A New Yorker’s Survival Guide to the Cold and Flu

Updated on Jun 30, 2022 | Cold and Flu, Your Health

You’re on the bus or subway during your morning commute. A fellow passenger near you starts sneezing and coughing. You eye them suspiciously. Are you at risk for catching something?

Matthew A. Weissman, MD, MBA, of the Mount Sinai Health System offers some street-wise strategies for beating the cold and flu in New York City.

As New Yorkers, we ride subways, buses, and elevators—does that increase our risk or build immunity?

I think it does both those things. There’s data that says being exposed to a lot of germs over time increases your immunity to disease. So in general, people who live in New York are more immune to stuff than people who live by themselves on a farm somewhere.

We’re tough here in New York!

Absolutely. The problem is, there are lots of different types of colds and viruses. And the flu virus mutates and changes every year, so even if you have immunity built up, it doesn’t mean you’re not going to catch something. So yes, we’ve got tough exteriors and a tough immune system, but we’re still at risk of catching diseases.

Should people worry about riding crowded subways and buses? If one person coughs in a subway car, are we all going to get sick?

I don’t think so. A lot of fresh air gets into the subway. Doors open all the time. You’re not in an airtight capsule. You might want to give yourself as much space as possible. And if possible, you might want to alter your commute during cold and flu season to a time or a line that’s not as crowded. It’s also a great time of year to bundle up and walk part of the way to work or school. Enjoy the fresh air! But I ride the subway all the time.

What’s the best way to cover your cough?

People should cover their cough with their elbow, not their hands. Because if you cough into your hand, and then grab onto the subway pole that’s not helping anybody. And part of being a good New Yorker is helping each other by not riding the subway or going to work when you’re contagious, which can last 24 hours after your symptoms and fever go away. On the subway, I’m thinking about airborne germs and picking something up with your hands from the subway pole. So keep your hands away from your face while you’re on public transit, and when you get to work, it’s a good idea to wash your hands (and maybe even to carry some hand sanitizer with you).

Why is handwashing so important?

Handwashing is key. It’s one of the most important things you can do, other than get the flu shot. We come into contact with so many contaminated things in the city. And when you touch your face or rub your eyes, that’s a problem. Of course, you should wash your hands before you eat and after using the restroom. But after your commute, or any time you come into contact with dirty things is a good idea. Frequent handwashing throughout the day is smart. We don’t think about all the things we touch that are frequently handled, like computer keyboards, phones, door knobs, or office kitchen appliances like microwaves or refrigerators. When you go to the gym, you should wash your hands after using the treadmill or using weights. At the salad bar, no matter how clean, the utensils are used by a lot of people. In public restrooms, I try to always use paper towels to dry my hands instead of the air blowers, which tend to just spray germs around.

Use soap and warm water to wash your hands. Twenty seconds of scrubbing vigorously on all surfaces is key. Keeping Purell or another alcohol-based hand sanitizer is good, too. That would be convenient after your commute even though it doesn’t kill all kinds of germs.

Is wearing a mask on the subway effective against germs?

It may reduce your exposure but I think masks are actually more useful in preventing your own germs from spreading, since they’re not really air-tight around the sides. A lot of people don’t use them correctly and keep taking them off or reaching underneath with their hands. Is it worth the trouble? Maybe, but I’m not convinced that it’s as effective or useful as the other things we’ve talked about.

How about cabs and car services like Uber? How risky are they?

You’re probably better off in a cab or ride-sharing service than a subway in terms of avoiding germs. I try to keep the windows open as much as possible. And seatbelt buckles and door handles are more things that are frequently handled that we don’t think about. So minimize touching them and wash your hands after.

What about public restrooms? Are they safe during cold and flu season?

Sure, public restrooms are safe. I use them all the time. I think it’s very hard to get anything from a toilet seat, so laying down toilet paper or sanitary guards isn’t really that helpful. Hand dryers are another story. The evidence is that they just spray germs around. I’d much rather use paper towels, given a choice. And once you wash your hands, opening the door with a paper towel is a good idea.

