HealthWorks: Winter 2019

HealthW ks WINTER 2019

HEALTHY SLEEP HABITS TREATING HEART DISEASE BEFORE IT HAPPENS

GET MOVING IN 2019

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LETTER FROM THE PRESIDENT & CEO

To our community:

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ust as individuals approach the New Year by making resolutions for change and improvement, so do organizations. At Montefiore Nyack Hospital, we look forward to opportunities 2019 will bring, maintaining our resolve to offer our community the very best in quality comprehensive health-care services.

In this issue of Health Works, several of our medical professionals share their insight to developing habits and making choices that will lead to long-lasting health benefits. Whether it is maintaining age-appropriate weight, getting enough sleep or scheduling an annual checkup, your proactive attention to your health will benefit both you and your family.

We encourage you to take full advantage of the numerous resources offered by Montefiore Nyack Hospital and our community health and human service providers. Together we can make a positive difference in the health and wellbeing of our community and its members.

HIGHLAND MEDICAL, P.C., OFFERS SAME-DAY APPOINTMENTS WITH PRIMARY CARE PHYSICIANS. ACCESS CARE WHEN YOU NEED US AND WHERE YOU NEED US. HIGHLAND MEDICAL, P.C., THE TRUSTED NETWORK OF PHYSICIANS AND SPECIALISTS WHO HAVE BEEN PROVIDING CARE TO OUR COMMUNITY FOR YEARS, HELPS YOU AND YOUR FAMILY STAY HEALTHY. CALL 1-866-550-HMPC. FOR A COMPLETE LISTING OF PROFESSIONALS AND SPECIALTIES, VISIT HIGHLANDMEDICALPC.COM.

Wishing you a happy and healthy new year! Be well and remember— take care of yourself!

BEST REGARDS, MARK GELLER, MD PRESIDENT & CEO MONTEFIORE NYACK HOSPITAL

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EDITORIAL STAFF Lauren Malone, Director of Public Relations and Marketing Rose McAllister Croke, Marketing Manager Briana Puncar, Marketing Manager, Highland Medical, P.C. Celia Vimont, Contributing Writer

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IN THIS ISSUE

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DETECTING HEART DISEASE EARLY Precision testing helps doctors treat heart disease sooner.

A SECOND CHANCE AT WEIGHT LOSS A new procedure gives surgical patients another opportunity to shed excess pounds.

PERIPHERAL ARTERY DISEASE Catch this potentially dangerous disease early to avoid surgery.

MULTIPLE SCLEROSIS New treatments offer patients new hope.

6 HEALTHY SLEEP HABITS Improve your health and performance through better sleep.

8 COLORECTAL CANCER SCREENING Don’t avoid this exam: It can save your life.

ROCKLAND COUNTY’S ONLY TRAUMA CENTER VERIFIED AS A LEVEL III TRAUMA CENTER

12 GET MOVING Tips for starting an exercise program from an orthopedic sports medicine surgeon.

15 WINTER SAFETY The Medical Director for Emergency Medicine offers his tips to help keep kids safe this winter.

Montefiore Nyack Hospital’s Trauma Center, the only trauma center in Rockland County, has been recognized by the American College of Surgeons’ Committee on Trauma for Outstanding Commitment to Critical Care.

The Trauma Center at Montefiore Nyack Hospital has been verified as a Level III Trauma Center through 2019 by the Verification Review Committee, an ad hoc committee of the Committee on Trauma of the American College of Surgeons. The Hospital’s Trauma Center treats approximately 800 individuals annually. It received this recognition for its commitment to meeting the ACS’ rigorous standards by demonstrating an ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients, and emergency operations.

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EARLY DETECTION OF HEART DISEASE CAN

KEEP YOU HEALTHY NEW PRECISION TESTING ALLOWS DOCTORS TO IDENTIFY PATIENTS AT RISK OF HEART DISEASE SOONER, WHEN TREATMENTS CAN HELP MAINTAIN HEALTH.

