Updated on Sep 7, 2024 | Your Health
A diagnosis of cancer, or knowing you have genes that mean you have an elevated risk for cancer, can complicate family planning decisions. Cancer treatments can affect your fertility, while a diagnosis of “hereditary cancers,” notably breast or ovarian cancer, will likely affect plans for conception.
While making decisions about whether to preserve your fertility isn’t simple, knowing your options can empower you to take proactive steps that will match your family-building goals.
In this Q&A, Matthew Lederman, MD, and Jovana Lekovich, MD, Assistant Clinical Professors in the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai and Reproductive Endocrinologists at RMA of New York, explain fertility preservation options for patients with cancer or who have a risk of hereditary cancer. Dr. Lekovich is also Director of the Oncofertility Program at the Blavatnik Family Chelsea Medical Center at Mount Sinai.
What is a hereditary cancer?
The most common hereditary cancer syndromes are the result of mutations of the BRCA1 and BRCA2 genes. These genes typically produce tumor suppressor proteins that help repair damaged DNA. However, when either of these genes is mutated or does not function properly, DNA damage is not repaired properly, and cells are more likely to develop genetic alterations that can lead to cancer.
What types of cancers are commonly seen as a result of these mutations?
Women with a BRCA mutation have an estimated 50-85 percent lifetime risk of developing breast cancer, an estimated 16-60 percent lifetime risk of developing ovarian cancer, and are at a higher risk of developing either of these cancers at much younger ages.
How can a hereditary cancer or a cancer diagnosis affect my fertility?
Individuals diagnosed with cancer or who face a risk of hereditary cancer may face issues regarding their desire to conceive, including:
- If and when to undergo risk-reducing surgery, particularly the removal of fallopian tubes and ovaries
- Potential risk of a diminished ovarian reserve, which can result in lower egg quality and quantity
- Age, which plays a role in all women’s fertility
- Desired family size
- Possibility of passing on the BRCA mutation since there is a 50 percent chance an offspring will be a carrier
What fertility options are available for cancer patients?
Patients who want to preserve their fertility may elect to freeze their eggs, a process called oncofertility, or may decide to undergo a less invasive option such as hormone monitoring.
What is oncofertility?
Cancer treatments such as chemotherapy or radiation are considered gonadotoxic treatments, which means treatments that could potentially harm your reproductive system and fertility. Oncofertility is the process of preserving fertility prior to undergoing those treatments. Eggs are frozen using a process called vitrification, which preserves them at their current age. In the future, they can be thawed, fertilized, and implanted to achieve a successful pregnancy, even if your fallopian tubes and ovaries have been removed. Embryos can also be frozen.
What is hormone monitoring?
If you are not ready to consider egg or embryo freezing but still want to be proactive, a less invasive option is hormone monitoring. Annual monitoring of your ovarian reserve includes a blood test to evaluate AMH (Anti-Mullerian hormone) and a transvaginal ultrasound of the ovaries to assess follicle count. A reproductive endocrinologist and fertility specialist can help you evaluate your fertility and decide the right time to freeze eggs and/or embryos.
How does RMA of New York work with the Blavatnik Family Chelsea Medical Center at Mount Sinai to provide fertility preservation treatments for individuals diagnosed with cancer?
Through an expedited referral process, RMA of New York works with a patient’s oncology team to schedule an appointment with a reproductive endocrinologist within 48 hours of initial contact and prior to any gonadotoxic treatments. In most cases, fertility preservation procedures can be completed within weeks of that initial appointment and scheduled around cancer diagnostic procedures and treatments. In this way, patients are able to preserve their fertility, and safely store their specimens until they are ready to focus on building a family.
To learn more about your carrier status or to assess your fertility, make an appointment with a reproductive specialist at RMA of New York.
Sep 5, 2024 | Your Health
Emma Guttman, MD, PhD, with a young patient before and after treatment. To see if your child qualifies for the new clinical trial, email our Clinical Research Program Director, Giselle Singer at giselle.singer@mssm.edu .
Pediatric alopecia areata, an autoimmune skin disease that causes hair loss, affects about 1 in 1,000 children and teens. Alopecia areata often first appears in childhood, with 40 percent of people with alopecia developing symptoms before the age of 40.
While alopecia areata is not a life-threatening condition, it can be devastating to live with this disease, according to Emma Guttman, MD, PhD, the Waldman Professor and System Chair of Dermatology and Immunology at the Icahn School of Medicine at Mount Sinai.
