Is It Time to See a Pain Specialist for My Knee or Shoulder Pain?

Updated on Mar 15, 2023 | Your Health

Your knee and shoulders contain complex joints that can make pain difficult to diagnose and treat. But with help from pain management specialists, you can find relief.

In this Q&A, Gary Esses, MD, Assistant Professor of Anesthesiology, Perioperative, and Pain Medicine at the Icahn School of Medicine at Mount Sinai and a leader of the Pain Management Service at Mount Sinai Brooklyn, answers common questions about managing knee and shoulder joint pain and explains when to seek help from a pain management specialist.

Gary Esses, MD

Why does my knee hurt?

Knee pain is typically caused by injuries, arthritis, and mechanical problems. Injuries often include an ACL injury (ligament tear), a fracture, a torn meniscus (tear in the cartilage between the shinbone and thighbone), bursitis, and patellar tendinitis (irritation or inflammation of knee tendons).

Types of knee arthritis include osteoarthritis (a breakdown of cartilage in the knee), rheumatoid arthritis (an autoimmune disease causing tissue deterioration), and gout (caused by uric acid crystals in the knee joint).

Mechanical problems can include loose bone or cartilage that might go into the knee joint space causing irritation, dislocation of the knee, and hip or foot pain that affects your gait, possibly impacting the knee joint.

What treatments are available for knee pain?

Depending on the cause of your knee pain, your doctor will likely recommend some treatment options to start, including:

  • Rest, ice, compression, elevation (RICE), as well as activity modification
  • Anti-inflammatory medication or injections
  • Gel (hyaluronic acid) injections to cushion your knee joint
  • Stem cell therapy
  • Radio frequency ablation, a type of heat therapy, to silence painful nerves in the knee
  • Physical therapy
  • Wearing a brace
  • Weight loss

What can I do at home to ease my knee pain?

In addition to medications, your pain management specialist may recommend low-impact, at-home exercises such as stretches, walking, cycling, and swimming, or using the RICE method. The specialist might suggest using a heating pad and, if there is swelling, applying cold compresses. Following a routine pain management plan will strengthen the muscles around your knee over time and reduce the pressure on the knee joint. Notify your doctor if you further injure your knee, or if you experience pain or a return of symptoms during exercises.

Why does my shoulder hurt?

The most common causes of shoulder pain include osteoarthritis, rheumatoid arthritis, bursitis, dislocation, injury (broken collarbone, rotator cuff tear, torn cartilage, sprain, tendon rupture), and tendinitis. It is important to note that shoulder pain can be caused by referred pain from the heart, lung, or respiratory system, which is why it is important to seek a proper diagnosis.

A family physician or orthopedic surgeon can help determine a course of treatment. Your physician will use X-rays and magnetic resonance imaging (MRI) to pinpoint the cause of the pain. Then, your doctor will advise you on treatment options. If you don’t need surgery, you will likely be referred to a pain specialist.

What kinds of treatments are available for shoulder pain?

Your pain specialist will work with you to decide on a personalized treatment plan based on your individual needs. The pain specialist will review X-rays or MRIs to assess which approach will best manage the pain. The pain specialist might recommend non-surgical options including muscle relaxants, prescription oral anti-inflammatory medications, and over-the-counter pain medications. The specialist’s recommendation for a shoulder injection will depend on the severity of your pain. They may also recommend physical therapy.

How can I treat my shoulder pain at home?

The pain specialist might recommend a number of ways to manage pain at home including:

  • cold compresses
  • heat therapy
  • compression
  • massages
  • over-the-counter pain medications

The specialist might also recommend limiting activity directly affecting your shoulder. Gradually increasing the level and intensity of exercise will reduce the likelihood of placing stress on the shoulder and prevent the likelihood of your pain returning.

When should I see a pain management specialist?

If you have seen a regular doctor and your pain isn’t healing, it may be time to see a pain management specialist. There are board certified medical specialists dedicated to diagnosing and treating pain-related disorders. Your pain management specialist will consider multidisciplinary approaches to treating your pain, and they will discuss possible therapies and help coordinate your care with other health care professionals. If needed, they will perform interventional therapies, such as administering an epidural injection in the spine.

