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Awards Recognize Mount Sinai’s Commitment to Quality Stroke Care

Updated on Jun 30, 2022 | Featured, Your Health

Six Mount Sinai Health System hospitals—Mount Sinai Beth Israel, Mount Sinai Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai St. Luke’s, and Mount Sinai West—have received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award.

The award recognizes each hospital’s commitment to ensuring that stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines that are based on the latest scientific evidence.

Each of these Mount Sinai Health System hospitals earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period.

“We are pleased to recognize so many Mount Sinai Health System hospitals for their commitment to stroke care,” says Eric E. Smith, MD, national chair of the Get With The Guidelines Steering Committee. “Research has shown that hospitals adhering to clinical measures through the Get With The Guidelines quality improvement initiative can often see fewer readmissions and lower mortality rates.”

Do I Need a Biopsy or Surgery for My Thyroid Nodule?

Updated on Jun 30, 2022 | Head and Neck, Your Health

Thyroid nodules are very common. These masses within the thyroid gland are composed of tissue and/or fluid and are estimated to be present in more than 50 percent of those aged 50 and older. Nodules can run in families, are more common in women, and increase in frequency with age.

Patients diagnosed with a thyroid nodule often ask if their nodule needs to be biopsied or surgically removed. Sometimes the answer is yes, but often the answer depends on a number of patient and nodule-related factors. Catherine Sinclair, MD, FRACS, head and neck surgeon at Mount Sinai West, explains why your nodule may, or may not, need special attention.

How do you know if you need a biopsy?

More than 95 percent of thyroid nodules are non-cancerous, although a family history of thyroid cancer in a first-degree relative or whole-body/neck/chest radiation exposure may increase the risk. Nodules have a low cancer risk, so whether to biopsy depends on the size and ultrasound appearance of the mass.

Over the past decade, many nodules smaller than one centimeter have been incidentally detected on imaging (CT, MRI) that was ordered for another reason. Often these nodules were inappropriately biopsied, and, if the biopsy was positive for thyroid cancer, overly extensive total thyroid surgery was performed. Recent data from Japan and the United States suggests that appropriately selected thyroid cancers can remain stable over time. Termed “microcarcinomas,” these cancers are less than one centimeter in size and may be adequately managed without surgery or with limited thyroid surgery.

How is risk measured?

In an effort to reduce “incidentally diagnosed” microcarcinomas, the American Thyroid Association (ATA) Guidelines for Thyroid Nodules and Differentiated Thyroid Cancer classifies nodules into risk categories for biopsy based on thyroid nodule size and ultrasound appearance. Those classified as high-risk nodules should be biopsied when more than one centimeter in size, whereas low-risk nodules—depending on their appearance on ultrasound—should not be biopsied until they are one and a half to two centimeters in size. Many thyroid surgeons perform their own ultrasounds and use the ATA risk classification system (along with any biopsy results) to determine who should have a biopsy, which nodules should be operated on, and which nodules can be safely observed.

What are the symptoms and treatment for thyroid nodules?

In addition to posing a cancer risk, nodules may also need to be removed if they grow very large (greater than four centimeters) and cause symptoms like difficulty swallowing, neck discomfort, hoarseness of the voice, and airway compression with shortness of breath. Frequently, a thyroid lobectomy—the removal of a portion of the thyroid gland—may be adequate treatment for a non-cancerous thyroid nodule as well as for small cancerous nodules that are less than four centimeters. However, patients should speak with their surgeon in detail beforehand about the many additional factors affecting surgery, such as the status of the other thyroid lobe, your age, and your personal preferences.

In summary, a thyroid nodule may require an operation if there is a high risk of the nodule being cancerous or if the non-cancerous nodule is large and causing symptoms.

Non-cancerous nodules that are asymptomatic should be observed with intermittent ultrasound follow-up when appropriate. If surgery is necessary, the least aggressive option that will effectively treat the nodule should be chosen.

How to Dine Out and Still Eat Healthy

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

Dining out can be a great way to spend quality time with friends and family. Health-conscious individuals, however, may find dining out to be a challenge due to the overabundance of unhealthy options and the lack of transparency on restaurant menus. Fortunately, by following these simple steps, you can painlessly make healthy eating choices while out on the town.

Before heading out, be sure to check the menu and have a snack.

Most establishments have their menu available online. Plan a nutritious meal in advance. Selecting your meal beforehand prevents you from being tempted by less healthy options once at the restaurant. To avoid overdoing it, have a small, healthy snack that includes fiber and protein before the meal, so that when the bread basket arrives, you won’t overindulge.

Start your meal smart by avoiding liquid calories and ordering a healthy appetizer.

Try to avoid sodas and alcoholic beverages, as these can quickly add excess calories and sugar. Go for healthier options like seltzer, water with lemon, or unsweetened iced tea. If you’d like an alcoholic drink, avoid one of the pre-made, sugary ones like margaritas or daquaris. Consider a light beer, a glass of red wine, or a seltzer paired with the alcohol of your choice and a lemon wedge.

