Your Health | Mount Sinai Today

How to Safely Gather With Family and Friends This Holiday Season

Nov 16, 2021 | COVID-19, Your Health

As we enter a second pandemic holiday season, many are comforted by the added protection of vaccines and the widespread availability of reliable testing to combat COVID-19. But the unpredictability of the virus means that we should continue to be vigilant.

Update: The Centers for Disease Control and Prevention (CDC) on November 26, 2021, said the agency is working to learn more about the new Omicron variant. The CDC continues to recommend wearing a mask in public indoor settings in areas where there are high rates of COVID-19, and getting vaccinated and booster shots for those who are eligible. Read more from the CDC.

Krystina Woods, MD, Hospital Epidemiologist, Medical Director of Infection Prevention, and Deputy Chief Medical Officer at Mount Sinai West, explains why it is safer to gather with family and friends this year and offers advice for how to navigate get-togethers that have a mix of vaccinated and unvaccinated guests.

Is it safe to gather with family this holiday season?

This holiday season is a lot safer compared to last holiday season. We have vaccines, which didn’t become available for most of the public until January 2021, as well as a third dose available for those who are immunocompromised, as well as boosters for the elderly, and those with underlying health conditions or who are at high-risk of contracting COVID-19 due to their occupation. Also adolescents and children, even those as young as five years old, are now eligible for vaccination. The increased availability and eligibility of these vaccines adds an extra layer of protection that we didn’t have last year. You may still become infected, but the vaccines increase the likelihood that your symptoms will be mild and there is a lower chance of serious illness and hospitalization.

We also know more about the virus in general, how to treat it, and what we can do to mitigate its spread. Having learned all this definitely puts us in a better place.

There will be a mix of vaccinated and unvaccinated at my holiday gathering. What precautions should I take to keep myself and my family safe?

To the extent that you can, the best thing you can do for your unvaccinated family members and friends is to try to get them to understand how important the vaccine is and to be an advocate for vaccination. The best gift you can give your loved ones is to make sure that they are protected coming into the holidays.

However, that process takes three to five weeks, depending on which vaccine is used, and it is certainly not going to help you in the moment that someone is walking through the door into your Thanksgiving dinner. If you’re inviting somebody into your home, you have to decide the appropriate level risk to yourself and your family, and whether or not you’re willing to assume the increased risk that comes with having someone who is unvaccinated come into your home.

In a post on how to safely date during a pandemic, Mount Sinai pulmonologist Lina Miyakawa, MD, advised asking potential partners the following risk profile questions. They provide a great start in assessing anyone who enters your home for a holiday get-together.

To assess a guest’s risk profile, you can ask them these questions:

How many contacts do you have on a daily basis?
Do you follow the recommendations to mitigate the risk of exposure, like wearing a mask and practicing social distancing?
Do you work in situations with high exposure risk?

The other tangible precaution you can make is to take the festivities outdoors. We have seen that gathering outdoors presents a significantly lower transmission risk than gathering indoors. Unfortunately, this is not always easy in the New York area especially as the weather gets colder, but it would be helpful. Other options include opening up windows to improve ventilation. There are also some filtration units that can be purchased for homes that help facilitate improved air quality indoors. And then, distancing and asking the unvaccinated individual to wear a mask will also help. What you’re looking to do is layer interventions to decrease the risk.

Should an unvaccinated family member get tested for COVID-19 prior to gathering with family and what about a vaccinated family member?

That’s a difficult question to answer. But, I think if I were in a situation where I was going to have a gathering inside my home and I had an unvaccinated adult coming, I would ask them to produce a negative test. I would not mandate that unvaccinated children be tested, but I would strongly encourage it. We know children can spread COVID to adults. For vaccinated family members, testing isn’t essential. But if you’re having someone older or immunocompromised at your holiday dinner, you may want to ask a vaccinated person to get tested, if they work in a high risk setting. For example, if they work in a hospital, grocery store, or some other essential work that interacts with multiple members of the public.

