May 21, 2018 | Featured, MSBI, Your Health
Maria Brito, MD, Director of the Mount Sinai Thyroid Center at Union Square, and Terry F. Davies, MD, Co-Director.
The Mount Sinai Thyroid Center at Union Square is a valuable new resource for patients with thyroid disorders, as well as physicians seeking referrals for complex cases. The Center is unique in gathering a wide array of services in one ambulatory facility.
“This collaborative center includes Endocrinology, Endocrine Surgery, Head and Neck Surgery, Pathology, and Radiology,” says Director Maria Brito, MD, Assistant Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine at Mount Sinai. “I don’t think there is another thyroid center in Manhattan that has all of these services in one single building.” The Center is still expanding and will be joined by a Diabetes and Endocrine Center at Mount Sinai Union Square within the next year.
One goal of the Thyroid Center is to simplify care. “It is one-stop shopping, which is what we all want when we go to the doctor,” says the Center’s Co-Director, Terry F. Davies, MD, the Florence and Theodore Baumritter Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine at Mount Sinai. “If your physician says you need to see another specialist, it’s nice if he or she is in the next room. Y
ou can have your interview with the specialist and the surgeon; you can have a biopsy; you can have a sonogram; and you can have your blood tests, all in the same visit.”
New patients will be offered an appointment within 72 hours, Dr. Davies says, addressing a frequent complaint in medical care— having to wait weeks for an appointment.
Five endocrinologists and five surgeons are active in the Center, including leaders in their fields, Dr. Davies says, such as William B. Inabnet III, MD, Chair of Surgery, Mount Sinai Beth Israel, and Professor of Surgery at the Icahn School of Medicine; and Mark L. Urken, MD, Professor of Otolaryngology at the Icahn School of Medicine. For appropriate patients, “remote access” thyroidectomy can be offered, in which the thyroid is removed through incisions in the armpit or the mouth, leaving no visible scar on the neck. For certain patients with recurrent cysts, nodules, and some thyroid cancer recurrences, Dr. Brito and her colleague Michael A. Via, MD, Assistant Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine, offer a minimally invasive option, ethanol ablation, in which an alcohol solution is injected into these lesions, causing reabsorption or destruction.
Additionally, the Center is the national headquarters of the Thyroid, Head & Neck Cancer (THANC) Foundation, founded by Dr. Urken. The nation’s largest private funder of research for these cancers, THANC administers the Thyroid Cancer Care Collaborative, a data registry in which physicians can record important data about their thyroid cancer patients, enabling them to share clinical information with their patients as well as de-identified data with other physicians and researchers.
The Center’s physicians work closely with peers across the Mount Sinai Health System. For example, “we meet twice a month for the thyroid tumor board, in which surgeons and physicians discuss difficult cases,” says Dr. Davies, a leading physician-scientist in autoimmune thyroid disease who has been funded continuously for 35 years by the National Institutes of Health. Sharing knowledge among peers is a top priority of the Center, which is an important referral destination for primary care doctors seeking to consult with endocrinologists, and for endocrinologists seeking to collaborate with surgeons.
“We think this is definitely an appropriate place for second, third, or fourth opinions,” Dr. Brito says. “But it is very important for both primary care doctors and specialists to know that we expect to collaborate with them. They will not lose their patient to the Center, instead, they will gain a colleague.”
May 14, 2018 | Ear Nose Throat, Your Health
Though many people take calcium supplements and eat calcium-rich foods, elevated calcium levels can be too much of a good thing. Mike Yao, MD, Associate Professor of Otolaryngology, explains how your high calcium levels might actually be signs of hyperparathyroidism.
Many of the body’s organs need calcium to be at a specific level to function properly. Calcium levels that are too high or too low can affect the function of the muscles, bones, heart, and brain.
Blood calcium levels are often too high due to abnormal growth of one of the parathyroid glands, a condition called hyperparathyroidism. The effects of high calcium levels can dramatically decrease your quality of life. For example, elevated calcium levels can worsen the quality of sleep and increase anxiety, depression, fatigue, and bone pain. High calcium levels can also decrease concentration, learning, and memory.
