HealthWorks WIN TER 2022
HOW TO MANAGE
SHOULDER PAIN
B.E. F.A.S.T.
FOR STROKE
MULTIPLE SCLEROSIS: KNOW THE SIGNS
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Montefiore Nyack Hospital Updates FROM THE PRESIDENT Dear Readers, Are you familiar with the Phoenix Phenomenon? This legend of a mythical bird dying and arising in an even more beautiful fashion from its ashes is quite relevant to our recent collective experience and suggests that it is possible to emerge a better version of ourselves for having endured the worst COVID-19 had to offer. Research has found that up to 70 percent of people experience psychological growth having successfully navigated profound challenges, resulting in a deeper sense of self and purpose, a greater appreciation for life and loved ones, and an increased capacity for altruism, empathy and desire to act for the greater good. Going forward into 2022, Montefiore Nyack Hospital aims to truly lean into the rising phoenix allegory. We will leverage our experience of the last two years to become an even better version of ourselves. With every ending, there is a new and even more exciting and rewarding beginning. The end of 2021 saw our hospital opening two new centers to advance the quality and accessibility of healthcare in our community—The Jacobs Family Pride Wellness Center and The Rheumatology and Specialty Care Center. The Jacobs Family Pride Wellness Center is a Central Nyack– based specialty clinic that, in collaboration with Rockland County Pride and Montefiore’s Oval Center, provides confidential and comprehensive healthcare services to the LGBTQ+ community in an inclusive, affirming and safe space. The Rheumatology and Specialty Care Center in West Nyack specializes in the diagnosis and treatment of all types of rheumatic diseases and conditions affecting the joints, muscles and bones. It also offers injection administration for specialty medications. In 2022, among other projects, we anticipate the full opening of our Ambulatory Surgery Center, which will provide same-day surgical and other procedures in a completely outpatient, contemporary and state-of-the-art facility. Each of these programs are critical elements in achieving the goals of our ongoing Transformation Project. To keep up-to-date on the ways in which we care for the diverse communities we serve, I encourage you to regularly visit the hospital’s website or follow us on Facebook, Instagram, Twitter or YouTube. With that, may we all rise and shine in 2022. Wishing you the happiest and healthiest of new years. Stay well,
THE WOUND CARE CENTER AT MONTEFIORE NYACK HOSPITAL RECOGNIZED FOR CLINICAL EXCELLENCE The Wound Care Center at Montefiore Nyack Hospital is recognized as a Center of Distinction by Healogics, the nation’s largest provider of advanced wound care services, for achieving outstanding clinical outcomes and providing highly specialized wound care treatments for diabetic ulcers, pressure ulcers, infections and other chronic wounds that have not healed in a reasonable amount of time. Leading-edge treatments include: • Biosynthetic dressings and bio-engineered tissues • Growth factor therapies • Hyperbaric oxygen therapy • Negative-pressure wound therapy • Total contact casting Our experts work with many specialists, including infectious disease, vascular surgery, interventional radiology and others, to identify factors that affect normal wound healing.
FOR APPOINTMENTS, CALL
845-348-7600
FOR GENERAL INFORMATION, VISIT
www.montefiorenyack.org/ wound-care-services
Mark Geller, MD President and Chief Executive Officer
facebook.com/MontefioreNyack @MontefioreNyack @MontefioreNyack To unsubscribe, please email us at publicrelations@montefiorenyack.org.
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@Montefiore_Nyack linkedin.com/MontefioreNyackHospital
EDITORIAL STAFF Lauren Malone, Sr. Dir. of PR and Marketing Rose Croke, Marketing Manager Briana Tolve, Marketing Manager Jasmine Gonzalez, Marketing Coordinator Celia Vimont, Contributing Writer
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winter
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SCREENING FOR A SERIOUS HEART CONDITION ATTR
amyloidosis is now easier to diagnose and can be treated.
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THE COLD HEART FACTS Avoid
becoming a cardiac case with these wise winter precautions.
