Tuesday, March 23, 2021

Social worker Joseph Alvino on how ‘connecting with others can really help’




By Chandra Wilson 

March 23, 2021


During the April peak of the COVID-19 pandemic in New York City last year, social worker Joseph Alvino was sick with COVID-19 himself. 


“I had every symptom in the book,” he says. He was also mourning the loss of his father from the illness. But Joe, who has been with VNSNY for over 25 years, opted to continue visiting patients by telephone, in keeping with COVID-19 protocols, a heroic act that gave him purpose and provided patients with a compassionate and expert resource.


“It was important for me to keep my mind busy and active, doing the best I could to help my patients with all they’re dealing with,” says Joe.


A full-time social worker with VNSNY Home Care in Queens, Joe cares for patients coping with a variety of medical conditions and for their often-overburdened family caregivers. During last year’s peak, at a time when even the simple act of going to the grocery store felt riddled with peril, he helped clients get through the day, bringing them updated information on the virus and preventive measures and assisting them in navigating the anxiety and depression amplified by the need to socially distance from friends and family members.


Joe recalls one client telling him that his phone call made her day.


“A phone call might not seem like much on the surface,” he says, “but considering what everybody was going through, it meant a lot. Reaching out and just having a conversation goes a long way, especially when people can’t visit with their families. I ask open-ended questions about their concerns, validate their feelings, and try to normalize what they are going through. I don’t sugar-coat things—they have every right to be anxious. It’s a frightening time, but connecting with others can really help.”


“While the pandemic has limited access to many community resources and services, Joe and his fellow VNSNY Home Care social workers, along with colleagues across VNSNY, have coordinated closely to share information and problem-solve together to address the needs of patients and each other.


Joe is particularly grateful for the compassion he received from his colleagues as he battled COVID-19 and mourned the death of his father on April 14. “Everybody has been so supportive,” he says. “Everybody stands out. That makes a difficult situation just that much easier.” 


Visit www.VNSNY.org or call 1-800-675-0391 to learn more about home- and community-based services that can be integrated into your health and wellness needs. 


Wednesday, March 3, 2021

Helping you prevent a heart attack


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Dr. Leandro Slipczuk, PhD, FACC, cardiologist; director, Advanced Cardiac Imaging; and director, Cardiovascular Atherosclerosis and Lipid Disorder Center, Montefiore Health System

February is American Heart Month. At Montefiore, we offer a full range of cardiac care and advanced screening tools which help us not only treat people with current health conditions, but also prevent new conditions from developing. 


Cardiovascular disease (CVD) –  disease of the heart and blood vessels – is the leading cause of death worldwide. The main cause of CVD is one or more blockages in the arteries that bring blood to the heart.


Plaque, which are small bunches of fat made up of cholesterol, can build up inside the arteries without producing any symptoms – that is, until the plaque breaks off.


As the plaque breaks, artery obstruction accelerates through the formation of a blood clot. Obstructive plaques prevent the free flow of oxygen-rich blood to the heart muscle, causing a heart attack. This build-up of plaque is a particular type of CVD known as coronary disease. 


Currently, up to half of patients with coronary disease don’t know they have a blockage until they’re being rushed to the hospital, having a heart attack. Unfortunately, about 16% of these heart attack patients die, and many more are left with long-lasting health consequences, such as heart failure and arrhythmias (an irregular heartbeat).


Fortunately, coronary disease is a treatable condition. But, seeking help after symptoms have developed is too late. 


Adopting a healthy lifestyle is key to preventing CVD, which includes eating a heart-healthy diet; having well-controlled blood pressure, cholesterol and blood sugars; quitting smoking; staying physically active; and losing excess weight. 


How do doctors determine who’s most at risk for a heart attack? 


Traditionally, doctors have used tools and special equations to determine a person’s risk for CVD, and have based a person’s care plan on these tools. This approach works well when generalizing the health of a large population, but not as well when determining an individual care plan. 


Since the goal is to identify and help patients before they have a heart attack or stroke, it’s important that our screening tools are as accurate and efficient as possible.


For patients without a history of heart attack or stroke, the best way to measure how much plaque is built-up in a patient’s heart is a figure known as a coronary calcium score (CAC). CAC can be measured by taking a picture of the heart, known as a CT scan, which allows health professionals to see how much plaque build-up is present. Then, health professionals compare these results with the average findings for a person’s age, gender and ethnicity.


CAC is a much better way to determine who’s most and least at risk of experiencing a heart attack. In fact, CAC has been particularly useful in patients deemed at low-to-intermediate risk – which is why it’s an excellent approach for catching CVD before it turns into a much larger health issue.