Fortunately, high calcium due to hyperparathyroidism is easily treatable with minor surgery.
How do I know if my high calcium level is due to hyperparathyroidism?
A simple blood test to check your parathyroid and calcium levels will confirm a diagnosis. Only hyperparathyroidism will cause the calcium and parathyroid blood levels to be elevated at the same time. Calcium testing is often a part of routine yearly blood tests for adults. High calcium levels are suspicious for this disease and should lead to further testing for hyperparathyroidism.
What can be done if I am diagnosed with hyperparathyroidism?
Hyperparathyroidism is caused by the abnormal growth of one or more of the parathyroid glands. In approximately 85 percent of cases, only one gland is abnormal. Minor surgery to remove the abnormal gland cures the disease. This short, outpatient procedure is completed in less than an hour through a one-inch long incision in the neck. If there is more than one abnormal gland, all abnormal glands are removed through the same incision. Typically, the surgery is not very painful. More than half of our patients do not take any pain medication and most return to work within a week.
Is there a medication I can take instead of undergoing surgery?
Patients reluctant to undergo surgery often ask about alternatives. However, surgery is the only treatment for primary hyperparathyroidism; there is no medication which eliminates the condition. Some endocrinologists will prescribe cinacalcet—a calcium reducer—to lower the calcium level in patients with hyperparathyroidism who are reluctant to have surgery. Yet, for most patients, cinacalcet causes existing problems to worsen. If prescribed, the drug needs to be taken forever to maintain the lower calcium level, and makes patients susceptible to bone loss and osteoporosis. For primary hyperparathyroidism, it may be safer to do nothing than to take cinacalcet. However, the drug can be useful for secondary hyperparathyroidism, a parathyroid disease that only happens in patients with kidney failure.
The parathyroid are four small glands located behind the thyroid in the neck. These glands are essential in regulating calcium levels throughout your body. Calcium is an essential mineral. It is important for strong bones, teeth, and muscle function.
May 8, 2018 | Featured, Your Health
Mount Sinai at Home leaders, from left, Operations Director Alexander Mandl; Albert L. Siu, MD; and Clinical Director Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine.
The Mount Sinai Health System recently launched Mount Sinai at Home, an innovative enterprise with two key components: a service line of programs across the Health System that care for patients in their own homes, and a research arm, the Institute for Care Innovations at Home.
“Mount Sinai at Home’s programs will align closely with the Health System’s population health strategies and advance our capacity to serve communities beyond our hospitals,” says Director Albert L. Siu, MD, Professor and Chair Emeritus of Geriatrics and Palliative Medicine. Treating patients in familiar and convenient environments can improve communication, coordination, and continuity of care, and reduce the risk of admission and readmission.
“This all started with Mount Sinai Visiting Doctors, which was founded in 1995 and gave us an opportunity to create the Mobile Acute Care Team (MACT),” Dr. Siu says. “When MACT started out in 2014, it was just Hospitalization at Home, but very quickly our teams found more ways to support our patients and our Health System, so we created services such as Rehabilitation at Home for care after hospitalization.” MACT, which was founded with a $9.6 million Health Care Innovation Award from the federal Centers for Medicare and Medicaid Services, has been a success, treating 750 patients so far. Its name presented a challenge, Dr. Siu says, since “MACT was not particularly descriptive from the point of view of patients.” As all of its home-based programs grew, the Health System saw a need to coordinate them and to find a new, unified name.
The result is Mount Sinai at Home, which is also headed by Clinical Director Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine, who was Director of Mount Sinai Visiting Doctors and Clinical Director of MACT; and Operations Director Alexander Mandl. Mount Sinai at Home will provide “operational, financial, legal, logistical, and clinical” support for home-based care across the Health System, Mr. Mandl says. Its clinical programs are:
- Mount Sinai Visiting Doctors, providing primary care for homebound patients, who are usually very frail and elderly;
- Pediatric Visiting Doctors and Complex Care Program, for young patients, such as children with chronic illnesses or infants who have just left neonatal intensive care;
- Hospitalization at Home, for patients with a condition that might otherwise call for hospitalization, such as acute pneumonia; and
- Rehabilitation at Home, for patients who need care that might otherwise be provided at an inpatient rehabilitation center.
