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Expert Advice on How to Keep Cool During the Summer

Jun 30, 2022 | Your Health

Summer is often a time to relax and enjoy the sun and the outdoors. But sometimes temperatures and humidity rise to the point where it can become uncomfortable, and potentially unhealthy.

In this Q&A, Erik J. Blutinger, MD, MSc, an emergency room doctor at Mount Sinai Queens and Assistant Professor of Emergency Medicine at the Icahn School of Medicine at Mount Sinai, offers some simple tips on how to keep cool when temperatures rise, and how to know when you or others may be overheating and require medical care.

Erik J. Blutinger, MD, MSc

How can you keep cool when it gets very hot during the summer?

First, make sure that you monitor your time in the sun. Try to stay in a cool place, out of direct exposure. Apply sunscreen. Wear loose fitted clothing. Drink plenty of fluids. And be careful of being in enclosed hot spaces, especially your vehicle. Within just a few minutes, you can get very hot inside a vehicle. So we always advise patients to be aware of your surroundings, especially your loved ones such as young children or older adults, to prevent anyone from getting too hot during the summertime.

Who is most susceptible to overheating?

People who are most susceptible to overheating include older adults, those with chronic medical conditions, and babies. That’s because it is more difficult for them “to adapt as adults to temperature change; they have a harder time regulating their own body temperature.” Others who are potentially at risk include those working outside and those who play sports outside.

Do you often see people seeking medical treatment for overheating?

At any emergency room, we often see people who come in seeking medical treatment for overheating, especially in the summer months. Fortunately we have the medical tools available to us to take care of them safely. But it is always best to be aware of your surroundings so that you don’t get to the point where you do need medical treatment.

What is heatstroke?

Heatstroke is a true medical emergency and is often fatal if left untreated. It is the most serious type of heat-related illness. It’s marked by very high temperatures, such as when your body temperature reaches 104 F (40 C) or higher. It is normally accompanied by other problems, notably confusion.

What are some early signs of general heat illness?

Early signs of general heat illness include having cool, pale, or even flushed skin. You can also have headaches, lightheadedness, or weakness among other symptoms

How do I know when I should seek medical care?

You should seek medical care when you feel as though you’re having a true life-threatening emergency. Generally what I advise patients and family members is that if you are starting to feel lightheaded or dizzy, have a headache, or feel hot, put yourself into a cool environment. Drink plenty of fluids, rest, and see how you feel. If you feel as though you’re not experiencing improvement after taking a few concrete steps to get better, then I would consult a medical professional and consider going to the hospital or contacting your doctor

How can I tell the difference between a sunburn and heatstroke?

It can be tricky to tell the difference between sunburn and heat stroke because the symptoms can be similar. Sunburn is usually marked as very mild irritation, flushed skin, or blisters that can be treated at home and with a few topical creams and ointments. But in some cases, a sunburn can lead to a heatstroke. Heatstroke usually will be accompanied by not only a rash, but also fevers or chills, nausea, vomiting, and possibly confusion.

How can I get help if I am concerned about heat-related illnesses?

New York City has many resources that are available to all. For those who do not have an air conditioning unit and may struggle financially, there are resources such as the Home Energy Assistance Program. You can also call 311 or find a cooling center in New York City during a heatwave, which can be found on the website.

Get more information from New York City to protect yourself from summer heat

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Answers to Your Questions About the COVID-19 Vaccines Just Authorized for Kids Six Months to Five Years Old

Updated on Jun 30, 2022 | COVID-19, Featured, Vaccines, Your Health

Parents of young kids finally have important news they have been waiting for: health authorities have authorized COVID-19 vaccines for kids six months to five years old.

This is welcome news for families and their younger children who have had to face the prospect of getting sick and have had to avoid many of their regular activities.

Federal health authorities have authorized the Moderna vaccine for children ages 6 months through 5 years, and the Pfizer-BioNTech vaccine for children ages 6 months through 4 years. The Pfizer vaccine requires three doses; the Moderna vaccine requires two doses. Pfizer’s vaccine was authorized for children ages 5 and over last November; the Moderna vaccine has now also been authorized for the 5-17 age group.