What about salad bars?

While studies show that salad bars may have bacteria, it is not clear how often they actually cause disease. My suggestions are that you want to have a sense that the salad bar is well maintained. The cold food should be kept cold and the warm food kept warm. Is it being replenished regularly, or has it been sitting there for a long time? Does it have a sneeze guard on top? Of course, you can’t avoid using the serving utensils that lots of other people have touched. So especially during cold and flu season, I make sure that washing my hands is the last thing I do before I eat.

Any other advice for New Yorkers?

Living in New York is stressful, and that’s not good for your immune system. We’ve got emotional stress, we’re rushing, we’re busy, we don’t sleep enough—and all of it takes its toll on our immune system. And then you have our exposure to airborne pollutants. It’s always important to get exercise, to eat healthy including lots of fruits and vegetables, to sleep well at night, and to reduce stress as much as you can.

Matthew A. Weissman, MD, MBA, is Chair of the Department of Medicine at Mount Sinai Beth Israel and Senior Faculty in Internal Medicine and Pediatrics at Icahn School of Medicine at Mount Sinai

Beyond Weight Loss: The Benefits of Intermittent Fasting

Updated on Jun 30, 2022 | Diet and Nutrition, Your Health

New Yorkers are born tough, but not Stone-age tough. Our ancestors were hunter-gatherers who often went periods of time without food while foraging. Humans had adapted to the unpredictability of getting their next meal.

But now we have “evolved” to expect three square meals a day, not to mention snacks.

“Weight loss has become a cultural obsession,” says Jennifer Cholewka, RD, CNSC, CDN, Clinical Nutrition Coordinator at The Mount Sinai Hospital. “And intermittent fasting is a trending topic. But it has roots in how we have evolved as human beings.”

Scientists are discovering that our bodies adapt to intermittent fasting in ways that our ancestors did. And according to a recent article in The New England Journal of Medicine, fasting has health benefits that extend far beyond weight loss. It seems that “when” we eat can be just as important as “what” we eat.

What is intermittent fasting?

With intermittent fasting, there are scheduled times when you eat and times when you don’t. Medical researchers have studied three approaches and shown them to be effective.

Daily time-restricted feeding means narrowing the time you eat to a shorter period of time during the day, usually eight hours. The time that you’re fasting is 16 hours each day. So you might stop eating at 8 at night, and not eat again until noon the next day. After 10-12 hours, your body throws a “metabolic switch” and you start burning through the glucose stored in your body. Your liver stores about 700 calories of glucose, and once gone, your body starts burning away that hard-to-get-rid-of belly fat.

5:2 intermittent fasting means that you eat as you normally do, five days a week. On the other two days, you only eat one moderately-sized meal. The two days that you’re fasting should not be consecutive. And your goal should be one 500-calorie meal on those days. You could work up to this gradually, by starting with one day a week. Your meal on that day could be 1,000 calories. Try that for a month, and then extend it during the second month to two days a week. The next month, reduce your meals to 750 calories. And then the next month, shoot for 500 calories.

Alternate day fasting is the most extreme version. On the days that you eat, keep it to a 12-hour window. Then you will fast that night and not eat anything the next day. It’s important to note that you can drink as much water as you want, and also tea and coffee if you don’t add any calories like milk, half-and-half, or sugar. You can also take vitamins, supplements, and of course, your normal meds. Talk to your doctor though, because certain meds and supplements need to be taken with food. So your plan might be to eat Sunday, Tuesday, Thursday, and Saturday. And then the next week, it would be Monday, Wednesday, and Friday.

What’s the payoff?

As if being svelte wasn’t enough, the benefits of intermittent fasting cited in The New England Journal of Medicine include:
• Cancer prevention
• Cellular and DNA repair
• Diabetes prevention and improvement
• Prevention of heart disease and stroke
• Greater mental acuity and brain health
• Greater muscle endurance

Some of these benefits are related to weight loss. Intermittent fasting increases your metabolism so you burn more calories, and it tends to target fat around the central organs. Belly fat is worse for the heart and causes inflammation. And less cholesterol means less heart disease and risk of stroke.

