Should I Wait to Have My Child’s Vision Checked?

Oct 26, 2020 | Children's Health, COVID-19, Ophthalmology, Your Health

This academic school year—in addition to the usual school supply lists and purchasing of new shoes—parents must think about COVID-19 positivity rates, appropriate face coverings, and reliable in-home internet access. Whether your child will be learning in the school room or remotely, their eye health is important and should not be overlooked. Douglas R. Fredrick, MD, Professor of Ophthalmology and Pediatrics at the Icahn School of Medicine at Mount Sinai, explains what parents need to know about their child’s vision.

Should I wait until after the COVID-19 pandemic to get my child’s vision checked?  

Please do not delay having your children examined. It is important to make sure their vision is sharp and their eyes are healthy. Most of our sensory connection to the world is through our eyes. Children who do not see properly can have difficulty developing academically and socially. If we catch and correct vision problems early, we can improve children’s day-to-day life and functioning in school. We can also detect eye conditions that could lead to further problems down the line.

While COVID-19 is still of great concern,  Mount Sinai Health System has gone to extraordinary lengths to make sure every patient receives the best possible care in a safe environment. We have developed stringent protocols to protect your family and our community. For instance, face coverings are mandatory and social distancing is enforced throughout the Health System. Additionally, we disinfect continually and regularly test our staff for COVID-19.

How often should I have my child’s eyes checked?

The American Academy of Ophthalmology and the American Academy of Pediatrics recommend that pediatricians and family practitioners examine the eyes and check vision in newborns, age two months, six months, one year, then annually until age six, then every other year until age 18. Most pediatricians check vision every year during their annual exam, and many school districts perform screening each year, beginning at age five or six.

What are the signs that my child has vision issues?

If you notice your child squinting or tilting their head to see objects that are far away, rubbing their eyes after reading, or if their eyes drift toward the nose or outward—as though they are trying to see their ears—you should schedule an appointment with your child’s pediatrician for a vision exam. The same is true if your child complains about fuzzy or foggy vision. I also recommend that parents check in with their child’s teacher as they may see vision impairment related behaviors in the classroom.

My child is struggling with vision issues. How can I help?

The first step is to see your child’s primary care provider who will check for any other health conditions that may be contributing to your child’s difficulties. If the pediatrician finds decreased vision on a screening exam or has any other concerns, they will refer you to a pediatric ophthalmologist. These ophthalmologists have additional training in caring for children and often have specialized equipment and child-friendly offices.

During the examination, the ophthalmologist will do a thorough exam of your child’s eye—probably using dilating eye drops. If the doctor finds that your child is nearsighted or has another vision issue, they may prescribe glasses. If the examination is completely normal but your child is still having a problem with reading or learning, your primary care provider may refer you to an educational specialist or school learning specialist to test for learning disorders and make recommendations.

My child will be learning remotely this school year and I am concerned about eye strain. I’ve heard that blue light glasses can help with this issue. Is this true?

Blue light glasses are special eyewear that block or filter the high-energy blue light coming from computer, tablet, and phone screens. It is not clear that they help with eye strain or eye disease. A recent study performed at the State University of New York School of Optometry found that these glasses did not decrease eye strain with “near work”—activities that require near vision such as reading, writing, and watching television.

While it won’t hurt to use these glasses, there are better ways to reduce eye strain. For instance, have your child hold their reading material, laptop, or tablet at the appropriate distance and make sure they have enough light to see—but not so much it causes glare on the screen. It can also help to have your child take breaks every 20 to 30 minutes when they are doing screen work. I recommend giving your child a task that gets them on their feet and their eyes off the screen, like feeding your pet or taking out the trash.

Should I limit how much time my children spend on screens?

All children will be spending more time with their eyes on the screen this year than in the past and that is going to make it hard to limit screen time to the typical recommendation of two hours a day. This year, instead of enforcing strict limits, try to keep track of what they’re doing with their screen time. Although most of their screen use should be educational, you’ll need to allow time for play—both to relax and to enable them to have social time with friends. Physical activity should also be a part of their daily routine. The key is finding a balance. For more on how—or whether—to limit your child’s screen time, read this blog post from Mount Sinai pediatrician Micah Resnick, MD.

