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HealthW ks FAL L 2019

WOMEN’S HEALTH SCREENINGS

KNEE REPLACEMENT WHAT TO KNOW

NEW OPTIONS FOR DIABETES

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e Nyack Hospital Updates

FROM THE PRESIDENT

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ith autumn approaching, we will start to transition from enjoying summer foods and activities to picking apples and harvesting vegetables at the many beautiful orchards and local farmers’ markets amid the colorful foliage that makes the Hudson Valley a premier fall destination region. At Montefiore Nyack Hospital the fruits of our labor, the seeds of which were planted in the spring of 2018, will become manifest in late October with the phase one opening of our hospital’s newly constructed state-of-the-art Emergency Department. All current emergency department operations will be transferred into this new space allowing us to then renovate the existing emergency department. The two phases of construction will be joined mid-2020, forming a completely new doubled-in-size contemporary Emergency Department. Later this year we will finish construction of our new Cardiac and Pulmonary Rehabilitation Center, which will provide outpatient services to all those in the community requiring care of this highly specialized service. And, as we say farewell to a busy and productive year, we look forward to the fresh start another new season brings and the many exciting projects that will be rolled out in 2020, further enhancing the depth and breadth of services our hospital offers the community. Next year, we also look forward to celebrating the hospital’s 125th Anniversary, a milestone that will also mark the completion of our Transformation Project, the largest construction initiative we have undertaken in several decades. We will keep you posted on our progress. Thank you so much for your support! Wishing you a healthy and safe autumn and holiday season! Best regards,

SAME-DAY APPOINTMENTS AVAILABLE 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.

LISTEN FOR BETTER HEALTH We’re pleased to offer two podcast series: “Health Talk” features medical advice and health news from Montefiore Nyack Hospital’s physicians, and “Sound Advice” features timely health and wellness-related topics from Highland Medical’s healthcare providers. Both podcasts are available free of charge. Subscribe on iTunes, Google Play and other satellite radio apps, or visit each homepage for podcast access: • MONTEFIORENYACK.ORG • HIGHLANDMEDICALPC.COM

Mark Geller, MD President and Chief Executive Officer

facebook.com/MontefioreNyack

@MontefioreNyack

@MontefioreNyack

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

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IN THIS ISSUE

fall 2019

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BACK TO SCHOOL WITH FOOD ALLERGIES How parents can work with staff to make school safe.

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KNEE REPLACEMENT Helping those with arthritis walk again without pain.

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BREAST SCREENING CAN SAVE LIVES Yearly screening mammography can find breast cancer early.

PREVENTING DIGITAL EYE STRAIN Tips to help protect your eyes.

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NEW TECHNOLOGY TO CONTROL DIABETES Continuous glucose monitors reduce the number of finger sticks.

RECOVERING FROM OPIOID ADDICTION A treatment that doesn’t require daily clinic visits.

M MONTEFIORE NYACK HOSPITAL AWARDED ACCREDITATION BY THE JOINT COMMISION

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ontefiore Nyack Hospital has earned The Joint Commission’s Gold Seal of Approval® for Hospital Accreditation by demonstrating continuous compliance with its performance standards. The Gold Seal of Approval® is a symbol of quality that reflects an organization’s commitment to providing safe and effective patient care. Montefiore Nyack Hospital underwent a rigorous, unannounced four-day onsite survey in mid-April. During the review, a team of Joint Commission expert surveyors evaluated compliance with

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COLDS AND FLU: HOW TO PROTECT YOURSELF Physician-approved tips to avoid getting sick and feel better faster if you do.

hospital standards related to several areas, including emergency management, environment of care, infection prevention and control, leadership and medication management. Surveyors also conducted onsite observations and interviews. Our renewed accreditation by The Joint Commission recognizes the exceptional quality of care provided at our Hospital and is a testament to the outstanding team that is the Montefiore Nyack family. M O N T E F I O R E N YA C K . O R G

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BACK TO SCHOOL WITH

FOOD

ALLERGIES

HOW PARENTS CAN WORK WITH STAFF TO MAKE SCHOOL A SAFE ENVIRONMENT FOR THEIR CHILDREN.