But once your “metabolic switch” kicks in, there are a host of other benefits. Once your body runs out of glucose, it starts converting ketone bodies from the liver for fuel. And this causes a wave of other changes throughout the body, because ketone bodies aren’t just fuel, they give orders to a variety of other cells and molecules that can affect health.

Scientists have been looking at the relationship between intermittent fasting and cancer in animals for quite a while. Calorie restriction or alternate day fasting has been shown to slow the growth of many tumors and increase their response to chemotherapy and radiation. Studies on humans are promising, but care must be taken to avoid malnutrition. Consultation with your doctor is key.

Another process triggered by the ketone bodies is called autophagy, which repairs the normal cells in the body. It’s like cellular house-cleaning, where the cells get rid of old proteins. Studies on both humans and animals demonstrate physical benefits. In one study, young men who fasted for 16 hours lost fat while maintaining muscle mass over a period of two months of resistance training. Balance, coordination, and endurance all improved in animals during fasting studies.

Brain power gets a boost, too. Verbal memory, spatial cognition, short-term and associative memory are all improved with humans in fasting studies. This is powerful news for the prevention of Alzheimer’s and Parkinson’s diseases. Neurological benefits have also been documented for multiple sclerosis and rheumatoid arthritis.

What’s the downside?

To gain the benefits, intermittent fasting isn’t a quick fix; it’s a lifestyle. Maintaining periods of not eating can be hard to stick to. But starting with a gradual program and working up to longer periods of fasting can help. In the beginning, you can expect to feel hungry, but science tells us that this is as much psychological as physiological. Drinking water when you feel hunger pangs can trick your body into feeling full. You might feel a bit foggy—but good news, black coffee and tea are your friend. And of course, if you’re under any type of medical treatment such as chemotherapy, consult your doctor first.

Throughout history, spiritual literature is full of examples of people who fasted for purification. On the basis of the latest research, it seems that the glow of health is here for modern-day fasters.

Are Natural Remedies Safe to Treat the Cold and Flu?

Oct 25, 2019 | Cold and Flu, Your Health

This year, millions of Americans will develop a cold and 5-20 percent of people will develop the flu. While these viral illnesses differ in severity—the flu can lead to hospitalization whereas a cold generally does not cause serious health complications—the best method of prevention is identical for both. To avoid getting sick, wash your hands diligently and—if you happen to get sick—cover your mouth with a sleeve instead of a hand when coughing to prevent your illness. In addition, everyone six months and older should receive a flu shot.

Once you have contracted a cold or flu, are over-the-counter or prescription medications always the best treatment method? Natural remedies—non-medicinal treatments that include vitamins, herbs and herbal supplements, and alternative treatments like acupuncture—may be adequate. Lee Coleman Hinnant, MD, a family medicine physician at Mount Sinai Doctors-Stuyvesant Town, explains when natural remedies are acceptable alternatives and when conventional medicine is the best bet.

What natural remedies can I use to treat a cold?

Zinc lozenges taken within 24 hours of cold symptoms may reduce the duration of a cold in adults. The effectiveness has not been proven in children. While effective for colds, zinc should not be taken long-term due to potential drug interactions and gastrointestinal side effects. Intranasal zinc should not be used as there is a risk of a permanent loss of smell.

Honey may be helpful in reducing nighttime cough in children and adults. It should never be used in children under one due to a risk for botulism.

Keep in mind that while these remedies may be effective in treating your illness, most colds are minor and will resolve within a week.

Since the flu can cause more severe symptoms, is it ever appropriate to treat naturally?

No. No natural or herbal remedies have been proven effective for the flu. The flu can land you in bed for a week or more with fevers, aches, and a severe cough. Within the first 48 hours of these symptoms, you should be seen by a doctor, as you may be a candidate for an antiviral medicine such as Tamiflu which can lessen the duration and severity of the illness.

