Category Archives: Expert Health Advice

THE MYSTERY OF AUTOIMMUNE DISORDERS

Posted on: January 26, 2016

THE MYSTERY OF AUTOIMMUNE DISORDERS

By Dr. Ronen Marmur

Without your immune system, your body would be open to infection from viruses and bacteria.

Ronen Marmur, MD/PhD

Ronen Marmur, MD/PhD

But this helpful ally can sometimes turn on you and mistakenly attack joints, muscles, and even organs. Because no one is sure what triggers autoimmune disorders, diagnosing and treating the problems can be puzzling for patients and doctors. Recognizing some of the potential risks and symptoms can help you get the care you need.

 

Early diagnosis is crucial to successfully managing autoimmune disorders.

Symptoms
Symptoms can be vague and the cause can be unclear. Patients should talk to their doctor if they have unexplained:
• fatigue
• fevers
• muscle weakness
• joint pain
• swelling or inflammation
Sometimes people will have breathing troubles, swollen lymph nodes, or digestive problems such as diarrhea.

There are more than 80 different types of autoimmune disorders and they affect between 5% and 8% of Americans, according the National Institutes of Health. About 80% of those afflicted are female—women of African-American, Native-American, and Hispanic descent have the highest risk.

One of the more common autoimmune targets is the thyroid gland. In Graves disease, an overactive thyroid gland can make patients restless, unable to sleep, irritable, and anxious. Hashimoto’s disease is the opposite: It slows down the thyroid gland and can cause weight gain, depression, and low energy. Other common autoimmune diseases include rheumatoid arthritis (joints), lupus (organs and joints), multiple sclerosis (nerves), and Type 1 diabetes.

Risk Factors
Why are women more susceptible? No one’s really sure, but hormone changes may play a role. Autoimmune diseases are often diagnosed in women of child-bearing age or during menopause. Other risk factors include a family history of autoimmune troubles, exposure to certain chemicals such as solvents, some viral or bacterial infections, and even dental issues like gingivitis. The Epstein-Barr virus can trigger lupus, for example.

Diagnosis
The first stop for patients is their primary care physician, where the doctor can go over the symptoms and see if the patient needs to see an autoimmune specialist—which type will depend on your symptoms. A rheumatologist such as myself focuses on arthritis, lupus, and certain autoimmune skin conditions; a neurologist can help diagnose multiple sclerosis; an endocrinologist can help manage thyroid problems or diabetes.

To help with the diagnosis, patients should keep a diary of symptoms and a detailed family health history. Your specialist will run blood tests and do imaging to try and identify autoimmune disorders while ruling out other potential causes of the symptoms. For example, chronic fatigue syndrome and fibromyalgia are not autoimmune problems, even though they have similar symptoms. The patient should be aware that testing doesn’t always lead to diagnosis.

Treatment
There are two major categories of treatments: Disease modifiers, which can prevent and in some cases reverse the damage caused by the disorder; and symptom relievers—medications that help manage the pain and associated problems with the disease. Some autoimmune disorders can be treated and controlled. With an early diagnosis, rheumatoid arthritis can go into remission, though medications alone won’t solve all the problems. Patients can still have pain and fatigue even if their rheumatoid arthritis is completely suppressed. That’s where the second group of symptom-relieving medications can play a role.

By sticking to the treatment plan, eating healthy, and staying active, patients can help keep their symptoms under control and slow the progression of their disease.

Early diagnosis is crucial to successfully managing autoimmune disorders. The research shows that late diagnosis and treatment leads to much worse outcomes—especially for rheumatoid arthritis and lupus. This is true for many autoimmune disorders, such as Type 1 diabetes, inflammatory bowel disease (Crohn’s or colitis), and celiac disease: The sooner patients can get treatment and alter their diet (removing gluten in the case of celiac), the better off they’ll be. Alternative therapies can sometimes help alleviate the pain, but they rarely help as a primary treatment. Once you start medical treatment, alternative therapies such as stress management, massage, physical activity, and altering diet may bring additional relief—just make sure to check with your doctor and keep him or her informed.

Currently there are no cures for autoimmune diseases but, depending on the condition, patients can minimize the impact on their lives. Treatments can bring about homeostasis—we can keep certain diseases from progressing. By sticking to the treatment plan, eating healthy, and staying active, patients can help keep their symptoms under control and slow the progression of their disease.

Editor’s Note:
Ronen Marmur, MD/PhD is a rheumatologist at Mount Kisco Medical Group and Northern Westchester Hospital. You can learn a lot more about autoimmune disorders at the website for the American Autoimmune Related Diseases Association: www.aarda.org.

