Updated on Sep 9, 2024 | Featured, Your Health
The approach of fall is when doctors normally begin reminding patients to think about getting the flu vaccine, and now they are also reminding patients about the new COVID-19 vaccines that were recently approved.
The new COVID-19 vaccines are recommended for everyone six months of age and older. The U.S. Food and Drug Administration approved the vaccines, from manufacturers Pfizer and Moderna, on Thursday, August 22. The annual influenza vaccine is also recommended for those six months and older.
You should think about getting both vaccines before the end of September, according to 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.
“The immune response from the COVID-19 vaccine can wane after a few months, so that’s why people should get the most current vaccine and be ready for the fall surge,” Dr. Camins says.
Those at risk for developing severe disease from COVID-19 should think about getting the new vaccines within the next month, according to Dr. Camins. This includes older adults, those with chronic medical conditions, such as diabetes, heart disease, chronic lung disease and those with reduced ability to fight infections, such as organ transplant recipients and those being treated for cancer.
You may find it easier to get your new COVID-19 vaccine and flu shot at the same time. However, if you want to get them one after the other, you should start with the COVID-19 vaccine, because the peak flu season usually occurs later than the COVID-19 surge, according to Dr. Camins.
Flu vaccines are important because the flu is contagious and can lead to serious illness, hospitalization, and even death, according to the U.S. Centers for Disease Control and Prevention (CDC).
Experts say getting the new COVID-19 vaccine is important now because the number of cases generally surges as colder temperatures arrive and people spend more time indoors, especially during the holidays.
In addition, the new COVID-19 vaccines have been developed to provide the best protection against the newest subvariants. The vaccines you may have gotten last year were developed for different strains. COVID-19 vaccines typically provide protection for up to 20 weeks before their effectiveness begins to decline.
Many private insurance plans, along with Medicare and Medicaid, cover the cost of COVID-19 vaccines. You can find more information from the New York City Department of Health about where to get the new COVID-19 vaccines.
Based on last year’s data, the COVID-19 vaccines will prevent COVID-19 in about half of people. But more importantly, they are more effective in preventing serious illness and hospitalizations for those who do become infected. They can also help you avoid complications from long COVID.
For kids, it’s important to get the COVID-19 vaccine because younger people can also have complications if they get infected, plus they can bring home infections where they can affect other family members who may be more at risk.
Meanwhile, your best defense against a COVID-19 infection remains the same: Keep up to date with your vaccinations, consider taking steps to limit your exposure to large indoor crowds, wear a well-fitting mask at public gatherings or in tight spaces such as an airplane or public transportation, and talk with your health care provider if you are feeling sick.
There is a third vaccine that older adults should consider getting, and that is for RSV (respiratory syncytial virus). RSV is a common respiratory virus that infects the lungs, but can also affect the nose and throat.
RSV spreads in the fall and winter along with other respiratory viruses, like flu and COVID-19. RSV usually peaks in December and January, according to the CDC. The CDC recommends the RSV vaccine for adults 75 years and older, and for adults 60 to 74 who are at increased risk for getting severe infections. You do not need to get the RSV vaccine every year.
Aug 28, 2024 | Your Health
As a new parent, it’s overwhelming to understand all of the recommendations and advice being shared. One sound piece of advice is to do “tummy time” with your baby.
Tummy time is actually a form of exercise, when you play with your baby while they are their tummy. This helps prevent two conditions seen in infants: plagiocephaly and torticollis. Although many new parents may not know what these conditions are, they are fairly common and respond well to treatment when caught early.
David Cancel, MD, JD
David Cancel, MD, JD, a pediatric rehabilitation medicine specialist and Director of Pediatric Rehabilitation Medicine at Mount Sinai, answers common questions about preventing plagiocephaly and torticollis and the best way to treat them.
“Early awareness of torticollis and plagiocephaly is important,” says Dr. Cancel. “Fortunately, most cases of plagiocephaly and torticollis respond well to conservative treatment. This is the reason we recommend early positioning and stretching.”
What is Plagiocephaly?
