2013 Winter Newsletter - Phelps Memorial Hospital

2013 Winter Newsletter - Phelps Memorial Hospital

phelps
WINTER 2013
T O D A Y
News from
Phelps
Memorial
Hospital
Center
Residency Program Begins
Preventing Childhood Obesity
High-Tech Pharmacy Enhances Safety
Mommy Wrist
The six physicians who make up the inaugural class of the NYMC Phelps Family Medicine Residency Program, the first family
medicine residency established in New York State since 1995.
Get better. Here.
Dear Friends,
Recognizing the growing need for primary healthcare across our community, Phelps
recently established a medical office and imaging center in Croton-on-Hudson. Marco
Zarlengo, MD; Michael Finkelstein, MD; Catalina Cincu, MD; and Jane Connelly, FNP
(family nurse practitioner) are now seeing patients in the beautifully appointed medical
suite. Patients can make an appointment or just walk in for care at the new facility, which
also offers diagnostic X-ray and ultrasound imaging services.
The Croton location is Phelps’ fourth primary care office to open since 2008, helping
to ensure that residents in our communities have convenient access to Phelps’ highquality care. Other Phelps practices are located in Ossining (Drs. Michael McCormick
and Rafael Soltren), Sleepy Hollow (Heritage Medical Group’s Drs. Satish Kapoor, Urmil
Kapoor, Madhavi Kancharla and Michael Loewinger), and Dobbs Ferry (Drs. Montgomery
Douglas, Michael Loewinger and Cynthia Brown).
Phelps’ commitment to the community’s health expanded in a new direction with the
implementation of operational support of Emergency Medical Services at community
events. Through generous donations, Phelps purchased a 19’ x 35’ tent, vehicles,
equipment and supplies to establish a mobile medical aid station. The Special Events
Medical Unit (SEMU) is managed by staff from the hospital’s Hoch Center for Emergency
Education, the only educational facility of its kind in the region. The SEMU, which
is manned by healthcare volunteers, is in great demand. Services have already been
provided at the Toughman/Toughkids Triathlon event at Croton Point Park, the Swim
Across the Hudson in Sleepy Hollow, and at Crafts at Lyndhurst in Tarrytown.
These are just a few additional ways in which we are working to bring our services to you.
Phelps is your community hospital – both on our campus and out in the community.
Best wishes for a healthy and prosperous New Year!
Sincerely,
Andrew C. Merryman
Chair, Board of Directors
Keith F. Safian, FACHE
President & CEO
Childhood Overweight and Obesity:
Effective Approaches to Prevention and Treatment . . . . . . . 8
Pharmacy Today: How Technology Enhances Patient Safety. . . 10
Mommy Wrist: De Quervain’s Syndrome . . . . . . . . . . . . 12
Early Diagnosis Is Key to Preventing Voice Problems . . . . . . 14
Contents
New Residency Program Benefits Hospital and Community . . . 4
Do You Have Silent Reflux? A Test . . . . . . . . . . . . . . . 15
Vitality Programs Help Adults Live Well and Age Well . . . . . 16
Phelps Opens New Medical Office Suite in Croton. . . . . . . 18
Postpartum Depression . . . . . . . . . . . . . . . . . . . . . 19
Support Group for Chronic Pain Sufferers Piloted at Phelps. . . 20
Sindrome de De Quervain . . . . . . . . . . . . . . . . . . . 22
Sobrespeso y obesidad infantil:
Enfoques efectivos para la prevención y el tratamiento . . . . 24
Programs and Services . . . . . . . . . . . . . . . . . . . . . 26
Request Your
Appointment Online!
Appointments for many Phelps
outpatient services can be made
on the hospital’s website. Just go
to phelpshospital.org and click on
“Request an Appointment” – any
time of the day or night!
PAY YOUR BILL ONLINE!
Phelps has an online bill paying
feature on the hospital website.
Just go to phelpshospital.org and
click on “Pay Your Bill Online” to
view and pay your bill, set up a
payment schedule, and more.
Visit www.phelpshospital.org to see our annual reports,
videos, physician directory, calendars and more.
PHELPS TODAY
Editor
Mary Sernatinger
[email protected]
Managing Editor
Tina Dorfman
Medical Editor
Bruce Heckman, MD
Editorial Advisors
Lucy C. Engelhardt, RN
Leonard B. Fogel
Kenneth C. Kaplan, MD
Keith F. Safian, FACHE
PHELPS TODAY is a publication
of Phelps Memorial Hospital
Center. Phelps is a member of
the Stellaris Health Network and
the Hudson Valley’s exclusive
affiliate of Memorial Sloan-Kettering Cancer Center.
If you would like to remove your
name from the Phelps Today
mailing list, or if you would prefer
to view Phelps Today online
instead of receiving a print copy,
please call 914-366-3100.
Visit us on Facebook:
http://www.facebook.com/
PhelpsMemorialHospitalCenter
Visit us on Twitter:
https://twitter.com/
#!/phelpshospital
New Residency Program Benefits
Hospital and Community
“Our family medicine residents have
infused a new and refreshing energy into
our work. Their enthusiasm and eagerness
to learn to serve those who are ill reminds
us all of the true purpose of what we do.
Their questions revive our awe of medical science and the wonders of the human
body in health and disease. It will be gratifying to watch them mature as doctors and
soon become teachers to the next class of
residents in July 2013.”
Louis Buzzeo, MD
Chief of Nephrology
Resident apartments are conveniently located on the Phelps campus.
I
“ will never forget my first week at
Phelps – the smiles and happiness
on people’s faces as they watched
us walk down the hallways. Everyone
expressed how happy they were that
Phelps had started a residency program,”
says Jorge Espana, one of six young men
and women who arrived at Phelps in
July to begin training as the inaugural
class of Phelps’ brand new family medicine residency program – the first such
residency program established in New
York State since 1995.
A family physician treats the whole
person in every stage of life. They are
trained to take care of the
entire family, dealing with
issues that may affect more
than one family member
and creating long-term, personal relationships with their
patients.
“Family physicians deliver
babies, care for children, and
are trained to see patients
from youth into middle age
and through their later years.
We bring a holistic perspective to healthcare that focuses
on prevention rather than
“Having the residents at Phelps creates an atmosphere of learning
for everyone. They’re fabulous to work with and eager to learn
and they understand the need for collaboration. Med/Surg staff
and the residents are developing relationships and partnerships
that have a positive impact on the quality of care our patients
receive now and in the future. They’re a welcome addition to the
Phelps Family.”
Barbara Vetoulis, nurse manager
of the medical/surgical unit
4
PhelPs Today
The residents are pictured with physicians and staff of
Open Door Family Medical Centers’ Sleepy Hollow
location, where the residents provide outpatient care.
“When I entered medical school 40 years ago, the pressing topic was the shortage of family medicine physicians throughout the United States, and that need is even more critical today. Our hospital is very fortunate in attracting an exceptional
group of individuals in this new program. Their bright-eyed optimism, quick minds, steely nerve and compassionate
hearts will positively impact tens of thousands of patients to come. I am proud and excited to have the opportunity and
privilege to participate in this program.”
J. Robert Seebacher, MD
Medical Director of the Phelps Joint Replacement Service
disease,” says Dr. Shantie Harkisoon, a
family medicine physician and director
of the 18-resident program (six additional residents will be added in each
of the next two years). Dr. Harkisoon
is also an assistant professor of family
and community medicine at New York
Medical College in Valhalla.
During the three-year residency, the
residents live in apartments on the
Phelps campus. They receive their clinical training at Phelps and at the Sleepy
Hollow location of Open Door Family Medical Centers, a healthcare provider that offers primary healthcare and
human services to the underserved in
our community. More than 100 Phelps
physicians currently serve as voluntary
faculty for the program.
“The establishment of this family medicine residency is a huge leap forward
for Phelps,” says hospital president and
CEO Keith F. Safian. “We have transitioned from a community hospital to
a teaching hospital, a sea change that
would not have been possible without
our partners at New York Medical College (the academic sponsor) and Open
Door.”
Dr. Lawrence L. Faltz, Senior Vice President for Medical Affairs, believes that
the evolution to a teaching mode at
Phelps is good for the entire community.
“Teaching challenges physicians and
keeps them on their toes,” he says. “Better doctors mean better healthcare, and
that’s a good thing all the way around.”
“What’s really unique and great about
our program is how eager and enthusiastic everyone is about supporting the
training of family physicians – from the
Board of Directors to the nursing staff,
to the specialists calling residents in
when they have interesting cases, to
community members offering financial
During a check-up at Open Door Family Medical Center in Sleepy Hollow, a toddler delights
in attention from resident London Muse, MD, (right) and Rebecca Williams, MD, Associate
Director of the residency program.
A 102-year-old
woman is
examined by
Jorge Espana, MD,
during hospital
rounds as
hospitalist Jeffrey
Gindi, MD,
looks on.
PhelPs Today
5
Sara Paul, MD, visits with a new mother whose baby she delivered under the supervision of
obstetrician Sarina DiStefano, MD.
support and community outreach,” says
Dr. Harkisoon.