To make an appointment with a Mount Sinai Brooklyn pain management specialist, call 718-758-7072.

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Is Pregnancy Causing My Headaches?

Updated on Mar 10, 2023 | Pregnancy, Women's Health, Your Health

While pregnancy brings joy and excitement for many people, it can also cause quite a few headaches. Headaches are common during pregnancy, especially early on. However, there are ways to manage the pain. Most often, headaches are not serious and do not cause harm. But it is important for you and your physician to monitor your headaches, as headaches can be associated with pre-eclampsia, a condition that can become serious and lead to complications. In this Q&A, Mount Sinai obstetricians Bruno Caridi, MD, and Jian Jenny Tang, MD, explain the different types of headaches you may experience, how to ease and prevent headaches, and how to know if you should be concerned.

Bruno Caridi, MD

How common are headaches during pregnancy?
Headaches are a very common medical condition, especially among those who are pregnant. There are three different types of headaches: tension headaches, cluster headaches, and migraine headaches. Almost 26 percent of pregnant patients will experience tension headaches, a mild-to-moderate pain that is often described as having a tight band around the head. Pain may also be located toward the neck with tension headaches. Cluster headaches are characterized by intense pain, often concentrated around one eye or on one side of the head, and occurring frequently. Cluster headaches are very uncommon in women, occurring less than one percent of the time. A migraine headache is usually unilateral, which means it is concentrated on one side of the head. During pregnancy, about 10 percent of people will have experienced some type of migraine headache. With migraine headaches, an individual may be more sensitive to light, to certain types of noise, and to certain smells. Migraine headaches can also be accompanied by other symptoms, such as nausea. After 20 weeks of pregnancy, careful attention needs to be paid to headaches to ensure they are not a symptom of pre-eclampsia. Headaches associated with pre-eclampsia are usually global tension headaches, occurring all around the head.

What is pre-eclampsia?
While the causes of pre-eclampsia are not understood, the condition may be related to placenta and maternal vascular dysfunction. However, high blood pressure and protein in the urine are the most common signs. In rare cases, the condition causes seizures. If you are experiencing frequent headaches, it is important to have your vitals checked by your physician to see if your blood pressure is elevated. Also, be aware of any headache that is different from what you’ve previously experienced. Changes in vision, such as spots or blurriness, or right upper quadrant abdominal pain or epigastric pain are all signs of pre-eclampsia.

Jian Jenny Tang, MD

What are the best over-the-counter and non-pharmacological treatments for alleviating pregnancy-related headaches?
The first line of treatment recommended is Tylenol®. Patients may take three regular strength Tylenol (975 milligrams total), or two extra strength Tylenol (1000 milligrams total). Tylenol can be taken every six to eight hours, and must not exceed 3000 milligrams per day. This medication is an excellent initial line of over-the-counter treatment for headaches. We do not recommend migraine medicines that you may have been taking pre-pregnancy, such as sumatriptan. Besides Tylenol, caffeine is a great way to help alleviate headaches. Caffeine is fine to use in moderation, and should not exceed 200 milligrams per day. If the headache persists, then the patient should contact their physician. Other non-pharmacological treatments include drinking plenty of fluids to stay well hydrated, keeping your blood glucose levels up by snacking or eating light meals every few hours throughout the day, getting adequate rest, moving to a dark room to avoid light, or placing a damp washcloth over your forehead and relaxing. Other stress reduction or relaxation techniques, such as taking a shower to relax your muscles, listening to soothing music, and aromatherapy can help. Deep mindful breathing and light exercise, such as yoga, are other common non-pharmacological methods that help with headaches. Prevention is key.

How can I prevent pregnancy-related headaches?
Experiencing headaches during pregnancy does not mean you have pre-eclampsia. Other common causes can include dehydration, low blood glucose levels, lack of sleep, and anemia. As such, staying well hydrated and getting enough food and sleep are good ways to prevent headaches. Also, if you consume a lot of caffeinated beverages before pregnancy, abruptly scaling back on caffeine could trigger headaches related to withdrawal. If you plan to give up caffeine, easing yourself off of these beverages gradually can prevent headaches. Your pregnant body is going through a lot of changes, especially during the first trimester. Knowing how to adapt to these rapid changes will help put both your body and mind at ease, so you can focus on your baby.