In this Q&A, Lindsey C. Douglas, MD, MSCR, a pediatrician at Mount Sinai Kravis Children’s Hospital, explains why parents should get their young kids vaccinated as soon as possible. Dr. Douglas is Medical Director, Children’s Quality and Safety, and Pediatric Hospital Medicine, and she is also Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai.

Why should I get the vaccine for my child six months to five years of age? What are the benefits and risks?

We’re really excited that the vaccine has been approved for children six months to five years of age, so now nearly all children can get vaccinated. The vaccine does, in fact, reduce the chances that a child will get COVID-19. Many people who have looked at the data believe the reduction doesn’t seem to be that much. But we know that the vaccine reduces the chance that a child will get severe COVID, and that is really important. Children are being hospitalized with COVID-19, and that is something we worry about. Also, the vaccine will help us truly get back to normal, with children being able to be around other children, around their grandparents, and reducing the risks of transmission in general. We hope this will get us back to where we were before the pandemic, so that we can all gather together and not be as worried about COVID-19.

Two vaccines are recommended. What are the differences and does it matter which vaccine I get?

We have some information about both of them. There were studies that were done for the authorization by the Food and Drug Administration, and the two vaccines seem to have similar efficacy. However, the doses are different, and the timing is different. There are three doses for the Pfizer vaccine and two doses for the Moderna vaccine. My recommendation is to get the one that’s easiest for you to get, the one that’s available at your pediatrician. The differences are probably not as important as the difference between having the vaccine and not having the vaccine. You can talk with your pediatrician if you have other questions.

Will children experience any side effects?

Side effects have been quite minimal, and they’re similar to other vaccines, which include soreness at the site of the shot, and some children experienced fevers and body aches. I like to think of these as proof that the vaccine is working, that your immune system is actually activated and working.

What can I do about these side effects?

You can give your young child acetaminophen (Tylenol) or ibuprofen (Advil or Motrin). They can help with fever and muscle aches. Some medications, such as ibuprofen, work as anti-inflammatory medications, whereas acetaminophen does not. Some believe anti-inflammatory medications may also block the immune response. I have two children of my own who are between five and 11 and had the vaccine, and I tried to wait it out with them, so that they could have the most potent response. The symptoms typically last only about a day. If you need to use something, I suggest acetaminophen.

What does the data show about how effective the vaccine is?

The effectiveness of the vaccine was shown in how often a child would get COVID-19. But that’s not the only thing that we worry about. The other thing that I worry about, as a pediatrician who takes care of hospitalized children, is preventing severe disease. There is not as much data on that, so it’s something that each parent should think about. Preventing severe disease in children is really important, and so is getting back to school and playgroups and all of the things that smaller children need for their development. Those to me are equally as important as not getting COVID-19 at all.

Are kids five and under at risk for serious disease?

People believe children don’t get COVID-19 as often or there are fewer cases of COVID-19 than in adults. That technically is true. More adults have been hospitalized. But there are children who have died from COVID-19. My opinion is this vaccine prevents both serious disease and hospitalization of a child, and that means it makes sense to get your child vaccinated.

Why is there no vaccine for kids under six months?

The studies for these vaccines were done in children over six months of age because the immune system is not fully formed in children under six months. We do start shots in infants as early as two months of age, but many vaccines can’t be given until kids are older, including the chickenpox shot. We tend to be much more careful with vaccines in children under six months of age.

If my child already had COVID-19, do they still need a vaccine?

Unfortunately, getting COVID-19 doesn’t prevent you from getting it again. I recommend that a child who has had COVID-19 be vaccinated. We know that vaccination is a strong way to prevent disease and prevent severe disease, and having some natural immunity from having the disease also provides some protection. The combination of the two is even better.

Is there anything else that patients and consumers should know?

