Monday, November 12, 2018

Veterans Day: Honoring Those Who Served in Their Final Hours


By Rosemary Baughn, Senior Vice President, VNSNY Hospice and Palliative Care

HEALTH– When Joseph Vitti first meets a veteran to whom he will provide the comfort care of hospice, he usually begins by saying, “Thank you for your service.” But for those who served in Vietnam, he begins with words that have long eluded them: “Thank you and welcome home.” A fitting thought to keep in mind as Veteran’s Day approaches.


Vietnam is very much in the national conversation now, with the debut last year of Ken Burns and Lynn Novick’s documentary series marking the 50th anniversary of the war’s escalation. Among the powerful legacies that the series brings to life is the toll that the war’s brutality and divisiveness still exacts on those Americans who fought and returned.

My colleagues in the Visiting Nurse Service of New York’s Hospice and Palliative Care program who are caring for veterans at the end of their lives find that the silence common to many veterans on the subject of war is compounded in Vietnam veterans by the lack of support—and even enmity—they experienced when they came back home. 

End of life is the last chance to change the equation—to build bridges of communication to family members and loved ones, to other generations—and even to oneself. 

VNSNY’s special hospice program tailored to military veterans helps do just that. Our veterans hospice team of physicians, nurses, social workers, spiritual care counselors and home health aides is specially trained to provide care for not only the physical illness at hand, but also conditions such as PTSD, survivor’s guilt, depression, and substance abuse. We help connect veterans and their families with community resources and veteran-specific benefits, and hold bedside recognition ceremonies that honor their military service. VNSNY’s hospice initiative also benefits greatly from our participation in “We Honor Veterans,” a program created by the National Hospice and Palliative Care Organization in collaboration with the Department of Veteran Affairs, to address the unique physical, emotional and logistical needs of veterans and their families at end of life.

Sharing Stories

This specialized hospice care includes prompting and listening to stories. “End of life is a time—for anyone—to look back on one’s life and reflect on what mark they have left,” says Joseph, who is the U.S. Army Veteran Supervisor for VNSNY’s Veteran’s Program, and is also a veteran himself. “For veterans, we work to create an environment that lets them understand it’s okay to talk, to share stories. It’s not that they don’t want to—it’s that they don’t know who to tell the stories to, or how to tell them.”

So conversations typically begin slowly, with Joseph or a colleague asking straightforward questions: What was your branch of service? Where did you serve? For how long? “Then,” says Joseph, “we take one small step forward: ‘Tell me about your friends.’ That’s where the stories are.” 

Joseph further supports the veterans in sharing their experiences by explaining to them that their stories could help him help other veterans and families. “Veterans are very selfless. Helping others is something they certainly want to do.”

Joseph describes what happens once the stories begin to come. With a Vietnam veteran living on Staten Island, a former machine gunner referred to our service by the Veteran’s Administration, Joseph began with his standard greeting: “From one soldier to another, Welcome home.”

“He broke down in tears,” Joseph recalls. “An instant bond formed between us, and a visit that was supposed to be about connecting his family with benefits became about connecting in a whole different way. It opened the floodgates. He talked about things he’d never talked about before, and said that there wasn’t a day that went by that he didn’t think about them.”

Another veteran, a deeply religious Catholic who was in the final stages of cancer thought to be caused by his exposure to Agent Orange during the war, felt that his life, and now his war-related terminal illness, were a form of purgatory for what he did during the war—namely, survive when friends around him were killed. Joseph helped him reframe the narrative and achieve a measure of closure. “Did you ever think that this wasn’t your purgatory,” he said, “but that you survived because you had another mission—to be a husband to your wife and a father to your children?”

The veteran embraced the conversation, talking as he never had before. “These veterans don’t want to be forgotten, and don’t want their stories or their friends to be forgotten,” says Joseph. “They just don’t know how to begin. So we say, ‘Tell us. We want to know about your experience. We need to know.’”