In March 2017, Frederick Ballen became the 500th patient of the Mobile Acute Care Team—now part of Mount Sinai at Home. He was treated at his home in Manhattan by Caitlin Pelan, RN, left, and Joanna Jimenez-Mejia, NP.
These programs will continue to function in collaboration with the Departments of Medicine, Geriatrics and Palliative Medicine, and Pediatrics. Over time, other efforts and collaborations may be added, such as a palliative care program that is now part of a clinical trial led by R. Sean Morrison, MD, the Ellen and Howard C. Katz Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine. In the program, a team of nurses, community health workers, social workers, nurse practitioners, and physicians provide care and support to seriously ill patients at home. “If it is successful, we hope to keep this as a clinical program,” Dr. DeCherrie says. Another study led by Dr. Morrison, on the cost-effectiveness of palliative care, was recently published in the Journal of the American Medical Association Internal Medicine.
Mount Sinai at Home also created a payment model for Hospitalization at Home that in September became the first to be approved by Medicare’s Physician-Focused Payment Model Technical Advisory Committee. “When it is implemented, it will be a model that hospitals around the country can use,” Dr. DeCherrie says.
The Mount Sinai Health System has long been a leader in palliative care, geriatrics, and health care at home. “We already have the largest academic house-call program in the country—Visiting Doctors—and our Hospitalization at Home program is already the largest in the country,” Dr. DeCherrie says. “To put it all together under one service line, that is very different and very new.”
May 1, 2018 | Children's Health, Your Health
Screens are everywhere, even in the waiting areas of pediatric practices. This makes it harder for parents to control the amount of time children spend engaging with digital media. While there are legitimate educational applications that involve handing your child, or putting your child in front of, a screen, limits are important. Micah Resnick, MD, a board certified pediatrician at Mount Sinai Queens, explains how, and why, parents should limit usage.
How much is too much screen time?
Parenting is not easy. Sometimes a screen is the most efficient solution for occupying your child while you attend to the needs of other family members, or even your own needs. Despite the ease and importance of using digital media, the American Academy of Pediatrics (AAP) recommends the following:
- No screen time before 18 months old except for video chatting
- Strictly limited screen time for toddlers 18 to 24 months old
- One hour a day of “co-viewing” for children two to five years old
- Consistent limits on screen time for children six years and older
Those are pretty serious restrictions, and with good reason. Too much screen time can result in lack of sleep, aggression, obesity, and loss of social skills. No one wants that, especially during your child’s crucial development stage.
So, what are parents to do?
An excellent starting point to help limit screen time is the creation of a family media plan. HealthyChildren.org, a parenting advice website from the AAP, provides helpful tools like a media plan template and a media plan calculator here. Using the media plan calculator, you are given an age-appropriate checklist advising how to help create screen-free zones, screen-free times, and device curfews, and how to balance online and offline time for your child. There are also important sections on how your child can be a good “digital citizen.” Speak with your child about cyberbullying, the dangers of sending or receiving explicit images via text, and the importance of following online guidelines.
Encourage tactile activities.
While digital media is ubiquitous, it is not essential. An early childhood filled with books and educational toys will pay off well into adolescence. Play with your children, read to them, and teach them about colors and numbers and how to play musical instruments. These tactile interactions will promote the most intellectual and emotional development.
Micah Resnick, MD, is a board-certified pediatrician at Mount Sinai Queens and an Assistant Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai. His clinical interests include well-child care, adolescent health, preventive medicine, and patient and family education. By educating patients and their families, he empowers them to make healthy decisions and strengthens their compliance with clinical recommendations.
Digital media is great, in moderation and with age appropriate supervision. When you allow screen time, be a media mentor. Watch or play online with your child. Always ensure that the content is age appropriate. As children get older, monitor their digital footprint, including social media accounts. For helpful suggestions on engaging with your child—both with and without screens—check out parenttoolkit.com.