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What Should I Do If My Child Has Norovirus?

Updated on Feb 24, 2023 | Adolescent Health, Featured, Pediatrics, Your Health

If your child has a stomach bug, it could be norovirus—a highly contagious stomach virus that causes diarrhea and vomiting. Cases of this virus are on the rise in New York City and much of the northeastern United States, according to the Centers for Disease Control and Prevention.

While typically mild in older children and adults, lasting usually only a few days, norovirus can cause severe dehydration in babies and kids with certain underlying conditions. Knowing how to care for them is crucial.

In this Q&A, Tessa Scripps, MD, a pediatrician at the Mount Sinai Kravis Children’s Hospital, and Assistant Professor of Pediatrics at the Icahn School of Medicine and Mount Sinai, answers your questions about the disease, including what to do if your child is sick.

What is norovirus, and what are norovirus symptoms?

Norovirus is a common contagious virus that inflames the intestines, causing nausea, diarrhea, and throwing up. Sometimes it can also cause fever. The disease is spread when particles from an infected person’s feces or vomit spreads to others, typically in bathrooms, but also by eating or drinking contaminated foods and beverages; using contaminated utensils; touching contaminated surfaces; or having any direct contact with someone who is infected. Norovirus is highly transmissible, and infected people can actually shed billions of norovirus particles at a time, but it can take fewer than 100 norovirus particles to make another person sick. People are most contagious when they actively have symptoms and in the few days after their symptoms have resolved.

Tessa Scripps, MD

How can I protect my child from catching norovirus?

The most common way norovirus is spread is through close contact with an infected person, so it’s a good idea to keep kids some distance from people who are sick, or who have recently recovered from being sick. Norovirus can infect an entire family at the same time, since even simple contact with others can lead to infection. So, the most important thing is for kids to wash hands frequently with soap and warm water, and for adults to do the same, especially if any of you have been in contact with a person who has symptoms. Alcohol-based sanitizers do not work as effectively against preventing transmission.

My child has norovirus. How does their age or health condition affect their risk for severe illness?

Newborn babies and children who have underlying chronic illnesses such as kidney disease and diabetes are at higher risk for becoming dehydrated and severely ill because excessive fluid losses can affect their kidney and their liver function. It’s important they get medical attention right away if symptoms last longer than three days or if they’re unable to keep hydrated.

What symptoms might indicate my child needs medical help?

Watch for symptoms of dehydration, such as decreased or less frequent urination and small volume- or very dark or strong-smelling urine. If it has been more than eight hours from when your child has had a wet diaper or used the toilet to pee, reach out to your doctor for advice. A rapid heart rate or a significant change in your child’s activity can also be a sign of dehydration. If you notice that your child seems very lethargic and listless, you should seek medical advice right away.

What can I do to help my child recover from norovirus?

Once the virus has passed and the vomiting and diarrhea have subsided, make sure they are well hydrated and rested. For newborns and infants, you can give them small amounts of breast milk or formula. Toddlers, older children, and adults should drink small volumes of fluids—about one to two ounces every one to two hours—to ensure fluids get absorbed and to prevent recurrent vomiting. Drinking water and electrolyte fluids like Pedialyte®, Gatorade, or watered down apple juice can be very useful to maintain hydration, and can help prevent complications from norovirus. They can also have bland foods like rice, dry cereal, applesauce, bananas, and crackers.

Are there any medications I can give my child to ease their norovirus symptoms?

There are no over-the-counter anti-diarrheals or anti-nausea medicines that are recommended for children. In rare cases, pediatricians may prescribe Zofran, an anti-emetic, to help children stop vomiting so they can re-hydrate without the need for intravenous fluids.

How do I prevent norovirus from spreading to my other kids?

It is important that everyone in your house washes their hands regularly with warm water, and avoid sharing food and drinking cups with anyone who is sick. You should also wipe down any contaminated surfaces with a bleach-based disinfectant, especially toilets and sinks after an infected child has used them. And everyone should try to maintain some distance from infected household members while they’re actively sick.

Is there a test for norovirus I can give my child?

Testing is available. However, norovirus is similar to other types of stomach infections, such as rotavirus, and symptom management is the same, so testing isn’t useful. If there has been an outbreak at your child’s school and they are sick, there is a good chance they have norovirus.

