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ROUTINE OR SERIOUS? ALL ABOUT HEADACHES SIGNS AND SYMPTOMS CERVICAL MYELOPATHY
SCREENING SAVES LIVES COLORECTAL CANCER
Montefiore Nyack
Hospital Updates
FROM THE PRESIDENT
Dear Readers,
Each New Year brings with it excitement about what the new year will hold. For those we serve, 2025 will offer expanded programs, technological advances and access to the academic level of healthcare you expect and can receive locally without the stress of travelling for similar services.
The journey into 2025 begins with the launch of our Montefiore Nyack Cancer Center’s new radiation oncology department. This department is led by the radiation oncology experts from the Montefiore Einstein Comprehensive Cancer Center which ranks in the top 1% of all U.S. Hospitals for cancer care according to U.S. News and World Report. With the newest and most advanced TomoTherapy unit and PET CT equipment, our team of cancer experts will be able to identify cancers earlier and offer more precise treatment with minimal side effects, providing an unparalleled level of care.
Our mission to provide comprehensive care for all ages continues into 2025 with our new offering of pediatric orthopedic services. Pediatric orthopedists will now be available to treat various orthopedic conditions affecting children from birth to age 21 and those with limb deformities of any age, all within our community. From state-of-the-art sports medicine to complex musculoskeletal disorders, pediatric orthopedists from the Children’s Hospital at Montefiore will see patients at the newly opened Montefiore Einstein Comprehensive Orthopedic and Spine Center in West Nyack. Please see page 12 on which Dr. Eric Fornari, co-director of pediatric orthopedics and associate professor of orthopedic surgery and sports medicine at Montefiore Einstein, shares his thoughts about what to look for in identifying sports injuries and treatments available.
Also beginning in 2025, our neurosurgery team of experts from Montefiore Einstein and White Plains Hospital will see patients afflicted with brain and spine conditions at our Highland Medical Neurology office in West Nyack and provide both scheduled and emergency surgical services at Montefiore Nyack Hospital.
With these new offerings and more to come later in the year, and in partnership with our colleagues at the Montefiore Health System, we further demonstrate to you, our community, our commitment to the health and wellbeing of our patients.
We wish you a year of good health and want you to know, should you need us, the Montefiore Nyack team is here for all your healthcare needs.
Mark E. Geller, MD, FACR
President & CEO
Montefiore Nyack Hospital
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BE PREPARED FOR COLD AND FLU SEASON
According to Alexandra Harris, PharmD, BCPS at Montefiore Nyack Hospital, a well-stocked medicine cabinet with these pharmacistrecommended items is essential. Check expiration dates and replace outdated items.
Pain Relief and Fever Reduction: (acetaminophen (Tylenol), ibuprofen (Advil, Motrin) and aspirin (for adults only; not recommended for children).
Cold, Cough and Allergy Relief (decongestant, antihistamines, cough suppressant, throat lozenges and saline nasal spray)
Digestive Health (antacids and anti-diarrheal)
Wound Care and First Aid (hydrogen peroxide/antiseptic solution; antibiotic ointment; instant cold packs; elastic bandage for sprains and adhesive bandages for cuts.
Skin Care and Anti-Itch (hydrocortisone cream for itch relief; calamine lotion for rashes; antifungal cream; hand sanitizer
“While over-the-counter medications are relatively harmless, consult with a pharmacist to ensure there aren’t any interactions with other medications you are taking,” advises Harris. “For example, the sedating effects of an antihistamine like diphenhydramine (Benadryl) can be compounded if you are taking certain painkillers.”
Storing medications in the bathroom is discouraged because of high humidity and temperature fluctuations, which can shorten shelf-life and effectiveness. Instead, store in a cool, dry place avoiding direct sunlight, and keep away from children and pets.
For more tips, visit our health blog at montefiorenyack.org/health-blog.