Plagiocephaly is a condition characterized by an abnormal head shape or a flattening of one side of the skull. Since the “Back to Sleep” campaign for babies started in the 1990s, there has been an increase in cases of plagiocephaly.
What causes plagiocephaly?
The most common cause is known as “positional plagiocephaly.” The skull of a newborn is softer and more flexible than in an adult. If the baby is laying in one position for long periods of time, usually on their backs, the head takes on a flattened shape in these areas. There are other risk factors including having a first child, having a premature birth, and having twins or triplets. Less common causes are medical conditions or genetic syndromes that may cause abnormal positioning in the womb.
What else should I be on the lookout for?
Older studies have shown that in about five percent of plagiocephaly cases, there are also associated hip abnormalities. In other cases, if there is a preference to turn the head to the same position, this can also lead to neck muscle tightness. This might lead to a condition called “torticollis.” These conditions are not always seen together, and one can be seen without the other.
What is Torticollis?
Torticollis is also known as a “wry neck” in which tightness at the neck muscles cause the head to tilt, turn, or rotate to one side. It may look like your infant’s neck is rotated at an odd angle. The top of their head may be tilted to one side, and their chin may be tilted to the opposite side.
What causes Torticollis?
Sometimes it can occur with plagiocephaly. Other times infants will turn their head to one side out of habit. It can also result from traumatic deliveries where an injured neck muscle limits head turning. In rare cases, it may be related to impaired vision, where the head is tilted to compensate for the difficulty in eye tracking. This is known as “ocular torticollis”.
What signs should parents look for?
For plagiocephaly:
- Your baby sleeps with their head in the same position.
- Baby’s head appears uneven when seen from above.
- There is a bald spot on the back of the head where it is flattened.
- The ear on the flat side appears “pushed forward.”
- One eye appears to be “squinting” because the cheeks are uneven.
For torticollis:
- A small bruise or “olive shaped” mass at the neck muscle (especially after difficult delivery).
- The head tilts to one side and chin tilts to the other side.
- Your baby seems to always “look” in the same direction.
- Baby has tightness or lacks full range of movement with their neck to one side.
- One of your baby’s shoulders is higher than the other.
What is the treatment for plagiocephaly and torticollis?
Both plagiocephaly and torticollis are treated using similar positioning techniques. For plagiocephaly, positioning is the key component. For torticollis, stretching is the main element parents learn to do at home. The earlier that the baby is treated with these techniques, the lower the risk of long-term problems affecting the head, neck, and face.
This is because over time torticollis can affect spinal alignment and impair hand/eye coordination and balance. In severe cases both plagiocephaly and torticollis can lead to an uneven shape of the head, jaw and, facial bones.
Some of the techniques include:
- Stretching exercises to loosen tight muscles and proper positioning to stretch the neck muscles. With consistent and daily practice, most babies are able to move their necks completely and build up equal strength on both sides of the body.
- Turning their heads to the non-preferred side. Babies can’t hurt themselves if they are turning their heads by themselves, so this should be encouraged.
- Carrying the baby in a position that gently stretches the neck while being carried.
- Playing with the baby to develop good motor skills and good hand coordination.
Some things your physical therapist might ask you to do at home include:
- Lots of tummy time.
- Positioning overhead mobiles or objects slightly towards the non-preferred side.
- Changing baby’s position or where they are sleeping, if they are turning their head towards sounds they hear.
- Teach therapy activities to your family and other caregivers.
- Practice some gentle massage techniques.
- Make the therapy and visual activities part of your child’s routine. Try to work therapy into all activities such as bath time, diaper changes, feeding, and carrying. This includes playtime.
One important note: You should do all therapy activities gradually and with gentleness. Do not move your child’s head forcefully. You may need to gradually build up tolerance to being stretched.
What if the head shape does not improve with therapy?
If the plagiocephaly still persists after these interventions, a physician or therapist will refer your child to have a cranial remolding helmet (plagiocephaly helmet) to help reshape their head. Most helmets are provided at about five months of age and must be worn 23 hours per day. In the most severe cases, if these measures are not successful, then the next step would be surgery to help reshape the bones of the skull (for plagiocephaly) or lengthen the affected neck muscles (in torticollis).
