The Inside Press

Magazines serving the communities of Northern Westchester

White Plains Hospital

Weight Watch

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Ultra-processed foods & increasing screen time have fueled rise in the obesity epidemic, putting more people at increased risk of heart disease.

When the World Health Organization recognized obesity as a global epidemic in 1997, less than 20% of Americans were considered obese, with a body mass index (BMI) greater than or equal to 30. Less than three decades later, the numbers are staggering. Obesity rates in the United States have doubled to 40% according to a 2021-2023 report by the Centers for Disease Control. As rates continue to rise, it’s predicted more than 250 million Americans will be obese or overweight by 2050.

“Obesity is one of the most common conditions I see in patients,” says Dr. Angel Rodriguez, Medical Director of Primary Care at White Plains Hospital Physician Associates. “Over the past several decades, we’ve seen a shift toward high-calorie diets comprised of processed foods that are full of salt, sugar, fats, and artificial colorings. They are designed to entice people to eat more, but they’re not very healthy and lack nutrients.” Though Westchester’s obesity rate sits well below the national average at 24% of the population, residents still report overindulging in ultra-processed foods. In the most recent Westchester County Community Health Assessment, 20% of adults self-reported consuming one or more sugary drink daily and 23% said they ate less than one fruit or vegetable daily.

Increasingly sedentary lifestyles also contribute to weight gain–a trend that’s been exacerbated in
recent years by increased screen time and work-from-home culture. “COVID brought that out more than anything. Now we sit in front of the computer eating and talking,” Dr. Rodriguez says. “I can relate. As with everyone else, I gained weight during the pandemic and am working hard to get back to a healthy weight.”

Shedding excess pounds has a positive impact on heart health. “Carrying extra weight is like carrying a backpack full of rocks,” Dr. Rodriguez says. “Your heart has to work harder, and the extra weight causes added stress in the whole body, including on the joints and liver as well.” Obesity is also tied to increased incidence of other chronic conditions, including hypertension, high cholesterol, insulin resistance, and diabetes–all risk factors for heart disease–as well as inflammation and joint pain.

Dr. Rodriguez recommends this commonly prescribed regimen for reaching a healthy BMI:

  • Follow a healthy diet and swap those processed foods for fruits, vegetables, whole grains, lean proteins, and healthy fats.
  • Aim for at least 150 minutes of exercise per week.
  • Eat slower to help with portion control.
  • And drink lots of water – it’s good for you and filling.

Before starting an exercise regimen, patients should visit their primary care physician for a physical–a step Dr. Rodriguez notes is often overlooked. A comprehensive exam confirms the heart is healthy enough for cardio and can identify other factors linked to weight gain, like genetics, hypothyroidism, and in young women, polycystic ovary syndrome. “Most patients who are obese are relatively sedentary,” he notes. “You want to have a sense of what their heart can handle before they go run on a treadmill.”

Physicians can also advise on injectable weight-loss (GLP-1 and GIP receptor agonists) medications for appropriate patients to help with weight loss and lower the risk of heart attack. “You still need to eat right and exercise, but the good thing is that these meds are working for the right patients,” says Dr. Rodriguez.

To combat this growing epidemic, small, sustainable changes to diet and lifestyle can make a significant impact over time. With the right support and resources, maintaining a healthy weight and reducing heart-disease risk is within reach, Dr. Rodriguez notes.

How to Help Children Develop Healthy Sleep Habits

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Dr. Ranaan Arens

Creating and sticking to a healthy sleep routine for every child is essential for successful school year. Getting ample sleep (9-11 hours a night) ensures that children get enough rest to meet the cognitive and physical demands of their days.

Keep in mind the following five tips to foster healthy sleep habits in children:

1. Set a regular bedtime and wake time. On weekends, don’t let them sleep more than an hour or so longer than usual.
2. Establish a regular bedtime routine – such as a bath followed by reading, and not eating close to bedtime.
3. No screens before bed. The American Academy of Pediatrics (AAP) recommends that we stop using electronic devices 30-60 minutes before bedtime. Keeping TVs and computers out of their rooms is also helpful to create a restful environment.
4. Turn off bright lights at night. Nightlights are okay, but stronger lighting can affect a teenager’s ability to fall asleep even more than usual. Teens have a delayed melatonin release, which is why their bodies naturally want to stay up later at night and sleep later in the morning.
5. Take advantage of morning light. Exposure to natural light in the morning advances the circadian rhythm to shut down brain melatonin production and promote daytime alertness.

