Nyack Fall 2023

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TASTY, HEALTHY

FALL RECIPES LEARN ALL

ABOUT GOUT GOODBYE PAIN,

HELLO NEW HIPS

SCREENING GUIDE FOR DENSE BREASTS

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The Breast Center at Montefiore Nyack Hospital Earns National Accreditation for High-Quality Care and Treatment

Montefiore Nyack Hospital Updates FROM THE PRESIDENT Dear Readers, As we shift into back-to-school mode and look ahead to a busy holiday season, now is a good time to assess and prioritize your health. With autumn nearly here, we know the cold and flu season is not far behind. Before the weather gets colder and the days get shorter, it is important to plan ahead and schedule an appointment for a flu shot with your primary care provider (PCP). The flu vaccine is recommended for anyone 6 months and older not severely allergic to its components, including eggs and gelatin.

If you do not currently have a PCP, there are excellent reasons to find one. A PCP can advise you on the many ways to maintain your health, treat you when you’re sick and help you access more advanced care when needed.

Our Highland Medical Group has primary care locations throughout Rockland County and also offers a wide range of specialty services and programs.

Embracing a healthy lifestyle requires commitment and starts with making smart decisions like finding and seeing a PCP if you have not already. At Montefiore Nyack Hospital, we offer educational community programs to help you on your journey to a healthier way of living. It is never too late and you are never too old to prioritize your health. We stand ready to assist you along the way.

Wishing you a happy and healthy fall,

Mark Geller, MD President and Chief Executive Officer

The National Accreditation Program for Breast Centers (NAPBC), a quality program administered by the American College of Surgeons (ACS), has granted accredited status to The Breast Center at Montefiore Nyack Hospital. This accreditation is the hallmark of excellence for breast centers.

To achieve voluntary NAPBC accreditation, a breast center must demonstrate compliance with the NAPBC standards that address a center’s leadership, clinical services, research, community outreach, professional education and quality improvement initiatives.

Patients receiving care at The Breast Center at Montefiore Nyack Hospital have access to:

•C omprehensive care, including a full range of state-of-the-art services • Genetic counseling •A multidisciplinary team approach to coordinate the best treatment options

• Information about ongoing clinical trials and new treatment options • Rehabilitation services and survivorship care

Montefiore Nyack Hospital Receives Gold Plus Stroke Honor Roll Recognition from American Heart Association Montefiore Nyack Hospital has received the American Heart Association’s Gold Plus Get With The Guidelines® - Stroke quality achievement award for ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines, ultimately saving more lives and reducing disability.

“Our stroke team is committed to continually improving patient care outcomes by adhering to the latest treatment guidelines,” said Anthony Matejicka, DO, MPH, Vice President and Chief Medical Officer. “Get With The Guidelines provides proven best practices that we implement daily, which studies show can enhance patient recovery timeliness and reduce long-term needs.”

Montefiore Nyack Hospital was also recognized as among the first hospitals to expand focus on caring for patients who have suffered hemorrhagic stroke by participating in the American Heart Association’s Hemorrhagic Stroke Initiative. Additionally, Montefiore Nyack Hospital earned The Joint Commission’s Gold Seal of Approval® and the American Stroke Association’s Heart-Check mark for Stroke Certification.

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EDITORIAL STAFF Lauren Malone, Assoc. VP, PR and Marketing Rose Croke, Director of Communications Briana Tolve, Marketing Manager Jasmine Gonzalez, Marketing Coordinator Celia Vimont, Writer

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IN THIS ISSUE

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Lifestyle changes and medications can help control polycystic ovary syndrome.

These tasty and nutritious dishes take full advantage of your favorite fall produce.

Expert medication management ensures better health.

EMPOWERING WOMEN AGAINST PCOS

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DENSE BREASTS: A GUIDE TO SCREENING

Advanced options can help detect cancer early in higher-risk women.

