How Can I Tell the Difference Between Seasonal Allergies and COVID-19?

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

Today, every sniffle, every cough, and every sneeze are a cause for concern. “Do I have COVID-19?” races through our minds. Madeleine R. Schaberg, MD, Director of Rhinology and Endoscopic Surgery, Mount Sinai Downtown, helps you tell the difference between allergies and COVID-19.

How do the symptoms of seasonal allergies differ from COVID-19?

The main symptoms of allergic rhinitis or seasonal allergies are itchy, watery eyes, runny nose, nasal congestion, and sneezing, while the symptoms of COVID-19 are fever, cough, body aches, sore throat, and shortness of breath. Many symptomatic patients with COVID-19 will have a fever which, in an adult, is a temperature above 99°F.

Other symptoms of seasonal allergies include post-nasal drip, facial pressure and sinus headaches, and mild fatigue. We generally do not see a significant amount of coughing with seasonal allergies, except in patients with significant post-nasal drip or allergy associated asthma. Sneezing is generally a prominent feature of seasonal allergies, but it has not been reported with COVID-19, although it may happen occasionally.

In general, the key differentiating factors between COVID-19 and allergies are fever and body aches (malaise). Typically, you do not see either symptom in allergy sufferers. While you may see some mild fatigue with allergies, the fatigue we are seeing with COVID-19 is more extreme.

Are there other symptoms that may indicate COVID-19?

Yes, in addition to cough and fever, many patients will experience a loss of smell (anosmia). We don’t typically see a loss of smell with seasonal allergies, unless patients have significant congestion of the nasal passages or have polyps blocking their nasal passages. The loss of smell that is associated with COVID-19 is thought to be due to direct damage to the olfactory nerve and specialized olfactory neuroepithelium.

It’s also worth noting that, for most people, COVID-19 is an acute illness. Patients will develop symptoms between 2 to 14 days after being exposed to the virus. Those symptoms will then last 10 to 14 days. Although symptoms may differ from person to person, they will appear in most people within the 14-day exposure window. This is true whether you have a moderate case or a severe case.

Allergies are more of a chronic issue. They will generally manifest as mild symptoms and last for the allergy season, which is typically from April to mid-June.  Compared to COVID-19, seasonal allergies, as well as allergies that occur perennially, have a much longer time course. In addition, patients will often be familiar with their typical seasonal allergy symptoms, as they often will be similar each spring.

What is the treatment for allergies?

For allergies, the first line of treatment is over-the-counter antihistamines. The main inflammatory mediator of seasonal allergies is histamine. This would include such medications as, cetirizine, loratadine, fexofenadine, and levocetirizine. There are also many over-the-counter steroid nasal sprays, which are extremely effective for allergy relief, such as budesonide, fluticasone, and triamcinolone.

If patients don’t get relief with over-the-counter medication, then an appointment with a rhinologist would be appropriate to explore possible prescription medication.

There are many prescription medications that can be extremely helpful.

I’m unsure if I am suffering from allergies or COVID-19. What should I do?

If you are experiencing mild symptoms that you are concerned may be COVID-19, there are a number of testing options available.

In-person testing is available at all Mount Sinai Urgent Care locations for walk-in or scheduled appointment.

You can also have your symptoms assessed virtually throughout Mount Sinai Urgent Care. Physicians are available for online consultations, video calls, and via text from your mobile device. Additionally, you can contact your Mount Sinai primary care physician or use Mount Sinai’s Express Online Consult Click4Care to receive virtual assessment of your symptoms.

Make an appointment with Dr. Schaberg
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How Do I Prevent—And Treat—A Muscle Strain?

Updated on Jun 30, 2022 | Sports Medicine, Your Health

Man running in park stops to check on injured ankle

During the pandemic, more people have been exercising on their own rather than with intramural teams or at the gym. That means if you run into trouble, you’re also on your own. If you have a muscle strain or sprain, you may want to know what to do—and when you really need to seek professional help. Melissa Leber, MD, Director of Emergency Department Sports Medicine at The Mount Sinai Hospital, answers some of your questions.

