Monday, December 10, 2018

Osteoporosis, the silent disease



Osteoporosis affects 10 million Americans; 8 million women and 2 million men. It’s a disease in which bone loses its mineral content, there is a change in its structure and bone becomes weaker. A fall, sneeze or bumping into furniture can cause it to break.

Osteoporosis is a silent disease. You don’t know you have it until you fall and break a bone. Last year it caused two million fractures. These fractures can lead to pain, disability and even death. In fact, osteoporotic hip fractures caused more deaths than breast cancer in women and more deaths than prostate cancer in men.

Frank Bonura, MD, FACOG, NCMP, CCD, director of Osteoporosis Program at St. Catherine of Siena Medical Center, a member of Catholic Health Services, shared some insight in how to identify osteoporosis, how to treat it and potentially how to minimize your chances of getting it.

How do I know if I have Osteoporosis?

“We can diagnose osteoporosis by measurement of your bone mineral density (BMD) using a DXA Scan Machine. The BMD is the amount of mineral in an area of your bone. Osteoporosis can also be diagnosed clinically, if you are 50 years or older, fall from a standing height and sustain a fracture.

You are entitled to a DXA Scan if you are a woman 65 years or older or a man 70 years or older. Younger women age 50 to 64 and men age 50 to 69 years old who are at risk for osteoporosis (family history, rheumatoid arthritis, chronic kidney disease, diabetes, etc.) or are taking medications that cause loss of BMD are entitled to have a DXA scan.” Dr. Bonura

If I have Osteoporosis, can it be treated?

“Once the DXA results demonstrate a diagnosis of osteoporosis, your physician should order lab work to confirm if your osteoporosis is due to your age, family history, a medical condition or to a medication you are taking. We do that because all medications used for osteoporosis have serious side effects. If you have a medical condition, we might treat that before prescribing a medication for osteoporosis. If it’s due to a medication you are taking, we may adjust the dosage or change the medication.” Dr. Bonura

What is the treatment for Osteoporosis?

“Osteoporosis can be treated but it can’t be cured in all cases. Some medications used (Fosamax, Boniva, Actonel, IV Reclast, Prolia) stop the bone cells that destroy the bone. Other medications (Forteo, Tymlos) stimulate the bone cells that build bone. All of the medications have side effects but they are rare and only should be used in patients who are at high risk for fracture.” Dr. Bonura

Do I need Calcium and Vitamin D?

“Calcium is necessary for bone health; therefore, all individuals should have an adequate amount of calcium and Vitamin D in their diet. If you are 50 years or older it is recommended that you take 1200mg of calcium per day. Our diet gives us 600mg per day. To obtain the other 600mg, the best sources are dairy products. An 8 ounce glass of milk gives us 300mg of calcium, as does a yogurt or 3 ounces of cheese. You can also get calcium from foods that are fortified with calcium (cereals, soy milk, and juices) or green leafy vegetables. If you are lactose intolerant then you can take a calcium supplement. They are best taken with foods in divided doses. To absorb calcium you need adequate Vitamin D. Without Vitamin D only 10-15% of calcium is absorbed. Vitamin D can be obtained from supplements and can also be made when your skin is exposed to sunlight." Dr. Bonura

For more information about CHS call 1-855-CHS-4500 or visit https://www.chsli.org/.

Wednesday, December 5, 2018

Tis the Season For Sharing, But Not Germs; Top 5 Reasons Why Washing Your Hands Is Important



Keeping hands clean is one of the most important steps we can take to avoid getting sick and spreading germs to others. 80% of common infections are spread by hands. For the general public, washing your hands at a minimum of five times a day has been shown to significantly decrease the frequency of colds, influenza (the “flu”) and other infections.

In honor of National Handwashing Awareness Week (now through December 7), Mercy Medical Center’s Director of Infection Prevention, Kelly Mulholland, BSN, RN-BC, CCRN-K, CIC, shares the top five reasons why washing your hands is important.

  1. Tis the season for sharing, but NOT germs (80% of infections are spread by hands.) The CDC notes that proper handwashing has been found to reduce the number of people who get sick with diarrhea by nearly a third, and reduces colds and related diseases by 16-21%.

  2. Flu germs are spread not only from droplets in the air but from touching items that may have the flu germs on them; like door handles, ATM machines, shopping cart handles, cell phones, etc.

  3. You can’t see the bacteria on your hands; avoid touching your eyes, nose or mouth since the germs on your hands can spread into your body.

  4. During the holidays with much food preparation and gathering together with larger groups of family and friends, the spread of germs from your hands increases.

