HealthWorks: Fall 2018

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NEW HOPE FOR ALZHEIMER’S HELPING TEENS CONQUER STRESS DEPRESSION & MEN HOW TO HELP

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LETTER FROM THE PRESIDENT & CEO

To our community:

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ith summer behind us, our thoughts turn from those of the beach and camping to school, team sports and local events. Autumn brings community into greater focus as our activities tend to center around the towns in which we live.

At Montefiore Nyack Hospital, community and the wellbeing of its residents are our primary focus. Beginning with the youngest in our community, Montefiore Nyack Hospital provides resources necessary to raise healthy children and support families.

Our efforts in this area were recently recognized with the 2018 International Board of Lactation Consultant Examiners Award of Excellence in lactation care. Additionally, The Prenatal Center at Montefiore Nyack Hospital was named one of the first OB/ GYN practices in Rockland County to achieve the New York State Breastfeeding Friendly Practice Designation by meeting New York State Department of Health’s comprehensive guidelines.

For those in our community seeking treatment for substance abuse, we provide a place of healing and support at the Hospital’s Recovery Center for Change. We recently moved the Center from the Hospital campus into the community to facilitate access and offer a greater degree of privacy to those struggling with addiction in our community.

We are building a brand new Transitional Care Unit, one of the pilot sites statewide designated by New York State Department of Health. This unit will offer additional recuperative and rehabilitative services to patients in need after their acute medical care stay within the four walls of the Hospital. This unit and the services provided will insure a safe return home or to our patient’s next care destination.

Finally, throughout September and October, The Breast Center at Montefiore Nyack Hospital will be hosting several community outreach events to promote women’s health and breast cancer awareness. This will include a free cancer screening event on October 26th for underinsured and uninsured women 40 years and older.

These are only a few examples demonstrating Montefiore Nyack Hospital’s commitment to serving and supporting our community. As a community member, we hope that you continue to enjoy our “Health Works” magazine and we welcome your feedback. If there is a topic that you would like us to address in an upcoming issue, please send your comments to publicrelations@montefiorenyack.org.

We are your community hospital here to serve your healthcare needs.

BEST REGARDS, MARK GELLER, MD President & CEO Montefiore Nyack Hospital

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Share Your Story!

DO YOU HAVE A MONTEFIORE NYACK HOSPITAL OR HIGHLAND MEDICAL, P.C., HEALTH SUCCESS STORY? IF SO, WE’D LOVE TO KNOW ABOUT IT! PLEASE EMAIL YOUR STORY TO: PUBLICRELATIONS@ MONTEFIORENYACK.ORG. WITH YOUR PERMISSION, IT MAY BE FEATURED IN A FUTURE ISSUE OF MONTEFIORE NYACK HOSPITAL’S HEALTH WORKS.

EDITORIAL STAFF LAUREN MALONE Director of Public Relations and Marketing ROSE MCALLISTER CROKE Marketing Manager BRIANA PUNCAR Marketing Manager, Highland Medical, P.C. CELIA VIMONT Contributing Writer

845-348-2000 MontefioreNyack.org facebook.com/MontefioreNyack @MontefioreNyack

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IN THIS ISSUE

fall 2018

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BREAST CANCER MYTHS DEBUNKED Learn the truth behind common misconceptions.

HELPING TEENS CONQUER STRESS Stress can lead to risky behavior. Use our tips to help teens cope.

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BACK ON TRACK WITH 3 NEW JOINTS New hips and a new knee: one patient’s inspiring story.

ALZHEIMER’S: HOPE ON THE HORIZON Early diagnosis and treatment can make a difference.

Excellence Award MONTEFIORE NYACK HOSPITAL EARNS AWARD RD FOR LACTATION N SUPPORT

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12 MEN & DEPRESSION How to help a loved one get the care he needs to regain his zest for life.