For more information about heart-disease screenings or to make an appointment with a cardiovascular specialist at Highland Medical, P.C., Advanced Cardiovascular Care, call 845-268-0880 or visit highlandmedicalpc.com.

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TOP TIPS TO AVOID HEART DISEASE

PICTURED FROM LEFT TO RIGHT: DAVID SOUTHREN, MD, FACC; JARED S. CORRIEL, MD, RPVI, FACC; AND DUANE BRYAN, MD, FACC.

We asked the experts at Highland Medical, P.C., Advanced Cardiovascular Care for their advice on the best ways to keep your heart healthy. Here’s what they said.

“Keep a positive attitude, walk 30 minutes every day, eat lots of vegetables and salads, and you just cut your risk of a cardiac event during your lifetime greatly.”

– David Southren, MD, FACC

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ntil recently, it has been difficult for doctors to determine which patients may develop heart disease years from now, and prevent it from occurring. But now, cardiologists are using tests that can help them pinpoint patients who already are developing atherosclerosis— hardening and narrowing of the arteries—years before they display symptoms. This means they can be treated before they become ill.

It can be difficult to detect early heart disease because it is clinically silent—it doesn’t cause obvious health problems that can be seen.

Today, doctors are taking a much more sophisticated approach to assessing a person’s risk factors for heart disease— such as diabetes, high blood pressure and high cholesterol—and more aggressively treating them. Doctors no longer wait until a person’s blood pressure or lipid levels become very high before they start treatment. They now have more exact ways to evaluate a person’s individual risk for heart disease.

When a person has risk factors, their doctor can refer them to a cardiologist for further testing. These tests include a coronary calcium scan—a CT scan that takes pictures of the arteries to check for calcified plaque in the arteries—and a CT angiogram, which uses X-rays to provide detailed pictures of the heart and the blood vessels to look for disease.

The American Heart Association

recommends the following heart-health screening tests: • BLOOD PRESSURE: High blood pressure greatly increases your risk of heart disease and stroke. Your blood pressure should be checked at each regular healthcare visit or at least once every two years if your blood pressure is less than 120/80 mm Hg. If your blood pressure is higher, your doctor may want to check it more often.

• CHOLESTEROL: A fasting lipoprotein profile should be taken every four to six years, starting at age 20. This is a blood test that measures total cholesterol, LDL (bad) cholesterol and HDL (good) cholesterol. Your doctor may recommend more frequent testing if you have elevated risk for heart disease and stroke.

• WEIGHT/BODY MASS INDEX (BMI): Your weight should be checked during your regular healthcare visit. Being obese puts you at higher risk for health problems, such as heart disease, stroke, atrial fibrillation and congestive heart failure.

• BLOOD SUGAR: High blood sugar levels put you at greater risk of developing type 2 diabetes. Untreated diabetes can lead to many serious medical problems including heart disease and stroke. Your blood sugar (glucose) should be tested at least every three years. The American Diabetes

“Maintaining a healthy and balanced diet will help reduce your risk of heart disease.

Increasing your intake of nuts has been linked with lower rates of cardiovascular disease. Other studies showed similar benefits with consumption of at least two servings per week of fish (non-shellfish).”

– Jared S. Corriel, MD, RPVI, FACC

“150 minutes per week of moderate exercise is recommended, but any exercise is better than none.”

– Duane Bryan, MD, FACC

Association recommends testing for prediabetes and risk for future diabetes for all people beginning at age 45 years.

If tests are normal, the doctor may repeat testing at a minimum of three-year intervals.

• DISCUSS SMOKING, PHYSICAL ACTIVITY, DIET: You should talk with your doctor about these at each regular healthcare visit. If you smoke, ask for help in quitting.

“Talk to your doctor about your risk factors for heart disease,” says David Southren, MD, FACC, Chief of Cardiology at Montefiore Nyack Hospital. “The earlier you treat them with lifestyle changes and/or medications, the greater the chance you’ll live a longer, healthier life.”