When Trouble Sleeping Signals a Sleep Disorder

Many people think of snoring as an adult problem, but children also sometimes exhibit snorting, rasping or gasping sounds while sleeping. In some cases, the problem might be caused by oversized tonsils and adenoids or being overweight. In others, the snoring could be the sign of a sleep disorder such as obstructive sleep apnea (OSA).

This is one of the most common sleep disorders I see in children. In sleep “apnea” (which means to stop breathing), children temporarily stop breathing and have reduced oxygen supply to their brain for 10 or more seconds at a time during their sleep. This condition is harmful to their and may affect their growth, development and behavior and lead to significant conditions as high blood pressure and diabetes.

Today, up to 5-7 percent of kids have sleep apnea. The size of their tonsils remains a common cause of obstructive sleep apnea, in addition to upper airway anatomical abnormalities. As with adults, being overweight is one of the biggest causes and risk factors; 17 to 30 percent of children today are in this category. The added weight in the chest and neck impinge on the mechanical construction of the airway.

Kids themselves may not realize they are having trouble sleeping, but parents might.

Signs include:

  • Frequent snoring
  • Abrupt arousals at night and difficulty staying asleep
  • Waking with a sore throat or dry mouth
  • Waking up with headaches
  • Difficulty waking in the morning
  • Daytime sleepiness
  • Poor attention and poor school performance
  • Moodiness or other behavior problems
  • Depression
  • Bed wetting

How a Sleep Study Can Help

If your child displays any of the above symptoms – and especially if they have more than one – the AAP recommends that you have your child evaluated for a sleep study.

It’s actually a very easy process – all the kids have to do is sleep! Polysomnographic sleep studies involve spending an overnight (with a parent) in our sleep lab. At our new facility, we have a special pediatric room with a private bathroom where parents can sleep in the same bed as their children, or in a separate bed next to them. The children are monitored overnight as they sleep using highly advanced diagnostic equipment that checks for things such as airflow and oxygen intake. A sleep technician is there all night to monitor equipment and attend to any needs.

And that’s it. In about a week, we’ll have analyzed the study data and be ready to make a diagnosis. Treatment for large tonsils could be as simple as a tonsillectomy to cure the apnea. In other cases, treatments include an airflow regulating mask to facilitate breathing in cases of apnea, as well as a weight management plan. Other sleep disorders such as parasomnia or “night terrors” might warrant behavioral health treatment.

Whatever the diagnosis, our credentialed staff is dedicated to getting to the source of the problem and helping your child get the sleep he or she needs.

Dr. Ranaan Arens is a Professor of Pediatrics at Albert Einstein College of Medicine. He is the Director of the Pediatric Sleep Center and Director of the Postgraduate Training Program in Pediatric Pulmonology at the Children’s Hospital at Montefiore (CHAM).
He sees patients at White Plains Hospital’s Pediatric Specialty Center in White Plains. To make an appointment, call 914-849-5437.

Advancing Stroke Care in Our Community

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Saving brainpower in stroke patients demands medical insight and quick thinking. At White Plains Hospital, the standard of care includes the most advanced technology and services.

Dr. Paul Lleva, Director of Stroke Services, White Plains Hospital

Each year, approximately 795,000 people in the U.S. suffer strokes – 17% of which are fatal. With one of the most comprehensive stroke programs in the region, providing immediate and lifesaving stroke care is an area where White Plains Hospital and its newly appointed Director of Stroke Services, Dr. Paul Lleva, is proud to excel.

Board-certified in neurology, vascular neurology, neurosonology (or brain imaging), and internal medicine, Dr. Lleva currently sees patients at White Plains Hospital Physician Associates in Somers and is working to further enhance the Hospital’s robust stroke care program. “White Plains Hospital has been building a world-class stroke program, bringing in top specialists and the latest technology and treatments,” Dr. Lleva says. “As we look to the future, our program aims to be the top advanced stroke care provider in our region and beyond.”

Recent notable advances in stroke care at the Hospital include:

Quicker Clot Busters. “For every minute elapsed after a stroke, a patient may lose 1.9 million neurons,” or nerve cells in the brain, says Dr. Lleva. The team at White Plains Hospital relies on the newest medicine, called Tenecteplase, to rapidly dissolve the clots obstructing blood flow. “This drug works very specifically against the clot, destroying it more quickly and more effectively than previous medications,” he says.

