Category Archives: Maternal Child Health

Kids and the Flu: Symptoms, When to Seek Care

Posted on: January 29, 2015

Flu Season’s in High Gear: How to Protect and Care for Your Kids

By Dr. Pete Richel

We are now in the middle of Influenza season (“the Flu”), which is typically October ID-100228285_Boy And Vaccine Syringe by Sura Nualpradidthrough March. Locally we did not see much of this in October and November, but it commenced last month and is going strong.

Most of the positive cultures are revealing Influenza type A, and even though the Influenza vaccine was not a great match this year, we still encourage all to receive it, since it may be protective against some strains, and we find no significant down side.

All children 6 months and older should be vaccinated against the flu.
-Centers for Disease Control and Prevention

It’s not too late to receive this at your doctor’s office. The vaccine is approved for those 6 months of age and older. When someone gets “the Flu” at any age, the classic symptoms are:

  • temperature instability (fever) as the body’s immune system fights for us,
  • generalized achiness,
  • and a rather hacking cough.

“…frequent hand washing for patients and their caretakers
will help to prevent contagion.”

When any of these symptoms occur, bring your child to see your pediatrician. We can evaluate them with a physical exam, of course, and we can do a rapid Flu test and make the diagnosis in minutes. If the test is positive, then we can prescribe Tamiflu, a medication which may lessen the severity of symptoms, and may shorten the usual week long course of the illness.

In addition, it is always prudent to keep up with plenty of fluids to prevent dehydration and the need for hospitalization. And we all know that good frequent hand washing for patients and their caretakers will help to prevent contagion. This is something that you don’t want to share!

According to the Centers for Disease Control and Prevention, “some children are at especially high risk.” Children at greatest risk of serious flu-related complications include the following:
1. Children younger than 6 months old -These children are too young to be vaccinated. The best way to protect them is to make sure people around them are vaccinated
2. Children aged 6 months up to their 5th birthday.
3. American Indian and Alaskan Native children.
4. Children with chronic health problems, such as: Asthma, neurological and neurodevelopmental conditions, Chronic lung disease, Heart disease, Diabetes or a weakended immune system.

Editor’s Note:
Peter Richel, MD, FAAP is Chief of Pediatrics at Northern Westchester Hospital. He is a member of Westchester Health Associates and has practiced on Smith Avenue in Mt. Kisco since 1990. Dr. Pete has authored “Happy and Healthy,” a book on wellness in the first year of life, and produced a CD of children’s songs called “Welcome to Dr. Pete’s Office.” Both of these are intended to educate and entertain children and their families.

Dr. Pete, as he’s fondly known, has received numerous recognitions including: Castle Connolly Top Doctor, Top Pediatrician by the Consumer’s Research Council of America and honored with Patients’ Choice Awards and Compassionate Doctor Awards.

Photo Credit: Sura Nualpradid / FreeDigitalPhotos.net

 

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Preventing Cervical Cancer

Posted on: January 23, 2015

Women – This Regular Screening Can Save Your Life

by Dr. Navid Mootabar

There’s important news for every woman in a recent report from the Centers for Disease

Navid Mootabar, MD Chief, Obstetrics & Gynecology Director, Institute for Robotics & Minimally Invasive Surgery Northern Westchester Hospital

Navid Mootabar, MD
Chief, Obstetrics & Gynecology
Director, Institute for Robotics & Minimally Invasive Surgery
Northern Westchester Hospital

Control and Prevention (CDC): Despite evidence that cervical cancer screening saves lives, about eight million women, ages 21 to 65 years, have not been screened for cervical cancer in the past five years. In addition, more than half of new cervical cancer cases occur among women who have never or rarely been screened.  Here, I explain which tests you need, when to get screened, and demystify the protective HPV vaccine. I also offer women a silver lining: You rarely have to worry about advanced cervical cancer if you are regularly screened.

Did you know that cervical cancer was the leading cause of death among women 40 years ago?

The introduction of screening through the Pap smear has caused the disease to drop to the fourth cause of female mortality. But that incidence could be lowered even further if more women had the recommended Pap test. To understand this screening’s exceptional value, you need to know more about the primary cause of cervical cancer: Human Papillomavirus (HPV).