For those who are unable to share their stories, families can learn their loved one’s history from military discharge papers, which the hospice team will help track down, along with any medals the veteran might have received. One soldier’s discharge paper detailed the circumstances behind his Silver Star, the military’s third-highest honor—a story the family had never heard. The only one in his eight-man team to survive an attack during the Tet Offensive, he kept firing even after he was shot and wounded—saving the lives of countless Americans ahead of him on the battlefield. When Joe shared the papers and the story with the family, including a young grandson, everyone was in tears, hugging the patriarch and hailing him as a hero. “They were a close family, but this brought them even closer,” Joseph notes. “That, the family’s support, is the ultimate medication and therapy.”

Joseph sees this time and again with veterans of all wars, but it is most pronounced with Vietnam veterans—who, after keeping their stories bottled up for decades, take the leap of faith in opening up to their families and find grace where they expected judgment, and honor where they expected contempt. 

“Imagine, your father afraid to tell his stories, maybe because he accidentally killed innocent civilians and he thinks he’s going to hell,” Joseph explains, citing a composite father built out of many fathers he’s worked with. “And then imagine that, instead, he hears from his children: ‘We love you, we’re proud of you. You’re not going to hell. You are a hero.’”

“What we need is a real national conversation that encourages people—especially a younger generation—to engage these veterans and hear their stories,” says Vitte. “Ask a friend, a neighbor, a loved one. Comfort care doesn’t begin with hospice. Many of these veterans have emotional and physical scars that go deep, and we owe it to them to listen.”

Thursday, November 8, 2018

Know the Warning Signs for Brain Aneurysms


By Janet M. McHenry DNP, FNP-BC, CCRN, CNRN
Doctor of Nursing Practice
Family Nurse Practitioner, Department of Neurosurgery

HEALTH– The journey begins: “I looked up from my desk and I felt like a bomb went off in my head. It was the worst headache of my life, it just exploded.”

“I wasn’t feeling well for about two weeks before this happened. The last thing I remember, I went into the grocery store and I woke up three weeks later in the rehabilitation hospital.”

“I was attending a family party and thought I had food poisoning. I felt like something popped behind my right eye and there was flashing in my eye like a light bulb went off, then I vomited.”

“My sister came home from work and said she had a bad day and a headache. She went upstairs to lie down before dinner. That was the last time we spoke, she died the next day.”

These stories are typical of survivors and their loved ones who have experienced a ruptured brain aneurysm resulting in a subarachnoid hemorrhage a type of hemorrhagic stroke.
Fortunately, aneurysmal subarachnoid hemorrhages account for only about 3% of all strokes. However, it is important for everyone to know the symptoms and risks, particularly in our community. First and foremost if you or a loved one get the “WORST HEADACHE OF YOUR LIFE,” please seek immediate and emergent medical attention.  

The sudden onset of the worst headache of your life is a “red flag” and may be a sign of a ruptured brain aneurysm. Other symptoms of brain aneurysm which may accompany the headache include: stiff neck, sharp pain behind or in the eye, blurry vision, light sensitivity, drooping eyelid, nausea & vomiting weakness of the arms or legs numbness and tingling of one side of the face or body, dizziness, confusion & seizures and/or loss of consciousness. There is normally a sudden onset of symptoms as described in the stories. There are a small percentage of brain aneurysms that leak a week or two before the rupture. People report that they have headaches and generally feel lousy, similar to the flu symptoms. When a brain aneurysm ruptures causing a subarachnoid hemorrhage it can cause brain damage, coma and even death.

What is a brain aneurysm?

A brain aneurysm is a balloon that arises from a cerebral artery. A brain aneurysm results from a weakness in the wall of the artery that supplies blood to the brain. Because blood continues to flow and finds the path of least resistance the vessel balloons out. 

Blood fills that sac and as pressure rises, that balloon can rupture and pours blood into the brain. 

