Nyack Fall 2024

HealthWorks F AL L 2024

NEW ADVANCES IN

BREAST CANCER TREATMENT

TREATING POSTSURGICAL PAIN

WITHOUT OPIOIDS LUNG CANCER SCREENING

SAVES LIVES

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Montefiore Nyack Hospital Updates FROM THE PRESIDENT Dear Readers, While watching the Olympics this summer, I found myself repeatedly in awe of athletic feats and the commitment required by Olympians testing their physical and mental limits to achieve their ultimate goal—winning medals. At Montefiore Nyack Hospital, our gold medals are measured in achievement awards, societal and other accreditations, and expansion of existing or delivery of new services to our community.

GOING FOR GOLD. We recently opened a state-of-the-art Ambulatory Surgery Center and Diagnostic Imaging Center containing a 3T high field open orthopedic and spine MRI system within the Montefiore Einstein Comprehensive Orthopedic and Spine Center.

Patients now have access to the most advanced level of orthopedic and musculoskeletal care coordinated under one roof by the academic experts at Montefiore Einstein Orthopedic and Spine Surgeons. This new multi-specialty, outpatient facility in West Nyack is home to the largest orthopedic physician practice in Rockland County and also offers physical and occupational therapy provided by the nationally renowned rehabilitation specialists from Burke Rehabilitation Hospital.

MONTEFIORE NYACK HOSPITAL RECOGNIZED AS A HIGH-PERFORMER FOR PNEUMONIA

Landing us on the Medal Stand for expanding academic medicine are our radiation therapy services now provided by the experts at Montefiore’s Comprehensive Cancer Center (MCCC) in Rockland County at Montefiore Nyack’s Cancer Center. MCCC is ranked in the Top 1% of all U.S. Hospitals for cancer care by U.S. News and World Report. Our new radiation therapy system will come online shortly and incorporates CT imaging with 360-degree delivery of radiation conforming precisely to tumors and targeting them with the most precise dose, significantly reducing any side effects.

U.S. News & World Report, the global authority in quality hospital rankings and consumer advice, has named Montefiore Nyack Hospital a High Performer for Pneumonia in its 2024-2025 Best Hospitals Procedures and Conditions ratings.

Our team also won big as we added several elite recognitions from well-respected healthcare authorities to our ever-growing list of awards and accreditations. These include the American Heart Association’s Get With The Guidelines® - Stroke GoldPlus quality achievement award, and the Target: Type 2 Diabetes™ Honor Roll award for providing the most up-to-date, evidence-based care to patients who might be at higher risk for complications when hospitalized due to stroke.

Pneumonia, an infection of the lung tissue, can be caused by bacteria, viruses or fungi.

Pneumonia treatment depends on the cause, how severe symptoms are, the age of the patient and their overall health. People who are hospitalized for pneumonia receive intravenous antibiotics and, where appropriate, breathing treatments and other indicated therapies.

Lastly, we scored high marks when named a High Performer for Pneumonia and Maternity Care (Uncomplicated Pregnancy) by U.S. News & World Report, the global authority in quality hospital rankings and consumer advice. We also earned the designation of “LGBTQ+ Healthcare Equality Top Performer” in the Human Rights Campaign Foundation’s Healthcare Equality Index with an impressive score of 95 out of 100.

The goal that drives us at Montefiore Nyack is like the goal of today’s Olympians: We strive for medal-worthy healthcare outcomes by delivering the highest quality care while exceeding your expectations.

Thank you for putting your trust in our care,

Mark Geller, MD, FACR President and Chief Executive Officer

facebook.com/MontefioreNyack @MontefioreNyack @MontefioreNyack To unsubscribe, please email us at publicrelations@montefiorenyack.org.

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U.S. News & World Report evaluated nearly 5,000 hospitals across 15 specialties and 20 procedures and conditions. The annual procedures and conditions ratings are designed to help patients and their healthcare providers make informed decisions about where to receive care for challenging health conditions or elective procedures. The pulmonology and lung surgery ratings are based on analysis of various data categories, including patient outcomes, the volume of high-risk patients, patient experience, nurse staffing and advanced clinical technologies.