“This condition has a tremendous negative psychological impact on many people who suffer from it, and those difficulties can be unique in the pediatric population compared with adults,” says Dr. Guttman. For example, about half of teens report that they’re embarrassed by their hair loss and 40 percent say that they’ve been bullied, according to the National Alopecia Areata Foundation.
In this Q&A, Benjamin Ungar, MD, Director of the Alopecia Center of Excellence, explains how pediatric patients and their families can find some relief and discussed the latest clinical trial at the Center.
“We have motivated patients who come to Mount Sinai seeking help, as well as a fantastic team of researchers working together to identify new treatment targets and design clinical trials to establish new treatments,” he says.
Out of all the clinical trials your department is doing, is there one you are most passionate about and why?
We’re excited about many trials, but one that comes to mind is the clinical trial with dupilumab in children in partnership with the National Institutes of Health (NIH). This is a population with a serious unmet need for safe and effective treatments.
What do you hope to accomplish with this clinical trial?
The NIH grant for the clinical trial for dupilumab in children is so exciting because it offers promise and hope for a population in need. We aim to evaluate dupilumab, which has been shown to be extremely safe in atopic dermatitis and other conditions, as an effective treatment for children with alopecia areata. Additionally, this trial will serve to provide insights into what causes the disease that will help progress future research.
Does alopecia areata differ at all in its presentation, severity, or prognosis in children than in adults?
Overall, alopecia areata in childhood generally presents similarly in children and adults, although an earlier onset in life can be associated with a worse prognosis in terms of severity and response to treatment. It’s also important to note that this condition has a tremendous negative psychological impact on many people who live with it, and those difficulties can be unique in the pediatric population compared with adults.
Why is it so important to develop treatments for children with moderate to severe alopecia?
We understand that it’s important to treat this disease within a few years of its onset, as the longer it goes untreated, the less likely an excellent response to treatment will occur.
To see if your child qualifies for the new clinical trial, email our Clinical Research Program Director, Giselle Singer at giselle.singer@mssm.edu .
Sep 4, 2024 | Your Health
Food poisoning is more common than you think. According to the U.S. Centers for Disease Control and Prevention (CDC), about one in six people in the United States get food poisoning each year. That’s about 48 million people. We usually only hear about food poisoning when there’s a food recall or when a restaurant is linked to an outbreak. In cases like this it may become big news, as it did recently after the CDC posted an alert about recalls of some deli meats due to contamination with listeria.
Most cases of food poisoning come from improperly prepared meals at home or at outdoor gatherings where food like deviled eggs, tuna salad, or other dishes sit out in the sun for too long. In this Q&A, Bernard Camins, MD, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System, discusses food poisoning and when you may need to go seek medical care.
What are the symptoms of food poisoning?
Symptoms of food poisoning can include nausea, vomiting, diarrhea, and sometimes fever. You may not have these symptoms right away. Depending on the type of food poisoning you have, it can take 24 to 48 hours, or even a little longer, until you develop symptoms.
When should I go to the doctor?
Most people recover from food poisoning on their own. Once your body has eliminated the toxin or the offending agent, you may recover on your own. If you experience symptoms for more than three days, if you become dehydrated and cannot keep liquids down, or if you have a fever for more than 24 hours, it’s time to see a physician.
How do I prevent food poisoning?
The majority of food poisoning happens at home. There are a few basic rules to prevent it:
- Washing is very important. Wash your hands with soap and warm water for at least 20 seconds before, during, and after preparing food, and before eating. Always wash your hands after handling eggs, flour, or uncooked meat. Don’t forget to rinse your fruits and vegetables under running water. Also, wash your knives and other utensils, cutting boards, and countertops with hot soapy water after preparing each type of food, especially raw meat or unwashed vegetables.
- Keep uncooked meat, poultry, fish, and eggs separate from everything else. They harbor bacteria that can cause infections. That means keeping them separate all the way from the supermarket to your refrigerator at home. Meat, poultry, and fish, especially might leak liquids that could spread germs. If possible, use two cutting boards—one for raw meat, seafood, and poultry and another one for produce, bread, and other foods you serve raw.
- Cook meat, poultry, and fish to the recommended temperature. You can use a meat thermometer to check. If you use the microwave, follow the directions carefully; for instance, letting food sit after you’ve microwaved it can help it cook more thoroughly.
