If you have always avoided vaccination and have never had the flu, you may wonder, “Why do I need a flu shot?” Here are five good reasons, along with answers to some common questions about flu vaccine, from Brian S. Koll, MD, recently retired as Executive Medical Director for Infection Prevention and Control, Mount Sinai Health System.
The holiday season is a time for celebration, fun, and decadent food. Eating healthy can be a challenge for anyone, but especially for those with kidney disease. Holiday dishes and old family recipes, while delicious, are often laden with sodium, potassium, and phosphorus, making it difficult to follow a renal diet.
“Mindless grazing on snacks and hors d’oeuvres can make anyone veer off track and can cause a lapse in dietary compliance. Thankfully, with a little planning, preparation, and mindfulness, you can enjoy a kidney-friendly holiday season, “says Jennifer Ross, MS, RD, CDN, Clinical Nutrition Coordinator with the Recanati/Miller Transplantation Institute.
Ms. Ross recommends that you keep the following tips in mind as festivities are in full swing:
Below are some additional ideas for each course that will help to keep you on track with your renal diet:
Remember, if you have kidney disease, or reduced kidney function, make an appointment with a dietitian to create a tailored plan to address your health needs.
Jennifer Ross, MS, RD, CDN, is a clinical dietitian at The Mount Sinai Hospital with the Recanati/Miller Transplantation Institute. She works closely with patients who are pre- and post-liver and kidney transplants. She is passionate about helping her patients conquer the world of nutrition in relation to their disease in order to help them live their healthiest life.
A renal diet is one that is low in sodium, phosphorus, and potassium. Those with kidney disease, or compromised kidney function, are unable to adequately filter waste from the body. A diet that reduces these nutrients limits the amount of waste, preventing the compromised kidney from being overworked. Depending on the condition of the kidney, people on a renal diet may need to limit protein, calcium, or fluids. If you have kidney disease, or reduced kidney function, make an appointment with a dietitian to create a tailored plan to address your health needs.
Charles L. Shapiro MD, FASCO
The New England Journal of Medicine published an article November 9 about the long-term risks of breast cancer recurrence after stopping endocrine therapy at five years.
Here are some answers to patient questions from Charles L. Shapiro MD, FASCO, Professor of Medicine (Hematology and Oncology) at the Icahn School of Medicine at Mount Sinai and Director of Translational Breast Cancer Research and Director of Cancer Survivorship at The Tisch Cancer Institute.
Q: What is important about this study?
A: The idea that breast cancer can reoccur late is not new information. There were always a small minority of women who experience a recurrence 10, 15, 20 years and even more after the diagnosis and treatment of the original primary breast cancers.
Q: What is new in the study?
A: What is new in this study is the magnitude of late-appearing recurrences, and that breast cancer-specific mortality is higher than one would expect. However, there are several caveats. Although more than 60,000 women participated in more than 80 clinical trials cited by the study, these trials were designed many years ago and included all estrogen receptor-positive cancers. So much has changed in the last 25 years.
Q: Can you give an example?
A: One change is our recognition that there are at least two types of estrogen receptor-positive breast cancers, Luminal A (that have a lower chance of recurrence) and Luminal B (that have a higher chance of recurrence), with very different biological behaviors and different clinical outcomes. This study does not distinguish between these two types of estrogen receptor-positive breast cancers. Also, there was no information in this study on patients who received adjuvant chemotherapy, and the studies didn’t use trastuzumab (Herceptin). Adjuvant chemotherapy and trastuzumab are frequently used to treat Luminal B cancers.
Q: What group of patients are affected by this study?
A: Women with estrogen receptor-positive breast cancers, which represent about 75 percent of all breast cancers.
Q: Who is most at risk?
A: Those most at risk of a recurrence are those treated decades earlier when treatment options and our knowledge of science were more limited.
Q: Should doctors immediately extend tamoxifen treatment to 10 years instead of five? If women have already gone off tamoxifen after five years, should they go back on?
A: No, not on the basis of this study. These trials were performed decades ago and do not reflect modern approaches to treatment in women with early stage estrogen receptor-positive breast cancers. For example, now we have tests based on genes expressed by the breast cancer that predict who is likely to recur five or more years after the original primary diagnosis. And more of these are coming.
Q: Should breast cancer patients be worried?
A: Women now undergoing treatment do not need to be extra worried. These study results are from old clinical trials, and so they are just not as relevant to women diagnosed today. There are improvements in breast imaging that leads to diagnosis of breast cancer at an earlier, more curable stage. That coupled with advances in treatments and supportive care (such as improved drugs for nausea or growth factors that boost the white blood cell count and aid recovery from chemotherapy) has led to a steady decline in breast cancer mortality during the last 30-plus years. Also, our deepening knowledge of the biology of breast cancer has led and will lead to new therapies for estrogen receptor-positive breast cancers. The future is full of hope.
Q: What should I do if I have questions?
A: Call your health care provider.
Family meals are a great occasion to enjoy time together. These shared meals can result in feeling closer, and more nutritious meals are an essential ingredient for a happy, healthy family life. Micah Resnick, MD, a board certified pediatrician at Mount Sinai Queens, explains how parents can use shared meals to establish a commitment to lifelong nutrition in children.