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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ILLUSTRATION BY WYNTER MALONE

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Here’s what current and former smokers need to know.

Knowing the basics about food allergies can help protect you and your family.

Our expert clinicians offer the latest research-backed treatments and a personalized team approach to help ensure the best possible outcomes.

LUNG CANCER SCREENING SAVES LIVES

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TREATING POSTSURGICAL PAIN WITHOUT OPIOIDS

Orthopedic surgeons now have many safe options to control patients’ pain.

KEEP YOUR KIDS SAFE FROM FOOD ALLERGIES

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OPTIC NEURITIS

This eye condition can be caused by an infection or related to multiple sclerosis. Find out how it’s diagnosed and treated.

2024

IN THIS ISSUE

NEW ADVANCES IN BREAST CANCER TREATMENT

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CARPAL TUNNEL SYNDROME Don’t ignore hand and forearm tingling and pain.

In September, Rockland GI will join the growing network of Highland Medical practices as Highland Medical Rockland Gastroenterology and Liver Disease.

ROCKLAND GI JOINS HIGHLAND MEDICAL

Led by William S. Silver, MD, Eric L. Tatar, MD, MS, and Svetlana Korenfeld, MD, Highland Medical Rockland Gastroenterology and Liver Disease provides advanced care and improved patient outcomes in treating conditions related to the GI digestive tract—from irritable bowel syndrome to constipation and food intolerances to liver diseases.

Highland Medical Rockland Gastroenterology and Liver Disease is located at 2 Medical Park Drive in West Nyack, New York. To schedule an appointment, please call 845-362-3300.

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

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LUNG CANCER SCREENING Can Save Lives in Current and Former Smokers

LUNG CANCER SCREENING CAN BE LIFESAVING. HERE’S WHAT YOU NEED TO KNOW.

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ung cancer is the second most common cancer in the United States and is the leading cause of death from cancer.

If lung cancer is found early, when it is small and before it has spread, it is more likely to be treated ROSTISLAV GORBATOV, MD

successfully. That’s why screening for lung cancer in current and former smokers is so important, says Rostislav Gorbatov, MD, a pulmonary and critical care specialist with Highland Medical Pulmonary Medicine Associates in Nyack, New York.

“Early detection can reduce lung cancer death rates by 20%—that’s significant,” Dr. Gorbatov says. “In some cases when we catch lung

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cancer early, it can be treated by relatively simple lung surgery, and we can avoid additional treatments like chemotherapy and radiation.”

Dr. Gorbatov notes that in Rockland County in 2023, one in eight adults were smokers, so having LDCT screening available in the area is very important.

WHAT IS LUNG CANCER SCREENING?

The only recommended screening test for lung cancer is low-dose computed tomography (also called a low-dose CT scan). Screening is recommended only for adults who have no symptoms but are at high risk. Usually, symptoms of lung cancer don’t appear until the disease is already at an advanced stage.

During an LDCT scan, you lie on a table and a CT machine makes detailed images of your lungs. The scan takes less than 10 minutes and is not painful. You do not need to be injected with contrast dye, unlike some other types of CT scans, Dr. Gorbatov noted. “The dose of radiation is quite minimal—90% less radiation than a regular CT scan,” he says.

WHO SHOULD BE SCREENED?

The U.S. Preventive Services Task Force (USPSTF) recommends yearly lung cancer screening with LDCT for people who: •H ave a 20-pack-year or more smoking history, and •S moke now or have quit within the past 15 years, and • Are between 50 and 80 years old.

A pack-year is smoking an average of one pack of cigarettes per day for one year. For example, a person could have a 20-pack-year history of smoking one pack a day for 20 years or two packs a day for 10 years.

The guidelines have changed over the years, Dr. Gorbatov says. “They used to recommend screening for people with a 30pack year or more smoking history who were 55 or older. The updated guidelines allow us to screen more people. This improves the chance that we’ll find more early cancers and avoid more deaths.”