- Refrigerate your food carefully. Don’t let perishables sit out on the table or counter for more than two hours—or, if it’s over 90 degrees Fahrenheit, not more than one hour. Thaw food in the refrigerator, in cold water, or in the microwave, not on the counter. Thawing on the counter can allow bacteria to grow more quickly.
- Keep on top of food recalls. You can check the website from the CDC to see what foods are being recalled due to contamination. If it turns out you have a food that has been recalled, throw that food out right away. Then clean the refrigerator shelves and drawers thoroughly, because germs in the recalled food could easily spread throughout your fridge.
What are the most common causes of food poisoning?
The most common causes of food poisoning are:
- Norovirus: This highly contagious virus causes vomiting and diarrhea. This has caused numerous outbreaks on cruise ships.
- Salmonella (non–typhoid): Salmonella is actually the name of the bacteria that causes infection from contaminated food. The salmonella infection leads to diarrhea, fever, and stomach cramps.
- Clostridium perfringens: Caused by meat, poultry, and gravy kept at an unsafe temperature, clostridium perfringens results in diarrhea and stomach cramps.
- Campylobacter: Usually stemming from eating raw or uncooked poultry or drinking untreated water, campylobacter gives you diarrhea.
- Staphylococcus aureus: This bacterium primarily causes skin and soft tissue infection. Some people can carry it on their hands. When they prepare or serve food without washing hands, this bacteria can produce a toxin that causes nausea, vomiting, stomach cramps, and diarrhea.
It is worth noting that listeriosis, or listeria infection, is rare compared with these other illnesses. Listeriosis can become serious and can be fatal for people at higher risk for severe disease, such as the elderly, pregnant persons, and people with weakened immune systems. The CDC says that the good news is that the listeria bacteria are easily killed by heating food to a high enough temperatures, and following the other basic food-safety steps.
Updated on Aug 29, 2024 | Endocrinology, Your Health
Whether you prefer sugar substitutes in your coffee or enjoy artificially sweetened foods, you may wonder how these products affect your body, and if there are potential health risks.
David Lam, MD
In this Q&A, David Lam, MD, Medical Director of the Clinical Diabetes Institute at the Icahn School of Medicine at Mount Sinai, explains what the research says and how to use artificial sweeteners for weight loss.
What are the health benefits of using artificial sweeteners?
The only demonstrated health benefit of artificial sweeteners is they reduce your chances for developing cavities. These sweeteners have zero or very few calories, compared with sugar. However, for those who are looking to reduce their weight or control diabetes, the research is conflicting. There is some evidence that in the short term, there are some improvements in weight loss and glucose control, but the research is not definitive on whether artificial sweeteners help with weight loss in the long term.
What are the potential risks?
There are concerns about whether sugar substitutes increase your risk for cardiovascular complications and diabetes. However, for each study that shows an increased risk, another shows it’s not so defined. While the research so far is inconclusive, patients should be aware these questions exist.
One thing you do need to be wary of—the blanket terms “artificial sweeteners” and “sugar substitutes” are broad.
What are the different types of artificial sweeteners?
Sugar substitutes generally fall into three categories:
- Synthetic sugars are made in laboratories and factories. Examples include Sweet’N Low® and Splenda®.
- Sugar alcohols are often found in processed foods labeled as diet products. Despite the name, these products don’t contain actual alcohol. Unlike synthetic sugar, sugar alcohols can affect your blood sugar, so the marketing labels on these products (e.g., “sugar free”) may be misleading. Additionally, people who have underlying digestive problems may have a negative reaction to sugar alcohols, such as stomach upset and bowel movement changes.
- Natural sugar substitutes, such as Stevia, are extracted from plants. These sugar substitutes are processed in laboratories and factories, but are essentially natural products, such as agave or honey.
How can I know if a food product contains sugar alcohol?
Sugar alcohols are usually found in diet products labeled “sugar free.” If you look at the food label and see ingredients ending in “ol” as in alcohol—such as sorbitol, xylitol, maltitol—it contains sugar alcohols.
Is there a way I can use artificial sweeteners for weight loss?