The COVID-19 vaccines have been available for quite some time now. Kids under five are not that much different from those older than five. As a pediatrician, and as a parent myself, I’m thrilled that we can offer the vaccine to our most vulnerable and youngest children. This age group has been out of school the most of any age group because of not being eligible for the vaccine and not being able to wear masks easily. I urge parents to consider getting their children vaccinated today.

Staying Informed on Mpox

Jun 6, 2022 | Featured, Global Health, Infectious Diseases, Your Health

Mpox—a rare disease caused by the monkeypox virus that results in fever and a blistery rash—has been in the news lately. Normally found in parts of Africa, an increasing number of mpox cases have been confirmed in Europe and the United States. In this Q&A, Bernard Camins, MD, Medical Director for Infection Prevention at the Mount Sinai Health System, says most people shouldn’t be too worried about mpox, but calls for a bit of vigilance by physicians and the public. “It’s good to just inform people, even though the likelihood of the average person living in New York being exposed to someone with mpox is low,” Dr. Camins says.

What is mpox?

The monkeypox virus is a virus that is in the same family as smallpox and cowpox. As you probably know, smallpox was eradicated years ago. But we do have to worry about mpox every now and then.

Should I be concerned about mpox?

Most of us should not really worry about getting exposed to or getting mpox. The current situation is that some people who have traveled to countries in Europe or Africa have been exposed to people with mpox, and potentially they could be at risk for also having mpox. These returning travelers have exposed other people within their social circles, so there are reports of people contracting mpox who have not left the United States. You should only worry about mpox if you know someone who has symptoms of mpox or who has been diagnosed with mpox.

Click here to read the latest travel advisory on mpox from the CDC

What are the symptoms of mpox?

The hallmark of mpox is a rash, but before the rash appears, people can have a fever and a feeling of malaise or tiredness. Another hallmark is “diffuse lymphadenopathy” or enlarged lymph nodes. So if you do have fever and enlarged lymph nodes, and you were exposed to someone suspected of having mpox or someone who has been diagnosed with mpox, then you need to seek medical care.

What should doctors do if they see a patient with mpox symptoms?

If a doctor suspects a patient has mpox, even before the rash appears, we instruct them to isolate the person in a private room. The medical team will then wear personal protective equipment that includes an N95 respirator, gowns, and gloves, and then they will do an extensive interview. We need to know the details of the patient’s interactions with people who may have mpox. One of the key things that decides if someone needs to be tested is whether they have an epidemiological link to someone with mpox—meaning that either they traveled abroad and were exposed to someone with mpox or that they are at high risk for having mpox. While mpox is not usually considered a sexually transmitted infection, the latest outbreak has been observed among sexual partners.

Why are we talking about mpox now?

While mpox is a viral infection that is rare, a large outbreak has occurred in the United States before, in 2003. Mpox is endemic in Africa, meaning it is normally found there, but because we have a lot of people traveling around the world, it is spreading in countries where it is not endemic.

You can get more information about mpox and the latest updates from the New York City Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention.

Helping Patients With Multiple Sclerosis Thrive

Updated on Jun 30, 2022 | Your Health

Sammita Satyanarayan, MD,

Multiple sclerosis (MS) is an autoimmune disease where your immune system attacks your central nervous system, including the optic nerve, the brain, and the spinal cord. This can cause serious neurological symptoms, however the field has undergone advancements in recent years with more therapeutic options available to prevent disease worsening.

In this Q&A, Sammita Satyanarayan, MD, Assistant Professor of Neurology at The Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Mount Sinai, explains some of the symptoms of MS, how doctors diagnose this condition, and the unique services offered at Mount Sinai.

What are the symptoms of multiple sclerosis?

There can be a lot of different types of symptoms with multiple sclerosis. MS is a disease where a person’s immune system starts going after their own brain and spinal cord. There’s inflammation that can sometimes build and leave a scar in the brain or spinal cords. Those scars are called lesions, and we can see them on an MRI. Not all areas of inflammation necessarily cause symptoms that people feel. It’s sort of like traffic. If you have a small fender bender on a quiet neighborhood road, that might not cause you any type of traffic delay, since you can just go around it and there’s plenty of ways to get to the main road. But if you have that same type of accident on a crowded highway during rush hour, you’re definitely going to feel that traffic delay. In a sense, that’s sort of true for signals going through our brain and spinal cord. There are areas of the brain and the spinal cord that are more like neighborhoods and some that are more like highways. With MS, these delays affect our sensations, our actions, and our thoughts.

