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1 phelps News Today fall 2013 from Phelps Memorial Hospital Center Having a Baby? Know Your Choices Why Women Should Know About Interventional Radiology Seeing Clearly After Cataract Removal Certified Nurse Midwife Judy McCarthy-Dalton and obstetrical Registered Nurse Dorit Michelson provide care and support to mother-to-be Ana Tello Nunez. Get better. Here.

2 Dear Friends, We hope that you enjoyed your summer, despite the heat waves! Patients and visitors at Phelps certainly appreciated the spa-like presentation of cool lemon- and cucumber-infused waters that our Hospitality Department offered each day in the main lobby. As hospitals and physician practices nation-wide confront ever greater challenges during this time of transition in the healthcare arena, Phelps continues to build its multi-specialty medical group Phelps Medical Associates which provides stability for both the hospital and the group s physicians. On July 1, the group welcomed three long-tenured Phelps cardiologists Arthur Fass, MD, Franklin Zimmerman, MD, and Dina Katz, MD. Their practice is now known as Phelps Cardiology in Briarcliff. We are delighted to strengthen our relationship with this exceptional group of physicians. Also ensuring the stability of the hospital is the fact that our employees consider Phelps a wonderful place to work, which was validated by a recent employee satisfaction survey. The survey was conducted by Press Ganey, a recognized leader in performance improvement, which partners with more than 10,000 healthcare organizations worldwide, including 50% of all U.S. hospitals. There was statistically significant improvement in 35 out of 49 categories compared to our 2010 survey. Of the more than 1,600 individuals employed at Phelps, 71% participated in the survey 14% more than in 2010 and well above the Press Ganey average of 65%. In comparison to peer hospitals in New York State, Phelps ranked in the 99th percentile for overall employee satisfaction and in the 96th percentile among its peers in our American Hospital Association region. Our employees expressed a sense of pride in being part of the Phelps Family and special appreciation for communication with managers, involvement in decision-making, and being respected and recognized for their work. Employee satisfaction is important because it not only reduces turnover, but studies have shown that hospitals with higher levels of employee satisfaction provide better experiences for patients. Consistent increases in Phelps patient satisfaction scores confirm that this is the case at Phelps. Physician partnerships and employee satisfaction are just two examples of how we strive to make each patient s experience the best it can be while protecting the viability of our hospital. We wish you a healthy and enjoyable fall season. Sincerely, Richard J. Sinni Chair, Board of Directors Keith F. Safian, FACHE President & CEO

3 Having a Baby? Know Your Choices Dental Care: An Essential Component of a Healthy Pregnancy Why Women Should Know About Interventional Radiology Seeing Clearly After Cataract Removal Seven from Heaven: Community Leaders Who Champion Blood Drives Healthy Life Calendar Contents Phelps Medical Associates News The Vitality Initiative Ver con claridad después de la remoción de cataratas Tener un bebé Conozca sus opciones Phelps Locations in the Community Programs & Services Request Your Appointment Online! Appointments for many of Phelps outpatient services can be made on the hospital s website, including: cardiovascular, diabetes, hyperbaric, infusion, nutrition counseling, occupational and physical therapy, pain center, pulmonary/ respiratory, radiology/x-ray, senior services, sleep, speech & hearing, voice & swallowing, and wound healing. You can even make an appointment to donate blood online. Just go to and click on Request an Appointment any time of the day or night! phelps today Editor Mary Sernatinger Managing Editor Tina Dorfman Medical Editor Bruce Heckman, MD, MPH Editorial Advisors Lucy C. Engelhardt, RN Leonard B. Fogel Kenneth C. Kaplan, MD Mary McDermott, RN Keith F. Safian, FACHE PHELPS TODAY is a publication of Phelps Memorial Hospital Center, a 238-bed, notfor-profit acute care community hospital located in Sleepy Hollow, NY. Phelps has been providing medical and mental health services to Westchester and surrounding communities since If you would like to be removed from the Phelps Today mailing list, please call (914) or Visit us on Facebook: PhelpsMemorialHospitalCenter Visit us on Twitter: #!/phelpshospital

4 Having a Baby? Know Your Choices One hundred years ago, more than half of births in the U.S. took place at home under the care of a midwife. Today, most babies are born in a hospital, where emergency care can be provided if necessary. Many women have imagined what it would be like to have a baby, but when they actually become pregnant, they realize they have many questions. Who should provide my prenatal care? Where should I have my baby? What is a natural birth and is that what I want? Is laboring in water beneficial? Who should be with me when my baby is born? What about a doula? Should I breastfeed my baby? Prenatal Care Obstetrician or Midwife? Both obstetricians and midwives provide care during pregnancy, labor and birth. Obstetricians (OBs) are medical doctors who have specialized education in the female reproductive system and surgical care. In addition to managing routine pregnancies, OBs are best able to oversee high-risk or complicated pregnancies. Women who have had previous complicated pregnancies generally choose an obstetrician for their care. Certified Nurse Midwives (CNMs) have a nursing degree and additional training in midwifery. Midwives usually limit their care to women with low-risk pregnancies. If a midwife s patient ends up having a complicated birth, an obstetrician can be called in for assistance. Midwives are known for offering care that is flexible and individualized, and they use as little medical intervention as possible, based on each patient s needs. Where to Give Birth One hundred years ago, more than half of births in the U.S. took place at home under the care of a midwife. Today, most 4 Phelps Today