15 MEDICATION MISHAPS Taking multiple medications? Our tips can prevent problems.

14 STAYING AWAKE AT THE WHEEL Avert drowsy driving, a lethal danger.

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MONTEFIORE NYACK HOSPITAL has been awarded the 2018 IBCLC Care Award for excellence in lactation care by The International Board of Lactation Consultant Examiners® (IBLCE®) and International Lactation Consultant Association® (ILCA®). This honor recognizes organizations Consu whose healthcare professionals hold IBCLC® certification and wh provide a lactation program that offers activities to help promote pr and support breastfeeding. To learn more about the IBCLC Care an Award, call 845-348-2676 or visit montefiorenyack.org/maternity.

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THE TRUTH ABOUT BREAST CANCER MYTHS

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WHEN IT COMES TO BREAST CANCER, THE DISEASE WOMEN FEAR MOST, INACCURATE BELIEFS ARE COMMON. LEARN THE TRUTH BEHIND THESE MISCONCEPTIONS.

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any myths surround breast cancer, the most frequently diagnosed cancer in women, according to Robbi Kempner, MD, FACS, Medical Director of Breast and Women’s Health Prevention Services at Montefiore Nyack Hospital.

“Knowing the facts about breast cancer is important in order to get the right diagnosis and treatment,” she says. Read on for some of the most common myths Dr. Kempner hears from patients—and to learn the real facts.

FOR ADDITIONAL INFORMATION ABOUT THE BREAST CENTER AT MONTEFIORE NYACK HOSPITAL, CALL 845-348-8551.

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RISK FACTORS

DIAGNOSIS

Myth: There’s nothing I can do to decrease my risk of breast cancer.

Fact: Living a healthy lifestyle can help decrease your risk. This includes vigorous exercise two to three times a week, a low-fat diet high in whole grains, having no more than one alcoholic drink a day, not smoking, and keeping your weight under control after menopause.

Myth: If I feel a lump that doesn’t show up on a mammogram, it can’t be cancer.

Fact: “If you’ve recently had a mammogram that didn’t show any signs of cancer and you then find a lump, it doesn’t mean it’s not cancer,” explains Dr. Kempner. Overall, screening mammograms miss about 20 percent of breast cancers that are present at the time of screening, according to the National Cancer Institute. If you feel something that did not show up on a mammogram, see a breast health physician for advice and consultation and a further workup.

Myth: Having a “breast cancer gene” such as BRCA1 or BRCA2 means I will definitely develop breast cancer.

Fact: Not everyone with a breast cancer gene will develop breast cancer.

It’s true that women with one of these genes have a higher risk. According to the National Cancer Institute, 12 percent of women in the general population will develop breast cancer sometime during their lives, while 55 to 65 percent of women who inherit a harmful BRCA1 mutation and around 45 percent of women who inherit a harmful BRCA2 mutation will develop breast cancer by age 70.

Myth: Breast cancer is less of a risk after age 70.

Fact: Quite the opposite— the risk of all cancer, including breast cancer, increases with age. “Although guidelines generally recommend that women over 70 discontinue mammograms, we advise all women should continue to be screened with mammography as long as they remain healthy and vigorous and have a reasonable life expectancy,” says Dr. Kempner.

Myth: There’s just one type of mammogram.

Fact: A new 3D Mammography exam is more effective 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 cancer,” says Dr. Kempner. The Breast Center at Montefiore Nyack Hospital is one of the few providers in the Rockland County area to offer this technology.

TREATMENT Myth: If I’m diagnosed with breast cancer, I must have surgery immediately.

Fact: Although it’s understandable that a woman would want immediate treatment, it’s safe to take a little time to get a second opinion, and to make sure you have the right information about the type of surgery and other treatment options that are best for you.

Myth: Having a mastectomy is more likely to increase life expectancy for a woman with breast cancer than having a lumpectomy.

Fact: The life expectancy and survival rates are the same for most breast cancers whether a woman is treated with a lumpectomy or a mastectomy. It’s true that there is a small risk that breast cancer may return after a lumpectomy with radiation. However, in those cases, a woman who goes on to have a mastectomy has the same survival rate and life expectancy as a woman who had a mastectomy right after diagnosis.