How do you strain a muscle?

A muscle strain happens when you pull, tear, or stretch a muscle. Strains sometimes happen from overuse, but often they’re caused by an injury. Muscle strains and sprains can trigger pain, swelling, and even bruising. You can strain or sprain almost any muscle in the body, but the ones we see most often affect the calf muscle (called the gastrocnemius), the ankle, or the lower back. We also see a lot of strained rotator cuffs, quads, and hamstrings.

How should I treat a muscle strain?

If you think you have strained or sprained a muscle, you should immediately stop what you are doing. Then, plan to rest the injured area and apply ice. Ice should not be applied directly to the skin, but rather wrapped in a towel. It should be held in place for about 20 minutes and then taken off. This can be repeated for the first 24 hours after an injury. After an injury you can also take an anti-inflammatory medication such as ibuprofen or naproxen, if you are allowed. If you can’t bear weight or if you can’t use your affected muscle at all, you should seek emergency care by at the nearest emergency room or urgent care facility. Otherwise, give it a day or two to see if the muscle gets better.

I have not worked out in six months. How can I prevent straining a muscle when restarting my fitness regimen?

Muscle strains and sprains are common—but they aren’t inevitable. To prevent straining your muscles, vary the frequency and variety of your workout. You don’t want to do the same thing over and over again because that can ask too much of the muscle. While you might not feel any pain in the moment, you could still be damaging the muscle. Then, later on, you could start to feel pain seemingly out of nowhere.

You’ll also want to vary the intensity of your workout. You can’t go hard day after day after day. Give your body at least one day off a week.  One way to vary the intensity of your exercise is to practice interval training. This means performing a series of high intensity workouts interspersed with rest periods.

When should I see a doctor about my injury?

If you are still in pain after treating at home for two to three days, you should make an appointment with a physician who might take an x-ray or perform a musculoskeletal ultrasound to gauge the severity of your injury.

Also, in addition to strains and sprains, a torn muscle can develop a hematoma. This happens when blood collects at the site of the torn muscle causing pain, swelling, and discoloration of the area. While many hematomas can be treated at home with RICE (rest, ice, compression, elevation), more severe injuries will need a medical intervention.  If you suspect that you have a hematoma and have severe pain and/or your injury expands over one to two days, seek medical attention.

Make an appointment with Dr. Leber
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Pregnancy and Antidepressants: Should You Avoid Taking Them?

Updated on Jun 30, 2022 | Featured, Mental Health, OB/GYN, Psychiatry, Research, Women's Health, Your Health

Approximately half of women who use antidepressants before pregnancy decide to discontinue use either before or during pregnancy due to concerns about the negative consequences for their child.

Those who are pregnant or who may be thinking of getting pregnant may wonder if taking antidepressants could affect the heath of the child. New research from Mount Sinai offers some potentially important findings and shows that the underlying mental health of the parents is more of a concern than the medication itself.

The study shows that while there is a link between maternal antidepressant use during pregnancy and affective disorders in the child later in life, the link also exists between paternal antidepressant use during pregnancy and child mental health.

The data suggest the observed link is most likely due to the underlying mental illness of the parents rather than any “intrauterine effect,” which means any effect the medication could have on the fetus developing inside the uterus. These affective disorders include depression and anxiety.

“Our study does not provide evidence for a causal relationship between in-utero exposure to antidepressants and affective disorders in the child,” says Anna-Sophie Rommel, PhD, an instructor in the Department of Psychiatry at Icahn Mount Sinai and first author of the paper. “So, while other long-term effects of intrauterine exposure to antidepressants remain to be investigated, our work supports antidepressant continuation for women who would like to continue taking their medication, for example because of severe symptoms or a high risk of relapse. It is important to note that untreated psychiatric illness during pregnancy can also have negative consequences on the health and development of the child. Women and their health care providers should carefully weigh all of the treatment options and jointly decide on the best course of action.”

