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Northern Westchester Hospital

A Team Approach to Weight Loss Management at Northern Westchester Hospital

November 13, 2020 by Beth Besen

Members of the team at Northern Westchester Hospital’s Center for Weight Management, which is housed in the Center for Healthy Living. (L-R): Rachel Goldman, Angelique Nicholson, Carla Larca, Julissa Pena, Laura Spallina

The Inside Press recognizes that weight management is a multi-dimensional issue, one which encompasses a myriad of physical and mental health issues. The following article seeks to provide some key information, and is neither judgment by nor opinion of the writer, editor or publisher.

These days, “home for the holidays” isn’t exactly the exciting work-break or reunion most of us associated with the phrase in years past. No, sadly, many of us have been home for quite awhile now, carefully working from that same home (if we’re lucky enough to be able to do so), helping our school-age children to learn from that same home and even supporting grown-and-flown adult children and/or parents who’ve returned to the nest as well. Likely, even Hallmark would agree that coziness has its limits, and holidays might take more than the usual toll on some.

For example, weight gain. Most years, as we approach the holiday season, we are both invited to indulge and cautioned to simultaneously take care; mouth-watering special holiday recipes on one morning talk show, “how to handle the office party and make healthy food and drink choices” on another. Let’s face it, celebrating and enjoying ourselves while remaining on the alert for hidden calories and sneaky sugars isn’t easy. Now, it’s not only that time of year again, but it comes on the heels of a nearly nine-month lockdown during which some of us became more sedentary, ate and drank more, and, much to our dismay, have had to recognize we’ve put on few pandemic pounds.

Sound familiar? Many readers will likely shake their heads in agreement, but also shrug it off as something they can deal with. However, for seriously overweight and obese people, additional weight-gain is actually quite critical. According to a CDC COVID-19 alert: “Obesity May Increase Risk for Severe Illness”. When President Trump was diagnosed as positive for the coronavirus, he was considered at higher risk for complications due to his age (74) but also due to his weight (undisclosed, but notably overweight).

Understanding Obesity

But what exactly is obesity? How do we define it? And, more to the issue, once defined, what can we do to better understand and remediate how it affects our health? For answers to these and related questions, The Inside Press turned to three members of the team of experts at Northern Westchester Hospital’s Center for Weight Management at Chappaqua Crossing; specifically Ms. Rachel L. Goldman, FNP-BC, CDCES. (Family Nurse Practitioner- Board Certified, Certified Diabetes Care Education Specialist); Ms. Pat Talio, RD, CDCE; and Dr. Mitchell S. Roslin, MD, FACS, Director of Bariatric Surgery.

In broadest terms, the condition of being overweight or obese is defined as having too much body fat, and the most widely used determining measure for this is the Body Mass Index, commonly referred to as the BMI. A simple equation originally proposed by a Belgian mathematician in the nineteenth century, the BMI is the body mass or weight (kg) divided by the square of the body height (m) or kg/m2.

Category BMI range – kg/m2

Severe Thinness < 16
Moderate Thinness 16 – 17
Mild Thinness 17 – 18.5
Normal 18.5 – 25
Overweight 25 – 30
Obese Class I 30 – 35
Obese Class II 35 – 40
Obese Class III > 40

Of course, like most tools, the BMI is not perfect; it doesn’t distinguish between body fat and denser tissue like muscle and bone. An athlete may have a high BMI and be perfectly healthy. But, for most people and healthcare professionals, the BMI is the gold-standard for determining people at risk for health problems due to excess weight. All interviewed for this article concur with this and with the World Health Organization’s (WHO) recommended body weight based on BMI values for adults. It is used for both men and women, age 18 or older.

While the BMI is but a simple measurement tool, the Center for Weight Management is a full-on toolbox of state-of-the-art health help. According to Goldman, when a potential patient calls the Center, the first order of business is a comprehensive medical screening including “a really long conversation with the patient to discuss their weight struggle over time; our relationship with food is complicated with many possible factors at play including emotional issues, lack of time to cook, lack of time to exercise. We take blood, and screen for weight-related underlying conditions–hormonal or metabolic conditions that make weight loss hard and unsustainable–and look for side effects of medications taken for other things. I’ve seen people who’ve been struggling to lose weight for years without knowing they have an underlying thyroid condition.”