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STROKE: QUICK TREATMENT IS CRUCIAL Receiving care at a
Primary Stroke Center like Montefiore Nyack Hospital helps to ensure prompt diagnosis and treatment.
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2022
IN THIS ISSUE
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Today’s individualized treatments are easier on patients and just as effective.
neck or shoulder may indicate an injury that needs prompt medical attention.
ADVANCES IN BREAST CANCER TREATMENT
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KNOW THE SIGNS OF MULTIPLE SCLEROSIS Recognizing symptoms of MS is key to getting an early diagnosis and the most effective treatment.
ROTATOR CUFF INJURIES: DON’T SHOULDER THE PAIN Pain in the upper arm,
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SHOULD YOU GET GENETIC TESTING FOR BREAST CANCER? For
those with a family history of breast and other cancers, genetic counseling offers many benefits.
MONTEFIORE NYACK HOSPITAL PROUDLY OPENS THE JACOBS FAMILY PRIDE WELLNESS CENTER The Jacobs Family Pride Wellness Center at Montefiore Nyack Hospital has opened at the Hub Shopping Center in Central Nyack. This community-based specialty clinic is a collaboration with the Phyllis B. Frank Rockland Pride Center and the Oval Center and AIDS Center at Montefiore. The Center provides confidential and comprehensive healthcare services to the LGBTQ+ (Lesbian, Gay, Bisexual, Transgender and Queer) community in an inclusive, affirming and safe space. Staffed with expert providers who are sensitive and responsive to the needs of LGBTQ+ community members, the Center will expand access to healthcare for LGBTQ+ people who live in Rockland County and its surrounding areas. For more information about hours and services, please call 845-348-7884 or visit www.montefiorenyack.org/pride-wellness-center. M O N T E F I O R E N YA C K . O R G
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EXCITING ADVANCES FOR A U SERIOUS HEART CONDITION
ALTHOUGH MORE COMMON THAN ONCE THOUGHT, ATTR AMYLOIDOSIS IS NOW EASIER TO DIAGNOSE AND CAN BE TREATED. ntil recently, the heart condition transthyretin amyloidosis (ATTR amyloidosis) was difficult to diagnose and had no treatment. Today, cardiologists are able to diagnose the condition with a non-invasive scan, and have medicine to treat it, says Duane Bryan, MD, Chief Medical Director of Nuclear Cardiology and Co-Director of Cardiac CT Angiography at Montefiore Nyack Hospital and cardiologist with Highland Medical, P.C. Since diagnosis has become easier, doctors now realize ATTR amyloidosis is more common than they once thought.
WHAT IS ATTR AMYLOIDOSIS? Normal proteins “fold” when they do their jobs. ATTR amyloidosis is caused when an unstable protein called transthyretin misfolds, forming protein clumps. These clumps build up in the heart muscle, causing heart muscle stiffness. “This, in turn, causes fluid buildup and leads to heart failure,” Dr. Bryan says. The clumps can also get caught in other tissues and nerves throughout the body. ATTR amyloidosis can be a genetic disease. An estimated 4 percent of people of African or African-Caribbean descent have the mutation that can cause this disease. It’s important to find out if a person with the disease has the inherited form so their family members can also get tested to see if they’re at risk of developing it, Dr. Bryan notes. Other people develop ATTR amyloidosis as they age, without having inherited the gene. This is known as senile or wild-type ATTR amyloidosis.
SYMPTOMS TO WATCH FOR Some of the symptoms of this condition are similar to those of heart failure— leg swelling, shortness of breath and fluid in the abdomen. Another more unusual symptom that may suggest
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ATTR amyloidosis is carpal tunnel syndrome in both wrists. “This is because the abnormal proteins can deposit in the tendons in the wrist,” Dr. Bryan says. Other signs or symptoms may include: • Numbness, tingling and pain in the hands and feet (neuropathy) • Bowel or bladder dysfunction • Spinal stenosis (a condition where the spinal column narrows and compresses the spinal cord)
NEW, NON-INVASIVE TESTING If a cardiologist suspects ATTR amyloidosis, the next step is testing. This includes an echocardiogram (ultrasound of the heart), to see if the heart muscle appears thickened because of the protein deposits. The cardiologist may also order a cardiac MRI. Until recently, definitive diagnosis of ATTR amyloidosis required a biopsy of the heart tissue. “This involves taking a piece of tissue from the heart muscle, which could cause complications,” Dr. Bryan says. Today, cardiologists can
order a non-invasive nuclear medicine scan to make the diagnosis. “We can see evidence that a person has the amyloid proteins in the heart with the nuclear scan,” he says.