Anna-Sophie Rommel, PhD

Approximately half of women who use antidepressants before pregnancy decide to discontinue use either before or during pregnancy due to concerns about the negative consequences for their child, according to Dr. Rommel, who is also an expert in epidemiology and has been studying how the COVID-19 pandemic disproportionately affects pregnant women in underserved communities.

Major depressive disorder is highly prevalent, with one in five people experiencing an episode at some point in their life, and is almost twice as common in women than in men. Antidepressants are usually given as a first-line treatment, including during pregnancy, either to prevent the recurrence of depression, or as acute treatment in newly depressed patients. Antidepressant use during pregnancy is widespread and since antidepressants cross the placenta and the blood-brain barrier, concern exists about potential long-term effects of intrauterine antidepressant exposure in the unborn child.

Using the Danish National Registers to follow more than 42,000 babies born during 1998-2011 for up to 18 years, researchers at the Icahn School of Medicine at Mount Sinai investigated whether exposure to antidepressants in the womb would increase the risk of developing affective disorder like depression and anxiety in the child.

In a study published April 5 in Neuropsychopharmacology, the scientists found that children whose mothers continued antidepressants during pregnancy had a higher risk of affective disorders than children whose mothers stopped taking antidepressants before pregnancy.

However, to understand whether the underlying disorder for which the antidepressant was given or the medication itself was linked to the child’s risk of developing an affective disorder, they also studied the effect of paternal antidepressant use during pregnancy and similarly, found that children of fathers who took antidepressants throughout pregnancy had a higher risk for affective disorders. Thus, the research team speculates that rather than being an intrauterine effect, the observed link is most likely due to the parental mental illness underlying the antidepressant use.

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Is Lip Filler Right for Me?

Updated on Jun 30, 2022 | Your Health

Full lips are a marker of youth and beauty. As we age, however, our lips tend to become thinner and flatter. Mount Sinai’s Facial Plastic and Reconstructive Surgery team offers both temporary and permanent solutions to help you achieve natural-looking, voluminous lips.

“The lips are an important part of our body—they are an area of sensuality and communication. When someone looks at you, they tend to be drawn to the eyes and the lips,” says Noah B. Sands, MD, who is a Facial Plastic and Reconstructive Surgery physician at Mount Sinai. “Our goal is to work with patients to help them find the right enhancement option and achieve their goals.”

What are lip enhancements?

The lips may look different from the rest of the body, but they are actually a thinner, more delicate type of skin. The same way skin wrinkles over time, the lips slowly lose their pillowy appearance as they produce less collagen. Lip enhancements are cosmetic procedures that augment the shape of the lips and the goal is to:

  • Plump up thin or flat lips
  • Redefine and enhance lip shape
  • Reduce vertical wrinkle lines that develop above the lip
  • Restore balance between asymmetrical lips
What enhancement procedures are available to patients?

The most common procedure is a temporary cosmetic injectable. These dermal fillers are gel-like substances that are injected into the lips to create volume. Juvéderm and Restylane, two common brands of dermal fillers, are generally well tolerated by patients because they are made of hyaluronic acid—a naturally occurring substance in the body. The effects of this procedure lasts for about one year.

If you are seeking a permanent solution, a plastic or silicone implant can be used to plump up the lips. A less popular implant choice, is a fat implant. This permanent option involves taking tissue from the belly or thigh and injecting it into the lip. Keep in mind that fat implants are typically not a standalone procedure. They are generally used when a patient is augmenting other areas of the face such as volumizing the cheeks or filling in wrinkles under the eyes.

If your goal is to define your lip shape, a lip lift is an appropriate option. This technique is used to emphasize the border of the lip, giving it a tighter and more defined shape. Additionally, lip reductions are available for patients who would like to de-emphasize their lips.

How do I know which lip enhancement is best for me?

Your surgeon should work closely with you to select the procedure that best meets your needs. However, when patients are unsure, Dr. Sands advises them to be conservative.

“Patients tend to have a fairly strong reaction to lip enhancements at first,” he explains. “I often advise to start with a temporary filler so they get a sense of what the modification will look like and then decide if they want something permanent.”