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How Do I Set Up a Personal Exercise Routine?

Updated on Feb 2, 2023 | Exercise, Your Health

We all know regular exercise is important for optimal health. But it is less clear how to set up an exercise routine that will work best, just for you. Here are some tips and insights from Hannah Kittrell, MS, RD, CDN, EP-C, Director of the Mount Sinai Physiolab, located at Mount Sinai Morningside.

Where do I even start while creating an exercise routine?

Three key elements are particularly important to keep in mind: consistency, variety, and fun.

Let’s start with consistency. Generally, we recommend spreading out your workouts between at least three to five times a week. This will help to increase the health benefits, improve your fitness at a faster rate so that you’ll get less tired during the workouts, and reduce your risk of injury. While we suggest five days a week, always check with your doctor before you start a new exercise routine.

Variety is also important—both because it’s fun to mix it up and also because you will work different muscles and improve your overall fitness when you include a variety of activities. Mix it up between aerobic activity, muscle and bone strengthening exercises, flexibility, and balance exercises.

Last—and most important—make it fun. No one wants to do an exercise routine that feels like a chore, so be sure to find the activities that make you the happiest, whether power walking through your favorite park, or biking to your favorite coffee shop. And if the activity itself isn’t enough to get you out the door consistently, find a friend who is happy to join you.

How much exercise should I plan for?

With aerobic activity, the American College of Sports Medicine (ACSM) recommends aiming for between 150 to 300 minutes of moderate intensity exercise or 75 to 150 minutes of vigorous activity each week. Keep in mind that aerobic activity includes anything that gets your heart rate up, from a run to a dance party in your kitchen. For muscle and bone strength work, the ACSM recommends two to three sessions per week. As we talked about before, it’s better to spread this activity out across several days in the week—ideally at least three.

What is the difference between moderate and vigorous intensity exercise?

With moderate intensity exercise, you should be able to carry on a conversation—but you should not be able to sing along to your favorite song. With vigorous activity exercise, you should not be able to talk in full sentences; instead, you’ll find yourself taking a breath every few words.

Why do I need a personalized health and fitness assessment?

A lot of the recommendations you find online or on gym equipment are generalized. They’re based on formulas, but don’t speak to your personal physiology. We’re all individuals, and a one-size-fits-all approach often doesn’t work. For example, you burn two main energy sources during exercise: fat and carbohydrates. Depending on your goal, you will want to incorporate different amounts of exercise that stimulate fat burning vs. carbohydrate burning. You typically burn fat when you’re at rest or doing low- to moderate-intensity exercise. Most exercise equipment, such as a treadmill or elliptical at the gym, will highlight a “fat-burning zone,” but the equipment doesn’t calculate this zone for you specifically. For instance, we know some people can continue to burn fat at higher intensities of exercise, while other individuals only burn fat up to moderate intensity exercise.

The best way to understand your body’s response to exercise is through assessment of your unique metabolism during a bout of exercise. When you have this individualized information, you can fine-tune your exercise routine to meet your goals efficiently.

How can a professional help me put together an exercise routine?

An exercise professional can help you develop a more targeted direction for your routine. You’ll want to look for either a certified personal trainer or an ACSM-certified exercise physiologist. Another option is to come into a health facility that can assess your metabolism and provide evidence-based advice on diet and exercise—like the Mount Sinai Physiolab. At our site, you can be evaluated on our metabolic equipment and work with our staff exercise physiologist. We can deliver the data points on your body composition and innate physiology that might be helpful in setting specific goals. Every test also includes a post-test counseling session to discuss what all the information means and help you figure out how to apply it to your daily life.

 

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What You Need to Know About the Latest COVID-19 Variant

Jan 24, 2023 | COVID-19, Featured, Vaccines, Your Health

You may have noticed that more people you know have gotten COVID-19 recently. One reason is the virus that causes COVID-19 continues to evolve into variants that are more contagious.

The latest one is known as XBB.1.5, and since early December it has become the predominant variant in the New York metropolitan area, according to the Centers for Disease Control and Prevention (CDC).