A NEW TREATMENT In 2019, the U.S. Food and Drug Administration approved medication called tafamidis to treat ATTR amyloidosis. The medication stabilizes amyloid clumps, preventing them from breaking down and depositing in tissue. There are also other available medications to treat the neuropathy. “Before treatment was available, ATTR amyloidosis had a negative impact on patients’ quality of life, with heart failure and neuropathy. Now patients treated for ATTR amyloidosis are less short of breath when they exert themselves, have less fluid buildup in their tissues, and have less neuropathy. Treatment can make a marked difference in their lives,” Dr. Bryan says.
A COMPREHENSIVE CARDIAC CARE PROGRAM Montefiore Nyack Hospital’s comprehensive Cardiac Care Program, a collaboration with the world-renowned Montefiore Einstein Center for Heart and Vascular Care, provides outpatient and inpatient routine and emergency cardiovascular services, including: • CONGESTIVE HEART FAILURE PROGRAM—for the diagnosis and treatment of patients with complex heart conditions. • CARDIAC CATHETERIZATION LAB—performs diagnostic angiograms, stent placements and electrophysiology. • INTERVENTIONAL CARDIOLOGY PROGRAM—uses non-surgical procedures to diagnose and treat heart conditions. • CARDIOPULMONARY REHABILITATION CENTER—helps individuals with heart disease and those recuperating from cardiac surgery or heart attack resume an active, healthy lifestyle.
Concerned about your heart health? To make an appointment with a board-certified cardiologist at Highland Medical, P.C., call 866-550-HMPC (4672).
TESTING LOWDOWN What to know about medical tests commonly used to diagnose ATTR amyloidosis.
ECHOCARDIOGRAM WHAT IT IS: An ultrasound scan that generates measurements as well as still and moving images of the heart’s interior, including its chambers, blood vessels, valves and blood flow. HOW IT’S DONE: An instrument called a transducer creates images as it’s moved over the skin of your chest and torso. WHY IT’S IMPORTANT: Obtaining information about your heart’s size, shape, movement, strength and function can reveal problems including faulty valves, structural abnormalities, heart attack damage, inflammation and heart failure.
CARDIAC MRI WHAT IT IS: A test that uses radio waves, magnets and a computer to create detailed still and moving pictures of your heart from many angles. HOW IT’S DONE: Patients lie on a table that slides into the MRI machine, which is large and tunnel-like. Once the patient is inside, the machine takes picures of the heart. The test is noisy, but painfree. Sometimes, a contrast dye is injected to improve the machine’s ability to capture detailed images. WHY IT’S IMPORTANT: MRIs can take pictures of the beating heart, producing precise, detailed images of the heart muscle and its surrounding blood vessels.
M O N T E F I O R E N YA C K . O R G
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LIGHTEN LOADS. Push snow if possible, rather than lifting it. When lifting, scoop small amounts of snow, rather than heavy piles, especially when snow is wet.
THE COLD
HEART FACTS AVOID BECOMING A CARDIAC CASE WITH THESE WISE WINTER PRECAUTIONS.