Healthy starters can keep you full so you are less likely to overeat when the entrées arrive. Some smart options include a vegetable appetizer, a tossed salad, or a broth-based soup rather than lobster bisque.

Eat your vegetables and steer clear of fried foods.

Vegetables are high in fiber, which will help you feel full without adding extra calories, so add non-starchy ones (i.e., not potatoes or corn) as side dishes. If your meal normally comes with French fries or onion rings, swap them for a side salad or a vegetable. Avoid anything fried, as well as entrees described as breaded, pan-fried, creamy, or crispy, since these are often higher in calories and fat. Instead, look for menu terms that are broiled, steamed, roasted, and baked – all healthier options.

Making smart eating choices while dining out is possible. By preparing before the meal, you can dine out without the guilt. Remember, indulging is okay occasionally; just try to get back on track for the next meal.

Healthy Pre-Dining Snacks

To avoid overindulgence, try a fiber- and protein-rich snack before dinner:

Greek yogurt with fresh fruit
An apple with 2 tablespoons of peanut butter
Hummus with vegetables

Salad Do’s and Don’ts

If you order a salad as your entrée, limit these high-calorie, high-fat add-ons and salty or creamy salad dressings:

croutons
fried noodles
candied nuts
blue cheese dressing
ranch dressing
Caesar dressing

Instead, substitute lighter options like olive oil and vinegar or lemon juice. Ask for salad dressings on the side, so that you control the amount.

Tips on Portion Control

Restaurants often provide very generous portions. Try ordering an appetizer instead of an entrée and add a small salad to complement the meal. Share an entrée with a friend and add a vegetable side to keep you full. If you do order a full-size entrée, ask to box up half of it before the meal starts to avoid the temptation of finishing the whole portion.

Could Your Sore Throat Be Caused by Acid Reflux?

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

Have you had a cough, tickle in the throat, itchy throat, or raspy voice that will not go away despite not having a cold or feeling sick? Is excess mucus causing you to clear your throat so often that it is annoying and, at times, embarrassing? Many who suffer from these symptoms are treated by doctors and urgent care physicians with allergy medications, nasal sprays, decongestants, and even antibiotics. Despite this, symptoms do not get better. Often these symptoms are not caused by allergies, a sinus infection, or a cold, but by laryngopharyngeal reflux (LPR). Also called airway reflux, reflux laryngitis, or atypical reflux, LPR is one of the most common diseases of the 21st century. Unlike gastroesophageal reflux disease (GERD), which primarily affects the esophagus, LPR will affect the larynx and pharynx—your voice production system. Lissette Giraud, MD, provides insight into and answers common questions about this widespread condition.

What causes LPR?

It is commonly accepted that this condition is caused by reflux of acid or bile. GERD symptoms like heartburn are not typical of the condition but may appear. The most common symptoms of LPR are hoarseness, sore throat, excess mucus in the throat, persistent cough, asthma-like, symptoms (wheezing, chest tightness, and difficulty breathing), postnasal drip, sensation of a lump in the throat, difficulties swallowing, and ear pain. However, LPR presents differently in each person.

When should I see a doctor?

If you have a sore throat, painful swallowing, cough, difficulty swallowing, or hoarseness for 10-14 days, you should seek medical attention, preferably from an ENT.

What is the treatment for LPR?

Treatment will vary in accordance with the severity of symptoms. It can be as simple as making changes to your diet, like avoiding spicy foods, tomatoes, chocolate, caffeine, citrus beverages or foods, and alcohol.

What's the difference between LPR and GERD?

Both LPR and GERD are caused by acid reflux. GERD, the more well known condition, occurs when stomach acid backs up into the esophagus. Patients with this condition may experience nausea and heartburn. LPR occurs when stomach acid reaches the back of the throat or, in some cases, the nasal passage.

Frequently, primary care physicians correctly make the diagnosis of LPR. Patients may be reluctant to start treatment since the typical “acid reflux” symptoms—like heartburn, belching, and regurgitation of acid contents—are not present. Additionally, when patients see a gastroenterologist after a referral by their primary care provider or otolaryngologist (ear, nose, and throat physician, also known as ENT), they are frequently told they do not have “acid reflux.” This confuses many patients and creates further frustration.

Learn more about ENT services at Mount Sinai

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Intermittent Fasting: Feast or Famine

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

Reclaiming the health of western society may require matching our diet and lifestyle to those that our bodies and minds evolved for, notes Julie Devinsky, RD, an inpatient dietitian of the Department of Clinical Nutrition at The Mount Sinai Hospital.

Julie Devinsky, RD

Before the modern age, we ate to survive. Our bodies and metabolism were more opportunistic and adaptive to what was intermittently available. There was no such thing as breakfast, lunch, or dinner. For most of human history, it was a mix of scavenging, gathering plants, and hunting. Diets varied by season, differing enormously across climates. At times, it was feast or famine.

Intermittent fasting—a term for prolonged cycles between eating and fasting—aims to mimic what early humans experienced by interrupting the regular flow of calories into our bodies.

Because intermittent fasts can be considered more of an eating pattern, rather than a diet, they may be more beneficial and can be used to complement a low-fat, low-carbohydrate, plant-based, or high-fat animal-based diet. However, this pattern works best for a very disciplined person and may not be realistic for many American lifestyles.