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Updated on Jun 30, 2022 | Ear Nose Throat, Your Health
Dysphonia, or hoarseness, affects approximately one-third of people under the age of 65 during their lifetime. This climbs to nearly 80 percent for high vocal users—like teachers and singers—and those over the age of 65. Symptoms of dysphonia include vocal fatigue, pitch changes, voice breaks, unintended volume changes, increased vocal effort, and decreased quality.
Hoarseness can range from temporary voice changes caused by a viral infection to a severe disability that makes basic communication difficult.
If you are seeking medical care for hoarseness, you doctor can now consult the updated Clinical Practice Guideline: Hoarseness (Dysphonia). Recently released by The American Academy for Otolaryngology-Head and Neck Surgery, the Clinical Practice Guideline details how your doctor can best treat this often irritating condition.
Matthew C. Mori, MD, Assistant Professor of Otolaryngology-Head and Neck Surgery at the Icahn School of Medicine at Mount Sinai and a laryngologist at the Grabscheid Voice and Swallowing Center, offers answers to some of the most frequently asked questions.
When should I see a health care provider about my hoarseness?
According to the recent Clinical Practice Guideline: Hoarseness (Dysphonia), you should see a health care provider if:
- Your hoarseness does not go away or get better in 7-10 days. (It’s especially important to see a doctor if you are a smoker.)
- You do not have a cold or flu
- You are coughing up blood
- You have difficulty swallowing
- You feel or see a lump in your neck
- Your loss of, or the severe changes in, your voice last longer than a few days
- You experience pain when speaking or swallowing
- Your voice change comes with uneasy breathing
- Your hoarseness makes your work hard to do
- You are a vocal performer (singer, teacher, public speaker) and cannot do your job
Do I need antibiotics, steroids, or imaging (such as an X-ray, CT scan, MRI)?
Maybe. However, except for some special cases, you will not need medications or imaging before a specialist looks at your vocal cords or larynx. The Clinical Guidelines recommend against these routine treatments prior to examination of the larynx. However, after an in-office laryngoscopy (examination of the larynx or vocal cords), one or more of these treatments may be prescribed. Acute hoarseness is often caused by laryngitis from a viral infection, making antibiotics ineffective. Additionally, corticosteroids should be avoided unless indicated due to the risk of rare, but serious, adverse effects.
What is voice therapy?
Voice therapy is a well-established program to treat many causes of hoarseness. It involves a trained speech language pathologist guiding you through voice and physical tasks as well as behavioral changes to help you shape healthy vocal behavior and attain the best possible voice. Voice therapy is the first-line therapy for behavior-related vocal lesions like vocal nodules and polyps. With few exceptions, it is covered under insurance.
Do I need surgery to treat my hoarseness?
This depends on the cause of the hoarseness. Lifestyle changes and voice therapy may be enough. But some patients may need surgery to improve the voice due to benign vocal cord lesions—like cysts or polyps—which have not responded to more conservative treatments. Also, if there is a paralysis of the vocal cord, or a form of muscular weakness known as paresis, an injection or implant may be required. If there is a possibility of a malignancy or cancer, surgery or an in-office biopsy would be required to make a diagnosis.
Is it better to wait to see if my hoarseness goes away on its own?
If your voice has not improved after 7-10 days, you should be evaluated by a health care provider. With any problem of the vocal cords, the earlier you start treatment the better.
If your hoarseness persists for more than four weeks, you should be seen by an otolaryngologist, also known as an ear, nose, and throat (ENT) surgeon.
Matthew C. Mori MD is an Assistant Professor of Otolaryngology at the Icahn School of Medicine at Mount Sinai. He is a board certified and fellowship trained surgeon, and a laryngologist at the Grabscheid Voice and Swallowing Center of Mount Sinai. Dr. Mori specializes in the diagnosis and treatment of airway, voice, and swallowing disorders while treating the full gamut of ear, nose, and throat disease.