Often times, we can have a false sense of security around negative test results, so I would caution that I wouldn’t necessarily assume a person who tested negative can’t have coronavirus.

It is important to remember that there is an incubation period of two-14 days with this virus. If, for example, your guest receives a negative test on Tuesday, this result does not tell you what their status will be on Wednesday or Thursday. So, if they attend Thanksgiving dinner and start experiencing COVID-19 symptoms on Friday, everyone who they encountered will likely have been exposed to the virus.

Despite this, it would be good to know that at least when that person is entering your home, they are negative. And if they were to be positive, then they would not come. So there is some benefit in testing.

Is masking and distancing necessary while gathering with family?

I encourage anyone who has not been vaccinated to mask. We know that if an unvaccinated person were to be positive, the mask will help to contain some of their virus by physically containing some droplets.

Also, as far as distancing and masking goes, you have to consider the venue and the mix of vaccinated and unvaccinated individuals. If you’re outdoors, the necessity to mask is a lot less—even if you have some unvaccinated guests. If you are indoors, and everyone has been vaccinated and feels well, I don’t feel strongly that you must be masked in that situation.

In short, to make a decision about whether or not you need to distance and mask, think about where the gathering is taking place, the ventilation and air filtration within the space, the risk profile of your guests, and the mix of vaccinated and unvaccinated guests.

How can families maintain safety in the days following a get-together?

I think it’s important to monitor yourself. Not just in the 14-day period following the gathering, but on a daily basis. If you begin to feel unwell, it’s important to stay home and get tested. Because you want to make sure that if you are not feeling well, and if you do end up testing positive, that you haven’t gone on exposing more people than was necessary.

So, just as a general rule of thumb, I think it’s a good thing to check in with how you are feeling. You don’t need to quarantine yourself after gathering with family, but be mindful of how you’re feeling in the days following.

Also, in addition to COVID-19, flu and several other respiratory viruses are starting to circulate. That is only going to ramp up throughout the winter and the holiday season. Many of these illnesses have overlapping symptoms. You should not assume that your sniffles are just a cold, it could be something more. Don’t be overly anxious about it, but if you’re feeling out of the ordinary, consider if you are really well enough to go to work, school, or to socialize.

Is there anything else that people should consider as they gather with family this holiday season?

It is important to stress that vaccines are safe and available for a wide range of the general public, including children as young as five. Everyone who is eligible should be vaccinated. Getting vaccinated will give everyone a level of comfort when they’re visiting family.

There are also a lot of questions around boosters. For people who fall into the categories that the U.S. Centers for Disease Control and Prevention has outlined as who should get boosters, they really should consider getting one coming into the winter season. This is not just to protect themselves as they mix with their family members, but because other viruses are floating around which could adversely affect them. We want to make sure everyone is as healthy as possible.

Can the Light In Your Office Make You Sleepy?

Nov 16, 2021 | Mental Health, Your Health

Do you often feel sleepy or unproductive at work? Poor lighting in your office could be one of the culprits. Whether you have returned to your normal office setting or continue to work from home, it is important to think about the kind of lighting you are using in your office space.

In this Q & A, Mariana Figueiro, PhD, Professor in the Department of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, and Director of the Light and Health Research Center at Mount Sinai, explains how light affects the brain and how exposure to daylight can improve your overall health and mood.

Could the light in my office be making me sleepy?

Yes, absolutely. An office that is too dark can make you feel like crawling back under your covers. That is because light has a profound impact on people.

First, it shifts the timing of your biological clock so that you are in synchrony with your watch. So, when you wake up and open your shades, the light that pours in helps your body confirm that it is seven in the morning and time to get ready for the day.

Second, light has a direct effect on the brain. Similar to a cup of coffee, light makes you more alert. Increasing the amount of light at any time of the day will make you perkier because of the cup-of-coffee effect of light.