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old weather can have a triggering effect on heart health. Shoveling snow and other means of snow removal, including pushing a heavy snow blower, can raise your heart rate and blood pressure more quickly and more dramatically than many other types of exercise. “Shoveling snow is often the most strenuous activity older people perform,” says Jared S. Corriel, MD, RPVI, FACC, cardiologist with Highland Medical, P.C. and Director of Echocardiography and Cardiac CT at Montefiore Nyack Hospital. “The cold weather can lead to coronary artery narrowing and if those with co-morbid conditions don’t take proper precautions, they can be placing themselves at significant risk for a heart attack. “The key is to take it easy, get help or hire someone else to do the
shoveling, especially if you have an existing heart condition,” he advises. The strain of heavy labor like lifting and throwing weighty scoops of snow can rupture buildups called plaques that often form on coronary arteries. A ruptured plaque can trigger formation of a blood clot that blocks the artery, causing a heart attack. Being out in cold weather also can cause vasoconstriction, in which blood vessels narrow, reducing blood flow so the heart’s pumping takes more effort. Bundling up in heavy clothes can add weight and make all your muscles work harder. Even if you haven’t been diagnosed with heart failure or coronary artery disease, you must be careful during the winter months. Everyone can benefit from the following steps to protect their heart.
To make an appointment with a board-certified cardiologist at Highland Medical, P.C., call 1-866-550-HMPC (4672).
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FULL STOMACH? LET SNOW WAIT. Allow food to settle for an hour or two after a heavy meal before heading out to the driveway. “The heart works harder to pump blood to the digestive system after a meal. Adding strenuous physical labor while digesting is not good for the heart,” Dr. Corriel says. NIP COLD WEATHER. Limit exposure to biting cold and wind to minimize vasoconstriction. Choose to exercise indoors if possible. Also keep in mind that cold-weather comfort foods like canned soup often contain high amounts of sodium, which can exacerbate high blood pressure. KNOW SIGNS OF TROUBLE. Chest discomfort sometimes signals a heart attack—but not always. “Be aware of other key indicators such as sweating, weakness, shortness of breath and nausea,” says Dr. Corriel. “Seek medical attention immediately if these last for 15 minutes or longer.” REMEMBER OTHER RISKS. Any health burden is a heart burden, especially infection. So be sure to: • Get vaccines. Check with your doctor to make sure you’re up to date with both COVID-19 and flu inoculations. • Wash hands regularly. Use soap and water for at least 20 seconds to reduce the spread of viruses. • Treat dry skin. Cracks in skin can become portals for germs to enter the body. • Get enough sleep. Slumber helps the body fight or fend off illness. • Stay hydrated. Having enough fluid in the body helps regulate blood pressure.
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AFTER A STROKE, QUICK TREATMENT IS CRUCIAL RECEIVING CARE AT A PRIMARY STROKE CENTER LIKE MONTEFIORE NYACK HOSPITAL HELPS TO ENSURE PROMPT DIAGNOSIS AND TREATMENT.
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n average, someone in the U.S. suffers a stroke every 40 seconds. Nearly 795,000 people have a new or recurrent stroke each year. A stroke is a medical emergency. It can cause lasting brain damage, long-term disability or even death. During a stroke, every minute counts. “The faster a person having a stroke gets to the Stroke Center, the faster we can intervene to save the brain and the person’s quality of life,” says Andrew Erian, MD, Director of Stroke with Montefiore Nyack Hospital and Highland Medical, P.C. The most common type of stroke is an ischemic stroke. This occurs when a vessel supplying blood to the brain is blocked, preventing the brain from getting oxygen and nutrients. Without oxygen and nutrients, brain cells begin to die within minutes.
The main treatment for an ischemic stroke is a medicine called tissue plasminogen activator (tPA). Also known as thrombolytic medication therapy, tPA breaks up blood clots that are blocking blood flow to the brain. It must be given within three hours after symptoms start. In some cases, it is given up to four-and-a half hours after the onset of symptoms. The sooner treatment begins, the better the chance of a full recovery.
EXPERT STROKE CARE Stroke patients receive top-quality treatment at Montefiore Nyack Hospital, which is designated a Primary Stroke Center by the New York State Department of Health. Institutions with this designation are recognized as being best able to address the medical needs of a person who is having a stroke with thrombolytic
medication therapy and comprehensive supportive care. “We have health professionals from a variety of disciplines who are specially trained in stroke care,” says Mohini Gurme, MD, Chair of the Stroke Committee at Montefiore Nyack Hospital and a neurologist at Highland Medical, P.C. “Our Stroke Center team is dedicated to providing quality care and achieving better outcomes for stroke patients.” In 2021, Montefiore Nyack Hospital received the Get With The Guidelines Stroke Gold-Plus Quality Award Honor Roll-Elite from the American Heart Association/American Stroke Association. This award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized guidelines based on the latest scientific evidence.
