2013 Winter Newsletter - Phelps Memorial Hospital
Transcripción
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.
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