During the daytime hours, if you are in a dark room or a low-light level room—like an office with no windows and inadequate lighting—you will tend to be sleepier. To counteract this, I recommend exposing yourself to bright light during the day to both maintain your body’s synchrony with your watch and for the cup-of-coffee effect of light which increases your alertness and makes you less sleepy.

What can I do to reduce fatigue caused by lighting?

While bright light is important during the day, you should avoid being in the direct view of the light source or the light bulb. This can cause eye strain or headaches. Northern exposures from windows will give you the most comfortable light because it provides an indirect light, or diffuse daylight, instead of direct sunlight. That bright, diffuse light is overall more comfortable.

So, to reduce fatigue, increase the amount of diffuse and ambient light and minimize direct pools of light or direct sunlight in the space.

I am a remote worker. What kind of light should I have in my home office?

During the daytime hours you want brighter amounts of light than what you probably have at home. We typically tend to have low-light levels at home, and that is appropriate for the evening hours. But during the daytime, when you’re working, I suggest adding two to four more table or floor lamps near you. This way you’re increasing the amount of ambient light and making your space brighter during the day.

If you can work near a window, specifically a northern exposure window that has daylight (not sunlight) coming in, that is the absolute best light source. It’s bright, it’s the right color, and it’s on at the right time. But if you can’t have daylight, for instance if you are working in a basement, I suggest you use table and floor lamps to brighten up your space.

How does exposure to daylight help regulate my circadian rhythm, or the sleep-wake cycle?

Daylight has a considerable amount of short wavelength or blue light, which is the light that we need to be synchronized with our biological clock. Also, we know that inadequate indoor lighting can make you feel sleepy and, daylight provides a lot of light. For example, on a bright sunny day you get about 50,000 to 100,000 lux [a standard measurement of the amount of light] of daylight, but indoors you probably get 200 to 300 lux reaching your eyes. So that gives you an idea of how much less light we’re getting indoors and how important it is to be exposed to daylight, not only to avoid dozing at work, but to keep your circadian rhythm in synch.

At the Light and Health Research Center, we just finished an interesting study related to this, using “smart” windows in a large building in Reston, Virginia. The smart windows that were installed in the building change the transmittance and the amount of light coming through the windows based on the heat and the sunlight hitting the window. For example, if there’s too much heat or sunlight coming in, the smart windows would reduce the transmittance of heat and light, making it cooler indoors and reducing sunlight coming into the space, which reduces eye strain or other discomfort. As a result, there is no need for window shades and the lights that come in are appropriate for stimulating your circadian system and keeping you alert.

For this study, we compared these “smart” windows to regular, untinted windows with shades. In just one week, we found that people who were exposed to the “smart” window slept better, had fewer feelings of anxiety and depression, and reported feeling more energetic. Daytime light will lead to better nighttime sleep. And when you sleep better, you simply feel better.

I have heard about blue light emitted by my electronic devices. Should I avoid blue light in the evening? Do blue light filters work?

Exposure to blue light is important to keep your circadian rhythm in sync, but too much of this light in the evening can disrupt sleep by suppressing the body’s production of the hormone melatonin. Triggered by darkness, the levels of melatonin in your body typically rise in the evening about a couple of hours prior to your normal bedtime— a signal to your body that it is time to sleep. While daylight is the largest source of blue light, it is also emitted, to a much lesser extent, by florescent lights, LED televisions (the newest sets), and cell phones, as well as computer and tablet screens.

Blue light filters work to a certain extent. We have done some work where we collected data with the iPad Night Shift, which automatically reduces blue light emissions in the evening, and we did see that there is a reduction in the impact on melatonin production, but it’s not perfect.

If you are looking at your cell phone for three hours before going to bed, even with a blue light filter, there will still be an effect on melatonin production. Albeit it’s going to be a smaller effect, but it’s not going to completely take away the problem. It’s better than nothing, so I do recommend using a blue light filter. More importantly, you should also dim down the screen, so that you get less light at your eyes.