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he start of the school year requires extra planning for parents of children with food allergies. In addition to packing allergy-free lunches and snacks, you should speak with the school’s nurse and your child’s teacher to make sure they are aware of your child’s allergies and what to do if they accidentally ingest an allergic food, says Lourdes de Asis, MD, Section Chief of Allergy and Immunology at Montefiore Nyack Hospital. “Schools have different policies about food allergies, so you should find out what your child’s school has in place, and tell them about your child’s needs,” she says.

HAVE AN ACTION PLAN Milk, egg and peanut are the most common food allergies for school-age children, Dr. de Asis notes. Other common food allergies include wheat, soy, tree nuts, shellfish and sesame. Children with a food allergy need to have access to an auto-injectable epinephrine (EpiPen or Auvi-Q) to treat emergency reactions. For younger children, the auto-injector is generally kept in the school nurse’s office. The school nurse and your child’s teacher also should have a copy of your child’s food allergy emergency care plan, which you and your child’s doctor fill out. This plan explains what your child is allergic to; what symptoms of a food allergy are; how to use the auto-injector; your child’s emergency contacts; and when to call 911.

WORK WITH YOUR SCHOOL Dr. de Asis says it is rare for a child to be so allergic to peanuts that they cannot be in the same room with another child eating a peanut

butter sandwich. But some parents prefer their children eat lunch at a nut-free or allergen-free table. Find out if your school sets aside space for children with food allergies. Ask the teacher to alert you ahead of time if there will be a celebration at school that involves food so you can be prepared and send your child to school with their own snacks that they can safely eat. The group Food Allergy Research and Education (www.foodallergy.org) has information for schools on food allergies that parents can share with school staff. This includes national guidelines from the Centers for Disease Control and Prevention on managing food allergies in schools; training on keeping students with food allergies safe and included; and a checklist for teachers with students diagnosed with a food allergy.

THE FUTURE OF FOOD ALLERGIES Some children who are allergic to egg or dairy are able to eat them if they are in baked goods, and eventually build up a tolerance enough that they can consume them directly. The outlook for peanut and tree nut allergy has been more challenging, Dr. de Asis says. Food allergy immunotherapy, whether oral or through different routes, are still experimental and not yet ready for widespread use. New hope is on the horizon, however. One treatment, which will be considered by the U.S. Food and Drug Administration next year, is a wearable daily patch that delivers small amounts of peanut protein through the skin that will protect the allergic person from accidental exposures. “Better treatments for food allergies are coming,” Dr. de Asis says. “I’m optimistic I’ll soon be able to offer new treatments to my patients that can help them overcome their food allergies.”

To find an allergy and immunology specialist, visit our Physician Finder at MONTEFIORENYACK.ORG. For more helpful tips, visit http://bit.ly/SafeSnack.

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

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KNEE REPLACEMENT: WHAT YOU NEED TO KNOW 6

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A NEW ARTIFICIAL KNEE JOINT CAN HELP SOMEONE WITH ARTHRITIS WALK AND CLIMB STAIRS AGAIN WITHOUT PAIN.

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hen a person has had worsening arthritis in the knee for years and has tried medication, physical therapy and injections without success, it may be time to consider a knee replacement. “I tell patients when it’s time for a knee replacement, they’ll know,” says Jordan Simon, MD, Director of the Joint Replacement Center at Montefiore Nyack Hospital. “Maybe it’s when they can’t walk more than a block or two, or they’ve danced at a wedding and their knee swells up and they can’t walk comfortably for days later.” There is no age cutoff for the surgery, but the most common time to have a knee replacement is between the ages of 55 to 75, says Dr. Simon. “I decide whether to operate based on the degree of damage to the knee, the degree of disability a person has and their general physical condition,” he says.