One of the benefits of fillers is that they are temporary and changeable. If patients are not satisfied with the result, it can be tweaked or even reversed entirely in the same visit. The filler can also be inserted gradually over several appointments.

“There is a misconception that fillers look ‘done’ or will cause a duck lip appearance,” says Dr. Sands. “If the filler is applied and balanced right, it will look like an inconspicuous, natural enhancement.”

When biological materials are used, Dr. Sands says lip enhancements tend to have a more natural look. Lip implants, which use synthetic material, often appear less natural and the texture of the lip itself may also feel different.

There are limits, however, to what fillers can do. “Sometimes patients have asymmetries that can be corrected with fillers but they cannot reshape the lip,” says Dr. Sands. “The lips will also only tolerate so much filler product without looking unnatural.”

How long will it take for the procedure to heal?

Many patients who come to Dr. Sands have had Botox or fillers in other areas of the face. But the lips, he warns, may feel a little different. Since the lips are a very vascular area of the body, they tend to bruise more.

“The results are immediate, but it generally takes a week for the swelling to settle,” says Dr. Sands. “Patients can return to work that day but it is best to schedule the procedure for a time where they do not have a lot of meetings, and at least one week before a major event.”

Photo of Noah B. Sands, MD

Noah B. Sands, MD

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I’m Young and Healthy. Why Should I Get the COVID-19 Vaccine?

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

States are moving quickly to enable more people to be eligible for the COVID-19 vaccines. In New York, for example, those 16 and older are now eligible. But many young adults may believe they do not need to get vaccinated.

In this Q&A, Michelle Cespedes, MD, MS, an infectious disease specialist at Mount Sinai who has treated many patients with COVID-19, explains that young people should get the vaccine to limit the spread of the disease, especially new variants; to avoid potential long-term complications for themselves; and to protect others, especially older family members, relatives, and friends. Dr. Cespedes is also an Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai.

Should young people worry about becoming infected with COVID-19?

This is a question I hear often these days. A lot of people think that because they’re young, they probably won’t get COVID-19. And even if they do, the reasoning goes, they won’t get a bad case. There are data that suggest younger people might not get as sick with the coronavirus as older people. They might be less likely to need hospitalization. But that doesn’t mean young people can’t get COVID-19 and potentially spread it on to other family members. This is especially important to remember when you think about visiting family members around the holidays. We saw that huge spike in cases last year right after Thanksgiving and Christmas. We’d like to avoid a repeat of that.

Is it true that if I get a mild case of COVID-19, it’s nothing to be concerned about?

It is true that young people might not get as sick as the elderly. But that doesn’t mean COVID-19 has no effect on you. Even people who had a mild case may experience long-term effects. Evidence suggests that COVID-19, like any other virus that causes inflammation, can affect the lungs, the nerves to the brain, and even the brain itself. For instance, the loss of taste or smell suggests inflammation in the nerves that control the ability to taste or smell.

Another common side effect is what we call brain fog, which is not a distinct medical or scientific term used regularly by medical professionals. Brain fog describes a collection of symptoms related to changes in thinking and memory. Patients who have had COVID-19 sometimes report that their thinking is sluggish or not sharp, often with poor memory, recall, or attention span. It can be best described as the sense that “I came into this room for something, but I can’t remember what.” While brain fog won’t land you in the hospital, it can last for many months.

Additionally, according to a study conducted by researchers at the Icahn School of Medicine at Mount Sinai and the Naval Medical Research Center, past COVID-19 infection does not fully protect young people against reinfection. The study found that reinfection was quite common amount young healthy adults, making it even more important for them to get vaccinated in order to prevent reinfection, boost their immune responses, and reduce transmission.

How does my getting the vaccine help other people?

When you get vaccinated, it means you likely cannot get the virus, which means it won’t make you sick—and you won’t pass it onto anyone else. In addition to protecting yourself, the vaccine also helps the larger community. If there are fewer targets for the virus to jump to, fewer people will get sick. And that means there will be less chance for more virulent variants to develop. Getting the vaccine is an act of love for your friends and family and the larger community.