Learn more about the Light and Health Research Center at Mount Sinai

Is Your Child Afraid of Getting a Shot From the Doctor? Here’s How to Help Them

Nov 9, 2021 | Children's Health, COVID-19, Featured, Vaccines, Your Health

A trip to the doctor is a common childhood fear. But when kids are afraid of needles, even a simple checkup can cause problems for children and their parents or guardians alike. With the proper preparation and planning, you can help make your next doctor’s visit as smooth as possible, and that’s more important than ever for those getting a COVID-19 vaccine.

In this Q&A, C. Anthoney Lim, MD, the Director of Pediatric Emergency Medicine for the Mount Sinai Health System and the Medical Director of the Pediatric Emergency Department and Pediatric Short Stay Unit at Mount Sinai Beth Israel, explains how you can help calm your child’s fears and ease their anxiety about the doctor’s office and needles. And if needed, how you can talk with your doctor in advance about key issues, including medications that can help reduce the pain. Certified child life specialists and music therapists will also be present at the Mount Sinai vaccination pods to help support children of all ages using play, preparation, distraction and relaxation strategies.

“We have plenty of experience with children who are afraid of injections, so we can work with you and your child to ensure they get immunized in a safe and comfortable manner,” says Dr. Lim, who recently gave his own seven-year-old son the vaccine. “We are creating a very family-friendly space for the COVID-19 vaccine because you will need to bring them back in three weeks for their second shot, so it’s especially important that your child has a positive experience.”

How common is it for kids to be afraid of needles?

It is a very common fear. We see it among children who may have been hospitalized or have chronic illnesses and are in the doctor’s office a lot. But a healthy child without any medical problems is equally prone to needle-phobia.

How can I talk to my child who is afraid of needles?

There are many things you can do to help normalize the process, and it’s important to prepare. A lot of it is knowing your child and if they are at an age that we can talk about their fears. Then, prepare them by having a conversation in advance, letting them know what is going to happen at the doctor’s office and explaining what the process may look like. It can help quite a bit. Not all kids want to talk about it. But they are generally pretty smart, and they will know they are going to the doctor and what they are going for. It’s also worth remembering: Kids will often follow your lead. So if you are prepared and calm, your children will more likely be prepared and calm

Anything more specific?

For younger kids, play can be a really helpful way to prepare for a doctor visit. It provides children the opportunity to approach the event with a sense of control while creating a safe environment to express feelings and to practice coping strategies. One option for younger kids is showing them with their stuffed animal or having them play doctor to get used to what happens when you get your vaccine. For instance, when we were teaching kids how to use masks, we had them make a mask or put a mask on their teddy bear so they can see what it looks like. This is a similar process.

What about bringing something to distract my child?

You can bring a toy to distract them or a doll or plaything they can squeeze really hard. Tablets or smart phones are fine, so make sure your devices are charged. You can bring a cold pack because sometimes that will numb the area a little bit and that is often helpful. There are special cold packs for kids that also include a vibrating tiny bee that can help soothe and distract young children.

Any other techniques?

There are many relaxation strategies that children of all ages can use when feeling anxious and worried. One example is deep breathing—taking deep breaths right before the shot, and then breathing out as the shot is being delivered, can help minimize the discomfort. For younger kids, there are specific positioning techniques you can use, basically a big hug that exposes their arm for the nurse to administer the shot.

What about medications?

Most of the time, approaches that do not involve medications work really well in kids. Prescription medications require a visit or a discussion with your doctor beforehand. There are prescription products, like EMLA or ELA-Max, which are creams that contain a local anesthetic we sometimes use for children for some injections and vaccines. You put the cream on your child’s arm before you go to the doctor’s office because it takes about an hour to kick in. Over-the-counter topical creams are also available.

Is it okay to take over-the-counter pain relievers?