5 babies are born in a hospital, where emergency care can be provided if necessary. Both obstetricians and midwives can attend hospital births. Giving birth in a hospital is considered safer because even in a healthy woman with an uncomplicated pregnancy, there is always the possibility that an unanticipated event or emergency could occur. Childbirth Natural or with Intervention? The term natural childbirth refers to a birth in which medical intervention is minimized, drugs and anesthesia are only used minimally, and the mother has learned how to use relaxation and breathing techniques to control pain and ease delivery. Even if a natural birth is planned, it is possible that during the course of labor and delivery some interventions may be necessary for health and safety reasons or because the mother desires. Some Types of Interventions Electronic Fetal Monitoring (EFM) is widely used to evaluate uterine contractions and the baby s response to contractions. Intermittent rather than continuous monitoring allows the mother to move and change positions more easily. Induction is an artificial way to start labor. Labor is induced if there is a clear medical reason, such as: the mother has gone past her due date or developed high blood pressure, the amount of amniotic fluid around the baby has become inadequate, or tests show that the baby has stopped growing at an expected rate. The cervix needs to soften and dilate to allow the baby to pass out of the uterus. If the cervix is firm, an oral medication or a medication in the vagina may be administered to help prepare the cervix for labor. Pitocin, an intravenous synthetic hormone, may be given to stimulate contractions, gradually increase their frequency and cause changes in the cervix. Pain Medications. In the early stages of labor, a woman can sometimes control her pain with relaxation exercises, breathing techniques and by frequently changing position. As contractions increase in intensity and frequency, many women choose to have pain medication administered. This can be accomplished through injection, intravenous administration or epidural and spinal blocks, which provide pain relief to the lower body without significantly slowing labor. Episiotomy is a surgical cut to the perineum and the muscle beneath it during the pushing stage to make delivery of the baby easier and avoid vaginal tearing. Episiotomies used to be done routinely, but now they are performed only rarely when the baby is in an abnormal position or needs to be delivered quickly, or if extensive vaginal tearing seems likely. Cesarean birth is major surgery that allows the baby to be removed through incisions in the abdomen and uterus. A Cesarean section is performed when the baby appears to be too large to deliver through the birth canal, if labor is not progressing, when changes in the fetal heart rate indicate a need for urgent delivery, or because the patient had previously delivered a baby by Cesarean. These days, breech presentations are also delivered by Cesarean. What is a doula? A birth doula is a woman who provides physical and emotional support during labor and delivery and just after the baby is born, following the old tradition of women being surrounded by other women during childbirth. Does water help during labor and delivery? Warm water is comforting and relaxing, and its buoyancy allows the mother free Chanel Garland, in a labor tub, rests between contractions as Garrard Hunte offers encouragement. movement to reposition herself during labor. Warm water promotes more efficient uterine contractions and reduces pain sensations. Some women stay in the labor tub during labor and get out when they are ready to deliver their baby, while others choose to give birth in the water, provided that their midwife or obstetrician agrees. Should I breastfeed my baby? The National Institute of Child Health and Human Development recommends that women should try to feed their babies breast milk for at least the first six months of life. Breast milk contains a balance of nutrients that is especially suited for helping your infant to grow, and it also helps protect your baby against illnesses and infections. Studies have shown that certain types of cancers occur less frequently in women who breastfeed their babies. Having Your Baby at Phelps Women travel long distances to have their babies at Phelps. Why? Planning the Birth Phelps obstetricians and midwives encourage their patients to discuss their preferences early in pregnancy. We want to know what our patients hopes are with regard to the many choices from natural childbirth and doulas to birthing methods, says obstetrician Sarina DiStefano, MD, and we will do whatever we can to fulfill their desires while ensuring safety for both mother and baby. The OBs, midwives, and nurses are dedicated to providing a family-centered birth experience. Flexibility When feasible, Phelps offers flexibility as to how the birth takes place, says midwife Kathy Herron, CNM, of Full Circle Women s Health. Patients want their birth preferences to be honored whenever they can be. For many, that means as few interventions as possible, allowing labor and birth to unfold naturally, at its own pace. For others, that means knowing they can choose pain medication if Phelps Today 5

6 to choose, including LaMaze childbirth, breastfeeding, baby care, sibling preparation, and Totsaver CPR classes. There are also special classes for adoptive parents. See page 7 for the list of classes. they want. At Phelps, patients receive respect and support for the choices they make for themselves and their baby always with the well-being of mother and baby as the top priority. Lowest C-Section Rate in Westchester Some women choose a hospital based on its rates of interventions, especially Cesarean sections. And that brings them to Phelps, because according to NYS Department of Health statistics, there are fewer Cesarean sections performed at Phelps than at any other hospital in Westchester. Phelps obstetricians perform C-sections only when necessary, such as when there is an abnormality or fetal distress, says obstetrician Lawrence Mendelowitz, MD, Director of Obstetrics/ Gynecology. We are often able to rectify some situations to avoid C-sections. For example, if the baby is in breech position, with his head up and feet down, attempts can be made to turn him. And even women who have previously had a C-section may be able to have a vaginal delivery in some cases. Exceptional Nurses The nurses are extraordinary, as noted by Debra Turner, whose son was delivered at Phelps last year: Being a first-time mother, I was extremely anxious but was quickly put at ease by the nurses. Once my son was born, the staff was amazing. I am sincerely grateful to all the maternity nurses and staff for their professionalism and kindness. It is rare to find people who go above and beyond... but I did find this during my stay at Phelps. Breastfeeding Support Mothers who give birth at Phelps are exceptionally successful at breastfeeding, thanks to the extraordinary encouragement from maternity staff and support from lactation consultants. Virginia Moore, lactation consultant, says, Everyone believes strongly in the benefits of breastfeeding, so the support new mothers get comes not only from the lactation consultants but from the entire Maternal- Child staff. As part of our commitment to successful breastfeeding, all breastfeeding mothers are welcomed back for a complimentary post-partum lactation consultation. Phelps was recognized by the New York State Department of Health as one of the top 10 hospitals in the state whose new mothers exclusively breastfeed their babies. In addition, Phelps operates a breast milk bank under guidelines set by the Human Milk Bank Association of North America, making it possible for donor breast milk to be prescribed when a baby needs supplemental nutrition. Education Phelps offers expectant parents a variety of educational programs from which Lawrence Mendelowitz, MD, is board certified in Obstetrics & Gynecology. He is director of the Phelps Department of Obstetrics & Gynecology. Dr. Mendelowitz earned his medical degree at New York University School of Medicine and completed a residency in Obstetrics & Gynecology at Bellevue Hospital Center. Sarina DiStefano, MD, is board certified in Obstetrics & Gynecology. She received her medical degree from New York Medical College and completed a residency in Obstetrics and Gynecology at Bellevue Hospital Center. Dr. Mendelowitz and Dr. DiStefano are members of Sleepy Hollow Medical Group along with Dr. Vanessa Dinnall and Dr. Karina Zhuravleva. The practice is located on the Phelps campus in the 755 building. ( ) 6 Phelps Today