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DEVELOP HEALTHY SLEEP HABITS LET 2019 BE THE YEAR YOU START GETTING THE SLEEP YOUR BODY NEEDS FOR PEAK HEALTH AND PERFORMANCE.

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leeping is a lot harder than it used to be. There’s so much to be done, with countless distractions and not enough hours in the day. Unfortunately, people often make time for other activities by cutting back on sleep. That decision can have negative effects on your health and well-being, says Montefiore Nyack Hospital Sleep Medicine Specialist Anita Bhola, MD. “Sleep is the time when repair and restoration of the body and brain take place,” says Dr. Bhola. Adults require at least seven hours of sleep per day to promote optimal mental and physical health, while teens need 8 ½ to 9 ½ hours. Younger children need as much as 10 hours.

Dr. Bhola notes that there’s a culture of “sleep machoism” in the corporate world. “You’re thought to be less productive if you get a full night’s sleep,” she says. “The reality is that lack of sleep, by affecting memory, concentration and clarity of thought, also impacts performance and success.”

For children and teens, sleep promotes learning, memory, brain development and mental and physical health (including growth in children). “Teens are often the most sleep deprived of all age groups as

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their schedules are packed, their biological clocks are delayed, they have terrible sleep habits and they have early school start times,” says Dr. Bhola. “That means their academic performance can suffer.” Sleep deprivation in teens can be associated with learning issues, behavioral issues such as impulsivity, mental health problems, increased use of stimulants and a higher rate of addiction and substance abuse.

Recurring sleep deprivation can have a serious effect on your health, says Dr. Bhola. Chronic lack of sleep contributes to many chronic health conditions, including diabetes, hypertension, heart disease and obesity. Not getting enough sleep also can affect a person’s mood, leading to irritability, anxiety, problems with relationships and depression.

If you feel sleep deprived or have questions about sleep medicine, call the Edythe Kurz Center for Sleep Medicine at Montefiore Nyack Hospital at 845-348-2209 for an evaluation and treatment options. Learn more at montefiorenyack.org/sleep-medicine.

HOW TO GET ENOUGH SLEEP For the best sleep, Dr. Bhola recommends that you: • Go to bed and get up at the same time every day, even on weekends.

• Establish a nighttime routine to help your body settle down for the night. Choose relaxing activities, such as reading a book (not related to work) or taking a warm bath.

• Sleep in a cool, quiet, dark room on a comfortable, supportive mattress.

• Exercise regularly.

• Avoid nicotine and alcohol late in the day.

• Manage stress about what tomorrow will bring by writing a “to-do” list before you go to bed.

• Do some light stretching, deep breathing, yoga or meditation before bedtime.

• Try to get away from screens an hour or two before bed.

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GETTING A SECOND CHANCE AT WEIGHT LOSS THANKS TO A NEW PROCEDURE, ONE PATIENT IS ABLE TO START LOSING EXCESS POUNDS AGAIN.

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alerie, a nurse working for Montefiore Health System, had weight-loss surgery called gastric bypass in 2009, which helped her shed pounds. After she started gaining weight again, she had another procedure in which an adjustable band, designed to restrict food intake, was placed around the top part of the stomach.

Several years ago, Valerie started having regular nausea and vomiting, caused by the band slipping out of place. She consulted Jonathan Arad, MD, FACS, a bariatric surgeon at Montefiore Nyack Hospital, who took the band out in July. He performed a procedure called overstitch gastric bypass revision surgery the following month.

“After gastric bypass, the connection between the stomach and small bowel may stretch out,” explains Dr. Arad. “Instead of being the size of a dime, it can stretch to the size of a half-dollar or more.” Patients no longer have the sensation that tells them to stop eating.