If you have concerns or questions, please call 212-241-3029 to schedule an appointment.
Learn more about Pediatrics at Mount Sinai: https://www.mountsinai.org/care/pediatrics
Updated on Sep 7, 2024 | Your Health
Those hand-held devices and social media apps can be useful tools for kids to learn and keep in touch with family, friends, and classmates. But excessive screen time can be harmful to our child’s mental health, physical well-being, and overall health and happiness.
This can be all the more important during times of transition, such as moving from summer vacation to the structure of the school year.
Kenya Maria Parks, MD, MS, FAAP
It’s important to create clear boundaries around screen time, according to Kenya Maria Parks, MD, MS, FAAP, a pediatrician and Medical Director of the Pediatric School Based Health Program at the Icahn School of Medicine at Mount Sinai.
Dr. Parks has some advice for parents about how to help their kids navigate social media and technology, based on years of experience talking with kids and families. She offers the following tips:
- Teach your child to use social media safely and responsibly. It is important to promote positive aspects, such as communication and learning. However, it is also important that parents stay on top of the latest apps, trends, and social media developments. The key is staying informed and engaged early in your child’s life. Encourage open communication around online privacy, inappropriate contacts, and cyberbullying. Have in-depth conversations with teens about their digital footprint and topics such as sexting. By doing this, you are helping to empower them to make informed decisions about their online activity.
- Set healthy guidelines for screen time. Work with your child to create the best plan that details expectations, time limits, and areas of the home for device use. Adhere to age guidelines. Children under five should have one hour or less of screen time. School-aged children should have a maximum of two hours. This is up to your own discretion and how social media may fit into your child’s life and activities.
- Create or maintain a balance. Encourage a healthy balance between online and offline activities so your child has a well-rounded experience filled with growth, exploration, social interaction, and overall well-being. Let your child choose activities, such as playing a sport or doing a craft, so they feel fulfilled and happy. It can also be beneficial to schedule media-free family activities, such as playing board games, going for walks, or cooking together.
- Learn when to seek mental health support. Without proper precautions, social media may have negative impacts. Pay attention to cues and changes in your child, such as appearing sad or depressed for two weeks or more, increased isolation, or anything else that seems different. Communicating with your child regularly is integral to understanding if they need help. Speak openly with your child and follow your gut instinct. Never ignore the signs and contact your pediatrician or mental health specialist with concerns.
- Identify developmental delays and learning disabilities. Look for red flags in your child’s development and if they are meeting important milestones. For example, make sure your child is speaking by two years of age. Most of their speech should be understandable by the age of three. Any delays in speech or motor development issues should be addressed early. Additionally, make sure that your child is thriving in school. Parents should also be vigilant for signs of learning disabilities in school-aged children. Attention issues, hyperactivity, constant getting in trouble, or failing grades could be signs of a learning disability. Contact the school or your pediatrician for guidance.
“Technology should be used to enhance rather than hinder your child’s back-to-school experience so that they enjoy a memorable year and a fulfilling life,” Dr. Parks says. “Remember to prioritize face-to-face interactions with family and friends and encourage children to connect offline as much as possible. Help them enjoy physical and outdoor activities with others to help build relationships beyond the digital world.”
She suggests leading by example and acting as a positive role model by demonstrating healthy screen habits.
“Parents should limit their own screen time. Prioritize spending time with your child and with family and friends,” she says. “Explore new interests and hobbies with your child that offer personal growth opportunities and fulfillment.”
If you have questions or if you are concerned about your child’s mental health, contact your child’s pediatrician and or a mental health specialist.
Updated on Sep 9, 2024 | Your Health
You may know someone who has torn their ACL, or you may have heard about this injury while watching sports on TV. In fact, a tear in the anterior cruciate ligament (ACL) is one of the most common knee injuries, and it can happen to professional athletes, to those exercising just for fun, or those just living their daily lives.
The ligament, located in the middle of your knee, connects the bottom of the thigh bone (femur) to the top of the shinbone (tibia). It provides critical stability for your knee, making it important for sports performance, as well as walking down the street.