WHAT TO EXPECT FROM SURGERY The procedure generally takes 60 to 90 minutes. Most patients are up and out of bed the day of surgery. Most hospital stays are one to two nights. Patients generally go directly home and have physical therapy there. Most patients start using a walker, then progress to a cane after several weeks. “Many people stop using the cane after three to four weeks,” says Dr. Simon. On average, patients continue with physical therapy for two to three months. Many people use narcotic pain medications for three to four weeks after surgery, then switch to non-narcotic pain medications. By six to eight weeks after

surgery, they usually are taking over-thecounter pain medications.

LIFE AFTER KNEE REPLACEMENT How soon a person can go back to work depends on how strenuous their job is. A person with a desk job may be able to return to work in three weeks, while someone who is on their feet all day may need six to eight weeks. If the surgery is on the left knee, a person can usually drive in two weeks if they can get in and out of the car comfortably. For right knee surgery, a person may need to wait four weeks, until they can use the pedals comfortably. How soon a person can get back to exercising is extremely variable, Dr. Simon says. Most people can get back to exercising at the gym in six to eight weeks. They can return to doubles tennis or golf in two to three months. In the past, knee replacements were expected to last about 15 years. Today, the implants being used are expected to last at least 20 years, says Dr. Simon. The best time to have a knee replacement varies from person to person, Dr. Simon explains. “I tell patients not to get it done too early. If they have a good range of motion in their knee and it’s not causing significant pain, I’ll tell them to hold off. Patients tend to be happiest with the results when they have waited until they’re significantly limited in their activities because of knee pain. The contrast between symptoms before and after will be more significant and they’ll better appreciate the improvement in their function.”

To schedule a consultation, call The Joint Replacement Center at Montefiore Nyack Hospital at 845-348-2663. Our staff will be happy to answer questions and can provide a list of surgeons. Location: The Joint Replacement Center at Montefiore Nyack Hospital, 160 North Midland Avenue, Nyack, New York.

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

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BREAST SCREENING CAN SAVE LIVES YEARLY SCREENING MAMMOGRAPHY CAN FIND BREAST CANCER EARLY, WHEN TREATMENT SUCCESS IS HIGHEST.

To schedule an appointment for a breast screening, call The Breast Center at 845-348-8551. Spanishspeaking assistance is available at 845-348-8582. Location: The Breast Center at Montefiore Nyack Hospital, 160 North Midland Avenue, Nyack, New York.

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ammograms can save lives by detecting breast cancer early, when treatment is more likely to be successful. For Stage 0 and 1 breast cancer, the five-year survival rate is nearly 100 percent, according to Shari Siegel-Goldman, MD, Director of Breast Imaging at Montefiore Nyack Hospital. Dr. Siegel-Goldman says she sees women who wait until they feel a lump in their breast before coming in for mammography. “We know we could have found those cancers earlier if the women had come in for screening on a yearly basis,” she says. Dr. Siegel-Goldman recommends women at average risk of breast cancer start having annual mammograms at age 40. You’re at average risk if you don’t have a strong family history of breast cancer (a parent, sibling or child who has had the disease), you or your family members do not have one of the breast cancer genes (BRCA1 or 2) and you have not had a prior biopsy with high-risk findings. Women with a family history of breast cancer or who have a breast cancer gene should talk with their doctor about when and how often they should be screened. “Generally, a woman whose mother had breast cancer should start screening 10 years before the age their mother was when she was diagnosed. So if your mother had breast cancer at age 40, you should start getting screened at age 30,” Dr. Siegel-Goldman says.

TYPES OF BREAST CANCER SCREENING Screening generally starts with a mammogram. Most women who come to Montefiore Nyack Hospital receive a 3-D mammogram, which is more effective than a 2-D mammogram in detecting earlier cancers, and decreases the need for women to get called back for

additional mammography. This type of mammogram is very good for women with dense breasts, which can make it harder for a radiologist reading the mammogram to see the cancer. Dr. Siegel-Goldman noted that most insurance companies will now pay for 3-D mammography. If a woman is found to have dense breasts on her mammogram, her doctor also might recommend ultrasound screening, which uses sound waves. It provides additional information on masses or lumps in the breast. “Ultrasound can find small cancers not found on mammograms,” Dr. Siegel-Goldman notes. An MRI may be used in certain cases, such as for women who carry breast cancer genes or have relatives who are gene carriers. “We recommend that women with a very strong family history of breast cancer, or who have a breast cancer gene, alternate between an MRI and mammogram every six months,” she says.