There are three types of intermittent fasting: the 5:2 method, alternate-day fasting, and time-restricted fasting.

The 5:2 method involves eating normally for five days and fasting for two. On fasting days, roughly 500 calories are consumed. Based on an archetypal “hunter-gatherer” diet, the proposed benefits of the 5:2 diet are based on the premise that fasting increases insulin sensitivity and decreases leptin levels. A hallmark of the fasting phase of this diet is mobilizing fatty acids and ketosis, a process in which the body uses fat rather than glucose for energy. Glucose is stored in the liver as glycogen, which runs out after about 10-12 hours (without exercise), forcing the body to burn fat.
Alternate-day fasting (ADF) requires eating no more than 500 calories every other day. In an October 2010 study published in the International Journal of Obesity, approximately 100 obese women on a ADF diet lost an average of 13 pounds over six months with reductions in cholesterol, blood pressure, triglycerides, and insulin. The mechanism of high-fat alternate-day fasting is inducing ketosis similar to the 5:2 regimen. Even lower-fat ADF diets were shown to be effective for weight loss. Further, the dropout rate in the ADF study was only 10-20 percent, which is considerably lower than other diet trials. Interestingly, researchers found that on the non-fasting days, participants ate less than expected. Instead of “feasting” to make up for the fasting days, participants only ate 10-15 percent more than baseline.

The time-restricted feeding diet requires that the entire day’s worth of calories be consumed over six to eight hours and the remaining 16-18 hours are to be spent fasting. Research is limited, but preliminary studies suggest this diet may lower cancer risk and help with weight maintenance.

The jury is still out on fasting diets. Initially, many experience a two- to three-week adjustment period where symptoms often include fatigue and nausea. The long-term effects remain to be seen. Fasting may slow metabolism and cause persistent fatigue while some studies show marked changes in weight, blood glucose, insulin sensitivity, and lipid profiles.

These regimens are not for everyone, especially those with diabetes, pregnant and breastfeeding women, people taking certain medications, or those with serious medical conditions. However, in this age of escalating obesity and when the failure of “dieting” is commonplace, intermittent fasting may be useful as part of a weight loss regimen.

The Big Fat Myth: Can Fat Be ‘Good?’

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

A low-fat diet was once touted as the best for weight loss and optimal health. Groceries stocked low-fat foods on the shelves and everyone avoided fat like the plague. Unfortunately, the low-fat diet trend did America a great disservice. In fact, obesity rates in the United States have consistently climbed. Adena Neglia, MS, RDN, CDN, Senior Dietitian at The Mount Sinai Hospital, explains why fat is not the enemy and how to incorporate ‘good fat’ into your diet.

Do fatty foods make you fat?

Let’s clear up a common misconception: Fat does not make you fat. We gain weight when we eat in excess of our needs, whether the excess comes from protein, carbohydrates, or fats. From a weight management standpoint, fat makes food taste good. When we eat it, we feel more satiated and wind up craving and eating less food later on. In fact, getting adequate amounts of healthy fats in your diet may make managing your weight easier. From a health and wellness standpoint, fat is needed to help our bodies absorb certain fat-soluble vitamins, including vitamins A, D, E, and K. In the brain, fat stimulates the creation of new brain cells and improves our memory. Fat is critical for reproductive health in men and women because it is used to both produce and balance our hormones.

What is a ‘good’ fat?

As with any macronutrient, quality matters. Healthy sources of fat include avocados, olive oil, nuts, seeds, grass-fed beef, and fatty fish. Incorporate healthy fat into your diet by mashing avocado on toast or pureeing it into a sauce for zucchini noodles. Drizzle olive oil on vegetables to roast them or use as a dressing with lemon on a salad. Add chopped nuts to yogurt and oatmeal or eat them as a snack by themselves.

So, what fat do I need to limit or avoid?

Trans fat. Found in most processed and packaged foods—such as cake, cookies, chips, and crackers—it can be hidden on the nutrition label as “partially hydrogenated oils.” This kind of fat is terrible for our hearts. Not only does it raise your LDL (“bad”) cholesterol, but it also lowers your HDL (“good”) cholesterol. In 2013, the U.S. Food and Drug Administration (FDA) specifically designated partially hydrogenated oils as no longer “generally recognized as safe.”

How can I avoid trans fat?

Choose whole food sources and check your labels for lurking trans fat. Here’s a list from the FDA of foods that contain trans fat.

What’s so bad about low-fat food?

When companies start to take fat out of their products, they often replace it with sugar to compensate for the taste. We now know that increased sugar intake contributes to obesity, heart disease, diabetes, and cancer. Food additives, emulsifiers, and stabilizers are also added to mimic the texture and mouthfeel of fat. Many people are under the impression that they can eat more of these foods because the low-fat label makes it “healthy.” As it turns out, these low-fat products often do more harm to our health than good.

Awards Recognize Mount Sinai’s Commitment to Quality Stroke Care

Do I Need a Biopsy or Surgery for My Thyroid Nodule?