Myth: Breast cancer surgery hasn’t changed in recent years.

Fact: There have been a number of advances in the field, including a new procedure called Radioactive Seed Localization. With this technique, the surgeon implants a self-enclosed, low-energy “seed” (the size of a grain of rice), which allows him or her to precisely target and remove small breast cancer tumors. Montefiore Nyack Hospital is the only hospital in the area offering this innovative procedure.

Myth: Breast cancer surgery always results in ugly scars.

Fact: Although breast surgery does leave scars, it’s possible to hide them so they’re not visible. “At Montefiore Nyack Hospital we use the Hidden Scar approach, in which we place the incision in a location that is hard to see so the scar isn’t visible when your incision heals,” says Dr. Kempner. As a result, you have little to no visible reminder of the surgery or your cancer. It’s even possible to have a mastectomy with reconstruction without a visible scar.

Myth: Mastectomies require removing all of the breast tissue including the skin and nipple.

Fact: New nipple- and skin-saving techniques have been developed that are just as effective at removing cancer and just as safe as a traditional surgery. The main difference is the benefit to the patient in her post-surgical appearance. These procedures are part of a new field called oncoplastic surgery, a coordinated breast cancer surgery with breast oncologic surgeons and plastic surgeons who use the latest oncologic and reconstruction techniques for best possible survival and cosmetic outcomes.

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BACK ON TRACK WITH

3 NEW JOINTS AFTER HAVING BOTH HIPS AND ONE KNEE REPLACED WITHIN FIVE MONTHS, JOHN KOMOROWSKI IS BACK TO WORK AT THE FAMILY RECYCLING BUSINESS.

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ohn Komorowski knew it was time to have surgery on his hips and knee when he was visiting his daughter last fall. “I couldn’t stand up straight, and when I got up in the middle of the night, my joints made a clicking sound that she could hear on the other side of the house,” he says.

John’s joint problems started four decades ago, when he was in a serious car accident in his senior year of college and dislocated his left hip. Over the years, his work in the recycling business took a toll on his body. Four years ago, he slipped on ice. “That accelerated my downward trend,” says John. He also had severe osteoarthritis. In normal joints, cartilage—a firm, rubbery material— covers the end of each bone, and provides a smooth, gliding surface for joint motion. In osteoarthritis, the cartilage breaks down, causing pain, swelling and problems moving the joint.

A friend recommended that John

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he says. Dr. Fond agrees: “In order for the surgery to be successful, the patient needs to have a positive outlook.

Recovery can involve pain, but most patients with the right attitude do well, as John did.”

John was so pleased with his experience at Montefiore Nyack Hospital that he has already recommended Dr. Fond to someone else. He says, “I don’t think you can get better care than I received.”

PICTURED: JASON FOND, MD, DIRECTOR OF ORTHOPEDIC SURGERY AT MONTEFIORE NYACK HOSPITAL, AND HIS PATIENT JOHN KOMOROWSKI, WHO HAD THREE JOINT REPLACEMENTS.

consult Jason Fond, MD, Director of Orthopedic Surgery at Montefiore Nyack Hospital. At the hospital’s Joint Replacement Center, Dr. Fond took a series of X-rays, and recommended that both of John’s hips and his left knee be replaced. “In patients who have tried more conservative treatments, such as physical therapy and injections, and still find their quality of life is considerably affected by joint pain, joint replacement surgery can be a very effective way to treat significant osteoarthritis,” says Dr. Fond.

3 SURGERIES IN 5 MONTHS “Dr. Fond gave me the choice of doing the surgeries close together or more spread out, and I decided to do them one after the other,” says John. Dr. Fond performed the three surgeries over a period of five months.

“I don’t give every patient that option,” he explains. “But John was extremely eager and motivated. He also didn’t have other serious medical issues that could slow down recovery. He progressed so well after each surgery that it was easy to say, ‘Let’s go on to the next one.’” John’s

right hip was followed by his left hip and finally his left knee.