EDITORIAL STAFF
Lauren Malone, Assoc. VP, PR and Marketing
Rose Croke, Director of Communications
Briana Tolve, Marketing Manager
Jasmine Gonzalez, Marketing Coordinator
4
4 WHEN YOUR HEAD HURTS
How to know if a headache is routine or something more serious.
6 WHAT YOU NEED TO KNOW ABOUT STATINS
The right information about this medication can help you make informed choices.
8
8
COLORECTAL CANCER: THE INS AND OUTS
Screening can detect signs of cancer. Here’s what to know.
10
CERVICAL MYELOPATHY: SIGNS AND SYMPTOMS
Here’s when to seek help for this spine condition.
12
12
PEDIATRIC SPORTS INJURIES
Understanding indicators of serious injury can help keep your child in the game.
14
TREATING SLEEP APNEA
Don’t brush off poor sleep as something you have to endure; there are many ways to treat sleep apnea.
MONTEFIORE NYACK HOSPITAL RECEIVES
QUALITY ACHIEVEMENT AWARD
Montefiore Nyack Hospital has received the American Heart Association’s Get With The Guidelines®—Stroke Gold Plus quality achievement award for its commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines, ultimately leading to more lives saved and reduced disability.
Stroke is the fifth leading cause of death and a leading cause of disability in the U.S. Early stroke detection and treatment are key to improving survival, minimizing disability and accelerating recovery times. In addition, Montefiore Nyack Hospital also received the American Heart Association’s Target: Type 2 Diabetes™ Honor Roll award. Target: Type 2 Diabetes aims to ensure that patients with this disease, who might be at higher risk for complications, receive the most up-to-date, evidence-based care when hospitalized due to stroke.
For information, visit heart.org
WHEN YOUR HEAD HURTS
HOW CAN YOU TELL A ROUTINE HEADACHE FROM ONE THAT SIGNIFIES A BIGGER PROBLEM?
Almost everyone feels the throb or tightness of a headache from time to time. Headaches are one of the most common medical complaints, but they can be complicated to manage. In some instances, a headache may indicate something more serious that needs medical attention.
“Usually, people with a history of headaches know them well,” says Andrew Erian, MD, a neurologist with Highland Medical, Rockland Neurological Associates in West Nyack, NY.
“What’s more concerning is headaches that aren’t like any headache you’ve had before. This is why understanding the different types, causes and treatments can help to manage them effectively.” Headaches can be classified into two main categories: primary and secondary
PRIMARY HEADACHES:
These are not caused by another medical condition and include:
• Tension Headaches: The most common type, a tension headache causes dull, constant pain, typically across the forehead or the back of the head and neck, that feels like a tight band around the head.
• Migraines: Intense, often debilitating pain, usually on one side of the head, often accompanied by nausea, vomiting, or sensitivity to light and sound. Migraines may also have an “aura” (visual disturbance) before the headache begins.
• Cluster Headaches: Severe, unilateral pain that occurs in clusters or groups (sometimes multiple headaches a day over some time). These are often accompanied by eye watering or nasal congestion.
• Trigeminal Neuralgia: Severe, shock-like pain affecting the face, usually on one side, triggered by light touch or movement.
SECONDARY HEADACHES:
These are caused by another underlying health issue.
• Sinus Headaches: Pain due to inflammation or infection in the sinuses. Deep, dull pain in the forehead, cheeks or around the eyes. These headaches are often accompanied by sinus pressure and congestion.
• Rebound Headaches: Caused by the overuse of pain medications, like ibuprofen or acetaminophen.
• Headaches due to dehydration: Low fluid intake or dehydration can trigger headaches.
• Cervicogenic Headaches: Caused by issues in the neck or spine.
• Headaches related to tumors, stroke or meningitis: These are more serious and rarer causes of secondary headaches.
COMMON TRIGGERS
Headaches, particularly migraines and tension headaches, can be triggered by stress and anxiety or worsened by foods and beverages like chocolate, cheese, caffeine, alcohol and processed foods. Poor sleep or not drinking enough water can also exacerbate headaches.