“The partnership with Open Door is
facilitating outstanding training for
our residents in the outpatient setting
where they can learn to be leaders in
a patient-centered medical home. And
the great thing about training residents
in a community hospital is that the new
doctors are being trained where they
will practice in the future. They are
already establishing relationships with
their patients, the specialists and the
hospitalists, and they know all of the
resources available in the community.”
“When I first arrived at Phelps
it was a much smaller place.
I’ve watched it grow into what I
believe is a great medical facility,
and when I heard that a residency
program would be coming to the
hospital I was overjoyed. The
fact that Phelps would become a
place to teach and learn, a place
for young practitioners to hone
their skills, seemed like a natural
progression. More importantly, I
was proud to know that Phelps
would forever be known and
remembered as the starting point
for many great medical practitioners. I feel that this form of recognition has elevated this great hospital to new heights.”
Manny Caixero,
Director of Security
A Q&A with the Residents
Why did you choose a residency
in family medicine?
Dr. Espana – I like family medicine’s
focus on preventive medicine, the
diverse patient population, and the
opportunity it offers you to become a
member of an extended family.
Dr. Muse – Family medicine physicians
follow patients through all ages and
stages of life, from birth to adulthood to
old age. When a whole family comes
in, we can take care of mom, baby,
teenager and grandparents. In one afternoon at Open Door, I saw a newborn,
an elderly lady with diabetes, a young
man for a physical and an elderly man
with a foot sore. You never know who’s
going to be behind the next door.
The inaugural class: (standing) Batel Isenstein, MD; Carol Jane Cha, MD; Jorge Espana, MD;
(seated) London Muse, MD; Anesh Badiwala, MD; and Sara Paul, MD.
6
PhelPs Today
Dr. Isenstein – I chose this field because
of the ability for continuity of care. I
also chose family medicine because it
is ideal for practicing internationally,
which is a goal of mine.
Dr. Paul – There’s a really special
dynamic with family medicine in the
relationships that you develop with your
patients. Also, I feel very strongly about
public health and preventative medicine, which is at the core philosophy of
family medicine.
Why did you choose the NYMC
Phelps residency program?
Dr. Badiwala – This program is a comprehensive, multi-dimensional educational experience in an outstanding
hospital in a scenic community. It’s
unique because it not only trains you to
be a comprehensive physician but also
a leader in medicine. Other programs
tailor their programs solely towards
academics. This one goes above and
beyond and trains us to become patient
advocates.
What do you enjoy most about
the program?
Dr. Espana – What I enjoy most about
the program is the enthusiasm and
energy that every provider in the hospital shows towards teaching the new
residents.
Dr. Muse – It’s great to have the chance
to shape the program, making it the best
program. I’m also able to work teaching
into my residency, which I really love.
Whatever the residents are strong in
they can bring to the table.
Dr. Paul – I absolutely love it! I’m new
to the area, but I knew during application season that I wanted to stay in the
New York area. I think Westchester has
so much to offer.
Have there been any surprises
so far?
Dr. Espana – The biggest surprise for
me was how a hospital that never had
a residency program before adjusted so
quickly.
Dr. Badiwala – One shocking surprise
is the culture of kindness this hospital
Dr. Cha – This program provides me
with the opportunity to become a
leader within a community, to work in
a clinic like Open Door, and to learn
from some of the best medical providers
in the field.
Dr. Isenstein – I was a medical student
at New York Medical College, and I
wanted to stay in the Westchester area
and be part of pioneering a brand new
program to help bring family practitioners to the amazingly deserving patients
we have here.
Dr. Muse – While at New York Medical
College, I did a couple of brief rotations
at Phelps (geriatrics, orthopedics, pediatric endocrinology). I loved the feel
of the hospital and its “culture of kindness.” I really like the marriage between
NYMC, Open Door and Phelps. I love
living on campus, walking to work,
driving to the clinic – it’s great to have
everything in close proximity.
Dr. Espana – Phelps is an amazing hospital with an amazing physical therapy
center, emergency room, hyperbaric
chamber, Hoch Center for education
and wonderful staff. Everyone is happy
to be here and enthusiastic about supporting the residency program
Dr. Paul – I loved everything about this
program – the location is ideal, the fact
that the program is new and all the
excitement around that, and having the
opportunity to be involved with such an
amazing organization as Open Door.
The union of NYMC, Phelps and Open
Door is such an exceptional platform to
learn from and be a part of.
Martha Maresco, RN, welcomes Sara Paul, MD, and London Muse, MD, at a “cupcake
social” held at Phelps to introduce the new residents to staff.
How do you feel about the
Westchester area?
Dr. Badiwala – I’m originally from
Toronto and am new to Westchester.
It’s gorgeous! My walk down the hill
from my apartment to the hospital is
amazing. The pride that I have in being
here and seeing that view of the river
every morning gives me a jolt of energy.
I would consider this area as home after
my residency is over.
Dr. Muse – I love Broadway shows, so
being able to park here for free and take
the train into the city, that’s my ideal.
I like that we serve a varied group of
patients, many different ages, ethnicities, economic status. It will prepare us
to be well-rounded physicians.
Dr. Espana – The Westchester area is
wonderful. We have a great view of the
Hudson River, there are delicious restaurants, and it is the only place where I
always find a deer, skunk or raccoon in
my backyard.
has, and how happy everyone is to be a
part of this institution. That’s a surprise
considering the current state of healthcare in NY State and hospitals. I did
clinical rotations in community hospitals in Brooklyn. That was completely
different.
How have your interactions
been with the medical and
other hospital staff?
Dr. Cha – The medical and hospital
staff are amazing. The specialists have
all been so kind and enthusiastic about
teaching, even when we’re taking valuable time out of their day. The nurses
have been so nice, welcoming us into
this medical home, and we appreciate all the feedback and support we’ve
been given.
Dr. Isenstein – Great! I especially love
interacting with the nursing staff here,
as well as the nutritionists, volunteers
and the wonderful staff of the cafeteria,
who are so kind.
PhelPs Today
7
Childhood Overweight and Obesity:
Effective Approaches to Prevention
and Treatment
Q&A with Kilwanna Jordan, MS, RD, CDE, CDN
O
ver the past 30 years, the
number of overweight and
obese American children has
increased to three times what it was in
the 1970s. More than a third of America’s youth are currently either overweight or obese, with approximately
12.5 million children and adolescents
age 2-19 in the obese category.
Some researchers have theorized that
the overweight and obese youth of
today may actually have shorter life
expectancies than their
parents. These children are
at increased risk for developing chronic illnesses
normally not seen in
individuals until they
reach middle age, such
as insulin resistance
and type 2 diabetes,
cardiovascular disease, stroke, high
cholesterol, asthma,
hypertension, joint
disorders and sleep
apnea.
What is the difference between
being overweight and obese?
Overweight is defined as having a Body
Mass Index – the measurement of weight
in relation to height – between the 85th
and 95th percentiles on the Centers for
Disease Control growth chart. Obese is
considered as having a BMI at or above
the 95th percentile. If you search on the
Internet for “body mass index,” you will
find sites with BMI calculators.
To address the obesity epidemic, many
local and national organizations have
developed programs to prevent and treat
weight problems in youth. In 2010, First
Lady Michelle Obama launched “Let’s
8
PhelPs Today
Move,” a national campaign to reduce
childhood obesity that involves parents,
government officials, healthcare professionals and community organizations.
What are the causes of
overweight or obesity in
children?
The obesity epidemic is the result of
several factors, including behavior,
environment and genetics. Behaviors
such as unhealthy eating and lack of exercise can lead to weight
gain. Many children
frequently eat fast-food
meals that are high in
fat and sugar from
French fries, hotdogs, milkshakes
and sugar-sweetened sodas or
“juice drinks.” It
is well known that
portion sizes have
also increased over
the past 30 years
(by up to 20%). Excess snacking during
the day on items such as cookies, chips,
fruit juice and candy can also lead to
overconsumption of calories. If children do not burn these extra calories
through physical activity, their bodies
store the energy as fat.
Environment can also
play a role in a child’s
becoming overweight
or obese. Many children spend more
time on sedentary
activities, such as
watching TV, playing
video games or surfing the Internet than
they spend engaged in physical activity. If children do not have access to
green spaces where they can play, such
as yards, parks or playgrounds, they
are less likely to get adequate physical activity during the day. Additionally, due to budget cuts, some schools
have reduced or eliminated recess time,
physical education classes, sports programs and extracurricular activities. The
net result is a nation of children who are
eating more and moving less.
Genetics is the third factor contributing to the development of overweight
or obese children. Studies have shown
that children of obese parents have a
greater risk of becoming obese than
children of non-obese parents. This
can be the result of inherited genes or
learned behaviors. In cases of twins
separated at birth, researchers found a
genetic predisposition toward the accumulation of body fat in 40-70% of the
subjects. Interestingly, adopted children had BMIs consistent with those of
their biological parents, not their adoptive parents.
But being born to overweight or obese
parents does not necessarily mean that
children will become overweight. In
fact, parents with BMIs in the
normal range can have
some children who
become overweight or obese and other
children who maintain weights in the
normal range.
Do the eating habits of parents
affect the quality and quantity
of the food their children eat?