We recommend pain relievers like Motrin or Tylenol but only if your child experiences muscle pain or fevers after they receive the shot, and not beforehand.

How is Mount Sinai helping to make the vaccination process easier for young kids?

At our hospitals, we are setting up special areas for vaccinations for young children. We want to make it a child-friendly, family-friendly environment. We want to make sure that they have a great experience

What should I do if I have more questions?

There are some great resources online, such as from the American Academy of Pediatrics and from the Meg Foundation, an organization that helps families with pain management. A conversation with your pediatrician is very valuable.

Get more information about COVID-19 Vaccination, Appointments and Resources

What You Need to Know About COVID-19 Vaccines for Children Ages 5 to 11

Oct 28, 2021 | Children's Health, COVID-19, Vaccines, Your Health

The moment many parents have been waiting for is approaching: Federal regulators are expected to decide soon whether to authorize COVID-19 vaccines for children ages 5 to 11. Vaccines for kids ages 12 to 15 were authorized in May.

The Food and Drug Administration (FDA) first authorized COVID-19 vaccines for adults in December 2020, and the safety and efficacy of vaccines has been widely discussed ever since. But those with young children still have many questions.

In this Q&A, Roberto Posada, MD, a pediatric infectious disease specialist in the Jack and Lucy Clark Department of Pediatrics at Mount Sinai Kravis Children’s Hospital and Professor of Medicine (Infectious Diseases), and Medical Education, at the Icahn School of Medicine at Mount Sinai, answers some of the questions most commonly asked of pediatricians and explains why the vaccines are extremely safe and highly effective.

How effective is the new Pfizer vaccine for children ages 5 to 11?

The new vaccine is highly effective at protecting children from severe COVID-19 disease. The studies, which included more than 4,000 children, showed children developed essentially the same level of antibodies that result in 90 percent or higher protection in adults.

How safe are they?

The vaccines are extremely safe, the same as with adults. There were minor side effects, such as pain at the site of the injection, fatigue, and headache. Importantly, there were no serious adverse events at all related to the vaccine among the more than 4,000 children that were part of the studies.

What about concerns about rare cases of heart inflammation in young men and boys?

Myocarditis is an inflammation of the heart, and a side effect that has been seen very, very rarely, mostly in young adult males. It was not seen in the recent studies of young children; there were no cases, and although the studies were too small to estimate what the rate might be in the general population of children, we expect it to be lower than in adolescents.

Will children experience any side effects from the vaccine? What can I do about that?

It is very likely that children who receive the vaccine, just like adults and older children, will experience pain at the site of the injection or headache. Those are expected to go away within a day or so. Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be very helpful in managing the symptoms. Parents should follow the guidance of their pediatrician as to how to administer those medications to their children.

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

Anyone who already had COVID-19 should still get the vaccine. That’s because cases of a second COVID-19 infection can happen in people who already had a first infection. The vaccine provides more protection against subsequent infections for people who already had COVID-19.

What are the benefits of vaccinating children ages 5 to 11 against COVID-19?

First of all, vaccinating young children protects them from getting seriously ill from COVID-19. We know that children have a lower risk for developing severe COVID-19 infection compared to adults, but that doesn’t mean they cannot develop severe COVID-19 infection. In fact, as an infectious disease specialist, I have seen children in the intensive care unit with complications of COVID-19. In addition, we know that even if children don’t get very sick themselves from COVID-19, children who have COVID-19 can pass it on to other people—to their parents, their siblings, their grandparents, and to kids and other people at school. So vaccinating children can also protect our community at large, including people that are at higher risk from COVID-related complications.

What if my child is afraid of injections?

It is not uncommon for children to be afraid of injections. Pediatricians have been giving vaccines for decades. Our staff are experienced in working with children who are afraid of injections. They will work with you and your child to make sure your child can get immunized in a safe manner.

Can the vaccine affect the fertility of my child?