His first operation was at the end of November, and he was back helping his son with the family recycling business before Christmas. “The second hip was much easier, because I knew what to expect,” says John. “After both hip operations, I received physical therapy at home, with a focus on getting my posture back. Before the surgeries, I was walking at an angle, but now I can stand up straight. People tell me I look like I grew three inches.”

Dr. Fond warned John that recovery from the knee procedure would be harder. The first two weeks of rehab were difficult, but they were made easier by a physical therapist who once again came to John’s home.

HARD WORK PLUS A POSITIVE OUTLOOK John’s hard work in physical therapy paid off, and he’s now back to getting up at 1 a.m. for work. “You can have the best surgeon who corrects your problem, but you have to work at it to really improve,”

FOR MORE INFORMATION ABOUT THE JOINT REPLACEMENT CENTER, CALL 845-348-2663 OR VISIT MONTEFIORENYACK.ORG/ JOINT-REPLACEMENT.

GETTING PATIENTS MOVING AGAIN Every year, board-certified orthopedic surgeons perform hundreds of knee and hip replacements at The Joint Replacement Center at Montefiore Nyack Hospital. “We provide individualized care to every patient, with the benefit of being near home,” says the Center’s director, Jordan Simon, MD. Candidates for joint replacement experience chronic joint pain, most often from osteoarthritis. “If you have tried conservative treatments and still have pain, difficulty walking, sleeping, climbing stairs or getting in and out of a chair, then joint replacement may be an option for you,” says Dr. Simon.

Joint replacement patients typically spend two nights in the hospital. Once they’re home, they begin in-home physical therapy.

Many patients can return to work in four to six weeks.

Today’s prosthetic knee joints commonly last between 10 and 15 years; hip joints, between 15 and 20 years.

Earlier this year, Montefiore Nyack Hospital earned The Joint Commission’s Gold Seal of Approval® for Hip and Knee Joint Replacement for the third consecutive time since 2014.

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HOW TO HELP YOUR TEEN

BEAT STRESS STRESS AND RISKY BEHAVIOR GO HAND IN HAND FOR TEENS, SO IT’S IMPORTANT TO KEEP STRESS IN CHECK. USE THESE TIPS TO GET THE NEW SCHOOL YEAR OFF TO A STELLAR START.

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s the school year begins, stress levels rise for teens.

Whether they’re starting high school or coping with the pressure of applying to college, teens can feel anxious or even panicked about academic demands and how to fit so many activities into their schedules.

A new school year can bring with it new and challenging social situations as well. It can be overwhelming to go to school, play sports, be involved in clubs and spend time with friends, in addition to hours of homework. Plus, school often starts so early that teens are exhausted before the day even begins.

UNHEALTHY COPING Some teens try to deal with these pressures by using drugs or alcohol, says Sandhya Katz, MD, attending physician in the Department of Pediatric Emergency Medicine at Montefiore Nyack Hospital. “Some teens suffering from depression, anxiety or stress may turn to drugs or alcohol to lessen feelings of distress,” she said. “Others may use certain illegal drugs or prescription stimulants obtained illegally because they think those substances will improve their performance.”

The statistics are alarming. In the most recent nationwide Monitoring the Future annual survey, 62 percent of high school seniors and 23 percent of 8th graders said they had tried

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alcohol. Among high school seniors, 37 percent said they had used marijuana in the past year.

BETTER CHOICES There are healthy steps teens can take to reduce the stress they may be feeling (see sidebar). Parents can help by boosting their teen’s self-esteem. Many times, teens turn to risky behavior because they have a negative view of themselves, says Dr. Katz. “Let them know you care, offer empathy and compassion, and give plenty of praise. If they feel better about themselves, they may be less likely to do risky things to try to get other people to like them.”

Setting limits on social media can help too. Teens feel peer pressure 24/7 on Instagram, Facebook and other social media.