HEALTHY HARVEST RECIPES

PHARMACISTS: A VITAL PART OF YOUR CARE

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TAKE ‘MINISTROKES’ SERIOUSLY

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LIFE IS GOOD AFTER TWO HIP REPLACEMENTS

Warren Clendenny is once again walking, working and sleeping pain-free thanks to robotic-assisted surgery.

Having a brain attack—however small—means you’re at high risk of another and need preventive care.

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ALL ABOUT GOUT

Treatment can help people with this common joint condition live pain-free.

HONORING OUR 2023 PHYSICIANS OF THE YEAR Montefiore Nyack Hospital proudly recognized Azfar Chak, MD, and David Hodes, MD, as its 2023 Physicians of the Year for their medical expertise and longtime commitment to patient care.

In 2009, Dr. Chak began his medical career as an infectious disease specialist at Montefiore Nyack, where he now serves as the Chief of Infectious Disease. Throughout the COVID-19 pandemic, Dr. Chak navigated uncharted waters and served on many COVID-19 advisory boards for local community organizations. Dr. Hodes is a board-certified attending physician with subspecialties in critical care and pulmonary disease. He practices at Palisades Primary Care and Pulmonary Medicine in West Nyack.

We congratulate and thank Dr. Chak and Dr. Hodes for their dedication to their profession and service to our community.

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

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EMPOWERING WOMEN AGAINST

PCOS

LIFESTYLE CHANGES AND MEDICATIONS CAN HELP CONTROL THE COMPLEX HORMONAL IMBALANCES OF POLYCYSTIC OVARY SYNDROME.

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n estimated 10 percent of women of childbearing age have a health condition known as polycystic ovary syndrome (PCOS) in which hormonal imbalances and metabolism problems may affect their overall health, appearance and fertility.

PCOS is linked to a cascade of health problems that includes prediabetes and diabetes; high blood pressure and cholesterol; depression and anxiety; and endometrial cancer.

Prediabetes can develop because women with PCOS often have high insulin levels due to insulin resistance, a condition in which the body’s cells do not respond normally to insulin, explains Christos Paras, DO, a clinical endocrinologist with Highland

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Medical Endocrinology, Diabetes and Metabolism in Nyack. “In 70 percent of women with PCOS, treating this insulin resistance with diet, physical activity and sometimes medication can help manage all their PCOS symptoms,” Dr. Paras says.

For example, better management of insulin metabolism can also help address a PCOS-related imbalance of male and female hormones that interferes with menstruation. “In many cases, treating the insulin resistance can resolve problems with a woman’s periods and fertility,” Dr. Paras says.

RISK FACTORS While PCOS can happen at any age after puberty, many women find out they have the condition in their 20s and 30s when they have problems getting pregnant.

Women are at higher risk for PCOS if they have a mother or sister with PCOS or have obesity.

The exact cause of PCOS is not known, but it is clear that several factors are involved. These include high levels of male hormones called androgens.

Women normally make small amounts of androgens, but those with PCOS have more than normal. This can not only interfere with a woman’s menstrual cycle but also cause extra hair growth and acne.

Insulin resistance is especially common in women who are overweight or obese, have unhealthy eating habits, do not get enough exercise and have a family history of diabetes.

DIAGNOSING PCOS Doctors can determine whether you have PCOS using a variety of methods. In addition to a general physical exam, these may include: • Pelvic exam to look for signs of extra male hormones and check if ovaries are enlarged or swollen • Sonogram to check your ovaries for cysts and inspect the endometrium (lining of the uterus, or womb) • Blood tests to check androgen hormone levels and test for diabetes

TARGETED TREATMENT While there is no cure for PCOS, you and your doctor can choose from a variety of treatments depending on your age, plans

for having children and risks for longterm health problems such as diabetes and heart disease. Many women receive a combination of therapies. “Treatment depends in large part on a woman’s stage of life,” Dr. Paras says. “Is she trying to start a family or is she more concerned with her appearance? Questions like these help inform treatment choices.”