Artificial sweeteners are useful for weening yourself off added sugar and gradually adapting a wholefood diet. We know they are not effective long term. A doctor or dietician can guide you on how to create a long-term weight loss plan that works for you. For example, a nutritionist can help you understand how to integrate whole fruits into your diet. While fruits contain sugar, they also contain fiber and other nutrients that are part of a wholesome diet, and can be a healthy substitute for processed snacks. Ultimately, there is no one perfect solution for weight loss. You need to weigh the pros and cons of artificial sweeteners on an individual level, and a health care professional can help you do that.
Updated on Sep 9, 2024 | Featured, Your Health
The approach of fall is when doctors normally begin reminding patients to think about getting the flu vaccine, and now they are also reminding patients about the new COVID-19 vaccines that were recently approved.
The new COVID-19 vaccines are recommended for everyone six months of age and older. The U.S. Food and Drug Administration approved the vaccines, from manufacturers Pfizer and Moderna, on Thursday, August 22. The annual influenza vaccine is also recommended for those six months and older.
You should think about getting both vaccines before the end of September, according to Bernard Camins, MD, MSC, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System.
“The immune response from the COVID-19 vaccine can wane after a few months, so that’s why people should get the most current vaccine and be ready for the fall surge,” Dr. Camins says.
Those at risk for developing severe disease from COVID-19 should think about getting the new vaccines within the next month, according to Dr. Camins. This includes older adults, those with chronic medical conditions, such as diabetes, heart disease, chronic lung disease and those with reduced ability to fight infections, such as organ transplant recipients and those being treated for cancer.
You may find it easier to get your new COVID-19 vaccine and flu shot at the same time. However, if you want to get them one after the other, you should start with the COVID-19 vaccine, because the peak flu season usually occurs later than the COVID-19 surge, according to Dr. Camins.
Flu vaccines are important because the flu is contagious and can lead to serious illness, hospitalization, and even death, according to the U.S. Centers for Disease Control and Prevention (CDC).
Experts say getting the new COVID-19 vaccine is important now because the number of cases generally surges as colder temperatures arrive and people spend more time indoors, especially during the holidays.
In addition, the new COVID-19 vaccines have been developed to provide the best protection against the newest subvariants. The vaccines you may have gotten last year were developed for different strains. COVID-19 vaccines typically provide protection for up to 20 weeks before their effectiveness begins to decline.
Many private insurance plans, along with Medicare and Medicaid, cover the cost of COVID-19 vaccines. You can find more information from the New York City Department of Health about where to get the new COVID-19 vaccines.
Based on last year’s data, the COVID-19 vaccines will prevent COVID-19 in about half of people. But more importantly, they are more effective in preventing serious illness and hospitalizations for those who do become infected. They can also help you avoid complications from long COVID.
For kids, it’s important to get the COVID-19 vaccine because younger people can also have complications if they get infected, plus they can bring home infections where they can affect other family members who may be more at risk.
Meanwhile, your best defense against a COVID-19 infection remains the same: Keep up to date with your vaccinations, consider taking steps to limit your exposure to large indoor crowds, wear a well-fitting mask at public gatherings or in tight spaces such as an airplane or public transportation, and talk with your health care provider if you are feeling sick.
There is a third vaccine that older adults should consider getting, and that is for RSV (respiratory syncytial virus). RSV is a common respiratory virus that infects the lungs, but can also affect the nose and throat.
RSV spreads in the fall and winter along with other respiratory viruses, like flu and COVID-19. RSV usually peaks in December and January, according to the CDC. The CDC recommends the RSV vaccine for adults 75 years and older, and for adults 60 to 74 who are at increased risk for getting severe infections. You do not need to get the RSV vaccine every year.
Aug 28, 2024 | Your Health
As a new parent, it’s overwhelming to understand all of the recommendations and advice being shared. One sound piece of advice is to do “tummy time” with your baby.
Tummy time is actually a form of exercise, when you play with your baby while they are their tummy. This helps prevent two conditions seen in infants: plagiocephaly and torticollis. Although many new parents may not know what these conditions are, they are fairly common and respond well to treatment when caught early.
David Cancel, MD, JD
David Cancel, MD, JD, a pediatric rehabilitation medicine specialist and Director of Pediatric Rehabilitation Medicine at Mount Sinai, answers common questions about preventing plagiocephaly and torticollis and the best way to treat them.
“Early awareness of torticollis and plagiocephaly is important,” says Dr. Cancel. “Fortunately, most cases of plagiocephaly and torticollis respond well to conservative treatment. This is the reason we recommend early positioning and stretching.”
What is Plagiocephaly?
