Category Archives: Expert Health Advice

Northern Westchester Hospital Pediatric Pulmonologist on Kids and Asthma

Posted on: September 22, 2014

Managing Childhood Asthma

by Lynne Quittell, MD

The soft wheeze or whistle as a child breathes. The chin tucked and chest pinched as he coughs incessantly. These are signs of childhood asthma, a maddening, frightening condition for kids and parents — and a leading cause of ER visits for children. While in the past asthma has been difficult to treat and manage, advancements in medications and methods have allowed doctors and families to tame this potentially dangerous condition in children.

The reasons why a child develops asthma can be murky. Potential triggers can be allergies, exposure to secondhand smoke, or a family history of asthma. Premature babies who spend time on a ventilator appear to be at higher risk.

The reason a child struggles to breathe is that the airways can easily become inflamed, muscles that support the airways can constrict, and mucus production can increase. Some kids will have exercise-induced asthma while others may find allergy season to be the source of troubles. Even a sudden change  in temperature or a rise in humidity can set off an attack.

Parents and children should work with their doctor to develop a treatment and medication plan. This is the aspect of asthma treatment that has really changed over the years. The medications have improved greatly. We teach children and parents to recognize the earliest signs of an attack, and encourage them to treat symptoms promptly — before they worsen. I like to use the analogy of smoke in the kitchen… You wouldn’t just let it go — you’d address it immediately. Asthma is the same: Stop the attack before the symptoms become more difficult to control.

When setting up a plan, a doctor must take into consideration the child’s triggers and needs. During the spring or fall allergy season, some children will require a daily preventive medication to minimize airway inflammation, while others may be okay using an inhaler to treat occasional flare ups linked to exercise. The next step is managing more serious flare ups, and then knowing when to seek emergency help. No one leaves my office without a written treatment plan. “It’s one of the most important aspects of asthma care.

Children whose asthma isn’t responding to treatment can benefit from pulmonary exercise program, similar to what is offered at Northern Westchester Hospital. An effective program would involve exercise and respiratory therapists who would create a program for your child to help him or her build physical strength and exercise capacity. The plan should be specifically tailored to your child’s needs and include education and advice for caregivers. The goal? To get your child to the point where they can play and partake in activities with their peers, without limitations.

With the excellent treatment available, I expect my patients to be able to take part in all age-appropriate activities with no restrictions.

Editor’s Notes:
Lynne Quittell, MD, is a pediatric pulmonologist who specializes in pediatric asthma at Northern Westchester Hospital

Did you know…
Asthma affects 7 million children under the age of 18.*
*Centers for Disease Control and Prevention

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Safe Satisfying Seafood

Posted on: September 18, 2014

Savory and Satisfying Seafood

by Kimberly Stein, RD, CDN

There are plenty of fish (and shellfish) in the sea, but sometimes it’s difficult to know which are the best choices. Seafood is a delicious protein source that is rich in omega-3 fatty acids that boost heart and brain health. The current recommendation from the 2010 Dietary Guidelines is to consume seafood about 2 to 3 times per week. A recent hot topic is sustainable seafood. There are many environmental groups that identify which fish are the safest for consumption, and for the environment. The Monterey Bay Aquarium is one of those groups. To make their list, seafood must contain low levels of contaminants (such as mercury), high levels of omega-3 fats, and be sourced from a sustainable fishery.
Here are some simple tips to ensure you are getting safe, fresh, and nutritious seafood!

1)    Be Finicky When Selecting Fish. According to the Monterey Bay Aquarium, and their strict criteria, here are some of the best choices of seafood: Arctic Char (farmed), clams, mussels, oysters, Pacific Cod, Alaskan Salmon, Tilapia (Ecuador or US), and US/ Canada Albacore/white canned Tuna. They recommend avoiding: imported Mahi Mahi, farmed Atlantic Salmon, Shark, imported Swordfish, and Bluefin Tuna. As you can see, it also depends on where the fish comes from. Some waters are better than others, which will provide you with fewer toxins. For a more complete list of sustainable seafood, check out www.seafoodwatch.org

2)    Oh my Omega! Fish are a fantastic source of omega-3 fatty acids. These unsaturated fats are found to lower levels of inflammation throughout the body and reduce your risk of cardiovascular events. Certain fish with a higher fat content are higher in omega-3 fats, such as salmon, trout, herring, sardines, and tuna. Enjoy these to reap their heart-healthy benefits!