HPV causes approximately 90 percent of all cervical cancer cases.

This sexually transmitted virus is so common, most people will contract it at some point in their lives. There are many strains (types) of HPV. Certain HPV strains are responsible for changes on a woman’s cervix that can result in cervical cancer. Other strains may cause genital or skin warts.  Additional factors that contribute to an increased risk for cervical cancer include smoking, extended use of birth control, and having multiple sexual partners.

Most women who have cervical cancer will have no symptoms. However, infrequent symptoms may include unexplained vaginal bleeding, bleeding after intercourse and abnormal vaginal discharge. What’s more, the strains of HPV that may lead to cervical cancer are also asymptomatic.

Regular screening for cervical cancer has extraordinary life-saving potential.

The screening test — the Pap smear– involves brushing cells off the cervix, which are then examined for abnormalities. Our goal is to identify cervical cancer in a precancerous state, when it is highly curable. The impact of identifying the disease early through a Pap smear is evidenced by the fact that, from 2001 to 2010, the incidence of the disease decreased by almost two percent per year.

So when should you get screened? New guidelines recommend that women start at age 21. A Pap smear is recommended every three years, combined with an examination of the same cervical cells for HPV, until the age of 65, provided you have no risk factors or abnormal Pap smears. At 65, screenings can be discontinued if there have been no abnormal results in the previous 10 years, or no history prior to the past ten years of moderately pre-cancerous growth.

“Seeing your gynecologist annually is a vital
part of a woman’s comprehensive health care.”

The three-year guideline takes into account that for most women, cervical cancer doesn’t progress quickly. Very rarely does it advance from normal to cancer in one year. Therefore, if a woman is screened every three years, there is every likelihood the disease will be caught while still in the highly curable pre-cancerous stage.

Keep in mind that the guideline represents the minimum number of screenings you need to be safe. However, some women require more frequent screenings. At each visit, your gynecologist will determine if it is appropriate to do a Pap smear, by assessing all risk factors.

There are two other forms of prevention for cervical cancer.

One is the condom. The other is the HPV vaccination, which protects women from several of the most common and aggressive strains of HPV that can lead to cervical cancer. However, it does not protect against all strains that can lead to the disease. The vaccine – a series of three injections over six months – is recommended any time from age 9 to 26. Because HPV is transmitted through intercourse, I often recommend to my patients that they wait until they are considering becoming sexually active. Many parents question if their daughter needs the vaccine at such an early age.  The decision as to when to receive the vaccine is very individual, and I believe it should be made in consultation with the patient’s gynecologist or pediatrician.  I want to stress that the vaccine does not replace regular Pap smears.

Treatment for cervical cancer in the pre-cancerous stage can be as simple as an office procedure called a LEEP (loop electrosurgical excision procedure) which involves a local anesthetic and removal of all pre-cancerous cells from the cervix. There is a low incidence of recurrence. If the disease advances to cancer, treatment depends on the stage and the woman’s wish to remain fertile.  It can involve a cone biopsy, in which the outer portion of the cervix is removed; a hysterectomy, involving removal of the uterus and cervix; or radiation therapy.

It is essential to understand that, although the recommendations call for a Pap smear every three years, seeing your gynecologist annually is a vital part of a woman’s comprehensive health care. Pelvic exams, Pap tests and cancer screenings can help prevent illness and detect problems at an early and potentially more treatable stage. All women need to be diligent about visiting their gynecologist each year.

Editor’s Note:
Dr. Navid Mootabar is a member of Westchester Health Associates in Mount Kisco, NY. He is the Chief of Obstetrics and Gynecology and a Director of the Institute for Robotic & Minimally Invasive Surgery at Northern Westchester Hospital. He received his medical degree from the Mount Sinai Medical School, where he also completed his residency in Obstetrics, Gynecology, and Reproductive Medicine. Dr. Mootabar completed his undergraduate courses at Columbia University and was named among “America’s Top Obstetricians and Gynecologists” from the Consumer Research Council of America. Dr. Mootabar has received advanced training in robot-assisted Single Incision Laparoscopic Surgery (SILS) and utilizes this approach for select gynecologic surgery procedures.