They may feel they need to respond immediately or their friends will be mad. Although many teens initially resist “social media-free” time, they often begin to feel emotionally free when they unplug. Have devices turned off overnight so they don’t disrupt sleep.

Ultimately, a key part of helping your stressed teen is to keep a dialogue going, says Dr. Katz. If you see behavior that concerns you, don’t confront your teen—you don’t want to turn them away. Instead, she advises parents, “Ask open-ended questions, and do a lot of listening.”

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62% TIPS FOR TEENS

OF HIGH SCHOOL SENIORS HAVE TRIED ALCOHOL

These steps can help to reduce stress and improve overall health, enabling you to work more efficiently and have more fun.

• MOVE YOUR BODY. Physical activity is one of the most effective stress-busters.

Find activities you enjoy and build them into your routine.

• GET ENOUGH SHUT-EYE. Sleep is key for both physical and emotional wellbeing. Ideally, teens should get nine hours a night.

• SET A SCHEDULE. Plan ahead for when you will do your schoolwork, and stick to your schedule. Afterward, you can enjoy free time without guilt.

• ENJOY YOURSELF. Besides physical activities, find other hobbies or activities that bring you joy.

• LET YOURSELF SHINE. Focusing on your strengths will help you keep your stresses in perspective.

• TALK IT THROUGH. It’s so much easier to manage stress when you let others lend a hand. Talk to a parent, teacher or other adult.

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OF HIGH SCHOOL SENIORS BINGE DRINK ( 5 OR MORE DRINKS IN A ROW )

37% OF HIGH SCHOOL SENIORS HAVE USED MARIJUANA

23%

OF 8TH GRADERS HAVE TRIED ALCOHOL SOURCES: NATIONAL INSTITUTE ON DRUG ABUSE; NATIONAL INSTITUTES OF HEALTH; U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES.

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ALZHEIMER’S:

HOPE ON THE HORIZON EARLY EVALUATION AND DIAGNOSIS CAN MAKE A DIFFERENCE FOR PATIENTS WITH THIS DEVASTATING DISEASE.

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f your spouse or parent suddenly has difficulty remembering things or has an abrupt change in personality, they may be experiencing the early signs of Alzheimer’s disease. “It’s important to have the person evaluated by a neurologist so treatment and planning for care can start as soon as possible,” says neurologist Earl Zeitlin, MD, of Highland Medical, P.C. Alzheimer’s disease is the most common form of dementia. Early signs can include getting lost, difficulty with money or paying bills, repeating questions, taking longer to complete tasks, losing things and a change in personality. “It used to be thought that memory difficulties were a normal part of aging, but now we know that in many cases it’s a sign of underlying disease,” says Dr. Zeitlin.

EARLY DIAGNOSIS HELPS PATIENTS & FAMILIES In many cases, by the time a loved one is brought to a doctor, the Alzheimer’s is advanced. There are several reasons early diagnosis is beneficial. The sooner the family understands the diagnosis, the earlier they can plan ahead for care. “As the disease progresses,” says Dr. Zeitlin, “the person may be more prone to dangerous situations, such as leaving the stove on or wandering away from home. Supervision becomes increasingly important.”

A person diagnosed early with Alzheimer’s may benefit from medicine that slows the disease. “The treatments we have now are not miraculous, but they may result in some mild benefit for a year or two,” says Dr. Zeitlin. The three medications currently approved by the U.S. Food and Drug Administration for mild to moderate Alzheimer’s are Aricept, Exelon and Razadyne. These drugs, known as cholinesterase

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inhibitors, treat the cognitive symptoms (memory loss, confusion and problems with thinking and reasoning) of the disease. For more advanced Alzheimer’s, doctors may prescribe a drug called Namenda, which also may slow the progression of the disease.

