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Osteoporosis is an all-too common disease, causing bones to become brittle to the point where even a minor fall or stressor can lead to a painful fracture and a difficult recovery. Unlike some illnesses, patients can’t feel their bones weakening, earning osteoporosis a nickname of the “silent disease.” Our bones are living tissue that regenerates regularly, but osteoporosis impairs this process and weakens bones, making a break much more likely. The disease is most common in women, affecting 20 percent of women 50 years and older, according to the CDC. One in 20 men are impacted as well, making osteoporosis a cause for concern for all aging adults.
As common as osteoporosis is, it often isn’t until someone finds themselves in the hospital or at the doctor with a painful injury that they are even diagnosed with it. As an Occupational Therapist (OT) at VNS Health, many of the home health care patients I work with have found themselves in this very predicament.
When we meet, they are usually happy to be home from the hospital but must now navigate uncharted territory tied to an osteoporosis diagnosis after a debilitating fall. It can be a challenging time, but I enjoy having the chance to work closely with my patients and their caregivers right in their homes, asking them questions and analyzing their daily routine to find ways to help them heal, and to prevent future injuries from happening. With almost all my patients, I work alongside my colleagues on the care team, particularly our team’s physical therapists (PTs) and nurses, to help patients learn and get comfortable with new movement patterns as they recover.
Everyone is unique, and there is no “onesize-fits-all” approach to healing.
Here are a few tips to keep in mind if you or a loved one has osteoporosis and are at risk for, or recovering from, an injury:
• Maintain a routine. Part of recovery involves keeping your muscles and body strong through exercises, particularly through weightbearing activities and walking—tailored routines that your PT and OT can work with you to develop. Once you have an exercise regimen that works for you, sticking to it will usually become easier over time as you grow stronger.
• Customize adjustments for daily activities. As an OT, much of my work is focused on helping my patients accomplish “ADL,” or their “Activities of Daily Life.” I work with my patients to see how they can safely live and function in their homes. For example, we might find that a shelf with dishes needs to be lowered so it’s closer to their center of gravity, or move a rug that could lead to a slip and possible fall. Additionally, we help in recommending assistive devices—for example, a grab bar or shower chair for the bathroom, or perhaps a “reacher” to pick up items. Changes like this can make a huge difference
when it comes to avoiding falls.
• Let us know if you’re in pain. One especially challenging aspect of osteoporosis is that a break or fracture can occur simply through normal activity, not just from falls or accidents. If you feel pain or something else unusual, be sure to let your clinicians know.
• Co-occurring illnesses can increase risks.
As adults live longer, they also may find themselves dealing with multiple chronic conditions. For example, I’ve had quite a few osteoporosis patients who also suffer from dementia or heart disease. It’s important to consult with your doctor and nurses to be aware of any medication side-effects that might put you at greater risk for falls, such as a certain medication that may cause dizziness.
• There is no such thing as a dumb question. When in doubt, I always tell my patients to ask me what I can do to help them as they recover—that’s what your clinicians are here for! And if it’s a question I don’t know the answer to as an OT, I always work with the rest of the team, including PTs, nurses and more, to find solutions.
Ultimately, with any choices about your health, be sure to consult with professionals before a major problem occurs. While chronic illnesses like osteoporosis are certainly a challenge, they can become more manageable with care and prevention measures, ensuring that you or a loved one can stay independent and comfortable at home.
Visit vnshealth.org or call 866-986-7691 for more information about VNS Health inlcuding healthcare services and career opportunities.
—Bernadette Timko is an occupational therapist with VNS Health
When he was only eight months old, William Long and his parents were diagnosed with COVID-19. Following a high fever, William suffered a seizure. Tests run at Cohen Children’s Medical Center revealed the presence of a lesion on the brain. Doctors at Cohen’s Children’s Medical Center said COVID ultimately saved William’s life. Pictured: Cohen Children’s Medical Center Dr. Shaun Rodgers, brave patient William Long, along with his parents, Alexandra and Michael. —Northwell Health
More than three million people in the United States have glaucoma. The National Eye Institute projects this number will reach 4.2 million by 2030, a 58 percent increase.