It’s a very common misconception that the COVID-19 vaccine can affect fertility. There’s no evidence at all that the COVID-19 vaccine has that effect.

My child is 11 and about to turn 12. Should I wait and get them the adult vaccine?

We recommend that children get vaccinated at the first opportunity. Studies show that children age 11 responded very well to the pediatric formulation of the vaccine.

How do I get more information?

Parents who want to get more information about the COVID-19 vaccine for their children should contact their pediatrician for specific advice.

Your Guide to Some of the Most Common Questions About Breast Cancer Diagnosis and Treatment

Oct 8, 2021 | Breast Cancer, Women's Health, Your Health

There have been many significant advances in the treatment of breast cancer that have helped patients to diagnose cancer earlier and to provide a range of treatment options. But patients still have many questions about what’s best for them.

In this Q&A, Michael Zeidman, MD, Assistant Professor of Surgery at the Icahn School of Medicine at Mount Sinai and a breast surgeon at Mount Sinai Brooklyn, answers some of the most common questions he gets from patients, including why it is critical to get regular mammograms, how doctors determine the stage of disease, and, if you are looking for a second opinion, the importance of visiting a leading medical center such as Mount Sinai.

Michael Zeidman, MD

How do mammograms help patients and doctors?

Mammograms are the only imaging method that’s been proven to save lives. If we go back to the early 1970s, before screening mammograms were widely implemented, the only way that a patient could discover that she had breast cancer is if she felt it. Now that we have the capability to diagnose breast cancer before it becomes symptomatic, we’re catching it much sooner. So it’s not surprising that survival rates have dramatically improved, while at the same time, we’ve been able to significantly cut back on the amount of treatment needed, which results in a better quality of life after breast cancer.

Why is it important not to delay a mammogram because of concerns about COVID-19?

We are only now starting to see the effects of the public’s general hesitancy of getting mammograms during the pandemic. It’s unfortunately increasingly common for patients who were normally very regular about getting their screening mammograms to skip getting one last year, and now they’re presenting to me with breast cancer that’s likely at a later stage than it would have been if it were discovered a year earlier. If there’s one message I want to get across is, come in, get your screening. The sooner we catch this, the sooner we can deal with it, the less treatment you need, and the better your prognosis will be.

How do you determine what stage breast cancer a patient has?

A very common question that I get from patients with a new diagnosis of breast cancer is “What’s my stage?” I explain that I can’t tell you your stage until after surgery. Determining the stage is made up of a three items: the size of the tumor, whether or not the cancer has spread to the lymph nodes under the armpit, and whether or not the cancer has spread to a distant part of the body. The pre-operative imaging does a fairly good job of estimating the size. But we won’t know the precise size of the tumor until it’s been removed. In fact, unfortunately sometimes the imaging can significantly overestimate or underestimate the true size of the tumor. The only way to tell whether or not the cancer has spread to the lymph nodes is to actually sample a few of them during the operation. We do that with a technique called a sentinel lymph node biopsy. In the operating room, we are able to determine if cancer were to spread to the lymph nodes, what are the few lymph nodes that would be the first to receive that cancer. So we identify and remove those nodes. And if the pathologist tells us that there’s no cancer in those nodes, we can safely assume that there’s no cancer in the rest of your nodes.

What do I need to know about the different stages of breast cancer?

Stage one breast cancer means that the tumor is two centimeters or less, and there’s no spread to the lymph nodes. Our goal is to catch breast cancer at this stage, because the five-year breast cancer specific survival from stage one breast cancer approaches 100 percent, which means that nearly all of those treated are alive five years after diagnosis. Also, the amount of treatment that a patient would need with stage one is much less than for later stages. It may result in smaller surgery, and patients at this stage are unlikely to need chemotherapy.
Stage two and stage three breast cancer means that the tumor is larger and it has spread to the lymph nodes. If this is the case, patients need more surgery and are more likely to need chemotherapy. Their five-year breast cancer specific survival is between 80 to 90 percent. This highlights the importance of coming in to get your screening mammogram because even though you may survive your breast cancer with a later stage, you’re going to need a lot more treatment to do so.
Stage four breast cancer is if the cancer has spread to another part of the body, other than the lymph nodes. At this stage, I tell patients that I can no longer cure them of breast cancer. The five-year survival rates drop to less than 30 percent. We can certainly treat it and, depending on how aggressive the cancer is, we can keep the cancer at bay for many years. But this is what we are trying to avoid.