The first step is often to treat insulin resistance. “We start with a healthy diet and exercise,” Dr. Paras says. “The diabetes medication metformin is also often used to treat Type 2 diabetes and can help some women with PCOS by lowering both insulin and androgen levels.

It can restart a woman’s period.”

Because metformin can increase fertility, women who don’t want to become pregnant need to be on birth control, he says. Women with PCOS who do want to become pregnant can often restore fertility with metformin. “If that doesn’t work, then they can move on to other fertility drugs to stimulate ovulation,” Dr. Paras says.

If treating insulin resistance does not restart a woman’s menstrual cycle, then hormone birth control such as birth control pills can be used. “It’s important for a woman to have regular periods to lower the risk of endometrial cancer,” Dr. Paras says. Hormone birth control can also help improve acne and reduce extra hair on the face and body.

Some women are prescribed anti-androgen medicines to help reduce scalp hair loss, facial and body hair growth, and acne. These medicines can cause problems during pregnancy, so women should use birth control while taking them.

“By discussing her priorities, a woman and her doctor will develop a PCOS treatment plan that keeps her healthy, manages symptoms and takes into account her family-planning goals,” Dr. Paras says.

If you are experiencing symptoms of polycystic ovary syndrome and would like to schedule an appointment, please call 845-897-8371.

SYMPTOMS TO WATCH FOR Some women with PCOS don’t have any symptoms and only find out they have the disease when they try unsuccessfully to get pregnant or gain weight for unknown reasons. Symptoms that do occur can include: • Irregular menstrual cycles, which can lead to fertility problems and development of cysts on the ovaries • Too much hair on the face, chin or parts of the body where men usually have more hair • Acne on the face, chest and upper back • Thinning hair or hair loss on the scalp • Weight gain or difficulty losing weight • Darkening of skin, particularly along neck creases, in the groin area and underneath breasts • Skin tags—small excess flaps of skin in the armpits or neck area

Scan the code for more information about endocrinology at Highland Medical.

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

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DENSE BREASTS: A GUIDE TO SCREENING

ADVANCED OPTIONS HELP ENSURE THAT CANCER IS DETECTED EARLY IN HIGHER-RISK WOMEN.

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omen with dense breasts have a higher risk of breast cancer.

Yet having dense breasts is a very common and normal characteristic of breast tissue. It’s also a feature you cannot change.

“When you get a mammogram, the report you receive SUNNY D. MITCHELL, will mention MD, FACS

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“If a mammogram shows you have dense breasts, talk with your healthcare provider about adding an ultrasound to your yearly screening.”

Sunny D. Mitchell, MD, FACS

whether your breasts are dense and, if so, how dense,” says Sunny D. Mitchell, MD, FACS, breast surgeon and medical director of The Breast Center at Montefiore Nyack Hospital. “This helps the radiologist determine if you may benefit from additional breast studies.”

WHAT ARE DENSE BREASTS? Breasts contain both fibrous and glandular tissue as well as fat. Breast density describes the amount of fibrous and glandular tissue compared

to the amount of fat. Dense breasts have more fibrous and glandular tissue than fatty tissue. For most women, breasts become less dense with age. But in some women, there’s little change over the years.

It’s unclear why dense breast tissue is linked to breast cancer risk. One factor may be that having dense breasts can make it harder to see signs of cancer on a mammogram. That’s why other screening methods may be recommended to supplement your mammogram if you have dense breasts.

WHAT TO DO “If a mammogram shows you have dense breasts, talk with your healthcare provider about adding an ultrasound to your yearly screening,” says Dr. Mitchell. “This test can be more effective than a mammogram at finding cancer in dense breasts.”

But getting an ultrasound because you have dense breasts doesn’t mean you should skip your yearly mammogram. The mammogram is still the gold standard in breast cancer screening, and most breast cancers can be seen on a mammogram even in women with dense breast tissue.