  5. Washing your hands can SAVE LIVES.

Ms. Mulholland also shared tips on how and when to properly wash your hands:

  • Using alcohol-based hand rub (gel, liquid or foam) apply a palm full and rub around your hand making sure to cover all surfaces of your wrists, back of your hands, nails and thumbs too.

  • Rub until the solution is dry about 15 – 20 seconds.

  • Soap and water is to be used if your hands are visibly soiled and after using the bathroom.

  • Use alcohol-based hand rub for all other instances; after coughing, sneezing or blowing your nose, after touching animals, before eating or preparing food.
For more information, visit www.chsli.org or call 1-855-CHS-4500.

Monday, November 26, 2018

Romaine Lettuce Still Unsafe; Director of Food & Nutrition Shares Tips


Last week, the Centers for Disease Control (CDC) issued this warning about an E. coli outbreak, “Do not eat any romaine lettuce, including whole heads and hearts, chopped, organic and salad mixes with romaine until we learn more. If you don’t know if it’s romaine or can’t confirm the source, don’t eat it.”
Today, that is still an active warning. Good Samaritan Hospital Medical Center's Director of Food & Nutrition Services Richard Doscher, RD, CDN, shared some expert thoughts on how to combat the E. Coli outbreak:
"Although the CDC has only issued a warning, I would highly recommend that the public take it very seriously. 32 people have been affected, 13 of whom have been hospitalized as a result of contaminated lettuce. Most sources of E.coli are harmless and may only cause a brief stint of diarrhea. However, the more dangerous strain, E. coli O157:H7, can cause severe abdominal pain, bloody diarrhea, vomiting and, possibly, a mild fever. The toxin generally enters the body through contaminated food sources like ground beef and fresh produce.
Combat this is by thoroughly cooking ground meat to 160F to kill the E.coli bacteria. Use a calibrated thermometer and insert the tip in the thickest part of the formed patty. Also, be sure to thoroughly wash all fresh produce like lettuce to remove any dirt or debris that may be harboring this dangerous bacteria. This does not mean the lettuce is free of the toxin but less will be present. Finally, avoid cross-contamination when preparing foods; wash hands before and after preparing individual food items, keep raw foods separate from ready-to-eat foods and always wash your utensils, knives and cutting boards with hot soapy water in between tasks."
Good Samaritan Hospital is a member of Catholic Health Services, an integrated health care delivery system with six hospitals, three skilled nursing facilities, a regional home nursing service, hospice and a multiservice, community-based agency for persons with special needs. Under the sponsorship of the Diocese of Rockville Centre, CHS serves hundreds of thousands of Long Islanders each year, providing care that extends from the beginning of life to helping people live their final years in comfort, grace and dignity. 
For more information, visit www.chsli.org.

Wednesday, November 14, 2018

Is the Keto Diet Safe for Diabetics?



While the ketogenic (keto) diet has recently gained popularity as one of the new “it” diets, it’s important to think twice before starting any diet that severely restricts any food groups, especially if you're diabetic. The keto diet limits carbohydrates and encourages a high fat intake. 

Beth Freedman, MPH, RD, CDN, CDE, certified diabetes educator and diabetes program coordinator at Mercy Medical Center, said, "While keto diets may be beneficial for those suffering from seizures, this type of eating plan would not be recommended for patients with diabetes whose medications are working under the assumption that the person is eating carbohydrates.

Additionally, carbohydrates are our main source of energy and should represent 45-65% of our daily intake. The keto diet is not sustainable over a long period of time and a new study shows that it can even be detrimental when a person starts eating carbohydrates again, possibly leading to a carbohydrate intolerance and/or diabetes. Because the ketogenic diet is a high fat diet it may also be detrimental to overall heart health including cholesterol levels."

The bottom line: think of eating as a meal plan, not a diet. Be sure to include a variety of fruits, vegetables, whole grains, lean proteins and healthy fats every day.

For more information, visit www.chsli.org or call 1-855-CHS-4500.

Tuesday, November 6, 2018

Breast Cancer Prevention Checklist



October was Breast Cancer Awareness Month but it’s always a great time to assess your risks and evaluate your healthy (and unhealthy) habits.

Did you know that about 1 in 8 women will develop invasive breast cancer in their lifetime?

As of January 2018, there are more than 3.1 million women with a history of breast cancer in the United States.

There is no one perfect strategy to prevent breast cancer; however, some foods and lifestyle habits can make your body the healthiest it can be and keep your risk for developing breast cancer as low as possible.

Stefanie Pappas, clinical dietitian at The Cancer Institute at CHS’s St. Francis Hospital, created the following checklist of lifestyle habits for breast cancer prevention.