The Gold Standard Of Care. The highest-quality acute care currently available for strokes, a procedure called a mechanical thrombectomy, is currently being performed at White Plains Hospital. During this minimally invasive procedure, specially designed instruments are inserted into a large blood vessel in the groin through a small port and threaded through thin catheters to reach – and remove – blood clots in the brain within 24 hours from symptom onset.

To assist in these procedures, the Stroke Team at the Hospital also uses advanced imaging, called perfusion imaging, to differentiate salvageable brain tissue from irreversibly damaged brain tissue to pinpoint cases where mechanical thrombectomies will be most effective.

Artificial Intelligence (AI)-Powered Software. This modern technology guides radiologists and neurologists toward the correct intervention within seconds. “Our team uses software that will detect the amount and location of salvageable brain tissue, as well as damaged tissue,” Dr. Lleva says. “As a tool for our care team, it provides a more uniform and consistent diagnosis in rapid time.”

24/7 Emergency Consultations. At White Plains Hospital, a neurologist is always available for an emergency consultation at the bedside, either in-person or remotely. “With telestroke services, a vascular neurologist can expeditiously see the patients within minutes of arrival, allowing us to quickly diagnose patients and get them appropriate care immediately,” Dr. Lleva says.

World-Class Team. The increasing complexity of stroke cases seen at White Plains Hospital has driven the recruitment of experts in neurocritical care and neuroendovascular surgery with decades of experience in treating and managing advanced stroke cases.

Smoother Recovery. After stroke, some patients will develop arm and leg spasticity, language difficulty, pain, inability to walk, and limited ability to care for themselves. These complications are addressed in our outpatient stroke center in collaboration with Burke Rehabilitation to improve patients’ mobility, lessen discomfort, and restore quality of life.

To make an appointment with Dr. Lleva at 325 Route 100, Somers, NY, call 914-849-5300.

This article originally appeared in Health Matters, a White Plains Hospital publication.

White Plains Hospital Ranks Among the Top 5% Nationally for Safety

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White Plains Hospital announced today that it has been awarded the Patient Safety Excellence Award™ and Outstanding Patient Experience Award™ from Healthgrades. The Hospital is one of only two in New York and 79 across the nation to receive top honors in both categories. With these awards, White Plains Hospital ranks among the top 5% in the nation for patient safety and among the top 15% for patient experience.

Healthgrades analyzed more than 4,500 institutions, with safety honors given to those who scored highly in 13 quality measures determined by the Centers for Medicare & Medicaid Services (CMS). Patient experience scores were based on patients’ perceptions of their hospital care, from cleanliness and noise levels to medication explanations and staff responsiveness. This is the 9th time White Plains Hospital has received the Outstanding Patient Experience Award.

“We are honored to continue to be consistently ranked among the top hospitals in the nation for quality care,” said Dr. Rafael E. Torres, Chief Quality Officer at White Plains Hospital. “Quality, safety, and the patient experience are at the center of everything we do and to receive these awards from Healthgrades highlights the efforts of our entire staff to deliver exceptional patient care.”

“We commend White Plains Hospital for going above and beyond to provide a best-in-class care experience for patients during their hospital stay,” said Brad Bowman, MD, chief medical officer and head of data sciences at Healthgrades. “White Plains Hospital’s dedication to superior patient care is particularly impressive given recent declines in patient satisfaction scores across the country. We look forward to their continued leadership and commitment to ensuring the health and wellness of all patients.”

In addition to the Patient Safety Excellence Award and Outstanding Patient Experience Award, earlier this year Healthgrades named White Plains Hospital one of “America’s Best Hospitals for Coronary Intervention.” A full list of White Plains Hospital’s accreditations and awards can be found here.

About White Plains Hospital  

White Plains Hospital is a proud member of the Montefiore Health System, serving as its tertiary hub of advanced care in the Hudson Valley. The Hospital is a 292-bed not-for-profit health care organization with the primary mission of providing exceptional acute and preventive medical care to all people who live in, work in or visit Westchester County and its surrounding areas. White Plains Hospital has outpatient medical facilities across Westchester, including multispecialty practices in Armonk, Hawthorne, Larchmont, New Rochelle, Rye Brook, Somers, Yonkers and Yorktown Heights; and Scarsdale Medical Group locations in Harrison and Scarsdale.