Glaucoma is called “the sneak thief of sight” since there are no symptoms and once vision is lost, it’s permanent. As much as 40 percent of vision can be lost without a person noticing.
Glaucoma is the leading cause of irreversible blindness. Moreover, among African American and Latino populations, glaucoma is more prevalent. Glaucoma is six to eight times more common in African Americans than Caucasians.
More than three million Americans, and more than 60 million people worldwide, have glaucoma. Experts estimate that half of them don’t know they have it. Combined with our aging population, we can see an epidemic of blindness looming if we don’t raise awareness about the importance of regular eye examinations to preserve vision. The World Health Organization estimates that 4.5 million people worldwide are blind due to glaucoma.
In the United States, approximately 120,000 are blind from glaucoma, accounting for nine to 12 percent of all cases of blindness.
Here are some ways you can help raise awareness:
• Talk to friends and family about glaucoma. If you have glaucoma, don’t keep it a secret. Let your family members know.
• Refer a friend to our web site, www.glaucoma.org.
• Request to have a free educational booklet sent to you or a friend.
• Get involved in your community through fundraisers, online information sessions or group discussions, etc.
Glaucoma is a group of eye diseases that gradually steal sight without warning. Although the most common forms primarily affect the middle-aged and the elderly, glaucoma can affect people of all ages.
Vision loss is caused by damage to the optic nerve. This nerve acts like an electric cable with over a million wires. It is responsible for carrying images from the eye to the brain. There is no cure for glaucoma—yet. However, medication or surgery can slow or prevent further vision loss. The appropriate treatment depends upon the type of glaucoma among other factors. Early detection is vital to stopping the progress of the disease.
There are two main types of glaucoma: primary open-angle glaucoma (POAG), and angle-closure glaucoma. These are marked by an increase of intraocular pressure (IOP), or pressure inside the eye. When optic nerve damage has
occurred despite a normal IOP, this is called normal tension glaucoma.
Secondary glaucoma refers to any case in which another disease causes or contributes to increased eye pressure, resulting in optic nerve damage and vision loss.
Glaucoma is the second leading cause of blindness in the world, according to the World Health Organization. In the most common form, there are virtually no symptoms. Vision loss begins with peripheral or side vision, so if you have glaucoma, you may not notice anything until significant vision is lost.
The best way to protect your sight from glaucoma is to get a comprehensive eye examination. Then, if you have glaucoma, treatment can begin immediately.
Glaucoma is a leading cause of blindness among African-Americans. And among Hispanics in older age groups, the risk of glaucoma is nearly as high as that for African-Americans. Also, siblings of persons diagnosed with glaucoma have a significantly increased risk of having glaucoma.
Are you at risk for glaucoma? Those at higher risk include people of African, Asian, and Hispanic descent. Other high-risk groups include: people over 60, family members of those already diagnosed, diabetics, and people who are severely nearsighted. Regular eye exams are especially important for those at higher risk for glaucoma, and may help to prevent unnecessary vision loss.
Visit www.glaucoma.org to learn more.
—Glaucoma Research Foundation.
Northwell Health announced the rollout of chatbots to obstetrics practices throughout the health system. An artificial intelligence-driven pregnancy chatbot, the customized, conversational platform is a key tool in Northwell’s high-tech and high-touch campaign to reduce maternal morbidity and mortality. The United States has the highest rates of those problems of any of the world’s industrialized nations.
The chatbot is both an educational program and a virtual safety net that can identify urgent concerns and ensure speedy help for women during and after pregnancy. It offers weekly informational dialogs that are based on the stage of pregnancy and personalized according to a patient’s self-reported risk factors. Many of the chat’s questions are designed to help patients notice subtle changes sooner than they otherwise might have, which can lead to earlier detection if complications are developing.
The chatbot links seamlessly with a Northwell care management team, enabling prompt escalation to in-person clinical care if a patient’s responses indicate a potentially serious issue, generally directing the patient to connect with her provider. “Red flag” responses trigger an immediate call from a care navigator at Northwell Health Solutions, the health system’s care management arm—or, in some cases, instructions to call 911 or go to the nearest emergency department.