Once plaque is detected by CAC, medications can be tailored to the patients’ individual risk. In addition, lifestyle changes can be discussed, and together, this personalized care plan can significantly decrease a patient’s 10-year risk of having a heart attack. If there is no plaque, lifestyle interventions can play a larger role than medications in preventing a heart attack avoiding unnecessary medications.


But, when there is significant calcification, lifestyle modifications alone are usually not enough. In this case, a group of medications called statins (which decrease blood cholesterol) together with aspirin can significantly decrease a patient’s risk. Moreover, we currently have a wide pool of medications for prevention that can be used on top of statins for patients at high-risk of cardiac events, like a heart attack. 


How can I learn if I’m at risk?

Getting your CAC score taken is painless. During the scan, patients simply lie down on a table which then slides the patient into the CT machine, scanning the heart in seconds. The entire procedure takes about 15 minutes and results are available on the same day. The patient’s doctor will then be able to incorporate the CAC score with other risk factors and discuss a personalized care plan to decrease a person’s risk of a heart attack.


Based on the results of a person’s first CAC, health professionals can determine how frequently this test should be repeated, but most times it’s not repeated at least for five-to-10 years. Interestingly, studies have even shown that CAC can help patients stick to lifestyle modifications, such as diet and weight loss!


CAC score is currently available at multiple locations at Montefiore. Speak with your doctor to determine for risk for CVD and whether you should schedule a CAC test soon. 


For more information, please call 646-670-5120.


Wednesday, February 24, 2021

The Changing Face of Eating Disorders




By Dr. Hina Talib, Adolescent Medicine Specialist, Children’s Hospital at Montefiore


In recognition of National Eating Disorders Awareness Week, which takes place February 22 – 28, it is important to raise awareness and share how eating disorders affect our community.


Typically, someone with an eating disorder was assumed to be a skinny teenage girl, usually white and affluent. Gone are those days. Those of us caring for teens now recognize eating disorders, which are a group of mental health conditions with potentially life-threatening consequences, in more diverse groups of teens. 


Paying attention to new or unusual eating habits is more important than ever, as the COVID-19 pandemic has made it more challenging to recognize who may be struggling with an eating disorder. And since the pandemic hit, fewer teens are coming in for their yearly check-ups. Here are five ways the face of eating disorders have changed over the last decade: First, younger teens and pre-teens are now facing eating disorders, including Anorexia Nervosa, which we used to think of more in older girls and adults. Pre-teens can actually have more rapid and drastic weight loss and have other mental health challenges like anxiety and depression. They are less likely to binge eat or force themselves to vomit, so, they may not look like a “typical” eating disorder, but they are still at risk. In fact, pre-teens can become very sick as a result of malnutrition from rapid weight loss. Fortunately, earlier treatment can lead to earlier recovery.


Another group we do not typically think about are boys, especially younger boys, who are often missed and have later diagnoses, when medical complications may arise. Doctors as well as families still don’t think of eating disorders in boys, who may be focused on body shape and muscles for sports, but are still struggling with troubling, disordered thoughts about food and their bodies. Student athletes of all genders should be screened at their yearly check-ups for eating disorders - another good reason not to skip sports physicals even during the pandemic.


Third, teens of color have historically not been given attention both in diagnosis and treatment of eating disorders, but studies in America now show that eating disorders are found in all races and ethnicities. It is important to do more to increase access for Hispanic and Black teens to skilled care, as well as to educate families and communities about eating disorders, as they might not be aware that eating disorder can affect non-white teens too.Fourth, teens who identify as LGTBQIA+ are actually at a higher risk, and teens who are transgender as well. Studies show that students in the sexual minority, including those who are lesbian, gay, or bisexual have more unhealthy eating and dieting than cisgender students. This is also true for young adults who may be attending college, as studies have shown similar risk in college students who identify as transgender.


Finally, teens who are not underweight and are actually overweight, may still have an eating disorder. These are challenging cases, as sometimes teens get a lot of praise for losing weight from doctors and families. This highlights the importance of discussing healthy eating and physical activity, and not solely focusing on a number on the scales.


It is important to recognize that teens of all ages, genders, races and even weights could potentially face an eating disorder. This awareness is the first step to identifying all teens who may be struggling with food, weight, and nutrition issues.


If you have concerns about your child having an eating disorder, please discuss with your pediatrician. At the Children’s Hospital at Montefiore - Division of Adolescent Medicine - we offer culturally competent and inclusive eating disorder treatment for all teens and families facing eating disorders. You can also contact the National Eating Disorder Association helpline at 800.931.2237, which has Spanish translation counselors as well. 