“The overstitch procedure retightens the connection without incisions or the complications of having to redo gastric bypass, which can be very risky,” says Dr. Arad. The overstitch procedure is done through an endoscopy, a non-surgical procedure in JONATHAN ARAD, MD, FACS which a flexible tube with a light and a

camera attached is passed through the mouth into the digestive tract.

The doctor first performs an endoscopy to check the stomach pouch size and the opening between the stomach pouch and the small intestines. Then, on another day, the surgeon uses the endoscopy to suture and retighten the entire stomach connection.

“It’s very safe and effective for getting people back on track to losing weight, with no incisions needed,” says Dr. Arad. Montefiore Nyack Hospital is one of the few hospitals in the area that has the equipment for this procedure, he notes.

The overstitch procedure takes about an hour, and most people go home the next day. Because there are no incisions, recovery is fairly quick, and generally involves some nausea for the first several days as the body adjusts. Valerie is thrilled with the results. “As soon as Dr. Arad took the band out, I stopped vomiting,” she says. In the month after the overstitch procedure, she has started to lose weight again. “I can see my pants are looser, my blood pressure is good and I’m getting back on track.”

For patients having weight-loss surgery for the first time, Dr. Arad recommends a newer procedure, gastric sleeve surgery, which permanently removes up to 85 percent of the stomach.

To schedule a consultation or for more information about surgical, non-surgical and endoscopic weight-loss solutions, call Dr. Jonathan Arad at 914-361-1835.

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COLORECTAL CANCER SCREENING CAN SAVE YOUR LIFE COLORECTAL CANCER IS THE SECOND LEADING CAUSE OF CANCER DEATH IN THE U.S. THE GOOD NEWS: CAUGHT EARLY, IT’S HIGHLY TREATABLE.

To find a gastroenterologist, please visit the Physician Finder at MONTEFIORENYACK.ORG.

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olorectal cancer screening saves lives. When adults get screened for colorectal cancer, the disease can be detected early at a stage when treatment is most likely to be successful.

Colorectal screening also can find and remove growths (polyps) inside the colon before they become cancerous, explains Yaron Langman, MD, a gastroenterologist at Montefiore Nyack Hospital.

Yet about one in three adults between ages 50 and 73—about 23 million people—is not getting tested as recommended. A national campaign called “80% by 2018” has been working to improve screening rates by reaching a goal of having 80% of adults aged 50 and older screened for colorectal cancer by the end of 2018 (the success of the campaign will not be known until 2020).

Dr. Langman explains that there are a variety of screening tests available. “In most cases, we recommend colonoscopy, which is considered the gold standard of colon screening,” he says. In colonoscopy, the doctor uses a flexible, lighted tube to look inside the entire colon. Samples of tissue may be collected for examination, or polyps may be removed. Most polyps are harmless, but some can eventually become cancerous. “Colonoscopy is extremely safe, and it allows us to find and remove polyps sooner,” Dr. Langman says. This test should be done every 10 years.

There are three other colorectal screening tests. If any of these tests are positive, a colonoscopy should be done.

• DNA STOOL TEST. This test looks for certain gene changes that are sometimes found in colon cancer cells.

It can find some colon cancers early, before symptoms develop, when they’re likely to be easier to treat. It should be done every three years.

• FLEXIBLE SIGMOIDOSCOPY. During this procedure, a doctor uses a flexible, lighted tube to look in the

rectum and lower part of the colon. It should be done every five years.

• HIGH-SENSITIVITY FECAL OCCULT BLOOD TEST. This test checks for hidden blood in stool samples. It should be done annually.

WHEN SHOULD SCREENING BEGIN? Most guidelines recommend adults with an average risk of colorectal cancer begin screening at age 50. Earlier this year, the American Cancer Society started recommending that screening begin at age 45, because a growing number of young adults have been found to have colorectal cancer. The reasons for the increase are not known, Dr. Langman notes.