Other triggers can be hormonal fluctuations, particularly in women during menstruation, pregnancy or menopause. Environmental factors like bright lights, loud noises and strong odors may also trigger a headache.
DIAGNOSIS AND TREATMENT
If headaches are frequent, severe or unusual, see a healthcare provider to review your medical history and conduct a physical exam to check for neurological signs. Regular sleep, hydration, stress management techniques (like yoga or meditation) and a balanced diet can help manage headache frequency and severity. In some cases, imaging tests like an MRI or CT scan may be ordered to rule out structural problems or tumors.
Treatment can vary depending on the type and severity of the headache. For mild headaches, over-the-counter pain relievers such as ibuprofen can be effective. For more severe cases, like migraines, beta blockers, CGRP antagonist medications, calcium channel blockers, Botox, antidepressants or anticonvulsants may be prescribed.
Other preventive treatments
may include acupuncture or physical therapy.
WHEN TO SEEK MEDICAL ATTENTION
While most headaches are not dangerous, certain warning signs require immediate medical attention.
• A sudden, severe headache that hits like a thunderclap should be considered a medical emergency. This may signify a brain bleed caused by an abnormality in the blood vessel system such as an aneurysm or ruptured blood vessel.
• Headaches that are accompanied by neurological symptoms, like confusion, weakness on one side, numbness, vision changes or difficulty speaking.
• A headache that worsens over time or does not respond to standard treatments.
• A headache that begins after a head injury or a fall and is followed by symptoms like vomiting or loss of consciousness.
PREVENTIVE MEASURES
To reduce the frequency or severity of headaches, keep a headache diary to track triggers and patterns. Persistent headaches that you can’t relieve with conventional remedies should be evaluated. If steps like rest, hydration and taking overthe-counter pain medications, such as acetaminophen or ibuprofen, don’t help after a week, or your headaches keep getting worse, don’t hesitate to discuss it with your doctor. Even though they’re common, headaches are worth investigating if they concern you.
To schedule an appointment with one of our neurologists at Highland Medical, Rockland Neurological Associates at 2 Crosfield Avenue, Suite 202, in West Nyack, NY, call (845) 353-4344 For more information, visit highlandmedicalpc.com/neurology
ANDREW ERIAN, MD
STATINS WHAT YOU NEED TO KNOW ABOUT
THESE MEDICATIONS HELP LOWER CHOLESTEROL LEVELS IN THE BLOOD AND REDUCE THE RISK OF HEART DISEASE AND STROKE.
Statin therapy is one of the most prescribed treatments for managing cholesterol and preventing heart disease. Studies show that statins significantly reduce the risk of heart attack, stroke, peripheral artery disease and other
cardiovascular events, especially in patients with high cholesterol, existing heart disease or diabetes.
“Statins work by reducing cholesterol synthesis in the liver,” says Duane Bryan, MD, FACC, chief medical director of nuclear cardiology at Montefiore Nyack Hospital and a cardiologist with Highland Medical, Advanced Cardiovascular Care in West Nyack, NY.
“Statins block an enzyme the
DUANE BRYAN, MD, FACC
“Statins block an enzyme the liver needs to make cholesterol, which causes the liver to remove cholesterol from the blood.”
Duane Bryan, MD, FACC, chief medical director of nuclear cardiology at Montefiore Nyack Hospital and a cardiologist with Highland Medical, Advanced Cardiovascular Care in West Nyack, NY
liver needs to make cholesterol, which causes the liver to remove cholesterol from the blood.”
BENEFITS OF STATINS
Statins are highly effective at reducing low-density lipoprotein (LDL), or “bad” cholesterol, which can build up in artery walls and lead to plaque formation known as atherosclerosis. Plaque buildup narrows the arteries and increases risk of heart attacks and strokes.
Statins help slow the progression of the disease and reduce risk of major heart events like heart failure or the need for coronary artery bypass surgery. Statins may help stabilize plaques in the arteries, making them less likely to rupture, which could otherwise trigger clot formation that leads to heart attacks.
