Metro New York’s Ask Mount Sinai: How to Live with Epilepsy

Updated on Jun 30, 2022 | Your Health

Those with epilepsy in New York can find  helpful services at a major medical system, including the Mount Sinai Health System, which have dedicated epilepsy centers that provide comprehensive management of epilepsy, according to Kyusang S. Lee, MD, Associate Director of the Epilepsy Program at Mount Sinai Union Square. The Epilepsy Foundation of Metropolitan New York also provides epilepsy education and advocacy combined with services such as counseling and vocational supports.

Read the Q&A in Metro New York

 

New York Daily News: Thyroid Disease May be the Reason You Feel so Bad

Updated on Jun 30, 2022 | Your Health

Thyroid disease is an under-recognized problem that can profoundly affect your day-to-day life. Getting the right treatment can be so transformative that patients will often say, “I didn’t realize how bad I was feeling for all of those years.” Here’s what you need to know from Terry F. Davies, MD, FRCP, Baumritter Professor of Medicine (Endocrinology, Diabetes and Bone Diseases) at the Icahn School of Medicine at Mount Sinai and Co-Director of The Thyroid Center at Mount Sinai Union Square.

Read the article in The New York Daily News

 

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How Can I Get My Child Through an Injection?

Nov 29, 2017 | Children's Health, Your Health

No one likes injections. In just the first year of a healthy baby’s life, 12 shots will be administered. More injections will follow through adolescence, making needles an uncomfortable but necessary fact of life. Micah Resnick, MD, a board certified pediatrician at Mount Sinai Doctors Queens, explains how to minimize the stress and pain surrounding these injections, which help you and your child stay healthy.

Only a handful of my friends get their annual flu vaccines, the rest skip out because of their needle phobia, so it is no surprise that infants and children are fearful of injections and blood draws. How can we, as parents and as physicians, help alleviate the fear? I never lie to parents when they ask me if infants can feel pain. Yes, they can. However, for babies and children of all ages, it is important that parents stay calm, smile, and use encouraging words. Your child, especially toddlers and older children, will take cues from you.

For babies, physical contact is very important. Hold your baby close in an upright position. You may want to breastfeed before, during, and after the immunization to calm your baby down. There are over-the-counter topical anesthetic creams that may minimize the pain, but these can take 30 to 60 minutes from application to start working.

Toddlers require more active intervention. Tell your toddler about the injection ahead of time. You know your child best—some young children respond well to being told just before, while other children may do better with several short discussions in the days leading up to the doctor visit. In either case, try to distract your child at the time of the injection by blowing on a pinwheel or even blowing something imaginary out of your hand. Don’t tell them it will only hurt a little, or it will be over soon. This will only remind them of the discomfort.

School-aged children are typically more reasonable. Honesty is the best policy here. The goal is to set a realistic expectation. Explain to your child that injections are necessary. Let them know that the little pinch from the needle keeps them from getting sick.  For the injection, your best bet is to distract your child: you can play music or talk about a book you both like. In my office, I have colorful posters of animals and trees on the wall. I often point to those animals or ask a child to list the different ones on the wall he or she recognizes.

Talk with your child about the experience afterward. Acknowledge the pain. Give praise for doing a good job, or even just for a “best effort.” Ice cream or another enjoyable treat may also be in order.

What do you do with an absolutely inconsolable toddler or child?  Number one, don’t drag it out. Take a short time to reason with your child, and if it is a no go, hold your child while the injection is given. It is only very rare cases, when the fear turns into a phobia, that the services of a psychologist may be necessary. Remember, we are hoping that your child sees injections as an unpleasant fact of life. Stay positive, stay supportive.

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.

Schedule an appointment with Dr. Resnick

Quick Tips for Parents

  • Use contact as a comfort.        Hold your child using as much skin-to-skin contact as possible.
  • Provide a distraction.                 Use movement, sucking, music, toys, talking, rocking, or singing to distract your baby.
  • Breastfeed before, during, and after an injection.               Nursing may be the perfect pain reliever for simple procedures. It involves holding, skin-to-skin contact, sucking, and a sweet taste—all proven ways to reduce the pain a baby feels.
  • Give a sweet treat.                          As an alternative to breastfeeding, give your child a sugar solution on a pacifier. Remember, never use honey in babies under one year old as it can cause botulism.
  • Have a pain reliever handy.        Ask your pediatrician about proper dosing of pain relievers—acetaminophen or ibuprofen—for your baby, or inquire about other medicines to help relieve pain after the visit.

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What to Eat During the Holidays If You Have Kidney Disease

Nov 17, 2017 | Diet and Nutrition, Your Health

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:

  • Bring a kidney-friendly dish. For general dietary compliance, this can be helpful, as you are ensuring that there is at least one thing at the party that you can eat. The National Kidney Foundation provides many kidney-friendly recipes that can be enjoyed by everyone.
  • Keep a food diary. It may be helpful to closely monitor what you are eating throughout the day to help keep your overall potassium and phosphorus intake in control.
  • Avoid salt as a seasoning. Party foods and larger holiday portions typically mean an increase in salt consumption. Therefore, it may be beneficial to decrease overall sodium intake. Instead of salt, incorporate flavorful components like onions and roasted garlic or fresh herbs like oregano, rosemary, and thyme.
  • Eat small portions. If high-potassium foods like pumpkin, brussels sprouts, or potatoes are being served, indulge in a small portion of only one of those foods.
  • Do not forget your medication. Make sure to take any prescribed phosphate binders with meals and snacks to keep your phosphorus level in control.

Below are some additional ideas for each course that will help to keep you on track with your renal diet:

Appetizers and Snacks
  • Unsalted popcorn
  • Cream-cheese or ricotta-based spreads with low-sodium crackers, unsalted pretzels, apples, or celery for dipping
  • Macaroni, chicken, or egg salad
  • Deviled eggs
  • Low-sodium soups and stews made with turkey or chicken and low-potassium vegetables
  • Breads made with zucchinis or apples
Main Courses and Accompaniments
  • Fresh roasted turkey or chicken
  • Baked, broiled, or grilled fish
  • Beef, lamb, and pork chops
  • Roasted low-potassium vegetables like green beans, peppers, cabbage, asparagus, and mushrooms
  • Glazed carrots
  • Low-sodium gravies
  • Cranberry sauce
  • Roasted cauliflower, which can also be prepared like mashed potatoes for a low-potassium alternative
  • Homemade stuffing
Desserts
  • Pies, tarts, custards, and cakes that incorporate kidney-friendly fruits like apples, berries, lemons, and cherries.
  • Ginger cookies
  • Glazed pears
  • Non-dairy whipped topping

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.

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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.

 

What is a renal diet?

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.

Q&A: What Women Need to Know about the New England Journal of Medicine Article on Breast Cancer Recurrence

Nov 17, 2017 | Featured, Your Health

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.

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