Although genetics plays an important
role in the risk for obesity in children,
familial eating habits must also be taken
into consideration. Family lifestyle can
play a significant role in a child’s attitudes and behaviors towards both eating
and physical activity. Cultural norms,
socioeconomic status and geographic
location have all been shown to influence eating habits of individuals and
families. Since parents are most often
responsible for the purchase and preparation of food in the home, they can
have a tremendous impact on what and
how much their children eat. If parents
model healthy eating habits, their children will be more likely to follow.
How does an unhealthy diet
affect children’s performance
in school?
When a child’s diet includes a lot of
fat or sugar-laden foods or drinks, the
associated calories contribute to weight
gain, but there is no nutritional benefit.
If children are filling up on these “empty
calories,”it can affect their academic performance by limiting their intake of the
vitamins, minerals, fiber and protein that
they need. Getting the proper nutrients
is especially important for young brains
that are still developing. Children who
eat breakfast receive higher test scores
than those who skip breakfast. Research
shows that healthy eating can improve
children’s concentration and help them
do better in school. Iron deficiency in
children can lead to tiredness and poor
concentration. The best food sources
of iron are lean beef, poultry, eggs and
dried beans and lentils. Vitamins are
also important for good concentration.
Vitamin B12, found in meat, dairy products and eggs, aids in concentration and
brain health. Vitamin C, which is important to proper brain function, is found
in mangoes, strawberries, green and
red peppers and citrus fruits
such as oranges, tangerines
and grapefruit. Fruit juice
can be a healthy beverage,
but because it contains no
fiber and is easy to drink in
large quantities, it can be
a source of excess calories. Children should be
given only 100% fruit
juice, limited to 4-6 oz.
per day for those 1 to 6
years old, and 8-12 oz.
per day for children 7
to 18.
High amounts of sugar and fat can affect
children’s concentration by causing
swings in energy levels. A high-fat, fastfood cheeseburger and French fries can
make kids feel sluggish because it slows
digestion. Sugary foods and sweetened
beverages can affect concentration by
causing blood sugar to spike, which
is followed by a rapid drop in energy.
Too much sugar also contributes to
excess weight gain, which can impair
physical and emotional well-being.
What can be done to help
families prevent or treat
overweight and obesity?
crackers, low-sugar cookies such as
graham crackers, and popcorn
kernels (for homemade popcorn).
• Keep lots of fresh fruits and
vegetables in the home.
• Do not use food as a reward or
punishment.
• Limit fast food to no more than once
per week.
• Encourage kids to drink water if
they are thirsty. Give them water with
snacks and throughout the day,
saving 100% juices and fat-free or
1% milk for meals.
• Exercise regularly as a family. Find
activities that the whole family enjoys
(walking, biking) and schedule a time
to do it.
• Involve the entire family in doing
household chores (raking leaves,
washing and folding the laundry,
cleaning the house).
• Monitor the time your child spends
watching TV, playing video games
and using the computer.
• Prepare healthy meals with the
entire family. Include fruits, vegetables, and whole grains. If children
are old enough, let them do the peeling, slicing and mixing.
• Eat dinner as a family and remember,
there’s no need to rush – eat slowly
while you share each other’s
experiences of the day.
• Stock the pantry with healthy snacks
– unsalted nuts, raisins, low-fat
Kilwanna Jordan, MS, RD, CDE, CDN, outpatient nutrition coordinator, is a Registered
Dietitian with a specialty as a Certified Diabetes Educator. She has additional specialty
certifications in adult, child and adolescent
weight management. For an appointment,
call 914-366-2264.
PhelPs Today
9
Pharmacy Today
How technology enhances patient safety
“The technologies we
use at Phelps are
expected to become
the standard for all
hospitals in the future,
but Phelps is
leading the industry,”
says Pharmacy
Director Fred Perino.
John Ascatigno, Assistant Pharmacy Director, and Fred Perino, Pharmacy Director.
T
here was a time when the main
role of a hospital pharmacist was
to make sure that nurses had adequate supplies of medications, which
were kept in labeled bottles in locked
cabinets on each hospital unit. When
a medication was needed, the nurse
would unlock the cabinet, take out the
dose from the appropriate bottle and
give it to the patient. There were few
safety measures in place to ensure that
the right medication in the right dose
was given to the right patient.
This was obviously neither the safest
nor the most efficient way to dispense
medications.
With the use of integrated medical
records and modern technology, however, the role of hospital pharmacists
has changed dramatically, evolving
from a supply function to one based
on the attitude of “patient safety first.”
Phelps is well ahead of the curve in the
use of these advanced technologies,
and in fact is among the top 1.6% of
hospitals nationwide for their utilization, according to HIMSS Analytics, a
subsidiary of the Healthcare Information and Management Systems Society.
“The technologies we use at Phelps are
expected to become the standard for
all hospitals in the future, but Phelps
is leading the industry,” says Pharmacy
10
PhelPs Today
Director Fred Perino. “Technology contributes immeasurably to ensuring the
safety of our patients. For example,
instead of working with handwritten
doctor’s orders and paper charts, we
receive clearly legible electronic orders
and records. This is not only a safer
method, it is more efficient. Greater
efficiency gives our pharmacists more
time to review each order thoroughly to
ensure that the medication and dosage
ordered is appropriate and safe for the
patient.”
Computer Physician Order
Entry (CPOE) and Medication
Dispensing Stations
Nearly all Phelps physicians now enter
orders for a patient’s medications into
MEDITECH, a hospital-wide computer
system that integrates all aspects of
every patient’s medical care, including lab work, X-rays and medication
administration. Because the number of
handwritten physician orders has been
significantly reduced, potential problems that can be caused by poor handwriting are prevented. Upon receipt in
the pharmacy, the accuracy of all medication orders is verified by the pharmacist based on a review of the patient’s
height and weight, age, proper dose,
ages and barcodes each dose a patient
is scheduled to receive over a 24-hour
period, producing a long strip containing the full day’s doses. A pharmacy
technician double-checks the robotic
strip for accuracy, places it in a medicine bin designated for the patient, and
adds any drugs that are not handled
by the robot. A pharmacist then triplechecks all medication before the bins
are sent up to the patient floors. No
medication leaves the pharmacy unless
it has been checked by a pharmacist.
possible drug interactions, allergies,
and the appropriateness of the drug for
the patient’s condition or disease.
Assistant Pharmacy Director John
Ascatigno explains: “With integrated
medical records, we are much more
involved with relating the medication
ordered to the individual patient’s diagnosis. This allows us to intervene with
physicians when needed, and to make
recommendations regarding medication therapies for patients – one more
way to ensure the safety of our patients.
For example, pharmacists are able to
monitor the renal function of every
patient and adjust the doses of appropriate drugs based on how the kidney
is functioning.”
Delivery of non-urgent medication
orders takes place on the next scheduled delivery round, which occurs
every hour. If the need for medication is
more urgent, such as when pain medication is needed, nurses can obtain the
drug from one of the PYXIS Medication Stations located at each nursing
station. The nurse enters a code and
the patient’s account number into the
PYXIS machine and the medication
is quickly and accurately dispensed.
Details regarding drugs dispensed
through PYXIS are integrated into MEDITECH and become part of the patient’s
electronic record.
Bar Code Technology
Every dose of medication is electronically bar coded before leaving the pharmacy. At the patient’s bedside, a nurse
or other professional uses a medication
verification system scanner to scan the
bar code on the patient’s wristband and
the barcode on the medication. The
two codes must match in order for the
medication to be administered, thus
ensuring that the right medication is
given to the right patient. The scan also
updates the patient’s electronic Medication Administration Record (eMAR),
which allows all medical providers to
view the entire medical record online,
including if a drug was given, when it
was given, who gave it, and any comments recorded by the nurse.
Receiving medications in this easily identifiable and ready-to-use form
means that nurses don’t have to spend
time preparing and organizing medications and have more time to be with
their patients. And pharmacists no longer have to spend time packaging items
by hand.
Pharmacy technician Wesley Kind, Jr. does a
quality control check of the strip of unit dose
medications produced by the TALYST robotic
packager.
Unit Dose Dispensing System
The Phelps pharmacy has a robotic
packaging device called the TALYST
packager, which individually pack-
Continuity of Care
Technology allows for a much better
flow of information about a patient’s
medications before, during and after
a hospital stay, which contributes to
patient safety. “Pharmacists, physicians
and nurses all strive for continuity during every phase of a patient’s care,” says
Perino. “With a computerized system,
it’s easy to compare
medications taken
by patients before
coming to the hospital with what they
receive while they
are here and help
to ensure that the
proper medications
will be prescribed for
them when they are
discharged.”
Before administering a medication, Lauren Einfrank, RN, scans both
the patient’s wristband and the medication to ensure that the right
medication is being given to the right patient.
“Our goal has been
to develop the safest
possible medication
delivery system based
on the technology
available, combined
with the expertise of
our pharmacy staff.
We are proud to have
achieved that goal,”
says Ascatigno.
PhelPs Today
11
Mommy wrist . . .
De Quervain’s Syndrome
Anjum Lone, OTR/L, CHT
This condition is also common to people who use their hands in repetitive
motions, such as constant gripping,
forcefully bending the wrist, placing the
wrist in awkward positions, or engaging
in lifting or pinching activities. It can
also be caused by direct trauma or sudden incorrect lifting, and it is sometimes
associated with conditions such as diabetes, rheumatoid arthritis and hypothyroidism.