WHEN SHOULD SCREENING STOP?

The guidelines recommend that yearly lung cancer screening stop when the person being screened: • Turns 80 years old, or • Has not smoked in 15 or more years, or • Develops a health problem that makes him or her unable or unwilling to have treatment if lung cancer is identified.

RISKS OF SCREENING

There are several potential risks of screening that Dr. Gorbatov discusses with patients. One of these is that screening may find something other than lung cancer, such as a problem with the thyroid. “This can lead to added anxiety and further testing that the patient wasn’t expecting,” he says. “We weigh the risks and benefits with patients, and for many of them, the benefits outweigh the risks.”

INSURANCE AND MEDICARE COVERAGE

Most insurance plans and Medicare help pay for recommended lung cancer screening tests. If the screening test finds something abnormal, you may need more tests. These follow-up tests may have a cost such as a co-pay or deductible.

Check with your insurance plan to find out what benefits are covered for lung cancer screening.

LUNG CANCER SCREENING AND TREATMENT AT MONTEFIORE NYACK HOSPITAL

Patients have access to advanced lung cancer screening and treatment at Highland Medical Pulmonary Medicine Associates, which is affiliated with and located within Montefiore Nyack Hospital.

“We have multiple specialists, including pulmonologists, interventional radiologists, oncologists, cardiothoracic surgeons and pathologists,” says Dr. Gorbatov. “We are also adding more diagnostic tools to be able to better sample and identify lung cancers after they’ve been found on screening tests. We provide a full range of services, from helping patients quit smoking to detecting lung cancer early. We offer the latest treatments by oncology specialists to patients who are found to have lung cancer so they have the best treatment outcome possible.”

Highland Medical Pulmonary Medicine Associates, at 160 North Midland Avenue, on the 2nd floor within Montefiore Nyack Hospital, specializes in the diagnosis and treatment of pulmonary conditions and lung disorders. To schedule a consultation or an appointment, please call 845-897-8371.

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TREATING POSTSURGICAL PAIN

WITHOUT OPIOIDS

ORTHOPEDIC SURGEONS NOW HAVE MANY SAFE OPTIONS THEY CAN USE TO HELP CONTROL THE PAIN PATIENTS EXPERIENCE AFTER AN OPERATION.

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hen a person is facing surgery, they often are nervous about the pain they may have afterward.

There are many effective options to treat postsurgical pain that don’t involve opioids, according to MICHAEL D. ROBINSON, MD

Michael D. Robinson, MD, Director of Pain Management and Palliative Care at Montefiore Nyack Hospital.

“For orthopedic surgery, we may use several types of medication to control pain,” he says. “Sometimes after surgery, especially a major surgery such as a spine operation or joint replacement, we may use opioids for a brief period. But the major focus these days is on other medications and methods

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one reason surgeons often look to other alternatives to treat postsurgical pain.

“In most cases, the pain is most significant several days after surgery,” says Dr. Robinson, who also practices at the Montefiore Einstein Comprehensive Orthopedic and Spine Center in West Nyack, New York.

“Over the course of the next week or two, postoperative inflammation continues to improve. It’s important for patients to have realistic expectations of what will happen. Having some pain after surgery is normal—you won’t be suddenly pain free.”

KNOW WHAT TO EXPECT

to control a patient’s pain.”

Opioids can be effective medicines for moderating severe pain. Today, they are most often used for certain types of pain, such as pain related to cancer. When taken as prescribed, they can be effective for managing short-term pain after surgery. But because opioids are narcotics, they can be addictive, especially when taken for long periods. That is

It’s also normal for a patient to be anxious about having pain after surgery.

“That’s why it’s so important for patients to be prepared for what will happen,” says Dr. Robinson. “I tell my patients that postoperative pain is a different kind of pain than what they were experiencing before surgery— pain that was getting worse and worse. After surgery, the pain won’t be relentless and overwhelming. It is likely the

pain will come and go, and it will get better over time.”

