The Inside Press

Magazines serving the communities of Northern Westchester

doctor

How Volunteering Enhances ‘Patient Centered Care’

by

David Miller, M.D.                                PHOTO BY CHAD KRAUS

By Grace Bennett

The volunteer effort at Northern Westchester Hospital (NWH) “dovetails perfectly with our focus which is patient-centered care. We don’t just say that here, we practice it,” says David Miller, M.D., chair of the Department of Anesthesiology at NWH. He stresses the key role volunteers serve at NWH and the vital impact they have every single day on patient care. “In the area of surgical services alone, we have a full time ‘navigator’ who arrives to help in the process of ambulatory care; there are many volunteers who show patients where to go and who, by the way, also help staff at different locations.”

It’s not too surprising then that Dr. Miller generously extends his own hand at the hospital wearing three vital volunteer hats. For over four years, he has been an active member of the Northern Westchester Hospital Foundation. He is also a member of the board of trustees and of the hospital’s medical board.

Playing a leadership role in critical, volunteer fundraising efforts for the hospital comes naturally for Dr. Miller.An Armonk resident for the last 30 years, Dr. Miller has two children, 31 and 28, both born at NWH. “Both my grandchildren were born here too. My wife had surgery here. Assuring great patient care here for everyone is personal for me and for many of us.” Other doctors who sit on the foundation board include plastic surgeon David Palaia, M.D., and obstetrician/gynecologist, Anita Grover, M.D., neurosurgeon Omar Syed, MD, and pediatrician Margaret Collins, MD.

The foundation’s success, he maintains, would not be possible without an extensive volunteer effort. “Our entire objective is to develop and maintain a strong relationship with our surrounding communities. Foundation Board members need to remain informed, and our volunteers act as Ambassadors to the community.” He called a recent presentation by Twigs volunteers to the board of trustees “tremendous” and “eye opening.” “They perfectly illustrated what volunteering really means to this hospital. The fundraising they do is phenomenal through their gift shop which has been in existence for almost 75 years.”

The foundation board plans a combination of educational programs and fundraising through hospital or community-based events, such as a walk benefiting cancer patients, golf outings, concerts with local bands, to the all-important annual gala. “It is our largest vehicle,” he explained, and this year, hopes are high to surpass the $1.4 million raised last year. This year, the ‘Imagine What’s Next’ gala date is November 18th. To attend or make a donation to the hospital, please visit www.nwhconnect.org/2017Gala.

Ultimately, said Dr. Miller, the foundation and all the hospital volunteers “send a very strong message to patients that our hospital is a community that takes a huge interest in the welfare of our patients and their families.”

 

Grace Bennett is Publisher and Editor-in-Chief of the Inside Press, Inc.

Four Questions for ‘Top Laser Expert’ Josh Fink, M.D.

by

Dr. Josh Fink in his Mount Kisco office

Considered by many of his colleagues a top laser expert in Westchester County, Josh Fink is double board certified in internal medicine and pulmonary diseases, and is also a Fellow of the American Society of Lasers in Medicine and Surgery. In addition to his laser and cosmetic practice based in Mount Kisco, Dr. Fink is the Director of the Clinical Trials Program at Northern Westchester Hospital, where he and his team of Clinical Research Coordinators oversee all new and investigational therapies. Previously, he dedicated years of his professional life caring for the sickest of all patients in the Northern Westchester Hospital’s Intensive Care Unit, where he performed most of the ICU procedures.

“Community is everything,” says Dr. Fink who makes sure that he donates to such causes as Force Blue and Operation Enduring Warrior, which are two Veteran causes he deeply cares about.

What draws clients into see you?

One of the most beautiful things about medical aesthetics is that it combines both Science and Art. As we age the brow sort of flattens a little bit, the cheeks splay outwards and we develop a jowl line. Face shape changes from heart shape to trapezoid. Part of that is due to collagen loss, loss of the elasticity of the skin and fat pads start to shrink as we age, asymmetry becomes more exaggerated.

I like to tell people to think of their facial structure as a table and tablecloth. The table is bone structure, fat, and volume while the tablecloth is the way it looks–wrinkles, pores, redness, and brown spots. We treat both the table and the tablecloth.

We’re known best for fillers and “neuro-modulators.” Things like Juvederm, Voluma, Restylane, Dysport and Botox. I have a background in art and think most fillers require the most artistic expression of any non-surgical based procedure. Lasers are fairly straightforward, fillers and the way you use them and the combination of fillers is very much artistry.

How do you customize your approach to each client’s needs?

I’m not likely to use long-lasting fillers on someone who has never had one before, as they may not like the look. So I may want to give them something that’s on the shorter lifespan of fillers and recommend coming back again in six months and we can do something that lasts a little bit longer. I suggest they grow into it and see if they like it. It’s a smart way of doing it.

There is no one size fits all. So if somebody comes in and says I want to have a pair of Angelina Jolie lips, but the problem is they don’t have the natural spacing for that to be done. We’re all cut slightly different. So when we do filler work, which is really the artistic part of esthetics, one size does not fit all.