 

 

New York Labor and Delivery Nurse on the Helpful Aspects of Electronic Fetal Monitoring

Posted on: November 18, 2014

Why Electronic Fetal Monitoring is a Woman’s Friend

by Enid Nwosisi

What is Electronic Fetal Monitoring?
As a labor and delivery nurse, I find that the majority of expectant moms need electronic fetal monitoring (EFM) at least once during their pregnancy. In addition, during labor, all women need EFM, either intermittently or continuously.

By providing critical information about the medical status of fetus and mother during pregnancy and labor, EFM plays an essential role in helping to ensure a successful pregnancy and delivery. The test results either reassure the care provider and family that the pregnancy and delivery can continue safely, or indicate the need for intervention.

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Flu Shot Facts for Pregnant women

Posted on: October 16, 2014

Pregnancy, Your Immune System and the Flu Vaccine

By Maureen Varcasio, RN

NWHmaternalchild.orgPregnant women can protect themselves and their babies by getting the flu shot. The Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists recommend that all pregnant women get vaccinated with the Influenza (Flu) vaccine.

During pregnancy changes in the immune system, heart and lungs put women at an increased risk for severe illness, hospitalization or even death from the flu.

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New York Neonatologist Talks Pulse Oximetry and Newborn Screenings

Posted on: July 16, 2014

The Fourth Vital Sign

By Dr. Rick Stafford

SONY DSCCongrats. You’re having a baby! Whether this is your first, or your fifth, you’ve most likely read everything you need to know about what to expect, and you’ve no doubt gotten advice from well-meaning friends and relatives. But before you take your infant home, doctors will be looking for a few key signs that your child is healthy and ready to leave the hospital. All states require specific tests for newborns to assess for potentially fatal disorders that aren’t otherwise apparent at birth, among them the recently required pulse oximetry assessment. The information below explains its significance.

New to the newborn screening docket, as of 2013, is pulse oximetry screening for cyanotic congenital heart disease (CCHD). Pulse oximetry, which indirectly measures the oxygen level in the bloodstream, has become almost a fourth vital sign (temperature, pulse rate and respiratory rate are the traditional 3 vital signs). New York State health code now mandates pulse oximetry screening for CCHD in all newborns born in New York. Northern Westchester Hospital was proactive in this regard and has been administering the screening since April of 2013.

The right side of the heart pumps blood through the lungs, where it picks up oxygen. Blood returns to the left side of the heart, where it is then pumped to the rest of the body. There are some congenital cardiac defects that impair oxygen delivery to the blood.  This results in the delivery of de-oxygenated blood to the body, a condition (cyanosis) that is not compatible with life. Pulse oximetry screening can pick this up in a newborn before he or she becomes critically ill. In a fetus, the circulation is very different. Oxygenated blood comes from the placenta and two shunts; it then circulates around the lungs into the left side of the heart where it flows to the rest of the fetus.  Because of this, a fetus with a cyanotic congenital heart defect will not be sick while in the womb.

These shunts are supposed to close within a few hours after birth, and when they do, the babies may begin to get sick. The shunts don’t always close right away and a baby may get sick after being discharged home. This is why applying pulse oximetry screening to a newborn is so valuable. Doctors and nurses normally wait at least 24 hours before administering the screening. Do the test too early and it’s possible those shunts are still working, thus masking the condition. Too late and the baby could become very sick very rapidly.

The test is administered with a sensor that measures and compares the differences in the wavelengths of oxygenated and deoxygenated blood. The sensor is first placed on the baby’s hand and then on the foot, with the expectation that the numbers will be the almost the same. A cardiologist would be called in for a consult if there is a percentage difference of three points or higher, or if the baseline saturation is low. If a diagnosis of CCHD is made, the neonatology team would then work to stabilize the baby and prepare him or her for transport to a large regional center where corrective heart surgery could be performed.

It’s all about early detection, intervention and treatment.

Editor’s Note: Rick Stafford, MD, FAAP is the Director of Neonatology at Northern Westchester Hospital. Parents looking for more information on this subject should check out the web-site of the American Academy of Pediatrics: www.aap.org