A pilot program at a Northwell obstetric practice showed the
tool to be effective. The chatbot was used by 1,632 patients, 96 percent of whom reported being satisfied or somewhat satisfied with the experience. The chatbot successfully identified urgent health problems in a handful of users. One woman whose red-flag responses regarding blood pressure prompted a message to call 911 was found to have severe preeclampsia requiring hospitalization. (Preeclampsia is a serious condition involving high blood pressure during pregnancy and can be fatal if not treated.) In another case, during an automated
new-parent chat, a woman shared that she had experienced thoughts of harming herself; she reported that she had not shared her symptoms with her provider but felt comfortable acknowledging them to the chatbot because of the feeling of anonymity. The care team reached out immediately and within 24 hours was able to connect the patient with a psychiatrist and other mental health support.
The Northwell Health Pregnancy Chats were developed in conjunction with Conversa Health (part of Amwell), a leader in providing automated virtual health. Spanning pregnancy and the first year postpartum, the chats include a health risk assessment and cover maternal and fetal changes throughout pregnancy, blood pressure tracking, prenatal testing, birth plans, lactation support and more. The chatbot will eventually be offered to women receiving pregnancy care at clinics and OB practices throughout Northwell’s catchment area. Sign-up is at no cost to the patient, and chats can be accessed on a patient’s smartphone, tablet or computer.
The tool is an important step in Northwell’s initiative to reduce the country’s maternal mortality rate. In the U.S., 26 out of 100,000 women die during childbirth, compared to four out of 100,000 in Italy and Denmark and nine out of 100,000 in the United Kingdom. The risk is particularly extreme for Black women in the U.S., who are three times more likely than White women to die from pregnancy-related causes.
—Northwell Health
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Dr. Eric Levene, pediatrician with Allied Physicians Group, and his colleagues urge parents to learn about how to protect their children from accidental consumption of cannabis products. New laws in New York State allow the licensed sale of marijuana to those 21 years of age or older. Now that cannabis is legal for recreational use, many parents are unaware of the hazards and dangers of having edible cannabis in their homes or in homes of friends and relatives.
“We have always been concerned about drug and alcohol use by teens. However, with the significant national rise in accidental consumption and overdoses with young children, we now must focus on educating parents about responsible cannabis use and storage,” said Levene. Parents need to know the facts:
• It is illegal to drive while high as it impairs cognitive motor skills and decision making. Drivers who are high will be charged with a DUI and will face the same penalties as if they were drinking and driving.
• According to Leandra’s Law, penalties for driving impaired with children under 16 in a vehicle are greater than when driving alone.
• Edible marijuana takes longer to enter a person’s system and this process can take up to several hours.
• For children, cannabis harms developing brains, impacts the ability to think and solve problems, affects memory loss, reduces coordination and causes difficulty maintaining attention.
• Cannabis potency has steadily increased over the years. Even small amounts can have long term impacts on children. Tips for safely securing cannabis:
• Keep marijuana and cannabis products in secure places well out of the reach of children.
• Ensure that all edible and other cannabis products are kept in a lockable, safe storing container that children do not have access to.
• Make sure all edible and other cannabis products are out of sight and never left out.
• Talk with children about the dangers of using cannabis.
“For those who buy cannabis products, secure them like you would alcohol or medications in the home. Lock them away, do not keep them anywhere near the kitchen or places where families normally eat,” Levene said. “Today, edible cannabis is packaged to look like ordinary candies and goods with familiar looking brand names and graphics. They can easily be confused for treats like gummy bears, lollipops and baked goods like cookies or brownies.”
For parents, it is important to know
Dr. Eric Levene
Get your comfort from this creamy American side dish, which uses healthy olive oil instead of butter to add flavor and richness.
1-1/2 pounds small Yukon Gold potatoes, halved or cut into two-inch pieces
6 medium garlic cloves
1/4 cup olive oil (extra virgin preferred)
1/2 teaspoon black pepper (freshly ground)
1/4 teaspoon salt
1 cup chopped green onions
Put the potatoes, garlic, and salt in a large saucepan. Pour in enough water to cover the potatoes. Bring to a boil over high heat. Boil for 15 to 20 minutes, or until the potatoes are soft. Transfer the potatoes and garlic to a colander. Drain well. Return them to the pan.
