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Cervical Spine Disc Replacement: A Major Gain in Mobility

Posted on: April 26, 2016

A newer spine surgery technique called cervical spine disc replacement leaves you far more mobile than traditional spinal fusion.  By Dr. Marshal D. Peris, Co-director of Spine Surgery at the Orthopedic and Spine Institute of Northern Westchester Hospital

Dr. Marshal Peris Northern Westchester spine surgeonIf you have discomfort – such as neck or arm pain – due to problems with cervical spinal discs (those in your neck), you’ve probably heard of the spinal fusion procedure, a common surgical solution, which locks cervical vertebrae together permanently after removing damaged discs. While this spine surgery offers excellent results, you need to know about a newer technique, called cervical spine disc replacement that leaves you far more mobile. Here, I explain this advanced and exciting treatment option, and help you determine if you might be a candidate.

The cervical spine is housed in the neck, with seven vertebrae separated by discs. Because cervical disc malfunction can impact the spinal cord, you can have problems throughout your body. You may experience neck or arm pain; weakness in the arms; numbness and tingling in the arm or hand; or balance problems. Symptoms can be intermittent, chronic, or triggered by specific activities.

Ultimately, all symptoms result from compression or narrowing (stenosis) of the space for the spinal cord or the nerves exiting the spinal cord. Stenosis occurs in various ways. As you age, your spinal discs lose height (that’s why we all get shorter), causing them to bulge. Picture gently squeezing down on a cream donut: It gets shorter but also wider. A bulging disc can press on a nerve exiting the spinal cord. At a later stage, the bulge can harden (calcify) into a bone spur, which can also compress a nerve. In the case of a herniated disk, now you’re squeezing the cream donut so hard that cream leaks out. This disc material can put direct pressure on a nerve.

Now, a sophisticated procedure called cervical spine disc replacement a goes a step better for suitable candidates than traditional fusion surgery, which reduces movement. By replacing the damaged disc with an implant closely resembling a human disc, the procedure maintains the mobility of the cervical spine; in some cases, even improving motion. In other words, your neck retains some – or even better — range of motion.

The best candidates are active people under 60 years, who want to maintain greater mobility. In fact, post-surgery movement is so good, that I don’t recommend the procedure for patients with existing arthritis in the neck joints. If you increase movement in a place with arthritis, you actually increase pain. While documented outcomes for cervical spine disc replacement are positive for 15 years, no longer-term data exists.

Following surgery, you will likely go home the same day, take precautions for six weeks, then resume full activities.  Northern Westchester Hospital is one of the few hospitals in the region to perform cervical spine disc replacement; surgeons use the most advanced version of the procedure, which permits the implanting of two discs at once.

Dr. Marshal Peris is a member of the Mount Kisco Medical Group, Co-Director of Spine Surgery at The Orthopedic and Spine Institute at Northern Westchester Hospital and President of the Medical Staff at Northern Westchester Hospital.  He received his undergraduate degree from Cornell University and received his medical degree from the University of Pittsburgh School of Medicine.  Dr. Peris completed his internship, orthopedic surgery residency, and a fellowship in spine surgery at the University of Pittsburgh Medical Center.

Marshal D. Peris, MD FAAOS is Co-director of Spine Surgery at the Orthopedic and Spine Institute of Northern Westchester Hospital and Director of Spine Surgery, Mount Sinai Health System at CareMount Medical. Dr. Peris is a Board Certified orthopedic surgeon and a Fellow of the American Academy of Orthopedic Surgeons. He received his medical degree from the University of Pittsburgh School of Medicine. Dr. Peris completed his internship, orthopedic surgery residency, and a fellowship in spine surgery at the University of Pittsburgh Medical Center. Learn more at www.nwhorthoandspine.org/DrPeris.

 

 

 

 

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Age-Defying Benefits of Non-Surgical Facelifts

Posted on: March 31, 2016

Age-Defying Benefits of Non-Surgical Facelifts
By Dr. David A. Palaia

The earlier in life you take a proactive approach to skincare, the fewer additional treatments faceliftyou’ll need to repair problems or simply maintain a healthy, vibrant look. It’s important to know that there have been major advances in non-surgical facial rejuvenation procedures. These include the medical-grade HydraFacial, as well as non-surgical laser and radiofrequency skin-tightening and skin-resurfacing technologies. Here, I explain how these newer procedures offer remarkable time-freezing results with far less visible surface damage, less discomfort, and only a minimal time investment on your part.