NEW TREATMENTS ON THE WAY Scientists are conducting exciting research that targets the underlying cause of Alzheimer’s disease, according to Marc London, MD, Chief of Neurology at Montefiore Nyack Hospital and a neurologist at Highland Medical, P.C. “Current medications are aimed at improving memory processing in the brain cells that are still intact or are only partially impaired,” he says. “Researchers are looking for medications that will prevent the disease from developing, or arrest its progression and possibly even reverse it.”

Scientists now understand that Alzheimer’s disease most likely begins to develop years before a person shows memory impairment, says Dr. London. A protein called amyloid accumulates in abnormal quantities in the brains of people with Alzheimer’s. This buildup of amyloid causes clumps, or plaques, that can damage and destroy brain cells. Researchers are developing drugs to stop the formation of these amyloid plaques, or eliminate the amyloid that is already present in the brain. Researchers also are developing medicines that will target a protein called tau. In Alzheimer’s, threads of tau protein twist into abnormal tangles inside brain cells, leading to the decline and death of the cells.

“We are optimistic that in the next five to 10 years there will be some major breakthroughs in the treatment of Alzheimer’s disease,” says Dr. London. “It is likely that we will have a combination of medications that target different aspects of the disease.”

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TO MAKE AN APPOINTMENT WITH A PHYSICIAN AT HIGHLAND MEDICAL, P.C., ROCKLAND NEUROLOGICAL ASSOCIATES, PLEASE CALL 845-353-4344. FOR MORE INFORMATION, VISIT HIGHLANDMEDICALPC.COM.

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DEPRESSION HERE’S WHAT YOU NEED TO KNOW TO HELP A LOVED ONE REGAIN HIS ZEST FOR LIFE.

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f you’re concerned about a man in your life who seems depressed, let him know you care and encourage him to seek help, says Michael Levy, MD, Senior Attending Physician in the Department of Psychiatry at Montefiore Nyack Hospital.

“Men are much less likely than women to ask for help when they feel depressed,” he says. “They’re more likely to fall off the radar when they’re struggling.”

Fortunately, most men with depression who seek treatment can get better and regain their zest for life, says Dr. Levy.

CAN LOOK DIFFERENT IN MEN

WHO’S AT GREATEST RISK? There are different forms of depression.

Some people have one or several episodes of major depression, which interfere with their ability to work, sleep, eat, study and enjoy life. Others have persistent depressive disorder, which lasts for at least two years.

Depression seems to be more common in the elderly, says Dr. Levy.

“It is often related to loss—as you get older you can lose loved ones, struggle with finances and declining health.” Men who are single, widowed or divorced are at higher risk of depression, as well as those with alcohol use disorder, financial problems, unemployment or a family history of depression.

DETECTING DEPRESSION Men who are depressed may have wellknown signs, such as feeling sad, “empty,” flat or hopeless. They may feel tired, not be able to concentrate or sleep, or they may sleep too much. They can withdraw from friends and family or become

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isolated. These signs are also common in women with depression. But depressed men are more likely than women to show anger, irritability or aggressiveness.

Men struggling with depression also may have physical symptoms, such as a racing heart, tightening chest, ongoing headaches or digestive issues.

The doctor will perform an exam and possibly lab tests to rule out other medical conditions that may have symptoms similar to depression. He or she also will ask about symptoms, including when they started, how severe they are, whether they have occurred before and whether there is a family history of depression or other mental health disorders.

DON’T IGNORE SIGNS OF DEPRESSION Anyone experiencing five or more of these symptoms for two weeks or longer should see their doctor or a mental health professional: • Persistent sad, anxious, or “empty” mood • Feelings of hopelessness, or pessimism • Irritability • Feelings of guilt, worthlessness, or helplessness • Loss of interest or pleasure in hobbies and activities

• Difficulty sleeping, early-morning awakening or oversleeping • Appetite and/or weight changes

• Moving or talking more slowly

• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease, even with treatment

• Feeling restless or having trouble sitting still

• Thoughts of death or suicide, or suicide attempts

• Decreased energy or fatigue

“Talk-based therapy can help men learn new ways of thinking and behaving and help them change habits that can contribute to depression.”