Can you give an example?

The symptoms of MS depend on where the inflammation actually is. Some people can have painful vision loss if the disease involves the optic nerve, which takes visual information from the eye to the brain. Some people can have inflammation in the spinal cord, and that can sometimes affect the sensation or strength in your arms or legs, or could affect urination, bowel movements, or sexual function. People can also have lesions in their brain, and that can cause symptoms like numbness or tingling in their face, trouble with dizziness or balance, double vision, and even sometimes trouble with cognition or memory.

What does it mean if you think you have symptoms like this?

There are a few important things to know about symptoms in MS. First, not everybody is guaranteed to have all of these possible symptoms. In fact, some people only ever have one. New MS attacks don’t usually have symptoms that come and go over the course of just a couple minutes or an hour. They usually worsen over days to weeks at a time before getting better. This is for the type of disease that most people get, which we call relapsing-remitting MS. It’s important to say that symptoms can improve over time. MS treatments these days have gotten really good, and while they do not fix any prior symptoms a person has, they are very good at preventing any new symptoms.

How do you diagnose multiple sclerosis?

MS is a life-changing diagnosis. And unlike other diseases, there isn’t one blood test that we can run and make the diagnosis. Therefore, doctors must be careful and comprehensive in our approach. We want to make sure that a person’s symptoms actually fit with MS, and want to make sure that we’re excluding other diseases that either don’t need treatment or need different non-MS treatments.

So what is involved?

We use different pieces of information to convince ourselves that this is a disease that’s happened in multiple places over multiple time periods, hence the name of multiple sclerosis. The types of information we use to assess this includes clinical symptoms, MRI, sometimes blood tests to rule out other diseases, and sometimes spinal fluid. With clinical symptoms, we look to see what’s affected. We look at what has happened over time with symptoms. We do a physical exam to see if we can find signs of injury to the nerves. We see if all those are consistent with what we expect in MS or if we get inflammation. We look at imaging and not just to see if there something on the MRI but we’re looking to see if there’s something specific for MS on the MRI. We look at the shape, the orientation, the location of what we’re seeing on the MRI to see if that characteristic of MS. We don’t have a blood test for MS, but there are times when we use blood tests to rule out other diseases. Lastly we sometimes use a bedside lumbar puncture, also called a spinal tap, where we look at the clear spinal fluid that surrounds the brain and the spinal cord. If there are signs of inflammation in the spinal fluid that are not in the blood, that can suggest there’s an inflammatory process in the brain or the spinal cord. But it’s just one piece of the puzzle. We are trying to fit all of these pieces together, and to do that we use an internationally approved set of diagnostic criteria to be able to actually make the diagnosis of MS.

What is unique about The Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Mount Sinai?

The Center, located at the Icahn School of Medicine at Mount Sinai, treats MS as well as other neuroimmunologic disorders. One of the things that makes this place special is the people. We have doctors who are deeply invested in all aspects of doctoring, whether it’s taking care of people, doing the cutting-edge research that helps advance the field, or even educating the next generation of doctors about MS. There are neuropsychologists who are learning more about cognition because we know that’s important to our patients. We have a group of nurse practitioners who are dedicated to the care and the well-being of our patients, as well as social workers and administrative staff who help people with getting the resources and medications they need.

How does the Center help patients live their lives?

One thing that is unique is the Center’s focus on the whole person. Despite all our advancements, our treatments are preventative. They help you for the future, but they don’t necessarily help with how you feel right now. That’s important, because while a big part of our job is to make sure that things don’t get worse, we also want to see people feel better. We know it takes a village to get there. We work with your diet, sleep, exercise, and mood because we know this affects your energy, strength, and cognition. And we know we have to find the best ways to help people not just survive, but really thrive. Our patients are not just defined by having MS. They’re defined by all the other things that they’re doing in their lives that are so important, and we want to keep them doing that.