The Hospital is fully accredited by the Joint Commission and in 2023, White Plains Hospital received another 5-star rating from the Centers for Medicare and Medicaid Services (CMS) – the highest distinction offered by that federal agency for the second consecutive year. In addition, the Hospital received its third Magnet® designation from the American Nurses Credentialing Center (ANCC), a distinction held by only two percent of hospitals in the country. In 2023, White Plains Hospital was awarded an “A” Safety Grade from the Leapfrog Group for the 10th consecutive time.

https://www.wphospital.org/

Rotator Cuff Repair: Recovery Can Be the Biggest Challenge

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Hear the phrase “rotator cuff repair” and you may think of professional athletes who have gone through the procedure. But anyone can be at risk for the condition, according to Dr. Gregg Cavaliere, a board-certified Orthopedic Surgeon and Sports Medicine physician at White Plains Hospital Physician Associates, practicing in Hawthorne and Yonkers.

“Anyone whose work involves repetitive overhand activities, like athletes in certain sports, carpenters, and electricians” can be particularly susceptible to a rotator cuff tear, he says. Even Today weatherman Al Roker underwent a rotator cuff repair on his left shoulder in 2014.

The main cause of a rotator cuff tear is injury, but in Roker’s case the trouble was caused by advancing osteoarthritis; as with many body parts, erosion can take its toll over time. In fact, rotator cuff tears are most common in people older than 60.

The rotator cuff is a group of four muscles and four tendons that hold the shoulder joint in place, allowing you to move your arm and shoulder. The “tear” in question is usually one of the tendons. Symptoms can include recurring pain at that site – sometimes so severe that sleep is difficult; a limited capacity for moving the affected arm; “cracking” sounds when moving the arm; and muscle weakness.

Dr. Greg Cavaliere

Such symptoms do not always set off alarm bells for the person experiencing them, however. “There will always be people who just take some more Advil and just hope the pain goes away,” says Dr. Cavaliere’s WPHPA colleague Dr. Anthony Maddalo, also a board-certified orthopedic surgeon. “Sometimes they live with the pain for years.”

The two surgeons have worked together for about 30 years, assisting each other with major procedures; they estimate they have done “thousands” of rotator cuff repair surgeries during that time, to the point where “we’re like a right hand and left hand working together,” Dr. Maddalo says. “That helps us do the procedures most efficiently and expeditiously.” Typically that means between 60 and 75 minutes for Drs. Maddalo and Cavaliere.

The majority of the procedures are shoulder arthroscopies, minimally invasive operations that involve inserting a small camera, or arthroscope, into the shoulder joint. The resulting images are displayed on a video monitor and are used to guide the miniature surgical instruments being used. Because of this, incisions are relatively small, certainly in comparison to open rotator cuff repairs, which involve incisions that are typically several inches long – more invasive and time-consuming, and usually requiring a longer recovery time.

There are two ways of conducting the surgery: the patient either lies down on their “good” side or is in a seated position. “We like the seated option,” says Dr. Maddalo, “because that allows us more easily to address any other issues we may discover when we go in.”

The surgeons recommend their patients, now with stitches and wearing a sling, avoid physical activity involving the affected shoulder for two weeks, followed by “passive motion” therapy for another two weeks; that involves a therapist or an assistant at home putting the arm through a comfortable range of motion while the patient is lying down.

Dr. Anthony Maddalo

“One of the biggest sticking points is educating patients on what ‘passive motion’ is,” Dr. Maddalo says. “They’ll come into the office for a follow-up and use both arms to push themselves out of a chair – exactly what they should not be doing, but it’s habitual and they don’t think about it. They also need to be careful about starting to drive again. If the surgery was on their right shoulder, they’ll need to use their left hand to put the car in gear.”

At the six-week mark, the sling and passive motion therapy are usually discontinued in favor of active assisted range of motion exercises, such as the patient lifting their arms above their head without help from a therapist in order to stretch the muscles used during a routine motion. Strengthening exercises then begin 10-12 weeks after the procedure; all told, Dr. Cavaliere says, full recovery usually takes four to six months, depending on the severity of the tear.

The key to all of this, the physicians say, is to not ignore the pain. “Everyone is different,” Dr. Maddalo says, “and everyone has a different tolerance level of pain. A sudden injury is one thing, but if they’ve been having chronic pain in their shoulder for a long time, they really do need to see a specialist. There’s no reason to keep experiencing that pain when there are many options available.”

Dr. Gregg Cavaliere and Dr. Anthony Maddalo are orthopedic surgeons at White Plains Hospital Physician Associates in Hawthorne and Yonkers. To make an appointment, call 914-631-7777 (Hawthorne) or 914-375-7777 (Yonkers).