Get Screened Regularly. While mammograms may not help prevent breast cancer, it can help find cancer when it is early and most treatable. For most women, regular mammograms can begin at age 40.

Stay Lean. Overweight or obesity dramatically increases the risk of breast cancer and other chronic diseases; this is especially true if obesity occurs later in life. If you are not sure what an ideal weight is for your body type, calculate your body mass index online using a BMI calculator. A healthy BMI range falls between 18.5 to 25 kg/m^2. 

Follow A Plant-Based Diet. This consists primarily of fruits, vegetables, beans/legumes, nuts/seeds, and whole grains. Aim to eat 8 to 10 colorful fruit and vegetable servings daily; this will also help you meet your daily fiber goals and keep your body in peak nutritional state. A study of about 3,000 postmenopausal women found that women who consumed 25 or more servings of vegetables weekly had a 37% lower risk of breast cancer compared with women who consumed fewer than 9 vegetable servings weekly.

Avoid Processed and Refined Carbohydrates. High sugar foods tend to be very processed and low in nutritional value. These foods also appear to increase serum insulin and insulin-like growth factor that can stimulate cancer cell growth. Try your best to limit white bread, pasta, and rice. Be careful with white sugar and items such as cakes and cookies. Opt for whole grains when possible, and indulge in moderation when it comes to sweets.

Focus On Healthy Fats. Research has found a protective relationship between omega-3 fatty acids and breast cancer. Some studies even show that omega-3’s can inhibit breast cancer tumor growth and metastasis. Strive to include healthy fats such as salmon, chia seeds, flaxseeds, walnuts, olive oil, and avocados in your diet.

Check Your Vitamin D. Some studies have found an inverse relationship between breast cancer risk and serum 25 (OH) vitamin D levels. Ask your doctor about having a vitamin D blood test. Maintain your level above 40 ng/mL through diet and, if needed, supplements.

Stay Hydrated. Water is essential for carrying nutrients throughout the body. Don’t neglect the simple task of meeting your hydration needs. Plus, increased fluid intake is needed for proper digestion of a high fiber diet.

Exercise Regularly. Women who are physically active for at least 30 minutes a day have a lower risk of breast cancer. There is no one perfect form of exercise- the ideal form is truly the type of exercise that you will stick to. If you hate cardio, try strength training or pilates. Find a form of exercise that you enjoy and can commit to on a regular basis.

Limit Alcohol. Even small amounts of alcohol can increase your risk of breast cancer. Try to slowly decrease the amount you drink, and consider diluting alcoholic beverages with seltzer.

Quit Smoking, For Good! Did you know that at least 15 cancers, including breast cancer, are linked to smoking? More evidence is suggesting that there is a strong link between smoking and breast cancer risk, particularly in premenopausal women. Plus, smoking causes bad breath, poor teeth, and wrinkles. Take control and make a change to quit smoking today.

Research on diet and breast cancer is ongoing. In the meantime, focus on maintaining a healthy body weight and choosing a primarily plant-based diet. Stay as active as possible, and don’t neglect important strategies such as adequate hydration.

For more information about Breast Health at CHS call 1-855-CHS-4500 or visit https://www.chsli.org/. 


Friday, November 2, 2018

Fall Back Into Your Routine: 10 Tips on How to Adjust to Ending of Daylight Savings



When it comes to sleep, it’s important to be consistent. But how can you do that when every six months you have to adjust to a new sleep schedule?

Rolling back the clock this Sunday, November 4, has its advantages. We get an extra hour sleep! However, we can experience natural “jetlag” as the amount of light and darkness shifts with the new times. If you think one hour of sleep doesn’t matter, ponder this:

  • The Monday after daylight savings starts there’s a 24% increase in heart attacks
  • The Tuesday after daylight saving ends there’s a 21% decrease in heart attacks 

Some experts from Catholic Health Services (CHS) five sleep centers shared top 10 tips on how to manage the impending change with ease.

  1. “Stick to your regular schedule. Wake up at your usual time on Sunday, Nov. 4. For example, if you awaken at 7 am most days, do the same on Sunday (clock will read 8 am).” Director of Center for Sleep Medicine at Mercy Medical Center Chrisoula Politis, MD.

  2.  “Get out in natural sunlight early in the morning to reset your circadian clock. However, if it’s dark when you wake up, turning on all of the lights will help.” Sleep Center Coordinator at St. Charles Hospital’s Sleep Disorders Center Brendan Duffy, RPSGT.