IMAGE-GUIDED BIOPSY If a mammogram or ultrasound picks up an abnormality, the next step is a biopsy to examine a sample of abnormal breast tissue. Montefiore Nyack offers image-guided biopsy procedures in which the radiologist uses a very small needle guided by either ultrasound, mammography or MRI. A local anesthetic is used so there is generally little discomfort. Results are available within 24 hours. Dr. Siegel-Goldman says that because some women find having a mammogram stressful, the caring and understanding staff at The Breast Center at Montefiore Nyack Hospital does everything possible to reduce stress. “It’s so important to have a mammogram,” she says. “It’s one of the most important things women can do for themselves to stay healthy.”

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

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RECOVERING FROM

OPIOID ADDICTION

TREATMENT ALLOWS PEOPLE TO GO TO WORK WITHOUT DAILY CLINIC VISITS.

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or people seeking treatment for an opioid use disorder, a medication called buprenorphine (Suboxone) can help them recover from their addiction while maintaining normal lives. Because the drug is taken at home, a person being treated with Suboxone can go to school or work while they’re treated for their addiction to prescription opioid painkillers or heroin. In contrast, people who take methadone to treat opioid addiction must get their medication daily at a clinic, notes Joseph Vittorio, MD, Medical Director of the Recovery Center at Montefiore Nyack Hospital. “Suboxone binds to opioid receptors in the brain and blocks other opioids so they

become ineffective,” he explains. “It provides relief from withdrawal symptoms, but doesn’t cause a ‘high.’” Suboxone’s opioid effects increase with each dose until they level off, even if a person takes more. This “ceiling effect” lowers the risk of misuse, dependency and side effects. The drug is taken daily as a pill or a film placed under the tongue. A person being treated with Suboxone sees the doctor several times in the first month. In Dr. Vittorio’s practice, once he determines the patient is stable on the medication, he spaces the visits further apart—often once a month. He writes a monthly prescription for Suboxone, which patients can pick up at the pharmacy.

Suboxone is used in combination with counseling and behavioral therapies. When taken as prescribed, the medication is safe and effective, Dr. Vittorio says. “Most patients take Suboxone for a year or two,” he says. “Once a person has been totally off opioids for a long time, and has a stable lifestyle—a full-time job and structure in their lives—then we may recommend they gradually get weaned off treatment.” It’s dangerous to stop taking Suboxone cold turkey, he cautions. “You have to come off it slowly or else you can have withdrawal symptoms,” he explains. Suboxone can be very effective in treating opioid addiction, “but a person has to be motivated to stick with treatment,” Dr. Vittorio says. “In our outpatient program, we have many successful people who have been able to work, go to school or get a job for the first time in a long time.”

For general questions about The Recovery Center at Montefiore Nyack Hospital, call 845-348-2070 or visit montefiorenyack.org/addiction-services.

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can include dry eye, blurry vision and headaches. When you look at a screen, you tend to blink less, which can cause eye strain and dry eyes. A good way to protect your eyes against eyestrain from devices is to take regular breaks using the “20-20-20” rule: Every 20 minutes, shift your eyes to look at an object at least 20 feet away for at least 20 seconds.

ABOUT BLUE LIGHT

PREVENTING DIGITAL EYESTRAIN TO PROTECT YOUR EYES, TAKE FREQUENT BREAKS FROM COMPUTER USE AND MAKE SURE YOU HAVE THE RIGHT EYEGLASS PRESCRIPTION.