3)    Safely Cooking Seafood. As with all meats, the USDA sets requirements for how fish and shellfish should be properly cooked to avoid potential food-borne illness. Cook shrimp, lobster, and scallops until they are an opaque, milky white color. Fish should be cooked to an internal temperature of 145°F, until it flakes with a fork.

4)    Restaurant Ratings. To avoid the high-calorie seafood options when eating out, opt for dishes without a batter-dipped coating, or butter sauce. Instead of the coconut shrimp, try grilled shrimp or instead of a breading and mayo-rich crab cake, choose steamed crab legs. You can still enjoy a variety of seafood without the added fat calories.

Here are some delicious seafood recipes to try! Enjoy!

Hoisin-Glazed Salmon Burgers with Pickled Cucumber
Courtesy of www.myrecipes.com

Ingredients
Serves 4
1/3 cup water
¼ cup cider vinegar
1 tsp. sugar
½ tsp. minced garlic
½ tsp. minced peeled fresh ginger
¼ tsp. crushed red pepper
24 thin English cucumber slices
½ cup panko breadcrumbs
1/3 cup thinly sliced green onions
2 tbsp. chopped fresh cilantro
1 tbsp. lower-sodium soy sauce
1 ½ tsp. grated peeled fresh ginger
1 tsp. grated lime rind
1 (1-pound) skinless wild fresh or frozen Alaskan salmon fillet, finely chopped
1 large egg white
1 ½ tsp. dark sesame oil
1 tbsp. hoisin sauce
4 (1 ½ ounce) hamburger buns with sesame seeds, toasted

Method
1. Combine the first 6 ingredients in a small saucepan and bring to a boil. Remove from heat and cucumber. Let stand 30 minutes. Drain
2. Combine panko and the next 7 ingredients (through egg white) in a bowl and stir well. Divide the mixture into 4 equal portions, gently shaping each into a 1/2 –inch thick patty. Press a nickel sized indentation into the center of each patty.
3. Heat a large cast-iron skillet over medium-high heat. Add sesame oil to pan. Add patties and cook for 3 minutes on each side or until desired degrees of doneness. Brush tops of patties evenly with hoisin and cook for 30 seconds.
4. Place 1 patty on bottom half of each bun and top each with 6 cucumber slices and top half of bun.

(Nutrition Facts: Serving Size ¼ of recipe, Calories 324, Protein 29.4g, Fat 8.6g, Sat Fat 1.5g, Mono 2.3g, Carbohydrates 59g, Fiber 1.7g, Sodium 473 mg, Cholesterol 59mg)

Fish Tacos with Sesame Ginger Slaw
Courtesy of www.foodnetwork.com

Ingredients  
Serves 4
1 ½ lbs. tilapia fillets
Cooking spray
¼ tsp. salt
¼ tsp. pepper
3 tbsp. plain Greek-style low-fat yogurt
2 tbsp. lime juice
1 tbsp. dark sesame oil
1 tbsp. low-sodium soy sauce
2 tsp. grated peeled fresh ginger
1 tsp. honey
3 cups shredded coleslaw mix
12 (6-inch) corn tortillas, warmed

Method
1. Heat a nonstick skillet or grill pan over medium heat. Spray fish with cooking spray and sprinkle with salt and pepper.
2. Add fish to pan and cook 10 – 12 minutes, turning once, until fish flakes easily with a fork.
3. Combine yogurt and next 5 ingredients (through honey) in a small bowl, stirring with a whisk. Combine dressing and coleslaw mix, tossing to coat.
4. Place 2 ounces fish in each tortilla. Top with coleslaw.