Preventative measures should be taken to avoid hoarseness, especially for high vocal users. Try the following to avoid the irritating disorder:
- Drink water daily. Dehydration is bad for you and your vocal chords.
- If you are in dry, arid conditions, try using an indoor humidifier.
- Be sure to rest your voice to avoid over-straining.
- Avoid smoking and second-hand smoke which can irritate your airway.
- Minimize excessive throat clearing or coughing.
- Limit drying beverages like alcohol and caffeine.
For additional tips on preventative measures that can be taken to reduce hoarseness, consult this chart from the Clinical Practice Guideline.
Mar 18, 2018 | Diet and Nutrition, Your Health
For those on dialysis, registered dietitians can sometimes sound like a broken record: “EATMOREPROTEINEATMOREPROTEINEATMOREPROTEIN!”
There’s a reason why this is your nutritionist’s mantra. Protein is extremely important for dialysis patients, because the treatment filters out protein. If you are on dialysis, you must replace the nutrients lost; otherwise, you may experience muscle wasting and fatigue, or your immune system may not function well.
Anyone who has ever gone food shopping knows that protein-rich foods, such as meat and fish, tend to be the most costly items in your shopping cart. However, it is possible to buy protein without breaking the bank.
Try adding the following inexpensive, protein-rich options to your diet:
Eggs
Compared to meat and fish, eggs are a relatively inexpensive yet potent source of protein—a three-egg omelet has as much protein as a three-ounce burger. While eggs have gotten a bad rap because of their cholesterol content, it is important to note that the dietary cholesterol found in eggs will not raise your blood cholesterol as much as saturated fats like those found in sausage, fried foods, and cheese. Also, most people on hemodialysis tend to have low cholesterol levels. Be sure to check with your doctor or nutritionist before adding more eggs into your diet.
Fish
While salmon and tuna are great, economical options such as perch or tilapia are delicious and have just as much protein. Cut down on costs by purchasing fillets which limit waste and have the lowest price per pound. If you shop at a local fish store, go at the end of the day. They may cut the price to clear out the day’s inventory, in order to make room for tomorrow’s catch.
Additionally, canned tuna is a good buy and markets often have it on sale. Chunk light tuna has just as much protein as white tuna for a lower price. Salt-free tuna tends to cost more. Remove salt at home by emptying a can of regular tuna in a strainer, then run under water.
Chicken and Turkey
Chicken and turkey are relative bargains. A whole chicken is usually inexpensive and will feed an entire family. Leave leftovers for later in the week if you live alone. You can use the bones to make soup stock. If you prefer boneless chicken, the thigh tends to be cheaper than breast and has just as much protein. Also, ground chicken and turkey make great burgers.
Meat
When shopping for red meats, go for lower-priced cuts. Round steak is cheaper than sirloin or club steak and very high in protein.
In addition to the above, dialysis patients should check their phosphorus levels with their doctor or registered dietitian. If levels are low or well controlled, beans or cheese may be incorporated as an inexpensive, and tasty, protein source.
Remember: there is no pill that you can take to increase this important fuel source. The only way to get enough protein is through nutritious food.
Diane Lieberman, PhD, RD, CSR, CDN, is the nutrition manager at the Mount Sinai Dialysis Center. Prior to working with Mount Sinai, she was the nutrition manager at Rogosin Institute for 21 years. There she managed a staff of dietitians, consulted on research projects, and was responsible for Hemodialysis, Home Hemo coverage, and Peritoneal Dialysis as well as chronic kidney disease and post- transplant patients.
Use these tips to optimize your grocery shopping:
- Prevent expensive impulse purchases by checking your supermarket’s weekly ads and deciding what sale items you will buy in advance.
- Fast foods may seem fairly inexpensive, but for the price of a single meal, you could have bought a whole chicken or two dozen eggs and gotten a lot more protein per dollar spent.
- If you get some of your food at a pantry, you may find that many of the items offered, like beans and canned meats, are not ideal for dialysis patients. Take them anyway. You may have family members who can eat those foods, leaving some room in your total family budget for you to buy alternate protein.