Tuesday, February 23, 2021

Keeping Hearts Healthy During the Pandemic




By Fatima Shell-Sanchez, Registered Nurse with Visiting Nurse Service of New York


February is National Heart Month, and as New Yorkers continue to wear masks, practice social distancing, take extra caution with hand washing and get vaccinated for COVID-19 when they are eligible, they’re also encouraged to check in with their health professionals about good heart health—especially with sedentary lifestyles on the increase due to COVID-19.


Hypertensive heart disease (HHD) is the leading cause of death for all Americans, and something to stay mindful of during the pandemic. HHD increases with age, and includes heart failure, coronary artery disease, and other conditions. 

Each year, approximately 100,000 home care patients in the U.S. report a prior stroke, and a recent study at the Visiting Nurse Service of New York Center for Home Care Policy & Research further shows that, at start of care, recurrent stroke risk is high for many patients and in particular, African Americans, due to uncontrolled blood pressure.


The American Heart Association (AHA), says nearly half of all Americans have hypertension, or high blood pressure, and many don’t even realize they have it. For African-American men and women, the risk for developing hypertensive heart disease is even higher as roughly 40 percent are estimated to have high blood pressure.


As a Registered Nurse Care Coordinator with the Visiting Nurse Service of New York in the Bronx, I work with many patients who are diagnosed with these conditions. I educate them on managing their disease and help them follow simple tips that get them on track for making healthier lifestyle choices. Here are a few of those helpful reminders.


Limit Saturated Fat 


Eating too much saturated fat can increase the cholesterol level in your blood, ultimately increasing your risk of heart disease. Opting for leaner meats and lower-fat dairy products helps.


Eat Fish


Fish is a great source of omega-3 fats, which can help protect against heart disease.


Restrict Salt Intake


Try to avoid adding salt to food you are cooking and do not add it to pre-made food. The AHA recommends adults eat less than 2,300 mg of salt daily, about one teaspoon, but the ideal limit is 1500 mg (approximately 1/2 tsp). 


Hungry? Try Fiber 


Fiber, such as oats, whole grains, potatoes, fruits and vegetables, can help lower your risk of heart disease. Try eating at least 30g daily, which is approximately one ounce.


Read Labels 


To make healthier choices, read the amount of salt content on labels and add to the amount you take in each day. Always check fat, salt, and sugar on labels when food shopping.


Stop Smoking


If you smoke, try to stop. Smoking is a primary cause of coronary heart disease. Your risk of heart attack falls to about half that of a smoker in just one year after quitting. 


Move 


Even if you can’t get outdoors to walk or exercise, remember that moderate activity can help reduce your risk of developing heart disease. You can always march in place while watching TV. Taking short indoor walks – even to the mailbox can help!


American Heart Month is a great time to begin implementing heart healthy habits, but it is important to keep up with these lifestyle improvements throughout the year. As always, it is important to consult your health provider before making significant changes.


Fatima Shell-Sanchez, RN, is a registered nurse with the not-for-profit Visiting Nurse Service of New York. Learn more about how home health care can support your well-being by visiting www.VNSNY.org or calling 1-800-675-0391.


Monday, February 22, 2021

AdvantageCare Physicians opens new center for GI care




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AdvantageCare Physicians (ACPNY), one of the largest primary and specialty care practices in New York City announced the opening of its new Flushing Annex Medical Office. This new medical office will house Gastroenterology (GI) consultative and endoscopic procedures in Flushing, Queens, one of New York City’s most diverse neighborhoods.

 

As part of ACPNY’s commitment to population and community health, doctors and clinical staff will perform colonoscopy and upper endoscopy procedures at the new office, with a focus on prevention, early detection and treatment of gastrointestinal cancers and other digestive diseases and disorders.

 

“Our new facility is designed to put patients at ease, serving as a beacon of excellence for GI care in the community,” said Dr. Navarra Rodriguez, Chief Medical Officer of ACPNY. “We are excited to continue to expand care options in the Flushing community.”

 

The center features endoscopy units and offers patients convenient access to gastroenterology care and procedures within the safety of a dedicated office. The experience aims to offer patients a personal office visit that is efficient and respectful of the patient’s medical and cultural needs.

 

The state-of-the-art 5,300-square foot office includes:


  • Two procedure rooms, equipped with the latest endoscopy testing and treatment technology.


  • Seven-bed post-anesthesia care unit.


  • An endoscope reprocessing room, equipped with the latest technology in scope reprocessing, infection control and patient safety.


  • Large waiting area that accommodates social distancing safety protocols.


  • Four patient examination rooms and three physician consultative offices.