7 Maternity & Baby Care Classes The Childbirth Experience/ LaMaze Method Wednesday evenings 7:30 9:30 pm for 5-6 weeks Start dates: September 11 or October 23 OR two-day weekend session, 10 am 3 pm: September 14-15, October 12-13, November 9-10, December Cost: $170 per couple Breastfeeding: First Choice for Babies September 30, November 4, December pm Cost: $45 per couple ABCs of Baby Care September 26, October 8 or 24, November 7 or 18, December 5 or 16 6 pm Cost: $65 per couple Big Brother/Big Sister: Sibling Preparation September 21, November 16 10:30 am $20 per child Totsaver Program: American Heart Association CPR for Family and Friends October 5, November 2, December 7 9 am $55 per person For up-to-date schedule, visit or call (914) for information or to register. Prenatal Clinic: Phelps Memorial Hospital Center and Open Door Family Medical Center, participants in the Medicaid Prenatal Care Assistance Program, jointly sponsor a Prenatal Program. Care for expectant mothers is provided by a highly trained, caring, bilingual staff. No one is turned away based on income or health insurance. Women are encouraged to seek prenatal care early in their pregnancy. Care is provided at Open Door during the first 36 weeks of pregnancy and at Phelps Memorial Hospital during the remainder of the pregnancy and for delivery. For information, call: (914) Atención Prenatal: Phelps Memorial Hospital Center en Sleepy Hollow y Open Door Family Medical Center, participantes en el Programa de Asistencia de Atención Prenatal de Medicaid, auspician conjuntamente un Programa Prenatal. La atención de mujeres embarazadas es provista por un personal bilingüe y solidario, altamente capacitado. No se rechaza a nadie basándose en sus ingresos económicos o seguro. Se alienta a las mujeres a recibir atención prenatal lo más temprano posible durante su embarazo. La atención es provista en Open Door durante las primeras 36 semanas del embarazo y en Phelps Memorial Hospital durante el resto del embarazo y el parto. Para mayor información, sírvase llamar al: (914) Phelps Today 7

8 Dental Care: An Essential Component of a Healthy Pregnancy While most would agree that, ideally, women should attend to all their oral health needs before even thinking about becoming pregnant, not everyone has the foresight to do so. By Janet Bozzone, DMD, MPH, FAGD; Rosa Martinez, DDS; and Joseph Morales, DDS, FACD The year was The dental patient who Dr. Morales was seeing was visibly upset. When he asked what was wrong, she explained that her sister had suffered a seizure two weeks earlier and fractured her front teeth. The sister had been seen in an emergency room and was referred to an oral surgeon and endodontist for care, but she had not been able to find a dentist willing to treat her. The reason? It was not because she was uninsured, uncooperative, or unwilling to pay for care (she did not fall into any of those categories), but because she was pregnant. With tears in her eyes, Dr. Morales patient asked if he would be willing to see her sister. His response was an unequivocal. Of course! Her sister came in the following day. She had multiple broken teeth, dental abscesses caused by a bacterial infection and an untreated fracture of her upper jaw. She was in excruciating pain, and it was obvious to Dr. Morales that the infection was certainly a greater risk to her pregnancy than his providing the dental care that she needed. He began on a mission advocating for the appropriate treatment of women, even if they are expecting a child. New York Leads the Way Promoting Dental Care for Pregnant Women Twenty years would pass before New York became the first state in the nation to issue guidelines encouraging the delivery of necessary dental care to prenatal women, prompted in part by yet another tragedy. In this instance, a young pregnant woman who had been unable to access dental care along the New York/ Pennsylvania border had overdosed on acetaminophen, resulting in the death of her baby due to liver toxicity. This woman spent several weeks recovering in the hospital and came very close to needing a liver transplant herself. Several states have followed suit, issuing their own set of guidelines, and in 2012 a statement was released called Oral Health Care During Pregnancy: A National Consensus Statement. Developed by the Health Resources and Services Administration (of the U.S. Department of Health and Human Services) in collaboration with the American Dental Association and the American College of Obstetrics and Gynecologists, the statement hopes to provide guidance to everyone involved in the care of prenatal women. It asserts that Oral health care, including the use of X-rays, pain medication, and local anesthesia, is safe throughout pregnancy. These universal standards for healthcare providers help ensure that women will not miss having an oral examination, dental prophylaxis or emergency dental care while pregnant. Dental Care During the Second Trimester Is Best While most would agree that, ideally, women should attend to all their oral health needs before even thinking about becoming pregnant, not everyone has the foresight to do so. Many women delay coming to the dentist while they are pregnant because they incorrectly believe that having dental treatment or X-rays poses a risk. As a result, they wait until they have more serious problems that require urgent or emergency treatment such as extractions, root canals and periodontal care. To avoid reaching this point, oral evaluations are recommended as early in a pregnancy as possible to help ensure that all necessary care is completed before the last six weeks of pregnancy. 8 Phelps Today

9 Ideally, dental care should be scheduled during the second trimester (months 4-6) because most pregnant women are better able to tolerate dental procedures during that time they are usually past the morning sickness period, and have not yet gained the additional weight that might make sitting in a dental chair uncomfortable. Why Dental Care During Pregnancy Is Important It is estimated that more than 75% of pregnant women experience bleeding of the gums or periodontal problems during their pregnancy. Studies examining whether oral health can reduce the incidence of low-birth-weight or preterm birth have been contradictory, but it has been shown that there may be a relationship between stillbirths and periodontal disease bacteria. While it may not yet be possible to prove scientifically that a causal relationship exists, one thing is certain: women, their families, and all of their healthcare providers can be assured that dental care is not only safe during the prenatal period, it is an essential component of a healthy pregnancy. For more information about guidelines for oral healthcare during pregnancy, visit the following websites: Oral Health Care During Pregnancy and Early Childhood Practice Guidelines (NYSDOH August 2006) publications/ 0824.pdf Oral Health Care During Pregnancy: A National Consensus Statement (2012) mchoralhealth. org/pdfs/oral HealthPregnancyConsensus.pdf The authors play important roles in the New York Medical College-sponsored general dental practice residency program, which was established in 2012 at Phelps and Open Door Family Medical Center in Port Chester: Joseph Morales, D.D.S., F.A.C.D. (residency program liaison) is a graduate of Columbia University College of Dental Medicine and has over 32 years of professional experience, with 25 years dedicated to academic dental medicine. He is Professor and Chairman of the Department of Dental Medicine at NYMC s School of Medicine and a fellow in the New York Academy of Dentistry and the American College of Dentists. Janet Bozzone, D.M.D., M.P.H., F.A.G.D. (residency program site director) has over 30 years of experience in com- munity-based dental programs for the underserved in New York. Dr. Bozzone received her Doctor of Dental Medicine from Fairleigh Dickenson University, School of Dentistry, and a Master of Public Health from the University of North Carolina Chapel Hill. A Fellow in the Academy of General Dentistry, she is Director of Dentistry at Open Door and a faculty member of NYMC s Department of Dental Medicine. Rosa Martinez, D.D.S. (residency program director) received her doctorate in dental surgery from Columbia University College of Dental Medicine and has over 26 years of professional involvement in graduate dental education and hospital dental services. She is Assistant Professor of Clinical Dental Medicine at NYMC. The Dental Residency Program at Phelps In 2012, Phelps and Open Door Family Medical Center in Port Chester became primary clinical training sites for the New York Medical College General Dental Practice Residency Program. Each year a group of four dental residents undergo a one-year training program, with a second-year option, seeing outpatients at Open Door and treating patients in Phelps Emergency Department, operating room and inpatient rooms. At Phelps, under the supervision of attending faculty staff of dentists and physicians, they also perform elective surgeries for patients with special needs or children who cannot be treated in an outpatient office. Pictured here are dental residents Benjamin Geisler, DMD; Christiane Getaz, DDS; Jeannine Holz, DDS; and Roselin Reiss, DMD. Phelps Today 9