Goldman notes that patients have continued to work with the Center remotely during the pandemic lockdown, and that the Center’s online content has grown and greatly improved. She also shares that the team has seen new patients as well, “people who recognize they’re extra vulnerable and are searching for new ways to be successful. We’re here for them, and eventually we come up with a plan which may include any or all of the following: nutrition counseling, medical-nutrition therapy, FDA- approved medication, surgery.”

Nutrition Counseling is Key

Explains registered dietitian Pat Talio: the foods we use to fuel our body aren’t all created equal. Talio discovered this herself as a freshman away at college for the first time. Having come from a “family who always ate well, used fresh and healthy ingredients and got outside to play sports a lot”, Talio wasn’t prepared for the relatively nutrient-poor but abundant food choices at college, and soon found she was on her way to gaining the proverbial “freshman 15”. Fortunately, she also found her way to health services who recommended she meet with a dietitian. The dietitian not only opened up her eyes to healthy food choices, but also to a regular exercise program (she’d been unaware that her home-based backyard sports games were about more than fun and were actually a means toward an ongoing healthy lifestyle).

What’s more, this all led to an abiding interest in nutrition, and her ultimate choice of career; Talio has been a practicing Registered Dietitian since 1985, and is further certified as a diabetes specialist. She sees a variety of clients including cardiac and pulmonary rehab patients for whom she points out that “nutrition is an important part of recovery.”

When asked about the differences, if any, between her work pre- and post-COVID-19, Talio says, “I never thought I’d be working from home but the hospital has been very supportive with technology and thinking outside the box! There’s greater scheduling flexibility for their appointments–and all without traffic and waiting rooms.” Her patient roster has remained fairly steady, but she does allow that the virus has led to new inquiries and perhaps provided an extra push to people who have been on the fence about seeking help; “they’re re-evaluating their health and their choices”. And, she adds, “I’m so thankful I’m able to offer support.”

Bariatric Surgery Option

Patients whose Center personal plan includes surgery often see Dr. Roslin, considered one of the best bariatric surgeons in New York, and an innovator in the search for new and better treatments of obesity. Roslin is full of compassion for his patients and their struggle as he describes the importance of surgical intervention.

He begins with what he calls Point #1: obesity is a chronic relapsing condition. He then provides a useful visual to what that means by saying “it’s like a rubber band that always wants to bounce back.” “And,” he adds, “this makes treating obesity extremely challenging.” Explains Roslin, “There’s an assumption that obese people overeat. That’s wrong. It has to do with insulin resistance which encourages fat formation as well as other metabolic activity. It’s impossible to tease out which comes first and they can also be synchronous. It’s not lack of will power.

Surgery is the only reproducible mechanism we have; it breaks insulin resistance and blunts recidivism–and it’s underused. The number of people who are in their 30s and 40s with obese BMIs will likely not be able to lose weight without surgery.” Roslin shares that his patients rarely come in due to some seminal event–e.g., a death in the family–but because they’ve reached a point in their lives “when functional impairment overcomes the fear of surgery threshold.” And, further, he notes “a majority have gained a significant amount of weight during the pandemic, as much as 25-30 lbs in the last few months.” Unfortunately, that doesn’t mean that they’ll be able to shed the weight as quickly as they put it on.

To be sure, surgery is not a substitute for a healthy lifestyle, and even though Roslin sees it as the linchpin to starting that healthy lifestyle, he, like Goldman and Talio all agree that the only way to truly treat the complex issue of obesity is to help the patient learn to make a sustainable lifestyle change. Sums up Roslin, “the reason centers like ours are so important is because we teach you!”

For more information or to speak to a member of the Center for Weight Management team, call (914) 223-1780.

Filed Under: Cover Stories Tagged With: Bariatric Surgery, Northern Westchester Hospital, Nutritional Counseling, team, weight loss, Weight Management

State of the Art Cardiac Cath Lab Anticipated Opening at Northern Westchester Hospital: September 2

August 24, 2020 by Lauren Rosh

The Newly Opening Cardiac Catheterization Lab at Northern Westchester Hospital

Northern Westchester Hospital will open its highly anticipated comprehensive Cardiac Catheterization Lab on September 2nd, providing state-of-the-art interventional cardiology services to residents of Westchester, Putnam and Fairfield Counties, who would otherwise have to travel long distances during cardiac events when every second counts.