ADVANCED SCREENING OPTIONS In some cases, even more advanced screening methods may be called for.

The Breast Center at Montefiore Nyack Hospital offers a full range of breast cancer screening services. Our boardcertified, fellowship-trained radiologists have access to the most sophisticated technology to help detect breast

cancer at its earliest stages. These advanced tools include: 3D Mammography: Also known as 3D tomosynthesis, this type of mammography uses multiple X-rays to create a three-dimensional image of the breast. It’s the most advanced imaging for breast cancer detection at the lowest possible radiation dose. 3D mammography is more effective than 2D mammography at detecting cancers earlier. It also decreases the need for women to be called back for additional testing. This type of mammogram is very effective at spotting potential problems in women with dense breasts.

Breast Ultrasound: This test uses sound waves to make images. It’s used on its own or in combination with mammograms to provide additional detail about an area. Ultrasound can sometimes find cancers not seen on mammograms.

Breast MRI: Magnetic resonance imaging expands the ability to diagnose earlystage breast cancers that may not be visible on mammography or ultrasound.

It’s a highly sensitive exam that uses radio waves and powerful magnets to create detailed images of breast tissue.

Having an MRI added to an annual mammogram and ultrasound screening may benefit some women who have a strong family history of breast cancer, a breast cancer gene or other high-risk characteristics.

Learn more about your personal breast cancer risk and screening eligibility by taking our health quiz at www.breastcare.health/quiz.

To make an appointment for a screening, call 845-348-7579. For additional information, visit montefiorenyack.org/breastcenter.

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

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THESE TASTY AND NUTRITIOUS DISHES TAKE FULL ADVANTAGE OF YOUR FAVORITE FALL PRODUCE.

HEALTHY HARVEST RECIPES

Recipes by Sandra J. Arévalo Valencia, MPH, RDN, CDN, CDCES, CLC, FADA, Director of Community Health & Wellness at Montefiore Nyack Hospital

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TURKEY & PEARS Makes 4 servings If you’re looking for healthy ways to reimagine chicken breast or turkey, this recipe adds a whole new dimension of sweetness and juiciness to this favorite pantry staple. For added health benefits, use low-sodium or no-salt-added chicken broth or skip seasoning your cutlets with salt. For smaller families, this recipe is a great alternative to cooking a whole turkey for Thanksgiving.

INGREDIENTS: • 4 turkey or chicken cutlets (about 1 lb.)

• 2 tbsp. olive or canola oil • P inch of salt and pinch of pepper • 2 large firm pears, thinly sliced

• 1 cup chicken broth (low-sodium or no-salt-added) • 2 tsp. Dijon mustard • ½ tsp. dried tarragon • ¼ cup dried cherries or cranberries (optional)

DIRECTIONS: • Rinse cutlets and pat dry. Place on cutting board. If cutlets are very thick, split them in half lengthwise.

• Pour 2 tbsp. of oil into a pan. Heat on high for about one minute. While the oil is heating, lightly sprinkle both sides of the turkey with pepper and salt.

• Add turkey to the pan. Do not cover. Cook on medium high for 1 to 2 minutes. Turn the cutlets over and cook 1 to 2 minutes on the other side. Cutlets will NOT be fully cooked at this point.

• Add pears. Cover and continue cooking on medium high for 5 to 7 minutes.

• In a small bowl, add chicken broth, mustard, tarragon and cherries or cranberries, and stir well.

• U ncover and turn cutlets over. Add broth mix. Cook on medium high for 3 to 5 minutes, stirring occasionally until the sauce thickens slightly and the pears are soft. Meat is well cooked when it is no longer pink in the center and the juices run clear. Serve cutlets hot, topped with the sauce from the pan.

• For a perfect meal, you can accompany this dish with rice or garlic mashed potatoes and a salad.