10 Why Women Should Know About Interventional Radiology The field of interventional radiology encompasses a variety of minimally invasive procedures that use imaging modalities such as X-rays, CT, and ultrasound to provide guidance for treatment of a disease. During the procedures, tiny catheters and miniature instruments are threaded through the body s network of arteries, veins or other tubular structures, allowing physicians to perform a variety of complex diagnostic and treatment procedures related to virtually all parts of the body. The procedures are performed by interventional radiologists, board-certified physicians with advanced training in diagnostic radiology, followed by additional training in vascular and interventional procedures. Interventional radiology techniques are used to treat many conditions that once required an operation. It starts with a needle and ends with a bandaid, says interventional radiologist Marc Hamet, MD. Patients benefit from lower risk, less pain and a quicker recovery than with open surgery. They also enjoy an improved quality of life. The procedures are generally performed on an outpatient basis, so hospitalization is not required. Why Women Should Know About Interventional Radiology Although interventional radiology procedures are commonly used to treat conditions in both sexes, a number of procedures are for medical conditions that occur solely or predominantly in women. They include: uterine fibroids, pelvic congestion syndrome, varicose veins, and spine fractures resulting from osteoporosis. Uterine Fibroid Embolization Uterine fibroids are smooth-muscle, noncancerous tumors that develop in the uterus. Eighty percent of women develop fibroids, but only about 25 percent experience symptoms. Uterine fibroids may cause severe menstrual cramping, abdominal swelling, and excessive bleeding, which can lead to anemia and even a need for emergency surgery. A uterus with fibroids may push on the bladder and cause more frequent urination. It may also create pressure on the colon or the back. One of the major reasons for hysterectomy is the presence of symptomatic uterine fibroids. Fibroids cannot exist without an adequate supply of blood. To ensure their continued growth, fibroids stimulate the formation of new blood vessels that bring in additional blood. The goal of the interventional radiology procedure known as uterine fibroid embolization is to cut off the blood supply. The procedure involves the insertion of a thin, flexible catheter through the femoral artery in the groin to deliver PVA (polyvinyl alcohol) particles into the blood vessels that supply the fibroids. The interventional radiologist performs the embolization while viewing the blood vessels using X-rays with the aid of contrast, or X-ray dye. Blocking the arteries that feed fibroids and filling them with particles eliminates the source of blood, which starves the fibroids and causes them to shrink and disappear. With this technique, all of the fibroids present are treated simultaneously. Pelvic Congestion Syndrome The condition known as pelvic congestion syndrome (PCS) is complex and is often misdiagnosed. When other causes of pelvic pain have been ruled out by specialists such as OB/GYNs, gastroenterologists and urologists, an interventional radiologist is often consulted for further evaluation and treatment. The syndrome, which primarily affects pre-menopausal women, comes about when reflux occurs in the left gonadal vein (the blood vessel that carries blood away from the ovary toward the heart), causing blood to back up into the pelvis. This reflux results in hemorrhoids or varicose veins in the thighs, buttocks or vaginal area. A woman with pelvic congestion syndrome can experience severe dull, aching pain from ovarian and pelvic varicose veins, much like the leg pain Dr. Marc Hamet uses a combination of ultrasound and fluoroscopy to place a catheter, demonstrating the first step in an interventional radiology procedure. 10 Phelps Today

11 associated with lower-extremity varicose veins. This chronic pain is worse when sitting or standing, and makes it painful to ride a bike and uncomfortable to walk. A CT scan with contrast is done to diagnose pelvic congestion syndrome. To treat pelvic congestion syndrome, the interventional radiologist inserts a thin catheter into the femoral vein at the top of the right leg and guides it into the affected gonadal vein using imaging for guidance. To seal the faulty, enlarged vein, the interventional radiologist blocks it off by placing tiny mechanical devices at the bottom and top of the vein and injects a solution in the area between the two blocking devices, thus eliminating the varicosity and reducing the associated painful pressure. Pelvic congestion syndrome in women is the same as a condition called varicocele in men, which can be treated in exactly the same way. Varicose Veins Veins have one-way valves that are supposed to keep blood flowing from the legs up toward the heart. If a valve stops working correctly, reflux occurs the blood goes in two directions. With every movement, the veins squeeze, the blood goes up and comes right back down. As a result, blood collects in the vein, pressure builds, and the vein becomes weak and enlarged. This varicose vein appears twisted and bulging near the surface of the skin, most commonly on the legs or feet. Age, pregnancy, being overweight or working at a job that requires standing for long periods all contribute to the development of varicose veins. Women are more likely than men to have varicose veins, and the condition tends to run in families. Other than their dark purple/blue or bulging appearance, varicose veins often do not have any symptoms. Sometimes they cause an achy or heavy feeling in the legs or a burning and throbbing sensation. Injury to the vessels can cause excessive bleeding. Painful clots may develop which sometimes become infected, a condition called thrombophlebitis. In severe circumstances, skin breakdown (venous stasis ulcers) or severe infections of the toes and feet may occur. To treat varicose veins, the interventional radiologist uses ultrasound and X-ray as a guide to insert a tube into the vein that Interventional radiologists are trained to do diagnostic studies in addition to interventional procedures. Here, Dr. Hamet dictates a report on the results of a diagnostic study. isn t functioning properly. A laser is guided through the tube and used to destroy the vein. This breaks the reflux cycle and allows the blood to go where it is supposed to go. Destroying the vein doesn t affect circulation because there are other veins located deeper in the leg that take care of larger volumes of blood. Osteoporosis and Spine fractures People with osteoporosis often experience back pain that is caused by spinal fractures, also called vertebral compression fractures. Women over 50 are at the greatest risk for these fractures, and by age 80, 40 percent of women will have one. In addition to back pain, symptoms of spinal fracture include loss of height and deformity of the spine. A nonsurgical treatment for spinal fracture called vertebroplasty can be performed by an interventional radiologist. During the procedure, the physician uses imaging guidance to inject strengthening material into the bone that has collapsed. The treatment reduces pain, restores the bone s strength and helps to prevent further collapse of the vertebra. Evaluation prior to the procedure involves an MRI of the spine. Sometimes areas of abnormal bone are found, which may be treated prior to collapse, thus preventing curving of the spine. Marc Hamet, MD, interventional radiologist, is board certified in radiology, neuroradiology and vascular and interventional radiology. He received his medical degree from the University of Maryland Medical System, where he completed a residency in diagnostic radiology, followed by fellowship training in vascular and interventional radiology at Johns Hopkins Hospital. He is an assistant clinical professor of radiology at Columbia University. Dr. Hamet can be reached at Phelps Today 11

