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

How You Can Manage Type 2 Diabetes

Mar 24, 2023 | Diabetes, Your Health


More than 37 million people in the United States have diabetes, and 90-95 percent of them have type 2 diabetes, according to the Centers for Disease Control and Prevention. Type 2 diabetes occurs when your cells don’t respond normally to insulin, a hormone created by your pancreas that regulates blood sugar in your body for energy.

While the incidence of type 2 diabetes is rising, you can prevent or delay the disease with active lifestyle changes.

David Lam, MD, Associate Professor of Endocrinology, Diabetes and Bone disease at the Icahn School of Medicine at Mount Sinai, explains what is behind the rising number of people with type 2 diabetes and how we can actively treat and prevent this disease.

Why is type 2 diabetes so prevalent?

Type 2 diabetes has been increasing in prevalence all over the world over the last few decades, and the biggest driver is likely the rising incidence of obesity. Though it is still being studied, the prevailing thought is that obesity leads to a state of inflammation in the body caused by fat cells releasing inflammatory chemicals. When that happens, insulin, a hormone your body produces to regulate blood sugar levels, doesn’t work as well, and your body becomes more resistant to insulin. This is ultimately the pathway that leads to type 2 diabetes.

What is the impact of type 2 diabetes on a person’s life?

Type 2 diabetes can affect you in many ways—the actual disease, the monitoring recommendations that clinicians provide, and even the treatments we prescribe—can all affect your life.

From a disease perspective, symptoms of high or low blood sugar can affect how you feel. Complications that arise from long-term or not-well-controlled diabetes can include neuropathy—a type of nerve damage that can cause numbness or weakness—and kidney or eye disease. Some of the medications we prescribe can have side effects and need to be taken multiple times a day.

What are a few steps the average type 2 diabetes patient can do to remain healthy?

The first step is to receive regular care and follow-ups with your health care team—not just with your clinician, but with a nurse educator, a nutritionist, an ophthalmologist, or any other specialists that’s involved in your health care. This ensures you are on the right track to take steps to improve your overall health. It is also important to take medications as prescribed, and talk with your health care team if there are any issues. The second step is to get regular physical activity. And the final step is to be mindful of carbohydrate intake, such as limiting things like soda, refined grains such as white bread, and many snack foods.

Who is most at risk for developing type 2 diabetes?

You are most at risk for developing type 2 diabetes if you are a person with obesity; have a history of prediabetes, or a history of gestational diabetes; if you have a sedentary lifestyle and/or a family history of diabetes.

How can I support my family members with type 2 diabetes?
Be present and open to hearing what they need and understand what they are going through. Listen to what they say, avoid giving them unsolicited advice, and be sensitive to their needs. For example, if they say, “It’s really hard when I go to parties or family events, and all there is to eat is carbs,” be sensitive to that. Talk to friends and family members about why it’s important to have healthy foods at parties and gatherings. The diet we recommend for patients living with diabetes is a diet everyone can benefit from.

If societal factors are to blame, what can Mount Sinai and other health care organizations do to help reduce the prevalence of the disease?

The first is ensuring individuals have access to health care. It really takes a village to treat someone living with diabetes. You might need dieticians, primary care physicians, endocrinologists, ophthalmologists, pharmacists; it takes a big multidisciplinary team.

We have to make sure patients have access to these specialists, especially those who are at the most at risk. The medications we frequently prescribe can be very expensive. There are programs that can help reduce the cost of the medications, and patients might need the help from us in navigating these programs. Lastly, larger organizations can really help support prevention programs. There are established, research-proven diabetes prevention programs that really focus on weight loss, and they have been shown to help reduce the progression from prediabetes to diabetes. Larger organizations can help support these programs to make an impact on those who are at risk.

Learn more about diabetes care at Mount Sinai
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Should I Take a Genetic Cancer Test?