 

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Detox Diet

Posted on: January 12, 2016

Support Your Body’s Natural Ability to Detox

By Amy Rosenfeld, MS, RD, CDN

Often thought of as the “quick, easy solution” to shed the pounds, detoxes or cleanses are all iStock_8309428_MultiPhoto_Foodthe rage in the world of dieting. Health claims range from improved health, energy, and digestion to decreased inflammation and weight loss, and while many people start cleanse diets to “jump-start” weight loss or “rid the body of toxins,” extreme diets are neither effective nor safe.

The theory behind detoxing is to give the gastrointestinal cells time to rest and become stronger. Instead, extreme cleanses are linked with lack of energy, headaches, irritability, constipation, nutritional deficiencies, blood sugar control issues, gastrointestinal bacterial imbalances, electrolyte imbalances, and even cardiac issues.

Specific diets vary, but extreme detoxes and cleanses often limit dieters to drinking fruit and vegetables juices and/or eating raw fruits and vegetables for an extended amount of time. The average cleanse is 800-1,000 calories per day, less than half the average 2,000 calorie intake most people need. Severe calorie restriction causes the body to break down glucose stored in our muscles causing water loss. After a longer period of time, the body breaks down muscle from limited protein intake. This water and muscle loss results in temporary weight loss that is regained once the diet is over.

Luckily, our bodies have a natural “detox” system – our kidneys, gastrointestinal tract, and liver. If we feed ourselves natural, unprocessed, whole foods, our bodies will do the rest. Follow these steps to create your own cleansing diet and revive from within:

1) Drink plenty of water, at least eight 8oz glasses per day.
2) Eat a high-fiber diet, with unprocessed whole grains (brown rice, quinoa, oatmeal), beans, lentils, nuts and seeds.
3) Fill at least ½ your plate at every meal with fruits and vegetables. The more colorful, the grater the antioxidant intake.
4) Choose vegetarian, plant-based meals.
5) Limit alcohol. The American Heart Association recommends no more than 1 drink per day for women and 2 drinks per day for men. (1 drink = 12oz of beer, 1.5oz hard alcohol, 5oz of wine.)
6) Limit sugar to 150 calories per day. Check labels for any added sugars, especially those sneaky sources of sugar including yogurts!

Create a week of menus for yourself –by planning each meal and sticking to a routine you can break free from old habits and maximize the positive benefits of a truly cleansing diet.
Healthy “Detox” Recipes for Breakfast, Lunch and Dinner

Beet Berry Smoothie

Ingredients:
2 beets, peeled and quartered
2 carrots, peeled and cut into 1-inch pieces
3 c. strawberries
2 c. plain Greek Yogurt
2 c. water

Directions:
Blend all ingredients until smooth!

Nutrition Facts:
(serves 3)
148cal, 1g fat, 145mg sodium, 34.2g carbohydrates, 8g fiber, 4.6g protein

Quinoa and Winter Fruit Salad
Courtesy of Food and Wine Magazine

Ingredients:
1 1/3 c. quinoa (about 1/2 pound), rinsed
1 1/2 c. water
2 kumquats—halved, seeded and coarsely chopped
2 Tbsp coarsely chopped cilantro
1/4 c pure olive oil
2 1/2 Tbsp fresh lemon juice
1/2 tsp kosher salt
1 large Bosc pear—peeled, cored and cut into 1/2-inch pieces
1 medium cucumber—peeled, seeded and cut into 1/2-inch pieces
1 c. coarsely chopped stemmed watercress
Directions:
1. In a medium saucepan, combine the quinoa and water and bring to a boil. Simmer over low heat, stirring often, until just tender, about 12 minutes; the grains should be separate and intact. Drain the quinoa and let cool completely.
2. In a small bowl, combine the kumquats and cilantro with the olive oil, lemon juice and salt and let steep for 5 minutes.
3. In a large bowl, toss together the quinoa, pear and cucumber. Add the dressing and toss well. Add the watercress and toss again. Serve at once.
Nutrition Facts:
(serves 4-6)
210cal, 10.7g fat, 1.5g saturated fat, 203mg sodium, 24g carbohydrates, 3g fiber, 5.4g protein