The Cath Lab will work as an extension of and in conjunction with Lenox Hill Hospital’s cardiac services, providing care for emergency level patients 24-hours a day, seven days a week.

“A cardiac catheterization lab is a specialized area in a hospital where cardiac specialists diagnose and treat coronary artery disease, such as various types of heart attack, using tiny flexible tubes called catheters to access the heart and coronary (heart) blood vessels,” explained Interventional Cardiologist Carl Dietrich Reimers, M.D., FACC, FSCAI, director of the new NWH Cardiac Cath Lab.

Garvey Rene, M.D., FACC, FSCAI of Caremount Medical, is associate director of the Cath Lab.

According to Dr. Reimers, Northern Westchester Hospital’s Cardiac Catheterization Lab will treat patients with coronary artery disease–a narrowing or blockage of arteries carrying oxygenated blood to the heart.

Until now, Northern Westchester Hospital patients who needed cardiac catheterization were taken to Valhalla, New York, or Stamford or Danbury, Connecticut. The new Cath Lab will eliminate the time between an emergency and treatment.

“It is critical to have a catheterization lab in close proximity since the most effective treatment is performed within 90 minutes of the onset of symptoms,” says Dr. Reimers, who is also vice chairman of cardiology at Lenox Hill Hospital and assistant professor of Cardiology at the Zucker School of Medicine at Hofstra/Northwell.

“When there is a blockage in the artery, the heart begins to suffocate from the lack of oxygen. However, if treated promptly, the damage can be reversed.

“When someone experiences chest pain and calls 911, the goal is to diagnose the patient, bring them to the catheterization lab and perform the procedure all within 90 minutes,” he added.

This new location eliminates delays in care that may come along with being transported to a location outside of Northern Westchester.

“The new Cath Lab will be vital to elevating the level of care that patients can receive right in the community,” said Dr. Reimers. “All of the physicians covering the Cath Lab also rotate at Lenox Hill to ensure seamless care for patients who require more complex procedures.”

Northern Westchester Hospital and Lenox Hill Hospital are both a part of New York State’s largest healthcare system, Northwell Health. A benefit of being a part of this network is the collaboration that exists between hospitals and facilities across the system.

All of the nurses preparing to work in Northern Westchester Hospital’s Cath Lab are trained in critical care medicine and have experience working in intensive care units. To build the team’s experience, the nursing team trained at two of Northwell’s facilities on Long Island. Additionally, Dr. Reimers said, four techs all trained at Lenox Hill Hospital to get hands-on experience prior to the lab opening.

Healthgrades ranked the cardiac program at Lenox Hill Hospital among the top 5% for six consecutive years. Additionally, Lenox Hill Hospital was one of the first hospitals in New York City to open a cardiac catheterization lab. In 1938, the first angiocardiography in the United States was performed at Lenox Hill Hospital, and in 1967, Lenox Hill Hospital opened the first cardiac care unit in the New York metropolitan area.

The collaboration between Northern Westchester Hospital and Lenox Hill Hospital will allow doctors, nurses and staff to discuss difficult scenarios.

“We will be available 24/7, 365 days a year to handle all cardiac emergencies,” said

Dr. Reimers. “We believe Northern Westchester Hospital’s Cardiac Cath Lab will save lives.”

For more information, please visit:nwhc.net/blog/CardiacCathLab

Filed Under: Cover Stories Tagged With: Cardiac Catheterization, cardiac emergencies, cardiac specialists, Cath Lab, coronary artery disease, heart attack, interventional cardiology, Northern Westchester Hospital, Northwell

COVID-19 Antibody Testing Available at Northern Westchester Hospital’s Center for Healthy Living