PAIN TREATMENTS AFTER SURGERY

In some cases, surgeons may use a milder opioid called tramadol for a brief period to control postoperative pain. In most cases, non-opioid medications are effective in treating pain after surgery, Dr. Robinson says.

These include: • Nerve blocks, which are administered at the time of surgery. They allow a reduced use of anesthesia and give pain relief for up to several days after surgery • Nerve-pain medication, such as gabapentin • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and celecoxib • Analgesic medications such as acetaminophen (Tylenol) Meditation can help reduce feelings of stress, anxiety and pain after surgery. “Meditation can help patients be more tuned into what they are experiencing,” says Dr. Robinson. “If you have pain, it’s like you’re being shot by two arrows,” he explains. “First, you have the physical experience of the pain. Second, you have all the concerns surrounding the pain, such as worrying that it won’t go away. Meditation has been used for a long time to help people suffering from chronic pain. It can help people after surgery, too, by giving them more control over what they are experiencing.”

For more information or to make an appointment, call (845) 348-ACHE (2243). If you have Medicare or an insurance carrier that doesn’t require a referral, you may call directly for an appointment. Otherwise, please contact your primary care physician for a referral first.

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KEEP YOUR KIDS SAFE FROM

FOOD ALLERGIES KNOWING THE BASICS ABOUT FOOD ALLERGIES CAN HELP PROTECT YOU AND YOUR FAMILY.

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s families prepare for the start of the school year, those whose kids have food allergies need to take extra steps to ensure their safety. Working with your child’s school, doctor and caregivers, you can help ensure a safe MA LOURDES DE ASIS, MD, MPH, FAAAAI

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milk and soy. However, peanut, tree nut, fish and shellfish allergies are most often lifelong.

Food allergy reactions can vary unpredictably from mild to severe. Common symptoms of food allergies include itching, hives, swelling, difficulty breathing, dizziness, stomach upset and cramps. Some food allergy reactions progress to severe anaphylaxis, which is a potentially life-threatening allergic reaction.

MANAGING FOOD ALLERGIES

environment for your child, says Ma Lourdes de Asis, MD, MPH, FAAAAI, Section Chief of Allergy and Immunology at Montefiore Nyack Hospital.

FOOD ALLERGY BASICS

The most common food allergens are the proteins in cow’s milk, eggs, peanuts, wheat, soy, fish, shellfish, sesame and tree nuts. Children frequently outgrow allergies to egg,

The most effective way to deal with food allergies is to avoid the food in question. “It’s important for the child to know what they’re allergic to and to feel comfortable asking what’s in food before they eat it,” Dr. de Asis says.

Every child with a food allergy should have a Food Allergy and Anaphylaxis Emergency Care Plan, such as the one available from Food Allergy Research and Education (www.foodallergy.org). The plan outlines recommended treatment in case of an allergic reaction, is signed by a physician and includes emergency contact information.

Keep your plan in a place where others can find it, and make sure you and others understand what to do in case of an emergency.

Children with food allergies should always carry self-injectable epinephrine (auto-injectable epinephrine) to be used in the event of an anaphylactic reaction.

“It’s preferable to have two autoinjectable epinephrine in a pack so if the first one doesn’t work, you can use the second one within 15 minutes,” Dr. de Asis says.

“Everyone who comes in contact with your child, including their teacher, the school nurse, babysitters, grandparents and other caregivers, should know what

they are allergic to and know how to use an epinephrine auto-injector, in case that becomes necessary,” she says.

NEW TREATMENTS

The U.S. Food and Drug Administration recently approved the first oral immunotherapy drug, Palforzia, to treat children ages 4 to 17 years old with a confirmed peanut allergy. The treatment focuses on building tolerance to peanuts. It desensitizes the body to the allergen.

The treatment starts with giving a tiny amount of peanut protein, then gradually larger amounts until a target dose is reached.

Peanut allergy immunotherapy is designed to reduce the frequency and severity of allergic reactions.

“It protects you from accidental ingestion of small amounts of peanut; it doesn’t allow you to eat a whole peanut butter sandwich,” Dr. de Asis says.