This variant is thought to be highly transmissible due to its ability to partially evade antibodies produced through vaccines or past infections. However, the vaccines still offer excellent protection against severe illness and death.

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.

In this Q&A, Bernard Camins, MD, MSc, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System, explains more about the new variant and how to protect yourself.

No matter the variant, it is important to remember that COVID-19 is not going away. The key is to reduce transmission to those who are at risk of getting seriously ill:

  • If you feel sick, stay at home.
  • If you want to be more vigilant, wear a high-quality mask, avoid being unmasked at large indoor gatherings (such as eating at restaurants), especially when infection rates in your area are very high.
  • If you are at high-risk for a serious infection, talk with your medical provider so you are prepared should you get infected.
  • Don’t forget to get your flu shot; you can get that at the same time you get your COVID-19 booster shot.

How does this new variant differ from the earlier variants?

The nature of COVID-19 is that the new variants are likely going to be more contagious than the older ones. There is currently no evidence that this latest variant is more dangerous. The symptoms do not appear different.

 Does the newest, updated booster shot help protect me from this new variant?

According to the CDC, being up to date with the bivalent booster that became available in September 2022 offers the best protection against COVID-19. (It is the only booster now available.) The updated bivalent booster specifically targets both the BA.5 sub variant of Omicron, of which XBB.1.5 is a descendent, and the original SARS-CoV-2 virus. The original COVID-19 monovalent vaccines, and the monovalent booster that became available in the fall of 2021, only target the original virus, and therefore potentially offer less protection against the Omicron subvariants.

 I was recently infected with COVID-19. How long should I wait to get the latest bivalent booster?

You may consider waiting up to 90 days from your last infection before getting the bivalent booster. Reinfection is less likely in the weeks and months after infection. But you may want to talk with your provider if you are at increased risk of severe disease.

 I never got any vaccines. Can I skip the first and second monovalent vaccines and just get the bivalent booster?

No. Before you can get the bivalent booster, you still need to get two doses of the monovalent vaccine.

 I received my bivalent booster more than two months ago. Has my immunity started to wane?

Your immunity does begin to wane after three to four months, probably more so if you’re older, such as older than 50.

 Can I get another dose to bolster my immunity?

No. Currently, there are no more recommended doses after you have already gotten the bivalent booster, regardless of how long it has been.

 Will the bivalent booster and antiviral medications prevent me from developing long COVID?

We do not have definitive data yet to know how much protection the bivalent booster and antiviral medications such as Paxlovid™ offer against the development of long COVID. But we do know that being vaccinated certainly reduces your risk of developing it.

I am at high risk for complications from COVID-19. What should I do to protect myself from the latest subvariant?

Because COVID-19 is so widespread now, it’s hard to avoid getting infected or exposed. While it is reasonable to take precautions to avoid a COVID-19 infection, the goal should be to reduce the severity or prevent complications when you do get COVID-19. High-risk individuals should have a plan for how to get antiviral medications, which can prevent severe illness or death. For this to work, you must take the medications within the first five days of symptom onset. If you have not done so already, you should talk with your doctor or your care provider to create a plan for what antivirals you would need and how to get them. Having a plan is also important because you may be on medications that interact with certain antivirals, and you may need to stop taking those medications temporarily to prevent drug interactions. Those at high risk include older adults, those with chronic medical conditions, such as diabetes, and those with reduced ability to fight infections, such as those being treated for some cancers.

Read more from Mount Sinai experts about COVID-19

Is Bariatric Weight-Loss Surgery the Best Option for Me?

Dec 29, 2022 | Surgery, Your Health

If you are struggling with obesity, you’re not alone. More than 25 percent of New Yorkers are overweight or obese, according to the Centers for Disease Control and Prevention. Obesity is related to a number of common medical conditions, including type 2 diabetes, high blood pressure, sleep apnea, and back pain.

If you’ve tried to lose weight and are still struggling, you may want to consider bariatric weight loss surgery. A popular and often ideal option for people who have not been successful losing weight on their own, bariatric surgery involves surgically altering the digestive system in ways that make weight loss easier.

However, the decision to undergo bariatric surgery should not be made lightly, and there is much to consider beforehand. In this Q&A, two of Mount Sinai’s leading bariatric surgeons answer some commonly asked questions about these surgeries.