Two Bean Soup with Kale
Courtesy of Cookinglight.com

Ingredients:
3 Tbsp olive oil
1 c. chopped onion
1/2 c. chopped carrot
1/2 c. chopped celery
1/2 tsp salt, divided
2 garlic cloves, minced
4 c. organic vegetable broth (such as Emeril’s), divided
7 c. stemmed, chopped kale (about 1 bunch)
2 (15-ounce) cans no-salt-added cannellini beans, rinsed, drained, and divided
1 (15-ounce) can no-salt-added black beans, rinsed and drained
1/2 tsp freshly ground black pepper
1 Tbsp red wine vinegar
1 tsp chopped fresh rosemary

Directions:
1. Heat a large Dutch oven over medium-high heat. Add olive oil to pan; swirl to coat.
2. Add onion, carrot, and celery, and sauté 6 minutes or until tender.
3. Stir in 1/4 teaspoon salt and garlic; cook 1 minute.
4. Stir in 3 cups vegetable broth and kale. Bring to a boil; cover, reduce heat, and simmer 3 minutes or until kale is crisp-tender.
5. Place half of cannellini beans and remaining 1 cup vegetable broth in a blender or food processor; process until smooth.
6. Add pureed bean mixture, remaining cannellini beans, black beans, and pepper to soup. Bring to a boil; reduce heat, and simmer 5 minutes.
7. Stir in remaining 1/4 teaspoon salt, vinegar, and rosemary.

Nutrition Facts:
(serves 6)
250 cal, 10.4 g fat, 1.4 g saturated fat, 11.8 g protein, 9.2 g fiber, 393 mg sodium

New Solutions for Inflammatory Bowel Disease (IBD)

Posted on: January 12, 2016

Something to Cheer About

By Dr. Elie Abemayor

I remember the day when an 18-year-old cheerleader came to see me, she knew something was dramatically wrong—but she didn’t want to talk about it. The normally bouncy high school student was becoming less social, and she was losing weight. She was having bowel issues, and she really didn’t want to talk about it.

Northern Westchester Eli AbemayorAfter discussing her symptoms, I checked for blood in her stool, and then confirmed her diagnosis with a colonoscopy and a biopsy. She had ulcerative colitis, a form of inflammatory bowel disease (IBD). Luckily, her condition was still in the mild to moderate stage; after she started medications she had a complete reversal within a few weeks. She was able to get back to a healthy weight and her symptoms subsided.

IBD, which includes Crohn’s disease and ulcerative colitis (the cheerleader’s condition), plagues as many as 1.4 million Americans, according to the Centers for Disease Control and Prevention (CDC). Given the nature of the symptoms, many people wait too long to seek treatment. Treating IBD early can make such a big difference in being able to manage the disease successfully.

Both Crohn’s and colitis can be characterized by persistent diarrhea, abdominal pain, cramping, fatigue, and blood in the stool. The reason for these symptoms is chronic inflammation in the digestive tract, which interferes with normal digestion. Crohn’s disease can target any part of the gastrointestinal (GI) tract, from the mouth to the anus, and it can penetrate the intestine walls to affect nearby organs. Ulcerative colitis, on the other hand, only involves the colon or rectum and irritates only the inner wall of the intestine.

If you’re seeing a GI specialist about IBD, expect to be questioned in depth about your symptoms. If your doctor believes you may be suffering from Crohn’s disease or colitis, he or she may order a colonoscopy, endoscopy, or other imaging such as a CT scan to check for inflammation. A biopsy of the inflamed area may also be necessary to confirm the diagnosis. Although it’s not possible to cure these conditions with medications, there are many effective drugs that can control symptoms, as was the case with the cheerleader. Anti-inflammatory drugs can calm a severe attack; immune system modulators can also quell symptoms. Often we find that a combination of medications works best.

For more severe cases, surgery may be required. Not too many years ago, surgeons would remove the entire colon and rectum in patients with ulcerative colitis. A patient would have to use a colostomy bag for the rest of his or her life. No more: New techniques such as ileal pouch anal anastomosis can create part of the rectum. In a two- or three-stage procedure, the surgeon can fashion a new rectum using healthy intestine, and reconnect to the anus so that the patient’s daily life is minimally affected.

Although about half of people with Crohn’s disease will require surgery at some point, the procedure won’t be curative unlike ulcerative colitis. In some cases a patient may need more than one operation. The goal of the procedure is to remove the damaged portions of the digestive tract and reconnect the healthy sections. With the right medications and a careful eating plan, patients may be able to avoid a return of their symptoms.

People with IBD can find excellent information and support through groups such as the Crohn’s and Colitis Foundation of America www.ccfa.org. Just remember that it’s key to seek treatment early, no matter how unpleasant it may seem to discuss your symptoms. You’ll have many more options for treatment and much greater success.