Using the tines of a fork, mash the potatoes and garlic, being sure to crush each piece of potato and each garlic clove.
Add the green onions, oil, and pepper, stirring until well combined. Makes eight, half-cup servings.
—American Heart Association
the signs and be aware if your child has accidentally consumed marijuana. Young children who unintentionally ingest a marijuana/cannabis product can have the following effects: increased heart rate, vomiting, slurring of words, lack of coordination, dizziness, paranoia, anxiousness and difficulty breathing.
As more states across the nation legalize the use of recreational marijuana, there have been reports of children under the age of 12 consuming edible cannabis. Between 2017 and 2022, The U.S. Poison Control Centers have reported more than 7,000 kids under the age of six have eaten
marijuana edibles.
Accidentally consuming edibles is a risk for children that can result in the need for emergency medical attention. Harmful effects can include difficulty breathing, impaired motor skills and vomiting. If your child has ingested edible marijuana, immediately call poison control, 1-800-2221222. If your child is exhibiting any of the symptoms listed, immediately take your child to the hospital or call 911.
Visit www.alliedpediatrics.com for more information about cannabis safety and how to get in touch with a pediatrician.
—Allied Physicians Group
QI have a shooting pain down my leg that is worse on some days, and I think I have sciatica. When should I see a doctor and how is sciatica treated?
APain shooting down your leg is a telltale sign you have sciatica as opposed to another type of back pain, such as discomfort caused by muscle strain. Sciatica is nerve pain that starts in the lower back and/or buttock and radiates down one leg.
The most common cause is a bulging disc in the spine that is pressing on the sciatic nerve. Also called a herniated or slipped disc, it can occur from wear-and-tear over time or from an injury. The gel-like interior of the disc protrudes through a tear in its outer ring and pinches a nerve.
Sciatica is commonly described by patients as pain with an “electrical” or “burning” character. Others describe feeling “ice water running under my skin” or “ants crawling over” a particular affected area. Symptoms may worsen when you bend over, lift something, twist, sit down, or even cough or sneeze.
The encouraging news is that sciatica usually goes away on its own. About 75 percent of patients get better within a few weeks to a few months as the bulging disc shrinks and stops irritating the nerve. Most people do not need surgery.
As for when to see a doctor, patients with mild and welltolerated symptoms may be able to wait it out and see if the pain resolves on its own. They can try resting a bit and avoiding activities that make the pain worse. An over-the-counter antiin ammatory such as ibuprofen or naproxen can help, unless a patient is unable to take this medication. If pain does not improve within a week or two, there is no downside to seeing a doctor. One’s primary care physician is a good place to start.
Less frequent causes of sciatica include a bony growth on the spine that is pressing on a nerve, a fracture or an infection. If the pain is very bad or an individual experiences signi cant weakness or numbness, it’s a good idea to see a doctor sooner rather than later.
Anyone who experiences changes in bladder or bowel control should see a physician immediately. Pain accompanied by fever could be a sign of infection − another reason to seek medical care without delay.
Answer from Matthew Cunningham, MD, PhD, a spine surgeon at Hospital for Special Surgery (HSS) in New York City and at HSS Long Island.
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Many people with and without liver disease have signs and symptoms of gastroesophageal reflux or as most people refer to it, heartburn. Heartburn is common and all people at some point in their lives will have an episode of reflux. Typical features of heartburn include a burning sensation in the chest that may or may not be associated with nausea or vomiting. These symptoms are worsened by lying down or bending over after eating. Heartburn can cause bad breath, especially in the morning and it is a common cause of chronic cough leading to it being often misdiagnosed as asthma. Reflux may also be a cause of laryngitis, hiccups or difficulty swallowing.
If heartburn occurs occasionally, there is usually nothing to do except take an over-the-counter antacid and try to determine which foods may have brought it on. Prevention of reflux is the cornerstone of treatment and this requires lifestyle modifications. Avoid large meals, decreasing dietary fat intake and not lying down within three to four hours after eating are important steps that can be taken. Avoiding certain foods that are known to worsen reflux such as citrus and tomato-based products, alcohol, caffeinated beverages, carbonated beverages, chocolate, onions, garlic and peppermint.