ORANGE SWEET POTATOES Serves 4 Although called potatoes, the nutrients in sweet potatoes are very different from their more simplified counterparts. Sweet potatoes are full of fiber, potassium and vitamins A and C. They make a tasty side dish with any meal. Pairing them with fortified orange juice adds calcium and vitamin D to this recipe.

INGREDIENTS: • 1 tbs. olive oil or canola oil • 6 medium sweet potatoes (about 3 lb.), diced • 1 ½ cups orange juice • 1 ½ cups vegetable broth

• ¼ cup brown sugar • ½ tsp. cinnamon or allspice •½ tsp. salt

DIRECTIONS: • In a small bowl, mix orange juice, vegetable broth, sugar, cinnamon or allspice and salt.

Put aside.

• Add oil to a pot and warm to medium high. Add potatoes and sauté until golden brown.

• Slowly pour the juice mix into the pot to cover the potatoes. Cover and let it boil on medium high until potatoes are soft but firm.

• S erve warm, pouring sauce over potatoes. If desired, sprinkle potatoes with a touch of cinnamon for decoration.

For more information about Montefiore Nyack Hospital’s nutrition counseling program and diabetes education, call the Community Health Education Department at 845-348-2004.

AUTUMN BOUNTY SOUP Serves 4 Fall is the perfect season to go apple picking or carve a pumpkin. Often, we have so many apples and pumpkins left that we don’t know what to do with our bounty of seasonal favorites.

Fortunately, apple and pumpkin are the star ingredients for this creamy and healthy soup that is packed with flavor and rich in vitamins A and C, and fiber.

INGREDIENTS: • 1 tbsp. olive or canola oil • 1 cup yellow onion, diced • 1 tsp. garlic, minced • 4 cups pumpkin or butternut squash, peeled and diced • 4 medium apples, peeled, cored and diced • 3 cups vegetable broth • 1 tsp. ginger, grated • S alt and pepper to taste • Brown sugar DIRECTIONS: • Put the oil to warm on medium high in a deep pot. When warm add onions and mix until they soften. Add the garlic and sauté until golden brown.

• Add pumpkin and apples and sauté until golden brown. If you need to add more oil, add another teaspoon.

• Cover the ingredients with the vegetable broth, add ginger, salt and pepper and a dash of sugar.

• Lower the heat and let ingredients simmer until soft for about 30 minutes. Check the broth: If it’s drying, add an additional half a cup and continue adding broth and cooking until the pumpkin is soft.

• When the pumpkin is soft, to the point that you can soften it with a fork, remove it from the heat. Move the mix to a blender or use a hand mixer to create a smooth creamy soup.

• S erve soup at room temperature, or bring it back to the pot to warm up and serve it hot.

• For an elegant presentation, garnish each plate with a touch of cream, roasted pumpkin seeds and parsley.

If you are not a pumpkin lover or simply don’t feel like carving a pumpkin, you can use carrots instead.

Just add a little more ginger for a delicious, creamy carrot ginger soup.

The nutritional value of both versions is very similar.

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

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“It’s nice to walk pain-free again,” says Warren Clendenny, who had both hips replaced by Arup Bhadra, MD, Director of Orthopedic Robotics at Montefiore Nyack Hospital.

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LIFE IS GOOD

AFTER TWO HIP REPLACEMENTS WARREN CLENDENNY IS ONCE AGAIN WALKING, WORKING AND SLEEPING PAIN-FREE THANKS TO ROBOTIC-ASSISTED SURGERY.

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arren Clendenny had been dealing with pain in both of his hips for a long time. The 58-year-old had difficulty sleeping. His job as a demolition supervisor involves a lot of walking and stair climbing, and his hip pain was impacting his ability to move well at work. “I’m also a motorcycle rider,” says Warren, “and I had a lot of trouble getting my leg over the seat of the bike. I was walking with a limp.” An MRI revealed arthritis in both hips. “It was bone-onbone on both sides,” he says.