People with a personal or family history of colorectal cancer or polyps are at higher risk of developing colorectal cancer. People with a long-term history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease) are also at higher risk. If you have any of these risk factors, talk to your doctor about when and how often you should undergo colorectal cancer screening.

Most insurance plans and Medicare pay for colorectal cancer screening for people who are age 50 years or older.

CAN COLORECTAL CANCER BE PREVENTED? Some research suggests that lifestyle modifications such as stopping smoking, exercising regularly, increasing dietary fiber and eating less red meat may lower the risk of colorectal cancer. But the best way to prevent colorectal cancer is to undergo recommended screening tests, Dr. Langman advises. “There are many options for colorectal cancer screening,” he says. “With so many options, there’s no reason to avoid it.”

“The best way to prevent colorectal cancer is to undergo recommended screening tests.”

RISK FACTORS FOR COLORECTAL CANCER There are a few factors that put you at increased risk for colorectal cancer. Some of them, like your age or family history, you can’t control. But here are a few factors you can influence.

WEIGHT: Excess weight and larger waistlines increase risk. Work to reach or maintain a healthy weight.

ACTIVITY: Regular exercise reduces risk. A half hour of moderate physical activity (brisk walking, swimming, mowing the lawn) five days a week is recommended.

DIET: Eat more vegetables, lean proteins, fruits and whole grains. Eat fewer red and processed meats, such as hot dogs.

THE SCOOP ON PREPARATION In order to detect polyps, doctors need to get a clear view, which means the colon has to be emptied. While that used to mean drinking a large amount of unpleasant liquid in a short time frame the night before the procedure, today the process is far easier. Now, you can drink about half of the bowelclearing liquid the night before, and the remaining dose about six hours prior to the colonoscopy. Planning to be home during this time will, of course, ensure you’re as comfortable as possible.

Yaron Langman, MD

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PERIPHERAL ARTERY DISEASE:

CATCH IT EARLY TO AVOID SURGERY

THIS SERIOUS, SOMETIMES SYMPTOMLESS CONDITION INCREASES AN INDIVIDUAL’S RISK OF HEART ATTACK AND STROKE.

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eople who have pain in their legs while they walk may be suffering from peripheral artery disease (PAD). This condition occurs when the arteries to the arms and legs narrow because of a build-up of fatty and calcified deposits. PAD is often a sign of a more widespread accumulation of disease in the arteries that may be reducing blood flow to the heart and brain, according to Sean Wengerter, MD, RPVI, an attending vascular surgeon at Montefiore Nyack Hospital.

PAD is more common in older people. According to the American

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tightness. The pain goes away when a person rests. “For the vast majority of patients, that is their only symptom,” says Dr. Wengerter. Pain is most common in the calf and foot. It also can occur in the thigh and buttocks, which may be a sign of more severe disease in the arteries in the patient’s abdomen.

More severe PAD can cause leg pain that interferes with walking. “Some people experience pain when walking one or two blocks,” he says. In the most severe cases, a person can only walk a few feet before they have to stop to allow the blood flow to catch up with the needs of the muscles. Some people with severe PAD find their leg pain is worse when they elevate their legs.

They resort to sleeping with their legs dangled over the side of the bed.

If severe PAD goes untreated, it may lead to limb loss. “In these cases, the blood flow is so diminished it can’t support tissue in the legs,” says Dr. Wengerter. “The tissue begins dying off, and patients can develop wounds that are difficult to heal or will never heal without surgery.”

DIAGNOSIS AND TREATMENT

Heart Association, it affects about 8.5 million Americans over age 40.

“The risk factors for PAD are the same as those for heart disease, including obesity, high blood pressure and high cholesterol,” says Dr. Wengerter. “The risk is especially high for diabetics and smokers.”