Other lifestyle changes that help reduce episodes of reflux include avoid wearing clothing that is tight around the waist, losing weight and stopping cigarette smoking.
There are no specific tests to diagnose reflux or heartburn. The diagnosis is based on symptoms. Unless the heartburn is associated with alarm symptoms such as weight loss, difficulty swallowing, painful swallowing or bleeding, diagnostic tests are usually not indicated and empiric treatment can be started. If any of the above-mentioned alarm symptoms are present, patients should be seen by their gastroenterologist as they may require an upper endoscopy to better assess the esophagus for inflammation, stricture or malignancy.
The initial treatment of heartburn is lifestyle modification. If that does not adequately control the symptoms, then H2 receptor agonists and/or proton pump inhibitors can be started.
Most people with heartburn will become symptomatically controlled if they follow the regimens outlined above. The rare patient who does not improve significantly should be referred to a gastroenterologist for further diagnostic studies and more advanced treatments.
—David Bernstein, MD, MACG, FAASLD, AGAF, FACP
Since its founding by Clara Barton on May 21, 1881, the American Red Cross has been dedicated to serving people in need. Red Cross received its first congressional charter in 1900 and to this day is tasked by the federal government with providing services to members of the American armed forces and their families as well as providing disaster relief in the United States and around the world. In 2021, the Red Cross celebrated 140 years of compassionate service.
Even while the Red Cross adapts to meet the changing needs of the people which it serves, the organization always stays true to its roots. Are you familiar with the classic images of Red Cross nurses helping American soldiers and civilian war victims during World War I? In fact, as you read this Red Cross staff and volunteers are still deploying alongside America’s military. Maybe you’ve taken a
class through the Red Cross, such as first aid certification or how to swim. Did you know the Red Cross has been offering similar training since the early 1900s? Have you ever given blood or received donated blood? The Red Cross developed the first nationwide civilian blood program in the 1940s and still provides more than 40 percent of the blood products in this country.
Red Cross Month celebration in March has been an annual tradition since 1943, when President Franklin D. Roosevelt issued the first Red Cross Month proclamation.
Today, as throughout its long history, the Red Cross depends on generous contributions of time, blood, and money from the American public to support its lifesaving services and programs. You don’t have to wait until next March to help people in need.
Visit www.redcross.org to learn more.
—American Red Cross
Northwell Health has appointed Richard D. Carvajal, MD, an internationally recognized clinician and researcher in melanoma and early phase drug development, as deputy physician-in-chief and director of medical oncology at the Northwell Health Cancer Institute. He also was named the R. J. Zuckerberg Chair in Medical Oncology. Carvajal’s expertise includes the development of novel therapies for patients with melanoma and other cancers, with the goals of controlling and curing these diseases.
Prior to joining Northwell, Carvajal led the developmental therapeutics service at Memorial Sloan Kettering Cancer Center and then served as director of experimental therapeutics and director of the melanoma service at Columbia University Irving Medical Center, as well as co-lead of the Precision Oncology and Systems Biology Program at the Herbert Irving Comprehensive Cancer Center.
At the Northwell Cancer Institute, Carvajal will oversee medical oncology across Northwell’s cancer network, the largest in New York, collaborating with the cancer institute’s other two deputy physician-in-chiefs who specialize in surgical and radiation oncology. In this team structure, deputy physician-in-chiefs lead all cancer programs in their oncologic specialty, integrating and expanding the health system’s services with regional and hospital cancer leaders across New York City, Long Island and Westchester. He also will help lead efforts for Northwell’s Cancer Institute to achieve National Cancer Institute designation as a consortium with Cold Spring Harbor Laboratory.
“Dr. Carvajal is an innovator in clinical care, immunotherapy and leading-edge research in the field of melanoma and other cancers,” said Richard Barakat, MD, physician-in-chief and director of the Northwell Health Cancer Institute, and senior vice president of the health system’s service line. “We are very fortunate to have such an esteemed medical oncologist and cancer researcher join the Cancer Institute’s leadership team. Our colleagues are looking forward to closely working with Dr. Carvajal to help design new clinical trials and treatment options more quickly to help patients fighting not only melanoma but other complex cancers.”