What kind of research is being conducted in MS?

We are involved in a lot of different kinds of research at Mount Sinai, and we’re always looking for anyone who wants to get involved with that effort, such as participating in clinical trials. That’s how we push the field forward. Everything we know at this point in time about all the therapeutics available for MS is there because there have been people before us who have been willing to give their time to MS research. We’re involved in a lot of different types of clinical research. For example, we are participating in a clinical trial that’s testing a new kind of therapy for people who have progressive disease. We are involved in longitudinal research projects, which is where people don’t have to take a medication; they help us by monitoring their disease and their symptoms over the years, which helps us better understand MS as a disease. Unique areas of research at our Center include understanding the impact of MS on cognition, the role that diet might play in MS, and understanding the role of the gut microbiome. My research interests have been understanding how social disparities of health can actually impact access to care and even disability, both within MS and Neuromyelitis Optica Spectrum Disorder. It’s really important to think about, because in addition to learning how to treat people better, we want to make sure that we’re understanding how social and economic factors in a person’s life can also affect disability.

How can someone get involved with this research?

We’re also always looking for people MS or other types of conditions, or even people with no medical problems at all, to be involved in research studies. So if you’re a person with MS or a person without MS and want to get involved with our research, please reach out to one of the physicians at our Center or call or connect to talk to a research coordinator and see if you’d be eligible for any of our studies.

Why You Should Get a COVID-19 Booster Shot for Your Child Age 5 to 11

May 24, 2022 | Featured, Vaccines, Your Health

The Centers for Disease Control and Prevention recently recommended that children ages 5 through 11 receive a COVID-19 booster shot five months after completing the vaccine series.

In this Q&A, Kristin Oliver, MD, MHS, a pediatrician and preventive medicine physician at the Mount Sinai Health System, explains the benefits of the booster shot and urges parents to talk with their child’s health care provider if they have questions.

“We know information about COVID-19 and vaccination is constantly evolving,” says Dr. Oliver, who is also an Associate Professor of Pediatrics, and Environmental Medicine and Public Health, at the Icahn School of Medicine at Mount Sinai. “Reach out to your child’s pediatrician if you have any questions. We are happy to talk with you.”

What are the benefits of getting a COVID-19 booster shot?

While two doses of COVID-19 vaccine continue to give good protection to children against severe disease and hospitalization from COVID-19, protection from infection decreases at around five months after completing the series. A booster dose may increase protection against infection, emergency department and urgent care visits, and severe disease.

What side effects can we expect?

Side effects after a booster dose are similar to side effects after the second dose, with pain at the injection site most common, followed by tiredness and headache.

Is there any data on how effective the booster shot is?

In the study of 5- to 11-year-olds, the booster dose increased levels of antibodies to COVID-19 to higher than they were after the first two doses. While there is not enough data from that study yet to see the effectiveness against infection in this age group, there is good data that a booster dose in older age groups provides increased protection against infection and severe disease. We expect to see this same increase in protection for children ages 5 to 11.

If my child had COVID-19, do they still need to get a booster?

A recent COVID-19 infection does provide some protection in the short term, but that protection also decreases over time. Depending on your child’s risk factors and potential exposures, for children with a recent COVID-19 infection you may want to consider waiting three months before getting a booster dose. Waiting this amount of time may result in a better antibody response. You can speak with your child’s doctor about this choice.

Is there anything else parents should know about the booster shot and staying safe from COVID-19?

The most important thing you can do is get the first two doses of the vaccine if you haven’t yet. Hospitalization with COVID-19 is twice as high for children who are unvaccinated compared to children who received two doses of the vaccine, even during the recent Omicron surge.

What Parents Should Know About the Baby Formula Shortage

May 24, 2022 | Your Health

A nationwide shortage of infant formula has caused anxiety for parents across the nation as local and national agencies and private industry work to improve supply.