SYMPTOMS OF PAD Symptoms can range from mild to severe. Mild symptoms start with leg pain, known as claudication, felt when a person is walking. People with PAD describe the pain as cramping or muscle

To diagnose PAD, the doctor will conduct a physical exam and discuss your symptoms. If warranted, the doctor may conduct a test called ankle-brachial index (ABI). This compares the blood pressure in your ankle with the blood pressure in your arm. “It should be almost equal,” says Dr. Wengerter. You may walk on a treadmill and have blood pressure readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking. Based on this initial evaluation, your doctor also may order additional tests such as an ultrasound, CT scan or angiogram to detect the severity and location of a blockage or narrowing in the arteries.

PAD often can be successfully controlled with medical therapy, quitting tobacco, eating a healthy diet, exercising and taking medicine to control diabetes, high blood pressure and high cholesterol. People with PAD often are advised to take aspirin to prevent acute worsening or thrombosis

of the diseased arteries.

If these steps do not control PAD, the doctor may recommend an endovascular therapy or a bypass surgery. Endovascular therapies are minimally invasive and can often be performed as a same-day or outpatient procedure. They may include one or more of the following procedures: • Angioplasty to widen or clear blocked arteries • Angioplasty with stent placement to keep open the cleared artery • Atherectomy to remove or cut away the blockage If the patient’s disease is not amenable to endovascular therapy, the surgeon may recommend peripheral artery bypass surgery to reroute blood flow around the blockage. Vascular surgeons are the only specialists able to offer both treatment options.

“In bypass surgery, we take a vein from the leg and attach it to the arteries above and below the blocked area to bypass it so blood can get to the lower leg,” says Dr. Wengerter. Patients usually spend a day or two in the hospital.

“Our goal is to identify patients early enough that they can treat their disease by modifying their risk factors without needing surgery,” says Dr. Wengerter.

“We want to prevent the disease from reaching that level of severity.”

Patients with PAD, severe leg pain or non-healing ulcers should see a vascular surgeon, says Dr. Wengerter.

These specialists can offer the most appropriate therapy, whether it be nonsurgical, endovascular or open bypass surgery.

“For patients who have severe disease and medical therapy is not enough, we want to be involved early so we can save their extremities,” says Dr. Wengerter. “Limb loss is a devastating result of severe PAD. Thankfully, this is often avoidable if we, as vascular surgeons, see patients early.”

Visit the Physician Finder at MONTEFIORENYACK.ORG to find a vascular physician.

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GET MOVING:

TIPS FOR STARTING AN EXERCISE PROGRAM

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f you’re not exercising regularly, kick off 2019 with a new physical fitness routine.

To have the best shot at sticking with it, keep your exercise schedule and goals realistic, says Barry S. Kraushaar, MD, an orthopedic sports medicine surgeon at Montefiore Nyack Hospital. “The first two to three weeks are the hardest for many people,” he says. “It’s easy to find excuses that derail your plans. But if you keep it up for a few weeks, you’re more likely to start seeing results, which keeps you motivated.”

Some people have the opposite problem—they become so enthusiastic about their new exercise BARRY S. KRAUSHAAR, MD

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routine that they go overboard. The result can be injuries. “I see patients who overdo it, especially with upper body exercises, from raising weights over their head or lifting weights that are too heavy for them,” he says. “The old phrase ‘no pain, no gain’ doesn’t apply anymore. When you’re starting out, use lighter weights and do more repetitions instead of using heavy weights.”

HOW MUCH IS ENOUGH? The Centers for Disease Control and Prevention says that for substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) of exercise a week. Try starting with 30 minutes per session. Or if you don’t have enough time, break it up into two 15-minute sessions during the day. But if you feel you can’t do that much, do as much as you can, advises Dr. Kraushaar. “Ten minutes is better than nothing,” he says. “Once you get started, you

can look for more ways to fit exercise into your schedule.”

WHAT KINDS OF EXERCISE SHOULD I DO? To get the best results, do a mix of aerobic conditioning, flexibility exercises and strength training.

• Aerobic exercise: Try walking, jogging or biking, or use a rowing machine, stair-climber or treadmill.