These medications are also prescribed to people with diabetes due to statins’ ability to prevent cardiovascular complications. Despite some risks of raising blood sugar levels, the benefits of reducing heart disease risk generally outweigh this concern.
RISKS AND SIDE EFFECTS
One of the most common side effects is muscle pain or weakness. Patients may feel this pain as soreness or tiredness. Some people report memory loss, confusion or cognitive impairment while on statins, though the evidence is mixed regarding whether statins directly cause these issues.
Statins can interact with certain antibiotics, antifungals, HIV drugs and some blood thinners since they are metabolized in the liver, sharing a common pathway with other medications. Levels can be affected by simultaneously taking other medications and could either be increased or decreased based on the drug interaction.
“It is important that your doctor is aware of all the medications you take for this reason,” advises Dr. Bryan. “Also, grapefruit juice can deactivate an enzyme that clears statins from your system and can increase statin levels.”
Dr. Bryan acknowledges that while statins do carry some risks
and potential side effects, these are often exaggerated.
ALTERNATIVE TREATMENTS TO STATIN THERAPY
Some alternatives to statins include medicines that reduce cholesterol in different ways. Exetimibe works by blocking cholesterol absorption in the gut. Bempedoic acid slows down the ATP citrate lyase enzyme in the liver to reduce cholesterol production. And PCSK9 inhibitors are a class of injectable medication taken twice monthly that targets the enzyme that lowers cholesterol.
For individuals who cannot tolerate statins or prefer nonpharmacological options, alternative treatments, lifestyle and dietary changes can manage cholesterol levels and improve heart health.
A heart-healthy diet is key to managing cholesterol. A plantbased or vegan diet has been shown to reduce LDL cholesterol. Incorporating fiber-rich foods like oats, fruits, vegetables and legumes can also help lower LDL levels.
Regular physical activity and weight loss, particularly around the abdomen, can help improve cholesterol levels, lower triglycerides and reduce the risk of heart disease. Stopping smoking improves HDL cholesterol, and limiting alcohol can reduce triglyceride levels.
Before starting statins or considering alternatives, speak with a physician or other healthcare provider to weigh the benefits and risks to your specific health condition.
To make an appointment with a cardiologist, call 845-268-0880. Highland Medical, Advanced Cardiovascular Care is located at 2 Medical Park Drive, Suite 3, West Nyack, NY.
WHAT YOU NEED TO KNOW ABOUT
COLORECTAL CANCER
SCREENING CAN PREVENT CANCER OR DETECT IT AT HIGHLY TREATABLE
EARLY STAGES.
CERIC L. TATAR, MD, MS
olorectal cancer is among the most common cancer in both men and women, according to the American Cancer Society. In recent decades, the overall rate at which people are diagnosed with this potentially deadly disease has dropped, due partly to increased screening. Yet colorectal cancer is also becoming more common among younger adults.
“Understanding your personal history and being able to recognize the signs and symptoms of colorectal cancer is your best defense against this disease,” says Eric Tatar, MD, gastroenterologist with Highland Medical, Rockland Gastroenterology and Liver Disease in West Nyack, NY.
What is colorectal cancer?
Colorectal cancer is a cancer that starts anywhere along the colon— the large intestine—which is the lower portion of the digestive system. These cancers often start as
precancerous abnormal growths called polyps that over time can turn into colorectal cancer.
Why is detecting colorectal cancer early so significant?
If you’re diagnosed with colorectal cancer in its early stages, you have a high chance of being cured. Colonoscopy screening detects polyps and removes them during
the same procedure to prevent them from becoming cancer in the future. Screening improves your odds of surviving cancer or avoiding it altogether.
At what age should people start colorectal screening?
Men and women at average risk should begin colorectal screening at age 45. Earlier testing may be appropriate for patients who have a family history of colorectal cancer or who have other risk factors such as inflammatory bowel disease.
What are the options for screening?