It may be possible to prevent peanut allergy from developing in the first place, she adds. Research has found that feeding peanutcontaining food to babies who are under a year old and at high risk for developing peanut allergy protected them from developing the allergy. Babies at higher risk of developing peanut allergy include those with eczema. “Talk with your child’s pediatrician before attempting this,” Dr. de Asis says. “They’ll let you know if it’s a good idea and how and when to introduce peanuts into your child’s diet.”

There are many resources out there to support parents of children with food allergies, she says. “It can be overwhelming at first, but use your pediatrician, your allergist and national foodallergy organizations to help you.”

To find an allergy and immunology specialist, visit our Physician Finder at www.montefiorenyack.org.

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OPTIC NEURITIS THIS EYE CONDITION CAN BE CAUSED BY AN INFECTION OR RELATED TO MS. FIND OUT HOW IT’S DIAGNOSED AND TREATED.

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f you have any vision problem, no matter how minor— especially if it involves eye pain—seeing an optometrist or ophthalmologist promptly is essential. The cause could be optic neuritis, inflammation of the optic nerve that can affect your vision.

Optic neuritis is common in people with multiple CHRISTOPHER LANGSTON, MD sclerosis,

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OPTIC NEURITIS says Christopher Langston, MD, a neuroimmunologist and medical director of The Madlyn Borelli Multiple Sclerosis Center at Montefiore Nyack Hospital.

“When people think of multiple sclerosis, they usually think of symptoms like difficulty walking, imbalance, numbness and tingling.

They don’t usually think about eye symptoms,” he says. “But optic neuritis can occur in people with MS, lupus and other autoimmune diseases. In some cases, it can be the first sign of MS.” In some patients, there is no apparent cause for their optic neuritis, and it is not linked with any other disease.

Optic Nerve

Swelling (Inflammation)

WHAT IS OPTIC NEURITIS?

Optic neuritis is a swelling of the eye’s optic nerve. This nerve carries light signals from the back of the eye to the brain so you can see. If the optic nerve is swollen, damaged or infected, your vision can be affected.

A common feature of optic neuritis is blindness in either the top or bottom half of vision. Typically, it occurs only in one eye. The vision loss may not affect the entire top or bottom half of the eye. “It may appear to a person that they have a smudge on their contact, except the smudge persists even after changing the contact,” Dr. Langston says.

Another symptom is eye pain.

“When the nerve gets swollen, it becomes painful to move the eye,” he says. “Sometimes this can result in headaches.”

The vision loss typically gets worse over the course of days to weeks, and then slowly resolves over weeks to months.

The symptoms may return when a person is stressed, sick or overheated. “All these conditions stress the optic nerve and can cause the symptoms of the original

injury to come out again,” he says.

“It’s important to understand that transient return of symptoms does not necessarily indicate a fresh injury.”

DIAGNOSIS AND TREATMENT

Optic neuritis may be diagnosed when a person comes to an optometrist or ophthalmologist with vision problems or eye pain.

But in some cases, the doctor will find evidence of optic neuritis even if the person doesn’t have symptoms. “When the doctor shines a light in the eye, they may see the eye doesn’t react to light equally in both eyes. That could be a sign of optic neuritis,” Dr. Langston says.

Some people get better without any treatment. Many people need treatment to improve vision or at least keep their symptoms from getting worse. “Some people have a full recovery, but others don’t,” he says. “If optic neuritis isn’t treated, its symptoms can get worse.

Getting diagnosed and treated early can help a person potentially get better faster.”

Optic neuritis is often treated with steroids to reduce inflammation.

In people with MS whose optic neuritis doesn’t respond to steroids, the optic neuritis is treated with a procedure called plasma exchange, a light form of plasmapheresis in which inflammatory molecules are filtered out of the blood.