Danny Sherwinter, MD, is Chief of Surgery at Mount Sinai Brooklyn and Assistant Professor of Surgery at the Icahn School of Medicine at Mount Sinai, and Patrick Dolan, MD, is Assistant Professor of Metabolic, Endocrine and Minimally Invasive Surgery.

What are the different bariatric surgery weight loss options?

There are three types of bariatric surgeries:

  • Lap band surgery decreases the amount of food needed to feel full. It involves placing an adjustable band around the stomach, restricting the amount of food consumed.
  • Sleeve gastrectomy is the most common bariatric surgery in the United States. It involves reducing the stomach to about 20 percent of its original size, significantly reducing the volume of food required to make you feel full.  It also has an effect on hunger hormones.
  • Gastric bypass surgery (also referred to as Roux-en-Y for the way surgeons perform this) is a procedure in which the surgeon creates a small pouch from the stomach and connects it directly to the small intestines. As a result of the surgery, the amount of food a patient will be able to consume is reduced, and even the food and calories they do eat will not be fully absorbed. 

Do I need to try all non-surgical weight loss options first?

Surgery is never the first choice for weight loss. You should try to lose weight on your own with diet and exercise.  You should also consult with your primary health care provider for their support and input. However, if you find that you are unsuccessful in losing weight despite these best efforts, you are not alone, as most people are unable to lose enough weight to improve their medical conditions and their quality of life.  For those people, surgery is an excellent option.

Who qualifies for bariatric (weight loss) surgery?

In general, most insurance companies are willing to cover bariatric surgery of any kind when a person’s body mass index, or BMI, is over 40 and they’re otherwise healthy; or if their BMI is over 35 and they have medical comorbidities associated with obesity, such as high blood pressure or diabetes. You can determine your BMI using the CDC calculator.

What will my insurance company require in order to get approved?

Most insurance companies will require you to go through a lengthy process to document your need for bariatric surgery. You will need approvals from a nutritionist and a psychologist, and will be required to see a number of other medical practitioners based on your medical history. In many instances, this will require you to visit a gastroenterologist, pulmonologist, cardiologist, and your own doctor. You will need to visit your doctor on a regular basis to document ongoing diet efforts, which you will need to submit to the insurance company for approval. This process, in some instances, takes up to six months or longer. Your bariatric surgeon will be able to guide you through the process.

Will my lifestyle and eating habits change after I have this surgery?

Yes. If patients don’t expect to dramatically change their lifestyle after surgery, then these operations will not result in weight loss. To succeed in the long term, you must fundamentally change your lifestyle, food choices, and how you eat, in addition to the operation. Getting enough exercise will also be important.

What will my diet be like before and after surgery?

A week or two before surgery, patients typically go on a liquid diet so they can lose some weight to make the operation even safer. After the operation, patients continue a liquid diet for a couple of weeks, then switch to a soft puree diet for a few more weeks. Within a month or so after surgery, the patient is put back on a regular diet. When you switch back to a regular diet, there is a risk of vomiting. However, if you avoid eating too fast or swallowing food without chewing, you will reduce this risk. We always recommend that bariatric surgery patients take vitamins, and follow up with their doctor to have vitamin levels checked.

Are there any complications from weight loss surgery?

As with any surgery, bariatric surgeries have possible complications, which are different for each. However, they are extremely safe overall. According to statistics, the risks for all of these operations, even bypass—the most complicated—is about the same as gallbladder surgery, an extremely safe and common ambulatory operation.

Will I be able to get pregnant after weight loss surgery?

In our experience, patients are more likely to become pregnant after weight loss surgery, and their pregnancies are often healthier and safer. Obese patients who are unable to become pregnant before surgery may become more fertile after surgery due to hormonal changes (reduction in elevated testosterone levels); possible ovarian issues (e.g. polycystic ovarian syndrome); and often a reduction in abnormal periods. The weight loss makes the entire birthing process safer. There’s also a higher incidence of gestational diabetes in pregnant women who are obese. We usually recommend waiting about a year after surgery before getting pregnant. But the timing should always be something to discuss with your bariatric surgeon and your obstetrician.

Schedule an appointment to discuss bariatric weight loss surgery with a doctor.