In this Q&A, orthopedic surgeon Shawn Anthony, MD, MBA, Associate Chief of Sports Medicine, explains what happens if you tear your ACL and describes treatments, including a new approach that repairs your torn ligament by regrowing your own tissue rather than removing the torn tissue and rebuilding it.
How common are ACL tears?
ACL tears happen often. A quick pivot or contact injury can cause this ligament to tear. I see patients from teens, to young adults, all the way to people in their 60s and 70s with ACL tears. It can affect professional athletes, weekend warriors, and even those who just misstep while walking down the street.
What does an ACL tear feel like?
An ACL tear is one of the more painful knee injuries at the moment it happens, when the ligament actually tears. The pain is followed by swelling, difficulty walking, and a sense of instability where your knee feels like it’s going to buckle under you. Over the first week or two after the ACL injury, the pain and swelling calms down, and patients regain their range of motion. They feel fairly normal by about three to four weeks after the injury. Patients can run straight ahead with an ACL tear, even run a marathon, with minimal to no symptoms. But they will experience a sense of instability whenever they do activities that engage the ACL—whenever they try to turn or pivot.
How do you diagnose an ACL tear?
We start with a physical exam, and if the ligament feels loose, then we follow with a magnetic resonance imaging (MRI) scan. This shows us the size and location of the tear. But there are some limitations to the information we get with an MRI, especially with partial tears.
How do you treat ACL tears?
The first step after an ACL tear is to start rehabilitation to regain range of motion and reduce swelling. Some partial ACL tears can heal just with time and physical therapy; we can usually get a sense whether this is likely based on the MRI. But patients who are active and engage in pivoting sports will choose surgical intervention to improve knee stability. There are two ways to surgically treat a torn ACL: reconstruction and repair. Both of these techniques are performed through a knee arthroscopy, or key-hole minimally invasive surgery. ACL reconstruction is the traditional approach. We remove the torn tissue and reconstruct the ACL using either the patient’s own tissue or material from a tissue bank. ACL repair, particularly using the BEAR implant, helps guide the ACL to heal itself.
How does BEAR ACL repair work?
BEAR ACL stands for bridge-enhanced ACL repair. We use a collagen scaffolding, which looks like a giant marshmallow and helps regrow the patient’s ACL. (Collagen is a protein and a fiber like structure that makes up your connective tissues.) We hydrate it with the patient’s blood, then insert it inside the knee, between the torn parts of the ligament. The BEAR implant guides the patient’s own ACL tissue as it regrows (called regeneration) and then it dissolves within two months.
With both approaches, most patients can return to normal daily activities in two to four weeks, running in about four months, and pivoting sports in about nine months. Both surgeries are effective, but clinical studies have found that patients who had the BEAR ACL repair reported that their knees feel more natural. In addition, the BEAR approach offers advantages in case the patient re-tears the ACL. Re-tearing the ACL happens in about five percent of cases, regardless of how it was treated. If a patient had a BEAR repair surgery, it is much easier to do a second surgery since BEAR does not involve harvesting the patient’s own tissue or drilling holes in the bone.
Do ACL tears lead to osteoarthritis?
After an ACL injury, about one in three patients will develop osteoarthritis, which means loss of cartilage in the knee, within 10 years of the injury. This is slightly higher in patients who have untreated ACL tears. We believe that’s due to the initial injury, the trauma to the knee cartilage when the ACL is torn. Animal studies have shown promising results of less osteoarthritis in those treated with BEAR ACL repair surgery; that is an area of ongoing research in the clinical studies of BEAR patients.
Updated on Sep 24, 2024 | Featured, Your Health
The battle against Alzheimer’s disease is advancing rapidly, thanks to groundbreaking research from the Icahn School of Medicine at Mount Sinai and other institutions around the world. Where there was once a bleak landscape—where diagnosis came too late and with very limited treatment options—there is now hope for researchers, clinicians, and patients as new drugs and imaging technologies become available. With the advancement of diagnostic tools, the research community has its sights set on an even more ambitious goal: preventing or delaying Alzheimer’s disease before it ever takes hold.