While it is most often linked with overuse injuries, the cause of de Quervains
remains idiopathic (unknown).
Anjum Lone, OTR/L, CHT, chief of the
department of occupational therapy at
Phelps, is an occupational therapist and
certified hand therapist.
D
e Quervain’s syndrome is
named after Swiss surgeon Dr.
Fritz de Quervain, who first
identified it in 1895. It is also known as
de Quervain’s tendonitis, de Quervain’s
stenosing tenosynovitis, mother’s wrist
or mommy thumb. In the past, this condition was also called “washer woman’s
syndrome.”
De Quervain’s tendonitis is caused by
an inflammation of the tendons located
on the thumb side of the wrist. These
tendons, which are associated with the
two muscles that allow you to move
your thumb away from your hand, run
side-by-side from your forearm to your
thumb inside membranes called synovial sheaths. When healthy, the tendons
glide smoothly inside the sheaths. However, if the tendons become inflamed
or the synovial sheath thickens, this
restricts movement of the tendons and
produces pain.
De Quervain’s is more common in
women than in men, and almost 50%
of new mothers experience this condition. It has a tendency to develop during
pregnancy, when fluid may be retained.
It may also develop during menopause.
12
PhelPs Today
When you have thumb or wrist pain,
it is important to see a doctor to rule
out other conditions such as a fracture,
osteoarthritis, intersection syndrome,
Wartenberg’s syndrome or carpal tunnel syndrome.
Signs and symptoms
The most common complaint of de
Quervain’s is pain and swelling near
the base of the thumb or on top of the
thumb. Sometimes the pain can spread
further into the wrist and forearm.
The pain may appear suddenly or may
increase gradually over time. Moving
the thumb and wrist may aggravate the
pain. Listed below are some signs of de
Quervain’s:
• Pain and swelling near the base of
the thumb.
• Tenderness above the wrist when
touched.
• Difficulty with gripping, pinching,
squeezing or moving the wrist from
side to side, such as when waving.
De Quervain’s Tenosynovitis
• Problems with lifting or
carrying a baby or an object.
• Restriction or “sticking”
sensation in the thumb or
wrist with movement.
Consult your doctor if
you have any of these
signs. The doctor will
perform a couple
of tests in the
office to confirm
this diagnosis.
X-rays or other
advanced tests
are not usually
needed.
Inflamed tendon
sheath (covering)
Preventing de Quervain’s
The following are ways to prevent de
Quervain’s:
• Avoid repetitive motions such as
those performed during prolonged
gardening, especially weeding and
pruning.
• Do not perform constant motions
such as chopping, sawing, knitting,
cleaning, sports motions or
texting without sufficient rest periods
or stretches.
• If you are a new mother, during
activities such as lifting the baby, the
baby carrier or the baby bottle, avoid
placing your thumb and index finger
in the “L” shaped position.
• If the symptoms start, avoid or limit
the activity that aggravates your pain.
Apply a cold pack for 5-15 minutes
frequently through the day.
Treatment for de Quervain’s
Anti-inflammatory drugs. Your doctor
may prescribe an anti-inflammatory
drug such as ibuprofen. In some
instances, the doctor may recommend
a steroid injection. In most cases, occupational therapy should be tried before
resorting to an injection.
Occupational therapy. A hand therapist will conduct a full evaluation and
may then provide one or more the following:
• A custom-fitted orthosis (brace) that
will rest your thumb/wrist and help
reduce the inflammation.
• Deep tissue massage of your thumb/
wrist.
• Myofascial release techniques (gentle
stretching).
• Ultrasound massage.
• As the pain decreases, therapeutic
exercises to stretch and strengthen
the area.
• An ergonomic assessment and
training to prevent further damage,
along with recommendations for
optimal ways for you to continue
your activities of daily living.
• Advice to new mothers on how to lift
their babies, the baby carrier, or baby
bottle to prevent this condition.
To receive occupational therapy, you
will need a prescription from your doctor. For occupational therapy at Phelps,
call 914-366-3700 to schedule an
appointment.
De Quervain’s
tendonitis is caused
by an inflammation
of the tendons
located on the thumb
side of the wrist.
A special wrapping technique is used to reduce pain caused by de Quervain’s Syndrome.
PhelPs Today
13
Early Diagnosis
Is Key to Preventing
Long-Term Voice Problems
P
Early diagnosis of
voice problems is
the key to prompt
correction and
prevention of future
long-term and
potentially disabling
conditions.
14
PhelPs Today
rofessional voice users, such as
singers, lawyers, teachers and
clergy, are particularly susceptible
to voice problems, which may include
hoarseness, vocal fatigue, voice breaks,
restricted range, a need for prolonged
warm-ups or extended post-performance recovery. Early diagnosis of voice
problems is the key to prompt correction and prevention of future long-term
and potentially disabling conditions.
Diagnosis is the first step, with a medical examination that includes stroboscopy, a technology during which not
only is the image of the larynx (voice
box) magnified but the vibration of the
vocal folds is slowed to ensure a proper
diagnosis.
Voice therapy may be the first (and
only) course of treatment, addressing both the speaking and the singing
voice through vocal function exercises,
resonant voice therapy, laryngeal massage, respiratory retraining and vocal
hygiene. Voice therapy is typically combined with medical management so
that maximal improvement can occur
within the shortest period of time. If
medical intervention is necessary, it
may include medication, office-based
injections or laser treatment.
If surgery is indicated, microflap surgery, which involves the microscopic
removal of abnormal tissue, often preserves the normal vibration of the vocal
folds. Laser treatment can remove
abnormal blood vessels that occur from
recurrent micro-trauma of the vocal
folds.
The interdisciplinary staff of the Institute for Voice and Swallowing Disorders provides medical and clinical services for children and adults with voice
or swallowing complaints. What makes
the Institute unique is that both the laryngologist and the voice rehabilitation
specialists work in Phelps’ Donald R.
Reed Speech and Hearing Center, collaborating daily to provide quality care
as a team.
Craig H. Zalvan, MD, the medical
director of the Institute for Voice and
Swallowing Disorders at Phelps, is a
board-certified otolaryngologist (ear,
nose and throat physician) who completed a specialty fellowship in laryngology, which focuses on voice and
swallowing disorders. The Phelps voice
specialists are speech-language pathologists with
many years of clinical
experience in the diagnosis and treatment of voice
disorders. They are also
trained singers who have
performed opera, musical theater and contemporary music. For more
information about diagnosis and treatment of
voice problems, call the
Institute for Voice and
Swallowing Disorders at
914-366-3636.
Do you have silent reflux?
Craig Zalvan, MD, Medical Director of Phelps’ Institute for Voice and
Swallowing Disorders, recommends taking this quick test to find out
if you might have Silent Reflux.
Within the last month, how did the following problems affect you?
0 = No Problem
5 = Significant Problem
Hoarseness or a problem with your voice
0
1
2
3
4
5
Clearing your throat
0
1
2
3
4
5
Excess throat mucus or post-nasal drip
0
1
2
3
4
5
Difficulty swallowing food, liquids or pills
0
1
2
3
4
5
Coughing after you eat or lie down
0
1
2
3
4
5
Breathing difficulties or choking episodes
0
1
2
3
4
5
Troublesome or annoying cough
0
1
2
3
4
5
Sensation of something sticking in your throat or
a lump in your throat
0
1
2
3
4
5
Heartburn, chest pain, indigestion or stomach
acid coming up
0
1
2
3
4
5
Total ________________
I
f your score is greater than 10, then there is a high likelihood that you have silent reflux, also known as laryngopharyngeal reflux or LPR. LPR is not GERD. You do not
have to have heartburn, indigestion or abdominal symptoms
to have LPR.
Symptoms of LPR include chronic cough, voice changes,
chronic throat clearing, burning in the throat or feeling of a
lump in the throat. Patients with these symptoms are often
told they have asthma, sinus disease or post-nasal drip.
If you have any of these symptoms and your score is greater
than 10, an examination by a laryngologist (ear, nose and
throat physician specializing in voice and swallowing disorders) is recommended to help treat your problem, screen
for esophageal disease (including cancer), and prevent the
long-term complications of reflux in the upper airway.
To arrange a consultation with Dr. Zalvan at the Institute
for Voice and Swallowing Disorders, please call (914) 3663636.
PhelPs Today
15
VITALITY PROGRAMS HELP ADULTS
LIVE WELL AND AGE WELL
T
he Vitality Initiative at Phelps provides educational
seminars, exercise opportunities and nutritional programs to help adults and seniors in the community
live well and age well.
In addition to the monthly Breakfast Club (a social and
educational gathering) and programs like Cool Conversations and Mind Games, which stimulate the mind and
memory, Vitality sponsors talks in the community on various healthcare topics, including the aging process, cardiac conditions and diabetes. At a recent “Ladies Night
Out” event held at The Club in Briarcliff Manor, Phelps
geriatrician Cathryn Devons, MD, made a presentation,
and attendees were treated to a cooking demonstration
and taste testing by Chef Maria Reina. The women enjoyed
delicious butternut squash soup, white bean
hummus and homemade biscotti.