Our eye gravitates towards symmetry, it’s really important. So we’ll measure angles and ratios because in beauty there’s science and in science there’s also math. So there is math to what we do, and we’ll actually measure out angles to see where we think what needs to be done and sometimes not often, but 20% of the time, someone will come in and I will say, I don’t think we should do anything with you. I think you look great.

What tends to be your clients’ biggest fears and concerns about any particular procedure?

Bruising. But people do bruise and bruises do go away. I think the biggest concern aside from the practical is they don’t want to look fake. We take care of hundreds of people in this community and I’ll ask [prospective clients], tell me the last time you saw somebody walking around here that looked that way. The nice thing about my practice is, people we’ve treated in the past, we’re still treating. I think to the credit of the practice, when we’ve had people who’ve gone to other locations I’d say half of them end up coming back here because the artistry is different. You can take the same doctors, the same fillers, and get completely different looks.

What are your best tips for optimal skin care?

Moisturizer and a sunblock are the most crucial. Everybody wants to look good when they need to look good but that requires you to do some maintenance along the way. You’re not going to take someone who is 55 and make them look 30, nor should you try. We want them to look really good for their age and that is something that I think can be done.

So stay out of the sun, don’t smoke, hydrate, wear your sunblock; avoid highly restrictive diets if not medically necessary (they can cause hair loss and acne), eat a rainbow of foods of all colors; good skin care products aren’t cheap, cheap products aren’t good and expensive products aren’t necessarily any better. So know your skin care products that you’re using.

There is a commitment that you make to your skin care because what you do when you come here is important but what you do every day that you’re not here is just as important if not more.

Discovering the True Gift of Dance… in an Operating Room

by

When I started ballet in the 3rd grade, I was immediately thrust into the two worlds of dance: the world of practice and the world of performance. Practice consisted of endless classes and day long rehearsals where skills could be honed in the privacy of a studio. Mistakes were acceptable but promptly corrected and mastery of technique directly correlated with hours of hard work.

Performance, on the other hand, was different. The music enveloped you, bright lights illuminated you and as you look out on the dimly light audience between movements of carefully set choreography you realized there were hundreds if not thousands of eyes in the room…and they were all looking at you.

And while many people think dancers perform only for the applause, the truth is we perform for the intense, adrenaline-filled rush that accompanies successfully completing painstakingly practiced movements while under extreme pressure.

Although we practiced for months at a time leading up to our shows, inevitably every performance comes with its set of unforeseen errors. Props get dropped, people fall on stage, someone stands on the wrong mark, backstage lighting malfunctions, music starts too early or too late (or recently for our Snow Scene not at all!), but it is in those moments of chaos where true performers shine. Maintaining a calm demeanor when your heart is beating out of your chest, thinking up quick, effective solutions to unexpected snafus, and emotionally dealing with the embarrassment of a mistake cannot be learned in the ballet studio; it can only be learned on stage.

When I hung up my ballet slippers in 2011 after 13 years of dance, I felt a void in my life where performance had once lived; the adrenaline-filled moments I experienced on stage were gone. I resigned myself feeling this loss as the inevitable punishment for those who walked away from dance. But then, in my third year of medical school, I rediscovered the excitement in the most unexpected place: the operating room (OR).

In the OR for the first time, I felt an implacable but eerily familiar feeling. Scrub techs and circulating nurses were busy ensuring the surgeon had proper lighting and securing the patient to the OR table. After the patient was placed under anesthesia and covered with sterile drapes the room quieted as the surgeon and his residents entered. They gowned/ gloved up, the room lights were dimmed, the OR lights were turned on, and it hit me; I was at a performance! The OR had lights, cameras, a stage, and audience members. Principle, soloist, and corps dancers were replaced by surgeons, residents, and medical students. Each surgery had a carefully laid out choreography that required precise technique, impeccable timing, and hours of practice before show time.

In those early moments of my surgical training, I realized the gift ballet had given me–the gift of being able to perform. Thanks to years on the stage, it came naturally to me that I could think quickly while under the OR lights, improvise when something was going awry, and keep a calm demeanor when my heart was racing. In the Operating Room, confidence saves lives, and yet again, the confidence that my body would perform as I wanted it to under intense circumstances was there from day one.

To feel sure that you will actually help someone by cutting them open, inflicting wounds onto their bodies–which in any other setting is considered assault with a deadly weapon–and to believe after you have pieced them back together they will be better off (than if you had never touched them in the first place)…these are not convictions that can be learned in the library.

There are so many pieces of my life I am eternally grateful to dance for giving me: the best moments of my youth, great friends I still love seeing, a work ethic which got me through medical school, and the ability to thrive under the pressure of the OR.

Former dance students don’t say this enough to their instructors, and certainly not years later, but to Mr. Logrea, Mrs. Logrea, Nick and Carol, thank you for all the lessons and time you spent with me, I truly believe I am a better doctor and a better surgeon because of all of you.