Important Statistics

A Brain aneurysm ruptures in this country every 18 minutes impacting approximately 30,000 people a year. Women are affected more than men approximately 3:2 ratio, generally between 40 and 60 years of age. In contrast, approximately 6 million people in the US have unruptured brain aneurysms or 1 in 50. Cerebral aneurysms are twice as likely to rupture in African Americans and 1.6% times more likely to rupture in Latinas and Latinos.  Of those who develop a subarachnoid hemorrhage resulting from a ruptured brain aneurysm 25% will die within 24 hours many more than 50% will have permanent neurologic deficits; approximately 50% will be unable to return to work and others will recover fully. 
 Risk Factors

Certain genetic diseases carry higher risk for the development of brain aneurysm such as polycystic kidney disease, genetic connective tissue disorders that weaken blood vessel walls, history of rupture in a first degree relative: parent, child or siblings. Those with sickle cell disease and Arteriovenous malformations carry a higher risk for development of brain aneurysms. Other associated risk factors include: smoking, drug use particularly cocaine and amphetamines and uncontrolled hypertension. Patients who have a known brain aneurysm are 20% likely to have a second brain aneurysm, usually on the other side.

Unruptured Aneurysms

Since there are rarely signs of unruptured aneurysms they are often discovered “incidentally”.  Patients may complain of headaches or dizziness and they are seen on magnetic imaging. We strongly recommend that anyone who has an incidental finding of a brain aneurysm be seen by an aneurysm specialist such as a neurosurgeon or neuroradiologist. They can offer treatment if it is required, further imaging to better characterize the aneurysm or to follow you on a regular basis. In particular, it is very important for family members of first degree relatives who have ruptured to be screened with an MRI and MRA or CTA if over age 21. We know about the connection to ruptured brain aneurysms it’s always better to find it before the rupture occurs and treat it then.

Brain Aneurysm Treatment

The only treatment for brain aneurysms in the past was open brain surgery. The aneurysm was located and a clip or clips were placed to secure the neck and stop blood from flowing into the sac. While this surgery is performed least often but is sometimes required due to the location or configuration of the aneurysm. Endovascular treatment has developed over the past 25 years and is utilized more commonly to treat aneurysm. The patient is taken to interventional suite and a cerebral angiogram is performed similar to a cardiac catheterization.  

The angiogram or catheterization of the brain is performed. The aneurysm can be treated through a microcatheter by inserting platinum coils to fill the aneurysm. In addition a stent device re-directs blood flow away from the aneurysm may also be used so the aneurysm will shrink. 

Message to the Community 

There are disparities in health care in this country based upon race and economic status. I know from my own experience speaking to patients that this often prevents community members from seeking the help that they need. 

Please don’t ignore the symptoms if they occur, Montefiore is here to help. We are not interested in your insurance or immigration status. We are a nationally designated comprehensive stroke center. We are in the forefront of aneurysm treatment and research. At Montefiore we have a multidisciplinary team that collaborates for the patients highest quality and most efficient care. In order to attain Joint Commission of Hospital Accreditation national designation as a Comprehensive Stroke Center there must be a high number of aneurysms treated and both operative and endovascular treatment must be offered. The entire staff including MDs, nurses and all health care workers who touch the patient must be educated. We must continuously maintain excellent standards of care that are benchmarked against the national standards. The standards are high, but so are the stakes for our community members who deserve only world class healthcare.

http://www.strokeassociation.org

Help Feed the Needy This Holiday Season

BX News: Help Feed the Needy This Holiday Season: City Harvest Holds Holiday Food Drive NEW YORK– With the holiday season quickly approaching, City Harvest , NYC’s largest food resc...





Tuesday, October 23, 2018

Battling Breast Cancer in the Bronx


Program Helps Survivors

By Alyson Moadel-Robblee, Ph.D., director, Psychosocial Oncology, Albert Einstein Cancer Center and Montefiore Einstein Center for Cancer Care

BRONX- My mother was an amazing woman. She was strong and passionate. My world was rocked, however, when at just 33 years-old, my mother was diagnosed with breast cancer.