The standard screening test for colorectal cancer is a colonoscopy, in which a flexible, lighted tube is used to examine the entire colon and rectum. This test requires a laxative preparation and is performed under sedation. Results are about 95% sensitive to finding a polyp. A screening colonoscopy is usually repeated every 10 years. Alternatives to colonoscopy include minimally invasive CT colonography, sometimes called virtual colonoscopy, and stoolbased exams in which you obtain a stool sample at home and mail it to a lab. Home-based tests aren’t as accurate as a colonoscopy and must be performed once a year or every few years. If any of these tests suggest colorectal cancer, you’ll still need a colonoscopy, which is the gold standard. If a colonoscopy detects cancer, a wide range of treatment options are available.
Combating Colorectal Cancer
The hope is that colonoscopy screening will prevent colorectal cancer. But in some cases, a colonoscopy and other measures such as a biopsy may result in a cancer diagnosis. Advanced treatments for colorectal cancer
offer a good chance of significantly prolonging life. Treatment is individualized and targeted to each patient’s unique cancer. Treatment options may include:
• Surgery: Surgical removal of cancerous growths is usually performed using minimally invasive techniques like laparoscopy or robotic-assisted surgery and is one of the most effective treatments for colorectal cancer.
• Chemotherapy: A variety of chemotherapy drugs can be administered to kill or shrink cancer at varying points during treatment depending on a patient’s disease, often in coordination with other therapies.
• Radiation therapy: High-energy beams such as X-rays are used to destroy cancer cells. The timing, method, dosage and type of energy can be calibrated to achieve the greatest effect for a patient’s particular cancer.
• Immunotherapy: Advanced therapies target specific functions of the immune response in ways that improve the body’s ability to recognize and attack cancer cells.
• Precision medicine: Profiling a cancer’s specific makeup of genes and proteins can guide doctors to the most effective therapies.
Key Signs of Colorectal Cancer
Check with your doctor if you notice:
• A change in bowel habits such as diarrhea, constipation or narrowing of the stool that lasts more than a few days
• A sense of urgency or bowel fullness that isn’t relieved by a bowel movement
• Rectal bleeding
• Blood in the stool or dark stool
• Persistent abdominal discomfort such as cramps, gas or pain
• Unexplained weight loss
• Weakness or fatigue
Highland Medical Rockland Gastroenterology and Liver Disease is located at 2 Medical Park Drive, Suite 14, in West Nyack, NY. Call 845-362-3300 to schedule an appointment with a gastroenterologist.
CERVICAL MYELOPATHY
SYMPTOMS TO WATCH FOR
EARLY DIAGNOSIS AND TREATMENT OF THIS SPINE CONDITION IMPROVES OUTCOMES. HERE’S WHEN TO SEEK MEDICAL HELP.
When daily activities like writing or holding a utensil become difficult, or you start to feel unsteady on your feet, don’t dismiss the symptoms. According to Ananth Eleswarapu, MD, an orthopedic spine surgeon with Montefiore Einstein, these could be signs of cervical myelopathy, which can and should be treated.
Approximately 20,000 people with symptoms of cervical myelopathy visit the hospital in the United States each year.
Myelopathy is a condition in which there is dysfunction of the spinal cord. It can result from many different things, including infection, tumors or compression of the spinal cord due to bones or disc herniations. Cervical myelopathy refers to dysfunction of the part of the spinal cord in the neck.
WHAT CAUSES MYELOPATHY?
Myelopathy can result from any condition that causes injury to the spinal cord. This includes viral infections, tumors, autoimmune conditions (in which the body’s immune system attacks the spinal cord), or compression of the spinal cord. It is important to find out what is causing the myelopathy
to occur, as the treatment will be different for each cause.
The most common cause of myelopathy is cervical spondylotic myelopathy (CSM)—this is when bone or soft tissue structures are pushing on the spinal cord. Almost all people will develop stenosis or compression of the spinal cord with age due to herniated discs, bone spurs or overgrown ligaments. Only a small minority of people develop symptoms of myelopathy. We don’t know why spinal cord compression causes no symptoms in most people and severe symptoms in a select few. Our spine team at Montefiore is engaged in research using multimodal artificial intelligence to try to understand
ANANTH ELESWARAPU, MD
what causes stenosis to become symptomatic. This may lead to novel, more targeted or even preventive treatments in the future.