• Flexibility exercises: Do stretches for both your upper and lower body at the end of every exercise session. Yoga and Tai Chi can help you become more flexible.

• Strength training: Work out with free weights or weight machines, or do exercises that use your own body weight, such as push-ups.

DON’T GO IT ALONE Dr. Kraushaar recommends exercising with a friend to help you stay motivated and on

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DO MORE FOR YOUR CORE These three exercises will strengthen your core, the muscles around your back, abs and pelvis. A strong core helps keep the body stable during daily activity and exercise, reducing injury risk. It also can minimize everyday strain on the back.

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LEG PULL

Sit with back straight, abdominal muscles tightened and legs outstretched. Lean back on your hands, then lift hips off the ground so your body forms a straight line.

Lift one leg up and bring toward your face, keeping it straight and pointing your toes. As you lower your leg almost to the floor, bend your ankle.

Repeat three times with one leg, then switch to the other. Add more repetitions as you’re able.

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SIDE PLANK

Lie on your right side, resting on your forearm, which should face forward. Position your elbow directly below your shoulder. With legs straight and feet stacked, tighten your abdominals and raise up off your hip. (Use your free hand to help if needed.) Raise your free hand. Keeping your back straight and abdominals tight, hold for 10–30 seconds to start, increasing as you’re able. Repeat three times. Repeat on the left side.

track. He also encourages his patients to have a few sessions with a personal trainer who can show them how to exercise safely.

“You don’t need to have a personal trainer long-term,” he says, “but it’s very helpful to have one set up an exercise routine for you, which you can then do on your own.”

He also suggests joining a gym that provides a range of exercise machines and equipment. “Some gyms have a very low monthly fee, which is worth it because you have access to expensive treadmills, rowing machines and elliptical machines,” he says.

Many gyms also offer personal training sessions to get you started.

Dr. Kraushaar sees the difference an exercise program can make. “A recent patient was heavy and had a bad knee,” he recalls.

“After I performed knee surgery, she changed her diet and committed to a program of total body conditioning. She now trains other people. She looks younger and feels great.

She’s a new woman.”

CLASSIC PLANK

Start in a modified push-up position, with elbows bent, positioned directly below shoulders, and forearms forward. Look down at the floor. Tighten abdominal muscles and flatten your back so your body forms a straight line from the crown of your head to your heels. Keep feet together. Hold for 10–30 seconds to start, increasing as you’re able. Repeat three times.

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MULTIPLE SCLEROSIS: NEW TREATMENTS OFFER HOPE NEW RESEARCH HAS LED TO A BETTER UNDERSTANDING OF MS AND MORE OPTIONS FOR PATIENTS.

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he number of approved treatments for multiple sclerosis (MS) has increased rapidly in recent years. The first drug for a type of MS called primary progressive MS was approved by the Food and Drug Administration last year. At the Madlyn Borelli Multiple Sclerosis Center at Montefiore Nyack Hospital, MS patients have access to all of the latest treatments. Experts at the center match each patient with the best treatment for their condition, says Jai Perumal, MD, Director of the MS Center.

“We provide highly specialized, comprehensive, expert care that’s accessible to the Rockland County and neighboring communities,” she says. “It’s gratifying to be able to offer patients these options.” The MS Center treats newly diagnosed patients and those who have lived with the disease for many years, giving them access to the best treatments to manage their symptoms.

WHAT IS MULTIPLE SCLEROSIS? Multiple sclerosis is thought to be an autoimmune disease, meaning that the body, through its immune system, attacks its own tissues. In people with MS, the immune system attacks the myelin coating around nerve fibers in the central nervous system. This interferes with the transmission of nerve signals

between the brain, spinal cord and the rest of the body, causing symptoms that often include muscle weakness in arms and legs and difficulty with coordination and balance. Most people with MS also have feelings of fatigue, as well as numbness, prickling or “pins and needles” sensations.