• Difficulty concentrating, remembering, or making decisions

Source: National Institute of Mental Health

A COMBINATION OF TREATMENTS Treatment often includes a combination of antidepressant medication and/ or psychotherapy. “A combination of both approaches is especially effective,” says Dr. Levy. Antidepressants (if helpful) generally are taken for at least six months before the doctor determines whether the person should try to start tapering off the medication. “People with more than one episode of depression often stay on the medication indefinitely,” he says.

Talk-based therapy can help men learn new ways of thinking and behaving and help them change habits that can contribute to depression.

HOW CAN I HELP? If you think someone is depressed, offer to help him find a doctor and make an appointment. If he doesn’t want to see a mental health professional, suggest he see his primary care doctor for physical

symptoms such as feeling tired or trouble concentrating.

Offer to bring him to doctor’s appointments and try to find activities that will keep him active and engaged.

Offer encouragement rather than advice. Often, the best support you can give is simply to be present, be patient and listen.

SUICIDE ALERT Never ignore comments about suicide. If a person makes comments about suicide, alert his family, doctor or therapist.

“More than half of people who ultimately commit suicide have talked about suicide or made a previous attempt in the prior six months,” says Michael Levy, MD. For immediate help, call the 24hour, toll-free confidential National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or go to suicidepreventionlifeline.org.

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KNOW THE SIGNS

DROWSY DRIVING: A DEADLY RISK FALLING ASLEEP AT THE WHEEL IS A COMMON PHRASE FOR POOR PERFORMANCE. BUT WHEN YOU’RE DRIVING, IT CAN KILL. USE OUR TIPS TO STAY AWAKE.

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rowsy driving is a major problem in the United States. According to the National Sleep Foundation, 60 percent of Americans have driven while feeling sleepy and 37 percent admit to having fallen asleep at the wheel in the past year. The National Highway Traffic Safety Administration estimates at least 100,000 police-reported crashes are the direct result of drowsy driving annually, causing an estimated 1,550 deaths and 71,000 injuries. According to a new study by travel and insurance group AAA, one in 10 U.S. highway crashes is the result of drowsy driving—eight times more than what previous estimates have indicated.

If you feel yourself nodding off while driving, it’s not enough to roll down your window, turn on the radio, chew gum or pinch yourself. “Pull over, find a rest area

and take a brief nap—20 minutes or so,” says Anita Bhola, MD, FCCP, FAASM, medical director of The Edythe Kurz Center for Sleep Medicine at Montefiore Nyack Hospital. “If you’re driving with someone, change drivers,” she advises.

In many cases, a person who drives while drowsy has not slept enough. In fact, studies show that being awake for more than 20 hours results in an impairment equal to a blood alcohol concentration of 0.08%, the legal limit in all states.

But drowsy driving also can be caused by untreated sleep disorders such as obstructive sleep apnea, medications such as sedating antihistamines or antidepressants, drinking alcohol, nightshift work or working more than 60 hours a week. Business travelers who get off a plane jetlagged and get directly behind the wheel are at risk, says Dr. Bhola.

Commercial truck drivers, especially longhaul drivers, are also at risk. Being sleepy at the wheel makes you less able to pay attention on the road and slows your reaction time.

WHO’S MOST AT RISK? Teens are by far the most likely to drive while tired. “Fifty-five percent of all drowsy driving-related crashes are seen in those less than 25 years of age,” says

Signs you should stop driving and rest include: • Difficulty focusing, frequent blinking or heavy eyelids • Daydreaming; wandering/ disconnected thoughts • Trouble remembering the last few miles driven; missing exits or traffic signs • Yawning repeatedly or rubbing your eyes • Trouble keeping your head up • Drifting from your lane, tailgating or hitting a shoulder rumble strip • Feeling restless and irritable

Dr. Bhola. “Teens have terrible sleep hygiene—they stay up late, they have to get up early for school and experience phase delay in their internal clock. They should be getting 8.5 to 9.5 hours of sleep, but they often don’t get anywhere near that and are among the most sleepdeprived Americans. Additionally, they are inexperienced drivers.”