  • Continued partnership with North America Partners in Anesthesia providers for procedure-related anesthesia services

 

“This new office will be the largest GI endoscopy unit at ACPNY and very likely one of the largest office-based endoscopy units in the NYC area,” said Dr. Leon E. Kurtz, Senior Vice President of Specialty Services, Gastroenterology at ACPNY. “We are proud of how well it has come together and thrilled for the opportunity to further help our patients and community through this specialty unit.”

 

For more information on ACPNY and the care options they provide, see their website:

https://www.acpny.com/

Thursday, February 4, 2021

BronxDocs Continues to Work with Community on COVID-19 Vaccination Efforts


Covid-19 Vaccinations in the Bronx
Photoby Don Pollard/Office of Governor Andrew M. Cuomo


By Dr. Denise Nunez, MD

Health Voice

February 4, 2021


After almost a year of working on the frontlines of the COVID-19 pandemic in the critical care unit as a community-based provider, light is finally at the end of the tunnel. 


After hundreds of thousands of deaths of Americans and 25.8 million patients who have been infected with the virus, vaccines are being distributed to communities, health care workers, and the elderly across the country, helping to stop the spread of the pandemic. 


Dr. Denise Nunez, MD


Like so many of my fellow frontline workers, I was fortunate enough to receive the vaccine. And while it has brought both myself and my family a sense of relief, the last few weeks working in the intensive care unit have been a sobering realization that we still have another uphill battle from COVID-19: education and vaccination supply. 

 

Though I am one of the lucky ones to be vaccinated because of my profession, vaccines still remain in limited supply, which means that people are still getting infected. Here in the Bronx, residents continue to suffer at a disproportionally higher rate than other communities in New York City.


In an effort to further serve the community, BronxDocs continues to partner with our affiliate AdvantageCare Physicians to utilize our three sites to aid the citywide COVID-19 vaccination efforts. We continue to receive available supplies and are working to vaccinate eligible patients and any city resident who meets the current criteria. It is definitely a large step in the right direction towards herd immunity. 

 

In addition to frontline workers, first responders, and residents over the age of 65, the BronxDocs team is thrilled to now provide vaccines to teachers, grocery workers, shelter staff and residents, public transit employees, and public safety and corrections officers. We are on the right track to getting more community members vaccinated, but everyone should remain COVID aware as this virus continues. Follow CDC guidelines and contact BronxDocs if you or anyone you know need educational materials. 


Remember, we can all do our part to keep each other safe. That includes reminding everyone to follow the CDC guidelines. Wear a face mask, frequently wash your hands, and practice social distancing -- these are all proven methods of preventing viral infections, such as the coronavirus, from spreading. It is important to remember that these small changes can help save lives. It is our responsibility to help one another as a community, and practicing these steps in our everyday routines is one of the best ways to protect our neighbors and loved ones. 

 

For further information or to schedule an appointment for vaccination, our COVID-compliant offices can be reached directly at (646) 680-5200 or visit us at www.bronxdocs.com. You can also call (877) VAX4NYC for further information.


EmblemHealth is one of the nation’s largest nonprofit health insurers, with more than 3.2 million members and an 80-year legacy of serving New York’s communities. BronxDocs, a part of EmblemHealth’s family of companies, is a full-service, community-focused, multi-specialty medical practice with offices located in the heart of the Bronx that provide adult primary care/internal medicine, specialty care, and diagnostics.  

 

Dr. Denise Nunez is a Pediatrician and BronxDocs’ Director of Medicine.

Friday, January 29, 2021

Surgical robots help replace joints at Montefiore



Surgical robots help replace joints at Montefiore


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Montefiore Health System just launched its new Robotic Joint Replacement Program, led by Dr. Carlos Alvarado who recently joined the Department of Orthopedic Surgery.


Montefiore is one of the first programs in the area to utilize the new surgical robot called ROSA - Robotic Surgical Assistant.


Over one million total hip and total knee replacement procedures are performed each year in the United States. Dr. Alvarado, director of Robotic Hip and Knee Surgery, uses the new technology at Montefiore to make a 3D model of the patient’s bone anatomy by taking x-rays - as opposed to most robotic devices which require CT scans.


CT scans can be more costly and difficult to access, so by using x-rays, more patients may be eligible for this state of the art approach.


ROSA is used under the direction of the surgeon, to tailor the placement of each patient’s knee implant. The robotic arm is guided by the surgeon to help improve the precision of the surgery and reduce the need for revisions.


Montefiore has one of the highest volume joint replacement programs in our area, providing care for the most complex cases. Typically patients are able to return home the day after their surgery.


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