From 1997-2007, Ari Bransdorfer, currently a first year Ophthalmology Resident at Montefiore Medical Center/Einstein College of Medicine, studied dance at Ossining’s Logrea Dance Academy www.logreadanceacademy.com  He returned as a guest dancer in 2008 and 2010.

 

 

 

 

The Eyes Have It!

by

Dr. Janet Woo, an optometrist for more than 18 years and with Eye Designs of Armonk since 2011.
Dr. Janet Woo, an optometrist for more than 18 years and with Eye Designs of Armonk since 2011.

By Miriam Longobardi

If you thought vision screening for your child was only for accuracy, think again. What we see is determined by our brain’s interpretation and processing of information and there are a number of connections between learning and vision. Dr. Janet Woo, an optometrist with Eye Designs of Armonk, and Dr. Carolyn Lederman, an ophthalmologist with Lederman and Lederman, LLP in Purchase, shared some of the impact visual processing and other issues can have on learning, as well as some common warning signs your child may well be experiencing vision problems.

According to Dr. Woo, “As young children acquire language, they tend to visualize images associated with people, colors and objects. Visual memory helps them recall something that they have been asked to retrieve or, as in reading, parts of a story. Children with poor visual memory tend to struggle with recall and multistep directions.” As an elementary teacher I see this type of behavior often. For example, if students are directed to go and take out their homework planner, a highlighter and red notebook, they may only remember one or two of those directions. Another common processing issue is visual closure. In other words, if an adult is shown a picture with parts missing or a word with letters missing, the brain takes over and fills in these gaps. Children who struggle with closure need to be taught other strategies to do this.

Other common visual processing issues I have seen amongst students are reversals of letters and numbers, color blindness and difficulty tracking without using a finger while reading. Some children skip entire words or lines of a book which leads to gaps in reading comprehension. Dr. Woo noted that many children experience double-vision when their eye muscles are fatigued but think that is normal so do not report it. They may abandon books or stop watching a movie and claim they are bored or tired when in fact eye fatigue is the cause.

Carolyn Lederman, M.D., is a pediatric opthalmologist in practice for 18 years with Lederman and Lederman, LLP, with offices in Purchase and Stamford. She is also assistant attending physician at New York Presbyterian Hospital.
Carolyn Lederman, M.D., is a pediatric opthalmologist in practice for 18 years with Lederman and Lederman, LLP, with offices in Purchase and Stamford. She is also assistant attending physician at New York Presbyterian Hospital.

Dr. Lederman agrees that vision issues may go undetected in children. “A child does not complain because he or she does not know what normal vision is. Good vision is essential for proper learning in school. Children who cannot see well may not be able to participate in class and may be distracted or withdrawn. Children, parents and teachers are often unaware of a child’s visual difficulties. Parents and teachers are frustrated by a child’s lack of progress which may resolve after a comprehensive eye exam uncovers a problem and treatment is initiated.” Lederman notes that while vision problems are not the cause of primary dyslexia or other learning disabilities, any child who isn’t reading at grade level or is suspected to have or has been diagnosed with a learning disability should have a comprehensive ocular exam.

Another concern Dr. Woo reports is that eye strain due to screen exposure is hazardous. “I recommend no more than 30 minutes at a time of looking at a screen, whether phone, computer or video game,” she said.

Dr. Lederman cautions parents and teachers to note warning signs in children. “Squinting, blinking or face turning may indicate a vision problem, as can holding books close or moving closer to the board or television. If the eyes don’t seem aligned (both eyes looking at the same thing at the same time), a child should be examined immediately. Normal ocular alignment is critical. If a child closes one eye when reading or comments on double vision, he or she should be examined.”
Headaches may also be an indicator.

Early detection of vision problems is a key part of treatment. Tracy M., a Mount Kisco mother of three, was told by her pediatrician that her youngest daughter, Maggie, may have amblyopia, commonly termed, “lazy eye,” and was referred to a pediatric ophthalmologist. This was at Maggie’s 18-month-old well check-up. The ophthalmologist confirmed the diagnosis, and prescribed a patch to be worn three hours a day on the dominant eye as well as glasses. The patch was used for another five years. Tracy herself was diagnosed with the same condition (but not until she was age five), and recalls wearing an eye patch. “Nowadays they have patches with all sorts of cute designs on them for kids. Maggie would even decorate her own patches.” Maggie continues to wear corrective lenses and her eyes are now able to work together.

So what tests and screenings should typical children have? According to Dr. Lederman, “The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) and the American Academy of Pediatrics (AAP) have designed a screening schedule for all children from birth through school years. Children as young as three years old should have their vision checked at their annual well visit examination; newer devices assess visual development even in pre-verbal children. School nurses assess vision and ocular alignment when students are entering kindergarten and periodically during a child’s years in school. Some test color vision and depth perception. If any abnormalities are suspected as well, a child should have a comprehensive ocular examination.”

Miriam Longobardi is a freelance writer, fourth grade teacher and single mother of two daughters living in Westchester.  A breast cancer survivor, she volunteers for the American Cancer Society, has completed four marathons and travels the world. Follow her on Twitter@writerMimiLong.com.