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taring at a computer, TV, phone or tablet for hours can cause eye discomfort known as digital eyestrain. “Taking periodic breaks for visually intense activity generally helps prevent the problem,” says John Chang, MD, of Spinak Medical Eye Center in Pearl River and Stony Point, New York. Digital eyestrain isn’t a single condition, but rather a collection of symptoms that

Glasses that claim to protect your eyes against blue light from screens are popular, but there isn’t strong evidence that they are helpful, Dr. Chang says. “While certain kinds of blue light (mostly the type used in older screens) can be potentially harmful to the eye, we haven’t seen that the kind of blue light used in current technology is harmful in the short term,” he says. “We still don’t know what the cumulative effect will be after years of exposure,” he adds. Anti-glare screens for computers are another popular item for people trying to reduce eyestrain. “I tell patients they can’t hurt, and they may help some people,” Dr. Chang says. His advice to people who spend a lot of time looking at a computer, phone or iPad is to increase the font size of letters so the eyes don’t have to work as hard to read.

EYE CHECKUPS ARE KEY The best protection against digital eyestrain is to make sure your prescription for glasses and contacts is up to date, and your reading glasses are the correct strength, according to Dr. Chang. “Some people have a prescription that gives them good distance vision, but it makes their eyes work too hard to read. In that case, a person may need stronger reading glasses,” he says. If you feel burning or grittiness in the eye and have frequent fluctuation in vision, it may signal you have dry eye disease that should be treated by an eye-care professional. There are several possible treatments. These include over-the-counter artificial tears, prescription eye drops and a procedure that blocks the tear ducts, keeping natural tears in the eye longer.

To find an ophthalmologist, please visit our Physician Finder at MONTEFIORENYACK.ORG. M O N T E F I O R E N YA C K . O R G

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NEW TECHNOLOGY TO CONTROL

DIABETES CONTINUOUS GLUCOSE MONITORS REDUCE THE NUMBER OF FINGER STICKS WHILE IMPROVING HEALTH.

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ew technology is allowing people with diabetes to reduce the number of times each day they have to perform finger-stick tests to measure their blood sugar (glucose) levels. Devices called continuous glucose monitors (CGMs) are making life easier while improving diabetes control, according to Valentine J. Burroughs, MD, an endocrinologist at Highland Medical, P.C. “Most people with diabetes who don’t use a CGM do not know what their blood glucose level is at any point in time and are supposed to use a finger-stick test three to four times a day,” Dr. Burroughs says. “Some people should be using them even more in order to determine their blood glucose level. Many patients don’t like doing finger-stick tests, so they don’t do as many as they should in order to control their blood sugar levels. With a CGM, you only have to do a finger stick every 12 hours—patients really love it.”

HOW DO CGMs WORK? CGMs automatically track blood glucose levels throughout the day and night. Seeing your blood sugar levels in real time can help you make better decisions about how to balance your food, physical activity and insulin. A CGM uses a tiny sensor inserted

under your skin, usually on the belly, which is replaced every week or two. The sensor measures the glucose found in the fluid between cells. It tests glucose every five minutes, and a transmitter wirelessly sends the information to a receiver. A person uses that information to figure out how much insulin they need. Some CGM models send information directly to a smartphone. “For parents of children with diabetes, this is extremely helpful,” Dr. Burroughs notes. “Kids aren’t always as attentive as they should be to their blood sugar levels. Now the child’s blood glucose information can be sent to their parent’s phone.” CGMs are very useful for people who are physically active. “After you do sports, your blood sugar may drop,” explains Dr. Burroughs. “The CGM can keep you safe.” The monitors are waterproof, and can be used while showering or swimming. You can set an alarm on your CGM to alert you when your glucose level goes too high or too low. “This is especially helpful when you’re sleeping,

when you may be at risk of having your blood glucose go too low,” says Dr. Burroughs. A person using a CGM still has to do a finger-stick test twice a day in order to confirm the monitor reading (calibrate the CGM).