  3. “Stay active! The temptation to skip those morning jogs will be great, but you will feel better for doing them and it will help you to keep your routine.” Sleep Medical Director at St. Joseph Hospital Iwona Rawinis, MD.

  4.  “The added darkness in the early evening can cause sluggishness and drowsiness if you work in an office. Try to get a workspace by a window so you can get natural light during the workday. Or, get up and walk around or exercise in the afternoon.” Duffy, St. Charles Hospital

  5. “Eat healthy meals. In the colder weather we seek heavier meals. Try a soup to warm you, with a salad with grilled chicken instead of a heavy beef stew filled with gravy and potatoes.” Dr. Rawinis, St. Joseph Hospital

  6. “If you are dealing with being sleepy in the morning by drinking coffee or energy drinks, remember that caffeine takes 20 minutes or so to have any effect on your alertness. So wait before you drive in a sleepy state. But be careful of resorting to caffeine in the afternoon as it could interfere with your sleep at night.” Duffy, St. Charles Hospital

  7.  “If you feel the need to nap, make it short – no more than 30 minutes. Anything more will interfere with your sleep cycle.” Dr. Rawinis, St. Joseph Hospital

  8. Avoid screen time prior to bed. The light emitted from electronics (cell phones, iPads and laptops) inhibits melatonin and delays sleep.” Dr. Politis, Mercy Medical Center

  9.  Daylight savings can be managed by going to bed 30 to 60 minutes earlier than usual. The brain can usually accommodate a 90 minute shift (adaptation), such as with time zone changes with air flight, every 24 hours.” Director of Sleep Disorders Center at St. Catherine of Siena Brian Margolis, MD.

  10. “Don’t eat too closely to bedtime. Some food can give you energy and interfere with falling asleep. For example, caffeine and sugar.” Dr. Rawinis, St. Joseph Hospital

If you want to take a quick quiz to determine if your drowsiness might be related to sleep apnea, go to https://goodsamaritan.chsli.org/sleep-apnea-quiz.

CHS is home to five sleep centers across Long Island. Go to www.chsli.org to find the one closest to you or call 1-855-CHS-4500 for assistance.

All CHS sleep centers offer sleep apnea tests and are located at:

  • St. Joseph Hospital, Bethpage
  • St. Charles Hospital, Port Jefferson
  • St. Catherine of Siena, Smithtown
  • Mercy Medical Center, Rockville Centre
  • Good Samaritan Hospital, West Islip



Tuesday, October 16, 2018

How to Find a Good Therapist?


It’s hard to find a therapist. Beyond that, when you do find one sometimes it can be tricky to know if the therapist is the right fit for your personality and needs. Most people seek recommendations from friends or through their employers’s EAP service. Many try going to web-based referral sites, where there is unfortunately little to no outside authority confirming a therapists quality.

David Flomenhaft, LCSW, PhD, and director at Mercy Medical Center’s Behavioral Health Services provided insight on the matter. He said, “There are some differences in how one seeks out a therapy referral. Some people are comfortable speaking about personal issues with friends and acquaintances. In general, men typically will call their insurance plan for an in-network referral. High copay and high deductibles are barriers. Many experienced therapist do not accept insurance so this becomes a prohibitive cost.”

Taking time to develop a strategy and considering the first session as a mutual interview, will greatly help you assess whether or not the therapist is the right fit for you. Dr. Flomenhaft suggests trying to ask a few questions to clarify the fit with the prospective therapist:

  • What is their specialty?
  • Are they familiar with _____ (a specific need)? If it is for child and adolescent, ask if the therapist has experience with that age group.

He also offers the following pointers:

  •  Be aware: patients are often looking to address current stressors of loss, transition, illness or chronic relationship struggles, it’s good to have that awareness in mind when seeking help. 
  • Do your research: most therapists have a social media or an internet presence. Be sure to research that website to become familiar with their practice and style.
  • Be patient: finding a good therapist takes time. Many clients report that they have to call many in-network providers to find one with openings.
  • Confirm their network: If you have moderate to severe depression, anxiety or more severe needs make sure that therapist has a working relationship with a psychiatrist or NP-Psychiatry.
  • Always be honest: If the problem involves substance abuse make sure you are honest and inquire if that therapist has experience and can provide the right care.

 If the ‘interview’ goes well, ask yourself if you’d like to see that therapist for a regular appointment.
“A general plan of care for therapy should be at least 12 or more visits. It takes a while to work through issues, identify priorities and implement a plan of change or acceptance of the circumstances that brought on the crisis to seek help,” added Dr. Flomenhaft.

For more information and/or to connect with a CHS doctor call 1-855-CHS-4500 or visit www.chsli.org