SIGNS AND SYMPTOMS
The spinal cord sends signals from your brain to the rest of your body to control movement and sensation. When the spinal cord is not working correctly, the first thing a patient will notice is difficulty with complex movements that require multiple muscles to work together in coordination. Think of tasks such as walking or tying shoelaces. We do these things so often we take them for granted. However, they require the brain to integrate information from our eyes and sensations from our skin and use it to coordinate the action of dozens of muscles in real time. All that information needs to pass through the spinal cord to get to the muscles. When the spinal cord is not working correctly, movements you do all the time can suddenly become difficult.
Myelopathy can be subtle at first, and patients may not attribute their symptoms immediately to a spine problem. A hairdresser might have trouble opening and closing scissors. Or a chef might fumble when cutting vegetables. Over time, the symptoms get more obvious.
In advanced cases, patients can have clumsiness of their hands and feet making it difficult to walk or feed themselves. They may have numbness that causes them to burn their hands on a hot stove without realizing it. In severe cases, even bowel and bladder function can be affected.
DIAGNOSIS AND SCREENING
The most important way in which myelopathy is diagnosed is by talking with patients. A doctor can ask questions about balance, dexterity, sensation and difficulty with daily tasks. We utilize the mJOA (modified Japanese Orthopaedic Association) scale, which asks patients how much
difficulty they have doing everyday things, such as climbing stairs or buttoning a shirt. This assigns patients a score reflecting the severity of their disease. We can then follow it over time to see if it is getting better or worse.
There are physical exam findings, such as increased reflexes, that are common in myelopathy. It should be stressed, though, that these physical exam findings correlate only loosely with patient symptoms. Treatment is guided by the severity of symptoms and not by a physical exam.
Several imaging studies can help determine what is causing myelopathy. Upright X-rays can look for kyphosis, or a tilted-forward posture, which can put pressure on the spinal cord. CT or MRI scans can identify bone or soft tissue, respectively, that are putting pressure on the spinal cord.
COMPREHENSIVE ON-SITE TREATMENT SERVICES
The course of symptoms in myelopathy is one of “stepwise decline”—that is, patients will have long periods of stable symptoms punctuated by brief intervals of rapid decline in function. Once the decline occurs, it is usually not reversible. That’s why it’s necessary to intervene early in the disease course, before this decline has occurred, to preserve as much function as possible.
Treatment for myelopathy involves addressing whatever is causing damage to the spinal cord. In the case of infections or tumors, the underlying disease is treated. For CSM, in which the spinal cord is being compressed, the treatment is surgery to decompress the cord. This can be done anteriorly, in which the spinal cord is accessed
from the front of the neck, or posteriorly, in which the cord is accessed through an incision in the back of the neck. The decision of what type of surgery to perform is quite complex and best discussed with a doctor who knows the individual case well.
Generally, patients will be in the hospital for one to three days post-surgery with an expected three-to-six-month recovery period. Patients who have a loss of balance or dexterity before surgery can do rehab to try to regain those functions after surgery. Many patients will have pain with swallowing after surgery—this can take a few weeks to get better. There are rare risks of surgery, including shoulder weakness and injury to the esophagus or blood vessels. Patients are, understandably, often nervous about undergoing spine surgery. In the modern era, however, cervical spine surgery is safe and routine. For patients with myelopathy, the risk of leaving the spinal cord compressed is usually far greater than the risk of having surgery.
SURGICAL OUTCOMES
The goal of surgery for myelopathy is to prevent spinal cord damage from getting worse. It is usually not possible to reverse spinal cord damage that has already occurred. This is why patients and doctors need to be aware of the symptoms of myelopathy and promptly seek evaluation by a specialist. In some cases, patients can have partial recovery of function after surgery. Having surgery early in the disease process before severe damage has occurred gives patients the best chance of recovering function.