What other natural remedies have been proven effective?

Studies show that meditation as a daily practice reduces the number of colds and their duration. This is mainly because meditation reduces stress which suppresses the immune system, making you more susceptible to illness. Exercise is also effective in this manner, but less so than meditation.

In healthy people, several studies showed that probiotics may reduce the number of colds a person contracts per year. Patients with health conditions should consult a physician before taking probiotics as there is a potential risk for infections.

Are there natural remedies that have been proven ineffective or harmful?

Yes. Vitamin C has not been proven helpful in the general population for cold prevention or treatment; however, it has been proven to reduce colds in half for those who pursue strenuous exercise like marathons or skiing.

Echinacea, which has commonly been used for cold prevention, is likely safe, but has not been proven effective.

American ginseng may reduce the duration of colds, but it needs to be taken daily over long periods of time and may cause side effects like interfering with blood thinners, so it is generally not recommended.

Lee Coleman Hinnant, MD

Assistant Professor, Family Medicine, Icahn School of Medicine at Mount Sinai

Dr. Hinnant is a family medicine physician at Mount Sinai Doctors-Stuyvesant Town with a specialty in Integrative Medicine and Functional Medicine.

Make an appointment with Dr. Hinnant

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If you remain ill after getting your flu shot or trying these natural remedies, please consult a physician. Mount Sinai Doctors-Stuyvesant Town cares for the whole family and is currently welcoming new patients.

Make a Mount Sinai Doctors Appointment

What is a Free Flap?

Oct 15, 2019 | Health Tips, Your Health

Patients who are diagnosed with cancer of the head and neck are often treated with surgery. Removal of tumors in the mouth and the throat can significantly inhibit speech and swallowing. Similarly, removal of the bone involved with cancers of the jaw affects appearance and function of patients. In some cases, the wounds, left as a result of cancer surgery, can be allowed to heal or be covered with the surrounding tissues. Often, however, the wounds are too big, and the tissue removed with the tumor must be replaced. In such circumstances, a “free flap” may be a sound option for repairing the defect.

Local Flaps Versus Free Flaps

A flap is any piece of tissue that is moved to cover a wound. A free flap is a piece of tissue that is disconnected from its’ original blood supply, and is moved a significant distance to be reconnected to a new blood supply. Let us use a lamp as an example. When a lamp has to be moved from one part of the table to another it may not need to be unplugged. This is similar to a “local” flap that is “rotated” into the wound. The electric cord is analogous to the blood vessels delivering blood to the flap. When the lamp must be moved from one side of the room to another, the cord cannot stretch the required distance. In these cases the lamp is unplugged (“free”), brought to its’ new location and plugged into another outlet.

Similarly, a free flap is taken from the body of the patient; the blood vessels that bring the blood in and out of the tissue are cut, and then reconnected to another source of blood (usually in the neck). The artery that comes with the flap is sewn to the artery in the neck to bring the blood in, and the vein is sutured to a vein in the neck, re-establishing the blood flow. The blood vessels feeding the flap are usually very small and the “re-plugging” of the flap is done through microvascular surgery. Microvascular surgery is a technique of sewing two small blood vessels together under a microscope.

The surgeon has to select tissue in the body that will do the best job of restoring the function and the appearance of head and neck tissues destroyed by the tumor. The commonly used free flaps include: forearm or thigh skin (thin skin that can be used to rebuild the inside of the mouth and throat), muscles from the abdomen or the back, and fibula bone (bone on the outer side of the leg).

The success of using a free flap in reconstruction after head and neck cancer surgery is 95-98 percent. The goal of the reconstructive surgeon is to return the patient to a state where they can enjoy eating, swallowing and speaking. With the advancements in the field of microvascular and reconstructive surgery, this goal is often achieved.