12 Seeing Clearly After Cataract Removal A cataract is the clouding of the lens of the eye, which is located behind the pupil and is surrounded by a thin, clear capsule. There are many causes of vision loss in older adults glaucoma, macular degeneration, diabetic retinopathy but one of the most common and easiest to treat is the cataract. About 90 percent of people over the age of 65 have a cataract. What Is a Cataract? A cataract is the clouding of the lens of the eye, which is located behind the pupil and is surrounded by a thin, clear capsule. The lens is clear at birth, but the eventual breakdown and clumping together of protein that is contained inside the lens causes the formation of cataracts. The lens, along with the cornea (the clear surface covering the front of the eye), focuses incoming light onto the retina, the area in the back of the eye that transmits images to the brain. For the retina to receive a sharp image, the lens must be clear. If it is cloudy, the incoming light is scattered as it passes through, and the image is blurry. Some of the factors that increase your risk of cataracts are: Age Diabetes Obesity Smoking High blood pressure Family history Excessive alcohol consumption Excessive exposure to sunlight Exposure to ionizing radiation (such as radiation used in X-rays and cancer radiation therapy) Previous eye surgery, injury or inflammation Prolonged use of corticosteroid medications Symptoms of a Cataract Some of the most common symptoms of a cataract are: cloudy or blurry vision; colors appearing faded or yellowish; the appearance of halos around headlights, 12 Phelps Today

13 Dr. Jean Tostanoski verifying calculations for LenSx Laser treatment. hospital in the Hudson Valley to offer cataract surgery using the LenSx Laser. The laser captures extremely precise, high-resolution images of the eyes, which are used to plan and perform surgery to exact, individual specifications not attainable with traditional cataract surgery. In addition to creating more precise incisions, LenSx also reduces the amount of ultrasound time needed to dissolve the cataract, thereby lessening the possibility of damage to the cornea. Most patients are candidates for the LenSx procedure. Exceptions include those with small pupils, certain corneal diseases and some forms of glaucoma. If you have a cataract that needs to be removed, your surgeon will be able to recommend the procedure that is best for you. lamps or sunlight; poor night vision, especially while driving; double vision in one eye; and frequent changes in prescription for eyeglasses or contact lenses. If you have any of these symptoms, check with your eye care professional. What Should I Do If I Have a Cataract? Just because you have a cataract doesn t mean it has to be removed immediately. Many people have small, age-related cataracts in their 40s and 50s, but the cataracts do not significantly affect their vision. In many instances, vision in these individuals can be improved with eyeglasses, brighter lighting or magnifying lenses. However, age-related cataracts grow slowly over time. When cataracts progress to the point where they cause vision loss that interferes with everyday activities, cataract surgery is the only effective treatment. In most cases, delaying surgery will not cause long-term damage to the eye. Cataract surgery, which involves removing the cloudy lens and replacing it with an artificial one, is one of the most common, safe and effective operations performed in the U.S. Approximately 90% of individuals who have had the surgery report better vision afterward. Traditional Cataract Surgery During traditional cataract surgery, the surgeon makes a very small incision in the cornea using a hand-held metal or diamond blade and inserts a tiny, highfrequency ultrasound device to break down the cataract while a miniature suction device removes the broken-down lens. This process is called phacoemulsification. A new artificial lens, called an intraocular lens, is then put it its place. Intraocular lenses, which are made of acrylic, silicone or polymethylmethacrylate material, are permanent and need no maintenance. They can also be removed, if necessary. Cataract surgery is an outpatient procedure that takes about 15 minutes and is performed under local anesthesia. Most patients are able to return to normal activities within hours, and full recovery can be expected in approximately two weeks. Laser Cataract Surgery Another type of cataract removal that is now available uses a technologically advanced option called the LenSx Laser. This image-guided laser performs several of the most difficult steps of cataract surgery, eliminating the need for a manual scalpel. Phelps recently became the first Jean Tostanoski, MD, is chief of ophthalmology at Phelps Memorial Hospital Center. Board certified in ophthalmology, she received her medical degree from Albert Einstein College of Medicine. She completed an internship in medicine at Norwalk Hospital, followed by a residency in ophthalmology at Bronx-Lebanon Hospital Center and a fellowship in ophthalmology at the Manhattan Eye, Ear & Throat Hospital. Her private practice, Hudson Valley Eye Associates, is at 24 Saw Mill River Road in Hawthorne, Phelps Today 13

14 Seven from Heaven: Community Leaders Who Champion Blood Drives By Marty Ketels, Phelps Blood Donor Recruiter I recently interviewed seven community leaders who have been instrumental in making many of Phelps off-site blood drives successful. They spoke so eloquently and with such near-angelic fervor about the importance of blood donation that I ve described them here as the Seven from Heaven. A local chamber of commerce breakfast crowd erupted into laughter when a participant announced that It s much easier to get people to donate money than to donate blood. The speaker, JoAnne Murray, who is president of the Allan Block Insurance Agency in Tarrytown, had been planning a Phelps blood drive with Sleepy Hollow village administrator Anthony Giaccio, but the sign-up had been going painfully slow. I thought we d have a line waiting, she said, I couldn t believe the excuses I was getting! While she and Giaccio, who arranged to hold the drive at the James Galgano Senior Center in Sleepy Hollow, were eventually able to attract a good many donors, their struggle mirrored national studies that find that only 5% of the public actually donates. JoAnne Murray, Allan M. Block Insurance Agency Getting Community Leaders Involved Faced with the daunting task of providing enough blood for Phelps patients, Carol Stanley, supervisor of Phelps Blood Donor Services, and I re- 14 Phelps Today