(Nutrition Facts: Serving Size ¼ of recipe, Calories 390, Protein 40g, Fat 9g, Sat Fat 2g, Mono 3g, Poly 3g, Carbohydrates 38g, Fiber 6g, Sodium 430 mg, Cholesterol 85mg)

Study: Genetic Testing for Ashkenazi Jews

Posted on: September 10, 2014

Study: Ashkenazi Jewish Descent as a Criterion for Genetic Testing
by Nancy Cohen, MS, CGC

Nancy Cohen Genetic Counselor WestchesterA new study, Population-based screening for breast and ovarian cancer risk due to BRCA1 and BRCA2 (abstract available in PubMed), suggests that population screening of Ashkenazi Jews for BRCA mutations may be beneficial because the cancer risks of those without a family history suggestive of a BRCA gene mutation were shown to be very similar cancer risks to those with such a history.

Since 2.5% of Ashkenazi Jews harbor BRCA mutations, and increased cancer surveillance and cancer risk reduction have been shown to improve outcomes for mutation carriers, such screening may have a useful role in this population. It will be interesting to see whether or not the guidelines from the NCCN will be adjsted to reflect this study.

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Northern Westchester Hospital Dietitian Shares Tips to Prevent Foodborne Illnesses

Posted on: August 28, 2014

Keeping Your Food Safe

By Stephanie Perruzza, MS, RD, CDN

Stephanie Perruzza MS, RD, CDN Northern Westchester Hospital

Every year, one in six Americans (about 48 million) gets sick from foodborne illnesses and 128,000 are hospitalized, according to the Center of Disease Control. The good news is most foodborne illnesses can be prevented with simple food safety tips. September is National Food Safety Month, which focuses on the importance of increasing food safety awareness.

Children, pregnant women, and those with weakened immune systems are often more susceptible to foodborne illness. To reduce your risk, follow these simple steps:

 

Clean
• Clean your hands and all cooking surfaces (counters, utensils, cutting boards) with hot soapy water before preparing or eating meals
• Consider paper towels to clean surfaces; if you use cloth towels wash them often.
Cook
• Use a food thermometer to cook foods to proper internal temperatures, for example poultry should reach an internal temperature of 165°F and fish to 145°F.
• Bring sauces, soups and gravies to a boil when reheating. Heat other leftovers thoroughly to 165°F.
Chill
• Keep your refrigerator at 40°F or below and your freezer 0°F or below to reduce risk of foodborne illness.
• Never defrost at room temperature.  Three safe methods to thaw are: in the refrigerator, in cold water or in the microwave. If you are thawing in cold water or the microwave food must be cooked immediately.
Separate
• Separate raw items (poultry, seafood) from other food items in grocery bags and in your refrigerator. Store raw items on shelving below cooked or ready to eat items.
• Use separate cutting boards for items like fresh produce and raw meats. I find that color-coded cutting boards (green for veggies, red for meats) work best to help prevent cross-contamination.

Myth Busters:
Below are some common food safety myths:
MYTH: Glass or plastic cutting boards don’t hold harmful bacteria like wooden cutting boards do.
FACT: ALL cutting boards can be a breeding ground for bacteria regardless of type.  It’s important to wash and sanitize after each use. Solid plastic and glass are dishwasher safe; however, wooden don’t hold up very well. Once cutting boards become old with cracks and excessive knife scares it’s time to dispose.
MYTH: Rinsing my hands under running water kills germs.
FACT: Water with soap is the best way to wash your hands and remove harmful bacteria. Be sure to scrub both the front and back of your hands under running water. Sing Twinkle, Twinkle Little Star twice (about 30 seconds) to ensure your hands are clean, dry with a clean MYTH: Pre-packaged produce does not need to be washed before eating.
FACT: Just because produce is pre-packaged doesn’t mean that it’s ready to eat. Ready the label to make sure it states, “ready to eat” or “triple washed,” if it does you’re good to go!