June 10, 2020 by Inside Press

Northern Westchester Hospital (NWH) has issued a release announcing the availability of serology COVID-19 antibody testing for community members living in the villages, towns (and hamlets within the towns) of:  Armonk, Bedford, Chappaqua, Lewisboro, Mount Kisco, Pleasantville, Somers, North Salem, Yorktown, Pound Ridge, and Mt Pleasant. In order to accommodate the local community with minimal wait times and to maintain appropriate social distancing guidelines, all individuals coming for a test must be pre-registered and will be expected to wear a mask. In compliance with NY State Department of Health (DOH) guidelines, effective immediately and through July 31, antibody testing is available at:

Center for Healthy Living

480 South Bedford Road, Chappaqua, New York, 10514

Located in Chappaqua Crossing – Next to Whole Foods. Ample Parking

Hours of Operation:

Antibody testing will be offered Monday through Friday between 7am and 3pm through July 31st.  You can come anytime during this designated time period.

Pre-registration is required 24 hours in advance and can be completed at https://bit.ly/3dFyuSG

Upon arrival please bring:

  • A copy of your confirmation email (from pre-registration). No prescription is needed but pre-registration is required.
  • A copy of your insurance card (copayments are waived)
  • Please know that you will be asked screening questions and will be masked upon entry per NYS regulation

Information about Antibody Testing:

What is serology (antibody) testing? After a simple blood draw, the antibody test may determine whether or not people who have been previously infected or exposed to COVID-19 have antibodies in their blood. Antibodies are proteins in the blood made by one’s immune system that help fight infection.

What does a negative result mean? Negative means that COVID-19 antibodies were not detected in your blood. Most commonly, this indicates you have not been infected with the COVID-19 virus. A negative result does not rule-out early or recent infection and antibody testing should not be used to diagnose COVID-19 infection.

What does a positive result mean? A positive result indicates that you have COVID-19 antibodies in your blood. This means you have been exposed to COVID 19 and developed antibodies. At this point scientists are unsure how detected antibodies impact immunity and protect against re-infection.  Therefore, it is important to note that regardless of your test result, it is essential that you continue to adhere to the Governor’s Executive Order and the New York State Department of Health guidelines for masking, social distancing and hand washing.

Why participate? Scientists are still working to understand many things about COVID-19, like how it travels from person to person, why it affects people differently, if it is a seasonal disease (meaning it can come back year after year like the flu), and if people can be infected again. That’s why these efforts are so important for you, your family and the community as a whole.

Reminder- Pre-registration is required 24 hours in advance and can be completed at https://bit.ly/3dFyuSG.

Participants will receive a confirmation email after successful pre-registration.  Please note that pre-registration takes 24 hours to be processed so please plan accordingly so there are no delays when you arrive for your test. 

Testing continues to be available for first responders and essential workers who live or work in the towns served by NWH and for family members of NWH staff.

Why participate? Scientists are still working to understand many things about COVID-19, like how it travels from person to person, why it affects people differently, if it is a seasonal disease (meaning it can come back year after year like the flu), and if people can be infected again. That’s why these efforts are so important for you, your family and the community as a whole.

Reminder- Pre-registration is required 24 hours in advance and can be completed at https://bit.ly/3dFyuSG.

Participants will receive a confirmation email after successful pre-registration.  Please note that pre-registration takes 24 hours to be processed so please plan accordingly so there are no delays when you arrive for your test. 

Testing continues to be available for first responders and essential workers who live or work in the towns served by NWH and for family members of NWH staff.

News and photo courtesy of Northern Westchester Hospital

 

Filed Under: New Castle Releases Tagged With: Center for Healthy Living, COVID-19 Testing, Northern Westchester Hospital

Northern Westchester Hospital’s Emergency Chair: 50 Percent Decline in ER Visits Impacting Patients with Life-Threatening Conditions

May 13, 2020 by Grace Bennett

Dr. James Dwyer, Chair of Emergency Medicine at Northern Westchester Hospital (NWH), discussed the alarming decline in visits to the ER among patients with serious, life-threatening medical conditions, including heart attacks, strokes, and appendicitis.

“We are seeing similar scenarios over and over again,” said Dr. Dwyer in an interview this week. “A patient, for example, who has abdominal pain is afraid to come into the Emergency Department, so they tough it out and think: ‘it will go away, it will go away..,’ and then by the time they realize it won’t, they come in with a ruptured appendix as opposed to catching the appendicitis before it’s ruptured and getting to the operating room earlier.”