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Is It Safe to Seek Screening and Treatment for Breast Cancer During the Pandemic?

Oct 19, 2020 | Breast Cancer, COVID-19, Your Health

Managing breast cancer screening and treatment can be worrisome in the best of times. During the COVID-19 pandemic, you may be even more uncertain. Elisa Port, MD, Director of the Dubin Breast Center of The Tisch Cancer Institute at Mount Sinai, answers some of your questions.

I’m due for my annual mammogram but I’m scared of getting COVID-19. Should I delay until there’s a vaccine?

At the height of the pandemic in New York City, we were not recommending women come in for screenings. We asked women seeking elective care and routine follow-up appointments to wait. But the number of cases in New York has dropped dramatically, and we have instituted stringent protocols making our hospitals and medical facilities extremely safe. We hope everyone will get back on track with routine screening tests, including mammograms.

I feel a lump in my breast. Should I get it checked out or wait and hope it goes away?

Any woman who thinks she might have a lump in her breast should get it checked out. While many lumps are benign, women of all ages and backgrounds can get breast cancer. It’s important not to dismiss your concern and assume a lump will go away. I recommend that you make an appointment with your primary care physician to receive a full evaluation. Your doctor might perform a physical exam and order imaging tests such as mammograms or ultrasounds or even a biopsy.     

I successfully completed my breast cancer treatment. Am I immunocompromised and at increased risk of developing COVID-19?  

A history of breast cancer does not increase your risk of contracting COVID-19 and neither does receiving cancer treatment—including hormonal therapies and other medications. However, women who are actively receiving chemotherapy and who are immunocompromised, may be at higher risk. The signs of COVID-19 are generally the same for breast cancer patient as they for anyone else. At Mount Sinai, we screen everyone coming into our facilities for issues such as fever, cough, and travel from an area with a high positivity rate (“red zone”).

I’m feeling stressed because of the pandemic. Do you have any suggestions on how to cope?

Stress management is very personal. Coping mechanisms, too, are very personal. The most important thing is to make sure that you don’t spiral into negative behaviors, such as overeating or drinking too much. Try to find healthy outlets for your stress. That can include physical activities like walking your dog or exercising; social activities such as spending time with friends and family; or doing things that bring you joy, like reading, listening to music, or playing a musical instrument. For more on how to cope during the COVID-19 pandemic, read this article on resiliency featuring Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai.

Do you have any other thoughts about breast health?

Remember that breast cancer is an extremely treatable and curable cancer—and early detection and diagnosis are key to successful treatment. The best way to find a cancer early is by getting regular screenings. Starting treatment when a cancer is in the early stages is most effective as it can also mean using less aggressive treatment.

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I Think I Have a Sinus Infection. What Should I Do?

Oct 15, 2020 | Ear Nose Throat, Urgent Care, Your Health

Each year, nearly 30 million Americans are diagnosed with a sinus infection. Commonly referred to as “acute sinusitis,” sinus infections occur when inflammation of the lining of the nose and sinus cavities develop. As one of the most common illness in the country, they are a very frequent reason for patients to seek urgent medical care. In this Q & A, Catherine Spaulding, MD, a physician at Mount Sinai Urgent Care, explains how to identify a sinus infection and how best to treat your symptoms.  

How do I know if I have a sinus infection?

Look for the common symptoms such as a runny or congested nose, headaches, as well as pain and pressure in the sinuses — which are located above and below the eyes and on either side of the nose.

Frequently, sinus infections also cause a sore throat and coughing that is worse at night or the first thing in the morning. This is caused by post nasal drip and occurs when mucus drains down the back of the throat—most common when lying flat—resulting in  irritation of the throat, a scratchy or hoarse voice, and/or a cough.

Symptoms of a sinus infection typically last between three to ten days.