Vitality recently launched a newsletter for
seniors. The first article, “Dysphagia in
Older Adults,” was written by Craig Zalvan,
MD, FACS, medical director of the Phelps
Institute for Voice and Swallowing Disorders
and the regional expert in such disorders. In
a column called “Ask the Doctor,” Phelps
medical professionals answer questions
submitted by area seniors. In the first several newsletters, family medicine physician
Montgomery Douglas, MD, wrote about the
shingles vaccine; internal medicine physician Catalina Cincu, MD, provided information on the importance of annual physicals;
and neurologist Eliz Agopian, MD, answered an array of
questions on neurological conditions.
On Thursdays from mid-summer through the fall, Vitality
sponsored the Sleepy Hollow Farmers Market at Phelps on
the Phelps campus. The market provided the hospital staff
and community with the opportunity to purchase fresh
fruits, vegetables and organic meats, and to pick up tips
on many healthy and delicious recipes using fresh, local
ingredients. You can find these recipes on Phelps’ Facebook page.
For more information on Vitality Programs and Services
at Phelps, contact Ellen Woods at 914-366-3937 or
[email protected].
Geriatrician Cathryn Devons, MD, (center) addressed a group of women at a
“Ladies Night Out” event held at The Club in Briarcliff Manor.
Phelps Supports Community Events
P
helps Memorial Hospital Center prides itself on bringing
healthy lifestyle programs to the community. We feel it is
important to not only encourage healthy lifestyle choices,
but to be actively involved in promoting this concept. Phelps
sponsors several community-based activities on an on-going
basis, including the Rivertown Runners’ Half Marathon and
10K events, the American Heart Association’s annual Heart
Walk and the Leukemia and Lymphoma Society’s Sprint Triathlon. These are just a few examples of the way Phelps shows
its commitment to supporting health and wellness programs in
the community.
The Phelps team at the American Heart Association’s
annual Heart Walk at the Kensico Dam in Valhalla.
16
PhelPs Today
James Hellerman, MD,
Merges Practice With Phelps
J
ames Hellerman, MD, an endocrinologist who has been on the Phelps
medical staff for more than 26 years, has recently merged his practice with
Phelps. Dr. Hellerman, who is board certified in endocrinology, diabetes
and metabolism, provides treatment for glandular and hormonal conditions
such as diseases of the thyroid and parathyroid glands, including under- and
over-active glands, nodules and thyroid cancer. He also treats diabetes and
specializes in the treatment of osteoporosis. Dr. Hellerman received his medical degree from the University of Rochester School of Medicine, followed
by residency training at Montefiore Medical Center. He then completed a
fellowship in endocrinology at Massachusetts General Hospital in Boston
while conducting research at MIT. Dr. Hellerman’s practice is located at 200
S. Broadway, Suite 100 in Tarrytown. (914-631-9300)
New Audiologist Provides VNG Testing for Patients
with Dizziness or Balance Problems
S
wapna Nataraj, AuD, CCC-A, has joined the staff of Phelps’ Donald R. Reed
Speech and Hearing Center, where she conducts videonystagmography
(VNG) testing for patients with complaints of dizziness or balance problems.
She has more than 10 years of experience as an audiologist and holds a doctorate
degree in audiology from the Graduate Center of the City University of New York.
VNG is a diagnostic test performed by an audiologist that helps determine if dizziness or imbalance is being caused by a condition of the vestibular system, the
sensory system in the inner ear that helps maintain balance. The test assesses the
connection between the eyes and the pathways connecting the vestibular system to
the brain. During the test, the patient wears a set of comfortable goggles equipped
with small infrared video cameras. A prescription is needed from a physician to
have a VNG test. To schedule an appointment, call the Speech and Hearing Center
at 914-366-3010.
Vestibular rehabilitation, evaluation and treatment are performed at Phelps by
physical and occupational therapy staff who hold vestibular certification and other
specialty training. A prescription for vestibular evaluation and treatment should be
obtained from a physician. To schedule an appointment, call the Department of
Physical Medicine and Rehabilitation at 914-366-3700.
PhelPs Today
17
Phelps Opens
New Medical
Suite in Croton
P
helps is pleased to announce the
opening of a new medical office
suite in Croton-on-Hudson. The
new facility, located at 440 South Riverside Avenue (in the ShopRite Plaza),
features three physician offices and nine
examination rooms and offers primary
care as well as diagnostic radiology and
ultrasonography. Internal medicine physicians Dr. Marco Zarlengo, Dr. Catalina
Cincu and Dr. Michael Finkelstein and
family nurse practitioner Jane Connelly,
FNP, are currently seeing patients there.
The office hours are 9 am to 5 pm, Monday through Friday. For an appointment,
call 914-269-1700. Walk-ins are also
welcome.
Michael Finkelstein, MD, Jane Connelly, FNP,
Catalina Cincu, MD, and Marco Zarlengo, MD,
outside the new medical office suite in
Croton-on-Hudson.
Members of the Croton primary care and radiology team: (standing) Joan Millen, practice
coordinator; Jane Connelly, FNP; Drs. Marco Zarlengo, Catalina Cincu and Michael Finkelstein;
Joan Parthemore, ultrasound technician; (seated) Susanna D’Angelo and Judith Morel, medical
assistants; Julissa Vargas, practice manager; and Lori Perlett, X-ray technician.
18
PhelPs Today
Postpartum Depression
A
fter giving birth, a woman’s body
undergoes physical changes,
such as a drop in hormone levels,
changes in blood volume, blood pressure, and metabolism. Emotional stress
may develop due to lack of sleep or
anxiety about taking care of a newborn.
There may also be lifestyle issues such
as demanding older siblings or financial problems. All of this can lead to the
“baby blues,” which is characterized by
mood swings and crying spells of short
duration.
In some cases, however, a longer lasting, more intense depression may
occur. Symptoms of postpartum depression include loss of appetite, insomnia,
fatigue, irritability, anger, severe mood
swings, lack of joy in life, withdrawal
from family and friends and difficulty
bonding with your baby.
Postpartum depression isn’t due to a
personal weakness. Sometimes it’s just a
complication of giving birth. It is important to know that if you have postpartum
depression, there is help for you. Prompt
treatment can help manage your symptoms — and enjoy your baby.
A new mother who suffered from
severe postpartum depression recently
shared her appreciation for the care she
received while in the Phelps psychiatric
unit, where she was admitted one week
after giving birth.
I gave birth to my first child in 2011. It
turns out that the hormonal shift after
childbirth caused me to go into a manic
episode. I had no idea what was going
on, and it was absolutely the scariest
time in my life.
Postpartum
depression isn’t
due to a personal
weakness.
You all made it possible for me to make
it through such a traumatic experience. Words cannot express my
gratitude for all of your patience (I
know I was a handful, especially
at the beginning—which I feel horrible about), knowledge, and kindness for everything that you did.
I really believe that it was because
of each of you (and my amazing husband – thank you for
helping him understand my
illness) that I was able to
come out of such a seemingly hopeless place. You
have hearts of gold and
are amazingly selfless individuals. I commend you on
being able to help people
like me, who others may
have given up on. It really
means the world to me
and my family.
Many, many
thanks,
Ashley
PhelPs Today
19
Support Group for Chronic
Pain Sufferers Piloted at Phelps
C
hronic pain is a public health
problem that affects over 100
million Americans and costs the
nation up to $635 billion each year in
medical treatment and lost productivity.
This is more than the total number of
people affected by heart disease, cancer
and diabetes combined.
Treatments for chronic pain currently
include medications, surgery, behavioral
interventions,
psychological
counseling, rehabilitative and physical
therapy, and complementary and alternative therapies.
However, a new study exploring the
benefits of a support group for patients
with chronic pain was recently piloted
at Phelps Memorial Hospital in collaboration with the College of New
Rochelle. The objective of the study was
to observe whether the support group
would help chronic pain sufferers manage their pain without additional pharmacological interventions. Dorothy
Larkin, PhD, RN, CS, associate professor at The College of New Rochelle’s
graduate program in holistic nursing,
facilitated the group along with cofacilitators Pamela Louis, director of the
20
PhelPs Today
Phelps Wound Healing Institute; Martha Maresco, MS, RN-BC, CAPA, nurse
manager of the Phelps Pain Center; and
Judyth Klein, BSN, staff nurse at the Pain
Center.
Group members attended an orientation session, where they were each
asked to set a positive health goal for
themselves and to score their pain on a
visual analog scale. At the five weekly
sessions that followed, progress toward
their health goals and pain scores were
recorded. Participants were encouraged
to give and receive support from each
other and were also trained in self-hypnosis, relaxation techniques and guided
imagery.
Remarks from participants regarding
their experience were positive:
“We began as strangers but were quickly
able to share our concerns because of
the feeling of safety.”
“It was easier to stay focused on healthenhancing activities with weekly reinforcement.”
“Because of my high pain levels, I had
difficulty bringing up specific images,
but with regular guided imagery, I have
learned to move into a more comfortable and relaxed state—resulting in
decreased pain levels.”
“It was interesting for me to really see
the progress I have made. I learned to
deal better with my problem! Perhaps I
no longer feel so overwhelmed.”