 

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If you would like to get a COVID-19 vaccine, contact your state or local health department for scheduling.

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Are Video Calls Straining My Vocal Cords?

Updated on Jun 30, 2022 | Ear Nose Throat, Speech Pathology, Your Health

Unless you are a performer or your job requires you to talk a lot, you probably do not give much thought to your vocal health. However, vocal cord damage is more common than you may think as it affects as many as nine percent of adults nationwide. And, experts say the increase in video and phone chatting during the COVID-19 pandemic will only make matters worse.

Sarah Brown, MS, CCC-SLP, a speech-language pathologist at the Grabscheid Voice and Swallowing Center of Mount Sinai, has seen a marked increase in the number of patients with vocal strain or fatigue over the past six months.

“People tend to speak louder on video or phone calls when they think they can’t be heard well. Over time, this can set someone up for a vocal injury,” she explains. “On the other side of the coin, elderly patients who are not talking as much during the pandemic, are losing vocal stamina.”

To help patients prevent vocal cord injury, Ms. Brown explains how the injury occurs and provides tips for proper ‘vocal hygiene.’

What causes injury to the vocal cords?

The vocal cords are two bands of elastic muscle tissue located in your larynx, or voice box, that join together to form a V-shape. These cords, which are about the length of your thumbnail, are constantly at work—they come together and vibrate when you speak and open up each time you breathe.

Like other parts of the body, your vocal cords are prone to wear and tear. The area that is most susceptible to damage is the outer layer of the vocal fold, called the epithelial layer or the muscosa of the vocal fold. When the cords rub together too hard, or for too long, the tissue becomes damaged. The most common vocal cord injury is a benign mucosal lesion—a callus-like growth also referred to as nodule, polyp, or cyst.

Who is at risk of vocal cord injury?

While anyone can injure their vocal cords, it is more common in certain careers.

“Vocal damage can occur anytime you take your voice past the realistic limits of what it can do,” explains Ms. Brown. “It is like when you repetitively lift weights or wear uncomfortable shoes and then develop a callus on your skin.”

Ms. Brown treats many performers, news anchors, teachers, and lawyers who sing or talk all day at work. She also sees a lot of parents with big families and young people who yell or raise their voice often.

How do you prevent vocal cord injury?

If you are at risk of vocal strain, Ms. Brown recommends that you establish adequate ‘vocal hygiene’ by abiding by the following:

  • Use an efficient speaking voice. Adequate breath support allows for your voice to resonate well. Try to avoid excessive glottal fry, also known as vocal fry, especially when projecting.
  • Stay hydrated. Vocalists have a phrase, “sing wet and pee pale.” Drink two to four liters of water each day for optimal vocal health. As a result, urine should be light and odor-free.
  • Limit substances. Do not smoke cigarettes and limit alcohol use as both can dry out the vocal cords, increasing your risk for vocal injury. Excessive amounts of coffee, and other caffeinated beverages, can also lead to vocal dryness. If you are a multi-cup-a-day coffee drinker, make sure you compensate by drinking extra water.
  • Exercise regularly: Cardio and strength training helps maintain stamina. Don’t hold your breath when lifting! Use proper breathing techniques when hoisting weights.
  • Stop behaviors that increase vocal strain. Avoid excessive yelling, screaming, or talking; beware of noisy environments such as bars and restaurants; and limit throat clearing and coughing.
  • Warm up and cool down. Learn exercises to safely start and stop prolonged vocal use such as resonant humming, lip trills, and straw phonation.
  • Take breaks. During peak vocal demand, take six vocal naps—a 15 to 30 minute period of vocal rest—throughout the day.
  • Use appropriate audio set up for video calls. A combination of headphones and microphone will ensure that you can hear yourself and your speaking partner clearly so that you don’t speak excessively loud.

For more vocal health information from Ms. Brown, follow her on TikTok @vocalhealth and Instagram @vocalhealthskb. If you would like to see a medical professional regarding vocal strain or fatigue, make an appointment with the Grabscheid Voice and Swallowing Center of Mount Sinai by calling 212-241-9410.

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