What occurs when you have a non-surgical facial procedure?

The dermis, the skin’s third-deepest layer, is composed mostly of elastin and collagen, which give our face its look of youthful vibrancy. As we age, our skin gets thinner, has fewer blood vessels, and produces less elastin and collagen. As a result, it loses elasticity, grows fragile, and is susceptible to developing wrinkles. This inevitable scenario is why all non-surgical facial skin-rejuvenating procedures aim to preserve and increase our skin’s supply of elastin and collagen. They achieve this by injuring the dermis, which causes an inflammatory response and triggers the production of more collagen and elastin.

What is a HydraFacial?

Formerly, a facial involved receiving a number of procedures separately. What makes the HydraFacial superior is that it combines many treatments into one 40-minute procedure: exfoliation (removal of dead skin cells), super-hydration of the skin, pore extraction (suction of dirt), and the administration of the antioxidant, glycolic acid and other peptides that stimulate production of collagen and elastin. Results last for about a month for most people.

What are non-surgical approaches with lasers and radiofrequency?   

Our most popular procedure at Northern Westchester Hospital (NWH) uses the 1540 fractionated laser to tighten the skin, eliminate fine wrinkles, reduce brown facial staining – sometimes called the “the mask of pregnancy” — and minimize the appearance of scars. The Smartskin laser is a major advance that permits “resurfacing” of the facial skin, minimizing the look of deep lines on either side of the mouth. The Intense Pulse Light treatment filters lightwaves to eliminate the appearance of small blood vessels as well as pigmented areas or “age spots.” The Protégé Elite technology uses radio (sound) waves to boost the production of collagen and elastin. This pain-free treatment can produce a significant tightening of the facial skin. The most noticeable benefits of all these procedures last from one to two years.

Where is the best place to go for these services?

Choose a physician board-certified in plastic surgery or dermatology. Be aware that a person might have a laser in their office, but not be familiar with the skin or expert in dealing with any after-effects of treatment. At Northern Westchester Hospital’s Laser Center and Medi-Spa, we offer full-service, safe and advanced cosmetic skin care administered by trained specialists. Treatment with Botox and fillers completes the picture of a non-surgical facelift. Today it is more possible than ever to look your best throughout your lifetime, thanks to a wide range of sophisticated non-surgical skin-rejuvenating procedures.

Endometrial Cancer: Reducing Your Risk

Posted on: March 15, 2016

Endometrial Cancer: Reducing Your Risk

By Dr. Iris Wertheim

Unlike breast cancer, endometrial cancer is not often the focus of media

 Iris Wertheim, MD Director of the Gynecologic Oncology Program, Northern Westchester Hospital


Iris Wertheim, MD
Director of the Gynecologic Oncology Program, Northern Westchester Hospital

attention, and is rarely cited as a health consequence of obesity. So you may be surprised to learn that endometrial cancer – cancer of the lining of the uterus – is the most common gynecological cancer in the U.S, and that there is a known link between obesity and this disease. Here, I raise your awareness of endometrial cancer, and offer empowering advice to every woman about reducing her risk.

Endometrial cancer arises in the glands of the lining of the uterus. It is the most prevalent gynecological cancer in the United States, affecting 50,000 women annually.

The major risk factor for developing endometrial cancer is age: onset is most commonly seen in post-menopausal women between the ages of 55 and 64.  Another major risk factor is any condition that produces excess estrogen. Throughout a woman’s life, estrogen receptors in the uterine lining make the uterus highly reactive to estrogen. This is completely normal. However, that very responsiveness can cause problems when there exists an elevated level of circulating estrogen in the bloodstream. When excess estrogen overly stimulates those highly receptive uterine cells, they can start to undergo uncontrolled growth and transform into a cancer.

By far the largest cause of elevated estrogen in American women is obesity. Let me explain: A woman who carries extra weight has more fat cells. These cells store a hormone called androstenedione, which is converted into estrogen. As a result, obesity puts women at risk for endometrial cancer. As obesity among American women has risen, so has the incidence of endometrial cancer. Equally disturbing is that the increase in obesity among children and teens has made endometrial cancer more common in young women, in whom the cancer is usually estrogen-related. Other risk factors for endometrial cancer include Tamoxifen use, hypertension, familial cancer syndromes (such as Lynch Syndrome), and diabetes.