What causes acute sinusitis?

The large majority of cases of acute sinusitis are caused by viruses similar to those that cause the common cold. Inflammation of the sinuses from other triggers can also result in similar symptoms to that of a virus such as  environmental allergies, smoke, or dry air, as well as extreme changes in pressure that can occur when scuba diving or on an airplane. Additionally, patients with abnormal nasal anatomy, such as a deviated septum or nasal polyps, are at increased risk of developing an infection.

How do I tell the difference between COVID-19 and a sinus infection?

Distinguishing between COVID-19 and a sinus infection can be difficult since both can cause nasal congestion, a sore throat, headaches and sinus pain or pressure.  However, COVID-19 is more commonly associated with a fever, cough, body aches, chills, chest tightness, shortness of breath and occasionally with diarrhea. It is best to share all of your symptoms with your doctor to help determine if you should be tested for COVID-19.

Do I need to take antibiotics to get rid of my sinus infection?

Typically, no. While antibiotics are useful in treating bacterial infections, they are powerless against viruses. Taking antibiotics when they are not necessary or indicated can lead to resistant bacterial infections and unwanted medication side effects. Because of this, it is important to discuss whether an antibiotic is really needed when treating any infection.

Only around two percent of sinus infections are caused by bacteria. However, there are several instances in which your doctor might recommend antibiotics for treatment. This includes:

  • If your symptoms persist beyond 10 days without any improvement
  • If your illness worsens after day seven
  • If you have fevers with a temperature greater than 102 F at the start of symptoms
  • If you have a history of immunocompromising conditions—such as cancer, a history of an organ transplant, poorly controlled HIV or an immunodeficiency —or use of immunosuppressant medications—such as high doses of corticosteroids or  chemotherapy
  • If you have undergone sinus surgery
What should I take to treat my symptoms?

Like the common cold, most sinus infections will go away on their own. Treatment  should be aimed at relieving congestion in the nose and sinus passages. Doing so not only improves symptoms of the infection but reduces the possibility of developing a secondary bacterial infection. Here are some things to try at home:

  • Rinse your nasal passages with saline. Use a nasal saline rinse or spray twice daily to remove the mucus from the sinus cavities. This will allow you to breathe much easier.
  • Use a nasal steroid spray. After rinsing out your nose with saline, use a nasal steroid spray such as Fluticasone—one spray in each nostril twice daily— to reduce post nasal drip and congestion.
  • Try an over the counter decongestant. Medications such as pseudoephedrine provide additional help in relieving your stuffy, runny nose. But keep in mind that pseudoephedrine is a mild stimulant that can cause insomnia, so avoid taking right before bedtime. Additionally, it can raise your blood pressure so those with hypertension should not take this and should try Coricidin instead.
  • Use a bedside humidifier. Running a humidifier while you sleep can help to moisten the nasal passages and throat which will improve the flow of mucus by thinning it . If you do not have a humidifier, try taking a steam shower before bed for the same effect.
  • Take preventative measures. If you have a history of seasonal allergies, consider starting a daily antihistamine to prevent inflammation and mucus production.

If you suspect that you have a sinus infection and would like to speak with a doctor about your symptoms, schedule a walk in or virtual appointment with a Mount Sinai Urgent Care physician. 

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October Is Breast Cancer Awareness Month

Oct 9, 2020 | Your Health

One in eight women will be diagnosed with breast cancer at some point in their lives. Early detection is key to surviving this disease.

For interesting facts about breast cancer, check out our October Breast Cancer Awareness Month Facts of the Day. A new fact will be added every day. Also follow the hashtag: #BreastCancerFact.

Finding breast cancer early maximizes treatment options and improves the likelihood of a good outcome. Screening mammography on a regular basis is the best way to find breast cancer before symptoms appear.

Mount Sinai offers a mobile mammography program that brings diagnostic technology to all five boroughs of New York City. Our goal is to help all women 40 and over get annual screening mammograms.