“The professionals had a lot to offer. I
used techniques I learned when I was
stuck in an airport—it helped.”
“The group appreciated having the
opportunity to gather with other people
who understood their situation and were
able to give back to them,” said Martha
Maresco. “In fact, we discovered that
after the five-week group ended, the
members began meeting on their own
at a local diner for continued support.
We look forward to offering pain support groups in the future. It is evident
that they fill a need that is not being
met.”
The goal of the Pain Center at Phelps
is to improve the quality of life for individuals with chronic pain. For more
information about pain management at
Phelps, call 914-366-3794.
VITALITY PROGRAMS FOR SENIORS
The Vitality Initiative at Phelps brings
health, wellness and aging-in-place
programs to seniors in the community.
Following are some of the programs
sponsored by Vitality:
The Breakfast Club is a social gathering for adults in their second half of life,
which meets once a month (except in
August and December) on Thursday
mornings from 8:30 to 10:30 am. Each
Breakfast Club includes a presentation
on a health topic, a nutritious breakfast
and some light exercise.
Living Well, sponsored by the
Westchester County Department of
Senior Programs and Services, is a
series of six workshops designed to help
seniors manage their chronic health
problems. Participants get the support
they need, find practical ways to deal
with pain and fatigue, discover better
nutrition and exercise choices, understand new treatment options, and learn
better ways to talk with their doctor and
family about their health.
The Vitality Newsletter is a bi-monthly
publication specifically for seniors. To
receive the newsletter, either by mail or
email, contact Ellen Woods at 914-3663937 or [email protected].
For more information about any of these
programs, call 914-366-3937.
Cool Conversations is a group that
meets after the Breakfast Club to engage
in some lively conversation on a variety of interesting topics. The program is
meant to be social as well as intellectually stimulating.
Mind Games is a fun way to stimulate
various cognitive functions – memory,
problem solving, focus and speed. If
you are you having trouble remembering things or feel that you are easily confused, come join the fun! The Memory
Game, Boggle, Set and Sporcle are just a
few of the games played, one Wednesday afternoon a month.
Ongoing Health Programs and Support Groups
Alzheimer’s Support Group
For information, call Curtis Au
(914) 253-6860
Outpatient Behavioral Health
Alcohol/chemical
dependency, counseling,
continuing day treatment,
supportive case
management (914) 366-3027
Bereavement Support Groups
(914) 366-3325
Better Breathers Club
(914) 366-3712
Blood Donations
(914) 366-3916
Blood Pressure Screenings
Generally the 1st & 3rd
Wednesday of the month,
9:30 - 11:30 am Appointments
necessary: (914) 366-3220
Cardiovascular Rehab
(914) 366-3740
Cardiovascular Wellness Center
Exercise under RN supervision
(914) 366-3752
Celiac Sprue Support Group
Sue Goldstein: (914) 428-1389
CPR Classes (914) 366-3166
Diabetes Education Classes
for Adults (914) 366-2270
Essential Tremor Group
Meets in Somers. Contact
[email protected]
for information.
Group Counseling
Help with issues such as:
separation & divorce, losses,
relationships, family issues,
parenting, coping skills (914)
366-3600
Hospice
(914) 366-3325
Look Good Feel Better® for
women undergoing cancer
treatment
(800) ACS-2345
Mammography
(914) 366-3440
Maternity & Baby Classes
(914) 366-3382
My Sister’s Place
(800) 298-SAFE (7233)
Ostomy Support Group
3rd Sunday of every month
(914) 366-3395 (Call 366-3000
for cancellation information)
Parkinson’s Support Group at
Kendal on Hudson
(914) 922-1749
Physician Referral
(914) 366-3367
Pulmonary Rehabilitation
(914) 366-3712
Sleep Well Support Group
(914) 366-3755
PhelPs Today
21
Síndrome de De Quervain
Anjum Lone, OTR/L, CHT
Anjum Lone, OTR/L, CHT, jefa del
departamento de terapia ocupacional
en Phelps, es una terapeuta ocupacional
y terapeuta certificada especializada en
manos.
El síndrome de De Quervain se llama
así por el cirujano suizo Dr. Fritz de
Quervain que lo identificó por primera
vez en 1895. También se conoce como
tendinitis de De Quervain y tenosinovitis estenosante de De Quervain. En el
pasado, a esta condición también se la
llamó “esguince de las lavanderas”.
La tendinitis de De Quervain es causada
por una inflamación de los tendones
ubicados en el lado del pulgar de la
muñeca. Estos tendones, que están asociados con los dos músculos que permiten mover el pulgar alejándolo de la
mano, corren paralelos desde el antebrazo hasta el pulgar dentro de membranas llamadas vainas sinoviales. Cuando
están saludables, los tendones se deslizan suavemente en el interior de las
vainas. Sin embargo, si los tendones se
inflaman o si la vaina sinovial aumenta
de espesor, esto restringe el movimiento
de los tendones y produce dolor.
El síndrome de De Quervain es más
común en mujeres que en hombres y
casi el 50% de las nuevas mamás experimentan esta condición. Tiene una tendencia a desarrollarse durante el embarazo, cuando puede haber retención de
líquido. También puede desarrollarse
durante la menopausia.
22
PhelPs Today
Esta condición también es común
en personas que usan sus manos en
movimientos repetitivos, por ejemplo
constantemente usan su motricidad
fina, doblan forzadamente la muñeca,
colocan la muñeca en posiciones incómodas o realizan actividades de carga
o pellizcan con los dedos. También
puede ser causada por un traumatismo
directo o una carga incorrecta súbita, y
a veces está asociada con condiciones
como diabetes, artritis reumatoide e
hipotiroidismo.
Signos y síntomas
Si bien lo más frecuente es que el síndrome de De Quervain se vincule con
lesiones por uso excesivo, la causa de
este síndrome sigue siendo idiopática
(desconocida).
• Dolor e inflamación cerca de la base
del pulgar.
Cuando usted tiene dolor en el dedo pulgar o la muñeca, es importante que vea
a un médico para que descarte condiciones como una fractura, osteoartritis,
síndrome de intersección, síndrome de
Wartenberg o síndrome del túnel carpiano.
La queja más común en el síndrome
de De Quervain es dolor e inflamación
cerca de la base del pulgar o en la
punta del pulgar. A veces el dolor puede
difundirse a la muñeca y el antebrazo.
El dolor puede aparecer de pronto o
puede aumentar gradualmente con el
tiempo. Mover el dedo pulgar y mover
la muñeca pueden agravar el dolor.
Sigue una lista de algunos sig nos del
síndrome de De Quervain:
• Dolor a la presión y al tacto por
encima de la muñeca.
• Dificultad con la prensión, pellizcar,
compresión o movimiento de la
muñeca de lado a lado, como
cuando la persona saluda con la
mano.
• Problemas para cargar o trasladar en
brazos a un bebé o un objeto.
• Sensación de restricción o “adherencia” en el pulgar o muñeca
con el movimiento.
De Quervain’s Tenosynovitis
Inflamed tendon
sheath (covering)
Consulte a su médico si tiene
cualquiera de estos signos.
El médico realizará un par
de exámenes en el consultorio para confirmar
este diagnóstico. Por lo
general no se necesitan radiografías ni
otros exámenes
de
tecnología
avanzada.
Prevención del síndrome de De
Quervain.
• Evite los movimientos repetitivos
como los que se hacen durante muchas
horas de jardinería, especialmente en el
desmalezado y podas.
• No realice movimientos constantes,
como picar, serrar, tejer, limpiar,
actividad deportiva o enviar mensajes
de texto sin tener suficientes períodos
de descanso o estiramientos.
• Si usted es una nueva mamá, cuando
carga al bebé, le da el biberón o lo
traslada en el portabebés, evite colocar sus dedos pulgar e índice en la
posición formando “L”.
• Si los síntomas comienzan, evite o
limite actividades que agravan su
dolor.Aplique un paquete de hielo
durante 5 a 15 minutos frecuent
emente a lo largo del día.
Tratamiento para el síndrome
de De Quervain
Medicamentos antiinflamatorios. Su
médico podría recetarle un medicamento antiinflamatorio, como el
ibuprofeno. En algunos casos, el
médico podría recomendar una inyección de esteroides. En la mayoría de
los casos, se debería intenarse terapia
ocupacional antes de recurrir a una
inyección.
Terapia ocupacional. Un terapeuta
especializado en manos realizará una
evaluación y luego podría proveer
uno o más de los siguientes:
• Un aparato ortopédico (inmovilizador) hecho a medida que permitirá
que su pulgar/muñeca descansen y
ayudará a reducir la inflamación.
• Masajes del tejido profundo de su
pulgar/muñeca.
• Técnicas de liberación miofascial
(estiramiento delicado).
• Masajes con ultrasonido.
• A medida que el dolor disminuye,
ejercicios terapéuticos para estirar y
fortalecer el área.
La tendinitis de De
• Una evaluación ergonómica y entre
namiento para prevenir daño adicional, junto con recomendaciones para
que usted encuentre maneras óptimas
de seguir con sus actividades de la
vida diaria.