The cause of MS is unknown. In some people, MS can be relatively benign, while in others it is somewhat or severely disabling.

MS often first appears between the ages of 20 and 40.

TREATING MULTIPLE SCLEROSIS There are a number of therapies that slow MS. “They don’t fix the symptoms you already have, but they prevent the disease from getting worse,” says Jennifer Reardon, NP, Certified Multiple Sclerosis and Neuroscience Registered Nurse at the MS Center.

In addition to medication, there are important lifestyle modifications patients can make to improve their quality of life, including reducing fatigue and stress. “Exercise is very important for people with MS,” says Reardon. “We encourage people to find something to do that keeps them moving, such as swimming, yoga or Pilates. With so much research going on today in MS, our goal is to keep patients as healthy as we can until a cure is found.”

For more information about the services provided at the Madlyn Borelli Multiple Sclerosis Center at Montefiore Nyack Hospital, call 845-348-8800 or visit MONTEFIORENYACK.ORG/MULTIPLE-SCLEROSIS.

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3 TIPS TO KEEP KIDS SAFE THIS WINTER

AN EMERGENCY MEDICINE PHYSICIAN SHARES ADVICE TO HELP KEEP CHILDREN OUT OF HARM’S WAY WHEN THE WEATHER TURNS COLD.

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inter brings many wonderful opportunities for outdoor play.

Use our simple safety tips to keep your kids safe while they have fun.

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SLED SAFELY

There’s nothing better than sledding down a fresh layer of snow. Help children do it safely by teaching them to stay away from roadways. “Unfortunately, every year we see kids who have been hit by a vehicle because they were sledding in an area where traffic couldn’t see them,” says Jeffrey Rabrich, DO, Medical Director of Emergency Medicine at Montefiore Nyack Hospital. “Don’t just send them out— supervise them. Make sure they aren’t sledding anywhere near trees, poles or other fixed objects.”

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PLAY SMART IN THE COLD

Be aware of how much time kids are outdoors on cold days. “Frostbite occurs more quickly in children than in adults,”

says Dr. Rabrich. “Don’t lose track of time when they’re outside in cold weather,” he adds, “and avoid long exposure to cold (no more than 15 or 20 minutes at a time), especially when it’s windy—cold wind increases the risk of frostbite.”

Frostbite happens when the skin and outer tissues become frozen. It tends to occur on extremities like the fingers, toes, ears and nose. If a child starts having pain in the fingers, face or earlobes, it may be a sign of “frostnip”—a precursor to frostbite. The skin may start turning red and painful. “That’s a sign to get out of the cold and warm up before the problem becomes more serious,” says Dr. Rabrich.

If the skin has become numb and white, it’s an indication that frostbite is setting in.

Full-blown frostbite can cause permanent damage to the skin.

At the first sign of frostnip, go inside.

Immerse the affected areas in lukewarm water. “Don’t just warm up a little and then go right back outside,” says

Dr. Rabrich. “Make sure you plan adequate recovery time.”

In addition to limiting time outside in the cold, dress children in layers and keep as much of their bodies covered as possible to help prevent frostbite. Always remember warm boots, mittens and a hat.

3

MONITOR INDOOR AIR

One of the most important things you can do to keep your kids safe this winter is check your carbon monoxide detector—or install one if you don’t already have one. Each year, 20,000 to 30,000 people in the United States are sickened by accidental carbon monoxide poisoning, and approximately 500 people die, many in their own homes. Carbon monoxide is an odorless, colorless gas. It cannot be detected by humans without the help of a detector. Carbon monoxide detectors sound an alarm when they sense a certain amount of carbon monoxide in the air over time.

M O N T E F I O R E N YA C K . O R G

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160 North Midland Avenue Nyack, NY 10960

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ANNUAL GOLF CLASSIC TO BENEFIT MONTEFIORE NYACK HOSPITAL

MONDAY MAY 13, 2019 FOR MORE INFORMATION, CALL 845-353-3333

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