15 alize that it s not enough just to hold blood drives; the drives have to be inspired by local community leaders like Murray and Giaccio, who believe that it s their social responsibility to support their local hospital. They are two of the Seven from Heaven who have enabled Phelps to continue to collect more than 100 units month after month to fill the relentless demand for blood. All seven have managed successful blood drive and are blood donors themselves. Gerry Riera, Family YMCA of Tarrytown Kevin Kaye, OnTrack Sport Center Social Responsibility Kevin Kaye, General Manager for On Track Sport Center in Tarrytown, notes that unlike big-money contributors who get so much recognition, all blood donors are on a level playing field. Blood is such a critical commodity, it s always in demand, and donating can make a huge difference where money can t. And everyone who donates is recognized equally. Working with Kaye on setting up drives and recruiting donors, Jenifer Ross, owner of a collaborative office space business for freelancers, located in Tarrytown, makes a similar point. Giving blood, she says, transcends social and cultural differences. Your blood doesn t go just to your socio-economic group it goes to help everyone! The Reverend David Harkness, pastor of the Irvington Presbyterian Church, muses that This is your life blood but you re volunteering it. There s something quite compelling about that. Jim Farrell, director of the Ossining Public Library, puts it succinctly: In half an hour, you can save a life. I don t have a lot of money to donate, says Gerry Riera, Chief Executive of the Family YMCA in Tarrytown, but donating blood doesn t cost me anything. I feel it s a social responsibility for me to donate this valuable asset that I have. And being socially responsible can be empowering, says Ross. You have this internal resource that is endlessly replenishable. It s always there to give and nothing will stop you but fear. Fear When it comes to giving blood, Sleepy Hollow administrator Anthony Giaccio admits, I m kind of a wimp, but I do it and always feel good, like I m accomplishing something. Some people think giving blood is scary. Why not just reach into your wallet instead? But giving blood is tremendously rewarding more than giving a ten dollar bill. Peer pressure and direction from the top of an organization can overcome fear. When they host a drive, Riera and his assistant, Sandra Wingate, donate blood first to show that the Family Y is fully Jenifer Ross, These Seven from Heaven have enabled Phelps to continue to collect more than 100 units month after month to fill the relentless demand for blood. Phelps Today 15

16 behind the effort. They want employees to also feel a responsibility to give. The result? Even if they feel queasy about the process, they go ahead. Murray s message about fear comes with an offer: Anyone who is afraid to give blood, call me. I will tell you that I was fearful for so many years, and you don t have to be. Former Marine Jim Farrell gets a little impatient about fear: Roll up your sleeve, squeeze the ball and go for it! Convenience and Comfort Make a Difference Going for it at the Ossining Public Library, where Jim is the director, can be a transforming experience. Blood drives are held in the beautiful Budarz auditorium where donors literally give blood on the stage, with the windows providing a panoramic, hilltop view of the city. The library is a perfect venue for a blood drive the auditorium is large, comfortable and well lit, and there s plenty of parking for donors. Jim Farrell, Ossining Public Library The same holds true for the venues of our other blood drive hosts. The Family Y in Tarrytown has convenient parking off Main Street, comfortable interior spaces and a membership base of 3,500 potential donors. The James Galgano Senior Center is just a block off Beekman Avenue, and many in the neighborhood are able to walk over to donate. The OnTrack Sport Center. located near the Tarrytown train station, offers a unique venue with indoor soccer fields and batting cages in operation. And at the Irvington Presbyterian Church, on Route 9, the community room in the Knox building functions well, used by a large enough church membership so that it s possible to get the critical mass needed for a drive, Reverend David Harkness says. But our blood drive hosts, like Reverend Harkness and two of his very active deacons, Debbie Crescenzi and Keira Smith, would not offer their ideal venues if they did not have a full appreciation for what their local hospital, Phelps, is doing. The Reverend David Harkness, Irvington Presbyterian Church Phelps and the Business of Donating I think of Phelps as a great neighbor and an asset to the community we re codependent, Giaccio says of Phelps and the Village of Sleepy Hollow. Rev. Harkness adds: Phelps is a dream to work with because their mobile donor services team is efficient, really wonderful. Similarly, Farrell states, Phelps phlebotomists are highly skilled, making donating a good experience. Most organizations want to be part of the community. By connecting with an organization like Phelps, which is so well respected in the community, it helps our business, adds Ross. There is an added benefit: Kaye observes that he and his OnTrack patrons who have donated have become closer. By helping the community together, he and his customers have created a deeper connection. Riera agrees: People who donate blood see beyond their everyday lives and realize that they re really contributing to something that s much larger. Even so, Murray says, We get so busy sometimes that we forget how important donating blood is for people in need. It shouldn t take a tragedy to recognize that. Anthony Giaccio, Village of Sleepy Hollow When tragedy strikes, people can press a button and send money, says Reverend Harkness. This high-tech mindset, he speculates, could lead people to believe that somebody, somewhere has already developed artificial blood and put it on the retail shelf. Nothing could be further from the truth. Recalling the Armed Forces recruitment poster of Uncle Sam pointing, Reverend Harkness says emphatically, The blood has to come from YOU. Editor s note: We encourage our readers to patronize the establishments of these Seven from Heaven and to participate in their future blood drives: Allan M. Block Insurance Agency, 24 South Broadway, Tarrytown, Family YMCA of Tarrytown, 62 Main Street, Tarrytown, Irvington Presbyterian Church, 21 North Broadway, Irvington, OnTrack Sport Center, 29 South Depot Plaza, Tarrytown, Ossining Public Library, 53 Croton Avenue, Ossining, Village of Sleepy Hollow, 28 Beekman Avenue, North Broadway, Tarrytown, Phelps Today