“We can slow down decline and degeneration, but we haven’t yet figured out how to stop it in its tracks,” says
Fanny Elahi, MD, PhD, Associate Professor of Neurology; Neuroscience; and Pathology, Molecular and Cell-Based Medicine at Icahn Mount Sinai. The focus, she explains, is now shifting toward early intervention—acting before cognitive impairment is even detected, when brain tissue can still be preserved.
“This is why I’m very excited about blood biomarkers,” Dr. Elahi continues. “We’re entering an era where, similar to early cancer detection, we can potentially change the course of Alzheimer’s disease if we catch it early.”
Dr. Elahi isn’t alone in her optimism. “We are really on the verge of revolutionizing medicine here,” agrees Mary Sano, PhD, Professor of Psychiatry and Director of the Alzheimer’s Disease Research Center (ADRC) at Icahn Mount Sinai. These emerging blood biomarkers can be a powerful tool for detecting early signs of brain degeneration, but they’re not yet ready for widespread use.
Mary Sano, PhD, left, Professor of Psychiatry and Director of the Alzheimer’s Disease Research Center, and Fanny Elahi, MD, PhD, Associate Professor of Neurology; Neuroscience; and Pathology, Molecular and Cell-Based Medicine.
“We need more data from a diverse range of people to fully realize the potential of these biomarkers,” says Dr. Sano. “The general public needs to know about these biomarkers, and how they can make them more powerful by participating in research studies.”
What are blood biomarkers and how are they linked to Alzheimer’s disease?
In the past, detecting Alzheimer’s and related degenerative diseases required invasive procedures, like spinal taps, and was typically reserved for patients already experiencing symptoms of cognitive decline. While these work-ups–or comprehensive tests– measure certain proteins, or biomarkers, that are telltale signs of the disease, they silo brain health from the rest of the body, says Dr. Elahi.
Now, researchers and physicians understand that what is present in the brain can be detected in the rest of the body, including blood, opening up new possibilities for early diagnosis. Key blood biomarkers linked to Alzheimer’s include:
- Hyperphosphorylated tau: One hallmark of Alzheimer’s disease is amyloid beta plaque buildup in the brain, and elevated levels of hyperphosphorylated tau in the blood is predictive of amyloid beta brain accumulation. This biomarker can accelerate the diagnosis and help guide the work-up that lead to treatment decisions.
- Neurofilament light (NfL): This structural protein found in neurons and axons is shed when axons degenerate, and is one of the earliest known biomarkers of brain degeneration for Alzheimer’s and other related dementia disorders. NfL levels can provide valuable insight into the disease’s progression
- Glial fibrillary acidic protein (GFAP): This protein is highly expressed by specialized brain cells called astrocytes. Approved by the Food and Drug Administration as a biomarker for traumatic brain injury, several studies show that levels of GFAP are also elevated in patients with Alzheimer’s disease and related dementias.
Paving the way for preventive screening
Blood biomarkers are currently being tested as a diagnostic tool for Alzheimer’s disease, with major efforts like the Davos Alzheimer’s Collaborative leading the charge. Mount Sinai is a key participant in these studies, which currently focus on individuals already showing symptoms.
However, researchers like Dr. Elahi are eager to expand studies to include healthy individuals, aiming to catch the disease before symptoms even appear. Mount Sinai’s ADRC is also at the forefront of this research, studying biomarkers from blood and neuroimaging to enhance early detection. However, to make these tools truly effective for widespread screening, especially in individuals who do not have symptoms, more data is needed from diverse populations.
Learn more about the Davos Alzheimer’s Collaborative project here.
To learn more about blood biomarkers and work from Dr. Elahi’s lab, click here.
“We are learning so much, but we need more participants to help use fine-tune these biomarkers,” says Dr. Sano. “We’re on the cusp of making these tools useful to clinicians and to the broader public.”
How you can help make preventive screening a reality
Participating in Alzheimer’s research is a vital step toward turning these promising biomarkers into reliable tools for prevention. Signing up for an Alzheimer’s disease research center registry is a good start, says Dr. Sano. The team at Mount Sinai will reach out to interested individuals offering various ways to participate.