Mohemmed Nazir Khan, MD

Assistant Professor, Department of Otolaryngology at Mount Sinai-Union Square

Dr. Khan’s clinical interests and expertise include the medical and surgical management of benign head and neck tumors; thyroid and parathyroid disorders; salivary gland disorders; head and neck cancers; and reconstructive surgery involving the head and neck. In addition to his professorship, he is the Associate Director of the Head and Neck Cancer Research Program at the Icahn School of Medicine at Mount Sinai. Dr. Khan is available for rapid referrals and same day appointments.

Make an appointment with Dr. Khan

More information on ENT services at Mount Sinai

What Does a Brain Tumor Feel Like?

Oct 1, 2019 | Featured, Neurosurgery, Your Health

After ignoring seemingly harmless symptoms for at least a year, Emmy-nominated producer Jeannie Gaffigan was diagnosed by a medical team at The Mount Sinai Hospital with a pear-shaped brain tumor. The large mass was severely compressing her brain stem, causing headaches, dizzy spells, and a loss of hearing in one ear. She had attributed the symptoms to being a busy working mom. Her doctors wondered how she was even able to walk or talk normally.

The Neurosurgery team at Mount Sinai, headed by Joshua B. Bederson, MD, Professor and Chair of Neurosurgery for the Mount Sinai Health System, quickly scheduled surgery to remove the life-threatening mass, which turned out to be benign (non-cancerous).

Read more about Jeannie Gaffigan’s story

Ms. Gaffigan’s case sheds light on the importance of paying attention to persistent symptoms. But not every dizzy spell is cause for concern.

Leslie Schlachter, PA-C, Clinical Director of Neurosurgery at The Mount Sinai Hospital, works closely with Dr. Bederson and was there to greet Ms. Gaffigan and her husband, comedian Jim Gaffigan, when they arrived looking for answers. Drawing on the numerous cases she has seen over the years, she explains which symptoms you should never ignore and why you are—probably—fine.

What specific symptoms may point to a brain tumor?

The brain is complex. It controls everything we do, allowing us to see, smell, and move. Because of this, symptoms of a brain tumor depend on where the tumor is located and what section of the brain it is pressing on. Generally, changes in your sensory, motor, or visual function that linger for more than a few days need to get checked. For example, if you have played tennis every weekend for the past twenty years and one day you cannot hold your racquet; that is a problem. Or, if you suddenly cannot see well out of your right eye, that is concerning.

I experienced dizziness for a few days last month. Should I check in with my doctor?

Nausea, vomiting, or a change in balance that lingers and does not respond to medicine warrants a visit to your doctor, especially if these symptoms are limiting your ability to function. Keep in mind: if you have a neurological condition, things are not going to get better. So, if your symptoms subside after a few days, there is likely no cause for concern.

Should I go to the emergency room if I am concerned? Will I seem like a hypochondriac?

If you are concerned, make an appointment with your medical provider first, whether that be a doctor, nurse practitioner, or physician assistant. I always tell people, you are going to get a cold, the flu, and food poisoning, and you may feel terrible. That is normal. However, if you are experiencing symptoms that progressively worsen and do not go away, call your medical provider. Not seeking medical help is the problem.

The only time you should panic is if you are having what I call “The Worst Headache of Your Life.” If your headache is so severely debilitating that all you want to do is sleep because you feel as though your head is going to explode, seek medical assistance immediately as you may have a brain bleed.

What happens if my doctor is concerned about my symptoms? Will I see a neurosurgeon right away?

No. If your medical provider is concerned about your symptoms, he or she may recommend a CT scan or, depending on your symptoms, refer you to an ear, nose, and throat specialist or neurologist. You will only see a neurosurgeon if you have been diagnosed with a neurosurgical condition that requires intervention.

What should I do if my doctor is not taking my symptoms seriously?

Unfortunately, there are times when a patient’s concerns are not heard. And sometimes, your doctor may chalk up your symptoms to stress. The most important message I can give to patients is: Advocate for yourself. You know your body. If something does not feel right, get a second opinion.