For more information, visit Montefiore Einstein Comprehensive Orthopedic & Spine Center at montefiorenyack.org/orthopedic-spine. To schedule an appointment or consultation, call 845-358-1000
PEDIATRIC SPORTS INJURIES RECOGNIZING
AND TREATING
HELP KEEP YOUR CHILD
SAFE FROM SPORTS INJURIES BY KNOWING WHAT TO LOOK FOR.
As kids begin to play sports, parents should be on the lookout for red flags— whether their child is a varsity athlete or simply enjoys a round of recreational tennis. Being aware of injuries involving the shoulders, hips, knees and ankles is important. In their rush and excitement to play, kids sometimes downplay small injuries that can lead to bigger problems such as stress fractures, tendonitis and muscle strains. They often don’t understand that pushing through pain can lead to problems, like when a mildly injured joint collapses under more strenuous use or when overworking a muscle leads to cartilage tears.
It’s not uncommon for kids to have growing pains, but when the pain or swelling starts to interfere with routine activities, such as an inability to move a joint or the feeling that a joint is “stuck,” those are signs that the injury needs further evaluation.
READY, SET, CONDITION
“The most important part of playing sports is conditioning. Kids should engage in proper strength programs—warm-up, cool-down and stretching routines—before and after playing,” advises Dr. Eric Fornari, co-director, Pediatric Orthopedics and Associate Professor of Orthopedic Surgery and Sports Medicine for Montefiore Einstein. Conditioning programs implemented before the start of a season are known to decrease ACL tears a soccer team will see
throughout that year.
Proper nutrition can help prevent stress injuries and fractures. Healthy eating also helps young athletes preserve lean tissue, manage weight and maintain healthy bodies.
No matter the sport or activity, every child needs to build a strong core with exercises such as scissor kicks, crunches and hip lifts to develop balance and strength throughout the body.
They need to build stamina so they can participate fully for the entirety of the season. Weight training—on machines or with free weights—resistance bands, pushups and crab walking can be great ways for kids to improve their overall fitness and help prevent injuries. Of course, children should be properly supervised to ensure they are using any equipment correctly.
PSYCHOLOGICAL COMPONENT TO TREATMENT
It is important to be aware that an injury may cause psychological issues. Pediatric orthopedists can help patients work through these psychosocial issues.
“A patient’s mental state can have a profound impact on their recovery and often determines how well the patient responds to a specific orthopedic treatment or how much physical therapy they participate in,” says Dr. Fornari. “Sometimes, that’s 80% of our job. If an injury sidelines a patient for weeks, months or even a year, that
break can leave them feeling alone, scared, anxious or depressed.”
Engaging kids in their treatment and healing requires doctors, coaches and parents to know the right questions to ask about how the injury is impacting interactions with friends and teammates and how students are navigating school; for example, asking whether there’s an elevator available and strategizing solutions if not.
TREATMENT OPTIONS
If a parent or coach is concerned but not sure where to begin, they can check in with a pediatric orthopedist to better understand how to distinguish between different types of aches and pains, concerning signs and symptoms to look out for and how to establish the importance of cross-training, using different muscles at different times and taking rest days. A doctor’s expertise is particularly valuable here because the unique aspects of pediatric anatomy are imperative to growth and development.
By understanding these and other pediatric distinctions, doctors and parents can work together to help kids obtain the best outcomes and prevent future injuries.
Montefiore Einstein
Comprehensive Spine and Orthopedic Center in West Nyack, NY, now offers pediatric orthopedic services in Rockland County so that families in the region can easily access care closer to home.
Learn more about Pediatric Orthopedics at the Montefiore Einstein Comprehensive Spine and Orthopedic Center at montefiorenyack.org/orthopedic-spine/pediatric. If your child is injured or needs to be evaluated, please call 845-358-1000.
ERIC FORNARI, MD
TREATING SLEEP APNEA
IF LEFT UNTREATED, VARIOUS SYMPTOMS CAN AFFECT OVERALL HEALTH AND WELL-BEING.