Diversity in these studies is crucial. “Different factors, like comorbidities, can influence biomarker levels, and we need to understand these nuances,” says Dr. Elahi. Historically, Alzheimer’s research has been predominantly white-centric, but the disease affects people of all backgrounds. To create effective screening tools, the research community needs participants from a wide range of medical, socioeconomic, gender, age, race, and ethnic backgrounds.
“We need to shift our thinking from treating Alzheimer’s disease to preventing it,” says Dr. Sano. This message is going to be important for people in their 30s, 40s, and 50s, so they can take appropriate steps, such as screening or adjusting lifestyle habits, to reduce or delay the risk.
“New tools, such as blood biomarkers, that push the frontier of early detection will impact what we learn about the causes of disease and eventually revolutionize treatments,” says Dr. Elahi.
Updated on Sep 23, 2024 | Allergy, Your Health
Many people enjoy the cool weather and colorful foliage autumn brings. But for those with fall allergies, the season also comes with watery eyes, itchy throats, and stuffy noses. Fortunately, there are ways to alleviate these symptoms and appreciate the change of season.
Rachel L. Miller, MD
In this Q&A, Rachel L. Miller, MD, Chief, Division of Clinical Immunology, and The Dr. David and Dorothy Merksamer Professor of Medicine (Allergy and Immunology), Icahn School of Medicine at Mount Sinai, explains what could be triggering your fall allergies and how to treat them.
What causes fall allergies?
The most common causes are weed pollens, especially ragweed, and outdoor molds. Ragweed is a very robust urban weed that is common in the New York City area—it grows in Central Park, along roadsides, and in sidewalk cracks, starting middle to late August through the fall. Outdoor molds, also prevalent during this time, are produced by decaying leaves and other organic matter.
How can I know if my symptoms are from fall allergies or non-allergies such as COVID-19 or a cold?
Allergies are more likely to trigger symptoms such as a stuffy nose, itchy throat, and teary eyes. If your throat is actually painful or you have a fever, that is more likely to be a virus. A cough can be caused by either.
What are the most effective over-the-counter treatments for fall allergies?
The first line of therapy is nasal steroids. Some effective over-the-counter nasal steroid sprays include:
- Fluticasone (Flonase®)
- Budesonide (Rhinocort®)
- Triamcinolone (Nasacort® Allergy24HR)
These work by reducing inflammation in your nasal passages that trigger symptoms such as a runny nose.
Antihistamines also can be helpful to alleviate allergic symptoms like eye irritation and sneezing. Over-the-counter antihistamines include:
- Oral treatments such as cetirizine (Zyrtec®) and loratadine (Claritin® and Alavert®)
- Nasal medications such as azelastine (Astepro®)
- Eye drop medications also with azelastine (Optivar®), ketotifen (Alaway® and Zaditor®), and olopatadine (Pataday®)
Higher strength treatments are available with prescription. An allergist can determine which options are best for your symptoms. You can also use over-the-counter sinus rinses, such as neti pots (NeilMed® and SinuCleanse®) and saline solution sprays, to cleanse your nasal passages of allergens and other particulates several times per week. Be sure to use distilled or sterilized water.
What medical interventions can reduce my symptoms?
The first step to seeking any allergy treatment is to schedule an appointment with an allergist. We can provide tests to determine if you have ragweed, mold, or other allergies. Based on the results, we may recommend certain allergy shots or prescribe daily sublinguals (under-the-tongue tablets). The latter is effective for treating ragweed allergies. For the sublingual tablet to be effective, you need to start the medication a few months in advance of allergy season and continue it during the season.
What else can I do?
In general, you want to reduce the amount of allergens you come in direct contact with. When you are outside, wear a head covering and sunglasses, so the pollen and mold spores don’t get in your hair and eyes. Take your shoes off when you are get home so you’re not tracking the allergens inside. Keep windows closed, and use an air purifier to reduce pollen and other allergens in your home. Shower and shampoo your hair before bed to remove allergens from your body and pillow.