As a young girl, just seven, I watched her go through chemotherapy, radiation and surgery. After an 8-year period of remission, the cancer returned. My older siblings were in the navy, and at age 15, I became my mom’s primary caretaker.
I was fortunate that where we lived, outside New Haven, CT, there was an amazing cancer support program that let us know that we were not alone. This formative experience of my mother’s loss and example that she set for me, led me to Albert Einstein Cancer Center and Montefiore Einstein Center for Cancer Care. Here, I serve as the director of Psychosocial Oncology. It is also where I found my calling, the creation of the Bronx Oncology Living Daily (BOLD Living) Program.

Now in its 10th year, BOLD has a full calendar each month of mind-body workshops, fitness/nutrition offerings, and peer support. 

Evolving each year, our goal is to meet the specific needs of people affected by cancer in the Bronx. Free activities for patients and their loved ones include everything from yoga, crochet, scrapbooking, a drum circle, Reiki healing, meditation, and more. There is also weekly counseling and support groups.

Additionally, we’re privileged to have amazing volunteers who participate in navigation initiatives like the BOLD buddy program which provide peer support for cancer survivors. In the last year, we also introduced BOLD Brother/Sister peer mentors, who are teens and young adults who have cared for a parent with cancer.

With great pride, we have so many programs to support our patients and their families. As we recognize Breast Cancer Awareness Month, I’m thrilled to have such an amazing platform to raise awareness of these types of programs, which are free for our community.

Support is available by going to http://www.einstein.yu.edu/centers/cancer/support/fundraiser/. Here you can learn about events and programs taking place. 

One event that we are particularly excited about is our BOLD Beauty Day, which is coming up on Thursday, October 18. From 1 pm - 3:30 pm, all cancer patients are welcome to enjoy an afternoon dedicated to beauty and relaxation, including arts & crafts, henna, hair, & make-up. Giveaways and food will be served.

The event will take place at 1521 Jarrett Place, 2nd Floor Conference Rooms.

To register, please call (718) 430-2380 or email cancersupport@einstein.yu.edu

Breast cancer rates have increased in both the Bronx and NYC. This year, there will be an estimated almost 300,000 new cases of invasive breast cancer. 

While early detection and treatment is of the upmost important, we need to also remember that it is vital to care for the mind and spirit, in addition to traditional medical needs. 

This October, use the reminder of Breast Cancer Awareness Month, to get educated about all of the local options that are available to you. We also encourage patients to be their health advocates, but this does not mean they need to be doing this alone.

We’re here and look forward to learning more about how we can support you!




Thursday, September 27, 2018

Weight Loss Surgery Patients Hold Fashion Show in Bronx



Weight Loss Miracle on Display

HEALTH- After dropping 200 pounds John Laguier of the Bronx struck a pose. He was one of many weight loss success stories who strutted down the catwalk at Jacobi Hospital’s Bariatric Fashion Show.  


Patients of the weight loss surgery at the Bronx hospital lost 30, 100 and even 200 pounds. 

The success of their patients gave officials at NYC Health + Hospitals/Jacobi the idea that patients should flaunt the benefits of the surgery by having a fashion show.



Serious medical conditions that accompany obesity — such as diabetes, high blood pressure, crippling arthritis, and sleep apnea — often clear up entirely after weight loss. And significant weight loss can have a near-miraculous effect on your confidence and lifestyle.


Wednesday, September 5, 2018

Back to School NYC – How to Get the Best Sales on...

BX News: Back to School NYC – How to Get the Best Sales on...: NEW YORK-  The first day of school is just around the corner and stores are filled with back-to-school promotions. Below are tips from...