While researching hip replacement, Warren found the name of Arup Bhadra, MD, Director of Orthopedic Robotics at Montefiore Nyack Hospital. “Dr. Bhadra explained the whole process, and I felt very comfortable with him,” Warren says, adding that he appreciated Dr. Bhadra’s approach to deciding whether it was time for a hip replacement. “He gave me all the information I needed and told me the choice was mine.”

WHAT IS ROBOTIC HIP REPLACEMENT? For total hip replacement surgeries, Dr. Bhadra uses the MAKO Smart Robotics system.

The system can also be used for partial and total knee replacements. It uses a CT scan to create 3D images for an individualized surgical plan, including choosing a more precise implant for each patient. MAKO then acts as a

guiding tool for increased precision during surgery.

At Montefiore Nyack Hospital, a multidisciplinary team—hospitalist (a doctor who specializes in treating hospitalized patients), anesthesia team, physical therapist, community nursing and home care service—work together with the goal of putting patients back on their feet quickly and safely.

Beginning with the initial consultation, joint replacement patients receive education on the process, including preoperative preparation, postoperative instructions and physical therapy, all part of the program designed to support successful results.

During the procedure, patients are given pain medication that allows them to feel well enough to begin physical therapy within hours of surgery. Patients generally take their first steps within a few hours after surgery and are usually released from the hospital after one or two days. A physical therapist provides therapy at patients’ homes for the next two weeks.

To find an orthopedic surgeon, visit www.montefiorenyack.org/ joint-replacement/our-experts.

TWO SURGERIES IN FIVE MONTHS Warren had his first hip replacement on February 2. “Before the first surgery, Dr. Bhadra told me what to expect before and after,” Warren says.

“Everyone at the hospital was fantastic.

I woke up from the surgery, and they asked me if I wanted to get up and walk, and I said, ‘Yes!’” He stayed in the hospital one night and started physical therapy once he was home. “I was skeptical at first, but now I know physical therapy is a must-do. You strengthen your hip much more quickly than you otherwise would.”

Once Warren recovered from his first hip surgery, he was ready for his second. “My new hip felt great, and the old one was still aching,” he says. He had his second surgery on June 8. Two weeks later, Warren was sleeping well and walking pain-free. He says the pain during his recovery was minimal.

“Many patients are apprehensive about surgery,” Dr. Bhadra says, “but once they recover, many say, ‘I wish I had the courage to get the replacement done sooner. It’s nice to walk pain-free again.’”

Scan the code to discover the benefits of robotic surgery at Montefiore Nyack Hospital.

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

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medication and that they can get it at a pharmacy in the community. “It’s a whiteglove service,” Dr. Schiller says. “Our pharmacists are providing individualized attention to make sure there’s a seamless transition into and out of the hospital.”

TRAINING FUTURE PHARMACISTS

PHARMACISTS:

A VITAL PART OF YOUR CARE EXPERT MEDICATION MANAGEMENT ENSURES BETTER HEALTH, BOTH IN THE HOSPITAL AND AT HOME.

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hen patients come to Montefiore Nyack Hospital, pharmacists play a vital role in their care team. Pharmacists ensure that patients are taking the correct dose of the right medication while in the hospital and that patients are being sent home with the medication they need.

“Our pharmacists have doctoral degrees, with many years of training,” says Daryl Schiller, MS, PharmD, BCPS, FASHP, Pharmacy Director at Montefiore Nyack Hospital. “They’re licensed experts in medication and work closely with doctors, nurses, patients and families to make sure our patients have appropriate treatments with seamless care when they come into the hospital and when they leave.”

Pharmacists often make rounds with doctors seeing patients in the hospital, and many work on patient floors as well as in the main pharmacy.