At Northwell, Carvajal will see patients at the R. J. Zuckerberg Cancer Center in Lake Success and Northwell’s Manhattan Eye, Ear & Throat Hospital. He also will participate in clinical research at Northwell’s Feinstein Institutes for Medical Research and Cold Spring Harbor Laboratory, with which Northwell has a strategic affiliation. Carvajal will hold an academic title of professor of medicine at the Donald and Barbara Zucker
School of Medicine at Hofstra/Northwell.
Carvajal received his medical degree from NYU Grossman School of Medicine and completed his fellowship in medical oncology/hematology at Memorial Sloan-Kettering
Cancer Center.
Carvajal’s research has been supported by the National Cancer Institute, the Food and Drug Administration, the Conquer Cancer Foundation, the Melanoma
Research Alliance, the Melanoma Research Foundation and the Empire Clinical Research Investigator Program. He has authored or co-authored more than 200 peer-reviewed articles, books and book chapters. Carvajal serves on the editorial board of six cancer journals and is an ad hoc reviewer for nearly 65 prestigious oncology and medical journals. He has received several awards in recognition of his work, including the Louise and Allston Boyer Young Investigator Award and the Melanoma Research Foundation CURE OM Vision of Hope Award.
In addition, Carvajal has served as the co-chair of the International Rare Cancer Initiative Uveal Melanoma working group, a joint initiative between the National Cancer Institute, the European Organization for Research and Treatment of Cancer, and the Cancer Research UK to enhance international collaboration in the conduct of clinical trials for uveal melanoma (arising from the eye).
Athough ticks are most active during warmer months (April-September) tick exposure can occur year-round. In fact, local hikers and dog walkers are reporting picking up ticks now on their regular daily walks already, due to the mild winter temperatures.
• Know where to expect ticks. Ticks live in grassy, brushy, or wooded areas, or even on animals. Spending time outside walking your dog, camping, gardening, or hunting could bring you in close contact with ticks. Many people get ticks in their own yard or neighborhood.
• Treat clothing and gear with products containing 0.5 percent permethrin. Permethrin can be used to treat boots, clothing and camping gear and remain protective through several washings. Alternatively, you can buy permethrin-treated clothing and gear.
• Use Environmental Protection Agency (EPA)-registered insect repellents containing DEET, picaridin, IR3535, Oil of Lemon Eucalyptus (OLE), para-menthane-diol (PMD), or 2-undecanone. EPA’s helpful search tool can help you find the product that best suits your needs. Always follow product instructions. Do not use products containing OLE or PMD on children under three years old.
• Avoid contact with ticks by avoiding
wooded and brushy areas with high grass and leaf litter. Always walk in the center of trails.
Check your clothing for ticks. Ticks may be carried into the house on clothing. Any ticks that are found should be removed. Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors. If the clothes are damp, additional time may
—Northwell Healthbe needed. If the clothes require washing first, hot water is recommended. Cold and medium temperature water will not kill ticks.
Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and daypacks.
Shower soon after being outdoors. Showering within two hours of coming indoors has been shown to reduce your risk of getting Lyme disease and may be effective in reducing the risk of other tickborne diseases. Showering may help wash off unattached ticks and it is a good opportunity to do a tick check.
Check your body for ticks after being outdoors. Conduct a full body check upon return from potentially tick-infested areas, including your own backyard. Use a handheld or full-length mirror to view all parts of your body. Check these parts of your body and your child’s body for ticks:
• Under the arms
• In and around the ears
• Inside belly button
• Back of the knees
• In and around the hair
• Between the legs
• Around the waist
—Centers for Disease Control and Prevention (CDC)
The things you love doing are more than just passions. They’re what make you “you.” This is why at The Bristal, our expert team members dedicate their time, attention, and energy to creating customized social activities that ensure each resident continues being the unique person they are. And, in the process, create the one-of-a-kind community we are, too.
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