Category Archives: Northern Westchester Hospital News

Hip Replacement Surgery on the Rise

Posted on: March 19, 2015

Hip Replacement Surgery on the Rise

By Dr. Eric Grossman

Researchers at the Centers for Disease Control and Prevention (CDC) recently released findings iStock_3875724_LoRezthat from 2000 to 2010, the number of hip replacements for those older than 45 more than doubled.

The CDC said: “The number and rate of total hip replacements among inpatients aged 45 and over increased significantly from 2000 through 2010. The greatest increase in absolute numbers was in the 55–64 age group, where the number of total hip replacements almost tripled, whereas the greatest percentage change was in the 45–54 age group, which experienced a 205% increase. The 45–54 age group also had the greatest increase in rate, which more than doubled from 45 to 117 total hip replacements per 100,000 population.” (February 12, 2015).

I am not surprised by these trends based on improvements in surgical technique, durability of the procedure, durability of the implants, and patients’ desired active lifestyles. In my practice, I use what is called the “anterior approach” which can result in a faster recovery time, without postoperative restrictions, less muscle damage and a more natural feel to the artificial hip.

Previous generations of general practitioners were reticent to suggest hip replacement to their patients because of longer hospital stays, unproven effectiveness and longer recovery times. There was a time when doctors did not suggest hip replacement due to arthritis pain until their patients could not bear to suffer any longer.

Now, with advances in the surgical procedure, primary care physicians are more inclined to suggest the surgery. This is in part driven by their patients’ expectations. Individuals with painful arthritis are taking a proactive approach – they do not want to suffer in pain any longer than necessary. Additionally, they want to engage in an active lifestyle, and many advances in the surgery since it began to be performed approximately 50 years ago have made the new hips more durable.

The CDC also found that “In 2010, the average length of stay was shortest for the youngest age group and longest for the oldest group. Among those aged 45–54, the average stay was 3 days, lower than for each of the other age groups, while the average among those aged 75 and over was 4 days, higher than for each of the other age groups. From 2000 through 2010, the average length of stay decreased for each age group.”

These findings studied patients until 2010. Now, in 2015, I am seeing much shorter hospital stays after hip replacement surgery. Approximately 80 percent of my patients go straight home from the hospital – not to an inpatient rehabilitation facility as had been routine in the past – within 24-48 hours after surgery. Some select patients are even able to go home the same day of surgery. Our rehab protocols include rapid mobilization where the patients are expected to walk the same day as their surgery.

Watch Dr. Grossman’s patients tell their stories of
living life without pain after hip replacement.
View patient testimonials.

Hip replacement surgery has become more routine and is now being offered to a much wider demographic of patient, particularly patients ages 45-64 and it is not only helpful for senior citizens. There is no need to suffer with painful and activity-limiting hip arthritis. Talk to your doctor to see if hip replacement surgery is an option to explore.

Editor’s Note:
Eric L. Grossman, MD, FAAOS is Co-Director of Joint Replacement Surgery at the Orthopedic and Spine Institute at Northern Westchester Hospital and a member of Mount Kisco Medical Group.

Dr. Grossman is a fellowship trained, board certified orthopedic surgeon who specializes in all facets of hip and knee joint replacement surgery including primary and revision total joint replacement, with a focus on the Anterior Approach to Total Hip Replacement.

 

 

 

 

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Simple, Slimmed-down Slow Cooking

Posted on: March 18, 2015

Simple, Slimmed-down Slow Cooking

By Caryn Huneke

In theory, I love the idea of using my Crock Pot to help get dinner on the table during the busy pulled-porkworkweek (or weekend for that matter). But with the exception of chili and soup, my track record for finding timesaving, healthy, and delicious recipes wasn’t exactly stellar. Over time, I noticed there were three main culprits robbing me from slow-cooking culinary success:

1) Time: Is it really going to save me time or will I have to prep a ton of ingredients or remember to brown the meat first?
2) Nutrition: Is it going to be laden with butter, cream-of-anything, and flavor packets, piling on the calories, fat, and sodium?
3) Taste: Will it actually be a satisfying meal that I’d want to make again?

Turning to cooking blogs, Pinterest, and family and friends, I started gathering (and tweaking) recommended recipes. Below you’ll find four easy slow-cooker recipes that you can feel good serving to your family. (Disclaimer: I’ve yet to try each one, but they all come on excellent authority to be foolproof and tasty.)