Learn more about Neurosurgery at Mount Sinai

I Am An Adult. Do I Still Need Vaccinations?

Updated on Jun 30, 2022 | Your Health

Recent measles outbreaks, which have disproportionately impacted New Yorkers, feel like an unforced error. Although the measles/mumps/rubella (MMR) vaccine has been available for more than 50 years, the highly contagious illness has landed dozens in the emergency room. Time and science has proven that vaccines are safe and effective, but there are still many misconceptions.

While most of the measles cases in the current outbreak in New York City are among children who were never vaccinated, 10 percent of confirmed measles patients are among those who had previously received a dose of the MMR vaccine, according to the New York City Department of Health and Mental Hygiene. Because the immunity conferred by the vaccine can wear off over time, this has prompted adults to seek another round of vaccinations that were previously completed in childhood. Erick A. Eiting, MD, MPH, MMM, Associate Professor, Emergency Medicine, Icahn School of Medicine at Mount Sinai, explains why some adults need “booster” vaccinations and which shots you may want to discuss with your primary care physician.

What is a “booster” and why might I need one for a childhood vaccination?

Booster shots are additional doses of a vaccine that was previously administered. Adults may need to “boost” their immune system so that they are adequately protected from an illness. The need for a booster shot depends on the person and the vaccine. Certain vaccines may be needed before international travel or after reaching a particular age. People who work in health care may need booster shots because they are exposed to certain diseases more frequently and need the extra protection.

Do I need a booster shot for measles?

If you have proof of immunity to measles, you don’t need a booster. Proof of immunity includes one of the following:

Written documentation of two doses of the vaccine during childhood
Lab tests that show enough measles antibodies in your blood
Lab tests confirming an actual measles infection
Being born before 1957

If none of the above applies, talk to your doctor about getting an additional dose of the vaccine. People with higher risk of getting measles (health care workers, for example) should get two doses.

What other booster shots may be needed as an adult?

In addition to MMR, you may need an additional vaccination for hepatitis A, typically a food-borne illness, and hepatitis B, transmitted through infected body fluids. Both illnesses can cause severe liver damage. Health care workers are usually required to get the hepatitis B vaccine, and the hepatitis A vaccine is often encouraged before international travel.

Booster shots are also required for the tetanus/diphtheria/pertussis (Tdap) vaccine. This combination vaccine protects against tetanus, diphtheria, and pertussis (whooping cough). It needs to be updated every 10 years, although health care workers may be required to do so more frequently, and you will receive a booster if you get a cut that lands you in the emergency room.

Which other illnesses should I be vaccinated against?

In addition to your annual influenza vaccine—which should be received by healthy people starting at six months—speak to your primary care physician about the following:

Shingles. Adults over the age of 50 who have previously had the chickenpox should be vaccinated against this painful rash. Shingles comes from the same virus as the chickenpox and can flare up when the immune system is weakened, including during times of increased stress, following physical trauma, and while fighting a disease like cancer or HIV.
Pneumococcal diseases. Smokers over the age of 19 and adults over 65 should be vaccinated against this set of conditions. The vaccination protects against pneumonia (infection of the lungs), meningitis (infection of the tissue covering the brain and spinal cord), and bacteremia (infection of the bloodstream).
Human papilloma virus (HPV). First introduced in 2006, this vaccine protects against HPV 16 and 18—the strains most associated with cervical cancer. Previously, the vaccine was only approved for those up to 26; however, the U.S. Food and Drug Administration recently approved the vaccination for people up to age 45.

Erick A. Eiting, MD, MPH, MMM

Associate Professor, Emergency Medicine, Icahn School of Medicine at Mount Sinai

Dr. Eiting is a tireless advocate for vulnerable patient populations. He has focused efforts on improving access to care for incarcerated patients using innovative care models and medical technology. In previous roles, he has used telemedicine to expand access to specialty care as well as to help triage patients with same day needs.

Visit a Mount Sinai Urgent Care location

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