Editor’s Note: Elie Abemayor, MD is the Chief of Gastroenterology at Northern Westchester Hospital.

Making the Holidays Special for Loved Ones in the Hospital

Posted on: December 15, 2015

Making the Holidays Special for Loved Ones in the Hospital

Tips for caregivers, family and friends from The Ken Hamilton Caregivers Center

Here are some tips that you may find helpful while your loved one is in the hospital during the holidays.  Remember for safety reasons, it’s very important to check with hospital staff before you bring any items into the hospital room.

1)       Bring small gifts to your family member if they are well enough to un-wrap the item.
2)       Bring something pleasant and safe as a decoration for their hospital room.
3)       Bring in some comforts of home, such as your loved one’s favorite pajamas, blankets or pillow.
4)       Deliver their favorite snacks or holiday food that fits within any dietary restrictions.
5)       If you think it will raise their spirits, assemble a photo album of pictures from previous holidays.
6)       If religious, bring in a recording of a religious service, or watch one on television.
7)       Play some holiday music or watch a favorite holiday movie together.
8)       If family is unable to visit, reach out to the volunteer department for visitors.

Gift Suggestions for hospitalized family members
Entertainment:  Books, magazines, music, movies, crossword puzzles, and playing cards.

Enjoyment:  Get well cards, holiday cards, and small gifts.
Gift of Service:  Have someone offer to run an errand for your loved one – this can feel very supportive when in the hospital.  If your family member needs information about a community resource, you can offer to assist them in gathering information.

Editor’s Note: The Ken Hamilton Caregivers Center is dedicated to caring for the family caregiver. The Caregivers Center serves as a private sanctuary during the very demanding and stressful times of providing care for your loved one, regardless of  whether they are hospitalized at NWH, at another facility or at home.

Care and Comfort for the Common Cold

Posted on: December 15, 2015

Care and Comfort for the Common Cold

By Dr. Elliot Barsh

Sneezing and coughing, symptoms of the common cold, are prevalent throughout the winter, and not surprisingly. According to the Centers for Disease Control and prevention, children average about six to eight colds each year. Understanding the symptoms, listening to your child and knowing when to see your doctor will help you provide the care and comfort your child needs.

The first thing to know about colds is that they’re caused by a virus, and that’s why doctors do not prescribe antibiotics in these instances, as they only work for bacterial infections. In fact, most of the symptoms you get with a cold—coughing, sneezing, fever—are your body’s way of fighting off the virus. It’s often a parent’s first instinct to treat the symptoms, but the cough and fever are therapeutic. Trying to suppress cold symptoms with medications can actually prolong the illness, and no one wants to feel sick longer than they have to. If your child is feeling miserable, by all means, give her Tylenol. If she seems to be feeling fine, there is no need to give her medicine. The key: Listen to your child and manage what she feels, by doing this you will be able to provide her comfort and help her body heal faster.

Colds last about 10 to 14 days. You’ll have two to three days of getting sick, possibly followed by a fever for three or four days, coughing may worsen over the next three or four days, and then you should see improvement over the last two to three days. It’s important to know that this pattern is not true of more serious infections, such as the flu and pneumonia, and I strongly recommend all children get the flu vaccine.

With colds, the plan is to get plenty of fluids, rest and sleep, and nourish your child back to health. Antibiotics don’t help speed recovery from the common cold. If your child seems run down or low on energy, make sure she stays home from school, play dates and sports practices. You can keep your child more comfortable by running a humidifier in her room at night. Dry air from heating can make coughs worse. I also recommend feeding your children plenty of citrus fruits. Vitamin C can help fight the virus, and the actual fruit is better than juice or pills because the fiber in the pulp delivers extra health benefits. And chicken soup, it’s not just an old wives’ tale, it’s actually medicinal. Should the symptoms get worse instead of better, persist longer than 10 days or seem more severe than the typical cold, call your doctor.

We can’t prevent our kids from getting sick, but we are able to reduce the frequency by reminding them to wash their hands well and often, and by teaching them to cough and sneeze into their elbows. Respiratory droplets expelled through coughing, sneezing and talking are how colds spread. Lastly, it turns out mom was right: keep the kids bundled up, if they’ve been exposed to the cold virus, they may be less likely to develop a cold. Simply remember, don’t treat the symptoms, treat your child, and speak with your doctor when you need to.

Editor’s Note: Elliot Barsh, MD, is a pediatrician at Northern Westchester Hospital and the Mount Kisco Medical Group as well as the school physician for the North Salem Central School District.