• Filipino Adobo Pulled Pork
• Flank Steak Fajitas
• Brown Sugar Balsamic Glazed Pork Tenderloin (
• Beef Stroganoff

Filipino Adobo Pulled Pork
Adapted from Skinnytaste.com

Ingredients
• 1.75 lb lean pork center loin or tenderloin
• 1/4 cup low-sodium soy sauce
• 1/3 cup apple cider vinegar
• 1/2 cup water
• 5 cloves garlic, crushed
• 6 ground peppercorns
• 4-6 bay leaves
*Optional: 1 jalapeno, chopped; 2 tablespoons chopped scallions for garnish

Directions
• Place pork, soy sauce, vinegar, water, garlic, peppercorns and bay leaves (jalapeño if using) in the Crock Pot.
• Cover and cook at low heat 6-8 hours turning over half way through cooking (note: I did not do this and I cooked it closer to 9 hours).
• Remove the pork, shred with two forks and put it back in the Crock Pot.for one more hour to let the flavor get into the meat (note: I probably only left it for another 15-20 mins).
• Discard bay leaves and serve over brown rice and top with chopped scallions.

Slow-Cooker Flank Steak Fajitas
Courtesy of Against All Grain, by Lisa Leake (link from Lisa’s 100 Days of Real Food website)

Ingredients
• 1 ½ lbs flank steak
• 1 ½ teaspoons chili powder
• 1 teaspoon cumin
• 1 teaspoon coriander
• ½ teaspoon salt
• ¼ teaspoon black pepper
• 2 tablespoons low-sodium soy sauce
• 1 jalapeno pepper, seeded and chopped
• 2 cloves garlic, minced
• 4 – 5 bell peppers, sliced, any color
• 1 onion, diced
*Optional fajita fixings: whole-wheat flour tortillas, reduced-fat grated cheese, fresh sliced avocado, cilantro, lime slices, fresh spinach leaves, reduced-fat sour cream, hot peppers, etc.

Directions
1) In a small bowl, mix together the chili powder, cumin, coriander, salt and pepper.
2) Rub the spice mixture over all sides of the flank steak and place it in the bottom of the slow cooker.
3) Pour the reduced-sodium soy sauce on top of the steak and add in the diced jalapeno and minced garlic. Slice the bell peppers and onion and throw those on top of the steak.
4) Cook on high for 5-6 hours or low for 8-9 hours, until the steak can easily be shredded with two forks.
5) Drain the meat and peppers and serve with the optional fajita fixings listed above.

Brown Sugar Balsamic Glazed Pork Tenderloin
Courtesy of Food52.com

Ingredients
• 2 pounds pork tenderloin
• 1 teaspoon ground sage
• ½ teaspoon salt
• ¼ teaspoon pepper
• 1 garlic clove; crushed
• ½ cup water
Glaze
• ½ cup brown sugar
• 1 tablespoon cornstarch
• ¼ cup balsamic vinegar
• ½ cup water
• 2 tablespoons soy sauce

Directions
1) Combine sage, salt, pepper and garlic and rub over pork tenderloin.
2) Place 1/2 cup water in slow cooker and add the tenderloin on top.
3) Cook on low for 6-8 hours.
4) About 1 hour before roast is done, combine ingredients for the glaze in small saucepan. Heat and stir until mixture thickens.
5) Brush roast with glaze 2-3 times during the last hour of cooking. (For a more caramelized crust: remove from crockpot and place on aluminum lined sheet pan, glaze, and set under broiler for 1-2 minutes until bubbly and caramelized. Repeat 2 to 3 more times until desired crust is achieved.)
6) Serve with remaining glaze on the side.

Slow Cooker Beef Stroganoff
Adapted from FiveHeartHome.com

*Note: Five Heart Home’s recipe for beef stroganoff doesn’t use cream-of-mushroom soup so you have to add a few more ingredients to make up for it, but it’s worth the sodium savings. To make it even healthier and easier, this modified version trims more calories and extra ingredients.

Ingredients
• 1.5-2 pounds lean beef stew meat (or lean beef round steak)
• 12 ounces white mushrooms, cleaned and pre-sliced
• ½ – 1 cup diced yellow onion (adjust the amount based on preference)
• 2 tablespoons minced fresh garlic (frozen or jarred would work too)
• 1 1/2 cups fat-free, low-sodium beef broth
• 1 tablespoon Worcestershire sauce
• 1 tablespoon Dijon mustard
• 1/2 teaspoon dried thyme
• 6 tablespoons whole wheat flour
• 4 ounces Neufchâtel cheese or one-third less fat cream cheese, at room temperature
• 8 ounces light sour cream
• Salt and freshly ground black pepper, to taste
• Bag of whole wheat egg noodles