I just had a COVID-19 vaccine. Should I delay getting my mammogram?

You do not have to delay your mammogram if you are receiving the vaccine, but you should make your radiologist aware which arm got the shot. There has been a lot of talk in the news about how the vaccine can mimic breast cancer. This is not entirely true. The purpose of the vaccine is to activate your immune system to produce antibodies that fight the virus. The cells that make these antibodies are located in small organs throughout your body called lymph nodes. The closest group of lymph nodes to where the vaccine is administered is in the armpit. These are called the axillary lymph nodes, and they are the first group of lymph nodes where breast cancer will typically spread. After receiving the vaccine and activating the cells in the axillary lymph nodes, they will grow in size. This may result in the radiologist wanting a closer look at the lymph nodes with an ultrasound to better delineate if these nodes are large due to the vaccine or if they are concerning for cancer.

What is the difference between a biopsy and surgery?

When we talk about a biopsy, we’re mainly talking about a core needle biopsy. This is where we get a small snippet of tissue in the area of concern, as discovered by the imaging. It’s usually done under the guidance of imaging, such as an ultrasound guided biopsy or something called a stereotactic biopsy, which is done under mammographic guidance. Usually the needle biopsy is done before we do the surgery because it helps us guide what type of surgery the patient needs and because it allows us to determine if chemotherapy is the first step, rather than surgery. For surgery, you are actually coming to the operating room and we remove a large area of tissue around the cancer. If we already know that it’s a very large cancer, we may perform mastectomy to remove the entire breast.

If I am looking for a second opinion, why is it important to go a leading medical center like Mount Sinai?

The treatment of breast cancer has become increasingly complex, as we’ve learned more about it, and so it’s now more important than ever to have a team that works in a collaborative way to tailor a specific treatment program for you. The Dubin Breast Center at Mount Sinai is a true multidisciplinary Cancer Center with specialists concentrating on one problem, breast cancer. The facility is beautiful, and that produces a sense of calmness that translates to patient care and to the patients themselves. While I generally recommend that patients go for a second opinion, because of how complex breast cancer treatment is, I think it’s imperative to go to a center where that’s the primary focus, where that’s all they do.

Learn more about the Dubin Breast Center at Mount Sinai

Learn more about the Center of Excellence for Breast Cancer at Mount Sinai

What Do I Do If I Sprain My Ankle?

Oct 1, 2021 | Rehab Medicine, Your Health

There’s a good chance you—or someone you know—has had a sprained ankle. This very common condition comprises about 30 percent of injuries seen at sports medicine clinics. And not just athletes are affected, more than 23,000 people each day seek care for a sprained ankle and half of all sprains seen in the emergency room are unrelated to sports.

Mariam Zakhary, DO, Assistant Professor, Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, and Attending Physician at Mount Sinai-Union Square, explains how to treat this common injury and what to do if you have chronic ankle instability.

What happens when you sprain an ankle?

Ankle sprains happen when you turn, twist, or roll the joint in a way that causes you to stretch or tear one or more of the three thick bands of tissue (called ligaments) that keep our ankles stable. Sprains occur when we misstep and put pressure on the ankle while it is out of its normal position. Often, we sprain our ankle when we walk on an uneven surface, such as a city street, or when we’re running and changing direction. Most sprains affect the ligaments on the outer side of the ankle.