We want to catch breast cancer as early as possible, when it can be most easily treated. Talk with your health care provider and schedule your mammography at one of our convenient locations or through our mobile mammography service.

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My Child May Have Trouble Hearing. Will Remote Learning Hurt Their Progress in School?

Oct 8, 2020 | Children's Health, COVID-19, Ear Nose Throat, Your Health

This academic year, many children have returned to school virtually. While remote education may be a safer option for some, it is not without its drawbacks—particularly for children who are hearing impaired.

Enrique R. Perez, MD, MBA, an expert in managing adult and child’s hearing disorders and Director of Otology at The Mount Sinai Hospital, provides advice for parents who are concerned about their child’s hearing when learning remotely.

What are the signs my child may have trouble hearing?

To figure out if your child has hearing issues, I recommend that parents or guardians ask themselves a series of questions:

  • Do you find yourself raising your voice or calling out your child’s name several times before they respond?
  • Is your child not startled by loud noises?
  • Do you notice that your child often turns their head or shifts their body position when listening to others or the TV?
  • Does your child raise the volume on the television, computer, or their phone to an uncomfortable level?
  • Is your child struggling with academic work?
  • Is your toddler not learning to speak at the expected rate?
  • Does your child have a history of recurring ear infections?

If the answer to any of these questions is yes, your child may be struggling to hear. Pediatricians often perform routine screening for hearing loss and they may be able to uncover even subtle degrees of hearing loss.

I am concerned about taking my child for a check-up during the COVID-19 pandemic. Can I delay their hearing exam?

Deciding whether to seek medical care during the pandemic can be difficult, but delaying care always comes with some risk. Delaying a hearing check-up is especially worrisome for children with significant hearing loss who are not being aided with a hearing aid or other hearing device. This is true for children of all ages. Young children, learning to speak may experience delays in achieving appropriate communication milestones, and those who are speaking well but cannot hear properly may fall behind in school. Studies have shown that these setbacks may be irreversible and may limit your child’s academic achievement.

However, I understand the concern, especially if your child has a condition that makes them more vulnerable to COVID-19. Fortunately, most healthcare facilities follow strict guidelines to screen for and minimize the risk of contracting the virus. If you are apprehensive, I suggest that you contact the facility and ask about their protocols.

How can I help my child who is struggling with hearing issues?

The first step in helping your child is to schedule a proper evaluation by a doctor. You might start with your child’s pediatrician, who can screen for hearing issues, and then, if appropriate, can refer you to a specialist for diagnosis and treatment.

Additional ways that you can help a child struggling with hearing issues include:

  • Minimizing background noise when you are speaking to your child.
  • When talking to your child, face them directly and speak slowly and clearly. Try not to shout as that can distort your speech and make your child feel uncomfortable.
  • Make sure your child’s teachers and school are aware of your child’s hearing issue so that they can help.
  • Address any insecurity your child may feel regarding their hearing issues as stigma could prevent them from using devices, such as hearing aids. You want to help your child to be comfortable and confident when used a hearing assistive device, especially during these formative years.

How should I set up my child’s space for remote learning?

Remote learning can create new challenges—and some opportunities—for educating children with difficulty hearing. With the proper set-up and equipment, remote learning may be easier than in-person schooling for a child with hearing difficulties.

The first step is to give your child a quiet area in the home for schooling. They will also need a computer with a reliable internet connection and the ability to adjust the volume.

A strong, stable connection enables your child to see the teacher clearly. Importantly, it allows them to see visual cues—such as facial expressions—which are important communication tools for everyone, especially those with hearing loss. And, being able to adjust the volume enables your child to mute other students, allowing them to focus on the teacher. Your child may also benefit from using headphones, including noise cancelling ones, which are normally not allowed in a classroom.

How else can I help my child with remote learning?

I encourage parents and guardians to build a relationship with their child’s teacher. Often, teachers are the first to notice that a child may be struggling to hear. But fostering a connection with your child’s teacher may be easier with in-person schooling than remote learning. Additionally, it helps to stay involved with your child’s education so that you don’t miss any of the early signs of hearing loss that could compromise their ability to learn.