TRACKING MEDICATIONS When a patient comes into the hospital, a member of the pharmacy staff will review the medications that the person was taking at home. For example, if someone with a chronic condition such as diabetes comes to the hospital for a traumatic injury, their diabetes medications may not be an issue but are still important to maintain.

“The pharmacy staff will make sure all of the home medications are accurate so the doctor can focus on the most critical issue,” Dr. Schiller says. “Some patients take medications in the hospital that need to be adjusted according to their condition. In these cases, the pharmacist may monitor blood levels of the medication to fine-tune treatment and find the balance between the drug being effective but not toxic.”

When a patient is discharged, the pharmacist makes sure they are going home with the right dose of each

Montefiore Nyack Hospital’s team of expert pharmacists takes pride in training the next generation of pharmacists. One key way they are doing so is through the hospital’s PGY-1 Pharmacy Residency Program. Each year, three pharmacy residents enroll in this one-year postgraduate residency program in pharmacy for graduates of pharmacy school. The program is designed to enhance a PharmD education, with a focus on acute care and leadership.

“Our pharmacy residents choose our program to gain more clinical experience and hands-on training,” says Magda Fulman, PharmD, BCPS, Assistant Director of Pharmacy and the PGY-1 Pharmacy Residency Program Director at Montefiore Nyack Hospital. The program, currently in its eighth year, was the first of its kind in the lower Hudson Valley. “By having a residency program, we were able to expand pharmacy services in our hospital and community,” Dr. Fulman says. “Our pharmacists and residents participate in many community events such as influenza vaccine clinics, health fairs and visits to senior centers.”

Pharmacy residents go through six-week rotations in areas of hospital practice such as dispensing, infectious diseases, internal medicine, critical care, practice management, research and transitions of care. Residents can also choose electives in behavioral health, medication safety, pharmacy informatics, diabetes education, oncology or ambulatory care.

“The pharmacy residency program has enhanced the quality of the hospital’s pharmacy program,” Dr. Schiller says.

“Our doctors rely on the services our pharmacists provide.”

Scan the code to learn more about our pharmacy residency program.

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TAKE ‘MINISTROKES’ SERIOUSLY HAVING A BRAIN ATTACK—HOWEVER SMALL—MEANS YOU’RE AT HIGH RISK OF ANOTHER AND NEED PREVENTIVE TREATMENT.

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person who suddenly experiences paralysis on one side of the body, has trouble speaking or notices a sudden change in vision may be having either a stroke or a socalled ministroke.

“If you start having those symptoms, call 911 immediately,” says Mohini Gurme, MD, a neurologist at Highland Medical Rockland Neurological Associates in West Nyack.

“Mini” may sound less serious. “But if it turns out you are suffering from a ministroke, or transient ischemic attack (TIA),” says Dr. Gurme, “you’re at higher risk of a full stroke or another TIA within the next six weeks.”

ALL STROKES ARE IMPORTANT A stroke—sometimes called a brain attack—is an injury to the brain due to lack of blood flow. The most common type of stroke, called an ischemic stroke, is caused by a blood clot that blocks blood flow to the brain, cutting off oxygen and energy that brain cells need to survive. A person having an ischemic stroke needs to be given a clotbusting drug within the first three hours of symptom onset to be most effective— one reason it’s important to seek medical attention as soon as possible.

“A TIA is a stroke that was about to happen, but clears up on its own,” Dr. MOHINI GURME, MD Gurme says. It produces symptoms like

those of a stroke, lasts about 30 to 45 minutes and generally resolves in about an hour.

“When you do an MRI of the brain after a TIA, you don’t see any brain injury or evidence of a stroke,” Dr. Gurme says. “It may have been a blood clot that gave the patient symptoms and cleared up on its own, so blood flow resumes and doesn’t create any ongoing damage.”

TREATMENT AND RISK FACTORS If tests indicate the person may have had a TIA, the doctor may prescribe medication to help prevent a stroke or another TIA. This therapy often consists of baby aspirin in addition to a statin drug to address high cholesterol.