Quervain es causada
• Consejos para madres nuevas sobre
cómo cargar a sus bebés, usar el
portabebés o dar el biberón para
prevenir esta condición.
ubicados en el lado
Para recibir terapia ocupacional, usted
necesitará una receta de su médico.
Para información de terapia ocupacional en Phelps, llame al 914-366-3700
para hacer una cita.
muñeca.
por una inflamación
de los tendones
del pulgar de la
PhelPs Today
23
Sobrepeso y obesidad infantil:
Enfoques efectivos para la prevención
y el tratamiento
Preguntas y respuestas con Kilwanna Jordan, MS, RD, CDE, CDN
D
urante los últimos 30 años, la
cantidad de niños obesos y con
sobrepeso en Estados Unidos
se ha triplicado en comparación con
la década de 1970. Más de un tercio
de jóvenes estadounidenses actualmente sufren de sobrepeso u obesidad,
y aproximadamente 12.5 millones de
niños y adolescentes de 2 a 19 años se
encuentran en la categoría de obesos.
Algunos investigadores
han elaborado la teoría
de que los jóvenes obesos y con sobrepeso de
la actualidad posiblemente tengan menores
expectativas de vida
que sus padres Estos
niños presentan un
riesgo cada vez
mayor de desarrollar enfermedades
crónicas que normalmente no se
observan
hasta
alcanzar la mediana
edad, tales como resistencia a la insulina y diabetes de tipo 2,
enfermedad cardiovascular, ACV, colesterol alto, asma, hipertensión, trastornos
articulares y apnea del sueño.
dad, diversas organizaciones locales y
nacionales han desarrollado programas
para prevenir y tratar los problemas de
peso en los jóvenes. En 2010, la primera dama Michelle Obama lanzó “Let´s
Move”, una campaña nacional para
reducir la obesidad infantil que involucra a padres, funcionarios del gobierno,
profesionales del cuidado de la salud y
organizaciones comunitarias.
¿Cuáles son las causas del sobrepeso o
la obesidad en los
niños?
Sobrepeso significa tener un índice de
masa corporal (BMI), es decir, la medición del peso en relación con la altura,
entre los percentiles 85 y 95 según la
tabla de crecimiento de los CDC (Centros de Control de Enfermedades).
Obeso significa tener un BMI en el percentil 95 o más. Si busca en Internet
“índice de masa corporal”, encontrará
sitios con calculadores del BMI.
La epidemia de la
obesidad es el resultado de diversos
factores, incluidos
la conducta, el
entorno y la genética. Las conductas tales como una
alimentación poco
saludable y la falta
de ejercicio pueden
provocar el aumento de peso. Muchos
niños comen con frecuencia comidas
rápidas que contienen gran cantidad
de grasa y azúcar, tales como papas
fritas, perros calientes, batidos y gaseosas azucaradas o “jugos”. Se sabe que
los tamaños de la porción también han
aumentado durante los últimos 30 años
(hasta un 20%). El exceso de refrigerios durante el día con alimentos
tales como galletas, papas fritas,
jugo de frutas y golosinas también puede dar lugar al consumo
excesivo de calorías. Si los niños
no queman esas calorías adicionales mediante la actividad
física, sus cuerpos almacenan
la energía en forma de grasa.
Para combatir la epidemia de la obesi-
El entorno también puede ser
¿Cuál es la diferencia entre
tener sobrepeso y ser obeso?
24
PhelPs Today
un factor importante en la obesidad o
el sobrepeso del niño. Muchos niños
dedican más tiempo a actividades sedentarias, tales como mirar la televisión,
jugar juegos de video o navegar por
Internet, que a hacer una actividad
física. Si el niño no tiene acceso a espacios verdes donde pueda jugar, tales
como patios, parques o áreas de juegos infantiles, es menos probable que
realice una actividad física adecuada
durante el día. Asimismo, debido a los
cortes de presupuesto, algunas escuelas
han reducido o eliminado el tiempo de
recreo, las clases de educación física,
los programas deportivos y las actividades extracurriculares. El resultado
neto es una nación de niños que comen
más y se mueven menos.
La genética es el tercer factor que contribuye al desarrollo del sobrepeso y la
obesidad en los niños. Los estudios han
demostrado que los niños de padres
obesos presentan mayor riesgo de sufrir
obesidad que los niños de padres no
obesos. Esto puede ser consecuencia de
genes heredados o conductas aprendidas. En los casos de mellizos separados
al nacer, los investigadores descubrieron
que existe una predisposición genética
a la acumu-
lación de grasa en el 40-70% de los
sujetos. Cabe destacar que el BMI de
los niños adoptados coincidió con el de
sus padres biológicos y no con el de sus
padres adoptivos.
Pero nacer de padres obesos o con
sobrepeso no significa necesariamente
que el niño tendrá sobrepeso. De hecho,
los padres con un BMI en el rango normal pueden tener algunos niños obesos
o con sobrepeso y otros niños que mantienen el peso dentro del rango normal.
¿Los hábitos alimenticios de los
padres influyen sobre la calidad
y la cantidad de alimentos que
ingieren sus hijos?
Aunque la genética desempeña un papel
importante en el riesgo de obesidad de
los niños, también se deben tener en
cuenta los hábitos alimenticios de la
familia. El estilo de vida de la familia
desempeña un papel significativo en
las actitudes y conductas del niño con
respecto a la alimentación y la actividad
física. Se ha demostrado que las normas
culturales, el nivel socioeconómico y la
ubicación geográfica influyen sobre los
hábitos alimenticios de los individuos y
las familias. Debido a que en la mayoría
de los casos los padres se encargan de la
compra y la preparación de los alimentos en el hogar, pueden influir enormemente sobre qué y cuánto comen sus
hijos. Si los padres sirven como ejemplo
de hábitos alimenticios saludables, es
más probable que sus hijos los imiten.
¿Cómo influye una dieta poco
saludable sobre el rendimiento
escolar del niño?
Cuando la dieta del niño incluye gran
cantidad de grasa, o alimentos y bebidas cargados de azúcar, las calorías
asociadas contribuyen a un aumento
de peso, pero no existe un beneficio
a nivel nutritivo. Si la dieta del niño
está basada en estas “calorías vacías”,
esto puede influir sobre su rendimiento
académico, por la ingesta limitada de
vitaminas, minerales, fibra y proteínas
que necesitan. Obtener los nutrientes
adecuados es muy importante para
los cerebros jóvenes que aún están
en desarrollo. Los niños que desayunan obtienen puntajes más altos que
aquellos que saltean el desayuno. La
investigación demuestra que la alimentación saludable puede aumentar
la concentración del niño y ayudarlo a
mejorar en la escuela. La deficiencia de
hierro en niños puede originar cansancio y poca concentración. Las mejores
fuentes de hierro son las carnes magras,
las carnes de ave, los huevos, y los frijoles secos y las lentejas. Las vitaminas
también son importantes para una buena
concentración. La vitamina B12, que se
encuentra en la carne, los productos
lácteos y los huevos, ayuda a mejorar
la concentración y la salud del cerebro. La vitamina C, que es importante
para un adecuado funcionamiento del
cerebro, se encuentra en los mangos,
las fresas, los pimientos verdes y rojos,
y las frutas cítricas como la naranja, la
mandarina y la toronja. El jugo de frutas
puede ser una bebida saludable, pero
dado que no contiene fibra y es fácil
de beber en grandes cantidades, puede
ser una fuente de exceso de calorías. A
los niños se les debe administrar únicamente jugo 100% de frutas, limitado a
4-6 onzas por día para aquellos niños
de 1 a 6 años de edad, y 8-12 onzas por
día para los niños de 7 a 18 años.
Grandes cantidades de azúcar y grasa
pueden influir sobre la concentración
del niño al causar oscilaciones en los
niveles de energía. Una hamburguesa
con queso y papas fritas con un alto
contenido de grasa puede hacer que los
niños se sientan aletargados, dado que
enlentece la digestión. Los alimentos
azucarados y las bebidas endulzadas
pueden influir sobre la concentración,
dado que provocan un ascenso de la
concentración de azúcar en sangre,
seguido por un rápido descenso de
energía. Demasiada azúcar también
contribuye a un aumento de peso excesivo, que puede afectar el bienestar
físico y emocional.
hojas, lavar y doblar la ropa, limpiar
la casa).
• Controlar el tiempo que pasa su hijo
mirando la televisión, jugando a juegos de video y usando la computadora.
• Preparar comidas saludables con
toda la familia. Incluir frutas, verduras y granos enteros. Si el niño tiene
edad suficiente, permita que pele,
corte y mezcle.
• Cenar en familia y recordar que no
hay necesidad de apurarse; comer
lentamente mientras comparten las
experiencias del día.
• Abastecer la alacena con refrigerios
saludables, por ejemplo, nueces sin
sal, pasas de uva, galletas reducidas
en grasas, galletas dulces con bajo
contenido de azúcar como galletas
integrales, y palomitas de maíz (para
las palomitas preparadas en el
hogar).
• Mantener grandes cantidades de
frutas frescas y verduras en el hogar.
• No usar los alimentos como recompensa o castigo.
• Limitar las comidas rápidas a no más
de una vez por semana.
• Alentar a los niños a beber agua si
tienen sed. Darles agua con el
refrigerio y durante todo el día, reservando los jugos 100% de frutas y la
leche desgrasada o con 1% de grasa
para las comidas.