Directions
1) Place beef, mushrooms, and garlic in Crock Pot.
2) In a medium bowl, mix together beef broth, Worcestershire sauce, mustard, thyme, and flour. Whisk mixture until flour is dissolved. Pour into Crock Pot and stir all ingredients until coated.
3) Place lid on Crock Pot and cook for 8-10 hours on low (or 4-5 hours on high).
4) About 20 minutes before serving time, start boiling water to cook whole wheat egg noodles according to package directions.
5) Also add cream cheese to Crock Pot, replace lid, and after 10 minutes stir warmed/softened cream cheese into sauce, pushing with the back of a spoon to break it up and incorporate it into sauce.
6) Stir sour cream into sauce. Replace lid and cook on low for a few more minutes until heated through.
7) Season beef stroganoff with salt and pepper as desired and serve over hot egg noodles.

Editor’s Note:
Caryn Huneke is a Registered Dietitian at Northern Westchester Hospital.

If you have any tried-and-true Crock Pot recipes, please send them to nwhealth@nwhc.net for possible inclusion on our website’s recipe page. Be sure to include your name for proper acknowledgement.

 

African Americans and Heart Disease

Posted on: February 20, 2015

Beating Heart Disease When the Risks are High

By Dr. Robert Pilchik

Heart disease is the number one killer of Americans, according to the American Heart Association. It takes more lives than all cancers combined. For African-Americans,

Robert Pilchik, MD, FACC Chief, Cardiology Northern Westchester Hospital

Robert Pilchik, MD, FACC
Chief, Cardiology
Northern Westchester Hospital

the disease is particularly deadly: Before the age of 50, African-American’s rate of heart failure is 20 times higher than Caucasians, according to research published in the New England Journal of Medicine. Despite the grim nature of these statistics, there is hope.

Many of the major risks for African-Americans are modifiable with lifestyle changes and, when warranted, drug treatment. African-Americans tend to have higher blood pressure on average than other populations; they are also more likely to have dangerous cholesterol levels, suffer from chronic kidney disease, and struggle with weight issues.

“Just losing five to 10 percent of your bodyweight
can significantly reduce your risk for heart disease.”

One well-established cause of high blood pressure is sodium—salt—in the diet, and research suggests that African-Americans may carry a gene that makes them more salt sensitive. By choosing low-sodium foods and eating more fruits and vegetables, blood pressure can be lowered.

Regular exercise—even daily walks—can also reduce blood pressure. If a patient’s blood pressure doesn’t respond to lifestyle changes or is already dangerously high, it can be controlled with safe and proven medications.

African-Americans also tend to have lower levels of the ‘good’ HDL cholesterol. Again, a healthy diet with lots of produce and lean protein such as poultry along with regular exercise can have a significant impact in improving cholesterol numbers. What’s more, statin drugs are very effective in lowering ‘bad’ LDL cholesterol.

Weight, another risk factor for stroke and heart disease, can also be managed with lifestyle changes. Just losing five to 10 percent of your bodyweight can significantly reduce your risk for heart disease. Shedding pounds can also lower the risk of diabetes, which also increases the likelihood of suffering a stroke or heart attack. Diabetes is another chronic disease that is higher in African-Americans: Their risk is about double that of non-Hispanic whites.

Visit your physician to learn more about your risk for heart disease and stroke. Understand your factors and put a plan in place to address them. Northern Westchester Hospital offers programs on a variety of chronic diseases as well as FREE tobacco cessation programs (smoking can dramatically raise your risk of heart problems and stroke) that can be incorporated into your personal healthcare plan. Give yourself the gift of health this year – even a few simple improvements will make a big difference to your wellbeing.

Stop heart disease before it’s started. Visit www.mylifecheck.org and get an assessment of your heart health.

Editor’s Note:
Robert Pilchik, MD, FACC is Chief of Cardiology of Northern Westchester Hospital. He is known for his compassion and for helping patients understand their cardiac health. In addition to clinical cardiology, Dr. Pilchik performs diagnostic cardiac catheterizations; cardioversions; transthoracic, transesophageal and stress echocardiograms; transvenous pacemakers; cardiac CTA/calcium scoring; and nuclear stress testing. Dr. Pilchik is a member of Westchester Health with offices in Mt. Kisco, Yorktown Heights and Valhalla.

Read more blog posts on heart health.

Northern Westchester Hospital
offers a Tobacco Cessation Clinic — at NO Charge — to all community memebers. Please call
Jennifer Lucas at 914-6666-1868 for more information.

Learn about cardiac rehabilitation services at Northern Westchester.

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

 

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.