Thursday, August 30, 2018

Pediatrician’s Back to School Checklist


By Bianca Calderon, MD, FAAP
Attending Physician in Pediatrics, Comprehensive Health Care Center, Montefiore Medical Group
Instructor, Department of Pediatrics, Albert Einstein College of Medicine 

NEW YORK- As summer winds down, it’s time to start thinking about preparing your children for the new school year. 

As a pediatrician at Montefiore’s Comprehensive Health Care Center, I have seen quite a few children go through this transition year after year. To make the back-to-school transition as smooth as possible, here is my recommended checklist for parents: 

HEALTH CARE MAINTENANCE: 

Make sure that your child is up to date with their annual physical. 

If you do not remember when your child last had a physical, you can always call your pediatrician’s office and ask. 

Make sure that your child is up to date with their vaccinations. 

You can refer to the CDC website for the recommended vaccine schedule: https://www.cdc.gov/vaccines/parents/childhood-vaccines

You can find the medical and vaccine requirements for New York City schools here: https://www1.nyc.gov/assets/doh/downloads/pdf/school/medical-requirements.pdf

And don’t forget about the flu shot! 

Most pediatric offices should be carrying the influenza vaccine by early September. 

Make sure to call your pediatrician’s office to find out when they will have the flu shot and what their policy is for coming in to get the shot (ask whether you need an appointment or if you can just walk in). 

For the 2018-2019 school year, all children aged 6 months through 59 months who attend a New York City regulated childcare program must receive the flu shot by December 31st. 

FIRST DAY: 
A lot of children have anxiety about the first day of school, especially if they are entering a new school. To help offset this anxiety, you can: 

Talk through what the new school year will be like with your child. 

For elementary school students, you can tell them their teacher’s name and go through any information/expectations the teacher has told you beforehand. 

For middle school and high school students, go through their schedule with them. 

For those attending a new school in the fall, in order to help your child feel more comfortable with the transition, make sure that both you and your child take a tour of the new school and go to orientation. 

SLEEP: 

Start having your children adjust back to the school sleep and wake schedule a few days to a week before school starts. 

That way, their bodies will already be accustomed to this schedule on the first day of school. 

Remember: younger children generally require 10-12 hours of sleep each night, and teenagers need 8-10 hours of sleep each night.

TRANSPORTATION AND TRAVEL: 

Make sure that you have a safe plan for how your child is going to get to school and how they are going to get home after school. 

If your child needs any special accommodations for travel, make sure to set this up with the school before the school year starts. 

Walking:

If your child will be walking to school, make sure that it is a safe and well-lit route. 

Make sure that you or another trusted adult has practiced the route with them before the first day of school. 

If possible, find out if other neighborhood children will be going to the same school so that the children can walk together. 

Remind your children not to talk to strangers. 
Bike:

Make sure that your child is always wearing a helmet when they are riding their bike.

Bus:

Make sure your child knows to look both ways before crossing the street. 

Make sure your child does not try to board the bus until the bus has come to a complete stop. 

Make sure your child wears the lap strap or seatbelt (if the bus has these devices). 

Car:

Make sure that everyone in the car is wearing a seatbelt. 

If your teenager will be driving themselves to school, remind them not to use their cellphones while driving and to always be fully focused on the road. 

BACKPACK: 
Back pain due to a heavy backpack is a common complaint. 

In order to avoid this complaint: 

Make sure that your child uses both straps when wearing their backpack.

Choose the right sized backpack. You should be able to adjust the straps so that the bottom of the backpack is near the level of your child’s waist. 

TALK TO YOUR ADOLESCENT

If your child is entering middle school or high school, you should have a frank conversation with them about smoking, drugs, alcohol, sex (including contraception and sexually transmitted infections), and romantic relationships. 

BREAKFAST

Find out if your child’s school provides breakfast. If the school does not provide breakfast, make sure that your child has breakfast before school each day. 

Children who eat breakfast have more energy, focus better, and have improved school performance.


If you want more information on preparing for the new school year, you can check out the American Academy of Pediatrics (AAP) website for parents: https://www.healthychildren.org

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