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Why Cancer Screenings are Important and How to Talk about them with your Doctor

Sep 29, 2020 | Your Health

While we are making significant strides in treating cancer, the fact is that no one is immune, and that is why regular cancer screenings are so important.

Regular screenings are recommended for a number of the most common forms of cancer, and they can be critical in detecting cancers at earlier stages, thus improving the possibilities for treatment.

“We know the best way to treat cancer is to actually diagnose cancer earlier,” says Kai Tsao, MD, a cancer specialist who is Medical Director of the Ruttenberg Treatment Center at The Tisch Cancer Center at Mount Sinai, and Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai.

One more important point: Cancer screenings are typically recommended by your primary care physician. So now that many may have delayed seeking medical dare during the COVID-19 pandemic, it can be especially important to talk with your doctor about these screenings.

In this Q&A, Dr. Tsao explains what you need to know about cancer screenings and some of the things to discuss with your doctor.

Why are cancer screenings important?

The earlier we find cancer, the better chance we have for more effective treatment, leading to better outcomes for patients. We have witnessed, with the implementation of cancer screenings for at-risk populations, a significant decrease in cancer deaths over the past decades. Without appropriate screening, patients will only begin appropriate treatments when they begin to experience symptoms, and by then a higher percentage of these diagnoses will be more advanced cancer. With effective screening, we are seeing what we call a “stage migration,” with more patients being diagnosed in early stages of disease rather than more advanced cancer.

How can I learn more about screenings?

Education campaigns and resource groups supported by the government and philanthropy (such as the American Cancer Society) have led the effort in promoting cancer screening to the general public. Importantly, patients can learn about screenings by engaging their primary care physician to discuss what type of testing may be appropriate.

What if I am still concerned about the safety of visiting the doctor during this pandemic?

At the Ruttenberg Treatment Center at The Mount Sinai Hospital, we have developed a number of measures to mitigate COVID-19 risk for patients, including both remote and onsite screening for all patients and visitors. We have a strict visitor policy to minimize the volume of visitors on site. We also require everyone, including our staff, to wear a mask at all times, and to maintain appropriate social distance. Similar measures have been implemented throughout the hospital. Patients should feel comfortable while receiving their health care here at The Mount Sinai Hospital.

How do I know which cancer tests I need?

A number of guidelines, based on the type of cancer, have been accepted as a standard to guide cancer screening. Currently, most practitioners rely on the recommendations of the U.S. Preventative Services Task Force, an independent panel of national experts in primary care, disease prevention, and evidence-based medicine. However, appropriate cancer screening requires a conversation with your doctor who can gather the most accurate information and consider a number of other personal factors, such as your age, prior medical history, family history of cancer, and possible genetic test information. It’s important to note that testing recommendations can change over time.

What are some of the most common cancer screenings?

In the United States, the most common cancer screenings that have been established are for breast cancer (breast exam and digital mammography), cervical cancer (Pap smear and HPV testing), colorectal cancer (stool testing and colonoscopy), lung cancer (Computed tomography (CT) scan of the chest), and prostate cancer (prostate exam and PSA). There are many factors that can change the timing and frequency of cancer screening beyond the established guidelines. For example, having a family history of prostate or breast cancer may require appropriate genetic counseling or testing, and earlier or more frequent cancer screening. It is important to know that every decision for cancer screening should be a shared one, between the patient and the doctor, to review the risk and benefit of the agreed approach.

People generally do not like to talk about cancer. What overall advice would you offer?

First, it is important to understand that cancer can occur in any age group, and maintaining routine health checkups with your primary care physician is essential. During such visits, use this opportunity to discuss whether cancer screening is appropriate for you. This is particularly important now given the ongoing COVID-19 pandemic, as delayed care will lead to worse outcomes. So make sure you continue to communicate with your primary care provider. That could be a telephone call, a video visit, or an office visit. That will ensure you continue to get the appropriate care to maintain your health.

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