BE FAST TO SPOT A STROKE Use “BE FAST” to remember the warning signs of stroke.
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Sudden loss of balance
Sudden loss of vision in one or both eyes
Face drooping
Arm weakness
Speech difficulty
Time to call 911
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ADVANCES IN
BREAST CANCER TREATMENT:
WHAT YOU NEED TO KNOW W TODAY’S INDIVIDUALIZED TREATMENTS ARE EASIER ON PATIENTS AND JUST AS EFFECTIVE.
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ith recent advances in breast cancer treatment, doctors are often able to reduce the amount and intensity of treatment that women receive, while maintaining equally good cancer outcomes, according to Sunny Mitchell, MD, Medical Director of The Breast Center at Montefiore Nyack Hospital. “Thanks to advances in research, we’re able to offer more personalized treatment
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“Breast cancer is very treatable when it’s detected at an early stage,” Dr. Mitchell says. “That’s why it’s so important for women to have annual breast screening—it saves lives.” Women at average risk of breast cancer should start annual breast screening at age 40, Dr. Mitchell advises. You may be at average risk if you do not 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 (i.e. BRCA1, BRCA2 or PALB2), and you haven’t had a prior biopsy with high-risk findings. “Some women, such as those with a family history of breast cancer or other risk factors, may be advised to start screening earlier than age 40,” Dr. Mitchell says. If a woman is found to have dense breasts on her mammogram, her doctor may also recommend ultrasound screening, which uses sound waves, or an MRI to provide additional information.
MEDICATION AND RADIATION
approaches that target each woman’s individual breast tumor,” says Dr. Mitchell.
IT STARTS WITH SCREENING Women who undergo breast screening that detects cancer early have the best chance for successful treatment.
There are a number of types of breast cancer medications, including chemotherapy, hormone therapy and targeted therapy. Breast cancer treatment today sometimes starts with medication before surgery. This may be given to try to shrink the tumor so it can be removed with less-extensive surgery. And by giving medication before the tumor is removed, the doctor can see how the cancer responds to it. Breast cancer tumors may undergo additional testing to help guide treatment. “Through tumor testing, we may confirm somebody doesn’t need chemotherapy, or would benefit from a specific form of treatment,” Dr. Mitchell says.
Radiation therapy is often an integral part of breast cancer treatment. The Breast Center at Montefiore Nyack Hospital offers women many other health services, including stateof-the-art screening and diagnostic testing, genetic counseling and testing, patient navigation and assistance from a social worker. “We also offer nutrition consults with our dietitians,” Dr. Mitchell says. “They can provide specific advice, such as how to adjust nutrition while going through chemo, or general guidance on how to eat healthier to keep your body healthier.” Women undergoing treatment at Montefiore Nyack Hospital may also be eligible to participate in clinical trials.
SURGICAL ADVANCES Women having breast cancer surgery today can benefit from advanced techniques that remove the cancer while preserving the physical appearance of the breast and hiding surgical scars. “We remove the cancer and leave the breast with a nice shape, size and contour,” Dr. Mitchell says. “It’s much more aesthetically pleasing to the patient. When she looks in the mirror, she’s not constantly reminded of her surgery.” Dr. Mitchell treats many patients with the “Hidden Scar” approach. “We place the incision in a location that’s most likely to heal very well and hardly be visible once healed, such as around the areola, under the breast or in the armpit,” she says. Today, many early-stage breast cancer patients are able to have less-invasive surgery than in years past. Genetic testing on tumors often can help doctors determine which type of chemotherapy will be most effective. And in some cases, they’re able to tell women they don’t need chemotherapy at all because their tumor type won’t benefit.