17 Donate Blood at Phelps Give the Gift of Life and Receive a Discount from a Local Business Did you know that every time you donate a unit of blood you can help save up to three lives? Also, each time you donate at Phelps, you ll receive a $15 voucher for a free meal in the Phelps cafeteria and will be invited to choose a discount offer from one of the many generous area businesses listed below. To donate, you must be between 16 and 75 years old and weigh at least 110 pounds. Please give the gift of life. To make an appointment, call A NU Toy Store, Tarrytown The Art Barn, Ossining Atria Senior Living, Ossining Bark & Meow Pet Products, Tarrytown Basilico Pizza, Pasta, Mount Kisco Bella s Boutique, Tarrytown Brasserie Swiss, Ossining Bridge View Tavern, Sleepy Hollow Canfin Gallery, Tarrytown Capri Pizza & Pasta, Ossining Caravela, Tarrytown Carpet Giant, Ossining Casa Rina, Thornwood Chiboust, Tarrytown Choice Pets, Ossining Coffee Labs Roasters, Tarrytown Connections with Elena, Tarrytown Corsi Tire, Ossining Courtyard by Marriott, Tarrytown Doca s Portuguese, Ossining Dominick s Limousine, Sleepy Hollow Doubletree Hotel, Tarrytown Eldorado West Diner, Tarrytown Elite Hair Design, Tarrytown Elmsford Chiropractic, Elmsford Fairview Golf Center, Elmsford Family YMCA, Tarrytown Fantastic Finds Boutique, Tarrytown Geordane s, Irvington Goldfish, Ossining Good Food, Briarcliff Manor Gordo s, Hawthorne Green Valley Nursery, Hawthorne Hair on the Hudson, Tarrytown Heritage Frame, Tarrytown Highland Cleaners, Ossining Hobston Jewelry, Tarrytown Hollywood North Pizza, Sleepy Hollow Horsefeathers, Tarrytown Il Sorriso, Irvington Images Art Gallery, Briarcliff Manor Isabella Bistro, Tarrytown J. P. Doyle s Restaurant, Sleepy Hollow Jacob Burns Film Center, Pleasantville Josephine s Hair Salon, Ossining Kendal on Hudson, Sleepy Hollow King Shell Service Center, Ossining King Shell Service Center, Tarrytown Kittle House, Chappaqua L3 Couture, Briarcliff Manor Landmark Diner, Ossining Main Street Sweets, Tarrytown Mandee, Ossining Manor Wine & Spirits, Briarcliff Manor Mediterraneo, Pleasantville Melita s, Ossining Moon River River Grill, Sleepy Hollow Mr. Nick s Brick Oven Pizza, Tarrytown mysherry&more, Briarcliff Manor NY School of Esthetics, Tarrytown Okinawa, Ossining Old Stone Trattoria, Chappaqua OnTrack, Tarrytown Paese Pasta & Pizza, Briarcliff Manor PHR Electrolysis, Tarrytown Pleasantville Colonial Diner, Pleasantville Pure Mountain Olive Oil, Tarrytown Quirky Consignments, Tarrytown River City Grille, Irvington River View Wine, Tarrytown Rock Island Sound, Tarrytown Santa Fe Restaurant, Tarrytown Sheraton Hotel, Tarrytown South of the Border, Ossining Sparx Hair Salon, Pleasantville SpringHill Suites by Marriott Squire s, Briarcliff Manor Studio A Gallery, Tarrytown Sunset Cove, Tarrytown Tarry Tavern, Tarrytown Tarrytown Floral Designs, Tarrytown Tarrytown Woodworks, Tarrytown Taste of China, Tarrytown Tasty Port Wine, Ossining Terra Rustica, Briarcliff Manor TGI Friday s, Tarrytown The Boathouse, Ossining The Cabin, White Plains The Huddle, Sleepy Hollow The Red Hat, Irvington The Tapp, Tarrytown The Tuscan Grille, Briarcliff Manor The Village Soccer Shop, Tarrytown Tarrytown Thornwood Ale House, Thornwood Threads of Life, Tarrytown Trapp Optical, Tarrytown Ultra Clean Car Wash, Ossining UNO Chicago Grill, Yonkers Warner Library, Tarrytown Westchester Broadway Theatre, Elmsford Westchester Marriott, Tarrytown Wobble Café, Ossining Please patronize these businesses and let them know you appreciate their community-minded support. To learn about donating blood, call (914) Phelps MRI New Expanded Hours: Monday Friday 7 am 9 pm Saturday 8 am 4 pm Our MRI features a 1.5 tesla magnet. A certified technologist helps put patients at ease. Earplugs are provided as well as music, when possible, and there is ongoing contact through a microphone system. The MRI building is conveniently located on the Phelps campus near the Emergency Department entrance, and parking is free. Phelps MRI Building Phelps Today 17

18 10 and 24; November 7 and 21; and December 5 and 19. Bess Steiger, LCSW, Bereavement Coordinator 2 3:30 pm; Hospice Office in the James House Suggested donation: $10 per session. Registration is required. Call (914) or healthy life calendar PHELPS Phelps Farmers Market at the Park Every Thursday from 11 am to 3 pm through November The Phelps Farmers Market at the Park continues through November from 11 am to 3 pm. The market is located at the entrance to the Rockwood Hall area of Rockefeller State Park, at the end of Route 117. Shoppers will find a wide range of farm-fresh fruits and vegetables, farm products such as cheeses, eggs and meats, and prepared food such as baked goods, sandwiches and salads. Vendors will vary from week to week. Call (914) for more information. Bereavement Support Group This ongoing support group for adults struggling with the loss of a loved one meets twice a month on the following dates: September 12 and 26; October Look Good... Feel Better This free, 2-hour workshop teaches beauty techniques to women undergoing cancer treatment to help them manage the appearance-related aspects of their treatment. The program, held monthly at Phelps, includes a hair consultation with a professional stylist and a makeup consultation with a cosmetologist. Attendees can take home a complimentary wig and a make-up kit donated by cosmetic companies. The program is offered in partnership with the American Cancer Society, The National Cosmetology Association, and the Cosmetic, Toiletry and Fragrance Association (CTFA) Foundation. Call (914) or (914) to register for an upcoming session. Prostate Screenings Thursday, September 19, 2013 Jack Hershman, MD, urologist 9 am 12 pm Monday, September 23, 2013 Jack Hershman, MD, urologist 9 am 12 pm 18 Phelps Today