By contrast, exposure to progesterone seems to lower the risk of developing endometrial cancer. Women are often are exposed to progesterone by taking birth control pills (virtually all of which contain progesterone) or by using progesterone-containing IUDs. Women are also exposed to progesterone throughout pregnancy: women with many children have a lower risk of endometrial cancer than women who have never been pregnant.

Because obesity increases the risk for endometrial cancer, women need to accurately understand the definition of obesity. A formula called the Body Mass Index (BMI) calculates body fat based on your height and weight. Obesity is defined as a BMI greater than 30. However, you should be concerned earlier than that. A BMI of 25-30 indicates that you are overweight, and thus that your risk for endometrial cancer is elevated. An ideal BMI is under 25. It is very easy to learn your BMI: Simply google “Calculate BMI” for online calculators that let you plug in your height and weight, instantly provide your BMI, and show where that number falls on the spectrum.

The most common symptom of endometrial cancer is bleeding after menopause. For women who are have not gone through menopause, it is important to notice an irregular bleeding pattern. Irregular bleeding means heavy bleeding or bleeding in between periods. For both groups, endometrial cancer should be on your radar.

At the first symptom, see your gynecologist. You will typically have an endometrial biopsy and a pelvic ultrasound. If the biopsy reveals endometrial cancer, you should see a gynecologic oncologist, the specialist who has a thorough understanding of the disease, is able to do a complete staging procedure, and can refer appropriately if other treatment is needed.

The primary treatment for endometrial cancer is hysterectomy – surgery to remove the uterus. During the procedure, the surgeon decides whether to sample nearby lymph nodes for cancer. Today, robot-assisted hysterectomy is mainstream, making surgery safer and more precise, while providing faster recoveries. Because endometrial cancer is frequently discovered at an early stage, post-surgical outcomes are good.

In light of the link between endometrial cancer and obesity, I urge all women to reduce your risk by maintaining a healthy weight and getting regular exercise. The overwhelming health benefits can’t be overstated. In addition, every woman needs to be vigilant. Women who see a gynecologist at the first sign of abnormal bleeding have better outcomes.

Robotic Surgery Offers Special Benefits

At Northern Westchester Hospital (NWH), robot-assisted surgery is performed on the vast majority of patients with endometrial cancer. Robotic visualization is enhanced and outstanding, and the instruments are very sophisticated, all of which permits very precise surgical movements. Benefits to patients include decreased blood loss and risk of infection, and far faster recoveries, with shorter hospitals stays. The technology’s tiny incisions are a boon for obese patients, who are at greater risk for wound infection. In addition, robotic surgery allows the surgeon unrestricted access to the pelvis regardless of body weight. What is more, the small incisions enable patients to be mobile the very next day, thereby decreasing their post-surgical risk for blood clots and infection.

Editor’s Note:
Dr. Iris Wertheim is Director of the Gynecologic Oncology Program at the Cancer Treatment & Wellness Center, Northern Westchester Hospital.

Protecting Football Players from Concussions and Other Injuries

Posted on: March 15, 2016

Football season is still months away, but concussion concerns in the sport are in the headlines year round.

Northern Westchester concussion treatmentRecently, a new study found that tackling methods that protect the head may be increasing the risk of leg injuries. However, the findings don’t reveal an actual link—just an association. And there may be other explanations for this unsettling news.

In the study, researchers at the University of Iowa in Iowa city tracked NCAA football-related concussions and other injuries for five years. During the period of the study, teams were instituting new protocols and rules that encouraged leading with the shoulders rather than the head, protecting defenseless receivers, and banning horse collar tackles (in which a player is pulled down by the shoulder pads at the neck).

Unfortunately, no change in concussions was noted over the five years; even worse, leg injuries rose from 9 per 1,000 tackles or collisions to 13 per 1,000.

The researchers speculate that the new focus on lower body tackles may be leading to the increase in leg problems, but I believe there may be other explanations for the findings in this study.

Athletes continue to get stronger, bigger and faster. Collisions thus take place with much greater force, and this alone could cause more leg injuries, regardless of tackling techniques.