For more information about The Breast Center at Montefiore Nyack Hospital or to schedule a consultation, call 845-348-7579.
M O N T E F I O R E N YA C K . O R G
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KNOW THE SIGNS OF
MULTIPLE SCLEROSIS RECOGNIZING SIGNS OF MS IS KEY TO GETTING AN EARLY DIAGNOSIS AND THE MOST EFFECTIVE TREATMENT.
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he symptoms of multiple sclerosis can easily be confused with a variety of other medical conditions, making it a challenging disease to diagnose. That’s why it’s important to understand what the symptoms are and to tell your doctor if you have any of them, says Christopher Langston, MD, Medical Director of the Madlyn Borelli Multiple Sclerosis Center at Montefiore Nyack Hospital. “People may have a lot of different symptoms, and don’t connect the dots,” he says. “Telling your doctor all of your symptoms will make it more likely they will suspect MS and refer you to a specialist who can help.”
WHAT IS MULTIPLE SCLEROSIS? Multiple sclerosis is thought to be an autoimmune disease, meaning the body, through its immune system, attacks its own tissues. In people with MS, the immune system attacks myelin coating around the nerve fibers in the central nervous system. This interferes with the transmission of nerve signals between the brain, spinal cord and the rest of the body.
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Symptoms of MS can include: • Double or blurry vision • Weakness • Clumsiness • Numbness • Strong, sudden fatigue • Burning or tingling • Urinary problems: sudden urge to urinate, urinary incontinence or difficulty in starting to urinate • Difficulty walking People with MS may have symptoms that get worse in the heat, such as blurry vision or trouble walking.
WHO CAN GET MS? MS is a lifelong disease. It most often occurs in women in their 20s, 30s and 40s. Men can also develop the disease, but women are three times as likely to be affected. “It can also develop late in life,” Dr. Langston notes. The cause of MS isn’t known, but there seems to be some genetic influence. “It’s more common in northern climates, including New York state,” says Dr. Langston. People with a family history of autoimmune diseases may also be at increased risk. After pregnancy, women with MS may develop three symptoms
together: the sudden urge to urinate, trouble walking and fatigue. “Women may assume these symptoms are all associated with being a new mother, so they don’t mention them to the doctor, but they can be a sign of MS,” says Dr. Langston.
VISITING AN MS SPECIALIST If the doctor suspects MS, you’ll be referred to a specialist. During the first visit, the doctor will ask you about all of your symptoms, including when they started and whether they got better over time. The doctor will do a physical exam to determine whether the problem originates in the brain and spinal cord, in nerves in other parts of the body or in muscles and bones. The doctor may order an MRI, lumbar puncture to examine fluid in the spinal cord or blood work. The ability to treat MS has improved dramatically in recent years. “In the last 15 years, there has been an explosion of treatments,” says Dr. Langston. “Today, there are many people who have MS and you would never know it. Our goal is to put people into full remission so they can lead a normal, active life.”
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For more information about the services provided at the Madlyn Borelli Multiple Sclerosis Center at Montefiore Nyack Hospital, call 845-348-8880 or visit www.montefiorenyack.org/multiple-sclerosis.
M O N T E F I O R E N YA C K . O R G
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ROTATOR CUFF INJURIES: DON’T SHOULDER THE PAIN PAIN IN THE UPPER ARM, NECK OR SHOULDER MAY INDICATE AN INJURY THAT NEEDS PROMPT MEDICAL ATTENTION.
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ROTATOR CUFF MUSCLES
BACK VIEW
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f you have shoulder pain, it may not be obvious whether you should see a doctor about it or try to tough it out with over-the-counter pain relievers, ice and rest. If your shoulder aches after an activity such as shoveling snow, you can most likely give it time to heal. But if you experience pain after falling, have a significant strain injury or feel a pop or tearing sensation in your shoulder, then it’s important to see a doctor as soon as possible, says Jason Fond, MD, Director of Orthopedic Surgery at Montefiore Nyack Hospital. “If you feel sudden, significant pain,” says Dr. Fond, “time is of the essence because you may have a rotator cuff tear or other injury.”