The biggest risk factors for a stroke or TIA are high blood pressure, high cholesterol, diabetes and smoking. “To reduce your risk, work with your doctor to get your chronic medical conditions under control. If you’re a smoker, find help to quit,” Dr. Gurme says.

“Just because a TIA produces no lasting injury doesn’t mean it should be taken lightly,” she emphasizes. “It’s a warning sign—and an opportunity to take steps to protect yourself from having a stroke.”

To schedule a consultation with a board-certified neurologist at Highland Medical Rockland Neurological Associates, call 845-353-4344.

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ALL ABOUT GOUT TREATMENT CAN HELP PEOPLE WITH THIS COMMON JOINT CONDITION LIVE PAIN-FREE.

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he humble big toe is where people most often feel the intense pain, swelling and redness that are hallmarks of gout. But the condition may also start in the ankle, knee or occasionally the hand or elbow, according to Jason Faller, MD, a rheumatologist at Highland Rheumatology Associates in West Nyack.

It’s wise to identify and address gout as early as possible: If left untreated, it can cause permanent damage to joints as well as internal organs. “While there is no cure for gout, it can be effectively treated and managed with medication,” Dr. Faller says.

WHO’S AT RISK? Gout affects an estimated 8.3 million adults in the United States. It is caused when the body accumulates uric acid, a waste product that is normally eliminated through the kidneys.

In many cases, uric acid builds up due to excessive consumption of foods containing a uric acid precursor called purine. Common sources of purine include shellfish, red meat and beer. Other purine-containing foods that can increase the risk of an attack include anchovies, asparagus and beans such as lentils or kidney beans.

The risk of gout increases with age, and some people are genetically predisposed to develop the disease. Gout is often worse in people with kidney disease or thyroid disease. Some patients with gout have associated high blood pressure, diabetes and cholesterol problems.

Gout attacks usually last days to weeks. “They may subside on their own but almost inevitably recur,” Dr. Faller says. Without treatment, gout can cause a hard stonelike material called tophi to accumulate under the skin.

KOSHNAF ANTAR, MD JASON FALLER, MD

HOW GOUT IS DIAGNOSED Diagnosing gout involves measuring a person’s uric acid level on a blood test. The doctor can confirm the diagnosis by analyzing fluid from the swollen joint.

Joint pain can be caused by other conditions as well, so the doctor will also look for possible alternative culprits such as psoriasis, Lyme disease or rheumatoid arthritis, says Highland Rheumatology Associates rheumatologist Koshnaf Antar, MD. “There’s also a condition called pseudogout, which can be difficult to distinguish from gout,” he notes.

To ensure accurate diagnosis and treatment, Dr. Antar recommends that patients be treated by a rheumatologist—a specialist who is trained to distinguish gout from other conditions.

LIFE WITHOUT GOUT With appropriate medication, gout can be totally eliminated. “When a person has been on medication for about six months, they are likely to never have another gout attack,” Dr. Faller says. Patients should continue to be monitored to make sure uric acid levels are sufficiently lowered, he adds.

Gout is best treated by permanently taking a daily medication such as allopurinol or febuxostat, which help the body limit its production of uric acid. In some cases, a patient will be prescribed a short-term course of the antiinflammatory medication colchicine to relieve symptoms.

“The number-one question I get from patients is, ‘Can I come off medication?’ And unfortunately, the answer is no,” Dr. Faller says. But while people are often concerned about side effects, if they’re able to tolerate the medication initially, they’re unlikely to develop side effects later, he notes.

“Once a person is treated for gout, they should be able to live an entirely normal lifestyle,” he says. “If their uric acid is lowered sufficiently, they can even go back to eating the foods they like and potentially even drinking beer in moderation.”

To schedule a consultation or an appointment at Highland Rheumatology Associates, call 845-735-4114.

To learn more about the practice, scan the code.

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