Dr. James Dwyer, Chair of emergency Medicine (standing) with Michael Pancoast (seated) at the triage station just inside the emergency room at Northern Westchester Hospital.
Photo courtesy of NWH

According to Dr. Dwyer, ERs around the country are seeing a drop in overall patient volume due to patient fears about COVID-19. As a result, untold numbers of people may be dying at home or risking long-term health consequences by ignoring serious symptoms.

Meanwhile, “when appendicitis (removal of the appendix) is performed as a routine procedure, the outcomes are outstanding; most of the people are out the same day,” said Dwyer. In contrast, a life-threatening rupture can spread infection in the abdomen requiring more involved surgery and longer recovery times.

Since the pandemic started March 11, about 50% of the appendicitis cases have presented as ruptured–a normal scenario is 5-10 percent,” he elaborated. “1 in 2 ruptured versus 1 in 10… people are definitely waiting to get this taken care of.”

NWH is seeing about a 50 percent drop to their usual ER volume, Dr. Dwyer said. At NWH, the ER typically sees more than 80 patients per day and is now seeing as few as 30. “The decline in ER visits among people with serious, life-threatening conditions, including heart attacks, strokes, infections and trauma, is taking a toll on the health and wellbeing of people in the United States and around the world.

Dr. Dwyer said some patients experiencing symptoms may not be calling their doctors because they are afraid their doctors will tell them to go to the Emergency Department. “It’s possible not enough people experiencing symptoms are reaching out to their primary doctors,” he said adding that the many excellent practitioners in the area could properly discern symptoms and steer patients to the ER, as needed.

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“I saw a patient who had been short of breath for six days before he decided to see his primary doctor;  when he finally saw him,  he found a very rapid heart rhythm, an atrial fibrillation. We immediately admitted him to the hospital.”

“We need people to understand that it is safe to go to the ER, and far more dangerous to stay home and wait for serious symptoms to disappear.”

Before coronavirus, 12% (just over one in 10) people with stroke symptoms waited one day before visiting the ER; now, 25% (one in four) wait at least one day, despite symptoms that can include loss of vision, speech, sensations and weakness on one side.

Surviving stroke, he explained, is very time dependent. “For those who present early– within 4.5 hours–we can give medication that breaks up the clot. The window for treating more severe stroke–via an endovascular procedure to open up the blood vessel–is traditionally within six hours, and in a small minority of cases, up to 24 hours.”

“The earlier you get these therapies, the more successful they are at preventing a bad outcome,” he said.

“We want people to know that it’s safe to visit the ER,” he emphasized. “At NWH, people are screened at the front door of the Emergency Department, everyone in the entire institution wears a mask, and patients are treated in private rooms.”

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Dr. Dwyer added: “The precautions we take here are working. Very few staff members have been diagnosed with COVID since this started.” Dr. Dwyer also pointed out that only a small number of visitors are allowed in the hospital so as to protect overall populations. These include partners of women giving birth, parents to a pediatric patient, and close family members to those dying of COVID-19 or any other condition.

As of this morning (May 13), NWH was caring for 19 COVID-positive patients in the hospital, which is significantly down,” Dr. Dwyer said.  “We were up in the 80s at the beginning of April, so it has come down quite a bit.  We still have 10 people on ventilators who are COVID positive. Some of these critically ill people require an extended period  of time for their lungs to recover on the ventilator.”

“We happen to have had some success treating patients on ventilators. The 10,000th discharge from Northwell in fact was from Northern Westchester Hospital, someone who was severely infected who is now recovering.”

“From our institution alone, we have had 247 live covid discharges.  That’s very encouraging.” There have been 58 COVID-related mortalities.

Dr. Dwyer elaborated: “We have worked very, very hard to make sure this is a safe environment, and in the ER, especially. When you come into the ER, you are screened at the door, and given a surgical mask and then escorted to one of 26 private rooms–there is very little chance of being exposed to COVID at NWH.

He pointed out that his nine-year-old nephew was a patient recently.  “He had a laceration. He had cut his ear on a branch outside running around–he came into the ER, and one of the nurse practitioners sewed his ear up. I feel comfortable having my own family here.”