Drowsy driving accidents are most likely to occur between midnight and 6 a.m., when the body’s need for sleep is greatest. Midafternoon is another common time for fatigue-related crashes.

Male drivers and people who drive alone are at highest risk.

PREVENT DROWSY DRIVING The best way to prevent drowsy driving is to get enough sleep: 7 to 9 hours for adults, and 8.5 to 9.5 hours for teens.

If you’re really sleepy, get a ride home, take a taxi or use public transportation. If you’re on a long trip, take a break about every 100 miles or every 2 hours. Drink some caffeine to keep you alert.

“Most people underestimate how drowsy they are, and focus on the need to get somewhere,” says Dr. Bhola. “But it only takes four seconds of lapse in attention to cause an accident. Don’t push yourself. Drive alert, arrive alive.”

IF YOU HAVE SYMPTOMS OF A SLEEP DISORDER, SUCH AS SNORING OR FEELING SLEEPY DURING THE DAY, CALL THE EDYTHE KURZ CENTER FOR SLEEP MEDICINE AT MONTEFIORE NYACK HOSPITAL AT 845-348-2209.

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SIMPLE STEPS

TO AVOID MEDICATION MISHAPS FOLLOWING THESE TIPS WILL HELP ANYONE TAKING MULTIPLE MEDICATIONS AVOID POTENTIAL ISSUES.

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or many older adults, staying as healthy as possible means taking a number of different prescription pills. The more medications needed, the greater the risk of interaction problems. Fortunately, there are steps older adults and their caregivers can take to reduce the odds of a medicine-related mishap. To stay safe, follow these recommendations from Daryl Schiller, PharmD, Director of Pharmacy Services, and Maureen Fallon, RN, MPA, Administrator of Home Care at Montefiore Nyack Hospital.

1

Get all your drugs from one pharmacy. This way, the pharmacist will know all the drugs you take and can alert you and your doctor to potentially dangerous drug interactions. “So many people have different drugs prescribed by different doctors,” says Schiller. “The pharmacist can see the big picture. In some cases, the pharmacist can recommend that the doctor prescribe a similar drug that won’t cause interactions or can tell you when to take each medicine so they won’t interact.”

2

Tell your pharmacist about which over-the-counter medicines you’re taking. These drugs can cause drug interactions too. “For instance, if you take a sleeping pill and take a sedating antihistamine on top of it for allergies, you could be putting yourself at risk of dizziness and falls,” says Schiller.

3

Keep a list of medications. Whether it’s on an app or written on paper, a list of medications should include the name and dose of the drug and how often the person takes it. If you’re taking a family member to the hospital, bring the list with you. “It’s important to keep the list updated, and bring it to every doctor visit,” says Fallon. She recommends keeping all medication in the bottle it was dispensed in so you can see the name, dose and expiration date of the drug.

4

Ask questions. When your doctor prescribes your medication and when you pick it up from the pharmacy, ask questions. What are the side effects? When should you take it?

How much? Can you take it with food? How should you feel if the drug is working properly? Can you crush or split the pill if you have difficulty swallowing it? What happens if you miss a dose?

5

Tell your doctor or pharmacist if you can’t afford your medication. They may be able to find you less expensive alternatives or find resources to pay for the drugs. Schiller advises, “Don’t make decisions on your own to stretch medications by cutting them in half because you can’t afford the co-pays.”

MONTEFIORE NYACK HOSPITAL HOME CARE IS A NEW YORK STATE MEDICARE-CERTIFIED HOME HEALTH AGENCY AND IS ACCREDITED BY THE JOINT COMMISSION. FOR MORE INFORMATION, CALL 845-638-8700 OR VISIT MONTEFIORENYACK.ORG/HOME-CARE.

M O N T E F I O R E N YAC K .O R G

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