“Understandably, this has been a scary and concerning time for parents,“ says Morgan Howard, RD, CDN, a certified clinically advanced nutrition coordinator for the neonatal intensive care unit at The Mount Sinai Hospital. She encourages parents to use their pediatrician as a resource, and offers some helpful answers to the questions they have now.

My local stores don’t have the baby formula I usually buy. What should I do?

In most cases, any standard infant formula should be safe and appropriate to feed your baby. There are some circumstances where a specialized or particular formula is needed—for example if your baby has a severe allergy or another medical condition. If this is the case, you should consult with your pediatrician before changing brands or formula types. But these are rare instances. Even if you are using a sensitive formula or a reflux formula, you should be able to switch to a standard formula that is available to you. It is okay to switch between brands. Most brands are very similar, and your child should tolerate differences between them. Store-brand formulas are also a perfectly safe option for your kids, and in fact, most store-brand infant formulas are the same, with only store-specific labels.

You want to look at a variety of local stores and smaller stores in your community for any availability. You can also use store websites to show you in-store availability before going to multiple stores. Be sure to reach out to your child’s health care providers if you are having trouble finding infant formula, as they may have other tips to help. They also may give you further information to help you find the best options for your child. If you use WIC to obtain your formula, please reach out to your WIC office, because they can also help with tips and formula availability.

Can I dilute the baby formula to make it last longer?

Diluting baby formula is not recommended. This is not safe, because it will water down the key nutrients in the formula that your child needs. Watering down formula can cause dangerous abnormalities in sodium or calcium levels in the blood. We also don’t recommend any homemade infant formulas, as these are going to be missing vital nutrients for your baby. We know that this is a challenging time to try to find infant formula, but sticking to the available options in your stores is going to be the best choice for your infant.

Is it okay to give my baby milk? If so, what kind?

During this time of need, the American Academy of Pediatrics is allowing for children six months and older to have some whole cow’s milk, only for a brief period of time, if formula isn’t available. The recommendation is to have no more than 24 ounces of your child’s feeds coming from whole cow’s milk, and not using any low-fat milk or skim milk. It is important to stick to whole cow’s milk, because, of the cow’s milk options, this will best meet your child’s needs. This should be for as brief a period as possible, because it isn’t typically recommended for this age group, but a few days should be okay for your child. Cow’s milk is low in iron, when compared to infant formula, so it is important to follow up with your pediatrician if this is something that you are doing, since additional supplements, especially iron, may be needed. If your child is eating solid foods, try to give some iron-fortified solid foods, like cereals or other iron-containing sources

What about donated breast milk?

Some families may also consider using donated breast milk. If you are considering this, the safest option is to obtain the milk from a certified milk bank, as this milk is pasteurized, tested, and known to be safe for your child.

How did this baby formula shortage happen, and what is being done?

The shortage has occurred for a few reasons, including supply-chain issues related to COVID-19, changing demands for formula, and, unfortunately, a recent recall of infant formula from a large formula manufacturer, which has significantly affected the amount of formula available for families to purchase. The government and formula companies are working together closely to try and resolve this issue. They are flying in formulas from overseas. The government is helping companies do whatever they can to increase formula production to try and provide more formula for your children. One large facility that was closed is now shortly going to be reopened, which should help increase the supply in the next six to eight weeks, first starting with specialty and allergy formulas for children who can’t otherwise tolerate standard formulas. Then the next step will be to increase the amount of standard formulas being produced so there should be more available for your infants.

Is there anything else parents need to know about the shortage?

We understand that this is a concerning time for parents. You should use your pediatrician as a resource. Many pediatric practices and local communities have made efforts to secure formula that may be available by donation. Any time you are getting formula from somewhere other than a retail store, it is important to make sure that you’re taking unopened, unused formulas that are not expired and also not part of the recall. The makers of infant formula offer support sites and hotlines that may be helpful to parents. And more information is available from the American Academy of Pediatrics, the U.S. Department of Health and Human Services, and New York State.