Dr. Dwyer urges people to recognize the signs and symptoms of the following life- threatening conditions:

Heart attack

People who survive a heart attack may have weakened heart muscles and are at risk for life-threatening complications including another more serious heart attack. Go to the ER immediately if you have any of the following symptoms:

  • Chest pain, including tightness, and pain that spreads to the arms, neck, jaw or back;
  • Sudden onset of shortness of breath, sweating, dizziness or lightheadedness;
  • Unexplained nausea, indigestion, or heartburn.

Strokes

When caught early, immediate treatment may prevent death and minimize the long-term effects of a stroke. Even if a stroke is minor, it is important to receive an evaluation and treatment in order to prevent another, possibly devastating, stroke: Go to the ER immediately if you have any of the following symptoms:

  • Body weakness, especially on one side;
  • Facial droop;
  • Difficulty speaking or finding words;
  • Sudden loss of vision;
  • Numbness or loss of sensation;
  • Unsteadiness on your feet.

Appendicitis

When caught early, a surgeon can remove the appendix and often send you home the same day. If the appendix ruptures, a patient will spend days in the hospital and be at risk of life-threatening conditions that include peritonitis and sepsis. Go to the ER if you have the following symptoms:

  • Pain in the right lower quadrant of the abdomen (which typically increases when you move and intensifies over 24 to 48 hours), sometimes with
  • Loss of appetite;
  • Nausea and vomiting;
  • Fever.

Filed Under: Surviving COVID-19 Tagged With: Advanced Stroke, Antibodies, Appendicitis, COVID-19, Emergency Room, ER, heart attack, heart disease, Life threatening conditions, Northern Westchester Hospital, Precautions, Primary doctors, Ruptured Appendix, Strokes

Teens Show How to Have Fun While Social Distancing

May 7, 2020 by The Inside Press

Mount Kisco, NY–Hoping to make a difference during COVID-19 quarantine and concerned their peers were getting antsy to get out and socialize, Northern Westchester Hospital’s (NWH)  President’s Junior Leadership Council (PJLC) produced a video encouraging teens to social distance and have fun at the same time (https://www.youtube.com/watch?v=L0-9yp54HZU .

The video stars students at high schools throughout Northern Westchester– enjoying at home activities that include dancing, painting, playing basketball and cooking.

“We’re hoping to motivate teenagers to find interesting and enjoyable activities they can do in quarantine,” says 15-year-old Byram Hills High School sophomore Sydney Levy. “Ultimately, staying home is the answer to ending the spread of this pandemic, and it is important to physically distance whenever it is necessary to leave home.”

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If you want to be cool, follow one simple rule: Stay home, the video begins.  It concludes by saying, We know everyone is feeling FOMO from COVID-19 and ends with students, each in their home, holding a word to collectively spell out The Shorter It Will Be Is Up To You And Me.

“Physical distancing contributes to the safety of the community and the health and wellbeing of the doctors, nurses and staff at Northern Westchester Hospital,” says 17-year old Sacred Heart junior Madison Mezzatesta, “We hope our video inspires others in the community to find things that they love doing at home to make the most of this difficult experience.”

PJLC is currently working on more COVID 19 videos, in an effort to create a series of inspirational messages for teens.

The NWH PJLC is a leadership organization that helps high school students in northern Westchester connect to their community; promotes the health, safety and wellbeing of adolescents and young adults; and engages them on issues that matter to them and affects their lives. Its members include 50 high school students from communities served by the hospital: Chappaqua, Armonk, Yorktown, Byram Hills, North Salem, Bedford, Katonah-Lewisboro, Somers and Pleasantville.

NWH relies on the PJLC to help hospital administrators understand issues facing teens and adolescents, and the students provide input on health-related educational programming that the hospital offers at local schools. Each year, students from the PJLC identify a major health concern within their peer group and develop creative, relatable ways in which educators can inform students, parents, and the community.

News courtesy of Northern Westchester Hospital

Filed Under: Stay Connected Tagged With: COVID-19, Northern Westchester, Northern Westchester Hospital, Northwell, PJLC, President's Junior Leadership Council, Quarantine, social distancing, teens

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