounce cups of brewed coffee. Caffeine can increase your blood pressure and can cause unusual heart rhythms, so energy drinks, energy boosters, and too much coffee should be avoided.

Is alcohol okay to drink on special occasions while I am pregnant?

Not drinking alcohol is the safest choice. However, a glass of wine—which means a six to eight ounce glass—, a beer, or a toast of champagne a couple of times during pregnancy should not harm your baby, especially if you’re not in the first trimester.

If you are in your first trimester, then abstaining from alcohol is the best, safest choice and you should avoid hard liquor.

Can eating nuts during pregnancy prevent my baby from developing a peanut allergy?

This is an old wives’ tale with absolutely no truth to it. Nuts are a nutritious snack and an excellent source of protein, but consuming them while you’re pregnant will not have an impact on whether your baby will have allergies in the future.

Is it true that you should avoid cheese while pregnant?

Not exactly. The goal here is not to avoid all cheese and dairy, but you should not consume raw cheese or unpasteurized milk as these foods may contain bacteria that is harmful to your baby. All of the dairy you consume should have been pasteurized.

Avoid raw goat cheese, or cheese that has been mold ripened such as gorgonzola, or Roquefort. Hard cheeses, such as cheddar cheese or Swiss, are a safer option. And make sure that you read your food labels to make sure that all of your dairy has been pasteurized.

In addition to dairy, make sure that eggs are completely cooked before you eat them. So, save the runny yolks for after pregnancy.

Is it safe to eat fish?

Yes, as long as it is not raw or high in mercury.

Fish is an excellent food that is low in fat and contains high-quality proteins in omega three fatty acids, which are very important for your baby’s brain development. You want to avoid fish that are high in mercury as it can interfere with your baby’s brain and spinal cord development. These are fish such as shark, swordfish, towel fish, and king mackerel. However, fish that are low in mercury are safe to consume and those are fish like salmon, tilapia, and flounder. Enjoy those as much as you want a couple of times a week.

Should I be eating for two?

Eating for two is a very common myth, but the reality is that you should not be consuming double the portions of every meal and snack. You only need about an additional 350 calories per day and that can be easily achieved by adding two or three small healthy snacks like: a banana with a couple of tablespoons of peanut butter or three to five wheat crackers with about an ounce and a half of cheddar cheese cubes. You don’t have to eat a lot of extra food while you’re pregnant; don’t feel that you have to splurge.

Is it safe to exercise?

If you’re healthy and you have a low risk pregnancy, then the risk of moderate intensity exercise is safe. Consistent exercise during pregnancy can minimize constipation as well as decrease the risk of gestational diabetes and depression. If you incorporate aerobic exercises, such as brisk walking two to three times a week for 20 to 30 minutes or flexibility and strength workouts like yoga, that is all you need.

If you have a high-risk pregnancy, you should discuss adding exercise or continuing the exercises you are doing with your provider to make sure it is safe for you and your baby.

Finally, ignore the old wives’ tales and the misinformation that’s out there. When you’re in doubt, reach out to your obstetrician or midwife to get the most accurate and up-to-date information about your pregnancy and nutritional needs.

Make an appointment with Dr. Lewis-Morris

Learn more about OB/GYN Services at Mount Sinai

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