Plagiocephaly is a condition characterized by an abnormal head shape or a flattening of one side of the skull. Since the “Back to Sleep” campaign for babies started in the 1990s, there has been an increase in cases of plagiocephaly.
What causes plagiocephaly?
The most common cause is known as “positional plagiocephaly.” The skull of a newborn is softer and more flexible than in an adult. If the baby is laying in one position for long periods of time, usually on their backs, the head takes on a flattened shape in these areas. There are other risk factors including having a first child, having a premature birth, and having twins or triplets. Less common causes are medical conditions or genetic syndromes that may cause abnormal positioning in the womb.
What else should I be on the lookout for?
Older studies have shown that in about five percent of plagiocephaly cases, there are also associated hip abnormalities. In other cases, if there is a preference to turn the head to the same position, this can also lead to neck muscle tightness. This might lead to a condition called “torticollis.” These conditions are not always seen together, and one can be seen without the other.
What is Torticollis?
Torticollis is also known as a “wry neck” in which tightness at the neck muscles cause the head to tilt, turn, or rotate to one side. It may look like your infant’s neck is rotated at an odd angle. The top of their head may be tilted to one side, and their chin may be tilted to the opposite side.
What causes Torticollis?
Sometimes it can occur with plagiocephaly. Other times infants will turn their head to one side out of habit. It can also result from traumatic deliveries where an injured neck muscle limits head turning. In rare cases, it may be related to impaired vision, where the head is tilted to compensate for the difficulty in eye tracking. This is known as “ocular torticollis”.
What signs should parents look for?
For plagiocephaly:
- Your baby sleeps with their head in the same position.
- Baby’s head appears uneven when seen from above.
- There is a bald spot on the back of the head where it is flattened.
- The ear on the flat side appears “pushed forward.”
- One eye appears to be “squinting” because the cheeks are uneven.
For torticollis:
- A small bruise or “olive shaped” mass at the neck muscle (especially after difficult delivery).
- The head tilts to one side and chin tilts to the other side.
- Your baby seems to always “look” in the same direction.
- Baby has tightness or lacks full range of movement with their neck to one side.
- One of your baby’s shoulders is higher than the other.
What is the treatment for plagiocephaly and torticollis?
Both plagiocephaly and torticollis are treated using similar positioning techniques. For plagiocephaly, positioning is the key component. For torticollis, stretching is the main element parents learn to do at home. The earlier that the baby is treated with these techniques, the lower the risk of long-term problems affecting the head, neck, and face.
This is because over time torticollis can affect spinal alignment and impair hand/eye coordination and balance. In severe cases both plagiocephaly and torticollis can lead to an uneven shape of the head, jaw and, facial bones.
Some of the techniques include:
- Stretching exercises to loosen tight muscles and proper positioning to stretch the neck muscles. With consistent and daily practice, most babies are able to move their necks completely and build up equal strength on both sides of the body.
- Turning their heads to the non-preferred side. Babies can’t hurt themselves if they are turning their heads by themselves, so this should be encouraged.
- Carrying the baby in a position that gently stretches the neck while being carried.
- Playing with the baby to develop good motor skills and good hand coordination.
Some things your physical therapist might ask you to do at home include:
- Lots of tummy time.
- Positioning overhead mobiles or objects slightly towards the non-preferred side.
- Changing baby’s position or where they are sleeping, if they are turning their head towards sounds they hear.
- Teach therapy activities to your family and other caregivers.
- Practice some gentle massage techniques.
- Make the therapy and visual activities part of your child’s routine. Try to work therapy into all activities such as bath time, diaper changes, feeding, and carrying. This includes playtime.
One important note: You should do all therapy activities gradually and with gentleness. Do not move your child’s head forcefully. You may need to gradually build up tolerance to being stretched.
What if the head shape does not improve with therapy?
If the plagiocephaly still persists after these interventions, a physician or therapist will refer your child to have a cranial remolding helmet (plagiocephaly helmet) to help reshape their head. Most helmets are provided at about five months of age and must be worn 23 hours per day. In the most severe cases, if these measures are not successful, then the next step would be surgery to help reshape the bones of the skull (for plagiocephaly) or lengthen the affected neck muscles (in torticollis).
If you have concerns or questions, please call 212-241-3029 to schedule an appointment.
Learn more about Pediatrics at Mount Sinai: https://www.mountsinai.org/care/pediatrics