FightBac!® is a campaign created by a non-profit organization called Partnership for Food Safety Education. It aims at improving public health and food safety by bringing together health educators and other partnered organizations to increase awareness and reduce the risk of foodborne illness. For more information on food safety please check out the following credible websites:
www.FightBac.org
www.FoodSafety.gov
www.HomeFoodSafety.org

Dr. Forcade on a Promising Treatment to Help Patients Battling Metastatic Liver Cancer

Posted on: August 25, 2014

When There is No Cancer Cure, There Can be ‘Cancer Control’

Carlos Forcade, MD

Chief, Interventional Radiology, Northern Westchester Hospital

Some radical cancer therapies are being replaced in favor of treatments that honor a person’s wish for quality of life over prolongation of poor life.

One example is an interventional radiology treatment at Northern Westchester Hospital using trans arterial radioembolization, or TARE.  TARE shows promise in prolonging quality of life for many patients battling liver cancer and metastatic colorectal cancer in the liver.

This unique interventional treatment delivers Yttrium-90, a radioactive isotope, directly to a tumor through the vascular system. It is a scientifically sophisticated technique for giving NWH patients a cancer treatment that doesn’t harm the healthy cells.

First, What is Interventional Radiology?

A subspecialty of Diagnostic Radiology, Interventional Radiology uses image guidance to perform minimally invasive procedures to treat a wide range of diseases.

Better Outcome for Our Patients

More than three-fourths of liver cancer patients can’t have surgery; TARE with Yttrium-90 gives patients more time.  And as an interventional radiology procedure, it offers the benefits of a minimally invasive treatment:

  •    Reduced infection rates, risk, pain and recovery time
  •    Shorter hospital stays
  •    Uses under local anesthesia instead of general anesthesia

TARE with Yttrium-90 is an advanced treatment that is invaluable for patients with primary and secondary malignancies of the liver who have previously exhausted or who do not have other options in combating their liver cancer.

How TARE with Yttrium-90 Works

Tumors need a blood supply, which they actively generate, to feed themselves and grow. Interventional radiologists are uniquely skilled in using the vascular system to deliver targeted treatments via catheter throughout the body. In treating cancer patients, Interventional Radiologists can attack the tumor from inside the body without medicating or affecting other parts of the body.

Combining the radioactive isotope Yttrium-90 (also known as Y-90) into microspheres to deliver radiation directly to a tumor allows for a higher, local dose of radiation to be used-without subjecting healthy tissue in the body to the radiation.

 trans arterial radioembolization Northern Westchester HospitalEach microsphere is about the size of five red blood cells in width. These beads are injected through a catheter from the groin into the liver artery supplying the tumor. The beads become lodged within the tumor vessels where they exert their local radiation that kills the cancer cells. Y-90 radiates from within and is administered via the hepatic artery. Y-90 treatment is approved by the Food and Drug Administration for the treatment of inoperable liver cancer and metastatic colorectal cancer in the liver.

While this advanced treatment doesn’t cure liver cancer, the lives of patients at NWH are being extended and their quality of life is improved with Yttrium-90 microsphere treatment.

The Team Approach at NWH

Paramount to the application of this leading-edge treatment is the multidisciplinary collaboration at Northern Westchester Hospital between the Interventional Radiology Department and the Radiation Oncology Department, led by Dr. Alfred Tinger, Chief of Radiation Oncology in The Cancer Treatment and Wellness Center.

There are other interventional radiology treatments available at Northern Westchester Hospital that are used to treat primary liver cancer, as well as other cancers that have metastasized in the liver, such as colorectal cancer, breast cancer, gynecologic cancers, melanoma, and others. These nonsurgical interventional radiology treatments are:

  • Trans arterial embolization (TAE)
  • Trans arterial chemoembolization (TACE), which delivers chemotherapy directly to the liver
  • Radiofrequency ablation (RFA), which kills the tumor with heat to treat the cancer locally.

Editor’s Note:  Carlos Forcade, MD, is Director of Interventional Radiology at Northern Westchester Hospital in Mt. Kisco, NY.  For more information or for a referral please call the Interventional Radiology Department at 914.242.8154

NWH is one of only 5 Hospitals in New York State to offer Yttrium-90 therapy for the treatment of liver cancer. (The other hospitals are: Memorial Sloane-Kettering, NYU, Mt. Sinai and NY Presbyterian.)