¿Qué se puede hacer para
ayudar a las familias a prevenir o tratar el sobrepeso y la
obesidad?
Hacer ejercicio regularmente como
familia. Buscar actividades que disfrute
toda la familia (caminar, andar en bicicleta) y programar un momento para
hacerlo.
• Involucrar a toda la familia en los
que haceres domésticos (rastrillar las
Kilwanna Jordan, MS, RD, CDE, CDN, coordinadora de nutrición para pacientes ambulatorios, es una Dietista Registrada con una
especialidad como Educadora Certificada en
Diabetes. También tiene especialidades adicionales en control del peso en adultos, niños
y adolescentes. Para hacer una cita, llame al
914-366-2264.
PhelPs Today
25
Programs and Services at Phelps
Bereavement Support
(914) 366-3325
Blood Donor Services*
(914) 366-3916
Cardiovascular Diagnostic Lab
(914) 366-3740
Cardiac Rehabilitation
(914) 366-3742
Child Care – Robin’s Nest
(914) 366-3232
Diabetes & Metabolism Center**
(914) 366-2270
Diabetes & Endocrine Center for Children & Young Adults*
(914) 366-3400
Educational Programs and Free Screenings
(914) 366-3220
Emergency Department
(914) 366-3590
Emergency Department’s PromptCare
(914) 366-3660
Emergency Education Center*
(914) 366-3577
Gastroenterology & Advanced Endoscopy*
(914) 366-1190
Hospice
(914) 366-3325
Hyperbaric Medicine Center
(914) 366-3690
Infusion Center*
(914) 366-3523
Laboratory (Outpatient)
(914) 366-3917
Lung Nodule Center
(914) 366-2333
Maternal Child Center
(914) 366-3382
Memorial Sloan-Kettering Cancer Center**
(914) 366-0664
Mental Health – Outpatient Counseling*
(914) 366-3600
Mental Health – Outpatient Chemical Dependency
(914) 944-5220
Mental Health – Inpatient Substance Abuse – Co-occurring Disorders
(914) 366-3027
Mental Health – Inpatient Psychiatry
(914) 366-3513
Nutrition Counseling
(914) 366-2264
Pain Center
(914) 366-3794
Pastoral Care
(914) 366-3090
Pharmacy for the Community**
(914) 366-1400
Physical Medicine & Rehab (PT, OT, Aquatherapy) - Outpatient*
(914) 366-3700
Physical Medicine & Rehab - Inpatient
(914) 366-3702
Physician Referral Service
(914) 366-3367
Prenatal Care Assistance Program (PCAP)
(914) 941-1263
Pulmonary Physiology Lab and Pulmonary Rehabilitation
(914) 366-3712
Radiology/X-Ray
(914) 366-3430
Respite Care
(914) 366-3356
Senior Services and Memory Loss Evaluation*
(914) 366-3669 or 3677
Sleep Center
(914) 366-3626
Speech & Hearing – The Donald R. Reed Center**
(914) 366-3010
Surgery – Call Physician Referral
(914) 366-3367
Thoracic Center for Chest Diseases*
(914) 366-2333
Vascular Institute
(914) 366-3008
Voice & Swallowing Institute**
(914) 366-3636
Volunteer Services
(914) 366-3170
Wound Healing Institute*
(914) 366-3040
*Located in the Phelps Medical Services Building (755 North Broadway).
** Located in the Phelps Professional Building (777 North Broadway).
For more information about Phelps services, visit phelpshospital.org and click on “Programs & Services.”
It is now possible to request an appointment for many services on the Phelps website. Just go to
phelpshospital.org and click on “Request an Appointment Online.”
26
26
PhelPs Today
PhelPs Today
Save the Dates:
A Lift for What
Ales You
10th Annual Phelps
A Beer and Food-Tasting Event
Golf Classic
Monday, June 10, 2013
11:00 am
Sleepy Hollow Country Club
Scarborough, New York
Monday, February 25, 2013
6:00 pm
Captain Lawrence Brewing Company
Elmsford, New York
An Evening of
26th Annual
Food & Wine
Champagne Ball
with Fine Friends
Saturday, November 16, 2013
6:30 pm
Trump National Golf Club
Briarcliff Manor, New York
Thursday, April 25, 2013
6:30 pm
Tappan Hill Mansion
Tarrytown, New York
RSVP
Contact: Marissa Coratti, Special Events Manager • [email protected]
or 914-366-3104 • Or register online: www.phelpshospital.org
Events to benefit Phelps Memorial Hospital Center
PhelPs Today
27
PhelPs
Nonprofit Organization
Phelps Memorial hospital Center
701 North Broadway
sleepy hollow, Ny 10591-1096
U.S. Postage
PAID
Permit #63
Mechanicsburg, PA
www.phelpshospital.org
Receive a Gift When You Give the Gift of Life!
Every time you donate blood at Phelps, you can choose a gift from one of the generous supporters listed below.
¡Reciba un regalo cuando dé el regalo de la vida!
Cada tiempo usted dona sangre en Phelps, puede escoger un regalo de uno de los partidarios generosos listó abajo.
Amalfi Restaurant, Briarcliff Manor
The Art Barn, Ossining
At the Reef Restaurant,
Cortlandt Manor
Atria Senior Living on the Hudson,
Ossining
Basilico Pizza, Pasta and Gourmet,
Mt. Kisco
The Boathouse, Ossining
Brasserie Swiss, Ossining
Bridge View Tavern, Sleepy Hollow
The Cabin, White Plains
Canfin Gallery, Tarrytown
Capri Pizza & Pasta, Ossining
Caravela, Tarrytown
Carpet Giant, Ossining
Casa Rina, Thornwood
Coffee Labs Roasters, Tarrytown
Crabtree’s Kittle House, Chappaqua
Creative Flooring, Mt. Kisco
Doca’s Portuguese Restaurant,
Ossining
Dominick’s Limousine,
Sleepy Hollow
Don Juan Mexican Restaurant,
Pleasantville
Doubletree Hotel, Tarrytown
Eldorado West Diner, Tarrytown
Elite Hair Design, Tarrytown
Elmsford Chiropractic, Elmsford
28
PhelPs Today
Fairview Golf Center, Elmsford
Family YMCA, Tarrytown
TGI Friday’s, Tarrytown
Geordane’s Deli, Irvington
Goldfish Restaurant, Ossining
Good Food, Briarcliff Manor
Gordo’s, Hawthorne
Green Valley Nursery, Hawthorne
Hair on the Hudson, Tarrytown
Heritage Frame & Picture,
Tarrytown
Highland Dry Cleaners, Ossining
Horsefeathers, Tarrytown
Horseman Restaurant & Pizza,
Tarrytown
Il Sorriso Ristorante, Irvington
Images Art Gallery, Briarcliff Manor
Isabella Italian Bistro, Tarrytown
J.P. Doyle’s Restaurant,
Sleepy Hollow
Jacob Burns Film Center,
Pleasantville
Josephine’s Hair Salon, Ossining
Karma Lounge Martini Bar & Grille,
Ossining
Kendal on Hudson, Sleepy Hollow
L3 Couture, Briarcliff Manor
Landmark Diner, Ossining
Louie Linguine’s Casual Bistro,
Pleasantville
Main Street Sweets, Tarrytown
Mandee, Ossining
Manor Wine & Spirits,
Briarcliff Manor
Marriott Westchester, Tarrytown
Mediterraneo, Pleasantville
Melita’s Home Furnishings,
Ossining
Moon River Grill, Sleepy Hollow
Moonbeam Café, Briarcliff Manor
Mr. Nick’s Brick Oven Pizza,
Tarrytown
My Sherry & More, Inc.,
Briarcliff Manor
Nevaeh Cuisine, Pleasantville
NY School of Esthetics, Tarrytown
Okinawa Hibachi Steak House,
Ossining
Old Stone Trattoria, Chappaqua
Paese Pasta & Pizza,
Briarcliff Manor
PHR Center of Electrolysis,
Tarrytown
Pleasantville Colonial Diner,
Pleasantville
Red Hat Bistro & Bar, Irvington
River View Wine & Spirits,
Tarrytown
Rock Island Sound, Tarrytown
Sheraton Hotel, Tarrytown
South of the Border, Ossining
Sparx Hair & Makeup Salon,
Pleasantville
Squire’s Restaurant, Briarcliff Manor
Striped Bass, Tarrytown
Sunset Cove, Tarrytown
Tarry Tavern, Tarrytown
Tarrytown Woodworks, Tarrytown
Taste of China, Tarrytown
Terra Rustica Ristorante,
Briarcliff Manor
Thornwood Ale House, Thornwood
Tramonto Restaurant-Bar-Café,
Hawthorne
Trapp Optical, Tarrytown
The Tuscan Grille, Briarcliff Manor
Ultra Clean Car Wash & Detail
Center, Ossining
Wake Robin, Briarcliff Manor
Warner Library, Tarrytown
Westchester Broadway Theatre,
Elmsford
Wobble Café & Catering, Ossining
Please patronize these businesses
and let them know you appreciate
their community-minded support.
To learn about donating blood, call
(914) 366-3916.