Doctors typically put sprained ankles into one of three categories:

Grade one: You have stretched at least one of your ligaments but there is no tear.
Grade two: You have stretched at least one of your ligaments and have a partial tear in another.
Grade three: You have a full tear in one or more ligaments. You’ve probably also stretched your ligaments. Your ankle will most likely feel unstable with this injury, and will require immobilization with a boot.

What should I do if I sprain my ankle?

It depends on the severity of the sprain. If you can put weight on your ankle, you should be able to do some self-care at home and walk it off. But if it hurts to stand on your ankle, you should be checked out by a doctor as this might indicate that you have done serious damage to your ligaments and ankle, or even broken a bone.

What kind of self-care can I do?

If you have a minor, grade one sprain, there are a few things you can do to heal at home. Try these for a day or two and, if your ankle does not improve by the third day, you should probably see a doctor.

Rest your ankle. The rule of thumb is: if it hurts, don’t do it.
Elevate it. Raise your ankle above your heart, especially at night. This allows you to enlist the help of gravity to drain any excess fluid.
Apply ice. I recommend icing for 20 minutes, every two or three hours for at least the first 48 hours. Then, continue to ice for pain relief as needed.
Use a brace. If your ankle feels unstable, use a brace to hold it in place.
Try compression. Wrap your ankle with an elastic bandage. The wrapping should be snug but not so tight that it hinders circulation.
Take a pain reliever. Use an over-the-counter anti-inflammatory, such as ibuprofen.

How long do I need to stay off my injured foot?

It depends on how bad a sprain you’ve got. As soon as your ankle can bear weight with minimal pain, you can walk on it. But respect the pain; it is your body’s way of communicating with you. If it hurts to walk, don’t. You may find you need to use a walking boot, crutches, or even a wheelchair for a while. If you find it hard to walk after a day or two, make an appointment with a doctor.

How long will it take to fully recover from an ankle sprain?

While a minor sprain can take about two weeks to heal, a severe sprain can take as long as three months. Listen to your body. If you try a new activity and it increases pain, that is your body’s way of telling you that you might be making the condition worse.

When should I see a doctor about my injury?

It’s never a bad idea to see a doctor about a sprained ankle—and the sooner you see one, the better. If you have a minor sprain, a doctor can tell you how to treat it and cope with the pain. If your pain is more severe, the doctor may order an X-ray to get a better idea of what is going on and see if you’ve fractured your ankle or done other damage.

I keep injuring my ankle. What can I do?

When you sprain your ankle, you stretch the ligaments, and these bands of tissue don’t recover their pre-injury tightness even after your ankle has healed. This may lead to chronic ankle instability—a tendency to turn, twist, or roll your ankle with the slightest provocation. Each time you re-sprain your ankle, you stretch the ligaments just a little more. Unfortunately, you can’t strengthen your ligaments, but you can strengthen your secondary stabilizers, which are the muscles around the ankle such as your lower leg and calf muscles.

Also, because repeated sprains may cause even more sprains, it’s not a bad idea to use an elastic bandage, tape, or an ankle brace to keep the joint stable. Many athletes with chronic ankle instability wear braces or use medical or therapeutic tape for increased stability, but the best treatment is to work on the muscles around the ankle.

How do I strengthen the muscles around the ankle?

The key is to strengthen the muscles both on the outside and inside of the ankle. Some of these muscles go all the way up to the knee. You’ll also want to strengthen the muscles in your feet.

One easy thing to do at home is to spell the alphabet out with your foot while seated. This activates the muscles in the ankle and works on conditioning them. When the ankle is more stable, you can start doing single leg exercises. An example of this is standing on one foot and hinging forward to touch an object out in front of you, close to the ground. This forces your ankle to use the surrounding muscles to remain stable. You can also do this single leg exercise as a preventative.

However, the best way to learn the right exercises is to work with a physical therapist.

Make an appointment with Dr. Zakhary

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