“The expected outcome for most patients with optic neuritis is good, unless you leave it untreated,” Dr. Langston says. “Especially if you have MS or another autoimmune disease, optic neuritis can potentially blind you if the underlying cause isn’t discovered. If you have vision problems, especially if they’re accompanied by pain, it’s important to seek medical attention right away to see what’s going on and whether an underlying condition is causing them.”

For more information about the services provided at The Madlyn Borelli Multiple Sclerosis Center at Montefiore Nyack Hospital, call 845-348-8880 or visit montefiorenyack.org/multiple-sclerosis.

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NEW ADVANCES IN BREAST CANCER TREATMENT OUR EXPERT CLINICIANS OFFER THE LATEST RESEARCHBACKED TREATMENTS AND A PERSONALIZED TEAM APPROACH TO HELP ENSURE THE BEST POSSIBLE OUTCOMES WITH THE LOWEST IMPACT ON PATIENTS. 12 HEALTH WORKS | FALL 2024 12-13 Nyack_BreastCa_Fall24_Final.indd 12

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ith recent advances in breast cancer research and treatment, doctors are often able to reduce the amount and intensity of treatment women receive while maintaining exceptional cancer outcomes, according to Sunny Mitchell, MD, FACS, medical director of The Breast Center at Montefiore Nyack Hospital.

Today, many early-stage breast cancer patients are recommended to have less invasive surgery than in years past. Additional testing on tumors may help provide recommendations on chemotherapy and radiation therapy.

With a full range of screening capabilities and state-ofthe-art diagnostic services, our multidisciplinary team of specialists creates a personalized, data-driven and coordinated care plan for each patient to deliver the best treatment options available.

IT ALL STARTS WITH SCREENING

Women at increased risk of breast cancer should start annual breast screening at age 40. Women who undergo yearly breast screening have the best chance for successful treatment if cancer is detected.

“Breast cancer is very treatable when it’s discovered at an early stage,” Dr. Mitchell says. “That’s why it’s so important for women to have annual breast screening—it saves lives.”

If a woman’s mammogram shows she has dense breasts, her doctor may also recommend ultrasound screening or an MRI to provide additional information.

Some women, such as those with a family history of breast cancer SUNNY MITCHELL, MD, FACS

or other risk factors, may be advised by their doctor to start screening earlier than age 40.

You may be at increased risk if you: • have a strong family history of breast cancer (a parent, sibling or child who has had the disease) • have one of the breast cancer genes (i.e., BRCA1 or 2) • had a prior biopsy with high-risk findings.

MEDICATION AND RADIATION

Breast cancer treatment sometimes starts with medication before surgery. This may be given to try to shrink the tumor so it can be removed with less extensive surgery, or because research has found this course of action is better for certain types of cancer.

There are several types of breast cancer medications, which may be referred to as chemotherapy, hormone therapy, immunotherapy and/or targeted therapy.

Breast cancer tumors may undergo additional testing to help guide treatment. “The findings from tumor testing may help provide additional treatment recommendations or determine whether chemotherapy may or may not be recommended,” says Dr. Mitchell.

Radiation therapy is often an integral part of breast cancer treatment. The length of treatment is determined on an individual basis following evidence-based medicine.

SURGICAL ADVANCES

The Breast Center at Montefiore Nyack Hospital offers advanced surgical techniques that remove the cancer while preserving the breast’s

physical appearance.

“We remove the cancer and leave the breast with a nice shape, size and contour,” says Dr. Mitchell, a pioneer in oncoplastic and hidden scar surgery. “It’s much more aesthetically pleasing to the patient. When she looks in the mirror, she is not constantly reminded about her surgery.”

COMPREHENSIVE ON-SITE TREATMENT SERVICES

Additional services offered at The Breast Center at Montefiore Nyack Hospital include genetic counseling and testing, patient navigation, support from a social worker, and a nutrition consultation with a dietician.

•G enetic counseling helps a patient understand the role of both family history and lifestyle on their risk for developing breast or other types of cancer.

• A genetics evaluation by a clinical geneticist includes a review of the patient’s personal medical history and a detailed medical and cancer family history.

• Women undergoing treatment at Montefiore Nyack Hospital may also be eligible to participate in clinical trials if they choose.

