Category Archives: Northern Westchester Hospital News

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.

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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.

Dr. Peris Discusses Relief from Back Pain

Posted on: September 16, 2015

How to Treat Your Aching Back

By Dr. Marshal Peris

You’ll be happy to hear that most people recover from back pain within a few days just by taking it easy, continuing gentle activity, and using over-the-counter pain medicine such as naproxen (Aleve) or ibuprofen to ease their pain. If the pain doesn’t resolve itself within a week or so, your doctor may suggest physical therapy where you can learn stretches and ways of moving that will ease the strain on your back.

If you are still experiencing pain, prescription pain medications and possibly steroid injections to reduce swelling in your back are likely next steps. Your physician may recommend imaging to determine if abnormalities in your spine are causing your pain. If your back pain doesn’t get better using these more conservative methods, your doctor may refer you to an orthopedic surgeon to determine if surgery can help. Sometimes abnormalities in the vertebrae or the soft discs that cushion your spine can press on spinal nerves and cause pain or numbness in your legs and make it difficult to walk or stand. In such cases, surgery can help immensely.

Your orthopedic surgeon will explore your options with you, and the two of you can decide on the best approach. The good news is that the surgical solutions for back pain are improving all the time. One exciting development used at Northern Westchester Hospital is direct lateral fusion, which can address back abnormalities that cause chronic pain. As “lateral” implies, the surgeon works from the side of the patient. This advanced technique is much less invasive and allows us to achieve amazing results. The incision is much smaller and we don’t have to fuse as many vertebrae to get great results. It’s often a simpler, more effective treatment, and patients are usually up and moving after one day (instead of three to four) and typically leave the hospital after three to four days versus six to seven. The vast majority of patients are much happier and back to their normal activities much sooner.

Editor’s Note: Marshal D. Peris, MD FAAOS is the Director of Spine Surgery at the Orthopedic & Spine Institute and President of the Medical Staff at Northern Westchester Hospital.

 

Ready to Run

Posted on: July 22, 2015

Ready to Run: Simple Stretches to Stave Off Injury

By Dennis McGovern

Each year, more and more people are inspired to start their own running program. Running provides both physical and mental benefits, the only equipment required is a pair of Runningrunning shoes and you can do it anywhere. I’m a big fan of setting fitness goals, and recommend taking a few precautions to help avoid injury.

A thorough warm up before running is a must. When you do any type of vigorous exercise, you get microtears in your muscles. That’s natural—when your body repairs your muscles, they become stronger. But if you aren’t properly warmed up, you’ll experience many more of these tears and you’ll be much sorer afterward.

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The Patriotic Plate – Red, White and Blue Superfoods

Posted on: June 22, 2015

The Patriotic Plate – Red, White and Blue Superfoods

Amy Rosenfeld, MS RD CDN

This 4th of July, celebrate our country’s independence with good health and a patriotic plate. American flagRed, white, and blue foods are superfoods: nutrition powerhouses packed full of rich antioxidants and phytonutrients.

Red fruits and vegetables like strawberries, tomatoes, and pomegranate, are full of phytonutrients, anthocyanins, flavonoid compounds; nutrients that reduce cancer by fighting free radicals and preventing oxidative damage to cells. Red fruits and veggies are particularly high in the phytochemical lycopene, shown to reduce the risk of prostate cancer.

White foods often get a bad reputation but fresh white foods, such as daikon radish, turnips, jicama or pears, are packed with nutrients. The anthoxanthins in white foods can reduce inflammation of all kinds.  One of the most common anthoxanthins, quercetin, is linked with lowering the risk of heart disease and cancer, easing the symptoms of allergies, and helping with pain from arthritis.

Blue and purple fruits and vegetables like blueberries, beets, and eggplant, have rich doses of phytonutrients and flavonoids that lower your risk of heart disease. Flavonoids may also help improve memory with aging and prevent many cancers.

Try out these easy recipes for your 4th of July this year. These recipes are perfect for a party, cookout or relaxing picnic.
Grilled Chicken with Red & Blueberry Salsa 

(Adapted from All Through The Year Cheer)
(Yield:  4 servings)

Ingredients:
4 (6 oz) chicken breasts, pounded to even thickness
1 tbsp olive oil (for grilling the chicken)
½ tsp pepper
½ tsp salt
1 c fresh blueberries, chopped
1/2 red bell pepper, seed and diced
1/4 red onion, diced
1 jalapeno pepper, seeded and minced (optional)
3 TB fresh minced parsley
2 TB fresh minced mint
1 TB lemon juice

Directions:
1) In a bowl, stir together all ingredients for the salsa and refrigerate until ready to use (you can make this up to 1 day in advance but if you do so, I recommend waiting until right before you serve it to add the fresh minced herbs).
2) Lightly brush olive oil on both sides of the chicken breast, then season both sides with salt and pepper.  Grill the chicken until fully cooked (there should not be any pink).
3) Serve the grilled chicken topped with salsa.

https://allthroughtheyearcheer.wordpress.com/2010/06/25/grilled-chicken-with-red-blueberry-salsa/

Nutrition Facts: 278 calories, 12.2 g fat, 2.8 g saturated fat, 393 mg sodium, 7.7 g carbohydrates, 1.8 g fiber, 33.6 g protein
Cous-Cous & Fruit Salad

(Courtesy of Eatingwell.com)
(serves 4)

Ingredients:
2 tablespoons extra-virgin olive oil
2 tablespoons orange juice
1 tablespoon cider vinegar
2 teaspoons finely chopped shallots
1/4 teaspoon salt
1/4 teaspoon freshly ground pepper
2 cups cooked whole-wheat couscous
1 cup chopped nectarine
1 cup mixed fresh berries, such as blueberries and raspberries
2 tablespoons toasted sliced almonds

Directions:
1. Whisk oil, orange juice, vinegar, shallots, salt and pepper in a large bowl. Add cooked couscous, nectarines, berries and almonds; gently toss to combine.

Nutrition Facts: 259 calories; 9 g fat; 1 g sat; 40 g carbohydrates; 7 g protein; 7 g fiber; 146 mg sodium

http://www.eatingwell.com/recipes_menus/recipe_slideshows/healthy_red_white_and_blue_recipes?slide=15

 

Red, White and Blue Yogurt Popsicles

(Adapted from The View from Great Island)
Yield: 10 popsicles

Ingredients:
1 cup raspberries
1 cup blueberries
1 cup vanilla flavored Greek yogurt

Directions:
1. Using a small food processor, or blender, puree the raspberries until smooth. Set aside. Repeat for the blueberries.
2. Put your popsicle mold in the freezer and freeze till firm, at least an hour, or more.
3. Layer a little bit of the blueberry puree into the mold. Put in the freezer for 10-20 minutes until solid. Alternate with layers, putting in the freezer for 10 minutes in between each layer.
4. When done layering, insert the popsicle sticks. Make sure to get the stick a little bit into the frozen layer so they will stand straight. Put back into the freezer until solid.
5. Once filled and completely frozen solid, you can un-mold your pops. If the pops don’t come out of the mold easily, run the outside of the mold under hot water for a few seconds.

Nutrition Facts: 31 calories, 0.1 g fat, 8 mg sodium, 5.6 g carbohydrates, 1.1 g fiber, 2.3 g protein

http://theviewfromgreatisland.com/red-white-and-blueberry-popsicles/