A COMPLETE SYSTEM Insulin pumps are small computerized pumps worn on your belt or in a pocket that can be used as an alternative to injecting insulin. Pumps deliver a very precise amount of insulin before meals, for different times of day and overnight. Newer CGM models are part of an insulin pump system. The sensor determines your blood glucose level and sends that information wirelessly to the insulin pump already attached to the abdomen. The pump calculates the correct amount and releases the insulin into the bloodstream, without you having to inject yourself. “With a continuous glucose monitor, you can control your diabetes better, and that will help you stay healthy and prevent complications of the disease,” says Dr. Burroughs.

To schedule an appointment with Dr. Valentine Burroughs at Highland Medical, P.C., call 866-550-4672. M O N T E F I O R E N YA C K . O R G

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PROTECT YOURSELF FROM

COLDS AND FLU 14

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USE THESE PHYSICIAN-APPROVED TIPS TO AVOID GETTING SICK AND FEEL BETTER FASTER IF YOU DO.

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hen autumn comes, cold and flu season isn’t far behind. Be prepared by knowing the difference between colds and flu, and how to prevent and treat common respiratory illnesses. Colds are caused by a different virus than the flu. “Generally, cold symptoms are milder and include sore throat, runny nose and, sometimes, a cough,” says Dana Corriel, MD, board-certified internist at Highland Medical, P.C. Pearl River Internal Medicine. “With the flu, it’s more common to experience fever, headache, muscle aches and cough.”

REDUCE YOUR RISK You can help reduce your risk of getting a cold or flu by washing your hands often, avoiding close contact with sick people and not touching your face with unwashed hands. The best way to prevent the flu is by getting a flu shot. The vaccine is recommended for anyone 6 months and older who is not severely allergic to the shot or its components (including eggs and gelatin). The ideal month to get vaccinated is October, because it’s close to peak flu season. It’s thought that protection can wane as time passes from vaccine administration. Dr. Corriel says that while the vaccine may not be 100 percent effective, it’s still worth getting vaccinated because the flu has the potential to be deadly. “I tell patients that some protection is better than no protection,” she says. “Please remember that getting vaccinated is not just about protecting yourself, but about protecting those around you in the community who have weak immune systems and may not be

able to fight off the flu as well as healthy individuals do (like the younger and older generations),” she says. “We must do our part to protect them, too.”

TREATING RESPIRATORY ILLNESSES If you get sick with flu, antiviral drugs may be a treatment option. If you get flu symptoms and are at high risk of serious flu complications, check with your doctor right away. People at high risk of flu complications include young children, adults 65 years of age and older, pregnant women and people with certain medical conditions, such as asthma, diabetes and heart disease. When used for treatment, antiviral drugs can lessen symptoms and shorten the time you are sick by one or two days. They also can prevent serious flu complications, like pneumonia. Many people treat colds with supplements, such as vitamin C, zinc and Echinacea. But overall, there is likely to be little to no overall benefit to taking these, according to Dr. Corriel. “A recent study showed that consistent use of vitamin C may possibly decrease the duration of a cold by a single day. Additionally, I sometimes advise patients with sore throats to suck on zinc lozenges to help relieve symptoms. But the evidence is scant. All in all, a healthy, intact immune system is the best way to fight these and feel better.” If you’re coughing, it could be due to various reasons, including viruses. “If you have a cough, you should be evaluated by your physician, especially if you develop fever, are elderly or have a chronic condition,” Dr. Corriel says. “It’s better to be safe than sorry. So when in doubt, come in for a visit.”

To find a primary care physician at Highland Medical, P.C., visit HIGHLANDMEDICALPC.COM/highland/primary-care.

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

Highland Healthy. Same-day appointments at our Primary Care Offices. Spanish-speaking doctors who clearly communicate and understand you. Online appointment scheduling on our patient portal.

Specialties • Primary Care • Cardiology • Endocrinology • Hematology/Oncology • Nephrology • Neurology • Pulmonology • Psychiatry • Surgery • Breast Surgery • Gynecologic Oncology • OBS-GYN

Convenient locations throughout Rockland County.

What you need, when you need us. That’s Highland Healthy.

1-866-550-HMPC Call for appointments. Llame para citas, se habla español.

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