Updated on Mar 23, 2023 | Cancer, Your Health

Knowing your genetic risks for cancer might seem scary. However, by taking a genetic cancer test, you will have even more peace of mind, because you will have a powerful tool to help prevent it.

Stephanie Blank, MD, Professor of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai and Director of Gynecologic Oncology for the Mount Sinai Health System, answers some common questions about genetic cancer tests. Dr. Blank is also Director of Women’s Health at the Blavatnik Family Chelsea Medical Center at Mount Sinai and Associate Director in The Tisch Cancer Institute at Mount Sinai with a focus on women’s cancers.

What are hereditary cancers?

Hereditary cancers are cancers you may be more likely to get due to a pattern in one of your genes. If you have a mutation in a certain gene, you may be at a higher risk for cancer. Some of the most common mutations associated with cancer are BRCA 1 and 2. If you have a mutation in one or both genes, you have an increased risk of breast and ovarian cancers.

How do you determine if you are at risk for hereditary cancer?

Family history is important, and there are a few different elements you need to know. It’s important that you know both the maternal and the paternal side of your family history, if those relatives had any cancers, what cancers they were, the ages of family members at diagnosis of those cancers, as well as their age of death, regardless of whether it was from cancer or not. When you have your family history and draw it out in a tree, you may notice many areas where there are relatives who had cancers, and you can trace that. Another important thing to know is if any family members had genetic testing and their results.

What would be considered a risk factor in someone’s family history?

Some red flags include relatives who got cancer extremely young or multiple family members who got the same cancer, including individuals who got more than one cancer and unusual cancers. In that situation, it is important to know the age of the family member’s diagnosis, and if they had any genetic testing done.

Does my ethnic background increase my risks for genetic cancer?

People from certain ethnic backgrounds, such as those who are Ashkenazi Jewish, may be at increased risk of having a genetic mutation, but there are others, including French Canadian and Icelandic—and we are always discovering more.

How do I find out for sure if I am at risk for hereditary cancer?

If you think you might be at increased risk of cancer based on your family history or ethnicity, speak with your doctor about how to get tested. At Mount Sinai, we provide both genetic testing and genetic counseling. In addition to testing, genetic counseling can help determine if you have one of these mutations. Oftentimes, you may see a genetic counselor either prior to getting the testing or afterwards. Testing generally consists of a blood test but can also be a swab from the inside of your cheek. If you do have a mutation, we can use that information to help you plan for how you are going to screen for or prevent cancer.

Will my health insurance cover the costs of genetic cancer testing?

Health insurance typically covers genetic testing, but you should confirm this with your health insurance provider. If your provider does not cover it, Mount Sinai’s genetic counselors can work with you to minimize the cost.

Why should I get tested to find out if I am at risk for hereditary cancer?

If you know your risk, there is a lot you can do to help yourself. If you have a BRCA 1 mutation, for example, you know you are at higher risk for several cancers, breast and ovarian being the most common, as well as pancreatic and prostate cancer. If you are a woman with a BRCA 1 mutation, you can start getting mammograms and magnetic resonance imaging early. Even if you do not have cancer yet, you might consider medication and even surgery to prevent breast cancer from forming.

If you have a genetic risk for ovarian cancer, you might go on birth control pills, which diminish the risk of ovarian cancer. Even if you already have ovarian cancer, we recommend genetic testing, because around 25 percent of ovarian cancer is genetic. Knowing if you have the mutation has a profound effect on your care, since we use different treatments depending on whether the cancer is genetic. Knowing if your cancer is genetic is even more important for determining prognosis. If you have a mutation, it is important that you tell your family members, so they can get tested and take measures to reduce their own risk.

Are most cancers genetic?

Most cancers are not genetic. Not having a mutation does not mean you won’t get cancer; we just don’t know what the likelihood is. When somebody has a mutation, we know a lot more about the likelihood of getting cancer, or the age at which they might get cancer. Hereditary information and knowing your risk of cancer is an opportunity to prevent it.

Get a genetic cancer test at Mount Sinai.