Obstructive sleep apnea (OSA) is a medical condition in which the muscles in the throat excessively relax during sleep, leading to a partial or complete blockage of the upper airway. A blockage can result in pauses of breathing, low oxygen levels, exhaustion due to poor sleep quality and various other health issues. Patients most at risk for OSA include:
• People who are obese
• Those 40 years or older
• Men (with larger necks)
• Those with a family history of sleep apnea
• Those with larger tonsils or smaller jaws
• Those with cardiovascular conditions, hypertension or diabetes
• Those who smoke, heavily drink alcohol or are mainly sedentary
• Postmenopausal women
• Pregnant women in the later stages of pregnancy
The most prominent signs and symptoms of OSA include loud snoring (not everyone who snores has sleep apnea), excessive daytime sleepiness caused by interrupted sleep patterns, insomnia, high blood pressure and choking, gasping or gurgling during sleep.
Patients experiencing the above symptoms should be examined by a pulmonologist/ sleep medicine specialist who will assess the patient’s medical history and symptoms. “It is important for patients
to be seen by a specialist who can determine the risk of sleep apnea for a patient and conduct proper physical and possible diagnostic exams,” says Murali G. Krishna, MD, FCCP, director of pulmonary medicine at Montefiore Nyack Hospital and board-certified pulmonary and critical care physician with Highland Medical, Pulmonary Medicine Associates.
HOW SLEEP APNEA IS DIAGNOSED
A physical examination is needed to examine the mouth, throat and nasal passages for signs of obstruction like enlarged tonsils, a deviated septum or other anatomical abnormalities that could limit airflow. Patients might be asked to keep a journal of sleep habits and answer questionnaires to determine if diagnostic testing is necessary. Should diagnostic testing be needed, patients may undergo a polysomnography or sleep study where they stay in a hospital’s sleep center overnight to be monitored during sleep. Another option is a home sleep apnea test (HSAT).
“Sleep disruptions can negatively affect your daily functioning and well-being, which is why it is so important to see a specialist for a proper diagnosis and treatment plan,” says Dr. Krishna. “Not only can OSA negatively impact your daily functioning, but there are also impacts on long-term health.”
Recurrent episodes of low oxygen levels and disrupted sleep can increase risks of major medical conditions like cardiovascular disease, type 2 diabetes, cognitive decline and increased mortality or premature death.
TREATMENT OPTIONS
When left untreated, OSA can worsen over time. The good news is OSA treatment options have been proven to improve or reverse the condition. For example, weight loss can help significantly reduce the severity of OSA. For some patients, it may even resolve the condition. Other options:
• Continuous positive airway pressure (CPAP) is the most used and effective treatment for moderate to severe OSA. A CPAP machine is used while sleeping to help keep the patient’s airway open, reducing the frequency of apneas and improving sleep quality.
• Lifestyle changes:
- Avoiding alcohol
- Smoking cessation
- Sleep hygiene improvements
- Sleeping on your side
• Oral appliances, also called mandibular advancement devices, can reposition the jaw and tongue to keep the airway open during sleep.
• Surgical treatment: Severe cases of sleep apnea may require surgery to remove excess tissue from the throat or correct an anatomical abnormality, such as a deviated septum or enlarged tonsils. A newer surgical treatment is the Inspire device, an implantable nerve stimulator that treats OSA by signaling the hypoglossal nerve to pull your tongue forward and keep your airway open while sleeping. This treatment would be used for patients who cannot use a CPAP machine or when a CPAP machine is not helping alleviate OSA.
To schedule a consultation with a pulmonologist/sleep specialist, please call Highland Medical Pulmonary Medicine Associates in Nyack at 845-897-8371 or Palisades Primary Care and Pulmonary Medicine in West Nyack at 845-727-7733.
For more information, visit: www.highlandmedicalpc.com/pulmonology.
MURALI G. KRISHNA, MD, FCCP
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