I encourage families to cook together, eat together, and talk together. This can happen at any meal – breakfast, lunch, or dinner – so try to find the meal that will allow the most time and relaxation.
What are the nutritional benefits to family meals? In June 2011, a study published in the medical journal Pediatrics found that sharing three or more family mealtimes per week resulted in a 12 percent reduction in the odds of being overweight; a 20 percent decrease in eating unhealthy foods; a 35 percent decrease in disordered eating; and an increase of 24 percent in the odds for eating healthy foods.
Family meal times are a great place to start your kids on a lifelong commitment to nutrition and a healthy relationship to food. Involve your children in age-appropriate meal planning and shopping. If dinner is your family meal, be sure to plan for healthy snacks beforehand so that your children are appropriately hungry at the start of mealtime, but not too crabby to participate in the fun. For picky eaters, mealtime offers an opportunity to try one or two new foods a week. Do not force your children to eat new foods; however, gentle consistent encouragement will go a long way toward a bite of broccoli or pineapple.
Meals are also an excellent time to hear about your children’s daily experiences. Ask about school, friendships, what is going well, and where they may need help.
Children learn a great deal from their parents about socialization and how to communicate. Meals are definitely a time for parents to model good habits like table manners and listening skills. Encourage your children to practice these skills which will provide enduring benefits. I recommend that parents model a “no screens rule” during family meals – TV off, phones away.
Consider your children’s ages to ensure successful mealtimes. Younger children shouldn’t be challenged to sit through long meals.
Quality is just as important as quantity. Set a realistic goal for your family – plan for three times a week to start and see if you can increase that number over time.
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.
Coaxing answers out of children can be difficult. To get an answer other than “fine,” I like to play a table game called “Talk Show.” I act as the host and treat my children as guests. It goes something like this:
Me (in my best announcer voice): Good evening and welcome to Micah Family Talk. I am Dr. Micah and my special guest today is Sophie. Sophie, please tell us what is the most fun thing you did at school today?
Sophie: Mrs. Reyes has us work on posters to welcome new kids to school. They move the posters around and put them in the classroom when a new kid starts. I used paints AND markers.
I ask follow-up questions and work to identify issues. We problem-solve as a family and I also give praise for jobs well done.
There are preventive steps you can take to cut your breast cancer risk. For starters, avoid hormone-replacement therapy and get mammograms and other screenings as recommended by your doctor. But you can also protect yourself with lifestyle changes, according to Paula Klein, MD, Associate Professor of Medicine (Hematology and Medical Oncology), Icahn School of Medicine at Mount Sinai, who sees patients at the Women’s Cancer Program at Mount Sinai Chelsea.
Vaccines represent one of the most important advances in medicine. The American Academy of Pediatrics (AAP)—an organization of 66,000 pediatricians committed to the well-being of all children—wholeheartedly endorses the recommended vaccination schedule created by the U.S. Centers for Disease Control and Prevention (CDC). Despite this, many believe that vaccinations are unnecessary, or even dangerous. Micah Resnick, MD, a board certified pediatrician at Mount Sinai Doctors Queens, explains why vaccines are safe and critically important.
Misinformation about vaccination is prevalent. Poorly conducted, debunked studies claim vaccines cause autism, and well-meaning but ill-advised parents assert that too many vaccinations are administered. If you have concerns about vaccinations, I encourage you to talk to your child’s health care provider. Get your questions answered. Feel comfortable. Then, get your child vaccinated.
Here are the facts: overwhelming scientific evidence supports the safety of vaccines.
Children who, for whatever reason, are not vaccinated against vaccine-preventable diseases are at risk for those diseases. Unvaccinated children also pose a significant risk for children who are medically exempt from receiving vaccines. Those medically exempt include immunosuppressed children who may be receiving chemotherapy, and children who have a severe allergy to a vaccine component or have another immunosuppressive condition.
When almost all children receive vaccines for vaccine-preventable diseases, herd immunity—a form of indirect protection from infectious disease—is achieved. Essentially, when a large percentage of a population has become immune to an infection, a measure of protection is provided for individuals who are not immune.
What happens when we do not achieve herd immunity? Preventable outbreaks. In 2015, a measles outbreak started at Disneyland in Anaheim, California. As a result, more than 100 people contracted the extremely contagious disease. According to AAP’s statistics, more than 3 percent of kindergartners in California claimed a non-medical exemption for vaccination at the time of the outbreak. Of those who came down with measles, 83 percent were either unvaccinated or of unknown vaccine status. Forty percent of the cases were in children too young to receive the vaccine, so without herd immunity, these children remain vulnerable. We must all do our part to protect our families, our neighbors, and our fellow citizens.
There are some side effects to vaccines—tenderness at the vaccination site, mild fever, fussiness, and even a high fever which may prompt a visit to your pediatrician. But the side effects are temporary. By contrast, contraction of a vaccine-preventable disease can result in permanent disability. For example, though rare, infection from mumps can cause deafness. A parent’s best defense is vaccination.
I may sound like a bit of a scold here, but it is a reflection of how strongly I feel about helping you protect your children. During visits, I encourage parents to follow the CDC vaccination schedule. I answer their questions and highlight resources like the CDC’s “For Parents: Vaccines for Your Children” and this FAQ.
Please remember that this information is not a substitute for direct medical advice.
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.