Another potential issue is that many college football programs are limiting the amount of live tackling and contact during practices. This could lead to de-conditioning of athletes: If they’re unaccustomed to full contact, they could be more susceptible to lower extremity injuries during games.

Finally, it’s important to understand that concussions don’t always occur with head-to-head contact. They also happen when the head hits the ground, collides with an opponent’s knee, or in an incidental collision with a teammate.

More research needs to be done to better understand concussion concerns. In the meantime, the best way to prepare players at all levels—from Pop Warner to the NFL—is to make sure they’re well conditioned to handle the speed and impact of competitive play. Hopefully, as tackling and training methods improve, we’ll see a decline in both concussions and leg injuries.

For more information or to request an appointment for concussion rehab please call 914.458.8700 or request an appointment online.

by Victor Khabie, MD, FAAOS, FACS, Chief of Department of Surgery, Co-Director of the Orthopedic and Spine Institute, Chief of Sports Medicine, Northern Westchester Hospital, Mount Kisco, NY

Visit Northern Westchester concussion rehabilitation.
Meet Dr. Victor Khabie.

Cardiac Rehab: Restoring Health and Well-Being

Posted on: February 23, 2016

You’ve had a cardiac event – possibly a heart attack, coronary artery bypass surgery or angina. Now you’re back home. How do you regain your strength, energy and confidence, while reducing the risk of a recurrence? The answer is: cardiac rehabilitation. Find out from the experienced Master’s-level exercise physiologists at Northern Westchester Hospital’s (NWH) certified Cardiac Rehabilitation Program how cardiac rehab can speed your recovery while significantly improving your health and quality of life.

Nurse With Patient During Health CheckCardiac rehabilitation, explains Jenna Angelucci, is a medically-supervised, individualized program of exercise and education that helps you recover faster from heart disease and acquire the strength to resume a full life. You are a candidate if you’ve suffered a cardiovascular event such as heart attack, bypass surgery, angina, heart valve repair or replacement, coronary stenting or heart failure. NWH’s outpatient cardiac rehab program requires a physician’s prescription, and besides the core training component, includes counseling in nutrition, stress management and meditation, as well as education in heart disease prevention.

Benefits of Cardiac Rehab

Perhaps surprisingly, a key benefit of cardiac rehabilitation is restored confidence. That emotion has as much impact as do medical issues on a person’s ability to resume an active, rewarding life. Some patients are initially afraid to do anything,” notes Leone. “A pain in the chest area makes them terrified another cardiac event is happening. They’re afraid to work, to drive, to leave the area where their doctors practice.” These fears typically evaporate after training – indeed, even during training, as patients see undeniable evidence of their gains in strength and stamina. “Walking uphill on the treadmill, riding the bike, using the rowing machine which they’ve never, ever done, gives them great confidence,” explains Angelucci.

Following her balloon angioplasty, Martha G. of Mount Kisco, had several dozen cardiac rehab sessions at NWH’s state-of-the-art gym at Chappaqua Crossing. Though she already walked for fitness, it was through the program that Martha learned about truly appropriate exercise. “I wasn’t doing enough to get my heart rate up. I could have been doing more,” she says. Today, after gaining strength and shedding significant weight, she says, “I feel better than I’ve ever felt in my life.”

What happens when you enter NWH’s cardiac rehab program?

A personalized exercise regimen is designed based on an extensive health history and your physical condition. You’ll have up to 36 training sessions, depending upon your insurance, during which you receive continuous EKG monitoring and close supervision by exercise physiologists. “We’re watching your heart rate and cardiac rhythm the whole time, till after cool-down,” says Leone. “Your blood pressure is taken before, during and after exercise.” Starting off at 30 minutes, you’ll work up to between 42 minutes and an hour of training, with weight training added when appropriate. A physician is always nearby and can be summoned instantly.

In choosing a cardiac rehab program, look for accreditation, convenient scheduling, insurance coverage and the expertise and experience of staff.  Whether you’ve had a heart attack, coronary bypass or other cardiac event, “you are basically getting a second chance after your cardiac event,” notes Angelucci. “So it’s wise to take advantage of all the benefits of cardiac rehabilitation.”

For more information on the NWH Cardiac Rehabilitation Center at Chappaqua Crossing, visit www.nwhRehab.org or call 914.458.8700.