ROTATOR CUFF INJURIES The rotator cuff is a group of muscles and tendons that surround the shoulder joint, holding the shoulder in the correct position. It helps support the movement of the shoulder joint and is subject to considerable wear and tear. You can injure the rotator cuff by a traumatic event or from overuse. If you have shoulder pain, your doctor may ask about the timing of the pain, history of any injury you’ve had or if there’s difficulty with strength or motion. It’s important to know where the pain is, says Dr. Fond. “Many patients think because they have pain in their arm that it can’t be a shoulder problem. But rotator cuff problems often can cause pain in the upper arm and neck region.” The doctor will perform a physical exam and will order X-rays. He or she may also order an MRI if there is concern about soft tissue damage.
TREATMENT If you have a rotator cuff injury, the doctor will first recommend non-surgical treatment, such as an
FRONT VIEW
anti-inflammatory medication (Motrin) or a pain reliever (Tylenol) and physical therapy. For tendinitis or bursitis of the shoulder, another option is a cortisone injection. “This is a direct, effective way to reduce inflammation and pain in the shoulder,” says Dr. Fond. “But if you give too many injections in one area, it can cause damage to the tendon.” If non-surgical treatments aren’t successful in reducing pain, the next step is to consider surgery. Most rotator cuff surgery today is done on an outpatient basis with the aid of an arthroscope, a tiny camera. “Three or four little holes are made in the shoulder and the damage is evaluated from different angles,” says Dr. Fond. “I choose the treatment technique depending on what is found at the time of surgery.” Typically, surgery is not required unless there is a complete tear of the rotator cuff.
RECOVERY FROM SURGERY After surgery, a person will feel uncomfortable for several weeks. “The patient will need to wear a sling day and night for three weeks, and then during the day for another three weeks,” says Dr. Fond. Physical therapy starts two to three weeks after surgery. For pain management, he recommends ice to reduce inflammation, as well as non-steroidal anti-inflammatory medications and pain relievers. It takes three months for the tendons to heal, and full recovery can take six to 12 months. There’s no definite way to avoid a rotator cuff injury, but Dr. Fond says keeping strong and fit is the best way to prevent one. “Maintaining strength and flexibility will help patients heal from injury and recover well following surgery,” he says.
For more information about shoulder pain or to schedule a consultation, call The Joint Replacement Center at Montefiore Nyack Hospital at 845-348-7489 or visit www.montefiorenyack.org/joint-replacement.
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SHOULD YOU GET
GENETIC TESTING FOR BREAST CANCER?
FOR THOSE WITH A FAMILY HISTORY OF BREAST AND OTHER CANCERS, GENETIC COUNSELING OFFERS MANY BENEFITS.
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utations in certain genes can increase lifetime risk for cancer. Women who inherit a mutation in genes such as BRCA1, BRCA2 and PALB2—either from their mother or father—have a much higher risk of developing breast and other cancers. If you have a personal or close family history of breast, ovarian or pancreatic cancer, your doctor may recommend
that you go for genetic testing. Three of the most well-known genes associated with increased risk of breast and/or ovarian cancer are BRCA1, BRCA2 and PALB2. Normally, these genes keep breast cells growing normally and prevent growth of cancer cells. But when these genes contain inherited mutations, they don’t function normally and increase the risk of breast cancer.
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In addition to an increased risk of breast cancer, men and women who have a BRCA mutation also might be at increased risk for pancreatic cancer, ovarian cancer, prostate cancer and melanoma. Knowing whether you carry a mutation in one of these genes can be very helpful, according to Myriam Kawaja, a Certified Genetic Counselor at Highland Medical, P.C., Breast Surgery. “Information empowers patients to be proactive with their health, and empowers family members by providing vital genetic information to assess whether they too may be at increased risk, so they can best care for their own health,” Kawaja says.