•O ur dietitians offer nutrition consults with specific advice on how to adjust nutrition while going through chemotherapy, or general guidance on how to eat better to keep your body healthier.

“Our patient-centered, evidence-based and tailored holistic approach treats the whole person throughout their breast cancer journey,” says Dr. Mitchell.

To schedule a screening appointment, call 845-348-8551.

We are a partner of the Cancer Support Community Greater NY & CT at Gilda’s Club, a non-profit organization that offers critical support services to anyone impacted by cancer—all free of charge.

For more information, call 914-644-8844.

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

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CARPAL TUNNEL SYNDROME DON’T IGNORE HAND AND FOREARM TINGLING AND PAIN.

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f you feel numbness, tingling and pain in your hand and forearm, you may be experiencing carpal tunnel syndrome (CTS). The condition occurs when one of the major nerves in the hand—the median nerve—is squeezed or compressed as it passes through the wrist.

In most people with CTS, the condition gets worse over time.

If it is left untreated for too long, it can lead to permanent damage to the hand. This can include loss of sensation in the fingers and weakness. This is why it’s important to diagnose and treat carpal tunnel syndrome early, according to Doron Ilan, MD, hand surgeon at Montefiore Nyack Hospital and co-medical director of the Montefiore Einstein Comprehensive Orthopedic and Spine Center. “If treated early, CTS is often completely correctable,” he says.

CTS CAUSES

The carpal tunnel is a narrow passageway in the wrist, about an inch wide. An estimated 3-6% of the population has carpal tunnel syndrome, Dr. Ilan says.

Many people assume CTS is caused by the overuse of computers.

However, in most cases, CTS is just part of the normal aging process, according to Dr. Ilan. “As we age, the carpal DORON ILAN, MD

tunnel can get smaller and/or its contents can enlarge,” he says.

Other factors that can contribute to CTS risk include: • autoimmune disorders (such as rheumatoid arthritis, lupus or gout) • diabetes • fluid retention due to pregnancy or menopause • fractures or trauma to the wrist • bone spurs/osteoarthritis in the wrist • thyroid disorders.

SYMPTOMS

Symptoms may include pain and tingling of the fingers and hand, which often get worse at night. The pain can radiate to the forearm and even sometimes up to the shoulder. In more advanced cases, true numbness of the fingers and/or weakness can occur. In severe cases, the muscle at the base of the thumb can shrink, making it hard or impossible to pinch the thumb against other fingers.

DIAGNOSIS AND TREATMENT

The doctor may diagnose CTS based on a person’s medical history and a physical exam.

Nerve testing and ultrasound may be used to confirm whether you have CTS or another condition with similar symptoms (such as a pinched nerve in the neck).

Nonsurgical treatment may include: • corticosteroid injections (to reduce swelling in the carpal tunnel)

• wearing a wrist brace while sleeping to help reduce night symptoms • medications such as nonsteroidal antiinflammatory drugs like ibuprofen or naproxen to help relieve pain and inflammation.

SURGERY

If non-surgical treatments are not working for CTS, your doctor may recommend surgery. There are two basic types of CTS surgeries to enlarge the carpal tunnel: endoscopic surgery or open surgery. They are performed on an outpatient basis.

For endoscopic surgery, the doctor makes one or two smaller skin incisions and uses a miniature camera, or endoscope, to see inside your hand and wrist. For open surgery, the surgeon makes a small incision at the base of the palm on the hand and views the inside of your hand and wrist through this incision.

“Both types of surgery have proven successful with high rates of satisfaction, safety and effectiveness,” Dr. Ilan says. Recovery from either surgery is relatively short.

Most people can use their hand for light activity within a few days. “Although mild soreness can last for one to three months, most patients get back to their normal life activity fairly quickly,” he says.

For more information, visit Montefiore Einstein Comprehensive Orthopedic & Spine Center at www.montefiorenyack.org/orthopedic-spine.

To schedule an appointment or consultation, call 845-358-1000.

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