19 Arno Housman, MD, urologist 5 8 pm Monday, September 30, 2013 Arno Housman, MD, urologist 5 8 pm Thursday, October 3, 2013 Jack Hershman, MD, urologist 9 am 12 pm Appointments are required. Call (914) to schedule. Tuesday, September 10, 2013 Better Breathers Club Pulmonary Fibrosis Support Group The Pulmonary Fibrosis Support Group welcomes those with pulmonary fibrosis to learn and share with others. Susan DiFabio, RT, Educational Coordinator for Phelps Pulmonary Rehabilitation Program 12 1 pm; Pulmonary Lab (B Level) Registration is required. Call (914) to register. Wednesday, September 11, 2013 The Breakfast Club The Breakfast Club is a series of free breakfast meetings designed especially for seniors. Each session includes a free breakfast, a presentation on a healthy lifestyle topic and a light exercise program. The group meets monthly, except for August and December. 8:30 10:30 am; Cafeteria (G Level) Call (914) to register. OCTOBER Friday, October 4, 2013 Help for Dizziness and Balance Problems Are symptoms of dizziness or imbalance affecting your life and the activities you participate in? Learn about videonystagmography (VNG) testing, which helps determine the cause of the dizziness, and vestibular rehabilitation, which helps reduce dizziness and balance problems. Sheetal Sheenoy, OTR/L, occupational therapist certified in vestibular rehabilitation Swapna Nataraj, AuD, CCC-A, audiologist 11 am 12 pm; C-Level Classroom Registration is required. Call (914) to register. Saturday, October 5, 2013 CarFit for Older Driver Safety An individualized 20-minute educational session for older drivers, designed to improve the fit of their cars for safety and comfort, promote conversations about safe driving, and link them with local resources to enable them to continue driving for as long as safely possible. The trained CarFit team, Phelps Occupational Therapy Department, will work with older drivers to help ensure a clear line of sight over the steering wheel, proper seat belt use and fit, and safe positioning of mirrors to minimize blind spots. CarFit was created by the American Society of Aging in collaboration with AARP, AAA and the American Occupational Therapy Association. 9 am until noon (rain or shine); Phelps parking garage. Appointments are required. Call (914) to schedule. Tuesday, October 8, 2013 Better Breathers Club The Better Breathers Club is an informal interactive support group for people with breathing disorders. Come and learn about the many free opportunities, information and workshops offered by the American Lung Association for individuals with lung disease. Light refreshments will be served. Serena Arabito, American Lung Association 12-1 pm; Pulmonary Lab (B Level) Registration is required. Call (914) to register. Tuesday, October 8, 2013 Controlling the Pain of Arthritic Knees Without Surgery Orthopedic surgeon J. Robert Seebacher, MD, will discuss a non-surgical therapy that often helps people with arthritic knees maintain active lifestyles while postponing or eliminating the need for surgery. Learn how injections and exercise can enable reconditioning and reduce inflammation and pain. J. Robert Seebacher, MD Medical Director of the Phelps Joint Replacement Service 6:30 pm; Auditorium (light refreshments at 6 pm) Call (914) to register. Wednesday, October 9, 2013 The Role of the Nose in Snoring and Sleep Apnea Learn about the role of nasal congestion in snoring and sleep apnea and the treatment options that are available. Michael Bergstein, MD, otolaryngologist, Surgical Director of the Phelps Sleep Center 7 pm; Auditorium Call (914) to register. Phelps Today 19

20 Thursday, October 10, 2013 The Breakfast Club See listing for September 11, Monday, October 14, 2013 Movement Therapy for Parkinson s Patients The LSVT BIG program is a physical therapy program designed to improve the major motor skills of people with Parkinson s disease by retraining their movements. The exercises, led by LSVT BIG-certified physical therapists, specifically address an increase in motion of the arms and legs, as well as turning of the trunk and walking. The program is designed to increase walking speed, improve balance and enhance quality of life. Leslie Sims, MSPT, LSVT-certified Jennifer Teyfel-Freestone, PT, DPT, GCS, CLT-LANA, CSCS 1 2 pm; Boardroom (C Level) Call (914) to register. Tuesday, October 15, 2013 New Treatment for Asthma Sufferers Learn about bronchial thermoplasty, the only non-drug treatment option available for asthmatics 18 years of age and older who are still symptomatic, despite use of currently available medications. Bronchial thermoplasty has been shown to reduce the severity of asthma attacks, visits to the emergency room, and time lost from work, school and other daily activities. Laurence C. Miller, MD, pulmonologist 6 pm; Auditorium Call (914) to register. Monday and Tuesday, October 21 and 22, 2013 Defensive Driving This two-evening certification program lowers insurance premiums, reduces violation points and sharpens driving skills. Robert Fogel 5:30 8:30 pm; Auditorium Fee: $45 Call (914) to register. Wednesday, October 23, 2013 Stand Up and Be Heard! As we age, our voices age too. Pitch and tone changes can occur. The voice may sound weak, breathy or hoarse. Many alterations of voice that come with age can be addressed to improve one s quality of life. During this interactive workshop, led by an experienced voice therapist, you will learn and perform group vocal exercises that help increase the power and clarity of your voice. You will also learn about how breath support, intonation, loudness, and pronunciation all contribute to a vital and dynamic vocal quality. Leah Ross-Kugler, MS, CCC-SLP, voice rehabilitation specialist Noon 1 pm; C-Level Classroom Registration is required. Call (914) to register. Thursday, October 24, 2013 Speech Therapy for Parkinson s Patients: Think LOUD, Speak LOUD Join graduates of LSVT LOUD and learn about this intensive speech therapy program for individuals with Parkinson s disease. Andrea Bracciante Ely, MS, CCC-SLP, Senior Speech Language Pathologist 10:30 11:30 am; Walkway Conference Room Registration is required. Call (914) to register. Monday, October 28, 2013 Laryngopharyngeal Reflux (LPR) Silent Reflux Screening Changes in the voice, throat clearing, mucus in the throat with discomfort, swallowing problems and chronic cough that does not respond to medications are all symptoms of Laryngopharyngeal Reflux (LPR). In addition, chronic asthma, recurrent sinusitis, dental disease and even cancer can all be caused or exacerbated by LPR. LPR is not GERD. Craig H. Zalvan, MD, laryngologist, Medical Director of the Institute for Voice and Swallowing Disorders at Phelps 8:45 10 am Registration is required. Call (914) to register. Monday, October 28, 2013 Swallow Screening Do you sometimes feel food or liquid going down the wrong pipe? Does food get stuck? Do you have pain when 20 Phelps Today

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