THE FIRST STEP If you’re concerned about your family’s history of cancer, talk to your doctor about your cancer risks. “Your doctor can help you decide if you should speak with a genetic counselor,” Kawaja says. “Genetic counseling will help you understand your inherited risks for cancer and what you can do to reduce your risk.”
WHO SHOULD GET TESTED? If you have a personal or family history of cancer, your doctor may recommend testing. The recommendation depends on many factors, including the age at which you or a family member were diagnosed; how close the family member is; the type of cancer and how extensive it is; and how many people in the family have cancer. Men with a close family history of breast or ovarian cancer also may be advised to seek genetic counseling. Men can develop cancer related to BRCA mutations, but at a lower rate than women. “In men, BRCA mutations can be associated with breast, prostate and pancreatic cancers,” Kawaja says. “And if a man or woman has the mutation, there is a 50 percent chance they will pass it along to each child they have.”
GENETIC IMPACT According to the National Cancer Institute, about 13 percent of women in the general population will develop breast cancer sometime during their lives. In contrast, 55 to 72 percent of women who inherit a harmful BRCA1 variant and 45 to 69 percent of women who inherit a harmful BRCA2 variant will develop breast cancer by 70 to 80 years of age. Genetic counseling can help you understand whether testing is appropriate and how the information from testing can influence your medical care. A genetic counseling session generally lasts about 45 minutes. “In order to get the most out of the session, it’s useful to have a detailed family medical history from both your mother’s and father’s side of the family, including information (and medical records if available) about family members who have had cancer,” Kawaja says.
WHAT’S INVOLVED IN A GENETIC TEST? A person undergoing a genetic test will give either a blood or saliva sample that’s analyzed to look for mutations. “At our center, we test for up to 35 genes (and sometimes more), depending on a person’s personal or family history,” Kawaja says. “If a patient wants to do the test at home, we can send them a saliva test kit.” The testing can look for mutations that increase the risk of breast, ovarian, prostate, pancreatic, gastrointestinal and skin cancer. “During the genetic counseling session, it will be determined whether a patient is likely to meet their insurance requirements for testing,” Kawaja says. “If the requirements aren’t met, but testing is still recommended or desired, it may cost anywhere from $0 to $250 out-of-pocket.”
WHAT IF YOU TEST POSITIVE? If you test positive for a genetic mutation that impacts cancer risk, there
are steps that, in consultation with your doctor, you may decide to take to reduce your risk of developing breast cancer. These include: Enhanced screening. Women who test positive for mutations in high-risk genes may choose to start mammography screening at a younger age, have more frequent screening than is recommended for the general population, or have MRI screening in addition to mammography. Risk-reducing surgery. Some women who test positive choose to have their breasts surgically removed to reduce their risk of breast cancer. To help lower their risk of ovarian cancer, some women may decide to have their ovaries and fallopian tubes removed. Chemoprevention. This is the use of medicines to reduce the risk of cancer. In women who are already undergoing treatment for breast cancer and have a positive genetic test, the oncologist may consider certain additional treatments that are molecularly targeted.
PERSONALIZED SCREENING Knowing if you inherited a genetic predisposition for breast cancer allows your doctors to better tailor your breast screening program, and will help your doctor choose the most effective treatment for you. “And if you test negative,” Kawaja says, “it can help relieve lifelong anxiety.” For example, for a woman with a family history of breast cancer, the likely screening recommendation would be an annual breast MRI along with an annual mammogram. “Testing negative would allow you to follow the general population breast screening recommendation, which is an annual mammogram,” Kawaja says. To learn whether you’re at higher risk of developing breast cancer, make an appointment at The Breast Center at Montefiore Nyack Hospital by calling 845-348-7579.
For more information about Montefiore Nyack Hospital’s Cancer Genetics Program and to schedule a consultation with a genetic counselor, please call 845-348-7579. Location: The Breast Center at Montefiore Nyack Hospital, 160 North Midland Avenue, Nyack, NY.
M O N T E F I O R E N YA C K . O R G
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The Diagnostic Imaging Center 160 North Midland Avenue Nyack, NY 10960 845-348-SCAN (7226) montefiorenyack.org/imaging
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